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13345 SW HOWARD DRIVE J V O O Co 6o LA CL ca 00 Lp / \ O O w /r Y \ O LZ ti 0") CL \, \ 13315 SOUTHWEST HOWARD DRK TIGARO, OREGON MLAWAY RESIDENCE Twp OREGON USA MAS nNumber K. Gw tur i IT-7 acne - - SITE p /j rove - NOTICE: IF THE PRINT OR TYPE ON ANY r-Ir l r III IIS III III IltI (_T. _� I � _TIT. ...� ��<< �_fT_ .� i. _i�r�_ �� tlllt1111111 � � � III III III 111 t � � � III III IIl IIl IIS III III f.�.f lli ITIIIII IIi 1 �i i�T171 � III III ► 111111•� ( 1111111111111111 I I 1 � 1 � I { I I ( I I I I I IMAGE IS NOT AS CLEAR A 1 I _ 4 6 / S THIS NOTICE, 9 - 10 11 1� ITIS DUE TO THE QUALITY OF THE _ _ _ _ _ _ _ _ _ _ ORIGINAL DOCUMENT v-- 6Z T8Z LZ 9Z � Z fiZ" EZ ZZ iZ _-- 4Z 1 6i � T - -L T' 9i5i fii ET Zi [ T �01 -- 6 -� 8 �-- L 9 9 fi E Z 1 �iai3w IIII III IIII IIII IIIIIIi� IIIIIIIIIIIIIIiIIlllll. 111111.111111111111U11�11111.1111Jill Lllllllillllillilllllllllllllllllllllllllllllllllllillillllill� llllllll l�ll �ll. �ll� lllll.lillll.l.l l� 1.1.1.1 '• I� IIIC�i11 I � k�1 13345 SW Howard Drive 1106:36 CleanWater�Service, Source Control lsboro Highway Durha►n Wastewater Treatment Facilit 75505W Hillsboro H�ghwav Y HII'503)846•893t23 LIQUID WASTE HAULER LOAD TICKET AND l503)846-8937 FAY HAULER INVENTORY SHEET LIQUID WASTE HAULER LOAD TICKET Company Name. A 14 f��r7:o��Ilt, � USA Permit Number: tl?F.?^t-- ~ ! Truck License Number: Date Liquid Pumped: Time Pumped: Date Dumped at USA: — �r _� Time Dumped: _ _si. Approx. Gallons Pumped: << Sample Taken: Yes '- X-No. r� PH ----_ `.""_.__.._.. LIQUID WASTE HAULER INVENTORY SHEET Yes❑No❑ Receipts Attached (Please Irlc!ude all Information requested) Customer Name: . ' r5� �,r ( J!rti_. - Telephone Number: .. Il 1 Address: 7 Date Pumped -_..'t^ r `"� - --- -- ballons Pumped: . _—_—_____✓ Vessel Pumped: .Septic Tank: ❑ Chemical Toilet: ❑ Other (Please List) Customer Name: _ ( s1 �-��a ;�_- ___,___—_ Telephone Number: Address: f r.1�.r-t.� �-�Gsr✓G�fti� 1�. Vic'`- --a- >-- -- _.__. _.__. _._ .. Y, Date Pum )ed �'. Gallons Pumped Vessel Pumped: PASeptic Tank ❑ Chemical Toilet L_� Other (Please List) Customer Name —__-- Telephone Number: Address Date Pumped. _. -- - _-___--- Canons Pumped: Vessel Pumped. ❑ Septic Tank ❑ Chemical Toilet C Other (Please List) Certification I certify under penalty of law that the above information is true and correct to the best of my knowledge, and further certify that the truck listed above contains only domestic septic tank or chemical toilet waste and does not contain process waste from eithera com rcial or industrial facility, Print Name/Title/ Signature Date .— _ )-L _ G 4 -- Reosed05101 Whitt, Clean Water Servicer,Yellow-industry Form 1201-02 CERTIFICATION OF EXISTING SYSTEM ABANDONMENT SEPTIC PERMIT NO. �i,� - QQ 171711 T S, R E, Section Tax Lot(s) I certify that the existing /('septi, tank) drywell / cesspool (;;ircle one or more) was properly abandoned to State sfandards. The sewage ,zrAents were removed by (Comp V N!3me) a licensed sQwage disposal pumping service. The unit was then backfilled with rock orQand and the building sewer promptly capped or removed. Date T?-a-1c-1, 6e . A-AFFORDABLE SEPTIC SERVICE Po.Box 1130 WILSONVILLE, OR 97070 (508) 682-1929 FAX(503) 570-0779 CUSTOMER'S ORDER =j;—,jo—t4e -- ADDRESS CASH C.O.D. CHARGE ON ACCT. MDSE.PiFD—. PAID OUT TAX �6CEIVEDiV-- TOTAL t Ao THANK YOU CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BLIP Received Date Requested 4P_ AM—_ _ PM____ _ _- BUP Location __ / 3 3 Y -- pL_Suite MEC Contact Person Ph(_—_—) 1 =-1 PIN L - Contractor ---�- -_ _ SWR - - BUILDING Tenant/Owner - _ ELC footing ELC Foundation Access: Ftg Drain ELR Crawl Drain -- Slab Inspection Notes: SIT -- -- Post& Boam G Shear Anchors - Ext Sheath/Sheaf Int Sheath/Shear 1J V - Framing -G-Tl Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling �- ---- -- Roof Other: - — — Final -PASS PART PART_ FAIL — - — PLUMBING_ _ Post& Beam -- Under Slab Rough-In — Water Service Sanitary Sewer Rain Drains -_—.- —. Catch Basin/Manhole Storm Drain ------ Shower Pan /�� — Other:_,zQ� Fir AS PART FAIL ANIC_AL Post& Beam Rough-In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL _ Service - Rough-In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of$__ re- uired before next Ins PASS _PART FAIL — 4 pection. Pay at City Hall, 13125 SW Hall Blvd. SITE^ Please call for rein pection RE: _ Unable to inspect-no access Fire Supply Line 't ADA Date�!' Inspector _Ext Approach/Sidewalk P Other: Final DON T REMOVE this Inspection record from the job site. PASS PART FAIL 10/22/01 09:49 x503 885 8235 CHEROKEE ELL( 9j 001 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 _F c2o'�'S11 IMPORTANT PERMIT NOTICE CHEROKEE ELECTRIC CO PO BOX 230230 R�CF'I�En TIGARD, OR 97281 ?0! CJ!�.�►��iry9Fyc,, , Electrical Signature Form Permit#: 141161 Q4-M19 - - Date Is-sued: 10/12/2001 Parcel: 2S103CA-01001 Site Address: 13345 SW HOWARD DR Subdivision: WOODCREST Block- Lot: 011 Jurisdiction- TIG Toning R-4.5 Remarks Interior kitchen remodel. Your company has been indicated as the electrical kzint,actor for the permit indicated above. In order for the elertm al permit to he valid, the signature of the supervising electrician is roquired Pie+ase havo the -ipprop6atn individual from your company sign below and return this Electrical Signature Farm 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 received OWNER: ELECTRICAL CONTRACTOR: CALLAWAY, KEVIN JOHN * LORI p CHEROKEE ELECTRIC CO 13345 SW HOWARD DR PO BOX 230230 TIGARD, OR 97223 TIGARD, OR 97281 Phone #. hone 11 638-1515 Reg # r Jr" 35681 SUP 2616S ELI 3.127C AN INK SIGNATURE IS REQUIRED ON THIS FORM LL..Z-rte'^— � -- Signature of Supervising Electrician If you have any questions, please rail (503) 639•4171, ext. # 310 CITYOF TIGARD MASTER PERMIT PERMIT#: MST2001-00519 DEVELOPMENT SERVICES DATE ISSUED: 10/12/01 13125 SW Hall Blvd., Tigard, OR 97223 (5C3) 639-4171 SITE ADDRESS: 13345 SW HOWARD DR PARCEL: 2S103CA-01001 SUBDIVISION: WOODCREST ZONING: R-4.5 BLOCK: LOT: 011 JURISDICTION: TIG REMARKS: Interior kitchen remodel. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS _ REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: Sf� LEFT: SMOKE DETECTORS. TYPE OF USE: SF FLOOR LOAD 40 SECOND: sf GARAGE: Sf FRONT: PARKING SPACES; TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: s1 RIGHT- OCCUPANCY GRP: R3 BDRM: BATH: TOTAL 0 00 of VALUE: S P00)0 00 R[AR. _PLUMBING SINKS: I WATER CLOSETS: I WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES. 1 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS CATCH BASINS: TUBISHOWERS: I GARBAGE DISP: I WATER HEATERS: WATER LINES: BCKFL.W PREVNIR, GREASE TRAPS: _ MECHANICAL OTHER FIXTURES: FUEL TYPES FURN<100K: BOIUCMP<AHP: VENT FANS: i CLOTHES DRYER- 1 ("As FURN>=100K: UNIT HEATERS: HOODS: 1 OTHER UNITS- MAXINP. ht" FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP_"IVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SIF 201 •400 amp: 201 •400 amp: tat W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 -600 amp: 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC/FDR: 601 - 1000 amp: 601+8mpa•t00ov: MINOR LABEL: 1000+amplvolt: Reconnect only: PLAN REVIEW SECTION >•4 RES UNITS: SVCIFDR>=225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO S STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM. OTH: BOILER: HVAC LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAfTELE COMM: NURSE.CALLS TOTAL a SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,468.40 CALLAWAY,KEVIN JOHN+LORI F DAN HART CONSTRUCTION INC This permit Is subject to the regulations contained in the 13345 SW HOWARD DR DAN SE 25TH Tigard Municipal Code,Stale of OR. Specialty Codes and 13345 S,OR WAR PORTLAND,OR 97214 all other applicable laws. All work will be done In TIGAaccordance 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 follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rae 4: LIC 126042 forth in OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Footing Insp Electrical Service Insulation Insp Foundation Insp Electrical Rough In Electrical Final PLM/Underfloor Framing Insp Mechanical Final Mechanical Insp Low Voltage Plumb Final Plumb Top Out Gas Line Insp Final inspection Issued By f ti �_ Permittee Signature ;ate Call (503) 639-4175 by 7:00 p.m. ff1r an Inspection needed the next business day Building i ivcd.rU, Permit no.: 2l -� City of 1 iga. City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223- Project/appI.no.: Expire date: Phone: (503) 639-4171 Date issued: Byltt 1 Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: --- 1&2 family:Simple Complex: d I &2 family dwelling or accessory U Commercial/industrial J Minn family U New construction U Demolition U AdditioNalteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: JOB SITE INFORMATION Jol,address: Bldg.no.: Suite no.: I.(it: Block: Subdivision: _ _ 'fax map/tax lot/account no.: I'rntr rl n,unc: •, � � �/V l�/i/0/' t?G T D/t/G �— --- ------ I)r-.rrtptttm and location of work on premises/special conditions:-_ Name: solar.etc.) Mailing address: _ 1 &2 famill duelling: City: -- - _ State: L.IP: — Valuation of work....... ................................ $ Q m Phone: I ax: IF-mail: No.of bedrooms/baths................................. Owner's representative: Total number of floors................................. Phone: I;tx: 1:-mail: New dwelling area(sq.ft.) .......................... _ Garage/carport area(sq.ft.) Name: Covered porch area(sq. ft) ........................ Mailing addn.•, Deck area(sq.ft.)............................. ....•..... City: State: LIP: Other structure area(sq. ft.)......................... Phone: II? mail ('onintereial/industriallmulti-family: tValuation of work..........................I......•...... Existing bldg.area(sq. ft.) ....:.t..............,�:,. Business name: New bldg.area(sq.ft.)....I.........I. ' Address: Number of stories State: ZIP: City: ........... Type of construction....•............. N.. — n oQ Phone: I ax: -+ � r j _ Occupancy group(s): Existing: CCB no.: __— New: — City/metro lie.no.: Notice:All contractors and subcontractors are required to be I with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may he required to be licensed in the Address: _ - urisdiction where work is being performed. If the applicant is Cit State: LIP: exempt from licensing,the following reason applies: Contact person flan lit, : - -- Phone: faxes-- �L-mail: Name: _ _ Contact person: Fees due upon application ........................... $ Address: Date received: -_ City: state: ZIP: Amount received ......................................... $ Phone: �C-mail: Please refer to fee schedule. hereby certify I have read and examined this application and the Not all iurisdicuom accept credit cards,pleas call jurisdiction for mora information. attached checklist. All provisions of laws and ordinances governing this U visa u Mastercard work will be complied with,whether s clfied herein or not. credit card numtkr. ��Q � �� Expires Authorized signature: %. �G1 s Date: J_SC Name of cardholder as shown on credit card Print name: i�>7!!=r- 1-1 �- _ - ^— Cardholder signature— —— E. Amount Notice:This per.nit application expires if a permit is not obtained within 180 da,s alter it has been accepted as complete. 440.4613 WXYCOM) One-and Two-Family Dwelling Building Permit Application Checklist leferenceno.: -- _ _ Associatcdpermits: city Of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,'1'igard,Oil 97223 U Other: I'h+me: (503) 639-4171 Fax: (503) 598-19hn I Land use actions completed.See jutisdiL I Wn criteria for concIll,rnl rcv;cw -- 7,oning.flood plain,solar balance points,,-antic soils designation,historic:(11,11 a+, .i ;--Verification of approved plat/lot, .1 Fire district��____approval required. -5 Sceptic system permit or authorization for remodel. Isxisting xystam capacity - 6 Sewer permit. 7 Water district approval. t{ Soils report.Must carry original applicable stamp and signature oil file or with application. 9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 i Complete sets of legible plans.Must he drawn to scale•showmv conformance to applicable local and state building codes. L,alerill design details and connections must hr inc++rl, +rated into the plans or on n separate full-sin sheet attached to the plans with cross references between PIM,location and dct.uls. ('fan review cannot he a,niplrtrd if copyright v_iulatiuns exist. �-- I I Sltelpint plat)drawn to scale. e phut must show lot ant huddinr a aback dinu'I1,I0f:property corner elevations(il filen is more than.,4-fl.elevation dil'1'erendal,plan must show coati ur Iltx"•.0 •' ti +nl+•rvals);location of easements and Drivcwtry;ttxltprnu of strlctwe(including decks);Ic1c anon of wrlh✓ti+I,u� �y ul;lity locations;direction indicator;Ica nnn:huilJing co r.,tte tirua;lcreentege of covernge;impervious urea;existing structures on site:and surface drainage. 12 Foundation plan.tihow Dimensions,anchor halts,any hold-clowns and reinforcing pads,connection details,vent 1:1 Flour plans. tibw% ,,II dirrielln ,room ufrnUlIC,I,on,window wr. location of smoke detectors,water heater, furnucr. .,niilauun fans,pinnhing fixtures,balconies and decks 3l1 inches above grate,etc. 14 Cross sertion(s)and details.tihow all t'rttming-member sizes and spacing such as floor be arras,headers,joists,soh Moor, wall consnuco,m,roof comuurliun.More than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,r(toA slope,ceiling height,siding materia{,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. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 all bracing(prescriptive path►and/or lateral analysis plana.Must indicate Details and locations;for nun-prescriptive path analysis provide specifications and calculations to engineering standards, 17 Floor/tont framing.Provide for all floor. roof assemblies,indicating member sizing,.,inacing,and hearing locations.Show attic ventilation. I8 Basement—and retaining walls.Provide cross sections and details showing placement of rebar. Tor engineered systems,see item 22,"Engineer's calculations." — 19 Beam calculations.Provide two sets of+calculations using current code Desitin valtrs for all beams and multiple joists over 10 feet long and/or any beam/joist carrying it non-uniform load. _ 20 Manufactured floor/roof truss design details. _ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. Agas-piping schematic is require) for four or more appliances. _ 22 M:ngineer's calcrdutions.When required err Provided,(i.e.,shear wall,roof truss)shall hr et;mapeJ by an engineer or architect licensed in Oregon and ~hall N, shoo n to hr appltcahle io the project under re-, +. 1 23 I•ive(5)site plans are required for Item I above. ti, ,_ plans mu-i Iw S-1/2" x i I"or I I" x 17". 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. 26 No rolled,reversed or mirrored building plans will tx accepted. 27 28 Checklist must be completed before plan review start Bute. Minor changes or notes on submitted plans may be in blue�or�bl4accvkWOM) Iced ink is reserved for department use only. Plumbing Permit Application Date received: Permit no.:&Z= City of `Tigard Sewer permit no.: Building permit no.: Address: 13125 SW liall Blvd,Tigard,OR 97223 City of Tigard phone: (503) 639-4171 Project/appl.no.. Expire date: Fax: (503) 598-1960 Date issued: By. Teceipt no.: Ladd use approval: Case file no.: Payment type: d"ll & 2 family tiwrll,ng or accessory U Commercial/industrial U Multi-family U Tenant improvement J Nctti cnn.tinucUrn U Addition/altera(ion/replace nu,III U Food service U Other: INFORMATION , jot)addre s, ? r�'S (,U S _ (Description Qty. Fee(ea.) Total ' Ne" I-and 2-family dwellings only: Bldg.no.: _ Suit. no.: --- - Tux map/lax lot/account no.: - (includes IO011.for each utility connecnon) - - SFR(1)bath Lot: Block: Subdivision: SFR(2)bath i— — -- Project name: J ke vi•% t- SFR(3)hash City/county: ZIP: ar? ?�Zy Each additional bath/kitchen Description and loss on of work on prernises:__ _-- Sheutililies: ��t1 I,y" .•r r�w� Catch hasinhuca drain Est.date of completion/inspection: - Dr;wells/leach line/trench drain PLUMBING CONTRACTOR Footing drain(no.lin. ft.) Manufactured home utilities Business name: Manholes Address: to , Rain drain connector City: re State: Q LIP: _Vj-39 nitary sewer(no,lin.ft.) Phone: (, ys VaYo Fax: G LY L t7 t E-mail: Storm sewer(no. lin. ft.) _ CCB no.: Y18-3 Plumb.bus.reg.no: u H'atcrservice(no. lin.ft.) — City/metro lic.no.: G o Fixture or item: Contractor's representative, gnaturc: Absorption valve - --- Back[low preventer _ Print name �y Dale: /d - b Backwater valve _ Basins/lavatory _ Name: Clothes washer �_ _ -- — ------ Dishwasher City: —�� State: /.I I': Drinking fountain(s) -- --_ _ _ Ejectors/sunlp -— _ Phone: Fax: P, mail: Expansion tank _ Fixture/sewer cap Name(print): nocrr drains/iloor sinksthub - --- —- - -- Garbage disposal 1 Mailing address: Ilose bibb -- City: State: ZIP: — Ice maker _ 1 _ Phone: Fax: E-mail: Interceptor/grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will he made by me or the maintenance and repair matte by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),Iays(s) — T Owner's signature* Date: Sump Tubs/shower/shower pan I Urinal Name: --- -- Water closet _ Address: _ Water heater City: Stute: ZIP:- Other: - Phone: Fax: E-mail obt Not all jurisdictirmse call juriulictirat for"MM information. Minimum fee..............) $ a accept credit cods,plea Notice:This permit appl+,:anon plan review(al _ � $ ❑Visa U MasterCard expires if a permit is m)t obtained Credit card number: �_______ _____— _�__ within ISO days after it has been State surcharge(8%)....$ Expires Nae of cardholder u shown on crrdit card ---- accepted as complete. TOTAL ....................... m S Codholderelpattue ��— Amount 4*Y4616f6ti7U/f'Ohti PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 24amily dwellings only: FIXTURES (indlvldual) QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT —� 16 60 for each utilityconnection) _ Lavatory Y——""- _ One 1 bath — $249.20 Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00 Shower Only 16,60 Three 3 bath _ -_ $399.00 — Water Closet 16.60 — --- SUBTOTAL_ Urinal 1660 _ 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 1660 TOl AL -- Laundry Tray — 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 1660 16.60 - PLEASE COMPLETE: 4" — 16.60 Water Heater O conversion O like kind 1660 — �uantit b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit _ _ _-- Capped MFG Home New Water Service 46 40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory _ — — Tub or Tub/Shower Hose Bibs 1660 Combination_ _ Roof Drains — 15.60 Shower Only Drinking Fountain — — 16.60 _Water Closet Other Fixtures(Specify) 16,60 -- — Urinal _ _ _ Dishwasher Garbage Disposal `—"— — — Laundry Room Tray _ ----- — -- — — Washing Machine_ _ Floor Drain/Sink: 2" Sewer-1 st 100' 5500 3" Sewer-cacti additional 100' — 46.40 4" Water Service-1s1 100' — 5500 — Water Heater _— Water Service-cacti additional 200' 46.40 — — Other Fixtures _ (Specify) _ Storm B Rain Drain-1s1 100' 55.00 Storm&Rain Drain each additional 100' 4640 Commercial Back Flow Prevention Device 46.40 - — Residential Backflow Prevention Device' — 2755 — — Catch Basin 16.60 -- Inspection of Existing Plumbing or Specially 72,50 Requested Inspections perthr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 Grease Traps —Y 16.60 -- ---------- -- QUANTITY TOTAL L ornetrlc or riser diagram is requirrA if --- — ---- -- -_ Qllantfl T_olal Is >9 '- 'SUBTOTAL ---------- 8%STATE SURCHARGE — — — -- "PLAN REVIEW 25°/.OF SUBTOTAL — Requimd ons If fixture qty total is,9 _ TOTAL 5 'Minimum permit fee Is$12 50+8%state surcharge,except Residential Backflow Prevention Device,which Is$3e 25+8%state surcharge 'All New Commercial Buildings require plans with Isometric or riser diagram and plan review I:\dsts\forms\plm-fees.doc 10/10/00 Mechanical Permit Application Dale received: Permit no.:A6y.,C"i.n�,5 City of Tigard Project/appl.no.: Expire date: CilvofTiRurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 - Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use a,iproval: rmit no 1 1 &2 family dwelling o: accessory ❑Commercial/industrial J Mulu family U Tenant improvement U New construction U Aclditiort/alteration/replacement U Other: .1011 SI 111 INUORNIA]ION CONINIERCIA11. VA11,111ATI(A SCHEDULE Joh address: L 401t l AD fZ� Indicate equipment quantities in boxes hclow. Indicate the dollar Bldg.no.: t—Ti Suite no.: value of all mechanical materials,equipment,labor,overhead. Tax map/tax lot/account no.: profit. Value$ t.ctt: Block: I Subdivision: -T-- - ^ *See checklist for important application information and Project name: �-1 N C�1x C�U�� — 6� jurisdiction's fee schedule for rc�:idctoi,d permit I'oc City/county: t(J fJ ZIP: cl '?�a $471111EDULE Description and location of work on premises: f - I,tv.(ea.) Tota) Est.date of completion/inspection: Description Oly. Rm.oniii Res.orlt Tenant improvement or change of use: Is existing space heated or conditioned'?id Yes U No Air handling anis ---ChM Is existing space insulated'?4 Yes U No Air con itioning(siteplanrequire ) Alteration of existing HVAC system MECHANICAL CONTRUIOR LI 01 er compressors Business name: / ' Stale boiler permit no.: HP Tons—,BTU/I1 Address: 7 1 A>- f'M A V •lr smo c dampersiduct smoke detectors City: Slate: OUIP: , Heat pump(site p an require ) _ nsta /rep acefurnace/ urner / Phone Fax: -trail: Including ductwork/vent liner U Yes U No CCB no.: '��-� Z [�t�� _ Install/replace/relocate eaters-suspended, City/metro hc.no.: il Z " _ wall,or floor mounted Name(please print): L �� Vent forappliance other than furnace WIN e gerot on: Absorption units BTIJ/H Name: ChillersHP Coll" orn ressors___ lip Adclnrss_Y_ ;nv ronmenta ex ust an vent al on: City: _ State: ZIP: -_ Appliance vent _ Phone: Fax. E-mail: yryerexhaust II I(Qs,I ype / I/res. tc a azmat - - hood fire suppression system Name: _ Exhaust fan with single duct(hath fans, Mailing address: — Exhausts stem apart from heatingor AT, City: - - Stale: ZIP: �' Fuel piping adistribution(up to outlets) - -- -- Type: ---LPG NG Oil Phone: Fax: E-mail: 'uc piping each ad tonal over 4 outlets Process piping(sc tematicrequire ) Name: Number of outlets _ — — ter 1Cste�fiance or eq-Unent: prTT Address: Decorative fireplace Cit a,u, Insert-type — ---_. - -_- _ __-- Wustovel—T love Phone: Fax: L mail: pelets Ql r_r: Applicant's signature: Date: I K: Name(print): Not all jurisdictions wcept credit cads,plena call jurmiction for roam infortnalon Permit fee................ ....$ U Visa U MasterCard Notice:This permit application Minimum fee................$ expires if a permit is not obtained plan review(at _ %,) $ cirdii card nondx,. T___.- .apims--' within 180 days after it has been �- Nww of cardholder as shown on credit card accepted as complete State surcharge(8%) ....$ _ s TOTAL .......................$ —� —�cadet djnattrrc —�� Arnow _ 440.4617 MWOMI 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 Ory (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Fumace to 100,000 BTU $1.52 for each additional$100.00 or Including ducts R vents 14.00 fraction thereof,to and including 2) Furnace 100,000 BTO+ $10 cuu.00. including duns&vents _ 1740 $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 Included in appliance permit $1.45 for each additional$100.00 or 6.80 - fraction thereof,to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up _ $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond _ fraction thereof, footnotes below. Comte 7)<3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 1a.00 8)3-15 HP;absorb Value Total unit 100k to 500k BTU 25.60 Descri tion: _ Ot (Ea) 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 8 vents 11)>50HP:absorb Floor furnace including vent 955 unit>1.75 mil BTU 87.20 Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM floor mounted heater 10.00 Vent not Included in applicance 445 13)Air handling unit 10,000 CFM+ permit 17.20 Repair units 805 14)Non-portable evaporate cooler <3 hp;absorb.unit, 955 1 1000 to 100k BTU 15)Vent fan connected to a single duct 3-15 hp;absorb.unit, 1,700 6.80 101k to 500k BTU 16)Ventilation system not included in 15-30 hp;absorb.unit,501k to 1 2,310 appliance permit 10.00 mil.BTU 17)Hood served by mechanical exhaust 30-50 hp;absorb.unit, 3,400 10.00 1-1.75 mil.BTU 18)Domestic incinerators >50 hp;absorb.unites 5,725 17.40 >1.75 mil.BTU - - 19)Commercial or Industrial type Incinerator Air handling unit to 10,000 cfM 656 69.95 Air handling unit>10,000 ctm 1,170 - -- 20)Other units,including wood stoves Non-portable evaporate cooler 656 1000 Vent fan connected to a single duct 446 -_ 21)Gas piping one to four outlets Vent system not included in 656 -5.40- AP Ipp lance permit - 22)More than 4-per outlet(each) Hood served by exhaust 656 1.00 Domestic Incinerator 1,170 _ Minimum Permit Fee$72.50 SUBTOTAL: $ Commercial or Industrial Incinerator 4,590 Other unit,including wood stoves, 656 8%State Surcharge $ inserts,etc. Gas piping 14 outlets 360 25%Plan Review Fee(of subtotal) $ Each additional outlet _ 63 Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: Other Inspections and Fess: 1 Inspections outsid,c`normal business hours(minimum charge-two hours) $72 50 per hour 2 Inspections for which no fee is specifically indicated (minimum charge-half hour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge4me-halt hour)$72 50 per hour 'State Contractor Boller Certification required for units>200k BTU. "Residential A/C requires site plan showing placement of unit I:ldstslforms\mech-fees doc 10/11/00 12.01%2ug0 1: 13 FAX 50/8817207 City of Tigard f�u01 Electrical Per n it Application -' �- uatcr«taved _ it no City of Tigard Pm)ect/appl.no- Expire date: City of Tigard Address: 13125 SW Hall Blvd,Tigard.OR 97223 Dareisstwd: — By: Recelptno.: Phone: (503) 639.4171 Fax: (503)598-1960 Can rile no.; Payment type Larid use approval: U 1 &2 family dweWng or accessory U Corti merciaUindustnal ❑Multi-family U Tenant trnprw culcnt O,New construction Q Additioo/aiteration/replaccmcnt O Other- _ 'J Partial Job tddress: I Bld)j.uo Scute no.. Tax lnap/taat lot/account no., Lor BIq k: 5ubtlivtsion: Traject nuns. ikscription and location of work on prerruses: j Estimated date of coat letlon/ins coon: Job no: _ _ Foe Max Business narne! D A J E R M E ELECTRIC -- °°- (`l TOW oo-b" Address: 751, I ra rrrnlnrda!-fh**or num Kealy pr P O BOX 7 51 rl.rllinG unit.Incladn attacbesl4awte. City: HILLSBQRO I St it. 7123 kr•ictiuehtrred Phone:648-514A jFax' 4 8-9 21-m11W. 1000+q n at lua 4 3 6 0 51 3 4-119 C Each additional W sq.R.or portion thereof CCBno.: Flee.bus.lie. o: - ---- l.imttedeoergy,rettdenrtl ; City/,letto lie,no.: Urrutcdcncigy.non residentiul 2 Fath manufactured hone or modular dwetlutp S itwurc of supervisin elecUiciUi uuCd Date $erv,u Ltd/arfeeder 2 Su ,'.IC.-L name.(print) DAVID A J E R O M E Deer-.eno:2 8 7 7 S 'fewrteadera=ins tauatiou, altwation at relocation: 200 ump or less 2 Name(print); 1 amps to 400 amps — 2 Mailingaddress: 401 amps to 600 anipt 2 001 amps w 1000 nra(rs 2 City: state: 2TP _ over 1000 vapor rolta 2 Phone: Fax: I E mall: ReconnextonlY - - -T 1 Owner in wilation:The installadon is being made on property I uwn rruaparah rer•ires or fredn - which is not intended for sale,lease,rent,or exchange According to iranallstim allerotton,or nksnsbn ORS 447,455,479,670,'101. 200 amps or leu 2 201 amps to 4UU amps 2 *Nanir asiuiatuirc. Date: 401 to 600,rru s 2 eraachcircrtlh ae».altaratiors, or extenalon per panel• A Fee for branch eucuita with purchase of Addres� scrvrcc or feeder fee,each brtmcb circuil 2 ( ilY. _ - Stale: 21p: b Fee for branch circuits without purchass E-mail. "— of ler-ice or fowl&fee.Gat branch circuit. 2 Fadi additional branch circuit [WrIn 19" M be.(Urviceorfete erect ). C,t Semce over 225 amps-wmirieretal U HealorcceefoeilityEach pompon irti uttoacircle 2 ❑Service ova 32Uamps-rating of lee': 0 Huardaulocabon Bschst n or ouiltne lillinnig 2 family dwellings 0 Building over I0,OW square feet four or Signal eucui ft or a limited cowlty panel, O Systemover 600 volts nominal more trsidential urats in one ruucture alteration,or extension• 2 3 Building over three stories ❑Feeders,400 amps of more •Detenpooa. �� _ 0 Oecupoat load over 99 pemtb 0 Manufactured structures or RV park Lach 3dditlortal tnrlveswn o.n the alln"14c,in any of the nbovr. T C1 F4reitulightingplan 0 o(h& _- - Fla inspection 61sabwit_—seta of plana Mile any of the rabave. Inveaupauon fee -- The above we oot ' ble to tempoml ceusaw(lon sevvlce. other Not an junrdwUuru aistpr credit c".psrare rsll rurssdtcnon feu more jalurmraion Notice,This permit application Pcrtnit foe.....................S 0 visa O MasterCard expires if a permit is not obtained Plat review(at ,_ %) S Crubt cant noMw ._. --- �. L... within 190 days after it has been State surcharge(8%)....$ ,P1e4 accepted as complete TOTAL ......... S Mine or eardbelder a Mown on acerin card S nd rid"sjuature Aearwnt� aaLL46rS(aAlNC'Uti) Electrical Permit Fees: Limited Energy Fees: - TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee......... .....--........ ....... —$75.00 ... . Number of Insp :tions per permit allowed (FUR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq It or less $145 15 _ 4 ❑ Audio and Stereo Systems Each additional 500 sq.It or 1 Burglar Alarm ❑ portion thereof $33.40 Limited Energy $75.00 Each Manuf'd Home or Modular2 Garage Door Opener' Dwelling Service or Feeder $9090 Services or Feeders Heating,Ventilation and Air Conditioning System' Installation,allefation,or relocation 200 amps or less $80.30 2 ❑ Varuum Systems` 201 amps to 400 amps $108.85 2 401 amps to 600 amps $16060 2 ❑ 601 amps to 1000 amps $24060 2 Other` -- Over 1000 amps or volts $454.65 2 Reconnect only $66.85 J 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders Fee for each system......................................................... $75.00 Installation,alteration,or relocation (SEE OAF,918.260-260) 200 amps or less $66.85 2 201 amps to 400 amps $100.30 2 Check Type of Work Involved: 401 amps to 600 amps $13375 2 Over 600 amps to 1000 volts, Audio and Stereo Systems see"b"above. Branch Circuits Boller Controls New,alteration or extension per panel a)The fee for branch circuits ❑ Clock Systems with purchase of service or feeder fee. Each branch circuit $665 ❑ Data Telecommunication Installation b)1 he fee for branch circuits ❑ without purchase of service Fire Alarm Installation or feeder fee. Firsl branch circuit $4685 _ ❑ HVAC Each additional branch circuit _ $6.65 Miscellaneous ❑ Instrumentation (Service or feeder not Included) Each pump or Irrigation circle $53 40 -. Intercom and Paging Systems Each sign or outline lighting $5340 Signal circuit(s)or a limited energy Landscape Irrigation Control' panel,alteration or extension _ $7500 Minor Labels(10) $12500 —__- ❑ Medical Each additional inspection over the allowable In any of the above ❑ Nurse Calls Per inspection $62.50 Per hour J $62.50 _ ❑ In Plant $73.75 Outdoor Landscape Lighting' • Fees: ❑ Protective Signaling Enter total of above fees ❑ - -- $_._ _ Other 8%State Surcharge $ _ ^___ Number of Systems 2596 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 _ --- Enter total of above fees ❑ Trust Account t1 -- _ 81,:State Surcharge - - Total Balance Due - i klstslfumu\elr.-fees doc 10.0900 r SEE 35MM ROLL #20 FOR OVERSIZED DOCUME NT CITYO F T I G A R D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2001-00428 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/29/01 PARCEL: 2S103CA-01001 SITE ADDRESS: 13345 SW HOWARD DR SUBDIVISION: WOODCREST ZONING: R-4 5 BLOCK: LOT: 011 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMF RE_SSORS HOODS: _ FUEL TYPES _ 0 - 3 HP.: DOMES. INCIN: i PG �^ _ 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 31 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of gas furnace and piping. Owner: � FEES -- CALLAWAY. KEVIN JOHN + LORI F Type By Date Amount Receipt 13345 SW HOWARD DR PRMT CTR 11/29101 $72.50 272001000C TIGARD, OR 97223 5PCT CTR 11/29/01 $5.80 272001000C Total $78.30 Phone: --- Contractor: ADVANCED HEATING + AIR GOND 5825 SE FOSTER PORTLAND, OR 97206 REQUIRED INSPECTIONS _ Gas Line Insp Phone:235-0060 Mechanical Insp Reg #:LIC 98573 Heating Unt Insp Final Inspection eXPI P 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 work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rui.7s 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 thr�se rules or direct questions to OUNC by calling (503)246-9189. Issue By: Permittee Signature: Call (503) 639-4175 by 7:0n P.M. for inspections needed the next business day r Sent By: Advanced Heating; 503 774 4391 ; Nov-26-01 5:33PM; Page 2/2 rtecelvedt e/ 7/01 6:01AMI > Advanced He®tinpl 1-000 w Aug 07 0? 07:068 RECEIVED p. 2 05/00/01 MON IC- 19 FAX 501 gIY"F'mmkIrIf OF TIQAM 1A002 3UILDINC��TVT��f: Mechanical Permit lApplication -- L�■termllvtKh ptnuitaQ City of Tigard rl��rleu■p,r1.a�. r�.pt,rA tats. CltyoJllacrd Addim a: 13125 SW Hall HMI,Tigwd,OR Sr/'2'13 -- — I)ste JanueJ I'ttoato: (5(13)fi;lSt-4171 —. 81: \ Ronedptnn.: Pu: (303)398-1960 Cu*Me nu- �— - Nsynleat type lAnd un approvd: _ ut,udnlapwinuno.: -- xl &2 family dwalllnp or scow" Q Comm:tvial/itKkWrinl U'Aultl4sluily 11 I taunt impttrvonlme (3 New eowbu&ic.n ❑AddlthiWdiaen icWhvdacemest U Other--- _ ktb aaldteaa: S �® Indicetc ealulprnmt quanridaa in blimp baklw Itulir"ow tulle P4.no.; I 3utts ao.: value tit ail ntochanir al uwsanNa,equlp.nwi,labor,crverhnatl, Tut mp�i/btz hN/aeecwttl tto,: ____ p,,7Crr vnlno s __ Lwtt: Block: SubdlYitRuO,__- 'See Owctklist for important sWicatielt info matiou and �M name; _ tutscllction'l fee kbwuk fbr neaidontw pa MA f'n Ci /cnunt � ZIP; berAption and Wadon of wotft on pmatues; - — �^�"�- !sa(wr.) raw 11AL Mr.of completiontiaqw,tU�a: � Ras w0by I yr,. 71'enanr Imptuvt-m—wt cr r'ltttttaa of un-e: R C]N.. Ak hiuld�unit t�rM tulWug quite booed or«rndititxeed?U Yte� b euatin8 21w.4 tut■JlttW7 U Yea U No ATA euirdn►Iwlinjj�iknphn re �iar■11ni exluingTl em — WWI 11o�erTYii%riwcs■ - — Bttaittaa Wilma L�,ft�IX J�._ ,tart huller permit rw Atwtt,a.6P Hr TO" _ Tw d etnn tY Stam ZIP lfcat a , e an u -- - - Pbone:77 Pu><: _ m,W: nal ce'lf _�11T't)1fT -- CUB n Im mil dunrrnrWV"M liner a Yra a Nu (:' /rrwru leo.no.' J �_ wall,ur floor etavlaod Name( ossa 0:SharrIA-LIN a to onadTaiuiiuctuce - - �` Ahvn1rtr,tNlaltsNam; Ublue" HIP HT1lRI _- Addseaa� - -- — - ------ __—_. C• tuxs 1 P CRY: 3lalc.: Zip, _ Apptlance.eet r}r>ist:: ... ---- I'es: _ L'•muC T kyer n's tF�itlri--------------- -- oalt 11ptT7)Ilrea.kn i'Mll - huttd Ilre aupprvwloa■yeuro j�_ Nsttsa: Hthnut f■a tetth slo�k dud(bath tam) Hallie.#mkLiess. ?o of A city^` a—��it ut e' rrn .n llama:___-.___._ ��t: - - C{-1f Wl: T n1n��-i� cm■ uv� _—_t� _-�--- -_ Number of outs - - Nanur AdAI _ i�'ii�i lLecrw c Addtell � s I]ecmuivc 0 ce � �r: O Ind-T�t'�la lbont3 I s: i1: WaiRTaiov tei�iinioie Appl)cnuCa u nature��it +t�>f'� U C Ik6ecOdkr'l -- None - --- {'crinit(4+e.................. . $ 401'^'r�+��trr n.W..i,r►r..W).�1.A•*.V rtv ed.IJNw.wllr. _ 1 t9Y Notlae:lliispererttapl+lioatirn Minimton fee............ f -- MY 0 'Y eR�lc.l I!' {wrtinh b OM ublruwd F'illU tC.leN(■1dn) Uri; within i eU day%■thr h hes tw+vr State sutcharae(89tr1....3 _— e -.� -11aot r�e�.pM.l e� wri.leta CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: S /9/02 00335 DATE ISSUED: 12/9/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103CA-01001 SITE ADDRESS; 13345 SW HOWARD DR SUBDIVISION: WOODCRLS'l ZONING: It-1 BLOCK: LOT: o I _ JURISDICT;ON: 116 TENANT NAME: USA NO: FIXTURE UNITS: CLASS O7- WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for existing SF rrisidence. Reimbursement District#22 fee of$6,000 paid on this date. _ Owner: _ _ FEES CALLAWAY, KEVIN JOHN + LORI F Description Date +Amount 13345 SW HOWARD DR TIGARD, OR 97223 1SWUSAISxvrConnect 12/9/02 $2,300.00 1 SWUSA I S\,%•r Connect 12/9102 $0.00 Phone: {,-;WINS 111 S\\r Inspect 12/9/02 $35.00 {ti�1'WSI'� tier Inshcrl 12/9102 $0.00 Contractor: Total $2,335.00 Phone. Reg #: Required Inspections _! This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, 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 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling(503) 246-6699. l Issued by: ( Permittee Signature: L/i A ,ILI Call (503) 639.4175 by 7:00 P.M.for an inspection needed tre pfixt business day Building Fixtures Plumbing Permit Application OFFICE USE ONLY I)ate reccPermitno.: ! City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Ila))Blvd,Tigard,OR 97223 01v o/Tigard phone: (503) 6394171 ProjecUappl. no.: T,-irick date: Fax: (503) 598-1960 Date issued: L Bk.. " Receipt no.: "ase file no Payment type: TYPE OF 1-1 & 2 Indy dwelling or accessory ❑Commercial/industrial lhilr,-I,umly J Tenant improvement �-J Ne%N n illum unn U Adt ition'aheralion'rvplaceincm A I'" i ,rt r J Other: JOB SftE tNFORMAT16N1 , Job address: 'j V"► iuyj 1\12 f) IIs.• 11 G�") 2-famIDescily idwel Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1-and 2-family dwrllings only: - - (Includes 100 ft,for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Block: Subdivision: SFR(2j bath Project name: SFR(3)bath City/county: ZIP: Fach additiona; hath!kitcher Description and location of work on premises: gww t' 571-0 ire utilities: Catch basin/area drain — - - - - - - - - Drywells/leachline/trench drain Fsl, date of completion'in.,j)'.01en PLUMBtNG CONTRACTOR Footing drain(no.lin.fl.) Manufactured home utilities siness name: _ anholes Address: Rain drain connector _ City: V �_r te: P: Sanitary sewer(no.lin. R.) Phone: Fax; inail: V Storm sewer(no.lin.ft.) � CCB no.: I P111mb bus.keg.no: Water service(no.lin.ft. City/metro lis.nn,; Fixture or item: - • Abso tion valve Contractor's repres tative signal ". Back flow prevents ptinthnme: Date: Backwater valve Basins/lavatory Name: Clothes washer Dishwas her Address: _ Drinking founta't1(s) Cit _St ate-- Z[P: Y Ejectors/sump ` Phone: Fax: E-mail: Expansion tan OWNER Fixture/sewer cap Name(print): Floordrains!floorsinks/hub C;arbage disposal Marling address: J [lose bibb City: y State: p ZIP: ),� ' Ice maker Phone: -G ' ax: F-mail: Interceptot/grease trap Owner installation/residential maintenance only: The actual installation Vrimer(s) — will be made by me or the maintenance and repair made by my regular Roofdrain(commercia) employee on the propert II�o�wn�/s e ORS/Chhantt It 447. Sink(s),basin(s),lays(s) Owner's si nature: -- 1,Y1�4i�. ��^'_�"' Date:��Z-��-- Sump - I ibs/shower/shower pan Urinal Name: _ Water closet Address:_ Water heater City: State; ZIP: Other. iN 5 C 1%G i5 Phone: Fax: B mail: Total Mulftnum ftr. S Not ail jurisdictions accept credit cordo,pleats cell jurisdiction for more informN ation. 5_ otice: This permit application plan review(at— %) $ U visa U Mastercard expires if a permit , not obtained a Credit card number within 180 days after it has been State surcharge(8/n).... $ 'TOTAL.........., $ � Natrre of cud older as shown nn credit and accepted as complete. """' " "- _ S _ Urdboldei tiQniture �Amount 440.4616(&WCOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (individual)_ OTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL JSink 1660 _ the dwelling and the first100 ft. QTY (ea) AMOUNT __- ------ for each utility connection) Lavatory _ 1660 One 1 bath $249.20 ` Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00 16.60 Three 3 bath $399.00 Shower Only - -- Water Closet 16.60 SUBTOTAL -� Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 26a/a OF SUBTOTAL _ 16.60 -- -._.__ TOTAL ------- ------ Garbage Disposal -� Laundry Tray 1660 Washing Machine 16.60 Floor Drain/Floor Sink 2" 1660 PLEASE COMPL EETE: 3^ 16.60 4^ 16.60 - - Quant! h Work Performed Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Peplaced Removed/ Gas piping requires a separate mechanical Capped permit. MFG Hoe New Water Service 46.40 Sink Home—New MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 combination _- Roof Drains 16.60 Shower Onl __.--- Drinking Fountain 16.60 Water Closet -- Urinal `- Other Fixtures(Specify) 1660 Dishwasher— Garbage ishwasherGarba a Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" _ Sewer-1st 100' 55.00 3^ Sewer-each additional 100' 46.40 4" Water Service-tat 100' 55.00 Water Heater Other Fixtures Water Service-each additional 200' 46.40 (Specify) Storm&Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 -_ Catch Basin 16.60 -.L-- — inspection of Existing Plumbing or Specially 82.50 Re nested Ins actionsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 -------- --- - Grease Traps 16.60 _ - - QUANTITY TOTAL Isometric or riser diagram Is required If _ Quantity Total is >9 v _ 'SUBTOTAL f 8%STATE SURCHARGE — "PLAN REVW 25%OF SUBTOTAL IE Required only If fixture qty total is>9 TOTAL *Minimum permit tee is$72 50•e%state surcharge,except Residential Backflow Prevention Device,which Is$36 25•6%state surcharge "All New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. is\dsts\forms\pim-fees.duc 12/26/01 /N CITY OF TIGARD PLUMBING PERMIT PERMIT#: PLM2002 00479 DEVELOPMENT SERVICES DATE ISSUED: ''2/?1/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103CA-01001 SITE ADDRESS: 13345 SW HOWARD DR ZONING: P,-4 5 SUBDIVISION: WOODCREST JURISDICTION: TIG _ BLOCK: LOT: 011 (CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS- SINKS: _ URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 80 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Connect existing house to newly installed sewer lateral. Septic lank is to be pumped, filled arid inspection. Reimbursement District#22 fee paid. FEES Owner: ---- -- Description Date Amount CALLAWAY, KEVIN JOHN + LORI F I I'LUC\411I 1'cimil I cc 12/11102 $72 50 13345 SW HOWARD DR I ANI X Slab la 12/11/02 $580 TIGARD, OR 97223 Total $70.30 Phone : Cortrao tor: A-AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Insp existing/capped fixtures Phone : 503-909-9548 Final Inspection Reg#: LIC 151481 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 -lays. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Permittee Signature: , ISSUed By: /� Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Permit Application OFFICE USE g -r\ Date received: ,Z a 1'er:nit no.: 7 y City of Tigard • Sewer permit no.: Building permit no.: Address: 13125 SW Ball Blvd,Tigard,OR 97223 - City q/'Tris and phone: (503) 639-4171 Project/appl. no.: date: Fax: (503) 598.1960 bate issued: Receipt no.: Land use approval:_ ease rife no.: Payment type: U I &2 family dwelling or accessory U Commercial/industrial U Mult.-family U Tenant improvement U New construction U Addition/alterationirepfacanent J Food service U Other: SCHEDULE.1011 SITE INFORMATION FEE Information Job address: ij < ! /j. ,' Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New I-and 2-family dwellings only: — (includes 100 ft.for each utility connection) Tax map/tax lot/account no.: SIR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: SFR(3)bath City/county: _ , 1 Zip: y' ?,? Each additional bath/kitchen Description an ocati n ofwork"o"n pre giises: Site utilities: %_'� '.,[ . [ < l rt l Catch basin/area drain Fs t.date of coml)letirni/inspection: i/ Drywells/leach line/trench drain Footing drain(no. lin. fl.) Manufactured home utilities Business name: rT11 11d,7 r 4 Manholes Address: -,k //�� _ Rain rain connector City: r /• _ State: 7C.' Sanitary sewer(no. lin. ft.) Phone: <'_ - Fax: _- E-mail: Storm sewer(no. lin. ft.) CCB no.: Plumb.bus.reg.no: Water service no.lin. ft. City/metro lic.no.: Fixture or Item: Contractor's representative signature: = Absorption valve Back flow preventer Prinuiame: - ate: - / Backwater valve ('0N IACT PERSONBasins/lavatory Name: j Clothes washer Address: — Dishwasher Drinking fountains) City: State:_ ZIP: Ejectors/sump _ Phone: I E-mail: Expansion tank _ Fixture/sewer cap' 7LI' -o ): I.I. Floor drains/floor sinks/hub Garbage isposat _ ir / a. .l -�' Hose bibb Statce'10 ZIP: 7 z��.� Ice maker ne: Fax: E-mail! Interceptor/grease trap Umner installation/residential maintenance only: The actual installation Primers) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's signature:_ Date: Sump Tubs/shower/shower pan Name: Urinal - _ Watercloset Address: Water heater —� City: —Zip- Other: —� Phone: Fax: State:E-mail: ota accept Not all juriadktiona accep credit cards.please call junxAlctinn for more infurrnari°o Minimum lee................ N visa ct Maacd Notice: This permit application Plan review(at_ %) E expires if a permit is not obtained Credit card number within 180 days after it has been Slate surcharge(8%).... $ , spires TOTAL. - ---- -- accepted as complete. ' Name of cardholder v shown on credo card I P � �� S _ cardholder signature Amount 440.4616(MCOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES individual r QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the firsl100 ft. QTY (ea) AMOUNT — Lavatory 16.60 for each utility connection) 1 --- -- _— One 1 bath Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00 Shower Only 16.60 Three(3)bath $399.00 Water Closet 16.60 I SUBTOTAL Urinal 1660 --8%STATE SURCHARGE Dishwasher 1660 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 1660 3" 16.60 PLEASE COMPLETE: 4" 16.60 _ Water Heater O conversion O like kind 16.60 uantity b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ ermit —__ _ Capped MFG Home Now Water Service 46.40 Sink _ MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs i 16.60 Combination _ Root Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) 16.60 I. ,Inal Dishwasher _ Garbage Disposal _ Laundry Room Tray _ - - — Washing Machine _ Floor Drain/Sink: 2" Sewer-1st 100' 55.00 31, — �— Sewer-each additional 100' 4640 4" Water Service-1st 100' 55.00 Water Heater _ Water Service-each additional 200' 48.40 Other Fixtures (Specify) Storm&Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 — Residential Backflow Prevention Device' 27.85 — -- Catch Basin 16.60 --�--- Inspection of Existing Plumbing or Specially 62.50 — Requested Inspections perAlr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 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 fixture gly.total Is>9 TOTAL a Minimum permit fee Is$72.50+8%slrts surcharge,except Residential Backflow Prevention Device,which Is$36 25*8%state surcharge "All New Commercial Buildings require.2 Bets of plans with Isometric or riser diagram for plan review. 1:%dstslformslplm-fees.doc 12/26/01