Permit / CITY OF TIGARD
1,„11 : Y . 4, DEVELOPMENT SERVICES PLUMBING PERMIT
= 4( PERMIT # : PLM96 -0309
,�- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 10 / 17 / 96
PARCEL: 15134CB- 02600
SITE ADDRESS...: 12150 SW SUMMER CREST DR
SUBDIVISION ° SUMMER HILLS PARK ZONING: R -4.5
BLOCK LOT •24
CLASS OF WORK..:ALT 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)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 20
Remarks:
Owner: FEES
SUE DAVIS type amount by date recpt
12150 SW SUMMER CREST DR PRMT $ 30.00 DRA 10/17/96 96- 285328
5PCT $ 1.50 DRA 10/17/96 96- 285328
TIGARD OR 97223
Phone #:
Contractor:
RESCUE ROOTER
PO BOX 1728
WILSONVILLE OR 97070 -•
Phone #: 685 -9050 $ 31.50 TOTAL
Reg #..: 44677
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Rain Drain Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final I n s p e c t i o n
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.
/ J
Permittee t�_rr•e �'
Issued By ° ` e ..M rif r '
Call for inspection — 639 -4175
i de % .
CITt OF TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd o! 7 '
Date to P.E. /✓
TIGARD, OR 97223 Date to DsT We
(503) 639 -4171 Permit P/_ 96 0329
Print or Type Related SWR s A y4-
Incomplete or illegible applications will not be accepted Called
•
Name of Development/Protect r FIXTURES (Individual) QTY PRICE AMT
Sink
9.00
Job
S�f 2?,9 v / s Lavatory 9.00
Address Street Address Suite
/2/50 s _ Tub or Tub/Shower Comb. 9
Bldg a _Ci��ty// Zip Shower Only 9.00
//�.y+ /, eBe 9 7-� ) --3 Water Closet 9.00
Name 39 � Dishwasher 9.00
Owner Mtidkhg Address Suite
Garbage Disposal 9.00
Washing Machine 9.00
City/State Zip Phone Floor Drain 2' 9.00
• 3 9.00
Pans 4 9.00
Occupant Meak+g Address Suite Water Heater - 9.00
Laundry Room Tray 9.00
City/State Zip Phone • Urinal 9.00 _
j Name
Other Fixtures (Speak) - 9.00
Gef...sc eeE , m0 7 - 9.00
Contractor Mailing Address _ Sui y 9.00
-i�t ' Affozw� / �7 //� C/ 9.00
City/State Zip / Phone
/ �/ 9,� 9.00
� �' Ce ?o O l�! Zf / 9.00
Oregon Const. Cont. Board Ur.* Exp. Date
Mock Copy of ' 5'Y6 77 o (p/ y /97
Mock 9.00
m
Current Plu c. s Exp. Date _ / Sewer - 1st 100' 30.00
Ukene1 3/ /.6 ra s.t O 33//9 7 Sewer - each additional 100' 25.00
COT Business Tax or Metro it Exp. Dat a Water Service - 1st 100' 30.00
•
i>!/� 7// / 7 Water Service • each additional 200' 25.00
Name
Architect Storm & Rain Drain - 1st 100' 020 e --- 7 - "Aih/el 30.00 &)
Storm & Ram Dram - each additional 100' ,�/ 25.00
Or I Mailing Address SL•te
Mobile Home Space 25.00 1
Engineer I City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Describe work New 0 Addition 0 Alteration 0 Repair Residential Backflow Prevention Device' 15.00
to be done: Residential ilp Non- residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional desaipt:on of work Catch Basin I 9.00
insp. of Existing Plumbing I 40.00
oeuhr
Existing use c( Specially Requested Inspections 40.00
31X16nq or propel oeuhr
Rain Cram. single family dwelling 30.00
Proposed use of Grease Traps ` 9.00
building or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes o No Isometric x riser siagram is required d Guam Total is > 9
Of yes see back of form) 'SUBTOTAL
340
I hereby acknowledge that I have read this application, that the information
given s correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE l 56
that clans submitted are in comoliance with Oregon State Laws.
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
Reaused only if Pocttue my. total is > 9
4,-/ 7 -Z TOTAL I - A..513'
Contact Person Name Phone
'Minimum permit fee is 525 • 5% surcharge. except Residential Backflow
Prevention Device. which is 515 • 5% surcharge
i :ldstslplmapp.doc 8/96 •
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PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
- 3 " -
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
.OMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: A.M. P.M. MST:
Location: 2 f , �� / (/1�1/j/��� J L / / BUP:
Tenant: Suite: Bldg: MEC:
Contractor: �°� o a� O� Phone: ca grj — �f ( PLM: d3o
Owner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFI/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FLNAL FINAL
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INIMIPIAIM _ .. i
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ArinjgrAr ...Aritz l
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O Call for reinspection Cl Reinspection fee of $ required before next inspection *Unable to inspect
Inspector: " 7/7.. Date: 7/r/f/ Page L of