Permit . ,.
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4� Iv DEVELOPMENT SERVICES P LUUMBING P ER11IT `
13125 SW Hall Blvd., -Tigard, OR 97223 (503) 639 -4171 PERM I T # — a � _ P121197
' JATE ISSUED: 04/0i/97
, PARCEL • �::S i i 5BB.._.�0l77 €
Ci rlDfREsS . 16,445 416,445 -ski- KING CHARLES '
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SURD I4s.iS I Or. " "„ ZONING •
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l?•.!-_C:ii...F „ . a . . 4 ;3.L!f I tJ: k. I N , -
CLASS OF WORK. , : REP - [BAR AGE DI.S A S ! MOB I. LE HOME SPACES : K 0
TYPE OF U S E , — . 4 : SF WASHING MACH. _ • o 0 BACKFL.OW P REV NT,RS„ . 0 1
:OCCUPANCY. Gl ='e . ^ l-I =- - FL.00l ,'DRAINS:. n „ . n r TIRAP'So e ., n , . e : i .
TOR S, . e . > W R HEATERS....: A -: :.. ,... _�•,
.� t_l.ile�, >`r - 'S�1�•1 ^r, J. CATCH BASINS,. •
FI:X Tl.JRF_" -- -- •, _ - - - - - - -• - LAUNDRY" TRAY s; - : a" Sr PIN . DRAINS,, a 0. ,
9II`ia: a. e ,: 0 ' !U'RI „ NA} S: a a ,.d ti'a ., 1?! . GREASE ,TRC -IP i ;.. _ ,` : 0 • .
1._AVAT0 RIr:9. < ' _ O OTI - FJ-P •FI0X,TLIRES , „ r
TUB/ SHOWERS. : „ : , 0 ' ' SEWER - L.:ENE ( fL - ) ▪ < < J 0 , ;, '' ' ' , .
bJA f< CL_Oi3ETS.: r t - W F,`, f"ER. LINE..(: ft') e : ''! C1! -
DIcHWASHERS. : = o . 0 RAIN ,DRAIN t:ft i .: a : �.
Re:mar- I.( s -ft. in.st1 ::+a.terr' h e t er'ir�ep1�ac. ~tam "en•L -, .. ,
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l\4AOMI' !'.RUSE - type a,m o'.sn•!:, by d1 t e' ' , ,'e,�'Pt ,
: r --' .c• -C -i -- ,r -' e.r_+' ;-a- E__ -. _- _ _- ._tv:R - -.Y- • - . C. .9..�,_ T" .-h:J.-/.-1.;__:- n r te = -r•_T :•T 11 --- - — ' :2. -„:.11'
, I NG CITY.- OR 97224 ,,P'C: !- ' ', 1 � TAT 0�rf 0 i . 3 7 , RING (I 'r
Phone . 1' : 629- 391 . . . ,
C on'!. r•a. ^_ r or - = . - -- - _ -- - -- --
_S ORGE MORL_ 1N. :PLLIMBING - •
5529 SE FOS FER RD - . . . - - , , ' . ' `
*SEC: ALSO MORLAN F-'L_UMBINS* .
PORTLAND OR ' • , ____ - ---_. - --
Pi.yone it : 77.1 -i 1.4,x, !t. i �a 25 TOTAL_ - , , ; ' • .
.Rt�cl 4 : $00; 311. - • , - - ,. . ,
.. . -- • - - - - -- c-iEOU I RCD : NS1DECT I ONE-- --- -. - - -- ` -
' Th rnif is issued subject to the.r'e�1.11ations contained is the We. t I_i"ne Ins p —_ �_ -'
Tigard Piunicipa.l Code 5t'ate of Ore. Specialty L'odes.'and al other Wcate1 Ser'v'),.. • 7 n -_:__— - --__ '
applicable lass: All work ,�ail'i be d±�re,in •accarcance ,' .. Ro'� ?1h- -in' : =� " . .
i I' z'
=rc ed Sian., This -.si't ail. .done
if,o�- ,rf'.. _ net started' : PL.M / 1.11 do r fi.i ,
- - -___ ---- • - - - : --
within 180 days of issuance, cr "if- wor ' it 5[S Lendetf„lr • q ore rii co Inspect ion _ - _- - - '
ten g :ub stay s. - ' • „ . F i. n � :l •. I n s fi :J c 1 i - on n , - ', .. ,
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" C i1 for i.ns•peLL,i.On - X6.3;'7-- , �:j.7`, ' , , ' ” ,
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CITY 1; TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Cate Rec'a
TIGARD, OR 97223 Date to P E.
(503) 639 -4171 Date to DST
Permit x . pang? -omg
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Called
Name of Oevelopment/Prolea FIXTURES (Individual) 1 QTY PRICE I AMT
Job sink f 9.00
S treet Address Lavatory 9.00
Address Suite
lG L L (S S.../ I1 // t11G CLlt{`ie t _ Tub or Tub/Shower Como. 9.00 I Bldg s Ciry ip Shower Only 9.00
kroi el V 01 4 / 21 l Water Closet I 9.00
Name
ss/aOm /��k s� Oistnvasher I 9.00
Owner Mailing Address /� A/ Suite Garbage Disposal 9.00
/(e, G /L/ S Sw if/4f `4gt(KI Wasting Machine 9.00
City/State Zip Phone Floor Drain 2
7[i i CA/ O 6i i 22'1 C 1'4 7 311 9.00
Name /
3' 9.00
_ 4' 9.00
Occ upant Mstlrq Address Suite Water Heater ' 9.00
Laundry Room Tray 9.00
City/State Zip Phone Unnal 9.00
N ,/,, Other Fixtures (Specify) 9.00
� GU, a. /"lv ✓'/ 9.00
• Contractor Mailing Address ,/i Suite
9.00
/L• r S) ALl Kiwi
G
-
ay/State Zip Phone 9.00
'7igk►^G( O1 4 /zL(_•p, 9.00
Oregon Const. Cont. Board Lic.5 Exp. Data 9.00
AAA Copy of OZ. -7 k ‘L 6 04/41 9.00
Current Plumbing Uc. S - Exp. Date Sewer - 1st 100' 30.00
u """' 7•66• 617014`7 Sewer - each additional 100' •
COT Business Tax or Metro * Exp. Date 4 25.00
nevi , //-/-17 Water Service - 1st 100' I 30.00
I Name Water Service -each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Of 11Aatting Address 1 S�. ;e Storm & Rain Crain - each additional 100' I 25.00 I I
! Mobile Home Space 25.00 I
Engineer I Cry/State Zip I Phone Commercial Sack Flow Prevention Device or Anti- 25.00
Pollution device
Osumi. watt New 0 Addition 0 Alteration 0 Repair fit Residential Backflow Prevention Device' I 15.00
to be done: Residential Non- resaential 0
Any Trap or Waste Not Connected to a Furture 9.00
Additional desctpt:an of work I
Catch Basin 9.00
insp. of Existing Plumbing 40.00
Per/hr
g use o f Specially Requested Inspecoons 40.00
o uiidirtg or property oenhr
Rain Drain, single family dwelling I 30.00
Proposed use of Grease Traps I 9.00
i pudding or property
QUANTITY TOTAL
Are you capping . moving or replacing any fixtures? Yes Q No 0 Isometric or user siram is requires it Cuanay Total is s 9
(If yes see back of form) 'SUBTOTAL
I hereby ackriowlecge that I have read this application. that the information '5t�
riven s correct not ! am the owner or authorized agent of the owner. and 5% SURCHARGE / a
/tat clans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Data PLAN REVIEW 25'/. OF SUBTOTAL
/....-A / /i/ i/i1 _,.. I 3/2//4.7 P ecurea only I Astute sty. total is' 9 TOTAL i lime
Contact Perss Phone
'Minimum I
-27 -/ i �� / � j krf/ (/� r/l 61-730 Minimum permit fee is S25 • S °/. surcnarge. except Residential SaUcflow
/ (// f ! Prevention Device. which is S15 * 5% surcnarge
i :viststiplmapp.doc 3/56
RECEWED
APR 14 1997
COMMUNITY DEVELOPMENT
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
/2] Date Requested: / 7 A.M. (/ P.M. MST:
Location: / Li-Y5- so h -4.4Yl Ck ak.e011 BUP:
Tenant: Suite: Bldg: MEC: p
Contractor: . :J / / A 11 i I 1 ° / Phone: PLM: / 7— 0/
Owner: ` 'h.C_i Phone: 639 — Q4/ 7 ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFUSlab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer N 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 Cr d Dr Heat Pump Low Volt
Approved ��F Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved . Not Approved
FINAL F 'j FINAL FINAL FINAL
' CC/ .
CI Call for re' tion Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: Date: c/..2_/ 2 Page of