Permit C1TY TIGARD PLUMBING PERMIT
ul DEVELOPMENT SERVICES PERMIT #: PLM2002 -00011
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/18/02
SITE ADDRESS: 11505 SW HALL BLVD
PARCEL: 1S135DA-01400
SUBDIVISION: ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: A2.1 FLOOR DRAINS; 9 TRAPS:
STORIES: 2 WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: 2 GREASE TRAPS: 1
LAVATORIES: 6 OTHER FIXTURES: 6
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 8 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: TEMPLE: Plumbing work for new temple. Other fixtures are: (2) drinking fountains, (3) hose bibs and (1) sump.
FEES
Owner:
Type By Date Amount Receipt
BRAHMAPREMANANDA ASHRAM/TEMPLE PRMT CTR 9/18/02 $776.80 27200200000
11515 SW HALL BLVD PLCK CTR 9/18/02 $194.20 27200200000
TIGARD, OR 97223 5PCT CTR 9/18/02 $62.15 27200200000
Phone 1: Total $1,033.15
Contractor:
D & A GENERAL CONTRACTOR INC
3100 TURNER RD SE #204
SALEM, OR 97302 REQUIRED INSPECTIONS
Phone 1: 503 - 581 -8036 Water Line Insp
Reg #: LiC 145089 Rough -in Insp
Underfloor /Underslab
PLM 24 5089
Top -out Insp
Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: ;� �, I /.1 Permittee Signatu
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
N.4111 .w2aooa - o oa 4/9 -
Plumlbing Permat Applica on �� � t � . *� q a Q
b ^ Date received:' . / D - Permit no.: ■ _ „,,, •
, � t f, City of Tigard. y _
g Sewer permit no.: Building permit no.:
�� Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 - Date issued: By: Receipt no.:
Land use approval: e-,---727e e-,---727e / P Case file no.: Payment type: I I I
C a If ' :: . t , ,} .0 .:; ; ; „, � � ` *s TYPE`OF PERMIT ._'� ° :e . A.� f�s�. J : W-k .. , : .
'ti= .'� � i'fi a � , , ,� ' �` '�� x - t r �,�r :�,+;, .+ 3 a . �M � n- � � ,,;...;.,,11.•
, '
❑ 1 & 2 family dwelling or accessory Commercial /industrial ❑ Multi - family ❑ Tenant improvement i
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
r''Aiyk 'iV `jai . .. S erg t Y�; r . ,r;A6,�' w -' -” is K u ...d' s s <. i
�.� ����r � �,„ ti ��,. ,JOB SITE INFORMATION, a�t� ,�•s ;�. � ,r �= t r. � ,� FEE J SCHEDUIE;(fo`r spec>Ial mfo>rmaton,use cti`eckpst) a- A
Job address: 115 15 ......u.)• H /S.1_ L it, Ly ,- le.v z'b ' F 4i7223 • Description Qty. Fee (ea.) Total
New 1- and 2 -family dwellings only: .
Bldg. no.: I Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 1 G v 1 5 ois . eftebi (s; 2 . SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath
Project name: 1EIAH MA rr EHAJ4 40 / *f M ' SFR (3) bath
City /county: -- '1' 1 Gl -? 17 t I ZIP: OR a 7 'L . Each additional bath/kitchen
Description and location of work on premises: — a_y . Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
j Footing drain (no. lin. ft.)
{{ ",'M ; 3 r itPLUMBING'CONJRACTOR4. i” '`Y"'�t $t 0,,,,-.;1;;;.-4, `,^ Manufactured home utilities
Business name:" - T N-- fq f Ca. flQTo Manholes
Address: Rain drain connector
City: 'State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: 1E-mail: Storm sewer (no. lin. ft.)
CCB no.: 'Plumb. bus. reg. no: Water service (no. lin. ft.)
' Fixture or item:
City /metro lic. no.: Absorption valve
Contractor's representative signature: Back flow preventer 1 I 4 16.40
Print name: Date: . Backwater valve
`,. 3 '- :CONTACT: PERSON ;g ` "' Basin . ato 7 A - I CA .4 9.4
Clothes .t.`er
Name: Dishwasher J I , it /6,60
Address: • Drinking fountain(s) / A ,13.ao.
City: 'State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
;2 r . C s,, ' r 0:4-64.4 c. r } OW✓l t v. a t ? ' :0' f m ' .. ; :1;N:'-''''''.'i
a "'`i' Fixtur cap
Name (pint): \/. e 44 1 t LGZ Floor drains/floor sinks/hub A( AI ,/ 7 . n N9.4/0
Garbage disposal
Mailing address: 1 1 r C J • 4-1,4,--L, 1-- I—u b - Hose bibb v 4 419•$0
City: 1- 4.-F -P , I Stated ° J ZIP: e:472. 23 _ Ice maker 3
Phone: 9 e- ax: I E -mail: Interceptor /grease trap t/ i 0 /'910
Owner insta lation/resi ential maintenance only: The actual installation Primer(s) .
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) ✓ (p It gQ•
employee on the property I own as per ORS Chapter 447. Sinkk ), basin(s), lays(s) ✓ %� ti .9. 8 0
Owner's signature: Date: Sump ✓ I o • 16.40
Tubs/shower /shower pan -
�' ;.. e .(: ' .a ► 1 : r t T ` Urinal V A tt 33,0
Name: • . Water closet of 8' 0 13 ,2, 80
Address: Water heater io a tf ,3?,. st
City: 'State: ZIP: Other: • ' .
Phone: Fax: 1E-mail: Total IN
Minimum fee P
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This $ a(o • r s permit application
Plan review (at 9,, %) $ / q 4, 9-0
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been TOTAL charge (8%) $ % w2.
Expires y
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6I001COM