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Permit CITY T I G A R D MASTER PERMIT PERMIT #: MST2004 -00126 j � DEVELOPMENT SERVICES DATE ISSUED: 10/8/2004 -' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14115 SW 89TH AVE PARCEL: 25111 AA -09300 SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R -4.5 BLOCK: LOT: 077 JURISDICTION: TIG REMARKS: New SF detached. BUILDING REISSUE: PH1020A STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 16 FIRST: 2,089 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 520 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 TI D: sf RIGHT: 5 VALUE: 209,975.60 OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 2,089 sf REAR: 15 PLUMBING SINKS: 2 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: 0 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: BOIL/CMP < 3HP: , VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN > =100K: 1 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st WO SVQFCR: 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: 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: $ 7,447.46 FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION This permit is subject to the regulations contained in the F F O R BOX ON FOUR BOX CON Tigard Municipal Code, State of OR. Specialty Codes BEAVERTON, OR 97075 BEAVERTON, OR 97075 and all cer applicable laws. Al. s l done in accordance anrace with approved ed This permit plans. This permi t will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 590 - 0805 Phone: 503 - 590 - 0805 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 71037 rules are set 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 Ersn Cntrl 681 -4444 Post/Beam Mechanica Plumb Top Out Exterior Sheathing Ins l Rain drain Insp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Water Service lnsp Building Final Foundation lnsp PLM /Underfloor Framing lnsp Gas Fireplace Appr /Sdwlk Insp Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation lnsp Electrical Final ` ' / Y Issued B : - Permittee Signature / l� Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the nex usiness d A. • Building Permit Application_ D F OFFICE USE ONLY Received / n d a , e �/ a t y0 Permit No.: f a City Of Tigard Date/By: j y: 7` l�+�rJ 13125 SW Hall Blvd., Tigard, OR 97223 , '1004 Plan Review Q Other Permit: j �� qq Phone: 503.639.4171 Fax: 503.598.1960 : L Ge n n " Date/By: /ttAti S- ) 7 y K _� ,/°2 Inspection Line: 503.639.4175 ■ �� ! I Date Ready/By: .1 uris: ® See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION -� TYPE OF'W5iiti . REQUIRED DATA 1- AND 2- FAMILY DWELLING pI New construction ❑ Demolition Permit fees* are based on the value of the work performed. Y� Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the 0M A ' CATEGORY OF CONSTRUCTION, n work indicated on this application. Valuation: $ F 1- and 2- family dwelling ❑ Commercial /industrial Number of bedrooms: 3 ❑ Accessory building ❑ Multi- family ❑ Master builder ❑Other: Number of bathrooms: 2 t ''" r� 3 , ORMATION AND LOCATION Total number of floors: ei t�2. Job site address: /y ✓J5--- .3, e„), ei.,ze Ai New dwelling area: 2 oe 9 square feet City/State/ZIP: '7'lyj t5 Garage /carport area: s60 square feet Suite/bldg. /apt. no.: Project name: Covered porch area: / 7? square feet Cross street/directions to job site: f 9 L& ' , c _3 r,, Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: " i . z , 3 Lot no.: 7 7 Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the W iiiii t~� a itAIN * � E * work indicated on this application. 0 - - C4 1 ) AW/e -L '-e- Valuation: $ Existing building area: square feet New building area: square feet 1 ,3 s i ° 1 i r . : , ,V P .,'�O �``�` Number of stories: Name: Fpc4 a STR ce c w Type of construction: Address: 7 c) „ 7 Occupancy groups: City/State /ZIP: .,,� 6 A-- Existing: Phone: (,5:::3) „c" o .. O8b C Fax: 4c4.5 ) S',O / 7,3 New: 4 ra t� tl. '' °` ;� NOTICE :.:_ �. 3 Business name: Sifr ,� 44 D (µi All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: apply: Phone: ( ) Fax: : ( ) E -mail: i Business name: ._ 1 /9-r-ag. AI), b O•.n-- BUILDING PERMIT FEES* Address: Please refer to fee schedule. City/ State/ZIP: Fees due upon application Phone: ( ) Fax:( ) Amount received CCB lie.: 7/ D3 7 / A ' Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name ,i& ��iejgp . Date:1 2/— t. 5f * Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Prnnits \BUP- PermitApp.doc 12/03 440- 4513T(I1 /02 /COM/WEB) One- and Two - Family Dwelling 'I Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Deceiv Permit No.: Y 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 �� Kb i � I 6\ 24- Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical IN I�j ! j Internet: www.ci.tigard.or.us ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 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. Name of district: ❑ ❑ ❑ 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, roofmg, 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 Ore:on and shall be shown to be applicable to the .ro'ect 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 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be 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 and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 I lectrjc Permit Application FOR OFFICE USE ONLY City of Tigard i \ / Received �1 ' an PermitNo.: / 13125 SW Hall Blvd., Tigard, OR F7123 1 V D Plan Review v Phone: 503.639.4171 Fax: 503.598.1960 1 Ainiei�,i F� � ,; P i Date/By: Other Permit: '" Inspection Line: 503.639.4175 2 'f Date Ready/By: Juris• la See Page 2 for Internet: www.ci.tigard.or.us Al-;1',), ! ! 1 004 Notified/Method: Supplemental Information P, p i ' p .s, �..: ° j; 7. 1fI . ; t . , PLAN R&VJEW El New construction aMg.#01itatdaii.61f£Ailkiement Please check all that apply: ❑ Demolition ❑Other ❑Service over 225 amps, comm'I ❑Hazardous location ❑ Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft., �° ' 1�.:itk; b 'd a of 1- and 2- family dwellings 4 or more new residential V] 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑ Other: El Building over three stories [Weeders, 400 amps or more ❑Occupant load over 99 persons OManufactured structures or W 7 ir i A � i. NWP a _" ,� :` ❑Egress /lighting plan RV park Job no.: Job site address: / y// S ' * kJ„ e A 0-t-- 0Health -car facility ❑Other: Submit 2 sets of plans with any of the above. City/State /ZIP: (S 4 1.4 p A- e2 72- 2 44 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: I Project name: aA. . " ' 7 Description I Qty. 1 Fee. Total Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: c'¢.y Af /4 1.1 9.4,-/e I Lot no.: *7 7 Ea. add'1500 sq. ft. or portion 33.40 1 Tax map/parcel no.: Limited energy, residential 75.00 2 ( Limited energy, non - residential 75.00 2 away ' . 1 t s '� s t.^ *N" ; ;, Each manufactured or modular <2 . • �� e ' 441-21...t.–• dwelling, service and /or feeder 90.90 2 ` / "� '^• / ^) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ' -4 , _ 1 a . ` 201 amps to 400 amps 106.85 2 ` '': ° : ; a > . .x '� �,,: r. ,, , � ; » ..''' x.. ' 401 amps to 600 amps 160.60 2 Name: = pt',L s-7g. 6 C7 - -e d,(1 601 amps to 1,000 amps 240.60 2 Address: 6, t. sX /5-----7 7 Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: T uL,V- 4; / 6/..-- `2 7 6 7 Temporary services or feeders installation, alteration, and/or �11) 0 eb S � b�) .5-7 relocation Phone: $- Fax: b —�S 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits – new, alteration, or extension, per panel `e: °` 4• " A. Fee for branch circuits with I` j : >. 35121111111 " service or feeder fee, each 6.65 2 Business name: .. S' R- 7 4.-Z A o U ,, branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'1 branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - w ,. e .. , �� , r .,.„ `' .� >,. .. 7 _ �, n ,:n i energy panel, alteration, or extension. Describe: Page 2 2 Business name: To17.ten - L�.�t, Address: 3 9 G..1 / / A v,� Each additional inspection over allowable in any of the above Y Per inspection 62.50 City/State/ZIP: 5a j , 01 / 6GL ?722- / Investigation per hour (1 hr min) 62.50 . Phone: 3) 2 Va 7 7s Fax: ( ) Industrial plant per hour 73.75 CCB Lic.: ?3 8R Electrical Lic.: : 3 c4._ 23 C Suprv. Lic.: 3 cpax S' Subtotal Suprv. Electrician signature, required: 1 /P 4- � .p– `mil Plan review (25% of permit fee) Print name: D at e: 4 2 1 -6 !` State surcharge (8% of permit fee) 76 `e G � u� �( T TOTAL PERMIT FEE Authorized signature: 4 -' This permit ap if a pe rmit not obtained within 180 !� c � / � ., days plication after it ex has pires been acc epted is as co mplete Print name: ( 7),Z__ 725 a , t 6,0e.✓ Date: ' Z/_ d, * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Permits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations \ Building 'Permits\ELC- PemutApp.doc 04/03 �chaniLal Permit Application FOR OFFICE USE ONLY City of Tigard Received : Permit No.: �70 _ // j7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 : 1004 ;< i Date/By: Other Permit: T Inspection Line: 503.639.4175 A ' ■ 41.- ' H _1 i Date Ready/By: Juris. See Page 2 for Internet: www.ci.tigard.or.us - �� Notified/Method: Supplemental Information CITY OF TIGAi •k r , is <' t" ; V, OMMERCI L 'FEE* SCHEDULE - USECHECKLIST Nif New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. r �. , s i * :17,4r,n 44�� `O€!R'3cf Ef3�`a6 � Value: $ RSIDENTIAL1 QUIP / SYSTEMS FEES* ® 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total , i / .r» .. � .:4. �A ,- g� ... , ,. .. Heating/cooling Job site address: /y// 5 //' � � q -� Air conditioning or heat pump �lJ (requires site plan showing placement) 14.00 City /State/ZIP: 7(L / 4 / O , Q C 72,,p__ C( Furnace 100,000 BTU (ducts /vents) 14.00 �/ Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: I Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 c? / ��! zi /44e 61,afiL Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), i( in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above 10.00 Subdivision: 0� r( I A. I Lot no.: 1 7 Other: 10.00 Tax map /parcel no.: Other fuel appliances - 4 ` a a • � s • ' Water heater 10.00 t , . ( fi t . sc,. . .' ar ; .. . Gas fireplace 10.00 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 i *.,:',..',',.--=0,,z 4 Chimney /liner /flue /vent 10.00 "O'' I , F <" tl �%! *- ;I: FL ` 2 . , t g , °, k,. ` -3 Other: _ 10.00 Name: 4 - c---2D S7, Environmental exhaust and ventilation Range hood/other kitchen Address: �(,. /5-7 7 equipment 10.00 City/State/ZIP: yf (�,_ pA- 9 7 c 7 r Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (5Zj3) .S 70. /— y -()„pG C Fax: (S .5 - 9 .(:).-- l 7-s toilet compartments, utility rooms) 6.80 ` °° Attic /crawls ace fans 10.00 j „,,, L 4 ...s. ALL 6 p,� Other: 10.00 Business name: g Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall/suspended/unit heater Phone: ( ) I Fax: : ( ) Water heater Fireplace E -mail: Range 044 7:14. . & F �i � 44 Barbecue Business name: S /14117-1'4)y Clothes dryer (gas) Other Address: /6 O / .S ' a- " , R i L1Rl - A t r. I [� 'A ,rTL1 X1fT' FEES City/State /Z1P: Fax: ( ) l 1/ L. ') b kb , IC- 7 7/2- 3 Subtotal Phone: (9s ) / 4�- " <46 � Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: 7 (ems b 7? State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: ///i65 > This permit application expires if a permit is not obtained within 180 �< SITS rn 2 days after it has been accepted as complete. Print name: N mA, X §-7�/L i., Date: 47 -2 7,- z> V • Fee methodology set by Tri- County Building Industry Service Board i:\Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /CO /M/WEB) "! Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\ Building \Permits\MEC- PermitApp.doc 12/03 2 Building Fixtures Plumbing Permit Application' . FOR OFFICE USE ONLY Receiv City of Tigard Date/B Permit No.. " 13125 SW Hall Blvd., Tigard, OR 97223 ,� y „' �w - Plan Review Phone: 503.639.4171 Fax: 503.598.1960 AN i ' NP R' �\ D ate/B • • Other Permit No.: 24- Hour Inspection Line: 503.639.4175 . • 111 L Date Ready/By: furls: 2 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information . v *: .. t FEE *' SCHE � ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) W0 s' g ` ,,a SFR(1)bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler sq. ft) Page 2 , _ '� .'� . Sit LL t111tIC5 Job site address: / (/ 5 ( �- - A' Catch basin or area drain 16.60 City/State/ZIP: 6,0 V Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 :' a0 � „ ,. d ' , s 6,: , Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 , 1 a '. .-, ' T. '� , 4 ' Drinking fountain 16.60 f , i `- .' Ejectors /sump 16.60 Name: / O�` -■ Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 . ' x - � , 4 Hose bib 16.60 .... u x `" I ce ma 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 * ° 9 , , Water closet 16.60 Business name: G' y- Z (We.."-,424.1 Water heater 16.60 Address: 1 5-92 p ,C',,S.Z --V,r� Other: City/State/ZIP: ,G/ /c S6 A /..,6 6 ic, S ubtotal Minimum permit fee: $72.50 Phone:3 ) 6 !/c,-.2.3// Fax: ( ) Residential backflow minimum permit fee: $36.25 9/ Plan review (25% of permit fee) CCB Lic.:.1 / �_� /7,07 , Plumbing Lic. no.:3 SC_ Zh State surcharge (8% of permit fee) Authorized signature: y� ..i _ _ -tr Lr- TOTAL PERMIT FEE Print name: YA i i/.. uZ.....--/ Date: Z/- -9_ (-- 6 5e This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building 'Pemuu\PLMF- PermitApp.doc 12/03 440-4616T( 10/02/COM/WEB ) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: xte ftil�ities `, � e �� q r. dotage Permit ,,ee: 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 Storm & Rain Drain - 1st 100' 55.00 p e it - Fi $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 � 3 4 � � �� e &� Fad � Il;r e�rr�� a a. s f '" cM, 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 * . 7 ilk Comments regarding fixture work: 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" - 4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley - Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i: \Building\Pemits\PLM- PennitApp.doc 3/03 CITY OF TIG/-._ ,D • BUILDING DIVISION' PERMIT #: MST2004 -00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/8/2004 Phone: (503) 639 -4171 �A "��'' °4��giuil',` I', Inspection Requests (24 Hrs.): (503) 639 -4175 __.. INSPECTION WORKSHEET FOR DATE: 6/22/2005 TIME: 7:13AM PAGE: SITE ADDRESS: 4115 SW 89TH AVE CLASS OF WORK: SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 077 TYPE OF USE: PROJECT NAME: GREENSWARD PARK NO. DESCRIPTION: New SF detached. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590.0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720 -7445 MOB. Inspection Request Scheduled For: Date: 6/22/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 009893-04 503-720.7445 N Corrections /Comments /Instructions: 1 / 1° � / ( hi 'ASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS • FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 1 r4 Date: C 2 Phone #: (503) 718 - f CITY OF TIGARD - - 1 . BUILDING DIVISION - ' PERMIT #: MST2004 -001 6 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1002001 Phone: (503) 639 -4171 ° / / /p �,1 Inspection Requests (24 Hrs.): (503) 639 -4175 .,.' INSPECTION WORKSHEET FOR DATE: 6/22/2005 TIME: 7:13AM PAGE: 2 SITE ADDRESS: 14115 SW 09TH AVE CLASS OF WORK: SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 077 TYPE OF USE: PROJECT NAME: GREENSWARD PARK NO. 3 DESCRIPTION: New SF detached. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720 - 7445 MOBI_ Inspection Request Scheduled For: Date: 6/2212005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 009893 -03 503. 720 -7445 N orrections /Comments /Instructions: l ell -- )ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: £ — 2 2 — t-Qf Phone #: (503) 718- CITY OF TIGARD . BUILDING DIVISION' PERMIT #: MST2004 00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/8/2004 Phone: (503) 639 -4171 � "' 1 � 4 �p� �� y i��i�ii� � I ' Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/5/2005 TIME: 7:12AM PAGE: 15 SITE ADDRESS: 14115 SW 89TH AVE CLASS OF WORK: SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 077 TYPE OF USE: PROJECT NAME: GREENSWARD PARK NO. 3 DESCRIPTION: New SF detached. 6/23/05: Added ANC. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 603.690 - 0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720 -7445 MOBL Inspection Request Scheduled For: Date: 7/512005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 010740-02 603- 720.7445 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 7--.S -- =d5 Phone #: (503) 718- CITY OF TICARD BUILDING DIVISION/ PERMIT #: MST2004 -00121 I 13125 SW Hall Blvd., Tigard,.OR 97223 DATE ISSUED: 10/W2004 Phone: (503) 639 -4171 °'�� "'4�� rymii, li � �` Inspec Requests (24 Hrs.): (503) 639 -4175 !J- __., INSPECTION WORKSHEET FOR DATE: 7/5/2005 TIME: 7:12AM PAGE: 16 SITE ADDRESS: 14115 SW 89TH AVE CLASS OF WORK: SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 077 TYPE OF USE: PROJECT NAME: GREENSWARD PARK NO. 3 DESCRIPTION: New SF detached. 6/23/05: Added NC. OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0805 CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720.7445 MOBL Inspection Request Scheduled For: Date: 7/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 010740 -01 503. 7207445 Y Corrections/Comments/Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Dater Phone #: (503) 718- 44 1 0 A STREET TREE C ... ® I, _�6JJ 1 D 3) ' POi23 , Owner/Agent for FO'../ _J— C-e) N,S 7 u c1/0 /I/ l ® (PLEASE PRINT) (PERMIT HOLDER) ® i y " A • ® ° ..5.. k.lf .iF A ® hr t Do e eb �.� ..e o �wi ,. location ® a 4 . � _ g ® f " - i.4 rd/"a •4g meets .. on bounty • ® l and use and development standards for street tree installation. It. ADDRESS: 1 7 / 1 5 - 3 - 9 7' A .LOT: 7 7 SUBDIVISION: (9 Sc,./..) J KO PAiLK BY: 4,i/ii DATE: 6 —2-3 -- 0 RECEIVED BY: DATE: 1 („x,7 '--- 0. ' CITY OF TIGARD Credit No.: 2004 - 000I- Date Issued: Engineering RECEIVED I4 / Authorization 1-1 R C ECE C G -mul Date: 3 -23 -04 g ?Ddb TRAFFIC IMPACT FEE CITY OF TIGARD CREDIT VOUCHER Land Use BUILDING DIVISION Casefile No.: SUB2003 -00002 In accordance with Ordinance 379 (Washington County Traffic Impact Fee Ordinance) Four D Construction developer) (name of is entitled to $ 44.194 in Traffic Impact Fee Credits that can be applied to TIF charges for development on lot(s) 1 -27 of the Greensward Park 3 Development. The use of TIF credits are subject to the rules and limitations of the TIF Ordinance which are listed on the back of this voucher. WARNING: This voucher must be presented at the time of issuance of the building permit, or if deferral was granted, issuance of an Occupancy Permit. 0_,......L, P a Director Date Permit Numbers Lot Numbers Credit Used Balance Beginning Balance $ 44,194 5 "12- --axf .24() (/- 000g 7_ SO 2.530 i 5 -i2 -oy 2a y— cresj /( 83 Z53 o l:3 �f 0 • - ei -04 X04 -OOi.J g A5 c3i7 ` / .00' 7- -g 1 - .2e6(V— i A5,30 3 • x �:7- - ec! _2.'4) - 0o/ d -Z) 3 /, '_•y. ? =2 4 . nOY `17 4;2-22._ 7 i „26 9 t ,2.6 °7L' 9 -i 7-09 2toOY —QO 189' t 4 � S3 o- `�" .,� —4+f ? l �' i Balance carried forward to TIF Credit No. • Ordinance 379 provides for an expiration 10 years from authorization. log in \viola \tif09.1