Permit CITY OF TIGARD
PLUMBING PERMIT
,, ,.. :; r1 DEVELOPMENT SERVICES PERMIT # • PLM98 -0052
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 02/24/98
PARCEL: 1S135DD -05106
SITE ADDRESS...: 11995 SW PACIFIC HWY
SUBDIVISION • ZONING: C —G
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..: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)...: 100
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Bank of America water service
Owner: FEES
CCC JOINT VENTURES type amount by date recpt
4739 SW 39TH DR PRMT $ 30.00 JSD 02/24/98 98- 303544
PORTLAND OR 97221 5PCT $ 1.50 JSD 02/24/98 98- 303544
Phone #:
Contractor
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN OR 97062
Phone #: 691 -6166 $ 31.50 TOTAL
Reg #..: 000879
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. 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 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- ml -wi10 through OAR 952- 0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued By: 4 Permittee Signature:
+ + + + + + + + + + + + + + + + + + ++ +++++++++++++++++++++++++ + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Recd .0
TIGARD, OR 97223 Date to P.E.
(503) 6394171
Date it DsT
Permit# PLC 9 9 -065 �
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called PAZ
Name of Development/Pro 'e On back Indicate Work Performed by fixture.
Job � - i ` v'"/ FIXTURES (Individual) , QTY PRICE AMT
Address Street Address Suite Sink 9.00
11 S S S ,S/1/4l Ar,t CL c- w1 Lavatory 9.00
Bldg # City/State Zip
1 1 �� b Tub or Tub/Shower Comb. 9.00
Name t `� Shower Only 9.00
C Q 3 ,A - k - \I Q n }, V, c e 5 Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
y13 q %\i, 3Q �' .0 C Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
- Ott \i q \ y5 Z g
Name /� Floor Drain 2' 9.00
51,4 07r Otner,'i a. 3" 9.00
Occupant Mailing Address Suite
4' 9.00
City/State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
\ 2,f v \ Q\ V`vvm cn n c Other Fixtures (Specify) 9.00
Contractor Mailing Address - Suite 9.00
1 \ \z( c - 4.n us \s∎vas
Prior to permit CV State Zip Phone r 9.00
issuance, a copy 4 (,G 10 4 i Q L & oi - I4 i 4' 9.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date 9.00
required if >? 12 \ C - c4 Sewer - 1st 100 30.00
expired in COT Plumbing Lic.# Exp. Date
database 34 - 250 \ 2 _ 3 1 -Ci�
Sewer - each additional 100' 25.00
Y
Name Water Service - 1st 100' , 30.00 so
Architect Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 Non - residential 0 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
Insp. of Existing Plumbing 40.00
per/hr
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 9.00
building or property
l___._ - QUANTITY TOTAL
acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9
:rrect, that I am the owner or authorized agent of the owner, and
*SUBTOTAL
t submitted are in compliance with Oregon State Laws.
t Owner /Agent ��' Date 5% SURCHARGE
'�SZ�A"6 Cc_. � ‘��..0•-
1 - a c l g PLAN REVIEW 25% OF SUBTOTAL Se
c .non Name Phone
Required only if fixture qty. total is > 9
_ ..„)Q r CD , g2-C.) e c e__ 6 I - CO I L( TOTAL
'Minimum permit tee is 525 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
•o.aoc :a97
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
Capped./ Removed Moved Replaced
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)
COMMENTS REGARDING ABOVE:
I:Wstslplmapp.doc 5/97
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: .5 / i g A. M. P.M. MST:
Location: //q � — sue/ ) 7 BUP:
Tenant: �j _ Suite: Bldg: MEC:
Contractor. / /- / / l//�' - Phone: 9i? 'ooS
Owner Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL
Site Post/Beam Post/Beam Post/Beam Cover /Service torm
Footing Roof UndFl/Slab Rough -In Ceiling
Slab Framing Top Out Gas Line Rough -In I er
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 Spick/Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved c prov
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved N ot Approved
FINAL FINAL FINAL FINAL CrNAL )
0 Call for reins • / O Reinspection fee of $ required bef re next inspection 0 Unable to inspect
Inspector: Date: / Page of