Permit CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # / 9 99 99 —¢ 064
DATE ISSUED: 03/08/
*10EL: 28116AD -19100
SITE ADDRESS...: 16814 SW RIVERA LN
SUBDIVISION • KING CITY NO. 10
BLOCK • 24 LOT °012 JU' .DICTION: KIN
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE °SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS 0 TRAPS : 0
STORIES • 0 WATER HEATERS • 1 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: Replace an existing water heater.
Owner: FEES
JOHN P KAIZER type amount by date recpt
16814 SW RIVERA LANE PRMT $ 25.00 GEO 03/08/99 KING CITY
KING CITY OR 97224 SPCT $ 1.25 GEO 03/08/99 KING CITY
Phone #:
Contractor
C GEORGE MORLAN PLUMBING
9806 SW TIGARD ST
TIGARD OR 97223
Phone #: 624 -6895 $ 26.25 TOTAL
Reg #..: 000027
REQUIRED INSPECTIONS
This per.it is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. This per.it will expire if work is not started
within 180 days of issuance, or if work is suspended for •ore
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- YA1 -0010 through OAR 952 -0001 -0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246-1987.
/ . G � �G%f/
Issued B y : , /��i_ �// Permittee Signature: ��
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
MA„R- 08 -'99 MON 08:44 ID: FAX NO: I4051 1
FE" -1? -1959 ;4: ' 7 RECEIVED e2
p REC EIVED Plumbing Application Read By
.�+
•
Dato Reid � - lQ � 9�i
3125 SW HALL BLVD. Commercial and Residential i,, 1999 b ate to P.E.
'IGARp, OR 97223 FEB 2X99
Oulu to oar S -if
50:) 639.;4171 I I ` UtvELOPMENPen
COMMUNI(1 UEVEIOPMEN( 1 cart pe Related 51NR p
/� Incomplete or illegible appli ions will not be accepted Celled -
W r0. 1 / � / 14) Q 7 R -
Name of Development/Project On beck Indicate Work Performed by Warm
Job Soh fl kou Ter FIXTURES,,pndlvidual)' :' ;1 - •.. , ; : T PRICE • AMT
Sink
Address I / 41 4 4 w +4l a L 9.00
•-r
Lavatory •9.00
Meg = Iryi rate Zip 'ND or Tula/Shower Comb. 9,00
i rn C art A r. _ 4� Snowier only 9.00
Name
S ' `water closet 9.00
Owner Mailing Address Suite Olatreeaher 9.00
Garbage Disponi 9.00
GtyrStats Zip Phone Washing Machute 9.00
Nome
Mot Mein r 9.00
• s• 9.00
Occupant "w "'am" swae ' 4- • 9.00
City /State Zip Phone
Water Healer 0 conversion tlke 0
Rind 1 9.0
Laundry Room Tray 9.00
• Name r
9.00
�
- !� p� Other Futuna (Specify) 9.00
Contractor 5 .'f - Ilrtg aroas � " Suite - 9.00
sw i SI 9.00 .
Prior to permit City/ le VO PRo e
issuance. a copy '"rC�tRRQ Q� g1. -j b2 - 9.00
of all licensee am Oregon Cones. Cont. Board UGS � p Data 9.00
required If .2. 6/ Sewer -1st 100• • 70.00
expired In CO1 Plumbing Lie's •
database Dam
2-G -••• (°O Pf5 w act/9$ sneer .scab addltlanal 100' 25.00
Name Water Service • 10t 100' . 30.00
Architect - avatar Sandra -each additional 200' 25.00
or Mailing Address Sutta ' Storm & Rain Ora% - let 100' 30.00
storm a Rain Drain - each a4atlonaf 100' 25.00
• Engineer c ltyrstate r Zip P Mobilo Home Spear 25.00
Commercial Back Flow Prevention Device or Anti. 25.00
OeVama work New 0 Addition 0 Alteration 0 Repair 0 Pollution devise
to be done: Reaiogrefel 0 Non-residential 0 Residential BackliOw Prevention Device- • 15.00 '
AdOluonet desongdo , of work: • Ani Trap or Waste Not Connected to a Pbourts 9.00
lia 1 6:114 J /Wak.e.r / eo..4 ee Catafl AIM 9.00
repLa e,im tAL - Insp. of waling PIUmbIng 40.00
per/hr
Existing use of Specially Regveamd Inspections 40.00
eulldtng or property por/M' ,
Rain Drain, single family beetling 30.00 •
Probated use of
building or property - Grepse Traps 9,00 •
I hereby aesnowledga that I nave read this application. that the Inkrrnedon laematttc rt r d<r dhgro b reotrba TOTAL
e t' Gtsttb Taut la s 9 _ - '
given is correct. that I em the owner or authorised agent of the owner, and. •8Y6TOTAt.
mat pia. - submteea ere In compliance wrm.Oregon State Lane. • : 5 ob
sign • r. of • etfAgent Data =�
/ 0% SURCHARGE
• 4 on MATS • s gran P LAN REVIEW 25% OF SUBTOTA4 .:.:•_ ••••• - •
.Fr T1
rr pp � AequIrea way r mum qtr. tea •. :v;d W ' , iiitssoa s o utr4ti• • • D�� .L .. plum al . . • ..,.,..:.....:::•• ... . .TOTAL r 2' i �
; r . , • • . -- . �j �G 1 •Minimum permit fee la 525. sumnerge. cu crept Residential gladiola • .
. // jdtevtrttdon OrvKe, tuhoN Ia 115.5% iid
a »rg4i ; , % , : 1 - ?t: ;_: ! ,
. V 3'"�'Q tfr/a +'(J, " . r 'w >:'.
• TOTAL P.02
6/9/00 Activities for Case #: PLM99 -00064
3:57:17 PM
4
Assigned Hold Updated 4;5
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 APPlication received 3/8/99 GEO FAX GEO 3/8/99
PLMA005 Create Permit 3/8/99 GEO DONE GEO 3/8/99
PLMA799 Final Inspection GEO 3/8/99
PLMA050 (F) Issue permit 3/8/99. GEO PASS GEO 3/8/99
PLMA845 Request inspection research 5/19/00 ST DONE No Hold ST 5/19/00
PLMA850 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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