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!TY OF TIGARD �'
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223@8199 (503)639-4171 PLUMBING PERMIT
PERMIT #. . . . . . . : PLM95-0061
639-4171 DATE ISSUED: 04/04/95
JJ Ir -ARCCL: IS-135DB-02(�Vil
SITE- ADDRIESS. . . : 11375 SW 90TH AVE
SUBDIVISION. . . . . TIGARDVILLE PARK ZONING- R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . .. . . . . . . ..3
---—-------
CLA5S OF WORK. . :ALT GARBAGE DISPOSALS. . : MOBILE 1-COME SPACES.
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . : 1
!ICCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . .
STORIES. . . . . . . . : WATER HE==ATE=RS. . . . . . . CATCH BASINS;. . . . . . .
LAUNDRY TRAYS. . . . . . : SF RAIN DRAIN 5. . . . . :
SINKS. . . . . . . . . . U R I 1\1 A L G). . . . . . . . . . . . . GREASE TRAPS. . . . . . . :
LAVATORIES. . . . . . OTI-JER FIXTURES. . . . , :
TUB/SHOWERS. . . , : SEWER LINE (ft ) . . . . :
WATER CLOSETS. . : WATER LINE (ft ) - - :
DISHWASHERS. . . . : RAIN DRATKI ift ) . . . . :
Ren ,WkS - IT1StAlliT1!J I)ac-P.flo(4 pr-evention device.
Owner: FEES
'3TEPHEN SIZER type A m 0 Un t 1:)y date r-ecpt
1111:575 SW 90TH AVENUE PRMT 15. 00 B 04/04/95
5PCT g 0. 75 B 04/04/95
—
r IC.44RD OR 17223
'i o n(--
4 #: 639-5701
Lcinty-actov--
OWNER
PhQTle 175. 73 TOTAL
REOUIRED INSPECTIONS
This pervit is issued subject to the regulations contained in the RP/BAt--,kflow Pt-ey
Tigard Municipal Code, State of Ora. Specialty Codes and all other Firial Ins pact ion
applicable laws. All work will t@ done in accordance with
approved plans. This permit wili expire
pire if work is not started
within 180 days of issuance, or if work is suspended for sore
rx tl;an 180 days.
V)
ermittee Sir4ilati.tv,er-
LD
By
I s si t.t e d
Call for inspection 639-4175
City .& Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # �t M-- _
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
N.-.1 - , � r New Singie Family Residences Only
Ade... ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00
Job ,f �) ❑ 3 BATH HOUSE$225.00
Addressc,ra.ry nP Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
-'- wm.,.r .yeuwn TFIXTUR.ES QTY PRICE AMT
ab-:--,� Sink 900
M.+o Aft� INN" Lavatory 9.00
Owner Tub or Tub/Shower Comb. 9.00
r.r •• Shower Only 9.00
Water Closet 9.00
N...(M n.R .r EIMR...r Dishwasher 3.00
j)lJ'` z h pY�J Garbage Disposal 9.00
Occupant M..,a Ad&- Ph" Washing Machine 9.00
I Floor Drain 9.00
aP Water Heater 9.00
Laundry Room Tray r 9.00
Urinal- 9.00
1 Other Fixtures (Specify) 9.00
M.Mg Ad&„. Pn... 9.00
Contractor 9.00
CRY19I.. 9.10
Sewer 1st 100' 30.00
!"A.R.Q ft on No. 7*•N. r" Sewer -ea. Addit. 100' 25.00
"Nater 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 Storm &Rain Drain 1st 100' 30.00
the owner, that plans submitted are in compliance with :.'tate laws, that
I am registerod with the Construction Contractor's Board, ;ha: the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exe-ipt fro-n State registration, please - -Mobile -
_ obile Home Space 25 OU
give reason below.)
Pack Flow Prevention
Device or Anti-Pollution Device - 9.00
J Sys
We Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new r ) addi'on Q a4csration repair Q Catch Basin 9.00
to be done residential Q non-residential 0 Insp. of Exist. Plumbing 40 00/hr
Specially Requested Inspections 40 00/hr
Existing use of
Rain Drain, single family dwelling 30-00
rr building or property -
Residential backflow prevention
N devices ) 15.00
F- Proposed use of
J building or property - -�. - -(Except o-ldentlal backflow
m preven.fon devfcrs)
U)
J NOTICE 'Minimum Ftp 525.00 SUBTOTAL
PERMI rS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 7`�
CONSTRUCTION OR WORK!S SUSPENDED OR ABANDONEDFOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25%OF SUBTOTAL
COMMENCED. _
TOTAL
Special Conditions _- _ �-- _--�
Date issued L/, 5 by
Permit#: --
p_F
Address:
Issued by: Date:
Statement: information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can he issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.OiO(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 313:
❑ 1. I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold of offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
313. I will'be my cwn general contractor.
If I hire, subcontractors, I will hire only subcontractors registered with the Construction Contractors
Beard. If[change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately not fy the office issuing this building permit of the
name of the contractor.
Cn I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Si afore of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
I