Permit CITY OF TIGARD
��� DEVELOPMENT SERVICES PLUMBING PERMIT
ti PERMIT # • PLM99 -0013
°= 1312 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/20/99
PARCEL: 2S111DA -05700
SITE ADDRESS...: 15320 SW PARKLAND TERR
SUBDIVISION • APPLEWOOD PARK NO. 2 ZONING: R -7 PD
BLOCK LOT •052 JURISDICTION: TIG
CLASS OF WORK...: OTR 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: Add residential backflow prevention device.
Owner : -- -- FEES
LEGEND HOMES type amount by date recpt
6900 SW HAINES ST PRMT $ 15.00 GEO 01/20/99 99- 312305
SUITE 200 SPCT $ 0.75 GEO 01/20/99 99- 312305
TIGARD OR 97223
Phone #:
Contract or
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
•
NORTH PLAINS OR 97113
Phone #: 647 -5567 $ 15.75 TOTAL
Reg #..: 000057
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Back f l ow 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 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 952-0'0'4-0080. You gay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987. / .
Issued By' / 1 -/ Permittee Signature . 1/0/./ �
++++++++++++++++++++++++++++++++++++++++++++++++++++++++.+ + + +++++++++++++
Call 639 -4175 by 7:00 p.m. for an inspection needed t e next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
1 CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # M'99 On 0/5
Related SWR #
Called
Name of velopmenUP ject FIXTURES (Individual) QTY PRICE AMT
Job fipp le- uJ Sink 9.00
Address Street1Addres Y Suite Lavatory 9.00
/ 632_0 A a r k ' l err, Tub or Tub /Shower Comb. 9.00
Bldg # City /State a Zip
7 ' ra 6; 72Z Shower Only 9.00
Name / , / Water Closet 9.00
le 1 Q Dishwasher 9.00
Owner Mailing Ad ree ?°° /� Suite Garbage Disposal 9.00
CO 4i nes 20° Washing Machine 9.00
C / tate Zip Phone Floor Drain/Floor Sink 2° 9.00
Name' 7/9eb 97a3 (0Z 0' $68c
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
h /� Urinal 9.00
Nme 1 G+�(r
ry i n S a C7
erS reCndi s 7 i Ad• Other Fixtures (Specify) 9.00
Contractor Maili Address Suite 9.00
P a &'x 3 D 7 9.00
Prior to permit C / to Phone Sewer - 1st 100' 30.00
Issuance, a copy Aj or7Z P/ r n j i (�� 9 7 ' 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 tic. # Exp. Date Water Service - each additional 200' 25.00
database 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.) /5
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 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
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures?
Yes O No O Grease Traps 9.00
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser H QUANTITY TOTAL
diagram Is required Quantity Total Is > 9
WORK COULD RESULT IN INCREASED SEWER. FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the information /5
given Is correct, at I am the owner or authorized agent of the owner, and 5% SURCHARGE
that . 1_ ns , b ;' ed are in corn . liance with 217- ! on State Laws. i 7
/ "PLAN REVIEW 25% OF SUBTOTAL
/ e , t - q Required only If fbdure qty. total is > 9
S c �' p,
�I /Ly itiff Date / -/ TOTAL
on rsj� ame Phone e 5 3'/!� /5.7'
/ n .D' / Mlnlmum permit fee is $25 + 5% surcharge, except Residential Backflow
�e l / e r 1//� 5 S (p�7-�5�0� Prevention Device, which is $15 + 5% surcharge
// "All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:',dststpiumapp.doe 7/2/98
PLEASE COMPLETE:
� Work Performed:
Moved: < >....I•t ..lace`d >I7emay�d ;.:..... :...:.:::.;:
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:
t:ldstslplumapp.doc 7/7198