Permit '~�
PLUMBING PERMIT �~
- �«� ITY OF � ���� � PERMIT #.......: PLM96-0003 ^ �m���-������ DATE ISSUED: 01/16/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 9722368199 (503) 639-4171 PARCEL: 2S1 10CD-00103
SITE ADDRESS...: 15581 SW 116TH AVE
SUBDIVISION....: KING CITY ZONING:
i< 7-� � .
BLOCK . . . . . . . . . : LOT ^ v � ~�_~-
_
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:COM WASHING MACH......: 0 BACKFLOW PREVNTRS..: 2
OCCUPANCY 8RP.. :B2 FLOOR DRAINS......: 1 TRAPS..............: 0
STORIES........: 0 WATER HEATERS.....: 1 CATCH BASINS ^ N
FIXTURES LAUNDRY TRAYS.... . : 0 SF RAIN DRAINS..
GINKS ^ 2 URINALS ^ 0 GREASE TRAPS.......: 0
LAVATORlES.; ....: 2 OTHER FIXTURES.... �
TUB/SHOWERS. . . . : SEWER LINE (ft )
WATER CLOSETS..: 1 WATER LINE (ft) �
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: Tenant improvement
Owner — — FEES
DQTTY'S type amount by date recpt
15581 SW 116TH PRMT $ 81.00 KC 01/12/96 KING CITY
5PCT $ 4.05 KC 01/12/96 KING CITY
KING CITY OR
Phone #:
Contractor:
MICHAEL AN[) CO.
P 0 BOX 23008
TIGARD OR 97281 -- •
Phone #: $ 85.05 TOTAL
Reg #..: 67877
REQUIRED INSPECTIONS
This peroit is issued subject to the regulations contained in the Rough—in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other PLM/Underfloor _
applicable laws. All work will be done in accordance with Top—out Insp
approved plans. This peroit will expire if work is not started PERMIT FENDED
within 18N days of issuance, or if work is suspended for more Final Inspection ___________
than 18@ days.
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Permittee Signature _ _ ____ __ _________________
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Issued B '-
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/^ ~
( Call for inspection — 639-4175
-- FEB -01.-' 00 WED 00:93 -I D: FAX NO: ..___ #068 P02
v. PLUMBING PERMIT APPLICATION, Planck/Rec. #
City of Tigard / . r- �Te Permit # t �+ c- ", ( 0 -0-1 - 1 z))
13125 SW Hali Blvd.
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
r,.,01 Of Owlen a.ee \ New Single F altlilY Residences Only
aa.. 0 1 BATH HOUSE $140.00 U 2 BATH HOUSE $195.00
Job j, S 3 ( ∎ 1 �� a 3 BATH HOUSE $225.00
Address mos.. ` r- VP Fee includes all plumbing fixtures In the dwelling and the first 100 feet
L am, of water service, sanitary sewer and storm sewer. See fees below.
Ow* td r*- ' FIXTURES CITY PRICE AMT
Sink 2 9.00
w kieva a+. Lavatory ' w ar e or.,.. __) 9.00
Owner _ Tub or Tub/Shower Comb. 9.00
o.raa.a s Shower Only 9.00
Water Closet I 9.00
wa,. ta.- ..... -..t Dishwasher 9 -00
NbOtt Garbage Disposal 9,00
Occupant „,„,, mato • w an..o Washing Machine 9.00 _
(Sa 1 tr%) I. )j`°" Floor Drain 1 ' 9,00
WS*. Water Heater I 9.00
r r C , � t � ( C Laundry Room Tray 9.00
�.�» "�`'� f �l Urinal 9.00
t � , „ r CC1 Other Fixtures (Specify) 9.00
Marto Address Ph.n. 9.00
Contractor
9.00
ugtsu,. D 8.00
Sewer 1st 100' 30,00
suee wmmeam No. Off a., T. T.. " 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. Audit, 200' 25.00
information given Is correct, that I am the owner or authorized agent of
Storm & Rain Drain let 100' 30.00
the owner, that Plans submitted are in compilanea with State laws, that
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain AOOIt. 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 4 9.00
ss,..w,. (0~ ar aeons N Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new Q addition Q alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non- resldentlel 0 Insp. of Exist Plumbing 40.00mr
Specially Requested Inspect 40.00 /hr
Existing use of Rain Drain, single family dwelling 30.00
building or property
Residential beckflow prevention
devices 15.00
Proposed use of
building or property " (Except resldentfal baGttivw
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL aipb '11D I
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% 40,-
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED �I
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL Z"
. v
Pie-M.0� � TOTAL 47 .
S Conditions I.4I 44
a s. . n r A A
J -22 -' 00 SUN 1B: 48—I FAX NO: #033 P01
r eAl-r C✓ p!0'3% `76- UtrD)
City of Tigard ( 0,�_%PLUMBING PERM1T.. PI-I &T - • —
13125 SW Mall Blvd, ppgt -It' "brand fax transmittal memo 7671 '=
Tigard, OR 97223
(503) 639171 ' 2 '
S �I / f
Dept. Phone #
of o oodess 4 f foe. 4
.. ,wVOC a17b.U0 b
Ad obSS l 1 lt!o' O 3 BATH HOUSE 5225.00 Fee Fee Includes all plumbing fixtures In the dwelling and the first 100 feet
l ��'1"� ® of water service, sanitary sewer and storm sewer. See fees below_
was Or ...... 6 st Casinos) { FIXTURES
!� 4n PRICE AMT
Sink / ?i 9.00 11-,,d1
M n ear.., Moss LaVatety • g,pp
Owner Tub or Tub!Shower Comb. 9.00
leeo ps Shower Only 9.00
Water Closet 1 ■ 9,00 it 0(Q
now to rams at halm..) Dishwasher
r 9.00
_ , Garbage Disposal 9.00
Occupant Washing Machine 9,00
•1 1 „10%} Ilta Floor Drain 9.00
Water Heater Ii 9,00 l 10 `
' 144t rt•gtv , c� Laundry Room Tray 9.00
Urinal 9.00
f 9 1 -04 , . o Otlter FpRUfes (specify) 9.00
Contractor t M.: a .da... c " -1. � 110 S NU 9.00
4 Q . E ss GJ Z 9.00
T
.....
t 8.00
no. - l � iz t Sewer 1st 100' 34.00
aG�• 4 ""� a Sewer - ee. Add. 100' 25.00
Water Service 1st 100' 30.00
I hereby latknowledge that I have read this application. that the Water Service ea. Addle. 200' . 25.00
information given Is correct, that I am the owner or authorized agent of
the vrmer, that plane submitted are in compliance with Slate laws, that Storm & Raln Drain let too' 30,00
I am registered with the Construction Contractor's Boar'o, that the Storm & Rain Drain Addit_ 100' 25,00
number sliven is correct. (I mpt from State registration, please
rttyo. sen her ) Mobile Home Space 26.00 ,
J Rack Flow Prevention `
Device or Anti - Pollution Device a 9.00
""' own Oste Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work \new 0 dition Co alteretion_O— repair -Q Catch Basin 9,00
to be done residential 0 non jsidential i� \ Insp. of Exist Plumbing 40,0Whr • C I Specially Requeated Inspections 40.0o/hr
Existing use of k • ! i Rain Drain. sin le famf wellin 30.00
building or property x /n 9 �' d 9
Residential bsekflaw prevention
�C devices 15.00
Proposed use of / / '
building or property .
"(Except residential beckflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL ,
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTFIORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE a. V
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 5636
Special Conditions I ; f, . w A • ! #. �� 2 !_