Permit CITY OF TIGARD PLUMBING PERMIT
^ .a " , ; I 1 DEVELOPMEN SERVI PERMIT # • PLM98 -0028
DATE ISSUED: 02/02/98
PARCEL: 291O4AD -02400
SITE ADDRESS...: 12925 SW WALNUT ST
SUBDIVISION ZONING: R -4.5
BLOCK LOT ° JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH : 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS • 0 TRAPS • 0
STORIES : 0 WATER HEATERS • 1 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: Installing a water heater
Owner: FEES
NICLAUS DURDEL type amount by date recpt
12925 SW WALNUT ST PRMT $ 25.00 B 02/02/98 98- 302945
TIGARD OR 97223 5PCT $ 1.25 B 02/02/98 98- 302945
Phone #:
Contract or
HARDY PLUMBING & HEATING
14689 NE COUNTRYSIDE
AURORA OR 97002
Phone #: 222 -9654 $ 26.25 TOTAL
Reg #..: 000609
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Top —out Insp
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 011NC by calling
(503)246 -1987. .
7
Issued By: t--- Permittee Signature / .. ,"---N `•
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
■
CITY OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd I
TIGARD, OR 97223 Date to P.E.
Date to DU
(503) 639 -4171 Permit # ( W^ /,
Print or Type Related SWRR #`
Incomplete or illegible applications will not be accepted Called
Name of Development/Project On back Indicate Work Performed by fixture.
Job FIXT_ JRES°;(Indlvtdual) , ; . • , . _ QTY PRICE AMT:
Address street Address Suite Sink 9.00
7 a
10 S sy✓ L✓Aj Air Lavatory 9.00
Bldg # --/-764)1Z Ciity/State Zip Tub or Tub/Shower Comb. ' 9.00
0 Shower Onl
Name Only 9.00
D U2 n;L l Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
1),.9 .SL✓ L./AL,- Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
17,1)120 elz . .c%)-
Name Floor Drain 2° 9.00
44 t 3" 9.00
Occupant Mailing Address Suit
4" 9.00
City/State Zip Phone Water Heater conversion 0 like kind 9.00 /
I Laundry Room ray 9.00
' Name > Urinal ' 9.00
i f iP Lig6 0 J� Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
I L/1M "if (A)-- S I OA- 9.00
Prior to permit City/State Zip Phone
issuance, a copy 2a/) l' I ' �2 ). - q /,s 9.00
G' L/
t
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date 9.00
required if 1,69 Li 9 -‘ 79 Sewer - 1st 100° 30.00
expired in COT Plumbing Lic. It Exp. Date
database 3"-- y p g ,_ 9
Sewer -each additional 100' 25.00
3
Name Water Service - 1st 100' 30.00
Architect Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Descnbe work New 0 Addition Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 N -residential 0 Residential Backflow Prevention Device° 15.00
Additional descnption of work: Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
/ as L J77 � Ins of E Pl
f- 1 re per/hh
(' per/hr
Existing use of Specially Requested Inspections 40.00
'
building or property i2 f per/hr
Rain Drain, single family dwelling 30.00
Proposed use of
I building or property 7 J 2 j /• Grease Traps 9.00
QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information ' or riser diagram is required if t]uanuty Total is > 9 • given is correct, that I am the owner or authorized agent of the owner, and •SUBTOTAL e;'. -;
that plans submitted are in c mpliance with Oregon State Laws. _ • : -:•
re of Owner /Agent / Date
5% SURCHARGE r ;
C Person Name Phone
PLAN REVIEW 25% OF SUBTOTAL
� n r� Required only if fixture qty. total is ? 9 /
eorJ �Y2-Lo y v�a� -7 /� bs Li TOTAL 2' -Z7
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
I tdsts\plmapp doc 5/97
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
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:
I ldstMplmapp doc 5/97