Permit CITY OF TIGARD PLUMBING PERMIT
c Ia DEVELOPMENT SERVICES PERMIT #: PLM1999 -00373
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
PARCEL: 2S 110BA -10100
SITE ADDRESS: 11867 SW TREEHILL CT
SUBDIVISION: REDWOOD VISTA ZONING: R-4.5
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
DALE DRPORTT PRMT DST 11/09/199E $25.00 99- 319647
11867 SW W TREEHILL CT 5PCT DST 11/09/199E $2.00 99- 319647
97224
TIGARD, OR 97224
Total $27.00
Phone 1:
Contractor:
RB LANDSCAPE INC
16824 NW PADDINGTON DR
BEAVERTON, OR 97006 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1: 503 - 531 -4027
Final Inspection
Reg #: LIC 5890
PLM 12565
ORIGINAL
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 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.
jr //)
Issued By: ..1 4( Permittee Signature: j; 4
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day -
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW IALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd
(503) 639 -4171 / Date to P.E.
Print or Type / ` �7 - Date to DST
Incomplete or illegible applications will not be aT‘pled Permit #pGlt'! /�l�l�(- 063.3
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT l
Job - Sink 11.50
Address Street Address Suite Lavatory 11.50
/ i8 67 Sw Treehl I ( Ct- Tub or Tub /Shower Comb. 11.50 '
Bldg # � Ciity /State Zip Shower Only 11.50
Name
/ 7 s� r � � 2 q/u Water Closet/Urinal (Specify) 11.50
Dl_ 1 £ Ic n e Dew r c4-t -� Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
//967 sc./ 7/-eehr/( C'E • Garbage Disposal 11.50
City /State Zip ,
T3G - c 172 Laundry Tray 11.50
N Washing Machine /Laundry Tray (Specify) 11.50
5 Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
Rg ` D , Inc-- MFG Home New Water Service 28.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 28.00
/(152 -ww Pael itvb r,Dt. Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy gc , O2 97006 531- 1 .'(027
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if roc 0 A /0W 1} 0 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database 5�9 p ( 600 0) ?I )2o00
Name
Architect Sewer - 1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone Water Service - each additional 200' 32.00
Describe ✓ work to be done: Storm & Rain Drain - 1st 100' 38.00
ua
New Repai 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential Commercial 0
Additional ed scription of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* / 19.00 j 9'
igAGJ7'jow leo /r r �ri 4-1- '- Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and "SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. J
Sign ure of Owner g Date y /S9 8% /
, ( 8/o SURCHARGE
Contact Person Name , Phone `
men e) i t 5 b 9-s,143 -PLAN REVIEW 25% OF SUBTOTAL •-..--
1 BATH HOUSE 5178 00 Required only if fixture qty. total is > 9
. ���� � _ w �k TOTAL
2 BATH HO °$250 00
3 BATH H OUSE 5285 00 I ; ' ', /
(This fee°lncludes -all plumbing fixturesrin the dweIUng and the flrst l - -Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 fee of sancta sew er sto rin sewer and water service) -. : 4,3. ; ; Device, which is $25 + 8% surcharge
"Ali New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I tdstsVormstplumapp.doc 10/1199 - -
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4'
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I: dstsVormslplumapp.doc 1011199 -