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Permit CITY OF TIGARD P LUMBING PERMIT iilu�► i DEVELOPMENT SERVICES DATE a -0428 E ISSUED: 1 1 / • 18i�e PARCEL: 25104BD —WIL01 SITE ADDRESS...: 13635 SW WALNUT ST SUBDIVISION • MLP98 -0008 WILSON ZONING: R -7 BLOCK LOT -001 JURISDICTION: TIG CLASS OF WORK..:OTR 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 - 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). °.: 160 WATER CLOSETS.: 0 WATER LINE (ft)...: 0 DISHWASHERS ° 0 RAIN DRAIN (ft)...: 0 Remarks: Connect existing house to existing lateral on property. Septic system must be pumped, filled, or removed and inspected. Owner: FEES OTIS T CAGLE type amount by date recpt 1708' NW SLUMAN RD PRMT $ 55.00 DEB 11/18/98 98- 310909 VANCOUVER WA 98665 SPCT $ 2.75 DEB 11/18/98 98- 310909 Phone #: Contractor OTIS T CAGLE 1708 NW SLUMAN RD • VANCOUVER WA 98665 Phone #: 360 - 696 -1483 $ 57.75 TOTAL Reg #.. REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Sewer Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection applicable laws. All work will be done in accordance with ' I n s p existing /ca • approved plans. This permit will expire if work is not started Final Inspection 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-m1 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246 -1987. /O Issued(::: � : � ' / Permittee Signature: ' i►� Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY TIGARD Plumbing Permit Application 1 0 9 PP Plan Ch 13125 SW HALL BLVD. Commercial and Residential Rec'd B - TIGARD, OR 97223 Date Recd / / - /g (503) 6394171 Date to P.E. Print or Type Date to DST ^ � Incomplete or illegible applications will not be accepted Relinelated e 1 � � ( - rj 3 Rd SWR WR # � ,,, i ter. S v � 3Je Called Name of Development/Project ;FIXTURES (individual) . _ ,'QTY,',- ,PRICEt, iAMT Job Sink 9.00 Address Street Address + 4J4L NUf Suite Lavatory 9.00 /gb h, fix), z.,0 AI 6 Tub or Tub /Shower Comb. 9.00 Bldg # City /State Zip 7Q /4/eD a‹. Y Shower Only 9.00 Name f Water Closet 9.00 ,T /S i �, p9L Dishwasher 9.00 Owner Mailing Address ,, /Suite Garbage Disposal 9.00 17� /v /d 7 , / Suite Machine 9.00 C�i date Zp Phon��6 O� Floor Drain/Floor Sink 2" 9 00 6 /V/Vezi'i/Uer /OA 9A- ,496-/5/ 3" 9.00 Name 4" 9.00 Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00 Gas piping requires a separate mechanical permit. City /State Zip Phone Laundry Room Tray 9.00 Urinal 9.00 ;, 1 c' /2- Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 9.00 Prior to permit City /State Zip Phone Sewer - 1st 100' MO / 30.00 30 - issuance, a copy i / Sewer - each additional 100' 25.00 c r of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date .� • required if Water Service - 1st 100' 30.00 expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00 database Storm & Rain Drain - 1st 100' 30.00 Name Storm & Rain Drain - each additional 100' 25.00 Architect Mobile Home Space 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00 (Irrigation timing devices require a separate Describgwork to be done: restricted energy permit.) New V Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00 Residential 0 Commercial 0 Catch Basin 9.00 Additional description of work: Insp. of Existing Plumbing 40.00 per/hr Specially Requested Inspections 40.00 • per/hr Rain Drain, single family dwelling 30.00 Are you capping, moving or repla ing any fixtures? Yes O No Grease Traps 9.00 If yes, see back of form to indicate work performed by QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required rf Quantity Total is > 9 , ,. ' WORK COULD RESULT IN INCREASED SEWER FEES. SUBTOTAL "-' ", 4, 1,2 ; � �_;•° � 00 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 , ;` ; ,' � *.t i1 4 '.: 7 � that pla tted are in compliance with Oregon State Laws. " °.. i . � (#' Sign •wner /Age Date "PLAN REVIEW 25% OF SUBTOTAL -` -_ , ° '' x"•: Required only if fixture qty. total is > 9 s - a.:a:. a TOTAL � = r:',., - , '';' '.2 7 onta . P o ame Phone3 O _ ' W. ;: • / A- I/ LLL �j r / // /�. /� / /��� 'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow Prevention Device, which is $15 + 5% surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review 1.ldststplumapp.doc 7/2/98 4 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 /Floor Sink 2" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: _ GvKZN _a�C) / po - , 7o 2�m ,bacie • ,.�. e Ze ,v, A/ .t/Z - 7 / e /i) �, 75. �© �, / /SY/ ,`' I \dsls\plumapp doc 7/7/98