Loading...
9730 SW NACIRA LANE NI VHIDVN MS 0£L6 J d F- Q � Z W � J 9730 SW NACIRA LN I r F24 V III•••\\\C o I 0 ° pu id h RE W z o o w ul � w cts CITY 406•QIGARD 24-Hour BUILDING Inspection Lino: (503)635-4175 MST INSPECTION DIVISION Business LIrtA: (503) 9-4171 ©UP .. Received _ Date Requested_ �G AM _PM 13UP Location 730 _ uite __ MEC - a -3 � Contact Person Ph(__.a_- ) ?�__ �' �_ PLM Contractor Ph( SWR BUILDING Terant/OwnerELC Footing Foundation ELC ACCA88: Fig Drain � ) �--- ELR Crawl Drain -- Sid',, Inspection Notes: SIT Post&tsoam ---�--.— _— -- _ Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - — — Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -- Roof Other: --�-- A6S PART FAIL _ — MBINa Post 8 Beam Under Slab Of _ Rough-In 00 Water Service — — Sanitary Sewer Rain Drains -- — Catch Basin/Manhole Storm Drain --------- -- --- ----- Shower Pan Other: Final PASS PART FAIL MECHANICAL Post 8 Beam Rough-In Gas Line Smoke Dampers Final y PASS PART FAIL. — ---- ---- -- . ELECTRICAL____ Service fo Rough-In W UG/Slab -j Low Voltage -- Fire Alarm Final U Reinspection fee of S _requln►d before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call tot reinspection RE: __ Unable to Inspect-no aocess Fire Supply Line ADA Appronch/Sidewalk Do% Other: Final _ DO NOT REMOVE thla InispoOdom r000nl Un fob itlR& PASS PART FAIL CITY OF TrIGARD 24-Hour BUILDING Inspection Line: (303)639-4175 MST 53dd�_� P* INSPECTION DIVISION Business Ine: (503)639-4171 SUP —� Received _-- Date Requested_____�.-_ _AM---PM SUP —_ Location _ __ 1 L��G — 1- �' Suite_ MEC _ Contact Person �'�-�s�_—---- h(— ) Z U PLM Contractor h(— ) SWR BUILDING _ Tenant/Owner _�__ —. __ ELC Footing ELC — Foundation Accessi: Ftg Drain ELR --- -- Crawl Drain Slat, Inspection Notes: SIT — — Post&Beam Shear Anchors — — Ext Shesth/Shear — Int Sheath/Shear I Framing K0—T-& I P—oy /D Insulation Drywall Nailing Firewall Fire SprinKler -- Fire Alarm _ Susp'd Ceiling --- — -- — ---- Roof Other: -- — -------- Final `---_-- PASS PART FAIL — - --_—�--- PLUMBING --- _ --- -- -- -- Post&Beam Undar Slab - --- — -- Rough-In Water Service —-- — —�-- y Sanitary Sewer Rain Drains - ---- —"' --`— Catch Basin/Manhole Stone Drain -- ---- — Shower Pan _ Other- — Final -�--- — PASS PART FAIL -^--�_-------- ----- MECHANICAL_ — Post A Beam Rough-In —� -- --— — --- -- —-- Gas Line 0�C Smoke Dampers ---- - - ------- -- -- — --- - Final _-- PASS PART FAIL -- --�- ---v— --- -- ELECTRICAL ED Service 5 Rough-In --- W UG/Slab _j Low Voltage FiaLAIarm FiePLl Reinspection fee of$�__. required before next inspe�+-n. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL WE 0 Please call for reinspection RE: ❑ Unable to inspect.-no access Fire Supply Line — ADA ' 8 S Ext Approach/Sidewalk Pate,-- _- �� � Other: Final DO NOT REMOVE this Inspoetlon mord from b slb. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST 'Y-0 0 /9d INSPECTION DIVISION Business Line: (503)639-4171 BUP Received _Date Regtlested__�' AM_—_ PM OUP Location _— d 1Suite _ MEC Contact Person Ph(--) PLM'S—D.S-,S? 1 -G Contractor_T__--- -- Ph( ) -._ SWR ---- BUILDING _ Tenant/Owner _._ ELC Footing Foundation ---� ELC r-tg Drain Access: ELR _. Crawl Drain ._ Slat Inspection Notes: SIT Post&Beam Shear Anchors - Ext Sheath/Shear _ Int SheaNShear Framing sulatior, Drywall Drywall Nailing Firewall Fire Sprinkler --- - Fire Alarm Susp'd Ceiling - — Roof Other:_ — ----- Final PASS PART FAIL - PLUMBING Post&Beam Under Slab Rough-In Water Service Sanitary Sewer Rain Drains -- - Catch Basin/Manho!e Storm Drain - Shower Pan Other. — nj ASS PART FAIL NIEVRANICAL Post&Beam Rough-In d Gas Line Smoke Dampers - -- I- Final U) PASS PART FAIL ELECTRICAL -d Service ---- m Rough-In W UG/Slab - -- -- — — _j Low Voltage Fire Alarm Final Reins ection The of$___ PASS PART FAIL p _requnc;t before next inspection. Pay at City Nall, 13125 SW Hall Blvd. SITE F] Please call for reinspection RE: _V_ l Unable to inspect- no access Fire Supply Line e ADA � ( Approach/Sidewalk - Daft ----� Other: Final T DO NOT REMOVE this Inspection record hem the job sib. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503 639.4175 MST INSPECTION DIVISION Business Line: (5 639-4171 SUP — I — _ Received - Date Requested— _ M_. PM BUP _ Location -30 751c) '_ _Suite MEC Contact Person _�—> ,Ph( _2� ��'� � PLM Contractor_—__U� Ph ) SWR ------ — ©UILDINGI Tenant/Owner ELC Footing ELC Foundation - - Ftg Drain Access: J/ �^n Crawl Drain T""J / ELR ---__- -- Slab Inspec 'o a Z-� n SIT _ Post R Beam ✓ �C.� Shear Anchors - Ext Sheath/ShearInt Framing )jA ir r-� O /e - Insulation Drywall Nailing TN Su A i Firewall - Eoz�-T-- T- Fire Sprinkler Fire Alarm Susp'd Ceiling - Floof Final_..) -- -- M �_ �/J►�l I�6 b�l D PG7�!��/ GL? 15 PASS PART FAI PLUMBING / - c ^ 3 C A Post&Beam Under Slab _ Rough-In Water Service _- Sanitary Sewer Rain Drains - Catch Basin/Manhole Storm Drain Shower Pan Other:_ --- - - Final -- ---- P T FAIL —_--- HANI Post R Beam Rough-In Gas Line a SR-CTRICAL ampers - --- U) PART FAIL - --- --- -- -- ----- --- J Service - -- ----- ----------- ------ --- - -------- m Rough-In (� UG/Slab — --- - - - -- _ Low Voltage Fire Alarm - Final Reinspection fee of$_____----.required betore next inspectlon. Pay at City Hall, SW Hall Blvd. PASS PART FAIL„ SITE -- El Please call for ref pection RE: Unable to ii Ito access Fire Supply l u•ie ADA Dab Approach/,44dewalk Other: Final DO NOT REMOVE this Inspection record a job nito. PASS PART FAIL s s City of Tigard Washington County Oregon Voluntary Compliance Agreement and Temporary Certificate of Occupancy For: Chris Christensen Vista Northwest PO Box 91459 Portland, OR 97291 Re: Temporary Certificate of Occupancy i, Chris Christensen, as the responsible person for 9730 SW Nacira Ln., Tax Map 1S135CD, Tax Lot 13400, agree to the following conditions: A temporary Certificate of Occupancy is hereby issued on a conditional basis for a period not to exceed 30 days from this date, by which time the following conditions must have been met and approved by inspection by the City of Tigard Building Department: Permit MST2004-00190 must be completed and approved, including all outstanding corrections, ancillary permits and fees. Specifically, the corrections listed on the inspection report dated 2/1/05. It is understood that the City will withhold action until March 3, 2005. Upon compliance with all above conditions, this case will be closed and the Certificate of Occupancy will become permanent. I further understand that if these conditions are not complied with fully, I may be served with a a Summons and Complaint without further notice for violation of requirements rc set forth in the Oregon One and Two Family Dwelling Specialty Code (Final approval required prior to occupancy). m' Signed: Date (Responsible Party) Signed: ` ' Date Z "d S (Inspection Supervisor) 07/29/2004 13:30 5036425815 ROSS ELECTRIC INC PAGE 02. . CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ROSS ELECTRIC INC 2870 SW 221 ST AVE #20:1 HILLSBORO, OR 97123 Electrical Signature Form Permit#: MST2004-00190 Date Issued: M812004 Parcel: 1 S 1350 D-13400 Site Address: 09730 SW NACIRA LN Subdivision: GREENBURG PINES Block: Lot: 005 Jurisdiction: TIG Zoning: R-4.5 Remarks: New SF detached 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 We appropriate Individual from your company sign below and return this Electrical Signature Form prior to i,4e start of the work to the address above, ATTN: Luilding Division. No electrical inspections will be authorized until this completed forma Is received OWNER: ELECTRICAL CONTRACTOR: VISTA NORTHWEST INC ROSS ELECTRIC INC PO BOX 91459 2870 SW 221ST AVE #203 PORTLAND, OR 97291 HILLSBORO, OR 97123 Phone #: 503-531-0505 Phone#: 503-642-2800 Req #: LIC 157991 ELE 34-436C a. SUP 423IS OC F AN INK SIGNATURE IS REQUIRED ON THIS FORM x �C _ J Signature of.Supervising Electrician If you have any questions, please call 503.719.2433. kAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ► A ► l o Poo. ► IP- A ► 4 .o ► i ► A ~ ° ► .4 ., 1 �■■� 0 0 ► 0 ► ' `+- Q p u :� ► � o � t ` ev q I—+f ► 0' L v, ► Poo. t' t0 pop q ► cu 1 P oc w A P LU Poo. vi Q ► ► 44w ► � d a as � ► CITY OF TIGAR.D -- MASTER PERMIT PERMIT M MSl•2004.00190 DEVELOPMENT SERVICES DATE la-SUED: 1/2.8/2004 13125 SW Hal: Blvd.,Tigard,OR 97223 (503)639-4171 SITE ADDRESS: 09730 SW NACIRA L.N PARCEL: 1S135CU-13400 SUBDIVISION: GREENBURG PINES ZONING: R-4.5 BLOCK: LOT: 005 JURISDICTION: TIO REMARKS: New SF detached BUILDING REISSUE: MAS2107 STORIES: 7 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NF W HEIGHT: 23 FIRST: 1,435 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF VLOOR LOAD: 40 SECOND: 955 of GARAGE: 440 at FRONT: 20 PARKING SFACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THPD: d RIGHT: 5 OCCUPANCY GRP: R3 BDRM: 4 BATH 3 TOTAL: 2,390 at VALUE: 233.1 HH.00 REAR: 15 _ PLUMBING SINKS: I WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 3 GARBAGE DISP: I WATER HEATERS: i WATER LINES: 100 BCKFI.W PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIL•CMP<3HP: T VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN` 100K: i UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: Mai FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS M13CELLANEOUS ADO'L INSPECTIONS 1000 SF OR LESS: 1 0 200emp: 0 - 200amp: WISVC OR FOR: Pumr.IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 4 201 400 amp: 201 400 amp. Int wO svdFDR: S;GNIOUT LIN I.T: PER HOUR: LIMTED ENERGY: 401 - $00 amp: 401 -400 amp: EA ADDL OR CIR: SIGNAUPANEI.: IN PLANT: MANU HWSVC/FDR: 001 - 1000 amp: e01+ampa-1000x. MINOR I ABEL- 1000.amolvolt PLAN REVIEW RECTION Reconnect only: -- — --'"—' `•- -4 RES UNITS: SVCIFDR>-225 A.: >8011 V NOMINAL: CLS AREA/SPc OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO A STEREO: VACUUM SYSTEM: AUDIO A STEREO: FIRE ALARM: INTERCOMIPAGING: OUTCOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSC.APEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: IN!TRUMENTATION: MEDICAL: OTHR: HVAC: LATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,596.99 This permit is subject to the regulations contained in the VISTA NORTHWEST INC V13TA NORTHWEST INC Tigard Municipal.,ode,State of OR Specialty Codes PO BOX 91459 PO BOX 91459 and all other applicable laws All work will be dorsa in PORTLAND, OR 97291 PORTLAND„OR 97291 accordance with approved plans. This permit will expire If work is not started within 180 days of issuance,or If the L work Is suspended for more than 180 days. 2 Phone: 503-531-0505 Phone: 503-531-0505 ATTENTION Oregon law requires you to follow rules adapted by the Oregon Utility Notification Center. Those n Rep 0! LTC 75507 rules are sat forth in OAP.952-001-0010 through 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by calling(503)248-1987. REQUIRED INSPECTIONS Ersn Cntri 681-4444 Post/Ream Mechanica Plumb Top Out Exterior Sheathing Inst Fain drain Insp Electrical Final LI Sewer I-ispection Underfloor Insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line Inap Wates I Ine Insp Plumb Final Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water SerAce Insp Hulid;ng Final Po sUB ural Mechanical Insp Shear Wall Insp Insulation Insp Appr/SdvAk Ins Iss ed By : Permittee Signature Call (503) 6394175 by 7:00 p.m.for an Inspection needed the next business day CITYITY ®F T I G A R D SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2004-00189 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 7/28i2004 SITE ADDRESS; 09730 SW NACIRA LN PPRCEL: 1S135CD-13400 SUBDIVISION: GREENBURG PINTS ZONING: R-4.5 BLOCK: LOT: 005 JURISDICTION: T16 TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO.OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF. Owner: VISTA NORTHWEST INC Description FEES ES Amount PO BOX 91459 _ PORTLAND, OR 97291 (SWINSP]Sewer Inspeci 7/28/2004 _ $35.00 (SWINSP]Sewer Inspect 7/28/2004 $0.00 Phone: 503-531-0505 1SWl1SAISwrConnecti4 7/28/2004 $2,500.00 (SWUSAJ Swr Connecti( 7/28/2004 $0.00 Contractor: -- -- ------ Total $2,535.00 Phone: Reg#: Required Inspections a oc N J_ m This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 Wdays 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 3 feet in all directions from the distance given. If riot 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 U '' Noti5cation Center. Those rules are set forth in OAR 982-001-0010 through OAR 952-001-0100. You may oin cope of these rules or direct questions to OUNC by cel inq(503) 246-0699. Issue (r ; — Permittee Signature: Call(503) 639-4175 by 7:00 P.M.for an inspection needed the next business day Builditne 1 ermi ReceivedBuilding �L..v Date/By: _ Permit N_o.: L_LrU rPlanning A oval Other :.ity d Tigard Date/ y: Permit No.:AOYA�' /S 13125 SW Hall Blvd. JUN 2 2004 Plan Review Other Tigard,Oregon 97223 Date/By: Y Permit No.: _ Phone: 50.3-639-4171 Fax: f 79�rl;-ARD Post-Review Land use OIVIs Date/By: Case No. � Internet: www.ci.tigard.or.us dU1LDING Contact 1 See Page 2 for 24-hour Inspe':tion Request: 503-639-4175 Name/Mcehod: supplemental Information _ TYPE OF WORK —_ REQUIRED DATA: — 'Aw construction __ Demolition__ 1&2 FAMILY DWELLING LJ Addition/alteration/re lacement CATEGORY OF CONSTRUCTION _ Note Permit fees*arc baud on the total value of the work Performed. Indicate 1 &2-Family dwellingCommercial/industrial the value(rounded to the nearest dollar)of all equipment,materials,labor. Ll ---- - overhead and profit for the work indicated nn this application. Accessory Buildit�_ - Multi-Family � Master Builder F1 Other: Valuation..................... .......................... JOB SITL INFORMATION and LOCATION No.of bedrooms: No.of baths --- — —' Total number of floors......................... Job site address: �J ----------- ���- � New dwelling area(sq.R.)................ Suite#: -- --- - Bld /A t.#: �_ _ Garage/carport area(sq. ft.)....................!f,�..� Project Name: —_ Covered porch area(sq. ft.)...................../..0.9 Cross street/Directions to job site: Deck area(sq. ft.)...................................Ow. Other structure area(sq.ft.)............................ REQUIRED t)ATAt COMMEPCIAL-USE CHECKLIST , Subdivision: o_t_ Tax map/parce #: Note: Permit fees•are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor, '- overhead and profit for the work indicated on thi r application. Valuation......................................................... S - -- ——� Existing building area(sq.ft.)......................... _-- _-- New building area(sq.ft.)............................... _ Number of stories............................................ ROPERTY�'WNIM ._ Il TEN.►C�'T n' s Type of construction....................................... _ Name: � ���r�r� ��; �,� Occupancy group(s): Existing: -�� New: Address: City/State/Zip: / Phone: -- Fax 5'- NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under APPLICANT rnNTArT-PERSON CONTACT—PERSONprovisions of ORS 701 and may be required to he licensed in the Business Name;s�7jT jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: a Address: ---- Cit /State/Zip: Phone: Fax: � ---�--'-- — — BUILDING PERMIT FEES- E-mail: CONTRACTOR -Please refer to fee schedule e � �r W Business Name: 5� Fees due upon application.............................. W Address: _ -i City/State/Zip: Amount received............................................. $_-- I Phone Fax. Date received:_ ---� - CCB Lic.± AuthorizedOF Notice: This permit application expires If a permit Is not obtained within Signature: _ Date: 180 davit after It hat been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. (Please print name) is\Dsts\Permit Forms\BldgPermitApp.doc 01103 One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: ^irvnlTigard gardCity oTigard Ti gd U Electrical U Plumbing U Mechanical Address: 13125 SW Hail Blvd,Tigard,OR 97223 UOther: _ Phone: (503) 639-4171 Fax: (503) 598-1960 I Land use action.completed.See jurisdir ion criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. _ 3 Verification of appro ed plot/lot. _ 4 Fire district approval required. / 5 Septic system permit( authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. _ 8 Soils report. Must carry o 'ginal applicable stamp and signature on file or with application. 9 Erosion control U planrmit required. Include drainage-way protection,silt fence design and location of catch-hasin protection,etc. 10 3 Complete set's of legibl lana.Must he drawn to scale,showing conformance to applicable lot and state building codes. Lateral design tails and connections must be incorporated into the plans or on a s crate full-size sheet attached to the plans with c ss references between plan location and details.Plan review c not be completed / if copyright violations exist. I 1 Sitelplot plan dawn to scale.The pl, must show lot and building setback dimension/liations; omer elevations(if there is more Ulan a 4-fl.elevation diflc qal,plan must snow contour lines at 2-ft.inttion of easements and driveway;footprint of structure(includin ecks);location of wells/septic systems;utildirection indicator;lot area;building coverage area;percentage of verage;impervious area;existing structund surface drainage. _ 12 Foundation plan.Show dimensionF.ancho Its,any hold-downs and feinfore' g pads,connection details,vent size and location. _ 13 Floor plans.Show all dimensions,room identi ation,window size,lot on of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balco 'es and decks 10 in es above grade,ctc. 14 Cross sections)and details.Show all framitig-memhqr sizes and s ing such as floor Ix.2ms,headers,joists,sub-floor, wall construction,roof construction.More than one cro, Re�-'inn ay he required to clearly portray construction.Show details of all wall apd roof sheathing,mofing,roof slope,(,-,t _ -ht,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construct ;mi 'mum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if change in adc is greater than four foot at building envelope. Full-size sheet addendums showing foundation vatiors with cr:..k references are acceptable. _ 16 Wall bracing(prescriptive path)and/or laitfal analysis plans.Mu, indicate details and locations;for / non-prescriptive path analysis provide spvlf ications and calculations to inecring standards. 17 Floor/roof framing.Provide plans fo I fl(xhrs/roof assemblies,indi,ating ember sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls. vide cross sections and details showing placer" of rebar. For engineered systems,see item 22,"Engine 's calculations." 19 Beam calculations.Provitwo sets of calculations using current code design values for al Ams mpltrple joists IL over 10 feet long and/or ifny beam/joist carrying a non-uniform load. fl. 20 Manufactured floor/roof truss design details. / 1— U) 21 Energy Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or —t architect licensed in Oregon and shall be shown to be applicable tv the project under review. _m W 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x I I"or 1 I"x 17". J •- 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. _ 28 Site plan to include tree sim,type&location per apprcved project street tree plan(if applicable),and COT Street Tree List. Checklist must be completed before plan review strut date. Minor changes or notes on submitted plans may be in blur or black ink. Red ink is reserved for department use only. 440-4614(doaroM) Electrical rmi r er]-�Ias}� n Received - -- -- ei Datc/I3 : PermitNo.:No.: O J Planning Approval Sign City of Tigard JUN 2 4 2004 Date/By: _ Permit No.: 13125 SW hall Blvd. Plan Review Other Tigard,Oregon 97223 /\RDDate/B : Permit No.: _ Phone. 503-639-4171 Fa>09A-i196Q Post-Ra icw Land Uae Date/B : Case No.: Internet: www.ci.tigard.or.us Contact Juris.: See Page 2 for 24-hour inspection Request: 503-639-417:. Name/Method: — Supplemental Information. TYPE OF WORK PLAN REViEW(PIe1i thiX. ,i+ll tbit 101—gew construction Demolition Service over 225 amps- Health-care facility commercial ❑Hazardous location Addition/altcration/replacement Other: -_ ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in & Ydwellin Commercial/Industrial ❑System over 600 volts nominal one structure 2-Fa_mfl -----"g- l - ❑Building over three stories []Feeder::,400 amps or more Aceess0 Builders Multi-Family f]Occupant load over 99 persons [J Manufactured structures or RV park Master Builder Other: O F.gress/lighting plan E]Other:_ Submit_ sets of plans with any of the above. JOB.WE INFORMATION and LOCATION - The she a are not applicable to tem orar c� onslructlon service. Job site address: - _ _ t'saml �'.,; .__ Suite#: Bld ./A t,#; _ _^ Number of Ins .,ctlons per permit allowed PCOject Name: _ Description _ Qty Fee(ca.) Total New residential-stngk or multi-family per Cross street/Direetions to job site: dwelling unit.Includes attached garage. Service Inchrded: 1000 sq.0.or Ices _ 1 145.15 4 Each additional 500 sq.R.or portion thereof 33.40 1 j Limited energy,residential 75.00 2 Subdivision' t "Ot#: _ Limited ever non residential _ - 75.00 — 2 Tax ma / 81 cel#: Fach manufactured home or modular dwelling Iy CR(PTIpN U$WORD -- service and/or feeder 90.90 2 -` Servkes or feeders-Installation, alteration or relocation: 200 am or less 80.30 2 _ — 201 amps to 4lq amps 106.85 2 401 amps to 600 amps ---_ 160.60 2 e TE 601 am to 1000 am 240.60 2 Over 1000 amps or volts _ 454.65 2 Name: _ Reconnect one 66.85 2 Address: T^mporery services nr feeders-Installation, alteration,or relocation: City/State/Zi j 200 amps or Less 66.95 I 201 em to 400 amps100.30 2 Phone z`i G Fax' 401 to 6(10 am s� -- 133.75 2 +APPLI T ____j U P9NTACT1'9MXBranch circuits-new,alteration,or Name: _ extension per panel: -- -"- A.Fee for branch circuits with purchase of AddCeSS: service or feeder Bach bench circuit 6.65 2 City/State/Zip: J B.Fee for branch circuits without purchase of - service or feeder fee,first branch circuit _ 46.85 2 Phone; FaX: _____ Each additional branch circuit 6.65 2 E-mail: Misc.(Service nr fader not included) CONS ' �c Pip or irrigation circle- 53.40 2 a - Foch sir or outline lighting 53.40 2_ Job No: Signal circuit(sl nr a limited energy panel, — alterrtion,or extension P 2 2 w Business ami: 21 / Description: Address: ,ee --- Each additional Inspection over the allowable In au of the above: —f Cit /State/Zi : —A&A! �'� Per inspection P�'r lar min.I lour) — 62.50 m 7 Fax: Investi tion fee: Phone;, (hher: iu CCB Ac.#: Lic. J Supe,vising electrician 1� Sut><ota1462*S _ si ature re uired: Plan Review(25%of Permit tee S Print Nam _ Lic.#: State Surchar a 8%of Permit Fee S _ TOTAL PERMIT_F_E_E S Authorized / Notice: This permit application expires If a permit Is net obt ilned within Sigasture: __ Dat 190 days after M has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. (Please print name) is\Dsts\Permit FormsME PermitApp.doc 01/03 Electrical Permit Application -City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for All systems....................... .................................... S75.00 Check Type of Work Involved: Audio d Stereo Systems* Burglar !arm Garage r Opener E] Heating,Ven dation and.Air Conditioning System* L_.I Vacuum Syste DOther—� ----.— i COMMERCIAL WOR \OLY: Feeforl0d system....................... ................................. 75.00 (SEE OAR 918-260.260) Check Type of Work Involved: ElAudio and Stereo Systems nBoiler Controls Clock S/inst�rurncnon stems F-1mmunication Ins ation Installation ond Paging SystemaEl rrigation Control* \ F1 Nurse Calls C6 El Outdoor Landscape Lighting* to [--j Protective Signaling El Other -- `___—___Number of Systems –j * No licenses are required. Licenses are required for all other Installations i:\Dsts\PerTnitForffs\ElcPerTnitAppPg2.doc 01/03 Mechanlcal Permit AQalication lsta/By: eceived Mechanics ��� Permit No.: K#�_-- Ci}�,of Tigard Planning Approval Building `, g Da Permit No.: 13125 SW Hall Blvd. RECEIVED Plan Review Other Tigard,Oregon 97223 ►L2ce/By: Permit No.: Phone: 503-639-4171 Fax: 9g 9 Post-Review I-And Ilse Dete/By: Case No.: Internet: www.J.tigard.or.us Con scl Juris TZ see Page 2 for 24-hour inspection Request: 503-639-4175 NartrlMethod implemental information. CITY of TIGARD BUILDING DIVISION f- TV PF.ow wow. WTOM ER 0AL FEE«6CHEDULE-,USR!C!lEGKI]3T. i. _cw construction_ Demolition Mechanical permit fees*are based on the total value of the work f Addition/alteration/i lacement Othei: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF O i;. mechanical materials,equipment,labor,overhead and profit. 1 & 2-Family dwelling Commercial/Industrial `/aloe: sY See Page 2 for Fee Schedule Accessory BuildingMulti-Family Master Builder Other: Description F ea. Tool Heatln Ce_Un JU1i FORMAT 1'I and' ' VO Furnace-Md-on air conditionin •• 14.0O /G Job site address: > 1,6/ Gas heat pump ^ 14.00 Suite#: _ Bld ./Apt.#: Duct work 14.00 Project Name: H tunic hot waters em 14.00_ Residential boiler Cross street/Directions to job site: for radiator or hydronic system 1_4.00 Unit heaters(fuel,not electric) in wall in-duct suspended,etc. 14.0_0 Flue/vent for any of above 10.00 — Subdivisio Repair units 12.15y Other Fuel A Uaaees "fax ma / arcel#: water heater_ 1 10.00 R1 ;011 Gas fireplace f 10.00 u Flue vent(water heater/gas fireplaces_ 10.00 L, ;lighter(gas) _ 10.00 _ Wood/Pellet stove10.00 _ Wood fireplace/insert L 10.00 Chinmey/liner/fluevent _ 10.00 JEWERr: _t"r 'Other: 10.00 __ dMfiddnteotal ERM & N �' �' � ��— Range hootUother kitchen equipment 10.00 / d _Address: _ _ �— Clothes dryer exhaust 10.00 City/State/Z�f - Single duct exhaust Phone: z c Fax: (bathrooms,toilet compartments, _ s utility room•) 4 6.80 Name: Y Attic/crawl space fans _ 10.00 Address: Other: 10.00 City/State/Zip: �• ""(ss.40 for first $1.00 each additional p. Furnace,etc. — / '• Phone: Fax: Gas heat pump_4� N E-mail: Wall/suspended/unit heater •• k1 Water heater I •• Business Name: M/ J Fire lace __ •• Address: .Z ICS r� BBQRange «« City/State/Zip: Clothes dr aa `--- — W Phone: Fax: Other: _ •• CCB Lic. #: r"" —Tow: Authorized // % mot Signature: Datea�� _ _ Su_btornl:_ S f h. Minitnum Permit Fee 87250 S Plan Review Fee(25%of Petmit Fee $ (Please print name) State Surcharge 8%of PaMitee S _ TOTAL PERMIT FEE S Notice: This perndt application expires if a permlf Is not obtained within "Fee metbodelaA set by Tri-CeAatr Building Industry 9"ce Beard. 1110 days after It has been accepted as complete. "•Slte piast rsildi s for exterNr A/C ralts. i:\Dsts\Permit Fomu\MecPernitApp.doc 01/03 Mechanical Permit Application -City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: It Penaft In: $1.0010$3,000.00 Minimum fee$72.50 _ $5,001.00 to$10,000.00 ` I $72.50 for the first$5,000.00 and SIV for each additional$100.00 o-fraction !hereof,to and including$10,000.00. 510,001.00 to S25, 00 $148.50 for the first 510,000.170 and $1.54 for each additional$100.00 or fraction thereof,tc,and including $25,000.00. _ $25,001.00 to$50, 00 $379.50 for the first$25,000.00 and $1.45 for each additional S100.00 or fraction thereof,to and including $50 000.00. 550,001.00 and up $742.00 for the first$50,000.00 and $1.20 for each additional 5100.00 or fraction thereof. Asrumld Valuations r Appll nce: _ Value Ttat Description: t Eai unt Furnace to 100,000 BTU,includi 955 ducts&vents Furnace>100,000 BTU including is 1,170 &vents Floor furnace including vent 955 Suspended heater,wall heater or Floor 95 mounted heater Vent nit included in appliance permit 5 RcPsh units 1805 <3 hp;absorb.unit, 955 to 100k BTU 3-15 hp;abrorb.unit, 1,700 101k to 500k BTU 15-30 hp;absorb.unit,501k to I mil. 10 BTU _ 30-50 hp;absorb.unit, 3,4 1-1.75 mil.BTU >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handling unit to 10,000 cfm _ 656 Air handling unit'10,000 cfm 1170 Non-portable evaporate coolW 656 _ Vent fen connected to a single duct _ 446 Vent system not included appliance 656 permit Hood served by mec ical exhaust 656 J _ Domestic inciners 1,170 Commercial or trial incinerator 4,590 _ 4. Other unit,including wood stoves, 656 a inserts,etc. Gas tin 1-4 outlets 3F0 N Each additional outlet _ 63 TOTAL COMMERCIAL S VALUATION:_ t7 W J i:\Dsts\Perrmt Fo rrm\MecPemAtAppPg2.doc 01/03 uu>< aing r fixtures cc}} Pum in Perm* oio lion Received Plumbing WteJBy: _ Permit No.: 1Q�� Planning Approval Sewer City of Tigaird \\\N Da" : Permit No.: 13125 SW Hall Blvd. V Plan Review Other F Da :Tigard,Oregon 97223 Permit No .: Phone: 503-6394171 Fax: 50306� f0k)\`J Pori-Review lind Use O9) Daro/B : _ Case No.: Internet: www.ci.tigard.or.us OP- Contact Juris.: I& See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information. 'TWF��-- -- H0e, New construction Demolition Descrl tlon Pa(aa. Total Addition/alteration/re lacement Other: 1 &2-Famil dwellin Commercial/Industrial SFR I)bath _ 249.20 SFR(2)beth 350.00 Accesso Buildin Multi-Famil j�' .�' SFR 3 bath L 399.00 Master Builder Other: Each additional bath/kitchen 45.00 B F T Fire sminkler-sQ.ft.: Pae 2 Job site address: "l —CAm-e Suite#: Bld ./A :.#: Catch baain/tlfea drain 16.60 Project Name: II/leach line/trench drain 16.60 -- Footing drain no.linear ft. P e 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes i 16.60 Rain drain connector _ 16.60 Sanit sewer no.linear ft. Pae 2 SubdivisiOT14 /F.$ Lot#: Storm sewer no.linear ft. _ Page 2 Tax map/parcel #: Water �� no.linearft Page 2 D ON !i : 0 i `, A on valve 16.60 Backflow venter Pale 2 Backwater valve 16.60 _ Clothes washer 16.60 -- - Dishwasher 1660 Drinking fountain 16.60 p Ejectors/sump 16.60 Name: J Expansion tank 16.60 Address / Fixture/sewer ca 16.60 City/State/Zip: r �7 Floor drain/floor sink/hub 16.0 Garbage di sal 16.60 Phone: / -r�� Fax: Hose bib 16.60 ",: Ice maker -- - 16.60 Name: Interceptor/grease trap i5.60 Address: Medical gas-value: $ P e 2 Primer :x.60 Cit /State/Zi P: — Roof drain commercial 16.60 IL Phone: _ Fax: Sink/basin/lavatory 16.60 _H Tub/shower/shower pan 16.60 E-mail N CONTRACT Urinal 16.60 Business Name: 5:) �/(1 Water closet _ _ 16.60 heater ater 16.60 Address: iZf�� Ead �� Other:— fn � OtheCity/State/Zip: r. rt5 /– J CCB Lic. #: P mb. Lic.#' j r.-,T Minimum Permit Fee S72- S Authorized Residential Backflow Minimum Fee S36.25 Signature: �-j �L mate: Plan Review(25%of Permit Fee) S State Surcharge 8%of Permit Fee S (Please print name) TOTAL PERMIT FEE I S Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or 180 days after It has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri-County Building Industry Service Board. is\Dsts\Permit Forms\PlmPermitApp.doc 01103 Plumbing Permit Application -City of Tigard Page 2-Supplemental Information Fee Schedule: Residential Fire SuppresMon Systems: Footing drain-10 100' 55.00 0 W 2PW $115.00 -- Footing drain-each additional 10046.40 2,001 to 3,6(1) $160.00 _ Sewer- Is(100' 3,601 to 7,200 _ — $220.00 55'00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-I st 100' 55.00 Medical Gas Systems Water Service-each additional 100' 46.40 Valuatlool Permit Fee; Storm&Rain[rain- I st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.5 or the first$5,000.00 and$1.52 for each k� Or. t s 1 t.; addi nal$100.00or fmclion thereof,to and Commercial Back Flow Prevention/Device 46A0 inc din $10.000 00, $10,001.00 to$15,000.00 S)48.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device jilich additional$100.00 or fraction thereof,W (minimum permit fee$36.25) 27.55 and including$25,000.00. __ Fain Drain,single family dwelling 65.7.5 525,001-00 to 550,(100.00 $379.50 for the first 525,000.00 and SI.45 for Inspection of existing plumbing or each additional 5100.00 or fraction thereof,to specially requested inspections- r hour 77 50 _ and includ;ng 550,000.00. Subtotal: 550.001.00 and up $742.00 for the first$50,000.00 and$1.20 for —— __ each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures? "yes",please indicate work performed by fixture. Failure accurate) report fixtures could result In Increased sewer fe Comments regarding fixture work: Baptistry/Font Bath -Tub/Shower _ -Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thtru — Cua idor/Water Aspirator Dishwasher -Commercial -Domestic Drinking Fountain Eye Wash _ Floor Drain/sink -2" - -3" -4" Car -- Car VI'ash Drain _ Garbage -Domestic *Note: If the fixture w k under this permit results in an d Disposal -Commercial Increase of sewer EDUs,a wer permit will be issued and OC -industrial — fees assessed for the sewer in ease must be paid before the NIce Mach./Refrig.Drains plumbing permit can be issued. Oil Separator dos Station Rec.Vehicle Durnp Station Shower -Gang m -Stall Sink -Bar/Lavatory W -Bradley —t -Comm tial -Service _ Swimming Pool Filter _ Washer-Clothes _ Water Extractor _ Water Closet-Toilet_ _ Urinal Other Fixtures: iADsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TiGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE SELBY PLUMBING INC. 2373 NW 185TH i HILLSBORO, OR 97124 Plumbing Signature Form Permit #: MST2004-00190 Date Issued: 7/28/2004 Parcel: 1 S135CD-13400 Site Address: 09730 SW NACIRA LN Subdivision: GREENBURG PINES Block: Lot: 005 Jurisdiction: TIG Zoning: R4.5 Remarks: New SF detached 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 the work to the address above, ATTN: Building Division. No plumbing Inspections will be authod7ed until this completed form Is received OWNER: PLUMBING CONTRACTOR: VISTA NORTHWEST INC SELBY PLUMBING INC. PO EOX 91459 2373 NW 185TH PORTLAND, OR 97291 HILLSBORO, OR 97124 Phone #: 503-531-0505 Phone #: 503-730-3437 Reg #: LIC 150252 IL PLM 34-397PB ac f- �' AN INK SIGNATURE IS REQUIRED ON THIS FORM X _ Signature of Authori ed Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT* PLM2003-00018 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 417/03 SITE ADDRESS: 09730 3V`J NACIRA LN PARCEL: 1 S135CD-GP005 SUBDIVISION: GREENBURG PINES ZONING: R-4.5 BLOCK: LOT: 005 JURISDICTION: TIG CLASS OF WORK: (JEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 1,050 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Water service. FEES Owner: Description Date Amount VISTA NORTHWEST INC [PLUMB] Permit Fee 1/21/03 $333.40 PO BOX 91459 Plan Review 1/21/03 $83.35 PORTLANDD,, OR 97291 [PLMPLN]O [TAX]8%State Tax 1/21/03 $26.68 (PLUMB] Addl Permit 4/7/03 $185.60 Phone : 503-531-0505 (PLMPLN] Addl Pln Rv 4/7/03 $46.40 Contractor: ["TAX]81/6 State Tax 4/7/03 $14.84 SELBY PLUMBING INC. Total $690.27 20565 SW TV HWY#373 ALOHA, OR 97006 REQUIRED INSPECTIONS Phone : 503-730-3437 Final Inspection Reg#: LIC 150252 PL"1 34-397PB A. ?N J This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. m Specialty Codes and all other applicable laws. All work will be done in accordance with approved Wplans. This 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 Isued By: Permittee Signature: all (503) 394175 by 7:00 P.M.for an Inspection needed the next bull ess day wr - • Plumbing PedW W11ruffin Datereceived: / Z! O '.r Permit no.;,�L,M�, Q Q City of Tigard J AIN ti t`� � 1 2003 Sewer permit no.: Building permit no.: ^� Address: 13125 SW Hall Blvd,Tigatd,OR 97223 — City ojTigard phone: (503)639 4171 CITY OF TIGAR PmjecUappl.no.: F.xpiredate: Fax: (503)598-1960 BUILDING I Date issued: By:4WIReceipt no.: _ Land use approval: case file no.:R P d y1 Payment type: IS 0 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U'fenant improvement Q U New construction U Addition/alteration/replacement U Food service U Other: Job addressse lie Deacrl lion Qt . Fce ea. Total `� Bldg.no.: 2� A14e /� Suite no.: lol f 5 6 7 fi t! New I-and 2-family dw Ifintga only: (Includes 100 fl.foreach utility catrtedbe) O Tax map/tax lot/account no.: e-�-- r SFR(1)bath ('J LoIS' -- VBlock: Subdivision 1 SFR (2)bath -- Project name:, ,,y�: ;!5v , �� f� _ SFR(3)bath — —- City/county: ZAP: Each additional bath/kitche 1 Description and location of work on premises:�.c��y�' r s" SNeartllltles: _IG',4yLU L/rVE S Catch basin/area drain Est.date of completion/inspection: Drywc5.0cach line/trench drain Fooling drain(no.lin.R.) Manufactured home utilities Business name: �' :J iM�j� � Manholes Address: G� J T Rain drain connector. _— �� Statjrjo� ZIP:`". Sanitarsewer(tio.lin.ft.) - Y Phone: - Fax: E-mail: Storm sewer(no.lin. ft.) _ (� CCB no.: Plumb.bus.reg.no:���_yG� atdr service(no.lin.ft.) Fixture or Item: v City/metro lie.no.: _ 1 Absorption_yalvr' (•j� \ Contractor's representative signature: Back -flow ter h� Print name. c- Date: r r,1 BackVit r valft Basin. _ Name: J � _ � ' Clothes -^ _ Dishwasher -- _ Address: Urinkin fountain(s) 't') City: State: ZIP: Ejectors/sum —A2— E-mail: Ex ansion tank FixtureIsewer cam___ Name(print): Via..- rl r- /� Floor drains/floor sinks/hub Garbage disposal Mailing address: ' -_,� [ - --� Hose hjbb — _ City: %�+>��'` Stair yt ZIP: j� '-c maker a Phon . - - •` Fax: __ I:mail: lntt: cepttod rease trap Owner installation/residential maintenance only: The actual installation Prim�qs) Nwill be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink,s),basin(s),lays(s) — J Owners si ature: Date: Sum, Tub,/shower/shower pan — Uri'lal Name: _ Water c oset -1 Address: _ Water heater City: State: ZIPa— — Other• - -- Phone: Fax: Email: otal '� D i r,dictlom oxept credit cod i,,^nae call Wa&iion for mare idbromlooi. Minimum fee................$ Not all j Notice:This permit application ��review(at � 96) $ 1_�• l_l Visa O MasterCard expires if a permit is not obtained credit rud onmber: — within 180 days after it has been State surcharge(8%)....$ ' ---- Name of earcarolder u.horvn an credit card es ,— accepted as otemplete. TOTAL .......................$ S _ Ar ollot W4616(190a,C(NN1 PLUMBING PERMIT FEES: PRICE TOTAL Nvw 1 and 2-hmity dtlwlllr►ga only: r FIXTURES individual QTY ea AMOUNT (,ncludes all plumbing fixtures In PRICE TOTAL ink 16.60 the dwelling and the first 100 QTY (IN) AMOUNT L tory 1660 for each utility connection _ One(1)bath __ $249.20_ Tub Tub/Shower Comb. 16.60 Two(2)bath $350.00 Showe ly i 16.60 Three 3 be) th _ $399.00 _ Wale r Clo 16.60 - gUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIE 5%OF SUBTOTAL Garbage Disposal 16.60 TOTAL _ Laundry Tray 16.60 Washing Machine 16.60 Floor DrainlFloor Sink 18.60 3" 16.60 KSink- COMPLETE: 4" 16.60 _ Water Heater O conversion O lik id 16,.60 Quanta Wark Perk4m*d Gas piping requires a separate mechani New Moved Replaced Removedf permit. _ Ca ed MFG Home New Water Service 46.40 MFG Home New SanlStorm Sewer 71 46.40 Tub or Tub/Shower Hose Bibs 16.60 Combination _ Roof Drains 16.60 Shower Only _ Drinking Fountain 1 .60 Water Closet Other Fixtures(Spec0y) 1 0 Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine _ Floor Drain/Sink: 2" Sewer-1st 100' 55.00 3" Sewer-each additional 100' 46.40 4" Water Service•1st 100' 55.00 S.S" Water Heater Water Service-each addltionaL. ' 1 �(1 46.40 !l y OtherFixtures �_w - Slorrn 6 Rain Drain 1st 100' 55.00 Storm&Rain Drain-each additional 10 46.40 _ Commercial Back Flow Prevention D Ice 46.40 Residential Baddlow Prevention 27.55 '- Catch Basin 16.60 inspection of Existing Plumb g or Specially 6250 Requested Ins ections per/hr COMMENTS REf3A IMG ABOVE: Rain Drain,single famlly welling 65.25 Grease Traps 16.60 _- - Q. / QUANTITY TOTAL IsomoN or riser diagram is required if (� ouprifilly Total is >9 'SUBTOTAL 8•/.STATE SURCHARGE J _ _ m "PLAN REVIEW 25%OF SUBTOTAL Required only If fixture qty.total Is>9 1 1 W "Minimum permit to*Is$7210•6%state sumhaMe,except Residential Backflow Prew,ntinn Dev",which Is$36.25 a sx state surcharge ""All New Commerclal Buildings requlre 2 seh of plans wtth IsonWrle or riser / diagram for plan revlew. 1:1dAslforms\plm-fees.doc 12/26/01 L.D T ��ai�c'-.�.�J/3tJP13 l�i.�IFS ll�p�►I y RECEIVEQ 9730 .SZY-J nlfGRft Z-Al JUN 2 4 2004 t gyo9 se •. CITY OF TIaARD E BUILDING DIVISION t 4' RECEIVED c< R'� � ��� • JAN 19 2005 -_ ITY OF TIGAAD ^� j e�-OVUILDING DIVISION s�i� FbR ���i1a�SFT Nl y0 r 1 . � OW oma) 1 1 � , ;� IL m J 6f90. r CITY OF PETI 3A1 _SITE PLAN REVIEW BUILDING NO ; PLANNINt; DIVISION: Required Seth,1cks• R q•s Side Arpp,ovecl [] Not A pploved Visual Maxintu+n EtAncr.JNJ,/r , fit,jr.7pu.er'o%`ed.... _.. - $ _ uildin, LNut .1Pprov''dkctrL «L fret:W"S Service Provider etter fickpaired: B YIN O � Krcci�-c ENGINEEkI ; UEP d.)ete: _ 9' 0.s Actual Slope: ,/ AR['MU 1. Site Plan. ❑ Approved 13 Not A BIJ Approved Pproved ❑ Not Approved Not+�s: Dote: �?• -e C4 as c4,,Z,,L a a t- y m