Permit ��-- - -���� - �� ' ��
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� ^ � CI1YOFTI � N�U�NITY'
" 1onosSww� o*w Tigard, wrozw°w y
ww (503) moe���n ' �
Blvd. ' ' PLUMBING PERMIT
• . . ' PERMIT #. . . . . . . : PLM95-0075
639-4171 DATE ISSUED: 06/06/95
• ' � PARCEL: 1S1260C_01107 '
SITE ADDRESS....: 09627 SW WASHINGTON RD '
S. DIVJSIOW. . .•. r ' . ZONING: C-G
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BLOCK........'..: ` ' � LOT�` ........ .... : '. .
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' CLASS OF WORK. .1ALT GARBAGE DISPOSALS.-,; MOBILE H ONE 8PACES. :
, TYPE OF USE. . . � :CDM WASHING MACH—.....: 'BACKFLOW P � VNTRS. . : 1 .
OCCUPANCY GRP. . :B2 FLOOR QRAINS, . . . . . . :2 TRRPS. . . . . . . . . . . . . ~ ;
STORIES ^2 - WATER HEATERS .,..''.:1 CATCH BASINS. .....^: '
FIXTURES-- ------ • LAUNDRY TRAYS. . . . . . u - 'SF RAIN DRAINS. , . . . : .
SINKS. .'. . . . . . . . :3 UAINALS.'. . . -. . . ,. . . . : •.GREASE TRAPS ' :
LAVATORI[�S. . . . i ; . R/ FIXTURES. .: .• . -7 ' � .. TUB/StWFRS. . . . : � SEWER LINE (ft ) . . .'. :� ^ � .
TUB/SHOWERS. •
WATER' CLOSETS
..x WATER LINE.(ft)....: :- DISHWASHERS. . . . : 1 • • DAIN DRAIN (ft) . ...'. : . , .
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Remarks : TI for restaurant , .
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Owner; ----- ------- -•• ---,---- FEES • --- ' .
WESTERN ROASTERS INC. t/pe aoount by date recpt
� PRMT $ 13�.0� SW 06/06/95 - � •
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1680 WILLAMETTE FALLS DR . � PLCK $ 33. 75 / SW' Q6/06/95 -`� ' ,
WEST LINN OR 97068 .' � � 5PCT $ ��. 75 SW � 06/0E6'95 -
Phone #: ' � '
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Contractor� --`------------'�------------ ,
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MODERN PLUMBING .
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11120 SW INDUSTRIAL WAY ' . ., .
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TUALAT IN! OR 97062 ' ' . - '- -------
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Ph one #: 691-6166 ' - $ ` 175.50 TOTAL , ' '• • . • . � �
Reg #. .'z 87906 . ^ � `�
^ � ' �� ' ' --:=---- REQUIRED INSPECTIONS ----•,--
This �r it is i��� sUject to the regulations z� � ta � in the ' Final Inspeotion _ '
Tigare Municipal Code, State of Ore. Specialty, Codes and all tith Er _`_________ ___ �_. _
applicable laws. AD xcrk will be done in accordance with ___________________ _______________
approved plans: This ��o�t will expire if �n'k i� n����tart�d ' .
within 180 ��� of i$uu�e or if xm� is su�anded for ome � '� ' . _ .__ --- �han �� oay� •�� ' . ` __ .�__________
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' Permit��e Si � ' --'--------�------- ' —r ' ----'---- — ___
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IIsue� Dy: _, I. __ _ ^___ ______ - ___.____________
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. ' Call for' 'inspect ion - 639-4175
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # J?l-M qS - -oo7S
Tigard, OR 97223
(503) 639 -4171 c-- ((6 l qs
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Nom of Cl o iwwit New Single Family Residences Only
gamier Raa+ S
� • ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job `10?7 C, y J Y irAh 1 i)0 ❑ 3 BATH HOUSE $225.00
Address aroma J Fee includes all plumbing fbctures in the dwelling and the first 100 feet
Tlaiid 0 K of water service, sanitary sewer and storm sewer. See fees below.
Nom W at a lowil FIXTURES QTY PRICE AMT
W 1 n mar Sink 3 9.00 ‘ ,27
Mang AO"O Phew Lavatory 9.00
Owner Tub or Tub/Shower Comb. 9.00
crow. aP Shower Only 9.00
Water Closet I 9.00 C
M ms n.m. of °is"°) Dishwasher 9.00
Occupant Garbage Disposal 9.00
''"'o Aes... Phew Washing Machine 9.00
CINI9We
/ Floor Drain i1 Z 9.00 le
°+ �'" Water Heater l 9.00 y
Laundry Room Tray 9.00
Nunn Urinal 9.00
Ma clefs1 t\ k m 6 j vi ce. Other Factures (Specify) 9.00
L , r i ce
Pop GJII1� 1 I 9.00 9
Contractor 1 1 I)- o J'�f�j - �-,r ` ' i •4., I. V( ll" 1-00( ( 6 c �
i In 9.00 .
iL h / A. J 9.00
I b1 l ., (V\ 1i n I O° Sewer 1st 100' 30.00
a'"' Reww 01 °ry Bus. T° W. Sewer - ea. Addit 100' 25.00
IS-1- a co I)-) 3, / f5 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
) \ V �,Qi (C( 1 - (e t /„ Back Flow Prevention ' 0 �
Y' �(J Device or Anti- Pollution Device 9.00
Squaws °+ °'° Any Trap or Waste Not
Connected to a Facture 9.00
Descnbe 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)
NOTICE *Minimum Fee 325.00 SUBTOTAL 1 35 00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF 5% SURCHARGE (0.7s-
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS 77
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL 33.75
.3 7
TOTAL ') ,SU
Special Conditions /q Date issued f (o by 9- q GUttif,m---