Permit - 1
CITY OF TIGAIkRD
PLUMPING PERMIT
PERMIT # PLM96 -0027
DATE ISSUED: 05/03/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard. Oregon 97223.8199 (503) 839 -4171 PARCEL: 2S 101 AA -09001
SITE ADDRESS...: 12585 SW 68TH AVE
SUBDIVISION • WEST PORTLAND HEIGHTS ZONING: C —P
BLOCK • LOT •29
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE °COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:B2 FLOOR DRAINS • 0 TRAPS : 0
STORIES ° 0 WATER HEATERS • 2 CATCH BASINS • 2
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS • 0
SINKS • 1 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 2 OTHER FIXTURES • 1
TUB /SHOWERS ° 0 SEWER LINE (ft)...: 100
WATER CLOSETS..: 2 WATER LINE (ft)...: 100
DISHWASHERS • 0 RAIN DRAIN (ft)...: 100
Remarks: Develop a 4,500 square foot office building.
Owner: FEES
J T ROTH CONST INC type amount by date recpt
12540 SW 68TH PARKWAY, SUITE B PRMT $ 189.00 JSD 05/03/96 96- 278962
PLCK $ 47.25 JSD 05/03/96 96- 278962
TIGARD OR 97223 SPCT $ 9.45 JSD 05/03/96 96- 278962
Phone #: 639 -2639
Contractor:
AC MECHANICAL
12300 SW 69TH
TIGARD OR 97223
Phone #: $ 245.70 TOTAL
Reg #..: 068388
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the PLM /Underfloor
Tigard Municipal Code, State of Ore. Specialty Codes and all other Top —o u.it Insp
applicable laws. All work will be done in accordance with Storm Drain Ins p
approved plans. This permit will expire if work is not started Rain Drain Insp
within 180 days of issuance, or if work is suspended for more Misc. Inspection
than 180 days. RP /Backf 1 ow Prev
Final Inspection
i
Permittee Signature: ',� jar'
41111111) Issued By: /�
/ Call for inspection — 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 6 / - 2,7--C---
13125 SW HaII Blvd. (4:4u e 96 - a° 3 Permit # PP-r� 94 - 0-0 z
Tigard, OR 97223 i M''� 5 0 9 6_ �
(503) 639 -4171 ge6(ke`l6- 0-013 (/7 MIN IMUM $25.00 PERMIT FEE + ST. SURCHARGE
Woe _ • New Single Family Residences Only / "Odi° �_ [� 0 1 BATH HOUSE 3140.00 0 2 BATH HOUSE 3195.00
Job 0 3 BATH HOUSE 5225.00
Address urea.. w Fee includes all plumbing fixtures in the dwelflng and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
Morro (co moo 0l FIXTURES QTY PRICE AMT
V • T yl rG. 43t ,o Sink i 9.00 c
Aodi c ,
avi l. Mang " Lavatory 2 9.00 / g.ogot) � ' � AwNRef. , /�GL,I� 91223 Tub or Tub/Shower Comb. 9.00
/ , ` Shower Only 9.00
d di 1,25'/C SaJ 6,8 Water Closet �� 9.00 / S
Nuns for malls of °i
n) Dishwasher 9.00
f 7 r 6- Garbage Disposal 9.00
Occupant M o Ado. Phone
Washing Machine 9.00
aWiteoYL Floor Drain 9.00 -,
atom. av Water Heater Z 9.00 re op
Laundry Room Tray 9.00
ti. Urinal 9.00
X • G. r Ct I- 5g 7 / / d Other Fixtures (Specify) 9.00
D 1 /4 k - ' w.vT.ar/,, , 9.00 y err)
,Z
Coltrador 9.00
/ 5A) ,/
dfi ,� q�I 9.00
� Sewer 1st 100' j 30.00 30, u0
Scots RoppoiotIon No. cky as. T° "0. Sewer - ea. Addit 100' 25.00
b Q 3 8 ' - 24/ 3 R5 Water Service 1st 100' / 30.00 3 o.
I hereby acknowledge that I have read this application, that the Water Service ea. Addit 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100'
/ 30.00 30. OZI
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
/ Bads Flow Prevention
► ��' - "'� i'14.- 96 Device or Anti- Pollution Device j 9.00 q do
•o•m o.e Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new A addition 0 alteration 0 repair 0 Catch Basin 2 9.00 / g. o-v
to be done residential 0 non - residential fir Insp. of Exist Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of / ,J
building or property t/n Gf P IJC� Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property ii .074-sT or744C-
'(Except residendal backflow
prevention devices)
NOTICE 'Minimum Fee 325.00 SUBTOTAL /V C'°
PERMITS BECOME VOID IF WORK OR CONSTRUCTION �/
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF 5% SURCHARGE 9, `'`S
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL 1 i eC
TOTAL 24/5' W
Special Conditions �/ /I , ii
Date is bsed W I. / / by / ,/ . ,