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Permit ��7 ilcy>~.,iz) �i :' c /ij it ✓' 1' C T O F tIGARD MASTER PERMIT PERMIT #: MST2001 -00112 �i� ;� DEVELOPMENT SERVICES DATE ISSUED: 4/18/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESSS PARCEL: 2S110BC -00100 SUBDIVISION: / ! /_ z /- v ` �L- ZONING: R -7 BLOCK: �J LOT: JURISDICTION: TIG REMARKS: Construction of new single family detached residence. Path 1. Only (1) hose bib allowed due to meter size. BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 32 FIRST: 1,180 sf BASEMENT: sf LEFT: 45 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,084 sf GARAGE: 440 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 30 VALUE: $ 205,371.00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,264.00 sf REAR: 99 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: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL • RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HWSVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,701.09 This permit is subject to the regulations contained in the GEORGE WALL GEORGE WALL CONSTRUCTION Tigard Municipal Code, State of OR. Specialty Codes and 11600 SW BULL MOUNTAIN RD 11600 SW BULL MOUNTAIN RD all other applicable laws. All work will be done in TIGARD, OR 97224 TIGARD, OR 97224 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: LIC 52392 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp & Foundation lnsp Mechanical lnsp Electrical Service Exterior Sheathing Ins F Water Line Insp Sewer Inspection Post/Beam Structural Mechanical lnsp Electrical Rough In Low Voltage Appr /Sdwlk lnsp Footing lnsp Post/Beam Mechanical Plumb Top Out Framing lnsp Gas Line lnsp Electrical Final Footing Insp Crawl Drain /Backwater Plumb Top Out Framing Insp Insulation Insp Mechanical Final Foundation lnsp PLM /Underfloor Plumb Top Out Shear Wall lnsp Rain drain Insp Plumb Final Issued By : I . LW" ♦ ..f� � Permittee Signature : . II. / .iiimCi Call ( 03) 639 -4175 by 7:00 p.m. for an inspection needed the -x>j iness day P7.4".. - 5 /j (% c G rG 6-1--e- 9,2- h/ zz , tir(*),3 ‘7' 7.i/z/ 1 3 ‘ /..CZ/ ° gc 1h 1 JGLl: x'70 /i — Y � / I U1 Zo y,e-C Pc 41. S d1O)d- /s j ,d e, S' �o ' ' ear 1: . 15.- I — I c. i ko i,© ¢, REVISION n eA' ,g / At r A It • -Al \ y \ ; INI6 / 1 - • -.. t., I .i-) 4‘ 1 bi ilk ik:, . __ IF I k i 1 41 1/4 11, ik rt- 1 1 t tdr'Z vi Tc- / V tU L .f, /� . c� l v _ jq 6o S W w ) aO :w - _ V I JUL 2 3.2003 G 1`V OF 1 iGM U Wilt IYNG DIVISION Pit3-1y -vI /1r , ,,v12...74,,,ot -00o Building Permit Application A, Date received: GJ 6/ Permit no.: /l9.66/ /i-- b -:1y City of Tigard Project/appl.no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 Date issued: By: Receipt no.: �� Fax: (503) 598 -1960 Case file no.: Payment type: V� \ Land use approval: 1&2 family: Simple Complex: . ti TYPE OF PERMIT A 1 & 2 family dwelling or accessory LI Commercial/industrial ❑ Multi - family ' New construction ❑ Demolition ❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: Job address: 2 /ya aNTR /A Bldg. no.: Suite no.: Lot: I Block: 'Subdivision: / t_(‘ g U 540 (2 O `rte -I Tax map /tax lot/account no.: c-2..57/46(/ -00/04 Project name: Description and location of work on premises/special conditions: OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: G � Orq e i,..),„? ( (Floodplain, septic capacity, solar, etc.) ; Mailing addres: p✓ Jin() ,' A� // ,/f 1 & 2 family dwelling: City: Ti da m State: 4 Z IP: 7z, 4 Valuation of work 0� . 3 7......... $ Phone: 6 7D - 7y)/f 'Fax:64.- 2 ,2, IE -mail: No. of bedrooms/baths 4 .A# Owners representative: r, , 1 ,,.4 /. Total number of floors X Phone: 7 _? /71.r Fax: E -mail: New dwelling area (sq. ft.) cgs .2 6 4 Garage/carport area (sq. ft.) /No Name: 6. - Co.--y ki j / / Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) City: I State: I ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: Commercial /industriallmulti- family: CONTRACTOR Valuation of work $ Existing bldg. area (sq. ft.) Business name: Ilya, oP.W �r1ki ` New bldg. area (sq. ft.) Address: / Number of stories � City: � S I ZIP: 9 7i9f Type of construction Phone: (p y to- f t/ I Fax: I E -mail: Occupancy group(s): Ex' ling: CCB no.: %2 34 C.)(P. 10 -9 -0/ New: City /metro lic. no.: ,a Notice: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: {j Z,,, „. fij, /,..tyf0ln�/ provisions of ORS 701 and may be required to be licensed in the Address: / 3 7/ , �t�✓ v e jurisdiction where work is being performed. If the applicant is exempt from licensing, the following reason applies: City: f �A61. ,�,( I State:M' I ZIP: er 7; 04' Contact person: Plan no.: Phone: Fax: E -mail: Name: /.— 7` �Q , ,je. j / Contact person: Fees due upon application $ / /53, O Address: Date received: City: ycl T fnr7`�r't y�� 'State: IZIP: Amount received $ Phone: ,.2,5'� 6a,9 Fax: I E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for mote information. attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard work will be complied with w er spec' te,4 hirein or not. Credit card number: / / Expires Authorized signature: f , d4// Date:, / ti/e/ Name of cardholder as shown on credit card $ Print name: :?'c_ ( / // Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/0 /COM) A A One- and Two - Family Dwelling 5e , , ;y ; , Building Permit Application Checklist Reference no.: „AI; __.. Associated permits: City of Tigard City Tigard t3' g ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 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. 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 c7tch -b in protection, etc. 10 l 3 plete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state but ding 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 f copyright violations exist. _ 11 ite/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer 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 Five (5) si • plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) 4ets)each are required for Items 16, 19, 20 & 22 above. _ 25 Building plans shall not contain red lines or tape -ons. 26 No rolled, reversed or mirrored building plans will be accepted. 27 28 Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6ro0/cOM) • Mi iR+�-0� -2O ©1 15 :23 JEROME ELECTRIC 5036489723 P.101 Electrical Permit Application Date received: Permit no.: st,j,l City of Tigard Project/appl. no.: Expircdate: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issucd: B;7 Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval; TYPE OF PERMIT O 1 & 2 family dwelling or accessory Cl Commercial/industrial 3 Multi- family U Tenant improvement U New construction ❑ Addition/alteration/replacement a Other: Cl Partial JOB SITE INFORMATION Job address: .J53 .,.,) iu L PST Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: 'Subdivision. .n.s // O,6 C., T-- /00 Project. name' 1 Description and location of work on premises: . Estimated (late of completion/inspection: CONTRACTOR APrIU :ATI ILE SCIJFU1 LE Job no: Fee Max Description Qty. (ca.) Total no.Insp Business name: i> F - Tr r,, ,,, F_ l -Pt _'h - -k-(, New residential , stagleorrmlti- family per Address; •t . i t`.„a ' "ls f dwelling twit, lndudes attached garage. City: H , t(S , - _ Statc�T 2 I ZIP: 4 1 7 1 1,-_ Z Servlcslnduded: Phone: l . 8 - .- 1`4` -( I Fax: h`(�-`(7L, E -mail: 1000 sq. ft. orless f pis, /4s� _ 4 CCB no.: ,.K L ( EICc. bus. lic. no: "f -1 l q L Each sddiUonal 500 sq. ft. or portion thereof .. 3 Limited energy, residential 2 City /metro 1i.. no.: Limited ener gy, non- resiiknrial 2 y � Each manufactured hone or modular dwelling Signature of supervising elec. ''' Date Service and/or feeder 2 Sup, elect. name (print) �1'� " c %F�✓K f License no: .,-.) 9 Se or feed ers - instaffattoat, a or re location: PROPERTY UYYN I :IZ 200 amps or less Milli Name (print): ) O 201 amps to 400 amps (print): G ,��,p�°. ( � 401 amps to 600 amps Mailing address: //t 017 4:/..) Rule /yl-,kh 601 amps 101000 amps 2 City: i- 4 ., ,,,,d 1 Statee ZIP: c - - Over 1000 amps or volts _ 2 Phone: 7 - nfi t t Fax: (,;t,1,--0„fr E-mail: CI Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - • which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: -- - Date: 401 to 600 amps 2 ENGINEER Branch circuits • new, alteration, Name: or extonaion per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee: each branch circuit 2 City_ l State: • I ZIP; B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E - mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) misc. (Service or feeder not included); O Service over 225 arnps•commercial O Health-care facility Each pump or irrigation circle 2 O Service over 320 amps -rating of 1 St2 13 Hazardous location Each signor outline lighting _ 2 family dwellings OBuilding over 10 ,000 square feet four or Signal circuit(s) or a lin ii icd energy panel. . O System over600 volts nominal more residential units in one structure alteration, orcxtension* _ 2 0 Building over three stories Cl Feeders, 400 amps or more Occupant toad over 99 Each additional — O Occu ns p persons Cl O Manufactured structures or RV park • Each a impedion over the allowable In any of the above: ❑ Egress/lightingplan 0 Other ..„, Per inspection J I I I Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other p Not art aaieuona accept cr edit cards, Permit fee S 2.7 rrr+ q please call jurisdiction for more information. Not This p ermi t application O Visa O MasterCard e xpires if a permit is not obtained Plan r (at — %) $ _ - Credit Cana number I I within 180 days after it has been State surcharge (8%) $ .� ,— Expire' accepted as complete. TOTAL $ '301' Nam car�rolAer $ alwwn CO t card $ Cardholder signMOe Amount _— 440-4615 (dvorc oM) f ihi Plumbing Permit Application . Date received: ,-/( i f , Permit no.: /-� , 7te/- �'F.1 ,/l. City of Tigard ,� ,' i l g Sewer permit no.: Building permit no.: --" Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TI PE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement I New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: :G � r ` � • — Descri'lion • . Fee(ea.) Total `'"``�_" New 1- and 2- family dwellings only: Bldg. no.: Suite no.: (includes 10(1 ft. for each utility connection) Tax map /tax lot/account no.: S // 0E6. - 1 - / / SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: SFR (3) bath / 3q/ 391 City /county: - , ; ,,,,,,f I ZIP: 9 7�2 y Each additional bath/kitchen Description and location of work on premises: 6 Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. din. ft.) Manufactured home utilities Business name: r /d u m,b )>; �I Manholes Address: J Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: f 9q? 7 I Plumb. bus. reg. no: -? tf — (e 4Lh Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer Print name: D a t e : Backwater valve • CONTACT PERSON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Floor drains/floor sinks/hub Name (print): l�� �Q Garbage disposal Mailing address: (1( , , 1 t_( ).-4 Th...) INi. Hose bibb CityrTi (D Pr 12_7 I State: i2 I ZIP: 27.2 Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan . Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total -on. Not all jurisdictions accept audit cards, please call jurisdiction for more information. Notice: This permit application Pl Minimum fee $ s' 9 `r ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card numb / / within 180 days after it has been State surcharge (8%) .... $ 3 / - 9.. Expires TOTAL $ 3(9 , IJ-, Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00✓COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink ( 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) One (1) bath $249.20 _ Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 1 16.60 Three (3) bath $399.00 Water Closet 7 16 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher I 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL i Laundry Tray y 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San /Storm Sewer 46.40 Lavatory • Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3 „ Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE * *PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** AII New Commercial Buildings require plans with isometric or riser diagram and plan review. i : \dsts \forms\plm- fees.doc 10/10/00 Mechanical Permit Application Date received: S ( ` Permit no.:i /4r1 Y !±�/ Ai ,, 4 -11 1 City of and I ' Ti J, . _ Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PER!1IlT ❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑ Tenant improvement New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: •- 2iFr.- a,c Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: ,2 c // ahl tL /,97 profit. Value $ Lot: (Block: I Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: T;� q Qr d ( I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and ldcation of work on premises: AND CONI111ERICAL /INDUSTRIAL EQUIPMENTSCHEDULE Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? 0 Yes ❑ No Air handling unit CFM space insulated? ❑ Yes ❑ No Alt conditioning existing plan required) Is existing P Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors State boiler permit no.: Business name: 7 ° ,, - , d ?? � �/i�. % 1 . )' wi G c (fry HP Tons BTU/H Address: 14 ,TQ p , 5 F v -/ ' 2 Fire/smoke dampers/duct smoke detectors City: v S tate: � I ZIP q 7'` S - Heat pump (site plan required) Y : T I .5,,, / Install /replace f urnace/burneVGtx2ZBTU /H Phone: l Sp - SO / I Fax: 5'5' 7 jq/� E -mail: Including ductwork/vent liner 0 Yes CI No L� No ) , j 7 1 Y p CCB no.: 7 / x7y Installlreplace/relocate heaters - suspended, City /metro lic. no.: wall, or floor mounted Name (please print): z1 o a i z„ / Vent for appliance other than furnace ) /gyp / fl CONTACT PERSON Refrigeration: Absorption units BTU/H Name: Chillers HP Address: Compressors HP Environmental exhaust and ventilation: o0 City: I State: I ZIP: Appliance vent / C C7 Phone: Fax: E -mail: Dryer exhaust ,r f � �1 ei OWNER Hoods, Type I/ I /res. kitchen/hazmat hood fire suppression system Name: ( y /,,,. / 1 Exhaust fan with single duct (bath fans) ii. `„o� ( � Mailing address: / //'.. 0 e7 .57...' AU//' /q� Exhaust aust system apart from heating or AC U pip g on up to 4 outlets ! h City: j, �� i^e Stater ' ZIP: 4'722 Type: LPG x NG Oil f 5.� S Phone: 7(9 - 7ov Fax -c2 E -mail: Fuel piping each additional over 4 outlets rocess piping (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: I State: I ZIP: Insert - type Phone: I Fax: I E -mail: Woodstove/pellet stove Applicant's signature: / I Date: Other: Ohm.; Name (print): �--p, -10 l / Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ /.. O Visa 0 MasterCard Notice: This permit application Minimum fee $ Credit card number: / / expires if a permit is not obtained Pl review (at •� %) i at $ Expires within 180 days after it has been State surcharge (8%) .... $ '7 Name of cardholder as shown on credit card accepted as complete. S TOTAL $ l .PD r 07 - - Cardholder signature Amount 440.4617 (6/00/COM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14.00 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond fraction thereof. footnotes below. Comp ** 7) <3HP;absorb unit to 100K BTU 14.00 ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb Value Total unit 100k to 500k BTU 25.60 Description: Qty (Ea) Amount 9) 15 -30 HP; absorb Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00 ducts & vents 10) 30 -50 HP; absorb Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20 ducts & vents 11) >50HP: absorb Floor furnace including vent 955 unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM floor mounted heater 10.00 Vent not included in applicance 445 13) Air handling unit 10,000 CFM+ permit 17.20 Repair units 805 14) Non - portable evaporate cooler < 3 hp; absorb. unit, 955 10.00 to 100k BTU 15) Vent fan connected to a single duct 3 -15 hp; absorb. unit, 1,700 6.80 101k to 500k BTU 16) Ventilation system not included in 15 -30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00 mil. BTU 17) Hood served by mechanical exhaust 30 -50 hp; absorb. unit, 3,400 10.00 1 -1.75 mil. BTU 18) Domestic incinerators >50 hp; absorb. unit, 5,725 17.40 >1.75 mil. BTU 19) Commercial or industrial type incinerator Air handling unit to 10,000 cfm 656 _ 69.95 Air handling unit >10,000 cfm 1,170 . 20) Other units, including wood stoves Non - portable evaporate cooler 656 10.00 Vent fan connected to a single duct 446 21) Gas piping one to four outlets Vent system not included in 656 5.40 appliance permit 22) More than 4 -per outlet (each) Hood served by mechanical exhaust 656 1.00 Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge $ inserts, etc. Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ Each additional outlet 63 Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: Other Inspections and Fees: 1. Inspections outside of normal business hours (minimum charge -two hours) $72.50 per hour. 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) $72.50 per hour 3. Additional plan review required by changes, additions or revisions to plans (minimum charge -one -half hour) $72.50 per hour `State Contractor Boiler Certification required for units >200k BTU. ** Residential NC requires site plan showing placement of unit. is \dsts \forms\mech- fees.doc 10/11/00 CITY OF TIGARD 13125 S.W. HALL BLVD. I � + h e / TIGARD, OR 97223 ft � . j • ` $� EC IMPORTANT PERMIT NOTICE ``-� � AP R 200� G + B PLUMBING PO BOX 1269 COMMUNITY DEVELOPMEN HILLSBORO, OR 97123 -1269 Plumbing Signature Form � /y� '" 1 _ Permit #: MST2001 -00112 (� Date Issued: 4/18/01 Parcol: 2SI 1 OBC -00100 Site Address: 1� 55. -SW BULL, MOUNTAIN RD Subdivision: Block: Lot: • Jurisdiction: TIG Zoning: R - Remarks: Construction of new single family detached residence. Path 1 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 Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: GEORGE WALL G + B PLUMBING 11600 SW BULL MOUNTAIN RD PO BOX 1269 TIGARD, OR 97224 HILLSBORO, OR 97123 -1269 Phone #: 503 - 670 -7814 Phone #: 640 -5770 Reg #: LIC 19907 PI M 34 -44PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X b ;( !l Ti Signature of Authorized Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 . STREET TREE CERTIFICATION T . L/a /) , OWNER /AGENT FOR eory -P, Ue // 6o? ce et ain (PERMIT HOLDER) DO HEREBY CERTIFY THAT THE FOLLOWING LOCATION MEETS CITY OF TIGARD LAND USE AND DEVELOPMENT STANDARDS FOR STREET TREE INSTALLATION. ADDRESS: % 4 ‘ , s J / /L- /� J , LOT: 3 SUBDIVISION: )a / BY: I��, 9-44( DATE: 7 /2_b // 3 SIGNAT•'E1 RECEIVED BY: DATE: 7 2 `Va -, SIGNATURE CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (5 : -4175 MST INSPECTION DIVISION Business Line: ( -4171 2 BUP Received Date Requested — oZ AM n3 23 1V1 BUP Location / � 13 b f L- Suite MEC Contact Person Lt_/ a--Q -Q -Ph ( ) /40 — 2-86/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear n It Sheath/Shear / c� , 7 I i �� / 5 (yJ) S S � Q Framing 111 Insulation Drywall Nailing D f Firewall Fire Sprinkler Fire Alarm ' c Q � j 4—Qa(27,-J,.j Susp'd Ceiling Roof �,.(S 1— Y` Other: � PART FAIL lir B ING 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 9 1 0 1 / 11C$4 0/001 :; , . - Post & Beam G s Gas a Line Smoke Dampers P PART FAIL E TRICAL 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 LI Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line C G / ADA D a te 4 2/ 2 - 4 v 3 Approach/Sidewalk I nspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 0206 /-00//. INSPECTION DIVISION Business Line: (503) 639 -4171 " BUP Received Date Requested ///2‘.0 A_ M PM BUP Location A i Suite '' MEC (° // Contact Person �,7 Ph ( ) , % 8Sl `t PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner QA/i ELC Footing Foundation ELC 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 I , a A 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 gi) PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: E Unable to inspect — no access Fire Supply Line ADA Date NJ� a � O Inspector J/ Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST ) J INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 1 ^ < < AM PM BUP Location rilt Suite MEC Contact Person kla.e_Z Ph ( ) � 0=2 FO ? PLM Contractor 1>� Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC 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 / / 6 j/-2 a Susp'd Ceiling "I Roof Other: Final PASS PART FAIL PLUMBING Post & Beam • Under Slab - ' �� / %�� %� �/ 1 ■ Rough -In 9 ' Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: 1 1r -'" PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS 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 rei spection RE: 111 Unable to inspect — no access Fire Supply Line ADA /� Approach/Sidewalk Date Inspector "� Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL MLP2001 -00006 CHANGED ADDRESS. OLD: 12155 SW BULL MT RD NEW: 14680 SW 120 PLACE. PERMITS ISSUED. OLD ADDRESS IS GROUPED TO THE MLP. OLD ADDRESS /PARCEL WAS RETIRED. JEANNE 2/7/03 1 AN Case Browse I Ojellint MI MI I _ SWR2001 _00065 12155 SW BULL MOUNTAIN RD WALL GEORGE WALL ELC2001000205 12155 SW BULL MOUNTAIN RD WALL GEORGE WALL MLP2001-00006 P 12155 SW BULL MOUNTAIN RD WALL PARTITION (81) GEORGE WALL ENG2001- 00044 M 12155 SW BULL MOUNTAIN RD ;WALL PARTITION GEORGE WALL _......_' ENG2001.00084 C 12155 SW BULL MOUNTAIN RD 2' GAS MAIN NW NATURAL GAS • PLM2002-00275 I 12155 SW BULL MOUNTAIN RD WALL PARTITION GEORGE WALL PRE2002-0D065 12155 SW BULL MOUNTAIN RD GEORGE WALL PARTITION GEORGE WALL ENG2002 -00109 I 12155 SW BULL MOUNTAIN RD WALL PARTITION RIZON I '