Permit } '0 CITY OF TIGARD PLUMBING PERMIT
i� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00026
All SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/20/04
SITE ADDRESS: 09802 SW SHADY LN PARCEL: 1S135BD-01200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 5 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Building fixtures. All new fixtures. Sinks: 1- 3 compartment, 1- veggie, 2 hand wash, 1 mop. 1 -2" floor drains.
FEES
Owner:
Description Date Amount
FORBES, DONALD CAROLYN
BURDICK, DONALD LINDA [PLUMB] Permit Fee 1/20/04 $116.20
434 RIDGEWAY RD [TAX] 8% State Surcharl 1/20/04 $9.30
LAKE OSWEGO, OR 97034 Total $125.50
Phone :
Contractor:
CASCADE PLUMBING CO.
2630 N HAYDEN ISLND DR. #503
PORTLAND, OR 97217 REQUIRED. INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 120893
PLM 34 -412PB
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
Issued By .' Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
eat
, -
01/20/2004 09:10 FAX 5035981900 ciri CF TIGARD a 002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Szsterns:
fMt`Pf*... e: f • - •
Pasting &Ma - 1 100' 3500 0 to 2000 $113.00
Poo ming drain - mali *Minoan 100 46.40 2,01,1 OS 3,600 5160.00 ,
3.601 so 7230 wow
Serra -1st 100' 35.00 7,20: and ammo 33210.00
Sewer - each erlditional 100 46.41)
REcEivc .„.. Barn:: I& ir Medical Gas S stems:
• gi 193. . MEM
64.1Q ; A'. . 1 ;Eggiif:%,.: .. .7' !•-..: : ..: - .
II 4 • & Rain Wide J I ft 100' 55.00 51.00 to upackao Minimum fee: $7230
. intsr IOC' .11111=11
Storm & Rein Drain 33,001.00m 31C,660.00 $72.53 for the first 0000.00 antl 91.02 for each
JAN 21) 2004' ' AV flTtt liTINIUMBINGN .44,n caul S120.00 or Becton lbw& f. 10 cad
inchiei : 310000.00.
Committal Rack Flow Prwannon Dea•ce ! 46.40 510901.00 to 525.000.05 I 5168.50 for Me &PSI. 02003 and 51.5d tor
each mida.revil 010000 el' Pennon theme:. to
CITYOFTIGARD) 1/ 20/2004 09:10 FAX 5039981.980 city OF T 1 GARD r6 0(11
BUILDING DIVISION
. .
Plimibjng Permit Application „ i •,,,,: • •,, „:, .... -, ,R v, . , ..4
131SW Hall ...1, I- 1 N . .`• • ' • . ' ' ' ' .
City of Tigard d., Tithed, OR 9,213 A r t,,,,, 7 ,_, AN ........,et_. Ag - Do0g-to
25 Blv
Phone: 501639.4171 Pax: 503.531.1463 Pin inciew
Omm ',min No..
24- Hour latabotion Linei 503.6194175
....).4.;:. 4 .P.: Den Reedrilin
Inarcet wwweicigudornis Naetiewmthw M riZZine
ei
.-1 faitiat!.0 41 ;T: '' isigiVT I W4ti: r' .': .1 Vi l 'f.' " ';.. 2 , \- • r i:IV i i., : .- .•'.1 r•I'. 7.5'.Et. i• ',.
0 New coachostion I 0 Demolition F. • . N, mew new elsecklisi
Deserter= WinliMMINNliMMI
ID Additiableheratimtiraplabeannt j 0 Other. _ 1 em.h hi sE : ( 5 .1421 - ) 7.-co :i figy b d ovk iti . 0111: 100 ft. Or each ualler corm
INE , ..-,. - - *c174ti';':; ,..• SFR ( )
7
la omuncidutrial
_ ,......_ 11420
330.00 I
39
SFR (2) bath
1:: Accessory bailttng 0 Alulti-fsertily 1 •
0 Mister beilder 0 Other
. : :-..71 . 2-::as1YLT Co alfins
......IL.am.-:....._,-_,.._ , .1-1.14. . .. • . . .1.1
-:.-wii ty,..:., so. wattles
jc6 lag °adieu: C 15 7 1(f), 5; 111:1KAy I IkIV 1 Cad, nein ar area drain 16.60
City/Sene/ZIP: ' - Olywell, kerb line. or trerch drain L 16.60
____
Suitaibli,g.htpt mi.: Prole:mud= 1■4 Stiii.,(.., Footing dmIn (no. linen ft : _____)
. Pinta
CA era featured home utilities 1)0.90
Cron antratirectient.; Ii jab 0110
91 16.60
. C_■?( '''>•k" \''' . / ( '1 h 1 iicCi• Rain davit connector 16.60
_
_...__) .
. Sanitary mum: (no. lin=r 1t: _
Stoten teo‘u (no. linear 11.. ____) Pace 2
SUMMACO: I Lot an.: Weer IMAM (es. hew AA .....) Page 2
nature*, item
Tim mapictarcal no.:
- ... ‘,.,,, Ataception 'alas 16.60
. q... i' .:: : :: 1 3 . ht itietig.,:i•r#F 1 et . , ,.'.:. '...,Ati, Elsekflow prmerrea Page]
'
:61 JAniir 1-, 1 -
tx -+ =,--;(-1,4z, )._
J Backwater Palm
Clothes washer 16.60
16.60
. Dishwasher 16.60
3 ...Z ..4'.0 I priaini rciAlZri 16.60
i Elston/sump 16.00 '
ion tank 16.60
Addrow: rFaco. 16.6■4 1 ----- 1
Clotleste.217: 1 1 airjA116 9... , 1660 1 "..", '',
Phone. f. )
Fox ( ) • dolma disposal 16.60 .. 1
infiNEFT 3111=1{N Hese tsh ........-. 16601 i
We Malt& 16.60 I
Bunneas mum .... - - • £_ • " • • Inestcarptereue trap 16.60 I
1--r--
1 Cornet came c - r - Aw l 1,4 - Medic& sria Md.: g ......... ) • 040 2
f AddrOs: 2..ta 7 ,0 l'■ IA ilftcr. - VI VA4-%A. Or C 3 Primer 16,00
t 01 2 1 ScIWZEP' c e 1' ci-r.)17 Roof drain (commercial; 16.60
. ,,, SinkibmintiityclarY ‘i l' '‘','"?! , ,../
71 '''''' C‘i'''..1 ) 544 '74494- Foae: , (513 ) 2CA -tag-PI Tubarhoweeraimaa par 16.60
E-mmi: Cr ).{,N_414 Urloa 55.60
•••3 .r:;!..M11111,:.:•:%:lie•PleOliMMIIIIIVII*.i:if,fi'41','"j'''r1 ii!i'll••::•.';:•A•q.t!Iti: Wate 1060
BUILDS tame 1 SI E wear hearer 16.60
Addams:2 ., ? ' G. • a S _'S Me..., ,
s.b.to
ay/smear: .pori. k ( 3., (‘ cr. q -Dt 1 _
- Minimum permit fcc : 512.30
, " (I) ( .-‘1.? - 4 - 1 <1 try Falr ( St3 ).ifiii -66 Residenbal bandies. minimum omit fedi 536.25 i g (,, ( , • r"
..
I CO3 1.1e.! I Ccieo 3 Plambiag Lie. no.: 314 -4 Q 96, Plan review (UK of pa& n fee)
-42/
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Authorised agehrozm - 47 . .)C it tl le c e -D-V Torm. P0Itinfr
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Priat astri±_]aLe. 1_,L,
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. I -7 I This e& application empires if a permit Is not obtained wahto
y
310 days after it hat been aceepoed in complete.
- "fee methodology let by ni•Contay 11 aild Mg industry 500'0I 0t Beam.
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