Permit ' PLUMBING PERMIT
Cl1Y OF � PERMIT #....... : PLM96-0269
DATE ISSUED: 09/12/96
' COMMUNITY DEVELOPMENT DEPARTMENT
1u1uoew Hall Blvd. Tigard, Oregon o72u°m1wm (503) 639-4171 PARCEL: 28113AD
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..: 1
OCCUPANCY GRP..:B FLOOR 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 : SEWER LINE (ft ) ...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 40
Remarks: LIMTED SITE PERMIT: Grading ONLY on private only. No site utilities
allowed. 1
Owner: — FEES
BINGHAM PROPERTIES ' type amount by date recpt
3939 NW ST HELENS RD PRMT $ 25.00 TAT 09/12/96 96-283896
5PCT $ 1.25 TAT 09/12/96 96-283896
PORTLAND OR 97229
Phone #: 224-2676
Contract or: ,
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD •
PORTLAND OR 97208-9328 —
Phone #: 503-777-7777 $ 26.25 TOTAL
Reg #..: 5009
REQUIRED INSPECTIONS -------
This pernit is issued subject to the regulations contained in the RP/Backflow Prev
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 pereit will expire if work is not started
within 180 days of issuance, or if work is suspended for more _
than 180 days.
•
Permittee Signature:
- — —
Issued By: _ _ ______ _ ____
Call for inspection — 639-4175
--y
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
' 13125 SW Hall Blvd. • Permit # PLIVt` -0,R 6q
Tigard, OR 97223 SI rt6 - G0o7
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
r I l r a» + /' 0 1 � J - New Single Family Residences Only
.0 lam(' Y c ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE 3195.00
Job S I&) 1 2 ❑ 3 BATH HOUSE 3225.00
Address u vsn.. n Fee includes all plumbing fixtures in the dwelling and the first 100 feet
1 lGO J ; l � 77.7 t4 of water service, sanitary sewer and storm sewer. See fees below.
I Nom (ot. an oo (itio / ( , " FIXTURES QTY PRICE AMT
,faP Ia.Y' n I . �l i rfre(? Sink 9.00
:FiC M.snp Aae« w'°"' Lavatory 9.00 •
Owner I r 11 ��� �� • . � � � �i e • • -2-40-u4 Tub or Tub/Shower Comb. 9.00
Shower Only 9.00
T0 r�, n 27 Water Closet - 9.00
"'om r°' mow e ' °i°°
", t / �/7 ' ' Dishwasher 9.00
Occupant _ i "' 1w t Ce Garbage Disposal 9.00
"'"'p A°° Washing Machine 9.00
/ 7 2-0 (SW 7 2-D-4 Floor Drain 9.00
m
_ Water Heater 9.00
l2 Lk '/, 0 R g7zz,4-1 Laundry Room Tray - 9.00
Urinal 9.00
• 1Ir vi }1,i, c ) % 7Y LANAI(' 0/116 Other Fixtures (Specify) 9.00
roam . ess R+i° 9.00
Contractor 1 - I -Th 7
1 � F)r� nF� Jioh ncnvl Lyk . el vd 9.00
°"'t'" , 9.00
- PO K+Alil ] , OR g 7 / JJ ^ Sewer 1st 100' 30.00
state Rspiitro1an No. °t' Bo. Tot "' Sewer - ea. Addit 100' 25.00
5 1)9 (51,16 -1 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that 1 am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain lst 100' 30.00
1 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
•�4 ���( � ,( %L/ L// 1U �� Device or Anti-Pollution Device , 9.00 �-
5 ipi'o`° (*.sou ° "p° °"° Any Trap or Waste Not
Connected to a Fixture • 9.00
Describe work new` 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 backtlow
prevention devices)
NOTICE *Minimum Fee 325.00 SUBTOTAL. R J/j4L 5-
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 77ii -
r J 1, �
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED r f7
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL 0 91
Special Conditions
Date issued by