13900 SW 102ND AVENUE 13900 SW 102ND AVENUE �,
INSPECTION NOTICE
City of Tigard Building Department
1-4zu S.W.Main St.
Tigard,Oregon 97223
Phone: 639.4171 /
Type of Inspection
C-- �
Date Requested /i Z 4 — Time _ A.M.__ P.M.
i Address 'fact- �/ �d'Z- PPrmit #...
4�J
Owner—_� _ -�f%'�4�.-i _ -- Lot
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Builder—�►L— .,a --------The foll-,wing Buil6ing Code deficiencies are required to be corrected:
Presented to — — pproved
Inspector —_ _• [.] Disapproved
Date
CALL FOR REINSPECTION
❑ YE8 ❑ NO I
CITY OF TIG AD P11,1mbj1't:j Permit
Building DepartMent 3 7� '
'ial ��O'
Resider, —
,� Commercial
New Installation L] Replace ( ] Addition ❑ Alteration
Licensed JA � ,�t
Date-.11! C.
Plumber 1 ;D1 tom'
Owner
Address 7o LJ
_ Job Address 13ea) Ida.,
Phone -�'_rtl
CITY BUSINESS LICENSE REQUIRED FOR A 1 CONTRACTORS AND SUB-CONTRACTORS
_— ITEM NO. FEE TOTAL IT►_M NO. FTOO
OTAL
Fixtures-Traps — 7.50 Sewer:First 100 ft. _ 30
Dishwasher_ _ _ 7.50 Each Addit.100 ft. —� —_ 15Garbage Disposal 7.5C Ejuctor Pump 7 _
Water Heater 750 Water:First 100 ft. _ _ 20.00 _
Backflow Pre';ent r ` `7.50 — Each Addit.200 ft. — 15.0.0
Storm&Rain Drain:First 100 ft.
_ _ 30.00
i
Each Addit.200 ft. —
--- _ 15.00
Mobile Home Space _ 25.00
Other(Specify : A_._ Rain Drain-Single Fam.Dwellinq 15.00 —
PERMIT FEE I,' 00 Comments— --Y — -- ^
§STATE ,/, % 06(' Issued 9y: _
Receipt No Applicait sem_ �n...�.t�_.r
TOTAL
/3 (,0
SignatuM
For Plm~ibing Inspection phone 639-4171