Permit CITY OF TIGARD
��„ „�� DEVELOPMENT SERVICES PLUMBING PERMIT
�N j
PERMIT # • PLM97 -0231
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/16/97
PARCEL: 29111CB -00700
SITE ADDRESS...: 14860 SW 103RD AVE
SUBDIVISION • DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK • LOT -6 JURISDICTION: TIG
CLASS OF WORT'...: REP 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 • 1 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)...: 0
Remarks: Replacement of gas water heater with like kind.
Owner: FEES
JOSH WOLF type amount by date recpt
14860 SW 103RD AVE PRMT $ 25.00 DRA 06/16/97 97- 296053
TIGARD OR 97224 5PCT $ 1.25 DRA 06/16/97 97- 296053
Phone #:
Contract or
GEORGE MORLAN PLUMBING
5529 SE FOSTER RD
*SEE ALSO MORLAN PLUMBING*
PORTLAND OR 97206
Phone #: 771 -1145 $ 26.25 TOTAL
Reg #..: 002007
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Top -out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Gas Line
applicable laws. All work will be done in accordance with Misc. Inspection
approved plans. This permit will expire if work is not started Final Inspection
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 -0801 -0010 through OAR 952 -0001 -0880. You lay
obtain copies of these rules or direct questions to O1J C by calling
(503)246 -1987.
Issued B y .�•.�- L44' Perm i t t e e Signature :
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
'Y OF TIGARD Plumbing Application Recd B� a �-►'�
-3125 SW HALL BLVD. Commercial and Residential Date Recd U X 1 7
iGARD, OR 97223 Date to P.E
Date to DST
'503) 639 -4171 Permit # P1_M97-093/
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) QTY PRICE AMT
Sink 9.00
Job
Lavatory 9.00
Address Street Address Suite
/L/ Sj /6 Ted 6V1 Tub or Tub /Shower Comb 9.00
Bldg # City /State Zip Shower Only 9.00
/ , Water Closet 9.00
(J
OS bs Wbl f
Dishwasher 9.00
Owner Mailing Address //', / Suite Garbage Disposal 9.00
/qf b jl.�l /V7rA Au Washing Machine 9.00
City/Stateey/ Zip�� Phone Floor Drain 2" 9.00
Gf'w ! 9z2 t/ 3" 9.00
Name 4• 9.00
Occupant Mailing Address Suite Water Heater 1 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00
Name ,�� l Other Fixtures (Specify) 9.00
� �• /� G • /�!�/l ddi �/ 9.00
Contractor Mailing Address ., f, Suite 9.00
l G rt.0 L C' 7/ f 9.00
(Prior to issuance City/State Zip Phone
9.00
I applicant must 77 1 '�ZZ7 CZ <fr
I provide all Ore9ton Const. Cont. Board Lic.# Exp. Date 9.00
contractors 0 Z Z 74-) 6-14-614 9.00
license Plumbing Lic. # Exp. Date Sewer - 1st 100" 30.00
information .2 G �p()(6 / 7 -47
Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
database).
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
i or Mailing Address Suite
Mobile Home Space 25.00
1 Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
"Tescribe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00
'o be done Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work / /_ h 4 Catch Basin 9.00
&e&'1474' �p ( fil Insp. of Existing Plumbing 40.00
per /hr
Existing use of a Specially Requested Inspections 40.00
building or property` � 5e per /hr
Rain Drain, single family dwelling 30.00
i Proposed use of Grease Grease Traps 9.00
building or property
QUANTITY TOTAL
Are you capping . moving or replacing any fixtures? Yes No ❑ Isometric or user diagram is required a Quanity Total is > 9
(If yes see back of form) 'SUBTOTAL
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
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner/Agent Date PLAN REVIEW 25% OF SUBTOTAL
Reaw I fixture red only qty total is >_ 9
G - �/ � TOTAL 26.7. S
Contact Person Name Phone
I J 'Minimum permit fee is S25 - 5% surcharge, except Residential Backflow
! ! f1'� CZtl. 70 ) Prevention Device, which is 515 + 5% surcharge
I:'•plmapp.doc 12,96 (dst)
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced I 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:
I:`plmapp.doc 12 96 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
,..
Date Requested: 03 / /0 - 0 _ ( 7 0 > P.M MST:
Location: / 60 . /D ow-e , BUP:
Tenant: y� ` Suite: Bldg: MEC: p
Contractor: ..)&eCJ - c'y p) 0 / LV L Phone: PLM: ! 7 /
Owner: . 'ii t" #L'.... Li 4. Phone: div , a — 4 ELC:
. t I /_
/'_ 1 A, - 1 Ar4t‘ ' ay. IVY . / ∎L _ � . / !1f.!� ELR:
I
SIT:
BUILDING BLDG (con't) PLUMBING, MECHANICAL ELECTRICAL SITE
Site Post/Beam ow seam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Dm' A/C UG Slab
Shear /Sheath Fire Spklr /Alm Craound Dr Heat Pump Low Volt
Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL (Ctila. FINAL FINAL FINAL
I
O Call for reinspection 0 Reinspection fee of $ required before next ' tion 0 Unable to inspect
� 77L ' Date / / J/ 9 Page / of -
6/16/00 Activities for Case #: PLM97 -00231
3:18:26 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 6/16/97 DRA PASS DST 6/16/97
PLMA005 Create Permit 6/16/97 DRA PASS DST 6/16/97
PLMA799 Final Inspection 10/3/97 MS PASS MRS 10/3/97
PLMA740 Misc. Inspection 6/16/97 DST 6/16/97
PLMA737 Gas Line 6/16/97 DST 6/16/97
PLMA725 Top -out Insp 6/16/97 DST 6/16/97
PLMA050 (F) Issue permit 6/16/97 DRA PASS DST 6/16/97
PLMA800 Case Finaled 10/3/97 MS PASS MRS 10/3/97
Page 1 of 1