Permit � PLUMBING PERMIT
CI TY OF TIGARD •
PERMIT # : PLM96-0277
. OMMUN0YDEVELOPMENT DEPARTMENT DATE ISSUED: 09/25/96
.~' 1u�oom�n�/o*u.r�m�. 97223.8199 (503) w�w��n
PARCEL: 2S109BA-HS227
SITE ADDRESS...: 14112 SW WAGONER PL '
SUBDIVISION...-: HILLSHIRE SUMMIT #2 ZONING: R-7 PD
BLOCK ^ LOT :27
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CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES-: 0
-TYPE OF USE....:SF WASHING MACH • 0 BACKFLOW OREVNTRS..: 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.....: Q� OTHER FIXTURES ^ 0
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"TUB/SHOWERS... 0- ' SEWER LINE ( f t ) . . . : 0
_WATER CLOSETS..: '0 WATER LINE (ft) . . . : ' 0 •
DISHWASHERS '^ 0 RAIN DRAIN (ft)...: 0 -
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Re.marks: DEVICE FOR IRRIGATION SYSTEM LOCATED NEAR WATER METER
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�Owner: � . FEES
' :5TEME lCiOSE_' type amount by date recpt
,.. SW WAGONER ' PRMT $ 15 JMH 09/25/96 96-284378
. - 5PCT $ 0.75 MN 09/25/96 96-284378
'�' OR 97223
ti24-6983
� .~
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s' Contractor: ' - -
PAC WEST PLUMBING INC
',2110 2110 NE CORNELL ROAD
�HJLLSBORO OR 97124 - ---- -----------
' Phone #: 648-644 $ 15.75 TOTAL
Reg St.. : 081902
- — REQUIRED INSPECTIONS -------
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This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other RP/Backflow Prey
' applicablo laws. All work will be done in accordance with Final Inspection
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. •
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Permittee Signature: „g~
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Issued By: (ljejb _ _
Call for inspection - 639-4175
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CITY OF T Plumbing Application Rec'd By al) 13125 SW LVD. Commercial and Residential Date Recd
TIGARD; 97 Date to P.E.
i(50ZY '639 -4171 Date to osT
Permit #
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) . QTY . PRICE AMT
Job it ffstki ✓C 54,,,.,,,_:'f- Sink 9.00
• Address Street Address Suite Lavatory 9.00
I 112 S W45°141 e ✓ Tub or Tub /Shower Comb 9.00
Bldg # City/State Zip Shower Only 9.00
i I ° ) A „ ° / 7 2 2 3 Water Closet 9.00
Nar r e u{ C (o s Dishwater 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
I ((2 5 , ,..„.24, Washing Machine 9.00
9.b Zip Phone Floor Drain 2 9.00
( �c Zip_ Phone
f2I - 1 ,' 1 3 3- 9.00
" - {--en.) e. ' C (aye.. 4 9.00
Occupant Mailing g Address 1 Suite Water Heater 9 00
v4 [ S 4 "eiv Laundry Room Tray 9.00
City/State Zip Phone 0 $ Urinal 9.00
ame __ a � ✓ L 7 2? j / c / 9 3 Other Fixtures (Specify) 9.00
CaSC CirlR we ST Ca' - •Sri cc ✓ . 9.00
Contractor oq(tfSAS J Gµra_2d Suite' / p 3 9.00
I 9.00
city/State Zip Phone �[
L ° A '), 1 700,' ( 27 9.00
Oregon Const. Cont. Board Ltc.# Exp. Date
9.00
., , Attach Copy of j Z (D -'f g t ( - q (P 9.00
Current Plumbing Lic. # Exp. Date Sewer - 1st 100' 30.00
Licenses ati rlcAre( Sewer - each additional 100' 25.00
C3Business n Tax or Metro 4 Exp. Date Water Service - 1st 100' 30.00
Nam n Water Service - each additional 200' 25.00
Architect ✓ Storm & Rain Drain - 1st 100' 30.00
Or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer ty /State _ o Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
ro ✓ 4 Pollution Device
Describe work New,l Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' g 15.00
to be done: Residential Non - residential 0 Any Trap or Waste Not Connected to a Fixture Y 9.00
Additional descnption of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
I Existing use of (1t S ; f am` C� per /hr
building or property d Rain Drain, single family dwelling 30.00 .
?roposed use of Grease Traps 9.00
ouilding or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes ❑ No/thz, Isometric or nser diagram is required if Quandy Total is > 9
(If yes see back of form) *SUBTOTAL / ( -7)--C)
I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE .(-
I that plans submitted are in compliance with Oregon State Laws.
Signs o /Ag nt Date PLAN REVIEW 25% OF SUBTOTAL
Z � q Required only fixture qty total is > 9
- / i° R fix TOTAL / S�
Contact Person Name Phone
f J 1 G - Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
! �� e_ C `�� �� ` - I 0 p Prevention Device. which is S15 + 5% surcharge
i:\dsts\plmapp.doc 8/96
•
PLEASE 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)
COMMENTS REGARDING ABOVE:
11/16/2004
Case Activity Listing
12:00:58PM
TIDEMARK Case #: PLM96-00277
COMPUTER SYSTEMS, INC
Assigned ,Done Updated
Activity Description » Date 1 P Date 2 Date 3 Hold
PLMA007 Application received 9/25/1996 None PAID JMH 9/25/1996
DST
- PLMA050 (F) Issue permit 9/25/1996 None PAID JMH 9/25/1996
DST
PLMA050 (F) Issue permit 9/25/1996 None PAID JMH 9/25/1996
DST
PLMA800 Case Finaled 10/2/1996 None PASS MS 10/2/1996
MRS
Page 1 of 1 CaseActwity..rpt