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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
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CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM1999-002.39
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 f ISUED: 8/2/99
SITE ADDRESS: 14960 SW 116TH PL 1
�`A 9ARCEL: 2S110BD-03400
SUBDIVISION: HELM HEIGHTS ZONING: R-4.5
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS. TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GR!:A?SE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WAFER LINE: ft
DISHWASHERS: RAIN DRAIN: it
Remarks: Installation of residential backflow prevention device.
Owner: FEES
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PURCELL, DWIGHT VIII Type By Date Amount Receipt
-
15450 SW 116TH PRMT DEB 8/2/99 $25.00 99-317336
TIGARD, OR 97224 5PCT DEB 8/2/99 _ $1.15 99-317336
Total $2.6.75
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: RP/Backflow Preventer
Reg#: Finan Inspection
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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 arproved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
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than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Tose 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.
11sued By: �ryx ./ 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 Plane7c
13125 SWHALL BLVD. Commercial and Residential Rec'd
TIGARD, OR 97223 Date Recd -
(503) 639-4171 Date to r E.
Print or Type Date to U T
Incompleie or ill�gibie applications will not be accepted Permit# �
Related SWR#
Called.! _
Name of Develo me Zroject -FIXTURES (inuividual) CITY PRICE AMT
Job Sink 11.50
Address Street)Ad a Suite Lavatory i - 11.50
Tub or Tub/Shower Comb. 11.50
Bldg OF City/State Zip Shower')nly 11.50
(z( �i -
Name ( Water Closet/Urinal (Specify) 11.50
A.t9 A-6cJt, Dishwasher 1150
Owner Mailing AddressSuite Garbage Disposal 11.50
Washing Machine/Laundry Tray (Specify) 11.50
City/Statei zip Phone
Floor Drain/Floor Slnk 2" 11.50
Name 3" 11.50
_ 4" 11.50
Occupant Mailing Address Suite Water Heater O conversion O like kind 11.50
_ Gas piping requires a separate mechanicei p_e,mit.
City/State Zip Phone MFG Home New Water Service 28.00
MFG Hcme New San/Storm Sewer 28.00
Nam , E� Hose Bibs 11.50
Contractor Mailing Address Suite Rain Drains 11.50
_ Drinking Fountain 11,50
Prior to permit City/SlAte Zip Phone Other Fixtures(Specify) 15.00
Issuance,a copy
of all licenses are Oregon Const.Cont.Board Llc.# E.x!. Date
required If
expired In COT Plumbing Lia# Exp.Date
catabase
Name Sewer-1 at 100' 39.00
ArchlteCt
__ Sewer-each additional 100' 32.00
or Mailing Address 7Ts,a Water Service-1 at 100' 38.00
En lrleer City/State Zip Phone Water Service-each additional 200' 32.00
9 Storm&Rain Drain-1st 100' 38.00
Describe work to be done: Storm&Rain Drain-each L- fitional 100' 32.00
New O Repair O Replace with like kind: Yes O No O Commercial Back Flow Prevention Device 3200.
Residential O Commercial O Residential Backflow Prevention Device" 19.00
Additional descripilorof work:
V�,, � � 500Catch Basin 0
Insp.of Existing Plumbing 50.00
Are you capping,moving or replacing any fixtures? per/hr
Yes O No O Specially Requested Inspections 50.00
If yes, see back of forrr, to indicate work performed by per/hr
fixture. FAILURE r0 CCURATEI-1' REPORT FIXTURE Rain Drain,single family dwelling 4500
- WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
s
I hereby acknowledge that I have read this application,that the Information QUANTITY TOTAL r
given is correct,that i am the owner or authorized n ent of the owner,and
I-- 9 9 Isometric or riser diagram Is required N Quantity Total is >9 �l
J that plans submitted ar In com (lance with Oregon State L ws. 'SUBTOTAL
W or/Agents rDu.� 7%SURCHARGE
c6plaict Person #roeorl<
W ..PLAN REVIEW 25%OF SUBTOTAL -
1 BATH HOUSE$178.00 Required only it fixture gly total is>9 _
2 BATH HOUSE$250.00 TOTAL
3 BATH HOUSE$285.00
(This fee'ncludes all plumbing fixtures In the dwelling and the first *Minimum pemrlt tee Is$50.7%surchmge,except Residential Backflow Prevention
100 feet of sanitary sewer stone sewer and water service) Device,which Is S.5♦7%surcharge
All New commercial Buildings require plans with Isome.rtc or riser diagram and
plat i review
I idslslrormsiptumapp doc 7/19!99
PLEASE COMPLETE:
Fixture Type~ Quantity by Work Performed
New Moved
Sink Replaced Removed/Gapped
Lavatory �— ------ - ---- - — -- —
Tub or Tub/Shower Combination - --��--i
Shower Only
Water Closet
Dishwasher --
Garbage Disposal _
Washing Machine
Floor Drain/Floor Sink 2"
Water Heater
Laundry Room Tray —
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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11dsleVorm.Iplum®pp doc 7119/99