Permit CITY OF TIGARD
- „,,, hl t\ DEVELOPMENT SERVICES PLUMBING PERMIT r,
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # • P L M 9 6 — 0 253
DATE ISSUED: 10/23/96
PARCEL: 2S110DB -00700
SITE ADDRESS...: 15532 SW PACIFIC HWY #3
SUBDIVISION • WILLOW BROOK /TIGARD PROMENADE ZONING: C —G
BLOCK • LOT -10
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 • 1 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 • 1 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
DANIEL MACDONALD AIA type amount by date recpt
1040 B ST PRMT $ 63.00 B 10/23/96 96- 285557
STE 214 5PCT $ 3.15 B 10/23/96 96- 285557
SAN RAFAEL CA 94901
Phone #: 415 - 459 -6150
Contractor:
MARXMEN PLUMBING INC
9665 SW 163RD AVE
BEAVERTON OR 97007
Phone #: 579 -2200 $ 66.15 TOTAL
Reg #..: 102432
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.
,1
Permittee Si• nature: I I =
p r
Issued By: 0 �. . !' -
Call for inspection — 639 -4175
(gift! alvch(-teck 9 - 3 110
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # la_01 611, -0253
Tigard, OR 97223
(503) 639 -4171 5w ° Ib -DAD
MINIMJM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Daralopmnd New Single Family Residences Only
- nGokWv ?rzoi-fes-ito7E- )
❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job l5- �2 S 1.4 1'A.i�IL 14147, , ❑ 3 BATH HOUSE $225.00
Address atr Fee includes all plumbing fixtures in the dwelling and the first 100 feet
-% rl Aim O t2 of water service, sanitary sewer and storm sewer. See fees below.
Name (ot name of Busness) FIXTURES QTY PRICE AMT
Sink Z• • 9.00 ( R
Magna Address . Phone Lavatory '1 9.00 a . 00
Owner Tub or Tub /Shower Comb. - 9.00
C4y /State aP Shower Only 9.00
Water Closet .1 9.00 9 00
Name (or name ot business) Dishwasher 9.00
' IYr Garbage Disposal 9.00
Occupant using ,,,dr,p Felon. Washing Machine ), 9.00 9, Q D
55 C.Act,1 f012ii 1 k - 71 • Floor Drain 1. 9.00 q , CO
City/State as Water Heater 1 9.00 9.00
64 ' ∎it -ISC--O , L Pc q y ION Laundry Room Tray 9.00
N1Te Urinal 9.00
M arr4 mleo .piu i n + i 1 tar e Crii c;4. Other Fixtures (Specify) 9.00
Mang Address a RIMS 9.00
Contractor �i
C 5 S • la) _ ((N' q ?001 9.00
fay/State 7�p
9.00
ecl.t very On Ovee) 0- Sewer 1st 100' 30.00
State Registration No. uy tin. Tax Na Sewer - ea. Addit. 100' 25.00
Rt. <2 4 3 M e l Po f // " Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti - Pollution Device 9.00
signature (os .ea or agent) Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration do repair 0 Catch Basin
9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of Rain Drain, single family dwelling 30.00
building or property Rn
Residential backflow prevention
devices 15.00
Proposed use of
building or property HPd St t'ri 0 *(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL 6 3100
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE -r S
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL i
r -
TOTAL lD f 1
Special Conditions
Date issued by
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Page No. 1 CASE HISTORY FOR CASE NO.: PLM96 -0253
DANIEL MACDONALD AIA
15532 SW PACIFIC HWY Unit: 3
09/15/97
Action Description Req/ Solid/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMC003 Application received / / / / 08/23/96 RECD JDA 08/30/96 BON
PLMC005 Permit Created / / / / 08/30/96 PEND B 08/30/96 BON
PLMCO50 (F) Ready to issue / / / / 09/03/96 Do not issue until SWR96-0408 is paid. MEMO B 09/03/96 BON
PLMC060 (F) Issue permit / / / / 10/23/96 PASS B 10/23/96 BON
PLMC799 Final Inspection / / / / 11/08/96 PASS TLP 11 /13/96 TLP
PLMC800 Case Finaled / / / / 11/08/96 PASS TLP 11/13/96 TLP
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