Permit C ITY OF TIGARD PLUMBING PERMIT
l jk DEVELOPMENT SERVICES PERMIT #: PLM1999 -00413
'- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12385 SW 106TH DR PARCEL: 2S103AA -01909
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 012 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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing permit for reversal of plumbing. Excavator will apply for separate permit for installing the sanitary
sewer line.
FEES
Owner:
Type By Date Amount Receipt
JAMES FLATTERS PRMT BON 12/08/199E. $50.00 99- 320255
12385 SW 106TH DR 5PCT BON 12/08/199E $4.00 99- 320255
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
LARRY CAMERON PLUMBING
1812 SE 158TH AVE
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone 1: 503 - 256 -2705 PLM /Underfloor
Reg Final Inspection
eg #: LIC 49792
PLM 26 -366PB
ORIGINAL
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: (I). ,A..OEL:V" - Permittee Signatu / _,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next dI ess day
CITY OF TIGARD Plumbing Permit Application Plan Che •
13125 SW HALL BLVD. Commercial and Residential Rec'd By .,6 \i
TIGARD, OR 97223 Date Recd i c 1
(503) 6394171 Date to P.E.
,�
Print or Type Date to DS Permit # 1 t.4fl & '(E i
Incomplete or illegible applications will not be accepted Related SWR#
Called
Name of Development/Project j FIXTURES (individual) QTY I PRICE AMT
Job -a-' 5 /Q H T� D. Sink 11.50
Address Street Address Suite Lavatory 11.50
Tub or Tub /Shower Comb, 11.50
Bldg # City /State Zip Shower Only 11.50
Name Water Closet/Urinal (Specify) 11.50
/�-1y /Lj ' G Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
/ZS 5 Sal /L� /2A Garbage Disposal 11.50
City /State Zip _ `
/6 7 Laundry Tray 11.50
F/z 7 l
Name Washing Machine /Laundry Tray (Specify) 11.50
Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /Sta Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
2 /07.e y G7 - - >2t / /9_,e6. MFG Home New Water Service 28.00
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 28.00
/ L , JS P T ,/ ,! Hose Bibs 11.50
Prior to permit !� State Zip Phone3- 25 - 22 :Roof Drains 11.50
issuance, a copy i trixnpl a t , 1? 6 47 • Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 5'17 9 2- Of - j,, _ d y Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date I I 4A/20/ y veM
database c /52 1 -J v- d, 6J
Name 2- 4 - (ric1 Id -- "'
Architect Sewer - 1st 100' 38.00
or Mailing Address / Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City/St - Zip Phone Water Service each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential Commercial 0
Additional escription of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
7 '7 /,cJd ,e4/C?!.) 09L Catch Basin 11.50
Are you capping, moving or replacing any fixtures? - Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 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.
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that pl n submitted are in compliance with Oregon State Laws. *SUBTOTAL
Sign e of Owner /A•� Date
g � _ 4 7 5y 8% SURCHARGE
ontact Pers N .c e Phone
/-r ' .14516r2-41-A.-.1 - , 6" * *PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE'$178.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL ELI G/0
3 BATH HOUSE $285.00
(This fee includes all plumbing fixtures in the dwelling and the first 'Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
"'All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
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PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced RemovedlCapped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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