Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMPING PERMIT
��Ili�d6hfll� PERMIT # : PLM97 -0194
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 _ DATE ISSUED: 05/29/97
PARCEL: 2 25115BC- 04200
SITE ADDRESS...: 16590 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 /replace 1 water heater in garage
Owner: FEES
JOE HEALY type amount by date recpt
16590 SW KING CHARLES AVE PRMT $ 25.00 TAT 05/29/97 KING CITY
KING CITY OR 97224 5PCT $ 1.25 TAT 05/29/97 KING CITY
Phone #s 620 -3185
Contractor
GEORGE MORLAN PLUMBING
5529 SE FOSTER RD
PORTLAND OR 97206
Phone #: 771 -1145 $ 26.25 TOTAL
Reg #..: 000027
REQUI RED 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 P L M / Un d e r f l o r
approved plans. This permit will expire if work is not started Misc. Inspection
within 180 days of issuance, or if work is suspended for more Final Inspection
than 180 days.
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Per mitt ee Sigrn to e:
/�
Issued By: � �., /... t ires . /.
i
Call for inspection – 639 -4175
.,-. MAY - 29 -' 97 THU 09:43 ID: FAX NO: , . t P02 0.1001 - N , ., - -..
. Rec'el By - IKL, a , a '7
r
.ITY OF TlGARO Plumbing Application
'3125 SW i BLVD. Commercial and Residential Date Rec'a c ,
rIGARD, OR 97223
(503) 639-4171 1 � Dat to ?.e.
l Permit a OST `
' `
Print or Tye Related sWR # �
Incomplete or illegible applications will not be accepted Called
Name of oeveloprrlentlPrtslect FIXTURES (Individual) QTY PRICE AMT
Sink 9.00
Job .. 9.00
Address Street Address Suite
5.40 J t" 1 eA Tub or Tub/Shower Comb. 9.00
Bldg * City/Slate Zip Shower Only 9.00
Water Closet . 9:00
Hamel c f) fit Dishwasher 9.00 hi
Owner Malting Address r` Suite Garoage Disposal 9.00
M cob ,S.l kv,�, eii, (, Washing Machine 9.00
Ci�IState ( Zip P hone Floor Drain 2' 9.00
. L ll�P� ��' % (26 - 3!S 3" 9.00
Name( e�, ' 4 ' 9.00 •
1 Occupant Mailing Address - Suite Water Heater ? 9.00 1 c b
i• laundry Room Tray ( 9.00
City /State Zip Phone
Urinal 8.00
I Other Fixtures (Specify) 9.00
Name
G,//4,2 9.00
Contractor Mailing Address Suite . • 9.tie
/2 S.5 cw Arlo`[ ktvI 9.00
(Prior to issuance City /State zip Phone 9.00
applicant Must 77 6 472.23
provide alt ' Oregon Conet. Cont. Board tic.* Exp. Date . 9.00
contractors 6247 311 C ._ `t' 7 9.00
license Plumbing Llc. a Exp. Date Sewer - 1st 100' 30.00
information C “',P,L3 - a - jJ - I'L'" Sewer - each additional 100' . 25.00
for COT COT Business Tax or Metro rd Exp, Gate ,
water Service - 1st 100' 30_00
dategase).
Name Water Service - each additional 200' • 25.00
Architect Storm & Rain Drain - 1st 100' . 30.00
or
Mailing Address Suite - Stow, & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
>`nginQ r , Gty /Stets Zip Phone Commercial bade Flow Prevention Device or Anu- 25.00
Pollution Device
Describe work New 0 Addition 0 Alteration O Repair Residential Baek}lew prevention Device* 15.00
i to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
• I Additional description of work / . ' : l� W
lrrt .t Catch Basin . 9,00
' e °lue3y� .4 7 �4. -r° a Insp. of Existing Plumbing 40.00
perthr
Specially Requested Inspecions 40.00
I Existing use, of qq ll per/hr
building or property k-G C. Rain Drain, single family dwelling 30.00 I
Prop4aeC use of l ; , f6
Grease Traps 9,00
building or property, (.�
QUANTITY TOTAL
Are you capping , moving or replacing arty lixti.ires? Yes Fr No 1:] isometric or u ser diagram is required if D Tote= i s > 9
(If yes see back of form) *SUBTOTAL I
I hereby acknowledge that I have read this application, that the information i
given is correct. that I am the owner or authorized agent of the owner, and 5% SURCHARGE l 5 k
that plans submitted are in compliance with Oregon State laws,
Signature of owner/Agent
Data PLAN REVIEW 25% OF SUBTOTAL ..
7 Required only it £aaur Qty. total is > 9 I
-it. i 5 L`l'f TOTAL ca.� S
Contact Person Name Phone
(Z.' -/ 7 3 1
- // /�,��� / - Minimum permit fee is 525 + 5% surcharge, except Residential Backflow
�L / 1/ 1 Prevention Device. which Is 515 + 5% surcharge
63 )!o j I:1plmapp.doc 12/96 (dst)
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: u I S k 1 A.M. P.M. MST:
Location: �,,i� A_J BUP:
Tenant: Suite: Bldg: MEC:
Contractor: Phone: Lg q (p n PLM: 7 7 D /
Owner: Phone: 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 Rough -In Ceiling Water Line
Slab Framing Top Out 14 + Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer (� Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved •pprov- II .Approved Approved Approved
Appr /Sdwlk Not Approved • o , pproved Not Approved Not Approved Not Approved
FINALS -- FINAL FINAL FINAL
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0 Call for reinspectio 0 Reinspection fee of $ - - required-before ,next inspection 0 Unable to inspect
Inspector: Dater , 5A ' Page j of
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