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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00332 14 DEVELOPMENT SERVICES DATE ISSUED: 11/29/2004 '` 5 =-° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14436 SW PENNYWORT TERR PARCEL: 2S112BA - BT028 SUBDIVISION: BONITATOWNHOMES ZONING: R - 12 BLOCK: LOT: 028 JURISDICTION: TIG REMARKS: New SFA. BUILDING REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 32 FIRST: 82 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 659 sf GARAGE: 570 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: 627 sf RIGHT: VALUE: 142,644.60 OCCUPANCY GRP: R3 BDRM: 2 BATH: 3 TOTAL: 1,368 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 BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 2 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT 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 +amps- 1000v:. MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & 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: $ 6,591.49 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 lnsp Rain Drain Insp Electrical Final Foundation Insp Electrical Service Roof Nailing Exterior Sheathing Ins F Storm drain in Plumb Final Wtr Proofing Bsm't Wa Electrical Rough -in Gas Line Insp Firewall Insp Water Line lnsp Mechanical Final Issued B � ° Permittee Signature : Cali (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day CITY OF TIGARD al 1 BUILDING DIVISION PERMIT #: M ST2004 -00332 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/29/2004 Phone: (503) 639 -4171 "'���� { s Inspection Requests (24 Hrs.): (503) 639 -4175 . -: , -_-- INSPECTION WORKSHEET FOR DATE: 4/27/2005 TIME: 7:11AM PAGE: 52 SITE ADDRESS: 14436 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 028 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: 4/27/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 005463 -01 503- 642 -2800 N Corrections /Comments/ Instructions: ,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (,,,t.. D 'v Date:' • 2 2 �� Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00332 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/28/2004 Phone: (503) 639 -4171 iciirom1 ° �ii'l� I Requests (24 Hrs.): (503) 639 -4175!�r - INSPECTION WORKSHEET FOR DATE: 6/3/2005 TIME: 7:14AM PAGE: 69 SITE ADDRESS: 14436 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 028 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503 - 533-4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503. 5334006 Inspection Request Scheduled For: Date: 5/3/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 005948 -02 503-209.2005 N Corrections /Comments/ Instructions: 1 r I r i. ---4. , A �' l T f re ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR I PECTION ❑ ADDITION L F ES ASSESSED Inspector: /� Date: 3 (J Phone #: (503) 718- CITY OF TIGARD , BUILDING DIVISION ' PERMIT #: MST2004 -00332 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/29/2004 Phone: (503) 639 -4171 �� " "' ° ° ��V °Nlii4lfil�` 1''�� Inspection Requests (24 Hrs.): (503) 639 -4175 " "f_�.. INSPECTION WORKSHEET FOR DATE: 5/5/2005 TIME: 7:16AM PAGE: 45 SITE ADDRESS: 14436 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: 13ONITA TOWNHOMES LOT #: 028 TYPE OF USE: PROJECT NAME: 13ONITA 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: 5/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 006178-03 503. 209-6038 N ' Corrections /Comments /Instructions: I t PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED /7)7V-- Inspector: Date: L3 ,05 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00332 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/29/2004 Phone: (503) 639 -4171 /� "�0� /J/ /��ypillJ� 1 1 / Ins Requests (24 Hrs.): (503) 639 -4175 _�'_ --, INSPECTION WORKSHEET FOR DATE: 5/13/2005 TIME: 7:12AM PAGE: 63 SITE ADDRESS: 14436 SW PENNYWORT TERR CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 028 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503-533-40% CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503 - 533-4006 Inspection Request Scheduled For: Date: 5/1302005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 006820 -07 503-209-2005 N Corrections /Comments/ Instructions: I � ,------- f __.------' , ...1.,...---- • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITION L FEES ASSESSED Inspector: 4i0 Date: i3 one #: (503) 718- Building Permit Application .FOR OFFICEUSEONLY City of Tigard Recened Pernvl No U i � ? 13125 SW Hall Blvd . Tigard, OR 9 "223 Date Re ) �_� O L I ��' ��� 7 J ✓� Plan Renee 3. � rr rC I �JJ Phone' 503.639.41 i 1 Fax :05 G Off rmu�`� ,J �� V r • Y t Date.•B:• // / / f /��� Other Pe J W ll� / '� ��� Inspection Line 50_.6.9 J 1 ?5 � W ," Dare Readv.B s El See Attached Checklist for Internet + -, sw ci tigard,or u5 ` 1 Notifi'1 ed eIhod' 1 1(,r Supplemental Information ! ) V ' O 1 2OOk F_ TxP� y OF 1 F�ORuARD i REQUIRED DATA: 1- AND 2- FAMILY DWELLING i i K New construction Al 199' ltigu°eo oN 1 Permit fees' are based on the '.clue of the work performed. Lidicate the xalue (rounded to the nearest dollar) of all ❑ Additro•alterahon'replacemenl ❑ Other. equipment. matenals. labor,, overhead. and the profit for the CATEGORY OF CONSTRUCTION j cork indicated on this application. ( �r? ��Y ‘O] 1- and 2 -famih dwelling •Commercial /industrial Valuation $ --_i I i umber of bedro [1:1 Accessory building ❑ multi-famil L I Number of bathrooms 2 j ❑Master builder ❑ Other I I —II JOB SITE INFORMATION .AND LOCATION - - Total number of Iloors 3 Job site address: 4 q a. , - r` .. I New dwelling area I5U square feet City'State /ZIP: ,1 II ) r ► -- I Garage.carport ares- square feet Suitebldg.'apt. no.. ' I Project ]. nanie: , � — Covered porch area d. square feet i Cross street:directions tojob site �IIJJJ��� -- ---111 1 i -� �� lac) � ' Deck area- l square feel [iy Other structure arca- square feet REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdi ision: ( y\ ` � e Lot no Permit fees' are based on the value of the work performed ` � j ' o n A Q � c Indicate the value (rounded to the nearest dollar) of all Tax map'parcel no.- A5 � `'a •► > 1 --1 j equipment. matcnaIS. Iabot. ON CI head. Ind the profit for the DESCRIPTION OF WORK 1 I 'c ork indicated on this application. Valuation S —� Existing building 31 C3' square feet New budding area square feet A PROPERTY OWNER I — ❑ TENANT I Number of stories Name OS CuS m_ me.s T:."pe of construction: Address: i (o o 1■)W (- 6Q}Arl p .- Occupant■• groups City -Slate ZIP: - �� t vf. ` .� i _ - j Existing Phone: (SD3) 533' L' Fax: IS e, 3) T63 - Li3o( v � New: ❑ APPLICANT [CONTACT PERSON NOTICE Business name: 3� ._) i All contractors and subcontractors are required to be Contact name: — -6Q,,_Itc. n licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address- 3 ni•Lt I Jurisdiction in which work is being performed- If the City.'State ZIP: applicant is exempt from licensing. the following reasons 11 c aPPIy: Phone: (S O3) at (09— l— 1 3 I Fax - ( ) i �p i ►y' ' l e_ E -mail . , • : ._ ., CONTRACTOR ' Business name `JPA BUILDING - PERMIT FEES* Address —1 Please refer to fee schedule. City; StateZfP. Fees due upon application Phone: t ) br Fax. ( ) Amount received CCBIie: i SC/ 9 7{.-- ) Date received: Authorized sig c&4 This pet - mit application expires if a permit is not obtained - te within 180 dais after it has been accepted as complete. Print name: p et; C , i -t Date ' Fee methodoloe) set by Tn- Counr. Building Industry Service Board BuiIdir ,g,Perrairr.BUP- Pcr.niiAppdec 12 440 4513T(IIO2'CO5t'ZB) 'Electrical Permit Application FOR OFFICE; USE ONLY 'f City of Ti Recei Permit No DaleiBy: 1 3125•SW Hall Blvd . Tigard. OR 97223 Plan Re'.iew Phone: 503.6=9 4171 Fax 503 595 1960 Date/Bv. Other Permit Inspection Line: 503 639 4175 I' ''. . Date Read>B! !cis 1 © See Page 2 for m a Internet wv..k ci Heard or us Notified,Tlethod' 1 Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition:alteratton 'replacement Please check all that apply ❑Ser'•ice over 225 arrps.cornm'l ❑Hazardous location ❑ Demolition ❑ Other ❑Senlce over 320 amps - ram ❑ Buildng user 10,000 sq ft , • CATEGORY OF CONSTRUCTION of I- and 2- farm'. d 'eilrnrs d or more new residential ❑ I- and 2- family dwelling ❑ Commercial industrial 111 Accessory building ❑System e• er 600 volts nominal cats in one structure ❑ Buildtne o d er three stones ❑ Feeers. 400 amps or more El Multi family 111 Master builder ❑Other ❑Occupant load 0. _t 99 persons 0 5-lanufaciured structures or JOB SITE JNFORMLATION AND LOCATION ❑Eeressdightrng plan R\ park ,,..-- ❑Health -care facility ❑Other. Job no. Job site address! r s Q,' A _ it \e-- - Submit 2 sets of plans ,vrth any of the above City/State/ZIP. ' I The abos e are not applicable to tempo�,ar; construction service ��� r ` -- FEE* SCHEDULE Suite-bldg ;apt. no.: Project nae. {-('', -- I _ m ._ Description I u,+. I Fee- I Tout Cross street directions to job site. y.\ ^ ` S . • t New . ew residential single- or multi - family ds■elling unit. Includes attached garaf'e. ' 1 sq. 0_ or less 145 -15 4 Subdivision: 1�. {,� 1e-� w Lot no . ,28 Ea add] 500 sq n- or portion 33 -4t) 1 �S 1 1 a g� l ►!'L+A limited energy, residential 00 Tax map;parcel no.: — Limited ghee_ }. non-residential 75_00 2 DESCRIPTION OF WORK Each manufactured or modular - d\sell;ne, service and or feeder 90 90 2 Services or feeders installation. alter and;or relocation • 200 amps or less -.. - 50 30 2 M. PROPERTY OWNER El TENANT 201 amps try 100 amps 55 V -101 amps i i 609 :11005 160 60 Name_ V F L S �lJl. �Y V�3 6151 amps m 1.000 amps 240-60 Address: l • r C •k . 1 I c p s I.i (ri :imps '.nits - H J5 =,65 Reconncct only i 66 3- City.'State:Z1P: evQ 1ln QI� •"Z(\f� hernpuran services or (ceders installation. alteration, andior l ` � r relocation Phone ( ) I Fax. ( ) , ba3 e�� sD 1 53� 200 amps or :ess 66_85 1 Owner installation: This installation is being. made on property that 1 own xvhich is not 201 amps to 4 17,fI amp; I(iO 50 2 intended for sale, lease, rent. of exchange. according to ORS 4-17. 4-19, 6 7 0, and 7 01 4O1 amps to ntii ar,,p j I ?? 5 • O signature: • _ Date: - - __ Branch circuits - nest'. alteration. or extension, per panel ❑ APPLICANT lg. CONTACT PERSON .A Fee for branch circuits 1 :1 I sers rce or feeder iee. each Business name: ' Z branch circuit 6 65 ` 13- Fee for branch circuits Contact name. ,r irhour service or feeder fee, -16.35 2 Address: each branch circuit (S Ea ch add'! hranch circuit 6 -65 2 Citv%Stale!ZIP: Miscellaneous (ser ice or feeder not included) � tA)1 � C - 1 q33 : ( ) 5�/'1 WIE Pump or lineation circle 53 40 2 Phone: Fax: i --� SiPrr or outline lighting 53 40 E -mail: Signal Crrctnt(s) or 'Milled- ' CONTRACTOR ' energy panel, alteration. or • r extension Describe Page 2 _ Business name: K EJ 1 Q c j ri C I ta Address: g 1 O n, d JQ pi -F ` I -k \_. an s additional inspection over allowable in a of the above Q , y Per inspection I 1 62 50 City State /ZIP: `1 i `� lr Q cc Q. l73 Investigation per hour 11 hr nun) 1 1 62 50 c6 t c{2 Phone: 3) _ aoOC> / c I Fax: /I x: ) (, L 4% 5815 industrial plant per hour I 73.75 ELECTRICAL PERMIT FEES' CCB Lic.: l t 82'0)2_ Electrical l c. q - Supry. Lic : I Subtotal 1 Suprv. Electrician signature, required •. j . Plan review (25) - of permit fee) Print name: a w� Dates Slate surcharge (3 ".b of permit fee) C - — ' TOTAL. PERMIT FEE Authorized si 7 ature: L • ' f- _ ` � _ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: � Z , �� c - � � � Date: . Fee methodology set b'• T ri - Count; Building Induarrp Service Board " Number of mspecnons per permit ollo'aed r'lluitding_Pcrmits'ELC- PermiiApp den 12'53. a40.4615T(ID'02:CO5tovEB . Mechanical Permit Application FOR OFFICEUS E ONLY '/ City of Tig ird Received Datea3v Pe; mtt No 13125 S;•\' Hall Blvd -, Tigard, OR 97223 Plan Re•:ie.. Phone. 503 639 4171 Fax 503 - 1960 r Date Bp Other Permit Inspection Line' 503 639 41:5 a lit Date Rea. :, iu,.5 El See Page 2 for Internet v ;��� ;w ci.tieard onus "` - rr ' � ' d B g Nonfied,Nethod Supplemental Information TYPE OF WORK COMMERCIAL FEE.* SCHEDULE - USE CHECKLIST New construction ❑ Addition alteration replacement Mechanical permit fees' are based on the value of the . erk performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and profit CATEGORY OF CONSTRUCTION ai,ie g RESIDENTIAL EQl;1P!\IENT! SYSTEMS FEES' [1- and 2- farruly dwelling ,K Commercial.'industrial ❑ Accessory building For special :010 ^ir:non use chec4!Io. ❑ ?Multi - family ❑ Master builder ❑ Other Descnpuon I 0.- I F3 j Total JOB SITE INFORMATION AND LOCATION Heating'cooline Job site address:K./ � — Air conditioning or heat pump �- �, k �� 1� M _ , (requires site plan sho , me placenu 1 00 City: State. "L 1 - �� O E , q m 1 Fuace 100,060 81 Our ts.. ems t l a 00 1 1 Furnace 100.009-' 871.. tduc s ,ents 1 90 Suiteibldg. /apt. no -: Project name: ' • Gas heal pump 14.00 Cross sireet'direcuons to job site . �C� �` Duct . xork _ 14 00 4 lIsdrotuc hot water system 14 00 �i L Residential holler (radiator or hvdronic) 1 00 _ Unit heaters (fuel -type, not etc(tncl, ` in- ooall, in -duct. suspended. etc I 10.00 �h \fC1. �(a Flue enlforanrof.Lee ]r -- Subdivision: �� Lot no 'p r� __.-._ 7 �' S — Other ! l0 00 Tax map /parcel no.: 51 (, � \ 1 � { • Other fuel appliances___ DESCRIPTION OF WORK \ \valet heater 10 le; Gas fireplace 10 00 ' Flue vent for rater heater fR gas • fireplace i 19.90 I Log lighter ',gas) 10 -09 \ \ stove 10 ()0 Wood fireplace rrrscrt 1 10.40 rA. PROPERTY OWNER Chnnnc. lmcr Iluc cnt f 10 00 ❑ TENANT — t Other: 10 oil Name: 3—LS C .` hg .+" CYl O�/Nps Ensironmental exhaust and ventilat Address: 163Q80 \ l ,� - `, ( ' 9 . yanae hood other kitchen vtil ` equipment ment 10.00 Cih' /State!ZIP 1^> r � • G Z Clothes dryer exhaust 10.00 Lest C14_ 1 1 ��,���J��� Sm21e -duct exhaust ihathmoms. Phone: (53 )5/3_ (0 Fax: (sex ) 533- C.(366 toilet compartments, utility rooms) 6.80 `, APPLICANT> " z, CONTACT PERSON Anic,crao lspace fans 10.00 Business name: h 10 - f10 I �� Other: Fuel piping P�P- Contact name: $5.40 for first four: 31.00 for each additional Address: 3B c\/E) Furnace. etc Gas heat pump City /State. /ZIP: Wall /suspendednmit heater Phone: (5 p 3 ) 969_ 1 qs, Fax: ( ) 51 ; F , Water heater Fireplace E- marl: !! ` ` Range CONTRACTOR Barbecue � \' \,� ^ �1 �1 A ry t yr C Clothes dive (gas) Business name: y `(-J` ` �(^` , 1 � ( ` �-'w Other address: II '•_ MECHANICAL PERMIT FEES* Cttv.'Slalet'ZIP: \ O 9 N ; Subtotal ) \ � Minimum permit fee ($72 50) Phone' (5 7) 5 91 - q 2 q Fax. (55 3) 8gii- (y) Plan review (25%of permit fee) CCB Ire.: J L.{ 131 LJ State surcharge (3 %%0 of permit fee) __--------- TOTAL PERMIT FEE Authorized si a•ature: This permit application expires if a permit is not obtained within I30 ■ _ _ da>,s alter it has been accepted as complete. % dirONNTh"-- 1 Pnnt name: i'-2 ` � — `�+ Date' • Fee methodology set by Tn- Count, Budding Indusn Service Board rsBuilding \Permits \R¢C- PernutApp dec 12/03 .340.4t 17; ( 1 V02:COrt'WEB) . ' Building Fixtures Plumbing, Permit Application FOR OFFICE USE ONLY . Z W City of Tigard Recet:ed Date'B y Perrml l lr. 13125 SW Hall Blvd . Tigard. OR 9722 — Plan Review Phone 503 639.4171 Fax 503 599 1960 Zt:' Other Perrrut No 24 Hour Inspection Line 503.639 41 r„ , - — Internet: ;�;,•; ci- tigard Or u5 .' 2 for NohfieciMethod Supplemental Information TYPE OF .1\rO RK FEE* SCHEDULE r New construction ❑ Demolition For special information use checklist_ — Description L_Qty 1 Ea 1 Taal ❑ Addition'alterauon•replacement ❑ Other. New 1- 2- family dwellings (Includes 100 0 for each ulilir, connection) ` CATEGORY .OF'- CONSTRUCTION.; SFR (1) bash 249 20 XI- and 2- family dw.;_elling XCommercial.%industrial SFR (2) bath 35000 r] Accessory huilding ❑ Multi- family SFR (3) bath 399 00 ❑ Master builder ❑ Other: Each additional bath/kitchen 45 00 Ire sprinkler q f F spri kl r i s t. ) Page 2 JOB SHE L' FO }iI■1AT1ON `ANND LOCATIOPI t _ 1 Site utilities Job site address: I A i Catch basal or area dram 16 60 CityiState!ZIP: di P'1 CI Dry^•yel1, leach tine, or trench drain 16 60 —) Footing dram (no linear 0.: Page lb Suite`bldg -rapt. no.: Project name: gii Cross street-'directions to job site, 1� Manufactured home utilities 1 1600 � � e Manholes Ira 60 Ram drain connector 16 -60 Sanitan se•.+er (no. linear ft.. ) Page 2 + -- ^� Storrs se,+rr no linear it ) I I Pace Subdivision- . _ Q . Q S 1 Lot n t �` , Q U Water service (no_ linear fl ) I Pace 2 Tax map/parcel no -: a 1 l 5' 1 ��` ` rp ixture or Item r_ 1 Absotion •.g,1 e 16 60 - DESCRFPTiON 9 F � voRK - F • - . . Backtlo'a prey. cruet Page Back•.;ater valve 16 60 — -- Clothes `.rasher 16 60 Dishwasher t 16 60 :, nnkl fountain 10 00 PROPERTY OWNER _; D n, Ejectors'sump 16 60 Name: L _ V ° Expansion tank 16,60 Address: . ' (, a Q 1111ke1.• - , .. Fixture /sewer cap 16 60 City/State/ZIP: ra` ` • • • P • • +' Floor drain'tloor sink•hub 16.60 Phone: c503) 553_ L ON.0 (56S)533_ y ar p .al 1 16 60 Fax: � V baeedls disposal a: r,: ;r.,,,rs -av, Hose bib I 16 60 'L ... , -© APPLICANT Sc? = * >- CONTAt �t .. .A.', t ; ice maker 1 6 60 Business name: [I �/ \t r interceptor /grease trap 16.60 Contact name: t - S • _ - Medical gas (value: $ ) Page 2 Address: 3f; YAF Primer 16 -60 City/State/ZIP: Roof dram (commercial) 16.60 Phone: ( 50 4 (169- Fax:: !4153 ( ) Sinkbasimlayator}• 16.60 Tub /shox;er, shower pan 16.60 E-mail: Urinal 16 60 >r 4 CONTRACTOR.:., ' .----,,`,— i xc v a c l o s e t 16 60 ! Business name: E - i • • u lb • _ Water heater 16 60_1 .Address: e2 11117.c) o Q� - \ce f , \ 1 , iv\ A Other: l \' e { Subtotal City%State %ZIP: H Llc \olz �r ' 9 3'1� l � Minimum permit fee. $72_50 Phone: (663 ( ) !D 30 Fax: (Sb3) ( _ (16 Residential backflow minimum permit fee $36.25 CCB Lic.: i ci, , r• Plumbing Lic. no.:31 Plan review (25% of permit fee) State surcharge (8% of permit fee) f r Authorized signature; �i L TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board Building \Perrnits YLMF- PernutA pp dc , c 12/03 aa0- 4616T(I0 /02'COWWEB)