Permit 1
CITY OFTIGARD
� � n, 9 , . DEVELOPMENT SERVICES PLUMBING PERMIT
:I+L' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # • PLM97 -0362
DATE ISSUED: 09/03/97
PARCEL: 15136CC -00100
SITE ADDRESS...: 11765 SW PACIFIC HWY
SUBDIVISION • ZONING: C —P
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B FLOOR DRAINS 2 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)...: 0
Remarks: Add two (2) floor sinks.
Owner: FEES
GENERAL MOTORS INC. type amount by date recpt
11765 SW PACIFIC HWY MENU $ 25.00 DRA 09/03/97 97- 298918
TIGARD OR 97223 SPCT $ 1.25 DRA 09/03/97 97- 298918
Phone #:
Contractor
DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND OR 97209
Phone #: 227 -2641 $ 26.25 TOTAL
Reg #.. 000025
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough —in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 - 0001-0010 through OAR 952-0801-8080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued : : . al A A1 A' I Permittee Si 9 nature u ' IQ "' 4
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + ++ + + + ++ + + + + + + + ++++ + + + + ++
7 7- 0 3& 2 -
ITY OF TIGARD Plumbing Application • Rec•d By
3125 SW HALL BLVD. Commercial and Residential -, •
Date Reed
'GARD OR 97223
r Q X ,i j
Date
03) 639 -4171 q DST
Permit tit
`1 $ - I q(c o Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Called
_. fgme of DeveloprnentIProjec2 : F.PCP REB � 4 i . r ifflifffi
Job Chu Will 5 1 ;a-m4 4 A-7 6.4.-4 Sink 9.00
Lavatory
Address stiftgtAdfte, 1 1 10 I�- fil Suite Tub wer b/Sho Comb. 9.00
9.00
Bldg s LC!hl Aate Zip Shower Only 9.00
II ( A < ( - °I a� 3 Water Closet 9.00
Name 'n / Dishwasher 6.PAA t aJ y ,6 ` ! Ce-4∎ D 9.00
Owner Address Garbage Disposal 9.00
0 S S c, J P c4 7 ry1. Washing Machine 9.00
City/State � Zip Phone -- Floor Drain 2' - 9.00
( t 02- Cf l a 13 _ r 9.00
- 4 ' 9.00
Occupant Nailing Address - Suite Water Heater 9.00
Laundry Room Tray 9.00
CttylState Zip Phone Urinal - • 9.00
• Other Fbrturss (Specify) 9.00
Name
f)ei-e C 4 v% 1;IAc -0 G OV S rw 9.00 1 �',
Contractor Mailing Address 9.00
•
1 ( AN) - 6/V-(44 -d/C 9.00
(Prior ii to (Q�a,r�xl GL Phone �� g Ll ( 9.00
provide all Oregonjos3t. Cunt Board Lt.* Exp. Date - 9.00
contractors 10 9.00
license Plumbing Lie.
information a (p a-5 P 6
Sewer - each additional 1W 25.00
d for m asee) COT 8trsiness T or Metro S Exp. Date Water Service - 1st 100' 30.00
Name G � Water Service -each additional 200' 25.00
Architect Storm S Rain Drain - 1st 100' • 30.00
Or Mailing Address Suite Storm & Rain Drain - each additional 107 25.00
Mobile Home Space 25.00
Engineer a to Zp Phone Commercial Bads Flow Prevention Device or Anti- 25.00
- Pollution Device - -
'be work New 0 Addition 0 Alteration it Repair 0 Residential Baddlow Prevention Device' 15.00
done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
- zonal desaiption of worts Catch Basin
/� 9.00
add .2 d' i 6 oi S x s Insp. of Existing Plumbing 40.00
perms
,ring use of Specially Requested Inspections 40.00
ping or properly Rain Drain. single family dwelling 30.00
aposed use of Grease Traps 9.00
Aiding or property
QUANTITY TOTAL 1: - , :,a
Are you capping , moving or Isometric*. riser c .1
Vxng replagng any fixtures? Yes NO � I � is requied Q Quinsy Total is a 9 � .�:;;�r "e `
i s r--: .
(If yes see back of form) 'SUBTOTAL �,: • .. ••_N _� 5
. hereby acknowledge that I have read this application. that the information
riven is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE _ .;="7 I r96
' :la t plans submitted are in compliance with Oregon
regan State Laws.
'rave oofOwnerAgent . Jn' n Date ^� PLAN REVIEW 25% OF SUBTOTAL . - '
y a ' " Q'O� D 2 i, ,Y�% t(3 I �'t /,^/ R eC anh.l6�eae cry. total is 3. 9 - --- - i g.
TOTAL ; - a,
'intact Person Name Phone ` ' o`
*Minimum permit fee is 525.5% surcharge. except Residential Baddlow
t.Gt,a e fl 1„)A10 0 27. 0 3( 0 q/ Prevention Device. which is 515.5% surcharge
I : \plmapp.doc 12/96 (dst)
•
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved..or replaced - .:. .4
Sink
Lavatory
Tub or Tub /Shower Combination -
Shower Only -
Water Closet _
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2" - -
3" .
- 4" .
Water Heater
- Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
-
:OMMENTS REGARDING ABOVE:
•
1:\pimapp.doc 12/96 (dst)
7/26/99 Activities for Case #: PLM97 -00362
1:52:47 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To. Done By Disp. Level By Updated Notes
PLMC003 Application received 9/3/97 GEO RECD GEO 9/3/97
PLMC005 Permit Created 9/3/97 GEO PASS GEO 9/3/97
PLMC715 Rough -in Insp 9/3/97 9/22/97 MS PASS J'H 9/26/97
PLMC799 Final Inspection 9/3/97 9/22/97 MS PASS J'H 9/26/97
PLMCO50 (F) Issue permit 9/3/97 DRA PASS DRA 9/3/97
PLMC800 Case Finsled 9/26/97 MS PASS J *H 9/26/97
•
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