Permit - CITY OF TIGARD PLUMBING PERMIT
A-lti� r DEVELOPMENT SERVICES PERMIT #: PLM2000 -00140
.+L -fl 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/03/2000
SITE ADDRESS: 14000 SW 120TH PL PARCEL: 2S1106B -06700
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 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: Install residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
FOUR D CONSTRUCTION PRMT KJP 05/03/200C $25.00 0001877
PO BOX 1577 5PCT KJP 05/03/200C $2.00 0001877
BEAVERTON, OR 97075
Total $27.00
Phone 1:
Contractor:
POSITIVE PLUMBING
618 MEADOWVIEW RD
FOREST GROVE, OR 97116 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone 1:
Reg #: LIC 00078209 Final Inspection
PLM 34 -234pb
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 co ' of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: s
Permittee Signature. _
�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
3ITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 V/`�J � Date to P.E.
Print or Type Date to D
Permit# �'�v0�
Incomplete or illegible applications will not be accepted Related SWR#
Called
• Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Trer t ddrep ) Pi
Suite Lavatory 11.50
U� lv I ` Tub or Tub /Shower Comb. 11.50
Bldg # Ci� I �� tatg J Zip Shower Only 11.50
// Water Closet 11.50
blame 1` /� p � \ ',,ecar 'Av Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Washing Machine /Laundry Tray 11.50
Name
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
/1 ��� � p, ' MEG Home New Water Service 32.00
isryrie . 151 ft I tit f J � � ► �"" ��
Contractor Mailing A Tess MFG Home New San/Storm Sewer 32.00
A . Suite `, 11.50
61y ii j Oc V ? V k-g 35 q -5T75 Hose Bibs
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy Fv v( 4 J /� vatie j9.4 // J / /•' S /d() Drinking Fountain 11.50
of all licenses are Oregon • t. Cont. Bo.rd Lic.# Exp. Da e Other Fixtures (Specify) 15.00
required if � �r, ' 8 • ari
expired in COT Plumbing L'c. Exp. ll
database 34-2 17 13 tt
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 Phone
Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New It( 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Resi en ial re. Commercial 0 Commercial Back Flow Prevention Device . 32.00
Additional description of work:
Residential Backflow Prevention Device* t 19.00
Catch Basin 11.50
Are you capping, moving or replaping any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No i 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
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Date 8% SURCHARGE ,
Contact e. me Phon
r L _ S 7 P ✓ * *PLAN REVIEW 25% OF SUBTOTAL CK
j I 4 r J I Required only if fixture qty. total is > 9
THlHOUSE$ ` 00� 2 A* ' > : TOTAL ,---- ', A OUSE f250 00 ' * V
.� r n OUSE X285 00 � r - . z s
r m
.1; 1 •' ' ncT ude8 ail, u mbing �l ures 1;16, dwelling 8ni the first i 'Minimum permit fee is $50 + 8 °h surcharge, except Residential Backflow Prevention
5akr�e .tea e ._ �,:P +.orz° s v7 '° o
. 0Q . • San yBe tAhrkl# d,11 4.4,6 11ICe). ;_ �2 ` Device, wh is $25 + 8 % surcharge
"'All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I.ldsts\toms\plumaPP . doc 11/18/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
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
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I: %dstsVorms\ptumapp doc 11/18/99
07/12/2000 Activities for Case #: PLM2000 -00140
12:33:01 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 05/03/2000 KJP RECD No Hold KJP 05/03/2000
PLMA005 Create Permit 05/03/2000 KJP DONE No Hold KJP 05/03/2000
PLMA750 RP /Backflow Preventer No Hold KJP 05/03/2000
PLMA799 Final Inspection 06/09/2000 MRS PASS No Hold AKJ 06/11/2000
PLMA050 (F) Issue permit 05/03/2000 KJP DONE No Hold KJP 05/03/2000
PLMA800 Case Finaled 06/11/2000 AKJ DONE No Hold AKJ 06/11/2000
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