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10340 SW Hillview Street
n1 ������D BUILDING PERMIT
CITY OF
PERMIT#: BUP2000-00328
DEVELOPMENT SERVICES DATE ISSUED: 8/11/00
13125 SW Hall Blvd..Tigard, OR 97223 (503) 639-4171 PARCEL.: 2S102CC-03200
SITE ADDRESS: 10340 SW HILLVIEW ST
SUBDIVISION: FRELEON HEIGHTS NO.2 ZONING: R-3.5
BLOCK: LOT: 015 JURISDICTION: Tir,
�s REISSUE: F,OOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 000 sf ROOF ;ONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf Af;r`A SEP. RAT'E%:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: _ REQD_ SET14ACKS _ REQUIRED
FLOOR LOAD: psf LEFT: 5 ft I�GHT: 5 ft FIR SPKI_: SMOK DET:
DWELLING UNITS: FRNT: 20 ft REAR. ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 6,0'?1.00
Remarks: replacing deck and cover
Owner: Contractor:
VVESTOVER, PHILIP S AND ED CAUSE CONSTRUCTION
CHRISTINE M 17460 SW TREE TOP LN
10340 SW7HRILgLVIEW ST LAKE OSWEGO, OR 97035
TI�A7ne' Y94 ,_'2 3 Phone: 636-5934
Reg#: LIC 82643
_--�— _---- FEES _—_-- --- REQUIRED IN3PECTIONS _
Type By Date Amount Receipt Fuuti c; Insp
PICK BT2 7/28/00 $62.56 0004050 Framing -n
rinal Inspection
PRMT GWL 7/28/-1 $96.25 0004050
5PCT GWL 7/28/-1 $7.70 0004050
Total $166.51
nis permit is issued subject to the regulations containad in the Tigard Municipal u,%Je, State of OR. Specialty Codes
and all other apF licable law All work will be done n accordance with approved plans. This permit will expiry: 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-1997. You may obtain a copy of these rules or direct quF ons to OUNC by
calling (503) 246-1987.
Pe rm itee IN
Signature: E--=Lk'
Issued By: ---
Call 639-4175 by 7 p.m.for an inspection the next bUsiness day
CIW OF TIGARD Residential Building Permit Application Rec'd By
Pian Check#Z�
13125 SW HALL BLVD. Alteration - Interior Only Date Redd
TIG ARD, OR 97223 Single Family 0elached or Attached (Duplex) Date to P E. b- I/ —W
V 50-639-4171 Date to DST �'-1l —w
F 503.684-7297 .� ,
Permit# :, � G�v-4 0,12)/
Print or Type Called_
Incomplete or illegible applications will not be accepted
Name of Project ��--Q(_eV C,#t-x 2^ - iTName
,ion �&-r_4` C.)V(`J- Mailinu Address
Address Site Address l Architect
( (C i �w i VrCCu City/State 7ip Phone
Name
Owner ailing Address Name
fW Sw 141 c.c-If 46k'
Cid/State Zip Phone Engineer Mailing Address
- City/State Zip -riw fie
General Nam
Contractor Describe work New O Addition O Alteration O Fepeir0
Mailing Address,,, to be done
Prior to permit (7 ' -� F/t."-f-v r.? Additional Description of Work
issuance,a copy City/State Zip Phone
of all licenses G G' °t;,0.4 G'?'(', 5
are required if Oregon Const Cont.Board Exp.Date I PRUJECT
expired in COT Llc.# -3dalah,ase -77u�•"�- VALUATION $ �c��✓ t�` � � �-
Mechanical Name _ I4_FW CONSTRUCTION ONLY:
sub- Sq. Ft. House: Sq. Ft. Garage
Contractor Maillog Address
Prior tc permit Indicate the restricted energy installation by the electrical
issuance,a copy City/State Zip Phone subcontractor in the follow in areas _
of all licenses Restricted Audio/Stereo
are required if Oregon Const.Cont.Board Exp.Date Energy SystemAlarms
expired in COT Lic.# Installations Vacuum Irrig
Sation
database; stem _ S ste+n
Plumbing Narne (cf,ecr,all that Other:
Sub- apply) _
Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO
_iott-(kune� check one) _
Poor to permit Cfty/S!eZip Phone Has the Subdivision Flat recorded? N/A YES NO
te
Issuance,a copy Solar Compliance ---- -�
of all licenses are Oregon Const Cont.Board Exp Bate (Calculation Attached)
required if Lia#
expired In COT I hearby acknowledge that i have read this application,that the
database plumbing Lia# Exp.Date information given is correct, that I am the owner or authorized agent
of the owner, and that plans submitted are in compliance with
_ Clregon State laws. _
Name Signature of Owner/Agent Date
Electrical
Sub_ Mailing Address Contact Person Name Phone#
Contractor FOR OFFICE USE ONLY:
Prig to permit City/State Zip Phone Plat#:
issuance,a copy --. Setbacks:
of Al licenses are Oregon Const Cant Board Exp.Date Zone: Solar.
required if Lic.#
expired in COT Engineering Approval: Planning Approval: TIF:
database Electrical Uc.# Exp Date
Electrical Supervisor Lic.# Exp Date
I formstsfintaltdoc(DST)10/23/98
�'
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� � � U ��
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
Date Requested_ -3r c AM PM _ BLD _
Location __ Suite — MEC
Contact Perron Ph �4� �� �� y/ PLM
Contractor Ph SWR
U)Lq ,a Tenant/Owner _ _ 4LC
Retaining Wall ELR
Fo•ging Access:
Fouiiiation FPS
Ftg Drain SGN
Cra%•,l Drain Inspection Notes: -- - —
brab L __-_- SIT
Post&Beam `
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _
Fire Alarm _
Susp'd Ceiling - -_____ _ _ ___._
Roof
Mise --- --m_—, --- - -- —
T7 n
ASS PART FAIL
GING
Post& Beam _ -- ---.---------�_�..__ ------.. _----- ___--.-..-____
Under Slab
Top Out ------ --
Water Service
Sanitary Sewer --- _-.- _ -- _--
Rain Drains _
Final _
PASS PART FAIL
MECHANICAL
Post& Beam - - - -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL -
Service
Rough In
UU/Slab
Low Voltage ._.__—___ _----------- ---------- -- --
Fire Alarm
Final
PASS PART FAIL -------_-_--
SITE
Backfill/Grading -Sanitary Sewer
Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RE - [ )Unable to inspect no access
- - - - -
ADA
Approach/Sidewalk
Other Date — - l (� - —- Inspector_ � L Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITY OF
T I G A R D _ ELECTRICAL PERMIT
PERMIT#: ELC200100117
DEVELOPMENT SERVICES DATE ISSUED: 2/28/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S102CC-0320.0
SITE ADDRESS: 10340 SW HILLVIEW ST
SUBDIVISION: FRELEON HEIGHTS NO.2 ZONING: R-3.5
BLOCK: LOT : 015 JURISDICTION: TIG
Proiect Dosrhotion: Kitchen remodel of 7 branch circuits.
RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNALIDANEL:
MANF HMI SVC/FUR: 601+amps - 1000 volts: MINOR LABEL (10):
SER\rICEiFEEDER BRANCH CIRCUITS
�—_ _ ADD'L INSPECTIONS
—-
0 200 amp: W/SEPVICE OR FEEDER: PER INSPECTION:
201 400 amp: 1st W/O SRV(; OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRP-CH CIRC. (3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ ampivolt: >=4 '�j-S UNITS: �> 600 VOLT NOMINAL:
J Reconnect only: _ SVC/FDR >-.�25 AMPS: CLASS AREA/SPEC OCC: l
Owner: Contractor:
WESTOVER, PHILIP S AND HEBERLE ELECTRIC
CHRISTINE M 19680 SW NEUGEBAUER RD
10340 SW !IILLViEW ST HILLSBORO, OR 9712.3
TIGARD, OR 97223
Phone: Phone: 503-628-20�5
Reg #: SUP 30535
LIC 42841
ELE 34-160
^_— FEES Required Inspections _
Type By Date Amount Receipt_ Rough-in `
PRMT CTR 2/28101 $86.75 2720010000( Elect'I Final
SPCT CTR 2/28/01 $6.94 2720010000(
Total $93.69
This Permit is issued subject to the regulations contained in the Tigad 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 180 days of issuance,or if work is
susp,nded for mam than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules are forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies o se-rules or direct questions to OUNC at(503)
246-1987
PERMITTEE'S SIGNATURE �Ci i�� j ISS JED 6Y: il
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent. —
OWNER'S SIGNATURE: — _ _ DATE:_
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ✓� -�-7;�`� '- '� d`-*-1. DATE:.-___..
LICENSE NO: _41-6 J
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
PDatereceived: ,
City of Tigard , F 97223 Project/appi.nc;.: Expiredate:
Address: 13125 SW Hall Blvd 'fig
R
ujTi�nrd Phone: (503) 639-4171 t Date issued: By: Receipt nn.:
Fax: (503) 598-1960 r,g �,� Z•4 F Case rile no.: Payment type:
Land use approval:
'4;add
family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U onstruction �Addition/alteratiott/replaccmcnt U Other: U Partial
-1101111 SUIT'I.NFORMAT110N
lob ss: (, S-10 c t LLVr,I WCV Bidg.no.: Suite no.: ITax map/tax lot/account no.:
Lot: Block: Subdivision:
Projr.-I name: UjEs�lir, Description and location ui work on premises: —
Estimated date of cora letion/ins ction: Q Lc..1J _ 2 '
Job no: see Max
BUSIneS9 name: Rls� _ Description Qty. (ca.) Tutal no.last)
New rt-idridial-.single or multi-family per
Address: 19680 SW Neugebauer Road dwellingrmit.Incho sattachedgamge.
City: illahoro. 6kin 971 ywrvice inc luded:
Phone: ,�Q Fax: - 7 E-mail: 1000 sq.n or less -- 4 —
EICe.bus.Ile.no: Each adddrnnnl SW aq.1't.or portion Ihercof
CCB no.:
� ( d Limited energy,residential 2
Q /metro lic.no.: LO ,7 Z Limitedenergy,non-residential _ 2
Each manufactured hone or modular dwelling
I�Sig e t rvi. ngelectrician(required Date �'�rG� Serviceankborfeeder 2
t
nc( rinH License u,:' _s Servleesorfeeders-IndallaNun,
Lug attention or relocation:
200 amps or less 2
y: [� )L 201 amps to 400 amps 2
401 amps l0 600 amps 2
ress: _ 601 amps to 1000 amps 2
City: 8 1 State: ZIP: over 1000 am s or volts 2
Phone I E-mail: Reconnectonl 1
Owner installation:The installation is being made on property I own Ttmpomryservicaorfeeders-
which is not intended for•,ale,lease,rent,or exchange according to ltwalla0on,sitemtion,orreloeatlon:
200 amps or less 1 2
ORS 417,455,479,670,701.
201 amps to 400 amps �2
Owner's si>naulre: Date: 401 to 600 snips 2
Branch circuits-ne 1r,alteration,
or extension per ranel:
Name: A. Fe-2 for branch circuits with purchase nf
Address: service or feeder fee,each branch circuit 2
City: State: 7.1?; B. Fee for branch circuits without purchase I 6, `
—.__ - _- ___.___ of service or feeder fee, vs-T i�rancTt cZrcuit: _
Phone: I- t &mail: Each a atonal same m circuit: G ^
MIse.(Service or feedernot Included):
U Service over 225 limps-comiercnal U Health-tare facility Each pump or irrigation circle 1 _2
•Service over 320 amps-rating of IBt2 U Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10.000 square feet four or Signal circuit(r)or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration,or extension* 2
U Building over three stories U feeders,41x1 amps or more "Description _
U Occupant load over 99 persons U Manufactured structures or RV park FAch additional Inspection oter the allowable In any of the above:
U Egmss/lightingplwr U Other — Perinspection �-
Submit sets of plans with any of the above. Investigation fee —
The above are not applicable to temporary construction service. other
Permi;fee.....................$
NM all Jurisdictions accept credit cans,please rail Jurisdiction for nunr mfonrstlon. Notice:This permit application -- _
U Visa U Mastercard expires if a permit is not obtained Plan review(at _ %) $
Credit card number: ---- --- -- ---- i . within ISO days alter i1 has been State surcharge(8%)....$
Expires accepted as complete. TOTAL. .......................$ —
Nartme of canllnol r u s own on II c
s
Cardholder signature Amount 440.4615(MOICOM)
Electrical Permit Fees: Limited Energy Fees:
.___--------___---
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allower, (FOR ALL SYSTEMS)
Service included: Items Cost Tota( y Check Type of Work Involved:
Residential-per unit
1000!;q ft or less $145 15 4 [] Audio and Stereo Systems
Inch additional 500 sq.it or
portion thereof _ $33.40 1 Burglar Alarm
Limited Energy $75,00
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $9090 _ _ 2
Services or Feeders [—] Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 Vacuum Systems'
2C1 amps to 400 amps _ $106.85 2
401 amps to 600 amps — $160.60 2 Other
601 amps to 1000 amps $240.60 7 —Over 1000 amps or volts _ _ :454.65 2
Reconnect only _ $66.85 2
rernporaryr Services or Feedurta TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Fee for each system.......................................................... $75.00
Installation,alteration,or relocation
200 amps or less $66.85 2 (SEE OAR 918-260.260)
201 amps to 400 amps $100.302
401 amps to 600 amps _ $133.75 _ _ 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see"b"above. Audio and Stereo Systems
Branch Circuits Boller Controls
New,alteration or extension per panel
a)The fee for branch circuits ❑
with purchase of service or Clock Systems
feeder lee.
Each branch circuit $6.65 Data Telecommunication InstaUstion
b)The fee for branch circuits
without purchs ss of service Fire Alarm Installation
or feeder lee. L)/
First branch cit cult L $46.85�1 b -- HVAC
Lach additiona.branch cirruit (,, $6.65 �Q
Miscellaneous Instrumentation
(Service or feeder not included)
Each pump or Irrigation circle $53.40 _ Intercom and Paging Systems
Each sign or outline lighting $5340
Signal circuits)or a limited energy ❑
panel,alteration or extension $7500 _ Landscape Irrigatiun Control'
Minor Labels(10) '—" $12500 _
F-1 Medical
Each additional Inspection over
the allowable In any of the above Nurse Calls
Per inspection $6250
Per hour $g?50
In Plant _` $73.75 Outdoor Landscape Light'ng'
Fees: u Protective Signaling
Enter total of above fees $ _ Other
8%State Surcharge $ _ Number of Systems
25%Plan Review Fee No licenses are required Licenses are required for all other installations
See"P!an Review'section on $
front of application
7� Fees:
Tonal Balance Due ,
— $ �• Enter total of above fees
L
J Trust Account.It 8%State Surcharge
Total Balan Due
iAdsts\forms\ele-fees.doc 10/09/00
CITY t--)F TIGARD BUILDING INSPECTION DIVISION
FAST
24-Hour Inspection Line: 639-4175 Business Line: 63 -4.171 =
(// BUP
-`Date Requested _ M _ _ BLD
Location.-�U �U J �"� �( �(yl 5 f __— Suite - MEC --_—-
Contact Person _- __--- -- Ph PLM -�
Contractor Ph SWR
BUILDING Tenant/Owner ��Pw 4�-�r r/ ' �'*�' ELG O/-UOf
Retaining Wall ELR
Footing Access:
Foundation FPS s
Fig Drain I SGN
Crawl Drain Inspection Notes: it �rn` — ----- -
Slab
Post& Beam
Ext Sheath/Shear �
Int Sheath/Shear
Framing ------
insulation
Drywall Nailing
Firewall
Firg Sprinkler - __--_ _ - ----_-- _-
Fire Alarm
Susp'd Ceiling
Roof - - -
Misr..
Final -
PASS PART FAIL -------- -- — -
PLUMBING
Post& Beam -- —
Under Slab
Top Out ------ - _-
Water Service
Sanitary Sewer s•
Rain Drains
�i idl
PASS PART FAIL_
MECHANICAL _ T
Post R Hearn - ---- - — — - --- --
Rough In
Gas Line --- — -
Smoke Dampers
Final e
"-ASS_ ART FAIL
• �CTI;ICA -- -- - ------------------
Service ------ - - - --- -
Rough In
UG/Slab
Low Voltage
r rm -- --- - - ---- -- ---
F
SS PART FAIL
wre-
Backfill!Grading -_-
Sanitar:Sewer
Storm Drain j )Reinspection fee of$_ required before next inspection r'ay at City Hall, 13125 SW Hall Blvd
Catch Basin ) )Please call for reinspection RE: __ _ — j Unable to inspect- no access
Fire Supply Line �-
ADA
Approach/Sidewalk �-,
Other Date ____ _ Inspector _ -- _�_Ext ___...
Final
PASS PART FAIL] DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
BUP
_ Date I?equested,�—�"�— _AM `'� PM SLD
Location q U J J LLv� �� _ Suite MEC
Contact Person �T/ ' _ Ph 217-- G�G z-- PLM �--
CGntractor_ y Ph SWR
BUILDING Tenant/Owner �,>e C&* -AD &Afm� r ELC
Retaining Wall ELR _
Footing Access: n, j N
Foundation _ FPS
J
Ftg Drain U -1),, k( /t`1 y - �� ��I p' �✓ ���•�
Crawl Drain Inspection Notes: SGN
Stab __— --- --_— —__ ._ _ _— —._ SIT
Post& Bear., ---'�
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _------_---- ----__—_._.. _ ----_---- — —_
Firewall
Fire Sprinkler
Fire Alarm _---
Susp'd Ceiling
Roof
Misc: -- -- --- - -- _ — — — - -----
Final
PASS PART FAIL ---_ -- — --- — --- _�_. —�---- ----�.--_` __
Post& Beam
Under Slab
TopOut ----------_—._..._---�-------- � — -�_e._�.�._
Water Service
Sanitary Sewer -------------------------._..__
R rains
PAS. PART FAIL
ANICAL
Post& Beam
Rough In \
Gas Linc —.___----
Siooke Dampers
Final
PASS PART FAIL
ELECTRICAL --"– `— ----_-- -_"--- --'
Service
RoughIn —_.—__---_—___--_—_ --- ----------"— --
UG/Stab
Low Voltage
Fire Alarm __—_—_— _�--
Final
PASS PART FAIL
SITE _
Backfill/Grading —
Sanitary Sewer
Storm Drain ( I Reinspection fee of$_—__ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire;>upply Linc [ )Please call for reinspection RE [ J Unable to inspect no access
ADA
Approach/Sidewalk 701 .
Date �, _� _ Inspector - � L �° Ext
Other - -- -
Final
PASS PART _FAIL_ I DO NOT REMOVE V-1s, inspection record from the job site.
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00132
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/3/01
SITE ADDRESS: 10340 SW HILL-VIEW ST PARCEL: 2S102CC-03200
SUBDIVISION: FRELEON HEIGHTS NO.2 ZONING: R-3.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DI700SALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES LA,:NDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DR,NIN: ft
Remarks: Alterations to plumbing for kitchen sink. _
FEES
Owner:
Type By Date Amount Receipt
WESTOVER, PHILIP S AND PRMT CTR 4l3/01 $72.50 27200100000
10340 SW M HII_LVIEW ST 5PCT CTR 4/3/01 $5.80 27200100000
10340 SW _
11GARD, OR 97223 Total $78.30
Phone 1:
Contractor:
GEORGE DAVIDSON CONSTRUCTION
7265 NW 1 131 H AVE
PORTLAND, OR 97229 REQUIRED INSPECTIONS
Phone 1: 503-643-8611 Rough-in Insp
Reg #: LIC 136682 Final Inspection
PLM 34-357PB
This 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 180 days of issuance, or if work is suspended for more
than 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You ma%, obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By:/��s��—� rl — —. Permittee Signature _
Call (503) 639-4175 b-iT.00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: Permit no.: -
City of Tigard Sewer permit no. Building g permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
Cityoffigard Phone: (503) 639-4171 Project/appl.no.: Expire date: _
Mo
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: -_�^- Case Elle no.: Payment type:
U 1 &=family lling or accessory U Commercial/industrial U Multi-family UTenant improvement
U New �i�dition/alteration/replacement U food service U Older.
111110 110 110111 U)LKI Will I L r.16 110 11M I Ell 108111111M
Job address: p a �(� iJ. l�(l ()i_ sr Description Qty. Fee ea. Total
Bldg.no Suite no.: New 1-trod 1.-ftun ly dwellings only:
(includes 100flforeachutilhyconnection)
Tax map/tax lot/accot:nt no.: _ ;FR(1)bath
I oL Block: 1 Subdivision; SFR(2)bath
Project name: _ SFR(3)bath _
City/county: Y~ Z1P: Each additional bath kitchen
Description and location of work on premises:_ Siteutilities:
i Catch basitl/area drain
Est.date of completion/inspection: Drywells/leach linc/tre:r-"grain
Footing drain(no.lin, ft.) _
Manufactured home utilities _
Business mune: 61C jP, 1004 In 6_4 r_ Manholes _
Address: , 9/ �(/!,(j // �� f� ~_ Rain drain connector
City: ?eI ' _ State: k/ I ZIP: 9 aSanitary sewer(no.lin.ft.)
Phone: i Fax: E-mail: Storm sewer(no.lin. ft.)
CCB no.: ! Plumb.bus.reg.no Water service(no. lin. ft.)-
City/metto lie.no.: Fixture or item:
Absorption valve
Contractor's representative signature:- ^ Back flow preve.nter
Print name Ca x c�tL(J1C1�S
- ——___ Dat 3 �� -Hackwatcr valve
(ON PI.IRSON
Basins/lavatory
Name: Clothes washer
_- ----_ --- Dishwasher _
Address: Drinking fountain(s) _
City: _ __ _ State: "ZIP: Ejectors/sum
Phone: Fax: E-mail: Expansion tank _
Fixture/sewer cap
Name(print): f/uz, l," oLsW Floor drains/floor sinkcAtub
Mailingaddress: 4�,J kgiL Ucc/- c' Garbage disposal
�Y�_� � Hose bihh _
City: j;9� State:(}X. ZIP: Q 7223 — Ice maker
Phone:,yvj llL' txyri Fax: E-mail: Interceptor/grease trap -
Owner installation/residential maintenance only: The actual installation Primers)
will fie matte by me or the maintenance and repair made by my regular Roof_Train(commercial) —
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: Date: Sunip V_
Tubs/shower/shower pan
Urinal
Name: Water closet a __
Address: Water heater
City; _ State: ZIP: _ Other:
Phone: �ax: E-mail: _- Total
NM all urisdlclion+rte aeeil cmdt,please can jurisdiction rm more infornutim. Plan
review
fee................
<
I t" Notice:This permit application -
U Visa U MasterCard expires if a permit is not obtained Plan review(at 9F) $
Credit cmd numlw: �__ / / - within 1 ti0 days eller it has hccn Stale surcharge(8%) ....$
V-spires
^— -- accepted as complete TOTAL. .......................$
Name or cart11to1der u shown on credit cmd
^^ CmdWdersignature "—_` s Atnoum 4404616(05MCOMI
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 24amlly dwellings amly:
FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato 16.60 for each utility connection
One(1)bath _ $249.20
Tub or Tub/Shower Comb. 16.60 Two 2 bash $350.00
Shower Only 16.60 Three3O bath_ _ $399.00 _
Water Closet 1660 SUBTOTAL _
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
�_ mT�__
LaundryTray 16.60
Washing Machine 16.60
Floor Drain/Floor—Sink 2"
3'• 7-6-6-0 0 PLEASE COMPLETE:
.
4^ 16.60 _
Waley hleater O conversion O like kind 16.60 Quandt b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
ermit. _ Capped
MFG Home Now Water Service 46.40 Sink _- _
MFG Home New San/Slorm Sewer 46.40 Lavatory
_
_ Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only _ _ _
Drinking Fountain 16,60 Water Closet
Urinal
Other Fixtures(Specify) 1660 _ Dishwasher
Garbage Dis osal
--
Laundry Room Tray—
Washino Machine_ _
_ Floor Drain/Sink:
Sewer-1 st 100' 55.00 3^
Sewer-each additional 100 — 46.40 4"
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
(Specify)
Storm&Rain Drain- Ist 100 55.00
Storm&Rain Drain-each r oaitiroal 100' 4640
Commercial Back Flow Prev,ntion Device 46.40 - —
Residential Backflow Preve,,linr Device' 27.55 —
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspectionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16 60 _---
QUANTITY TOTAL
Isometric or riser diagram Is required If
Quantity Total Is IQ _
'SUBTOTAL '—
8i/-.—STATE SURCHARGE
"PLA14 REVIEW 25%OF SUBTOTAL
_ Requli ad ony II fixture t total Is>9
TOTAL 5
*Minimum permit fee Is$72 5o.8%stare surcharge,except Residential Backflow
Prevention Device,which is S36 25 t 8%state surcharge
**Alt New Commercial Buildings require plans with Isometric or riser diagram and
plan review
1Adst9\forms\plm-fees.doc 10/10/00