15779 SW 87TH AVENUE r.
ADDRESS.
16779 -S 704AV
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CITY OF T I GAR®
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
1::41-1194 »0 W 7,
T L ISSUED 05/19/94
710RCEI-.- 2C3JA.1Dl) 14400
SITE ADDRESS- -n 15779 13W 871-1-1 OVE
SUEDIVISION. . . . : MILIMONT PARK ZONING: R-7
BLOCK. ,. . . „ . ,. . a LOT. . . . . . . . . . . . . 01.
---------------------------------- --------------------------------
CLASS OF WQRK. . v0DD GARBAGE DISPOSALS. . s MODII E H 0 11 k- :>PA C EIS
FYPE OF USE. . . . :8F WASHING MACH. . .. ,. ,. ,. . : DACKFLOW PREVINITRS.
OCCUPANCY GRP. . Uml FLOOR DRAINS. .. . . .. . . ;; TRAPS. . . . . '' . . .
STORIES. . . . . . . . : I WATER HE . . . . . . C 0 T C11 B AS I N S. .. -, . - ..
FIXTURES------------- LAUNDRY TRAY:. ., „ . .. ., SF F 1--i A 111 1)R()I N�4
SINKS. . . . . . . . . . .. URINALS. . . . . . . . . ., ,. .. G[',EASE TRAPS. .
LAVATORIES. . . . . OTHER 1::JX'T(JRF-S.
I LJD/SHOWLRS. . . SEWER LINLi
WATER CLOSETS. . ,. WA T E R 1...114
DISHWASHERS. . . . 1:4111A DRAIN 1.00
Remarks: NEW ORAINAGE SYSTEM FROM ARUUND HIJUSE INTO 11101,11101-Aii. NEED 3)TREET OPENJ:
NG
PERMIT FOR WORK DONE: IN r-',UBLTC RI(.',*HT..-OF*-..WAY
Owner: FEES .......-----
BETTY CARLSON type AMOLO-It by (Jz.%te reept
1577. SW 8iQl ORMT $ 30, 00 J0 05/19/94
5PL,"Y $ 1. 50 JG 05/19/94
TIGARD OR 912d4
Phone On
Contractors
!tl-[-'S'ON & OLE-SON CON!:JRUCTIOP
1.5405 SW PLEASANT VOLLEY RD
DEAVERTON OR 97007 -----------------..........
4hane % $ 31. 50 TOTAL
keg H. . N 26266 REQUIRED INSPECTIONS ------
]his permit is iesued subject to the regulations co-itained in the Rain Drain Insp ...................
Tigard Municipal fide, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. all work will be done in accnrdance with -------
approved plans. This permit will expire J worl'. is not started .................
within 181 days of ismane, or if work is suspended for more ...............
than 180 days. ..........
...............
....................
r'-('1Jqttee Signature. tlece-!.Ca'z*"
ned By:
Call for inspection 639-4175
City oiiigard PLUMBING PERMIT Planck/Rec. #
13125 3w Hari Blvd, APPLICATION Permit # —
Tigard, OR 97223
(503) 639-4171
'"• escnption
ORS 814.21-F 10 QTY PRICE AMT
Job /-S- 2 �� ,S ? FIXTURES
Andress - - -- —
^" Sink
lavatory � ^�.�
4M a NYT �'7 u or u Ower CoIIIb. /..50
i7 r-�� �•z�o �� Shower Only - 750
Water Closet
7.50
Owner 7U`slwasher —
DID ge Disposal — 7.50
-
�t as ing cine
.M iwr or Drain
Water Heater 750
Occupant «. u ryAoom--Tray- -'7
_ nna
T 7.50
77xc 7.50
MISCELLANEOUS 4
Contractor �q
�� P r•../ ` L.,� `J.7 U U i wee TstTm.
'"/— •• war• ar,�rTdt fbS--
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-tit(
afar vi'ce`i-st�bi
re y ac .owthat I have read is app ica ion,that the -Water Service ea. Addit. 200 15.00
intornation given is correct,that I am the owner or authorizea agent of
the owner, 9het plans so'-mitted are in compliance with State laws,that I Storm d Rain Drain 1st 1$10' _ 30.00
am registered with the Construction Contra-toy's Board, that the number Storm d Frain Drain Addit. 100' 15.00
given is correct. (If a vempt from State registration, please give reason
belga.) Mobile Home Space 25,00
c ow reventwn —- -
- r ->•' Device or Anti-Pollution Devioa 7.50
• _VnyTra_p or as e
Connected to a Fixture 7.50
Nsmbe wo6 hew Ua tion a terabon _-Catch Basin
to be done reskbritiai non-residential Q - --- ---
- _ Insp. of Exist. Plumbing per h,
Existing use ofl � Specially Requested Inspections per hr
building2 5 �'`- (i er - Rain rain, sing ia5n- y—'
or��� - dwntiing 15.00
-Res nna )ar: w prevention �.
v Proposed use of ' devices
building or property, P
., '(Except resi�nha ac ow
-' prevention devices)
C —
iC.D NOTICE *Minimum Fee$25.00 SUBTOTAL L
-' PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5q6 SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF _
CONSTRUCTION OR WORK IS SUSPENDED OR A13ANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 95%OF SU9TO':AL
COMMENCED.
TO1AL
Special Conditions
Date issued by�-
.au+ar,r.