Permit .
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT # • PLM97 0036
13125 SW HaII Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 02/07/97
PARCEL: 261O9AA —WHOO2
SITE ADDRESS...: 12929 SW WILMINGTON LN
SUBDIVISION : WILMINGTON HEIGHTS ZONING: R -7
BLOCK • LOT -002
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
, TYPE OF USE....:SF WASHING MACH 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:H1 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 SEWER LINE (ft)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: instl backflow device
Owner: -- FEES
SLS CUSTOM HOMES INC type amount, by date recpt
PO BOX 1093 PRMT $ 15.00 TAT 02/06/97 97- 290047
5PCT $ 0.75 TAT 02/06/97 97- 290047
TIGARD OR 97223
Phone #: 691 -9878
Contractor:
ALL OREGON LANDSCAPE INC
8575 SW SOROENTO RD
BEAVERTON OR 97008
Phone #: 646 -6426 $ 15.75 TOTAL
Reg #..: 000066
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Service In
applicable laws. All work will be done in accordance with Misc. Inspection
approved plans. This permit will expire if work is not started RP /Back f 1 ow Prey
within 188 days of issuance, or if work is suspended for more . Final Inspection
than 180 days.
Permittee Sign ur : ,
Issued By: / A.. /, . (A.6.1.0
'all for inspection — 639 -4175
CITY OF TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR-97223 Date to P E.
63J -4171
Date it DST
(503) Permit # Y(.m l 7 - "'" i
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
� Na ` me of Development/Prolect FIXTURES (Individual) QTY PRICE AMT
Job W Jm v L'T 44 2- Sink 9.00
S treet Address Suite Lavatory 9.00
Address Tub or Tub /Shower Comb.
1 a- 1-S W �I ,� 9.00
Bldg # City /State Zip Shower Only 9.00
7 O ' Water Closet 9.00
Name �� (
S. (...5 Cu- s m-i lNc--- Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
fo ( Washing Machine 9.00
City /State Zip Phone Floor Drain 2' 9.00
1 L& - J 4 1'lOk,y - __. (o■\ 'WW
3' 9.00
Name
4' 9.00
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City /State Zip Phone Urinal 9.00
Other Fixtures (Specify) 9.00
Name (
- - Pc \,-\ \ (` I d1--ZOs - 1.0 2 L - = _ = - _ 9.00
Contractor Mailing Address Suite 9.00
9.00
(Prior to issuance City/State Zip Phone
applicant must 9.00
provide all Oregon Const. Cont. Board Lic.# Exp. Date
9.00
contractors 9.00
license Plumbing Lic. # Exp. Date Sewer - 1st 100' 30.00
information Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
database).
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00 h �
Pollution Device d6'
' Describe work New 0 Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
1 Additional description of work Catch Basin 9.00
n r Insp. of Existing Plumbing 40.00
S ee.APIki 1 d\ N 'a- IP'4.,N0- per/hr
Specially Requested Inspections 40.00
R Existing use of per/hr
ouilding or property Rain Drain, single family dwelling 30.00
I Proposed use of n Grease Traps 9.00
building or property �.eJ�
QUANTITY TOTAL •
Are you capping , moving or replacing any fixtures? Yes 0 No o Isometnc or riser diagram is required if Mandy Total is > 9
(If yes see back of form) 'SUBTOTAL r
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. ►�S
S ature o / Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
Required orgy A Tatum qty. total is > 9
-
7 1 TOTAL 4
ontact Pe Name Pone -
"J�
I U( - A?? / *Minimum permit fee is S25 + 5% surcharge, except Residential Backflow
Prevention Device, which is S15 + 5% surcharge
l:\plmapp.doc 12/96 (dst)
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
•
Fixtures to be capped, moved or replaced Qty
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:
RECEIVED
FEB 0 6 1997
I:\plmapp.doc 12/96 (dst)
COMMUNITY DEVELOPMENT
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - umb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gaas Appr /Sdwlk Reins.
Other: /31—C4C ` !-
fO
Date: —2 -1D - 97 A.M. P.M. Entry:
Address: /24 2- rr!_c) tO/ l✓n /.U? k.,r) L/1/
Tenant: Ste: MST:
'" ' Olt- a�- nd 6 b Y2 4 EC:
Co wn:
S L 5 C _ �(1e S PLM: ,y7 - 00<3 F,
G� J J ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Al // /
IF z ri-fr
Ins ector: Date
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO 7