Permit . ^
PLUMBING PERMIT �~
` � CITY OF TI ���� � PERMIT # : PLM95-0339
��C�-�� �m���-�k�=�� DATE ISSUED: 11/09/95
COMMUNITY DEVELOPMENT DEPARTMENT
131 , Oregon 97223°8199 (503) 639-4171 PARCEL: 2S104BD—RMO23
SITE ADDRESS0..~ 12701 SW 138TH AVE
SUBDIVISION....: ROSE MEADOWS ZONING: R-7
BLOCK..........: LOT ...... .......:023
• • _
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:SF WASHING MACH......: 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:R3 FLOOR DRAINS......: 0 TRAPS..............: 0
STORIES....'...: 0 WATER HEATERS : 0 CATCH BASINS ^ 0
FIXTURES------------- LAUNDRY TRAYS.....: 0 SF RAIN DRAINS ^ 0
SINKS ^ 0 URINALS ^ 0 GREASE TRAPS.......: 0
LAVATORIES. . ... : 0 OTHER FIXTURES.. .. : 0
TUB/SHOWERS • 0 SEWER LINE ( f t ) . . . : 0
WATER CLOSETS..: 0 WATER LINE (ft) ...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: Install residential .backflow prevention device.
Owner: ---- — — — FEES ---
DICK KERKER1NG & SUSAN type amount by date recpt
12701 SW 138TH AVE PRMT $ 15.00 JSD 11/09/95 95-272742
5PCT $ 0.75 JSD 11/09/95 95-272742
TI8ARD OR 97223
Phone #
Contractor: • —
TRYON CREEK LANDSCAPE INC
11400 SW NORTH DAKOTA ST
TIGARD OR 97223 --- ------------
Phone #: 624-2174 $ 15.75 TOTAL
Reg #..: 006296
REQUIRED INSPECTIONS -------
This peroit is issued subject to the regulations contained in the RP/Backflow Prey _
Tigard 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 permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more _ _
than 18111 days.
Permittee ure :
Issued � ' , ~-- - g �._ - �
Call for inspection — 639-4175
'
City,of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # r `i5 o -33
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Desebpment New Single Family Residences Only
ROS('_ i't !_ +OOc-'s
Address _ ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job l a�Q) - 5` - '3 1 L 4l)L ❑ 3 BATH HOUSE $225.00
Address City/State Di Fee includes all plumbing fixtures in the dwelling and the first 100 feet
T( ocIfk_ OR er of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of eaa) FIXTURES QTY PRICE AMT
.. r . '10/1 P � I I't1 e-/ 9.00
Main. ..dress A e 4 Lavatory 9.00
Owner I. ' ■ law 1 ' AI Tub or Tub /Shower Comb. 9.00
City Sta at/ te ,�� V V V 11, I F 7 r Shower Only 9.00
wl . OR '7) Z23 Water Closet 9.00
Name (or name of busmen) Dishwasher 9.00
.)tLK - k 54641-1 1 Ke 1l--ilj Garbage Disposal 9.00
Occupant Muting Address °„ „• Washing Machine 9.00
1 Z. O I S• I1 A >L Floor Drain 9.00
City /State tb Water Heater 9.00
T) t-i..0 1 Dk , c ' ... Laundry Room Tray 9.00
Name Urinal 9.00
(R- fOTl C Li S (Aj . .1 rt C Other Fixtures (Specify) 9.00
Mafng Address p,,„„. t� 9.00
Contractor t
11400 St-) HoRr) - 1 A CTU ST a- - 4 L i 9.00
City /State LP 9.00
U f Z Z Sewer 1st 100' 30.00 fl
State R °g °B°° No. Tea No. Sewer - ea. Addit. 100' 25.00
)525 / G 2, q 6 Water Service 1st 100' 30.00
I hereby acknowledge that l ave 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 ' correct. (If exempt from State registration, please
givvreason b w.) Mobile Home Space 25.00
r Back Flow Prevention
.: �m�' Device or Anti - Pollution Device 9.00
Mora feeler • agent) t ( Date Any Trap or Waste Not
1 ',J.- Connected to a Fixture 9.00
Describe work new addition 0 alteration 0 re air 0 Catch Basin 9.00
to be done resider l ()11 non- residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00 /hr
Existing use of ) I )
building or property del✓ "6 Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices I 15.00 1. a
buildilding or p up of 1 `v, ` eZ5 t j ( �
buing r l 7`
'(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL (c
/
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
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 I C q C
Special Conditions
Date issued by