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9535 SW BROOKLYN LANE
CITY CF TIGARD
DEVELOPMENT SERVICESPLUMBING PERMIT
PERMIT #. . . . . . . : RLM98-035:
13125 SWHatlBlvd., Tigard,OR97223(503)639-4171 DATE ISSUED: 09/24/98
PARCEL: CS 1 1 1 B,!:1—SHM01
`5I1-E ADDRESS. . , : 09".35 SW BROOKLYN LN
SUBDIVISION. . . . : SHANNON MEADOWS -ZONING: R-4. 5
BL.00F;. . . . . . . . . . . L_OT. . » . . . . . . . . . . :001 JURISDICTION: TiG
C(_!iSS OF' WORK. . -At_.T GARBAGE_ DISPOSALS. : 0 MOBILE HOME SPACES. : O
TYRE OF' USE. . . . :5F WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . 0
OCCUPANCY GRP. . : R3, F-LOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . . 0 WATER HF;'•ERS. . . . . . 0 CATCH BASINS. . . . . . . . O
FIXTURES-------------•---- LAUNDRY TRAYS. . . . . . 0 SF:' TRAIN DRAINS. . . . . : 171
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . O
LAVATORIES. „ . . : O OTHER FIXTURES. . . . V_1
TUB/SHOWERS. . . : O SEWER LINE (ft ) . . . : 100
WATER CI..OSET .i.. : 0 WATER LINE (ft ) . . . a 0
DISHWASHERS. . . . : 0 RAIN oRAIN (ft ) . . . : 0
Remarks : Installing sewer- line
Owner- _____.________...____._
_____._._.__---.--.--•--______.____..___-______.___._. FEES
RICHARD 'WHITEMAN type amol_int by date recpt
9535 SW BROOKLYN LANE RRMT $ 30. 00 B 09/24/96 98-309459
TIGARD OR 37224 `:;Pf T E 1. 50 R 09/24/98 98--309459
Phone #:
Cantr�tc•t or__.__._____-_--•-----•------...----•---._._.__.__...__...
OWNER
l'hic,ne #: f 31. 50 TOTAL
Req #. . .
------- REQUIRED INSPECTIONS
This persit is issued subject to the regulations contained in the Sewer Inspection
7,gard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
4pplicable laws. All work will be doee in accordance Mith
approved plans. This persit will expire if work is not started
within ICO days of issuance, or if work is suspended for sore
than 188 days, ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rule .-e _---
set forth in DAR 952-PN81 881® through OAR 952-N081-A888. You say
obtain copies of these ruses or direct questions to OX by calling � �—
(583)246-1987. `— -
Iss .1 ed By : Permittee Signatur•e)�X
4-f+++.++++++++++-,..+++++++++++++++•!-++++++++++4+++4•+++++++++++++++++. ++++++++
Call 639-4175 by 7:00 p. m. fur an inspection needed the next btisiness day
++++++.f.++•f++++++++++++++++++++++++++++++++++++++++i-+++++++++++.t+ h+++++++++•++++
CITY.OF TIGARD Plumbing Permit Application Plan Checo i
13125 SW HALL BLVD. Commercial and Residential Recd By
--
TIGARD, OR 97223 Date Recd
(503) 639.4171 Date to P.E. r _
Print or Type Date to D^T
Incomplete or illegible applications will not be accepted Permit* A!- _Z_>
Related SWR tl� _('I !r
Called
Name of Develr,_ ,,,,'^roject i FIXTURES 'individual —
If( QTY , "PRICE AMT
Job L,LA,) Sink 900
Address Street Address Suite Lavatory 9.00
e Tub or Tub/Shower Comb. 9.00
Bldg 0 City/State Shower Only 9.00
T lGA12u OC'. Zi LI? y _ —
N e 'Nater Closet 9.00
/ f( y/}I�t7 (nJf I /'T6Jd►AJ�� Dishwasher 9.00
Owner MaillAddress Sufte Garbage Disposal g.00
1437 5w 97-' A v-c Washing A1a::hlne 9.00
City/State Zip Phone -
/C�+r2D, 02, Zi -124 6z0- s'1() 7 Floor Drain/Floor Sink 2" - 9.00
- - Name 3-- 9.00
4" 9.00
Occupant Mailing Address F
Urinal Water Heater O conversion O like kind 900
Gas I in re uims a se arate mechani al ermit.
CitylState Zip e — Laundry Room Tray 9.00 -
_---
Name _ — 9.00
-5AV^L- Other Flxt-i a(`.pecify) 9.00
Contractor Mailing Address Suite 900
—- ---- — 9.00
Prior to permit City/State Zip Phone Sewer-1 st 100'
issuance,a copy 3000
—
Sewei -each additional 100' 25.00
of all licenses are Oregon Const.Cont.Bua(d Llc,# Exp.Date _ _—_
required if Water Service-1st 100' 30.00
expired In COT Plumbing Llc.0 Exp.Date Water Service-each additional 2)0' 25.00
database— Storm&Rain Drain-1st 100' 30.00
Name Storm&Rain Drain-each additlonsi 100' 25-00
Architect Mobile Home Space i 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 2500
Pollu,on Device
Engineer CltylSlate Zip Phone Residential Backflow Prevention Device* 1500
(irrigation timing devices require a separate
Describe work to be done: _r-Mricted energy pemtit).
New (K Repair O Replace with like kind. Yes O No O terry Trap or Waste Not Connected to a Fixture 9.00
Residential 4� Commercial O _ Catch Basin y.00
Additional description of work: Insp.of Existing Plumbing 40.00
Specially Requested Inspezllons 40 00
per/hr _
Are you capping,moving or replacing any fixtures? Rain Drain,single family dwelling 30.00
Grease Traps 9 00
Yes O No
It yes,see back of form to Indicate work perfornted by - --- -
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram Is required H QuantRy Totnl is >rJ
WORK COULD RESULT IN INCREASED SEWER FEES. '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 b%SURCHARGE
that plans submitted are in compliance with uregon State Laws. •h�t
Signature of owner/Agent Date " PLAII REVIEW 26%OF SUBTOTAL
-� Required only H fixture .to
qtytal Is>9
TOTAL
Contact Person Name Phone
*Minimum permit fee Is$k9+5%surcharge,except Residential Backflow
I Prevention Device,which is$t S+5%surcharge
"AIL New Commercial Bulldh.gs require plans with isometric.or riser diagram
and plan review
I-ldatl,p"Sm doc Im"
1
PLEASE COMPLETE:
Fixture Type- - i--� Quantity by Work Performed _
New Moved Replaced�Removed/Capped
Sink _ --
Lavatory
Tub or Tub_/Shower Combination — -
Shower Only ---
Water Closet_ _�_- _ -- - ----- - - --
Dishwasher_ "-
Garbage Disposal �-
Washing Ma_chine__ -
Floor Drain/Floor Sink 2" -- --- --
Water Heater
Laundry Room T►�-Dy ^- �-
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I Wsfmvlumapp aoc Unme
- __
CITY CJ F TIGARD SEWER CONNECTION
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223(503)639.417, PERMIT #. . . . . . . : SWR98-0265
DATE ISSUED- 09/ 24/98
51TE ADDRES!3— :09535 SW BROOKLYN LN PARCEL: 2S11lBA---SHMo1
5UBDIVISION. . .—SHANNON MEADOWS ZONING: R--4. 5
BLOCK. . . . . . . . . . LCT. . . . . . . . . . . . . :001 JURISDICTION: TIG
TENANT NAME. . . . . : rRICHARD WHITEMAN
USA NO. . . . . . . . . . : FIXTURE UNITS. . . Irl
CLASS OF WORK. . . :AL.T DWELL I IVIG LIN I TS. . :
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 0
INSTALL. TYPF. . . . .L-TPSWR IMPERV SURFACE: 0 sf
Remarks : Installiiig sewer- line
Owner.: FEES
RICHARD WHITEMAN type aml)l-knt by date )'Pept
953�5 SW BROOK!-YN LANE PRMT $ 2304. 00 B 09/24/98 BANCROFT
TIGARD OR 97224 INSP $ 35. 00 B 09/24/96 BANCROFT
Phone #:
Cantr-artor-:
OWNER
Phone #: $ 2335. 00 TOTAL
Reg #. . .-
REQUIRED INSPECTIONS
This Applicant agrees to coo'pl-,, with all the rules and regulations Sewer- Inspection
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will, be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in ail directions from
the distanre given. If not so located, the insta;Ier shall purchase
a "Tap and Side Sewer" Permit and the Agency will install a jateral,
ATTENTION: Oreqon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
152-001 0010 through OAR 952-AWI-Me. You may obtain copies of
those rules or direqt questions to UX by calling 1903)246-1987.
I s s 1.i P d b v Vv Permittee Signati-tt,p :
h+++++++++++-!•++++++++++•+++-! .............4........+++++++4....+++r•++++++++ ++++
Call 639-4175 by 7:00 p. m. for- an inspection needed the next bl-Iriness day
..............4.......................#-+4...4 4-++++++++++++++++++++4-++++++