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CI'T'Y OF TIGARD Plumbirn Permit
Bu?tdtng D�pati int �p 3 47 No. u
Resident,al [✓� Comm-rcitil [_� '�' Vi 7.,223 RE10EIVED
New Installation D Replace Addition [4----Alteration [.� G j� to
Licenseddc.T F -_+-
Plumber _f-� -y_ �rs:,�.-� l� �►�2f� vv►L..- Owner - - -4- ;Y-10E-fIGAft
D) T-
Address : C ^�� . - JobAdMess s: '4u( lir'
Phone ___�'��'__`�� �. ___--.__-- Applicant
s
CrTY BU.�INESS LICENSE REQUIRED FOR ALL CONTRACTORS AND SIJB-CONTRACTORS
I._� .T.—..
ITEM NO. FEE TOTAL ITEM NO. FEE TOTAL R
Fixtures-Traps _ t 50 Sewer:First 100 ft. 30.00 1,
Dishwasher 50 Each Addit.100 ft. 15.00
_Garbs a Disposal '50 _ Ejector Pump 7.50
Water Heater 7.50 W.,ter.First 100 R. 20.00_ _ y
_Backflow Prevents 7.50 Each Addit.200 ft. 15.00IL K _
storm&Rain Drain:First 100 ft. 30.00 _
Each Addit.200 ft. 15.OU
` - Mobile Home Space 25.00 --
Other(Specify): _ Rain Drain-Single Fam.Dwelling 15 00 1r,
PERMIT FEE
Comments:
STATE G Issued By:
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— 60 Receipt No. - - Applicant
TOTAL ,� -- - ;7- Signature 4
For Plumbing Inspection Phone 639.4171
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BUILDING PERMIT APPLICATION COF zIGARD DATE19_
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUIL_DF_R PHONE _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE—...._:--_..—
LOT NO._
OWNER !o4ko4i4 146001 :OBADDRE551 hi r,'• 1,1L1fi)MMrr_rikAL HOMEADDRESS Work I
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE ❑NEW rREMODEL ❑ADDITION ❑REPAIR ORENEWAL ❑FIRE DAMAGE (:]DEMOLITION
C RESIDENCE OLOMM ❑EDI ITIONAL ❑GOV'T ❑RELIGIOUS OPATIO ❑CAR PORT ❑GARAGE (]STORAGE QSLAB L]FENCE
OBOND ❑MOVING ❑CONDITIONAL.USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY - LAND USE ZONEI_ _. BLDG.TYPL.— f __-FIRE ZONE--,ILAN CHECK BY - � L1:: HEAT_ _—
•�'T.r
9C �L49B OAD StiL_•--.-_-- NQ�TQ. ._ AREA 363
BUILDING DEPARTMENT SET BACKS FWNT REAR LU LEFT SIDE �; RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONINF3
Plan Check REJULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAI THF
- � V40RK WILL.BE DONE IN ACCORDANCE WITH THE PLAITS AND SPECIFICATIONS AND IN COMPLIANCE WI fH
Sub-total -, 0 ALL APPLICABLE CODES ANG ORDINANCLS. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY "(AINFSS
State Tax M .�L LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By
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APPLICANT OR AGENT __.�..
Approved I;' Receipt No
DATE IVSP• TYPE INSPECTION REMARKS PLUMBING _ DATE —
` C Ir Contractor
Permit No. Lam— y
Rough-in
Final
HEATING
Contractor
Permit No. �•
Gas or Oil
1 _
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storni Drainage
(Rain Drain)Final
Sidewalk
Curb&Str"et Final
Approach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
Landscaping
Zoning Final
I
I
BUILDING PFRMI
T APPLICATION SOF TIGARD DATE f? -sS_-- .-. 19
THE UND HSIGNFD HEREBY APPLIES FOR APE.RMIT FOR THE WORK IIEHEIN INDICATED BUII_DERPHONF--.--_..
OR A5 SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. Od'NLFTFro1IFSrw�-.r6yf
LOT NO -_ -
-___10RnC:1(-RE:S$ fZl� S'\�/ �.r'/Y1111��.AR�:.ICiTE -�___ ._- a-KTO
E14GINF.ER
1CTUAE -. I
-]NEW C�Rt MODEL, ADDITION LJF+i PAIR ❑RENEWAL F THE UAfAAGE GEMC i TTI JN
ESIDENCE IJCOMM ❑EOUCA110NAL fjriOV'T t_JRFLIGII)US[.]PATIO (JCAR PORT UGAPAGE ❑5FORAGE-OSLAB3
;PANCY LANG R'7 0I.DG T\'PE .�N F I H E Z.GNE 3_--
PLAN CHECK B� ;._-.
:�..HEAT_.-
G aN A T %%j O o0 I�,ItA1.N'1 _ .QQ Ifi>'l�_.?� --
,SlINGr&Ar f'AA4. r.)w4r4A/IVC
WER_ PE3MIT._ ... -..
A Fl�1CRlra,,� ,_ICaHT
C' NO. SfL;F11E5 I __ 4R�A�•.3
..._.._ _.. RIGHr SIDE,?p
BUILCIN, Gr ,F;IA'ENr 1 Ky FRUNT _ FI r.AS //� _ LE SIDE -
,111 i
KMIT IS I'SUFD SLIBJFCT 10 THE RFGULATIONS CONT4INFD IN THE BUILDING CODE. 7(i N' JC
TIONS w- D At L APPLICABLE (,0OFS AND ORDINANCES, AND IT IS ►'SPEBY AGREED THAI THE
Check Z I TN
____ .-.... TIC L BE CIJNE IN AC.WRE`4NCE WITH THE PLANS AND :.NO INC
"
total �7 S FLICARLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PIERMIT DMS NOT WAIVE
FIVE Cr:1�FNAN1'S CCJNTRACTOR AND SUB CONTRACTORS TO HAVE CUPP.. T CITY FiLISi'1E5F
CTAleh/ 2 O I I �. SEPARAIE PERMITS REQUIRED FOR SEWER. PLUMBING AND HEATING
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WER INSPECTION
WER SURCHARGE
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7- S Permit
Name of Occupant Permit charge
Connection fee--
Paid
Bate connected-_-- -_-----
Type of Building__ -_- _-_ Inspection fee
Service I3atP----- ------- - - --- Paid by - Datel/ " ` (-
Contractor _-_--__ ._-_- - Assessment_. -_- _ --Paid
_—
Size of connection
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PERMIT TO CONNECT
Tigard Sanitary District
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PERMIa.' N9 1051 D,\rlti
PERMIT IS GIVEN TO
OF ,
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TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $..... ............................TIGARD SANITARY DISTRICT
By
,gM.,�wrwa.A.•
1
CONNI?C"1'1oN INSPECTED AND APPROVED
-- Date — SuporintiaOnt _
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