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15590 SW EMPIRE TERRACE v+ co C) M 3 m m m r 4 I I t 15590 SIN Empire Terrace CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4.175 Business Line: 639-4171/; f 1i•BUP Date Requested. 5 ' Z � AM 4--"PM BLD Location—/ S l S Fe i s Suite MEC _ Contact Person _- _ Phi 3 3 7 y PLM _ Cc-itractor Ph _ SWR _ IL — Tenant/Owner ELC Retaining Wall .� ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post& Beam Ext Sheath/Shear _ Int Sheath/Shear \ Framing Q- VZe- Insulation / Drywall Nailing L Firewall ,,/ Fire Sprinkler Fire Alarm Susp'd Ceiling Roof h' incl SS PART FAI --- Post&Beam Under Slab — — Top Out Water Service Sanitary Sewer rains FinjaL3 12c- PART FAIL Post&Beam - ----- Rough In Gas Line -- Smoke Dampers PART FAIL ELECTRSCAL - Service Rough In UG/Slab Low Voltage Fire Alarm — Final PASS PART FAIL —SITE Backfill/Grading Sanitary Sewer Storm Drain <jl L b [ j Reinspection fee of$— rens irk i before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RE: [ j Unable to inspect no access l.DA L I Approach/Sidewal�o Date 52Z� t Inspector_ �..�` �~ Ext� I Other Fin AS PART FAIL DO NOT REMOVE this Inspection record trom the job site. CITY OF TIGARD BUILDING INSPECTION DIVISIONMs r — 24-Hour Inspection L,ne: 639-4175 Business Line: 639-4171 — BLIP -- Date Requested S' _AM—v___PM _ BLD Location_1 f ,5 Jir! ✓ Suite _ --___ MEC _ Contact Person Ph 2 -33 7U PLM -- ---- --- — - ----- Contractor_ Ph — _ SWR _ __-- BUILDING Tenant/Owner ELC ----- - Retaining Wall ELR _ Footing Access: FPS Foundation Fig Drain _ SGN Crawl Drain Inspection Notes: -- — Slab -- --- ----- SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL _-.-- PLUMBING Post&Beam Under - -_— Under Slab Top Out - - Water Service Sanitary Sewer --- - - - Rain Drains Final PASS PART FAIL _ MECHANICAL Post& Beam --- ---- -- - Rough In .gas Line - - - -- --- - Smoke Dampers Final P j_ PART FAIL EC Service Rough In UG/Slab - --- -_--- ------__.�—_.- ----.. _ __ -- Low Voltage Alarm - ----- ----- ---- ------ —--- PASS`S ART FAIL _. -_ -------- ------- - Backfill/Grading -- — -- - Sanitary Sewer Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please call for reinspection RE: [ J Unable to inspect no access ADA Approach/Sidew.jik Date V Inspector Ext Other - Final PASS PART FAIL 00 NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION CMS�O� 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 .-. BUP Date Requested 5 Z I_ Q �AM�PM __ BLD Location �S�/ 1/_��r`-p — Suite MEC Contact Person Ph PLM Contractor Ph _ SWR UILD — Tenant/Owner ELC Retaining Wall ELR Footing Access: —+ Foundation FPS Ftg Drain SGN Crawl Drain Inspecticn Notes: — Slab — SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler _. Fire Alarm Susp'd Ceiling Roof Misc: — pAS� PART FAIL --- PLUMBING Post& Beam Under Slab _ _ _ Top Out y — Water Service _ Sanitary Sewer Rain Drains _ Final PASS PART FAIL MECHANICAL Post&Beam --- /'0z Rough In Gas Line - Smoke Dampers Final — — — — PASS PART FAIL ELECTRICAL - Service Rough In UG/Slab Low Voltage ire Alarm Final PASS PART FAIL SITE Backfill/Grading Sanitary Sewer Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 5W Hall Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RE: _Y M [ ]Unable to inspect-no access ADA ^ I Approach/Sidewalk Date Z- / —Inspector V — EX Other —, Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 41z� - CITY OF TIGARiD BUILDING INSPECTION LiVISION MST Z`0 s 1` 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 r- BLIP _—Date Requested s AM PM _ BLD Location f a S`,, (f;,,6 7`-c ✓ Suite MEC Contact Person _ Ph ,�^ �'l Z PLM Contractor ph i U SWR IIILDING _ Tenar"Owner, ELC Remning wall ELR FooGnq Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab ----- SIT Post& Beam Ext Sheath/Shear y -- Int Sheath/Shear Framing � J l�c"iyi�•v�iJ l r �t; _ I�, �. amort: i1cn� Zesr- Insulation Drywall Nailing Firewall Fire Sprinkler -� Fire Alarm Susp'd Ceiu;ig --- Roof Mi � , __— --- -- _ — --- 011- SPAR I FAIL -- - P UMBING Post& Beam Under Slab 1'op Out Water Service Sanitary Sewer Rain Drains — Final PASS PART FAIL ECHANICAL Post& Beam Rough In Gas Line — Smoke Dampers PASS PART FAIL L _CTRICAL -- — — - -- - - --~— Service Rough In UG/Slab ---- - Low Voltage Fire Alarm -- - - - - --- -- -- --_ Final PASS PART FAIL �-- SITE _ Backfill/Grading - - Sanitary Sewer Storm Drain ( j Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please cell for reinspection RE: _- [ ]Unable to inspect-no access ADA Approach/Sidewalk ate Z5 -- el Inspector � Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. Z tlY CITY OF TIGARD BUILDING INSPECTION DIVISION T 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 _ BUP Date Requested AM PM BLD Location .Sv✓ AFib? Suite MEC Contact Person, Ph Za'-,✓r� �� p!,M 4/ .2/3 Contractor — Ph SWR BUILDING Tenant/Owner ELC _ Retaining Wall ELR Footing Access: Foundation FNS _ Fig Drain SGN Crawl Drain Inspection Notes: Slab —_ SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear -- ---- Framing Insulation -- - - Drywall Nailing Firewall Fire Sprinkler Fire Alarm — Susp'd Ceiling Roof Misc: Final PAS ART FAIL -- Post&Bea Under 67 Slab Top Out Water Service Sanitary Sewer Q-- - Rain Drains ASS PART FAIL HANICAL Post& Beam — Rough In Gas Line ----- Smoke Dampers Final ----- -�--_ - — — — PASS PART FAIL ELECTRICAL — --- Service Rough In UG/Slab _ Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill/f,rading — Sanitary Sewer Storm Drain [ J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ J P [ J Unable to inspect-no access ADA Approach/Sidewalk (� Other Date _Z Inspector VC� t"-- Ext Final PASS PART FAIL DO NOT REMOVE this Inspection record from this fob site. o `r] O O a. y o c• N (� CL cr 91 o n o � x o A v' �0 S� /\ CITY O F TIGARD — MASTER PERMIT PERMIT#: MST2000-00556 DEVELOPMENT SERVICES DATE ISSUED: 1/30/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 ' SITE ADDRESS: 15590 SW EMPIRE TERR PARCEL: 2S111DA-14200 SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R-7 BLOCK: LOT: 135 JURISDICTION: TIG REMARKS: New SF detached.Path 1 BUILDING REISSUF: STORIES: 2 FLOOR AREAS REQUIRED SEI BACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1.127 sf BASEMENT: at LEFT: 17 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 0J SECUND: 1,294 at GARAGE: 755 sf FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSME.NT: of RIGHT: 14 VALUE: $228,071.00 OCCUPANCY GRP: H3 BDRM: 3 BATH: 3 TOTAL: 2,421 00 of REAR: 16 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN* 100 TRAPS: LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 sr RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 3 GARBAGE UISP: 1 WATER HEATERS: 1 WATE4 LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOILICMp<3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN>000K: I UNIT HEATERS: HOODS: I OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT SERVICE.FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 2U0 amp: 0 - 200 amp: WISVC OR FOR: 1 PUMP!IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 301 400 amp: 201 400 amp: 1st W/O SVC/FDR: 00 SIGNIOUT LIN L' PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HM/SVC/FDR: 601 • 1000 amp: 601+amps•1000v: Mh1OR LABEL: 1000+amplvolt PLAN REVIEW SECTION Reconnect unIV: _>•4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAI: CLS AREAISPC OCC: ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTFRCUM/PAOING: OUTDOOR LHJSC LT: BURGLAR ALARM. OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL. GARAGE OPENER: CLOCK: INSTRUMENTATION- MEDICAL: OTHR: HVAC! DATA/TELE COMM: NURSE CALLS: TOTAL I SYSTEMS. Owner: Contractor: TOTAL FEES: $ 4,246.84 This permit Is subject to the regulations contained'n the MATRIX DEVELOPMENT CORP LEGEND HOMES CORP Tigard Municipal Code,State of OR. Spec 'Codes and 12755 SW 69TH AVE#100 12755 SW 69TH AVE#100 all other applicable laws. All work will be done in TIGARD,OR 97223 TIGARD,OR 97223 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 1b0 days. ATTENTION Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rep#: !IC 60583 forth in OAR 952-001-0010 through 952.001-0090. You may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp& Post/Beam Mechanica Mechanical Insp Framing Insp Gas Fireplace Electrical Final Sewer Inspection Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Footing Insp Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final Foundation Insp Fooling/Foundation Dr. Electrical Service Low Voltage Water Line Insp Final inspection Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Appr/SdwIM Insp Building Final 7 Issued By : .{ Permittee Signaturti � _— Call ( 03) 639-4175 by 7:00 p.m. for an Inspection needed the nt:,ct business day CITYOF TIGARD SEWER CONNECTION PERMIT_ DEVELOPMENT SERVICES PERMIT#: S30/01 -00382 DATE ISSUED: 1/30/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 25111 DA-14200 SITE ADDRESS; 15590 SW EMPIRE TERR SUBDIVISION: APPLEWOOD PARK NO 3 ZONING: R-7 BLOCK: LOT: 135 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEIN DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERN/ SURFACE: Remarks: Sewer connection for new SF detached. Owner: FEES _ MATRIX DEVELOPMENT CORP Type By Date Amount Receipt 6900 SW HAINES ST STE 200 TIG.ARD, OR 97224 PRMT CTR 1/30i01 $2,300.00 27200100000 INSP GTR 1/30/01 $35.00 27200100000 Phone: Total $2,335.00 Contractor: Phone: Reg#: Required Inspections Sewer Inspection This Applicant agreeE to comply with all the rules and regulations o; 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 given,the installer shall prospect feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-.1987. �J Permittee SI natu / f . Issued by: Lf f _ 9 1L ___s._` — LL I--, Call ( 03) 639-4175 by 7:00 P.M. for an Inspection needed the next business day /ell"7 j 7 - �/ TAk ... Building Permit Applicah®n —� '•-- Date received: - 5 Permit no.;� City of Tigard ProjecUappl.no.~- Expire no.; Ctryoj7igard Address: 13125 SW Hall Blvd,Tigard,OR 97223 7--l- Receipt(503)639-4171 Dace issued: By:_,,, Receipt no.: Fax: (50)598-1960 Case file no.: Payment type: Land use approval: _— 1&2 family:Simple Complex: 1 71 &2 family dwelling or accessory O Commercial/industrial O Multi-family O New construction C Demolition G Addition/altelation/mplacement O Tenant improvcment O Fire sprinkler/alarm O Other. Job address: �Z - 'C Bldg.no.: _ Suite n0.: Lot: Block: Subdivision: u3 z)V 0 PSL( � Tax map/tax lo_Uaccount no. Project name-. Description and lo.ation of work on premises/special conditions: `^ 1 1 1 Name: + + Mailing addr6s 1&2 family dwelling: City: G Stater ZIP: 7 ' Valuation of work........................... _ Phone: E-mail: No.of bedrooms/baths................................. Owner's representative: MULC)01-j Total number of floors................................. _2- Phone' FjyV - � Fax: S` .`j p E-mail: New dwellitu„area(sq.fL) .......................... Z 4z6111 ffilki / Garage/carport a.0(sq.R.)......................... 755 Name: Covered pomti i area(sq.ft.)......................... _ Mailir ,add ss: Deck ammo(sq.it)........................................ _ City: sus z&f, Za�� y Other sttvscKure area(sq.fL)......................... Phone- (, d Faxes E-mail: Cornmercial/ladastrlalfwaitl-famliy: Valuation of work.................................. .... $ _ Business name: Z Existing bldg.area(sq.fL)...... ........ ........New bldg.area(sq.R) City: p• Stated ZIP '17i�n2 Number of stories.................... ........ ....... _ Phone O 1 Fax Email: Type of construction........... _ CCB no.. D(o p oo Occupancy group(s): Existing: +� — New: _ City/metrolir.no.: 7 Notice:All contractors and subcontractors aro required to be licensed with the Oregon Construction Contractors Board under Nom; f provisions of ORS 701 and may be required to be licensed in the Address: j- �q_ jurisdiction where work is being performed.If the applicant is City: P,-9& Staten ZIP: &I exempt from licen3ing,the following reason applies: Contact person: jtja;v Plan„o.: — — Phone:4, p . OX-0 117ax _ E-mail: -- Name: ,,e Contact n: Fees due upon application........................... $— - Address: G• g!TwDate received: City. a� State ZIP: f 7.)=�3 Amount received ...................................... $ Phone: p� Fax: E-mall: _,Please refer to fee schedule. I hereby certlfy I have read and examined this application and the Not all imiadicrima accept credit cards,pkaro call jurisdiction rot mme information attached checklist.All provisions of laws and ordinances governing this ❑Visa o Mastercard work will be complied with,whether s ecified he in or not. Cwt cars,umber: e■Pea Authorized ' nature: ate: IU -- Name of c#r&older to alhown on credit cud---- Print name: — — s - �moW,i Notice:This permit applica' n expires if a permit is not obtained within 180 days atter it has been accepted as complete. 440-4617(tiAl(LCOM) Plumbing Permit Application City of Tigard ><gard w Datereceived: ��/�„) Permit no.- r7"'1r'r' '�• G unit no.: — Address: 13125 SW Hall Blvd,Tigard,OR 97223 sewer Building pennitno.: City of Tigard Phone: (503) 539-4171 Proiect/appl.no.: Expire date: Fax: (5U.!) 598-1960 Date issued: By;' _ Receiptno.: Land use approval: _ -`- Case file no.: Payment type: 1 1 &2 family dwelling or accessory ❑Commerrial/industrial U Multi-family U Tenant improvement R New construction ❑Addi►ion/alteratiu.dreplacemcnt Q Food service El Other. 1 1 t Job address: r-t-T(P� L MZ Description Fee ea. Total Bldg.no.: Suite no.: New i-and 2-famlly dwellings only: (Includes 100 M for each Willy connection) Tax m- a_ loU_iccount no.: SFR(l)bath Lot: Bloch: I Subdivision: SFR(2)bath -- - Project name: kAJ'�L�C Etc'-rp4)__}� SFR(3)bath -� City/county�T'C-f-�y'�, ZIp: �j r.)_ Each additional bath/kitchen Description and loon of work on premises: Slteutllltles: Catch basin/area drain Est.date of compledon/inspection: _ Drywe;ls/leac line/trench drain -- Footinp drain(no.lin.ft.) Manufactured_home utilities Business name: ��d - Manholes —- Address: PO B© f, app Rain drain connector City:(_Q"g�6 of _ I State:pZTP�C �p3�'� Sanitary sewer(no.lin.ft.) - Phone: ,, - Fax: L.7-y F mail: Storm s,wer(no.lin. ft.) LilCCB no.: Plumb.bus.rug.no: p Water se ce(nn.lin.ft.) City/metro lic.no.:_ -��-----� Fixture or Item: Absoon valve Contractor's representative signature: _01, t on Back flow preventer _ Print name: 61 / e �,� T� DaBackwater valve as ns/lavatory Name: _Jr6 Jor r'cr Clothes washer Address: o - pp 7- -� Dishwasher -L- o --- Drinng fountains) -- ('tt_Y' State ZIP: �t3d Eki E'cctorslsump _ -- Phone: Fax: E-tr.ail: pansion tank• - Fixtu_relsewer cap Name(print): Z? Q �n S Fluor drains/floor sinks/hub --- Oarb�a e disposal Mailing address: � � G City: _ stair: ZIP: Ice m r Phone: ' - okD Fax:d -et I E-mail: Intcreeptor/grease, a - - Owner installation/residential maintenance only: The actual installation Primer(s) _ will be made by mu or the maintenance and repair made by my regular Roof drain(commercial) employee on the propetty I own is per ORS Cha . r 447. Sink(s),basin(s),lays(s) _ Owner's signature: /' Z 13 L\ sump WIM Tu'bs/shower sho,ter pan rival - N Water choses Address: 011 _ Water tie-stet- - CitY: Stater I ZIP:-.7� -_ _-- Phone: 05 Fax:_ E-mail: _ r Total Not all Juriatietionr accept credit card.,plow call Jurirdictioo r«mare Wormation Notice:This permit application Minimum fee................$ __—_-- U Visa U MasterCard Plan review(at _ %) $ _ expires if a permit is not obtained ------ Credit card number- t St --[�._ ae surcharge 8% _— Fapirer within 180 days after it has been . ) •"'S — accepted as complete. TOTAL ................. ....$ Nara nr �u shown m enx1H carA _ P P S -- lr alder s1pruure —�-- Amouni PLEAS.E_:^_�;LEIE: FIXTURES (iridividual). ,Ql� >�,T.` r ;TO I Fixture Typo QuanUt b Work Parformad Sink - -_ 16.60 -- Nr. Moved Re Removed/c.pPer Lavatory 16.60 sink Lavatory - Tub or Tub/Shower Comb. 10.60 Tub or TuNShower Combination Shower Only _ -- 16.60 Shower Only Water Close' - 16.60 _Water Closet - Urinal Urinal 16.60 Dishwasher Dishwasher 16.60 Grybage Disposal - _ Laundry Room Tray - Garbage Disposal 16.60 Washing Machine -- Laundry Tray 16.60 Floor Drain/Floor Sink 2' 3' Washing Machine 16.60 --- 4- - ---- Floor DraiNFloor Sink 2' 16.80 Water Healer - 3' 16.60 Other FWur•. S ci - - - 4- 16.60 '- Water Healer O conversion O like kind 18.60 -- GasI In re uq fires a separate mechanical permit. _ -' --- MFG Home New Water Service 46.40 --- - MFG Home New SaNSlorm Sewe• 46.40 Hose Bibs 18.60 COMMENTS REGARDING ABOVE: Roof(rains - 16.60 --- -- _- Drinking Fountain 1660 Other Fixtures(Specify) - 21.75 - Sewer-1 at 100' - 55.00 Sewer-each additional 100' 46.40 Water Service-1st 100' 55.00 Water Service-each additional 200' 46.40 Storm&Rain Drain-tat 100' - 65.00 Storm 6 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Devirx --- 46.40 Residential Backflow Prevention Device' 27.55 ratch Basin - 16.60 Insp.of Existing Plumping or Specialty Requested 72.50 Ins lion _ per/hr Rain Draln,skgle family dwelling 65.25 Grease Traps - 16.60 QUANTITY TOTAL Isomatic at riser diagram is required I Ou ToW h 3-9 `SUBTOTAL- RPM - 6•�a SORCHARGF "PLAN REVIEW 25%OF SUBTOTAL Regaled only If to&"qty.101611 h 19 TOTAL PHI 'Minimum permit fee Is$72.50•s%surdunpe,except Reslderdial BsckMow Prevemkm Device.whkh Is SM.25♦0%sudrarge. "Aa New Commercial Buildings require plans with IsomeWA:or riser diagram and pW revkw. Mechanical Permit Application �—� Datereceived: iy ' Permitno.:�� City of Tigard Project/appl.no.: Expire date: CiryofTigord Address: 13125 SW Hall Blvd,Tigard,OR °721.3 Date issued: By: % H' Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: I wd use approval: _ Building permit no.: Xl &2 family dwelling or acce Gsory U Commen iat/industrial U Multi-famil U Tenant improvement N&w construction U Addition/alter:ation/replacement O Other. __ Job address: h�� 1 �t �. F 14r' i_ ( 't(1 Indicate equipment quantities in boxes below.Indicate the dollar Bldg.no.: Suite no,: v value of all mechanical materials,equipment,labor,overhead, Tax map/taA lotlaccount no.: profit.Value$ Lot: Block: Subdivision: *See checklist for important application information and Project name: c, jurisdiction's fee schedule for residential permit fee. City/county- 1 ZIP: Description and loAtion of work o:1 premises: Iee(en.) Total Est.date of completion/inspection Description Qt . Res.only Rr.s.only Tenant improveme r change of use: Is exist! space heated or conditioned?U Yes U No Air handling_unit — —CFM Air conditioning site plan 6require _ Is e ' ing space insulated?U Yes U No teration o e sung system e _ of r compressors Business name: � ) State boiler permit no.: HP Tuns_—E3TU/H Addtrss S' _ �pS — ` Fire/smoke atnper c uct sm-- oke detectors — City: eL _ _ S[att��' ZIP: 9701 f eat pump site plan require E-mail: ns�rep ace urnac urner BTI J/H Phone -7 ) Faxc-- E-mail: __ Including ductwork/vent liner ❑Yes U No CCB no.: nstal rep ac re ocatr. eaters-suspended- City/metro uspen e ,City/metro lic.no.: wall,or floor mounted — — Name(please print) a., Vent ors tam-c other an furnace e tan on Absorption units_.-- BTU/H _ — Name: % -- Chillers ---_� HP _— Address: f — Compressors — HP agmen exhaust andvent at on: _City: �� State:o Q_ ZIP: 9 Appliance vent Phone -7J Fax �� Email: ere ausi —_ Hoods,Type res. tc ten/haazmat hood fire suppression system Name: j Pq�pn p/0Q Exhaust fan with single duct(bath fans) Mailing address:/ .2 �FaaxA �Q P.-c- Exhaust a,�stem a artirom-Iieau— n nr AC_Ni — Cit Stas ZIP: prptnL an ut on up to outlets Y Y� t0.�_ T ___LPO NO —_ Oil Phone: - - 4V E-mail: ue r utg sac aadtiionaTover—d out eT t� cressp p aS(scRmatic required) _ Number of outlets Name_ ter st spp cr or equfpmene: Addrt:ss: � Decorative fireplace City: 90.70 -- State: 7IP: - nsert-type -- -- Phon,;: U?-1�- Fax: E-mail Woodstovetppelletstove -+�— er: Applicant's signature ¢1 _ r `J/',�►r,, e —_ Name (print): e p .1 Not all iud"ctiotu taxept creat cudt,piecan w flcuen rot more informsuon. Permit fee ................$ —-- U Visa 7 Mastercard Notice:This permit application Minimum fee................$ :xp res if a permit is not obtained Plan review(at _ %) $ _ Credit card number: _—_—._ _Les h within Igo days after it as been F.apirea State surcharge(896) ....$ ---- accepted as complete.None of cudholder u shown on credit card P P s TOTAL .......................$ ----- Cudhdder rrptature —� Amount 4404617(t>WOM) Commercial Schedule 1812 Family Dhr;ellint;';chedule ASSUMED VALUATIONS PER APPLIANCE oescrtptfcn F'umace to 100,000 BTU Tawe 1A Mec hanlu(coda _ ay Price Taal including ducts 8 vents 955 +) Fwnaoe io i00.000 cru g t _ Nhctudhhp ducts S vents ;•:.00 Furnace>100,000 BTU 2)Fumsty 100,000 BTUr - -- inchAing duds 6 vents17.40 Includiriq ducts&vents 1,170 3) Flom Fumsos --- flOOf fumaal -`�f1'---- 14.00 4)SSuspended Mater,was hnsler Including vent 955 or door ff unted healer 14.00 suspended heater,wall heater s)vent not Included to spplia rim permA e.30 or floor mounted heater _ 955 s k units 12.16 ;Mock rl that aptly: 'Bohr Heat Ak Vent riot included In appliance permit 445 For Hams 1.10,see or Plrmp Gond ay Price Taal Repair units 605 footnotes 1,2 c - �_.-_ T)c7HP.x'.sorb unit to <3 hp;absorb.unit 10OK%N 14.00 e)1-.5 HP;absorb unit to 100k BTU 955 1aa.to 500k BTU 25.00 3-15 hp;absorb.unit -`-� �- 9)15.10 HP;absorb -- unit.5.1 ml BTU 35.00 101k to 500k BTU 1700 10)10-50 HP;absorb - -- ons 1.1.75 mi BTU 1 52,20 15-30 hp;absorb.unit 11)>50HP;absorb wit>1.75mil 871) - 501k to 1 roll.BTU 2310 e720 _ -� _ 12)Ak h,ndU,q r�,+l to 10,0�cfM 30-50 hp;absod).ur It 11)Air handlry unk 111,000 CFM+ 1-1.75 rnll.BTU 3400 evaporate 1720 41 Non�ollaWs aak rooky' - >50 hp;absorb,unit 1000 > 1.75 mil.BTU 5725 15)vent ran cnnneryeA to a single d`ua - 6.50 Air handling unit to 10,000 c n _ 656 15)ventilation rotern not Incbxw in Pal Air handling unit>10,000 dm 1170 1 r)Hood.env by mechanical exhaust Non ortable evaporate Boller 656 - te)araroastk kairworatara vent tan connected to a single duct 446 _ _17.4° 19)commercial a wustrtal type Indnerata Vent sysi.not Included In appliance permit _ 656 Hood served bymechanicalexhaust 656 20)Other units'kw*Pdln°w°°d stoves I0.n0 Domestic Incinerator 1170 211 Gas Pblrw one w'low ambo -- - -- -- _5.40 Commercial or Industral Incinerator 4590 22)i'+ i Bhen 4"r owlet(each) 1.00 Other unit,Including wood stoves,Inserts,etc. 656 Mlnlmum PermN Fie 72.60 -SUBTOTAL �- Gas piping 1-4 outlets _ 360 e%SumclanGE Each add'.+ .al outlet 63 MMI REVIEW 25%Or SUBTOTAL ItpuNed tot ALL commercial permits ail TOTAL Oaw h.speeanns end rsee: 1. xvopedwr e.41de d nomW huaYhen ban(MNnhrn ri.rpelwo haxal 472.50 per hour 2. Yrpecfna ax.Ogd no M h M Yhdlcxled Irrvr+mxn rrur0�Aea rax) pw hex r•,, _1 172110 19t�V_E,'AlWiL._ Pee 5, Aad O-A ren ft~-1'A d w .rldMurf d nrvltlnn.b 1+na(Mrfnxn _ _ •SIM.Caw.dc.bWw c«wkee n,.W-d S1.00toS5,000.00 Minimum S72.50 -- •'"e'""'"'""'c"'°`e'imPlan'"°"`0PLO-n-40-A 55,001.00 to 510,000.00 572.50 for the first$5,000.00 and S1.52 for erch additional$100.00 or fraction thereof, to and including$10,000,00 510,001.00 to$25,000.00 St 411!50 for the first$10,000.00 and SI 54 for each additional$1100.00 or fraction thereof,to and including$25,000.00 525,001.00 to 550,000.00 $379.50 for the first$25,000.00 and$1.45 for each additional S 100.00 or fraction thereof,to and including 550,000.00 $50,000.00 rind up 5742.00 for the first$50,000.00 and$1.20 -- -� for each additional S 100.00 or fraction thereof -- Electrical PermitApplication POW Date received: /2,�f!/�� Permit no. j Tigard City of Project/appl.no.: Expiredatc: City of7igard Address: 13125 SW[fall Blvd,Tigard,OR 97223 pate issued: By_--�ecciptno.: Phone: (503) 639-4171 Fax: (503)598-1960 Case file no.: Payment type: Land use approval: slim 1 &2 fancily dwelling or accessory 0 Commercial/industrial U Multi-family U Tenant improvement Ild New construction U Addition/alteration/replacement U Other.y U Pial 1011 SUI F 1 Job address: 'EC- c–) e-ti (aT-- " B1dK. no.: Suite no.: Tax ma tax lottaccount no.; I.ot: 7��� Block: Subdivision: ' ��L � S1�� 1 Project name: __ r Description and location of work on premises: — Estimated date of cornpledon/inspection: n Job no: Fee MAX Business name: O� Desert tlo„ . (ea.) Total no.In. ,�e I-L.L Y4'L �' Nen resideadal-Wngk or meld-farolly per Address: - LZ�' {` ��� dnellingtrw_ y: dtAncludesattarl dgari Cit �lIIfeQ 7aIP: Service Included: Phone - rj Fax:6W j,2 �m811: 1000 eq.ft or Icss _ — 4 .3 Each additional 500 sq.it,or portion thereof C o.^ r S Else.bits.lie.no: 3 `_ t i!nirrdenergy,residential _ 2 MY 74 7S Limiteagtergy,non-residential 2 s ( L r 5 !�' &clr manuf ,i!ed home or modular dwelling - __n tune supervra g el cion(r uired) _Date Service and/or fader_ 2 Sup.elecL name nn rxnse� Srvkesorfeeders-Insallation,: erattio or relocation: 200 amps or less 2 Name(print)'L B 1i "5 _ 26-1 amps to 400 amps — 2 401 amps to 600 amps 2 Mailing address: 73- - L>J d ►`Z� �_ __` _ 601 amps to 1000 amps 2 City: ' Statet'a ZIP: 7_, 1 Over 1000 amps orylts Phone:LO(Mb Fax:5-? - E-mail: Reconnect only �— l Owner installs ion:The installation is being made on property I own Temporary services or feeder- which is not intended for sale,lease,rent,or exchange according o Inst,ru"don,•ltentlon,orrelocation: ORS 447,455,479,670,701. 200 amps or less 2 / t ; 201 amps to 400 amps_ _ 2 Wer's si nature: 0 /n '' Date: 1 ; 401 to 600 ams 2 Branch clrrnits-nen,alteration, or extewdon per panel• Address: e•s: ' � q A. Fee for hra,tch circuits with purct,:•eof Aress: J service or feeder fee,each branch circuit 2 City:`d' ,. $tatep ZIP.. B. Fee for brunch circuits without purchase Plione: • —" of service or fader fee,first bunch circuit: 2 en.) Fax: E-mail: Eacl!additional branch circuit: Mise.(Service or feeder not Included): 7farnity amps<»mmerrial U Health care facility Each pump or irrigation circle —R — 2 amps rsling of 142 U Ha:srdotu location Each sign or outline lighting 2 s U Buildingover 10,(1(10aquaretextfouror Signal circult(a)or a limited energy panel. volts nominal more residential units In one.stnrcture alteration,or extension' 2 U Building over throe stories U Feeder,400 amps or more [ non rscrip _ — U Occupant load over 99 pemans U Manuf►ctured structures or RV park ..Facit*Description: additional Inspection err the allor►ahk In any of the above •Egress/lighting plan U(]cher. ---__-__----_- __—_— Per inspection --_-�— Suhmlt____sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Na all)udsWicaa accept credh cards. all PCClrtlt fie.....................$ _— please lurirdicdoe ra mere Inrarerudar. NoUc a This permit application U Visa U MasterCard expires if a permit is not obtained Plan review(at ­ %) $ _ Credit cud numl*7 ---_—__...�___-_-- [-__[.___ within I RO days afler it has been State surcharge(trio) ....$ Espires screplM as complete. TOTAI. .......................$ -----— Name of cardbo'Ider a show"on errs it rsn f Can9mlder.i�naturc Amrwn! 4"15(6tlllll('OM) -` TYPE OF WORK INVOLVED-RESIDENTIAL ONLY 4. Complete Fee Schedule Below: Number of Inspections per-mrilt allowed Restricted Energy Fee.................. $76.00 Service included: Items Cost Total (FOR ALL SYSTEMS) 4a Residential•per unit Check Type of Work Involved: 1000 sq.0.or less $147.15 __ 4 Each additional 500 sq,ft.or �- n Audio and Stereo Systems portion thereof _ _ $33.40 1 Limfled Energy $75.00 Burglar Alam, E nrh Manurd Home or Modular Dwelling Service or Feeder $90.110 _ 2 Garage Door Opener- 411.Services or Feeders Installation,alteration,or relocation Heating,Ventilation and Air Conditioning System' 200 amps or less $80.30 _ 2 201 amps to 400 amps _ $106.85 ___ 2 Vacuum Systems" 401 amps to 600 amps -_ V $160.60 2 601 amps to 1000 amps _ _ $240.60__ 2 Other Over 1000 amps or volts $454.65 2 - --- Reconnect only _ --- $66.85 M 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY 4c.Temporary Services or Feeders Installation,alteration,or relocation Fee for each system.............................................. $76.00 200 amps or less $60.85 2 (SEE OAR 918-260-260) 701 amps to 400 amps _- $100.90 2 401 amps to 600 amps $192.75 _ 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. Audio and Stereo Systems 4d.Branch Circuits New,alteration or extension per panel Boller Controls a)The fee for brands circuits with purrlrase of service or Clock Systems feed«r fee. Each br nch circuit $6.65 _- 2r--t b)The Ice fns branch cirwits LJ Data Telecommunication Instatfatlon without purchase of service ❑ or feeder fee. f"are Alarm installation First branch r*mh $46.85 Each additional branch drcull _-_^ $6.65 _ HVAC 4e.Misccll:.neous (Service or feeder not included) Instrumentation Each pump or Irrigation cirde $53.40 Each sign or oulline righting $53.40 ^ L_1 Intercom and Paging Systems Signal circu"(s)or a G-nited energy panel,alteration or extension $75.00_^ Landscape Irrigation Control' Minor Labels(10) $125.00 - r--� 4f.tach additional Inspection over __1 L_ Msdical tfhe allowable in any of the above r-1 Per Inspection $62.50 - LJ Nurse Calls Per how _ $62.50 In Plant - $73.75 --- Outdoor Landscape Lighting' 5. fees: Protective Signaling 6a.Enter total of above fees S _ 8%Surcharge(O8 Y,total fee $ _ Otlte; Subtotal $ 6b.Enter 25%of fine 6a for _ _A _ __`Number of Systems Ilan Review If required_ (Sec.3) $ subtotal $ No licenses are required Licences are required for alt other Installations -� 1 Trust Acxokml R___-__ FEES: Total balance Due $ ENTER FEES - 8%SURCHARGE(.08 X TOTAL ABOVE) TOTAL $ FL CST FLAN �- �srz� LOT #135, AFFL,_EWOOID PARK R-1 251 11 O,4 TAX LOT *14200 15590 5,U EMPIRE TERRACE 5.E. 1/4 OF SECTION 11, T.2, R.IW, W.M. CITY OF TIGARD W,45PINGTON COUNTY, OREGON WATER METER LEGEND U1-- ----- WATER LINE '� I HOMES SS———— SANITARY SEWER ! � 18786 s0 69th AVRNDR surra loo 'ut omcs (609) 620-so6o POMAND, OR, 97229 SD-- — — -- STORM DRAIN 1111 I M11 (663) 696-6900 cce/ 60663 ` -- — — (t OF STREET MANHOLE ® CATCH BASIN c�' /U V PROPOSED w I _ STREET TREES STREET LIGHT LO 13� I FIRE HYDRANT k' I I 15' STORM ESMT. `- 58S'54'25„W I I I �---W 60.13' 5W GREENING LANE �GURB—__ `y 202.5' SIDEWALK �, 8' UTILITl� r"' 2023' 1 c EASEMENT I I iA N =-- -- " 5.180 SQ. FT. i . 1 I U)I N.000D B ui ' nl I FIN. FLR. , 202.8' Id aa,' GARACsE PLR. 2 20:! ” I_ PROVIDE EROSION CONTROL FENCE PER COMMUNITY - - EROSION PLAN 10' PRIVATE STORM ESMT. 51�j' --- - --�D-- - - - - - - - - -SLS- - - S 88' 52' 00" W , 9652' CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GARNER ELECTRIC 21785 SW TUALATIN VLY HWY #C ALOHA, OR 97006-1249 Electrical Signature Form Permit #: MST2000-00556 Date Issued: 1130101 Parcel: 2S111 DA-14200 Site Address: 15590 SW EMPIRE TERR Subdivision: APPLEWOOD PARK NO. 3 Block: Lot: 135 Jurisdiction: 11G Zoning: R-7 Remarks: New SF detached.Path 1 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 io the address above;, ATTN: Building Dept. No electrical inspections, will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MATRIX DEVELOPMENT CORP GARNER ELECTRIC; 12755 SW 69TH AVE #100 21785 SW TUALATIN VLY HWY #C TIGARD, OR 97223 ALOHA, OR 97006-1249 Phone #: Phone #: 503-648-4552 Req #: I rc 121159 SUP 3707S ELE 34-305C AN INK SIGNATURE IS REQUIRED ON THIS FORM XAN1% Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD _. PLUMBING DEVELOPMENT SERVICES PERMIT#: PLM2(,,. -00213 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/23.'01 SITE ADDRESS: 15590 SW EMPIRE TERR PARCEL: 2S 111 DA-'^,)n^ SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R-7 BLOCK: LOT: 135 JURISDICTION: TIG CLASS OF WORK, ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: FLOOR DRAINS: TRAPS: S1ORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUBlSHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install back flow preventor _ _FEES Owner: — - -� Type By Date Amount Receipt MATRIX DEVELOPMENT CORP --- PRMT CTR 5r'23/01 $36.25 27200100000 TIGARD, ORR 97223 12755 69TH AVE #100 5PCT CTR 5/23/01 $2.90 27200100000 _- Total $39.15 Phone 1 Contractor: MARTIN SANDERS GROUNDS MAINTEN PO BOX 307 NORTH PLAINS, OR 97113 REQUIRED INSPECTIONS RP/Backflow Preventer Phone 1: 647-5567 Reg #: LIC 00005742. PLM 11608 1 his permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. I his permit will expire if work is not started within 180 days Of issuance, or if work is suspended for more than 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in nAR 952-0001-0010 throiigh OAR 952-0001-0080. You may obtain copies of these rules or direct qL—stions to OUNC by calling (503) 246-1987. Issued By: ,XPi yyl4,,1yZ Permittee Signature:' z - Call (503) 639-4175 by 7:00 P.M. for an inspection needed the n .xt business day Plumbing Permit Application Date received: S--Z3-01 Permit nO OtI City of Tigard Sewertmit no.: Building g permit no.: ALUAMM Address: 13125 SW Hall Blvd,'T'igard,OR 97223 — City ojTigard Phone: (503) 639-4171 Project/apol.no.: Expire date: Fax: (503) 598-1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: 1 U 1 &2 family dwelling or accessory U Commercial/industrial U MUlti-(:unity U Tenant improvement 0 New construction U Addition/alteration/replacement U Food ser vice U Other: Jobr- /;r- �, Description Qty- Fee(ea.) Total Bldg.no.: Suite o.:address: Ju +rte �Q Neii t-and 2-family dwellings only: Bld (includes 100 fl.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath _ Lot: Block: Subdiv• ion: SFR(2)bath Project name: XeeZV +,� �� SFr:(3)bath City/county: r ZIP: i ' ;� `J' Each additional ath/kitchen Description atidIKkatioq of wo on premises: Site utilities: e. It c _ Catch basin/area drain Est.date of completion/insprction: Drywells/leach line/trench drain J 1 Footing drain(no.lin.ft.) _ Manufactured home utilities _ Business name: �•- `_ Manholes Address: Rain drain connector City: '- " State ZIP: Sanitary sewer(no.lin. ft.) Phone: Fax ' E-mail: Storm sewer(no.lin.ft.) CCB no.: �- r � Plumb.bus.reg.no: Water service(no.lin.ft.) City/metro lic.no.: Fixture or Item: Absatption valve Contractor's representative signatu /�,� �-�-._� re — Back flow preventer _ Print name: coNT41 PERSON_ - h,ttc: L'�' Backwater valve __ Basinstlavatory Name: /�It. >it, { Y ��� Clothes washer _ Dishwasher Address' Ab 3 Drinking fountain(s) City: Statea" Z1Pf2 7/3 7, Ejectors/sump Phone: Fax: E-mail: Expansion tank — Fixture/sewer cap Name(print): L� �E�t M, Floor drains/floorsinks/hub � _ ^ Mailing address: Garbage disposal — —_ ►lose hibb _ Cit I Stat '�t ZIP: 7 Ice maker Phone: , Fax: E-mail: Interceptor/grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will he trade by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property 1 own as per ORS Chapter 447. Sink(s),hasin(s),lays(s) _ Owner's signature: Date: Sump T'ubs/shower/shower pan -7- -Urinal Name: _ _ Water closet —�— -- Address: _ Water treater City: State: ZIP: _ Other. Phone: !` Fax: E-mail: Tot ` Not all jurisdictions accept credit cants,plew call juri4dictlon for more information Nolice: Mis permit application Minimum fee................$ , a,J O Vii sr. U MasterCard expires if a permit is not obtained Plan review(at _ %) $ �Z . credit cord number: _.�— %%ithin 180 days atter it has been State surcharge(8%)....$ Expires TOTAL .......................$ 3 9 a� Name of cardholder anc showon credit card accepted as COmpICIC. _ S Cardholder signature --- Amount 440-461616Mnt OM1 PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (Individual) QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory — 18,80 for each utility connection __ One(1)bath i $249.20 Tub or Tub/Shower Comb. 16.60 Two L2Lbath $350.00 _ Shower Only 16.60 Three(3)bath __$399.00 Water Closet 16.60 - _—__ SUBTOTAL __ _ Urinal 16.60 _ 8%STATE SURCHARGE _ Dirhwas h her 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16,60 3" -- 16.60 PLEASE COMPLETE: 4" -- 16.60 Water Heater O conversion O like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit _-- __ _— _—__ Capped MFG Home New Water Service 46.40 _— MFG Horne New San/Slorm Sewer 46.40 Lavatory Tub or TubrShower Hose Bibs 16 60 Combination Roof Drains 16.60 Shower Only -_ Drinking Fountain 16.60 Water Closet— —_ Other Fixtures(Specify) 16.60 Urinal — _ Dishwasher Garbage Disposal Laundry Room Tray Washing Macnine _— F;oor Drain/Sink: 2" Sewer-1 st 100' 5500 3" Sewer-each additional 100' 46.40 _ 4" Water Service-1st 100' 55.00 Water Heater Water Sei: iI e-oach additional 200' 46.40 Other Fixtures _ _ (Specify) — Storm R Rain Drain-list 100' 5500 Stone&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 -- — - Residential backflow Prevention Device' 27.55 - _ --- Catch Basin 1660 Inspection of Existing Plumbing or Specially 72.50 — _rtequesled InspectionseP rthr — COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL ------�---- —� _ Isometric or riser diagram is required If — __ Ouanlhy Total is >9 — --- 'SUBTOTAL - -- — 8%STATE SURCHARGE -- -- -- "PLAN REVIEW 25%OF SUBTUTAL- Requlred only 4 fixture qty total i >9 TOl Al_ E Minimum permit roe is$72 50+8%state surcharge,except Residential Backflow Prevention Device,which is$36 25-8%state surcharge **All New Commercial Buildings require plans with isometric or riser diagram and rl,n review 1:\dsts\forms\plm-fees.doc 10/10/00