Permit •
....CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 '
PLUMBING PERMIT
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PERMIT *.......g PLM95 -0096
• 639 -4171 DATE ISSUED: 05/05/95
PARCEL: 1 S 1 `6 OC - -01 107
SITE ADDRESS...: 09659 SW. WASHINGTON SQ. RD
SUBDIVISION •- ' ZONING: C -G
BLOCK........... • LOT
CLASS OF WORK—:ALT GARBAGE DISPOSALS..: MOBILE HOME SPACES.:,
TYPE OF USE.... :COM WASHING MACH.......: BACKFLOW PREVNTRS..:
OCCUPANCY GRP..:B2 FLOOR DRAINS .1 TRAPS...—. ....... :
STORIES ..... 1 WATER HEATERS......: • CATCH BASINS.......: •
FIXTURES • _- - -._ -- •LAUNDRY TRAYS......: SF RAIN DRf I NS.... .
SINKS URINALS . GREASE TRAPS.......:
LAVATORIES ^1 OTHER FIXTURES.....: • •.
TUB /SHOWERS....: SEWER LINE (ft) .:
WATER CLOSETS..: 1 WATER LINE • (ft) .... s
DI SMASHERS— ..: RAIN DRAIN (ft) ....
Rclnarks: TI
Owner: - -- _.___.._ _. __ ___ - FEES - - -- - - - --
- SAM GOODY C/O STATE PER!q!IT type amount by date recpt
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PRMT $ 27.00 B 05/04/95 -
PO BOX 0224 PLCK $ 6. 75 B .05/1Z14/95; -
KENOSr,A WI 53141
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SPCT $ 1.35 B 05/04/95
Phone tl e 800-432-2597
Contract -------- �_:._---- .___._
ANCTIL PLUMBING
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16900 SW MERLO RD
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BEAVERTON OR 97006 -- -• __ -_. _-
Phone 44:0 642 -7323 35.10 TOTAL
Reg 41: .. o 24184
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REQUIRED INSPECTIONS
This pet' °pit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other _ __
applicable laws. All work will he done in accordance with
approved plans. This pernit will expire if work is not started •
within 180 days of issuance, or if work is suspended for pore
than 180 days. _ . _
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Percis Si nature: 1AAAAA
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Issued By; _
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Cali for inspection . - 639 -4175
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # gill 4g-ilogo
Tigard, OR 97223
(503) 639 -4171
• MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Nam, of p ,� Z New Single Family Residences Only
/ 0 1 BATH HOUSE $140.00 0 2 BATH HOUSE 5195.00
Job 7 652 S e, f.
r , 44. ,ST) 0 3 BATH HOUSE $225.00
Address Waste 6 ��m Fee inductee all plumbing 16cbues in the dwelling and the first 100 feet
1
- S '�... 3 of water service, sanitary sewer and storm sewer. See fees below.
"`°' ( �n 'm' of Selma) FIXTURES QTY PRICE AMT
1
(.J L.v- n.,,-eit...) Sink 9.00
Wing AWN' Rau Lavatory / 9.00 67. t217
Owner o , s' Q,,.� S& 2‘.5.-.0. Tub or Tub/Shower Comb. ( 9.00
°" m Shower Only 9.00
S.Q -d./ CA 1/-9-(' 'J' "' /O Water Closet / 9.00 4.00
1 em (Q °'°" a I Dishwasher 9.00
Occupant '''' �01... (/ Garbage Disposal 9.00
'' A 0 . Rare Washing Machine 9.00
P t) /S / 82 L/ Floor Drain / 9.00 4 &
zo Water Heater 9.00
r SZ l'/ Laundry Room Tray 9.00
Urinal 9.00
t_,Q-01 y, ZSP .P ,,1. Other Foctures (Specify) 9.00
°"°"' 9.00
Contractor / /�
G, DO .S, G.� . 0A15 / r-i-- 9.00
cra-Le--e. a 9.00
t5 9'P0 6 Sewer 1st 100' 30.00
°y Bus Tax "' Sewer - ea. Addit 100' 25.00
Z 4i / j' / 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
? _-,C ) '� 71//3-- Back Flow Prevention
„ >, v 5 Device or Anti - Pollution Device 9.00
so c°"'°' pang My Trap or Waste Not
Connected to a Forture 9.00
Describe work new 0 addition 0 alteration 0 repair Q 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) Z 7,061
NOTICE *Minimum Fee $25.00 SUBTOTAL ( ,
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% '�
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF /01S
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 ' 3S,ID I
Special Conditions
z otetLz
Date issued 4^-67- (S by