Permit CITY OF TIGARD
PLUMBING PERMIT
ti DEVELOPMENT SERVICES PERMIT # PLM99-01Z163
_ '��� 1 3125 SW HallBIvd .,Tigard,OR97223(503)639 -4171 DATE ISSUED: 03/05/99
PARCEL: 2911EDC -01400
SITE ADDRESS...: 15875 SW 74TH AVE #A * **
SUBDIVISION : CREEKSIDE INDUSTRIAL PARK ZONING: I —P
BLOCK LOT °004 JURISDICTION: TIG
CLASS OF WORK•.:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE :COM WASHING MACH 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:B 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: Backflow prevention device
Owner: FEES
PACIFIC AMERICAN PROP EXCHANGE type amount by date recpt
17700 SW UPPER BOONES FERRY RD PRMT $ `5.00 B 03/05/99 99- 313461
PORTLAND OR 97224 5PCT $ 1.25 B 03/05/99 99- 313461
Phone #:
Contractor
C EAGLE PLUMBING ENTERPRISES INC
13801 S FORSYTHE RD
OREGON CITY OR 97045 -1219
Phone #: 760 -5565 $ 26.25 TOTAL
Reg #..: 000479
REQU IRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backflow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 tore
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 way
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued B: /�J` �' `�� Perm i t t e e Si gnat ur e L—�
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + +•+
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Chec # IJ
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Rec'd -S
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # PLM 0
Related SWR #
Called
Name of Development/Project FIX =T,l1RES (i dividual) '� a ^ QTY Am 1.)q , AMT
- is -ro�x,
Job CJ/.�.) I �� Sink 9.00
Address reet Address 7,,,s, Suit Lavatory 9.00
3 Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip A Shower Only 9.00
Na cc X
Az (FL Fe_ Water Closet 9.00
P k( Arr`utic'Jn r0p L / CLY Dishwasher 9.00
Owner Mailing Address / 1 Garbage Disposal 9.00
17100 ' W O g i c e "' , "''" y Washing Machine 9.00
City /State °` Zip Phone
P DX _ ! q�i v o Floor Drain/Floor Sink 2" 9.00
1 3" 9.00
Name /
4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State r Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name Other Fixtures (Specify) 9.00
Vic-, ( 4 --&-,
Contractor Mailing Address Suite 9.00
133c Yi ' 9.00
Prior to permit City /State � Zip S7byj P one Sewer - 1st 100' 30.00
issuance, a copy �2_t' C ill c• 4 bZo -I 3 Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date a l l
required if `i 7S I Water S ervice - 1 st 100' 30.00 9
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database 1 •..- Lill- f S -^- cl Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Z
Pollution Device 1
Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New Cc Repair 0 Replace with like kind: Yes 0 No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0., Catch Basin 9.00
Additional description of work:
Insp. of Existing Plumbing 40.00
per /hr
Specially Requested Inspections 40.00
per/hr
5 ?) L�•d'L e.t�
I ,�c-. --`
)
Rain Drain, single family dwelling 30.00 0.00
Are you capping, moving or replacing any fixtures?
Yes 0 No 0 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 h
WORK COULD RESULT IN INCREASED SEWER.FEES. *SUBTOTAL ._ , 4'''' -t
I hereby acknowledge that I have read this application, that the information ; r4 7 5
given is correct, that 1 am the owner or authorized agent of the owner, and 5% SURCHARGE ,
that plans submitted are in compliance with Oregon State Laws. &C i x � N , 1 3 ,
Signature of Owner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL Ifw 7�
Required only if fixture qty total is > 9 _ t.,
. - 59 TOTAL i f-
Contact Person Name Phone ,, g -:�
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
* *AII New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:kJstslplumapp.doc 7/2/98
PLEASE COMPLETE:
Ffixture T : e
New Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
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:
•
1:1dstslplumapp.doc 7/7/98