Permit A . - CITY OF TIGARD PLUMBING PERMIT
=�,r DEVELOPMENT SERVICES PERMIT #: PLM1999 -00251
44- „� J- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12905 SW WILMINGTON LN PARCEL: 2S109AA -02700
SUBDIVISION: WILMINGTON HEIGHTS ZONING: R -7
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT 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: Residential backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
JOHN TEA PRMT BON 8/9/99 $25.00 99- 317500
12905 SW WILMINGTON LN
5PCT BON 8/9/99 $1.75 99- 317500
TIGARD, OR 97224
Total $26.75
Phone 1:
Contractor:
PATRICK H. COSTANDINE
PO BOX 86631
PORTLAND, OR 97286 REQUIRED INSPECTIONS •
RP /Backflow Preventer
Phone 1:
Reg #: LIC 10361 + BACKFLOW Final Inspection
ORIGINAL
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 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 OUNC b calling (503) 246 -1987.
Issued By: I/• � aif t__ Permittee Signatur- `„, r ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed e next business day
1 ■ 9 99 0 -60.01
CITY OF TIGARD Plumbing Permit Application Plan Che
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, O 97223 Date Rec'd g I
(503) d39 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit #Pi��/�c -
Related SWR #
Called
Name of Development/Project FIXTURES (individual) . QTY PRICE AMT
Job / & Sink 11.50
Address •Street Address t Suite Lavatory 11.50
f aga 5'. w 4LIJ{ tt14 1 Tub or Tub /Shower Comb. 11.50
Bldg # City/ /State Zip Shower Only 11.50
Name ^
/O 4-6.. Water Closet/Urinal (Specify) 11.50
4 aH 7 -4 Dishwasher 11.50
Owner Mailing Address Suite Garbage Disposal 11.50
/Qyo3" . 1, GI,Lµropcs.i 1 ' J Washing Machine/Laundry Tray g ry y (Specify) 11.50
City /State Zip Phone Floor Drain/Floor Sink 2" 11.50
T r 0/1-o, e\ D4.
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
Cj te Zip Phone MFG Home New Water Service 28.00
MFG Home New San/Storm Sewer 28.00
Name _
= �_Q_l_ 01.E Ed_ _t Hose Bibs 11.50
Contractor Mailing Address Suite Rain Drains 11.50
$et. 4sb (r / Drinking Fountain 11.50
Prior to permit City/State Zip Phone Other Fixtures (Specify) 15.00
issuance, a copy � C,(_ », - L 7!I- $) (v
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if At 3Ce I 7 - 3 ( - 0 0
expired in COT ' • Plumbing Lic. # Exp. Date
database
Name Sewer - 1st 100' 38.00
Architect Sewer - each additional 100' 32.00
or Mailing Address Suite Water Service - 1st 100' 38.00
Engineer City/State Zip Phone Water Service - each additional 200' 32.00
Storm & Rain Drain - 1st 100' 38.00
Describe work to be done: Storm & Rain Drain - each additional 100' 32.00
New 0 Rep •r 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00
Residential Commercial 0 Residential Backflow Prevention Device' 19.00
Additions escnption of work:
Catch Basin 11.50
Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per/hr
Yes 0 No 0 Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
'ven is correct, that I am the owner or authorized agent of the owner, and Isometric or nser diagram is required if Quantity Total is > 9
tha .tans submitted are in compliance with Oregon State Laws. *SUBTOTAL - Sig ure of Own Date g---9' Date ZS�
' 110 , '-27 7% SURCHARGE ..
o k" ct Person Name Phone I.
� t[ Vb k _v- A;AQ '?7,/-T * "' **PLAN REVIEW 25% OF SUBTOTAL
I BATH' OUSE4S178 00 a '.. s , r Required only if fixture qty. total is > 9
" r , s # �u R� ` .7 . '
2•BA TOTAL
BATH HOUSE 5250 00 `� « ,
3 • TH HOUSE $285.00 k `r '4 7;, t : ' 7
(This
fee licludee all plumbing flztures In the dwelling and the first` ,:
4sw v Minimum permit fee Is $50 + 7% surcharge, except Residential Backflow Prevention
100 feet of, sanitary ( storm sewer water service) ; ; .
' Device, which is $25 + 7% surcharge
*'All New Commerclal•Bulldings require plans with isometnc or riser diagram and
plan review
I:tdststformstplumapp doc 8/5/99
PLEASE COMPLETE:
. Fizture'T,ype' _. ° ; Quantity v.NW,ork P, erformed: :P
;!,�l:, '� s -� - `a:r,�°,( .t • '`i ,$, . r .., F ...,Mvo- �„+a;; ed :;Replaced'
+ ced
`rr- +fir
' :RemovedlCappec!
„�s•.�, ^ ^ m. -, w ...- �z"�, �m °-.�
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:
I.tdsts'ormslplumapp.doc 8/5/99