Permit CITY OF TIGARD
r ia ,,. ;. DEVELOPMENT SERVICES PLUMPING PERMIT
' Uvf l' j
PERMIT # • PLM97 -0334
13125 SW HaII Blvd., Tigard, OR 97223 (503)639 -4171 DATE ISSUED: 08/29/97
PARCEL: 251O2BD -01503
SITE ADDRESS...: 12740 SW PACIFIC HWY
SUBDIVISION • FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK • LOT •1 JURISDICTION: TIG
CLASS OF WORK..:ALT 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 • 1 URINALS 0 GREASE TRAPS • 0
LAVATORIES • 1 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 1 RAIN DRAIN (ft)...: 0
Remarks: Tenant improvement
Owner: FEES
ROSE GOSPODINOVIC type amount by date recpt
12750 SW PACIFIC HWY PRMT $ 27.00 DRA 08/29/97 97- 298782
TIGARD OR 97223 5PCT $ 1.35 DRA 08/29/97 97- 298782
Phone #:
Contractor
AC CONSTRUCTION & PLUMBING
2157 SE HARLOW
TROUTDALE OR 97060
Phone #: 666 -0347 $ 28.35 TOTAL
Reg #..: 100919
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 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 -0901-6810 through OAR 952 -6101 -0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Z Issued = � �� 1L��_1►`_ Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++ + + + ++ + + + + + + + + + + + + + + + + + + + + + ++ + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
OF
CITY OF TIGARD Plumbing Application Recd By 0.1e
13125 SW,HALL BLVD. Commercial and Residential Date Recd Sllirtll�il
TIGARD, OR 97223 Date to P.E.
Date to DST
(503) 639 -4171 Permit # L.
Print or Type Related SWR # 4 1 zie
Incomplete or illegible applications will not be accepted Called V5 7
Name of DevelopmenVProject
Job 7 garci eaL /e/biEG%t FIXTURES, (Individual) _ : :t ..1.7.2:; QTY - !TICE • AMT .=
- 1
Address Street Address pp Suite Sink 9.00
/2 79 Scti 6c /c,C //cu y Lavatory / 9.00
Bldg # City /State Zip Tub or Tub/Shower Comb. 9.00
Name /GA� ox 97 Z Z 3 Shower Only ' 9.00
ASE Aroadp /.vary /c, Water Closet - : 9.00
Owner Mailing Address Suite Dishwasher / 9.00
/Z 75 Sc..) /J5C /F'c 19.1ary Garbage Disposal _
9.00
City /State Zip Phone -
T /G,'4 7 o.0 9 7 z23 GZo -5-5-2-9 Washing Machine _ 9.00
Name p 41/9 Floor Drain 2• _ 9.00
' '6' ., / 3' - 9.00
' //4 Occupant Mailing Address Suite q• _ g
I /y 905 ,t.,,-.) G�+a+,IJ//uF Water Heater 0 conversion 0 like kind _ 9.00
City /State Zip Phone -
T/G,0.2p ore 9722 5 - y/t' Laundry Room Tray _ 9.00
Name /� Q Urinal _ 9.00
�� C�O�S7OC /,/t/ 9 if 4 044- Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite
Z/5 5" Fi4GGw 9.00
(Prior to issuance City /State Zip Phone 9.00
applicant must '7,( r ,ae 46 47,e, 9706 G66 -43 VI 9.00
provide all Oregon Const. Cont. Board Licit Exp. Date 9.00
contractors / O O 9/ 9 4/ 9 r 9.00
license Plumbing Lic. # Exp. Date • Sewer - 1st 100• -- 30.00
information if
expired Z ea. - She /',6 T/9,r Sewer - each additional 100' _ 25.00
in COT COT Business Tax or Metro # Exp. Date Water Service - 1st 100' - 30.00
database). Cocoa 34,5/ , t 1 9' Water Service - each additional 200' 25.00
Name
Storm & Rain Drain - 1st 100' - 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
Or Mailing Address Suite
Mobile Home Space 25.00
Engineer City /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Describe work New 0 Addition 0 Alteration 0 Repair 0
Residential Backflow Prevention Device' -- 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
Existing use of • per/hr
building or property Rain Drain, single family dwelling 30.00
Proposed use of
Grease Traps 9.00
I building or property
QUANTITY TOTAL :
Are you capping , moving or replacing any fixtures? Yes No p Isometric or riser diagram is required it Ouanity Total is > 9
(If yes see back of form) 'SUBTOTAL �I 1l !"'J
I hereby acknowledge that I have read this application, that the information 5% SURCHARGE // Z
given is correct, that I am the owner or authorized agent of the owner, and ' , J(
that plans submitted are in compliance with Oregon State Laws. PLAN REVIEW 25% OF SUBTOTAL
Signature of Ow /A Date
Required only if fixture pry. total is > 9
/ / '� TOTAL 5r
4 10,0"---- J '
Contact Person Name Phone *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
/�E J,, Ylt S.2 4/' 5 - 6 Vi,/ Prevention Device, which is 515 + 5% surcharge
, :bstslplmapp.doc 5/97
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink C ae-
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:
1 5197
6/16/99 Activities for Case #: PLM97 -00334
2:14:29 PM • •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 8/7/97 B RECD BON 8/15/97
PLMC005 Permit Created 8/14/97 B • PASS BON 8/15/97
PLMC799 Final Inspection 2/17/98 TLP PASS J *H 2/24/98
PLMC725 Top -out lnsp 8/15/97 2/17/98 TLP PASS J'H 2/24/98
PLMC040 (F) Ready to issue 8/15/97 B MEMO BON 8/15/97 Need CCB U plumbers license
info before issuing. • PLMCO50 (F) Issue permit 8/29/97 DRA PASS DRA 8/29/97
PLMCO57 Issue plumbing signature form 10/10/97 SW RECD S'W 10/13/97
PLMC800 Case Finaled 2/24/98 TLP PASS J *H 2/24/98
•
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CITY OF TIGA BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: c —1 7 - ! g . P.M.)( MST:
Location: • L 1 / � / //. /' &.... L . BUP:
Tenant: rieZA /a)4 & ckQ j / 4 I Suite: 1 Bldg: MEC:
Phone: ,,-,2 V-'2 PLM: — •
O ier: LA. . L2 Phone: ELC:
J/ .1 ' _ 41t__A411. // _' Z. L / /L _li ELR:
SIT:
BUILDING BLDG (con't) UMB I ` MECHANICAL ELECTRICAL SITE
Site Post/Beam • : .! Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer 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 ,rely Approved Approved Approved
Appr /Sdwlk Not Approved No . • • a ved Not Approved Not Approved Not Approved
FINAL INAL FINAL FINAL FINAL
0 Call for - m = 0 Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: 4 Date: 2/i 7 /YO Page of