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Permit ` M CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2003 -00454 4 i k A. DEVELOPMENT SERVICES DATE ISSUED: 10/14/03 - I "' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13910 SW 87TH CT PARCEL: 2S102DD - 06000 SUBDIVISION: KERR PART /MLP2002 - 00004 ZONING: R -4.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: Const. new SF detached residence. BUILDING REISSUE: MAS1111AA STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 14 FIRST: 1,595 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 433 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 157,899.90 OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 1,595 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER: 1 GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 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: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 3 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL 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: $ 7,323.39 This permit is subject to the regulations contained in the PAYS CUSTOM HOMES PAYS CUSTOM HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and 17481 SW HOODOO CT. 17481 SW HOODOO CT all other applicable laws. All work will be done in BEAVERTON, OR 97007 BEAVERTON, OR 97007 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 - 591 - 5078 Phone: 503 - 591 - 5078 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 155849 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 Rain drain lnsp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Water Line Insp Plumb Final Foundation Insp PLM /Underfloor Framing lnsp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation Insp Appr /Sdwlk lnsp Issued By : / Permittee Signature : Cg Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day !IIP. To q— JO-9 -63_ B uilding Permit Application FOR OFF10E I1SE ()NIA' Received Building Date/By: "02 03 /3 Pernut No.�,0 3 DD y5' City of Tigard RECEIVE , Planning Approval Other y g DateBy: Permit No. (?,21430 3 -o ),3., 13125 SW Hall Blvd. SEP 0 Plan Review Other Tigard, Oregon 97223 2 200 , Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 ii'� ' I > � Post - Review Land Use Internet: www.ci.tigard.or.us CITY O F TIG . -:._. ' I C 3T Case No. g Contact Juris.: See Page 2 for 24 - hour Inspection Request: S IpII71'DIVISION Name/Method: T/ U Supplemental Information 0avi — 0‘0' 1 0 ,- g h -C p'. }'' ,. x S';' '∎ ■ ®.New construction El Demolition ,s, _ _ �_ _ u ` ! ifac u .._. _ . ❑ Addition/alteration/re.lacement • Other: 3 : q t. ..' "" f'',,., zJ ,, ',' ,e ,> 5 ,,'i Note: Permit fees* are based on the total value of the work performed. Indicate 1 & 2- Family dwelling ❑ Commercial/Industrial th v alue (r t o th neares d of all equipm materials labor overhead and ou profit for the work indicated on this application. al Accessory Building ❑ Multi - Family ❑ Master Builder • Other: Valuation $ .. �' " . .. N o. of be o. o baths: 2- Job site address: t q`� $74A-. Total number of flo ... New dwelling area (sq. ft.)....k Suite #: Bld • . /Apt. #: Garage /carport area (sq. ft.) 4..... Project Name: ,( 6 Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) ,M t PQ�� it �k \ r m L�Pxo .-a000 ,,, ., ' 9 :,. a 1 x , 'g Subdivision: t�f ' r 1 Lot #: 3 � q ,,�d � � ``' Tax ma • l s arcel #: 0 2.5 0 kUJ 'o Z- 2-5I 0 , u Note: Permit fees* are based on the total value of the work performed. Indicate , - f ' a the value (rounded to the nearest dollar) of all equipment, materials, labor, �� z _ ,i _ "` ' ` ,.:1:%:':::...,, �� overhead and profit for the work indicated on this application. 1((j' /1'yl, l\/ � , I Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories : ` *., ,s , .. ..,_ Type of construction Occupancy group(s): Existing: Name: OLtc CU Fern %u. Address: • City /State /Zip: Phone: Fax NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under ' -. '; ° ° x � '1` : " = - ' 1 provisions of ORS 701 and may be required to be licensed in the Business Name: S / C �� V,�- f n, . ref r C. jurisdiction where work is being performed. If the applicant is exempt Contact Name: -is -t"A S LN►o 111) 415-504 I from licensing, the following reason applies: Address: 1 '7 4$1 clO 1400 &» && City /State /Zip: B2Aveir - f ,n 0 GZ • cvloo 1 Phone: <0-- sti. 1 SD? ?,I Fax:.Se7 - z,i of Ssbo E-mail: Arc S C61)-1-- CAS -e-, 4 a . � Business Name: F Ol.V15 Co Sr�ph1 • frV5 I le.. Fees due upon application $ Address: 0 City /State /Zip: Amount received $ Phone: Fax: Date received: CCBLic. # 53 Authorized I Notice: This permit application expires if a permit is not obtained within Signature: 6� Date: �1 � J 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03 Plan Submittal Requirement Matrix 4411 Commercial & Multi- Family oulual City of Tigard New, Additions or Alterations F. .1 I Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities 2 Building 1* Fire Protection System 3 ** Mechanical 2 Plumbing - Building Fixtures 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. is \Building \Forms \PlanSubMatrix.doe 04/03 Building Fixtures ' Plumbing Permit Application FOR OFFICE b in g ONLY Received Plumbing Date/By: Permit No.: 01570003- no V-5 Cit of Tigard Planning Approval Sewer y g 1 ^ V �� \' ED Date Review Permit No.: 13125 SW Hall Blvd. R Plan Re Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503A90-166 ') . r Post Review Land Use \ Internet: `vwrv.ci.tigard.or.us .1.1.: I i Date/By: Case No.: Contact Juris.: Z See Page 2 for 24 - hour Inspection Request: 50� / - t17)1 ,. N _ Name/Method: Supplemental Information. 11J1!..D1NG DIVISIO - .. TYPE OF WORK ' i r .' .. ' ` FEE* SCHEDULE (for special informatiiifl a cheOdist) `,. ew construction ❑ Demolition Descri s tion Qty. Fee(ea) Total n • Addltlonlalteratlon/re . lacement 11=1 Other: , : .' ' New I -: & 2-family 'dwellin t a ' , . g ncludes 100 ft for each tam ilit conn `} � , .. , .i-, ,1 .i ° a t . ' 5 SFR (1) bath 249.20 `: 1 & 2- Family dwelling • Commercial/Industrial S R ) bath 350.00 •Accesso Buildin_ ❑ Multi -Famil ath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JIB I' I • ' A I ` an' e - ii , Fire sal so . ft.: Pale 2 Job site address: t. Olt sk,) :1-E _, -. ,. Suite #: Bld_. /A • t. #: Catch basin /area drain 16.60 Pro ect Name: Drywell/leach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 4 � JA 11 Rain 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: - . ° O , Lot #: [g ` 'l /� j - Storm sewer (no. linear ft.) Page 2 Tax ma. /. arcel #: O ZS 011.00 Q Z- ZS) • 4.41M Water service (no. linear ft.) Page 2 n �,� lx #ure`or Item � �� .�. F mom I' ' _ ' . s :: , :.,.. Absorption valve 16 60 t Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ' y s. :: - -: 1; t$ � L '.a a a ,.. .� t s '_..�„'. _ f �, �� :, Ejectors /sump 16.60 _�t Expansion tank 16.60 Address: Fixture /sewer cap 16.60 Cit /State /Zi.: Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 ( v.. li _' e t)'t Ice maker I� r -. -,` p 16.60 /�i 1 ' V _ Interceptor /grease trap 16.60 Address: a S ,vJ , V • Medical gas - value: $ Page 2 --fey, _ & 2 Ci 700 Primer 16.60 Cit /State /Zi.: __a • �X \ Roof drain (commercial) 16.60 Phone: So3 S' 1 -5 - 0'7 g Fax: So 2 9 dJ Sink/basin/lavatory 16.60 = Tub /shower /shower pan 16.60 x . _' ' ;a , " Urinal 16.60 Business Name: ''t • CI V) • SEMPIIIMIMI Water closet 16.60 Water heater 16.60 Address: i 0.i. - 1.95g Other: . Cit /State /Zi.: d --, • Ftt O( ' - 1 S Other: Phone: S ") . - 5 - 150. inrirt, s a? t '. ¢I It f . m_ '>` CCB Lic. #: l S 2130 Plumb. Lic. #: - i Z �� Subtotal $ 5 al Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 Signature: Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE $ Notice This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Fornu\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: to Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation•. Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and Fixture or Item Qty., Fee,(ea) Total including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections -per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. Quantity by (Rata") Work Performed - Comments regarding fixture work: xtr T e . Replacs 4� s I Vew m Mimed` ' ,Exfsting . Capped Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash - Floor Drain/sink - 2" -3" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes - Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Fotmms\PlmPermitAppPg2.doc 01/03 Mechanical Permit Application FOR OFFICE USE ONLY Received Mechanical 3= I v Date/By: Pemvt No.: /Y\S — c 5 00 `/ S Cit Cl of Tigard L Planning Approval Building y g Date/By: Permit No.: 13125 SW Hall Blvd. 'SEP 0 2 1003 Plan Review . Other Tigard, Oregon 97223 (r' / ]-Y Date/By: Permit No.: F Post - Review Land Use Phone: 503 639 - 4171 Fai30430 - Y A� gR r ,r, � ,k Date/By Post-Review Case Use Internet: www.ci.tigard.or.us 0118s . l .� I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. µ r ; `f COMMERCIAL FEE* SCHEDULE - USE CHECKLIST. ' ►r2 New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/re • lacement • Other: performed. Indicate the value (rounded to the nearest dollar) of all L _ -: k mechanical materials, equipment, labor, overhead and profit. IM- & 2 - Famil dwelling • Colnmercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accesso Buildin: ❑Multi - Famil RESIDENTIAL EQUIPMENT /SYSTEMS;FEE* SCHEDULE Description I Qty I Fee(ea.) J Total ❑ Master Builder El Other: Heating/Cooling JOB SITE INFORMATION . an! E I t Furnace - add -on air conditioning ** 14.00 Job site address: ' I 0 5 ;MM�iNIM Gas heat pump 14.00 Suite #: Bld_. /A•t. #: Ductwork 14.00 Pro ect Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Mc Pon i tcl ( I4,,■ Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 AI r - r Z R units 12.15 Subdivision: t Lot #: Other Fuel Appliances Tax ma./ • arcel #: OZS 0 W 0 2 I ' 0 - - 1 . Water heater 10.00 ;` rI t m ' = .: Gas fireplace 10.00 _. t Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner /flue /vent 10.00 ''g t -, : ., Itlp Other 10.00 / Environmental Exhaust &Ventilation Range hood/other kitchen equipment 10.00 Address: Clothes dryer exhaust 10.00 Cit /State /Zi • : Single duct exhaust Phone: Fax: (bathrooms, toilet compartments, � All, ; _ ' � , '' ,s s A utility rooms) 6.80 %M Attic /crawl space fans 10.00 Address: 1 La \ v J o p I Other: 10.00 _ Fuel Piping City /State /Zi • : t,' . 0e_ ono 0 * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: (.1 5`1 5 '] Fax: b 3 Z 1 ' Gas heat pump ** �. Wall /suspended/unit heater ** : f' g � . t Water heater ** Business Name: 4 ' k +A, I i ey _ . Fireplace ** Address: - a tt� Z _ Range ** kill. BBQ ** Cit /State /Zi • : i . 0 E-. ci 117,4 Clothes dryer (gas) ** Phone: $o (eta I ( Fax: go S+-[) O32 Other: ** CCB Lic. #: Total: Mechanical Permit Fees* Authorized Subtotal: $ Signature: Date: Minimum Permit Fee $72.50 $ Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 z Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: i : \Dsts\Permit Fotms\MecPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MS _ 1 - v INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested ) - - `M BUP Location X Suite MEC et cC ra WS so Contact Person � Ph ( ) 7 ` � PLM Contractor s Ph ( ) to 9f ' &7/ 7 SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: 3 - oa 319 Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final Pte` T FAIL dEETM Post & Beam Under Slab Rough-In Ro� - �anita Rain Drains Catc i = - • hole orm Dra . Shower Pan Other: F • PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final P. T FAIL " ough -In UG /Slab Volta. - ire arm F Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. A PART FAIL S ❑ Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 7 11 ( 1/05. Inspector L 1 v v�`� L L Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL Electrical Permit Application FOR OFFICE USE ONLY Received Electrical Date/By: Permit No.: l6 TX 3 -0d1 C . of Tigard Planning Approval Sign y g Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 r� I V Date/By: Permit No.: 3�f ,u�- Phone: 503- 639 -4171 Fax: 5 Post- Review Land Use r dlONg hl° �� Date/By: Case No.: Internet: www.ci.tigard.or.us : � i Contact Juris.: IN See Page 2 for 24 -hour Inspection Request: 503 -639 1P5 0 " " `W .. Name/Method: _ Supplemental Information. CITY OFTIGARD "..t 44, - I'YP , - 7A' 7 ' g : ' ° T - ; PLAN REVIEW (Please check all that apply. , x "I V ►1 ew construction ❑ Demolition ❑ Service over 225 amps- El Health -care facility commercial ❑ Hazardous location • Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, i. Os CATEGORY OF CONSTRUCTION .''S':',4 1 & 2 family dwellings four or more residential units in ►�p 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Buildin ove three stories ❑ Feeders 400 amps or more ❑ Accessory Building El Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: a g Submit _ sets of plans with any of the above. JOB SITE INFORMATION and LOCA r ...w. .r ;. The above are not a licable to tem •ora construction service. Job site address: 13 5 5 C Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total 1 Cross street/Directions to job site: New residential-single or multi-family per .l dwelling unit. Includes attached garage. Service included: lin GJ pa. A 1,ka, 1) 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 L i i t 75.00 2 Subdivision: ` A-1.4. °�((� Lot #: 3 _fi cc Z m ed energy, residential Limited energy, non residential 75.00 2 Tax ma s/ s arcel #: 0 v W 62- 25 I ' 0 ..4 17.0 Each manufactured home or modular dwelling : ; '3 _ � .. iI , service d/ 90.90 2 n,- Q �� " / Services an or or feeders feeder - installation, - ,0 /3 5 t n at n1 �` I ^ Z- [ alteration or relocation: 1 J 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 , 2 a ''', :' a t 8 , € ; amps to 1000 amps 240.60 2 �l ° PR O601 O ver 1000 amps or volts 454.65 2 Name: ,�� u, r"'1 4 M.9) , 14L • Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 p=er ' r -� (I :� - (� Branch circuits - new alteration, or Name: - � /h / - _ Qo ` L - extension per panel: of Address: -1 U 5 s i s lA1 i A Fee for branch f feeder circuits each purchase ui /� �7 service or feeder fee, each branch circuit 6.65 2 City /State /Zip: j - 6Q_ G 1 ` B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: `3 cc} v ( so 9, I Fax: _Se 3 L 9, S5 Each additional branch circuit 6.65 2 r E -mail: 4 -'t S Corn. . ' ' , i -I Misc.(Service or feeder not included): Each pump or irrigation circle 53.40 2 =4 Each sign or outline lighting 53.40 2 Job No: - Signal circuit(s) or a limited energy panel, nd alteration, or extension Page 2 2 Business Name: I �f ecx �1 x leD Eigt - R U �. Description: Address: {30, 23 1Z ` i City /State /Zip: l CL i Q a .. Ol 2 23 Each additional inspection over the allowable in any of the above: `� Per inspecctioo per our (m n per hour (min. 1 hour) 62.50 Phone: 50 3 S2-1- 6000 Fax: 9D3 5 5 8 (o Investigation fee: CCB Lic. #: 153 qt Lic. #: 3 f — 1( C. other a ^ate 9 Supervising electrician Subtotal � $ signature required: _,� �/ fGw P lan Review ( 25% of Permit Fee) $ Print Name: �. CJ ' S' Lic. #: 41225 5 State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. - (Please print name) i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: Audio and Stereo Systems El Burglar Alarm n Garage Door Opener n Heating, Ventilation and Air Conditioning System D Vacuum Systems 0 Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation HVAC n Instrumentation n Intercom and Paging Systems n Landscape h Control Medical 0 Nurse Calls D Outdoor Landscape Lighting Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE / WESTERN CASCADE ELECTRIC INC PO BOX 23124 TIGARD, OR 97218 Electrical Signature Form Permit #: MST2003 -00454 Date Issued: 10/14/03 Parcel: 2S102DD -06000 Site Address: 13910 SW 87TH CT Subdivision: KERR PART /MLP2002 -00004 Block: Lot: 002 Jurisdiction: TIG Zoning: R - 4.5 Remarks: Const. new SF detached residence. 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 Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: PAYS CUSTOM HOMES WESTERN CASCADE ELECTRIC INC 17481 SW HOODOO CT. PO BOX 23124 BEAVERTON, OR 97007 TIGARD, OR 97218 Phone #: 503 - 591 -5078 Phone #: 503 - 521 -0000 Reg #: ELE 34 -616C SUP 4625S LIC 153416 AN INK SIGNATURE IS REQUIRED ON THIS FORM Signatuf&bf Supervising Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 t/ IMPORTANT PERMIT NOTICE TROY ELLIOTT PLUMBING PO BOX 1958 NORTH PLAINS, OR 97133 Plumbing Signature Form Permit #: MST2003 -00454 Date Issued: 10/14/03 Parcel: 2S102DD -06000 Site Address: 13910 SW 87TH CT Subdivision: KERR PART /MLP2002 -00004 Block: Lot: 002 Jurisdiction: TIG Zoning: R Remarks: Const. new SF detached residence. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: PAYS CUSTOM HOMES TROY ELLIOTT PLUMBING 17481 SW HOODOO CT. PO BOX 1958 BEAVERTON, OR 97007 NORTH PLAINS, OR 97133 Phone #: 503 - 591 -5078 Phone #: 503 - 309 -5750 Reg #: PLM 34 -402PB LIC 152310 AN INK SIGNATURE IS REQUIRED ON THIS FORM l - � ignat of Authorized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 - 4175 M 3 4/ CO 5< INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received 3/ .81 ev Date Requested -3/2/0 9 AM PM BUP Location /3 q/ V F 7& Suite MEC Contact Person c .dd ' I/ Ph ) ' «/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fir4,....04 rm Fin El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line j�� p� ADA Date % "2 OA Inspector v &� 1 ' � Ext Approach/Sidewalk P /'� Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Lin . (503) 639 -4175 �� INSPECTION DIVISION Business Li : (503) 639 -4171 BUP Received 3 // , G � / � 7� Date Requested 7" 0 AM PM BUP Location /3 "6 L 6 g " C Suite MEC Contact Person 4r/' Ph k5_ , 417' SD «! PLM Contractor Pd l:l1.0 ,Fyt SWR BUILDING lgnant/Owner ELC K Footing ELC Foundation Access: / n"--.9 Ftg Drain ` 1‘16"; ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors ' L j ( Lam Jt�(p Ext Sheath/Shear Int Sheath/Shear Framing T� a —Po i. 3 •1O•0 y (t<') ZSSU6 ' Insulation Drywall Nailing NL�jl L�r Firewall Fire Sprinkler Fire Alarm VZ b 1 1`.GE! Susp'd Ceiling Roof a to • SS PART 4:0 PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASQ PART FAIL 'MECHANIC &I Pos & eam Rough -In Gas Line 1E ampers PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: 0 - ess Fire Supply Line ADA / 7, � - Approach/Sidewalk Date I O I nspector _ / L A A Ext Other: Final DO NOT REMOVE this inspection re ord from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 3 -06 «s ' INSPECTION DIVISION Business Line: (503) 639 -4171 �L BUP Received3/' Date Requested - - 3 / 2 "M C I AM PM BUP Location / 9/0 a 7 Suite MEC Contact Person d d / Z - Ph ( ) '/ 75 "'- S/ PLM Contractor (U/ Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection IT es: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Roof Ceiling ,do < Roof Other: ¢- 6n) Final 1 (/ PASS PART FAIL PLUMBING .1 Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In c)/(� � / 17) Gas Line pens •".. PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line / /4(7/ 4Dproach/Sidewalk Date C� `` Inspector Est ter• DO NOT REMOVE this inspection record from the job site. PART FAIL Alk . CITY OF TIGARD Residential Certificate of Occupancy Permit No.: 1 51 Z 3 0 0 4 7S -1- / Address: 1 '7 /0 8 7 c----i Owner /Contractor: _ Date of Final Inspection: 1/ . U L Inspector: 41 _ This structure has been found to be in substantial compliance with the provisions of the State of Oregon One & Two Family Dwelling Specialty Code and is hereby approved for occupancy.