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I TT q I 1 020(D , . 0 _ 7" , 'Ti 11 ,I ,'",I* ,,I, - - - .1-L ­­� 4 D-&0, evj 4/ .1 , .1 � - I � _____ - . � IT IS DUE TO THE OUALITY OF THE - ____ _____ ----I— No.36 6-11::ZA�... _`11I - --I".." '. I . � _ _ ii � L 9 11 I 11 I --lIl ul' m 11111111111'�H[111 III �jl , ORIGINAL DOCUMENT 9 I I 9 2 t I 01411301 I 11111 I I lil'I'l "I'l 111.1 l'i'l I'11 I Ili I'I'll','I I Ili[*Ill 'utg"I �111,itfli It[11 ,111[1,ll1,1,1"1']I_11H,1l '1,111[11,1,11,1111 l'i'l ali','11,11 I I 1111 11 .11 1111,Ili'11111i Ill '111111 I'll 'Ill llul'[LI'111-111-1 11111 11111IL1311hil I Ii I T I 111m. "' W, �1,,111'111,i I Ij 1,1111 ' I 1, I MIN I I I I � 1 . - - - _ I-— - -1 _­_...- . ­ - ..____ I­ � � -1 -'L-"--'�"--- ' -' -----."'�'-"-"-�--' -­­­......- ­­­­ L- � ­___­­_ __ . ­ -.--,---- 11 ---- ­-­, - ­­ ­­ _-_1 I 1___-____- I.. - ­ ­­ �___­ I.- ­­-­­-- ­­ - ­ � � - - � �c C Z m �o m (' m , 1 11445 SW FONNER STREET CITYOF T I GA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2004-00269 13125 SW Hall Blvd., Tigtird, OR 97223 (503)639-4171 DATE ISSUED: 6/16/2004 SITE ADDRESS: 11445 SW FONNER ST rJARC EL: 2 S 103AC-06400 SUBDIVISION: PP1997-080 PJLP96-00009 ZONING: R-4.5 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: Mr' 'E SPACES: TYPE OF USE: SF WASHING MACH: REVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: BATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 220 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Apprcx. 220' line work connecting existing house to lateral. Septic system to be pumped and filled, or removed. FEES Owner: Description Date Amount GRECO, LEONARD R 8151 SIMMS SL ll'LIIM[il Permit I rr 6/16/2004 $147.80 ARVFDA, CO 80005 I l'AX1 8 State Surrhnrl 6/16/2004 $11.82 Total $159.62 Phone : Contractor: J W r, REQUIRED INSPECTIONS Phone : Sewer Inspection Final Inspection Reg #: This permit is issued sjhject to the regulations contained in the Tigard Municipal Code, State cf OR Specialty Codes and all other applicable laws. All work will be done in actor;lance with approved plans. "chis permit will expire ii work is not started within 180 days of issuance, or if we 1, suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon l Itility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Issued By: _as..a ��l;1 : Permittee Signature: Call (503) 639-4175 by 7:00 P.M for an inspection needed h;4.t business day CITY OF T I GA R D SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2004-00183 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/16/2004 PARCEL: 2S 103AC-06400 SITE ADDRESS; 11445 SW FONNER ST SUBDIVISION: 1.111997-080 N1I P90-unuity ZONING: It-t.5 BLOCK: LOT: JURISDICTION: Ilci _ TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF%":nF:K: NEW DWE'-LING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection existing residence to lateral. Septic system to be pumped and filled or removed. Owner: _ FEES GRECO, LEONARD R Description Date Amount 8151 SIMMS SL -- — ARVADA, CO 80005 1 S4%I JSA I S�%r l'unnccti, 6116/2004 $2,400.00 JSWUSAJ Swr Connccti, 6/16/2004 $0.00 Phone: ISWINSPI Sewer Inspeci 6/16/2004 $35.00 1SWINSI11 Sc\\cr Inspect 6/16/2.004 $0.00 Contractor: _ Total $2,435.00 Phone: Reg #: Required Inspections Sewer Inspection This Applicant agrees to comply with all the rules and regulations of the Clean Water Semices The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Seaver" Permit and the Agency will install a lateral ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Issued by: ��� `t Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed 1:41n xt business day Building Fixtures Plumbing Permit Application Received Plumbing Date/B Permit No City of Tigard Plannin Pero I sewer Date/B : Perrmt'�10 �� �() y� 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No Phone: 503-639-4171 Fax: 503-598-1960 Poet-I:eview I and Use - —" Date/By:: ('ase No Internet: www.ci.tigard.or.us --- — Contact Juris See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method_ Supplemental Information 'fir 1` L' - .�V{IU ;,e`er SCA$ o _ ellaltWiprlimix o kllst New construction Demolition Descri ition city Fee(ea.) 'Total Addition/alterction/re lacemert Other: y '�,,• c. ,� d ,��'"� ��:��nE[std�atiOQ 1$',1br'eYlant. coil "cti •��a," 1 &2-Family dwelling `Commercial/Industrial SFR 1 bath . SFR 2 350 bath _ 350.0000 Accessory Building _ Multi-Family SFR 3 bath _ 3990 EJ Master Builder Other: Each additional bath/kitchen 45.00 -- j'.'�; . ROL&A0CA C). x " Fire s rinkler-sq. ft.: Pae 2 Job site address: vX,41stillt Suite#: Bld ./A t.#: Catch basin/area drain 16.60 Project Name: Q cC Ur ell/leach line/trench drain 16.60 _ . � Footing drain no linear ft. Pae 2 Cross street/Directions t0 job site: Manufactured home utilities 110.00 WNI-N�" feo-o,- lOe1r h+OVSI- Manholes 16.60 �(✓ � ` �. ��\1 ^ei 11a4` Rain drain connector 16.60 Sanitary sewer no. linear ft. Pae 2 Subdivision: Lot#: Storm sewer no.linear ft. Pa e 2 Tax ma / areel #: -- Water service no. linear ft. Page 2 n Tu Absorption valve 16.60 "T Backflow pteventet page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 Ejectors/sump 16.60 Name: nig)kc r.4 a r r _ Expansion tank _ 16.60 Address: ; I'1•i 1 St T L AA 'ejt"' Fixture/sewer cap 16.60 City/State/Zip:'gip.F,;c_1 U�,-_ �"1 1-Z 3 _ Floor drain/floor sink hub 16.60 phone: 4 Garbage disposal _ 16.60 3 Q 1'1 Fax: Host:bib 16.60 )lr1 _ TQC Ice maker 16.60 Name: _ Interce tor/ ease trap16.60 _ Address: c, - — __ Medical as-value: S Pae 2 -- City/State/Zip: Primer 16.60 —_ - "----- Roof drain commercial 1660 Phone: _ Fax: Sink/basin/lavatory 16.60 E-mail: Tub/shower/shower pan 16.60 ' s Urinal 16.60 Business Name: Water closet 16.60 — -- -- — Water heater 16.60 Address: yG' - Other: City/State/Zip: Othcr: -- — _ Phone: _ Fax: - J •11t 1" :' Subtotal S CCB Lie. #: Plumb_LicA _ Minimum Permit Fee 572.50 S Authorized / � � Residential Backflow Minimum Fee$36.25 7"e "ISignature s Plan Review(25%of Permit Fee) S State Surcharge 8%of Permit Fee S ----- -(Plcase nu names - - — TOTAL PERMIT FEE I 51,!LVL.• p RZ Notice This permit application expires it r permit is not obtained ssithin 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 TH-urtunty Building Industry Service Board. i:tDsts\Permrt Forms vPlmPerrnitApp.doc 01103 H f• I'lumhin2Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppressioa Systems: e oota.. Rd: Permit Fee: Footing drain-1"100' 55.00 0 to 2,000 — $115.00 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer-Ist 100' 55,00 .5r;.w 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-Ist 100' 55.00 Medical Gas 5 stems' Water Service-each additional 100' 46.40 „+►,� 5 '' Storm&Rain Drain-let 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Itain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof,to and including$10,000.00. _ Commercial Back Flow Prevention Device -Ni 41) $10,001.00 to$25,000.00 $148.50 for the first$10,001,1.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27 55 and including$25,000,00. Rain Thain,single family dwelling e5 25 7 $25,001.00 to$50,000.00 $37950 for the first$25,000.00 and$1.45 for each additional$100.00 or fraction thereof,to Inspection of existing plumbing or and including$50,000.OU. specially requested inspections-per hour _ �2 SI) $50,001,00 and up $742.00 for the first$50,000.00 and$1.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: %re you capping, nursing or replacing existing fixtures? If "yes please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. s. fi„' ii tl Fxf a Wo 'Morin+= ('onunents regarding Fixture work: htttire Ty, . a i. to Ba tis /Font Bath -Tt,b/Shower -Jacuzzi/Whirlpool -- — Car Wash -Each Stall -Drive 1'hru Cus idol/Water Aspirator - Dishwasher -Commercial -Domestic _ Drinkinit Fountain --- E e Wash — Floor Drain/sink .2" 4" Car Wash Drain _ *Note: If the fixture work under this permit results in an C -Domestic Disposal -Commercial _ increase of sewer H:1)t's, a sewer permit will .)e issued and -Industrial fees assessed for the sewer increase must he paid before the rce Mach./Refri .Drains _ plumbing permit can be issued. Oil Separator Gas Stbtion Rec.Vehicle Dump Station Shower -Gang _ -Stall Sink -Bar/Lavatory -Bradley -Commercial _ -Service Swinurring Pool Filter Washer-Clothes Wr.ter Extractor Water Closet- roilet Utinal _ Oti,er Fixtures i DstiTermit FormsT1mPermitAppPg2 doc Ol%03 CITY OF TIGARD MASTER PERMIT PERMIT#: MST2003-00351 DEVELOPMENT SERVICES DATE ISSUED: 8/21/03 13125 SW Hall Blvd., Tigard,OR 97223 (503) 639-4171 SITE ADDRESS: 11445 SW FONNER ST PARCEL: 2S103AC-06400 SUBDIVISION: PP1997-080 MLP96-00009 ZONING: 1t-4.s BLOCK: LOT: 002 JURISDICTION: 11(i REMARKS: Addition of 1050 square footage. BUILDING REISSUE STORIES FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: AUC HEIGHT: I;' FIRST, •15o at BASEMENT: 6IIo at LEFT: 5 SMOKE DETECTORS. TYPE OF USE: Sr FLOOR LOAD: 40 SECOND: at GARAGE: st FRONT: PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: I 114RD at RIGHT. ti 020 00. OCCUPANCY GRP: R3 BORM: T BATH: 1 TOTAL aG�� at VALUE97, REAR IS PLUMBING _ SINKS: I WATER CLOSETS: WASHING MACH. LAUNDRY TRAYS: RAIN DPAIN. TRAP- LAVATORIES. DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS •1 CATCH BASINS TUB/SHOWERS. GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR. GREASE TRAPS OTHER FIXTURES. MECHANICAL FUEL TYPES FURN<100K: I BOILICMP<3HP: VENT FANS CLOTHES DRYER FURN—TOOK. UNIT HEATERS HOODS: OTHER UNITS. MAX INP. btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS. , ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS 1:11SCELLANEOUS ADD'L INSPECTIONS 1090 SF OR LESS: 0 - 200 amp 0 - 200 amp. WIS VC OR FDRPUMPIIRRIGATION. PER INSPECTION EA ADD'L 500SF: 201 - 400 atnp. 20t - 400 nnp. 1st WIO SVC/FOR: SIGNIOUT LIN 1.T PER HOUR. LIMITED ENERGY: 401 - 600 am0. 401 - 600 atnp EAADDL BR CIR SIGNALIPANEL IN PLANT. MANU HM/SVC/FDR: 601 - 1000 amp'. 601+8mps.1000x. MINOR LABEL- 1000-amplvolt PLAN REVIEW SECTION Reconnect only. —4 RES UNITS. SVCIFDR-225 A.. >600 V NOMINAL CLS AREA/SPC OCC'. ELECTRICAL-RESTRICTED ENFRGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO R STEREO: VACUUM SYSTEM. AUDIO 8 STEREO. FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT BURGLAR ALARM: OTH BOILER: HVAC. LANDSCAPEIIRRIG: PROTECTIVE SIGNL GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: H.AC DATAITELE COMM- NURSE CALLS TOTAL 0 SYSTEMS. Owner: Contractor: TOTAL FEES: $ 1,845.15 This per is Suubject to the regulations contained in the GRECO,LEONARD R ()tNNER Tigard Municipal Code,State of OR. Specially Codes and 8151 SIMMS SL all other applicable laws. All work will be done in ARVADA, CO 80005 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 180 days, ATTENTION Oregon law requires you to follow rules adopted by the Phone Phone Oregon Utility Notification Centel. Those rules are set forth in OAR 952-001-0010 through 952-001-0080. You Reg It may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Eroskin Control Insp 8, Post/Beam Structural Pl-Vundslab Insp Electrical Rough In Gas Line Insp Roof Nailing Gradirg Inspection Post/Beam Mechanica PLM/Underfloor Framing Insp Gas Fireplace Electrical Final Footing Insp Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Foundation Insp Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final Wtr Proofing BsI'1't Wa Fcoting/Foundation Dr; Electrical Service Low Voltage Storm drain Insp Final inspection Issued By . CZ-�__i �: — Permittee Signature/ 'A Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application. ' M Itccci�cd Building � Date/B _ Permit No� /�Vff_ City of Tigard Planning Approval Other y g Datc/B : Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: _— Permit No,: Phone: 503-639-4171 Fax: 503-598-1960 " Post-Review land Use Internet: www.ci.tigard.or.us 6,, Date/B : Case No. g Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: supplemental Information �L�t�GYr L��.Z.�yf_. ��;�f.L%�•E;.�L �Cc2�i �, �=mak,-1/�%y �'�,k-tc�•li .c�.� �" � _—��� _ ew consTYPE OF WORK QUIRF,D DATA: [_Ntruction - 10 Demolition 1 &2 FAMILY DWELLING [� Addit.ion/alteration/rel lacement 1 0 Other: _ CATEGORY OF CONSTRUCTION Note: Permit fees*are based on the total valt-of the work performed. Indicate =-I &2-Tamil •Owellin., ❑ Commercial/Industrial the value(rounded to the nearest dollar)of all eyvipment,materials,labor. � y -�- Accessory Building Multi-Family overhead and profit for the work indicated on this application. DD Master Builder_ ❑Other: Valuation......................................................•. $-L% . JOB SITE INFORMATION and LOCATION No.ofbedrooms:S No.ofbaths:_J_IL — 'Total number of floors. Job site address: 4}4S 5(,J -�pt1 ti — ...............••................ r -- BldT/A t.#: New dwelling area(sq.R.).........................•,.,. Suite #: I _ _ Garage/carport area(sq.ft.).. Project Name: 45 4 ,T- p-4alp t _ _ C.tvcrcd porch area(sq.ft.)............................ Cross street/Directions to fob site: Deck area(sq. ft.)............................................ C) Rx i SI};rot L baA 1 *^4% S F-P D#1 Other structure area(sq.ft.)...................•........ REQUIRED DATA: Of f-tMCOMMERCIAL-USE CHECKLIST Subdivision: — _E Lot#. -- -` Tax map/parcel #: Note: Permit fees$arc 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 this application. - - Valuation.....................•........•••...........•.....•...... $ Existing building area(sq.ft.)......................... ' -- - New building area(sq. ft.)...............................oftn nJ buck _i1�.� Number of stories............................................ _ -- PROPERTY OWNER TENANT -1 D tARA 7 ypeccu of construction................•..........•....ting � Occupancy group(s): Existing: Name: _ ,�ra:i ig C cu-c-a _ _ New: Address: _ City/State/Zip: T — Phone:S03 toG' �' Fax: NOTICE: All contractors and subcontractors arc required to be JZJA P iCANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under _ provisions of ORS 701 and may be required to be licensed in the Business Name: L4 C, - jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: Address: — - — — Cit /State/Zig - b Phone: Fax: BUILDING PERMIT FEES' E-mail: WNT CT Pleas!refer to fee schedule. — r Business Name: _ Fees due upon application.................... Address: City/State/Zi Amount received............................................. $ Phone: Fax: Date received: _ CCB Lic. - 1,' Authorized / Notice: t Irls llcrmrlt application expires if a permit is 1101 olllainell ss ithln Signature:i _ Date180 days after It has liven accepted as complete. (Z_ "Fee mvihodologv set h%Tri-Uouni) Building Industri Service Board. (Please print name) is\Dsts\Permil Forms\BldgPermitApp.doc 01 r03 c i I i Dine-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Assoc rited permits: City of Tigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd.Tigard,OR 97223 U Other. Phone: (503) 639-4171 Fax: (503) 598-1960 REQUIRED FOR PLAN REV111V Ve% No N/A 1 Land use actions completed.See jurisdiction cri :ria for concurrent reviews. 2 Zoning.hood plain,solar balance poh ts,seismic soils designation,historic district,etc. _ 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel Existing system capacity _ 6 Sewer permit. 7 Water district approval. 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size slice(attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. _ 1 I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(ff there is inure than a 441.elevation differential,plan must show contour lines at 2-ft,intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 7C 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. -- 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for auditions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,i•ulicating member sizing,spacing,and bearing locations.Show attic ventilation. - 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. - 21 Ene- � Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required for fOL, or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project un tri rrvi JURISDIC11ONAL SPECIFICS 23 Five(5)site plans are required for Item 11 above. Site plan,must be 8-1/2"x I I"or 11"x 17". 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 "brawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. W-4614 urooicoM) Bunning r fixtures Plumbing Permit Application Received Plumbing ,. DaWl]ly Permit No ao--+- City of Tigard Planning Approval Sewer Date/13y: Permit No: 13125 SW Hall Blvd. /1k Plan Review other 'Tigard,Oregon 97223 DaudBy: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Past-Rcview land Use Internet: www.ci.tigard.or.us Datc/by Case No: Contact �- Juris.: see rage-2for 24-liour Insion Re uest: 503-639-4175 p q Namc/Metlind - Supplementallnformation. _TYPE OF WORK FEE"SCHEDULE(for special Information use checklist New construction_ Dcmolitio_n DescriptionLo( Fee ca.) Total Addition/alteration/replacement Other: New I-&2-family dwctlings CATEGORY OF CONSTRUCTION includes 100 ft.for each u Ility connection SFR(1)bath - _ 249.20 _ [] 1 & 2•Family dwelling Commercial/Industrial SFR z bath 350.00 ❑Accessor�Building- Multi-Family- - - srR 3 bath 399.0(1 Master Builder Other: :,ch additional bath/kitchen 45.00 _ JOB SITE INFORMATION and LOCATION ! uc sprinkler-sq. ft.: Page 2 Job site address: 14qS st � _ _ Site Utilities _Suite#: _ I Bldg./Apt.#: Catch basin/area drain _ 16.60 - - - Ur well/leach lint/trench drain_ 16.60 Project Name: `J� � ���� - PDoting drain(no. linear f1) _ _ Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 F-00 )&c -4 a A-N WPt-IV.t`- �iS Manholes 16.60 Rain drain connector 16.60 _ Sanitary sewer no. linear 111.) P 2 Subdivision: Lot#: Storni sewer(no. linear f1.) #: Pagc 2 Tax map/parcel -- -�- - - water service(no. linear fl.) _ Page 2 DESCRIPTION OF WORK AbsorptionFixture or Item -- valve 16.60 13ackflow pieventer Page 2 Backwater valve 16.60 Clothes washer 16.60 - - - ----- -- --- -- Dishwasher_ _ 16.60 --- - Drinking fountain 16.60 PROPERTY OWNER TENANT E ectors/sump 16.60 Name: - Expansion tank - 16.60 Address: tlyy W F 1 5 �Dnnt�- C,�__- Fixture/sewer cap _ 15.60 City/State/Zip: rd Floor drain/floor sink/hub 16.60 -u--�-- Phone:5'025 (op2j.C� IGarbsedis-osal 16.60O � Fax: 6arbagb _ 16.60 -�-- �APPLICANT _ i CONTACT PERSON Ice maker _ _ 16.60 Name: - - Interceptor/grease trap - 16.60 Address: -_-- - - - Medical gas-value: 5 - Page 2 City/State/Zip: Pnrner 16.60 - - --- ----- Roof drain(commercial _ 16.60 Phone: _ ---- Fax: - - Sink/basin/lavatorY� � 16.60 E-mail: Tub/shower/shower pan 16,00 CONTRACTOR - Urinal 16.60 Business Name_ r, - t�W� Water closet _ 16.60 -- Water heater 16.60 Address: ---. other: -- Cit /State/Zip: Other: -- Phone: _ _ Fax: Plumbing Permit Fees• _-- - - -- Subtotal 5 _CCB_ Lic. M _ Plumb. Lic.#: Minimrrn Minimum Pcit Pec$72.5(1 $ Authorised _ f Residential Backflow Minimum Fee$36.25 titgnatur "=F� Date:(O III to Revicw(25%of Permit Fee) 5 (i Z State Surcharge 8%of Pcnnit I'ee 5 (Please print name) TOTAL PERMIT FEE t 5 Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of pians with Isometric or ISO das s after It has been accepted as complete. riser diagram for plan res►ess. 'I-cc mrthodoiog� set b.� Tri-('ounts Building Industry Service Board i flstsTernw fonnsV'IrnPennuApp doc 01103 Plumbil2 Pcrmit AnDlicution - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: footing(hall, . I" I(X)' 55.(X) 0 to 29,M0 $115.00 — — - — Footing drain-each additional 100' 4640 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00_ Scwcr-gat 100' 55.00i 7,201 and greater $309.00 _ Sewer-each additional 100' 46.40 Water Service-Ist 100' 55.00 Medical Gas Systems' Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm& Rain Thain-each additional 100' 46.40 $5,1)01.00 to$10,000.00 $72.50 for the first$5,000,00 and$1.52 for each additional$100.00 or tiaction thereof,to and Fixture or Itetn Qty, Fee(ea) Total including$10,000.00. (Commercial Flack How Prevention Ikvicc 40400—,M)$I1 1x1 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Oevice _ each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27 55 and includinit$25,M0.00. Rain Drain,single family dwelling r 5 25 $25,001.00 to$50,000.00 $379.50 for the first$25,0)0.00 and$1.45 for — each additional$100.00 or fraction thereof,to Inspection of existing plumbing or and including$50,000.00. specially requested inspections-per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you cjpping;, moving;or replacing existing; fixtures? If "yes",please indicate work per•fonned by fixture. Failure to accurately report fixtures could result in increased seiner fees*. uan_tlt b Fixture Work Performed f otnments regarding;fixture work: Flxture'rype: Replace New Moved Existing Capped — -- -- Ila List /font Bath =1'ub/Shower - -Jacuzzi/Whirl ool -- — Car Wash -Each Stall -Drive Thru _ Cus idor/WaterAspirator _ — ---J-- Dishwasher -Commercial -Domestic Dn7nking Fountain -- --` Eye Wash — Floor Drain/sink 2" 3" —^ — -- — 4„ Car Wash Drain Garbage -Domestic *Note: If the fixture irork under this permit results in an Disposal -Commercial increase of sever F,DUs,a setrer permit will be issued and -industrial fees assessed for the server increase must he paid before the Ice Mach./Refri .Drains _ _ plumbing;permit cal, be issued. Oil Separator Gas Station Rec,Vehicle Dump Station Shower -Gang Sink -Bar/Lavatory _ -Bradley -Commercial -Service Swimming Pool Filter Washer-Clothes — Water Extractor Water Closet- ''oilet Urinal Other fixtures: OristsTermit Fomu\PlmPermitAppPg2.doc 01/03 Electrical Yermit Application Received Electrical Date/By: Peinut No City of Tigard and Planning Approval Sign y Date'By: I'ernut No 13125 SW hall Blvd. Plat Review Other -- Tigard,Oregon 97223 Dcte/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1Cate/By: Case No.: 960 Past-Review Land Use — '' Internet: www.ci.tigard.or.us 1'pntact Juris.: sec Page 22 for - 24-hour Inspection Request: 503-639.4175 Name/Method: Su tpiemenlal Information. TYPE OF WORK_ _ PLAN REVIEW(Please check all that apply) New construction Demolition Service over 225 amps- LJ Health-care facility commercial ❑Hazardous location Addition/alteration/replacement ❑Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in 1 &.2-Family dwelling L1 Commercial/Industrial­­ El system over 500 volts nominal one structure ElBuilt:;ng over three storic:. ❑Feeders,400 amps or more ❑ Accessory Building Multi-Family _ _ p Occup: it load over 99 persons ❑Manufactured structures or RV park ❑ Master Builder Other: _ ❑Fgress/lighting plan ❑Other: JOB SITE INFO RMATION and LOCATION Submit_sets of plans with any of the above. rhe above are not appllcable to temporary construction service. Job site address: j_-�� _— FEE*SCHEDULE Suite#: I Bldg/Apt.#:- - Number of It H)ections er cr►nit allowed Project Name: Description Q1v CC2.0 Total New resirlential-single or mull-family per Cross street/Directions to Job site: dwelling unit.Includes attached garage. WA00 t,' pr,n ley- Service Included: _ t 1000 s R,or less 145.15 4 VAr�✓ �P) Each additional 500 sq.R.or portion thereof 33.40 I Subdivision: Lot#: Limited energy,residential 75.00 2 __-- Limited energy,non residential _ 75.00 Tax rcel M Each manufactured home or modular,hvclln,g DESCRIPTION OF WORK service and/or feeder _ 90.90 2 - Services or feeders-Installation, alteration or relocation: 210 amps or less 1 80.30 2 201 amps to 400 amps _ 106.85 2 401 amps to 600 amps 160.60 2 PROPERTY OWNER TENANT 601 ams to LE loon amps __ 240.60 2 / - --- / Over 1000 amps or volts 454.G5 2 Name: 0 sal Gr _�_ - Reconnect only - -- - - - — 66.85 2 Address: Temporary services or feeders-installathn. ('J - alteration,or relocation: City/State/Zip:'T,a A(-d Z _ zoo snips or less 66.85 - 1 Phone: p ( Fax: zo l amps to a«)ams 100.30 -- — 401 to 600 ams 133.75 2 APPLICANT CONTACT PERSON Branch circuits-new,alteration,or Name: - extension per panel: -- —� -- A.Fee for branch circuits with purchase of Address: _ service or feeder fee,each branch circuit 6.65 _ 2 City/Slate/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-triad: Misc.(Service or feeder not included), CONT CTOR Each um or irrillation circle __ 53.40 2 Each sign or outline lighting 53.40 2 Job No: r— a 1,0A,1 Signal circuit(s)or a limited energy panel, Business Name: alteration,ur extension Pa 2 2 Description: Address: _ Cit /State/Zip: Each additional Inspection over the allowable In an of the above: _ Per inspection per 1 1 62.50 Phone: Fax: Investigation fee CCB Lic. #: Lie. #: other: = _ Electrical Permit Fees* Supervising electrician J — subtotal S Signature required: Plan Review 25%of Permit Fee) S _ Print Name: LiC. #: State Surcharge(8%of Permit Fee) $ TOTAL PERMIT FEE S AuthorizedrL Notice: This permit application expires If a permit Is not obtained within Signature: /' �__. Date: a� �3 180 days after It has been accepted as complete. *Fee methodology set by Tri-Counly Building Industry Service Board. (Please print name) i\Dsts\Pem it Forms0cPermitApp.doc 01/03 Electrical Permit Application -City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENI.AL WORK ONLY: Feefor all systems............................................................ S75.00 Check Type of Work Involved: EJAudio and Stereo Systems* Burglar Alarm RGarage Door Opener* F1 I leating,Ventilation and Air Conditioning System* EJVacuum Systems* Other COMMERCIAL WORK ONLY: Feefor each system.......................................................... 575.00 (SI];OAR 918-260-260) Check Type of Work!nvolved: 0 Audio and Stereo Systems Boiler i'ontrols Clock Systems Data Telecommunication Installation Fire Alarn Installation IIVAC u Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* Medical Nurse Calls ❑ Outdoor Landscape Lighting* Protective Signaling ------- Number of Systems * No licenses are required. Licenses are required for all other installations is\Dsts\Permil FormsNFIcPerrnitAppPg2.doc 01103 Mechanical Perm- Application Received Mechanical Date/By: Permit No.: Planning Approval Building City of Tigard date/By: Permit No.: _ 13125 SW Hall Blvd. Plan Review Other CDate/13y: Permit No.: igard,Oregon 97223 _ Phone: 503-639-4171 Fax: 503-=98-1960 Date/Post- y: land Use Date/By: Case No.: Internet: www.ci.tigard.or.us Contact Juris.: see Paae 2 for 24-hour Inspection Request: 503-639-1175 Name/Melhod: Su�rlcmcnlal Information._ _ _ COMMERCIAL FEE*SCHEDULE-USE CHECKLIST TYPE OF WORK �]i ❑_ Demolition Mechanical permit fees*are based on the total value of the work New construction DF8iti Addition/alteration/replacement t] Other: performed. Indicate the value.(rounded to the neared dollar)of all CATEGORY OF CONSTRUCTION _ mechanical materials,equipment,labor,overhead and profit. Vaiue: S See Page 2 for Fee Schedule 1 rx 2•Family dwellin _ CommerciaUlndustrial RESIDENTIAL Fel UIPMENT/SYSTEMS FEE•SCILEDULE Accesso Buildin Multi-Famil _ Descri Uon F'ee ea. Total Master Builder ❑ Other: Heatin Coolln JOB SITE INFORMATION and LOCATION Furnace-add-on air condoning*' 1 - / U Job site address: 1 1 y�5 Fonn� Gas heat um 14.00 Suite#: Bld ./A to — Duct work 14.00 Hydronic hot waters teen 14.00 Project Name: S Residential boiler Cross street/Directions to job site: for radiator or hydronic system) 14.00 Unit heaters(fuel,not electric) - in wall,in-duct,suspended,etc. 14.00 Flue/vent(for_ any of abovel 10.00 _- --- - — Repair units Subdivision: _ _ Lot#: — other Fuel A t trances _ .ax man/parcel 11: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace • - Fluc vent(water heater/gas fireplace) 10.00 _ Log IIt! r(gas) 10.00 Wood/Pellet stove 10.00 Wood fire lace/insert 10.00 Chimney/liner/flue/vent 10.00 ®PROPERTY OWNER T TENANT_ Other: 10.00 _ Environmental Exhaust es Ventilation_ _Name: [ 1.) t—_;,J\ .�ssr - ---- Range hood/other kitchen equipment I0.00 Address: 50 f'r7nnaT _ Clothes dryer exhaust 10.00 d _City/State/Zip:'rib,� Z� ci3_ - Single duct exhaust Phone:� r13 ,o f'y Fax: _ (bathrooms,toilet compartments, APPLICANT CONTACT PERSON utilitymems 6.80 -- -- fans 10.00 —-- Attic/crawl s ace Name: - Other: 10-Et Address: -- Fuel Piping City/State/Zip' - **($5.40 for first 4,V.00 each additlona -- Furnace etc. *` Phone: Gas heat pump ** - ---- . --- E-mail: Wall/suspended/unit heater ** CONTRACTORWater heater *' — Fireplace ** Business Name: - Atj k� .. Address: _ Range ©B .. Cit /State/Zl : Clothes dimer as _ ** Phone: __ Fax: Other: _ Total: 3 CCB Lic. #: _ _ Mechanical Permit Fees" Authorized Subtotal: Signatu ___._ Date Minimum Permit Fee 572.50 rrS 7?(k _ Plan Review Fee 25%of Permit Fe. ' S �E A -- -- State Surcharge R%of Permit Fee $ (Please print name) TOTAL.PERMIT FEE 1 $ Notice: This per mit application expires If a permit is not obtained within *Fee rnethodoloay set by Tri-County Building Industry Service Board. 180 dais after it has been accepted as complete. "Site plan required for exterior A C units. i'1)sts"I,cmio I•ormS,Mcc[let muApp doc 01103 Mechanical PermitApplication - City of'Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation:� Permit Fees $1.0010$5,(M.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 for the first$5,000.OG and$1.52 for each additional$100.00 or fraction thereof,to and including$10,000.00. 510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$100.00 or fraction thcrcol',to and including $25,000.00. $25,001.00 to$50,000 00 $379.50 for the first$25,000.00 and $1.45 for cacti additional$100.00 or �f fraction thereol',to an6 including _ $501000.00. $50,001.00 and up $742.00 for the first$50,000.00 and $1 20 for each additional$100.00 or fraction thereof. Assumed Valuaticss Per_Applianee: _ �T Value Total Description: _ t Ea Amount Furnace to 100,000 BTU,including 955 ducts&vents Furnace>100,000 BTU including ducts 1,170 &vents _ floor furnace inc�t 955 ,suspended heater,wall heater or floor 955 mounted heater Vent not included in appliance permit 445 RT!ir units 805 <3 hp;absorb.unit, 955 to 100k BTU -15 hp;absorb.unit, 1,700 101k to 500k BTU 15.30 hp;absorb.unit,`Olk to I mil, 2,310 BTU 30-50 hp;absorb.unit, 3,400 1.1.75 mil.BTU 150 hp;absorb.unit, 5,721, 11.75 mil.BTU Air haAling unit to 10,000 cfm 656 Air handling unit>10,000 cfm 1,170 _ Non-portable evapot ite cooter _ 656 _ Vent fen connected to a single duct 446 Vent system not included in appliance 656 permit _ I loud served by mechanical exhaust 656 Domestic incinerator _ 1,170 Commercial or industrial incinerator 4,.590 Other unit,including wood stoves. 656 inserts,etc. C';ss pipin i-0 outlets 360 teach additional outlet 63 TOTAL COMMERCIAL VALUATION: 1 i f i\DstsNPermit Forms\MeRermitAppPg2.doc 01/03 File Number 3A7 ClcanWaierServices onr cornn,itu,cnt is cleat Sensitive Area Pre-Screening Site Assessment Jur:,.diction _ �,� _ _ Date Ma a Tax Lot - - Owner Map ' cSL.r'3r9C OF 4OD _.___Site Ad Tress 1iti�s s��,,.s• Contact Pioposed Activity fin_ %_ �SFL,? Address ---- _ —`---- —— Phone So 3- V.0 56'0,* Oficial use only below this line Y N NA Y N NA Sensitive Area Composite Map ((��r�,711 Stormwater Infrastructure maps ❑ ❑ Map #_ �� -_--- ❑ ❑ LY�1 as # y3 i 8 7n� locally adopted studies or maps Other F] F16��� ❑ ❑ Specify ---- Based on a review of the above Information and the requlremints of Clean Water Services Design and Construction Standards Reso!ution and Order No. 03-11: ❑ Sensitive areas potentially exist on site or within ?00' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR S'rORMWATER CONNECTION PERMIT. If Sensitive Areas exist r.n the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. [� Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently;discovered on your property. NO FURTI IER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATEP CONNECTION PERMIT. k, The proposed activity does not meet the definition, of development. NO SITE. ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: 0 e.47 d 1_x/44 Ore , Reviewed By: —_ G%! •Y - - Date: z�p� —-- Returned to Applicant Mail p_ Fa-Y _ Counter__ Date 7/gl/0-3 Byz AL 155 N First Avenue,Suite 270•Hillsboro,Oregon 97124 Phone: (503)84"621 •Fax (563)846-352.5•�r�tw.clegnw_aterservices:r� i SF; , 35MM ROI.JL# 23 FOR LARGE DOCUMENT CITY OF TIGARD BUILDING INSPECTION DI VISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 _ — q BUP Date Requested cJ." ��1 ! AM PM BLD _ Location 1 < < t_f> DV1 Y elL S`r Suite MEC Contact Person —_ L Ph _ ��5 �? PLM -3) Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Acces'1: — Foundation FPS Fig Drain SGN Crawl Drain Inspection Notes: — -- Slab — SIT Post& Braam —i Ext Sheath/Shear Int Sheath/Shear _ Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: - ---- -- —� --— Final PASS PARI FAIL Post& Bearn Under Slab lop Out — VY3ter ServTct, Sanitary Sewer ---_--- --------- -- -------- Rain Drains P S PART FAILMEtM _ ANICAL Post st R Ream _—__.---- --- ---- -- ----- Pflugh In t;,is I ine ---------- `"oke Dampers PASS PART FAIL � ELECTRICAL -_ -- ---� �^....-------- ---------- - — __ Service Rough In ------- --- — _.— ---- --- ----___._ UG/Slab Low Voltage Fire Alarm Alarm Final PASS PART FAIL SITE Backfill/U rading —�--- �— Sanitary Sewer Storm Drain )Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line I ] Please call for reinspection RE: _ _ [ J Unable to .,*pact-no access ADA ILI Approach/Sidewalk — Date � inspect4�---' Ext her Final PASS PART FAIL_ DO NOT REMOVE this inspectimi record from the jots site. CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM1999 00139 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: PARCEL: 2S103AC-GR002 SITE ADDRESS: 1 1445 SW FONNER ST SUBDIVISION: MLP96-0009 ZONING: ? BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: NEW 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: 210 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 210 feet of water line. _ FEES Owner: Type By Date Amount Receipt I F:ONARD GRECO MISC DST 5/3/99 $2.75 99-315038 11441 SW FONNER ST PRMT DST 5/3/99 $55 00 99-315038 I IGARD, OR 97223 — Total $57.75 Phone 1: 603-0914 Contractor: REQUIRED INSPECTIONS Water Line Insp Phone 1: Water Service Insp Reg #: Final Inspection I 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. This permit will expire if work is not started within 1130 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 OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Is ed By: - _g:t r L ;; 1� Permittee Signature: G Call (503) 629-4175 by 7:00 P.M. for an inspection needed th next business day CITY OF TIGARD Plumbing Permit Application Plan,Check10 13125 SW HALL BLVD. Commercial and Residential Reo'� ,- TIGARD, OR 97223 Date Recd (503) 639-4171 Date to P.E. - Print or Type Dote to T ^ Incomplete or Illegible applications will not be accepted Permit Related SWR 0 Called Name of Development/Project FIXTURES (Individual) QTY PRICE' AMT Job Sink 'aw 9.00 A Jdress Street Address Suite Lavatory 9.00 i 144r `' C' = ..�,t- Tub or Tub/Shower Comb. 9.00 Bldg* City/State Zip Shower Only 9,00 Name ` (�^ Water Closet 9.00 (_-k9,Com, Dishwasher 9.00 Owner Mailing Address Suite Garbage Disposal 9.00 11 `�� �C �c�Cr Washing Machir s 9.00 C,Ity/State Zip Phone Fluor DraUVFloor Sink 2" 9.00 d G ��I Name 3" 9.00 J>Av,4 C� � 4" 9.00 Occupant Mailing,Address Suite Water Heater O conversion O like kind 9.00 S •d"� ftv Gas pipIng requires a separate mechanical permit. City/State Zip Phone Laundry Room Tray 9.00 __rc ]j Z.,3 Urinal 9.00 Name Other Fixtures(Specify) 9.00 Contractor Mailing Address Suite 9.00 9.00 Prior to permit City/State Zip Phone Sewer-1st 100' 30.00 Issuance,a copy Sewer-each additional 100' 25.00 of all licenses are Oregon Const.Cont.Board Lic.rt Exp.Date _ _ required If Water Service..1 at 100' 30.00 r expired In COT Plumbing Lic.* Exp,Date Water Service-each additional 200' 25.00 database - � _ ------ Storm&Rain Drain-1 at 1 CJ' 30.00 Name Storm&Rain Drain-each additional 100' 25.00 Architect - Mobile Home Space 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device Engineer City/State Zip Phone Residential Backflow Prevention Device- 15.00 (Irrigation timing devices require a separate Describe work to be done: restricted eQeV.permit,) New O Repair O Replace with like kind Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 Residential 40 Commercial O Catch Basin 9.00 Additional description of work Y Insp.of Existing Plumbing 40.00 _ per/hr +i �'1�`�r Specially Requested Inspections 40.00 er/hr Rain Drain,single family dw, 'ng 30.00 Are you capping, moving or replacing any fixtures? _ Yes O No A Grease Traps 9.00 If yes,see back.of form to Indicate cork performed by - fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL Isometric or riser diagram Is required M puAntxy Total Is >9 WORK COULD RESULT IN INCREASED SEWER FEES, *SUBTOTAL r I hereby acknowledge that I have read this application,that the Information given is correct,that I am the owner or authorized agent of the owner,and 5%SURCHARGE that plans rubmitted are In compliance with Oregon State Laws. Slgnatungof OwneyAgant Oeta "PLAN REVIEW 26%OF SUBTOTAL Required.only If Rxture qty trial is>3 TOTAL Cont#ct Person Name Phone *Minimum permit fee is$25+5%surcharge,except Residential Backflow /1/ Y v c) Prevention N.vice,which is$15+5%surcharge "All New r:ommercial Buildings require plans with isometric or riser diagram and plan review I Wstsq+liimapp doc MM PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed/Capped Sink Lavatory _ Tub or Tub/Shower Combination _ Shower Only _Water Closet Dishwasher Garbage Disposal Washing Machine _ Floor Drain/Floor Sink 2" 3" ` Water Heater _ Laundry Room T.-ay Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received Date Requested AM —PM BUP _ Location '4 L45- Suite MEC Contact Person .1,19 PLM 2QO Contractor _ Ph SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR _ Crawl Drain _ Slab Inspection Notes. SIT Post& Beam Shear Anchors ,� Ext Sheath/Shear 2ZJL Int Sheath/Shear Framing -----... -- -- -` ---- —- Insulation Drywall Nailing ---- -- - --- - Firewall Fire Sprinkler -- - -- -- - - -- -- Fire Alarm Suspd Ceiling -- - - - - Root Other:-�_-- -- --- --------- Final PASS PART FAIL PLUMBING Post&Beam Under Slab ----- --- Rough-In Water Service -- --- -- 611Tary-Te wer Rain rains -- --- ----- - - --- ------ _ _ _ Catch Basin/Manhole Storm Drain - - -- - - - -- —.. --_ Shower Pan Other: -- Fi AS PART FAIL ---------------- C_HANICAL__ — Post& Beam Rough-In Gas Line Smoke Dampers __-----___--- Final PASS PART FAIL - - -- _ --- - ELECTRICAL __ Service - - - .�--- - -- Rough-In - ----- --- -- ---- UG/Slab Low Vohage Fire Alarm Fina. Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE [� Please call for reinspection RE:_ _ Unable to inspect- no access Fire Supply Line ADA ' Approach/Sidewalk Date Inspector _ y Ext -- Other Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL