Permit A , 'CITY OF TIGARD
%,:� DEVELOPMENT SERVICES PLUMBING PERMIT
' "I L I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # PLM97 -¢ 317 7
DATE ISSUED: 08/18/97
PARCEL: 2S1O2AA -00600
SITE ADDRESS...: 11940 SW PACIFIC HWY #D
SUBDIVISION • TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK • LOT •12 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 1 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M FLOOR DRAINS • 0 TRAPS : 0
STORIES • 0 WATER HEATERS • 2 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 4 URINALS • 0 GREASE TRAPS • 0
LAVATORIES 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 1 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Tenant improvement
Owner: FEES
STANDARD INSURANCE CO type amount by date recpt
ATTN: TAX DEPARTMENT PRMT $ 72.00 DRA 07/30/97 97- 297770
PO BOX 711 5PCT $ 3.60 DRA 07/30/97 97- 297770
PORTLAND OR 97207
Phone #:
Contract or
NASU CONNECTION INC
635 SW COLONY DR
PORTLAND OR 97219
Phone #: 246 -5562 $ 75.60 TOTAL
Reg #..: 009174
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Top -out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
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 9521-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
�:� I
Issued By: — � Permittee Signature: 1 ,�../
f i
++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
ITY OF TIGARD'' Plumbing Application Red lit
31 SW'HALk BLVD. Commercial and Residential ateR -3c 27
GARD, OR 97223 Date to P.E
=s03) 639 -4171
Date to DST
Pam** P / UMW
Print or Type Related SWR i 'NM 5
Incomplete or illegible applications will not be accepted Called
Name of Development/Project : F.URU ASIONSt p :tp .4
Q� - 'i4/.� sites / 9.00 9 6
Job 4a Im
Address Street Address Suite Lavaf° 9.00
/ /9yr F/G /*/,;/ _ t Tub or Tub/Shower Comb. 9.00
Bldg i C ity/State Zip Shower Only 9.00
r 02 9 9.4Z5 Water Closet .P0�.l./P / 9.00 CO
Name Dishwasher ,
9.00
Owner Mailing Address Suite Gestate Disposal 9.00
Washing Machine
/ 9.00 9 00
City/State Zip Phone Floor Drain r 9.00
Name ■ 3 ' 9.00
_4' 9.00
Occupant "wing Ad - Suite water Heater a l , 9 /� ��
Laundry Room Tray d ✓ - 1- 9.00 1 99
City/State Zip Phone Urinal 9.
9.00
Name
Other Fixtures (Specify) 9.00
- 7%/r AIAJ'tJ GD,J,v p v 9.00
:ontractor Mailing Address suite _5 99/19. b/, 5,'J/ S 3 9.00 „ 2 7 °c -
Qrfor to issuance 63r zz2ep cD,vl_T 9.00
app8cant must PD�iC- �A.4DL 9 o r i 9.00
provide all Oregon Const. Cont. Board Lira Exp. Date 9.00
contractors . s 9.00
8cense Exp. Date Sewer - 1st 100'
information � i/�� �� 30.00
J
for COT COT Business Tax or Metro it Exp. - each additional 1 00'
25.00
database). Ems• Date
Water Sefviee - 1st tar
30.00
Name Water Service - each additional 200 25.00
Architect Storm a Rain Drain -1st 10IT • 30.00
or "sing Ad - Suite Storm & Rain Drain - each additional tar 25.00
Mobde H o m e SpaCe 25.00 -
Engineer City/State Zip Phone Back Flow Prevention Device or Anti- 25.00
Pollution Device
'Describe worts New 0 Addition 0 Alteration 0 Repair o Residential Baddlow Prevention Device' 15.00
:o be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of wont, Catch
7 d /✓l l/IP 96APT - A - a& 9.00
insp. of Existing Plumbing 40.00
#,Q6.2 SAXOi Defibr
resting use of Specially Requested Inspections 40.00
.riding or property aD/9/V02- //9i` Per/hr
Rain Drain. single family dwelling 30.00
• 'Dosed use of Grease Traps 9.00
. riding or property GDf/./7�.& /4 -
QUANTITY TOTAL 4-- • � • -- �'
''e you capping . moving or replacing any fixtures? Yes k No Q isometric or riser diagram is required it Quinsy To is > 9
f yes sae back of form) 'SUBTOTAL : - - j
hereby adurowledge that I have read this application. that the information ' :' J
. 'en is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE _ _i: - , - ;i • O
•:.at clans submitted are in compliance with Oregon State Laws. Tr
anatu f OwnedA • Date PLAN REVIEW 25°/. OF SUBTOTAL yts �� 1 � • • Reoused e n s , thralls alp. total is 9 • TOTAL _ • s ` - q
=ta eson,,,, Phone
'Minimum permit fee is S25. surcharge. except Residential Badcflow
Prevention Device. which is $15 + 5% surcharge
I:\plmapp.doc 12/96 (dst)
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'LEASE COMPLETE AS APPROPRIATE TO PROJECT: T ,_
I Fixtures to be capped, moved or replaced =7 Qty .
Sink ety
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3 "
4"
Water Heater /-/.61 GAL,
Laundry Room Tray
Urinal
Other Fixtures (Specify)
;OMMENTS REGARDING ABOVE:
I:\plmapp.doc 12196 (dst)
do
Page No. 1 CASE HISTORY FOR CASE NO.: PLM97 -0317
ALL ABOUT HAIR
11940 SW PACIFIC HWY Unit: D
12/01/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMC003 Application received / / / / 07/30/97 RECD DRA 08/06/97 BON
PLMC005 Permit Created / / / / 08/06/97 PASS B 08/06/97 BON
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PLMC015 DST Post Review Complete / / / / 08/07/97 PASS B 08/07/97 BON
PLMC040 (F) Ready to issue / / / / 08/07/97 Needs licensing info and to pay MEMO B 08/07/97 BON
SWR97 -0315 before issuing this permit.
PLMCO50 (F) Issue permit / / / / 08/18/97 PASS JSD 08/18/97 JD
PLMC715 Rough -in Insp / / / / 08/25/97 PASS LP2 08/25/97 J*H
PLMC725 Top -out Insp / / / / 08/25/97 PASS LP2 08/25/97 J*H
PLMC799 Final Inspection / / / / 09/08/97 PASS MS 09/11/97 J*H
PLMC800 Case Finaled / / / / 09/08/97 PASS MS 09/11/97 J*H
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