11700 SW TIGARD STREET-1 ADDRESS:
J01ecords\microflm\fargets\building.doc
1
Paq® No. l CASE HISTORY FOR CASH NO.; PLM98-0129
BRET' A O'DELL
1171n 9W TIGA.RD DR
07/02/96
Action Dencripticai Req/ Schd/ R Action Noten Dinp By Update Upd
Code Sent Done Dor.. Date By
P114A001 Application received / / / / 05/11/99 RBCD OBO 05/11/98 DST
PLMA005 Create Permit / / / / 05/11/99 DONE ONO 05/11/98 DST
PLMA050 (F) Inoue permit / / / / 05/11/99 PASS ORO 05/11/98 DST
PL14A710 Water Line Inap 05/11/96 / / 03/26/96 PASS MS 05/27/98 J•H
PLMA799 Final Inopection US/11/96 / / 03/26/96 PASS MS 05/27/98 J•N
PLMA800 Came Finaled / / / / 05/77/96 PAS: M3 05/27!96 J-H
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 f5O3)639-4171 PERM IT #. . . . . . . : ["LM98-0129
DATE ISSUED: 05/11/98
PARCEL: IS134CD-07300
=TTE ADDRESS. . . : I1.'700 SW TIGARD DR
5, RDIVISION. . . . : BURLWOOD NO. 3 ZONING. R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :033 JURISDICTION: TIG
C"ASS OF WORK. . :AL.T GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . 0 TROPS. . . . . . . . . . . . . . . 0
STORIES. . . . . ,. . . - 0 WATER HEATERS. . . . . . 0 CV,TCH BASINS. . . . . . . . 0
F I XTURF3——--------- LAUNDRY TRAYS. . . . . : 0 EF RAIN DRAINS. . . . . : el
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 BR7-..ASE TRAVIS. . . . . . . . 0
LAVATORIES— . - 0 OTHER FIXTURES. . . . : 0
TILIB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
TATER CLOSETS. : 0 WATER LINE (ft ) . . . : '35
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remark,-7 : Replace existing water 1 .ine for a single family dwelling.
Owner: ------------------------------------------------ FEES ----------------
BRETT' A O' DELL. type amoi.tnt by date rec-pt
11700 MI TIGARD STREET PRMT $ 30. 00 GEO 05/11/98 98-307-64
TIGARD OR 97223 5PCT $ 1 . c50 GEO 05/11/98 96--305664
Phone #.- 579-45051
Con',ractor--------------------------------
OW14,--R
Phone #: $ 3 1. E'O TOTAL_
Reg #. . : 000000
------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Mimiripal Code, Statf, of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work sill be done in accordance with .......
approved plans. This permit will expire if work !s not started
within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTMN- Oregon law requires you to follow rules
adopted by the Oregon Utii4y Notification Center. Those rules are
sit forth in DAR 952-900I-0010 through DAR 952-0001O80. You may
obtain copies of these rules or direct questions to OLW. by calling
(9503)246-1967.
S s 1-(e(
Permittee
.......4-++++4-++4-++4-+4-++-4-+4 4-+4....................4............................. +
Call 639--4175 by 7:00 p. m. for an inspection needed the next bi-Isiness day
....................................4..............4-4•..............................
CITY OF TIGARD Plumbing Permit Application Plan Check*
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Recd
(503) 639-4171 Date to P.E.
c�. 7 Print or-type 0;,,e to DST
Permit
Incomplete or illegibleR
applications will not be accepted atee 0t #SrR
Related SWR#_
C211ed
ffName of Development/Project — On liack Indicate Work Performed by fixture.
Job i)-=413 env:�3_; FIXIURES-(individual) QTYPRICE AMT,
Address Street Address Suite Sink — _ 9.00
() tJ Lavatory --�- 9.00
Bldg# City/State Zip Tub or Tub/ hower Comb 9.00
Name 1 Shower Only - 9.015
31--(:q � Water Cl
11 OaL - oset - - 9 00
Owner Mailing Address Suite Dishwasher 9.00
)j �L'O ';,J T16n Garbage Disposal 9.00
City/State Zip Phore -
Washing Machine 9.00
_ I clot/-�- 2 7H- 150;
Floor Drain 2" 9.00
Name
3" 9.00
Occupant Mailirg Address; Suite 4' 9.00
_- Water Heater O conversion O like kind 9.00
City/State Zip Phone
Laundry Room Tray 9.00
Name -- Urinal �—-- 9.00
_ Other Fixtures(Specify) 9.00 —�
Contractor Mailing Address Suite 9.00
9.00
Prior to permit City/State Zip Phone
issuance,a copy Sewer-1 st 100' 30.00
of all licenses are Oregon Const,Cont. Board Lic# Exp.Date Sewer-each additional 100' 25.00
required if I Watrr Service-1st 100' 3000 �lr�
expired In COT Plumbing Lic.# Ev.Date Water Service-each additional 200' 25.00
database _
Name Storm d Rain Orain-1st 100' 30.00
Sturm&Rain Drain-each additional 100' 15.00
Architect _ -- ----- -
Mobile Nome Space ' 25.00
Or Mailing Address Suite — ___1
Commercial Back Flow Prevention Devicu or Antl- 25,00
City/State Zip Phone Pollution 1evice
Engineer Residential Prevention Device' 1500
Describe work- New O Addition O Alteration O Repair m� Any Trap or Waste Not Connected to a r"ixture 9.00
t to be done: Residential• Non-residential O Catch Basin 9.00
Additional description of work: /_ Insp.of Existing Plumbing 4000
e QtL M _ e�rrn_r
Specially Requested Inspections 40.0
S!1/►�aGL A`(4 TvLtd _ per/hr
Rain Drain,single family dwelling - 30.00
Exist'.ng use of
building or property Grease Traps 9.00
�Z>Z �,ewl:�( '1„y. �Lt�raet�tr 4
Proposed use of T QUANTITY TOTAL
building Or property Isometric or riser diagram is required 'Ouamty Total Is >9 --
"SUBTOTAL
I hereby acknowledge that I have read this application,that the Information - -- --- --- - -
given is correct,that I am the owner or authorized agent of the owner,and 61,; SURCHARGE ;.i,. n, ]t• .
that plans submitted are in compliance with Oregon Stara Laws.
Signature of Owner/Agent Date PLAN REVIEW 25%Of SUBTOTAL •'
Required an f fbcture gt�total is 9 — —�
C/(1 ut J -1 1 _��' TOTAL
contact Person Name Phone --I —
v'Minimum permit fee is$25+5%surcharge except Residential Back@ow
4 0).X u 5 71-145C1, Prevention Device,which is$15 t 5%surcharge
**All New comme•clal Buildings require plans with isometric or riser diagram
and plan review
I tdernWlumbapp do:5/51911
i
PLEASE COMPLETE:
Fixture Type _ Q jantity by Work Performed
New Moved Replaced Removed/Ca ed
P _ PP
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal --
Washing Machine
Floor Drain — 2"
411
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify) —
COMMENTS REGARDING ABOVE:
I%dstllrk nhepp doc 515198
Hermit #:
Address:
H
"',ate:
Issued by:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.95j(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
, I I ()wn, reside in, or will reside in the completed structure.
i3,d ? I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
(-� 3A. My general contractor is —---— ——
U (Name) Contractor regis. #
I will instruct my general conttactor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
Bi 3B. I will be my own general contractor.
If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, 1 will contract with a L rntractor who is
registered with the CCB and will immediately notify the office issuing this building pern it of the
name of the contractor.
I hereby certify that the above information is correct and that 1 have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
I
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Information Notice to Property Owners
IAbcut Construction Resp-)nsibilities
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OTHER .�ESPC)NSIEi'_.ITIE r3 AND ARRAS OF CONCERN:
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LiaLilit;,,gild property dantage insuranve: ulll<i.i 'illAl .4;Cill lU`•t•C if y11u hill.:1111 NUilh•illisui
►iildellt.: 10111 utnissicrtl such l� lillsllll il!ltlti, i 11110 t :Cf:.l4titl, \klllt'1'tl;.I1UIgt: fVQ11i I?Il,c'
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Time 141%aperciv.employers. N1aL. .urr l(llI h;I 4nffit irni. IITilt, I(1 ',Ilper(•isr: v0111f altlployee,
Ptplertkv MaktlivlfwvolsIt:►vethe oxIvIitike:tvaohsvotirown general contrictor.tomorditiatt the ,Iktil
trade, and to Otify handing nffie i3lc At IN'i ormlirilte timri,;co
the c1►Tt t'•;ffhrnl the tel{ttired in4 e(:6n1'
If you have arl(lititltl►I cluviiitwiv, Nvot ott call t.hc C(lnslrucutln Cimli,tlt(1e, h(ord 01() liox 141401$al'enl,OR 07309-
503078-462 1)
73t►U503078-4621) The Board IN located a, 700`ummt't SI. NI'. Stlite. .31M, In Saleln.
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