Permit CITY TIGARD PLUMBING PERMIT
rf�I DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00424
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/1/02
SITE ADDRESS: 12030 SW 135TH AVE PARCEL: 2S104AB 00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: REP 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:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 15 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace approximately 15' of water service.
FEES
Owner:
Description Date Amount
SUNAMOTO, TOMO TR +
SUNAMOTO, ROBERT K TR [PLUMB] Permit Fee 11/1/02 $0.00
12030 SW 135TH AVE [PLUMB] Permit Fee 11/1/02 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 11/1/02 $0.00
[TAX] 8% State Tax 11/1/02 $5.80
Phone 1:
Total $78.30
Contractor:
CLOG PRO PLUMBING
12511 NE FOURTH PLAIN RD
VANCOUVER, OR 98682
REQUIRED INSPECTIONS
Phone 1: 360-260-1368 Water Service Insp
Final Inspection
Reg #: LIC 123318
PLM 37 -470PB
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 -0100.
You may bt ia_n copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issu B �� P ermittee Si na ture: // i
By: a... i�G 47- g /rir ✓tL�%
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Oct ,31 02 11:55a CLOG PRO INC 380 944 7664 p.l
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OCT 'A 1 2002 •
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P1ii�ibi�n PP D / 3/ .99
Building PCrtnit no •
.. C1 of Tigard cpirodate:
a.: r,`� - `7' Tigard, Olt 97223 ��
' - ' Tigard Address: ti` SW Hall Blvd, L�1 � Receipt no.:
City oJTtgard Phone: (30 ) 71
598-1960 8- 1960 Date issued: �j / `--
Fax: (503) 59 &19b� Payment type: ,
Land use approval:
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'TYPE OF PERMIT CJ Tenant improvement
O Multi - faintly
CI C I Food service Q Tenant
r. I e 2 country dwelling or accessory D Addition/alteration/replacement
l`Iew constmcdon FEE SC1IEDULE alit special information use c :t) .
JOB SITE INFORMATION Description (13111=I -row
( 35 '4�� New 1- and 2- campy dwellings only:
Job : iZ07i0 S� Suite no•: ( includcx1aofl ..
Bldg. tux no -: : SFR (1) bath _
Project name:
Tax map/tax lot/account no.: SFR (2) bath
Block: Subdivision: SFR (3) bell' S
Lot: I. Z a� Each additional bathllotchcn
.s •
�c� Cl a S'iteutdlUes:
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Citylcounty: .4,1,.‘ Catch basinlarea drain MI Description and location • f w • k on premises: Dr line/trench drain MI .---
00 I ' so FOOtin: drain (no- lin. ft.) M ME Est. date of co mplction U M BI iien : M MN
anufacture • home util ities
PLUMBING CONTRACTOR O Yi Manholes -
fQ 1 fY1 • i ! Rain drain connector _ _
Business name: • .. �lA In i r _ •
,2l 1� l ZI 2 Sanitary sewer (no. lin. ft.) _ MO
Address: /ZS r t P E r State: WA � � � Storm Sewer (no. Gn. ft.) �
City: V o . .2.4 • Water service o. l n. f .) P — Pho n n o: Z(r D' I ?1� $ U 4 6 l03 p(unrb -.bus. reg- no: :� 7 - `1 g � lr or jlem: � _ CCB . n et I 3 l AI _ / -3/- -151111111111 Abs va►ve
City/metro lie- no.: to - : ack flow . rcventer _
Contractor's rep ve signa ;���Q.��D _ _
resentati 8 Datc: /O 31/ & 7
Print name: (V • DI A : gasinsllavatory WI ('(lh ,4- PERSON / Clothes washer r
(1,4 Dishwasher � , "' Mil
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Address: Drinking fountain(s) _
Addt ss: S tale: E cctors /sump _ ` MS
City: Ex . anion tank NM
F loo F ixture/sewer cap MIN OWNER loor drains/floor sinks/hub Garbage dis• • al N • 16 i Name (Pant1 A 1 �� 1--S " .-4.‘"-- Hose bibb
Mailing address. ' 2 S u SuieO`( ZIP:. a s .
Ph : S - . . Intetce . tor/grease Era! IIIIIII
_
Phone: in - .4 i B I Z( ' The actual installation _
Owner be m a by maintenance and repair ma by my regular Roof drain (commercial) . 11111 will to made by m or the maintenance ao Pai Sink(s), basin(s), lays(s)
employee on the property I own as per ORS Chapter 447- Sump MI Tubs/showcc /shower pan _
Owners signature:. 1:
ENGINEER U[in• _
Water closet . 111111
Name: _
Address: � Other. 1111 MI Total
Phone: Minimum fee • ............... S 7 50
e . edit ee:ds. P 1ea.e col! ju..uGe.lao fa[ mme iatom.odon.
Notico: This permit a pplication plan review (al %a)
Not Lei iv.i; xeevr expires if a permit is not obtained State surcharge (8%) • ••• 5
Chi[ cud number O Visa D M6sutCtud �J � � within 160 days Mier it has been COTAY.....--- •• - •••• $ - -
@cp accepted 85 complete
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