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9747 SW ELROSE STREET
CITY O F T I C A R D PLUMBING PERMIT
PERMIT#: PLM1999 00121
DEVELOPMENT SERVICES
DATE ISSUED:
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S111 BA-00304
SITE ADDRESS: 09747 SW LLROSE ST
SUBDIVISION: TIGARDVILLE HEIGHTS DICT ON TIG
BLOCK: LOT: 027 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCI 13ANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _. LAUNDRY TRAYS: 3F RAIN DRAINS:
SINKS: URINALS: GRF_ASE TRAY S
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Add water line for refridgerator.
FEES
Owners - Type By Cate — Amount Receipt
JANICE CARLSON PRMT GEO 4/22/99 $25.00 99-314758
9747 SW ELROSE MISC GEO 4/22/99 $1.25 99-314758
TIGARD, OR 97224
Total $26.25
Phone 1: `
Contractor:
OWNER
REQUIRED INSPECTIONS
Misc. Inspection
Phone 1: Final Inspection
Reg #:
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 w thin 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 ruies or direct questions to OUNC by calling (503) 246-1987.
Permittee Signatures -
Issued By:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed th/e next business day
CITY OF TIGARD Plumbing Permit Application PlanGhecktY _
-13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Rec'd
(503) 639-4171 'Date t)P,E.
Print or Type rale to DST
Incomplete or illegible applications will not be accepted Phrmlt*AN IffI-a!;?/
Related SWR 0
Called.
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 9.00
Address street Address Suite Lavatory - 900
Tub or Tub/Shower Comb. 9.00
Bldg* City/State Zip Shower Only 9.00
Name �
z c/ Water Closet 9.00
�. Dishwasher 9.00
Owner Mailing Address Suite Garbage Dlbposal 9.00
7 r Washing Machine 9.00
City/State Zip Phone Floor Drain/Floor Sink 2" 9.00
- --
Name �" 9.00
_
4" 9.00
Occupant Mailing Address Suite Water Hestbr O conversion O like kind 9.30
Gas piping rewires a separete mechanical permit.
Clty/State Zip Phone Laundry Room Trey 9.00
Urinal 9.00
Name Other Fixtures(Speclt,i) 9.00
UJA7l;F Li fit:. f(^ �
Contractor Mailing Address - Suite _ �G f x:1 9.00
9.00
Prior to permit Clty/State Zip Phone Sewer-1 at 100' 30.00
issuance,a copy Sewer-each additional 100' 25.00
of all licenses are Oregon Const.Cont.Board Lic.0 Exp.Date
required If Water Service-1st 10(' 30.00
expired In COT Plumbing Llc.* Exp.Date Water Service-each additional 200' 25.00
database Storm&Rein Drain-tat 100' 30.00
Name Storm&Rain Drain-each additional 100' 25.00
Architect Mobile Home Space 25.00
or Meiling Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device _
Engineer City/State Zip Phone Realdentlal Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: mstricted energy permit.)
New O Re air O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential Commercial O match Basin 9.00
Additional description of work: Ins of Existing Plumbing 40.00
e,00e G LW �-le P 9 9 per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping,moving or replacing any fixtures? Rein Drain,single family dwelling 30.00
Yes O No O Giesse'Traps 900
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 6 Quantrty Total is >J _
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL
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 6%SURuHARGE
that plans submitted are In compliance with Oregon Slate Laws.
Slpnatu / wner/Agent Dr�q **PLAN REVIEW 26%OF SUBTOTAL
R uired only M fixture total is>9
526> '), `� r) TOTAL A
ntact Poreon Noma Phond _
iJ Prevention
permit fes is Is +5%surcharge,except Residential Backflow
Prevention Device,which Is E15+5%surcharge
**All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
lVeo napp.doe 7)1/98
PLEASE COMPLETE:
YFixture Type-_v- -- 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"
391
Water Heater_ —
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMML'.NTS REGARDING ABOVE:
I WoMpkunpp.doc MM