Permit PLUMBING PERMIT
PERMIT NO . : PL8914 6
CRYOF �� CITY OF TINA RD R
COMMUNITY DEVELOPMENT DEPARTMENT OREOON DATE ISSUED: 7/11/89
13125 S.W. Hall Blvd., P.O. Box 23397. Tigard. Oregon 97223, (503) 639 - 4175 PRIM . I :'M T . N O .
JOB ADDRESS: 9500 SW WASHINGTON SQ RD
TAX MAP/LOT SUB: LT: BK:
LAND USE: -
LOT SIZE:
ITEM: NO : NO:
WORK CLASS: WATER CLOSET TRAP
USE TYPE: COMMERCIAL_ UPIAL BKFLOW PRVNTP
CONST . TYPE: L.AVORATORY 1 TRAP PRIMER
OCCu1=' . GRP . : T(JI3 SHOWER GREASE TRAPS
'DISHWASHER
GARBAGE DISPOSAL
NO. STOR I.ES : WASHING MACHINE
DWELL._ . UNITS : LAUNDRY TRAY 81_DG . DRAIN (DIA
FLOOR DRAIN •
SINK 'SEWER (FT)
WATER HEATER STORM / RAIN (FT
OTHER
•
•
REMARKS:
•
FEES:
p Jr PFNNEY' S PERMIT $15.00
W 9500 SW WASHINGTON SQ RD
E TIGARD OP 97223 FIXTURES
R STATE •FAX $.75
OTHER
•
C
0
N
T
R
A •
C
T
O TOTAL: $15.75
R
RECEIPT NO. Jf)L/,S / 7 .
This permit is issued subject to the regulations contained in Title 14 - •— •--- ___._.___ ____� ._ ______._ .
of the TMC, State of Oregon Specialty Codes, zoning. regulations REQU :I :I: E :D INSPECTIONS
and all other applicable codes and ordinances, and it is hereby PI_.13 . UNDERSL.AIB
agreed that the work will be done in accordance with the plans and
POST & BEAM
specifications and in compliance with all applicable codes and
ordinances. The' issuance of this permit does not waive restrictive WATER I °:1. LINE
covenants. Contractor and subcontractors shall have current city PI...I:i . TOPOUT
business tax permits. This permit will expire and become null and RAIN DRAINS
void if work is not started within 180 days, or if work is suspended or FINAL
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved.
•
Perm' tee Signature •
•
Issued By: CALL FOR INSPECTION 639 - -1175
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
, `�
i . „ P.O.Ebx 23397
CITY OF TIGARD PLUMBING 1-117534 Hall Blvd.
Applicants must hold Oregon Registration to conduct a plumbing PERMIT
Tigard
39 -41755
business or must be property owner /operator not hiring outside help.
Name of Development 0 *1.7
/
WA-514 /N -TON S(U 1 ) Plumbing Permit No. to
Address Description
Job Tax SrW, W ii-/NG -Tail SQ. Rio , ORS 814- 21-610 QUAN. PRICE AMT.
Tax Lot Map. No.
Address FIXTURES
Lot Block Subdivision
Sink 7.50
•
Name (or name ofbusiness) Lavatory I 7.50 'l, S D
Tub or Tub/Shower Comb. 7.50
Mailing Address Shower Only 7.50
Owner City/State Zip Water Closet 7.50
Dishwasher 7.50
Phone Garbage Disposal 7.50
Name Washing Machine 7.50
1- G . PENN V S 6.2o - 67S-0 Floor Drain 7.50 -
Mai i ng Address Phone Water Heater 7.50
• 9500 S.4. W4StHNGTON S , 20, Laundry Room Tray 7.50
Occupant City /State ZIP Urinal 7.50
1 6- 4 •
-
' ame - • e Other Fixtures (Specify) 7.50
(oD N ) L- Co 7.50
mailing AMress Phone
/ , 2ox a (a39 -370( 750
Contractor City /State Zip 7.50
77 6 k .b , D /Q, 97g MISCELLANEOUS .
# City Bus. Tax No. Sewer 1st 100' 30.00
U /7 P/3 Sewer-ea. Addit. 100' 15.00
' State Bs.dAo. State mums Bus. tic. No.
(Residential) Water Service 1st 100' 20.00
• I hereby acknowledge that I have read this application, that the information Water Service ea. Addit.2O' 15.00
given is correct, that tam registered with the State Builders Board. and also Storm & Rain Drain 1st. 100' 30.00
have a State Plumbing license that the numbers given are correct, that all '
plumbing work will be done in accordance with applicable provisions of Or Storm & P'un Drain Addit. 100' 15.00
gon Revised Statutes Chapters 447 and 693 and applicable codes and that Mobile Home Space 25.00
no help will be employed unless licensed under ORS 693. (If exempt from
State registration, please give reason below). Back Flow Prevention
HOMEOWNERS - I hereby certify that I am the owner of the property de- - Device or Anti-Pollution Device 7.50
skxtbed above, at which location I propose to make a plumbing installation for Any Trap or Waste Not
my own use and this property is not being constructed for sale, lease or rent. Connected to a Fixture 7.50
Catch Basin 7.50
Insp. of Exist. Plumbing 40.00 Per Hr
Specialty Requested Inspections 40.00 Per Hr. _-
' Aker. of Plumbing within
^ an Existing Bldg. 15.00 min.
It.. , !_-
__./7___
A • - IZED SIGNATUR -/ D ., . New Bldg. or Build. Addition 25.00 min.
Rain Etain,single family _-
Describe work new ❑ addition ® alteration 0 repair ❑ wing 15.00
■• be done residential • non- residential .i
Existing use of
Wilding or Property erri b- ...t SUS -TOTAL , 8700
TOTAL /5,-25--
NOTICE
This permit becomes null and void if wo,t or construction authorised is not corn-
nerload within 180 daystor If oonsruction or worths ttsperded or abandoned for
• period of 180 days at any time alter work Is commenced.
SPECIAL CONDITIONS • .
Date issued by
ocn -489 (11/8.5 re ■
P.O. Boot 23347
CITY OF TIGARD PLUMBING 11195 SA Ball RM.
Applicants must hold Oregon Registration to conduct a plumbing - PERMIT ' Tigard -4141 -
business or must be property owner /operator not hiring outside help.
Name of Obv�Cbpmem�, /lam
%•r �- % �e' /2"--:v 0 Cq Plumbing Permit No.
Address / // �� Description
Job V a f/A / , W fc- ORS 814-21410 OUAN. PRICE AMT.
Tax Lot /Map. No.
rem FIXTURES
Lot Block Subdivision
Sink k '
Name (or r ss) Lavatory / 7.50 7 S)
Tpi . C r . Tub or Tub/Shower Comb. 7.50
a Shower Only I 7.50
• Owner City /State zip Water Closet C 7.50
Dishwasher 7.50
P hone Garbage Disposal 7.50
Name Washing Machine 7.50
r/ C gf/Me Floor Drain 7.50
Marling Address y �J Water Heater • 7.50
9 ;(.1 /C1.0 /17F4 /ed Laundry Room Tray I 7.50
Occupant pry /State Urinal 7.50
'Name Phone .. Other Pictures (Specify) 7.50 -
. 7.50 •
MabTng Address Phone - -
7.50
Contractor CBy /State ZIP • [ 7.50
MISCELLANEOUS
City Bus Tax No. Sewer 1st 100' 30
- State Skips. BoardNo. State Plumbers Bus. tic. No. $°" '°a Addit 100' 15.00
(Residential) Water Service 1st 100' 20.00
1 hereby ecloawledgs that I have read this appMcadon. that the kdormation Water Senios ea. Addit.200' 15.00
given is correct. that 1 am registered with the State Bulldogs Board. and also Storm a Rein Drain 1st. 100 _ ' 30.00
Plumbing license have a State Plumbing that the numbers given are correct. that t at .
plumbing work will be done in accordance with applicable provisions of Ore- Storm & Prim Drain Addid. 15.00
gon Revised Statutes Chapters 447 and 893 and applicable codes and that Mobile Home SPA - 25.00
no he wit be employed unless licensed under ORS 693. (if exempt from Beck Flow Preveh6on
State registration. please give reason below).
HOMEOWNERS - I'hereby certify that I am the owner of the property de- Osvioe arAn6•Pctution Device 7.50
HOM
scribed above. Munich location I propose to make apkarbing Installation for Any Trap or Waste Not '
my own use and this property is not being constructed for sale. lease or rent Connected to a Fixture - " 7.50
Catch Basin - 7.50
insp. of Exist Plumbing 40.00 Per Hr.
Speclaty Requested Inspections 40.00 Per Hr.
Aker. of Plumbing within
- an Existing Bldg. _ 15.00 tin.
AUTHORIZED SIGNATURE Date New Bldg. or Build. Addition 25.00 min.
Rain Liain,simle faultily
Deaaib work new ❑ addition ❑ alteration a &ening . 15.00
!n be done residential n non - residential _
Existing use of SUB TOTAL /500
• bus ttf3atx tY .5% SURCHARGE / 7S
:Zeg tme of
rplOptitty PLAN REVIEW 25% OF SUB TOTAL 33. 7$
NOTICE •
This permit becomes nut and gold M wwork or construction authorized is not corn- TOTAL /9 $0
minced within 1SOdayeuor If oerver uction or wonkisttisperded or abandoned for
• period of 180 days at any lime after work Is aonrctncinced. •
SPECIAL OOMOmONS • •
Date Issued by - --
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