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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00329 11 DEVELOPMENT SERVICES DATE ISSUED: 11/29/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 SITE ADDRESS: 14396 SW PENNYWORTTERR PARCEL: 2S112BA -BT025 SUBDIVISION: BONITA TOWNHOMES ZONING: R -12 BLOCK: LOT: 025 JURISDICTION: TIG REMARKS: New SFA. BUILDING REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 32 FIRST: 167 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 820 sf GARAGE: 585 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: 787 sf RIGHT: VALUE: 181 OCCUPANCYGRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,774 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOWCMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: 0 GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 3 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVI E W S ECTION Reconnect only: >=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,890.70 This permit is subject to the regulations contained in the JLS CUSTOM HOMES JLS CUSTOM HOMES Tigard Municipal Code, State of OR. Specialty Codes 16280 NW BETHANY 16280 NW BETHANY and all other applicable laws. All work will be done in BEAVERTON, OR 97006 BEAVERTON, OR 97006 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 533 - 4006 Phone: 503 - 533 - 4006 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 139970 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or dired questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Sewer Inspection Slab Insp Mechanical Insp Gas Fireplace . Structural welding final Water Service Insp Footing Insp Plm /undslb lnsp Plumbing Top Out Insulation Insp High strength bolts fina Smoke Detector Foundation lnsp Electrical Service Framing Insp Shear Wall Insp Rain Drain Insp Electrical Final Wtr Proofing Bsm't Wa Electrical Service Roof Nailing Exterior Sheathing Ins Storm drain insp Plumb Final Ftg Drain t-Wal Electrical Rough -in Gas Line lnsp Firewall lnsp Water Line lnsp Mechanical Final Issue y : : _. �/L ,l L Permittee Signa J, �; ,LL r.a! Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day • CITY OF TIGARD ` BUILDING DIVISION PERMIT #: MST2004 -00329 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/29/2004 Phone: (503) 639 -4171 �� iijr 1 ° 4 °iNIi 1,, Inspection Requests (24 Hrs.): (503) 639 -4175 _' INSPECTION WORKSHEET FOR DATE: 512!2006 TIME: 7:10AM PAGE: 10 SITE ADDRESS: 14396 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 025 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SF A. OWNER: JLS CUSTOM HOMES, PHONE #: 503 633 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503-533-4006 Inspection Request Scheduled For: Date: 612/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 1 299 Final inspection 005818 -03 503-209-6038 Y 1 Corrections /Comments /Instructions: 101_--- -------.' „._ ,,,,,, \J J ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIO L FEES ASSESSED /00 Inspector: ` Date: Phone #: (503) 718- . CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST2004- 0032r3 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/29/2004 Phone: (503) 639 -4171 ! A' "����- 919 i s Inspection Requests (24 Hrs.): (503) 639 -4175 .'. INSPECTION WORKSHEET FOR DATE: 4/18/2005 TIME: 7:14AM PAGE: 34 SITE ADDRESS: 14396 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 025 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503 - 5334006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503 - 5334006 Inspection Request Scheduled For: Date: 4/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 004737 -01 503-642-2800 N \ Corrections /Comments/ Instructions: ' ic P Ci) Av.° \iv )6"V-'k L G, \P • ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G"'__—' Date: T " / ;:57 Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION • PERMIT #: MST2004 -00329 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/29/2004 Phone: (503) 639 - 4171 Al i U��q�r�ii l� Inspection Requests (24 Hrs.): (503) 639 -4175 J INSPECTION WORKSHEET FOR DATE: 4/22/2005 TIME: 8:06AM PAGE: 2 SITE ADDRESS: 14396 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 025 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503- 533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503. 533 -4006 Inspection Request Scheduled For: Date: 4/22/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 005193 -02 503-209 -6038 N Corrections /Comments/ Instructions: 1 Al 11111rAIMIN/IE ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ALL FOR INSPECTION ❑ ADDITIONA FEES ASSESSED • ItI Inspector: Date: 72 1 6 P one #: (503) 718 - CITY OF TIGARD, BUILDING DIVISION PERMIT #: MST2004 -00329 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/29/2004 Phone: (503) 639 - 4171 Ali Mr�� Inspection Requests (24 Hrs.): (503) 639 -4175 ,..': '__— INSPECTION WORKSHEET FOR DATE: 5/2/2005 TIME: 7:10AM PAGE: 11 SITE ADDRESS: 14395 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 025 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: `LS CUSTOM HOMES. PHONE #: 503 - 533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503533 -4006 Inspection Request Scheduled For: Date: 5/2/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 005818 -02 503-209-6038 Y Corrections /Comments/ Instructions: fiA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS' ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 014' Date J if Phone #: (503) 718- _ V';DNC � fj- To W F`' HopS . . r Buildin Permit A Iicatt L ( Y 1f FOR OFFICE :USE ONLY `` City of Tigard VE ° V Rece Date/By' j Permit No L ;/ 5' Tigard, OR Plan Review , 13125 SW Hall Blvd., Ti , O 97223 I g Phone: 503.639.4171 Fax: 503.598.1960 ^ " : t + � Date/B, /-ii// _09 13 Oth Pemtiljay j / 4 `q �j Inspection Line. 503.639 - 4175 \ . eM Date Ready/By: O See Attached Checklist tor Internet www.ci tigard.or.us ''w OF 1C2WilL0 Noufied.Qvlethod: Supplemental Intormation ri tit nil. n l 9,I� `t XV'\ r, -. - ':TYPE OF WORK ;_ ,. - -i2 EQUIREDTATA: 1"- AND 2- FAMILY DWELLING New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the C ►TEGORY QR- CONSTRUCTION. work indicated on this application. ic43�0 Valuation: $ Igi I- and 2- family dwelling Commercial /industrial I ❑ Accessory building ❑ Multi - family Number of bedrooms. ❑ Master builder ❑Other: Number of bathrooms: 1 L; JOB` SITE. INFORMATION AND LOC Total number of floors: 3 l � Job site address: )439 (, a y\v e e1� New dwelling area: 11-34 square feet i City /State /ZIP:� y �� }� Garage /carport area: � 85 2 square feet Suite/bldg. /apt. no.: Project name: m � ,. Covered porch area: 32 square feet • Cross street/directions to job site: y\k\-.0, - V-0,y\ n� P rpp 1 Deck area: I square feet L1—�� Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision:Y 0 ��� \ \ � +[ J Lot no.!]� Permit fees* are based on the value of the work performed- ^ �' n �� ( � t � Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: oe GY equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF' «ORK work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet .' PROPERTY OWNER-- TENANT Number of stories: j Name: S Ct -- C.Nr (\ Z Type of construction: Address: (oa,$ I 1�� Occupancy groups: City /State /ZIP: ����Qrk Vp f-+�� v " 9 - Existing: Phone: (Sa(56.1) 5 '' 3 � v 3 ``' - /4013( ' Fax: (aS ) sZ - LigCA0 New: L', w " ©ti4APPLICANT X CONTACT PER'S_ ON Y ; NOTICE Y Business name: SN All contractors and subcontractors are required to be Contact name: ' r— S licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 31-- jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons ' IS apply: Phone: (SOS) a t Ca q `� 't{ 5 S Fax: : ( ) lit E -mail: "'� ¢ CONTRACTOR .s f, .�f ,. Business name: ,at "` ..Y - . - - _ - ,c:_ ` 3.p EERmiT. F_ EES* Address: Please refer to fee schedule. City /State /ZIP: Fees due upon ap Phone: ( ) Fax:( ) Amount received CCB hc.: im q 7.h Date received: Authorized signat e: / This permit application expires if a permit is not obtained < tr _ E nithin 180 days after it has been accepted as complete. _ Print name: e ; �` — � Date: * Fee methodology set by Tri -County Building Industry 1 Service Board. i' /Building'Termits \BUP- PcrmaApp doc 12//03 440- 4613T(11/02/COM/WEB) Electrical Permit Application ` FO.... FFICE USE Qty Of Tigard Received Permit No Date/By' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598 1960 ' t,f/iy,. ''' Datev. Other Permit: Inspection Line: 503 639 4175 ' I� B Date Ready/By Jur. 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method- Supplemental Information . ` - .1. ,, .;, .: -: : TYPE .0E- WOR , . ' PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition 111 Other: EService over 225 amps, cornm'I ['Hazardous location , ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., Ca;TEGORY.OF.;CONSTRUCTION of 1 -and 2-family dwellings 4 or more new residential El 1 and 2 family dwelling II Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ['Building over three stories ❑Feeders, 400 amps or more ❑ Multi family ❑ Master builder ❑Other: J , ['Occupant load over 99 ❑ e p rsons vlanufak tured structures o a OB SITE INFORMATION "AND LOCATION ❑Egress /lighting plan R park Job no Job site address: ill 3% �� ❑Health -care facility ❑Other: wit., r..,1) r l P� (� Submit 2 sets of plans with any of the above. City/State/ZIP: f The above are not a construction service 1 1 OLO�C�C� t C)12 applicable to temporary P n Suite/bldg. /apt. no.: (S Pro name ��, FEE* SCHEDULE 0. Description Qtr. I Fee. Total Cross street/directions to job site rievrx. ` 1 � �� 0 r S Qe t_ New residential single - or multi - family dwelling unit. Includes attached garage,•• I ( 145.15 4 Subdivision 1 1,�� ` _ Q Lot no � Ea add'1 500 sq. ft. or portion j 33.40 1 Tax map /parcel no.: S t . V a � g � � l Limited energy, residential 75.00 2 D „ Limited energy, non-residential 75.00 2 L m ted nergy non- dential _ - , E CRIPTION OF WORK' ;� ' - - Each manufactured or modular . dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation • • 200 amps or less 80.30 I 2 201 amps to 400 amps 106 85 2 PROPERTY' O WN ER ®` "TE 401 as to 600 amps 160.60 2 Name: TLS C �•c Iv- \1 ., 601 amps to 1,000 amps 240.60 2 Address: w Over 1,000 amps or volts 454.65 1h 2 0 Ia . - �! • Reconnect only 66.85 2 City /State /ZIP ci \1 Q � ' t Q . IA � r _ Q Temporary services or feeders installation, alteration, and /or Phone: (b'b ) `�� � ) [ relocation 3 533 - fo Fax: �.S 533 1 200 amps or less 66.85 1 - Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel w ';' ❑ APPLICANT, r CONTACT- PERSON -, A. Fee for branch circuits with service or feeder fee, each Business name: branch circuit 6.65 2 Contact name: - B. Fee for branch circuits without service or feeder fee, 46.85 2 Address: each branch circuit ( Ea ch add'1 branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: (h' 1 ( , 1 (.13 ?S I Fax: : ( ) 51g j� � Pump or irrigation circle 53.40 2 ' • ` Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited '. t` ° ` CONTRACTOR - .` - l = '' _ energy panel, alteration, or r extension. Describe: Page 2 2 Business name: Km,.., El (2. c ,rat C Address: an ` '� c �l _ \ �-t -09 a�/ 1�^ 1 Ks- Each additional inspection over allowable in any of the above v * l l+ Per inspection 62.50 City/State /ZIP: u `l L �� c O e_ Q '�2 Investigation per hour (1 hr min) 62.50 (503) ` : _ d80c t I r te / 4 L _ 5Rts Industrial plant per hour 73.75 Phone: v Fax: C ) ` 1p „- r "• ;'. ELECTRICAl:.PE O . - T ",FEES ' . CCB Lic.: l i $a2.... I Electrical c.: q - 4, S Lic.: Subtotal • Suprv. Electrician signature, required:... i It Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: 5-k. Gv __ Dates - TOTAL PERMIT FEE Authorized si: nature: - L • r = = _ � i _ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: c 11 f R Date: - Fee methodology set by Tri- County Building industry Service Board ,. Number of inspections per permit allowed. i.\ Building \Pcrmits\ELC- PemutApp-doc 12/03 440-461 5T( 1 0/02/COM/WEB Mechanical Permit Application ; F O . ' City of Tigard Received Permit No.: Date/By: 13125 SW Hall Blvd., Tigard OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 � rMC i� iii Date/By: Pernik. Inspection Line: 503.639 4175 •`�m Date ea -4.E D Ready/By: El See Page 2 for 1m�is Internet: www.ci.tigard.or.us - Notified/Method: Supplemental Information - -. TYPE':OF- -WORK s " . - COMMERCIAL FEE* SCHEDULE USE CHECKL IST X New construction 0i Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. ' - '"I ..CATEGORY 'OE CONSTRUCTION TION -- ' . " - - Value $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* [ 1 - and 2 family dwelling N Commercial /industrial ❑ Accessory building For special information use checklist- ❑ Multi - family ❑ Master builder ❑ Other: Descnption Qty. Ea Total AND LO _. ,. - ._ .: , JOB 'SITE INFORMATION ,ANDS LOCATION . Heating, cooling Job site address: t( Js Air conditioning or heat pump (D IA ,.,'T T-ef r (requires site plan showing placement) 14.00 City /State/ZIP: 1 Y - � O q Furnace 100,000 BTU (ducts /vents) � 14.00 60 1 Furnace 100,000+ BTU (ducts; vents) 17 -90 Suite/bldg. /apt. no.: Project name: V`l }� Gas heat pump 14.00 Cross street/directions to job site: c ../ $ ` v sz,\ c Duct work 14.00 `l Hydronic hot water system 14 00 ���i Residential boiler (radiator or • hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision V } Lot no.: Other: for any of above 10.00 S Other: 10.00 Tax map /parcel no.: J 5 (.. 1 /1R i Other fuel appliances a r eater ' ESCRIPTIOhI "OF: WORK; :.. .. . :... • " W to h 1 10.00 Gas fireplace / 10 00 Flue vent for water heater or eas fireplace 10.00 Loe lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner/flue/vent 10.00 PROPERTY "OWNER:;',:.: .' ®';,TENANT'," Other: 10.00 Name: 3L CI mtO, l 1 �` - " ___) Environmental exhaust and ventilation Address: 14i�O �� (� Range hood /other kitchen equipment 10.00 City/State/Z 1' : n is a% , • . ► • fag , Clothes dryer exhaust / 10.00 Single -duct exhaust (bathrooms, Phone: (503 )5'2 _ bn, Fax: (56 S ) 533' y? 6 toilet compartments, utility rooms) 3 6.80 A ttic /crawls ace fans 10.00 . - :`v:��PfICANTr - -.' . . � CQNTACT° RERSON " : p I cy) Business name: Other: 10.00 cS� Fuel piping Contact name: C �� a o , $5.40 for first four; $1.00 for each additional Address: ��A l \� J M E) Furnace, etc. Gas heat pump City/State /ZIP: . Wall /suspended /unit heater ��jj M Water heater r Phone: (5 3) 9(o9- I /453 I Fax:: ( ) S�� ` t� Fireplace E -mail: Range - ` 'f.... ;'CY','RAET'OR ; ,` 4 ._ ` p` `,..0 Barbecue • Business name: Clothes dryer (gas) 1 .� ��� • • , '.� � a •lb a Other: Address: 0 (9 5 b_� , ' 1 ♦ZECHANICAT ", P ... , .. City /State /ZIP: 1\& OR_ . 9 `} Subtotal r Minimum permit fee ($72.50) Phone: (56/) 59 -9 ii? z L J Fax: ( 563) ,q _ 0--).8c,:,, plan review (ZS% of permit fee) CCB lic.: j "I 131 LJ State surcharge (8% of permit fee) 11 TOTAL PERMIT FEE r This permit application expires if a permit is not obtained within 130 Authorized si azure: • • _ • days after it has been accepted as complete. �" Fee methodology set by Tr -Count Building Industry Service Board Print name: Jv ',et. .L.- �- S D a t e: Y y i. \Building\ \MEC -Perms Appdoc 12/03 440-4617T (11 /02 /COM/WEB) Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY .....:.:;...y....::::, - '. 1 . , '.'X'• City of Tigard Received per l No 4011p 13125 SW Hall Blvd., Tigard, OR 97223 Date/By Plan n Review m Phone 503.639.4171 Fax: 503 - 598.1960 // �d/el.� I r '� � Date/By. Other Perrrut No. 24- Hour Inspection Line: 503.639.4175 . LL i�ru Internet: www ci ti and -onus ^ • Date Ready/By E l See Page 2 for g Notified/Method: Supplemental Information �. _, . .0 ::. ,.,r;. FEI SCHEDULE` _ E OE IVOR7C. For special information use checklist ,New construction ❑ Demolition Description Qty. Ea. I To;al ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (Includes 100 ft. for each utility connection) .�, r * CATEGOR OF CONSTRUCTTOL�G - - SFR 1 bath 249.20 k . x1- and 2- family dwelling XCommercial/industrial SFR (2) bath 350.00 El Accessory building ❑ Multi- family SFR (3) bath 399 -00 ❑ Master builder ❑Other: Each additional bath/kitchen 45.00 > s '. _ 5:.n:' ,:x:., s ;�.: a <_ , q , ; . , Fire sprinkler ( sq. ft.) Page 2 t ; . :: s , s OB NF : ORN I ATIO1s6 • S AN D ,L o€ T 1s 1; F` M IgI , A• ll Site utilities C Job site a )4S9 (1 f+ r ( Catch basin or area drain 16.60 City /State /ZIP: 1 `�ii• , f In . C Drywell, leach line, or trench dram 16 -60 Suite/bldg. /apt. no.: V Project name: Footing drain (no. linear ft.: ) Page 2 CIV\V Manufactured home utilities 110.00 Cross street/directions to job site: ' , . bib - ■ a % Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 _ _ • ` l t \ i _ � /1 Water service (no. linear R -: ) Page 2 Subdivision 1 � Lot no.: sL Tax map /parcel no.: a it � 1 ay „\ Fixture or item ::: r;:,y c x;,y.:_ "r:' Absorption valve 16.60 F, :: - -, °t -. .DESCRIP.,ION O.,, . W ORD . ,.. .. -::. . . "��� ..;.. �y'.:'a • : ..,. . .. , r . - . _ = ._,,,,.',,,,,,;&, ... ... ..:. ..... . > , .. ,.. ...... .., 1 Wc`;�' Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher ` 16.60 h ss +.wt;::M,0.,r zu= : (x, r; [�sa: • ::r F' r,4 ?,. ..,.�:_ z may:. n •. .Kt :r; Drinking fountain 16.60 a ,; :: :YRQPFRf- r64YNEIt;. 'g .,; ; _0 r ia;' , M. g _ : ....3;,: 5��:,_ .':�.':.. �'�¢ � Ejectors /sump 16.60 Name: .‘ C ,t 1,cl '\e� S Expansion tank 16.60 Address: ` agO .,c,..,.., Fixture /sewer cap 16.60 City/State/ZIP:C L/l• ri (42 q 1 • Floor drain/floor sink/hub 16.60 Phone: �3 rs 22 / ► / � / V , J r l� Fax: (� ) 3 �0 4,�� Garbage disposal 16.60 • kma: ^o• r rya ,- :;t4, -; �. , ,,,. lD ' ', ^"�'� ..m.„. .�'r�'. � ., • �,� .,�,. � � � �. � �. � � Hose bib � 16.60 Y I�, v % `� ,', i z y . ., Ice maker 16.60 Business name: t < � Interceptor /grease trap 16.60 __ Contact name: tCl-f-9- Medical gas (value: $ ) Page 2 Address: 3Pi_wLE_ j Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone: (5 ) 0 X69 - y53 I Fax:: ( ) Ed Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: ::= P ..:: ' -t;, _ st:w__ v " : a =:.Yx�:r :af:7 '� •;t: y «:,.,• Urinal 16 -60 4 i ' ,,e T.. , r ' yA O V"TiR�C�' , r; F.: �a': • i :,,;:,+ :.:x':r= 3ti?'tm .�;1'�'�,•�.x.,�'. . w.±_. �:: �: e,. ri. � , -i:Fkd��t�;�,yM � z,. : ,e,,,,,a- .. . . ,..• r�: « t.� Water closet 16.60 Business name: M u \\ ry. `ix 4v.\-;1y\ F` Water heater 16.60 Address: opittin 6 (2... n ) 1 l' To . Other: 6 ' Subtotal Hi City/State/ZIP: l�j 1.lc r� 1'� �' Minimum permit fee: $72.50 Phone: (563 1DZes - 1 t Z Fax: ( L _ 1ik„:2., Residential backflow minimum permit fee: $36 -25 CCB Lic.: o `a bA9 Plumbing Lic. no.:3q a6,r Plan review (25% of permit fee) v State surcharge (8% of permit fee) Authorized signature: - � �_� ei __.1"--, TOTAL PERMIT FEE Print name: _ Date: This permit application expires if a permit is not obtained within j J 180 days after it has been accepted as complete. • *Fee methodology set by Tri -County Building Industry Service Board. Buildinacrmits\PLMF- PcrmitApp doc 12/03 440 4616T(10 /02/COM/WEB)