15795 SW 80TH AVENUE ADDRESS:
1,57 ?5 SW 9 voi u
Cn
w
lAtecordsimicroflm\targets\buftdiiig.doc
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PLUMBING PERMIT
PERMIT #. . . . . . . . PLM94-01.1
639-4171 DATE ISSUED: 07/19/94
PARCEL: ES 1 1`CC--•0yi 101
3ITC ADDRESS. . . : 1J795 SW 80TH AVE.
SUBD I V T S I ON. . . . : BOND PARK NO. 3 ZONING: R-1.2
BLOCK. . . . . . . . . . . LUT. . . . . . . . . . . . . :69
CLASS OF WC.7R1:. . :ALT GARBAGE DISPOSALS. . : MOBILE HOMO= SPACES.
('YPE OF USE. . . . -SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRG. . : 1
OCCUPANCY GRP— :R3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . .
STORIES. . . . . . . . : WATER HEATERS. . . . . . : CATCH
1"1XTURES--.__- -- _______ .- LAUNDRY TRPYS. . . . . . : SF RAIN DRAINS. . . , ..
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . ..
LAVATORIES. . . . . . OTHER FIXTURES. . . . . :
1"UB/SHOWERS. . . . . SEWER LINE_ (ft ) . . . .
WATER CLOSETS. . : WATER LINE (ft ) . . . . :
DISHWASHER' . . . . 14f41N DRAIN (ft ) . . . . :
Remark LACK FLOW DEVICE:
Owner: _....._w.__.__ _.-..-_________..____ ________________._.__.______.__ FEES
TIM SHIELDS type amount by date recpt
15795 SW BOTH F'RMT $ 17. 00 SW 07/19/94 -
5PCT $ 0. 70 SW 07/19/94
TIGARD OR 9'7`~
Gontrac-tor: ----___. _ •---_.___.__.._.____.___
SUPERIOR LANDSCAPE INC.
,_. Q. PDX 355
I UALAT IN OR 9706E
Fhane 1#: $ 15. 75 TOTAL
^ley #. , 6315
-- _-_-- REOU I RErD INSPECTIONS
This permit is issued subject to the egulatrons contained in the RF'/D?ckflow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection _
ap^licable laws. All work will be done in acre- '.1nce with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
2 than 180 days,
�'. Perini L t e e 5i gnat1.rre :
m
uLO, 1. S s u e d By
J
Call for inspection - 639-4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # _
Tiaard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Nam.of°"'°'a""•n' New Single Family ri:jldenres Only
"d0 i•• ❑ 1 BATH HOUSE$140.00 U 2 BATH HOUSE$195.00
Job ,`.) ❑ 3 BATH HOUSE$225.00
Address n, Fee includes all plumbing fixtures in the dwelling ar;1 the firsi 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
Nn (,„n.""elbalm...) FIXTURES QTY PRICE AMT
T\ �� G } n'� Sink 9.00
M.&O Ad1k... Ph" Lavatc;y 9.00
Owner Tub ur Tub/Shower Comb. 9.00
'R'•'• ZIP Shower Only 9.00
Water Closet 9.00
N.m.(m n.m.of bum...I Dishwasher 9.00
Garbage Disposal 9.00
Occupant M.AYg,may.• Mon. Washing Machine ,. 9.00
Floor Drain 9.00
ZIP Water Heater 9.00
Laundry Room Tray 9.00
N•m• Urinal 9.00
(
i Other Fixtures (Specify) 9.00
M.r'a^"°'"• Pne"' 9.00
Contractor _
V l. ` l L)�' 1 9.00
na 9.00
t -j Sewer 1st 100' 30.00
s'•'•R•a•b"'^n No Oty&a T■•Nn Sewer-ea. Addit. 100' 25.00
Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, 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 '4 laws, that Storm &Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storrs &Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason belo v.) Mobile Home Space 25.00
Back Flow Prevention
�• Device or Anti-Pollution Device 9.00
*• °^" M•p^^" °i1n Any Trap or Waste Not
Connected to a Fixture 9.00
DP cnbe wo.k new O addition Q alteration Q repair' Catch Basin 9.00
to be done residential Q non-residential rasp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
_ Existing use of
`^ building or property Rain Drain, single family dwelling 30.00
` Residential backflow prevention
i
N devices 15.00
Proposed use of
-. building or property -
.� '(Except residential backflow
c prevention devices)
M ,
LD
WOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED --FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions l
bets Issued :Z- _I cl Ll by '