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IT
CITY OF TrGEAR® PERIIIIPLUM#.BING P
. :ERMPLML)6--012'8
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/03/96
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
PARCEL: 1S135JDB-03000
..2ITE ADDRESS. . . : 11555 SW 51ST AVE
SUBDIVISION. . . . : CHARBEN ZONING: R-4. 5
BLOCK.. , . . . . . . . . : LOT. . . . . . . . . . . . . : 11
CLASS OF WORI-/,. . :REP GARBAGE DISPOSALS. : 0 MOBILE NOME SPACES. : 0
I'YPE OF USE. . . . :SF WASHING MACH. . . . . . : I BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :A1 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
SI'ORIEG. . . . . . . . 0 WA'I'ER HEATERS. . . . . . 0 CATCH BASIN'S. . . . . . . . 0
FI X I'U LAUNDRY TRAYS. . . . . : 0 SF PAIN 14GAINS. . . . . : 0
S I N!%S. . . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE - RAE'S. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXT'URES. . . . : 0
_1'UB/SHOWERS. . . . 0 SEWER LINE (ft ) . . . : 0
WA I ER CLOSETS. . : 0 wNATER LINE ( ft ) . . . : 0
DISHWASHERS;. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks - Hot & cold line for washing nac.-hina.
Owner-: FEES
JANICE FLEENER type amount by dai;e recpt
11555 SW 91ST AVE PRIVIT $ 25. 00 CJS 0E-/03/96 96--280105
5
PC I 1. 25 CJS 06/03/96 9 6--2 B 0 1 O!j
I 1GARD OR 9722Z&
Phone #:
Contractor:
13ESCLJE ROOTER
PIC) BOX 1728
WILSONVILLE OR 97070
1-':,hone #: 685-9050 $ 26. 25 TOTAL
Reg z.4677
-------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. inspection
Tigard Municipal Cod-. State of Ore. Specialty Codes and all other Final InspectioTi
applicable laws. All tork will br done in ac�_uclai.ce with
approved plans. This permit will expire if work is n3t started
within 180 days of issuance, or if work is suspended for more
than 180 days.
i-,ermittee Signature:
un
issued B y s C'C le
cc Call for inspection 639-4175
_J
City of Tigard PLUMBING_ PERMIT APPLICATION Planck/Rec. # 96 �oc�los
13125 SW Hall Blvd. Permit # /?L
Tigard, OR 97223
(503) 639-4171
MINIMUM $75.00 PERMIT FEE + ST. SURCHARGE
New Single Family Residences Onr
C / f i(J i[
d""' S7– ❑ 1 BATH HOUSE 5140.00 F] 2 nATH HOUSE$'95.00
Job _ UJ (– ❑ 3 BATH HOUSE $215.,`.,
Ac!dress -�,, .t. J DP Fee includes all plumbing fixtures in the owelling and the first i00 feet
of water service, sanitary sewer and stem sewer. See fees below.
No— °.m.°rB—ml FIXTURES � QTY PRICE AMT
-w w ASink 9.00
M.I.9 Ade... Phm Lavatory 9.00
')wrier Tub or Tub/Shower Comb. 9,00
`o'''"" =° Shower Only
9.00
Water Closet 9.00
Dishwasher 9.00
Garbage Disposal 900
Occupant M.Mv ,... Mh Washing Machine y goo 4x_
Floor Drain 9.00 '
Z. Water Heater 9.00
Laundry Room Tray 9,00
N- Urinal 9.00
� ./' Other Fixtures (Specify) 950
M.i.y Adn... rn°n.
Contractor 9.00
s S S� �,�c" -XS i� 9.00
cfttsw. — 9.00
r 0.4–9. Ile � (/ Sewer 1st 100' 30.00
stn.lR"uati.°N. c,ty n„ r.,.N. Sewer -ea. Addit. 100' 25,00
/ 1Ci 7 _� Wates Servlce i5t 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
informatior. given is correct, that 14.,n fha owner or authorized agent of _
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please _
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
C tG ✓�`
L4Deviceor Anti-Pollution Device 900
Any Trap or Waste f'a
Connected to d Fixture 9.00
Describe work new v adidition O !+oration Q repair Catch 8aein
9.00
,o be done residential no -resir;intial Q Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40 00/hr
Existing use of
uuilding or property Rain Drain, single family dwelling 3000
r _ _
F Residential backflow Prevention
devices 1500
ti-
F– Proposed use of —�
building or property _ — rExcept residential backflow
prevention devices)
NOTICE 'Minimurn Fse $25.00 SUBTOTAL S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHAPGE I ZS
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PIAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions
Dare issued _r? `�� b/ C_T-S
INSPECTION NOTICE
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspecticn Line (Rec-o-Phone:: 639-4175 Business Phone: 639-4171
Inspection: —�
Footing Plbg. Ilnderslab Rech. Rough-in Appr/Sdwlk
Found. Plbg. Top out `L Cas Linf: `, FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Me,:h. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach.
Date Requested: 17-17 ` _X
Times ✓�- AN PH
Address:
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIREDs
W, UIVi��v..�sq
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�'3 W�PT�• /�EA'i c 1L��1� �n�iAlaL��D �%�7!�S' �u9�%
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Inspectors � �_
_ _ -'thta:`L�!.__- --
gppROM DISAPPROVED 11PPROVED SUBJECT TO ABOVE
Call For Reinsp.
U
Address J /.� � / a t-e Permit No.
Name off-Occ-upant -}�—_ Permit charge
n
v~i
Paid by
m p�
Da,- ccnnccted
.J
Type of Building Inspection fee-_
Service Pate_ Paid b Date___
Contractor Assessment-.,� Paid
Size of connection <<_ ___--_
OWN
CITYOFTIGARDMECHANICAL. t
CfiYOF TWA RD
COMMUNITY DEVELOPMENT DEPARTMENT ORIooa FERMI T
13125 SW Hall Blvd. P.O.Box 23307,Tigmd,Oregon 07223(503)&W4175 PERMIT #. . . . . . . : MEC 9 1—0 1 6 7
639-4171 DATE ISSUED: 09/ 10/91
SITE ADDRESS. . . : 11555 SW 91ST AVE P'ARuEL: -
SUBDI V ISION. . . . : "ZONING:
HLOCK. . . . . . . . . . . LO"f. . . . . . . . . . . . . .
CLASS OF WO[-.K. . :NEW FLOOR FURN. . . . EVAP' COOLERS:
TYPE Off' USE. . . . :SF UN IT HEATERS. . VENT FANS. . . :
OCCUPANCY GRP'. . : R3 VENTS W/O AP'P'L: VENT Sir o T EMS:
STORIES. . . . . . . . . BOILERS/COMPRESSORS HOODS. . . . . . . .
FUEL TYPES-_-_______.__..__. 0-,?, HP'. . . . : DOMES. INCIN:
/GAS! / 3- 15 HP'. . . . : C;OMML. IN-IN,
MAX I NP'UT: BTU 15-30 HF'. . . . : RE,:,A I R UN.L i S:
FI RC DAMPERS?. . - HIP. . . . : WOODSTOVES. . :
GAS PRESSURE. . . : 50+ HP'. . . . : CLO DRYERS. . :
NO. OF UNITS------------ AIR HANDL_I NG UNITS OTHER UNITS. : 1
URN ( 100K BTU: 1 (= 10000 cfm: GAS OUTLETS. : 1
F UPN ) -100K DTU: ) 10000 cfm :
I�emarka
1)l'lN FLEENER type amol.rnt l)y date r,ecpt
J. 1555 SW 91ST F'RMT f 2'5. 00 JLH 09/10/91 -
5PCT $ 1.. =5 JI_H 0')/10/1)1 -
l':Gr,RD OR. 117223
----_—_--------_._... ---•---_.—__._--._.—
is;01_ J11BIA HEATING
H9,j0 SW BURNHAM
.SPACE E-110
I .1 GARD OR 97223
4ione #. 624-2704 $ 2_6. 25 TOTAL
lgeq #. . . 38026
------ - REQUIRED I NSF'EC-f I ONS -------
This pproit is issued subject to the regulations contained in the Final Inspect i Ctn
Tigat,d Municipal Code, State of Ore. Specialty Codes and all other
applicable laws, All vork will be done in accordance with
approved plans This permit will expire if work is not started __,____�_�__ _ __• _ _, _
within i80 days of isswce, or if work is suspended for more
F- than 180 days.
m )'er-mittee 5ignatl_rre :
LLl
V Call far, inspect . on - 639-4175