14875 SW 79TH AVENUE ADDRESS:
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hsi,Ofvd.Tigard,Oregon 97223*8199 (503)639-4171
PL-UMFING PERMIT
PERIIIT fit. . . . . . . : PI-M95--0011
639-4171 DATE ISSULDi 01/23/95
..;ITL ADDRESS— 1.4875 SW 79TH AVE
SUBDIVISION. . . . : DURHAM ACRES ZONING. R-4. 5
6LOCK. . . . . . . . . . I._O*r. . . . . . . . . . . . . .49
CLASS OF WORK. . :AL..r 157PRBAISF- DISPOSALS. . : IIOBII_r.'. 1101E SPACES.
TYPE OF USE. . . . S;P WASHING IliPCH. . . . . . . : BACKFLOW PREVNTRS. .
OCCUPFiNLY ERP. . R3 FI-OOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . .
STURIES. . . . . . . . .. WATER HEATERS. . . . . . . CATCH BASINS. . . . . . .
FIXTURES-------- LAUNDRY TRAYS. . . . . . .. SF RAIN DRAINS— —
51NKS. . . . . . . . . . .. URINALS. . . . . . . . . . . . .. 6REASE TRAPE13. . . . . . . ..
LAVATORIES. . . . . : mvirzR r-'1xTuRE5. . . . . :
SEWER LINL (ft) . . . . :
WATER CLC.G)ETS. . WATER I-INE Ift ) . . . . .300
DISHWASHERS. . . . RAIN DRAIN (ft ) . . . . :
Remav-ks - WAFER SERVICL RLPLA(_Ety'1EI\JT
Owner': FEES
M'4RY DORNE I 1 type amol.int by date ir,ecIii
148-15 SW 79T+4 AVE PRMT $ OCA JG 01/23/95
—
PL1_ $ L. 75 JG 01/23/95
I' I F,17)R D 0R '-) 1%224
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RAYBORNIS PLU11BING, INC.
19990 SW CIPPL.E ROAD
TUALAIIN OR 9706�'
Phone #- 692-413. $ 51. 75 101-AL
Reg #. . : 87852
RLUUlRLIj I NEJJEC"I' IONS
This persit is issued sjbject to the regulations contained in the Water Ser,vice In
Tigard Municipal Code, State of Ore. 9
'pecialty Codes and all other Final IriF;pfction
appl:cablr lAms. All hork will be done in accordance w.th
CL
approved plans. This pennt will expire if work is not startea
4ithin 180 days c' issuance, or if work is suspended for oo?,p
than 160 days.
_j X444�
Pov,mitLee � _
Call for inspection
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Business Phone: 639-41 1
,
Inspection:_ �'_GrZ tn� �4c/ ,�'"LQ tt- It-, ,
Footing Su-so. Ceiling Sprink, Rough-in Appr/Sdwlk
Founda ion Plbn. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. P!ba. Tc, Dut Elec. Rouqh-in FINAL:
Post/Beam Ivieeh. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Llgo Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. E!M
Date Requested:,
-L ( Time: AM PM
Address: --
�1
Builder:_ Permit tf
THE FOLLOWING CORRFCTIONS ARE REQUIRED
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Ins/ector: _ Date: Z ^S
APPROVED —DISAPPROVED —APPROVED SUBJECT TO ABOVE
__Call For Reinsp.
cn*v or rIroF'D -- RECEIPT Or PAYMENT Rf CFTI-',T Nn. s95 81i'7
CHECK AMOUNT ; 57. -r
NAMC s RAY)vOPN' S) PLUMPING cAg!pH r44 InUNT s 0. 00
(-4DDRE'''.7,5 s PAYMPNT i)n"(F' t 01/23/97)
SUP 1)1 V I I ON t
:I.Ii;'POSF.' OF F'AYMI.iy l' AMC]I..INT PA I f] LIIJRt:,O [-' OF PAYMENT AM()I.1N''f PA I D
n: '�'I_UMk III 1"'E:RM 5701. 00 �T. Lal.lIl..[) F'CR i`:. 7`:i
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14873 SW 7")-r1i cavi
ruT Al.. AMOUNT PA 1 u -" - > 57. 75
-City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # _
i3125 SVV Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. 0GURCHARGE
"""'•°'0 "°0'"•°' New Single Family Residences Only
A1°•'• I 0 1 BATH HOUSE$140.n0 O 2 BATH HOUSE$195.00
Job (1-. e>15 Q 3 BMIH HOUSE$225.00
Address Gty141.1. Zb Fee includes at! plumbin6 fixtures in the dwelling ana the frst 100 fent �.
of water service, sanitary sewer and storm sewer. See fees below.
FIXTURES QTY PRICE AMT
` Sink _ 9.00
M"",Adie... ph°^• Lavatory 9.00
Owner _ Tub or Tub/Shower Comb. 9.00
"Y'"'• Shower Only 9.00
Water Closet x.00
^- "•"^""^^"^M"...... Dishwasher 9.00
Garbage Disposal 9.00
Occupant ��. Washing Machine 9.00
Floor Drain 9.0'1
m V Water Heater 9.00
Laundiy Room Tray 900
Urinal 9.00
r '�utimP�tN V Other Fixtures (Specify) 9.00
MdY,p P7Qn. Rhona 9,0D
Contractor
TIWO 12'90 Cilbts EJ 9.00
C.Vlsl.l. ZM s.00
,fu L4&-TITj Q IRLE 911)&l Sewer 1st 100' - 30.00
61.1.R.0.1-1 n Nn Coy a,. r„N° Sewer-ea. Addit. 100' 25.00
L7 N I rn 1 Water Service 1st 100' 30.00 '
I hereby acknowledge that I have read this application, that t1-1 Water Service ea. Addit. 200' 25.00
infon r,dtion given is correct, that I am the owner or authorized agent of _ ZS
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 dorm &Rain Drain Addit. 1C0' 25.00
number given is correct. (If exempt from State registration, please -
c ve reason below.) Mobile Home Space 25.00
L Back Flow Prevention
r Device or Anti-Pollution Device 9.00
- '•'°" ^~^^'" p"^" °n1 Any Trap or Waste Not
�, Mq_ S�>Q a Connected to a Fixture 9.00
Describe work. new J addition Q alters::- U repair Catch Basin 9.00
to be done residential non-residential O Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building o^property �t�`S DC�CE Rain Drain, single family dwelling 30 00_
Residential backflow prevention
devices 15.00
Proposed use of
budding or property j�.rv.r.r� ._ -
--- '(Except residential backflow
prevention devices)
NOTICE 'Wnlmum Fee $25.00 SUBTOTAL SS UD
PERMITS BECOME VG'C IF WORK 01 CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR iF 5%SURCHARGE 2�5
CONSTRUCTION OR WORK IS SUSF!ENLIED OR ABANDONED -FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions "-
Date Issued `by -