Case File OV
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NOTE: CENTERUNE CONIC-PTS,
SURVEYORS, WILL PIN ALL EXTERIOR
FOUNDATION CORNERS AND PROVIDE
SUBSEQUENT rAORTGAGE SURVEY.
v
EROSION CONTROL:
1. PROVIDE &MAINTAIN 8' (rein) THICK
GRAVEL PAD& DRIVE UNTIL PERMANENT
CONCRETE DRIVE IS IN PLACE.
.�-
+t / � 2. PROVIDE& MAINTAIN SOIL SEDIMENT
ACTL;, FENCE AS INDICATED.
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SCALE DRAWING LOT 45 EAGLE POINTE
N.W. 1 /4--SEC. 10,T.2S,R.'1W, W.M.
CITY OF TIGARD
--AN EIGHT FOOT PUBLIC UTILITY EASEMENT WASHINGTON COUNTY, OREGON
SHALL EXIST ALONG ALL STREET FRONTAGE. 0JUNE 39 1997 Centerline Cf o n c e p t s Inc.
DRAWN BY: MSG CHECKED BY: WGDIII
OKSCALE 1 "=Z0' ACCOUNT 115 640 82nd Drive Gladstone, Oregon 97027
M: \MLI\PLAT\EAGLEP0\L45EP 503 650--0188 fax 503 650-0189
NOTICE: IF THE PRINT OR TYPE ON ANY II_I. III III III III 111 ' 111 ISI ► II 11 ! III III III III III 111 11 ( ! 11 I ( Iflll III iIl III IIi III 111 111 I ( I III III 111 111 III II !- I . ' � II.! 111 111 1111111 1 �r_ III 11T1_11_i ' i11 111 1111111 '
I I I I r I ( I I I I ' i
IMAGE IS NOT A', I I I � I I I I ,� ?
CLEAR AS THIS NOTICE, 1 _ _ _ 3 _ 4 _ 5 7 $ �J - lU 11 12 �
IT IS DUE TO THE (QUALITY OF THE _ � _ !� ��~ � -��- _ No.36
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13777 SW AERIE_ DRIVE
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171 CERTIVIU4TE OF
OCCUPANCY
PERMIT #. . . . . . . : MST97 0i7.'5 9
DATE ISSUED: 0".t0&,'9b
PARCEL 21131041)D-05AtOO
i FE ADDRESLS. . . a 1377*7 �.W PEPIE DR
,LIBUJIV [SION. . . - c EAGLE POI NTC ZONINGiR-4. t. PID
. . . . . . . . . . : LOT. . . . :045 J UP I GV I C T I ON:I IG
LASS 13F WORK. iNEW
YPE OF' IGE. . . c 9F
! YPE OF CONSTR:5N
1cc,(jpAtqc,y cifir'. 1 R3
)CLUPANCY LOAD z2
+emarkqqc 7 Path
'tFRIA ISSANCE CUCiFOM HOMES
i672 SW WILLAMETTE FALLS) DR
,.JF-;T LINN OR 97062
'Dune #s 557-6000
"Utitractorl
1?LNAISSANCE DEVELOPMENT
1672 SW WILLAMETTE FALL�; DP
WEST LTNN OF? 97v1(,8
,hone '4! 35i - 13000
(4er
q #. , 0004991
it-iis C.Pi-tificate pi ants occuoency of the kbovs, ref,�—?nc ed t.)itildinU or, portion
thereof ay,d co--)f it ins that, the bui Irling hai baf TI inspected fav compliance with
1.,11 p Oregon Slpvc. irelty Codes for the gv-omp, occupaiincy, x,rd use under
. St of Ov
,-
jhic-h the refprenced per m.1 wag if%ULmd.
PWJ IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPFrT10N DIVISION
24-Hour Inspection Line. 6394175 BusinesE Phone: 6394171
Date Requeetod: ( �� A.M. P.M. MST: •`/'l— 62-5 /
Location: Z�S 7 / 7 �J` L� C^'�� ` �_k. �1 /`—- 1 S/_� BUP:
Taaant•_ Suite: —Bldg: MEC:
Contractor. -�1� �-'1 f� �` C'� Phone: PLM:2Z- z4 7 j—
Owner; Phone: ELC:
ELR:
_ SIT:
BUILDING __I�LUM�BIIVG ECHANh_1C��— LEC7 _ SITE
Site 1'ost/Beanm Post/Bemn y Pts tff i;edii Cover7s rvice Sewer/Stonn
Footing Roof Undl'I/Slab Rough-in Ceiling Water Linc
Slab Framing 'fop Out Gas bine • Rough-In UG Sprinkler
Foundation Insulation Sewer ll(xxl/I)uct Reconnect Vault
Bti7nt Damp Drywall Stonn Furnace 'hemp Sc-vice MISC.
Masonry Ceiling Rain Thain IVC UG Slab >
Shear/Sheath Fire Spklr/Alm Crawl/Found IN I leaf Pump Low Volt ck.
�Ar(Qyed
improv ppro c 7Al2K(v proveeAppr/Sdwlk NNot roved N roved ,Noroved NoC roved
,'t T'L c-FIRLINALFIS NAL:
Cl Call for ieinspection O Reinspection fee of S required before next inspection O Unable to inspect
Inspector: -- --- — — —— Data PaKe_ "f
CITE' OF TIGARD PIASTI=R F,FRI-Ill.
DEVELOPMENT SERVICES DATE
#. . . . . . . : MST97--0259
DATE ISSUED: 07/10/97
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
F'ARC.EL: 2,51041)D-05400
SITE ADDRESI:i. . . : t3777 SW AERIE I:I'
9UBD I V I S I ON. . . . :EAGLE PO I NI-E: ZON I Nf;: R- 4. 17) F'D
ISI-OCK. . . . . . . . . . LOl.. . . . . . . . . . . . . .04"x, JURISDICI-ION: TTG
Remarks: SF - Path 1
--------------------------------------------------------------- BUILDIN6 ------------------------------------------------•--------------
REISSUE: STORIES.......: 2 FLOOR AREAS--------- BASEMENT...: 0 sf REQUIRED SETBACKS----- REQUIRED-------------
CLASS OF WORK.:NEW HEIGHT.........: 21 FIRST....: 1364 sf GARAGE.....: 665 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1166 sf FRONT.........: 20 PARKING SPACES!
TYPE OF CONST.-.5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 5
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 2530 sf VALUE..t: 181014 REAR......... : 60
------—-----------I--------------------------------------.---------- PLUMBING, ---------------------------------------------------------------
SINKS.........: 1 WATER CLOSiETS. 3 WASHING MACH..: I LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 180 TRAPS.........: 0
LAVATORIES..,.: 5 DISHWASHERS... : i FLOOR DRAINS.. : 0 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS.. : 0
TUB/SHOWERS... : 3 GARBAGE DISP.. : WATER HEATERS.: t WATEP LINE ft: 100 BCVFLW PREVNTR: 1 GREASE TRAPS..: 2
OTHER FIXTURES: 0
----------------- MECHANICAL ------------------------------------------------------------
FU-L TYPFS----------- FURN ( INK ..: 0 BOIL/CA^ ( 3HP: 0 VENT FANS....... 4 CLOTHES DRYERS: 1
(=45 FURN =I WK ..: i UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: i
MAX INP.: 0 BTU FLOOR FURNACES: 8 VENTS.......... 0 WOODSTOVES....: 0 GAS IIITLETS...: I
- --------------- --- ---------------------------------- ELECTPICAL -------------------------------- --- -- ------ - --- ._.. ..
-RF5IDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS—
i00P SF OR LESS: 1 0 - 280 amp..: 8 0 200 amp..: 0 W/SVC OR FDP..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 508SF.: 5 ('01 - 400 amp..: 0 201 400 amp.. . 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
IMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp.. : P EA ADDL BR CIA: 0 SIGNALiPAMEL...: 0 IN PLANT...... : 0
M.W HM/SVC/FDR: 0 601 - 1888 amp.: P 601+amps-1088 v: 0 MINOR LABEL -10: 0
1080+ amp/volt. : 0 -- ------ --------- -- - ---------- PLAN REVIEW SECTION --._..---- --- --------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A. 600 V NOMINAL: CLS AREA/SPC OCC:
----------------------..----- - --- --- _ . _ ELECTRICAL -- RESTRICTED ENERGY --- - -- ------------------------------------------
0. SF RESIDENTIAL---- ....--------- - ------- B. COM'ERCIh---------------------------------------------------------------------------
AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO 6 STEREO. : FIRE ALARM-- INTERCOM/PAGING: OUTDOOR LNI)SC LT:
BURGLAR ALARM.. : 0TH: :: X BOILER.......... HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER... CLOCK..........: INSTRUMENTATION: MEDICAL......... OTHR: :.
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL 4 SYSTEMS: P
nwr.er: ------------------------------------Contractor: ----------------- --------- TO-,AL FEES:! 2758.10
^FNAISSANCF. CUSTOM 'COMES RENAISSANCE DEVELOPMENT This permit is subject to the regulations contained in the
'672 SW WILLAMETTE FALLS DR 1672 SW WILLAMETTE rALLS DR Tigard Municipal Code, State of Ore. Spec,alty Codes and all
WCs' ,.INN OR 97062 WEST LINN OR 97068 other applicable laws. All worN will be done in accordance
with approved pians. This permit will expire if wore. is
Phone t: 5r7-9880 Phone 1: 557-8000 not started within 188 days of issuance, or if the woo is
Reg A..: 888499 suspended for more than 188 days. ATTENTION: Oregon law
---------..____------------------------------------------- - requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rule are set forth in OAR 952-NI-0010 through OAR 952 001-888Q. You may obtain copies of these rules or
direct questions to OUNC by calling (503)246-1997.
----------------------------
-------- ------ RE4l11PED INSPEC'IONS -----------------------------------------------------------
Erosion Contol Crawl Drain Electrical Rough Gas Line Insp Water Line Insp Plumb Final
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
Foundation Insp Mechanical Insp Shear Wall :r•sp Insulation Insp Appr•;'SdwlW Insp
Post/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
Past/Beam Mechan Electrical Servi Fireplace Insp Rain drain Insp Mechanical FLnal
Issraed By: � Permittee Sign ati.iv-e :
t++++t+++++++-1-++++t+++++++++ F+++++++i++++++++++++++++++++ 4+++ +++++++ +++F4+
Cal. l 639-4175 Ijy 6:00 p. m. for an inspection needed the next; brasiness day
is
CITY OF TIGARD
DEVELOPMENT SERVICES SE=WER CONNECTION
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 F'ERM IT
P,F R T . c 5
DATE ISSUED: 07.110/97
F'ARCi=i_: 2 S 1.04DD-0:400
''ITF" ADDRE_SS. . . : 13777 SW AERIE-: DR
`A.)BI)I V I S I ON. . . . :EAGLE F'O I NTE: ZON T NG: R--4. 5 F'D
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :045 .JUR I SD I C71 ON: T I G
EENANT NAME. . . . . :RENAISSANCE CUSTOM HOMES
L ISA NO. . . . . . . . . . : FIXTURE UN" TS. . . : 0
r-;LASS OF WORK. . . :NEW DWEI_I__ING UN "TS. . : 1
T YF'E OF USE. . . . . :SF NO. OF BUILDINGS: 1
I NSTAL I.. TYF'E. . . . :DUSW t IMF-'ERV 91 JR1 ACE: Vh -,f
Remar-ks : SF - F'ath 1
Owner: - ---- ------ -- -_____.______._._._.___..... ..__.. ..._..__..----..__.. ..._..___.._._____.__ FEES _. _---.---------
RENAIS)ANCE CUSTOM HOMES type amor.rnt by date recpt
1672' SW WILLAMETTE FALLS DR F'RMT $ c:'2.'00. 00 B 07/10/97 97-296959
WEST I-INN OR 97062 IN':;F, $ 715. 00 B 07/10/97 97-213G959
SWM $ 1.80. 00 B 07/10/97 97-696959
Phone #: SWM $ 100. 00 B 07/10/97 97--,7:96939
EROS $ 64. 00 B 07/10/97 97-296959
I:ontr<actor: -.____.____--_-•_-----_--__._______ERF'U $ L10. 80 B 07/10/•97 97--29695`3
()WNER ERF'C $ x'0. 80 11 07/1.0/97 97--296959
r-'hone #: $ 26 121. 60 TOTAL
----- REQUIRED INSF,E_CTIONS --------
P ;s Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 188 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Ayency 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 give;. If not so located, the installer shall purchase
a "Tap and Side Server" 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
T52-181-8010 through OAR 952-MV-0M. You may obtain copies of
these rules o- direct questions to DX by calling (563)246-1987.
�t, f
� 5�ired by: T
4-++4-+++++++++++++++++--?..........4.........4....... ................ . t++++++++++++++++
Call 639--4175 by 6:00 p. m. for an inspection needed the next business day
++i-+++++++-►+++++++++++++++++++++++++++++4•+•+++•t+++++++++++++++++t+++++-1++++++++++
Plan Check
ITY OF T!"'OARD Residential Building Permit Application Recd By i —
312_: SVY HALL•BLVD. New Construction Additions or Alterations Date Recd
IvARD,OR 97223 Single Family Detached or Attached (Duplex) Date to P E.(p 7`)
503-639.4171 Date to DST -2
503-6$4.7297 Permits
Print or Type Caned
Incomplete or illegible applications will not be accepted
Name of Project Name
i Job Z /1G 11` ."19,
Address Site Address Architect Mailing Address
Name n , City/slate Zip I Ph ns
Owner Mailing Address / - Name
1Z 410Z r7
GiyrStsts Phune � Engineer Mailing Address )
is j .0/f
Name City/stale Zip Phoria
General r164k E Ii _
�f`.? !�ilrljt j' c :di�s►ry ,l;Fj•»-s �— ^7.�3 f� LrtrS
assaibe work New fy Addition O Alteration O Repair O
Contractor Mailing Address _ to be done:
;•%r-� mi t/,( l �'�� A.ddibonal Description of Work:
Ci (Slate Zip Phone
Oregon ConsL Cont. Board Lic M Exp.Date.
Attarh Copy o/ .
Current COT Business Tax or Metro a7Z,gate PROJECT
Lice. sea f-I ("�> 1 j VALUATION j v
Name
'Mechanical'/ , ,;%-�� ,_7/'1.,,��,���,� NEW CONSTRUCTION ONLY: __-
Sub- Mailing Address Sq. Ft. House: Sq. t. Garage
4 =3r� _
ontractor /)��, / ,/►1v ' Comer Lot YES N Flag Lot ]=V'�
C:rtyr5tate lip Ph�tiei c �.5 sib (check_onel (check one
Oregon Const.Cont. Board Lic N Exp. o to Restricted Audio/Stereo Burglar
i.lich Copy of �> - �; „� ;,t, Energy System Alarm
Cunene COT Business Tax or Metro a E atti Installation Garage Door HVAC
l-ir.�nSea
Name Opener _ S/stems
(check all that Other.
i'lumbinta , ,�%� 'C�/1 �i' . W� tJ'4�G apply)
Sub- Mailing Address Will the electrical subcontractor wire for all YE` NU
, restricted energy inst _llations?
Account Description Amt Anit. Ed. faaLu
MST. Permit (BUILD)
Plumb. Permit (PLUMB) ZZ 5
to
Mech. Permit (MECH) �. J
fV
ro
ELC/ELR Permit (ELPRMT)
State Tax (T,q)O
Bldg: Jam/
Plumb: .
Mech:
Js
ELC/ELR:
Plan Check
MST: (BUPPLN) r7
Plumb. (PLMFLN)
Mech: (MECPLN)
CDC Review (LANDUG) _ _
Sewer Connection (SWUSA)
Reimbursement District
Sewer Inspection (SWINSP)
Farks Dev Charge (PKSDC) e,9
Residential TSF (TIF-R)
Mass Transit TIFMT)IF-
(T
Water Quality (WQUAL)
Water Quantity (V\/QUANT)
Erosion Control Permit (ERPRMT)
Erosion PlanckJUSA (ERPLAI1)
Erosion Planck/COT (EROSN) b� _
Fire Life Safety (FLS)
TOTALS: 7S' F7 ,S_ j Z �
1A02PPAOC (04t) 1/97
Solar Salance Point Standard Worksheet
i Sox A calculations: North-`south dimension for the lot. Box A.
i1,is dimension is determined by finding the midpoint of the North lot line and drawing
.An intersecting line perpendicular to that point.
Jetermine which property tine is the North lot line. The North lot line is the line
Neth the smailt-5E angle irom a line drawn east-west and intersecting the northern most
point of the lot.
I
r..ems d5"
t
R w t www
N North-South
Dimension for lot:
,Measure the distance from the midpoint of the North lot line to the South lot line along
die descibed line. �3
feet
IF71
N
Box B calculations: Shadent height for r residence.
� � � Box 6:
1. Determine whether measurements will be based on the peak or eave of your Which describes
suuct m The orientation of the ridge is also important: your residence?
1 a. If the rncf line rurs North-South, measurements will (circe one)
be 'teased on the peak of the roof.
1A i 1B 1C
1 b: If tr•e rcoci line runs cast-West and the rcoi pitch is
less :..an 3r'12, measurements will _e :asec cn '.he
ea%e.
2-04�srt w
1c: If he :cof lir.e runs Eas .vest and the roof pitch is �
Sr'12 cr ,!;Zee--.er, measurements vviil be based on the
teak G•""`'
I
Box B. continued Box 8:
Measure chane .n elevation Cram front property line to finished floor elevation. If
the !cc slopes uo from the front !cc line to the foundation, the figure is positive. If -X k
the lot slopes down from the front lot line to the foundation, the figure is negative.
3. kteasure distance from finished floor ele%ration to he affected peakleave. + 3_ _ k
4. If the roor line runs North-South, deduG three feet If the roof line runs East-West, '� k
deduct nothing.
;. subtract one foo, for each foot or 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 etas no slope or slopes up from the rear to the front, dedua nothing. _
ti. Tod figure for box 8:
Box C- Distance `o the shade reduction line- Box C
I, Measure the distance fmm the North property line to the foundation near the k
itfeaed peakleave-
Measure the distance froth the foundation to the affected peak or eave_ + ft
13. Total figure for box C- k ,/
t,s most use(W to draw a vertical fine to represent d-e appropmaw 66we knurd in bat Wand a honzorttal Gne tjo replem t the
aptxvprute rnpwe fauxd in boa'C'. Tfw inorrsecaon of die venial and horkor"SA"drie+mines the value found in box'O'.The value
n boor ^D'tl+oukl be mrnpantd oo the value in boor'8'; if die valve in box'9'is km than or equal to the value found in boot'O', then
.tie txutdirtS is ++axnpGance M„th the sdar balanct axle. U yuu have arty gtrestiorts please aontaa us at 6]9--t1 T1,x304 or at the
)mmurwty Oeveloprnent County.
MAXIMUM PE1lJMtTTED SHADE POINT HEIGHT (la Fess)
Cisance oa Nord+-soiA lot dimaWon an feet!
made 100+ 95 90 85 80 75 70 63 60 55 50 4S 40
reducbm Qne
frvrn rMuThem
Eat 5ne fin fr+t _
J0 40 40 40 Al 42 43 44
63 38 38 38 39 10 41 42 43
�0 36 - -_..36 36 37 319 .34. Ae 41 'b
:3
3.4 34 -U 35 36 37 38 39 $, jt
J 32 32 33 34 35 26 37 23 39 40
i 30 30 30 31 32 33 3-11 35 36 37 38 39
=0 :3 :3 21 29 30 31 32 33 34 35 36 37 33
I :3 :5 25 25 27 28 29 30 31 32 33 34 35 36
14 :t 24 :5 :6 27 23 :9 30 31 22 33 3.1
5 " 22 23 24 :5 :5 :7 :3 :9 30 31 32
:7 :0 :0 :0 21 L? 23 :s ZS 216 27 :8 29 30
i .3 18 '8 19 :0 21 �' 23 2a :S :5 27 '9
.0 16 .6 16 17 13 19 :0 .'1 :y '_3 _4 :.5 25
i la 14 1a 15 16 17 18 19 A 21 3? 23 24
-�.
rRox D. ,��a,<imum ailowe•.i shade Point height: � �
2e"xd _.S?5
SEE 35MM
� ROLL# 22
FOR
LARGE
DOCUMENT
' -_ - - --
�
N �
m
Rec'd
1
r
CITY OF TIGARD Plumbing Application By} -e '� ✓ l
1312'5 SWHALL BLVD. Commercial and Residential /I '_�Y T �DDate ate Ret.1 /
TIGRD, OR 97223 Date to DST _
(503) 639-4171 /� Permit V='
Print or Type Related SWR
Incomplete or illegible applications will not be accepted Called --
Name of Development/Prc;ect On back Indicate Work Performed by Fixture.
lob �C!q/ �ruite
/' FIXTURES (Individual) QTY PRICE WT
Address Street Ad ass Sink r 9.00
w Air C Lavatory 9.00
Bldg 0 II City/Stat3 i-p Tub or Tub/Shower Comb.
—_111 �,••/ 02 `iza�.3 s.ao
Name Shower Only 9.00
Water Closet 9.00
Owlter Mailing Address Suit Dishwasner --
9.00
Garbage Disposal 9.00
City/State Zip i-hone _
! y Washing Mcc„tiine 9.00
Name IS Floor Ora it 2' 9.00
3* 9.00
Occupant Mailing Address Suite 4" 9.00
City/State Zip Phone Water Neater—0conversion O I:ba kind 9.00
Laundry Room Tray n no
Name Urinal —906-
Other Fixtures(Specify) 9.00—'-�—+
Contractor
Mailing Addr ss Suite
900
Prior to permit Cit1�/State Zip Phone _ 9 00
issuance.a copy Q -123 / d f��' 9.00 --II
of all licenses are Oregon ConFt.Coni.Board'ic./ Exp.Date 9.00
required if Ya _ 7- l- 30.00
__—_- '>Y sewer-tsi too•
expired in COT Plumbing Lic.0 Exp.Date Sewer-each additional 100' i
database 25 00
— Name Water Service- 10l 100' 30.0(.
A.chitect Water Service-eacn additional 2500
Or 'lading Address Suite Storm&Rain Drain-1sl too'--- 30.00
Storm ii Rain Drain_e.ch additional 100' 25.00
Engineer city/Stat Zip Phone Mobile Home Space 25.00
Cornmorcial Back Flow Prevention Device or Anti-� 2 5.00
Oescnbe work New Ad ion O Alteration U Repair O Pollution Device
to be done ?esid_ential Non-residential O _ Residential Backflow Prevention Device' 1500 !T�
Additional descno ion of work. Any Trap or Waste Not Connected to a Fixture 900
Catch Basin 9.00
Insp.of Existing Plumbing 4000
---- ver/hr
Existing use of Specially Requested Inspections 4000
budding or property__. ^_______- _ _ per/hr
Rain Drain,single family dwelling 3000
Proposed use of Grease Traps 9.00
budding cr property-_________
QUANTITY TOTAL
I hereby acknowledge that I have read this application.that the information Isometric or riser diagrams required d Ouanrty Total is ,4
given is correct.that I am the owner or authorized agent of the owner,and =SIaBTGTAL
that plans submitted are in compliants with Oregon State Laws. /5
Slyn tura of O ner1A ant Date — -
� 5%SURCHARGE
r
ContactPerson Name Phons
`s PLAN REVIEW 25%OF SUBTOTAL
/
Requ,ed only A fixture qty toter.s 9
/.7�C iLt.�. •�'e�'>>D TOTAL
'Minimum permit fee is;25+5%surcharge.except Residential Backflow
Prevention Device.which is$15+5%surcharge
I dmtopimaco joc 5/W
1
FLLASE COMPLETE:
Fixture Type CurA!'ttity by Work Performed
New Moved Replaced Removed/Capped
Sink
Lp,latory — - —
Tub or Tub/Shower Combination --
Shower Only - —
Water Closet ___ - --- _
_Dishwasher - -
Garbage Disposal - --------
_Washing Machine
Floor Drain 21. - --
311
--
Waiter 4°
—.
eater - --
Laundry Room Tray - ---- -
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1'dstITIMaor tloC 5/97