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PL UN S I N S PE,f',,"'I Ir T
,-ERNIT 11. . . . . . . .
CITY OFTI GARD DATE I SCUED 04/0�11 /1-D6
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd Tigard.Oregon 97223*8199 (503)639-4171
UB 1):1,,,11 Ell I C,N. I N%M7 V I El 14 ZONINGi
LOT. . . . . . . . . . . . . .
CL.n"JS 0"' WORK. A: T (,-W-)RVA0c
TYPE OF UZZE. Cr W'ASIIING MACH. . . . . . .. 0 BACKFLOW PREVNTRS. 0
0 c c t.1 r Y o r.i r "Or, Grp
ZT0r,It:1:. . . . . . . . .. t W''-" 11 E A T E"c".S. . . . . . 0 U11 H DPSIM . . . . . . . . 1 .
FTXTURCS Lf',,L' - -Y -!n'('. . . . . . 7r" PnIN . . . . . .
02 1 N K ES)* . . . . . . . . . . i u r".,,, . . . . . . 0 CR!:nSE-: TRAP C. . . . . . . . 0
n YA T 0 r%I . . . . . . ',cel
TUP/31-40WEMS. . . . SEWER LINE (ft ) . . . a 0
''ATCjj r T r-R LJIqC-" (ft ) . . . G7
015HWPiSHERS. 0 MIN DRAIN (ft) . . . 0
Aitiditi 0 f v2 at a t' 1 1* n c
7'E!
�-r�TSWORLD, V.- a m c, -,I t, d4A C. c,
I SW 70TH 30. 1,10 JDA 0! /01/9"E: 0C,_.
7r-'(-7 1 .1. 50 inn 014/c
0t '?72"`3
# -C 17FL
r,E.TU 1 I N-OPT77 7,77
,his is issued su%vt t� the rcjulatic-,is c;,itained in tl,,,e W=Acl- 1-iric 1r1rp
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1jard Code, ,"ate ;f Ore. Specialty Codes ane all cthtr r*a rl;,• I I! i, L:t: .1 q
loss. Ali wtfli will be done llr� a-cord3nre with
riakis. This pars"t will expire it pork is n;t started
tithir 182 days of ili"rcf, or if Work is suspended for we
"Jays.
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13120 SW Hall Blvd. Permit # PL.M ? 0953
Tigard, OR 97223
(503) 639-4171
MINIMUM `$'25.00 PERMIT FEE + STI . SURCHARGE
New Single Family Residences Ont+
-
Job 1 BTH HOUSE 5140.00 Q 2 BATH HOUSE S:95.00
>O ❑ 3 BATH HOUSE$225.00
Address an+ww all Fee includes all plumbing fixtures in the dwelling and the first 100 feet
91 of water service, sanitary sewer and storm sewer. See fees below.
4—( ""'°' "�" MIXTURES QTY PRICE AMT
4 Sink 9.00
U."Ad*— Fh, Lavatory 9.00
ONrrter Tub or Tu6Shawer Comb. 9.00
ar Shower Only 9.Op
Water Closet 9.00
Dishwasher 9,00
Occupant --- Garbrnge Disposal 9.00
y
'"A"— Ph" Wasting Machine 9.00
Floor Drain 9.00
an Water Heater 9.00
Laundry Room Tray 9.00
Unnal 9.00
v O Other Fixtures (Specify) 9.00
wrN . °n"" —` 9.00
Contractor S�C-y lC 9.0c
WON" / ..Y a' 9.00
Sewer 1st 100' 30.00
a"'R"Mmon"' `"'°' ,... Sewer -ea. Addit. 100' 25 GC
7 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this ap4,ication, 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 Stcrm &Rain Drain 1st 100' 30.00
I am registered with the Constructicn Contractor's Board, that the Storm &Rain Drain Addit. 100 — 25.00
number given is correct. (If exempt from State registration, pieasa
give reason below) Mobile Home Space 25.00
Back Flow Prevention
Device or Anli Pollution Device 900
Nw1 °"" W*"M) D.. Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new Q addition Q altentlonQ repair ) Catch Basin g 00
to be done residential Q non-residential Q Inso. of Exist. Plumbing 40.001hr
Specially Requested Inspections 40.00/hr
building or property Existing use Rain Drain, single famiy, dwelling 3000
_ _
Residential backflow prevention
devices 15.00
Proposed use of -"- -
v; building or property —_
'(E>t'cept residential backflow
prevention devices)
NOTICE 'Minimum Fee 525.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION ^^ —
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE I
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK 1S
COMMENCED. PI-AN REVIEW 25°6 OF SUBTOTAL h
Special Conditions TOTAL
f
_ Date issued �_„by