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13400 SW DOE LANE
CERTIFICATE OF OCCUPANCY
CITY O F T I G A R®
PFRMIT#: MST99.00079
DEVELOPMENT SERVICES GATE ISSUED: 3/17/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104AC-12200
ZONING: R-7
.JURISDICTION: URB
SITE ADDRESS: 1,3400 SW DOE LN
SUBDIVISION: DEER POINTE
BLOCK: LOT:U 13
CLASS OF WORK: NEW
TYPE OF U,-,E: SF
TYPE OF CGNST1?: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: PATH I: New single farrily dwelling w/attached garage.
Final Inspection Approved 6/29/99 by Ken Schriendl, Building Inspector
Owner:
DON MORISSETTE HOMES
5000 SW MEADOWS ROAD
SUITE 151
LAKE OSWEGO, OR 97035
Phone: 620-7538
Contractor:
DON MORISSETTE HOMES
5000 SW MEADOWS RD
STE 151
LAKE OSWEGO, OR 97035
Phone: 620-7538
Reg #:
This Certificate grants _ccupancy of the above reference(,' building or portion thereof and
confirms that the buil ling has been inspected for compliance with the Statc of Oregon
Specialty Codes for the gro p, occupancy, and use under which the referenced permit voas
issued.
i P
BUILDING INSPECTOR BUI DING OFFICIAL
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUiI_DING INSPECTION DIVISION MST Rq
24-Hour Inspection Line: 639-4175 Business Line. 639-4171
dl1P
Date Requested l.('' C�C� AM PM ( BLD -
Location Suite — MEC
Contact Person ' L��►�CL� _ Ph L,,_Go2'7"7 PLM
Contractor Ph SWR
ILII Tenant/Owner ELC -- ----
Retaining Wall ELR
Footing Access: FPS
Foundation -- - -
Ftg 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
i�
PASS PART FAIL - -- -- ------
PLUMBING —
Post 8 Beam - - —�------!
Under Slab
Top Out _..—.----------
Water Service
Sanitary Sewer ------a-- - _-- --
Rain Drains ----
Final
PASS PART FAIL _ _ _---
CHA LC
Post& Beam
Rough In
Gas Line ----
Smoke Dampers
PASS PART FAIL.
E _ RICAL
Service _
Rough In
UG/Slab
Low Voltage
Fire Alarm —.-- -
Final
P/'SS PART FAILSIFE
Backfill/Grading
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ j Please call for reinspection RE __ - — [ J Unable to inspect-no access
Fire Supply Line
ADA Ir
Approach/Sidewalk Date Q� ��� f►'�' Inspector �Zz -- Ext --__
Other —
Final
PASS PART FAIL DO NOT REMOVE this inspection record fro:n the job site.
CITY OF TIGARD MASTER F,ERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : ME--IT99-0079
13125 SW Hall Bko., Tigard, OR 97223(503)6;19-4171 DATE ISSUED: 0?,/17/99
FIARCEL.: 2S 104BD-08800
SITE ADDRESS. . . : 1:s400 SW DOE: L-.N
9LJBDIVISION. . . . :DEE:F4 F,()INTE ZONING: R-7 `
DL-OCK. . . . . . . . . . 1-01.. . . . . . . . . . . . . :0.1.6 JUIRISDICTION: URB
Remarks: PATH 1: New single family dwelling w/attached garage.
--------------------------------------------------------------- BUILDING -- --------------------------------------
REISSUE: STORIES.......: 2 FLOOR AREAS----------- BASEIENr...: 0 sf REQUIRED SETBACKS---- REQUIRED--- ------ -
CLASS OF WORK.:NEW HEIGHT.,,,.,,,; 23 FIRST....: 1498 sf GARA6'.. ..: 672 sf LEFT..........: 10 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1552 sf FRONT....,....: 20 PARKING SPACES: 2
TYPE OF CONST,:5N DWELLING ONITS: 1 FINBSMENT: 0 sf RIGHT..,......: 8
OCCUPANCY GRP..-R3 BDRM: 4 BATH: 3 TOTAL------: 30* sf VALUE..1: 224972 REAR........,.: 26
----------------------------------------------------- --- --
---- PLUMBING --------------------------------------------------------------
SINKS.........: 1 WATER CLOSETS.: 3 WASHING MACH.,: 1 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 100 TRAPS,....,..,; 0
LAVATORIES,...: 4 DISHWASHERS...: l FLOOR DRAINS..: 0 SEWER LINE ft. I* SF RAIN DRAINS: CATC:( BA9r';..: 0
TIIB/SHOWERS.,.: 2 GARBAGE DISP..: 1 WATER HEATERS.: 1 WATER LINE ft: 100 BLr;LiW PREVNTR: 1 GREASE TRAPS..: P
OTHER FIXTURES: 0
----------------------------------------------- ---- - - MECHANICAL -------------
-------------------------------------------------
FUEL TYPES------------ FURN ( I ..: 1 BOIL./CMP ( 3HP: 0 VENT FANS,....: I CLOTHES DRYERS: I
GAS FURN )=100K ..: P LVIIT HEATERS..: 0 HOODS.........: 0 OTI4ER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS...,.....: I WOODSTOVES....: 0 GAS OUTLETS...; 1
-------------------------------------------------------------- ELECTRICAL ------------------------------- --------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- -----MISCELLANEOUS---- --ADD'L INSPECTIOW-
1000 SF OR LESS: 1 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR,.: 0 PIMP/IRRIGATI9N: 0 "ER INSPL-.CTION: 0
EA ADD'L 580SF.: 6 201 - 400 amp..: 0 201 400 amp.. : 0 1st W/O SVC/FDR: 8 SIGN/OUT LIN LT: 0 PER HOUR....,.: 0
LIMITED ENERGY.: 0 401 600 amp..: 0 401 - 600 amp..: 0 FA ADDL BR CiR: 0 SIGNAL/PANEL...: 0 IN PLANT......: P
MANF HM/SVC,/FDR: 0 601 - 1000 amp. : 0 601+81ps-1000 v: 0 MINOR LABEL -10: 0
1000+ amp/volt.: 0 _..__._.___-_. .-.-.---__..--------_-__-- PLAN REVIEW SECTION --------------------------------
Reconnect only.: 0 )=4 RES UNITS..: S'iC/FDR)=225 A.: ) 600 V NOMINAL. CLS AREA/SPC OCE:
---------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ----------_ --._
- --------------------------------- -
A. SF RESIDENTIAL--------- --------- B. COMMERCIAL----------------------------------------- ------- --------------------- I
AUDIO d STEREO.: VACUUM SYSTEM..; AUDIO d STEREO.: FIRE AL.ARM.....: INTERCOM/PAGING: OUTDOOR LWC LT: f
BURGLAR ALARM.. : 0TH: :: BOILER.,,....,.: HVAC........... : LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: X CLOCK..........s INSTRUMENTATION: MEDICAL........: OTHP:
HVAC...,.....,.: DATA/TI=LE CUM.: NURSE CALLS....: iuTAL N SYSTEMS: 0
Owner: -----------------------------------Contractor: ------------------------- TOTAL TOTAL FEES:1 2089.01
DON MORISSFTTE HG ES DON MORiSSETTE HOME; This permit is subject to the regulations contained in the
5000 SW MEADOWS ROAD 5000 SW MEADOWS RD Tigard M11nicrpal Code, State of Ore. Specialty Cedes and all
SUITE 151 STE 151 other appl. ble laws. All work will be done in accordance
LAKE OSWEGO OR 97035 LAKE OSWEGO OR 97035 with approved plans. This permit will expire if work is
Phone 1: 628-7538 Phone 0: KIK-7536 not started within 180 days of issuance, or if the work is
Reg t..: 000355 suspended for more than 180 dans. ATTENTION: Oregon law
--------`------------------------------------- --- requires you to follow rulei adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 001-0010 through OAR 952-001-0880. Yo-j may obtain -opies of these rules or
direct questions to OUNC by calling (503)246-1987.
----------------------------------------------------------- REQUIRED INSPECTIONS ---------------------------------
-------------------
Erosion 844-8444 Post/Beam Meehan Electrical Servi Gas Fireplace Electrical Final
Grading inspecti Crawl Drain/Back Electrical Rough insulation Insp Mechanical Final
Footing Insp PLM/Underfloor Framing Insp Rain drain Insp Plumb rinal
Foundation Tnsp Mechanical Insp Shear Wall Insp Water Service In Building Final
Post/Beam Struct Plumb TopOut . Gas Line Insp Appr/Sdwlk Insp
Tsst.red Sy : —�� Permittee Signatr.rre :
++++++++++ ++++ ++++ +_F + ++ �.+ +++++ ++++++A +++++++++++ ++++ +++++++++++++++-+
Ca11 639-4175 by 7:11 ' p, m. for an inspection needed the next business day
--- unified SANITARY
agency SURFACE WATER � 1
Q1155 N. First Ave.. Suite 270, Hillsboro, Or.,97124
503 648-8621
+l c r10N F'17 RMIT
ISSIX 001 ' 03J599 EXPIRATION PATE' 0911.99 r'C, EXP DATE 031401. PERMIT 11.ia,,
;3TWUCrUFtE ADDRESS 14()0 r Fia..JECr )�1
STRUCTURE' ':rTEtEF:'T i5W 1,nE uwE:
I._a'1 13 Hi..C'1CK
TYF'E CONNEC1IQN . NEW OV DEER PoINTL.
TYPCC ( 19 ) BLD SWR/UO CON/9DC
TYPL OCCUPANCY- ( 1 ) SINGLJ' FAMTI_ Y PAFeCE1- !S 1. 00 9800
()TR SEC 4316 MH fJ%"
GWNEr,; TICIN MOR15SE:TIF" HC)ME ;i
ADDRE"',. `a0(){) SW MEADOWS RTI 111 ) t TPFA'TMENT PLANT DURllir
LAKE OSWE GO aFP 970:35
PHONE F,20-'/530 4J ftT'ER DISTRICT TTGARD
F IX1URE FC)L)IVA1.f,,NI DWEI L IN6 REST DENIIAl..
L)N G F.P1)TCE:: 1.1N1143 0. 0 UNITS 1. SERVICE LINT I '
GONNECT ION F"c"175 SURFAC'E' WA I FR CICVF'LJ)PMF'N1 F FFS
GF:WF.E; CONNCCT'I0111 21300 . 06 Wf"-r1'E'R 0t}At. j TY .210. 0fi
I-ESS CREDIT 210,0%
WATER QUANT I UI 290,00
EROSION CONTROL.
IN9PE CT 10N 64 ,0•'
PLAN CHECK �
SUIITOT6L. '2:300, 00 SUBTOTAL
TOTEat :63;
PHONE
of-F ILL. IATION REP
C C K SI-OT 1 3 Pk0..1 8173 DF FP F"01N'TF.
*24 1-.0UR NQ,
1 .10E. FOR EROSION CONY OL. JrIS)'EC1IaN3 REPUTPL:D
Nlfrfrh�' ' f,r•I C01 I. Vo I S f CT 11lN H44 >1144 >i ,*�;*>1r
'S T(,NI) fL)F;I : . n ,' � t. .�.�r �4�i,_ (' ISSUE TFI`I t1�I+C�E; �!I;,; -
Permit Conditions. The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,including those regarding erosion control
A 24-hour notice is requited for erosion control InRopctlons 'i he Inspection request number is 044.0444.When cnifinq for an inspection,plense refer tr)
the permit,project and lot numbers
Ttie permit expires one hundred eighty(180)days from the date of Issuance.The Agency does not guarantee the accuracy of the location of side sewer lateral.
7'43 WHITE - USA, BLUE. - Accounting, GREEN -Inspection, Y6LI.nw - customer
DA1 E -
I NSPECIF D By
CIONIRACICIR/INIST AL1.FR
IIm olL PIPE _...__.__.____._ i)IAME IF OF PIPE
Inspector , Please sketch t7Plow or attach the following information,
II Strw?t R nearest crus5 street �
?.. iocaLion of structure I)Pi;ly SPrved
Route of service line from structure to property
1 i ne where it
c,�;inPcts, tri th? service lateral . Include lenyth & dperty linetPr
of service line , depth ihtoSstructureructure � property lines
pro
dimensions referencing line
ani/or corners, etc.
1
4 1Jurth arrow
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4
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Plan Ch--.K#_
CITY OF TIGARD Residential Building Permit Application Rec'd By
13'^.5 SV, HALL BLVD. New Construction Additions or Alterations Date Recd 1' —
TIGARD, OR 97223 Single Family Detached or Attached (Duple.::) nate to P.E. 3 �'
Date to DST C4
V 503-639-4171
P
F 50.3-684-7297 ermit# /f?5 y 9-�3
/y(I
Print or Type Called 3' `� �`1 � i
Incomplete or illegible applications will not be aedopted
Nome of Project -T--7
(� - Nam1 /J �Cn I .--i(
Job
Architect Nlai.ng Address
Address S1t�Addr s )� G l I
51
C _Csa ,�___ ty/ tate Lp C Phone
me
Lt t� Nome_LUC ( I I
Owner Mailing Address
Owner �:J
Engineer Mailing Address )� C
Ci JState Zip /Ph-one 9 � f t" i K
lL, it /Sta a ip Phonel
General Name t ' }�r-,-�l-
Contractor --101 '/ 1 > Describe work IJew• Addition O Alteration O Repair O
Mailin Address il to be done:_
Prior to permit 71� Additional Description of`Nork:
issuance, a copy Gity/Slare Zi h e —
or all licenses L _
are squired d Oregon Conn Cont.Board Exp Data PROJECT'
expired in COT Lic# 3 �� CC, VALUATION $ 2 I (`p / I s `+'
__database J ✓✓�� — -
Mechanical Name l NEW CONSTRUCTION ONLY: _
Sub- _-��.) I �� �. Sq F- House: Sq. Ft. Garage �� Q-•
Contractor Mailing Address — C�
L Corner I_ot YES) NO Flag Lot YES NO
Prior to pemnt Nty/si_a
1issuance,a ccoy e 0. ` ne _(check one) _ (check one)
of all licenses {"�l Restricted A Tdio/Stereo Burglar
are requires" ' Oregon Const.Cont.Board Exp. Date Energy _ System Alarm
expired in CUT Llc.B -7���?,- 3'�� Installation Garage Door HVAC
database Opener S stems
Plumbing Name _ //�V — -- --
Sub- 171 UI`�g) �� I (check all that Other.
aoPIY)
Contractor Mailing Address req
Will the electrical subcontractor wire for all YES
NO
CSU ristricted energy installations?
Prior to permit City/State i�p,] Ph ne ` Has the Subdivision Plat recorded? N/A YE,S NO
issuance,a copy "I � L x_
of all licenses are Oregon Const.C nt.Board Exp•Date -Reiss •of MST#: Solar Compliance
required if tic.# l �-7�--� �I �� � (Calculation Attached)``
expired in COT _
database Plumbing Lic.# Exp.Date I hearby acknowledge that I have read this application,that the
G I
(-I C3 information given is correct,t!tat I am the owner or authorized
agent of the owner,and that plans submitted are in compliarce
Name with Oregon State laws.
Electrical G lSig\\nture of OwnerlAgent Datq
Sub.. Mailing Address Imo, �1, V --' _� -- YD,
-7C jvN NL rnbV�5 � ��"c- Oo tact Person Name Phone#
Contractor , I Imo- C _�r�-S 1 S
City/State Zip Phone
Prior to permit FOR OFFICE USE ONLY:
1&ic ",ifybi C*r Q 7 "C.C�I• Plat#: Map
fTL#:
issuance,a copy __
of all licenses are Oregon Const.Cont.Board Exp. Date ;,r. .?,4
O
required if Lic.# � (fjr3l Setbacks: Zone: Solar/
expired in COT
database Electrical LIc.# Exp.Date Engi Bring Approval Planning Approval: TIF:
'ri t i'S5L• 3 (?,ATN l-7R- r- !'
1 SFREM.DOC (DST) 4!47
4 -�
DGI .Lw - MORISSETATL
H 0 m E S
50n0 �. R. Y KAD0Q3 ROAD 30116 151
LAKE 0511EG 0, 0 R E a 0 N 97033
,at (5 0 3) 6 2 0 — 7 5 3 8 j? k X (303) 0 2 0 — 7 d B 5 OBE . 1880
0
LOT: 13
�T J(
z DATE: 2/23/99
T,�INDEP'f Cs,4R�1C,i=
PROPERTY: DEER-POINTE
_ C1TY: TIGARD
322 9cALE: 1"=200
322 ' PLAN No.: 17B
324
32h I � 3 4bpr ch ' 4.2
329
concrete , I 3�
.'prlvCwe�'• I i m
I � Ire
Ii• +�: �1' i I 33 31 I I
�. 21'
i 3�2
330
{ I
gar,
FF.E. 333' � I
33? 14' 10' 44, '
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33a% i 2 i/2 brth �
e �
FF �
336. 1PJ i
i
4, 4
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330
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34C
545 15 5L E. SSE.
342 / �Ci 2.�e�'�
344N
LOT 13
6,96,9 eq. Pt.
'1
CITYOF T I/A A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT M PLM1999-00273
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED:
PARCEL: 2S 104AC-12200
SITE ADDRESS: 13400 SW DOE LN
SUBDIVISION: DEER POINTE ZONING: R-7
BLOCK: LOT: 013—` _JURISDICTION: URB
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
____FI_X_TURES LAUNDRY TRAYS- SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
L AVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installing residential backflow preventic device
__FEES
Owner_
-- — Type By Date Amount Receipt
DAVID M ETZEL
13400 SW DOE LNPRM4 BON _ 8/27/99 515.0099 317991
TIGARD, OR 97223 5PC2 BON 8/27/99 X1.75 99-317991
'Total $26.75
Phone 1: 503.579-4144
Contractor: _
(1LI-1 iVX0-
REQUIRED INSPECTIONS
RP/Backflow Prevenler v
Phone 1: Final Inspection
Reg #: / J
ORIGINAL
This permit 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 052-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 6-1987.
O.
4
Permittee Signature \
Issued By: �u, -�. 9 --
Call (503) 639-4175 by 7.00 P M. for an inspection needed he next business day
CITY OF TIGARD Plumbing Permit Application Plan Che
13125 SW HALL BLVD. Commercial and Residential Recd By
I IGARO, OR 97223 Date Recd ' - -�
(503) 639-4171 Date to P.E.
Print or Type Date to DST
Inr ompiete or illegible applications will not be accepted Permit# P"
Related SWR#_
Called
Name of Developmunt/Project FIXTURES (nmocv°dual) QTY PRICEAMT
Job / On/%;) Sink 11.50
Address Street Address Sulte Lavatory 11.50
Tub or Tu')/Shower Comb. 11.50
Bldg# City/Stale Zip Shower Only 1 50
Names Water Cioset/Urinal (Specify) 11,50
AJ\ �}ZQ I Dishwasher 11 .50
Owner Mailing Address Suite Garbage D+gposal 1-1-5-0--
3-100 S•-i bee- L-'1 Washing Machine/Laundry Tray (Specify) 11,110
City/Slate Zip Phone - -- — _
I- UFloor Drain/Floor Sink 2" 11.50
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater O conversion O like kind 11.50
Gas piping requires a separate mechanical permit.
City/State Zip Phone Mr-G Home New Water Service 28.00
_ - MFG Home New San/Storm Sewer 28.00
Name -- - --
r (l )y k0v Hose Bibs 11.50
Contractor Mailing Address - Suite Rain Drains 11.50
Drinking Fountain 11.50
Prior to permit City/State Zip y Phone Other Fixtures(Specify) 15.00
Issuance,a copy
of all licenses are Oregon Const Cont.Board Lic.# Exp.Date
reopired if
expired in COT Plumbing Lic # Exp Date
database
Name Sewer-1st 1n0' 38.00
Architect _ Sewer-each additional 100' 32.00
Or Mailing Address Sulte Water Service-list 100' 38.00
(State ti Phone Water Service-each additional 200' 32.0)
t
Engineer y p -
Storm&Rain Drain-1st 100' XUu
Describe work to be done. Storm&Rain Drain-each additional 100' 32.00
New Repair O Replace with like kind: Yes O No O Commercial Back F low Prevention Device 32.00
Residential O Commercial O
Additional description of work: Residential Backflow Prevention Device. 18.00
Catch Basin 11.50
Insp.of Existing Plumbing 50.00
Are you capping,moving or replacing any fixtures? _ per/hr
Yes O No,d Specially Requested Inspections 50.00
If yes,see back of form to indicate work performed byper/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain,single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
1 hereby acknowledge that I have read this application,that thlt Information QUANTITY TOTAL
given Is correct,that I am the owner or authorized agent of the owner,and Isometric or riser diagram Is required M Quant ty Total is >9
that plans s bmittedare In compliance ith Oregon State Laws. *
SUBTOTAL of ODate
I Pt- - SUBTOTAL
+�/ -L 7" — 7%SURCHARGE
Cora on Na 1-7
Phone
_
TZ, r:r-1 F� C lrz ( 'j 1`1 ��`/` **PLAN REVIEW 25%OF SUBTOTAL
1 BATH HOUSE$178.00 Re uu_ed_only d fixture qty total is>9
2 BATH HOUSE$250.00 TOTAL
3 BATH HOUSE$285.00 _
(Thiq foe Includes all plumbing fixtures In the dwelling and thr first
100 feet of sarltary aower storm sewer and water service) Device Devlee,w permit tee is$50.7%surcharge except Residential Backflow Prevention
which is$25+7%surcharge
••All Now Commerclal Bulldings require plans with isometric or riser diagram and
plan review
I%dsrsUormslplumapp doe 7119/99
PLEASE COMPLETE:
Fixture Type — — Quantity by Work Performed _
New Moved Replaced RemovedlCapped
_Sink__
Lavatory --- ---- ---- --- - - — ----
Tub or Tub/Shower Combination —�
Shower Only
Water Closet --------— - -- --------- ------
Dis_hwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2" —
411
Water Heater
Laundry Room Tray
Urinal-- ---- -- — --------- -- ----- -
Other Fixtures (Specify) —
I --
COMMENTS REGARDING ABOVE:
I%ds:aVdmsWumam do 7119M