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i lrecordslmicrcflm\targets\building.doc
INSPECTION NQTYCE
Citi of Tigard Suliog ldDepartw—t (./�'
1312S SO W.l Blvd. Tigard, Oregon 97223( .-1. L
In3pection Lina (Roe--OO-Phona)s 639-4175 BBunin.en Phones 639-4171
Inspections
tooting Plbg. Und.ralab Koch. Rough-Ln Appr/Sdwlk
Pound. Plbg. Top Out Gas Lina FINAL:
Pont/seem Struct. San. Sewor lruming -Bldg.
Poet/ssam Meeh. Rain Drain Insulation -Plumb.
Plbg. Undorrloor Nat r .Line
gyp. Rd. -Hoch.
Data R.qu..t.d:_ ✓ Tim. -AM
Addr..a: Permit to
Builder:
TOW VIOLLONING CORRECTIONS ARR REQUIRRD:
T
Inspectors / Lw
Pse _. __.__ Date /
APPROVRD DISAPPROVED APPROVEb SUB"CT
Call For Rain.p.
CITY CSF TIGARD
COMMUNITY DEVELOPMEN'T DEPARTMENT
13125 SW Hell Blvd.71grrd,Oregon 97223«8199 (503)639-4171
PLUMB :U PE RM T
f=[_Fi111 T 4. . .
639-41'71 D►al"El 155TJrwU: 04/13/9;s
o e"'596 614 PISHF S: NU ST V1ARCLL s cS 1 1.CP
�ID1VI d{uN. . . . . RENAIS AANCEWUIJflr; ZfJN1NGr R--k. 5
.;utvK. i_C)'f Xv . :7
Oi WURK. » t ADf3 UAR)SUE I)1 SP13'3AL S. . MOB I l_L t iOML SVAL.ES. r
4JE UF UST . , . . ;5r' WASHING MACH. . . . . . . . bOCKFL.UWF-R. : N f RSt
t:tJF-'F lquy Ctif.'F'. , :1i,:3 FI_00R DRAI1d3,. . , . , e TRAPS. . Y . , .
JRI ES. » . . « . , 2 WFJL-R HLATE RS. . . . . . . G ATCEI BOOS I NS. . . . . . . .
/,TUN1zS. .._. ,,-:..... __. _ .__.. L.CiUNDRY TRAY'a. . . . . . ltOIN DRI-41ML. . . .
INKS» . . . . , : URIPlAlr=3. . . , . . . . . . » s CREASE. TRAPS. . .. . .
c
VAI UPILro. . . . < 0THLR F`1XTURES. . . . . .
SEWER LINE ( ft ) . — !
W0TER LINE (ft ) . . . . .
`•`le tY W�-Tr�1 � :
11PF4( VVSNDi:.i-iSF type amc, . ,)t by d,.-Ate r,4 C: :, i
7;198 SW ASHf=DRU ta'f PRM I' s 1`.i. 00 JH 04/ 13/K,
SPC'T t 0. 75 JH
T'I GARD OR 17Z`4
+,�JI,RoGTUFt AUT ON NILE
� ,,,rr t: #: t• 1'3. 7::i 'T'U T Ai._
RL01.IIREV IN;d wLLT"IJ'NL
Tnis pere,t is itsuet subject to tite replatimy ccatained in the i'Qp- out zrrrF,
` ra. Mw.ici�al Cone, State of Ort. 5pecialtr Lodes and :11 other Fitial Inspect inn
app:icr.bl a laws, All wk +lii i be clone in accordance kith
K ;,ed plans, This perert 1411 expire if w01,14 is not started
w;•. :n 1W days of issuance, or if ark is suspended for More
—Ar, 1W day's.
y
Ca1I f-irr 'ispectiorl - 639 -i17`t-,-
City of Tigard Pt U 013 'AG PERMIT Planck/Rec. #
'13125 SW Hall RIA. APS--' .IGATION Permit # �
Tigard, OR !j 7223
(503) 639- 4171
., s«tPoon
ORS 814.21.810 QTY PRICE AMT
'
Job I FIXTURES
Tu-aTawer Z-omu. '-' 7.50
M' eit 4�y.-S Z n lo Shower Only— 7.50
ate,Clow
Owner 7 5 �Vv �)'t-fU,-d �wa�
1 Z 2 y Was 7.So
Floor Drain
Water eater 7.60
Cauh3ry Room fray
Occupant
—50
Other Fixtures .2pea�
Tso
Contractor -- MISCEUANEOUS
----Y Sewer 1 st 100' 30.00
w • 1T.
-ea. "00'
ater 1 st 100' "—
TFen iy-arc ina eepe'tFoat'have read this aprAication,thaj e Water Service ea A&M.200' 15.00
Information given is correct,that I am tlhe owner or ft'iorirad agent of
the owner.that plans submitted are in compo ince with State laws,that 1 Skwm 6 Rain Drain 1st 100' 30.00
am rwgistorod with the Construcdwi Contractor's Hoard,that the number Storm 6 Rain[rain Addit. 100" 15.00
given is axrecL (If exempt from State registration,please give reason _
below.) ? Mobile Nome Snore 25.00
- - - Back Flow Prev;ruon ----- -
!-� Device c r Any-Polution Device7.50 -
"`�— 7GT.7o(Waste Not -"
Connected to a rixture 7,50
Describe work new 0 a rtan a teration repair�- a asin to be done re6dontiall nm residential 0
Insp.of Exist_Plumbiwl ------- per hr
7 40.00
Spnciaily Requested Inspections per hr
Fxisting use of m(N-ain,single �,----
buildng or property 5''ALL. - -- dwelling is,
Res ntial backflow fauventioon ^' -
Proposed use of devices-
building or property
'( xcept rrsJWnhal9,-P,4�;►;
-- Y_ prevention devices)
NOTICE 'Minimum Fee$25.00 SUr•; "-
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5%SURCHARGE
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF
CONSTRUCTION OR WORK.IS SUSPENDED OR A13ANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25%OF SUBTOTAL
COMMENCED.
TOTAL �' s
Special Conditions
')ate issued -_-by
�.+iwrvr
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� ^ CITY OF TIBARD - RF'�FIPT OF PAYMENT REC�IPT NO.
CHECK AMOUNT : 15' '75
� NAME n VANDEHEY, NARK CASH AMOUNT : 0. 00
ADDRESS v 7!598 SW ASHFORD 8T PAYMENT DATE x 04/13/93
SUBDIVISION ,
Tl8ARD, OR 972E4—
PURPQ8E OF PAYMENT P.MUUNT PAID PURPOGV OF PAYMENT AMOUNT PAID
' ----- -------'----- ----'-----'---------- ------------
� oLU�� rr4B PE�M 15. 00 GT. BUILD PER 0. 75
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SPRINKLER SYSTi:-,M �
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TOTAL AMOUNT PAID - — — —} 1S. 75 �
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