Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT DEPARTMENT PERMIT # ° PLM96- 11001
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 DATE ISSUED: /15/96
PARCEL: 1 S 1348C- 1210200
SITE ADDRESS...: 12160 SW SCHOLLS FERRY RD .
SUBDIVISION....: ZONING: C -G
BLOCK........... LOT.. ..... ......:
CLASS OF WORK.. :ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -COM WASHING MACH . 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP.. :B2 FLOOR DRAINS 3 TRAPS . 0
STORIES . 101 WATER HEATERS.....: 0 CATCH BASINS : 0
FIXTURES-- ---- - - - --- -- LAUNDRY TRAYS 0 SF RAIN DRAINS 0
SINKS - 3 URINALS - 0 GREASE TRAPS - 0
LAVATORIES.....: 0 OTHER FIXTURES 0
TUB /SHOWERS....: 0 SEWER LINE (ft)...: 0
WATER CLOSETS-2 0 WATER LINE (ft)...: 0
DISHWASHERS . 0 RAIN DRAIN (ft)...: 0
Remarks: Tenant modification
Owner: -- -- - -. FEES -- -
WILLIAN1 SAUNDERS type amount by date recpt
0/0 MELV I N MARK PRMT $ 54.00 JMH 03/15/96 96-277051
111 SW COLUMBIA SPCT $ 2.70 JMH 03/15/96 96-277051
PORTLAND OR 97201
Phone #:
Contractor: ---------------------- --
ROBERTSON PLUMBING INC
18523 SE MIARLY LN
CLACKAMAS OR 97015 - - - - -- ------------------------
Phone #: $ 56.70 TOTAL
;Reg #fi..: 88717
-- REQU I RED INSPECT IONS -- - - - - --
This peroit is issued subject to the regulations contained in the PLM /Underfloor _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Top -out Insp
applicable laws. All work will be done in accordance with Final Inspect ion
approved plans. This peroit will expire if work is not started
within 160 days of issuance, or if work is suspended for core
than 160 days.
_
Permittee Signatur
4L6
Issued By: _ 1. 1 ,dP� -
Call for inspection - 639 -4175
13$(-- 4 / % — MO /
_ . Allidilk
etai4 e-ae.re i3 cKR• 2. -
_City of 'Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # PlJY Ab - cool
Tigard, OR 97223 Sw g(p -exv l
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
dice"
°" New Single
w ( ev
❑ 1 BATH HOUSE S140.00 ❑ 2 BATH HOUSE 5195.00
Job 1 21 (00 SO 5Citioll5 kY Ii i 2/1 ❑ 3 BATH HOUSE 5225.00
Address ohm.- Fee indudes all plumbing fbchues in the dwelling and the first 100 feet
-I % c I OP �,-1 � -a bel
of water service, sanitary sewer and stone sewer. See fees ow.
'"' Or "°r FIXTURES QTY PRICE AMT
k l\aill . 1 I XL‘k-t k&2 r< 1' F Sink 3 - 9.00 2 7
YY1fArivt 1r � �.0J C L, "Pct,-V►1' Lavatory 9.00
Owner ► \ 1 SUIT .c i. vn. Tub or Tub/Shower Comb. 9.00
Shower Only 9.00
Fir LLt CYIZ. 41 ? 0 ` Water Closet 9.00
�, • ""yo (O O
"'1 bawl* Dishwasher 9.00
- Occupant
'1 � (, S\ - ae, Voo P Zqz - L(a- x top Garbage Disposal 9.00
4���//,,�� (� Washing Machine 9.00
11 640 c� ' 1S G YI(L� 12-(!! Floor Drain 3 9.00 2 7
a. Water Heater 9.00
(W - Vi d l D e. C 3, c Laundry Room Tray 9.00
Lei 1 is t �
Urinal 9.00
f Lt44bL 4 7 -31 -1 � (- I �J o, i L��Yr• i Other Tortures (Specify) 9.00
Contractor ,,
M ains Addre 9.00
I)35 Z? 6s m (' L, L� vs� 9.00
_ wawa. 9.00
C L Ic V-pccf r'�� 0 R 970 (5 Sewer 1st 100' 30.00 '
State rey.er.e N► Ca, eus. Taft. Sewer - ea. Addit. 100' 25.00
X 6 l 1 l -7 - I ?5'`I �' (' Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. AWL 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. (H exempt from State registration, please
give reason below.) Mobile Home Space 25.00
( Back Flow Prevention
, � „, -„A �-> � • ��. ,,,/ ,, � _- Device or Anti- Pollution Device 9.00
` are (°""' ° 'P" 4 Ows Any Trap or Waste Not
� Connected to a Fixture 9.00
Describe work new Q addition Q alteration tld • repair 0 Catch Basin 9.00
to be done residential 0 non- residentai 0 Insp. of Exist Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property ,‘6(_, Rain Drain, single family dwelling 30.00
Residential backftow prevention
devices 15.00
Proposed use of ` t
budding or property �vt 1)1\(',v1 S \rv..0
'(Except residential bacidfow
. prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL SL, .l)o
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE z 10
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
TOTAL 7 o 70
Special Conditions
Date issued by
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ROBERTSON PLUMBING INC
18523 SE MIARLY LN
CLACKAMAS OR 97015
Plumbing Signature Form
Permit # • PLM96 -0001
Date Issued.: 04/16/96
Parcel • 1S134BC -00200
Site Address: 12160 SW SCHOLLS FERRY RD
Subdivision.:
Block Lot:
Zoning C -G
Remarks:
Tenant modification
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing ,Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER:
•
PLUMBING CONTRACTOR:
WILLIAM SAUNDERS ROBERTSON PLUMBING INC
C/O MELVIN MARK 18523 SE MIARLY LN
111 SW COLUMBIA
PORTLAND OR 97201 CLACKAMAS OR 97015
Phone #: Phone #:
Reg #..: 88717
X �i� --- Ca
Signature of Authorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
•
If you have any questions, please call 639 -4171, ext. #310
CITY OF TIGARD BUILDING INSPECTION NOTICE ‘ o„ i
Inspection Line: 639 -4175 Business Phone 639 -4171
Footing Rain Drain Cover /Service FINA :
Foundation Water Line Ceiling
' i
Post/Beam Mech. Shear /Sheath Framing -Mech.
Plbg Und /FIr /Slab Plbg Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
e r Gas Line Appr / Sdwlk'.
Other:
Date: ,S/aLf k fo A.M. X P.M. Entry:
Address: I)— \ co 0 L
Tenant: Ste: MST:
BUP:
Con /Own: 3 7.0 — L I 9 to__ MEC:
-- 1 8'3 ?— ELC. � PAD d
THE FOLLOWING CO RECTIONS ARE REQUIRED: ELR:
Inspe or: Date: ■S 2 //"' 74
APPROVED DISAPPRO ED /CALL FOR REINSP. C CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San Sewer as Line Appr /Sdwlk ' Reins. ,10
Other:
Date: .D— ' A.M. P.M. Entry:
Address /,-- / (p C ,Yl ,e .l ,t, A
Tenant: + Ste: MST:
BUP:
Con /Own: MEC:
5 1 14 �j ELC:
THE FOLLOWING CORRECTfONS ARE REQUIRED: ELR:
I ector: /L /� / Date: �` �'
V
ROVED DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service Fl .
- Foundation Water Line Ceiling - 41100,
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -E: 41EPP
Line Appr /Sdwlk Reins.
Other:
Date: S J 2-3 1. ! c , M. P.M. /
Address: ' ' Entry: /
� �`,� �_
�1 .Apt
• Tenant: Ste: MST:
BUP: -
Con /Own: MEC:
PLM: cfc, --ceo 1
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
3w p_5'c- -000(
AWAIl
o I
A . 4'442.) 4 ._ i
liPek. _ter; .. �,. _ ► L L. -' - 1 IP; ' 4 I
. 2 . . 1. 4 . . 6 : e i _‘,..4,.1._ a_TA...z4„,...? ..4:. _2_4. ovi.....
0 -it,e,... .5 ? , - G 4 . . , "Lew e el-&01,4k . ,,Y.A. 4 4,0 1 -.PC71-2 .4.1U-4
4. L
Inspector: - t.' Date: 5
_APPROVED 6ISAPPROVED /CALL FOR REINSP. CF CO