Permit 41,
CITY OF TIGARD
' DEVELOPMENT SERVICES PLUMBING PERMIT
- IL 13125 SW Hall Blvd., Tigard, OR 97223 ) PERMIT # • PLM98 -0148
DATE ISSUED: 05 /29/98
PARCEL: 2S1O4CD -10100
SITE ADDRESS...: 13620 SW TRACY PL
SUBDIVISION • HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK LOT •100 JURISDICTION: TIG
CLASS OF WORK..:OTR 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: Residential backflow prevention device.
Owner: FEES
MCKINNEY type amount by date recpt
13620 SW TRACY PL PRMT $ 15.00 DLH 05/29/98 98-306121
TIGARD OR 97223 5PCT $ 0.75 DLH 05/29/98 98- 306121
Phone #:
Contractor
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123
Phone #: 503- 628 -3411 $ 15.75 TOTAL
Reg #.. 000058
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 pereit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
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- M1-0010 through OAR 952-0991-9980. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued By: Permittee Signature: "9/1
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + ++
:ITY OF.TIGARD Plumbing Application Recd By -
3125 SW HALL BLVD. Commercial and Residential RECEIVED Date Redd s1Z Vdyp
IGARD, OR 97223 care to P.E.
303) 639 -4171 MAY 2 1998 oats to DST
Permit a Pe.ii -D/ ytP
Print or Type Co ^ �r.^or�ITV a Related SWR d
Incomplete or illegible applications will not be accepted Caned
.'�I� �s 7 - D36S
Name of F.g.R ES4Qndivtd_ WI) MO+ &$&E 'TO
Job A,u pes,' oe# cP ` 9.00
Address Street Address Suite � " ' a10f) ' 9.00
• ( 3Co ?U 7 PL Tub or Tub/Shower Comb. 9.00
Bldg s I City /State Zip Shower Only 9.00 4
I 7 6 ee- 97Z Z3 - water Closet
Name
9.00
. Dishwasher - 9.00
Owner Maikng Address Suite Gasba a 9.00 • Washirc Machine 9.00
City/State Zip Phone • - Floor Drain r 9.00
Name 3' 9.00
• 4" 9.00
Occupant Madtrhg Address - Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal - 9.00
-
Name Other Fodures (Specify) 9.00
eel) - Cst,vdSC -V"- 9.00
Contractor hurtling, Address Suite • . _
/ City /S�s sw L Phone . 9.00 -
(Prior to issuance
applicant must Pt / /g6 02 97/ (o 78 -s"(1( 9.00
provide all Oregon Const Cont. Board Lime Exp. Date 9.00
oahtradors 5 3 G!3 ay 9r ✓ 9.00 • in
license Plumbing Li. s Exp. Date Sewer - tat 100'
30.00
Sewer - each additional 100' 25.00
for COT COT Business Tax oreetro g) Exp. Date
database). A - -7-1-4713 Water Service -tai 100' 30.00
Name Water Service -each additional 200' 25.00
Architect Storm & Rain Drain - let 100' • 30.00
Or Marling Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer Cily /State Zip Phone Commercial Bads Flow Prevention [levies or Anti- 25.00
Pollution Device • ' -
•sctibe work New 0 Addition 0 Alteration 0 Repair O Residential Baddlow Prevention Device' / 15.00 /5 ,•
oe done: Residential -- Non-residential 0 Any Trap or waste Not Connected to a Fixture - 9.00
Additional description of work
Catch Basin 9.00
r
� (7 �'H`` � I 7- l0 .�
Insp. of Existing Plumbing 40.00
�v.4e� Pep- e,),,-B2 perthr
acting use of Specially Requested Inspections 40.00
gilding or property perfhr
Rain Drain, single family dwelling 30.00
roposed use of Grease Traps 9.00
+Adding or property
QUANTITY TOTAL A �ti 4 .
kre you capping , moving or replacing any lbctures? Yes Q Nom Isorrtear ar riser (Warn is reset* a, if Windy Total is 9 I -:
:If yes see back of form) 'SUBTOTAL : - L: , -`,11,:,:t..-, - +: S 43t
hereby acknowledge that I have read this application. that the information
_ l
liven is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE : ; :;.;
nat plans submitted are in compliance with Oregon State Laws. ...:= 7s
sIgnatu of OwnerfAgent D PLAN REVIEW 25% OF SUBTOTAL - - - '. i .
, "r,-- • �- Recuied o I' if 'blurs pry. total is > 9
- - �( -- 8 TOTAL ' • : '1:= 7S
= ^
:ontact Pe n Name Phone : '6 -
*Minimum permit fee is 525 + 596 surcharge. except Residential Back low
aTZ(,C•P �i 5 5e,l PreVention Device, which is S15 + 5% surcharge
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•
'LEASE 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:
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