Permit CITY OF TIGARD
PLUMBING PERMIT
^ DEVELOPMENT SERVI DATE 06/iii�7 -0220
PARCEL: 1S134CD -01100
SITE ADDRESS...: 11665 SW KATHERINE ST
SUBDIVISION - LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK..........: LOT -81 JURISDICTION: TIG
CLASS OF WORK..:ALT 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: Installing a water heater
Owner: FEES
ARTHUR HAAS type amount by date recpt
11665 SW KATHERINE ST PRMT $ 25.00 B 06/11/97 97- 295731
TIGARD OR 97223 SPCT $ 1.25 B 06/11/97 97-295731
•
•
Phone #:
Contractor
GEORGE MORLAN PLUMBING
5529 SE FOSTER RD
PORTLAND OR 97206
Phone #: 771 -1145 $ 26.25 TOTAL
Reg #..: 000027
-- REQUIRED INSPECTIONS '
This permit is issued subject to the regulations contained in the Misc. Inspection
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.
• r
Permittee Si nature: t(Q41%. '/ I
Issued By: • iltUL,.C.IAiii't----1 ■ /
Call for inspection — 639 -4175
:,ITY OF TIGARD Plumbing Application Recd By $-
`= 3125 SW IfiALL BLVD. Commercial and Residential Date Recd 6'i(2 4
°'IGARD, OR 97223 Date to P.E.
Date to NT
;503).6394171 Permit # 11 - 10
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 9.0
Address Street Address J Suite Lavatory 9.00
//66 Q S sw k Neos* Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
J. I - r ! , Water Closet 9.00 '
Name 4r 1 ) //, G�
Y/1 Dishwasher 9.00
Owner Mailing Address //�� Suite Garbage Disposal 9.00
//6.65" S� _ /fed i4 f4 Washing Machine 9.00
City/Sta Zip Phone Floor Drain 2" 9.00
� �R q 72.t3 3" 9.00
Nanfe
4" 9.00
r`
C1
Occupant Mailing Address Suite Water Heater ) 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00
Name
Other Fixtures (Specify) 9.00
� /
r �) . .G "1. Rwf t 9.00
Contractor Mailing Address Suite 9.00
/zSFs Ail A / 9.00
• (Prior to issuance City/State Zip / Phone
applicant must
eg 1 ( ZL / - 7 3F/ 9.00
provide ail O on Const. Cont. Board Lic.# Exp. Date 9.00
contractors 2.73z1 6- /q -i7 9.00
license Plumbing Lic. # / j� Exp. Date Sewer - 1st 100' 30.00
information 2l COc,I 6-30 - 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
Or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
j Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
I Pollution Device
Describe Work New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work e/_ _k ./ 6 - le oliv? (AA H. Catch Basin 9.00
49 ' 1131 4 1 11tr'1►#c rbu✓►\ Insp. of Existing Plumbing 40.00
per /hr
Specially Requested Inspections 40.00
Existing use of l per /hr
building or property Ha-ice
Rain Drain. single family dwelling 30.00
Proposed use of U� / Grease Traps 9.00
building or property ` / 1
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes No El Isometr c or riser diagram is required if 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% SURCHARG
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
I---1:7-:-- I---1:7-:--
'(Idtj'il- l O
/'' Required only if fixture ow, total is ? 9
-- jU (� TOTAL 9
Contact Person Name Phone ZC.�"s
'Minimum permit fee is 325 + 5% surcharge, except Residential Backflow
7 ��1 j (� i GN -130 Prevention Device, which is 515 + 5% surcharge
/03 2 3 5 I: \plmapp.doc 12/96 (dst)
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
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)
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: g 7 A.M. P.M. MST:
Location: S ( ) BUP:
Tenant: ! me. Suite: Bldg: MEC:
Contractor: , iA , `
ii RW , Phone: 6,�L- 6 rq.s PLM: q7 od..D-O
`
Owner: ` Phone: 5 — 6 1 ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING ' MECHANICAL ELECTRICAL SITE
Site Post/Beam : - Post/Beam . Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab , j 1 Rough -In Ceiling Water Line
Slab Framing. Top Out o n Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer , /9l Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Dram A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved .� ov =.. Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
•
CI Call for reinspection 0 Reinspection fee of $ required befo next inspection 0 Unable to inspect
Inspector: Date: 12` 92 Page l of I
•