Permit - CITY OF TIGARD
PLUMBING PERMIT
hi ,_; J � 1 1 DEVELOPMENT SERVICES P # • PLM97 -0024
13125 SW Hall Blvd., DATE ISSUED: 01/29/97
PARCEL: 15136DB —®0100
SITE ADDRESS...: 11543 SW PACIFIC HWY
' SUBDIVISION • ZONING: C —G
BLOCK • LOT •
CLASS OF WORK..:REP GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M 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)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 100
Remarks: Replace 6' of storm drain line
Owner: FEES
US BANK type amount by date recpt
PO BOX 8837 PRMT $ 30.00 JSD 01/29/97 97- 289614
SPCT $ 1.50 JSD 01/29/97 97- 289614
PORTLAND OR 97208 EXPIRED
#: 275 -5196 RED
Contractor: I �
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM OR 97030
Phone #: 239 -8801 $ 31.50 TOTAL
Reg #..: 049418
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Storm Drain Insp
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 sore
than 180 days.
Permittee Sig atur
oile
Issued By:
Call for inspection — 639 -4175
- ` W ' - -`i;ti :'.: is Mme - • - r'r7 4 �t; �;. _
plumbing A � iication '�`'° a ''
.1 my OF 71GARD 9 AA Date Recd / z�
• 1 3123 S `r'IALL BLVD. Commercial and Residential Date to P.E. -
TIGARD, OR 97223 Date to DST
(503) 639 -4171 permits P/-'- 9� vow
Print or Type Related SWR0 97
Incomplete or Illegible applications will not be accepted Called ( Z
Name of Development/Proieet
FIXTURES (Individual) QTY PRICE AMT
Job • (A5 V____ M Sin k 9.00
Address t A ddress Suite L avatortt • smo
3 (_.J Tbc Tub or Yublshawer Comb. 9.00
•
d g 0 .. CltylState p, Shower Only 9.00
I 1 �� 0� water Coast 9-00
J '
Name C ' 7`l `-K - Dishwasher 9.00
(1 Garbage Disposal 9.00
ailing Address Suite
Owner
p l gg b'7 washing Machine 9.00
CityAa � Phone C Floor Drain 2' g•
I '-i 3 1 n 61 Z 7-- C- S I% 3- 9.00
-- Name ..
4• 9.00
`'� - te t ieatu 9.00
Occupant Mailing Addreea Suite _
Laurrdry Room Tray 9.00
CR)nState Zip Phone udnel 9.00
Daher Fisiures (Specify) 9.00
f iAez 1 n ort-L ..aTh 2X U � - 9.00 Contractor ailing Address S lW a 9.00
ZZ LA) ta
b� In LA) rd SdaiQ is �_ 9.00
(Prior to issuance t ylSUte Zip Phone 2 °fl - swo I 9.00
apoticant must t) f - 12-Crha1Y1 O '113 - 9.0
provide all Oregon Conet. Cont. Board Liam Exp. Date ,--.-_
contractors 1- 4 l 4s " 115 IGi7 9.o0
license Plumbing Lim 0 Exo. Date - 73 ow' -1 et 100' 50.00
information - 533 P G3 ID 1 c�l ] Mister - each adattlonat 100' 25.00 '
for COT COT uamass Tax or Metro 0 Exp. Da 30.00
database). 3O�s dL t Ctel way s. - 1111air
Name XP Water = as - each sdditiona1200' + 30 00 ri 25.00 `
-
Architect Ltomt & Rain Crain -1st too' ti �'
• Storm Rain Cain - each aadnta+al 100' 25.00
a lli n Add ress Suit-
or g - Mile Home :apace 25.00
Engineer GtylState Zip Phone • mmetaat = r* Prevenson Device or Anti 25.00
Pollution Device
: Deaotoe worts New 0 Admtlon 0 Alteration 0 RepairX Thesidentiai Sadttlow Prevention Oevioe 13.00
to be done: Residendel 0 Non- re3ldendal A _ An Trap or Mate Not Connected to a Flxture 9.00
Additional description of work - Colors Elwin 9.00
r Q49 ) l c p 5l7 '' C �� insp. of Existing Plumping 40.00 parthr
g yp al�sll'�y Requesleo Inspections 0
Existing use of � ` �� �„ n pertly
auilding or property C•_ '
moth single family awaiting 30.00
I Proposed use of
Grease Traps 9.00
1 budding or progeny QUANTITY TOTAL ‘
• Are you Copping . moving or replacing any }�alires? Yee a No (Id_ Isomeric a rearms disarm is s Qus+wy Toter is s 9 1
• of yip see back of fermi 'SUBTOTAL '=
i Hereby acknowledge mat I have reed this application, that the information 6 °l6 SURCHARGE §.' given is carreet that I am the owner or authorized agent of the owner. and
;Hat plans submitted are in compliance with Oregon State l-awe. PLAN REVIEW 25% OF SUBTOTAL
.• nature e o GwnerlAgent Oa catty ears= rarer ears= is >_ 9
e l ` in 61 i/2 J hemmed TOTAL_ - 315e
1
� elm Parson Name p Pitons Minimum permit fee is 525 surcharge. except Residentisi Bat low
3 u i 1 1 ) C oi'I €Y - g SUI Prevention Device. which is 515 4. 5% =Marge •
I :lpintapp.dOC 12/96 (dst)