8995 SW PINEBROOK STREET-1 ADDRESS:
i
i
is\re(:ords\microfilm\targets\huilding.doc
•ate i
II CITY OF TIGARD BUILDING INSPECTION TI
Inspection Line: 639-4175 Business Phone: 9 1 1
Footing Rain Drain Cover/Service INP
Foundation Water Line Ceiling
Post/Beam Mach. Shear/Sheath Framing
Plbg.Und/Flr/Slab Plbg.Top Out Insolation
Post/Beam Struct. Mach. Rough-in Gyp. Bd. Bid
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date. a- A . _ .M.___ En ry:
Address: �_ C 4 a,_
Tenant:— _ Ste: _— MST:5�_,fljl
�v Z G r BUP:
Con/ '. 5 3c� `— MEC:_
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED. ELR:
In ector: _ Date: Z
APPROVED _.-_DIS rPPROVED/CALL FOR REINSP. CF CO
' Y OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639.4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL.
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulatior -Elect.
Post/Beam Struct, Mech. Rough in <�GLP�._e� Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: `� _ A.M. M. Entry:
Address:
Tenant: — Ste: _ MST: 1 U
BUP:
Con/Own: ___ __ MEC:
PLM:
ELC:
THE FOLLOWING COPPECTIONS ARE REQUIRED: ELR:
Inspector: -----__� --- Date/3
_PROVED _DISAPPROVED/CALL FOR REINSP, CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Pnone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Lima C6iling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Meth.
Plbg.Und/Flr/Slab Pibg.Top OutInsu watt r' -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: _
Date: , y_ �4 A.M. _ .M Entry:
Address: Lz___ S
Tenant: .._ Ste: MST: __
BLIP.
ConO144Lt,& .�� MEC:
PLM:
ELC: _.
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
tj
Inspector: _ Date: / !_
PPROVED __LISAPPROVED/CALL FOR REINSP CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Dral,i Cover/Service F
Foundation Water Line Cefl=Framing
pQ¢ -Plumb.
Post/Bearr Moch, Shear/Sheath 1 -Meeh.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
a St c Mech. Rough-in Gyp. Bd. -Bldg.
San. SewCe,r G�a.,s, Line Appr/Sdwlk Reins}
Other:
Date: A.M. P.M. Entry:
Address: ---
Tenant: ..—_ _ n Ste: MST:
Con/Own: '1'YI,I'T�-cQ 1L,c.,�c, — BLIP:
MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Ins ector, Date:
_ PPROVED _DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL: \
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath -Mech.
Plbg.Und/Flr/Slab Plbg,Top Out �It�ri -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: ��' =1-3U `q A.M.—P.M.__ Entry: _
Address: _ �}'�CI � .SL'J A
Tenant: Ste: MST:
BUP:
Core _ e a.' -- MECPLM:: —
ELC:
TH FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
�1 ac_r,�
f' F .ace,-e. STS�'o '/�-•
etb
Inspector: _ —� Date:
_APPROVED <-91S&FPeVED,CALL FO CF CO
� J
CITY OF TIGARD BUILDING INSPECTION NOTICE
+�spection Line: 639-4175 Business Phone: 639.4171
Footing Rain Drain Peilinag
ervice FINAL:
Foundation Water Line -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/17IN1",b Plbg.Top Out Insulation -Elect.
Post/Beam Cfwct. Mech. Rough-in Gyp Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: ? " 1" A.M. PM Entry:
EntrY --
Address:
Tenant: --------- Ste: MST: . LL-�-
BLIP:
Con/Own: _ —, MEC:
PLM: _
ELC: _.
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Yenctor: __ — Date:PPROVED —DISAPPROVED/CALL FOR REINSP. CO
ay
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Lina Coiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mach.
Plbg.Und/Flr/Slab Plbg.Top Out -Elect.
Post/Beam Struct<M ch. Roy-ugh in Gyp. Bd. F31dg,
San. Sewer o Gas Line Appr/Sdwlk Reins.
Other:
Date:
cc � A.M. P M Entry: _
Address:
Tenant: — � Ste MST:
L BUR:
Con/Own: Aj, jr MEC:
75-3 Z_ PLM: -- —
ELG: �_—
THE FOLLOWING CORRECTIONS ARE REQUIRED. ELR:
Insp r: -- Date: - a 9'r
L
PROVED DISAPPROVED/CALL FOR REINSP. CF CO
_ ---- - -- -- -------- -�
-ted
- c
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639.4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/,qheath Framing -Mach.
Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Elect.
ust/Beam Str Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: :�A4e—_ A.M. P.M_ Entry:_
Address: fygs� /�.✓�d�q,G_-- _.-
Tenant: --- ._..... - --- Ste:- MST:
BUP:
Con/Own _ MEC:
PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _
In ector: Date: _—APPROVED -_DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
;)Inspection Line: 639-4175 Business Phone: 639-4171
Fo Rain Drain Cover/Service FINAL:
Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mach.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mach. Plough-in Gyp. Bd -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: a (o A.M. P :a?__ try:— --
Address: --r-9 I J S w
Tenant:— _ ^te: MST:
"Up:CCo�npwn: U MEC:
6olY-5 72 U 6)-0 7532— ELC:
THE FOLLOWING COP9ECTIONS ARE REQUIRED: ELR:
Inspect , _ — Date:7
K
PROVED -DISAPPROVED/CALL FOR REINSP. CF CO
CITE' ®F TIGARD MERMIR #ERMIT. . : M5T96-018''L.
COMMUNITY DEVELOPMENT DEPARTMENT DAIS ISSIJE_D: : 5/31/96
13125 SW Hell Blvd.Tigard,Oregon 972238199 (503)839.4171
P'ARCEL: 2S 1 1 1.AD•-04300
SITE ADDRESS. . . : 06993 sw P"I NEBROOK ST
SLIDDIVISION. . . . : PINEBROOK' TERRACE-" ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :40
Remarks: 336 sq ft additior.
---------------- BUILDING -------------------------------------------------------
REISSUE: STORIES.......: 1 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS—— REQUIRED-------------
CLASS OF WORK.:A' HEIGHT........, 13 FIRST..... 336 sf GARAGE.....: 0 sf LEFT..........: 8 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES:
TYPE OF CONST..-5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL-------: 336 sf VALUE..1: 21726 REAR..........; 37
PLUMBING -------••----------------••-------------------
SINKS.......... 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 (RAPS.........: 0
LAVATORIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS.. : 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTii: 0 GREASE_ TRAPS..: 0
OTHER FIXTURES: 0
-------------------------------------—-------------------- MECHANICk -------- ---------------------------------------------------
FUEL TYPES----------- FURN ( IBM ..: 0 BOIL/CMF ( 3HP: 0 VEKT FANS.....: 0 CLOTHES DRYERS: 0
/ELE/ / / FURN )=100K ..; 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....; 0 GAS OUTLETS...: 0
-------- -------------------- ELECTRICAL ------------------------------------------...------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- ---TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS----- --ADD'L INSPECT
1000 SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: v'
EA ADD'L 5005F.: 0 201 - 400 amp..: 0 201 - 400 aip..: 0 'st W/O SVC/FDR: I SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: A SIGNAL/PANEL...: 0 IN PLANT......: 0
MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps•1000 v: 0 MINOR LABEL -10: 0
IN& aspivolt.: 0 ------------------------------------ PLAN REVIEW SECTION - --------------------------------
Reconnect only.: 0 1=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL, CLS AREA/SPC OCC:
I --------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ---------------------------------------------------
P. SF RESIDENTIAL--------------------------- B. COMMERCIAL--------------------------------------------
A11TIO 6 STEREO.: JACUINM SYSTEM..: AUDIO b STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: OTH: ;: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE IGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC.,......,..: DATA/TELE COMM.: NURSE CALLS....: TOTAL N SY�fEMS: v
Owner: ------------------------Cont•actor: ----------------------------- TOTAL FEES:$ 296.01
VIRGINA ':SM.OND OWNER
8995 SW PINEBROOK ST
TIGASRD OR 9724
Phone N: 624-5120 Phone N:
Reg C.: 13125
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will bp 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 sore than 180 days.
------------------------------------------ REQUIRED INSPECTIONS ---------------------------------------------------------
Footing Insp Insulation Insp Erosion Control
Foundation Insp Gyp Board Insp
Post/Beal Str•uct Rain drain Insp
Electrical Servi Electrical Final _
Framing Insp Building Final
Permittee Signattr.ire : ���2' Tss1.:eci By s(
Caul for- inspection - 639-4175 �,
Residentiai_Buildina Permit Aplication.
City of Tigard
13125 SW Hail Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
Subdivision:h�{�►'�+�C 7+rr, Lot# Office Use Only_ �Lf ZR
Valuation: 7Z J Contact Date ! / Initials-
Resul:
New Construction Only: (Square Footage)
r-ianck/Rec#
Permit# M 5 '9 6 l S
House:__ ''4-. Garage: � -- -
Reissue of
Corner Lot? Y (N Flag Lot? Y N ZMap one&TL#�2`1 1 14. Vq S00
Owner: L V'C /V t A , Ll W o e1 (/ Plat#TV--7 — LVtcLC4_
Address: �� LQ I-u b►-ton/C N? AP-P vats Req_yirqd
t,4 "p vt7�, p K- 2-X- Planning Setbacks n Solar
Engineering e i dam _fin j 14S �!�
Phone: ( 56-9) L a -- a o -T-h u/y2 u_< Other
Contractor: e) LV h Q YL Items Required r��^��
Address: _ Subcontractors �7&—lr c
Truss Details
Other
Phone: ( ) Notes
Contractor's license# —
(attach copy of current Oregon license)
Contact Name:
Contact Phor e: I — 1 _.
Subcontractors: ArchitecUEngineer: _
C-L ccV?(CAL
Plumbing: Address:
Mechanical:
(attach copy of current C.?Contractor's License)
Electrical:_ 1 Phene: ( 1
CP r� r Li m
JOB DESCRIPTION:
Applicant Signature 1 Applicant Phone nuniLera Li-&--71 a " 7bp
Received bv: _ Date Received: _ L112 T
H'lOain''dlSa'lRuOC
Permit x Account Description Amount Amt,. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit !^' UMB)
Mach. Permit (MECH)
Bldg: / 7
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb.
Mach:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erasion Planck/'JSA (ERPLAN)
Erosion Planck/CO T (EROSN)
TOTALS:
Permit#:
Address: R <jUfv
Issued by: Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This stater,tent is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2,and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
E] 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB witi immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (bate)
(White copy to issuing agency permit file,
pink copy to applicant)
Solar Balance Point Standard Worksheet
Address--/. '-'- dy)
�+ r ad l" _-`
Box A calculations: North-South dimension for the lot. Box A:
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point.
First, determine which property line is the North lot line. The North !ot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot.
450-0
l0 ENLOT LINEN
;,. N / North-South
Dimension for Lot:
Measure the distance from the midpoint of the North lot line to the South lot line along
the described line. feet
--.L-- -
t
N
N.11SOUM IMNSION •�
Box B calculations: Shade point height for your residence. Box B:
1. Determine whether measurements will be based on the peak or eave of your Which desLribe5
structure. The orientation of the ridge is also important. your residence?
1 a: If the roof line runs North-South, measurements will
(circle one)
be based on the peak of the roof. TC-30-0-0 "
1 B 1 C
1 b: If the roof line runs East-West and the roof pitch is
less than 5/12, measurements will be based on the
eave.
SHADE POINT EASE
1 c: If the roof line runs East-West and the roof pitch is
5/12 or steeper, measurements will be based on the
peak. 5RAM iC647^ME
Box B. continued Box B:
2. Measure change in elevation from front property line to finished floor elevation. If
the lot slopes up from the front lot line to the foundation, the figure is positive. If S-
the lot slopes down from the front lot line to the foundation, the figure is negative. ft
3. Measure distance from finished floor elevation to the affected peak/eave. + 3 ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, - ft
deduct nothing. 0
5. Subtract one foot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing. �_ ft
6. Total figure for box B: ft
Box C. Distance to the shade reduction line. Box C:
1. Measure the distance from the North property line to the foundation near the ft
affected peak/eave.
2. Measure the distance from the foundation to the affected peak or eave. + ft
3. Total figure for box C: 3� ft
It is most useful to draw a vertical line to represent the appropriate figure found in box"A"and a horizontal line to represent the
appropriate figure found in box"C".The intersection of the vertical and horizontal lines determines the value found in box"D". The value
in box"D"should be compared to the value in box"B"; if the value in box"B"is less than or equal to the value found in box"D",then
the building is in compliance with the solar balance code. If you have any questions, please contact us at b:39-4171,x304 or at the
Community Development Counter.
MAXIMUM PERMITTED SHADE POINT HEIGHT In Feet
Distance to North-south lot dimension(in feet)
shade 100+ 95 90 85 80 75 70 65 60 55 50 45 40
reduction line
from norti�ern
lot line(in feet)
70 40 •10 41 42 43 44
65 33 38 38 39 40 41 42 43
60 35 36 36 37 38 39 40 41 42
55 34 34 34 35 36 37 38 39 40 41
50 32 32 33 34 35 36 37 38 39 40
45 31 30 30 31 32 33 34 35 36 37 38 39
40 23 28 28 29 30 31 32 33 34 35 36 37 38
35 25 26 26 27 28 29 30 31 32 33 34 35 36
30 24 24 24 25 26 27 28 29 30 31 32 33 34
25 22 22 23 24 25 26 27 28 29 30 31 32
20 20 20 21 22 23 24 25 26 27 28 29 30
15 1 18 18 19 20 21 22 23 24 25 26 27 28
10 16 16 16 17 18 19 20 21 22 23 24 25 26
5 14 14 14 15 16 17 18 19 20 21 22 23 24
I
Box D. Maximum allowed shade p I
nt height: L- feet
� `• •'a�.y....
PLAN iECfC FEES LIST WOwwi
/may,
PLAN qt#
DRES "SIT# 1��DA'!'E
SUSDIV?Orr
Vx EIZaTION�• l►�Z RrE. LOT - LAND U
AN
DU US�c -4j5--
SE R
T3ACR FRvORK CLASS ONTR SIGcT LEFT
USE E � TOTAL AREAyIGr�F-It'T^
CONST TYPE}};•;-----FLOOR LOAD ." Ist FLOOR
HEAT TYPE —� 7 •�
OCCUP GROi.; -_�2nd FLOOR
CCCUP LOAD DWELL,/UNITS_ 3rd FLOOR
STORIES --BED ROOM �- BASEMENT
------ BATHS — comac,
�P EMIT 4�.. DESCRIPTION AMOUNT-yfzrL '� 3UILING PERMIT FEES +MOUNT PD BA, DUE
-------- PLS PERMIT FEES
ME" PERMIT FEES --- --
ELC PERMIT FEES -- ---IEEE_
ELR PERMIT FEES —`�} -3-j
STATES 3UILD TAX '----
BUILDING
PLUMBING 2 d'
MECHIANICAI`
EL
PLAN C:-lECR FEES
BUILDING ±jn / 2 —
'LIBIVG f
ME Ch T AYCi1L•
----------_- ;;qER T O � CN FEZ
S" CTICN FEE -
;L1SS .........
1-
1
WATER QL?Y^ T ----
a
ERL ICN PLAN C{' �cA ----
EROSION PLAN CR CCr - -
10TALJ: �?(J��L
- 0,
--7 '0 ...-
BY .......... DATE. SUBJECT....// ..�91A-"-'-
............ SHEET NO.........!...-OF
BY................DATE................... ..................................................
CHKO. -5Wl/ JOB Np�... ...... ........
....................... ..................................
.................. ........................................... .................................................................... .........-........................ .......... . ..........-
APPROVED FOR CONSTRUCTION
CITY OF TIGARD
PERMIT NO.► S}W-0189TE ADDRESS 9of -Ovl(
DATE
ea -
,t3/r7r X30 CCD -3
cn (D
7r
CD LD
- w
(D
CD
9
'ell CD
A,J All
.35'
,-C-'Ie v
BY...... ............DATE.4/ SUBJECT.... SHEET NO.... �........OF to........
e
CHKD. SY................DATE..................._ .................. J L.Z17..^f........................... In JOB NO................................................
....................................................................... .............. 12
.................................
GA
Z4 11
n 9.
R-I
or
F
kt -N
By ...........:......****''DATE................... SUBJECT...... ............ SHEET NO. .......3........OF
.......... JOB NO.................................................
C;HKD. BY...............DATE..................... ........ Aelio
....... .................
...... ..................... ...................... ............................................... ........................................................... ....... ........................
+
�
Al
%j
E!Y__.�T!'.V. .........DATE.-l"���y1 6UFiJECT....... l., .�Mla... ,..�SM/oA1 SHEET NO.......�.......OF.....�........
.... .... ...... ..J......................
CLiKD. BY.................DAT!l..................._ .�� .9.` .:'..,.(!�:. ...... JOB0... .....
T...
ec f qr� �iG°YYo ai 4Vs/ q Gt/�" �z �-b
........................................................................ ........................................... .... ............. ............................................. .......................
M
G y So/�d l�I�.k'�yP 6efw�r,o .,rr�s
ro c. 3-r'x c rr�ad..e ems. vv�+do Jnr
/Nsr,+ o�l �.-�" v G �x 3 ,`f-,va/ ds��l/�► �,vC W���s�w
All
T.S,Al.coRNe4 .-
1
l
fir�-•
.✓eelsl��s
" a t� tel•
•'__,�-. � �" ,eta 8�>b -,�
r ���
q�tCfi�� I/GmLxl �oo ,If
Noma
!R►�Q 7� �br��
BY_..rf�.c.�Y..:.........DATE.//4/.? SUBJECT... .../lrt�. p�!, ... .. r..s`? )r)d. ... ............
SHEET NO.......Y..........OF....�3......
JOB�J.!'�• 0 .......... NO.. _
....... ..........�.......
................
CHKD. BY................DATE..................... > �...... .....- ..-----..... /
..................................................................... ....
N.2. n .�.. �� ...�............ _.....�:��................
zxG n�
az OG/t (- rz 2xG / 4
46-e
� ��ll`` r B9
)
BY.....*C.....�x..............DATB.., �/. ,�� 8UBJECT.. �.. .... ......... ...................................... 0....................OR...............
SHEET N
T[/ Io
...n. . - OCHKD. BY................DATE.................... _............ ... �C�:. ....J/...
.
.......�......�J..........r�.............�
��.�-.....�..
t I �
I
Ix N
LJ r f
ch
0 I'
0
i
e � I
� I I
j (I
r`
t
0 i
� t
BY.......
. 9PG $UBJTE"�CT'.. . ..........DATE.( :
SHEET
/... �/.L../.(./.. /...c./.M..P...�L...T.I.�..�.....o...C....'.
.. O ................OF.................
. ............ JOB NO. ................CHKD. BY... DATE..................... .. .:...:..../ :. ....
.................................v ..s f/47,
a A
I ' �
I
� I til
I
t I -A �1
�� � � �! I I •R n ; A
O
BY rY..!. 't�'J..-_ DATE_��ly! ➢�! SUBJECT...-..�� r
NvA..... ..... .. SHEE'" NO.........f.••.......OF.....
........
......� 9.5... ..w.. !s'�6,�r.r�....... JOB jo. ................. ............�
CHKD. BY ...............DATE................... L -L x /.....r....
..............
rl
Aos
�ra G �`�( 3-t,X G" /•/�adrG !? E'�4r, v'.�i,.+.'o w
/A/Sl,l Af /O,.)
rr
n
I
d�eaius T. SW,
1
i
l
Z//7�rjM�� ✓O�l rl / Y,
fu
ovf 9
�►�:i��'�l1�rr1PT Q/eot'nv9 C'"l e✓C �avr v _--.. _ _—_-— --
��,.
�r c'Q fa �..'heet
BY ...4 1/.7............DATE../e/Z-./�*�**�—`/ SUBJECT . ............ SHEET NO............. OF
JOB NO...............................................
CHKD. BY................DATE..................... .................. .. ... ... ...
.......................
.............. ................... ......... ...... ..............................
7P
Nf
rN
77
.A
XN
i
f
- 1
1 J I Y !IF 111 •11; 1i Ili r lit k-t Jill Wil. a'-9ky r:'1a91119�+1;"a
;11n P14mi 11f.), V tNO1r1it1 [;F 1'.,tI 1tMltt1111 a W. owl
1'I•t PINI- 1:•11ru11E t'i4vf•11.111 1liilf., / ot's/.IIi�)i.
1.[
Vj P P1.). 171E
1
I
1'1 1`r E.il 1'.11 i Wit 1 0 1 1 1'1 1 (11 1 'I 11'1 4 1 1 1 11 t '. 1 !•11 I I 1 \ 1 111111 114 1 1'H 1 1)
1'hl I ,. 1 1 I I ;1 1 ';1 OIA
4). '.F' Will " 11.11 J 11 1 1'. 1 111 1
I
I
i
f 't,irnlJ { FUR ODD 1' 1111'~1 P1 1.41iOHP,'! ,1')11";
I 1 1 1111 t-IMIJI thl 1 [•'t-i 119 .- _ ;'cn1.�1, ,'��,
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone). 639-4175 Business Phone- 639-417
Inspection: , r L
Footing Susp. Ceiling Sprink. Rough-m Appr dw Yk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldrj.
Plbg. Underfloor Rain Drain Framing (-':r 6mb,)
Alarm Water Line Insulation -1GTe h
Underflr. Insul. Shear Wall Gyp. Bd. fEec -
Date Requested: �� /j��' j j Time: AM PM
Address: ! 32L q�
Builder: k C Permit #:Ez AZ l -Sy -3
THE FOLLOWING COR PTIONS ARE REQUIRED: (11 Z 4'� U I
In/APPROVED
tor Date:DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
ELECTRICAL PERMIT
CI1Y OF TIGARD RESTRICTED ENERGY
COMMUNITY DEVELOPMENT DEPARTMENT; PERMIT #s ELR95-0233
13125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639-4171 DATE ISSUED: 12/13/95
PARCEL: 2SI11AD-04300
11-E ADDRESS. . . : 08995 SW PINEBROOV, ST
jB1,i'JISION. . . . : PINEBROrK TERRACE ZONING:R--4. 5
_OCK. . . . . . . . . . I LOT. . . . . . . . . . . . . :40
cliect Description:
RESIDENTIAL..--__---- B.
AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM & PAGING. . :
BURGLAR ALARM. . . . .- BOILER. . . . . . . . . . : LANDSCAPE/IRR10ilT. . :
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . : MEDICAL. . . . . . . . . . . . .
HVAC. . . . . . : DATA/TELE COMM. . ! NURSE CALLS. . . . . . . . :
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITES
OTHER. : HVAC. . . . . . . . . . . :X PROTECTIVE SIGNAL... . -
INSTRUMENTATION. I OTHZ:R. . s .13
TOTAL # OF SYSTEMS: I
01:)pl7 ;_:aT,t : FEES —------------------- ---
PHIL' S ELECTRIC type amoLint by 6to recpt
6600 GE CHARLES ST PRM,r $ 40. 00 CJS 12/13/95 95-27,3830
SPOT $ 2. 00 CJS 12/13/95 95-273830
MILWAUKIE OR 97222-2828
PhOT-le #: 503-659-0303
Contr —-tori
CONTRACTOR NOT 01\1 FILE 4.:.,:,.. 00 TOTAL
REDUIRL!j INSPECTIONS
------ -
Ceiling Covet, Elect' I Ser , ice
Wall Covet, Elect' I FiTi-a
Ren
This persit is issued sub,ject to the regulations contained in the
Tigard Municipal Code. ')tate of Ore. Specialty Codes and all other Permitee Signati-ire
aDolicable laws. All work will be lone in accordance with
aoproved plans. This Dpreit will expire if work is not started
within 188 days of issuance, or -f work is suspenLed for liore
than 180 days. I S S�.i e d Sy
----OWNER INSTALLATION
The installation i� being made on property I own which is not intPT-1ded for-
sAle, lease, or rent.
OWNLRIS GICNATURF7.
DATE
INSTALLATION
SIGNATURE OF SUPIR. ELECIN-
DATE-
L I CENSE tsl,O
................
Call for inspection 639--4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT# _I:Zl�Qs=o�3
A,A
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED IQ–/3- 915-
TDD
S TDD No. (503)684-2772
CITY OF TIGARD Inspection (503) 639-4175 ISSUED BY
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTAL TION 4. TYPE OF WORK
�d Y' Ab
RESIDENTIAL—Restricted Energy Fee. . . . . . . . . HIM
(FOP.',i L SYSTEMS)
Chy State Zip Cbeck Type of Work Involved:
PERMIT6 ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
IS NOT STARTED W11 HIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APPLICATION ❑ Garage Door Opener'
n Heating,Ventilation and Air Conditioning Svstern'
Contractor 4),1s EI"Ifrr c —Type_ la,1 In' c$1 ❑ Vacuum Systems*
F1 Other—
Address IABD S. I_^ 'd c1l'o /.s �', � —--
Date
f COMMERCIAL—Fee for each system . . . . . . . . . ;��,
G. ro � � !5 _ _- --
iSf f OAR'))1I-260-260)
Property Owner Oeli . 4 ' a r, _ Check Type of Work❑ Audio and Stereo Systems
Contractor's Board Reg.No.�1 l►/s � ___ y
❑ Boiler Controls
Phone# _ 30 ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
a HVAC
Print Owner's Name Phone No ❑ Instrumentation
Address ---- ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control'
City State Zip ❑ Medical
this permit Is Issued under OAR 918.320-370.This applicant agrees to mak, only ❑ Nurse Calls
restricted energy Installations(too volt amps or less)under this permit and to do the ❑ Outdoor Landscape Lighting'
following:
1. Only use electrical licensed persons to do Installations where required.(Certain Protective Signaling
residential and other transactions are exempt from licensing.These have U Other_
asterisks(•).All others need licensing).
2. Call for an inspection when all of the installations under this permit are ready
for inspection at 503.639.4175.
❑ Number of Systems
3. Purchase separate permits for all Installations that are not ready for inspection
when the Inspector is out to Inspect under this permit. •No licenses are required. Licenses are required for all other installatiors.
4. Assume responsibility for assuring that all corrections required by the Inspector ---.--- ---
are done,and
5. Assume responsibility for calling for a final Inspection when all of the 5 FEES
corrections are completed.
The person signing for this permit must he the applicant or a person a. Enter Fees $ y,ro
authorized to bind the applicant.
h. 5% Surcharge (.05 x total above) $ 1-00
Signature i
TOTAL $—+I.d0
Authority if other than applicant
ENERGAP.CHP
IN I
4 0-;r! i 101 11 Jl\I I e If). 00
(-,,600 Sf-. (-J4(a[fl 1 L;
y III, IV I I ki)If
A)HI I V .!7,i 111"1
1(lk�.lj OF PflYMI N I Atylt 1 1101
I
(I I Of (414CIt IN I P(41 D
CITY OF TIGARD BUILDING INSPECTION NOTICE
'nspection Line (Rec-O-Phone). 639-4175 Business Phone: 639-4171
Inspection: C. ',U'L c k_— y
Footing C Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab ( WcT1,Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Undertlr. Insul. Shear Wall Gyp. Bd. -Elect.
Dale Requested: ,� /S I S Time:--AM /a�!3—C PM
Builder: - C �(�- (� Permil U LL O
THE FOLLOWING CORRECTIONS ARE REQUIRED:
/y,� �.�?.�-i ^wiz r:,�<,�cr ��-�5;�`.-��; c2—•�--'
ST7 L l 4 i 7 h•y r S � i�c v�1.�T j
Inspector. Date: / 2
—APPROVED _DISAPPROVED ED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab ec Rough-in Fireplace
Pos!/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -EI t.
/ M
Date Requested: 4= T S Ti/me: AM
Address: �j �. -�- LL-C
Builder: L,_`�_ <o Permit #11h:C
THE FOLLOWING CORRECTIONS ARE REQUIRED: Q '
Inspector Date:_
APP3OVED G-DMAPPROVED APPROVED SUBJECT TO ABOVE
�t;alf For Reinsp.
MECHANICAL
OF T I GARD PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MEC95-04e11
11126 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171 DATE ISSUED: 11/28/95
SITE. ADDRESS— : 08995 SW PINEDROOK ST PARCEL: 29111AD-04300
SUBDIVISION. . . . : PINEBROOK, 'TERRACE ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .40
-------------------
CLASS OF WORF. . :NEW FLOOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . .-SF UNIT HEATERS. . : 0 VENT FANS— . : 0
OCCUPANCY GRP. . :R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL 0-3 HP. . . . - 0 DOME'S. INCIN: A
- /GAS/ 3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HP. . . . .. 0 REPAIR UNITS: 0
FIRE DAMPERS?. . 1 30-50 HP. . . . : 0 WOODSTOVES. . l: 0
GAS PRESSURE. . . 1 50+ HP. . . . : 0 CLO DRYrRS. . : Q-
NO. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. : ril
FURN ( 100K BTU: I (= 10000 cfm : 0 GAS OUTLETS. : I
FURN ) =100K BTU: 0 > 10000 cfmg 0
Remarks : Install flArnace and outlets
Owner: -------------------------------------------------------- FEES ----------------
VIRGINIA ESMOND type amol.knt by date recpt
8995 SW PINEBROOK PRMT $ 25. 00 JSD 11/28/95 95-273279
5PCT $ 1. ;::,5 JSD 11/28/95 95--273271)
TIGARD OR
Phone #:
Contractor! ---------------------------------
MORRIS HEATING AND A. C.
19659 S. MCCORD ROAD
OREGON CITY OR 97045 _..•..•______.__..._
Phone #: 655-561.6 $ 26. 25 TOTAL
Req #. . 3 73184 REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained an the Mechanical 1 n sp
Tigard Municipal COO, State of Ore. Specialty Codes and all other F i n a 1 Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started –-------
within 160 days of issuance., or if work is suspended for more
than 180 days.
F,e r in i t t e e S i q n ak t iu-tr e
`
I ssi-led By .............
CAII for inspection 639-4175
City of Tigard MECHANICAL PERMIT Planck/Rec. # mC"c
13125 sw Hall Blvd. APPLICATION Permit # SOC,'
Tigard, OR 97223
(503) 639-4171
m•• escnptlon
�`� •� .P �� r; Yf��+j t Table 3A Mechanical Code -� OT's PRICE AMT
Job jj" ?��� /X2.4' 1) Permit Fee -o- -0- 10.00
/Address
2) Supplemental Permit 3,00
.m. m..
Furnace to U
1) incl. ducts &vents 6.00 d�
• 6 ••• ^^ Furnace i110.000 BIFU +
Owner 2) incl. ducts &vents 7.50
rFloor Furnance
3) incl. vent 6.00
"I Suspendedheater, wall eater
`, • /�:"r'.( 4) or floor mounted heater 6.00
... «• Vent not incl. in
Occupant 5) appliance permit 3.00
.. Repair of heating, re ng.
6) cooling, absorptici unit E 00
.m. -Toi er or comp, seat pump, air con .
7) to 3 HP; absorp unit to 100K BTU 6.00
n w r •. Boiler or comp, heat pump, air cond.
-h J' / / 81 3-15 1-:P: absorp unit to 500K BTU 11.00
Contractor .,-`-1 �. w oiler or comp, heat pump, air con
Floe` "'L 9) 15-30 HP; absorp unit 5-1 mil BTU 15,00
•• •v • •� Boiler or comp, heat Fumi57 air cond.
31 l l 10) 30-50 HP', absorp unit 1-1.75 mil BTU 22.50
sere y acknowledge that I have rFAd this app icati0n, t ai F t e —Boiler of comp, heat pump, air cond.
inf,3rmation given is correct, that I am the owner or authorized 1 1) >50 HP; absorp unit 1.75 mil BTI1 37.50
a,.ent of the owner, that plans submitted are in compliance with —Air handlino unit to
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State
Air handling um
registration, please give reason below.) 13) 10,000 CTM + 7.50
_ on portable
14) evaporate cooler 4.50
/ sVent fan connecte
15) to a single duct 300
,y enti ation system not
16', includei in appliance permit 4.50
oM,«.x,.• •• oo sere eT7y—
'7)
y--'7) mechanical exhaust 4 50
Describe work new addition l aeration repairl om-^ercia 0r m ustriaT•
to he done residential non-residential Q I 19) t,pe incinerator 30.00
xisting use of er i e, woo stove. water
budding or property Ll 1 19) he.iter, solar, clothes dryers, etc. 450
Proposed use ofC� 20) Gas piping one to four outlets 200 l
buddinq or property L
21) More than 4-per outlet (each) 2.00
Tvpe of fuel -oil natural gas j LPG �j electric Q -
Minimum Fee S2500 SUBTOTAL '
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR 5% SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% CF SUBTOTAL
AFTER WORK IS COMMENCED
TOTAL < t'
Special Conditions
Date issued _ _by
•ILOWPAOSTTMECHVMT
I Y 01 1 11 i(,W11) I l l F 11"'I i l IF lyll.N'l pl-(3- .1 P I 11( 9tp—p 7 3i,�,/9
(31F.C.If $411111ANU
MORWS likArING & 14IR I "M(jt IN I lAW
1-111,41)J I I ON I NO 1N1; PWVftll-,NJ W41f a I I
19651) 1 MCA 1.)H1.7 RD !AJOJYMISION
ORF OON I A I Y CM 9704tj
P1 1141 TO-51-, OF PAYML-NI WOUNi I-1010 ►-IMNINI Ppjj)
Pill 1 ,1111111M11. PF I IAU I I t I I
1w P114`33141.41K
11111(..)1 $41101INI PIAID
PLUMBING PERMIT
#. . . . . . . : 95-035,i
CITY OF TIGARD DATEPCR11IT ISSUED: 11/28/9PLM537
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 972234199 (503)039-4171 PARCEL: 2S111AD-04300
.� ITE ADDRESS. . . : 08995 SW PINEBROOK 'F:')T
?;UBDIVISION. . . . : PINEBROOK TERRACE ZONING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . .. . . . . . . . :40
-----------------------------------------------------------------------------------
CLASS OF WORI-/,. . :NEW GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . 6SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . s 0
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 117.1 TRAP'S. . . . . . . . . . . — ". 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0
FIXTURES-- LP1JNDRY TRAYS. . . . . . 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAP'S. . . . . . . . 0
LAVATORIPS. . . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . . 1 0 SEWEF' LINE (ft ) . . . ! 0
WPTER CLOSETS. . .- 17, WATER LINE ( ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks - Install water heater
Owner: FEES ——————---—————--
VIRGINIA ESMOND type amoont by date rprDt
8995 SW PINEBROOK PIRMT $ 25. 00 B 11/28/95 9!5—c-.73299
5PCT $ 1. 25 B 11/28/95 9 5 7,,.9
TIGARD OR
Phone #:
Contractors
OWNER
Phone if., TOTAL
Req !4,
REQUIRED TNSPECTIONS
This Pei-rit i� issued sub'iect to the regulations contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inc:pvctinyi
applicable laws. All work will be done in accordance with
approved plans. This pernit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days.
Permittee S * at Ur e
By .
Call for inspection 639-4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
New Single Family Residents= Jnly
tot•71 til'
r� ❑ 1 BATH HOUSE$140.00 [12 BATH HOUSE$195.00
Job 7 <�� � ❑ 3 BATH HOUSE$225.00
Address .r.r 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"'°A°°"' '1- Lavatory 9.00
Owner " '�J 7� Tub or Tub/Shower Comb. 9.00
Shower Only 9.00
Water Closet 9.00
hwK Dishwasher 9.00
n..
- ', Garbage Diseosal 9.00
Occupant 1A.&nq,,,d.. A.... Washing Machine 9.00
Floor Drain 9.00
Water Heater
I 9.00 F
Laundry Room Tray 9,00
"'" Urinal 9.00
_ �� _ Other Fix(ures (Specify) 9.00
ph.M
Contractor M..y,i Ad*M 9.00
9.00
CAm91.1„` tw
9.00
Sewer 1st 100' 30.00
St"""'4",'h'""° °j 8T.,N0 Sewer-ea. Addit. 10U' 25.00
_ Water Service 1st 100' 30.00
1 hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200 1 25.00
information given is correct, that I am the owner or authorized agent of
the owrer, that pians submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm&Rain Drain Addit 100' 25.00
number given is correct. (If exempt from State registration, please
give r on below.) Mobile Home °pace 25.00
Z �' rr Back Flow Prevention
C�CC.� -�/� - �C -`��j Device or Anti-Pollution Device 9.00
'0""' °i' Any Trap or Waste Not
Conr,ected to a Fixture 9.00
Describe work new Q addition Q alteration } repair Q Catch Basin 9.00
to he done residential Q non-residential Q
Insp. of Exist. Plumbing 40.00/hr
Existing use of
Specialty Requested Inspections 40.001hr
�
btidding or property _ J Rain Drain, single family dwelling 3�r
Residential backflow prevention
devices 15.00
Proonsed use of 'l� -
budding or property lY
'(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION -
x>
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER\ WORK IS
COMMENCED PLAN REVIEW 250.6 OF SUBTOTAL
TOTAL
Special Conditions --
Date issued by
I_:1 1'y (IF I I OORO fo (J I P I 1 is 111 1 III-.r,l I RI I I I I'I Nit.
r-..SM(,.)Nl'), VIRGINIO I;wifl 0. 00
BW PJNl:. BROW 1"HylvUlil
r 1;1.10141.) ('114
I It I'f I Y MV W I Pill 1) I'll- PHYMNI
I'1 I IMH I NN Pt-14PI 00
WIFII_ AM(KINT PAID