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Permit CITY OF TIGARD MASTER PERMIT IIIII k- ' { Permit#: MST2022-00248 a COMMUNITY DEVELOPMENT t <` Date Issued: 10/13/2022 T I I:J A R p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AC14200 Jurisdiction: Tigard Site address: 9494 SW LONGSTAFF ST Subdivision: ASHBROOK VILLAS Lot: 9 Project: Ash Brooke Villas, Lot 9 Project Description: New detached dwelling. REPRINT FOR ELECTRICAL CONTRACTOR CHANGE. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 104 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 842 sf Garage: 651 sf Front: 15 Smoke Yes Dwelling Units: 1 Third: 860 sf Right: 3 Detectors: Total: 1806 sf Value: $315,325.71 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 1 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 3 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Fum>=10OK: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea addl 500 sf: 3 201-400 amp: 0 201-400 amp: 0 W!O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N SecurityAlarm: N Vaccuum System: N Garage Opener: N All Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 1806 Owner: Contractor: ABVOZBP21 LLC SAGE BUILT HOMES Required Items and Reports(Conditions) 1815 NW 169TH PL STE 1040 1815 NW 169TH PLACE,SUITE 1040 1 Ersn Cntrl 503-639-4175 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: PHONE: 971-221-4597 FAX: 503-533-5164 Total Fees: $40,613.11 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR oc9-nn1_nnin thrn,,nh nip oc _nnt-nnon Yni1 n,a,,nhrvin n rnr, of tho ndoc nr rliron n„cernne In ni INr by Tallinn col 979 1Qk7 nr'I W1'll9 j9'idd Issued By: Permittee Signature: `4 e 4(--"P I r C ctrL t U`1 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. I This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the lob site at the time of each inspection. Electrical Permit Application FOR OFFICE USE°NI.I City of Tigard Received : p, Pccmn : 111 • 13125 SW Hall Blvd.,Tigard,OR 97223 we ,.)_ •t A:..L, plan Review I- ' Phone: 503.7182439 Fax: 503598.1p6G. - -,;1 : _.;1�,t; Da. : : Related Permits- /�00 r F:G R D Inspection Line: 503.639.4175 Ready Date/By: kris: fa See Page 2 for Internet: www.tigaid-Or-gov Notified/Moho& Supplemental Information TYPE OF WORK PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans whims checked): 0 Service or feeder 400 amps or more 0Building over three stories ❑Demolition 0 Other. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps as 150 volts or El Floating buildings. l/industrial ❑Accessory building la to ground,or exceeds I4,000 ❑Commercial-use agricultural®1-and 2-family dwelling 0 Commereia amps for all other installations, buidings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or JOB S1'rE INFORMATION AND LOCATION 0 Emergency system larger separately derived .lob#: 13ob site add[PSS•[](� �f��\ O Addition of new motor load of system. - '[ q( O LONELSTAFF SI•T 100HP or more. 0"A",`E•,`1-2",-1-3", City/State/ZIP:Tigard, OR 97223 O3is or more residential units occupancy.- 0 Health-cam facilities- 0 Recreational vehicle parka Suite/bldg./apt#: Project name:Ash Brook Villas ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE nesnipdoa I Qty. I Garb I Tatar I ' New residential single-or multi-family dwelling unit. n Subdivision:Ashbrook Villa's Lot#: CI includes attached garage. Tax map/parcel#: t,000 sq.ft.a less 168.54 ' 4 DESCRIPTION OF WORK add,energy, ft' Via' ener 33.9Z 1 Limited gyyr,residential 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.f) la PROPERTY OWNER 1 0 TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,andfor relocation Name:ABVOZBP21 LLC 200 amps orless 1 100.70 100,70 2 Address:1815 NW 169TN PLACE, SUITE 1040 201ampsfo400ainpe 133.56 2 City/State/ZIP:Beaverton,OR 97006 401 amps to 606 a 20034 2 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email:kaae@sagebuilthomesilc-cunt relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps _ 168.54 2 Branch tdreuits-new,alteration,or extension,per Farad ® APPLICANT 0 CONTACT PERSON Business name:ABVOZBP21 l LC A.Fee for branch circuits with above service or feeder fee, 7.42 2 Contact name:Katie Patterson each branch cienuit B.Fee for branch circuits without Address:Same as above service or fonder fee first 56.18 2 brand.circuit City/State/ZIP: Each add'l branch circuit 7.42 2 : Miscellaneous(service or feeder not included) Phone:603-5Q26623 Fax ( ) Each manufactured or modular 67.84 2 Email:katie@sagebuilthomeslic.com dwelling service and/or feeder CONTRACCOR Recanted only 67-84 2 Pump or brigalion circle 67.84 2 Business name:Grizzly Electric �Inc j, Sign or outline lighting 67.84 2 Address: 21LT {M Jr d, - t'W- 117 ptS�arcaiio)or extension_ ❑ See 2 e�1 panel,alteration,a•extension- 2 1 City/State/ZIP:Vancouver, WA 98660 Each additional inspection over allowable in any of the above Additional inspection(1 hr ram) 6625/hr Phone:( 9 7/ 570- Q/a 1 Fax:( ) Investigation(i hr min) 90.00/hr Email:grizzlyelectric@msn.com Industrialplam(ihrmin) 78.18lbr Inspections for which no ice is ' 9000!hr CCB Lie.:186218 Electrical Lic.: Suety.Lie. ! S apocificauy listed Ph hr min) Suprv.Electrician signature, ELECTRICAL PERMIT FEES gn ture,required � /��'� S Subtotal: Print name:/1?e yay� , tit{/., y :/ f ( 0 Plan Review Required(25%of permit fee): / ` J �/ State surcharge(I2%of permit fee). • Authorized signature: /� &;4.. PAf., TOTAL PERMIT FEE: This permit application expires If a permit is not obtained within r80 Print name:Katie Patterson Date:12/1/22 days after it has been accepted as complete. ' Number of inspections allowed per permit ItUivildinglPtrmieUlite PennkApp p(•R-rsR&doc RevO6/172015 440d61511 11/051COMM•Ea CITY OF TIGARD MASTER PERMIT a ' COMMUNITY DEVELOPMENT II Permit#: MST2022-00248 T[GAR b 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/13/2022 Parcel: 1 S135AC14200 Jurisdiction: Tigard Site address: 9494 SW LONGSTAFF ST Subdivision: ASHBROOK VILLAS Lot: 9 Project: Ash Brooke Villas, Lot 9 Project Description: New detached dwelling. BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 4 First: 104 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 32 Bathrooms: 3 Second: 842 sf Garage: 651 sf Front: 15 Smoke Yes Dwelling Units: 1 Third: 860 sf Right: 3 Detectors: Total: 1806 sf Value: $315,325.71 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100 Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 1 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywall-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 3 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add,500 sf: 3 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 1806 Owner: Contractor: ABVOZBP21 LLC SAGE BUILT HOMES Required Items and Reports(Conditions) 1815 NW 169TH PL STE 1040 1815 NW 169TH PLACE,SUITE 1040 1 Ersn Cntrl 503-639-4175 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: PHONE: 971-221-4597 FAX: 503-533-5164 Total Fees: $40,613.11 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Orego law requires y to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR OF91 ni_nni n Ihrnunh rim::OF/ soon may f in If of the n Jnc nr rlirert nneetinne to rll'Fur by rallinn col 9 10A7 nr 1 Rangy lg.) 0dd 9 Issued By: - Permittee Signature: CC C�i' ' ("CGI G Call 503.639A1 5 by 7:00 a.m.for the next available Inspection date. This permit card shall be kept In a conspicuous place on the Job site until completion of the project. Approved plans are required on the job site at the time of each inspection. B>'„iding Permit Application Residential FOR OFFICE USE ONLY City of Tigard DECEIVED Received �1 / / --" Permit Nu.. a 13125 SW Ball Blvd.,Tigard,OR 97223 Y ff// ^'� � �`"-- '"v g Plan Review ' = Phone: 503.718.2439 Fax: 503.598.1960Date/By: 2,7 Zy Other Permit: '�.,` 06LU3 JUL 2 8 2022 (O/CCJJ�T (/� T I G A R D Inspection Line: 503.639.4175 Date ReudyBy: / lurk: El See Page 2 for Internet: wwsa tigard-or gov CITY G Rr� - ticdrnadhod ,y pp I NOF plvv;I - U {.. �/ 77, 0. Supplemental information WQ �UILDINr; lvR�=ICI < TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING \ ®New construction El Demolition fees*are based on the value of the work performed. `r1 Indicate the value(rounded to the nearest dollar)of all r� E Addition/altcralion/replacement D Other: equipment,materials,labor,overhead,and the profit for the L CATEGORY OF CONSTRUCTION work indicated on this application. �/.1 fi Valuation: $ 31 S 32 l-and 2-family dwelling El Commercial ( sit, ❑ Accessory building �i m ` Number of bedrooms: 4 ili ❑Master builder ❑ Other: Number of bathrooms: 3 Total number of floors: 3 Zt�7 JOB SITF, INFORMATION AND LOCATION 1 16 site address:9494 SW I.ONGSTAFF ST New dwelling area: 1806 square feet Q,(vb City State/ZIP:Tigard Oregon Garage/carport area: 651 square feet U� Suite/bldg./apt.no.: Project name:Ash Brooke Villas Covered porch area: 24 square feet l o� VVV.,.iCross street directions to job site: Deck area: e` e square feet Other stnicture area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision:Ash Brooke Villas Lot no.:9 Permit fees*arc based on the value of the work performedis Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. New Residential Construction Valuation: S Existing building area: square feet New building area: square feet 0 PROPERTY OWNER 0 TENANT Number of stories: lic Name:ABVOZ Type of construction: Address:1815 law 169°h Place Suite 1040 Occupancy groups: ity/State/ZIP:Beaverton Oregon 97006 Existing: Phone:(503)533-5167 Fax:(5(13)533-5164 New: 121 APPLICANT Business name:Sage Built Homes LLC ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Structural plan review tee(or deposit): • Contact name:Alex Rodriguez FLS plan review fee(if applicable): Address:Same as above Total fees due upon application: City/State/ZIP: Amount received: Phone:(971)336-6911 Fax: :( ) E-mail: planningtasagcbuilthomcsllc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photovoltaic Solar Panel System. Business name:Sage Built Homes LLC Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:Same as Above Solar Installation Specialty Code checklist. Ciry/State/ZIP: Permit Fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.:189330 Total fee due upon application: $201.60 Authorized signat This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Alex Rodriguez Date: I`)- \J-(2_,2_,_ *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No..Date By: 13125 SW Hall Blvd..Tigard,OR 97223 I Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: T IciARD 24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: uww.tigard-or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes I Land use actions completed. See jurisdiction criteria for concurrent reviews. El ❑ ❑ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. El ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ 0 i 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 ❑ 6 Sewer permit. 0 0 0 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑ basin protection,etc. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑ there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals); location of easements and driveway; footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 0 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ 0 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,rooting,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ 0 ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ El 0 prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 0 systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ 0 ❑ architect licensed in Ore.on and shall be shown to be applicable to the .r&ect under review. JURISDICTIONAL SPECIFICS 23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ 0 ❑ 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY EGEIVEC eeioed Permit No City of Tigard elly: T-yd POp 13125 SW Hall Blvd.,Tigard,OR 97223 Ian Review Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: TIGARD Inspection Line: 503.639.4175 JUL 2 Date/By:2022 Date Ready/By: luris: RI See Page 2 for Internet: wwwctigard-or.gov CITY OF TIGARD Noti fied/Method: Supplemental Information 8tPILING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit tees`are based on the value of the work ®New construction ❑ Addition/alteration/replacement performed Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION 3 Heating/cooling: Air conditioning 1 46.75 46.75 Job site address:9494 SW LONGSTAFF ST Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name:Ash Brooke Villas Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: 23.32 Subdivision:Ash Brooke Villas Lot no.:9 Other fuel appliances: Tax map/parcel no.: Water heater 1 23.32 23.32 DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 33.39 Flue vent for water heater or gas New Residential Construction fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 ® PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation: Name:ABVOZ Range hood/other kitchen - equipment 1 33.39 33.39 Address: 1815 NW 169'Place Suite 1040 Clothes dryer exhaust 1 33.39 33.39 City/State/ZIP:Beaverton Oregon 97006 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 4 23.32 93.28 Phone:(503)533-5156 Fax:( ) Attic/erawlspace fans I 23.32 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 .. Fuel piping: Business name:Same as Above $14.15 for first four;$4.03 for each additional Contact name:Alex Rodriguez Furnace,etc. Gas heat pump Address:Same As Above Wall/suspended/unit heater City/State/ZIP: Water heater 1 Phone:( ) Fax: :( ) Fireplace Range t E-mail:Plannnig@sagebuilthomesllc.cnm Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name:All Time Heating&Cooling MECHANICAL PERMIT FEES* Address:PO BOX 1341 Subtotal CityiState/ZIP:Lake Oswego,Oregon 97035 Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:(503)208-2276 Fax:( ) State surcharge(12%of permit fee) CCB tic.: 1845757 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within l80 days after it has been accepted as complete. Authorized signamr * Fee methodology set by Tn-County Building Industry Service Board Print name:Alex R uez Date:t 0 - \I-2:2 1:1Building\Perrnits..MF.C_PersniApp_0401 13.doc 440-4(d 7 r(I I.02/COM/WEBt Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to S 10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. l:\Building\Permits\MEC_PermitApp_0401 13.doc 2 Electrical Permit Application 1,oR Di I ICE I SI. (l'l } City of Tigard Received D,te/By Permits: ferty7—� ,,,G�- ( / ' 13125 SW Hall Blvd.,Tigard,OR 97223 III • �° �� iew Phone: 503 718.2439 Fax: 503.598.1960 C A Rev: RelatedPermit a: = v Inspection Line: 503.639.4175 ReadyDate/By. rurir I ® See Page 2for 1'I(,A R[) Internet: www.tigard-or.gov JUL 2 8 2022 Notified/Method. l Supplemental Information j TYPE OF WORK T�(( E TIGAI�D PLAN REVIEW ®New construction ❑Addition/alteration/ripQptl r+ p f Please check all that apply(submit 2 sets of plans w/items checked) i F'3 JJJ LUI\la DIVISION ❑Service or feeder 400 amps or more 0 Building over three stones. s 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards I CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings ® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 CI Commercial-use agricultural amps for all other installations buildings. ❑Multi-family ❑ Master builder 0 Other: 0 Fire pump 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived lob#: I lob site address: ❑011-OP or Addition more f new motor load of system. 9494 SW LONGSTAFF ST ❑"A","E","I-2","!-3", City/State/ZIP: Tigard Oregon ❑Six or more residential units occupancy. 0 Health-care facilities ❑Recreational vehicle parks Suite/bldg./apt.#: Project name: Ash Brnnve Villas 0 Hazardous locations 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site: FEE SCHEDULE Description I Qh. I Earn I Tate 1 " I• New residential single-or multi-family dwelling unit. Subdivision: Ash Brooke Villas Lot#: 9 Includes attached garage. 1,090 sq It.or less 168.54 4 Tax map/parcel#: Ea add'I 500 sq.ft.or portion 33 92 I DESCRIPTION OF WORK Limited energy,residential New Residential Construction (with above se ft) 75 00 2 Limited energy,multi-family 75.00 2 residential(with above sq ft) Renewable Energy ❑ See Page 2 ® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation 1 Name: ABVOZ 200 amps or less I I 100 70 I 100 70 12 Address: 1815 nw 169TH Place Suite 1040 201 amps to 400 amps ( 133 56 I 12 401 amps to 600 amps 200 34 2 City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04 2 Phone:(971)221-4597 Fax:( ) Over 1,000 amps or volts i 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less I 59 36 1 intended for sale, lease,rent,or exchange, according to ORS 447,449,670,and 701. 201 amps to 400 amps 125 08 2 Owner signature: . _ Date: _____ 401 amps to 599 amps 1 168 54 2 ® APPLICANT J 0 CONTACT PERSON Branch circuits—new,alteration,or extension.pe anel A Fee for branch circuits with Business name:Same As Above above service or feeder fee, each branch circuit 7.42 2 Contact name: Alex Rodriguez B Fee for branch circuits without Address: service or feeder fee,first 56.1 8 2 branch circuit City/State/ZIP: Each add'1 branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(971)336-6911 Fax: :( ) Each manufactured or modular 67 84 2 dwelling,service and/or feeder Email: Planning t sagebuilthomesllc-com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 1 67.84 2 Business name:Ross Electric Sign or outline lighting 1 I 67 84 { 12 Signal circuit(s)or limited-energy 0 See Page 2 i 2 Address:2870 SE 75th Ave 203 panel alteration or extension City/State/ZIP: Hillsboro Oregon 97123 Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) _ 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no tee is 90 00/hr CCB Lic.: 157891 Electrical Lic.: 34-436C I Suprv. Lic.: soectfically listed(Yo hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: .,„‘Ar f `ILA Subtotal: Print name: Stephen Ross '` 4 ,� ko f f� ate: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within Igo Print name: Alex Rodriguez Date: 'O ib (2:2, 1 days after it has beep accepted as complete. • Number of inspections allowed per permit. Il&,ildina\Permits\ELC PenniiApp ELR ERE doc Rev 06/17/2015 440-4615T(IIN5/COMIWEB Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard Received IN' RECEIVED Date/By: Permit Nn-:mC.y,y,�.y> �o • 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review 7 • sv P7T Phone: 503.718.2439 Fax: 503.5 T)ate/Bv: Other Permit No.: TIGARD htspection Line: 503.639.4175 • Date ReadyBy: luris: WI See Page 2 for Internet: www.tigard-or.gov Noti tied/Method' Supplemental Information TYPE OF WOR(:ITY OF TIGARD FEE* SCHEDULE ®New construction MiL111416DIVISION For special information use checklist. • Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® I-and 2-family dwelling ElCommercial industrial SFR(2)bath 437.78 III Accessory buildingSFR(3)bath x 500.32 500.32 ❑Multi-family Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:9494 SW LONGSTAFF ST Catch bas n or area dra n 18.76 City/State/ZIP:Tigard Oregon Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name:Ash Brooke Villas Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision:Ash Brooke Villas I Lot no.:9 Fixture or item: Tax map/parcel no.: Backtlow preventer 1 31.27 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 25.02 New Residential Construction Dishwasher 1 25.02 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ii PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:.4BVOZ Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:1815 NW 169'Place Suite 1040 Garbage disposal 1 25.02 25.02 City/State/ZIP:Beaverton Oregon 97006 Hose bib 2 25.02 25.02 Phone:(503)533-5156 Fax:( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:Sage Built Homes LLC Medical gas(value:S ) Page 2 Primer 12.51 Contact name:Alex Rodriguez Roof drain(commercial) 12.51 Address:1815 NW 169ts Place Suite 1040 Sink/basin/lavatory 5 25.02 125.10 City/State/ZIP:Beaverton oregon 97006 Solar units(potable water) 62.54 Phone:(971)336-6911 Fax: :( ) Tub/shower/shower pan 3 12.51 25.02 E-mail:planningt-sagebuilthomesllc.com Urinal 25.02 Water closet 3 25.02 75.06 CONTRACTOR Water heater 1 37.52 37.52 Business name: Edward Mullen Water piping/DWV 56.29 Address: 1601A SE River Road Other: 25.02 City/State/ZIP:Hillsboro Oregon 97123 Subtotal Phone:(503)572-4586 a Fax:( ) Minimum permit fee: 572.50 CCB Lie.:92689 r {{{��umbing Lie.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signatu�/ TOTAL PERMIT FEE Print name:Alex Rodriguez Date: This permit application expires if a permit is not obtained within 180 days l O 2_ after it has been accepted as complete. *Fee methodology set by Tti-County Building Industry Service Board. L'Euilding\PermitsPLMn-PermttApp.doc IO/O1(09 440-4616T(IO/D2'COMIWEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information - , • • Fee Schedule: _Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain- 1'`100' 50.03 _0 to 2,000 S 121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 I Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain- 1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 �, Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for 1 Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to 525,000.00 $148.50 for the first$10,000.00 and S1.54 for which no fee is specifically indicated 90.00 hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first S25,000.00 and S1.45 for I hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1i2 hour) each additional$100.00 or fraction thereof. . Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for anyof the following. Work Performed: Capped Added Relocate 9 g Baptistry,Font Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2"and -Jacuzzi/Whirlpool 1pool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive That ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. 1 4.. Isometric or Riser Diagram • Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food _ _ q • I Disposal -Domestic-food related that meet the qualifications above. • -Commercial-food related I • -Industrial-food related Ice Mach.iRefrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: • Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley ' -Commercial-food related • -Service • Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and Water Extractor Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. 1 Other Fixtures: S:\Sage Built\Subdivisions\Ash Brook Villas1Lot 91Applications\PLMF_PPrmitApp.doc ' City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review - Residential Building Permit #: /15; ;-,)--c 3t-t. ' Site Address: c3yay sW jbs F1= RV Project Name: A<>f-{-> _ sz)lL VtLUIS Lot #: 9 Proposal: Sriv900PervitAa; SiWUoL� krEhc-o tio�se Land Use Case: 1:912 7.0 go-CODO z Zone: Res - 2/ 12-IZ Required Submittal Elements 4opies of site plan Ck,Square footage of buildings to be demolished wn to standard scale ZFootprint of new structure and FFE h arrow R twined trees, drip line / tree protection address, project name, lot # �-eet trees shown / labelled et names � j ewalk / driveway shown and dimensioned 0'-Applicant name and phone # Utility locations & easements (new / additions) Lot and setback dimensions Vation of wells / septic systems t Existing structures on site area and lot coverage percentage Er ion control rner elevations (2' contours if > 4' differential) "WVision clearance triangle shown Ground slope at building pad calculated / shown Planning Review .1%1V:e.pify address / suite # active in Accela. Clean Water Services - Service Provider tter (lot platted prior to 9/10/1995) Required: ❑ Yes No Received: ❑ Yes ❑ No /ZrPublic Facilities Improvement (PFI) Perm t, Required: ❑ Yes CLNo Applied For: ❑ Yes ❑ No, stop intake ensitive Lands: ❑ Yes Q'hTo Type: in Housing Supplemental Sheets Completed O Cottage Cluster C&O (1 site, 1 per unit) ❑ Quad ❑ Courtyard Units C&O (1 site, 1 per building) ❑ Ro ouse ❑ Cottage Cluster Type II (1 per unit) mall Form Residential / ADU ❑ Courtyard Units Type II (1 per building) ❑ River Terrace Addendum ❑ Conditions met prior to issuance of b it ng permit 1-aYU _ (o' t Approved By Planning: Date: /Ze/ - Notes Revision 1: ❑ Approved 0 Not Approved Date: Revision 2: ❑ Approved ❑ Not Approved Date: I,vBuddingA Forms VBldgPertmtRvw Res 070722 docx Building Permit Submittal r' Original Submittal Date: 7f Site Plans #: Building Plans #: Building Permit #: Keguilding permi:t__# entered on page 1 Workflow Routing: Fd'PTanning ngineering ID--Permit Coordinator L -Building Workflow Sign-off: CA-Sign-off for Planning (include notes from planning review) Route Documents: gineering: (1) copy of permit application, (1) site plan, (1) bu'lding plan and original plan review routing form. uilding: original permit application, site plans, building plans, engineer and beam calculations and trust details, if applicable, etc. Permit Technician: �J�_ '� Date: 7/..'i/22 Notes Engineering Review Slope at building pad verified Slope: -Conditions met prior to issuance of permit Cd'tasements (encroachments) per engineering conditions of approval and plat Plater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Ek-No Assess Water Quantity Fee in-lieu: ❑ Yes ErNo LIDA Facility on lot: ❑ Yes i�No Add Fee: ❑ Yes ❑ No p`Final Plat Recorded ❑ NOT Approved Date: Notes Approved By Engineering: I<. l'i 5►4-C-s'.2. Date: 8"3 -z�Zz Revision 1: ❑ Approved ❑ Not Approved Date: Revision 2: ❑ Approved ❑ Not Approved Date: Permit Coordinator Review Conditions met prior to issuance of permit ❑ Approved, NOT Released: Date notified applicant: ❑ ENG Revisions Required: Date notified applicant: ❑ SDC Exemption: ❑ Received I 'Does not apply C SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A Tigard Trans SDC: Yes 0 N/A Parks SDC: Yes 0 N/A LIDA 0 Yes .9 N/A 'I OK to Issue/Approved by Permit Coordinator: ,\ <<tk Date: _ Z Revision 1: 0 Approved ❑ Not Approved Date: Revision 2: ❑ Approved ❑ Not Approved Date: • City of Tigard u COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Small Form Residential Supplemental (Non-RT) Building Permit #: Project Name: ASS ' c - VILLAS Site Address: 9 y�y c-N0J bon/6s7AFF' �P Lot #: df Total Existing Units: 0 One 0 Two 0 Three New Configuration: 0' Single Detached 0 Duplex 0 Triplex ❑ +ADU Small Form Residential Standards Setbacks 0 Front: /5-- Rear: /5- Side: 3 Street Side: OA Garage: /Height CIMax. Height: �S Actual Height: 32 e Landscape 0 Landscape Area: % Lot Coverage Max: gp 0/0 Entrance back no more than 8' from street-facing wall 2 Parallel to street or offset 45 degrees or less Windows El Minimum 12% of area of all street-facing facades Garage Garage oor is behind widest street-facing wall es 0 No, and one of the following is met: ❑ Door extends no more than 5' from wall and there is a covered porch extending beyond garage. ❑ Door extends no more than 5' from wall and there is a 12 sq ft. window above garage on 2nd floor. Garage oor width is: 12' or less ❑ 50% or less of facade D 60% or less and includes 7 of following: ❑ Covered porch ❑ Recessed entrance 0 Wall offset ❑ 1' Roof eave 0 Roof offset 0 Fire shingles ❑ Lap Siding 0 Gable, hip, gambrel roof 0 Dormer ❑ Roof pitch 0 Accent siding ❑ Window trim ❑ Window recess 0 Window projection 0 Balcony Approved By Planning: /tv Date: //;42 L BuildinglEoxms Bldg)ernalR n_SFR Supplemental 070722 FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ■ ' Transmittal Letter r i c,A Ft rl 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED AUG 2 2 2022 FROM: Alex Rodriguez CITY OF 1IGARD COMPANY: Sage Built Homes LLC BUILDING DIVISION PHONE: 971-336-6911 By. RE: 9494 SW Longstaff St MST2022- 241- (Site Address) (Permd Number) Ash Brooke Villas 1& O (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. X Other(explain): REMARKS: Comment Responses FO OF CE USE ONLY Routed to Permit Techniciap pale: `) 27 ZZ Initials: k�/ Fees Due: ❑ Yes [y� Fee Des 'ptio : Amount Due: D p (,- (- $ )7.25- rs- Special Instructions: v-- Reprint Permit(per PE): ❑Yes to ❑ Done Applicant Notified: j� Date: /0 l .( L. - Initials: /� 1:1Build ngTorms\TransmittalLener-Revisions.doc 05/25/2012 FOR OFFICE USE ONLY— SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT II Transmittal Letter 114 r 1 1 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Allyson Armstrong DATE REECEIVVED•• DEPT: BUILDING DIVISION RECEIVED V ECG FROM: Samedy KernSEP 2 0 2022 CITY OF TIGARD COMPANY: BUILDING DIVISION,& PHONE: 971.563.0552 By: EMAIL: samedy@kem-consultant.com RE: 9494 SW Longstaff St MST2022-00248 (Site Address) (Permit Number) Ash Brooke Villas-Lot 9 (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. 3 Revisions: Full set Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 2 Other fl 11v(erx�plain):Trusses talc �^� ,, REMARKS: i l T)Cid (� R,// /t t, ei mo- m' FOR OFFICE SE TNLY Routed to Permit Technic' ate: / 1 ZZ- Initials: Fees Due: El No Fee Description: 111111 Amount Due: C � $ pr-,...______. rs---) 0l $ Special Instructic ns: Reprint Permit(per PE): n Yes ) No `' El Done Applicant Notified: lJL Date: (L/i. - Initials: ` l