11665 SW KATHERINE STREET i
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CITY OF TIGARD BUii DING INSPECTION DIVISION j �
/--( MST
24-Hour Inspection Line. 639 4175 Business Line: 639-4171 ---� -
BUP
_ Date Requested__ �� R� AM _/ _ _ BLD _
Location -�1 ( Solite E
Contact Person Ph
Contractor — /� �— Ph _-_ SWR
BUILDING Tenant/Owner —_— LC " --
Retaining Wall ELR
Footing —--
Foundation Access: G� ��Ax7 FPS _ —
Ftg Drain - SGN
Cra..'nrain Inspection Notes: - —
Slab _—_- ------- SIT
Post&Beam — --
Ext SheathiShear _
Int Sheath/Shear
--
Framing --_--
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ---------__ -- -- - - _- _-__-- _
Fire Alarm
Susp'd Ceiling ---___—
Roof w
Misc -- --- — --
Fina! -------
PASS PART FAIL -- -- ------ ----------v----- - —�
PLUMBING_
Post&Beam - --- - -- --
Under Slab
Top out --------------- -- --- -�_-_ ----
Wates Service
Sanitary Sewer -- ---- --------------- -- --
Rpin Drains
Final
'ASS PART FAIL
I,osl am
moke•Dampers
Final -- - ----�-- _-- --- __ __----- ----
PAR"T FAIL
Ser✓ice
Rough Ir
UG/Slab
----------------------
Low Voltage
Fire Alarm --- --- - ---- -
naT`- -- -
PART FAIL -- - ----- --- -
SITE
flackfill/Giadiny - ------ --- - - -- -
Sanitary Sewer
Storm Drain ( (Reinspection fee of$ _ _ required before next Inspection. Pay at City Hall, 13125 5W Hall Blvd
Catc i F'asin
Fire Supply Line ( ] Please call for reinspection RF:i— --__- ( j Unable to inspect no access
AJA
Approach/Sidewalk r
Other Dat- /� /R ` ,!� — inspector -�-�' -- - Ext
Final -.—
PASS PART FAIL 00 NOT REMOVE this inspectioi: record from the job site.
CITY O F T I G A R D MECHANICAL.
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . : MEC98-0516
DATE ISSUED: 11/16,198
PARCEL: IS134CD-01100
SITE ADDRESS. . . : 11665-1 SW KATHERINE ST
SUBDIVISION. . . . : LERON HEIGH'rS NO. 3 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :081 JURISDICTION: TIG
--------------------------- - -----------------------
CLASS OF WORK. . :AL.T FL-O()R FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . .-R,:s VENTS W/O ADPL: 0 VFir SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/rDMPIRESSORS HOODS. . . . . . . . o
FUEL. 0-3 HP.. . . . . 1 DOMES. INCIN: 0
:GAS 3-1 HP. . . . : 0 COMML.. INCIN: 0
MAX INPUT: 0 BTU 1.5-34 HP. . . . : 0 REPAIR U"JITS: 0
FIRE DAMPERS?. . - 30-50 HP. . . . -. 0 WOODSTOVES. . : 0
GAS PRESSURE. . . : 50+ HP. . . . : 0 CLIO DRYERS. . : 0
NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : 0
FURN ( 100K BTU: 0 10000 cfm : 0 GAS OUTLETS. : e,
FURN >=100K BTU: 0 > 10000 cfm: 0
Remark-, - Exterior A/C unit. Unit oust not encroach into 51 sid, or rear vard
setbacks.
Ow.iert ------ FEES
ARTHUR HAAS type amoi..tnt by date recpt
t1665 SW KATHERINE ST PRMT $ 25. 00 B 11/16/98 98-310831
TTCARD OR 97223 5PCT $ 1. .'5 B 11,116/98 98--3 1.083 1
Pt,nne #:
contractor:
WJABODE HEATING AND A/C
,'.51 BE HACIENDA STRFFT
$ EfF, 25 TOTAL
HILLSBORO OR 97123
Phone #c 649-2440
Rel #. . : 007611
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. :Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final. Inspection
app'icable laws. All work will be done in acr-*dance with
approved plans. This permit will expire if work to not started
within 188 days of issuance, or it work is suspended for more
than 180 days. ATTENTION: Oregon taw requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAP 952-881-010 through OAR You may
obtain copies if these riles or direct questions to OW by calling
(50 31
T -'sl.le By:
Permittee
i•+++++++++++•++++++++++++•!+-4•++++++++++++i•++++++++++++- ++++++f•++++
Call 639-4173 by 7:00 p. m. for inspections needed the next bi,isiness day
++•+-+++i-4 4+4-1,+4-f.........4-++++4}+++++++++++-1-+i-++•1 .++++++++++++++++++++++++++++t+++
CITY OF TIGAR-D Mechanical Permit Application Plan Check#
13125 5W HALL BLVD. Recd By
Commercial and Residential Date Recd_I i3O
TIGARD, C 97223 Date to, _
(503) 659-4171, x304 Date to r
Print or Type °ermit# --1 �
Incomplete or illegible applications will not be accepted called
Name of Developmenwrojed Description —'—
�qt) • Table 1A Mechanical;ode Qt Price Amt
Job Street Address — S,4"e# A) Permit Fee - 10.00
Address 1�r<� < <y �� 1) Furnace to 100,000 BTU
' rl ci CC r` including ducts&vents
aidga Coy/State zip 6.00
2) Furnace 100,000 Bi U+ -
-�_ Tq •2:1 _includir, ducts&vents
Name(or name of business) ��—� --�'--`— - 7.50
11 3) Floor Furnace
Owner /�T�(,. _
including vent 6.00
MailingAddress p 4) Suspended heater,wall heater --
7fr S or floor mounted heater __ 6.00
city/SlateZip C/t ,ham _- 5) Vent not included in appliance permit
/ __ _one 3.00
.�"b CHECK ALL r Boiler Heat Air
NaFFe(or ncme of business) THAT APPLY: Y I or Pump Cond City Price Amt
Com ••
Occupant Mailing F,ddress _-_-- ----- 6; <3HP:absorb unit to -
p 1 OOK L'TU_
s.o4-
-Fd—y/st-te
_ _ 7)3-15 500k sorbBTLI unit
'lip hrnia 1Ctlk l0 500k BTL' _ 11.00
-_ -�— 8) 15-30 HP;absorb -
Contractor Nnme -- _unit.5-1 mil BTU
15.00
30-50 HP,absorb --'
Prior to permit Nailing Addrres.�s unit 1-1 75 mil BTU U _
22_50
issuance,atopy $/ �� SnL 10)>50HP;absorb un;( —�
/Q _ >1.75 mil BTII _
of all rcenses city/state zip Phnne handling unit to 10,000 CFM 37.50 _
are required if /bs �4� 9F,71-2F,71-26Y9_.?VYU 11)Air 4.50
expired in COT Oregon Const Conl Poard I_ir p -- Cxl ate - 12j Air handling unit 10,000 CF'M+
database � ��1�_g�
Architect Nnme 7.5013)Non-portable evaporate cooler
I
4.50
or Mauing Addiass -- -�� 14)Vent fan connected to a single du_ct
3.00
15)Ventilation system not included In
Fngineer cny;state �— Zip Phone _appliance permit
4.50
_ 16)Hoodry
seed by mechanical e>-0,aust _
--`
Describe work to be done _ -- _ _ 4_10
17)Domestic incinerators- -� -
New O R_epa;r O Replace with like kind: Yes 0 No O
Residential Jf� Commercial O 18)Commercial or industr,al type incinerator
/ 30.00
Additional information or description of work l _ 19)Repair units - -
FAA W-kc e N C VCA+;
bo-c_
t
(_I o
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CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #v ELC98-0686
13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 DATE ISSUED: 11/16/98
PARCEL: IS' 34CD-01100
SITE ADI",PE55. . . : 1 1665 SW KATHEPINE 5'1'
SUBDIVISION. . . . :1-ERON HE'1014TS NO. 3, ZONJNG,: R-4. 5
BLOCK. . . . . . . . . : LOT. . . . . . . . . . . . . :081 JUPI43DICTION-, TIG
ProJect Description: Haas
----RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS----- -----MISCELLANEOUS--.---..
1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADDIL 500SF. . . -. 0 201 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MING" LABEL ( 10) . . . : 0
----SERVICE/FEEDER—.--- -----BRANCH CIRCUITS----- INSPECTIONS- -
0 — %_00 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPIECTION. . . . . ., 0
201 — 4.00 amp. . . . . . : 0 1st W/O SRVC OR FDR. : t PIER HOUR. . . . . . . . . . . :
401 So@ amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 2 IN PLANT. . . . . . . . . . . :
601 1000 amp. . . . . : 0 ------------------PLAN REVIEW SECTION—
10004. amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR )- 225 AMPS. . : CLASS AREA/SPEC OCC. :
Owner:
ARTHUR HAAS type amount by date rer.,pt
11665 SW KATHERINE ST PRMT $ 45. 00 JSD 11/16/,j8 98-31081.6
TIGARD OR 97223 5PCT $ 2. 25 JSD 11/16/98 98-310816
Phone #s
Contractor: ------------------------_.—__
WEST SIDE ELECTRIC CO INC $ 47. 25 TOTAL.
1.834 BE STH AVE
-------- REOUIRED INSPECTIONS
PORTLAND OR 97214 Roi.igh—in Elect9l Final.
Phone #: 231--1548 Elect' l Service
Reg #. . : 13306
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with 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. ATTENTION: Oregon law requires you to follow the rules adopted by
- forth i.
the Oregon Utility Notification Center. Those rules are set f rth i OAR W. -MI-0010 through OAR 952-mi 87. You ray obtaii!l-"Ppy
I
of these rules or direct quest iolk tLnw/tLcal I ing (511 41-1 ------
Permittee SignatLkre* I s Is i-ted
INSTALLATION
'The installation is being made an property I own which is not intended for
sale, lease, or, rent.
OWNER' S SIGNPTURE: DOTE-
_CONT RArTOR INSTALLATION
STGNAT(IPE OF SUPR. ELECINt DATE-
LICENSE NO:
+.+++++++i .....++4......41.......F4.....................4•.......4......4............... ...4
Call 639-4175 by 7:00 p. m. for an inspection needed the next business day
.............4++++-&-A-++-+,+-4-+4..............4.4.......4........4............4-4.......4 4
NOV-13-98 03 :36 PM WEST SIDE ELECTRIC 503 7A6 0677 P. 01
CITY OF TIGARD Electrical Permit Application Man Check 0 —
13125 SW HALL BLVD. Reed By
TIGARD OR 97223 Date Rso'd
Phone(S031 639.4171, x304 Date to PA
Inspection(5DPrint or Type Date to DST
')639 4175 Permit 0 L L[„j 7+ C) C
Fax(503)684-7297 Incomplete or Illegible will not be accepted called
I. Job Address: 4. Complete Fee Schedule Below:
Name of Development-- _ Number of Inspections per permit allowed
Name(or name of business), 1*leS _y Service Included: Items Cost sum
l;ddresslZ14_ ata/ --��le s'/ 4a. Residential-parttnh
City/StateCZip_-�i ��_� fl/� � z�3 1OMsg A or legs $110.00 e
. Each additional SM sq h,or
pnAlon thereof $2900 1
Commercial El Residential® LimlleJ Energy
Farh ManrA'r1 Home or Modular
2a. Contractor/nsDwelling Service or Feeder !66.00 _—_ 2
�alla:.on only:
(Attec.h copy or all tt rrent 11w e) 4b.S*Mce!or Feeder*
Electr"No. -42
or l' �� � Installatlon,ahoration,or relocation
Addfa20u amps or lase te0.o0 ?
201 amps to 400 amps r hW 00 _ 2
r City_ (;tete 2iT� 401 amps to 600 amps !120.00 ?
Phon -- jX r- 601 amps to 1000 amps
Job No. Over 1000 amp3 nr volts $340 rXr — 2
Elec Cont lice NoExp.ptle Reconnect enly $50.00 2
OR Stets CCB Req No Exp Date _ 4c.Temporary Services or Feeders
COT Rusinest;Tax or Metro No. _Fxp.Date Instaliatlon,alteration,or relocation
200 amps or lase $50.00 2
Signature 19Supr.Clet:'n— - 20t amps to et><+amps !75,00 2
--- 401 amps to 600 amps $10000 --- 2
Over 600 amps to 1000 volts,
Licence NP S Fxp.Dflte -- sae"b"above.
Phone Nr
yallatlOns: 4d.Branch Circuits
ZIT. For OWR6r ill3f
Now.aftarstimn or r.lenslon per panel
a)The lee Icer branch rlrculte w/th
Print Owner's Name pN�r lel r service or
Address Eorh brnrrch circult l5.no 2
b)The tee for branch circuits
Phone No �P_ rvllheur purchase mf
--------- service or fmodar fee.
_ fir,0 braneh rtreuit i36,W S 2
The Installation is being r ade on property I own which Is not Etx n nddnflonal branch droll!� 15.00 �/_ 2
Intended for sale,lease or rent. 4e.Miscellaneous
ri*rw-BSlt}nelurA__. (Service or Innder not Incl-Aad) -
- - —„ Each pump or Irrtgatlon circle
Farh elan or nulline lighting - !a0 no 2
3. Plan Review section(if requlred).-a Signal oincun(s)or i tlmtted energy
panel,aflnratlon or arten,lon $40.00 2
Minor Labels(1u) !100.00
Plen9e cheek epp►oprllle Item end enter ices In section 5!,-
4 or more residential unlls In om structure 41.Each additlnnal Inspection over
Service and feednr X25 amps or more the allowable In any of the above
9yslnm over 900 volts nominal Per Insp-DcUmn $3500
Classified area or aln cturn conialninq special o:c4an.y Per hour 15500
Fin dn-,crlbed In N.E t.Chnt)ler!i In Plant $5500
'9ubm!t 2 sets of plans with application where any of the&boys apply. S. Fees:
Not required for temporary construcllon services. Sm.Fnlnr loin!of obnve lame f
5%Surcharge(.05 X folal fees;
"T yj. subtotal a --
eb.Eider 25%of Nan As fm'
PERMITS OECOME V010 If WORK OR CONSTRUCTION AUTHORIZED 19 Plan Review j-mulr}d(Sec 3) !
NnT COWIRNGFD W1TN1 lA0 DAYS,OR IF CONSTRUCTION OR WORK 3ubfoMl -
IS SUSPENDED OR A8ANgONFD roti A PERIOD OF IBO nAY9 AT ANY LJs
TIME AFTER WOR IS COMMENCED, Trunl Accounts _
tntal balance Due
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: .�'� _ A.M. _ P.M.� _ MST: _
--- - --- --
Location: t Bi1P:
Tenant: Suite: Bldg: _ MTC:
Contractor: (.� Phone �_ _� �
-� � PLM:
Owner: Jf IAAk, Phone: -
__— ELC:
— - ELR.
_ � ^-^'_'�,_— SIT:
BUILDING BLDG(cn►n't) PLUMBING� MECHANICAL ELECTRICAL SITE
Site Post/Beam I c�istl�cam AA Post/Beam Cover/Service Sewer/Storm
Footing Roof lJndFUSlab L Rough-In Ceiling Water Line
Slab Framing "fop Out �� Gas Line Rough-In i1G Spripkler
Foundation Insulation Sewer flood/Duct Reconnect Vault
Bsmt Damp I)rywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C 11G Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Or Neat Pump Low Volt
Approved ov Approved Approved Approved --
Appr/Sdwlk Nui Approved Not Approved Not Approved Not Approved Not Appro•.ed
FINA12 FINAL FINAL FINAL FINAL
O Call for reinspection C7 Reinspection fee of$ _ required befo ext inspection O sp
::noble to inect
�'
Inspector: Date: �� _ Pa5ge-r� of
I
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #.. . . . . . . : PLM97-0220
13125 SW Hall Blvd., Thnard,OR 97223 (503)639.4171 DATE Ir- J E D: 06/11/97
PARCEL : 1SI34CD-01100
SITE ADDRESS. . . : 11665 SW 1-(ATHEPINE. ST
SUBDIVISION. . . . : LERON HEIGHTS 1\10. 3 70NING: R--4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .81 JURISDICTION: TIG
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME Sf 'ACES. : 0
TY71E OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GPP. . : R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . ,. . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0
LAUNDRY -TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE.. TRAPS. . . . . . , : 0
LAVATORIES. . . . 0 OTHER FIXTURES. . . . : 0
1 LIB/SHOWE RS. . . 0 SEWER LINE (ft ) . . . - 0
WATER CLOSETS. - 0 WATER LINE (ft ) . . . . 0
DISHWASHERS. . . . 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Installing a water heater
Ownp-: FEES
ARTHUR HAAS type amoi-�nt by date t-erpt
11665 SW KATHERINE ST PRMT $ 25. 00 B 06/1. 1/97 97-295731
TIGARD OR 972123 5P(--T $ 1. 25 B 06/ 11/97 97-295731
Pt-iorfe 4:
contractor - _________.__.______.__._.___...__._.._.___._.._
GEORGE
ontY-actor—
GEORGE MORLON PLUMBING
552'9 SE FOSTER RE)
PORTLAND OR 97206
Phone #: 771-1145 $ 26. 25 TOTAL
Reg #. . : 000027
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misr. Inspection
Tigard Municipal Code, State of Ore. Spe,Aalty Codes and ail other Final Inspection
applicable
pplicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 18@ days of issuance, or if work is suspended for more
than 180 days.
Permittee Sinati.tv-e: #IA-
Issi-tecl By : A, J k01A Ali
Call for inspection 633-4175
Recd
'ITY OF TIGARD Plumbing Application �—
:125 SVV MALL BLVD. Commercial and residential
Date Recd b
:GARD, OR 97223 Date to P E
Date to DST
503) 639-4171 Permit 0 r n-rl DL:>,E
Forint or Type Related SINK
Incomplete or illegible applications will not be accepted called
— Name of Development/Project FIXTURES (lndivldual) QTY PRICE AMT
Job 'ink — 9.00
Lavatory -' g 00
Address Street Address Sinte
LL�5 rlh! h1141 )* Tub or TubiShower Comb 9,00 -�
Blc'g 0 — CityiSiate Zip— —� Shower Only _— 9,00 -
Water Closet 9.00
Name (A
�_.— _ -- --
1 Dishwasher 900
Owner M ding Address T Suite Garbage Disposal 9.00
1��y(✓ r� /�w� lY� �Vashino'n schine 9.00
City/Slate Zip Phone Floor Drain 2'
9.00
3" 9.00 �
Nan a SCI — _
4-- 9,t'0
Occupant Mailing Address Site Water Heater 9.00
Laundry Room Tray S.00 --
City/State — Zip Phone Urinal 9.OU
Name Other Fixt res tSpecdy) 9.00
9.00
Contractor Mailing Address Suite 9.00
lL SF T f, �IA at ----- ---- -'— 0.00
(Prior to issuance city/State zip
r Phone -1 t ) — --- 9,00
applicant n ,st ZL/� 7 J F! — — -
provide O g-on Const Cont.Board LIC 0 Exp ')atc — 9.00
contractors / J/ �—� ���7-47 - ---- 9.00
license —PI-uLmbbiingg L. Sewer- 1st 100'Se
ic.0 Ex .oat w — 3000
information ""L '6b�p a-7-4 a — __ —_ - - 30.00
Sewer each additional 100' 25.00
j for COT COT Business Tax or Metro 0 Exp Dale
database) Water Service-1st 100
I _ _ _
— Name -'— Water Service-each adddional 200' 25.00
Architect Storm R Rain Drain- 1st 100'
or Mailing Address Suite Storm 3 Rain Drain-each additional 100' 25,00
Monde Home Space ?5.00 —�
Engineer -I CityiStale Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
::escribe work New O Addition O Alteration O Repair O Rte•_denial Backflow Prevention Device' 1500
=7 be dune Residential O Non-residential O _ An Trap or Waste Not Connected to a Fixture' 900
Additional deli nption of work -
-- -- -
&/eeyo,t ��L��•� (�v.FJ- Catch Basin 900
fKl�I�G�►tt�f f '
Gt Otr) l rovev1 Insp,of Existing Plumbing 40.00
I per/hr
------ ------
Extsung use of Specially Requested Inspections 4000
�./ / _ _ per/hr
budding or property Pot,U�)e_ —_Y—__— Pain Dram.single family dwelling - 30.00
Pr,mosed use of Grease Traps — 900
building or property-- S (//�� 4fr _—.-- --�--
_ QUANTITY TOTAL
Are you napping , moving or replacing any fixtures) YeslQf No[] Isometric or user degran;s regwrrl I ouanrti Total is >9 _
(if yes see back of form) _ "SUBTOTAL
I hereby a:knowledge that I have read this application.that the information
given is correct,that I am the owner of authorized agent of the owner.and 5% SURCHARGE
that plans submrned are in compliance with Oregon State Laws
Signature of Owner/Agent Data i PIAN REVIEW 25% OF SUBTOTAL
Re red onry f 1!x,,ure 'otal i1>9
TOTAL
Contact Person Name Phone E--' nimum permit fees 525 5%surcharge.r!xcept Residential Backflow
Ile �z��-� 3Fr Prevention Device.which is S1-� -5%surcharge
103 2113 5 L• pimapp.doc 12;96 (dst)
PLEASE COMPLETE AS APPROPRIATE-T-0-FROJECT:
LF-,X—tyres to be capped, moved or replaced City
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only — _
Water Closet _
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2" _-
3"
4"
Water Heater
Laundry Room Tray
Urinal _
Qther Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:`,p1mapr •1• 2196 (dst)