Permit CITY TIGARD 7.0 PLUMBING PERMIT
l4 DEVELOPMENT SERVICES V
� PERMIT #: PLM2000 -00081
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -417Y DATE ISSUED: 3/14/00
SITE ADDRESS: 14110 SW 97TH AVE PARCEL: 2S111BA -00109
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT: 028 I JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 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: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of less than 100' of water service to move water meter to back of property.
FEES
Owner:
Type By Date Amount Receipt
PARKER, THOMAS D + LINDA PRMT DEB 3/14/00 $50.00 0000641
14110 SW 97TH AVE 5PCT DEB 3/14/00 $4.00 0000641
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
CROWN PLUMBING
23172 SW STAFFORD RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 771 -9449 Water Service Insp
Reg #: LIC 000042 Final Inspection
PLM 34 -70pb
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: iO Permittee Signature:.4 it /II
Call (50 ) • • -4175 by 7:00 P.M. for an inspection needed the next • usiness day
CITY OF T ".CARD Plumbing Permit Application _ Check
13125 SW HALL BLVD. Commercial and Residential Recd By . 7/
TIGARD, OR 97223 Date Recd 'P 7OO
(503) 639 -4171 Date to P.E.
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit
Related WR SWR ;�/
#
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
I
Job J 64, . f 1 /�.� , rlat- Sink 11.50
Address S tye t o dress � Suite Lavatory 11.50
/ � � � .. (" S_ ai. C 74rjf. Tub or Tub /Shower Comb. 11.50
( 1./ Bldg # City /State - 9 Zip Shower Only 11.50
l �/C ( / /') /, 7 2 2 4 Water Closet 11.50
N ! V e ige /FQ Urinal 11.50
Owner Mailing Address A +^ Suite Dishwasher 11.50
Me 5 & 9 Aa Garbage Disposal 11.50
City/State Zip hone
Laundry Tray 11.50
/ N a e ' 09g 97 y Po-717i Washing Machine /Laundry Tray 11.50
Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Addres Suite 3" 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
Name MEG Home New Water Service 32.00
e( ��A ' NA/ MFG Home New San /Storm Sewer 32.00
Contractor Ma firing Address Suite
I V?' y A- r r, Hose Bibs 11.50
Prior to permit ity /State Zip Phone Roof Drains 11.50
issuance, a copy g 1 U r G 72_0 -77/-9.7.y9
D C Drinking Fountain 11.50
of all licenses are ree on Co st. nt Board Lic.# Exp. Da e /
required if 74 7 /3 , fiu y 4- 00 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect Sewer - 1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
En ineer City /State Zip Phone Water Service - 1st 100' 38.00 DD '/ Ot^1
g Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 Inspections per /hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps ' 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
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 Isometric or riser diagram is required f Quantity > 9
that plans submitted are in compliance with Oregon State Laws. *SUBTBT is
Si. ,r :ture of O n' /A.,- t Date
A _4.• A / / /.. / 3- /4/ Q 8% SURCHARGE J Gam
_
Contact Pe on Na e phone
/� `'I�1L * *PLAN REVIEW 25% OF SUBTOTAL
C Required only if fixture qty. total is > 9
1 BATH HOUSE $178.00 TOTAL
2 BATH HOUSE $250.00 �Z
3 BATH HOUSE $285.00
(This fee includes all plumbing fixtures in the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
**All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I'. \dsts \forms\plumapp.doc 11/18/99
- 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
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I. \dsts \forms\plumapp. doc 11/18/99