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11304 SW IRONWOOD LOOP ti N w n w E h O E O O CL r 0 0 ti � r a f i E i i dOOrl QOOMNOUl '95 fiO£TT .. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-41751l Business Line: 639-4171 —�� BUP LA LIZ- _ —_Date Requested_ /1 r 2 K r AM. , _--PM — BLD Location �� = CI L4 S(z) r%!, C'n4v�r�� Suite _ � �'( C(Q —00 1� Contact Person Cv ISeIU, �✓t �t z�_,�c i Ph T 3�7 C,)ntractor Ph SWR BUILDING Tenant/Owner ELC _ Retaining Wall ELR Footing Access: Foundation FPS — Fig Drain SGN Crawl Drain Inspection Notes- ---- -- Slab --- ---- ----_ — _— _- --- SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear Framing _— Insulation Drywall Nailing Firewall Fire Sprinkler ___..---.--------------- ---_-----_ __-- Fire Alarm - Susp'd Ceiling - --- ---- ----------- - Roof — —Y Misc: - ---- - --- - - --- -- ------------- Final -- - `- PASS _PART FAIL - -- --- _. . --- - ----- ----- --- --- ( PLUMBING. — Post&Ream - --------- -- Under Slab Top Out -_ - -- -- ---------------- Water Service Sanitary Sewer - - - — ---- -- ------- — RDrains r PART FAIL CHANICAL Dean)Post 8 E�eam ---- --- _ In asLine - - - - -- - - - - ---- ---- -- Srrighe Dampers PART FAIT_ ELECTRICAL .-- Service Rough In � ---- UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill/Grading - -- --- --- — -- Sanitary Sm)r Storm Drain [ Reinspection fr; of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ Please call for:oInspection RE: ( ]Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk --- Date d`b'' Inspector -�� Ext Other 411 — Final PASS PART FAIL 00 NOT REMOVE tons inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line-, 639-4175 Business Lines: 639-4171 BUP Date Requested l (�l �� AM / _PM BLD Y _ Location r ~ t uJ 4�� _ Suite MEC _ Contact Person �Qvyt_[, �0 ti�-� �P � �Ph �J� 9��' PLM Contractor PhCC, ZELC .— BUILDIf Tenant/Owner Retaining'Wa::i Footing Access: Foundation FPS `tg Drain SGN Crawl Drain Inspe&-lo Notes: - -- Slab <-/ { Ccs if SIT _ Post 8 Beam Ext Sheath/Shear _- Int Sheath/Shear Framing -!- _-• -- Insulation Drywall NailingFirewall Fire Sprinkler --- Fire alarm C CC Susp'd Ceiling -_ �-c-Y -�-�--- 1 1/►� �' ---.__ --- - Roof -�- Misc ---- .-_ - -- - -- - - ---- Finalc- PASS PART FAIL PLUMBING Post&Be!am - ____ _ -- -- - - - - -----_.._ ---- —.— _---- ------ -------- Under Slab Top Out Water Service Sanitary Sewer Rain Drains - Final PASS PART FAIL MECHANICAL Post& Beam ---— -------- __ - - ---- - -------� -- Rough In Gas Line ---- ----- ---------- -- _- - -- - --_..- Smoke Dampers <\ Final _.._....------_-____ --- --..--.. _------- -- ------ - - PASS PART FAIL __ Rough In UG/Slab - Low Voltage final PASSAN i FAIL -------- __ - —- -- ---- - --- ---- ----- - �ackflll/Grading ----- __------._-.. --- -- ----- Sanitary Server Storm Drain [ ] Reinspection fee of$-__ required before next'nspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ 1 Please call for reinspection RE [ ]Unable to inspect-no access ADA / r Approach/Sirlewalk Date ! / Ir1Spector Ext Other -_ ^_L _. .. —... Final PASS PART FAIL DJ NOT REMOVE this inspection record from the job site. CITYOF TIGARD _ MECH A-t`VrAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC19-9-00477 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/08/1999 PARCEL: 1 S134A3-00300 SITE ADDRESS: 11304 SW IRONWOOD LP SUBDIVISION: ENGLEWOOD ZONING: R-4.5 BLOCK: LOT: 002 JURISDICTION: T,G CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: 3F UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS _ HOODS: _FUEL TYPES _ 0 - 3 HP: DOMES. INCIN: 3 15 HP: COMML-. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLCD DRYERS: FURN < 100K BTU: 1 _ AIR HANDLING UNITS OThr_R UNITS: FURN >=100K BTU: <= 10000 cfm GAS OUTLETS: 1 > 10000 cfm: Remarks: Install 1 gas furnace furnace, vent not included in appliance pennit and gas piping. Owner: �._ _ FEES LASCINK, GARTH V AND RUBY E Type By Date Amount Receipt 11304 SW IRONWOOD LOOP PRMT KJP 11/08/19f $50.00 99-319630 TIGARD, OR 97223 5PCT KJP 11/08/19 $4.00 99-319630 Phone: __ +____ Total $5400 ti Contractcir: TRI COUNTY TLMP CONTROL 13150 S CL.ACKAMAS RIVER DR OREGON CITY, OR 97045 REQUIRED INSPECTIONS Gas Line Insp Phone: 503.557-2220 Misc. Inspection Reg #:LIC 7262.3 Final Inspection ORIGINAL This 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 wirk is riot started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law requires yc-; to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain coofies of these rules or direct questions to OUNC by calling (503)246-9189. Issue By J Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day SWels led CITY OF TIGARD Plan Chs-a# RECEIV chanical Permit Application. Recd 6;- 1?125 5W HALL BLVD. Commercial and Residential Date Re,.'. TIGARD, OR 97223 NOV 0 :, 1999 Date to P E (503) 639-4171, x304 Date to DST�--, COMMUN111 DEVELOWN' print or Type Permit r (h Ec/ti y _a�y 7 j Incomplete or ills Ible applications will not be acc"ted called Name of DevelopmenWrolect DesCnrpton �- Table 1.4 Mechanical Code _ Qty Price Amt Job sliest AddnSWtM I• A�Permit Fee _ _ '"' 16.00 Address /�%[(-��.c �1�rhGc U�C�I ( 1) Furnace to 100.000 BTU including ducts&vents see footnote 1,2 9.65 Cayrise" LP 21 Furnace 100,000 BTU+ ncludur9 ducts A vents _s_ee footnote 1,2 12.01; Norrap oIbu ) 3) Floor Furnace Owner 1 t "T inducting vent ser footnote 1,1 9.65 Mailing Addraw 4) Suspended healer,wall healer WPr-� or floor mounted healer see footnote 1,2 965 �b 5 Vent not included in appliance pemut 475 0_7,5 cKw_9h" 4 Check all that apply 'Boiler Heat Air i (�v e p7tc'j St{Q��c�(, For items 6-10,see or Pump Cond uty Pn.� Amt j Name( nrrrc of Business) i footnotes 1,2 __ Coin `� 100K BTU 9.65.It IC (;:,A , 0-21--e6)<3HP;absorb unit to _ Occupant MaungAedre., 7)3-15 HP,absorb unit _ 1 U01k to 500k BTU _ 17.65 Cnpsute iTcrwne'— --� E) 15-30 HP;absorb _ unit.5 1 mil BT_U_ 24.15 L 9)30.50 HP,absorb COntraCtDr Name unit 1-1 75 mil BTU 36.00 Fy7��' iii s 10) '501-1-P—absorb unit Prrnr to normlt Moog Address ,1 75 mil BTU _ �_ _( �q.15 _ issuance,a copy � 9��4 lint 11 Ai;handling unit to 10,000 CFM of all licenses CKY/8raie Zip Phar�r 7 n0 are required if .� 'Cv E.G,(- 7.S 17)Air handling unit 10.000 CFM+ --I expired in COT Oregon coral cont.t>a es Ere^ Date 11,85 F� database � 2 ._j ) _ M)Non-portable ova oor_ata cooler v� Architect "ams _ I4)vent left connected to 7.0071. a single o.'^t or Mailing Address - 4 15)Ventilation system not included to _ _ apphanre permit _ 700 Engineer Cor/Slate 7-ir on�r,e! 16)Hood served by mechanic,exhaust _ _ —--� _4 7.00 Ck±scam work to be done - 171 Domestic incinerators _ 12.00 New - Repair O Replace with like kind Yes O No O 18)Commercial or induslnal type inanerator Res,clerdmalY Commernal0 48.25 _ 19)Repair units �A,ddrttonal information or des xrptron of work _ 6.40 I 20)Wood stove/gas FPlother units/clothe dryerletc _ 7.00 NOTE: For Commema'protects only;Units over 400 lbs require 21)Gas piping one to four outlets _ structural gas talcs See footnote 1 _ 375 3, Type of fuel oil O natural pas V LPG Cr elednc c) 22)Mare than 4-per pullet(each) Minimum Permit Fee$5_0 00 (1 I hereby b knowledge That I have read Umis arplkc atrnn that the Information- _ _ --_ SURCHARGE. -„. it given is cnr,act that I am the mvner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL + ,r rrrrits only ; a the owner,That plans submitted are in compliance with h Oregon State law ._—Required for ALL commer�c_ial TOTAL ' L Signare of OwnerfAgent [late tu Other Inspections and Fees: �T/ 0 v _ 1. Inspections outside of normal business hours(mininum charge-two Con P on Neots phone hours) $50.00 ver hour A 2. Inspections for which no fin Is specifically indicated t ninimum charge-half hour) $50.00 per hour foOf104nf—comm rcial projects only: 3. Additional plan review required by changes,addtbons n, v viotiens to 1. Ptovkb ftd schermafrc of existing and proposed gas fine and pressure plane(minimum charge-erre-half hour)$50.00 per hour 2. Provide drawirgs to stoke showing exMling and proposed mechanical units 'State Contractor Boiler Certification required -- —— — —Residential AIC requires site plan showing placement of un" 1 lmechperm doc rev 7/19M9 CITY OF T I G A R D — ELECTRICAL PERMIT PERMIT#: ELC1999-00679 DEVELOPMENT SERVICES DATE ISSUED: 11/12/1999 13125 SW Hall Clvd.,Tioard, OR 97223 (503) 639-4171 PARCEL: 1S134AB-00300 SITE ADDRESS: 11304 SW !RONWOOD LP SUBDIVISION: ENGLEWOCD ZONING: R-4.5 BLOCK: LOT : 002 jURISDICTIUN: TIG Proiect Description: Install 2 branch circuits in single family dwelling. RES+DENTIAL UNIT TEMP SRVC/FEEDERS _MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION: EACH ADD'L. 500SF: 201 •• 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER — BRANCH CIRCUITS _ADD'L INSPECTIONS 0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 arrp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVS.:/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Own 3r: Contractor: LASCINK, GARTH V AND RUBY E BOONES FERRY ELECTRICAL 11304 SW IRONWOOD LOOP PO BOX 628 TIGARD, OR 97223 WILSONVILLE, OR 97070 Phone: Phone: 682-4936 ORIGNAL Reg#: SUP 00088 LIC 00088. 82 ELE 3-2230 FEES _ 'eAuired Inspections Type By Date Amount Receipt —..r— Elect'I Service PRMT KJP 11/12/199 $42.85 99-319728 Elect'I Final 5PCT KJP 11/12/199 $3.43 99-319728 Total $46.28 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, Slate of OR. Speraa,ty 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 wor'< is suspended for mo,e than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth it OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these ules ordirect questions to OUNC at(503) 246-1987 PERMITTEE'S SI(•NAT"JRE --�y1 Ck, � ; ISSUED BY: ___ _ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: C_ONTPACTOR INSTALLATION ONLY _ <.2 sc tcr,_? SIGNATURE OF SUPR. ELEC'N: c=c._�� r)ATE:_� �.� LICENSE NO: __ 300 S _�—_--- –-- Call 679-4175 by 7:00pm for an inspection the next business day CITY OF TIGARD PI an 13125 SW HALL BLV) i 1999 Electrical Permit Application Rec'a eckak^`----_ Recd By TIGARD OR 97223EMT Date Recd Nltt ,,,.vr.LUP1� Date to f.E. Phone(503)B: ,17�t W Date to DST Inspection(503)639A175 Print of Type - Permit aE L l-n0 � Fax(503)598-1960 Incomplete or illegible will not be accepted Called ^ y� 1. Job Address: 4. Complete FPe Schedule Below: Name of Development— Number of Inspections per permit allowed Name(or name of business) •'/r '7 1_1L. �; �t k� Service included: Items Cost Sum Address ZI ✓011 r;Gc.�) _ rr'vVl 1> ),O ,LC>r�� 4a. rResaerltial•per unit CI /StatP�l ( J f t r,.> 1000 aq-n.or less S 11775 a ry p— _ � ��., ---- - - addAionai 5rA sq n.of portion thereof S tri 25 1 Cornmerual❑ Residential united Fnergy — $ 1110 no -Each Manufd home or&odular - - - 2a. Contractor installatiun only: Dwelling Service or feeder __ S 72 75 2 (Prior to permit Issuance,applicants must provide contractor license 4b.Services or Feeders information for COT data base). Installation,alteration.ur reincalion Electrical Contractor Ei00NES FERRY ELECTRIC _ 200 amps or less S 6425 2 Address P 0 Box f?�fi 701 amps to 400 amas s 8550 _�- 2 City W i 1 S 6-n-'71 1lSlate 0 R _Zip-27 010 401 amps to 600 amps ,--_ s 128.50 - 2 601 amps to 1000 amps S 19250 7 Phone No - 503-682 -4936-- t i'war 1000 amps or vans - -- 3 38375 - - - - z JO o -1---2 _ Peconned only $ 5350 z Flec.Cont.Lice. No -2 23—` Exp.Date N 1 O O 4c.Temporary Services or Fs,eders ' OR State CCB Reg No. 8 8 4 8 2 Exp.Date 2.1 2-3j Cj-' installation,alteration,or relocation COT Business Tax or Me N 3. 0 2 8 5 1 Exp Date_g.Zj/9 200 amps or less S 5350 _ z 201 amps to 400 amps S 80 25 2 Signature of Supr EI v�G�c�,�i 401 amps to 600 amps _ S 10700 W- -- --- Over 000 amps to 1000 volts, _Exp Date 1 0/1/0 , see"b"above License No 3 170 S 1' Phone No _ 682--49315 4d gnncnclrzults New,aneration or extension per panel a) the fee tot branch circu'fs 2b. For owner installations: With purchase of service or feeder fee. Punt Owners NamnEach branch circuitS 535 2 b)The lee for branch circuits Address-------- without parchasa of service --- City--_----- — -Slate--_IIp — - — or feeder fee. _ Phone No _ _ First branch clrwd TL� S 37.50 3O Each additional branch circuit --�_- S 5 3.5 The installation is being made on property I own which is not 4e.Miacenaneous intended for sale,!ease or rent. (Service or feeder rot Inchuded) Encti pump or irrigation circle S 42 75 _ llwrter'S Signalure- Each sign or outline lighting S 42.75 —� Signal clnuil(s)or a limned energy * panel,aneration or extension S 60 00 3. Plan Review section (ii required): Minor I abels(10) ^�--- S 107.00 Please check apF mpriate Item arid enter fee in section 5A. 41`.Each additional Inspection over — 4 or more residential units in one structure the allowable In any or C he above ;ervkm n and leader 225 amps or ore 1'er Inspection S 50,00 -- f'rr hour S 50,00 System over rM vans noininal In Plant — -- f 59 00 — - - - — Cclassified area or structure conlainiN sperial occupancy a --- --_ described in N E.0 Chapter 5 5. Fees: 6a.Enlor total of above roes S �� Submit 2 sets of plans with appllcatlon whore -(the above apply. 1111%S itc harge(05 X tltal fees) S Not required for temporary construction service Subrofal s b Sh Filar 25%of line Sa for NOTICE Plan ftecrieY if Tgulrod(Ser_ 3) S PERMITS t3ECOMt VOID If M)FRK OR CONSTRUCTION AU IHORIZEO Subtotal s y IS NOT COMMENCED W111IIN 180 DAYS,OR IF CONSTRUCTION Oil r , WORK IS SUSPENDED OR ABANDONED FOR A PFRIOD OF 180 DAYS LJ Trust Arxount 0 _ AT AMY TIME AF117-.R WORK IS COMMENCED Total balance Due $ iMsformstelectric dnc ?on nen nr r rn r r r nn♦ CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM1999 00371 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: SITE ADDRESS: 11304 SW IRONWOOD LP PARCEL.: 1S134AB-00300 SUBDIVISION: ENGLEWOOD ZONING: R-4.5 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE_TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SPOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install new water heater. _ Owner: FEES �--— — - —� - -'-' Type By Date Amount R,:ceipt LASCINK, GARTH V AND RUBY E 11304 SW IRONWOOD LOOP PRMT KJP 11/081199 $50.00 S� 119631 TIGARD, OR 97223 5PCT KJP 11/08/199 _ $4.00 99-31,16;:1 LTotal $54.00___ Phone I: Contractor: TRI COUNTY TEMP CONTROL 13150 S CLACKAMAS RIVER DR OREGON CITY, OR 97015 REQUIRED INSPECTIONS Phone 1: 557-2220 Misc. Inspection Reg 4: LIC 72.623 Fina !nspection PLM 26-428PB ORIGINAL This permit is is---ued subject to fie regulations contained in the Tigard Municipal Code, State of OR. Specialty Cedes and all other ap,!ic2I)le 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. ATTENTIONS Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: -Q-Lk--7'0- w—.,/ _ Permittee Signature: 1T7 6LZ-i'e( Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check. _ 13125 SW HALL BLVD. RECEIVED Commercial and Residential Recd By TIGARD, OR 97223 Date Recd (503) 639-4171 Date to P.E. NOV1 j Print or Type Dale to Ds - If �&Mtft,?r,�1k{g)ble applications will not be accepted Pelmhlk Related SWR*-_- Called Name of Development/Pro)ect FIXTURES,0ndIVIdUAl)�a , I ": QTY i,' ("PRICE AMT Job Sink 9.00 Address Street Address Suite Lavatory, - 9.00 Tub or Tub/Shower Comb. - 9.00 Bldg ar Clty/State ZI r - -'� r �- shower Only 0.00 lli.?�t` r TZ�' Name J / Water Closet 9.00 �4' LOS( hl4< Dishwasher 9.00 Owner Mailing Address _ Suite Garbage Disposal -9.00 Washing Machine 9.00 - City/xate Zip Phone - - , Floor Drain/Floor Sink 2" 9.00 Name 3" 9.00 J C%J/ 4" - 9.00 OccupantMailing Address 7 Suite Water Heater conversion O like kind 9.00 d 3Jq Sk l j476ti-(*16 --_- Gas pipin requires a separate mechanical permit. _ City/State Zip Phone laundry Room Tray 9.00 c( 7-23 Q J'�l� Urinal --- 9.00 Nie // Othe,Fixtures(Specify) 9.00 u w &/ick ---- -- - Contractor Mailing Address/ Suite - 9.00 3/50 5 lrytJilu� k u Y - - --- 9.00 Prior to permit Clty/State Zip Phone Sewer-1st 100' _-- 30.00 Issuance,a copy (1W Q76 5��'L 2GG --- - - �Y- £ewer-each additional 100' 25.00 of all licenses are Oregon 06fist.Cont.Board Lie.# Exp.Date - ---. required If - 31 3.Z 1 �- Water Service-1a 100' -_ 30.00 expired In COT Plumbing Lie.9# -, Exp. t Water Service-each additional 200' 25.00 database C�Zh _P�S �_ �' uUG �" Storm&Rain Drain-1st 100' 30.00 -- Name Storm 6 Rain Drain-each additional 100' 2500 Architect Mobile Home Space - -- 25.00 or Malling Address Suite Commercial Back Flow Prevention Device or Anil- 25.00 Pollution Device Engineer City/State Zip Phone Residential Backflow Prevention Device* 15.00 (Irrigation timing devices require a separate Describe work to be done: reslr cted_energy permit.) NewR air U Replace with like kind Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 Rosid n ial Commercial O Catch Basin 9.00 Additional d scription of work: -- - Insp.of Existing Plumbing , 40.00 per/hr Specially Requested Inspections �I 40.00 perthr Rain Drain,single family dwelling 30.00 Are you capping, moving or replacing any fixtures? ----- -.--- Grease Traps 9.00 'Yes O No O If yes,see back of form to Indizate work performed b� -- --- QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagramis required N Uuantity Total is >9 WORK COULD RESULT IN INCREASED SEWER FEES. _ - `SUBTOTAL I hereby acknowledge that I have read this application,that the information given Is correct,that I am the owner or authorized agent of the owner,and 6%SURCHARGE that plans submitted are in compliance with Oregon Slate Laws. _ Signature of Owner/Agent o �r "'PLAN REVIEW 26%OF SUBTOTAL /1 Required only 9 ix1u=ty total Is>9 2 TOTAL. Cnn(�)Porion Name ? 'Minimum permit feo Is$25+5%surcharge,except Residential Backflo `fir 7 S k Prevention Device,which Is$15+5%curt harge - "AII New Commercial Buildings regltlre plans with isrimeMc or riser diagram 1/ and plan review I tdsiMpkxnapt+doc 7r2799 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced e Removed/Cap d� p Sink - Lavatory Tub or Tub/Shower Combination _ -- — Shower Only -- — Water Closet Dishwasher _ Garbage Disposal Washina Machine _ Floor Drain/Floor Sink 2" 410 Water Heater LaundryRoom Tray _ Urinal_ - — — — -- Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I ldsWj*l mapp do 711/4