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Permit CITY TIGARD PLUMBING PERMIT ,1:414-41111?' DEVELOPMENT SERVICES PERMIT #: PLM1999 - 00317 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/14/1999 SITE ADDRESS: 14865 SW 74TH AVE * ** PARCEL: 2S112AC-01200 SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2 OCCUPANCY GRP: FLOOR DRAINS; 6 TRAPS: STORIES: WATER HEATERS: 18 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 18 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 200 ft WATER CLOSETS: 18 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing for a new basic building. Sewer permit #SWR1999 -00203 FEES Owner: Type By i Date Amount Receipt KHNS DEVELOPMENT PRMT GEO 10/14/199. $824.00 99- 319075 26262 S MERIDIAN ROAD PLCK' GEO 10/14/199, $206.00 99- 319075 AURORA, OR 97002 5PCT GEO 10/14/199 $65.92 99- 319075 Phone 1: Total $1,095.92 Contractor: CANBY PLUMBING 805 NE 4TH AVE ** CCB EXPIRES 8/2/200 REQUIRED INSPECTIONS CANBY, OR 97013 Courtesy inspection Phone 1: 266 -2091 #: L IC 00033572 Water Service Insp Reg Top -out Insp PLM 3 -7PB Rain Drain Insp RP /Backflow Preventer Final Inspection ORI c3 INAL This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By: Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • CITY OF TIGARD Plumbing Permit Application PlanChec # q-- gc... 13125 SW FALL BLVD. Commercial and Residential Rec'd By ■ TIGARD, OR 97223 Date Rec'd 91 -- 1 `r (503) 639 -4171 Date to P.E./ - A4 -f - a-- Print or Type Date to DST tQfr) fy • it #,��i>t .0 ��- Incomplete or illegible applications will not be accepted Pe Pe rmrm edSWR#1fe 1 �y 0 0 � �� 7 d )A NIK5 Called /O� /s ?- WOKE ‘,1 6', Name of Development/Project FIXTURES, (indtvldual) c ~QTY-" PRICE AMT Job F AV. FS Sink we ll-30 Address Street Address Suite Lavatory ` 2o7,0 /h1C,SS ' - 74 Tub or Tub /Shower Comb. .. 9.00 Bldg # City /State Zip Shower Only ,.6 9.00 Name , a DR) /6 g O U K ZZ3 Water Closet (� !$,� 7 , - fJ H-5 J &20(4'1 & /(/T / Dishwasher 9.00 Owner Mailing Address Suite Garbage Disposal 9.00 ©t / ` Z62(� 2" s /'- Etc: 17! /M' Xi Washing Machine 9.00 ° 6 � ty v t 3 a- a 4 7p ea_ 4-03-67-5(49-'71- Floor Drain /Floor Sink 2" 6 ,.. //6 50 4 Name 3" ,.. 9.00 fii200O Azta.F5 4 Lis "0 4" -'&-- 9.00 Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind / 1 69, 20 er ;I--` 2_6' �/ EX10`192e/ )2, Gas piping requires a separate mechanical permit. f lr City /State Zip Phone Laundry Room Tray 9.00 /502_0424 an 97002-- 7Z3 -67� /F Urinal 9.00 Name - � �/3 V / CJ/�tf! , -/ Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 q AJC 1-/1/4 9.00 Prior to permit. City /State Zip Phone Sewer - 1st 100' 13g.00 3g -"' issuance, a -copy . G ,4 y OK 9,..'70 / 3 v3 - 2_Cc - Loll Sewer - each additional 100' . 3X00 / 3,2_ - cif all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if r 2 .- 5 7y Water Service - 1st 100' A 30.00 expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00 database 3._ 7/l/3 Storm & Rain Drain - 1st 100' . X 30.00 Name Storm & Rain Drain - each additional 100' 25.00 Architect �N6 /J & //LL Mobile Home Space —.0---.- 25.00 Or M al ing Address ill Suite Commercial Back Flow Prevention Device or Anti- 3 00 G - / 4 .- T. /3-- S 5 e - Pollution Device ,2_. `� Engineer City/State Zip Phone -- Residential Backflow Prevention Device* 15.00 /9 - L &-� C VZ 73 sc' - 39 139 ➢ (Irrigation timing devices require a separate Describe work to be done: restricted energy permit.) _ . • New I Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Cohnected to a Fixture 9.00 Residential 0 Cornmercial Catch Basin 9.00 Additional description of work: • Insp. of Existing Plumbing - 40.00 • per /hr -- Specially Requested Inspections 40:00 I per /hr i Rain Drain, single family dwelling 30.00 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 QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9 WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL ` " . C I hereby acknowledge that I have read this application, that the information - o ay given is correct, that I am the owner or authorized agent of the owner, and /o SURCHARGE 6 that plans submitted are in compliance with Oregon State Laws. Signature of Owner /Agent 7e * *PLAN REVIEW 25% OF SUBTOTAL ,,/ f 9 � y S , �7 Required only if fixture qty. tota is > 9 . . ,/ ti / > TOTAL lU��- 4 _ Cor erson Name L c Phone 6 6 S-l�S :i 5- J �6,3-ZL6 -2U 5I *Minimum permit fee is urcharge, except Residential Backflow Prevention Device, which is $ 0+ p/o surcharge * *AII New Commercial Buildings require plans with isometric or riser diagram and plan review I:1dsts \forms\plumapp.doc 10/29/98 PLEASE COMPLETE: • Fixture Type : Quantety; by Work .Perform,ect , New Moved Replaced Removed /Capped Sink Lavatory j CC Tub or Tub /Shower Combination r4-- Shower Only , Water Closet ( ? Dishwasher --�- Garbage Disposal Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I:\dsts \forms \plumapp.doc 10/29/98 --pLrn199iq - 0031-7 1 t'f r" _ i o , N 2i 0 Al -IP U <p ► WA. ‹... r� 2, r T/PI c L B Y i?oo/11