11830 SW 91ST AVENUE �n
11830 SW 91ST AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main S'..
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Date Requested Time A.M. P.M.
Address Permit
Owner Lot #
Builder
-'The following BuiWino Code deficiencies are required to be corrected:
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Presented in �Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
EJ YES 0 NO
■
CITY OF TIGARD Plumbing Permit V 1 g
Building Department NO.
w3sidential Commercial ] � � 1
t".ew Installation Replace L� Addition [] Alteration JIr '1 y Date-.L�r
Licensed ff l 1 I' _I.. iyovi W a r.: ' U��- �� 7 7
Plumber � J 'CWO ��11'v1 � �"`�' ' -- Owner _
��3 �„ � Job Address �—�_---
Address (,(r 7 ��—� -- -- — ----
Phone 7 J'- L 3 _��--- - Applicant = c,#� ►t --
_CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS AND SUB-CONTRACTORS
— — ITEM NO. FEE TOTAL ITEM NO. FEE TOTAL
7,50 Sewer:First 10011. _ _ 30.00
Fixtures-Traps — -
Dishwasher 7.50 Each Addit.100 ft. 15.00
_ _--
7.50 Ejector Pump 7.50
7.50
Garbage Disposal _— _000
Water Heater 1.50 Water:First 100 It
7.50 Each Addit.200 ft. 15.00
Backflow Preventor _— -
-- Storm 30.00 8 Rain Drain:First 10011. _! __
154A.�r?rAVr_ )
00
Each Addit.200 ft. — —
t�— Mobile Home Space 0Other(Specify):
Rain Drain-Single Fam.Dwelling0
Comments: It
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PERMIT FEE
-- - Issued By:
Co C ' is
STATE ',d- Receipt No.. ' — Applicant 1"7/_1_ —
' Sbn m
TOTAL �.f -�"� _- For Plumbing Inspection hone 639-4171
1
- CITY OF TIGARD �
I Numbing 6�ec�m;t
Building Department NO.
Residential Commercial ❑ �.'
New Installation LTJ Replace C-] Addl'ion [I Alteration ) i
❑ Date JZ=�Z z__
Licensed
Plumber rI ,-1 , rol T J�'1)ge, 1116 Owner Jivapt WaV J _
Address -w-0tst5._ tri
�9,r� � •-s��=-a-1--
Phone ---� _-�`=�'— ----_..---- - - Applicant _6 �eSNrl,
'iCITY BUSINESS LICENSE REQUIRED FOR ALL CONTRAC SUB- NTRACTORS
ITEM �T NO. FEE TOTAL ITEM NO.
FEE TOTAL
Fixtures.Traps 7.50 Sevier:First 100 ft. 00,00
Dishwasher 7.50 Each Addit.100 ft. 15!00 i
I Garbage Disposal 7.50 _ Ejector Pump 7.50 —
Water Heater _ _ 7.50 Water:First 100 It._ 20.00
.x
backflow Preventer 7.50 Each Addit.200 ft 15.00_
IStorm&Rain Drain:First '00 It. _ 30.00ti hiWi
J) Each Addrt.200 ft. 15.00
obile Home Space
Other(Specify): i Drain Sin le Faking — t 5.00
S.�� --- r
PERMIT FEE is `.". Comments: _ _
I P Issued 8y:- - -- -
STATE *f % C ¢
Receipt No. Applicant-_
TOTAL �`�' For Plumbing Inspection Phones 3g-kiature
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Address��� � 1 1 -- --
Name of Occupant���� {jiaA -� Permit charge
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Paid by_ L
Date connected --
Type of Building _ _ Inspection. fee
Service Hate_. = Date
Paid by
—� -- -----
Contractor Aasessrnent___- ._ _ _
Paid
Size of connection—