Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERM IT
PERMIT # PLM97 -0419
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 10 / 17 / 97
PARCEL: 2S104CD -10500
SITE ADDRESS...: 13665 SW TRACY PL
SUBDIVISION ° HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK • LOT °104 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: Install residential backflow prevention device
Owner: FEES
WINDWOOD HOMES type amount by date recpt
14076 SW BENCHVIEW TERR PRMT $ 15.00 JSD 10/17/97 97- 300160
TIGARD OR 97224 SPCT $ 0.75 JSD 10/17/97 97- 300160
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 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.
Issued By: � ' Permittee Signature: Q (/✓
+ + + + + + + + + + + + + + + + + ++ +++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7 :00 p °m° for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + ++
1_
ITY OF TIGARD Plumbing Application Re YI By
•
3125 SW H: ,1LL BLVD. Commercial and Residential ate Rerd t Of /4
1 GARD, OR 97223 Date to P.E.
Date to OST
303) 639 -4171 permit* M..0" 517 _ ovi 5
Print or Type Related SWR It
Incomplete or illegible applications will not be accepted Called
Name of Development/Project . F [1,M.§iQndlvlattal) 0240011109e. 49 tp �
Job // - Sink 9.00
�
yi��d 4' ESTi Z7 -
Address Street Address - Suite Lavatory - 9.00
/3G,6S Sup T�Qgc L, _ Tub or Tub/Shower Comb. • 9.00
Bldg I CityiS to Zip Shower Only 9
1 7 M. Water Closet 9.00
Name Dishwasher .
9.00
Owner idailing Address - Suite Garbage Disposal 9.00
Washing Machine 9.00
City/State Zip Phone - -- Floor Drain Y 9.00
Name 9.00
4 ' 9.00
Occupant waft A ddress Suite _ Water Heater 9.00
Laundry Room Tray •
•
9.00
City/State Zip Phone Urinal 9.00
Name Other Fixtures (Specify) 9.00
CEZIQ /.stazscaoe .7 9.00
Contractor Address _ Suite - - - - -- - -- - -. • -
P1375 AlrRic /A d . 9.00
(Prior to issuance Clty/State Zip Phone •
9.00
applicant must / 1230/, (A 97/- 6-28-.7-1 //
provide all Oregon Cont. Cont. Board Lic.i Exp. Date - 9.00
contractors SWV3 6 - 98 - 9.00
Boense Plumbing Lk. i Exp. Date Sewer - tat 100' - 30.00
iMormatlon /.23 - S 6 -V - - Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro i Exp. Date Water Service • 1st 100'
database). 30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - let 107 • 30.00
Of Mailing Address Suite Stem & Rain Drain - each additional 107 25.00
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Mb- 25.00
- -- • -- Pollution Device - •- ...
Describe wont New 0 Addition 0 Alteration 0 Repair 0 Residential Batidlow Prevention Device* / 15.00 ��.-
:o be done: Residential 0 Nonresidential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional desctiption of work
Catch Basin 9.00
.. - - insp. of Existing Plumbing _ 40.00
perms
Existing use of Spectrally Requested Inspections 40.00
wilding or property ter
Rain Drain. single family dwelling 30.00
Imposed use of Grease Traps . - 9.00
• .wilding or property
QUANTITY TOTAL
Are you capping . moving or replacing any fbnures? Yes 0 No p I$omevac or lief is recuied d °sanity Total is t 9 y E: .X .,.,ry e = s�;. ,
;If yes see back of form) 'SUBTOTAL - - • � ^n ��
Thereby acknowledge that I have read this application, that the information
ven is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE ,4.a:', 7r
1st plans submitted are in compliance with Oregon State Laws.
_�.
signature OwradAgent - pat e PLAN REVIEW 25% OF SUBTOTAL
/ Reamed only d nature cry. total is 3. 9
_ ,,2_ l l0 - 7( -97 TOTAL ' �
_ �75
ontaet ; Peerson Name Phone •; ` ' _
!/c�(/ L(lo lI
w,.? --.11 °-� Prevention Device. which is 315.5 surcharge. except Residential Backflow
. I: \plmapp.doc 12/96 (dst)
-
Y
'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:
1:\plmapp.doc 12J96 (dst)