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6993 SW LOCUST STREET G q I 6993 SW Locust Street CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 63i 75 Business -ane. 639-4•, MST BUP ___ Date Requested- /U -3 AM _—PM _ 131_13 Location__ - t� Suite MEC Contact Person -•o -.�a�'- Ph ze.:; PLM Contractor Ph SWR _ FUILDINC Tenant/Owner _ ELC �t Retaining Wall �I_R Footing Access: -- ---._----_____.-_ -.--- Foundation ,p Fig Drain ; Q`.. FPS ------ Crawl Drain Inspection Notes: SGN Slab - - Pust& Beam - SIT Ext Sheath/Shear Int Sheath/Shear --- -- - Framing Insulation Drywall Nailing Firewall - - _- --- Fire Sprinkler Fire Alarm — -- -- Susp'd Ceiling Roof --- -- Misc: Final - — -- PASS PART FAIL PLUMBING -- Post& Beam - -- -- Under Slab Top Out --- - -- - Water Service Sanitary Sewer - — --- — Rain Drains Final _ -- "ASS PART FAIL MECHANICAL — Post& Beam --- Rough In Gas Line - ----- _ Smoke Dampers A Final -- —f PASS PART FAIL ELECTRICAL --- - Service Rough In - --- -- UG/Slab Vie,�•,�,�, --_ ------- — ____ Fir" RT FAIL SITE -- - Backfill/Grading --- — Sanitary Sewer Storm Drain [ ]Reinspection fee of$ _— —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please call forr nspecti n RE: _ _ — [ J Unable to Inspect-no access ADA / Approach/Sidewalk ��' � (_ Other Date -- ___-- I InspectorFxf Final PASS PART FAIL no No*r REMOVE this inspection record from the job site. CITY OF TIGARD C3'"WING INSPECTION DIVISIC MST 24-Hour Inspection Line: 6azr-4175 Business line: 639-4-171 BUP Date Requested �� -��' AM- _-PM _ BLD Location < < J �� Suite MEC Contact Person Ph PLM Contractor — Ph _ SWR BU,_DING Tenant/Owner ELC _ _- Retaining Wall ELR Footing Ices ) Foundation _ 1 �j�l FPS Fig Drain I - SGN Crawl Drain insp ction ------- Slab SIT Post&Beam Ext Sheath/Shear o Int Sheath/Shear ) r� rOS � /J Framing l/l> �-V-----'-------------------------- Insulation Drywall NailingFirewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: _ - -inal _ SS PART ---- PLUMBING Post&Beam Under SlabA /V Cl SIC �dti"tJ� C� d i Top Out Out Water Service _-_/' , /p �i-✓L� =�-�� -Y-7 t a-e �/�-G Sanitary Sewer Rain Drains �./ / ' /'r�'-a--✓� `-'�'� ��_ S PART FAIL` -- Wvu '�/ G_�`-fi��,.,� • _ MECHANICAL Post&Beam n C.-•� ---- Q - Rough In J V' (f C_�G�,--� C� d S j�/i �✓�.. Gas line V / n Smoke Dampers `�•t�t C, 4.-4• (' -,CT�� --�C - S PART NL t-Le&RICAL ServiceQe- Rough In UG/Slab - 1 ` Low Voltage Fire Alarm Final PASS PART FAIL ' SITE Backfill/Grading -- Sanitary Sewer Storm Drain 1 [ J Reinspection fee of$ _v required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin 1 Fire Supply Lin ( ]Please call for relnspedfon RE: -- ---_— ( J Unable to inspect no access Fire Supply Lil ADA Approach/Sidewalk other Date f�1� Inspector c Ext3 I . - - -i _'.,ns� -- ------ Final PASS PART FAIL 00 NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION -1 �,sT 2ov 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ',. - `- BUP _ —__Date Requested / LJ _` AM__-- PM -- BLD Z Location �� 1, 3 , St' Suite — MEC Contact. Person �-!.e��'— Ph 2f/ �� Contractor Ph SWR BUILDIN22 TenanUOwner ELC _ a'in mg Wall ELR _ F a oit'1rTq Access: Foundation C,rJ'yy1 L FPS Fig DrainSIGNN + Crawl Drain Inspection Notes: SIPb ( --�-C � - -- SIT Post& Beam ----- Ext Sheath/Shear c .. Int Sheath/Shear --� --- -----�- F-raming Insulation ------------_---------- ---- Drywall Nailing fj p L� Cea-- 1 r Firewall Fire Sprinkler Yo i-C —------ - -- - Fire Alarm Susp'd Ceiling Roof Misc: _- - n a -- _-PA'RT,, GAIL --- __ ING Hearrr Under Slab INA Top Out Water Service z Sanitary Sewer �J Rain-Drains PASS PART FAIL _ ANICAL Post& Bram --- Rough In Gas Line -- - --- Smoke Dampers Final -- — PASS PART FAIL ELECTRICAL - - Service Rough In ,-- UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE ------ -- Backfill/Grading --- - Sanitary Sewer Storm Drain I )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 p': ( )Unable to Inspect-nt%access ADA ApprOther Date /d�Inspector Ext Final PASS PART __tALLJ 00 NOT REMOVE this Inspection ret.ord from the job site. A CITY OF T'IGARD _ _MASTER PERMIT DEVELOPMENT SERVICESPERMIT#: NIST2001-00190 DATE ISSUED: 4/18/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 06993 SW LOCUST ST PARCEL: IS136AA-09100 SUBDIVISION: VENTURA ESTATES ZONING: R-4.5 BLOCK: LOT: 013 JURISDICTION: TIG REMARKS: Construction of new single family detached residr_nce. Path 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS _ REQUIRED SETBACKS REQUIRED _ CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1.322 of BASEMENT: of LEFT: 13 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,305 of GARAGE: 598 of FRONT: 20 PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 9 OCCUPANCY GRP: R3 SDRM: 3 BATH: 3 TOTAL: 2,62800 of VALUE: $245,127.00 REAR; 36 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHErS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS; TUBISHOWERS: 3 GARBAGE DIEP: 1 WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: MECHANICAL OTHER FIXTURES: FUEL TYPES _` FURN<100K: ROIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYER: I GAS FURN 0-10OK: 1 UNIT HEATERS: HOODS: I OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADU'L INSPECTIONS 1000 SF OR LESB 1 0 - 200 amp: 0 209>mt,: WISVC OR FOR: 1 PUMP/IRRIGATION: PER INSPECTION: EA ADO'L 500SF: 5 201 400 amp: 201 •400 amp: 101 W/O SVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 •600 amp: 401 600 amp: EA ADDL OR CIR: SIGNAUPANEL: IN PLANT: MANU HMISVC/FDR: 801 - 1000 amp: 1101+ampa•11000v: MINOR LABEL: 1000+amp/volt: Reconnect only: PLAN REVIEW SECTION -4 RES UNITS: SVCIFDR> 225 A.: >800 V NOA'_nAL: CLS AREA/SPC OCC ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 9 STEREO: X VACUUM SYSTEM: AUDIO 9 STEREO: FIRE ALARM: INTERCOM/PAGING- OUTDOOR LNOSC LT: BURGLAR ALARM: X OTH BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,098.84 WINGATE CORP This permit is subject to the regulations contained in the 15840 S POPE LANE Tigard Municipal Code,State of OR. Specialty Codes and OREGON CITY, OR 97045 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 the work is suspended for more than 180 days. ATTENTION Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg N: forth in OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to REQUIRED INSPECTIONS OUNC by calling(503)246-1987. Erosion Control Insp 8, POst/Beanl Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final Sewer Inspection PosUBeam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Footing Insp Undr rfloor Insulation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final Foundation Insp Crawl Drain/Backwater Elerf1cal Service Low Voltage Water Line Insp Final Inspection Wtr Proofing Bsm't Wa Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Building Final Issued By : _ 1 E -`_ Permittee Signature : y� Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next !,uEiness day CITY OF T I GAR D SEWER CONNECTION PERMIT_ DEVELOPMENT SERVICES PERMIT#: SWR2001-00133 13125 SW Hall Blvd., Tigard. JR 9722' (503) 639-4171 DATE ISSUED: 4!18/01 PARCEL: 1 S136AA-09100 SITE ADDRESS; 06993 SW LOCUST ST SUBDIVISION: VENTURA ESTATES ZONING: R-4.5 BLOCK: LOT: W3 _.____—JURISDICTION: TIG 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 permit Owner: A� Ff_ES WINGATE CORP Type By Date Amount Receipt 15840 S POPE LANE OREGON CITY, OR 97045 PRMT CTR 4/18/01 $2,300.00 27200100000 INSP CTR 4/18/01 $35.00 27200100000 Phone: 503-793-8895 Total $2,335.00 Contractor: Phone: Req #: Required Inspections 1-his Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503) 246-1987. Issued by: _ _ _ Permittee Signature:_— Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Permit A Permit no.:l�5jx,-' -W/ City of Tigard Expire date: Cityn(TiGard Addre:, '125 SW Hall Blvd,Tigard,OR 97223 --- Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no. Payment type: Land use approval: !__ __ 18c2 family:Simple Complex: I!U I & 2 family dwelling or accessory U Commercial/industrial U Multi-family New construction U Demolition I &ition/alteration/rcplacernent U Tenant improvement U Fire sprinkler/alarm U Other: Job address: VACJI 5 A`. - 5 BlcJg.no.: Suite no.: Lot: Block: Subdivision: y��J;.A �,S rR-�E.S Tax map/tax lot/account no.: 15 i Alk -Ci l O'0 Project name: - _ _�- Description and location of work on premises/special conditions: MIA "e::� , Mailing address: IC 1 &t family dNclling; Cit v T Slate:Q ZIP: 5 Vrluation of work 71�' � Phone: OG Fax:�`� -y E-mail: No.of bedroomstbaths................................. r Owner's reprcsentativc: - y , - jS Total number of floors................................. _ Phone: "}�1 ` S :> Fax: E-mail:`"'moo New dwelling area(sq.ft.) .......................... t _ 11 Garage/carpott area(sq. ft.)......................... Los-Z- Name: f '. Covered porch area(sq.ft.)......................... L- �-- - Deck area(sq.ft.) mailing address: City: State: ZIP: Other structure area(s . ft.)......................... _ Phone: i Email: Commerelal/iedintriai/multi-family: Valuation of work............................ ...... $ Existing bldg.area(sq.ft.) . ......... ............ Business name: CA-alL New bldg.area(sq.ft.) Address: _ Number of stories.............. .............. -- City: State: ZIP: Type of construction........ ......... .,.......... Phone: Fax: 13-mail: Occupancy group('): Existing: CCB no.: cAlAIP16 New: _--- City/metro lic.no.: Notice:All contractors and subcontractors are required to lie licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Namesoar's - --- Address: L c 3 jurisdiction where work is being performed.If the applicant is ' exempt from licensing,the following reason applies: City: ) �'t N U State:O _ ZIP:11 f LLS Contact pereon: t.- Plan no.: -- Phone:Zcj Fax: I ►nail: — Name: r=j .o.e_R- Er'EA r,14-JUntact person: ,9 Fees due upon application .......................... $ Address: i u b o rJ u.1 w Date received: City: c' t-A N� Stater(?_ ZIP:cl„q Z.Z 1" Amount received ......................................... R R � —_ Please refer to fee schedule. Phone:may; '��'{ Fax: E-mail: - hereby certify 1 have read and examined this application and the Na ell jurisdictions rTW credit cards,please call jurisdiction for more information. attached checklist.All provisions of laws and ordinances governing this U Visa U Maaterlard work will he complied with,whether specified herein or not. Credit card"nmhcr: J - - Expires Authorized signaturr.:C�_'Af; IDate: �tf 2_L Nme c car ohkr as shown on credit cud Print name: '(4, r_T 17 >Qs t G rl S Cardholder slpwum S Amount Notice.'Phis permit application expires if a permit is not obtained within 190 days after it has been accepted as complete. 440.461.1(6MCOM) One- and Two-Family Dwelling �3uilding Permit Application Checklist Reference no.: -- –'— City of Tigard Associated permits: Address: :3125 SW Hall Blvd,Tigard,OR 97223 (l Electrical U Plumbing U Mechanical Phone:Phone: (503) 639-4171 — Fax: (503) 598-1960 III I OLLOWING I I FIIS A1ltFMEQIr FOR PLAN , Ves. No NIA 1 land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. — -- 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or au'horization for remodel.Existing system capacity 6 Sewer permit. – -- 7 Water district approval. 8 Solis 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 be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate lull-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. I I Sitelplot platy drawn to scale.The plan must show lot and building setback dimensions;property ccmer elevations(if there is more than a 44 elevation differential,plan must show contour lines at 2-11.intervals);location of easements and driveway;f(x)tprint 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. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent sire and location. 13 Floor pians.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbin E fixtures,balconies and decks 30 inches above grade,etc. i 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-flotm wall construction,roof construction.More than one cross section may he 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 additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than f-)ur foot at building envelope. full-sine sheet addendums showing foundation elevations with cross references are a.:cc table. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive pati• analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Pmvide plans for all floors/roof assemblies,indicating member sizing,spacing,and beating 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 Energy Code compliance. Identify the prescriptive path or provide calculations.A gas-piping schematic is required for four or more appliances. _ 22 En%ineer's calculations.When required or provided,(i.e.,shear wall,rcxtf miss)shall be stamped by an engineer or ••.rchitect licensed in Oregon and shall he shown to be applicable to the project under review. 2:•1 Five(5)site plans are required for Item I I above. Site plans must be 8 1/2" x 1 I"or 1 I" x 17". 24 Two(2)sets each are required for items 16, 19,20&22 nbove. 25 Building plans shall not contain red lines or tape-ons. 26 No rolled,reversed or mirrored building plans will be accepted. 27 -- 28 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. eut.4e14(60WOM) Mechanical Permit Application -- _-� Date received: ,�IfCj/ Permit no.:��j� / City of Tigard Project/appl.no.: Expire date: Citvq(Tigard Address: 13125 SW Hall Blvd.Tigard.OIt 97223 Phone: (503) 639-4171 pate issued: By:-1Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: Building perniii no.: 1 U I &2 family dwelling 0l';trccssnry U Commercial/industrlal U Multi-family U Tenant improvement jr7New construction U Addition/alteration/replacement U Other: _ 1 SiTE INF'OkMAT)ON1 Joh address: f;,Cici 6 s�-:t_rL .GW ; Indicate equipment quantities in boxes below.Indicate the dollar Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax Iot/a"ount no.: 16 13b rApt -p 3 1 pp profit.Value$ _ Lot: I I 1131ock: Subdivision: T,)aA "-,)pts *See checklist for irnportent application information and Project name: jurisdiction's fee schedule for residential permit Ice. City/county:Tftc>> Ayilr*4-0 ZIP: Ct�''LZ� MIUM Description and locatio.a of work on premises: S Fia r l 'w _ I 1 1 f -- Fee(ca.) Total Est.date of completion/inspection: Ilk-wripllon "Y. Rtn.only Res.ouly Tenant improvement or change of use: e Airhandlin�unit _ CFIvi Is existing space heated or conditioned?U Yes U No Aircondiliuning(siteplan require ) —- -- Is existing space insulated?❑'t'es U No A teration ofexisting- ITVAT sy.9tem 1 rn er compressors - Business name: State boiler permit no.: ._.tAEAnNista. W Ca, HP _Tons-_BTU/H Address: ifopUp t,, r I _ ire/smoke ampe-r uctsmo a detectors City: A State:(DZIP: eat pump(site p an req-tiT"-ij-- -- Phone: ' < < Fax: E-mail: nsta l7iep ai eefurnace/ urn�— / - ~ t r Including ductwork/vent liner U Yes U No CCB no.: _ Install/rep ac relocate caters-suspen ed, Cily/metro lic.no.: wall,or floor mounted Name(please print): Will f' appliancet anor of er urnace Rcfrigcrat on: Absorption units_ _ BTU/H Nance: Chillers lip - Address: Com ressors HP - - - -- ENV1ea ex st an vent at on: City: - Stale: �.I!'. Appliance veni Phone: E-mail: Dryer exhaust OWNER lino s,Type /Wires. tc en azmat hood fire suppression system Name: Exhaust fan with single duct(bath fans) Mailing address: x a u s t s stem a art from satin o-i�C - Fuelpiping an( 41t u 0 outlets) city: _ Stale: ZIP: �y�; LPG NG oil Phone: Fax: E-mail: Fuc tin each additional over outlets - Process piping(schematic recti, Number of outlets Name: Other listed appliance or egti)pment: Address: Doc:orative fireplace City: Stag_: Inscrt-type - Phone: Fax: &mail: Woodslove/pellet stove --- __ of er. _ Applicant's signature: r D7at _ 0 1 ter: - Name (print):��cs,r-r r�t,►t, -- - -Not nil Judkilclionv accert credit cards,please call Jurisdiction for marc infmmatinn. Notice:` Permit fee.....................$ UVis a UMaslclCard if permit application Minimum fee.............. .$ Credit card number: expires If a pCllnll IS not obtainedPlan review(at %) $ expires within 180 days after it has been Wine Stale surcharge(896)....$ _ e o as cr oldrr shown o, edit ` accepted as,complete, TOTAL .......................$ ---- Cardholder signature Amount MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE. Description: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code _ Qty (Ea) Amt $5,001.00 to$1u,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or Including ducts&vents 1400 fraction thereof,to and includinrl 2) Furnace 100,000 BTU+ $10,000:00. Including ducts&vents 11.40 _ $10,001.00 to$25,000.00 $148.50 for the first$10.000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or including vent _ _ 14.00 fraction thereof,to and Including 4) Suspended heater,wall healer $25,000.00. or Floor mounted heater _ 14.00 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or _ 6.80 fraction thereof,to and including 6) Repair un!ts $50,000.00. 12.15 _ $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond fracti.)n thereof. __ _ footnotes below. Comp" •+ _ �_ 7)<3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU _ _ 14.00 _- Value Total 8)3-15 HP;absorb - unit 100k to 500k BTU_ 25.60 Description: Q Ea Amount 9)15-30 HP;absorb Furnace to 100,000 BTU,including 955 unit.5-1 mll BTU _ 35.00 ducts&vents 10)30-50 HP:absorb Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU _ 52.20 ducts vents 11) Floor umace includingvent 955 unit >11.75 absorb -- unit>1.75 mil BTU 87.20 _ Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM - floor mcinted heater 10.00 Vent not Included in applicance 445 13)Air handling unit 10,000 CFM+ Hermit _ _ ___ 17.20 Repair units 805 _.� 14)Non-portable evaporate cooler <3 hp;absorb,unit, 955 10.00 to 100k BTU 15)Vent fan connected to a single duct 3-15 hp;absorb.unit, 1,700 6.80 101k to 500k BTU 15-30 hp;absorb.unit,501k to 1 2,310 18)Ventilation system not Included in mil.BTU appliance permit 10.00 30-50 hp;absorb.unit, 3,400 17)Hood served by mechanical exhaust 10.00 1-1.75 mil.BTU _ -- >50 hp;absorb.unit, 5,725 18)Domestic Incinerator^ 17.40 Air ha mil.BTU 19)Commercial or Industrial type Incinerator Air handling unit to 10,000 cfln 650 _ 69.95 Air handling unit>10,000 cfm 1,170 20)Other units,Including wood stoves Non-portable evaporate cooler L446 1000 Vent fan connected to a so Ingle duct 21)Gas piping one to four outlets Vent system not included in 5.40 a liance permit 22)More than 4-per outlet(each) Hood served by mechanical exhaust 1.00Domestic incinerator Minimum Permit Fee 572.50 SUBTOTAL:Commerclal or Industrial Incinerator Other unit,Including wood stoves, 658 _ 8%State Surcharge $ Inserts,etc. _ Gay piping 14 outlets 360 - 25%Plan Review Fee(of subtotal) $ Each additional outlet -_ 63 Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: 3 VALUATION: t7Jher Inspections and Fees: 1. Inspections outside of normal business hours(minimum charge-two hours) $72.50 per hour 2 Inspections for which no fee is specifically Indicated (minimum charge-half hour) $72.50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-ono-half hour)$12 50 per hour "State Contractor Boller Certification required for units+200k BTU. "Residential A/C requires site plan showing placement of unit. is\dsts\forms\mech-fees.doc 10/11/00 Plumbing Permit Application Datereceived: ,^r,�, �/ Permit no.: City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard.OR 97223 -- City(!fTigard Phone: (503) 639-4171 project/appl.no.: Expiredate: Fax: (503) 598-1960 Date issued: — By: Receipt no. Land use approval: Case file no.: payment type: U I &27fannitily dwelling or accessory U Commercial/industrial '-I Multi-fanlily U Tenant improvement Gil Ncl� mction U Addition/alteration/replaceittent U Food service U(ober: JOB$11TEINIA TION Job address: 1�,C�CkZ� �� W� l7escri tion Qty. 1'(Y(ca.) 'total Bldg.no.: Suite no.: -- Nen 1-and 2-family dwellillg-i only: Tax map/lax lot/account no.: 1S 1. 6 AA_.p 100 (includes 100 ft.fi►reachutllityconneclion) SFR(1)bath Lot: 1 Block: Subdivision: (Lpk eSj-0T FR(2)bath - - ---- _-_-- -_-_ Project name: SFR(3)hath City/county: R Zip: il L Each additional badi%kitchen -^- -- Description and location of work on Siteutilities: Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain -- Footing drain(no.lin. ft.) Manufactured home utilities -- Business name: ,�►, �w rAty>,,Iill ko_) _ Manholes — --- Address: - Ill Il Rain drain connector City: J t t2- State: A ZIP: Q l Sanitary sewer(no.lin,ft.) �— Phone: ' o -tr, ;-5•' Fax: E-mail: Storm sewer(no.lin. ft.) -- CCB no.: j�C,'j�Z Plumb.bus.reg.nog -4 Water service(no.lin.ft.) - City/metro lie.no.: Fixture or Item: Contractor's representative signature: - Absorption valve Back flow preventes _ Print name: �(y Date: ' 2�, o Backwater valve Basirs/lavatory - Name: _,M , r y� Clothes washer - — -- Address: rDishwasher -- Drinkingfountaia(s) City: State: ZIP: Ejectors/sump - Phone: 71?, y 3.I Fax: E-mail: Expansion tankoiii - '- Fixture/sewer cap _Name(print): Floor drains/floor sinks/hub _ Mailing address: Garbage disposal Hose bibb City: A_ State: ZIP: Ice nicker Phone: Fax: Email interceptor/grease trap ` Owner installation/residential maintenance only: The actual installation Primer(s) - `- --will b.:made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property 1 own as per ORS Chapter 417. Sink(s),basin(s),lays(s) --- - t'hvncr's signature: _ _ Date: _ Sump - Tubs/showcr/shower pan Name: Urinal - - -- - - -- Water closet Address: - - - -- Water heater - ---- City: State: ZIP: Other: Phone: Fax E-mail: -�� Total Na all jurisdictions acceln credit cards,please call jurisdiction for more infonnaliatMinimum fee................$ Notice:'Phis permit application -- O Visa U MasterCard expires if it permit is not obtained Plan review(at ._- %) $ -- ('redN cant number: within IRO days after it has been Stale surcharge(8%)....$ ircr TOTAL •••••••••••••••••••••••$ accepted ascom tete. A Name e><cardholdrr as shown on credit cord Fxp — � P p Cardholdrr signature S Amount 4404616(WlCOM) PLUMBING PERMIT FEES: -� PRICE TOTAL New 1 and 2-family dwellings only: I FIXTURES (individual) QTY (eaL AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink - 1660 the dwelling and the first106 ft. OTY (ea) AMOUNT Lavatory -- 16.60 for each utiII!Y cconnection) Tub or Tub/Shower Comb. 16.60 One 1 ball _ _ �J_______ $249.20 -_ Two(2)bath _ _ _ $350.00 Shower Only 16.60 Three 3 bath I _$399.00 Water Closet 16.60 - - �SUBTOTAI. Urinal 16.60 8%STATE SURCHAr<GE Dishwasher _ 16.60 _ PLAN REVIEW 25%OF SUET,OTAL _ Garbage Disposal 16.60 1'JTAL Laundry Tray 1660 _ Washing Machine 16.60 YY Floor Drain/Floor Sink 2" 16.60 3" 16.60 --- PLEASE COMPLETE: 4" 16.60 Water Heater O conversion O like kind 16.60 _ Quantiy b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Remov_ed) ermit. - - -- - _Capped MFG Home New Water Service 4640 Sink _ MFG Home New Son/Storm 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 �- Other Fixtures(Specify) - 16.60 Urinal Dishwasher _ Garbage Disposal LaundryRoom Tray Washing MachineFloor _ v Sewer-1st 100' 55.00 - -Drain/Sink: 2" - 3„ -- - Sewer-each additional 100' 46.40 - 4" --- -- ---- Water Service-1at 100' 55.00 Water Heater --- Water Service-each additional 200' 46.40 Other Fixtures Storm 8 Rain Drain• 1st 100' 55.00 (Specify) - Storm 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 -_ Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 - - - - Inspection of Existing Plumbing or Specially 72.50 Requested Inspections _ erlhr_ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 _ _ Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required If --- - uuanlity Total is >9 'SUBTOTAL 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL -- --- `--_ -_ � ----- ---- Required only II fixture qty.total Is>9 TOTAL $ 'Minimum permit fee Is$72.50+8%state surcharge,except Residential Backflow Prevention Device,which Is$36 25+8%elate surcharge. "ATI New Commercial Buildings require plans with Isometric or riser diagram and plan review I:\dsL9\forms\plm-fees.doc 10/10/00 Electrical Permit Application �Y Datc received: City of Tigard Projecl/appl.no.: Expiredate: City nfTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 6394171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: U I &2 family dwelling or accessory U Commercial/industrial U Mulli-lamiiy U Tenant improvement W New construction U Addition/al(eration/replaceren( U Other: U Partial JOB SI I IN11:01011AIJON Job address: Bldg.no.: Suite no.: Tax map/tax lot/account no.:l SI' • A Lot: i Block: Subdivision: N7 i Ll u- i Project name: I Description and location of work on premises: S r(L r.► t?stimated date of completion/inspection: CONTRACTOR Job no: Fee Max ion Desert t, � � t L, P Qty. (ca.) Total no.ImpBusiness name: New residential-single or multi-family per Address: C6'2,q SL IPP-+ T=Jlr'_ _ dwell)^¢,unit.Includes attached garage. City: t Slater)P— I ZIP:LAI ZZ-L Service,included: Phone: Fax: E-mail: 11x10 sq.fr or less _ 4 Each additional 500 sq.ft.or porting thermf - CCB no.: Elec.bus.lic.no: Limited energy,residential - 2 City/melte lie.n0.: Limited energy,non-residential 2 .r 1 Fachmanufactured homeormodular dwelling Signature of suftrvising electrician(required) Date ,zm lr Service and/or feeder 2 Sup.eleci,uarric(print):17n.1� r. , Mc R_ jIAcenseno: Z6J)7,j Services or feeders-installation, alteration or relocation: 200 amps or less 2 Name,(print): 201 amps to 400 amps 2 - - 401 amps to 600 amps 2 Mailing address: - _ 601 amps to 1000 amps 2 City: State: _ Z01: — -- Y Over 10(10 amps or volts 2 Phone: Fax: E-mail: Reconnect rinly l - Owner installation:The installation is being made on property I own Temporary services orfeeders- which is not intended for sale,lease,rent,or exchange according to lnstallanon,alteretion,orreloestion: ORS 447,455,479,670,701. 200 amps m less 2 201 amps to 400 amps 2 Owner's si nature: [)ate: 401 to 600 ams 2 NoUll Branch circuits-new,alteration, oe extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit _ 2 City: Slate: 71P: B. Fee for branch circuits without purchase + -- -- of service or feeder fee,first branch circuit: _ 2 Phone: Fax: Email: Each additional branch circuit: Misc.(Service or feeder not Included): 7Se- ver amps-commercial U Ncahh-carrfacility Each pump or irrigation circle 2 amps•rating of ,ic2 U Hazardouslocation Each sign or outline lightings ❑Building over 10,000 square feet four or Signal circuil(s)of a limited energy panel, volts nominal more residential units in one structure alteration,or extension* _ _ _2_ ❑Building over three stories U Feeders,400 amps or more *Description: _ ❑Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable In any of the above: ❑Egress/lightingplait U Other: —,_,- Perinspection r= T—�-- Submit__sets of Alam with any of the above. Investigation fee •rhe above are not applicable to temporary consiruction service. Other Not all Jurisdictions accept ctedh ratds,please salt Jurisdiction fa more information. Notice:"is permit application Permit fee.....................$ U Visa U MasterCard expires if a pennit is not obtained Plan rev%ew(at _ %) $ Ocdit card number:_ _ _ L_-_1within 190 days rifler it has been State st,rcharge(8%)....$ _ 1`'xl'irc' accepted as complete. TOTAL $ Nance of can$io�er in shown nn credit card S Carp, 'der signalure Amount 440-4615(~0M) 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 allowed) (FOR ALL SYSTEMS) Service included: Items Cost Totai y Check Type of Work Involved: Residential-per unit �I 1000 sq fl.or less _ — $145.15— 4 L I Audio and Stereo Systems Each additional 500 sq fi or portion thereof _ $33.40 1 ❑ Burglar Alarm Limited Energy —__ $7500 --- Each Manut d Home or Modular f'-1 Dwelling Service or Feeder $90.90 _ 2 LJ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less _ _ $80 30 2 Vacuum SyStPms' ❑ 201 amps to 400 amps $106.85 — 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps _ $240.60 2 E] Other Over 1000 amps or volts _ $454.65 _ _ 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alleration,or relocation Fee for each system......................................................... $75.00 200 amps or less $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 amps _ $100.30 2 401 amps to 600 amps — — _ $13375 _ 2 Check Type of Work Involved: Over 600 amps to 1000 volic, see"b"above. ❑ Audio and Stereo Systems Branch Circuits ❑ New,alteration or extension p,3r panel Boiler Controls a)The lee for branch circuits with purchase of servke or Clock Systerns feeder fee. Each branch circuit _�— $6.65 _ _ 2 ❑� Mata Teiecommunicatlon Installation b)The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46 85 _ _ ❑ Each additional branch circuit v� $6.65 HVAC 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 circuit(s)or a limited energy panel,alteration or extension — $75.00 ❑ Landscape Irrigation Control' Minor Labels It 0) $125,00 _— Each additional Inspection over ❑ Medical the allowable In any of the above Per inspection —_ $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73,75 _ �_� Outdoor landscape Lighting' Feer: ❑ Protective Signaling Enter to� I of above fees $ Other 8%State Surcharge $ _ _— ^--_Number of Systems 25%Plan Review Fee No licenses are required 1_Icenses are required for all other Installations Sr+e"Plan Ravi 3w-section on $ f(ont of application _--- --------------- ----- Fees: Total Balance Due $ ---- Enter total of above lees S_ ❑ Trust Account# 8%State Surcharge Total Balance Due i:\fsts\fumistcic-fecs.doc 10/)9/00 Cc, og9� 6� LociST Sr. IS �3� A — 09100 1" reX 5PO 6TtPM S� � /^ � 69.03' ——- 0;" —— FS Fj�,Frfl CAse�rl[ l I ` y qoo ' I I v9IJb `J9��,_ e2 6.7 4,1 9.75 �49�„— f� CITY OF TIGARD 13125 S.W. HALL. BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE I M PLUMBING 411 HARNEY WAY VANCOUVER, WA 98661 Plumbing Signature Form Permit #: MST2001-00190 Date Issued: 4/18/01 Parcel: 1 S136,%A-09100 Site Address: 0699:► SW LOCUST ST Subdivision: VENTURA ESTATES Block: Lot: 013 Jurisdiction: TIG �:oning: R-4.5 Remarks: Construction of new single family detached residence. Path 1 Your company has been indicated as the plumbing contractor 'or the permit ins; .sated above. In order for the plumbing permit to be valid, please have the appropriate individual fr,)m your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, I%TTN. Building Dept. No plumbing inspections will be authorized unti; t, completed form is received OWNER- PLUMBING CONTRACTOR: WINGATE CORP I M PLUMBING 15840 S POPE LANE 411 HARNEY WAY OREGON CITY, OR 97045 VANCOUVER. WA 98661 Phone #: 503-793-8895 Phone #: 310-2083 Reg #: I IC 115262 PI M 37-357ob AN INK SIGNATURE IS REQUIRED ON THIS FORM/ i Signature of Authorized Plumber If you have any questions, please call (503) 639-4171, ext. 4 3'10 CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00516 13125 SW Hall Blvd., Tigard, OR 97223 (5C3) 639-4171 DATE ISSUED: 10/11/01 SITE ADDRESS: 06993 SW LOCUST ST PARCEL: 1S136AA-09100 SUBDIVISION: VENTURA ESTATES ZONIN O: R-4.5 BLOCK: LOT: 013 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAWS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTUFZES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Irrigation backflow prevention device. Owner: _ —_ ___ FEES Type By Date Amount Receipt WINGATE CORP --- — 15840 S POPE LANE PRMT GTR 10/11/01 $36.25 27200100000 OREGON CITY, OR 97045 5PCT CTR 10/11/01 $2.90 27200100000 _ Total — $39.15 Phone 1: 503-793-8895 Contractor: I M PLUMBING 411 HARNEY WAY VANCOUVER, WA 98661 REQUIRED INSPECTIONS Phone 1: 310-2083 RP/Backflow Preventer Reg #: LIC 1152.62 Final Inspection PLM 37-357pb 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 riot 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 oy 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) 2.46-1987. Issued By<<_ �_� _L w�, -- Permittee Signaturey1�. Call (503) 639-4175 by 7:00 P.M. for an inspection needed'the no') u ess day Plumbing Permit Application City of Tigard Date received: t"It, r Permit no.:/G��-t1�Si Address: 13125 SW Wall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: CirynfTigard phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 A /1 Date issued: By,b Receipt no.: T '/ ('ase file no.: Payment type: Land use approval: y ❑ I & 2 family dwelling or accessory U Commercial/industrial ❑Multi-family U i inert iniproecmr•nl U New construction ❑Addition/alteration/replacement U Food service J t 1hcr. Job address: �r 9„3 „S/ G n (LS - Description Qt Fee(ea.) Total Bldg.no.: Suite no.: _ New I-and 2-family dwellings only: Tax map/lax lot/account no.: (includes 10011.for each utility connection) SFR(1)bath 1.0t: Block: Subdivision://Z,7 4 S SFR(2)bath - - --- — - Project name: _ SFR(3)bath City/county: ZIP: Each additional bath/kitchen -- Description and location of work on premises:. Sheutilities: Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain Footing drain(no. lin. ft.) Manufactured home utilities Business name: j41 101 u/t1�jHr Manholes Address: Rain drain connector City: r:ir, State:40A ZIP: , (f, Sanitary sewer(no,lin.ft.) Phone: -931 Fax: I E-mail: Storm sewer(no.lin.ft.) CCB no.: d2 Plumb.bu.;.reg.no: Water service no.lin.ft.) - City/metro lic.no.: -- Fixture or Item: Contractor's representative signature_ Absorption valve _ % Back flow pmventer Print name: , ( �_ Date: tea - I I-o i Backwater valve Basins/lavatory Name: Clothes washer _ Address: - Dishwasher Drinking fountain(s) City: ^� State: IIP: Ejectors/sump Phone: Fax: Gmrail: Expansion tank Fixture/sewer cap Name(print): Floor drains/floor sinks/hub —- ----- Garbage disposal Mailing address: [lose hibb City: State: 7,IP: Ire maker Phone: Fax: —�E-mail: Interceptor/grease trap _ Owner installation/residential maintenance only: The actual installation Primer(s) will he made by me or the mainteimrice and repair made by my regular Roof drain(commercial) _ Phone- employee on the property I own as per ORS Chapter 447. Sink(^.) hasin(s),lays(s) — Owner's signature: Date: _ Surri Tu>�hower/shower pan -- Name: l rinal -� Address: Water heater City: _ State: 7.IP: Other. Phone: Fax: E-mail---- Total Not nil jurisdictions accept credit cards,please call jurisdiction for more inrormaaon.v Notice:This permit application Minimum fee................$ U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ _ Credit card number —Ft/ Ire within ISO days ager it has been State surcharge(8%)....$ q? P —L_ S -- accepted as complete. TOTAL .......................$ � Name of cardholder es shown tm credit c�� p p --�--- Cardholder signature Amount 440616(610n/l"OM) PLUMBNG PERMIT FEES: PRICE TOTAL New 1 and 2-famlly dwellings only: FIXTURES (individual) QTY ea —_AMOUNT (Includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT ,6.6o for each utility connection_ Lavatory ^�— _—_ One�1)bath —_ $249.20 Tub or Tub/Shower Comb 16.60 _Two 2 bath $350.00 Shower Only 16.60 Y Three(3)bath —�—_-- _— $399.00 _ Water Closet 16.60 — _ — SUBTOTAL Urinal 16.60 8X STATE SURCHARGE Dishwasher 16.60 — PLAN REVIEW 25%OF SUBTOTAL _ TOTAL Garbage Disposal 16.60 --- - ---- Laundry ,Yay. 16.60 Washing Machine �— 16 60 `lnorDrain/r lour Sink 2" _ — 1f 60 PLEASE COMPLETE: 4"--- 16.60 — _ --- Quantity bFReplaced erformed Water Healer O conversion O like kind 16,60 Gas piping requires a separate mechanical Fixture Type: New Moved Removed! Capped permit. --- "AFG Home New Water Service 46•r0 Sink MFG Home New San/Stom Sewer 46.40 TubLavorr — _ _— Tub or Tub/Shower Hose Bibs 16 60 Combination — Roof Drains — 16.60 Shower Only Dunking Fountain 16.60 Water Closet _Urinal — Other Fixtures(Specify) 1660 Dishwasher - -" Garbage Disposal — _ — — -- Laund Room Tra - - _ Floor Drain/Sink: 2" _ Sewer 1st 100_— — 55.00 3" Sewer-each additional 100' 46 41.1 — 4 — _W11- Service-1st 100' 55.00 — Water Heater _ _ — Other Fixtures Water Service-each additional 200' _ 4640 _— �S eci Storm$Rain Drain-1,t7100' 55.00 --_ — Storm B Rain Drain-each additional 100' P27.55 6.40 —_— — Commercial Back Flow Prevention Device 6.40 — Residential Backflow Prevention Device' 5Calch Basin6.60 _— Inspection of Existing Plumbing or Specially 72.50 Requested Inspections _— __2ermr —,_—_ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 --- Grease Traps ---- -- 16.60 -- --- --- _ -- QUANTITY TOTAL Isometric or riser diagram Is required 11 Quanilty Total Is >9 -- "SUBTOTAL — -----------——_—— ---- 8%STATE SURCHARGE -- — -- — "'PLAN REVIEW 25%OF SUBTOTAL _Required on-ly II fizlur� total�s>9 _____ TOTAL "Mlnlmum permit fee is$72 50+8%stale surcharge,except Residential Backflow Prevention Device,which Is$36 25+8 state surcharge "All New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. is\dsts\forms\plm-fees.dnc 08/29101 % I CITY OF TIOARD Re,v1dential Certificate of Occupancy Permit No.: a Address: Owner/Contractor: ��M G A --- _ --- —— --—-- bate of Final Inspection: �L Inspector: e�,�► — This shucture has been found to he in substantial compliance with the provisions of the State of Oregon One& Two Family Dwelling S ecialt y Code and is hereby arovedfor 0ccuP-1 nn