Permit 7.
CITY TIGARD PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2003 -00552
�`�" r � I 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/23/03
SITE ADDRESS: 12511 SW 68TH AVE PARCEL: 2S101AA 08700
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 029 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 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: Backflow located on 68th, close to corner of Beveland, near water main
FEES
Owner:
Description Date Amount
ROTH, J T JR + THERESA
12600 SW 72ND AVE, STE 200 [PLUMB] Permit Fee 10/23/03 $72.50
TIGARD, OR 97223 [TAX] 8% State 10/23/03 $5.80
Total $78.30
Phone :
Contractor:
HERITAGE LANDSCAPE GARDENING
11709 SE WOOD AVENUE
MILWAUKIE, OR 97222
REQUIRED INSPECTIONS
Phone : 503 317 - 7152 RP /Backflow Preventer
Reg #: PLM 6963
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: /P/ryl Permittee Signature: . ,/ij / , y�
Call ( 3) 639 -4175 by 7:00 P.M. for an inspection needed the next busin •ss day
Oct 22 03 05: 10p Steve Skowronek 503 - 794 -8619 p.l
10/22/2003 08:31 FAX 5035981980 CITY OF TIGARD W1001 /003
Budding ¥fixtures
Plumbing Permit Application Recoive Plumbing
. t No. 1 3 -0-04-6-Q,
City of Tigard Planning , Sewer
13125 SW Hall Blvd..
Plan Review • Tigard, Oregon 97223 Parni
Date/By: Permit No.:
Phone: 503 - 639 - 4171 Fax: 503 - 598 - 1960 Internet: Post • Lend use
Case No.:
Internet: wWW.C1.tlgard.OruS ti.'' � f.'. e
Date/By:
24 Inspection Request: 503 - 1 �� Contact Case
• r See Page 2 for
.. Nam /Method: I Supplemental la formation.
3t- % :.;,>; J'� ` , .:
, :ta1'1!IE:OR7.4VOR1G s.r ";_; = ':K. :;F: .: r. . ;;: '-r°- �-r�
. .New construction _ � ��• . ^ pEpt :.�.SI:�oUL'�E:(tor.:apet9aE lit .
over 'iaiic��iila'rcbiie
Demolition Description ' Qty. l Fee(ea -) ( Total
Addition /alteration/replacement cj Other. %: : :: ' - Nsiw• r &Z laiiotix•
� .'• l'+TIQI'f::l'`:';u^::::..::;�z `� .e <�_'..:.`:,' ;: .m
E1 1 & 2-Family dwelling ► ommerciaUlndustrial 5FR•(l) bath T 249.20
- SFR (2) bath 330.00
- DACcossOry Bi 1ding U Multi - Family _ SFR (3) bath 399.00
J Master Builder . • Other: _ Each additional bat /kitchen 45.00
r • ' : • • JOB'SITE.;DIFORMATIONi d LOC'it►TrON: , . ... Fire - sq. e sprinkler ft.: Page 2 • • . '
o s ite address: s : s..= site > ,...... _
C �Q r� .., "rt'�'`: .:L•:�. ?\7YG 'rr��.�=��tr.:�, �h:.•:: .•::;_ - � , ;
Suite #: / ? 5 )/ 1 Bldg- /Apt. #: • catch basin/area drain 16.60 -
Project Name: DryweII/leaclt line/trench drai 16.60
Footing drain (no. linear 1t.) Page 2
• Cross street/Directions to job site :.�Jt� 1 ,).� ` Manufactured home utilities t 10.00
e-e-r v� GA (r�FAJ l�. G„e. ''7,e.../ z.1c,„:) d - Manholes
� 16.60
Rain drain connector 16.60
• - Sanitary sewer (no. linear R) Page 2
Subdivision: 1 L It; Storm sewer (no. linear tl.) Page 2
Tax map /parcel #: y 7c_ Water service (no. linear R) _ Page 2
ie:ur' -..:
> =:.. B QN:QF.AHQR)CC. • .:'',!*:','..'s.:1••••,::: .. Itlim =:,= : `16 . 6 .. c::
Absorption valve 16.60 '
t low e) z V Cc S41c.1 Backflow prevextter 1 Page M1o• :` -
(gc 1 l fie- 4.4(4- C.C�O-4 4-0 Backwater valve 16.60
Ce- b Iry . mp ' Clothes washer 16.60
lJ DiShwasher 16.60
PROPERI'X`AVP.NRR ' =.,: 54 ;r1 FAil t' ::i= = =..;: ! =. ,s'J Drinking fountain 16.60
Ejcctors/stttttp 16.60
Name: - I; 0 C M �
S A -r-1- Expansion tank
} 16.60
Address: 12 ec' SC,:i .- 12 ,... /, vim. Fixture /sewer cap • 16.60
City / State/Zip: i ;-r pR x ( 7 22 5 Floor draiNfloorsink/hub 16.60
Phone: So - foS i 3� Fax: Garbage disposal 16.60
Hose bib 16.60
Viet ,' ;: . ..: •::::::: .: . CO VACMPERSOft :: "
Ice maker 16.60
Name: .ST- z- b ,. 5 k.r,.r f� cv , Interceptor /grease trap 16.60 -
Address: I ) R g', L.) o c Ave_ Medical Ras • value: 5 Page 2
Primer 16.60
City/State/Zip:
M :) wr•✓ k ' , e_ tie cj - 1 z 2 Z Roof dtrtin (commercial) _
16.60
Phase: fi g- 31 -7 t$ 2 I Fax: So; 7 / LI - yC -- S" Sink/basin/lavatory - 16.60
E -mail: ---- _ Tub/shower /shower pan 16.60 •
, :
... '.:•;'.': :'•f • _; := :....: . : I ACTOR:: •'• •'';: :-. :: Urinal ' 16 -60
Business Name: ! � • Water clos 16.60
NGr� �t �,n'' ��r rtS 1 �c Water heater 16.60
• Address: 11 SE b- k r:cc Ave. . Other: •
City /State/Zip: 1b.1;1 wa ` ic ;c__ 0 (z 972. 2 2 ^ Other:
Phone: Co 5 - --it s Z Fax :�0 3 - 1 `i ' .. ?:
. V ;: '. 4 ";•i� .ge aait,Fees!!:: . ' • , : .
. . , i .,:. ..
CCB Lie_ #: (o �' PI ,. • . Lic.# :/2_3=7"1 Subtotal $
�1 t L. - t� -
Authorized / ! Minimum Pesmlt Fee S72.50 S
Date IO / ��� R esidential Backflow Minimum Fee 836.25 72- 5b .
signature: : iii /f Plan Review (25% ofPermit Fee) $
S%gf t.,ti A �"��
S FtwT �k.. Stets Surcharge (8% of Permit Fen) $ S. Sup
(Please print name) TOTAL PERMIT FEE b S ice. '
Magee: This penult application expires ins permit is not obtaiood within All maw wmmareial buildings require 2 sets orplsms with isometric or i
180 days alter it bss been accepted as complete riser diagram fur Ono review.
R E E D 'p m��
set Tel- Connly Building Indian, Service Board.
i:�Dsts\Permli Fo T s P1mPenn, App.doc 01103 RECEIVED
OCT 2003 OCT 2 2 2003
CITY F TI RD CITY OF TIGARD
BUILDI G DI SION BUILDING DIVISION