Permit CITY TIGARD PLUMBING PERMIT
ai..*A DEVELOPMENT SERVICES PERMIT #: PLM1999 -00449
' VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/29/1999
SITE ADDRESS: 11735 SW QUEEN ELIZABETH ST PARCEL: 2S110CD -00104
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: • JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Commercial backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
JACK MEDAK PRMT BON 12/29/199E $50.00 KING CITY
4029 NE SANDY BLVD 5PCT BON 12/29/199E $4.00 KING CITY -
PORTLAND, OR 97212
Total $54.00
Phone 1:
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Contractor:
CEDAR LANDSCAPE
14145 SW GALBREATH DRIVE
SHERWOOD, OR, 97140 • REQUIRED INSPECTIONS
Phone 1: 625 -3700 RP /Backflow Preventer
Reg #: LIC 75535 Final Inspection
O
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: &t4r Permittee Signature: ,01/1 4pp (c64.10 — p44,114
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
DEC -29 - 99 WED 10:38 AM City of King City FAX:503 639 3771 PAGE 2
CITY OF TIGARD Plumbing Permit Application
13125 SW HALL BLVD. Commercial and Residential Plan Check g
TIGARD, OR 97223 Recd By
Date Recd 11.- -
(503) 639 -4171 Date to P.E.
Print or Type Date to T ' i • '
Incomplete or illegible applications will not be accepted Permits P 41 q' - g co g
Related SWR 0 _
Called
Name of Developmen �2,/ • I
Job • 0.� I G�. .. •�. a U. • ... >� • . ..: N`•: - .0?Y; 'Pftic�� , gIyIT .: ; I
Sink 11.50
Address Street Address Suit= q L Lavatory - 11.50
A - I.een c 4 a •.' h Tub or Tub /Shower Comb. 11.50
Bldg 0 City /State Zip j
I, I e C: 0 r '7- , i/ Shower Only 11.50
O j,��►L/�jr 7 Water Closet 11.50
iii romLAIielminsmiffreil . Dishwasher 11.50 '
Owner .Mailing Address Suite Garbage Disposal 11.50
110 r~ - Washing Machine 11.50
• 1 y / ip Phone
�J 3 Floor Drain/Floor Sink 2° 11.50
ante i 6,C-c n �� 11.50
Occupant Mailing Add Suite Water Heater 0 conversion 0 like kind 11.50
•
Gas piping requires a separate mechanical permit. •
City /State Zip Phone Laundry Room Tray 11.50 '
Nvq e Urinal 11.50
C :P r Leunl se • a .1 ' Other Fixtures (Speafy) 15.00
Contractor Mailing Address Su"
Jyly,
Prior to permit /State ,Z Phone
issuance, a copy a - t . + v - - .1 -!, - 71 .
of all licentes are Or����l, Cont. Board Lie.* Exp. pat • .
required if /00 .. . •
ertpired in COT Plumbing Lic, 0 Exp. D t§
database 50y3 4 ^^ •
Sewer -1St 100' 38.00
Name Sewer - each additional 100' 32.00
Architect water service -1st loo' " 38.00 •
or . Mailing Address Suite Water Service - each additional 200' 32.00 •
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En ineer City/Slate Tip p� Storm & Rain (rain - 1st 100' 38.00
9 Storm S Rain Drain - each additional 100' r 32.00
Des - be work to be done: Mobile Home Space 32.00
New Repair 0 Replace ith tike kind: Yes 0 No 0 Commercial Back Flow Prevention Device ' 32,00
Resi ential 0 Commercial
Additional description of work' rk: Residential Bac flow Prevention Device' 18,00
Catch Basin 11.50 •
Insp. of Existing Plumbing • . 50.00
Are you capping, moving or replacing any fixtures? .
Yes 0 No 0 Specially Rquested Inspections 50.00 •
If yes, see back of form to indicate -work performed by - - per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, sin family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. • Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL "'`
given is correct, that I am the owner or authorized agent of the owner, and Isometric or Weer aisyyram is required if Quantity Total is p. 9 ms's
that plans submitted are In compliance with Oregon State Laws. "SUBTOTAL
Slgna re Ow Age t Date •
/ 7 • 6 ?I SU RCHARGE '•
Contact P�rsorlrNam n Phone y
Q , A
///� gO. 374 "PLAN REVIEW 27% OF SUBTOTAL ,
1.`8AT r�Ei 1 } �, 0 0 ' � Z.•.•�I + } : •, r a.„ , s ..., : • ,, r C r elit qty. total is 9
ittl ci rl.: cl'. ,' :1 'l; Required on e a :,:.1-;'.'*;:. ,
4.. Bb1MS,15t� . k#40,40 i`• ul . 4 ,E ' rid 1 "� �" 4 i'' TOTAL
f . ' + ..,: ,�. WIG: : ;3. '� r y, Ir k ' w r r' 1 'i ' 1" �f�'Wj .'......,..7;‘.: _ ,�.: ���
��$ - yrr ►?; q "� �'..'l�jtr <��?fi:` " 7 il' .'.'i1: "iii '� ,." SY
(7h „ „ ku li 1N lss n �lioku ng.444 - i i txty . a'
100 e tl �y; s�e tii ��o"�'Y;.,`� (WBfb�Gp� n ,�'� }i •Minimum t�ormh fee Is j50 +796 surcharge. except Residential f3acMbw PreYglrion
- 050100. whw, is 325 + 796 wrcherge
-°Alt New Commercial Buildings require plans with isemctrie or riser diagram end •
plan review.
, ,as,saamabiumepp.doa 715199
01/05/2000 Activities for Case #: PLM1999 -00449
• 11:14:38 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To . Done By Disp. Level By Updated Notes
PLMC003 Application received 12/29/1999 BON DONE No Hold BON 12/29/1999
PLMC005 Permit Created 12/29/1999 BON DONE No Hold BON 12/29/1999
PLMC750 RP /Backflow Preventer • 12/29/1999 12/29/1999 No Hold BON 12/29/1999
PLMC799 Final Inspection 12/29/1999 12/29/1999 12/30/1999 MRS PASS No Hold AKJ 01/02/2000
PLMCO50 (F) Issue permit 12/29/1999 BON DONE No Hold BON 12/29/1999
PLMC800 Case Finaled 01/02/2000 AKJ DONE No Hold AKJ 01/02/2000
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