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Permit ti / '/'- MASTER PERMIT 4 ...k e ....4 t _ 34, 4,- CITY OF I G A R D PERMIT #: MST2002 -00440 �I�� DEVE P M ENT SERVICES OR 639 -4171 DATE ISSUED: 11/4/02 SITE ADDRESS: 14617 SW 126TH AVE PARCEL: 2S109AD -10200 SUBDIVISION: MCCLINCY MLP2001 -00008 ZONING: R -7 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: New SF detached residence, Path 1. Adding a/c unit, 10/24/03. BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,793 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 940 sf GARAGE: 525 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 265 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,733 sf REAR: 41 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: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: 1 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL /PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps 1000v: MINOR LABEL: 1000« amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,029.59 This permit is subject to the regulations contained in the MATT CRINO MATT CRINO CONST. Tigard Municipal Code, State of OR. Specialty Codes and 3 MONROE PKWY STE P 3 MONROE PARKWAY STE P all other applicable laws. All work will be done in PMB 335 PMB 335 accordance with approved plans. This permit will expire if LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 244 - 0052 Phone: 503 244 - 0052 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 138051 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Mechanica Mechanical lnsp Framing lnsp Insulation Insp Backflow Preventor Sewer Inspection Crawl Drain /Backwater Plumb Top Out Shear Wall Insp Rain drain Insp Electrical Final Footing Insp PLM /Underfloor Plumb Top Out Exterior Sheathing Insr Water Line Insp Electrical Final Foundation Insp Mechanical Insp Electrical Service Low Voltage Appr /Sdwlk Insp Mechanical Final Post/Beam Structural Mechanical Insp Electrical Rough In Gas Line Insp Misc. Ins.: tion Mechanical Final Issued =y : I ` . �' = 4.•., Permittee Signature : - ` i � Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day • t -clSrJo 2- 3 -0 Z- Building Permit Application _ Date received: /0 /t DP- Permit no.: / /5�p0p - �5 'y Q t lir City of Tigard -- Project/appl.no.: xpi : . City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 �• Phone: (503) 639 -4171 Date issued: 1 Receipt no.: Fax: (503) 598 - 1960 Case file no.: Payment type: V Land use approval: 1" Lf2,ci- DDoels 1 &2 family: Simple Complex: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial LI Multi family ,New construction ❑ Demolition t ❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: I Job address: /Lf / 7 �, �� , 4t 771�9-f17 77 a..f Bldg. no.: Suite no.: bi . Lot: ,3 I Block: Subdivision: I Tax map /tax lot/account no.: Project name: /l `( i Description and location of work on premises /special conditions: i Jef mot) /- r /G '� .�� OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: / vr7 �.,g (Floodplain, septic capacity, solar, etc.) Mailing address: e r ft v‘ lip /�j r5 1 t33( 1 & 2 family dwelling: D City: 4124 e a. 0 ( State :04 I ZIP: e 7 s- Valuation of work $ la zt & Phone: 5753 ZW pjjsz I Fax: &r{ 01:06 I E -mail: No. of bedrooms/baths t-' / Z- /z_. Owner's representative: /vim Total number of floors ? Phone: 1 7 - r - i t,c,• e y:7 - Fax: Zt i refs -z E - mail: New dwelling area (sq. ft.) 1 7335E APPLICANT Garage/carport area (sq. ft.) ,41`'25 F � � I2 , Covered porch area (sq. ft.) Name: Mailing address: Deck area (sq. ft.) City: ill f State: I ZIP: Other structure area (sq. ft.) Phone: Fax: � — E- Commercial /industriallmulti- family: CONTRACTOR Valuation of work Existing bldg. area (sq. ft. Business name: /441-77- / -?_.; AEC) 6 r, New bldg. area (sq. ft.) Address: "" Number of stories City: Z I State: I ZIP: Type of construction Phone: I Fax: I E -mail Occupancy group(s): Existing: CCB no.: /-__ 9, New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under Name: / < � 7 - provisions of ORS 701 and may be required to be licensed in the Address: 8 j3� 4 jurisdiction where work is being performed. If the applicant is City: s f ¢t m State:D . I ZIP: 'I 7 & (g z, exempt from licensing, the following reason applies: Contact person: (1/k}t..< Plan no.: II Z'7 Z Phone:5638g3S ? Fax o E -mail: Name: Contact person: Fees due upon application $ Address: Date received: City: IState: IZIP: Amount received $ Phone: I 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 more information. attached checklist. All provisio of laws and ordinances Bove in this ct Visa O MasterCard work will be complied I. r s s ified herein or not. Credit card number: / / Expires g / Date: Authorized signa . f/ / /Armor // i " �� Nam of cardholder as shown on credit card Print name: Ld atl i $ AMJA � 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 (6/00/COM) , One- and Two - Family Dwelling ,; Building Permit Application Checklist Reference no.: • Associated permits: City of Tigard City of Tigard y 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 I 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 platllot. 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 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 t ,. 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, 1 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. 7 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 ix 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 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 & 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. 4.40-4614 (6/00/COM) Fir . A - Mechanical Permit Application _� Date received: /e 1$ Dp Permit no.:, , r jea - eri 54 L ••' i' City of Tigard Project/appl. no.: Expire date: City gfTigard 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: Land use approval: Building permit no.: TYPE OF PERMIT ❑ I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement i tir-New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: /1.14,1 - , i (o kp4 e . Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ • Lot:_ 'Block: (Subdivision: *See checklist for important application information and Project name: G L..,)..,, / . . rj)TJ jurisdiction's fee schedule for residential permit fee. ��4 City /county: rj � _ I ZIP: 1 720y 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE 7,t4 /4 7 -- L G o a T. . 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? ❑ Yes ❑ No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: /tt�¢L .P /) . < e i- pil ,- Cerz-,- J State boiler permit no.: HP Tons BTU /H Address: Fire/smoke dampers/duct smoke detectors City: I State: I ZIP: Heat pump (site plan required) Phone: --75q , fit; (, (Fax: I E - mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner ❑ Yes ❑ No CCB no.: /3 4 5) '7 j 8 Install /replace/relocate heaters - suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace CONTACT PERSON Refrigeration: Absorption units BTU /H Name: h,z7i / Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone p 7e`g Fax: E -mail: Dryer exhaust OWNER Hoods, Type 1/11/res. kitchen/hazmat hood fire suppression system Name: #447 tL0 Exhaust fan with single duct (bath fans) Mailing address: namet/ f _ r _ p�./ 1? J � i e 0 _ 3 � Exhaust system apart from heating or AC Fuel piping and distribution (up to 4 outlets) City: i E pftU J f � / 0 I State:4 I ZIP: 1 y per Type: LPG NG Oil Phone: III co _Z Fax: Z+-t E -mail: yPe Fuel piping each additional over 4 outlets Process piping (schematic required) Name: Number of outlets Address: Other listed appliance or equipment: Decorative fireplace City: I State: I ZIP: Insert - type Phone: I Fax: I E -mail: Woodstove/pellet stove Other: Applicant's signature: Date: Other: Name (print): Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ❑ Visa ❑ MasterCard Notice: This permit ap Minimum fee $ expires if a permit is not obtained Credit card number: / / Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ Cardholder signature Amount 440 -4((7 (6/O0/COM) ,Ill 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 Floor furnace including vent 955 11) >5OHP: absorb unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 floor mounted heater 12) Air handling unit to 10,000 CFM Vent not included in applicance 445 10.00 permit 13) Air handling unit 10,000 CFM+ 17.20 Repair units 805 14) Non - portable evaporate cooler < 3 hp; absorb. unit, 955 10.00 to 100k BTU 3-15 hp; absorb. unit, 1,700 15) Vent fan connected to a single duct 101k to 500k BTU 6.80 15 -30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in mil. BTU appliance permit 10.00 30 -50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust 10.00 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 18) Domestic incinerators >1.75 mil. BTU 17.40 Air handling unit to 10,000 cfm 656 19) Commercial or industrial type incinerator 69.95 Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves Non - portable evaporate porate 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 inserts, etc. 8% State Surcharge $ 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 A/C requires site plan showing placement of unit. is \dsts \forms\rnech - fees.doc 10/11/00 F • . . . , . Electrical Permit Application Date received: /p i 8 o,Q Permit no.: /rhT 0,f lye City of Tigard : y g Project/appl. no.: Expire date: City gfTigard Address: 13125 SW Hall Blvd, Tigard OR 9722 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT U 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ('_New construction ❑ Addition/alteration/replacement Cl Other: ❑ Partial JOB SITE INFORMATION Job address: / / 7 5.,0 / Z ( ry , A- i ei Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: 3 I Block: I Subdivision: Project name: O c 6 ;, t ,.cy ii i - I Description and location of work on premises: it1 //�-7C -,,5,,,,....47:-. Estimated date of comple 'on/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: Fee Max Business name: �'u��,�, 1 z_--6)-4; Description Qty. (ea.) Total no. insp Address: / -7 - ,, O 33Co 6647 ;(te ,e,-,e. ?7Z 7 New dwelling residential cl single attached multi-family per dwelling unit Includes attached garage. City: I State: I ZIP: Serviceincluded Phone: '7 rof -$7 f3 7 I Fax: I E -mail: 1000 sq. ft. or less 4 l , .� Each additional 500 sq. ft. or portion thereof CCB no.: I Elec. bus. lie. no: Limited energy, residential 2 City /metro lic. no.: Limited ener gy, non-residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect, name (print): License no: Services or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 14917 ZQq /I-1 t., 201 amps to 400 amps 2 Mailing address:3 neraR Pe , ,,. /Lime a 401 amps to 600 amps 2 ""77 , > 601 amps to 1000 amps 2 City: �,.K4 /9 .),i 1> I State: OA ZIP: 1 7133s Over 1000 amps or volts Fax. 2 Phone: Zt -i v ©S�Z 7`i t OOSLI E -mail: Reconnect I 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, or relocation: 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): ❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2 0 Service over 320 amps - rating of I &2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighting plan 0 Other. Per inspection I I I Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /COM) • A Electrical Permit Fees: Limited Energy Fees: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4 Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 n Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular n Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. n Audio and Stereo Systems Branch Circuits New, alteration or extension per panel n Boiler Controls a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 n HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 �I Each sign or outline lighting $53.40 I I Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 n Nurse Calls Per hour $62.50 In Plant $73.75 n Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ is \fists \forms \elc- fees.doc 10 /09/00 . Plumbing Permit Application D ate received: / / /, /p Permit no.: �5T D ,V- OG 544 .� �,�_ ;^ City of Tigard •� Sewer permit no.: Build p ermit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/ap no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receip no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement ill New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) L Job address: / /6 S .' /Z a,rrr n v.E• _ Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: Tax map /tax lot/account no.: ltifL��0/ — (includes 100 ft. for each utility connection) i7t c T 11 5 Cup SFR (1) bath Lot: 3 (Block: I Subdivision: 0‘1°70e.. SFR (2) bath Project name: ji4e4,tic ©apt,-,` t7 oy�.P SFR (3) bath City /county: �(��d .l , p I ZIP: q 7 z . i j Each additional bath/kitchen Description and location o work on premises: Site utilities: Nlit y /,7Z/. Gepte Sr Catch basin/area drain Est. date of completion inspection: Drywells/leach line/trench drain Footing drain (no. lin. ft.) PLUMBING CONTRACTOR Manufactured home utilities Business named y 4- , 'r ?i4 iL f, ry0 - j I A..fC. Manholes Address: 1 300 y.t,,.9 7 .14., r. Rain drain connector City: L _'_ Li State: , L ZIP: - rifer._ Sanitary sewer (no. lin. ft.) Phone:5'63 -/7j' Fax:gy 5 -7 r E -mail: Storm sewer (no. lin. ft.) CCB no.: Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lie. no.: Fixture or item: Absorption valve Contractor's representative signature: Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory Name: Co (r te 1 p..[ j p-r-lN Clothes washer Address: Dishwasher City: I State: I ZIP: Drinking fountain(s) Ejectors/sump Phone: Fax: E -mail: Expansion tank MINER Fixture/sewer cap Name (print): 4 Cuts Floor drains /floor sinks/hub Garbage disposal Mailing address:? , 46 i3, ,, T . f ? at 31/73S Hose bibb City: (A jz e State: O,( I ZIP: 9'7035— Ice maker Phone:V -11 -0 , . ` Fax voices 2 I E -mall• 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 Name: . Urinal Address: Water closet Water heater City: I State: ZIP: Other: Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards. please call jurisdiction for more information. inimum fee $ n Notice: This permit application ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: Ex ir within 180 days after it has be State surcharge (8 %) .... $ p TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6 /00 /COM) Wj 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 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 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 ri Hose Bibs 16.60 Tub or Tub /Shower Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet ,j Other Fixtures (Specify) 16.60 Urinal Dishwasher A 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. * * All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts\forms\plm-fees.doc 10/10/00 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE SUNWARD CONSTRUCTION INC PO BOX 336 GLADSTONE, OR 97 027 -03 36 Electrical Signature Form Permit #: MST2002 -00440 Date Issued: 11/4/02 Parcel: 2 S 109AD -10200 Site Address: 14617 SW 126TH AVE Subdivision: MCCLINCY MLP2001 -00008 Block: Lot: 003 Jurisdiction: TIG Zoning: R - Remarks: New SF detached residence, Path 1. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MATT CRINO SUNWARD CONSTRUCTION INC 3 MONROE PKWY STE P PO BOX 336 PivMB 335 GLADSTONE, OR 97027-03-36 LAKE OSWEGO, OR 97035 Phone #: 503 - 244 -0052 Phone #: 761 -8787 Reg #: MET 00003183 LIC 00038173 ELE 26 -469C AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of Supervising Electrician If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 NOV 0 5 2002 IMPORTANT PERMIT NOTICE BEAVERTON PLUMBING INC 13980 SW TUALATIN VALLEY HWY BEAVERTON, OR 97005 Plumbing Signature Form Permit #: MST2002 -00440 Date Issued: 11/4/02 Parcel: 2S109AD -10200 Site Address: 14617 SW 126TH AVE Subdivision: Block: Lot: Jurisdiction: Zoning: Remarks: New SF 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 Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: MATT CRINO BEAVERTON PLUMBING INC 3 MONROE PKWY STE P 13980 SW TUALATIN VALLEY HWY .tReo 0)01e RFAVFRTON_ OR 97005 LAKE OSWEGO, OR 97035 Phone #: 503 - 244 -0052 Phone #: 643 -7619 Reg #: MET 00001047 LIC 12889 PLM 34-4PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X i_-?‘‘,4 Signature of Authoriz mber If you have any questions, please call (503) 639 -4171, ext. # 310 AAAAAA11® 111111111111,1111 1111111111111111111111111111111 /® STREET TREE C _i ► I • A t I, I1n /-ZA 'LGd , Ow ner /Agent for 7 " /lJ 9 ■ (PLEASE PRINT) (PERMIT HOLDER) ■ A / - \ • a ► • RECEIVED • ► 1 1 1 .. NO* hereb - � . e , l • i g location OCT 24 2003 00. meets t rd � � h , n county CITY OF TIGAR ► ��� � � � �� � � '�' �, � � o � �� Y BUILDING DIVISION ► land use and development standards for street tree installation. • Am ADDRESS: _1 p /7 S-{,r) /9 6 ra4 ► r LOT: SUBDIVISION: (CL G / " MvT7 17 19 �( , II 11 J BY. A / /II / DATE: I Q Z'i �3 ► / • RECEIVE I BY: r = X.,_____' 110' �.�� '� A / /4 / y DATE: �' � j • CITY OF TIGARD 24 -Hour '$UILDING Inspection Line: (503) 639 -4175 4 25 - • 2_ a cwd INSPEC7I10N DIVISION Business Line: (503) 639 -4171 • BUP Received 01/6.6 Date R eq sted /a17/5-/J3 AM PM BUP Location 1 C / 7 5 /� ( '' Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR ILDI 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: in S PART FAIL MBING 6 °1811 , 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 Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line l ADA Approach /Sidewalk Date Inspector �' - Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CI OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST L2 3L ( INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested -- ..,, A , PM BUP Location t4 f 2 (2 Suite MEC Contact Person Ph ( ) ,t2--4 PLM Contractor 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 Susp'd Ceiling Roof Other: Final ' • J i FAIL ■ r Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan P S 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 Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA (O/277o2 Approach/Sidewalk Date Inspector 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 ° —56 VW) INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / r Z 3 AM PM BUP Location / / 7 / a Co ` NUQ— Suite MEC Contact Person Ph ( ) 3 / a — O4 X'C PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: _ r SIT Post & Beam e L= 1D ^ b Shear Anchors Ext Sheath/Shear V ` e.t. L. \ h5 F'CAS Ina Sheath /Shear �.c7 �- e C 7 r� c HIV U�� ' C ^�,%�c- j -e p, Framing � � 0 _ Insulation Z ,') Y 2� iMOZWerr7" �5 - e j 5 fir' e � V n"-t Drywall Nailing Firewall 3 J as p [ hGLl �� y - e 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 S • • .e Dampers 41 v a rc,-c , Co - .. bcit_Gk Flow - "C'r � — s PAS PART FAIL RICAL 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 111 Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date b ' Z 3— 03 Inspector v `� Ext Other: c � Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING ' Inspection Line: (503) 63 175 0 ` M �"12:,440 INSPECTION DIVISION Business Line: (5O» 63 - 7 UP Received Date Requested A PM /��— BUP Location /4/7 " J (t /7V Suite MEC Contact Person Rdif C)7fl' & Ph ( ) 3/2— C, PLM ,'O® / Contractor Ph ( ) S# r —,:.. U E ---- Tenant/Owner ELC Footing ELC Foundation �7 Ftg Drain Access: ailizetwejezr.Y /LL — ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam �7 / !'�� /free ��v� Shear Anchors /� AJ / - Q j iffe) Ext Sheath/Shear GC�� ©� Int Sheath/Shear Pli-Ahr,A, ,--, Framing L'' � Insulation J 1 T / 2 -- 3 / (�� Drywall Nailing f �J (f"' ( \ Firewall �I l Fire Sprinkler Fire Alarm \J4_. T- < , Roof Ceiling 4 \Cl. ^ G C'� - • PASS PART FAIL 4liii _ ' Ut-e________ Post & Beam Under Slab Rougljln -- Se == Sanitary Sewer ✓ C .k- 1 8 2-k/ U (\) Rain Drains Catch Basin / M ole 1 $ L 7' "vim 1 Storm Drain Shower Pa Ot - I inal 6 S \e..,/1 , I f -�J I • SS PART FAIL I ► L Post & B eam d f ' tiY` GL c-, Rough -In _4.14 Gas Line - Smoke Dam ers �n - PART FAIL RICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date 16/2,y0 / Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL FROM : JOHN DARBY LANDSCAPE IN FAX NO. : 5035246613 Oct. 22 2003 09:02AM P1 FIRE EXTINGUISHER SVC CENTER INVOICE #: WIL 451,84 3460 SW 209TH BEAVERTON OR 97007 BEAVERTON (503) 6433309 VANCOUVER (206) 695 -9371 EAST PORTLAND (503) 231 -0535 TOLL FREE: (800) 234- •7317, • ACCOUNT NUMBER: SERVICE ADDRESS: o4,:3 L2 045E50 JOHN DARBY LANDSCAPING RESIDENT I I 13867 SW BENCHV.IEW TER 14617 SW 126TH AVE TIGARD OR 97223 TIGARD OR 9722:3 - EITRM , = NETT. —r — c — =w�s�ass ®m.e o oceanc� .m m esee amen -- -""' -" w . xc�ue 'Q��.r..•..- .«-- me— ....� -- -z I ' INVOICE DATE TELEPHONE CON1ACT PERSON PURCHASE ORDER a�— �aca�.-. �. �ca�����xxx�- c,.— v���ac�. avaat�af�xtwmtsrs�as�aa�grisi :rx�-= =__�_� ��vanRatmnweaaw 05/17/03 503- 579 -5298 JOHN DARBY -. ^. QTY. DESCRIPTION PRICE EACH TOTAL sF R :tc.iE` 5 et Ft RMIE.0 BACK FLOW TESTED $ 37.50 $ 37.50 • COMPLETED BY: 1417 DOUG vm-= sec. = = = = == == == �,oeseaaaeammmmsa .�.•� - -sr=s• -- - - - - =_ ...... ... ...... ..�._eA,�mio¢==== =,e mm= =s_ T' QT'(- R.. !.YMO JN"1"' C)lJIE: } PRASE REMIT TO P.O. 80X #1391 -- BEAVERTON, OR 97075 -1391 TO INSURE PROPER CREDIT PLEASE INCLUDE ACCOUNT NUMBER ON PAYMENT THANK YOU FOR YOUR BUSINESS