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10747 SW NORTH DAKOTA STREET-2 S VION110 H1HON MS MM f co Q 0 ILY ca �. 0 m w cn 0 r 10747 SUV NORTH DAKOTA ST CITY OF TIGARD MASTER PERMIT �e PERMIT#: MST2003-00411 DEVELOPMENT SERVICES DATE ISSUED: 9/11/03 13135 SW Ha11 Blvd.,Tigard,OR 97223 (503)6394171 SITE ADDRESS: 10747 SW NORTH DAKOTA ST PARCEL: 1S134DA-06300 SUBDIVISION: PP1991-107 ZONING: R-4.5 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: 625 sq ft master bedroom addition. BUILDING .__. RE.ISSIIF: CUSTOM STORIES I FLOOR AREAS 14EQUIRED SETBACKS RIC~ CLASS OF WORK: ADD HEIGHT: FIRST!f 625 of BASEMENT: III LEFT: 5 SMOKE DETECTORS: Y 1 YPE OF USE: SF FLOOR LOAD, 40 SECOND: of GARAGE: of FRONT: 20 PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: I TMA of RIGHT: 5 , OCCUPANCY ORP: R7 BORM: BATH: TOTAL: 525 111VALUE: 57750 DO f REAR: 15 PLUMBING - SINKS: WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS. I CATCH BASINS: TuRiSHOWERS: I GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTW GREASE TRAPS- OTHER FIXTURES: MECHANICAL FUEL T`I. FURN a 100K: BOIUCMP<3HP: VENT FANS: I Ct OTHES DRYER: ~— FURN>-100K: UNIT HEATERS: HOODS. Ol HER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS. ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 3F OR LESS: 0 200 emp: 0 200 amp: WIS VC OR FOR: PUMPORRIGATION: PEP INSPECTION: EA ADD'L 50QSF: 21" - 400 emp: 201 400 nnp: let WIO SVC/FDR: 00 SIGNIOUr LIN LT: PER HOUR: LIMITED ENERGY 401 - !00 amp: 401 800 amp: FAADDL BR CIR: I nO SIGNALIPANEL: IN PLANT: MANU HWAVCIFDR: 601 1000 4m0: eM+amps-1000x. MINOR LABEL 1000-amnlvoll: PLAN REVIEW SECTION Reconnect only: '—.- -4 RES UNITS: SVCIFDR>R225 A.: >600 V NOMINAL: CL9 ARENSPC OCC: ELEC rRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO a STEREO: VACUUM SYSTEM: AUDIO A STEREO: FIRE ALARM: INTERCOMVPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPIMRRIG: PROTECTIVE SIGNL: GARAGE OPENER- CLACK: INSTRUMENTATION: MEDICAL: OTHR- MVAC: DATA7TELE COMM: NURSE CALLS: TOTAL!SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,221.90 WHITNEY,JACK C HEATHER A VINTAGE REMODELING This permit Is subject to the regLItations container)In the 10747 SW NORTH DAKOTA ST 5301 EDMONDS I-N,NE Tigard other r applicable Code,State o k Specialty Codes and TIGARD,OR 97223 BROOKS.OR 97305 all other ce puha laws. All work will be done in accordance with approved plans. This permit wHl expire If work is not started within 180 days of Issuance,or If the IL work's suspended for more than 180 days. ATTENTION: FE Oregon law requires you to follow rules adcpted by the ti P"°n": Phone: 503-803-4399 Oregon Utility Notification Center. Those rules are set U) forth in OAR 952-001-0010 through 952-001-0080. You Rao�° LIC 16766 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS W Erosion Control Insp 8, Underfloor Insulation Electrical Rough In Rain drain Insp J Footing Insp Crswt Drain/Backwater Framing Insp Electrical Final Foundation Insp PLM/Underfloor Shear Wall Insp Mechanical Final Post/Beam Structural Mechanical Insp Exterior Sheathing Inst Plumb Final Post/Beam Mechanica Plumb Top Out Insulation Insp Final inspection Issued By : ` w ' Permittee Signature Cali (503)639-4175 by 7:00 p.m.for an Inspection needed the next business dari 70 -r X3-2 -en tA,%V RuAldingfermit ,Application t i Received Building DateF D Permit No.: 0�003'� Planning Approval Other City of Tigard DateB : Permit No.: 13125 SW Hall Blvd. Plan Review Other I Tigard,Oregon 97223 Dat&B :tihv Y'.)-0 11 Permit No.: Phone: 503-639-4171 Fax: 503-599-1960 Post-Review land Use Date/By Case No. Internet: www.ci.tigard.or.us Contact i see Page 2 for 24-hour Inspection Request: 503-639-4175 (� Name/Method: Supplemental Information New construction Demolition Addition/alteration/replacement 0 Other: Note: Permit tees•are based on the total value of the work performed. Indicate 1 & 2-Family dwelling CommerciaUIndustrial the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application. Accessory Building Multi-Family Master Builder Other: Valuatiotp.. ................................... a 71 750 , No.of bedroo s:. / _ No.of baths: Job site adtfress: j `7]Rtpr Total number of floors .//. .. New dwelling area(sq. ft.).........b,�}.................. Suite#: Bld ./Apt.#: Garage/carport area(sq.ft.)............................ Project Name: Covered porch area(sq.ft.)............................. Cross street/Directions tojA site: Deck area(sq. ft.)........................................... Other structure area(sq.ft.)............................ NAME Subdivision: Tax map/parcel #: Note: Permit fees'are based on the total value of the work performed. Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application. (l `l Valuation........................................................ $ —�—'— -� Existing building area(sq.ft.)......................... --- - —_ New building area(sq.ft.)............................... Number of stories............................................ `— ?• Type of construction............... Name: u Occupancy group(s): Existing: -- New: Address. 7 _r-10-174 City/State/Zi Phone: Fax: NOTICE: All contractors and subcjntractors are required to be 3 licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: Q, Address: _^ City/State/Zip: — N Phone: _ —Fax: E-mail: m Business Name: V1 Inc Fees due upon application.......... .......... S uu Address: 'I Cit /State/Zi • Etnt) Amount received.................... Phone: D Fax:� - Date received: SignatuAuthore: Notice: This permit application expires If a permit is not obtained wit'iln Signature: w� Date 1R0 days after It has been accepted as complete. __. 101a "Fee methodology set by Tri-County Building Industry Service Board (Please pr' e) p� p i:\DstslPermit Forms0dgPerrnitApp.doc 01/03 ��So + I'l- n I'-, ` Y 1 - t-DO-43V One- and Two-Family Dwelling Building Permit Application Checklist Reference no.: Cir✓ofTigardCit of Tigard Associated permits: City g O Elecuical O Plumbing ❑Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 O Other: _ Phone: (503) 639-4171 Fax: (503) 598-1960 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. _ 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. _ 3 Verification of approved plat/lot. _ 4 Fire district_ _ approval required. 7 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applic le stamp and signature on file or with application. 9 Erosion control ❑plan ❑permit requireInclude drainage-way protection,silt fence design and location of catch-basin protection,etc. _ 10 3 Complete sets of legible plans.Must be rawn to scale,showing conformance to applicable local and state building codes.Lateral design details and tonne ions must be incorporated into tine plans or on a separate full-size sheet attached to the plans with cross referencesb ween plan location and details. Plan review cannot be completed if copyright violations exist. 1 I Site/plot plan drawn to sale.The plan must show lot a 1 building setback dimensions;property mer elevations(if there is more than a 4-ft.elevation differential,plan musts w contour lines at 2-ft.intervals); ation of easements and driveway;footprint of structure(including decks);location o wells/septic systems;utility I tions;direction indicator;lot area;building coverage area;percentage of coverage;impervi s area;existing structure n site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold- w is and reinforci pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window s e,loc n of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30' es above grade,etc. 14 (Toss sectlon(s)and details.Show all framing-member sizA�gheight, ► such as floor beams,headers,joists,sub-floor, wall construction,mof construction.More than one cross see uired to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,cesidi material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. _ 15 Elevation views.Provide elevations for new cons tion;minimum of two cl\are for additions and remodels. Exterior elevations must reflect the actual grad the change.in grade is greatour foot at building envelope. Full-size sheet addendums showing founda' elevations with cross referencece table. 16 Wall bracing(prescriptive path)and!jWlateral analysis plans.Must indicate details d locations;for non-prescriptive path analysis rrov' s ecifications and calculations to engineering star rds. _ 17 Floor/roof framing.Provide p ns for all floors/roof assemblies,indicating member sizing, acing,and bearing locations.Show attic ve tion. 18 Basement and re ng galls. Provide cross sections and details showing placement of rebar.F engineered systems,seqite6 22,"Engineer's calculations." 19 Beam c culations.Provide two sets of calculations using current code design values for all beams and Itiple joists (L over 10 feet long and/or any beam/joist carrying a non-uniform load. _ It 20 Manufactured floor!roof truss design details. N21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. _ 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. W L7 W "Fiveite plans are required for Item 11 above. Site plans must be 8-1/2"x 1 I"or 11"x 17ets each are required for Items 16, 19,20&22 above. _ 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit& System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 4614(6100con) " 82-.1-2'w C I wH MY HOLSE ADDITUN 10 74 7 SW NORTH DAKOTA TIOARD,OR I TAX LOT 4199 1-10 7 I a I 1 F Q I I PROPOSED I ADDrMN a \0 �p I ra I � N• N p I I EXIS TING S TR U'T1R E I moi_ s I I p I 66_39' T I I II I i I I CL l a I � II I I NORTH � � I netMo e�rwwr 1 RECEIVED P IG 0 2003 CITY 01- TK ARD BUILDING DIVISION • 1 CffY OF TIGARD-SITE PLAN REV E BUILDING PERMIT NO.. PLANNING DIVISION' Required Setbacks: ,r cks: Approved G] Not Approved Side. Street Side: 4— Front. _20_ Garage: K:E Rear: v isual Clearance: PQ Approved [] Not Approved Maximum Building Height ,30— feet CWS Service wider better Required: 'Yes ❑ No ❑ Received BSA: J< • ��t.�.a� nate.&4tLr4a %NCINFF.RING DEPARTMENT: Actual Slope.-% Approved ❑ Not Approved Site plait: Approved E] Not Approved H,,. � , Date• r a ac W J oY2� 'uka t3- CleanWaterServices 01]r cnuiniitnient is clear. September 4, 2003 CO 6b G0�f D1VIS10" Kim Okelberry zi` 01. 5301 Edmond lane N.E. Brooks, Oregon 97305 RE: Whitney Vintage Remodeling 1S134DA06300 Clean Water Services has received your Sensitive Area Certification for the above referenced site. District staff has reviewed the submitted materials including site conditions and the description of your project. Staff concurs that the above referenced project will not significantly impact the existing sensitive areas found near the site. In light of this result, this document will serve as your Service Provider letter as required by Resolution and Order 03-11, Section 3.02.1, and your Stormwater Connection authorization from Clean Water Services as required by Crdinance 27, Section 4.13. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. This letter does NOT eliminate the rneed to protect sensitive areas if they are subsequently identified on your site. If you have any questions, please call me at 503-846-3613. Si,icerely, H Astrid Dragoy Site Assessment Coordinator m W J F:1De%vk j merit 3vrel4P 00-7lForm Documenta Camw with cat-no hrpact to water gaulity.doc 155 N First Avenue,Suite 270• Hillsboro,Oregon 97124 Phone:(503)846-8621 •Fax:(50"1)846-3525•www.cleenwaterservices.org ■ z OOZ9 En _ X16 ExiStiNj Neuse cuni i_ Prp e5e 0069• a _ h W J ■ � r CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ADVENT CONSTRUCTION LI-C 18710 SW VINCENT ST ALOHA, OR 97007 Electrical Signature Form Permit #: MST2CO3-00411 Date issued: 9111103 Parcel: 1 S134DA-06300 Site Address: 10747 SW NORTH DAKOTA ST Subdivision: PP1991-107 Block: Lot: 003 Jurisdiction: TIG Zoning: R-4.5 Remarks: 625 sq ft master bedroom addition. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: WHITNEY, .JACK C + HEATHER A ADVENT CONSTRUCTION LLC 10747 SW NORTH DAKOTA ST 18710 SW VINCENT ST TIGARD, OR 97223 ALOHA, OR 97007 Phone #: Phone #: 503-259-2548 Req#: ELE 34-6120 IL LIC 153338 pK SUP 23355 H AN INK SIGNATURE IS REQUIRED ON THIS FORM M W x L tJ Signature of Supervising Elec rician If you have any questions, please call 503.718.2433. CITY OF TIGARD Y►rl �"' BUILDING DIVISION PERMIT 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: .. TIME: PAGE: SITE ADDRESS: 107 4'1 Dck K# � CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: L/ PHONE #: Q 43 �r/ Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message ff V\�L D\h/ G r►r�L 9 m 150)1 Correcfions7 Commentslnstrutrions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS (� FAIL ❑ CALL FOR !NSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: _i�_, _ _ Date: .3 _dam__ Phone #: (503) 718- dul�� CITY OF TIGARD (t) ST' allILDING DIVISION PERMIT#: 13125 SW Hall Blvd ,Tigard, OR 97223 DATE ISSUED:aw Phone: (503) 639-4171 Inspbction Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: .3 - 9 TIME: PAGE: SITE ADDRESS: ,� CLASS OF WORK: SUBDIVISION: LOT#: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: �l � PHONE #:47P 3— Li`.3 Inspection Request Scheduled For: Date: Pour Time: Code # © Inspection Description Confirm # Contact # Message -T v Corrections/Comments/Instructions: QC a m J PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION [] ADDITIONAL FEES ASSESSED Inspector: __ _� Date. =9— !T!!c__ Phone #: (503) 718- CITY- OF TIGARD , - BUrLDING DIVISIG.- (�'� PERMIT C MST.1003-D0#11 13125 SW Hall Blvd., Tigard, C., 5,'223 DATE ISSUED: Phone: (503) 639.4171 Inspection Requests (24 Hrs.): (503)639-4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESSJ 074 7 Me et� kko4r CLASS OF WORK:PLm,(3 SUBDIVISION: LOT C TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: /� ,M PHONE #: CONTRACTOR: k PHONE#: Inspection Request Scheduled For: Date: Pour Time: Code # 399 Inspection Description Confirm # Contact # Message 9 Corrections/Comments/Instructions: oc a� W J 19 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date— ~- Phone #: (503) 718- ,�_ CITY OF T I G A R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00187 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 5/8/01 SITE ADDRESS: 10747 SW NORTH DAKOTA ST PARCEL: 1S134DA-06300 SUBDIVISION: PP1991-107 ?TONING: R4.5 BLOCK: LOT: 003 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install back flow preventor _ _ FEES Owner: —~ Type By Date Amount Receipt WHITNEY,JACK C + HEATHER A PRMT CTR 5/8/01 � $36.25 27200100000 10747 SW NORTH DAKOTA ST 5PCT CTR 5/8/01 $2.90 27200100000 TIGARD, OR 97223 - --..Total $39.15 Phone 1: Contractor: PARNELL PLUMBING INC 2120 HIDDEN SPRINGS COURT WEST LINN, OR 97068 REQUIRED INSPECTIONS RP/Backflow Preventer Phone 1: 503-657-9991 Reg#: LIC 139389 PLM 3-438PB This pen-nit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty 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 work is suspended for more 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 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling 3) 24 7. Issued By: Permittee Signature: Call(503 639-4175 by 7:00 P.M.for an Inspection needed the next b siness day • - Plumbing Permit Application Date received:S Permit no.:PMa City Of Tigard — -- Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: City of Tigard phone: (503) 6394171 Project/appl.no.: - Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: I ❑ I &2 family dwelling or accessory U Commercial/industrial U Multi-family O Tenant improvement U New construction U Addition/alteration/mplacement ❑Food service U Other: Job address: /©y t-'L`7. St.,, ,y -1"VDescrl Non . Fee ea, Total i Bldg.no.: I Suite no.: ew-1-and?.-family dwellings only: Tax m_ap/tax lot/account no.: (larlWo106 ft.roreachmilky connection) � SFR(1)bath Lot Block_ Subdivision: SFR(2)bath — -- Project name: SFR(3)bath — City/county: r q,Gp ZIP: 2, Each additional bath/kitchen Oestri Dtio�nat)dlocation of work on premises: 7d Z_AasULC-k Sltettttllitka: — 'Cor✓ _ v r. T Catch basin/area drain Est.date of completion/inspection: D wells/leach line/trench drain Footing drain(no.lin.ft.) Manufactured home utilities ' Business name: 1119ANIst;- T d^ic Manholes Address: AlAn - ,r e ; Rain drai..-onnector A City: State:a/? IP: ,�+ 1,Er Sanitary sewer(no.lin.ft.) Phone: e y Fax: do Y /j F.mail- A -/x 3 g' Storm sewer(no.lin.RJ CCB no.: /39 3 T q L-i I Plumb,bus.reg.no: I Water service no.lin.R.) City/metrolic.no.: ;zg^. F7xtwe or kem: Contractors representative signature: Absorption valve Back flow prmventerON Print name: c err t 0 Ll G* Date: ` tir�i Backwater valve Basins/lavatory Name: - Clothes washer - Dishwasher Address: O a4 IV C S C-T Drinking fountain(s) City: _ r State.:o ZIP: y p � Ejectors/sump_ Phone: S7 1/ Fax: 65Y 9,P9/ E-mail: Expansion tank Fixture/sewer cap _ Name(print): Floor drains/floor sinksthub Mailing address: -- Garbage sal City: State: ZIP: ee maker 0� Phone: Fax: E-mail: Interceptor/grease Owner installation/residential maintenance only: The actual installation Prinler(s) F.. will be made by me or the maintenance and repair made by my regular Roof drain(commercial) U) employee on the pmperty 1 own as per ORS Chapter 447. Sin (s),basin(s),lays(s) HOwner's signature: Date: Sum n Tubs/shower/shower pan ra Name: U ater closet ty Address: Water heater "'t City: State: ZIP: Oder. Phone: Fax: E-mail: Total Not all jddicU isau accept"edit cardr,please call jmiMkdm on ten ote irdarrwion. Notice:This permit appllCatiAlt Minimum fee................$ O Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $ Credit care Mrmber: (� within 180 days after it has been State surcharge(8%)....$ Expires ac- -d as onm lete. TOTAL. "'r...................$ None of cardholder u shown on credit card p S Ctrdholdtr sianMre Aa�oam 44N616(NOaR t3M) PLUMBING PERMIT FEES: ' PRICE TOTAL Now 1.nd�-dwellings only: FIXTURES pndlvidual QTY N AMOUNT ondudes all plumbing A><tures in PRICE TOTAL Sink 16.60 the dwelling and lire firstloo ft QTY (sa) AMOUNT Lavatory 1680 iter each trill oortneWon 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%OF SUBTOTAL Garbage Disposal 1660 _-___ TOTAL Laundry Tray 16.60 Washing Machine - 16.60 Floor Drain/Floor Sink 2" 16.60 3" \16.60 PLE SE COMPLETE: Water Heater O conversion O like kind 18. Qunntl Work PetiOrmed Gas piping requires a reparate mechanical Flxt Type: New Moved Replaced Removed/ permit. _ -- Capped MFG Home New Water Service 46.40 SI k _ MFG Home New San/Storrn Sewer 46.40 vatory - Tub or Tub/Shower Hose Biba 16.60 Combination _ Roof Drains 16.60 Shower Onl - Drinking Fountain 16.60 Water Closet _ Urinal Other Fixtures(Specify) 16.60Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer-1st 100' 55.00 3" Sewer-each addHional 100' 46.40 _4" Water Service-1st 100' 55.00Water Heater Water Service-each additional 200' 46.40 x Fixtures . a Storrs R Rain Drain-1st 100' 55.00 t Storrs b Rain Drain-each additional 100' 46. _ Commercial Back Flow Prevention Device 4 40 - Residential Backflow Prevention Device' 7.55 Catch Basin 18.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections _ er/hr I COMME TS REGARDING ABOVE: Rain Drain,single family dwelling 6525 Grease Traps 16.60 - CO QUANTITY TOTAL - Isometric rx riser diagram Is req d II F- Cluanttty Total Is >9 -' N #01 111TOTAL -- J 8%STATE RCHARGE --CO 90 - CO "PLAN REVIEW 20.OF SUBTOTAL W Required ly if fixture .total is>9 J TOTAL p I *Minimum p.rmlt fso is$72.50+8%state surcharge,except Residential Backflow/ Prevention Device,which Is$3e.25+ax elate surcharge All Now Commercial eulldings require dans with Isometric or rber dlsgram and pan revknv I:k%tsVomtalphn-fees.doc 10110M CITY OF TIGARD BUILDING INSPECTION DIVISION - 14-Hour Inspection Line: 639-4176 Business Line: 639-4171 S-__MST / UP Date Re uested_ �( `AAA/ 41?02 PM BLD _ Location_ea� (�-` Suite MEC Contact Person Ph� PLM Contractor _ _ Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS _ Ftg Drain Crawl Drain Inspection Notes: SGN Slab Post&Beam SIT -- Ext Sheath/Shear Int Sheath/Shear , - Framing �_l��•�fl` Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL Post&Beam Under Slab Top Out Water Service Sanitary SnPAFAIL '-- R ' ralinS MECHANICAL Post&Beam Rough In Gas Line Smoke Dampers Final -- LZ PASS PART FAIL ELECTRICAL a Service Rough In F- UG/Slab N +_ } Low Voltage t Fire Alarm "f Final m PASS PART FAIL LU W 817E J Backfill/Grading Sanitary Sewer Storm brain [ ]Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RF: — ��_ [ ]Unable to inspect-no access ADA Approach/Sidewalk L11__Ins C/l '-'S: ._— J t Other Date _Inspector E P x Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.