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Permit A ._ CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2004 -00292 �IW DEVELOPMENT SERVICES DATE ISSUED: 11/17/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 07805 SW WATER PARSLEY LN PARCEL: 2S112BA -BT001 SUBDMSION: BONITA TOWNHOMES ZONING: R - 12 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: New SFA BUILDING REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 32 FIRST: 167 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 820 sf GARAGE: 585 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 TURD: 787 sf RIGHT: VALUE: 181,320.30 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,774 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: EAADD'L 500SF: 3 201 - 400 amp: 201 - 400 amp: 1st W/OSVC/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 AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & 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: $ 6,903.03 JLS CUSTOM HOMES JLS CUSTOM HOMES This permit is subject to the regulations contained in the 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 lnsp Plumbing Top Out Insulation Insp High strength bolts fins Smoke Detector Footing Insp Plm /undslb Insp Framing Insp Shear Wall Insp Rain Drain lnsp Electrical Final Foundation Insp Electrical Service Roof Nailing Exterior Sheathing Insr Storm drain insp Plumb Final Wtr Proofing Bsm't Wa Electrical Rough -in Gas Line Insp Firewall Insp Water Line Y Signature Mechanical Final Ail i Issued B : Permittee Si nature : k 4 , 1 Li/ ■ , . ,d / A Call (503) 6 9-4175 by 7:00 p.m. for an inspection needed the next business day AO CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00292 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17/2004 Phone: (503) 639 -4171 i w��m°4P4p0(1 \ Inspection Requests (24 Hrs.): (503) 639 -4175 AA- INSPECTION WORKSHEET FOR DATE: 3/24/2005 TIME: 7:09AM PAGE: 21 SITE ADDRESS: 07805 SW WATER PARSLEY LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 001 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: 3/24/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 002727 -01 603 -642 -2800 N Corrections /Comments /Instructions: 4 "i K A/4(%y4t PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i y Date: i / Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00292 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17/2004 Phone: (503) 639 -4171 / /u " Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/3/2005 TIME: 7 :14AM PAGE: 76 SITE ADDRESS: 07805 SW WATER PARSLEY LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 001 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA OWNER: JLS CUSTOM HOMES, PHONE #: 503-633 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 603 - 633.4006 Inspection Request Scheduled For: Date: 5/3/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 006946.02 503- 209 -2005 N Corrections /Comments /Instructions: i i Ili 111 - 40,1 A I ❑ ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITION L FE S ASSESSED Inspector: • 1 `� ' Date: 3 C2 -hone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION r r� PERMIT #: MST2004 -00292 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/17/2004 Phone: (503) 639 -4171 ,,l�° Inspection Requests (24 Hrs.): (503) 639 -4175 .��n,��� : INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 5/10/2005 7:16AM 49 SITE ADDRESS: CLASS OF WORK: 07805 SW WATER PARSLEY LN SUBDIVISION: LOT #: TYPE OF USE: BONITA TOWNHOMES 001 PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA OWNER: PHONE #: 503- 533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: JLS CUSTOM HOMES 503 -533 -4006 Inspection Request Scheduled For: Date: 5110/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 006500 -05 503-209-6038 Y Corrections /Comments/ Instructions: i t , 1 1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL LI CALL FOR SPECTION ❑ ADDITIONAL FEES ASSESSED AIR- ye Inspector: Date: 0 os Phone #: (503) 718- CITY OF TIGARE * ' BUILDING DIVISION PERMIT #: MST2004 - 00292 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 � Nl 11/171200 Inspection Requests (24 Hrs.): (503) 639 -4175 � INSPECTION WORKSHEET FOR DATE: PAGE: &1012005 TIME: 7 :16AM 50 SITE ADDRESS: CLASS OF WORK: 07805 SW WATER PARSLEY LN SUBDIVISION: LOT #: TYPE OF USE: BONITA TOWNHOMES 001 PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA OWNER: PHONE #: JLS CUSTOM HOMES, 503-533-4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503- 533.4006 Inspection Request Scheduled For: Date: 5/10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 006500 -04 503 -209 -6038 Y Corrections /Comments /Instructions: fi 7 (7/ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: DateL5/ / Phone #: (503) 718- CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MULLEN COMPANY, THE 24470 SW RAINBOW LANE HILLSBORO, OR 97123 Plumbing Signature Form Permit #: MST2004 -00292 Date Issued: 11/17/2004 Parcel: 2S112BA -BT001 Site Address: 07805 SW WATER PARSLEY LN Subdivision: BONITA TOWNHOMES Block: Lot: 001 Jurisdiction: TIG Zoning: R -12 Remarks: New SFA Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. ' No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: JLS CUSTOM HOMES MULLEN COMPANY, THE 16280 NW BETHANY 24470 SW RAINBOW LANE BEAVERTON, OR 97006 HILLSBORO, OR 97123 Phone #: 503 - 533 -4006 Phone #: 503 - 628 -1632 Reg #: LIC 92689 PLM 34 -260PB AN INK SIGNATURE IS REQUIRED ON THIS FO i' X . 0 AIINII.■ Sigre of Aut • ' umber iii If you have any questions, please call 503.718.2433. 4 , Building Permit Application � � FOROFFICEUSE ,' Plan Revie — City of Tigard �t e \ .ceteiiBved v I � A�m Perrrvt No �- �f 5 ' JI ��,a9a 13125 SW Hall Blvd., Tigard, OR 97223 Phone - 503- 639 4] 71 Fax. 503.598.1960 G ' x +1 t 1 / �af' � Other Penm 4 _ ��� Inspection Line: 503.639.41 75 . 8 � I -. `Gl' is advB � S Attach Chl t for Internet: ww .v.ci.tigard.or.us G 1ci 0J` o, VO le +fi ' M et o - hd } / /(p. Supplemental ee In form TYPE OF !YORK REQUIRED•DATA: 1- AND 2- FAMILY DWELLING New construction ❑Demolition Permit fees* based on the value of the work performed - Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, e and the profit for the CATEGORY OF CONSTRUCTION work indicated on thus application. n76 O . 0 Valuation: X 1- and 2- fancily dwelling 'Commercial industrial ❑ Accessory building El Multi-family Number of bedrooms: 3 ❑ hlaster builder El Other. Number of bathrooms. JOB SITE INFORMATION AND L' CATION Total number of floors- 3 Job site address 1 New dwelling - area. 1-4-3.4 square feet City /State!ZIP: 1 r P Garage /carport area: 584-7, square feet Suite/bldgiapt. no.: Project name: , te - IL _ Covered porch area: ,_37___ square feet Cross streeidirections to job site: ' hkIcQ t- [ we � Deck area ' square feet i Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE C}IECKLJST Subdivision: \ �o�n n� S Lot no -: ' Permit fees* are based on the value of the work performed. a C 1 t . ` t �� Indicate the value (rounded to the nearest dollar) of all Tax map parcel no � { equipment. materials. labor, overhead, arid the profit for the DESCRIPTION OF WORK . work indicated on this application. • Valuation: $ t 5 9 1 4 1 / 0 0 Existing building area square feet New building area: 15 ( 7( square feet pt PROPERTY OWNER ' -- ❑ TENANT - �` Number of stones: ! 3 Name: �S C S'1\ { `+� Type of construction: Address: V � Q f�Ql 1 ZQ Occupancy groups: City %Slatc,'ZIP: '� —' t1Y1 1 C�� —! -t � Y � -�(`' ' Existing: Phone. (5b . L ) 533 '(t tti ` 6 Fax: (561)s-63 ' L1ac tI New: ' Cl_ APPLICANT [CONTACT PERSON • NOTICE Business name: E All contractors and subcontractors are required to be Contact name: —n licensed with the Oregon Construction Contractors Board under ORS 70] and may be required to be licensed in the Address: 3 Q L4 jurisdiction in which work is being performed. If the City /State. /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: (SOS) (3 / (09_ i L is 3 I Fax:: ( ) '3 1p 7 E -mail: - CONTRACTOR _ . Business name: m BUILDING - PERMIT FEES* Address. Please refer to fee schedule. City /State'ZIP: Fees due upon app lication Phone: ( ) . Fax: ( ) � Amount received CCB lic. ,39 ( t T() Date received: Authonzed signat e: / This permit application expires if a permit is not obtained � AK 'within 180 days after it has been accepted as complete. Print name: e 1 , � ‘1 — a Date: * Fee methodology set by Tn- County Building Industry Service Board_ i ''Bmlding•.Permits BUT-Perron App doc 12/03 440 1 i3O2;COAV.YEB) Electrical Permit Application 1` FOR OFFICE USE ONLY City of Tigard R %C E V E Received Perm [ 13125 SW 1-1,g11 Blvd... OR 97223 Date/By: �ti� - tea 9y Plan Review Phone 503.639.4171 Fax: 503 598.1960 r7 1 t raa�dl i �3��{ Date/By: A Other Permit: _ V ' � , =.� t1 Inspection Line: 503 5 v ` 0 ` 639 417 Date Ready/By: Ions IRI See Page 2 for Internet: wPw Ci.ttgard.or - Notlfied/Mthod Supplemental Information -,-ry n5 TICARD . =: ; TYPE�(��r pI \IISIO(`I PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply ❑ Demolition ❑ Other: Service over 225 amps. comm'l EHazardous location Service over 320 amps - rating ❑ Buildng over 10,000 sq, ft -. ' CATEGORY OF CONSTRUCTION „ of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ESystem over 600 volts nominal units in one struc ore ❑Building over three stories ❑Feeders. 400 amps or more ❑ Multi-family ❑Master builder ❑Other: ❑Occupant load over 99 persons ❑Manufactured structures or -- JOB SiTE.INFORIVLATION AND LOCATION .' ❑Egress /hehtingplan RV park Job no -: l Job site addresgbs SW UvlJllly 01ealth -care facility ❑Other Submit 2 sets of plans with any of the abo\e- City /Stale /ZIP: ' p � ! The above are not applicable to temporary construction service. I I�Q�C -I I Q1L FEE* SCHEDULE • Suite/bldg./apt. no.. Project name: � n t l� Description Qtr. Fee. Total .• Cross street /directions to job Site: C ri p . New residential single- or multi - family dwelling unit. T 1 includes attached garage... 1.000 sq. ft or less 145.15 4 r Subdivision: 1� '� � l \ ( 1�� _y.� , , „ ` Ea. addl 500 sq. ft or portion 33 40 I IV �j U.'-�► l l�A�a�LI Lot no.: Tax map /parcel no.: as , i ce' a g1 1 Limited energy, residential 75 00 2 Limited energy, non - residential 75 00 2 , DESCRIPTION OF WORK. . Each manufactured or modular dwelling, service and /or feeder t 90 -90 2 Services or feeders installation, alteration. and /or relocation • 200 amps or less 80 -30 2 i. PROPERTY • ❑ TENANT 201 amps to 100 amps 106 -85 2 -3" • 401 amps to 600 amps I 160 60 2 Name: C C ,` u 1L� ,- 601 amps to 1.000 amps 1 240 60 2 Address. 1 ` _ Over 1 .000 amps or volts 454 65 2 ���' i only Reconnect on 66.85 City/State/ZIP: aorta . Q IA �` • Temporary services or feeders installation, alteration, and /or • �� ) relocation Phone: J �e�e� 4 Fax: ( 53�- q ih, • 200 amps or less 66 -85 1 Owner installation: This installation is being made on property that I on which is not 201 amps to 400 amps 100 30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 -75 2 Owner signature: - • Date. Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT - CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each Business name: S : branch circuit 6 -65 2 Contact name: � - B. Fee for branch circuits op i �� ∎ without service or feeder fee, 46 -85 2 Address: each branch circuit ( m 1 ' `� Each add'I branch circuit 6 -65 ( 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( 6-1•A) l � 1 , 1 l `.Z Fax: c ( ) I � l �/� 5n y E Pump or irrigation circle 53 40 2 1 / v Sign or outline lighting 53.40 2 E -mail: - Signal circuit(s) or limited- 1111 - 7,7/411VUWi fia , , ' /S i TRA r'tr '' - 4 . energy panel, alteration, or D extension. Describe. Page 2 2 ` Business name: - �, r t Address: w Each additional inspection over allowable in any of the above ND � L�11���,Z =�w 1 Per inspection 62.50 City; State, /ZIP: . ` t` • .P • - a • _ Investigation per hour (1 hr min) 62 50 Phone: (63) l4 4'Z _ O c \ i Fax: ) ( /42_ 5Bls Industrial plant per hour 73 75 Electrical c.: q - .L Suprv. Ltc -: co Subtotal U v ELECTRICAL PERMIT FEES* CCB Lic.:,} ; ,` � t ` Supry Electrician signature - nature required: � (' A r Plan review (25% of permit fee) �.•r.. Print name. a &.„ I 1 State surcharge (8% of permit fee) • -- Datt -� ' TOTAL PERMIT FEE Authorized sig attire' L • .-- - ` This permit application expires if a permit is not obtained within 180 �\ days after it has been accepted as complete Print name: c it Ct e- R�1 Date: • Fee methodology set by Tn- County Building Industry Service Board T ' ` Number of inspections per permit allowed_ i' its`.ELC- PemutApp deg 12103 440- 4615T(1,0102 /CO!d/WEB Al Mechanical Permit A ! `YC�d` 1( �!Il"�E FO OFFI . __ SEONLY : • City of Tigard Received / Date/By: I , Permit No. /r ,/ C y 13125 SW Hall Blvd., Tigard, OR 97223 � r n 7 p /"� f (�J I r Phone: 503.639.4171 Fax: 503.598 -1960 LA, ' � L Pl an Review Other Permit. Inspection Line: 503.639.4175 t � (I� ", Date Ins Re p AI eaw Date Ready/By Jut 0 See Page 2 for Internet. wwv. Ci.tigard onus No tifiecVMethod. Su pp Information CITY OF TICF�RL pp . TAI Ill DING DIV1SV TYPE OF WORK' - - COMMERCIAL - FEE* SCHEDULE - USE CHECKLIST X New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition. ❑ Other: mechanical matenals, equipment, labor, overhead, and profit CATEGORY Value: $ Y OF• CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* [(1- and 2- family dwelling ,Commercial /industrial ❑ Accessory building For special information use checkhsr ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea Total JOB SITE X. INFORMATION . Heating/cooling Job site address: `�qbS ( k J$ 0/ p " 7 0 ( n ( V1 .fir conditioning or heat pump ✓ % h�...�w++ Vv (requires site plan showing placement) 14.00 Cir /S1atc/ZIP: - Q Z. Furnace 100,000 BTU (ducts':ents) 14.00 t Furnace 100,000+ BTU (ductsfvents) 1 7.90 Suitebldg -;apt. no.: Project name hl }ems Gas heat pump 14.00 Cross street/directions to job site: • yN 1 �j� Duct work 14.00 CSZ_Ef, lz, Hydronic hot water system 14 -00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall. in -duct, suspended, etc 10 00 i Subdivision Lot no.: Flue/vent for any of above 10100 Other: 10.00 Fax map /parcel no.: J � 5 1 1 /1� l Other fuel appliances C pl 'DESCRIPTION OF WORK . Water heater 10.00 Gas fireplace 10 00 Flue vent for water heater or pas fireplace 10 -00 Lop lighter (gas) 10 00 \Voodipellet stove 10.00 Wood fireplace /insert _ 10.00 �, PROPERTY OWNER - El TENANT Ot );liner . llue. /vent 10 00 Other i 10 00 Name. SLS C.` )torn O YNe Environmental exhaust and ventilation Address: { r �8h 1 , \..... k . 1 `, � Range hood /oth kitchen / wcac v ! CA_ e equipment 10 -00 City Stale /ZI dd etiCS r�� v� wa-±s�� Q . C III \ R /" Clothes dryer exhaust 10 00 1 III 777 �� ) i Single -duct exhaust (bathrooms, Phone: (3 )5 ! p i? , _ cio��, Fax: (56 $) 533' l 36 6 toilet compartments, utility rooms) 6.80 ❑` AP r .. x, CONTACT PERSON Attic/crawlspace fans 10.00 Business name: SSE\ Other: 10.00 Fuel piping Contact name: eel 7 r �e --:, $5.40 for first four; 51.00 for each additional Address: :C.- ) M C Furnace, etc. �J Gas heat pump City /Stale /ZIP: Wall /suspended /unit heater l (543) 9ea9_ / s: Fax: ( ) 5C h F Water heater Phone: J' l f `'i : `, ^ Fireplace E -mail: Range - CONTRACTOR` ' ' • Barbecue Business name: . ,e Clothes dryer (gas) di •'�� �` Other_ Address: ' , (p 5 53 . - . MECHANICAL PERMIT FEES* City/State/ZIP: 10 O (- • 9 /'� -I Subtotal l V Minimum permit fee ($72 50) Phone (6)) 591 _9p24 Fax: ( $p g) ,L{_ U , Plan review (25 %ofpermit fee) CCB lie. l f 131 L ! � ® vc State surcharge (8% of permit fee) t � — TOTAL PERMIT FEE 1 Authorized sig 3IUTe This permit application expires if a permit is not obtained within ISO � _ r� _ _ days after it has been accepted as complete. Print name i rye Date: ` Fee methodology set by Tn- County Building Industry Service Board i \ Bu,Idin_g',Permia PenruiApp doc 12/03 a 440 -461 iT (1 I /O2!CONL'WEB) . Building Fixtures ,./ Plumbing Permit Appl IVED FOR USE ONLY City Or Tigard Received (t'65� ^ 13125 SW Hall Blvd -, Tigard, OR 97223 +fit`+ Da R v: Permit No I,W y 200 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Ls : tie*, Date /By Other Permit No.. P 24- Hour Inspection Line: 503.639.4175 1 v ci.tigard.or.us ry I : - : Date Ready /By. r u t ' s 0 See Page 2 for Internet: w1a CITY OF TIGni iI Notified/Method Supplemental information TYPE { j 3 iV . FEE SCHEDULE a New construction ❑ Demolition For special information use checklist Description Qty. f Ea. Tonal ❑ Additionialteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF SFR (1) bath 249 20 Kl- and 2- family dwelling Commercial /industrial SFR (2) bath 350 00 ❑ Accessory building 111 Multi-family SFR (3) bath 349.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. 0.) Page :_ ; r - :,i. L- ; - J:i`_:SOB` SITE''INF.OR LOC4TION :;.r ;` - °` -: a:'t ; "!`' • � �� ,.. . �:, �:_ :. -s =�` S ut Job site address:' 7 O5 , op EJ' �,l.Y - �i 1 ' Catch basin or area dram 16.60 City/State/ZIP: i II ° 9 Dryvell, leach line, or trench drain 16 60 Suiter'bldg- /apt. no -: V 1 Project name: /(' Footing drain (no linear (t. ) Page 2 � V\k r A . Manufactured home utilities 11000 Cross sneer/directions to job site -- \r\"�o �' rn P � L � vC Nlanholes 1660 Ram drain connector 16.60 Sanitary sewer (no. linear 0.: ) Page 2 Storm sewer (no linear r. ) Page 2 Water service (no linear ft ) Page 2 Subdivision: Q , + V - Lot no.: Tax map /parcel no.: 1 C 0 1w�` Fixture or item 1 Absorption valve 16.60 DESCRIPTION, UF- ��ORIC Backtlo.v pre +enter Page 2 Backwater valve 16 60 Clothes washer 16 60 Dishwasher # 16 -60 - `; -_.. 1660 1 , PROPERTY - OWNER = Y „ i °° 0 F =TNA,�1T i r`, '-.- . ,. _ >, -. Ejectors /sump 16 60 Name. �S LS ( _ IN,V A • V. Expansion tank 16.60 Address: l & aso ,,, . ,, ` ' - , Fixture /sewer cap 16.60 CiryiStale!ZIPr °`` ` ,• ■12* • r% Floor drain/floor sink/hub 16 -60 Phone: .51,33) 5 3- ��( Fax: (53)5 _ 4.80(o Garbage disposal I 16.60 �T - ;ts e �+�v»o tsar =: - , �r�.t —p..- Hose bib I 16.60 =:�,:� k3 ;�_ApPtiic - ��� ;�{��colvr �:::p>JRSi��vR ice maker 16 60 Business name: ( A rn Interceptor /grease trap 16.60 Contact name: l . Medical gas (value $ ) Page 2 Address: 3[-'] ` `it.. Primer 16 -60 City: /State /ZIP: Roof drain (commercial) 16.60 Phone: (6CS) 4 Q 11/53 Fax:: ( ) m, Sink/basin/lavatory 1660 Tub/shower/shower pan 16 60 E -mail: Unnal 16 60 CONTIL�G,IOR _ - r x Water closet 16.60 Business name: E., ILL - C ` u ,, Water heater 16 -60 Address: (2_0: , � l 1 .. t ` • Other. Cite /State /ZIP: l -1 ; \ 1n"oo" � 9 T1 bC .3 Subtotal Minimum permit fee: $72.50 Phone: ( 3) 29 _ Fax: (553) 1 , . Residential backflow minimum permit fee- $36.25 _ Plan review (25% of permit fee) vo CCB Lic.: o A9 _ Plumbing Lic. no.:3q o2WC1 State surcharge (8% of permit fee) Authorized signature ...Mk * -- >♦ TOTAL PERMIT FEE _ Date: This permit application expires if a permit is not obtained within 12121�. M__ 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. Building 'Perrrls\PLMF- PermitApp doe 12!03 4 40- 4616T(10/02/COM/WEB)