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13044 SW BROADMOOR PLACE RE,1IS01IS DA It BY PREL116 4R7 M 1 L //MAoxQ.BPERM'T 6ET 6Al M 6 YLU6TER / Ia 41016' ♦a1o'—. 401 r 40 ` V 406 IXIITINS 4'PVC Q UNITARY 61SER LME—� 100 ` IXPO610 AOGRIAOATE i' 40SAO' 404 LOT 14 0�Q CONCRETE DR MAY / � 1,110 60 FT w V \, r-SANITARY SEWER i \ \ �Y 11100= L � �i ATEYERAL11E407 6 40)Jb' l• /i \ ` 4'PvC SANITARY y 0 6BAR LME \ -CC"4C SLAB FDR / F _nQ \ \ \ \\\ \ A r C LIMIT 400 LLI LuOARAO! \ \\ )16 Ill p O /i. \ ►v \\\. \ bQO bb !16 E O 7 MAD, U Lu u a 416 e RIETJ7Yt AK r IIATEER LINE / t'7.00' \ \ 316.00' ♦/ \ \ \ \ \ \\ / WOOD DECK tµ 410.16' �\ \ \ \\ \ ELEV 417i0' x !10 PROPOW 1676 60 FT I•V2 STORY NOUN \\ MAM FLOOR ELEVATION 40,00' /\ LOWER FLOOR ELEVATaN 10lDO' \ / / \ \ \ \ \ 40000 MAO, 412 \` \\ \ \ \ \ \ \ \\ / / 'I MAX bL CPE 109D0'/ ,,p r 410 hV \ ' E�LeOVD ' / i,� x LL N 6CAPE 40600Z IIIALL \ �P> / 0 / CANTELEvER• it NO MA61ER BATN ap 406 .1.,. O\ ' ELL D4bEbK LOT 15 / `,� In 6,410 en FT x � F to6 A. 402DO' J 40ADO' 404 / Q LOT Ib , i al FENCE SAO 00 FT LOT XJ 407 / 3S7 am 60 FT � / \ x / / 4 / n LAz �I too `v / .�-4'AS6 Y RAIN DRAIN a )w O 1TORM DRAM LATERAL f MAO'N• X z 314 EXI6TNG 4'PVC Z Q \ STORM DRAM ONE J !16 IOD0 WIDE PRIVATE - ~ \ STORM DRAMSE EAMENT d HAA!' D ` V \ N � NORTH ` I DRAWN By MICHAEL LOT 15, 'AMESBURY WEIGWTS' SOVE LOCATED N TWE S.E. V4 OF SECTION 4, APPLICANT Ni B(R TOWNSWIP 2 SOUTH, RANGE I WEST, WILLAMETTE MERIDIAN, CITY OF TIGARD, WASHINGTON C004TY, OREGON DALTON CONSTRUCTION 8U5A S.W. HEMLOCK STREET c 13044 S.W. DROADMOOR PLACE TIGARD, OR 91;23 X1( 1T E PLAN TAX MAP 8261005 TAX LOT 0 WO (W3) 4b2-O%S SHEET -0' ZONING, R4A � 12 NOTICE: IF THE PRINT OR TYPE ON ANY _rl �-1 � i � � I � I � I � � I � I � I � � I � I � I � � IIlIII ' llllll r�r�r�"1 11-r-11�1 I � II11 �ff- 1 fllllll IIIIIII 111 � 1 � 1 1III1 I Illlllf f-If .fl_l Ilr(l � I � L f � f 1� f I � I I � IlIII f � f III I �.I_II � I 1111111 IJill II IMAGE I I 4 II I I I I SNOT AS CLEAR AS THIS NOTICE 1 2 1 Q I_ 11 12 IT IS DUE TO THE QUALITY OF THE N0,36 �� ;' '� .. _ _•. . ,. ORIGINAL DOCUMENT - T - - -- - -- --- E 6Z SZ LZ 8� 5Z fiZ EZ Z IZ U�? 16I 8I LT 9I 5i � I ET TI11111[il'i T i 6 8 L 9 9 I I I I I I I I I I I I! I I I I I I I I I I I I I I I I I i l l l l l l l l I I !l fill �111 .11l 111 l loll l ll l l ll Irl l l�I LLI I I I I I l i l 111111111111 , I IIIIII I1J.1 ILII 111 IIII 11.11111 1111 l 11 lll.11ll�lll _.�.. .�� n co O 0 9 O O n n1 r iI 1 I 13044 SW BROADMOOR PLACE CITY CF TIGARD DEVELOPMENT SERVICES 13125 5W Hall Blvd„ Tigard,OR 97223(503)6394171 1, 11 Ili F.rR d0F, PE:RM1 i -*. . . . . . , 1 MS7g8--01 ' - mm i.)aUED: 01/1.5/99 PARCEL..: 25104PS--01500 all"E: ADDRESS. . . t 13044 SW HROADM[71"R I-,L AMtVISION. . . . t AMESPURY HEIGHT/' P. 2ONI103: -4. 5 F]l..l]CIt. . . . . . . . „ 1 LOT. . . . . . . . . . . , 1015 JURI SVICTIONITIC _:LAGS OF, WORK. t NE W l Yr=,E Or UsE'. . . .sr. 1'YF7E. Of: L:ON TR a 5N JCCUt~ANCY URP. :R;3 rirr-1 1PIANCY LOAD 1 c [tOmarks 1 Rath 1 Nen angle fae:ly dwelling wiattached gar;,ge, f.iwneY. t - _.. .. +:c1L_L KIMMER 13044 SW BPOADMOUR VILACC. 11GARD OR 97,.:2 1'hcrne+ #: ,. contractor: __ _...._.._ .... .._._........._....__.. .... _ _._. oAL TON CONSTRUCTION I ldC 1465 SW HEMLOCK ET i iu 11'E. A rIbARD OR 97e:,'-.:'3 I'°hone #: 4a°r.-0969 12 e g 40. . : 0006-77 7'7 Yhf a Certificate grants me upiAncy of the cibnve referenced building or portion / hereof and confirwi that the building has b"on inspec_teri for compliance with the State of Oregon Specialty Codes for the group, aecrupanc,y, and lisp under- ich the r'efere,nC.ed pei mit 1'JAs Jssl.ced. i i tl_111_D I NG INSPECTOR 1-tL i I NSPEC C T I0 :,Uf-T71 POS? IN CONSV,I CUolis r-IL.ACE CITY OF TIGARD 11FISTER PERMIT DEVELOPMENT SERVICES PF NM I T #. . . . . . . .. MSTg8- 0199 OAF,/1.0!90 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 D--JE IO_;UFI7: r'AR1:E'I..: 2"n'404013 01500 T'Tr: ADDRE'.31:i. . . : 1.3044 SW 1 ROAUI1OLiR 91.IBi)1 V I a T nNi. . . . :AMESBURY 1AF.T 0HTS 7C)NI 11\15: R-4. 5 D1 OCI!. . . . . . . . . . 1.117. . . . . . . . . . :015 JIJRISJ)ICT'T0Nt TIG Remarks: Path I - New single family dwelling w/attached garage. -------------------------------------------------------------- BUILDING ------------------ -------------- REI5SUE: STORIES.......: :1 FLOOR AREAS--------- BASEMENT...: 669 sf REQUIRED SETBACKS---- REQUIRED----------- :LASS OF WORK,:NEN HEIGHT........: 30 FIRST....: 2259 sf GARAGE.....: 742 sf LEFT,......... ; `, ME DETECTRS: Y TYPE OF USE..,:SF FLOOR LOAD....: 40 SECOND...: 1366 sf FRONT......,..: 20 PARKING SPACES: 2 TYPE OF CONST,:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 5 OCCUPANCY CRP,:R3 BDRM: 3 BATH: TOTAL-----: 3625 sf VALUE,.1. 268910 REAR..........: 28 ------------------... -----... --- ---.._. ...- -- -- -. ._. PLUMBING ---------..-.-_--..----- ---------------------. SINKS.........: 2 WATER CLOSETS.: WASHING MACH..: 1 LAUNDRY TRAYS.: I RAIN DRAIN ft: 100 TRAPS.........: 0 LAVATORIES....: 5 DTSHWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0 TUB/SHOWERS..,: 4 GARBAGE D15P..: 1 WATER HEATERS,: WATER LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS., : 0 OTHER FIXTURES: 0 —---------------------_.------------- ._--------------------. MECHANICAL ------------------------------------------------------------ 'UPI TYPES----------- FURN I IW_ ..: 0 BOIL/CM0 ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1 WAS FURN )=I00K ,.: 1 UNIT HEATERS..: P HOODS.........: 1 OTHER UNITS...: 1 4AX INP,: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAB OUTLETS...: 1 ------------------------------------------------------------------ ELECTRICAL -----.---- I--------------------- --RESIDENTIkI. UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- -----MISCELLANE(XUS---- --ADD'L INSPECTIONS-- 1000 SF OR LES: 1 0 - 200 amp..: 0 0 - 200 asp..: 0 W/SVC OR FOR... 0 PUMP/IRRIGATION: 0 PCR INSPECTION: 0 EA ADD'L 500SF.: 8 201 - 400 asp..: 0 201 - 180 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OLIT LIN LT: 0 PER HOUR......: 0 LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNALiPANEL...- 0 IN PLANT....... MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0 '.000+ amp/volt.: 0 - - ------- ----.-...- ----- PLAN REVIEW SECTION ----------------- ------------- Reconnect only.: 0 )=4 RES UNITS...- SVC/FDA)=225 A.: 1 600 V NOMINAL: CLS AREA/SPC OCC: ..---------.---- --------------------------- ELECTRICAL - RESTRICTED ENERGY a. Sr RESIDENTIAL-------------------------- B. COMMERCIAL---—-----------------------------—-------------------------------------- nUD1O I STEREO.: VACUUM SYSTEM.,: AUDIO I STEREO.: FIRE gLAPM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM..: OTH, :: X BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: HVAC...........: DATAITELE COMM.: NURSE CALLS....: TOTAL 4 SYSTEMS: ` Owners ------------------------------------Contractor: ------------------------------ TOTAL cEES0 5641.81 DALTON CONSTRUCTION INC DALTON CONSTRUCTION INC This permit is subject to the regulations contained in the 9465A SW HEMLOCK ST 8465-A SW HEMLOCK ST Tigard Municipal Code, State of Ore. Specialty Codes and al) TIGARD OR 97223 TIGARD OR 97223 other applicable laws. All work will be done in accordance with approved plans. 'his permit will expire if work is 'hone It: 452-0969 Phone R• 452-0%9 not started within 190 days of issuance, or if the work is Reg A.. : 000677 suspended for tore than 180 days, ATTENTION: Oregon law ---------------------------------.---------------------------------- requ reg you to follow rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR 952-001-P010 through OAR You say obtain copies of these rules or direct questions to OLRIC by calling 15031246-1987. -------------------- _.---—.-----_--------------------- RMIRED INSPECTION- ---------------------------_�_--------------------- Frosion 844-8444 Post/Bras Mechan Electrical Servi Gas Line Insp Mechanical Final " ,"ing Inspecti Crawl Drain/Back Electrical Rough Insulation Insp Plumb Final ing Insp PLM/Underfloor Frasinc '7sp Water Service In Building Final ,dation Insp Mechanical Insp Shear Wall Insp Appr/Sdwlk Insp 4 Beam Struct Plumb Top Out :-ow Voltage Electrical Final ,r-ted Py : r,ermittFP Signature : I-++ +4.1-4.4-1- 1 rf r ++ + , ; , .I } , 4 f 1 I 1 f 4 F1 + 1-+1 + ++ 1-++ 14.4 .4 + If f I I 1 f ' 1 . f 1 + + fall 6.39--4175 by 100 }r. m. f'c,, an ins,pectiotr needed the next bl_tsiviess duty CITY OF TIGARD DEVELOPMENT SERVICES SEWER CONNECTION L, PERMIT AviasAft 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : SWR98-0 t 10 DATE ISSUED: 06/10/98 PARCEL: 2S104DB-01500 ':+ITE ADDRESS. . . : 13044 SW BROADMOOR PL. SUPDIVISION. . . . :AME:SBURY HEIGHTS ZONING: R-4. 5 Il_OCK. . . . . . . . . . LOT. . . . . . . . . . . . . :015 JURISDICTION: TIG ------------------------------------------------------------------------------------- rFNANT NAME. . . . . :DALTON CONSTRUCTION INC USA NO. . . . . . . . . . : FIXTURE: UNITS. . . 1 0 fl-ASS OF WORK. . . :NEW DWELLING UNITS. . : 1 7YPE OF USE. . . . . :SF NO. OF BUILDINGS: 1 TNSTALL TYPE. . . . :BUSWR IMPERV SURFACE: 0 sf ?emarks: Sewer connection for a new single family dwelling. ']wn er: _ ... ._..__ __.__. ._...._..___._..._.........._..._._..._ _.... _......._.... ._.__._._ ..._.___._...._.._ ___._._ FEES DALTON CONSTRUCTION INC type amotint by date reccpt 134F.,5A SW HEMLOCK ST PRMT $ 2200. 00 JSD 06/10/98 98-306432 TIGARD OR 97223 TNSP $ 35. 00 JSD 06/10/98 98-306 +3P '."hone #: r'ontractor: ---•--_.------__---._---_—.---__— DALTON CONSTRUCTION INC n4r-,5—A SW HEMLOCK ST rIGARD OR 97223 lone #.- 452--0969 $ 2235. 00 TOTAL 000677 --- --- RE'QUIRE'D T NSPFrT I ON5 — —This Applicant agrees to comply with all the rules and regulations Sewer Inspection if the Unified Sewage agency. The permit expires 180 days from `he date issued. The total amnunf pari will be forfeited if the permit empires. The Agency does Ent g,.rarantee the accuracy of the Ade sewer laterals. If the sewer is not lor_ated at the measurement given, the installer shall prospect 3 feet in a'.1 directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Pereit and the 4gency will install a lateral. aTTENTION: Oregon law requires you to `ollow rules adopted by the 7-egon Utility Notificatior Center-. Those rules are set forth in Ch15 952-001-8010 through OrR 952-0801.0080. You may obtain copies of 'hest rules or direct questions to OX y Calling iS03124f,-1987. . .gid by : µ Fermii:tpe ,a�.gnat+.rre: «+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Call S39-4175 by 7:00 p. m. for an inspection needed the next business day ++++++++.+++++++++++++++-:.+++++++•r`+++++++++++++++++++++-+++++++++++++++++++++++++•+ Plan Check# 62 CITYOPTIdARD Residential Building Permit Application Recd By 6R (7 13125 SW HALL BLVD. New Construction Additions or Alterations Date Reed !` ` TIGARD,OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. V 503-639-4171 Date to DST F 503-684-7287 Permit# Print or Type Called Incomplete or illegible applications will not be accepted Name of Project Name Job Amesbury Heights Gpt 15 M . Weirich Architect Mailing Address Address 5iie Address 4351 N City/Slate Zip Phone Name Portland OR 7218 184=61�7 Dalton Construction Inc. - Name Owner Mailing Address Dor? P Sh r Hemlock St. Engineer ineer Mailing Address City/State Zip Phone 3747 S E Morrison St. Ti. and OR 97223 452-0969 City/State :ip Phone General Name Portland nR 1 I-A R 7 6 Contractor Dalton Construction, Inc. Describe work New Rx Addition O Alteration O Repair O Mailing Address to be done: Prior to permit 8 4 6 5 A S .W. Hem 1 oc k St. Additlonal Description of Work: issuance,a copy City/State Zip Phone of all licenses P.igard OR 97223 452 -0969 'X` are regvlrnd H Oregon Const.Cont.Bcard Exp.Date PROJECT expired In COT Llc.# 67798 7-5-9 8 VALUATION $ - � database — — Mechanical Name — — NEW CONSTRUCTION ONLY: Sub- KenTec Heating Contractor 5q. Ft. House: — / ,,,j4i� Sq. Ft. Garage Contractor Mailing Address — _ 3625 7 4 2 _ Prior to permit PO Box 233 1 1 U Hazel Nut Corner Lot YES NO Flag Lot YES NO Issuance,a copy City/State Zip Phone (check one) _ x (check one) of all licenses Woodburn OR 9707 9B2-6082 Restricted Audio/Stereo Burglar are required if Oregon Const.Cont.Board Exp. Dale Energy System X Alarm expired in COT Lic.# 03(,21 7-9-98 database Installation Garage Door HVAC Plumbing Name x Opener X �ystems Sub- J&R P l umbinq (check all that Other: Mailing Address apply) - 1 -- 34308 SW 209th Ave. -- Contractor Will the electrical subcontractor wire far all YES NO restricted energy installations? _ Prior to permit City/State zip Phone Has the Subdivision Plat recorded? I N/A YES NO issuance.a copy Aloha OR 97007 642--7776 of all licenses are Oregon Const.Cont.Board Exp.Date required if Lic.072680 3-28-99 Reissue of MST#: Solar Compliance expired In COT _ _ (Calculation Attached) database Plumbing Lic.# Exp.Date F, I hParby acknowledge that I have read this application,that the 34-214 P B 4-30-98 information given is correct,that I am the owner or authorized Name agent of the owner, and that plans submitted are in compliance with Oregon Slate laws. Electrical Evans Electric Inc. Signature of wner/Agent i Date Sub- Mailing Address � 5/ 12/98 Contractor 1 1 8 67 SW Wilton Ave. Contact Per Name Phone# etty Marie Gabel 452-0969 City/State Zip Phone Prior to permit FOR OFFICE USE ONLY: issuance,a copy Tigard O R 97223 968-3157 Plat N: MapITL#: f f n - of all licenses are Oregon Const.Cont. Board Exp.Date c required if Lic# 0104896 3-6-99 Setbacks: Zone: Solar: expired in COT database Electrical tic.# Exp.Date Engineering Approval: Planning Approval TIF: 34-4050 10-1 -98 - I.SFREM.DOC (DST) 4197 Solar Balance Point Standard Worksheet Lot 15, Amesbury Heights Address 13044 S.W. Broadmoor Place Box A calculations: North-South dimension for the lot. Box A.- This :This dimension is determined by finding the midpoint of the North lot line and drawing an intersecting line perpendicular to that point. Pim, 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. 4!r—• t � �w 1 �w ------ N North-South Dimension for Lot: Measure the distance from the midpoint of the North lot line to the South lot line along the described line. 105. 5 0 feet f N T7 NCWDLICUN > Boat 8 talc- 'ations: 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? 1 a: If the roof line nuns North-South, measurements will �~ (circle one) be based on the peak of the roof, I 0 0 o a to 16 (1C�) 1 b: If the roof line runs East-West and the roof pitch is less ,nan 3/12, measurements will 'e—,used on tF,e �* eave. 1 c: If the rcof line runs East-.Vest and the roof pitch is 5/12 or steeper, measurements will be based on the peak. G---C Box B. continued Box B: ,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 0 It the lot slopes down from the front lot line to the foundation, the figure is negative. ------- 3 measure distance from finished floor elevation to the affected peak'eave. + 24 ft 4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, —LL- deduct nothing. 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, 0 ft 6. ToW Figure for box 8: 24 It Box C. Distance to the shade reduction line. Box C. 1. Measure the distance fmm the North property line to the foundation near the 29 ft affected peak/eave. 2. Measure the distance from the foundadon to the affected peak or eave. + 1 6 ft 3. Total figure for box C: 45 ft It is mcvt useful to draw a vertical One to represent the appropriate fipm frnxsd in boor'A'and a horizontal One to represent the appropriaoe rV"found in box'C'.The intersection of tete vertical and horkonal ruses determines the value found in box'O".The value in box 'O'should be compared to the value in box'R'; if the value in box'8'is lei than or equal to the value found in box 'O', then the bolding is in cnmpl'iance with the solar balance code. If you hoop_any questions,plewe contaa tts at 639-4171,x.304 or at the Community 0 velofxnent Counter. MAXIMUM PERMITTED SHADE POINT HEIGHT (In feet) Oiscame to North-south lot dimension On feet) shade 100+ 95 90 85 80 75 70 65 60 53 50 45 40 redur7ion tine from norther Int rine(10 feet) 70 40 40 40 41 42 43 44 65 38 ! 36 38 39 40 41 42 43 60 36I 36 36 37 38 39 40 41 42 si 34I 34 34 35 36 37 38 39 j0 41 30 32i 32 32 33 34 35 36 37 38 39 40 As 30 . 30 30 31 32 33 34 35 36 37 38 39 .to 28 28 26 29 30 31 32 33 34 35 36 37 38 35 26 26 26 27 26 29 30 31 32 33 34 35 36 70 24 24 24 25 26 27 28 29 30 31 32 33 34 =5 23 2-1 22 23 24 25 26 27 28 2.9 30 31 32 20 20 20 20 21 22 23 24 25 26 27 28 29 30 13 18 18 18 19 20 21 2-1 23 24 25 26 27 28 10 16 16 16 17 18 19 20 21 22 23 24 25 26 5 14 14 14 15 16 17 18 19 20 21 ;i2 23 24 Mx D. Maximum allowed shade point height.: � 10 _ M_ feet h \wW.Cip R"ied 2!36°6 CITY OF iIGARD OREGON INTENT TO HAUL EXCAVATION l4� _ (print name), hereby certify that all excavation material on the subject property will be removed from the site and not be placed as fill, except for that amount necessary to back-fill the foundation ONLY. I understand that failure to remove the excavation material will result in the requirement to remove the material or obtain a grading permit by submitting grading plans prepared by a licensed engineer accompanied by a geo-technical rpport regarding the Placement of the excavation material as fill. Signature Date Joh ^ddress: 3 o yy S�✓ /�vz��a�v+14-,y Q / Subdivision: (A' Lot: a I I i 13125i3WikJdJftvittsiicg0rd, OR 97223 (503) 639-4171 TDD (503) 684-2772 - SEE 35MM ROLI...J# 22 FOR LARGE DOCUMENT I CITY CF TIGARD DEVELOPMENT SERVICES PIL_UMBING V,ERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 F,E RM I T #. . . . . . . : F'LM98-04O9 DATE ISSUED: 11/02/98 FIARCE:t_.: 2S 1 O4DB-0 15 00 !3ITE ADDRESS. . . : 13044 SW I3R0,ADMCIOR FI1_ �31.113DIVISION. . . . AMESPURY HEIGHTS ,'ONING: R---4„ `.5 BLOCK. . . . . . . . . . . LOT. . „ . . . . . . . . . . :015 JURISDICTION: T I G CLASS OF WORK. . :OTR GARBAGE DISPOSALS. - 0 MOBILE HOME: SPACES. : 0 "I YPE OF USE. . . . :13F WASHING MACH. . . . . . : 0 PACKFLOW F,REVNTRS. . 1 OC;C:UP,ANCY GRP,. . :R3 FLflOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WA-1E:R HEATERS. . . . . : 0 C'A'TCH BASINS. . . . . . . ; 0 FIXTURES-------------- L..AUNDRY TRAYS. . , . . : 0 SF RAIN DRAINS. . . . . N SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . : 0 GREASE TRAFIS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURE'S. . . . : 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 backflow prevention device. Owner: --___.__._._.___.____..__.__.________________________.________ FEES DALTON CONSTRUCTION INC type amol..int by date recpt 8465A SW HEMLOCK ST PRMT f 15. O0 DEB 11/02/98 98-310477 TIGARD OR 97223 SPCT f 0. 75 DEB 11/02/98 98-3110477 Flhone #: Di=WAYNE DENNIS 5930 S MORGAN RD ESTACADA OR 97023 C'hone #: 519--7179(MOB) $ 15. 77) TOTAL. Reg #. . : 12319 --------- REQU I RED I NSF'E:CT I ONS This perut is issued subject to the regulations contained i,i the RFS/Backflow F'rev Tigard Municipal Code, State of Ore. Specialty Codes and al.' other Final Inspectionapplicable laws.laws, All Mork Mill be dont in accordance with approved plans. This permit rill expir,a if work is not started within 180 days of issuance, or if work is suspeeded for voce than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-9001-NII through OAR 052-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling _ 503)246-1967. 1ss1.led _ Permittee Signature : +++++........................................ ++++++++++ + + +++ +i+++ ++++.+ Call 639-4175 by 7:00 p. m. for an inspection needed the next 1_:szness day ++++++++++++++++++++.4-+++++++++++++++++i•++++++•.++++++++-+++++++++++++ ++++++++.. CITY OF TIGARD Plumbing Permit Application Plan Che 13125 SW HALL BLVD. Commercial and Residential �. Rec'd By TIGARD, OR 97223 Date Rec'o (503) 639-4171 ��q{� �� Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# LJ4YK-Oyu Related SWR# Called - --.._ Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job 9 / - � Sink 900 Address Stree,Address, / ) Suit (7 Lavatory 9.00 Tub or Tub/Shower Comb. 9.00 Bldg# /Stale r Zi 5Shower Only 9.00 Name Water Closet 9,00 ,n Dishwasher 900 Owner Mailing Adiffess Se Suite Garbage Disposal 9.00 Washing Machine n nn City/State Zip Phone Floor Drain/Floor Sink 2" 9.00 Name 3" 9.00 Occupant Mailino Address Suite �f Water Heater O conversion O like kind 9.00 e-- _y 'C YLf_aUVt' L Gas piping re uires a separate mechanical permit- /State Zip Phone Laundry Room Tray 900 ie�_ Urinal 9.00 Other Fixturas(Specify) goo Contractor Mailing Address Suite 900 9.00 Prior to permit Cit /State Zig Pho Sewer-1st 100' 30.00 issuance,a copy ? --- — / ;ewer-each additional 100' 25.00 of all licenses are Oreg ro I,-Cont.Board Lic.# Exp.Date — — required if D _ Water Service-1st 100' 3006 expired In COT Plumbing is # Exp Date Water Service-each additional 200' 25.00 database — -_ _ Storm&Ram Drain-1st 100' --- - 30.00 Name Storm&Rain Drain-each additional 100' 2500 Architect _ _ _ Mobile Home Space 2500 or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 2500 Pollution Device Engineer I City/State Zip Phone Residential Backflow Prevention Device' 15.00 (Irrigation timing devices require a separate Describe work to be done — rcc!^c!ed eneTLpermit.) __ New O Repair O Replace with like kind Yes O No O Any Trap or Waste Not Connected to a Fixture 9 00 Residential O Commercial O_ Catch Basin 900 Additional description of work _ — Insp of Existing dumbing 40.00 per/hr Specially Requested Inspections 40 U0 per/hr _ Are you capping, moving or replacing any fixtures? i Rain Drain,single family dwelling 30 nn Yes O No O Grease Tr,,.� 900 If yes,see back of form to indicate work performed by -- QUANTITY TOTAL fixture, FAILURE TO ACCURATELY REPORT FIXTURE Isomeric or riser diagram is required N Ouantrty Total Is �9 lNQ�C _RESULT IN�N.QKASED SEWER FEES._ *SUBTOTAL I her et Bye that I have read this appllca that the information ecl_ al I am the owner-Of authorized age t of the owner,and 6% SURCHARGE --~ that I s submi ed are in compliance with Ore on late Laws 2ontac-t i Wert ens' / Date **PLAN REVIEW 26%OF SUBTOTAL ured only If/fixture qty.total is>9 . / TOTAL - 7 Person Name PPhhccnee \ � � Minimum permit fee is$25+ 5%surcharge except Residential Backflow &wb/ �/� Preventton Device,which is$15+5%surrharr,e V "Alt New Commercial Buildings require plans with isometric or riser diagrarn and plan review I Xdst%\plumapp doc.MIN PLEASE COMPLETE: Fixture Type Quantity by Work Performed ---1 New Moved Replaced Removed/Capped Sink Lavatory - Tub or Tub/Shower Combination _ Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine� _ Floor Drain/Floor Sink 2" Water Heater Laundry Room Tray Urinal _ Other Fixtures (Specify) COMMENTS REGARDING ABOVE: