Permit CITY OF TIGARD
mane, .,� ,t DEVELOPMENT SERVICES PLUMBING PERMIT
�'iG�l PERMIT #.. ...: PLM97 -0039
13125 SW Hall Blvd., Tigard, OR 97223 (503)639 -4171 DATE ISSUED: 02/.10 /97
PARCEL.: »l.S128DC - 1001 •
0 ..
SITE ADDRESS..— : O9335 SW ,LEHMANN ST • , •
SUBDI•VI.SiON....•..;: • LEHMANN =ACRE TRACT ZONING: R-4 5
BLOCK........... LOT. — — — :2
CLASS OF WOK,..: 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.......... 0 CATCH BASINS . - .....: 0
FIXTURES _LAUNDRY TRAYS - 0 SF RAIN DRAINS.....: 0
SINK,.. .. .. ! UR I,NAL.$:a .. .. o.: 0 , GREASE TRAPS;.., .. . , 0.•.
LAVATORIES.....: 0 OTHER FIXTURES....: 0
TUB/SHOWERS, T.LIBISFIOWERS4, .44 : ., SEWER. LLNE (ft)_. ,0,
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS. 6 ..: 1 RAIN DRAIN .(ft)...:. 0
Remarks: Install dishwasher
Owner: FEES —•
MARCIA TOBEY type amount by date recpt
9335 SW LEHMANN ST . PRMT $ 25.00 JSD 02/10/97 97- 290154
5PCT $ 1.25 JSD 02/10/97 97- 290154
TIGARD OR 97223
Phone #:
Contractor :7- - -•
ANCTIL PLUMBING INC
16900 SW MERLO
BEAVERTON OR 97008 _- ____ -___
Phone #: 503-642-7323 $ 28.25 TOTAL
Reg #..: 24184
REQUIRED INSPECTIONS --- - --- --
This permit is issued subject, to, the_ regulatiops „contained Misc. Inspect.i.on
Tigard .,Municipal . Code., .State -•of Ore. Specialty ._ Codes and all other: . .. Final I n s pert i on
applicable laws. All_work will. be One .in accordance „with
approved - plans'. • This'pereit will expire if _workds:not started; • •
within 180 days• of• issuance, or if. work is suspended for• ®are° •. • .
than 180'days. • . „ • .. . . .
Permittee
Issued By
_, Call for inspection – .839 - 4175
CITY OF TIGARD Plumbing Application Re`'dBy /------,
Date Recd CD C (09
13125 SW HALL BLVD. Commercial and Residential Date to P.E. 07- -C
TIGARD, OR 97223 Date to DST
(503) 639 -4171 Permit P t 9' - 0-0 39
Print or Type Related SWR #_IZE___
Incomplete or illegible applications will not be accepted Called
Name of Devlopment/project = , , 3 flew' , Single Fami(y "Residences OnlMvtRi � `� :"1.'4N:
Job *- x f v '�" _�' 'a, :4- Y4 � r
C 1 BATHHOUSE $140 00 � 2 BATH HOUSE $ l95:00 ¢ 4
Address treet Address Suite '- ... 0 3 Hp E,$225` - t ` °��,,,
� w Sly � m� Fee ni:44es ap:plunibing ,buns intthe dwelling and =ttteairsti100 feet'of 7
•ML.4 °�3e's:.b" ^ «r?^ Ya.'^.f'° 3.. � '� .x^ y " e � Wy .� ( '
Bldg # City/State / . /J to k Zip water service sanitarysewer and storm sew er See fe�"es bed w NMk,
r ' y e AV-' 41-4- V tom ¢ ,�, x t 3' � 1V,
Name / FIXTURES (individual) QTY PRICE AMT
/ �� - 145t Sink 9.00
Owner Mailing Address E i te Lavatory 9.00
Tub or Tub /Shower Comb. 9.00
City /State Zip Phone
Shower Only 9.00
Name Water Closet __ 9.00
Dishwater � 9.00
Occupant Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9,00
City /State Zip Phone Floor Drain 2" 9.00
3" 9.00
Name Q
Name eU vVi1/L/ - y .�1�: 4 " 9.00
Contractor Mallln J 64 /0 Suite Water Heater 9.00
��Y Laundry Room Tray 9.00
WIZ . Zip Phone
�. % `.+cf Z ?323 Urinal 9.00
Oregon Const. Cont. oard Lic.# Exp. Date Other Fixtures (Specify) 9.00
Attach Copy of ? L.�/ '(( 9.00
Current Plumb lc. # Exp. Date
License el - / 6pZ !mod P 9.00
Sewer - 1st 100" 9.00
COT Business Tax or Metro # Exp. Date Sewer - each additional 100' 30.00
Name Water Service - 1st 100' 25.00
Water Service - each additional 200' 30.00
Architect Mailing Address Suite Storm & Rain Drain - 1st 100' 25.00
or
Storm & Rain Drain - each additional 100' 30.00
Engineer City /State Zip Phone Mobile Home Space 25.00
9 Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration Repair 0 Pollution Device
to be done: Residential Non- residential O/ Residential Backflow Prevention Device' 15.00
Additional description of work Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
-P; - 5 / ,s -2 A - / v 5 qqPe- Insp. of Existing Plumbing 40.00
-
- perhr - - - - -- --
Existing use of Specially Requested Inspections 40.00
building or property per hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps
building or property P 9.00
QUANTITY TOTAL n�= -
Are you capping any fixtures? Yes 0 No p
Isometric or riser diagram is required if Quanity Total is > 9 47;; ?) t.,
I hereby acknowledge that I have read this application, that the information R , „� ;,
given is correct, that I am the owner or authorized agent of the owner, and SUBTOTAL '..� :'C "::". kM s Vii• - t ' ' -
that pI s submitted are in co pliance with Oregon State Laws. c
Sign ure of Own / 'gen Date 5 /o SURCHARGE Ys „ fir S •
. 04.-___ r -/6 - 9 7 PLAN REVIEW 25% OF SUBTOTAL y t ,� • 1
'
ontact Person Name Phone Required only if fixture qty. total is > 9 - °`ta . 'T,„ N 7
/ TOTAL : : w., „ 'N " : � � S
t/ )114, /11/,'-6Z- i =;= ;:? Vii.
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
i:\dsts\plmapp.doc
Prevention Device, which is $15 + 5% surcharge
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location 3 5 , S W .. Suite MEC
Contact Person Ph PLM 9 7- QOt -,/'
Contractor Ph Coyer — 73_23 SWR
•
Tenant/Owner ma -(0_, % ELC
Retaining Wall ELR
Footing Ace FPS
Ftg on NOT REQUESTED
g FOUND DURING RESEARCH SGN
Slab Crawl Drain Ins NO INSPECTION(S) IN FILE
SIT
Post & Beam �
Ext Sheath /Shear �9�r
Int Sheath /Shear --
Framing
Insulation t / / 0
Drywall Nailing �C /� / /., /.
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING °z, -N ..
Post & Beam
Under Slab
Top Out
Water Service , V
Sanitary Sewetl
Rail
Drains
4,r PART FAIL
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
;ELECTRICAL P
Service
Rough In.
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE `
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
[ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA ��Y %�
Approach /Sidewalk Date �' / Inspector 07, Ext L
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.