Permit CI1YOFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 539 -4171 PLUMBING PERMIT
PERMIT # • PLM95 -0321
639 -4171 DATE ISSUED: 10/19/95 •
PARCEL: ES10ECB -02300
SITE ADDRESS...: 13200 SW PACIFIC HWY
SUBDIVISION • FREWINGS ORCHARD TRACTS ZONING: C —G
BLOCK ° LOT - e
CLASS OF WORK ^.:ALT GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
TYPE OF USE •COM WASHING MACH • BACKFLOW PREVNTRS..:
OCCUPANCY GRP. °:B2 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) •100
WATER CLOSETS..: WATER LINE (ft)
DISHWASHERS • RAIN DRAIN (ft) •
Remarks: Repair private sewer line
Owner: FEES
PACIFIC PROPERTIES type amount by date recpt
PRMT $ 30.00 JSD 10/19/95 95- 271883
5PCT $ 1.50 JSD 10/19/95 95- 271883
Phone #:
Contractor:
RESCUE ROOTER
7717 SW NIMBUS
BEAVERTON OR 97006
Phone #: 243 -1172 $ 31.50 TOTAL
Reg #..: 44677
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspect ion
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 180 days.
Permittee Signature: _ _
I ssued By: ,X
Call for inspection — 639 -4175
A
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 Hall Blvd. Permit # rLrn q5 - 0 - 50 I
Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job 13R co s (,J ems, H 4._ ) (�}i ❑ 3 BATH HOUSE $225.00
Address cmw
Ise (J an Fee includes all plumbing fixtures in the dwelling and the first 100 feet
r i & y d Q Y S 2 22' of water service, sanitary sewer and storm sewer. See fees below.
Name (« name a xm.les.) FIXTURES QTY PRICE AMT
AGdr. L 6-0 p T ' LS Sink 9.00
Meip Addr..s " Lavatory 9.00
Owner / 3 " 2 CID -S W 0 k e_ , 6ic,7 Tub or Tub /Shower Comb. 9.00
City/ State Shower Only 9.00
( Ord 5 7223 Water Closet 9.00
Name (or °h.. of bswm o ' Dishwasher 9.00
Occupant M Garbage Disposal 9.00
°a" Ad'°° Pnone Washing Machine 9.00
Floor Drain 9.00
C"A"S`°`° as Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
S Q _ 4„ '� e--/ Other Fixtures (Specify) 9.00
Main Address Rime 9.00
Fi t 9.00
Contr a ctor
citytsm. an 9.00
4 0s0n (/l' /f? Sewer 1st 100' 20 30.00 '30
State Reparation No. CrY a"'• Tax Na. Sewer - ea. Addit. 100' 25.00
1 / 6 77 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
oiD- ckt.- GE2g- Device or Anti - Pollution Device 9.00
Signature (owns or a DiSe Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration 0 repair 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 backflow prevention
devices 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 W ) WITHIN 180 DAYS, OR IF 5% SURCHARGE /�0
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 -3/
Special Conditions
Date issued by