Permit PLUMB 1 NU PE NM I 1
'`CF1Y OF TIGARD DATE S E ISSUED: 06/2:129: M6 —019
T
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 136 DB -00201
SI TLt31 1( a1 igtd.Tigard. P cra33t P6 Y
SUBDIVISION • Xpl" ZONING: C —G
BLOCK • LOT • ( S(Q O FD ZO N I
CLASS OF WORK..: REP GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B2 FLOOR DRAINS • 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 1 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: Installing gas water heater
Owner: FEES
ALPINE DRY CLEANERS type amount by date recpt
11569 SW PACIFIC HWY PRMT $ 25.00 B 06/28/96 96- 281169
SPCT $ 1.25 B 06/28/96 96- 281169
TIGARD OR 97223
Phone #:
Contractor: —
GEORGE MORL LUMBING
5529 SE FOS R D
PORTLAND OR 97206
Phone #: 771 -1145 $ 26.25 TOTAL
Reg #..: 02734
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Top —out Insp
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 sore
than 180 days.
1 I
Permittee Si•nature: 1 i,
1
i/ e g i /
Issued By: _ i ��
M all for inspection — 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
131'25 SW Hall Blvd. Permit # 6' - o('D
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Al Name Development New Single Family Residences Only
QI D C,IQainQis
aaa... ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job
11569 SV\I QC 1 c, N w ❑ 3 BATH HOUSE $225.00
Address wow. ze J Fee includes all plumbing fixtures in the dwelling and the first 100 feet
�`"I, q c c\ 0v, 91133 of water service, sanitary sewer and storm sewer. See fees below.
Name ^ a of 8 ....' ) FIXTURES QTY PRICE AMT
Sink 9.00
Maiv Address PhOAe Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
ca)"state zo Shower Only 9.00
Water Closet 9.00
Name (or name of ttuemea) Dishwasher 9.00
Garbage Disposal 9.00
Occupant wing ,,,.. Phmtte Washing Machine 9.00
Floor Drain 9.00
°"+"Stet° zv Water Heater ' 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
C� Po. M ox \ a1n A l o N0 m . Other Fixtures (Specify) 9.00
Mein Address P hone 9
Contractor -
12 S B 5 S U\I . (-n c.1 is . 1 9.00
CtyI ate t+P 9.00
I `GV 6 1 O 1 91 13 Sewer 1st 100' • 30.00
State R Parton No.• (� Cdv Bus. Tao No. Sewer - ea. Addit. 100' 25.00
0 2134 9 6 A 29 2 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
giv- reaso below.) 9n A ri�l �, !�� - 9 6 Mobile Home Space 25.00
v r , t � JN t� ° U 1 ,Y 11 Back Flow Prevention
Device or Anti - Pollution Device 9.00
(mater or agent) Data Any Trap or Waste Not
Connected to a Fixture 9.00
Des =e 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 25 00
PERMITS BECOME VOID IF, WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF • 5% SURCHARGE r (1 2.-5-.
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 ?j
Special Conditions
Date issued by
A
5 /9 /00 Activities for Case #: PLM96 -00190
3:45:50 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 6/28/96 BON RECD DST 6/28/96
PLMC005 Permit Created 6/28/96 BON PEND DST 6/28/96
PLMC799 Final Inspection BON 6/28/96
PLMC725 Top -out Insp 6/28/96 BON 6/28/96
PLMC060 (F) Issue permit 6/28/96 B PASS BON 6/28/96
PLMA850 Expired by limitation 3/22/00 HAP DONE No Hold AKJ 3/22/00
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