Permit •
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT •
13125 SW Hall Blvd. Tigard, Oregon 9722348199 (503) 639 -4171 /'_ G PERMIT
PERMIT - . o ..... P LM9 5 -0 :10G
639-• -4171 DATE ISSUED^ 05/25/95
• PARCEL, PARCELP 1 S 1260C -011 i
SITE (DDRESS. o . o 'x^647 SW WASHINGTON SQUARE RD
SURD =VISION° ... o ZONING C —G
L� C
r o . o o a u o a a o o. o 0
CLASS OR /. T CAR E D I CP SA iro n s E 1 r E GPP EG
OF �hl�I "i��v u vi'1i�r 1... �"l.:A.�1 -i�l_. L/yvrl.JJ.-If_Se u o �yr l.r!`�t. L6.: 17iJ 1'li �7YY- ICL.Jn n
TYPE CF USE. o a o gCOM WASHING MACH„ .... o ° o BACRFLOW PREVNTRS.. a
OCCUPANCY G RP. a aB2 FLOOR DRAINS.... a e e ,. o?
STORICSoovavoaoo2 WATER HEATERS......o1 CATCH BASINS......
FIXTURES- --' - -' LAUNDRY "RAYS. o. e. c u SF RAIN DRAINS.....:
CINKSoe000v000. 11 URINALS............: o GREASE TRAPS..--g
LAI T R I XTURES�
s.- ,IC ^a�So,e�, o OTHER F �ooe
TUB /SHOWERS.. e s o o SEWER LINE (ft) v o o v o
NA ` 1 TE C CSET2 1 1 TEn v IN= ; -
TER LM ET 1 0 0 o W:A rr ' G.t Y �I,..l �v.: •I L 7 u u o o u
DIrSPWASi i 1 E - 1 " • S o u u c RAIN DRgIN (ft) . .. o u °n •
Reli] .:''ks a TI for rood court r•estaurarit
Owner --- •--- •--- • - -• -- - - --- - - -- FEES _
"T
r .
L ype riourlt by date rec
2269 PRMT 126.00 JD 05/25/93 95- 265832
• X11- 1 r,� r' 5 i •-.r_
�.d_ ,orlai.0 r ac c+ ,
PORTLAND OR 9723 PCT $ 6.30 3D 05/25/95 95- 265382
Pihi:1i;cy :r 2B3 -5272
Cont i''act or - - --- - -- - -. - - ---
PURE PLUMBING
1350 , LEW I S ST. , SE •
SALEM OR 9730= .. . y _._— •--- .- __.____..,_.__
Li ' TOTAL
Reg { -o o d 71677
REQUIRED INSPECTIONS __-- ._ -__•
This pe'ci; is iaseed subject to the re iatioris contained' in the Final I n spG� i cn
Tinar�
Nunicipal Code, State of Cre. Specialty Codes and all other
app.izatle laws. Ali '.ark :;iii be doe- 17J accordance with • ` •
approved plans. This peroit will eripir•e if work is iiot started
4th in leo days of issuance, or if 'f): i{ is =;.Spa: dei: fix rte
then m days. .....__ _. _
•
Si - oi:elt i' E 4y(! __ �_,_
•
Issued TA/ •"'
Call for inspection — 639 -4175
•
•
•
•
City of Tigard PLUMBING PERMIT APP CI ATION /P an k/Rec. #
13125 Hall Blvd. °fr
Tigard, OR 97223 � d � 'y���ti� 2' � P rmit # �QLM °lS-Oloa
(503) 639 -4171 `)1 P'
INIMUM $25. 0 PERMIT FEE + ST. SURCHARGE
�; y F2 ,9 a.n c��� 6 /�' New Single Family Residences Only
�� (_ ❑ 1 BATH HOUSE $140.00 ❑ 2. BATH HOUSE $195.00
;IV `� ❑ 3 BATH HOUSE $225.00
Address caT/sme an Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
"""° (°'°"° or Busmen) FIXTURES QTY PRICE AMT
Sink , / ` 7 9.00 a 7
Mean° Address P'°"° Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
CIN/State ZIP Shower Only 9.00
Water Closet 9.00
Rune (« name at busmen) Dishwasher 9.00
Garbage Disposal 9.00
Occupant Haft Ado. Phew Washing Machine 9.00
Floor Drain // 2... 9.00 / q
ca,' /SVte z4 Water Heater / / 9.00 9
Laundry Room Tray 9.00
Name Urinal 9.00
v`k_ Pl , l 5 , 41 Other Fixtures (Specify) 9.00
ctor Melling Mamma - 3'ot -�bq3 % op 5 c 114111 '7 9.00 6 3
1 So �,�,, �, e� Sim 1 9.00 I'
ray /Shoe ZIP 9.00
50 \lr.r' j O 3 O a Sewer 1st 100' 30.00
State Registration No. ON Bus Tax No. Sewer - ea. Addit. 100' 25.00
�--.."." 1 I - VA 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
Signature (oenet or agent) Date Any Trap or Waste Not
Connected to a Fixture 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 backflow prevention
devices 15.00
Proposed use of
building or property
°(Except residential backflow
prevention devices)
/,‘
ad
NOTICE °Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION .3 v
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE '
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED Sc.)
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL ( " s )
Special Conditions ce _ - � � ‘
D
Date issued by
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: 64.,.104.-5 1-1./a....—....
Footing Seiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Pumb
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: 7 - / / 7 ime: AM PM
Address: 9 .L 1 / td,/e.—
Builder: Permit #: 7S / cr
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Ins ector: '� Date: < ,zt_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.