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PLUMBING PERMIT
PERMIT #. . . . . . . .. Pl—M96-010i 3
CITE' CSF TIGARD DATE ISSUED: 05/07/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 25110BB-04500
I'm Tigard,Or"on 97223e8l 99 503N 039-4171
SI1 'r— iTVIMTIV�-. . , 12,117 5W CHAIN LEP I)p
SUBDIJISION. . . . : ARLINGTON RIDGE ZONING: R-3. 5
BLOCK. . . . . . . . . . 1-01.. . . . . . . . . . . . . :022
---------------------------------------------------- ----------------------------------
CLASS OF WORK. - *.04DD GARBAGE: DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . sSF WASHING MACH. . . . . . :, 0 BACKFLOW PREVNTRS. . : I
OCCUPANCY GRP. . :A1 FLOOR DRAINS. . . . . . : 0 TRAPS. . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH B SINS. . . . . . . : 0
F I X*1 U RES--------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHEP FIXTURES. . . . : 0
TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. . : 0 WATER LINE (ft ) . . . : 0
DISHWA.17jHERS. . . . : 0 RAIN DRAIN (ft ) . . . z 0
Remat-lis: Installing one t,esidential backflow prevention device.
Uwner,: FEES --------------
11L.LEN H0101- T type amount by date t-ecpt
SW CH,INDLER PRMT $ 15. 00 CJS 05/07/96 96-2179005
5PCT $ 0. 75 CJS 05/07!96 96-27900b
I IGARD OR 1.)7L'23
L,hone 4: 503—.168-2760
HICHARD HANSEN
25540 SW GRAHAMS FERRY RD
SHERWOOD OR 97140 --------------------------------
Phone #t 503-682-4157 $ 15. 75 TOTAL
Reg 41. . : 10382 REOUIREG INSPECTIONS
1his persit is issued subject to the regulations contained in the RP/Backflow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Fir-al Ii spection
applicable laws. All work will be done in accordance with
approved plans. This peroit will expire if work is not started
within 180 days of imance, or if work is suspended for eare
than 180 days.
1-',-v-mittee SignatlAre:
IssLied By :
Call for inspect ion 639-4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # l 1 7q,/e7,<13125 SW Hall Blvd. Permit # P4, %1,76
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
New Single Family Residences Only
'
Job /`- (� ❑ L-31 BATH HOUSE $140.00 2 BATH HOUSE$195.00
/���, ��G�' !l d 0 3 BATH HOUSE $225 00
AddressZIP Fee includes all plumbing fixtures in the dwelling and the first 100 feel
�� of water service, sanitary sewer and storm sewer See fees below.
FIXTURES QTY PRICE AMT
(�L4. li d• ./L-f l f� O �' Sink �-
9.00
MYny nAdn. Pnnin � —
�Y / Lavatory __
9.00
Owner A 6,the k,) Q rI�i�� Tub or Tub/Shower Comb_ 900
Shower Only _ 9.00
— Water Closet 9.00
N.mn is .m.or Mn«.u1 Dishwasher 9,00
Ga — —
rbage Disposal 9.00
Occupant M.�,a,_ �. —
' Washing Machine 9.00
Floor Drain 900
Water Heater _ 9.00
Laundry Room Tray 9,00
Urinal _ 9 00
pe
Other Fixtures (Scify) _900
Contractor �' � �J( 900
9009-00 —
sr
Sewer Ist 100' -- 3000
54U Hnpnn rtwn Nn CM . fu Nn
Sewer-ea Addit. 100' 25.00
76�� Water Service nst 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea Addd. 200' 2500
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 Conshuction Contractor's Board, that the25.00 _ ^
Sturm 3 Ram Drain Addil. 100'
number give%is correct. (If exempt from State registration, please
give reason b'elow.) Mobile Home Space 2.5.00
Back Flow Prevention
ytila ( y Device or Anti-Pollution Device 900
-
Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new (_) addition ) alteration U repair Q Catch Basun 9 00 —
to be done residential nun-residential O Insp of Exist Plumbing 40.u0/hr
Existing use of Specially Requested Inspections _ 40 OU/hr
building or property _ _ Ran Drain, single family dwelhn9 30.00
Residential backflcw prevention
devices 1500 ;S
Proposed use of — -- 1--
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 -JAYS OR IF 59; SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED -
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PIAN REV'EW 25". OF SUBTOTAL
Special Conditions TOTAL --
_ ._ Date issued by -
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mach.
PIbg.Und/Fir/Slab Plbq.Top Out Insulation -Elect.
Post/Beam Struct, Mach. Rough-In Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins,
Other:
Date: _ A.M. —P.M. Entry: _
Address: � ' 7 -5CU ��ahL Pf �
Tenant: Ste: MST:
BLIP: _
Con/Own: –�
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
i
'nspector/ _ Dater
f
APPROVED __.DISAPPROVED/CALL FOR REINSP. CF CO