Permit .
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT PLUMB I NG PERM I T
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PERMIT #.......: PLM95- -0092
639 -4171 DATE ISSUED° 06/14/95
PARCEL: 15126OC -01107
SITE ADDRESS...: 09625 SW WASHINGTON SQUARE RD
SUBDIVISION ZONING° C —G
BLOCK LOT
CLASS OF WORK. . :ALT GARBAGE DISPOSALS..: MOBILE HOME SPACES.°
TYPE OF USE. ... :COM WASHING MACH BACKFLOW PRE VNT RS. . :1
OCCUPANCY ,GRP.. :B2 FLOOR BRA INS. °°°... :1 TRAPS
STORIES WATER HEATERS :1 CATCH BAS I NS. ......r.
FIXTURES -• - -- LAUNDRY TRAYS. .... -.: SF RAIN DRAINS °
SINKS °5 URINALS GREASE TRAPS. ... ... :1
LAVATORIES. . . . . :1 OTHER FIXTURES • •
TUB /SHOWERS SEWER LINE (ft) °
WATER CLOSETS..: WATER LINE (ft) •
DISHWASHERS RAIN DRAIN (ft) • '
Remarks: Restaurant TI
Owner: — _- - - - - -- — FEES
L AND M DEVELOPMENT CORP_ ty "pe - amount . by date recpt - - - -
3335 PARK DRIVE PRMT $ 96.00 CTR 06/14/95 95- 266755
PLCK $ 24.00 CTR 06/14/95 95-266755
COLUMBIA CITY OR 97018 - 5PCT $ 4.80 CTR 06/14/95 95- 266755
Phone #: 397 -0779
Contractor: — - --
MYERS '& SONS PLUMBING, INC.
6024 SW JEAN RD. 9 BLDG. F SUITE 170
��i LAVE OSWEGO OR 97035 _ --
'. Phone #: 684 -6602 $ 124.80 TOTAL
Reg #..: 40.389
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 I n s p e c t i o n
applicable laws. All work will be done in -ccordance with
approved. plans. This permit will expire if ork is not started
within 180 days of issuance, or if work is su- ended for more
Iran 180 days. .
/, .
"Fermittee Signature: �, /' . /��_ _
I Issued By: /..., �. , 1
Call for inspection — 639 -4175
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.City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. - Wit �� D Permit # 4'LM qs -Qo`a
Tigard, OR 97223 J
(503) 639 -4171 4- W13 e ', r 5 014
Meer * MINIMUM 25.00 PERMIT FEE + ST. SURCHARGE
NaTe of Development New Single Family Residences Only
7)-0 5 4?4,.1- -L.4.2 3 CF..
ess � ,� l�^I �� - CI BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job nea 'lq( c SVv UV�� CI 3 BATH HOUSE $225.00
Address wostata aP /' Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
Name (a naAe of B1°feaa) FIXTURES QTY PRICE AMT
Sink c� 9.00 y T, 0 6
Main) Address Phone Lavatory , 9.00 9, 00
Owner Tub or Tub /Shower Comb. 9.00
City/State D' Shower Only 9.00
Water Closet 9.00
Na1e (n ntlAe of business) Dishwasher 9.00
Garbage Disposal 9.00 •
Occupant maim A°d °° Phone Washing Machine 9.00
Floor Drain I 9.00 900
smite DO Water Heater -1 9.00 9 ^c
Laundry Room Tray 9.00
Name 4 S-6)--- Urinal 9.00
Other Fixtures (Specify) 9.00
M.-Q..1r _- - _ - Mew Address Phone 9.00
Contractor
9.00
utyrState DP 9.00
Sewer 1st 100' 30.00
State Repeatratwn No. City Bus. Tao No Sewer - ea. Addit. 100' 25.00
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
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti - Pollution Device 9.00 1 �
Signature (owner or aped) Data Any Trap or Waste Not
Grcn
Connected to a Fixture "Nei() 0. 9.00
Describe work new 0 addition 0 alteration 0 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 backfiow prevention
devices 15.00
Proposed use of
building or property
°(Except residential backflow
I
prevention devices) /,
NOTICE *Minimum Fee $25.00 SUBTOTAL / v ) D Q
PERMITS BECOME VOID IF WORK OR CONSTRUCTION �
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE / 1 Ka
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED _
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS e o-o
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL qq
TOTAL 1 /- 4
Special Conditions 'L.-:r 1 _ ��:"�i /�
/ qf I l') by ak.
== = Ti! ) Date issued
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