Permit L/
aW OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT •
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PLUMBING PERMIT
PERMIT *.. ° . ° ° ° o PLM95 -0083
639 -4171 DATE ISSUED: 04/27/95 •
PARCEL: 1S1260C- -0i107
SITE ADDRESS... 09645 SW WASHINGTON SQUARE RD '
1 SUBDIVISION....: ZONING: C —G
BLOCK ° ° ° ° ° ° ° ° ° °° LOT........ ..... °
F _____ -- — - - - - - -- -- • _ CLASS OF OF WORK—.ALT GARBAGE DISPOSALS— E. MOBILE HOME SPACES.
TYPE OF USE ° COM • WASHING MACH BACKFLOW PRE'VNTRS° ° s 1
OCCUPANCY GRP ° °:82 FLOOR DRAINS ° ° ° °a ° °03 . TRAPS........ ° ° ° °°
STORIES° °.. .... 02 WATER HEATERS CATCH BASINS ° ° ° °...
F=IXTURES • - - - - -- LAUNDRY TRAYS ° EF RAIN DRAINS
SINKS.... ...... :9 URINALS . ° ° ° ° ° ° ° ° ° ° °o GREASE TRAPS.......:
LAVATORIES°°°°°; OTHER FIXTURES.°°°°;
TUB4 /SHOWERS.... o SEWER LINE (ft)
WATER CLOSETS..: WATER LINE (ft).. ° . o
DISHWASHERS.....: RAIN DRAIN (ft).. ° °o
Remarks: TI
Own er s - - -- - - -- - _ FEES - - --
• GYROS GYROS INC. type amcen'c by date recp4
PRMT > 117.00 JD 04/27/95 95-264771
1106 SE TAYLOR PLCK $. 29.25 JD 04/27/95 95-264771
PORTLAND OR 97214 5PCT $ 5.85 JD 04/27/95 95- 264771
Phone 1 d 503-235-6185
Contractor, _. _._-- ____ -- _ - __ - _ — •
ANCTIL PLUMBING '
16900 SW MERLO RD '
BEAVERTON OR 97005
Phone *c 642. -7323 152.10 TOTAL
Reg #.. 0 24184
REQUIRED INSPECTIONS --
This perDit is issued subject to the regr.iations containee in the Final Inspection
Ti and Municipal Cede, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in acccrdance with
approved plans. This pernit will expire if work is. not started —
within 15@ days of issuance, or if work is suspended for sore _ —
than 187 days. ...
Perinittee Signat e° //
- Call for inspection — 639 -4175
City o: Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # - i'LM `S
Tigard, OR 97223 "` - _,1 ? �- 0 , (7 . / 9 5 -
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
G Nama, ' • • em New Single Family Residences Only
)k � ` ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job % 5co 0 ❑ 3 BATH HOUSE $225.00
Address _rawstata m r Fee includes all plumbing fixtures in the dwelling and the first 100 feet
I t (f l? 01172.3 of water service, sanitary sewer and storm sewer. See fees below.
Name ( or n of S1°"aa) FIXTURES QTY PRICE AMT
Sink hw, .5 9.00 yf
Mating Address Phone Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
cdy'state a' Shower Only 9.00
Water Closet 9.00
Name (or name's t"mian) Dishwasher 9.00
Occupant mans, Garbage Disposal 9.00
a Aloes, Ptme Washing Machine 9.00
Floor Drain r j/ 9.00 a ?
CYy /State ZIP Water Heater 9.00
Laundry Room Tray 9.00
Name /' (/ -r�� Urinal 9.00
Other Fixtures (Specify) 9.00
Nang Ada Phone /fop S> k / 900 9
Contractor _
0 4 r- DO/'Si IV 1�1 9.00 1 7
LP 9.00 .
Sewer 1st 100' 30.00
/, $11fe Regiitretion No. Gay Om. T° Na. Sewer - ea. Addit. 100' 25.00
Water Service 1st 100' 30.00
I y 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 & 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
Device or Anti - Pollution Device 1 9.00 -/ Q
Signature tower or agent) Data Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property
'(Except residential backflow
prevention devices)
CO
NOTICE *Minimum Fee $25.00 SUBTOTAL i/ 7
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS ...2-..c I
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL _2g.___
�70 TAL (iis /
Special Conditions
// /
/, - ma c,/
Date issued _ by /
Or