Permit ,
CITY OF TIGARD PERMI # RING PERM PLM96 -0195
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/02/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S104CD -10400
SITE ADDRESS...: 13649 SW TRACY PL
SUBDIVISION ° HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK • LOT °103
CLASS OF WORK °° :ADD GARBAGE DISPOSALS °: 0 MOBILE HOME SPACES.: 0
TYPE OF USE .SF WASHING MACH 0 BACKFLOW PREVNTRS ° °: 1
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 ° 0
TUB /SHOWERS • 0 SEWER LINE (ft)...: 0
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS ° 0 RAIN DRAIN (ft)...: 0
Remarks: Install residential back flow prevention device
Owner: FEES
DAVID MCKINNEY & TAMI MCKINNEY type amount by date recpt
13649 SW TRACY PL PRMT $ 15.00 JSD 07/02/96 96- 281257
SPCT $ 0 °75 JSD 07/02/96 96- 281257
TIGARD OR 97223
Phone #:
Contractor:
OWNER
Phone #: $ 15.75 TOTAL
Reg #..
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Back f l o w 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 iv days of issuance, or if work is suspended for Dore
than 180 days.
Permittee Signature:
C -
Issueg 0r -
Call for inspection - 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
11 SW Hall Blvd. Permit # 0 96'-0/9,
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
Oav1 - t T a m , Mci i11 n eti
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job 1 3 ( yq 5 Tra P (a ee, ❑ 3 BATH HOUSE $225.00
Address CItISae / zro Fee includes all plumbing fixtures in the dwelling and the first 100 feet
T i a rd o 6 q 7 Z Z3 of water service, sanitary sewer and storm sewer. See fees below.
Name ( ame of Starnes') / FIXTURES QTY PRICE AMT
S a me, a 5 abode- Sink 9.00
Ma®n° Address
Rhone Lavatory 9.00
Owner Tub or Tub/Shower Comb. 9.00
City/State ZIP Shower Only 9.00
Water Closet 9.00
Name (or name of buskins) Dishwasher 9.00
61 riV 6-5 abUVe Garbage Disposal 9.00
Occupant mamma yes Phone Washing Machine 9.00
Floor Drain 9.00
City /Sae Zip Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
amR as above,
Other Fixtures (Specify) 9.00
Malin Address Phone 9.00
Contractor 9.00
Cay /sae np 9.00
Sewer 1st 100' 30.00
State Registration No. CRT Bus. Tax No. 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 Storm & Rain Drain 1st 100' 30.00
the owner, that plans submitted are in compliance with State laws, that
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 25.00
give reason below.) Mobile Home Space
Back Flow Prevention
"JQiwt.t. "rifle- ,ri rli 7/Z/96' Device or Anti- Pollution Device 9.00
Signeme (owner or agent) > > J Date Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new go 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 Rain Drain, single family dwelling 30.00
building or property
Residential backflow prevention
devices 1 15.00 15
Proposed use of
building or property *(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL i5c
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF r
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
PLAN REVIEW 25% OF SUBTOTAL
COMMENCED.
TOTAL l c `
Special Conditions
Date issued by