Permit CITY OF TIGARD
L��L..I.nTIBa:r1C� PERMIT
� ., DEVELOPMENT SERVI 1-�LhIT11 T � y pL..M98• -0109
DATE ISSUED: 04/2 !/ 78
PARCEL: 26 :I.03DB- 00500
SITE ADDRESS...: 11015 SW PARK ST
SUBDIVISION MIRA PARK ZONING: R -4.5
BLOCK.... ...... L..OT.................. :001 JURISDICTION: TIG
CLASS OF WORK. . :ALT GARAGE DISPOSALS.: 1 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 - 1 URINALS - 0 GREASE TRAPS........: 0
LAVATORIES.....: 3 OTHER FIXTURES....: 0
TUB /SHOWERS...: 0 SEWER LINE (ft) ...: 0
WATER CLOSETS..: 3 WATER LINE (ft) ...: 0
DISHWASHERS - 1 RAIN DRAIN (ft) ...: 0
Remarks: Removing and replacing 1 sink, 3 lays, 3 toilets, 1 dishwasher, 1 Barba
g E ,
disposal.
Owner: - - -- -- -- - - -- FEES - - -- - - --
NINA HOASHI type amount by date •recpt
11015 SW PARK PRIM $ 80.00 DEB 04/27/98 98-305270
TIGARD OR 97223 5PCT $ 4.05 DEB 04/27/98 98-305270
Phone ##:
Contractor-- ____ -- __ _______ -__
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE
OREGON CITY OR 97045 _ .
Phone #t: 632 -7374 su 84..0 5 TOTAL..
Reg O..: 81746
_________ REQUIRED INSPECTIONS -----
This permit is issued subject to the regulations contained in the I*l i. sr.'. I ns pect i. on
Tigard Municipal Code, State of Ore. Specialty Codes and all other I ns p ex existing/ca
applicable laws. All work will be done in accordance with Final Inspection
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 - 080188. You may
obtain copies of these rules or direct questions to OIAJC by calling
(503)246 -1987.
Issued Permi•4tee Si nature:
++•+-++•+•+++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + +•+• + + + + + + + + + ++
Call 639-4175 by 7 :00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++ + + + + + + + + + + + +•+• + + + + + + + ++ + + + + + ++ +•++ •+• +•+• + + + + + + + + + +•+• +•+- + + + + + ++
X3gi
r
,CITY OF TIGARD Plumbing Application Recd By`�-I�. )
9 PP
l 13125 SW HALL BLVD. Commercial and Residential Date Reed
Date to P.E.
TIGARD, OR 97223 Date to DST
(503) 639 -4171 Permit* l0?
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Developmen Project On back indicate Work Performed by fixture.
Job /v f 4 A A-6/4-/ FIXTURES (Individual) . . .QTY PRICE AMT
Address St'I�A�res 5. poi k_ Suite Sink , 9.00
Lavatory 9.00
Bldg # City /State Zip Tub or Tub /Shower Comb. 9.00
N e j Shower Only 9.00
-• i -6A4 . Water Closet 3 9.00
Owner Mailing Address Suite Dishwasher ) 9.00
Garbage Disposal 9.00
City /State Zip Phone Washing Machine 9.00
Name Floor Drain 2" 9.00
3" 9.00
Occupant Mailing Address Suite 4" 9.00
Water Heater 0 conversion 0 like kind 9.00
Ci /S Zip Phone ,
Laundry Room Tray 9.00
Name - • , , nj Urinal 9.00
( \'�(Q r /�t '7 `OA Ply L' 1 7 C - Other Fixtures (Specify) 9.00
Contractor Mailing Address ulte
1 5 S S. #41144.1 ) LPL 9.00
9.00
Prior to permit City /State Zip Pone
issuance, a copy 84-4 9n et( Q n t 1 O S f� 32 93 `7'f 9
of all licenses are Oregon,Conss. Cont. Board Lic.# Exp. Date 9.00
required if c lCi '7H ( /1 /cc' Sewer - 1st 100" 30.00
expired in COT Plumbing Lic. # Exp. Date
database 3- 3s, / t_ 9 Sewer - each additional 100' 25.00
Name Water Service - 1st 100' 30.00
Architect Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
• Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition 0 Alteration Repair 0 Pollution Device
to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' 15.00
A• • itional d- scription of work: Any Trap or Waste Not Connected to a Fixture 9.00
i , ‘ 1-9" Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40.00
building or property - per/hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL
•
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9 - -
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL . G� p • that plans submitted are in compliance with Oregon State Laws. � Up,
Sign t f Cpn r /Agent Date
5/o SURCHARGE cti-4)
Conta t arson Name Phone PLAN REVIEW 25% OF SUBTOTAL .. .
f Required only if fixture qty. total is > 9 •
4ce 6v -') 3 TOTAL ¢ .s
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflo
Prevention Device, which is $15 + 5% surcharge
l:ldsts plmapp.doc 5/97
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
•
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:ldstsVlmapp.doe 5/97