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Permit | . ~~' �^ COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd. Tigard, Oregon 9722 398199 (5o3)m39-41n PLUMBING PERMIT PERMIT #.......: PLM95-0161 639-4171 DATE ISSUED: 07/13/95 . .� PARCEL: 1S134AD-03000 SITE ADDRESS...: 10875 SW 108TH AVE SUBDIVISION....: BLACK BULL PARK ZONING: R-4.5 B OCK. . . . . . . . . . : LOT.... . . . . . . . . . :16 ____ _ _____ _ _ CLASS OF WORK :NEW GARBAGE DISPOSALS..: MOBILE HOME SPACES.: .. .. TYPE OF USE.... :COM WASHING MACH.... . . . : BACKFLOW PREVNTRS.. :1 OCCUPANCY GRP.. :A3 FLOOR DRAINS.. . . .. . : TRAPG.. . . . . .... .. . . : STORIEG........:1 WATER HEATERS......: CATCH BASINS.......: FIXTURES--- -- LAUNDRY TRAYS...... : SF RAIN DRAINS. .. .. : ! SINKS..........: URINALS............: GREASE TRAPS.......: LAVATORIES.....: OTHER FIXTUBES.. ... : TUB/SHOWERS....: SEWER LINE (ft)....: WATER CLOSETS..: WATER LINE (ft)....: DISHWASHERS....: RAIN DRAIN (ft) ^ � Remarks: Install residential backflow prevention device , Owner: — ------------ --- FEES --- DAVID ROSETTE type amount by date recpt 10875 SW 108TH AVE PRMT $ 15.00 JD 07/13/95 95-267997 - 5PCT $ 0.75 JD 07/13/95 95-267997 TIGARD OR 97223 � Phone #: . Contractor: ---------- ----- PREST TOM HOMES INC 1 z / iL/ Ea , ______ _________ Phone #: $ 15.75 TOTAL Reg #..: — REQUIRED INSPECTIONS ------- This peroit is issued subject to the regulations contained in the Final Inspection ____ Tigard Municipal Code, State of Ore. Specialty Codes and all other _______ applicable laws. Ail work will be done in accordance with • __ approved plans. This peroit will expire if work is not started within 180 days of issuance, or if work is suspended for oore '_ ___ - than 180 days. . ___� � __ _ _______ _ _ __ ____� --- ----- -- Permitt Si re: __ _______ __ Issued �~�__ ' � - ___ -- -- Call for inspeci,ion — 639-4175 • . | |' . �� _ � � � � _ � � City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 13125 SW Hall Blvd. Permit # ML i -0/(0( Ti OR 97223 (503) 639 -4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE Name of Developm New Single Family Residences Only Aadra ac/. A sa ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00 Job ❑ 3 BATH HOUSE $225.00 Address cit ZIP Fee includes all plumbing fixtures in the dwelling and the first 100 feet of water service, sanitary sewer and storm sewer. See fees below. Name (or name of Business) (039_• FIXTURES QTY PRICE AMT DP/ V10 ) .- 34,3 Sink 9.00 Mating Address P O°° Lavatory 9.00 Owner IC) O 7,c S(- JQ AIE _ Tub or Tub /Shower Comb. 9.00 city/state Shower Only 9.00 7 2 2 d 9 77Z Z 9Z33 Water Closet 9.00 Name (or name of business) Dishwasher 9.00 . S x^1 p j M g c,v, Garbage Disposal 9.00 Mang Mn Address Phone Washing Machine 9.00 Floor Drain 9.00 City/State ZIP Water Heater . 9.00 Laundry Room Tray 9.00 Name Urinal 9.00 ` \� Other Fixtures (Specify) 9.00 Meting Address Phone 9.00 Contractor 9.00 City /State '\ \ Zip 9 \ \ Sewer 1st 100' 30.00 State Registration No. CdY BU. Tax No. Sewer - ea. Addit. 100' 25.00 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 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 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 'V\,, Jf 9S Device or Anti - Pollution Device 9.00 Signature (o ' Or ; ,. Date Any Trap or Waste Not Connected to a Fixture 9.00 Describe work new 0 addition 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 /1 building or property - 14001NC7 f/ZILi ; e "/ Rain Drain, single family dwelling 30.00 Residential backflow prevention 'devices / 15.00 4.5 Proposed use of building or property *(Except residential backflow prevention devices) l NOTICE *Minimum Fee $25.00 SUBTOTAL /� U PERMITS BECOME VOID IF WORK OR CONSTRUCTION / --- AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE Al °� 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 TOTAL i 4 Special Conditions © 6 9- 130! Al Cr C'•. Date issued (/ ? ( -3q CITY OF TIGARD BUILDING INSPECTION NOTICE fr----', Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171 Inspection: _ ter _! , / if it` - .' ._ II Footing Susp. Ceilin Sprink. Rough-in A p r ' dwlk L Foundation Plbg. Underslab Mech. Rough -in Fireplace Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL: Post /Beam Mech. San. Sewer Gas Line -Bldg. Plbg. Underfloor Rain Drain Framing - Plumb. Alarm Water Line Insulation -Mech. Underflr. Insul. Shear Wall Gyp. Bd. - Elect. Date Requested: - 7/..,) -,c Time: AM PM Address: /19 87< /o E v( /C)---u`-e-- fi Builder: Permit #: i ! 5 5 c f (Q( THE FOLLOWING CORRECTIONS ARE REQUIRED: - r _/. . r1-41.,/./4 , / 6 //l' 4 C.�" 1ti pp Inspector: Date: APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE _Call For Reinsp.