Permit << A � CITY OF TIGARD DEVELOPMENT SERVICES Rt�7 PLUMBING PERMIT
• Y t ��±±���� PERMIT #: PLM1999 -00326
� DATE ISSUED: 10/11/99
13125 SW Hall Blvd., Tigard, OR 97223 (503 -4171 .
SITE ADDRESS: 13588 SW WHITEHALL LN PARCEL: 2S104DB -00400
SUBDIVISION: AMESBURY HEIGHTS ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: •
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention device.
FEES -
Owner:
Type By Date Amount Receipt
CASCADE WEST CONSTRUCTION CORP PRMT DEB 10/11/99 $25.00 99- 318979
10445 SW CANYON RD 5PCT DEB 10/11/99 $2.00 99- 318979
#103
BEAVERTON, OR 97005 Total $27.00
Phone 1:
•
Contractor:
JOHN DARBY LANDSCAPE INC •
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 579 -5298 RP /Backflow Preventer
Reg #: LIC 7110 Final Inspection
•
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other 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 • e Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -00 I rough R 95.'- 0001 - 0080.. _
Yo ay obtai • • pies of these rules or direct questions to • - IC b - •- ' :7
��
Is ed By: ■0 I OlfijILLt , /IL_i / Permittee Signa ure: A � ,
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed t ; b ess day
CITY OF TIGARD Plumbing Permit Application Plan C • t#
1312�3W HALL BLVD. Commercial and Residential Rec'd
T OR 97223 Date Rec'd //J- / /
(503) 639 -4171 Date to P.E.
Print or Type Date to DST --
Incomplete or illegible applications will not be accepted Permit
Related SWR #
Called
Name of Development/Project FIXTURES (individual) r,• QTY PRICE AMT
Job m P ) It+ J Sink 11.50
Address Street d ess ,� Seite Lavatory 11.50
13j�s- �j ID KJ ht-e 1ti /ft V Tub or Tub /Shower Comb. 11.50
B ldg # CV State Zip Shower Only 11.50
1 \i/ 40� I 23 Water Closet/Urinal (Specify) 11.50
Name '' l y
C- Cc-�� /A)09 ` CO(4 Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
/f)uy Sc.) C-C nybn Y4 a - Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
P 14 t �� 971:05 �'Y_ 7 a
Warn l Washing Machine/Laundry Tray (Specify) 11.50
Floor Drain/Floor Sink 2° . 11.50
Occupant Mailing Address / Suite - 3° 11.50
4° 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
Name
�0� n D 4 r 1 4 / k � 0e MFG Home New Water Service 32.00
• Contractor Mailing Address Suite MFG Home New San/Stor 32.00
n Sewer -
/ QQA ` c9 3 gC ikl) Hose Bibs 11.50
�
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy - 7 - 1 0011 ' ? 9724 3 , // 5 j4 Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
Other Fixtures (Specify) 15.00
required if " 7 1 ► C) //''' �
expired in COT Plumbing Uc. # Exp. Date
database
Name
Architect Sewer - 1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Commercial Back Flow Prevention Device 32.00
Additional description of work:
Residential Backflow Prevention Device* / 19.00 /9,00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 .
Yes 0 No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK ,s ULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I here n. . = : • a have read this ap I' -. •.n, that the information Isometric or riser diagram Is required if Quantity Total Is > 9
give act, the .... - : or a r • • - • - _ - • - owner, and *SUBTOTAL 96,00
.,. -ifi. ,.‘, :: • v. . lance with Oregon S . e Laws.
j - e en �e / ` 8% SURCHARGE At °°
r l
Co :.r''P N e
..1 0 q RIM "PLAN REVIEW 25% OF SUBTOTAL
1 Ill US ` ES178�00 j `� ' Required only if fixture qty total is > 9
�� ;' Y TOTAL O
SEA 5250 lw - a 7" o
Xg2 $285011 m
all plumbing fixtures in the dwelling and *Minimum permit fee Is $50 + 8% surcharge, except Residential Backflow Prevention
ZMIIICQsanita , sewer storm sewer and water,'` Device, which Is $25 + 8% surcharge
All New Commercial Buildings require plans with isometric or riser diagram and
plan review
i ldstslformsNplumapp.doc 10/8/99 - - --
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
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify) •
•
COMMENTS REGARDING ABOVE:
I:Wsts formspplumapp.doc 10/8/99 - - -