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Permit CITY OF TIGARD "-�,�� DEVEH OPMEN �T SER 6C�ES F�ERMI # RING PERM F�LM98 -0359 9 DATE ISSUED: Q�9/�9/98 F�ARCEL: `S101AD -0�E00 SITE ADDRESS...: 1625 SW 69TH AVE SUBDIVISION WEST RORTLAND HEIGHTS ZONING: MUE BLOCK LOT •G31 JURISDICTION: TIG CLASS OF WORK..: ALT GARBAGE D I SF'05ALS.: 0 MOBILE HOME SF�ACES.: Q� TYF�E OF USE :COM WASHING MACH Q� BACKFLOW GREVNTRS..: Q� OCCUPANCY GRP..:B FLOOR DRAINS 0 TRAGS O STORIES Q� WATER HEATERS Q� CATCH BASINS Q� FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS O SINKS Q� URINALS @ GREASE TRAPS @ LAVATORIES O OTHER FIXTURES �D TUB /SHOWERS...: Q� SEWER LINE (ft) ...: Q� WATER CLOSETS.: Q� WATER LINE ( ft) ...: 8Q� DISHWASHERS 0 RAIN DRAIN (ft)...: 4� Remarks: WATER SERVICE Owner: FEES JOHN MCCROSKEY type amount by date r ^ecpt 141E5 SW FARMINGTON RRMT � 3Q�. @0 B Q�9/�9/98 98- 3Q�9577 BEAVERTON OR 97Q�G5 SPCT � 1.50 B 09/29/98 98- 309577 F�hone #: Contr ^actor GRIDLINE PLUMBING & HEATING 4343 SE 37TH AVE PORTLAND OR 97EaE ph on e # : 771 -879Q� $ 31. 5Q� TOTAL Reg #..: 000741 REQUIRED INSF�ECTIONS This pereit is issued subject to the regulations contained in the Water Service In Tigard Municipal Code, State of Ore. Specialty Codes and all other F i n a l I n s p e ct i o n applicable lass. All cork sill be done in accordance with approved plans. This persit will expire if work is not started within 180 days of issuance, or if work is suspended for yore than 180 days. RTTENTION: Oregon lay requires you to follow rules• adopted by the Dregon Utility Notification Center. Those rules are set forth in OAR 95P- 0�1�010 through ORR 95�-0001�080. You way obtain copies of these rules or direct questions to OUNC by calling (503)24b -1987. .` / Issued By: t � �`� permittee Signat�_ire:�i /' %�� %�� Call E39 -4175 by 7:00 p. m. for an inspection nee•ed the next business day ++++++++++++++++++++++++++++++++++++t++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY OF TIGARD Plumbing Permit Application Plan Che «,� 13125 SW HALL BLVD. Commercial and Residential Recd e �'' � TI�.�RLl, OR 97223 Dace Recd `'T" ' � (503) 639 -4171 Date to P.E. Print or Type Date to • � Incomplete or illegible applications will not be accepted Related swR�� I �- � Called _. 1.�� Name of Development/Project •FIXTURES tindivldual) � � QTY �: PRICE -AMT . JOb � �9T�! /�tl// Sink s.0o Address treet Address Suite Lavatory 9.00 Tub or Tub /Shower Comb. 9.00 Bldg # C�� t� D � / Zip Shower Only 9.00 1� me Water Closet 9.00 �� fC �psj��/ Dishwasher 9.00 Owner Mailin� s � � � Suite Garbage Disposal 9.00 Washing Machine 9.00 City /State Zip Phone Floor DraiNFloor Sink 2" 9.00 J�� me 3" 9.00 ✓L1r�L �LiiviG 4" s.00 Occupant Mailing Address Suite Water Heater O conversion O like kind 9.00 Gas piping requires a separate mechanical permit. City /State Zip Phone Laundry Room Tray 9.00 Urinal 9.00 C e o ��,� IVI ' �� //��P ��i1�0� � /7r�si�� Other Foctures (Speafy) 9.00 Contractor ling Address Suite 9.00 �.3 �� 3�i s.00 Prior to pennit I /State Zip Phone Sewer -1st 100' 30.00 issuance, a copy ,�I��/ �7,�0 � 7�/_ R 7 q � 6 / Sewer -each additional 100' 25.00 of all licenses are re on nst. Cont. oard Lic.# Exp. Date required if � �� 9� Water Senrice -1st 100' �j��,r --� � 30.00 �� expired in COT lumbi g Lic # Date Water Senrice -each additional 200' 25.00 database �� g �� Stone 8 Rain Drain - 1st 100' 30.00 Name Storm &Rain Drain -each additional 100' 25.00 Architect Mobile Home Space 25.00 Or Mailing Address Suite Commeraal Back Flow Prevention Device or Anti- 25.00 Pollution Device Engineer City /State Zip Phone Residential Badcflow Prevention Device' 15.00 (Irrigation timing devices require a separate Desaibe work to be done: restricted energy perrnft.) New Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 Res dential O Commeraal ,Ir� Catch Basin 9.00 Additional description of work: Insp. of F�cisting Plumbing 40.00 per/hr Specially Requested Inspections 40.00 perRtr Are you capping moving Or repl Ing any fixtures? Rain Drain, single family dwelling 30.00 Yes O No � Grease Traps 9.00 If yes, see back of form to indicate work perForrned by QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quarrtily Total is > s - ®� WORK COULD RESULT IN INCREASED SEWER FEES. "SUBTOTAL 1 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 5% SURCHARGE that plans s bmitted are in com liance with Oregon State Laws. f �S� Slgna� �1�'ner /Age Date "*PLAN REVIEW 25% OF SUBTOTAL �y� �j� Required onty if fixture qty. total is > 9 � � J /`7 TOTAL 3��0 tac Person Name Phone � � � �� 'Minimum permit fee is $25 + 5 °� surcharge, except Residential Backflow Prevention Device, which is $15 + 5 °� surcharge •'All New Commercial Buildings require plans with isometric or riser diagram and plan review I:tdstslplumapp.doc 7?J98 • 4 „ PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain /Floor Sink 2" 3 " 4" Water Heater Laundry Room Tray Urinal ' Other Fixtures (Specify) � COMMENTS REGARDING ABOVE: 1:ldsts�plumapp.doc 7l7KJB