12414 SW 134TH AVENUE 12414 SW 134TH AVENUE
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CERTIFICATE OF
CITYOFTIGrAp4v!
OCCUPANCY
CIiYOFT16r71RD PERMIT N. . . . . . . a BUPS91424
COMMUNITY DEVELOPMEHYT DER*Fa4 f o�noow PRIM. PERMIT N. : 891424
13125SwFWI8W. P.o.8=2M97.Tipad,%Upon o72Y (6W)6394176 �- / DATE ISSUED: 04/12/n0
SITE. ADDRESS- ,, !Ph 14 SW 134TIl AVE. PARCEL_R ''S184AB-13600
SUBDIVISION. . . . a ZONING&
BLOCK. . . . . . . . . . : LO1 . . . . . . . . . . . . . 1164
CLASS OF WORK. tNEW
TYPE OF USE. . . aSF
OCCUPANCY ORP. aR3
OCCUPANCY LOADa
TENANT NAME— it
it
Reamarkst 3 bedroom house plum Jen
Owners _.._�__.._____._._..._..._..._........_.__.._..______...__....._.
DAN E ANDERSON
I
9363 SW AE:AVERTON--HILLSDAL.E:
M HWY.
BE.AVE FUTON OR 00000 -0000
Phoney N: 0008600090
Contractors -______..._._.._._.___....._._.. _..........._._...__. ..__.
D. E. ANDERSON INC
936.3 SW BEAVERTON HIGHWAY
BEAVERTON OR 97005
Phone N: 297-7666
Rej 0- 1 46344 �
Occupancy of the above referenced building is tie-rob), given, and ce•rti f irs
the compliance with tho State Of Oregon Specialty Codes for the group,
orci.tpanr.y, and use under which the refere red permit was issued.
_ - FIRE DEPARTMENT OUILDINf ..SNCVfEi;!'gR
AUI NO OF'F'ICIAL
POST IN L;ONSPICUOUS PLACE
INSPECTION NOTICE
Q� City of Tigard Building Department
(I�) P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of inspection _ /- i.v
Date Requested `J Time--- A.M. _p M
AddrPsa Permit #e"t Y `�
Owner Lot #
Builder 122c A t' p cxj {,h:! +i iC
The following Building Code deficiencies are required to be corrected-
Presented to _
Approved
Inspector
-- Disapproved
Date %t
CALL FOR REINSPECTION
EJ YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department �7
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
ryp, Ins llion
Date Requested_ y_ �'/ Time A.M.�s P.M.
Address —�� �J`7 1.� Permit #_ L _
Owner--- A Lot # C�1=�•�-�_
BuilderThe following Building Code deficiencies are required to be corrected:
Presented to � � _ _�— Approved
_ ;,
Inspector f,, � ____ Disapproved
Date _
CALL FOR REINSPECTION
❑ YES 0 NO
I
I
i
i
i
i
..........
I
(- �,✓ INSPECTION NOTIEt OG,,/-J�V �
l^ � City of Tigard Building DepartmentL�
P.O. Box 23397
Tigard, O!pgon 97223
Phone: 639-4175
Type of Inion -
Date Requested—�. �`t'[� Time y.M. P.M.
Addressmit
Owner__— — Lot #— —
Bnilder_
The following Bulling Code deficiencies are required to be correctud:
i
I
Presented to '7 r Approved
Inspoctor _ 'Disapproved
Date
CALL FOR REINSPEMON
�( YES I.] NO
w
I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397J� /
Tigard, Oregon 97223 C C/
Phone: 639-4175
L
Type of Inspection
Date Requested `�`� Time A.M. P.M.
Address Permit # _
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to P Approved
Inspector _ .i [J Disapproved
Date
CALL FOR REINSPECTION
1-1 yes 0 NO
INSP,$CTION NOT! E
City Tigard Building partment
P.O. Box 2W7
Tigard, Orep6n 97223
Phonw 4139-4175
Type s ction 11 N -U,--L
Date Requested Time A.M. P.M.
Address -3V Permit
Owner Lot
Builder
The followi,ig Building Code deficiencies ar-i required to be corrected:
4�F
A
4d/— 17E;,4 FrJ,6-ES
Presented to Approved
Inspector F Disapproved
Date
CALL FOR REINSI ;''TION
O YES "j vo
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection 1 — ---. .-- -- ----
Date Requested �/ " C > Time A.M. P.M.
Address y�`� �� — Permit
Own-r / Lot #
Builders r ��Z --
Thfollowing Building Code deficiencies are required to be corrected:
_�'r_w(a�sC. .tf t el
-
e
a
Presented to _ _ rT"Approved
Inspector _ ❑ Disapproved
Date
CALL P'OR I" 'INSPECTION
❑ Y28 ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested. 'O q Time_ A.M. P.M.
Address �17 �y��'r _--_.__ Permit
Owner _ Lot # _
Builder
The following Building Code deficiencies are required tc be corrected:
i'
Presented to _ _ --�' � � Approved
Inspector r _ Disapproved
Date �/'
CALL FOR REINSPECTION
1 YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested ��� Time_,L� A.M. P.M.
Address L�7_-�, ~--- ---_�— Permit
Owner_ — Lot #
Builder
The following Building Code deficiencies ara required to be corrected:
f
j-v
Presented topp
A p
roved
Inspector _ ❑ Disapproved
Date —
CALL FOR REINSPECTION
❑ YES fl NO
fi
I
Wff
INSPECTION NOTICE
City of Tigard Building Department
P.O, Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection 't )
Date Requested A./ - 26 Time X/-- A.M. P.M.
Address Permit
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
A4
Presented to e. rApproved
Inspector 0 Disapproved
Date
CALL FOR REINSPECTION
El YES 0 No
I�
I
INSPECTION NOTICE
C;ty of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 L
Type of Inspection '1921 �� / tt- , ��)
Date Requested -..z Z/`(f rime. ti A.M. P.M.
Address
Penait
Owner_ Lot #
BuilderThe following Building Code deficiencies are required to be corrected:
Presented to
Inspector _
...y. Approved
L1 f�---11
Disapproved
Date —_ l<� -
CALL FOR REINSPECTION
YES Ll NO
I
INSPECTION NOTICE
City of 1 igard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested !� Time A.M. P.M.
Address �.c�_�!/L�__f �r/�� Permit # 1
Owner_ Lot #
Buildar 22L'd'zCe'rz
The following Building Code deficiencies are required to be corrected:
Presented to _—_ i Approved
Inspector ,� _ Disapproved
Date
CALL FOR REINSPECTION
■
INSPECTION NOTICE
City of Tigard Building Departr.gnt
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested 'e'6�- Time G7
P.M.
Address Z' !Zlz!!� Z3 Permit
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
Presented to
Plipproved
Inspector
EJ Disapproved
Date
CALL FOR RErk-spaTION
1-1 YES I I NO
— BUILDING PERMIT
CITYOFTIGARDPERMIT NO. : BU891424
CITY OF TWA RD
COMMUNITY DEVELOPMENT DEPARTMENT OREGON TE ISSUED: 9/15/89
13125 S.W.Hall Blvd-0.0.Box 23397,Tigard,Oregon 97223,(503)639-4175 P I M.PMT.NO. 891424
JOB ADDRES: 12414 SW 134TH AVE
TAX MAF'/LUT 2S14AB SUB: MORNINGHILL LT:164 PK:
LAND USE: R25
LOT SIZE: VALUATION: $ 90,232 SETBACKS
FRONT: REAR:
WORK CLASS: NEW DWELL.UNIT9: 1 LEFT: RIGHT:
USE TYPE: SINGLE FAMILY NO.BEDROOMS: 3 EXT.WAI_L CONST:
CONST.TYPE: VN NO.BATH: : 2 N: S: E: W:
OCCUF'.GRP. : R3 FIROT.OF'ENINGS:
OCCUP.LOAD N: S. E:
IOTNI_ AREA: 1926
NO.5TORIES: 1 1ST: ROOF CONST: C FIRE RET?
HEIGHT: 14 2ND: AREA SEPAR? RATED:
BASEMENT? 3RD: OCCUP.SEPAR? RATED:
MEZZANINE? BASEM'T
FLOOR LOAD: 40 GARAGE: 689 FIRE SPRKLR? ALARM?
FLOW(GPM) DETECT'? YES
HEAT TYPE: GAS HDCP.ACCESS? CORi,?
PLAN CHECK BY: bcr
nEMARY,S:
bedroom house plias den REISScE OF NO.
LAST REISSUE
FEES:
w
O ANDERSON DAN f PERMIT 1406.00
N 9363 SW BEAVERTON-HILLSDALE PLAN REVIEW $263.90
R beaverton Or FIRE DEPT
R
STATE TAX $20.31
OTHER
C DEVELOPMENT CHARGES:
N FINDERSON DAN F. SDC(STORM' $250.00
T ML2DOWBROOK DEVELOPMENT SDC(STREI '600.00
R '9363 SW BEAVERTON-HILLSDAL-E PDC(N1 ) $250.00
A
C beaverton or 97006 PREPAID ( t10H.00)
T PHONE (503) 297--7666
n
R REGISTRATION NO. 46344 TOTAL: $1,690 .20
L_ -
RECEIPT NO.
This permit is Issued subject to the reg.11atlons:onteined In Title 14 �F
of the TMC. State of Oregon Specialty Cudes,zoning regulations
and all other applicable codes and ordinances, and it Is hereby REQUIRED INSPECTIONS
agreed that the work ,Ill be dodo In accordance with the plans and FOOTING SEWER
specifications and In compliance with all applicable codes and ►FOUNDATION WALL RAIN DRAIN'S
ordinances The issuance of this permit does not waive restrir.tivE ,
covenants Contractor and subcontractors shall have current city POST x BEAM WATER LINE
huslness tax permits This permit will expire and become null and PL B.UN DERSLAB CITY APPRCH,"5W
void if work is not started within 180 days.or If work is suspended or SLAM FI NAL
ahandoned for a period of 180 wys any time after work has PLB. 1OP0U1
commenced It shall be the responsibility of the permittee to assure FRAMING
all required inspections are requested and approved F IREPLACE
GAS LINE
INSULATION
GYP. BOARD
Permittee Signature
lss,led By EALL FOR TMSPEETi43 4-639-4 ----
1
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
fair W WSf Wlm
CITY OF TIFA
SEWER PERMIT
RD PERMIT NO. : SE8914:;3
CITY TWARD
COMMUNITY CIEVEL OPN�ENT DEPARTMENT "'�
TE ISSULD: 9/15/89
13125 S W.Hall Blvd.,PLO.Sox 23397',igard,Orogon 97223,(503)639-4175 P I M.PMT.N0. 891424
f JOB ADDRESS: 12414 5W 134TH AVE — USA NUMBER: 39057
TAX MAP/LUT 2G14AB SUB: MORNINGHILL LA :164 BK:
LAND USE: R25
LUT SIZE:
SECTION: 4 TWP: s RNG: w
WORK CLASS: NEW
USE TYPE: SINGLE FAMILY
The applicant agrees to comply with all rules and regulations of the Unified
f�ewerage Agency. The permit expires 120 days from the date issued. The total
amount paid will be forfeitpr+ if the permit expires. The Agency does not guar-
antee the accuracy of the location of the side sewer laterals. If the sewer is
not located at the measurtvt_nt given, the installer shall prospect 3 feet in
all directions from the distance given. If not so located, the i •stalle•r shall
purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral.
INSTALL. TYPE: BUILDING SEWEK IMFI RV10US AREA:
FIXTURE UNITS:T ': TENANT IMPROVEMENT: NO
DWELLING UNITS: 1
NO. OF BLDGS. : 1
[FEES:
O
W ANDERSON DAN E PERMIT
N 9363 SW BEAVERTT'-NILL-SDALL CONNECTION CHARGE 41 ,150.00
R beavertan or LINE TAP INSTALL.
_---_--_-_ -- - OTHER
C
O
N ANCERSON DAN E
T MEADOWPRUOK DEVELOPMENT
A 9363 SW BEAVERTON-H1LL.SDALE
C beaverton or 91006
T PHONE (583) 297-7666
RI RLGISTRAIIUN NO. 46344 TOTAL: $1,285.00
This permit is issued subject to the regulations contained In Title 14 RECEIPT NO. cX .3574
of the TMC. State of Oregon Specialty Codes. zoning regulations
and all other applicable codes and ordinances, and it Is hereby REQUIRED INSPECTIONS
agreed that the work will be done In accordance with the plans and ROUGH—IN
Ispecifications and In compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive
Icovenants Contractor and subcontractors stall have current city
business tax permits.This permit will expire and become null and
volu if work Is not started within 190 days.or f work Is suspended or
abandoned for a period of 190 days any time after work has
commenced It shall be the responsibility of the permillee to assure
all required inspections are requested and approved
f
PAMea at
Signure
Issued B -
i �rr�tt r(� r �r7s�----- _
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
C17Y OF TINA PLUMBING PERMIT
PERMIT N0. : PL891451
UTnP
COMMUNITY DEVELOPMENT DEPARTMENT TE ISSUED: 9/15/89
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigare Oregon 97223,(503)639.4175 I M.PMT.NO._ 891424
JOB ADDRESS: 12414 SW 1341H AVE
TAX MAP/LOT 2S14AB SUB: MORNINGHILL LT:164 BK:
LAND USE: R25
LOT SIZE:
ITEM: NO: NO:
WORK CLASSe NEW WATER CLOSET 2 TRAP
USE TYPE: SINGLE FAMILY URINAL BKFLOW PRVNTR
CON,T.TYPE: VN LAVORATORY 4 TRAP PRIMER
OCCUP.GRP. : R3 TUB SHOWER 2 GREASE TRAPS
DISHWASHER 1
GARBAGE DISPOSAL 1
NO.STORIES: 1 WASHING MACHINE 1
DWELL.UNITS: 1 LAUNDRY TRAY BLDG.DRAIH (AIA
FLOOR DRAIN
SINK 1 SEWER (FT)
WATER HEATER 1 SFORM/RAIN (FT 100
OTHER
REMARKS:
3 bedroom house plius den
FE _5:
0
w ANDERSON DAN E PERMIT $132.50
N 9363 SW BEAVERTON-HILLSDALE
Rbeavertorl or FIXTURES
STATE TAX $6.63
- --__._---_-___-- OTHER
C
0
N WOLCOTT PLUMBING CONTR5 1NL.
A POBox872
C Gresham OR 97030
PHONE (503) 667--1781
a REGISTRATION NO. 23841 TOTAL: $139. 13
RECEIPT N0. �/.'
1 his permit is issued subject to the regulations contained in Title 14 _
of the TMC. State of Oregon Specialty Codes.Zoning regulations REOUIRILD INSPECTIONS
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done In accordance with the plans and PLB.UNDERSLAB
specifications and in compliance with all applicable codes and POST K BEAM
ordinances The issuance of this permit does not waive restrictive WATER LINE
covenants Contractor and subcontractors shall have current city PLB.TOPOUT
business tax permits This permit will expire and become null and
void if work is not started within 180 days.or if work is suspended or RAIN DRAINS
abandoned for a period of 180 days any time after woik has FINAL
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Per r ttee Signature _
Issued By eAtt. FOR INSPEC"tw
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY �� TIVA
� MECHANICAL PERMIT
� , PERMIT NO. : ME891452
GW0f n6ARG
COMMUNITY DEVELOPMENT DEPARTMENT �ar'o«
TE ISSUED: 9/15/89
13125 S W Hall Blvd..P.O.Box 23397.Tigard.Oregon 97223.(503)639-4175 P I M.PMT.N0. 891.424
JOB ADDRESS: 12414 SW 134TH AVE
TAX MAP/LOT 2S14AB SUB: MORNINGHILL LT:164 BK:
LAND USE: R25
LOT SIZE:
ITEM: NO: NO:
WORT; CLASS: NEW FURNACE (100K AIR HANDLR (10
USE TYPE: SINGLE FAMILY FURNACE 10OK4 1 AIR HANDLR 10K
CONST.TYPE: Vf" FLOOR FURNACE EVAP.COOLER
OCCUP.GRP. : R3 HEATER VENT FAN 4
VENT VENT.SYSTEM
BLR/COMP (3HP HOOD 1
NO. STORIES: 1 BLR/COMP 3--15HP INCINERATOR(DOM
DWELL.UNITS: 1 BLR/COMP 1C•-•30HP INCINERATOR(COM
FUEL TYPE GAS BLR/COMP 3050HP REPAIR UNITS
1AX. INPUT BLR/COMP 50*HP OTHER 1
IRE DMPRS? GAS PIPING OUTIETS i
HIGH PRESS?
LOW PRESS? — ---- _— r
REMARKS:
3 bedroom house plius don
FEES-
IN ANDERSON DAN E PERMIT 110.00
N 9363 SW BEAVERTON-HILLSDALE PLAN REVIEW $10. 13
R beaverton or FIXTURES $30-50
SLATE 'FAk $2.03
---- - --- --— OTHER
C
0
r:
T FOUR SEASONS HEALING AIR GOND.
A POBox66469
C Portland Or 97266
T PHONE (503) /15-5913
REGISTRATION NO. 48283 TOTAL: ♦52.66
RECEIPT NO. A)J ,i,:s—6
This permit Is issued subject to the regulations contained In title 14 _ __
of the TMC, State of Oregon Specialty Codes, toning regulations kEOUIRED INSPECTIONS
and all other applicable codes and ordinances, and It is hereby
agreed that the work will be done in accordance with the plans and GAS LINE
specifications and in compliance with all a,,plicable codes and POST R BEAM
ordinances The issuance of this permit does of waive restrictive ROUGH-IN
envnnants Contractor and subcontractors shall have current city FINAL
business tax permits This permit will expire and become null and
void If work is not started within 180 days.or if work Is suspended of
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permillee to assure
all required inspections are requested and approved
Permittee Signature
Issued By —
I
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
RF W wffw�w ff-xla���W-AWA
CITY
OF
TKA
RD jt PLAN CI(LCK APDLj�CATION
1 cmo�r�cAFM J PIAN CHECK 11 (,�- '`� 3/ '
COMMUNITY DEVELOPMENT DEPARTMENT / PERMIT tt ,r `/ 1yay
uer;sw.Faeai.a r.o.ao�zzsv�.1�«do.�o�9�r�•C1��'n / DATE ISSUED
JOB ODRESS�� /_'—� S �- I AX MAP/LOT _
SU �.f (OT: LAND USE:
V LUATION: -
OWNER SPECIAL NOTE'S
NAME REISSUE OF:- ----_—
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
---- fLb SENSITIVE LAND:
PHONE:
APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME: ENGINEERING:
AFIRE DEPT
ADDRESS:
OTI(ER: �_...
PHONE: ITEMS RE UIREO
LIST/SU(3CONTRACTORS:
AROVENGINEER BUS TAX:
CALCULATIONS:
ADDRESS: TRUSS DETAILS:
PARKING PLAN: —.
- LANDSCAPE PLAN_
PHONE: OTHER' -- _ _--
COMMENTS: ----
-11"Awaoe,111162
PERMIT H ACCT N DESCRIPTION AMOUNT AMOUNT PD. (IAL. DU(.
10-432 00 Building Permit Fees v ------
1.0-431 00 Plumbing Permit Fees -------
_�— 10--431 01 Mechanical Permit Fees _ — -
10-230 01 State (luilding Tax (5X)
Rui ldirr) _
Plumbing
Mech
10-433 00 Plans Check Fee _ 1 ----
Building
Plumbing _
Mech
30-202 00 Sewer Connection
— - 30-444 00 Sewer Inspection -
51-448 00 Street system Dev Charge (SOC) __--
52--449 00 Parks System Dev Charge (POC)
31-450 00 Storm Drainage Syst Dev Chrg (SSDC)
10-2.30 09 TRFO _ --- - - -
10-230 06 Washington County Fire NI (95X)
10—VO 00 AmarC9rwood
O
nPPLlCAN GNAtuRE.
Received By: _ ` -- -- Data Received: -
co/3587P/l8P
U I Y VI• I IUAHU MECHANICAL PERMIT Permit M
Description
City of Tigard
able 3A Mechanical Code _ CITY PRICE AMT
-
13125 S.W. Hall Blvd. 1) Permit Fee -0- •0• 10.00
P.O. Box 23397 -- --
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents- 6.00 f�>.
Furnace 100,000 BTU +
2) incl.ducts&vents 50
Name of Development Floor Furnace
3) incl.vent 6 00
Job Address - Suspended heater,wall heater
Address �� yJy ��,/, /lc�rs f� f��^�� 4) or floor mounted heater _— 800
Tax Lof Map No Vent not incl.in
Lof f G Block Subdivision 5) appliance permit 3A0
Name for name of business) 6) Repair of heating,refr ig., 600
cooling,absorption unit
Mailing Address Phone 7Boiler or comp to 3 HP
Owner ) absorp.unit to 100,000 BTU 8.00
_E'—1y slate Zip Boiler or comp to 3 HP•15 HP
8) absorp.unit to 500,000 BTU t 1
Name - Boiler or comp 15.30 HP
_9) absorp.unit' -1 million 15.00
h
Mailing Address Phone — 10j Boiler or comp to 30-50 HP 22.50
absorp.unit i -1.75 million
Contractor City State ZipBoiler or comp to 50 HP
11) absorp.unit 1,750,000 BTU 31.50
Stele Reg strehon No City Bus fax No 12) Air handling unit to
10,000 CIF P.4 4.50
I herebv acknowledge that I have read Ih s application that the information given is 13) Air handling unit ' SO
1
correct,that I em the owner or autfanted agent of the owner,that plans submitted are m 0,000 CFM +
compliance with State laws,that I em registered with the State BuildersBoard,that the 141 Non portable 4 50
numbu,,.van is correci (if exempt from State registration please give reason below) evaporate cooler
Vent fan connected
-- -- 15f to a single duct y !PO
1(') Ventilation system not
included in appliance permit 4 so
Hood served by - - - -
17) 4.50
mechanical exhaust
Signature towner rx agent)_ Dab Domestic type
Describe work Cl addition Cl alteration LI repair O 18) Incinerator t.50
-to be done residential (J non-residential Ll 1 b► Commercial or industnat mr 3000
Existing use oftypeIncinerator--___ - __ __
building or property _ Other i e woodstove,water
20) heater,solar,clothes dryers.etc 4
50
Proposed usu of _
building or property __ - 21) pas piping one to four outlets 2.00
Type of fuel- oil I natural gas LPG ❑ electric ❑ �-' '•
22) More than 4-per outlet
NQT!_QE — - - SU&TOTAI
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 SURCHAMN
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF 9111111111-TOTAL 9 4P
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER - -----
WORK IS COMMENCED TOTAL
Special Conditions
---- - -- -- -- Date issued - --- - - by .
r
Is t ■r a ItWA
P.O.Ibx 23397
CITY OF TIGARD PLUMPING 13125 _cWIbU Blvd.
2�� CR 97723
Applicants must hold Oregon R.glstration to conduct a plumbing PERMIT 639-9175
business or must be property owner/operator not hie ing outside.help.
Name of Development
ALOI� '. Plumbing Permit No.
Address Description
.z V/� _(1 V¢=_L�___ �r/f�7(} ORS 814-21.010 DUAN. PRICE AMT.
Job Tax Lot Map.No.
Address
__ -- FIXTURES
Lot Hkx:k Subdivislon - - -- --
/ Sink 7.50 7 SD
Name or name o sines Lavatory _ 3 7.50 7�.`SV
Tub or Tub/Shower Comb ' 7.50
ing-A3dross ----_----
Shower Only 7.5u
Owner Clry/State - Znp Water Closet -- 7.50
Dishwasher _ Y I 750 7
-----_--�- _----. Pe Garbage Disposal -� _ 7.50
Name Washing Machine_ I 7.50 L�
Floor Drain _ _ 7.50
T�aTng A(T�rass - Phone_.. Water Heater _ 7_50_ -2 - f
_ Laundry Room Tray 7•.0
Cc,�upant City/State Zip Urinal _ 7.50
--- ams Photie Other Fixtures(Specify) 7.50 -
7.50
ar ingA Phoria 7.50
Contractor City/State - -_---Zip — - - 7.50
MISCELLANEOUS
--- City Hue TTax iJo Sewer 1 at 100' 30.00
tate !. tate Sewer-ea.Addd 100' 15.00
(Residential) Water Service 1st 100' _ 20.E
I herel,y*(.'knowledge that I have read this application,Hut the 6 dormation Water Service ea.AoiitMr 15.00 --- -
grven is correct,that 1 am registered with the State Builds s Hoer J.and also Storm g Rein Draln 1 tp.100' 30.00
nsr
have a Stale Plumbing license that the numbers gtvn aro oonrd.Moat all - --
glue.!r+nng wr.-k wie on done in accordance with appacar io provisions of Ore- Storm b P!-tin Drain Addh.100'- _ 15.00 ---
gon Revised Statutes Chapters 447 and 693 and sppllc rble codes and that Moate!•tune Spm 25,00
no help will be employed unless licensed urxirw ORS 093 (H exempt from ----- — -
State registration,please give reason below) Back Flow Prevention
HOMEOWNERS -1 hereby owtify that I am the ownrw of the property de- Device orAnti-PollulionDevice 7.50
embed above,at which location 1 propose to maks a pkrrt*v Installatlon for Any trap or waste Not
my own use and thio property In not being corglnxaed for sale,tease or ren" Connecled to a Fixture 7.50
Ca"Basks ^ - ----- -_ - 7.50
kW.of Exist.Pluirnbmg 40.00 Par Hr.
Specialty Requaated Inspections t 40.00 Per Hr.
-_- -- -- Altar.of Pkxnbkq within
_ _—_ -- --- an Existing Bldg 15.00 min -
_-- ----
AUTHORIZED SIGNATURE Dal"- Now Bldg.or Build.Addition 25.00 min
— ' )DLain,sUU1e famil
Describe work new{_I addition(] alteration{-J repair f I r3.ell' 15.00
IQ be dorle resldentialL1 non-reskiential[J
Exch ng use of
Sue-TOTAL
btllldtrlp rx prr>Ewrty ._..-
P1tppMd u"of - - Ik KOCHANN t: y
ix"g or pmpetty -- - _- TOTAI _
NOTICE -
ThM penma beoomos null antivoid M warn or oonwuoticn with"":ed la m1 con
mum W*Mhln 190 days w 11 oerrdnictkxu or work is*upend or abandoned
s perkxl d 190 dayr alt any sme ellen wok is arxnrnenowl
8MCuu.OONO(T/ptttl
Data Isetre•1 by -
Meadowbrook Development
D.E. Anderson, Inc.
9363 S.W. Beaverton Hillsdale Hwy. • Beaverton,Oregon 97005 • (1503)297-7666
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