Permit •
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CITY .OFTIGARD P LiJMBING f= 'ERMII
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+i,„s „.., DEVELOPMENT SERVICES . PERMIT #�... , a •f= 'LM97- -ooao
., ' 13125 SW Hall Blvd., Tigard, OR 97223 (503)6394171 DRTE 'IS31JEDe 2131.14 /97 . '
TE ADDRESS.. p'ARCEL, =51�1��'�D- -kyi.i71�►1
3I ESS.. 0��,97 � I..9i N cT ST ,
i•S `;a -DI,V S � AO . ,NCI. TI_G RDVI,4LE RDDZ=TION: f- ,1ti,ENp .;'Z,O1NjINO R- .i..[a '
p[= ��SJ....'�.:_:.Y,° , .w, .- L'0.!'_'_ ' '.=== _z'o.r'._`i
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- CLASS OF WORK.. :ALT GARBAGE' DISPOSALS : ti's MOBILE HOME SPACES. e 0
• TYPE OF USE.... vSF . . WASHING MACH...... o ., 0 , BACKFLOW PREVNTRS.,. e 0
OCCUPANCY SRP.. =H.3 FLOOR DRAINS...'.... 0 TRAPS:... _ .... _ . .
STORIES........ . 0 WATER. HEATERS...... - • 4 ., CATCH .BASINS...„— .. '2'
FIXTURES - -- --- LAUNDRY TRAYS..... e ,0 SF' RAIN DRAINS. - ... _ 0
SINNiK.S... . _,,•.0 ,..,•,.:', „URINRLSa ... . ;on Q �
1. .. i ',
,.•' GREASE TRAPS” e . •.0, .
• LAVATORIES.. _ .. t 0 OTHER FIXTURES..... 0
TU,B. /SHOWERS...., . � , 0 ,SEWER LINE' (ft ), . -
2 '
WATER CLOSETS 0 �� WATER LINE (ft) _ = . t 0
.DISHWASHERS RAIN ,,DRA3N (,ft) _,,, , , .
Remarks= inst1.4 water heater=, .
in bldg' s 8, 9 10 & ,12 ' ,
Owner ° - - -- -- -- _ FEES -- - -.
RON SLIME - . type amount by date recpt-
a 170 SW MAPLE DR ' PRMT ' % 36.00 TAT 03/14497'97-291737'
. PLCK. -0 9.00 TAT 034 14497 97- 291737 '
T
•
I t3 ,RD OR 97225 . 5PCT $, 1.80, :TAT ' Z13/ 1 4 /97 97-291737
Phone •kh 292 -9621
KENNEDY PLUMBING - - '
13985 S 4 FARMINGTON, RD •
. , ,
BEAVERTON OR 97005 -
Phone , # : 643 -5535 $ . 46. 80 - TOTAL ,
Reg #.. t 100967 ; .
.. REQUIRED: I NSPECT'I ONS' -
TF:s perrit is 'Li tt . subject tL;the regulatiGnS cgi,taainet ,i i the Water Line I,nsp ,
, Tigard .piaicice.l.,Code State of 7r•,s. Cedes, e all e }her, Wat el.,- ,, Service I n ■ • - , ' ,
aprilica`u1e C :i., ,R11,i-L 'rii1-1- e cion,e in r ar e t;it,i?- Rough --,in Ipso . .
' ar rever"p.e ';`ie. pei it_1;ii .-pi if verik:, pot,etaite.t , PLM/JUnd „erflpot' ,, . , -
i;i {tin'i -,ys' r: .7 s uance , of if ,4�oi'k, is s iisp?P.E? �' fort gre_ _ • , ,- T on - o at Insp - • _ - - ' ' ' '
then in', 'ays. ;I , , , , Mi sc..,,Inspect ion . � •
. Final Inspection '
,Permittee Si,gnarF.n,,' �'f . __— ' i. A k . .
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.
Issued • B, t = _ ,.A..441, .11-4 I.11 d L 1_ I .l .4 - _ -_
, for inspect i. E,S`? -41 _
CITY OF TIGARD Plumbing Application Recd By
13125 SW;I:IALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E.
Date to DST
(503) 639 -4171 Permit # Pu q 1-
Print or Type Related SWR it
Incomplete or illegible applications will not be accepted Called .
Name of Development/Project FIXTURES (individual) . QTY PRICE AMT
Job L 0C& Lr\u- - Cpur+- A-0"3 Sink 9.00
S treet Address L ufF L Uite Lavatory 9.00
Address Tub or Tub/Shower Comb. 9.00
Bldg # City /Sta a Zip Shower Only 9.00
'2 9 i o , 1i. 1 C G �!.( o r 91223 Water Closet 9.00
Name
on e l i n c Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9,00
8110 Sto male le D( Washing Machine 9.00
/State Zip Phone Floor Drain 2 9.00
\iq 0 i gf2.23 gct . o 3° 9.00
Name
4' 9.00
Occupant Mailing Address Suite Water Heater 4.. 9.00 36
Laundry Room Tray 9.00
I City /State Zip Phone 9.00
Urinal
Name
Other Fixtures (Specify) 9.00
ended;-, RA M.0 n q- _ . 9.00 _
Contractor Mailing Addrea Sihit 9.00
13`1 5 5 t ) - Fa ✓ rn i Ac , n 9.00
(Prior to issuance ,qty/State Zip Phone
applicant must ✓-l-t1 Dr q 5 6`
loo I3-55 35 9.00
provide all - Oregon Const. Cont. Board Lic.# Exp. Date 9.00
contractors 101 6 7 9.00
license Plumbing Lic. # t Exp. Date Sewer - 1st 100' 30.00
I information 3'f - L{ 2 B Sewer - each additional 100' 25.00
I for COT COT Business Tax or Metro # Exp. Date
database). 1 31 3 Water Service - 1st 100' 30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 10 30.00 •
Or Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City /State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
' Describe work New 0 Addition 0 Alteration' Repair 0 Residential Backflow Prevention Device° 15.00
to be done: Residential' Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr I
Existing use of Specially Requested Inspections 40.00
building or property per/hr
Rain Drain, single family dwelling 30.00 .00
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes.K No CI Isometric or riser diagrams required A Quanity Total is > 9
(If yes see back of form) - 'SUBTOTAL !> o o
I hereby acknowledge that I have read this application, that the information J ,
given is correct, that I am the owner or authorized agent of the owner. and 5% SURCHARG I 2. o
I that plans submitted are in compliance with Oregon State Laws.
Signature' i Owner/Agent Date PLAN REVIEW 25% OF SUBTOTAL
I n v 1 O R equired eny if fixture qty total s> 9 1
�'� '" J TOTAL `/� I/b
Contact Pers g n Name Phone , V
� 1 1 *Minimum permit fee is S25 + 5% surcharge, except Residential Backflow
I J 'e &s 643, 553 Prevention Device, which is S15 + 5% surcharge •
I: \plmapp.doc 12/96 (dst)
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet •
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater .ele.,cst -{ ; c.
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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I:\plmapp.doc 12/96 (dst)