9175 SW EDGEWOOD STREET ca
2,
0
m
v
C)
orO
v
M
m
m
9175 SW EDGEWOOD STREET
CITY OF TIGARD
DEVELOPMENT SERVICESP1 tJMPTI\Jf-) r1rRMIT
PFRMT'r it. . . . . .. . : n
13125 SW Kill Blvd., Tigard,OP.97223 (503)639.4171 DOTE !SSI IFD . 03/03/9A
PARrEL.
Eo
7ntq111rj: R 4.
1. Or
I (:Yr'. . J1 J FR I D I CTinm T T G
MOPTI-E HOME "P(ICES. : 0
ASS 131 WORK—AL I GARBAGE DISPOSnU3. S
YPE OF USE. . . 9F WASHTNG MACH. . . . . . : 0 BACKFLOW PREEVNTRS. . : I
.1r[.'UPPNCY GPP. R3 FLOnP DRnT'1\4.1. . . . . . . : 0
'STORIES. . . . . . . . . 0 Wr43*FR HUYTERS. . 0 mrci-i BAs" rjS. . . . . . . . 0
T X*TUREG----------------- LALJ1\1DRY TRAYS. .. . 0 9F FSA Ihl DRAINS. . . . . ; 0
TNKS. . . . . . . . . : 0 URINALS. , . . . . . 0 (3PFP9P TPnPS, . . 0
nVATOPTE!7. . . . : 0. (3T1-IrP F-"TYTUP17!';). . 1A
'UB/SHnWEP(5. . . - Q! SEWER I.-INE (ft) . . . - 0
'() I'F-..R CLO3L'1'3). : 1A WP'TF-R LH\1E ( ft ) . 0
i1qHWASHFRS. . . . 0 RAT!u r)RrIN ( ft) . . 0
- -ksr Tnt7itallinr
1. ow nt'�,vt-,nt i Or! dPV I .F?
F-FES
G n T A P 3 t y P '
ainol.int by dAl- o r v r."I:;
7!!i SW F:D('JPwnnr) r;-r npm-r 1 17-1. 00 T 0"2"/ .n ,/'11) 9A-7;07P,
M. "7 LA 7!0- 11 R 13P 7 0'77 P
rr,nn nP 9"7 7,2
EXPIRED
9,7999 9
P F01.1 T 9,7 11 i :
aprsit is issued subject to the requlations contained in the
igard Municipal Wo, State of Ore. Specialty Codes and all other I T T-1 i Y ,r .......
�Inplicable laws. All work will be done in accordance with
oproypd plans. This persit will expire if work is not started
-ithin IA? days of issuance, or if work is suspended for more
pian 180 days. ATTENTION: Oregon law requires you to follow rules
-dopted by the Oregon Utility Notification Center. Those rules are
et forth in OAR 952-000I-W10 through OAR 352-WI-PAPP„ You say
Itain copies of these rules or direct questions to OUNC by calling
'1031246-1987.
By , 16, r-ir
.4 +++4.+++++4-4-+a-+.+.+.4 4 A 4. f.4-+4-+4.4-++44-++++,4..+.h4.+4+,a-++++++++++++{-4 +++++++..4.4 a 4.
('al. 1 f339-417 by 1:00 p. m. for an inspeizt ton n(?eded th,, newt bitsinils- dray
+4-444+.+++-t.....4--+++++++++4•..................4..........F+++-4 1-+1-++•+++4++i-+1-.1,+4 +++
CITY C'F TIGARD Plumbing Permit Application Recd By.
13125 SW HALL BLVD. Comme—Jal and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
Date to DST
503 539-4171
Permit# E-
Print or Type Related SWR 0
Incomplete or illegible applications will not be accepted Caned
y Name of Development/P bject On bark Indicate Work Performed by fixture
.)oh i �� r (` , FIXTURES (Individual) — QTY PRICE AMT
Address Street Ad_*ess Suite Sink �^ 9,00
` u% 1)6Lavatory — ---- —� 9.Oo —
Bldg# City/State Zip Tub or Tub/Shower Comb. 9.00
_---- Name Shower Only 9.00
ti e SWater Closet 9.00
Owner Mailing Add ss / L,,,'�n
Dishwasher 9.00
r Lo&' CcGarbaqe Disposal 900
City/State L Zip Washing Machine 9.00
Name Floor Drain 2' 9.00
3' _ 9.00
Occupant Mailing Address Suite 4' 9.00
City/State Zip Phone Water Heater O conversion O like kind 9.00
Laundry Room Tray 9.00
Name Unnal 9.00
(�
,� J
) J)_
) Other Fixtures(Specify) 900
Contractor Mailing Address Suite --- -
9.00
Prior to permit City/State Zip Phone —�� -- -- — 900
issuance,a copy 900
of all licenses are Oregon Const,Cont.Board Lic# Exp.Dale 9.00
required if _— Sewer-1st 100" — 30.00
expired in COT Plumbing Lic # Exp.Date
database Sewer-each additional 100' 2500
Name Winter Service-1 st 100' 30.00
Architect
Waler Service-each additional 200' 2500
_ - _
Mailing Address Suite Storm&Rain Drain-1st 100' —30 CU_
of —
Storm A Rain Dram-each additional 100' 25.00
Engineer City/State Zip Phone Mobile Hon a Space 25.00
Commercial Back Flow Preventio,i Device or Anti- 25.00
Describe work, New O Addition O Alteration O Repair O Pollution Device
to be done: Residential O Non-residential O _ Residential Backflow Prevention Device' 15 00
Additional description of work. Any Trap or Waste Not Connected to a Fixture 9.00
Catch Basin 900
Insp.of Existing Plumbing 40.00
Existing use of Specially Requested Inspections 4000
building or property- _ erihir
Rain Drain,single family dwelling 30.00
Proposed u-se of Grease Traps 900
bullring or property
QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the information Isor riser diagram is required I Quanny Tolal is >9
giometric ven Is correct,that I am the owner or authorized agent of the owner,and _ — "SUBTOTAL 1 f
that Alam;submitted are in compliance with Oregon Sldte Laws
Signature of Owner/Agent Date -- e
5/e SURCHARGE
-Z � =- —--- --- PLAN REVIEW 25%e OF SUBTOTAL
Contact Per'aon Name Phone Requued on n fixture brei is>9
_y qty_.i------- —
TOTAL
'Minimum permit fee is$25+ 5%surcharge,except Resident,al riackftow
Prevention Do rice,which is$15+5%surcharge
EXPIRED
I dsta�nimepp doc SN)
'LEASF__COMPLETE.
Fixture Type — — Quantity by Work Performed _
Now Moved Replaced Removed/rapped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only _
Water Closet - --- - -- -- -
Dishwasher -----_—_ --- __-- — --
Garbage Disposal —
Washing _Machine_— — — - - --
Floor Drain — 2" --^_
411
Water Heater —
Laundry Room Tray_ ---- ��
Urinal
Other Fixturas (Specify) —~-
COMMENTS REGARDING ABOVE:
e m_M doc SMI