Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM1999 -00271
E ISSUED: 8/23/99
y6�� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14345 SW PACIFIC HWY PARCEL: 2S110AB -00200
SUBDIVISION: CANTERBURY PLACE ZONING: C -G
otZ BLOCK: LOT: 1 -3 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of commercial backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
KOLVE, C G PRMT DEB 8/23/99 $50.00 99- 317829
14345 SW PACIFIC HWY 5PCT DEB 8/23/99 $3.50 99- 317829
TIGARD, OR 97224
Total $53.50
Phone 1:
Contractor: EXPIRED
CHRISTIAN PLUMBING
23172 SW STAFFORD RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
•
Phone 1: 503 - 638 -8231 RP /Backflow Preventer
Final Inspection
Reg #: LIC 00042671
PLM 3470PB
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other 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. ATTENTIQN: 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 y o copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
s ed By: i � / �� ' Permittee Signature:
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day
AUG -20 -1999 08:53 AM CROWN. PLUMBING 503 771 9454 P.01
r
CiTY OF TIGARD Plumbing Permit Appiica on Plan l
13125 SW HALL BLVD. Commercial and Residentla Nadel
TIGARD, OR 97223 Date Read $ , - 9
(503) 8394171 Date to P.E.
Print or Type Date to DST
. Incomplete or illegible applications will no be accepted Pam* A Pc. M c49 Y �oQa /
Related VAR*
C.aled ' •
- Name of Development/Protect _ ' ►,;, ' ►4 r }.?%% k ; ..y r', :" F tzW , f t il,i r
Job Sink 11.50
Address Street Address e . - Suite Leyden 1 11.50
5 5 W • • • , Tub or Tub /Shower omb. 11.60
Bldg* CitylStata n at) Shower Drily I 1 11.50
u ...l+ ` • 1 Water 010se1/UrInal i (Specify) ■ 11.50
Name
ovw (3111 Dishwasher I 11.50
O wner ` VMg,Address - he erbage Disposal 11.50 INN
5 l4444 a Washing ndry Tray (S • - 11,60
CitylStete 71p Phone ,-.9 -Pt► Floor Drum/Floor - 7 11.50
Nam% 3 11.5c
.1.. 4 11.50
Occupant Melling A ddre � ss `, � S uite Water Heater o - version 0 like acrd 11.50
$ Pti - Gas + t• re. ukes s- • - rate mechanl r rmit.
fry/Stets Zip Phorio MFG . . New r Serwioe 28.00
MFG Home New Storm Sewer 28.00
Nwne - 'P Bibs 11.60
Contractor Mailing Addr•SS Suite Rain Drains 11.50
SY x? 3e 7;-%^-.1 orWckrg Fountain 11.50
Prior to permit C !State Zip Phone sorer Fixtures (G . ., , )
im
issuance, a Dopy. filar 4-(4. .. OA 9 y30(0 77r- 9 Y 7 �
of all licensee are Oregon Cartel. Cont. board Lk.* Exp. Date
required if Li A 4 ) / o4 . d er e
expired e+ COT Plumbing Lie. * 1 Exp. Date
database 39 -7 0 Pt3 04 - 9 _ o 1111111
Name Sewer -1st log 3 =.00
Architect Sewer- each edds 1100• 32.00
Or Malang Address Sul __ Water Service -1st 00' 38.00 I
Engineer
Notate Zip ,ice. Water uluu1ce • ea' , ad 130418! 200' X2.00
s'' a te - orm A Rain Drain 1st 100' 38.00 b.
• Dveortlre work to be done: , form • , .n i ea - xi • n : IT. r 32.00 rr �s -
New k Repair 0 Replace with like kind: Yee 0 No 0 Commercial Back I . Prevention Device / ` 32.00 q► • •
Residential O Commercial
Additional description of work Residential BaaMl Prevention Device' 19,00
r� Catch Bash 11.50
111f 54-12-11 i43 (0 .- ) rJ ')(vv►J D tit a ^ - Insp. of Existing - I , , . 50.00
Are you capping, moving or replacing any fixtures? I tartar
Yes 0 No 11 Specially Request Inspections 60
If yea, ma back of form to Indicate work performed by perlhr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE - Rein Drain, single y dwelling 46.00
-
WORK COULD RESULT iN INCREASED SEWER FEES. (..mace traps 11 -50
I hereby adrnowedge that I have read ells appiiration. that the Information - r ; ' ' T + : 1 • r•
I ta1,fANTIT' TOTAL �, ' ; p,.„ ��
given Is correct. that I am the owner or authorized agent of the owner, and Isometrics rises .. - is requires M • ',tolls I. 0 a pA" +aid; * ..
that plans submitted are in compliance with Oregon State Laws. ' SUBTOTAL r ,'_ . r74,VP , li
Signature OwnodA ant Dam MOP. i5r °1 4' •
/ / rte-+ �y Sr' > S'9 196 SURCHARGE ��""'i ;;
Contact Parson Nana Phone " !".4 1 + u� ' ,1 '!
■ K-e thlocii-4 un - 7) 9'01 7 "PLAN R EW 25% OF SUBTOTAL I ' ,4 , y ' ra;
t . . , r 1 r fk t "1� :. i i r R . :do d ■ ; p .tNaI Ia 9 f�'�' V�1 � +, i 0 i
t
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i , Ir.. m 7:1:', r j , '. t ' .. 'Intim= panne ,except Restsenttal Beckon Prer�sntforr
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• Aa New Com I BuIWlnp requiw giros wah Inometrto or rtalr awpram arm
pear meow.
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•
FUND RAISING PRICES • .
(Effective July 1, 1999)
NATURAL GOURMET BEEF JERKY
n
$1Fund Raising Snacks Your profit $54.00 per case!
1 oz. Natural Beef Strips Case $54.00 (6/12 Count) .
Teriyaki Original Cost Per Pkg. $.75
Pepper Jalapeno Retail Per Pkg. $1.0
Red Chili Pepper & Garlic
Bar -B -Q Sweet & Spicy Profit Per Stick $ . b-- O
Brown Sugar
$6.00 Fund Raising Snacks Your Profit $108 per case!
4oz. Natural Beef Strips Case $108 (36 pkg. per case)
Teriyaki Original Cost Per Pkg. $3.00
Pepper Jalapeno Retail Per Pkg. $6.00
Red Chili Pepper & Garlic
Bar -B -Q Sweet & Spicy Prat Per Package $3.00
•
Brown Sugar
$11.50 Fund Raising Snacks Your profit $103.50per case
8oz. Natural Beef Strips Case $103.50 (18 pkg. cases)
Teriyaki Original Cost Per Pkg. $5.75
Pepper Jalapeno Retail Per Package 11.50
Red Chili Pepper & Garlic
Texas Hot Sweet & Spicy Fret Per Package $5.75
Brown Sugar
Contact your Sales Distributor TODAY