Permit CITY TIGARD PLUMBING PERMIT
,l�� PERMIT #: PLM2003 -00083
DEVELOPMENT SERVICES DATE ISSUED: 3/10/03
�
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16640 SW 72ND AVE B -10 PARCEL: 2S113AD -01900
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install commercial backflow preventer. Located in water service room by So. Loading deck.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 3/10/03 $72.50
PORTLAND, OR 97224 [TAX] 8% State Tax 3/10/03 $5.80
Total $78.30
Phone :
Contractor:
POWER PLUMBING CO
P BOX 19418
PORTLAND, OR 97280 REQUIRED INSPECTIONS
Phone : 503 - 244 - 1900 RP /Backflow Preventer
Final Inspection
Reg #: LIC 52378
PLM 34 -150PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other 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. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Permittee Signature: /11
Issued By: 4 /, �/L/ •� ` _ � 9 Al L , i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
MAR 04 2003 11:33AM HP LASERJET 3200 p.1
•
• Plu i ngPermit Appllcat ion
• . . , - M - i D -0 3 Plermit no.: I`�'CJh obt73 -o Dog`
. - - . �� I of : T i gard : , ; ' V E T o.: ' Budding pe no.: i . Address:13125 Hall Blvd. Tigard, OR 9 7223 Crryofllgarid �� (503) 639.4171 ;A _ r o.. E:cpire date: ;; Fax: (503) 598- 1960 - M 4 ' 2003 . Big 1 Receiptno.: . Lind'use approval• CIT TTGARD Pays nttypc:
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= 1�Jl��li;��>aml
1 1 1'I: 01 1'1.10111
U 18c.:2 famil dwelling ' ` .. sus '�" *' > . nd .. : `0 Muld- fa'iuly '' Tenan ? mptovem ent -
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t] New co�stntcdaa ... . : .
.1011 sI I I: {N101211\ 170\ I I:1:.',( II 1,DI II_ D(0 .pr,.ia1 unt(l ;niation usk.thecl,lia)
021= Total
Job address: ( _ O �r1i � . ,
11 1'.1., • i \' ��Ili._ 111 �
Bldg. no.: Suite no.: (fododes100 ft. 64ireochutifityc nseetlon)
Tax map/tax lot/account no.: SFR 1) bath
Lot • .. • ' Block Subdivision: Y
Project name: ; , " , \ v . Ie • —
City /oamty: _ • ZIP: • 22. ir: Tf fti:.II : 1'
e •.1•. and 1:.....anof work on . - . iA1 . Sited
J� _ • 14P - L Catch basin/area � �ddr��ain III
T! R ' till" 1 . I . 1 MO
. r- D. r.;ll 1. ti t .,1 l 111 _
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drain n0. . ft.
1 1 1 ; ; ' I I I \(. (1)\ 112:11 11)1 -
.l I I r.11 1..11.- 1 . 1
" 'a'' a- ;�Ir.111r�, ill � - Ell .
Fr.77711W14, -.1 1 ., I1 connector —
Oy 1. IMIIIIIIII=M State:OIL ZIP: - .r .. oar sewer ( 1
Phone qy op Fax E-mail: . . , 1 tam sewer (no. 1 • ft.) —
Plumb. bus. reg. no: 3 - �•• f ti;� —
C7CB ao.:. 3 = Fixture or
III
metallic. no.: / 62 .
.:.:11. 1 valve
Contractor's representative signals= r! .41 .�. . a , , _ _ I to Wi lnlAra
Print name: Jo .,,, liSatr6 I : _' Date: .3 . -=10 _ Backwater ve =
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Qty State • v ' ZIP: g72S! _
or 11 r. 1111;1 M
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City: State: ZIP:
Phone: Fax: E -mail: •
Owner installation/residential maintaranoe only: The actual installation . 11 - s)
will be made by me or the maintenance and repair made by my regular ., t 1 r ••, I 1 I ,., ,:
employee on the property I own as per ORS Chapter 447. F
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Name: "ater .- - .
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City: State: ZIP: ..., • 1 =1
Phone: Fax: . E-mail: Minimum fee • I
' Not A Jatiolin o.e soap mat t oil Macao. lot mom lonnmetloe. Bolton This permit application Plan review (at _ 96) $ $
S
O Vira O MawmCnd mipires if a permit is not obtained ,
4S .dlt wed snob= - -- within 180 days after tarns been Stale sur arge (896) .... $
accepted as complete. TOTAL . ..».. S 71, 3 3-
Namedout eitierm awn on age cod -
' s 440461d (660/C014) \ Cootholder Amami „I