Permit PLUMBING PERMIT
°~'���I � � OF TIGARD PERMIT # ^ PLM96-0268
DATE ISSUED: 09/12/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223°8199 (503) 639-4171
PARCEL: 2S104DC-06800
SITE ADDRESS...: 13870 SW FERNRIDGE TERR
SUBDIVISION ^ MORNINGSTAR ZONING: R-4.5 PD
BLOCK...... ^ LOT........ ..... :G09
____________
CLASS OF WORK..:NEW 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
SINKS..........: 0 URINALS...........: 0 GREASE TRAPS.......: 0
LAVATORIES.....: 0 OTHER FIXTURES....: 0
TUB/SHOWERS ^ 0 SEWER LINE (ft)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: PATH I
Owner: -------- — — ------ FEES --
TOM ARVIDSON type amount by date recpt
13870 SW FERNRIDGE TER PRMT $ 15.00 TAT 09/12/96 96—
5PCT $ 0.75 TAT 09/12/96 96—
TIGARD OR 97223
Phone #: 524-6261
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 contained in the RP/Backfl Prey ___
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect ion
applicable laws. All work will be done in accordance with ___________________
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for nore
than 180 days.
Permittee Signature:
---
Issued By: —
Call for inspection — 639-4175
CIF,/ of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. • Permit it PLm96- c 2bb
Tigard, OR 97223
(503) 639 -4171
• MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Nerds of °id°0"°" New SIngle Family Residences Only
' � R 70 ( � l 1 BATH HOUSE $140.00 0 3 BATH HOUSE $225.00 HOUSE $195.00
Job �vl PA- � vi��Ue,� iP�'r
Address atom. L) m _ Fee includes all plumbing fixtures in the dwelling and the first 100 feet
F 1 00 A id , G 7 z7-3 of water service, sanitary sewer and storm sewer. See fees below.
"'"''(s same a a,..+seer FIXTURES QTY PRICE AMT
l_i.i1( 2U l DVY1 ATV! i t /r Sink 9.00
Rw.. Lavatory 9.00
524 -
Owner 1.,.. sw F r i ( - f (y( 4‘,21L4- Tub or Tub/Shower Comb. 9.00
°y` t.t• ` " As Shower Only 9.00
Ti (lard , 0K. 6 i - 7 Z 2-3 Water Closet 9.00
der°° is der"'' ■ ta=me) Dishwasher
. 9.00
Garbage Disposal 9.00
Occupant ,,,,,, ,,,,,., Roar Washing Machine 9.00
Floor Drain 9.00
m'"0"' DO Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
• S ' D -6a- 1 iugcl � it i �t Fxtt
i Other tures (Specify) 9.00
�
Contractor ++o ram... - 7 - 1 5 I - l']� 9.00
- 1F 3E% LTOtiilSon (,vPe'k- b I Vd 9.00
I /� 9.00
(yr - 10. -ii'ld t Da " 70
� to Sewer 1st 100' 30.00
�"' Ra N. °r' am Tax No. Sewer - ea. Addit 100' 25.00
�} • 0 5b1604 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
c'l� Back Flow Prevention
/ � � � , / ` Device or Anti - Pollution Device 9.00
S . ».'ca""°` °"4 °" Any Trap or Waste Not
Connected to a Fixture • , , 9.00
Describe wort 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
I Specially Requested Inspections 40.00/hr
Existing use of family single Rain Drain, sin 30.00
building or property g y dwellin g
Residential backflow prevention I
devices 4 15.00 ,
Proposed use of
building or property
*(Except residential bacldlow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL 5 --
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE ■ ` /) J
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 I5, /o
Special Conditions
-
Date issued _ by