Permit •
CITY TIGARD PLUMBING PERMIT
,, A � � DEVELOPMENT SERVICES PERMIT #: PLM1999 -00367
' ' ��� Ia 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: . 11 /05/1999
SITE ADDRESS: 12212 SW QUAIL CREEK LN PARCEL: 2S103CB -10300
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 061 JURISDICTION: URB
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 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: Residential backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES PRMT KJP 11/05/199E $25.00 99- 319575
5000 SW MEADOWS LANE SPOT KJP 11/05/199E $2.00 99- 319575
LAKE OSWEGO, OR 97035
Total $27.00
Phone 1: 274 -5223
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
ORIGINAL
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.
l
Issued By: , Z A-- -".ems✓ Permittee Signature: . ���1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
06/08/99 TUE 10:57 FAX 503 598 1960 CITY OF TIGARD (11/x// g] O02
CITY Plumbing OF TIGARD EiVr Plan cneck7 mbing Permit Application •�
'13125 SW HALL BLVD. REC Commercial and Residential �� geed By
TIGARD, OR 97223 NOV A 4 1999 Date Recd
(503) 639.4171 Date to P.E.
Print or Type Date to DST
COMMUNITY wr!ti
4• n r Permit# n / 0319
lncompiete or illegible applications will not be accepted
Related SWR #
Called
Name of Deveo ment/Project - )X_'FURES individu l ,.. ?- _ :--•"-,,, -; ?(1 Y --i- •�:PRics- - -AMT
p ) COT lot =F _..__ .._.. -... ..:._. • ...._,_ r.... --
Jo �� •Q' Hi) LLOLO - Sink 11.50
Address Street Address . I Suite Lavatory 11.50
/da /Q .LU (1.LUa Liz.Crt.I .kk (...CCn L. Tub or Tub/Shower Comb. ' 11.5C '
Bldg # City /State Zio Shower Only 11.50
nq OIJIC.t_ 9 - 1 2-2;3
.kia !'later Closet 11.50
136n mot SSC1-,te_ Ha1Me-S Clsrwasher 11.50
Owner Mall ngAddress Suite Garbage Disposal 11.50
LID30 SLO Galeui L°h•
Washing Machine 11.50
City/State Zip Phone Floor Crain/Floor Sink 2" 11.50 j
( 14.e.. O cqI) CSR. "790. 6 - rorrl .
Name 3" 11.50
4" 11.50
Occupant _Walling Ad . ss SLite Water Heater 0 conversion 0 like kind 11.50
• Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 11.50
_ Urinal 11.50 -
Name
LAiiOSL -u_pc. Pr0C7 s L_.l�rtdsU znc_, Other Fixtures (Specify) 15.00
Contractor Malting Address Suite
atI rs so ic Q-o •
Prier to permit City/State Zip tPhon -fo -7 Sewer - 1st 100' 38.00 •
Issuance, a copy U.) LL 6' l Ueile Ott K Oil Sewer - each additional 100' 32.00
of all licenses are Oregon Cont. Cont. Board Uc.* Exp. Date '
required if (D 1 (o •13)100C3 Water Service -1st 100' 38.00
expired in COT Plumbing Lic. 5 Fes, pate Water Service - each additional 20C' 32.00 •
database ( I 55 ' I 7 / )o /. ec Storm & Rain Drain - 1st 100' 38.00
Name i & Rain Drain - each additional 100' 32.00
Architect Mobile Home Space 32.00
Or - Malting Address Suite Commercial Back Flow Prevention Device or Anti- 32.00
I Pollution Device
Engineer I Oty/Stat Zip Phone Residential Baccfiow Prevention Device" 19.00 ob
(Irrigation timing devices require a separate I 17
Describe work to be done: . restricted energy permit) '
New Repair 0 Replace with like Idnd: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 11.50 •
Residentlaf"q Commercial 0 Catch Basin 11.50
Additional description of work: - Insp. of Existing Plumbing 50.00 i
6 A - Oleh &U • lo j Pre- e-)(IY1 be/t) r cep per/hr
Are ou capping, moving or replacing any fixtures? I Specially Requested Inspections
50.00
Y pp 9. S p 9 Y per/nr •
•
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of form to indicate work performed by •
Grease Traps I 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL =_ ;'I: � ## •
I hereby acknowledge that i have read this application, that the information Isame:ric cr riser diagram it required If Quan:iy Tctal is > 9 ( . . - _ :F ' ;' ;_
given Is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL ,3 ' ;,
that plans submitted are In compliance with Cregon State Laws. _ • - : oC e .:
Slyn of ner�gent Q Date 1Oj y� g � `6°(s SURCHARGE _ _ ;` i
Contact P rson Name ( o g a _ (o071a Phone "PLAN REVIEW 25% OF SUBTOTAL - ';
Eller) I VY Kt ail Required only ii fir we qty. total Is > 9 -. . ,1 : ;I
��. :.:_ _ . _ Rte:, �.��.�,. -� =_ vay TOTAL i
1 •- tIg 2 M 4:u4L._..'��.: rjl�: -� 4 ? - i.j_. ......_ .. ,
kl f +:: -:: lri' V* - V r1..+. 'Minimum permit fee is $50 kilow
.�j'.t?�49U�= � :� : o_a�s r� . �;a ��= '--- -- _ "'J.``�r� * i� + 5% surcharge, except Residential Bac
J _- _ •_ tie. 4 - Prevention Device, which is S25 +got surcharge g
f "! : !I ; _��. f >!4 � id;fieSc - [i4listllD$T�9>€r ,ti
egg j B gt : •,4 rg ' sM• ;;ES ''All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:tds:scannstoiumepp.dcc 50.1 S', .