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Permit
f! CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00102 II DEVELOPMENT SERVICES DATE ISSUED: 4/23/04 ---- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12655 SW BAILEY TERR PARCEL: 2S104BC - BW009 SUBDIVISION: BAILEY WOODS ZONING: R -7 BLOCK: LOT: 009 JURISDICTION: TIG REMARKS: New SF detached. Other mechanical units include (2) gas fireplaces. BUILDING REISSUE: BVH2433 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 26 FIRST: 998 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,435 sf GARAGE: 412 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 236,812.80 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,433 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: BOIL /CMP < 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 SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,628.11 This permit BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES Municipal i subject to the regulations f OR. Specialty C o in ode s and the 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES all other lca ble laws. Code, State All work w ill be done Ce PORTLAND, OR 97219 PORTLAND, OR 97219 all oher applicaapproved wn i accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 443 - 6033 Phone: 503 443 - 6033 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 152235 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Structural Mechanical Insp Shear Wall lnsp Insulation Insp Appr /Sdwlk lnsp Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insj Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Water Line Insp Plumb Final Fou Ion Insp\ PLM /Underfloor Framing lnsp Gas Fireplace Water Service Insp Final inspection / Issue /:�. e i Permittee Signature : % / terI Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the nexti)t usiness day Bundling A • ' �� FOR OFFICE USE ONLY u �` � _- -. �+ _ - � :_ . � Received � Building Date/B : p1 l ,, Permit No. s•_ City g of Tigard , ^ Planning Ap.roval Date/By: Other Permit N .. , Y /6/ 13125 SW Hall Blvd. a 1` Q �, 4 L Plan Review Other Tigard, Oregon 97223 p Date/By: C'l' 6 2 3 - Or/ Permit No.: Phone: 503 -639 -4171 Fax: 503- 5901UtrF TI "��""'�� Post -R view d Use Internet: www.ci.tigard.or.us BUILDING �i '_� �,, Lan _ Inspection Request: 503- 639 -4175 Contact Su See Pane for 24 - hour Ins P 4 Name/Method: /(; _ Supplemental Information . TYPE OF WORK. • • : _:.:.: ; : • :, . , .. REQUIRED © Demolition DATA: "'..: .;, .:. : ;; �;� �., ".. • New construction ❑ 1 & 2 FAMIhtY.DWELLING :. (7 Addition/alteration /replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate © 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation S . JOB SITE INFORMATION and LOCATION _ . No. of bedrooms: No. of baths:3 Job site address: / 5 5 S 4itxo GQi Total number of floors New dwelling area (sq. ft.) Ut. Suite #: Bldg p #: Garage /carport area (sq. ft.) 41 . Project Name: rS �.,� (�c C Covered porch area (sq. ft.) ( OO Cross street/Directions t6job site: Deck area (sq: ft.) Other structure area (sq. ft.) REQUIRED DATA:.' ° COMMERCIAL = U SE CHECKLIST : ,, Subdivision: Lot #: Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK . . • • the value (rounded to the nearest dollar) of all equipment, materials, labor, NEW CONSTRUCTION — SINGLE FAMILY RES , overhead and profit for the work indicated on this application. DEATACHED RESIDENCE Valuation S Existing building area (sq. ft.) New building area (sq. ft.) Number of stories PROPERTY OWNER . } ❑ TENANT. :: _ = : ' : Type of construction Name: Buena Vista Custom Homes Occupancygroup(s): Existing: Address: 6932 SW Macadam Ave. Ste C New: City /State /Zip: Portland, OR 97219 Phone: 503 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be [� APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: Eliabeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: E -mail: BUILDING, PERMIT: FEES *.' PI Wert!) f st hed i ease re . o:, ee u e • CONTRACTOR` Business Name: Buena VIsta Custom Homes Fees due upon application S Address: 6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 97219 Amount received S Phone: 503- 443 -6033 Fax:503-443-2443 Date received: CCB Lic. #: 152235 Authorized //) .. Signature: Notice: This permit application expires if a permit is not obtained within [A• Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Boa (Please print name) is \Dsts\Permit Forms \BldgPermitApp.doc 01/03 • One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City of Tigard City Of Tigard Associated permits: 'Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Electrical 0 Plumbing 0 Mechanical Phone: (503) 639 -4171 0 Other: Fax: (503) 598 -1960 TILE 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 catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, 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 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. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. 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 t6/00/coMi �., 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 • Electrical Permit Application Reed ved Electrical �� E0 DatciBy: Pcrmit No,: t CD-- City of Tigard IRE( jE Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 ��,, AARR ` , 4 213W Date/By: Permit No.: Phone: 503- 639 -4171 Faxit'l3- 598 -1960 Post - Revicw Land Use '" ` - '' D a t ey: C ase No.: Internet: www,ci.tigard.or.us rtGpRd /B _ 24 -hour Inspection Request: ( y6 F 1 j \Sl e `�"` - Contact Juris.: Su See ent l for BU1LDl �i Name/Method: Supplemental information. ..::TYPE;OF W011 C • . ... • : .... ..• . .. ..; • ...: ..; .., ..:: P, I: APFI[ tEVTEWOIeetsithec[cSt1!',`tlrat:a.., New construction Demolition 0 Service over 225 amps- 0 Health -carp facility ❑ Addition /alteration/replacernent Other; ❑ S mmercial ❑ Hazardous location Service over 320 amps - rating of ❑ Building over 10,000 square feet, . . 'CATEGORY{1!F'CONS'FRtnl,1CTI l'. ' 1 & 2 family dwellings four or morn residential units in • & 2 -Famil dwellin Commercial/Industtial ❑ System over 600 volts nominal one structure Accessory Building Li Multi - Family ❑ Building over three stories 0 Feeders, 400 amps or more jj Accessory Builder 0 Occupant load over 99 persons ❑ Manufactured structures or RV park Other 0 Egress/lighting plan ❑ Other: •' ,:: :. JOK SITE. 1TIFopM[ATIONiatit :OCATION • ' .. Submit _ seta of plans with any of the above. Job site address: I�:iY'1 Vi - The above are not applicable to temporary construction service. • Suite #: Bldg. /Apt. #: L��.- 'Err SCI > ': : i ;': ;�; . :: ;:.:'. Number of inspecdops per permit allowed Project Name: Description Qty For (ea.) Total New residential - single or multi- family per Cross street/Directions to job site: 1 dwelling unit Includes attached garage. Service Included: 1000 sq. f. or less 145.15 4 _ Each additional 500 sq. ft. or portion thereof 33,40 1 Subdivision: Lot #: Limited energy, residential 75.00 2 a Limited energy, non residential 75,00 2 Tax map /parcel #: Each manufactured home or modular dwelling service and/or feeder 90.50 2 F�I.V Con n s S Services or feeders - Instanadoo, _ j C /1/9/t_., R/ii! ly alteration or relocation: 0' `l - Cl Lh e C o 1 t� en -� � 200 amps or less 80,30 2 ,, -- 201 Loops to 400 amps 106.85 2 -� 401 amps to 600 amps 160.60 2 • rAFZ)plFili'L'Y OWNER :: : .:. 'FEAP . - 601 amps to 1000 amp 240.60 2 l ,l Over 1000 amps or volts 454.65 2 s Name: l en a- � 1 S� G [. Reconnect only 66.85 Address: < 5t� l a „ �f St ec. Temporary services or feeders - installation. 2 City /State /Z Pc+ 0 Jp alteration, orreiotation: 9 -7 a - 200 amps or less 66.65 1 Phoo l0 2 /L/3� - 400O53 FaX ,cj f (�, /ii ' 201 amps to 400 amps 100,30 2 C I � 401 to 600 amps 133,75 2 • Branch circuits - new. alteration. or Name: „l/Q., / .55 _ extension per nano: Address: A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State/Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: _ Each additional branch circuit 6.65 2 ' E-mail: Misc,(Service or feeder not included) 1, . ...... :. G0�1TI L. oR Each pump or irrigation circle 53.40_ . 2 Each sin or outline lighting_ 53.40 2 Job No Signal circuit(s) or a limited mergy panel. Business Name: ' 055 E - .c ' / j, alteration, or extension Page 2 2 Description: Address: a S 70 50 IIO2! 3 CiVIState/Zip: i-f t It S j -6 i D j2 4171P.3 Each additional inspection over the allowable in an of the above: Per inspection per hour (min. I hour) 62.50 Phone :5 3 Co I n 2.800 Fax: 5r3 W. 4 S investigation fee: CCB 7 Lic. #: IS Lic. #: 3 3t . . Other _ • Supervising electrici I; 1cal Pekial t ota l $ ' ° '� ' X si n ature re uired unit Fee $ Plan Review (25% of Permit Fee) S Print Name: QC 12OSS Lie. #: 4 /23,2,c State Surcharge (8% of Permit Fee) $ Authorized TOTAL PERMTr FEE S Notice: This permit application expires if a permit is not obtained within Signature: _ Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building industry Service Board. (Please print name) i:\Dsts \Permit Forms \ElcPermitApp.doe 01/03 , 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 Mechanical Permit A ' tion FOR CO' Fit 1•: t .' F (1.. Received — 0 c Oate�l3 : - i •. City of Tigard f ec Planning Approval Dat 13125 SW Hall Blvd. , !} 2 *ik pt� Rev, ie+iew •tltet Tigard, Oregon 97223 PA Dates . Permit No.: Phone: 503 - 639 -4171 Fax: 53- 598 -19 Post - Review Land Use www.ei.ttgard.or.us % -c•? 0 z , J - } .‘,4 '• Contact Cass No lttttertuct: o .:.• See Pagel for 24 - hour Inspection Request: 5� k3(9t1iA� - NamcMethod: Snpptententni Inlbrmatioo. • • ... , ,... ,, • ill _ ... , y : :. :.. :. . •i: •. .:1•z:: Alt eai eIAL•FEE ±BCHID EF cKIE/Sr . ; . k . New construction I Demolition Mechanical permit fees* arc based on the total value of the work Addition /alteration/replaCemezlt Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGOR .iOF.CONSTRUCTIO ,: ': , . _. r : .:' .: mechanical materials, equipment, labor. overhead and profit. L 1 & 2- Family dwellin: 0 Commercial/Industrial 'Value^. $ _ See Page 2 for Fee Schedule Multi-Fartil R'ESLDE>!rn.,' t t DI l ER_ DUfi [(N Accesso Buildirl_ • Deur'• • Fe ea. Tow Dr Master Builder Other: nemingiCooliag „Jp : 1 0 t s ■ - 'TON a i i .. ' a TTON . :. Furnace - add-on air conditioning *` 14.00 t �. Job site address: - • SS - • i. . .. E Gas heat • ,• 14.00 Sid _ ./A. • t.#?: Duct work 11.11 14.00 MEM Hydronic hot water system 14.00 Project Name: Residential boiler Cross street/Directions to job site: for radiator or . tonic system 14-00 ' Unit heaters (fuel, not electric) in wall, in•duc su tided. del ill 14.00 Flue/vent for an of above ■ 10.00 Lot #: R • air units w 12.15 Subdivision: t Tax / • arcel #: Water heatet 10.00 . , • ' '• DES or t' LON a F WORK ' : • • Das fireplace 10,00 NEW CONSTRU TZON —ST GL r • Z. .., ' Flue vent (water heatortgas tiirepieet) 10.00 DETACHED ?ESIDENCE - Lo: li• ter 10.00 — Wood/Pellet stove ■ 10.00 Wood . - • lace/insert ■ 10.00 MIMI Chit naL iner /Eluelvettt El 10.00 A ti . ; Other. 10.00 • pPEit1'SC b' :a •, .. .1 NA1!Qx 1t" <. . Environments Exttattsc & Venttta on N ame: B _ ^ .,_ - V i $ - - - II -0 It ' Range hood/other kitchen equipment 10.00 Address: 693_2 SW Macao_ - d, • v S . - C Clothes dryer exhaust 10.00 Ci /State /Zi.: Portland OR 9721 9 Single duct exhaust - .. Phone • . _ A ■ _ . I Fax: 1 - , . - , • (bathrooms, toilet compartments, IffigraCgaallIMIONINP CONTACT PERSON utility rooms) . 6.80 Attic/crawl •ace Ems 10.00 1`1i><zz>e: David Goloba Other: 10.00 Address : lyp in g. City/State/Zip: 40 for first 4. S1-00 elect addidonal Phone Fax: tate/Zll?: Furnace, etc. Phone: eras hest tntmp E-mail: 9Ja1Vsua • euded/unit heater MEM= • .. , co 'TOR . , • Business Name: stir GL ow lIIIIIIIMIMNI Address :2 428 SE 105th ,eve. ::• ., Ci /State/Zi.:Port1and, OR 97216 — — FaX :503 -25 - , iv '.5 Oute ■ •* Pho>l�e;$(}3 253 -7789 Milllia lliall CCB L1C. #: 451 31 hiIUME Pcrnti:t Fees" signature: Authorized _ t Subtotal: 5 gigna ns<tur tse: ,=1.�- d.� -_t� � Date: mu y Mie;rn permit Fee $72.50 S David Golob y name) PE State SuroAar i t Pee gaIMINMEM (Please print na FEE 5 Notleet This permit application expires Ira permit is not obtained within * Fee P ttte` ho dO O o � tadustry Service Board. 180 days after it has been accepted n complete. i;\Dsts'lFermit Ferms\MeoPetmitApp•doa 01)03 • Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to $2,000.00 Minimum fee $72.50 ' $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. • $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. i :lBuilding\Permit Forms\MecPermitAppPg2 09- 01- 03.doc 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY + BUENNA VISTA 2 002/003 •, .. ,,,, .. ., FOROFFR I ISE ONLY Plumbing PermitAl '6 t ation Received Plumbing ' iiketIl Date/8 : Permit No.: City of Tigard '4 4 . l*I‘ Planning Approval DatefElv: Sewer Permit No.: 13125 SW Hall Blvd. lhik‘k Plan Review Other Tigard, Oregon 97223 • .. , •D Date/B: Permit No.: Phone: 503-639-4111 Fax: AI d'919 \ 01' , : - . Po-Review Land Use Internet: www.ci.tigard.or.u.P.,' D` elj,..• -- 11 Date/B : Contact Cue No.: 'aria.: t:s See rage 2 rot 24-hour Inspection Request2M03'43 9.4175 — Narne/Method: Sc • • temente' Information- - .:: ..''. •:, • - ME OP_WORK. . , FEVICUED.UL18 - (facipeeralinfointittreltail: New construction — Demolition Addition/alteration/replacement - Other. Descri . don Qty. Fee(ca.) Total • - - -'•-• :', :• ,1 ; Nit'&. 7.41mBy . . v i-..4 ; : P..1:7:21.....:, !al & 2-Family dwelling 0 Commercial/Industrial SFR (2) bath 330.00 Access° 131ryfflch,En SFR (3) bath 399.00 Ill's/taster Builder _ Other: Each additional bath/kitchen _ 43.00 • ,' . dos srrE INF a ' . • MON incl: 0 • T Fire sprinkler - sq. ft,: Page 2 Job site address: I -wilaltiltaIl' .., .•,• •:..:, • • .. '„ ,: :•7. .. Suite #: Bldg./Apt.#: Citch basin/area. drain 16.60 Project Name: . DrywellAeach line/trench drain 16.60 Footin: drain (no. linear ft.) Faze 2 Cross streeVDirections to job site: Manufactured home utilities 110.00 • Manholes 16,60' Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Pa: e 2 St.72diViitiOr-ot #: Storm sewer (no. linear ft.) 2 Waxer service no linear ft. F. :e 2 Tax map/parcel #; DESCRIPTION OF WORK ' - Fixture or Item ; :-. 'A .. , • '-''' ''. -. ** '' ' :,.. Absorption valve 16.60. NMI, ,CONSTRUCTION -SINGLE FAMILY Bacitflow prcventer Pao 2 TARTLY DETACHED RESIDENCE Backwater-valve 16.60 Clothes washer 16.60 Dishwasher 16:60 Drinking fountain 16.60 TENT -. :::. ....' .-.;•.:::. :. • -: — Ejectors/sumo 16.60 Name: Buena Vista Custom Homes Expansion tank 16,60 Address: 69 32 SW Kaca,..dam Ave '.. Stp _ C Fixture/81MM' cep 16.60 16.60 Ci /State/Zi• : Portland OR 9721 9 . Floor drain/floor sink/hub Garbage disrmal 16.60. _ Phone: 5 03 - 3 - 6 033 Fax: 5030443-2443 Host bib • 16.60 APPLICANT - - . _. -.' : , U CONTACETERSON . . ' Ice maker 16.60 . Name: Ray Mullen Interceptor/grease nu (6.60 I Address: Medical gas • value: S Page 2 — Primer 16.60 , Ci /StateV--- Roof drain (cornnicretal) 16.60 Phone: I Fax: Sink/basin/lavatory 16.60 E-mail: Tuti/shower/shower_pan 16.60 - . ' - . CC , ...:,.... -• i_i....—.71 RACCOR - - _ • - . , . Urinal 16_60 i - Water closet 16.6o Busness Nam:: ED 14121 len 1' 1 ng - ---- Water heater 16.60 Address: 24470 SW Rainbow Lane Other: . - City/State/Zip: fall ubnto . (1)3 071 7 a other: . . , : „ , .. .,,.,,:„.::PitualitisfracitdaSeert_' ,'....' • -.: .. ' • . .. .. Phone: 0 -628-1 . _ Pax: I - . : - , . subtotal s CCB Lic. #: • . : • Plumb. Lic.#: • - . 0 - : '. Minimum Permit Fcc S72_50 S __. Authorized 01111MPIPry . " 9 (4 Residential Sack:flow Minimum F 536.2$ Signature: .44/ 4 -4/ ..,., 0 C: ,...' /*--' Plan Review (5 34 of Permit Fee) S . Ray ul en Air State Surcharge (8% of Permit Fee) S ----- (Please print name) TOTAL PERMIT FEE _ S Notice; This permit application expires Ira permit is not obtained within . AU maw comMerdal butbiltip require 2 OW of puns with isometric or 180 days esker It hat been accepted es complete. riser diagram Ibr plan review. v Fee methodology set by Tri-County Betiding Industry Service Beard. ii‘Dsts\Pertnil Porms‘PlmPermItApo.doe 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities . - Qty. Fee (e!) Square Footage: Permit Fee: Footing drain - I 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater - $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each ft additional $100.00 or fraction thereof, to and '`.F.010r 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 Bacicflow 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 S379.50 for the first $25,000.00 and SI.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 72.50 550,001.00 and up $742.00 for the first $50,000.00 and S1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. , . Quantity b(Fiititie)..Woik.Peifoliiiii:L.:' Comments regarding fixture work: Fixture Type: . • Replace :Moied 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" Car Wash Drain Garbage -Domestic *Note: If the fixture work under this permit results in an Disposal -Commercial increase of sewer EDUs, a sewer permit will be issued and -Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory • -Bradley -Commercial -Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: DstsTermit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour `l , Ar B 14. 11111" - UILDING - Inspection Line: (503j6.39 -4175 Lk) lid O INSPECTION DIVISION Business Line: (503 }.64171 MST # - D-' ti. . L. �► BUP - Received Date Requested AM PM BUP Location ' Suite MEC Contact Person Ph ( ) • 7/ U' 8/45 PLM Contractor — 1:34,( 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 l iY y 70 Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Otth �z - ART 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 Pte APART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line Approach /Sidewalk Date 7 Inspector a 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 07 .6a 66 / INSPECTION DIVISION Business Line: (503) 639 -4171 BUP S Received Date Request d o as AM PM BUP Location / Suite MEC Contact Person Ph (_ I t) �PLM Contractor 41 , Ph ( ) 71/ 27 /3 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 PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower„pan Other: Kt :e. GP PART FAIL CHANICAL Post & Beam Rough -In • Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Anal ❑ 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 Date g 1 t-4 Inspector � L (� b � 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 '°1 ac) 6 a� INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested g / AM PM BUP Location / 4 Suite. MEC Contact Person C iiLA 2,o Ph ( ) 6 qat - 7 ' () PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing - Foundation ELC Access: Ftg Drain ELR Crawl Drain ,A= Slab Inspection Notes: SIT Post & Beam FM' Shear Anchors Ext Sheath/Shear ` .. int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FA . ! : ► Po . & Beam Unde Slab Rough - Water S: vic: Sanitary ' - er Rain Drair - Catch :: sin Manhole Stor II rain She ' er Pan • er: 4VAIP SS PART IL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PAS ART FAIL CTF;ICAL Service Rough -In UG /Slab Low Voltage Fire Alarm ,, PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S " Please call for reinspection RE: LI Unable to inspect – no access Fire Supply Line ADA Approach /Sidewalk Date 494 — 2) 1 k Inspector I Est Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL