Permit 1 CITYOF .:Vi
CIiYOP CARD
COMMUNITY DEVELOPMENT DEPARTMENT OREGON/
t312(SW FBI Blvd. P.O. Banc 23397, Tigard, Oregon 97223 (603) 639 -4176
•
PLUMBING PERMIT
PERMIT # • PLM91 -0171
639 -4171 DATE ISSUED: 09/25/91
SITE ADDRESS...: 11960 SW PACIFIC HWY PARCEL: 2S102AA -00602
SUBDIVISION • TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK LOT •10
CLASS OF WORK.. :ALT GARBAGE DISPOSALS..: MOBILE HOME SPACES.:
TYPE OF USE •COM WASHING MACH BACKFLOW PREVNTRS•.:
OCCUPANCY GRP.. :B2 FLOOR DRAINS • TRAPS •
STORIES WATER HEATERS • CATCH BASINS •
FIXTURES LAUNDRY TRAYS SF RAIN DRAINS •
SINKS • URINALS • GREASE TRAPS •
LAVATORIES • OTHER FIXTURES
TUB /SHOWERS SEWER LINE (ft) •10
WATER CLOSETS..: WATER LINE (ft) •
DISHWASHERS RAIN DRAIN (ft) •
Remarks: REPAIR 10'SEWER LINE; INSTALL NEW CLEAN —OUT
Owner: FEES
DICK KAYDAKE • type amount by date recpt
PO BOX 110 PRMT $ 30.00 JLH 09/5/91 —
SPCT $ 1.50 JLH 09/25/91 —
TOKELAND WA 98590
Phone #:
Contract or:
RESCUE ROOTER
PO BOX 23873
BEAVERTON OR 97006
Phone #: 644 -3341 $ 31.50 TOTAL
Reg #..: 44677
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Top —out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 sore
than 180 days.
Permittee Signature: a-L- _
Issued By:
d
/■J
Call for inspection — 639 -4175
A
City of Tigard PLUMBING PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION / Permit # ti - o 1 / 7)
PO Bak 23397 Pr r. D ?/
Tigard, OR 97223 1 ��U
(503) 639 -4171
IQ) .«. QT E _5 ORS 814-21-610 I QTY I PRICE I AMT
I Address a ' I 6 0 S� (C2 1r2G A/4,.), FIXTURES
zed Sink 7.50
i R 2 0 2Z Lavatory 7.50
Nan. (a name a Baan..a) Tub or Tub/Shower Comb. 7.50
-
[J 2Gk k `9 f/ I�/� k E Shower Only 7.50
Porn. Water Closet 7.50
Owner fo 11 0 to 4.40 Dishwasher 7.50
ociato• 72P Garbage Disposal 7.50
/,1761. 4,,r590 Washing Machine 7.50
Nanr (a nwr a b.siww) Floor Drain 7.50
Water Heater 7.50
Wine Ammer Phone Laundry Room I ray 7.50
Occupant Urinal 7.50
Asa* 1P Other Fixtures (Specify) 7.50
7.50
Nanw 7.50
I fE c 'Loa fE& 7.50
Mang AAt«a /j Phone
" f Z ` 5 Z3 MISCELLANEOUS
Contractor
« zP
(0,t ("2E600 �j Sewer 1st 100' / 30.00 �
Saw sa *a No. _ � ; y Sewer - ea. Addit 100' 15.00
Water Service 1st 100' 20.00
I hereby acknowledge that I have read this application, that the 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 Contractors 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 And- Pollution Device 7.50
Somas. (arwr.« 'o- oar Any Trap or Waste Not
Corrected to a Fixture 7.50
. Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 7.50
to be done residential Q non - residential 0 . 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 bacldlow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25% OF SUBTOTAL
COMMENCED. TOTAL
• Special Conditions
Date issued by
haPLUNSPIAT
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