Permit CITY OF TIGARD PLUMPING PERMIT
..' %1 � ,� DEVELOPMENT SERVICES DATE ISSUED: �`i� -0035
Tigard, ( )
PARCEL: 25 1O2DC- 02300
SITE ADDRESS...: 09265 SW MC DONALD ST
SUBDIVISION....: EDGEWOOD ZONING: R -4.5
1 BLOCK • LOT •15
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 • 0 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)...: 100
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installing 100' of waterline
Owner: FEES
ARLIE MAWHIRTER type amount by date recpt
9265 SW MCDONALD ST PRMT $ 30.00 B 02/06/97 97- 290032
5PCT $ 1.50 B 02/06/97 97- 290032
TIGARD OR 97224
Phone #: 639 -6645
Contractor:
OWNER
Phone #: $ 31.50 TOTAL
Reg #..: 99999
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 Final Inspection
applicable laws. fill 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 sore
than 180 days.
Per'mittee Si ture: /4 N
Issued By: . .
Y �.
Call for inspection•— 639 -4175
'TY OF TIGARD Plumbing Application Recd By ' ftiu�
125 SW'HALL BLVD. Commercial and Residential Date Recd .2-' 7
;";GARD, OR 97223 Date to P.E.
Date to DST �,y�
' 7 03) 6394171 Permit # �1 !"` IOW
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 9.00
Address Street Address J Suite Lavatory 9.00
2 S , ( . W r1 a 1.1 , I Tub or Tub /Shower Comb. 9.00
Bldg # City/State Zip Shower Only 9.00
TM `i 'r " < it . 97 2 y Water Closet 9.00
Nam
/ (l Y - ( Dishwasher 9.00
' Owner Mailing
Address Suite Garbage Disposal 9.00
S arr► -e' Washing Machine 9.00
City/State Zip • gope 4/ K � Floor Drain 2" 9.00
IP) J Jd/'► 3" 9.00
Name
S. art) 4" 9.00
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
•
City/State Zip Phone Urinal 9.00
Other Fixtures (Specify) ' 9.00
Name
5 / •-- 9.00
Contractor Mailing Address Suite 9.00
9.00
(Prior to issuance City/State Zip Phone 9.00
applicant must
I provide all Oregon Const. Cont. Board Lic.# Exp. Date
9.00
contractors 9.00
license Plumbing Lic. # Exp. Date Sewer - 1st 100" 30.00
information Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00 2�1 ,N,�1l
database). .!/ �( J
Name Water Service - each additional 200' 25.00
Architect Storm 8 Rain Drain - 1st 100' 30.00
Or Mailing Address Suite Storm 8 Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
'Describe work New 0 Addition 0 Alteration 0 Repair AN Residential Backflow Prevention Device' 15.00
to be done: Residential - Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
additional scri tion of work
�n �deH i 2 Gv to / q- T a ( . L i (.( Catch Basin 9.00
(1 ti 4 A Insp. of Existing Plumbing 40.00
'�, 1' per /hr
Existing use of _ Specially Requested Inspections 40.00
'auilding or property A e_ .S ( e n C 2 per/hr
Rain Drain. single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property .5 rrt e
QUANTITY TOTAL ' .3d ,d0
': Are you capping , moving or replacing any fixtures? Yes ❑ No,Q' Isometric or riser diagram is required it Quanay Total is > 9
(If yes see back of form) 'SUBTOTAL
! I hereby acknowledge that I have read this application, that the information 5 % SURCHARGE / S�
. given is correct, that I am the owner or authorized agent of the owner, and
that plans submitted are in compliance with Oregon State Laws.
Si lure !Owner gent tt -� Date PLAN REVIEW 25% OF SUBTOTAL
9 9
� ^ Required only d fix ture qty. total is? 9
•
w � � _ __n 7 TOTAL l.Sb
Contact Person Name Phone .
-Minimum permit fee is 525 + 5% surcharge. except Residential Backfiow
S A M r 63c-6 -6 6 q
Prevention Device. which is 515 +. 5% surcharge p
I:\plmapp.doc 12/96 (dst)
I
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory r
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garb Disposal
Washinachine
Floor Drain 2"
3"
II
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
■
I: \plmapp.doc 12/96 (dst)
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Busi : 639 -4171
Footing Rain Drain Cover /Service NA1P ---
Foundation iron- Ceiling - Plum - b.
Post/Beam Mech. Shear /Sheath Framing
PIbg.Und /FIr /Slab Plbg. Top Out Insulation _
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk . Reins. f '
Other: /00 / U 1'4`( "�
Date: a -- /U - 97 A.M. P.M. Entry: ,, /�
Address: 9 ;24 S /,) .W c � c, l_ Ilea
Tenant: // �� � rr�� Ste: MST:
[/iJ7& �I4b(,J h /R 7-6--)C BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTION : .AAREE R 'JU RED;, ELR: •
W % "F Alf110
C < r1 42 5 cc/I ! // /~
, U — biLe e) ef • ,� // 1...t/ d2
/A' Sf e. rte.:
,--_ /4' /e . -'---
In pector: Date?//0 (79
In
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO