13755 SW 116TH PLACE-1 t
1.3755 SW 11 6TH PLACE
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PLUMBING PERMIT
holder of a valid plumbing contractors Iiczrse is hereby
authorized to cause plut#lbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the rime the installations are ready for inspection. City of Tigard Business License required
fur all cuntrgctors and sub•contractorit,
Owner_.�2LZ�_ c1E�= Address— 5,•� /f'f''i � , :�c it^C+ Date ' tel'S1
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS REE ON EACH AMOUNT (Office USA Only)
RE- 10AN-T-!A-L---- �.
Si le Family-11-bath..each _ 25.00
Du lex-Each 1 bath unit 25.00
Additional bathroami-tach 10.00_
Mobile Hume !;pace-tech 18.00_
INOIVIOUAI. FIXTURF FEES
1 to 50 Fixtures in 1 buildirxl-tech 2.00
SI to 100 Fixtures in 1 luilding_tach 2.50 �-
101 to 200 Fixtures in 1 Luilding-r, h 2.00
201 or mnrsi Fixtures in 1 UuildinZ.tacn 1.50
MISCELLANEOUS _
Building Sewer-1st 50 ft. 10,00
Sewtr-txh additional 100 ft. 10.00
Water Sankt to buildirn 5.00_ _
Private Water Systems-each 100 ft. 1U.00 �^
Other fsoerif ):i.
PE RM I T_ A/ for Plumbing Inspection Phone 639-4171
State "�' Plumbing Contracwr By
TOTAL /0'410_ RECEIPT NO. Issued By
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME' ''"'' PERMIT
DATE : G �l DATE ISSUED
f
OWNERS NAME
A f y D R E S S.
CONTRACTOR :
TEST : Air u, Water❑ , V.sual [] , Laboratory 0
RESULT: ApnrovedX Dijapprovad G Pending r]
SKETCH.' f_
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INSPECTOR DATE
NOTE !Attach suppl-?mental test dn'n hnret.1
LAM
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME:
DATE: L/ / > '/' DATE I S S O E L)
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OWNERS NAME
ADDRESS: �i
C 0 N T R A C T 0 R : —
TEST : Air O , \tooter❑ , Visual aboratory p
RESULT: Appt^vodDisapproved ❑ , Pending []
SKETCH:
Aea
INSPECTOR DATE
LNOTE Attach supplemental test data hereto]
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Permit No•
4746 -
Address ?s 3.W. 11 th k'L c e !
Permit ebarge
was 9uadranConnection feet corp. �_.......— .....,..._�.-..--�.
owner F
Paid by quadrant
residence Late connected
Type of building
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3.00 permonth Inspection fee
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Se.rvice rates
q+.iadrant cork. --�-M Paid by _ same --_.r Late
Contractor .__
Assessment
Size of connection _._.._.._..�._.__.
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10-
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' PL"TNG PoeaT APPLICATION
Jurisdiction of CITY OF TIGAV
'o. Type of Fixture Fee Permit No. ,79-13? -P
Permit fee moo ri
2 Water Closetslorlet.s Permit Issued
Bath bs Approved by �J
LavaBuilding Per
Shower Receipt No. - _
Sin s Ui hwacFi_g +
Sinks,s i.tclien
it s Ordinary nary Location of Building
SU nk s Bar i� 11755 SW 11§TH LACI:
Sinks.
Automat Ls was i� er ^�
t U sncsal
Laundry Trays Name & AddrNss of Owner_-____�
Drains, Floor*
- Tr7 n s Area _1I.UL_51+ SKM I N My"
Drains, Reig erator eanoZ4D 1 OREGOAi 47 721 .�.,_.
Rain Drains 5.00
Automatic Washer Name & Addre.ss of Plumber
oun ains, Drinking IMPERIAL PLUMING C HEATIG, Ilr.
Fountains, Soda _ P o KW, 00632 _
Hot Water Tank AM O R_ECM �N _
Water Service Siz
UTina s Buildin Old or. Newt �Alter, rRepa.i.r, or
Catch-Basins - Yard- n:�
rInr-ler System NFW
swimming
`� Por Fier
ri.nkler System
_ r-
This permit becomes nul]. and Amici if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended or abandoned
for a period of 120 days at any time after work is commenced.
All plumbing firms must be licensed by the City of Tigard and post a $1,000 band.
1 hereby certify that I have r-ad and examined this application and know the svine
to be true and correct. All provisions of laws and ordinances governing this type ,
of work will be complied w;I-th whether specified herein or not, the granting of e
permit does not presume to give authority to violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction.
IMPERIAL PUIBIM 9 MATING, INC.
i
;7gnaturp�of'
appli c jnt
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UNIFIED SEWERAGE AGENCY NO. _ 474
WASHINGTON COUNTY DATE _ 10"13-72
CITY OF
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER:
OWN R'S A D D R ESS: ____-_---- .175o 8,W,-.Sk d_jne Hund.
STREET
------ ------
-9W-
-
BUILDING SITE: I.OT—fl —._ __ BLOCK -_ _ ADDITION
TAX LOT NO. _____ TYPE OF OCCUPANCYeidlDO�
ADDnESS 13755_B.N. 116th
DWELLING UNITS _-_---�— _--_- FIXTURE UNITS 1k
SURCHARGE �F APPLICABLE __ �p.�pp to Derry vnLl
PERMIT FEE INSPECTION FEETOTAL DEPOSITED — 500•00
(NEW) (EXISTING) BUILDING SEWER SYSTFM Tim_
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTr-M,
LINE SIZE 4" _ 1 TALLER �� _ _.—L—loyd—..Brow►
RECEIVED BY
_ G- C S AOE
COMMENTS:
''his Application and hermit expires in ninety (90) clays. T�e amount paid will be forfeited
should expiration occur.
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VALUE cG 5�"J FEE �' i'6-� DATE
--�- _.,.
LOCATION / t OWNER
10 d ._` A P TYPE t.j
PLUMBER rt car PERMIT —/7 -/
SEWER. PER FEE MECHANICAr I'ERMTT
DATE BY DATE BY..
EXCAVATION FILL AIR CONDITIONING
! V-7z FOOTINGS FOUNDATION VENTILATION
FORMS SPRINKLER SYSTEM
SLABS _ L_ MA.'ONRY FLUES
REINFORCING STEEL FIRE-DOORS/EXITS _
_ STF.UCTURAL STEEL GARAGE FLOOR_ —�
PLUMBING R. I , _ DRIVEWAY
--- ROOF/FLASHING _ , SEWER
. _J.,r FRAME STORM DRAIN
_ LAT/WALLBOARD PARKING
HEATING FENCE SCREEN _
WATER HEATER FINAL
I 77
CITY OF TIGARD y
12470 t, W. N do !Mw!
TIGARD, OANGON 9777
APPLICATION '!'OR BUILDING PERMIT
New Construction Demolish ❑ Addition CJ Remodel ❑ Move❑
ZONING g_7 _ DATE ISSUED 10'5'72 BUILDING PERMIT
DATE RECEIVED 10'4-72 BUILDING FEE $—-11.0p__ No72*jI9�.
BY BH PLAN CHECK $ 4-
OTHER $ 10.00 VALUATION 2Q�5al_OD
TOTAL $_ 87.00_ RECEIPT No. Lle�2C Z
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT Y 8 MAP A 281 3G CENSUS TRACT W JOB /
Arch: .ect or Engineer
---Jwal4-ilopdslaa-J.-As aaLtta_
Address Beu-wa. Mashi.ngton Phone
Owner %adrant Carp.
Address Phore
Builder-- -QWid.ant
Address - - _ —— _ Phone
BUILDING USE Single Res. ❑X Multi Rea. ❑ Comm. ❑ Industrial❑
OCCUPANry GROUP I� No. of Stories 1_ , Totai Height 16— _ Area of Lot 7000+
-
Type of Construction V Floor Area B`'` 11355 � 2_
Set Backs: Front_ Back 30_, L.Side_2R.Side 6
Private Sewer Pipe Size 4" Sewer U.B.A. Tigar4septi.c Tank I_J
Water Service Pipe Size 40 Storm Sewer a Ditch ❑ DryweII❑
Street and Curb Requirements1xi.sting
Driveway Width__171 _ _ _ �No. of Parking Spaces_ 2
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
----- -- No OCCUPANCY UNTIL MWORI M Lu'm
ADDRESS ASSIGNED12755 8-161-
FIELD CHECK BY ,.,
PERMIT APPROVED BY L* %
it is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and she City of Tigard, Oregon, and that the building will +
not be occupied until a Certificate ofOccupanc has been issued by the City of
Tigard Building Inspector. ��� '�'
� e
S gnature of Applicant