Permit - -■' CITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: P /23/19 00305
�! 11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/23/1999
SITE ADDRESS: 12144 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00101
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M 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: Commercial backflow prevention device
FEES
Owner:
Type By Date Amount Receipt
WILLIAM W. SAUNDERS TRUSTEE PRMT BON 09/23/199E $32.00 99- 318574
AVE 5PCT BON 09/23/199E $2.24 99- 318574
HONOLULULULU, , HI 96875
Total $34.24
Phone 1:
Contractor:
CEDAR LANDSCAPE
14145 SW GALBREATH DRIVE
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 625 -3700 RP /Backflow Preventer
Reg #: LIC 75535 Final Inspection
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 callin• (503) 246 -1987.
8 ,
Issued By: �� Permittee Signa i A_.
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede • he next business day
CITY OF TIGARD Plumbing Permit Application Plan Check
13125 S,IV HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd 2-3 `d/
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # M 1 -
Related SWR #
. Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job cocri \ r Sink 11.50
Address Street Address Suite Lavatory 11.50
llyy SCJ sr1>dls Tub or Tub /Shower Comb. 11.50
Bldg # -t- lily /State I Zip C/ Shower Only 11.50
Nam= IL L,//IPt ,:/ $ 70 7'7Lf5 Water Closet 11.50
-- I0 liallf.at..= Dishwasher 11.50
Owner Mailing A.. ress 90000 Suite Garbage Disposal • 11.50
'' O /L Washing Machine 11.50
. CV State Zip Phone Floor Drain/Floor Sink 2" 11.50
5b[,u 1 -u qW 5 .36 -8�s
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 11.50
j Urinal 11.50
N „e i w r 1 C �, _ Other Fixtures (Specify) 15.00
Contractor Mailing Address ��(t�� // llchx -�R Suite
/ i /Q5.Sr) Gct /jea Dr
Prior to permit City /State Zip Phone
issuance, a copy sh ?ve 5 - -37c 9)(. i II
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 5134/3
expired in COT Plumbing Lic. # Exp. Date
database cg /,' Sewer - 1st 100' 38.00
Name Sewer - each additional 100' 32.00
/ ° -
{� /�(�. �Ct -AM , ''� i -�
Architect e (� - Water Service - 1st 100' 38.00
or Mailing Address Suite Water Service - each additional 200' 32.00
En ineer City/State Zip Phone Storm & Rain Drain - 1st 100' 38.00
g /77 7 _ yaaa Storm & Rain Drain - each additional 100' 32.00
Describe work to be done: Mobile Home Space 32.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00 llll���7 2
Residential 0 Commercial,B( Residential Backflow Prevention Device' 19.00
Additional descripfon of work:
,t l j n' Catch Basin 11.50
if' 1 en ba ckci W Insp. of Existing Plumbing 50.00
Are youkcApping, moving or replacing any fixtures? per/hr
Yes 0 No 0 Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per /hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.0
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that plans submitted are in compliance with Oregon State Laws.
*SUBTOTAL
Sign ure o Owner /Agen Date .3 it
9 9Y /3 - 7% SURCHARGE ` .7 ,4'„r v '�
Contact Person Name Phone ���
ec7 Plank-en 62 -37aU X alI "PLAN REVIEW 27% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
•
2 BATH HOUSE $250.00 . TOTAL
�JJ
3 BATH HOUSE $285.00
(This fee Includes all plumbing fixtures in the dwelling and the first
, �'
.100 feet of sanitary sewer storm sewer and water service) *Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
Device, which is $25 + 7% surcharge
"Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:tdstsVorrnstplumapp.doc 7/9/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
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:\dsts formslptumapp.doc 7/9/99
10/08/1999 Activities for Case #: PLM1999 -00305
10:42:37 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 09/23/1999 BON DONE No Hold BON 09/23/1999
PLMC005 Permit Created 09/23/1999 BON DONE No Hold BON 09/23/1999
PLMC750•RP /Backflow Preventer 09/23/1999 09/23/1999 No Hold BON 09/23/1999
PLMC799 Final Inspection 09/23/1999 09/23/1999 09/24/1999 TLP PASS No Hold AKJ 09/26/1999
PLMCO50 (F) Issue permit 09/23/1999 BON DONE No Hold BON 09/23/1999
PLMC800 Case Finaled 09/26/1999 AKJ DONE No Hold • AKJ 09/26/1999
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