Permit PLUMBING PERMIT
• �I I O F T I GARD DATE I ISSUED: 02/06
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL : 2S 1 1 1 BD- 0311210
SITE ADDRESS...: 09770 SW PEMBROOK ST
SUBDIVISION • CLOUD CAP ZONING: R -3.5
BLOCK • LOT •13
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS 0 TRAPS • l71
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: Install water heater
Owner : - -- FEES
SUE HOPE type amount by date recpt
9770 SW PEMBROOK PRMT $ 25.00 JSD 02/06/96 96- 275680
5PCT $ 1.25 JSD 02/06/96 96- 275680
TIGARD OR 97223
Phone #
Contractor: —
COLUMBIA HEATING
PO BOX 230397
TIGARD OR 97281
Phone #: 624 -2704 $ 26.25 TOTAL
Reg #..: 76359
REQUI RED INSPECTIONS
This periit is issued subject to the regulations contained in the Mi sc. Inspection
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 160 days.
Permittee Si n_ .'_.'e: _ '/ i/
Qamigale
Issued 41'
Call for inspection — 639 -4175
City•of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
131-25 SW Hall Blvd. Permit # (Le 96-ace?
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
na i Dsva l _ ^ , New Single Family Residences Only
. Job 0 1 770 V) I 0 PP hC(J() -' 1 BATH HOUSE $ 0 3 BATH HOUSE $225.00 0TH HOUSE $195.00
Address ( or /�,
Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
a
0 �7�
ems of ti amess) FIXTURES QTY PRICE AMT
51) i Q 1 li p M' Sink 9.00
Maim Adams Phone Lavatory 9.00
Owner 5q9 - 7 51 Tub or Tub/Shower Comb. 9.00
°"t"State Shower Only 9.00
Water Closet 9.00
Name ( of baseless) 03A Dishwasher 9.00
Occupant M , 7 26a ' " '^ Garbage Disposal 9.00
°'^o e,.
Phone Washing Machine 9.00
Floor Drain 9.00
G siState DP Water Heater
) 9.00 q O
Laundry Room Tray 9.00
r e n Li ��� �t1 �iL Ill ^ , 1 � 1 � / JI Orinal 9.00
n G Other Fixtures (Specify) 9.00
Miming Address V Phone 9.00
Contractor Po. Tam v 23039 / 6,22/ ''3I ,276 el 9.00
-- '' off d ,of\ q /v� 30.00
.00
Sewer 1st 100' 30
State don No. ' O°+' Ban. Tex No. Sewer - ea. Addit. 100' 25.00
. 7 . 7(v3.59 'q 5 . 3/0() r 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
/ / ���� i � , ^
Back Flow Prevention
y �/ Device or Anti - Pollution Device 9.00
signs owner e r eg t) 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 backtlow
prevention devices) //yy��
NOTICE *Minimum Fee $25.00 SUBTOTAL asW
PERMITS BECOME VOID IF WORK OR CONSTRUCTION P AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
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 d / / ,2J
Special Conditions .
Date issued by