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13465 SW HOWARD DRIVE rI�ww V, x 0 v x i 13465 SW HOWARD DR CITY OF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-00195 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/24/03 PARCEL: 2S103CA-00601 SITE ADDRESS; 13465 SW HOWARD DR SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: Ilc TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWP IMPERV SURFACE: Remarks: Connect existing house to sewer lateral. Reimbursement District#22 fee paid on this date. Owner: FEES WEEKS,JACK A ELIZABETH E Description Date Amount 13465 SW HOWARD DR TIGARD, OR 97223 [SWUSA] Swr Connect 6/24/03 $2,300.00 [SWUSA]Swr Connect 6/24/03 $0.00 Phone: [SWINSP]Swr Inspect 6/24/03 $35.00 [SWINSP] Swr Inspect 6/24/03 $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" Perm Issu6d by: Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the fiext business day UT ! OF TIGARD — PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00304 13125 SW Hall Blvd., Tic.ard, OR 97223 (5031639-4171 DATE ISSUED: 6/26/03 SITE ADDRESS: 13465 SW HOWARD DR PARCEL: 2S103CA-00601 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICT;,)°,i TIG 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: I TUB/SHOWERS: SEWER LINE: 30 ft WATER CLOSETS: WATER LINE..: ft DISKWASHERS: RAIN DRAIN: ft Remarks: Install 30' of sewer line and reversal of plumbing under the house to connect to newly installed sewer lateral. Septic tank is to be pumped, filled and inspected.Reimbursement District#22 pain. FEES Owner: — -- �— Description Date Amount WEEKS.JACK A ELIZABETH F - - 13465 SW HO'.'VARD DR �I'I,UMl31 Permit rr 6126/03 $109.50 TIGARD, OR 97223 I I AX] 8°n State la,. 6/26/03 $8.00 i otal� $117.50 Phone -- Contractor: MCKEE PLUMBING PO BOX 801 CANBY,OR 97013 REQUIRED INSPECTIONS Phone : 503-266-7982 Sewer Inspection Misc. Inspection Reg#: LIC 116965 PLM 3-301111 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon r r Issued By: e Permittee Signatur ' % ih� Call (503) 6394175 by 7:00 P.M. for air inspection needed the next business day Building Fixtures V.-ambing Permit Application OFFICE USE ON LY Permitno. Cit of Tigard Date received Address: 13125 SW l tall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.:� -- 0tyofTigard Phone: (503) 639-4171 Projecl/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: iBy Receipt no.: Land use approval: case file no.: Payment type: 1 , ❑ I &2 family dwelling or accessory 0 Commercial/industrial ❑Multi-family U Tenant improvement ❑New construction. U Addition/alteration/replacetnent U Food service U Other: 1 : SITE INFORMATION1 (for speeial information ti!spchec list) Job address: :� ; J �" '_ ) ) 1 Description Qly. Fee(ea.) 'Total Bldg. no.: Suite no.: New 11-and Z-family dwellings only: (Includes 100 ft.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: SFR(3)bath City/county: (,, � J Zl�� ZIP: Each additional bath kitchen Description and location of work on premises: Siteutilities: ) k:� 412u_4 L/3 Catch basin/area drain Est,date of completion/inspection: T— Drywells/leach line/trench drain Footing drain(no.lin. fl.) Manufactured home utilities Business namq: (2LLL111L Manholes Address: ` ' " Rain drain connector City: State:, ZIP: z Sanitary sewer(no. lin. fl.) r- o o s a c Phone: •.-) " Fax E-mail: Storm sewer(no. lin. fl.) Ct'B no.: Plumb.bus_.reg.no: Water service(no, lin.tl. City/metro tic.no.: low Fi rture or item: Contractor's representative signature: b Absorption valve Back flow preventer Print name: C L 1 , fate: (,zt74<L4--x-3—,_Backwater valve ��- 1 Basins/lavatory Name: )� L J� L� Clothes washer Dishwasher City State: ZIP; Drinking fountain(sj o Y' Ejectors/sump _ Phone: S. '71 Fax: E-mail: Expansion tank 1 WWI N Fixture/sewer cap Name(print): L Floor drains/floor sinks/ b ff Garbage disposal _ r Mailing address: Hose bibb _ City: i _ State: ZIP: _ _ Ice makes Phone: Fax: E-mail: Interceptor/grease tr p Owner instillation/residential maintenance only: The actual installation Primer(s) will be made by me of the maintenance and repair made by my regular Roof drain(commerc 1 /0 employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(. Owner's signature: Date: Sump Tu s/shower/shower rinal Name: — Water closet / Address: Water heater (_ city: State: ZIPS �( L Phone: Fax: I E-mail: Total Minimum fee................ $ 7 kel", Not all jurisdictions accept credit cards,please cell jurisdiction for more information. i Notice: This permit application Plan review(at _ % S ,/� U visa ❑ntettetcera > expires if a permit is not obtained �l �1� Credit card number _ within 180 days after it has been State surcharge(8%).... S aplraa -- accepted as complete. TOTAL........................ $ Name of —_ 'y .� nrdltolder u shown on credit cu /e/0 _ a _ r GMholder signature Amount 4404616( ) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures inPRICE TO1AL Sink 16 6� the dwelling and the first100 ft. CITY (ea) AMOUN1 Lavatory v 1660 _for each utillt�r ___ connection _ One 1 bath _ $249.20 Tub or Tub/Shower Comb. 1660 Two(2)bath v i $350.00 Shower Only 1660 Three 3 bath --_,__ _ $399.00 Water Closet 16.60 r - - SUBTOTAL Urinal 15.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25`/.OF SUBTOTAL Garbage Disposal 16.60 `i __-.__ TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater O conversion O like kind 16.60 QuantitYb 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 Lavato - Hose Bibs 16.60 Tub or Tub/Shower _ _ _Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet _ Other Fixtures(Specify) 16.60 Urinal _ -__ Dishwashar Garbage Dis osal_ - Laundry Room Tray Washes Machine _ Floor Drain/Sink: 2" _ Sewer•1st 100' 55.00 r C 3„ Sewer-each additional 100' 46.40 4" Water Service-1 at 100' 55.00 Water Heater _ Water Service-each additional 200' 46.40 Other Fixtures Specify) Storm&Rain Drain-1st 100' 55.00 - Storm 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 -- - -- -- --- Residential Backflow Prevention Device' 21.55 Catch Basin 16.60 -"---- - -- Inspection of Existing Plumbing or Specially 62.50 Requested Inspections erthr _ 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 >g - 'SUBTOTAL --- -- - 8%STATE SURCHARGE -- "PLAN REVIEW 25%OF SUBTOTAL -- Required only if fixture gly total Is>9 _ - TOTAL V b `Minimum perml:foe is$72 50.B%state surcharge,except Residential Backflow Prevention Device,which Is$10 25•8%stale surcharge **All New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. l:\dsts\forms\pim-fees.doc 12/26/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639.4175 MST INSPECTION DIVISION Business Line: (503)639-4171 ;L-7 BLIP Received _ ____._ — Date Requested LIZ— _ AM _ PM—_.___ BUP _ Location __ uite_— MEC 2 d Contact Person __ Ph(_ ) -��— PLM Contractor __ —_ Ph(— ) — — (S1f N ---_- - 8_UILDiNG Tenant/Owner ' ___-__ ELC Footing EI C Foundation Access: Ftg Drain ELR __-- Crawl Drain — Slab Inspection Notes: SIT Post& Beam -__-- Shear Anchors Ext Sheath/Shear _ Int Sheath/Shear Framing _ --- Insulation Drywall Nailing --- - - - _ ---�Firewall Fire Sprinkler -- -- --- Fire Alarm - ' Susp'd Ceiling - -- -- --- —- ----- Roof Other. - - Final PASS PART FAIL PLUMBING ----- Post& Beam — Under Slab "„ - --------- - — Rough-In �(/G Water Service eum — — -- - --- SanfMry Sewe X 1) Tra-in-11rains - Catch Basin/Manhole Storm Drain - - Shower Pan Other: ---— - --- FIae1- ,, Y {GASP_PART_ FAILMEdHANICAL Post& Beam Rough-In Gas Line Smoke Dampers - — Final PASS PART FAIL ELECTRICAL Service Rough-In UG/Slab -- -- - - - --- - Low Voltage Fire Alarm Final Reinspection fee of$___ __required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE L Please call for reinspection RE . _. _ _ Unable to inspect-no access Fire Supply Line ADA 7 Approach/Sidewalk Date _- Inspector .- Ext--- Other: Final - DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 6344175 Business Phone: 6394171 Date Requested: (C% 1j ` A.M. P.M. y MST: Location: '7 �s I i - 7Y4— _ _ BUR _ Tenant: Suite: Bldg: ME Contractor: 1(x.1 t Phone �`�y�- l PLM: t �� (honer: I'hone: _ ELC: — ELR: =--- - Srl': BUILDING BLDG(coni) PLUMBING �' 'I ANICAL �� ELECTRICAL SITE Site Post/Beam Post/Beam A/Beam Cover/Service Sewer/Storm Footing Roof UndF1'Slab Hugh-In Ceiling Water Line Slab Framing Top Out vas Linc 6v69 Rough-In UG Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Stonu Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alm CrawUFound IN Heat Pump Low Volt Approved Approved Approved Approved Appr/Sdwlk Not Approved Not Approved ved Not Approved Not Approved FINAL FINAL 'SINAL FINAL FINAL Call for reinspection O Reinspection fee of S_ `required be lure next inspection O Unabin to inspect Inspector:JG1� Date: /^ I �— Page_of_ /\ CITY CF TIGARD DEVELOPMENT SERVIC 5 PLUMBING PERMIT PERMTT T #. . . , . . . PLM97-O'r'36 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE I SSLIF_D: 06/20/97 PARCEL: =S 1.0CCA--O060 i. SITE ADDRESS. . . 1.3465 SW HOWARD DI, SUBDIVISION. . . . : ZONING: R-4. 5 BLOCK,. . . . . . . . . . . LOT. . . . . . . . . . . . . . JURISDICTION: URB CLASS�OF�WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : iD BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . . 0 -CRAPS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 1 CATCH BASINS. . . . . . . : 0 F•IY,'TURES--_____________ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINf). . . . . : 0 SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . , 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 10 SEWER LINE (ft ) . . . : 0 WATER CLOSETS. : 0 WATER LINE (ft ) . , . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remar•I<s : Installing a water heater- Owner: ----_____.__.---._________._______._----___._____._-- ----___-_- FEES JACK WEEKS type amor_int by date r�ecpt 13465 SW HOWARD DR PRMT 4 25. O0 B 06/20/97 97-296266 TIGARD OR 97223 `.iF='CT $ 1. 25 B 061120/97 97-296266 1--'hone #: Cort Tact or COLUMBIA HEATING PC) BOX E,30397 B9O0 SW BURNHAM ST STE F- 11.0 TTGARD OR 97281-0397 97 __.___._..._-..____._---•--_.____._.._.__.____ Phane #: 624-2704 26. 25 TOTAL Reg #. . : 000763 - ----- - REQUIRED INSPECTIONS ----- This peroit is issued subject to the regulations contained in the Misc. Inspect ion Tigara Municipal Code, State of Ore. Specialty Codes and all other Final. Inspection 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 Pore _______�__ __.• ___ _ __ _ 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 952-00A1-0080. You say _____•__-^_r_,_ �____ obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. Is.sl.red By: ' _ �Lv- --- Per,mi.ttee Signatyxti e : ( -/ - --- - _. +++++++++++++++++++++•h+++++++++++++++++++++++++++++++ +++++++++++++ ++++ Call 639-4175 by 6:OO p. m. for- an inspection needed t� next bl_isi.ness ay +++++++++4++44-4-+4 ++++++++++++++++++++•+++++++++++++++++++++++•F++++++++++...."'++� CITY OF T'aARD Plumbing Application Recd By 13125 SW HALL BLVD. Commercial and Residential Cate!Recd_ Cate to P E. TIGARP, OR 97223 Date to CST _ (503; 339-4171 171 Perm t a JKA) 7— 07--14' Print or Type Related SWR s — incomplete or illegible applications will not be accepted called vain or Oevel pmenuProiect - FIXTURES (Individual) QTY PRICE AMT -� rc 1 k Sink 900 Job 'e, --(-- Lavatory 9.00 i S Address Slrget.Address suite?L / /.rte r�// Tub or rublShower Comb. 9.00 Bldg• `! CO/State Dip Shower Only �j 722 Water Closet )00 va 9 00 Dishwasher I �{ S L Mailing Address 5ude Garbage Disposal � 9 CU Owner —g r J� „ Nasn n9 Machine 9A0 /Slate Zip Phoney �l Floor Drain 2' 900 I f ��Q "��'/ 3' 9.00 "Whe _,.t rY1 a - 9.ao �ss Water Heater 9 Occupant ^meq AddreSuite _ — .00 7 (Laundry Room Tray 906 Gtyistate Zip Phone Unnat 500 ^l Other Fixtures(Specify) 9.00 � Nair � tL — u11��' C� Irl 9.00 Contractor flai "r Address Suite 900 i't, A ��<_ 9.00 C. State Zi Phone - 9.00 7 c - - - —. C req n Corut.Cont.fl erd Limit Ex .Date � _— 9 0�7 Admcfs Copy of / 900 Current PhanbrUe.II Ex .DAte Sewar- t st 100" 3000 Licensee _i/-J�9- r 7 / ) -) _/ sewer-eacn additional 100' 2500 C�T Bus-neAs Tax o Metro 0 Exp.Date Water Service- t st t00' _ W I 3000 ,,��, _ _ Name Water Service-each additional 200 2-100 Architect Stonn.S Rain Dram- 1st 100' 30 00 Storm S Ran Crain-each additional 100' 25 J0 or ..tailing.address St.:e _ I Mobile Home Space 25 00 1 Engineer :•.tWstater Zip 111 Phone Commercial 9acit Flow Prevention Cevice or-anti- — - 5 Pollution Cevice .JeeUllbe worts /ew J Addition O Alteration 0 Reoair 0 Residential Backflow Prevention Cevice' 15 JO ,o be done. 7esidenbal 0 von-resioential 0 Any Trap or Waste Not Connected to a F zture 9 00�- A4drb",jesrnpuon of worts Catch Basin i 9.G0 !nsp of Existing 9 Plumbin I 4Q 00 I _ oervhr ------ --- �beGaily Requested Inspections —� 4000 rrsorg use of oenhr I xW" or property _—_ Rain Crain single famny dwelling 30 30 'noosed use of Grease Traos 9:0 nwlding or property QUANTITI TOTAL Are ycL :.aoping, moving or replacing any flxtures7 Yes Q No❑ Iscrretrc x•iser jagram.s reauwm rt Cuanity Totals >9 )If yes see back of form) 'SUBTOTAL I therebv ackriowledge that I ha-.e read this application,that the information -— -- 25- ven.s:.owed.teat I am the owner or authorized agent of the owner.and 5% SURCHARGE 1 'nat dans su mined are.n comolle es with Oregon State Laws. _ �-- 3ign�rie OwneriAgent Date PLAN REVIEW 25% OF SUBTOTAL I — q geoused only I Itimmue atv.otai s,3 C TOTAL �onrscf non Name Phone -- r 'Minimum permit fees S25• 5°'6 surcharge.cil except Residential Backflow Prevention Cevice which is S15 • 5%surcnarge i:tdstmplmapp.doc 9196 pL,�E COMPLaTJ=AS APPRQPRIA,TE TQ PROJECT: rFixtures to be capped, moved or replace—Qty j Sink _— �Lavatory Tub or Tub/Shower Combination Shower Only _— Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain 2" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: CITY OF TIGARD BUILDING INSPECTION ',tVISION 24-Hour Inspection Line: 639-4175 Business Ph,ac: 6394171 N_�•� �h Date Requested: 1 A.M. P.M._ MST: / L Location: 13 CJ S BUR —-_--- Tenant: _ Y __ (J Suite: Bldg- MEC: Contractor: PLM:_ ui/ a7 Owner: Phone: -590 —(77I _ ELC: ELR: SIT: BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE Site Post/Beam Post/Beam ocCh3�4f'"" Cover/Service Sewer/Storm Footing Roof UndFVSiab Rough-hi Ceiling Water Line Slab Framing Top Out Gas Line Rough-In LIG Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shcar/Sheath Fire Spklr/Alm Crawl/Found Dr I lea ATump Low Volt Approved ApprovedApprov Approved Approved Appr/Sdwlk Not Approved Not Approved oved Not Ap Not Approved FINAL FINAL FINAL. FINA FINAL VIA S 9 — �"__ r� • a I for reinspection 0 Reinspection fee of S_--_req 'red before next inspection 0 Unable to inspect tor._—_`_ ----_—_-- Date:_._ Page of CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Phone: 639-4171 Date Requested: 8 9 i M. P.M. MST: 0.505U.5- Tenant: Location: � � —� BUR ----- —�-- T— Suite: Bldg: ME Contra _ ontrt►ctor: a�=Z 70 W Phone: y PLM: _ Owner: -- _Phone: _ l(J / 7 ELC: ELR: BUILDING BLDG(con't) PLUMBING SI7. Site 77!it+tECHANELECTRICAL SITE Post/Beam Post/Beam Cover/Service Footing Roof UndFl/31ab Rough-In Sewer/Storm Slab Bh Ceiling Water Line Foundation Framing Top Ch►t Gas Line Rough-In UG Sprinkler Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Mason Temp Service MISC. ry Ceding Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/I'ound Dr Ficat Iluilip Low Volt Approved Approved C Approved Approved Approved Appr/Sdwlk Not Approved Not Approved =,,,A,, ed pprFINALNot Ap Not Approved FINAL. FINAL: FINAL ct — Ch (VV5 1 e.) A-en 9 QL 'Ofor inspection D Reinspection fee of S req 'red before next inspection O IJnable to inspect pectot:_ -- — Page of _ c DEPARTMENT OF LAND USE b TRANSPORTATION WASHINGTON LAND D%-VELOPMENT SERVICES DIVISION 155 NORTH FIRST,HILLSBORO,OR 97124 COUNTY, INSPECTION REQUESTS: 503/640-3561/693-4415 OREGON Page • 1 Date 05/20/97 Time 16 : 54 Permit Type RESMECH Permit # 05095'055 Permit Status APPROVED Applied u5/20/1997 Site Address 13465 SW HOWARD DR TI Issuers 05/20/1997 Permit Descr. SFR - GAS PIPING Completed 1 TO 4 OUTLETS To Expire 11/16/1997 Project # P0068823 Valuation S . GO Parcel Number 2S1 03CA 006u1 Legal De :cr . ACRES . 35 ( FROM A&T: 05/10/915 ) Owner WEEKS, JACK A ELIZABETH EConstruction C1'T'Ei Appl4.cant Name COLUMBIA HEATING Classilication 800 Applicant Addr . P, O, BOX 230397 Occupancy TIGARD, OR 9'7281 Validated By '1'LM Inspector Area Applicant Phone 624-2704 Applicant Fax Also is CONTRACTOR ---------------------- Permit Fee Oblieiatiun. . . . . . Permit Account Status . . . . . , Mechanical Fee . . . . iz . UI1 Fee:,, Calculated $12 . 6u Fees Due $12 . 60 State Surcharge . . . bO Payments to Date : $12 . 60 PERMIT BALANCE $ , Ou NOTICE This permit becomes null and void If the work or construction for which It Is Issued!a not commenced within 180 days Once construction has started, the permit becomes null and vold If construction is Interrupted for a period of 180 days I certify that the Information presented by the applicant and his agent or agents in support of this permit Is true and correct to the beet of our knowledge. I acknowledge that the Building Department's reliance upon false and misleading Information may Invallrlste this permit All provisions of applicable laws and ordinances governing the construction and use of this building or structure will he compiled with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that the granting of a permit does not grant authority to access private property or to use e.isements. I further acknowledge that tire use or occupancy of the Wticture or building permitted depends upon my calling for Inspections at various times during the process of construction and the building Inspection staff verifying compliance with the various codes, Use or occupancy of the bullding or structure permitted prior to approval by the Building Department Is solely at the risk of the applicant and such use or occupancy is revocable until all Inspection requirements are satisfied and approval la given by the Building Official. I further acknowledge that a Ilan may be placed on the title of the property upon which the permit Is issued specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requirements. APPLICANT'S SIGNATURE MR,r ;_43—'a7 05 "P14 RM F. 02 WASHINGTON COUNTY Department of Land Use 8 'rtansportatlon RESIDENTIAL Mechanical Inspection Section MECHANICAL P E R ISI IT 155 North First Avenue, X350-12 Hltishoro, Oregon 97124 Information: (503) 640-3470 Pax: (503) 681-3993 ProincU � (r Inspection Requests.. 503 681.3699 or 681-3698 p q ( ) Permit Number PRINTand complere PERMIT FEE SCHEDULE ame of ev prnent — - - e 1QO/1 Oo / i)� PIRMIThtsUANCEFEE ltt Addres L/��• DESCRIPTION OTY, COST IEa I AMOUNT �s FURNACES Mij No Tax L t uptu loo.uUUBTU s.cru Job incluLrrq d,•twcrk over 10(7.000 BTU 5n r Address OR1�g a9f. Section a,d vents Map Boot, - Directions toSIfB HEATERS suspended,wal!or floor-mounted 800 or Cross Street AIR HANDLING- -! - UNIT up to 10,000 CFM 4.60 T_ AIR CONDITIONER over 1o,U0r1 CFM - _7.S0 I`tarno (or No a °f B mess HEAT PUMP 7.� _ Qac k-� �� ALTER EXISTING SYSTEM -- -- - 4.50 Mailin Address __-- Owner F+ REPAIR OF EQUIPMENT LISTED PROVE 0.00 Cd titate il' Non piMahle EVAPORATIVE COOLER 4.50 hurle VENT FAN :onhected to single un I 100 VENT not inchrded m Appliance Pern,t_ lov N, . �I VENTILATION SYSTEM not ire•I App PMA 4,50 Uflkbi cLA>?L�T!� --- — 1A 1Hnnrl served by meth exha110. 4.50 r rens _ x)'�-�321— — —.� . .-- - - - --- �1 L7 DOWN DRAFT FOR RANGE 3_tx1 Contractor city t., -'Zip ------ [ WATER HEATER VENT_ _ 4�r1 01 Z 3 ._ --- I INCINERATORS dwmesh,typ- ' _ 7 50 - Siete WOOD STOVES FIREPLACE --.- 4 M) Rr it;trntion No SOLATI SYSTEM 4.SU ------ ---- --- a hereby acknowledge that I have rend thle application, CLOTHES DRYER rhar rho Informarlort given Is correct, that I am the nwnpr / 4A9 PIPING or euthnrlred agent or the owner, that plans submitted - Ito 4 outlets 200 UV are In rompllonee with Srafe Iaws, that!am ragisfornd eachadddionNl Su wlih the State Builders' Hoard, that the rrrgistration - - -`- - —_i— number given is correct. (If exempt from State reg/sera- tion, please givo ranson hrrro) OTHER SUBTOTAL R'S of n.rblolal fn,St:lm Surcharge yy , nal TNUSTACCnUNT tea✓ z n _ Receipt No TOTAL FEE DUE uth a Siynet - fJa c APPROVED BY D I e work O new oaddRlon rl alteration []repair - natn . ._._._.._.__._ Date Issued ^� NOTICE: This permit becomes null and void If the work or construction authorized Is not commenced within 180 days, or if construction or work authorized is suspended or abandoned at any time after work is commenced. [.c7 1,'41 -,AFrORDABLE o© �� SEPTIC SERVICE P.U.90X 1130 WILSONVILLE,OR 97NO (503) U24929 FAX 1503) 570.0779 r cUs10MER'sORDFRNO PHONE/ DAiE, _ a- NAME �1 - AD s5 - � _ _ 801D� CAS H G.O.D. CHARgE ON ACCT. MDSE.RET'D. PAID OUT — i j I J /�� —--t— I _ I I � I I y I I I � I ' Ic I _— _""—-- TAX I RECEIVEb 11 TOTAL All claims and re oods MUST be accompanied by Ihic hill r°' ft.' or vin�oTHANK YOU qtr 22�.6'1RD Dm