Permit - CITY OF TIGARD
� ;�� DEVELOPMENT SERVICES PERMIT PERMIT
TM98 -0'166
1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 06/11/98
PARCEL: 29104DB -03800
SITE ADDRESS...: 13212 SW WELLINGTON PL
SUBDIVISION....: AMESBURY HEIGHTS ZONING: R -4.5
BLOCK..........: LOT . :038 JURISDICTION: TIG
CLASS OF WORK.. :ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE.... :SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 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 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: Residential backflow
Owner: -- -- FEES
DALTON CONSTRUCTION INC type amount by date recpt
8465A SW HEMLOCK ST PRMT $ 15.00 JSD_ 06/11/98 98- 306460 .
TIGARD OR 97223 SPCT $ 0.75 JSD 06/11/98 98- 306460
Phone #:
Contractor - - -- - - - --
KOREY WINCHELL
17465 NW CARL CT
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PORTLAND OR 97229 -- -- --- •---- -- - - - - -- --
Phone #: 614-0814 $ 15.75 TOTAL
Reg it..: 000126
REQU I RED I NSPECT I ONS -
This permit is issued subject to the regulations contained in the RP/Back flow Prey .
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect i o n
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- P -0010 through OAR 952 - 0001- %80. You may
obtain copies of these rules or direct questions to OUNC by calling __
(503)246 -1987.
ir
Issued By. 4illroA Permittee Signature :
+ + + + + + + + + + + + + ++ ++ •++++++++++++++++ ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ ++
Call 639 -4175 b :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++i-+++++++++++++ + + + + + + + + + + + + + + + + ++ + + + + ++ + + ++ + ++
CITY OF TIGARD Plumbing Permit Application Plan Check ••
13125 SW 'HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Rec'd - (2 ' 9'
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # Pt/7
Related SWR #
Called -- / 6--
b 61 f ti( Name of Development/Project On back indicate Work Performed by fixture. JdtS U /4/1/ fr� 1.1/1. c /4 17 r 44--..s FIXTURES (Individual) QTY PRICE ' AMT
Address Street Address Suite Sink 9.00
1 SW A/C-1(;)+6\}onl / Lavatory 9.00
Z(C Idg # City /State Zip Tub or Tub /Shower Comb. 9.00
j -- I', q / 02 Z z
Name Shower Only 9.00
\- o & C r i S+ Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
Garbage Disposal 9.00
City /State Zip Phone Washing Machine 9.00
Name Floor Drain 2' 9.00
3' 9.00
Occupant Mailing Address Suite 4' 9.00
Water Heater 0 conversion 0 like kind 9.00
City /State Zip Phone
Laundry Room Tray 9.00
1
Name ` Urinal 9.00
k---01 " -f _ V J .. i h r t- \ \ Other Fixtures (Specify) 9.00
Contractor Mailing Addrer&s Suite
1 o M- CA---Li C--C--1- - 9.00
Prior to permit City /State Zip Phone 9.00
issuance, a copy PO R.A. . ® -0-I__ ,r -0 r I U Sewer - 1st 100' 30.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date Sewer - each additional 100' 25.00
required if / j i- 7 j0 -- `7'�
Z � � I( Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. �y Exp. Date Water Service - each additional 200' 25.00
database
Name Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
or Mailing Address Suite Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Engineer City /State Zip Phone Pollution Device
Residential Backflow Prevention Device' I 15.00 /S c'='
Descnbe work New 0 Addition 0 Alteration 0 Repair O Any Trap or Waste Not Connected to a Fixture 9.00
to be done: Residential 0 Non - residential 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
Existing use of
building or property Grease Traps 9.00
Proposed use of QUANTITY TOTA
building or property Isometric or riser diagram is required if Quandy Total is > 9
*SUBTOTAL • ' - >77
I hereby acknowledge that I have read this application, that the information 5 SURCHARGE
given is correct, that I am the owner or authorized agent of the owner, and ' v..
that plans submitted are in com•lian > ith Oregon State Laws. "PLAN R EVIEW 25% OF SUBTOTAL
1 k -•
Slgna of Owner /Agent Date . , ' • , ":
fp
- .004 - ....woCaN Required only d fbdure qty. total Is > 9 4, - ' _ •-• . ' • , '' f`•'
(( -9K TOTAL . ,'
Contac'Persort'Name Phone
'Minimum permit fee is $25 + 5% surcharge, except Residential Backfltiw
Prevention Device, which is $15 + 5% surcharge
**All New Commercial Buildings require plans with isometric or riser diagram
and plan review
l:tdstslplumbapp.doc 5/5/98
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
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
:OMMENTS REGARDING ABOVE:
1.ldstslplumbapp.doc 5/5/98
1103
201— CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: / _ _ — ' O , A. P.M. MST: 97
Location: / I
_ L _� / BUP:
Tenant: • ' Suite: Bldg: MEC:
Contractor: clam Phone: (579 (1(' PLM: ,'( /( h
Owner: Phone: , ELC:
ELR:
BUILDING BLDG (con't) LUMBING) MECHANICAL ELECTRICAL SIT.
P
Site • Post/Beam Post7Beam Post/Beam Cover /Service Sewer orm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab /
Shear /Sheath Fire Spklr /Ahn Crawl/Found Dr Heat Pump Low Volt I /
Approved Approved Approved Approved • ., . ed
Appr /Sdwlk Not Approved - o - ; .roved Not Approved Not Approved Not Approved
FINAL INAL , FINAL FINAL FINAL
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0 Call for re. 0 Reinspection fee of $ r wired before next inspection 0 Unable to inspect
i
Inspector: — Date: _ ? z �/, Page of
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