Permit • CI1YO FTI G ARD
COMMUNITY'' •DEVELOPMENT: DEPARTMENT . ' _ PLUMB INr PERM IT. ,
.,• • 13125 SW Hall Blvd. Tigard, Oregon 97223°81,99 (503)•63 = 4171 , • , r�E RM I T :r: • e PLM9 5 - ij21,;
.' - .. 639 -4171 DATE: ISSUED , iZZi8/ 2/95., •
: ; I=°ARC' L 12 126 BA -f 1500 • SITL ADDRESS„ .', o 09724 SW WASHINGTON`I RD - • ' ,
SUBD V I S Ii)IV. ; _ . ZONING o ' - • • • •• BLOCK. .... e .. LOT, . ' .. - .
CLASS OF WORK. o TEN • GARBAGE D I SPOSAL_S.., e . ' . MOBILE • HOME SPACES. • .
TYPE OF USE - CON • WASH I•NG MACH......... BACKr LOW' PREVNTRS. :
OCCUP. NCY GRP.. z B2 ' . `FLOOR DRAINS - ° 2 '; . ` TRAPS.. .._ `� „' . -..: '
STORIES........ :O WATER I- IE RS. ..... 1 ; CATCH BASINS . ,
FIXTURES -• -' . LAUNDRY' TRAYS .:- SF .RAIN!: DRAINS. e . e a '' . , '
S I NKS..... o ...... . URINALS - ' G,REAS,E: TRAPS.' . . •. , •. ' , . •
• '' 1IAVATORIES.. ; .. ,r, 2 OTHER FIXTURES = 1. • •
SUB /SHOWERS. . . ' _ SEWER. LINE (ft - - '
'W TER CLOSETS.. • 02. ' . • WATER LINE (ft)` ° .' • . , .
'D SHWASHERS. ,a`o a • RAIN DRAIN (ft) - - - -
R m,arkso tenant improvement'
Oi ner. __ -- -- .----- - - - - -- FEES - - - - .
TI IL' GAP /. EXPRESS :PERMITS • - type . tarowtnt. : by d e recut
-1, 27 • : ". ' ' FERMI" $ • 72. 06 J'DA .17,18:122/95 • i8 :122/95 95-26;96'49..
P ST.:AVE. •. PLCK $ . 18..0.0. J'Dl . iii8 /C:2 /.9J 95- 269649
T { RENCE C. 90,501 5P'CT $ 3.60 3DA QQi3/c_2195 95= a69h49
P1 \nne...0 r .31Qi- 323 -6301 •
Cn t Tact or , _ - . - - - - --
t+It)DERiV PLUMBI - ..
1; 1�'�c"i SW I.NDUSTRI L :WAY ?. •• • •
'1UALATIN OR .7 .
9 4?io2
. _ T ' .. .
.Phone � -. 691-6166 � �93. 6i�, TOTAL AL
'Re #.... 87906 : .• . • . . .' .
REQU I RED I NS;PECT IONS -
This peroit is issued subject to the re•guiations contained in the - PLM /Underf 1 oor^ •
Tigard Municipal Code, State- of Ore, Specialty -Codes and all other ' To p -out I n s Ci'. , . ' ' " • • - •
applicable laws. A11 work k w i l l be done in accordance with - Drink i n g• F'o unt ad '• - - - - • .
,1 approved plans: This'perait will expire - i,t work is not started Finai - Inspection• :: _
within IN days of issuance; or if work is suspended for uore _ •
than 1$49 da .
y.. — _
Perm it•tee •Signat'ur / I % // ' -�- .- , ''• — . , 1
. �. 1.1 .for ;in; s •
-• Ca ec't:ioni • 6 9- .41'75
•
•
•
City of(igard C 1 �'� PLUMBING PERMIT APPLICATION Planck/Rec. # Co- c(
1';(125 SIN Hall Blvd. ve -61 Permit # GI5'
Tigmrd; OR 97223 G ∎tf
(503) 639 -417 a y
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Q UD0.5\ c W .
t " w ( New Single Family Residences Only
• C` �Er'1S 1A
A.df.es ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job \ "7 -- R)%7 - N - • " - - - 1 c- 14 ❑ 3 BATH HOUSE $225.00
Address arfsm al Fee includes all plumbing fixtures in the dwelling and the first 100 feet
Cc: Ci4 . 90-7U 1 of water service, sanitary sewer and storm sewer. See fees below.
/ " h em (of � Mm. a ""
fh"') FIXTURES QTY PRICE AMT
1.9+x' 'o 1P S -1�`+k T Sink 9.00
Melina Addles. cn... Lavatory // 9.00
f
Owner 13 2 1 )05i f S� 4 Tub or Tub/Shower Comb. 9.00
zo Shower Only 9.00
T c e-t`I e '( . 90C) I Water Closet / / 9.00 ' is
NMm (m name a buns.) Dishwasher 9.00
Occupant C' C/ b�24P=S� l� Garbage Disposal - 9.00
""° Addles PM" 3r0 Washing Machine 9.00
3z 7 I - . war 5n.tocc, Floor Drain // 9.00 / '
Ta ='P Water Heater / 9.00 q
__C?A ( -- 9001 Laundry Room Tray 9.00
, A b C P '
Urinal 9.00
�V1 Other Fixtures (Specify) 9.00
Addl (� • • ) I
t =Con actor 1 41Le - 14 ( �' V Ps m r�rrr� Tr a , ti 9.00
-- -- S Lv 9.00
r'\..b Ill a Zfj d Sewer 1st 100' 30.00 ,
9.00
9°" ta.°.a.ua. No. Cif t Ti. NO. Sewer - ea. Addit. 100' 25.00
q rK 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 & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please ,
give reason below.) Mobile Home Space 25.00
4 A ��J Back Flow Prevention
l'1� ��t5 S. � ?S �.1 Device or Anti - Pollution Device 9.00
Any Trap or Waste Not
- 13q_ r , • V CAT i4 I �� Connected to a Fixture 9.00
Descri wo ne addition 0 alteration t� repair 0 Catch Basin 9.00
to be doe residential 0 non - residential 0
Insp. of Exist Plumbing 40.00/hr
Existing use of Specially Requested Inspections 40.00/hr
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property L t,4-1_,6,--7.3
*(Except residential backflow
prevention devices)
r/CJ
NOTICE *Minimum Fee $25.00 SUBTOTAL c
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE J f
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Q '
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL i/ O
TOTAL '73
Special Conditions
Date issued by
.4