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11650 SW ANN S'T'REET
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
�- Phone: 639.4171 I
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Type of Inspection ;►'--r-- �
Daae Requested S l-�1.s2 �imQ -_.—A.M:�_.P.IVL
address __— __ _ �ma! Permit # —
Owner —� --- Lot # —
Builder--------�-- -
Yhe follew=ngldinf f..rda deficiencies are required to he corrected:
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Presented to -- — --_— F11 raved
Inspertor _ _--.—. �— —__ �� IVisapp:oved
Date
CALL FOR REINSPECTION
DYES 0 No
cry G":. 'rPGARD Plumbing Permit:
E3uiiding Department
nesidential i�J Commercial ❑ No
New Installation L] Replace ❑ Addition ❑ Altoration EJ
Licensed
Plumber
Owner
Address
Job Address
Phone _ _ ' ' Applicant
CITY BUSINESS LICENSE REQUIRED_F �i 1 ALL CONTRACTORS AND SUB-CONTRACTORS
_ ITEM NO. FEE TOTAL ITEM` NO. FEE TOTAL
F!xtures—Traps _ 7.50 - Sewer:First 130ft,
_
30.00
Dishwasher 7.50 Eac;,Addit.100 ft. --- -- �--
- _ 15.0_0_
Garbage Dispo:,al --_ -- _ 7.50_ -- Ejector Pump ?.50
_Water heater 7.50 v _ Water:Firat 1_00 ft -
` 20.00 _
Backflow Prever,ter -_ 7.50 Each Addit.200 t 00
Storm&Rain Dr i irst 100 ft. _ 10.00
— - --- ---- A Oft. �,��� 15.00
Spa 6��1T_✓�� _ 25.00
Other(specify): _ R ' Drain-Single F wetI ng 15.00
PERMIT FEE �l Comments. —
STATE Issued By _-- -,—
r Receipt No.
TOTAL -_-_._ Applicant,_- • '
- ----- / (er�� eh------------For Plumbing Inspection Phone 1139-4171
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