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_9180 SW BURNHAM STREET
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMI'f
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : PL.1197-007,',
DATE ISSUED: 02/11/97
PARCEL.- 2SI02AC,-.00200
rTE ADDRES ', 09180 SW BURNHAM ST
SUBDIVISION. . . . : BURNHAM -1"RA(.,'T ZONING: CBD
BLOCi/.. . . . . . . . . . : LOT.. . . . . . . . . . . . . :2
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES.
TYPE OF USE. . . . :COM WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :M FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . .
STORIES. . . . . . . . I WATER HEATERS. . . . . . T CATCH BASINS. . . . . . .
F1 --- LAUNDRY TRAYS. . .. . . : 0 9F PAIN DRAINS. . . . . :
9 1 NKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . .
L-AVATORIES. . . . . : 0 OTHER FIXTURES. . . . : I
TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 300
WATER CLOSETS. . : 0 'DATER LINE (ft) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks; : Installing water,/nil sppar•ator, and sewer, line. 1-15fl permit 111-220-1 ff!
r
industrial waste management. Connecting to USA intpreeptot,. Final approval
.'11bJect to payment of additional E110' s if any.
Owner,: ----------------------------------------------------- FEES
F;1F'VFNS MARINE type amount by date t-eept
9180 SW BURNHAM PRM1 $ 98. 00 JSD 02/11/97 97-290253
r,ixiN s 24 90 JSD 02/11 /97 97-290253
TIGARD OR 97223 `:'PCT $ 4. 90 JSD 02/11/97 97-290253
rifi(irle #:
Contractors --------------------------------
MYERS & SONS PLUMBING
6024 SW JEAN RD, BLDG F
LAKE OSWEGO OR 97035 ----------------------------------
Pf-ione #: 684-6602 $ 127. 40 TOTAL
Reg #. . : 040389
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough—in Insp,
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All *orl, will bo done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within IN days of issuance, or if work is suspended for more
than 180 days.
4L
')-mittpe Sig 'Ar
Sued LA
C--.11 for inspection 639--4175
I! �� LI�yL'S`1•f
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # �/'���
Tigard, OR 97223 ,
(503) 639-4171 ` 51 G� �� " 001
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
".-°'Do."iw" New Slnule Family Residences Only
'f— ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE $195.00
Job C- ?�' 1 \ _ IL ❑ 3 BATH HOUSE$225.00
Address cMle.". m Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and stone sewer. See fees below.
FIXTURES QTY PRICE AMT
c t�l C K`' Al2-1 L Sink 9.00
M."AM... Pear Lavatory 9,00
Owner LI- Jks i-1�% Tub or Tub/Shower Comb. 9.00
w Shower Only 9,00
Water Closet 9.00
Dishwasher_ 9.00
Occupant �a�Adt Garbage Disposal 9.00
M &— '"°"' Washing Machine 9.00
Floor Drain 9.00
"`"""' ZIP Water Heater
9.00
Laundry Room Tray 9.00
"""" Urinal 9.00
N C '` q _ _t,:jS }�J�2{� -(��(1 Other Fixtures (Specify) 9.00
Contractor M."Ada... ` Ph— vo r"TFZ 1v ' Tj j, 9A0
LC 1A_ S Irl 9.00
crown.
A. —
9.00
(� (-'�, Sewer 1st 100' 30.00 c c
°f'"°' To"° Sewer-ea. Addit. 100' 25.00
Water Service 1st 100' 30.00
I hereby acknowledge that I have mad 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 1 Mobile Home Space 25.00
Back Flow Prevention
Device or Anti--Pollution Device 9.00
Any Trap or Waste Not
_ _ Conne=ted to a Fixture 9.DO
Describe work new ' addition 0 alteration,.O repair O Catch Basin .00 <'
to be done residential O non-residential 9
Insp. of Exist. Plumbing �— 40910
Specially Requested Inspections 40 001hr
hwIding use of Rain Drain, single family dwelling 3000
bedding cr property — --�--�-_ 9 IY 9
Residential backflow prevention
devices 15.00
Proposed use of
ruulding or property
!-- '(Except residential backflow
prevention devices)
NOTICE. *Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION II
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%SURCHARGE
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
Saecial Conditions --"
Date issued by
Tenant Name: S MPAP�i Accumulative Sewer Tally This SWR#: PtMg7-003ff-
Address: 1M chis PLM#:
Fixture Value Previous # Previous Credits Capped Rxtures Rxtures New New
Value Capped oft value added # added total #s total
Count Oft#s count value values
Baptistry/Font 4
Bath - Tub/Shower 4
Jacuz/Whpi 4
Car Wash-Each Stall 6
Drive Throuqh 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest _ 2 1
rT
Drinking Fountain 1
Eye Wash 1
Floor Drain/sink 2 inch 2
3 inch 5
t7
4 inch 6
Car 'Nash Drain 6
Garbage Disposal 16
Dom (to 3/4 HPI
Comm (to 5 HPI 32
Ind (over 5 HPI 48
Ice Machin-/Refrigerator Drains 1
Oil Sep(Gas Stationl PMQ-B y 6
Recreational Vehicle Dump Station 16
Shower-rang(Per Head) 1
_ Stall 2
Sink Der/Lava;orv__ 2 � a,
Bradley 5
Commercial 3
Service 3
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
Water Closet. Toilet 6
Urinal 6
TOTALS I�7�
Total fixture values: divided by 16 = EDU
HISTORY
9� r - .
HISTORY c Gt O to+�r �'r/ia/ttdc�. wryL� G'�l c� �-kAA
_
PLM# Z "ROOM`S # SMMIC90 FILM PLM# EDU SWR#
PLM#17..p034EDU# C SWR#q,—QG � PLh9# EDU# SWR#
rtm# EDIT# 6WR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
SEE 35MM
ROLL# 22
FOR
LARGE
DOCUMENT