Permit ~
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CIW TI PERMIT #......: pLM96-0175
� ��� � DTF ISSUED: 06/28/96
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COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 2S101AA-06100
SIT Pi
SUBDIVISION ^ WEST PORTLAND HEIGHTS ' ZONING C-G
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . .: 17 � �� ,0��^~� ^� �
________ -- � � «�= ~ ~ �� v ' `- 14„ �.
CLASS OF WORK.. :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES.: '0 '
TYPE OF USE ^COM WASHING. MACH. . . ... . : 0 BACKFLOW PREVNTRS.. : 0
OCCUPANCY 'GRP. . :B . 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)...: 60
WATER CLOSETS.. : 0 WATER LINE (ft). ; . : 50
DISHWASHERS ^ 0 RAIN DRAIN (ft)...: 0 '
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Remarks: Site work for temporary buildings
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Owner: FEES '
LANDMARK FORD type amount by date •ecpt
12000 SW 66TH AVE '`PRMT $ 60.00 B 06/28/96 96=281160
5PCT $ 3.00B 06/28/96 96=281160
TIGARD OR 97223
Phone #:
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Contractor: '
POWER PLUMBING CO '
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P 0 BOX 23144
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TIGAR OR 97281 ---- ' ----
Phone #: 244-1900 • $ 63.00 TOTAL
Reg #..: 52378 ` .,
REQUIRED INSPECTIONS --
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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 Misc. Inspection
applicable laws. All work will be 'done in accordance with Final Inspection _
approved 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. - __ � __
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Permittee Si ature: � ��. - \ ___ _____ ____
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Issued By:. 7�� �v ___ ~_ .
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' Call for inspection - 639-417�5 `
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. - � �( s Permit # Pi-/-6 01 }S
Tigard, OR 97223 t� o r � c � ' C am. s SG- 01 es"
(503) 639 -4171 �q L
o M MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name otOsi o eni New Single Family Residences Only
LO Inl d w• uZ( l o
AddreA ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job 1 -70 Q.0 (-,C9 Qv-C- ❑ 3 BATH HOUSE $225.00
Address cis . ro Fee includes all plumbing fixtures in the dwelling and the first 100 feet
Ti 9ca,1• -/ (NJ) 1-111.3 of water service, sanitary sewer and storm sewer. See fees below.
Nom name at esa) J FIXTURES QTY PRICE AMT
j iv /"a&z.>K" Funs. Sink 9.00
Meal Address P hone Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
cimsate ro Shower Only 9.00
Water Closet 9.00
Name tar name at dueness) Dishwasher 9.00
Garbage Disposal 9.00 •
Occupant wino Addr,aa Mame Washing Machine 9.00
Floor Drain 9.00
cawsat• ro Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
Poi..J -ell- ?1-u,..-RI v..y ) 242'1°- /900 Other Fixtures (Specify) 9.00
Marling Address Phone 9.00
Contractor _ !�
Q S SIt) (Ltaa.i2_ 00//22) 9.00
City /sate AP 9.00
? aru , 016 I 7.2/ 9 Sewer 1st 100' Ga 30.00 30 0t
State Roost/at/on No. City Sus. Tax Na. Sewer - ea. Addit. 100' 25.00
Ga 2.37V ) t /( t Water Service 1st 100' S' 30.00 �
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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 •
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
� / Back Flow Prevention
_) t� a,,h (;"-Z1-7(c) Device or Anti- Pollution Device 9.00
sidrtaue co.. '., ar agent) Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL G .440
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE '
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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 p
TOTAL p
Special Conditions . (27.-"
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Date issued by