Permit CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW H_ a1)'Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PLUMBING PERMIT
PERMIT # PLM93 -0253
639 -4171 DATE ISSUED: 11/16/93
• PARCEL: 2S1O2CA -00925
SITE ADDRESS...: 13240 SW VILLAGE GLENN DR
SUBDIVISION VILLAGE GLENN ZONING: R -4.5
BLOCK • LOT -25
CLASS OF WORK..:ADD GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
TYPE OF USE .SF WASHING MACH BACKFLOW PREVNTRS..:
OCCUPANCY GRP..:R3 FLOOR DRAINS TRAPS
STORIES WATER HEATERS °1 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:
Owner: FEES '
KLINKENBERG type amount by date recpt
13240 SW VILLAGE GLEN DR PRMT $ 25.00 JH 11/16/93 —
5PCT $ 1.25 JH 11/16/93 —
TIGARD OR 97224
Phone #:
Contractor:
DIAL ONE WESCO PLUMBING
M&F CONTRACTORS, INC
8900 SW BURNHAM
TIGARD OR 97223
Phone #: 639 -4700 $ 26.25 TOTAL •
Reg #..: 73626
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
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 18A days.
Permittee Signature:
Issued By: d;/\-
Call for inspection — 639 -4175
CITY OF TIGARD'
PLUMBING 'PERMIT 13125 SW HALL BLVD.
P. O. BOX 23397
Applicants must- hold Oregon Registration to conduct a plumbing T I GARD , OR 97223
business r must be property owner /operator not hiring outside help.
Name or Development (503) 639 -4175
Plumbing Permit No
•
Address a in s ().- v ► I \ct 6 I DC' Description
814-21 -610 OUAN. PRICE . AMT.
Job Tax Lot Map. No.
Address
FIXTURES
tot Block Subdivision
Sink 7
Name (or name H of business) Lavatory 7.50
a
f L 1 1 l f _e_ 1 be x5 2 j Tub or Tub/Shower Comb. 7.50
Mailing Add ress U 750
Shower Only
-
Water Closet 7.50
Owner City/State � 1 —
._T 161)" n O --1 2.23 Dishwasher 7.50
Phone Garbage Disposal - _ 7.50
Name Washing Machine - _ - -7.50
_Floor Drain 7.50 _
Mailing Address Phone Water Heater I 7.50 7;5
Laundry Room Tray _ 7.50
Occupant City /State bp
Urinal 7.50
-Name WARN, Phone� . Other Fixtures (Specify) 7.50 -
0 LO / � LOAN) Oi ii 7.50 _
Marling ess &X. (330 s 4,39 )� ;
ftj Contr a ctor ./State Zip
f I LFj -W OE q l -1 I MISCELLANEOUS
City Bus. Tax No. Sewer 1st 100' 30.00
State Bld li
as. Board No. State Plumbers Bus.c_ No. , Sewer -ea. Addis 100' 15.00
(Resdentia ' ` 3 c/ / 91 , Water Service 1st 100 20.00
I hereby acknowledge that I have read this appticatton, that the information , Water Service ea Adds ' 15.00
given is correct, that I am registered with the State Builder's Board, and also • Sty 8 Rain Drain 1st 100' 30.00
have a State Plumbing license that the numbers given are correct that all •
plumbing work will be done in accordance with aepp<iceble provisions of Ore- . Storm S P:.in Drain Addit.100' 15.00
gon Revised Statutes Chapters 447 and 693 and applicable codes and that Mobile Hone Space 25.00
no help will be employed unless licensed under ORS 693. Of exempt from
State registration, please give reason below). Back Flow Prevention
HOMEOWNERS - 1 hereby certify that 1 am the owner of the property de-
Device o Anti-Pollution Device 7.50
*abed above, at which location I propose to make a plumbing Installation for Any Trap or Waste Not
my own use and this property is not being constructed for sale, lease or rent. Connected to a Fixture 7.50
Catch Basin 7
Insp. of Exist. Plumbing 40.00 Per Hr. _--e
Specialty Rimed Inspections 40.00 Per Hr.
- • R ain D rain,
V / / / Single Fam. Dw 15.00 •
AU • • tZE JSIQNATURE . r Date - ,
Describe work new Q addition ❑ aeration ❑ repair ❑ .
• be done "` residential ■ non - residential ■ .
Existing use MINIMUM PERMIT FEE 25.00 i
.. building SUB –TOTAL y CO
« � -�
� .g5.--
5% SURCHARGE / a
baPpPedY 25% PLAN REVIEW
NOTICE - _-.
TMs permit becomes null and void* work or construction authorized Is not corn- . TOTAL ,,,2Cp ?-5
.
tnineerl widMn Undertow W oondrucfion or work le sUsparded or abandoned for '
a period of 180 days et any art: idbr work to coalman: ad.
SPIECIAL COMMONS .
Date issued by •- - - - - -- --