Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2003 -00053
•
A DEVELOPMENT H B S RR9 2CES 639 -4171 DATE ISSUED: 2/19/03
SITE ADDRESS: 16825 SW RIVERA LN PARCEL: 2S116AD -19000
SUBDIVISION: KING CITY NO. 18 ZONING:
BLOCK: 26 LOT: 001 JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 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: I
FEES
Owner:
Description Date Amount
SID & ANN STULLER
16825 SW RIVERA [PLUMB] Permit Fee 2/19/03 $72.50
KING CITY, OR 97224 [TAX] 8% State Tax 2/19/03 $5.80
Total $78.30
Phone :
Contractor:
COMFORT MECHANICAL
17936 SE DIVISION
PORTLAND, OR 97236
REQUIRED INSPECTIONS
Phone : 503 761 - 1500 Final Inspection •
Reg #: LIC 79558
PLM 26 -556PB
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. 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 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued By: a ,. J, Permittee Signature: lI r
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
02/13/2003 14:08 5036393771 CITY OF KING CITY PAGE 03
12/02/2002 16:06 5936393771 CITY OF KING (:11Y ►+��
TltiuebOt . OFFI1( 1 . ltil.: 0:`4,1
SEc>c CENTER Plumbing Permit Application 2 II
� . - y Date recelvedr' 19 d I I /�.�, M. - �� 0
Receipt no.:
� G City Of Kills City - S,evrerperrt►itno: Building permitno.;
.`' i 13125 SW Hall Blvd R .:T 1 . ProjecVappl. no.: _ Expire data:
Tigard, OR 97?23
Multnomah Phone: (�) 639 -4171. FAX: (503) 684 -7297 pale issued: �%�
Clackamas
Washington Case 13 2003 Case lilt no,: Payment tYPC -
e o u r• . t+ e s Land use approval : - T OF TILiAFiu
1 & 2 family dwelling or accessory CI Corantercial/induatrial • CI Multi - family O Tenant lmptovtn ent
O New construction f3 Addition /alteration/replacement 0 Food service 0 Ott
lull. s 1 E I.Nf (.)It;MA t KIN FFE .tit. trrnl ivr: if", tiprl inl.1r icon r,,r c liccl.li.t 1
lob � . :. . lPee tt�a. Total
Bldg. address: . 2S IMP �'�e` Vv' New 1. and Manny dwe 1 � .. WIT
Bldg. tto -: _ Suite no.: (mdudm 100 R. Poe eadh Milky caaaon)
Tax map/tax tot/account no.: — . SFR (l) bads .
Lot: • Block: Subdivision: SIcR 2) bath .
P roms : - -- ... • • • -- - . . ' 1 • (3 ,., i __
, City /county: f-j v`S _ e4! I zip: ° j-E 2 Nfo
2- `1 garb additional bath/kitchen
Description and location of • k an pre I. • - : Site utilities:
• .. Catch boslut/area drain •
etlwAeach line/trench c�ieils •
Est. date of coin • Ledo dog Foo : ;. drain (tin. lin_
PI.litillING CON I KAt'1011 7. funned home utilities
auatneas name: ,a V A / / .�., r Manholes
A•ddl;ess: 1 3 c, ! G-, I vi a 10 '43 , drain unmet-tor . Y
City: 00 ie State: - e" ? !: 9- ( s anitary s ewer (no. lin. .)_ — -
Photwe: /, - T. e Fax: . S i E -Mall: Storm sewer (no. lin. (t..) , _ _ —
r
S a5 Plumb. bus. m . no: eater service no. Iln.'!kL_,
CCB no: : S' k 2L.: Sb P3
Fixture or item: -
City/metro (Ic. no.: 6 0 a a — a , -D'S Fixtu a Absorption or valve
Contractor's Mad signature: - Motive signate: ." ' Back now valve
Print twine: Data a • 3 Backwater valve
(' N IN I t't• : aster/lavat• .
Name: Clothes waaha �____
- D ishwasher
Address,: D u►kins_t'•rntaia(a) _ -
City: State: ZIP: - lectors /sump -
Phone: Fax: Erman: Ex • - ion tank .
r o.W' N F J( Fixtute/sewrr _, '
moor sutks/b • —
L / c/ • nor drait>a - - ,
Name (• rllat : l • - ge sposal
Mat Wtg address: Nose blob -
City: • IState: IZIP: 'fee raker
Phone: I Far I Pewit ' , tercept /g rease trap
•
Owner instailatkurlresidendal torah manse oily: This actual installation Pri s
will bt made by me or the mainterrannee and repair made by my regular Roof dra t -cotrmterrial)
employee on the property I own as per ORS Chapter 447. Sink(s). basin(s). lttvs(s) _ _
• Owner's sr are: Date: - S
Tubs/shower/shower
rills!
Name: .' Water'closet '
Address: - �r hea ter # t
City: - State: ZIP: Other: ,
Phone: Fax, E -mail: To
sdtnuixl fee
-- ` ei
NP1 al .07 ,fm
n icrr t nr.�rp again cords, pkase call jr..i.dinU h au
•. r MOM i.r•rm.e;n.. Nacica Thu permit application • .. Mi Mi n rmviow (tit +) S • ' p '•'
1 vin O At•seerCard • eipins if a p is nod oRd oiemi Vile
aim number - 1 / ,.. within 184 ddf's After it has Raise State eulcharse (S%) S
Empires TOTAL, S ' '
Nome or wdbetd.►.e shwa en craii cord aacoptM complete.
—
cya•Wsr ui4eawi m o oar 4404616 (6100/COM)
Listing 1:12:00
Case Activity Li g 12:12:OOPM
TIDEMARK Case #: PLM2003 -00053
COMPUTER SYSTEMS, INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLMA003 Application received 2/13/2003 None RECD FAX 2/19/2003
BB
PLMA005 Create Permit 2/19/2003 None DONE BB 2/19/2003
BB
PLMA799 Final Inspection 2/28/2003 None PASS MRS 2/28/2003
MRS
PLMA050 (F) Issue permit 2/19/2003 None DONE BB 2/19/2003
BB
PLMA800 Case Finaled 2/28/2003 None PASS MRS 2/28/2003
MRS
Page 1 of 1 CaseActivity..rpt