Permit SIN OF TIGARD PILUh1BING PERMIT 5_
PERMIT # • PLM9� 0381
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 12 / 29 /9
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S 104BA -08900 •
SITE ADDRESS...: 13863 SW LIDEN DR
SUBDIVISION CASTLE HILL #2 ZONING: R -25 PD
BLOCK • LOT •124
CLASS OF WORK..:(LT 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 O 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: Installing backflow prevention device
Owner: FEES - - - -•
LEUNG NIKI type amount by date recpt
13863 SW LIDEN DR PRMT $ 15.00 B 12/29/95 95- 274419
SPCT $ 0.75 B 12/29/95 95- 274419
TIGARD OR 97223
Phone #:
Contractor:
PRO LANDSCAPE
P 0 BOX 5952
BEAVERTON OR 97006 - -- -•-
Phone #: 642 -5452 $ 15.75 TOTAL
Reg #.. : 5903
REQUIRED INSPECTIONS
This permit is issued subject to the reoulations contained in the Final Inspection —
'Hoard Municipal Code, State of Ore. Specialty Codes and all other
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 180 days.
P e r m i t t e e Signature: C •
Issued By: g• Q,t'� __
Call for inspection - 639 -4175
•
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # PUN► IS -0g1
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
"ma d Droinallool New Striate Family Residences Only
1 P.IA v■.0 lV i Ici
� .` ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
S W
Job ' 36623 b y` d � jl I� v. ❑ 3 BATH HOUSE $225.00
Address Waal* m Fee includes all plumbing fixtures in the dwelling and the first 100 feet
`r u - - Gg q 7 2 z-3 of water service, sanitary sewer and storm sewer. See fees below.
Mona ( a' d a ' ° " ° ' FIXTURES QTY PRICE AMT
Sink 9.00
Wino Mama "10°a Lavatory 9.00
Owner 1 5 eea v au L-1 r1 de4'? Dr. Tub or Tub/Shower Comb. 9.00
Shower Only 9.00
- ri r of 012- 972- Water Closet 9.00
Name al °"'°ar Dishwasher 9.00
Occupant Garbage Disposal 9 .'00
"""o A Phan Washing Machine 9.00
Floor Drain 9.00
OtatStoto ao Water Heater 9.00
Laundry Room Tray 9.00
'a"' ( z - Urinal 9.00
- Lei 'Vloi 4.v Co Other Fixtures (Specify) 9.00
Al Contractor a as.a 9.00
P 1 0 ' J ox 52 9.00
mow. m 9.00
le Q -o n Q c' 7 (��o Sewer 1st 100' 30.00
State Ropit adOA "a. Cay eis. T° "° Sewer - ea. AddiL 100' 25.00
5 9 O 3 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. AddiL 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 Contractors Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reaso below.) Mobile Home Space 25.00
h
Back Flow Prevention
. _ C / 2 -2.-9 -S Deevi ce or Anti-Pollution Device 9.00
at agora) °i° Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new et addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backfiow prevention
devices 15.01
Proposed use of
building or property
'(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL i I S'CC,
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE /7C
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 511C
. Special Conditions
Date issued 2 -I- ( q, r 1�
C-- by g, pL .a ti r•--