Permit -_
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COMMUNITY DEVELOPMENT DEPARTMENT
1o1oomw Hall a* Oregon 97223°8199 (503) 639-4171 PLUMBING PERMIT
PERMIT #.......: PLM95-0043
639-4171 DATE ISSUED: 03/1217/95
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PARCEL: 25104AA-02200
SITE ADDRESS...: 12305 SW 127TH AVE
SU8DIV2BION....: BELLWOOD ZONING: R-4.5
BLOCK..........: LOT. ............:71
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CLASS OF WORK. .:ADD GARBAGE DISPOSALS..: MOBILE HOME SPACES.
TYPE OF USE.... :SF WASHING MACH : BACKFLOW PREVNTRS..:
OCCUPANCY GRP..:R3 FLOOR DRAINS.......: TRAPS..............:
STORIES........: 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 ) ....:100
DISHWASHERS— ..: RAIN DRAIN (ft)....:
Remarks: Adding 100' water service
Owner g, --- FEES ----- ----
JUDY BALLARD type amount by date recpt
12305 SW 127TH AVE PRMT $ 30.00 JDA 08/07/95 -
• • 5PCT $ 1.50 JDA 03/07/95 -
TIGARD OR 97223
.. Phone #:
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Contractor: ' - •
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN OR 97062 -------- --
Phone #: 691-6166 $ 31.5@ TOTAL
Reg #. . : 87906
REQUIRED INSPECTIONS -
This perait is issued subject to the regulations contained in the Final Inspection ____
Tigard Monicipal Cmjo State of Ore. Specialty Codes and all other _ _
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. _- _ _
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Permittee Signature: ._ ^ .' ��� / / � - ___-_-
Issued By: ���' ' _ __ __� _ __
v Call for inspection - 639-4175 __'
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City of,.Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # f MQS- 00 43
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
1 -7 - 5 b. S.1a.9 I � ‘ .
Adze" ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job --1; , 6.�, A4 OR l ��7 ❑ 3 BATH HOUSE $225.00
Address ctrfstataJ Lp Fee includes all plumbing fixtures in the dwelling and the first 100 feet .
of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of Business) FIXTURES QTY PRICE AMT
- S1.6; - C S-qc) ?2 7 Sink 9.00
Mailing Address Phone Lavatory 9.00
Owner \D 3 o 5 S t.-J t ' -r Tub or Tub /Shower Comb. 9.00
City/State 4 Shower Only 9.00
�_ , 0 Pte.- Water Closet 9.00
Name (or name of business) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Mailin M&eaa Phone Washing Machine 9.00
Floor Drain 9.00
City /State
ZIP Heate 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
V - DDLIZ.PY it) /,., Pi 10b 0 Mrt ,. Other Fixtures (Specify) 9.00
Ma�9ng Address Phone 9
Contractor (p9 / -Ca /1
k(0 Si Ai ttc4OSC'n...+ Lti3 9.00
ctyfs tat�J A LAT j 0, O fti aJ 1 6 (0 " - 9.00
(v Air .. Sewer 1st 100' 30.00 .
State Registration No. City Bus. Tax No. Sewer - ea. Addit. 100' 25.00
'TIP 6 (p • .24/Z(e) Water Service 1st 100' /ejlb' 30.00 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
�J "/, y _ Back Flow Prevention
an e J� Device or Anti Pollution Device 9.00
e� er a n Date Any Trap or Waste Not
. Connected to a Fixture 9.00
Describe wo new 0 addition ® alteration 0 repair 0 Catch Basin 9.00
to be done residential ® non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00 /hr
Existing use of R.�- t.GiVI�1
building or property . Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of j� C,,, 1.0.121.
building or property I'l,
*(Except residential backflow
prevention devices)
NOTICE . *Minimum Fee $25.00 SUBTOTAL 30. OC"?
PERMITS BECOME VOID IF WORK OR CONSTRUCTION •
. AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE I '5°
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 // ���
Date issued ' i r 7 / / Gt ( by 4 ' (/ Z�t/wav- --
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CITY OF TIGARD BUILDING INSPECTION NOTI
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 63 -4171
Inspection: L e..7 Q/� J
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post /Beam Struct. Plbg. Top Out Elec. Rough -in 46,
Post /Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing (mffi >
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: 3/e /gs� Timer PM
Address: / 2 0.5 /r.� - "7 V ---�
Builder: COg / -6, ( (p fp Permit #: /tin ( ) t)
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date: ,
APPROVED _DISAPPROVED APPROVED SUBJE T TO ABOVE
_Call For Reinsp.