Permit CITY OF TIGARD EVISED MASTER PERMIT
I . COMMUNITY DEVELOPMENT Permit #: MST2012 00048
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2012
Parcel: 1S136AA08200
Jurisdiction: Tigard
Site address: 10009 SW 70TH PL
Subdivision: VENTURA ESTATES Lot: 4
Project: Dixon
Project Description: Create 610 sq ft of habitable space in unfinished basement, add stairs to basement, new decking
and guardrail for existing deck.10 /1/12 REPRINT Added (1) low voltage permit
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 610 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 610 sf Value: $110,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 1
Drywell- Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: DWV
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
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! 500 sf: 0 201 -400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 3
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 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing. Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R -3 610
Owner: Contractor:
DIXON, HEATHER L HAMMER AND HAND INC Required Items and Reports (Conditions)
10009 SW 70TH PL 1020 SE HARRISON STREET
TIGARD, OR 97223 PORTLAND, OR 97214
PHONE: 503 - 816 -1911 PHONE: 503- 780 -0321
FAX:
Total Fees: $3,292.08
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 Op 952 - 001- 0090. Y ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i� / NAIL/ Permittee Signature: DAL U �`1 1 I o 13
j Call 503.639.4175 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.
CITY OF TIGARD MASTER PERMIT
v Permit #: MST2012 00048
i • COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 9 7223 5 03.718.2439 Date Issued: 03/21/2012
T[ G A R L1 Parcel: 1 S 136AA08200
Jurisdiction: Tigard
Site address: 10009 SW 70TH PL
Subdivision: VENTURA ESTATES Lot: 4
Project: Dixon
Project Description: Create 610 sq ft of habitable space in unfinished basement, add stairs to basement, new decking
and guardrail for existing deck. No change in footprint.
BUILDING
Floor Areas Required Setbacks Reaulred
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 810 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 610 sf Value: $110,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 1
Drywell- Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: DWV
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea add! 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3
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 8 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 -3 610
•
Owner: Contractor:
DIXON, HEATHER L HAMMER AND HAND INC Required Items and Reports (Conditions)
10009 SW 70TH PL 1020 SE HARRISON STREET
TIGARD, OR 97223 PORTLAND, OR 97214
PHONE: 503 -816 -1911 PHONE: 503 -780 -0321
FAX:
Total Fees: $3,208.08
This permit - ue. •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don n accordance MI appro . • • , ns. his permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • TTENTION: Oregon , • requires to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-041-0010 rough OAR 95
• , 1 -009 ' ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /.
Issue By: 1 i! ` Air / _ 1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available Inspe on ate.
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
EYED
Residential 1:012 OFFICE l'SE ONL.1
6 2012
City of Tigard � " 9 Permit No.:
y Received {�
• 13125 SW Hall Blvd., Tigard, O' *t, �� y Clt� DateB : �� / / . .
., �V �
0 Phone: 503.718.2439 Fax: y.� i 11 F. A 1S10 ' Plan Review Date/B : ��� Ill® Other Permit:
TIC n R p
Ins ction Line: 503.639.417 V Ready See Page 2 for
Pe •,,, . I 1. Date R at Juri
Internet: www.tigard- or.gov !_X � �� Notifie) e od: / �/ Supplemental Information
TYPE OF we. ,\ / REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El New construction S•,■ 1 r lition 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
CATEGORY OF CONSTRUCTION work indicated on this application.
® I- and 2- family dwelling ❑ Commercial/industrial Valuation: $110,000
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 4
JOB SITE INFORMATION AND LOCATION Total number of floors: f
Job site address: 10009 SW 70 Place New dwelling area: 610 square feet
City /State/ZIP: Tigard Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: Dixon Remodel Covered porch area: square feet
Cross street/directions to job site: SW Locust Street Deck area: =-- square feet
Other structure area: square feet
I REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Ventura Estates I Lot no.: 4 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New habital space infill of existing unfinished basement. Valuation: $
New interior stairs connecting to basement level Existing building area: square feet
New decking and guardrail on existing deck footprint New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Heather Dixon Type of construction:
Address: 10009 SW 70 Place Occupancy groups:
City /State /ZIP: Tigard, OR 97223 Existing:
Phone: (503)816 -1911 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: Steelhead Architecture (Please refer to fee ubedutc)
Structural plan review fee (or deposit):
Contact name: Gabe Headrick, AlA
FLS plan review fee (if applicable):
Address: 3369 SE Raymond Street
City/State/ZIP: Portland, OR 97202
Total fees due upon application:
Amount received: fl ?5 1 3
Phone: (503) 348 -8874 Fax: : ( )
E -mail: abe.headri PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
g dega1eepteadarehitecture.com
Co t tercial and residential prescriptive installation .
CONTRACTOR roof -to. •• runted Photo Voltaic Solar Panel Sy - .
Business name: Hammer and Hand Submit two ( - of roof plan with co . ion details
and fire department a - s, along i . I e 2010 Oregon
Address: 1020 SE Harrieon Street S o l a r Installation S p e c i a l .. - - checklist.
City/State /ZIP: Porland, OR 97214 Permit Fee (inclu• plan -view $180.00
ant .. inistrative fee •
Phone: (503) 780-0321 f '�
I Fax: ( ) State s - arge (12% of permit fee): ` $21.60
CCB lic.: 105118 gig/ Total fee due upon application: $201.60
Authorized signature: ((( ��- � �� � � This permit application expires if a permit is not obtained
��- within 180 days after it has been accepted as complete.
Print name: Gabriel Headrick, AIA Date: 2/17/12 * Fee methodology set by Tn County Building Industry
Service Board.
I:\ Building \Permits\BUP- RESPcrmitApp.doc 02/24/2011 440 -4613T(l l /02/COM/WEB)
Electrical Permit Application FOR OFFICE 1 aE o\ 1.1 ■ 1111 City of Tigard RECEIVED Received f /%� PermitN °.: ),-/- 13125 SW Hall Blvd. Tigard, OR 97223 Plan Review
p Other Permit:
Phone: 503.718.2439 Fax: 503.5 1 0
Date/B
l I GA R I) Inspection Linc: 503.639.4175 ^ 6 2012 Date Ready/By: Janis. El See Page 2 for
Internet: www.tigard Notified/Method: Supplemental Information
T �CA� PLAN REVIEW
TYPES DIVISION Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction ® Addition a terattonnn///replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural •
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. separately "1 system.
A o
❑ Addition of new motor load of El " "AA "", , "E E"", . " "1I -2 "", , "l -3 ",
Job no.: Job site address: 10009 SW 70th Place IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Dixon Remodel ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Locust Description I otv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage. _
Subdivision: Venture Estates Lot no.: 4 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
-
� ? `/ Limited energy, multi - family 75.00 2
/\ `�� J fr �/ A. /Lc.., 4,...1.,-/ 4,...1.,-/ 4 - l / / • i residential (with above sq. R.) _
/ -7 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Heather Dixon 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 10009 SW 70th Place Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
ty g relocation
Phone: (5003)816 -1911 Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 1 2
Contact name: branch circuit
Each add'I branch circuit '?. 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 _ 2
E -mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Oakley Electric panel, alteration, or extension. Pa • e 2 2
Each additional inspection over allowable in any of the above
Address: 4120 SE International Way Suite A -102 Additional inspection (I hr min) , 66.25/ hr
City/ State/ZIP: Milwauike OR, 97222 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503 ) 908 -0514 Fax: (503) 908 -1729 Inspections for which no fee is 90.001 hr
specifically listed (%] hr min)
CCB Lic.: 184315 Electrical Lie.: C-456 Suprv. Lie.: 5176s ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 168.54
Plan review (25 /a of permit fee):
Print name: Troy Fisher Date: 3 -2 -2012 State surcharge (12% of permit fee): 20.22
TOTAL PERMIT FEE: 188.76
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Troy Fisher r Date: 3 - 2 - 2012 days after it has been accepted as complete.
y • Number of inspections allowed per permit.
I \BuildingWermits ttLC- PcrmitApp.doc 07/01/10 440. 46157(11 /05 /COMIWEB
-I
Mechanical Permit Applicati FOR OFFICE USE ONLY D
Received v
-
City of Tigard r � i Permit No..� / O/ _ �8
Er
13125 SW Hall Blvd., Tigard. OR 97223 Date/By: Phone: 503.718.2439 Fax: 503.598.1960 MAR 6 2012 Plan Review
Date/By: Other Permit.
I Line: 503.639.4175
■
TIGARD TIGARD Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard or.gov CITY OF Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead. and profit.
Value: S
CATEGORY OF CONSTRUCT/ON RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 10009 SW 70th Place (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100.000-' BTU (ducts/vents) 54.91
Suite /bldg. /apt. no.: Project name: Dixon Remodel Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: SW Locust Duct work i 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: Ventura Estates Lot no.: 4 Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
//��� Gas fireplace 33.39
t ..2' r0 v 4 . - t o< d2A i fs-J d ('t Flue vent for water heater or gas
1-e=, c�. � � � w q i �� - fireplace 23.32
�""�' ! Log lighter (gas) 23.32
G..n -ck_ d.1 t.sot.-..ar - _ , Wood /pellet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER I 0 TENANT I Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Heather Dixon Environmental exhaust and ventilation:
Address: 10009 SW 70th Place Range hood /other kitchen
equipment 33.39
City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)816 -1911 Fax: ( ) toilet compartments. utility rooms) / 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspacc fans 23.32
Business name: REM- �� 1 `_ _ 4 - A .- Other: 23.32
s" ( Fuel piping:
Contact name: MA 7 ey a as SI4.15 for first four: 54.03 for each additional
Address: eta 2. Y ' o i O - Furnace, etc.
City/State/ZIP: heat pump
City /Slate / 6r Q 7.1 Wall /suspended/unit heater
Phone: (S �S - 3.:16a 3 Fax:: (cay) X5- ... 3.) Ca i Water heater
Fireplace
r t
E-mail: e� . 4-- �U -G4 , r � 4 _,°r`S IC2{ Range 1
NTRACTOR Barbecue
Business name: Clothes dryer (gas) 11\ Other:
Address: NI ECIIANICAL PERMIT FEES*
City /State/ZIP: Subtotal
Minimum permit fee (590.00)
Phone: ( ) I Fax: ( ) Plan review (25 %ofpermit fee)
CCB lie.: 1 '76 3- t� State surcharge (12% of permit fcc) ,
I TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days nfter It has been accepted as complete.
Print name: ?�� Date: 3/S/fp? ' Fee methodology set by Tri- County Building Industry Service Board
I tnuildinglPermitst. \tEC•PcrmitApp doe 09/09 /IO 4 (I I /02ICOM/VElt)
Pluin bind Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received D /y: �" / Permit No.: -
v 13125 SW Hall Blvd., Tigard. OR 97223 6 2012 y' )16ra°i2 ax' 8
Other Permit No.:
Mi I
' MAR Plan Review
- Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
TIGARD Inspection Line: 503.639.4175 CITY ■ OF' 1G A RD Date Ready /By: g
luris� ®See Pa e 2 for
Internet: www.tigard- or.gov No tilled/method: Supplemental Information
TVPE OF WO1Wi'." DING DI VISION
FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Pace 2 '
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10009 SW 70th Place Catch basin or area drain 18.76
Drywcll, leach line, or trench drain 18.76
City /State/ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite /bldg./apt. no.: I Project name: Dixon Remodel Manufactured home utilities 50.03
Cross street/directions to job site: SW Locust Street 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 II.: _) Page 2
Subdivision: Ventura Estates Lot no.: 4 Fixture or item:
fax map /parcel no.: Backtlow preventer 31.27
�/ 1 DESCRIPTION OF WORK Backwater valve / 12.51 /t tsJ
�Y /1 j/ ! l B 1 { /: / 1 L V Clothes washer 25.02
_ _ Dishwasher 25.02
1-" fin« Val(/c- TO che �La// /i� Drinking fountain 25.02
e p i �� �f ,604 (� G.te / & E Ejectors /sump 25.02
/ ® PROPERTY OWNER ❑ " 11 ENANT Expansion tank 12.51
Name: !leather Dixon Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 10009 SW 70th Place
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)816 -1911 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
1usiness name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basi lavatory / 25.02 OS l
City /State /ZIP: Solar units (potahle water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
Water closet / 25.02 85 t9d
CONTRACTOR Water heater 37.52 Business name: v` ` �/�;- I Water piping/DWV 56.29 ( t l
Address: �> p(` l ' 4 ii ' Ave Other: 25.02
City /State/ZIP: p ',vi' g-26/7 Subtotal 118,89
Q N y fcc: $72.50
Phone: ( �
� W 9_ 4 / ! Fax: ( t ' 3. Minimum permit -
CCB Lic.: iZ, �, Plumbin r W Plan review (25 %ofpcnnit fee)
�� '��- Lie. no.: (325,6k3 State surcharge (12% of permit fee)
Authorized signature' / /'- TOTAL PERMIT FEE
Print name: L Dal w� This permit application expires if a permit is not obtained within ISO days
� after it has been accepted as complete.
*Fee methodology set by 1'6-County Building Industry Service Board.
I:\ BuddinfPcrmits \PLMU- Ptrma..'panc 10 /01109 440.46
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SHEET NOTES: W N
1. Refer to A0.1 for symbols, hatches re
and abbreviations. All items are -' o re
existing to remain, u.o.n. u u
5Y -0Y8' 2. Extent of new addition for interior W a
-
1 stairs. I-
3. Dashed line of existin deck = o
footprint -new deck mater g to 0 a
match existing footprint. Variance re
• tii
/ § No. VAR2002 -00014 allows deck in Q o
• H I side yard setback 0 >
4. Front door <
/ — — \ •
— — - 1 • 5. Driveway w W
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/ / \ y 'ci -aE 'Pc RE
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BUILDING D VISION "°'
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/ 3 / RECEIVED \ °F o RE
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•
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