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Permit r= - CITY OFTIGARD •• • . . .COMMUNITY DEVELOPMENT DEPARTMENT .13125 SW Hall Blvd. Tigard, Oregon 97223.8199 1503) 839 -4171 PLUMBING PERMIT . PERMIT # : PLM95 -0167 639-4171' . DATE ISSUED: 07/24/95 • PARCEL: 1S1260C -01107 SITE ADDRESS..,: 09469 SW. WASHINGTON SQUARE RD SUBDIVISION.... 1 ZONING: ,C-.,G ' • . BLOCK LOT ° • CLASS OF WORK. °:ALT GARBAGE DISPOSALS..: - MOBILE HOME SPACES.: TYPE OF USE ' °COM WASHING'•frU CH ° BACKFLOW PREVNTRS...: OCCUPANCY GRP•.:B2 FLOOR DRAINS TRAPS...• ° ......... : STORIES...•.... :1 WATER HEATERS • CATCH BASINS• FIXTURES LAUNDRY TRAYS.......: • SF RAIN DRAINS.....: SINKS ..c.' URINALS • GREASE TRAPS ° LAVATORIES.....: - OTHER. FIXTURES ° • TUB /SHOWERS SEWER LINE (ft) .. : WATER CLOSETS • : 1. WATER 'LINE (ft) ° DISHWASHERS • RAIN- DRAIN (ft) • - . Remarks: Tenant Mod: Health Haus, interior work only. remove 2 sinks and 1 R1 and reinstall same • • • Owner:_ •- - FEES - -- HEALTH- HAUS type. amount • by date recpt 9469 SW WASHINGTON SQ PRMT $ 27.00 JD 07/24/95 95- 268397 ' PLCK $ • 6.75 JD 07/24/95 95-- 268397 TIGARD OR 97223 5PCT $ _ 1.35'JD 07/24/95 95- 268397 Phone - #: • Contractor: , ARRIS CORPORATION . 4795 NW 191ST AVENUE PORTLAND OR 97229 . , . - Phone #: $ 35.10 TOTAL , Reg #..: 58909 • ' - ' • REQUIRED INSPECTIONS • This permit is issued subject to the regulations contained in the . Water L i -n e Insp• • Tigard Municipal Code, State' of Ore. Specialty Codes - and all., other Rough-in Insp applicable Laws. All work will be done in accordance with Misc. Inspection approved plans. This permit will expire, if work is not started, Final i n s p e c t i o n ' within 180 days of issuance, or if work is sp:nded f ., sore . than 180 days. . ' . 411 ' il - Perm itt.ee Si ■,= 1-..re: :r - 1 _ � • - �' • Call for inspection L•639- 4175'' . • 5�� 9r_ O t. City of Tigard V PLUMBING PERMIT APPLICATION . la ck/Rec. # 13125..SW Hall Blvd. y � 2 s (N $ \ 0NG ?. 1 . Permit #A02 � Tigard, 97223 ���,�A� -� Sr 14, - c,- •�.4m tg , ° . 1 ' � / G (503) 639 -4171 2 vy ii I v) ; / �^''`` INIMUM $25 00 2 FEE + ST. SURCHARGE Name of Development J4 i 4 144‘.23 ew Sin • le • mi Residences On Z O ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00 Job 9 Li tO 4 to4A S AP ❑ 3 BATH HOUSE $225.00 Address Wslete nP Fee includes all plumbing fixtures in the dwelling and the first 100 feet r D�� J q7 22.3 of water service, sanitary sewer and storm sewer. See fees below. Name (at naAe °' Somas) FIXTURES QTY PRICE AMT 1.4..1/41/4)-isyl, oz. Sink 2, 9.00 Madre Address °2" pfi0m0 Lavatory 9.00 Owner 7 19 x44 4-11 ?.(ctb�� � �3 ys� Tub or Tub /Shower Comb. 9.00 atwgate ro Shower Only 9.00 . z j -77.-6" /cC4 Water Closet ( 9.00 Name (or name el busman) Dishwasher 9.00 ) 4L -1- 6 Lam-/-( 1-1k0 Garbage Disposal 9.00 Occupant maim A°°°° 310° Phone Washing Machine 9.00 10 / E- 0 &A : 1 ( t - 7S3 Floor Drain 9.00 Csy's'°te ZIP Water Heater 9.00 V&s... , . ( /86(00 Laundry Room Tray 9.00 me Urinal 9.00 Aep,IS C I?4 , Other Fixtures (Specify) 9.00 MaBp Address Phone 9 Contractor X5 5(-3_9 -33 c7 //41- 9.00 Cily/Stnt° e/ � Z , 9.00 4'o 2`( L.4 r 9 q Sewer 1st 100' 30.00 State Regadnaaon No. City Bus. Tex No. Sewer - ea. Addit. 100' 25.00 ©. [f-f 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 ..-16e-tTht-‘121)&J Back Flow Prevention ��� /65 ` Device or Anti-Pollution Device 9.00 Sp nature (game, or agent) D ate Any Trap or Waste Not X 4t'r -7 Connected to a Fixture 9.00 Describe work new 0 addition 0 alteration repair Q Catch Basin 9.00 to be done residential 0 non - residential 32( Insp. of Exist. Plumbing 40.00/hr Specially Requested Inspections 40.00 /hr Existing use of building or property d )1, g . Rain Drain, single family dwelling 30.00 Residential backflow prevention devices 15.00 Proposed use of ,2 building or property �eTO / L `J 2 '(Except residential backflow prevention devices) NOTICE 'Minimum Fee $25.00 SUBTOTAL 27 r 5 PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 1 CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25% OF SUBTOTAL / 75 COMMENCED. L 3 S'" / TOTAL Special Conditions /°1 ( ;� Date issued /� b y or •