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GAARDEWING LOT 5, EAGLE P
STREET N. POINTE
_ W. 1 r.2.S. W. W.M.
-�-4N EIGHT FOOT PUBLIC UTILIT`,' EASEMENT CITY OF TIGARD
HALL_ EXIST ALONG ALL STREET FRONTAGES. WASHINGTON COUNTY, OREGON ,
JUNLl 3 1996 Center-line Concepts 1nCT
DRAWN BY:Yw TGB CHECKED BY: WGDIII 640 82nd
SCALE 1 -20 ACCOUNT 115 503 650x101 8afa:<o5��3 �50�rU189027
NOTICE: IF THE PRINT OR TYPE ON ANY � � � � IIi � I I � iII � I ISI i � I I ( ! ISI 1 � I I�T _�i �T _�`.rl rTV {�T � j_1. 1� 1 l � I FI-. .j 1-11 T I II11 ] 1 1 � 1 1 1 [ 1 IT1- 1 ! 1 ! 1 ! 1 1 ! I1 ! 1 1 � 11 ; 11II I f � 1 1 1111
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IT IS DUE TO THE QUALITY OF THE _ - I
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No.36 0`
ORIGINAL DOCUMENT E 5 , � T 8 S F Z 31413"
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13981. Sial AERIE Det
CITY O
F TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
CERTIFICATE- OF"
OCCUPANCY
pEpmI7' #. . . . . . . i MST9(,
DOTE ISSUEDs 01 /22/97
PARCEL: 25104DD--EP005
;ITF:. ADDREW3. 13981, SW AERIC' DR
ZIONF IG c R-4. "_% Pr)
;UBI)IVIGION.. EAGLE POINTE
OLOCK. . . . . . . . . . c LOT. . . . . . . . . . . . . 1005
LASS OF WORK. xNEW
IYPE OF USE. . . i SiF
TYPE OF CONGTP:5N
(.30-UPANCY Gpg:,. -R3
1CCUPANCY LOADa2
ilemarks : PATH I
RENAISOANCE CUOTOM HOMES
167,? SW WILLAMETTE FALLS DP
WEST LINN OR 9706S
-riorip #. 557-SOCAO
RENAISSANCE CUSTOM HOMES INC
1 (.72 SW WILLAMETTE FALLS OR
WLST LINN OR 97068
Phone #:
0. .. - 97ri99
Ihaw Cfiy_t i f i ce -on portion
.jtp yt-ants occi.tpancy of the above referenced building of Or
ti,,ev-,vaf and confirms that the building has been inspected l?r compliance with
thState f Oregr
Specialty Codes for the group, occLlpAT"Id "Alke undei
� :
which the rorprol, permit was isigued. J
BUILDING OFFICIAL.
Plrt;/IEDN�D�N(310_:4SPEC TOP
POST IN C.ONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line 639-4175 Business Phone 639-4171
Footing Rain Dra;n Cover/Service FINAL.
Foundation Water Line Ceiling -Plumb
Post/Beam Mech. Shear/Sheath Framing -
Plbg Und/Flr/Slab Plbg. Top Out Insulation EIecT
Post/Beam Strutt. Mech. Rough-in Gyp Bd.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other –
Date: _ A.M. _ -. P.M.-----,- Entry:-_-_—
Address:
S
Te t 1- - -- ---
-- Ste: MST: ?4"_03 Z i
BLIP: �—
Con/Own: -- __ MEC:--- --
PLM:
ELC: - -THE FOLLOWING CORRECTIONS ARE REQUIRED EL9:
Inspector: — Date:
I PROVED DISAPPROVED/CALI_FOR REINSP CF
I
i
CITY OF TIGARD MASTER #.. .. .
COMMUNITY DEVELOPMENT DEPARTMENT
Ufa-FE ISSUED: 07/09/96
13125 SW Hall Blvd.Tigard,Oregon 6722398109 (503)630-4171 F'ARGE.L : 2S 1 04DD--F1-,005
iI fF_ ADDRES;.). . . : 13961 SW f) RIE DR
3UEIDIVIE;.[CIN. . . . : EAGLL POINTE ZONING: R--4. 5 F'D
(al.-0cl{. . . . . . . . . . . 1-01 . . . . . . . . . . . . . :12105
Remarks: PATH I
--------------------------------------•-------------------------- BUILDING --------------
REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REJUIRFD SETBACKS---- REQIJ?RED-------------
CLASS OF WORK.-NEW HEIGHT........: 27 FIRST....; 1321 sf GARAGE.....: 605 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1155 sf FRONT......... : c0 PARKING SPACES: 1
TYPF- OF CONST.:5N DUELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........; 10
XLOPANCY GK-.:R3 BDRM: 4 BATH: 3 TOTAL-------- :476 sf VALUE—$: 170444 REAR..........: 43
----------•-----•------------------------------------------------ PLUMBING ---------------------------------------------------------
31INKS........... 1 WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 5 DISHWASHERS...: 1 FLOOR DRAINS.. : 0 SEWER L;NE ft: 0 SF RAIN DRAINS: 1 CATCH 3ASINS..: 0
TUB/SHOWERS...: 3 GARBAGE DISP.. ; 1 WATEF HEATERS.: 1 WATER LINE ft: 100 P.CKFLW PREVNTR: 1 GREASE. TRAPS..: 0
OTHER FIXTURES: 0
------------------------------------------------•---------------- MECHANICAL
DUEL TYPES----------- FURN ( 100K .. : 0 BUIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1
/GAS/ / / FURN )=100K .,: 1 UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...; 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOUPSTUVES....: 0 GAS OUTLETS...: 1
_-_------------- -----..----------------------------------------- ELECTRICAL -------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER•---- --TEMP SRVC/FEEDER6-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS—
!OiM SF OR LESS: 1 0 - c'00 amp..; 0 0 200 amp.. : 0 W/SVC OR FDR..: 0 PUMPr1RRIGA71ON: N PEN INSPECTION: 0
EA ADD'L 500SF.: 5 201 - 40P amp..: 0 201 - 400 amp,.: 0 1st W'0 ,"',.IFDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp.. : 0 FA ADDL it, .'0: 0 SIGNAL/PANEL...: 0 IN P-ANL.....: 0
MANE HM/SVC/FDR: 0 601 - 10k10 amp. : 0 601+a1ps-1000 v: 0 MINOR LABEL -10: 0
10001 asP/volt.: 0 --------------- ----------------- - PLAN REVIEW SECTION --------------------•--------------
Reconnect only.: 0 )-4 RES UNITS..: SVC/FDR)=225 A.: ► 600 V NOMINAL: CLS AREA/SPC OCC:
---------------------------•-------------------------- ELECTRICAL - RESTRICTED ENERGY -----------------•-------------------------------
C1. of RESIDENTIAL--------------------------- B. COMMERCIAL--------------------------------------------------------------------------
AUDIQ I STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..; UTH: :: :. BOILER.........: HVAC............. LANDSCAPE/IRR16; PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTA ION: MEDICAL.....,..: GTHR:
HVAC.......,...: DATA/TELE COMM.: NURSE CALLS....: TOTAL. 0 SYSTEMS: 0
Owner: --------------.--------------------.-Contractor: ---------•-------------------- TOTAL FEES:$ 4631.21
RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES INC
1672 SW WILLAMETTE FALLS DR 1672 SW WILLAMETTE FALLS DR
WEST LINN OR 97069 WF5T LINN OR 97068
'hone A: .i57-8800 Phone il:
Reg A..: 97599
This permit !s r;sued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
apO icable laws. All work will be done in accordance with approved plans. This permit wili expire if work is not started with;r 18P
days of issuance, or if work is suspended for more than 1841 days.
------------------------------------------- -..- .--- _ __ REQUIRED INSPECTIONS ---_---------------------------------------------------
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Buildino Final
Foundation Insp Mechanical Insp Shear Wail Insp Insulation Insp Appr-/Sdwlk Insp Erosion Control
Post!Beam Struct Plumb Top Out Low Voltage Gyp Board Ins; Electrical Final ,
Post/Beam Mechan Eiectrical Servi Fireplace Irsp Rain drain Insp M?rhanical Final
Crawl Drain Electrical Rough Gas Line Insp r Water Line Insp Plumb F/ina-1 _
in , 1;t;eF Signi4t�_it^e : � ...� ._Y -�r.uad IAy ^ kv►� �-�� C���
(-all for- insp ,tion — 639-4170 r
SEWER CONNECI"ION
CITY OF TIGARD ISSUED:
PERMIT
a'E�.RMIT #. . . . . . . : SWR96-03::,�
DATE ISSUED: 0I/09196
COMMUNITY DEVELOPMENT DEPARTMENT
13125 8W Hall Blvd.Tigard,Oregon 97223.6199 (603)639.4171 F='ARCEL,: `S 104DD-EP'005
i11E ADDRESS- - 13981 SW ALItIE DR
,iUBD I V I S I ON. . . . : EAGLE F'O I NTE ZONING- R--4. 5 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :005
FENANT NAME. . . . .
USA NO. . . . . . . . . . : FIXTURE UNITS. . . 0 0
--ASS OF W()RK. . . :NEW DWELLING UNITS. . : 1
r YP'E Of- USE. . . . . :SF NO. OF' BUILDINGS: 1
INS ALL TY1='E. . . . --DUSWR 114P'E.RV 13UR1:ACE 0 s f
Remar-ks : F'ATH I
Uwner: -__._.. .. ________._-•-------__.______.____..____..-_____._____._ FEES
RENAISSANCL. ' � .,rnM HOMES type aRl0Unt by date r-ecpt
1672 SW WIL.LF' 1' `� Fr ' r .3 DR F'RMT _c:'th0. 00 JMH 07/09/96 96-281389
INSP' 9 3'5. 00 JMH 07/09/96 96-281369
WES1' LINN OR
i 'hune #: 557-800ft'
CONT RAC:TOR NOT ON FILE
1-hone #: $ 2,233. LAO TOTAL
------- REQUIRED INSPECTIONS -
(his Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 190 days from __.r.............--._____�_
the date issued. The total amount paid will to forfeited it the
permit expires. The Agency noes not guarantee the accuracy of the �•_ _ __. _ �__
side sewer laterals. if the sewer is not located at the measvrement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the i.rstaller shall purchase _—
a "Tap and Side Sewer` Permit and the Agency will install a lateral,
Fier-mittee Sigaat1_rre:
d LA
Call for, inspection - 639--4175
ittn
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: , `6 9`r) 1 `,�K� Gae-✓i e r�� • �'�
�j Office Use Onfy
Subdivision: l_ �*���0 F-'G t N r L Lot#
Contact Date f, / Jl, Initials C :7-fValuation ti �4�'rl ��, `t' `i Result
New Construction Only: (Square Footage) Planck/Rec#
Permit#AS f fG -U-3 ,22
House: Garage: ' Reissue of
Map & TL# �-:, (_,I, .. • ..-
Comer Lot? Y {N Flag Lot? Y (N Zone 2- t I, PID
Iyer ui ssane C s Hcnrne Plat#
Owner.
�. 1.1� �"�'1 $ ~
I l.c�z S W . �)� l IC�vn�{�-L ells Qr•
Approvals Required
Address:
I"ti '
\�,�e5}- ��h 0 R • 9�0 ec 8 Planning Setbacks_Pi Solar �`
' — Engineering °IIF fW J
Phone: ( 503 557- 6 o oo Other
Contractor. Re✓a+SscLinec C�sr�r, N wtcS Items Re ug fired
lIarre+re �ali� D�• Subcontractors
Address: �� b.V•) • �+ _ Truss Details
�1JeCl Other
Phone:
_ Notes _ -- --
Contractor's License # _ 0n 4 S cV
(attach copy of current Oregon license)
Contact Name: _ (3E rrl C e NCL �—
Contact Phone: ( t503) E -7 - 8000
Subcontractors: Arcl...ectfEngineer: Nlat)Ccy-d Des w A5SC( ,
ije. t . eCA EICc"Ar_ca, ; _` li4'�—:-
Plumbing: ap► kmhinn Address: I�)cG N . E . IS-! Ave •
Mechanical: �1cYtiat.1c) . Gr2 . c1-7 C`l
(attach copy of current OR Contractor's License)
Phone: Lj��3 L Z- Z_5 `l
JOB DESCRIPTION VN n i C RQ S( c( it 1C e
CC`, _ -
Applicant�ignature Applicant Phone number
Received bv: Date Received:
a�wn.rano
L
Permit Account Description Amount Amp-pd� Bal. Due
AJ1>tG. S! Bldg. Permit
Plumb. Permit (PLUMB)_
Mech. Permit (MECH)
Stats Tax (TAX)
Bldg:
Plumb:
Mech: L:/
Plan Check (PLANCK) ' r
Bldg:
Plumb:
J(, P �- 2 t Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (P!{SDC)
Residential TIF (T1F-R) 10
Mass Transit TIF ('i 1F %M
Cammercial TIF (TIF-C) —'----
Industrial TiF (T 4) — —
Institudcnal TIF (T!F-S) _— —
Cff;cn T1F (i.F-a)
Water Quality (WCUAL) 1
'Nater Cuantirl
Fire life Safety (FLS)
c:asian C.nCi rerrr"it (ERP4N1
:csicn ?!ar,cklUSA (ER.OLAN) _ -fd, _ _.---- 21,Fv
_.csicn ?!ancklCC T (SRCSN)
d!(
SEE 351VIM-
ROL-L#
22
FOR
LARGE
DOCUMENT
Solar Balance Point Standard Worksheet
,Address !3��f ���� h 4 i -1 tl
Box A calculations: North-South dimension for the lot. Box A:
Fhis dimension is determined by finding the midpoint of the North lot line and drawin,
an intersecting line perpendicular to that point.
Fust, determine which property line is the North lot line. The North lot line is the line
with the smallest angle from .: line drawn east-west and intersecting the northern most
point of the lot.
450-0-
t
5°-0.t
NCA�+EIM
t �
North-South
N /
D;mension for lot.
Measure the distance from the midpoint of the North lot line to the South lot line along
the described line.
t - feet
�NCRT14-SCUTH C:MENWN(C.'y� >
\ /
Box B .al:ulations: Shade point height for your residence.
Box B:
1. IDetermine whether measurements will be based on the peak or eave of your Which describes
str acture. 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. 773 r F 1 :v
'A 1B 1C
1 b: If the roof line runs Eist-West and the roof pitch is
less than 3, 12, measurements will be based on the
ear e.
,t4•1:E r ra:A.(
1 c: .f the roof line runs East-West and the roof pitch is
S , ._ or steeper, measurements will be based on the
peak.
•a:F
Box B. continued Box B:
2. Measure change in elevation from front propertv line to finished floor elevation. If
the lot slopes up from the front lot line to the foundation, the figure is positive. If
the lot slopes down from the front lot line to the foundation, the figure is negative. ` ft
3. Measure distance from finished floor elevation to the affected peaWeave. + ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, __. _ ft
deduct nothing.
5. Subtract one foot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
Iet has no slope or slopes up from the rear to the i'mrit, deduct nothing. _ ft
6. Total figure for box E: 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 _ rt
affected peaWeave.
?. 'vicalsure the distance from the foundation to the affected peak or eave. + 1t
3. Total figure for box C: _ ft
It is most useful to draw a vertical;ine to represent the appropriate figure found in box '.A' and a horizontal line to represent the
appropriate figure found in box 'C'. The intersection of the vertical and horizontal lines determines the value found in box "D". The value
in box "D"should he compared to the value in box '8 if the value in box 'B"is iess than cr 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 contai us at 639-4171, x304 or at the
Community Development Counter.
MAXIMUM PERMITTER SHADE POINT HEIGHT (In Feet)
Distance 'o North-south lot dimension !in fee0
shade 100+ 95 90 85 80 73 70 65 60 55 30 45 40
reduction line
from northern
lot line in feet' _ --
-0 40 40 40 41 42 43 44
65 39 38 38 39 40 41 42 43
60 36 36 36 3" 38 39 40 41 42
55 34 34 34 35 1 36 3' 38 39 40 41
30 32 32 32 33 34 35 36 37 38 39 40
45 30 30 30 31 32 33 34 35 36 37 38 39
-1 23 23 28 29 30 31 32 33 34 35 36 317 38
33 - 26 26 ?' 28 29 30 31 3- 33 34 35 36
30 14 24 24 25 26 2- 23 29 30 31 32 33 34
23 22 22 22 73 24 23 16 2" 28 29 30 31 32
20 20 20 20 21 22 23 24 25 26 27 28 29 30
15 13 18 18 19 20 21 22 23 24 25 26 27 28
10 16 16 1u 17 18 19 20 21 22 23 2.1 23 M
5 1.1 is i4 15 16 17 18 19 20 21 22 23 24
Box D. tila dmum allowed shade point height: 1�> _ feet
h:docsnanc.`.entura srlar oho
Re%ised 2J26,96
CITY OF TIGARD
13125 S.WI. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
EAGLE PLUMBING
13801 S . FORSYTHE RD
OREGON CITY OR 97045
Plumbing Signature Form
Pertnit # . . . : MST96-0327
Date Issued. : 07/09/96
Parcel . . . . . . : 2S104DD--EP005
Site Address : 13981 SW AERIE DR
Subdivision. : EAGLE POINTE
Block . . . . . . . : Lot- : 005
Zoning . . . . . . . R-4 . 5 PD
remarks :
PATH I
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 work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNEP : PLTjMBING CONTRACTOR :
RENAISSANCE CUSTOM HOMES EAGLE PLUMBING
1.672 SW WILLAMETTE FALLS DR 13801 S. FORSYTHE RD
WEST LINN OR 97068 OFEGON CITY OR 97045
Phone # : 557-8000 Phone # : FAX/650-8720
Reg # • . : 47914
X C--Ql, Q,w,�—
.ignature of Authorized Piumber
Please return this completed form to the address above.
ATTN: Building Dept.
If fou have any questions, please call 639-4171 , ext. #310
CITY OF TIGAR® PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : PILM97-00IC
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 01/27/97
PARCEL: 2SI04DD-EP005
ADDRESS. . . : 13981 SW AERIE DP
,.-'IJBD I V I S I ON. . - . : EA83LE PC T NTE ZONING: R-4. 5 Pl)
BLOCK. . . . . . . . . . .* LOT. . . . . . . . . . . . .
POSAI
,LASS OF WORK. . :ALT GARBAGE DIS -S. MOBILE HOME SPACES. : 0
TYPE OF' USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . . 1.
,)CCUPANCY GRP. . :R3 FLOOR DRPINS. . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
DORIES. . . . . . . . e 0 WATER HEATE,r"I't). . . . . . 0 CATCH BASINS. . . . . . . : 0
F I LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : V,
`.MINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
T'UB/SHOWERS. . . . V1 SEWER LINE (ft) . . . ! 0
14AIER CLOSETS— : 0 WATER LINE (ft ) . . . : 0
`,.TSHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Ppmar-ks : Installing residential bar-14flow pi-evention device
qwner: FEES ---------------
RENAISSANCE CUSTOM HOMES type amount by date v,ecpt
1672 SW WILLAMETTE FALLS DR PRMT $ 15. 00 B 01/24/97 97-289424
5PC1 $ 0. 75 B 01 /24/97 97--289424
WEST LINN OR r97068
Phone #: 557-8000
i'.ontt-actor:
MOODY ENTERPRISE INC
PO BOX 98
F-STACADA OR 97023 ---------------
1."'hone #: $ 15. 75 'TOTAL
17eg #. . : 5973 ---- REOUIRED INSPECTIONS
This pervit is issued subject to the regulations contained in the RP/Backflow Prev
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This pervit w)I1 expire if worts is not started
within IN days of issuance, or if work is suspended for sore
han IN days.
Pet-mittec Slatlit'e.
Issiied 13y :
Call for- inspection 639-4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # _
' 25 SW Hall Blvd. Permit # i!(t�l/
1'0 ird, OR 97223
07, 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
New Single Family Residences Only
1 C 1 BATH HOUSE 5140.00 0 2 BATH HOUSE$195.00
Jib .�� v/L v Ut 1 0 3 BATH HOUSE$225.00
Address Cmrr.r.le_ J Z; Fee includes all plumbing fixtures in the dwelling and the first 100 feet
-i of water service, sanitary sewdr and storm sewer. See fees below.
"•m•'"n.A•'°"""" r FIXTURES QTY PRICE AMT
/ C n 'i S, ,Al i l� Sink
Munq AYQNI W +• Lavatory 9.00
Owner •�� lJ J /lS i Tub or Tub/Shower Comb. 9.00
"^g'•" i r" Shower Only 9.00
t 5 t 4,I N / / ' Water Closet 900
-- come�a nsme nl eu.neui Dishwasher 9.00
Garbage Disposal 9.00
Qu:upant Me g.e&-. pl'— Washing Machine 9.00
Floor Drain 900
°A'�"'•
Zip Water Heater 9.00
Laundry Room Tray 9.00
"•m• /J / Urinal 9.00
h)h,j'of•_LA) Other Fixtures (Specify) 9.00
Me"Aftne -'ice R".".
Contractor 9.00
0v./jIg -27r
o"rmy' m 9.00
(770 Sewer 1st 100' 30.00
"•"•�7'"'"" / c., a'" T'•"° Sewer -ea. Addit 100' 25.00
j / 0,�-/ty�7� Water Service 1st 100' 3000
I hereby acknowledge that I ave read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized ageit of
the owner, that plans submitted are in compliance with State laws, that Sturm &Rain Drain 1st 100' 30.03
1 am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registraticn, please
give reason below.) Mobile Home Space 25.00
back Flow Prevention
Device or Anti-Pollution Device 900
sv,.".I ..owl °"' Any Trap or Waite Not
�j �C4 S Connected to a Fixture 900
Describe w rk new Q a itionalteration U repair 0 Catch Basin 9.00
to be dune res dent ial V non-residential Q lisp, of Exist. Plumbing 40.00/hr
I Specially Requested Inspections 40 00/hr
building or prooperty
Existing use 1 Rain Drain, single family dwelling 30.00
� - _
Residential backflow prevention
devices 15.00
Proposed use of
building or property •(Except residential backflow
prevention devices!
NOTICE 'Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME DID IF WORK OR CONSTRUCTION [
AUTHORIZED IS NOl COMMENCED WITHIN 180 DAYS. OR IF 5% SURCHARGE � )^
CCNSTRUCT'^N OR WORK IS SUSPENDED OR ABANDONED -- — i
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED PLAN REVIEW 25% OF SUSTOTAL
TOTAL
Special Conditions
_ Date issued _ �— by