Permit A, CITY OF TIGARD
PLUMBING PERMIT
s .� � � DEVELOPMENT SERVI PERMIT #a n n a o o nPLM9B —O0G1
DATE ISSUED: 03/06/98
PARCEL: 25 O3CC -00600
SITE ADDRESS...: 13760 SW 121ST AVE
SUBDIVISION....: COLONIAL VIEW ZONING: R -4. 5 �. _
BLOCK..........: LOT.......e.....:001 JURISDICTION:!URB
CLASS OF WORK.. :ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE.... :SF WASHING MACH--; 0 BACRFLOW PREVNTRS. o: 0
OCCUPANCY GRP..: R3 FLOOR DRAINS......: 0 TRAPS„ o o o e, ...... w o o 0
STORIES........: 0 WATER HEATERS.....: 0 CATCH BASINS.. ... o o 0
FIXTURES -- - °-- -- - - -_ -- LAUNDRY TRAYS... e e s 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) e .. s 100
DISHWASHERS.... 0 RAIN DRAIN (ft),.. 0
Remarks: Install new water service for an existing single family dwelling.
Owner: ----- ___. FEES
DONALD D ERDT type amount by date recut
13760 SW 121ST PRMT $ 30.00 GEO 03/06/98 98- 303914
TIGARD OR 97223 SPCT $ 1.50 GEO 03/06/98 98-303914
Phone #: 590 -3950
Contractor---- - - - - --
CHRISTIAN PLUMBING
23172 SW STAFFORD RD.
TUALATIN OR 97062 _.____...._________.._._ _. -
Phone d#: 503 -638- 8231 $ 31.50 TOTAL
Reg #..: s 000426
------- RE&U I RED INSPECTIONS
This perait is issued subject to the regulations contained in the Water Line Insp
Tigard municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws.. All work will be done in accordance with Final. Inspection .
approved plans. This perFit will expire if work is not started _ ________ ___________
within 180 days of issuance, or if work is suspended for pore
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are .__M_._.___ ____._.__
set forth in OAR 952- 0001 -0010 through OAR 952 -0001 -0080. You nay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued B e,`/ Permittee Si natures /
4.+- 1-4 -++ ++ + ++ + ++ + + + +++ + + ++- 1- + + + + + ++ {-+ + + + + + ++ ++ +++ +++ + ++ + + +-1-++ + ++^i ++ ++ + ++ +4.4.4• t 4 -1-++
Call 639- -4175 by 7goe p.m. for an inspection needed the next business day
+- r- +--+-a- +4-4-4.4 -+ ++ , + + + +- ++++++++++++ + + + + + + + ++ + + + + + + + + + + + + + + + + + ++ ++ + + + + + + ++ + + + + + + ++
CITY OF TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Ci /,•
,,5 Date to P.E.
Date to DST
(503) 639 -4171 c c C 0 ti/,9 L v/ Permit #f C /J'l ! g' -Qd(�/
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project On back indicate Work Performed by fixture.
Job FIXTURES` (Indlviduai)' -2 e : _,; . ,L:y t,°. :, QTY ; PRICE; AMT.,
Address Street Address Suite Sink 9.00
1376 5 1 ;/ 5 7 _ Lavatory
9.00
Bldg # City/State Zip
co et Q A 9 7 as 3 Tub or Tub /Shower Comb. 9.00
Name v Shower Only 9.00
T-)p yv 0 yr - 1 -- Water Closet 9.00
Owner Mailing Address Suite Dishwasher
/ 3 7(O 5 CA) j a.1 s7 9.00
Garbage Disposal 9.00
City/State Zip Phone
--1,5" u� (TR 97...1-.1-3 ,� 9'0 - 395 O Washing Machine 9.00
Name Floor Drain 2" 9.00
3" 9.00
Occupant Mailing Address Suite 4" 9.00
City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
Name n Urinal 9.00
CC L g41 p V ( °' 7 I V t3 R w r ci Other Fixtures (Specify) 9.00
Contractor Mailing Address J Suite 9.00
23 / s1 c'
Prior to permit City/State Zip Phone 9.00
issuance, a copy �0cxlcr4tv. o R ' 970 u2 771 . 9.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date 9.00
required if i i a. ( 7 / 6/2----/
`/r," Sewer - 1st 100" 30.00
expired in COT Plumbing Lic. # Exp. Date Sewer - each additional 100' 25.00
database 3 y- 70 ) D 8 ( / / 2'F
Name l 30 ` Water Service - 1st 100' -i 30.00 3D Op_
Architect Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration 7( Repair 0 Pollution Device
to be done: Residential`O Non- residential 0 Residential Backflow Prevention Device* 15.00
Additional description of work: [ Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
y� Insp. of Existing Plumbing 40.00
P�L"i /V eW caxa A_ SeN'c/l c `<- per/hr
Existing use of Specially Requested Inspections 40.00
•
building or property _ per /hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps • 9.00
i building or property
QUANTITY TOTAL
I I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9 • 3 0 --
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 • .
5% SURCHARGE
I ./jet e C 3 5 Y.r
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
/�
n /y k Required only if fixture qty. total is > 9
/ /Vln_._S,�_l`' 7 71 9 `f Y ? TOTAL � � ‘,7D
' Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
I :ldstslplmapp.doc 5/97
PLEASE COMPLETE:
• fixture guantity':bil/yotk Od,
New ,„ :,,, M oved Replaced Removed/Capped
. , .
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3 „
4 "
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
COMMENTS REGARDING ABOVE:
I: \dsts1p1mapp doc 5/97
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 3-9 - (7 A.M. P.M. MST:
Location: 1 5(A) ID- ( At BUP:
•
Tenant: Suite: Bldg: MEC:
Contractor: �-� r i a.,., CAA ,Gry\_ p l Phone: 7 7 / -1(/ ( 7 ! PLM:� '7F_
Owner: a
�'� / 4 4.' / Phone: 5 [ 0 -3.75 ELC:
/I
_ SIT:
BUILDING BLDG (con't) MECHANICAL ELECTRICAL SITE •
Site Post/Beam 'os :eam Post/Beam, Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling ater L_m €', V
Slab Framing Top Out Gas Line Rough - • UG Sp er
Foundation Insulation Sewer Hood/Duct - : •nnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain e ' UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved • • f • 1.1 Approved Approved pprov
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved i- A pproved
FINAL FINAL FINAL FINAL FINAL
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O Call for reinspection y f 7
` Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: Y Date: 3/4 As Page of
•