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BUILDING DEPARTMENT, TIGARD
PLUMBING PERMIT '" ' •�
�K: 7L vin �:•. ,_✓_�___�._. __, holder of valid plumbing contractors license is hereby
authariz to cause plumbing work as herein noted -,r, he insta0ed in accordance with ':ie plumbing code of
Tigard. Such installations require insoection by the City Inspe.:tor who shall be notified riot less than four
(4) hours prior to the time the instnliatiorls are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors.
c✓G c Address�o' % L' A' .�'c=_ Date,-
Owner. ------= —
NUMSF.R OF TOTAL PERMIT NO.'S
C- TYPE OF PERMIT Il EMS FEE ON EACH AMOUNT (Office Uv Onlyl
_S I@ Family-1 bath-each ___-_- __25,00
Duplex-Each 1 beth unit - 75.00._
% dditional bathrooms-each
Mobile Home Spare-each —_, 15.00 -
IN_DIVIOUAL FIXTURE FEES �� - ---- -- --
1 to 50 Fixtures in 1 building-each 300 ---
_51 to 100 Fixtures in 1 building-each _ _-_ _ -. 2.50 -
101 to 200 Fixtures in 1 building each _- ___ 2.00
201 or more Fixtures In 1 buildin2•eech _ - 1,50
MISCELLANEOUS --
Buildin Sewer-1st 50 tt. _. _10.00 ---•--- - I
Sewer_each additional 100 ft. - _.__10.00
j Water S^rvice to building- T -5.00 _
Pnvate Wetar syste ne-each 100 ft. —_ __. _ 1000 _ TG
0 .er Ispecify):
PERMIT For Plumbing Inspecrion Phone 639-4171 805 N.E. FOURTH .AV
3 Stale /, y U Plumbing Contractor BV `__�ANLY, OR 91013
- !.
_ TOTAL zj.ve RECEIPT NO. Issued By __� ` -,j6Q_209L
City of Tigard Mechanical Permit _ � Permit_ up,
Fee___�Lt'�A�_..�
New Installatio Replace J Relocation ❑ Addition ❑ Alteration �...� 3%:hate
TOTAL—
CONTRACTOR
OTAL_.CONTRACTOR
? vel.ON
ER
ACDRE.SS_ ` L � & v/' WWRDRESS
71�
-ZONE_ � ' //S9 _ _ APPLICANT
Heat Input Rating (BTU Per Hour) �� 700 Vent Size Flue Size___
FULL O1L. ❑ GAS U ELECT OTHER����
Il EM NO. FEE ITEM NO. FEE
TO T Issuance of Permit _ 3.00 Air Condition Compressor 15 to 30 HP 10.00 '.
New- Under 100,000 BTU T _ _ 4.00_, Air Handling 10,000 CFM _ A 3.00_ 't
New- 100,000 B,TU &over __ 5.00_ _ Air Handling Over 10,000 CFM
Floor Furnace 4.00 Evaporative Cooler ~3.00
Wall Floor Suspended 4.00 RangR Vent Fan _ 2.00
Install Vents Only J�+ _ �_ 2.00_ Vent System_
_Repair- Heat& Cooling'——
ooling _ _4.00 rt_ood Commercial —_
Air Condition Compressor Under 3 HP 4.0_0_ Commercial Duct System 10.00
Air Condition Compressor 3 to 15 HP J— 7-50
INSPECTOR'S COMMENTS
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS
APPROVED BY_ DATE —-- ISSUED BY _ DATE
RECEIPT NO.
�+ Signature of Applicant
..+air"" pIopm-lo:p%4AW".T". .x ._ _ .�••r- -"'7'.t. "1�� 1�Pi .pro
CITY T�GARD DATE..__ _ 19 ,r r;
BUILDING PERMIT APPLICATION OF •,y t
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED GUILDERPHONE�
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONI=
LO'T N.
OWNER 'iilliik Hiil Tnv, tFS 11DRESS J41 lulal 'Sfotll HOME ADDRESS --
a ARCHITECT
ENGINEER
BUILDER ��yy�tOC1N� i«�e ADDRESS � ";� Tk' ' nt�tt' 4PtILta DESIGNER
STRUCI"URE LJNE:W ❑RFMCIDEL ❑_ADDITION _ ❑RE.PAIR � ❑RENEWAL ❑FIRE DAMAGE_—❑DEMOLITION
❑ RESIDENCE ❑!:OMM ❑EDUCATIONAL ❑GOV'T ❑REI_ICIOUS❑PATIO ❑CAR PONT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOV ING ❑CONLf10NAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS —
OCCUPANCY __`LAND USE ZONE BLDG. TYPE— FIRE ZONE PLAN CHECK BY- HEAT
ur..t yin ,l+a FaMily dt GIIilty w/sttachad yaregee 2 0odr•s3iffis --
_._ ---- I HOUR rin UALL. BETWEEN HUILCIMIl,!,. -
5swar Pormit #16b2fo - $625.00
QO 20 l � 10 A NO BED e 2 1��80C.
SIQ.STORIES______.AB P.��. H41?► _.__..Yf�
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR 20 LEFT SIDE RIGHT SIDE
Permit __.. _ — _
— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check h3. REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PIANS ANC SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 190,50 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PFRMIT DOES NOT WAIVE
RESTRICTIVE ^.UVENANTS CONTRACTOR AND SUB CONTRACTC;RS TO HAVE CURRENT CITY BUSINFSti
State Tax • 0c' LICENSE, SEPARATE; PF,`RM�T$ REQUIRED FOR SEWFri PLUMBING AND HEATING.
Total
by —
_____- /+�I� A LICANT OR AGENT
Appl c,ved _ Th Recpitlt No. (;J 1
Y........W..a --
REMARKS PLUMBING DATE
DATE ISNSP. TYPE INSPECTION _
Contractor / //
Permit No. o/ t _qb• ?-7�
_L 79 Rough-in
n / —
�� Fixture - -— --
g-/d'� Final -- —
-'/ HEATING
— —- - --- Contractor n
-- -- --- Permit No.
r
— ---- - -- Gas or Oil
---- -- --- -------_- Haugh-in
Final
-- -------- SEWER
-�.__-_---_.-- Final _
�.- - - ---- ----- '� DRIVEWAY
—__�_-__— _—_- ---- Final
SlorYn Drainage
--_- -- --- - ��----- (Rain Drain)Final -
---- — Sidewalk
Curb&Street Final _—
Approach -
BL►X3. DEPT.FINAL -TEMPORARYCERTIFICATE OCCUPANCY Final — __—_--
CERTIFICATF_OCCUPANCY
Landscaping
Zoning Final
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