11635 SW 114TH PLACE ADDRESS:
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PLAcivil,
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CITYOF TIGAR D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT M PLM'1999-00167
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 63 DATE ISSUED: 5/25/99
SITE ADDRESS: 11635 SW 114TH PL
PARCEL: 1 S134DC-00900
SUBDIVISION: 114TH PLACE ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF'JVORK: ALT GARBAGE DISPOSALS: MOBILE i!OME SPACES:
TYPE_ OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OrCUPANCY 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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 60'of new wa •:r service.
Owner: FEES-- Typc By Date Amount Receipt
TANNER, NANCY TRUSTEE
10940 SW GAiNDEN PARK PLACE A PRMT DRA 5/25/99 $30.00 99-315641
TIGARD, OR C7223 MISC DRA 5/25/99 $1.50 99-315641
Total $31.50
Phone 1:
Contractor:
CHRISTIAN PLUI0B'NG
r
23172 SW STAFFOr\U RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503-638-8231 Water Service Insp
Reg #: LIC 00042671 Final Inspection
PLM 3470PB
in
y
This permit is isslaed subject to the regulations contained in the T igard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
UJ
This permit will expire if work is no` started within 180 days ,), 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 OAK 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
sued By: Permittee Signature:
` Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Kheck#
13125 SW HALL BLVD. Commercial and Residential Rec' ,By�, Q -)•
TIGARD, OR 97223 Date Reid
(503) 639-4171 Date to P.E.
Print or Type Date to DSA
Incomplete or illegible ;,oplications will not be accepted
Reiated SWR#
Called
Name of Development/Project FIXTURES (Indio ual) QT Y'l l PRICE AMT
Job Sink
Address Street Street Addresslv ;y Suite Lavatory 9.00
h j } 5 �� Tub or Tub/Shower Comb. 9.00
Bldg# Citi/Stale Zip Shower Only 9.30
Name Water Closet 9.00
t kw C, �R Iv rV t 1r- Dishwasher 9.00
Owner Mailing Address Suite Garbtige Disposal 9.00
-5-' /M Washing Machlr,^ 9.00
City/State Zlp Phone
Sy 'A Floor Drain/Floor Sink 2" __ 9.00
Name 9,06
4" 9.00
Occupant Mailing Address Suite Water Heater O onversioi. O like kind 9.00
Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 9.00
Name Urinal 9.00
C .� ,�' C V c'a/►v' Other Fi).lures(Specify) 9.00
Contractor Mailing Address �uile 9.00
9.00
Prior to permit C'"tat Zip Phone Sewer-1 st 100' 30.00
Issuance,a copy (.La_r",•
)f all licenses are Oregon Const.Cont.Board LIc.# Exp.Date Sewer-each additional 100' 25.00
required If / d-4 '70 c. Water Service-151 100' 30.00
expired In COT Plumng Llc.# Exp.Date Water Service-each additional 200' 25,00
database ISI -.7c PI, C 1. �' r- Storm u Rain Drain-1st 100' 30.00
Name Storm 8 Rain Drain-each addit"mal 100' 25.00
Architect _ Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Antl- 25.00
Pollution Deviue
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restr,cted energy permit.)
New 0 Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residuntial Q Commercial O Catch Basin 9.00
Additional description of work: Insp,of Existing Plumbing 40.00
er/hr
Specially Requested Inspections 40.00
per/hr
Rain Drain,single family dwelling 30.00
n Are you capping, moving or replacing any fixtures? _
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by - -
f- QUANTITY TOY!'
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or rlur diagrer is required M Quantity Total Is >9
WORK COULD R-ZULT IN INCREASED SEWER FEES. -*SUBTOTAL r
I hereby scknc•:Ae-,„a it it I have read this application,that the Information 3 Ct
c_ given Is coned,that I ern the owner cr authorized agent of the owner,trnd 6%SURCHARGE
that plans submitted are In compliance with Oregon State Laws. _ S
Signature of Owner/Agent Data e
I,) '"PIAN REVIEW Z5/o OF SUBTOTAL
l, j - nth d{LL'1+" c�`• j'.-�f'
Required only Ifflzture Y total Is>9
TOTAL V-1 PersonNafN Phone
t 1^ ��t •Minimum permit fee Is$25+5%surcharge,eycept 12nsldentlal
Prevention Device,which Is$15+5%surcharge
"'All Now Commercial Buildings require plans with isometric or riser diagram
and plan review
�MMttlpAanapp.tfoo 1/111!
PLEASE COMPLETE:
Fixture Type _ Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink
Lavatory _
Tub or T_ub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2" —
311
Water Heater
Laundry Room Tray -- __
Urinal
�ther Fixtures (Specify) —
COMMENTS REGARDING ABOVE:
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I�dgjs,pAmWp dx 77/98