Permit C 1 TY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223°8199 (503) 63e-4171
PLUMBING PERMIT
PERMIT #.......t PLM95-0050
639-4171 DATE ISSUED: 03/21/95
PARCEL: 25110AA-00300
SITE ADDRESS...: 14145 SW 105TH AVE
SUBDIVISION--: ZONING: R-12
BLQCK..........: L8T.............:
CLASS OF WORK—:ALT GARBAGE DISPOSALS—: MOBILE HOME SPACES.:
TYPE OF USE~...:COM WASHING MACH.......: BACKFLOW PREVNTRS..:1
OCCUPANCY GRP..:B2 FLOOR DRAINS.......:1 TRAPS..............:
STORIES........:5 WATER HEATERS......: CATCH BASIW8.......:
FIXTURE8----- -- LAUNDRY TRAYS......: SF RAIN DRAINS.....:
SI�KS.. ...... .. : URINALS. ....... .. .. : GREASE TRAPS. .... . . :
LAVATORIES.....: OTHER FIXTURES.....:
TUB/SHOWERS....: SEWER LINE (ft)....:
/
WATER CLOSETS..: WATER LINE (ft)....:
DISHWASHERS....: RAIN DRAIN (ft)....:
Remarks: INSTALL BACK FLOW DEVISE AND FLOOR DRAIN
Owner: — -- ----- FEES -----
TIBARD CARE CENTER type amount by date recpt
14145 SW 105TH AVE PRMT $ 25.00 SW 03/14/95 —
5PCT $ 1.25 SW 03/14/95 —
TIGARD OR 97224
Phone #:
Contractor: —
MP MILWAUKIE PLUMBING
PO BOX 393 •
CLACKAMAS OR 97015 --- ----
Phone #: 244-6600 $ 26.25 TOTAL
Reg #..: 005002
— REQUIRED INSPECTIONS -------
This peroit is issued subject to the regulations contained in the RP/Back Prev
Hoard 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 WI days of issuance, or if work is suspended for oore
than 180 days.
,
Permittee Signature:
Issued By _ _
y : _ ~/ ' � � __ _
Call for inspection — 639-4175
I
•
.CitysQf. Tgard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 S'W Hall Blvd. • Permit # PImgS -O0SD
Tigard, OR 97223
(503) 639 -4171 -
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
Address Job ��� 7S 5L 105 ( !'e_ ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
❑ 3 BATH HOUSE $225.00
Address t asd,, zip Fee includes all plumbing fixtures in the dwelling and the first 100 feet
/ / 2 l d 6 C 732 of water service, sanitary sewer and storm sewer. See fees below.
Name (« of Business) t FIXTURES QTY PRICE AMT
Sink 9.00
Magog Address Phone Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
��� Shower Only 9.00
Water Closet 9.00
J 44 c c (. (or name of business) Dishwasher 9.00
(r v Garbage Disposal 9.00
Occupant M. ,; g Pt oM Washing Machine 9.00
L5 -, Cci) a. Floor Drain ( 9.00 q 01)
City/State ta S Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
-' 1i ) i N t- n 9 CO Other Fixtures (Specify) 9.00
Meiling Address Phone i 9
Contractor -1 � 1 .-
t) Y D 5/3 . 9.00
'
City/State 211, • 9.00
\✓lJr" 3"C-U4 0+ 1A-5 -7� Vl MDI'S Sewer 1st 100' 30.00
State Registration No. City Bus. Tax No. Sewer - ea. Addit. 100' 25.00
ape z- 3" ( `7 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
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' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
L-- 1 D L' Device or Anti - Pollution Device j 9.00 9 5°
.• -._ . r •. _,r„ t e Any Trap or WactA Not I
. i Connected to a Fixture I I 9.00
Describe work new 0 addition 0 alteration - repair 0 Catch Basin 9.00
to be done residential 0 non - residential • Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of ,_ Rain Drain, single family dwelling 30.00
C.A. uilding or property ( d '
Residential backflow prevention
devices 15.00
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL d26c5c,
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE o2 s
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
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions
Zie- r
Date issued 3 I' 5 ` by . LD
CITY OF TIGARD BUILDING INSPECTION NOTICE '
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: 0 ,jY)/1/'}1/7 0 n i -,l,ca_
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post /Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post /Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
Date Requested: 2 //f C Time: AM PM
Address: H/ yl 4' 5 5_ / 6 S e`
Builder: Permit #:/; '?S- - 6-/S'
THE FOLLOWING CORRECTIONS ARE REQUIRED:
i
Inspector: Date: Z
APPROVED _DISAPPROVED APPROVED SUBJECT T ABOVE
_Call For Reinsp.
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STATE OF OREGON CONSTI U CTI CONTRAC BOARD==-
5] `_ REGISTRATION CERTIFtCATe`
This certifies that: t = perso na me d hereon = • is registered as provided by.laas a _ , =_ _
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