Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2000 -00151
=-" c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/15/2000
SITE ADDRESS: 07400 SW LANDMARK LN PARCEL: 2S112AB -00400
SUBDIVISION: ZONING: I -H
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACK FLOW PREVNTRS: 1
OCCUPANCY GRP: 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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install commercial backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
HAYTER FAMILY LIMITED PARTNERS PRMT KJP 05/15/200C $50.00 0002153
23643 SW STAFFORD HILLS DR 5PCT KJP 05/15/200C $4.00 0002153
WEST LINN, OR 97068
Total $54.00
Phone 1:
Contractor:
PROGRASS LANDSCAPE SERVICES
29895 SW KINSMAN RD
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone 1: 682 -6076 RP /Backflow Preventer
Reg #: LIC 00006136 Final .Inspection
PLM 11558 •
OR
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 copi of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: .l"( et, _A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
06/08/99 TIT, 10:57 FAX 503 598 1960 CITY OF TIGARD j002
CITY OF TIGARD Plumbing Permit Application Plan Crleck:
13125 SW HALL BLVD. Commercial and ResidenC.1VE Re d By
TIGARD, OR 97223 Da:e Recd
(503) 539 4171 y� '1Q ®® Date to P.E.
Print or Type 1�6�" ��FF Date tc DST
In or illegible applications will � tOgi PermaM
MOW Related SJ ;R 8
Called
I Name of Deveiopment/Projec I .= .F1X'.URES individual .=s : _':: , -.? - s ' OTY :, '`iFRIeE;i AMT:::
.�
Job J� I +ZL xr Procdu. s sok I 11.50 I
Address Street Address I Suite Lavatory I 11 -50 1 •
"7 5O0 SW Lan dm U-n.4C 4 -041.t Tub or TubiShower Comb. 11.50 t
Bldg 4 City /State Zio Shaver Only I 11.50 i
T lQ 0.4 0 � �/ I D`a --`I
Name Shower
Water Closet 11.50 I C-( r D t i 1 Ge_Ac CO S� C�7dy(. I C!sf-washer 11.50
O wner Mailing Address Suite Garbage Disposal 11.50 1
1 7 1 /O , 4 3,E • Washing Mad 11.50
Clty/S *.ate Zip Phone
Su LQ.M OIL 9 s33 3ioa - it b y Floor Crain/F!oor Sink 2' 11.50 - •
Name { 3" l 11.50 I ,
. I 4" 11.50
Occupant Mailing Address Suite Water Healer 0 conversion 0 like kind I 11.50
' Gas piping requires a separate mechanical pen I • -
City/State Zip Phone Laundry Room Tray 11.50 '
. _ I Urinal 11.50
Name
?c& ro-Qs La.rviSccy G YnG Other Fixtures (Specify) 15.00 I
• Contractor Mailing Address I Suite .
PCigg5 SrW 1(.111cYN-n If 2-0
Prier `o permit City/State Zip ,Phone hod )IP
I
Sewer -1st 100 38.00 I
issuance, a copy LUilS1ynOilAe' OK C1700 ��j0- ,5r 1
Sewer - each additional 100' 32.00
of all licenses are Oregon Const. Cont. Board Lie.* Exp. Dare
required if ( 3(4 at 3) IOC) Water Service -1st 100' I 38.00
expired in COT Plumbing Lie. # Exp. Date Water Service - each adcltlonal 20C' I 32.00
database I Storm & Rain Drain - let 100' 38.00 I
Name Storm & Rain Drain - eacn additional 100' 32.00
Architect Mobile Home Space 32.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- ' I 32 00 3 -fir;
Pollution Device
Engineer 1 Cty /State Zip Phone Residential Bacxflow Prevention Device' 19.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New'S Repair 0 Replace with like kind: `'es 0 No 0 Any Trap or Waste Not Connected to a Fixture 11.50
Residential 0 Commercial "q Catch Basin 11.50
Additional description of work: ' mp of Existing . Plumbing 50.00
per /hr I
Are you capping, moving or replacing any fixtures? I Specially Requested Inspections 50.00
per /nr
Yes 0 No 0 R _ in Drain, single Carr /y dwelling t 45.
If yes, see back of form to indicate work performed by Grease Traps I I 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL :.
I hereby acknowledge that : have read this application, that the information Isom etric cr riser diagram is required if Quantity Total is > 9
given is correct, that I am the owner or authorized agent or the owner, and *SUBTOTAL - •"i'
that plans submitted are in compliance with Cregon Stale Laws. _ •
_ - r;
Signature of Ow e"r7Agent D e �°7 ..SURCHARGE
Contact Parson a hone 1 * *PLAN REVIEW 25% OF SUBTOTAL
81 i en QQ. K°� )( .,- al 9 Re duced sdy ii fixure qty. total is > 9 ' = l (�
- -_ 4 - - - TOTAL
-`'t$ . . Off: - z' ,yj^
A t �.= :tom ;� - - : �.;�._; - , °ra a�?_ - -_ ..� -�v
,;_IT ri �e +�aa - � _ w • : f i u•� i ;n`= ,_ =' ' , ! 'Minimum , permit fee is 550 + 5% surcharge, except Residential Backtlow
+ W± S' Yufr .•�r�;.1rhQ pra, i id: ; ,ir _ � - -- :._ c,1 i,iii�- =rs:i`rriji4=� p
h- , -�* cf 1 3fr ores glom " - , Prevention Device, which is $25 + 5% surcharge
∎ Eit)Qrvku3`,:80.00,I3-#1.0k4.1- tinIr_sev� '4 t< 111 ' ew _ _ "All New Commercial Buildings require plans with isometric or riser diagram
' ` d
and plan review
- - - - iadssifcrms:plueapo:doc 6/21S9 - -- - - - - -- -- -- - - -- - - - - - - '1)16' -- -
06/08 /99 TUE 10:59 FAX 503 598 1960 CITY OF TIGARD ,003
PLEASE COMPLETE:
`Fixture Type C u. [ r b y. Wo P e orm
N ew Moved Replace i move:dlC
Re ped
Sink
Lavatory
Tub or Tub /Shower Combination , 1
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)
Ct .04<-00 Pre-4)6/441 cm I
(pito L C
COMMENTS REGARDING ABOVE:
__ -I tdctstformsp:urr. app.doc 6/2!82