Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00009
Al DEVELOPMENT SERVICES DATE ISSUED: 1/25/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11222 SW 84TH AVE PARCEL: 1S136CB-10300
SUBDIVISION: ASH CREEK MEADOWS ZONING: R -7
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: Construction of new single family residence. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 22 FIRST: 709 at BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 905 sf GARAGE: 413 sf FRONT: 24 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 8
VALUE: $ 156,057.80
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,614.00 sf REAR: 52
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 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: 1 BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 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 PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 3 201 • 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: SIGNAL/PANEL: 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 & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,542.79
This permit is subject to the regulations contained in the
ESLINGER BUILDERS INC ESLINGER BUILDERS INC Tigard Municipal Code, State of OR. Specialty Codes and
11575 SW PACIFIC HWY 11575 SW PACIFIC HWY all other applicable laws. All work will be done in
TIGARD, OR 97223 TIGARD, OR 97223 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 62363 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 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Gyp Board Insp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Final inspection
Foundation Insp Footing /Foundation Dr; Framing Insp Gas Fireplace Appr /Sdwlk Insp
Post/!. -am Stru Loral Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final
Issue. = :. _ .� ,, if: - ,, / Permittee Signature : '
'
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed t e next business. ay
,7 1)5 / , -OZ- Bo 6r . .,
B uilding Perm it Application
Y�) I ". City of Tigard / /`� 09-- Permit no.:K� -oeae •
'� Project /app1. no.: Expire date:
City 'f Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Dale issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: I &2 family: Simple Complex: 4
• . .. • -TYPE OF PERMIT . .
O I & 2 family dwelling or accessory CI Commercial /industrial U Multi - family ,kNew construction U Demolition
U Addition /alteration /replacement U Tenant improvement U Fire sprinkler /alarm U Other:
. JOB SITE INFORMATION . .
Job address: LI? 2:7 Sw gym. 4 Y�_ Tigard G 9'1Z2 Bldg. no.: Suite no.:
Lot: Block: Subdivision: • 4 • A , e i� eCW OW Tax map /tax lot /account no.: ( C
5 3G i /6
Project name: . .5 h (,y e . p —
Description and location of work on premises/special conditions: 1.f".1. 1) tL ✓ Tcmily flDrn e....
. owigR :FOR SPECIAL INFORMATION, USE CIIECKLIST . •••
Name: E.� tI'll' r B _, 1 . _ ( Flogdplall , septic capaclly,solar,cue.)
Mailing address: //q Up, ' 1 & 2 famil y dwelling: !�) ��.1 I(' . I. t,U �Il(�, l L7� (°r ate: ,e ! ZIP:
City: . 97 . -3 Valuation of work /5 C 0 - 5 7 7 $ '� '
Phone: 6 h _ Q ' /S• �Fax:6,2'j 9 St !f 1S -mail: No. of bedrooms/baths 3 ' 2 �Z
Owner's representative: . (g fa Iwl —• , �/
yl .e I' Total number of floors
Phone: •34. - y Fax: yp(,e E - mail: New dwelling area (sq. 1i.) -
AI'PII.ICANT.. Garage /carport area (sq. ft.) ti 13
Name: E6//,14,-.0 >~'s B LA t IC, t LNLC_ . Covered porch area (sq. f t.) I1 f\
_
Mailing address: 60 VN f o . 6,{ (,) n lie J Deck area (sq. ft.) —
City: I State: [ZIP: Other structure area (sq. ft.) _WA
Phone: Fax: E -mail: Commercial/industrial/multi-family:
•
CONTRACTOR Valuation of work $
r Existing bldg. area (sq. ft.)
Business name: F idlr:/n(' Ru.1 Chia ✓ : 1 ' •' ari C. • i
New bldg. area (sq. ft.)
Address: -5,Q } 1e-d (} �, ,, «,°
Number of stories
City: State: TZIP:
Phone: I Fax: I E -mail:
Type of construction
Occupancy group(s): Existing:
no.: 6,13l , .'
New:
(' two tic. no.: • 6 Notice: All contractors and subcontractors are required to be
ARCHITECT /RESIGNER - licensed with the Oregon Construction Contractors Board under
Name: P 1 (, re lo5 me v 14,...,,x_... , provisions of ORS 701 and may be required to be licensed in the
Address: 71 2.,g SL) I < on t ri •, 1 9,0 jurisdiction where work is being performed. If the applicant is
City: "] j r 4 1 i3 Stite 2 IZIP:Q %2,;?•,3 exempt from licensing, the following reason applies:
Contact person:Br2Al 8 01,01 ( 7 ! Nan no.:
Phone:60 IF 2 7.2.5 / Fax: E -mail:
Name: r • I - 1•!)e wi e , Contact person: Fees due upon application $
Address: --SCI Irv% (so e, _ Datc received:
City: Slade: IZIP: Auwunl received $ ....-V _ ___ _____--_-
I'hoine: L1aax: I E-mail: Please relcr lu Ice schedule.
I hereby certify I have read and examined this application and the Not all jwisdiciiuts accept credit cants, please call jwisdicuun fur uuue info* naliwi
attached checklist. All provisions of laws and ordinances governing this O Visa U Mastercard
work will be complied 1, het t : herein or no . circa cad number: -1_/___
fisprres
Authorized signature: ell Date: t f l4IO/ L Name of cardholder as shown on medic card
Print name: a v
r Cardholder signature Antonin Notice: This permit application expires if a permtl -i not obtained within 180 days after it has been accepted as complete. 4-10-4613 (wtxucont)
•
Pluinbing Permit Application
Date received: / /5! D 7- Permit no.: ) 4r
" To,,,, • City of Tigard -oab9
..4.4 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: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family Cl 'Tenant improvement
New construction ❑ Addition /alteration/replacernent ❑ Food service ❑ Other.
3011 SITE INFORMATION FEE SCIIEDULE (for special Information use checklist)
Job address: 1127Z Slur $4 AYE . J ,( OR 9?zh Description Qty. Fee(ea.) Total
Bldg. no.: 1 Suite no.: 1 New 1- and 2- family dwellings only:
Tax map/tax lot/account no.: (includes 100 R. for eaclrutility connection)
3� CI IOOt3
SFR (I) bath
Lot: 7 (Block: [Subdivision: AS, ((t elf Meckdato SFR (2) bath •
Projcc: num.:: A S t- C r e e k /'1 a w 5 SFR (3) bath
City /county: Ti gqgrd 1 ‘,44 ZIP: 97 2.23 Each additional bath/kitchen
Description and I(Scation of work on premises: Site utilities:
New 51.1 14 FQ '►.. i l y N r,+., . Catch basin/area drain
Est. date of completion/inspection: 7 - - 01. - Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. tin. ft.)
Manufactured home utilities
Business name: 1 " O(Yle It,>rtll- }:21 (MC Manholes
Address: I'12. "6 `J ect Li fai (J Rain drain connector
City: 5he.44.)6x)r\ J IState:Ce 1 ZIP:Ct" WTI° Sanitary sewer (no. lin. ft.)
Phone: L - tz6Z I Fax: 1,,L - 1 1E-mail: Storm sewer (no. lin. ft.)
CCB no.: C\ ( ( !Plumb. bus. reg. no: ? - 2t..S fl" Water service (no. tin. ft.)
City /metro lie. no.: 0000 jO `?� Fixture or hem: j
Contractor's representative signature: �� r Absorption valve
Back flow preventer
Print name: 0 Ms1-- Date: IU •23 0% Backwater valve
CONTACT PERSON Basins/lavatory
Name: ik 1 f k Kri In, t Clothes washer
Address: 5a t AI qbo V-t Dishwasher
Drinking fountain(s)
City: I State: 'ZIP:
Ejectors/sump
Phone: Fax: E -mail: Expansion tank _
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name
(Print): E s l i ti, -e r f5 c, : d e r S jam r Garbage disposal
Mailing address: 1I 5A 1%, ?cx C ;f :c. Ijw po PS IG,n Hose bibb
City: T ma 1 rt State:0 K I ZIP: ( 1717 3 Ice maker
Phone: Ca icy - 94ITi IFax:(', d 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)
i
employee on the pro wn er ORS Chapter 447. S
y nk(s), basin(s), lays(s)
Owner's signature: Date: 1 / 0 1/0i. Sump
Tubs/shower /shower parr
Name: Urinal
Na
N Water closet
Address:
Water heater
City: State: ZIP: Other:
Phone: Fax: E -mail: Total .
Not all Juriulictlons swept credit cants, please call Jurisdiction for Information. lafoatioa. Minimum fee $
Notice: This permit application
❑ Visa ❑MasterCard Plan review (at _ %) $
! / wit if a days permit is not has be State end
Credit card number: ae surchar 8% surcharge
Expire( within 180 days alter it (has been g ( ) $
accepted as complete.
Nam TOTAL $
e of cardholder as shown on credit card p $
Cardholder signature Amount • 440 -4616 (6/00/COM)
L..____,
Electrical Permit Application
Date received: / /y DV Permit no.: X4 /, ,1- 7 17
w 1i" City of Tigard l Y�l � y � an ProjecUappl. no.: Expire (Isle:
Ciryuf "Iignrd Address 13125 SW 1 - lall Blvd, Tigard, OR 9722 Date issued: By: l Rccciptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory U Commercial /industrial ❑ Multi - family ❑ Tenant improvement
New construction U Addition /alteration/replacement U Other: U Partial
. • . JOB SITE INFORMATION
Job address: 11222 5 9 ti /}v . 1 TNytArd to Bldg. no.: Suite no.: Tax map /tax lot /account no.: 'Slit % CIS (00)
Lot: 7 I Block: 'Subdivision: Ash Cr•ei K Pt cc dour,
Project name: A iv, C r e , el( I Description and location of work on premises: N4 u, S i Al 14. Fa}‘ i IJ,
Estimated date of completion/inspection: - — —
... ._. .._ ^a,, CONTRACTOR - iPPLICAT ION ...:!.....,.:. -.._- ..; - .. ............ --- ..... FEE .- SCI11's-DULC...; _._..._, ._- :_.s._...-
Job no: Fee Max
Business name: D escription Qty. (en.) Total no. (lisp
. A. Jerome Electric
e e t r i C New residential -sink or nntlti- family per
Address: FD BOX 751 dwelltngunit. Includes attached garage.
City: Hillsboro I Stateo R I ZIP: 97123 Service included:
Phone: 648-5144 I Fax: 648-97 2I-mail: l oon sq. ft. or less 4
CCB no.: Each additional 500 sq. ft. or portion thereof
3 6 0 51 I Elec. bus. tic. no: 3 4 -119 [:
Limited energy, residential 2
City /metro lic. no.: 1063 Linritcd energy. non-residential 2
Each manufactured home or modular dwelling
Signature of supervising c eeuician (required) Date Service and/or feeder 2
Sup. elect. name (print): Davie j - • n - License no: • Services or feeders installation,
• alteration or relocation:
PROPERTY OWNER 200 snips or less 2
Name (print): E t t �, r ' I �� U t d 201 amps to 400 amps 2
-e t- 5 I'h C _ 401 amps to 600 amps 2
Mailing address: It 5 l�j 5 W foci iC E arc Mai ICC) 601 amps to 1000 amps 2
City: T j rd IState:a f ZIP:9 Over 1000 amps or volts 2
Phone: c a - ci r 1 ri I f ax: (n ,i Cl 11751E-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 btstallallon ,alterelion,orrelocalion
200 amps or
ORS 447, 455, 479, 7 1. 201
amps to 40 o less amps 22
Owner's signature: Date: I t s / 0'11- 401 to 600 amps 2 '
Branch circuits - new, alteration,
or extension per panel:
Name:
/ pt.
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not lrtclttded):
O Service over 225 amps - commercial . 0 Health-care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of I &2 0 I lazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal mote ucsidcntial units in one structure alters ' , Of extensions 2
O Building over three stories U Fecticrs, 400 amps or more s Description:
O Occupant load over 99 persons U Manufactured structures or KV park Each additional Inspection over the allowable In any of the above:
O Egress/lighting plan U Oilier:
Per inspec • I 1 I I
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 j urisdiction for more information.
Permit fee $
i ra p jurisdiction Notice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at ` %)
$
Credit card number: / 1 within 180 days after it has been State surcharge (8%) .... $
Expires TOTAL
accepted as complete. $
Name of cardholder as shown on credit card
Cardholder signature Amount A•10 -4611 ((ulx)/ 'OM )
I
Mecliamica' herinit Applicatioin ',, ..: , :..:.. :
Date received: / / Permit no. :1#r J j1 -( 9
>� � ` .Il
-" � +. - Cit y of Tigard - ProjccUappl. no.: Expircdalc:
City (if Tigard Address: 13125 SW Flail Blvd, Tigard, OR 97223
Phone: (503) 639 4171 Dale issued: By: I Receipt no.:
.ix: (503) 59R -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
•. ':TYPES OT PERR'lIT ..;:'..:
• • U I & 2 family dwelling or accessory U Commercial /industrial U Multi - family U Tenant improvement
I. New construction U Addition/alteration /replacement U Other:
'.' JOB SITE. INFORMATION ' COMMERCIAL .VALUATION; SCHEDULE _'
Job address: Ii 2,z z SW 5i't V4 I • iGgrel 10K q)z.Z) Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: .4 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot /account no.: / 134_,cE. 1 000 profit. Value $ .
Lot: 7 Block: Subdivision:k,J1 are )L t '0 . /xf 5_ *See checklist for important application information and
Project name: `5!n .. .- t° jurisdiction's he schedule for residential permit fee.
City /county: '£r r re ZIP: 0 0..a..3 ; &.2 FAMILY: DWELLING PE IT FEE SCHEDULE.
Descr and location t work HE
I wk on premjses: AND COMMERICALIINDUSTRIAL EQUIPMENTSCDULE
PeLt) i et e 1e T�,wat to f ���Y � ° - , .- Fec(ea.) Fatal
Est date of completion /inspection: - 1- -0 Description Qty. Res. only Res. only
Tenant improvement or change of use: IIVAC:
Is existing space healed or conditioned? U Yes O No Air handlin unit CFM
Air conditioning (site plan required)
Is existing space insulated? U Yes O No Alteration of existing IIVAC system
MECHANICAL' CONTRACTOR . :. ' Boiler /compressors
Business name: !If r State boiler permit no.:
Ex) : e. .► .,- vte
IIP Tons 13TU /11
Address: t D, 2 0x. /2. • Fire /smoke dampers /duct smoke detectors
City: /afp y) I Stanek_ IZI P: 9 0/3 I lea( 1 p (site plan required) —
Phone:abp_ j7 „q Fax: I E -mail: Install/replacefurnace/burner 13TU /il
CCB no.: (�,Q� Including ductwork /vent liner U Yes U No
I Install/replace/relocate heaters - suspended,
City /metro lic. no.: i I J 3. wall, or floor mourned
Name (please print): 0 Ill r - • X67 c 0-r” Vent for appliance other than furnace
CONTACT PERSON
r g rr on•
Ab sorption un 13TU /fI _
Name: et) f'� M, rive- n Chillers I-1P
Address: ( l 0 9tip. Compressors FIP
t' _ � Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
.. , 01 _ Hoods, Type U it /res. kitcheiihazmat
( hood fire suppression system
Name: 6 Il r v1c E. ((' Bi,l 14 ICalr'S I e rn C.. , Exhaust fan with single duct (bath fans)
Mailing addressli S 60) / p � G lli,V 'PM t 66 Exhaust system apart from heating or AC
Cil Fuel piping and distribution (up to 4 outlets)
Y: "r' rC I State: jai Z g zp�.3 Type: LPG NG Oil
Phone: Fax(,?p e '-mail: Fuel piping each additional over4 outlets
Process piping (schematic required)
N ber of outlets
Name: 1 0 /A-..
Other listed appliance or equipment:
Address: Decorative fireplace
City: I Stale: I ZIP: Insert - type
Phone: I Fax: I ma il: Woudsluvc /pcllelxlove
Oilier:
Applicant's a
signature: — I Dale: e: _ other:
Name (print): fl'h_ ,QIVVt L---1—__'..f-111-4 � - - - - -- — — — — —
Not all jurisdictions accept cicdit cants. please call jurisdiction for more information Permit fcc $
an
0 Visa 0 MasterCard Notice: 'this permit application Minimum fee
expires if a permit is not obtained $
Credit cart ber: Plan review (al
P ��) $
Expires within 180 clays tiller it has been Slate surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
TOT A L $ —
$
Cardholder signature Amount
•1.1(1 -4(17 (6AX /K:061)