Permit A CITY OF TIGARD
DEVELOPMENT SERVICES ,_ DEVELOPMENT SERV PLUMBING PERMIT
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE I ISSUED: 06 /03/977 —¢� 199
:
PARCEL: 2S115BB -04200
SITE ADDRESS...: 16100 SW KING CHARLES AVE
SUBDIVISION ZONING:
BLOCK - LOT - JURISDICTION: KIN
CLASS OF WORK..:REP GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:H2 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: instl 1 water heater /replace existing water heater
Owner: FEES
HELEN BROWN type amount by date recpt
16100 SW KING CHARLES AVE PRMT $ 25.00 TAT 06/03/97 KING CITY
KING CITY OR 97224 5PCT $ 1.25 TAT 06/03/97 KING CITY
Phone #: 624 -8661
Contract or
GEORGE MORLAN PLUMBING & APLIANCES
12585 SW PACIFIC HWY
TIGARD OR 97223
Phone #: 503 - 624 -6895 $ 26.25 TOTAL
Reg #..: 000027
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Rough—in Insp
applicable laws. All work will be done in accordance with PLM /Underfloor^
approved plans. This permit will expire if work is not started Final Inspection
within 188 days of issuance, or if work is suspended for more
than 188 days.
...,,,ALL_____
Permittee Signati e
Issued By: , t „ IA / i . L . L d 4 /
C
/1 for inspection — 639 -4175
JUN -02 97 MON 13: ID: FAX NO: ##O94 P02
-TY OF TIGARD Plumbing Application Recd By
•
:125 -SW BALL BLVD. Commercial and Residential DateRec'a
.7 IGARD, OR 97223 Date to P.E.•
_
503) 639 -4171 11-11 Date to DST
C Permit a l 9 7_ p 1 1
Print or Type Related SWR a
Incomplete or illegible applications will not be acc called
•
Name at Developrttent/Proied FIXTURES (Individual) QT PRICE AMT
j Jpb ' Sink 9.00 '
I Address Street .Suite Lavatory
fo j{X s `[i4 elutki To or Tub /Shower Comb. 9.00
I Bldg z /S{a ?i� Shower Only 8-00
Name � In r •
/ 7 2 2C1 water Closet 9.00
l icleyi r /lq Dishwasher 9.00
Owner htailiri9 A4dress r I Suite Garbage Disposal - 9.00
/6(&) 'L k ' � l avns er Washing Macnina 9.00
City/State 9 Zip Phone Rota' Drain 2•
L //�,� i
. N L-lz G4 ��zzll 7ti - 9.00
Name (( 3' 9,00
f t - .sue 4' - 9.00
Occupant Meiling Addreoa T . Suite Water Heater f 9.00
Laundry Room Tray ( ' 9.00
CtrylSlate AS PdlonA Urinal _ 9.00
Na. me Other Fixtures (Specify} 9.00
�?1, > /� o Lei + IJrkKi 9.00
Contractor tvtailin_g Address .Suite
9.00
J Z s• S4, P f %
(Prior to issuance City/State 21 1 Phone 9.00
applicant must 7Z2 3 G � i_ '7 9.00
- t g
provide ail Oft) on Conat, Cont. tioerd Lic.# Exp. pate 9.00
contractors �a 771 G.. r - 7 900
Hoene{ Plumbing Lic. it ExP, Data Sewer - 1st 100• 1 30.00
information Z A� gib - 1 -
for COT COT Business Tax or Metro S ' Exp. Data
Secret each additional 100' 25.00
database). Water Service - 1st 100' 30.00
Name Water Service - each additional 200 25.00
Architect Storm & Rain Drain - at 100' 30.00
or Matting Redress Suits Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
-
Engineer City/State Zip Phone Commercial Back rtow Prevention Device or Anti 25.00
Pollution Device
scribe work New 0 Addition 0 Alteration 0 Repair O Residential gackflow Prevention Device- ' 13.00 }i
Os none: Restoentlat 0 Non-residential 0 ° Any Trap or waste Not Connected to a Fixture 9.00
.!- cioItIDtltll deeciiption of work c�,l�,.r'< ,4, N'� '!r 6,,,,,i,„,
�°b ( C atc h B asin 9,00
"1414
.14. i'l 'liW Cfg d
insp. of Existing Plumbing 40.00
per/hr
a• is ;iris use of /-71/214C( Specially Requested Inspections • 40.00
adtng or property per/hr
Rain Drain, single family dwelling • 30.00
'roposed use of A / `ce Grease Traps 990 -'
ending or property- c-�l
QUANTITY TOTAL
-re you capping . moving or replacing any flrtiures7 Yes 9 No p Isometric or rises diagram is rewired if Quanity Total is ' 9
(If yes see back of form)
'SUBTOTAL
• Hereby acknowledge that I have read this application. that the Information ,• /0
von is Correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE /
i :iat plans submitted are In compliance with O regon State Lawn. !r
Signature of Owner /Agent Dat PLAN REVIEW 25% OF SUBTOTAL -
�-� Required ony rt focture qty. - -- /�'' l'� total is 9 TOTAL LLB,[
. : %ontact Parson Nam* Phchne
' 'Minimum permit fee is $25 + 5% surcharge. except Residential Backftaw
�'d',d�1 G �� Prevention Device. which is 515 1- 5% surcharge
/(1 ig? I:\plmapp.doc 12/96 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 7 -).-1-q 7 A.M. P.M , t/ MST:
Location: ( / C d -u) 4,4, C� 1, Af tzt- T/JJ 1 <-C , BUP:
Tenant: Suite: B1 g: MEC:
Contractor: /�, Phone: PLM q 7- 9 ?'
Owner: /( i., � // � P hone: di f , ELC:
ELR:
- SIT:
BUILDING BLDG "(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam •os , i - •I 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 Dra 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 0 • proved Not Approved Not Approved Not Approved
FINAL ( FINAL - FINAL FINAL FINAL
I
CI Call for reins cti O Reinspection fee of $ required before next inspection ® Unable to inspect
Inspector: � '� ( %� Date: 1/9
Page / of