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Case File I I 13037 SW ASCENSION DRIVE CITY OF TIGARD BUILDING INSPF T"OIC DIVISION our Inspection Line: 639-4175 BuMness Line: 539-4171 MST U —1 BUP Date Requestera�z1� �? �6 '_`AM PM B Location k LD � 1_,ti1 j •_.0'�.Suite —_ MEC Contact Person _ ^ _ __ Ph PLM — Contractor _ — nh SWR �I Tenant'Owner ELC etairnng Wall "� - �— ELR Footing _— Foundation Access: FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab Post&Beam --'— ------— SIT Ext Sheath/S'hear Int Sheath/Shear 1Framing .Q�v Y�i'1 w S &4 -s C �-�G;_ Insulation Drywall Nailing _ Firewall 1 —�— Fire Sprinkler Fire.Alarm -- - --��_-- Susp'd Ceiling RoofMisc: }�II �//�� na —- S' PART FAIL PCUMBING Post& Beim Under Slab _r�s 4—t Top Out - Water Service ��`NV1 e_1. Sanitary Sewer -� — -- Rain Drains Final PASS PART FAIL MECHANICAL Post&Beam ------- T—_—_ Rough In Q Gas Line ---�z`A^ \_ 3 S� -- Smoke Dampers Final -tt=c1 --L C ' —�--A/- —`4.7—I — PASS PART FAIL ELECTRICAL --- Service Rough In 3/Slab ` --- (Low Voltage — Fire Alarm Finalcl PASS PART FAIL '1 ✓ ! /� �_----�� $ITE Backfill/Grading ----- Sanitary Sewer Storm Drain [ )Reinspection fee of$ required before next nspection. Pay at City Hall, 13125 SW Hall Blvri Catch Basin Fire Supply Line [ )Please call for reinspection RE:— _— [ )Unable to inspect-no access ADA tI� Other ApproachlSidewalk Date r Inspector �� C.i > EXt \� Final -- PASS PART FAIL DO NOT REMOVE this inspection record from the Job site. a,- r �o ' Ig l•I I'8 12:57 '0.503 692 3075 EFI-F[IF1LAND 11001. 001 E„�pne SJIC9 • (541)087.8723 Eugene Pax • (541) 6871243 Portland Sales • (503)692-6167 Empire Pacific .ndustries Portland fax • (503)692.3075 ,:.crornen;a Sales • (916) $49.2840 �i�\,�:�""a�-C.- Sacr, •et, s:a� . (916) 649 14•'5 s 56 clyl j , I ,, C"( i 4 � ) 662 �5 S.W. SNQ �.r,L rCC ; '— w CITY OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd..Tigard,OR 97223(503)639-4171 ELECTRICAL PERMIT — RESTRICTED ENERGY PERMIT #: FL._R9F-02`,'P DATE ISSUED: 09/09/98 PARC "L..: 2E3104CB-02000 ADDRESS. . . : 12037 SW ACCENS I ON DR SUBDIVISION. . . . :H I LLSH I RE: WOODS 701\11 NC:R-7 F'D BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :0:36 ,JURISDICTN: TICS Project Description- Landscape irrigation control. A. RES IDFNTiAL.- _—_- _-- R. AUDIO R STEREO. . . : AUl)I O & STEREO. . : i NTE RCOM & IDPG I NG. . : BURGLAR ALARM. . . . : BOILER. . . . . . . . . . : LANDSCAPE/IRRIGAT. . : GARAGE OPENER. . . . : CLOCK. . . . . . . . . . . : MED ICAL.. . . . . . . . . . : HVAC. . . . . . . . . . . . . : DATA/TEL.E COMM. . : NURSE CAL.LS. . . . . . . . VAC1..lUM SYSTEM. . . . : FIRE ALARM. „ . . . . : OUTDOOR I._ANDSC LITE,-, X I.1I HER: _ : HVAC. . . . . . . . . . . . . PROTECTIVE S3TGNAL.. . . INriTR1.1MENTATT0N. wr1AF:.R. . : TOTAI_ # OF S3YSTE115- I Owner-: _ FEES GORDON, . BC)A�R� DEhITOF.._�-.----.-._.____.______._.__type amQl_tnt by date recpt 13037 SW ASCENSION DR PRMT $ 40. 00 (3EO 09/09/98 98- TIGARD OR 972-'3 `,PC' $ P. 00 GEO 09/09/98 98--30896(- Ph o ne 8--i0896E- -'hone 4: EXPIRED (_.OTItY'r-ICtQr'0 __-.___._.._....__.__.._.__-___..L(L�_L.7.��-�.-.-_._..____...__-___.._.---.._..-----_---•----__.___._ $ 00 'TOTAL.. RF C:LJ I RED I NSPFCT I ONS; Low Voltage Insp F'hQi� #: Elect' 1 Fina]. Reg #. . : Thi, permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon iaw requires you to follow rule adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 thrnugh OAR 952-0014080. You may nbtain copies of these rules ar direct uesti (503)216-1987. i ISsi_ted b _._.___.._. ".. -.�___�_r Permittee Si gnat1-tr _ �._� _.__7 OWNER I NSTAL_L AT I ON ONI Y T'he installation is t>Plag made on property I own whir.h is not: intended f (.1r, ,ale, lease, or" rent. UOWNE R' S SIGNATURE: UAT F. I NS/TALI_.AT I ON ON1 Y 1'7TGNATURF OF SUPR. EL.EC' N: DATE.: LI CENSE NO ++•+.++++++++++++-F+++.+++++++++•f++++++-++++++++++++++4 ++++++i•+++•+4++'+++++ F4++4-++ ++4 Cal l 639-4175 by 7:@0 P. M. for- an inspect ion needori the next; hi_tS int,s=_ ti:=y -+-+++4-.+.1...................4++++4-+++++4-++++++++++++++++4++++++i.+++++++-h++++++ h F + + ++}- CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by: 13125 SW HAIIK BLVD Date Recd: TIGARb OR 97223 PRINT OR TYPE V-503-639-4171 X304 Permit#: F-503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd: WILL NOT BE ACCEPTED Name of Development Proje S TYPE OF WORK INVOLVED -RESIDENTIAL ONLY C° iV 5%� Restricted Energy Fee........................................ $40.00 130-3-7 1 P/l.� �5 Iron (FOR ALL SYSTEMS) JOB Street Address Ste# Check Type of Work Involved: ADDRESS i' ;State 7 zip -- Phone# � Audio and Stereo Systems _ a r y Nam 1� -4,r�^,5lL t �.]C� F-1 Burglar Alarm A 7 Garage Door Opens ' OWNER Maili ddr s� A , 5'i' t V�— ❑ He; ing,Ventilation and Air Conditioning Systrm' City/State I ZLD Phone# r r r 2 , El Vacuum Systems' Name ` ✓"`( )0y C 4 ❑ Other — ---- - CONTRACTOR Mail'pd res•. l' �� Z *W CIeV I��y TYPE OF WORK INVOLVED -COMMERCIAL ONLY (Prior to Issuance a City{51ate�►� F�, Phone# Fee for each system.............................................. $40.00 copy of all licenses I rc vr� / t �9'SZ (SEE OAR 918-260-260) are required if Oreg Contr.Brd Lic # Q Q E p ate expired in C.O.T. 6 ]v 1 (f? / Check Type of Work Involved. data base) Electrical Contr.Lic.# Exp Date l� l Audio and Stereo Systems C.O.T.or Metro Lic.# Exp Date Boiler Controls Owner's Name Clock Systems OWNER - Mailing Address APPLICANT Data Telecommunication Installation City/State Zip Phone# ❑ Fire Alarm Installation This permit is issued under CAE 913-320-370 This applicant agrees to make only restricted energy installations(100 volt amps or less)under this HVAC permit and to do the following —. I j InstrUmentation 1. Only use electrical licensed persons to do installations where required Certain residential and other transactions are exempt from licensing. Intercom and Paging Systems These have asterisks('). All others need licensing. Landscape Irrigation Control' 2. Call for Inspections when installation under this permit are ready for Inspection at 603-639.4176; F-] Medical 3. Purchase sep,rate permits for all installations that are not ready for an Nurse Calls Inspection when the Inspector Is out to inspect under this permit; 4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting' inspector are done,end; Protective Signaling 5. Assume responsibility for calling for a final inspection when all of the corrections are completed. EjOther _ Permits are non-transferable and non-refundable and expire if work is not started within 190 days of issuance o. if work is suspended for 180 days Number of Systems The person signing for this permit must be the applicant or a person No licenses are required licenses are required for all ether installations authorized to bind the applicant. FEES! Signaturer ENTER FEES $ 5%SURCHARGE(.(tri X TOTAL ABOVE) $ Authority if other than Applicant v - TOTAL $ _ 1 ldstskesele.doc 7197 -—` CITE' OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 97223 (50-3)639-4171 ELECTRICAL PERMIT RESTRICTED ENERGY PERMIT #: ELR98-0-218 DATE ISSUED: 08/11/98 PARCEL: 2S104CB-02000 SITE ADDRESS. . . : 130:37 SW ASCENSION DR SUBDIVISION. . . . :H I LL.SH I RE: WOODS ZONING:R-7 PD BLOCK.. . . . . . . . . . : LOT. . . . . . . . . . . . . :036 JURISDICTN: TIG Project Description: Installation of timer for residential backflow prevention device. --------------------- A. RESIDENTIAL---------- B. COMMERCIAL------------------------------------------- AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM & PAGING. . - BURGLAR AGING. . -BURGLAR ALARM. . . . : BOILER. . . . . . . . . . : LPNDSCAPE/I RR I GA-I'. . : GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . . HVAC. . . . . . . . . . . . . DATA/TELE COMM. . . NURSE CALLS. . . . . . . . . VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE : OTHER:BACKFLOW : :X HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL.. . : INSTRUMENTATION. : OTHER. . : . . TOTAL. # OF SYSTEMS: 0 Owner: -------------------------------------------------------- FEES SIERRA PACIFIC type amol.trnt by date recpt PO BOX 1745 PRMT $ 40. 00 DES 08/11./98 98--308173 LAKE OSWEGO OR 97035 Sr='C'T $ 2. 00 DEB 08/11/98 98-308173 Phone #: 684-3175 ('> f0� Contractor: -------------- ________/-----____.---_----.__--_ CEDAR I_ANDECAPE !; 42. 00 TOTAL_ 14375 SW PATRICIA ------ REQUIRED INSPECTIONS ------ - HILLSBORO OR 13'/1R3 Low Voltage Insp Phone #: 628-3411 Elect' 1 Final Reg #. . : 000058 �- This permit is issued subject to the regulations containel in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work All be done in accordance mitt, approved plans. This permit will expire if work is not started within 188 days of issuance, or if woik is suspended for more than 188 days. ATTENTION: Oregon law requires you to foll,iw rule adopted by the Oregon Utility Wification Center. Those rules are set forth in OAR 952-881-8818 through OAR 952-881•-8888. You may obtain copies of these rule r direcf gpestions to Ol1NC at i(LI) Fi-1987. Issue by ,�. � 1 _ Permittee Signature ._ _________________.----•-_-----_L�WNER INSTALLATION IJNI_Y------- ------- ----------_-- --- The installation is being made on property I own which is not intenderd, for sale, lease, or rent. OWNER' S SIGNATURE: DATE: INSTALLATION ONLY-- -------------------_.___ _ _. SIGNATURE OF SUPR. ELE CI N: DATE: LICENSE NO s +4•+++tt+t++t+++++++++++++++++t+++++++++++++++.4+++++•4.+++++++++++++++•1-+++++++•f++++ Call 639-4175 by 7.00 P. M. for an inspection needed the next business day +++f++.I...ff++++++++++t+++++++++•.•4++++++++•t++++++++++f++++++++t+++++++-F+i +.}+-F+i+ CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLI�,AT",/rl-, Recd by Date Rec'd: 13116 SW HALL BLVD TIGARD OR 97223 PRINT OR TYPE V-503-639-4171 X304 Permit#: ��--Q -c'�� F - 503-634-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Call'd WILL NOT BE ACCEPTE6 _ Nam,a of Development Project T TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Restricted Energy Fee....................................... $40.00 FOR ALL SYSTEMS) JOB Street Address Ste# Check Type of Work Involved. ADDRESS 1 3Q37 ` City/State zip Phone# F Audio and Stereo Systems U Ndme Burglar Alarm F-1 Garage Door Opener' OWNER Mailing Address PU ` I1 Heating,Ventilation and Air Conditioning System' City/Stata Zip Phone# Vacuum Systems' Name Other — --- CONTRACTOR Mailing Address TYPE OF WORK INVOLVED -COMMERCIAL ONLY KLic.. V -- (Prior to issuance a city/StateZip Phone# qQ Fee for each system.............................................. $40.00 copy of all licenses �,I 'S I I (SEE OAR 918-260-260) are required if Oregon CoExp ate t1(1 expired In C O T Check Type of Work Involved: data base) Electrical Exp Date ❑ Audio and Stereo Systems , Ex Date t� C O T or p F_� Boiler Controls 0 -`—� Owner's Name �- _ LJ Clock Systems OWNER - Mailing Address ❑ APPLICANT Data Telecommunication Installation CltylState Zip Phone# Fire Alarm Installation _ _ —I This permit is issued under OAE 918.320-370 This applicant agrees to r—I HVAC make only restricted energy Installations(100 volt amps or less)under this LJ permit and to do the following Instrumentation 1. Only use electrical licensed persons to do installations where required Intercom and F'agin9 Systems stems Certain residential and other transactions are exempt frons licensing These have asterisks(') All others need licensing, iLandscape Irrigation Control' 2 Call for Inspections when installation under this permit are ready for inspection at 503-639-4175; Medical 3 Purchase separate permits for all installations that are not ready for an F_� Nurse Calls inspection when the inspector is out to inspect under this permit. 4. Assume responsibility for assuring that ail corrections required by the Outdoor Landscape Lighting' inspector are done,and, u Protective Signaling 5 Assume responsibility for calling for a final inspection when all of the f-1 Other �— corrections are completed l J Permits are non-transferable and non-refundable and expire if work is not I `Number of Systems started within 180 days of issuance or if work is suspended for 160 days No licensee are requires' t censes are required for all other installations The person signing for this permit must be the applicant o� a person —_ authorized to bind the applicant - - — FEE_S: ENTER FEES s--�-`�-_ -- Signature 41oo 5%SURCHARGE(.05 X TOTAL ABOVE) $ y`' —. TOTAL. f�� ' oc) - Authority if other than Applicant I\dstsvesele doc 7197 CITY OF TI+C ARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 972.13(503)639-4171 J,C l-'CIVA i I TF SW ASCENSION DR J.P.)DIV151nN, HILLSHIRE WOODS . . . . . . . . LOT. . . . . . . . . . . . s4,--;,s nr WOW. vMFW OF IYIF.. f 10FDANCY LCN-40. I tw 0 15 7 C.Far t, i f I r a t c., f1r,,na n c:y n f i 4,o f -i i J c on f I r m s h at t h P bu I I ri i n L) F ('It peci alty 1:'cdf-7- rot tl, 14, I')F.b I mit W;k q j i e.,J, jjjf POST IN CONFT' ll 1110 1 01 k% ,1C ZTec Engineers, Inc. Civil- Strudursl-Surveying 3 73 7,S.L. Rlh A ventut John Mcl. Middleton, P.E. Portland737. . Oregon vent s ll? Ronald K. ,tiellardc, l'.H'. Cht7s C. Fischborn, P.L.S. (503) 235-8795 Lean l'. 7.arosinski, l'.E. FAX(503) 233-78R9 Tigard Building Department Residential Inspection RE: Sloped Excavation @ f113037 SW Ascension(at W,:,.. and Pier Footing Dear Ruilding Inspector This letter is to inform you that I inspected the excavation and the footings on the above referenced residence. The soil is adequately sloped away from the footing and pier. The bearing capacity of the soil under the footings in both the wall and the pier footing is not diminished. Please contact me if you need any additional information. Sincerely, 17 Dean P. arosinski PE CC John @ Waterford Pj�t�c�C �. O N �^Y. 16.i� - A CITY OF TIGAR ® PLUMBING PER DEVELOPMENT SERVICES PERMIT #. . . . . . . : PILM98--0277 13125 SW H811 Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 08/11/98 PARCEL: 2SI04CB-02000 SITE ADDRESS. . . : 13037 SW ASCENSION DR ZONING: R-7 PD SUBDIVISION. . . . : HILLSHIRE WOODS BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . ..I Z 13 F, JURISDICTION: TIG ----------- ------------------------------------------------ ----------------------------------- CLASS OF—WORK. . :OTR GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : I OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . 0 FIXTURES---------'----- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . ,, : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0 WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks: Installation of residential backfln- prevention device. Owner: FEES -------------- SIERRA PACIFIC type aMOIAnt by date recpt po BOX 1745 PRMT $ 15. 00 DEB 08/1- 1 /98 98-308173 I-AKE OSWEGO OR 97035 5PCT $ 0. 75 DEB 03/11/98 98--308173 Phone #: Cont r act or----------- CEDAR r----- CEDAR LANDSCAPE 14375 SW PATRICIA AVE HILLSBORO OR 97123 15. 75 TOTAL. Phone #: 503-628-3411 Reg #- . : 000058REQ1.JIRED INSPECTIONS This permit is issued subject to the regulations contained in the RP/Backflow Prev Tigard Municipal Code, State of Ore. Specialty Codes A% all other Final Inspection applicable laws. 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 sort than IN days. ATTENTION: Oregon low requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-888I-8818 through OAR 95P.-MI-M. You N&Y obtain copies of these rules or direct questions to OLK ',y calling (593)246-1987. ---------- -'ermittep Siqnati_tre : s s i-ted r . 14-41+ ++t++++++++++ ++++++++4•+++++•++•++++++++++ I.++++++++++++++++++t++++++++++++++++•++ ..................................... Call 639-4175 by 7:00 p. m. for an inspection needed the next bi.isiness day ++++++++•t++++++++++++++++++ ..+++++ +-+4-+-I-+++4'++-f-++-$............................... CITY OF TIGAPl7 Plumbing Application RECEIVEr, 6y t 614,1 "f � PP RECEIVC�'r Date Redd -i/- 13125 SW HALL BLVC). Commercial and Residential TIGARD OR 97223Date to P.E. (503p 639-4171 AUG ,j Ic9R Date to DS --" Permit* Print or Type r" " „` Related SWR# Incomplete or illegible applications will not be accepted Called----- Name alled_ -_Name of Dev�lopmenb'Project On back Indicate Work Performed by fixture. Job I `jl ,gIZA Ptc-i rlG L07" -#-- 3& FIXTURES (Indlvldual) �- ^-- r QTY PRICE AMT Address Street Address TSuite Sink 9.00 I.LC32 Sw `� _ Lavatory - _ 9.00 Bldg# City"State zip r Tub or Tub/Shower Comb. 9.00 - -� -- Name- ti tg V 01-r, 7 , a. s Shower Only - 9.00 1 r-.kR A PAcl.1c r� Water Closet - 9.00 - Owner Mailing Address v Suite - Dishwasher - 9.00 U.5.131 _ _ Garbage Disposal -- 9.00 City/Slate Zip Phone Washing Machine - - 9.00 Name Floor Drain - 2' 9.00 Mallin -c- 3- - 9.00 Occupant g Address quite 4 9.00 City/State _ Zip Phone --_ Water'rleater O conversion O like kind 9.00 Laundry Room Tray 9.00 ------- Name /-- - -- Urinal --- 9.00 .A K,-(.mak t i��CA ' - Ar , _ Other Fixturks(Specify) �- 9.00 Contractor Mailing Address Suite -- L`�-��&, A - --_ 9.00 Prior to permit Cily/Slate ZIP Phone 9.00 issuance,a copy jLi saoe,C, Ck 4��93-3 911 ctof all licenses are Oregon Const.Cont.Board Lic.# Ex ate V - 900 -� required if 5��" q ;ewer-1st 100' 30.00 � G, _ .-----.- J _ expired in COT Plumbing Lic. r Exp.Date Sewer-each additional 100' - database 25.00 Name -` Water Service Ict 100' 30.00 Architect Water Service-each additional 200' 25.00 Or Mailing Address Suite - Storm&Rain Drain- 1st 100' 30.00 Storm 3 Rain Drain-each additional 100' 25.00 Engineer City/State Zip Phone Mobile Home Spece 25.00 - ------ -- Commercial Back Flow Prevention Device or Anil- 25.00 Describe work New O Addition O Alteration O Repair O Pollution Device _ to be done: Residential O -Nnn-residential O -_- Residential Backflow Prevention Device' 15.00 -� Additional description of work: Any Trap or Waqte Not Connected to a Fixture 5.00 Catch Basin ----- n 00 Insp,of Existing Plumbing 40.00 __ _ pe,'/hr Exrsting use of - - ~-� - Specially Requested Inspections - 40.00 building or property-__-__--__ �- ___ per/hr Rain Drain,singie family dwelling v �- 30.00 Proposed use of Grease Traps - - 9.00 building or property _A-.-- ---` I hereby acknowledge that I have read this application,;hat the Information QUANTITY TOTAL- lsometric or riser diagram is required rl Quanity Total is >9 given is correct that I am the owner or authorized agent of the owner,and _-- - 'SUBTOTAL that plans submitted are in compliance with Cregon Stale Laws. r Signature of-OwnerlAgent Date - - - 5%SURCHARGE 1 1------- PLAN REVIEW 251.OF SUBTOTAL C6ntaCt Person emg - _ phone Required only d/Ixture qty total is 9 ---� - - - - ------- - - - TOTAL 'Minimum permit fee Is$25- 9%surcharge,except Residential Backflow Prevention Device,which Is$15 5°%surcharge I ldatelplmal Ocr.5197 PL A SE-C-QUIP—LE-M Fixture TypeQuantity by Work Performed - -�F4401 W --Moved-----T-'--Re-plan -ke—mo�-e-41,-C-a-p p-e-d Sink Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disp&s-al - Washing Machine Floor Dram 2" 3" -Water Heate--r--- Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: Ch"Y OF TIGARD MASTER PERMIT �- PERMIT #. . . . . . . : MST��7-0 .59 DE'1frLOF'I'�!cNT SERVICES DATE ISSUED: 09/03/97 i ii28 5W Hall B'vN, ;lgwd,OR 97223 (503)639.4171 PARCEL-: 2S 104CB-02000 : 1,3037 SW AS"7ENSI ON DR • ' ZONING: R-7 PD))lu1;4 1(IN. . . . :HI' .LSHIRE 1.41OODS JURISDICTION: TIf3 ! +Lt'• LOT. . . . . . . . . . . . . :036 sem,Ns: BATH : HEN PROPOSED SINGLE t01ILY DWELLING N/ATTACHED BARABE. _—_—_---------- BUILDING - --------_—__—___—__— I ,,qE: Ss,,,•ES, 1 FLOOR AREAS--------- BASEMENT••. 837 sf REQUIRED SET&rXS---- REQUIRED------_---- T .....: 2t r�RST....: 1972 sf GARA�...... 689 sf LEFT........... 5 SMOKE DETECTRS: Y ,,;?'4 OF WORK. !"'' HE'_ .. FIM....... 20 PARKING SPACES: 2 i"rIx -> 'ISE...:SF SWR LUTil....` 40 S--OND... 0 sf : AIS.....'. 5 TYr „rIi -l% OHELLINS UNITS: 1 FINBSMENT: 0 sf ..: OCM4�,#,'Y Gk,' :RI 7*•% 4 BATH: 3 TOTEU.•----: 1972 �( VALUE..f: 199944 REAR..........: 73 PLUMBING SINKS.........: 1 WATER CLOSETS.. 3 WASHING WC H..: I LAl1HDRY TRAYS.: t RAIN DRAIN ft: 100 TRAPS.........: 0 LAVATORIES....: 4 DISHWA5IERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0 TUB/SHOWERS...: 4 GARBAGE DISP..s 1 tM;TER HEATERS.: l iR;TEA LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS..: 0 OTHER 'FIXTURES: 0 __ _ --_�_ ------- MECHANICAL _ -------- -----_ ----------- FUEL TYPES-- FURN ( IBM ..: 0 BOIL/CMP ( 3W: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1 GAS FURN )=188K ..: 1 UNIT HEATER:i.,: 0 HOODS.........: 1 OTHER UNITS...: 1 MAX IMP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1 --- --------------- ELECTRICAL ------ ------------------------------- --- - -RESIDENTIAL LIMIT— ---SERVICE/FEEDER--- --TEMP SRVC/FEEDERS-- --BRANCH CIRCUITS--- ---MISCELLANEOUS---- --ADD'L 1%, 'K:Tt -- 1000 SF OR IE9S: 1 8 - 200 amp..: 8 6 - 200 alp..: 0 W/SVC OR FDA..: 0 PIMP/IRRIGATION: 8 PER INSPECTION: 0 EA ADD'L 586,qF.: 5 201 - 400 alp..: 8 201 - 400 alp..: 0 1st W/O SVC/FDR: 0 SIGN/OU( LIN LT: 0 PER HOUR......: 0 '.IMITED ENERGY.: 0 401 _ 600 alp..: 6 40). - 600 alp..: 0 EA ADDL BR CIR: 0 SIp'K/PANEL...: 8 IN PLANT..•...: 0 MANF HM/SVC/FDR: 8 68l - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0 1000+ amp/volt.: 0 ------------------------------`-"-- PLAN REVIEW SECTION -------------------------------- Reconnect only.: 0 )-4 RES UNITS..: SVC/FDR)=225 A. ) 600 V NOMINPL- CLS AREA/SPC OCC: ELECTRICAL. - RESTRICTED ENERGY ------------ A. SF RESIDENTIAL----------- R. COMNERCIAL------------------w------------- -- ----_ -------- ---------- AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO L STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM..: OTHs X BOILER......... HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIN:: BE OPENER..: CLOCK.......... INSTRUMENTATION: MEDICAL........: OTHR: . HVAC...........: DATA/TELE COMM.: NURSE. CALLS....: TOTAL 1 SYSTEMS: 0 Owner: ----------------•--_—..------------ Contractor: -----------—--------------— TOTAL FEES:$ 4624.68 SIERRA PACIFIC SIERRA PACIFIC This permit is subject to the regulations captained int e X 1754 PO BOX 1754 Tigard Municipal Code, State of Ore. Specialty Codes and all PO BO LAKE X 1754WEGO OR LAKE OSWEG0 OR 97038 other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is phone t: 684-3175 Phone A: 684-3175 not started wit'lin 190 days of issuance, or if the work is Reg /..; 889822 susr ;led for o •e than 190 days. ATTENTION: Oregon law require yru to follow rules adopted by the Oregon Utility -~ — },hrou ORR 95e +xe1-0880. You may obtain copies of these rules or Notification Center. Those rules are set forth in OAR 952-001-•06. gh direct questions to OUNC by calling (583)246-1987. -------_----__ ----------------- __ _ -------- REOUIkFD IW !'CTIONS --------- Erosion Control Post/Beam Struct PLM/Underfloor ;nq Insp Insulation Insp Electrical Final ' Was, I:. grading Inspecti Post/Beam Meehan Mechanical Insp ; ryp Board Insp Mechanical Final Footing Insp Underflc--,r insul Plumb Top Out L,,a l91tage Rain drain Insp Plumb Final Foundation Insp Crawl Drain Electrical Servi Gas L+Ile Insp Water Line Insp Fir2l inspection Wtr Prooring i Fnotin�/Foynda.i Electrical Rough Gas Fireplace Appr/Sdwlk Insp A�r gnat / 1 Issued ye / L ' __ — 0 Permittee Si �.ir^e :,_ + - -- +++++++++++++++•++++++++++++++++++++++++++++++++•++++++•++++++++++f*+++i ++++++++ Call 639-41755 by 6:00 P. M. for an inspection needed the ne)ct business day CITY OF TIGARD DEVELOPMENT SERVICES SEWER CONNECTION 13125 SW Nall Qivd., Tigard,OR 97223 (503)639-4171 PERMIT PERMIT #. . . . . . . : SWR97-0346 DATE ISSUED: 09/03/97 SITE ADDRESS. . . : 13037 SW ASCENSION DR PARCEL: 2S 104CB-0000 SUBDIVISION. . . . :H I I_LSH I RE WOODS ZONING: R-7 PD BLOCK. . . . . . . . . . LO1.. . . . . . . . . . . . . :036 JURISDICTION: TIG _--------------•--------------•---------- TENANT NAME. . . . . :SIERRA PACIFIC USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0 CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1 TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1 INSTALL_ TYPE, . . . :BUSWR IMPERV SURFACE: 0 sf Remarks : Add sewer connection to new proposed single family dwelling. Owner: -------•---------------------•-------------•------------- FEES SIERRA PACIFIC type mount by date reept PO BOX 1745 DUN $ 290. 00 DRA 09/03/97 97-29892-, LAKE OSWEGO OR 97035 PRMT $ 2200. 00 DRA 09/03/97 97-298922 INSP $ 35. 00 DRA 09/03/97 97-298922 Pfijne #: EROS f 64. 00 DRA 09/03/97 97-298922 ERPU t 20. 80 DRA 09/03/97 97-29892 :: Contractor: ---------------------------------ERPC f 20. 80 DRA 09/03/97 97-298920. OWNER Phone #: f 2630. 60 TOTAL Reg #_ : . ---- This Applicant agrees to comply with all the rules and regulations ------- REQUIRED INSPECTIONS_ of the Unified Sewage Agency. The permit expires 181 days from the date issued. The total amount paid will be forfeited if the r permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement -- given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase _ a "Tap and Side Sewer" Permit and the Agency will install a lateral. _ -- ATTENTION: Oregon law requires you to follow rules adopted by the _ Oregon Utility Notification Center. Those rules are set forth in OAR ` 952-01-4111 through OAR 952-WI-W. You may obtain copies of _ these rules or direct questions to OUNC by calling 15131246-1987. tssued by:,��_� Permittee Signature: +++.M++++i+tt++•+++++++•1-•++++++++•++++++++4•++++1.++++++++++++++++++++++++++++++++++++ Call 639-4175 by 6:00 p. m. for an inspection needed the next business day +-1-4.+4++++t+++++++++++++++++++++++++++++++i-++++++++++++++++++++•+++++++++++++++++-t Plan Check# 7/X "i OF TIGARD Residential Building Permit Application Recd By _ 25 SW HALL BLVD. New Construction Additions or Alterations Date Recd7 V11» q 7 rIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E. �% 4 V 503-639.4171 Date to DST F 503-684-7297 Permit#/rte``� — � Print or Type Called-�--- Incomplete or illegible applications will not be accepted iN e of Protect u - Name J ' _�YIA v Job II1e3: 01 �k 1 Architect Mailing Address Addrese. Site Address W Kj 4g. I/•Stattp ) p� Zip q Phone Name 1�.51 � �'' Names Owner Mailing, dffd��ress 1 P-4�4 - Engineer Mailing/ddd-rtesss=•--_ssLt City/State Zip � Phone , -« — -- U -_-1 �,.�(�1 �C t ��LLL. Zip Phone Name Gcneral `�VJq `C A�C.�L-�( _ _ Describe work Newt Addition U Alteration O Repair O Contractor Mailing Address to be done -- Additional Description of We �: Gty/StW Zip Phone Ornnegnnonn C��,ost.C nont. Board Lic# Exp.spate Attach Copy of stS�LY.�.�.�.3 4-)`'o) I-- Cu.rant COT Business Tax or Metro# Exp ate PROJECT VALUATIONName $ r NEW CONST RUCTION ONLY: Mechanical (�dV NJ;e4�'PU�1-05 Sq. Ft. House: Sq. Ft. Garage Sub_ Mailing Address (/ �I�o r Contractor I , �� P Corner Lot YES NO Flag Lot YES NO City/State Zip Phone (check one) (check one) \\ Oregon Const.Cont.Board Lic.# Exp.Date Restricted Audio/Stereo Burglar Attabb Cbpy of Energy System Alarm — cubvnt COT Business Tax or Metro# Exp Date Irstallation Garage Door HVAC LlEcnses _—_ __ Opener Systems_ Name (check all that Other: Plumbing � ty—�� apply) Sub- Mailing Address Will the electrical subcontractor wire for all YES NO Contractor I I , `41> restricted energy installations? City/State Zip Phone Has the Subdivision Plat recorded? NIA YES NO Oregon Const.Cont. Board Lic.# Exp.Date Reissue of MST# Solar Compliance y A111ch Copy of a Calculation Attached) 6urroht Plumbing Lic.# Exp.Date I hereby acknowledge that I have read this application,that the LiceMsea information given is correct,that 1 am the owner or authorized COT Business Tax or Metro# Exp.Date agent of the owner, and that plans submitted are in compliance �._ -- -- Name with Ore on Sh9te laws. -'� - ✓ Signature,of /Agent Date t i Electrical (� Sub- Mailing Address Contact Pers&iVame Phone# Contractor >'C ►' --.� cl �,/ fir' City/State Zip Phone Flat_FOR_OFFICE USE ONLY: # MaprTL# P&e Oregon Const.Cont.Board Lic.# Exp.Date 5/ t ACA AttLch copy of _ _ Setbacks: % i IrZone: Solar. Cent Electrical Lic.# Exp.Date - f r OJT Cent Engineering Approval: �Ia�nnin6A`pproval: TIF: COT Business Tax or Metro# Exp. Date P I SFAPP DOC (DST) 4/97 Permit# Acct.Descritpion COT WACO Amount Amt. Pd. Bal. Due /t2ML41 MST. Permit (BUILD) BUILD) Plumb. Permit (PLUMB) (U U ) S, r 2f Mech. Permit (MECH) (U CH) _ S �y , ELC/ELR Permit (ELPRMT) ( L T) ��, _ S, "�` ✓ State Tax (TAX) (UT BLDG: 3� y PLUMB: // z MECH: ELC/ELR: 3 , '7 S-U Plan Check MST: (BUPPLN) ( BUPLN) E�l�J? Plumb: (PLUMB) ( PLUMB) Mech: (MECPLN) (U EPLN CDC: Review(BUILD) 'DCBLD) CDC o'0 �. w CDC Review(PLN) (CDCPLN) N/A (2V su,Yc�� o.3s/G "____Sewer Connon (SWUSA) (U W SA) " '200,� ��?e,y Reimbur. District ( ) ( ) Sewer Inspection (SWINSP) (U INS) 33 Parks Dev Charge (PKSDC) N Residential TIF (TIF-R) (U I -R) At�<a �_,�—~ Mass Transit TIF (TIF-MT) (U F-M) 1361, Water Quality (WQUAL) (UV QUAL) Water Quantity (WQUANT) (UQANT) ?401 Erosion Control Prmt (ERPRMT) (U RPMT) v Erosion Planck/USA (ERPLN) E RPLN) ;-d n I . Erosion Planck/COT (EROSN) ( E USN) Via' Fire Life Safety (FLS) (U LS) TOTALS: , ........ }f I SFAPP DOC (DST) 4197 Solar Balance Point Standard Worksheet Address '\'�o Sox A calculations: North-South dimension for the lot. Box A. This dimension is determined by finding the midpoint nf the North lot line and drawing an intersecting line perpendicular to that point. First, determine which property line is the North Ir� line. The North lot line is the line with the smallest angle from a line drawn east-west and interscaing the northern most point of the lot. as0 m- \ t , � N \UM UM North-South Dimension for Lot: IIS measure the distance from the midpoint of the North hat line to the South lot line along the described line. feet t N ��+cxKIauN o.��+ Box B calculations: Shade point height for your residence. Box 9: i. Determine whether measurements will be based on the peak or eave of your Which describes strucxur2. The orientation of the ridge is also important_ your residence? 1a: If the roof line runs North-South, measurements will K.«4�,` (circle one) be based on the peak of the roof. Q,�11 1 B (Li"C7, 1 b: If the roof line runs Fast-West and the roof pitch is less than 5/12, measurements will be based on the eave. �Popp UA%4 1c: If the roof line runs East-West and the roof pitch is 5/12 or steeper, measurements will be based on the peak. "M a" Box B. continued Box B: 2. Measure change in elevation from front property line to finished floor elevation. If the lot slopes up from the front lot line to the foundation, the figure is positive. If the lot slopes down from the front lot line to the foundation, the figure is negative. - ft 3. Measure distance from finished floor elevation to the affected peak/eave. + r ,"� ft If the roof line runs North-South, deduct three feet. If the roof line runs East-West, - ft i deduct nothing. �+ 5. Subtract one :.x)t for each foot of difference in elevation from the front property line to the rear property line, if the lot slopes up from the front to the rear. If the lot has no slope or slopes up from the rear to the front, deduct nothing. _ _ ft 6. Total figure for box B: ft Box C. Distance to the shade reduction line. Box C: 1. Measure the distance from the North property line to the founr±ation near the ft affected peak/eave. 2. Measure the distance fmm the foundation to the affected peak or eave. + ft 3. Total figure for box C: ft It is most useful to draw a vertical line to rep esent the appropriate riguue found in box'n'and a ho hzontal line to represent the appropriate figure found in box 'C'. The intorsecxion of the vertical and horizontal lines determines the value fouixi in box'D'. The value in box'D'should be compared to the value in bout'p'; if the value in bux'9'is less than o:equal to the value found in box'D', then the building is in compliance with the solar balance code. If you have any questicxis,please cootac..us at 639-4171, x304 or at the Community Development Counter. MAXIMUM PERMITTED SHADE POINT HEIGHT (In Feet) Distance to North-south lot dimension(in feet �w— shade 100+ 95 90 85 80 75 70 65 643 55 50 45 40 reduction line from northern 70 40 40 40 41 42 43 44 63 38 38 38 39 40 41 42 43 60 36 36 36 37 38 39 40 41 42 55 34 34 34 35 36 37 38 39 40 41 50 32 32 32 33 34 35 36 37 38 39 40 45 30 30 30 31 32 33 34 35 36 37 38 39 -10 28 28 29 29 30 31 32 33 34 35 36 37 35 26 26 26 27 28 29 30 31 32 .33 34 35 36 30 24 24 24 25 26 27 28 29 30 31 32 33 34 25 22 22 22 23 24 25 26 27 28 29 30 31 32 20 20 20 20 21 22 23 24 25 26 .27 28 29 .10 1-, 18 18 18 19 20 21 22 23 24 25 26 27 28 10 16 16 16 17 18 19 20 1-1 22 23 24 25 26 5 14 14 14 15 16 17 18 19 20 21 22 23 24 [Box D. Maximum allowed shade point height. �i-w feet h71docs4unoAvemra\9o1:r 6p Revised?l_'6`96 lu Hocic mA,� Q�o�► �'�I ql tWtl1 PAMY Ri ^r criw AV t F ✓ •�. _ uvea MJ ov 444 vtA Ra 36 CITY OF TIGARD F'l_UMB I NG F ERM I T DEVELOPMENT SERVICES PERMIT #. . . . . . . . PLM: 8 -0317 13125 SW Hall Blvd., Tgard,OR9;223(503)639.4171 DATE ISSUED: 09/09/98 PARCEL : E.S104C13--0000 51TE ADDRESS. . . : 1307 SW ASCENSION DR SUBDIVISION. . . . : HILLSHIRE WOODS ZONING: R-7 PD DLOCK.. . . . . . . LOT. . . . . . . . . . . . . :036 JURISDICTION: TIG CLASS)�OF�WORK. . :ALT _ - GARBAGE�DISPOSALS. :__. .N_ MOBILE HOME 13P'ACE S. : 0 -T'YP'E OF USE. . . . :SF WASHING; MACH. . . . . . : 0 NACKFL.OW PRFVhITRS. . : t 9CCUP'ANCY GRP'. . : R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0 5TORIFS. . . . . . . . .. 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 f'IXTURES-- ------_.____._ l_ALJNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 531NKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAP'S. . . . . . . . 0 i nVA'TORIES. . . . : 0 OTHER FIXTLJRES. . . . : 0 ILIS/SHOWERS. . . : 0 SEWER LINE (ft) . . . : 0 WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : Residential backflow prevention device. FEES (30RDON BOB R• DENISE type- -�-amount by data' rerpt 13037 SW ASCENSION DR P'RMT 4 15. 00 CiE[] 09/09/98 98-30896r T IGARD OR 97223 5P'C'T $ 0. 75 GFO 09/09/99 98-3089E:t L,Iione #: CoTit ractot TC]HN DARBY LANDSCAPE MA I IVTF_NANCE 1 `152 SW CLEARVIEW TTrARD OR 972 :3 Phone #: 579-5298 9 15. 75 TC)TAL.. Reg #. . : 000069 • ------- REQUIRED IiuSF'EC i IONS per@it is issued subject to the regulations contained in the RP'/Backflow P'rev 1 tgard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect i nn —_— applicable laws. All work will be done in accordance with _ _ --------- - approved plans. This per@it will expire if work is not started _ ---- within 180 days of issuance, or if work is suspended for @orethan 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAA 952-0001-9010 through DAA 952-0001-0080. You lay _ ---- --- cbtain copies of these rules or direct questions to OUNC by calling --- -------- (503)246-1987. Tss1..ted Ny : Permittee Signati t-e : ++++-t-++-+++++++.4-+4.4+4- +++++•++++++++++-++++++ ++++++++++++ Call 6313--4175 by 7:00 p. in. for an inspection needed the next bi.tsiness day ++++++++-h+++++++•++++++++++++-++++++++•F+++-+++++++++++++++++++++++++ i-+4-4 +-4- F4 ++++i CITY OF TIGARD 13125 Plumbing Permit Applicaltion SW HALL BLVD.ii Commercial and Residential Plan Check#�_`TIGARD, OR 97223 Rec'dBy_� (503) 639-4171 Date Rec'rt =`L_ Date to P.E. Print or Type Date to DST IncompSete or illegible applications will not be accepted Permit#u Reined SWR# -- Narne _--.- Job FIXTURES (individual) PRICE ApN7 Address Street Address 01,, =sulle --- — _ 900(' Lavatory -�-- — --__ 3;�eS 1,6^^ 9.00 Bldg# Cily/State Zi — Tub or Tu /Shower Comb. —` Zip 9.00 I, Or'Q -� �� Shower Only _ ling 1.-F_`: _._-__ 9.00 Water Closet �! !'CilC�/� DishwasherOwner Mddiess _ Suite 9.00 13 QGarhage Disposal - -�- - � City/State Wa8.00 ZI shing Machine _.. Phone Floor Drain/Floor;Sink 2" — 9.00 9.00 g Md Occupant ailinAdress 4" —- -- — -- P Suite — 8.00 Water Heater 0 conversion O like kind 9.00 Gas�rn -e5Tires a separate mechanical ermit— J—CityState Zi-- hone Laundry Room Tray a_1m_e i nnah` -- - 9.00 Olher—%ture') --- 9.00 Contractor Mailing Address /— 9.00 Suite I 1 J)- &.> C(aw U m ' 9.00 Pdor to permit CltyrState Z.in_ Phone - 9.00 Issuance,a copy C) Sewer-1st 100' —�— -�-- of all licenses are pre - 1 r—`�i — 30.00 gtfn Const Cont.Board Lrc.# Exp. ate Sewer-each additional 100' required if ,c 25.00 �. )g __ /O /lP�, Water Service-1sl 100, --- _ 3000 expired In COT Plumbing Llc.# Exp.Date Waler Service-each additional 2o0' database _ 25.00 Name -- --_ Stonn 8 Raln Drain-let 100' 30.00 Architect Storm&Raln Drain-each additional 100' - __ Mobile Home S 25.00 Or Malling address e Suit - pace 25.00 Commercial Back Flow Prevention Device or Antl- Engineer Cny/State ZipPollution Device 25,00 Phone Resldenti--ial Backgow prevention Device* -- Describe work to be done: — - (Irrigation timing devices require a separate 15.00 New O Repair O Replace with like kind: Yes 0 No O restricted ener ermit. Residential 0 Commercial O Any Trap or Waste Not Connected to a Fixture — 9.00 Addltlonal description of work: --- Catch Basin 9.00 ;lisp.of Existing Piumbing — - 40.00 Specially Requested Inapectlons r/hr 40.00 Are you capping,moving_ or replacing any fixtures? - Rain Drain,single family dwelling — Mir 1 — 30.00 Yes 0 No Grease Traps If yes,see hack of form to indicate work performed by 9.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL WORK COULD RESULT IN INCREASED SEWER FEES. Isometric or riser dlagiam is required M Quanilty Total is >9 I hereby acknowledge Thal I have read this appliration,that the Information "SUBTOTAL --- given Is correct,that I arr,the owner or authorized agent o,'the owner,and that Ians submitted are In com Ilance with Ore on State Laws. 5°!o SURCHARGE Slgrrature of Ownsr/Agent bate Sl p '"PLANREVIEW 251,. OF SUBTOTAL .-- /CJ Refired oNy H li tura qry.total is>9 I Contact onName - — Phone TOTAL — — - 'Mtnimum permit foe is S25+5'M surcharge,except Residential Backflow - - --- - Prevention Device,which is$15+5%surcharge "All New Commercial Buildings require plans with Isometilc or riser diagram and plan review I�•1sislplu�nn;.p x+c 7/?,�P f PLEASE COMPLETE: Fixture Type _ Quantity by y Work Performed New —Moved Replaced Removed/Ca ed _ R RR Sink - ---_--- Lavatory ---- -- --- � - Tub or Tub!S_hower Combination Shower Only _� — --------------- -- ------ I Water Closet --- ---- -- - ------ - - Dishwasher Garbage Disposal Washing Machine_— _— Floor Drain/Floor Sink 2" 311 411 Water Heater Laundry Room Tray Urinal — Other Fixtures (Specify) COMMENTS REGARDING ABOVE: