Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES. PE
DEVELOPMENT PLM1999 -00098
a's ' r� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/8/99
SITE ADDRESS: 11390 SW 92ND AVE PARCEL: 1S135DB-03900
SUBDIVISION: DOGWOOD RIDGE ZONING: R - 4.5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: OTR 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: Move and convert water heater.
FEES
Owner:
Type By Date Amount Receipt
JOHNSON, CHARLIE APPL DST 4/8/99 $25.00 99- 314361
11390 SW 92ND MISC DST 4/8/99 $1.25 99- 314361
TIGARD, OR 97223
Total $26.25
Phone 1:
Contractor:
I
PoLTL t-o & R- 17 0 -0-c? REQUIRED INSPECTIONS
_�� / Top -out Insp
µ �
Phone 1: 0- Misc. Inspection
Reg #: 1 OCfq -S-- Final 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 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.
Iss ed By: X_ ) 0,60 _ ' .. Permittee Signature:
P.M. for an inspection n ded the next business d y
Call (503) 639 -4175 by 7:00 needed y
CITY OF BARD Plumbing Permit Application Plan r -
13125 SW HALL BLVD. Commercial and Residential Rec'd
TIGARD, OR 97223 Date Rec'd y -'/`'
(503) 639 -4171 Date to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit # L -iIVr 9- 619e9
Related SWR #
Called
ame of Development/ o ect ;� ; <„ : <,; ;: tx.. x.> ,:,> , ° ,
P ` FIXTURES`ti'ndividual) Qi' RICE
� �
Job � tQ A_Ar' k Sink 9.00
Address Street Ad ess Suite Lavatory 9.00
/ 1 3 /0 . tY / 2 Tub or Tub /Shower Comb. 9.00
Bldg # City /State �!1 Zip.. Only 9.00
a e /�� Water Closet 9.00
c r \ .1_ Q Dishwasher 9.00
Owner Mg "' res Suite Garbage Disposal 9.00
Washing Machine 9.00
City /State Zip Phone Floor Drain/Floor Sink 2" 9.00
Name 3" 9.00
4" 9.00
Occupant Mailing Address Suite Water Heater .Conversion 0 like kind ) 9.00 v�
Gas piping requires a separate mechanical permit. I " -
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name
4-1- . o2 . 6- Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 9.00
[T3?1/ /1/P 6<,eNIyL , - 9.00
Prior to permit Ci State Phone Sewer -1st 100' " 30.00
issuance, a copy /��� fir' 417 ? 227 I%p y / Z,
Sewer - each additional 100' 25.00
of all licenses are Or goncp nst. Cont. Board Lic.# Exp. ate
required if I / y I od Water Service - 1st 100' 30.00
expired in COT Plumbin Lic. # Water Service - each additional 200' 25.00
database 7.4 ._ 6 as P * I g 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
Pollution Device
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 0 Repair Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential _' Commercial 0 Catch Basin 9.00
Additional description of work:
I / J� 649-5j Insp. of Existing Plumbing 40.00
/44 d V &. W` � ��'.0 TO per /hr
Specially Requested Inspections 40.00
per/hr
Are you capping, mov g or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL ';
,� "_" ~ f =-
fixture. FAILURE TO ACCURATELY REPORT FIXTURE a' ° :. 's
Isometric or riser diagram is required if Quantity Total is > 9 £ ',,
WORK COULD RESULT IN INCREASED SEWER FEES. Y- s ; c O
I hereby , �L
acknowledge that I have read this application, that the information >'%-> ' < ; O�
Y 9 PP ..f�.� emu_
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE - 4 1 ";11
that plans submitted are in compliance with Oregon State Laws. -.' / ` �
Signature of ner/Agent Date j n ** PLAN REVIEW 25% OF SUBTOTAL -. h ° :4 w :_
/� / '/ v l / /9�) / Required only if fixture qty. total is > 9 ! j ;,. > A
1 !/ TOTAL .: -
Contact Person Name Phone 2 : ' ` : �t�'
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:kiststplumapp.doc 7/2/98
„I.,
PLEASE COMPLETE:
..... ...........................................................................................................................................................................
........... Moved Replaced . • .-.
."..: • • •••••• •••••. .
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)
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COMMENTS REGARDING ABOVE:
/440/i6 IA rc) Cakii/C405YoA/
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I:Idsts \plumapp.doc 717/98