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t;ITY GF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hal:Blvd.Tigard,Oregon 97223.8199 (503)639-4171 PLUIhIB I Nh PEE RM I T
PERMIT #. . . . . . . : E'LI194-017E
639-4171 LATE ISSUED: 08/17/94
SITE ADDRESS. . . 13000 5W 107Tc I CTF riRCEL: 2S]03AD-04`00
SUBDIVISION. . .. . - PATHFINDER ZC)IvING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :32
CLASS OF WORK. . :NEW GARBAGE DISPOSALS. . : 1"10La I LE HOME SPACED. :
1 YPL OF USE. . . . :SF WASHING MACH. . . . . . . : DACKFLOW PREVNTRS. . : 1
OCCUPANCY 13RP. . : R3 FLOOR TRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . : 1 WATER HEATERS. . . . . . . CATCH HASIMIS. . . . . . . .
F I XTURF_'S-- -_______._.____. LAUNDW.Y TRAYS. . . . . . : SF RAIN DRn i;NS. . . . .
S.:NKS. . . . . . . . . . URINAL_S. . . . . . . . . . . . . GREASE TRAP<<. . . . . . . .
LAVATORI S. . . . . : 0-i-ICR FIXTURES. . . . . :
TUE+/SHOW�cRS. . . . : SEWER LINE (ft ) . . . .
WATER CL.O'z)ET'S. . : WN T FR LINE
DISHWOEHE:RG. . . . : RAIN DRAIN (ft ) . . . .
Remark- : HACK FLOW
Owner: __..._._______________.____________.______ ____.--•--_ FEES
ALICE SAVAGE SAVAGE type amotrnt by d,.-Ate recpt
3000 SW 107TH CT PRP1T $ 15. 00 JF 06/17/94
i I GARC? OR -
5P(-'T 0. t5 JF 08/17/94 -
[ 'i-rone #:
Loritractor:
MODE RI,I PLUMBING
PO BOX 23307
TIGARD UR 97281
Phone #: 639--3701 t 15. 75 TOTAL
Peg #. . : 67906
-- ----- REJUIRED INSPECTIONS -- - 1
This permit is issued subject to thz regulations contained in the Final IT,spection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All wcrk will be done in accordance with —
approved plans. This permit will expire if work is not .started —
within IN days of issuance, or if worN is suspended for more
than 188 days.
-' !e r m i t t e e £3 i g n a t u r�
LL) i s 5l_led By : --
J
:all for inspc.►ctiop - 639-417
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o- PURPI 0.1 1 it PAYMN'T OIN101INI, Ptill) PURPOSIFn. OF PtivMF,N1' WOUNI POID
1:11 i IMB t tI.1,i I If".14M P1. MI)4---(At 7 6 163. 00 ST., BUILD PFR W. 5
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1,4(4100 SW MTH CT
'If,1411L. 14M,11..INI PAID
Qity of Tiqard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # _
Tigard, OR 97223
(503) 639-4171 Al
MINIMUM $25.00 PERMIT PEE + ST. SURCHARGE
Nem..(D-v pm f New Single Family Residences Only
AKI&W ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00
Job ��r� (�) ❑ 3 BATH HOUSE$225.00
Address cm«sr ap Fee includes all plumbing fixtures in the dwelling and the first 100 feet
T U.C(_ u__� of water service, sanitary sewer and storm sewer. See fees below.
N.-i«A0.W&.4-1 FIXTURES QTY PRICE ANT
( '�'-- JP, tfQ e Sink 9.00
M..e,Ate'••• ph-. Lavatory 9.00
Owner 1300 6 ` (,l 1, 1 (7-74` 0J. Tub or Tub/Shower Comb. 9.00
���'•'• _70 Shower Only 9.00
f' Water Closet 9.00
"•m•' •°'"°•••••� Dishwasher 9.00
Sc. m Garbage Disposal 9.00
Occupant o A"- Ph- Washing Machine 9.00
Floor Drain 9.00
�"�'ry°'• 'b Water Heater 9.00
Laundry Room Tray 9.00
N•°'• Urinal � 9.00
)lIt'ACM PILAIML4 _ J Other Fixtures (Specify) 9.00
M.itp A.a«. 9.00
Contractor
L 9.00
cnr15r". ao 9.00
j 7 blaL_ Sewer 1st 100' 30.00
sm.n.dm.rM N. cp ,.
a .r..N. Sewer-ea. Addit. 100' 25.00
#
7 t) , fib kl -3q a5() 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 own!r, that plans submitted are in cc, pliance with State laws, that Storm &Rain Drain 1st 100' 30.00
1 am reg stered with the Construction Contractor: Board, that the Storm $Rain Drain Addit. 100' 25.00
number iliven is correct. (If exempt from State registration, please
give as)n below.) Mobile Home Space 25.00
^� IBack Flow Prevention
4
/ Device or Anti-Pollution Device 9.00
"r•"+ '°""'" •a•°" D•'• Any Trap ar Waste Not
Connected to a Fixture 9.00
Describe work new Q addition Q alteration Q repair O Catch Basin 9.00
to be done residential Q non-residential Q :nsu Ex°st. Plumbing 40.00/hr
Specially %quested Inspections 40.00/hr
a Existing use of
building or property Rain Drain, single family dwelling 30.00
rt _
N Residential backrlow prevention
devices 1500
Proposed use of
building or property _
- '(F_ycepf residential backflow
�^ prevem(on devices)
LD
LL' NOTICE `Mlnlmur.i Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%SURCHARGE
CONS rRUCTION 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 7`)
Special Conditions -
Date ,ssued __by