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11511 SW BULL MOUNTAIN ROAD-1 � r N L' hd t , ii 1 1 I i i i I I 11511 SW BULL MOUNTAIN ROAD CITY OF TIGARD Plumbing Permlt �; .2, Building Department No a 5 Residential ❑ Commercial ❑ New Installation [_] Replace ❑ Addition [_] Akeratior (_] Date l 22' J Licensed �. Plumber "?^_'-4 r01,1 Owner- Address wner_Address �' �,• ? �-+ �i�i%d') I Job Address— /I /� --yt .-t• C. 1. Phone ---��_ r - - Applicant _ ----_ -- CITY BUSINESS LICENSE REQUIRED F JR ALL CONTRACTORS AND SUB-CONTRACTORS _ ITEM NO. FEE TOTAL ITEM _ NO. FEE TOTAL Fixtures-Traps 7.50 Sewer:First 100 ft. - 30.00 Dishwasher 7.50 Each Addit. 1009 15.00 _ Garbage Disposal _ 7.50 Ejecto 7.50 _ Water Heater 7.50 - 100 fL 20.00 .Backflow Preventer 7.50-�---- h 0 _ _ 1500 --_ — Stor _i is First 1 Op ft. 30.00 — dit.200 ft. 15.00 bila Homle_Sp 25.00 Other(Specify): ain_ .in- ing am.Dwell' 15.00 PERMIT FEE Comments: _.,, -- --- - - ----- STATE "1 (� Issued By: Receipt No. Applicant TOTAL -/r'•� Signature For Plumbing Inspection Phone 639-4171 CITY OF TIGARD Plumbing Permit Building Department NO. 3602 _ Residential ❑ commercial ❑ New Installation [] Replace ❑ Add!tIon ❑ Alteration ❑ &p�L'7tg'�' Date_ Licensed � �/� Plumber —, l�r?__�C^ 041_ I►'+j6t Owner 45IN C Ste_- t' Address 7�� u� �� Job Address , S',). An4J.k}1, Phone ----.-.[�-•��[ �Q� _ Applicant - - _ CITY BUSINESS LICENSE REQUIRED FOR AU. CONTRACTORS AND SUB-CONTRACTORS ITEM�_- NO. FEE TOTAL _ ITEM [ NO. FEE TOTAL _ Fixtures-Traps— 7.F0 ©0 Sewer:First 100 ft. _ 30.00 b Dishwasher _ 7.50 Each Addit.100 ft. _ 15.00 AK 00 Garbage Disposal 7.50 Ejector Pump _ 7.50 Water Heater 7.50 Water:First 100 ft. _— 20.00 Backflow Preventer 7.50 _ Each Addit.200 ft. 15.00 Storm b Rein Drain:First 100 ft. 30.00 ` — Each Addit.200 ft. 15.00 _ Mobile Home Space 25.00 Other(Spedfy): Rain Drain-Sf le Fam.Dwel 15.00 PERMIT FEE (+�� Y Comments: STATE % q0 Issued By:-_ _ Receipt No. ��:'� Applk�rrt_ fj-02', A��� TOTAL - �(� --- -- — For PknrA q Irw,v*m Phone ON 4171 INSPECTION NOTICE City of Tigard Building Department 12420 S.W. Main St. Tigard,Oregon 97223 Phone: 639.4171 Type of Inspection � r Date Requested - .Z 8-cTime A.M. P.M. Address -1.1y511 _r� ee'�e" �' Permit Owner —----- -- Lot # -- Builder -__--- —___-_- The following Building Code deficiencies are required to be corrected: ------ ---- Presented to . 'rApproved -- Inspector -- , - --�--- --- __ 1 Disapproved Date (off- L„8-cy 3 CALL FOR REINSPECTION 0 YES V NO !1 SEWER Pk: MIT U Unified Sewerage Agency . of Washington County CITY OF DATE OWNER t - -r. ..S ^ .��A L ,;;,," PHONE OWNER 'S ADDRESSa ~' !��' V. TYPE OF INSTALLATION: ❑ SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP TYPE OF OCCUPANCY: ❑ NEW ❑ EXISTING ❑ SINGLE FAMILY ❑ COMMERCIAL EXIST. (PRIOR r0 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL FIXTURE UNITS DWELLING UNITS ADDRESS OF STRUCTURE , Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency. When calling for Inspection, please refer to the Permit Number The Application expires In one hundred twenty (120) days. The amount paid will be forfeited should expiration occur. The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer Is not Ic...zted at the measurement given, the installer shall prospect three feet in all directions from the distance and dP;:h giver. If not so located, the Installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency will install a lateral at the location specified by the Installer. FEES PERMIT FEE CONNECTION CHARGE LINE SAP INSTALLATION OTHER ISSUED BY TOTAL s APPLICANT --_ _ DATE SEXIER PERMIT ADDRESS OF STRUCTURE TAX MAP `} _ '�_ TAX LOT ^� SYSTEM LOT BLOCK --- OF --- — APPROVED BY DATE ISSUED BY DATE D. U. 'S _ RENARKS 1' INSPECTIONNOTICE City of Tigard Building Department 12420 3.W Main St. Tigard,Oregon 97233 Phone: 6'9-4171 Type of inspection --_— zZ _ Time- - A.M.- P.M. Date Requested -__ — - Permit # AddressOwner - Lot # Builder -- ----- - --- --- — The following Building Code deficiencies are required to be corrected: r - - F'resentrd to __ - - El Approved ❑ Disapproved Inspector - Date - --- - - "' CALL FOR REINSPECTION ❑ YES ❑ NO