Permit PLUMBING PERMIT
: - 'CITY OF TIGARD PERMIT M BING ... PLM95-1Z133 4
DATE ISSUED: 11/07/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1 S 134 CC -01700
SITE ADDRESS...: 12325 SW KATHERINE ST
SUBDIVISION....: ZONING: R -4.5 .
BLOCK........... LOT. ....... .....:
CLASS OF WO Rig... :REP GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:ED WASHING MACH . 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP...B2 FLOOR DRAINS o 0 TRAPS..............: 0
STORIES........: 0 WATER HEATERS.....: 0 CATCH BASINS.......: 0
FIXTURES--- - - - - -- LAUNDRY TRAYS.....: 0 SF RAIN DRAINS.....: ►Zi
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; Sewer repair on private property
Owner: -- -- FEES -•
TIGARD SCHOOL DIST. 23J type amount by date recpt
MARY WOODWARD SCHOOL PRMT $ 30.00 B 11/07/95 95- 272595
12325 SW KATHERINE ST 5PCT $ 1.50 B 11/07/95 95- 272595
TI•GARD OR 97224
Phone .*
Contractor: - - - -. --
ENVIRONMENTAL DEVELOPMENT, INC
2945 NE ARGYLE ##203 .
PORTLAND OR 97211 - • - - - - -•
Phone #: 2134 - -9689 $ 31.50 TOTAL
Reg #. 0 35443
-• 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 pereit will expire if work is not started _ _ T _
within 180 days of issuance, or if work is suspended for sore — ---_
than 180 days. — —
• Permittee Si at�_�r�e� ___x . ' I /'� _ __�_— _ ___ _
Issued By: ._e Q..._ __®.._ I _. 0 0"� .� .____.__ ... Ti _._.._
Call for inspection - 639 -4175
Citji of.�.Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # •
1.3125'.SW Hall Blvd. Permit # Fowls-66N
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name at Development New Single Family Residences Only
Address t _ ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job Address 1 , r/ e t ) 5 (jv. l�r�i�f i� u&- 5 ❑ 3 BATH HOUSE $225.00
ut st L Fee includes all plumbing fixtures in the dwelling and the first 100 feet
10 cC2 92.2,3 of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of Business) FIXTURES
C QTY PRICE AMT
0 6 c�x�G *)L b/S eRic T Sink 9.00
Mailing Address /' �-- f P+one if- Lavatory 9.00
Owner �. 1 - 9 1 /- r T t ,-,/ ,Aa,- i Tub or Tub /Shower Comb. 9.00
City /State .,� / ~7 ZIP Shower Only 9.00
! ' C /tt7i.e (� JC .Q 2-7 Water Closet 9.00
Name (or name of business) Dishwasher 9.00
l J3 . o I) CO I ,
S✓e-:- lam- Garbage Disposal 9.00
Occupant Mailing Address Prone Washing Machine 9.00
• �. t% Floor Drain 9.00
airy /State Le Water Heater 9.00
i
Laundry Room Tray 9.00
Name /(f VI �) �� �y Urinal 9.00
I !, - �aj //a Other Fixtures (Specify) 9.00
Mailing Address Phone
Contractor ( 7 - 1 " t 9.00
G = / ( ` T 6 , 2 7 4 " 6 " 9.00
s tate zo C 9.00
(P1.97( - c 2 C -e . 9 -i/ / Sewer 1st 100' .i 30.00 30
State Regsstrabon No. City Bus. Tao No. Sewer - ea. Addit. 100 25.00
e
, %j j^ 1 4 3 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 Contractors 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
• Device or Anti - Pollution Device 9.00
Signature (owner or agent) Date
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 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
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)
NOTICE °Minimum Fee $25.00 SUBTOTAL 7 ('b
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE I
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 ') ,
Special Conditions 1
•
Date issued 1 (- 7 -- I� by q