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10840 SW CASCADE AVE14UE
P.0.13w 213W
CITY Ol 'TIGARD PLUMBING_ 1:i125 sa H&u E,1vd.
Applicants must hold Oregon Registration to conduct ,s plumbing Ti9wd CR 9'722
��R M l 1, 639`x175
business or must be property owner/operator not hiring outside help.
Name of Development
Plumbing Permit No. � V o
Address Deeoriptlon --
i G'c L � OAS 814-21-610 .UAN. PRICE AMT.
Job Tax Lot Map.No.
Addre is
FIXTURES
Lot Bk)ci( SubdMslon -— - -
Sink 7.50
Name or n of�usrneara Lavalnry - _ 7.50 -^
l' x __ __ Tub orTub/ShowerComb 7.50
ori ing resp --- --- —...--
Snower Only 7.50
Owner G"y/ tatezip r �- WaterrAosel - --- -- 7.50 --
L� Dishwasher _ - _-- --7.50
Phone Garbage Disposil 7.50
-
Nemo Washing Machine -- -750_
� _
Floor Drain -- - - -- 7.50
WaiteAddress Phone WalerHealer ----- - -- 7.50
Laundry Room tray 7.50
Occupant GryrState w Zip -- — - - --
Urinal _ 7.50
-- I Ta-m-e Other Fixtures(Specify) 7.50 J -
/ - �r / 4, 7.50 --
ssa -
C,e"T .S� �' _71T7i 7.50
Contractor � ap _ - - -- - 7.60
MISCELLANEOUS
City w. .ex No c r Is(100' 80.00 _
sialla,mor. Boardu State s Rus Ik No Sewer-ea.Addit.100 -- 15.00
(ResxJential) Water Service 1st 100' / 20 r�
- - .�.A _ - -- t-- -_.
^^nkry aura wlsclge that I have read itis spWstlon,that the Information Water Service ea.Addit.21I -- 15.0u -
7v,vn is coned,esat I sun reQlafered with the$tare Bu*We Board,and also Storm 8 Rain Drain 1 st.100' 90.00
haus a State Pkwrtbksg Now"that the numbers given are oorred,that all -
pkimbwig work will be done in acvordence with applicable proviriorts of Ore Stora d Pr}n Drain Addd.100' _ 15'10 __. ...
gon Revised StaAdn ar
Cheows 417 x1893 and appilcable codes end that Mobile Horne Space 25.00
rv)help will be employed urA mt licensed under OIRS 693 (if exempt from - -
Stats registration.please give reason below). Back Flow Prevention
HOMEOWNERS--1 hereby nwVy diet I sun the owner of the property de- Device orMtl-Pollution Do-Ace 7.60 -
sorbed above,of wrtloh ksctdw i propos b make a pltanbktg in UAMion tory Any Trap or Waale Not
rrh own use and IhM properly is not bskq constructed kx sale,lease or rens Conrwcftd to a Fixture 7.50
Cath Basin _ 750
- - _ Insp.of Exist.Pltntbing 10.00 Per Hr -
--f -- -- ---- SpecisMy ReWealad ktapeoMons 10.00 Per Hr
- Aller.of Pkanbkq withllt
an Exlating Bldg 15.00 min -
AUTKORIZED SIGNAttl - -Date I New Bldg.or Build.Addition 25.00 min
e Ear d.l
Describe wor'c new(_-] eddirion f j ellwation$1 mpalr Q d'elli — 15.00 --
te done _ _retidenlial f eld
-w -rsential -- --_
Exlstlnq tree of
►moo or property 4.t/` C4-+.^ OWTIOTAL ob
Ptqmw We of -- --
--
NOTME TOTAL
T1Uo penMl baovres null and*gold 9 wo*or ocataauallon gullhu ued IS rsol carr*
tltsx+oad wliltlrt*110 dayanr M osn/nrcMurt or work le Mnpentled or abandoned for
a pwbd o1 180 days M any Mne atter work is oohingtoed
Date Is"d — sus '"�f by
r.
INSPECTION NOTICE
City of Tigar;l Building Department
P0, Box 23397
Tigard, Oregon 97223
Phone: 639-4175 '
Type of Inspection 4J.''�'�jl1�l',
Date Requested �T�� //_(//7/—/ Time A.M.
Address � ��
-�br- ^�-�_ Permit #,
Owner
Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _ Approved
Inspector
— ❑ Disapproved
Dote
CALL FUR REINSPECTION
CJ Y E 8 LJ No