Case File �J
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_„ 13203 SW ASCENSION DR ..,
CITY OF TIGARD MASTER 1DERMIT
DEVELOPMENT SERVICES
DATE ISSUED: 07/21/97
13/J5S6Hall Blvd. Tigard, Dq97223 (5C3)6384/7/ �
PARCEL: 2B104CB-01200 �
')ITE ADDR�F.SS. . . . 13203 SW AS ,'EN3I0M DR �
"UBDIVT5IO1\!. . :HILLSHI�E WOOD� ZONING: R-7 PD
^ . �
8LOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :028 JURISDICTION- TIG �
Remarks: New SFDPATH l �
------ -------------------------------- BUILDING --------------—-------------------—-------
nEl5SUE.: 8TDHlBC.......: 2 FLOCK AREAS'------' BASEMENT... 0 sf REQUIRED SFTOACKS--- R[QUYRED------
nASS OF WORK,:NEW HEIGHT........ . 21 FlRSJ...� 1786 s[ GAHAGE..... 756 of LEFT..........: 10 SN8KE 0ETEC KS: Y
TYPEO[ U8[ .:SF FLOOR LOAD ...; 4N SECOND . 894 s FR0T.......... 21 PARKING SPACES: 2 |
|
TYPE OF CONST :5N DWELLING bw^TS: l FlN88MEN7; N 5Y RIGHT......, 10
OCCUWY GRP :R3 BDRM: J BATH: J TOTAL----- 2�,80 sf VALUE .$: 192658 REAR ........ 78
_____________________________-- PLUMBI46 --——----------------------------------------------------------
SINKS.........
------'SlNKS....... I WATFV CI^B[TS. J WASHlN8 MACH.: \ LAUNDRY TRAYS. ' \ RAIN DRAIN ft: 100 TRAPS ....., 8
LAVATORIES.... 5 UISH4A9HE}RS.. 1 FLOOR DRAINS..: 0 SEWER LINE ft; 109 SP RAIN DRAINS: l CATCH 0ISBNS..: m
D0/SHOWERS... 3 GAQ'J0'4GT: 0SK, 1 WATER HEATERS.: 1 WATER LINE ft: 100 BCKRLW ;REVNTR: N GREASE -RAPS..: 0
OTHER FIXTURES: 0
--'------- ' -- -------------------------- MECHANlQ& -------------
r-UEL TYPES—'------ FUHN < l@N .., 0 FOIL/CMP < 3HP: N VENT FANS ...: 4 CLOTHES DRYERS: I
GAS FU0N >=10 .; \ UNIT HEATERS..: N HOODS ...... I 0H[R UNITS...: i
MAX INP.: N K0 FLOOR FUHNmrES/ N VENTS....... 0 W0DDSTOV8S..... 0 GAS OUTLETS...; \
--------'---------------------'---- ------------- ELECTRICAL -------------------'----- ---
—��lUENTlAL
UNIT --S[RVlC[,r�r ,, ' --TEMP 8HVC/PEFU[HS— ---BRANCH CIRCUITS--- --'-NlBCELL04E0US-- --ADD'L INSPECTIONS—
IM SF UH LESS: \ 2* ... / C N - 2N amp.. 0 W/SVC DH FDR..: N PUMP/lKRlGAIYON- N PER INSPECTION: N
EA ADD'i 50NSF.` 5 201 - 48P '*p. N 801 - 4N amp. 0 Id N0 SYC/RDR: N SIGN/OUT LIN LT: 0 PER HOUR ....; N
LIMITED ENERGY.: N 40 ' SQ asp..: N 00 - 600 amp..: 0 Eq A0DL BR ClR: W SIGNAL/PAWL...,. N IN NAT.....: N
MANF HM/SVC/FDR: N 9> ' ION asp. N 6@1+amps-1me v: N MINOR LABEL -\N: N
10WN vuy/volt. N ------------------ PLAN REVIEW SECTION ---------------------------'-
8*connect only,, N }=4 RES UNITS..: SVC/FD0=225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
---------------------------------
ELECTRICAL - RESTRICTED ENERGY ---'''--------'------ ----'-----
Q. SP N[SlUEN71AL-----------~----- B. COMMERCIAL-----------------------------------' -----------
AU01OISTEHE0.' VACUUM SYSTEM..: AUDIO ISTEHED.: FIRE ALARM..... INTERCOM/PAGING: GNTDO0PLNbJCLT:
BURGLAR ALARM..: GTBX BOILER......... HVAC........... LAN08M/0R}8: PROTECTIVE Slo`NL:
3ARACk 6V8NER..; CLDCP.......... INSTRUMENTATION: MEDlCAL........ OTHH;
`fYAC........... UATA/TELICOMN ' NUNS[ C&LS.... TOTAL MSYSTEMS: 3
3wmm': —'—' ---- ---------' --Con�r��or� ------'---------'---- TOTAL FE[8:1 4594.86
WlNDW00D MU0[S WlWUW000 MS This permit is subject to the regul/timo contained in the
!4076 SW B[NCHVlEW T[HH 14076 SW 88NCHV1[N TERRACE Tigard Municipal Code, State of Oro. 3pecio\ty Codes and all
-rRAND OR ?7224 (FAX 0 5W7606) other applicable laws. All work will ho done in accordance
Tl8AOD OR 97224 with approved plans. This oorw/t will expire if work is
/none ». 590-4700 Phone 0' 59847NN not started within 180 days of issuance, or if the work i,
Rog #..: 581 s'.sp»nded for tore than 180 days. ATTEN110W: Oregon law
-----------'------------------------' requi,�s you to follow ro\s adopted by the 0iogon itilit',
| Notification Cooter. Those rules are set forth in DAR 952-M1-0018 through OAR 958-001-M, You may nh|oio copies of these rules m'
|
' diroct 0etiono to 0UNC by calling (548)246-1987.
------------------------------------ REQUIRED INSPECTIONS -------------------------------------------------
Emuion Contol Post/Beat Mechan Electrical Se,vi Gas Line lnsp Water Lino 1nop Building rina\
SrmdinU Inspecti Crawl Drain Electrical Rough Gas Fir»piace Appr/Sdwik lnsp
rooting Insp PLM/Underfloor Framing losp `noolmtion lnop Electrical Final
r000datinn InIpl Insp Shear Wall Insy Gyp Board lnsp Mechanical Final
n";t/D»an Struct Rain drain Insp P\. ,h Final '
l ssued By Permittee Signature :
/ +++++++++++++^ + 4 / ^ ^ / . ' + ^ +++++++++++++++++++++++++++++++Trf++++++++++~+4 ' ~+ +
Call 639-4175 by 6:00 p. m. for an inspection needed the next business day
I
CITY OF, TIGARD
DEVELOPMENT SERVICES SEWER ERMICTION
PERMIT
TT
., 13125 SW Nall Blvd., Tigard, 0H 97223 (503)639.4171 PERMIT #. . . . . . . : SWR97--02 f,7
DATE ISSUED: 07/'21/97
PARCEL: 2 S 1'J-iCB -01 i :00
'";ITE ADDRESS. . . : 1320.3 SW ASCENSION DR
;.MBDIVISION. . . . :HILLSHIRE WOODS ZONING: R-•7 .,D
I:%L...00,'. . . . . . . . . . {._177. . . . . . . . . . . . . :028 JURICP.CTTCN: TIG
ENAN T NAME:. . , . . ,:W I NDWOOD HOMES)
LISA NU. . . . . . . . . . : FIXTURE UNITS. . . V_1
CLAS!') OF WORK. . . NEW
DWELLING lJN1'TS. . : l
TYPE OF USF'. . . . . :SF NO. OF' BUILDINGS , 1
T NSTALL TYPE. . . . :BUSWR T MPERV SURFACE: 0 s'F
?emair,ks : New SFD
(".)wnar. __. . ___..._...__.-_.........._.__. ._------._._.__.._..____._.______.___...___._.__..____..__.
FEES
1 WTNDWOOD HOMES type amoi.int 12y date r-ecpt
14O76 SW BENCHVIEW ',ERR PRMT $ 22OO. O0 B 07/0:1/97 97--297,36,
T I GAFM OR 137;='24 I IVSP t 35. 00 P 07/::1 /97 97 -4:9 738
OUL. $ 210. 00 T3 07/21 /97 97-297382
111 onia #: 59O -4700 G?lJl'J E 29117. I'M 13 0'7/21/97
EROS $ 64. O0 B 07/21/97 X17-297382,
contractor : -___. .-._.__._....------ _ ._.__.. _ ..
_ . _ .__._... ERPIJ .t lc:0. 80 n 07/x:1/'77 S7-297382
OWNER ERPC $ 210. 60 B 07/21 /97 97--2.'973P,2
Ph L,.n e #: $ 2840. 60 TOTAL
ReLI #. . :
REPU I RED I NSPECT I ON5
This Applicant agrees to comply with all the rules and regulations Sewer inspection
of the Unified Sewage Agency. The permit expires 10A days from ------
the date issued. The total amount paid will be forfeited if th.? -- - —
permit expires. Tne Pqency 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 froF __• _ _______� ---
the distance given. If not so located, the installer shall purchase �_N....
a "Tap and Side lewer" permit and the Agency will install a late-al.
ATTENTION: Oregon law requires you to follow rules adopted by the -
Oregon Utility Notification Renter. Those rules are set forth in OAR
952-001-0010 through OAR 952-MI-0W. You may obtain Copies bf --
these rules or direct questions to OX by calling (503)246-1987.
l s,3 i.r F,d by --1 v U '�C �- P a r;n i t f e e S i g n e t ii i,e
++++ F+++++++++++1.+'+++++4-++++-F++++++++++++++++++-F++-F+•+-t +++++++4•+++++++- +++++++4++
Call 639-• 4175 by 6:O41 P. in. for an inspect ion needed the next bi.rsines,s day
+•+++-t-+++•+4+++•#-+++++-1•-f+++++'++++-i-+++++f++++-1-+++-F++++++++++++++++ r+++•++•-1-+++++++-++4
)r
Plan Che _ /�''
"ITY OF TIGARD Residential Building Permit Application Recd By _
'3125 SW HALL BLVD, New Construction Additions or Alterations Date Recd-? 'o '
'GARD, OR 97223 Single Family Detached or Attached Date to P.E.�--
a3) 639-4171 Date to DST
Print or Type? Permit#IA,
Incomplete or illegible applications will not be accepted called_
Name of Subdivision I_ot# Name
Job � 1� C ; �
Site Addie Architect ai ing Addrea
Address r ��
N r Char S,ateZi Phone
Owner Mallin Address 2�
Na j
3C 0 74 Sw—�-� C i.� Engineer Mill Address-k��(�J r
City/ tate / Zip Phone g�
i Name i L t a Zip Phone
General {( Describe work neyo!t -'aeldihon O alteration O repair O
:ontractor i V lading Address to be done:
Additional Description of Work
City/State Zip Phone
Oregon Const.Cont.Board Lic.# p.Date •L '`'y`--�
Attach Copy of �� /` � ,Pr')Iect Q
Current COT Basi ess Tax or Metro# Exp ate i Valuations 7
Licenses � : �c ' _I
`'dame NEW CONST
RUC'►,Z ONLY:
Mechanical vie ir--1 Sq.Ft. House:,,, _ Sq.Ft.Garape:
Sub- Mailing Address _.2
02 6112
Contractor ` /�f Comer Lot Yes �!o FlagLouYe o;
Cit /S a zip Phone (check one) (check one)
� 0,C ?)2-03 Restricted Audio/Stereo Burglar
Oregon nst.Cont.Board Lic.# Exp.Date , ' Energy System Alarm
Attach Copy of Y,4;
Current COY tTwinness Tax of Metro# SAO. Date Installation L Garage Door HVAC
Licenses _ rJL�7 � Opener Systems
Name (check all that Other: `—
Plumbing _ apply) _
Sub- Mailing Address Will the electrical subcontractor wire for all Yes No
' "r /ba restricted energy installations?
Contractor �.�6 9y ..
City/ nate h,� zi ,c Phone -- Has the Subdivision Plat recorded,?. N!A 1' s No
1Zk
Oregon Const.Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
Attach Copy of _ Calculation Attached)
Current Plumbing 1.ic.# Exp. Date I hereby ackno;71.ica that I have read this application, that the
Licenses �G _ ( ��j _ / �j information given i correct,that 1 am the owner or authorized agent of
COT Busine is Tax r Metro W Exp.0 Ifis the owner,and that plans submitted are in compliance with Oregon
�__ State laws __
Name Signatu nt Date
Electrical / �' _
�- rsa Nam
Sub- Madinq Address v - Phone
Contractor W A�;,,X FOR OFFICE USf ONLY;
Ci tate Zip Phone plat" '--
r, MapiTL##:
+.3 63,9—,S 33
Ore IfinConst.Cont Board Lic.# Exp.Date y �>
Attach Copy of !,� 5- g acko..-� Zone: r Solar.
Current Electoral LIC..N' .�Exp. Dale L, ,,1/ ;
Licenses ; i ir.r ,
COT Business Tax or Metro# Exp D to ( En neerin5 Approval: Planning Approval: TIF:
!•-ate / �]
tslmstapp.doc Ii
P_elmit [�cco�ant_Qescriotion l�rYlount Amt. P-�L Bal. D��
MST. Permit (BUILD) 6d,
Plumb Permit (PLUMB) Z�S, N_ _ Z25,
Mech. Permit (MECH)
LC/ELR Pe,-mit (ELPRMT) �,j t y _ c,74,
';-
State Tax (TAX) _�� ,y 3
Bldg:
Plumb. /fir
Z �
Mech: e2 r
ELC/E-R: 13 ----
Plan Check
�r)
MST: (BUPPLN)
Plumb. (PLMPLN)
Mech: (MECPI_N)
CDC Review (LANDUS)
Sewer Connection (SWU SA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) fc 5o.
Residential T IF (;IF-R)
vD ^
Mass Transit TIF (TIF-MT) /3U _ Ju,
Water Quality (WQUAL) 0 0, '
v%iator Quantity (WQUANT) g�O— U
Erosion Contr,.11 Permit (ERE'RMT) G�.
Erosicn Planck/USP, (EP,PLAN) __
�Iv
Erosion P!ancic;COT (EROSN)
Fire I-ife Safety (FLS)
TOTALS:
Rrl.l/ild E6/
Solar Balance Point Standard Worksheet
Address
Box A calculations: North-South dimension for the lot. B:►x A:
This dimension is determined by finding the midpoint of the North lot line and drawing_
an intersecting line perpendicular to that point.
First, determine which property line is the North lot line. The North lot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot.
45°—+
"ounce" LoNOrw�e>
N O / North-South
.i Dimension for Lot:
Measure the distance from the nidpoint of the North lot line to the South lot line along
the described line.
feet
t
\�
NORIWSOUM DMAENSION�
Box B calculations: Shade point height for your residence. Box B:
1. Determine whether measurements will be based on the peak or eave of your Which describes
structure. The orientation of the ridge is also important.
your residence?
r JMMY.IM/JC2
1 a: If the roof line runs North-South, measurements will (circle one)
Z711be based on the peak of the roof.
I A 1 B 9C
1 b: If the roof line runs East-West and the roof pitch is
less than 5/12, measurements will be based on the
e n,1.ea•ew
ea%e.
SNAG W-W EAW
I c.: If the roof line runs East-West and the roof pitch is
5/12 or steeper, measurements will he based on the t_-I'm
peak. vVAN PC"Wnt
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. - -f/------ 't
3. Measure distance from finished floor elevation to the affected peak/eave. --- it
-t. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, -- ------
deduct nothing.
5. Subtract one foot 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
I
:at has no slope or slopes up from the rear to the front, deduct nothing.
6. Total figure for box B: �'�^� It
Box C. Distance to the shade reduction line. Box C:
1. Measure the distance from the North property line to the foundation near the
affected peak/eave.
2. Measure the distance from the foundation to the affected peak or eave. + _ it
3. Total figure for box C: ft
i
It is most useful to draw a vertical line to represent the.appropriate figure found in box"A"and a horizontal line to represent the
appropriate figure found in box"C". The intersection of the vertical and horizontal lines determines the value found in box"D".The value
in box "D"should be compared to the value in box "8"; if the value in box "8"is less than or equal to the value found in box"D", then
the building is in compliance with the solar balance code. If you have any questions, please contact us at 639-4171,x304 or at the
Community Development Counter.
MAXIMUM PERMITTED SHADE POINT FREIGHT (In Feet)
Distance to North-south lot dimension(in feet)
shade 100+ 95 90 85 80 76 70 65 60 55 50 45 40
reduction line I
from northern
JUL line tin eCti
70 40 40 40 41 424 44
65 38 38 38 39 40 4 42 42
60 36 36 36 37 38 3 40 41 42
34 34 34 35 36 3 38 39 40 41
50 32 32 32 33 34 3 36 37 38 39 40
45 30 30 30 31 32 3 34 35 36 37 38 39
40 28 28 28 29 30._.. 32 33 34 35 36 37 38
35 26 26 26 27 2R i 30 31 32 33 34 35 36
30 24 24 24 25 2+ ?7 28 29 30 31 32 33 34
25 22 21 22 23 24 25 26 2' 28 29 30 31 32
20 20 20 20 21 22 23 24 25 26 27 28 29 30
15 18 18 18 19 20 21 22 23 24 '5 26 27 28
16 16 16 17 18 19 20 21 22 23 24 .25 26
14 14 14 15 16 17 18 19 20 21 22 23 24
Bax D. Maximum allowed shadespoint.height: _ i ' feet (1)l1
h:\docs\nancylventu ralsolar.chp
Revised 2/26/96
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CITY OF TIGARD
DEVELOPMENT SERVICES
/3/25 SN/Hall 8lvd, Tigard,DR07223 (503)639-4/71
CEpTIFICATE OF
� OCCUPANCY
' PERMIT #. . . . . . . : MST97-027,?
DATE I3SUEDx 02/13/98
PARCELx 2S104CB-0/ L00
;lTE ADDRESS. . . z 13203 SW ASCENSION DR
AUBDIVISION. . . , : H{LLS141RE WOODS ZONTNGoR-7 PP
OLQCK. . . . . . . ' . . : LOT. . . . . . . . . . . . . 1028 JUMlSDICTION»T2(-)
| �'LASG OF WORK. xNEW
CCUPANCY GRP. i R3
rIGARV OR 972a4
14076 SW BENCHVIEW T*F-.FiPACF
Dhone #1 '390--4700
|
1hereof and confirms that the building has been ivispee::ted for compliance t-4ith
01
POLB"T TN CONSPICUOUS PLACE
|
v
CITE'OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requeateu: ^� !� �v .M. P.M. _ MST:A
Location: I �--CJ BUR
Tenant: — Suite: Bldg: MEC:
Contractor: Yz Phone: _ 5 � PLM:
Owner: Phone: _ ELC:
-- ELR:
SIT:
BUILDING Wcon't) (11iLUMBO- le MECHANICAL ELECTRICAL SITE
Si;.' eam P(fjV eam Post/Beam Cover/Service Sewix/Storrn
Footing Roof I JndFUSiab Rough-In Ceiling WatfT Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Remmect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
v Ap Approved Approved Approved
Appr/Sdwlk Not ve Not Approved Not Approved Not Approved Not Approved
A �Z[ .�� FINAL FINAL FINAL
0 Call for reinspection 0 Reinspection fee of S required before next inspection 0 Unable to inspect
Inspector:— ��:/_ �_ Date:_ 3' 1� Page of__.
CITY CSF TIGARD PLUMBING PERMIT
+: DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM98-0054
C`ATE T SSUED: 02/26/98
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171
PARCEL: 2S1O4CB-01200
SITE ADDRESS. . . : 13203 SW ASCENSION DR
SUBDIVISION. . . . : HILLSHIRE WOODS ZONING: R-7 PD
BLOCK. . . . .. . . . . . . LOT. . . . . . . . . . . . . :O28 JUPISDICTION: TIG
---------------------------------
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBII.E H04E SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS . . . . . . . . . . . . . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SJNKS. . . . . . . . . . 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: Installing residential backflow prevention device
Owner: --------------------- ------------------------------ FEES - ----- ---------
PAM FRANKLIN type amount by date recpt
13203 SW ASCENSION DR PRMT 9 15. 00 B 02/26/98 98-303624
TIGARD OR 97224 SPCT 9 0. 75 B 02/26/98 98-303624
Phone #:
Contractor---------------------- -- ----- ----
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123 ---------------------------------
Phone #: 503-628-3411 9 15. 75 TOTAL
Reg #. . : 000058
----- --- REWULRED INSPECTIONS
This persit to issued subject to the regulations contained in the RP/Backflow Prev _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection — __-
applicable lava. All vork •ill be done in accordance vith
approved plans. This persit till expire if vork is not started -
vithin 181 days of issuance, or if vork is suspended for sore _ --
than 181 days. ATTENTION: Oregon lav requires you to follov rules --
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-MI-Mil through OAR 952-1111-1181. You say --
obtain copies of these rules or direct questions to OURC by calling
(513;246-1987.
7
Issued By: I' � Permittee Signature:
4 4 t t4 ........... .... . .....................
t.♦t.f.+*. •}44 . +4.1tit♦t+T.t.♦1t+ift i ..........f t t.t t t 4 t♦♦t f.t ........ .t1ft♦f♦ .
Call 639-4175 by 7:00 p. m. for an Inspection needed the next business day
f f 4 i+f t♦t+♦........... ........................................ ttt♦it44 4 +++++
J
LEASE COMELE EAS �Ft0�IE192.RQff-QI:
Fixtures to be capped, moved or replaced Qty .
Sink
Lavatory
Tub or Tub/Shower Combination_ _
Shower Only _
Water Closet
Dishwasher _
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures r=ixtures (Specify)
'UMMENTS REGARDING ABOVE:
Pplmapp.doc 11'96 (dst)
I
'I'i� F TIGARD Plumbing Application Rrc'd By
31255 :QIP HALL. BLVD. Commercial and Residential Date Road - Z-
IGARr, or, 97273 Date to P E.
503) 6,39-4171 Dale to DST
Permit t 1'
Print or Type Related SWR A
lnr.,,rnplete r_r illegible applications will not be accepted �ausd
�. ...�.- Na jv of r%r woprnjvtT-, ,Kt fiX'jURE9.(Indlvidlrel)^,NSo�;�
.fob %_ ',/t'E C�a�!k7S �'7' :fri su,k 9.00
:ihta ddrhh;+s Stu``;a Laval" 9.00
�dftiA�El Tub or Tub/Shower Comb.
kris e-,11sn: cat; s.c>n
Bldg a CA Istste ZIP Shower Only - 9.00
water Closet 9.00
Mame
`Dbhwasrhar 9 00
Owner Me*q Addles -� Swte Garbage Disposal 9.00
Washing Madtine ~_ 9.00- -
CAy/State ZIP 'none Fkw Drawl �� 2' 9.00 ^
- _ Name3. �. 9.00
Name
4- 9.00
Occupant Mailing Address Suite-- Water beater 9.00
Laundry Room Fray 9.00 J
City/state ZIP Phone Ur nal - 9.00
Norm Other Fbxttirss(Specify) 9.00
e4-010W IA•'N C 7e -/We, 9.00
Contractor V Addtese Salts 9.00
/ 3ieJFir, e0, /J�f
(Prior to issuance Clty/Stata &Mo pthor» _- 9.00 -
applicant mustyNa's� GbGJ �j.'/29 JJ' .''9 9.00
pmvvie au Orrrgon Const.Cont eoenl t,,UI Exp.Oats _ 9.00
9.00 --
license Ptumbing Ur.S - EXP.Date sewer-1st 100=-
- 30.00
W,fortt,atl«h � 1 s L yci' Sewer-each addgional 100' 25.00 ---
tnr COT COT Business Tax or Metro i Exp.Oats Water Service-1st 100 ----
database). 30.00
-" Name Water Service-each additional 200' 25.00
Architect Storm&Rar,Drain-1st 100• 30.00
or Mang Addr-u Suds Storm b Rain Drain-each additional lar 25.00
Mobile Nome Space 25.00
Engineer City/State Zip Phone Corrwmeraal Balt Flow Prevention Device or Anti. 25.00
_ Pokutlon Dervie,
:esahbe wont New O Anja O A erstion O Repair O Residential Backflow Prevention Device' 15.00
1 be done: Residential O Non-residnntlal O Any Trap or Waste Not connected to a Fixnue 9.00 -
,ddihonal description of waK
Catch Basin 9.00
Insp.of Ems:rn r it-gybing - - 40.00
_ perthr
-lusting use of wsiC:iiy Arstill -4n*cdons 40.00
,skiing or property _ oedhr
KWIN.'fair.,single family dwelling 30.00
Dosed use of Brea nos 9.00
ding or p►op"_..- -
_____ QUANTITY TOTAL
=re you Ca move or r! each an fixtures? Yes No Isomi i - r ,ser diagrsn b requires 4 Total is -9 r a-ry �Ltt'D
Y PPin9. �9 P' '4 Y ❑ Q _--_ _ 0iarit►' _
(if yes see back of form) 'SUBTOTAL
1 hereby admowledg" -at I have read this application, that the Information
liven is correct Itut -1 fie owner or authorized agent of the owner and ` 5%SURCHARGE LIT
that plans submitted + n compliance with Oregon State Laws. -
Signature of OwnurlAgNnt - Date PLAN REVIEW 25%OF SUBTOTAL
Aeour"oral t Rhus air r law is 19
TOTAL
.intact Pereoft Noma Phwn
V, � 'Minimum permit fee n$25 • 551,surcharge.except Residential Badd w
e l --,j-6j Prevention Device.which is$15•5%surcharge
L\plmapp.dce 121% (dst)
LEASE QQMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub cr Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine _
Floor Drain 2"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
— —_
'OMMENTS REGARDING ABOVE:
I:Nplmapp.doc 13/96 (dst)
Paye N-, 1 CASE HISTORY FOR CASE NO.: PLM98-0054
PAM FRANKLIN
13203 SW ASCENSION DR
08/10/98
Action Description Req/ Schd/ End/ Action Notes Diep By Update Upd
Code Sent Done Done Date By
---- ------------------------- ---- -----*► ------- -------- --- --------------—---- -- ---- --- -------- ---
PLMA003 Application received / / / / 02/26/98 RECD B 02/26/98 DST
PLMA005 Create Permit / / / / 02/26/98 DONE B 02/26/98 DST
PLMA050 (F) Issue permit / / / / 02/26/98 PASS B 02/26/98 DST
PLMA750 RP/Backflow Preventer 02/26/98 / / 06/29/98 PASS 08 06/30/98 J*H
PLMA799 Final Inspection / / / / 06/29/98 PASS OS 06/30/98 J•H
PLMA799 Final Inspection / / / / 07/07/98 Already approved. PASS MS 07/07/90 J•H
PLMA800 Case Finaled / / / / 06/30/98 PASS O.S 06; j/93 J•H