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11051 SW 81ST AVENUE
CITE' OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERM I'T #. . . . . . . : P'L.lyl'J 1 IJ 0
13125 SIN Hall Blvd., Tigard,OR 97223 (503)639.4171 DAIE 'IsSUED: 02/05/97
PARCEL: I.S136CLA 07600
SITE ADDRESS. Lw, i. sw gis,r AVE
SUBDIVISION. . . . HERB & PIEGGY' S PLACE ZONING: R-4. 5
I`ALOC!!. . . . . . . . . . I.-OT. . . . . . . . . . . . . ..7
--------------
C'LASS OF WORK. . :Al-T GARSAGF DISPOSALS. : 0 mnBTI-,E HC)ME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. R3 FLOOR DRAINS. . . . . . . 0 I"RA1719. . . . . . . . .. . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0
I-PUNDRY I-RAYS. . . . . : 0 517 RAIN DRAINS. . . . . : 0
9 1 NKS. . . . . . . . . . : 0 URINALS, . . . . . . . . . . . 0 GREASE TRAP' . . . . . . . ...
LnVATORIES. . . . . ; 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. . : 0 WATER LINE ( ft ) . - - : 0
DIr,HWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : install. in kind water- heater replacement
Owner: FEES
1111-1_ ONDERSON type anicifint by date r e c.,p t;
11.051 SW SISI' AVE PRMT $ 25. 00 JSD 02/05/97 97-289938
5PCT $ 1. J9D 02/05/97 `-37-2899 )P
TTGARP nr? 97223
Phone #: 639--5367
Cont Tact nr.-
GEORGE MORLAN PLUMBING
5529 Sr VOSTER RD
PORTLAND OR 97206
PhonFi #: 771- 1, 145 $ G. 25 TOTAL
Reg #. . - 02734 REQUIRED INSPECTIONS
This permit is illu#d subject to the regulations contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect ion
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 20 days.
Permittee 5 i g n t
Call for inspection 639-41*75
.1TY OF TIGARD Plumbing Application Recd B{r
13125 SAN HALL BLVD. Commercial and Residential Cate Rec J C),7-c-5,
Date to P c. Al/41
1 IGARD, OR 97223 Date to DST
1503) 639-41 11 Permit �,'��7 cb3
Print or Type Related SWR x
Incomplete or illegible applications will not be accepted Calledy r' �
Name of Ceve!opmenuPro!elct nn FIXTURES (individual) _ QTY PRICE AMT
Job PJACVN>?� Sink
Address Street AddressSl Suite Lavatory _- _ 9.00
it) SW 'i'l CI UC I Tub or TubiShower Cornu 1 9.00
j dltlg 0 Gtyistate Zip Shower Cnly 9,00 —�
Water Closet 9.00
Name ----
Dishwasher — _ 9.00
Owner Mal"Address �ls —� � Su,te Garbage Disposal — � - 9.00
�W�l t, Washing Machine — 9.00 - I
city/state Zip _ Phone Floor Oram Z' 9.00 —J
--. rc� OR 61-0-�7 '' -5 Gl 3• 9.00
a• 9.00
Occupant Hagg Address Suite Water Heater 9,00 —I
Laundry Room Tray 9.00
� C,tyrStats Zip Phone Urinal __ _ _- 9.0
NName0
_�. _ Other Fixtures CS tyl 9.00
,��jn�
(�. /Y(i ,/,n 9.00
Contnctor Marling Adcress Suite _ 900
rj > t7)l�ty 9.00
C tyrStaie Zip Phone
T a,C � 7 G! __ 9.00
Z4-
t 9.00
Oreg n Corot.Cont. Board Lac 0 Exp Dto
Adhwh Cc"of 01-111 C) -7 9.00
Cswreett P1 ng Lrc.0 Exp. ate Sewer'- lit 100• 3000
Nicene" _ � ,I -I Sewer-each additional 100' 115.00 I
JT Business Tax or Metro 0 Exp.Cate Water Service- ter 100' I 3000
— I Name -- Water Service-ea::n additional 200•— Soo
Architect Storm S Rain Crain- 1st 100'� 3000
L-- Slone S Rain Crain-each additional 100 25.00 i
or I Hiding Address Si :e -,
} Mobile Span 2500
Home Spa � 25 00 �
Engineer I wNiblate Zip I Phone Commercial Back Flow Prevention Cevice or Anti- I— 25 00
Po!luticn Cevice
.*cape work New ') Addd un O Alteration O Reoair O Residential Backflow Prevention Cevice* i 1500 I
a be done: Residential O Von-residential O Any Trap or Waste Nei Connecled to a Fixture 900 �I
warbonal descT,i:on or work Catch aasin 3 00
Irsp of Exi%urg P!umbmq .1000
• prnhr
5peaai R,+ou•steri Inspections 4000
ins"use o _ � I oerrhr
>,aMtinq or nropenv_.�_. Rain gain singe-amity dweiling 30 30
Deposed use of Grease Traps -100
—i
Xdding or property ---— QUANTITY TOTAL
Ate yCr tipping, moving or replacing any fixtures? Yes O No C1 Isometric-r risar Surgram u reouvw A Cuanay Totals +9
(If yes see back of form) — 'SUBTOTAL
I herebv acxnow!ecge that I hr.e read this aoplicat on that the information - ----- --
green s.orrect 'nat I am the owner or authonzed agent of the owner and 5% SURCHARGE
.gat cions subm tted are n:cmoliance with Cre4cn State laws -
3i9nature of OwnertAgent :)at* PLAN REVIEW 25'.19 OF SUBTOTAL
-+ �& 7-, G; q`7
! � °�aurW onOrlyI mature 7 :clot•s_+ a _ J
fl�=-� .� TOTAL
I
Contact Parson Name Phone
_ 'Minimum permit fee is S25• 51:surcharge,except Residential Bachftew
Prevenucn Cevice which it S15 - 516 surcharge
\ostsiptmapp doc 9x98
/U�410 b
P1 �_(2 PLEiE As.A P P R _1ATE p ECT:
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�
—__ 4"
Water Heater _
Laundry Room Tray
Urinal _ _ —
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE: