Permit CITY OF TIGARD PLUMBING PERMIT
A, DEVELOPMENT SERV SERVICES DATEIISSUEDn�Q�'3, /1�1'M388 —�
Tigard,
PARCEL: `S 1 1 0 -1B —HM X07
SITE ADDRESS...: 11455 SW JACKIE CT
SUBDIVISION....: HAWK MEADOWS ZONING: R -4.5
BLOCK........... LOT ............. :007 JURISDICTION: TIG
CLASS OF WORK..: NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP.. :R3 FLOOR DRAINS......: 0 TRAPS..............: 0
STORIES........: 0 WATER HEATERS.....: 0 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
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 80
Remarks: Installation of a pproximately 8O' of storm drain.
Owner: -- -- FEES --
RIVERWOOD DEVELOPMENT LLC type amount by date recpt
4035 DOUGLAS WAY PRMT $ 30.00 DEB 09/14/98 98- 309093
LAKE OSWEGO OR 97035 SPCT $ 1.50 DEB 09/14/98 98- 309093
Phone #:
Contractor-- ----- ------ - - - --=
G & B PLUMBING
PO BOX 1269
H I LLSBO RO OR 97123 -1269 - -_
Phone #: 640-5770 $ 31.50 TOTAL
Reg #..: 000001
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Storm Drain Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 -m4 -0010 through OAR 952 0001 - 0080. You m'ay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued "'v:' • Permittee Signature: wt %� /
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + +-1-- + + + + + + + + + + ++
Call 539-4175 by 7 :O0 p.m. for an inspection needed the next business day
+ +•+ 1- -{ + + + + + + + + ++ + + + + + + + + + + + + + + + + +- +++++++++++++- 1- ++ + + + + + + + + + + + + + + + + + + ++ + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Ch A
13125 SW HALL BLVD. Commercial and Residential Rec'd B 7_. O
TIGARD, OR 97223 Date Rec'd 9 -/ -
(503) 639 -4171 Date to P.E.
Print or Type Date to DV
Incomplete or illegible applications will not be accepted Permit # L,y9g-- o3 2�2-,
Related SW: #
Called
Name of Development/Project sFIXTURESra. individual � ` c; ; " . `,4'" :'Q. " PRICE'` TAMT
Job J., Awl- Pc MDO(ALS Sink 9.00
Address Street Address Suite Lavatory 9.00
ti S $ t f C.C/ s' Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
-7jc, Water Closet 9.00
NAne "� ,�
I' to pp 1) ,0 On D u 1 T Dishwasher 9.00
Owner Mailing A/ ue, ddre / s , Suite Garbage Disposal 9.00 .
`1 l f - Ok tj Washing Machine 9.00
CA /State Zip J Phone
/ 0 ds.° 61 3 s t� r W g 7C9 Z - 2 �,, 2 _ Floor Drain /Floor Sink 2" 9.00
Name w 3" 9.00
4" 9.00
Occupant. Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name
- /. !� /� ( �J ) gym I I km Other Fixtues(Specify) 9.00
� 9.00
Contractor Mailing Address Suite
"j7, 0. 6 H Zbq 9.00
Prior to permit City/Stte Zip Phone Sewer- 1st 100' • 30.00
issuance, a copy j.4. i I IS b 9 9r1 I %' b O ,- S770
y Sewer -each additional 100' • 25.00
. of all licenses are • Oregon Const Cont. Board Lic.# Exp. Date •
required if / Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Alqe.8 6/30/9 Storm & Rain Drain - 1st 100' I 30.00 50 .0 d
Name Storm & Rain Drain - each additional 100' 25.00
• . Architect Mobile Home Space 25.00 •
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device` 15.00
(Irrigation timing devices require a separate •
Describe work to be done: restricted energy permit.)
New ., Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential ye Commercial 0 Catch Basin 9.00 •
- Additional description of work:
Insp. of Existing Plumbing 40.00
per /hr
Specially Requested Inspections 40.00
per /hr
•
Are you capping moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes O No O Grease Traps 9.00
•
If yes, see back of form to indicate work performed by _ ;
QUANTITY TOTAL_ \_
. fixture. FAILURE TO ACCURATELY REPORT FIXTURE • Isometric or riser diagram is required if Quantity Total is > 9 _ , , ", ,;;;� -���"
'WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL -, .d,
I hereby acknowledge that I have read this application, that the information „,jj;' , ;` ,
given is correct, that I am the owner or authorized agent.of the owner, and - - .
5% SURCHARGE - ti ;a t, �
P compliance Oregon plans submitted are in com liance with Ore on State Laws. ,� fg .,,` " „
Signature of Owner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL " s `'„i!""I
di
/ Required only if fixture qty. total is > 9
TOTAL r s t:Pr• :, ":' 1. p
Contact Person Name Phone
/4&14A7
D /04 2 0 pa !� / r Z� Z � j *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
7- Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
l: \dsts\plumapp.doc 7/2/98 • .
-- —
PLEASE COMPLETE:
.....................................................................................................................................................................
.............
•••••..:: . • ••••-• . • ........ Replaced Removed/Capped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
•
Washing Machine
Floor Drain/Floor Sink 2"
3 "
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
\ dsts \plum app.doc 7/7/98