Permit CITYOF TIGARD 114
COMMUNITY DEVELOPMENT DEPARTMENT
e 10125 SO Hell Blvd. P.O. Bac 233117, Tigrud. Oregon 97223 (503)839-4175
+� u .I. L.mn
PERMIT # ^ PLM91-0221
639-4171 DATE ISSUED: 12/10/91
SITE ADDRESS - 14750 SW 72ND AVE PARCEL: 2S112AD-00600
SUBDIVISION ^ ZONING: I—L
BLOCK ^ LOT ^
CLASS OF WORK.. :ADD GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
TYPE OF USE ^IND WASHING MACH • BACKFLOW PREVNTRS..:
OCCUPANCY GRP..:82 FLOOR DRAINS • TRAPS
STORIES ~ WATER HEATERS • CATCH BASINS
FIXTURES LAUNDRY TRAYS • SF RAIN DRAINS ^
SINKS • URINALS............: GREASE TRAPS •
LAVATORIES ^ OTHER FIXTURES ^1
TUB/SHOWERS • SEWER LINE (ft) ^ 200
WATER CLOSETS..: WATER LINE (ft) •
DISHWASHERS....: RAIN DRAIN (ft) •
Remarks: 1000 GALLON WATER/OIL SEPARATOR AND NEW SEWER LINE
Owner: FEES
RYDER TRUCKS type amount by date recpt
14750 SW 72ND AVE PRMT $ 52.50 JLH 12/10/91 —
PLCK $ 13.12 JLH 12/10/91 —
TIGARD OR 97224 5PCT $ 2.62 JLH 12/10/91 —
Phone #:
•
Contractor:
FULLMAN SERVICE CO
0706 SW BANCROFT
PORTLAND OR 97201
Phone #: 224-5221 $ 68.24 TOTAL
Reg #..: 67818
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other
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 180 days.
-- --'
Permittee Signature: Ai ,^ � ---
Issued By
Call for inspection — 639-4175
City of Tigard PLUMBING PERMIT PlancwRec. #
13125 SW Hall Blvd. APPLICATION Permit #
PO Box 23397
Tigard, OR 97223
(503) 639 -4171 To b #. - 3,2yg
Nam of Dn«+ ` Description
-!" J G S ORS 814 - 21-610 I OW I PRICE I AMT
Job • ILicier
� .5' 1") �, '� FIXTURES
Address ows. aD Sink 7.50
1 I Q 00: v 2 / .7.�3 Lavatory 7.50
"' (or of J Tub or Tub/Shower Comb. 7.50
Shower Only 7.50
Maim Add Water Closet 7.50
Owner Dishwasher 7.50
cincsow by Garbage Disposal 7.50
Washing Machine 7.50
Maw (m name of °i Floor Drain 7.50
Water Heater 7.50
Mang "a'w ° ..- Laundry Room Tray - 7.50
Occupant Urinal 7.50
COPSUP ZIP Other Fixtures (Specify) 1 7.50 I ,
LJB..� -er- I hi 1 Telo a.rcd- e 1 7.50 750 y
flan � ,.� 7.50
V II/ 1 1Q.h &D. 7.50
Contractor 51 I / 11114-D0d S • -294i .5e') MISCELLANEOUS
7 70 r-r'( of Sewer 1st 100' 30.00
oft t Olt g� 50. X
+°^ "° e� Tax "° Sewer - ea. AddiL 100' 13.00 )
L./ L 1/ 9 ) - Water Service 1st 100' 20.00
I hereby advrowledge that have read this application. that a Water Service ea Addit. 200' 15.00
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 I . Storm & Rain Drain 1st 100' 30.00
am registered with the Construction Contractor's Board, that the number Storm & Rain Drain Addit. 100' 15.00
given is correct. (If exempt from State registration, please give reason
below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti- Pollution Device 7.50
S f°0 ' ° t °°^ -« a ° Any Trap or Waste Not
Connected to a Fixture 7.50
Describe work new 0 addition 0 alteration repair 0 Catch Basin 7.50
to be done residential 0 non-residential ® 40.00
Insp. of Exist. Plumbing per hr
40.00
Specially Requested Inspections per hr
Existing use of Rain Drain, single family
building or property dwelling 15.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property
*(Except residential backflow
prevention devices)
NOTICE *Minimum Fee $25.00 SUBTOTAL 5 Tb
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 596 SURCHARGE . - 9, (,
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED PLAN REVIEW 25% OF SUBTOTAL J3 0 - , FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. TOTAL 6g, .y
Special Conditions
• Date issued by
..mtuAevMi
.end« i .