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adopted, `he:Oregon i;til'ity Notification Ce'iier. Those !"uies• are? - _.
set soi,th in uRR 352- ; i.- szio 3 R "3 2- iI;7�O1 -I T Z. Vol .' ii. -i, ' ' ; -
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CITY OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd I 1 J 4 q7
tt
TIGARD, OR 97223 r Date to P.E.
(503) 6394171 i3u Pq � -04a"1� Date to DST N
Permit # I�c,l'�'1�7 -6�k31
Print or Type Related SWR # j(,l M..7 -Q 1
Incomplete or illegible applications will not be accepted Called I it (-(- ( 417
Name of Development/Project On back Indicate Work Performed by fixture.
Job lj1)It/I Wre 11- 5Ng- o1s/16-o FIXTURES (Individual) ' - . QTY PRICE„ AMT
Address St dress Suite Sink I 9.00 9f t
� ( ,e ) L) U M M I6V- -. Y) i Lavatory I 9.00 r
Bldg # City /State Zip
POOL Q - ne Q /mi, Tub or Tub /Shower Comb. ' ) 9.00
Name Shower Only 9.00 q.at
et jW e .] rl fJP1 f.0 7 j ICOC Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
11.0 614.1 MD DPI l Garbage Disposal 9.00
City /State Zip Phone
� G
pivibRon a 71 zoo 274 154a) Washing Machine 9.00
Name F Floor Drain 2' Z 9.00 10
74.1/I P.0.7 D4iNI . 3' 9.00
Occupant Mailing Address Suite 4' 9.00
City /State Zip Phone Water Heater 0 conversion 0 like kind I 9.00 q. QQ
Laundry Room Tray 9.00
ame Urinal 9.00
-A-47-A,\11 p L o 1 i/1611.56r / Other Pictures (Specify) 9.00
! Contractor ailing Address _ Suite 9.00
)2;r Zot. rif ST ' 9.00
Prior to permit -- cny/state - - - Zp _ _ P_hnnp
- c,
issuance. a copy .;)75/.�i('I 'GTf'Ll1J►J� � 3FQ - b8 },31 9.00
of all licenses are bregon - Board Lic.# p. Date . r ! !
i f, 7 � • j f , ta t 1, / ()per 9.00
required if ( t 2, -5pl' ' / Sewer - 1st 1 00' , .] 30.00
expired in COT Plumbing Uc. # Ex p. D to' " � C/s -Q.
' Sewer - each additional 100' I 25.00
database ' ' . 2 -(or. rj 7 3 °°�'$ -� Water Service - 1st 100' l 30.00 v -.-
Name
Architect M Glii mial Iiwg. Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' l 30.00 .7
102iz. SJ ' Pt,I4/1ty7.1 ,-D Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
fenn .�� 9 / Si-Z Commercial Back Flow Prevention Device or Anti- 25.00
Describe work ®' Addjtion 0 Alteration 0 Repair 0 Pollution Device I 2.c
to be done: Residential a Non- residential 0 Residential Backflow Prevention Device* 15.00
Additional description of work:
� y � � U 1 1P Any Trap or Waste Not Connected to a Fixture I 9.00 q ..---- ( , pi..Jtiy, /►J 4 Catch Basin 9.00
� Insp. of Existing Plumbing 40.00
(PON N b.q-s oc+t.) r- sits trne4 Sr per/hr
Existing use of / Specially Requested Inspections 40.00
building or property _ per/hr
Rain Drain, single family dwelling 30.00
Proposed use of , Grease Traps ' 9.00
building or property
' QUANTITY TOTAL
. hereby acknowledge that I have read this application, that the information
i 1 . •
Isometric or riser diagram is required if Quanity Total is > 9
s correct. that I am the owner or authorized agent of the owner, and •SUBTOTAL }�
ass subm"t:ed are in compliance with Oregon State Laws. ; ,.1, ' in.
i re of Owned r n Date
Z$-� 5% SURCHARGE G �,1
U, U
'7 person Name Phone PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is> 9
A Jnk» , IL teST f -t N1( TOTAL 114`f6
*Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
ap.coc 5197
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
Capped / Removed Moved Replaced
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:\dststplmapp.doc 5/97
3-R
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 3 A.M. •
Location: l 47 Q W BUP:
Tenant: Poo L H'O U S6 Suite: Bldg: ME t
/ �� 'IF
Contractor. 111,14A II �, t �l . A ill/ Phone: -- — (p a D- 3 PLM: ^ 6 q
•
Owner: 1 Phone: C:
ELR:
SIT:
BUILDING BLDG (con't) ING MECHANICAL ELECTRICAL SITE
Site Post/Beam m Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Sj Dr Heat Pump Low Volt
Approved C Approved J ; Approved Approved Approved
Appr /Sdwlk Not Approved Not A oved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
•
O Call for reinspection CI Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: ! Date: ,Vie)/9A Page of
•
I/