Permit _", CITY �
DEVELOPMENT PLUMBING PERMIT
~�"���~"��~" "°"n�"�" SERVICES PERMIT # ^ PLM96-0345
13125 SVK Hall BRvd.,7i�rd�R�72�/ 8�3 �B�4/7/
Tigard, ` DATE ISSUED:' 11/15/96
PARCEL: 2S104AC-05200
'SITE.ADDRESS...t 1,2772' SW 133RC\ AV.E ' • . ' ' `
' 'SUM I MORNING': HILL •8 ' ZONING: R-25
BLOCK ^ LOT— ...........:196
_
CLASS OF WORK.. :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF • WASHING MACH...... : 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:R3 • FLOOR DRAINS... 0 'TRAPS..............: 0
STORIES ^ 0 . - WATER. 'HEATERS.....'�:'^`0' CATCH. BASINS....... : 0
FIXTURES LAUNDRY TRAYS - 0 SF RAIN DRAINS....': 0
6'....~:�61'' ''.` 'URINALS...���.':.,�:`r��0 ' GREASE TRAPS..... : 0
LAVATORIES.....: 0 OTHER FIXTURES - 0
TUB/iSHOWERS. SEWER. LINE- (ft) 0'-'.
WATER CLOSETS..: 0 WATER LINE (ft)...: 0 `
DISHWASHERS.���•' 0., ' RAIN, DRAIN (ft). . . • 0 .
Remarks: Installing RESIDENTIAL BACK FLOW DEVICE
Owner: - FEES
ROBERT QUIJARRO type amount by date recpt
12772 SW- 1•3RD ` • • PRMT $ 15.00'TAT 11/15/96 96-286561
5PCT $ 0.75 TAT 11/15/96 96-286561
TIGARD OR 97223
Phone #:
Contractor: ' `
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND OR 97208-9328
Phone #: 503-777-7777 $ 15.75 TOTAL
Reg #..: 5009
REQUIRED INSPECTIONS --
This permit is issued subject to the regulations containod'inthe' ' Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Service. In
applicable laws. All work will be done in accordance with . Rough-in Insp
approved plans. This permit will expire if work,isAot. started PLM/Underfloor
within •180 days of issuance,' or if-work is suspended •fnr morei Top-out Insp
than E0'days. ' — ' ' '' RP/Backflow Prey
Final Inspection
/
Permittee Si ure:
� - • •
.._ • ^/ • »^ / . ^
Issued By: ^ .��..
Call for inspection* - 639-4175
- ' -- '' ' ^'
City of.Tgard PLUMBING PERMIT APPLICATION Planck/Rec. #
131 SW Hall Blvd. • Permit # Z17796 -0
Tigard, OR 97223
(503) 639 -4171
• MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
"""' of Owskopment New Single Family Residences Only
Job Add. ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Address I -7 - 7 2 31/1/ � 13 ,r(, ❑ 3 BATH HOUSE $225.00
p /� Fee Includes all plumbing fixtures In the dwelling and the first 100 feet
l ' (J , ()� "l 7zz `h- of water service, sanitary sewer and storm sewer. See fees below.
""-t°" FIXTURES QTY PRICE AMT
rKi /o `Ro r - t D I A ,I l LU rr Sink 9.00
Lavatory 9.00
Owner ' - f % 7 SW 1 :_5� Tub or Tub/Shower Comb. 9,00
ovum. no / / Shower Only 9,00
lv and °12' gl 224- Water Closet 9.00
Dishwasher 9.00
Garbage Disposal 9.00
Occupant ,,,,,,, ,,,,... vn.rl. Washing Machine g,00
Floor Drain 9,00
"'"t"' • no Water Heater 9.00
Laundry Room Tray 9,00
pr. I Urinal 9,00
• Drni — 7 1 L-CUrt ,i✓p -u Other Fixtures (Specify) 9.00
Contractor - "Fri - )-127 9.00
355 5E CJoh nSoi-, GveeV b1 vc1 9.00
9.00
R)(' I Cl , 0R_ (1 7 -Dz Sewer 1st 100' 30.00
• State R.dw+ten H. °tv a s. T. N '' Sewer - ea. Addit 100' 25.00
bOC 05U3D1 Water Service let 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
t ,c A, � ( 1 )1'12% Device or Anti- Pollution Device 9.00
y°i4r (°""" °1 60" Data 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 non - residential 0 Insp. of Exist Plumbing 40.00/hr
Specialty Requested Inspections 40.00/hr '
Existing use of Rain Drain, single family dwelling
building or property ,sin le fami dwellin 30.00
Residential backflow prevention ( devices ( 15.00 I S" .M
Proposed use of
building or property
*(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL 15 07:
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE ■ 7
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 167_5
Special Conditions -
Date issued by
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STATE OF OREGON
LANCSCAF E CONTRACTORS - 6CAP,O
HIS CERTIFIES THAT THE PERSON NAMED HEREON IS LICENSE 5009
.ICENSED AS PROVIDED BY LAW AS A NUMBER:
LAND SCAF 'NG 6USI NESS i‘ 0 T EXPIRES: 11/30/9,6
ALL PHASES
PLUS EACKFLCW
- • -
DENNIS SEVEN E E . LAIN NC, • 0 ,
7.5 SE jO C
FORTLAND, C. 0
SIGNATURE OF LICENSEE
18-000-302 (9/91)
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•
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling CT
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: 7
Date: 1/ " 2-0 9 -` A.M. P.M. Entry:
Address: /2 7 7 2 SIi) 1 3 3/ -
Tenant: 16-4A .# " Ste: MST:
BUP:
Con /Own0 it i 7 ? 7 -77 7 7 MEC:
S ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
(j
ek
Inspector: / � Date: I.--./ 1 r
/4 >
L ..
' -_ APPROVED _ DISAPPROVED /CALL FOR REINSP. CF - CO