Permit CITY OF TIGARD
al DEVELOPMENT SERVICES PLUMBING PERMIT
I
PERMIT # • PLM96 -0333
__.. . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: i 1 / 07 / 96
PARCEL: 25110BD -05700
SITE ADDRESS...: 11872 SW V I EWC REST CT
SUBDIVISION • ASPEN RIDGE ZONING: R -4.5
BLOCK LOT •024
CLASS OF WORK..:NEW 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: Backflow device for sprinkler system located at meter (double check)
Customer: Strand
044 01- ' FEES
CHINOOK LANDSCAPING LIMITED type amount by date recpt
EARTH PRMT $ 15.00 JMH 96- 286258
33615 SOUTH HIGHWAY 213 5PCT $ 0.75 JMH 96- 286258
MOLALLA OR 97038
Phone #: 503 -829 -2429
Contractor:
IRINGER, LYNN (CHINOOK LNDSCP)
33615 SOUTH HIGHWAY #213
MOLALLA OR 97038
Phone #: $ 15.75 TOTAL
Reg #..: 12039
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP/Back flow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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.
Permittee Signature. Ord
- `
Issued By: _._. 'WM 4 ( MN
/ Call for inspection — 639 -4175
CITY,OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. . Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E.
(503) 639 -4171
Date it DST
Permit #
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Develop ent/Pr /^ FIXTURES (individual) QTY • PRICE •AMT
Job / J g-1 D Sink 9.00
S treet Address Suite Lavatory . 9.00
Address Tub or Tub /Shower Comb. 9.00
Bldg it City /State Zip Shower Only 9.00
• Water Closet 9.00
me
a
//� � /(g / /(/ s1/2,25,7d....
Dishwasher 9.00
Owner / Mailin Address Suite Garbage Disposal 9.00
/a 3z SW (/ f/r/1DiC . Washing Machine 9.00
CU/State /� �q Y �Zi Phone Floor Drain 2' 9.00
� Gv Na r cY / i/ 22 3' 9.00
y11 ) 4' 9.00
Occupant Maili g ✓ Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State_ _ Zip _ Phone _ •. _ Urinal- - - -9.00 -- - - -
„_ � Other Fixtures (Specify) 9.00
9.00
Contractor Mailing Address Suite 9.00 •
33C/SS / Z / � 3 j 9.00
/ e `L v y i/ y -. 7
a,eP Z e_ .2- ( 4 2 -
9.00
Oregon Const. �ont. Board Lie* Exp. Date 9.00
Attach Copy of /7 p 3 9 9/�7 9.00
Current Plumbing Lic. # Exp. I ate Sewer - 1st 100° 30.00
Licenses Sewer - each additional 100' 25.00
COT Business Tax or Metro it Exp. ate
I/43 7 "7-// 97 0 K- Water Service - 1st 100' 30.00
Name • Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
• Pollution Device
Descnbe work New 0 Addition Alteration 0 Repair 0 Residential Backflow Prevention Device' / 15.00 / j DO
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin 9.00
iitjetie.- [� „ -� / �/ Insp. of Existing Plumbing 40.00
J C �y� °` �c/Lc -� l7 (JtC� per/hr
Existing use of Specially Requested Inspections 40.00
per/hr
building or property
Rain Drain, single family dwelling 30.00 .00
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes o Novz Isometric or nser diagram is required d Quanrty Total is > 9
(If yes see back of form) V *SUBTOTAL /S: a
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 ,r /�.S
that plans submitted are in compliance with Oregon State Laws. i fS
SIgnat f Owner /A nt . Date PLAN REVIEW 25% OF SUBTOTAL
/ / Required only d fixture qty total is > 9
af_c„-- ,/ / 7 TOTAL /�. 7.----- Con t P ame Pon
*Minimum permit fee is S25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
• i:\dsts\plmapp.doc 8/96
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PLEASE 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
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE: