Permit l CITYOFTIGARD
t i, DEVELOPMENT SERVICES PLUMBING PERMIT
„ :., . 13125 SW Hall BIvd., Tigard, OR97223 (503)639.4171 DATE 08/28/97 -0357
PARCEL: 2S103BD —HG032
SITE ADDRESS...: 12621 SW 115TH AVE
SUBDIVISION • HUNTER'S GLEN ZONING: R -4.5 PD
BLOCK . LOT •032 JURISDICTION: TIG
CLASS OF WORK..:ADD 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: Installation of residential backflow prevention device.
Owner: FEES
LEGEND HOMES type amount by date recpt
6900 SW HAINES ST 5PCT $ 0.75 DRA 08/27/97 97- 298724
TIGARD OR 97223 PRMT $ 15.00 DRA 08/27/97 97 -298724
Phone #:
Contractor
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS OR 97113
Phone #: 647 -5567 $ 15.75 TOTAL
Reg #..: 000057
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Rack f l ow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other F i na 1 Inspect
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 952-1 -0080. You may
obtain copies of these' rules or direct questions to OUNC by calling
(503)246 -1987.
Issued Permittee Signature: er.. -1J .AOQ
y " 1 �- 1 "
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++±++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
:ITY OF TIGARD Plumbing Application Rac'd By ' ' ` •
3125 SW MALL BLVD. Commercial and Residential hate Recd q" 7
`iGAR OR 97223 • oats to P.E.
503) 6394171 • fr„6 x . 7 L ( j^ Sc•,.,-td2e. hate to
Permit • 4
Print or Type Related SWR $
Incomplete or illegible applications will not be accepted Caned
ti c , ,,t 4"e ,<S 6 k �y� -^ U ft..,��, . -
Name of Development/Project • ♦ .174 • - ' .. f k salt -- • _`-.� •
s.00 ; �
Job
Address 7� /
Lavatory 9.00
Tub or Tub/Shower Comb. 9.00
BIdg 4 Ci State n Zip Shower Only 9.00
tx)4-� Z TV c, r.AV `j 7 Z Z - s Water Closet 9.00
Name t, J , /
r -P trier e � 9.00
Owner Suite -- Garbage Disposal 9.00
Washing Machine 9.00
n P / Floor Drain r
/Blithe 2i Phone .. l 1 *-C G t7 20 CJU (50 9.00
_ 4' 9.00. .
Occupant Address Suite Water Heater 9.00
- Laundry Room Tray . - -• 9.00
. CltylState Zip Phone Urinal • 9.00
Nam r Other Endures (Speak) 9.00
v1� ✓7 l.■% (n , f ,� 9.00
Contractor Address ' o Suite . _ .. - .. • .-_. _... 9.00
O :2,07 - 9.00
(Prior to issuance % Zip y (3" Phone / - •
applicant must a v Lk 0 i�,J titS l�' tr . Y. 7S 7 9.00
provide an Oregon Const. Cont. Board Lic.s Exp. ate - 9.00 • contractors 7
karate Plumbing / � � � �l � / � -. _
bing Lic. a . Date. Sewer- 1st 100' 30.00
Information d
for COT COTS Tax or Metro * Date • Sewer each adddionallar 25.00
database). Water Service -1st 1ar 30.00
Name Water Service - each additional 200' 25.00
Architect • Storm & Rain Drain - 1st tar - 30.00
or Mailing Address Suite storm &Rain omen -each additional tar 25.00
Mobile Horne Space 25.00
Engineer City /State Zip Phone C oev Flow Prevention Device or And- - 25.00 - .
. °suite word New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' / 15.00 i t, -- .C• 42
•:
be done: Residential 0 Non - residential 0 My Trap or Waste Not Connected to a Fixture 9.00
•dciteonal desaiption of work
Catch Basin 9.00
Insp. of Existing Plumbing - • -- 40.00
per/hr
fisting use of Specialty Requested Inspections 40.00
pedtir
• !ding or properly Rain Drain. single family dwelling • 30.00
aposed use of Grease Traps 9.00
:doing or property
QUANTITY TOTAL - 5...:�: - --- , , ,.,
, re you rapping . moving or a fixtures? Ye s No Isometric or riser Diag is requred it ' + • _ ;.
n'P�an9 any Quality Taal is 2. 9 :i: -. sue,
ill yes see back of form) - - • - - - . - - 'SUBTOTAL ' ._ P" :: - -. = - _ -' /S
. co
: 1:�: '',
hereby acknowledge that I have read this application. that the information - • -
riven is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE •_ ,17 , : r 7 C
flat otans submitted are in compliance with Oregon State Laws.
gtiature of Owns - D PLAN REVIEW 25% OF SUBTOTAL
_ e
Required only it fixture cry. total is > 9
TOTAL _ /5-.75
arnact Person Name Phone
'Minimum permit fee is 525 + 5% surcharge. except Residential Backflow
. Prevention Device. which is 515 + 5% surcharge
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•
'LEASE 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)
;OMMENTS REGARDING ABOVE:
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