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11670 SW 114TH PLACE ADDRESS: .. 7DJzw 1PLA 1:\rrcotdSWIcrofImMargetslbullding.doc fo$ E /f CU 2k/ G\ R � §» %) c k � § \\/ X70 E '521, {/y ) ) (\/k\If %\ >kC . CL z k kEak £ e'4E/tm � All \ ® § k ® § % § A § a § 3 a § to a a a a a C� \§ ( ( \ \ } § / � }k CD � _ CD n o e = e I m 2 U fn U) \ k / k § f / ] \ @ t 0 � 2 ) \ V r m $ $ 7 I m $ $ ¢ a � \ § § \ CIA d C,4 d $ 2 ® > � 69 � k \ j \ � % w / % / / } ƒ CAL � � . k \ \ ) a � CA In f § ) :D { f { k \ U-) E LL ® a ° $ / @ e 2 f © ° § � \ 6 / \ / / \ / J § w § § § § w § §W6 § o Of o m .a -oCc, o � NN N OI DC7 d OC y I I C U r- > p f0 m C1 U N o N N � � :3< a q - ac _ 00 p aN c `2 Z �o a E > R� rn 0)i OD 00 rn rn rn rn o CL N N iz N N N N CL U.) It] C� 'D F D 0 J Z LO Go P p G Z Uj Z Z Cw 0a UO O co c m U o w w W ~ 0 o Y n yy v Tf: C 010 0 Q' V m rn °�i rn rn o CN W N }d d m 04 V U C/ J U t7 W N J _ C Q O a) a C C n Q o a a _ I� co In —I vS yy 4 m C N _ ryN�p Q ¢ U LL M o n o clq— t` o O o CIJ � r- c0 vL+ U U U U U U U k z V £ 6 % % C g ! 2� _j CD 0 CN 0 & c c o / - ¥ 2 a « a 2 = & _ cL �D a m @ I = I m 0. a § 2 � Q 10In \ � � 2 % $ 4.0 U � � $ � t / e / S e / / bcmE / \ \ f \ § \ , § 2 Ln / E \ \ \ � a = / d C14 0 ƒ $ 2 b ) 2 § > J 7 ) ) 7 n a CITY OF TIGARD DEVELOPMErin SERVICES PERMMECHANICAL IT 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT ff NEC98-0185 DATE ISSUED: 05/27/98 PARCEL: 1S1.34DC-02200 SITE ADDRESS. . . : 11670 SW 114TH FIL SUBDIVISION. . . . : 114TH PLACE ZONING: R-4. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .015 JURISDICTION: TIG CLASS OF WORK. . :REP FLOOR TURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . .- 0 VENT FANS. . . : 0 OCCUPANCY GRP. . : R3 VENTS W/O APDL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUEL TYPES-------------- 0-3 HP. . . , : 0 DOMES. 1NCIN: 0 :GAS 3-15 HP. . . . : 0 COMML. INCIN: 0 MAX INPUT: 0 BTU 15--30 HP. . . . : 0 REPAIR UNITS: 0 FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . 50+ HP. . . . ; 0 CLO DRYERS. . : 0 NO. OF UNlTs--­------- AIR HANDLING UNITS OTHER UNITS. : 0 TURN ( 100K BTU: 0 10000 cfm : 0 GAS OUTLETS. : 1. FURN ) =100K B"r(..I: 0 > 10000 c-fm : 0 Remai-ks . Reroute gas line frog meter to appliance. Gas company has shut off gas lin., old line was under garage slab. Owner-: FEES MARGARET ANTICO type AMOLInt by date �-ecpt 11.670 SW 114TH PLACE PRMT $ 25. 00 DEB 05/27/98 98-306059 TIGARD OR 97223 5PCT $ 1. 25 DEB 05/L-17/98 98-306059 Phone #: Contractor: ------------------------------ ENERGY MASTERS HEATING P. A/C 6470 SW 76TH -------------------------------------- $ 26. 25 TOTAL PORTLAND OR 97224 Phone #: 244-8880 Reg #. . : 000585 REQUIRED INSPECTIONS -------- - This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code. State of Ore. Specialty Codes at -111 other Mechanical Insp applicable laws. W1 work will be done in accordance wi . Final Inspection approved plans. This permit will expire if work is not t, rtpd within 180 days of issuanep, or if work is suspended for i re than 180 days. ATTENTION: Oregon lais requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-'M-88I8 through OAR 952-001-0880. You may ——----- obtain copies of these rules or direct questions to OLK by calling (503)246-9187. Iss e By : Permittee SiqnatiAi--e :_ '7- q/ .........................................f...................................... Cal 1 639-4175 by 7:00 p. m. for, inspections needed tht- next business day +-.j 4+4-++4-++4.4................i..............±......f A-++++4....... +j-+++++++++++ Plan Chq6# CITY OF TIGARD Mechanical Permit Application Recd By 3125 SW HALL BLVD. Commercial and Residential Date Recd TIGARD, OR 97223 Date to P.E. (503) 639-4171, x304 Ddte to D T_� 7 Print or Type Permit# Called Incomplete or illegible applications will not be accepted _ Name of Deveb^p'menvProlect Descnption n yv( !ns'`-C IMT C() Table 1A Mechanical Street Address Code CITY PRICE AMT SuAeX Job .f� A) Permit Fee � -0- -0- 10.00 Address 11 (,>7 0 l ICS PL, Bldg# rry/State zip 1.) Furnace to 100,000 BTU 6.00 t G?, U) c;47•4? including duds&vents Name(or name of business, 2.) Furnace 100,000 BTU+ 7.50 Owner �_ including(:ucts&vents Will n9A1� 3.) Floor Fumace 6.00 I including ent cityiS e Zip pn �O4r 4.) Suspended heater,wall heater 6.00 (D or floor mounted heater Name(or name of business) 5.) Vent not included in appliance permit 3.00 Occupant Madp,4m#v 6.1 Boder of comp,heat pump,air Gond. 6.00 to 3 HP;absorb unit to t00K BUT" Citylotate Zlp Phone 7.) Boiler or comp,heat pump,air Gond. 11.00 3-15 HP;absorb unit to 500K BTU" Contractor Name 8.) Boiler or comp,heat pump,air Gond. :5.00 C- l✓std 6l W1 r�s T*f"j (U L 15-30 HP;abso.b und.5-1 mil BTU" Prier to permit Marin Address 9.) Boder or comp,heat pump,air Gond. V 22.50 issuance,a copy 74 7U S•7'7& 30-50 HP;absorb unit 1-1.75mit 8TU- of all licenses City/State zip Phone1� 10.) Boiler or comp,heat pump,air Gond. 37.50 arr required if l� 3 Z'f4 T/� >50 HP;absorb unit 1.75 mil BTU ­ expired in COT Oregon Const,Cunt.Board Lic# Exp.Date 11.) Air handling unit to 10,000 CFM 4.50 database Architect Name -- 12.) Air handling unit 7.50 _ 10,000 CTM+ _ or Mailing Address 13.) Non-portable evaporate cooler 4.50 Engineer CRY/State zip Phone 14.) Vent fan connected to a single dud 300 Descnbe work New O Addition O Alteration Repair O 15.) 'Ventilation system not included 4.50 to be done_Residential O Non-residential O in appliance permit Additional Descn tion of work. 16.) Heod served by mechanical exhaust 4.50 Q� e,()Pk- Lt l�r't.� L to 17.) Domestic incinerators 7.50 C)F- G� Lr'ot/c Existing use of 1h.) Commercial or industrial 30.00 building or property_ h,pe incinerator 19.) Repair units 4.50 i Proposed use of 20.) Wood stove 450 building or property -L 21.) Clothes dryer.etc. 4.50 un Type of fuel-oil O natural gas O LPG O electric O 22.) Other units 4 50 I hereby acknowledge that I have land this application,that the information 23.) Gas piping one to four outlets 2..00 given is correct,that I am the owner or authorized agent of �.� the owner,that plans submitted are in compliance with Oregon State laws 24.) More than 4-rer outlet(each) .50 LLl _ -� Signature of OvgnerlAgent Oats *SUBTOTAL 6--'2-�" , 5%SURCHARGE fl1 Cc"'''ntact P�on Name Phone PLAN REVIEW 25%OF SUBTOTAL � // ,C� /! _Required for all commercial permits only. 7 l S! / -2" 'r{`T 'U �j�i' G TOTAL 'Minlmum permit fee is$25+5%surcharge "Residential A/C requires site plan showing placement of unit. 1:4nechprmt.doc rev 4/15/98 MECHANICAL CITY ®FTI GAR® PERMIT PERMIT #. . . . . . . : MEC96-0140 DATE ISSUED: 0�/20/96 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hell Blvd.Tigard,Oregon 97223*8199 (503)839.4171 PARCEL.: 1 S 1:34DC-•02 2'00 S1 1-I_ Al)DRL51 . . . : 1 1670 SW 1141 H PL SUBDIVISION. . . . . 114TH PLACE ZONING: R-4. 5 BLOCK. . . . . . . . . . . 1-01.. . . . . . . . . . . . . . 15 ------------------------------------------ CLASS OF WORK. . :ALT FLOOR FURN. . . . : IZI EVAP COOLERS: 0 TYPE OF U&_-. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :R1 VENTS W/O AP'P'L: 0 VENT SYSTEMS: IZI STORIES. . . . . . . . : 0 BOILERS/COMP'RESISORS HOODS. . . . . . . : 0 FUEL TYPES------ 0-3 HP'. . . . : 1zl DOMES. I NC I IV: 0 : /GAS/ / / 3-15 HP. . . . : 0 COMML. INCIN: 0 MOX I NI''UT: 0 BTU 15--30 HP. . . . : 0 REPAIR UNITS: 0 FIRE DAMPERS'). . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURL. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0 NO. OF UNITS--- - ----- AIR HANDLING UNITS OTHER UNITS. : 1 FURN ( 1 00K BTI.I: 0 (= 101AIDIZI cfm : QI VAS OUTLETS. : 1. FURN ) =100K BTU: 0 > 10000 cfm : 0 Remarks : ALTERATION OF WATER HEATER 1=ROM EI-ECT13IC TO GAS & ASSOC. P'IP'ING Owner: - -- _________.___.___-_•--__._________.____._________-.__ FEES _---- --------- MARGARE:T ANTICO type amol..tnt by date recpt 11670 SW 1147H PLACE PRMT $ 25. 00 .TMH 05/20/96 9b-279607 5PCT' $ 1. 25 ,JMH 05/20/96 96-27' 601 1 I CARD OR 97223 Plhrone #: Contr-actor: ENERGY MASTERS 7470 SW 76TH PORTLAND OR 97224 --------------------------------------- Phone _____-_____-------------------------- Phone #: 244--8880 f 26. 25 TOTAL Reg #. . : 058556 RE".QUI RED INSPECTIONS This permit is issued subject to the regulations cnntained in the Gas Line Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical I n s p applicable laws. All work will be done in accordance with Final Inspection approved plans. This perp t will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180, days. Permittee Signatl.tre : at(— I ssi_ted BY t c / _ - L l Call for- inspection - 639-4175 J �' CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 6394175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling um Post/Beam Mech. Shear/Sheath Framing <jEch. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect. Posb'Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appy/Sdwlk Other:, i��,L*Z_ ► O /4 m - _ Date: S,L A.M. P.M. Ent : Address: Tenant: _ — Ste: _._ MST: _ ----t BUP: Con/ wry MEC 14 THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: Oa J J I I In ector: — _ Dat e: APPROVED —DISAPPROVED/CALL FOR REINSP. CF CO CITY t3F TIGARD BUILDING INSPECTk�N NOTICE Inspectio�i Line: 639-4175 Business Phone:639-4171 Footing Rain Drain Cover/Service FINAI Foundation Water Line Ceiling um Post/Beam Mach. Shear/Sheath Framing Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elbct. Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwik ,;,, �eM'yn�'i✓ Other: Date: La 2/�t_._ �p A.M.__ P�M/.� Ent3: Address: _ c,Q-2U--� L ' `r"� � ....� Tenant:_ Xf.���C_ ifl3rS7�.�s. _ Ste: MST: 5/6/ 88 BOP: Con/Own: MEC: PLM: EI_C:THE FOLLOWING CORRECTIONS ARE REQUIRED:4r IA-4 -- -------- --- ----- - Inspector: _ Date: —APPROVED &—_—rTrPPRROVED/CALL FOR REINSP, CF CO CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundatii)n Water Lire Ceiling Post/Beam Mech, Shear/Sheath Framing e Plbg.Und/Flr/Slab Plbg Top Out Insulation -Elect. Post/Beam Struct, Mech. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Reins. Other: _ '�y Date: —��L1_� _ A.M. -- Address: -- Tenant: _--- - _ —_— Ste:--- MST: BUP: Con/Own:— — -- MFC: PLM: ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED ELR: Date: Inspector: — _APPROVED _DISAPPROVED/CALREINSP CP CO CITY OFIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-41 71 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct. erh. Rough-in Gyp. Bd. -Bldg. San. Sewer s Lin Appr/Sdwlk Reins. Other: Date: __.._.__ A.M. P.M, Entry: Address: �� Tenant: ____ Ste:______ MST: BUP: Cori/Own: _ MEC: PLM: ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED ELR: �Ja en,-in /Lyne LA,6m ,72,5a 5,5 L -- —— 1 e —J �— - — ---- u Inspector: _- Date:G_z/� _APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line. 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL Foundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear/Sheath Framing -Mech. PIbg.L►nd/Flr/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct, Mech. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Reins. other: 9 _ _ _0 'C x-- �-$_ Date: l3� l ;3 �1 (p A.M. P.M. Entry: Address: Tenant: _ Ste: MST: BUP: Con/Own: MEC: PLM: 2..C� ELC: _ THE FOLLOWING CORRECTIONS Ar E 9EOUIHED ELR: Inspector: i _ Date:_ APPROVED —DISAPPROVED/CALL FOR REINSP. CF CO r C.1'1`Y OF: '1'1(3WN1) NNCI~1.PiLIF PAYML;Ni K-A':F.AVII NO. aC1r~ IyF,ut1 L.HE,L:Fti Hi11.11.1N I" `ic�'. :�W NOME tl ENEW—fY INC I:;W!3H NMIALINi' n 141. IAW ADDRESS tl 7470 SW '71;'IFi IAAYMk::.Ni' 11►- W tl 0" L)to SUBUIV1.li11.1N s PORTLAND, UR 9-ze2 3-- PLIRP1.1!+l OF PA YMI-.1'J l WM(JLJN'l PA 10 PURPOSE Of- PH YMF-.N 1 $4MOUN 1 E'W 11) PL.UMN 1 NN P+RM 91 . HU 1 L.i► ('F he c �0 MECAJAN I C:t L PI::' `►. 00 Ww1 I E11 MiATER PERMITS FUN J C311 1.1 f 1 1 E 70 SW 1 14 1'H I'1 (1CV; to'TA1_ WMUUNT PAID . -a City of Tigard MECHANICAL PERMIT Planck/Rec. # rr'? ip�=l��'��i� 13125 sw Hall Blvd. APPLICATION Permit # Tigard, OR 97223 (503) 639-4171 5 escnptron TI Table 3A Mechanical Code QTY PRICE AMT /)PS /�. - Job .� D �Q �'({ 1 t Permit Fee 0. 0- 1000 Address 7L 2) Supplemental Permit 3.00 «. urnaceTo ib=bbt3- 1) incl. ducts &vents _ 6.00 Owner �' 2) incl. ducts &vents 7.50 { Floor Furnance 3) incl. vent 6.00 �.m..r5=;;;T— Suspended heater, wall seater 4) or floor mounted heater 6.00 ...,, ... Vent not inci. in Occupant 5) appliance permit 3.00 „ .. Repair of Reating, re ng. 6) cooling, absorption unit 600 of er or comp, eat pump, air con . Eft h�t/1 �HSS 7) to 3 HP; absorp unit to 100K BTU 6.00 u «. � Boiler or comp, heat pump, air cond. Lt--)U raw. 04,4'>` a 8) 3-15 HP; absorp unit to 500K BTU 11 00 Contractor Boiler or compTeat pump, air cond. 9) 15-30 HP; absorp unit .5-1 mil BTIJ 15.00 .. .P .« •• of er or comp, ea pump, air con . 314,1 10) 30-50 HP; absorp unit 1-1.75 mil BTU 22.50 ere y ac now a ge that I have read this application, that the Bo-filer or comp, heat pump, air cond. information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37 50 agent of the owner that plans submitted are in compliance with Aii handling unit to State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50 Board, that the number given is correct. (If exempt from Slate it handling unit registration, please give reason below.) 13) 10,000 CTM + 7.50 — olTri portaEle 14) evaporate cooler 450 Vent fan connected 15) to a single duct _ 300 Ventilation system not 16) included in appliance permit 450 ..«d. oo-Tserv�by— �i �� 17) mechanical exhaust 4.50 Des i e wo new addition aeration repair � Commercial or industrial to be done residential O non-residential Q 18) type incinerator � 30 00 xisting use-of ter i.e., woodstove wa r building or property jZ 1�`� __ 19) heater, solar, clothes dryers, etc. I 450 Proposed use of r� •rJ20) Gas piping one to four outlets 2.00 — building or property F- _—_ 21) More than 4-per outlet (each) 2.00 E pe of fuel -oil Q natural gas LPG Q electric Q TICE Minimum Fee S25 00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR 5% SURCHARGE IF CONSTRUCTION OR.WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 21% OF SUBTOTAL AFTER WORK IS COMMENCED -- TO rA L Special Conditions - Dite Issued by — M40GIM0lTSMFCHPMT PER IT CITY OF TIGARD PERMITU#BIN.• .. : PLM96-0120 COMMUNITY DEVELOPMENT DEPARTMENTDATE ISSUED: 05/20/96 13126 SW Hall Blvd.Tigard,Oregon 07223.8100 (503)838-4171 PARCEL: 1 S 134DC-02200 SITE ADDRESS. . . : 11670 SW 114TH Pi- SUBDIVISION. . . . : 114TH PLACE ZONING: R-4. 5 BLOCK,. , . „ . . . . . . . LOT. . . . . . . . . . . . . : 15 CLASS OF WORI',. . :AL1” GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP'. . : R1 FLOOR DRAINS. . . . . . , N TRAPS. . . . . . . . . . . . . . . 0 STORIES. , . . . . . . : 0 WATER HEA" cRS. . . . ., : 1 CATCH BASINS. . . . . . . : 0 FIXTURES--- ---------- I-AUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . 0 UR I NALG. . . . . . . . . . . . 0 GREASE: TRAPS. . . . . . . : 0 LAVATORlf_S. . . . . ; 0 OTHER FIXTURES. . . . : 0 FUb/SHOWI_.RS. . . . : 0 SEWER LINE. (ft ) . . . : 0 WATER CLJSETS. , ; 0 WATER LINE ( Ft ) . . . : <► DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : ALTERATION OF WATER HEATER FROM ELECTRIC TO GAS & F1z,:30C. PIPING Owner: ---_..____._--__.______.__-_---.-_--.-_-•----__._______.____.__-- FEES MARGARET ANTICO type amor_int by date recpt 11670 SW 114TH PLACE PRMT $ 25. 00 JMH 05/20/96 96-279607 5P'C'1_ $ 1.. 25 JMH 05/20/96 96-•279607 1 1(iARD OR 97223 F'bane #: L o n t r'act or^: --____.____.___._.-_----_-.------_ F-I\IL:RGY MisrERS 74 /0N SW 76TH 1- .)RILAND OR 97223 I-'I,cine #: PH 244-8480 $ 26. 25 TOTAL Reg #. . : 056556 -------• REQUIRED INSPECTIONS ---- --- This permit i!: issued subject to the regulations contained in the Final Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plan!. This per-mat will expire if work is not started — within 188 days of issuance, or if work is suspended for more _ than 180 days. N I-'a r-m i t t e e S i g n a t la r e ; Issued By: J co Call for- inspection - 639-4175 .J City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # rZ,A 13125 SW Hall Blvd. Permit # Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE "'""°'°""`"P'"•"' New Single Family Residences 0nly A°0 0 1 BATH HOUSE$140.00 C7 2 BATH HOUSE$195.00 Job /l(�p S-.l.v / I ¢ "� 0 3 BATH H^,USE$225.00 Address c&YiS.,. :i, Fee includes all plumbing fixtures in the dwelling and the first 100 feet fj O/7 �'f 72 Z 3 of water service, sanitary sewer and storm sewer. See fees below. FIXTURES QTY PRICE AMT Sink 9.00 A"... ph— Lavatory 9.00 Owner �� Tuh or Tub/Shower Comb. 9.00 C'"isw. "moi' =° Shower Only 9.00 Water Closet 9.00 """•'«"""`°'°•"'•" Dishwasher 9.00 Garbage Disposal 9.00 Occupant M.„g v,,� P%-. Washing Machine 9.00 Floor Drain 9.00 ayrsr°'• zo Water Heater 9.00 Laundry Roorn Tray 9.00 Urinal 900 P�61 /VA Ps S/ "" S AI ( Other Fixtures (Specific) 9.00 J."Ad..... ah.. 9.00 Contractor 7470 S.w. Z 44':!�996 900 onry". .0 9.00 L_ n , of? q 2'z- 3 Sewer 1st 100' 30.00 3131.n<g■n,n.o No nr 1— rr,,11° Sewer -ea. Addit. 100' 25.00 Water Service! 1st 100 30.00 I hereby acknowledge that I have read this application, that the Water Servicer ea. Addit. 200' 25.00 information given is correct, that i am the owner or authon-!ed agent o` —— the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30,00 I ;3m registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00 number given s correct. (If exempt from State registration, please give reason below.) Mobile Home Space 25.00 Back Flow Pnwention Device or An!-Pollution Device 9.00 Any Trap or b'iaste Not /� �-U•� "� Connected to a Fixture 9.00 De 514te work Anew l_) addition Q alteration repair 0 Catch Basin 9.00 to be done ralsidential Q non-residential Q Insp of Exist Plumbing 4000lhr Specially Req jested Inspections 40 00/hr Existing use of �{, building or propertyRain Drain, s,igle family dwelling 30,00 Residential brnckfiow prevention devices 1500 Proposed use of �1 building or property -- (Except resiclential backflow prevention aevices/ 'J NOTICE 'Minimum Fer $25.00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED PLAN REVII W 2541" OF SUBTOTAL 'TOTAL Special Conditions y __ Dete issued _by CITY OF TIGARD 13125 S.W. HALL BLVD, TIGARD, OR 97223 RECEIVED IMPORTANT PERMIT NOTICE JUN 1 2 199E; COMMUNITY UEVELUPMENI ENERGY MASTERS 7470N SW 76TH PORTLAND OR 97223 Plumbing Signature Form Permit # . . . . : PLM96-0120 Date Issued. : 05/20/96 Parcel . . . . . . : 1S134DC-02200 Site: Address : 11670 SW 114TH PL Subdivision. : 114TH PLACE Block . . . . . . . . Lot : 15 Zoning . . . . . . R-4 . 5 Remarks : ALTERATION OF WATER HEATER FROM ELECTRIC TO GAS & ASSOC. PIPING Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, pleasE� have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM OWNER : PLUMBING CONTRACTOR: MARGARET ANTICO ENERGY MASTERS 1.1670 SW 114TH PLACE 7470N SW 76TH 'TIGARD OR 97223 PORTLAND OR 97223 Phone # : Phone # : FX 244-82 0 N Reg # 0585 6 r- X '_j ignature of Aut rized Plumber Please return this completed form to the address abo ATTN: Building Dept. If you have any questions, please call 639-4171 , ext. #310