Loading...
14059 SW 119TH PLACE ADDRESS: ! r SIN // "CE a r J i:kecotdsltnlcrollmltargelsu;,d(rfing.doc, W J v 0 z o3) i o0) rn rn m rn ro o o `c v v 3 a a a a a a ro C m a o 0 o m m o ro d o > =J 0 W co In w O h 7_ w cn Z o a a o T U °) LJ a° o o m m o c o c tn Q (9 U obi m o � n � W + O air Q � is O: F- vi >- i .. 4 o c m c �v Lo 'a ao _b T !n ll 7 �C v m C) r 2 a W cu- w LLU o) LO Q Q Q Q �Q Q Q Q w W W W W W W � } \ \ ) z ƒ . m $ + � \ \ \£ j [ J ® / a m = o > D _ Z ) cu � _ o K / z z § ) § luƒ §2 $/ � co O k / m \ \ / 2 m �0 $ � \ (n m © � 2 > Q ' k � \ � L § f 2 3 f > £ ( [ 2 on \ / .k E LU ) E ) z \ a 7 I T- } <4 IF k } 0- j § } �\} £ b �} - E :3. kb\ t §f } g] $) �22\ eRo= = Q, 8 . E_ \ Ba330 {\ \\ / �t�( \ &� ) (/knf ucu0a)/ {5 cEocl \) \ -—2x ki& a 0 4{ 0 3: t:W0 /7\ mk z @¥ E £ mS § @ & §tee » e CD $ 2 § § $ § { $ $ § a § / \ 4 ® } m� 2 2 % 7 2 2 }< e o �i � ] > k �± k z LO C14 0 G- o / j \ } } } } } j � c 0 0 CL G / j § / = m § % � 2 \ Q �o cu# 0 Q $ $ $ m $ $ m $ § O k & \ a \ & a § � a @ ! 2 3 a > 2 § \ � A a % / 2c � k � § \ { � \ e \ r , c ) ° \ ) j \ ■ � ) \ / ) ƒ } E k I J @ R G G m G @ to / 8 / @ < < < k < $ E 0 ami a� ,ru N `U) y 2 M o E o Z n3 v � a• > U) U) ) CL 0 0 G 7-1 a o > � =J Z G CL Q W U) U) W (_) Z ) U, Z O Tui O <t a O o a a 0 m O (DLJ ( m cn c o O f- W e C) m 0) rn a W � A 0 � QQ11 0 a a o y a C U 4 v Li J � n O> a _ tw cli (DCO o v n o fn (n ) fn (f) ) CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP _ Date Requested AM PM BLD Location__ lLl 0 5 Suite MEC Contact Person Ph PLM Contractor Ph SWR BUILDING Tenant/Owner _- ELC Retaining Wall ELR _ Footing Access: Foundation FPS Fig Drain SIGN Crawl Drain Inspection Notes: Slab _ __ SIT Post R Beam Ext Sheath/Shear _ _ -- Int Sheath/Shear Flaming __�--- Insulation --- 7— Drywall Nailing Firewall Fire Sprinkler — ---- — ----- Fire Alarm Susp'd Ceiiing — - --- ---- -- -- --- -- - Roof Misc: ___ — — ------- -- -- --- Final — PASS PART FAIL ------------ _ --_�— - _�_ — PLUMBING _- Post8 Beam ----_---- ---- -- - ----�-- -----------------._---- Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post& Beam ---- Rough In Gas Line --- - --- -- - - Smoke Dampers Final - PASS PART FAIL ELECTRICAL — Service 'q Rough In UG/Slab cwt Low Voltage i c~/7 Fire Alarm - -- --- -- PASS PART FAIL - J Backfill/Grading CD Sanitary Sewer J Storm Drain I J Reinspection fee of$ required before next inspection. Pay at City Hall, 13175 SW Hall Blvd Catch Basin I Please call for reinspection RE: f I Unable to inspect-no access Fire Supply LineADA // Ext Approach/Sidewalk Date sp ectol; Other _ In.c � Final PASS PART FAIL DO NOT REMOVE this inspection retord from the job site. /� M: i MYn.1 `.L"r`•�.0 . IV fIL:Vf1L/LfI VI'11..1..•.VUW UVVI•.W..1I V.M•.�,•••v '.��w/r�rr ^""lYi�iiG,ii' +. �•' CITY OF IGARD.,BUILDING INSPECTION DIVISION a ; 4-11oul ns e�ction L, a 639-4175 " ;�Bush ass Line: 639-4171 ` F44p it: BUP ". Date Requestedd AM PM BLD Location•_ it4n — ^ 1 pie. Suite MEC Contact Person _ �(Y1 I Ph PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Foundation FPS Ftg Drain SGN Y Crawl Drain Inspecti otes- Slab _ �.. J SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailirg ,. Firewall Fire Sprinkler /, Fire Alarm Susp'd Ceiling Roof Misc. Final PACS SART _FAIL ' /✓� • -� PLUI• BIN d/ o eam - Under Slab Top Out Water Service Sanitary Sewer Rain Drains S PART F L MECHANICAL Post&Beam ----4---- � - -- '/ Rough In Gas Line -- — Smoke Dampers / D Final PASS PART FAIL Q� 4 ELECTRICAL _ Service a Rough In UG/Slab V1 Low Voltage Fire Alarm — �` Final PASS PART FAIL SITE 00r*i. w BackfilUGrading -- -- -' Sanitary Sewer Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection REQ Fire Supply Lire [ ] P -- [ ]Unable to inspect-no access ADA ApproOther ch/Sidewalk pate ( �1 ,� Other • �—Inspector � _Ext Final PASS k,:PART FAIL DO NOT REMOVE this Inspection record from the job site. i , a 1• L®Hk' ,� A,NM `bRY SERVICE RO. Box 309, BANKS, OREGON 97106 644-2797 648-6254 639-5188 2283 NAME: _ ADDRESS: r S ( S CITY: J1�si STATE: { ZIP: HOME: � WORK: CELL: JOB SITE: < �� P.O.#: PAID BY CHARGE O CNECK l{d/ CASH Cl CREDIT CARD O DATE —3O DRIVER AMOUNT I PUMP SEPTIC TANK _ O LINE OPENING O INSPECTION FEE O SERVICE CALL 71 O `LABOR LOCATING DIGGING & BACKFILL O MATERIAL C'6 - ---THIS IS NOT A SEPTIC SYSTEM INCTION REPORT---TOTAL $ G� /M - — REMARKS — TYPE -� _ TYPE OF TANK: STEEL CONCRETE O PLASTIC I1 HOMEMADE HORIZONTAL Cl VERTICAL O ❑ RO fel i 7 ECTANGLE 71 OTHER SIZE OF TANK: 350 71 500 � 7 0 O 100 1250 1500 2000 3000 O LID LOCATION: INLET 71OUTLE_ \O MIDDLE O ENTIRE TOP O T!,"IK CONDITION: GOOD 71 FAIR / POOR O FITTINGS: BAFFLES 71 CONCETE O CAST IRON O PLASTIC ❑ NEEDS NEW LID? I-1 YES SIZE / GROUND COVER OVER TANK 1 COMMENT ON CONDITION OF DRAINFILD ETC. J � Li SIGNED BY _ _ DATE CITY OF TIGARD F..LEC'.TRICAI_ P'ERMTT PrRMTT ##: El-C99- 0-070 CEVELOPMENT SERVICES DATE ISRL)ED: 02/1.0/99 13125 SW Hall Blvd., Tigard,OR 91223(6,03)6394111 PARCEL-: P-01. t onD- 00100 LTTE AODRC_'_".3. `,:JW 119TH PL. SUPDTVISION. .. . . : ZONINC:R-7 PL.00K. . 1-.OT. . . . . . .. . . . .. . . . JURISDICTION: TTP r'ro j r• ct De scr i.Fat i n, n . Reconnection ofelectrical service. ---RESIDENTIAL- LJNIT------- ----TEMP SRVC/FE:EDERS--•-- -----MTSCE:LLANEOIJS------ 10Q10 SF OR 1__ESS. ,. , . : 0 0 — 20111 ramp. . . . . . . : 0 r'i.JMP'/TRRIGAT ION. . . . : 0 EACH ADD' l.. 5005E . . . : 0 201. -- 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 L'M I Tr7D ENERGY. . . . . : 0 401 -- (LOO o m p. . . . . . . . 0 S T GNAL/PANEL... . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601+amps--1000 volts. : Q' MINOR LAPEL ( 10) . . . : 0 _....._...--rERV I CE/FEr='DER.-..---- --- -BRANCH CIRCUITS---- . -. _- ._-ADD" L I NSP'ECT I ONr- 0 - 2,00 amp. . . . . . : 0 W/SE=RVICE OR FEEDER: 0 PFR INSPECTION. . . . . : 0 .x'6'11. -- 400 amp. . . . . . : 0 1. =,t W/O SPVC OR FOR. : 0 PER HOUR. . . . . . : . . . . : 0 401 — GOO tamp. . . . . . : 0 EA HDD' L. PRNrH CIRC: 0 IN Pt-ANT 0 601 -_ iQ100 amp. . . . . : ID _...,.._.________.. _ . _..._..._.P'�..AN REVIE=W 1.000+ ,amp/volt. . . . . : 0 )-4 RES LJNITS. . . . . . . . : ) 600 V71-T WMINAL.. . : Reconnect only. . . . . : 1 SVC/FDR ) 225 AMP'S. . : CI-ASS AREA/SPEC OCC. : nwnet-: FEES JANICE JUSTICE', DR DC type ,amount by dafi r recpt 11920 SW GAARDE ST PRMT $ 50. 00 DER 02/10/99 99-312808 T I CARD OR 97284 `TVT t 121. 50 DED 021101139 99­3`1280S (-'hone #; Contr^ar.t:or: — FRT BERG ELECT R T C CO 6 521. 50 TOTAL_ 4636 N WII._I. IIIMS AVE - -- -- - RE FLIT.RE'D I NSP'ECT I ONS PrORTL.AND OR _17^17 Rol.lgh-An rl.czr.t' 1 Final. PlFione #: P811--5161 Elect' 1 Ser-vir_e, Reg #. . : 0, 00013 _. This permit is issued subject to the regAstions contained in the Tigard Municipal Code, State rf Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit wi'l expire if work is not started within 180 days of issuancR, or if worts is suspended for more than 1R0 days. ATTENTION: Oregon law requires ?,u to follow the rules adopted by Clregon Utility Notification Center. Those rules are set forth in OAR 95`-'001- rok.lg 52-001 1'397. ymi may obtain a copy ' these rules or din!ct questions to OUNC by rallin (503)246-1987. 7 •mit`ee Signratl_1re , .__ Ias�ied y:. ' __. INSTAI._LATION rn in tall.ati.on Is bpi ng macie an property I own whish is not intonded for- L�„ le, 1 r ,a,r, car rent. y 'NPRI S STCNATURF: - DATE CCINTRA�:TCOR IN' i11..LoT ON nm..Y- ­- -­.- ......... __...__....__ W rNATI.IRF` OF Sl1P'R. Fl. E:C" N: J<i 01�'�eDATE: I_. ICr"'NOE Nn: ++ #-1-++++++ 4 4-4++4•++r4 4 1+4 4++A-++ 1-+4 ++a+4-I +++4-++++++++h++++++a•+++++.+++++++++++P Call (. ."1 417" by 7:00 p. m. for- an ins+hart i on np4,ripd tt-Ip nlnxt- bt.�sinps s day +++4-++++++ I•++++4.-1.+ +..4-+ I.++ f d.+++4-,+4•1-+4 1-+++ F+++4+4. 1_++4++4 4.4+4 4++ r•++-4-++++++4•++++++++ Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. ___---- FFF+ Tigard, OR 97223 Planck/Rec. # — Permit # F t-C r - 070 [JITY ULYLLU1 phone (503) 639-4;71 Date Issued tea--- fr�-I FAX (503) 684-7297 Issued by t + Jc-tO 11,4 CU t'vtt�a4L I CITY Of TIGARD TDD No. (503) 684-2772 Inspection (503) 639-41-4 5 _ 1. Job Address: 4. Complete Fee Schedule Below: Name of Development t0— �u5'1 e f— Number of Inspections per permit allowed Address F� f<-`-' w C�?A0`y<< I ` Pi Service included. Items Cost(ea) Sum City/State/Zip %i0taerd 01Z• 4a. Residential- per unit 4 —'� 1000 sq it or less $110 00 Farb addiorel 500 It or Name (or name of business) portion thereof _� $2500 1 Commercial ❑ Residentia; Each Energy $2500 Each Marul'd Home or Modular ? Dwelling Service or Feeder $e6 00 2a. Contractor installation only: 4b.Services or Feeders Installation,a4eralian,or relocation ` Electrical Contractor f:be r �2 G zoo amps or lase $60 00 Address �• /1V W 1 t�l 1y11 201 amps to 400 amps $80 00 -�-,� 401 amps to 600 amps $12000 2 City j>('04 /n+ State 02 Zip�7� bol amps to 1000 amps -� $160 0o 2 Phone No. ' S (,/ Over 1000 amps or volts $34000 2 Contractor's License No. 2 6e _5/L i` Reconnect only $5000 Contractor's Board Reg. No. 1 4c.Temporary Services or Feeders Installation,alteration,or relocation 2 Signature of Supr. Elec'n 200 amps or less $5000 _ 7 License No Phone 201 amps to 400 amps $7500 401 amrs to 600 amps $10000 Over 800 amps to 1000 volts 2b. For owner installations: see•b•above 4d. Branch Circuits Print Owner's Namo New,alleialion or arta inion per panel Address _ a)The tee for branch circuits with city, purchase or aarvks or llNdrr Ara. ci `State Zlp_—-- ( Each branch circuit $500 Phone No. b)The fee for branch circuits without The installation is being made on property I own which is purchase of eenr;cs or Netter Ma. Firsnot intended for sale lease or rent. branch circuit E$5 00 � Each additionalal branch branch dreuil $500 Owner's Signature 4e. Miscellaneous (Service or feeder not includer,, 2 3. Plan Review section (if required): FaLh pump or irrigation circle $4000 2 Foch sign or outline lighting 94000 Signal circuits)or a limited energy Please check appropriate item and enter fee in section 5B. panel,alteration or eldension $4000 4 or more residential units in one structure Minor Labels(10) $10000 — S9rvice and feeder 225 amps or more System over 600 volts nominal 4f. Each additional inspection over a- Classified area or structure containing special occupancy the allowable in any of the above —' as described in N E.0 Chapter 5 $31,00 � - i.,hind E55 no n Submit 2 sets of plans with application where any of the above Y apply. Not required for temporary construction services. 5. Fees: 49 Sa. Enter total of above fees $ _S0 NOTICE 5%Surcharge(.05 X total fees) PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b.Enter vix, line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Reevieww if required(Sec 3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED. ❑ Trust Account I>r $ Balance Due s 51 ..wl•.nwMYNY nm qp CITY C F TIG,AR D SEWER CONNECTION DEVELOPMENT SERVICES PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT . . . . . . 13WR- 99-00,`.`1 DATE ISSUED- 0�./05/99 P A R C F I.. . 'f;1 t 0 n B 00100 7TTr 1DORE09. . . : 14059 $7W 1, 19TH PL 5USDIVISION. . . . : 'ON TNG: R 3LOCK. . . . . . . . . . LOT. . . . . . . . . . . _ 1 JURISDICTION: TIP TENANT NAME. . . . . :JANICE JUSTICE USA NO. . . . . . . . . . : FIXTUBE UNITS. . . 0 CLASS OF WORV. . . :ALT DWELLING UNITS. . : I TYPE: Or USE. . . . . :SF NO. OF 13UTLY)TNGS: f INSTALL TYPE. . . . :1._TP3WR IMPERV SURFACE: 0 s Rema,,-kir : Install sewer- line. Septic tank to b(t PUMped, filled and inspecter. 1wnev— FEES `ANTCE JUSTICE, DR I)C type amor.rnr by date 1,.,Pcpt 11-920 SW GAARDE ST PRMT $ E,3,00. 00 P 02/05/99 99-312735 rIGARD OR 972"n-4 INSP $ ?f0 13 02/05/99 99---,_,12735 --hone #.- "'alit t,act or,4 1,WNE91 `hone $ 2339. 00 TOTAI_ RE=MAIRED INSPErTIONS This Applicant agrees to comply with all the rules and regulations Sewer- Tnspec.,tion ,f the Urifled Sewage Agency, The permit expires 180 days free Septic Tank Fill 'he date issued. The total amount paid will be forfeited if the ,_-ersit expires. The Agency does not guarantee the accuracy of the ide sewer laterals. If the sewer is not located at the measurement iven, the installer shall prospect 3 feet in all directions from t4 distance given. If not so located, the installer shall purchase - "Tap and Side Sewer" Permit and the Agency will install a lateral. "ITTMION: Oregon law requires you to follow rules adopted by the nregon Utility Notification Center. Those rules are set forth in OAR 72-001-0011 through MR 952-001I-0080. You may obtain copies of kjest rules or direct questions to D.INC by calling �2SSUOd Poi-mittee Signatt.ti �, c_s ���� +++++++++4.......4+++++-0-4.+4-+++++4+4-#-+++•f +-+++++4..........f f.++4--4-+-r-++,++++-,(-+++-++-I 4 4. 1--f- Uj 1 5 by 7tOO p. m. fai- an inspect i on needed the next bl.1s iness day +4-+++++4-4+++++-++..++++++++++i++++f.......+++++4++++4......+.++....+4-++++++++++4-. + 1 i CITE" OF TIGARD PLAJMBING PERMIT DEVELOPMENT SERVICES PF RMT it. . . . . . . : PI-M99-002,5 13125 SW Hall Blvd., Tigard,OR 97223(503).;39.1171 DATE IL3SL.lFD. 02/05/99 T.TE ADDRESS. 1.4059 SW I I OTH PL ,UPD 11)1 ri I ON. . . . : ZONING: R-7 ,,,LOCI;. . . . . . . . . . : LOT. . . . . . . . . . . . . .. Jl.JRI9DIC'TT0N-. TIG GARBAGE DISPOSALS. - 0 MOBTI.E HOME SPACA"S. 0 -I-ASS OF WORK. . :Al.T TYPE OF LJ9E. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PRE VNTR- S. . 0 OCCI-IPANCY GRP. . . R3 FLOOR DRAINS. . . . . . : 0 Tpnr,s. .. . . . . . . . . . . . . r3-r 0 R I C S. . . . . . . . .. 0 WnTER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 LAt-INDRY TRAYS. . . . . : GF RATN DRAINS. . . . . : 0 SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . : 0 GREASE" TRAPS. . . . . . . . 0 I-AVnTORIES. . . . : 0 OTHER FTXTLJRES. . . . 0 T UTI/S110WERS). . . 0 SEWER LINE (ft ) . . . .- 1.00 WATER C.LOSETS. 0 WriTER t INE (ft) — . ". 0 PTSIAWASHPRS. . . . : 0 RAIN DRAIN (ft) . . . : 0 Roma0<s : Install sewer line. ,owner- FEES 'ANTCE JtJrTICE, DR DC t yp(. ainoLtnt by date reept 19 0 SW GAARDE ST PRMT $ 30. 00 B 02/05/99 99-312734 TGAPD OR 97224 15PCT $ t. 50 a 02/07-5/99 99-.312734 z #: o n t r ac t a r-- ``NICE JlJOTICE 4059 SVI 1. 19TH PI-ACE "'TGAPI) nP 97*22'4 'hone 31. 50 Tarnt- rl RE01.11RFD INSPECTTnNS ,.s pirvit is issued subject to thr regulations contained in the rewer IT15PPr-t:i0T1 'd .gard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection Jplicable laws, Al) wort will be done in accordance with ,-Ip+-Dved plans. This permit will oxpjie if worN is not 5tartpd --------- ;tHn 18101-5 of issnanre, or ;f work is suspended for more pan 18t days, ATTENTIONS Oregon low requires you to follow rules -'iptpd by the Oregon Utility Notification Center. Those rules are I forth it CAR 92-0VIVII through OAR Yoti may 'tain copies of these rules or direct questions to CXX by calling r5 UJ isued Permittpe 1-4-+.-f-4-4.4-4,444,+ 4-+44-4.4-4,4.++4,4.-I-++++4-++++4-4-++4-4-4-4+-f-+++-4-4 1 4 Cal 14 6,719 4171 by 7tOO p., m. for an inspertion needed the next htt:- gess day -.44-4++4.+.+.++++4.++4-1-++++++1.-I..+++•++-4-++•}i•+4 4-+ r+++•++�+•+f-++++++++++4-+++4,4...4-44+4+++-1- CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SVV HALL BLVD. Commercial and Residential Recd By C -T -i TIOA.RD, OR 97223 Date Recd _ (503) 639-4171 Date to P.E. ` Print or Type D;rte to DST, Incomplete or illegible applications Will not be accepted Permit#_ Related SWR#2�OCI•?f Called Name of Development/ProjectFIXTURES (Individual) QTY PRICE AMT Job .J H PJ I C r �7t��,7( C Sink 9.00 Address Street Address Suite Lavatory 9,00 Tub or Tub/Shower Comb. 9.00 Bldg# City/State Zip Shower Only 9.00 Ti r�if`t�/O/' - Nae Water Closet rn9.00 rcj rn� l Dishwasher 9.00 Owner Mailing Address5c I // 7 Garbage Disposal 9.00 1 ' City/State Zip Phone Washing Machine 9.00 Floor Drain/Floor Sink 2" 9.00 Name 3" 9.00 4" 9.00 Occupant Mailing Address Suite Water Heater O conversion O like kind 9.00 Gas Piping requires a separate mechanical permit. City/State Zip Phone Laundry Room Tray 9.00 Name - Urinal 9.00 Other Fixtures(Specify) 9.00 Contractor Mailing Address Suite 9.00 9.00 Prior to permit City/State Zip Phone Sewer-1 st 100' 30.00 r i issuance,a copy Sewer-each additional 100' 25.00 of all licenses are Oregon Const.Cont.Board Llc.# Exp.Date i required If Water Service-1st 100' 30.00 expired In COT Plumbing Lic.# Exp.Date Water Service-each additional 200' 25.00 database _ Storm&Rain Drain-1st 100' 30.00 Name Storm&Rain Drain-each additional 100' 25.00 Architecf Mobile Home Space 25.00 or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Devlcn EngineerI CItY/State Zip Phone Residential Backflow Prevention Device' 15.00 (Irrigation timing devices require a separate Describe work to be done restricted energy permit.) New-5d' Repair O Replace with like kind Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 ResldenliaU,V' Commercial O Catch Basin y 9.00 Additional description of worki insp.of Existing Plumbing 40.00 _ ermr Specially Requested Inspections 40.00 per/hr -- Rain Drain,single family dwelling 30.00 Are you capping,moving or replacing any fixtures? Grease Traps 9.00 Yes O No O If yes,see back of form to indicate work performed by - fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL Isometric or riser diagram Is required M OuanlRy Total Is >9 WORK COULD RESULT IN INCREASED SEWER 'SUBTOTAL _FEES. 5 r _ F- I hereby acknowledge that I have read this application,that the!rformation given is correct,that I am the owner or authorized agent of the ownar,and 5%SURCHARGE r that lans submitted are in compliance with Oregon Sta',e Laws. _ _ S !'I nature of Owner/Agent Date __.. **PLAN REVIEW 25%OF SUBTOTAL W _ r _ Re )red oAil flrture qty total Is>9 I' - TOTAi Contact Person Na Phono I _ *Minimum permit fee In$25+5%surcharge.except Residential Backflow Prevenf on Devine,which Is S 15+ 5%surcharge **All New Commercial Buildings require pians with Isometric or riser diagram and plan review I tdslalphxnapp doc 70M A& PLEASE COMPLETE: Fixture Type Quantity by Work MPerformed_ New oved Replaced Removed/Capped Sink Lavatory Tub or Tub/Shower Combination -^ Shower Only _ Water Closet Dishwasher Garbage Disposal Washing Machine _ Floor Drain/Floor Sink 2" Water Heater Laundry Room Tray Urinal _ Other Fixtures (Specify) COMMENTS REGARDING ABOVE: cc -_-- — _ Ln r – w — 0 1 bm aoo&C law