Permit CITY TIGARD PLUMBING PERMIT
„AI-
4°4 40 I DEVELOPMENT SERVICES PERMIT #: PLM2000 -00100
'�I I' 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12565 SW QUAIL CREEK LN PARCEL: 2S104DA -00300
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 040 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 • PRM4 BON 03/29/200C $25.00 0001013
4230 GALEWOOD STREET 5PC2 BON 03/29/200C $2.00 0001013
SUITE 100
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.
Issued By: e, ( , ( �,�Q`(,�(�, Permittee Signature: cr l Cedtd'V•
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
06/06/99 TUE 10:57 FAX 503 598 1960 CITY OF TIGARD e 002
CITY OF TIGARD Plumbing Permit Application Plan Cneck
13125 HALL BLVD. E ' VD
DCommerciai and Residential Reed By ( J
TIGARD, OR 97223 RECE' Dare Recd 3 -7 -yaw
(503) 639 -4171 Q Date to P.E.
• MpR 2 9 ZOQ� Print or Type Date to :DST
In or II le applications will not be accepted Permit P, RAVI -AbfA"
COMMUNITY DEV�W Related SWR e
Called
Name of DeveiopmenUPrcjec LOT 4/0 :FIxTURWAI.1 .4 e? ... - •`QVY' :,PRICE i-i4M7_;
Job 0 -a- 4ol10-v3 Sink 11.
Address Street Address �1'�,,,�� Suite Lavatory 11.50
• /a. SO, 5 SW camit -.. Gi'I e& r! 4e- Tub or Tub/Shower Comb. . 11.5C '
• Bldg fi " • City /State Zip - ' Shower Only 11.50
77/em k 0/2 91.9.a1-3
Name Water Closet 11.50
73OY) /17bYI Hd Clshwasher I 11.50
Owner Maifng Address Suite Garbage Disposal 11.50
Wa30 s'w Ga.lewood Washing Machine 11.50
City /State C
Fl
Zip Phone Floor Crain/Floor Sink 2° 11.50 .
oor n.
y 790- le 9 SO
(..a -fcc vSwc o oR,
• Name 3° 11.50
4° 11 - 50
• Occupant Melling Ad , ss Suite Water Heater O conversion 0 Ike kind 11.53
Gas piping requires a separate mechanical permit. ,
City /State Zip Phone Laundry Room Tray 11.53 I
Urinal 11.50
r4r/Ctsco.p - rib Grass L aid soap e, Other Fixtures (Specify) 18.00 l
■
Contractor Meiling Address Suite I
a9Ir5 S gv kGnfmaj.P -4)
Pricr to permit City/State Zip Phone G t?a - Sewer - ist 100' . 38.00
Issuance, a copy WO Sin u/lk 0297070 107ep an Sower - each additional 100' 32.00
of all licenses are Orego Const. Cont. Board Lic.x Fes. Date
required if Oregon ' /3 /) 0 Water Service -1st 100' 38.00
expired in COT Plumbing Lie S I Exp. Date" Wa }er ServIoe - each additional 200' 32.00 .
database I Storm & Rain Drain - 1st 100' 38.00
Name • Storm & Rain Drain - each additional 100' 32.00 l
Architect Mobile Home Space 32.00
or - Mailing Address Suite Commercial Back Flow Prevention Devise or Antl- 32.00
• Pollution Device
Engineer I City/State Zip Phone Residential Bacltfow Prevention Device" i 19.00 `y eo
(Irrigation timing devices require a separate
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 Fixture 11.50
Residential 0 Commercial 0 Catch Basin 11.50
Additional description of work: .
Insp. of Existing Plumbing 50.00
per/hr
Are you capping, moving or replacing any fixtures? Specially Requested Inspections per /i
E! /'lf
Yes 0 No O Rein 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 : have read this application, that the information Isomnrle cr riser diagram Is required if Quan'iy Taal is s• 9 1 • i - .. - . ° !_' _' •
given Is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL _ .
that plans submitted are In compilance with Cregon State Laws.
SjyAetvrsr'efSv ent . Date V. T►°A, SURCHARGE ;:: ;_
Contact Person Phoni "PLAN REVIEW 25% OF SUBTOTAL "
Requi ed Drily 11 fixture qty. total Is; 9 : : :
•
:T Is "" ` 1 a
_ _ _ _ _ r_ - xse _r te :� > . TOTAL _
w ° ; . '.:
, ith"; _-_-. .r �� :L __.;_ F_ ri� + Mi permit fee is $50 + 5% surcharge, except Residential Backflow
1� _ , ;t ms o�.
fr . i oval(rifti;,,p pidri - 1 t�4 41.1 ! b a;� :> ; j -- Prey Ion Device. wh_L:h is 25 + 5% surcharge
i• _� ;,. • Vetal`sahf te siviBit S_lomr s�tt�;_ Ij!f ._1 "All New Commercial Buildings require plats with isometric or riser diagram
._ • - - - °`_. and plan review
I:1ds :st`xmstplumaps.dc: Sr21S3
06 /08 /2000 Activities for Case #: PLM2000 -00100
3:45:13 PM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 03/29/2000 BON DONE No Hold BON 03/29/2000
PLMA005 Create Permit 03/29/2000 BON DONE No Hold BON 03/29/2000
PLMA750 RP /Backflow Preventer • No Hold BON 03/29/2000
PLMA799 Final Inspection 04/04/2000 MRS PASS No Hold AKJ 04/04/2000
PLMA060 (F) Issue permit 03/29/2000 BON DONE No Hold BON 03/29/2000
PLMA800 Case Finaled 04/04/2000 AKJ DONE No Hold AKJ 04/04/2000
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