13033 SW CADDY PLACE W
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CITY OF TIGARD BUILDING INSPECTION DIVISION MSTi �
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 T�
BUP _
Date Requested /C> # AM — PM_PM _ BLD -
Location 116—3 ��_� �_ Suite MEC -
Contact Person — Ph _ PLM - —
Contractor _ Ph SWR
[BUILDING — _ 7'enant/Owner ELC -
Retaining Wait - ELR
Footing Access:
Foundation FPS _
Ftg Drain _ SGN -� --�
Crawl Drain Inspection Notes. -- -.----
Slab ------- --- - ---- - -- SIT
Post&Beam --- --- -
Ext Sheath/Shear
Int SheathlShear — --
Framing --- ------_ _—_ _.-------
Insulation
Drywall Nailing
Firewall ----- -,-_-`_.-----------
Fire Sprinkler
Fite Alarm ------ .-
Susp'd Ceiling
-PA S PART FAIL --- — - - . —_....------ ----------- _....-_ — _ -- --- -
PLUMBING
Post 8 Beam
Under Slab
Top Out ------- - -------- --
Water Service
Sanitary Sewer
Rain Drains
Final ----- __- _-- - --------_.—�.-_ -
P RT FAIL
HANK - - - ---- --- ----
Post& Ream -- -- - -- - --
Rough In -- --_ ---- ------
Gas Line
�Mqke Dampers
PAS PART FAIL _
ELECTRICAL "-- - - ----
Service
Rough In -__----- -- - - -
UG/Slab
Low Voltage -
Fire Alarm
Final -- - - --
PASS PART FAIT_
SITE - _.-- - - -
Backfill/Grading - -' -- -
Sanitary Sewer
Storm Drain ( J Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch 9asin
Fire Supply Line t J Please call for reinspection RE:_r [ J Unable to Inspect-r+;,access
ADA
Approach/Sidewalk
Other Date _ Inspector Ext .
Final
PASS PART FA!L 00 NOT REMOVE this inspection record from the job site.
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CITY OF '-IGARD
13125 S.W. HALL BLVD,
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONT. INC
PO BOX 2007
GRESHAM, OR 97030
Plumbing Signature Foran
Permit #: MST2001-00216
Date Issued: 4110/01
Parcel 2S1 04DA-1 3500
Site Address: 13033 SW CADDY PL
Subdivision: QUAIL HOLLOW - WEST
Block: Lot: 121
Jurisdiction: TIG
Zoning: R-4.5
Remarks: New SF detached rowhouse in Building #14. Setbacks as per sheet A10.10
Plan B-N
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 Foran prior to the start of the work to the address above, ATTN-. Building Dept.
No :J'umbing inspections will be authorized until this completed form is received
"WNFR-: PLUMBING CONTRACTOR:
BROWNSTONE HOMES LLC WOLCOTT PLUMBING CONT. INC
12670 SW 681-H PKWY #200 PO BOY 2007
PORTLAND, OR 97223 GRESHAM, OR 97030
Phone #: 503-598-7565 Phone #: 667-1781
Reg #: 1 Ica 23847
PI M 26-208PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature- f AuV-ized Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
STREAMLINE ELECTRICAL
6017-B EAST 18TH "T. REET
VANCOUVER, WA 98
Electrical Signature Form
Permit #: MST2001-00216
Date Issued: 4/10/01
Parcel. 2 S 104DA-13500
Site Address: 13023 SW CADDY PL
Subdivision: QUAIL HOLLOW - WEST
Block: Lot: 121
Jurisdiction: TIG
Zoning: R-4.5
Remarks: New SF detached rowhouse in Building #14. Setbacks as per sheet A10.10
Plan H-N
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER- ELECTRICAL CONTRACTOR:
BROWNSTONE HOMES LLC STREAMLINE ELECTRICAL
12670 SW 68TH PKWY #200 6017-B EAST 18TH STREET
PORTLAND, OR 97223 VANCOUVER, WA 98
Phone #: 503-598-7565 Phone #: 360-993-5080
Req #: LIC 118514
ELE 34-432C
SLIP 44976 la 4r l S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x
Signature of Supervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF T I G A R D __ MASTER PERMIT
PERMIT#: MST2001-00216
DEVELOPMENT SERVICES DATE ISSUED: x/10/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 13033 SW CADDY PL PARCEL: 2S104DA-13500
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
B!-OCK: LOT: 121 JURISDICTION: TIG
REMARKS. New SF detached rowhouse in Building#14. Setbacks as per sheet A10.10
Plan 13-N
Bllll_DING
REISSUE: STORIES: 3 ,-LOOR AREAS REQUIRED SETBACKS REQUIRED _
CLASS OF WORK: NEW HEIGHT: 11 FIRST: 173 of BASEMENT: of LEFT: SMOKE DETECTORS: Y
TYPE OF USE: Sf FLOOR LOAD: 50 SECOND. 735 if GARAC°E: 519 of FRONT, PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: 1 FINSSMENT: 580 if RIGHT.
VALUE: E 138,19300
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 1,488.00 of REAR:
PLUMBING _
SINKS: I WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 2 CATCH BASINS:
TUBISHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFI-W PREVNTR GREASE TRAPS:
OTHER FIXTURES: 1
MECHANICAL
FUEL TYPES FURN<10vR: 1 BOILICMP<3HP: VENT FANS: 3 CLOTHES DRYER: I
GAS FURN�,•100K: UN 1'HEATERS: HOODS: OTHER UNITS: I
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPLCTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 200 amp: WISVC OR FDR: 2 PUMPIIRRIGATION: PER 114SPECTION:
EA ADD'L 500SF: 3 201 -400 amp: 201 400 amp: tat WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 800 amp: 401 800 imp: EA ADDL BR CIR: I SIGNAL/PANEL: IN PLANT:
MANU HMISVCiFDR: $01 • 1000 amp: 801+ampe•1000v: MINOR LABEL:
1000+amplvolt
PLAN REVIEW SECTION
Reconnect only:
"Al RES UNITS: SVCIFDR>-225 A.: 800 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 8 STEREO VACUUM SYSI EM AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNOSC LT:
BURGLAR ALARM 07H: ALL ENCOMB BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER. CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATARELE COMM: NURSE CALLS: TOTAL N SYSTE AS:
Owner: Contractor: TOTAL FEES: $ 3,553.49
BROWNSTONE HOMES LLC BROWNSTONE HOMES,LLC This permit is subject to the regulations contained,1 the
12670 SW 68TH PKWY#200 12670 SW 68TH PKWY Tigard Municipal Code,State Specialty Codes end
PORTLAND,OR 97223 PORTLAND,OR 97223 all other applicable laws. All work
w will be done
accordance with approved plans. This permit will expire N
work is not started within 180 days of issuance,or if the
work is suspended for more then 180 days. ATTENTION
Phone: Phone: Oregon law requires you to follow rules adapted by the
Oregon Utility Notification Center. Those rules are set
Reg# 1 a: 1246:7 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
Erosion Control Insp 8, Underfloor insulation Electrical Rough In Gas Line Insp Rain drain InspElectrical Final
Sewer Inspection Plmlundslab Insp Framing Insp Gas Fireplace Roof Nailing Mechanical Final
Footing Insp Mechanical Insp Shear Wall Insp Insulation Insp Water Line Insp Plumb Final
Foundation Insp Plumb Top Out Exterior Sheathing Insl Gyp Board Insp ter Service Iris Final Inspection
Slab Insp Electrical Service Low Voltage Firewall Insp Appr dwlk Insp
Issued By : �'C1� � J _ Permittee Signature : _ _
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next . t siness ay
/ SEWER CONNECTION PERMIT OF TIGARD
DEVELOPMENT SERVICES PERMIT#: SWR2001-00144
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/10/01
SITE ADDRESS; 13033 SW CADDY PL PARCEL: 2S104DA-13500
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT: '121 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: N1-W DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: L I PSWR IMPERV SURFACE:
Remarks: Sewer coruiechon for new SF detached rowhouse
Owner_
�.__---- FEES
BROWNSTONE HOMES LLC
12670 SW 68TH PKWY #2.00 Type BY Date Amount Receipt
PORTLAND, OR 97223 PRMT CTR 4/10/01 $2,300.00 27200100000
INSP CTR 4/10/01 $35.00 27200100000
Phone: 503-598-7565 Total $2,335.00
Contractor:
Phone:
Reg #:
Requirerl Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement n,the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall p e a"Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law r fres you t foll rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952 00 -0010 roup AR 2-001-0,
You may obtain copies of these rules or direct questions to OUNC by calling (50 246-198
Issued by: Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next b siness day
Building Permit Application
trate mccived: Permit no.: [`";� I
City of Tigard Project/appl.no.: • Expire date:
CrtyajTign►d Address: 13125 SW Hall Blvd,Tigard,OR 972.23
Phone: (503)639-4171 Bate issued: By Receipt no.:
Fax:(503)598-1960 Case file no.: Payment type:
Land use approval: - 1&2 family:Simple Complex:
LU! &2 family dwelling or accessory ❑Commercial/indus(rial C Multi-family "ew construction U Demolition
U Addition/alteration/replaeLment O Tenant impmvcment U Fuc sprinkler/alarm U Other.
INVORNIATION
Job address: ,r' '.J 1�-� i}7.)j) ;-'t. 131dg.
Lot: Block: Subdivision: 67vA;\ Itv�u wr3T -- Tax map/tax account no.:
Project name: On„' h1u%10%A3 -
Description and location of work on premises/special conditions: P-6w tl &S✓y__JJtu1 CDt��TtZ II�t _ ,_T
WYNTH
FOR A 1
Name: t (Floodplain.
Mailing address: cw 64z "LUA91 tW 1 &2 family dwelling:
City: Statc:crr' ZIP: 172L� Valuation of work........................................ S
Phone:!"J!,715&.5 Jr-ax: "F oEll F.-mail No.of bcdrooms/baths............:�... ............
Owner's representative: Wl -0e�-
P Total number of floors........... „
Phone: 7 -��ti Fax: 7r 399 2_ C-mail• New dwelling area(sq.ft.) .....
t;aragelcarport arca(sq.ft.).....(0.v.4.....
Name: -5-/t A16 AFS A e« Cove,-ed porch area(sq.ft.) ... .�.::.....
- .. - -- -- Deck areas fc
O s is�r
Mailing address: ( q. ) .................. .....................
City: State: ZIP: _ Other structure area(sq.ft.).........................
Phone: Fax: ��
E-mail: erciaUlada4trlal/multi-fatmily:
Valuation of work........................................ $
Business acerae: Existing bldg.area(sq.ft.) ..........................
New bldg.area(sq.ft.) ...............................
Address: — ^_ -
City:
Number of stories........................................
_ tate: ZIP:
Phone: Fax_ E-mail: Type of construction
_ - — Occupancy group(s): Existing:
--
CCB no.: -----
-----
City/metra It(,, 11o.. New:
All contractors and subcontractors arc required to b;
AIiCIIITrcr)DLSiGNFR licensed with the Oregon Construction Contractors Board und-,r
Name: O provisions of ORS 701 and may be required to be licensed in the
Address: I 111 9--&ami 1~ jurisdiction where work is being performed.If the applicant is
City: e exempt from licensing,the following reason applies:
tT tk State: w A ZIP:q (-2 [.+�
Contact person: NI*. Plan no.:
Phonc:2-1'-'0 t=zf: Fax: 67-DbZ E-mail: — - - -
Narne: ILC �t j6ontact person: U uj I'I, Fees due upon application ...........................$
Address: Date received: --
City_ V-201
_ StatetSr ZIP: 971133 Amount received .................
Phone: ttY�gt?"�" Fax: E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Not at Juria kdom wcep creat cans,plew,cart jurirdiction rot mm inrnr,n,llinn.
attached checklist.A:1 provisions of lawsand ordinances governing this U visa U MasterCard
work will be complied w' whether s i ed herein or not. Credil card number
Eipirer
Authorized signature:_� Date: --f""'d I_ Now of cardiotder as rbown an ctdil cull
Print name: .I __ S
Cudholder�irmuwe Amount
Notice:This permit application expires if a permit is not obtained widdu 180 days atter it has been accepted as complete. 1141613(60"M)
MechaWM Permit Application
Patereceived: Permilno.:r"rlool
City of Tigard Pmjecl/appl.no.: Expire date:
Cir o T� and Address: 13125 SW Hall Blvd,'Figard,OR 9722'
Phone: (503) 639-4171 -r -� —
Y f 8 Date issued: By -
Receipt no.:
-- —
Fax: (503) 598-1960 Ctsc file no.: Payment type: --
Land use approval: —_ Building permit no.: _
U I &2 family dwelling or accessory U Commercialfindustrial U Multi-family U Tenant iunpmvement
U New construction U Addition/alleration/irhlacemcnt U Other:
1 1
.1611 SITV INFORMATION
Job address- I`)n 1j7 l; Indicate equipment quantities in coxes below.Indicate the dollar
Bldg.no.: i ,'� L�Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account mm profit.Value$
Lot: I°l I Block: Subdivision: / u •: "See checklist for important application information and
Project name: n (- >, i jurisdiction's fee schedule for residential permit fay.
City/county: ZIP: /M' ' ' A N&MIN Ilk 911-
Description and location of work on promises:
Fee(ea) flat
Est.date of completion/inspection: — 1Desail Qty. Res.oal Res.only
Tenant improvement or change of use:
Is existing space heated or conditioned?U Yes U No Air handling unit _CFM
Air con itionmg
Is existing space insulated?U Yes U No Alteration of existing HVAC system _
MECHANICAL CONTRA(7614 tit er compressors
e: VbL)E oyL • Siete boiler permit no.:
Business nam
- �.. ------- HP _Tons BTU/14
Address: C.7 rp C) _ _ ampe uct smo a electors
City: )lk 1`: Statet.1_ ZIP: _�y 7 eat pump(site pan requr )
Phone: ' i Cl Fax:7 I)¢J E-mail: nsta rep ace umace umcr
CCB no: 'L S Including ductwork/vent liner O Yes U No `
nsta rep ac re ocale heaters-suspen ,
City/metro lic.no.:D ODS b - wall,or floor mounted
Name(please print): - 1 MA 1 Q enc ora lance of er an furnace
11011111111111619 e en n:
Absorption units BTUAI
Name: 1,;�14 AA G A-a 0,6401(CChillers____�_�_ HP —
Address: Cum remors — HP
av oar exxiausl vent ton: 1
City: State: 'LIP: 7 Applianccvent
_
Phone: Fax: E-mail: ryerexhaust l _
s,'1`ype res. rte c azmat
hood fire suppression system _ —
Nc me: _ �, 6 Fl QJ1,�f� Exhaust fan with single duct(bath fans)
Mailing address: VExhausts steo a ar rem enc n or AC
_City: _ State: ZIP: 1,set p p (up to 4 outlets)
Phunc�
Fax E-mail: Type' ---LPGNC Oil
Fuel i mF each additional over 4 outlets
ro-m piping(schematic requir )
Number of outlets
Name: 1� rt' �}�' 1� jxth�eedipp Grace or equipment. ---
Address: _ Decorative fireplace
City: State: ZIP: nsert--type
Phunc. J Fa,-,: E-mail: tov pc let stove
Other:
Applic:anl's signature: I ! Date: 4 r V
Name(print): — I OYN V(_A f)&d "5 -
Permit fee........... S 2
Na all Pridic6am aceta c"i earth,pl ate till Jwidictim fa dime idammnatim •
C1Yita ❑MestnCartl Notice "ibPeunit is application
Minimum fee................$
r"t crd nnmba. _ --I_ f expires if a permit is not obtained Plan review(at —_ %) $ ^--�
Expiry, within 180 days after it has bren - -
State surcharge(896)....$
Nroe d crtdnoldet a Chown on credit cans--^ accepted at complete. —
s TOTAL ... $ Z? _
Cardholder tipatrae Amami �v101617(a�YC OM1
C?/A 7,,2M 11:49 :609935082 STREAMLINE EL:.CTR:C FA:,E 0:/0_
Electric.Permit Application
Date reeal+.o'd:7-7
rntltae.: I G0 I
Aim, City of Tip" •teLaev.otal ndate:Addmse. 13123 9W Hall Blvd,716a1'd,OR 97223Date is nMime: (301)619-417: -- Y: R�1 1p;Fait:(107) 398.196(1 Cane na ao.' rn+eaterplr;
LAnd use approval
U T A 2 family dim!hng or awaotery 0 CwtiwmialAmduorial U Multi-family O Tenant inmmvsment
U Now conKn+o m U AdditioNalremtlonimplacemcnt U Other: 0 Pariiai
lob edlMoa '. I BI^
Lot: Block: bdiv ,o: Suitr no.: Tu lav
arvct>tet
L Ko11uw Wkvr - --.-
Projeef acme: IDM f10 I It1W Da1", ion and kxA00n o µrxk M PFSMI1W New 0K»711WTIW
Wmated date of c9mPletio"Anspecoon.
Job fie+ thta ay„
8uahwa runva, g i 1i"
Addrfarr *ownWWL +si.�`rMfe. °.r
City Vancouver 5tawa. WA ZW 8661 aatataaaa �
9 -508 Pu: r mad: 100oc�Im
CCU
- �addido"aI S�OD�n��x peroon Ihc,eel ttu.:1 1 1 Elec. bat.IIc.no
34-432 _
C umll.a �.Trmua
1AMI
Lit Jrtlettolk,eo,. ciwry non�edanai `-
6aeh momfi an htmw or w dvmtl►N
di le �- lervkt tndtor No"
-
ttlp W.+ sJdfy tat Lrae"aa no �� IhtMM
aIt I III M"19"Iba:
200 Oppm Ids
None S�"� I�.�t>� �L_ -`�'-t0---�•--------- 2_
.ti I"'Tr Io 600.rrrpr
ailiCity, ng addnxa: y�w�V -
b�
CfltegA -7 r --- Pu tr 6 nLll: Rwmeam on 1
clwvm inatellollott -ft iftewlatien isi I mw%on tw3perty 1 nave rowl-Myaw+ie�a1
which Is w InkrA*d foi axle.I lN,or exchmp aocarct4q to Imaar4aw .atatrarr+l*aallaar
ORS 417.e73.47V,pitTlUl �'1"-b ---
(�..nd'a d euro:
Data, ?�(► 01 10—1 w 6w Amp
...__-
r •wcN,s
Nafna w•aMa ke pm hwl:
A Fee Por braneh e4mufla wtth pr4aw of
AddRat' aamo or Aalar OW*WA brooh clm.n t
Clt� r'- — $ll�: 7.IP. Kn arwlu.m(ielNprd;u+
,-�- ---- - — of swoon or at e.fec(Unl brmclr c"It 1
Pticx,a Pa>,• I.i.tnail w{` "�rnwTr: - —
mums(owwoser loattee afMh
t�frNao++w 22f wrpr�sn.ni of a, O"mm":arr farnty Bach or Wqg�,nada -
n trlwra ow.120 amya+rdp M I A 2 O Hut>♦d"ae k+I:aMrn1 oe ovurnr M ha my _
fan�yAa�'Mp UNOI'.610tM04mr/w hdrof iN IlUora nlf"ad`--r type el•
Q t"*m ow a00 vaa noftm' now rYddaatrl a%M mw Mmoetan alrotHlow,er extomanr - 1
0 Ya.wenlewnMsrtx,ar U POWO 100amwo xrr.n •pMyr
U 06w4wo IM 0+w M mno a Menutaahwdair -AW M RY pora
0 FlpwMatwtA1t4- U00"
9"b"k_ _.nb of phala W"etch in tiff IWA*. tn.e Sd_-
11w aRoa mew applaW u----w tnt>I o ww"a. -
IWr/1lar,rMratr a* pefmtt rev....................s -•....
O Vllr 4 AlaaaarCard ex>tira If a pumk is nei ebrinb Mo"raview'a' -
trona wrd WNW -____ . �. I with{"110 days agar it has Sm State o,trrhatwe(8%)
aotrtetrd as oar,QlNh 7 OTA L ._....................%
1
Plumbing Permit Application
Date received: Permit
Ci of 'Tigard
`7 Sewer pari!no,: Building permit no ie
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of'17gard Phone: (503)639-4171 I'rujaUappl no.: Expire date:
Fax:(503)598-1960 Date issued: By: Receiptno. :r .a yfi b.
Case file no.: Pa rent
Land use approval: y tv
1
::i2 family dwelling or accessory U CommerciaUndustrial U Multi-family U Tenant improvement 41,,r440
ev,consuucdon U Add ition/alteration/re.placement U Foci service U Other:
lob address: n)Q Sw y i DesclrEption F Qty.I Fee(ea. Total
Bldg.no.: Suite no.- New 1-and 2-family dwellings only; -
(includes 100 n.for each utility connection)
Tax map/tax lot/account no.: SPR(l)bath
Lot: Block: Subdivision: UrNtt- SPR(2)bath_
Project name: (t>ZUA;i I to u-t SPR(3)bath
City/county: ((�H(D� Luglk I ZIP: 172,1 Each additional badAitchen
Description and locatian of work on premises: Ne-0 Site utilities:
Catch basin/area drain
Est.date of completion/inspection: Dn wells/Icach line/trench d
1 I ooting drain(no.lin.ft.)
Manufactured home utilities
Business name: L 0yiuT-S ��lnn�)( � _- Manholes _
Address: Rain drain connector -
City: li>40A State: ZIP: Sanitary sewer(no.lin.ft.) --- ---
Phone: `% j F4x:(oG17 1f ► E-mail:- Storm sewer(no.lin. ft.)
CCBbno: Water service(no.lin.ft.)
_ no.: _-_ Plumb.� us.reg._�-___ -_ fUtare or Rem:
45Y7
It 11C.no.:
Contractoes representative signature: Absorption valve
_. _-_ Back flow pmventer _
Print name: Date: Backwater valve _
Basins/lavatory
Name: Clothes washer ---
- ---- - -- -- - -- Dishwasher
Addi ss: Drinking fountain(q) --�-
City: _ - _ State: ZIP E'ectors/sump
E-mail: Expansion tank
Fixture/sewer cap _ _-
Name(print): P7oor drainsifloor sinks/hub
Mailing address: -- Garbage disposal
Hose hibb
City:- -- — State: ZIP: _ Ice maker —_ -
Phone: Fax: E-mail: Interce or/grease trap
Owner installation/residential ms•'•Itenance only: Inc. actual installation Primers)
will be-made by me or the maintenance and repair made by my regular Roof drain(commervial) _
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: _ Date: Sump _
Tubs/shower/shower pan
Urinal
Name: Water closet - —
Address: Water heater
City: State: ZIP: Other. -- -- T
Phone: Fax: _ E-mail: -- Total
--— --
Nu dl jutiod"n►wow aafit c",pteur call iu s&ctioo for rue WWmlim Nolicc:'Illis pennit application Minimum fee................$
U Visa U MasterCard expires if a permit is not obtained Plan review(al __ %) $
credit card number: ----- --L.-�- within IRO days after it has been
Stale surcharge(8%) ....$ --_ —
Flores
— m-- - accepted as complete. TOTAL. .......................$
N me d utdboldrr&Z "" credit cad ----`
_ _ S
C U"kler dynture -- Amotrta - 440-1616(60MX)M)
Mar-06-01 03:05P Wolcott. Plumbing 503 667 9891 P•02
13..06!ul 711, 11 42 FAX 50.7 598 190 CITY OF
�Q OOJ
PLUMBING PERMIT FEES:
RI y TOT,�}.�• .1 ly d!Nr 1 pf Only:
FlrtTt�Rt� �Indlvldutl q _�`_ ea 1� AMOVMt plllmbina'fj��lituhf I" PLACE ( To-
'irk 6.61 �� arl0.th6 ilryg100 ft. QTY (" AMOUNT
LevNor• ____ IY 16 0) i —;do
— e 20� 11
Tub or-utyshwrer Comb _ 10.6 i 0.00
�`sn veerony 1es1
17
139 00 _
", :r clam -
ur ,Is' iUeTo— ,►L -
e•A URCIIARGE
C'uhwealef 16.00
_
M411_91"111Y9TOTAL
Garbage GMpoul 1 ��
L.aurldry is e0
"VMS ng Mach'ne 1
Floc UNiN Qbr$Ink 2' V 16 t0
J• - 't F Z COMPLETE:
4- 1e l0
Natty tatter O convert om O Ilk*Mind 15( '1 ' -�- ubn :b
or i'P,d tinned
Ga{pipmp reQuve***dperme mMh*rrcal I '//� e, 1 New. Mov r Rep Iced Remover
;*MR rr � Como
MFO l+cmo!Yew ter S*rvlon 46-0
Mko Nome N*w S*N5-10 m 'ewir •s 0 -� - - -
l-fate B b* ie 10 ?ht>te6r I
r
Rooi 0•ame 16,1.p
Drink'nq Fountain
Oh*1 fla!u4lrpeclly) 16.110 l
-- ± 0661 ---- --
!
9two(•ttt 10—�� i- tS7 to r �
Sower•*se additional 100' is 70 4•
Walir Sam to•I a - b,
ws er erYce ..ah.0 Ilortm 100 .-6 10 I as - --
�m 6Rijn Oralr,• I h 100' 65, -
Skxrn 6 Rsln reir-each sM8 onel 100' 18.10
Commemil Back Flow reWnllan Dev • 4640 ----
Retklenlirl Nxxflcw Prevention evlc*' 27 5 - ----_i
C„tleh Ditin 16 o - J
Inlpodifin dl F-xdtl;F-PA,mbing or pecioly ---r25-0
..250
Re ueeledIntl 011, IRI• C' 3 REOARDINQ ANOVII:
Rein Oral.tIn-gl V114y dwelinq 6 25 - -- ^--
3relme Traps - - 16
QUANTITY TOTAL - - --
twittnd or w,41WIM is "wiled a �
060Attr foul M a o — — —
'BU9TOTAL --
5Y1 8TAT13URGHAROlr — �—
j PLAN REVIEW 25%OF SLBTOTAL
r 1e0aingyr rifrumretin,relll h>s _
--
TOTAL t:
'Mlnhem perrnN fN 1{{),]0•as tare urrhwp/,na*r Rer;a nalel 6aekrorr
PeVMnon Oaw•[f,MhCh t 1{t!!�eta ILIO IYRMIpt
"Ali A Naw Ceprimemlal eull*Inee mq.ka pail wkn luiewiv Or 04 Ir llapffm it'd
qan'r.1_w.
wits m%molm-leeadoc �Ort0/00
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