Permit c ITv OF TIGIARD PLUMBING PERMIT
PERMI # PLM96 -0158
COMMUNITY DEVELOPMENT DEPARTMENT
DATE ISSUED: 06 /18/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 - 4171
PARCEL: 2S113AD -01700
'SITE ADDRESS...: 16920 SW 72ND AVE
SUBDIVISION : ROSEWOOD ACRE TRACTS ZONING: C —G
BLOCK • LOT •30
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE :COM WASHING MACH ° 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:8 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)...: 800
WATER CLOSETS..: 0 WATER LINE (ft)... 0
DISHWASHERS : 0 RAIN DRAIN (ft)...: 0
Remarks: Sewer line only
Owner: FEES
BINGHAM DEVELOPMENT type amount by date recpt
C/0 MACKENZIE /SAITO PRMT $ 205.00 JSD 06/18/96 96- 280724
PO BOX 69039 5PCT $ 10.25 JSD 06/18/96 96- 280724
PORTLAND OR 97201
Phone #: 224 -9570
Contractor:
KEEFER PLUMBING INCORPORATED
52300 SW SOUTH RD
GASTON OR 97119
Phone # : 503 -640 -7457 $ 215.25 TOTAL
Reg #..: 065481
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
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.
� 1
Permittee Signature . I" • \» 1 .1.
Issued `H •.�i� ��*
Call for inspection — 639 -4175
City Tigard PLUMBING PERMIT APPLICATION Planck /Rex. # (lL 9 6-6 ' 151
=13125 SW Hall Blvd. 5r� 96- 0-30 � Permit
Tigard, OR 97223
(503) 639 -4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
New Simile Family Residences Only
S, � __ ' p ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job / Oct 2-0 W `` 1 S ❑ 3 BATH HOUSE $225.00
Address ^-�nv Fee includes all plumbing fixtures in the dwelling and the first 100 feet
1 1 ck 9 0-v- a l 1 Z? of water service, sanitary sewer and storm sewer. See fees below.
Name (or narrTe at Bushes.) FIXTURES QTY PRICE AMT
n! �
t J Lavatory 9.00 LcuA, .�.-� `�'Q'I.1 veld 1 Sink 9.00
Malin Address
31 3c( 4-/ � �,Q ' j T , g) Tub or Tub/Shower Comb. 9.00
Owner ZIP Shower Only 9.00
t
?O (44 eu-ci. , 0 a.
, 0 7 Z) 6 Water Closet 9.00
Name �
(or name of business) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Malq Adg,aa Pitons Washing Machine 9.00
Floor Drain 9.00
Oty
BP Water Heater 9.00 Laundry Room Tray 9.00
_ Urinal 9.00
e_ctt p I 1 `� L Other Fixtures (Specify) 9.00
`�� 9.00
''Aeeip Address 9.00
9.00
Contractor 5 Zsdo S x.�l Sox t0cto
zw
9.00
&0 aMSan "TD
30.00
t _ 16) v C�' Sewer 1st 100' i 3d
7 cnr am. Tex P1° Sewer - ea. Addit 100' 7 25.00 / T S
State Raghuetlon Mo.
to .514-.Z( Water Service 1st 100' 30.00
1 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 Stone & Rain Drain 1st 100'
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 1 100' 25.00
I am registered with the Construction Contractor's Board, that the
number given is correct. (If exempt from State registration, please Mobile Home Space 25.00
give reason below.)
I Back Flow Prevention 9.00
1 iS_ 1 _ Device or Anti - Pollution Device
�� %I>_ ∎ di '`1 ' -'� Date Any Trap or Waste Not
7:...i ., •rr c a 9.00
8 � ll ��� Connected to a F ixture
in 9.00
Describe work new 0 addition 0 alteration 0 repair Catch Bas t
n on - residential NZ Insp. of Exist Plumbing 40.00/hr
to be done residential 0
Specially Requested Inspections 40.00/hr -
Rain Dra single family dwelling 30.00 i in, sing
Existing use of -
building or property Residential backflow prevention
devices 15.00
Proposed use of
building or prope '( E xcept resi dential bacM/ow
prevention devices)
NOTICE �y
'Minimum Fee $25.00 SUBTOTAL v L7
✓
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE I
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF /
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
PLAN REVIEW 25% OF SUBTOTAL
COMMENCED.
TOTAL �c'
Special Conditions
Date issued by