Permit CITYOFTIGARD
�a ,:i,, ,; DEVELOPMENT SERVICES PLUMB I NS PERMIT
'..... 1 3125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 PERMIT .. , .. .: l'' r —
�-.M9E 0172
3ATE ISSUED e 03/12/97
PARCEL: 281. 13:AD -0 1. 7 00
SITE ADDRESS--; 16920 SW 72ND AVE
S:Jn Y VISION..... ROSEWOOD ACRE_ TRACTS ZONINGS C-0
BLOCK....... • LOT .............: 30 JURISDICTION : TIC
CLASS OF WORK. = : NEW GARBAGE. D ' CPOSiALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE., .. : CON WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY ORP..:8 FLOOR Dfl iiNS.... _ .. 0 TRAP.;.. - ........... , ; '!
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) ...: 0
WATER CLOSETS.: 0 WATER LINE (ft) . = .: 100 .
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 200
Rema.rks e Site related plumbing only
Owner: ---------- - -- -- -- - -- - - - - -- - - - -- -- FEES
BING' -HAr DEVELOPMENT type amount by date recpt
C/O MACKENZIE /SAITO PRMT $ 103.00 B 08/12/97 97- 298176
PO BOX 69039 PLCK fl; 25.75 B 03/12/97 97- 298176
PORTLAND OR 97201 5PCT $ 5.15 8 08/12/97 97-- 298176
Phone i
Contract or .--- •- --- ----- ----- -• - --- - - --
KEEFER PLUMBING INCORPORATED
52300 SW SOUTH RD
GASTON OR 97119 - • - - - - -- -- --------------- - - - - --
Phone #: 503-640-7457 13 133.90 TOTAL
Rel #..: 056481
---- -••• -- REQUIRED INSPECTIONS - •- - - -- - --
This pereit is issued subject to the regulations contained in the Water Service In
Tigard Municipal Code, State of Ore. Specialty Cades and all other Storm Drain Insp
applicable laws. All work will be done in accordance with Rain Drain. Insp -
approved plans. This periit will expire if work is not started F i n a l Inspection
withir.. 183 days of issuance, or if worn is suspended for pore
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 95 -0010 through OAR 952 -0001 -0080. You may
obtain copies of these rules or direct questions tc OUNC by calling _
(503)246 -1987.
issued 8 y; _/��21 /��/ 1 — p' e r e 1 t t e e S i l� n a' r_r r^ e: �1!l G I l Cam' `o-ri
_____
+ F h ++++-F. F +•i-+ + +-1--F +•f . + +++- F + ++ + + + + +-i•+ + +- }•-F• +-F-I f F. ...................
(2 .11 639-4175 by 6:00 p.m. for an inspection needed the next business day
- 1-4- +-1- --}• ++ + + + + + + + + + + + + + ++ +++.4 F -1 - 1- 4- +++ + +•i-•i-++ +-t-•1 + + +-1-+ ++°F•-f ++ ++ + + ++-t•+- 1-+-t- 1 -4-1 - h•+- F•-.+4.-I --t•++
City of Tigard PLUM IN ' . T APPLICATION Pianc ec. # 6 -0
13125 SW Hall Blvd.. , Permit # r 96 • o /�2
Tigard, OR 97223 / C e 6 �, < < _ S q(- 0 '3j �r
(503) 639 -4171 0(9 '_`e ��-d(5� + T. SURCHARGE
S ,(.-- Ci UL MINIMUM $2E.00 'PERMIT FEE S
Name Deeebpmem A New Single Family Residences Only
I c Val► CX CRAZ,
Address ❑ 1 BATH HOUSE $140.0r; ❑ 2 BATH HOUSE $195.00
Job L (e el 20 S (.0 1 V p ol-e ❑ 3 BATH HOUSE $225.00
Address coy ZIP Fee includes all plumbing factures in the dwelling and the first 100 feet
- 27_3 of water servi0p, sanitary sewer and storm sewer. See fees below.
Name (or na of Business) FIXTURES QTY PRICE AMT
1u O ' `t".�.� '4 Sink 9.00
Ma®np Address I� . _ 1 - j Lavatory 9.00
t1� f % caner 3 5/ I w St1 Z r Tub or Tut.'Shower Comb. 9.00
/ 1CDVAA-U11■4k. o p Shower Only 9.00
0 V Cr) Z. (0 Water Closet 9.00
Name or nam • • r ` Dishwasher 9.00
fi. �a�• -•' Garbage Disposal 9.00
• Occupant M ;= r Mime �-
P M • • . _ Washing Machine 9.00
Floor Drain 9.00
ZIP Wa ter Heater 9.00
Cpy/Slets • +.__
Laundry Room Tray 9.00
-- Na Urinal 9.00
V --`-C rZ- V .- PU- Other Fixtures (Specify) 9.00
Meiling Address ,,,� g � Phone 9.00
C i , tractor 5 s C b k ` p z 0 00 ' / 9.00
1 cayrsrn. 9.00
iii � ° �.� l ( av I a\r - c9 Sewer 1st 100' 30.00
! `
• �� A at. Registration No. . ay But Tax Na• 6 Sewer - ea. Addit 100' 25.00
fi r? -8,1 (' ' l - 1 G �' Y1 Water Service 1st 100'
1 I 30.00 ? 0
I hereby acknowledge that I have read this appli o , t the Water Service ea. Addit 200' 25.00
information given is correct, that I am the owner or authorized agent of Storm &Rain Drain 1st 100' , 30.t!0 7
the owner, that plans submitted are in compliance with State laws, that
i am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' / f 25.00
number given is correct. (If exempt from State registration, please Mobile Home Space [ �` ' 25.00
give reason below.) _
I Back Flow Prevention
di • 0_ - • �' 11 I P Device or Anti - Pollution Device 0• 9.00 /
Signature (0M1ef or e •, ) Date Any Trap or Waste Not
Connected to a Facture 9.00
9.00 9. �
Describe work new 0 addition 0 Aeration 0 repair 0 Catch Basin - 7?
' .
g to be done residential 0 non - residential _ Insp. of Exist Plumbing 40.00/hr
Specially Requested Inspections , 40.00/hr
Existing use of Rain Drain, single family dwelling 30.00
building or property
Residential backflow prevention
devices 15.00
Proposed use of �n (AAA n ( l 1
buildi or property v ll v (�( `�--�C *(Except residential backflow
prevention devices) --- .
NOTICE \ " Minimum Fe. 10700 ` i$"� -'
`
e $2500 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE J
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5,15
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED ,
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25% OF SUBTOTAL ?'Y'
COMMENCED. . _
TOTAL ��� 1� • Special Conditions 0 �
Date issued by I