Permit tr CITY OF TIGARD PLUMBING PERMIT
�L� PERMIT #: PLM1999 -00426
d ot �•I DEVELOPMENT SERVICES DATE ISSUED: 12/13/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12522 SW QUAIL CREEK LN PARCEL: 2S104DA -00800
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
• BLOCK: LOT: 045 JURISDICTION: URB
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: • RAIN DRAIN: ft
Remarks: Residential backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRM4 BON 12/13/1995 $25.00 99- 320371
4230 GALEWOOD STREET 5PC2 BON 12/13/1995 $2.00 99- 320371
SUITE 100
LAKE OSWEGO, OR 97035 Total $27.00
Phone 1: 274 -5223
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 00006136 Final Inspection
PLM 11558
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: I •/ti(,1.1 -e -tl Permittee Signature: DVL (t iVfre-cleze
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the rfe t business da
Ca (5 ) y p day
N tP6/O8/99 TIT. 10:57 FAX 503 598 1960 CITY OF TIGARD x 002
CITY OF TIGARD • R ECEIVED Plumbing Permit Application Plan Cneck
131.2 ' SW HALL BLVD. Commercial and Residential Red By
TIGARD, OR 97223 0 9 79 Da:e Recd 2_--to
(503) 639 -4171 DEC Da :e to P. E.
�
tn DEVELOPM Print or Type Date to DST �� 4
tpMMU ncomplete or illegible applications will not be accepted Perm it ° 2%
Related S'(R x
Called
Name of Deve,opme f_OT y S -F XTURE$` :(Individual) .? ' ; . :_ - " :; - • QTY ; :PRICE : AMr .
d
Job a -- lkoU(YU 1 Silk 11.50
Address Street Address (011--t-4L8-121 I Suite Lavatory 11.50
• A°l6-•)-a- S � C-k-12-44(-- LGr "L. Tub or Tub/Shower Comb. 11.50 I
Bldg f! Shower Only 11.50
I City /State Zip
T 9 Q R 9 ,.Z3
Name Water Closet 11.50
Dart r170Y1 SS c Hif7nCS Clehwasher t 11.50
Owner Mai•ng Address Suite Garbage Disposal 11.50
zia3o sw 64k ood_ Washing Machine 111 11.50
City /sate Zip Phone Fl CBWFIoor Sink 2° 11.50
L z kc bSWCga o r2, 790- [o v S(o • I
Name 3" 11.50
• 4" 11.50
Occupant Mailing Ad . ss Site Water Heater 0 conversion 0 Ike kind 11.53
• Gas piping requires a separate mechanical permit
City /State Zip Phone Laundry Room Tray 11.53 I
Urinal 11.53
U .4il:(S CII P L me ro Grass Ls1 14 � Other Ftxttues (Specify)
16.x7 ,
c ,
•
Contractor Mailing Address Suite 1
, a9 9 S S2v kinfmnA.
Prier to permit City/State Zip Phone bp- Sewer - 1st 100' 38.00 I i
Issuance, a copy WO u /lk Ok 97070 tm0710 9.1 • Sewer - each additional 100' 32.00
of ail licenses are Orego Conat. Cont. Board Uc.* Exp. Date
required if ao13 .0 • g/3 /)a00 p Water Service -1st 100' 38.00
expired in COT Plumbing Lis 4 Exp. Date Water Service - each additional 20G' 32.00 • .
database i Storm & Rain Drain - 1st 100' 38.00
Name Storm & Rain Drain - each additional 100' 32.00 1
Architect Mobile Home Space 32.00
or • Mailing Address Suite Commercial Back Flow Prevention Devise or Anti- 32.00
• • Pollution Device
Engineer ( City/State Zip Phone Residential Bacxflow Prevention Device" i 19.00 !9
(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 O Any Trap or Waste Not Connected to a Fixture 11.50
Residential O Commercial 0 Catch Basin 11.50
Additional description of work: Insp. of Existing Plumbing 50.00
Specially Requested Inspections • - 50.00
peuhr I
Are you capping, moving or replacing any fixtures? I per /ir j
Yes 0 No 0 Rein Drain, single family dwelling 45.00
If yes, see back of form to indicate work performed by Grease Traps 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I a ':iiii `�+
I hereby acknowledge that : are read this application, that the information Isornscrie Cr riser diagram Is required If Quan'iy Total is s• 9 J •.' !, :n!= =; l_ I j
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
tat plans submitted are in compliance with Cregon Stale Laws. _ - =- ` ; ., T''
Si .. • .. . • er /A. ' t Date V. E% SURCHARGE - ol-_
on ct Parson Name Phone "PLAN REVIEW 25% OF SUBTOTAL - _ _
Required Daly If tare qty. total Is >9 1 ; I
:::-.t-•_, r�- 47 =N il'7..,: s. �,35;t",-:r =`� TOTAL _
• �aC81a��i7,US�'S1Z8��;`,� _ _ � _ : :__= _ := .�. =- it >;._r_.: :Y:� -- _� - : :; : ,.::.•
::a •ems a "'.T = s..- m=--,.-.. ;.- =_ 1
{� ,� - . 7, _ 0. ri c _- .0 - =s.,- >. n •_. '.: ...r + 'Minimum permit fee is $50 + 5% surcharge, except Residential Bacidlow
4t1S ?I tSf9 `"""" ` "' -'"" r " . Y .� ,�4' L Prevention Devic which is $25 + 5% surcharge
f i ydo ?ltwO e: 110 �kild 3 g
:=1.06 fae':61*1 4 era?id_r eKSBf?Ii F r ffig3 All New Commercial Buildings require plans with isometric or riser diagram
" '-� ° "" � :" and plan review
i :Ws:s :`Drms\.plumapp.dc: sr? /99 •
•
01/05/2000 Activities for Case #: PLM1999 -00426
11:53:39 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 12/10/1999 MAIL RECD No Hold BON 12/13/1999
PLMA005 Create Permit 12/13/1999 BON DONE No Hold BON 12/13/1999
PLMA750 RP /Backflow Preventer 12/13/1999 12/13/1999 No Hold BON 12/13/1999
PLMA799 Final Inspection 12/13/1999 12/13/1999 12/16/1999 GS PASS No Hold GES 12/16/1999 •
PLMA050 (F) Issue permit 12/13/1999 BON DONE No Hold BON 12/13/1999
PLMA800 Case Finaled 12/21/1999 JMT DONE No Hold JMT 12/21/1999
•
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