Permit CITY OF TIGARD
4, � � DEVELOPMENT "P RAIf : 7 -0192
13125 SW Hall Blvd., Tigard, OR 97 (x ¢- figMg/97
PARCEL: 1512600 -01107
SITE ADDRESS...: 09499 SW WASHINGTON SQUARE RD
SUBDIVISION • ZONING: C-6
BLOCK • LOT • JURISDICTION:
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE :COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY 6RP..:B FLOOR DRAINS • 2 TRAPS • 0
STORIES • 0 WATER HEATERS • 1 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS • 0
SINKS • 2 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 1 OTHER FIXTURES....: 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 1 WATER LINE (ft)...: 0
DISHWASHERS : 0 RAIN DRAIN (ft)...: 0
Remarks: Plumbing tenant improvement
Owner: - — FEES --
EYE CARE CENTERS OF AMERICA type amount by date recpt
11103 WEST AVENUE PRNT f 63.'.x JH 05/20/97 97- 294811
SUITE 111 5PCT $ 3.15 JH 05/20/97 97- 294811
SAN ANTONIO TX 78213
Phone D:
Contractor -- ---
SUNSET PLUMBING CO
6 LONG ENTERPRISES INC
8920 SW LANDAU
TIGARD OR 97223
Phone D: $ 66.15 TOTAL
Reg 0..: 012089
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 more
than 180 days.
Permittee Signature: ,o_i /Lilt,
Issued By:' �
Call for inspection - 639 -4175
a ;
/ City ri ar'�J PLUMBING PERMIT APPLICATIO 6 anck/Rec. # 7 tY 9 � � ���1
13125W Hall Blvd.
, � ermit # q cu.
Tigard, OR 97223 / C � swit
(503) 639 -4171 Z _ -7 J 0 1 •
�� V ll NinAUM $25.00 PER IT FEE + ST. SURCHARGE
,.. of Development New Single Family Residences Only
66l NVOIcAS EklE1,(10` la
Job neaea. ' ,,�) \ 1 1 S{) ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
� s W W�� Al
0 3 BATH HOUSE $225.00
Address ctrstete ao Fee includes all plumbing fixtures in the dwelling and the first 100 feet
1 j nQp(\Th of water service, sanitary sewer and storm sewer. See fees below.
Name (Of INTO of Buaneeq FIXTURES QTY PRICE AMT
E\�F en no s O- ` ec1 Sink .2 9.00 goo tfn
Map eat Phone
Lavatory iFe SCATS { 9.00 q 60
Owner 1110 W • 'VYUtSUgi WO 311- 3 Tub or Tub /Shower Comb. 9.00
`tly/Stats n Shower Only 9.00
Girl ArA0 r o � * q g • al Water Closet peL,ocA.E 9.00 q ,(90 came (« name or tit Dishwasher 9.00
Occupant 6 I N kit) Ni S F'YF (".V ( 16 Garbage Disposal 9.00
""N`' P° '°° A ' ° " e Washing Machine 9.00
Floor Drain
I 9.00 9 CX.)
CayrState Di Water Heater { I 9.00 9CX
Laundry Room Tray 9.00
Name Urinal 9.00
GUN l4( Al, Co d' -S - 1 1 1) I Other Fixtures (Specify) 9.00
Maim Contractor 1 �� rAa,`�5;�� 9.00 ��
ON/State r ?O�
/� \ 2 aP 9.00
ION O1 `-1 Sewer 1st 100' 30.00
State Repatraaon No. Dh Pen. Tao No. Sewer - ea. Addit. 100' 25.00
CA 2a 4 3 Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
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 Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
giv: - as• below.) Home Space 25.00
c / Back Flow Prevention
Agilligithil, (/ j Device or Anti- Pollution Device 9.00
E' antra (caner or t) 7 , , a Any Trap or Waste Not
Connected to a Fixture . 9.00
Descnbe work new 0 addition 0 alteration repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 / Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00 /hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property
°(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL (3 00
• PERMITS BECOME VOID IF WORK OR CONSTRUCTION l!� 5
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 3
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions / �
Date issued by (06 I ° -y
q 7 -? 87/
,Tennant Name: h tw1 E P ( ( n Accumulative Sewer Tally This SWRI a
Address: 0 q This PLAU 1 - 1 L
Fixture Value Previous # Previous Credits Capped Rxtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuz/Whpl 4
Car Wash - Each Stall 6
i
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 1 Z 1 4 7-
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
l Sink - Bar /Lavatory 2 / 2 / Z I I I en
- Bradley 5
I
- Commercial 3 Z- U' 2_ Co
- Service 3
I --^
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6 I
__�
Water Closet. Toilet 6 1 CP 1 ‘ / C'
Urinal 6
TOTALS 1W3 • 2011
Total fixture values: �D t I divided by 16 = f V,,(/' EDU ' (21p70'` ..
•
HISTORY ND bv 4/.44 yK �°t
PUVI # 17-00N EDU# 12-5 SWR# q'7 -1 35 PLM# f . - it-- EDU# 'V/ SWR# , , (Q' 9(o
,/� / ���
PLMd l-0O3 EDU# /GCD SWR# -7 - PLM# EDU# SWR#
PLM#' 7- 7D EDU# 125 SWR# C /7 - 602- 1 , 1 PLM# EDU# SWR#
PLM# p - 'ti 9EDU# %Ll' SWR# 'j/ '5', 0 PLM# EDU# SWR# -