Permit CITY OF TIGARD
• % � , ,/ � � DEVELOPMENT SERVICES PLUMBING PERMIT
� �'L 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE I ISSUED: 05/19/97 -0180
0 , PARCEL: 15134BC -90007
SITE ADDRESS...: 10927 SW 121 AVE NING: SUBDIVISION • WOODSPRING CONDOS R -7
BLOCK LOT •7 ISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBOCE HOME SPACES.: 0
TYPE OF USE -SFA 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: REPLACE ELECTRIC WATER HEATER
Owner: FEES
PATRICIA MCGANN type amount by date recpt
10927 SW 121ST PRMT $ 25.00 JMH 05/19/97 97- 294579
TIGARD OR 97223 5PCT $ 1.25 JMH 05/19/97 97- 294579
Phone #:
Contract or
GEORGE MORLAN PLUMBING
5529 SE FOSTER RD
PORTLAND OR 97206
Phone #: 771 -1145 $ 26.25 TOTAL
Reg #..: 000027
REQUIRED INSPECTIONS
This per.it is issued subject to the regulations contained in the Top —out 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 permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Perm it tee Signature: - a— C T"
Issued By:
n- /�►� �`"i/I YL
Call for inspection — 639 -4175
CITY OF TIGARD Plumbing Application Recd By
1 3125 S,: WALL BLVD. Commercial and Residential Date Recd 7
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171 ���� 7 �� 7 Date to DST
Perils pL wig 7- p/5 -D
Print or Type Related SVR s N/.
Incomplete or illegible applications will not be accepted Called
- no
Name of Development/Project . FIXTURE&(IndiVidual) '° y.r ; rAti gag 4.3VS.E: to
Job Sink 9.00
Address Street Address Suite Lavatory 9.00
) aq Z'7 SW J .i St Tub or Tub/Shower Comb. 9.00
Bldg I City/State Zip Shower Only 1 9.00
TI lsA la.p 1'72.1.3 water Closet
Name 1 9.00
PA'rf2,L(.! I�tc N Dishwasher 9.00
Owner Making Address - Suite Garbage Disposal
101 Z7 s k...) l 2I y *' Washing Dishing Madtine 9.00
City/State
Ti L Ana° 4 11 - 1, - Lo SID- 141a Floor Drain 3' 9.00
Name _ 3 9.00
.5A-7 l 4' 9.00
Occupant Marling Address Suite Water Heater 9.00 J
Laundry Room Tray 9.00
City/State Zip Phone Urinal
9.00
I Name Other Fixtures (Specify) 9.00
li lbat.. 1n ort..4 Pj Gr 9.00
Contractor malting Address Suite
11.. s3 s)...) plc. H-L47 9.00
(Prior to issuance City/State Zip Phone 9.00
applicant must T1 4:1Al2(19 71-44. (01 '13 8 1 . 9.00
provide all Oregon ?3 Cont Board tic.* Exp. Date 9.00
contractors 1 't 141
license Plumbing UUc. * Exp. Date Sewer - 1st 100' _ 9.00
i information ?4 . (t O 'Q (/ (3o 11t' 30.00
Metro*
- each additional 100 25.
! for COT COT Business Tax or Metro
Exp. pate Water Service - 1st 100'
database). I ctlo ( I 1 ' 1 30,00
Name Water Service - eadt additional 200' - Y5
Architect Storm & Rain Drain - 1st 100' 30
Or Mating Address ' Suite Storm & Rain Drain each ea additional 100 25.00
Mobile Home Stye 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
escnbe work New O Addition O Alteration O Repair Residential Baddlow 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 works
0..../ C ctt Basin 9.00
��� � N ' - ' Insp. of Existing Plumbing 40.00
� per/hr
'Existing use of / Speaally Requested Inspections 40.00
!ding or property 711�Z1rt c.." per/hr
Rain Drain, single family dwelling 30.00
:csed use of - Grease Traps 9.00
cling or property
QUANTITY TOTAL . t __
, re you Capping , moving or replacing any Tortures? Yes No 0 1 _ Isometric err riser diagram is requked d Quaney Taal is > 9 ;;.; _? -*
11f 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 - .-- - -
hat clans submitted are in compliance with Oregon State Laws.
Signatu of Owned gent _.. - Date PLAN REVIEW 25% OF SUBTOTAL . _
5)i'tfrr Reourso only R fixture sty. toW is > 9 '
TOTAL ;; -
.)mast Person Name Phone
'Minimum permit fee is 525 + 5% surcharge, except Residential Backtlow
Prevention Device. which is S15 + 5% surcharge
I: \plmapp.doc 12/96 (dst)
•I / 1 • • • • • ►•
.
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)
;OMMENTS REGARDING ABOVE:
l: \plmapp.doc 12196 (dst)
5/10/00 Activities for Case #: PLM97 -00180 EXPIRED
1:04:38 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA007 Application received 5/14/97 JMH RECD J *H 5/19/97
PLMA011 Create Permit 5/14/97 JMH J *H 5/19/97
PLMA799 Final Inspection J *H 5/19/97
PLMA725 Top -out Insp 5/19/97 J *H 5/19/97
PLMA050 (F) Issue permit 5/19/97 JMH PASS J *H 5/19/97
PLMA845 Request inspection research 3/28/00 JMT DONE No Hold JMT 3/28/00
PLMA850 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00
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