Permit CITY OF TIGARD
,�, DEVELOPMENT SERVICES PLUMBING PERMIT
`- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # - PLM96 -0341
DATE ISSUED: 11/13/96
PARCEL: 2S1O2CA -00925
SITE ADDRESS...: 13240 SW VILLAGE GLENN DR
SUBDIVISION VILLAGE GLENN ZONING: R -4.5
BLOCK • LOT • 25
CLASS OF WORK..: ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
' OCCUPANCY GRP..:R3 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)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS 0 RAIN DRAIN (ft)...: 200
Remarks: Rain drain
Owner: - FEES
LOUISE KLINKENBERG type amount by date recpt
13240 SW VILLAGE GLEN DR PRMT $ 55.00 JSD 11/13/96 96- 286417
5PCT $ 2.75 JSD 11/13/96 96- 286417
TIGARD OR 97224
Phone #:
Contractor:
SCHOLLS FARM & NURSERY INC
22214 SW SCHOLLS SHERWOOD RD
SHERWOOD OR 97140 -•
Phone #: 628 -2218 $ 57.75 TOTAL
Reg #..: 005612
REQUIRED INSPECTIONS
This persit is issued subject to the regulations contained in the Rain Drain 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 peroit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
than 188 days.
Permittee Signature: ' A"""Alisor
Issued
Call for inspection - 639 -4175
CITY`OF TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd - ` 7 C
Date to P.E.
TIGARD, OR 97223 Date to DST
i (503) 6394171 permit* r'LaM 96 -63 L
Print or Type Related SWR # A
Incomplete or illegible applications will not be accepted. Called OTC
Name of Development/Project FIXTURES (Individual) . QTY PRICE :AMT
Sink J 9.00
Job
Address Street Address / Suite Lavatory 9.00
/3a yo S44/, rC - 4;1 • Tub or Tub /Shower Comb. 9.00
Bldg # City /Stale Zip Shower Only 9.00 .
Water Closet 9.00
N ame c /(--""? / Dishwasher 9.00
O`er / o 4.11.3 ill <
Owner Mailing Address S uite Garbage Disposal 9.00
/3x2 ya s' fr %> e�^ai Washing Machine 9.00
/State Zip Phone - Floor Drain 2 9.00
/i o ..... 5'72Z3 ,/3 f.'1 -�7 3• 9.00
Ntme
4 9.00
O ant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Urinal 9.00
/� � y� Other Fixtures (Specify) 9.00
1X07/:14;/ t /� -Vir , "0 r.-- 9.00
Con Mailin Ad dress /Suite 9.00
a 2 2 / Y f ° 4 1 ��/ :/.�� °� 9.00
City /State Zip Phone ,./
.5-4914A1`4.7 97,9 Cz "22-/c 9.00
Oregon Const. Cont. Board Lic.# Exp. D e . 9.00
Attach Copy of 5-e/Z 9/f? 9.00
Current Plumbing Lic. # Date Sewer - 1st 100' 30.00
Licenses Sewer - each additional 100' 25.00
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00 3p
Or Mailing Address Suite . Storm & Rain Drain - each additional 100' 25.00 _Z�-
Mobile Home Space 25.00
Engineer City /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Describe work New 0 Addition 0 Alteration D" Repair 0 Residential Backflow Prevention Device' 15.00
to oe done: Residential D-- Non- residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work c �/� Catch Basin 9.00 •
.1/!' l' /27 %c !/l, /t7 G% / 'Q /// 7 -
Insp. of Existing Plumbing 40.00
//' 44-4-,.; 4., 4 P�G�(q �� 6 - 4. »- Specially Requested Inspections pe r O
Exi t i n use of �J /
building or property /C P/ 9��+
Rain Drain, single family dwelling 30.00 30.00
•
Proposed use of Grease Traps 9.00
building or property
. QUANTITY TOTAL .
Are you capping , moving or replacing any fixtures? Yes ❑ No Er Isometric or riser diagram is required if Quaint) Total is > 9
(If yes see back of form) *SUBTOTAL r,---
I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE i - 1l7
that p ns submitted are in compliance w Oreg n State Laws.
Sig attire of Own r/ gen Date � PLAN REVIEW 25% OF SUBTOTAL
Required only d fixture qty. total is > 9
r .- // /2 /�
/ `f TOTAL
Co tact Person Name - Phone
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow f
Prevention Device, which is $15 + 5% surcharge ,.
i:\dsts\plmapp.doc 8/96 ('%,
•
PLEASE COMPLETE AS APPROPRIATE TO PROJECT: \`
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171 -
Footing Rain Dr.' Cover /Service , 1 INAL;
e
Foundation " ate Line Ceiling l -PI b
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
•
Other: 11
Date: 7-1 1 A.M. /� P.M. Entry:
Address: /3 2 ') (Ju -Ogf n ict
Tenant: Ste. MST:
BUP:
Con /Own: (e/2-$
PLM:
00(p ELC:
THE FOLLOWING COR A19E REQUIRED: ELR:
G 3 - $c)Ce)
•
Inspe or: Yk Date: /1
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO