Permit CITY OF TIGARD
PLUMPING PERMIT
%�,, i DEVELOPMENT SERVICES DATE ISSUED: 12/31/98 -0536
PARCEL: 2S1O1BB -00301
SITE ADDRESS...: 11834 SW PACIFIC HWY
SUBDIVISION • TIGARD ROAD GARDENS ZONING: C —G
BLOCK • LOT •001 JURISDICTION: TIG
CLASS OF WORK..:REP GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M FLOOR DRAINS • 0 TRAPS • 0
STORIES • 0 WATER HEATERS 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 100
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Sanitary sewer repair on site only Texaco
Owner: FEES
TEXACO type amount by date recpt
11834 SW PACIFIC HWY PRMT $ 30.00 JSD 12/31/97 97- 302180
TIGARD OR 97223 5PCT $ 1.50 JSD 12/31/97 97- 302180
Phone #:
Contract or
TIMBERLINE DEVELOPMENT CO INC
PO BOX 279
GLADSTONE OR 97027 -0279
Phone #: 656 -8253 $ 31.50 TOTAL
Reg #..: 23225
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspect ion _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 -0001 -0010 through OAR 952 - 0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued By: `�
jI Pe rmittee Signature ��--- .
+ + + + + + ++ + + + + + + + + ++ fr+++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + ++
CITY OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd -- zJ / S
Date to P.E.
TIG`ARD, OR 97223 Date to Ds
(503) 6394171 Permit* - U G
Print or Type Related gWR U
Incomplete or illegible applications will not be accepted Called �-�je
Name of Development/Project On back Indicate Work Performed by fixture. Cam'
Job - rex A C C FIXTURES . (Individual) . QTY PRICE AMT
Address Street Address 141 Suite Sink 9.00
l sw PA j iC Lavatory 9.00
Bl # City/State Tub or Tub /Shower Comb. 9.00
- nc > fr -D
Name �^ , C O I o r Shower Only 9.00
x Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
Garbage Disposal 9.00
City /State fr Z ip Phone Washing Machine 9.00
Nam � � Floor Drain 2" 9.00
Name‘
- 3" 9.00
Occupant Mailing Address Suite 4" 9.00
City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
.- n ZL) )4 @.1) -1 0 1-40i Other Fixtures (Specify) 9.00
Contractor ry 5 g 9 ,d dre ; s x � 9 Suite
r j'�� 9.00
Prior to permit C' /State Zip .. 7 Pttpng � -J-'
issuance, a copy S1 ive V V 1 ` 9.00
of all l icenses are Oregon Const. Cor Bo Lic.# p. ate 9.00
a-a
required if •a 3 q,(1
expired in COT Plumbing Lic. # j p Date
1 st 100" ��� 30.00 3Qdvv
database Sewer - each additional 100' 25.00
Name Water Service - 1st 100' 30.00
Architect
/ Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device* 15.00
Additional description of work: Any F �r'TN. i SLY S e� e � e'q I Catch Basin or Waste Not Connected to a Fixture 9.00
ON S I Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
building or property g CiOZVVOYN. per/hr
Rain Drain, single family dwelling 30.00
Proposed use of
building or property Grease Traps 9.00
QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9 -
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL 'r r.
that plans su.4.'tted are in compliance yrith Oregon State Laws. r!
Signature . •wner : nt / Date 5% SURCHARGE ' r
oft Pers • Name Phone PLAN REVIEW 25% OF SUBTOTAL
' / Required only if fixture qty. total is > 9 � � r /� ,
G- Ry N /G }OI,S SR TOTAL C
(,LIB C - (y/ ate *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
J r r (vd Prevention Device, which is $15 + 5% surcharge
1:ldststplmapp.doe 5197
f.
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:ldstsVplmapp.doc 5/97
04/07/2000 Activities for Case #: PLM97 -00536
2:54:36 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 12/31/1997 JSD PASS JSD . 12/31/1997
PLMC005 Permit Created 12/31/1997 JSD PASS ' JSD 12/31/1997 -
PLMC799 Final Inspection 01/02/1998 TLP PASS J *H 01/02/1998
PL■C705 Sewer Inspection 12/31/1997 01/02/1998 TLP PASS - J'H 01/02/1998
PLMCO50 (F) Issue permit 12/31/1997 JSD PASS JSD 12/31/1997
PLMC800 Case Finaled 01/02/1998 TLP PASS J'H 01/02/1998 •
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Page 1 of 1
CITY f
OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171,
Date Requested: • - . / ./A i A.M. / 1 ` ✓ P.M. MST:
Location: . / /= _Mt . i /, . �f BUP:
i
Tenant: �� Suite: } Bldg: MEC:
Contractor: � n ,„ - ( ----1..) ----.
Phone: 2,.S �a �O PLM:9 7' (353 / ,
Owner: . Phone: l ') / j 5 9_ Y4 ELC:
9Cei(J L/ l Aitaeli — di7c./- ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer /Storm
Footing Roof UndFl/Slab . Rough -In Ceiling Water Line
Slab Framing T.. 01 , // Gas Line Rough -In UG Sprinkler
Foundation Insulation / Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved zvozprav Not Approved Not Approved Not Approved
FINAL . CFINAL FINAL FINAL FINAL
O Call for rein; • .'on ' Reinspection fee of $ required before next inspection 0 Unable to inspect
I
Inspector: A Date: Page of
IMP-