Permit CITY OF TIGARD
,-.- oy,„,e, " � ` DEVELOPMENT SERVICES PLUMBING PERMIT
' '. I 13125 SW Hal! Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # : PLM98 -0 152
DATE ISSUED: 06/02/98
PARCEL: 2S102AB -00912
SITE ADDRESS...: 1 125 SW 92ND AVE
SUBDIVISION - VIMBERLY ADDITION ZONING: R -7
BLOCK LOT °012 JURISDICTION: TIG
CLASS OF WORK.. :OTR GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE °SF WASHING MACH - 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP.. :R3 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 (f t) ...: 50
DISHWASHERS - 0 RAIN DRAIN (ft)...: 0
Remarks: Alteration to single family residence.
Owner: FEES
KAREN MCALLISTER type amount by date recpt
12125 SW 92ND PRMT $ 30.00 DLH 06/02/98 98- 306206
TIGARD OR 97223 SPCT $ 1.50 DLH 06/1212/98 98- 306206
Phane #: 684 -4547
Contractor
CROWN PLUMBING
23172 SW STAFFORD RD
TUALATIN OR 97062 -
Phone #: 771 -9449 $ 31.50 TOTAL
Reg #..: 004267
REG.UIRED 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 Misc. Inspection
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. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- , -0010 through OAR 952 -0001 -0080. You may
obtain copies of these rules or direct questions, to OUNC by calling
(5031246 -1987.
Issued By: Permittee Signatur -: /' %�
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
C ITY OF TIGARD Plumbing Application Rec'd By .... C.- /
3125 SW HALL BLVD. Commercial and Residential Date R c1/4/9, •
rIGARD, OR 97223 Date to P.E.
Date to DST
'503) 639 -4171 ( Permit # /�L/4-19'f -D /5 l
Print or Type Related SWR #
Incomplete or illegible applications will not be a cE a ted Called
9 pp p
1 Name of Development/Project On back indicate Work Performed by fixture.
Job Iniiiv cktoi P
�� : (... )��t1i�F;�: ° = <��:x� "`��'`:� �.��; QTY . RICE:. , AMT r,
Address Street Address Suite Sink 9.00
/a /as c5 Lt) 9, vt/C Lavatory 9.00
Bldg # City /State Zip Tub or Tub /Shower Comb. 9.00
O (� 9�aa - �
f Name I ^ Shower Only 9.00
I j�(a ,- e, ,�/ 0r.1.C-��r5 -i e-- Water Closet 9.00
I } Owner
Mt: Address Suite Dishwasher 9.00
� d.
)a.J �S 51t) 9 d . Disposal 9.00
I City /State Zip Phone
Qcc 04Q 9)22 y- 16`97 Washing Machine 9.00
Nam Floor Drain 2" 9.00
3" 9.00
Occupant Mailing Address Suite
4" 9.00
Water Heater 0 conversion 0 like kind 9.00
City /State Zip Phone
Laundry Room Tray 9.00
Name Urinal 9.00
c- ktr' 3 h f Di r3) Cvciw i U Other Fixtures (Specify) 9.00
Contractor Mailing Address / Suite •
a 50' 5 cv4.' 9.00
Prior to permit City /State Zip Phone 9.00
issuance, a copy c.-rt.t q la t' t:vs. 0 rz > 6 ( 77 /- i yy 9. 9.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date 9.00
required if i-AA_Co `/ / L �
�, / a 3 1% Sewer - 1st 100" 30.00
expired in COT Plumbing Lic. # Exp. Dafe
database " 3Y - 70 P 13 6 j 30/ Ply ✓ Sewer - each additional 100' 25.00
Name Water Service - 1st 100' � � �- 30.00 0 �'
Architect Water Service - each additional 200' 25.00
or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City /State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential I( Non - residential 0 Residential Backflow Prevention Device' 15.00
Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
S / JcV U`c Insp. of Existing Plumbing 40.00
per /hr
Existing use of Specially Requested Inspections 40.00
building or property per /hr
Rain Drain, single family dwelling 30.00
Proposed use of
building or property Grease Traps 9.00
QUANTITY TOTAL
, i flex - . t acknowledge that I have read this application, that the information .
Isometric or riser diagram is required if Quanity Total is >9 36
Tv-7. correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
is submitted are in compliance with Oregon State Laws. _ r,-,.<:
5 c, fa of Owner/Agent Date 5% SURCHARGE • 5�
PLAN REVIEW 25% OF SUBTOTAL
.of 'srs Name Q Phone Required only if fixture qty. total is >9
-, 1/1/1/‘-t-E-, 1/1/‘-t-E-, 1/1A °'o°j `C/' -' 77/ TOTAL 5-0
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
r .doc 5/97
PLEASE COMPLETE:
Fixture >;;:; <,;::; >: <'.::
TYP..,:e:: «. >: ::: .::: >: <::<:: > .Q uanti orrn.ed
b Work: >Perf
Ca d :I Removed
e
e
• laced
PP
R
P
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)
COMMENTS REGARDING ABOVE:
I:\dstslpImapp.doc 5/97
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