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10415 SW HIGHLAND DRIVE 0 v+ U. I � w CL CD i� t I� �G415 SW Highland Drive CITY OF TIG,A►IRD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPICTION DIVISION Business Line: (503)639-4171 —�_— __/''/S BUP Received Date quested Am--. PM— - BUP Location �LhI`� Suite---------- MEC �1111 Contact Person _ __ _ Ph( ) _ —_ PLM — Contractor - --- ---_ - --- Ph(—', -----_ --- SWR -------. BUILDING Tenant/Owner _ _ _—__ __ ELC Footing — —_- ELC ---- --_ __— Foundation Access. Ftg Drain ELR Crawl Drain Slab Inspection NotP,�- SIT _ — Post& Beam Shear Anchors — Ext Sheath/qhr Rr In, neath/Shear I Framing -- --�-- r --1 -- -------.�_ Insulation Drywall Nailing Firewall File Sprinkler Fire Alarm Susp'd Ceiling - / ------- Roof Roof Other: -- Final PASS _PART FAIL P-0& Beam Under Slab -- - Rough-lo �- ;Nater Service - Sanit9ry Sewer Rain Drains Catch Basin/Manhole Stoi m Drain — Shower Pan Other: - Final Z -�-- P PART_FAIL r 6 Post Beam Swk Dampers - -- — --(� — PAS PART FAIL ELECTRICAL _ Service Rough-In UQ/Slab - - - Low Voltage _ Fire Alarm Final Reinspection fee of$ __— required Before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _PASS PART FAIL SITE _--� (] Please call for reinspection RE:__ -___—____- __ _ Unable to inspect-no access Fire Supply Line ADA ✓ 1.� , Ext - Approach/Sidewalk Date —� Inspector I Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARL 24-Hour BUILDING Inspection Line: (503)639-4175 114SPECTION DIVISION Business Line: (503)639-4171 MST B!"P Received __ _ Date Requested- --_.' v _ AM _ ___—___ PM BUD Location --- Suite_ — MEC Contact Person .-- — ----- - - --- _ Ph PLM 6 ! Contractor _._.__-- -_- Ph ' _) SWR — BUILDING Tenant/Owner EI w --- -- Foundation Access: z ELC --_-__-. -- -- Ftg Drain ELR Crawl Drain ----- Slab Inspection Notes: SIT Po3t& Beam - -- _ -- _ -- -- _-----...--------------- Shear Anchors j Ext Sheath/Shear Int Sheath/Shear -- ------- - Framing ------------------------- ------------ ------ - - Insulation Drywall Nailing -_-- Firewall Fire Sprinkler ----- Fire Alarm Susp'd Ceiling Roof — __-__-.--- Other: Final - _ r T FAIL UM2VG Rough-In Slab Rough-In ----------- Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole — Storm Drain -- Shower Pan yy'? Other:—____ ?T PASS) PART FAIL -�-_.-- -- —__._-- _-- -_- -- ANICAL - - - ----- Post&Beam Ror gh-In - Gas Line Smoke Dampers Final ---- -- ---- PASS PART FAIL _ ELECTRICAL------ ----' ------ -- ---- Service ------ Rough-In UG/Slab - - - Low Voltage Fire Alarm - --- - Final ( Reinspection fee of$__- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL q SITE _ _ r Please call for reinspection RE __- -� Unable to inspect no access Fire Supply Line _ - - ADAt A roach/sidewalk Date _ ��.' G I.1� Z -- 7�' PP -- -- Inspector - - -Ext--- Other. Final DO NOT REMOVE this Inspection records front the job site. PASS PART FAIL CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES DATES UIED: 3/14/02 2 00108 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEr_: 2S111 C C-12100 SITE ADDREK: 1041E SW HIGHLAND DR SUBDIVISION: SUMMERFIELD NOA ZONING: R-7 BLOCK: LOT : 172 JURISDICTION: TIG Proiect Description: Installation/alteration of(4) branch L'rcuits for kitchen remodel. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS _ 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIG4TIUN: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/ FLjR- 601+amps - 1000 volts: MINOR LABEL (10): SERVICE!FEELER BRANCH CIRCUITS _ ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL.: Reconnect only: SVC/FDR >= 225 AMPS: �CLASS ARF-AiSPEC OCC: Owner: Contractor: WILLIAM JAMIESON ST JOHNS ELECTRIC INC 10415 SW HIGHLAND DR 4415 NF MINNEHAHA TIGARD, OR 9722.4 VANCOUVER, WA 98661 Phone: Phone: 360-693-5100 Reg #: 43135 Stir 3024S LLE 37-350C �+ FEES _ Required Inspet:f?nne, Type By Date Amount Receipt Rough-in 5PG T CTR 3/14/02 $5.35 272.0020000( Elect'I Final PRMT CTR 3/14/02 $66.80 2720020000( Total $72..15 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Specialty Codes and all other applicabie laws. All work will be done in accordance with approved plans. This permit will expire it work is not siarled within 1 i IO days of issuance, or if work is suspended forth 180 days. ATT TION: Oregon law rEquires you to follow rules adopted by the Oregon Utility Notification Center. Those pules are set r in OAR 952-0) 010 rough OAR 952-001-0080. You may obtain copies of these rules-or.direct questions to Permit Signature: Li ' y -1 4�'� -- Issued By: OWNER INSTALLATION ONLY The installation is being made on property I ownwhich is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE:- ------ ATE:__ ___ CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPIR. .-AlLP LICENSE NO: _ 017 S _ Call 639-4175 by 7:00pm for an Inspection the next business clay w Electrical Permit Application 15 Datereceived: /`r' �' Permit no.: City of Tigard Projecdappl.no.: ate: Cityoff,ard Address: 13125 SW Hall I'lIvd,Tigard,OR 97223 Date issued: fay: ceipi no.: Phone: (503) 639-4171 — — AV -- Fax: (503) 598-1960 Casufrleno.: Payment type: Land use stnproval: TYPE OF 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction XAddition/alteration/replacement U Other: U Partial 1 Joh address: ' 1 /i/stn ,61 2" 131dg. no.: Stole no.: av map/taY IoNaccount no.: Lot: I Block: Subdivision: - - -- --_--- — Project name: _ Description and location of—work on preriises� Estimated date of completion/inspection: CONTRACTOR Job no: Fee Maas Businessname: St. Johns Electric, Inc. Description — 01y. (ea.) Total no.insp New rrcMmtial-single or multi-family per Address: 4415 NE Minnehaha St. dwelling unit.InchdeiAthchedgarage. City:Vaneouver State:WA ZIP:98661 ServiceInclude(k Phone:3606935100 1 Faxfi99-1345 I E-mail: 1000 sq,ft.or less _ _ 4 CCB no.:43135 Elec,bus,lie.no:37-350C Each addifional50(isq.ft orportioniliereof Limited energy,residential 1. City/metro IIC r. 00CA9 Limited energy,non-residential 2 C-4 jeol C ,O _ _ jj --0 2 Each manufacmed home or modulardwelliug Signature o su rvising electri an a uired) _ Date Service and/or feeder _ _ 2 Sup.elect.name(print): Dea . B'ur Licenscno:3024S Services or feeders-Installation, alteration or relocation: t 200 amps or less _ — 2 0m stName(print): 1 L4k_ 1 l�1 fp. ;D 21 ao 400 amps 2 _ +01 amps to 600 amps 2 Mailing address: Intl 15 &Q UI(MLAO 1` L! ---- - - _ GOi amps to 1000 amps 2 City_r h State: ZIP: Over IC!'n amps or volts 2 _ Phone: Fax: I E-mail: Reconnect only i Owner installation:The installation is being made on property I own Temporary senlces or feeders- which;,not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation: ORS 447,455,479,670,701. 200 amps or less _ _ 2 201 amps to 400 amps 2 Owner's sl '..mn: Date: 40t to 600 ams 2 Branch circuits-new,siteratlon, Name: or extension per panel: A. Fee for branch circuits with l orchase of Address: service or feeder fee,each branch circuit 2 _ City: Stale: ZIP_ B. Fee for branch circuits without purchase J/ Phone: Fax: Tr7imail: of service o�feeder fee,first branch circuit: ' 7F JK� 2 Each additional branch circuit: 9 Misc.(Service or feeder not Included): 7SWZ r 223 amps-contrra rcid l7 Health-care facility Each pump or irrigation circle 2 r 320 amps-reting n(t2 ❑Hatnrdous location Fatch sign or outline lighting 2 Iinga U Building over 10,000 square feet four or Signal circuit(s)ora limited energy panel.r 600 volts nominal more residential units in one structure alteration,or extension' 2 U Building over three stories U Feeders,400 amps or more *Description: •Occupant load over 99 persons U Manufactured structures at RV park Fich additional Inspection over thr allowable In any of the above: U Egress/lightingplan U Other —. Perinspecunn Submit—_sets of plan with any of the above. Investigation fee The above are not applicable to temporary construction service. other Permit fee..................... Nd oil)uriadkf'rm accept credit cards,please call Jurisdicnon for more informsoon Notice: nils permit application �— U visa U MasterCard expires if a permit is not obtained Plan review(at -_ fib) $ Credit cud number: within 180 days atter it has been State surcharge(9%) .. .$ Expires Nam(of cardholder at shown on credit card--- accepted a7 complete. TOTAL .......................$ /Oc _ S Cardholder tignatwe Amount 440-4615(6A7arCOM) c Electrical Permit Fees: Limited Energy Fees: — '— TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedu.✓ Below: Restricted Energy Fee........... ...................................... $75.00 Number of Inspections per permit allowed) (FOR AI'_SYSTEMS) Service included: Items Cost Total y Check Type of Work Involved: Residential-per unit f� 1000 sq.it or less _ 1145.15 i 4 L1 Audio and Sterno Systems Each additional 500 sqIt or portion thereof $33.40 _ 1 L� Burglar Alarm Limited Energy $75.00 Each Manurd Home or Modular Garage Door Opener' Dwelling Service or Feedw $90.90 2 Services or Feeders Healing.Ventilation and Air Conditioning System' Installation,alteration,or reloAtiun 200 at-^s or less $80.30 2 Vacuum Systems' 201 at ,,s to 400 amps $106.85 _ 2 401 amps to 600 amps $16060 2 ❑ 601 ampr )1000 amp; $240.60 _ 2 Other Over 1000 amps or volts J $454.65 2 Reconnect ot•ly � $66.85 _ 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders Fee for each system.......................................................... $75.00 Installation,alteration,or relocation 200 amps or less $66.85 — 2 (SEE OAR 91E-260-260) 201 amps to 400 amps _ $100.30 1 Check Type of Work Involved 401 amps to 600 amps J _ $133.75 2 Over 600 amps to 1000 volts, Audio and Stereo Systems see"b"above. Branch Circuits Boiler Controls New,alteration or extension per panel a)The fee for branch circuits with purchase of service or Clock Systems feeder fee. Each branch circuit $665 _ 2 Data Telecommunication Installation b)the fee for branch circuits without purchase of service Fire Alarm Installation or feeder lee. GG First branch circuit _�_ $46.85 D S HVAC Fach additional branch circuit _� _ $6.65 Miscellaneous F__1 Instrumentation (Service or feeaer n( included) Each pump or irrigation circle $53.40 L1 Intercom and Paging Syu!ems Each sign or out!ine lighting _ $5340 Signal circuits)or a limited energy Landscape Irrigation Control' panel,alteration or extension $75.00 Minor I abets(10) $125,00 _ ❑ Medical Each additional inspection over the allowable in any of the above Nurse Calls Per inspection $62.50 _ _Per hour $62$tit.50 In Plant T __ $73.75 _ Outdoor Landscape Lighting' Fees: [] Protective Signaling Enter total of above fees $ �y Other_ 9•;State Surcharge $ �r 3S Number of Systems 25%Plar.Review Fee No licenses are required Licenses are required for all other InstallalVns See"Plan Review":;^,tion on $ frort of application _ Fees: iota/Balance Due $ = -- 170or total of above fees $ — LLTrust Account!!__--_ 8!1.State Surcharge $ -�� Total Balance Due $ --- \fists\fnrms\elc-fces.doc 10/09!00 CITYOF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2002-00130 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/3/ 2 PARCEL: 2S111 CC-12100 SITE ADDRESS: 10415 SW HIGHLAND DR SUBDIVISION: SUMMERFIEI D NOA ZONING: R-7 BLOCK: LOT: 172 JURISDICTION: TIG CLASS OF WORK: A:T FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: GCCUPANC'r GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS FLOODS: _ 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 + HP: CLO DRYERS: S: FURN < 100K BTU: AIR HANDLING_ UNITS C OTHER UNITS: FURN >=100K BTU: v <= 10000 cfm: > 10000 Cf M. GAS OUTLETS: 1 Remarks: Kitchen remodel - add one gas outlet Owner: FEES VOLLIAM JAMIESON Type By Date Amount Receipt 10115 SW HIGHLAND DR PRMT CTR 4/3/02 $72.50 2720020000 TIGARD, OR 97224 5PC1 CTR 4/3/02 $.5.80 2720020000 Tota! $78.30 Phone: --------- — — Contractor: PACIFIC GAS WORKS PO BOX 30,',46 PORTLAND, OR 97294 REQUIRED INSPECTIONS _ Final Inspection Phone:503-317-5573 Reg#:LIC 136391 This permit is issued subje :t to the regulations contained ;n the T igard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will 5e done in accordance with approved plans. This permit will expire if work is not started witi,in 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OU4fy�76y-c"ing l�,fl 1?dR-q 1 Ra - Issue B y Permittee Signature: Y – Call (503) 639 175 by 7:00 P.M. for inspections netyded the next business day Mechanical Permit Application ' -- -- Datereceived: r_f_ :2,Lk Perrp(jrtlt�'C �C l C..c,f,=;L AMMS City of Tigard Prolcct/appl.no.: Expire date: t'irvoffigaid Addle, +: 13125 SW Hall Blvd,Tigard.OR 97"L23 Phone: (503) 639-4171 Date issued: I3y: Receipt no.: Fax: (503) 598-1960 Case file no.. Payment type: Land use approval: Buildinp permit no.: &2 family dwelling or accessory U Commci ial/industrial L.Mufti-family U Tenant improvement U New construction U Ad(!ition/alteration/replacement Li I Wiri Job address: ! < . . i E Indicate equipment uantilics in hoxes below. Indicate the dollar Bldg.no.: _ Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit. Value$ Lot: Block: Subdivision: *See checklist torr important application information and Project name: jurisdiction's fee schedule torr residential permit I' o City/count , 'LIP: — Description and oration of work on premises: Wil N —_ Fee(ex ) 't'olal Est.date of completion/inspection: Dwirlpfflon Qt . Res.only Res.only Tenant improvement or change of use: C. Is existing space heated or conditioned?U Yes U No Air handling unit CFM Air conditioning(site plan required) Is existing space insulated?U Yes U NoF ,= Alteration of exist ng-ii C system- -- or I cr co�sors — Business Warne: ' � �� State boiler ncrrnit no.: Address: l HP . Tons BTU/11 Fir smo a damper, uct smoke detectors City: '7 Stat ZIP: e5-2 ieat pump(site plan require ) -�- - Phon : E-mail: nsta rep ace t'urnace urner - - - Including ductwork/vent liner U Yes U No CCB no.: •J ;°j nsta 1/i relilace� ( . ate heaters , City/metro lic.no.: wall,or floor mounted Name(pleas print):` i _-- Vcnt for a� lance other than furnace - e gerat on: Absorption units--__,_..-_______ liTCi/II Nome: Chillers - dd�Pss: Com ressors nv Ealnta exhaust an vent at on: City: _ State:�ZIP: _ Appliance vent_ Phone: Fax E-mail: Uryerexhaust ---^ 1 oo s,Type I/If/res. itche azinat hood fire suppression system Name: Exhaust fan with single duct(hath fans) Mailing address: Exhaust systema act romating or A( -- -----a, _-- ue piping and,fr(istru1t_on(up to out els)Sate: 7PTYCity: NCilPe Phone: --- Fax: E-mail: Fuel pipm 9 cac t additional over 4 outlel; - — ' (cesspiping(schematicrequired) Number of outlets Name: _ ----- -- - Other 0 app once or equ pment: Address: i —__ Decorative fireplace City: State _ 7.1 P: nsert- type —v-__- Iirone.: Fax: E-mail: oo stov pe ctstove Applicant's signature: I)ale: Other: - - Name (print): ------- ---- Not all jurisdictions accept credit cards,please cell jurisdiction ror mrxe Inrmr aarm Permit fee.....................$ !�— U Visa U MasterCard Notice.This permit application Minimum fee...............$ - _ expire:,if o permit is not obtai:ted Credit card numMr: , _-- _. 1—L F Ian review(at %) $ Expires within 190days after it has been —. -- -- State surcharge(R9F) 7 ....$ SL Name or cardholder u shown on credit card accepted a4 complete. _ S TOTAL .... ..................$ J -_31—) ---- Cardholder sifina(ure Antouni_ 4404617(600000M) r 1 MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE:_ Description: price Totall Table 1A Mechanical Code Uty (Ea) Amt- $1.00 mt_$1.00 to!'5,000.00 Minimum fee$72.50_ -- 1) Furnace to 100,000 BTU $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 andT Including ducts&vents 14.00 _ $1.52 for each additional$100.00 or 2) Furnace 100,000 3'U+ fraction thereof,to and Including t 7.40 $10,000.00. including ducts&vents $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $;.54 for each additional$100.00 or includingvent 14.00 fraction thereof,to and Including 4) Suspended heater,wall heater $25 oon,00. or floor mounted heater 14.00 $25,001.00 to$50,000.00 VIT45 0 for the first$25,000.00 and 5) Vent not included in appliance permit 6.80 for each additional$100.00 or ---- fraction thereof,to and Including 6) Repair units tt.15 $50,000.00. -- $50,001.00 and up $742.00 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 Pump Cond _ fraction thereof. footnotes below. Comp -J - Minimum $ 7)<3HP;absorb unit Permit Fee 572.50 SUBTOTAL: to 100K BTU 14.00 - - - 8)3-15 HP;absorb 8%State Surcharge unit 100k to 500k BTU 25.60 25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb unit.5.1 mil BTU 35.00 _ 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 ---- -- unit>1.75 mil BTU _ 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00 Value Total 13)Air handling unit 10,000 CFM+ Descr( tion: Qt Ea Amount 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler ducts&vents 10.00 Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents _ _-_ 6.80 Floor furnace Including vent _ 955 16)Ventilation system not incltided in Suspended heater,wall heater or 955 a Bance ermit 10.00 floor mounted heater 17)Hood served by mechanical exhaust Vent not Included In applicance 445 10.00 permit 805 18)Domestic incinerators 17.40 Re air units -- <3 hp;absorb.l.tnit, 9J5 19)Commercial or Industrial type Incinerator to 100k BTU 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,including woos'.stoves 101k to 500k BTU 10.00 15-30 hip,absorb.unit,501 k to 1 2,310 21)Gas pining one to four outlets mil.BTU 5.40 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 658 ---- 8'/°State Surcharge $ Air handlin unit>10,000 cfm _ 1,170 Non• or able evaporate cooler _ 658 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct _ A46 Vent system not Included in 656 - - a1pliance permit Other Inspections and Fees: Hood served h me -+n.�I exhaust 656 Y-re . 1 170 1. Inspections outside of normal business hours(minimum charge-two hours) m Doestic incIneratot $ee 50 per hour Commercial or Industrial incinerator 4,590 2. Inspections for which no fee Is specifically indicated (minimum charge-half hour) Other unit,including wood stoves, 656 $62.50 per hour Inserts etc. 3 Additional pian review required by changes,additions or revisions to plans(minimum cies piping 1 4 outlets_ _ 360 charge-one-half hour)$62.50 per hour Each additional outlet _ 63 'Slate Contractor Boller Certification required for units>200k BTU "Resldvntial A/C requlres site plan showing placement of unit. TOTAL COMMERCIAL $ VALUATION: -. I All New Commercial Buildings require 2 sets of plans. i:\dsts\forms4nech-fees.doc 12/26/01 CITYOF TIGARD PLUMBING PERMIT _ DEVELOPMENT SERVICES PERMIT#: PLM2002-00320 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/14/02 SITE ADDRESS: 10415 SW HIGHLAND DR PARCEL: 2S111CC-12100 SUBDIVISION: SUMMERFIELD NOA ZONING: R-7 BLOCK: LOT: 172 JURISDICTION: TIG CLASS OF WORK: (QTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GI.P: R3 FLOOR DRAINS; TRAPS: STORIES: WATFR HEATERS: CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residentia! backflow prevention device for irrigation system. FEES Owner: — PRISCILLA JAMIESON -- Typo, By Date Amount Receipt --- 10415 SW HIGHLAND DR 5PCT CTR 8/14/02 $2.90 27200200000 TIGARD, OR 97223 PRMT CTR 8/14/02 $36.25 2.7200200000 Total_ $39.15 Phone 1: Contractor: OWNER REQUIRED INSPECTIONS Phone 1: RP/Backflow Preventer rt Reg #: Final Inspection 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 riot 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 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. �r /{( / 4 Issued By: _1�_�,�,�L� S � �9,_��, r s�rmittee Signature: Call (503) 639-4175 bl, 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application latc/By:_ cccivcd Plumbing .y�a;� ./t1 Permit No.:/-c,Nva Ge3%1C City of TigardPlanning Approval Sewer Test Form Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Usc Date/By: Case No.: Internet: www.ci.tigard.or.us contact Juris.: tics I'agc 2 for 24-hour Inspection Request: 503-639-4175 Name/Method' Supplemental Info rron. TYPE OF WORK FEE*SCHEDULE(for special Information use checklist) New construction Demolition Dcscri rtion Qty. Fcc(ca.) Dotal Addition/alteration/re nlacement Other: New I-K 2-family dwellidga Cit TEGORY OF CONSTRUCTION includes 100 ft.for ich utility connection �1 &2-Family dwelling ,Commercial/Industrial SFR I bath 249.20 SFR 2 bath 350.00 EA E3uildin Multi-Family SFR 3 bath 399.00 Master Builder LJ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION a d LOCATION Firesprinkler-sq.ft.: Pae 2 Job site address: 1 c VI) _I `r Site Utilities Suite#: I Bld ./ t.#: Catch basin/area drain 16.60 Project Name: Dr well/leach line/trench drain 16.60 -- Footingdrain no.linear fl. Pae 2 Cross street/Directions to job site: Manufactured_home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary scwcr(no. linear ft.)_ Page 2 Subdivicion: , L t#__ Storm scwcr no.linear A. TPage 2 Tax ma / arcel#: Water service no.linear ft. Pa c 2 DESC'RIP'rlON OF WORK Fixturc or Item — - — Absorption valve 16.60 _ Backflow prcventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER —=TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: \r i c c r f YVI t-C E A--) Expansion tank 16.60 Address: U(l-I�.� S GU? ) r _ Fixture/scwcr ca — 16.60 City/State'?ip_ , (% Floor drain/floor sink/hub _ _ 16.60 Phone: r 1 � �.: Fax: Garbage disposal _ I G.GO Hosc bib 16.60 APPLICANT I LJ CONTACT PERSON Ice maker � 16.60 Name: Interceptor/grease trap _ 16.60 _ Address: Medical gas- ;aluc: $ Pa e 2 City/State/zip: — Primer 16.60 _ Roof drain commercial _ 16.00 Phone: _ FaX:� — Sink/basin/lavatory 16.60 -V E-mail: Tub/shower/shower pan16.60 CONTRAC Olt Urinal _ 16.60 _ - lA Water cicsct 16.60 _ Business Name: ��d_ �{ Water heater _ 16.60 Address: Other: — City/State/Zip: — Other: — _-- --- _ — _Phone: Plumhin I'crmit Fees* CCB Lic. M — ' Plumb. Lic.#: -- subtotal $ -- Minimum Permit Fcc$ $ // AAuthorized Residential Backflow Minimum Fce _6.2 � _ �j� 1t Signature: �_>�C��� � Date: Plan Review(25%of Perna_� $ State Surcharge 8%of Permit Fee) 76 TOTAL PERMIT FEE I'I,;lir i,r nu nnn''t Notice: 'rhis permit application expires If a permit Is not ohtalned within All new t ornmerviol budding require 2 wi%of Alam with iscmetrle n: 180 day;:after It has been accepted as complete. riser diagram for plan review. *Fee meths dology set by"l ri-County Building Industry Service Board. Plumbing Permit Application - City of Tigard Page 2 - :_.(pplemental Information r ' Fee Schedule: Residential Fire Suppressiou Systems: _�_-- Pite Utilities Qty, Fcc(ca) ToalFoota ge: Permit Fee: -- Footing drain 100' 55.00 0 to 2,000 $115.00 Footing drain-each addit:,)nal 100' 46.40 2,001 to 3,600 $160.00 _ 3,601 to 7 200 $220.00 Sewer-1 st 100' 55,00 7.201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-Ist 100' 55.00 Medical Gas S stems' Water Servicc-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1,52 for each additional$100.00 or fraction thereof,to and Fixture or Item Qty. Fee(ca) Total including$10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27.55 _ and including$25,000.00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for —_ each additional$100.00 or fraction thereof,to inspection of existing plumbing or and including$50,000.00. s eciaIly requested inspection per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing;existing fixtures? If "Yes",please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sever fees*. Q uantity b rixtnrc Work Performed Comments regarding fixture work: Fixture Type( N10ed F.xisting Ca i iedHa fist /FontBath -Tub/Shover-Jacuzzi/Wliirl oolCor Wash -Each Stall -Drive'I'hru Cuspidor/Water Aspirator -— Dishwasher -Commercial --- -Domestic _ _ — Drink) i'ountain _Eye — Floor Drain/sink .2" _4„ -- Car Wash Drain — --_. *Note: If(lie fixture work under this permit results in .111 Garbage -Domestic Disposal -Commercial increase of sewer EI)Us,a sewer permit will be issued and Industrie) _ fees assessed for the sewer increase must be paid before Ole Ice Mach./Refri .Drains _ plumbing permit can be issued. Oil Separator Gas Station _ Rec.Vehicle Dump Station Shower -Gang _ -Stall Sink •liar/La%story -Bradley -Commercial _ -Service Swimmin fool Filter Washer-Clothes Water Extractor Water Closet-Toilet _ Urinal _ Other Fixtures: �__— ___—