Permit CITY OF TIGARD PLUMBING PERMIT
i4 DEVELOPMENT SERVICES
PERMIT #: PLM2000 -00189
'�I i� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12271 SW QUAIL CREEK LN PARCEL: 2S103C6 -07800
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT: 027 JURISDICTION: TIG
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 Device
FEES
Owner:
Type By Date Amount Receipt
DON MORISSETTE HOMES INC PRMT JMT 06/08/200C $50.00 0002796
4230 GALEWOOD ST #100 SPOT JMT 06/08/200C $4.00 0002796
LAKE OSWEGO, OR 97035
Total $54.00
Phone 1: 387 -7538
Contractor:
REQUIRED INSPECTIONS
Phone 1: RP /Backflow Preventer
Reg #:
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.
Issued By: / Permittee Signature: d /2 21_ ,
Call (5 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
06/0 6 r99 TUE 10:57 FAX 503 598 1960 CITY OF TIGARD lw....,...
CITY .OF TIGARD Plumbing Permit Application Plan Check
13125 SW HALL BLVD. Commercial and Residential Redd By ITI„0.,,:2
TIGARD, OR 97223 Date Rac'd .
-
_
(503) 639-4171 . RECEIVED
- .: •
• Print or Type . Date to DST . . •
, ,,, •
or Illegible applications will not be accepted Perrnft* ` sbept) - (34" / V
• . r . ...
Related SWR a
. -
. .
COMMUNITY DEVELOPMENT . .. Called -: • . .7
' ....
Name of Daveopment/Project .Lor __ri . AP.ogmlticitiagaioig,:izititiwtvi t-. .. -..• -
Job atu-d- 61ollolk3 Sink 11.80 • -
• Address SireetANddress ... I Suits Lavatory . _ . 11.50 ..
- ra---- 3 LL" I L:€-- ' C Lti_vie_ Tub or Tub/Shower Comb. 11.50 •'
. -
.........._ only
, ban MOYiscedle... ifirwrieS .. Cishwasher • .. . .
- • -- .... , _. .... . :. . _.
• Owner . Haling Address Suite . Garbage Disposal . " 4 11.50 .*
qa30
SW 6,raci-voc,CL.
Washing Machine . 11.50 .
atylS'ate Zip Phone
1.4:LieC OS Weci0 OR., 790- L C/ S� Floor Crain/Floor Sink 2' . 11
. .50
' •
,
• Nac . re\ . 3" • 11.50 - •
-. -
• . r , 11 53
Occupant Walling Ad . ss Suite • Water Heater 0 convemion 0 11w kind . 11.53
• Gas piping requirea a separate mechanical permit '
Cfty/State Zip Phone - Laundry Room Tray . 11.50
- Urinal
. . .
-- - .
C _ 1- Pro Grems Lame 1 s• c e_., .. : Other Fbthaes (Specify)
15.00
. .
Contractor Mang Address .- . Suite -
N - • ''' -
. -- •
.91 5' gv Ktnori4A . . . . , - .. . . .
., ._
Prior to permit City/State Zip Prone LP - - -; sewer - 1st ivy
issuance. a copy Lvi i sin ville. o1L97070 1.074, Sewer -7-9.17 - — each additional 100 -32 00
: ...
._,.. - ' . . : . . • ' -'-,-.-
- of all licenses are Grego Conat. Cont. Board L1c.# . • . Exp. Date .: - ,_ • -
required if . • - Celtp • . g/ a Water Service -1st 100 • . • - - , . • .:,.: . - 18.00_ , .",.,•!..:„.., q .
_ ._
. . . ... . .
expired In COT Plumbing 1.1c. 8 • Exp. Date . .• . '•-• Water Service - each additional 200' ' ., .,: , .' n-:.-4,•• ,..; ..;32.90
. .. .. ,...
:database . Storm & Rain Drain - 151100' . - , , : ..: ; i . ,..t ', 38.00
Name • .__
- - Storm & Rain Drain -: each additional 100' . 32.00 • _:• • - --• ;•.
Architect - - :- Mobile Home Space : - : ' -, , - . .: r. :. . ' 3200 , - r -• ••••.‘ .,-:".::,.".:: .
or . Mailing Address Suite `
' Commercial Back Row Prevention Device or Aral- ,, 32.00 , ': -.-
. • Pollution Device
• Engineer City/State Zip Phone Residential BOCKnOW Prevention Device' • a 19.00
• (Irrigatlor timing devices require a separate /
. i . .-. .
. -
Describe work to be done: . restricted energy permit) . .
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fbdure • 11.50
Residential 0 Commerdal 0 Catch Basin 11.50 . —
Additional description of work:
Insp. of Existing Plumbing 50.00
•
perer
Specially Requested Inspections • 50.00
Are you capping, moving or replacing any fixtures? per/nr •
Yes 0 No 0 , Rein Drain, single family dwelang 45.00
If yes, see back of form to indicate work performed by Grease Traps 11.50
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. —
QUANTITY TOTAL 1;1:4
I hereby acknowledge that i have read this application, that the information Isomeric a Our diagram Is required If Quanty Teta! Is ,• 9 I 1.
4.: 1,n....-,,i
given Is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL i. - 7, - " , ' Xf4A
that plans submitted are in compliance with Cregon State Laws.
=ef,Svngent Qate , -
V. 15% SURCHARGE :.:-:
1 1F-i':11 1 -V: i0::V43:
. .
Contact Person . Phone' "PLAN REVIEW 25% OF SUBTOTAL 51:
• Requimd vrly [item qty. totsI is a. e ! . il.Iii••. ir3jiii".it-lr'l, •
IMMIWAMPAN TA X. rig4L.rr—i-al TOTAL - .....E- -- - , •ou' Aeigb.
rAkIeW0.0E.A.;50.3.3024.-'ji--.1tatfit÷-t-vitif...4-g-amm...4._---:latplxeLz • .
M.M11:113:01104.41-?-.7 _
Minimum permit fee is $50 + 5% surcharge, except Residential BackRow
ffiThEstp..r.A-Mti:FANIAMIODWalifgre.40110A10(ggitierg:fiu --• Prevention De•Acs. whid) is $7„5 + 5% surcharep
■t-i-06;24ariii1.1-aiieSfier-Vtgillie*-.;11-4--t*L4liAlkriani-gigg **All New Conenercial Buildings require plans with isometric or riser diagram
and plan review
Odstsnmeslsiumapp de: 5/2!
•
06/15/2000 Activities for Case #: PLM2000 -00189
2:45:09 PM
Assigned Hold Updated ,
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 06/07/2000 MAIL RECD No Hold JMT 06/07/2000
PLMA005 Create Permit 06/07/2000 JMT DONE No Hold JMT 06/07/2000
PLMA750 RP /Backflow Preventer 06/12/2000 MRS PASS No Hold AKJ 06/12/2000
PLMA060 (F) Issue permit 06/08/2000 JMT DONE No Hold JMT 06/08/2000
PLMA800 Case Finaled 06/12/2000 AKJ DONE No Hold AKJ 06/12/2000
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