Permit CITY OFTIGARD
__ ‘ �a�, $° ,ix DEVELOPMENT SERVICES PLUMBING PERMIT
��p�6ti ( PERMIT I T # • PLM97 -0360
4.611- l:. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/28/97
PARCEL: 1S133CD -14300
SITE ADDRESS...: 11921 SW TALLWOOD DR
SUBDIVISION : PEBBLECREEK II ZONING: R -25
BLOCK LOT °034 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: Add residential backflow prevention device.
Owner: FEES
DANA BERGER type amount by date recpt
11921 SW TALLWOOD DRIVE PRMT $ 15.00 GEO 08/28/97 97- 298762
TIGARD OR 97223 SPCT $ 0.75 GEO 08/28/97 97- 298762
Phone #:
Contractor
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND OR 97208 -9328
Phone #: 503- 777 -7777 $ 15.75 TOTAL
Reg 4..: 000050
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough -in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with RP /Backf low Prey
approved plans. This permit will expire if work is not started Final Inspection
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.
f /T Issued By: di � Permittee Signature:
+++++++++++++++++•+++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
City of Tig PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SV� Hall Blvd. Permit #/7 7 y
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
n..n.aca New Single Family Residences Only
Jo b e.
0 1 BATH HOUSE $140.00 0 2 BATH HOUSE $195.00
Address -H92-I SW i _ (klAWQr� DR, ❑ 3 BATH HOUSE $225.00
c"fi As Fee includes all plumbing fixtures in the dwelling and the first 100 feet
,1.- t q 1 ZZ3 of water service, sanitary sewer and storm sewer. See fees below.
� . FIXTURES CITY PRICE AMT
lizu gk _ ►t2�tA�1ioi1( S ink 9.00
one cJ P"«+• Lavatory 9.00
Owner I 1 9 Z ( vv . TQ,IA W 0 Tub or Tub/Shower Comb. 9.00 '
dij8tat n ° Shower Only 9.00
I l r/ �,{� ( �
23 Water Closet 9,00
� ;"'' (CI
Dishwasher 9.00
Garbage Disposal 9.00 , ,
Occupant ;,,& o „,,.. Me . Washing Machine 9.00
Floor Drain 9.00
«rte no Water Heater
9.00
Laundry Room Tray 9.00
Nom* Urinal 9.00
• ;I)f• - -uc.' - 7 1t eS LcuriciGc.ap v Other Fixtures (Specify) 9.00 rota
adIng Contractor ~ ^ '1 - i't J I 9 -00
- 1
i3 SF air n€bvl Crer_k eiv(,(. 9.00
Clyet•I• ZIP 9.00
T orts a_ KO j N C 177___Q ( p Sewer 1st 100' 30.00 • • 8t°t° R'Odmstlnn 14P. mc "°' Sewer - ea. Addit. 100' 25.00
0000 I4 Water Service let 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
Information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit 100' 25.00
number given is correct. (if exempt from State registration, please
give reason below.) Mobile Home Space 25.00
/ Back Flow Prevention
` ,..A ,ALA__ hi �1 ' , g 2P Device or Anti - Pollution Device 9.00
5'°" "` • (e•"'°` `r '0""r O•t• Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new Q addition 0 alteration 0 repair 0 . Catch Basin 9.00
to be done residential, non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices I 15.00 15, (i
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE •Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 1 1- 5
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL t s 7
Special Conditions
Date issued by
i
1 3, ===4 n===te 3C=4 3.==4 3 =0=11=4 t=4 IC==.1 3C=4 *04 x
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THIS CERTIFIET �T THE PERSON NAM D HEREON IS 0 A R D
L
el
ICENSED AS PROVIDED BY LAW AS A LICENSE NUMBER: 5 0 09
e LANDSCAPING BUSINESS - NON- EXEMPT EXPIRES: 11/30/97
Al]. phases
PLUS BACKFLOW -
el
e DENNIS SEVEN DEES LANDSCAPING
7355 SE JOHNSON CREEK BLVD
' ,... -- iciA___e_c-- 1 ......,.. 7 4,.........-- el
PORTLAND, OR 97206 -9329
918- 000 -302 (9/91)
SIGNATURE OF LI9ENSEE
3C?4 7C— _12=4 3- 41=D1 2=3} 3 4iC=X 9C�iiC�i ..... ,_...
4
_. _ •
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5/9/99 Activities for Case #: PLM97 -00360
8:31:29 PM .
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 8/28/97 GEO RECD GEO 8/28/97
PLMA005 Create Permit 8/28/97 GEO PASS GEO 8/28/97
PLMA750 RP /Backflow Preventer 8/28/97 9/10/98 TLP PASS J *H 9/10/98
PLMA799 Final Inspection 8/28/97 9/10/98 TLP PASS J *H 9/10/98
PLMA050 (F) Issue permit 8/28/97 GEO PASS GEO 8/28/97
PLMA800 Case Finaled 9/10/98 TLP PASS J *H 9/10/98
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