16100 SW 113TH AVENUE ADDRESS:
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CITY•CSF TIFA R® C4M LARD)
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW HWI Blvd. P.O.Bac 23397,TkpLrd,OrogDn 97223(503)&19-4175 PLUMPINf-, PPRMT'r
IDERMIT # PLM9117)1it'i ""
639-4171 DATE ISSUED: ' 04/03/91
I I E ADDRESS. . . - 1G 100 SW 1 1.3 TH AVE. PPARCEL : c i1 15A0 Q11'7QI'
SUBDIVISION. . . . : WILLOWBROOK FARM ZONING: R-25
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :25
ALASS OF WORK. . :ADD GARBAGE DISPOSALS— ! MOBILE HOME SPACES.
YPE OF USE. . . . :IVIF WASHING MACH. . . . . . . » BACFVLOW PREVNTRS. . :3
JCCUPRNCY GRP. . :R3 FLOOR DRAINS. . . . . . . . TRAPS. . ., . . . . . . . . . . .
;TORIES. . . . . . . . : WATER HEATERS. . . . . . : CATCH BAS INS. . . . . . .
I X TIJRES------- LAUNDRY TRAYS. . . . . . SF RAIN DRAINS. . . . .
_;INKS. . . . . . . . . . :I URINALS. . . . . . . . . . . . GREASE TRAPS. . . . . . . :
.AVATORIES. . . . . .. 0TH'7-R FIXTURES. . . . . ..
!-UB/SHOWERS. . . . SEWER LINE (ft ) . . . . :
,!ATE_R CLOSE-TS. . » WATER LINE (ft ) . . . . :
413HWHbHERS. . . . RAIN DRAIN (ft ) . . . . a
emA1kS' 3 BACKFLOW PREVENTT.ON DF-VICES
�Jwner. ------------------ FEES
A ADO BARICEVIC type a m 0 1_1 n t by date I-ecl-It
PORTLAND CONSTRUCTION PRM7 2115. 00
SW PAT TON ROAD 151 P C 1' R 1. 25
)ORTLAND OR 97221 PAYM s 26. 25 JLH 04/03/91
'hone
rent ractor:
JEST PORTLAND CONS T RUCT I 01\1
_78113 SW PATTON ROAD
'OR""LAND OR 97,221 --------------------------------
:Ihone ft- 292-9437 26. ;-.,5 TOTAL
')eu #. . : 64001
REQUIRED INSPECT':OPTS
'his nervil 11 imll 1u1.11Ct to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
loplicablt laws. All work will be done in accordance with
-,iroved plans. this pervit will mire if work is not sta-ted
,ithin 180 days of issuance, or if work is sitsuended for Pore
N
-Ear 180 days.
BY :
Call fot., inspection 639-4175
CITY faE T'1[3ARD - REC U I PT OF PAYMENT PEUF I f 11' NO. :9 1 r 11557
CHECK AMOUNT 26. 25
NAME Wl'-:P7T PORTI..AND COWTRUC'F CASH AMOUNT 0. 00
AD0R,E GS, PAYMENT DATE » 04/03/91
SUBDIVISION
16100 ,SSW 113TN
a PUFtPOSE. OF PAYMENT AMOUNT PAID PI1RPOiE OF* PAYMENT AMOUNT PAID
uo) r✓1_.I.IMBINfi pERhl l='L...M91-00kT x'5. 00 G*T. yEiIJII.._11 PER 1. 25
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BACKFI-OW DEVICES
ti.
TOTAL AMOUNT PAIi:, - - -> 2h. 25
CITY OF TIGARD
PLUMBING PERMIT 13125 SW HALT. BLVD.
P. O. BOX 23397
Applicants must hold Oregon Registration to condtxx a plumbing TIGARD Q OR 97223
business o,-must be property owner/operator not hiring C.Aside help. pt�1
Name of Deve0priu rd (503)639-4175
Plumbing Permit No. gLL6 )L 7
ss / d De%cniption
ORS 814-21$10 DUAN. PRICE AMT.
job
Tax Lot Map.No-
Adcress
FIXTURES
Lof Mock Subrfivislon - -
`'ink 7.50
Name or name ol btl"sslLavatory 7.50
.L- i Tub or Trrt Shi)wer Comb. 7.50
Address
Shower Only f.50
Owner Cky/State zip WaterCknet _ 7.50
Dishwasher 7.50
PhC1e Garbage Disposal 7.50
Name Washing Madwie ---- — 7.50
Floor Drain 7.50
? ing Water Heater 7.50
—_ Laundry Room Tray --7.50
Occupant CifyJState Zip
Urinal 7.50
Name Other RKtUres(Specify) 750 -
7.50
"litq Addrosi Plano 7.50
Contractor City/State $ — 7.50
_
MISCELLANEOUS
City Bus.Tax No. Sewer 1 st 100' 30.00
late FTo— So~-e&Addit•100' 15.00
(R 6aq Water Service 1 st 100' 20.00
1 hereby acluawledge that 1 have read this application,that the Mdormation Water Senice et Addit2V 15.00
given is correct.that I silt regiclerod with the State Bidders Board.and atso Storm 6 Rein Drain 1 sL 100' 30.00
have a State Pkxvi*g fioense that the numbers given are correct."100 —
Mumbing work will be done in accordance%lh appRc*Ve prov%ionS o1 Ore. Storm i P-in Drain Addit-100' 15.00
gon Revised SlahAes Chsptors 447 and MI and applk-able codes and that Mobile Home Space 25.00
no help will be employed utless licensed rxder ORS 6W-i(11 exempt horst --- - —
Stale regfstrstion,please give reason uebw). 134Kir Fk►w Prwenbon
Device or MEi-Pdwtan Device ) 7.50
HO04FOWNERS-1 hereby cw*tied I am the owrxrr of the property de- —
eonbed above.at which location 1 prime In maks a pkrmbirV Installation for Any Trap oc Waste Nd
my own use and Vfib property Is not bekq constricted for sate.leave Or rent. Connected to a Fixture 7.50
_ Catch Basin 7.50
kw.d Edat.PkxA*q v 40.00 Per tlr.
Specialty Requosted InspaWons 40.00 Per Hr.
~
After.of Pkrrrt*v wkfrin -
y an ErdelkV Bldg. -- 15.00 mIn.
AUTHORIZED SIONATURF J - -- Date N*'Bldg.or Build.Addtdon 25!00 min.
Lta3ltccI'Sirille Lr3TT11 --
Describo work new❑ addition(_j ahereWn❑ repWr C7 c3a ui 15-130
U: -V-!n done - residential -- non-roeldential f�----- -- --- —
Exis"use of
125.00 minimum FL'i3-.COTAL
lxAkJk�rx ProportY----- -- - •'
fNvpoaed use of a-% SURCWRGE :p0higj
orpioperty _- . -- - ------- -- 25'0 PLAN REVIe.W
NOTKT
Tttla pernA be000mea niA wxd vold M work or oonstruadon atRMxtiad M not oom TOT&-, $) ,
manned vA*M t$0 dayrr nor M ow w*ucAm a work M oosparrdod or abandoned for
a t»rind of 180 day+d any&no aftw work Is oorrrrr«road.
Dab Issued by _--