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Permit CITY OF TIGARD MASTER PERMIT :��! 2 COMMUNITY DEVELOPMENT Permit #: MST2012 -00012 • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2012 Parcel: 1 S125DC06200 Jurisdiction: Tigard Site address: 9700 SW 74TH AVE Subdivision: ASH CREEK GATES Lot: 4 Project: AP Pacific Project Description: Finish portion of basement to include new bedroom, interior remodel of living room, baths & kitchen. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 1 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $24,000 00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs /Showers: 3 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 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: 7 201 -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 Other. N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 0 Owner: Contractor: AP PACIFIC AP PACIFIC LLC Required Items and Reports (Conditions) 800 NE TENNY RD STE 110 -423 800 NE TENNY RD, STE 110 -423 VANCOUVER, WA 98085 VANCOUVER, WA 98685 PHONE: 360- 967 -4303 PHONE: 360 - 907 -4303 FAX: 503 - 206 -5797 Total Fees: $1,322.68 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 952 -001 -0010 through 0 952- 001 -0090. You ma • • -.• - co.y oft. — - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / ! _ 4 , Issued By: —' - =ri Permittee Signature: 1 44175 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. Building Permit Application ' . Residential FOR OFFICE USE ONLY City of Tigard R ������ Date/B 1 ® / Permit No.: c� �I' .7 ° 1 3125 SW Hall Blvd., Tigard, OR 97 Plan Review ' C .' Phone: 503.718.2439 Fax: 503.598.13 01 3 1 2012 qq Z Date /B ar���1� n Other Permit: r�V v I' 1 G \ IZ D Inspection Line: 503.639 Date Ready • : Juris: ® See Page 2 for Internet: www.tigard CITY OF TIGARD Notified/Method: "(of J Supplemental Information TYPE WW DIVISION ° AY 6 011 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 ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the { CATEGORY OF 'CONSTRUCTION work indicated on this application. Valuation: $ 2'1 D00 [I- and 2- family dwelling ❑ CommerciaUindustrial I ❑ Accessory building ❑ Multi- family Number of bedrooms: l Ai €60 ,ffl ❑ Master builder ❑ Other: Number of bathrooms: '- 0 /1 e & JOB SITE• INFORMATION AND LOCATION Total number of floors: 1.1 Job site address: q .7 00 5 crJ g' New dwelling area: square feet City /State /ZIP: " rI 5 a rct) Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area square feet Cross street/directions to job site: Deck area: square feet 7'4 `'‘- 8 0-4 (.a *e-- Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: I 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. �t in / s i ��, f d ( ,35 i4A.Ar �/e,04 -ave Valuation: $ l...--s A It Vh �` _ _ y' ` �� �_ Q Existing building area square feet b .L '4- hs • ' f< l ". ' C D I _�v I A^ "��/C• New building area: square feet [- PROPERTY OWNER ❑ TENANT Number of stories: Name: P' p„ c c. Type of construction: Address: rb D , g 2.0 n • o f le, - L) Occupancy groups: City /State /ZIP: ca.A.", c.a, G k, f t kJ- A q 115 yS Existing: Phone: (- 4 O + 96 • 4 .1o3 Fax: ( ) New: APPLICANT Q. CONTACT PERSON BUILDING PERMIT FEES* (Please refer lojee schedule) Business name: -Q.& t is 'Q ,� T ' ' .P � G \ `` Structural plan review fee (or deposit): Contact name: I3 0 41 - j ' t2 e1e FLS plan review fee (if applicable): Address: • b t 3 Sly a-6 Aa -A-A, Al gl trt--.4 Total fees due upon application: City /State /ZIP: (.,S a. a•.A. l 1.../...)0.... L7 �j ,J � �, Phone: (� - p •'7L 3 1 -- Fax:: ( ) r Amount received: A PHOTOVOLTAICSOLAR PANEL SYSTEM FEES* E -mail: rT t l l $ 1,1, (,,,,o 4.1„,„1 c+t Vt c'6'1^' CONTRACTOR Commercial and residential prescriptive installation I roof -tc . mounted Photo Voltaic Solar Panel Sys . Business name: A. P Pot-e:t 4 c, L 4 G Submit t • sets of roof plan with con • • on details and fire departm• ..ccess, along w' e 2010 Oregon Address: Solar Installation Spec'• - . checklist. City /State /ZIP: Permit Fee (incl , plan 'ew $180.00 . • : •ministrative fees Phone: ( ) Fax: ( ) States arge (12% of permit fee): $21.60 CCB -lic.: /.2(of a Z Total fee due upon application: $201.60 Authorized signature: 27 genV This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: f b -5 * d c e _ I Date: ' —. 3 r -- ( I * Service methodology set by Tri- County Building Industry I:\ Building \Permits\BUP - RESPermitApp.doc 02/24/2011 440- 4613T(11/02/COM/WEB) • Building Permit Application Checklist One- and Two- Family Dwelling FOR. OFFICE USE ONLY 1 P ^' � Received City of Tigard < Date /By: �,7 g Permit No.. 4 13125 SW Hall Blvd., Tigard,OR 97223 Associated permits: I . 8 Phone: 503.718.2439 Fax: 503.598.1960 T CGA It D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ 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 oh 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., . 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- - ❑, • ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. . 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member §lung, •spacing, arid liearing ' ❑ ❑ ❑ 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 to the .ro'ect under review. ' -JURISDICTIONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 1,1" 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 - RESPermitApp.doc 02/24/2011 440- 4613T(11/02/COM /WEB) " - / Electrical ?cold' Application RECEIVED , , „z err chi, r list7 c,:v1 v City of Tigard RECEIVED ruta o.a t ,� 13125 SW Han Blvd. , Tlgatd, OR 97223 ' /t'l % 0 d /a— OZTI'(� Maier 503,7182439 Asa; 50,3.508,1060 JAN 3 1 2 01 �' " Inspection Lino: 503.639.4175 DateBy ' ' ' " Hate Ready/By: taro r tig r gov CITY OF TIGARD wolf ieduethnd Pogo _' L ..............................--,•:, tat lafcrmatioo P even Q New cone ruction ❑ Addition /atter$tionheplactment roue cheek ell then apply (wi 3 sets .' . m,s write= chentrod below); El Demolition ❑ Other In Satviee fabler amps m mate 013uQd1Lg aunt to 4 :... '`.ri ,s ?r a . rs x - ,' ` i. r .. whiner av®1ab19 cuIIEII[ ❑ Pleating and arch. Weeds lQ,000 130 volts pleating . i- sled 2- faintly dwelling ❑ e mrnercraUitldtlstrml El p gS , Wilding r less to ground, or extends 14.008 Q Cmttmreetal.yg4 AQriouitural Multi fanrl amts e4r all e th er mau11 sue buildings. Y ❑ Maar builder f 7 4 ❑ � Oi11Ct- Drat pump. lhsmnazioao193It:VA ar ..... : ...... .. _x..e. pti, , 1 { r r t ° H Omargam system laT6cr Melt derived Job El ob no, v ? �) Addtt Di oew mater load of d r, % h 12 — Cit /St Jab cite address: ? C3t7 S iA/ ...,:. A L 2 It10Flh ar toorc, ate /Zip: /� ©llealakana facilities, 0 Supply vOltago for mare '� ❑ Six ea mere re•. amts. CI :ere= uch�cie g Y t \ than Suite/bldg. /apt no.; 1.1.3___rof J Project mom CI Servi dohulocatiooa. 60avnitattomirwal Q Servitx or Mader 600 .. or more, Cross stt+eat/ditectiOnO to job Bitty ' ` ' Dtaept [ten . ' ' u'• - L' ~'p New residential single. or mnitl-tgmily dwelling wait. ]Includes attached orate. Subdivision: I Lot no.: 1,000 sq. ft. or less 1111 168.34 11111111111 T a n a r a p / p a r d c l n0.: &a, add' 13dD eq. fl or porno 33.92 1 ' ' ' vi."' :'...2. i • . united energy, brav .. 8: st>tlgi MI r . .. ..__ ....__. `. . . ..... -� . ._:?' � -. ;'� ,_. - -_ .. _`�.�_. (witltaboves'.R 75.oD .1...-=‘....-:::--'''''!;•.&':_:.5.1.4-'...,L.:' energy, multi- v,' 75.00 =© rC5iden'tial with above 9q. ft.) " - Semite' or feeders installation. alteration. n a�nd/or relocation •t'1 S 7 k .,.. 5 .. '� - ,'"',',...1.", 2 n1 - . 4 or t b0 100.5 M..,,.,..v. _..,. - .. _, _r a/ t ; i` , e _ ` ,. 0] : „ e ntp t � I Norte: s F ... s 401 snipe to 600 am 200.94 Address: 401 emp6 its 1,000 amps 301.04 -- �— Over 1.000 amps or trolls 3$2.26 II CS ts+/5taic!?.IP Temporary se or leaders insinuation, alteration, and/or relocation Phone: ( ) �ax: ( ) — • 200 amps, tit leas IN 536 — fl Ovvaer'tnstatllation: This installation is being maaa on pia airy that t own which is not 201 . t0 400 MI 125.08 �Q intended for salt, lee, rent or axehange, Recording to ORS 447, 449. 674, and 701. a air to 699 amps Id &Sa Owner sipp.ure: Date: *and circuits - .ithltP alteration extension 131 A. - for branch eitou t6 with ' � aacb brsneh tilvtiit 7.61 business nARte; c f Cr c <1" r(� @ B. Foe for b : 1 ... ci cults wanner CtkttaCi omit; O service or &tat r tee, first " ! . _ branch citOOtt Address: ^ ( j ! au Etch 1111E1 breach circuit g 7.62 2 p Miscellaneous service or feeder not h.eladed City/State/ZIP: IL A o f t? ' r j Q1.4._ WH 9) 64 2, Each maiuddcaued • � © dwelling„ garlic* and/or feeder Phone: ( 0 ) 44 $ Z.31 # Fax :: ( )) 5'6 hq "'j - Reconnect only IIIII 67.sa 11111•11111© ., 'i- tnnttl S...2-• U t 5 • (,pwt • 'Pomp or irrigation Girds 67.84 � . r 1 . ?" K S .: � Or outlier lighting 67.84 f :: * L art, ' ° , . r .. ....a ly ' 1 1. .al ouG11 t(a) 07 i Business name: A) L � . 1 te . panel, Maratioo.Ocextenamnn Page Address: X rV I ........... ( , , on over aFlowabk In inapt the above ) Mditionelbu..oEton(lhrmin) - 66,25/ hr Ciry/SYata1zlP: 1 \ d e, y j e ` (1 a r InVe&tagation (1 hr min) 6625/ hr Phone(( t. c 't lndnstrtai pla (1 hr min IN 78.18/ hr Ill , rt)' /98 1I0 ( F .111111111 - � ) to r l i 3 Inspections ter which no e is 111 C B i t 7 `!) l q Elech ip1 Lic.: /► t r tI g Mall listed if lir mitt) OO/ hr 1 Q0 0 7 SUPry, Lie.; 7515 . Suety. Electrician ► x _:_<: Signature, required: +4 subtotal i�?'?. Man nwtcrr (2546 of permtt fee) Print name: r' , Date: .... e 4 .. Cr{ t - 9_,,g 2 0 Stara surcharge (123+0 of pmt ); Authorized signet uro: + T TOTAL.t ERM 1"1 p; ^-' Print rr'' ^ 'fate penult application capita If a permit it oat obtained within 190 W (�Yti 1:3414: l -2)1") 1O 11 • day. Neer it bas boon accepted as men**, of inspections auowtd per pint. r:18u17dInithineslE C- Pernu4yp,d0t O7flVre Maselst(,hros/COmeYFB Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received Date/Bys Permit No.: ( rAD / �_ � 1 Z n 13125 SW Hall Blvd., Tigard, OR 972 at �EI� Ili 3 j T t C/`" Phone: 503.718,2439 Fax: 503.598,11.4 X1./9 Plan Review DatelBy: Other Permit. T1GA RD Inspection Line: 503.639.417 Date Ready /By: Juris: H Sec Page 2 for Internet: wm +'w. tigard - or. gov 3 1 2012 Notified /Method: Supplemental Information _ q JAN y �,�' %`t�S�;4� a'9"'""'': _ ,,. ,.,�,• - ,.�raw JAN - - - ;s a. �,, �,.. �.. 7.. �..- ....,.n.;r. t - .x� . ' - ', ' i g 0 ` ~fir 4a � nedi1iM RCIAL FEE'"'SGHEDU EA F1SE CHECKLISTt ;; �' 7 ,. kx,'awxxrwr.., ! h ,'- ST' -a., — .'z+ .a,.,.�,. a..�,.._=,.e..� - - _ s x t I I EUM ,�� �a 3 Mechanical permit fees' are based on the value of the work ❑ New construction ❑ Addition /iii r�HMfhL dtt�fti IAN performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. `:,� +' sc an3e r�..:+, >9Nne «,a.,a Value: $ , � , . :.,:.-'7 ' , CA OF''�G� T<IUN ' �� ` ' • ❑ I - and 2-family dwelling *y - B T[ ,1 MS FEE - g ❑ .Commercial /industria ❑ Accessory building _ For special information use checklist. El Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. ' Total +t' 'wY`:£ 7`•,y i "c.•?. r... , sJ..yam ,, °' F x t°-:c " °��^ '� �r�,�w'j �, �.m�.�<�h,- �'- ean coon a i, :� `„ . a tglI ilitA IYI,(1 +TI� 149, L QCATIOtV '� �;' �' ? g . �: ;,,'x",.9...,2:.. � iu �:is .. -+� .•. �, �:•;�- :.•. „; .,;sar.��Wka;,:� + siAx::sn�:�'a #���•li�V, � &:.�,ds(+il� Ai r c ing g' Job site address: 9 0'0 ( h j '] i // J (requires site plan showing placement) 46.75 Furnace 100.000 BTU (ducts /vents) 46.75 J City /State /ZIP: ''t l(� t't.� ' o I � t V 1' t-- Furnace 100,000+ B'I'U (ducts/rents) 54.91 Suite /bldg, /apt. no.: Project name: Heat pump • (requires site plan showing placement) 61.06 ' Cross street/directions to job site: Duet work 1 23.32 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 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: ,Y.' I Z � 'N+'Nn.•6. hM Ae F 'N..e hM"h'i_ 3�m' 'Y• ` '1 i" o ff 11 :S O YCl ik 1 - ��7 f � , Water heater 23.32 r. Gas fireplace 1 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 21fArR rei h<.,5.tt =w Chimney /liner /Flue /vent 23.32 Name: Other: 23.32 Environmental exhaust and ventilation: Address: Range hood /other kitchen equipment ( 33.39 city /State /ZIP: Clothes dryer exhaust I 33.39 Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32 Mir . ;p ' ¢�r�. z .. �',.�;t.��r,� � fit"' fiX: �.w a:< -�,s *:+.,aa w:�.n.':;. -..�. °APPI TGAIT.; tk k .' ONTPt ace fan . t, et C ; GT "'PETtS 1V — Attic /crawls s - �sK�sner.wMn xaa'#, s��'. �a�a�- )rs'�. r��. ,.�.r:,- e��,,�.A,.,�r���rs.)3' <, p 23.32 Business name: 4 pA-c -- [ " ! � , C Other: 23.32 ` u_r1 L� Fuel piping: Contact name: {{ � R , `Ck b ��:'t"QiY� t"'" I ):--1 y') $14.15 for first four; $4.03 for each additional Address: kip o ,,/ jay Furnace, etc. � � , �� ow 1 V Gas heat pump City /State /ZIP: (I a \ c. 4 Vv re r 4- 9 6i Wall /suspended/unit heater Phone: ('A() 0 G 07 ( `. 0 Fax: (503) a 0 �� —7 Q Water heater ( V I Fireplace E-mail: ',s •��� u s �:, Range � s uk• , . ' v 41W ,.GONTRACPCi .� e as ��a ,4R.,... „� . �. ,. ,, .. 'VW. � .•." � �� Barbecue Business name: A. p p � C-- ` T t G L.,—(..,,C Clothes dryer (gas) Q�� T tt '' / Other Address: r . 0 - m JO 5-+p 11 1 u ? '.:,' f , a:. 4 .. ME ICilf� x ' _..;��, a �.zw* ", ��SS;� �:��'td�. City /State /ZIP: Vc y 0,0- Vi /t Q•� F)9 Subtotal Phone: (`34 Ol 61 4-3 W. )) r L U �+ 9 7 Minimum permit fee r mit fee Fax: ( �.2-06 � .�J� 9 Plan review (25% of permit fee) -- CCB lie.: f c3 I "LOq' 3,s t 7' State surcharge (12% of permit fee) ? at" TOTAL PERMIT n FEE Authorized signature: this permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: C ' � ( 5a j t v1 Da1 / / Z��Z * Fee methodology set by Tri- County Building Industry Service Board 1: WuddinglPermits� MtSC- PermitApp.doc 09/09/ 44 1617T(II/02 /COtiAYEi31