13447 SW ESSEX DRIVE .a..,•, .. i.,...�..:.:-...-:..:,�.�,«p,o;,v.�.:.�. .. to�,.. ,�, .,x«.ddra'tiW':'mww.Kf+dWKw. ..�n sa:�.,_. � ,a,.=_aw,�.,..Jt<�'��,. ,....�. .......,�.....-.... ...
1
F-�
�l
:fM
I
{ b
x
i
`I
I
13447 SW ESSEX DR
C1'1Y OF T i GARD
COMMUNITY DEVELOPMENT DEPARTMENT PL(IMBINr P"RMIT
13125 SW Hall Blvd.Tigard,Oregon 47223+8189 (503)839.4171 .,n, r
D,TrE ISSUED: 061171619!',
1: ZONING: P.
i• .. CICF'LOW PRFVNTPS. . : J.
I IC.1 i`r:`Ft- , , . - l.,'I7r H BASING. . . . . . . .
,,, r��fTrd I}Ft�tl�, . . . . . .
. . . . . . TfRt)PS. . .
I„ t- ^111 N C�1 t<F-'•i lti ( �{)
T7
I
. 1
,i
City of Tigara PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Mall Blvd. Permit # Cic, _ c>i
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.44 PERMIT FEE + ST. SURCHARGE
Dow".• New Single Farnrifv Reeldencss Onix
�.... , ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00
JOU A K-", ❑ 3 BATH HOUSE 5225.00
Address CW~ n. Fee includes all plumbing factures in the dwelling and the first 100 feet
�_Rk 'J �� �� of water service, sarairy sewer and storm sewer. See fees below.
�. e+�i I . - \ FIXTURES QTY PRICE AMT
i`�) .`. / �'WV�`���L� Sink _. 9.00
Mw Ad*� Lavatory g•W _
OWn3r U _.- Tub or TublShrwer-Comb.- 9.00
C&~ Shower Only 9,00
Water Closet 9.00
rw..i.�.. M V. l Dishwasher 9.00
Garbage Disposal 9.00
Ocxxrpaltt mom Ad"" pr. Washing Machine 9.00
Floor Drain 9.00
nwrAft a► Water Heater 9.00
Laundry Room Tray 9.00
Urinal 9.00
Oftr Pictures (Specify) 9.00-
yry Nrr 9.00
Contractor ,c, 900
✓� 9.00
Sewer 1st 10030.00
au+........ �+° T.M` Sewer-ea. Addit 100' 25.00
c^(� � ��� Water Service /st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Servide ea. Addle. 200' 25.00
information given is correct, that I am the owner or authorized agent of -'
the rwner, that plans submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 3000
1 am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addit 1W 25.00
nu r_"s s leo (If exempt from State iegisbation -)lease
e naso beldw.) Mobile Name Space � 15.W
Baric Flow Prevention
1itIli(/\_ & Device or Anti-Polluticia Device 9.00 `
....> o.. Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new Q additian alteration repair Q Catch Basin 9.00
',o be Done residential non-residential Q tnsp. of Exist Plumbing 40.00/hr
Specially Requested Inspections 40.00fhr
Existing use of Rain D ja,-0;rrq�IMT*r-.dwglling 30.00
building or property --
sidential backflow prevention
�devieer 15.00
Proposed use of �_-
building or property _�._. *(Except residenflat backflow
prevention devices)
~ NOTICE "Minimum Fee $25.00 SUBTOTAL
PERMTiS BECOME_VOID IF WORK OR COIJSIRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%.SURCHARGE 7 7
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED '--_-- --i
i
FOR A PFRIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
F�' N REVIEW 25%. OF SUBTOTAL
COMMENCED
TOTAL
Special Conditions
by
DaDowi�atud > 1