Permit CITY OF TIGAID PLUMBING PERMIT
PERMIT # F'LM96 -0143
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06 / 13/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S 02BC -07100
SITE ADDRESS...: 12687 SW WATKINS AVE
- SUBDIt I —ETON ;ti "o ° o v,NORTH TIGARDVILLE ZONING: R-4.5
BLOCK "' E' LOT
-3
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
BILL WOLFORD & NAN WOLFORD type amount by date recpt
12687 SW WATKINS PRMT $ 15.00 JSD 06/13/96 96- 280568
5PCT $ "0.75 JSD 06/13/96 96- 280568
TIGARD OR 97223
Phone #:
Contractor:
OWNER "
Phone #: • $ 15.75 TOTAL
Reg # °. ° .
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Back f 1 ow Pre v _
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 more
than 180 days.
Permittee Si •nature: _ J< • ' � /
Issued
Call for inspection — 639 -4175
•
PLUMBING PERMIT APPLICATION Planck/Rec. #
City_o�Tigard Permit # PL f/`(7
fi3125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development
New Single Family Residences Only
Address
❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job i Z6 R ) ❑ 3 BATH HOUSE $225.0
Address CIt
,S'. W � �fEt -� IA; n s p F ee in cludes all plumbing fixtures in the dwelling and the first 100 feet
I D '1 �r ? 2Z -� of water service, sanitary sewer and storm sewer. See fees below.
TiC� nel lL
Name (Br name of Business) FIXTURES QTY PRICE AMT
7 S/ ) 1 }I WO j -rnre1 Sink 9.00
Mang Address
Phone Lavatory 9.00
r ' g " e _ Tub or Tub /Shower Comb. 9.00
Owner J
otyistate EP Shower Only 9.00
Water Closet 9.00
Name (or name of business)
Dishwasher 9.00
Garbage Disposal 9.00
Occupant McQmg Add PhoOe Washing Machine 9.00
Floor Drain 9.00
canstte
EP Water Heater ' 9.00 Laundry Room Tray 9.00
Urinal 9.00
Name
Other Fixtures (Specify) 9.00
. - - - :
Phone
Mating ess 9.00
Contractor
9.00
cgy,Stete EP
•
Sewer 1st 100' 30.00
• State Regbtratlat No. City Sue Tax No.
Sewer - ea. Addit. 100' i 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 3
00
1 Rain Drain 1st 1' 30.00
the owner, that plans submitted are in compliance with State laws, that Storm & 25.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain 1st
number given is correct. (If exempt from State registration, please Mobile Home Space 25.00
give reason below.)
Back Flow Prevention 9.00
Device or Anti - Pollution Device
Date Any Trap or Waste Not
� °"`° � - 1 ° , Connected to a Fixture 9.00
�,,,tw� [ (� 43
Describe work new addition ® alteration 0 9.00
eration 0 p
Catch Basin of Exist. Plumbing 40.00/hr
to be done residential ef non - residential 0 I ns p' 40.00/hr
Specially Requested Inspections
Existing use of Rain Drain, single family dwelling 30.00
building or property Residential backfiow prevention
S
/
devices 15.00
/
Proposed use of
building or property *(Except residential backflow
prevention devices)
I��
NOTICE *Minimum Fee $25.00 SUBTOTAL
i
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
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 t 5 ' �>-
. Special Conditions
Date issued by