Permit , .
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Awe' im tiARD
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DEVELOPMENT SERVICES . . , PLOMBIN5 'PERMIT:-H
PERMTTH PLM98 -01SL ,
. A.61■.,'--.. . 13125SW Hall Blvd., Tigard, OR 97223 (503) 639-4171.
' 'DATE. ISSUED g, 0672219Es . - 'it ,
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PAROEL'.; 2S,11.1c6i3O9600 . .
SITE ADDRESS..2 09890 SW. KIMBERLY DR
SUBDIVISION—,..'.1., RERWOOD, ESTAIES .
70NI NG : R-4. 5
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BLOCK........: JUR I SD I CT I ON :, ' .T IS - .. .. ..
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CLASC.1 OF ,WORK. . ; ALT ,CDAREPGE,DISPOSALS. - ,0 , ',HMOtILE - ,HONE SPACES.,V .
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TYPE OF 'USE. ''. „ '. 1: SF " L MACH.,.„ ..,— :,:,: • .,, 0 '. ' BACKFLOW PREV,NTRS,:....
OCCUPANCY 'CRP— 2 R3 . '.i FLOOR DRA INS. — .,--. : ; .. - 0 . ,:: Tf,'-:APS:.
STOR I ES — , , . . . ..; 0 , , . ' ' ' WATER HEATERS. ...; ; ; . : : .. 1: ' ' • , ' CATCH B S N S „.;, ".,,,,.1....,,''.' : 0 , . • ' -
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,FI X TURES------ LAUNDRY' TRAYS.' .' „, „ . i , 0., , SF RA I KilDRA I NS,„•.„
S I NI — — ., — . : • 0 UR :MAL'S. . ''' ' ^ ' 0 ' ..' GREASE-T RAPS.
LAVATDRIES—'. „:.. ‘0 ' OTHER I= 1X.TLI P.ES
TLIB,SHOWERS— , ; 0 SEWER L I NE ( ft ) .•. . ;,. .,, pit.
WATER CLOSETS. 2 . 0 • , W AT ER • L I N E , ( f t ) , . . i..1 , •:
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D I SHWASI-IERS — ... : , 0 ., „ ' RAP'} D R T N ( ft ) . .' . g ,,, 0 . ..
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• 'R ma •,' s ; : A 1 t ' e rat i 0 n to , r e s 1 d e n c e to r-,e p 1 c.e • 2 1 e bt:r i c IA at r ' i) e i.. .. i t h p as
heat er.
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---r- FEES .
PH 11 • P‘1151TIA WV, . 1-. 'A -n n . IriA-. h v I-1;i ni
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3LJ0,' SW KIM D ' PRMT $ ' 2500_DLH,..,06722/98 d.la -7,067'62_
T1 G(-1RD 0 R 97223 . ' . .
' ' 5PCT $ 1. 2' DLH 06/22/ 9El 9-2-' 306762
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'Phone 41:: 60-658 • ,, , ., . •
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Cont ractor ---' . . . . .
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COLUMBIA HEATING 8: COOLING INC , , . .
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PO , BO X 230397 , ,
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. 8900 SW BURNHAM ST ' STE E-11.1
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T I GC-IRD ' OR' 97281-0397 .. • .
Phone 44:: 624-2704 . . ,
. $ 26. 25 TOTAL . . .
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Reg 4- „ : 000763 , , . . , • . . „
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., --------.- REOU I RED INSPECTIONS
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This per nit ' is issued 'subject to the regulations contained in the . Final .. Insoebt ion
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Tigard Municipal Code, State of Ore. Specialty Codes • and all other ,' . ' .
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applicable laws. All work will' be done in accordance 'with .
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proved plans. This pernit will expire if work is not started
within 18Z days of issuance,, or if or is' suspended for none ___...... , ......
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than 160 days: ATTENTION: Oregon law requires you to follow rules • ______________ _________ ___ - -
', adopted by the Cragon,Utility Notification Center, Those rules are . . '
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set forth in OAR 352-2;031-02,10 through CAR 952-OZZI-U You nay '
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obtain copies .of these rules' or direct questions to OLNC by ' calling . .. , . • .. , : '
NG) 246-1987. • . . . 7 .---- 7 —
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I Bsued By :__ , ' , , • Per mitt es Slur 'P
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-!--I-q-i-4-1-4-4-*-FA-q-:i-A-i-i-I-+-F-+++-1-4-4-+-i-4-+q-1-4-1-4-1-+.++74-A-+-i-+A74-i-+-i-ar-i-A,--FA"F4 -.+4-4-A-4-444-q-+t+-i4*1.4A-+A-'7F.4'
Ca i 1 639-4175 t x 1 - 4 7 : 00 p'. al . for an i. n s pebti on . ne i , t h:cs next biis in s.s •• d a
-4-4-4-4-4-4-!--4-4.-4-
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'7.1TY TIGARD Plumbing Application Rec'ti By ../- /J7
3125 SW HALL BLVD. Commercial and Residential Oats Reed •72-2.-/ ‘,,p
!GARD, OR 97223 Date to P.E.
Date 503) 6394171
Permit • P Uy 9,P -e
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Caned
of Development/Pro .:EIXjURES.- 05.14ldt�al) l • f za Lp B: d
Job - 1" l) , I os tuJ ick 9.00
p street Address • Suite�'Y
Address -/ vo gto I/ bedPr' Tub or Tub/Shower Comb. 9.00
Bldg s City/Steil rf Zip Shower Only 9.00
7 rd lae, 9' 7e4 water Closet 9.00
1 5 7) t I - Bosko i .k Dishwasher 9.00
Owner q Mang Add f ss� - Suite Garbage Disposal 9.00
?Rq l0 c6rN 7 )1 71 b el l y Pr washing Machine 9.00
- q t' Cie- q '79ac� 1 -4 x.5-- Floor Drain 3. 9.00
Name 8.00
5a, m as t) E-- 4• 9.00
Occupant M ading Address Suite Water Heater / �-, ll
- Laundry Room Tray 9.00 UV
City/State Zip Phone Urinal - 9.00
Other Fbdures (Specify) 9.00
Nam rum 61 a - J 9.00
contractor -
j5o 9.00 • -
Prior to issuance Phone
applicant must rd oi2970P - z� 70� 9.00
provide all Coast t. Board Lice . Date . 9.00
contractors /74, �� a j � /0 '- oZ •-' 6 -
Lies Exp. ate . Sewer -1st 100' 30.00
information ` /75P6 ID sewer _tad, additional 100'
for COT �s Exp. Date 25.00
database). CO � Tax 0 / 9 or Metro ✓ Water Service - 1st 100' 30.00
Name water Service - each additional 200' 25.00
Architect Storm & Ram Dram - lst 100' • 30
or Mailing Address S Storm & Rain trait - each additional 100' 25.00
Mobile Home Space 25.00
Engineer CAY /State Zip Phone Commercial Back Flow Prevention Device or Anti- . 25.00
Pollution
. )esaibe wort New 0 Addition 0 Alteration,e Repair o Residential Baddlow Prevention Device* 15.00
o be done: Residentia),0r Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
adrtional description of wort Catch Basin
EJ C //V6-- Z(//9"-,t'/e- if -6- 9.00
-,e-0 /`' C � 6 - � ' Insp. of Existing Plumbing p
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sting use o f Specially Requested Inspections 40.00
;ding Rain Drain, single family dwelling 30
'posed use of Grease Traps 9.00
riding or property
QUANTITY TOTAL -•: ti,
re you capping . moving or replacing any fixates? Yes B-- No ln
No Isometric or new Twain m requied d Mandy Total is > 9 is
If yes see back of form) 'SUBTOTAL -
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i hereby acknowledge that I have read this application. that the information +. :_' °,'°` � eiC
,even is -• • � I am the . or authorized agent of the owner. and
5% SURCHARGE •
gat slams ate • with Oregon State Laws. •� 1 /
•grad+ - .' N • : - o PLAN REVIEW 25% OF SUBTOTAL •
� / )l . �Ivea� , l / W ,�{�C � g Required one ttieae 410. tail is > 9 L
�'� • - TOTAL /
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n • e •. n Name Phone '. - _g6 o�5
� /� *Minimum permit fee is 525 + 5% surcharge. except Residential Backflow -
�- N L ) n roll I G[ /1 r- -r- i Prevention Device. which is $15 + 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)
:OM TS REGARDING ABOVE: II /
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lac r !� �Q��:�-/, t Ct)a442 r �1�Gt,� l w � h QS 1 ")ea -
I:\plmapp.doc 12/96 (dst)
1/7/2005
Case Activity Listing 1:44:21PM
TIDEMARK Case #: PLM98 -00182
COMPUTER SYSTEMS. INC.
Assigned Done Updated
Activity Description Dated Date 2 Date 3 Hold Disp To By By Notes
PLMA003 Application received 6/22/1998 None RECD DLH 6/22/1998
DLH
PLMA005 Create Permit 6/22/1998 None DONE DLH 6/22/1998
DLH
PLMA799 Final Inspection 7/16/1998 None PASS TLP 7/16/1998
J *H
PLMA050 (F) Issue permit 6/22/1998 None DONE DLH 6/22/1998
DLH
PLMA800 Case Finaled 7/16/1998 None PASS TLP 7/16/1998
J *H
Page 1 of I CaseActivity..rpt