Permit CITY OFTIGARD
r � ��,� i DEVELOPMENT SERVICES PLUMBING PERMIT
'!+L ' � -� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # ° PLM97- 043.3
DATE ISSUED: 10/29/97
PARCEL: 2S 104CD•- 09917J0
SITE ADDRESS...: 13684 SW TRACY PL
SUBDIVISION....: H I LLSH I RE ESTATES NO. 2 • ZONING: R- -7 ' PD
BLOCK LOT.......... :098 • 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: Installation of residential backflow prevention device.
Own er: - -- - - - -- -- -- - - - - -- • - -- FEES - - - -- --
WINDWOOD HOMES type amount' by date recpt
14076 SW BENCHVIEW TERR PRMT $ 15.00 DRA 10/27/98 97- 300438
TIGARD OR 97224 5PCT $ 0.75 DRA 10/27/98 97- 300438
Phone #:
Contractor - - - -- -----
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123 --------------- • ---
Phone #: 503 -628 -3411 $ 15.75 TOTAL
Reg #.. : 000058
REQUIRED INSPECTIONS -- -- -- - - --
This peroit is issued subject to the regulations contained in the RP /Backflow Prey
.Tigard Municipal Code,' State of Ore. Specialty Codes and all other Final Inspect ion
applicable laws. All- work will be done in'accor•dance with '
approved plans. This peroit 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- m1 -6010 through OAR 952-m1-0080. You may -
obtain copies of these rules or direct questions to OUNC by calling .
(503)246 -1987.
Issi-re1 By: Permittee Signature:
+ +++++++++++++++++++++++++++++++++- 1-+++++++++ ++ + + ++ + + + +-1- + ++ + + ++ + ++ + + +++ +-F ++ + + ++
Call 639 -4175 by 7 :00 p.m. for, an .inspection needed the next business day
+ + + ++ ++ + + +-1- +-1--I^+++ ++ 1•• + + + + + ++ + + + + + + + +-I + + + + ++ + + ++ + + +++ ++ ++ + +++. +-1--t -1- .-1--1--1--1- + -t--t + ++-F+ + ++
•
:ITY OF TIGARD Plumbing Application Recd
3125 SW H#LL BLVD. Commercial and Residential Date Redd In -1./147
IGARO , OR 97223 oats to P.E.
Oats to On c.
503) 639 -4171 Pemui pc-pg -(Y-/, �
Print or Type _ Related SWR s ----
Incomplete or illegible applications will not be accepted Called
! Name of Development/Project FIXTIMES OndNvld!aq it06004411M k9Udi :Lp1 il
Job i //d �. e Esi , 2 o 9?
silt 9.00
Address Street Address Suite � "ai0f �' 9.00
/3(0•5 $a)
7M_.' PL, I ' Tub or Tub/Shower Comb. 9.00
Bldg it I City /State Zip Shower Only 9
7 Or? 9 7 2 3 Water Closet 9.00
Name ' D ishwasher
. 9.00
Owner Ming Address - Suite Garbage Dis 9.00 •
Washing Machine 9.00
•
ay/State Lp Phone - Floor Drain - r
Cit 9.00
r 9.00
Name - .. ' - - -
•
. 4' 9.00
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray - 9.00
City/State Zip Phone Urinal 9.00
Name
Other Fixtures (Specify) 9.00
Lt z» L/mi7ISGI .r /C, 9.00
Contractor - Marling Address Suite -- 9.00 - -
/4373 PAirxiciA /vw
(Prior to issuance City/State Z Phone 9.00
applicant must /1/i / /s 4'o oe, 97/23 6.4? -34// 9.00
provide all Oregon Const. Cont. Board Lies Exp. Date - 9
contractors 6 r'3 (- Clr _ 9.00
•
license P4omb ng Lies Exp. Date Sewer - 1st 100'
30.00
information / 3 2 r - 9R • - Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro s Exp. Date Water Service -1st 100' 30.00
database).
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 107 • 30.00
Or Address Suite. Storm S Rain Drain - each additional 100 25.00
Mobile Home Space 25.00
Engineer City /State Lp Phone Commercial Back Flow Prevention Device or Anti- 25.00
__ Pollution Device . . . .. --
Desaibe work New 0 Addition 0 Alteration 0 Repair 0 . Residential Baddtow Prevention Device' / 15.00 /5
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional desorption of work _
• Catch Basin 9.00
... .. _ _ . . _ . Insp. of Existing Plumbing _ -.- 40.00
per/hr
_xisting use of Specialty Requested Inspections 40.00
, luikling or property
Rain Drain. single family dwelling 30.00
Proposed use of - . - Grease Traps . - .- - - - 9.00
building or property
QUANTITY TOTAL 1 -
Are you capping , moving or replacing any fxtu es? Yes p No p Isomeric er diagram n is required d (Wendy Tobias ! 9 ._ . .: r :r ;.
(If yes see back of form) - 'SUBTOTAL : -":.. - ,_ ` ; /$�
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 :._. ..
that clans submitted are in compliance with Oregon State Laws.
Signature of owneriAgent Date PLAN REVIEW 25% OF SUBTOTAL _ - .i::
� " � Recoiled a n t / I ay. toW e > 9 L_
r ower 7�[/ /O" .� 7. �7 TOTAL 2 : :. ,..
: `:,; /6-75--
Contact Person Name Phone r
a4V 410/0( 703 - Z SU •Prevention permit ice. which is $15 . 5% surchhaargexcept Residential Badtflow
I: \plmapp.doc 12/96 (dst)
•
•
'LEASE COMPLETE AS APPROPRIATE TO PROJECT: (
Fixtures to be capped, moved_or replaced Qty ..:.
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only -
Water Closet _ . ._ •
Dishwasher
Garbage Disposal V
Washing Machine
Floor Drain - 2" -
3"
. - .. . 4" _. •
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify) - - - -- -
:OMMENTS REGARDING ABOVE:
I:\plmapp.doc I2/96 (dst)