11285 SW WALNUT ST 65(e)`i - o - o .
0 lik WASHINGTON COUNTY C1) Z RESIDENTIAL
Department of Land Use & Transportation
Plumbing Inspection Section
PLUMBING PERMIT
155 North First Avenue, #350 -12
Hillsboro, Oregon 97124 Project/
Information: (503) 640 -3470 Fax: (503) 681 -3 93 Permit Number S ! Date 1/47/ r/ 7
Inspection Requests: (503) 681 -3699 or 681 -3698
Permit Fee Schedule
PLEASE PRINT and complete all sections. DESCRIPTION OTY. COST (Ea.) AMOUNT
RESIDENTIAL - SFR (1) BATH $210.00
Name of Development NEW SFR (2) BATH 275.00
Job Address -� SFR (3) BATH _ 325.00
Address i z. S ski Via0)n u� 5T SINK (KITCHEN) 9.00
a IV o. ax Lot WATER HEATER 9.00
j� - �(� DISHWASHER 9.00
Thomas Page Section DISPOSAL 9.00
Map Book WATER CLOSET 9.00
Directions to Site BASINS 9.00
or Cross Street
TUBS 9.00
SHOWERS 9.00
• c p CJOUri CLOTHES WASHER
LAUNDRY TRAY 9.00
Nam / j 1 9.00
Mailing Address MISC. 9.00
Owner 1 / L6- .S _� w al o (Air REMODEL EACH FIXTURE
City /St T . \ rd or._ q Itg -, (minimum fee - $25.00) 12.50
Phone I FLOOR DRAINS _ 9.00
6 -33/ RAIN DRAIN /DOWNSPOUT 9.00
Name DRY WELL/LEACH LINE 10.00
_ WATER SERVICE first 100' ✓ 30.00 4/).-/
Mailing Address WATER each addnl 100' V 25.00 a._5 .
Contractor City /State Zip REPLACING in building
water supply lines
Phone FIRST FLOOR 30.00
ADDN'L FLOOR - each 12.00
State Registration No. Plumbing Lic No. SAN. CONNECTION
SEWER first 100' 30.00
I hereby acknowledge that / have read this application, that the each addnl 100' 25.00
Information given is correct, that I am the owner or authorized
agent of the owner, that plans submitted are in compliance with seperate permit to prevent
State laws, that lam registered with the State Builders' Board, that two contractors from working
the registration number given is correct (If exempt from State
registration, please give reason here.) off same permit 40.00
BACK FLOW PREVENTER 9.00
STORM up to 4" diameter - per 100' 10.00
SEWER over 4" diameter - per 100' 15.00
for ea. addnl 100' 30.00 i
Print CATCH BASINS /AREA DRAIN 10.00
MOBILE HOME UTILITIES 60.00
A rized Signature Date INSP. OF EXISTING PLUMBING
escribe work ❑ new ['addition ID alteration Vepair per hour 40.00
o be done SOLAR - MINIMUM 30.00
HEAT EXCHANGE 9.00
COLLECTOR /PANEL 9.00
• TANK 9.00
NOTICE: MINIMUM FEE 25.00
This permit becomes null and void if the work
or construction authorized is not commenced SUBTOTAL
within 180 days, or if construction or work 5% of subtotal for State Surcharge
authorized is suspended or abandoned at any TRUST ACCOUNT TOTAL FEE DUE 77
time after work is commenced. �d�
8L26 • 8/95
DEPARTMENT OF LAND USE & TRANSPORTATION
AN WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, INSPECTION REQUESTS: 503 /640- 3561/693 -4415
OREGON . r + Page : 1
Date : 01/09/97
Tiriie • 14:02
Permit Type : RESF'LMB Permit # : 05090020
Permit Status : APPROVED Applied : 01/09/1997
Site Address : 11285 SW WALNUT ST TI Is.sued : 01/09/1997 •
Permit Descr. : SFR - WTR SERU /LIN Completed :
To Expire : 07/08/199?
Project # : P0065242 V a l u a t i o n : $.00
Parcel Number : 2S1 03AB 00403
Legal Descr. : ACRES 2.41 (FROM A &T:05/10/96)
Owner : CLOUD, CLAUDIA G Construction : OTH
Applicant Name : CLOUD, CLAUDIA G Classification : 700
Applicant Addr. : 11285 SW WALNUT Occupancy : R3
Validated By : LG
TIGARD OR Inspector Area :
Applicant Phone :
Applicant Fax -
Permit Fee Obligation Permit Account Status
Plumbing Fee 55.00 Fees Calculated : 57.75
Additional Fees : $.00
State Surcharge • 2.75 Fees Due : $57.75
Payments to Date: $57.75
NOTICE: This permit becomes null and void If the work or construction for which It is issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction is interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents in support of this permit is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are satisfied and
approval Is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit Is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the sa sfaction of alpispection requirements.
APPLICANT'S SIGNATURE