Permit P.O. Bloc 23397
CITY OF TIGARD PLUMBING 13125 341 I1311 B1yi.
Tigard CR 97223
Applicants must hold Oregon Registration to conduct a plumbing PERMIT 639-4175
business or must be property owner /operator not hiring outside help.
Name of Development � ^
.6?i v e.,IC /I& F &Jf• ,_`� n r e - e. Plumbing Permit No. ,� .." / f -
Addr'ess Description
7t:7 s'6,, 71c e ORS 814 - 21.810 (MAN. PRICE AMT
Job Tax Lot Map. No. -
Address
FIXTURES
Lot Block Subdivision
-
Sink 7.50
- Name (or name of business) Lavatory / 7.50 7 ' 1.
MA / Tub or Tub/Shower Comb. 7.50 wy
Mailing4l4dress
Shower Only _ -- 7.50
Owner City /State rip Water Closet / 7.50 _2 J' T
Dishwasher 7.50
Phone Garbage Disposal 7.50
Name Washing Machine , _ - ,- 7.50
Floor Drain 7.50
Mailing' dress Phone Water Healer / 7.50 ,
r
Occupant
Laundry Room Tray - 7.50 ���
P City /State Zip
Urinal 7.50
'Name Phone Other Fixtures (Specify) -_ 7.50
/71 cg4e-C ICs , 6e3 f-3//7 7.50
Mailing Address Phone _ 7,50 •
/&(.7a ..S'e-v 7J ='° 7.50
Contractor CIty/State Zip
4. 47,4,2 -.1 Q Q t' 7,,7a MISCELLANEOUS
City Bus. Tax No. Sewer t at 100' 30.00
LSO C j c.2 4 P6
State - Wgs Board State P Bus. lac. No. Sewer ea. Addit. 100 J 15.00 -
(Residential) Water Service 1st 100' 20.00
I hereby ackrwwlsdge that I have read this application, that the information Water Service ea. Addit200' 15.00 ..
given is correct, that I am registered with the State BuiWsrs Board, and also Storm & Rain Drain 1st. 100' 30.00
have a State Pkxnbing license that the numbers given we correct, that all
plumbing work will be done in accordance with applicable provisions of Ore- Storm & P: in Drain Addit. 100' - - 15.00
gon Revised Statutes Chapters 447 and 693 and applicable codes and that Mobile Home Space 25.00
no help will be employed unless licensed under ORS 693. (If exempt from - - - . ,
State registration, please give reason below). Back Flow Prevention
• HOMEOWNERS -1 Device or Anti- Petlution Device 7.50
hereby certify Cte t 1 am the owner of the property de-
serted above, at which location I propose to make a plumbing Installation for My Trap or Waste Not
my own use and Cris property is not being constructed for sale, lease or rent. Connected to a Fixture 7.50
Catch Basin 7.50
Insp. of Exist. Plumbing 40.00 Per Hr �,
Specially Requested Inspections 40.00 Per Mr •
�� �, � Abler. d Plumbing within
/O�T!/� (1 ' `) an E.deting Bldg. 15.00 min .._ ..--
• • IZED SIGNATURE Date New Bldg. or Build. Addition . 26.00 min
Bain L'tain,sirclle farr ly _ _ '
Describe work new ❑ addition ❑ alteration Zt repair ❑ cliellirg 15.00
1p be done residential (1 non - residential Ltd'
Existing use of -
bulkinGapropefty - - 0t10-TOTAL ,--
` ,-- .
__ =St UN of 4 16101NICfMR311 'f'
rpooperty _ TOTAL 1] `
This per becomes null and midi work o r construction wCarized is not corm
1 0 d - 5 aimed 5uld
onrollmnorworklietaperdedor abandoned tor
• ddISO -
SIP at arty erne ear work a aornlsiinI d.
'St3IAL coMOmT otS 1 f -- \
et
Date issued - 9 7 4 3 by 1 ... _ _.
''V WASHINGTON COUNTY INSPECTION CARD
DEPARTMENT OF LAND USE AND TRANSPORTATION PERMIT NO. 3 / I
FOR INSPECTIONS CALL: 640 -3561, 24 HOURS �(
FOR INFORMATION CALL: 640 -3470 / 2f2_4 DATE _ 1- /5 u � / ADDRESS - 7 4 ,S (-`�-i H`.i' Zl /L.0 `1 PERMITEE 146-1 b u rg...-
DIRECTIONS Cat/ tf ( PHONE NO.
BUILDING MISCELLANEOUS PLUMBING ELECTRICAL
ftg post /beam nail mobile home rain drain temp service
fdn frame apron/ wood stove post /beam storm sewer cover & service
sidewalk
slab insul solar top out cINAL' FINAL
FINAL J
gas test
OTHER
NOT APPROVED REQUESTED INSPECTION
APPROVED
[D NOT
AND RE- INSPECT APPROVED HOWEVER NOTE: 111 STOP WORK UNTIL:
f ----- 01 '
tilhil...._ ,
INSPECTED BY — <-- DATE ./ 5 .72 r
_____.
UNIFIED SEWERAGE AGENCY OF WASHINGTON COUNTY
FIXTURE U N I T RAT I NGS
TOTAL TOTAL
FIXTURE VALUE NUMBER NUMBER
BAPTISTRY /FONT 4
BATH — TUB /SHOWER 4
- JACUZ /Y.7 -IPL 4
CUSPIDOR /WATER ASP 1
DISHWASHER — COMMER 4
DOMEST 2
DRINKING FOUNTAIN 1
FLOOR DRAIN — 2 INCH 2 4.
— 3 INCH 5
— 4 INCH 6
GARBAGE DISPOSAL
— DOM (TO 3/4 HP) 16
- COMM (TO 5 HP) 32
- I ND (OVER 5 HP) 48
OIL SEP (GAS STA) 6
SHOWER — GANG 1
— STALL 2
SINK — BAR 2
f
— BRADLEY 5
— COMMERCIAL 3
— SERVICE 3
WASHER, CLOTHES 6
WATER EXT 6
WATER CLOSET 6
URINAL 6
DATE �- "/_1 — 7 1 NSP .fL -� TOTAL
BUSINESS //,11 -4 1 EDU
PERMIT NO. 7 / 3
ADDRESS 7.3 C- J G� /�SdG L _
TAX MAP / LOT S I - 11? P T L COUNTED FROM ✓ / >7�LL✓t�
73 -25 R83
i CITY OF TIGARD No. 22925
13125 S.W. HALL BLVD.
P.O. BOX 23397 /!
TIGARD, OR 97223 Dater 3 - ti)
Name
' '.K - -4-4 apt...2A <- ,
Address
Lot Block /Map Subdivision /Address
Permit #'s Bldg. Plumb Cash Check
Sewer
Other Other Rec. By I
•
Acct. No. Description Amount
10-432 Building Permit Fees
_ 10- 431 -600 Plumbing Permit Fees
10- 431 -601 Mechanical Permit Fees
10- 230 -501 State Bldg. Tax
10 -433 Plans Check Fee t--,7.S. ?)3
30 -443 Sewer Connection
30 -444 Sewer Inspection
51 -448 Street Syst. Dev. Charge
52- 449 -610 Parks I Syst. Dev. Charge
52- 449 -620 Parks II Syst. Dev. Charge
31 -450 Storm Drainage Syst. Dev. Charge
10-430
10 434
Business Tax
Alarm Permit
10 - 227 Bail
10 455 Fines - Traffic /Misd /Parking
10 -230- CPTA Traffic /Misd /Vic. Asst.
10 -456 Indigent Defense
30-122-401 Sewer Service /USA
30- 122 -402 Sewer Service /City 30%
30-123 Sewer Sevice /City Maint.
30 -125 Unmatched
' 31 -124 Storm Drainage
40 -475 Bancroft Prin. Pymt.
40 -471 Bancroft Int. Pymt.
10 . -2 g C 6� \ 62-3
/0 -4 -7 Qev
TOTAL 1110. c{ O (4.
C
0 .
DlT. •
®: