Permit >\ - MASTER PERMIT
CITY TIGARD PERMIT #: MST2002 -00147
.Jli DEVELOPMENT Tigard, SERVICES 639 -4171 DATE ISSUED: 4/18/02
SITE ADDRESS: 14225 SW 128TH PL PARCEL: 2S109AA -04800
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
REMARKS: S/F Path 1 Mark out tree conservation area.NO CONSTRUCTION of any kind in this area.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,361 sf BASEMENT: sf LEFT: 16 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 972 sf GARAGE: 537 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 5
VALUE: $ 231,387.60
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2.333.00 sf REAR: 17
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 • 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNALJPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps•1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,491.51
This permit is subje MASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUCTION the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes and
15435 SW ASHLEY DRIVE 15435 SW ASHLEY DR all other applicable laws. All work will be done in
TIGARD, OR 97223 TIGARD, OR 97224 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 #: LIC 69010 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS .
Erosion Control Insp & Post/Beam Mechanical Electrical Rough In Gas Line Insp Water Line Insp Final inspection
Grading Inspection Underfloor insulation Framing Insp Gas Fireplace Appr /Sdwlk Insp
Sewer Inspection Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final
Footing Insp Plumb Top Out Exterior Sheathing Insr Gyp Board Insp Mechanical Final
Post/Beam Structural Electrical Service Low Voltage Rain drain Insp Plumb Final
ousyry
Issued By ;S' _ __-_, ., � _4_s �. .1 Permittee Signature : y C I A -t '" ----
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
5wrzaaoa_-00 /6Z
A Building Permit A plicati ®n = ' k L , , .. r ,T , ,,,, : `y .: - , . <
V �l of Ti d Date received: di / ( oz.. Permit no :/nSTa0 � _ / (17
: _ : Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 --) Case file no.: Payment type: /
j v
Land use approval: i%. - - � �..=- 1 &2 family: Simple Complex:
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❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi - family 7. ew construction 0 Demolition
❑ Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
4�-' + t p r e ,F d a e ta r C: x�� t �� A±4'; ” 4 F, ,r a e'' } S
,�'.?_'-V.i``^�"' : V . :14` »1'�ec.:,. : »1.. t �'i a 44 : 1 . JOBSI7EINH9,0.1A 17ON:• 3 ,' rw`�'�x- .,,,,,- _. ti I.l'` c.c- .�s. l- ' 7`�l'�`1
Job address: 1 L f , r S (,t/ /0-�j P7: . Bldg. no.: Suite no.:
Lot: / - I Block: (Subdivision: Cc ( q y_.. i i r, I Tax map /tax lot/account no.: /07 , _ 6 y� 0 0
Project n e: i -3 J O y/ I
Description and location of work on premises/special conditions: A/ �� t:- - 0 M-- c
, ` ° OWNER '' -.7 J; ' h011 S PECIAL INEORM '171ON •:USE CH1 CKLIST
Name: V h L. ,,:..%(, V . 1 ' ` f , ( septi ":4"-' apa , s olar, e ! , -s. � ,:
Mailing address: / C lI 3 �- cS' tr... j t.. 1' kt, i 1 & 2 family dwelling:
'-r g f
City: lwd IStat . ZIP: q 7 Valuation of work $231 3Y
Phone: � -5'5' ) IFax:5' V t-37/T Z E -mail: No. of bedrooms/baths 3 $
Owner's representative: ,4 11 (2 t, 0 A Lr'F- (rat -'f 1, Total number of floors 2
Phone: Fax: E -mail: New dwelling area (sq. ft.) 2....3 3 .3
, =APPl (CAN I : , k G- -. , -1. « F Garage/carport area (sq. ft.) 3.3 7
Name: r /9 -AN c Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.) -'/'V /
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: CommercialindustriaUmulti- family:
- s
CONTRACT OR f ;
, ,,. ,,: • ;:.. . .._ Valuation of work $
Existing bldg. area (sq. ft.)
Business name: c519- ■New bldg. area (sq. ft.)
Address:
Number of stories
City: I State: I ZIP:
Type of construction
Phone: 6Fax: I E -mail: Occupancy group(s): Existing:
CCB no.: (, / Col New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
' , ARCIII11 CT /Dl S I GNER '' licensed with the Oregon Construction Contractors Board under
Name: t h IC (7 �� }-�"r provisions of ORS 701 and may be required to be licensed in the
Address: ..< L..) . S it, 1. C P' jurisdiction where work is being performed. If the applicant is
City: -r V !a � `- w Star 'ZIP: 77 0k 7..../
exempt from licensing, the following reason applies:
Contact person: /1&, ., (L- Plan no.:
Phone: , • $ e Fax. yl -mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ visa 0 MasterCard
work will be complied�w,t�h,, wh r sp cifred he in or not. Credit card number: / Expires /
Authorized signaturd'J( Date: —2 `r �` �� Name of cardholder as shown on credit card
Print name: i 1 Its 1 IA/ Cardholder signature $
y � Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00/COM)
One- and Two -Fa ' y Dwelling w ,,
Building Permit Application Checklist Reference no.:
City ofTigard City of Tigard Associated permits:
b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
•tTIIEFOLLOWING ITEMS ARE RE UIRED:FOR PLAN =REVIEW x �,�� ;'� ,Y
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 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 ❑ plan ❑ 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 be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. 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.
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 additions 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, indicating 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 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review. - --
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" 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 "Drawn 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. 440 -4614 (6ro0/coM)
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El l ee eal` Iltt k rapplIcati®Hli � �i : n` ,,, w ; x i [ +EGA„ 'v4 r` g iG „ 'T' ri *stk i
Date received: Permit no.: 2 067
;143 City of Tigard ProjecUappl.no.: Expire date:
GityofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
:.3''F <,a ." 4, .'rt. r n S :n i� krvs.�,�a. T � o , ; }#t F' 6 - J 1 . i , , 1eA rsf =`^�iC�' f r . k: ? 4I, i.. '} 'f, i SkM , a .v�s r a
, .. , f„ n , ! .; y�x!�.. s. a"f 7' l P, . O - T PLItA1I I � ,° 4 i . 4 , r.v �1. i t
■ �:���. i �'.r',�s.s ?..-. H. M, r.. 2t+ 46+ 3; i 1 �. �' n�A 1iW�"` k':_: tM' JV1+ i�k�a., R��. ...- �»�.�{esvi's:�.e- , a.._. , �� „ ,r�l at.;��.afi.rtY ,�7 ...�Y�_b r:i'. , .:F �3 ... tI`
1Q 1 2 family dwelling or accessory LI CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement
New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
K •i 4 t - e'� . , a a fi l s r. , .. I 1 r5 ' ii4t`. [ i` � �; hT : -. [ 7 � "• eti �'' ti O n 1,, M
1 r r JOI3'ITE INIORMATION MAY' } - w:i.i � htr, ,D : „ r
t �
��'., v .:;.._ �s:t�.SYF4...sv' ?rte ia„ � w. �� � w �:' v' t. �^. a ? .k « �....:�•.a., .x. x.... A�:,� ._i tk,f! �i;r - � �.
Job address: - 1_7' 1 — S ■A-1 t T o _ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: :lock: Subdivision: E- WIEMEILEtaill.111M11.
Project name: Description and location of work on premises: i o
Estimated date of completion/inspection:
4 ! - 1rdk-i ., A vAiif, IC ,ks " '` � yt.gq r v n t r r , l 'S
ELC a.,t' qr °t ='' , z
4 - ; , ri+ , r GONTIt A CT > t � � y�i ..,, ,..-, . ,a ., _, _ >,> � ^ , f no ` ,ok
.apf, � �. ��. -.: -. , ,� "z. ..�,.�.. s..a -. . ,e u, � ., �,, ., .,:+P „P .c .. ,. -: t.Y "�� }�tJ �. _ s ..,
Job no: Fee Max
Business name: • • ? L ete—f /Z& S r Description Qty. (ea) Total no. insp
■ New residential - single or mull- family per
Address: I '\ `' dwelling unit. Includes attached garage.
City: . tit_ t, 1(M ZIP: Service included
Phone: , — k ( Fax: E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof ___—
CCB no.: ,, S _ Elec. bus. lic. no: — / Limited energy, residential ___ 2
, City /metro lic. no.: Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder ■■■ 2
Sup elect name(print) C� ye,A C License no (0( Serncesor feeders — installation,
alteration or relocation: Mil
�r[•r. rs ;7 p ' ;V 4 . 4 s `7 ,c. P NQPER7-Y OYVNLII; r , , lngns- it «-7y,�, r 200 amps or less 111 2
Name (print): z. le— ' l t r OK— 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: ( S q l, 0 9-.' k • 601 amps to 1000 amps ___ 2
EMISIMMENIMINIMEMEM ZIP: .:-.L.,-L, Over 1000 amps or volts ___ 2
Phone: Z, Fax: E -mail: Reconnect only __ 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation , alteration, orrelocalon:
200 amps or less . 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps I=M_ 2 rEl ' 4 4 . . • iE NGINEERs` ` ;if , , Branch circuits- new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ..1 2
Phone: Fax: E -mail: Each additional branch circuit: ___—
PLAN 12LVILW (Please cc heck all that apple') : misc. (Service or feeder not included): ME
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1 &2 ❑ Hazardous location Each sign or outline lighting MEM 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ISM
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* - 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Descri . tion:
❑ Occupant Toad over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 - 4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: s
• 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 Total `, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n A udio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n G arage Door Opener
Dwelling Service or Feeder $90.90 2
•
Services or Feeders 0 Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 n V acuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n 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, alteration, 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 $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ri HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 �
Each sign or outline lighting $53.40 I i Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n O ther
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $ •
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms\elc- fees.doc 08/30/01
Pl»bing Permit Application , -, . , _t , _ =
Datereceived: P e r m i t p 7 Oa - 00N 7
1:'; jF.. City of Tigard � � � City � Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
� - r ;e r '�^}�' + T PL OE I M IT I� � � � r ti
6� t�.. -#'3 ?_��` ' .- ? ' " �''� f ES�'y,'K. �dY��,. 5.. � -_ 1 ._ -: _ ER .,_ K S }_� t �' Z^ ' €`�' t� y ^� ,- � t ,N . _. � :„ y `F'h
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
M t _ J Stit' NFORMATION is ` ,�:. .';'''''''' , 7, : " FFE SCIIEDULE s pecial information use checklist)`F
Job address: ^Z2 c ,S t.�.� t2 d ' p Descri 1 tion Qty. Fee (ea.) Total
Bldg. no Suite no.: New 1- and 2- family dwellings only:
(includes 10011. for each utility connection)
Tax map /tax lot/account no.: Z .S a' kg. fa-- — tj , U . SFR (1) bath
Lot: r' Block: Subdivision: c -L : '),— SFR (2) bath _
Project name: SFR (3) bath _ -�
City /county: \ q,1, " ZIP: ' .Lw Each additional bath/kitchen I=
Description and location of work on premises: �1 Q �C Site utilities: ■-.
(1 Catch basin/area drain
Est date of completion/inspection: Drywells/leach line/trench drain _
p , ' PLUMBING CON RACTO r ' '21- , 4 a Footing drain (no. lin. ft.) _
°' .: r ' . : - ' Manufactured home utilities _
Business name: / t - t P ' V P t w Manholes
Address: ( L " W t, - 5 T ArMill Rain drain connector =
City: , 1.., Eli - Statetk- ZIP: ' t Sanitary sewer (no. lin. ft.) ME
Phone: ,L _ ,, 1 ', Fax: E -mail: Storm sewer (no. lin. ft.) .
CCB no.: SEEM Plumb. bus. reg. no: ,3 _ __ _ , Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item: ■-.
Contractor's representative signature: Absorption valve
Back flow preventer _
Print name try- ie Al gq Date: Backwater valve
� � ', ,, ",-;' ■ '' = PLIt SQIN` .k± ` a_ „ ,rL ,r Basins/lavatory =I
Name: Clothes washer MI
Address: Dishwasher MI
-�
Drinlcing fountain(s) MI
City: State: ZIP: Ejectors/sump =
Phone: Fax: E -mail: Expansion tank _
° ', ' '' - OWNER , ' Fixture/sewer cap � ME
Name (print): L %A-3 e` - / L C. - Lill IA- j , Floor drains/floor sinks/hub
Mailing address: WI, (5 �. lc_ j - !� Garbage disposal =
Hose bibb
City: l R., - EMEME ZIP.' 2` Ice maker = --
Phone: ISESERILI Fax: E -mail: - Interceptor /grease trap =
Owner installation/residential maintenance only: The actual installation Primer(s) =
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
IIIIII
Owner's signature: Date: Sump =
Tubs/shower /shower pan
Urinal =
Name: Water closet _
Address: Water heater =
City: State: ZIP: Other:
Phone: Fax: E -mail: Total Mill
Not all jurisdictions accept credit cards, please call jurisdiction for more information- Notice: This permit application Minimum fee $
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete. ,
$
Cardholder signature Amount 440 -4616 (6/00/COM)
PLUMBING PERMIT FEES: •
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) 6 " , - .QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink '' • 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /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
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3 „
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & 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 62.50
Requested Inspections per/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 > 9
*SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
Required only if 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% state surcharge.
** All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:\dsts \forms\plm- fees.doc 12/26/01
• ' Mechanica t Application 't :,, " {?- ° , : < :, , �, t � L ,,, 4. , f , ®�
Date received: Permit no.: `, /Ilk
F y .1'1 ,', City of Tigard
. 1. - Project/appl.no.: Expire date:
Ciry ofTigard Address: 13125 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: *: Building permit no.:
, yy
} '� t Y j, - `dh W. .,V Y 4 , 0 'L ' C t� ti ' 4 - - r.9 , 7
1 ,, b+ i i- Gv e ) ;?;�� 1 M r 4:? s,4, 6 T ; 1 PLr t 0I I , ER1V11T ' , :.
�^ ,: - „, ti .a' k ,: C ,,s _.r . ' S r ,�.. F 4
`�.., , � ^';
, , , - ,0
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family • 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
„„...1, a . '-'. "' -i' r j s , ? , arJ013 SI,I I ; , INI;ORM ATION ,' ° r . � f -' v� COMME:RLIAL-VALUAT ;SCHEDULE L .4
Job address: 1 t- 'Zr _T l.J (2_t a Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: S t 0 O -( - V ■ profit. Value $ .
Lot: ( - Block: u • • 'vision: alg *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: t A..- ZIP: ' S -2 FAIVII11' D 1 ELLING PERM ITzFEEsSCIIEDULE, ky�
cANDCOMMERICAL /INDUSTRIAL EQUIPMPNTSCIIEDULE'
Description and location of work on premises: n,�, a.; 1 .�, ff _ ; � ,,,_ ,c,-.,..!.... -,,,4,.,,.:-„, ,; .� A „_ .:�,. ,a
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res.only
Tenant improvement or change of use: HVAC:
III --
Is existing space heated or conditioned? 0 Yes ❑ No Air handling unit CFM
Air conditioning (site plan required) -
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
iiii
i I1,ILCIIAIVICALj'CON s Boiler/compressors • Stae boiler permit no.:
II■■
Business name:
State boiler
HP Tons BTU /H
Address: :" t a ( . L Z_ Fire/smoke dampers/duct smoke detectors —
_- r ZIP: ' Q Heat pump (site plan required) - MI
Phone • 0 ■ • -5 - ._15 1r E -mail: InstalUreplacefurnace / burner BTU /H ■
Including ductwork/vent liner LI Yes 0 No
CCB no.: (.{
Install/replace/relocate heaters- suspended, ■--
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace =
Y r Rb p Absorption units BTU /H n: ■
� ' i : ; (ON CAL 1-Pl R SON ' `' r 4 Absorption u __
Name: C F Chillers HP MI
Compressors HP (
Address: Environmental exhaust and ventilation: III
City: State: ZIP: Appliance vent
Phone: Fax E-mail: Dryer exhaust =
I OWNER , ...:_,..',1,,,- = i ;; Hoods, Type U II/res. kitchen/hazmat _ —
- - - hood fire suppression system
Exhaust fan with single duct (bath fans) -
Mailing address: /c-) 1, 5 (.-•-. 19 , Exhaust system apart from heating or AC I=
State: 6t_ ZIP: uel p pmg an . drstnbu on up to 4 outlets) Ill
Type: LPG NG Oil
Phone: '4-u Fax: E -mail: Fuel . i • ing each additional over 4 outlets I=
[ r : LNG I N I .... , . :, -, ;i,? _ Process pip 1 g (schematic required) -
Name: Number of outlets
Other hst , apphance or equipment:
Address: Decorative fireplace ■
City: State: ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove — —
Other: =
,.._ ,�,1
Applicant's signature: Okles2 Date: , -t � --bti - 0th. _
Name (print): A, etti- ► s ,_,G0 t, -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained plan review at _ %
Credit card number: Ex ire wi th i n 180 days after it has been ( ) $
Expires State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount j 440-4617 (6100/COM)
fi
t
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION PERMIT 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 $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$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 heater
$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 units
$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
fraction thereof. footnotes below. Comp ••
Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit
$ to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 - 50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >5OHP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM
10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Fumace to 100,000 BTU, induding 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Fumace > 100,000 BTU induding 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor Fumace induding vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, induding wood stoves
101k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.1. 75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfrn 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1 170 1 Inspections outside of normal business hours (minimum charge -two hours)
$62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Other unit, induding wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes. additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge-one-half hour) $62.50 per hour
Each additional outlet 63
State Contractor Boller Certification required for units >200k BTU.
TOTAL COMMERCIAL $ **Residential A/C requires site plan showing placement of unit
VALUATION: All New Commercial Buildings require 2 sets of plans.
i:ldsts\forms\mech- fees.doc 12/26/01
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS, OR 97015 -1429
Electrical Signature Form
- -- Permit # :__MST2002- 00147 _ - -- _ - _
Date Issued: 4/18/02
Parcel: 2 S 109AA -0480 0
Site Address: 14225 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot: 014
Jurisdiction: TIG
Zoning: R -7
Remarks: S/F Path 1 Mark out tree conservation area.NO CONSTRUCTION of any kind in
this area.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
MASTERPIECE CONSTRUCTION INC GAGE ENTERPRISES INC
15435 SW ASHLEY DRIVE PO BOX 1429
- TIGARD, OR - 97223 — — CLACKAiviAS, OR 97015=1429 -
Phone #: 503 - 267 -6730 Phone #: 503 -657 -0142
Reg #: L 34544
ELE 3 -128C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising Erectrician
If you have any questions, please call (503) 639 -4171, ext. # 310
ELEVATION CERTIFICATION
PER SECTION 710.1 of the OSPSC CITY OF TIGARD
3510.1 of the OTFDSC OREGON
THE UPSTREAM MANHOLE RIM APPEARS TO BE ABOVE SOME OR ALL
OF THE FIXTURE SPILL RIMS IN THIS STRUCTURE. INFORMATION IS
NEEDED ON THE ELEVATION DIFFERENCE FROM THE MANHOLE TO
THE LOWEST FLOOR CONTAINING PLUMBING FIXTURES TO
ESTABLISH THE NEED FOR A BACKWATER VALVE(S) AND TO
DETERMINE WHICH FIXTURES NEED TO BE PROTECTED FROM
BACKFLOW. OBTAIN AND SUBMIT WRITTEN DOCUMENTATION TO THE
CITY OF TIGARD BUILDING DEPARTMENT WITH THE FOLLOWING
INFORMATION:
LOT NUMBER
SUBDIVISION Elt /`70 r -e -
ADDRESS / r 2 /2-r z .
PERMIT# Iii t 200 00 /V 7
A TRANSIT SHOT ON (DATE) /'Z - Q 2 - HAS VERIFIED THAT THE FIRST
UPSTREAM MANHOLE SPILLRIM IS � ? c HGI OR LOWER (CIRCLE
ONE) THAN THE LOWEST FINISH FLOOR ELEVATION.
DATE
PLUMBER
/3 o Z
DATE S - —
JOB SUPERINTENDAN
ABOVE INFORMATION ACCEPTED AND APPROVED BY:
INSPECT ai DATE -/
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
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1 I, F\ \\ ‹. 1N\ a ` 0 , Owner/Agent for
1 (PLEASE PRINT) (PERMIT HOLDER)
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Do hereb cer`tif Y that g the following location
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City of Tigard /Was ,
meets :Cihington County
44 ® land use and development standards for street tree installation.
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25' -1— ^j2(
ilf p›.
ADDRESS: 22 cS `` „ ��.: _ _ 'p e
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1 LOT: l SUBDIVISION: C I k & 0)'
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RECEIVED BY: DATE:
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Lir>tey (503) 639 -417 MST 2 -e d / '4 7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /( 1 7 AM PM BUP
Location 1 `7 Z 2 - S �� P Suite MEC
Contact Person Ph ( ) /SD ��S PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing Q /��' �/� ��dt/ /0 /
Foundation ELC
Access:
Ftg Drain ,/ o . ,e=C% ELR
Crawl Drain
Slab Inspection Notes: I 7 SIT
Post & Beam C. G�
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof —:
Other:
gip AMIN/
SS PART FAIL
Post & Beam
Under Slab mom\
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan - --
Other:
Final
P • • FAIL
=ID
Pos -- :": -am
Rough -In
Gas Line
- D a m p e r s
`' PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 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 /7/7/ Approach /Sidewalk Date Inspector r 0 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST Z-G
•
INSPECTION DIVISION Business Line: (503) 639 -4171
• BUP
Received Date Requested ` "Z / AM PM BUP
Location j q 7 2-‘) 5 4 - - 7 2 , 6 / 1 7- '— Suite _ MEC
Contact Person Ph ( ) . S ' 5) ' PLM
Contractor F,ac`4} j Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain � � J • v
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam VV
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain • SV3
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PA RS PART FAIL
aE1 ECTRIC -Ij
Service
Rough -In
UG /Slab
Low Voltage
're Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'PAS) PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA D t1i Inspector /-"W d ( Ext
Approach /Sidewalk ` V p ,��j�
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL