Permit CITY OF TIGARD
DEVELOPMENT PLUMBING PERMIT
u�u�mn�n���o nmno�»�o SERVICES PERM IT . . :
- 'a. /3/�;8N/Ma08hui Tigard, /�3)G���/7Y ^ ^ ^ ^ ^ PLM96-0191
Blvd., '"--' `' DATE ISSUED: 12/09/96
/599,5 PARCEL: 2S113AB-00800
SITE ADDRESS...: 4-6455-SW 74TH AVE
SUBDIVISION.. .. : ZONING: I-P
BLOCK..........: LOT.............:
_
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 DRAINf�'... .. : 0 TRAPS... ....... .... : 0
STORIES.. . . .... : 0 WATER HEATERS.....: 0 CATCH BASINS. ...... : 0
FIXTURES LAUNDRY TRAYS ^ 0 SF RAIN DRAINS ^ 0
SINKS. . . . . . 0 • ' URINALS ' • - ^ 2 • GREASE TRAPS ^ 0
LAVATORIES..... : 5 OTHER FIXTURES.... : 5
TUB/SHOWERS....: 0 • SEWER LINE (ft)...: 100
WATER CLOSETS..: 5 WATER LINE (ft)... : 300
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 100
Remarks: New building: JADCO
Owner: - FEES
JOHN DUNCAN type amount by date recpt
16055 SW 74TH AVENUE ,PRMT $ 277.00 JSD 12/09/96 96-287454
PLCK $ 69.25 JSD 12/09/96 96-287454
TIGARD OR 97223 5PCT $ 13.85 JSD 12/09/96 96-287454
Phone #: 684-0044
Contractor: -
OWNER
Phone it: $ 360.10 TOTAL
Reg #..: 99999
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contaioedjo the ' Water Service In
Tigard Municipal Code, State of Ore. Specialty Codes and all other Rough-in Insp
applicable laws. All work will be done in accordance with PLM/Underfloor
approved plans. This pormit.wi\l expire if work is not started Top-out• Insp
within`180 days of issuance; orifwork- is suspended for more Storm Drain Insp
than 180 days. Drinking Fountai
RP/Back fl Prev
Final Inspection
Permittee �� ~-���
~ (� )
Issued a:. ^ �m��' .�\ ����_Amite
Call for inspection - 639-4175
r
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
11125 SW Hall Blvd. Permit # ( - ^ '` 96 " -5 19/
Tigard, OR 97223 5wit ci - 6`3
(503) 639 -4171 A
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
"e °f Deie1opTent • New Single Family Residences OnIy
Addr ,S " t � / � ��� ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
S /
Job ❑ 3 BATH HOUSE $225.00
Address • /State zip Fee includes all plumbing fixtures in the dwelling and the first 100 feet
ay, O � Oc � �2?2 / of water service, sanitary sewer and storm sewer. See fees below.
N a name of Bumf,.) FIXTURES QTY PRICE AMT
Sink 9.00
Mailing Address Phone Lavatory , s` f 9.00
y5 r Or
Owner Tub or Tub /Shower Comb. 9.00
City/State DP Shower Only 9.00
Water Closet ,/ 9.00 7c ,art
Name (or name of business) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Md g ,gym Phone Washing Machine 9.00
Floor Drain 9.00
Cay /State Lo Water Heater 9.00
Laundry Room Tray 9.00
NamO Urinal y,,, ✓ 9.00 / e . vi..
1 1 4 Other Fixtures (Specify) 9.00
1 � MaTng Address Phone / ^ H 5e / ` 1 / 9 U, o -o
Contractor Q
Dr/pi /4 nli / 0u., Z / 9.00 . at-
City /State MP
- L66 2 ..5i•/ k4 ",), v" 9.00 7 g.ov
Sewer 1st 100' 30.00 3 0. 0 -0
State Registration No. City Bus. Tat' No. Sewer - ea. Addit. 100' 25.00
Water Service 1st 100' / 30.00 3 0 • 0-0
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' , 25.00 25 . 0z1
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.vz)
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
Device or Anti - Pollution Device / 9.00 9. v-t)
Signature (or.'+er or 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 67-7, et
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 13,9
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 C2
TOTAL r 61°
Special Conditions L i x �
Date issued by --
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Of
Footing Rain Drain Cover /Service
Foundation Water Line Ceiling -•1 •.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. To. Out Insulation - Elect.
Post/Beam Struct. ech. Rough -'' Gyp. Bd. -Bldg.
San. Sewer as Line Appr/Sdwlk Reins.
Other: 4W
5 �e- 7
Date: / //? l A.M. P.M. Entry:
Address: Aar vmo - allibi
�
Tenant: ���- -� �• Ste: •� MST:
7 BUP:
Con /Ow 7. EC:
M: / /,__._�i/
EL :
THE FOLLOWING •RRECTIONS ARE REQUIRED: ELFit ' 1111111111FP--
Lim \
Inspector.!! Date: /7j (U 'C�v
PROVED _ DISAPPROVED /CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Ibg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 3 4 ( A. P.M. Entry:
Address: .. C 5/—A-- %llt
i
Tenant: 1 ��` Gay MST:
/� / BUP:
Con /Own: (9 S Li - O 0 y MEC:
PLM:
ELC:
r THE' FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspec . -� Date: 3/6
APPROVED DISAPPROVED /CALL FOR REINSP. CF CO