Loading...
14533 SW 128TH PLACE i r 14533 SvV 128'x' Place CITY OF TIGARD BUILDING INSPECTION DIV;SION MST 24-Hour InEpec,u.:wti Line: 63, 175 Business Line: 639-4. BUF9 Gate Req jested AM PM _ _ BLD Locations 4 - C_ Suite _ MEC _ - Contact Person -_ �i�� Ph _ �i � PLM -- Contractor Ph SWR. _ BUILDING — Tenant/OwnerELC — rReiaining Wall — w ELR -- — IFooti ig Access: � r-oundation i'I FPS — Ftg Drain I SGN Crawl Grain Inspection Motes: Slab —------ -- _ — - -------- -- SIT Dost& Beam Ext Sheath/Shear Int Sheath/Shear — Framing Insulation Drywall Nailing ------- _ �.— --- -_-- -------- Firewall Fire Sprinkler — Fire Alarm Susp'd Ceiling -------- -- --- — - -- --- ------ Roof Misc: ----- ---- — _-- - - -- -- ---- Final -- — PASS PART FAIL — — -- --- _ ---__ MFw Beam --_—.— -------- - ------- -- Under Slab Top Cut ----— — —.—-- ---- - — -- Water Service _ Sanitary Sewer -- -- R ' Drains in S PART FAIL XMLANICA� Be - _ -_ --_.-.-- -_---- ---- __ - �Rough In Gas Line ------_—._ ___-- _— ----.--_—_--- _. ---_ smoke Dampers Final -- PART FAIL Rough UG/Slab Low Voltage — FireAlarrn a� PART FAIL backfill/Grading --- --- ---- -- --- — --_.— — -- - -- Sanitary Sewer Storm Drain I I Reinspection fee of$`-- —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Calch Basin Fire Supply Line I 1 '-lease call for reinspection RE ( I Unable to inspect no access ADA Approach/Sidewalk LDateolh�r —_�_ L Inspector_ Ext Final PASS PART FAIL DCS NOT REMOVE this inspection record from the job site, CITY OF TIGP AD 24-Hour BUILDING Inspection Line: (513)639-4135 INSPECTION DIVISIONMST __ Business Line: (503 X39-4171 RUP -------- — Received , Gate Requested AM PM BLIP Location _. / `t! s.33 /�- �"t ��-- Suite MEC Contact Person _ Ph(--) _ PLM Contractor ---__-- Ph(-- ) — SWR -------_-__. BUILDING _ TenantOwner _� _ _ _ ELC Footing Foundation ELC Ftg Drain Access: ____. - 6ex �- Q �7 Crawl Drain ELR Slab Inspection Nates: SIT Post&Beam Shear Anchors _- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall NalI4, Firewall _- --- - --- - Fire Sprinkler Fire Alarm -__.--- Susp'd Ceiling - --- -- -- ---- Roof - - Other: - - ------- - — - - PART FAIL - - - - -- -- - - PLUMBING Post&Beam Under Slab Rough-In - ---- Water'service -- Sanitsry Sewer Rain Drains ---- - - Catch Basin/Manhole Storm Drain -- -- - Shower Pan Other: Final PASS PART FAIL --- - - - - - MECHANICAL " Post& Beam Rough-In - - - Gas Line _ Smoke Dampers - Final PASSPART FAIL — - -- - _ ELECTRICAL Service Service -- - Rough.In UG/Slab Low Voltage Fire Ala►,11 Fina' E�-l-1 Reinspection fee of$_—__ _PASS PART FAIL L.� P required before next inspection. Pay at City Hall, 13125 SW Hall Blvci SITE ❑ Please call for reinspection RE:__ _ tw J Unable to Inspect-no access Fire Supply Line ADA 3 � � D Approach/Sidewalk fDab--- Insp�ator— Ext Other: Final DO NOT REMOVE this Inspectio:ii record from the Job site. PASS PART FAIL Y iTl - O C) m m 03 co C m � - n1 C co mrri � y G) C/) m n z CA c HT1 m � m z rn b m° -i z o c� m co � aU m -TI uo o m t 'i ------� �„ d Q b � � � � � � � � � � �� 3? � o � � b � � N � � � � iH p a � � ~ a s � � G � ` t a ° C* G� o � W Ct r+. �� a �, � � � � � � �� c � n ��� � � � � � y �.' . � a ^ a' \ 1 w � � � � a � •o � h � , � r.,,. s � � � � �� s � � ° ,., � A � ro v `� � � =� �, n J � 1 a � �z � n� � y � ` 7 I p �e s' x CITY OF AGARD BUILDING INSPECTION DIVISION 24.-Hour inspection Line: 639-4175 Business Line: 639-4171 MST - 8UFy ----------Date Requested_- _AM PM .,...,^ Location w Suite BLD G-�--- MEC Contact F✓arson � Ph PLM �/-aa„7�„� Contractor _ _ Ph SWR _ FdUILDING Tenant/Owner ELC Retaining Wall - -'-- - Footing ACCqELR Foundation I JjSs' -- ---- Ftg Drain i ole-LrAl, PPS Crawl Drain Inspection Notes.- SGN Slab ---- ---- Post&Beam —_ --- - - SIT Ext Sheath/Shear - Int Sheath/Shear Framing Insulation ----------- Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Final PASS PART FAIL_ —_ LIMBI --- ---- -- a � Beam --- -- --- - Under Slab Top Out Water Service Sanitary Sewer 5alkDrains PART _ v M HANICAL - - Post& Beam Rough In - Gas Line —.- Smoke Dampers Final _ PASS PART FAIL ELECTRICAL Service Rough In - - UG/Slab Low Voltage -- _ Fire Alarm Final PASS PART FAIL SITE -- - -- -- Backfill/Gradtnq --- Sanitary Sewer Storm Drain [ )Reinspection fee of S _required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ )Phase call for reinspectlon RE: - ( )Unable to inspect-no access ADA Approach/Sidewalk � ' 1 f!7 � / Other Date t / Inspector _1_a �L<<"rc?Ut.. Ext Final - PASS PART FAIL DO NOT REMOVE this inspection record I'vom the job site. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE JIM'S PLUMBING PO BOX 7160 ALOHA, OR 97007 Plumbing Signature Form Permit #: MST2001-00064 Date Issued- 3!9101 Parcel: 2S 09AD-07700 Site Address: 14533 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Block: l-ot: 003 Jurisdiction: TIG oning: R-7 Remarks: SIF Path 1 Geotechnial engineer shall review the house foundation and deck excavation and bearing support, footing-to-slope setback Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your companv sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: O'BRIEN HOMES INC JIM'S PLUMBING 34444 SW LADD HILL ROAD PO BOX 7160 WILSONVILLE, OR 97070 ALOHA, OR 9700.7 Phone #: 503-625-4400 Phone #: 649-4034 Reg #: I IC 71860 PI M 34-186Db AN INK SIGNATURE IS REQUIRFD ON THIS FORM Signature of Autho ' d Plu er v If you have any questions, please call (503) 639-4171, ext. # 310 CITYOF ` IGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: /9/01 1-00373 8 13125 SW Hall Blvd., Tiga.J, OR 97223 (503) 639-4171 DATE ISSUED: 8/9/01 PAROL: 2S109AD-07700 SITE ADDRESS: 14533 SW 128TH l' SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 00 _ __ JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HC ME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAW DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES. OTHER FIXTURES: TUBISHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of backflow preventer FEES _ Owner: _-- Type` By Date Amount Receipt O'BRIEN HOMES INC PRMT CTR 8/9/01 $3625 27200100000 34444 SW I-ADD HILL ROAD 5PCT CTR 8/9/01 $2.90 27200100000 WIL':ONVILLE, OR 97070 — Total $39.15 Phcnt 1: 503-625-4400 Contr.,ictoi: CI_PSSIC GARDEN CREATION, INC. 16080 NW PARSON RD. FOREST GROV1`=, OR c.'7116 REQUIRED INSPECTIONS RP/Backflow Preventer Phone 1: 503-359-1823 Final Inspection Reg #: PI-M 1204 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicaNe laws. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules arF set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You n, iv (01ain copies of these rules or direct questiors to OUNC by calling (503) 246-1987. Iss.+ed By: Permittee Signature: �1LJ�C �/Vv7� Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit App"ion aO Daterec,eiv C' Permit no. J, -QCity of Tigard Sewer permit no.: Building permit no.:Address: 13125 SW!-fall Blvd,Tigard2? Project/appl.no.: Expire date: City q("fiyaid Phone: (503) 639-4171 Fax: (503) 598-1960 Date issued: By: Receipt no.: _ Case ftic no.: Payment type: Land use approval: 1 7UNew family dwelling or accessory LI Commercial/industrial U Multi-family Ll Tenan'improvement construction Ll wdditicm/alter;tliou/repl;tcenicnt LI Food service Ll Other: 1 1 1 11 = �.. .� tL, L I Description Ot Fee(ea.) 'Total Job address: 53'l LJ A — New 1-and 2-family dwellings only: Bldg.no.: Suite no.: (includes 100 ft.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath 1. v I Block: Subdivision: SFR(2)bath Project name: _ _ SFR(3)bath City/county: r t.✓ ZIP: Each additional bath/kitchen Desc 'p ion and location of work on premises: _ a Siteutilities: — Catch basin/area drain Drywells/leach line/trench drain _ Est.date of completion/inspection: _ Footing drain(no.lin.ft.) 1 1 Manufactured homt utilities Business name: ( L �a�t �.oyc!{-i /1 C Manholes Address: Rain drain connector City: U ti)v'eState: Q(�?IP: 7// _ Sanitary sc wer(no.lin.ft.) _ — Phone:' Fax: E-mail: Storm sews r(no.lin.ft.) Plumb.bus.re Water seryice(no.lin. ft.) CCB no.:(_C # t g'no: ----- >F'ixture or Item: City/metro fir.no.: Absorption valve Contractor's representative signature: _ Back flow reventer I Print name:("(1,A)I Date: — — -� Bnckwater valve _ Basin;/lavatory Clothes washer _ Name: Dishwasher Address: b IVI,J 105;v_1011 Drinking fountain(s) City: State:()/Q I ZIP:61'7 i! (J Ejectors/sump Phone: Z Fax: " -J I E-mail: Cxpansion tank _ Fixture/sewer cap Floor dra_ins/Iloor sinks/hub Name(print): (]/A/,`Ai1 t �YLp� �_ Garbage disposal Mailing address: Hose Bibb City: State: ZIP: Ice maker Phone: Fax: E-mail: Interco tor/ rg case trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my rrgular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),_asin(s),lays(s) Owner's si nature: Date: Sum p Tubs/shower/shower can Urinal Name: Water closet _ Address: _ _ Weter cater City: — State: ZIP: Other: _ Phone: Fax: [E-mail:Fail: Tota �— Minimum fee................$ Not aft Jurisdictimu accept credit ertds,pies.call Jurisdiction I'm mme Inrmtnstion. Notice:This permit application ('Ian review e.. ,_ 9i.) $ _---��- U Visa U MasterCard expires if a permit is not obtained State surcharge(896) ....$ Credit cud number: — — — s within 180 days aper it has been p accepted as complete. TOTAL ......................$ itis, I Name or cuM--oltTec u sin on credit:r�— --- Cardholdet signature Amount 4444616(M)OCOM1 PLUMBING PERMIT FEES: - - ----- PRICE TQTAL New 1 and 2-family dwellings only: PRICE TOTAL QTY ea AMOUNT (Includes all plumbing fixtures in AM JUNT FIXTURFS IndividualL _ 16 60 the dwelling and the fir'at100 ft. QTY (ea) Sink I for each utiles connectlon) -- - 16.60 Cne 1 bath __—_- - $249.20 _-_- Lavatory 16.60 TwuL 2)bath - -_ $3_50.00 _— Tub or TublShower Comb --- Three 3 bath $399.00 _- 16.60 --5tr-- —--- - Shower Only -- -- ----_S_UBTOTAL 16.60 _Water Closet _ - _ �----- 1560 g•/,47ATE SURCHARGE __ Urinal - PLAN•`tEVIEN;25°/.l'F SUBTOTAL - -- 16.60 - TOTAL Dishwasher - 16 30 Garbage Dispr edr -- 16.60 _ Laundry Tray -- 16.60 Washing Machine 1s.so 2" PLEASE COMPLETE: door DrainlFloor Sink _-- 3„ 16.60 _ 4" 16.60 Quantic b Work Performed 16.60 Fixture Type: New Moved Replaced Removed/ Water Heater O conversion O like kind Ca ed Gas piping requires a separate mechanical - - ermlL 46.40 Sink - -- - MFG Home New Service Lavato --- --- MFG Flome New San/Slorm Sewer 46.40 Tub or Tub/Shower 16.60 Combination - -- - Hose Bibs ower Or-fly _ -- - 1660 -- _ Roof Drains Water_ Closet Drinking Fountain 16.60 Urinal --- -----' 16.60 Dishwasher Other Fixtures(Specify) - Garba - _ sal -i Laund Room Tra -- Washinla Machine ---- �._ Floor Drain/Sink: 2" - - 55.00 3" -- - --- Sewer 46.40 4" - — Sewer-each additional 100' _ 55.00 Water Heater Other Fixtures -- -- Water Service-1st 100' -_ Water Service-each additional 20U' 46.40 S ed -- '--- 55.00 - - Storm&Rain Drain-1st 100' _- - Storm R Raln Drain-each additional 100' 46.40 -_ - --'-' - Ccmmarcial Back Flow Provenllun Device 46.40 -- Residential Backflow prevention Device- 27.55 - _----- 16.60 _ _ -- Catch Basin - Existing Plumbing or Specially 72.50 Inspection of erA1r COMMENTS REGARDnvv ABOVE: Re usated Ins actions - 65.7.5 -_.------ ---� Rain Drain,single family dwelling —! - 16.60 Grease Traps ---_ -- QUANTITY TOTAL isometric w riser diairem is required It _______.------------ — Quantity Total Is >9 ---- •SUBTOTAL _ --_ -- %S TA SURCHARGE �-�_P__LAN REVIEW 25%OF SUBTOTAL Required only If fixture qty total Is>9 TOTAL S *minimum permit fee is$72,N+e%stars surcharge,except Residential Backflow Prevention Device,which;(j$36 24•K­stete surcharge "All New commercial Bulld!ngs require pians with Isometric or riser diagram arid pian review I:\dsts\forms\plm-fees.doc 10/10/00 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE CANBY ELECTRIC INC 790 S IVY CANBY, OR 97013 Electrical Signature Form Permit #: MST2001-00064 Date Issued: 319101 Part-,el: 2S i 09AD-07 7 00 Site Address: 14533 SW 928TH PL Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 003 Jurisdiction. TIG Zoning: R-7 Remarks: SIF Path 1 Geotechnial engineer shall review the house foundation and deck excavation and bearing support, footing-to-slope setback Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized Until this completed form is recei.ed OWNER ELECTRICAL_ CONTRACTOR: O'BRIEN HOMES INC CANBY ELECTRIC I1`11C 34444 SW LADD HILL ROAD 790 S IVY WILSONVILLE, OR 97070 CANBY, OR 97013 Phone #: 503-625-4400 Phone +`t: 266-7873 Req #: LIC 261171 SUP 2123S ELE 3-112C AN INK SIGNATURE IS REQUIRED ON THIS FORM X ,_(� ' 6 ' a.,-- — Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 � M:'ASTER PERMIT �� OF ® PERMIT#: MST2001-00064 DEVELOPMENT SERVICES DAIS ISSUED: 3/9/01 13125 SW Hall Blvd., Tigard, OR 970223 (503) 639-4171 SITE ADDRESS: 14533 SW 128TH PL PARCEL: 2S10SAD-07700 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 003 JURISDICTION: -I IG REMARKS: S/F Path 1 Geotechnial engineer shall review the house foundation and deck excavation and bearing Support, footing-to-slope setback BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS _ REQUIRED CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1.111, sf BASFMENT. of LEFT' 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.95N st GARAGE: 919 of FROND: 20 PARKING SPACES. TYPE OF CONST: IN DWELLING UNITS: i FINSSMENT: sf RIGHT: OCCUPANCY GRP: R3 BDRM: 4 BATH: 4 TOTAL: 3,877 0VALUE.: $343,842000 sl REAR ]-i PLUMBING SINKS: 1 WATER CLOSETS 4 WASHING MACH: t LAUNDRY TRAYS RAIN DRAIN: 1110 TRAPS LAVATORIES: 7 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS: TUB/SHOWERS: 5 GARBAGE DISP: 1 WATER HEATERS. 1 WATER LINES: 100 BCKFLW PREV'NTR. I GREASE TRAPS. MECHANICAL OTHER FIXTURES: FUEL TYPES FURN<100K: BOIL/CMP<3HP VENT FANS: 6 CLOTHES DRYER: FURN>=100K. 1 UNIT HEATERS HOODS: 1 OTHER UNITS I M;.X INP: btu FLOOR FURNANCES: VENTS i WOODSTOVES: CAS OUTLETS: 1 ELECTRICAL. RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amu: 0 200 amp: W1SVC OR FDR. i PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 50OBF: 8 201 - 400 ante: 201 400 amp: let WIO SVCIFDR: C") SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY. 401 - 600 amp: 401 600 amp: FA ADDL BR CIFE SIGNAL/PANEL: IN PLANT: MANU HMISVCIFDR: 601 1000 amp: 601-amps•1000v: MINOR LABEL: 1000.81TIplvolt Reconnect only: PLAN REVIEW SECTION >•4 RES UNITS: SVCIFDR>•228 A.: >600 V NOMINAL: CL` ',,"EA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: x VACUUM SYSTEM x AUDIO 9 STEREO: FIRE ALARM INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: ., 0TH: BOILER: HVAC: I.ANDSCAPEnRRIG: PROTECTIVE SIGNL: GARAGE OPENER: x CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X CIA TArIELE COMM NURSE CALLS TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES. $ 8,138.19 O'BRIThis permit is subject to the regulations contained in the 34444 N HOMES INC 3444O'BREN HOMES INC Tigard Mn- eipal Code, State of OR Specialty Codes and 34444 SW LADD HILL ROAD 34444 SW IADD HILL RD WILSONVILLE.OR 97070 WILSONVILLE,OR 97070 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 the work is suspended for more than 180 days ATTENTION. Phone: Phone- Oregon law requires you to folklw rules adopted by the Oregon Utility Notification Cerditir. Those rules are set Rep N: LIC 69361 forth In OAR 952-001-0010 thr,jugh 952-001-0080 You may obtain Copies of these rules or direct questions to OUNC by calling(503)246-1987 REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final Grading Inspection Post/Beam Mechanlca Mechanical Insp Shear Wall Insp nsulation Irish Mechanlcat Final Sewer Inspection Urderfloor insulation Plumb Top Oil Exterior Sheathing Insl Rain drain Insp Plumb Final Footing Insp Crawl Drain/Backwater Electr::at Service Low Voltage Water Line Insp Final Inspection Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appy$d9 k Insp Building Final Issued ByJ�`,y�y permittee Signature : ����t Call (503) 639-4175 by 7:00 p.m. for an inspection neoded the next business day CITYOF TIGARD _SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2001-00036 DATE ISSUED: 3/9/01 13125 SW Hall Blvd., Tigard, OR 972.23 (503) fi.9-4171 PARCEL: 2S109AD-07700 SITE ADDRESS; 14533 SJV 128TH PL ZONING: R-7 SUBDIVISION: ELK HORN RIDGE EST!\IES JURISDICTION: TIG BLOCK: LOT: 003 — - — TENANT NAME: FIXTURE UNITS: USA NO: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF detached. Owner: FEES O'BRIEN HOMES INC Type By Date Amount Receipt 34444 SW LADD HILL ROAD - WILSONVILI_E, OR 97070 INSP CTR 3/9/01 $35.00 27209,J0000 p-IMT CTR 3/9/01 $2,300.00 27200100000 Phone: 503-625-4400 - Total $2,335_00 Contractor: Phone: Reg #: Required Inspactions Sewer Inspection 1 his Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be 'orfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals If the sewer - not located at the measurement given,the installer shall prospect 3 feet in all directions from the distance given. If not so:ocated, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-OC 60. You may obtain copies of these rules or direct questions to OUNC by calling(503) 246- . / E Permittee Signature: `T Issued by: y j_ Call (503) 639-4175 by 7:00 P.M for an inspection needed the next business day One- and Two-Family Dwelling Building Permit Application Checklist Reference no.: '— — Associated permits: City ofTigard Cit of Tigard and City � Q Electrical U Plumbing U Mechanical Address: 13125 SW Ball Blvd,Tigard,OR 97223 U Other: Phone: (503) 639-4171 Fax: (503) 598-1960 I Land-us- se actions completed.See jurisdiction criteria for concur.ent reviews. 2 Zoning. flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. _ 4 Fire district __approval required. S Septic system permit or authorization for remodel Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with app ration. 9 Erosion control U plan U permit required.Include drainage-way protection,silt fence do sign and location of catch.basinprotection,etc. 10 _ Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be..incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed if co yright violations exist. _ _ I I Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions,property comer elevations(it' there is more than a 4-ft.elevation differential,plan must show contour lines at 24 intervals);location of easements and driveway;fixxprinl of structure(including decks);location of wells/septic systems•,utility locations;directior indicator;lot area;building coverage ama;percentage of coverage;iml�ervious area;existing structures on site;and surface drainage. Y _ 12 Foundation plan.Show dimensions,anchor bolts,tiny hold-downs and reinforcing pads,connection details,vent simian ocation. 13 Iluorp ons.Show all dimensions,room identification,window sire,location of smoke detectors,water heater, furnace,ventilation fans, 1p umbing fixtures,balconies and decks 30 inches above grade,etc. _ 1,t Cross seclion(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor. wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. _ 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. fsxtcrior elevatiot:;must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendmus showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing IMalions.Show attic ventilation. _ 18 Basement and retaining walls.Provide cross sections and details showing placement of rehur.For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculations,Provide two sett of calculations using current colic design values for all beams and multiple joists over Ill feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured noor/roof truss design details. _ 21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or mora•appliances. 22 FmglneWs calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamper'by an engineer or architect licensed in t)tegon am shall be shown to he applicable to the project under review. 21five(5)site plans are required for Item I 1 atx►ve. `a_ 25 26 _ 27 28 Checklist must be completed before plan review start date. Miner changes or notes on submitted plans may be in blue or black ink, Red ink is reserved for department use only. W4614(MUMM) atttttttttt� ldlechameal Permit Application — a Date received: /t "A , I'tYMfIno.:,?_c.0 !. OC=4 City of Tigard Project/appl.no.: Expire date: - Ciryn(Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: -- Phone: (503) 639-4171 -- --- Fax: (503)598-1960 Case file no.: Payment type: Land use approval: Building permit no.: 11111 KU oil 0 tin jd 18c 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement New construction U Addition/alteration/replacement U Otli n: i Job address: ? i( � Indicate equipntc-t quantilics in boxes below. Indicate the dcllar Bldg.no.: Suite no.: value ol'all mechanical materials.equipment,labor,overhead, Tax map/tax lot/account no.: - profit. Value$ L.ot: - Black: Subdivision: '`Bee checklist for important application information and Project name: - jurisdiction's fee schedule for residential permit tee. City/county: ZIP: 1191 1 Description turd location of work on premises: � In _ IN oil 10111671 1141LI M Kill hee(e�t.) Total Gst,date of completion/inspection: Ih cription txy. Res.only Res.only 'tenant improvement or change of use. ian Is existing space heated or conditioned?U Yes U No Air hanJling unit _ CFM _ — 'P Air con ilre-ung(site plan required) i _ Is existing space insulated?U Yes U No Alteration o.existing HVAC system ___ or er compressors State boiler permit no.: Business name: �U 4)_G"Sox S _ HP __Tons BTU/II Address: 40-32- .Std X03 P_r) ire smo a amper uct smo•e electors City: StateQ(Q Zl "� L1 cat (site plan require ) Phonc:f / Fax: -r;9/ E-mail: Installnstall/re�niic urner Including ductwork/vent liner U Yes U No - CCB no.: Z� — Insta rep ac re locate heaters-suspended, City/metro lic.no.: wall,of Moor mounted Nam (plettsc print): — (��r s Mance other than furnace Refrigeration: Absorption units-----_-_ RTU/fl Name: { CK_T tom Ger CxChillers 11P - Address:,5q44 D rfrcc P2 Y) Cum uv ronmenmes__ -- nta exhaust and ventilation: City: It_5&K ,, I Stat Q ZI . 7070 Appliancevent Phony (024 U� Fax �y( E-mail: Dryerexh ust--_��-- - — - ouds, ype res.kite en azntat - - hood fire suppression system -_ Name: ��y�{{f _ Exhaust fan with single duct(batt,fans) _ - Mailing address: — 'x,Taust s stem apart from catn of C _City; State_- ZIP: - - ue p p ng a s an tr ut oe up to outlets) fype: _-_I.IKi NO Oil Phone: s Fax: E-mail: ___J_T--1,CTPlping each additional over 4 outlets Process piping(sc,ematicrcquirc ) Mame: Number of nutlets _ _ t er lstiapp once or equ p eent: Address: _ Decorativefirc lace_ City: Stale: ZIP:_ nsert-type-- — Phone: Fax: l:-mail moo( stov pe ct stove ,. a ,— Applicant's signature: Date: _J- l I tr. Name (Print): —_ --�- - - -- Not all jurisdicnom atxept cmut cards,please call imiwlit-Imn t.0 more hdivtnatinn on Permit fee.....................$ U Visa U MaslerC•trd Ntdicc Ibis permit not obtain Minimum fee................$ credli card ratrnler .-- --- —�_ / / c ithin iia permit is not obtained , - `�� F Ian review(at _— r#.) $ — aplres „idtin IRO days eller it has been State.surcharge(9%) ....$ - --- erne r cardhn r ai shown on credit c -- accepted as complete. TOTAL ... ...................$ ------ _-___ —(tudhuldcr signoUrre AmountJ 444617 ifiANW(Y,M) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: Price Total $1.00 to$5,000.00__ Minimum fee$72.50 __ Table 1A Mechanical Code (qty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,OOC.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents _ 14.00 fraction thereof,to and including 2) Furnace 100,000 BTU+ __ $10,000.00. including ducts&vents 17.40 10,001.00 to$25,000.00 $148.50 for the first$10 000.00 and 3) Floor Furnace -- '-- $1.54 for each additional$100.00 or including vent _ _ 14.00 fraction thereof,to and including 4) Suspended heater,wall heater -- - ____ _ $25,000.00. or floor mounted heater 14.00 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not inCIL.ded in appliance permit $1.45 for each additio,ral$100.00 or _______ _ 6.80 fraction thereof,to eair unitnd including 6) Reps - __ $50,000.00. 12.15 $50,001.00 and up $742.00 for the first$50,000.00 and 4 Check all that apply: Boller Heat Air �- $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond _- fraction thereof. -_- _-_ footnotes bblow. Com 7)<3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: -- to look BTU _ 14.00 --- -- 8)3-15 HP;absorb Value Total unit 100k to 500k BTU 25.60 Descr_ iption__ Qty Amount 9)15-30 HP;absorb Furnace to 100,000 BTU,Including 955 unit.5.1 mil BTU 35.00 ducts&vents --.-- 10)30-50 HP;absorb - - Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU 52.20 ducts&vents _ _ �__ 11)>50HP:ansorb Foor furnace Including vent _ _ 955 _- unit>1.75 mil BTU _ 8_7.20 Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM -- floor mou.;ted heater Vent not Intruded in applirance - 445 - ___�. 10.00 Vent - 13)Air handling unit 10,000 CFM,i �� Repair unitF _ 805 - -- ---..�- _ _17.20 - <3 hp;ab:•orb.unit_ 955 - - 14)Non-portable evaporate cooler to 100k BTU _ 10.00 3-15 hp;absorb.unit, 1,700 15)Vent fan connected to a single duct _ 101k to 500k BTU __ _ - _ 6.80 _ 15-30 hp;absorb.unit,501k to 1 2,310 -- 16)Ventilation system riot Included in mil.BTU appliance permit - 10.00 30-50 hp;absorb.unit, 3,400 -- 17)Hood served by mechanical exhaust t 0.00 Incinerators 50 h rrlll.BTU > - - >50 hp;absarti unit, 5,725 181 Domes _ >1.75 mil.BTU - -- 19)Commercial or Industrial h rP,ncinerator Alr handling unit to 10,000 cfm 656 _ _ Air handling unit>10,0000 cfm 1,170 69.95_ Non-portable ev_a orate cooler 656 20)Other units,Including wood stoves _ _ _ ___ __ _ Vent fan connected to a single duct 448 10 00_ Vent system not included in 656 21)Gas piping one to four outlets ___ appliance permit 5.4022)More than 4-per outlet(each) Hood served b mechanical exhaust _ _ 856 _ 1.00 _ Domestic Incinerator 1,170 Minimum Permit Fee$72___.50 SUBTOTAL: Commercial or Industrial Incinerator 4,590 S Other unit,!ncluding wood stoves, 656 -- 8%State Surcharge -� Inserts,etc. g S Gas I In 14 outlets Each additional outlet -25'i:Plan Review Fee(of subtotal) E� _ -_ 63 _ Required for ALL commercial permits only TOTAL COMMERCIAL a TOTAL RESIDENTIAL PERMIT FEE: VALUATION: Other Ins e I na�n�Fees: 1 Inspections outside of normal business hours(minimum charge two hours) $72 50 per hour 2 Inspections for which no fee Is specifically Indicaled (minimum charge-half hour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimun charge-one-half hour)$72 50 per hour "State Contractor Boller Certification required for units>200k BTI I. "Rosidentlal A/C requires site plan showing placement of unit i1dsts\formslmech-fees.doc 10/11/00 Electrical Permit Application City of Tigard --- Date rec raved: D Penart City uf7igard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Prolect/appl.no.: Expire date: Phone: (503) 639-4171 Lite issued: By: Receipt no.: Fax: (503) 598-1960 Case"le no.: - Payment type: Land use approval: &2 family dwelling or accessory U Conunercial/industrial New construction ❑Multi-family LJ Tenant inwrovemeni U Addition/aller,ition/replac,�menl 0 Other: U Partial Joh address: Z ( ' 13idg. It().: Suite no.: Tax ntap/tax lot/account no.: I o� Block: 5ubdi/ision: e! -102�C/��l196r C_' Project name: Description and location of work on premises: - Estimated date of completion inspection: / © 7"M= o: ss na C.� x f« �•�" Description Qt . Address: T� s New residential-MIR o'r multi-family per (ea.) Total no.Ins City: -.� - -- dwelling unit.Includes attached gar-age. _ Stat ZIP: 0/3 Service included: Phon -7 ry Fax 4-715 E-mail: l0(10 sq.ft.or r.-a 1 CCB no.:Z!. Elec.bus.tic.no-/ 'A —// 2-C_ Each additional SW .fl.or portion thereof City/metro Ile.no.: Limited energy,residential - - L Limitcdenergy,non-residential - -G�'��^- -� _ - Fach manufactured home ur modular dwelling 2 Signature of supervising electrician(required) — DD e` Service and/or feeder Sup.elOct.name(print): Servlcesoa feeders-lnslrllanon, 2 License no: - alteration or relocation: 200 amps or less Name(print): Q/ 201 amps to 4W amps — - 2 Mailing address: ��5� G -,-�� 401 amps loGfll)amps 2 Cit : /<< L=�=• 601 amps to 1000 ams - - _ 2 Y ✓Il'iUlGLC Stateo'f ZIP. C> p' _ _ 2 Phone: , Fax Over Iiia amps or volts S -mail: Reconncclonl—y - - Owner ins,allation:The installation is being made on property I own acmpnr•ary services or feeders- 1 which is r of intended for Ie,lease,rent,or exchange according to Installation,alleratlon,orretncation: 0125 447,455,479,67 1. 200 amps or less ,(�� 201 amps to 4(x)amps 2 Owner's signature: hate: 3 �? - 2 1_ 401 lu 611(1 nntps -`-- -- -- Branch clrculG-new,dteraHon, 2 Nanta �(/�_ or extenslon per panel: Address: l A Fer for branch circuits with purchase of City: - service or feeder fee,each branch circuit Slate: LIF': B Fee for branch circuits without purchase 2 Phone: I a X Fil: �` of service or feeder fee•first branch circuit: Bach additional branch circuit -� U Service over 225anps-«nmmrrtial U Health-care facility Misc. - ice or feeder not Included): U Servicr.over320amps-rating of 1&2 U Hazarkluslocation E:achpumporinrgnuoncircic Each sign or outline Iightin 2 familydwellinpx U Piuilding over 10,�square feet fouror Signal circuit(s)or a limited energy panel. 2 USyatmnover6Wvolunominal more residential units in one structure alteration,or extension* U Building over threestories U Feeders.1(x)amps or more 2 U Occupnnr load over 99 persons U.Manufacturers structures or BV park "Description U I*ress/lighting plan U Other: tach additional Inspection over the allowable in any of the ahoy. Sabah any sets of plans with any of the above. -- per inspection _ Invests ationfax T'he above are not applicable to leinporary convtructlon service. Other Nrn sll jurlsrNctlon$acept credit cards,please call pmnlicaon ha morr inbmnstirnr This permit apphcahon J Visa U Mon Notice: Penna fee............... .. ..$ r'rrdir card nor,mtaer -__ expires if a peer alt is not obtained Ilan review(at within 11((1 day after it has been Stale surcharge(8%) .... sae c r�er n/own ort c Ir c. accepted as co nplde. TOTAL .......................$ Cardholi r Ilrtrallu Amoum 1104615(ti j"M) Electrical Permit Fees: Limited Energy Fees: --- — TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Fco-;�Plete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00 Number of Inspections per permit allowed) (FOR ALL.SYSTEMS) Service included: Items Cost Total 41 Check Type of Work Involved: Residential-per unit $145 15 4 �j Audio and Stereo Systems 1000 sq.it or less —Each additional 500 sq it or $33.40 1 Burglar Alarm portion thereof — ----- Limited Energy $75.00 Each Manufd Home or Modular $90.90 2 Garage Door Opener' Dwelling Service or Feeder -- ® Heating,Ventilation and Air Conditioning System' Services or Feeders Installation,alteration,or relaxation $80.30 2 200 amps or less _ — 2 Vacuum Systems' 201 amps to 400 amps — $106.85 _ 401 amps to 600 amps $160,60 2 © $240.60 _ 2 Other 601 amps to 1000 amps ,— 2 Over 1000 amps o volts _ $454.6,5 _ — Reconnect only $66,85 _- 2 --'�` TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders Fee for each system............................................ ........... $75.00 Installation,alteration,or relry-ition $66 B5 2 (SEE OAR 918-260.260) 200 araps or less — — — 2 201 amps to 400 amps _ $100.30 —` $133.75 Check Type of Work Involved: 401 amps to 600 amps Over 600 amps to 1000 volts, Audio and Stereo Systems see"b"above. Branch Circuits Boiler Controls Now,alteration or extension per panel a)The fee for branch circuits Clock Systems with purchase of service or feeder fee. $6 65 2 Each branch circuit --__ �� Data Telecommunication Installation b)The fee for branch circuits ❑ without purchase of service Fire Alarm Installation or feeder fee. $46.85 _ Firr 1 branch circuit _ _. -------- C7 HVAC Each additional branch circuit $665 Miscellaneous Ej Instrumentation (Service or feeder not included) Each pump or Irrigation circle $03.40 _ Intercom and Paging Systems Each sign or outline lighting $5'40 _-- Signal circuit(s)or a limited energy $75 00 Landscape Irrigation Control' panel,alteration or extension _ Minor Labels(10) $12500 !_ _ Modica) Each additional inspection over the allowable in any of the above $6250 Nurse Calls Per inspection _.._— $6250 _ Per hour ------ $73,75`— Outdoor Landscape Lighting' In Plant Fees: ❑ Protective Signaling Enter total of above fres $ ,--- n Other 8%State Surcharge $ __._ _-_ fJumber of Systems 75%Plan Review Fee $ No licenses are required Licenses are required for all other Installations See"Plan Review"section on — front of application — -- Fees: Total Balance Due $ .- - FJ Enter total of above fees $---- LJ Trust Account p__- .-. _ 8%State Surcharge - -- — — — -^- Total Balanre Due $—_—.- -- i 41s(s\rnrms,elrtees.doc 10109AX) Plumbing Permit Application � Date Pcrmith0... '20o/- City of Tigard Sewer permit no.: Building permit no.: __— Address: 1312.5 SW Hall Blvd.Tigard.OR 97223 Project/appl.no.: Expiredan•: Ciryn(Tigard phone: (503) 639-4171 Fax: (503) 598-1960 Date issued: —�By: Receipt no.: Case file no.: Payment type: Land use approval: ------ — Evan- 701t 2 family dwelling or accessory U Commercial/industrialU Multi family ❑Tenant improvementw con.,11 ion U Addition/alteration/replacement U Food service U Olhel. Desc6lition Qty. Fee(ea• Total Job address:_ , `._-- —`'"=4` — New 1-and 2-famiiy dwellings only: Bldg tto: J Suite no.: (includes IooIV.for each utilitpconnection) Tax map/tax lot/account no.: __ _ SFR(1)bath- Lot: —� Block: Subdivision: SFR(2)bail Project name: _SFR(3)bath _—.— l—I21P: Each additional hathlkitchen City/county: - Siteutilities: Description and location of work on premises: Catch basin/area drain _ --_ Drywells/Icach line/trench drain Est.date of completion/inspection: -=mJFooting drain(nil,lin.ft.) Manufactured home atilitics — Business namej IuIS hl IA iA/L�11y _-- Manholes - FAddress: PC) O y- 7 O Rain drain connector — - � tatciQ►'Z "LIP: � Sanitary sewer(no,lin.ft.)A��_��._ Storm sewer(no.lin.fl.) : Fax: E-mail: �{� 1 Water service(no.lin.ft.) no.: 7/8(a O Plumb.bus.reg.no:j -18G p-� Fixture or item: City/metro lic.no.: _ _� --- Absorption valve Contractor's representative signature: i_Sle t � _E/u1_� Back flow preventer - Print name: —� D`tt`:' Backwater valve — Basins/lavalory _ Clothes washer _ Name: (: �W �)?i1/!ya --- Dishwasher ----- -._Address: 'PO Drinking fountains) — Stat .)rL- LIP: 700 7 Ejcctors/sump -- City: — — — x E-mail: an Phone: Fax: sion tank - ixture/sewer cap FhKtr drait s/Boctt sinks/huh — - Name(print): Garbage disposal Mailing address:, — -- y y S[�J L�T�%iJ f/LC' �L�— Hose bibb Slat . ZIP: O Cite LSmTcJ/L-L _ _ - �' _l 7 Ice maker Phone: �/YGY� Fax: Z•S 4 y GmaiL• Imerce for/grease trap — Owner installation/residential maintenance only: The actual installation Primer(s) will he made by file or the maintenance and repair matk by Illy regular Roof drain(cummercial) _ employee on the property I own as.per ORS Chaplet 447. Sink(s))_hasin(s),lav,,(,) _ t hDate: Sum sncr's signature.—� Tub, shower/shower pan — Urinal _ - Name; 4'_ _ — — Watcr closet _ -- Address: —_ Water heater -- City: State: ZIP: Other: Fax: E-mail: 1'otatl Phone: — _ --- _ — Minimum fee................$ _ -_------ N•it all furialictifine accept credit cant+,pleaec call lurixliclirtn fax arae informatinn Nnlirc: Iliis pemlil application 111,111 review(al _— %) $ — Uvisa U MasterCard expires if a pernlil is not obtain State suteharge(9%) ....$ t'teuit reed numlrcr within 190 clays alter it has been TOTAL .......................$Uipires accepted as complete. Norte or cardltnlder as ah,wn on credit card S 440 4616 IrJlln/1'M1) --- Codlud'lek r iiRnamre _-- Amount PLUMBING PERMIT FEES: -' PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (indivldual) QTY ea` AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavato 1660 for each utili�r connection) ry . One 1 bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two(2)bath _ _ $350.00 Shower Only - 1660 $399.00 Water Closet 16.60 - _---" SUBTOTAL. Urinal 16.60 _ _ 8%STATE SURCHARGE Dishwasher - 16.60 PLAN REVIEW 25%OF SUBTOTAL Gartiage Disposal 16.60 Y A TOTAL - Laundry Tray 16.60 Washing Machine 16.60 =loot Drain/Floor Sink z" -- 16.60 - g•• 16.60 PLEASE COMPLETE: 4" 16.60 _ Quant/ b Work Perfonnad Water Heater O conversion O like kind 16.60 -r-- Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ ermit. Capped MFG Homl:New Water Service 46.40 Sink MFG Home New San/Storm Sower 46.40 Lavatory _-- _ - "ub or Tub/Shower Huse Bibs -16.60 Combination_ _ Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet - -- _ --- Urinal Other Fixtures(Specify) �_- 16.60 -_ Dishwasher Garba a Dis osal -- La_undry Room Tra ---- - -- Washing Machine -- Floor Drain/Sink. 2" Sewer-1st 100' - 55.00 3" Sewer-each additional 100• -46 40 -- --__--- _4 Water Service-1st 100• 55.00 Water Heater Water Service-each additional 200' 46.40 Other Fixtures _ _ (specify) dorm 8 Rain Drain .100' 55.00 _ Slomt&Raln Drain-each additional 100 46.40 _ - Commerr•ial Back Flow Prevention Device 46.40 ------ -- -- Gosidentlal Backflow Prevention Device' 27.55 -"- - Catch Basin - 16.60 �- - Inspec'ion of Existing Plumbing or Specially 72.50 Requested In_peclions perrnt _- COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grcase Traps 16.60 ---- --- - -- QUANTITY TOTAL _- Isornoiric or rlser diagram Is required If �- - Quantity rotal Is >B '- 'SUBTOTAL ---- --- --`- 8%STATE SURCHARGE - --- - "PLAN REVIEW 25%OF SUBTOTAL Required only II fixture t total Is>g TOTAL S *Minimum permit fee Is S72 50+8%state surcharge,except Residential Backflow r'mventtun Device,whir.,is$ae 25 r 8%state surrharga ..All New Commercial Buildings require plans with Isometric or riser diagram and plan review L\dsts\forms\plm-fees doc 10/10/00 01 Feb 06 17:07:08 R:1It\LT3EHRE.dWg RIDS N 0'15'23*' E 6800' --——————————-- Xxxxxx 7 MAIN FLOOR EL :496 0' OD l(n to I IR m IDIS 111_ GARAGE PORCH EL :494 0' L.495 4cQfqc DRIVEWAY 13$60 PSII ax S 1:15,2j""W b 6800, S.W. 128TH PLACE S rONr RrrAINM NKL A -2-0 0 AIM MASCOAD U("ASSOCIATES WC IS NOT C (,A&[F OR 14 ACCLINACY OF THE JOPOOPA"'j ITY OF TIGARD IMPONVA TIM IT Is"olsoll 111SPONS40"IF tlf ELK HORN RIDGE ESTATES 3 PLOWFOWKINFIAL lit COW400110CLUDING L 2` 43E ANY FILL PLACID 04 THE SITE AND Nctfv b4l, LOT 3 O*W to OF ANY POTENTIAL FIELD MODFICAtID148 *AM NA80M 042M AllOW118.NC 6,05 SO Fr.)