Permit CITY TIGARD PLUMBING PERMIT
r DEVELOPMENT SERVICES
PERMIT #: PLM1999-00198
I ' l l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/25/99
SITE ADDRESS: 14912 SW 109TH AVE
'� PARCEL: 2S110AD -90039
SUBDIVISION: CANTERBURY WOODS CONDOMINIUM ZONING: R -12
BLOCK: LOT: 039 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: 1 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: Replace water heater with like kind.
FEES
Owner:
Type By Date Amount Receipt
ROBERTS, CHARLENE F PRMT DEB 6/25/99 $50.00 99- 316420
14912 SW 109TH MISC DEB 6/25/99 $2.50 99- 316420
TIGARD, OR 97224
Total $52.50
Phone 1:
Contractor:
GEORGE MORLAN PLUMBING
9806 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 624 -6895 Top -out Insp
Final Inspection
Reg #: LIC 000027
PLM 26 -60BP ORIGINAL
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.
Issue B / , Permittee Signature: / I ■
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
JUN -14 - 1999 10: 24 • •-------�' • • r (1-25
r ;Jr t n..7"11.1.0 id
Residential and esential RECEIVED rG -b,�
125 SW HALL, BLVD. Pat fppf -0014g
;ARD, OR 97223 JUN 1 199 JUN 1999
3) 639 -4171
COMMUNITY DEVELOPMENT Print or Type
Incomplete or illegible applications will not be accepted COMMUNITY DEVELOPMENT
U) /0 -4 J '1 9 9l `I x 41T PRIO 1lMT
- Name of Development/Pre) �, UJ FIXTURES:ilndI dual).: Z x t . J ,
Job �ii l �, L'�-� - Sink 11.80
�
Lavatory
Address 30 / Q Q 11.50
ttttl��//gg00�1J Tub or Tub/Shower Comb. 11.50
Bldg * / - City Cato Zip Shower Only .• 11.50
r !c !r ` 1� , Water Closet 11.50
• NarTle _ 11.50
�l�tir}u+,��� Dishwasher
11.50
Owner Melling Address Suite Garbage Disposal -
-- Washing Machine 11.50 r
City/State Zip Phone Floor Drain/Floor Sink 2' 11-50
3• 11.50
Name L . 11.60
M elling Address Suite Water Heater conversion a like kind 11.50 ),
Occupant . O sion
Gas piping requires a separa mecha permit. ,
Clry /State Zip Phone Laundry Room Tray 11.50
Urinal 11.50
N Other Fixtures (Specify) ty) 15.00
Contractor Add s Suit - -
Prior to permit City/ tats / Phoonne Sewer- 1st 100' 38.00
asuanoe, a copy ► t CI- Or. 7 lo ci ] (/ Qr_, Serer - each adelUonal 100' 32.00 -
if all licenses are Orego net. Cont. Board Lie.* Exp. Da Wat Service 1st 100' 38.00
required if �;- 0 32.30
P�,
expired In COT Plumbing Lk. 0 n C� pp Exp. Date Water Service - each additional 200`
database - - • $ r • • • Storm & Rain Drain - 1st 100' 38.00
Name Storm & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space 32.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00
Pollution Device
Engineer Cly /State Zip Phone Residential Baddlow Prevention Device' 19.00
(irrigation timing devices require a separate
)ascribe work to be done: restricted energy permit.)
lew 0 Repair 0 Replace with Ilke kind: Yes 0- O Any Trap or Waste Not Connected to a Fixture 11.50
tesidentlal 0 Commercial O - -- - -. Catch Basin f 11.50
additional description of work: ! Inap. of Existing Plumbing 50.00
�� 4i, he_ -L-P _ per/hr
d I ctions
Specially Requested 50.00
:re you capping, moving or replacing any fixtures? per/hr
Yes 0 No O Rein Drain, single family dwelling 45.00
f yes, see back of form to Indicate work performed by Grease Traps 11.50
ixture. FAILURE TO ACCURATELY REPORT FIXTURE
VORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
hereby acknowledge that I have read Ibis application, that the information Isometric or fleet diagram Is required K Quantity Total is > s
w M F
en is correct, that 1 am the owner or authorized agent of the owner, and :: �^
'SUBTOTAL 7 :: - �.1
nat plans submitted are in compliance th Oregon Slate Laws.
n t 1 •`�
Ig e pent Dale 6 "/° SURCHARGE ° " "' ,S-C
le > 8
•h•ne "PLAN REVIEW 2Et% OF SUBTO n't
. , Po • Nam. >* h , ` ' •t'..
�! d v � I . -6630 Required only W fixture qty, tote) iK'"
� " "`'.::' . >:
• TOTAL � 5c
n Sa .Ydw. ::;x::�
o >
r �s "" Nr$1, ; P K I r aav o- ,.. Ae+a . * k w • Minimum permit fee is $50 • 5% surcharge, except Residential Backftow
� 3 l «< ` Z dZ k a « ' �c " ' Prevention Device, which Is $25 • 5% surcharge
D a sh J �> n s � k.� -All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
9 - 3/4 Va
Worms Npi rnopp.doC 6/2B/ '9
TOTAL P.01
6/19/00 Activities for Case #: PLM1999 -00198
1:50:10 PM
CA I
Assigned Hold Updated d5
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 6/25/99 DEB DONE No Hold DEB 6/25/99
PLMA005 Create Permit 6/25/99 DEB DONE No Hold DEB 6/25/99
PLMA725 Top -out Insp 6/25/99 6/25/99 No Hold DEB 6/25/99
PLMA799 Final Inspection 6/25/99 6/25/99 No Hold DEB 6/25/99
PLMA050 (F) Issue permit 6/25/99 DEB DONE No Hold DEB 6/25/99
PLMA740 Misc. Inspection 2/23/00 2/23/00 2/23/00 JMT DONE No Hold JMT 2/23/00 research inspection request
PLMA850 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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