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Permit CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2004 -00370 IIii DEVELOPMENT SERVICES DATE ISSUED: 1/12/2005 -- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 07817 SW BROOKLINE LN PARCEL: 2S112BA -BT015 SUBDIVISION: BONITA TOWNHOMES ZONING: R - 12 BLOCK: LOT: 015 JURISDICTION: TIG REMARKS: New SFA. BUILDING REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 32 FIRST: 77 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 585 sf GARAGE: 470 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: 633 sf RIGHT: VALUE: 133 OCCUPANCY GRP: R3 BDRM: 2 BATH: 3 TOTAL: 1,295 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOILICMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EAADD'L 500SF: 2 201 - 400 amp: 201 - 400 amp: 1st W/OSVCIFDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNALJPANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v. MINOR LABEL: 1000+ amp/volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,219.77 This permit is subject to the regulations contained in the JLS CUSTOM HOMES JLS CUSTOM HOMES Tigard Municipal Code, State of OR. Specialty Codes 16280 NW BETHANY 16280 NW BETHANY and all other applicable laws. All work will be done in BEAVERTON, OR 97006 BEAVERTON, OR 97006 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 533 - 4006 Phone: 503 - 533 - 4006 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 139970 rules are set 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 Ersn Cntrl 681 -4444 Ftg Drain Bsm't Walls Mechanical Insp Gas Fireplace Structural welding final Water Service Insp Sewer Inspection Slab Insp Plumbing Top Out Insulation Insp High strength bolts fina Smoke Detector Footing Insp Plm /undslb Insp Framing Insp Shear Wall Insp Rain Drain Insp Electrical Final Foundation lnsp Electrical Service Roof Nailing Exterior Sheathing Insc Storm drain Insp Plumb Final Wtr Proofing Bsm't Wa Electrical Rough -in Gas Line lnsp Firewall Insp Water Line lnsp Mechanical Final Issued B W1..t Permittee Signature : p . i�o- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00370 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/12/2005 Phone: (503) 639 -4171 ° �.��� , �'WP��l�i�ilfi i,l ' Inspection Requests (24 Hrs.): (503) 639 -4175 _..' __,. INSPECTION WORKSHEET FOR DATE: 2005 TIME: 7:13AM PAGE: 50 SITE ADDRESS: 07817 SW BROOKLINE LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 015 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503-533-4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503.533 -4006 Inspection Request Scheduled For: Date: 6/6/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 008522 -02 503-642-2800 N Corrections /Comments /Instructions: c ? o ff s w/ S A$12k V scprx14 . kS ©tk lea Irl L' YCI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1� Inspector: Date: b - 2 -, Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004- 00370 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/12/2005 Phone: (503) 639 -4171 � °m. "' °1' "U��gp��ifhfl�`�\ Inspection Requests (24 Hrs.): (503) 639 -4175 �_'!- INSPECTION WORKSHEET FOR DATE: 6/8/2005 TIME: 7:12AM PAGE: 16 SITE ADDRESS: 07817 SW BROOKLINE LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 015 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503- 533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503-533 -4006 Inspection Request Scheduled For: Date: 648/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 008742 -02 603 -209 -6038 Y P,"1 Corrections /Comments/ Instructions: / FI &X 1 ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: / Date:" 1 (/v #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00370 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/12/2005 Phone: (503) 639 -4171 fl l �'�� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/8/2005 TIME: 7 :12AM PAGE: 15 SITE ADDRESS: 07817 SW BROOKLINE LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 015 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503- 533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503 - 533 -4006 Inspection Request Scheduled For: Date: 6/8/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 008742 -03 503-209.6038 N Corrections /Comments/ Instructions: OA • SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ir in.. Date: I Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00370 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/12/2005 Phone: (503) 639 -4171 �niijj1b41 °NIiIINIi Inspection Requests (24 Hrs.): (503) 639 -4175 .. ___ INSPECTION WORKSHEET FOR DATE: 6/10/2005 TIME: 7 :05AM PAGE: 5 SITE ADDRESS: 07817 SW BROOKLINE LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 015 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503 - 533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503 -533 -4006 Inspection Request Scheduled For: Date: 6/10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 008993 -04 503-209 -6038 N Corrections /Comments /Instructions: [ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITI NA FEES ASSESSED d 7i1 f / Inspector: AMPIAL _ Date: (77 Phone #: (503) 718- 1- Building Permit Application FOR OFFICE USE ONLY ' ` s City of 'fig Lipt . � D Received t� ) DaleiBy: i3 r�7 /sY / Permit No `yam Q eTr�// (/ /JJ�'.2� 13125 SW Hall :v v.1 . • 7 2 Phone: 503.639.4171 Fax. 503_598.1960 �lf DateBy r ^ ,�� 0 Y/ $ Other PermitS'JW �j Z . 7 [/w ddy dO3 ! / 1 Inspection Line: 503.6i4}�r5 0 2004 v Plan Rev l � -� Dace Ready:Bv_�s� See Attached Checklist for Internet: www.ci tigar � NoufiediMethod- ) Supplemental Information CITY OF TIGARD E UIi+ I��I�.DII G D��9�Y r F WQRI{ RE DATA: 1= AND 2- FAMILY DWELLING New construction ❑Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Additionialteration'replacement ❑ Other: equipment. materials, labor overhead. and the profit for the CATEGORY OE CONSTRUCTION work indicated on thus application. xi 1- and 2- family dwelling Xj Valuation: $ ��3 s ConunerciaUindustrial ❑ Accessory budding ❑ Multi- family Number of bedrooms ry ❑ Master budder ❑Other: Number of bathrooms 5 JOB SITE INFORMATION AND LOCATION Total number of floors: 3 New dwelling area: �' s Job site address: , ) g 2, square feet q Cir /State /ZLP: 1TA ' " 1 • CV...... Garage/carport area �� square feet Suiterbldg.!apt. no.: ` �V Project name: 0._ a vt-0,.. Covered porch area. b square feet Cross street'directions to job site. \' \ - t S e reek( Deck area: I C J square feet I Other structure area square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision. n`•�-y� Ci [j Lot no.: i Permit fees" are haled on the value of the +ork performed. ���� � ` V � 1 (D �� Indicate the value (rounded lo the nearest dollar) of all Tax map/parcel no : equipment, materials labor. overhead. and the profit for the DESCRIPTION OF WORK work Indicated on this npphcation. Valuation: 8 Existing building area: square feet New budding area square feet A PROPERTY OWNER - . - - ❑ TENANT Number of stories: Name. OS C u.S FYI dot 4 Type of construction - Address: 1t9- `Q ,s. ` f• '• • Occupancy groups City /State /ZIP: < f .ti'l OIZ_ . 9 ■■•• r Existing: _Phone (563) 533- t IOC � ' Fax: X ' l ' `aO(o New! APPLICANT - " CONTACT PERSON - NOTICE Business name: S All contractors and subcontractors are required to he Contact name: 1 GQ� licensed with the Oregon Construction Contractors Board t l' _ _ under ORS 701 and may be required to be licensed in the Address: '� Jurisdiction in which work is being performed. If the City /State /ZIP: v applicant is exempt from licensing. the followine reasons apply: Phone: (Sb3) 9 (..1- 1145 S Fax:: ( ) �p �7 f_J E -mail: CONTRA GTOR . Business name: 5 Am a L - BUILDING - PERMIT FEES* Address: Please refer ro fee schedule. CityiState /ZIP: Fees due upon applicat Phone: ( ) Fax. ( ) CCB lic.: i3 1 1 i Amount received ���ttr r Date received: Authorized signatt�e: / i r } �/ ^ This permit application expires if a permit is not obtained 0/ -sithin 180 days after it has been accepted as complete. Print name: N1 co i. fi \ie 5 Date: * Fee methodology set by Tri- Count: Buildm Industry Semite Board. i \Building\PermiisBLT•PcrrnnApp doc 12.03 440- 4613T! 11UO2'COM,WEB) L' JCt.LI Mal 1 CI MIL ti4J jlllt.dLlUhl A City of Tigard DaterBy PermitNo.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax' 503 - 593.1960 *X y,;. l'i Date/Bv: Other Permit: Inspection Line: 503 639.4175 Alp ,` fir Date Ready/By Jcris a See Page 2 for Internet. www.ci.tigard.or.us Notified/Method Supplemental Information tia', (';, V ,. TYPE" OF WORK. PLAN REVIEW ❑ New construction ❑ Addition/alteration /replacement Pease check all that apply ID Demolition El Other: [1] Service over 225 amps. comm 'I EHazardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. 0 CATEGORY OF CONSTRUCTION_ of 1- and 2- farnih dwellings d or more new residential El 1 - and 2- farruly dwelling ❑ Commercial /industrial [1] Accessory building ❑System over 600 volts nominal units in one structure ['Building over three stones ❑ Feeders. 400 amps or mor ❑ Multi- family ❑ Master builder ❑ Other: ❑M2nufactured structures c ['Occupant load over 99 persons JOB SITE - INFORMATION AND LOCATION - ❑Egress'liehtmgplan RN' park Job no.: Job site address R1 5 6ye t la ) ❑Health - care facility ❑Other w- 1) J"r Submit 2 sets of plans v.ith an} of the abor e City /State /ZIP n ^ �-, O � . The above are not applicable to temporan construction service `� J FEE* SCHEDULE Suite /bldg. /apt. no.: f Project name nt } I . Description I tQty. I Total ool Cross street /directions to job site k � w' Ne residential single - or multi - family dwelling unit. a 1 � Includes attached garage. - - 1 sq. ft. or less i 14` 11 L ot no.: 1 Ea. add'1 500 sq ft or portion 1 33 40 ^� Limited energy, residential 7 5 00 Tax map /parcel no.: (YS i l,v a Psi Limited ener_y. non - residential 73 00 . DESCRIPTION OF WO RK . Each manufactured or modular dwelling, service and.'or feeder I 90 90 Services or feeders installation. alteration. andlor relocation • 200 amps or less 1 80 30 _ . PROPERTY OWNER 201 amps to 4G0 amps I 106 ❑ TENANT - T - � S -101 amps to 000 amps 160 60 Name: Ct� 5 \--\ - 601 amps to 1,000 amps 240 60 Address: 1 1,, C C Over 1,000 amps or iolts 45 65 Reconnect only � 66 35 ; City /State /ZIP a. \ \ `Qv -._ t Q� � Zt � p �f Temporary sers ices or feeders installation - alteration. andlor 3) as g_ ` _ ` /1 � relocation Phone: 66 W Fax: ) 53 '(Z' 200 00 amps s or less 66. , Owner installation: This installation is being made on property that 1 o\sn Which is not 1 201 amps to 400 amps 1 100 30 intended for sale, lease, rent, of exchange, according to ORS 447, 419, 670, and 701 401 amps to 600 amps I 133 75 I Owner signature: Date Branch circuits - new- alteration, or extension. per panel 1 ❑ ,APPLICANT XCONTACT PERSON A Fee for branch circuits 1.,/,./1 1 service or feeder fee. each Business name: 5 I branch circuit 6 65 //� B. Fee for branch circuits Contact name: N V ! ( L.. without service or feeder fee, 46$5 Address: each branch circuit . ( � y i ► l Each add') branch circuit 6 65 City /State /ZIP: Miscellaneous (service or feeder not included) ( 'r)s) `� 1 - 1 1 -3 ( ) 5 1/1 E Pump or irrigation circle 53.40 Phone: Fax: '- t t Sign or outline lighting 53 40 E -mail: - Signal circuits) or limited- . CONTRACTOR energy panel, alteration, or extension. Describe- Page 2 Business name: f ) M F 1 1 C.:1-1-1 G I Address: g 1 5� a 2 1l� _L Each additional inspection over allowable in anv of the above i j , � 1 Q`] ? Per inspection I 62.50 City /State/ZIP: `vS�U c v ` ` 1�J Investigation per hour (l hr min) 1 62.50 Phone: (53) ( _ i g , Fax: S ) 6(425 5 Industrial plant per hour 73 i5 ` V ELECTRICAL PERMIT FEES* CCB Lic.: 1 (gg _ Electrical c.: q - Suprv. Lic: Subtotal Suprv. Electrician signature, required: �� ( Plan re (25;-0 of permit fee) P 9 iA n/%� . .. • State surcharge (8% of permit fee) Print name: a- - v im , Dates �� TOTAL PERMIT FEE , Authorized S1 �fe attire: V� A ' This permit application expires it a permit is not obtained r�'ithin 181 days after it has been accepted as complete Print name: I cat [�p A e5 0 Date: • • Fee methodology set by Tn County Building Industry Service Board • Number of Inspections per permit allowed. iaBuitding \PermitsiE LC- Permit App.doc 12'03 440- 46157(10.'02 /COMJS'EB ivieciiauicai r cum' L tippiicauu><i f , City b of Tigard Received Permtivo t Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone, 503.639 -4171 Fax. 503.598 1960 A J i� Date By- Other Permit. Inspection Line: 503.639.4175 [7 {7/ �I Date Readv.E furs Internet www.ci.ti ardor -us z —p °' o S See Page 2 for g Notified/Method Supplemental Information TYPE" OF l�'ORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the ".cork New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of a' ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit .... .: CATEGORY OF 'CONSTRUCTION , Value 5 RESIDENTIAL EQUIPMENT / SYSTEMS FEES' [Z1 and 2 family dwelling XCommercial /industrial ❑ Accessory building For special iniermnnon use checkllsr ❑ Multi- family ❑ Master budder ❑ Other: Descnpnon Qty Ea 1 Total '" _JOB SITE INFORMATION A N D LOCATION Heating/cooling Job site address: - 1411 u 4 5� l 1 ill Air conditioning or heat pump I , I (requi site plan showing placement) 3 00 City/State/ZIP: Furnace 100 BTU (ducts/ vents) I 0 14.00 � J O � � Furnace 100,000+ BTU (ducts :, entsj 17 0 0 Smiofbldg. /apt. no.: o Project e YLI }� Gas heat pump 14_00 • Cross street/directions to job site n � r- call \\ l Duct ",cork 14 00 � l CSEE_/ ik Hydronic hot water system 14_00 Residential boiler (radiator or hvdronic) 14.00 Unit heaters (fuel-tvpe, not electric), i Y in to - duct, suspended, etc 10 00 Subdivision ` T��}" Lot no.: I Flue: grit for am of above 10 -00 S Other- 10 00 Tax map /parcel no.: o z5 1 Ot 1 `s-a Other fuel appliances ■ ' ' DESCRIPTION. OF WORK Water heater 10 00 Gas fireplace 10 00 . Flue rent for water heater or gas ' fireplace 10 00 I Loy hehter (gas) I 10 00 Wood pellet stove I 10 00 Wood fireplace /insert 10 00 �; PROPERTY OWNER Oilier 1 - ;:h nert(lue`� en1 10 00 ❑ TENANT Other_ I 10 00 I Name: SLS C 1 )(St ' O YNe Environmental exhaust and sentilation Address / fl I . • Ranee hoodiother kitchen lD� �� equipment 1 I 00 Cit /stale /ZI b ���(� Clothes deer exhaust 10 00 Single -duct exhaust (bathrooms, Phone: (53 ) 533_ L0((,, Fax: (5 ) 53s. y366 toilet compartments, utility rooms) 6 80 APPLICANT.;;; ' CONTACT PERSON Attic eraivlspace fans 10 00 Business name: Sf E Other: 10 00 Fuel piping Contact name: - Q Ai f , J $5.40 for first four: 51.00 for each additional Address: t O f1 ) Furnace, etc - Gas heat pump City /State /ZIP: - Wall suspended /unit heater (542) 96 9 _ ILLS! LS ( ) St; F l Water heater Phone: J ' 7 ``1 Fax:: `' l Fireplace E -mail: Ranee . - - x CONTRACTOR Barbecue Q • Clothes drier(2as) Business name: 1 1 • WI / ` ,L.- , ...11b ' Other- Address: . Wm- CO 5 63 • MECHANICAL PERMIT FEES* • Ciry /State /ZIP: \0 O (z_ * 9 1 N `} Subtotal p r p R Minimum permit tee ($72.50) Phone: (53) 59I —9 ( 4 Fax (50.3) O'_ 0 Plan review (25% of permit fee) • CCB tic.: 114 1 31 LJ State surcharge (8% of permit fee) �� ..----' TOTAL PERMIT FEE / { This permit application expires if a permit is not obtained ,'ithin 130 afo Authorized si re: • Nt / t om✓ V days after it has been accepted as complete. Print name: i ` {! Date. � 7 Service • Fee methodology set by Tri- County Building Industry Seice Board i ` Buitding•Permitsit1C- -P PermitApp doe 12/03 440 - 4617T (I I /02 /COM./WEB) Dui wing 1 4 Plumbing Permit Application - .. -, : . : , .-:: , --•:;:' , " , i.::::-,,A--.:,::: , ::::..:: ,. ,.,'::::Ecott.cittICE'.usE- ONLY City of Tigard Received Permit No Date/13y. 13125 SW Hall Blvd_, Tigard, OR 97223 Plan Review Phone: 503 639_4171 Fax: 503.598.1960 11001 .. NIAI''` DatelBy: Other Permit No.: 24 Hour Inspection Line: 503.639.4175 _ ■LL.411,. ,„, .,,,,.....; Date Ready/By: i ''''' s El See Page 2 for Internet: www_ci.tigard_or us Notified/Method Supplemental Information '; 'iWi bi' ;f:-" : ? T" - '''"''' . W : l':t --:---;- ..'=: .'. ,Ili - kiiiiViir'''''' New construction E Demolition For special information use checklist g( Descnption I Qty I Ea. I Total 11] Addition/alteration'replacement El Other. New 1-2-farnilv dwellings (includes 100 0 for each utility connectior -- -7'•:-`',7' ' - ='" -- •'.CArtEGORY,.. QF'. -. - . .. ." ", --. - SFR (1) bath 249.20 14 and 2-family dwelling Commercial/industrial SFR (2) bath 350.00 SFR (3) bath )‹.... 399_00 Ell Accessory building ['Muhl-family Each additional bath/kitchen 45.00 ii] Master budder 0 Other, '- i,_, F re sprinkler ( sq. ft ) Page 2 '''''''' ii• ''':•';.”'"':" ' "-- r"/''' '-'''' ---'"",', ' - --'' •:"'':''''" 49 4/STIT.ITF9-1-ATPcq''PR- Site utilities Job site address:lit ' bo 63 p-critv(i_ ( Ar _ Catch basin or area dram 16_60 City/State/ZIP: . c., 2 ct - Drywell. leach line, or trench dram 16.60 ) Foottng dram (no. linear 0 - ) Page 2 Suite/bIdglapt. no.: Project name: NI anufactured home utilities 110 00 Cross street/directions to job sit rt:o r \ 1_ ' f Manholes 16 60 Ram dram connector 16.60 Sanitary sewer (no linear ft - ) Page 2 Ston sever (no. linear 0 : ) Page 2 Water service (no linear (l., ) Page 2 SubdivisioniN -- T i i - u 3nI t _l t . v ( v\e_ s Lot no.: jS Fixture or item Tax map/parcel no. (• S 1 ( ),.._ 1.artA , „ , Absorption valve 16.60 .,.;:',, : i . . „, .,..•:.-,:. -. ,„ • , i.. -, -:. ,:i,-__ ))1E OF ..yypw. -:- -:_ : : .'-,...-:::1:- Backflow preventer Page 2 Backwater valve 16 60 Clothes washer 16 60 Dishwasher 1 16_60 16 60 - - - -- - - -- - - - •-•••• - - Dri Dunking fountain i'11:''.:-.;. % :". i lii Yi k i ti : :' 01 - 7:W .: ;' 7 „1:: -;; ; --; • - - :::41 - :1- .,.f.= ; :: LIC :* *-0t Wr i ''g-....:% -- '''' '''''''''''' ' ' ' ' Ljectorsisurnp 16.60 Name: LS ( I x,s-{- w Expansion tank 16.60 to Address: I a8C) . )( ... 0 A i\ Fixture/sewer cap 16.60 City/State/ZEP: k ig Floor drain/floor sink/hub 16.60 r 1 1 Phone: c 53 ._ /ION Fax: (51z)533 Garbage disposal 16.60 _ 4806 vx . fa?1 .: ; ,,, :fri , 5:. :-;;, v . : ,..,:.:-.. : ,,,,.: 1; :, i ,r 1; .,=4, ;; - = -, T y- izmgrA ,--F, gw . Hose bib 1 16_60 aiiX7: Business name: R fr E, Interceptor/grease trap 16.60 Contact name: (0 Medical gas (value: $ ) Page 2 Address: 3P, m Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone: (5tS) 0 cio_ 11153 I Fax: : ( ) (.1. SinkThasiniavatory 16.60 Tub/shower/shower pan 16.60 E-mail: Urinal 16 60 - , -,'..'::i , :i-zt. , :-:•-• 7 CONTRACIOR ..: :.''.--,..-' ,v arercloser 16_60 Business name: ■t\ u1/4 \ v. ( \ „N yr \c„ Water heater 16_60 Address: 0 ? IN - 1•In • S I .ji, Zo.in\ozsb3 \ Other: - Subtotal City/State/ZIP 17-1 _ k 1 --- c , Ofe_ 9 Tu Minimum permit fee: $72.50 Phone: (563 ( — 1 ( Fax: (615 ( en Residential backflow minimum permit fee: $36.25 CCB Lic.: O to A9 Plumbing Lic. no.:3q ....Royi6) Plan review (25% of permit fee) — ,•'? ) State surcharge (8% of permit fee) Authorized signature; it)/ / (. 1 '-- - -' . if . , - TOTAL PERMIT FEE ---- _.„-• . Pnnt name: .___Ely Y ge • . e-5 d I Date: This permit application expires if a permit is not obtained vvithir 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Boar( , Building \Permits doe 12103 440 I 0/02./COM/WEB)