13780 SW 116TH PLACE M A 1Mzff�W1wjw1[R
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CV_-, of Tigarv! Bnildlaq Department
1-3-25 Sit Hall Bled. T19:a11, Oregon 97223
Inspectior Line ;Rec-O-Phone): 639-41"'' Business Phone: 639-4171
Inspect ion:_!—_-
Foot a Plbg. Underelab Medi. Aouyh-in Appr/Sdwlk
Found. Plbg. Top Out Gas 1,1,") FINAL:
'lost/Pear Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation .-Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Hoch.
Data Requested:_ / Z_- 8, J _.Time: AM `� , PH
Address: L7 �� /�cr _ Permit #rf
Builder:
TBE FOLLOWING CORRECTIONS JURE REQUIREP.
Inspectors ./ ___ Date: J Z. ' I b 19
�APPROVIO _ DISAPPROVED APPROVED SUBJECT YC, ABOVE
—_Call For Reinep.
CITI�`'®F TICs,>�1RD-- rcff� MECHANICAL
RD PERM 1 T
COMMUNITY DEVELOPMENT DEPARTMENT 011200N ,-,ERMIT #. . . . . . . : MEC92-0081
13125 SW HWI Blvd. P.O.Box 23397,Tigard,Or"m 97223(503)630-4175 7��77
ITE ADDRESS. . . .' 13780 SW 116TH PL PARCEL: 2SI03CD-02600
-AJ13DI VISION. - - - - HOLLYTREE ZONING;: R- 4. 55
',LOCK __.__.__.. . . . . . . . .. LGT. . . . . . . . . . . . . :6
LASS OF WORK. . :ALT FLOOR FURN. EVAP COOLERS:
YPE OF USE. SF UNIT HEATERS. VENT FANS— :
1CCUPANCY GRP. . .-R3 VENTS WIO APPIL: VENT SYSTEMS:
�ITORIES. . . . . . . . : BOILERS/COMPRESSORS HFIODS. . . . . . . .
Uk-..L TYPES---_--___----- 0-3 HP. . . . : 1 DOMES. INCIN:
.- /GAS/ 3--15 HP. . . . : COMML. INCIN:
MAX INPUT: STU 15-30 HP. . . . : REPAIR UNITS:
F'I RE DAMPERS?. :710-50 HFA. . . . : W 0 0 D I-3'TO V E S.
GAS PRESSURE. . . 50+ HFA. . . . : CLO DRYERS'.
ND. 01-' AIR HANDLING UNITS oTK.1R UNITS.
F:*URIq 100K BTU: 1 t= 10000 cfm: G1,4S OUTLETS. - 1
FURN ) -100K BTU: 10000 c:-Fm :
Remarks:
(Jwner: ----------------- FEES
(JOODRICrA t ype OLMOI.Int by datp v,e p I
i 3780 SW 116TH FIL PRMT $ 25. 00 JL.H 04/30/92
5PCT $ 1. 25 JI-1-4 04/,350/9-:-`
If:',ARD OR 97223
–1hone 4:
31JNSET FUEL CO
-0 BOX 42287
,,ORTL.AND OR 972,'2
�--,honp 23.4-061. 1 t 26. 25 TOTAL
00,374
REQUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained in the Vinal Inspection
'icard Municipal Code. State of Ore. Specialty Codes and all other
ar,plicablf laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
.itlia III d,,, of issuance, or if work is suspended for more
than
I s s 1_ted By
Call for inspec-t i rin 639-4175
Mani
1
City of Tin MECHANICAL PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLIvATION Qermit #
PO Box 23397
Tigard, OR 97223
(503) 639-4171 _
escrrpuun
i ab{e 3A Me&anical Code QTY PF110E AMT
Job ( -�"j cj +�1 h r 7 1) Permit Fee -0- -0- 10.00
Address �h...
��_I� _!J r✓,Z ," Z_L. �> 2) Supplemental Ps(mit 3.00
urnace to 100,000 BTU
_)C.l L `'k 1) incl.ducts&vents coo
makv «. Furnace 100,000 BTU +
QwnOr l)_3�/�� l�l.G �i3r1�-' ;Z 1 2) incl.ducts&vents 7.50
w 40
Floor Fumance
`lf��l S}�, a �__1D3) incl. vent 6.00
J.—. «.r -Su ss poned heater,-(a I eater
4) or floor mounted healer 6.00
Occupant
•• Vent not.itc. in
5) appliance Permit 3.00
a. otepaT 7. naaung.retng.
6) cooling,absor,ition u." 6.00 it
«
o�p, hum u'
for er --
P. pump,acon
7) to 3 HP absorp unit 1) 1(rK BTU ( 6.00
MMOV Ftc'!er or comp, heal,)un p,air conJ_
COiltr 1CtOr 29Y4 �c 001,k)o Usti 8) , 15 HP absorp unit a)50CK ETU 11.00
1,P `.ojer or comp,liear pump,air con .
no lal-)C1 OL (17 9) 15-30 HP abs,)rp unit 5-1 mil BTU 1x 00
'•MOMSown N., y a.Tu N. der or comp, heat pump,air cond.
I() 30-50 HP absorp unit 1-1.75 mil BTU 2250
hereby-a-cWo-w-ledge that IF have r9aO this app icauon,tiat 1e BRer or comp,heat pump,air Fc nd
information given is coarect,that I am the owner or authorized agent 1 1) >50 HP absorp unit 1.75 mil BTU 31.50
of the cwner, that plans submitted are in compliance with State Air handling unit to
laws, that I am registered with the Construction Contrs cto s Board, 12) 10,000 CFM 450
that the number given is cr-.-qct. (If exempt from State registration, Air handling unit -`
please give reason below 13) 10,000 CTM . 7.50
Non portable
14) evaporate cooler 4.50
—Vent fan connected '
15) to a single duct 3,00
1 C Ventilation system not
i u ' ` 16) included in appliance permit 4.50
1 7) mechanical ex. ust 450
_17escri wor new addition ) ^teration repair Commercial or industrial
to be done residentialto' non residentiaf Q 18) type incinerator 30.00
Existing use of Other i e,woodmvp.water
building or property 19) heater,solar, clothes dryers,etc 4.50
Proposed use of 20) Gas piping one to fair outlets ' 200
building or prnperiy
Type of fuel -oil natural as LPG 21) More than d_per outlet
Y'P � 9� (� O electric(J
OPV
Minimurn Fee$25.00 SUBTOTAL ± Lt
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE
IF CONSTRUCTION On WORK IS SUSPENDED OR —
ABANDONED FOP A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25960E SUBTOTAL
AFTER WORK IS COMMENCED. --
TOTAL
iI__J
Special Conditions_ �� `— --"
_ Date issued_ by _
CITY 'IF TIGARD RECEIPT OF PAYMENT REX',' I PT NO. r 9P--226 723
NAIYIC:'. SONSET FUFL r,o ("HECK Amol 11,17' Z:G 29
ADDRESS PO BOX 42P,87 CASH AMOUNT (0a: 00
PAYMENT DATE t 04/30/9i?
PORTI.-ANP, OR 9 7;,'240-02137 SUnD I V I 1310N
,'(JRPM.'E OF PAYMENT AMOUNT PA 11) PURPOSE OF PAYMENT AMOUNT PAID
MECHANICAL. PE P.51. 00 9T. PUTIA) PER
e.
GOODRICH
13780 SW 11.6TH pj-.
10TAI... AMOUNI pin lD
BUILDING PERMIT APPLICATION TIGAHD DATE
THE UNDERSIGNED HERE=BY APPLIES FOR A PERMIT FORTH E WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE
LOT NO. 3.Yt. _
OWNER Clan Goodrich JOBADDRESS 13'7uu :,Lt ilottt t�lact _ Uu,�alraonl t,�
ARCHITECT —
BUILDER tt.y Canst.ruction ENGINEER
ADDRESS 11.3�12 SU Barbur B1Vd. DESIGNER Pyramid I:esigns _
STRUCTURE El NEW El REMODEL _0A_DDITION 1:1 REPAIR _❑ RENEWAL _ ❑ FIRE DAMAGE _❑ DEMOLITION
❑ RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE -] STORAGE ❑ SLABD. FENCE
OCCUPANCY LANDUSEZONE BLDG.TYPE �N i FIREZONE _e. PLANCHECKBY rtllt HEAT_
--_.. fiStruct gret�nhouse addition to Sifl(lt-16 family_residence.
COURLCTION SHEET.
SEWER PERMIT M
OCC.LOAD FLOOR LOAD 10 HEIGHT_` 1() NO.STORIES I AREA 19-� NO.BEDROOMS VALUE
BUILDING DEPARTMENT
SETBACKS FRONT REAR LEFT SIDE R,GHT SIDE
—_ ----
Permit ��,' 11 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, TONING
PlanCheck 32.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
_ WOE'S WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
G,- WITH AL1 APPLICABLE CODES AND ORUINANCES. TIIE ISSUANCE OF THIS PERMiT DOES NOT WAIVE
Subtotal 00 WITH
COVENANTS. CONTRACTOR AND .SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING,
Slate Tax ;.'.
SOC—
Total
By
POCM APPLICRNT OR ADEN F-
�,
Approved — dt,IFl Receipt No.
ADDRE88
PHONE
I
i
4
—DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
z_�q ✓ _ Contractor
Permit No.
Rough-in
Fixture
' Final
�i _
-- HEATING
`- Contractor � Va
_ --- - Permit No. !- --
`---_-
as or Oil
-------- - ---- Roughdn
-- -• - -- ------ Final '- ---
SEWER —
DRI'rEWAY - -
-.r Final
Storm Drainagw
(Rain Drain)Final
Sidevwl k
Curb&Street Final
Approach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCLUPAN..Y FinN__A� -�_._,.
�and�copinq
Zoning Final
A."
BUILDING P ��r
PERMIT APPLICATION TIGARD DATEgV4 Z 19 /
THE UNDERSIGNED HERF_zBY APPLIES GOR A PERMIT FGR THE WORK HEREIN IINDICATE.D BUILDER PHONEl_*7"G(0g3
OR AS SHOWN A14D APPROVED IN i HE ACCOMPANYING PLANS AN04SPECIFICATIONS. OWNER PNC.! Its !1&
� /" 1
OWNER - �..�-Q i'1 JOB ADDRESS/'� "��-�'�ry ����' LOTPJO.� 46
---:
ARCHITECT
u �,• ENGINEER
BUILGE' IOrI1DDRES_SZt c����� �N�•DESIGNER p It 4,%ltot ay"OjGM —
STRUCTURE Cl NEW ❑ REMODEL _ "AODITION :3REPAIR ❑ RENEWAL _0 FIRE DAMAGE L-1 DEMOLITION
RESIDENCE C COMM ❑ EDUCATIONAL ❑ G V'T ❑ RELII:it/j'ta C: PATIO ❑ CAR PORT ❑ GARAGE C STO
RESIDENCE �----�—� --- _ GE ❑ SLAB❑ FENCE
OCCOPANCYY. ��"�' — �""- •"
-��- _ LAND USE ZONE —J BLOC, Tl'PE. _•!�—FIRE ZONE PLAN CHECK BY HEAT_
-- ---_! _ a1!me g' --Gk9 I-e �►+J -----
SEWER PERMIT N _
OCC.LOAD_ _ FLOOR LOAD HEIGHT NO.STORIES ?? AREA /474' NO.BEDROGMS VALUE/! Oo
BUILDING DEPARTMENT SET_BACKS FRONT REAR .R 3 _LEFT SIDE RIGHT SIDE
P^_rmit _ 6�l••m0 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZOPJ:NG
32,dpp REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check _ WORK WILL BE DONE IN ACCORDANCE wrm THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
k�� _ T� WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV:
ut>t_Ota) _ 96• 00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTO 3S TO HAVE CURRENT CI t f t3USINESi
4 LICENSE.SEPARATF PERMITS REOUIRED FOR SEWER,PLUMBINGAND HEATING.
Slatn Tax
Total SQC— _TON (�a.
By PDC# APPUC_A i Uri AG O T— {� _ Ilk
�^� Q )
Receipt No. —51� - (�i ly Z.7 7� /� / 0
Approved ADDRESS PHONE
locr
loc s 1� •
[EWER CONNECTION g
EWER INSP CT._ 121100
EWER SURCHARGE S e
"e
nmrnon}n�
%A. �� ��lJ _ vr• -- -
�S
a;
y
14
El 0 .0 F1
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: a:q5 &7 PERMIT NO. :- -
DATE. DATE ISSUED :—/ / -
OWNERS NAME : !Z �V_L CORP.
------
ADDRESS: / 32,?u 5
i EST : Air V, Water E] , Visual C] , I-aboratory f—
RESULT: Apnroved , Aisupprovad ❑ Pendi og
SKETCH.*
src y°�7ia11` 40
3
CNSPECTr R DATE
NOTE. Attach supplemental test data heroto,
I
i
i
City of Tigard
INSPECTION REQUEST
for
_�.
SIDE OP,
INSPECTION TIME: . PERMIT NO. :--1-7a--3
DATE: 60- /Y.a/ 7.2- DATE ISSUED : ? tZZ2Z
CIWN!~!;S NAME : (k)wAae,441T (LeP.
ADDRESS: � Zsc,- geg,
CONTRACTOR
'►TEST : Air (], Water[] , Visual p;Laboroto,xy p
RESULT: Approved 0 Disapproved L1 , pending p
SKETCH:
INSPECTOR DATE
t MO1 E Attach sup,)1amental toot data Aare ta]
r_�
=IRK 1,441K
,_ — ter*. ,�.�«._-,_,.,., r•-.��..,�,�... _.,.,m --.,-„,.,...
CITY OF TIGARD RATING PERMIT
Y
Iu►TIl4 PERMIT NO. 7? CG to RECEIPT NO.
i15f FEE
1. P mit shall be obtained prior to commencement of installation,
2<. Permit shall be obtai ncd for all appliances which are to become a f��'c.ur•
to the bu i i d i nq
3. Relocatior , repiacemer.t: c changes to burners and dvct 'work
require permits .
4.. All work Ltd be concealed mw_t be �.�or. . .. l before cover up,
Sew Installation t`xj Replace 1- 1 Relocation ❑ Addition ❑ Alteration
�ONTR. (,�IAI)RMYT OWNER _
WDRESS 1'S6 SW SKfLINE BLVD __ _ WORK ADDRESS 13780 SW 116T H JOB H 6
�PORTLAND.ORFr4w APPLICANT IMPERIAL pL h” tfi tfAUM
TELEPHONE NO. � 1
47 3801
.URNACE - MANUFACTURER _GENERAL ELECTRI�_�__- TELEPHONE NO
SEAT It put ..�:sting (Btu Per Hour. ) Vent Size 4 11y(H - Flue Size
FURL OIL l_1 GAS A ELECT ❑ 7rHER _
rO°T'AL SO. FT. Top Floor Main Floor _.__ 1555 Basement
GENERAL
ITEM NO. FEE AM'T ITEM NO WEE AM'T
fag Issuance of Permit X 3 001 Boilers over 50 Hp _ �_ _ 3„0
► w - Under 100, 000 Btu %� 4„0 _-- Air Handling 10 000 CFM ._ 300
JoW - Over 100, 000 _Bt—u` 5�0 _ Air Hand 1 ing_Over _10 000 CFM 5,0
moor Fu ace CO Evaporati,re Cooler Sop
gall -- Floor - Sus pendedt�- 4„U vent "an
2.00
[notall Vents _ 2. 0 _ _ Vent 'system __- 3,,OC
ko�a. ir - Heat & Cool inW 4 u �oodOOJ
BSilers Under 3 Iip _ _ 4,,OC Domestic Incinerator r 5.00
Vilars 3 +-o 15 Hip 7 , 5 _ Comm Incirerator _ _ 0.00
joi lore 15 to 30 Hk __ _ 1010C YOtlter- Not. Listed 3, 00
Boilers 30 to 50 .y 5. 0
INSPECTOR' S COMMENTS
l
APPROVED BY � DATE Y✓f 91 ISSUED BY ITE
IMFRIAL L Sir ATIW,, INC
I
Signat o A 1 i cant -
r
q �, CITY OF TIGA. D, OREGON V
rmit Issued_ ..?.3 _ w RPvrmlt No.;, - iJ
;+ City Hall
" ptleMion Approv 11uildir,; Department Cost of Instatwti tr
By_ _- At� 1GO{ Prtae44 P"Uq Y«a&lloficia
Fee for Permit.
Applicant shall fill in cost of installation only,
Date_ Q __. above this double line. I Street Sewer Permit___
,+ roll O( Plumbing Pipes or Fixtures according; to plans and specifications and
Application is hereby made to ,'IO(X
install description as given below:
.Location of builving---Number and Street_- 13780 SW 116TH LOT H 6
Lot --- - — -. _. Block Addition_
Name and Address of owner __-THE CORP _1750 SMSKYLINE BLVD PROTLAND A
Name and Address cf Plum her-_IMPERIAL PLUMBING C 4EATIGN," P 0 BOX #06327 PORTLAND
Nu±lding (Old or Nein) __NEf_____. _ Height In Stories_ — ONE Occipied as-...-___ RESIDENCE
SCHEDULE OF WORK
NUMBER I_ NUMBER
` -FIXT_URS_$` ' New ' Move .�R'pl'ce FIXTURES ( New j Move 'R'pl'ce
Water Closets. __i___.__ Fountains%rmkrng_�I-._r_�..-I___ ._
R-Ah Shower. Fountains, Yard _
BathTub----.
_
Tub_— -. - _1 ,FountainsSoda
Q __ --- ----I - -
I I- -i � I I
P.asins _. I I_ Hol Water Tank
Sinks, Ordinary___ _�_ _ �..I.r _ Sinks, Isar. � 1
y
Sinks, Dishwashin, -- i __ p
D SPO AL h � �' -� -' Sinks. Slop
Automats Dishwasher__h .. Drains, Refrigerator
Laundry Trays---I- j_ Drains. Ice
Drains, Mont- _ � i Urinals
Drains, Arca _ 5.00 .__ _ T___ Catch-Basins, Yard
Rain Drains_- _. __ Catch-Basins, Garage_.-„
Automatic Washer _ Catch-Basins, Sub Soil__,
Water Permlt No.^ ._- _ - Bldg. Perthit No.
RIrMARKS:__.s
IMPORTANT#--Plumbing shall not be Installed In any building, (either new, a )red, or repaired), except as shown or designated
on the corresponding building plans as filed with, or required by, the Building Department In accordance with the
provisions of the Building Code and Ordinance 61.19 of the City of Tigard
rX1Yi)tr the plumbing system according to this descriptio its and s ecificatsons an a PlumbingCode of the
I agree IoXX�cr stall 111 j City of Titinrd. p
in
Plumbing Firm. IMPERIAL PLUBMIN6 & HEATING,INC. ,-- -_-- ?�tC.IfIzUSu�.
pervisor
I
l:
CITY OF TiGARD
124M L W. Mein*~
TIYARp, 0R100K 17X11
APPLICATION FOR BUILDING PERMIT
New Construction Demolish ❑ Add: ,ion U Remodel ❑ Move❑
ZONING R-7 _ DATE ISSUED 8,4U-72 _ nUILDING PERMIT
DATE RECEI'.►ED 8aT-T2 BL�iLDING FEE $ p000
No. 72�1C7
' PLAN CHECK $
B r-- - - dA',UATION $ �,'f87.N0
q OTHER S '10dj n+
A7-
TOTAL RECEIPT No. o(ot
$ m
V- cP V-7,?---
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICA'i IN
LOT 0 6 Zia" 1 MAP A CENSUS TRACT W-19 JOB /
Architect or Engineer— �� ��� �■
Add -ess 30.UATW, ftshingtw Phone
Owner %wArsnt Oozy___.__ ---
Address ��- ----- _ _Phone
Builder saris
Address Phone
BUILDING USE Single Res. ❑ Multi "es. ❑ Comm. ❑ industrial❑
OC'CUPANCY GROUP T No. of Stories-_j__ Total Height___Ib! _ Area of Lot 7gQgL_
Type of Construction XECKEDOOMMUMM V Floor Area B 1 2`
Set Backs: Front 25'_ Back 35' L.Side_ 6' P. ie_ 151
Private Sewer Pipe Size
--.k— Sewer __TjS" ,&j1_w.jgptic Tank
r�jwater Service Pipe Size-- 4" Storm Sewer L Ditch 11 -1
Street and Curb Requirements s„Istns
Driveway Width 111 ,No. of Parkinq Spaces_—_2_
SEPARATE FERMITS REQUIRED FOP SEWER AND PLUMBING
SPECIAL INFORMATI�IN
ADDRESS ASSIGNED _ 1} 8.Y• 116M _ — _
FIELD CHECK BY DATE 8-M-7=
PERMIT APPROVED By ad -
Tt understood that all work will conform with a �licabie c es and oLdin6n
i s u P!
{ of the State of Oreqon and the City ofZTiqd, Oregon, enc the building will
not be occupied until a Certificate ofancy has h ed by the City of
Tigard Building Inspector. •
S ature o Ap icant
wiffiff,
UNIFIED SEWERAGE AGENCY No. __ 4723
VVAS H I N G TO N COUNTY DATE
CITY O F. Ttgerd
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: _ Wadrant_ Corp. --- -
OWNER'S /'ADDRESS: 3.750 S.w. Skyllas, Suite ?A �_.—�.____._______.._ _
STREET
Portland Oregon
CITY STATE21P
BUILDING; SITE: LOT_... 6 BLOCK __ 3 ADDITION __. }�
TAX LOT NO. _ T rPE OF OCCUPANCY Residence
ADDRESS 13780 S.W. u6th Place
DWELLING UNITS 1 FIXTURE UNITS 14
SU R C H A R G E I F APPLICABLE ___ _ ____. 5P.A6 �e Bares in lieu -et
PERMIT FEE .425-00 INSPECTION FEE 25.00 _ TOTAL DEPOSITED
f(NEW) (EXISTING) BUILDING SEWER SYSTEM
The Applicant alfnves to comply with all rules and re tions of the Unif 1 c vv Agency.
APPLICANT ///AJ&PAd1d&Fd�
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWFH SYSTEM.
n
LINE SIZE INSTALLER Ll° Brown
RECEIVED BY iis�_ns4�.
�IAGEgCY OR ITS AGENT)
COMMENTS:
This Application and permit expires in ninety (90) days. The amount paid tivill I)t+ forfeited
should expiration o cur.
11
f _
#`._.2 fGJSUILDER VALUE X9,5 FEE 7 g`' DATE
LOCATION OWIVr;R
JOB # 'MAP LOT !o TYPE
'L I LR J PE MIT FEE
`NEWER PI;RMI t}l i _F ; 5 ,t"7Q IECHANICAL t'ERMI'1'
BY DATE '...._��..�_. — 13Y
__
S EXCAVATION FILL AIR CONDITIONING _._._
'' .� ? FOOTINGS/FOUNDATION VENTILATION
FORMS SPRIN-VLER SYSTEM
SLABS MASONRY FLUES
REINFORCING STEEL FIRE DOORS/EXITS
STRUCTURAL STEEL GARAGE FLOOR
Qom_ PLUMBING R I i 1 - � � _..._��J�_ DRIVEWAY__�_�____
ROOF FLASHING , SEWER�_____`_____�
FRAME kh STORM DRAIN
LATH/WALLBOARD PARKING
_ HEATING v FENCESCREi N __.�. ._._.... ......_..___
WATER HEATER FINAL
Address 13780 S.W. 116th Place _ _ Permit No,
Permit charge
Omer was quarlraat corp. Connection fee 4c?
Paid by same .�
Type of building Residence Date connected 10-1272
Service rate 3.00 per month Inspection fee 25
Contractor quadrant core Paid by same Date
Size of connection 4
11 _ Assessment �_ Paid .....�.��