12121 SW LANSDOWNE LANE-1 v3n{n q h(
ADDRESS:
4j
�1
:1
s
ti
S
i:\records\microIrn\targets\buiIding.doc
1
4
i
� n
v
f'
it
r�. ,F of q ! ,• � � � rJly�!r! �!i� � �
CITY OF TIGARD BUILDING INSPECTION NOTICE ,
Inspection Line: 639-4175 Business Phone: 639-4171 n Il,f
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line CeilingPlum 1
Post/Beam Mech. Shear/sheath Framing -Mach. • ; ';�+ s I ,
Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect.
M!'
Post/Beam Struct, i4ech. Rcugh•in Gyp. Bd. -Bldg. 1
q San. Sewer Gas Line Appr/Sdwlk Reins.
, � r
111 I �
li+
Other: 1:,C 11.1111 L
Date: �� A.M. P.M(.f_ try„ I � t+Z
Address: afkn'' )
Tenant:— Ste:----- MST:
BLIP:
Con/Own:
— MEC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
i
Al
1 r1U r`,
+ i r91 15 x�L 9'up I/f5.
h
— �Fi4lyj�rr� ka•: -.
Inspec or: �-- Date
__APPH-`./ED DISAPPROVED/CALL FOR REINSP. Cr- CO
I. '
I �.i
f r
S r
�' ,Y ' r �tGkq�, � , �� •'. �� u� K x ,.6mr i�,���ir`�`�jlat����M lt...
i r���y^i•v Fu4 I i,� �1 - � i '`u1�+�tp 4 5t`�71Pr+ ��.
w. rl
e
I
+ IP M �y �� � - _ � �, 1 ra � ,'fir+ �;��+ ,X���`�o k+ .��• A I„
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Y�h`���l�f t°�•�to '1' I�f.
sl Footing Rain Drain Cover/Service FINAL:
Foundation +Vater Line Ceiling Plumb. !
T
Post/Beam Mech. Shear/Shea,h Framing ech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mach, ugh-in Gyp. Bd. -Bldg.
San. Sewer e6as Line /�~ Appr/Sdwik Reins.
Other:
Date A.M. —P.M. Entry— - -- ---
_ -nS
Address: Z 1
T ant:
--- Ste: MST.
BUP
Con/Own: 1wL1u �-- - P M
Ll&,,b ( ELC _
THE FOLLO IN�CORRECTIONS ARE RE UIRED: ELR:
-------------
i
.01
3 Zus
Inspector: �i_ Date: r:
APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO I ,I
a
I
IIS,
Al
i
I
QITYF TIGARD „- P17r111CFli.CS
COMMUNITY 0EVELOPP4ENT DEPARTMENT PERMIT #. . . . . . . . MEC9C 0068 I
13125 8W Hall Blvd.Tigard,Orap m 97223.5199 (503)539.4171 DATE I^SUED :
;'t TC i..iDrrrS^. . . : 1'121 114 I.-ANSDOWNr- L.N
' ,LJBDIVISION. . . . : ZONING.- R--4. 5
I_Ot~K. . . . . . . . , , LOT„ . . . . . . . . . . . . . l�
I.-ASS, Or WORK. . ALT FLOOR rURN. . . . : 0 r:Vrr rrnLE'RS: 0
I'YPE 01 US317. . . . i SF- UNIT VIER' —RS. . 0 VENT 'TANS. . . O .
"G.t1F'AC�CY CFSP. . : P3 VC'14TS W/0 N7i=A_: Z1 VE1`47 �Y. '"`it s 0
I CIO, HOODS.
JC"L. Y TPCS. . ._. . 1r►OI�CR^/{�1Mp'RL::'i^C�R"J IC?MC;. ,." s �
� . 0
q 'Gr)al / / .3-1,5 HP. . . . 0 COMML,, INCIN: 0 �
1 1X
INPUT: 0 BTU 1';-"10 I IP. . . . 0 "r-r-, 4I r UNITS. 0
r i r'r �AMF'ERin% . . 30. !4) VIP. . . . 0 WOODSTOVC:. . . 0
I �; f'riEsiOlJr?E. . . e 50.1. I1r. . . . i 0 CT.1, DRYERS. . q1
. Or UNITS-- _____.__.._.. AIR 14iNDLING Ur:1"' OTHER UNITS. . 1
S lrihl < 11711711' ITL1: 0 f. 1 1.4'10 f C,1 : � "iAO (JUTr....F[T
.JRN > =1 Qi1 i); BTU a 171 > 1001210 c:f m 0
Inc kti : Addition of g-as piping
Owne1-e _ ..._._----......__..__._._....._.__.__....____. .__....... rEEO _..__..__._... ..
"'AM rYI;['- L yl.)e amai.mt by cia-l;a i'eC4ii
1:'1C:1 5W LANESD- JNE L.N Pr\M7 25,. 00 JDA 03/1.9/95 9b -227_717
71":,CT 1, 1. �r� 3DA �:1'�,"?C• '3 f.+...;-:'i'I1 "'�'
I IaARD
ON 07223
13 CONNECTION INC. Or PD X
'301 Or WNID AVIa
®R,;3RTLAND OR 97226 _......_... _. ._._._.. ... ...._..... _ ,
inns #: f-0:73 771. 171301 ;"'6. :: ToTfll..
it g #. . . 10314b
_...,.......__-. REQUIRED INSPECTIONS
''•15 pe lit is issued subject to the regulation! contained in the G.As3 1-ineti 7nsFr
,ard Nu►,iripal Code, State of fire. �Fe;ialtl C des and all othe+^ r int Tns;ppc_t i c►n
plicable laws. All Mark will be done in accordance "ith
;.proved plans. This pereit will expire if Mork is not started
".hin = days of issuance, c+- if work is suspended fnr more
n 100 daps.
C'E%1 .1 fi^ i1-1 pectio:1 430 417
. '�j1y6'>�!� "'' m:..• I .Alk nig �Y 1. 1
I
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit # MC-0&--Wb�'
Tigard, OR 97223
(503) 639-4 i 7 i '
.m+11 UIVOWPff—1esc,ption — —
.ee Table 3A Mechanical Code QTY PRICE AMT A
Job
`;I,:
1' Permit Fee -0- -0- 10.00
Address
2) Supplem,.ntal Permit I 3.00
urnto TMUFMID —
1) ncl. duces &vents 6.00
Mailing ••' —n'r"— furnace
i
Owner 1-) t 2) incl. duct! &vents 7.50
•"• "� Floor Fur,iance —
3) incl. ven. 6.00
.uspeo a iea�ter,w' eatar
E4) or floor mounted heater 6.00
Occupant ent not incl In
5) appliance permit 3.00
' '° repair o iea—ti r—gr e ng.
6) cooling, abso,ption unit 6.00
oier or comp, heat pump,air con
7) to 3 HP: absorp unit to 100K BTU 6,00
M.dinu "' — °° Boiler or comp, ea pump, air cond. —
C.`
Contractor ! ` I 8) 3-15 HP, absorp unit in 600K BTI) II.cc,
ofer or comp, ea` pump, air cond.
9
,) 15-30 HP; absorp unit .5-1 mil BTU 15.00
Boiler or comp 7^.a: pump, air con
10) 30-50 HP, absorp unit 1-1.75 mil BTU 2250
hereby acknowledge that I have read this app .duan, at a mol e'f r or,omp— ieeat pilmp, air con
informrdion given iF correct, that I am the owner or a ithorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that pl-ms submitted are in comfiiance with Air handling unit o —
State, laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 450
Bor rd, that the ember given is correct. (If exempt from State Air an ing uni ---
wgistration, please give mason below) 13) 10,000 CTM + 7.50
Non porde
14) evaporate cooler 4.50
Vent fan connec e
15) to a single duct 3.00
Ventilation system not
16) included in appliance permit 4.50
Hood serve y _
17) mechdrical exhaust 4.50
Describe wqW newaddiittion alteration repair _ — Commercial or in .s na
to be done residential non-residential Q 18) type incinerator 3000
Existing use of Other i e, woo stove, water
building or property _ 19) heater, solar, clothes dryers, etc 4.50
Proposed use of 20) Gas piping one to fore outlets 2.00
building or property
21) More than 4-per o itlet (each) 2.00
Type of fuel -oil 0natural gas 0 LPG () electric O —•—
Minimum Fee $25 00 SUBTOTAL ' G��
PERMITS BECOME VOID IF WORK OR CONSTRUCTION —"--
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARr,E
IF CONSTRUCTION OR WORK IS SUSPENDED OR ---- —
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW ci% OF SUBTOTAL —
AFTER WORK IS COMMENCED --- -- _J
TOTAL`- r�S
Special Conditions _ _ —"' // ,/,
--^—. _ Date issued _ � � --hY
1+LL0GIMQ9ISMECNPMT
i
i,
f't
I
r •x
l...I I 'r I If 1 .I t-+f-IVilr F•."-1 k .I I' i 111 I'1lYhli ISI I h'; � t t l ' I f�Jl 1� :5'►e�—rc'r' �;i !^1 I
illi 11 114 1
i t'a/llYlk (iF�`:i 1..1 11 It 11 .1:I k 111.1 1.1�7t: 1 tF f!I)!; I .I t;.rl 1 r 11'11(Llf t I IR1. t t1�t
I••!k)k.)(tt�':�i`,•i rah31,II 1 ;al• t•tr•:'tJI.I (•1'l1I I 't I r I'll 1 1 ( 1�(t 1 1 a 1� ,' 1.'�!!elf, I ,
d11111f'.•' 1 'r1111I
{>f)Fel l..f lhlk:)r Llli '•a,'i'(,(;. --
r'UfJF'L1'-�k:. (11 F '�P!I- I t Ilrvll.IlJl�l I L'11I 9 III 1141-A(':,: (it I'(-! (pit rtt`'li 11114 I I 'll I ;,
I )ANICAL !:='E
i
I
I L'�
I
I( n
'iW k..GaWi1111WNI t.,N, i I.1
Ii
I
I
i
1
I
1.
I
CITY OF TIGARD
February 1, 1996
i
OREGON
I
1 ! �
FYRE, MILTON F PAMELA S
12121 SW LANDSDOWNE LN
TIGAR.D, OR 977.23 e
PERMIT#PLM93-0183 at 12121 SW 1.ANSDOWNF, LN
We issued a permit for this project on 9/15/93, however we have no record of any inspection being
performed.
Permits -xpire if there has not been an inspection performed for over 180 days. In that case, the
Building Division may require a new explication and fees to commence or continue work. The
City may also pursue civil enforcement if work has proceeded v-`;out the required insrections.
Please advise the Building Division, IN WRITING, within 15 days regarding the status of this
project. You may request additional time to complete the project.
Respond, IN WRITING, to: Building Division, 13125 SW Hall Blvd., Tigard OR 97223.1 fie
sure to include the following information:
/ Permit#. / r/
2. Address of property.
3. Your name.
Your day time phone number. Q ZPl�-
r -�-
If you are ready to schedule an inspection, please call our 24-hour Inspection Recorder at
639-4175.
A�e tlla� .6
�vd2. Gly /C�' CE�i�7✓ ,��L���G��� ><- CG�>!�� �
13125 SW Hail B;vd., Tloard, OR 97223 (503) 639-4171 TDD (503) 684-2772 —
_ u N Y"r'rA�WPrf,YyyC3.i41iFAYi��111+�v.• u,. , , ri'foelif✓..•
a,
i
jNSP8CTI0„jl���
City of Tigard Building Department 4
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O-Phone)s 639-4175 Business Phones 639-4171
r
Inspections
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Pl,j. Top Out 'Line FINALS
Prut/Beam Struct. hen. flower \ Framing -Bl..g.
Post/Beal. Hoch. Rain Drain Insulation --Plumb.
Plbg. Underfloor P-ttor Line Oyp. Bd. Mach.
Date Requesteds Times AM pM
1�3
Builders
TBE FOLLOWINCI CORRECTIONS ARE REQUIREDs
t
Inspectorsl� / —•_ Dates
A kPPROVED -� nISAPPROVED APPROVED SUBJECT TO ABOVE
//�--- _Call For Reinsp.
d4r�tp!
11 I
41.1111. '
SIFT
aip
i
i
i
1 �
CITY SOF TIGARDF,)E t, 'tl1,;' ■
I COMMUNITY DEVELOPMENT DEPARTMENT
-13126 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171
21,313C 300
.,L. 435 Or l•W[?RK. . GALT FL.CIO T=URIN1. . , K-A)PP COOLURS:
YPE OF USF.;'. . . . :SF UNI_T. Vi-`NT r (IN G. . . .
!ICJ APA-'!.. �'LPRT �Y�1'T:i�lrr» ■
;TDRIl i. . Y .. i b01LL..Rf3AC0lylV-`,:;:i:.;C1RS 1-I f_:JL1D,7i. . . . . . ,
TYI;y _ r(. Fff'• rt i_?h1[ `_�, xMt"TN
/ta�l;:i/ 1 •:3.... :_. ;.,i'. . , - t:flMl�iL.a I!�lC�Ihl: ..
"ifak :lt`;f'11T: U'1t..! i`:;- ,i;V !•I1''•. . 1?t:�'F�) ! L!N1'f':.: ■
I FRC C?p!h'1F ERE 7. . : ;;0.-...:)0 1-11. . . . . WOLIDS l 0VFS. .
'Ps f-,RrHFi LjRF:. . 50'r' HP. . . . . t.:l_t'] DPYERS. . .
iO. OF lJtV17 r _.__.__._..._ .. ...___....... A[R HANDL.f NI-Z t�N i i"::; O THLP UNI'T'S.
URN ': 1:1111' rt T, ; a. - .L 01600 c f Irr: (�'.� U0
URN > 1001110
!I!_.TON I="r` 47 t; y pi? A In 0 .,r t); is, r!ut t r•_ t'�t^�
` '.?'1 `-iW LFIN`•DOWME LN PRlylT $ L5,, OVA .iH 09/16/93
5PCT $ 1. 2`5 ,J!•'f Q!9/1 F/9,,:,
i
i
OR
3
?;V�11i sr. 771-1 on,
. 0. 110 X 14 FI b"
,c ri e 01.
0. W4 j
F2L-.9UIRCr:L, INr:K''E'C*FIOW
Y
This pertit is issued subject to th^ re9ulations contained in 'he Gas L•i ii v Ina;p
;ar•d Municipa'. Code, Mate n,° Dre. Specialty ;:cdes ar.c all athsr
pica le lana, (,il rrcr� .!i.': nn done in acre :ance wit`•
:.proved plans. This pe-Ot vi ll expire if work is not started
-thin 18th days of issuancr, cr if work is suspended for tore
.an .80 days _..._._.._ ..... _....-..__...__--.__. __..
tir
r;
..IAF ; A Y•I'TM ..
1 •l'.VNy' �M �M'i��;01(rr', Q b �. C1.•7Y'" ON�'.f�y #�'b�� �
'i ,.. ,.,;,.-r;..�..n.._ ... _...•�+-e.M Kax,.Rr'M"'Fr,:r ;:, , . .,..,..,. ._.r;w vMRNwFkaaMlR/MW"'
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Han Blvd. APPLICATION Permit #
Tigard, OR 97223
(503) 639-4171 _
.«.TETa, 5e0ption
l ,,/ /_ Table 3A Mechanical Gude CITY PRICE AMT
Job ,�/a/s(�v,�G( �[I 1) Pennit Fc 7 -0- -0- -10.00
Address - �
2) Supplemental Permit 3.00
« Furnace to 100.000 /
1) incl ducts a vonts / xl.00 . o
«��p Furnace 100,000 +
Owner
.x/121 V d"00 ' 2) incl.ducts d vents 7.50
_- _
Floor Furnanoo
3) Ind.vent 6.00
- Suspended heater.wall heater
4) or floor mourned heater 6.00
vent not NO.in
Orcupant 5) applianoe permit 3.00
— •�
----Te—pair of heating,refrig.
6) cooling,absorption unit 6.00
Miller or c-'vp,heat pump,air--c-o-n-cT.—
AAW boy
7) r:3!it'absap unit to 100K BTU 6.00
Y.IiV Boiler or romp, Hump,air coed.
E) 3-15 HP absorp unit to 500K BTU 11.00
Contractor Boiler or comp, al pump,air co
9) 15-30 HN abs(rp unh.5-1 mil BTU 15.00
... vN r or oomp,heat pump,air oo .
10) 30-50 HP absorp unit 1-1.75 mil BTU 22.50
hereby ticknowl9dge Viat I have read tis application,diat ei er or comp,haat pump,air co Fid.
j information given is -�cmrct,that I am the ownr�r or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50
k of the owner,that plans submitted are in cornolinnce with State randung umt to
laws,that I am registered with die Construction Contractors Board, 12) 10,000 r!-M 4.50
that the number given is correct. (If exempt from Stala registration, — j- an&ing unit
please give reason below.) 13) 10,000 CTM+ 7.50
Non porLZTe
14) rwaporate cooker 4.50
_
Vent fanconned W— —
15) to a single dud 3.00
I env ation system not
�{ O 16) included in appliance permit 4.50
o sery
17) mechanical exhaust 4.50
Describe woe( new teon alteration 0 repair _ Commercial or istna
to be done residential non-residential Q 18) type incinerator 30.00
fisting use oT her i.e.,woodstrive,water
building or profxerty` 19) heater,solar,clothes dryers,etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00 .d�
building or property
21) More than 4-per outlet
Type of heel -oa Q natural gas k LPG O electric Q —- ---
NOTICE_
Minimum Fee$25.00 SUBTOTAL �0
PERMITS BECOME VOID IF WORK OR CONSTRUCTION -
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE a
IF CONSTRUCTION OR WORK IS SUSPENDED OR —
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PIAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED - —
TOTAL 6,a�
Special Condition, - -- --
--------------��� -_-_.__- Dato issued by
I
■
f
1
1
CITY OF TiGARD — RECEIPT Or PAYMENT RECEIPT NO. a9;3-244r"41
CHECK AMOUNT 'E,• �'5
VAME a ROGSEN & ON! HEATING CASH AMOUNT 0. 00
)DDREIGIS PO BOX 14867 PAYMENT DATA: : 09/16/93 k
SUBDIVISIONPORTLAND, OR9-7214—
V-,URPOSE. OF PAYMI+N-i AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
c's, Q10 r'C. Nl I I I...11 �:�F �1. 25
c
TYRE
1:2121 SW LANSDOWNE I.N
TOTAL AMOUNT F t�,' — —> 26. 25
,
k
r n
A
wa�a>a
,
r
1.
•.uMWNIM.1l�PJM.1!r.h•.h(1•:. iriJ.:.`..I. '",..` ,,,...it
CITY OF TIGARD
I COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223381 OD (503)830-4171
!•'L_UMLA.LNG PERMIT a
##. . . . . . .
639 1T I)NT'E: ISSUL::D:
131 ! L.. AUDRL:"
iUBUIVX'r'alwili:. . ., . ,. ZON1.NUt R•• i. "i
3LUC;K . . . . . „ .(]T. . . . . . . . , . . .
"i_..bl;36 OF` WJ!:!i.., :A1)D t:�NPA(;"'-E i't1'3f='(7`1f�L_('. . MODILE:• HOME :3PA(„iwa.
I'YPE OF USE. . . . »,a F W091.1INO MACH. . . . . . . .. HGICKF'LOW PREVNT 'S. . .
JCC IJt='I P1C1' f: R t L.UUCa TRAPS. „ . .. . . . .. . . . . . . .
`3TCIP I ES. . . . . . 1 WATER HEATERS. . . . . . I C(ITC;H 3-AG I N'.::. . . . . . . . t
I'X TURE'S i._PUI'v0RY •;':AY`,i. . . . . . ., C)r FxA IN DHP)?N;3. . . . . .
.ilial"{U. . . . . . . . . URINALS . . . . , C)REASE;: TRAVIS. . . . . . . ,
7L►OdSNgWERO1. . . . , SEWfZf? :.INE: (ft ) , , . .
1
AAI Ery (LU,,;ETI�. . : WFI'I_E.'� L.INr ( Ft ) . . .
..,ISHWHSHERS. . . . a RAIN DRWIIV (f't ) . . . . {
;rem;ar•14S
)caner _.._... _. . _ - _.._.._._.,__..........__.._.,.._.... ._._ ..._ .._.._... ...............
•11L ION I:YRL type U'l Aate ti ecpt
"t c!1 SW Lf)W.-`C10WHE L.h( PRMT $ 25. 00 3I!
:ir"C'T 1. c :i J'hl 09/15/93 -
J.:a l•1I21� Lar? 9I3:'3
283-33611(2751
)E AN WpR KNI PLUMBING
E L317He
J
CJR'rl._AND 01N 137.:''�
1 I .—ri.1 on p il•,� ,:.:A!': "Y.l'`7!.. •Y' ,.:.+�.r. �.,yJ TL.)•f}y1_,.
i
tee .M. . t rGla7 '
riI.-- UIRELI INSPECTIONS _-
'�is pel-tit is IsVied subject tJ tie rPuiatiorl eartalnfa in the f- irial In!;�prer_t• icln
Tigard Municipal Elder State of Ore. Spe,.ialty Lodes and ail other
:applicable laws. Ali work w:.il be stone in accordance with
appreved plan!.. 'his pe-pit will expire i( wv4 is gat stare ed
within 180 days of issuance, or if work is suspended for more
',han 1811 days.
..se r'm i 1+.t e e f.'•,�.s r„�, ,
on 6344175
n �
y AV X,
..;..
I. M
City of Tigard PLUMBING PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit #
Tigard. OR 9722.3
(503) 639-4171
—• "— OTUZopfion i
ORS 814-21.610 QTY PRICE AMT '
Job � �T C� FIXTURES
Address — n .50
Lavatory 7.50
Tub or Tub/Sh-o-w-Gr-175-m-15.
Shower Only 7.50
1 ater Inset 7.50
Owner Dishwasher so
.« LP Garbage Disposalti
Washing Machine 7.50
Floor Drain 50
star eater 50
Occupant �. tau ry irx�Toom ray — 7W
Urinal 7.50
.p — 7-then IxUires(, c, .50
50
Y -
C'tl!�
J/// MISCELLANEOUS
Co itractor — —
X,1",7410"w C/)'V, . i� ��G'.Z Sewer 1st 100' -- 30.00 --
W N L1 / b, .. ,.,ewer-ea. L 100' 15.00
C'r. G 93 Water Soivies 1st 100' Moo —
re y acknowledge thathave ead this application,that the Watrx Service on.Addh.200' 15.00
information given Is coned,that I am the owner or authorized agent of —
dw owner,that plans submitted are in compliance with State laws,that 1 Storm t Rain Drain 1st IOr;' 30.00
nm registered with the Conshvcdon Contractor's Board,that die number Storm 6 Rain Drain Addit. 100' 15.0X1 —
given is correc•_ (If exempt from State registration,please give reason
below.) Mobile Home Space 25.00
15Tbw Prevention
Device or Anti-Pollution Device 7.50
Any Trap or ast. of
Connected to a Fixture 7.50
-b-e`c-c-n'W work n9w a rtry alteration repair atch Basin 5o
j to he done rasidenual 40 nt. .asiclential Q 40.00
Insp.of Exist.Plumbing per hr i
4000
Specially Requosted trlsp3cti^ns per fir
Existing use of /, / m ran—�e family
building or property A C-1-5, s)/ ej r E_ dwelling 15.00
Residential backflow prevention
Proposed use of devices — 15.00
building or property _
T (Exceptm-sr entr�Uow
prevention devices)
NOTICE *Minimum Fee$25.00 SUBTOTAL. Z5
PERMI-S BECOME VOID IF WORK OR CONSTRUCTION 5%SURCHARGE S
AUTHORIZED 13 NOT COMMENCED WITHIN 180 DAYS,OR IF
CONSTRLIC'?,ON 011 WORK IS SUSPENDED OR ABANDONED
FOR P.PERIOD OF 180 DAYS AT ANY TIME/FTER WORK IS PLAN REVIEW 25%OF SUb-3TAL --
COMMENCED.
JAL (t,
Special Gxxbtions J--
------- _--.__- -- Date issued by
i
1
r,
i4
r
9 i
CITY T'Y OF T I GARD — RECEIPT OF PAYMENT RECEIPT NO. :93-244184
CHECK AMOUNT a 26. 25
�NAME z WARREN, DEAN PLUMBING CASH AMOUNT z 0. 00
ADDRESS c 311 . SE 13TH PAYMENT DATE a 09/15/93
SUBDIVISION r
PORTLAND, OR 97,202—
PURPOSE OF' PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT- PA I D
('LUMBING~PERM� 25. 00 ST. yBUILD PER
1. 25.,
1
}
1 ;1.1.121 SW I_AN!IDOWNE
i'
.1
i
TOTAL_ AMOUNT PA I D - > 26. 25
i
1
S'
1
. 1