Permit CI1YOFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PLUMBING PERMIT
PERMIT # • PLM94 -0115
639 -4171 DATE ISSUED: 06/24/94
PARCEL: 2S104CD -06500
SITE ADDRESS. °.: 13658 SW WHITE CEDAR PL
SUBDIVISION • HILLSHIRE ESTATES ZONING: R -7 PD
BLOCK LOT •065
CLASS OF WORK. .:1dE14 A L7 GARBAGE DISPOSALS..: MOBILE HOME SPACES. :
TYPE OF USE •SF WASHING MACH BACKFLOW PREVNTRS..:1
OCCUPANCY GRP..:R3 FLOOR DRAINS • TRAPS
STORIES •2 WATER HEATERS • 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: PATH I
Owner: FEES
SHELBURNE DEVELOPMENT type amount by date recpt
7008 SW NYBERG RD PRMT $ 25.00 — 06/24/94 —
SPCT $ 1.25 — 06/24/94 —
TUALATIN OR 97062
Phone #: 692 -6383
Contractor:
RYCHEN LANDSCAPING
5702 SOUTHWOOD DR
LAKE OSWEGO OR 97035
Phone #: $ 26.25 TOTAL
Reg #..: 5143
REQUIRED INSPECTIONS
This peruit is issued subject to the regulations contained in the Top —out Insp
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 wore
than 180 days.
Permittee Signature:
Issued By:
Call for inspection — 639 -4175
r
City of Tigard PLUMBING PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION .--
#-P \ �!4 -nib
Tigard, OR 97223
(503) 639 -4171
(p r Descnphon
Ilgart- `J _ ES L. R5 ORS 814-21 -610 I QTY PRICE I AMT
Job FIXTURES
Address , , �� / Li Sink 7.50
:: Lavatory 7.50
� ' /� Tub or Tub/Shower Comb. 7.50
h l} IS - , 4 f k Shower Only 7.50
IA Address Pgans Water Closet 7.50
Owner Dishwasher 7.50
`ayr5sste LAP Garbage Disposal 7.50
Washing Machine 7.50
Name (or rams of business) Floor Drain 7.50
Water Heater 7.50
Using Address Plume Laundry Room Tray 7.50
Occupant Urinal 7.50
CerSxste '' Other Fixtures (Specify) 7.50
7.50
7.50
2i..1 / ( I 7.50
l mg
MISCELLANEOUS
IM
Contractor . ( A""�� E
t� %I IEN1rl Sewer 1st 100' 30.00
°_ ' Sewer - ea. Addit. 100' 15.00
� Water Service 1st 100' 20.00
I hereby acknowletlg thJ a read this app iTcation, Oat the Water Service ea. Addit. 200' 15.00
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' 15.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention �
Device or Anti- Pollution Device / 7.50 7 .. . SD
Souefe teener or agent) Oats Any Trap or Waste Not
Connected to a Fixture 7.50
Describe work new U addition 0 alteration 0 repair 0 Catch Baser 7.50
to be done residential 0 non - residential 0 40.00
Insp. of Exist. Plumbing per hr
40.00
Specially Requested Inspections per hr
Existing use of Rain Drain, single family
building or property dwelling 15.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property
?Except residential bacM►ow
prevention devices) �� !! /�
NOTICE Minimum Fee $25.00 SUBTOTAL 4. , OD
•
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE / ( 23
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 2-L p r(
Special Conditions nn /L I lI
Date issued ! x (� l 104 by ( (4
keml.wevrr
wordkmndes
• -
•
•
STATE OF OREGON
LICENSED LANDSCAPE CONTRACTORS BOARD
AS: NO.: 11 981
ALL PHASES
PLUS BACKFLOW
'KLEINE. SCCTT E
8616 SE GARDEN LANE
PORTLAND. CR 97266-0000
EXPIRES:
04/30/951
STATE OF OREGON
LICENSED LANC.iCAFt: CC!'ilikPCT0i- f,C af
AS: NO.: 13
-Iv 9 I1.L1iQ N
C C , ■FY -
PO
L OSLiF t3C• OF 97033-0000 -
EXPIRES:
ie.
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