Permit CITY OFTIGARD
iar : , DEVELOPMENT SERVICES �'LUMBING PERMIT
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # PLM96 -0 ,25 5
DATE ISSUED: 10/29/96
PARCEL: 2S112DA -01300
SITE ADDRESS...: 06640 SW REDWOOD LN
SUBDIVISION • MLP96 -0002 ZONING:
BLOCK • LOT •
CLASS OF WORK..:NEW 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 • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES : 0
TUB /SHOWERS • 0 SEWER LINE (ft)...: 200
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installing sanitary sewer line
Owner: FEES
SISTERS OF PROVIDENCE type amount by date recpt
470E NE GLISAN PRMT $ 55.00 B 10/29/96 96- 285863
SPCT $ 2.75 B 10/29/96 96- 285863
PORTLAND OR 97213
Phone #: 215 -6184
Contractor:
TEMP— CONTROL MECHANICAL
4800 N CHANNEL
PORTLAND OR 97217
Phone #: 285 -9851 $ 57.75 TOTAL
Reg #..: 004944
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
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. _
Permittee Si attire° kyiy,,f, Oro-
,
Issued By: Y ie...
Call for inspection — 639 -4175
1(m \ov3 .. SSU\
:ITV OF TIGARD Plumbing Application Recd By fr.--
3125 SW HALL BLVD. Commercial and Residential Date Recd iv - Y/
'1GARD, OR 97223 Date to P.E.
503) 639 -4171 pate to DST
Pem,itsNA1(Q -b3Z"
Print or Type Related SWR # IJA
Incomplete or illegible applications will not be accepted Called ID 24 - 110
C- (T -COLO---
N me of DevelopmenvProject FIXTURES (Individual) PTY PRICE AMT
Sink 9.00
Job cz-c). CE Mt-ski... Lavatory 9.00
Address Street Address r , r�� ` Suite
n W _ 0tl� Tub or Tub /Shower Comb. 9.00 I
t W 11-iD Bldg a Ci /State Zip Shower Only 9.00
Water Closet 9.00
i Name
L - ZS c J ' Dishwater • 9.00
. Owner Mailing Address Suite Garbage Disposal 9.00
4 tJe G \`S.P•nl Washing Machine 9.00
Dty / q State Zip Phone CIA Floor Drain 2' 9.00 1
(rC1 c • ° V - A - 2--c a ) 0 &^ tit M 3' 9.00
Name
4' 9.00
Occupant Mailing Address Suite Water Heater 9.00 .
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00 '
Other Fixtures (Specify) 9.00
Name
ICED V 1 ■ L 11, . ' _ 9.00
Contractor rP ..i • - firtrig' l �' s pite 9.00
ill � ` ri / � ' , 9.00 l _F :.�1' 9.00
Attach Copy of F 9.00
Current - a E ° Tvai/ Sewer - 1st 100' I 30.00 3d 00
i Licenses 4 1 . ' Or IF i Sewer - each additional 100' 1 25.00 9
1 B . �r7 = r Metro * p Date �S V
(` Water Service - 1st 100' 30.00
N Water Service - each additional 200' 25.00
Architect . \Ccd4- -ra (DcoJn Storm & Rain Drain - 1st 100' 30.00
Or Mailing Address _ A-r 1 Suite Storm & Rain Drain - each additional 100' 25.00
c ( \o `7 C-K{)� -4 Mobile Home Space 25.00
Engineer ty /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
'ZAJ,() a -'Zp\ _ZZ4 -4 p Pollution Device ,
�escribe work New p Addition 0 Alteration 0 Repair 0 Residential Backfiow Prevention Device' 15.00 I
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work
S1 '2 MV r.-1 Catch Basin 9.00
C , \ --- 0M z ..TL cDf. .\y6 Insp. of Existing Plumbing 40.00
per/hr
Fisting use of Specially Requested Inspections 40.00
per /hr
lding or property Rain Drain, single family dwelling 30.00
s
•posed use of Grease Traps 9.00
. i!ding or property
QUANTITY TOTAL
e you capping , moving or replacing any fixtures? Yes 0 No ea Isometric or riser diagram is required a Ouanrty Total is > 9
If yes see back of form) 'SUBTOTAL 5
hereby acknowledge that I have read this application, that the information
..'en is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE d 9
- rat plans submitted are in compliance with Oregon State Laws.
e lure of O n PLAN REVIEW 25% OF SUBTOTAL i
� wner / /'� Required only if fixture qty. total is > 9 1 ....-- 7_,--H
/Ag � �, ' l 1 TOTAL � Lfa
tact Parse N 'M/ ' one
7 MI/ 9 r n
/
' �l/ ��,nl/ „ � um permit fee is 525 + 5% surcharge. except Residential = ackflow
Prevention Y 1' I / /I L �� Prevention Device, which is $15 + 5% surcharge r�
i:ldsts\plmapp.doc 8/96 ., Ofr
?LEASE COMPLETE AS APPROPRIATE TO PROJECT:
I
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" 1 z
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
ti •
COMMENTS REGARDING ABOVE:
Page No. 1 CASE HISTORY FOR CASE NO.: PLM96 -0325
SISTERS OF PROVIDENCE
06640 SW REDWOOD LN
05/13/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMC003 Application received / / / / 10/28/96 RECD JDA 10/29/96 BON
PLMC005 Permit Created / / / / 10/29/96 PEND B 10/29/96 BON
PLMCO50 (F) Ready to issue / / / / 10/29/96 PASS B 10/29/96 BON
PLMC060 (F) Issue permit / / / / 10/29/96 PASS B 10/29/96 BON
PLMC060 (F) Issue permit / / / / 10/29/96 PASS B 10/29/96 BON
PLMC705 Sewer Inspection 10/29/96 / / 01/23/97 Approved by review. PASS TLP 01/27/98 J *H
PLMC799 Final Inspection / / / / 01/23/97 PASS TLP 01/27/98 J *H
PLMC800 Case Finaled / / / / 01/27/98 Approved pending verification of working PASS TLP 01/27/98 J *H
RP device.
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