Permit CITYOFTIGARD
•
A DEVELOPMENT SERVICES PLUMBING PERMIT
I PERMIT # • PLM97 -0237
'
13125 SW Hall Blvd., Tigard, OR 97223 m639-4171 DATE ISSUED: 06 / 27 / 97
PARCEL: 2S112DA -01300
SITE ADDRESS...: 06640 SW REDWOOD LN #303
SUBDIVISION • MLP96 -0002 ZONING: I —P
BLOCK • LOT • JURISDICTION:
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
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 • 3 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 1 OTHER FIXTURES 1
TUB /SHOWERS...: 1 SEWER LINE (ft)...: 0
WATER CLOSETS.: 1 WATER LINE (ft)...: 0
DISHWASHERS 0 RAIN DRAIN (ft)...: 0
Remarks: Physical Therapy Clinic
Owner: FEES
MACKENZIE /SAITO type amount by date recpt
PO BOX 63039 PRMT $ 63.00 DRA 06/27/97 97- 296557
. PORTLAND OR 97201 PLCK $ 15.75 DRA 06/27/97 97- 296557
5PCT $ 3.15 DRA 06/27/97 97- 296557
Phone #:
Contractor
PENINSULA PLUMBING
PO BOX 16307
PORTLAND OR 97216
Phone #: 761 -0500 $ 81.90 TOTAL
Reg #.. : 000022
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other PLM /Underfloor
applicable laws. All work will be done in accordance with Top —out Insp
approved plans. This permit will expire if work is not started Final Inspection
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 B - Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Application Recd By ' ' 30 4
13125 SW HALL BLVD. Commercial and Residential Date Ret tl 41iirjr
Date to P.E.
TIGARD, OR 97223 UAW
(503) 639 -4171 Permit �osT ` � E "ji
Print or Type Related SWR s S+ 97-eE i'
Incomplete or illegible applications will not be accepted caned 06 zsi9?- 'ices
.
G1 i s 9-7
Nam. of Developmen roI e FIXTURES (individual
QTY PRICE AMT
Job / Sink -g 9.00 2V_�-
z ,,e, -! i / %i_ -_, /r Lavatory
Address eet /'• ress / .!te' / 9.00 9 1
06_ 0 '/ G !, 3o Tub or Tub/Shower Comb. 9.00
Bldg s City/St - to Zia Shower Only 9.00 -
7(3. el'f 7,1-?9 Water Closet J 9.00
Dishwasher ( 9.00
tAtie
Owner Mad Addr s s � Suite Garbage Disposal I 9.00
70e l� Washing Machine 9.00
��W iA4 Zip Phone Floor Drain 2' 9.00
' 3� 9.00
4' 9.00
! Occupant A ddress rte Water Heater 9.00
I Laundry Room Tray 9.00
I City/State Zip Phone r Urinal 9.00
i /
X.,71-010//.4.1.4. v er Fixtures ( "a/Au-Ur if 9.00
rr 9.00
Contractor Mailing Address sic
AO l‘30 7 9.00
P
t+t fate et Phone 9.00
�✓ 9.00
Oregon Const. Cont. / Board Lc.* E ate /�' ..tat
ANN* Copy of 9.00
G6 �.2 %L if v" /:( /71f 9.00
Current Plumbing Lic. C p. D e Sewer - 1st 100' 30
f�
Licenses ' - . / G / � Sewer -each additional 100 I 25.00
p �
• COT c� 800 [/ essY ax or Metro x ' Water Service • 1st 100 I 30.00 ' I
79.1
Name "Q44u,vt L /0i.0 F Or ,, Water Service -each additional 200' 25.00
Architect Ba Storm & Rain Drain - 1st 100' 30.00 1
lm. from A �'
Of Mailing Address �1 /' ' K- eor Si ;e Storm & Rain Drain - each additional 100' 25 I I
f ;, 7- r vK/ /Ie9 Mobile Home Space $ 25.00
/
Engineer , i ty/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
f 0 7;"4 y�1) ay^ 1 / 45 2- Pollution Device f
Ossaibe work New � Addition 0 Alteration 0 Repair O Residential Batkflow Prevention Device' I 15.00
to be done: Residential 0 Non - resiaential 0
Any Trap or Waste Not Connected to a Fixture 9.00
Addroonat description of work
Catch Basin 9.00
Insp. of Existing Plumbing i 40.00
Per/hr
/ /�
�cson of � Specially Requested Inspections 40.00
:1071 q use or property , V 13 P `7 I oerihr
Rain Drain. single family dwelling 30.00
Proposed use of C / e L to (' Grease Traps I 9 .00
budding or property .l (�
I
QUANTITY TOTAL
Are yoc capping , moving or replacing any fixtures? . Yes 0 No Isometric or riser aiagram is requires if CuanRy Total is > 9
. (H yes see back of form) 'SUBTOTAL y_'��
I hereby acknowleoge that I ha' a read this application, that the information lIT�JJ
given .s correct, trial I am the owner or authorized agent of the owner- and 5% SURCHARG -51.5-
7iat clans submitted are in comoliance with Oregon State Laws.
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL I t t S �
-�
Reeuired only if fixture qty. total is?. B
TOTAL c
Contact Person Name Phone I o ��
'Minimum permit fee is 525 • 5% surcharge. except Residential Bacxflow
Prevention Device, which is S15 * 5% surcharge
i:ldststplmapp.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: