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Permit CITY OF TIGARD DEVELOPMENT SERVICES P9_l.1MI ING PERMIT 4 "' ° 01i Iil'j PERMIT 0 ° PL..IYI98 -00 I 13125 SW Hall Blvd., Tigard, OR 97223 (503)639 -4171 DATE: ISSUED: 03/16/98 PARCEL: 2S 1O4DB- •04500 SITE ADDRESS...: 13142 SW ROCK :I :NGHAM DR SUBDIVISION.....: AMESBURY HEIGHTS ZONING: R -4.5 BLOCK LOT °045 JURISDICTION: TIG CLASS OF WORK.. :ADD 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 SEWE :R LINE (ft)...: 0 WATER CLOSETS.: 0 WATER LINE (ft)...: 0 DISHWASHERS - 0 RAIN DRAIN (ft)...: 0 Remarks: Add residential backfl.ow prevention device to a new single familly dwelling. Owner: ---------------------- _.._---- ..___.________.___ FEES -- ------- GREG SIMMONS type amount by date recpt 4214 SW KANAN DR PRMT $ 15.00 GEO 03/16/98 98- 304148 PORTLAND OR 97221 5PCT $ 0.75 GEO 03/16/98 98. 304148 Phone #: Cont ractor-- •-- _..__— .___— .__._.____ ____ KOREY WINCHELL 17465 NW CARL. CT PORTLANDOR 97229 __._ _.______. _.._.._.._.....____.___.___.... _._ __._....._.__...._..__......__. Phone ##: 614 -0814 15.75 TOTAL Reg # #..: 00012E ------ REQUIRED INSPECTIONS ----- This permit is issued subject to the regulations contained in the RP /Bac:I;•fl.ow r rev Tigard Municipal Code, State of Ore. Specialty Codes and all other Fina I nspect ion applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started __•__ ___,•••__.__. ___ ._..__. within 188 days of issuance, or if work is suspended for more than 188 days.. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 0881-8910 through OAR 952-8881-8888. You may obtain copies of these rules or direct questions to OUNC by calling (593) 246 -1987. issued By: Pe•rmi.ttee Signature: +•+••4 +++++++++++++++++++++++++++++++++++++++++++++• +• + + + + + + + + + + ++ + + + + + + + ++ + + + ++ +•4 + Call 639-4175 by 7 :00 p.m. for an inspection needed the next business day ++++++•+•++•+•+++++•+•+++•+•++++++•+•++++++•+•++++•+•++++++++++•+•+++ +•+• +•+• + + + + + + + + + + + + + + + + + + + +•+• CITY OF TIGARD Plumbing Permit Application Rec'd By 13125 SW HALL BLVD. Commercial and Residential Date Rec'd TIGARD, OR 97223 Date to P.E. Date to DST (503) 639 -4171 Permit #,E'C:)JQ g' - ex , - 7, Print or Type Related SWR # Incomplete or illegible applications will not be accepted Called Name of Development/Project On back Indicate Work Performed by fixture. Job Ain e6ku j }/-e s t ic k-� j FIXTURES (Individual) _ QTY PRICE AMT Address Street Address J , Suite Sink 9.00 t , - tZ 5w e -pc & I Lavatory 9.00 Bldg # City/State Zip Tub or Tub /Shower Comb. 9.00 R t (le Shower Only IY 9.00 C LoL, e" CO.0 - 5 ,C)Cr(, (AU Water Closet 9.00 Owner Mailing Address Suite Dishwasher 9.00 gzlq 5 U g � be Garbage Disposal 9 City/State Zip Phone P© ni oR er7z7.1 Washing Machine 9.00 Name Floor Drain 2' 9.00 3' 9.00 Occupant Mailing Address Suite 4• 9.00 City/State Zip Phone Water Heater 0 conversion 0 like kind 9.00 Laundry Room Tray 9.00 Name Urinal 9.00 Q. e vo I -"C cf- ca-u._ Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 i 1- 1. 6 S u'-.J C---4 Cl- Prior to permit City/State Zip Phone 9.00 issuance, a copy cbgrtkiL'I pe. C7z 6 c( -A'(4 9.00 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date 9.00 required if (2-663 I I / 3f)/We Sewer - 1st 100' 30.00 expired in COT Plumbing Lic. # Exp. Date Sewer -each additional 100' 25.00 database Name Water Service - 1st 100' 30.00 Architect Water Service - each additional 200' 25.00 Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00 Storm & Rain Drain - each additional 100' 25.00 Engineer City/State Zip Phone Mobile Home Space 25.00 Commercial Back Flow Prevention Device or Anti- 25.00 Describe work New 0 Addition 0 Alteration O Repair 0 Pollution Device to be done: Residential 0 Non - residential 0 Residential Backflow Prevention Device' 1 15.00 Additional description of work: Any Trap or Waste Not Connected to a Fixture 1 9.00 Catch Basin 9.00 Insp. of Existing Plumbing 40.00 per/hr Existing use of Specially Requested Inspections 40.00 building or property per/hr Rain Drain, single family dwelling 30.00 Proposed use of Grease Traps 9.00 building or property QUANTITY TOTAL ��,,j (Nanny I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if is > 9 LAY"" given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL that plans submitted are in compliance with Oregon State Laws. ` Sig / li 3---g-eiza ture of Owner /Agent Date 5% SURCHARGE Contact arson Name Phone PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total Is > 9 i<oRecc wtAiC C- feLl_ 519-581) TOTAL 16‘,7_5 *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow Prevention Device, which is $15 + 5% surcharge I:ldststplmapp.doc 5/97 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved . Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain 2" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I:Wstalp mapp.doc 5/97 Page No. 1 CASE HISTORY FOR CASE NO.: PLM98 -0072 GREG SIMMONS 13142 SW ROCRINGHAM DR 06/12/98 Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By PI14A003 Application received / / / / 03/16/98 RECD GEO 03/16/98 DST PLMA005 Create Permit / / / / 03/16/98 DONE GEO 03/16/98 DST PLMA050 (F) Issue permit / / / / 03/16/98 PASS GEO 03/16/98 GEO PLMA750 RP /Backflow Preventer / / / / 03/18/98 PASS TLP 03/22/98 J *H PLMA799 Final Inspection / / / / 03/18/98 PASS TLP 03/22/98 J *H PLMA800 Case Finaled / / / / 03/18/98 PASS TLP 03/22/98 J *H • Page No. 1 CASE HISTORY FOR CASE NO.: PLM98-0072 GREG SIMMONS 13142'SW ROCKINGHAM DR 04/10/98 Action Description Rea/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By -- -- - -- -- --- --- --- PLMA003 Application received / / / / 03/16/98 RECD GEO 03/16/98 DST PLMA005 Create Permit / / / / 03/16/98 DONE GEO 03/16/98 DST PLMA050 (F) Issue permit / / / / 03/16/98 PASS GEO 03/16/98 GEO PLMA750 RP /Backflow Preventer / / / / 03/18/98 PASS TLP 03/22/98 J *H PLMA799 Final Inspection / / / / 03/18/98 PASS TLP 03/22/98 J *H PLMA800 Case Finaled / / / / 03/18/98 PASS TLP 03/22/98 J *H