Permit :.CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
o
13125 SW Hell Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PLUMBING PERMIT
PERMIT # ° PLM94 -0255
639 -4171 DATE ISSUED: 11/22/94
PARCEL: 2S104BB -02000
SITE ADDRESS...: 14268 SW WINDSONG CT
SUBDIVISION ° CASTLE HILL ZONING: R -12 PD
BLOCK LOT -047
CLASS OF WORK °. :NEW 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: ADDING A BACKFLOW PREVENTION DEVICES
Owner: FEES
PAUL PERKINS type amount by date recpt
14268 SW WINDSONG PRMT $ 25 °00 BLT 11/22/94 °
5PCT $ 1.25 BLT 11/22/94 °
TIGARD OR 97223
Phone #: 635 -3816
Contractor:
DENNIS' 7 DEES
7355 SE JOHNSON CREEK BLVD
PORTLAND OR 97206 -9329
Phone #: 777 -7777 $ 26.25 TOTAL
Reg # ° °: 5009
REQUI RED INSPECTIONS
This peroit 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 peroit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee Signature:
Issued By:
Call for inspection — 639 -4175
City . of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. • Permit # Pl ni 9(1 - O25•S
Tigard, OR 97223
(503) 639 -4171
• MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
"° °r OwnI i o New Single Family Residences Only
Job
Marne
•
0 1 BATH HOUSE $140.00 0 2 BATH HOUSE $195.00
Address I ? /na i Q � Fee includes all plumbing fixtures in the dwelling and the first 100 feet
/ f G;P arik , (�1 r9 Con 1 - a S of water service, sanitary sewer and storm sewer. See fees below.
0...e..rcc,. mo J FIXTURES QTY PRICE AMT
(t.(.(.t. 4.- 6A- USa,r) Pte(f .A Sink 9.00
°"°.e Lavatory 9.00
Owner Tub or Tub/Shower Comb. 9.00
awatise m Shower Only 9.00
0 a Imam) Dishwasher ' 9.00
Occupant � * etta3014,`adeziY5 Garbage Disposal 9.00
Washing Machine 9.00
Floor Drain 9.00
°"ia"' Of Water Heater 9.00
Laundry Room Tray 9.00
Nom / Urinal 9.00
1n LS - 3 & C--Q,nOLS b ir5 Other Fbctures (Specify) 9.00 .
w wa. 9.00
Contractor
7355 SE U hr),eOn C( t-8& vd
9.00
9.00
+16 ry [n °fl 0( Sewer 1st 100' • 30.00
ca0 fu i N°' ca iii ra''" Sewer - ea. Addit 100' 25.00
50 051-160 I Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit 200' 25.00
information given is correct, that I am the owner or authorized agent of Storm & Rain Drain 1st 100' 30.00
the owner, that plans submitted are in compliance with State laws, that
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
.5{ ta(410 , 4
f/ - � (p -CPI Device or Anti- Pollution Device 9.00
°' °°"i Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new Q addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 3$) non-residential 0 Insp. of Exist Plumbing 40.00/hr
Existing use of Specially Requested Inspections 40.00/hr
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention / �r ap
devices / 15.00 U�J
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL 26
PERMITS BECOME VOID IF WORK OR CONSTRUCTION I
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL lJ ZJ
Special Conditions
Date issued by