Permit CI1YOFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
1o1ossw Hall Blvd. Tigard, Oregon 9722 303199 (503) 639-4171 PLUMBING PERMIT
PERMIT #.......: PLM95-0278
639-4171 DATE ISSUED: 09/29/95
/3/07) �
- 10 - r� 060 d~==4%, Jenn, , PARCEL: 25109BA-01500
• SITE ADDRESS...: +efe@-04 SW %. - 7.1 ' ' � #NE
SUBDIVISION....: HILLSHIRE SUMMIT 2 ZONING: R-7 PD
BLOCK..........: LOT : /��
^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ ~ ^ �9=�� e
_
CLASS OF WORK..:NEW GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
TYPE OF USE -SF WASHING MACH.......: BACKFLOW PREVNTRS..:1
OCCUPANCY GRP.. :R3 FLOOR DRAINS.......: TRAPS..........
....
STORIES. . . . . . . . :1 WATER HEATERS,. . . . . : CATCH BASINS. . . . . . . :
FIXTURES----- --- LAUNDRY TRAYS......: SF RAIN DRAINS.....:
SINKS..........: URINALS ~ GREASE TRAPS.......:
LAVATORIES.....: OTHER FIXTURES.....:
TUB/SHOWERS ^ SEWER LINE (ft)....:
WATER CLOSETS..: WATER LINE (ft)....:
DISHWASHERS....: RAIN DRAIN (ft)....:
Remarks: Install residential backflow prevention device. Actual location is
monument at NE corner of Benchview/Bull Mtn
Owner: ----- -- - FEES -
SIERRA PACIFIC DEVELOPMENT type amount by date recpt
PRMT $ 15.00 JSD 09/29/95 95-271116 •
5PCT $ 0.75 JSD 09/29/95 95-271116
LAKE OSWEGO OR 97035
Phone #: •
Contractor:
CEDAR LANDSCAPE, INC
14375 SW PATRICIA AVE
HILLSBORO OR 97123 ------ -
Phone #: 628-3411 $ 15.75 TOTAL
Reg #..: 5843
------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP/Backflow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection ______
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 more
than 180 days. _______
.
Permittee Si* • re:
Issued B .
Call for inspection - 639-4175
___
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
'1312 SW Hall Blvd. I , ,, P # ( GS OZA
Tigard, OR 97223 . -. S ( Dq 4 J -, 015-0-0 s -o1sa
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
1 L
Job Address 0 ��■ Cr ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Seaec..NUIti .) 4 Sot 13uu.. i7'►Oot3TA•0 ❑ 3 BATH HOUSE $225.00
Address Ci zip Fee includes all plumbing fixtures in the dwelling and the first 100 feet
cp tt
I ( 7 > O>2 - 4 1'?2,2-.3 of water service. sanitary sewer and storm sewer. See fees below.
Name (or name of Business) FIXTURES QTY PRICE AMT
7 U n.Jt -a vaG)Fo 'DO)61-orn4ca r. Sink 9.00
Mating Address Ph« Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
City /State ZIP .,r Shower Only 9.00
LA V - - Oe eo , OIL � c.IsS Water Closet 9.00
Name (or name of business) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Medmg Address Phone Washing Machine 9.00
Floor Drain 9.00
Gn / Sate Z/P Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
abf>}✓L._ L-41"- Other Fixtures (Specify) 9.00
Matig Address Phone 9
Contractor
[L4- $L4.3 PA -TtI c14 62 -III 9.00
City /State Tp 9.00
J-4 i u, s ao,zo / 0-1‘, Q '7 f 2 $ Sewer 1st 100' 30.00
State Regwtratian No. City Bus. Tax No. Sewer - ea. Addit. 100' 25.00 .
5 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
Device or Anti- Pollution Device 9.00
. gnature (owner or agent) of An Trap or Waste Not
m C_gvi Z5cafd-- � �='9l Connected to a Fixture 9.00
Describe work new) 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 I 15.00 1f '
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL lx,
1
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 5
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
- - FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. - - PLAN %0E SUBTOTAL -- I
TOTAL 19 15
Special Conditions
Date issued by
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Susp. Ceilin Sprink. Rough -in Appr /Sdwlk
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
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall / Gyp. Bd. - Elect.
Date Requested: / 0 (3 L � , S Time: AM PM
Address: / 3, 0 d
Builder: ''- { Permit # f Jfl I...5 - 7 �
THE FOLLOWING CORRECTIONS ARE REQUIRED:
•
Inspector: 1 77 V 7--.1 ' Date : 3/7�
PPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.