Case File 1 - _ � . , . . ,.. /�`��:!'.'����;tat....r:►: �.�
L EXCAVATION MATERIAL REMAINNG ON
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TOTAL BLDG AREA 2013 Sa FT.
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LOT AREA= 10,645 S.F. ---�.-
LOT COVERACaE: 2,143 Sr-. I .....
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AN-
rw9l...W. FULLERTON
LOT w WILLSWIRE LLY;IlOCIS
CITY OF TIGARL7 WASHNNTON GOl1WTY
ORl530N
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13154 SW ASCENSION DR
CITY OF TIGARD
�.� DEVELOPMENT SERVICES MASTER PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERM I T . . MST77-��]
;
BATE I SSLIFb LIER:; 03/1.9/97
PARCEL: 2S104CC-HWOSO
I TE ADDRESS. . . : 1.3154 SW ASCENS T F1n1 DR
;I.JBDIVTSTON. . . . : HILL-SHIRE: WOODS ZONTN(.;: R-7 PD
r1L.00K. . . . . . . . . . . L.OT. .. . . . . . .. . . . . . :080
Remarks: Single family new residence PATH I
--------------------------------------------------------------- BUILDING -----------------------------------------
REISSHE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT_: A sf REQUIRED SETBACKS--- REQUIRED-------------
,LASS OF WORK.-.NEW HEIGHT........: 21 F'IRST....: 1433 sf GARAGE.....: 727 sf LEFT..........: 11 SMOKE DETECTRS: Y
TYPE OF USE...-SF FLOOR LOAD....: 40 SECOND...: 1292 sf FRONT.........: 23 PARKING. SPACES:
TYPE nF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 14
17I9 4NCY GRP.03 BDRM: 3 BATH: 3 TOTAL------: 2725 sf VAI.IIE..{: 195156 REAR..........: 63
--------- - --- ----------------- ------------------- ---
PLUMBING ---------------------------------------------_
SINKS.........: 1 WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS.........: 0
AVATORIES....: 5 DISHWASHERS...: 1 FLOOR DRAINS..: 0 SEVER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS..: 0
TUB/SHOWERS...: 3 GARBAGE DISP..: 1 WATFR HEATERS.: 1 WATER LINE ft: 100 BCKFLW PREUNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
------------ MECHANICAL ------- ----------------------------- ------
cOEL TYPES---------- FURN ( INK ..: a 8011 TMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1
,GAS/ / / FURN )=IN', ..: 1 UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: l
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1
-------------------------------------------------------------- ELECTRICAL --------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEE%RS-- --BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-
1000 SF OR LESS: 1 0 - 200 alp..: 0 0 - 200 amp..: 0 W/SVC OR FDA..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
7A ADD'L 508SF.: 5 201 - 400 amp..: 0 201 - 406 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
, TMITED ENERGY.: 0 401 600 aen..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......:
MANE HM/SVC/FDR: 0 601 1000 amp.: 0 601+a1ps-1000 v: 0 MINOR LABEL -10: 0
1080+ amp/volt.: 0PLAN REVIEW SECTION -------------------------------
Reconnect only.: 8 1=4 RES UNITS..: SVC/FDR)-225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
- ----------------------------- ELECTRICAL - RESTRICTED ENERGY --------------------_—---------------------
0. SF RESIDENTIAL-------------------------- B. COMMERCIAL---------------------------------------------------------------------------
AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO t STEREO.: FIRE ALARM...... INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0111: :: X BOILER.......... HVAC...........: LANDSCAPE/IRR16: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: ::
!IVAC............ DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMS: 0
Owner! ---------------------------------Contractor: -------------- ------------- TOTAL FEES:$ 4763.20
P W RU.LERTON CO THE R.W. FULLERTON COMPANY
4PF. eta BVTN HILLSDALE HWY 9700 SW CAPITOL HWY
SUITE 0 275
FILPND OR 97221 PORTLAND OR 97219
u4,one 0: ?97-4433 Phone R: 293-2277
Reg 0..: 48671
ihl� pe-eit is is4�ued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codei and all other
applicable laws. all work will bo done in accordance with approved plans. This permit will expire if work is not started within lee
rays of issuance, or if work is suspended for more than IN days.
------------------------------------------------------ REQUIRED INSPECTIONS --
erosion Contol Post/Beam Meehan Electrical Servi Gas Line Insp Water Line Insp Building Final
�,radina Inspecti Crawl Drain Electrical Rough Gas Fireplace Appr/Sdwlk Insp
Eaoting Insp PLM/Underfloor Framing Insp Insulation Insp Electrical Finan _
Foundation Insp Mechanicai Insp Shear Wall Insp Gyp Board Insp Mechanical Final
!:,,c+/Ream Struct Plumb Top Out o age Rain drain Insp PIVb Final
I 1 �w r; ! T1T1at�it'F a .. l/�J Vv I3s!led FAY : 6 ,Kk,� <_{
f"al l for- in-.nf-rtion - 639-4175
CITY OF T SEWER CONNECTION
DEVELOPMENT SERVICES PERMIT
PERMIT #. . . . . . . : SWR97-0013
13125 SW Hall Blvd., Tigard,OR 97223 (503)539.4171 DATE ISSUED: 031/1.9/97
>ITF ADDRESS. . . : 13154 SW ASCENSION DR
IUBDIVISION. . . . : HILLSHIRE WOODS ZONING: R--7 PD
RL.00K. . . . . . . . . . . LOT. . . . . . . . . . . . . :080
TENANT NAME. . . . . :
)SA NO. . . . . . . . . . . FIXTURE UNITS. . . : 0
I-AS OF WORN.. . . :NEW DWE1_L INP UNITS. . : 1.
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
rN5TALL TYPE. . . . :RUSWR TMPFRV SURFACE: 0 sf
f7Pm�rks : Single family new residence
!)caner': -._______._._._--_.__._—_.___...___.__.____... _..._..______._.________ -_- FEES
R W RULLERTON CO type amor_tnt by date recpt
4,716 SW PVTN HILL_SDALE HWY PRMT R 2200. 001 B 03/19/97 97-291.92'..'
INSP $ 35. 00 S 03/19/97 97-2919,2":
r'ORTI_AND OR 972'21
Phone #: 297-4433
c.ontt,actor: ---_—_---_--_---.----------------.
CONTPACTOR NOT ON FILE
Phone #: _8_ 2235. 00 .TOTAL__..____.________
Q,Lag #. . :
------- REOUIRET) INSPECTIONS ------
This Applicant agrees to cooply with all the rules and regulations Spwer Inspection
if the Unified Sewage Agency. The peroit expires 188 days froe _�•____
the date issued. The total aoount paid will be forfeited if the
oersit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the oeasureoent
given, the installer shall prospect 3 feet in all directions froe
the distance given. If not so located, the insnk-3
1 purchase
a "Tap and Side Sewer" Peroit and the Agency wa lateral. _
r'pT`mittPP S1 ��:irt P 1 _ M -
T 5 5 i t e d B y V�
('all for- inspection — 639-4175
Plan Chock
:,TY OF i iGARD Residential Buildint ' !rmit Application rtec'd By
13125 SW HALL BLVD. New Construction Adi ,ns or Alterations Date Recd-10
TIGARD, OR 97223 Single Family Detached or Attached Date to P E.
f Sn?; v39-4171 Date to OST-,'
Print or Type Permit,t��C�lr�lr}�,
IIncomplete or illegible applications will not be accepted called,
- Name of Subdivision lots Name 1 `
Job I1.�. H tRF \\I QIJtJ Q
Address Site Address Architect Ma,"Adrdress
-, C /state Zip Phone
t,)t_L.tT_tZTtJIJ C ARc��� 2A
Owner n ss F�o�1�.❑ �. FU Lt_r Q
w gjEn►i. �t�.SD�. �w� Engineer address
T -000 0p, �a p j Pirrone 0 3 L�"3'Z3_ owrZi _
— /Shte� Zip one
Name 1' U Ph
51
General 91 . _LLE 2T11w Go . Descnbe work new t�k addition O attemnon O repair O
Contractor Marling Address to be done.
S\-1jE)fAJ-�LL5DlL.. 11%Ny 11%NAdditional De,
tion of
.Cdy/State Phone
10 J Q ) 293-?r?.
0 on Const.Cont.hoard Uc.0 .D to
Attach Copy of M4 o(oI I P( U 91 Project r
Current COT Business Tax or Metro s to Valuation
-_ ur enstes aName��31 IQ `� NEW CONSTRUCTION ONLY:
Mechanical _t �Ir.L��tV Sq.Ft. House: S .Ft.Garage:
Sub- Mai"ng dress �!�_ _ 7 t' 7
Contractor L3E &� l�M Comer Lot Yes Nq Flag Lot Yes No
,'dy/St2te P (check one) } (check one)
t�6 Z.J Restricted Audio/Stereo Burglar
Attach Co of OregonGotBoaBoardLrc e 2ate Energy System PJarm
Installation Garage Door HVAC
i w:.urnnt COT Business Tax or Metros late O O
LiceOpener Systems
nses C)I�1 _
- Name (check all um7tr Other.
Plumbing r'Y1S4 1 LW113fi _apply) _
Sub_ Marling Address Will the electrical subcontractor wire for all Yes No
Contractor ZZ95_ restricted energy installations?
/Statephone Has the Subdivision Plat recorded? N/A Yes No
7 - -
,�l C ns Cunt. Board Lice 4 Reissue or MST# Solar Compliance
Arta-ch Copy of V1 �l JI (Calculation Attached)
Current mt, ate I hereby acknowledge that I have read this application,that the
Licenses I information given is correct.that I am the owner or authonzed agent of
-- 'OT Business s T or Metro t E p ate the owner, and that plans submitted are in compliance with Oregon
_ 'T State laws.
Name/ Montact
rieft D e
! Electrical I�\IQ't�}T I C� U \ 11 9
Sub- Marling address n e t o
ESS
Contractor 5(D \j IE FOR OFFICE USE ONLY:
44y/state Phone Plat## Map/TL#:
l�
O n Gon� nt. Roard l.,c s P.Date ICS-i�c.1a:�'
Attach Copy of �12j")j— Setbacks Zone: Solar.uCurrent E ncal L,c a
Ltcernses ( p
s Tax or Metre e
astsYMUpp.docoO QOT ?-411-
17,
1713
Engineering AAproval: Planning Approval: TIF:
1
Permit # Account Description Amount Amt. Pd. BaI. Due
RT97-00ia MST. Permit (BUILD) 73, `
Plumb. Permit (PLUMB) 2 2 S. 2 2 v
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT)
State Tax (TAX)
Bldg: 33, --
Plumb:
33, --
Plumb: //
Mech:
ELC/ELR: j 3, ��' ✓
Plan Check
MST: 437 �' �`�°� �*���� (BUPPLN) �,�'
Plumb. (PLMPLN)
Mech: (MECPLN)
CDC Review (LANBIJS)
E I cC,3 Sewer Connection (SWUSA) p 00
Sewer Inspection (SWINSP) 3��
Parks Dev Charge (PKSDC) __LO,-,<, ;0'
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT) — > - _� __ Ga•
Erosion Control Permit (ERPRMT) _
Erosion Planck/USA (ERPLAN) ,2V, V.
v
Frosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS: r ' ; :o t�7
Wstsvmtavp.d« '
Rev 3
Solar Balance Point Standard Worksheet
Address
Box A calculations: North-South dimension for the lot. Box A.
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to 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.
450-1-
t
r �
N UN North-South
Dimension for Lot:
Measure the distance from the midpoint of the North lot lirn, to the South lot line along
the described line. feet
1
N
Manu"
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 WhirJi describes
structure. The orientation of the ridge is also important. your residence?
1 a: If the roof line runs North-South, measurements will ..... (circle one)
be based on the peak of the roof. 1130001
ww"_► 'A) 1B 1C
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.
SOM PrVa L*A
0
1 c: If the roof line runs East-West and the roof pitch is
5/12 or steeper, measurements will be based on the oe�
peak.
Box B. continued Box B:
2. Measure change in elevation from front property line to finished floor elevation. If
th4 lot slopes up from the front lot line to the foundation, the figure is positive. If ft
the lot slopes down from the front lot line to the foundation, the figure is negative.
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,
deduct nothing.
5. Subtract one foot for each foot of difference in elevation from the frontro
P Perty
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. i;> ft
6. Tc:al figure for box B: r 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 `� It
affected peak/eave.
2. Measure the distance from the foundation to the affected peak or eave. + ft
3. Total figure for box C: ft
It is most useful to draw a vertical line to represent the appropriate figure found in box'n'and a horizontal line to represent the
appropriate figure found in box'C'.The interscction 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 10'; if the value in box'0'is less than or equal to the value found in box'D then
the building is in compliance with the solar balance code. If you have any questions,please contact us at 639-4171,x304 or at the
Community Development C^unser.
MAXIMUM PERMITTED SHADE POINT HEIGHT (In Feet)
Distance to North-south lot dimension On feet)
shade 100+ 95 90 85 80 75 70 65 60 55 50 45 40
reduction line
from northem
Is.Liifi (ice n feet)
70 40 40 40 41 42 43 44
65 38 38 38 39 40 41 42 4'1
60 36 36 36 37 38 39 40 41 42
55 34 34 34 35 36 37 38 39 40 41
50 32 32 32 33 34 35 36 37 38 39 40
43 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 26 26 26 27 28 29 30 31 32 33 34 3+ 36
30 24 24 24 25 26 27 28 29 30 31 32 33 34
25 22 22 22 23 24 25 26 27 28 29 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 20 21 22 23 24
FBox D. Maximum allowed shade point height: G� _ _ _ feet
h 7Wocs%mncy\ventu-\"ar.chp
Reviled 2126196
April 16, 1996
Jill Aldrich
City of Tigard
13125 SW Hall Blvd.
Tigard, or. 97223
Dear Ms. Aldrich,
Re Solar Balance point- Lots 80& 81, Hillshire Woods
Per my discussion with Dale Richards of Windwood Homes, the owner of Lot 81 Hillshire
Woods, the single-family home to be built by The R. W Fullerton Company on Lot 80 Hillshire Woods
will not have any windows on the side adjacent to Lot 81 Hillshire Woods, This should resolve any solar
balance point issues with respect to these lots.
IsiP ly,
Ralph Fullerton
The R W Fullerton Company
SEE 35MM
RoLL# 22
FOR
LARGE
DOCUMENT
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hail Blvd., Tigard,OR 97223(503)639-4171
CU R`F I F I CATE OF
OCCUPANCY
PERlrtl'T 0. . . . . . : : MST97-001c'
DATE ISSUED:
r'ARCE1_: 25104CB--03400
+:;ITE ADDRESS. . . c 1:3.154 SW ASCENSION DR
SUBDIVISION. . . . c H.11.1-SHIRE WOODF- HIN I NO s R--7 PI)
DLOCK. . I . . . . . . . e LOT.. . .. . . . . . . . . . . 1111130 JURI'M ICTION:TIG
CLASS OF WORK. :NEW
i YPE Or USE. . . s SF
1"YPE OF CONST'R:5N
1)C."CUPANCY GRP. :R3
11C.A.,UF'ANCY 1._( ran:2
-oma, -ks c Single family ner, ree►dence PAM 1
........ ...
!-{RULE ENDICOTT
1.3154 SW ASCEN4i I ON DR
1-1(:3ARC) OR �17,"24
hone N:
:r,ntrat•^tor- : -.. ..,_ ._._ ....__...._ .._..._. ,.,._._ ......_.. . . _ -.._
01-LEPTON COMPANY'
SW BE AVE RTON HI LL.S DALE HWY
PORTLAND OR 97221 11 'fi
i hane #: 297-•4433
'leg #. . c 000406
i'hi % Cert a ficate pr-ants occupancy of thN ,hove r-efe►-ence,cl bui ld.ir,q o► po►^tic,.
he'r^wof and cc,nfir-ms that the bui. idiny has hewn irnslaerrte!d fear campl. ianr.e with
rhu State? of OgPgor, SpHc�i.r-alf:Y Codes Por the group, ocr.Upan�.Y, Arid uee r.�ncier
,jlrir^h the rwf-e 'ericed pfwmit was issued.
'UJILDING IN5- 'C;' O'R a1-i 6s�rcnivsu 'E.1?V l`a(.�}
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION MsT 77.-e,1C7`i�-
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -
BLIP
Date Requested AM PM BLD
Location /S� {�C�,� ��� '��'��lL- �/,r Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
IL TenantfOwner ELC _-- --
Retaining Wall ELR
Footing A FPS
Foundation NOT REQUESTED --- ---
Drain FOUND DURING RESEARCH SGN
Slab Crawl Drain Ir NO INSPECTION(S) IN FILE __. SIT
Post& Beam —�
Ext Sheath/Shear
Int Sheath/Shear {{ i ,
Framing / -- -- -
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler T Fire Alarm
Alarm
Susp'd Ceiling --- - --- -- -- - -
Roof
Fin
PART FAILPUU-MBING
Post& Beam -----�... . ---------- -- --
Under Slab
Top OutWater Service
Service _
Sanitary Sewer
Rain Drains _
Final
PASS T FAIL
ANI
Post& Beam
Rough In
Gas Line -- - - - -- — -
Smoke Dampers
AS PART FAIL
-
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
slit-
Backfill/Grading - --- -—
Sanitary Sewer
Storm Drain I ] Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd
Catch Basin I ) Please call or reinspection RE: ( �Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date I 7'2 ther Inspector V& Ext
Ext
o —
Final
PASS PART FAIL- 00 NOT REMOVE this Inspection record from the job site.
Page No. 4 CASE HISTORY FOR CASE NO.: MST97-0012
R W FULLERTON CO
13154 SW ASCENSION DR
12/24/98
Action lescription Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
MSTA780 <<REINSPECTION>> / / / / 10/01/97 elect final errors of 100197, assessed PAID BRP 10/09/97 DST
$35
PAID, $35, ON 10-9-97, RECEIPT
#97-299921.
MSTA780 <cREINSPECTION>> / / / / 11/28/97 #301202 PAID JT 11/28/97 JT
paid $15
reinspect fee for final
MSTA790 Electrical Final / / / / 09/25/97 Complete all installations and call for FAIL BRP 09/26/97 J•H
reinspection.
MSTA790 Electrical Final / / / / 10/01/97 Check setback on all FAIL BRP 10/01/97 J•H
receptacles/switches. Outlet boxes do
not comply with ART370-20. Wall plates
don't cover wall opening. Gap around
outlets, ART370-21.
Wires at receptacles not wrapped around
terminal screw. Many locations.
Second reinspection fee assessed,
$35.00.
MSTA79u Electrical Final / / / / 10/02/97 I am passing this final with the below PASS BRP 10/03/97 J•H
questions for the record:
1. What is going on with the exposed low
voltage wires to furnace? 2. Wall finish
around outlets? 3. Unable to remove wall
plates for inspection. Have supervisor
electrical licensee contact me.
MSTA795 Mechanical Final / / / / 10/03/97 If final is okay, will rescind FAIL RB 10/05/97 J+H
reinspection fee per Hap.
Not approved, see bldg final.
MSTA795 Mechanical Fl!,al / / / / 12/22/98 Passed by review of file. PASS RB 12/22/98 RB
MSTA797 Plumb Final / / / / 10/03/97 Sanitary sewer and backflow also final PASS WA 10/05/97 J*H
(previously approved).
r -
I\ CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT #. . . . . . . . PLM97-0379
.: 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DAT(. ISSUED: 09/12/97
PARCEL: 2SI04CB-03400
SITE ADDRESS. . . : 13154 SW ASCENSION DR
SUBDIVISION. . . . : HILLSHIRE WOODS ZONING: R-7 PI)
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :080 JURISDICTION: TIG
--------------------------------------------------------------------
CLASS OF WORK. . :ADD GARBAGE DISPOSALS. : 0 MOBILE_ HOME SPACES. : N
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . :R3 FI—OOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
F I XTURES --- _.—__.___.___ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
L_AVAT'ORIES. . . . : 0 OTHER FIXTURES. . . . : 0
"TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Add residential bac-kflow prevention device
Owner: ----- ---- ------- -- _---_ _____ -— - -_—_____ ----- FEES -------- ------
R W FULLERTON CO type amoi.tnt by date recpt
E.426 SW BVTN HILLSDALE HWY PRMT $ 15. 00 GEO 09/12/97 97--299171
PORTLAND OR '37221 5PCT $ 0. 75 GEO 09/1 /97 97-299171
Phone #:
MICHAEL & CO PLUMBING
1, 0 BOX P3008
TIGARD OR 97281
Phone #: 639-3189 $ 15. 75 TOTAL
Reg #. . : 000679
---- --- REQUIRED I I ISPECT I ONS — --- — -
This permit is issued subject to the regulations contained in the Rokigh—in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws, All Mork will he done in accordance with RP/Backflow Prev
approved plans. This permit will expire if work is not started Final Inspect ion
within 189 days of issuance, or if work is suspended for more
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are — �—
s®t forth in OAR 952--9881-9810 through OAR 952-9881889. You may
obtain copies of these rules or direct questions to OUW, by calling
(583)246-1987. _
I
ICsued By: _�%' Permittee Signati_rr
i
+++++•ht+++ti•.•F+ ......................................................h
Call 639-4175 by 6:00 p. m. for an inspection needed the next business day
4.++++++++++++++++++++++++++++++++•F++++++++++++++++++++++++++++++++++++++++++++
CITY OF TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'u
Date to P E.
TIGARD, OR 97223 Date to DST_
(503) 639-4171 Pend 0 If 1-fn/
Print or Type Related SWR r
Incomplete or illegible applications will not be accepted Called
Name of Development/Project
Job / / �� f, JC��c"S�'-i%N FIXTURES (IndividuN) OTY PRICE AMT
Addresn Street Address Suite Sink 9.00
Lavatory 9.00
Bldg t 77,_/&;,,4/1z
ity/stale Zip Tub or Tub/Shower Comb. 9.00
(-)It Shower Only 900
Name
11 L't, (" /c v. 0 Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
_ Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
Name Floor Drain 2' 9.00
t Gv r In �( 3^ 9.00
Occupant Marling Address Suite a' 9.00
Water Heater O conversion O like kind 900
CitylState Zip Phone
Laundry Room Tray 900
Name Unnal 900
iI [ //> N/,)/ "t Other Fixtures(Specify) 9.00
Contractor Meiling Address Sufle — 900
l'1,< <) 7 tiJ d' -- 9.00
(Prior to issuance City/State Zip F`one
applicant must l/y ' ?=J�/ )� -- -- 9 00 —�
provide all Oregon Const.Cont.Board Lic.i Exp.Date 900
contractors iLc 1,1 1`7 900
license Plumblr;g Lic.• Exp.Date Sewer-1st 100' 30.00
information if 7 /�
expired �� (,^ _ j I ) Sewer-each additional 100' 25.00
in COT COT Business Tax or Metro t Exp.Date Water Service- 13t 100' 30.00
database) Water Service-each additional 200' 25.00
Name
Storm d Ram Drain-1:.t 100' 30.00
Architect Storm&Rain Drain-each additional 100' 25.00
Or Mailing Address Suite Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
9 Pollution Device
Cescnbe worts New O Addition O Alteration O Repair O— Residential Backflow Prevention Device' 15.00_ /~
,o be done. Residential O Non-residential O Any Trap or Waste Not Connected to a Fixture 900
Additional description of work ll Catch Basin _ 900
C Insp.of Existing Plumbing 40.00
perthr
Specially Requested Inspections — 4000
xishng use of / 1 _ perRv —
oudding or property k l ✓i O�^�%�^/� _ Rain Drain,single family dwelling 1000
Grease Traps 0 00
Proposed use of
building or property QUANTITY TOTAL
Isometric or neer diagram is required 4 Ouanrty Total is >9
Are you ganping, moving or replacing any fixtures? Yes L) No C — 'SUBTOTAL
�(if Vas see pack of fo.m)
i I hireby acknowledge that I have read this application,that the information 5%s SURCHARGE 7 i
given is correct.that I am the owner or authorized agent of the owner,and
that Dlans gubmitted are in compliance with Oregon State Laws PLAN REVIEW 25%. OF SUBTOTAL
Signaturs of O
wner/
Agent Date _Required ontya Torture my total,s>9
".7 TOTAL
Ci:ijiltiwt Person Name Phone 'Minimum permit fees 525�5%surcharge except Residential Backflow
'_ /_�/ 1,4'�� ,li Prevention Device,which is 515- 5%surcharge
A
I WstaiWmp eec 847
P-LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixiure_s to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher _
Garbage Disposal
Washing Machine
Floor Drain 2"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I%astsw"am do[5191
1