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Permit CITY OF TIGARD �� DEVELOPMENT SERVICES PLUMBING PERMIT PERMIT # • PLM97 -0124 ■ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04 / `9 / 97 PARCEL: 2S102BD -01503 SITE ADDRESS...: 12760 SW PACIFIC HWY SUBDIVISION • FREWINGS ORCHARD TRACTS ZONING: C –G BLOCK • LOT :1 JURISDICTION: T I G 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 ° 0 TRAPS • 0 STORIES : 0 WATER HEATERS 0 CATCH BASINS ° 0 FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0 SINKS • 1 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: Installing one sink that will be pumped to sanitary sewer Owner: FEES ROSE GOSPODINIVIC type amount by date recpt 12750 SW PACIFIC HWY #100 PRMT $ 25.00 B 04/29/97 97- 293848 TIGARD OR 97223 5PCT $ 1.25 B 04/29/97 97- 293848 Phone #: Contractor M P PLUMBING CO (MILWAUKIE) P 0 BOX 393 CLACKAMAS OR 97015 Phone #: 655 -9161 $ 26.25 TOTAL Reg #..: 000050 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 PLM /Underfloor applicable laws. All work will be done in accordance with Top –out Insp • approved plans. This permit will expire if work is not started Final Inspection within 180 days of issuance, or if work is suspended for more than 180 days. Permittee Si nature: evta 'IC eh -made( l I Issued By: i 61AVALICA Call for inspection – 639 -4175 '.:ITY OF TIGARD Plumbing Application Rec'd By ig. t 1t ti- 3125 SW HALL BLVD. Commercial and Residential Date Rec'd -9 -�?1 r Date to P.E. R 'IGAD, OR 97223 Date to DST (503) 639 -4171 Permit # PL- 9 7 - Ole y Print or Type Related SWR # Stall 9 /- ©//S Incomplete or illegible applications will not be accepted Called O/ S? ,„/6, (2,C. 6 F Pc.,, x,204- -, 4 si.-, ' ri9'TC 1 , 7 Name of Development/Project FIXTURES (Individual) QTY PRICE AMT Sink 9.00 Job AT (n ,T NL , Lavatory / S treet Address Suite ry 9.00 Address Ric. or Tub /Shower Comb. 9.00 1,17100 5L Pc.t.Ric. Ela: Bldg it City /State Zip Shower Only 9.00 Tyra. t O c17 12. Water Closet 9.00 NAme Dishwasher 9.00 1 as 'cock 1/Utvls. _ Owner Mailing Addresg Suite Garbage Disposal 9.00 14750 SW VtkcAlc- IluJY IOC) Washing Machine - 9.00 City /State Zip Phone Floor Drain 2' 9.00 I1017415k, O e . C 1 1 . 3 ( 3 9.00 Nafffe • ALL 1 hAS G t,tTryBS 4' 9.00 Occupant Mailing Address p n Suite Water Heater 9.00 11l100 S t raGt F >L. ' Laundry Room Tray 9.00 City/State /'j Zip Phone Urinal 9.00 Tte rArr t o t -1 i 2.2- Z Q (pk- °I S) O a J ! 0th Fixtures (Specify) 9.00 VO 1GNl�. 11)111 1 31), , &fl 1 / t 1 7 9.00 Contractor Mailin ddress Suite 2 9.00 10335 6 Babe lien: a (.;t7fi l iA7 ,..` 9.00 (Prior to issuance City/State Zp Phone 9.00 applicant must 1 / 1 t twau t 0 R. ci 7 2(0 ( . 055 9.00 provide all Oregon Co nt. Board Lic.# Exp. Date contractors ;40 /J-02/-91 9.00 license Plupding Lic. # Exp. Date Sewer - 1st 100 30.00 information ,i,24,-445 1 e i s la- 31-9) Sewer - each additional 100' 25.00 for COT COT Business Tax or Metro # Exp. Date Water Service • 1st 100' 30.00 database). 00 00 /9t5 _ 49-/-9 7 Name Water Service - each additional 200' 25.00 Architect Storm & Rain Drain - 1st 100' 30.00 Or Mailing Address Suite Storm & 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' Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00 to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00 Additional description of work Catch Basin 9.00 Afie l r J 1 n S) 11 l� .1n I e� C m . Insp. of Existing Plumbing 40.00 V per/hr Existing use of \ \ Specially Requested Inspections 40.00 building or property �ptWr1 ‘ 3) . .c) 1c1-ewf1T"tA S1.O$-Q• per/hr Q J Rain Drain, single family dwelling 30.00 Proposed use of Grease Traps 9.00 building or property SC t -t C&S 0A QUANTITY TOTAL Are you capping , moving or replacing any fixtures? Yes ] No o Isometnc or riser diagram is required d Quandy Total is > 9 (If yes see back of form) *SUBTOTAL ;�-, I hereby acknowledge that I have read this application, that the information (/7 given is correct. that I am the owner or authorized agent of the owner, and 5% SURCHARGE t in hat plans submitted are in compliance with Oregon State Laws. Signatu f Owner /Ag 6,62.12_, Cat PLAN REVIEW 25% OF SUBTOTAL /g�7 Required only it facture qty. total is > 9 l / TOTAL i r j Contac Person Name Phone V *Minimum permit fee is 525 + 5% surcharge, except Residential Backflow Daieo TH y 6'56- Y-9 �) Prevention Device, which is 515 + 5% surcharge ---- 1 _c6 �l i Y �� !I: \plmapp.doc 12/96 (dst) /041U s � 1 c� PLEASE COMPLETE AS APPROPRIATE TO PROJECT: Fixtures to be capped, moved or replaced I Qty 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: Lo ckAA n rn s,n16 ou .e.,AJecs (Wry, . i In %5 Sink 1S on 1(1 O0 .c S , I:\plmapp.doc 12/96 (dst) 4/19/00 Activities for Case #: PLM97 -00124 5:52:40 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMC003 Application received 4/9/97 BON PASS JD 4/15/97 PLMC005 Permit Created 4/15/97 JSD PASS JD 4/16/97 On 04/16/97 at 9am, I left an answering machine message with the plumber requesting an indication as to all pre - existing • plumbing fixtures. I also spoke with Mike S earlier on 04/16/97 who indicated he will try to do a site visit today. This is the 5th business day for processing. • jsd PLMC799 Final Inspection 5/5/97 MS PASS MRS 5/6/97 PLMCO50 (F) Ready to issue 4/17197 JSD PASS JD 4/17/97 Need to hand applicant the blue USA card. jsd PLMC060 (F) Issue permit 4/29/97 B PASS BON 4/29/97 mailed permit PLMC800 Case Finaled 5/6/97 MS PASS MRS 5/6/97 • • • Page 1 of 1