Permit OF ` r PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT it : PLM98 -0399
13125 SW Hal Blvd, Tigard, OR97223(503)6311171 DATE ISSUED: 10/28/98
PARCEL: 2S103AC -05100
SITE ADDRESS...: 12775 SW 113TH PL
, ;.SUBDIVISION • HUMBOLT CREEK ESTATES ZONING: R -4.5
,,`pL.00K • LOT :002 JURISDICTION: URB
' , CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH : 0 BACKFLOW PREVNTRS..: 0
'.m OCCUPANCY GRP..:R3 FLOOR DRAINS • 0 TRAPS : 0
STORIES........: 0 WATER HEATERS : 1 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS - 0
SINKS • 0 URINALS : 0 GREASE TRAPS : 0
' LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
F WATER CLOSETS.: 0 WATER LINE (ft) ...: 0
k:, DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
0 ) Remarks: Dahien convert electric to gas water heater
Owner: FEES
'.,;MARK DAHLEN type amount by date recpt
p., 12775 SW 113TH PL PRMT $ 25.00 JSD 10/28/98 98- 310343
v' °'TIGARD OR 97223 5PCT $ 1.25 JSD 10/28/98 98- 310343
Phone *:
', Contractor
OWNER
1
Phone N: $ 26.25 TOTAL
i Reg L. .
REQUIRED INSPECTIONS
This perait is issued subject to the regulations contained in the Misc. Inspection 3
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect ion
applicable laws. All work will be done in accordance with
approved plans. This pereit will expire if work is not started y
within 188 days of issuance, or if work is suspended for sore
than 188 days. ATTENTION: Oregon law requires you to follow rules .
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952.8801-8118 through OAR 952-9881-8981 You nay
obtain copies of these rules or direct questions to O(1C by calling , 41
(5E/246-1987. 4 � . ;
V
41110 C■--1/ilk ti
Issued By: /f Permittee Signature =
+ + + + + + + + + + + + + + ++ ++++++++++++++++++++++++++++++ + + + + + + ++P+ + + + + + + + + +�F• + + + + + ++++
Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
I +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
4
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Commercial and Residential
Print or Type Dale to i
Incomplete or illegible applications will not be accepted -
, Name of DSVOlOpMent/Project
1, Job Sink too ,,,,,
-. Address SIMM Address Suite Lavatory 9.00
'., Bldg a I City/State BP Shower Only 9.00 1
Water Closet 9.00 1
''. ow Mailing Address Suite Garbage Disposal 9.00 i
Washing Machine 9.00 i
1:, City/State LP Phone
Floor Drain/Floor Sink 2" 9.00
1,- Name Am _,w...,, r 9.00 ,
' , Occupant Mailing Suite Water Heater •• conversion 0 like kind 1 9.0° 9.00
l',', Gas piping requires a 17 permit
, C4Ze '-'- - Zip Phone Laundry Room Tray 9.00
Name ,
Other Fixtures (Spicify) 9.00
9.00
}"J Contractor Mailing Address Suite
9.00 I
,,, Prior to permit City/State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy
Sewer - each additional 100' - ,
, of all licenses are Oregon Const. Cont. Board lic.. Exp. Date
, required if Water Service - lst 100' 30.00
`'.; expired in COT Plumbing Lic. a Exp. Date Water Service - each additional 200' 25.00
database
. Name
Storm & Rain Drain - each additional 100' 25.00 ,
I, Architect Mobile Home Space
k or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 '",.4:47,
f' Pollution Divice
Describe work to be done: restricted energf Demi.) ,
New 0 Eir 0 Replace with like kind: Yes 0 No 0 Any Trap or Walk. Not Cormected to a Fbdure
Catch Basin
Additional ption of wodc:
insp. of Existing Plumbing 40A10 ' P 1, ,'" , k,
Are you capping, moving or rtplasing any fixtures? ,, lt
Yes 0 No Aftr,.
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isomsticerrisow • is • ' • ' ,; „,_:, rst"1,#,„,>;z7,4; ,.,""'
WORK COULD RESULT IN INCREASED SEWER FEES.
I hereby acknowledge that I have read this application, that the information ..._ .. '',..4. , ' ;5r7,1: 1 , i'.
given is correct, that I am the owner or authorized agent of the owner, and 116 , 1 PROW1,06 ' ,•'''/ - j'''
that plans . _.„.; • are in compliance with Oregon State Laws.
/ te/A9.1tA Date **PLAN REVIEV‘ 26% OF SUBTOTAL;
1 kisteplumapp doc 7/2/98 ( ( 1 ' * ■ :*:,' ' ' ‘ ' '' ''.;.. ,'4 .,:? *° ! ` ' * *: .