9945 SW PEMBROOK STREET 9945 SW PEMBROOF STREET
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CITY OF TIGARD l��umb:rrg Permit V18
6luRuing Department NO.
Residential Commercial ❑
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New Installation [�] Replace � Addition Alteration Ll Date�;
Licensed r (�pb� �► �`..G fl>�.
Plumber � t.6''ti,w1 _ Owner
Address _ ' _ _���- rty ( /� ---- Job Address,
Phony ff������� ' L`� ---- -- Applicant �'I/�!� Y Ali.1.� NiMn Y�r,�a --
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS AND SUB-CONTRACTORS _
ITEM NO. FEE TOTAL _ - ITEM _ NO. FEE TOTAL
Fixtures-Traps 7_50 — Sewer:First 100 ft__ - 30.00
Dishwasher ` _ 7.50 _ _ Each Addit.100 ft. _ 15.00-
Garbage Disposal 7.50 -Ejector Pump _ _ 7.50
Water Heater 7.50 ti 1 1 Water:First 100 ft. _- _ 20.00
Backflow Presenter 7.50 v Each A,idit.200ft.----- 15.00
.� Storm,,&Rain Drain:First 100 ft. 30.00
-----; L—' — t
E_ech_Addit.20_0 fl. 15.00— -- __ Mobile Home Space Y� — _ 25_ 0
Other(Specify): - Rain Drain-Single Fam.Dwelling 15.00
`_. � Comments: ._ LLL=�_f Cl�e,".£',;<2 'f
PE1iMIT FEE �' �1 ,
v Issued By:
f % - urU"�
Receipt No.
STATE Applicant _ r te:•-- / l !- --
TOTAL f,f C-0sIgnatre
For Plurnbinq Inspection Phone 639-4 t i t
I
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Orrgon 97223
Ph^^:. 639-4171
Ty,,e of Inspection _ J19,4--INJ
Dace Requested �Z�;' � S . Time—_—_. A.M. L � P.M.
Address --(( 56j ,,6TV U -5t—_/ -Permit #_31 39
Owner 1�0 I•'� f) o 15 __ Lot #_
BuilderThe following Building Code deficiencies are required be rxe d:
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— -- -- _—
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-- -— ---------
Presented
-----Presented to _� Approved
Inspector _.._._ _. �_ L_I Disapproved
1
Date --
CALL FOR RFINSPF,CTION
I ❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639.4171
Type of Inspection
Dwe Requested_ -2 do- Time-A.M.-_Atf P.M.
Address Ae/ Permit #_
Owner_ _ -- Lot #_
Builder --------
The following Building Code deficiencies are required to be. corrected:
-
Presented to n Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
C7 YEs C$NO
PERMIT
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UnifiedSewerayeAgencY
�.,�
of Washington County CITY OF / -G-G --------- DAl r
OWNER : — PHONE :
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
❑ SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE O� OCCUPANCY:
❑ NEW ❑ EXISTING ❑ SINGLE FAMILY COMMERCIAL
EXIST. (PRIOR 1"0 -1-1- 70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS
ADDRESS Or STRUCTURE : –
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer is not located at
the measurL-.ment given, the installer shall prosor-_'! inree feet In all directions from the distance and depth given.
If not so located, the Installer shall purr rase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will install a lateri l at the location specified by the installer.
FEES:
PERMIT FEE $ _–
CONNECTION CHARGE
LINE TAP INSTALLATION
ISSUED BY
01-HER
TOTAL ----
_ APPLICANT DATE
SEWER PERMIT
ADDRESS OF STRUCTURE
TAX MAP _� TAX LOT ?� c� _ SYSTEM
LOT BLOCK OF
4 J�- b'z.
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APPROVED BY DATE ISSUED BY DATE
D . U . ' 5 REMARKS
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