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Permit 7' ■ V IW • - .„. COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PLUMBING PERMIT PERMIT # ° PLM95 -0259 • 639 -4171 DATE ISSUED: 11/01/95 PARCEL: 191260C -01107 SITE ADDRESS ° 09718 SW WASHINGTON SQUARE RD SUBDIVISION ° ZONING: C -G ' BLOCK . LOT ° „ _ j,, L W a-U-4_ CLASS OF WORK.. :ALT GARBAGE DISPOSALS..: MOBILE HOME SPACES.: - TYPE OF USE °COM WASHING MACH • BACKFLOW PREVNTRS..: OCCUPANCY GRP.. :B2 FLOOR DRAINS • TRAPS STORIES WATER HEATERS :1 CATCH BASINS • FIXTURES - - -- LAUNDRY TRAYS - SF RAIN DRAINS • SINKS URINALS GREASE TRAPS.......: LAVATORIES °1 OTHER FIXTURES ° TUB /SHOWERS SEWER LINE (ft)....: 1 WATER CLOSETS.. :1 WATER LINE (ft)... °: DISHWASHERS ° RAIN DRAIN (ft)....: ' Remarks: Tenant modification. Owner: ' - - - -- FEES BLG ENTERPRISE type amount by date recpt 12000 SE 82ND AVE S -2013 "PRMT $ 67.00 CTR 11/01/95 95- 272390 PLCK $ 16.75 CTR 11/01/95 95- 272390 PORTLAND OR 97266 5PCT $ 3.35 CTR 11/01/95 95- 272390 Phone #: 786 -1 Contractor: . CROUCHLEY PLUMBING 871'7 N LOMBARD PORTLAND OR 97217 Phone #: $ 87.10 TOTAL Reg #..: 001184 -- - - - - -- REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Sewer Inspect ion Tigard Municipal Code. State of Ore. Specialty Codes and all other Water Line Insp applicable laws. All work will be done in accordance with Top-out Insp — �— approved plans. This permit will expire if work is not started Misc. Inspect ion within 180 days of issuance, or if work is suspended for pore Final Inspection than 180 180 days. , • Permittee Si nature: /.'� - I, s s �u e d B y : / . —._. -- —__ -_— Call for inspection - 639 -4175 • \ i' Cityaof Tigard 7 7 P LUMBING PERMIT APPLICATIO /�PI nck/Rec. # 13125 SW Hall Blvd. �- � � I Permit # 04 -�Z5�f ► Tigard, OR 97223 1 0),...5D r � (503) 6394171 v 5w �t5 Off! - MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE 1°'"' w a'Y"°0"" / - New Single Family Residences Only I,^! / Nr r®,N SO . ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00 Job 97a; S•11) . ki4r & ❑ 3 BATH HOUSE $225.00 Address atom. Fee includes all plumbing Postures in the dwelling and the first 100 feet - 1744 s �,Z of water service, sanitary sewer and storm sewer. See fees below. Name (or nom. of Manual FIXTURES QTY PRICE AMT c$• 6 V1Z poe4- Sink 9.00 Wino Mann Plano Lavatory / 9.00 Owner /000e7 .SE 20/3 Tub or Tub/Shower Comb. 9.00 Clantota a° Shower Only 9.00 1 /►O� ( °1720 Water Closet / 9.00 Name i« nom of bpi � ' " - Dishwasher 9.00 Occupant /) - 277-/- `/� /442 Garbage Disposal 9.00 " ""a Am,. Pont. Washing Machine 9.00 97R S .G1) kI42, S9. Floor Drain 9.00 Water Heater / 9.00 X �,e._ Laundry Room Tray 9.00 Urinal 9.00 C eozeNLE'' /9Z//Jze .:2zo Other Factures (Specify) 9.00 -9.00 Contractor _ - _ - - 2�y 9.00 CIty'ffi'" ©, Zvi 9.00 cn6 � n s� (o -i °q (O Sewer 1st 100' 30.00 Removals Heovals No. (' 6 C°y Om Tat 1,1o. Sewer - ea. Addit 100' 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 Contractors Board, that the Storm & Rain Drain Addit. 100' 25.00 number given is correct (If exempt from State registration, please give reason below.) Mobile Home Space 25.00 Back Flow Prevention yam, Device or Anti - Pollution Device 9.00 ?('. S'a10'° (oon... j ' Cato Any Trap or Waste Not Connected to a Fixture 9.00 Describe work new 0 addition 0 alteration )3:z repair 0 Catch Basin 9.00 to be done residential 0 non- residential 0 Insp. of Exist Plumbing / 40.00/hr o Specially Requested Inspections 40.00/hr Existing use of building or property Rain Drain, single family dwelling 30.00 Residential backfiow prevention devices 15.00 • Proposed use of building or property '(Except residential backflow prevention devices) GrO NOTICE *Minimum Fee $25.00 SUBTOTAL ‘7 PERMITS BECOME VOID IF WORK OR CONSTRUCTION .3s AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED "7,..r FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PLAN REVIEW 25% OF SUBTOTAL TOTAL / ! .. /) Special Conditions Date issued by `A M.(0 5 • q -15 - y am