Permit CITY OF T I GARD
L...-
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PLUMBING PERMIT
PERMIT # : PLM95 -0327
639 -4171 DATE ISSUED: 10/30/95
PARCEL: 29104BD —RM009
SITE ADDRESS...: 13763 SW ROSY CT
SUBDIVISION • ROSE MEADOWS ZONING: R -7
BLOCK • LOT °009
CLASS OF WORK..:ADD GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
TYPE OF USE -SF WASHING MACH • BACKFLOW PREVNTRS..:1
OCCUPANCY GRP..:R3 FLOOR DRAINS ° TRAPS °
STORIES -2 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: Installing backflow prevention device.
Owner: FEES
ERIC TOFTE type amount by date recpt
13763 SW ROSY CT. PRMT $ 15.00 B 10/27/95 95- 272194
5PCT $ 0.75 B 10/27/95 95- 272194
TIGARD OR 97223 .
Phone #: 524 -4918
Contractor: -- --
OWNER
Phone #: $ 15.75 TOTAL
Reg 4t.. : 000000
REQUIRED INSPECTI
This permit is issued subject to the regulations contained in the RP /Backflow Prey
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 •ore
than 180 days.
______
Permittee S nature: I'I/
I ssued By: Q15L4Urt✓ _ —
Call for inspection — 639 -4175
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
i312' SW Hall Blvd. Permit # (roil '15 -63 1
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
"a "' � D sv . 1opn,.m � New Single Family Residences Only
._. i <--- J c t
Job f 3 Address 3 � w ���� L�. ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
❑ 3 BATH HOUSE $225.00
Address cn ao Fee includes all plumbing fixtures in the dwelling and the first 100 feet
4 1 AYUC •-..- q�f 22_3 of water service, sanitary sewer and storm sewer. See fees below.
NaRe ( n m a ' auor FIXTURES QTY PRICE AMT
S li0^,g- As AL ri- Sink 9.00
Meant t Address Phone Lavatory 9.00
Owner .X - 4'1 (R Tub or Tub /Shower Comb. 9.00
c' Shower Only 9.00
Water Closet 9.00
Name (o' naAe o1 Imams) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Mm mom
Mole Washing Machine 9.00
Floor Drain 9.00
"^"Slat° re Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
�A+"� I _ . A p J j •1 Other Fixtures (Specify) 9.00
Msi'p Address Plane 9.00
Contractor
9.00
City /State no
9.00
Sewer 1st 100' 30.00
State Re(pstre°on No. CSy Sus. Tao Na. Sewer - ea. Addit. 100' 25.00
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
sq sma Cosner d • - /
Date Any Trap or Waste Not
/�t�- 1 I' / Connected to a Fixture 9.00
Describe t^rs' new 0 ./. ition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential ! i 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 15 ,a
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL I� 00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION /
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE t -75
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 1S775
TOTAL
Special Conditions /0"-- , �j �j
Date issued 7 � ✓� (C by 1/ ' tl/tua-Lall_" 1/--
5/24/00 Activities for Case #: PLM95 -00327
2:09:06 PM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA007 Application received 10/27/95 B PEND B 10/30/95
PLMA050 (F) Issue permit 10/30/95 BON PASS B 10/30/95
PLMA800 Case Finaled 11/3/95 MMS PASS MRS 11/3/95
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