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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00232 i, DEVELOPMENT SERVICES DATE ISSUED: 9/1/2004 4 — 2 --- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15155 SW 94TH AVE PARCEL: 2S111 DB -KE226 SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R -4.5 BLOCK: LOT: 026 JURISDICTION: TIG REMARKS: New SF BUILDING REISSUE: BVH2342 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 21 FIRST: 970 sf BASEMENT: sf LEFT: 15 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,372 sf GARAGE: 528 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 TURD: sf RIGHT: 5 VALUE: 229,23120 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,342 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 - LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 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: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 ELECTRICAL • RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS 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: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVCJFDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: 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: $ 7,742.88 This permit is subject to the regulations contained in the BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES Tigard Municipal Code, State of OR. Specialty Codes 6932 SW MACADAM AVE # C 6932 SW MACADAM SUITE C and all other applicable laws. All work will be done in PORTLAND, OR 97219 PORTLAND, OR 97219 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. Phone: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 152235 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 Mechanical Plumb Top Out Exterior Sheathing Ins F Storm drain Insp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Gas Line lnsp Water Line lnsp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service Insp Building Final Foundation Insp PLM /Underfloor Framing Insp Insulation Insp Appr /Sdwlk Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain Insp Electrical Final Issu d By : k \ Permittee Signature : : 'o Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day z Building Permit Application - . FOR OFFICE USE ONLY .. , ` , City of Tigard • @@6e��� ������ DateB d /f G % ,v Permit No.:\\/\ z/y0y --0/A,7 13125 SW Hall Blvd., Tigard, 0" ' Plan Review �re� Phone: 503.639.4171 Fax: 503.598.1960 � i dl HG � I�ti Date/By: MA,/ • •, - 7 - O'1 Other Permit: c (� M.2176 5, .�11,�2�✓ Inspecti Line: 503.639.4175 AUG 13 2004. �-_ Date Ready/By: is" 2 See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: oar , Saris- Cr Supplemental Information , v^ ; r .i -i „X;, .. , ;, :' a y c :;R' , ,-, . zY tom' , ..& - t2 . _ -,,, ,,: r fI 1.i { " b : x �. f ''"RE D 1, A1� " FA IV III 1' W. !IL L IN G EfNew construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ,,E „ ":3 „ s;et' * >;�a ='� ., ? ° °r, :, ;:.y ���/ £ , 1 g CATEG©RY¢ a SIS IOgra _ W , '' work indicated on this application. V 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: 1 ❑ Master builder ❑ Other: Number of bathrooms: ' 1., ,. JOB7SITL IENFOR'M.�TIO AND. LOCATION. Total number of floors: Z a.�`Ziu, 'd.'4. '��r... a.. ,? >'.�x.d �..:� 5. ..,. ,.... «� . = �a�. °ars . .rte.. _b_ , o E.. ,.. °<__,� Job site address: 6 — f ,iii-L, .A- �'7 New dwelling area: ) square feet 2 3 v2 City/State /ZIP: ' -`,; c, a j 772 2 3 Garage /carport area: L `N square feet Suite/bldg. /apt. no.: Project name: )c . s/e v FE,4 ? Covered porch area: 6 square feet 0 Cross street/directions to job site: Deck area: p square feet Other structure area: n square feet : REQ RCIAI ' 'iUSE,,CBE,C KLIST. =x'Sb4 kr.'.3 .i_'.oYF.$..'fit:: ^,,a,, :: :, ,",m:, h. ,..k..$4... 4:- ..o-,i ,,vy:fr.. y :, .,,, , . Subdivision: " ) i.e ` & E7 V---e 1 I Lot no.: 2 Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the " ... J �14"' ' DES . „ O �'ORK01 - ' A work indicated on this application wd J ',, t� 1-6 1 r� Valuation: $ rv) 1 . ri c 1, .•v� .t.� 6 l i- , P n✓ Existing building area: square feet New building area: square feet • ” PROPERT ' OWIV�ER" . r �_ �. w����.;.,_.; �... x;�o,.:.�;�.�<.��::::.e- ..�,.. =1�� :��. _ ��'r> NAI\rT in k.4 Number of stories: Name: 1) �,F h V L ((16,.., An /1 yr o n' om e. Type of construction: .— Address: , q 7 2 � So) - &-t�, 3 i0 tA.vv. /T e 5,,�F Occupancy groups: (, P y gr P l0 s City/State /ZIP: 13, p 0 P ei 7 2/ g Existing: Phone: (653) L i/ ZJ 4 6 5 Fax: ( ) New: :*�,y, � � ,�, � f, z �� . � `� . � . 'rt ', a. �" � , "s�' =° "�t�:�;<4'�` �. �; «s����r:' :.i�� - , 't',`., E� 5,,, ..` "�' t . IVW §.: w r"�' " a t9 4¢ $ "._, ", ; :. . `,.':` . qu...: " ��: xt,7,v.�.im v.s_v _-*if SI x - V,� . 1,V - 1iIi x ®< , •,-A,? n.. ,CONTACT`PERSO ?. ., e.t .' , I ,,,,f, .,: w : : u�, .a :ms s N'.r.. za.. >:dk»�k'z., ' z.= ,.,r: §:a��t�xY s�.wa.:.,,., ,ra._ . �ai,,c #..t. ,:Y ".•, .: . ,_ ?z".... �:' _:" ' `'s; = „,, , lY� ..„ u,�s r ,4..y,;., , �� `�'�,, ,,.� ,s.,:.:'�r�: F, :''r.�".'M ^:� ��' i, �.; v�,+ •+:'. � z-.= .�C� •'»:+.c.:xaY*;+�.s.,, w; ,. ; ° Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax: : ( ) E -mail: tor imm_ C T g 7 � n .. .,. w . , .ON E . „g . t. i. : , r , E iii _ . � i...., Business name: r > s , w ,, �f r a. ?w x _ r� � l / � �`�l�h .� `� r V,WPRR PERNTIT FEES* Address: 6 / ;, 2_ <Sco m d:� A-V -S ��, C ., _ . - � Please r e a_ .. ,, u ,; . , . ,� ¢ , � �t ' ^ � '�' Please refer to fee schedule. City/State /ZIP: Po , L - T ` � " k #t ' kf / ► � 21 Phone: (03) t�y F ax: ( ) Fees due upon application O 3 ,� Amount received CCB lic.: I 22_J Date received: Authorized signature: N. This permit application expires if a permit is not obtained � /, V / 9 y within days after it has been accepted a complete. Print name: � Date: / * Fee methodhod ology set by Tri- County Building Inn dustry Service Board. i:\Building \Permits \BUP- PermitApp. doe 12/03 440- 4613T(I t /02/COM/WEB) \ One- and Two - Family Dwelling 4. i Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/By Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 u ''NiiN ,1 i': ❑ Electrical ❑ Plumbing ❑ Mechanical 24- Hour Inspection Line: 503.639.4175 _ ∎1 I 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. rp 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 .. . uired 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 0S/12/2004 09:28 5032537693 SUN GLOW INC PAGE 01 ,5/12/:004 09,,43 FAX 5035981960 CITY OF TIGARD 41001 C}Iam @L ftt 13D Cdt1 ® 0 ® FOR OFFICE E L; X11;1' City of Tigard Tf a><d CEI !1 ED Date/By: te, 1 13125 SW Halt Blv*d.,'1'tgard, 0 +.+ s1" Plan Review Phone. 503.639,4171 RI: 50 5 • 1960 Olken Par+ dt .103.639.4I75 o Set Faze 2 far Inspection Line: .� • N In Me In'.ernet: tiyvVlV,Ci.etgand.or.aa AUG 13 2004. - vpt;treAlM�thedt in SuPPIn>itnntal isfbratatioe i , r t 1, , µ 7 1 i tilll LJ` i , tr > ].hflr`"'� '"Y., th' r ,T1• '-,`' 7 li "�i. .;' i 1- rd— i'ii 'I , qa. it c.},. .. El NeW construction EiLl ( � lacernent Meclumica] permit feese tie based on the value of the work performed. hulieux the value (rounded to the nearest dollar) of all ❑ Demolition Q Other: mci,snical materials • vi • Teen. tabor, Overhead, and . at ,.r.� . s . t :I a,' 1 7 7 ? 77-7V.,7-.;, ..1.1c �, 7r7, i t h ZI 4 iii' T l,! ValuC $ J-,‘.,. 1 v li 4 > .: , :,.' . - + .. ,'' . 1.3 : 42 : 1, ',' , ',..• ! , - 'r...t.ti>1 1�i w ,•. .— . nu4iY tLtt.�usiivir ,r..- .' ' y ** 4. �W . t f ❑ i- taad R- fartily dwelling D Commercial/indu5crial ❑ Accessory building � w - - fl Multi- family ❑ MaSter builder ❑ Other, Description Qty, Ea, Totai I .tint 1 i{{ 1, t ; r t c y r y e ' t c o . : "Kl T r , audit_ cnolin: �, t 1 J i s ` _ .lj -,. fi . �. t ' fi ; 'fy �. trvf ,.5 ,21:,r. lob s ite address: /' `/ / �� Air conditioning or heat pump u (regtdres site plan s e placcthca j hon t a -00 City/Start/ZIP; ity/Staar/ZIP; ° / / /� w : _ e 100 000 BTU ] dttctiveets) 14,00 � ` Furnace 100,0004-BTU (ductstvt n 17.90 ) S lilrelbldgJapt no.: Prol avt naino: heat a r, ]4.0{1 i GaS Cross greet/directiaus to job site: Duct week _ ,_ 19_00 1 Hydronic hot water systeer 14.00 —._J Ree1dential boiler (radiator or j • •some) `! 1 4,00 I --- - Unit heaters (fuel -type, not electric). in 11 is -0uc suspended, eV;..- 10.00 4 Lat no,: Flue/vent test any of above 10.00 Other: 10.00. I 'Pak maplpereel no Other Fuel uppl;:aaces _ L — I,r ; t #.' t r 1 �� iL:.. i Jyi _, l .. '[ )�5eu #� F4 � r l 1;,1 a ' 'g"..":-,-.,,,,,---' ,r heater I � �,� � ' r P r,r � IV' for water heater or gas - ftre(ilace , 10.00 I Log lighter (gas) 10.00 1 WoodtpcAetstove 10.00 I _ Woad firen1ac lnsett 10.011 e_, , a .,� r , ',,T;;;1',',-.411 t „— ; Cbinme 01ne= /fluen+ent 10,00 rl r ,r I f ,':1: - .:.,. - .1...1.,,4'.2.', QJJ t '. c 7 > 1.1 i t ,,. '. L r L n ) i ' , J. ?s_.....�,�_,.a ?tl�. _-- ., _.L LC, r ..I. t I f...� , . .a_ _ _: . 1. Other: 10.00 _ Nance: Environmental cxha1ast and ventibation Address Range hood(other Ititthen - . • oquiptrtSttt 10.00 . Citq/State/ZIP: Clothes dryer exhaust _ I0,(10 Slnale.dnrt &thauet (bathrooms, Fhone; ( ) Fax: ( ) toilet c , ., uoli . moms b.tiO M • 1 ' ,f tt,j ;. 7.;L: r 1J1 1. :�._ I _ u _� ',01,....1,41., .; _ ■ a . ,'1, Mf E .,lq r 1,, 't4 t., 11„`; ,, I ltttictetawl • eefg19 10.00 _,.. Other: 10.00 Fuel pip Contact name: : ' $5.40 for first four 51.00 for each additional __ ; Address: LEirnace, cte, Gas heatpuntit City/Stetc/ZIP: I walls , de&unit beater Moe! ( ) I Fax :: ( ) Water heater t+ I r j i .,3,,..: . r 7 r a: -.. 1 ..S f, l ii. r,' -1' ? I , ! y , : WIT,--;; r B • eC 4 i. , •,-r iv �. S ` .. ' _lam u.i.r'CU - . ''.. ;:,'11 1}6 .. t. 1.- Business name: i p Clothes dryer (gas) ddress' 2.�i_ SE 4 105 Other; A ,1 � ....... >, ' '.� ` ,.er.:h I t.: ��t y ta� -��'r. ;K nkkAa � ° -- Cit 1statazar; earidfin . A. S ff - 7 Subtotal Phone; p ' 7 f Fax: 194) 2 --/ bg , Minimum permit fee (872.50) 1 _ Flan review (15% of permit fee) CCB lit.; 4 Se7te surebcge ($r/e ptpermit fro) _ TOTAL PERMIT FEB Authorized signature: (n �..] + ', �' -1\d041,1 'r'ho perrmit appiia.r+r+n.sspir*s if a pn'enit tK nest aht3InrE within 450 �''� Q _ days attar it hat been accedes s? rmnplrtr. kit111t Yffi4fC 1✓ I oY #4 • 0 . ) i. . „ Dates e igra .. • nee reetltbdoloey set by Tri-county Pwld9ait tnrt.r S,,,;ar Efmrd iiBulldinePsmiteMEC.PeramtApp.don 17103 m0 017T (11107Jcown'Pn) ` Buil1ing,1Eixtures Plumbing Permit Application . FOR OFFICE USE ONLY City of Tigard �� ,l e® Received Da Permit No.: 13125 SW Hall Blvd., Tigard, OR 9 VA VA Plan n Re Review Phone: 503.639.4171 Fax: 503.59:,,1".74 3 4 //H��;Ni 1 ' +hl\ Date/1Permit y: Other Pert No.: 24- Hour Inspection Line: 503.639.4175 ( ■'�j�� Date Read B Sufis: El See Pa e 2 for www.ci.tigard.or.us Internet: www.ci.ti ,``` ` " y y g g Pv Notified/Method: Supplemental Information `, 7 A ." I TYPE 1OF^ - n„ 4 lii. .v ; "EE <, ° rF * S > - �a e �T`� L . > ,S°. ��� � 3 E.'�. t. � a� -' � �. A,n.; - ax. t _ ... .,-i � 2 5��. «. _ '. ,Se.. 5c�s�hc�r6e� a..-, �-a res,:.; �,au ❑ New construction \ `nlolit For special information use checklist. 50-1" Description Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) '. y ^s:.p..,s. � � ^.e. =J :.° -x tr^.- 7 r :<;:,.tTairie ."-"'sBs r'er'i ;:'Sz..° 'zj -=-ti'- , _ _ , „, i x i . ^:ls -iggi ''T GOR Q. ' CON T U ,: 5i.� ^.._.. . SFR (1) 249.20 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder ❑ Other: Each additional bath/kitchen 45.00 :, :� . Fire sprinkler ( sq. ft.) Page 2 0 i , • JOB STI' INFO R M ATION ANA LOC P` . ? ,1 Site utilities Job site address: /575T 9g)-1, 6Ur 2 Catch basin or area drain 16.60 City/State /ZIP: " 1 6S ti t� oe ?? 22 3 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: 1 Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 � ^�•er `•1�.'r �} �+,^ ',� + «:'.; ^: .;, �g:;:s :.�. ,. ,, ^ -ya 14 t :` � biktiii T O OF WORK " ` " i - ;�° ' z A.� . 1- . fl _, dltk . � .•. . . _. _ -.t aN _a.. ', = Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 .,-z4, z , _ w 1 = .. Drinking fountain 16.60 R.',. ri),VT. =P R 1W6).74,-kR i- ,. _ 134' 1 0' 4., ., .: ^. � . T N ,4. : '4 ,,, � J Ejectors /sump 16.60 Name: S AI-` to, v s,..0 - 6,, Cw / s Hn /1 [.1 Expansion tank 16.60 Address: /R 2 _s W // ` 7"..tin r � N w� ITV r S 4,rr �z ( . Fixture /sewer cap 16.60 City/State /ZIP: D ✓ �/a Y1-+L 0 IQ. 9 7 2) 9 Floor drain /floor sink/hub 16.60 Phone: (�� ) t ` y 3 .. G 0 3 7 Fax: (�3) [ f lj , � Z i t�Ji Garbage disposal 16.60 w l -,,thr Hose bib 16.60 was - ; ll ` Rt.ICANT �� : CONTACT`�PERSON wU ; Ice maker 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 „ w�n VAi ' 4ONTRACTOR4: �` ',. °'; Wate closet 16.60 c , - . . .fir _....�.:.�. ?'` . _ .f.,, . - „ .�^ _ Business name: a9 1' Ivy i l C - Y w(n., W J, , // Water heater 16.60 Address: 2y�U CJ, o.] t^41:. beP („ M>ti, Other: Subtotal City/State /ZIP: )h IL b8,) ® le 97 2 1 Minimum permit fee: $72.50 Phone: (re* ) 5"'72_ 7 Z$ 7 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: / 2 6 )7 , Plumbing Lic. no.: 3 9 2/ D Plan review (25% of permit fee) / / u' State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: .- /� /ir� Date: This permit application expires if a permit is not obtained within i 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\Building\Pemiits\PLMF- PermitApp.doc 12/03 440- 46 16T(10/02/COM /WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: as :; ,. m m �5 teaL� i l><tres k r. # ` 9 i [(e Square P erm>t Fwee ;:.; Footing drain - 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 :e°�:,'`'` ' , °mss °" °:�_ =' -'�` Storm & Rain Drain - 1st 100' 55.00 v aluation c ermlt Fee ' $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 +! i'0 tis- otal -p additional $100.00 or fraction thereof, to and FltureorI>tem Qty e y4} 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 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 * . bra - , 2QuW ht 8y (Fjxtu Work Per4o ned ¢RA` ai mew Movea , gt �ap t k 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\Permits\PLM- PermitApp.doc 3/03 08/12/2 @04 10:00 5036425815 ROSS ELECTRIC INC PAGE 01 Electrical Permit .1. . II' f . _ FOR 014 [t F iaE: ONLY . Received Electrical Date/By: Permit No.: city m Tigard cl 1.0 Plea g Approval Sign SW Rail Blvd. p�G 1 J y Permit No.. Tigard, Oregon 97223 Dian Review Other Dute/By: Phone: 503 Fax: 503 - l 0 , ' Post- Review — — La a t No.: Internet: www.ci.tigard.or.us G� • 1NG01 t , ;:1 , Dot y: use Case No.: 24 -hour Inspection Request: 543 -6 J4T75 � • t : Contact Ms.: �+ See Page x for NmndMtthOd: — snpplamental Information. ,' (" ; ;- : :;zlri,..l �• .� . 'yam ,� • ; ,- » : » ,�,, :.. :.,. `. kli lL. .4 C 3 :irk }�4.: :� i � r /R w '415.4...7.: f II New construction + ' '�? , .:2'A, i,b •rnc x- .'d.�'',' � , 1 . f:L �r "'^'�f�",�,, r r3;4i;;r;*"�.1'A�,� Demolition # Service over 225 aims- 3ti • Health -are facility al Additiotl/alterationx/r .Iacernerit ■ Other ° alai (] Hazardous location a s' s',6caL .M ,. :,. 0 Service over 320 amps - rating of 0 Building over 10,000 square feet, .• :. r . s 1 & 2 family dwellings four or III 1 & 2- FantiI dwelling D$ Commercial/Industrial © system over 600 volts nom one structure r ►e residential units in DO Accesso Buildin • RU Multi -Fami1 ❑Bonding over three stories Q Feeders, 400 amps or more D i Master Builder Other: ❑ Occupant load over 99 persons 0 Manufactured structures or RV i''w Vi i` ^'i ;'• te — - -. a : ❑ Egress/lighting plan P ' . + ' . 0 " a - ' a ' t M t D • ' :; , { d'. : + ";' '. i i; Submit sets of plans wi th any of the above. Job site address:] a V 2 ` The above arc not a Ileahte to tcm■ era construction Suite #: !t:. ; 3 °R'+I'�.. 0 � �. I ' 'i • •...w, y service. Pro'ect Name: Number or inspections per permit allowed 11esCrtin„ 1 Qty Fie (ea) Tate{ Cross street/Directions to job site: New reaidmitla43ingle or mnitt -r�„tty pe dwelling unit. lnelndes attached garage. • Service Included: 1000 sq. it of less 145.15 Each additiorctl 500 so. R or portion thereof MN 33R0 101 NI Subdivision; Limited Lot #; energy, residentia Mill Tax map /parcel #: Limited eher non residential NM 75.04 : •e.: w : y Each manufactured home or modular 75.06 � Wit dwelling . , ., i,6...: ' ::+� :; ';v�Si Or; ". (5 ca +y r•_ ; ?`'r" :: service and/or tLcdar 8 Servlem or feeders - installation, 90.90 alteration or relocation: II 201 amps to 400 amps 06.30 EMI . 7 T ^ , , -r , - 401 stn m bbb 16060 — IIIMMIIIEI Nam _ai r " ,-;; •r r r� )ig :r 601 amps to 1000 amps . 1..../131 Over ]000 amps or volts 454.65 d Address: ---- °°"° «, 6ttas Temporary services or feeders - installation, City /State /Z1,.: Alteration., or relocation: Phone: — 246 amps or le sa 00 30 �I f . Fax: x011 amps to 444 arne tr .?klvj . : ; M , i ; y 47,T' . i t . io 40 an v 100.34 4 �. Z t Name: I3r aoctiCircuits -dew siteratio 0 133.75 extension per panel: 4 r Address! utta A. Fee for branch eirc with pachase of Ci /State /Zi • : �or feeder fee, each branch circuit 6.G5 8. Fee for branch circuits without purchase of Phone: Fax — ce or feeder fee fast branch circuit 46.85 E -mail: additional brarrcli t :',•;4 - V:;F E-mail: .` ri..? ;tee's -e'il 1 1 y ,., w .1 r r,. Mc h Firm vice or feeder not included); 6.43 r " ri p, ;r. r � ;S,r'� Each 11111111 Job ` ? x' t For i circle No: Signal "' ' E sign s 53.40 pAt or outline light y o n or extension limited energy pa — j iir Business Name: (� f .tf achsan.or P53.46 a 2 Address: .8 0 5 i• 3 .aa.l 2' 11: alne Ci fState/Zi r : `' —� Z -y �y b(� 1 � r` � 'Zt c/.3 �h additional in , cetian over the allowable In an of the above: Phone :. ) FAX: ' Per' ,.. . - hour in. 1 hour 82.30 J - investigation fee S in CCB Lic. #: 1S -'7,5q Lie. #: -4(34 other' — — S NM. Min upervising electricia - � :' :�' _ : ;- ; $ si _ store re • oiled. '' --/Ze. a:. -z � S Btoca ' �' ' :.� ><qi � :, =n Platt Review 25% i $ Print Name: . ' Ve j OS S I..ic. # , 2 fo of Permit Fee $ State Surcharge ($°ia of Permit Fee) $ Authorized TOTAL PERMIT FEE $ — Signature; Notice: This per mlt applleatlon expires !r a permit Is not obtained within Date: 180 days after It bas been accepted as complete. Fee methodology set by Tri- Couaty Building Industry Service Board. (Please prim name) i:\Dsrs1Permit Porms\ElcFemritApp,doe 01/03 , 4Ri, ; ) F \ ;: .+t :t �� m' /'� s � Was h , ,- -nn County, Oregon ?;, ,:;i, `;a 2004 - F' -r ;iti 4` W ;, : a ∎ : ) —�C/ 0712i': 02 3217 y t \;, ^� :�� � .� <: � �:\�` : �, X4 1 � ,�J '' /1 Imo -} , � • :; �. � �:as '~ ,,, � ,, ; Al'•1 c , t;1 ?�' ` ,,�1`.' w1 ' c , - vL / % � I D -DW Cnt =1 S GRUNEWALD •,,' to =7 K }. ... ,h` ` `l ti `i\` � \ r �„ , `y1; ` 7 �J ` ' , a�,, ;''Y "�,;` '�•�;''" ? �<g, Title Order No. 04248752 $10.00 WOO $11.00 $1,409.00 - Total = $1,406.00 =' i ;• , ,, : `:?e � siyn� ` �,.,t ,`�:, h 4 ; •c i w,§i Escrow N0. 04248752 = — � ','� ,1 ,.'4 ::. z. gg:.; .;I - ,...A L 111111 I 1 111111 II I 111111111 11111 >A;: ; ;;' ; � VI After R ecording Return To: i 00623251200 0 i aL ^1 s ,,,V ; aj? ,, ;.:$ ;1' R „ l 4 0832170020028 ' . ' ,,, ; '` C ° , : ■ I, J erry Hanson, Director of Assessment and Taxation ,. ` ,' ?, ;• , � i' , " ;, . '?,• s,t s,,, ±a, B uena Vista Custom Homes, Inc. Ino I [l AUG {� )00 � e ion ..suet , �'`�: }t , , „i v + , �• • I ��JU tP I ✓ � and Ex- ORICIo County Clerk for Washington County, - r, �'.i l';; +`�e ,�'�; +; '� \� :� A TTN' Roger Pollock I II � Oregon, do hereby certify that the within Instrument oft '_y �V :. , � ,” `w ,�" �' �'ii•; •;;���;1:,; 1 tJ U writing was received an d recorded In the book • r!'1!"� ' c: ?att ' " * 1:;� , rr: t:l i 6932 SW Macadam Ave. I records of said county. ook of ,', °! ; �C �;� ; 'i a,; :, "1y`h @' e P ortland OR 97219 I _� ' + - e; �`' t � : ±5 t?i,� ��` ,,,`, +, � r i_�f �_-_ -.. . Jer R Henson, Director�., �, , ment and Taxntlon, ,; fie..: 57 ; :.. r.$J , i i . : ix � ^ :4. i e E x- Ofn c l o County Clerk r ah._' `,1,,, ;',W,,, , ?.a•,a i l,',,�`;h?` I!" ;::. - - - `' ; ; �,. ` „ "A' i* P.• *.*:,.'0 ,,,,, ,,g; ' Until a change is requested all tax statements shall be sent to ';ill', °` ,':iS F;; ?i'.:4' ,. ` yG''∎M'�' ' F " ` l ',,' -;, c�,h: ,; i`: ,•:; �, +„� ,•� S the following address: s ,?'' • 'i' '''' `" ';'','" '''+ &V r ' `;'; " �' Buena Vista Custom Homes, Inc, ii; , ti` "ia ; ATTN: Roger Pollock ! ! , , i• i ^ ..,t,; itg` `; ;i ! 6932 SW Macadam Ave. L Ati< '• ' ,' ` " Portland OR 97219 is ' STATUTORY WARRANTY DEED Beacon Homes Northwest, Inc., an Oregon corporation, Grantor, conveys and warrants to Buena Vista Custom Homes, Inc., ;;?S;': an Oregon corporation, Grantee, the following described real property free of encumbrances, except as specifically set forth " :'��•`' herein situated in Washington County, Oregon, to wit: 'r ; C �z" 2 24 25 26 and Tract A , L.tz Lots 16 , 17 , 18 , 19 , 20 , 21 , 22 , 3, , KESSLER ESTATES NO. 2, in the City of Tigard, \ , I ` County of Washington and State of Oregon. 3 3: r ; ;Pic ss 104: i:?t" i , , ; t This property is free from encumbrances, EXCEPT: See Exhibit A attached hereto and made a part hereof. • �a ^a,� THIS INSTRUMENT WILL NOT ALLOW USE OF THE PROPERTY DESCRIBED IN THIS INSTRUMENT IN ,' ;: VIOLATION OF APPLICABLE LAND USE LAWS AND REGULATIONS. BEFORE SIGNINGORR ACCEPTING E THIS INSTRUMENT, THE PERSON ACQUIRING FEE TITLE TO THE PROPERTY SHOUL D ?• , •' q'' ;a,;;.,t`,,.,, APPROPRIATE CITY OR COUNTY PLANNING DEPARTMENT TO VERIFY APPROVED USES AND TO • , , ,•,;; ' ,'_,,; DETERMINE ANY LIMITS ON LAWSUITS AGAINST FARMING OR FOREST PRACTICES AS DEFINED IN ORS . 30.930. The true consideration for this conveyance is $1,468,500.00. (Here comply with the requirements of ORS 93.030) _ WASI 1NGTON COUNTY ' <" 7RAN5FER 7 - TAX -�r� _ _ , R A l P L P ..�, E Dated this July I , 2004. t� ` ' i r . ,a FEE PAID GATE ;` ?;; i Beacon Homes Northwest ' c, ¢e , is ; ' Peter A. Kusyk Pr rdent STATE OF OREGON ss .- r County of Multnomah On this July I , 2004, before me, the undersigned, personally appeared the within named Peter A. Kusyk as President of .• , =.1 Beacon Homes Northwest, Inc. known to me to be the identical individual who executed the wi e'+ instrument and acknowledged to me that he executed the same freely and voluntarily. /L • OFFICIAL "';`' _; ?'•� •t' , I 'I L SEA No u Tic for the State of Oreg n ,, e ,F JOHN W WILLIAMS My compassion expires: / /6) d ? : >" - NOTARY PUBLIC- OREGON � ,, ; ,0 COMMISSION NO, 376273 • ::-''.:;%'..-:1,:''', MY C OM MISSION EXPIRES FEB 10, 2008 RECEIVED " AUG 1 3 2004 CITY OF TIGARD ::j BUILDING DIVISION CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST Z. `c -- INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested ( AM PM BUP Location / �/ LS 5 / ^ ., Suite MEC Contact Person Pr ( ) 4t2 -28'c56) PLM Contractor ( ) 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 Fire Alarm A S S PART FAIL Reinspection fee of $ required before next spection. Pay at City Hall, 13125 SW Hall Blvd. • $ _ 0 Please call for reinspection RE: / 0 Unable to inspect — no access Fire Supply Line ADA Date Inspector � .® � Ext Approach /Sidewalk -- Other: Final DO NOT REMOVE this inspection recor ', om the Job site. PASS PART FAIL - CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST .1) 4 , - -- a3„_ INSPECTION DIVISION r Business Line: (503) 639 -4171 _ BUP Received Date Requested I 1 AM PM BUP Location 7 / S3 , T '"'- ' Suite MEC Contact Person ,1-- c.4 Ph ( ) 1/ — Z9 /S PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: 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: AS PART FAIL AS Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL , Service Rough -In f UG /Slab Low Voltage Fire Alarm Final Li Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE . r t 0 Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line , ADA Approach /Sidewalk Date Inspector Ext Other: fib Final , O OT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested _ ` AM PM BUP Location / ' 4 Suite MEC Contact Person Ph ( ) 7 jD --c7 q lSI PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing ` - � SQL ��ac ,ct Insulation Drywall Nailing Fi rewall k k Ho Fire Sprinkler / 7' 0 h Fire Alarm Susp'd Ceiling Roof Other: SS PART FAIL MBING & 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 • PA = PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Anal Reinspection fee of $ required before next inspe tion. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL / SITE c ❑ Please call for reinspection RE: 111 Unable to inspect — no access Fire Supply Line ADA ' Approach /Sidewalk Date J / 3 -- d Inspector Ext Other: Final • DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL - -- ii -s - -��-_ --u la uiii LIOTf i f. i % •U a Q ,j e• Immom • P SIMI' li 1 1 mipi •ii IN " ' QT oB c �,, j II , . __,111 L. _.. --- fit.! t' T '1 ► 7 --" I -- 7 1t 1 - - _ _ ■ t A ,i 1 -' — al I� El inii ii EN