12495 SW 112th Avenue 12495 S.W. 112TH AVENUE 1 OF 1
12495 SW 112th Ave.
C liv OF Tl . OMB • • P..t E3E T j
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COMMUNITY DEVELOPMENT DEPARTMENT «�
13125 S W Hall Blvd P O Box 2')97 Tigard.Oregon 57223 (503)639-1175 OAl E 1.ca Uk C): 10/19/Ub
P14,104.4.104.1 .444t 411:3i.O9A
..11Jb AT)Oww.:S5 . 1 'I95 SSW 11P.1 H AVE
1 AX MAP/LOT 51.1E1 I. I BK
I AND USE
I. 0'1 51.2'.E :
:f. TE_M: N(:1 NO
WORK CL ASS Al. 1 l'RA'f :L(aN WATER CI-.O''1E.T 1 PAP
11SE. 1Yp1�. 5:I:NCI F' F:AMT1...Y I1WINAI.. E3KF 1_UW PPVNCR
CONS.' I YPE: LAVORA1 OWY I)SAP PRIMLR
111 I.1 IP . (PP 1 UE) SHOWE:11 (:;RF:A5E TRAPS
E)I:!:iHWASHE P
CAWBAGE 0:1.1 l'tJAL.
NO STOP I L.S WASHING MACHINE:
OWL I..I UNI TS 1.AUNOPY TRAY 131...1)C. . OPAIN (DIA
I1..U(:)I( DPA IN
'',INK ,I:::WkP (F T)
WAIEW I-IF:AlER I '.1TOPM/PAIN IF I
Cr I 1-11-.14 I
IE
1_MAT K S
fJT111-Li IS (:AS PCPINla ONE. Ill I 00: 111)11 l. 1 (Ii
I
I fl S ..
0 i
F.".
w 1...e5ACPE:.I E I F RMI1 $15 00
E 1 Ir'49"1 SW 1 1 c'T I1 AVE
R I1( ARD 1)1' 9Ii'2..3 I I.X 1 IJI1E
")HONE I!i()...44 I 604 -59Prf, ':1 T A I E:: TAX A I5
— (.1 THE R
C
O 1)F:MANUS 1 i 1Il3E:Nl:i
N
I l.ANYON Fla IIME 1 N(, ANI.) HE AT 1141.
R
A 4905 SW I Al 11.41•:1.W1101) DP
C par t.l.4n11 (It
'r.)9 9/r!i?'
T I.�HI)til I '50,3) P9P....1;)i
O
R 1')F GI S I PAT ION N(.) die'1 9 I l.)TAI. $1.5 /5
This permit is issued subject to the regulations contained In Title 14 RF_CE:I V7 NC) /�)//�(' �'
of the I MC State of Oregon Specialty Codes toning requlatiors "-"
and all other applicable codes and ordinances and it is hereby WI L,11.I I F1E:.I) I.NS L'I.C:1 ICON'
agreed that the work will be done on accordance with the plans and GAS 1 1 NI-
specifications and In compliance with all applicable codes and I I NAI
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tali permits This permit will expire and become null and
void if work is not started within 180 days or if work is suspended or
abandoned for a period of 180 days any time liter work has
commenced It shall be the responsibility of the permittee to assure
all required Inspections ale requested and approved
Permittee Signature }'�
Issued By �1 Cl (
:Al I FOP I N'S'F 1. I I ON 639--41 i 5
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
/
Y ;
MAI ep J ').
CIF(OF TIGARD
OREGON
25 Years of Service
1961-1986
Date:
This is to certify that /9,QEAf VZ5Z- z /-t ,e , doing business as :
< R /)Ai /(113 t h1TG , has my permission to sign
plumbing permits as my agent .
Nameof plumbing firm: - CANYON PLUMBING & HEATING
Address of plumbing firms 4905 S.W. Laurelwond Dr., Portland, OR 97225
Telephone: ,;(7QA- 9.4'„"?
Signature
State Builder' s Board M : - �-f i 1 Exp.Date : ///5-j,)1
State Plumber' s License M : Exp.Date: 4„,/ ji'7
City of Tigard Business License M. Ceeke 71 •
13125 SW Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223 (503)639-4171- - -- — —
y lir
P.O.Box 2337
CITY OF TIGARD PLUMBING 13125 3ei Hall Blvd-
CR
Applicanb must hold Oregon Reglsuation to conduct a plumbing PERM I 163)•4175 3
business Of must be property owner/operator not hiring outside help. '3 3S 7
Name of O v.lopment
Plumbing Perm,I No. .* ( •!--_
Adb.MDescrkptlon
/.' 1e.7 (re./-//�f</' ORS 61421-010 DUAN. PRICE AMT
Job
Tax LAI Map.No.
Address
FIXTURES
Los Stock r Nan -- - - -
Sink 7.50
-
-- -Ram.(o -an
ce ss Lavatory - 7.60
/L Z f- L t ‘4j/-96;,G - T, or TubSlwwer Comb 7.50
IA.7 Amnia, S nowy ONy 7 50
/ y•%, %.7 LL, //. t/h,
Owner 01y/elate zV Water Closet 7.50 la
j i J1A L) c'.)X . Y�d.� - Dishwasher 7.50
Pt10/ Garbage Disposal 7.50 Mill
�__..
-Nona �:rr _r2-14.6 Washing Machin --
7.50
Floor Orale+ 7.60
rest Phone Water Hester / 7.50
Occupant pIy w laundry Room Tray 7.50
tlrk hal 7.50 0
....
-Ram h Phone Oder natures(Spedh) 7.t.0
l�rq
(444 J2iJ t ,/x 4:'0-`..1111 7.50
Wsor» 7.50
ContractoregrArTAO
;_'l 'Li . `L /i MISCELLANEOUS
/-+e 4A.e/atdY_;c A..r cis S~ Sewer 1a lot' 30 00
i! /-1./ G16l. t-1/761. -- • •-----
Male*RSABoardpo $1111 Pf SI S'ti gitllits,No.+ 8•4".61sa.Addle.100' 16.00 -----
(Reerdential).4,/, .4 !_-7/.e 1 - Water Sendai/M WO' 20.00
.�
I hereby acko►owledpe Mal I have mad role apparlMrt Maiothe Mkt/nation Wafer scrubs•a Adds ' 15.00
Oven Is correct.road I am reglsier•d wilt the Stara Builder's Hoard.and also Storm a Rain Drain 1st 100' 70.00
hey a Steno Plumbing Scans*rut the numbers given are correct rut ail
plumbing wort we be tone In•ooadarce with applcable prohANarM d Ore. Storm I Rein Drain Adds.100' 15.00 II
Von Revised Statutes Chapters 447 and 6113 and applicable cock*end Mal Mobil Home Spans 25.00
no hep wA be employed unties licensed under ORS 6113 (r saempt from
Stn registration.Mesas give reason below) Back Flow Prevention
HOMEOWNERS-I hereby retry hd I rn re erne►d the property de 0•hhsaaArt�PoMAionO.No• _ r 7.60 -
eorbed above.at which lac-eon I propose to meta a *.a*Wp Mleaa'nn for Any Tran or Waite Not
my own use and this property Is not Nine conaYucMA for sale.Mase or rent Cemalsd to a Atrium 7.50
Catch Basin 7.50
r.
t_ LL e;If; _"'i/-1 i G C. i'C' /'N1 LL'h/ Mrp.d EodN.PMerk iIn 60.00 Per Nr
~8p•dafy R.glraalad Ytspecbarle e0 00 Par 14
LL
Aur.d PLaht Ing wlt+lrl
A JTIORIIED IMMATURE �- l �OOats Naw OId6 or Sind.Amon _ 26.00 nun _
Pain 18311r8,lltgle fanny
Di,ecrtbe worts new[) addition[) 'iteration[1 repak 0 dlellitlg 15.00
ep be done residential,(-1non-residential 1_1 ---
-
FAWN use d . -
bulking or propertyufms of
_ BI�.TOTILL -[
"SI
bU1�rt0 t t piop.rty D r BIAIONTA1- -_' 7.2
i.
NOTICE ------ _._.__._____--_.___._-.-__
This pond O.00maa nub and well wort or oonquo►bn authorts ed Id mot O
"UMW smites 00 dsyarw r osnrnrdon or work le Mrparded or abendaed for tl
a period et 1b Aare MOn"'ne aur hart,le oornwathad
BMCIAI ooiso 10NB_.--_---.----------- ----- --_- -
Date Issued -- by
.. _ • I