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-CITY OF TIGARD
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COMMUNITY DEVELOPMENT DEPARTMENTFT
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13125 SW Hall Blvd,Tmpud,Oregon 97223.8199 (503)830.4171 l
UMB I NG PE.RM I T `
PERM: f #. . . . . . . ; 1-'LM94•-Or'200
63�' -4171 DATE ISSUED: 09/06,'94
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PARCEL: yS 1 1 1 BR••••0 I500 �
f S I" . ADDRESS. . . : 09582:' SW JUBILEE CT �
SUPuIVISION. . . . : JUFILLE PLACE: ZONING: R-4. 5
FLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . :003
CLASS OF WORT.. . :NEW GARBAGE DISPOSALS. . : MOBILE HOME SPACES. : �
(YPE: OF' USE. . . . :SF- WASHING MACH. . . . . . . . BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . . ('RAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . ..i-' WATER HEATERS. . . . . . . CATCH BASINS. . . . . . . :
FIX'TURES-,---_._....___. ._._.-. LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . . :
)INKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . , .
LOVRTORIES. . . . . ; OTHER f-T X TURES. . . . . :
IUB/SHOWERS. . . . : SEWER LINE (ft) . . . . :
WA7C:R CLOSETS. . : WATER LINE:. (ft ) . . . . ;
DISHWASHERS. . . , RAIN DRAIN (ft ) . . . �
Remark s : ["ATH I
Owner•: ___._._____.__._..._.___._____._______________.______-___.___ FEES
DAVE SWANSON type amar_tnt loy cute recpt
4582 SW JUBILEE CT PRM1 $ i5. 00 PLT 09/06/94
5V-`CT $ 0. 75 BLT 09/06/94
TIGARD OR 97224
Phone #:
(...Ont;r,�r-.��r•,; _....---_.__......____..__._.._-----._.....___._._......_...._.._.........
(IL I X HENRY LANDSCAPING i
,151 SW DOUGLAS C I R'-LE
I
OSWF_GO OR 97035
' Phon- #: s 1'5. 75 TOTAL
Eley #'. . : 6338
__._. .._.-• REQUIRED .T.N SPECT I ONS --- -- -
This permit is issued s4bj!ct to the regulations contained in the Trip--or.1t Insp
Tigard Municipal Code, Sta`e of Ore. Specialty Codes and all other, Final. Inssper_tion
! applicable laws. All wark w,ll be done ir accordance with
approved plans. This permit will expire if work is not started
within 180 days of i;suanc?, or if work is suspended for more
than 180 days,
Rermittea Si.gn�turE�:/__•
l�2/11:s s _red BYtt
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Call for, inspec am 6:,9•-4175
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City of Tigard PLUMBING PERMIT APPLICATION Pla zk/Rec. #
13125 SW Hall Blvd. Permit # /M=-- °� �`�
Tigard, OR 97223
Y' -4171(5031639
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
w-«o.WNew Single FaimitRasldences C I � 1
�.«."� � I�� �� 0 1 BATH HOUSE$140.00 0 2 BATH HOUSE$195.00
Job Ty r r7 3 BATH HOUaE$225.00
Address anveai. ar Fee includes all plumting fixtures in the dwelling and the first 100 feet
�'r ti✓�' l�k , f ?Z Z or water service, sanitary sewer and stonn sewer. See fees below.
I N •ra .1 I«.) FIXTURES QTY PRICE IMT
C�1,+�2 Sl l�"ti i13Y Sink 9.00
MM"AW� R'•" Lavatory 9.00
Owner ) -Y,' Tub or Tub/Shower Comb. _ 9.00
C"a"" ZIP Shower Only 9.00
Water Closet 9.00
N•r« b.*• l Dishwasher 9.00
Garbage Disposal 9.00
Occupant M""Ad*w ph« Washing Machine 9.00
From Drain 9.00
cxwa«. a Water Heater 9.00
Laundry Room Tray 9.00
"■^• Urinal 9.00
�/X 4/1 �. yc /v f Ulq '�XS� Other Fixtures (Specify) �- 9.00
Ma"nm.. ^"^• 9.00
Contractor
,31- s.00
• 9.00 -'
Sewer 1st 100' 30.00
sta.A"/W"dw No. Gr MA.Te No. Sewtlr-ea. Addlt. 100' �25'00
4'33 Water Service 1st 100' 30.03
1 hereby acknowledge that 1 have read this application, that Use Water Service an. ,Addlt. 200' 2E.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 Sf�nn Pa Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm &Rain Drain Aodit. '00' 25.00
number gtven Is correct. (If exempt from State registration, please
give reason be' ) Mobile Home Space 25.60
Back Flow Prevention
Device or Anti-Pollutic,i Device 9.00
•^R•�••^• .•a^r - �"• Any Trap or Wastn Not
Connected to a Fixture 9.00
Describe work new Q 0gdltfon Q alteration Q repair Q Catch Basin 9.00
to be done residential Q non-residential Q Imp. of Exist. Plumbing 40.00/hr
Specialty Requested Inspections 40.00/hr
Existing use of
building or property , saJ>��� t Rain Drain, single family dwelling 313 00
Residential backflow prevention
devices 5.00
Proposed use of -- -
building or property _
'(Except residential bAckflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL j
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMWENCED'"ATH N 180 DAYS, OR IF 5% SURCHARGE
CONSTRUCTION OR WORK IS SUSPEIIDL'D OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PLAN REVIEW 25% OF SUBTOTAL
L TOTAL � _� •J j
Special Conditions ._
Date issued by_
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CITY OF 'FIGARD - Ftf=C;F:,IPT CIF PAYMF:141" RF:C'EIPT N(::1. :94--k?'564d02
C,F F.CK WOUNT a 15. 75 I
NAME a AL.I X HLNRY LANDSCAPING t ASIA AMOUNT
ADDRCNS a 3150 SW DnLIGMAS C.T.RC;LE I'IAYMENI' DATr~. a 09/0f%/9-4
SUBDIVIBION a
LAKE 1'l3WF.IiCI, OREGON 970,35—
PURPOS OF PAYMENT AMOUNT PAID "`URPCJSF' OF PAYMF-:NT AM13UNT PAID
FSI.UI+18I Nta f'F RM �I._M9A a �=' +M
15. rho Fir.. F0.I T 1-D PFR 0.
95i8i JUBILEE CT
I CJ"C ial.. F1M('UN I PAID - _> 15. 75