Permit CITY OF TIGARD
. 14 1, � DEVELOPMENT SERVICES PLUMBING PERMIT TM96 -0350 A
DATE ISSUED: 11/20/96
PARCEL: 2S1O4CD -10600
SITE ADDRESS...: 13697 SW TRACY PL
SUBDIVISION • HILLSHIRE ESTATES NO. 2 ZONING: R -7 PD
BLOCK • LOT •105
CLASS OF WORK.. :ALT 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
WINDWOOD HOMES INC type amount by date recpt
14076 SW BENCHVIEW TERR PRMT $ 15.00 JSD 11/20/96 96- 286751
5PCT $ 0.75 JSD 11/20/96 96- 286751
TIGARD OR 97224
Phone #: 590 -4700
Contractor:
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123
Phone #: 503 - 628 -3411 $ 15.75 TOTAL
Reg #..: 5843
REQUIRED INSPECTIONS
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 F i n a 1 Inspect i on
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 more
than 180 days.
(2- 7-, ( tt‹(
Permittee Signature: / c
Issued Y• � -� - t� - "-/
Call for inspection — 639 -4175
CITY Of TIGARD Plumbing Application Recd B/- -0
Date Recd P / c --0.16
7
13125 SW HALL BLVD. Commercial and Residential Date to P.E.
TIGARD, OR 97223 Date to DST
(503) 639 -4171 Permit # Pt/ 9 - x535 °
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called c5 -- - " '�; e rr
Name of Devlopment/proiect 4 _ . , __ _.a ij�lew Siriole FamiN•Residenaes - Only - • �: R
Job n / ('/,s/L f.2 6 1 46. 4 3 , :44„Z -x= '\''..4.'''- d -. � ?r` * %Z. V �n = 00 :5 - !`a es' : ±} �-
f
; p E•57.4 .00�,. �- pw2_ 1ATI HOUSE4195.
Address Street Address Suite - HOUS " `
i3 &9 9 SW 7R/kf/ - , Fee'litdudes Iamb fi xtures Jn `` the ,. - 10071* e '` ,
P Ing the dwellfrig�`'arid the first 100 feefof ;��
Bldg # City/State Zip ,water service; sanitary sewer and stone sewer }.Seelees below %.iW? .Z-4
//.76/2/ ^ 2W \ O� -;± w. _._ 1' w` w-_' 1' �„* �s'-__=''-+ :`_3'�:'= ;'°h}�:h�s4'n
�:« �. A. ::k ::'?•"'y.
Name / / '/ ,4 FIXTURES (individual) QTY PRICE AMT
w,dd'4/» e es Sink 9.00
Owner Mailing Address Suite Lavatory 9.00
Tub or Tub /Shower Comb. 9.00
City/State Zip Phone
Shower Only 9.00
Name Water Closet 9.00
Dishwater 9.00
Occupant Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
City/State Zip Phone Floor Drain 2° 9.00
Name
3 9.00
e,neIR L4n/brca4aE .. - Nc. 4° 9.00
Contractor Mailing Address , Water Heater 9.00
/13 75 sw 11Ti4IC;A AVE Laundry Room Tray 9.00
Citt�y /State Zip Phone
Nils 60,20 G 9°7/23 6-257- 3g// urinal 9.00
Oregon Const. Cont. Board Lic.# Exp. Date Other Fixtures (Specify) 9.00
Attach Copy of •sel3 6 - 97 9.00
Current Plumbing Lic. # Exp. Date 9.00
License / .23aS (0 - ?9
Sewer - 1st 100" 9.00
COT Business Tax or Metro # Exp. Date Sewer - each additional 100' 30.00
Name Water Service - 1st 100' 25.00
Water Service - each additional 200' 30.00
Architect Mailing Address Suite Storm & Rain Drain - 1st 100' 25.00
or
Storm & Rain Drain - each additional 100' 30.00
Engineer City/State Zip Phone Mobile Home Space 25.00
9 Commercial Back Flow Prevention Device or Anti- 25.00
Descnbe work New 0 Addition 0 Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 Non - residential 0
Residential Backflow Prevention Device' 15.00 /Std
Additional descnption of work Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per hr
Existing use of Specially Requested Inspections 40.00
building or property per hr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps
building or property 9.00
QUANTITY TOTAL .r�` ":°;".:1`
Are you capping any fixtures? Yes 0 No p :
Isometric or nser diagram is required d Qua Total is Y > 9
I hereby acknowledge that I have read this application. that the information 9 �' :.:.51---.
'SUBTOTAL `°' "ts' ' a,o
given is correct, that I am the owner or authorized agent of the owner, and - - • 4 _, / `T
that plans submitted are in compliance with Oregon State Laws. = "' "'=
5% SURCHARGE 1S' i'= r � `='
Signet of Owner /Agent Date �T - x .`'
// PLAN REVIEW 25% OF SUBTOTAL , f, 4 - -=- - C 2 .14 -3- 1. -- t:: -
_
Contact Person Name Required only A fixture qty. total is > 9 ; r -,ti.
Phone
TOTAL - :s- :=�
"1.-<-11..1.0\1-1 _,4M /S�
DOCVE 14%/61 0 /4 - 923 P �.. r
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
is \dsts)plmapp.doc Prevention Device, which is $15 + 5% surcharge