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`• COMMUNITY DEVELOPMENT DEPARTMENT •. •
, .. • 13125'•SW - Hall Blvd, Tigard; Oregon 97223.8199 - - (503) 839 -4171 - 'PLUMP MP` I NG - PM I T, - ,
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- di7t-t R's) OR .97223- . - � -
ON P.'2 I N RD T, 'PLUMB I NBa r i NC • - , ,
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City - of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 9s- 7oR/
13125 SW Hall Blvd. Permit # k m9c oa
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 16640 S.W. 72nd ❑ 3 BATH HOUSE $225.00
Address aMSed. zw Fee includes all plumbing fixtures in the dwelling and the first 100 feet
PORTLAND OR . of water service, sanitary sewer and storm sewer. See fees below.
Name (or name of Business) FIXTURES QTY PRICE AMT
PACK - TRUST CO Sink 9.00
Many A0i°ae Phan Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
CIN/State ZIP Shower Only 9.00
Water Closet 9.00
Name (or name of wdnml Dishwasher 9.00
PERCISION INTERCONNECT CO. Garbage Disposal 9.00
Occupant „ wing mt. Pone Washing Machine 9.00
16640 S.W. 72nd 1,47 - Iyia Floor Drain 9.00
alyiState ZIP Water Heater 9.00
PORLAND OR. Laundry Room Tray 9.00
Name Urinal 9.00
JOHN E. REINHARDT PLUMBING INC. Other Fixtures (Specify) 9.00
Contractor Men neam P . O. BOX 129 P"°" 9.00
9.00
CayIState ZO 9.00
NEWBERG / o • .OR. 97132 Sewer 1st 100' 30.00
19. 111-/ 0:016 16 O f e r n e g Or Sm. Tan No. Sewer - ea. Addit 100' 25.00
36 - 9 PB - 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 b w.) Mobile Home Space 25.00
Back Flow Prevention
� �" _ e J __ �/4(' Device or Anti - Pollution Device 1 9.00 9.0
a (owner or agent) Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration ® 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 backflow prevention
devices 15.00
Proposed use of
building or property
*(Except residential backflow
prevention devices)
NOTICE • 'Minimum Fee $25.00 SUBTOTAL 25.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION J
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 1.2 S
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
q /
TOTAL , �
Special Conditions
Date issued by
CITY OF TIGARD BUILDING INSPECTION NOTICE •
. Inspection Line (Rec -O- Phone): 639 -4175 siness Phone: 639
,
Inspection: `i /i / /�v �� ' +
Footing Sus.. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
Date Requested: /D /Zl 'L Time: AM PM
Address: ) 66 Lio 7 - 1 d
Builder: S3 - Permit #: eL1nn► t 04 7;--
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspect : Date:4 / /'
PROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.