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- "TY OF TIGARD Plumbing Application Rec By
'1 25 SW HALL BLVD. Commercial and Residential Date Recd
GARD, OR 97223 Date to P E
:03) 639 -4171 Date to OST
Permits ri-M / p
-t7 I l
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted called 0/
Name of OevetopmenuProiect FIXTURES (individual) QTY PRICE AMT
Job Sink 9.00
Lavatory
Address ( Street Address l I Suite 9.00
13500 SL,/ p6Ci f/ r1� < f lwyJ P rub or tub/Shower Como. 9.00
Ei.ig s C,tyrState Zip Shower Only 9.00
779 GA q.7227 Water Closet
Name 7_ // 9.00
` f �►Sf6e r , D+snwasner
9.00
Owner Mailing Address p / �+- Suite Garbage Disposal 9 00
5 Sw fin e c-1. Washing Machine 9 00
� P , ,State Zip Phone • Floor Drain 2' i 9 00
art; OR 4 - "i,a -1 22 - G"MI
Name - > 3- 9.00
! _ G6 %v fielg004 fiA 6 4- 9.00
Occupant 1 3 Mailing Address ni /J Suite Water Heater
/ 9.00
i 500 sw / ulik NW/ Laundry Room Tray
9.00
City/State Zig. Phone Unnal
77 �_ OQ (/7, 23 C2e-/ -4722- 9.00
Name "--• / Other Fixtures (Specify) 9.00
I � �G .. (� 4 AU(rl 6✓, 9.00
I
Contractor Mailing Address Suite 9.00
) 51,1 P rA Huy 9.00
•P ',or to issuance City/State Zip ` Phone
applicant must T ei OR x Gz(4'7 3 0 C
t 9.00
Provide all Oregon Const. Cont. Board Lic.s Exp. Date 0 9.00
contractors 0 Z, '� 7y c -/ - 47 9.00
license Plumbing Lic. 4 l Exp. Date Sewer - 1st 100' 30.00
information 2,666,0 6 -70 -q-i
Sewer -each additional 100' 25.00
for COT COT Business Tax or Metro 4 Exp. Date
aatabase). Water Service - 1st 100'
Name Plater Service -earl; additional 200' 30.00
25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Or Mailing Address I Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
_ Engineer cityrstate Zip I Phone Commercial Banc Flow Prevention Device or Anti- I 25.00 1
Pollution Device
:.:f:be work New J Addition D. Alteration C Repair C Residential 3ack9cw °revention Device' I I :5.00
ce
done. Residential 0 Non - residential 0 I Any Trap or Waste Nct Connected to a Fixture I 9 00 I
- .:c:::onal descnotion of work
Catch Basin I I 9 00 1 ;
insp. of Existing = .umo+ng I I 4 0.00
per /hr
;:rig use of Soeoally Reouested Inspections 40.00
:rig or property I oer:hr
Rain Drain. singe family dwelling I 30.70
•:cosed use of Grease Traps I I 9.00
..icing or property
QUANTITY TOTAL I
a you cawing moving or replotting any fixtures Yes r" No I isometric x riser c:agram .3 recur/ea I Quairty 'ctai's > ?
I yes see back of forms I 'SUBTOTAL
- ereby acknowledge that t have read this application. that the information
"en is correct. that I am :he owner or authonzed agent of the owner and I 5% SURCHARGE I '
;: plans submitted are it Ompliance with Oregon State Laws.
;;nature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
-� -3` 7 . a ecuxec prim i `z : a
re •T/ •l :s > 9
�� "7 q I TOTAL
tact Person Name Phone I 12.G. ZS i
/ / J�J� I� ^ I / 7 ^ C 'Minimum permit fee is 525 - 5% surcharge. except Residential Backilow
/1't'1 /�'/ ! v 6 4 1 _ f 7 Prevention Device. wnica is 515 - 5% surcharge
ift0sts'.olmapp.doc 3/96
.)
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced I Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal '
I Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
L .-27,2_. / - . Y-- 1
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other L.,0 t /4" ,
Date: A.M. P.M. Tntry:
Address: / - 3 .cO 0 f _.
Tenant: .III ..... 1 d_.v_ /Ste: ff MST:
a ii —g7 z� B
Con /Own: • � M UP: EC:
PLM:
�Y) -�- ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
.Ins ector. / Date: /��
PPROVED DISAPPROVED /CALL FOR REINSP. CF CO