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14785 SW 98TH AVENUE 4 00 u, cn ca 0o D C CD 14785 5W 98'x' Avenue CITY �� ® � p ELECTRICAL PERMIT / \ ERMIT#: ELC200Z-00231 EEVELOPMENT SERVICES DATE ISCOED: 5/23/02 13125 SW Hall Blvd., Tiqard. OR 97223 (5')3) 639-4171 pA i..:E L: 25111 E U-01 E03 SITE ADDRESS: 14785 SW 98TH AVE SUBDIVISION: ALDERBROOK FARM ZONING. R-3 5 BLOCK: LOT : 005 JURISDICTION: 1 Proiect Description: Install 200amp. servicesanc' 7 branch circuits. Job#R43-81 RESIDENTIAL UNIT _TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMP/IRPIGATION: EACH ADD'L 500SF: 2.01 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 600 amp: SIGN %L/PANEL: MANF HM/SVC/ FUR: 6014amps 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ BRANCH CIRCUITS ----- -- _ ____— _ ADD'L iNS"ECTIONS _ 0 - 200 amp: 2 W/SERVICE OR FEEDER: 7 PER INSPECT ION: 201 - 400 amp: 1st WIO SRVC OR FDR: PER HOUR: 401 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ _ PLANREVIEW SECTION 1000+ amp/volt. _>=4 RES UNIT.:: > 600 VOLT NOMINAL: Reconnect only: SVCIFDR >= 225 AM"S: CLASS AREA/SPEC OCC: Owner: Contractor: GARY STREALY ABC ELECTRIC CORPORATION 11200 SW FAIRHAVEN ST. 135 NE 9TH TIGARD, OR 97224 PORTLAND, OR 97232 Phone: 503-624-2704 Phone: 233-7551 Reg #: LIC 288 SUP 1241S PLM "'SEE" ELE 26-2C _ FEES _ Required Inspections Type By Y Date Amount Receipt Rough-in PRMT CTR 5/23/02 — $207.15 2720020000( Wall Cover Elect'I Service 5PCT CTR 5123/02 $16.58 27211020000( Elect'I Final Total $223.73 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 Not,i cation Center Those rules are set forth in OAR 952-001-0010 through OAR 952.-001-0080 '(ou may obtain copies of these rules ordirect quesU)ns to OUNC at(503) 246-6699 or 1-800-332-2344 Permit Signature: Issued By: OWNER INSTALLATION ONLY The installation is being made on property I awn which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ _ _ _. DATE:— CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE:__ LICENSE N O: — Call 639-4175 by 7.00pm for an inspection the next business day May 17 02 10: 54a RBC Electric ..001 11:27 FAX 5035981980 503 233 7552 U• CITY OF TIGARU P i�uuz Electrical Perndt Application Datereoelvcd: •_. Pmattno,�.f;' _,- _ � i City of Tigard Pro}oetlappl.no.: fdxpiredate: ,,,orT,g; rd Address: 13125 SW Hall Blvd.Tigard,OR 97223 Date issued: Y By: . r Receipt nn Phone: (503)639.4171 -- Fax: (503) 598.1960 Cue rilo ng.: Payment M, Land use approval: w , e I & 2 family dwelling or accessory 0 CommerciaLinduslnal U Multi family O Tenant tmrrovemcnt U Nr.w conswctinn O AdditionlalteratioNreplacctnent Q Other. _ U NunraJ r Job_addn ss: /_ j �" `+ Bldg no., Suite no.: Tax map/tax lotlaccount no Lot: __ lock: Subdivision._ _ — 1'rolect nattte: Ir L& a nescription and location of work on prcmiscs: isarnmed date of com Ir.tirkinspccuon r,�tl1 Job no: JC !a Mart Busineaa risme I_' Rede ties r3ry, 14) Tutal no.lasso ' Addre[s: Nettltisidartid•afr eertnultl•ralYyper Otteltfrsamut lnc"daalad+adaara�a City. r , State: Zl BervloetnlWded Phone_m }'IA- �� .•mail 1000 It 011016a CCB no Elec,bus.lic.to - _ (acItadditional 500W horpon11 ronthersol tadmat enrfel y feslo2' City, tm lie. Ittli---g-Li2 mfttdcner energy, �7/�-..► awe f s rmndvlrdweWn bE Icf (req lite u.couvur fewer 2 Su .elect name(P' License nu I ,�/ ►vicwnr elven-irutalWfun, ` alseretfon er reloaatioa: A,<), 200 amps or let► 2 Ntllne riot) _ 201 artwa to 100 imp! - 401 strips to 600 am a Meilin�sddress: — 7 6n 1 am s to 1000 amps 2 Chy: SUIe: 6—Amps or volts Phone: Fax: Ental' arennrcr onl -- - l Owner installation:-the instatUation is being made ou property I own 7rfupahrya—arkrders which is cot intended for sale•lease,rent,or excharo a according to trsadllatfon 1lkrehon,orretoaliae: ORS 417,455,479,670,701. 200_anpr ar + 2 aw� 1 I1wne1'f twture: Date: of.r 101 - ranch dr,arts-neu,■tersllon. Naltlr: at extension per paneb �AddRar: NG + S '- - — - A. etre for branch citeutu with purchatc of — service e+Ueder tae,each bnttch eirceu � rF�`� 2 Stalel1-- - , rw for brrurch circuits Wthour purehaw - Phone: Pax' olaervrreorrmterfee,fintbronehcircutt. 2 mine NJ trach aoATTt onit Lour oicwr __- uc(Sr rVi ce or rveder sot Inc ). 1)5rrvimover W amps•eommeMal U If a11. veru,,n Fxh pump or urtawon c;,rb 2 OServiotover?20anrpa"raunaoI1 2 Utla,arduu,rocauun Bachsi4nofOudtneligh`nQ-^ (trrulyd+tllmg' O Buildigo.0 10000squarefeerinuror -jig—no!cveuills)orallmfedenafayPanel. - H ❑System aver 600 volts normlnU mre reaiddndxl emu In nne structure olterwon,or extension• O Building over three stories ❑r%edae,r1no amps or moot •peteri(bnn �- 0 Ckeupent toad over tl9 ire—,, n Murufactumd feucruits or R v pari -- 0 Fjrrrr/lithunBplan O Otho. [ee MontI LOU Portion Iter the Idol OWN t io aey or Iha �r =—I— above Suboalt _arts of plats My IA an orthe sbure. ln.all ton u- po - -__� r �- --T-il anon lee The a►ore ary net■ plieshle to temporary Cos"j ettlon tort AW that - - — — — -- rva all IvnrdNmr c,aNr ra dr,Woa,e aril jvnWrUen let Ines IrVarrrtaaeo -- }enrdt fee , Not all O u e 'uv Notice:This perniif applicauau S expires If a permit ie not obtained Plan review(at ^ %) $ CrMir c r � ^ d� r within 110 days after it hake been Stale surcharge(11%)., .S _._,L(p"•,� f e n o a L- l I I accepted a oornplde T'OTAI, - , -W3 Amowl aapNd 5 16eIDCOMI CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST — INSPECTION DIVISION Business Line: (503)639-4171 BUP -- Received Date Requested AM PM BUP --- Location �� __ TH Suite _ MEC Contact Person �� Ph(� ) _�-�� PLM Contractor __— Ph( ) — SWR --_— BUILDING _ Tenant/Owner —__ ELC Footing' ELL -4=Q—()Z-_ VIZ' Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: StT Post&Beam -. Q COOS _ Shear Anchors Ext Sheath/Shear �--- — Int Sheath/Shear Framing --- — — - -- ---- - I Insulation ZI� ✓�%L.- Drywall NEiling --- -- 9rewall _ Fire Sprinkler Fire Alarm Susp'd Ceiling Roof �! Other:- - -------Final PASS _ _— PASS PART FAIL PLUMBING - Post&Beam Under Slab - - Rough-In Water Servico — -- Sanitary Sewer Rain Drains ------- - Catch Basin/Manhole Storm Drain -- Shower Pan Other: --- Final ---- _---- _ _ PASS PART FAIL_ --- - - — ME_CH_ANICAI. - Post&Beam Rough-in - Gas Line Smnke Dampers Final -�-� 489 PgHT�, FAIL ECTRI -,- -- ervice Rough-In UG/Slab --�-- - - --- Low Voltage — Fi�t.Alarm ins PART FAILElReinspection tee of$_. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _ E — 0 Please call for reinspection RE:_ _ ___ ❑ Unable to inspect-no access Fire Supply Line ADAoach/Sidb�ralk Date_ _Q � Inspe��to -- —_---_txt--- Pp Other:. Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL 24-Hour CIT°Y OF "Ti(aARD Inspection Line: (5,,$)639-4175 MST — - BUILDING Business Line: (503) 639.417, BUP - - INSPECTION DIVISION AM— PM BUP - — Received _ _ ___- Date Req shed ' MEC _ j J suite_.--— Location l --- � � �. PLM Contact Person Ph SWR - ---- Contractor - — ELC BUILDING TenanU0wnvi ELC Footing ELR Foundation Access: Ftg Drain SIT Crawl Drain i Slab Inspection Notes: .� Post&Beam Shear Anchors Ext Sheath/Shear _�_----— Int Sheath/Shear Framing Insulation i �GGc�2 /tee/�-�� L. 7 Drywall Nailing Z_�?S•f /o !S� �/u� —� Firewall �� Qg �►r t_ S _ �`T' "�`�` t I Fire Sprinkler � �3�� Fire Alarm Susp'd Ceiling _ Roof ---- other: -- Final — PASS PART FAIL --------- Post&Beam Under Slab Rough-In Watbr Service Senitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other:_ Final PASS T FAIL MECHANIC ----- --- —` Post& Beam Rough-In as ins e Dampers --- "ina A PART FAIL — EL ,CTRICAL Service Rough-In ----- UG!S,ab ---------- _ --- Low Voltage --- Fire Alarm requited before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Final Reinspection tee of$.�------- q _ PART FAIL Unable to inspect-no access PASS U Please call for reinspection RE: SITE Fire Supply Line Ext i li n pi eator --- ADA Dats S7-'/7 ✓— -.,— _. Approach/Sidewalk Other.___ ____ - DO NO'p REMOVE tins lorcpoc.tiion record from the jab site. Final I- PASS PART FAIL n CITY OF TIGARD _ MECHANICAL PERMIT DEVELOPMENT SERVICE`' PERMIT #: h1EC2002-0018' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED- 5/7/02 PARCEL. 2S1 i1BD 01603 SITE ADDRESS: 14785 SW 98TH AVE SUBDIVISION: ALDERBROOK FARM ZONING: R-3 5 BLOCK: LUT: 005 JURISDICTION: TIG CLASS OF !'YORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS. OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 3 '15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS?: 30 •• 50 HP: REPAIR UNITS: GAS PRESSURE: 50 4 HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN >='IOOK BTU: — 10000 cfm: - OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Install gas lire and gas furnace. Owner: -� --— FEES GARY STREALY Type ByDate Amount Receipt I 11200 SW FAIRHAVEN ST. PRMT CTR 5/7/02 $72.50 272002000. TIGARD, OR 97224 5PCT CTR 517/02 $5.80 272002000C Phone:503-624-2704 iTotal $78.30 Contractor: COLUMBIA HEATING+ COOLING INC 8900 SW BURNHAM TIGARD, OR 97223 REQUIRED INSPECTIONS Gas Line Insp Phone:624-2704 Mechanical Insp Reg M LIC 76359 Heating Unt Insp PLM 34-175 Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within '180 days of issuance, or if•:,nrk is suspended for more than 180 days. kTTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (s;ni)'2AR-ca1 aca Issue By: Permittee Signature: - Call (503) 639.4175 by 7:00 P.M. for inspections needed the next business day Mechanical Permit Application 1 Date receivesS�� 0 Permit no.: City of. Tigard Pmject/appl.no.. Expire date: Cil'y of Tigard Addregs: 13125 S`.'.'Hall Blvd,Tigard, OR 97223 Date issued: e r Phone: (503) 639-41 iced tno.: /t yl�' p Fax: (503) 598-1960 r Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT GKI &2 family dwelling or accessory L Commercial/industrial U Multi-family U'I'cnant imp,ovetnent U New construction ?rAddition/alteration/;cplacement U Other: JOB SITC INFORMATIOL4-vi1 1SCHEIDAtUL Job address: '"- _m , pr-Allit-. Indicate equipment quanuues in boxes below. Indicate the dollar Bldg.no.: /y1777-5F6 cAJ Y Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit. Value$ Lot: Block: Subdivision: "Sec checklist for important application information and Project name: jurisdiction's fee schedule for residential p.rmit fee. City/county: T;rn CA 12 2 1 1 Description and Iodation of work on pre ices:._____-___ ( 1 1 �'• 1 ✓1 cttA. vt[�L� Fctilc'a.! 1�r1a1 Est.date o .!om letion/inspection: -- - _ Dmriplion (j!r. Rcs.only Rm.only Tenant improvement or change of use: Is existing space heated or conditioned?U Yes U No Air handling unit ('F _ Iscxisrin s Icrinsul;ded'rU'fc,, UNn Air conditioning(site planreq ,lred) ^� k f Iteration of existing HVAC system ti=oier Cr State holler permit no.: Business name: C-1wpb�1k{ 1�� \er r� i� � HP Tons�—_BTU/H Address: r `.; n II LD Fire/smoke damperRiductsmokedetectors City:_. 1 Srate:p ZIP: 9 2 Z. -Heat pun required) I ax E-mail: nsta rclr t c-!fur c wrner Inclu ork/vent liner d Yea U No J� CCB no.: 4 r rj nsla rep ace re ocatc :caters-suspen ec, City/metro lic.no.: 7 _ wall,or floor mounted _ Name(please print): I Vent for appliance other i tl•an lurnace - e gerailon: Mum!killim Absorption units i f(1/t I Name: , nl Ix ` ;,► (�{' ('hitters__. Hl' -- Address: Compressors Hl' -- En"roftMeOtal e1111111111511 End ventilation: City: State: ZIP: Appliance vent _ Phone: - L( I-ax: E-mail )rycrex aunt -- T Hoods,Type res. its cN aztnat - ( C hood fire suppression system - __- Name: �. 5} (� Exhaust fan with single duct(hath fans) _ Mailing address: 1-G 11.U '"� �,�,��y` I -F.x dust s�stcE� art rom eatin or C • �-- — uc p pl T ing and distribution(up to outlets) City: nd Ista(c z fYpc _LPC? , N(3 O+I -- Phone: / j c ?-J o(I I Fax: E-mail: I Fueln ui:•each additional over 4 outlets rocesspiping(sctematicr�(schematic required) _. Name: Number of outlets _ _-- — — t7T her1Gf ape fiance or equ equipment: Address: Dtcorativefirep'ace C'i(y: __e: ^lx: State: ZIP: Insert- type Phone: 1U-mail. -� cox stove/pe et stove ()t ter: Applicant's signaturC Date: I ter: Name (print): Not all jurirlkrlcwu aree(n crecllr cards,plrasc call}urirdkrlon rd mcxe Inrnrmatldr Permit fee..................... Nolice:'this petmir application Minimum fee................$ U Visa U MaslerCerd — expires if a permit is not obtained Cndll card number _ Plan review(at _ %) $ x(dre� within 180 dt,vs eller it has been State surcharge(896) $ —dame n der i sliown on cretin mplete.cant accepted as co21 3 $ TOTAL .......................$ Cardholder sisnnurr --- Amount 440.4611(MOMM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: t TOTAL VALUATION: PERMIT FEE: Description: Price Total $1.00 to$5,000.00 � Minimum fee$72.50 Table 1A Mechanical Code Oty (Ea) Amt 1) Furnace tc 100,000 BTU $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts vents 14.00 $1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+ fraction thereof,to and In,Juding includina ducts&vents 17.40 $10,000.00. 3) Floor Furnace $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and including en► 1400 $1.54 for each additional$100.00 or 4) Suspended healer,wall heater fraction thereof,to and including or foor mounted heater 14.00 $25 000.00. $25,001.00 $50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit to f 80 $1.45 for each additional$100.00 or - fraction thereof,to and Including 6) Repair units 12.15 $501000.00. $50,001.00 and up $742,u0 for the first$50,000.00 and Check all that apply: Boller Heat Air $1.20 for each additional$100,00 or For Items 7-11,see or Pum I Cond Comp fraction thereof. footnotes below. 7)<3HP;absorb unit Minimum Permit Foe$72.50 SUBTOTAL: $ to 100K BTU 14.00 d)3-15 HP;absorb 25.60 8°/.Ctate Surcharge $ upit 100k to 500k BTU _--- 9)15-30 HP;absorb 35.00 25%Plan Review Fee(of subtotsl) $ unit.5-1 mil BTU -- Required for ALL commercial permits only _ 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU _ 52.20 11)>50HP;absorb 87 2n --- - unit>1.75 mil -- 12)Air handling unit to 10,000 CFM 10.00 ASSUMED VALUATIONS PER APPLIANCE: _ Value Total 13)Air handling unit 10,000 CFM+ Description: Ql Ea Amount 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler 10.00 ducts$vents Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct 6.60 ducts&vents _ Floor furnace Including vent 95� 955 _ 16)Ventilation system not Included In Suspenter,wall heater or a Ilance ermil 10.00 ded hea floor mounted healer 17)Hood served by rlechanical exhaust Vent not Included In applicance 445 10.00 permit - 805 18)Domestic Incinerators Re air units 17.40 <3 hp;absorb.unit, - 955 19)Commercial or Industrial type incinerator to 100k BTU 69.95 3.15 h,:,�osorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU 10.00 15-30 hp;absorb.unit,501k to 1 u 2,310 21)Gas piping one to four outlets 5.40 mil.BTU 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU 1.00 >50 hp;absorb unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mil.BTU _ Air handling unit to 10 000 cfm 656 '- 8%State Surcharge $ Air handling unit>10,000 cfm 1,170 ortat+le evaporate cooler -656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan cornected to a single duct 446 Vent system not Included In 656 a (lance ennit _ -. _pPE_._. _ Other Inspections and Fees: Hood served b mechanlCal exhaust 656 ___ 1 Inspections outside of normal business Mum(minimum charge-two hrurs) Domestic Incinerator i'170 $62 50 per hour Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee is apedricaily Indicated (minimum charge-hall hour) Other unit,Including wood stoves, 656 $62.50 per hour inserts etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-one-half hour)$62 50 per hour Gas 1 In 1.4 Outlets 360 Each additional outlet _ 83 'State Contractor Boller Certification required for units 2,200 BTU. "Residential A/C requires site plan chewing placement of unit. TOTAL COMMERCIAL $ VALUATION: _� All New Commercial Buildings require 2 sets of plane. I\fists\forms\mech-fees doc 12/26/01 / C IT ll' OF TIGARD A_ PLUMBING PERMIT _ DEVELOPMENT SERVICES PERMIT#: PLM2002-00153 DATA= ISSUED: 5/7/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PARCEL: 2S1 11 BD-01603 SITE ADDRESS: 14785 SW 98TH AVE SUBDIVISION: ALDERBROOK FARM ZONING: R-3.5 _ BLO_CK: LOT: 005 — JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: —Y SINKS: URINALS: GREASE TRAP` . LAVATORIES: OTHER FIXTURES: TUB/SHOW'1F.'r,S: SEWER LINE: ft WATER CLOSET. WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Water heater replacement. -- _ FEES Owner: Type By Date Amount Receipt GARY STRE:ALY PRN1T CTR 5/7/02 $72.50 27200200000 11200 SW FAIRHAVEN ST. 5PCT CTR 5/7/02 $5.80 27200200000 TIGARD, OR 97224 — Total $78.30 Phone 1: 503-624-2704 Contractor: COLUMBIA HEATING + COOLING INC F';1 GOX 230397 8900 SW BURNHAM ST STE E-110 REQUIRED INSPECTIONS TIGARD, OR 97281-0397 Final Inspection Phone 1: 624-2704 Reg#: LIC 76359 PLM 34-175PB j 1 This permit is iFsued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all oiher 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. ATTENTIOIJ: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: !t_ permittee Signature:. Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day Plumbing Permit Application Date received: '7 (Jy Permitno.:(�M -Dv/ ✓. Cit of Tigard City g Sewor permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tig-trd.Ort 97223 Project/appl.no.: Expire date: City uCTrgard Phone: (503) 639-4171 Fax: (503) 598-1960 1 Date issued: cciptno.: i Case file no.: Payment type: Land use approval: OF PIEWT ;Job 2 family dwelling or accessory U .oi.,mcrcial/indu.,.trial U Multi-family C3 Tenant improvement w c(instruction )dAddition/alteration/replacement U Food service J r nitrt 1 1 , IN 1 1 1 Description _ (jt . hee(ea.) Total dress: I I Z:Z;+•{ —N—c" I-nird 2�famil d"ellings only: Bldg.no.: S ` %� suite (include~100 ft.for each tit ilityconnect Ion) Tax map/tax lot/account no.: SFR(1)bath E;vBltxk: Subdivision: SFR(2)bath _ Project name: SFR(3)batt: City/county: T-; a �.� A ZIP: e17 2-2 3 Each additional bath kitchen Description and location of work on premises: __._ Siteutllitiea: (-.f lu trQ i i s-ba LY (arch basitt/area drain Drywells/leach line/trench drain fast.date of cr npletion/inspection: Footing dtnin(nn,lin.ft.) Manufactured Lome utilities Business name: Crte_ H Lea 110 C, f ( P_cManholes Address: rv— j Rain drain connector City: n f CA State: L.IP:C Y Sanitary sewer(no.lin.ft.) Phone: (s p Fax: E-mail: Storm sewer(no,lin.ft.) b, ,9 Plumb.bus.re Water service(no.lin.ft.) CCB no.: Fixture or Item: City/metro lic.no.: / ` Absorption valve Contractor's representative signature ,�- �� Back flow reventer Print name: _ I= Al Backwater valve CONTAO PERSONBasins/lavatotY _ C otic s washer Name: TA rJ Dishwasher Address: Drinkingfountain(s) City: P: Bjcctars/sum State: ZI p Phone: t'—? Fax: F-mail: Expansion tank _ Fixture/sewer cup Floor drains/floor sinks/hub Name(print): t r e rd'i Garbage disposal Mailing addrt.ss: 112 L) ` LJ FdX i UOn Hose bibb _ City: Slate:Ue -ZIP: r)7 2 7 Ice maker Phone: Fax: E-mail: Interceptor/grease trap (Avner installation/residential maintenance only: The actual installation Primer(s) will be made by me r r the maintenance and mpair made by my regular Roof drain(commercial) employee on the property I own n;per ORS Chapter 447. Sink(s), asin(s),lays(s) Owner's signature: Date: Sum Tubs/s ower/show!pan Urinal Name: _ Water closet Address: Water heater City: State: ZIP: _ Other: Phone: Fax: E-mail: ata! _ _— Minimum feeY• 7 a �� ............... Not all Jurisdictions uccet„credit cards,please call aurisdictian rase mOm lnrmmwtion Notice:This permit application Plan review(al _ %) U Visa U MasterCard expires if a permit is not obtained Credit card r•tmber `— --�— within 180 days after it has been State surcharge(8%).... t-Apitea TOTAL .......................S accepted as complete. `— "— Name chi c older u a own on c it c $ Card slEnalure Amounl 440-46161 XWOMi PLUMBING (PERMIT FEES: PRICE TOTAL New 1 and 2-famlly dwellings only: -I FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dvieiliog and the first100 ft. QT (ea) AMOUNT Lavatory - 16.6r, for each utility co c inaction) One 1 bath $249.20 Tub or Tub/Shower Comb. lo.60 Two 2 bath $350.00 Shower Only i x16.60 Three 3 bath $399.00 Wate Closet 16.60 - - SUBTOTAL Urinal 16.60 8%STATE SURCHARGE _ Dishwasher 16.60 PLAN REVIEW 2.5%OF SUBTr 1TAL Garbage Disposal - 16.60 - TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sln� 1 2" 16.60 3" 16.60 PLEASE COMPLETE 4" 16.60 Water Heater O conversion O like kind 16.60 v Quantit b Work Performed Cas piping requires a separate mechanical Fixture Type: New T Vcved Replaced Removed/ _permit. Capped MFG Home New Water Service 46.40 SinkLav _ MFG Home New San/Storm Sewer 46.40 Tub or _- - Tub or Tub/Shower Hose Bibs 16.60 Comillnatlon _ Roof Drains 16.60 Shower Only Drinking Fountain - 16.60 Water Closet Other Fixtures(Specify) 16.60 Urinal _ _ Dishwasher _ Garbage Disposal _ Laundry Room Tray _ Washing Macl,ine Floor Drain/Sink: 2" - Sewer-1 at 100' 55.00 3- Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater Water Service-each additional 200' 46.40 Other Fixtures (Specify) Storm&Rain Drain-1st 1 10' 55.00 _ Storm&Raln Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 _ Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections erfir COMMFNTS REGARDING ABOVE: Rein Drain,single family ewelling 65.25 Grease Traps 1660 -- QUANTITY TOTAL - Isometric or riser diagram is required if -- ---- - ----� - Quantity Total Is >9 ---------- -- ----- "SUBTOTAL --- ------ -- - --- - 8%STATE SURCHARGE ---- -------- "PLAN REVIEW 25%OF SUBTOTAL Required only If fixtw 3 qty total Is>B - TOTA! II fr "Minimum permit tae is$72 5o+C°i state surcharge,except Residendal Backflow Prevention Device,which Is$36 25.8%state surcharge "Ail New Commercial Buildings require plans with Isomeh.c or riser diagram and plan review I\dsts\forms\plm-fees.dor, 10/10/00