15565 SW 109TH AVENUE e
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PLUMBTNG PERMIT
CiTY OF TIGARD DATE T ISSUED: + 1 ] /02 /955 -033
25
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall 81M. ..pard,O egan 9722368199 (503)839-4171 PARCEL: P51 10DD•-1..-,,'r00
`1TE ADDRESS. . . :. 11565 SW 109TH AVF_:
AUPDIVISIOA. . . . : SUMMERFIE"LD 110. 14 ZONING: R-7
3LOCK. . . . . . . . . . . LOT. ... . . . . . 7 . . . . :704
_._.._.._-__•-_•___--_.--.._._.__.-_._.._.--__._.--__,_-_.---•_---_----__ --__-_---••-_- --_--_•L-_•--------_.__.____.
:LASS OF WORK. . :ALT GAPPAG1 DISPOSALS. : 0 MOBILE HOME SPACES. : 0
I YPE OF USE. . . . :SF WASHING MACH. . . . . . : el )BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . 1 0 TRAPS. . . . . . . . . . . . . . . 0
;TORIEL. . . . . . . . : 0 WATER HEATERS. . . . . : 1 CATCH BASINS. . . . . . . : 0
'FIXTURES------------- LAUNDRY TRAYS. . . . . : 0 5F RATN DRAINS- - : it
s3INKS. . . . . . . . . . . 0 URINALS. . . . . . . .. . . . .. 0 GREASE TF'APS. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
TUB/S !OW R;. . . . : 0 SEWER LINT' (ft ) . . . : 0
WATER CLOSETS. . : 0 WATER LINE (ft ) . . . : 1:1
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . Q1
Remarks : Install water heater
Uwrner ______.__._.___-_._-___--___ _.__-- Ft"ES
JOHN ALKIRE type amount by date recpe
15565 SW 109TH P R M T $ 2-5. 00 JSD 11/02/95 95 272431
SPCT $ 1. 25 JSD 11/02/95 95-272431
TIGARD OR
Phone #:
Contractor: ---------_-______.___--_.-_.--..._- - ---
tall_ WEST PLUMB DBA/BOMAR INC
`=;8.35 LANGFORD LN
..AKE OSWEGO OR 9703.4
r-h o n e #: 62:'0-0217 $ 2,6. 25 TOTAL
Rer. #. . : 83717
REQUIRED INSPECTIONS
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This permit is issued subject to the regulations contained in the Ihi E.0 Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire 0 work is not started
with.r 180 days of issuance, or if work is suspended for more
+han 180 days.
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Permittee Signature
> fssi.ted
Call for inspection - 6.39--4175
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CITY OF TIGARD BUILUiNG INSPECTION NOTICE �)�
Inspection Line (Rec-O-Phone): b39-4175 Business Phone: 639-4171
Inspection-_
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Bearn Mech, San. Sewer Gas Line -Bldg.
Plbg. Underfloor R,rn Drain Framing -Plumb
Alarm Water Line Insulation -Merh.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Data ;Hequeste/d: 7 ? Time:XAM PM
Addre!
Buildvr: ly U C� ( � Permit #: ,j D x..301—`
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Ins actor:
PPROVED DISAPPROVED APPF'OVED SUBJECT TO ABOVE
—Call For Reinsp.
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + S' SL .CHARGE
New Single Famil. R-PSiden Ls Only
.lob `i.'S � ; �� �`�l� ❑ 1 BATH HOUSE $140.00 C1x 2 BATH HOUSE 25.00
� : �� O 3 BATH HOUSE $225.00
Address COMM. ar -- Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. E:e fees below.
""'"�°'"""°°'a"•""� FIXTURES QTY PRICE AMT
Sink 9.00
M""°Ad'... "10"• Lavatory 9,0
Owner At Tub r Tub/Shower Comb. _ J.00
c"r si.i. ro Shower Only 9.00
• /r'»,+J•�P� ^� �� �s',,�• Water Closet 9.00 —
"."» rush%.--her 9.00
garbage Disposal 9.00 `
Occupant o - Ph•... 'Washing Machine 900
Floor Drain 9.00
G"iSi1i ^ Water Heater 9.00e
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Laundry Room Tray 9.01
"•m• — Urinal _ 9.00
`L- /.y $ 7 :.(4*.*^, Other Fixtures (Specify) 9.00
"e'"°A"u "'"" 9.00
Cont:actor
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CMylSl.l. j� 1
/'�f• i rA•'r•" "-� l .� Sewer 1 st 1 n0' 30.00
SIM.N.MR."d,"0 CNV en T-N. Sewer-ea. Addit. 100' 25.00
-'• , Water Service 1st 100' 30.00
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I hereby acknowledge that I have read this appl;.ation, that the Water Service ea Addit. 200' 25.00
information given is correct, that I am the owner or authcrized agent of —
the owne•, that plans .submitted are in compliance with S ate laws, that S'orm &Rain Drain 1st 100' 30.00
1 am registered with the Constiuction Contractor's Board, 'hat the Storm &Rain Drain Audit. 10J 25.00
number given is --orrect. (If exempt from State registration please - —
,,t;*e ason beloN ) " Mobile Home Space 25.00
Back Flow Prevention
Device or Anti-Pollution Devi.;e 900
•"•" °^•"'�'"" — °i'• Any Trap or Waste Not
Connected to a Fixture 900
Describe work new addition O alteration repair QI Catch Basin 9.00
to be done residential Q non-residential Q I Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 3000
t/1 Residential backflow prevention
devices 1500
t— Proposed use of
J buildino or property _ (6rcnpt residential back Row
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c� _ prevention devices)
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J NOTICE *Minimum Fe a $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK ON CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DA`r3, OR IF 5% SURCHARGE 7 1
CONSTRUCTION OR WORK IS SUSF_NDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT AN( TIME AFTER WORK IS
COMMENCED PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions
Date issued —by