12055 SW MANZANITA COURT 12055 SW MANZANITA COURT
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INSPECTION IOTA'S ell— -
City of Tigard Building Mpartsent
13125 571 Ball Blvd. Tigard, Oregon 97223
Inspection Line 'Re: -O-Ph ne))�1 639-4175 Bunmeae Phone: 639-4171
Inspection:_ 6!✓L'—
Footing Plbg. erelab Mach. Rouqh-in Appr/Sdwl,k
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line LL�r Gyp. Bd. -Mech.
Date -.4equeotedt L���_ _T1 : X—AM PM
Addreass_ �_�����" , "� 1�eva •:
THE FOLLOWING CORRECTIONS ARE REQUI11ED:
<J
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y
Inspector: // ^ ^_ Date:
,APPROVED —` DISAPPROVED APPROVED SUBJECT TO A80VE
Call For Reinop.
City of Tigaid PLUMBING PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit # _
PO Box 23397
Tigard, OR 97223
(503) 639-4171 0�7
sarpoon
ORS 814-21-610 OTY PRICE AMT
.K
Jot) Qz)bb c� M FIXTURES
Address .e. n .50
21
lavatory
�'"t a C '� Uo or U�1_ower 'Om�.
1 t. g� ( Shower Only 7.50
"' Water Closet 7.50
owner ` 5 `z� MaDishwasher .50
urfZap Uarbage Disposail — -
Washing Machine 7.50
r�aiin_ 7,50
L
alar eater 50
Pam "' Laundry m rnvy 7.50
Occupant Unna - ?.50
up Other. ixtures( 35) 7. 0
50
.ti 1
I 1 ` t 7.50
r.qw
Contractor
MISCELLANEOUS
,.,. — —_
Sower 1st loo' '+ 30.00
w mnw M — +TuMSewer ea.Ackit. 100'
Water Service 1 st 100' 20-60
hereby acknowledge at ve n vis app--p kation,,t at tFe Water Service ea- Addit 200' 15.00
information given is correct,that I am the owner or authorized agent of _
the owner, that plans submitted are 'n compliants with State laws,that I Storm R Rain Draav 1st too' 30.00
am registered with the Construction Contractor's Board,that the number Storm 1 iin Drain Addit. 100' 15.00 —
given is correct. (If exempt from State registration, please give reason
below.) Mobile f,_rive Space 25.00
( t %-ck Flow Provention
Device or Anti Pollution Device 7.50
Ajiy Trap or Waste Not
Connected to a Fixture 7.50
rescribe work new - a itvon alterati no repairCatch asn
to be done residential non-re!:idential O — "— 40.00
Insp of Exist. Plumbing per hr
40.00
Specialty Requestod Inspections per hr
Existing use of Rain Drain.singfanvly
building or property —�^ dwelling 15.00
Atisidantial back w prevention
Proposed use of devices 15.00----- --
building or property
(Except residential -71_ow
prevention devices)
NOTICE 'Minimum Foe 525.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5%SURCHARGE
AUTHORIZED IS NOT ''OMMENCED WITHIN 180 DAYS,OR IF _
CONSTRUCTION OR iA IRK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF to /SYS AT ANY TIME AFTER WORK IS PLAN REVIEW 25%OF SUBTOTAL
COMMENCED. v
t TOTAL
Special Conditions --- —
Date issued by
WOIUMBPW
.rwfco�f..
CITY OF TIGA RD P,LUMBING FBF'RMIT Xo_�
COMMUNITY DEVELOPMENT DEPARTMENT
(CIIYAMW P,ERMIT #. . . . . . . : FILM91-0172
one"
13 125 SW HWI Blvd. P.O.Bar.23397,Toad,Or g.UM
r"IT1174176
7w,7) DATE ISSUED: 09/x.7/91
S51 1 E ADDRESS. 1c:'055 SW MANZANITA ST P,ARCFL: 131.34CA-00613
SUBDIVISION. . . . : PANORAMA ZONING: R-4. 9
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . 121
CLASS OF WORK. . :ADD GARBAGE DISPOSALS. . : MOBILE HOME SPIACES.
-
TYPE OF' USE. . . . :SF WASHING MACH. . . . . . . : BACKF'LOW F-IREVNTRS. . - 1
OCCUPANCY GRP,. . R3 FLOOR DRAINS. . . . . . . . 'TRAP'S. . . . . . . . . . . . . .
STORIES. . . . . . . .
S WATER HEATE=RS. . . . . . . CATCH BASINS. . . . . . .
FIXTURES------- LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . .
SINKS. . . . . . . . . . : URINALS. . . . . . . . . . . . . GREASE TRAPS. . . . . . . .
LAVATORIES. . . . . . OTHER FIXT`URES. . . . . .
iUB/SHOWERS. . . . : SEWER LINE (ft ) . . . . :
WATER CLOSETS. . : WATER LINE (ft ) . . . . :
DISHWASHERS. . . . : RAIN DRAIN (ft ) . . . . :
[ emAr-ks : BACKFLOW DEVICE FOR SPIRJNKLER GY571M
Owner. ---------- FEES
RALPH BURNETT type afo0l.knt by date reent
12'055 SW MANZANITA CT PRMT $ 15. 00 JLH 09/27/91
5PICT $ 0. 75 JLH 09/27/91
TIGARD OR 97223
'.-.,hone #:
ontrar:,tor; -------------------------------
IWNER
--------------------
Fhone 15. 75 TOTAL
Peg
------- REUUIRFD INSPECTIONS -------
This pervit is issued subject to the regulations contained in the Top—out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This persit will expire if work is not started
within 180 days of issuance, or if work is suspended for sort
than 180 days.
I-,ev-mittpe Signature -�_._
15q1_1PCJ Py :
Call for inspection 639-4175
II
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT NO, 01-217979
CHECK AMOUNT 15. 75
NAME BURNETT, RALPH CASH AMOUNT a IA.00
ADDRESS 12055 SW MANA'ANITA PAYMENT DATE s 09/211/91
SUBDIVISION
TIGARD, 014 97223—
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
PLUMBING PERM 15.00 ST. BUILD PER 0.75
SPRTNKLI:,P SYSTEM
TOTAL Fai UNT PAID — — — — 15. 75
Address/4 Permit No.j�ej
Name of Occupant__ _ Permit charge
Connection fee
Paid by
Date connected 7 --2 4CIX
Type of Building JI.P /6 .
Inspection fee
Service Rate Paid by Date
Contractor Assessment Paid
Size of connection
PERMIT T4 CONNECT
Tigard Sanitary District
PERMIT N° 987 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTII.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $__ .:....................... .TIGARD SANITARY DISTRICT
By
4 � Ill
CONNECTION INSPECTED AND APPROVED
Date Superintendent