Permit CITY OFTIGARD
�, 1111\ DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT # : PLM97 -0079
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/21/97
PARCEL: 1S134DC -03000
SITE ADDRESS...: 11130 SW TIGARD ST
SUBDIVISION - CHERRY HILL ACRE TRACTS ZONING: R -4.5
BLOCK • LOT -1 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -? WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:E1 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)...: 1.00
WATER CLOSETS.: 0 WATER LINE (ft)...: 100
DISHWASHERS • 0 RAIN DRAIN (ft)...: 100
Remarks: Installing sewer, water and storm sewer lines
Owner: FEES —•
TIGARD TUALATING SCH DIST 23J type amount by date recpt
13137 SW PACIFIC HWY PRMT $ 90.00 B 05/21/97 97- 294834
TIGARD OR 97223 5PCT $ 4.50 B 05/21/97 97- 294834
Phone #:
Contract or
BERRYHILL BROTHERS EXCAVATION
20897 SW SCHOLLS — SHERWOOD RD
SHERWOOD OR 97140
Phone #: 628 -3891 $ 94.50 TOTAL
Reg #..: 000621
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspect ion
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Storm Drain Insp
approved plans. This permit will expire if work is not started Rain Drain Insp
within 180 days of issuance, or if work is suspended for more Final Inspection
than 180 days.
Permittee Si. Y =tur - .
I ssued By: �1 ' /
Call for inspection — 639 -4175
CITY OF TIGARD Plumbing Application Recd By I*
13125 SW H BLVD. Commercial and Residential Date Recd 3- I -01
TIGARD, OR 97223 Cate :o P
503) 639 -4171 Date to CST
Permit s V I-TA � 0757G�
Print or Type Related SWR s /
Incomplete or illegible applications will not be accepted called
Name of CevelopmenuProiect FIXTURES (individual)
QTY PRICE AMT
Job Utility Connections /Modular Sink 9.00
Address S;reetAddress C u ae Gro ^m Lavatory 9.00
11130 SW Tigard S 4 . ruo or Tuo,ShowerComo 9.00
Bing s C.ty/State Zip Shower Only - 9.00
Tigard, OR Water Closet
i Vame 9.00
Tigard - Tualatin School Dist, Disnwasne 9.00
Owner 13 I Pac. . Hwy. , Suite Garoage Disposal
9.00
Washing Machine 9 00
City/State Zip Phone Floor Drain
Tigard, OR 97223 684 -2235 2 9.00
Name 3' 9.00
as above - 4 ' 9.00
Occupant Mailing Address Suite Water Heater 9.00
•
Laundry Room Tray 9 00
City/State Zip Phone Urinal i
9.00
Name Other Fixtures (Specify) 9.00
Berryhill Brothers Excavation 9.00
Contractor Mailing Address Suite
21400 SW Scholls- Sherwood Roac 9.00
(Prior to issuance City/State Zip Phqn 9.00
applicant must Sherwood, OR 97140 628 -3891 9.00
provide all Oregon Const. Cont. Board Lic.s Exp Date 9.00 1
contractors 62191 Oct . ' 9 7 9.00
license Plu � neLc- Jr I Exp. t o X Se - 1st 100' I A 30.00 3
information i _ Y
for COT COT Business Tax or Metros xp. Dae t Sewer -each additional 100' 25.00
database). 00003714 I E 10 -1 -97 x Water Service - 1st 100' r I 30.00 4 3 0 .001
Name 'hater Service - each additional 200' 25.00 i
Architect Se /Lee /Rueda x Storm & Rain Drain - 1st 100' 1 3000
or Mailing Andress Suite Storm d Rain Drain - eau( additional 100' 25.00 I
213 SW Ash I Mobile Home Space 25.00 1
Engineer City /State Zip Phone I
9 C °mmemal Baca Flow Prevention Device or Anti- 25 00 1 1
Portland, OR 224 -0173 Pollution Device
esor be work New V Addition C Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00 l
:° ce done. Residential O Non - residential O
Any Trap or Waste Nct CDnnerec to a Fixture I 9 00
= cdi::onai descnotion of wcrx
Install water line Catch Basin ( 900
from main to within 10 feet of structure "sp. °r Existing = umoing I 40.00
Der/hr
casting use of (water hooK up to be done Specially Requested Insoections l 40.00
- _i(cing or property by ROME plumbing) license 4 I oerrhr
Rain Crain. single family dwellin
a `Q� 94 above
9 y 9 30 �o
•
"cCosed use of Modular classroom Grease Traps I I 900
::.doing or property
QUANTITY TOTAL 1 3
=re /ou capping moving or reolacir.g any fixtures? Yes = No Isometrc x riser c asram •s reeuied I Cuarirry T etas •s > 9
If yes see back of forms 'SUBTOTAL �0 U
I O
' 'ereay acknowledge that I nave read this application, that the information
mien is correct that I am :he owner or authorized agent of the owner and 5% SURCHARGE
- at plans submitted are :' :amaliance with Oregon State Laws. \
S.gnature of Owner/ ens I Date PLAN REVIEW 25% OF SUBTOTAL I /
\
LT 4ecurea cm. L-
I tse :'r :::ai :s > 5
�y 3 ?-7 TOTAL ct�
•�ontact arson Name Phone �y'
Douglas Ber yh i 11 1 319-0903 'Minimum permit fee is 325 - 5% surcharge. except Residentra Backflow r
Prevention Device. which is 315 - 5% surcharge
i:` 5/96
•
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
j Fixtures to be capped, moved or replaced I 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: