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CITYCdr TIG Q' D _ _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM98-00261
DATE ISSUED: 1/18/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2`'102 BC-00600
SITE ADDRESS: 12675 SW GRANT AVE
SUBDIVISION- NO TIGARDVILLE ADDITION AMENL ZONING. R-4.5
__ 8l_I7CK: LOT: OU5 _ JURISDICTION: TIG ---
CLASS OF WORK: REP 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: 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: 100 ft
WATER CLOSETS: 0 WATER LINE: U ft
DISHWASHERS: 0 RAIN DRAIN: U ft
Remarks: Iverson sewer repair _ —
FEES _
Owner: — --- Type By Da' , Amount Receipt
JAMES IVERSON PRMT CTR 1/18/02 $30.00 272(:0200000
12675 SW GRANT AVENUE 5PCT CTR 1/18/02 $1.5C 27201200000
Total $31.50
Phone 1:
Contractor: —
APOL LO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: 239-8801 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 apprc , 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
�_---- --
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
t
CITY OF i IGARD Pitarnt'�ing Por!riit Application Plan Check#�__
13125'3W HALL BLVD. Commercial and Residential Recd By_
TIGARD, OR 97223 Date Recd _
(503) 639-4171 Date to P.E.
Print or Type Date to DST _ /
�1� -
Incomplete or illegible applications will not be accepted Permit*. L Q C�'
Related SWR#
me of De3e pmenuProject FIXTURES (individual) -�-QTY PRICE AMT
a
f 9.00
I Sink
Job -
Addiess Street Address Suite Lavatory 1 9.09
Tub or Tub/Shower Comb. 9.00
Bidg# City/Staw ZI Shower Only _ 9.00
Water Closet 9.00
Name
Dishwasher 9.00
Owner Mallinq ddress Suite Garbage Disposal_ 9.00
c Washing Machine 9.00
Cly/ tat6 Phone Floor Drain/Floor Sink 2" _ 9.00
-- / '- C( - 3" 9.00
m
Nae
4" 9.00
Occupant Mailing Address Suite Water Heater O conversion O like kind 9.00
Gas piping requires a se erste mechanical ermit.
City/State Zip PhoneI Laundry Room Tray 9.00
_ Urinal 9.00
Name Other Fixtu es(Specify) 9.00
ApeAA 9.00
Contractor Mailing/Add
ress Suite 9.00
') )
Prior to pem'ii City/Stale 9'O Phone Sewer-1st 100' 3J.00HtO
issuance,s copy ZI I Sewer-eacli additional 100' 25.00
o!all licenses are E-6re-�gIdIfi Const.Cent.Board LIc.# Dee Water Service-1st 100' 30.00
required Ii tr iexrired in COT ing L c.# Exp. r Water Service-each additional 200' 25.00
databasea 5�3 �_ Storm&Rain Drain-1st 100' 30.00
Name form&Rain Drain-each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suito Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City/State Zip Phone Residential Ba::kflr�w Prevention Device' 15.00
(Irrigation timing devices require a separate
restricted energy permit.)
Describe work to ne done:
New O Rr,pair A Replace with like kind: Yes O No O Any Trop r,.:^:cite Not Connected to a Fixture __9.00
Residential dD Com_mercla•. O _ Catch Basin 9.00
Additional description of work: I Insp.of.-xisting Plumbing 40.00
�r� erlly
Specially Requested Inspections 40.00
er/hr
_ ---- Rain Drain,single family dwelling 30.00
Are you capping,moving or replacing any fixtures? Grease Traps 9.00
Yes O No q
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 >r9
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%SURCHARGE t
that lans submitted are in c iic94fth Ore on Slate maws.
signatu owner l en Date "PLAN REVIEW 26%OF SUBTOTAL
Required only If fixture qty.total Is>9
YOTOTALOIL
I
Con t Penson N Phone
*Minimum permit fee is$25+5%surcharge,except Residential Backflow
Prevention Device,which Is$15+5%surcharge
----
**All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I\dite\plumaPP doc MIN
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Remove i/Capped
Sink
Lavatory .- ------ ---- ----
Tub_or_Tub/Shower Combination
Sho_wP, Only - --- -- - - --- ---------
Water Closet --
Dishwashei _—
_Garbage Disposal
Washing_Machine
Floor Drain/Floor Sink 2"
4" _
Water Heater —
Laundry Room Tray
Urinal
Other Fixtures (Specify) _
COMMENTS REGARDING ABOVE: