Permit CITY OFTIGARD
�� �,, � I DEVELOPMENT SERVICES PLUMBING PERMIT
'1 A 2 13125 SW HaII Blvd., Tigard, OR 97223 (503) 6394171 PERMIT # • PLM97 -0335
DATE ISSUED: 08 /15/97
PARCEL: 1S136CC —CH001
SITE ADDRESS...: 08376 SW PFAFFLE ST
SUBDIVISION • CARRIAGE HOUSE APARTMENTS ZONING: R -12
BLOCK • LOT • JURISDICTION:
CLASS OF WORK.. :ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •MF WASHING MACH 0 BACKFLOW PREVNTRS..: 3
OCCUPANCY GRP..:R1 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: Installation of 3 commercial backflow prevention devices.
Owner: FEES
ANDREWS MANAGEMENT, LTD type amount by date recpt
4000 SW KRUSE WAY #270 PRMT $ 75.00 DRA 08/15/97 97- 298337
LAKE OSWEGO OR 97035 SPCT $ 3.75 DRA 08/15/97 97- 298337
Phone #:
Contract or
LANDSCAPE MANAGEMENT OF ORE
20625 SW 65TH AVE
TUALATIN OR 97062
Phone #: 638 -6212 $ 78.75 TOTAL
Reg #..: 6701
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. Inspect ion
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 189 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 -8851 -8$10 through OAR 952 - 0801 -0088. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
-- ') Issued aQ��- ���'�1) Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
'1TY OF TIGARD Plumbing Application Recd By 0" .
3125, SW HALL BLVD. Commercial and Residential Oats Recd
IGARD, OR 97223 Date to P.E. ''
503) 639 -4171 Date to D&T Y .
/
Permit it / 7 - 6 , , .
Print or Type Related SVVR s l
Incomplete or illegible applications will not be accepted caned
-SIT 9 6 -c. o LPL - .
Name of Devatopmenro pct . *MA Job
L�AA�O N o Sf Sink 9.00
Address Street Address - Suite Lavatory 9.00
831 6 54/ PFA F FLL _ Tub or Tub/Shower Comb. 9.00
Bldg 5 City /State Zip Shower Only 9.00
I / 1 6 - 4 % % dGo 0X Water Closet
. 9.00
.
A) 0 R 3 Po N Dishwasher 9.00
n Mailing Address Garbage Disposal 9.00
Washing Machine 9.00
�
L /S/ate . Zip Phone Floor Drain r 9.00
.(So.vi_,(Ip d<
Name 3' 9.00
4' 9.00
Occupant Meiling Address Suite water Heater
- 9.00
Cny/state Zlp Phone laundry Room Tray 9.00
Urhtal - 9.00
Name Other Fixtures (Specify) 9.00
,1. ..,vas 1..P.E AAd/t 4 "ENT 9.00
Contractor Mailing Address Suite 9.00
20 6:_5 3141 4 s
(Prior to issuance ^ C Zip Phone 9.00
applicant must IY�L/.A7i OA 970 Z 9.00
provide an Dragon Const Board Lie* Exp. path 9.00
contractors /
license Plumbing lx Ex
p. 9 9.. 0
information 6 7 of r 19 7 - 1st t ao• 90.00
for COT COT Business Tax or Metro* 1 � -each adddbnal 1 ar x5.00
database). Date Service • 1st lar
. 30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st tar • 30.00
or Ma hg Address ' Suits Starm & Rain Drain •each additional tar 23.00
Motile Home Space _ 25.00
Engineer C Zip Phone CG Flow Prevention Device or Ami. 23.00 75.-
•
- *scribe work New 0 Addition 0 Alteration 0 Repair 0 Residential Baddlow Prevention Device' 15.00
o be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin
5a�f,..kLEq 57371 -.1 s.00
Insp. of Existing Plumbing 40
d be le PL D. (,,,cc per/hr
Existing use of Specially Requested Inspections 40.00
r
wilding or property per0
' Rain Drain. single family dwelling 30.00
3 roposed use of Grease Traps 9.00
wiling ing or property ,o I
QUANTITY TOTAL _ Y
-.re you capping . moving or replacing any fixtures? Yes o No p Isometric or roar Cagan is required if Ouanity Toni is 3. 9
7-V1 f4
IN yes see back of form) 'SUBTOTAL . _ "�s.•
'iereby acknowledge that I have read this application. that the information - � _
,fen is cared. that I am the owner or authorized agent of the owner. and 5% SURCHARGE
: ' . 7 ::: ;'7S
•,at plans submitted are in compliance with Oregon State Laws.
∎Ignature of Owner/Agent Date PLAN REVIEW 25% OF SUBTOTAL - _ • t
Recueed only d Areas cry. total is' 9
TOTAL
o
7( ----
ntact Person Name Phone
*Minimum permit fee is $25 + 5% surcharge. except Residential Badkflow
Prevention Device. which is 315 + 5% surcharge
I: \plmapp.doc 12/96 (dst)
'LEASE 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)
:OMMENTS REGARDING ABOVE:
I:\plmapp.doc 12/96 (dst)
Page No. 1 CASE HISTORY FOR CASE NO.: PLM97 -0335
ANDREWS MANAGEMENT, LTD
08376 SW PFAFFLE ST
04/25/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMD003 Application received / / / / 08/15/97 RECD DRA 08/15/97 DST
PLMD005 Permit Created / / / / 08/15/97 PASS DRA 08/15/97 DST
PLMO050 (F) Issue permit / / / / 08/15/97 PASS DRA 08/15/97 DST
PLMD799 Final Inspection / / / / 08/20/97 PASS BB 01/28/98 RB
PLMD800 Case Finaled / /. / / 01/30/98 01/30/98 JT
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