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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEFARTMEN.
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171 PLUMBING PERMIT
PERMIT #. . . . . . : PLM95-0275
639--4171. DATE ISSUED: 09/27/95
PARCEL: 2SI04DC-02300
SITE ADDhCSS. . . : 13403 SW CLF_ARV I EW WAY
SUBDIVISION. . . . : BENCHV I EW ESTATES ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . :23
--------------------------
CLASS^ OF-WORK. . :REF' ---h `GARBAGE-DISPOSALS. . : MOBILE_ HOM;' bP141 ES.
TYPE OF' UF,E. . . . :SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. .
OCCUPANCY GRP. . :R3 FLOOR DRATNG. . . . . . . : TRAPS. . . . . . . . . . . . . .
STORIES. . . . . . . . :2 WATER HE',fFRS. . . . . . : CATCH BASINS. . . . . . . :
F I X'i'UFtFS-_- - -- ------ - LAUNDR r TRPYS. . . . . . : aF RA (N DRAINS. . . . . :
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREAFE TRAPS. . . . . . . .
LAVPTORIES. . ., . . : OTHER FIXTURES. . . . . :
TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . 32O
WATER CLOSETS. . : WATER LINE (ft ) . . . . :
DISHWASHERS. . . . : RAIN DRAIN (ft) . . . . :
Remarks : Sewer repair
Owner: -_ _ _ -- _-.------------------.---- FEES
HUGH' S EXCAVATING & PLUMBING type amount by date recpt
PO BOX 4227E PRMT $ 30. 04 ,JDA 09/27/95 95271020
5PCT $ 1. 50 .TDA 09/27/95 95L710,2_O
PORTLAND, OR 97242
Phone #: 503-'77-3116
Contractor:
HUGH' S EXCAVATION h PLUMSI IG
PG BOX 42276
POR(LAND OR 97242 -------------------- -------------------
Phone #: 503-•777-3116 $ 31. 50 TOTAL
Req #. . : 3267O
_______ REQUIRED INSPECTIONS --- -This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. S)ecial%y Codes and all oth^r Mi sc. Inspection
applicable laws. Al) work will be done in accordance with -
approted plans. Tnis permit will expire if work is net started -----
within 188 days of issuance, or if work is suspended for tore
than 188 days. ---
Permittee Signature : ^' ��,_— -
i
Issued B y: --
C,:.11 for inspection - 639-4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Fel ltti[ # Ir ly
Tigard, OR 97223 —
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
4ew SI_gle Family Residences Only
p 1 BATH HOUSE$140.$11. ❑ 2 BATH HOUSE 195
Job LI h �- 1 $ .00
-�� 1r V i L- (A'`� 7 3 :'kTH HOUSE$225.00
Address cxvw.,. Fee includes all plumbic, Ilx,ures in the dwelling and the first 1UO feet
' � �( Cn �r A L ```-- of water servi•;e, sanitary ,P,ver,nd atoms sewer. See fees below.
@Soa1&-- FIXTURES — QTY PAIGE AMT
Fri=' - �'t Y•� I Sink _ 9.00
"..,p A". pe",. Lavatory — 9.00
0-nNr _ Tut or Tub/Shov,er Comb. 9.00
:b _'hewer Only 900
Mater Close. 9.00
Dishwashe 9.00
r:arbage 'Disposal
Occupant M. „Ad&-. Washing 9.00
Floor Dra-; 900
`""`'•'• !ip Water Hea etr — 9.00 �—
Laundry Room Tray 9.00
lrinal 9.00
ion : Plu► y�t'� Other Fixtures (Specify) �- 9.00
Me"+e" �... —p,"ns _ 9.00
Lq r ontractcr
2 z -7
K�_ -- — - 9.00
zip 9.00
IA 2-_ Sewer 1st 100'
Sian n.opp.ape No - CM But T.,No Sewer -ea Adds IOU - 25.00
l
3 C�(Ql( 7- I� ) Water .ri@NIC' 1st I'n, 30.00
I hereby acknowledge that I have read this application. ghat the Water Service ea. Aadit. 200' - 25.00
information given is correct, that I am the owner or authorized agent of _
the owner, that plat's submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 30.00
I am registered with the Cunstru.-tion Contractor's Boa•d, that the Storm R Rain Drain Addit ton' 25.00
,ii iiubr y1Lc11 is uun c..i. (Ir ext malate rogig tmtion, pi'asQ
give reason below.) Mobile Horne Space 2500
Rnrk Flow Prevention -
- Device or Anti-ooilution Devicaa 900
°ie Any Trap or Waste Not
Connected to a Fixture _-� 9.00
Describe work new Ll a,'.,dition O alteration L� repair :,atch Basin 900
to be done residential non-residential L) Insp of Exist. 17,tumbing 40.00/hr
Specially Wequeited Inspections 40 CO/hr
Existing use of ---.
building or property _-� _ _ Rain Drain, single family dwelling 30.00
Residential backflow pt-wention
devices 15.00
Piuposed use of _
ouildi,tg nr property - -- -
_-- -' '(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $23.00 SUBTOTAL_
PEhrAITS BFCOMF VOID IF WORK OR CONST4UCTI0N -
AUTHOPZZD IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE I J y l
CC'ri.SrF.UCTION OR WORK IS SUSPENDED OR ABANDONED -- --- I )
FOR A PERIOD OF 180 DAYS_Aj ANY IWE AFTER AIORK !S
COMMFNCFD �--�~ �,` PLAN REVIEW 25"x. OF SUBTOTAL
�// /SC
to C (' �E �1 Y� SLI// TOTAL
:iit c!al Go,1,1,Jons —t- --L
`--- ----�- Date issued _by