Permit r• � C��OF TI .
' lsOMMUNITY DEVELOPMENT DEPARTMENT .
13125 SW Hall; Blvd.' Tigard, Oregon 97223.8199," (503),639- 4,171_ - - : '
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_ - - _ - - �- , "u. _ •
" PLUMBING' PERMIT `
, 'PERMI1 4... . . ''PLM93- 1u��- •
• 639-4'171 • D(T i SS JED: s l6 /a9 -/9?, :
-,.
SITE: „ADDRESS. . s 09300 SW WASHINGTON SGIUc- RE 'RD, , ,•. � '-PARCEL': 1 S 12Bi , C -1 1 -4@?, •
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SUBDIVISION N • ' LONN4I i\IG o L -G ,
i;LOC;•. .. . „ - •LOT o , ,
7,'1/47-31,--P18,0'.-OF' WORK.., .,ADD ' ,' :,f. ARBAGE-'. DISPOSALS.. ' d' =1CB'ILE I HOME . SPACES.. ,
- i".Yp' • OF 'USE.... ,;.CO! .WASHING- MAMA.' . ,BLACKFLOW PREVN�TRS. _, --
" OCCUPANCY'- ''GRP; . e E'.= • - .FLOOR DRAINS.; .'... , . :TRAPS— . ... , . ,
STORIES . , . t 2,.._,,L. - WATER HEATERS..... , . • CATCH Bi-1S I NS.. a , ' . •
', • F- X T URES- -,- <.- -,__ - -- "_•` LAUNDRY Tf.AYS. •. • ... , SE •F:AIN DRAINS.... - .;
SI•NKSe ".. URINALS... e .".. n o . " GREASE TRAPS. E
_ • i'_.AVATORI S. .. OTHER • �= I XTURES.. - -: . ' ' . .
1UB'%SI- HOWERS SEWER LINE (ft.) -
WP i'ER, • CLOSETS. a . WATER LINE ( ft) . ,
DISHWASHERS.. e - ; RAIN DRAIN (ft) .. f - ..: •
' - 'Re,marki.s Add second' stor =y" I to e->< I,st'ing •bIdg9 add exits, add Lir'i ge "to pr kg. ;l
Alterations to rain drain =_ysten to aco•oincidate new, constri'cti,on. .
.; Oiwn e r."q 7 - :
: '. -- - =. — —._
. — _ . ' FE -- .--- - -• - --
• ' ;:MA'?• T.SEP, iRT�IENT 'STO'RES r,
-_. t - � FEES --- -
' '••-e -.''•amo-unt .,r` ; by � e ' �c
rec_vt ,
,6 OL I V'I_ -471 . ; , - - , r PRM , 30, > ) Jr •, Ie�•. 2') / 93 _ 3- -2.4 ; - -
- PLCK - - . 7.5 'JF; '. 0h/29/93 93- 24'2
S�T , LOUIS ` MO. 6316'1 _ • 2 -, - PCT $ •. '1.: Jr' 17.i0 /29 /93 93- '.242 .'
Con1tr•';.tur,_ -i= . - -•- •
3 9r35;" SE ASH ;
1 ' 9721€" - -- - -- - - -
Phone e # ... „ : 'u.. 3 ..t�1 +Z' :7C1 'T�L` .. ^' . . • • r e 4i ,.. 12857 ". . :
J
-•- " REGU I RED'' - I NSPr CI ONS •
'Tnis percit is issued, subject• to the reguiations cci,taireo in the Ro ugh- in Insp 0
Tiu'srd "i;unicipal.Code, Stst•e cf Speciialty:Cades''anai al.l `other T,op- n - u-it Insp '.
- _
"- , a pplica�ble' laws.. 'A11 Hcrk i.1�1- be'`done in 'accordance, witir�` .Ra'i�n Drain •Insp °� ,•— _ ;
-' . appr'ue'ed ,plans: This per mit -il•1 • e>;ppire If hark i5 rint, Stai'ied" z. - • ' Final I n s pe c t ion .. '
r within• i'ECk; days of ;' • s5uance, or if work. is suspended for care , _ -_
than i8' +Jays. • - -
.Per iitte'i , Si g - "« P .. ■
i -s 5 t_t'E? d1 .J - yJ a' - -
`;• '`- � ,__.. , ' _ .. ,,,'.,'Ca'l
., 'Cal�1 ..f'or :i'n - 639--41.7 - _
•
city of Tigard PLUMBING PERMIT Planck/Rec. #
131 S Hall Blvd. APPLICATION Permit # -®lO.S •
Tigard, OR 97223 .
(503) 639 -4171 r -
Novo el C000 Oopoon, rf L �� 51-- Re? Description ORS 814 -21 -610 I QTY I PRICE I AMT
Job J?� s'�l Wad) el FIXTURES
Address n.. Sink 7.50
Lavatory • 7.50
"`"'t« "'"' of Bi..wa Tub or Tub/Shower Comb. 7.50
Shower Only 7.50
Ma"g Minns ""0A Water Closet 7.50
Owner Dishwasher 7.50
`'`S'"' zP Garbage Disposal 7.50
Washing Machine 7.50
N"" t« "`" Cl °""
''t Floor Drain 7.50
��ro � _ /
. Water Heater 7.50
P"p"
Occupant Laundry Room Tray 7.50
Urinal 7.50
"" zo Other Fixtures (Specify) 7.50 '
7.50
Name
7.50
A *'r 01 7.50 Pilaw
. 2 9!2S MISCELLANEOUS
_. Contractor _ moo" .._
Sewer 1st 100' 30.00
$ W, Rocostaoan N'' Coy Bus. T" No. Sewer - ea. Addit. 100' 15.00
Water Service 1st 100' 20.00
I hereby acknowledge that I have read this application, that the Water Service ea Addit 200' 15.00
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 I Storm & Rain Drain 1st 100' / 30.00A/
am registered with the Construction Contractor's Board, that the number Storm & Rain Drain Addit 100' 15.00
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 7.50
s°'"°" ta++w °f vox) o "' Any Trap or Waste Not
Connected to a Fixture 7.50
Describe work new Q addition 0 alteration repair 0 Catch Basin 7.50
to be done residential Q non - residential 40.00
Insp. of Exist Plumbing per hr
• 40.00
Specially Requested Inspections per hr
Existing use of Rain Drain, single family
building or property dwelling 15.00
Residential baddlow prevention
devices 15.00
Proposed use of
building or property -
'(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL 30,170
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5% SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Ir SD
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25% OF SUBTOTAL 7 J
COMMENCED.
TOTAL 39,0
Special Conditions
Date issued by
M/PtLJMBPMT
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