Permit , 'i CITY OF TIGARD
PLUMBING PERMIT
4., t , DEVELOPMENT SERVICES PERMIT # • PLM97 -0219
• . ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 06/11/97
PARCEL: 251O1DA -02000
SITE ADDRESS...: 06980 SW VARNS ST
SUBDIVISION • VARNS ACRES ZONING: C —P
BLOCK • LOT -3 JURISDICTION: TIG
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 • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 100
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Installing new water service
Owner: FEES
WEST COAST LUMBER INSP BUREAU type amount by date recpt
6980 SW VARNS ST PRMT $ 30.00 B 06/11/97 97- 295726
TIGARD OR 97223 SPCT $ 1.50 B 06/11/97 97- 295726
Phone #:
Contract or
FULLMAN COMPANY
5805 SW HOOD
PORTLAND OR 97201
Phone #: 224 -5221 $ 31.50 TOTAL
Reg #..: 000004
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 Water Service I n
applicable laws. All work will be done in accordance with Final Inspection
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.
Permittee S l('L 0 nature: IAA - (O11 -/�
Issued By : 41/1411.-ke-afis
Call for inspection — 639 -4175
I]
t
CITY OF TIGARD Plumbing Application Recd BY f3"l
3125 SW LL BLVD. Commercial and Residential Date Recd ' (Q '�1'/
IGARD, 0 97223 Date to P E
• 303) 6394171 Date to DST
Permits _ E l =
Print or Type Related SWR e
Incomplete or illegible applications will not be accepted called
Name of CeveeiopmenuProtect FIXTURES (Individual) QTY PRICE AMT , t
Job (,Jest 694,§f _ i..44,1 Sink 9.00
Street Address Lavatory
Address / (y suite 9.00
6 9 0 0 SW Uar I rub or Tub /Shower Como 9.00
Stags ...L....liyi.State Zip Shower Only 9.00
Name I j.54.401 7 Water Closet - 9.00 I
5"4 41...e Crsnwasner 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
C•ty /State Zip • Phone Floor Drain 2- 9 00
Name
.57:1A., r 9.00
.r a 4. 9.00 Jt
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Unnal
9.00
Name • Other Fixtures (Specify) 9.00
I ) t ..-Ce-rvit.4*-- 9.00
Contractor Mailing Address Suite 9.00
5805 SG-) 0604
9.00
i {Prior to issuance 91tyr t to a ZiD Phone
' applicant must , .r w 2 r L/-5 l
;L . 9.00
provide all Oregon onst. Cont. Board p. Date 9.00
j a: contractors 1, 7 g / 0 ` 9.00 I
license Plumbing Lic. >Y
Exp. Date Sewer - 1st 100' 30.00 I
information )-h, _ 4 3 P/?
for COT COT Business Tax o tvt etro� Exp. Date der -each additional 100' 25.00
database). I o I y
Water service - 1st 100
Name Water Service - eacti additional 200' 30.00 �� ,
25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
or Mailing Address 1 Suite
Mobile Home Space 25.00 I
Engineer City/State Zip 1 Phone Commercial Back Flow Prevention Device or Anti- 25.00
P ollution Device r
: work New, Addition C Alteration O Repair 0 Residential Back9aw 3 revention Device' 15.00
'o ce done: Residential 0 Non - residential C Any Trap or Waste Nct Connected to a Fixture I 9 00 I
Addit:onal description of wont
4 ,2_40 e1/4.71 5 a.4 'v t �_ Catch Basin I 9 00 I
insp. of Existing numbing 40.00
perrhr j
: :st :rg use of Speaaily Requested Inspections f 40.00
'ci. g or property Q Xi P e I Denhr
Rain Drain. single family dwelling I I 30.00 I
,:csed use of Grease Traps I 9-00
•e:r•.g or property _ 1..1-...--
QUANTITY TOTAL ( I 3r
r. ° .au cooping . moving or replacing any fixtures % Yes c No err) Isometric x user diagram •s recurred I Cuanrty ±otai •s .
:r •: es see back of forma // 'SUBTOTAL
'e acknowledge that t nave read this application, that the information
- ' :en is correct. that I am • ie owner or authorized agent of the owner, and 5% SURCHARGE
at Mans submitted are in :amplian with Oregon State Laws. ''
gnature o O ner /A Date PLAN REVIEW 25% OF SUBTOTAL
6M
Recurred am 1 9rure c^r *drat ,s > 9
TOTAL 1 3). S P
.o' ntact arson ame Phone
-
� .�� 1 'Minimum permit fee is 525 - 5% surcharge. except Residential Backflow
i i� /Orre • �d-/ Prevention Device. which is S15 • 5% surcharge
i :'asts',plmapp.doc 9/96
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced I Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher N
Garbage Disposal
Washing Machine
Floor Drain 2" _ - - - -- -
3"
4"
Water Heater
Laundry Room Tray -
Urinal
Other Fixtures (Specify)
;OMMENTS REGARDING ABOVE:
_____
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: i � A.M. P.M. MST:
Location: 6. do • I. /I . / _I :! BUP:
Tenant: n Suite: Bldg: MEC: p
Contractor: i Q/Y1 P lPhone: 2 2-(4.- - z
S 1-) PLM: 1 7 -004 '
/
Q
Owner: a /_ /� ' i!,�_ �iJ&. / . i Phone: ELC:
■ /
ELR:
• SIT:
BUILDING BLDG (con't PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Po -: eam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water me
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Ahn Crawl/Found Dr Heat Pump Low Volt
Approved - pproved Approved Approved
Appr /Sdwlk Not Approved • .roved Not Approved Not Approved Not Approved
FINAL INAL FINAL FINAL FINAL
•
•
, y' "
0 Call for reinspectio O Reins. do • fee o $ required before next inspection 0 Unable to inspect
Inspector: / / /, 'rI '• �llibil► . �:�_. Ia . Date: ., " Page of
IF 4111V - r
•