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PLUMBING PERMIT
CITY OF TIGARD PERMIT #. . . . . . . : PLM96-0071
COMMUWTY DEVELOPMENT DEPARTMENT DATE I1—jSUE0 04/10/96
13125 SW Hall Blvd.Tigard,Oregon 97223481,99 (503)839-4171
SITE ADDRESS. . . : 15585 SW 109TH AVE PARCEL: 2SI1ODD-13300
SUBDIVISION- . : SUMMERFIELD Nl:). 14 ONING: R-7
B:..00K. . . . . . . . . . LOT. . . . . . . . . . :703
CLASS OF WORK. ADD GARBAGE DISPOSALS. MOBII-17 HOME SPACES. : 0
TYPE OF US,'E. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
013'CUPANCY GRP. . : R3 FLOOR DRAINS. . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
STORIES. . . . . . . . . 0 WATER HEATERS. : 0 CATCH BASINS. . . . . . . 0
FIXTURES-- ---_--- -- LAUNDRY "I"RAYS. 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . : 0 URINAi.S. . . . . . . . . .. . 0 GREASE TRADS. . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
'rup/SHOWERS. . . . : 0 3EWEF LINE (ft ) . . . : 0
WATER CLOSETS. . : o WATER LINE (ft) . . . 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Pemarks : Install. one residential backflow device.
Owner- ,
LORENE HEIN type amol.tnt by date t'C!Cpt
.15585 SW 109TH AVE PRMT $ 25. 00 CJS 04/10/96 K-�.
T 1. 25 CJS 0 4 10 9 6 Y
TIGARD OR
Phone #:
Contractor,:
GARRON GROUNDS MANANGEMENT
9720 SW HILLMAN CT
it 8 15
W11-SONVILLE OR 97070
1-11-ione #: 503--68J:---7172 $ Lb. 25 TOTAL
Reg #. . : 5562
REQUIRED INS)PEGTIONS
This pewit is issued subject to the regulations contained -,n the M i S c. Inspection
Tigav,d Municipal Code, State of Ore, Specialty Codes and all other RP/Backflow Prev
appli7:abip laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if worl, is not started
within 180 days of issuance, or if tvrrk is suspended or more
than 180 days.
'Pr-.mittee
Issued By : ---
Call for- inspection 639-4175
CITY OF TIGARD BUILDING INSPECTION NOTICE �I
Inspection Line: 639.4175 Business Phone: 639-4111
Footing Rain Drain Cover/Service FINA .
Foundation Water Line Ceiling
Post/Beam Mech, Shear/Sheath Framing -Mech.
PIog.Und/Flr/Slab Plbg.Too Out Insulation -Elect.
Post/Beam Struct, Mech. Rough-in Gvp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: 1b M. _P. .__— Entry:_ --
Address:
Tenant: ---- -- - -- - _ _ . Ste: MST: - ---- -
BLIP:
Con/Own:------ _--- --.--
- --_ - MEC:
PLM:
ELC:
THE FOLLOWING CGRRECTIONS ARE REQUIRED: ELR:
V--
ti
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11001 oe
Inspector, -_ Dat .
OPR VED [,,rAPPROVED/CALL FOR REINSP. CF CO
City :A,Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 1,?,111*795 G'G�/
'6125 SW Hail Blvd. Permit # /4 if
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE * ST. SURCHARGE
�J Nin i1Or""'"N Now Sinole-Fingy Residences Only
Job �V El 1 BiJH HOUSE S140.00 0 2 BATH HOUSE 5195.00
�v v ❑ 3 BATH HOUSE$225.00
Address o.ym.,. ,ar Fne includes all plumbing fbxtures in the dwelling and the first 100 fLtt
of w ter service, sanitary sewer and storm sewer. See fees bsirN,
""" i�""""`'• "� FIXTURES CITY PRICE 0IF,
LDKNE 4 b�f'� Sink 0.00
""� ^"•"—r °""" Lavatory 9.00
Owner AMC Tub or Tub.rS``awer Comb. 9.00
r"t"eim Shower Onry 9.00
^ _ water Clmiat _ 9.00 ---
"'""r.^•^°awl Dishwasher 9.00
Occupent r l Gamage 9.00
Noshing Machine 9.00
Fleer Oraln 9.00
�++�• M_ + water Heate' 900
Laundry Room Tray 4.00
p � rROUNps qo T- G Urinal 9.u0
aT (TFC I OdGRTlO/`� Other Fixtures (9pecif ,, 9.00
M.1'+,ut... 9.00
q7I CJI I lr`-t�tly C`.1 g1S 9.00
enwsir. all 9 00
VuII,� V I L1.F_-,Lo i 0'70 Sewer Ist too' --- 30 00
sw r.,y.r.r..,n. (VV e.. t.;;7- Sewar-aa. Addit 100' 25.00
IANDSuG 55&A HE7fb I433 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service as. Addit, 200' [5.00
Infonnalinn given is corner, that I am the owner or a KPiorizea agent of -the uwner, that plans subr'nt!ert ern In compllenrn with State laws, that Storm &Rain Drain let 100' 30.00
14M rrtgistered wfth the Construction Contr'actor's Board, that the "loan R Rain Drain Addd 1110' 2500
number given is correct. (If exempt Ram Stele registration, please --
plve mnaan below.) Mobile Home Space 2s oo
Bark Flnw Prevention
/L� �I- Dx!vICE or An(1-Pallutlnn Devirft 900
••••i••-- �'�'^'� Any Trap or Waste Not
Connected to i Fixture 9.00
DesUlbe work new ddition 0 alteration repair L, Catch Basin 900
to be done residential non-reeldenuai Q Insp of Erist Plumbing 40 oORv
Specially Requested Inspections 4o,OQlhr
r Exlsttng use of
t- Rain Drain, single (amity dwelling 50.00
builrllnq or oraocrty �. _
Reyidentisl beckllaw prevention
devices J f�00
Proposed use gf --� -
buildinq or property —
(E.ct:ept rwlCentiai backflow
prevention devices)
J
NOTICE ''Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID Ir L'rORK OR CONSTRUCTION
AUTHORIZED IS NO' COMMEN,.ED WITHIN 180 UAYS, OR IF 5,S SURCHARGE
CONSTRUCTION CR WORK IS`;USPENDED OR AnANDONEO 1.- —_
FOR A PFRI'iD Cr 180 DAY( AT ANY TIME AFTER WORK IS
COMMENCED PUN REVIEW 25!, OF 3U8T4TAL
TOTAL 51��
SWjal Conditions
4ste Issued y'�119 by