Permit CITY F TIGARD O A
. DEVELOPMENT SERVICES PLUMPING PERMIT
•
�I�l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE I ISSUED: 03 / 31 / 99 -0094
PARCEL: 25111DA -05500
SITE ADDRESS...: 15240 SW PARKLAND TERR
SUBDIVISION • APPLEWOOD PARK NO. 2 ZONING: R -7 PD
BLOCK LOT :050 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
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)...: 0
Remarks: Installation of residential backflow device.
Owner: FEES
LEGEND HOMES type amount by date recpt
6900 SW HAINES PRMT $ 15.00 DLH 03/31/99 99-314126
PLAZA 2, SUITE 200 SPCT $ 0.75 DLH 03/31/99 99- 314126
T I GARD OR 97223
Phone #:
Contractor -
MARTIN SANDERS
PO BOX 307
NORTH PLAINS OR 97133
Phone #: 647 -5567 $ 15.75 TOTAL
Reg #..: 11068
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backflow Prey
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 yore
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.
Issued By: Permittee Signature: /�'
... 4‘b:124{,,c_„_______ +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By ! L/i�
TIGARD, OR 97223 Date Rec'd 3 ®J `%
(503) 639 -4171 Ti ate to P.E.
Print or Type _ / Date to DST
Incomplete or illegible applications will not be accepted
P swR _����
/ 9? -&5/7_5 / .D Called
l Name of Development/Project / II, FIXTURES (individual) QTY PRICE AMT
Job 4, /e_ (,..} O O ,0,q !4- Sink 9.00
Address Street Address � Suite Lavatory 9.00
f S Z y v .� cJ 0 "s .- 4 /4.1)))_ Tub or Tub /Shower Comb. 9.00
Bldg # I City/State /1 Shower Only 9.00
(�c, ` d 6L 5'7 1,3 .7.. Closet 9.00
Name
L e L„ 1•14.0P4‘ e-s Dishwasher 9.00
Owner Mailiddress Suite Garbage Disposal 9.00
Washing Machine 9.00
Zip Phone
t -` 0v / h 7 D 60 Floor Drain/Floor Sink 2° 9.00
Na lJ L 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
Other Fixtures (Specify) 9.00
Contractor g� y e, v r it" �) ing Address 3 1 ,y) Suite 9.00
/'O. e../4x1.- 9.00
Prior to permit City/ tat Zip Phone Sewer - 1st 100' 30.00
Issuance, a copy ..1"1..., p, , , t. s Cpl, ‘97....<667
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date ,-
required if )/ �� -� 4 3c_: 5'`i
Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. It Exp. Date Water Service - each additional 200' 25.00
database 5 7 4 1 4 zi -, 3s - 7 S 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 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 ie-- Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial O 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 0,. Grease Traps 9.00
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER. FEES. *SUBTOTAL �, j
I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and 6% SURCHARGE
that plans submitted aye in compliance with Oregon State Laws. / 7-
Signature of Agent Date **PLAN REVIEW 25% OF SUBTOTAL
�7"--z _ 3 -31- 7 C' Required only tf fixture qty. total Is > 9
7S TOTAL /.%
Contact Person Name Phone
' " ° urcharge, except Residential Backflow
c Prevention Device, which is $15 + 5% surcharge
**All New Commercial Buildings require p ans with isometric or riser diagram
and plan review
l:ldststplumapp.doc 7/2/98
PLEASE COMPLETE:
Fixture
:.:... Quantity b. Work . :Perf.or.:m. d ::: ::::::::::.:::_:::.: >:.::::::.:
New...:..:::. :.: :::.
Moved ::.::::Replaced Rem ..
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:
1:ldstsVstumapp.doc 7/7/98
5/17/99 Activities for Case #: PLM99 -00094
9:14:36 PM
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 3/31/99 DLH RECD DLH 3/31/99
PLMA005 Create Permit 3/31/99 DLH DONE DLH 3/31/99
PLMA799 Final Inspection 4/7/99 TLP. PASS AKJ 4/8/99
PLMA750 RP /Backflow Preventer 3/31/99 DLH 3/31/99
PLMA050 (F) Issue permit 3/31/99 DLH DONE DLH 3/31/99
PLMA800 Case Finaled 4/8/99 AKJ DONE No Hold AKJ 4/8/99
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