Permit CITY OF TIGARD
„,,_H A DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT # • PLM97 -0520
�!+� __.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/08/97
PARCEL: 2S1O2CB -00302
SITE ADDRESS...: 13285 SW PACIFIC HWY
SUBDIVISION • NORTH TIGARDVILLE ADDITION ZONING: C —G
BLOCK • LOT :033 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH.. • 0 BACKFLDW PREVNTRS..: 1
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 • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 2
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Install a hot flush system, indirect waste line, and a commercial back
flow prevention device or anti— pollution device for an existing bldg.
Owner: FEES
7 -11 type amount by date recpt
13285 SW PACIFIC HWY PRMT $ 43.00 GEO 12/08/97 97- 301539
TIGARD OR 97223 5PCT $ 2.15 GEO 12/08/97 97- 301539
Phone #:
Contract or
MICHAEL & CO PLUMBING
P 0 BOX 23008
TIGARD OR 97281
Phone #: 639 -3189 $ 45.15 TOTAL
Reg #..: 000678
RUM IRED 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 RP /Backf low Prey
applicable laws. All work will be done in accordance with Final Inspection
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 -0001 -0010 through OAR 952- 0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued By: Permittee Signature: Aglc.c:AAmri
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
;ITY OF TIGARD Plumbing Application Recd By
3125 SW HALL BLVD. Commercial and Residential Date Recd
s IGABD,' OR 97223 Date to P.E.
Date to DST
(503) 639 -4171 Permit # f4/ l? ..e},v'
Print or Type Related SWR #544'9-9 -exi,q
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) .. QTY PRICE AMT
- 7 - I ( # a 5t Sink 9.00
Job Lavatory 9.00
Address Street Address Suite
/3a 8 G ��'' Z W - 034,1 tC ' Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
't90CA. q Water Closet 9.00 '
Name OI Dishwater 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City /State Zip Phone Floor Drain 2' 9.00
-'93 3• 9.00
Name
4' 9.00
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Urinal 9.00
• Other Fixtures (Specify) 9.00
Name n II
11'1iC VA. SCrl. tkritU 14nT FIis ►+ S Ys Tcy t 9.00 9 PO
Contractor Mailing Address Suite 7no(, li✓aii< <- i -e / 9.00 o/, 0a
' PO - anK X3008 9.00
Ci /State Zip Phone 9.00
lard O& g1a81 en6 3184
Or n Const. Cont. Board Lic.# Exp. ate 9.00
Attach Copy of e 1 II:V1'7 9.00
Current Plumbing Lic. # Exp. Date Sewer - 1st 100 30.00
Licenses c e -63 9R Sewer - each additional 100' 25.00
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
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 I 'ZS, (2 0
Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work n S. d// /-i.eT f w1' I, G e a
Catch Basin 9.00
O a T t +d r• «r "'Yre 3tagoir Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
: xisting use of per/hr
;uilding or property Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
• QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes o No o Isometric or riser diagram is required if Ouanity Total is > 9
(If yes see back of form) 'SUBTOTAL 113,CU
I hereby acknowledge that I have read this application, that the information 5 SURCHARGE
given is correct, that I am the owner or authorized agent of the owner, and Z t S
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL ys r ) S
Contact Person Name Phone
*Minimum permit fee is 525 + 5% surcharge, except Residential Backfiow
a £ s)-- reA�o'/ 6 39- 31 $h Prevention Device. which is 515 + 5% surcharge
( I` i:\dsts \plmapp.doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
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)
COMMENTS REGARDING ABOVE:
0 8 0 r
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: /el — i� -F7 . A.M. P.M. MST:
Location: /3285 S-W PaC (Uf c / BUP:
Tenant: l I Suite: Bldg: MEC:
Contractor. C.. .I _A _/ / � Phone: 639-3/87 PLM: q 7 -a5
Eimer-- ii J f ' �l O�1, /A P hone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMB MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam , ,, Post/Beam Cover /Service Sewer /Storm
Footing Roof U 1 Slab . Rough -In Ceiling Water Line
Slab Framing " op • Gas Line Rough -In UG Sprinkler
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 Spklr /Alm CrawUFound Dr Heat Pump Low Volt ,
Approved 4���`r= ► Approved Approved A.: foved
Appr /Sdwlk Not Approved of Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
0 /,iJD/ eq ' hI4 77
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al C M BA - -K-FLV of p,Qw. ,Del/C6-
07/
6 /
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Call for reinspection O Reinspection fee of $ 7 requirred before next inspection O Unable to inspect
Inspector: Date: r.2 // .77 2 Page 2 of