10120 SW HALL BLVD ,
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WL..L)MaING PERMIT o
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CITYOFTIIFARD
F�F:F:M:I:'T' N(). laL.CTwtt'77'it
CITYOr T16ARD
rr COMMUNITY DEVELOPMENT DEPARTMENT
". 13125 S.W.Hall Blvd„P.O.Box 23397,Tigard,Oregon 97223,(503)6394 i 75 P F2:I:M . PM'T' .NO , 9817'79 e
5
JOB ADDRE'S'S : 1.0120 SW HAI_.1... 9l_VD t
MAP/L.CTT ICK
i_.AND USE::
I..OT SIZE :
ITEM : 140 NO:
WORK C:L.ASS : AL.';i=r1A'T'ION WATER C:I OSFi:T' T PAP
USE: TYPE : C(:)MME'P(:IAI.., UPINAI... 1:)KE'I...CIW PPVN'T'R
C:CINS'T' .TYPE: : I..AVORATORY T PAP PP I:ME:R
OCCUP.(;Pp. TUB SHOWER GF't1"r_'ASE: 'T'RAPS
DISiHWASHER
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(:,APBA(.,E DIS V'OSAI_.
NO. S:ITIRIE:S : WASHING Vv'CI••I:I.NE
DWEI...I.. . UNI I'S I_.Al.1Nl:)F:Y 'T F<AY BI-IN; . DRAIN ( DIA
F'L.(7C)R
DRAIN 1.
SINK 2 SF.::WI I*) (FT)
WA'T'ER HEATER 511,11PM/PAIN (FT
C)THE:R 1.
Flhi:MARI<S:i
tN(I1'HEP :I:Sa 1C.*F MA(.',1•I:rNI::
AM/PM M7:N:1:-MAP'T WEPMT r $30 . 00
N
E F,I X'T U RE S
H `a1A'TE, 'T'AX $3. . "50
O T'I••IER
C COOK JAMES
N M:I:I._WAI.IKIE PLUMBING
R pa BOX 393
A 9"701;:1
C PHONE ("503) 635-91.6t
T
0 REGIS-141AT'ION NO . 500E?
R T'C)'TAI.. : 1111111-51 . Ci()
NEC:E I PI' NO. /00 ,57,3
This permit Is Issued subject to the regulations contained in Title 14
of the TMC. Slate of Oregon Specialty Codes,Zoning regulations
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done in accordance with the plars and
specifications and in compliance with all applicable codes and
ordinances. The issuance of this permit does not waive restrictive
covenants. Contractor and sWicontractors shall have current city
business tax permits. This permit will trpire and become null and J.
void if work is not started within 180 days,or if work is suspended or
aband:ned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved.
Permittee Signature
issued By: _.. ---�� C:AL.I_ FOR INSPECTION 639-41.73
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
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P.O.Box 23397 I
CITY OF TIGARD PcLIp..�MpBING �� �' t� ��
Applicants mint hold Oregon Registration to conduct a plumbing P[:i�
PERMIT 639-41Ti9xid7 9r7M II
' business or must be property miner/operator ncN hiring txriside help.
4 . - Name of Development
Plumbing Permit No. al
Address _ (� D"CnpyAl �I
ORS 814-21-610 CAJAN. PRIDE AMT. 11
Job Tax tot Map.Nc
Address
FIXTURES
W Block Subdivlskn L_ 7.50
- - l�
Sink
ame-To name ness Lavatory 7.50
MTub or Tublehower Comb -_ 7.50 _ al
Mailing- res -- _
Shr•.:.,r^nly _ _ 7.50
Owner CRY/Nat" Lip - Water Closet 7.50
Dishwasher 7.50 41�
Ph-N» CirbageDisposal 7 50 t
Name - Waatiing Machine 7.50
Flora tjral►r :j N� - '- 7.50
Mailing XTdress Phone Water Heater 7.50
Occupant Ci(y/State - Zip - LaundryRoom Tray -- - ,7.50 -
Urinal 7.50
Name I `-FrFna �- Other Fixtures(Specify) - 7.50
�1w1�1u C.;l: Ptib�, � 7.50
I" Nddress I Phone k 7.50
Qn -
Cofdractor /State 7.55'
MISCELLANEOUS
City t:1us.Tax No. Sewer 1 at 100' 30.00 1
+
s.Board N6'-- State rLic. Sewer-ss.Addit.100* 15.00
Bus.
(Residential) Water Service 1 st 100' 20.00
1 hereby acknowledge that I have reed this application,that tins Informall.-n wow Ssrvioe ea.AddiL2001 15.00 _
given is oorsix,that 1 am registered with the State Builder's Board and also Storm 6 Rain Drain t st.100' 30.00
taws a State Plrrrmbi ng Iloo nss that the numbers given we corrsrx.than all -
plumbing work will er vv."be done in aoocvdsnoapplicable provisions of t7re• Storm a P-Jin Drain Adds.100' 15.00 _
goo Revised StaUAes Chapters 447 and 893 and applicable codes end that Mobile Home Spaos 25.00
no help will be employed unless licensed urAer OHS 893.(If exwno from -----�- -
State rsglWation.please give reason bokow). Back Flow Prevention
HOMEOWNERS-1 hereby owWv that 1 am the owner of the property de- _Devtoe orAnti4'oltution Device 7.50
scribed above,at whiicft location 1 propose to make a pkambbV hstallaaon for Any Trap or Waste Not
my own use and this property Is not being creteln_rctrd for sale.hale tx rom Cernnacfatt Ins Fixtum 7.50
CalchBasin7.50
YT- -�- kap of F_xist.Plumbing -- 40.00 Per Hr.
`'.rally Requested Inspections 40.00 PM Hr
__--- -- AIW.of Pkrrnbkrg wflhirt _ - ----
an Existing Bldg. 15.00 min.
AUTHORIZED SfONATU a-- - D - New Bldg.or&M Addition 25.00 min. +_
1 � Jt � anny
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Describe work new❑ addition❑ of ation❑ i"Ir (IP-jlinq 15.00
los done rssldential 1-1 non-residential F1 ._ -
E)dsting use of
W*1111%fx property-_ - ---m_.-...._._ V-WTOTAL
ft Ws Of �1!1 W�1CttAlIOR' _L SU
TOTAL
---
ThM Psm*hsoortnsa MA and told N work or oonatruorlcn author{:W is nol otrr-
nWVW*Wdi 100 deyatsr If conn rcdon or w+ork M suspended or absr 1orwd for f
a Period of 180 days d any retia after work M oorllrrAwxmd
-- -- Date Issued- by
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