Permit T . .
/5640?-- Sy) /`� EXPIRED %3k2- , --
- Building Permit Application ,,. ', ' ` r s r":=
EcEly f f ?4 r FOR OFFICE USE L i
e �� qv" d ° v F.,�.. /, kK! ..h a• yF v.t�' OYLI t ;J , ,. � `�,- :: ' `ti
aT '`F 1 ! Rccuvcd (3 ir �� �� I Pennant N„ Co C ity o f Tigard
r Dalc•l� 1
v 131_ 's‘ti IlallBlvd Iigaru OR 97223 C EP 2 4 2007 Plan Roto ,> [ � n y A - �I
,>, Phone >Q i 639 - 71 I a\ 50 i 598 1960 J Daiell3\ • '' 2 ()the' Penna t n ,\ g /�..� R
�TIGARD' Inspection I me 503 6;9 117 CA Date Redd% l3\ GC7 /'/ J a W �ec \f (h 7 X foi
y.,_.,.k:r..,i. I nlCt nel \ \N \\ tiaald oI go\ Bun n oN Notilied+Nlethod 3 w6 / (r + :. S upp le me n t al I n ( ormannn
` 4., t / reCeOCJNIV
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
/:1 New construction ❑ Demolition Permit fees* are based on the %aloe of the work performed
Indicate the %aloe (rounded to the nearest dollar) of all
❑ Addition /alteration /replacement ❑ Other. equipment. materials. labor. overhead. and the profit foi the
—
CATEGORI OF CONSTRUCTION I work indicated on this application.
Valuation S ,,,?,i O
Vii
I - and 2- faamIly dwelling ❑ C ommercial /industrial
❑ Access or building El MuIII- Ianuly Number ofhcchooms
ill Master builder ❑ Other Number of bathrooms 4
JOB SITE INFORMATION AND LOCATION total number of floors
Job site address tf 9 O I S-}- /41y_ New dwelling area c....7 square feet
City /State/ZIP. ---c«i11A'Y-r-) (“2_ G 2 Garage /carport area . 77 square feet
Suite /bldg /apt no Project name c-w J { . 4,��,� Covered porch at ea �� square feet
Cross street /directions to fob site: " Deck area square feet
i 4 .Is < Other structure area square leer
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision ( i , I t(L • A - I 11,1. t! 15 / VA I of no • Permit fees are based on the \clue of the work performed
Tax map /panel no : Indicate the value (rounded to the nearest dollar) of all
equipment. materials. labor. overhead. and the profit for the
DESCRIPTION OF WORK work Indicated on this application
?L J t � : �� I ( ��' Valuation. S
1 S Y lJ� F\istin building area square feet
New building aiea_ square feet
PROPERTY OWNER ❑ TENANT Number of stories
Name (4-1,4,e4 1 (AU a. _L VI , J fype
Address: ' L-w7C S(� Le S-41..." ( >!,/ 3U 4 Jr� ,, 1 l /• Occupant) groups
C•It) /Stale /LIP. Om i - , OIL.- ci Z -2) Existing
Phone: ( a.5) - 3101 -( l a\ ( 5977) fig• G f 0'1 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name Lam( rn ► LL'rD i v\ hDvn _-9 y, All contractors and subcont'tactors are required to he
Contact name- J �` 5 1 w v1o{,V t n(r� licensed with the Oregon Construction Contractors Board
_ under ORS 701 and ma) he required to he licensed in the
Address' 12.1f7O StA) to St'` ve •I � 1 CID Jurisdiction in which work is being perforated. If the
r) City/Stine/ZIP lid n 2 q12--Z-3
applicant is exempt from licensing. the following reasons
/ l/ apPl� 518, 0 Phone /( (gi p? ) ) - 31 1) 1 1 ay ( r j �3
1. -ma ' t--,( e.li[�
ill ( CONTRACTOR
Business name • C. , 1 % m 1 ' - L /L ,j)v∎ / ��G� � 1 UL tl l v f ( d
St BUILDING PERMIT FEES*
Address' 1 1212_100 D SW IQS ! t' ! 5141k-40D (Please referrofee
�lef
Structural pan review fee or deposit):
City /State /ZIP: "¶! Ll � .Ar ►D Oa. G ZZ z�
—
Phone: (5n3) l03g • 3lozl l a\ (�� .��g FI.S plan review fee (if applicable):
CCB tic.: ' 72 5 Q (� r Total fees due upon application
1 Amount received
Authorized signature.
This permit application e\pires if a permit is not obtained
\vithin 180 da)s after it has been accepted as complete.
Print name' �I t WI �W + , n �, „ )ate. q 1($ w-7 * I cc methodolo „et h) I IA I3ullding Industry
V 7, ' ' (M l 'service Board
I \nwlt6nc\Pci finny \Rlll'I'ei mn App doe nt/?tin(, 4 4 1 , 4 6 1 I I,I V U' /(oV• WI UI
' 1' J
1
08/29/2007 14:24 5036425815 ROSS ELECTRIC INC EX: i•:.' C PAGE 02/02
Electrical Permit A� i�a IV • f ,'i ` �, 1411: OF1 1( I` 1 c£ i i• 1 1
City of Tigard Received , /off ,
13125 SW Hall Blvd., Tigard, OR 97223 S E P 2 4 2007 Review �� ► - i "N° v�T -Gold
Phone: 503.639 4171 Fax. 503.598.196 fi , • I . Date/By. Other Permit
Inspection Line: 503 639.4175 ( TY OF ri ' r ^t if .1 ' 4 J.. Date R By. r ® see Page 2 roe
Internet: www,ci.tigard onus l J Notified/Method Supplemental Information
omit xj „ s „„
V ` :I 1 if ., M' in 7 : : 'Y. •~� ,l wyT "A: n i.,, ‘-'•• I, `mac=! cT•'t 7-.. r
..II__ �..- :. ., � h ,l'•4z , � . �.T ��. :a r }I / %y`I�- .. -1'I' i tP . � L.e YI �I� c m. Lf��x� 11 'f . ,,,.; G .� 1�- ,I " �.y}1' ,��y.� F ,7 !
rg) New construction ❑ Addition /alteration /replacement Please check all that apply
El Demolition ❑Oda ❑ m
Service over 225 amps, com'I °Hazardous location
❑Service over 320
F � tfr }, a itFtrtU . li ` �� , Q ro wpb - rating ❑BUlldng over 10.000 sq. fi
t,n a uwr'a; of 1- and 2- family dwellings 4 or more new residential
1- and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building ❑sysram over 600 volts nominal units in one structure
Multi-family ❑Master builder ❑Other ❑Building over three stones [Weeders, 400 amps or mor
= ti �(� 1 ' r I; f w " �° �cr ui i. ❑Occupant load over 99 persons Man
, �r..L2AR r f0 J; 3',a f 1. ,�' �'` �, r4'. tJ: @:'..t er .` I ❑ uthetiired structures 0
P.; irS eT as S: wxi rt ' il"Mis ,Y �l+w t J- , �� 1 ❑Egress/hghting plats RV park
Job no.: Job site address: 1 5i, 02_ 5 L.0 es l Iq- t, ❑Heaith-care facility ❑Other
Submit./ sets of plans with any of the above.
City/State/ZIP: n ( la.z1:2_, rQ el -7 Z,4 J The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: a r`'. - 5� c n L � � w r uF . � + l f t 5 "''
Y ((J iLt/� J Deicdptbn Q4- Fez Total -
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
L ' / includes attached garage.
;'J w1 A ' a / gb 1}-ve. 1,000 sq. ft. or less I I 145.15 4
•
Subdivision: 6. 61,, '., 1 , , , ` / Lot no.: 1 Ea add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
-
�` ?�f t f *�k +r , 1 Y , Limited energy, non - residential 75.00 2
n ! fez 1 ' I,li, �'Ti w7�h ;N'ad'�'ly t (� Inr r � ;,�
s, i,,. ET A ,, `x.11';,;t . -, ,:J1x.>b.E_ 17 . WIR , b y� Eath manufactured or modular
(�7 � � ^ 0-1471&----' - dwellin service and/or feeder 90.90 _ 2
` ' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
ZOl a
1e ��tiu�..r `
m(,, `a i LA , 7 ', : ` . °.,1, '"' „!tea I rgi a t - �� -111_5 1, rttpsto400 10685
I � �SI' �FJ19Yifd��',ia. nt'r '+ �::d � " " -s .� v�y' s7�- Aal,:l� 1 Oh. . -. q ..
to 600 amps 160.60 - 2
401 amps 2
Name: / ✓ ii Ux I 601 amps to 1,000 amps 240.60 2
Address: � iiip 51,o 1 o g-i -- P , tr yc Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: I -, 1 02_ ci 7 Z-Z_ Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 1 3 r - lb Fax: (,r. 0 ) 'B . q ®R 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 an to 400 amps 100.30 2
intended for sale, lease, ren or exchange, according to ORS 447, 449. 670, and 70 .
Owner signature: Date. a 401 amps to 600 amps 133.75 2
r Branch circuity new, alteration. or ex tension, per panel
2 : 7 0 -111.:• 1. , rai74' ` .` -.y ..., i' rl for branch
er feecircuits with cas 6.65 2
Business name: Cam{ AY I'Yl 1 _
fit, / L r ' Aa. _ branch circuit
Contact name: 7 1� 8 Fee for branch circuits
Y 14✓ i Yi f� without service or feeder fee, 46.85 Z
o each branch circuit
Address: 1 jp � $-ice J .$ KD/) Each add'I branch circuit 6.65 - 2
City/State/ZIP: I (.. veyr7 v �77,Z Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( p _/ ) r 01 - It)�, Fax: ( gip .A 8 - D :
Sign or outline lighting 53.40 2
[.._ ,ll,� ■ - _ _ signal circuits) or limited- '
sl . v �,!isuT3'i 1} A iti.....4 n r3.2 :1) i24. P . :i t' i_t!a gy .3 ener paDnelescribe:
, alteration or
r� e•�e- extens
Business name: I�0 SS e p c ' r' 1 Page 2 2
Address: dC g 70 S 7 L- PI-0.e_ #'243 Each additional Inspection over allowable in any of the above
Per.inspectton 62.50
City /State/ZIP: l-l) I s core) r o r C) 7 ra "" ' investigation per hour (1 hr min) 62.50
Phone: (S ) IL y-7 2 S. 0 I Fax: (Po, ) t/ z 51( /S- Industrial tint per hour 73.75
CCB Lic.: e+ 1;5,73:`4..;-4,7" p t '1' ter: ,13" i.: ,� 4� ' �;.,
15 l Elec trical Lic : 3L -y36 c S uprv. L ie.• z3. £ r: a.,� (, L,,� + „ � .
Subtotal
Suprv. Electrician signature, required: -'' .Y7 g-Q/1"J Plan review (25% of permit fee)
Print name: S'f "2.P k..Q-\ gip S S Date: state surcharge (890 of permit fee)
TOTAL PERMIT FEE
Authorized signature; THis permit applicatio es ire, if a
p m is tain
Print name: d ays after n it bag bew a as nor comobplete ed within 180
,
V ( /I 1 d ✓ • Date: 1 7 • Fee methodology set by Tei-County Building Industry Service Board
•• Number of inspections per permit allowed f
i' weuu dln5}Porreils\Ei- C- PermitApp.doc 1.7-413 440- 46t6T(iW 2 /COM YES
i
'Plumbing Permit Application, FOR OFFICE USE ONLY
'L -1
2 4 LUU/
Received
City ' of Tigard i P ermil N . .
111
q 13125 SW Ilal Blvd Tigard OR ( TM- Dale /t3) ��1�� —�� •
' "� •�1 1 .S•• Plan ale / Re.ie+ �@ \ , d RED Oilier Perim! No
Phone 503 639 l 171 fax 503 • . 4... DB
TIGARD Inspection I me 503 639 4I 75 time Ready B` See P 2 fur
Internet ++ww nn,rrd -or gm Noulred'Mclh l
od p Supplemen tal Infurmanon
TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information rise c /�ec6/rst.
Description Qty Ea focal
❑ Addition /alteration /replacement ❑ Other. New I- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUC ION SFR (I) bath 249 20
cgl I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350110
❑ Accessory building ❑ Multi - family SFR 13) bath 399 00
Each additional bath /kitchen 45 00
❑ Master builder ❑ Other. - -
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: ( e7li O2 . J 3 $ l - 141-V/ ) Catch basin or area drain 16 60
City /State /ZIP. I , V I I4 tL�) t DE_ c „,.. Drywell. leach line. or trench drain 16 60
Suite/bldg /apt. no Pro ect name. `� / !� r '` Footing drain (no linear ft ) Page 2
g /a p l ��� T ��� JT Manufactured home utilities 110 00
Cross street/directions to job site
-- Manholes 16 60
(Y Y'F lA., +D l .w 10)-1-0,u S-1 -}-p RI 5-I- Alit , Rain drain connector 16 60
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no linear ft ) Page 2
Subdivision c ity ^ �,� t , re 5� v � sLD\ Lot no. ' Water service (no linear ft ) Page 2
'1 Fixture or item
lax map /parcel no -
Absorption valve 16 60
DESCRIPTION OF WORK
Backflow preventer Page 2
r z3' d20_ 5'{ 2 Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60
,/ ,,,/ 'M
Electors/sump 16 60
Name C. 4 /t' Y' I I I I , 10 7Atflo_ 1r 5 lc) L.L// Expansion tank 1660
Address. I, ZLl10 S LA7 U Swt -k Lite Fixture /sewer cap 16.60
City /State /ZIP. 'fl - [- 0 Q_ a -)7/7; Floor drain /floor sink /huh 16 60
Phone. (5 r7-7) W - 31 ll" l lax ( 3 s 8 , Gfo g / Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16 60
Business name Cat >' rn `U 1 ��������c (�(� Interceptor /grease trap 16 60 yig Contact name �1 ' 1' i 9._ f yi i 1 I n goo Medical gas (value. $ ) Page 2
rit
Address. -+ 'I' sc ti C) , Yt �i/ i 51A/C-16 . oo Primer 1660
City /State /ZIP: `r1 & ) I o G2zz3 Roof drain (commercial) 16 60
Sink/basin /lavatory 16 60
Phone ( ) 3 J -r 1pl I Fax (53) Ct �j8•SID8
�Q Tub /shower /shower pan 16 60
" ail I SWLS4 . (/ l� Y.Abl- am Urinal 1660
� CONTRACTOR Water closet 16 60
Business name- Th {/ m, 6,A,, /lyxn ea ✓i t , / Water heater 16 60
Address: 1 t p i 5f.„ T0.l V(� Foot L- Other
City /State /ZIP. - I �'l bp v v D� c I� / z3 Subtotal
.
1 Minimum permit fee $72 50
Phone (%y ( -0 ) 3 Fax ( 503) fete - cm 3 Residential hackflow minimum permit fee. $36 25
CCB Lic (/l2� cg. Plumbing Lic no.: 3N _ 9t v „ Plan review (25 % of permit fee)
�G State surcharge (8% of permit fee)
Authorved signature: , — 1
TOlAL PERM II I El. 1
Print name --SLvi C - 740/..444 Date q /1 3 107 This permit application expires if a permit is not obtained within
- 180 days after it has been accepted as complete.
*I ec methodology set by Tri- County Building Industry Service Board
I 'Buddrngil'er nw.APL5I -Pei nID app doc 502 , 06 44(1- 1616T( I 0/02,("Ox1 /WEB)
Plumbing Permit Application - City of Tigard
'Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I " 100 55 00 0 to 2.000 $1 15 00
Footing drain - each additional 100' rI6 .10 2.001 to 3,600 $160 00
3,601 to 7.200 $220 00
Sewer - 1st 100 55 00 7. and greater $309 00
Sewer - each additional 100 46 40
Water Service - 1st 100' 55 00 Medical Gas Systems:
Water Service - each additional 100 46 10 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100F 55 00
$1 00 to $5.000 00 Minimum fee $72 50
Storm & Rain Drain - each additional 100' 46 40 $5.001 00 to $10.000 00 $72 50 for the first $5 000 00 and $1 52 for each
Fixture or Item Qty. Fee (ea) Total additional $100 00 or fraction thereof to and
including $10.000 00
Commercial Back Flow Prevention Device 46 40 $10.001 00 to $25.000 00 $148 50 for the first $10.000 00 and $1 54 for
Residential Backflow Prevention Device each additional $100 00 or fraction thereof. to
(minimum permit fee $36 25) 27 55 and including $25.000 00
Ram Drain, single family dwelling 65 25 $25,001 00 to $50,000 00 $379 50 for the first $25.000 00 and $ 1 45 for
Inspection of existing plumbing or each additional $100 00 or fraction thereof to
specially requested inspections - per hour 72 50
and 00 for a the 0 00
$50 001 00 and up $742 00 for the first $50.000 00 and $1 20 for
Subtotal:
each additional $100 00 or fraction thereof
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following
please indicate work performed by fixture. Failure to Please check all that apply
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater. except systems desiened and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- .Iacu'zi /Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040
Car Wash - Each Stall
- Drive Fhru Submit 2 sets of plans with any of the above.
Cuspidor /Water Aspirator
Dishwasher -Commercial Isometric or Riser Diagram
- Domestic
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2
4 .. Comments regarding fixture work:
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach /Refng Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang *Note: If the fixture work under this permit results in an
-Stall increase of sewer EDUs, a sewer permit will be issued and
Sink -Bar /Lavatory fees assessed for the sewer increase must be paid before the
- Bradley
Commercial plumbing permit can be issued.
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures
\Buddmg \Permits \PLM -Perms App doc 00/22/06
,
Mechanical Permit Applic . ',1 t . , �, . . :. ` � _': u k r' t ,':'� Y � `f OR ( I CFF I S ONI s ,
� f c ∎ -, 6 Received
Si t of Tigard 1 .L. r' t ^ F �f /L /� Pern Nn o /
maid Olt 972 ; DateB i�rj t/ s �` �/rJr)��/�4O
� 4 13125 SW Hall Blvd I ;6 _ Plan � -_� - -- �`� � V _
w . Phone 503 639 4171 Fay 505 59$giEf) 2 4 2007 tl(u:; Primal
Date/By
r•, Ins ecUOn Line 503 659 4I 7 — J
TIG'�R p D: 4 Date Ready,B El See Page 2 fur
: Internet utvw ttgard - go, G YOF Tl Nuufied/Method EXPIRE • - VG,' ° Supplemental Infurmanun �
TYPE OF WORK — COMMERCIAL FEE SCHEDULE - USE CHECKLIST
W 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 materials equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value $
m
RESIDENTIAL. EQUIPMENT / SYSTEMS FEES*
I_ and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other
Description Qty Ea 1 oral
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address 1 c3L OZ �v 5 1 1p.y -, J Air conditioning or he�t pump
J I 'pry (requires site plan showing placement) 14 00
City/State /ZIP - �/i -1l.? 1 n .. V' /,t- Fumace 100,000 BTU (ducts /vents) 14 00
IL Furnace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg. /apt no . Project name 6 1AS� k V' A7 Gas heat pump 1400
Cross street/directions to job site. J Duct work 14 00
�
,/ , Hydronic hot water system 14 00
Lk 1 I' f. g I r v p 1 , ic, Residential boiler (radiator or
hydronic) 14 00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc 10
r-
1 V U Lot no Flue /vent for any of above 10.00
Subdivision:
C i�.qt.' d�� 4 �� 1 Other 10 00
Tax map /parcel no. Other fuel appliances
DESCRIPTION OF WORK Water heater 10 -00
y� y , ' ^,�,� Gas fireplace 10 00
t f�% Co V\S't t' iA((T i'V ' \. Flue vent for water heater or gas
fireplace 10 00
Log lighter (gas) 10 00 J
Wood/pellet stove 10 00 1
Wood fireplace /insert _ 10 00
Chimney /liner /flue /vent 10 00
IX PROPERTY OWNER ❑ TENANT
J � Other. 10 -00
Name C,-ail( ( m l L( -rOwAh.+) vY t L _/ Environmental exhaust and ventilation
��, J Range hood/other kitchen
' �
Address' Q- 0 )7 LI 8 Y'l v b 5 //W equipment 10.00
City/State/ZIP. Tt&- i- - ail- � ? Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: ( ) cl , 31 aid Fax: (Q2,) c1g • go 2,1 toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name. lf�t . V ,/1/1 i t -rO � b u s -n ��
Fuel i i 10.00
-Si PPng
Contact name J WI 5A-, v--4 1 v1) S5.40 for first four; $1.00 for each additional
Address: 2yp1 O S L) g� �vzi l 5i '-!DD Gas heat c P um P
City/State /ZIP. Tc ,,,/i„r) ,n /)
r � 41-72.-2..-3 Wall /suspended/unit heater
Phone: ( ) t3q . 3 'NI t / Fax: • ( 1.3) u,, a , � , 8 / Water heater
l� C `] G ail) /n J, 0 / Range
E -mail: 3 5
'�• _ 0_,_, C(,v t (OWL/ Range e
CONTRACTOR Barbecue
Business name. - { I / J io Clothes dryer (gas)
Other -
Address. 7 , (J
2 31e, 5iA✓ vn -- _ I ,, (S �T r 1 . 00 MECHANICAL PERMIT FEES*
City/State /ZIP: 170 (� l (/1. v-‘4. l D Q 61---)7_2_14 Ci Subtotal
Minimum permit fee ($72 50)
Phone: ( 5 4 - III - S3 3 U ?j Fax: (5(5) V10 - G DLP '
Plan review (25% of permit fee)
CCB he.. J I , L i —7 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
` DI Y' 3 w g //Pui
EXPIRED to/ti
CITY OF TIGARD - SITE PLAN REVIEW AECEVE)i
f BUILDING PERMIT NO: MSTZCO7 - enl$ r 5 J) STREET TREES MUST OCT 1 7 2007
*1\
CITY OF TIGARD - SITE PLAN REVIEW BE PER APPROVED
BUILDING PERMIT NO.: IJISTLCCYi - CO t& 1 SLlv Street Trees: ❑ Approved ❑ Not Approved COP/ ®1= IIGMRD MARK STEWART
Protected Trees: ❑ Approved ❑ Not A DEVELOPMENT TREE PLAN BUILDING DIVISION \ HOME DESIGN
PLANNING DIVISION:
pP Approved
Required Setbcks• Approved - By
Re e �'
q pp ❑ Not Approved
Side: C Street Side: i° Notes:
o
Front. I Garage: Rear: 1 oz._
Visual (learan;e. 1 Approved ❑ Not Approved TRACT'' - PRIVATE ST. _
3 5 13.� 1 8137 S.W. SENECA
'�Ia \Im1U ?1 Builriint. Height S feet \ Tualatin, Oregon 97062
e�VS Service Provider Letter Required: ❑ Yes No ` \ 9l ( ( 1
J
T
^_. _ l ❑ Received , \� \ ; i 0 � I� 1 (503) 685.6377 P
t$ : � �+/L• Date: I b I i 21 / ' '' `\ ' \,� ■� 1 4) I (503) 579.4132 F
% % ' � Icy w www.markstewart.com
ENOI EERING DEPARTMENT: ; \ ` .,,,,,,,,,,,,,,,,,, ,;,,,,.,,,,,,,,,,.,,,,,., ll I in
Actual Slope:% Al Approved ❑ Not A�ppfatfed `!A , • - - -- -- - -- - -- -; - ;------- - --- -- - N� T
Site Plan: Approved • .-14 ∎ ■ (oio.� a
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