10967 SW HALL BLVD I
0
rn
x
r
r
tz�
r
10967 'W HALL BLVD --
CITY OF TIGARD
�,. DEVELOPMENT SERVICES PL._IJMBING PE=RMIT
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : PL.M97_0151
DATE. ISSUED: 04/29/97
PARCEL..: i S 135AD-02500
,ITE: ADDRESS. . . : 10967 SW HALL BLVD
!:UBDIV1..SION. . . . MtrTTLGER ACRE_ TRACTS ZONING: R-1t=:'
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :6 ,JURISDICTION: TIG
------------------
CLASS OF WORK. . : REP GARBAGE DISPOSALS. : 0 MOBILE FiOME SPACES. - 0
"TYPE: OF USE. . . . :SF WASHING, MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
(')CCUPANCY GRP. . :P3 FI.00R DRAINS. . . . . , . 0 TRAPS. . . . . . . . . . . . . . . 0
c1TOR J ES. . . . . . . . . 0 WATER HEATERS. . . . . .. 1 CATCH BASINS. . . . . . . . 0
FIXTI.JRE=S---.__.____._.__.____._. LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINf . . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . . 0
I...AVATOR IE:S. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . ; 0
DISHWASHE::RS. . . . : 'A RAIN DRAIN (ft) . . . : 0
Remarks : Replace water' heater- with like--kind.
Dwnwrs ___.____-.___._______._.___._.____________.___.__________.__.___.-•- FEES -_.._._---_----_..-
I ARRY THOMAS type amoI.Ant by date rer_,pt
1.0967 SW HALL. BLVD PRMT * 25. 00 DRA 04/29/97 97--293880
-11GARD OR 97223 SPCT $ 1. 25 DRA 04/29/97 97- 293880
Phone #:
EX e F
GEORGE MORLAN Pl-UMBING �*�
5529 REr. FOSTER RD
*SEE ALSO MORI-AN PLUMPING*
PORTL..AND OR 97206 ______-__.___________________-_-_-_-_._._..
Phone #: 771-1145 $ 26. 25 TOTAL_
Reil #. . 002007
- ------ REQUIRED INSPECTIONS)
- -- -- -
This permit is issued subject to the regulations contained in the Mi sc. Inspection
Tiqard M•inicipal Code; State of Cre. Specialty Codes and all other Final J n s rest i on
apnlicable laws. All worl; will be done in accordance with
approsed plans. This permit will expire if work is not Started __—
within 1110 day-, of issuance, or if worN i; suspended for more
than 18N days.
Perm I tte
'gall fcr inspection -- 639-4175
CITY OF TIGARD Plumbing Applicatio�-t RecItic
13125 SW HALL BLVD. Commercial and ResiderJal CateRece L'I
_.—
TIGARD, OR 97223 ` 1 � C � Date to DST
(503) 639-4171 1 � � 1 -� � " Permit s P01
Print Or Type Related SWR is
Incomplete or illegible applications will not be accepted caned`- �=
came of Ceveldpmenuf'oleci FIXTURES (Individual) QTY PRICE P.MT
- Sin' tr 900
Job Lavatory 9 00
Address Street Address Suite -
i , r. 1 = - Tub or iublShower Como 900
r3ldq a r City/State Zip Shower Only 300
�t Water ;loser 9-00
-Name Dishwasner I 9.00
Mading Address l Suite Garbage Disposal I 9 00
OwnerNastnng Machina 9.00
CitylState I ---Vp Phone Floor Drain 2 9.00
3• 9.00
i� Name y• 9.00
I
Occupant MaiMrtq Address Suite `Nater Heater 4.00
Laundry Room Tray 900
C,ry/State Zip Phone llnnal - 9
w _ Other Fixtures(Specify)- 9.00
Name
- - -- — - -
1 Contractor %jailing Address Suite 900
i 900
Gty15tate Lp Phone
9.00
Oregon Const.Cont. Board Lic a Exp.Date-- _____._-_--- __
AraeA CIO"of 900
ctarrvnt Pkrrnbmg Lic.0 Exp.Date Sewer- Is, 100' 30-00
Llcenwea �r�„',/I/7, _ v Sewer-each additional 1C0--- - ZS DO
SOT Bus ness Tax or Metro o y Exp.Date Water Sernce• 1st o00 - 3000
Fame
Water Service-each addiuonal X00' ^� 25 00
f _ Storm S Ram
orm dram• tsl 100 3000
Architect _
adirq Address a StS Rain Crain• each additional-1-00' --t-4-
25 00 —1
I or ��---- Mobile Home Space -500 I
Engineer I ryvState Zip Phnne Commercial Back Flow Prevention Device or Ain-
Pollution Device
�5;;s rba work New 0 Addition O Alteration O Repair a Residential Backflovr Prevention Cewce' I 15 00 -�
b be hone. Residential O Von-residemial O _ Any Trap-,r'Naste Nit Connect”to a Fixturo 9 00
Additional d rsart:unn of work i Il Catch Basin - 1-3 CO
jc ' /?Cal fir_;v Yr/ G'(fl�ryl In- of Extsbrg Plumbing I I +0 00
rrl „ l 1 ri pt's oerrhr
�- Sceaany Requested!nspec;xns I a0 90
oenhr i
xWdkq it property __ --- Rain gain single'armty mvenmg =0 z0
proposed use of Grease Tracs r I 3;o I
i building or property _, — — CUANTITY TOTAL
Are you tipping. moving or reolacmg any fixtures? Yes J1 No 7 Isemetrx x nser�ugtyn s recuvtC.f Cuarrty Tcis 9 —
(t( es see back of form! 'SUBTT OTAL
I hereby acknowledge;hat I ha,,e read this application,that the information -- "- SURCHARGE
given.s :orrect.tnat' am the cwner or authonzed agent of the owner and "0
flal Nans submitted are n cgmonance with Oregon Slate Laws. - PLAN REVIEW 25% OF SUBTOTAL
5ignsura of Owner Agont Date ecurrd orifi a nture ity roar s>
----_ TOT A L
ontact Person Name Phone Minimum pamht fees$25• 9".surcharge.excRot Residential Backflow
Prevention Cevice.which is S15 • 5%surcharge
__- - '.dstslolmaop dor 8196
PL,�,: C O M l� Ll� g?30 P�1AI4_?�Q,�QCT:
Fixtures to be capped, moved or replaced Qty
S i n k
Lavatory -- ----t
Tub or Tub/Shower Combir::tion
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine --_
Floor Drain— 2"
Water Heater _
Laundry Room Tray _ — _—
Urinal
Other Fixtures (Specify) —_
COMMENTS REGARDING ABOVE: