Permit _A
CITY OF TIGARD PLUMBING PERMIT
FIA DEVELOPMENT SERVICES PERMIT #: PLM2000 -00102
i! 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 03/30/2000
SITE ADDRESS: 09245 SW 69TH AVE PARCEL: 1S125DA -07700
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT: 076 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water heater with Tike kind.
FEES
Owner:
Type By Date Amount Receipt
TOMASOVIC, ROBERT S AND PRMT KJP 03/30/200C $50.00 0001077
DENISE B 5PCT KJP 03/30/200C $4.00 0001077
9245 SW 69TH AVE
TIGARD, OR 97223 Total $54.00
Phone 1:
Contractor:
FIRESIDE DISTRIBUTERS
18389 SW BOONES FERRY RD
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone 1: 684 -8535 Rough -in Insp
Reg #: LIC 40979 Final Inspection
PLM 128WH1
ELE 1146RET
ORIGIN
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 copie f these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
--" 4 ,13 / 2 1/00 TUE 12:26 FAX 503 598 1960 CITY OF TIGARD Z002
:ITV OF•TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL. BLVD. RECEIVED Commercial and Residential Recd By
fl(3ARD, OR 97223 Date Recd
503) 639 -4171 MAR 2 3 2000 Date to P.E.
Print or Type Dale to Ds
Permit* L a1 ar- - 00 to Z-
cgrAgrareeptittortiatitileglible applications witl not be accepted Related SWRft
Called
Name of Development/Project _E • RES-; .- tM001) s t;: 'i,; w`- sPo-' `'`7QTJ�z ` ='P. .E °A�IA�T';:
F.. - , _. _�., :; ..� :>.
Job Sink 11.50
r eet Address L Suite Lavatory 11.50
Address a4c SW ( F tk 1 11.50
Bldg # J City/State /State ((�� , 1i a v � Zip ( � Shower Only 11.50
I I b�xCY " • - 1 7-13 Water Closet 11.50
me L
V S e, 1 aSCO % C." Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
City/State a � G4 ) Zip Garbage Disposal 11
Phone
2q 3 -62`1- l I Laundry Tray 11.50
Name - Washing Machine/Laundry Tray 11.50
Floor Draln/Floor Sink 2' 11.50
Occupant Mailing Address Suite 3" 1 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion O like kind 11.50 1 I , SC
Gas piping requires a separate mechanical permit. 1
Narne 11 _ - � O• . MFG Horne New Water Service 32.00
Contractor Mailing Addrr esss s 1 S
� t Old "f MFG Home New San/Storm Sewer 32.00
uite
I 1, .389 A C; Hose Bibs 11.50
Prior to permit ity /State Zip one Roof Drains 11.50
Issuance, a copy 1 q"121� B - i5SZS Drinking Fountain 11.60
of all licenses are Oregon Cont. Cont. Board Lie.* '1 Exp Date 15.00
required if 09 - 7 9 It I i l Other Fixtures (Specify)
expired database Pw 1
12 � tic. It w 1• -1:1`- Exp.
4 it 100 N -
Name
Architect Sewer -1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00 -
Engineer City /State Zip PhO1@ Water Senile° - each additional 200' 32.00
Describe work to be done: Storm & Ran Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes • No 0 Storm & Rain Drain - each additional 100' 32.00
Residential * Commercial 0 Commercial Back Flow Prevention Device 32.00
' Additional description of work:
Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes If No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL ?'�'-.- -'' `' ;
hereby I had thls application, that the information 1 - "`
Y acknowledge that re
Isometric or riser diagram is required If Quantity Total Is > 9 _ 'T'T,.. , ; :; r' -
given is co , • at 1 am the ow • r or authorized agent of the owner, and . .. : :.;;w , 1 ; z : 0
that •tans tiled are in com ;lance with Ore on State Laws. . *SUBTOTAL _ . - .111 C"
, • e Ag: -4 Z ,� - 8% SURCHARGE 4 1 1/4.)....i Signature
...erir! y
Contact • :` o Name ' , n • ` : "PLAN REVIEW 25% OF SUBTOTAL + 4‘-'°-"3"44::, f
•t- E F �,. .�, r -. Required only r fixture qty. total Is 2.9 9 , 1
. Yk 1rl"5 ,�i;, '?- ; 5 _.. �+'. ` IT-, 1=. i yT r TOTAL 4•a h . P sq
' b ' � f "t '4: 't ' , i f F ° ' t r ... i j ,f ., s JJ • 'Minimum permit fee Is $50 * 8% surcharge, except Residential Bacidlow Prevention
'� " 'L t 'r -' . r' ci = v, I � i:: ` Ztri' ' t '-" 7 ,l : , fi r ; ;,t. g .. _fix DeVlce, watch is $25 .8% surcharge
"A9 Kew Commercial &:fldtng9 require plans with Isometric or tsar diagram and
plan review.
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�.a 4j,3; 21/00 TUE 12:28 FAX 503 598 1960 CITY OF TIGaRD I�003
PLEASE COMPLETE:
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,`.:� ���jw,Krsi,•y=t,,,4�: $n,- r..��r. ^; t• :tt:�•.�; .T'w _.:;:53!t1L '�� r{. 4ik �' �:. � - , : t . • ., � a "�� � � -
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Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
•
Dishwasher
Garbage Disposal •
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2
3"
4 "
Water Heater 1
Other Fixtures (Specify)
•
• I
COMMENTS REGARDING ABOVE:
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