Permit CITY OF TIGARD
/nr i DEVELOPMENT SERVICES PLUMBING PERMIT
I=. 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # • PLM98 -0356
DATE ISSUED: 09 /25/98
PARCEL: 28114BB -01400
SITE ADDRESS...: 10265 SW SERENA WAY
SUBDIVISION ° PICKS LANDING NO.1 ZONING: R -4.5
BLOCK LOT °028 JURISDICTION: TIG
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: Alteration to residence.
Owner: FEES
CHRIS JABLONSKY type amount by date recpt
10265 SW SERENA WAY PRMT $ 25. DLH 09/25/98 98- 309489
TIGARD OR 97224 SPCT $ 1.25 DLH 09/25/98 98- 309489
Phone #: 968 -1624 • EXPIRED .
Contractor
RESCUE 'ROOTER
PO BOX 1728
•
WILSONVILLE OR 97070
Phone #: 243 -1172 $ 26.25 TOTAL
Reg #..: 127325
REQUIRED INSPECTIONS
• This permit 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 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 Signature: ?i/g"
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
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C ITY OF TIGARD Plumbing Permit Application Plan Check# -
13125 SW HALL BLVD. Commercial and Residential Rec'd By L),
TIGARD, OR 97223 Date Rec'd V:- .. 7
(503) 639 -4171 V Date to P.E.
Print or Type I I Date to DST
Incomplete or illegible applications will not be accepted Permit# f�G/`f 9,P G 35
Related SWR #
Called �-
Na e lopment/Pro'ect FIXTURES (individual) QTY}' = PRICE n AMT.
Job / • CAM /S�� Sink 9.00
Address S / - t Address 1, , `�� �� > Suit Lavatory 9.00
AO 2 &5 SW <9 " A llAll- Tub or Tub /Shower Comb. 9.00
Bldg # ,may /St�
97 Z'24 Shower Only 9.00
Name cst�� Water Closet 9.00
Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
City/State Zip Phone
Washing Machine 9.00
Floor Drain /Floor Sink 2" 9.00
74./ �y .
Nam 3" 9.00
4" 9.00
Occupant Mailing Address Suite / Water Heater 0 conversion like kind 9.00
/'1 Gas piping requires a separate echanical permit. I
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Na� rt i „ , - gGr , `
C� % d N mil/ Other Fixtures (Specify) 9.00
Contractor
Mpjlmg Ad ss 7 � Suite 9.00
Pi 7 o / IRFri 9.00
' Prior to permit Ci /St to cl0 Pon Sewer - 1st 100' 30.00
issuance, a copy o1/3-)/7 7r
Sewer - each additional 100' 25.00
of all licenses are regon Const. Cont. B rd Lic.# Exp. D to q .
required if /oZ 7 3 Z /a ,vzi," Water Service - 1st 100' 30.00
expired in COT P Lic. # Q Exp. D to Water Service - each additional 200' 25.00
database Ca 3 79 J J O 3/ 4�Pg '' ,�' / ?? 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
Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential ej b[_ Commercial 0 Catch Basin 9.00
Additional d scription 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 No O Grease Traps 9.00
If yes, see back of orm to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL �6 11
I hereby acknowledge that I have read this application, that the information
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ��
that plans submitted are in compliance with Oregon State Laws. , ,
Signature of Owner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL .
V Z5/ 9e Required only if fixture qty. total is > 9
TOTAL n
tact Person �?a Phone , ae,,,a.s
4 91-/ /l y V , *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
7 Prevention Device, which is $15 + 5% surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
1ldstslplumapp.doc 712/98
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 /Floor Sink 2"
3 "
4"
Water Heater /
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:ldsts\plumapp.doc 717/98