Permit CITY OFTIGARD
iW DEVELOPMENT SERVICES PLUMBING PERMIT
' r 11 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # PL M97 -03¢ 2
DATE ISSUED: 08/13/97
PARCEL: 2S110AB -00200
SITE ADDRESS...: 14357 SW PACIFIC HWY
SUBDIVISION • CANTERBUURY PLACE ZONING: C —G
BLOCK • LOT •1 -3 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..:B FLOOR DRAINS • • 0 TRAPS : 0
STORIES • 0 WATER HEATERS • 1 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 2 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installing two sinks and a water heater
Owner: FEES
GERRY C KOLVE type amount by date recpt
14389 SW PACIFIC HWY PRMT $ 25.00 GEO 08/12/97 97 -298197
TIGARD OR 97224 SPCT $ 1.25 GEO 08/12/97 97- 298197
PRMT $ 2.00 DRA 08/13/97 97- 298261
Phone #: SPCT $ 0.10 DST 08/13/97 97
Contractor
OWNER
Phone #: $ 28.35 TOTAL
Reg #..: 999999
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 -0001 -0010 through OAR 952 ''.4-0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
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Issued (Q• Fermittee Signature: 111, �- r -
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
;MY OF TIGARD Plumbing Application Read .
31,25 'SW HALL BLVD. Commercial and Residential Oats Read cSa2
- IGARD, OR 97223 Date to P.E.
03) 639 -4171 Date to OST
Permits / - / . 30Z.-_ ,
Print or Type Related SWR s6 iar/
Incomplete or illegible applications will not be accepted Caned 7 --- 2 1
Name f Development/Project :FgrAmESAQndhddwl) sue; i MN 4.130.4
Job ,JLL T A ,
Sink 9.00
Address Street Address 5, (n/ , Suite _ LaVitOry 9.00
3 PACT Ftc tat? Tub or Tub/Shower Comb. 9.00
I Bldg 9 City /State Zip Shower Only 9.00
j Alan Q . 47 Water let 9.00
Name . Dishwasher ib - e .1 a Q, 9.00
Owner Mailing Address suite a 9,00
143 Q S.W - S�iic ��� r flu/ Washing Machine 9.00
•
City/State Floor Drain - r 9.00
NNaarnr++�� r 9.00
_ 4 ' 9.00 •
Occupant M a i ling Address _ Suite Water Heater 1 9.00 g
City/State Zip Phone Room Tray 1 9.00 Ci
Urinal - 9.00
Name Other Fixtures (Specify) 9.00
rt,t 1 MLA. 9.00
Contractor M ailing Address suits 9.00. .
Prior to issuance CttyiState Zip Phone 9.00
applicant must 9.00
provide all Oregon Const. Cont Board Lie* Exp. Date - 9.00
contractors
Exp. Date Sewer 9.. 0
license info tion Plumbing Lie. 9 . ewer - 1st 100
30.00
for COT COT Business Tax or Metro * - each additional 100' 25.00
database).P• Date Water 00' -1st 1
30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' • 30.00
Or +9 Address sine stoma Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
ngineer Cityrsta Zip Phone Flow Prevention Device or Anti- 25.00
Pollution
..escribe worts New 0 Additiona Alteration 0 Repair 0 Residential Baedlow Prevention Device* 15.00
yo be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
o description of work
Catch Basin 9.00
Insp. of Basting Plumbing 40.00
per/hr
/� /� n �- , �l
tm use o pe� X��i�l l ,�iLx Specially Requested tnapections
Rain Drain. single family dwelling 30.00
' ii w,g use of / Grease Traps 9.00
•utlding or property �r l
QUANTITY TOTAL
• re you capping , moving or replacing any fixtures? Yes a No kg 'somatic or riser dagran is reamed it auaroty Totals 21 9 .
II yes see back of form) . ..: - ..-...:4',v1 'SUBTOTAL . ..: - ..-...:4',v1 ....: 2:7 i
hereby acknowledge that I have read this application. that the information .
' pmn is correct, that I am the owner or authorized agent of the owner. and 5% SURCHARGE - ..?:".- : - - ' .
. at Drams submitted are in compliance with Oregon State Laws. _
gnature g t Date PLAN REVIEW 25% OF SUBTOTAL . ' _ e . '
Reouied oro f ( toss s cry totals'' 9 _ ` _ zz
-02'�' Q 7 TOTAL ' z d "� ec
. ct Person Name Phone
/ P is D
���/ _ Z Q _(a 7 'Minimum permit fee 525 + 5% surcharge. except Resid s Beddow
/Lf� �,(/r, �, C ( Prevention Device. which 515 + 5% surcharge C \
Ir I: \plmapp.doc • • = • .
'LEASE COMPLETE AS APPROPRIATE TO PROJECT: •
Fixtures to be capped, moved or replaced Qty ..
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)
:OMMENTS REGARDING ABOVE:
1:\plrnapp.doc 12/96 (dst)
1/25/00 Activities for Case #: PLM97 -00302
•
4:18:54 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 7/24/97 JD RECD BON 7/29/97
PLMC005 Permit Created 7/29/97 B PASS BON 7/29/97
PLMC799 Final Inspection 12/30/97 TLP PASS J *H 1/2/98
PLMC725 Top -out Insp 7/29/97 12/26/97 LP2 PASS RB 12/26/97 (Terry Nelson) complete PTRV
drain w/ air gap at floor sink
complete air vent to existing-
check at final
PLMC015 DST Post Review Complete 7/30/97 B PASS BON 7/30/97
PLMC040 (F) Ready to issue 7/30/97 B PASS BON 7/30/97
PLMCO50 (F) Issue permit 8/13/97 DRA PASS DST 8/13/97
PLMC800 Case Finaled 12/30/97 TLP PASS J'H 1/2/98
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: lea — � 0 • / 7 / / A.M. P.M. � MST:
Location: I '1" 3.c 7 S L.L) IL-C,L -e_ /�- f-��l�i�— C 'C..fbe(.2�. J � BUP:
,�/
Tenant: /i+,F _.--- �� - 1'Y l ,; `��t l C L ` ��1 it S _ �' Suite: ! � B ry ld C '
G g: / r /
MEC: �y
Contractor: / , . ( ( t - f i v / 7 J / e - L � ' 1 4 Phone: 310- / - `-- y C� 0 In /.LL _PLM: 7 a- --
Owner: Phone: V
Y c CJ ( i ' , - A C --fit . , 2 6 ( C - ( ' , ∎dit ja_' ELR:
. -Z ,O GC' ariiir SIT:
BUILDING BLDG (con't) 4 r Il :4 MECHANICAL ELECTRICAL SITE
Site Post/Beam 'o : eam 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 A oved Approved Approved Approved
Appr /Sdwlk Not Approved o roved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
*— )se _e (-i - (4-u Gi h a (k LC-ttLeJ h Lf iikC -.. •
cZ -/. /A. 1 C �`7 L.. , t t' - ( i' .��C L -C a C, C` 1'...L/-J
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�� -C t C l 1 f / J �J - C _(� ) l/ /
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O Cal - 'on O Re' -I.. •.nfee of $ required before next inspection O Unable to inspect
Inspector: 4� Date: (.--z_ .— c) ( 7 Page of
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