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12340 SW JAMES ST
CITY OF 'TIGARD ----- PLUMBING PERMIT
DEVELOPMENTSERVICES PERMIT#: P DATE ISSUED: 08/25.20 125!20 00 00317
13125 SW Hail Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103013-01500
SITE ADDRESS: 12340 SW J.AMC'S ST
SUBDIVISION: WILLAMETTE ZONING: R-4.5
BLOCK: LOT: 040^^ JURISDICTION_TIG _
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES_ _ LAUNDRY TRAYS: 517 RAIN DRAINS:
SINKS: — URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES-
TUB/SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
'lemarks: ------ ---
__ _ FEES
Owner: _ _ _______� Type By Date Amount _Receipt
REISBECK, RALPH N PRMT CTR 08/25/200( $50.00 27200000000
12340 SW JAMES ST 5PCT CTR 08/25/200( $4.00 27200000000
TIGARP, OR 97223 =
Total $54.00
Phone 1:
Conhactor:
REQUIRED INSPECTIONS
Water Line Insp
Phone 1:
Reg#:
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 by calling (503) 246-1987.
an o
Issued By: L: (
Call (5014-k
3 �_) 639-4175 by 7:00 P M. f Permittee Signature:
r Inspection needed the next business day
p
CITY OF TIGARD Plumbing Permit Application Plan Check# _
13125 SW HALL BLVD. Commercial and Residential Recd By_ Cr
TIGARD, OR 97223 Date Recd
(503) 635-4171 ` �` Date to P.E.
rint or Type Date to DST
Incomplete or illegible applications will not be accepted Permit#lG-P11C00"dill 7
Related SWR#
Called
Z�Ivw
of Oevelopment/Pr ect — FIXTURES (individual) QTY PRICE AMT
Job y,, ,
Address S reit ddress Suite( Lavatory 11.50-
� ✓T 1J ✓V" 1 �J- . Tub or Tub/Shower Corrb — - 11.50
Bldg# S`tgte Zi 4C,
C Shower Only 11.50
---- -- - - `= - - — Water Closet --- - 1,.50
Nam--- & Al 14049 �/!L- Uri _-- -- -
q _ nal 11.50
Owner Mailing Ad
Suu' Dishwasher - 11.50
Garbage Disposal 11 50
City/State Zip Phone --
Laundry Tray 11.50
Naine . Washing MachinelLaundry Tray 11.50
. Floor Drain/Floor Sink 2" 11,50
Occupant Mailing Ar10ress p Suite 3" 11.50
11.50
City/Slate Zip Phone - -- - -- -
Water Heater O conversion C) like kind 11.50
Name - Gas piping requires a separate mechanical per nit.
*yyt�lowex - - MFG Home New Water Service ^ - 3200.
Contractor Mailing Address„/ Suite MFG Home New San/Storm Sewer _ 32.00
Hose Bibs 11.50
Prior to p(imit City/State Zip Phone Roof Drains 11.50
issuance•a copy -
Drinking Fountain 11.50
of all licenses are Oregon Const Cont.Board Lic.# Exp.Date -
req,Ired if Other Fixtures(Specify) — 15.00 --
expired in COT Plumbing Lie # Fxp.Date _
database
-- Name - - - - - -- ---
i Architect -- Sewer-1 st 100' - - -38.00
M -
Or ailing Address Suite Sewer each additional 100' 32 nn
Cil /Stale -ZIp Phone - Water Service- 1st 100' 38.00
;cer y b Q
En h
0 Water Service-each cddilional 200' 32.00
Describe work to be done Storm R Rain Drain- 1st 100' 3800
New O Repair O Replace with like kind Yes No O Storm&Rain Drain-each additional 100' 3200
Residential Commercial (_1
Additional escription o1 work -—' Commercial Back Flow Prevention Devnce 3200 -
/�//�/C ,v . �mm 11tic 7 If o,,UVJ�!- Residential Backflow Prevention Device' - 1900.
C e�4/Ye. �/ Catch asln 11.50
Are you cap ging,m ing or replacing any fixtures f so o1 Existing Plumbing or Spe:tally Requested - 50 00
Yes F No X CA
Inspections
If yes, see back of f rm to indicate work performed by /cA (t- Rain Drain,single family dwelling --- 4500
fixture. FAILURE TO ACCURATELY REPORT FIXTURE !1` Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES.
I hereby acknowledge that I have read this application,that the information QUANTITY TOTAL
Isumetnr or neer diagram Is required it Quantity Total
given is correct.that I am file owner or authorized agent of the owner,and s�9 /
that plank submitted are in coni -nice wit Oregon Slate Laws 'SUBTOTAL j r
Si na r�of��w,no A/g�t D to ---
_9 ��Lr�11 �� D t Z�'��O 8%SURCHARGE
Cont ct Pe .on Nam3 Phone — — --
"PLAN REVIEW 25%OF SUBTOTAL
1 BATH HOUSE$178.00 — Reui' red anly it fixture qty total is>9
TOTAL d1/1
2 BATH HOUSE$250.00
3 BATH HOUSE$285.00 ----- --
,This fee Includes all plumbing fixtures In the dwelling and the first *Minimum permit' , ,s$50+814,surcharo� ,.xcept Residential Backnow Prevention
100 feet of sanitary sewer storm sewer and water service) Device which is$�5+Poi --rharpe
"All New Commercial Hultdings require plans with isometric or riser diagram and
plan review
I ldslsllormslplumepp dor.11118199
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink -_-------- — _— —. —
Lavatory —
_Tub or Tub/Shower Combination _
Shower Only
Wate,-_Closet— _
Urinal
Dishwasher
Garbage Dssposaw_
Laundry Room Tray -------_ — -- __-- -- _-_
Washing Machine_ -
Floor Drain/Floor Sink 2"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1 AaISVnrms�lumapp A,x'1111 Bf99
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