Permit 2e q5 -Z41713 cp c/
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PLUMBING PERMIT
PERMIT #....... PLM95-0144
639 -4171 DATE ISSUED: 06/22/95
PARCEL: 2S103DD- 0100
SITE ADDRESS...: 13935 SW PACIFIC HWY
SUBDIVISION • ZONING: C —G
BLOCK • LOT •
CLASS OF WORK..:ADD GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
' TYPE OF USE •COM WASHING MACH BACKFLOW PREVNTRS..:1
OCCUPANCY GRP..:B2 FLOOR DRAINS TRAPS •
STORIES •1 WATER HEATERS • CATCH BASINS
FIXTURES----- LAUNDRY RAYS • SF RAIN DRAINS
SINKS • URINALS . GREASE TRAPS •
LAVATORIES • OTHER FIXTURES -
TUB /SHOWERS • SEWER LINE (ft) •
WATER CLOSETS..: WATER LINE (ft)....:
DISHWASHERS • RAIN DRAIN (ft)
Remarks: INSTALL COMMERCIAL BACKFLOW DEVICE FOR IRRIGATION — ALSO ELECTRICAL
PERMIT ELR95 -0023.
Owner: --- - -• - - -- - - - - -• FEES ---
BOSTON CHICKEN type amount by date recpt
1111 MAIN ST PRMT $ 25.00 SW 06/22/95 —
5PCT $ 1.25 SW 06/22/95 —
VANCOUVER WA 98660
Phone #: (206)750-0668
Contractor: • . - -- --------------
OREGON GROUND MANAGEMENT
4703 SE 65TH PLACE
PORTLAND OR 97206 -- —
Phone #: 503- 771 -6130 $ 26.25 TOTAL
Reg #. : 005813
REQUIRED INSPECTIONS -- - - - - --
This permit 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 180 days.
Permittee Signature:
Issued By: .W / A M
Call for inspection — 639 -4175
•
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13126 SW Hall Blvd. Permit # QI IM95_c ( f q( •
- Tigard, OR 97223
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
0.5- ��� 7 4 ) 7 New Single Family Residences Only
A � �
0 1 BATH HOUSE $140.00 0 2 BATH HOUSE 5195.00
Job /393' 5 / C /7 e' L/6 ❑ 3 BATH HOUSE $225.00
Address
croft Fee includes all plumbing fbcbues in the dwelling and the that 100 feet
7e-g, GQ of water service, sanitary sewer and storm sewer. See fees below.
77 (v name at Bs.rSE FIXTURES QTY PRICE AMT
Zas i,Ai, 7" ,4 G( J.
Sink 9.00
" / "' o
3763 Lavatory 9.00
Owner / /// //7,9;-;_5"Z a 7 750 - ES Tub or Tub/Shower Comb. 9.00
cr m" a Shower Only 9.00
ic r by o A• �4S/._. Water Closet 9.00
w°' (d 11°" d &amm' Dishwasher 9.00
/loo -ZA . ! "E l 7 Garbage Disposal 9.00
Occupant
,,��ii Washing Machine 9.00
//// ///�! /N ,< 7 ' Six, / 546 Floor Drain 9.00
no Water Heater 9.00
/it/ G OG/ v e e-- Ge--,40 Laundry Room Tray 9.00 j
i "' Urinal 9.00
Yt. O ,tJ C9 ' .i!?OU �i�,�c.19 o/fk1N� Other Fixtures (Specify) 9.00
eking 9.00 . Contractor U
/7. 3 .<--(. 6 / Sal 77'/ - (/36 9.00
ao 9.00
eXg77 /,g, 0/ 97206 Sewer 1st 100' 30.00
�"' R spitri 00 n "° ° h a" Tax "°• Sewer - ea. Addit 100' 25.00
• 57/3 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 th Storm & Rain Drain
number given is correct (If exempt from State registration, please Addit 100' 25.00
give reason below.) Mobile Home Space 25.00
/ 9.4z===. ack Flow Prevention
( 5 -- '7 7 -95 Device or Anti - Pollution Device 9.00
s ( • a peel oar Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new ® addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential ® Insp. of Exist Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property �, 5 e- i gl,U� Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property Sin S
'(Except residential backflow
prevention devices)
NOTICE `Minimum Fee 525.00 SUBTOTAL .,4,
G-/
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE • Z
ITH
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
C_____ TOTAL ��
Special Conditions
Date issued I Z 74 6 by 6,
•