Permit •
A CITY OF TIGARD PLUMBING PERMIT
, r � DEVELOPMENT SERVICES PERMIT #: PLM1999 -00166
'�' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 57
SITE ADDRESS: 13217 SW ROCKINGHAM DR PARCEL: 2S104DB -02200
SUBDIVISION: AMESBURY HEIGHTS ZONING: R -4.5
BLOCK: LOT: 022 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 prevention device
FEES
Owner:
Type By Date Amount Receipt
TILLEY HOMES INC PRMT BON 5/24/99 $15.00 99- 315606
14210 SW 121ST AVE MISC BON 5/24/99 $0.75 99- 315606
TIGARD, OR 97224
Total $15.75
Phone 1: 620 -4196
Contractor:
G + B PLUMBING
PO BOX 1269
HILLSBORO, OR 97123 -1269 REQUIRED INSPECTIONS
Phone 1: 640 -5770 RP /Backflow Preventer
Reg #: LIC 00000199 Final Inspection
PLM 34 -44PB
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: ' �- Permittee Signat �� _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Che
13125"SW HALL BLVD. Commercial and Residential Rec'd By o
TIGARD, OR 97223 Date Recd '�' 1' erir
(503) 639 -4171 Date to P.E.. A
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# Il �(
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE . AMT
Job RAMS hu lo ,1�, f A, k Sink 9.00
Address Street Address Suite /� Lavatory 9.00
/32/7 541 reilAyikitil o Tub or Tub /Shower Comb. 9.00
Bldg # ty/Shat Zip 7 Shower Only 9.00
Name
��� 7 / z z u Water Closet 9.00
-7----/ C. E_fS' /s /A7f5 Eke, Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
/I/Zip f w l Z at 4V 1Nashing Machine r 9.110
City /ate Zip -- Phone Fl Drain/Floor Sink 2" 9.00
/ 11-11%€ 177 6 9/`�
Name _ 2" 9.00
4" 9.00
Occupant Mailing Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal . 9.00
Name 6 F 1u -„(rte ( Other Fixtures (Specify) 9.00
Contractor Mai' g Ad ss � - Suite 9.00
'V i 1 9.00
Prior to permit I /S Zip 30.00
issuance, a copy 1-V I I a OR. / /L5 Phoo Sewer -1st 100' 3
CD 1.40-57
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database - Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device T,
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00 , 0
(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 O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes 0 No O Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. 'SUBTOTAL 0
I hereby acknowledge that I have read this application, that the information 1i
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ` _f'
that plans submitted are in compliance with Oregon State Laws. _ .
Signature o ner /Age t Date "PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
r
. 3 1 ° 0 9 TOTAL 11�'
Contact Person Na a Phone • 1 J' ��
'j ,r k^ ^ � I 1 I b z �yJyJ� „ _ i 'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
�Ic / 1 ` Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
1:ldstsWonnslplumapp.doc 11/30198
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PLEASE COMPLETE:
Fixture Type Quan .by Performed,;
New Moved . I Replaced Removed /C apped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:ldstsVormslplumapp.doc 11/30/98