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11455 SW GREENBURG ROAD-3 I-' N lT1 U� S L7 O I i 4 ' i 1 � f r rrr ra 11.455 SW GREENBURG ROAD CIT Y OF TIGARD ON COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERM IT 13125 SW Hall Blvd,Tigard,Oregon 97223.8199 (503)639-4171 1 r #. . . . . . . : BUP(34-0350 DATE IE3SUEDli 12/06/94 A+ P,ARCEL : IS135CD--00400 Tl'.*-, OUDRE5G. 11455 SW GRE ENDURG RD ZONING: ,BVIVI�jIUN. . . . : OCK. . . . . . . . . . : LlJ .. . . . . . . . . . . . . I FL-0011 AREAS EXTERIOR WALL CONSTRUCTION ..AlsS OF WORK. :NE,W F I Rc3T. . . . S f N. S E W rPU- 01-' LJSI*.--. . . :ACS SECOND. . . -,f P-ROTECT 1-+.. Of. LONIST. :5N 7'H I F?D. . . . qf- N: W 'CUPIANCY GIRPI. :K2 ...... 0 S f. ROOF CON9T : FIRE RET?: ..,UILIPIANCY LOAD: BASEMENT. 5f AREA SEE'. RATED: i OR. HT. :8 1-t BAR,-GE. . . OCCU SEP'. RATLD-. �Ml�) MEZZ? . REUD SETBACKE),-------, .-OOR LOAD. . . . : p s f LEF*T: f t RGHT : f FIR SPIF1,L : F)MOK DET. . , WLLLING tJNI"FS: F'RN'r ft REAR: ft F.-.*IR ALRM- HNDICF' ACC: D R M,5 BATHG: IMF, SURFACE: ",Re CORR: k,ARKINU: 7: 0 INSTALLING A F=ENCE AP.-PIROX 55F7 BETWEEN 7FJ `rO 8 F-1 .qnev— JHN DFRLNNAN type ,amount by elate r-ecpt -3 1495 '.-31W GREENBURG P,Rml- $ -5. 0111 .IF 12/05/94 94- : 9300 P'LLK $ 16. 25 JF 12/05/94 94--259300 I IGARD OR ')72:2:;3 5P,C 1 1. l2/0 x/94 9 4 iR5 1)--i 0 W, hone #: :kc t Orltr L .... ...... tiorlp M.. 4,"'. 50 TOTAL leg #- REWJI RED I NSP'EC.-T I ONS iis permit is ISSUed SUbleCt to the regulations contained in the isc)c)t/found Insp :gird Municipal Code, State of Ore. Specialty Codes and all other Flr-Fkmirig Irisp applicable laws. All work will be done in accordan_r with Itispect iori approved pians. Tnis permit will expire if work is not started 1within 180 days of issuance, or if wark is suspended for more �han 160 days. ------ ........... 49 " .0 By : i 1-� -- "ICall fol- inspect ion 639---4175 Cify of Tigard Residential Building Permit Application 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639.4171 Jobsite Address:__L14 5 5. �(�, t IS(J A Subdivision: Lot # Offtce Use Only Valuatlo 7.� Q r(�'� Planck/Rec# Corner Lot? y �N Permit #AK r4a.,osr, P/m y y•-o Zr,L bovR yy Flag Lot^r Y V' Reissue of Map & TL # Owner: J r_itf AY Approvals Regufred Address: ��. �. i I"i)X ,G" , Planning N Tl � �if� �' „�l �1 i�'�I — Phone: Engrnepring 5c.':5 �� 2 `j -- 5 �r` " Other Contractor: Items Required Subcontractors Truss Details Phone: � ,. .� (, �'atj - �a •� �� --r'__— Other Contractor's License # (attach copy of current Oregon license) Contact Name & Phone: Subcontractors: Arcliltect/Engineer: _ Plumbing: Address.- Mechanical: ddress:Mechanical: i (attach copy of current OR Contracbr s License) Phone.- JOB hone:JOB DESCRIPTION: L Appli nt Signature & Phone number Received by: Date Received. N MORMCOMDMRESAPP —J Permit# Account Description Amount Amt. Pd. Bal. Due Du('yg-03.5 Bldg. Permit (BUILD) _S. a S ot) — ?bn y -�4 Z Plumb. Permit (PLUMB) Mech. Permit (MECH) State Tax (TAX) _J 77 Bldg: Plumb: s �' Mech: Plan Check (PLANCK) Bldg Plumb: Mech: 5"ti I �-a 3 y 5" Sewer Connection (SWUSA) Sewer Inspection (SWINSP) '7 J Parks Dev Charge (PKSDC) _ Residential TIF (TiF-R) Mass Transit TIF (-TIF-MT) Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-0) Water Quality (W.)UAL) Water Quantity (WQUANT) - Fire Life Safety (FLS) ------- Erosion _Erosion Cntrl Permit (ERP;:MT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) TOTALS: CITY OF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PLUMBING PERMIT PERMIT #. . . . . . . : IDLIYIS44- 1 639-4171 DATE ISSUED: 12/06/94 ODDRIESS. . . : 11-1-55 SW (3RLEI,4B(iRC.,.7 15135ED--00400 Ij D VISION. . . . : ZONING: R- 12 )CK. . . .. . . . . . . 1-01... . . . . . . . . . . . . LL(- SS OF WORI,,. NI.-W 'GARDi-1GE DISPOSALS. . : MOSILE 14014E SPACES. iyPi-- OV UIBE. . . . ..SV WAESHING MACH. . . . . . . : SACKFLOW PRE.VNT RS. . Q1.,LUVIONLY GRP. . : R3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . !.i I L14 I ES. . . . . . . . : wA,r'L--.R HEATERS. . . . . . . LATCH BASINS. . . . . ASINS. . . . . . . RES- - LAUNDRY TRAYS. . . . . . : '33F RAIN DRAINS. . . . . LINKS. . . . . . . . . . LJ RINALG. . . . . . . . . . . . : GYREASE TRAPS. . . . . . . LAVA FOR I ES. . . . . . 01IJER rIXTURES. . . . . I Ub/LoHOWLIRS. . . . SEWER LINE (ft ) . . . . :470 JA I L k' LI-0511. 1 ':J. . WATER LINE. (ft ) . . . . - DI EiHW(45HE RS. . . RAIN DRAIN (ft ) . . . . : Remar-ks : 1I\I':'31"0LL- [NG APPROX. 410 I' ll" OF STORM LINE 1U STAY DRY UNTIL STOR14 I-ir� UN `)8 H"S BEEN LOM(-'LETLD BY CITY (Jwnei,: FEES 301-11\1 DRENNAN type i-imal.tnt I)y cl a t,-(2 r-ec.-pt i, 1495 SW GREENBURG PRMT 130- 00 JF IL/05/94 94--259300 50 JF 16'/05/94 ()4--t-Ll�j 1) L,i v i I IF;ARD OR 3 h-me #: 639-5792 )WNL I< hone ti r --_$_-_,1. -3C,. 50 TOI'AL ,'LIP REQUIRED INRPE:CJIONS ,iis pewit is lisued subject to the regulations contained in theTap—C)LIt t rl S P Tigard Municipal Lade, State of Ore. 5PeC181ty Codes and all other F i n a I lnpect I un Lpplicable laws. fill week imlr.il be done in accoraance with Approved plans. This pewit will expire if "ark is not started ....... ,:ithin 18@ daus of issuance, or if work is suspended for vore ^an 18@ days. t t e ii a t i..i t-P ...... f)0440tIEA y Tall fot- inspection - 639--4175 City of Tigard PLUMBING PERMIT APPLICATION Pianck/Rec. # r/'tt_ 13125 SW Hall Blvd. Permit # _ Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE '�•^•°"'•°•'°�'^•^' New Single Family Residences On�y 11d°'••• _ F-11 BATH HOUSE $140.00 112 BATH HOUSE$195.00 Job 1 4 j );(,(/ (,-h'r:'f'/u l3✓�Y G- /c�►�• ❑ 3 BATH HOUSE $225.00 Address carreur. _ =ee includes all plumbing fixtures in the dwelling and the first 100 feet of water service, sanitary sewer and storm sewer. See fees below. N..* oininio1sms") FIXTURES CITY PRICE AMT Sink — 9.00 M••^•AdV... °h^^^ Lavatory 900 Owner L, (icJ X o0 S Tub or Tub/Shower Comb. 900 "�'�'•'• ZIP Shower Only 9,00 CI li ) H / 3 0 Water Closet 9.00 "^'^•'W.—of hu^^^•" Dishwasher 9.00 — Garbage Disposal 9.00 Occupant M"kog,,,,r,.. Pn_. Washing Machine 9.00 Floor Drain 900 ZIP Water Heater 900 Laundry Room Tray 9.00 Urinal 9.00 Other Fixtures (Specify) 9.00 M.&Q Ad*... Phone 9.00 Contractor 9.00 cMsni. Zip 9.00 Sewer 1st 100' 3000 Mo.R"°nn.a^n No Cm Bu. nx No Sewer-ea. Addit. 100' 25,00 Water Service 1st 100' ~� 30.00 I hereby acknowledge that I have read this arplication, that the Water Service ea. Addit. 200' 25.00 information given is correct, that I am the o,vner or authorized agent of the owner, that plans submitted are in compliants with State laws, that Storm &Rain Drain 1st 100' 3000 3 L r 1 am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addit. 100' ( _ 25.00 (J(1 number given is correct. (If exempt from State registration, please —••---- give reason below.) Mobile Home Space 25.00 y Back Flow Prevention — Device or Anti-Pollution Device 900 ' -- D•'^ Any Trap or Waste Not 4,41 ,r i,4-teConnected to a Fixture 9.00 Describek new O addition O alteration Q repair Q Catch Basin T-00 to be done residential Q non-residential (7 Insp. of Exist Plumbing 40 00/hr — Specialty Requested Inspections 40.00/hr Existing use of building or property � � , Rain Drain, single family dwelling 30.00 — Residential backflow prevention devices 1500 Proposed use of � building or property I t. *(Except residential backflow prevention devices) NOTICE *Minimum Fee $25.00 SUBTOTAL Q� PERMITS BECOME VOID IF WORK OR CONSTRUCTION -z—see It 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 Special Conditions _ — Date issued __ u by ` _ _ CITY OF TIOARD SEWER CONNECTiotQ COMMUNITY DEVELOPMENT DEPARTMENT PERMIT 13125 SW Hall Blvd. Tigard,Oregon 97223.0199 (503)639.4171 PERNIT #. . . . . . . 4 SWR94-0,395 DATE ISSUED: I`/06/94 PARC.'EL: I5135CD-0121400 iL-' ADDRES13. . . : 11455 SW W3LENBURG Ill-I )W31)1V I S I ON. . . . : LOVING: R--ic- LOCK. . . . . . . . . . . L-01.. . . . . . . . . . . . . . IENANT NAME. . . . . : JSA NO. . . . . . . . . . : F*IXTURE UNITS. . . LAS' OF' WORK. . . :ADL) DWELL I NG UN I 1-S. . :2 YPE. Of Ubf :Accj NO. OF BUILDINGS:2 NhT PLI- T'YPL. BUSWI-'i 1 MPERV SURFACE. sf* emar TING MAIN -ks : INSTALLING 2 LATERIALS ONTO Lxis "Wn e l- . - - - - - - - - -- - - - -- -- -- —, - - I — — r:EEr3 JOHN DRENNAN type amount by date v,ec,pt SW G)REENBURG PPMT $ 4400. 00 JF117/V-116/94 I NSF' 1, /0. 00 JF' 12/06/94 16ARD DR 97223 .,hone #: 639-579c.' ontr-actor,: UNIRALJCSR NOI ON FILL )'honer it: 4470- 17.10 TOJAL REQUIRED INSPECTIONS his Applicant acrees to comply with all the rules and regulations c-.',ew,,- Inspection . t the Unified 5emaqt Agency. The permit expires 180 days from —it date issued. The total amount paid will be forfeited if the ------ ermit expires. The Agency does not quarantee the aimuracy of the ide sewer laterals. If the sewer is not located at the measurement .,Yen, the installer shall pi-cspect 3 feet in all directions from ...... ,lit distance given. If not so located, the installer shall purchase "Tap and Side Sewer" permit and the 043encu 11 install a lateral. I In 1 T: t e la I n4 i sr�,..ted LAY Call f c)v- inspection 639-4175 CITY OF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Flail Blvd.Tigard,Oregon 9722398199 (503)639-4171 1::'I-L)I'l H:I*.N G V'E R 11 I'T P['::*.R 111 T H. « « « « . . -. V,L 1119 4 (a V) ,-39 41 /1 D(.)T'E 05/25/94 P()R(:1'..L l: 151;355.,1) -004W0 OWME5'�. . . -.- 11-455 SW RI) D 0.1.V.k 1:)J. N. ZONINGill R--12 . . . . . . . . . . 11OF111 E-*' HC)PIE 51:4)(* L*S. TYPE OF WASHING NACH. . . . . . . II 13ACKFLOW F'REVNI*Rs. 0(,XL)1*-"0N(') R3 FLOOIy DR(41NS. . . . . . . . 7'RAP5. . . . . . . . . 10 R I E 13. . . WO T E-K, H E..Ii.) I L.,H'i. . . . . . . C(a 'LH 1.()S11qS. . . . . . . . I X*1 U R E. ....... I.J.)UNDRY IWAYS. . . .. . . a SF R(IIN DR(0IN5. . . . . .. 11%W3.. . . . . . . . . . a UkINPLS. . . . . . . . . .. . . > (3REOSE UR(41S. . . . . . . f)VO WRILES. . . . . UMLR [: JX1URE-"3. . . . . .. L)B/SHOWERS. . . . .. SEWER LINE (ft) . . . . : 140 P0*H::'.R (.,I 013E'T'S. WOTER LINE ( f t) -1 9HW(-)St4ERS. . . . .. RePIN 1)kA11q (-ft) F'XTEND [:'R:1:V(1T1::, fi;FWER LINE, ....... .......... FEES I OHN DREMNON type 'A M C:)Lt 1-1 t by date 11�C.I, 'IJ t3UX E36W-s P R M I' $ 45.00 JIG 05/25/94 -- 1 $ P. H`.J JG 0'11)/2b/94 ON 1.)071.1a 4:. A)rit-raetcvr: ............... ...................- R r)i c;i+r & f-.) I U R D Y FF N C I N G7 PDX P.3603 10,ORD OR 97281-13603 0- 6119-- 5?92 $ 47.25 T'O'TAL R L*UWRLD INSPLUTIONS `lis permit is issued subject to the rejulations contained in the ':)ewe-r IT11spactiorl igard Municxp#? Code, State of Ore. Specialty Codes and all other Fivial Ji-iqpertiati ...................... oplicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within IN days of issuance, or if work is suspended for sort .................. ................. ........ .......................... than 180 days. ...... ............ ........... ........... ....... .......... ........... ................. ........... rcl .......... dl- Ij for, j,)-)s;pe, 639--4175 City of Tigard PLUMBING PERMIT Planck/Rec. # 13125 sw Hall Blvd. APPLICATION Permit # Tigard, OR 972.23 (503) 639-4171 ` - Descripbon--=- - --- ORS 81421-610 —T CITY PRICE AMT Lmµ -- Job ��9 S� S.({l (-ram Lnir;t� /'��, FIXTURES Address CIO sink - - - Dre/vN/4,v, TomAl t,✓. --TGF a ower omb-- Shower ems"- , 7.50 Owner FC' r3 c,* <3Cv3 V 3`! J 7`! atwa�ztw 750 .aseer Cr`- MiUage rspo's T-- -- T J c1 1281- 366J Was n9 rte - ran -7M-- 1° -- - u ry m ray- -- Occupant .-__ -_ 7.50 rine 0 TSS--- `r er ixtures - '- PE'cAY ----- MISCELLANEOUS Contractor ---- __ - leew"e� er-Qa.7UNFTM- - atni - rc y ac rhv age affiiTTiave're; this app a--T*�n,that the Water Service ea. Addit. 200' - 15.00 information given is correct,that I am the owner or authorized agent of the owner,that plans submitutcl are:t compliance with State laws, that I Stomh d Rain Drain 1st 100' 30.00 am registered with the Construrtoon Contractor's Board,that the number Storm d Rain Drain Addit. 100' 15.00 given is correct (If exwnpi from Stats registration, please give reason bElow) Mobile Home Space 25.00 — Device or Anti-Pollution Device `- I 7,50 y I rap or aste o -I}— - Connected to a Faure7.50 srn'�e �j-a�rditxin a erabon U repair - -- to be done residential Q non-residential Q --- 40.00 _ Insp. of Exist. Plumbing per hr Specialty Requested Insp--tions per hr Existing use of t n rain, y —_ `- building or Property !1 1-S r a�r�N 77AL singe ami _- dwelling 15.00 s nbaac mow prevention devices 15,00 Proposed use of - bLak ng or property t S r J c ry Ti/j L __ T xcep resaenrra ab�ow-- -- prrvention devices) NOTICE 'Uinir,um Fee$25.00 SUBTOTAL -- PERMITS BECOME VOID IF WORK OR CONSTRUCTION _ 5%SURCHARGE AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 2 -17 CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTFR WORK IS PLAN REVIEW 25%OF SUBTOTAL COMMENCED - -� TOTAL L 7 J Special Conditions - --- ------- -- - _1 --,---�__ Date issued�_ by MEMiORANDUM CITY OF TIGARD, OREGON TO: File FROM: Jim Hendryx, Community Development ment Director ��1a DATE: June 29, 1995 SUSJEC r: 1 1455 SW Greenburg Road The Community Development Code (Section 15,100.090) allows fences along Major Collectors to exceed 6 ft, in height in order to mitigate against potential adverse effects. I find that Greenberg Road has high volumes of traffic and the proposed fence wily mitigate adverse etfec:ts. The request to exceed the 6 ft height limit is approved. M0495 PLUMBING PLRlyll I I1 PERM . . . . . . : CITY OF T I GARD DATE IISIES#UE . D: 06/14PLM96-0145 /96 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd Tigard,Oregon 97223*8199 (503)539.4171 PARCEL: 1S135CD--09000 S1 T1 : - ( — .' .: 1 1 - ) .:)W GREENBURG RD SUBDIVISION. . . . : MLP94-0003 ZONING: R-12 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . ..vio 1 CLASS OF WORK. . :114EW GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :#tF5 WASHING MACH. . . . . . : 0 BACKFLOW PRFVNTRS. . : 0 OC(.','UP'ANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. 0 L-,"r o H I E.s. . . . . . . . : o WATER HEATERS. . . . . .* 0 CATCH iA — ' — SINS0 FIXTURE=S----- -_.___..____ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . , 0 GREASE TRAPS. . . . . . . 0 LAYATORJES. . . . . . 0 OTHER FIXTURES. . . . : 0 *IUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 0 WATER CLOSETS. . : 0 WqTER LINE (ft ) . . . : 100 DISHWASHERS. . . . : 0 RAIN DRAIN (ft) . . . : 0 Remarks : Water, service 1st 100ft. Owner: FEES JOHN DRENNAN t ype amo�-int by date recpt 11495 SW UREENBURG PRMT $ 30. 00 CJS 06/14/96 96-28121368 5PC-,-T $ 1., 50 CJS 06/ 14/96 96-280368 1*IGARD OR 97223 Phone #: E-39-5792 Cont ractor: STRAIGHT & STURDY FENCING PO BOX 23603 JIGORD OR 97281-3603 ------.-----_.__-_--...______-__-__--___- Phone 4: 503--639-5792 $ 31. 50 'TOTAL Reg #. 27194 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the F- inal Inspection Tigard Municipal Code, State of Ore. Specialtv Codes and al I other Water Line I n s p applicable laws, All work will be done in accordance with Mi 5c. Inspection approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. Vermittee Signati.tre : I s s 1-t e d B y Call for inspection 639--4175 City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # O 3E 13125 SW Hall Blvd. Permit # VL--Lis Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE -- �•^•.t�•KK^•^� q -- New Single Family Residences Only E c- r it �....• r„ 0 1 BATH HOUSE $140.00 L] 2 BATH HOUSE$195.00 Job 1 [�5� �� - - /1tiF�G. ��> ❑ 3 BATH HOUSE $225.00 Address zb Fee includes all plumbing fixtures in the ''welling and the first 100 feet 1-2- 3 of water service, sanitary sewer and storm sewer. See fees below. N.—t. ^^^M&,•^•••1 FIXTURES CITY PRICE AMT ti ,O �+lVI) li'rL A/A/AAl Sink 900 /M..^y wa•°• °Avns Lavatory 9.00 Owner !".(),h 0 X Tub or Tub/Shower Comb. 900 cnrIst.t. —� ,�—+� :o Shower Only 9.00 T7 C--A q — 'H ,j 6.p3 Water Closet 9.00 4+ ,«^•m•^t a ^•°°I \ Dishwasher 9.00 niri f-/1 RRF►(. P, M rlEk) Garbage Disposal 9.00 Occupant M.i Q A:„uPnoo N Washing Machine 9.00 _ 5-q p•-y L ' _ Floor Drain 9.00 .. Water Heater 9.00 / int i . j 7 � 'u} � 0 /� t Lj 7L-� J Laundry Room Tray 9.00 —^ �•^• - Urinal 900 _ )]� r �' ��NC Other Fixtures (Specify) 9.00 'A.i^y MA... Ph— 9.01 Contractor � ��0,>^�> , r C -- 9.00 � >< 2,�Gc� X31 - 7L1 .11,9,.1. ::. 9.00 6-AK) PZ, q -)2 91 Sewer In 100 -- _ Moo _ a...R.p.bRon Na vY�• *•°v^ Sewer -ea. Addit_100' 2500 Water Service 1st 100' 3000 I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00 information g,ven is correct, that I am the owner or authorized agent of — the owner, that plans submitted are in compliance with Slate laws, that Storm &Rain Grain 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) Mobile Home Space 25.00 Back Flow Prevention De.ice or Anti-Pollution Device 900 v. •w '— �•t• Any Tran or Waste Not r • ( t ►�,x+17 n �j _ f Ej Connected to a Fixture _ 9.00 Descnbe erk new addition(-) alteration U repair Q Ca-ch Basin 900 to bed a residential non-residential 0 In<o of Exist. Plumbing 4000th, Existing use of r Specially Requested Inspections 4000/hr Rain Drain, single family dwelling 3000 building or property _)%%��C�[,,� [-��/�-F, �� rrk=ivtr"_ - Residential backflow prevention _ devices 15 00 Proposed use of C building or property �A i`1 r= nt '(Except residential backRow prevention devices) 5v, ,l NOTICE 'Minimum Fee S25.00 SUBTOTAL 5,�/�.00 PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF 501, SURCHARGE I .50 CONSTRUCTION CR'WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED PLAN REVIEW ZS°a OF SUBTOTAL TOTAL Special Conditions _ Date ssued _(am ” 2 - 1)6_ by `_-IT'S -- ---