11980 SW NORTH DAKOTA STREET s �. • ss
11980 SW NORTH DAKOTA STREET
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IffnrTION NOTICE
City of Tigard Building Bepartswant
13125 SM Bell Blvd. Tigard, Oregon 97223
Inspection Line
--..�( Phone): 639-4175 Business Phone: 639-4171.
Inspections
Fasting Plbg. Ut►derslab Mach. Rough-in Appr/Sdwlki
Tound. Plbg. Top Out Cas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg. i
last/Beam Mach. Rain Drain Inv:latlon -Plumb.
Pibg. Underfloor Nater Line Gyp. Bd. -Hoch.
Date kay.,ont_edt 'r-,� Timet �_AM PM
/ ,t n
Addreee: ! `� i `PerLmit 4. J
Builder:
T11R FOLLOWING COR14TTONS iii" RZQUIRZDt
Inspector �'" - - -- -- Dates
APPROVRD DISAPPROVED APPROVRn SUBJECT To ABOVE
1
Call For Reinep.
CITYOFTIFARD ciffly TWID PLUMBING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT ueleooN PFr-r1TT #. . . . . . . .. PLM9 1—0041
131.1 SW Holl Blvd. P.O.Box 23397,Tkpd,Oregon 97223(603)8394176
1'64
� -P i @ L4
illt= ODDRESS. . . : 1198LA SW NORTH DAKOTA ST PARCEL: 1S134CA-03001
3UBDIVISION. . . . : BURLWOOD NO. 2 ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . .. . . . . . . .
CLASS OF WORK. . :ADD GARBAGE DISV'OSALS. . MOBILE HOME SPACES. $
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : DACKFLOW PREVNTRS. . : 1
13CCUPANCY GRP'. . :R3 FLOOR DRAINS. TRAP53. . . . .
VORIES. . . . . . . . .
WATER HEATERS. . . . . . : CATCH
L-ALJNDR"(' TRAYS. . . . . . . GF RAIN DRAINS. . . . .
S'INKS. . . . . . . . . . t URINALS. . . . . . . . . . . . .. GRHSE TRAPS. . . . . . . :
LAVATORIES. . . . . .. OTHER FIXTURES. . . . . :
TUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . -
14ATER CLOSETS— : WATER LINE (ft ) . . . . :
DISHWASHERS. . . . : RAIN' DRAIN
Remav-1<5 -- SPRINKLER SYSTEM
Uwner,: hEES
MARK NIELSEN tvDe pmol.mt by date r-err)t
` 19A1,71 SW NORTH DAKOTA VIAYM $ 15. 75 JLH 03/25/91
PfRMT $ 15. 00
IiGORD OR 97223 5PCT $ 0. 75
Plimie 0:
Contv,sc_tov,:
f.)WNF.�..R/CONTRAL TOP
I-Itione *r, 15. 7`,3 TOTAL
PJa�11
REQUIRED INSPECTIONS)
_---- -
This peroit is issued subject to the regulations contained in the Final Insipprtion
Tigard Municipal Code, State of Ore, Specialty Codes and all other
applicable laws, All work will be done in accordance with
approved plans. This cervit will mire if work is not started
within leO days of issuance, or if work is suspended for sure
than 18@ days.
Ine-mittee
trisk.ied Bys
Call for insDPutiGn 639-41715
CITY OF' TIGARD F4F—(-,EIPT OF r.'A-YMFN*I' RFC t-"l PT NO. 91--21016
CHECK AMOUNT s 115. 75
NAME 114tELSEN, TONYA CASH AMOUNT i it I L71 0
PAYMENT DATE a 03/25/91
SUSS I V 13I ON
11990 NORTH DAKOTA
PURPOSE OF' PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUN r P(-'l 11)
'I—L)MBING PERM ~ PLM91--0041 1,25. 00 ST. BUILD PIFR _.0^ 75
SP F?I
NKL,rR SYSTEM
TOTAL AMOUNT PAID 15. 75
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? - 1025
1025 DATE �"
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT f
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAIL �.... �..............TIGARD SANITARY DISTRICT
By
q
CONNECTION INSPECTED AND APPROVED
Date 8upeAiitendent
Address IW DA eif rA Permit No. 1492d—
Name of Occupant Permit charge
Connection fee 2 X&
Paid by
Date connected 47
Type of Building JC� Inspection fee -Z-0—
Service Rate--- Paid by __ -- Date
Contractor Assessment— Paid
Size of connection +
CITY OF TIGARD
PLUMBING PERMIT ( �3 �� 131.25 SW HALL BLVD.
P. O. BOX 23397
Applicants must hold Oregon Regisuation to conduct a plumbing T I GARD, OR 97223
business or must be property owner/operato(noel hiring outside help.
Neme d Oevek)pnwnl
- (503)639-4175
- -- - -- -- _ Plumbing Permit No. _ - -
Acldress Doscnption
ORS 614-21-61C DUAN. PRICE MAT.
Job Tax Lot Map.No.
Address
i1XTURES
Lot Elkhck StbA�ivlalan -. _`_.____----- - - 7.50 --
a wi or name a 5FS*teas Lava" -- 1 7.50 - -
G{ Tub ex Tub/Stxswer Comb 7.50
Ma" ess Sihoww Onty 7.50
/( j ( � K 0 - Waist Cknel J z 7.50
Owner - - -
-T 7.50
Garbage Disposal -- _ -__ 7.54
Name WashinV Mactwne 7.50
-- -- -
Fba Drain
mg morass Phone Water Heater 7.50 -_
-- Lp ---- ! 'dry POorn Tray -- 7.50
Occupant City/State
Lkinal 7.50
PtKxlo OewFixtures(Specify) --- - 7-50
7.50
4mmwqmess -- Phare - 7.50
Contraclor C8y/State- ------- 23p - 7.50
MISCELLANEOUS _
----_____-__----
City Bus.Tax No
15.00 N
_ 1 (ResxientiaJ)-- - _ waler Swvioe tst 24.0 _
1 hereby adw*wW"that I have read fhb WV%catkw%dW the YdonnaUon Water service ea Addit lJDh_ ^_ 15_00 - -
giwn is oorrecd VW 1 am reortered with the State Buildoes 000d.and at- Sk mn 6 gait Drain 1 t1.100' - 30.E -
he"a Stab Pkxv**vV license Thal the nunt rs pivon ars oared.VISI aN -- -`
pkrmbw>V work will be done in aomwdance with applk e"p of Ore' Sbrm L P.yn Drain A&M.100- 15.00
Don Revised Statutes uismors 447 and 69r3 and appilcable codes and Val Mobile fbxne Spsoe 25.00
no help will be arnpkhyod hwdess loorwed under ORS 683.(11 exartKA from --- --
State registratkm,pbaso"resson bah". Back Flow Prevention
HOMEOWNERS--I hereby 0ertify tut 1 am the owner of the property de- Device or Antr-Poilutwxh Dov" --1.50
Barbed above.at wt* h locator 1 propose to maks a plumbkhV lrtefaMatkxh for Any Trap or Waale Not
nvy awn use and fhb property is rr t bokhV oarftrucood for sale,lease of"w* Comer?b s Fixture - - -- 7.50
Catch Basin 7.50
kap.d Elm.pkmt*v 40.00 Per M. _ -
�' ----- ----- - SpepiNp Requested InspWlons - -V40.00 Pr t*
--- -_ --- -- ----- -__-�- - Ahm.d- within
an Exwm BIdV 15.00 min.
AUTf4ORIZFD SIGNATURE Data New Bldg.or Build.Addlton 26.00 min. -
[ �LYain, le Galnil -
Descr#3o wok new[] addition[] aflembon U repair C7 Cuellia, 15.03 --
be done resideordial[] rlan-f�seldential j]-_ --
Fxfs"use of
txtldkV(xlrcn)ooty _�---_-----.------ $25.00 minimum SUB-TOTAL _
5% SURCHARGE
25% PLAN REVIEW -
Th%penult b oorxhvee rvLA and void N wank or const xiod h a awttad Is ml c om TOTAL
monad vrMhkv 160 dayarvr V co naft Man or world is ouspen(W osbardoned fur
a porlod d ISO 6"at any ernw atMr,work Is oornmero d.
411"CfAL OG*ffafT10"S
nate lasuod by .-- ---- ---