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Permit / CITY OF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PLUMBING PERMIT PERMIT # PLM9S -0131 639 -4171 DATE ISSUED: 06/15/95 • PARCEL: 1 S 136 DB•-- 1Z12601 SITE ADDRESS...: 11610 SW PACIFIC HWY SUBDIVISION • ZONING: C —G BLOCK • LOT CLASS OF WORK..:ADD GARBAGE DISPOSALS..: MOBILE HOME SPACES.: TYPE OF USE •COM WASHING MACH ° BACKFLOW PREVNTRS..: OCCUPANCY GRP..:B2 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)....:100 DISHWASHERS RAIN DRAIN (ft) Remarks: INSTALL WATER SERVICE — 1ST 100' Owner: - - - - - -- FEES - -- DWD CONTRACTORS type amount by date recpt 11610 SW PACIFIC HWY PRMT $ 30.00 SW 06/15/95 - 5PCT $ 1.50 SW 06/15/95 — TIGARD OR 97223 Phone #: Contractor: •- MP MILWAUKIE CO. PO BOX 393 CLACKAMAS OR 97015 -- Phone #: 655 -9161 $ 31.50 TOTAL Reg #..: 005002 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Water Line Insp 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 permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. Permittee Signature: Issued B y :tom, Call for inspection — 639 -4175 city,,of Tigard \' ti , PLUMBING PERMIT APPLICATION Planck/Rec. # 13125 SW Hall Blvd. k 3 Permit # P9.3- l.4 Tigard, OR 97223 _ j J (503) 639-4171 J� ,--.. MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE / S7 3o D 6 -0 acozo , Name of Development New Single Family Residences Only Address 1' i ❑ 3 BATH HOUSE $225.00 ❑ 1 BATH HOUSE $ 140.00 ❑ 2 BATH HOUSE $195.00 Job 1 I LP 0 S 1.o Pal✓ c .- L -k Address ,- Fee includes all plumbing fixtures in the dwelling and the first 100 feet '" 1 3 of water service, sanitary sewer and stor sewer. See fees below. Nano (°r of lk FIXTURES QTY PRICE AMT Sink 9.00 Hang .N Phone Lavatory 9.00 Owner PO (3DX. c950 3b iy - 1 )33 Tub or Tub /Shower Comb. 9.00 peorglate ZIP Shower Only • 9.00 6r-kle n4 (2A q7gc3S Water Closet 9.00 ,Name (or name � a of wtiese) Dishwasher 9.00 am Occupant wan, na,e„ a s c. S Garbage Disposal 9.00 Washing Machine 9.00 • V .Q. Os J- 4 Floor Drain 9.00 City/State ti Water Heater 9.00 Laundry Room Tray 9.00 Naive Urinal 9.00 HP lPlAminb, CD Other Fixtures (Specify) 9.00 Haring natrea J Rron° 9.00 Contractor ..Pb 60Y- 3 613 9.00 � C fy/Slee ap 9.00 Li(.a-C ,J3 ) l - `7 -)V / S - Sewer 1st 100' 30.00 6tata Rt:Pe No. My' Bus. Tax No. Sewer - ea. Addit. 100' 25.00 5 5 / 3 Water Service 1st 100' / 30.00 300 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 S Back Flow Prevention �� Device or Anti - Pollution Device 9.00 ston°me (ewer or agent) Data Any Trap or Waste Not 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 15.00 Proposed use of building or property *(Except residential backflow prevention devices) NOTICE *Minimum Fee $25.00 SUBTOTAL 3D PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE / St:' 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 3) 5 Special Conditions Date issued (8I I 151 �/s by 6, k91". n (P ,(�,� A 111 (De_4- i \<-C- _, CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171 Inspection: Footing Susp. Ceiling 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 - Plumb. Alarm 4SZODTN Insulation -Mech. Underflr. Insul. Shear Wall Gyp. Bd. - Elect. Date Requested: C7 9's Time: AM PM f Address: / /I C / V ,5 6/ Builder: Permit #: THE FOLLOWING CORRECTIONS ARE REQUIRED: 6°L,'71 0 / 3 / # • Inspector: Date �/ ©�� 2 Le t _ DISAPPROVED APPROVED SUBJECT TO ABOVE _Call For Reinsp.