Permit G�I_.l.l i"iE::]: NC - -; I�'I�:I�lM:C•r
PHF NO. : PL..8B1.0
CI1'Y'OF TINA RD .
clTrof
OREGON
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 6 / 6/88
13125 S.W. Hall Blvd., P.O. Box 23397, Tigard, Oregon 97223, (503) 639 -4175 ^ P i ]: M . faM•T' . NC) . 881095
JOB A171:)pf_sS : 9806 SW T':1C RE) ST
TAX MAP/LOT SUB: T :I GARI :) INDUSTRIAL PARK LT: I:-)I< :
LAND 1.151:: •
I...( :)T SIZE:
ITEM: NO: NO:
WORK CLASS: ALTERATION .I:(7N WATER CLOSET 1. TRAP
USE TYPE : INDUSTRIAL UR :I :NA1_. Bl<F'L..OW PPVNTR
CONS:iT . •'I'YPI:: :: L.AVORATORY 1 TRAP PRIMER
OCCUP . (:;RP . : BE.! TUB SI- I( :IWER GREASE TRAPS
DISHWASHER
GARBAGE DISPOSAL
NC) . S:iT•OR :I :ES : WASHING MACHINE
DWE1_I.... UN :[TS : LAUNDRY TRAY BLDG . DRAIN (17 :I:A
FLOOR E)RA :I:N
SINK SEWER (FT)
WATER HEATER STORM/ RAIN (I-
OTI -IER
PE: :MAP :IC :
Add' n of two :Litt. partitions & walls for
i t rcicim .
0 T :i.rja:ar•cl St. Inv. PERM] :T $15.00
N
FIXTURES
y
STATE TAX $ . 73
OTHER '.1a;3 . l:a
A
O
TOT'AI...: tla:1.9.50
PIECE I Iz'T NO . f 7
This permit is issued subject to the regulations contained in Title 14 _ _....._ .__..._ ._......_._._...._.____._.._.._ _
of the TMC, State of Oregon Specialty Codes, zoning regulations
REQUIRED :I:NSPE C T :I:[7NSi
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done in accordance with the plans and PI_.13 . I.JNI.)F:12SL..AI:;
specifications and in compliance with all applicable codes and ROUGH• — IN
ordinances The issuance of this permit does not waive restrictive F:'1...1:3 . TOPOUT
covenants Contractor and subcontractors shall have current city GAS 1...:I:NE:.
business tax permits This permit will expire and become null and
void if work is not started within 180 days, or if work is suspended or F ]: WA_
abandoned 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
P• rmittee Si. ature
Issued By /./ - CAL.1... OP :I:N".;s:?EC ION Ca:39 -- :1.75
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
•
.
P.O.Box 23397
CITY OF TIGARD PLUMBING 13,175 S') Hai, BM.
Applicants must hold Oregon PERMIT � �'
MP regon Registration to conduct a plumbing
business or must be property owner /operator not hiring outside help. 639-4175
' Name of t
T9irc( / nc l<
G 17C? �j k Plumbing Permit No. s`i� /b
- 7! Q / ORS 81 -2
Job DC � T 4� ORS 81421 -810 OUAN. PRICE AMT.
Tax Lot Map. No. -
Address
FIXTURES
Lot Block Subdivision
Sink 7.50
Name (or name ol"business) Lavatory / 7.50 '7.50
Tub or Tub/Shower Comb. 7.50
Mailing Address
Shower Only 7.50
Owner City /State ZIP Water Closet 1.____ 7.50 7.0
Dishwasher 7.50
Phone Garbage Disposal _ 7.50
Washing Machine 7.50
Name / r �t� Floor Drain 7.50
Woo,. ^ '� Water Heater 7.50
Occupant City/State , (j(/ ✓ a Laundry Room Tray _ 7.50
Urinal 7.50
Name Phone Other Fixtures (Specify) 7.50
7.50
•
Mailing Address Phone
7.50
Contractor Ctly /State zip 7.50
MISCELLANEOUS
City Bus. Tax No. Sewer 1st 100' 30.00
• State Blips Board No. State Plumbers Bus. Lic. No. Sewer -ea. Addit. 100' 15.00
(Residential) Water Service 1st 100' 20.00
I hereby acknowledge that I have read this application, that the information Water Service ea. Addit.200' 15.00
given is correct, that 1 am registered with the State Builders Board. and also Storm 8 Rain Drain 1st. 100' 30.00
have a• State Plumbing license that the numbers given we correct, that all
plumbing work will be done in accordance with applicable provisions of Ore- Storm 8 P'un Drain Addit. 100' 15.00
gon Revised Statutes Chapters 447 and 693 and applicable codes and that Mobile Home Space 25.00
- no help will be employed unless licensed under ORS 693. (If exempt from
State registration, please give reason below). Bads Flow Prevention
HOMEOWNERS - I hereby certify that 1 am the owner of the properly de-
Device or Anti-Pollution Device 7.50
scribed above, at which location I propose to make a plumbing Installation for Any Trap or Waste Not
my own use and this property is not being constructed for sale. base or rent. Connected to a Fixture 7.50
Catch Basin 7.50
Insp. of Exist. Plumbing 40.00 Per Hr
Specially Requested Inspections r 40.00 Per Hr _~
Alter. of Plumbing within
an Existing Bldg 15.00 min.
AUTHORIZED SIGNATURE Date New Bldg. or Build. Addition 26.00 min.
• Fain [ka.in, single family
Describe work new ❑ addition 0 alteration 0 repair ❑ dwelling 15.00
to be done residential l non- residential fl
editing use of _
. or Property MI -TOTAL i_S .00
=t o of srty VIA SURCHARGE , 7
NOT 2.5% PI Review mow 3.
This permit baoomas null and void* wadi or construction authorised is not corn- Z sQ
mowed MO* ISO daystar C construction or work is eimperded or abandoned for
• period of 190 days at any time after work Is commenced.
SPECIAL OONOmoNB
Date issued by __
nc .ARO n t ,AS rev .