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16270 SW PALERMO LANE 16270 SW PALERMO LANE: CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 �) ! BLIP Received -- --_—Date Requested l'-`-� �r AM _ PM---- BLIP -- -- -- Location _._ � 02_,70 IC U !�N Suite—._— MEC �_.-_-- Contact Person 'J_a_,,,CAn - Ph(--) 7:2_S2L0.5 PLM Contractor �- _� — _ Ph(__. ) -- SWR ILIN _ _ Tenant/Owner -__ _ -- ELC noting _._ ELC Foundation Access: Fig Draici ELR Crawl Drain _ Slat; Inspection Notes: SIT Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - [1 V► V�b L '��_ a�;�- t"�,e.��i�1 s_� Insulation Drywall Nailing - Firewall Fire Sprinkler ---- ----- --— -- -- --- Fire Alarm Susp'd Ceiling --- --- - ----- --- - -- ----- - -- Roof O►der: —__._. _.__- - - - - - ------------ - Final SS_PAR IL — - _PLUMBING Post 8 Beam --------- - ---- --- - ----- -- Under Slab ------_--- Rough-In Water Service - -- --- - - -------- -------- ---- ----- Sanitary Sewer Rain Drains -- Catch Basin/Manhole StormDrain ------ _-_. _--- -- - -.- ----.-------._..___.__..`- __- Shuwer Pan Other:_ _ ---------------- - --- --- --- -- --.- ---- Final PASS_ PA FAIL__ - --- ---- -- -- ----- ------ CHANICAL __... Post& -am --Y -- - Rough-In ------- -- -- -- -_ ----- ------ -- — - ---- Gas Line Sm ampers - -- --- —�-- -------- - inal _ S PART FAIL ---_------ ------._--__-__-.._------- _ _R_ICAL _ Service Rough-In —_ --- - -- ---- ---- ---- UG/Slab Low Voltage - _-- ----- - __-- Fire Alarm Final Reinspection fee of$_-_ required before next inspection. Pay at Cit 111, 13125 SW Hall Blvd. PASS PART _FAIL _ SITE _ Please call for reinspection RE;.— ___—� __- ; Unable to inspect-no access Fire Supply Line C ADA Approach/Sidewalk Dante I Li --- Inspeder�` -Gs,��_ 5.0 Other: Final -- DO NOT REMOVE this !nspection record fronn the ,Mots site. PASS PART FAIL CITY OF TIGARD 2 Inspection Line: 639-4175 rn : ( } BUILDING MST INSPECTION DIVISION Business Line: (503)639.4171 a BUP _ Received _ �-7 _Dat Reju.,_.ested_��— AM — PM — BUP Location r c/ 2 1. � po n -----Suite MEC — Contact Person C'oy� PLM Contractor — e eA�A —_ _ Ph( ) _ SWR BUILDING Tenant/Owner ELC Footing ELC -- Foundat.on Access: Ftg Drain ELR — Crawl Drain Slab Inspection Notes: SIT Post&Bear,, Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing —- - --- ---.-a--- ---------- ------- _ ---- Insulation Dry%val'Nailing _— -- - - --- _—------- ------- -- — Firewall Fire Sprinkler ------- -- -- - --------- ------ - - -- -�_.-- Fire Alarm Susp'd Ceiling -------- -- -- --_..__._._-----__.------_..__.--- Root ---- Other: —._-- Final PASS PART FAIL LUMBt _ --- ---- ---------- ----- -- -------- — Post&Beam Under Slab - ----- _--- ----- — --- ----- - Rough-In Water Service ---- -- ----- --- --- -- Sanitary Sewer Rain Drains --- -------�- '-- - -- — Catch Basin/Manhole Storm Drain - ---- - — - - Shower Pan Fin ASS _PART FAIL - ------- - •--- -- _ ICAL —_ --- ------- --- ---- ---- ---— Post& Beam Rough-In - — ---- -- --- Vas Line Smoke Dampers ------ -- ---- --_ —. -- -- -- ---- Final P 8 FAIL ------.. ---- _ ECT_RIC:AL Service- Rough-In _—..-- -------- UG/Slab Low Voltage EkaAavl�.? mRF] Reinspection fee of$ required before next inspection. Pay at City Fail, 13125 SW Bali Blvd. PART_ FAIL _- _ [] Please call for reinspection RE: _ -.r-- F� Unable to inspect-no access vire Supply Line ADA Approach/Sidewalk Dete—Z-0 Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY CF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 ( "[0 Z6 g INSPECTION DIVISION Business Line: (503) 639-4171 � /1 BUP Received _� __ _ Date/�equJested— i o /(, AM - PM _ - BUP Location — Q_� _. If P�Y`Y� Suite _. -__- -_—_ MEC — Contact Person Q=01 - PLM — Contractor C e.vt_442,)( Ph;--_) _ SWR _ UILDING Tenant/Owner ELC _____ —_. _--__— _ o ing ELC - Foundation Access: Fta Drain ELR Crawl Drain Slab Inspection Notes: SIT _ Post&Beam _ -._-------.---- _ _ Shear Anchors Ext Sheath/Shear -------- int Sheath/Shear - Framing - Insulation Drywall NailingFirewall _ Fire Sprinkler --- — ------ — Fire Alarm - Susp'd Ceiling __.__--,��----- -- ---- ----- Roof i Other: -- �--_- -... - _ - ---- - �. PART FAIL �- f_ BI_NG _--- ---___--- -Post&Beam — Under slab ---- - -- Rough-In Water Service --_- ---- - — -------------- .-_..— Sanitary Sewer Rain Drains - ------ -- ..._-- - ---- -- ---- Catch Basin/Manhole Storm Drain ----- - - - Shower Pan -- -_- Other: ------- - __ ------------ - Final --__-.-- PASS_ PART FAIL MECHANICAL ------- — - - - ----- — --_ --- -_ Post& Beam -- ----- Rough-In - --- - _ - - - --- ----- - -- Vas Line Smoke Dampers ----- --- --- - -_.. --.-._— _ - -- -- Final PASS PART FAIL ---__-.—._._- ------ -- -- --_--- --------------. ___._ ELECTRICAL Servica Rough-In _ - ---- __- - --- --- - UG/Slab Low Voltage —_-- - --- - --- -- - -- - Fire Alarm Final ReinspE--tion foe of$_ required before next inspection. Pay at City Hall, 1312.5 SW Hail Blvd. PARS PART FAIL g - — n Please call for reinspects n RE:__ _.. F'� Unable to Inspect-no access Fire Supply Line - ADA Approach/Sidewalk Date ;,t� _},6 Inspector � `�— _-_._____-- .Ott_---- Other:— -_ V Final DO NOT REMOVE this Inspectlon record from the Job 91f 9. PASS PARFAIL AAAAAAAAAAAAA. '.AAAAAAAAAAAAAAi AAAAAAAAAAAA/r 4 :� O l7 ► { N ~' ► .4cn � !► 4 d a+ 4 , � ► 4 P 4 P 4 ► 44 b l ► d `J ► dCDcr q 1 ► 4 O IrD °, ► No. M ► r> > ► t-ri m " o ► 41d Ok- ( m i r• 101. 44 P •� � O P ® P, � P d P t ► '�r�vveeeevevvi i� �tiseiii��ev� �ieveeeeeee��►- �' co � r= zi I- a 0 0 I O ' J A STV I � O i� C n CITY OF T f G A R D -_.-__ MASTER PERMIT PERMIT#: MST2003-00208 DEVELOPMENT SERVICES DATE ISSUED: 6/27/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 16270 SW PALERMO LN PARCEL: 2S105CC-T0022 SUBDIVISION: TUSCANY ZONING: R-7 BLOCK: LOT: 022 JURISDICTION: ('Illi REMARKS: Construction of new SF detached residence. BUILDING REISSUE: CEN2433 STORIES: 2 FLOOR AREAS _i REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1.112 at BASEMENT, at LEFT: n SMOKE uETECTORS. r TYPE OF USE: bF FLOOR LOAD: 40 SECOND: 1.321 at GARAGE: 450 of FRONT: i5 PARKING',PACES: TYPE OF CONST: 5N DWEI LING UNITS: I THRD of RIGHT: 5 OCCUPANCY GRP: H3 BDRM: 3 BATH: 3 TOTAL: 2.437 of VA'-UE: 237.952 00 REAR: 'S PLUMBING SINKS: I WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: IQQ TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS. I CATC4 BASINS. TUBISHOWERS: 3 GARBAGE DISP: I WATER HEATERS: 1 WATER LINES: 100 BCKFLW PRF.VNTR: GREASC TRAPS OTHER FIaTIIRES: MECHANICAL _FUEL TYPES FURN c 100K: BOIL/CMP<3HP: VENT FANS, 5 CLOTHES DRYER: 1 GAS FURN>*100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS- . MAX INP: btu FLOOR FURNANCES: VENTSt WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL, RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 - 200 amp: WISVC OR FDR: PUMPIIRRIGATIOW PER INSPECTION. EA ADD'I.500SF 4 201 400 amp: 201 400 amp: tat WIO SVCIFDR: SIGNIOUT LIN LT: PER HOUR LIMITED ENERGY: 401 800 amp: 401 800 AMP EAADDL OR CIR: SIGNALIPANEL: IN PLANT - MANU HM/SVC/FDR: 601 - 10u0 amp: i01•ampS•1000V: MINOR LABEL: 1000-amp/volt PLAN REVIEW SECTION Rrconnect only: >,4 RES UNITS: 9VCIFDR>=225 A.'. >600 V NOMINAL: CLS AREAISPC OCC ELECTRICAL•RESTR!CTED ENERGY A.SF RESIDENT IAL B.JOMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL. GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR, HVAC: DATA/TELE COMM: NORSE CALLS: TOTAL a SYSTEMS. Owner: Contractor: TOTAL FEES: $ 5,520.78 1 his permit I s subject to the regulations contained In the CENTEX HOMES CENTEX HOMES Tigard Municipal Code State of OR Specialty Codes and 16520 SW UPPER BOONES FERRY 16520 SW UPPER BOONES FERRY all other applicable laws All work will be done In PORTLAND,OR 97224 #200 accordance with approved plans This permit will expired PORTLAND,OR 97224 work is not started within 180 days of issuance,or if the work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Phone: 501-609-3060 Phone: 503-608-3060 Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through 952-001-0080 You Rog 0: LIC 124490 may obtain copies o`these rules or direct questions to OUNC by calling(503)246-1987 REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Mechanica Plumb Top Out Exterior Sheathing Inst Gyp Hoard Insp Appr!Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final Foundation Insp PLM/Underfloor Framing In.3p Gas Fireplace Water Line Insp Plumb Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Servi - Insp Building Final lsi Lued By : ':� ___ _ Permittee Signature Call (50 ) 639-4175 by 7:00 p.m. for an inspection n,?eded the ext Usi ess r4ay o SAKI ITARY• 000cic.a»VUater Services 87174 SURFACE WATER CONNEC;TiON PER141T "',SUE DATE 050903 EXPIRA"'ION DATE 114503 FC EXP DATE 050805 PERMI'1 124062 RLTCTURE ADDRESS 16270 PROJECT 8610 STRUCTURE STREET SW PALERMO LANF. LOT 22 BLOCK 'YPE CONNECTION•. NEW OF TUSCANY SUBDIVISION 'T'YPE INSTALLATION- ( 19) BLD SWR/ERO CON/SDC TYPE OCCUPANCY- ( 1 ) SINGLE FAMILY PARCEL 251 5CC 11 '100 QTP SEC: 4413 MH 2 40 5'4 WIDER CENTEX HOMES ADDRESS 16520 SW UPPER BOONES FCR TREATMENT PLANT DURHAM PORTLAND OR 9.7224 PHONE 503-308•-3050 WATER DISTRICT TrGARD FIXTURE EJQUIVALE:NT DWE:LLTNG RESIDENTIAL TS SERVICE UNITS 0 . 0 UNITS 1 SERVICE UNITS i CONNECTION FEES SUPFACE: WATER DEVELOPMENT FEES SEWER CONNECTION 2300 -00 WATER QUALITY 225 - 00 LESS CREDIT <: 225 .00> WATER QUANTITY ?.75 . 00 LESS CREDIT 0. (40> EROSION CONTROL, INSPECTION 64 .00 PLAN CHECK 41 . 60 SUBTOTAL 2300 . 00 SUBTOTAL 380 . 60 TOTAL 2680 . 60 AI'PI. NAME MIKE PHONE AFFI:LLIATION REP REMARKS LOT X2 , TUSCANY, 48610 ` " ` Number r. a i. l <�r INSPECTION----846-8444 ` " )IPIAl'±JRE , 1 � __..__...sc:_. . ISSUED BY WiLSONM ��; Pemdt Conditions: fhe applicant agrees to oornply wth all rules and regulations of the Unified Sew--rage Agency Mm calling for an ns ledion, please refer to the Perrin Nunes The Pemrit expires one hurximd eighty (180) days from tho date of issuance. The Ager y doss not guarantee the acau:uv of the location of side sewer laterals. 7/93 W9ITE - USA, BLUE - Accounting, GREEN -Inspection, YELLOW - Customer I NS PF C I F. 1) R Y f!A.7 C,0N T R AC I OR/I NST AL It I R ."YPI OF Pill[ Inspector, P I v a s e s k e t r h b P I ow or attach t. I Street & near? ;t crops ctrvet. Location of structure h-in 1 Route 0 st-'ry ice I i nf, i connpc t.S t'o the (�r v i lr�rl;t6l r it T m- of ,r,ry i cr.- I i no, de 0. fit dimen0, nc, r0prp nring I lrie to I "'N", and/rit, cornets, etc. 4 North arrow 6- l!;-er, M�� Building Permit Application A Date received: -0J i Permit no:I C74� •1 % City of Tigard ProJect/appl. no.: Expire date- C)e, r Ci o Tigard Address: 131 �y=� IrBl�c�,TR 97223 -- rY f 8 Phone: (503 "�E719Y ,- V/ Gat issued: By: ' Receipt no.: Fax: (503) 598-1960 Case file no.: Payment We: Land use apprci g� 1 oo� 1&2 family: Simple— Complex:ass ice, t I &2 family dwelling or accessory Q Commercial/industrial U Multi-family )(New construction Q Demolition 1.3 Addition/alteration/replacement Q Tenant improvement Q Fire sprinkler/alarm ❑Other: Joh addrt ss. / Com_;(-✓y/ }�/L-_______—�. Bldg. no.: _ Suite no.: Lot: Block: Subdivision: Tax mapltax lodaccount no.: Project name: Description and location of work on premises/special conditions: �[�1 /?moi p L�71I�%�� NST• ---- Name:(caWr �_ 1-IOM mT. M Mailing address: i , zd 5 ,FEKF I & 2 famii} dnclliug: City; C State: ZI_Pg� Valuation ol'work 5 _IrPhonc: 0$-30(ot7 Fax:(OD8- E-mail: No.of bedroums/haths .................................. —Owner's representative: (,IKE N I � Total number of floors .................................. — Phun7Jz) ..0<<� Fax: Y" E-mail: New dwelling area(sq. fl.)............................Garage/carport area(sq. ft.) .......................... —Name: C_S . [—.-. Covered porch area(sq. ft.) .......................... ----- —v -- Deck areas ft. Mailing address: ( q. ) .......................................... City; �7L-state:�. ZIP: Other structure area(sq. ft.)......................... Phone: F,tx !E-mail: Comm.:rcitillindustriullinuiti-family: t isValuation of work ......................................... S Existing bldg.area(sq. ft.)............................ Business name: New bldg,area(sq. it. Address: Number of stories.......................................... City; State: Z[P: — Type of construction ................................ . Phone: Fax: E-mail: Occupancy group(s): Existing: CCB no.: /-� -- — New: City/metro lic.no.: Notice:All contractors and subcontractors are required to be i licensed with the Oregon Construction Contt•.ctors Board under Name: provisions of ORS 701 and may be required to be licensed in the �-- jurisdiction where wort,is being performed if the applicant is Address: exempt from licensing,the following reason appli^s: City: State: ZIP: ---- Contact person: Plan no.: -- Phone: Fax: L-mail: --�------ — Name: 9i.-_9Y. Contact person: Fees due upon apphcatio.. _ ..................... 5 Address: Date received: City: � State: ZIP: Amount received . ........................................$ Phone: Fax: E-mail: Please refer to fee schedule. I hereby certify 1 have read and exainined this application and the Not sit)urirdicaons accept credit cards,please call iuritdiction for mora information. attachrd checklist.All provisions of laws and ordinances gu-cming this u Vita ❑MasterCard work will be complied w;ih.whether Ane 1(-fl herein or not. Credit card number___c / Expires Authorized s' _LDate: mime of cardholder as shown on credit cud - Print name: A ei(•� Cardholdr.r uynature--�_ Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete WM613(61001COM) Electrical Permit Application ONIN Date re-eived: _ Permit no.: r City of Tigard Project/appl. no.: Expire date: Ciro of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 6394171 Date issued: By: Receipt no.: i' Fax: (503) 598-1960 Case file no.: Fay"ent type: Land use approval: t I1 &2 family dwelling or accessory U Commercial/industrla! O Multi-family O Tenant improver cit, New construction O Addition/alteration/replacement ❑Other. —❑Partial W 01,t t Job address; 6• Bldg, no.; I Suite no.. ITax map/tax lot/account no.: Lot: �� Block: Subdivision: UCA My Project name: Description and location of work on premises:N SIN UE FAM 1IAL Estimated date of completion/inspection: 1 1 1 t Job no: p_�� Fee I MRN Business nem —�� ' Description _ Qty. (ca) foul nn.lnsp New residential•%angle or multi-family per Address: dwellingunll.lnclude%attached garage. City; LEM State: ZIP: Serviceincluded: Phone:a9 4 Fnx: U.pRN IE-mail: 1000 sq.ft.or leer 4 CCB no.: �L Elec.bus.lie.no; =y 5 1 G Each additional 500n_'t_or_portion thereof _ ( lty/meti0 lie.n0.: Luu,oni unuta,, :-•tdent{sl 2 ____ Limited energy, non-residential 2 Rich manufactured home or modular dwelling SI nature of supervising electrician (required) Date Service and/or feeder 2 Su .elect, name(print): — r Services or feeders—Installation, Sur ) �( h ''� ` t.. License no: y1i•3�7S alteration or relocation: PROPERTY fWNE It 200 amps or less 2 201 am a to 400 ams __ 2 Mallin address: "r -- 401 am a fo 600 amps _ 2 �� p—El ?'WW 601 amps to 1000 amps 2 City: State: ZIP: -7 Over 1000 anis or volts Phone: IF Fax: (p E-mail: Reconnect only Owner installation: The insraJation is being made on property I own Temporary services or feeders- which is not intended for sale,lease,rent,or exchango-according to Installation,alleration,orrelo:stion: ORS 447,455,479,6701. 200 amps or leu Y _201 amps to 400 amps _ _ 2 OWller's 9i re `J ��'�� / 1)StC; 401 to 600 ams 2 Branch circuit%-new,attention, Name:_ or extension per panel.- A. anel:A. Fee far branch circuits with purchase of Address: __ service or feeder fee,each branch circuit 2 City: _ —__ ---`_ State: ZIP: B. Fee for branch circuits without purchase Phone: FaX. E-mail: _of service or feeder fee,first branch circuit: 2 Each additional branch circuit: ' Mist.(Service orfeeder not Included): U Service over 225 amps<omntercial U Ilealth-care fan'.;% Each p or{rtigetion circle _ A 2 U Service over 720 amps-sting of 1&2 U Pamdous locor,m Each sign or o_utlirre lighting _ 2 family dwellings O Building over 10,000 square feet four or Sigrid cimuit(s)or a limited energy panel, O System over 600 volts nominal more residential units in one,overrun alteration, or extension* 2 O Building over three stories U Feeders,400 amps or more _•Description: U Occupant load over 99 persons O Manufr tuned structures or RV pork Each additional Inspection over the aIle wable in any of the above: j U Egress/lighting plan U Other: — -- Pe, inion Submit_sets of plans with any of the abeve. Investigation fee The above are not applicable to temporary construction service. Other —�+ — Not all jurisdictions accept credit cards,ptwu call jurisdiction for anon information. NONcet This permit application Permit fee......................S O Visa O MasterCard expires if a permit is not obtained Plan review(at _ %) S _ Credit ca d number _ within 180 days after it has been State surcharge(8%).....S .. Name of cardholder u shown on credit caExpires accepted as complete. _ _ t Cardholder ngnstun Amount 44"613(6/00/CCM) Mechanical Kermit Application OFFICE Date received: Permit no.: ' City of Tigard Project/appl.no.: Expire date: Ciq,nfTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 - Phone: (503) 639-4171 Dale issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approva'. [Building permit no.: OF 1 &2 family dwelling or accessory O Commercial/industrial ❑t tulti-family O Tenant improvernt:nt )kNew construction O Addition/alteration/replacement O Other: _J JORSITE INFORMATION1 1 'SCHEDULE Job address: 16.) /-�A/, � Indicate equipment quantities in boxes below.Indicate the dollar Bldg. no.: Suite no.: value of all mechanical materials,equipment, mor,overhead, Tax map/tax lot/account no.: profit. Value S Lot: $lock: Subdivision: 'See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: Description and location of work on premises: f t I t + Feer(ea.) 1 utal F,st,date of completion/inspection: Description Qty. Res.only Res.only Tenant improvement or change of use: Is existing space heated or conditioned?O Yes O No Air handling unit CFM — Is existing space insulated?O Yes O No Air conditioning(site plan required) 6 p' Alteration of extsung IIVAC syoem _ W01011 t ' boi er/compressors Business name: KE�NZ-t;C, A- State boiler permit no.: FIP Tons BTU/H Address. 0 2 n 2LANUT R Fire/smoke dampers/duct smoke etectors City: auvE�u lemState: Z1P: 9eat pump(site plan r- equt-'re) Phonc: 8 a- a Fax:q ga a$ E-mail: nsta repacF a furec umer CCB no.: Including ductwork/vent liner LI Yes❑No nsta rep ace re ocate caters-suspense City/metro lic,no.: wall,or floor mounted _ Name(please print): _ Vent for appliance other than furnace CONTACT fERSON r rigeratfon: Absorption units B'rum Name: Chillers , _ HP - -- --- Address Compressors _ HP ------ - -- Environmental exhaust and venllfut un: City: ZIP`� Appliance vent_ _ Phone Fax: F-mail: D er ex aust t Hoods,Type 1/IUres,kitchen'haanrel hood fire suppression system Name: "�_ ��[� _ Exhaust fan with single duct(bath fans) Mailing address: ��_ Exhaust systema art from heatingor AC City: State - ZIP. ue piping■ndistribution(up to 4 outlets) Type: LPG___ NG Oil Phone: D 04 o Fax; 1; 111:111ate tin tecT oa tuona over—t eta ENGINEER rocess p p ng(schematic required) _ Name: JOINumber of outlets ter listedappliance or e-uTnl:— Address _- _ Decorative fireplace City: _ _ _ State:_ ZIP: Insert-type _ Phone: Fax: 7E-mail: oo stovr-pe et stove Other: Applicant's signature_ Date: _ t Name - -- Name(print): Not all jurisdictioa accept credit cords,pletu call judsdlcbon rot more information. Notice Perm it fee .....................S O Visa 7 MasterCard This permit application Minimum fee................ S _ Credit card number -_�_ expires if a permit is not obtained Plan review(at _ %) $ _ Expires within 190 days after it has been State surcharge(8%).... S Nome of cattiholdet at shown on credit cud accepted as complete. _ s TOTAL....................... S holder sigmture Amount 440.4617(6MICOM) Plumbing Permit Application M Date rec ived: Permit no.: _ City of Tigard Sewer permit no. Building permit no.: Address: 13125 SW Hall Blvd,Tigard,Gtr 97223 — City of7igard Phone: (503) 639-4171 Project/appl. no. Expire date: Fax: (503) 598-1960 Date issued: By: I Receipt no.: Land use approval:_ Case rite no.: _ Payment type: t r ❑ t &2 family dwelling or accessory C Commercial/industrial 0 Multi-family 0 Tenant improvement New construction ❑Addition/an• lteratio 'replacerrrent 0 Foud service Cl Other:_ Jub address__1 � 'f�e_�� Description Qty. Eee(ea.) Total Bldg. no.: Suite no.: New 1-and 2-family dwellings only: (includes 100 rt.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Rlock: Subdivision: N fimv!t SFR(2)bath Project name: �17"C -&y, i SFR(3)bath City/rounty: ZIP: Each additional bath/kitchen Description and location of work on premises: _________ Site utilities: Catch bnsin/area drain _ Est.date of completion/inspect:on: Drywells/leach line/trench drain i INQ t Footing drain(no. lin.ft.)PL�M _ Manufactured home utilities Business nameCp Sym r Mfjt f T � 'S—_t T�_ Manholes Address: IA�QQ `GW -Vill Rain drain connector City; T StatA:( ZIP: a,2 Sanitary sewer(no.lin.ft.) Phone: Fax:4, E-mail: Storm sewer(no. lin.f' CCB no,: j5ok1 3(Q Plurnb. s. reg. no:3t}_3S6PH Water service lin ftt. City/metrolic.no.: (o A 5 Fixture or Item: Contractor's representative signature: Absorption valve Bac!: tloM hrcvenler Print name: ,4 IL(_- STD �Q� Date Bac's;wncer valve \ t '" Basins lavatory Clothes Name: A Y} Yl GI pJ( t�Y1 _ Address: Dishwasher er Z 3170 SYL�9 , VP- Drinking fountain(s) Ci �—�— State_: (Z ZIP: 2-a3 �Y_=�_tnr� Ejectors/sump r.e r,�3.�5g.t.I�gfi' Fax So3 �34nu4f�' :r ail: Expansion tank t Fixture/sewer cap Name(print): r �M ES _ Flovr drains/Flour sinks/hub Mailingaddress: ?C; �— �Fjj Hose a disposal Hose Bibb _ city: —� State ZIP: Ice maker Phone Fax: E-mail: Interceptor/grease trap Ownet installation/residential maintenance only! The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per 0 Chapter 447. / Sink(s),basin(s),lays(s) Owner's ` Date: a Sump Tubs/shower/shower pan Urinal Name: Water closet Address: _ _ Water heater _ City: �^ S►ate: Z1P_ ____ Other: done: Fax: lotgj Not all jurisdictions accept credit cards,plain ail jurisdiction for more information. Notice: This permit application Minimum I n revie fee.•.........o!) S ❑Via 0 MuterCsrd expires if a -plan review(at � o) S + / � p permit is not obtained State surcharge(8`0).... S Credit card number, Expires within leu days after it hal beeq Noma o cardholder u shown one It card accepted u complete. Toy $ _ udho et sisnstute Amount ""4616(MCOM) SCALA ~ 363.12 I"-20' SQA LAT 363.58 D D= .8' n 50.00' ---.:s #US. __------ _// — ---15 -------- ��. — ____---- 7.5' PUBLIC STORM ———'k———————r - DRAINAGE EASEMENT ^ I I OT 22 I / N I 5.238 5F I N l f3UILt71NG I � I 5ETF3ACK5 I I , i I 5' F/ ' 1 * I // I 'f 5 / 1 I 1 /21 N d >�1�, RIP o VVIX0 11 1" S / 3y s0 1.01" 2� 1 m I 1 � 111 g $ 1 I a I 1 8 I 11 N I 1 I I —CACKLE N FlEm5rk 1 — / TELEPHONE rem5fAI. 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