Permit CITY OF TIGARD
„x, ��:n,, , ;k DEVELOPMENT SERVICES PLUMBING PERMIT
1 1 PERMIT # • PLM98 -0074
! +� =' � .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 03/19/98
PARCEL: 2S11OCC -12100
SITE ADDRESS...: 15955 SW QUEEN VICTORIA PL
SUBDIVISION • KING CITY NO. 3 ZONING:
BLOCK • LOT •034 JURISDICTION: KIN
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS 0 TRAPS : 0
STORIES • 0 WATER HEATERS • 1 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: Anderson
Owner: FEES
EDWIN ANDERSON type amount by date recpt
15955 SW QUEEN VICTORIA PRMT $ 25.00 JSD 03/17/98 KING CITY
KING CITY OR 97224 5PCT $ 1.25 JSD 03/17/98 KING CITY
Phone #: 624 -8751
Contractor
ACTION WATER HEATERS ONLY, INC
8948 SW BARBAR BLVD., #418
PORTLAND OR 97219
Phone #: 503 - 643 -2737 $ 26.25 TOTAL
Reg #..: 108953
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 952 ' through OAR 952 -0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
C(
Issued By: -! ■., /�1
. Permittee Signature: 0 1'l qdd // 7 d�
4 1 �
+ + + + + + + + + ++ ++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
MAR -17 - ' 98 TUE 16:14 I D: FAX NO: ..... . -. _ it176_ P02
:ICY OF TIGARD Plumbing Application Rec'd By p.-
3125 HALL BLVD. Commercial and Residential Date Reed -1, ..1
IGARD, OR 97223
Data to P.E.
503) 639-4171 oats to D5 - 1
Permit* . - 0O0 (
Print or Type Related SWR 0
Incomplete or illegible applications will not be accepted Called
, lame of Oevalopmenvproject On beck indicate Work Performed by fixture.
Job • FKTU. ES tIlndlvldtlal
Address f )<:t;y :r:+ }f • R.�1 {. QTY; PRICE >AMT
I ,� „) & LPD \ tI Suite Sink 6.00
ff 9.00
9Id9 0 fete Zip
N Or qi ii-44 Tue or Tub/Shower Come.
Name Shower Only 9.00
�.1.0f r1 Alt ftQ,rl/ i1 Water Closet 9.00
9.00
Owner Mailing Address A n 1 Suite Dtehwasher
I 9 SS - St.J r, �J t ii 9.00
Cifyrsta 4 Phone
.-�. Oai rage Disposal 9.00
, ' fv r� ai 4 Z _ (a�1,sl �7S"l Washing Machine 9.00
Name Hoof Drain r 9.00
Occupant Mailing Address Site 3 9.00
4 � 9.00
City /Slate Zip Phone Water Heater 0 Corwereion like kind ` 9.00
Laundry Room Tray 1 9.00
Name 1 J. Urinal 9.00 1 4(1.0A(Ai t t ,,,,k1.6).., ()y3, Other Fixtures (Specify)
Contractor Meiling Address g 9.00
„ Fi t t? 4w4d &a 9.00
Prior to permit City /State /� Zip Phone 9,00
lsauance, a copy R3V or �L?2ri _ rai - -73 1 �1 9.00
or all licenses are Oregon Coast. �/ t Board Lis* Exp. Date Q i - 9.00
required If tOF i S3 ✓ 0 113 i&'3 /-5 ` Sewer -1st 100' 30.00
expired In COT Plug Li a Exp. Date
database j,Bl,. H 1 13 l- t_ q. c Sower -each additional 100' 25.00
Name Water Service .1St 100' 30.00
Architect Water Service - each edamonal 200' 25.00
or Mailing Address S Storm & Rain Drain -181100' 10.00
Steno & Rain Drain - each additional 100' 25.00
Engineer City /Stale Zip Phone Mobile Hama Specs 25.00
Commercial Sack Flow Preventian Device or Anti- 25.00
Describe wont Now 0 Addition 0 Alteration 0 Repair 0
Pollution Device
•o be done: Resldentlal 0 Nan- resioenlial 0
Residential Bacxtlow Prevention Device 16.00
Additional description of W0t . Any Trop or Waste Not Connected to a Fixture
9.00
Catch Basin 9.00
kj li0 te I + Insp. of Eclsting Plumbing 40.00
ixieting use of Specially Requested Inspections 40.00
uilding or propert/_ per/hr
'roposed use of
Rain Drain, single family dwelling 30.00
.uilding or property _ Grease Traps 9.00
hereby acknowledge that I hone reed this appllcatloh, that tits information , QUANTITY TOTAL
Isoinetne
'yen Is correa, mat I am the owner or authorized agent of the owner, and or riser mown is required if Quanity TOW to ? 9
net pions submitted are In compliance with Oregon State Laws. 'SUBTOTAL ,.;
'Ignatu of Owner/Agent
/� Data :,:•.,,,,,:;,., "
�� -S�^^� - I�,,,.iiA .,,,e"- 3 -17- q 5% SURCHARGE f
:ontact Person Marne Phone PLAN REVIEW 25% OF SUBTOTAL `
•
(sr" Requite only 9 future qty. tout le 9
607 @,� g95 i TOTAL '
*minimum permit fee Is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which Is 615 + 5% surcharge
1p1mapp.aoc 5/97
- , (ily
- 7/111-1). CITY OF TIGARD BUILDING I PECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phon : 63 4 1 l
• 1 � �
'
r
Date Requested: , - i /� O P.M. MST:
Location: l <t / _ 1'II 4eL ! ,d. . A `' BUP:
Tenant: A.I /L ► %W Suite: Bldg: MEC: '
Contractor: ami / . // / /l r1�/%/"./, /� D 0
L , / . 1 'hone: &c:14 -� PLM: l
Owner: 22 �^ C� Phone: — F / �S / ELC:
& Z J'� ELR:
0 ' -,•016 1- 7k h i , — SIT:
BUILDING BLDG P' n't P_ i i ' : ' . MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam •ost/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab " ough -In Ceiling Water Line
Slab Framing Top Out 1 ‘ Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer 1 f Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spk1r /Alm Crawl/Found Dr Heat Pump Low Volt
Approved •prov ----‘` Approved Approved Approved
Appr /Sdwlk Not Approved__:.,. Not Approved Not Approved Not Approved
FINAL FINAL ' FINAL FINAL FINAL
sari . fI PI ./ / , ' 00L /A /, ■�/r
?JAI! 4. RE , /
0 Call for p
// O Reinspection fee of $ required befor ' ext inspection O Unable to inspect
ilip
Inspector: • m
- # Date: 3 / 7 5 7 Q Page of