Permit . ' . ` CITY OF TIGARD
A PLUMBING PERMIT
DEVELOPMENT ~="���~"-*�" "°"~~"=" =°"-""�"~=~~~° PERMIT # • PLM97-0140
~��'�J� t 3���N/�NBh�.Y�ooi��g�����9�/7Y DATE ISSUED: 04/24/97
PARCEL: 2S103BC-696900
SITE ADDRESS...: 12230 SW LANSDOWNE LN
SUBDIVISION - FYRESTONE ZONING: R-4.5
BLOCK ....... ...: LOT ' ~8 JURISDICTION: TIG
_
CLASS OF WORK..:ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH....iH.: 0 BACKFLOW PREVNTRS.. : 1
OCCUPANCY GRP. . :H2 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 (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS ^ 0 RAIN DRAIN (ft)...: 0
Remarks: INSTL RESIDENTIAL BACKFLOW PREVENTION DEVICE
Owner: ----- - FEES -
SUSAN BAXTER type amount by date recpt
12230 SW LANSDOWNE. LN .. PRMT $ 15.00 TAT 04/24/97 97-293686
TIGARD OR 97223 5PCT $ 0.75 TAT 04/24/97 97-293686
Phone #:
Contract or -
PRO LANDSCAPE
PO BOX 5952
BEAVERTON OR 97007 --
Phone #: 642-5452 $ 15.75 TOTAL
Reg #..: 005903
REQUIRED INSPECTIONS
This permit is issued subject to the contained inth* Water Line Insp.
Tigard Municipal Code, State of Ure. Specialty Codes and all other Misc. Inspection ____
applicable laws. All work will be done in 'accordance with RP/Backflow Prey
approved plans. This'permit will expire if work•is not started • Final Inspect ion ,
within 180 days of issuance, or if. work is suspended for more .
than 180 days. . - '---
�
--' '
______
I » / ' -_-
Permittee Signa / ^� ,
Issued By: _ ... �/ fftli „ _ __ . ---� _ --
C.11 for inspection - 639-4175
' -
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125.SW Hall Blvd. Permit # OL.V11tJ7 /f0
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
No1e or Develop"'"` New Single Family Residences Only
Address ��,�, � "� � ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job 17.3D S L� LQi ��%�CJI;(k n Liu ❑ 3 BATH HOUSE $225.00
Address otWstate 7 ze Fee includes all plumbing fixtures in the dwelling and the first 100 feet
-1-1 ` ! 1 re---' 97 LZ-',3 of water service, sanitary sewer and storm sewer. See fees below.
Name (•r of ' �7 - Z,b- FIXTURES QTY PRICE AMT
USa /3 0--X K 2 i i (DZ Sink 9.00
Maine Address Lavatory 9.00
Owner . 9 = 1 - 1/ 1 6 - ' Tub or Tub/Shower Comb. 9.00
"'''stare ro Shower Only 9.00
Water Closet 9.00
N. xar name 0 ' °ia01d•) Dishwasher 9.00
Occupant M S , I " ` b' Garbage Disposal 9.00 • g iro Adersn " Washing Machine 9.00
Floor Drain 9.00
myrsrw Do Water Heater • 9.00
Laundry Room Tray 9.00
"°' ; � � � /1 Urinal 9.00
(P s�J� Other Fixtures (Specify) 9.00
Mai'g Address R'"'° 9.00
Contractor /
p' 0 80X g� 5 Z L0 -' 9.00.
c ry�srar. zo 9.00
,I KJziy a, �,�7G J2 Sewer 1st 100' 30.00
�� ' �'' � "` Rminhabun No. ' C e"°. Tat No. Sewer - ea. Addit. 100' 25.00
S C j � /12.174-m-3575 ;k Water Service 1st 100' 30.00
I hereby acknowledge that I have rea d/ I vL 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.) / y-/-7-q? Mobile Home Space 25.00
A^^^ -C�l ri AVAQ Pal J,-- De Row Prevention
Device or Anti - Pollution Device 9.00
s'W`• t°•"•r °" 9°"`r °iti Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new addition Q alteration 0 repair 0 Catch Basin 9.00
to be done residenti 1 0 non - residential 0 Insp. of Exist. Plumbing 40.00air
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices I 15.00
Proposed use of
building or property
`(Except residential backflow
prevention devices) .
NOTICE *Minimum Fee $25.00 SUBTOTAL
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 15
Special Conditions
Date issued by
1/4/2005
Case Activity Listing 1:31:32PM
TIDEMARK Case #: PLM97 -00140
COMPUTER SYSTEMS, INC.
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fi/f .. .y ,.:�.... .. .� rY -,, ,. .. Y 3 � -, „ :'R „! tii %N +;.:
t� _.- .. �....�, �<. -:._ -:: ssi rigid; <' -> ..Done U dated
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+5..
'D�s To %% �B. Notes
at 2 .� Date 3 -'Ho
1' D e �`t � ,�;
� ate ;
cry tion::
=D
PLMA007 Application received 4/24/1997 4/24/1997 None 4/24/1997
TAT
PLMA799 Final Inspection 4/24/1997 4/28/1997 None PASS MS 4/28/1997
MRS
PLMA050 (F) Issue permit 4/24/1997 None PASS TAT 4/24/1997
TAT
PLMA800 Case Finaled 4/28/1997 None PASS MS 4/28/1997
MRS
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