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12030 SW LINCOLN AVENUE-2 � o � Ak tj J� rt c.�• 74 -- .i' A ` ;' ' ore v -Z ...� �' _�- r�- .., �-��.�� ,�.,..� � i -�- � Ems►' ..�.. �. , 1T fie. /44 pmftK �i!�...___A ) ar...k.s . V Of - L t> • { t Z — .�. .. �/ . rr... ;m, } A.. . • V rAl MxI &ZT'A* Haft• & 1. M *pb ta► 1 ' © s 1 D q 4 VJ o Q _-_ . tom.�.�� � tom. �.t•a �.�.. — 0 ul T- r Y Tl'- o r i x John D. Annand, II NCARB Architect 8260 C.W. Hunziker Rd. Tigard, OR 97223 15 em " I � ` F. .� __ . �1 1.. +�► -_.., A si . rm Oak, :._ .e. _ C»G'�►•� ►`11 .�."`"lam ` -'U L fE, row I Q L Ci 2, R. S E. I AN L As, b > I 7I � Irl 1203 0 S . e L 1 �,4 CCoL N S1%-%JUVmmm `#r 14z , ^bk ilomlp* c� R.. ems► 'NOTICE: IF THE PRINT OR TYPE ON ANY ' lli IIIIIII IIIIIII IIIIIII IIIIfl1 III III III I I III III III III III III III I � I III III III III III ill IIII III III III 1 ( 111 1 .( li III 1111111 III III 1111111 I I I I I I ( I I I IMAGE IS NOT AS CLEAR AS THIS NOTICE, 2 3 4 6 7 $ 9 1 11 12 IT IS b U E TO THE QUALITY OF THE -- - -- ._.. -------------_. __--- -- — — ---- ------ No 38 ��.��..�.----------- ORIGINAL DOCUMENT 0 I; 6Z 8 Z G Z o 7 1 19 Z V Z E z Z T Z OZ 6 i 8 I S L I 9 I 5�I � t '11, T Z TI I T T 6 8 L 8 9 V E Z T ��tli�w1 Illl�illllllllllll!I IIII IIII IIII IIII�II!illllll�lllllll III IIII 11111111111111111 illllllllllllllllll I� I I � I I I I I I I I I I ,IIII .I I i I I I I I l l l�l l ill IIIIII I I I I I I I I I I I I �I I I��I I I I I l l l l ill I l l i Ll l I I I I LI I I Li l 1. lla.l � 111, 1-1.11 I ll ll 1111 � .�� 111111111) �. - N 0 w 0 N r 0 5 D 0 c c� i a t .— 12030 SW Lincoln Avenue CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST BUP — _ _____Date requested AM L� PM BLD — - Location /2 �_, J >�' it ��,.. 14 L-a Suite MEC _ Contact Person ��� Ph l Jy SZ' PLht -C J' '.) S _ mac' i !� � - Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall Footing ELR Foundation Access: Y FPS Ftg Drain - t.,. i"i r> " Crawl Drain Inspection Notes. - SGN — _ --- Slab Post& Beam -- --- ---- —---- ---- --- - SIT Ext Sheath/Shear Int Sheath/Shear ------`----�-- Framing Insulation ------ ----- ---- ---__--- ----Drywall Nailing Nailing Firewall Fire Sprinkler __ _. - - -- ------ ----- ------ - — -- -- Fire Alarm Susp'dCeiling -- - --- --_---- --- ---- -_- - -- -- --- ---.. Roof Misc -------------- Final -----------_---- -..._ PASS PART FAIL ---- —_.- ____.____- ---- -----------__-__-- --_--- -- Past&Beam ----- _ ----- __--- --- -- - --- - ------ Under Slab 0p0 - Cat Sanitary Sewer Drains 11§S PART FAIL Post R Beam -- --- --- Rough In __-- Gas Line ------ Smoke ------Smoke Dampers Final PASS PART FAIL 4 ELECTRICAL - -- Service --------------- Rough In - _---- - - —_---- --------_-- _____ UG/Slab - --------- - ------ - - Low Voltage Fire Alarm Final "-- -__ -- ---- ---------- --- PASS PART FAIL SITE ------. . — ------ BacktilliGrading ---- -- - - -- - --____ Sanitary Sewer Storm Drain ( ]Reinspection fee of$ _ `required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ] Please call for reinspection RF --__— _- ( ]Unable to inspect-no access ADA Approach/Sidewalk1- 7, L Other Date2 - c / Inspector S, /L C. �Z /cr✓E Ext Final PASS—PART --FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD MPERMRTFIEERI"IT. . . : MST98-0:71 DEVELOPMENT SERVICES DATE ISSUED: 11/30/98 13125 SW Wall Blvd., Tigard,OR 972.23(503)639.4171 FDARCEL.: F-'S 10c'A19--0090 _ SITE ADDRESS. . . : 12030 CW I-..I Nl,01..-N AVE__ SUBDIVISION. . . . :KTMBERLY ADDTTI()N 7_DNTN(3: R-7 BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :00":' JL.IRTSDICTION: TTG-; Remarks: Annand addition to SFD -------------------------------------------------------- ----- BUILDING -------------------------------------•-------------------------- REISSUE: STORIES.......: 1 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED------------- CLASS OF WORK.:ADD HEIGHT........: 16 FIRST.... 1092 sf GARAGE.....: 0 sf LEFT,.........: 5 SMOKE DETECTRS: Y TYPE OF USE...:9F FLOUR LOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0 TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 9 sf RIGHT......... : 0 OCCUPANCY GRP.:R3 BDRM: 1 BATH: 2 TOTAL------: 1092 sf VALUE..S: 76047 REAR..........: 15 -- PLUMBING ---------------------------------------------------------------- SINKS.. ------------------------------------------------.-.SINKS.. ......: 1 WATER. CLOSETS.: 2 WASHING MACH..: 1 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0 LAVATORIES....: 2 DISHWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 0 TUB/SHOWERS... : GARBAGE DISK..: 1 WATER HEATFPS.: 1 WATER LINE ft: 0 BCKFLW PRFVNTR: 1 GREASE TRAPS..: 0 OTHER FIXTURES: 0 --------------------------- - ----- MECHANICAL -----------•-------------------•---------------------------------- FUE1. TYPES----------- FURN ( 100K ..: 1 BOIL/CMP ( 3HP: 0 VENT FANG.....: I CLOTHES DRYERS: 1 GAS FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES.... : 0 GAS OUTLETS...: 1 - ----- -- - ELECTRICAL -------------------------------------------------------------- --PFSIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-- 1000 Sr OR LESS: 1 0 - 2@0 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP!IRRIGATION: 0 PER INSPECTION: 0 EA ADD'L 500SF.: 1 201 - 4@@ alp..: 6 201 - 400 alp..: 0 1st W/O SVC/FDR: 0 SIGN/9111 LIN LT: 0 PER HOUR......: 0 LIMITED ENERGY.: 0 401 - 600 asp..: d 401 - 6@0 asp..: 0 EA ADDI. BP CIR: 0 SIGNAL/P91EL...: 0 IN PLANT......: 0 MANF HM/SVC/FDR: 0 601 - 1000 asp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0 1000+ asp/volt.: 0 ------------------- ------ PLAN REVIEW SECTION - ------- - - - ----- Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC: --- ELECTRICAL - RESTRICTED ENERGY —------—--------------------------------------..-_ A. SF RESIDENTIAL------------•--_-__. B. COMMERCIAL---------��� --------------------------------------------•------------------ AUDIO 6 STEREO.: VACUUM SYSTEM..: AUDIO 6 STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM..: DTH: :: BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTEZTIVE SIGNL: GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHP,: HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL. R SYSTEMS: 0 Owner: -- - - ---------Contractor: ---------------------------.---- TOTAL FEES:$ 1339.47 EDNA ANNAND BERG ENTERPRISES This pareit is subject to the regulations contained in the X1640 SW LEBEAU RAY LEE BERG Tigard Municipal Code, State of Ore. Specialty Codes and all SHFRWOOD OR 22895 SE VAN CUREN other applicable laws. All Nark will be done in accordance EAGLE CREEL! OR 97022 with approved plans. This permit will expire if work is Phone (1: Phone M: 637-3572 not started within 180 days of issrlance, or if the work is - Reg A__: 19586- suspended for, more than 180 days. ATTENTION: Oregon law --_ --------------------------- requires you to follow rules ado,'ed by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952401-0080. You may obtain copies of these rules Or direct questions to OIJNC by calling (503)246-1987. -- REQUIRED INSPECTIONS ----------------------------------------------- - _ Erosion 844-8444 Crawl Drain/Bark Electrical Rough Insulation Insp Building Final Footing Insp PLM/Underfloor Framing Insp Rain drain Insp - Foundation Insp Mechanical Insp Shear Wall Insp Electrical Final —- Post/Beam Struct Plumb Top Out Low Voltage Mechanical Final — _ —_— Post/Beam Meehan Electrical Servi Gas Line Insp Plumb Final - Issr-:ed By: Permittee Signattr-:rem 4-4-+++-+-+ ++++1 ++++ +-+i++++•F•++•+++++-+ + +-++++++++++++ + .►+ ++.+ F{.--+ +.{ 1 i Call 639.-4175 by 7:00 p. m. for an inspection needed thy, Trext br-rsiness day r Plan Check# �r CITY OF--;.I(-;ARD Residil.I Building Permit Application Recd By 13125 SW HALL BLVD. New Const)uction Additions or Alterations Date Recd L, TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E. G�Trvff-?".e V 503-639-4171 Date to DSTI, �1+F F .503-684-7297 Permit# ."/t Print or Type called r i'% a� ncomplete or illegible applications will not be accepted Name of Protect Name Job ALF��t V7,E r-.3 ..acv 1-4 Ill t>. l�r_J Int Atai �t7>C,>i T I C' Mailing Address Address Site Address - Architect 9 1 2.c)?ac.- S. J. tt�l�_"LN 8 2.Ca v S•w: 1-t V til 2-1 1•t E M_--- City;State Zip Phone L 1j:>"A /a r.;-A/-. r_..1 l� T 1 A 1 1 Name Own,)r Mailing AddressY _ Engineer Mailing Address City/State Zip Phone g _ 7H r=IL,^/<wLvCity/State —7.ip Phone General Name Contractor "T5E_42t_-j t.-t-/LEI pF'(Lt`>�'.c}3 Describe work New O Addition i Alteration O Repair O Mailing Address to be done _ Prior to permit le,r/•5- } V4 r ;�,/ P4a ciJitional Description of Work: ' issuance. accoy City/State Zi Phone or all licenses Ia ��i� are required if Oregc r const.Cont. Board Exp. Date PROJECT er.oired in COT Lic# f Q,[� !� Z VALUATION $ ��r� database _ _ — . r Mechanical Name 777��� NEW CONSTRUCTION ONLY r Sub- � ,t l K. 1�_��,J t� - Sq Ft. House: Sq Ft. Garage Contractor Mailing Address //)%j- __ P or to permit �U r �, �= Corner t.ot YES NO Flag Lot _TYES NO issuance, a copy City/State Zip Phone (check one) (check one) of all licenses C U , z,)^ Restricted Audio/Stereo Burglar are required if Oregon Const.Cont. Board Exp Date Energy System Alarrn exoired in COT Lic# Qatabase 11 7bz- g Installation Garage Door HVAC --� Name -- —-- Opener Systems Plumbing — Sub- (check all thatOther: Mailing Address apply) _ Contractor g __Will the electrical subcontractor wire for all YES NO 4 A c-,:, r,r4 5m_ restricted energy installations? Frior to permit City/State Zip Phone Has the Subdivision Plat recorded? N/A YES NO issuance, a copy f ,Q.rt_ ) 1141 of 311 licenses are Oregon Const Cont Board Exp. Date -- required if Lic# _ Solar Compliance e,prred in COT 12 Z 114L� •; � f 3 (Calculation Attached) database Plumbing Lic # Ex6. Da I hearby acknowledge that I have read this application,that the cJ �t Q`7 information given is correct,that I am the owner or authorized Name agent of the owner, and that plans submitted are in compliance -J with Oregon State laws. _ Electrical C�1J j�Rc:� t_ti,_�,g �_ _ �, Signature of Ow_ ner/Agent iDate SUb- Marling Address S (Wi- L'/9 Contractor �(� Jam; j ii xi,oij t,`S_ C-6n act P rson Name Phone# CityiState zip Phone S L:It a,._•} /"*-,. Prior to permit `i) rZ— FOR OFFICE PSE ONLY: _ ssuance. a copy A/i 04111-10 C42- Plat#: C _L n�� Map of all licenses are Oregon Const Cont. Board Exp. Date required if Lic# Setbacks: Zone: Solar. expired in COT • database Electrical Lic # Exp Date Engineering/Appro af3 Planning Approval: TI : I SFREM.DOC (DST) 4T7 I ���a v� � �� �;� Solar Balance Point Standard Worksheet Address Box A calculations: North-Soi:!h dimension for the lot. Box A: This dimension is determined by fi iding the midpoint of the North lot line and .drawing an intersecting line perpendicular i.o that point. First, determine which property line is the North lot line. The North lot line is the line with the smallest angle from a line drawn east-west and intersecting the northern most point of the lot. 45° XT tN North-South Dimen-,ion for Lot: Measure the distance from the midpoint of the North lot line to the South lot line along the described line. ! _ feet 1 �,r�"'�NOf71N50UM fAMENSIUN J Box B calculations: Shade point height for your residence. Box B: 1. Determine whether measurements will be based on the peak or eave of your lWhich describes structure. The orientation of the ridge is also important. your residence? 1 a: If the roof line runs North-South, measurements willM (circle one) be based on the peak of the roof. Q o o IM �" _► 1 A 1 Bi 1 b: If the roof line runs East-West and the roof pitch is less than 5/12, measurements will be based on the eave. 71H7E P0114i EA�f 1 c✓ If the roof line runs East-West and the roof pitch is 5/12 or steeper, measurements will be bi,sed on the �� � peak. I i Box B. continued Box B: 2. Measure change in elevation from front property line to finished floor elevation. If the lot slopes up from the front lot line to the foundation, the figure is positive. If the lot slopes dow- from the front lot line to the foundation, the figure is negative. —C> -- 3. Measure distance from finished floor elevation to the affected peak/eave. + — ft 4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, ft deduct nothing. 5. Subtract one foot for aach foot of difference in elevation from the front property line to the rear property line, if the lot slopes up from the front to the rear. If the lot has no slope or slopes up from the rear to the front, deduct nothing. - ft h. Total figure for box B: ft Box C. Distance to the shade reduction line. Box C: 1. Measure the distance from the North property line to the foundation near the 3' ft affected peak/eave. 2. Measure the distance from the foundation to the affected peak or eave. 5 ft 3. Total figure for box C: 3 __ ft i It is most useful to draw a vertical line to represent the appropriate figure fot nd in box "A"and a horizontal line to represent the appropriate figure found in box "C". The intersection of the vertical and horizontal lines determines the value found in box "D". The value in box "D"should be compared to the value in box-V' if the value in box "8"is less than or equal to the value found in box"D", then the building is in )mpliance with the solar balance rode. If you have any questions, please contact us at 639-4171,x304 of at the Communiry Development Counter. MAXIMUM PERMITTED SHADE POINT HEIGHT (In Fee!) Distance to North-south lot dimension fin feet) shade 100+ 9'; 90 85 80 75 70 65 60 55 50 45 40 red, coon line froi.i northern lot lin_ a(in feet) 70 40 40 40 41 42 43 44 65 39 38 38 39 40 41 42 43 60 36 36 36 37 38 39 40 41 42 55 34 34 34 35 36 37 38 39 40 4' 50 32 32 32 33 34 35 36 37 38 39 40 45 30 30 30 31 32 33 34 35 36 37 38 39 40 28 28 28 29 30 31 32 33 34 35 36 37 38 35 X16 26 26 27 28 29 30 31 32 33 34 35 36 30 24 24 24 25 26 27 28 29 30 31 32 33 34 25 22 22 22 23 24 25 26 '7 2829 30 31 32 20 20 20 20 21 22 23 24 25 26 27 28 29 30 15 18 18 18 19 20 21 22 23 24 25 26 27 28 10 16 16 16 17 18 19 20 21 22 23 24 25 26 5 14 14 14 15 16 17 18 19 2.0 21 22 23 24 Box D. ,tiiaximurn allowed shade point height: _ 1 _ feet ` I h �docs\nancvrventurawlar chp Revised 2,'26/96 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Lillie: 639-417 / .t y � v� BUP Date Requested AM PM BLD — Location I Z��b _�� .{� Suite `, AEC Contact Person L��� PhIPLM —�— Contractor —_ h SWR BUILDING — ~ Tenant/Owne- ELC _ Retaining Wall _ — ELR Footing A,,:e`;5 -- -. Foundation FPS Ftg Drain �`-� �"J S SGN Sl - awl Drain Inspection otes — --- — Slab — SIT Post&Beam -- -- Ext Sheath/Shear Int Sheath/Shear — Framing Insulation ------ ------------_-_—._----_------ --- Drywall Nailing Firewall _.._, ____-- -----_ -------------- _ -- ----- Fire Sprinkler l Fire Alarm ----- Susp'd Ceiling ---.__—..— -- ------ ---.-.._.._ -------- --- Roof Misc: - --------- Final PASS PART FAIL --------_-.__-__ -- -----��--- ___ PLUMBING Post& Beam -- - ---- --- Under Slab Top Out - -- Water Service Sanitary Sewer - Rain Drains Final - ---- - _._----- --- -- PASS PART FAIL MECHANICAL Post&Beam - _.._ _ ------ --- -- Rough In Gas Line - - - Smoke Dampers Final - -- - -- - -- -- PA3 PART FAIL Service Rough In - ------__------------ - -- UG/Slab Low Vo" e - Fire AIarrr. firM- � - ------- — - ---- ------ rAS ' e✓�^RT FAIL Backfill/Grading — --- ---- Sanitary Sewer Storm Drain ( J Reinsp,�ction fee of$ required before next inspection. Pay at City Hall, 13125 SIN Hall Blvd Catch Basir. Fire Supply Line f I Please call for reinspection RE -_— I I Unable to insnect-no access ADA Approach/Sidewalk Date _ Other __-- -- Inspector - -� Ext Finpi PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-1-lour Inspection Line: 639-4175 Business Line: 639-4171 BUP — —�_r, ale Requested ��� '9 11 AM- L4E-e, PM BLD Location_—( 1.L N Ln Lc_�_0 Suite /" MEC _ Contact Person C_ — — Pht'"tY� 7(o PLM Contractor Ph SWR Tenant/Owner ELC - e dining Wall EL.R _ Footing Access: — Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes; -- - Slab - SIT Post&Beam Ext Sheath/Shear _ Int Sheath/Shear --- Framing �`d t.jAZ5 �i�lruS �T•T'�sT At'i'1 "TZ . Insulation Drywall Nailino. q 20 'Iii . QA," 12c szti z P-V Jr yr i,�� Firewall Fire Sprinkler -�s_AQ li✓l5� Fire Alarm Susp'd Ceiling — Roof Misc: - --- - - - ------ $ _PART FAIL ---_--- ------- ------ 6 Post& Beam - ---- -- -- ---- Under Slab Top Out - - — Water Service Sanitary Sewer _ - -- Rain Drains Final PASS PART FAIL Post& Beam ---- - -------- --- - -- - - -- ---- Rough In Gas Line - - - -- Smoke Dampers rtnpL, - - --- ----- - -- — Vj PART FAIL CTRICAL -- -- ---—---- ------ -- Service Rough In ---- UG/Slab Low Voltage Fire Alarm — -- ---- ---------- -- -- -- Final PASS PART FAIL- _..-- -------- ---_---- _ SITE Backfill/Grading Sanitary Sewer Storm Drain I 1 Reinspection fee of$ - _ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line f 1 Please call for reinspection RE' _ [ )Unable to inspect-no access ADA Approach/Sidewalk Date G-- 2 `I S Inspector Ext Other ------------ Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: P 002.55 13125 SIAI Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/11 8/01 8/01 SITE ADDRESS: 12030 SW LINCOLN AVE PARCEL.: 2S102AB-00902 SUBDIVISION: KIMBERLY ADDITION ZONING: R-7 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: V URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 40 t; DISHWASHERS: RAIN DRAIN: ft Remarks: Install 40'of water service FE_ ES Owner: -- — -- Type By Date Amount Receipt SA.KATA-ANNAND, EDNA N + PRMT CTR 6/18;01 $72.50 27200100000 ANNAND, JOHN D II 5PCT CTR 6/18/01 $5.80 27200100000 12030 SW LINCOLN AVE TIGARD, OR 97223 Total $78.30 Phone 1: Contractor: EARL WISDOM 3966 NE GARFIELD PORTLAND, OR 97212 REQUIRED INSPECTIONS Phone 1: 503-528-9551 Final Inspection Reg #: L!C 122960 PLM 26-620pb 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 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. Issued B y: �� _ � ` ' Permittee Signature: --,� ----------=� ^ --____----- ( Call (503) 6394175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application -QI C Date received: Per i ti CityCit of Tigard — - b Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- ('ifynf7igard phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: _— Case file no.: Payment type: I &2 family dwelling or accessory U Commercial/industrial U Multi-family U'Tenant improvement U New construction U Addition/alteration/t•eplacement U Food service U()cher. Job address:/ � (J �(,C� p Description Qty. Fee(ea.) Total Bldg.no.: Suite no.: New 1- and 2-family dwellings only: Tax ma /tax lot/account no.: (includes 100 ft.foreach utility connection) P SFR(1)bath Loc Block: Subdivision: _ SFR(2)bath ------- T Project name: _ SFR(3)bath _ City/county: c ZIP: Each additional bath/kitchen Description and x ation of work on premises:'e Site Wilities: Catch hasin/area drain _ Est.date of completiorihnspection: Drywells//leach line/trench drain Footing drain(no. lin ft.) _ Manufactured home utilities Business name: f e- D& "aiovl( _ Manholes _ Address: ��, / , -ir/ Rain drain connector City: 114' Sanitary sewer(no. lin.ft.) Fax:_v E-mail: Storm sewer(no.lin.ft.) CCB no.: Plumb.bus.reg.no: (o -fjp10� Water service(no.lin.ft.) City/metro tic.no.: fixture or Item: Contractor's representative signature: Absorption valve Back flow preventer Print name: 250,A 4L k// Daae:(i /r—cy/ Backwater valve Basins/lavatory Clothes washer Name: L.s��2� 601 S Df'M ----• Dishwasher Address Drinking fountain(s) City: State: ZIP: Drinking _ Phone:03 .3gtr 7$5 Fax: I E-mail: Expansion tank Fixturelsewer cap _ Name(print): �/,G�,fyji� Floor drains/floor sinks/hub Mailing address: —— Garbage disposal - - — Hose bibb City: State: ZIP: _ Ice maker Ph (o�� �r%, . k Fax: E-mail: Interceptor/grease trap Owner instal lation/residential maintenance only: The actual installation Primer(s) will he made by me or the maintenance and repair made by my regular Roof drain(commercial) _ employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's si nature: Date: Sump Tubs/shower/shower pan Urinal Name: — Water closet Address: _ Water heater City: State: L.IP: Other: -- _ -- Phone: Fax: E-mail: Total Not all lurixdictions accept credit cants.please call juriWiction fot nwtr informationMinimum fee................$ Notice:'Phis permit application — U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ _ Credit card number _ _ / L- within I RO days after it ha been Slate surcharge(891,) ....$ — Expires — Name of cerefholdrr as shown no credit card accepted as complete. TOTAL. .......................$ _ S — — —Cardholdersisnemrc Amount 440 4616(6K)WOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (Indlvldual�_ QTY_ ea AMOUNT (Includes all plumbing fixturos in PRICE TOTAL ;,ink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT for each utlli connection Lavatory 1660 One(1)bath $249.20 Tub or Tub/Shower Comb 16.60 Two 2 bath _ $350.00 Shower Only 16.60 Three bath - -` $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8•/.STATE SURCHARGE Dishwasher 16.60 - PLAN REVIEW 25%OF SUBTOTAL _ Garbage Disposal --- - 16,60 -- - - _ TOTAL ---- --- Laundry Tray 16.60 - Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 1660 -- - PLEASE COMPLETE: 4" 16.60 Water Heater O conversion O 'ike kind 16.60 JW QuanTy b Worn 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 Now San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 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 sl 100' - 55.00 -- 3- -- Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water neater Water Service-each additional 200' 46.40 Other Fixtures (Specify)_ Storm&Rain Drain-1st 100' Storm&Rain Dain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 - - Residential Backflow Prevention Device 2755 - ---- Catch Basin 16.60 - InSDectlon of Existing Plumbing or Specially 72.50 Requested inspections - - er/hr- COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 Grease Traps -- - 16.60 __ ,-- --- --- - QUANTITY TOTAL - Isometric or riser diagram Is required if Ouantil Total is >9 `SUBTOTAL - -- -------- - ---- 8%STATE SURCHARGE -- --- -- - --- "PLAN REVIEW 250,1)OF SUBTOTAL Required ons if fixture city total is>9 TOTALp r `Minimum permit fee is$72 50+8%state surcharge,except Residential Backflow U Prevention Device,which is$38.25+8%state surcharge "All N:;w Commercial Buildings require pians with Isometric or riser diagram and plan review I\dsts\forms\plm-fees.doc 10/10/00