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15235 SW CRITERION TERRACE i < N o c � (P n N ✓� Ul m U O 00 7 z m cD n n ro m r a 3 I 1 1525 SW CRITERION TERRACE CITY OF TIGARD -,. DEVELOPMENT SERVICES ik 13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 CE RT I F-I C AT E: OF OCCUPANCY PERMIT #F. ., . . . . . : MLST98• OW3 DATE ISSUED- 12/11/98 PARC F.-A-t ::'..c.1 I I DA..-0'+700 G11": ADDRESG. . . 19235p 5k CRITERION Tr:.PR SUBDIVISION. . . . t APPLEWOOD )ARK NO. 2 ZONING:R -7 VID EiLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . ...04.2 ,JURISDICTIONiur CLAS- OF WORK. t NEW TYFaE OF USE. . . :GF TYNE OF CONS', R:5N OC.'CI.JF,FINCY' CiRF,. : R3 OCCUPANCY LOAD-2--' Remat•ks : 9F New - Path I. !.F'(.A ND HoME7l3 6900 SW HAIIVE S fiTF?E:1'c:T PLAZA 2, EFIITEw 200 TIGARD OR 972*23 Phone #t: EN20-8080 r'nntractor : _ _....._..._........._.....__.__.. ... .... ...._........__.____ ._ TEND HOMES C.,OPP W rW HAINEE; ST #Z:00 I GARh OR 147223 Phone 6C-10-8080 I r f+tj 40. : 00060 7hiw Certificate grants occ_upe.ncy of the above rf-ferenced building or pnrtion Hereof and confirms that the bmildinq has I.-30en i.nsperted for compliance with lie 5tai; p of Or-egon Specialty Codem for' the group, occ+#pancy, and ..Ise milder iicl -thp refei•e -ed pevrmit was issued. h ! ,J LDING 11413PECTOR . Au:INfaPErT N S6P R2V SOFT PCIS'(' It.) C-ONSL-'I CUOUS PLACE CITY OF TIGARD -UILDING ►NSPECT ION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST BUP q Date Requested L HM PM ------- BLD Location _� Jr!il ) � ,�f-Atzn J, C� Suite MEC Contact Person Ph PLM — Contractor h.�� _ Ph �=QC �� = SWR -- _—_ 'JIBUILDIN Tenant/Owner _— _-- ELC -- Retaining Wall ELR Footing -- - --- -- Foundation Access: FPS Ftg Drain — Crawl Drain Inspection Notes: SGN — Slab - --- -- - SIT Post& Beam ------- -- _-__-- Fxt Sheath/Shear Int Sheath/Shear --- -- Fre,ning Insulation -- --------- -- ._ Dryweil Nailing ---- —Firewall Fire Fire Sprinkler __-_- --- --- - --- ---- .- Fire Alarm -- Susp'd Ceiling ----- --------....—--- -- ------------ --- - Roof - Mi —. --- -- -- --_--- Rw PART FAIL BINC Post& Beam ---- --- - - -- ----.- -- ---- -__ Under Slab Top Out -- - - - --------- -- --- -- — Water Service Sanitary Sewer - -- - Rain Drains Final - - -- PASS PART FAIL ECHANICAL Post& Ream Rough In ------ ----- ------- -- Gas Line - -- --- - --- -------- - — __.. - -- ---- wuke Dampers A PART FAIL EL CTRICAL -- -- - -- Service Rough In - UG/Slab Low Voltage -- _ -- - Fire Alarm --------- ----- Final - --------...--------- PASS PART FNIL SITE Backfill/Grading �I --.- -- ------- --- ------ — ------- Sanitary Sewer Storm Drain [ ]Reinspection fee of$ - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd C.tui B1sin Fi, • "-,.)ply Line [ ] Please call for reinspection RE:_ —_ [ ] Unable to inspect- no access A,. > Appy. ewalk Other Date -�. inspector Ext Final ---..--- - _ PASS PART _ FAIL. 00 NOT REMOVE this inspection record from the job site. CITY OF TIGARD MASTE=R PERMIT DEVELOPMENT SERVICES OE=RMIT #. . . . . . . : MST98-0103 13125SWHall Blvd., Tigard, 0R97223 (503)639.4171 DATE ISSUED: 08/05/98 PARCEL_: ..'Si 1. 1.DA--04700 SITE=. ADDRESS. . . : 15 ;:;5 SW frc iT-4 TE'RR SUBDIVISION. . . , -.APPL_EWOOD PARK NO. Z ON I N(3: R-7 FAD I;I_OCK. . . . . . . . . . L_0 f. . . . .. . . . . . . . . :042 JURISDICTION: TIB Remarks: SF New - Path I. ---------------------- BUILDING -------------------------- -- -- ------------------------- REISSUE: STORIES.......: 2 FI.6'9R AREAS---------- BASEMENT...: 0 sf RE())TREO SETBACKS---- REQUIRED-------••--- CLASS OF WORK.:NEN HEIGHT..,,,,,.; 24 FIRST....: 842 sf GARAGE.....: 441 sf LEFT.,,,,.,...; 6 SMOKE DETECTRS: Y TYPE OF USE...:9F FLOOR LOAD....: 40 SECOND...: 1007 sf FRONT.........: 20 PARKING SPACES: TYPE OF CONST.:SN DWELLING UNITS: 1 FINBSMFNT: 0 sf RIGHT.........: 14 OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 1849 sf VALUE..$: 131495 REAR..........: 13 ------------------------------------------------------- SINKS.........: 1 WATER CLOSETS.: 3 WASHING MACH..: I LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 100 TRAPS.........: 0 LAVATORIES.... : 4 DISHWASHERS...: 1 FLOOR DRAIN;..: 0 SEWER LINE ft: 100 Sf RAIN DRAINS: 1 CATCH BASINS..: 0 TUB/SHOWERS...: 3 GARBAGE DISP..: I WATER HEATERS.: 1 WATER LINE f : 100 BCKFLW PREVNTR: 1 GREASE TRAPS-: 0 OTHER FIXTURES: 0 ------------------------------------------------------------- - MECHANICAL ----------------------------------------------- FUEL ----------------- --FUEL TYPES----------- FURN f 100E ,,; 1 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1 GAS FURN )=IW ..: 0 UNIT HEATERS..: fi HOODS.........: 1 OTHER UNITS...: 1 MAX INP.- 0 BTU FLOOR FURNACES: 0 VENTS.........: I WOODSTOVES..... 0 GAS OUTLETS...: I --------•--------------•----------------------------------------- ELECTRICAL ------------- --RESIDEN LAI UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- -----MISCELLANEOUS---- --ADD'L 1N%-2CTIONS-- 1000 SF OR LESS: 1 0 - 280 asp. : 0 0 - 200 alp..: 0 W/SVC OR FDR..: a PUMP/IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 5W.: 3 2N1 - 400 asp..: 0 201 - 400 asp..: 0 1st W/O SVCIFDR: 8 SIGN/OUT LIN Ll; 0 PER HOUR...... : 0 LIMITED ENERGY.: 0 401 - 600 amp.. : 0 401 - 600 amp..: 0 EA gDDL BR CTR: 0 SIGNAL/PANEL...: a IN PLANT...... : 0 MANE HM/SVC/FDR: 0 601 - 1000 asp.: 0 601+asps-1000 v: 0 MINOR LABEL -18: 0 1000+ asp/volt.: 0 --------- --------- - ---- ----.._ PLAN REVIEW SECTION ---- -- ------------------------ Reconnect only.: 0 )=4 RF; ;NITS.. : SVC/FDR)=?.25 A.; ) 600 V NOMINW_: CLS 4REA/SPC OCC: --------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY --_.___.__---------- A. SF RESIDENTIAL------------------------- 5. COMMERCIAL---------------------------------------- ------- ---------------------- AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO $ STEREO„: FIRE ALARM.....: INTERCOM/PACING: OUTDOOR INDSC LT: BURf>y_AR ALARM..: 0TH: :: X BOILER.........: HVAC,..........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: :: HVAC...........: DATA/1ELE COMM.: NURSE CALLS....: TOTAL N SYSTEMS: 0 (kner: ------ - -------...----- ContrPctor: -•---------------------------- TOTAL FEES:$ 4676.76 LEGEND HOMES LEGEND HOMES CORP This permit is subject to the regulations contained :n the 6900 SW HAINES STREET 6900 SW HAINES ST #200 Tigard Municipal Code, State of Ore. Specialty Codes and all PLAZA 2, SUITE 200 TIGARD OR 97223 other applicable laws. All work will be done in accordance TIGARD OR 97223 with approved plans. This permit will expire if work is Phone 0: 620-8080 Phone 0: 620--8880 not started within IN days of issuance, or if the work is Reg C.: 88<>68`' suspended for more than 180 days. ATTENTION: Oregon law --- -- - ------ ----------- - ---- '---- - --- requires you to follow rules adopted by the Oregon Utility Notification Center. Trose rules are set forth in OAR 952-001-0010 through OAP, 952--801-•9088. You may obtain copies of these rules or direct questions to OUB by calling (583)246•-1987. -------------•-------------------------------------------•- REQUIRED INSPECTIONS ------------------ ------------ - Erosion 844-8444 Crawl Drain/Back 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 Insp Insulation Insp Appr/Sdwlk Insp _ Post/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final Post/Beam Mechan Electrical Servi Fireplace Insp Rain drain Insp Mechanicjq Final _ 15s1-ked AY :._�(/ —'- .... Permittee SignAtt-:re : —'��'' +-+i•+F + ++++++++++++++++++++-1•++ +++ ++++++++++ h+ + + ++ + +++•f++++ Call 639-4175 by 7:00 p. m. for an inspection needed t ne business day CITY OF TIGARD SEWER CONNECTION DEVELOPMENT SERVICES PERMi-r An-21VM 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 PERMIT #. . . . . . . : SWR98-0060 DATE ISSUED: 08/05/98 PARCEL: 17?SIIIDA-04700 SITE ADDRESS. —: 15235 SW 89TH TERR SUED I V T S I ON. . . . -.HPI11EWOOD PARK NO. 2 ZONING: R-7 PD BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :042 JURISDICTION: TIG ------------------------------------------------------------------------ TENANT NAME. . . . . :LEGEND HOMES USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0 CI-ASS OF WORK. . . :NEW DWELL I NO UN ITS. . I TYPE OF USE. . . . . :SF' NO. OF PUTLDINGS: I INSTALL TYPE. . . . :BU3WR 111PERV :SURF ACE: 0 s RemArks - SF New - Path I. Owner': FEES LEGEND HOMES type amol..tnt by date rec,pt 6900 SW HAINES ST FIRMT $ 2300. 00 DLH 08/05/98 98-308044 PLAZA 2, SUITE 200 INSF` $ 35. 00 DLH 08/05/98 98-308044 TIGARD OR 972,23 Phone #: OWNER Phone #: f 2335. 00 TOTAL Reg #. . : REQUIRED INSPECTIONS This Applicant agrees to comply with all the rules and regulations Sewer Inspection of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expire!;. 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 fDrth in OAR 952-001-0010 thruugh OAR 952-000I-9080. You may obtain copies of these rules or direct questions to IXNC by calling (503)246-1987. Issued by: Permittee Signature ......................4..........*.......................... ......................4 Call 639-4175 by 7:00 p. m. for an inspection needed the next business day ............................. . ++++++++++++++++4++++++++++++++++++++++++++++ Tian Check# J �_ CITY OF TIGARD Resideritis: Building clerrnit Application Recd By (� r- 131.25 SW HALL BLVD. New Construction Adriitions or Alteratioi is Date Recd _ TIGARD, OR 97223 Single Family Detached or Attached (Dupjex) ,pate to P.E. V 503-639-4171 O'Data to DST /i I F 503-684-7297 I (� Permit# Print or Type called 'il Incomplete or illegible applications will not be accepted JName of Project Job , d l Address Site Address � Architect MailiAddress ---- '� �' "� t./ /�l� City/;tate Zip Phone Na e ✓1�LfL1r1� ='-�2'2 � — Na Owner Maili Address n e-rlar)tD i State - Zip Engineer Mailin AddressPhone - . - City/State Zip Phone General Na/m _ _ �� Contractor L fCq �f41-mv �$ _ Describe work ew` Additi6n O `Alteration"O Repair O Mai—lin 'Adddrress to be done: Prior to permit (quo 6 vkj:i or Additional Description of Work: issuance,a copy City/StateZip Phone -- -- _ of all kensPs --- C,z.0 --6p$6 — --_ are required if OregtA Const.Cont.Board Exp.Date PROJECT expired in COT Lic.# / q database U GO 16 0 r VALUATION MecL•,qnical Norte NEW CONSTRUCTION ONLY: Sub- J V n Sq. Ft. House: Sq. Ft. Garage Contractor ling Addrea Prior to permit ` 2 S C C)j h _ Corner Lot YES NO Flag Lot YES N issuance,a copy City/Statb Zip Phone _(check one) (check one) A of all licenses ��t.+fin n�( ,w a 2-5 - Restricted Audio/Stereo Burglar are required if Oregon CCoon's�.Cont.Board Exp.Date , . Energy System Alarm expired in COT Lic.# -- database $13 1 S" 3c� 1�� installation Garage Door HVAC Plumbing Name Opener Systems Sub- l�'U LCt�� (check all that Other: Contractor Mailing Address spply)-- - — �7b �Ox Will the electrical subcontractor wire for all YES NO C?t�11 restricted energy installations? x Prior to permit Cit#state _ Zip Fhcne Has the Subdivision Plat recorded? N/A YES NO issuance,a ropy �a �.7 ( _ of all licenses are Oregon Const Ccnt.Board E(p.Date required if Lic# Reissue of MST#: Solar Compliance expired in COT —-3 �/J 10 (q -9 ,6 _ (Calculation Attached)_ database Plumbing Lic.# Exp. Date I hearby acknowledge that I have read this application,that the -?l �� ' O �� $ information gi^en is correct,that I am the owner or authorized Name -- agent of the owner, and that plans submitted are in ,ompliance Electrical � with Oregon State laws. Signature of Clner/fent' , Date Sub- Mailing Address _ �L_ z j' Contractor 5(v TV tt t Contact Persun Herne Phone# City/State ZIP F e Prior to permit FUR OFF �U$-E ONLY: _ issuance,a coy Sq 1 "(�� C� Y Pr 1�Zo� CTQ�, q f�V Plat#: Map/TL#: of all licenses are Oregon C s�ont. BoafL Exp.Date ��S - _ .1 ��/ ,�l _ ^e,1 � required if Lic.# c� Setbacks. lone: Solar: expired rn COT 1 k P7 Z D 9 - r _ database Electrical Lic.# — Exp Date -- - ''nyclgineering Approval. Planning Approval` TIF: I C- �v i= 10 I SFREM DOC (DST) 4197 Rox S. 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 osindation, the figure is negative. it 3. Measure distance from finished floor elevation to the affected peaWeave. + °2 �- ft If the pouf line runs North-South, deduct three feet. If the roof line runs East-West, , ` it deduct nothing. S. 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 lot has no slope or slopes up from the rear to the front, deduct nothing. _ it 6. Total figure for box R: it Box C. Distance to the shade reduction line. Box G 1. Measure the distance from the North property line to the foundation near the afectedpeaW._avee e fC . 2. Measure the distance from the foundation to the affected peak or eave. + it 3. Total tigure for box C: it It is moat us-%"to draw a vert"Lire to represent the appropriate figure found in boot-A,and a hor4ontal Gne to represent the -` aWapriate figure found in boor'C'.The inte►secnon of the vertical and horizontal Kr+es dem"nines the value found in box ICY. The value in box 'D'should be amipared to the value in box'9'; if the value in bout*9';s cess than or equal to the value found in boot'O', then the )ui6ding is in mmpGance with the solar balance code. If per haw-any quesdogm Please txmt3a us at 639-4171, x304 or at the Cort-munitlr De%*Ioprnent Couni er. MAXIMUM PERMITTED SHADE POINT HEIGHT (In Feet) Qistance to 'north-south hat dimension On feed shade 1004- 95 90 85 W 75 70 65 60 S 50 45 40 redumon tine In"nonherr, Ir*Jnr fialttn_____ 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 33 34 34 34 35 36 37 38 39 40 41 50 32 32 32 .33 34 35 36 37 38 39 40 30 30 30 31 32 33 34 35 36 37 38 39 '0 28 23 28 29 30 1 32 33 34 35 36 37 38 35 26 26 26 27 28 9 30 31 32 33 34 35 36 70 2-4 24 24 25 26 7 28 29 30 31 32 33 34 =5 2-1 22-11 2222 23 24 IS 26 27 28 29 30 31 32 -0 20 20 20 21 22 j1 24 25 36`-ZT 28 _29--m is 18 18 18 19 20 21 22 23 24 25 26 27 28 10 16 16 16 17 1b 19 20 21 22 23 24 25 26 5 14 14 14 15 16 17 18 19 20 21 22 23 24 I Box D. maximum allowed shade point: height o7 C feet h`dorfquncvlre+m"kvstar chp Remsed Solar Balance point Standard Worksheet Address Box A cmlculations: North-South dimension for the lot. Box A. This dimension is determined by find'•• the midpoint of the North lot line and drawing an intersecting Koe perpr:ndicular to that point. First, determine which property line is the North lot line. The North lot line is the line with the smailest angle from a line drawn east-west and intersecting the northern most point of the lot. mss. d5'.-. L tU_ WX N North-South Dimension for Lot: Measure the distance from the midpoint of the North lot line to the South lot line a:,)ng the described line. feet 4 N v'// Box B calculations: Shade point height for your residence. Box 13: 1. Determine whether measurements will be based on the peak or eave of your Which describes structurfi The orientation of the ridge is als-^ ortant your residence? 1a: If the roof line runs North-South, measurements will (circle be based on the peak of the roof. _F1313 0 0 1 b: If the roof line runs East-West and the roof pitch is less Flan 50 2, measurements will �Ce bases..' en the 1r If the roof lire runs East-,vest and the roof pitch is 5/7. 2 or steeper, measurements will be based on the �-n...... peak. FLOT FL 4N LOT #42, AFFLEWOO� � Rl 251 11 D,4 � 15235 SLU 89th TERRACE S.E. 1/4 OF SECTION 11, T.2, R.1W, W M. CITY Oi. 'GARD LU45HINczTON COUNTY, OREGON LEGEND HOMES I. HAWES SIRE TIGARD, OREGON 2, SUITE 200 67223-2514 E (503) 820-6060_ FAX (503) 568-8600 PROVIDE EROSION CONTROL FENCE PER COMMUNITY EROSION PLAN y f- i 2mi5 LOT 43 1�u�I � is N89'54'25" E JI N J I i iq W N -1 0 1 AL1 L0749 ----W -y ILII 29.99' 1 N "+n,L CIA CI WATER METER -""---- WATER LINE w �- �S'-"'- SANITARY SEWER , /i� i R.1902' r / ,�•11.92' D I SG ,— - - — STORM DRAIN `-� 9 / 0 / — -- -- t OF STREET MANHOLE 9 '- / 7/Q r ® CATCH BASIN rn1 O 0 3 r (� PROPOSED STREET® TREES STREET LIGHT R=44.mm J (v IL FIRE HYDRANT r i i �w I L■43.11' � I E Lor 130 N 89'54'25" E 1 58.91' l ?00. 1' / SD-7 TR4Cr C --W---- �\ I LOT ✓1 �m a 1 Lor 41 ' A \ CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: P!M2002-00355 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUcD: 9/9/02 SITE ADDRESS: 15235 SW CRITERION TERR PARCEL: 2S111DA-04700 SUBDIVISION: APPLEWOOD PARK NO. 2 ZONING: R-7 BLOCK: LOT: 042 JURISDICTION: TIG CLASS OF WORK: OFR GARBAGE DISPOSALS: MOBIL` HOME SPACES: TYPE OF USE: )F WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: 133 FLOOR DRAINS: TRAPS: STORIES: WA" _R HEATERS: CATCH BASINS: _ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATOWES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Instaliation of residential backflow prevention device. _ FEES `--- i Ow n a : --------_— Type By Date Amount Receipt ASHUTOSH SANZC3!RI -- -- 15235 SW CRITERION TERR PRMT CTR 9/9/02 $36.25 27200200000 11GARD, OR 97224 5PCT CTR 9/9/02 $2.90 272(.,. 00000 Total $39.15 Phone 1: — Contractor: CASCADE SHOWERS INC 4720 SE BOISE PORTLAND, OR 97206 REQUIRED INSPECTIONS Phone 1: 503-880-9220 RP/Backflow Preventer ^� _ Reg #: LIC 7249 Final Inspection 'This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Code,) end 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 law requires you to follow rules adopted by the Oregon Utility Notification Center. Those r0es are set forth in OAR 952-0001-0010 through OAR 952-0001 0080. You-rl`4 6b'taifTcopies of these rules or direct questions to OUNC by calling (503) 246-1987. sued B a ^ Permittee Signature: , - - Call (503) 619-4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing PermitApplicatinn ID�atere"ccive . �` Permit no.ke�1 "Y City of Tigard J b Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 City of Tigard Phone: (503) 6394171 Project/appl. no.: Expire date: Fax: (503) 598-1960 Date issued: By: Rec ie pt no.: Land use approval: L C.se file no.: Payment type: TYPE OF IsFIRMI'll C7 I &2 family dwelling or accessory 0 Commercial/industrial ❑Multi-family I]Tenant improvement I]New construction I]Addilion/alteration/replacen!"ni I.J Food service ❑Other: h information Job address: 1 Description Qt . Fee(ea.) 'hotal Bldg. no.: Suite no.. ew--and 2-family dweflings only: TeX map/tax/tax IoUaCCount no.: (includes 100 ti.for each utility connection) P SFR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: SFR(3)bath City/count; �(,'tt.v� I ZIP: ZZy Each additional bath/kitchen Description and location of work on premises: _ p Site utilities: Catch basin/area drain ells/leach line/trench t drain Est.date of completion/inspection: � � : Dryw_ — Footing drain(no.lin. ft.) Manufactured home utilities _ Business name: ..i. Manholes _ Address: -r' " gL_) A-vQ, Rain drain connector _ City: C,- e Uh tate: 7.11': 91035 Sanitary sewer(no.lin.f.J Phone: 1�0^`l t Fax:,tz0 " E-mail: Storm sewer(no.lin. P.) CCB no.: ' jtj I I Plumb.bus.reg.no: Water service no.lin ft.) City/metro tic.no.: Fixture or item: Contractor's representative signature: c^ lsr� (�Q_iv Absorption valve �. Back flow preventer Print name: l\aw, 1 r.�tti h Date: tc 4 L Bach eater valve PERSONCONTACT Basins/lavatory Name: Clothes washer Address: - e S{ Dishwasher _ Drinking fountain(s) City: r Slate: p Z[P: 2 O j Ejectors/sump Phone: - •r Fax:b t 0-t E-mail: Expansion tank Fixture/sewer cap �. Floor drains/floor sinks/hub Name(print): 1N SCt n f� -- — Garbage disposal Mailing address: 15-7 3 5 e R,' ,t`�� 7� — I lose bibb - City: 7 SAA State:p ZIP: s1 7 Z i Ice maker Fa Phone: x: E-mail:— Interceptor/grease trap OtWer installation/residential maintenance only: The actual installation Primer(s) _ wil'oe made by me or the maintenance and repair made by my regular Roof drain(commercial) _ employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ i ner's si natur _ Date: Sump Tubs/shower/shower pan Name: Urinal -Water closet _ Address: Water heater City: State: ZIP: Other: Phone: Far: E-mail: - _ oto Not all jurisdictions accept credit cards.please call jurisdiction for tree information. Minimum fee................ $ Notice: This permit application plan review(at _ %) S ❑visa ❑MasterCard expires if a permit is not obtained ° Credit card number: _ — within 180 days after it has been State surcharge(8%).... $ _ Expires Name of ser older a shown on credit card - accepted as complete. TOTAL........................ S _ S _ Cardholder si`neture Amount 4404616(N001COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 243mily dwellings only: - FIXTURES_ _ _ I(ndivldual) __ QTY ea_ AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. CITY (ea) AMOUNT Lavatory 16.60 for each utility connections - -_ One 1 bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two 2'bath _ $350.00 Shower Only - 16.60 Three 3 bath $399.00 Water Closet -� 16.60 - �_ _ SUBTOTAL Urinal 16.60 8%STATE SURCHARGE - Dishwasher 16.60 PLAN REVIEW 25%e_OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater O conversion O like kind 16.60 --� Quantity by Work Performed _ Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. _ _ Capped MFG Home New Water Service 46.40 v Sink _ MFG Home New San/Storm Sewer 46.40 Lavatory Hose Bibs 16.60 --- Tub or Tub/Shower Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) 16.60 Urinal Dishwasher Garbage Disposal �- Laundry Room Tray _ Washing Machine Floor Drain/Sink: 2" Sewer-1 st 100' 55.00 3" Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater Water Service-each additional 200' 46.40 Other Fixtures (Specify) Storm 8 Rain Drain-1st 100' 55.00 Storm 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 -- - - -- Catch Basin 16.60 - Inspection of Existing Plumbirip or Specially 62.50 Requested Inspectionsper/hr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 - _-_ ---- - - QUANTITY TOTAL - -- Isometric or riser diagram Is required If - -- - -- ------ `- OuantHyTotalls >A -- -------- ------------------------- *SUBTOTAL - ---- ------- -- --- 8%STATE SURCHARGE ------- ----.-----..----.---__-- _- **PLAN REVIEW 25%OF SUBTOTAL Required only II fixture qty total is>g _ TOTAL $ *Minimum permit fee is$72 50+896 slate surcharge,except ResidentO Backf ew Prevention Device,which is$36 25•8%state surcharge **ATI New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. i.\dstslforms\pin-fees.doc 12/26/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 INSPECTION DIVISION; Business Line: (503) 639-4171 MST _--- BUP Received __ Date Requested (� ' BUP --_ r � , Location �J a 3 S Suite MEC Contact Person — Ph(--) 922-0 PLM Contractor_ _ Ph( _) _ S W R BUILDING _ Tenant/Owner -_. hLC Footing Foundation E LC - Ftg Drain Access: f' l A� C-awl Crain 57,4 (.)C)t) ' EL.R Slab Inspection Notes: SIT Post&Beam Shear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing -_- Firewall Fire Sprinkler --- - - Fire Alarm Susp'd Ceiling - Roof � Other: - Final — A T FAIL MBIN 4 __ Po m Under Slab _ Rough-In ` Water Service Sanitary Sewer Rain Drains - Catch Basin/Manhole rm Drain - -- S,ower Pan — _ - ASC�)_ART FAIL — -- — _ MECRANICAL Post&Beam ---- ---- ROL,,'On - Gas Line Smoke Dampers Final PASS PART FAIL - -------- ELECTRICAL Service --_ -- - Rough-In UG/Slab -- - - Low Voltage _ Fire Alarm —_ Final Reinspection fee of$ inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL � P --required before next SITE Please Gail for reinspection RE: - Unable to inspect-no access Fire Supply Line ADA Z Approach/Sidewalk Data _ _ Inspector 7_77� Ext Other: Final DO NOT REMOVE this Inspection record from the jub site. PASS PART FAIL I