Permit aCITY OFTIGARD
I I' , DEVELOPMENT SERVICES PLUMBING PERMIT
��+a��p� " +� PERMIT # • PLM97 -0314
Ail- _ __.. 13125 SW Hall Blvd., Tigard, OR 97223 503) 639.4171 DATE ISSUED: 08/14/97
PARCEL: 2S102BD -00701
SITE ADDRESS...: 12785 SW PACIFIC HWY
SUBDIVISION • NO.TIGARDVILLE ADDITION AMEND. ZONING: C —G
BLOCK • LOT •8 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..:A3 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)...: 0
Remarks: Tenant improvement
Owner: FEES
SPADA, FRED & JOSEPHINE type amount by date recpt
3250 SW DONNER WAY CT PRMT $ 25.00 DRA 08/14/97 97- 298280
PORTLAND OR 97201 5PCT $ 1.25 DRA 08/14/97 97- 298280
Phone #:
Contractor -
CANBY PLUMBING
805 NE 4TH AVE
** CCB EXPIRES 8/2/2000 /TAT
CANBY OR 97013
Phone #: 266 -2091 $ 26.25 TOTAL
Reg #..: 000335
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. Inspection
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 9501 -8818 through OAR 9501 -8088. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued - _ .11,144,1 Permittee Signatur- ��^
++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + ++ + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection neede= - e next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + ++
.?TY OF TIGARD Plumbing Application Recd By
'1 25 SW WALL BLVD. Commercial and Residential Date Reed O
3ARD, OR 97223 oats to P.E
Date to
)3) 639 -4171 Permits , ' 'b
Print or Type Related SWR s'/- r 12-
Incomplete or illegible applications will not be accepted Called jl -q -q7
Name of Development/Project :FIXjURES;;Qndivldwl) atatale _t i `A i_
ti t R
Lite oi rS 0 a S'f• u Vam+ 8.00
Job
Address StreetAddr6ss I Suds ' t0f1 ' 9.00
) 2.7 8'S S W PQ c i l� c 1 f w,} Tub or Tub/Shower Comb. 9.00
Bldg 5 City /State / /� Zip Shower Only 9.00
I / yf a .-d 012 Water Closet
Name I U �+ �J 9.00
Fr ec t' Y c S ego)„ x n f Sic a Gr"a a r 8.00
Owner Mailing Address Suite Garbage Disposal 9.00
3250 S cJ Donn ..v W� t!'aur1 Washing Mathlne 9.00
City/State p ne - Floor Drain r
9.00
lid)-- a 012 9Tao/ 3' 9.00
W ek)Py ' s ) b, i ' / th 4 ' 9.00
Occupant Mailing Address Suite Water Heater 9.00
7 ""9 / S W / li u w ks Laundry Room Tray
9.00
City /Stale Zip Phone Urinal • 9.00
1u G t u 'f , .i a r e 97 D 62_ 671 .20.7. 2- Other Fabuss (Specify) 9.00
yontractor % Adtlrdsa �/� .>K r M ' ' Suite . - 9.
SOS ,VP `Ft'l 9.00
9.00
*dor to iswancs City/State Zip Phone
applicant must C 07R `�' 7 0/3 266 -.209/ 9.00
provide all Oregon /o nst Cont. Board Lic.s Exp. Data 9.00
contractors Z Li ors ' 3 3 7 p ?n Z 9.00
license
Plumbing tic 3 7 P Exp Date Sewer - let 100' . 50
information
_ 17( � - Sewer - each additional 100' 25.00
for COT database). j COT ehrs,rhess 9 or G Metro ��p �j v water Seivioe - 1st tar 30.00
Mune Water Service - each additional 200' 25.00
Architect Sloan & Rain Drain - 1st 100' - 30.00
or Address Suite Storm & Rain bran - each additional tar 25.00
Mobile Home Space 25.00
Engineer Cily /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
- • ' / Pollution Device
Describe wort New 0 Addition 0 Alteration ® Repair O Residential Baddlow Prevention Device' 15.00
to be done: Residential 0 Non- residential 0 My Trap or Waste Not Connected to a Fixture 9.00
Additional description of wort
Catch Basin 9.00
- Insp. of Existing Plumbing - 40.00
I Q /� h per/hr
P 1't'i rl v e Ai a 1�iGr' °1 Y ��
Specially Requested Inspections ' 40.00
-sting use of 1 1 -/ / p �
ilding or property i •P .c 1 it Yeti . Rain Drain. single family dwelling 30.00 •
Proposed use of n Grease Traps 9.00
, w7oing or property / r .c l - k r c rt r"
QUANTITY TOTAL � =4
a you capping , moving or replacing any fixtures? Yes ( No ❑ Is(melne or r dram is require! if Guano Tow is 2 9 ? - v14`,.' , . � :4 - ' -
f yes see back of form) 'SUBTOTAL • - ;. - '- w ,c
•tereby acknowledge that I have read this application, that the information
-en is correct, that I am the owner or authorized agent of the owner. and 5% SURCHARGE ; 4.175 -' (,
at olans submitted are in compliance with := / � L
Oregon State laws.
nature ofp ent / Date PLAN REVIEW 25% OF SUBTOTAL . _ •: i "
12?-, /) //
,..„,..
/ 7/ Required or" r ftetwe qty. total is > 9
/ // Pr ee�c TOTAL , ° :.. , z i p 5
ontact Person 'o Z
L !/ 1 Q 'Minimum pen fee is S25 + s% surcharge. except Residential Baddlow / pest* n : r G, r- el L- -e 4 `y/ e . / c 6 2 0 7 996 Prevention Device, which is 315 + 5% surcharge
V ✓ 1: \phnapp.doc 12/96 (dst)
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
I Fixtures to be capped, moved..or replaced 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) _- - -
:OMMENTS REGARDING ABOVE:
ewrUvP �a H •
J c4. a 1, I
I:\plmapp.doc 12!96 (dst)
Page No. 1 CASE HISTORY FOR CASE NO.: PLM97 -0314
SPADA, FRED &JOSEPHINE
12785 SW PACIFIC HWY
12/01/97
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
---- --- -------- ---
PLMC003 Application received /' / / / 07/29/97 RECD JD 08/04/97 BON
PLMC005 Permit Created / / / / 08/04/97 PASS B 08/04/97 BON
PLMC015 DST Post Review Complete / / / / 08/04/97 PASS B 08/04/97 BON
PLMC040 (F) Ready to issue / / / /. 08/04/97 PASS B 08/04/97 BON
PLMCO50 (F) Issue permit / / / / 08/14/97 PASS DRA 08/14/97 DST
PLMC799 Final Inspection / / / / 08/15/97 sink capped PASS RAB 09/25/97 J *H
PLMC800 Case Finaled / / / / 09/24/97 PASS RB 09/25/97 J *H