Permit •
1TY OF TIGARD PERMI1T #WING FERMI T
PLM96-0200
„/
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: ' 07/08/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1S134DC -00600
SITE ADDRESS...: 11355 SW TIGARD ST
SUBDIVISION ° ZONING: R -4.5
BLOCK ° LOT •
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 ° 0
STORIES 0 WATER HEATERS 0 CATCH BASINS 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS ° 0
SINKS • 0 URINALS - 0 GREASE TRAPS ° 0
LAVATORIES • 0 OTHER FIXTURES 1
TUB /SHOWERS • 0 SEWER LINE (ft)...: 0 •
WATER CLOSETS..: 0 WATER LINE (ft) .•.. : 0
DISHWASHERS 0. RAIN DRAIN (ft)...: 0
Remarks: Alteration of a sump pump.
Owner: -- FEES
LARRY ANDERSON type amount by date recpt
11355 SW TIGARD ST PRMT $ 25.00 CJS 07/08/96 96- 281387
SPOT $ 1.25 CJS 07/08/96 96- 281387
TIGARD OR 97223
Phone #:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON OR 97008
Ph on e # : 503 - 642 - 7323 , $ 26.25 TOTAL
Re g #..: 24284
• REQUIRED INSPECTIONS
This per ®it is issued subject to the. regulations contained in the Misc. 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 oore
than 180 days.
Per mittee Si gnat ure: f(c� /C • -
I s sued B y : - 1 7 G _ f $ •J i �� �.__ _—
•
Call for inspection — 639 -4175
•
•
•
•
Ci*"� of'tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 4G-�.:&g13R7
13125 SW Hall Blvd. Permit # P 1 - 191 46-6),
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name otDow/opr New Single Family Residences Only
Ad'°" q 3i c1 ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job l 1355 5u,s 1-1 :j /ek f 9 . ❑ 3 BATH HOUSE $225.00
Address " c stat. l Do Fee includes all plumbing fixtures in the dwelling and the first 100 feet
-r-1 '( A 4 .0- of water service. sanitary sewer and storm sewer. See fees below.
Name for neme of Ruanaas) FIXTURES QTY PRICE AMT
A N/ t3 Sink - -- -. -..- 9.00
Meting Adaaw Pit on. Lavatory 9.00
Owner 6 Tub or Tub /Shower Comb. 9.00
°^''$te zip Shower Only 9.00
Water Closet 9.00
Name (O ' name °'busman) Dishwasher 9.00
.S"" 6 Garbage Disposal 9.00
Occupant Ma,r, Ada,.. wane Washing Machine 9.00
Floor Drain 9.00
CdyIState aP Water Heater 9.00
Laundry Room Tray 9.00
Nom Urinal 9.00
74/ L Pturne9 --IJC• Other Fixtures (Specify) 9.00 en r Main Affirm Contractor t i 0 6 5i r i / G r /0 4 � �� m J._ 9.00 :elf)
/ (p 9.00
�t bent) • .1 1 L1Z �3Z Sewer 1st 100' 30.00
State Regntreea, No u
/ v R.• Tan No. Sewer - ea. Addit. 100' 25.00
1 O 4 c)c_ /1'2 r /6 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 g' en is correct. (If exempt from State registration, please
give re on below.) Mobile Home Space 25.00
L a fief/ Back Flow Prevention
�f((,� Device or Anti - Pollution Device 9.00
$1 Q 1. tw. ) °a"° or ago"' Data Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration FiP repair 0 Catch Basin 9.00
to be done residential r 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,'
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE l • ZS
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 Z 'ZS
Special Conditions
Date issued 7 ,./ 9a by l
CITY OF TIGAR'' BUI 'DING INSP TION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
Plbg.Und/FIr/Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 31 4.o l q( A.M. P.M. Entry:
Address: .�. L_� e 1'
Tenant: ' t e: MST:
BUP:
Con /Own: MEC:
PLM: (p
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector: Date:
/ P_PROVED _DISAPPROVED /CALL FOR REINSP. CF CO