Permit A °I CITY OF TIGARD
4 PLUMBING PERMIT
4, DEVELOPMENT SERVICES PE RMIT #: PLM1999 -00450
'�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 3 9 -41 %1(8)/A641. ATE ISSUED: 12/30/99
PARCEL: 2S110CC -20500
SITE ADDRESS: 12384 SW KING GEORGE DR -
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT: 082 JURISDICTION: KIN
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: '
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
• TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN:. ft
Remarks: Installation and conversion of electric water heater to gas water heater. Gas piping taken out under
M EC 1999- 00575.
FEES
Owner:
Type By Date Amount Receipt .
CHRISTA LENZ PRMT DEB 12/30/99 $50.00 KING CITY
11724 SW BOONES BEND DR 5PCT DEB 12/30/99 $4.00 KING CITY
BEAVERTON, OR 97008
Total $54.00
Phone 1:
Contractor:
RHINO PLUMBING INC
13811 SE RAMONA ST
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Phone 1: 777 -8946 Water Line Insp
Reg #: LIC 128026. Top out Insp / /
/
PLM 26 -640PB Final Inspection
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 m • • copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
C Issu d By: I - 0 ,0 I
i • # j _______.
'� t �I Permittee Signature: -2 la , i 1 el:/
Call (503) 639 , 175 by 7:00 P.M. for an inspection neede a next business dly U
11,
CITY T I GA R D Op PLUMBING PERMIT
/
,.�1ik DEVELOPMENT SERVICES PERMIT #: PLM1999 -00450
C� ATE ISSUED: 12/30/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 /!f
SITE ADDRESS: 12384 SW KING GEORGE DR 9 PARCEL: 2S110CC - 20500
SUBDIVISION: KING CITY NO. 5 \ ZONING:
BLOCK: LOT: 082 JURISDICTION: KIN
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: 'SF RAIN DRAINS:
SINKS: URINALS: • GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: / Co ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation and conversion of electric water heater to gas water heater. Gas piping taken out under
MEC1999- 00575.
FEES
Owner:
Type By Date Amount Receipt
CHRISTA'LENZ PRMT DEB 12/30/99 $50.00 KING CITY
11724 SW BOONES BEND DR SPOT DEB 12/30/99 $4.00 KING CITY
BEAVERTON, OR 97008
Total $54.00
Phone 1:
Contractor:
RHINO PLUMBING INC
13811 SE RAMONA ST
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Phone 1: 777 =8946 Top -out Insp
Reg #: LIC 128026 Final Inspection
PLM 26 -640PB
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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987. _____
Issue By: i , i 1 ` / CIA0a-N)A- Permittee Signature :A
Call (50,3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
DEC - 29 WED 03:04 PM City of King City FAX:503 639 3771 PAGE 3
CITY OF TIGARD it . .
13125 SW HALL BLVD.
Plumbing er
Application
Commercial and Residential
�` PI>irt ched� s .
TIGAEtD, OR 97223 Reid By
(503) 639 -4171 • ... 1 Date to P E.
. ._ -.,... .. Print orT a ... ..• • 9 2'
.
Incomplete or illegible applications will not be accepted • �`" to Date 6a * 1999 "ct 5O
Related SWR a:
Called
p
Name of Dereiopmen /Protect ;) c �; � r - ` - F , �
• Job Kr J6- C z ry sink , z. w�. z°c : : , - ; . �, � 4 � • }[ p
9.00
Address Street Address 6tnte" Lavatory 9.00
/Z3 . 5W ,"' �! N ` ./ nib or Tub/Shower Comb, 9_00
Bldg S City /State Shower Only 9.00 •
- _ OR 73-? -e
Name Water Closet 9.00
(:// 5 r4 G' Dishwasher 9.00
Owner Mailing Address Garbage Disposal 9,00
1/ 7 4 ' % t'" "' 1 - a • Washing Machine 9.00
city/State i Zip Phone
.-Ifer /7�o g G rp_ 3gzo Floor Oralr✓Floo 2 - 9.00 •
Name 3" 9,00
,7eCIN Eie 4-
Occupant Mailing Address Suite Water 9.00
Heater cenversion 0 like kind � 9,00 � Dv
Gas piping req Ives a separate mechanical permit.
City/Stale Zip Phone Laundry Room Tray 9.00
0
. Urinal 9.00
Name Other Fbdures (Specify) 9.00
Contractor Mailing Address Suite 9.00
‚ i`g r St RA,t'l uiA 54, 9.00 •
Prior to permit City /State Zip Phone Sewer -1st 100' 30.00
a' „ tL °`
Issuance, a copy 3_4
of all licenses are Oregon Consi Cont. Board LIc.# Exp. Date Sewer -each additional 100' 25.00
required if / 2 $ Q 4 3 _9 _DD Water Service -1st 100' II 30.00 Q 1 `
expired In COT Plumbing Uc. # Exp. Data Water Service - each additional 200' 25.00 •
database 2 ( - C. '/0 /96 &Yz/co —OC Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Bads Flow Prevention Deuce or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Baddlow Prevention Device 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair Cl Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00 •
Residential 0 Commercial 0 •
Additional description of work: Catch Basin g,o0
Insp. of Existing Plumbing 40.00
. .r/hr
Specially Requested Inspections 40.00
perthr
Rain Drain, single family dwelling 30.00
Are y capping, moving or replacing any fixtures? .
Yes O No Q Grease Traps 9.00
If yes, see back of form to Indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE " "'A'` `°� tl '
Isometric or riser diagram is re4ulmd a quantity Total is a 8 a' ` .,, :
WORK COULD RESULT IN INCREASED SEWER
th is application, lha t the information r77,71,',,':17;7,', . FEES. "SUBTOTAL . Ali I Hereby acknowledge that I have rea rre � ^'• `r�
a
given is comet. that I am the owner or agent of the owner, arid 9 SURCHARGE � t
4 ‘!‘/:7,17(4-4/:4;;.,!,l I' -
^
that plans submitted are in compliance with Oregon State Law*.
Sig ure of Owner /Agent Date "°`, tree onl °`P it m qry. V I i e 9 r� xz •r •�.�� -a trri„2
aroaLAN RE °a OF SUBTOTAL. G t
l_VU 25 / .
`Z_' 2" l _
contact "teen Name 1 OTAL t << ". . , ' `r-„ 3 5�•
Phone t , , . � be
'Minimum permit fee is $25 + 5% surcharge. except Residential Baddlow
— .
- —
Prevention Device, which Is $15 + 5% surcharge
— - - - "All ldory 00 eroldl "Build{t1 s
g require'plariS wttti isoi'netiic oa ilsrar dlagrarh
and plan review
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