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Permit CITY OFTIGARD 1_ , d, ,, ,� DEVELOPME SERVICES PLUMBING PERMIT ��I PERMIT # PLM99 -0096 "' 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/01/99 _ J PARCEL: 2S1O4DD- 06900 SITE ADDRESS...: 12811 SW RIDGEFIELD LN SUBDIVISION : MOUNTAIN HIGHLANDS NO.3 ZONING: R -4.5 BLOCK LOT °027 JURISDICTION: TIG CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0 TYPE OF USE -SF WASHING MACH : 0 BACKFLOW PREVNTRS..: 1 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)...: 0 WATER CLOSETS.: 0 WATER LINE (ft)...: 0 . DISHWASHERS • 0 RAIN DRAIN (ft)...: 0 Remarks: Installation of residential backflow device. Owner: FEES MICHAEL LOVE type amount by date recpt 12811 SW RIDGEFIELD LN PRMT $ 15.00 DLH 04/01/99 99- 314177 TIGARD OR 97223 5PCT $ 0.75 DLH 04/01/99 99- 314177 Phone #: Contractor NORTHWEST LANDSCAPE, INC DBA ABEL IRRIGATION PO BOX 80067 PORTLAND OR 97280 Phone #: 245 -2798 $ 15.75 TOTAL Reg #..: 6316 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the RP /Backf low Prey Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection 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. i i r ' C Issued By: Permittee Signature: I.,�li� +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY OF TIGARD Plumbing Permit Application Plan Check # 13125 SW HALL BLVD. Commercial and Residential Rec'd By a ..#- _ TIGARD, OR 97223 Date Recd Vy'71 (503) 639 -4171 Date to P.E. Print or Type � Date to DST Incomplete or illegible applications will not be acc pied Permit # , 9 -- 00 96, Related SWR # Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Sink 9.00 Address Street Address l 'I Suite Lavatory 9.00 1 2 °) / S K. Z7 f) P I Tub or Tub /Shower Comb. 9.00 Idg # City/ ate Z lp Shower Only 9.00 Name ' Water Closet 9.00 MI 2 L o V-e Dishwasher 9.00 Owner Mailing Address Suite Garbage Disposal 9.00 cl' Washing Machine 9.00 City /State Zip Phone 52 /- O/73 Floor Drain/Floor Sink 2° 9.00 Name 3 9.00 4" 9.00 Occupant Mailing Address 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 Urinal 9.00 Nagle, ,� ■ f Other Fixtures (Specify) 9.00 Contracts 5 Mailing Address /� Suite 9.00 V C O(m 7 9.00 Prior to permit City State Zip Phone Sewer - 1st 100' 30.00 Issuance, a copy . p -4 9 - 72 Ro 2/-2 ) H of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date Sewer - each additional 100' 25.00 required if Water Service - 1st 100' 30.00 expired In COT Plumbing Uc. # Exp. Date Water Service - each additional 200' 25.00 database (,LC P nT ( (0 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 scription of work: Insp. of Existing Plumbing 40.00 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 No O Grease Traps 9.00 If yes, see back of form to indicate work performed by fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL Isometric or riser diagram is required If Quantity Total is > 9 WORK COULD RESULT I CREASED SEWER FEES. *SUBTOTAL / I hereby acknowled• - I at I read this application, that the information /J. given correct, th . I am t .wner or authorized agent of the owner, and 6% SURCHARGE t, • that ans submi • , n •mpliance with Oregon State Laws. / 7_5 Sign to •1 f =r Date *"PLAN REVIEW 25% OF SUBTOTAL fi L ) Required only if fature qty. total is > 9 / / TOTAL // Con t Perm Name Ph n �5: "7S //�� _ •MInImum permit fee is $25 + 5% surcharge, except Residential Backflow �� Cpl /viiA Jf l 1 Prevention Device, which is $15 + 5% surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review I:tdstslplumapp.doc 7/2/98 PLEASE COMPLETE: e New Moe::; . Re placed RernovedlCapped 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:ldstslplumapp.doo 7/7/98 5/10/99 Activities for Case #: PLM99 -00096 3:03:15 PM • Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By • Disp. Level By Updated Notes PLMA003 Application received 4/1/99 DLH RECD DLH 4/1/99 PLMA005 Create Permit 4/1/99 DLH DONE DLH 4/1/99 PLMA799 Final Inspection DLH 4/1/99 • PLMA750 RP /Backflow Preventer 4/1/99 4/15/99 TLP PASS AKJ 4/15/99 PLMA050 (F) Issue permit • 4/1/99 ' DLH DONE DLH 4/1/99 PLMA800 Case Finaled 5/7/99 JT DONE No Hold JT 5/7/99 • • • • • • Page 1 of,1 • •