12050 SW MANZANITA STREET ISHHIS VILINVZNVW MS OSOZT
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12050 SW MANZANITA ST
CITY QEF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT 4
RERMIT #. . . . . . . : PLM97-0272
AyMMUM 13125 SW Hall Blvd.,flgard,OR 97223 (503)6394171 DATE ISSUED: 07/10/97
PARCEL: 1S134CA-00606
;ITE ADDRESS. . . : 12050 SW MANZANITA ST
SUBDIVISION. . . . : PANORAMA ZONING: R-4. 5
BLOCK,. . . . . . . . . . . Lo-r. . . . . . . . . . . . . :5 JURISDICTION: TIG
_---------_ ---------
CLASS OF WORK. . :ADD GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
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. . . . : N
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (rt ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Rema►-ks : Add residential backflow prevention device
Owner.. ------------------------------------------------------- FEES --------------
JANETTE M TRUSSELL. type amount by date recpt
12:050 SW MANZANITA COURT PRMT $ 15. 00 GEO 07/10/97 97-296960
TIGARD OR 97203-3261 5PCT $ 0. 75 GEO 797/10/97 97-2296960
Rhone #:
Cont r-act or----------____-_-----------------
OWNE=R
--------------------------------------
Phone #: 639--4171 X370 f 15. 75 TOTAL
RPg #. . : 000131
------- REQUIRED INSPECTIONS ------ -
This permit is issued subject to the regulations contained in the RP/Backflow Prev
Tigard Municipal Lode, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
a approved plans. This permit will expire if work is not started
X within 189 days of issuance, or if work is suspended for more —
N than 188 days. ATTENTION: Oregon law requires you to follow rules
} adopted by the Oregen Utility Notification Center. Those rules are
J set forth �n OAR 952-A I-011 through OAR 952-MI-MM. You may
m obtain copies of these rules or direct questions to OUNC by calling
(503)246-1987.
W
Issi_ied By : Permittee Signatut-e :
+++++++++++++++++i-++++i•+++++++i•+++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 6:00 p. m. for- an inspection needed the next business day
' +i++++++++++++++++++++++++++++++++++++++++++++++++i+++++++++f•++++++++++++++++
I
r
ITY QF TIGARD Plumbing Application Recd Br_
3125 SIM HALL BLVD, Commercial and Residential °ia ReCd
IGARO, OR 97223 oaf.to P E
503) 639-4171 Us*"OST
Print or Type Roo ltd SVWR 0
Incomplete or illegible applications will not be accepted 1:aNd
visnas of oewwgrnenNPtoNaW WOW
RE�q
Job Llr1i1LIy CLLt e � b34rt 9.00
Address SW" +1r 9.00
r- CTub orubfshow.r Comb. 9A0
SM9! f tat9 allShower Dfwy 9.00
Nartte WaW Ckteet 9.00
@ �_ o�trrasfter f00
Owner Mwirq Address suite Gwftp MaPoeM 9.00
`ucttl c cMq fitactMrte 9.00
C11rfStVA Zip Pttorte Flow orsm 2' 9.00
Tl �Svn 3,117.1
9.00
'
4-
9.00
Occupant meM Address Suite water Heat.. 9.00
Cityrstete ZIP Phone LaurW1r Room Tray, aw
Urinal 9.00
Name
00tr names(may) 9.00-
L 9.00
.00-
9.00
Contractor few nmesa Sut: 9.00
-tor to WWI" Cityrs M 2Ip Phone - 9.00
+op"Cant must - 9.00
provide all Oregon Const.Cont.Board, Exp.Date - 9.00
contractors
t>esme
Pkmnbft tJc.! Exp.Date Sewer-1at 1o0' 9.00
ktforrtnMon 30.00
for COT COT Business Tax or Metro! Fxp•Dan Sewer-each adttltlorteJ 1110 23.00
vysNa Service-tar 100
datattase►. 30.00
Name - water Seton-ear+,additional 200' 25.00
Architect I ))I ) storm A Ram Drain-1st 1W J0.00
Or -G-ft;Address Stith slam A Rale Drain-each additional 100' 20.00
Mobft Home span 25.00
Engineer Gtyfstate Zip Phone co r�i s Fktw Pniven yon Devin-or ArrtN 25.00
Pokid
evto
,!scnbe work New O AddRion O Alteration O Repan O Residenm SAcWtow Prevertlion Device' 15.00 J
oe done: Residential O Non-residentIM O
Any Trap or waste Nut Corrteuad to a Fuchxra 9.00
aditional description of work
i1 Catch Basi - 9A0
Insp.of E-xkrkq pkm*kq
U sting use of Specially Requested Irtspectlpts 40.00
ding or propertypwft
-
Ram Drain.sirt *family dwe" 30.00
J oo3e+q use of Grease Traps
m Ming a-property__ 9.00
ui T QUANTnY TO'AL
:you capping, moving or replacing any,flxhxes7 resIsorr eft or riser d WM is re**"r auarry Total a
I you see back of form) 'SUBTOTAL
.z. ..^, -
KretiY acknowledge that I have read this apptication.that the information-
-,en is correct that I am the owner or authorized agent of the owner.and 694 SURCHARGE
At olars wbrttitieq are in compliance with at Slate Laws. - . -; .• y J
gnature of OwnerfAgent n.y PLAN REVIEW 25%OF SUBTOTAL ' _
Ry, Und only f fba"Wy.total is>9 �L
TOTAL
Person 1 1
P
'
rite" i
•Mk0murn permit fee 3%
is 323. atxeharge.&=W Raaide+.'al
59e 347 Pt.wntion _ *is 3,s.sx at,r ,r9.
BP1Mttipp.doc 12/96 (dst)
' .EASE COMPLETE AS APPROPRIATE TOPROJECT:
Fixtures to be capped, moved or replaced Q
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)
'OMMENTS REGARDING ABOVE:
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COMMUNITY DEVELOPMENT
0plmapp.doc 12/% (dst)
CITY OF TIGARD BUILDING INSPECTION Di VISION
24-Hour inspection Line: 639-4175 Business Phone: 639-4171
INte Requested: ( I�i �1 A.M. _ PAL MST:
13UP: ----
T.nruat Suite: MEC:
Contractor: Phone' �`r(�'- -3 -7 Ll
C
Owner: Phone: C o [ V��� _ ELC: —
SIT:
BUILDING BLDC(con't) PLUM;gING MECHANICAL ELECTRICAL SITE
Site Post/Beam Poo/Beam Post/Beam Cover/Service Sewer/SGmn
Footing Roof UndF/Slab Rougn-In Ceiling Water Line
Slab Framing Top Out Gas Lige Rough-In IJO Sprinkler
Foundation Insulation Sewer / Hood/Duct Reconnect Vault
Rsmt Damp Drywall Storm furnace Temp Service MISC.
Masonry Ceiling Rain Dram A/.: UG Slab
Shear/Sheath Fire Spklr/Alm W/Found I icc! 'lump Low Volt
Approved ihl2d- App cued Approved Approved
Appy/Sdwlk Not Approved ved Not ikpproved Not Approved Not Approved
FINAL FINAL FINAL FINAL
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0 Call for reinspectio
n Q Reinspection fee of S , u fore next inspection C1 TJnable to inspect
Inspector: [��L Lite: Page_�of /
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