The URL can be used to link to this page

Permit `.� ° �� CIT OF TIGARD MASTER PERMIT ` 4 ak- COMMUNITY DEVELOPMENT Permit #: MST2009 -00173 T GARU 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2009 Parcel: 2S104BA00200 Jurisdiction: Tigard Site address: 12103 SW 135TH AVE Subdivision: Lot: 0 Project: Williams Project Description: Remodel bathroom. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms' 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third. 0 sf Right. 0 Detectors: Yes Total' sf Value: $25,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp. 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 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 Other: N Other Description: Ecompasing N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) WILLIAMS, M MAX & GINA H LYNN FEINAUER 12103 SW 135TH AVE 12820 SW RIVER RD TIGARD, OR 97223 HILLSBORO, OR 97123 PHONE: PHONE: 503 - 730 -6004 FAX: Total Fees: $781.13 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 - •rdance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if ork is suspended for more the 180 days. • ENTIO . Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center hose rules ar- forth in OAR 952 -0r -0010 through aAR 9 -00 -01 • O. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6 •r 1.800.332.234- Issu • By: ` / etes Permittee Signature: /` ` � / , r Building Permit Application .r Residential RECEIVE" FOR OFFICE USE ONLY City of Tigard Received : Permit No.: lg - 2 0 0q , 00 t 13125 SW Hall Blvd., Tigard, OR 97223 Au r, 2 009 g Plan Review ' C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: I' I L. A R D Inspection Line: 503.639.417 �i Date Read /B :furls: 0 See Page 2 for Internet: www.tigard- or.gov CITY ®FTIGA. ` otifi e d /Melhod: Supplemental Information BUILDING DIVISI# TYPE OF WORK REQUIRED DATA: 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 Et AdditioLltera r n/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 0 Z_I - and 2- family dwelling ❑ Commercial /industrial Valuation: $ TO./ 00 ❑ Accessory building ❑ Multi- family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: l (02) 1, (0 ∎ ' t h � New dwelling area: square feet City /State /ZIP: Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: I/0 l l \, . Covered porch area: square feet Cross street/directions to job site: J Deck area: square feet Other structure area: square feet - REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. 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. Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: y\,(\_, Q t^. n cc w( l k ` q m C Type of construction: Address: ( 2 ( Q 3 I E—"1.-1 Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT , ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business name: .BUILDING PERMITFEES* y �a� � �( N � ( - r te Address: / - v 5(4/ t U4?) h ( � S (Please refer to fee schedule) City /State /ZIP: N , (I S { j O 1'o D h Structural plan review fee (or deposit): Phone: (5v3) '7 3 0 - 6j OU y Fax: ( ) FLS plan review fee (if applicable): CCB lie.: D Z 0 (r/ �, Total fees due upon application: Amount received: t Lk q Authorized signature: - T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: L,,' N . yv 1 vi 4 c Lsp? Date: •� 2/ — O ,- * Fee methodology set by Tri- County Building Industry Service Board. . I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY City of Tigard Received Permit No.: illi V 13125 SW Hall Blvd., Tigard, OR 9722 Date By: C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: TIGARD 24- Hour Inspection Line: 503.639.4175 1:1 Electrical 1:1 Plumbing 1:1 Mechanical Internet: www.tigard- or.gov ❑ Other: THE. FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes ' No ' N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ 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 ❑ ❑ ❑ 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. 11 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, ❑ ❑ ❑ 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- ❑ ❑ ❑ 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, roofing, 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. ❑ ❑ ❑ 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- ❑ ❑ ❑ 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 ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 ❑ ❑ ❑ architect licensed in Ore. on and shall be shown to be a• elicable to the Iro'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 ". ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11 /02/COM/WEB) Sep 03 09 10:59a David Haupt 503 -554 -8506 p.1 SEP -03 -2009 00:51 AM a �r-pp . 503 628 0424 P.01 Electrical Permit Application w as ti 114 I '. il: I i ti I I 1+ 1 1, City of Tigard SEP 0 3 ZOO ayd Permit No. ST240 )l PIN 13125 SW Hell Blvd., Tigard, OR 97223 Review o Rv Phone: 503.639.4171 Fax; 503.598,1960 Plat R v Oilier Penult: - t ,. • e a inspection Line: 503.639.4175 CITY OF -WAR t'�y�+ Plan 912AR rare Readyllly: Ivris: (a Sea Pane 1 for • Internal; www.tlgesd or.8ov RI Hi w ' MIQf'Kaltfted/Melhod: Supplemental tnformadon t-- D.cnkliti0 TtfPE O P WORK - - y - • .... P P'grW D New constmictlon 1 l t 0 replacement Please cheek dl Nor apply (submit 2 sets of plena w /itemachockedbelow): ❑ sorvicc or feeder 40d amps or more ❑ Building ova !h: ec atones, ❑ Demolition ❑ Other: where the &vedette Soli unseat ❑ Mirka* and boatyards. c,A`ttf io&Y OP coNamuc- IDLY exceeds 10,000 amps at 150 volts or ❑ Floating buildings. , tail to ground, or exceeds 14,000 Cl Curen ercial -use agriculbarel % 5Z],.1. and 2- family dwelling ❑ CommerciaVindustrial 0 Accessory building amps for all Miler inetaltations, buildings. ❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 instillation of 75 KVA a t JOB ant 4 Fo*MA1ioN AND LOCATION ❑ Addit o new i n' laser aep 4enved system. - 0 Adttillor. of new motor load or ❑ "A" "L" '`t -2" "I.3" 160HP or more, occupancy. Job no.: Job site address- O ____ A ❑ six or mote reti4erti units. ❑ Recreational vehicle perks. Ci /Sra(c /Z1P: ❑ Health -care facdlttea. ❑ Supply voltage tor RIM than ❑i fwrdoualtKatione, 600 volts moo ii, Suite/bldg. /apt, no.: Project name: C] service or feeder 600 snipe or more. -- • ,1140 SC1IRD LE Cross street/dircctions to job Site: aace.uan I' Rex• I Fr.. f Tel.' I ' - - - New residential single- or mullbfamlly dwelling unit. Includes attached garage - Stlbdivisiun. Lot no.: 1,000 sq. R. or less 145.15 4 Ea. add - 1 500 sq tt. or portion 33.40 1 Tax map /parcel no.: limited energy. residential ' D11 riON a!' WORK (with above eq. it.) 75.00 2 Limited energy,multidamily ___T 75.00 2 04 n /I L t residential (with calve sq. ft.) � �" Services or feeders Installation, alteration. and /or relocation 200 amps or less 80.30 I 2 0, sonic r'v twfdil I 0 TENANT I01 amps to 400 amps 106.85 2 401 amps to 600 corps 160.60 2 " t +r t..\, �CS� - 601 amps to 1 amps 240 60 _2 Address: Over 1,000 amps or volt 45465 2 City/State/ZIP: - 'temporary services or feeders InstellaHnn, alteration, and /or •_ relocation Phone: ( ) Fax ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that ( own which is not 201 amps to 400 amps 100.30 2 intended for talc, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 133,75 2 Branch circuits- uew,alteration, or extension, oer panel Owner signature: _Hate: _ _ A. ?cc kx brunch ci with J .APl'ti 1CAP'f i , t . C4INTACT PERSON above service Or feeder fee. 6.65 2 cnch branch circuit Business name; B. Fee for branch circuits wllhaur service or feeder fee, ( 46.85 2 Contact name: first branch circuit Address: Each add'l branch circuit _ 1` . 6.65 _ 2 - -- Miscellaneous (service nr feeder not includedL City(StatcfZiP: Tisch manufactured or modular 90.90 2 dwelling, service ardor feeder Phone. ( ) fax: ( ) _ Reconnect only 66.85 2 E-mail: Pump or irri ion circle 53.40 2 CO TL AC OR '.,.. Sign iv outline lighting 53.40 - 2 nssinoss name: �/�//)) zz�� c' Signal cireuit(9) or limited - fl +,C'C /�! // 417-' _4, la► CAlc energy panel, alteration or Address: 9 8 iv J c� - '` actension. Doscr2,c: Page 2 2 City /State/ZIP: j �}�X 4. (4(.) - Each eddl4ianal inspection over allowable In any of the above _ / Per inspection 62.50 Phone: ( 5 1)3 53 9- - 2 i Zi 1 Fite: ( 573 551 / �ij investigation per hour (I hr min) 62.50 CCtS Lic.: / 01: 3 ' 7 Electrical Lie.: - 'jb-54c. ,suprv, I sic.: (///745 Industrial plant per hour 73.75 /O /t / ELECTIRtAL 'EMU FEES Suprv. Electrician g nat re, required: / tillir Subtotal slimLr (-O:.5 Print name: D vLc0 _ T Date: j - j- p f Plan review (25%o permit fee): / State surcharge (12%oof perm it fee): 2 Authorized signature: TOTAL PERMIT PEE: 4 ' Print Ram[: Date: Pas permit applcatsoa eupirea its permit h nil obtained wttbia 180 day. slier It Itu been accepted sex complete. • Numbs of ia,peotlnns allowed per permit. I:UluildinermitoN 1..l:PtrmitApp.doo 05/21/06 440-4611T(I von eorwwan • p - ,5..„, Mecha Permit Appl><eatio Fff „.., _ ;!E:1 � . 1� -.. LIP . FOR OFFICE USE ONl ti' City of Tigard Received Permit No.: 0 131 SW Hall Blvd., Tigard, OR 97223 AUG 20 9 p a n Re _ Z004 - Qb l !Ian Review M Phone: 503.63).4171 Fax: 503.598.1960 Other Permit: C ; Inspection Line: 503.639.4175 CITY` OF D ate to TI A It 1) D Re ate adyBy: IuriE 55 Sec Page 2 for Intemet: www.tigard•or,goV BUR DING DI \/ION! Notified/Mcthod: Supplemental Information •ii.:'1 �:a.. t ti ��{�5'��y "��JF1= 'fr.� � f�i;�C " .�y�� .r��i ��r�$5 �;�!CfY�F�;E�.7 ; `zpx`�'at t+;��J�' s• fii+l'�'l, ' 1' " �.� �� ''� "�,�, 1 7 77 ".i t �'.c�i (' ? »i21:3'i; .4; 1 ! yyt'tiuF ,rte fR7i`trr:,., � i,k�^ i"' ; 1 ° x 'R'" w a�o 'W •. LL ry t 4 '17d N ,'i rl 0 Ncw construction Addition6tcrat�1 /replacetllenl Mechanical permit fees arc based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical malerinls labor, overhead, and profit. „..: er ; i ,g,,�1 ; ,� .w i, r ^W,.• '' h "qty` `'. ^ -x..- d:�(xr.u , 1'T1' value: $ „ �."<PAi;•ntry.�7. ;ig y � X 7 •.r�, .x., .:t ?P,' 11S , 0, • ' / „°.,4.,; + ,,k: ' El�`.t1� , R, .; :io ,, e • v ° • ;t , k , , , , �-1 and 2- family dwcllin w ;, ` S , lt ' 1 , v ,I _ 1 g ❑ Commercial /induslriai ❑ Accessory building " "' " "� ' ° " ❑ Multi -famil For special information use checklist. y 0 Master builder ❑ Other: uescriphun I Qty. Ea. I total t.:t•• i� �:.��x� r,•',�i'�1..,A. a, ,.�. _•. .t. ASR •:{�Y,',i '_jay_ ., �� ..s ",r "Q,1��,L _ :!�.:' �r ..�=`�.� niV' :off "Ldf� r�•:id-" "'1 01 ^'1 „N.'.4., ,, **O '!' �`�'-(-'=�+t' Ni' p� 1 y1Y" '1m`�le �F:1.i, Hcatin cooling Job site address: ') /� `` Air conditioning or heat. pump v' d L � ' , (requires sire plat, showia8 placement) 14.00 __ City/State/ZIP: Furnace 100,000 BTUjducts/vcnts) M 14.00 lridg, /opt. no.: Project name: , - �, Furnace 100 000+ BTU (duos/vents) Suite/ 1 1 . \ { j_ (14 Gus heat pump ___ . 14.00 _� Cross street/directions to job site: Duct work 10.00 _ Hydronic hot wateraslem 14,00 , • Residential boiler (radiator or - hydronic) 14.00 -- -' ....: -- .... -_ ... _ - -' --- . • -- _ --- Unit heaters (fuel -type, not electric). • in - wall, in - duct, suspended, etc. . 14.00 _ . Subdivision: Lot nu : Flue/vent for any of above 6.Ro , _ . Other: 10.00 Tax map /parcel no,: Other fuel appliances `I JM vrru' r9 °:J: �1 <.r;:rr. , m, � r,, . 4,,4.' 4f.:}.^ ! : t c ^� �t rm ;�ylr." t;w�) "�� s "cwtx �1 Water heater 10.00 •- r „ n. 1 11:.41 't.W. irc.1' d'fil e-• 'si A , �, f,K: 4.,Pw.I �Ma`N.'4 ,10,1C/,' ;• 7FP1 d:'.) P,":, � i l l yY rtia,1'L,t1' Gas fireplaCe 10,00 7'l f", /� '""l �- ` 7�� Flue vent for water heater nr gas ' (l.4/Wt - 0 el � A/1-4- � - fireplace J IO Lop, fighter (pas) • 10.00 Wood /pellet stove, 10.00 _____._ Wood fireplace /insert 1000 r;; " *'r \ � J t voi ,, ..7 , , .„ , tit rr) } }T"2_7 ,1 1,r'N �p Chimney/liner/flue/vent 10.00 i A . k ° „`-• ■ • A t. t _...!tj {x..1 (� ... .... ..... ........ . IF .I ....V .^o r pM1y "!..... c� .1.. , ° ! ' ^l' S other- 10.00 ■ Name: Q 4 . ' I ti t Enyironmenoal exhaust and ventilation Address: l - 1 Range hood/other kitchen . - -_,._ equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 Phone: ( ) Fax: Single -duct exhaust (bathrooms, ( ) toilet compartments, utility rooms) P 6,80 • . r, ,:, 42 1wiii' } p. 't;: t „ 1 ..,d..,,w ?�%'.y_ , Cl .N `�tip'�1 .. r ... � O Ii W , '��r,, �' � -.4'- t� Ap. . ,3,�C. .t`: .. r. , ,. Zw:, ; ..X ; ,, '�,. �;;x' -rltMr tr<<'tlf,:u', :a'r,iap,n,�. "`:«• ...,M�.,��.nr�9�;l��y,:,,�r�:`} .�tticicrawlsace fans 10.00 : _- Other: 10,00 Business name; ^`� Fuel piping Contact name: 55.40 for first four; 51.00 for each additional • Address: Furnace, etc. Gas heat pump Ci ty /State/ZIP: _ Wall/suspended/unit heater - Phone: ( ) F ax: : ( ) _ Water healer E -mail: -- Fireplace Range 'r 5";;� - 2 - ° . ; ,x,;� , . N .: o �•,:4 } <'a� ;:rh;: �. ...t 2.t ?':h "x,,:e_: �. '' °' ��54�' „u1:r.7: �i0' n.m'.f <� - } r ' ,�. tu..:,. Ya .1 ?S..nk.1,..7x;,.��.xiY�:';, ,. t A2Y,i y�rbi" ! 3k l i,:�4 r, r M'",LI7�/.`� htflii+Jrliyxuai Sl"�r.'i�`; `g . Barbecue _. Business name: ?!; 1 ;, ; D`,,, t j Clothes dryer (gas) Other: City /State/ZIP: Subtotal I hone: Minimum permit fee ($72,50) 7 2 .,C) ( -� _ I . Fax: ( ) Plan review (25% of permit fee) CCB lie_: _ State surcharge (12% of permit fcc) 1 , 7 0 TOTAL PERMIT FEE . 7_0 Authorized siSmatur This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name y // /i' a,- e Date: / /,/ / " 1" mnthodolotly ant by Tri•bunty Building Industry Servioo Board IAD ' ' : -. r` . • .due 01/19/07 e4u -4c 7'r (1r /07/ /CUNVWBB) R # 0961.869809 1S9J0 uolW 69 60'60 -9Z -80 Sep 08 09 Ol:llp Mike Rea 503 - 640 -9344 p.l ' Plurmbiuz Permit Applica ECEOVED . . . . , . . . . • . rr ij4 t.t► <I it i i •.1 ' t ':\t , • . . .. • • City of Tigard SEP 0 8 2009 Received : . 13125 ,$ W HMI Blvd., 'Tigard OR 97223 Da,e/B : klti f , �I � d . • • Phone• 503 639,4171 Fax: 503. F TIGARD Plan Review • Inspection Line: 503.639 4175 VI O Dete/ Other Permit Na.. J I r - ,a; I.' Date Rend !R Internet wwty lrgarA Pf gov • I , DIVISION • Y c rung Peke 2 iv, .�;;. , " 3,� F.r r I.: r - �: . ! a * N '_ t' edM thoA. Supplemrnt.! informattoe ° :. r X4 rrrr��rk1,J, 'ate . r� : Est , �'SB,,ts 9. ::,- e ' • _3:,•'1 ' e.l '/�i'?..Y.'�,c- }e?h- ':�- nIX...� ,. � - IJ�.yuR �:t'`y V� l'4� 1� 1, i1 � �y t � •• 9 y. r >. _ n - b..<_ � ..rt' � ,r.,i: iDio + ...!.v.:. - w ' l �� /_ �..:. `.,.. �.J t s,2..r'! ":: ❑ New construction ❑ Demolition For specio information sue e/erckilse M Addibor ltore eplace,nent ❑ Other: Description Qty Ea. ( Total .;':',.::."9!..-.;•'•';:' r 4 .. , � ~I lit New I- 2•famlly dwelling* (includes t 00 for each utility connection) • , y t . .,::a9 I, ,s �, ,, r ,,�, ' � ; r.u.•. L k SFR (1)bath 24420 fz I - and 2 fumrly dwelling ❑ Commercial /Industrial SFR (2) bath _ ❑ Actxssory building r ` 0 SFR Multi•famil (3) bath "' 350.00 Y — 399.00 Each additional hathlkiichcn 45.00 ❑ Master builder ❑ Other v.:. t.;: � .•t � r r .ec 3Rr; t y r Firesprinkler _.. sq. ft.) Paget `1e '.Hr : 5 x 2tgi.•t �i.L:r .}a .ii+ 1?....,, , r site )ob she address: + r 1 � iQ ]� t + � h Couch basin nt eroq drain 36,60 — City/State/ZIP: Drywall, leach {ire, or trench drain 10,60 Suite /bldglspt. no_ Project name: Footing drain (no. linear fl.: _) Page 2 Cross street /directions to job site: Manufactured home utilities 110.00 Manholes 16.60 "° Rain drain connector 16.60 Sanitary sewer (no. linear ll.: ) Page 2 Storm newer (nn. linen R,: _•,__) Page 2 Subdivision: 11-ol no,: Watet sorvice (no linear ft.: ) 1 Page 2 Tax map /parcel no.: — nature or item yr"� i .i idr r rS d ;;? : ` s rg a�?"4 ' t Absorption valve 16.60 t f. H Disallow preventcr Page 2 ti 0 ch I t ] }, i "' `age am here t" Backwater valve 16.60 + . _ ... �� — Clothes washer 16 60 • Dlahwttyher IT , 41tA 11 •1. ... / , i: [ a ,,,w rP. Y .G F 16.60 1 , , L w 1 t/ 1 r �, ' • ,: e Dunking fountain - , , .. : 1.: a ., < •1.{, r {�: ,i ...:tn , ....._._.__ 16.60 Name: J � j cctors/sutnp 16.60 N x I � a I " (t I � S Expansion tank - r 16.60 Fixture f;ewer cap _ 16.60 City/State/ZIP: Floor drain /floor sink/hub 16,60 Phone ( }, ) Fax: ( ) Garbage disposal 16.60 > r} f 1! r „ r s i +,5 V: t t r t '. , h • r q va Hns bib ., .14./..1.):•'.:a.-4:641::,:..1,0.-":' re.... d4 ri v:j )t [lt[rl ra '..V. 16.60 ,_.,..± ha. .a.rs. a . ice maker Autinesa name: _ 1 6.(10 Contact name Interceptor /grouse trap 16.60 Medical gas (value: $ ) ' Page 2 Address: Primer 16.60 City /State /ZIP: _ Roof drain (commercial) 16.60 Phone: ( ) Pax:: ( ) Sink/basin/iavntory ' 16.60 E -mail: Tub /ehuwerlthnwer pan 1650'` .M ^ "'�'xEAIL . G . c (� �r ` r tat w 0� lr z a '+lrrtit W n Urinal IG,60 ` + 4.. +'sU tD7 t r • }• ,'.+• b:r. .. , ?-it .t. Wtcr closet Beefiness name• ��e:. I \-e. •r In- C . ... _,.•... •._._. ,. . _ ... I _.. _ 16.60 Water teeter 16.60 Address: 3c330 S1/4.2J V ,, t Other CiIy /State/ZIP: 1-{= \\ sb;;/1:? 66 4' 1 i 2 -./ Sabmwl _Phone: (4�()3) 5 - , ;LS Z._ ax: 603 )( i �f Minimum permit fee: 572.50 �� 50 34 7 RrsidentlalbarkFlow $3615 CCB Lie.: (Lt e •CC 3 7 11N1 II IF Plumbing Lic. no. 3 y 3 E 5, Plan review (25% of permit fee) Authorized signature: / la t} e {� 0 g nalure: 9l� // State surcharge (12/ of permit fcc) t i 1V Print name: i�� ci This v TOTAL PERMIT FEE ( 2C), � / l Date: cl -a f'-0 s wink applitatinn e:perea if a Permit is not obtained within 180 days after It has been accepted as complete. 'Fee methodology set by Tri -County Building Industry Service Board tdBrrildirvitPrrmihVLM •hrmnAeP.dor 12m/nM1 445-46161110/112/47014A0,19)