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ADDRESS:
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CITY OF TIGARD
DEVEiLOQNIEN'r SERVICES P' PERMIT
PERMITT ##.. .. .. .. . . . : P1_M97-0210
i3125SNHall.1jivd., Tigard,OR97223 (503)639.4171 DATE ISSUED: 0E/04/97
PARCEL: 2S111CB-02200
SITE ADDRESS. . . : L4845 Si.1 100TH AVE
SUBDIVISION. . . . : MURDOCK HILL ZONING: R-3. 5
BLOCK. . . . . . . . . . . '_OT. . . . . . . . . . . . . :3 JURISDICTION: TIG
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . : R- FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES-------------- LAUNDRY TRAYS. . . . . . 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LIPtE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (fl"- ) . . . : t20
DT.SHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Adding 120 ft of water service line
Owner: --__.__--------.___._____________._____-------------____-- FEES -.-------------
LEST HINTZ type amoi_tnt by date r•ecpt
14845 SW 100TH PRMT t 55. 00 DST 06/04/97 97-295449
'TIGARD OR 97-2,2"'F, 5P'CT $ 2. 75 DST 06/04/97 97-295449
P`ione #:
Cont r•act or-.__.___-------___.-- --___---.__________.__--
MODERN PLUMD I NG
11120 SW INDUSTRIAL WAY
TUALATIN OR 9706._
Phone #: 691--6156 $ 57. 75 TOTAL
Reg #. . : IZIOO879
REQU I RED INSPECTIONS
This permit is issued subjer to the regulations contained in the Water Line Insp _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All pork will he done in accordance with
approved plans. This permit will expire if work is not started
within 198 days of issuance, or if work is suspended for more
than 190 days. _
Permittee SignatI.arek/
I s s o_i e d By -
-all
y -all for inspection - 639-4175
I
CITY OF "i!GARD Plumbing Applicata M Rec'dBy������
Date Rec'
13125 SW HALL BLVD. Commercial and Residential Date to P.E.
TIGARD, OR 97223 Date to DSTx�
(503) 639-4171 Permit it, (i/ IVl
Print or Type Related SWR#
Incomplete or ,.legible applications will not be accepted Called_ 0
Name of Devlopment/project :'i c NeW SlOglefan y ResFienr�s OnIW%Kak +hx ry i
Job «. r, .... �
r 140 00 �� t,.;T,• .p�2 BATH jOUS 51,9500
�
Address Street dress A i
�� �7(.� � ''� ''Foo Includes'all'p�iirnbing fl�cturos In thA dwelling and rho tlrst lQO feeto(r �FF;
Bldg x City/State Zip A water sorvice,sanitary sewer and;tnrm sewer:See(ees helovr:..l µi�(i:: `?tri::.
am r FIXTURES (individual)^ QTY PRICE AMT
/� Sink 9.00
Owner Mallin Ad rt:ss Suite Lavatory 9.00
Tub or Tub/Shower Comb. 9.00
City/State /�Zip Phone
71 Cl �' ! ` rC? r Shower only 9.00
Namb Water Closet 9.00
([ l Dish valer 9,00
Occupant Marling Address Suite Garbage Disposal 9.00
Washing Machine 9.00
city/Stale Zip _ Phone Floor Drain 2' -�--� '1.00
3" r,no
Name --
ch iL i L ?1'L '0 4" 9.00
Contractor Ma ling Aduress ,// S e Water Heater 9.00
///"G S _Ct�,�/'1(ti/r r SrC r w` CC s C�c Laundi y Room Tray 9.00
City/Slate Zip Phone Urinal
-k/&�
> c��� rcF a _ 9.00
Oregon Const.Cont.Board Lic.4 Exp.Dae Other Fixtures(Specify) —__ 9.00
Attach Copy of 1 r/ 9.00
Current Plumbing Lic.# ✓ Exp.Date 9.00
License a (/ ) .5 of/:� � — -- _
� Sewer-1st 100" 9.00
COT ausmx ess or Metro# Exp.D to
/ }v Sewer-each additional 100' 30.00
Name ry / / , Wa.er Service• 1 st 100' ( 25.00
Water Service-each additional 200' 30.00
Architect Maifng Address Suite Storm&Rain Drain-1st 100' 25.00 _
Storm&Rain Drain-each iddilionat 100' _3o_00
Ur
Engineer City/State Zip Phone Mobile Home Space 25,on
g ! Commercial Back Flow Prevention Device or Anti- 25.06
Descnbe work New O Addition O Alteration O Repair O Pollution Device
to be done: Residential O Non-residential O Residential Backflow Prevention Device' 15.00
a Additional descnplion of work.ly/� Any Trap or Waste Not Connected to a Fixture 9A0 I
7 Catch Basin 9.30
cn Ara) LL,IL- (.-L. , Insp.of Existing Plumbing 40.00
F-
hr
Existing use of - per
Specially Requested Inspections 40.00
J building or property_ per hr
Rain Drain,single family dwelling 30-00
Proposed use of
t6 building or property Grease Traps 9.00
LLl "
-' - - - -"
Are you capping any fixtures.? Yes[; No a Q''ANTITY TOTAL
`.^rnby acknowiedye that I have read this application,that the information Isometric or nser diagram is required Ouanlfy Total is >9 r' r
'SUBTOTAL ,NE• r
given i. coned,that I am the owner or authod4ed agent of the owner,and ' , +►.
that plans submitted are in compliance with Oregon State Laws. 5% SURCHARGE
6�f3 1
Siflnatr.re of OwnerlA aril � Date
It
Requires o PLn nn ,re R gV1PlW S /o 5°4OF SUBTOTAL
Contact Pers Nam Phone _
TOTAL . ,• S7, S
'Minimum permit fee is$25+5%surcharge,except Residential Backflow
I:\dststplmapp.dnc
Prevention Device,which is$15+5%surcharge