Permit CITY OF TIGARD
PLUMBING PERMIT
m DEVELOPMENT SERVICES DATE ISSUED: 1� PLM96 -0372
PARCEL: 2S111CA -02500
SITE ADDRESS...: 15433 SW SUMMERFIELD LN
SUBDIVISION SUMMERFIELD NO.7 ZONING: R -7
BLOCK LOT °328
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:SF WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:A1 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: water heat work /install
Owner: -- FEES
VIRGIL BROWN type amount by date recpt
15433 SW SUMMERFIELD LN PRMT $ 25.00 TAT 12/12/96 96- 287670
5PCT $ 1.25 TAT 12/12/96 96- 287670
TIGARD OR 97224
Phone #:
Contractor:
COLUMBIA HEATING
PO BOX 230397
8900 SW BURNHAM ST STE E -110
TIGARD OR 97281 -0397
Phone #: 624 -2704 $ 26.25 TOTAL
Reg #..: 000763
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the. Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Water. Service In
approved plans. This permit will expire if work is not started Rough —in Insp
within 180 days of issuance, or if work is suspended for more PLM /Underfloor
than 180 days. Misc. Inspection
Final Inspection
Permittee Signat►. : Lai/ A
Issued By: LeldW ,/ 4% / ir�it
all for inspection — 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # p,Lm 96 - D37L
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
erns of D New Single Family Residences Only
ir a nn(.
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job /5LM.3 ✓,i.l1. a 4,/,tnnimP!P(t L/1 . ❑ 3 BATH HOUSE $225.00
Address G star. ro Fee includes all plumbing fixtures in the dwelling and the first 100 feet
/ ►14 r � 0 q �i of water service, sanitary sewer and storm sewer. See fees below.
Name (oo name of Busmen) / /� FIXTURES QTY PRICE AMT
U I Brokyi lO ,24- /g / A 9 Sink 9.00
1.4 ° n Phone Lavatory 9.00
Owner ) 5'133 5 f.o. & m/ rQf Ira L, Tub or Tub /Shower Comb. 9.00
t //��
o Shower Only 9.00
i C(, rOt- 1 or� .,l 7028 / Water Closet 9.00
Nam name of baseless) Dishwasher 9.00
6 111a) ) . Garbage Disposal 9.00
Occupant ma n ,,,erssa Ptwne Washing Machine 9.00
Floor Drain 9.00
City/Slate ro Water Heater 9 9.00 q.
Laundry Room Tray ( 9.00
rinal 9.00
&) t Nn 14 O
1,, �!d/ Other Fixtures (Specify) 9.00
Madng Address Phone 9.00
Contractor Kl.)oe / �2 _, n2^ `y / ,/ ,27
a_�/�y OCJ(/ / Q ! Y 9.00
9.00
Sala a l OR "/ Z � Sewer 1st 100' 30.00
No. COY Bus. Tea No. Sewer - ea. Addit. 100' • 25.00
76' � 3 9 - 15 - .34 D I 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 Contractors Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt fro 'stration, please
give reason below.) Mobile Home Space 25.00
` 5 `� � �� 9' Back Flow Prevention
� Device or Anti - Pollution Device 9.00
s aNra (Du n ` N( - 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 backflow
prevention devices)
•
NOTICE 'Minimum Fee $25.00 SUBTOTAL 025-CC)
PERMITS BECOME VOID IF WORK OR CONSTRUCTION /o SURCHARGE �.�
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF 5% 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 oWg s a25
Special Conditions
Date issued by
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: A.M: P.M. MST:
/ Location: _ _4 v/A //L_i /_ .. . i . / . ./L __ BUP:
Tenant: Suite: Bldg: MEC: / y 6— O 3
Contractor: _ /.. 444, �� y .,.–.. Phone: 6A 4( 2 7 0 4 24 PLM: C I b 0 37'
Owner:
Phone: ELC:
v %4 ' --''' e. e- .fi> i q7 ,O) a.) ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer .W . Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm � Temp Service MISC.
Masonry Ceiling Rain Drain UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved • pprov:.• Approved Approved
Appr /Sdwlk Not Approved Not Approved 1 of Approved Not Approved Not Approved
FINAL FINAL enFr? FINAL FINAL
c- .7)k,4 ( 16-e_.,r. . it..11.42- - 444 .--C... - /6 —
O Call for reinspection O Reinspection fee of $ required before next inspection 0 Unable to inspect
7li �G
Inspector: Date: ‘ Page t-- of r
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