Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2000 - 00250
� I - -j � DEVELOPMENT I Tigard, ) 639 - 4171 DATE ISSUED: 7/5/00
SITE ADDRESS: 11865 SW 91ST AVE * ** BLDG 3 PARCEL: 1S135DC
SUBDIVISION: VILLA LA PAZ ZONING: R -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R1 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: Installation of one commercial backflow prevention device inside building.
FEES
Owner:
Type By Date Amount Receipt
VILLA LA PAZ LIMTED PARTNERSHI PRMT DEB 7/5/00 $50.00 0003461
BY COMMUNITY PARTNERS FOR 5PCT DEB 7/5/00 $4.00 0003461
AFFORDABLE HOUSING INC
TIGARD, OR 97281 Total $54.00
Phone 1:
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone 1: 239 -8801 RP /Backflow Preventer
Reg #: LIC 00049418 Final Inspection
PLM 26 -533pb
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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 ma obtain copies of these rules or direct questions to OUNC by callin• 0 03) 2 i. -1987.
Issue B IA -r S ,, . Permittee Signature: o A 4 1/71(
�. Call (503V A 9 -4175 by 7:00 P.M. for an inspection needed ne t business day
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1 CITY OF TIGARD ; Plumbing Permit Application Plan Ch
'Ii 'Syn BLVD. Commercial and Residential Rec'd A'.
TIGARD, OR 97223 Date Rec'd 7 - S - - O O
(503) 639 -4171 Date to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit# G - rm SC
Related SWR #
'
/ ( 7 5 - o a oo a Called
Name of Development/Project ( )',,; _�. s
? 'FIXTURES °° individual ".-;��; �� '' ° "QTY PRICE'- i AMT =l
Job V 1 ' t Aar._ .�,; � ��at�
i �t# LA F'1ar- A . . Sink 11.50
Address Street Address Suite Lavatory 11.50
/ 6%.5--- t '51A) 91 li'I/t'- Tub or Tub /Shower Comb. 11.50
g Bldg # City /State Zip Shower Only 11.50
r +uAeo oP , 57223
m
I ! / 4Z19 (, / Urinal , 11.50
Owner Mailing Address Suite Dishwasher 11.50
#Y (690 P/�,e -" ,r- 70 AM. Garbage Disposal 11.50
C / /Statee Zip c 2 Phone 1 L / a�undry Tray 11.50
Y r C� `/` j / ,07,,,,T..5 /fF�wspi �� Machine /Laundry Tray 11.50
Name /./
-- Moor Drain /Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Na //��/�_ Gas piping requires a separate mechanical permit.
1 Jl CWL- U(LI) MFG Home New Water Service 32.00
Contractor Mailing Address \ j l Suite MEG Home New San /Storm Sewer 32.00
U p� )fris , �a s1 0 Hose Bibs 11.50
Prior to permit Aty/State O Zip Phone Roof Drains 11.50
issuance, a copy y eo,voni ot - e 93ci -V0(
Drinking Fountain 11.50
of all Iiccnses are Oregon Conet. r'cnt. Board tic* Exp.., ate ,
required if .°14 Ii It I 1 c ) Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. to f
database Oil `- 53 1
Name I
Architect Sewer- 1st 100' 38.00
or • Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone
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 GY rpyyc�� •
Additional description of work: Commercial Back Flow Prevention Device 32.00 ,G "
#157 54e FLo-k) /te viz n e4e 604- e Residential Backflow Prevention Device* 19.00
�r/ / Oe /i" Catch Basin 11.50
Are you capping, moving or replaci any fixtures? /" Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 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.
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL �-;� r
Y 9 PP
Isometric or riser diagram is required if Quantity Total is ? 9
given is correct, that I am the owner or authorized agent of the owner, and - , ..ry..
that plans submitted are in compliance with Oregon State Laws. SUBTOTAL _� t o ,; -i rP
Si g t o of Owner /AgentA Dat / 8% SURCHARGE y > yAT '' C'` °`
** REVIEW 25% OF SUBTOTAL -T i
g
Required only if fixture qty. total is > 9 ., . 7
:_.
"9: TH,kVU FM7,8 - �<<� �.; ,:. _ - <;�-� I . ? : H..: .
2 8A F
rH ki0U5E$250 0 TOTAL ;
f tNi .
(This =fee tnCiudel4,lumi6ing•f xtUres irl the dwelling an the ' ? e -Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
11 .
00 4 4 00 � storm sewer and°water�seivrce p h Device, which is $25 + 8 surcharge
_ . �., >� )
**All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
l:\dsts \forrns\plumapp.doc 11/18/99
PLEASE COMPLETE:
nnovok
Sink
Lavatory
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 doe 11/18/99