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14293 SW LUKAR
COURT
.ZWEP CONNECTTON
PERMIT
CITY OF TIGARD PERMI 'r #. SWR96
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 01/18.,96
13125 SW Hall Blvd Tigard,Oregon 97223@8199 (503)639.4111 PORCEL: 2c3104BC-HW(b1j6
SITL. . . . 1.i.`-- -- -'N
SUBDIVISION. . . . : HILLSHIRE WOODS ZONINC- : R-7 J:IL)
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :56
"-.NAI'JT NAMF.. . . . . .DAN & REL!-Y t-inw,rE
3A NO. . . . . . . . . . ; FIXTURE UNITS. . . .16
A9n OF WORK. . . :N17W DWFLLIN173 UNITS I
/PE OF USE:. . . . . :SF NO. OF' BUILD INIUS: I
;STALL TYPE. . . . -LTPSWR IMPERV SURFACE: 171 9 f
marks : Sent-,c -tank ml.,tst be rjumr)Pd, filled anti inspected. (Existing h3use)
;ner, FEES
ERRA PACIFIC DEVELOPMENT t Vc)p Amount by dat f� r e C,.D t
r MY 1754 PRMT $
.;?v)
�0. 00 .ISD 01/18/96 9 7„iV1 ice,
INSP 4� 35. 00 JSD 01 /18/96 96-275055
W&. OSWEGO 0P 9711.1 35
,,one #: 503-780-1785
;111:--actor:
& N PSCAVATION
;IKE OSWEGO OP 97035
�urie #-. *# .-'c7,1 3 Fj. 00 TnTnl-
n
REQUIRED INSPECTIONS
is Awlicant aorw to cosulv with all the rules and reculation: Sewer Insuec:tion
the Unified Sewage Agency. T'ip oet-mit ex0r,es 180 devs frog SeDtic Tar Fill
-p date issued. The tolal avount uaid will be torfeited if the
—v it PfDi-ps. The Apency does not uuvante@ the acciracv of the
.It sewer- laterals. If the sewer is not located at the fleasureoent
.,)en. the initallev, shall aroscect , feet in all directions frog
distance give-- If not so localed, the installe- shall ourchase.
'Tao and Side Sewer" Pereit and the Acency will install a lateral.
ateral.
rz—i
Cal I for inspec:t icy-i 639--417!-:-
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SlN Hall Blvd. Permit #
Tigard, OR 97223 ��I�I�� rel( _
(503) 639-4171
�lr• 1 1- ,�� �r� -jl X r�(�( MINIMUM $25.00 PERMIT FEE + ST. SURCHARGEJ4
_ •J
New Slndls Family Residences Only
❑ 1 BATH HOUSE 5140.00 0 2 & TH HOUSE$195.00 c.
Job1147 AV C"t ❑ 3 BATH HOUSE$225.00
Address cnrmw. nr Fee includes all plumbing fixtures in the dwelling and the first 100 fent
of water service, sanitary sewer and storm sewer. See fees below. Q
FIXTURES QTY PRICE AMT
1 r min Sink 9.00
"°"''Ad*- Lavatory � 9.00
Owner f= j( 750 1'78,�;- Tub or TublShower Comb. 9.00
no Shower Only 9,00
Water Closet - y
0 Z 9 t%_. 9.00
wwa i«n.e,.a h r ) Dishwasher 3.00
7::)a,) �Y tr L �� ,, . Garbage Disposal 9.00 r.
Occupant V."Ad*- A... Washing Machine 900
1
t-A5 ljtJ. �K lZ Floor Drain 9.00
caw. Water Heater 9.00
Laundry Room Tray 9.00
1 Urinal 900
v
All)�TwNA T�L Other Fixtures (Specify) 9.00
ti."Aft- n... 9.00 �
Contractor _
?.? 9.00
I '
m 9.00 ..1
Sewer 1st 100' 30.00
Ch&A.""No. Sewer-ea. Addit 100' F 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 State laws, that Storm &Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm 8 Pain Drain Addit. 100' 25.00 �
number given is correct (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
M� Back Flow Prevention.
Device or Anti-Pollution Device 9.00
"0"" °i• Any Trap or Waste Not t�
Connected to a Fixtr,re 9.00
Descr a work new 0 addition Q atteraticn U repair Catch Basin � 9.00
to be done residential non-residential 0 Insp. of Exist. Plumbing 40.00[hr
Specialty Requested Inspections 40.00Rtr
Existing use of `>
budding or property 1`�5 rG[��r tC ' '� Rain Drain, single family dwelling 30.00
V,
Residential backflow prevention -
devices
Proposed use of �? -/ �J
b!!dding ar property
'(Except residential backflow
prevention devlc")
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF'NOPK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF 50,e SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDFD OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 257,1. OF SUBTOTAL
TOTAL
Special Conditions/, A" l?.4 �J�1_,( / / /�►///�
�h 1 ,. C Gay 4` 9/c Date issued _L� C .,_by �iJ- � L�f'�lGtLrl