Permit _
PLUMBING pE10111
PERMIT # ^ PLM96-0058
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CITY � TIGARD DTE ISSUED: 04/04/96
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COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 2S101BD-00103
I TOu nftle §m 7§0eip, 171
SUBDIVISION ^ ZONING: I—L
BLOCK ^ LOT ^ .
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CLASS OF WORK..:ALT GARBAGE. DISPOSALS. : 0 MOBILE HOME SPACES.: 0
TYPE OF USE ^COM WASHING MACH : 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B2 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)...: 100
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS ^ 0 RAIN DRAIN (ft)...: 0
Remarks: Install up to 100' of sewer line
Owner: FEES
PACIFIC UTILITY EQUIPMENT type amount by date recpt
12805 SW 77TH PLACE PRMT $ 30.00 JSD 04/04/96 96-277821
5PCT $ 1.50 JSD 04/04/96 96-277821
TIGARD OR 97223
Phone #: 503-620-0611
Contractor: —
OWNER
Phone #: $ 31.50 TOTAL
Reg #..: 000000
REQUIRED 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 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 Signature: A0Part-(-/ Ai
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Issued By c�tc~~ '�~ `—
Call for inspection — 639-4175
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Tenant Name: ( /<: e- ----(---c ` ' /' ! 7 Accumulative Sewer Tally This SWR #: `AIL, - 0 /3 3
Address: i c �.
7 eS 5 7-2,=` pi This PLM#: g7Cr- c`Z'
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Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry /Font 4
Bath - Tub /Shower 4
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4 ,
- Domest 2 1
Drinking Fountain 1 _
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1 I
Oil Sep (Gas Station) 6 j-- U I
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6 _
Water Extractor 6
Water Closet, Toilet 6 ,
Urinal 6
TOTALS (c4
1 •
Total fixture values: divided by 16 =- - C/ EDU ! ,N j:5>-t- C/-64 6 t
HISTORY r n-7i / �
PLM# EDU# " SWR# &.../ '''`" �' - PLM# EDU# SWR#
PLM# EDU# S# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
ity of Tigard , dj ` PLUMBING PERMIT APPLICATION Planck/Rec. # 3 - I55 C✓
13125 SW Hall Blvd. ND' ' ( - o`O` Permit # , G
'Tigard, OR 972' 3 � der' c 96- a( 3 '3
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
pw Na a of Development � New Single Family Residences Only
�c /F ( C U t L( fiy 64
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
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Job yv - &J ri g77v) PL , ❑ 3 BATH HOUSE $225.00
Address c(wstet. n �1 LP Fee includes all plumbing fixtures in the dwelling and the first 100 feet
7 7 a/4 /C {) 0 /E 9 7)- 7.__ of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of Busneaa) FIXTURES QTY PRICE AMT
6 F Sink 9.00
Meing Address Phone Lavatory 9.00
Owner Tub or Tub /Shower Comb. • 9.00
City /State r4 Shower Only 9.00
Water Closet 9.00
Name (or name of busnaaa) Dishwasher 9.00
,4i Garbage Disposal 9.00
Occupant Malang Mn.. dr Phan. Washing Machine 9.00
Floor Drain 9.00
Cary/State 4 Water Heater 9.00
Laundry Room Tray / 9.00
Name Urinal / J , I 9.00
CLAMA - -5(2_ r Other Fixtures (Spa[ ii\fy) jI ----- 9.00
Marino Address Phone N ' / 9.00
Contractor YY i -
CDM- WA - n(L- �I�' . 9.00 - DC
Cfry /State Z. / ARTD. - ------- 9.00 ...)
. S6er 1st 100' ( 30.00 . 3 . 000
State Regbtration No. City Bus. To No. Sewer - ea. Addit. 100' 1, `(.. 25.00
Water Service 1st 100' « p r - 30.00_ _-
i I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 207(,. r'" 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' I 30.00
' I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 10 •,(, -e/t. 25.00
m from State registration, please
number given is correct. (If exempt g p
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti - Pollution Device ( 9.00
Signanee former or agent) Da1e Any Trap or Waste Not /
Connected to a Fixture 9.00
Describe work new Q addition 0 alteration 0 repair 0 Catch Basin I\\ , 1 - ___// 9.00 ,
to be done residential 0 non - residential 0 Insp. of Exist. Plumking t l 4,0_00/6 r
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) ,� •
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NOTICE *Minimum Fee $25.00 SUBTOTAL �� _ a ►�
e ! O a -- l r • RK OR CONSTRUCTION 5% ',
y 5/o S URCHARGE � - 180 DAYS, OR IF I ,� • • ONED'l ' ''' tK IS
W AND • SE ATTLE • SPOKANE i PLAN REVIEW 25% OF SUBTOTAL / �~
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Nw . �IllAS . �' � �-
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s ���
TOTAL
P a � s Ma h C f b V
PQ BOX 23009 h a9er Date issued y
1 2805 S.W. 77TH PL C
PORTLAND OR 97223
TEL: (503) 6200611
FA: (503) 684 - 7579