Permit ...._,.
CITY OF T PLUMBING PERMIT '
, � „N,, DEVELOPMENT SERVICES PERMIT #. o .....: r'L�198 -0315
L�Ip EIpi DATE ISSUED: 09/11/98
!+L = 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
j l PARCEL: 1 S 1 25CD -04000 '
SITE ADDRESS...: 7 Sw LANDAU ST
SUBDIVISION....: BOULEVARD HEIGHTS ZONING: R -4.5
BLOCK........... L-OT.. ... 4. ..... JURISDICTION: TIG
CLASS OF WORK..: NEW 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)...: 100
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: Hook up of existing house to newly installed sewer line.
Owner: --------- . -- -- FEES ---
PETER KUSYK type amount by date recpt
BEACON HOMES PRMT $ 30.00 DEB 09/08/98 98- 308949
9500 SW 125TH AVE SPCT $ 1.50 DEB :09/08/98 98- 308949
BEAVERTON OR 97008
Phone #2
Contractor_ - - - -_- ___ - -.
CUSHMAN FAMILY PLUMBING
4535 SE 35TH PLACE
PORTLAND OR 97202 --------- __ ------
Phone #: 775-4472 $ 31.50 TOTAL
Re.g #..: 001068
REQUIRED INSPECTIONS --
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection —'
applicable laws. All work will be done in accordance with I n s p existing/ca
approved plans. This permit will expire if work is not started ' Final Inspection
within 180 days of issuance, or if work is suspended for more _ _ — _._,�,' _
than 180 days. ATTENTION: Oregon law requires you to fallow rules _ __
adopted by the Oregon Utility Notification Center. Those rules are _ __.,_______- -,_
' set forth in OAR 952- ', A1 -0010 through OAR 952 -0001 -0080. You may __ _ — _
obtain copies of these rules or direct questions to OUNC by calling ,. _...
(503)246 -1987.
I ssued : _ �� Permittee Signature: / ,, X0 /./i
+ + + + + ++ + + + + ++ + +++t++++++ + + + +t:Lt + + + + + ++ + ++ + ++ + + +++++ + ++ + ++ + ++-�h1- + + + ++ ±± + ++ ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++ i-++++++++++++++++++++- h+++++++++++ + + + + ++ + + + + + + + + + + + + + + + + + + + ++ + + ++
CITY' OF TIGARD Plumbing Permit Application Plan Ch k#
13125 SW HALL BLVD. Commercial and Residential Recd BL --�
TIGARD, OR 97223 Date Rec'd 9'-g 5'Ei
(503) 639 -4171 Date to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit # 1 9 . 6 - `'
Related SWR #641,1 2.32
Called
Name of Development/Project FIXTURES1 nd"ivitlual ~" r, 4 ',Q7Y I,?RICE= , AMT x
Job - 176 -, ' O CL Sink 9.00 :a
Address Street Address Suite Lavatory 9.00
` Sc h WdtU Tub or Tub /Shower Comb. 9.00
i / L11 Bldg # � y I -0 ta to ��Zi Shower Only 9.00
�p Water Closet 9.00
Li • \ ‘,LeD, 1A1W/5. Dishwasher 9.00
Owner Ailing Address k (+ Suite Garbage Disposal 9.00
J SW t. Z5 iscUQ Washing Machine 9.00
dy /State Zip Phon
�, q Q, �•� L ZG/r (1C 1 ? Floor Drain /Floor Sink 2" 9.00
Name x" J 3" 9.00
4" 9.00
Occupant Mailing Add ess Suite Water Heater 0 conversion 0 like kind 9.00
' Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
r Urinal 9.00
. 4 , _ _, . l ,. la/AAA , Other Fixtures (Specify) 9.00
. .Contractor ailing Address Suite
9.00
-'( ' 'wI25 -r p . • 9.00
Prior to permit ty /State oi Sewer - 1st 100' / 6 30.00
- issuance, a copyp(\,� Phone /
Sewer - each additional 100' 1, 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 70 707 f z/olo‘ Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Dat Water Service - each additional 200' 25.00
database g900 A P (- //��' 9 Storm & 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 Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device _
Engineer City /State Zip Phone Residential Backflow Prevention Device* • 15.00
- (Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential Commercial 0 Catch Basin . 9.00
Additional desc 'ption of work: K V p rZ C( /N
_ � ��c Insp. of Existing Plumbing 40.00
tC7 CC i Se.t.JQ , per /hr
Specially Requested Inspections 40.00
per/hr
Are you capping moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes 0 Notc Grease Traps 9.00
• If yes, see back of form to indicate work performed by QUANTITY TOTAL �` ``
fixture. FAILURE TO ACCURATELY REPORT FIXTURE r; _ ` - ' ?'
Isometric or riser diagram is required if Quantity Total is > 9 ,��;;< s� T:;„<n •
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL -"Ig ''.F.4--AW G(')
I hereby acknowledge that I have read this application, that the information r��; .,r : .
• given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE '°°'%, , „'' • 5
that plans submi • are in compliance with Oregon State Laws. ; ;. ;_" ; E g
Si. nature of • ,• Agent D t9 (� * *PLAN REVIEW 25% OF SUBTOTAL " �'" ," ; F Al
/U �7 Required only if fixture qty. total is > 9 ; ,,
TOTAL , ,t' r., f l' ; `, $' i J J )
r o Person Name Phon ,,;,, y;, '- D'f
j
*Minimum permit fee is $25+ 5% surcharge, except Residential Backflow
��� \ � � � �� � 1 Prevention Device,, wfiich is $15 + 5% surcharge
* *AII New Commercial Buildings require plans with isometric or riser diagram
- and plan review
I : \dsts\plumapp.doc 7/2/98
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced ...........
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:
•
I:\dsts\plumappdoc 7/7/98