Permit •
CITY TIGARD PLUMBING PERMIT
P ERMIT #: PLM1999 -00106
� I� � DEVELOPMENT H B Tigard, E RV SERVICES 639 -4171 DATE ISSUED: 4/14/99
SITE ADDRESS: 12950 SW PACIFIC HY 3B PARCEL: 2S102C6 -03101
W
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS: 1
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Alteration /moving existing plumbing, cap hub drain.
FEES
Owner:
Type By Date Amount Receipt
P J AMERICAN INC MISC DST 4/14/99 $3.60 99- 314501
9109 PARKWAY EAST PRMT DST 4/14/99 $72.00 99- 314501
BIRMINGHAM, AL 35206
Total $75.60
Phone 1:
Contractor: n
Po � a3ats3
774 2D o2 9 7a23 REQUIRED INSPECTIONS
Rough -in Insp
Phone 1:
gy s -49x4 PLM /Underfloor
Reg #:
,*# t aOg9 3 Insp existing /capped fixtures
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other 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 ob copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue• By: J i i ! Permittee Signature: 60/?,, .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
'ITY OF TI,GARD Plumbing Application lication Recd
3125 SW HALL BLVD. Commercial and Residential Date Recd Y -
iGARD, OR 97223 Date to P.E.
03) 639 -4171 Date to OST
Permits ,LP! /Q -G»/OG
Print or Type Related SWR eg 6274,
Incomplete or illegible applications will not be accepted Caned g-/ '
Y=23
zlocr /*ll
Name of Developm ject - FIX�URES�( d! ) • -C1T k CE4 R
Job Po Pa . J nS 4 9'N 3(atr0
Address St Addresse 9.00 WO 2-'b Si tig& C y Tub or Tub/Shower Comb. 9.00
Bldg S SIrtate / Zip Shower Only 9.00
� a 1 Water Closet
Name 9.00 9 •d Q
Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City/State Zip Phone Floor Drain 2' - / 9.00 iritc
Name / r 9.00
4' 9.00
Occupant Meng Address - ' Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal -
9.00
Name
Other Fixtures (Specify) 9.00 -
5u NSt1- Pi UmnN Co 9.00
Contractor "" 9.00
Pt.) f icc) -IiO3 9.00
'Prior to issuance , State `` /� Zip Phone
applicant must i i( d (VS 7. 2io 9.00
provide all Oreg L Cont. Board Liss Exp. Date 9.00
contractors '2_G VA 3 -WOO 9.00
license Plumbing Llc, fi Date Sewer - 1st 100' 30.00
information :2 q -Z h4 (2 Ms - I fit 9 - Sewer • each ad Tonal 107 25.00
database). COT Business Tax or Metro II n Q Water Service -1st 100' 30.00
Name L �'t 1 Water Service - each additional 200' 25.00
Architect Storm & Rain Drain . 1st 100' ' • 30.00
or 9 Address Suits Stomp a Rain Drain - each additional 100' ' 25.00
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
• Pollution Device •
• '.escribe work New 0 Addition 0 AlterationX Repair 0 ' Residential Badcdow Prevention Device' 15.00
, be done: Residential 0 Non - residential isk Any Trap or Waste Not Connected to a Fixture 9.00
Additional desciption of work Catch Basin
9.00
Insp. of Existing Plumbing 40.00
per/hr
- xisting use of Specially Requested Inspections 40.00
Biding or property Pedhr
Rain Drain. single family dwelling 30.00
'reposed use of Grease Traps 0 AA /1ll
wilding or property 9.0 q,u V
QUANTITY TOTAL 1 ,i S
Are you capping , moving or replacing any fixtures? Yes ig No p dro muted or riser gran is uied a Cuanity Total is 9 # � ^ • "-
(if yes see back of fore) 7i�s 'SUBTOTAL . f"':. .
' - E • ;.
hereby acknowledge that I have read this application, that the information ��
.even is corned that I am the owner or authorized agent of the owner. and 5% SURCHARGE - - :_
hat plans submitted are in compliance with Oregon State Laws. 3k0
I TOTAL of Ovrrher/A . REVIEW 25% OF SUBTOTAL •.; =Pit-17516-
-.
i c '
D
v -15 - yq - C9
Required sre t��
. - - Person Na , Phone _ ,
'Mi Ptevention Device• which is 515.5rgexeept Residential Badtflow
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'LEASE COMPLETE AS APPROPRIATE TO PROJECT: •
! Fixtures to be capped, ov or replaced Qty
Sink . 2
Lavatory 1,
Tub or Tub /Shower Combination •
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2 /7
3
4" --
Water Heater •
Laundry Room Tray
Urinal
•
Other Fixtures (Specify)
J - -
:OMMENTS REGARDING ABOVE:
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