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CITY OF -1-IGARD PLUMBING lain 94 Iali Rhki.
PERMIT
ApplicaApplicantsct muss hold Oregon Registration to condua plumbing TiguldCRWM
639-4175business or must be properly owner/operato. not hiring outside help.
Name of Development —
_�j,._. _. _ Plumbing Peril No
Address
.lob L-_.L
—I ,�1— --�t ORS S 921.610 MAN. PRICE AMT.
Tax Lot Map.No.
Address
FIXTURES
I.ol !� Block Subdivision - -
Sink 7.50
Name or n&qm ofbusines_sj - Lavatory - _ 7.50
' — —r 2 - - Tub or Tub/Shower Comb, _ 7.50 -
ess
Shower Only 7 50 -
Owner City/ 1?,ele------a- Tip Water Closet _7.50_
-- --- - -
Dishwasher -- - -- -- 7.50 - --
Phcrie - ----- -
Garbage Disposal - 7.50
- Nnm» Washing Machine _..�_ 7.50
Floor Dram 7.50
Ing re`s----�--- -fix' Water Heater 7.50
ObCu ant --- Laundry Room Tray -- - 7.50 -—
P Clry/Stets Zip — - _
Urinal 7.50
— _ Other Flxlures(Specify) - 7.50
7.50
T'5
Contractor Stats _— ZIP - - _ 7.50
MISCELLANEOUS _
City Bus Tax No Sewer 1 w 100' 3000
State Wd9s. ol�arr7l of -' state Pkmtws Bus LJc No Sewer-ea.Addit.100' t 500
(Re bat) _D --��JJ ? Water Scrubs tat 100 +
�__._�111___='L�.1. - -- -�- 20.E _
I hereby acknowledge#hal I have read fts1 am Water Service at Addis XO' 15.00
glwn is Domed,#Wa��•sisal Mie InkxmaUon - _ -
nagislered with the State Builder's Bos and also Storm 3 Rain Drain 1 at.100' 30.00
have a State Pturntx V comae OW Its numbers given are Domed,that all ----
pk-**v work will be dom in socoManoe with app"*prov*km of Ora- Storm 3 P*Jn Orafn Addis 100' 15.00
gon Revised StntAaa CIW*Wl 447 and 03 and applicable c ori"and that Mobile Home _
m help will be empbyed urAm licensed under ORS 003 (11 exempt hen ce - 25 00
State reglstralk)n,please give reason below). Back Flow Prevention
HOMEOWNERS -I hereby oeryfy aw I rein the owner of the pmperty de- Devoe«Mt%PolkMion Devlos 7.50
sorbed above.N rNslcf+1000on i pwlpoa to make tt pkmbhg M1ltallaMcxr for -
my own use and tlda Arty Trap or Waste Not
ProDe1b k nal bafng oonapucyed t+a sag.ls�aee o►rerN Connected to a Fixture 7.50
CeWh Begin 7.50
W".of Fusel Pkxnbkv — 10.00 P%r Fit
------- --._-� -�� -SPWAally Requested Inap1 10.00 PM H►
Attar of Pkrerbkq wMMn
an Exie"Mg15.00;nAt. A
AUTHORIZED Fvr1NAPjW_ -- _ Daly New Bldg.or BuW.AdAWon t6.00"Mn
Rain [rain,sirxxle fartd.l
Daalxiba work new($ addition(- aftwaitbn❑ r n (Ia`.1.1i 1`)X0
doth rsakferttiel !�or�laelderttlal - - -- - —_
- �__
-
Exk"ues W - ------ - --
hAkft or Property- --- OWTt)TAL
Prqpmed uq*of LL� .,
apaPslty_.-__. ---___ _ MrNI1K�NAiIq! L.
Tho pet, 6�+o0 null end vmld a uonstruaMon authonxed 18 owl aam-
a period of tfal0M ate Nr��+dad or alrandonad br
days M any M»after week Is oornav~
f�dAL OOIfbtTlQ/ti_------_--
---- ons rsued 1 av
. dt►�ts esti t�� e.� �.
BUILDING PERMIT APPLICATION ,�► DATE- -_�.,»____ 6183 ,
THE UNDERSIGNED HEREBY APPLIE=S FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE 684-7543
OR AS-HOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE __
c c-SLOTt`40,,, 7 over w
OWNER u:?'( T-1L_i!t? JOB ADDRESS 10543 S.W.
-• E�.
97-273.3 ARCHITECT
:'SF1TftC p.o.Qnx 23291 Tigard ENGINEER
DESIGNER
BUILDER ADDRESS —,
STRUCTURE MEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Ci RENEWAL CJ FIRE DAMAGE ❑ DEMOLITION
rX RESIDENCE 11 COMM C1 EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE 0 SLAB EJ FENCE
OCCUPANCY _ R-3 LAND USE ZONE BLDG.TYPE _? FIRE ZONE PLAN CHEOIL RY SBR HEA'r
Construct ,-31ng1e family c1we.1 J ing w/attached garacre, all per approved plans.
Subject to 85 code. _
RE-ISStIE of 6391
SEWERPERMITM 34080 z baths, 20 traps gmr.nge area 340
OCC.LOAD F!0_08 LOAD 4C1HEIGHT ? NO.STORIES AREA 1822 NO,BEDROOMS 4 VALUE 78,000
BUILDING DEPARTM:NT SET BACKS FRONT REAR 42' LEFT SIDE RIGHT SIDE 'f
Permit 367 ,,00THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check _ 110.00 I WORK WILL. BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL A?PLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
_T 3 LIC�g[�{,� SEPAA�1�f PEBMITS 14EOUIRED FOR SEWER,PLUMBING AND HEATING.
Total State TaxJ `", U U._
�Q.t)U SDC- 600.00
-- PDCM T T 150^00 A1PI.ICANT OR AGENT
By 385.-15
Receipt No. ..•f•:'y! !
Approvedf A�DiiESS � PHONE
DATE !N$P. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor �r� / �j
Permit No,---
o. _ y -3 --
Rough-in
/6 Fixture _-
Final
HEATING /^
Contractor
Permit No.
Gas or Oil
Rough in �—
3 d ��.. —..e.-- — — Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Strre-f inai
Approach
BLDG. DEPT.FINAL -TEMPORARY r CERTIFICATE'OCCUPANCY 1
CFinal
CERTIFICATE OCCUPANCY` Lends aping
Zoning Final _
i
CITY' OF TIGARD BUILDING DEPARTMENT PLAN CHECK. NO. :
PLAN CHECK APPLICATION DATE RECEIVED:
P.O. Box 23397, Tigard OR 97223 P/C DEPOSIT PAID: )
This is to certify that the attached _ sets of plans have been submitted for plan
check pursuant to the Oregon Structural Code and Fire & Life Safety Code, edition.
PROPERTY OWNERi- 1' . �� (� ,'� OWNER'S ADDRESS: L)
CONTRACTOR: /� FLEPHONE:
JOB ADD Lr ,
ESS: L �V' C� AJC LOT N & MAP:
DESCRIPTION OF WORK: (ST V
Approvals Required SPECIAL NOTES
OPlanning Dept, O Reissue
OEngineering Dept. 0 Flood Plain/Sensitive Lands
O Fire District O Sewer Availability
O Other 0 Other
Items Resuired
aList of subcontractors
Business Tax
�1 Calculations
0 Truss Details
OParking Plan
OLandscape Plan
O Other
COMMENTS:
City of Tigard Building Department
BY:
CITYOFTIFAR® No. 250 .0
13125 S.W. HALL BLVD.
P.O. BOX 23397 Date
TIGARD, OR 97,03
Name
Address -
i
Lot Block/Map $ubdivl iorl/Add 9mal /{
Permit M's Qid�.� Plumb Caah Check
Sewe- Other Other Rep. By;
Acct. No. Description Amount
10.432 _ Building Permit Fees
10.431.600 Plumbing Permit Fees
10.431.601 Mechanical Permit Fees. _
10.230.501 State Bld . Tax
10.433 Plans Check
30.443 Sewer Connection -
30 444 d SPWer Inspection --`
51 446 - Street S at. Dev. Charge — --��
52.449.610 Parka I Syst. Dev. Charge
52.449.620 Parks II Syst, Dev, Charge _�`
31.450 Storm Drainage Syst. Dev. Charge
10-430 _ Business Tax -
10.434 Alarm Permit --__---�
10-227 Bail
10-455• Fines - Traffic/Mlad/Parking —-
0-2 30 CPTH Traffic/Mild/Vic Asst_.
10-458 Indigent Defense -
30.122-,01 Sewer
service/—
30.122-au2 Sewer Sere Fce/City 30°x0
3 •123 Sewer Sevice/City Maint. i
30-T29 Unmatched -
31.124 $tormTrainage -
475antro t Vrin Pymt.
4 •471 antro t int. ymt.
--- TOTAL 1
DEPT. .
�6
PERMIT #
PLAN CHECK It -42-
BUILDING
`?"2-BUILDING RECEIPT
A-
N V4 E: DATE:
ADDRESS & LOT # & SUBDIVISION NAME:
ACCT'. # DESCRIPTION AMOUNT
10-432 Building Permit Fees $
10-431-600 Plumbing Permit Fees $ —
10-431-601 Mechanical Permit Fees $ _
10-230-501 State Building Tax C5%� $ _
10-433 P1_ans Check :"ee '-15�z�
30-44.3 Sewer Connection (20X) $
30-202 Sewer Connection (80%) $
30-444 Sewer Inspection $
51-448 Street System Dev. Charge (SDC)
52-449--610 Parks I System Dev. Charge (PDC)
52-449-620 Parks II System Dev. Charge (PDC) $
31-450 Storm Drainage System Dev. Chrg (SSDC) $ __
1-0-230-505 TRFD (95%) $
10-435 TRFD (5X) $
10-230-506 Washington County Fire X11. (950) $ ,�
10-435 Washington County Fire #1 (5X) $
10-220 Amart/Wedgewood $
TOTAL.
(Separate Check for Leron Heights $150.00) .
(br/1214P)
CITY OF TIGARD MECHANICAL PERMIT Heceipt# -
Permit#._=V 2 yo -_
7escrlption
liable 3A Mechanical Code CITY PRICE AMT
City of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee 0 0 10.00
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 1 Furnace to 100,000 BTU 6.00
incl.ducts&vents
2) Furnace 100,000 BTU + 750
Incl.ducts&vents
Name of Development 3) Floor Furnace 600
incl.vent
Job Address — 4) Suspended heater,wall heater 6.00
' or floor mounted heater
Address S --
Tax Lot Map No. 5) Vent not Incl.in 3.00
Lot s rilock Subdivision appliance permit
Name(or name of business) 6) Repair of heating,refr lg., 6.00
cooling,absorption unit
Mailing Ad ess G Prone 7) Boiler or comp to 3 HP 6.00
Owner dabsorp.unit to 100,000 BTU
��/-iSs�
Cityrstate Zip 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU
NameBoiler or comp 15-30 HP 15.00
9) absorp.unit t/h-1 million _
Mailing Address -J Phone 10) Boiler or comp to 30-50 HP 22.50
absorp.unit 1-1.75 million
Contractor CRY/State Z4p11 Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No. cay sus.Tax No. t 2) Air handling unit to 4.50
10,000 CFM
Air handling unit 7.50
I hereby ecknowtedge that I have read [his application that the:-r^mistinn given is 13 1 0,000 CFM i
correct,that I am the owner or authorized agent of the owner,that pians�.tbrnitted are in
Compliance with State laws,that I am registered with the State BuNdeot Board,that the 14) Non portable 4.50
numbo;given is aired (If exempt from State registration please give reason below) evaporate cooler _
15) Vent fan connected 3.00
to a single duct
--- - — 18 Ventilation system not 4.50
Included in appliance permit
(- - - 17) Hood served by _ 4.50 S a
C{ � mechanical exhaust
lure(owner or ager") Date 18) Domestic type 750
Describe work add tion [I alteration O repair -1 incinerator
to be done esidential non-residential p 19) Commercial or industrial 30.00
Existing us�of type incinerator
building or properly _ �_ 20) Other i.e.,woodstove,water 4.50 '
Proposed use of heater,solar,clothes dryers,etc.
building or property _._ �� --- 21) Oas piping one to four outlets 2.00
Type of fuel- oil f l natural gas LPG ❑ electric C]
— 22) More than 4-per outlet
NOTICE SUB-TOTAL 3 6
THIS PERMIT BECOMES NULL AND VOID IF WORK OR COW
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S&10 416 SURCHARGE IF
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. TOTAL >✓�
Special Conditions
Dale issued by
' l_
i
��prkS1'1PE� PLAN CHECK NU.�
!or inspections call 639-4175
PERMIT N0.
CITY OF TIGARD 639-4171 DATE I•---
BUILDINGPIRMIT 7 _su901vIs1oN cVp
P.U. Box 2 397, Ttgaru OR 97223 TAX MAP —LOT NO.
JOS ADDRESS _ (Q�y3 '� ►vv� �r
OWNEI _ 30161 EXP.DATE , (..t- 16" 7
BUILDER _/rz�
� j STATE REQ.NO._ -
9JILDER•SPHONE / !J
PHONE OTHER _---
ARCHITECT ---
STRUCTURE MEW ❑ REMODEL C1ADDITION Q REPAIR CO MOVE C1 OTHER ❑ OEMOLfFIOh
RESIDENCE 000M ❑ EDUCATION ❑ IND (:1RELIGIOUS 0-ACCESSORY [] GARAGE Q OTHER O FENCE
(NrCUPANCY ,S' -+ LAND USE ZONE Y.S BLDG,TYPE fIRE ZONE_PIAN CHECK BY 14EAT
Construct single fami I dwei I i}�na PP r 'PPS^Led PIic�4
_-S`t> j&-r L-t D 85
SEWER PERMIT/, yJf�7 -(Idu) baths traps
Darane ar sy°
-, ?x
OCC.LOAD FLOOR LOAO HEIGHT '�'' NO.STORIES AREA ,'�'�1 NO.BEDROOMS �� VALUE
BUILDING DEPARTMENT 8E7 BACKS FRONT 2 REAR LEFT SIDE a-' RIGHT SIDE ..........
1
Pwm1I ,�� THIS PERMIT fS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
REQULATIONS AND ALL APPLICABLE CODES AND ORDINANCES,AND IT IS HEREBY AQRSED THAT THE
Plan Chock C- WOAK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPIECIFICA"ONS AND IN COMPLIANCE
WET" ALL APPLICABLE CODES AND ORDINANCES. THE DANCE OF THIS PERMIT DOES NOT WAIVE
PI CTc Flri RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONT CTORS TO HAVE CURRENT CITY BUSINESS
-� TAX PERMfTS.SEPARATE PERMITS RE"IRED F R EWE LUMBINU AND"EAT1N0
Stale Tax 5Sr i1
SDC- --- -c- ---- - - - ---
Told IC
s APPLA
- - _ PDQ', a � � �- � �, a r d _ 6_��-•7s.�3
Prom Q
Rece1P1 No ADDRESS PNONf
.3 5
Sal Due
Ix xued d Br
SSUC
RECEIPT #
PDC--- j i1 L i S G'
— DATE PD.
SEWER CONNECTION 5 �� �� AMOUNT PD._
SCWCR INSPECTION S
SEUER SURCHARGE S
0mr1e0te: —