16364 SW 72ND AVENUE ■ vDDRESS■
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QiNERAL NOTES -�--- STANDARD SYMBOLS . ON STANDARD SYMBOLS UG SYM. TYPE MFQ./MODEL TVAP. 912E FINISH CANOPY FMBH QTY. pe`i N0 REVI'3ION DE--CPIPTI(IN 11ATE APPROVALS DESIGN CRITERIA
Aunts VALVE OGGUPANCY' E�CT_R I�AZZ/�RD
I PIP MATERIAL AND EDUIPMElR O E NEW ANO UN DIMENSIONS SHOWAPPRON
♦ POST INDICATOR - -_� - - _ I�O eApts �O ��� ��� ��
r DENSITY:
y PIPING DIMENSIONS ARE CENTER TO CENTER E>tttPT DIMENSIONS SHOWN THU4r �� DRY PIPE VALVE T - NON-RISING STEP GATE ---~ ------J-- --- -_- " _�-__-_.__, __..._.._
(IPPRK
WHICH ARE END TO END * REMOTE AREA: °�s3EZ—
J
I ! EAR TNGUAAE BRACING 91ALL BE PROVIDED IN ACCORDAN C$ WITH NEPA - FLOW SWI1Ty1 {� FIRE Nl'T1RAN, w/PUMPER - - ---- ------�--- ____ -'- - ----- 4 _ ---- _ __ INSIDE HOSE; `I��
P IPE "A
T No 13 1 �T 3 5 I (o i 4 D S�,t1 2'J D /1.V E..
! DE
1 PIPE MANGERS AND METHOD HANGING TO BE IN Arr' .t_ - WATER MOTOR GONG -- - -- 0 5. OUTSIDE HOSE: 4od _--�_ ,
PAMPHLET NO IS ORD ANtt WITH NEVA --�° - ERIE DEPT CONNECTION NQf'TH - ----- - --------
r ELECTRIC BELL L.�,t -- -- ----- — -- —---- T I CA A GZ p o R I-&C)Q
� PIPING sHAu BE IN ACCORDANCE WIN NEPA OA11P�+LC1 NO IJ � DOUBLE CMECR VALVE ASSEMBLY WATER .9l[PPLY FIRE , INC.
�
d 1GINING OF PIPE AMC) r',TTtN". "EAOED AND WELDED SHALL BE IN ACCORDANCE ♦� DRAIN VALVE - 0 CHECK VALVE -
DESIDN BASED ON: _ __._ _- __---_ ____
WITH NEPA PROVIDED N,, T STATIC: c� TfTLE ---- PLOT PL_A11
' tWNER 1O PROVIDED ACEOUA+E NEAT in PREVENT WATER IN PIPES CRr1M rREEiING ORT>•tVED COVPUNG NEW UNDER,YtlYiHO -_- - RESIDUAL: _ �'� - -_
- - — --- oATE— to_g 7 SCALE ". g o GREET ----- FIRE PROTECTION CONTRACTORS
.N AS 0 C D 9v + PET PIPE SPRINKLER SYSTEM
-�- C
�-� - EARtHOUAPE BRACE - - - .... ------ FLOW: 3 ------ --- I I OF-Z'--
EVIST UNDERGROUND ONT. DRWK ACiG _
7 $ UC RAL ApE VUAfY 'X TIME BVIICING TT] SUPPORT TN[ SPRINY LlR PIPINf, I$ --4 `- _-- _------ -- - 14716 SM 72nd. POR7I.AW � Y72.2♦ ( ;) B�-AZO
ME RE:+P7-SIBILI TY ,X 91E OWNER AND,OR NIS STRUCTURAL REPRESENTATIVE CI ---- I,.00ATION: '
sreTEM
-- - -- -
-
HYDRAULIC REFERENCE POINT -
---- PUBLIC MATER LIRE
-
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CITY OF TIGARD
Apptt7v(3d....... 1 ;
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GENERAL' NOTES STANDARD SYMBOL$ . ON STANDARD SYMBOLS . UO 9YM. TYPE MFG./MODEL TEMP. SIZE FINISH CANOPY PNINSH 7TY. REV. NO, REVISION DESCRIPTION DATE APPROVALS DESIGN CRITERIA
1 ALL MATERIAL AND EQUIPMENT TO BE NEW AND UNDERWRITERS APPROVED
ALARM VALVE t - POST INDICATOR � SSP RELIABLE MODEL F-t 133 1/2' CHROME F-I CHRtlME v9
_ 1• CITY OF TIGARD OCCUPANCY: EXTRA HAZARD OREGON BUSINESS PARK I ...�
CDEPIPING DIMENSIONS ARE
ARE 000 ro CENTER EXCEPT DItAENSiUNB SHOWN THuslr Q SSU RELIABLE MODEL G 212 17/32' BRASS 2..3 OWNER / ARCHITECT DENSITY: .30
E I•T' U ICH ARF. ENO t0 END Q DRY PIPE VALVE T NON-RISING STELA GATE 2• BUILDING #8 (PTR #124)
s EARTHOUAIcE BRACING SHALL BE PROVIDED IN ACCORDANCE WITH NFPA � Q HSW RELIABLE MODEL G 212 1/2 BRASS 25 •j• REMOTE AREA; 3000 _
PAMPHLET No I J �� eWlrtyR - FI4E HYDRANT w/puAtI+ER ® 16360 S W 7 2ND AVE.
y� SSP RELIABLE MODEL G 165 1/2 BRA 8 L 4. INSIDE H05E:
PIPE HANGERS 40 ANO YET1100 of HANGING TO eE IN ACCORDANCE WITH NFPA S_L • WATER MOTOR OONO _< - FIRE DEPT CONNECTION PORTLAND, 0 R 97224
CIZPAMPHLET LL IJ 5• OUTSIDE HOSE: 500 _
- ELECTRIC BELL DOUBLE CHECK VALVE ASSEMBLY S PIPING SHALL BE IN ACCORDANCE WITH D A WELDED
NO I = WATER SUPPLY FIRE , INC .
a JOINING OF PIPE AND FITTINGS. THREADED AND WELDED SHALL BE IN ACCORDANCE ~ d1AM VALVE --�— - CHECK VALVE D�911aN 01�8QD ON: __
WITH NFYA PAMPHLET l+0 13 n STATIC: 97 TITLE PIPING PLAN
Cr �J" GROOVED COUPLING >+r•.,�,. NEW UNDERGROUND N.F.P.A, 1,; 1 94
7 OWNER TO PROVIDED ADEQUATE NEAT TO PREVENT WATER IN PIPES FROM FREEZING
CL n. AREAS PROTECTED BY A WET PIPE SPRINKLER srsTEIA .� EARtHouAlu BRACE >! : RESIDUAL: 87 DATE 6-4- 1998 SCALE I/8" 1'-0" SHEET 2 FIRE PROTECTION CONTRACTORS
e STRUCTURAL ADEQUACY OF THE BUILDING TO SUPPORT THE SPRINKLER PIPING IS - EXIST UNDERGROUND _
THE ft"SGILITY OF THE OWNER AND/GR His STRUCTURAL REPRE9FNTAITVE O HYDRAULIC REFERENCE POINT — PUBLIC WATER LINE FLOW: �'96'� CONT. 98-9223 DRWN. D.L. $Y$TEM WET tA79S S.W. 72nd. PORTLAND, OR fM24 (903) 6"-4020
163(A Ser 72%"AVI-Nt 11 — I.00ATION: S.W. 72ND
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EO EARS N.W a Plies
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Note on Ptah: Hanger INrILbR►and 'A'DYnwLRfen
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OENERAI NOTES
N STANDARD SYMBOLS , OH STANDARD SYMOLS . UG SYM• TYPE MFGJMODEL TEMP. SIZE FINISH CANOPY "48H GTY. REV. NO. REVISION DESCRIPTION DATE APPROVALS DESIGN CRITERIA
All uATIMID AND EOUIPNEHr to BE rM AND T DERr iom APPROVED ALAM4 VALVE t - POST INDICATOR SSP RELIABLE MODEL F-1 155 1/2' CHROME F-1 CHROME 66 OR
BUSINESS PARK I
4 1 CITY OF TIGARD OCCUPANCY EXTRA HAZARD
z PIPING 01111EIi41(>l15 ARE 'XII TER ro CENiF)P ExfIPT DIME►ISIONS 5110Yw1 THUSIr
v e1 wHICN ARE CND TO ENO NON-RtSINO STEN GATE (� SSU RELIABLE MODEL G 212 11/32• BRASS --- --- OWNER / ARCHITECT DENSITY: .30
O - DRY PIPE VALVE T 212 BUILDING #9 (f'TR #122)
s EART►IWAAE BRActrIG slAu BE PRovtpm IN ACCORDANCE rNTH NEVA Q.. d HSV RELIABLE MODEL G 212 1/2 BRASS --- --- 21 3, REMOTE AREA: 3000
PAMPHIEI NO IS - Flow SIRIT04 FIRE HYDRANT w/PUMPER
yy HSV RELIABLE MODEL G EC 165 1/2 CHR F--I CHR , ; INSIDE HOSE: 0 1 6550-78 SW 72ND
C A PIPE HANGERS AND 11ETIIOD a AANG'MG ro BE IN ACCORDANCE W11H NiPA .1 L - WATER MOTOR GOND —< FIRE DEPT CONNECTION 5. OUTSIDE SE: goo PORTLAND, OR ND AVE.A DE
� Pw� � � ,�•�. }1 y NORTH
S PIPING ,"HALL LIE IN ACCORDANCE WITH NEPA PAMPHLET NO 17 �•` - ELIC-MIC BELL 1 DOUBLE WCK VALVE ASSEMBLY
^' a lOMMO OF PtpE AND FITtITIOS THREADED AI4D WELDED ;HNA BE M ACCORDANCE ~' °RAM VALVE --�- 24
CI4= VALVE (MATER SUPPLY
MiH NfPA PAMINIL[T NO 13 __..—
T OKWP TO PROVIDED ADEQUATE MEAT TO PREVOIT WATER IN ptpcs r"m "ram" ��� NEM UNDERGROUND D�a9IGIP! BA SED ON: _ FIRE , INC .
a,00rEo Comm STATIC: 97 TITLE PIPING PLAN
CL IN AREAS PROTECTED BY A WT PIPE SPRINKLER SYSTEM S EARTHQUAKE BRACE N.F.P.A. , 13 1994 RESIDUAL: 87 A / _ FIRE PROTECTION CONTRACTORS
- EXIST Lr,DERaRouND DTE 5-10- 1998 SCALE I 8" I'-0" SHEET 3
sTRtTCT11PGt ADEQUACY OF THE BUILDING TO SUPPORT T►K SPRBRt1ER PIPING IS FLOW: 3962 DONT, 98-9223 DREIIL D.L. SYSTEM WET 14793 S.W. 72nd. PORTLAND, OR 97274 (303) $20-4020
o HYQRAwc RE�EAENct PONT - - LOCATION: S.W. 72ND
flK R[SPONSIBttITY a THE OWNER A,iD/fy1 HIS 41RUCTUIIAL REPRESENTATIVE — — PUBLIC WA1ER LINE
If,1(,4 C%1 72 AVI NI'l
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16598 1 3596 16592 16588 16586
7
Ll658 16580
22____
6' WATER FLOW SWITCH
Hanger No. 8 �— Hanger No. 9
U—Hook Angle Clip
N/1e Jaw or awn Detail No. 28
`°�;Q j j j S j / / / Une J" III
Standard EQ Brace Detail
,• SCH. 40 PIPE ,. Q 6 RELIABLE MODEL E
5....I1. v PIPE CLAMP ALARM CHECK VALVE
N
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Q , 1Mltat r,ItYI •Nw t ,Ar
u erattt•two r �w
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POST INDICATOR
NI on Plat: Hapw Nunbw and �A'D1nlnNon
NMS on Plan. Hapw III be and 'A' DYn•rt111n
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ao
CITY Of TtO ARO 1 �+
F-I:lEIR D
APP ^iilot1811y APP,ovctcl.,.. , .., ' In.
Coed debE' 2Z�e-
For ol,iy 1ne WO( I
pE�N11j p1U _FOOOW..y..•..,... ...( �'
Seo Letter to• 1 h..... .. �I�.�1
AddrC`$'A-L — ---
Job -
OI®iRAL NOTES STANDARD 8YMSOL8 . OM STANDARD SYMWX$ . UG BYM. TYPE MFQJMODEL TEMr. 81ZE I CANl11PY
ALL IIATEPIAL AND EOUIPWI TO PE NEN AND UNDERNRITERS APPROVED 0 I�MBH OTY, REV. NO, REVISION DESCRIPTION DATE APPROVALS DESIGN CRITERIA
PI"- DRIENSIONS ARE CENTER *D a,TO1 C.CEPT OIIIENSIONS SHONN TNUStr - AUIRU VALVE t POST INDICATOR � SSP RELIABLE MODEL F-1 193 1/2' CHROME F-1 CHROME 70
1111) "M1°' ' END Q DRY PIPE VALVE T NON-RISWO $ity OAT[ O SSU RELIABLE MODEL G 212 17/32• BRASS 197 t, CITY OF TIGARD OCCUPANCY: EXTRA HAZARD OREGON BUSINESS PARK
EMt1HQIAkf eITAUNo sNAu BE PIIVVIOED nI ACCORDANCE NITN NEPA 1. - Rpq s1�ITr�I HSV RELIABLr MODEL G 212 1/2 BRASS 22 2, OWNER / ARCHITECT DENSITY: .30
PPE 4AM "° 1] nRE N1011A11T M/PU4PER BUILDING #1 1 (PTR #124)
— 3. REMOTE AREA: 3000
/ •rPE HANOI�S ANO YETNDp DE HANcn+c ro � IN ACCORDANCE NITH NEOA � . WATER wTOR oDNc _ r� DEPT. CONNECTION Z 4, INSIDE HOSE: 0 16596 S'JV 7 N AVE.IPWG SH No 1] f►fit o 2 D
DE
DRAM V VE 5. OUTSIDE HOSE: 500 PORTLAND, OR 97224
S PIP94G SHALL ®E IN ACCORDANCE N1M NiPA PA►MMLEt NO 1] DOUBLE CHECK VALVE A3SE11l1•r
6 A N A PAL AND FITTOIOS TIMAOED MIO IEID[D SNA11 BE IN ACCORDANCE DIIAIN VALVE ♦-- CHECK VALVE _
MTN LAPPA PAY//lET ND I] - DE811�iN SA81QD ON: WATER SUPPLY FIRE , INC ■
OMIER ro PROVIDG) AOFAUATE Nur ro PR[vb/t MAt01 iN PTES TRDMIREE21N0 0R0a'� COUPUNO raffi97
NI AREAS PROTECTED BY A NET PIPE IMIRBIER SrS}a N.FIN 1 13 1994 STATIC: — TRLE PIPING PLAN
EARTT+auAKE t. Exlst RESIDUAL: 87 DATE 5 18- 1998 SCALES 1/8" 1'-0" S►+EET a FIRE PROTECTION CONTRACTORS
9 nc tv A`EtRIACr D► TTK lUAIDDNI Tc 9UPPa1T TIIE SPR IEJU TINE IS O FLOW: 396214795 S.M. 72nd. PORTLAND, OR 97224 (s T e20-4020
' 11K RE9P'OIS■IL1Tr Q► 111E OMNQI AND/E8 N19 511111C111RAL RE►IIEl8NtA11VE MYDIfAtLIC RfFtRENCE POINT — .�
• PU�1C MATER UNE
16164 X11'72`'1'A`1 NI1f
14•1 t,1 a CONT. 98-9223 DAWN. O.L.LSYSTEM WET
LOCATION: S.W. 72ND
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OF TICARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 p
BUP4
-�/
3, P pate Requested c���•�/�f� _AM PM_ BLD
Location /lei"y _ f�C ��/�� Suite r- MEC
Contact Person r Ph PLM
Contractor L f C' �: �. Ph SWR
(BUILDING Tenant/Owner ELC _
Retaining Wall ELI
Footing Access:
Foundation FPS
Fig Drain SGhi
Crawl Drain Inspection Notes: --
Slab ---_—__— ti� �i ✓�d�,litcG+� SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
F_irewall.__` d �\
ire Sprinkler -ea
Fire arm
Susp'd Ceiling _
Roof
Misc: _
P-UMEB
PART FAIL
ING
Final,
Post& Beam
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
ELECTRICAL --
Service
Rough In
UG/Slab
Low Voltage
' Fire Alarm
Final
PASS PART FAIL _
SITE
- Backfill/Grading
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: ( Unable to inspect-no access
ADA
Approach/Sidewalk
Other Date _ inspector �— ^ Ext
Final '
PASS PART FAIL DO NOT REMOVE this Inspection record from thy+ ioL. site.
CITE' OF TIGARD
DEVELOPMENT SERVICES BUTI.-DING PERMIT
13125 SIN Hail Blvd., Tigard,OR 97223 (503)639-4171 PFRhIIT #. . . . . . .. :
DATE ISSUED: 06/10/98
PARCEL: 2611.30A-001.1710
113TTE ADDRESS. . . : 16364 SW 721\ID AVE
SUBDIVTSION. . . . : ROSEWOOD ACRE TRACTS ZONTNG. I-L
BLOCK. .. . . . . . , . . LOT. . . . . . . . .. . . . . :OOA JURISDICTION:ITG
REISSUE: FLOOR AREAS----- EXTERIOR WALL CONSTRUCTION
CLASS OF WORK.j,,Q FT RST. . . . . 0 S f N: S: F' W:;
TYPE OF USE. . . :COM SECOND. . . : 0 c_- f PROTECT OPEN
TYPE OF CONFIT. -3N . . . 0 s N: F3: E: W:
OCCUPANCY GRP,. :1-I?, TOTAL_- 0 S f ROOF' CONST: FIRE RET?:
OCCUPANCY LOAD: 0 BA9EMENT. : 0 s f AREA SEP. RATED:
STOR. : 0 I-IT: 0 Ft GARAGE. . . : 0 sf OCCU SEP. RATED:
SSMT? : MF7Z ) : REDD SETBACKS-- REMIT RIFD—----.----------
FLOOR LOAD. . _ : 0 p t;-f LEFT: 0 ft RGHT: 0 ft F I R GFIK'L-Y SMOV DET. . .
DWELLING UNITS: 0 FRNT: 0 ft RFnR: 0 ft FTR ALRII: IANDICP ACC:
SEDIRMS: 0 BATHS: 0 TNF! SURFACE- 1A PRO CORR: PARK 1 1\1(3: 0
VAL (JE. $ : 27000
Remarks : Add fire sprinkler system. This is a spec space - Based on the
Occupancy hazard EX!, we presume the use will be an "H"
Owner-: FEES
F,ACTRUST type amai_tnt by d i.-A t e r-ecpt
15350 SW SEQUIA PARKWAY PIRMT $ 179. 50 BON 06/05/98 98-306315
surrE 300 S 8. 9R BON 06/1215/9a 98--306315
TIGARD OR 972c'M FT RF $ 71 . 80 BnN 06/05/98 98-306315
Phane #-
Cantr-Artat-:
DELTA FIRE INC
14795 SW 7c:'I\ID AVENUE
TIGARD OR 97i::.,24.
Phone
$ 260. 28 TOTAL.
Reg 000614J.
----RFC?L)IRFD ACTIONS cir- JNr3PFCTini\is-_--
This permit is issued subject to the regulations contained in the Sprinkler- Rot-tgh—
Tigard Municipal Code, State of Ore. SpPcialty Codes and all other Spt,inl(let- Final -------
applicablp laws. All world 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
Ln than 180 days. ATTENTION: Oregon law requires you to follow the
rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAP 952441-0010 through OAR 95240101987.
C.3 You many obtain a copy of these rules or direct questions to OLK
LL by calling (503)246-1987.
e r m i t t e e Signatl.tt-e (�� LY t.Z' I s s r e ri Fa /,
4++-1-+4-++++-+++-F++++++.+++++4-++++4-++-+-+4-4-+++4............4-++++4.......4.++++++++++
Call 639-4175 by 7-00 p. m. for an insipe(-tion needed the next bi.isiness day
4....................4.........4.......4.......4 4....................4•......4-
Fire Protection Permit Application Plan Check#
CITY OF TIGARD Commercial or Residential Recd By
13125 SW HALL BLVD. Date Recd
TIGARD, OR 97223 Print or Type Date to P E.
(503) 639-4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST c e
Oernit#
Called
Job Name of Development/Project Type of System (Complete A or B as applicable)
i dgrpss Addre , A.) Sprinkler Wet d Dry ❑
Name ,}L �, N �kw�. Standp-pes
OCl.� pj,,,,9 y1¢So � 1 ` ,,� I �vr✓
Owner Mallin Address . Hazard Group
Additional
Cityl Zip Phone Information Density
v
Name Design Area
pc7
Occupant Mailing Address K. Factor
Z-
City/State Zip Phone A.1) Sprinkler Project Valuation $
Contractor Name B.) Fire Alarm
(Sprinkler or -_Y L
Alarm company) Mailing Address Submittal Shall Include Battery Calculations YES C1
Pnor to permit -P O . Cao,c y0/U
issuance, a City/State Zip Phone Individual Component YES❑
Cut Sheets
copy 1
of all licenses 'Au— I 0 2 1-7 61,02 2D -40-Lo B.1) Fire Alarm Project Valuation $
are required if State Const.Cont Board Lic# Exp. Date
expired in COTProject Valuation Subtotal (A 8 or B) $ o_
database Ln 1_7 2--11`79 _ :Q-).0C)O
Name Permit fee based on valuation $
(see chart on back) 7
Architect Mailing Address 5% Surcharge $
City/State zip one FLS Plan Review 40% of Permit $
_ f.bo
Describe work A.)New O Aadition pl Alteration O Repair O TOTAL
$
to be done _ 21n(-3 .2-2)
B.) Modification to sprinkler heads only. Plans required Submit three sets of plans,including a vicinity map and
1. 1-10 heads=No plans required
the location of the nearest hydrant.
2. 11—Plan review required
I hereby acknowledge that I have read this application,that the information given is
-- _ _�--
cortect,that t am the owner or authorized agent of the owner,and that plans submitted
Number of sprinkler heads ^_ are in compliance with Oregon State laws
Additional Description of Work;
Signature of Owner/Agent Date
t A.)In Existing Building New Building ❑ Q-S`
Building Contact Person Name Phone
i)ata 8.) Commercial Ig Residential ❑ ��a -' sslr T k Z o — UyZD
FOR O FICE USE ONLY:
-� Plat# Mapffa
No of stories
cD
J Sq. Ft: Notes V-
Occupancy Class Type of Construction
i firesupr.doc
CITY OF TI ARD
BUILDING PERMIT FEES
TOTAL
STATE BUILDING
VALUATION OF PERMIT F.L.S. TAX PERMIT
PROJECT FEES (40%) (5%) FEES
1-1500 25.00 ' 10.00 1.25 36.25
1,501-1600 26.50 10.60 1.33 38.43
1,601-1,700 28.00 11.20 1.40 40.60
1,701-1,800 29.50 11.80 1.48 42.78
1,801-1,900 31.00 12.40 1.55 44.95
1,901-2000 32.50 13.00 1.63 47.13
2,001-3,000 38.50 15.40 1.93 55.83
3,001-4,000 44.50 17.80 2.23 64.53
4,001-5,000 50.50 20.20 2.53 73.23
5.001-6.000 56.50 22.60 2.83 81.93
6,001-7,000 62.50 25.00 3.13 90.63
7.001-8,000 68.50 27.40 3.43 99.33
8,001-9,000 74.50 29.80 3.73 108.03
9,001-10,000 80.50 32.20 4.03 116.73
10,001-11,000 86.50 34.60 4.33 125.43
11,001-12,000 92.50 37.00 4.63 13413
12,001-13,000 98.50 39.40 4.93 142.83
13,001-14,000 104.50 41.80 5.23 151.53
14,001-15,000 110.50 44.20 5.53 160.23
15,001-16,000 116.50 46.60 5.83 16893
16,001-17,000 122.50 49.00 6.13 177.63
17,001-18,000 128.50 51.40 6.43 186.33
18,001-19,000 134.50 53.80 5.73 195.73
19,001-20,000 140.50 56.20 7.03 203.73
20,001-21,000 146.50 58.60 7.33 212.43
21,001-22,000 152.50 61.00 7.63 221.13
22,001-23,000 158.50 63.40 7.93 229.83
23,001-24,000 164.50 65.80 8.23 238.53
24,001-25,000 170.50 68.20 8.53 247.23
ti
25,001-26,000 175.00 70.00 8.75 253.75
26,001-27,000 179.50 71.80 8.98 260.28
27,001-28,000 184.00 73.60 9.20 266.80
28,001-29,000 188.50 75.40 9.43 273.33
29,001-30,000 193.00 77.20 9.65 279.85
30,001-31,000 197.50 79.00 9.88 286.38
31,001-32,000 202.00 80.80 10.10 29290
32,001-33,000 206.50 82.60 10.33 299.43
33,001-34,000 211.00 84.40 10.55 305.95
34,001-35,000 215.50 86.20 10.78 312.48
35,001-36,000 220.00 8800 11.00 319.00
36,001-37,000 224.50 89.80 11.23 325.53
37,001-38,000 229.00 9160 11.45 332.05
is firesupr doc
DELTA FIRE Fax:5036201058 Jan 5 '99 9:28 P.02i07
SY5TEAt AC-CEP'['ANCE 1$-7
Contractor's Material and Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work,inspection and tests 0hal be mace by the contractor's representative and witnessed by an o'+wner'3
representative. All defects shall be corrected and system left in service before contractors personnel finally leave the job,
A certificate shall be filled out and signed by boir,i?presentatives. Copies shall be prepared for apprnving authorities,owners,and
contractor. I;is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty materiai,poor
workmanship,or failure to comply with approving nulhorlty's rectutremetils or local ordinances.
PROPERTY NAME DATE
PROPERTY ADDRESS 5w 1\Z�
--
jACCEPTED BT APPRO_ AIJTHO1�ITIE5M ES)
,ADDRESS V
; /s'"(�
PLANS l 3 [G[ 1 ` 41�t L ---
INSTALLATION CONFORMS I.0 ACCEPTED PLANS 191 YES ` NO
'EQUIPMENT USED IS APPROVED „I� YES '_ NO
IF N0,EXPLAIN Df;VIATIONS
HAS PERSON IN CH,AFGE'JF FIRE EQUIPMENT.SEEN INSTRUCTED AS I YES U NO
TC LOCATION OF CONTROL VALVES AND CARE ANr)MAINTENANCE
l OF THIS NEW EQUIPMENT?
IF NO,EXPL%IN
INSTRUCTIONS
No VE CJPIES O'THE FOLLOWING RF9N LEFT ON THE PREMISES? YES ~ NO
I. SYS T EM COMPONENTS INSTRUCTIONS $ YES NC
2 CAF49AND MAINTENANCE INSTRUCTIONS 24 YES NO
J. NFPA 25 g YES _ NO
LOCATION SUPPLIES 9UII.OING5
OF SYSTEM
YEAR OF I 0PIFICF j TEMFEnHT,aF
- --
MAKE btODEL ' MANUFACTU.RE ! SIZE QUANTITY : RATING
SPRINKLERS
.e\.t►11e t -
t�1 t+t►�r G _
.�-
z _
PIPE AND Type of pipe ��eV\� \(�_� �D
FITTINGS Type of Fittings��rj "SA
1 _ _
j MAXIMUM TIM[TO OPERATE
ALARM ALJ.RM DEVICE THROUGH TEST CONNECTION
VALVE — YFYF E MAKE MODEL MIN SEC
OR FLOW _
INDICATOR Flow SW �t .�,,L IF
DRY VALVE _ 0.0.0, 1
MAKE _ MODEL SERIAL NO. MAKE I MODEL SERIAL NO
ORt PIPE TIME TO TRIP i I TIME WATER i ALARM
OPERATING THRCUC3H TEST WATER AIR TRIP POINT REACHED OPERATED
TEST I CONNECTIONI i AFIESSIJRE I PRESSURE j AIRPRESSURB TEST OUTLET' PRCPEIALY
I MIN ' SEC I PSI j psi PSI MIN i_ SEC YES NO
Wit out
With j i I j i I
IF NO,EXPLAIN
1WEASURED PSICMI TIME INSPECTORS TEST CONNECTION IS OPINED,
Figure 9-1(a)Part 1.
1999 Ed,
DELTH FIRE Fax:5036201058 Jan 5 '99 9:28 P.03/07
L3-ib INSrALL.-\TION OF SPRINKLERSYSTESIS
OPERHTION
PNEUMATIC C ELECTRIC ZI HYDRAULIC _
PIPING SUPERVISED YES (I NO !, DETECTING MEDIA SUPERVISED I YES :j NO
DOES VALVE OPERATE FROM THE MANUAL TRIP,REMOTE.OR BOTH I. YES F7 NO
DELUGE AND CONTROL ST4TIONS
?REACTION IS THEaE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN
VALVFS FOR TESTING
YES ❑ NO
DOES EACH CIRCUIT OPERATE DOE
.S EACH CIRCUIT MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS AVRM? OPERATE VALVE RELEASE? OPERATE RELEASE
YFS 1 VO YES I NO MIN SEC
LOCATION ?4AKE 3 SEi ING STATIC PRESSURE I RESIDUAL PRESSURE j FLOW RATE
PRESSURE d FLOOR MODEL (FLOWING) I
REDUCING
VALVE TEST INLET(PSI) OUTLET(PSI) INI_PT(PSI) OUTI FT(PSI)j FLOW(GPM)
I i
HYOP-QAT,AjIC. Hyrroatadc tests shall to made at not less than 200 psi(13.6 bars)tort hours or So psi(3.4 bars)
above stauc preaaurs in excess of 150 psi(10.2 bars)for 2 hours. Ditferential dl--pipe,calve clappers small ba telt
TEST i open during the teat M prevent damage. All aboveground piping leakage small be stopped.
DESCRIPTION PNEUMATIC: Establfpn 40 psi(2.7, bars]air pressure and measure drop,which shall not exceed 1'h psi(0.1 bars)
in 24 hour,. Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall
not exceed 1':psi(0.1 bars)in 24 hours.
ALL PIPING PYDPOSTATICALLY TcST_C AT2-C-Q PSI I—BARS)FOR 2 HAS; IF NO.STATE REASON
DRY PIPING PNEUMATICALLY TESTED SZ YES NO
EOUIPMENT OPERATES PROPERLY X YES NO
00 YOU CEPTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS.
SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE.BRINE,OR OTHER CORROSIVE CHEMICALS
WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
moi': YES J NO
DRAIN READING^F GAUGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS TEST ELP=�Y 7257 CONNECT;CN: PSI(_BARS)i CCNNECTiON OPEN WIDE: PSI(_BARS)
UNDEF40PCUND MAINS AND LF-40 IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE
CONNECTION MADE TO SPRINKLER PIPING
VERIFIED BY COPY OF THF U FORM NO.959 YES NO i OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER- I
Ga0UNO SPRINKLER PIPING ^ YES '^ NO
IF POWDER-ORIVEI=ASTENEPS ARE USED IN J YES _ NO IF N0,EXPLAIN
CONCAETE.HAS?=?RE3eNTs`.',,SAMPLE
TC:STING BEEN SATISFACTORILY COMPLETED?
BLANK TESTING NUMBER USED LOCATIONS I NUMBER RFMOVEO
GASKETS
WELDED PIPING YES _ NO
IF YES...
DO YOU CERTIFY AS THE SPftINKL.ER CONTRACTOR THAT WELDING
PROC220UFIEB COMPLY WITH THE AEOUIREMENTS OP AT LEAST YES ❑ NO
AWS 010.3,L9VELAR-37
'WCLDING 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED 9Y WELDERS
QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST YES 'u,
AWS 010.9,LS/E:AR•31
DO YOU CERTIFY THAT WE401NO VAS CARRIEr OUT IN COMPLIANCE
WITH A DOCUMQNrED allALlry C:.NTROL PROCEDURE TC ENbUP1r
THAT ALL DISCS ARE RETRIEVE: '`-AT OP!NINGS,N PIPING ARE r^ YE3 , N
SNICOT, THAT SMG AND OT'r+c ?3SIOLE ARE REMOVE.
-Ni -',A7-F,E !NT_.RNAL DIANItTERS OF PIPING ARE NOT PENETRATED')
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FUTURE TO
(DISCS) ENSURE THAT ALL CUTOUTS(DISCS)ARE PIFTRIEVEO? CJ YES ❑ NC
Fiwre D•1(a1 Par"!.
199e 2dlhon
DELTA FIRE Fax:5036201058 i 1 t�Jan 5 '99 9:29 P.04/07
13-77
HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN
DATA
NAMEPLATE D YES [] NO
LATE LEFT IN SERVICE WITH ALL CONT AOL VALVES OPEN
REMARKS
NAIAE.0 SPRINKLER CONTRACTOR
4/7
SIGNATURES / TESTS WITNESSED BY
F ! ERrY OWNS GN y TI Gf�yU DATE
FUR KLA'ICONT '0R 'iaN ) TITL' DATE
ADDITIONAL EXPLANATION!AND NOTES
Figure Lt-l(o)Part 3.
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DELTA FIRE Fax:5036201058 Jan 5 '99 9:29 P.05/0,
-- SYSTENII.jccEPrANCE !3-i
Contractor's Material and Test Certificate forAboveground Piping
PROCEDURE
Upon wmplobon of Work inspection and tests shall be made by tn.contractor's representative anti witnessed by an owner's
representative. All detects shall be corrwed and system lett in service before contractor's Personnel linally leave the job.
• A certificate shall be filled out and signed by both representatives. Copies shall be prepare"r:r approving authorities,owners.ai,d
contractor. It is understood Ute owner's representative's signature in no way prejudices any claim against contractor for faulty material,poor
workmanship,or failure to Comply with approving authority's requirements Cr local ordinances.
PROPERTY NAME y-� I DATE
PRCPE971'AOORESS i
1ln'.�Ld^�
j ACCEPTED 8 PoPT�VING UTI- TIITiE5(NAMES)
ADORESS
PLANS
INSTALLATION CONFORMS TO ACCEPTED PLAN`a _ YE5 NO
EQUIPMENT USED IS APPROVED YES NO
+IF NO,EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE.EQUIPMENT BEEN INSTRf10TED AS YES NO
!TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
I
OF THIS NEW EQUIPMENT'
IF NO,EXPLAIN
I
INSTRUCTIONS
HAVE COPIES OF THE FOI-LOWING BEEN LETT ON THE PREMISES? YES r NO
1, SYSTEM CCMPONENTS INSTRUCTIONS YES NO
2. CARS AND MAINTENANCE INSTRI'CTIONS YES NO
3. NFPA 25 YES _ NO
LOCATION SUPPLIES 61.11L01NGS
OF SYST5M
YEAR OF I ORIFICE TEMPERATURE
+� 'BAKE MODEL i MANUFACTURE SIZE QUANTITY RATING
1G�liAto�4 Cb S I 1 .1el
SPRINKLERS A
I.,Rye _ �^ ( �
_C ;_Nth C C WSWy
l 1t v Che Ft 0
PIPE AND Type of Pipe .CC:,,N
FITTINGS Type of Fittings
MAXIMUM TIME TO OPERATE
ALARM ALARM DEVICE THROUI3H TEST CONNECTION
VALVE
OR FLOW TYPE MAKE MODEL MIN SEC
INDICATOR
CL DRY VALVE O O D
R MAKE MODEL 1 SERIAL NO. MAKE I MODEL SERIAL NO.
U1 i
DRY PIPE TIME TO TRIP TIME WATER ALARM
oP5RATTNc1 THAQUGH TEST WATER I AIR TRIP POINT REACHED UPERATED
~
TEST CONNECTION' I PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PROPERLY
►-
MIN SEC PSI PSI PSI MIN SEC YES NO
en Wlrno t
i
LD O.O. „
LL, With
IF NO,EXPLAIN
IMEASUREC FRCM 7'%i6 INSPf%:i DR'S TEST CCNNEC71ON IS OPENED,
Pigurr,f-l(s)Part 1.
19911 Edition
UELTR FIRE Fax:5036201058 Jan 5 '99 9:29 P.06/07
13=;6 1N,S7ALL1TION OF SPRINKLER SYSTEMS
I OPERATION
PNEUMATIC ❑ ELECTRIC C HYDRAULIC
PIPING SUPERVISED ! YES E::' NO DETECTING MEDIA SUPERVISED (' YES NO
DOES VALVE OPERATE FROM THE MANUAL TRIP.REMOTE,OR 00TH YES [] NO
• DELUGE AND CONTROL STATIONS
PREACTION iS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUITi IF NO,EXPLAIN
VALVES FOR TESTING
YES r NO
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKE ,MODEL SUPERVISICN LOSS ALARM? OPERATE VALVE RELEASE? ' OPERATE 19ELEASF
YES 7' NO I YES i NO MIN SEC
LOCATION MAKE&, SETTING STATIC PRESSURE RESIDUAL PRESSURE I FLOW RATE
PRESSURE &"LCCR MODE! (FLOWING) i
REDUCING INLET(PSII OUTLET(PSI) INLET(PSII !OUPSI TLET
VALVE TEST _ i _ l )I FLOW(GPM
)
HYDRO.,jTA 1 Hydromat,c tesr shall be made at not less than 200 psi(17.5 bars)for 2 hours or 50 psi(3,4 ears)
above static pressure in excess of 150 psi(10.2 bars)for 2 hours. Differential dry-pipe valve clappers shall be left
TEST open during the test to prevent damage. All aboveground piping leakage Shalt be stopped.
DESCRIPTION MATT Establish 4U psi(2 7 bars)air pressure and measure drop,which shell riot exceed 1 14 psi(0.1 bars)
in 24 Moura. Test pressure tanks at normal water level and air pressure and measure air pressure drop,whlcn,hall
M61 exceed 1 l5 psi(0,1 bars)tr 24 hours.
ALL AIRING PY7PGSTATICALLY T;STSC ATViol PSi I—BARS)FCR Z HAS IF NO.STATE REASON
CRY PIPING PNEUMATICALL''TESTED YES NO I
EQUIPMENT OPERATES PROPERLY YES NO
CO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,
SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS
WFAE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
YES NO
ORAIN READING OF GAUG;-LCCATED NEAR'NATER RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS TEST SLP°L'r-EST:.CNNECTIONI PSI I—BARS),CONNECTION CPSN WIDE: PSI(_BARS)
UNCEAGPOUNO MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE
CONNECTION MADE TO SPRINKLER PIPING I
V5AIPIED BY COPY OF THE U FORM NO.85B J YES NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING l
YES r NO
IF PCWC6P-0RIVE`I=ASTENEPS.ARE USED iN ,_ YES — NO IF NO,EXPLAIN
CONCRE`E.HAS°EPRESENTAT.'•e'SAMPLE
TE37INa BEEN SATISFACTORILY COMPLETED?
BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS
WELDED PIPING YES = NO
IF YES
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING
PPOCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST YES NO
d SWT 01-0,9.LEVEL AR-31
cr
N rYELDING 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS
QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST YES NO
> AWS 010.9,LS`/EL AR-3?
F—
' DO YOU CERTIFY THAT WELDING VAS CARRIED OUT IN COMPLIANCE
rJ, WITH A DOCUMENTED QUALITY CLNTROL PROCEDURE TC ENSURE
m THAT ALL DISCS ARE RFTRIEVEC "OAT OPENINGS IN PIPING ARE YES Q NO
SMOOTH,THAT SLAG AND OTHe DI• ' 'ESIOLB ARE REMOVE--
-%,a
EMOVE--%,; HJ'THE iNTSANAL DIAMETERS OF PIPING ARE NOT PENS T RATED?
I:
J _
7CUr;
QUTOO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ❑ YE9 NO
SCS) ENSURE THAT ALL CUTOUTS(DISCS)ARE RETRIEVQO?
figure I.Ila)Fort 2,
1996 Ec,,,r
UELTH FIRE Fax:5036201058 Jan 5 '99 9.30 P.07/07
�rain�tn��tr>hr�� 13-77
HYDRAULIC I NAMEPLATE PROVIDED IF NO,EXPLAIN
DATA
NAMEPLATE ❑ YES [] NG
DATE LEFT IN SERVICE WITH ALL CONTROL VAL�iS OPEN
• HEMARKS
NAME ORSPAMLER CONTRACTOR
AZT/.r ,? ✓C�
SIGNATURES TESTS WITNESSED BY
101?ERTY OWNER(S NnTITI_ 0/7- �i 7294`*ATE
rc�eqNKL.p OONTR , R(S TITLE DATE /
ke-
ADDITIONAL EXPLANATION AND NOTES
Figre 8•101)Part�.
INSPECTION N_OT_ICE -
City of Tigard Building Department
13125 SW Hall Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 634-4175 Business Phone: 639-4171
Inspection:
--___�_.__
Footing Plbg. Underalab Mech. Pough-in Appr/Sdwlk
Found. Plbq. Top Out Ca Line Tj1IALs
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation zftlu
Plbg. Underfloor 9ater LLina �J Gyp. Bd. -Hoch.
Date Requeetedt / / Times AM PM
A.1�lro9es Grr Permit
i
Builders
THE FOLLOWING CORRECTIONS ARE REQUTREDt
--------------
- -7
Inspectors. Dete:-���'��'"�
XC --- - -- i
APPROVED DISAPPROVED APPROVED SUBIEC'f TO ABOVE
_Call For Aelnap.
' J
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PLUMBING PLRM I T
F,ER11IT #. . . . . . . : PL_M94-0130
639--4171 DATE ISSUED: 07/06/94
PARCEL: cS 1 13AA--0010lZ1
SITE ADDRESS— . : 16364 SW 721ND AVE
SUBDIVISION. . . . : ROSEWOOD ACRE T 'tCTS ZONING: I—L
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :A
CLASS OF' WORE'.. . :ALT GARBAGE DISPOSALS. . : MOBILE HOME SPACES.
TYPE OF USE. . . . :COM WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . :
OCCUPANCY GRP. . :B2 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . . WATER HEATERS. . . . . . CATCH BASINS. . . . . . . .
FIXTURES -___._._____._._—_ LAUNDRY TRAYS. . . . . . : Sr:- RAIN DRAINS. . . . . :
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . . GREASE TRAP'S. . . . . . . .
LnVATORIES. . . . . : OTHER FIXTURES. . . . . :
TL)B/SHOWERS. . . . : SEWER LINE. (ft) . . . . :
WATER CLOSETS. . : WATER L._INE (ft ) . . . . : 300
DISHWASHERS. . . . .. RAIN DRAIN (ft ) . . . .
Remarks : REPLACE WATER LINE
Oviner: -- - ...___._________.___________..__.._______--.---_._._----.__--____-- FEES
PACTRUST type amor_Int by (date r,ecpt
PRMT $ 55. 00 JG 07/06/94 -
PLCK f 13. 75 JG 07/06/94 -
5PCT $ ,=. 75 JG 07/06/94 —
fhone #:
Contractor ____-.----------------__-----.__--
POWER PLUMBING CO
1:10 BOX 23144
TIGARD OR 97291
Phone #: 244--1900 L 71. 50 TOTAL
Reg #. . : 52378
REQUIRED INSPECTIONS -----
This permit is issued subject to the regulations contained in the Wattar Line I n s p
u Tigard Municipal erode, State of Ore. Specialty Lodes and all other Final Inspection
appi:cable laws. All worti will be done in accordan,e with
approved plans. 'his permit will expire if wort( is .iot started
within 180 days of issuance, or if work is suspended for more
than :80 days.
Permittee Sign at1_(r•e :
Issued By :
W
Call foo- inspection — 6:'.9 4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
3125 SW Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
New Single Family Residences Only
°'••' C1 1 BATH HOUSE$140.00 0 2 BATH HOUSE$195.00
Job 72C7 3 BATH HOUSE$225.00
Addressawn. a, Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
FIXTURES QTY PRICE AMT
Sink 9.00
M.""""•'• ^""' Lavatory 9.00
Owner Tub or Tub/Shower Comb. 9.00
ze Shower Only 9.00
Water Closet 9.00
"•^•�"^"^•°'""'""' Dishwasher 9.00
Garbage Disposal 9.00
Occupant MN"Ad* Ph".
\,1Washing Machine 9.00
1 �I e1M Floor Drain 9.00
Water Heater 9.00
iLaundry Room Tray 9.00
"""• Urinal 900
Other Fixtures (Specify) 9.00
MW"A".*Contractor 9.00
900
ch+n•�.1 � --
�� y _ 9.00
,` p►� q I Sewer 1st 100' 30.00
"""' I-% Sewer-ea. Addit. 100' 25.00
oZ y�Z Water Service 1st 100' 30.00
I hereby acknowledge that I have read this applicatlon, that the Water Service ea. Addil. 200' 25.00 "3,r
Information given is correct, that I a- the owner or authorized agent of a
the owner, that plans submitted are In compliance with Stale laws, that Storm &Rain Drain 1st 100' 30.00
I sm registered with the Construction Contractor's Board, that the Storm d Rain Drain Addit, 100' 2500
number given Is correct. (If exempt from Slate registration, please
giy Qason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Antl-Pollullo, Device 9.00
'"''""•"°"" •0"''u c•'• Any Trap or Waste Not -!
_ Connected to a Fixture 900
Describe work new kY addition 0 alteration 0 reonir U Catch Basin 900
to be done residential (_) non-residential 0 Insp. of Exist. Plumbing 40 00/hr
Specintly Requested Insper Ions 40.00/hr
Fxlslinq use of Rain Drain, sin le Tamil dwelling 30.00
huildinq or property — � r�- �,.�o --- 9 Y 9
Residential backflow prevention
n. devices 15.00
c~i`, r`rnposAd use of ---
hr111ding or prnpedy \JQ0
--�-�-- - '(Except resfdenflal backflow
J prevention devices)
NOTICE *minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%.SURCHARGE h -7
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED ct-
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS 7S
COMMENCED PLAN REVIEW 251.10 OF SUBTOTAL
TOTAL
Sprrlai „ondIlloni _
Date Issued _ by
05/17/94 08:00 $503 024 7755 PACTRI'ST/M&T/PDA 1&03/003
R
ST
E
5
4 8
11
3
3
2
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5 � ifTTTTI".7
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MAY-17-1994 01.00 503 624 7755 94% P.03