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city �of Tigard
INSPECTION REQUEST
for
INSPECTION TI ME: PERMIT N(_' - —
DATE: � �" DATE 1 SSUE1, J--
OWNERS NAME : _
" 1 �
I ADDRESS :
CONTRACTOR :-.-
TEST:Air 0, Water r> , Visual C) , Lahorotory Ci
IRESULT: Approved rJ , Disapproved O Pend.,iy !:I —
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I INSPECTOR DATA:
IcNOTE Allach supplemental t(1et dote t+ereiol
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1
BUILDING DEPARTMENT, TIGARD
PLUMBING PERMIT
holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors.
Owner —__ Addresses 41 _ Date
M NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS FFE ON EACH AMOUNT (Office Use Only)
V E_eLLLA L --- —------ - a ---� .—. _
Single Family--Il bath—each _ _ _25.00
___Duplex_Each 1 bath unit ^_ _____25500
Additional bathrooms—each _ _ 10.00 _
Mobile Home_§)ace—each _ 15.00
INDIVIDUAL FIXTURE FEES
1 to 50 Fixtures i . 1 building--each _ 3.00 _
51 to 100 Fixtures in 1 building—each _ _ 2.50
101 to 200 Fixtures In 1 building--each _ _ J� 1.00 -
201 or more Fixtures in 1 building-.each _ — _ 1.50 _
MISCELLANEOUS _ _ _
Building Sewer-1st 50 ft _—� 10.00
Sewer—each additional 100 It. _ _ _ _ _ 10.00 _
Meter Service to building 5.00_
Private Water Systsms-each 100 ft. 10.00
Other scif :
PERMIT For Plumbing Inspection Phone 6394171
3%State _ Plumbing Contrartor By
TOTAL _ _ T R2CE1PT NO. Issued By
Address
Permit No.
Name of Occupant_ Permit cb:arge
Paid
Date connected
Type of Building •e&i Insvection
Service Rate Paid by Date.-----
Contractor Assessment Paid
Size of connection—