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Permit
N ,, CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2004 -00101 DEVELOPMENT SERVICES DATE ISSUED: 4/23/04 2 ---� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12650 SW BAILEY TERR PARCEL: 2S104BC -BW008 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 008 JURISDICTION: TIG REMARKS: New SF detached. Additional mechanical units include 3 gas fireplaces. BUILDING REISSUE: BVH3053 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 85 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,560 sf GARAGE: sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: 1,408 sf RIGHT: 5 VALUE: 301 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,053 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN <100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 3 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 6 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: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,185.79 This permit is subject to the regulations contained in the BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES Tigard Municipal Code, State of OR. Specialty Codes and 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES all other applicable laws. All work will be done in PORTLAND, OR 97219 PORTLAND, OR 97219 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. 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 PLM /Underfloor Framing lnsp Gas Fireplace Water Service lnsp Grading Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk lnsp Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ins F Rain drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Storm drain Insp Mechanical Final Fou Ion Ins. Footing /Foundation On Electrical Rough In Gas Line lnsp Water Line Insp Plumb Final Iss ed By : ' � � ��' / it ' � i / Permittee Signature : ` /� �/ - � Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne4 usiness day /4 , Building Permit Application FOR OFFICE USE ONLY' Building Date/B Received ,N Aft, Permit No.: --oo f City of Ti and Planning Apt ■.val Other n/� y g Date/By: Permit No.A..()R- 0 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 , Date/By: 1 14 n tl 11 .2 -oa{ Permit No.:' Phone: 503- 639 -4171 Fax: 503 - 598 -1960 / `"`' i : Post-Review Case d Use Internet: www.ci.tigard.or.us Inspection Request: 503- 639 -4175 Contact Jy I . ( . . IS See Page l for 24 -hour Ins P q Name/Method: � I. Supplemental Information .TYPE OF WORK. • :. ..._ ... " _ _ REQUIRED DATA: :: . : • . © New construction ❑ Demolition 1'& 2 FAMILY DWELLING _:. ❑ Addition/alteration/replacement El Other: • • • _ I .� �� _ . - CATEGORY OF CONSTRUCTION ... .. •. Note: Permit fees* are based on the total value o he work performed. Indicate © 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of quipment, materials, labor, overhead and profit for the work indi on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation s JOB SITE INFORMATION and LOCATION No. of bedrooms.. r o. of baths: 5 Job site address: / ez;npL Total number of oors Suite #: Bld . /Ap #: New dwelling area ' (sq. ft.).... i '- Garage /carport area (sq. ft.) . Project Name: b Covered porch area (sq. ft.) ?�' Cross street/Directions job site: Deck area (sq. ft.) if' Other structure area (sq. ft.) 72 Fr .. _. " • REQUIRED DATA :..: -, . COMMERCIAL - USE CHECKLIST::':4' - .. Subdivision: Lot #: 0 o 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 - I 0 TENANT . • 1 .:: -: Type of construction • Name: Buena Vista Custom Homes Occupancy Existing: - Address: 6932 SW Macadam Ave. Ste C New: City /State /Zip: Portland, OR 97219 Phone: 503-443-6033 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be 0 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: t . _: E -mail: B FEES P cchedul DING PE ii i :.. . . , lease i:efec�to :fee`s, _ .;. ,. 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: L91 Date: Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03 • 4 1 1,6 One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City of Tigard City of Tigard Associated permits: o Electrical 0 Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O 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 platfot. 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 0 plan 11 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. 4-io -1611 t6roaco.rl 03/04/20+04 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 • Electrical Permit Application FOR OrFIC : t`sF., O\i : 1 Received Electrical DatuBy: Perm o.: W ro oo /Q/ City of Tigard Planning Approval gi Date/gy: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639.417.1 Fax: 503-598-1960 „, .., .. Post-Review Land Use -- "Y'-‘.;•.:;,, , . DatcBy: Case No.: Internet: www -or.us Contact 24 -hour inspection Request: 503- 639 -4175 ` �" ' Juris: S See Page for Name/Method: S JrplementaI Inlbrmation. TYPE;OF WORK • . • , tPlegse'' Cliecfc itU ;that ?iiPti4'} • , ” .. New construction 1 Demolition ❑ Service over 225 amps. 0 Healthcare facility ❑ Addition/alteration / replacement Qtll�t ; cornmcrcial ❑ Hazardous location ❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet. • AT'1 CKYRYOF'CONSIRVI FIO N'. 1 & 2 family dwellings four or more residential units in • • 7 & 2 -Famil dwelli . • Commerclal/Industt al ❑ System over 600 volts nominal one structure • Access° Buildin l Multi-Family ❑Building over three stories ❑Feeders, 400 amps or more [] Occupant load over 99 persons ❑ Manufactured structures or RV park p Master Builder LI Other: ❑ Egress/lighting plan 0 Oth =. '.IOU. stn. I NFORMAIGION stint EOCt1;�'IOM' 77-7—.. Submit _ sets of plans with any of the above. Job site address: 52) - 4 ?c . The above are not applicable to temporary construction service. '�P Suite #: � Bldg./Apt.#: �' '' • . . • Number of ins tons per permit allowd . _ Project Name: Description Qty ' Fee (ea.) Total Cross street/Directions to job site: New residential- singlo or motel-family per dwelling unit. Includes attached garage. Service Included: 1000 sq. ft. or less 145.15 4 • Each additional 500 sq. ft. or portion thereof 33,40 1 Subdivision: Lot #: Limited cnergY residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: manufactured home or modular dwelling -, ' • Each manuf DE ' - -1. ON.OF WORK' :: • •. service and/or feeder 90.90 2 r • " k l.\ Services or feeders - installation, F GG n S '- S / /19' C fe rn f /y alteration or retocadon_ "° - (-IA t c -. P...a � ∎ d en e2— 200 amlps or less 80,30 2 zot am t o Oat a 106.85 a 401 snips to 600 amps — _ 160.60 2 r, '' O. • '.RiQPER R i' O 17 PE R : :. II TE N - .: - ' •'. - 601 amps to 1 � amps ' 244.60 2 N ame: C Over 1000 am_ps or volts 454.65 2 �� 5 Gl 1 � �` tlf� Re on Address: I `l /I l / I 1 � �. 66.85 ., 2 : x1 JG� l G(�C.... Tempo rary services or feeder - instal lation. City/State /Zl s : 'of -}-(o 0� 9 --/g/9 200 a atp s o� le relocation: �i l 1 200 amps or less 66.65 I • Phon -. • 3 - (� 3 Fax 2A • 3 201 amps to 400 amps 100,30 2 iR : C''. • .. CT: 's. QN 401 to 600 amps 133.75 2 nslre - new, alteration. or NEE' : i'Q.- / o 5S extension Branch per panel: Address: _ A. Fee for branch circuits with purchase of service or feeder fee, cacti branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of Phone: service or feeder fee, first branch circuit 46.85 2 Fes Each additional branch circuit 6.65 2 E -mail: Misc.(Scrvice of feeder not included); . C TRA R ` '.::' :: 7 Each pump or irrigation circle ., . •. 53.40 2 Job No: Each+ or outline lighting_ 53 ' 2 Signal circuits) or a limited energy panel, Business Name: fi 055 el„,C'' j �/'_ ,— alteration, or extension Page 2 2 Address: 243 City/State/Zip: i+1 it S t ti-C. l DR q -1I P.3 Each additional inspection over the allowable In antof the shove: Phone:,$e23 Co (j Per in, lion bout min. ! Iota 62.50 Z Z8Q F ax :. 3 •1 investigation fee: CCB Lic. #: IS Lic. #: 3 34.c Other: �y Supervising elcctnci ,. ,• • ElettcEcal :,pekm ;`r., : .. ';,;; ::,;,::.:.;;.••••,•;;;;;,,:',.., X _ s nature required' �.< Permit Fe ar $ tic Plan Review (25% of Permit Fee] $ Print Name: j-CQC j?oS Lic. #: 2 _As State Surcharge (8% of Permit Fee) $ Authorized TOTAL PERMIT FEE S Notice: This permit application expires If a permit is not obtained within Signature: Date: 190 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board - (Please print name) i:\Dsts \Permit Fnrnts \E1cPcrmitApp.doc 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 r Meehanicat Per ,App lic at ion FOR OFFICE k: I :sF (1 \ {.1 Received Oate/13 : - ii DO(o Planning Approval City of Tigard - Oat 13125 SW Hall Blvd. Oat Review ether Tigard, Oregon 97223 Meal , Permit ; Phone: 503 -639 -4171 Fax: 503-598-1960 ;• !s. , Post - Review Land Use . , :, i a, Date/13 ; Case • Internet: www.ci tigard.or.us Curie.: See page' Eor 1,�.. � Contact 24 -h Inspection Request: 503 639 - 4175 ` -- ' Naetc/Methe4: StIppletetental folbrmado .. . I.' ' , , , , .. I n n s OF W O R K • s.. ,t-,,.. , , : , : . ::.:.: , 1 : ; ':t'.e C O I t C L I L • F E E ' . B C E D • 1.est,conc• , . ; , . . :iassr ; ... • IS:, New construction Ill Demolition Mechanical permit fees* are hued on the total value of the work NM Addition /alteration/re ilacement U Other: performed. Indicate the value (rounded to the nearest dollar) of all ': , OF.CONSTRIt TI" :L: Y -'n ` "' , mechanical materials, equipment, labor, overhead and profit. L I & 2- Faxnil dwellinf ■ Commercial/Industrial values $ See Page 2 for Fee Schedule Accessory Building Multi-p�l l Egir:sC ptiu ,M A ry $ Deser' • den a Fe ea- Total DI Master Builder ❑ Other: Bead, ; Coolie: „JO : SITE INTORMATCON an• LOCATION ' •::. Furs - • • 4 . • : Oft. • • 1 ' 14.00 Job site address. • _ % � �" la Gas heat - ,. MI 1 Sid, IA. t. #: Duct work 14.00 MINIM Suite 0: H dronic hot water s tern 14.00 MEN PLO CCt Name: Residential boiler Cross street/Directions to job site: far radiator or h : ronic ;vg= 14.00 Unit heaters (fuel, not electric) (in wall, in.duc su nded etc.) 1111 14.00 Flue/vent (for any of 4bove 10.00 .1. Repair units Subdivision: Lot #: R 12.15 Fuel A • llaaecs Tax = ./ • arcel #: Water hewer III 10.00 • • • DES or I' [ON !. F WORK , ' • • Gas fi -lace 10.00 NEW CONSTRU TION —SI GL F' I' Flue vent (water hater /eastireplace) -- 10m immin Log li, ter =- . • 10.00 DETACHED RESIDENCE Wood/Pelletstove 10.40 "cod • 10.00 MEM Chiron !liner /flue /vent 11111 10.00 w.i.<'Y;: Ot 10.00 Fir ' ' 1PE S� O' :a ., - 1 NAPiT a Environmenm Exhaust & Veatstadon N ame: g _ ^- .._ c. Nils - .. • „ - • It - Range hood/other kitChetl equipment 10.00 Address: 6 ' SW Mace: - .,, ' v-_ S . - C Clothes dryer exhaust 111111 10.00 Ci /State /Zi•: Portland OR 97219 Single duct exhaust Phone a _ , • _ . e Fax: 1 _ • . _ , • (bathrooms, toilet compartments, r! rCPPLIC/CN 1' .11P CONT - • . PERSON will morns . 6.80 Attie/crawl space fans 10.00 /slum David Goloba Other 10.00 Address: Fneljap +�� .40 for first 4. S1.00 each addidonal Ci /State/Zi : Furnace etc. M 111 1 E11 PhO e: Fes' Gas heat pump E-mail: Wa11/ us•ecded/unit MEE :'','.'s '''' , ; .. ,. _ . CO CTOR Water heater r� Business Name: G . w 9. . _ � i� Address:2428 SE 105th Ave. BS ' •' City /State/Zip:POrt1arid, OR 97216 Clothes. er gas IIIIIMEMNI - 25 Phone: 5 43- 253 -7789 1 F ax:503 -3 - b " Other. • Total; � CCB Lic.#: ' 131 31 Mechanical Pcrutit Fees" - -- Authorized — e Subtotal: S 5ig'nature: ,' ` 0 _ Datc: ti Minimum Permit Fee 571.50 IIMMIIIMIM David GolobbY Plan Review Fee (25%ofPermit Fee) 5 (Please print name) State Surcharge (8% of Permit Pei S TOTAL PERMIT FEE $ Notice: Tbts permit application expires if a permit is not obtained •'ithln • Feeeta methodology for b= � bounty Building Industry Scrvlee Board• 180 days after it has been accepted as complete. i:■Psts1Pumit FemateeeerriitApo.doe 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. hBuiidingPemiit Forrns MecPermitAppPg2 09- 01- 03.doc • 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY + BUENNA VISTA a 002/003 Plumbing Permit A ,plication -F(`w(.OFFEc 1 i ON L, Received DateJB : IIMEMPAW—ele) fi • City. Of 'Tigard Planning Approval Sewer Datr./Bv: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/ ; Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -1960 Post - Review Land Use Internet: www.ci.tigard,or.us r ' Contact Case No.: a _ A j l Date : act tuns.; trs see Page 2 for 24 -hour Inspection Request: 503.639.4175 '- - --• Name /Method: Su • .losneorai tnformatioo• " - TYPE OP_VitgRliv'' - ` , , 'f''' . FEIV C ULZ taut u ` ak `A New constructions Demolition Descri o 1 Qtr• i Feo(ea Tom Addition/alteration/replacement ,_ Other ... - °•..7' „�+` 4we><iugs• . { �.,, ,, . , : 1, : � ]i � fYl '.:- .:�tfe .�1 f!brriihb: t .oinilidton. 'its.':.,•.- •.;�,� /, ` SFR 1 bath 249.20 • 1 & 2- Farnil dwelling l Commercial/Industrial SFR (21 bath 350.00 IU Accessory Building Multi - Family SFR 3 bath _ 399.00 [ - r Master Builder 8 Other: Each additional bath/kitchen _ 1.00 • . I OB STYE IINFORMA,TIOd ' i .LOCATION ' ' Fire • ler - ... fr.: Pa:e 2 Job site address: ., , 71 — , * 'l' . • • . - Slte.Vtifttles :, '':.:,.`' t _ .. . Spite #: BldgiApt. #: Catch basin/arca drain 16.60 Project Name: - Drywcll/lt:aeh line/trench drain 16.60 Footing dinar (no. linear ft.) Pace 2 Cross St eet/Dir'ections to job site: Manufactured home utilities 110.00 Manholes 16.60' - Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdiv1SiOn: _ I Lot #: 5t r ti sewer (no. linear ft.) Paso 2 T ax ma / arcel #: Water service (no, linear ft) Page 2 _ maw parcel , ' , Fixture or Item .. . DESCRIPTION OF WORK Absorption valve „ 16.60. NNW, ,CONSTRUCT ION - SINGLE FAMILY Bad:flow prevcntcr Page 2 FAMILY DETACHED RESIDENCE Bacicwatervalve i - 16.60 Clothes washer 16.60 Dishwasher 1 6.60 Drinking fountain 16.60 .01PROPERWO'171F11111? ,: :: El TENANT Bjeotortfaump 16.60 Name: Buena Vista Custom Domes Expansion tank 16.60 Address: 6 9 32 SW MacAdam _Ave . stp c Fixture/sewer ca- 16.60 Ci /State/Zi.: Portland OR 97219 Floordrain/floorsink/hub 16 _ Garbage disposal 16.60. Phone: 503 -- 443 - 6033 Fax:5030443 -2443 Hose bib • 16.60 UN APPLICANT • • • ', B. , ' :4: aN ' tee maker 16,60 • Name: R a Mu l l eri interceptor /grease trap 16.60 Address: Medical gas • value; S Page 2 Primer 16.60 Ci /State/Zi • : Root (commercial) 16.60 _ Phone: Fax: _ - Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan - 16-60 • , CONTRACTOR • • • • Urinal 16-60 _ Water closet 16.60 Business Name: ED MU , ..., Plu • , n • - water heater 16.60 Add &ess: 24470 SW Rainbow Lane Other: 1151 .. • . Other. - Phome. 503 -628 -1632 Fax 5Q3- F28 -dFi3 ^..:PIw�OZiasPet:mJerBeb *.. Subtotal S CCB Lic. #: 1 !! . : Plumb. Lic.#: _ - o Minimum Permit Fee S72.50 S Authorized ' „.9. � Residential Backflow Minimum Fee 536.25 Signature: ✓ e y e c: / / Plan Reviewsz5% of Petmic Fee) S _ Ray ul ens State Surch a 8% of Permit Fe S (Please prim name) TOTAL PERMIT FEE S Notices i bls permit appllestion expires Ira permit is not obtained within AU new commercial bulldlep require 2 sets of Plans with isometric or !80 days esker L has been accepted u complete. riser r me methodology r plea by T review Building Service Board. gy by h S i:Wsts\Pertnii Forms \PitrnPermltApo.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea} . ,, Tot,t. • Square Footage: Permit Fee: Footing drain - i 100' 55.00 0 to 2,000 $1 15.00 Footing drain - each additional 100' 46.40 2.001 to 3,600 $160.00 Sewer - 1st 100' 55 3,601 to 7,200 $220.00 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 Fixture Or Iteur';; Fee ea " ' additional $100.00 or fraction thereof, to and Qty _ _ 1 ) , Totat•• including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Fixture Work: • Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. . Quantity .by(Fixture),Worklerfornied..: Comments regarding fixture work: Fixture Type: • • t • .',.: . New Moved : . = SEifsttng `; .:Gipped i 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" 3" -4 „ 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: i:� Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03 84/67/2004 09:49 5032290626 BARRY R SMITH PC ARC PAGE 02 L G • • STR€Er T2ECS MAST . ?4 ft Af z &UEt).. S,n 13 D .x v = S ro4 Tat( ?mi.). / WATER STORh1 I ~I , �3' -- . (d' -r " ' I �4'_0 ^ In'i 6 11/16R • I fs � SAS –_ AT =R " - I JIM r IU EL>rC_ N 89`22'18° E 75 .2g' Z ' — 284,' ..2' .1 3-'-1 3 / �" , • �. i 1 ..........__....... SAN! AR - r..-- ----7 IIn IS"' !ilk __- ._- .- - - -- ____-_• - g SEWER 21.00 '°"�� " 283.5' .. 1--, -SILT 21 3©' - - Ir.-- \ 4 � ENG� CsQF'4GE n„ l. • I - ii' � —+ �: -�► � " A gars � I 5496 SF 21, - 1. I '81/143053 Q �t Z '�;.�IC � t 6 "' ilk ;...L_, _ • - -t - W _ P itigi f :" .1 : . -. :::, . - 1I�� - -- _> -. .6 �_ L am. "9 N. 0 4°' �" r V� - � 93. W o C'S .Q • 61 >- a Q F- _1 o go � EE��' _ � _ ll.l 5 5 -g3'_.T 3/s" 30'7_.0•' . • • S'-(01-.- _ ; - - - - -CC m mr■ 14,11--,..v„..2. � 1 J(%. 5 'i'7" U.l= 843 0 29'1' 9' • J ,.i. j — SPEC (E :) PROVIDE T1�EE PROTECTION 0 FECINc A -- ROUNu ALL TREES TO BE SAv Ep, INSTAL h'' ER CIVIL DRAWING / LOT S -- S ITE PLAN NORTH Ho BUENA Vi CUSTOCUSTOM _E �� LOTF3 HON 'E SUEM M)ST CUSTOM HOMES X 932 SW MACADAM AVE, STE C . BAILEY WOODS' OUBDW1 ON - 14125 X14 FERN $T, TItl (503) ARD, OR 97223 PC�t9TL 6 332661 4 443 -6088 SITE PLAN FAX: 6503) 443 -2443 04.07.04 • CITY OF TIGApr - SITE PLAN REVIF AMP BUILDING PERMIT NO.: $7,,00 _ oo a IIIMA PLANNING DIVISION: _ Required Setbacks: � A 7 Side: S Approved ❑ Not Approved Street Side: _1_(2__ Front. IS Garage: o D Visual Clearance; Rear: is A pp r oved 0 Not Approved Maximum Building Height's feet CWS Service Provider Letter Required: ❑ Yes ;RI No a. Rcc ived ENGINEER' G DEPARTMENT Date: Actual Siope: � Sit Site Pl: n: t Approved ❑ Not Approved i 0 Approved ❑ of • 'proved Notes: Date: 4 l • - e/yi C40 et CITY OF TIGARD • 24 -Hour BUILDING Inspection Line: (5031639 -4175 S q_ e (b f INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested /' v � AM PM BUP Location 1 - Lc) 5 --Q/1A Suite MEC Contact Person c— Ph ( ) /2/0 - g //s PLM Contractor �� Ph ( ) SWR BIIDIN Tenant/Owner ELC Foo r ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: G° 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 r101ECHANIC' Post& Beam Rough -In Gas Line Sm.. Dampers i - AS `' PART FAIL 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 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date rte if- Inspector _ Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL 1 I CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503)' 639 -4175 MST Y `)( INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / AM PM BUP Location s7; /.c-L Suite MEC Contact Person s Ph ( ) 6 'f Z ZedO 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 ' t Framing C. Mt //. , /� Insulation / / Drywall Nailing Firewall Fire Sprinkler Fire Alarm i 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 PAS PART FAIL - e Rough -In UG /Slab Low Voltage Alarm (0' "� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL //// SI Ei Please call for reinspection.RE: ( Unable to inspect — no access Fire Supply Line n �� ' J ADA 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 '00 — 6 1 6/0 /0 f INSPECTION DIVISION Business Line: (503) 639 -4171 ma y' BUP Received Date Re sted ! - ue ZZ � AM L PM BUP f �-- (esa Location Suite MEC Contact Person O/ Ph ( ) 2/o —8 //� PLM Contractor Ph ( ) SWR • BUILDING Tenant/Owner ELC Footing Foundation 7LP6 ELC Access: / � Ftg Drain kJ( j f C� 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: ' ASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers M L. 0PART 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 Ej Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line t ADA Approach /Sidewalk Date 4` a� Inspector . (7 J ) 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 .X 0 /0 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested — I �— AM PM BUP Location - .TI 4 , __. Suite MEC Contact Person Ph ( ) 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 Final PASS PART FAIL C \-1 7C7- 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 Anal El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ID Unable to inspect — no access Fire Supply Line ADA TD () roach /Sidew Date Inspector Ext Other: Fi DO NOT REMOVE this inspection record from the job site. PART FAIL