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Permit CITY TIGARD MASTER PERMIT PERMIT #: MST2005 -00064 Bill DEVEL SERVICES DATE ISSUED: 3/29/2005 13125 SW PARCEL: 2S115AA -10100 SITE ADDRESS: 10936 SW BRETTON CT ZONING: R -4.5 SUBDIVISION: BRETTON WOODS LOT: 006 JURISDICTION: TIG Project Description: New SF BUILDING REISSUE: SSN3269 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,431 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,838 sf GARAGE: 486 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 314,894.60 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 3,269 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: I GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 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/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BRCIR: 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: ALL - ENCOMP BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes LEE -LAND HOMES LEE -LAND HOMES and all other applicable laws. All work will be done in 28 BECKET ST 28 BECKET accordance with approved plans. This permit will expire LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 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 Phone: 503 Phone: 635 1343 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: LIC 41535 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 10,673.61 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 2 ‘..,.....„ Issued By : 2 4 L , C L . r e - Permittee Signature : 7 6 ' Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. t . r ! Bui' ing hermit Auplic , S4 ` � 14-.), ;OR o f a icl USE ON , City of Tigard . Permit No.: e 13125 SW Hall Blvd., Tigard, OR 97223 P Review/ �, � 1,Ai elD, , / Phone: 503.639.4171 Fax: 503.598.1960 M p R p 0 ll I�h'a , a,i I �\ Date/B .MAn) 3 "2 g -o 5 Other Permit:jC,�G00 04.. � G4p 1 Inspection Line: 503.639.4175 ._t . t a v e`f_ Date Ready/By: n 65 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: 7 On) - -'an Supplemental Information CITY OF Tic b. p 4..t 1 )- s 3 1 1 : $ , Ire" , RE ED,DATA: 1- AND 2. FAMILY DWELLING , New construction ❑ Demolition Permit fees* are based on the value of the work performed. • Indicate the value (rounded to the nearest dollar) of all . ❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1- and 2- family dwelling ❑m Comercial /industrial Valuation: $ 3 dQ J ®UO 3 ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder 0 Other: Number of bathrooms: 2 f /2 JOB SITE INFORMATION. AND LOCATION Total number of floors: Job site address: 1 d q3c arG> fiev, �'� New dwelling area: 32 (q square feet City /State /ZIP: ) 0-1-1, 0l Garage /carport area: Ca6j square feet Suite/bldg. /apt. no.: Project name: 1 Covered porch area: ! V square feet Cross street /directions to job site: f c) 0 . / Deck area: square feet P ar / Other structure area: square feet REQUIREHDATA: COMMERCIAL -USE CHECKLIST Subdivision: rf �e14)r) 00 Lot no.: C Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. . Valuation: $ • Existing building area: square feet , New building area: square feet A. L OWNER ° . TENANT Number of stories: G-. • Name: F Ef 411/19 p, e3 Type of construction: . Address: 2,g !✓ G Z. r 5", ) Occupancy groups: . - City /State /ZIP: L Jt /C- ©5 4'A C/ /►. 0 if /p�s Existing: Phone: ( 9 (35/3 Fax: ( ) ,G(. nv •� New: APPLICANT iq CONTACT PERSON NOTICE - r, Business name: L./4/02 Hal/ 47 . All contractors and subcontractors are required to be Contact name: f� L.€ .a licensed with the Oregon Construction Contractors Board © ,./�� // under ORS 701 and may be required to be licensed in the Address: ,2,F /3 .ec /Ce1-- r5 . _ jurisdiction in which work is being performed. If the 7�3s applicant is exempt from licensing, the following reasons City /State/ZIP: ii..., C am / 4 /1 (9 apply: Phone: (5 03) JS — /3 £/J ax: : ( ) SA.,yl l .e, .. E -mail: CONTRACTOR ' Business name: C E — I ' ' 1 s P V BUILDING PERMIT FEES * Address: ! / eG C�Jj�, �) �J Please refer to fee schedule. City /State/ZIP: / C� C?s Q (9 /l , -! 7©3s (3703) 63 >– _/.310 / Fax: ( ) M Fees due upon application Phone: CCB lic.: 9 /5-3 5 -- -- Amount received 9 Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: ` Date: 5_1_0 * Fee methodology set by Tri- County Building Industry Service Board. i:\Building\Permits\FPS- PermitApp.doc 12/03 440- 4613T(I I /02 /COM/WEB) "• • City of Tigard: Fire Protection Permit Checklist Page Supplemental Information • 'Describe work to be done: 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition ❑ 1 -10 heads: No plan review required. ❑ Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: Type of System '(Complete A, B, C or D as applicable): A.) Comm ercial . Sprinkler ❑ Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ C.) Fire Alarm Submittal shall Battery Calculations ❑ Yes include: Individual Component ❑ Yes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) . Square Footage: Permit Fee: 0 to 2,000 $187.50 2,001 to 3,600 $232.50 3,601 to 7,200 $292.50 7,201 and greater $381.50 Sprinkler Project Square Footage: sq. ft. Project Valuation Subtotal (A, B & C): $ Permit fee based on valuation (see attached chart): $ Permit fee based on square footage (D) (see fees above): $ State Surcharge 8% of Permit Fee: $ FLS Plan Review 40% of Permit Fee: $ TOTAL: $ Plan review requires a completed application and 3 sets of plans at submittal. Plan review fees are required at submittal. "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. I :\Building\Permits\FPS- PermitApp.doc 2 Electrical Permit Appl fi ,,, . . FOIiOFFICE USE ONLY Received , r. S 4 � 4 City Tigard .,.. ` yT Received Permit No.: Q ' [ / �,� j " /, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 MAR 0 3 1 � �'�i�M< r mirrfy ' ' I � � Date/B . Other Permit: Line: 503.639.4175 _1 J, j..e'_ Date Ready/By: iuris: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information 'CI r �Z�r; ` ;�, a. PLAN REVIEW , � tT . � W � O , RK N New construction A cl ... e b Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑Hazardous location OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories 0 Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE .INFORMATION AND LOCATION ❑Egress/lighting plan RV park 0 ❑Health -care facility ❑Other: Job no.: Job site address: V ������ G Submit 2 sets of plans with any of the above. City /State/ZIP: - 7 0/1" 0 / ?/ The above are not applicable to temporary construction service. Suite/bldg./apt. no.: Project name: //)J /' / [/ • - FEE* SCHEDULE j/ I`� W ��i�l� 5 Description I Qty. I Fee. I Total I •' / Cross street/directions to job site: . 73 O M. / -AA New residential single- or multi - family dwelling unit. l C Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: 13re -/fo„ 4 � Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 • DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 �� 401 amps to 600 amps 160.60 2 L Name: ‘ — Lop gooks ` 601 amps to 1,000 amps 240.60 2 Address: .2g je 6, /c f Si- Over 1,000 amps or volts 454.65 2 J Reconnect only 66.85 2 City/ State/ZIP: L� /r !. (75 c g o ©r( '( 2 5 Temporary services or feeders installation, alteration, and / Phone: (c SC-41.Z— 2J) 0 /21/,) Fax: ( ) relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ' ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each Business name: L4 C_ L lippt,S „ ar L l ee . branch circuit 6.65 2 Contact name: D , e 6 i'n L, z,,, £ B. without our service circuits without service or feeder fee, 46.85 2 Address: 7,6 e G" t each branch circuit Each add'I branch circuit 6.65 2 City / State/ZIP: / e� ,j 0 �,O c, 0 0, q 2 Miscellaneous (service or feeder not included) /� Y/ Pump or irrigation circle 53.40 2 Phone: (<OJ (3 S , f-J 4/) Fax: : ( ) S� yr ,fL Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - CONTRACTOR / L'� energy panel, alteration, or Business name: / 7 ' �' r / / ,. / ' G extension. Describe: Paget 2 Address: pO, 6 X. 216(2- I Each additional inspection over allowable in any of the above /\ / / ' �� � � Per inspection 62.50 -- City/State/ZIP: /-'i [ '5 ,, ' ? Z3 Investigation per hour (1 hr min) 62.50 IN a Phone: (5 3) 2. 13 /7 Fax: ( ,3) y�/D 6g a 3 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: /q62 Electrical Lie:: 7 t, -5"t Suprv. Lic.: L L t %[ S / e"� Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) � � / State sur (8% of permit fee) Print name: r& A G Date TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: 8 ,) L, L Date: J - j 5 • Fee m ethodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. i:\ Building \Permits\ELC- PermitApp.doc 12/03 440.4615T00 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: SIDENTIAL WORK ONLY: I Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: _ � 1 Fee for each commercial system $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i: \ Building \Permits\ELC- PermitApp.doc 04/03 Mechanical Permit A lice 'on,,. Vii FOR OFFICE USI. O NLY ` ' /City � Tigard Received Date/By. By. Permit No.: H5r 1 i5 , / - � 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / /y' *.r 1h t ,4\ Date/By. Other Permit: Inspection Line: 503.639.4175 � I i p MAR 0 3 21, y. ' I I Date Ready/By: Juris: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information � I" a T '' } �iK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST `repla ` ai cement Mechanical permit fees* are based on the value of the work New construction ❑ �dritfl o >t7 "al�eratton/ performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CAT EGORY OF CONSTRUCTION Value: $ dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* - and 2 g ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total • JOB SITE INFORMATION AND LOCATION Heating /cooling Job site address: / 19q bre #©,) CA Air conditioning or heat pump (requires site plan showing placement) 14.00 City /State /ZIP: 7$,-i", OA Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street /directions to job site: `0 r._ at-,A Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: /j/. m `�/dGis Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances . , DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue/vent 10.00 p,PROPERTY OWNER I ❑ TENANT Other: 10.00 Name: 4.... . / /�f /5✓ Environmental exhaust and ventilation Address: F —,� /U) /3 i, $ Range hood/other kitchen g s �,` r equipment 10.00 City /State /ZIP: (4 05 49 p ,/2/?, 47 70_ r Clothes dryer exhaust 10.00 7 ` Single -duct exhaust (bathrooms, Phone: (5 7 ) �� J am- ( 3 �J Fax: ( ) c$ toilet compartments, utility rooms) 6.80 .APPLICANT ❑ CONTACT PERSON Attic/crawispace fans 10.00 Porn Business name: r- LAO � NOTh1 65 Other: Fuel piping 10.00 Contact name: f 1�Oh b tch Z p, ��t $5.40 for first four; $1.00 for each additional Address: 2? / e C /.e74 S{ Furnace, etc. Gas heat pump City /State /ZIP: L,_ /x,.. a &- 0 �� tI 7 5- Wall /suspended/unit heater Phone: ( ‘35 Fax: : ( )54 Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: 1 /4 e,, � 6ba/ h Clothes dryer (gas) C O ther: J A h Address: C(0 S6h V. MECHANICAL PERMIT FEES* City /State /ZIP: 40 !O (../ D m t q 70 72 Subtotal Phone: (593) . _ /...a V' Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) / CCB lic.: L State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized Signature: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Print name: Date: - /._ 6 9 5— • Fee m ethodology set by Tri- County Building Industry Service Board i:\ Building \Permits\MEC- PermitApp.doc 12/03 440- 4617T(11 /02/COM/WEB) 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. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • i:\Building\Permits\MEC- PermitApp.doc 12/03 2 r. REcEVErI 'Plumbing Permit Application FOR OFFICE USE ONLY ' , City of Tigard MAR 03 2005A Receivd e , l �, r s �� �,%' / Receive Permit No.: t " t .. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Pho 503.639 Inspection 1 Fax: 6359875LITY OF r�` -G / „ ••r /b irch ril�u li Date/By: Other Permit No.: -a �!' __ Date Ready/By: Juris: 65 See Page 2 for Rt T ILDINC_ �' a � °�° � . Internet: www.ci.tigard.or.us 3. - Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) 12:( CATEGORY OF' CONSTRUCTION SFR (1) bath 249.20 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 - JOB SITE INFORMATION AND LOCATION j � Site utilities Job site address: 10g3‘ 137-3170.-) Gi, Catch basin or area drain 16.60 City /State /ZIP: -1 /e /� CPL ` t Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1111 I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directioonstoo job site J a y / Manholes 16.60 / C /`f(// 0 6A7/ Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 �� Subdivision: 42421- Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve J 16.60 'DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 ,. Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER ❑ TENANT Ejectors sump 16.60 Name: -LAW 011 Expansion tank 16.60 Address: � f Fixture /sewer cap 16.60 City /State /ZIP: t t ie 05 eve h op q7,0_3_5 Floor drain/floor sink/hub 16.60 Phone: (c0) (. 35-1 /J Fax: ( ) �f_ h9 „L Garbage disposal 16.60 ' ❑, APPLICANT ❑ CONTACT PERSON Hose bib 16.60 - j A a ! ®/4 5- Ice maker 16.60 Business name: L /� Interceptor /grease trap 16.60 Contact name: / ®4Zj` C r e e_ Medical gas (value: $ ) Page 2 Address: C L `� c/ Primer 16.60 � City /State /ZIP: ; "� DS' �P�Cj �/I t Roof drain (commercial) 16.60 Phone: (59D) 7-8 Fax: : ( ) , ,.,, Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 rr j CONT R A CTOR / . Water closet 16.60 Business name: G ,- > if f`Yi t7 j Water heater 16.60 • Address: e D l 261 1 , I , r . T Other: City /State /ZIP: ti) /6t„ NZ q7 /2 /261 Subtotal - y Minimum permit fee: $72.50 ( 7 Phone: ) 0 --,2-; 7/ Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: G ei 6 7 Plumbing Lic. no.:3 /� Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: ' 7 , Date: 3- / d 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. i:\ Building \Permits\PLM - PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: :Site Utilities' Qty. Fee (ea) Total Square Footage: . Permit Fee:' �' � Footing drain - 1' 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 ValUatlon' 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 Q Fee Total additional $100.00 or fraction thereof, to and Fixture or Item ee (ea) 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 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) Work'Performed Fixture Type: Replace New Moved Existing capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is.required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 3/03 N I I ts T REE CE STREET 1� TIFICATION l� fk, I, (`OX/i / L a , Owner /Agent for L-/I 7--/iwk---.5 0. .. (PLEASE PRINT) i (PERMIT HOLDER) t { Do hereb c fy t afth location = ,: r „ , s` s' =r:, - : : µms I meets ,City of: Cigard/ Xl ashn g ton County m,9,.N..��...� „,a��p� l and use and development standards for street tree installation. ADDRESS: O /1 (--' _0. LOT: SUBDIVISION: /3/ d BY DATE: • /0 te/ O 4 RECEIVED BY: DATE: D ` Z � ` C S CITY OF TIGARD _, it BUILDING DIVISION PERMIT #: INiST2005 000Ci 401111 , 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/29/2005 Phone: (503) 639-4171 p i Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7 :08AM PAGE: 22 SITE ADDRESS: ' 10936 SW BRE I ION CT CLASS OF WORK: SUBDIVISION: BRETTON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRE I I WOODS DESCRIPTION: New SF 10/18/05: Added backflow device for irrigation. OWNER: LEE -LAND HOMES, PHONE #: 503 -635 -1343 CONTRACTOR: LEE - LAND HOMES PHONE #: 635 -1343 Inspection Request Scheduled For: Date: 10/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Messag 299 Final inspection 019018-02 503.789 -6795 N. I A6 Corrections /Comments /Instructions: ?© STIR T - -- / --T)■ S U 1./4 13..? 1 D • P4 • ASS • P= RTIAL APPROVAL ❑ CANCEL NO ACCESS ❑ FAIL / 6' A FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspecto : `m. Date: /0 - 2/ 0 Phone #: (503) 718- CITY -OF TIGARD BUILDING DIVISION PERMIT #: MST200S-00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005 Phone: (503) 639 -4171 A �ii`I Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/18/2005 TIME: 7:10AM PAGE: 67 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: C SUBDIVISION: BRE i i ON WOODS LOT #: 006 TYPE OF USE: g PROJECT NAME: BRETTON WOODS DESCRIPTION: New SF OWNER: LEE -LAND HOMES, PHONE #: 503 - 636-1343 CONTRACTOR: LEE - LAND HOMES PHONE #: 635 -1343 Inspection Request Scheduled For: Date: 10/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 1991 Electrical final 018590 -02 503 - 789-6795 N Corrections /Comments /Instructions: !17 • PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ■ Inspector: ■ Date:, Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005-00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005 F Phone: (503) 639-4171 / ,2 111 Inspection Requests (24 Hrs.): (503) 639-4175 ,0 INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7: 08AIVI PAGE: 23 SITE ADDRESS: 10936 SW BREI ION CT CLASS OF WORK: SUBDIVISION: BRETTON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRETTON WOODS DESCRIPTION: New SF 10/18/05: Added backflow device for irrigation. OWNER: LEE-LAND HOMES, PHONE #: 503-636-1343 CONTRACTOR: LEE-LAND HOMES PHONE #: 635-1343 Inspection Request Scheduled For: Date: 10/21/2006 Pour Time: Code # Inspection Description Confirm # Contact # Me(agg) 699 Mechanical final 019018-01 503-789-6795 Y Corrections/Comments/Instructions: ajeASS ARTI L APPROVAL [1] CANCEL Li NO ACCESS I I FAIL /FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector Date: /0 Z/ S Phone #: (503) 718- CITY 1:MTIGAR D BUILDING DIVISION PERMIT #: IVIST2005-00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005 Phone: (503) 639-4.171 ,.. :4 , /,1 0 4,1111 R A Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 11 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: SUBDIVISION: BRE I I ON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRETTON WOODS DESCRIPTION: New SF 10/18/05: Added backflow device for irrigation. OWNER: LEE-LAND HOMES, PHONE #: 503-635-1343 CONTRACTOR: LEE-LAND HOMES . PHONE #: 635-1343 Inspection Request Scheduled For: Date: 10/20/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 018858-01 503-789-6795 . N Corrections/Comments/Instructions: PASS I I PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS El FAIL LII CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED Inspector: (17)\-0--&-k\ Date: 1-0/...00/-0 Phone #: (503) 718- CITY 'OFTIGARD . . BUILDING DIVISION ,PERMIT #: MST2005-00064 13125 SW Hall Blvd., Tigard, OR 97223 -DATE ISSUED: 3129/2005 Phone: (503) 639-4171 ,_ Inspection Requests (24 Hrs.): (503) 639-4175 1 INSPECTION WORKSHEET FOR DATE: 10/18/2006 TIME: 7:10AM PAGE: 613 SITE ADDRESS: 10936 SW BRE I I ON CT CLASS OF WORK: SUBDIVISION: BREA ION WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: ORE I ION WOODS DESCRIPTION: New SF OWNER: LEE-LAND HOMES, PHONE #: 503-6351343 CONTRACTOR: LEE-LAND HOMES PHONE #: 635-1343 Inspection-Request Scheduled For: Date: 10/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 018590-01 503-789.6795 N Corrections - tion u omments/Instrcs: , No p_ e,,,,,,c,k , 414.„. _c_D■ \ ,,, ,,,,L. t,,,i c. ,,Jc,,,,,,C 1- b-ct,L ■Pusv e\ l...A.-v../N. \ ez` ■_1"--- ei----■-..--f-A A .. N a C 6 ? aq/5 ILIA _ , ii Cn T 6eLel Wl' "111 11■1111flailara1/&&■=0'4111 0 I.. 1 ') I ° iiss■ ,f. , _ AA& kr ■ ,.„ , ____ i l\C ) ' ;' - >Je Nre(4 S f'\ kP-- 7) 1A (1 T7 ‘ \ - 1-0 ° .)(C-e_QL_J h) FL-v‘,.:, 176--I <1k, e.AJ ie-re x_r_c_ t - 2,eS - ' I ' • L,... -i \ - -. (0 . I I PASS El PARTIAL APPROVAL El CANCEL H NO ACCESS j FAIL El CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Vbs\c)......... Date: OA 0 Phone #: (503) 718- U CITY OPTIGARE BUILDING DIVISION A, PERMIT #: MST2006-00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2006 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 U. INSPECTION WORKSHEET FOR DATE: 6/16/2006 TIME: 7:10AM PAGE: 87 SITE ADDRESS: 10936 SW BRE I ION CT CLASS OF WORK: SUBDIVISION: BRE I I ON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRETTON WOODS DESCRIPTION: New SF OWNER: LEE-LAND HOMES, PHONE #: 603-635-1343 CONTRACTOR: LEE-LAND HOMES PHONE #: 635-1343 Inspection Request Scheduled For: Date: 6/16/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough-in 009430-01 503-789-6795 Corrections/Comments/Instructions: • jX1 PASS fl PARTIAL APPROVAL CANCEL El NO ACCESS II] FAIL Ej CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: c1 Date: ___6_4(4c‘ Phone #: (503) 718- I CITY 'OF'TIGARE , BUILDING DIVISION PERMIT #: ST 00S -000 13125 SW Hall Blvd., Tigard, OR 97223 DA TE ISSUED: 3/29/2005 �� Phone: (503) 639 -4171 ! ,, ,ilyputpl� � �+1'\ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/18/2005 TIME: 7 :14AM PAGE: 36 SITE ADDRESS: 10936 SW BREI ION CT CLASS OF WORK: SUBDIVISION: BRE I I ON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BREI ION WOODS DESCRIPTION: New SF OWNER: LEE -LAND HOMES, PHONE #: 503- 635 -1343 CONTRACTOR: LEE-LAND HOMES PHONE #: 635 -1343 Inspection Request Scheduled For: Date: 4/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rain drain 004736-03 603- 789 -6795 N Corrections/Comments/Instructions: _, - ' 111M1 V _■■• - • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS i I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1/71)1( Date: 1� j /'5 Z Phone #: (503) 718- CITY 'OF TIGARD ., BUILDING DIVISION PERMIT #: MST2005 -00064 I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/15/2005 TIME: 7:08AM PAGE: 92 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: SUBDIVISION: BRETTON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRE I I ON WOODS DESCRIPTION: New SF OWNER: LEE-LAND HOMES, PHONE #: 503 -635 -1343 CONTRACTOR: LEE -LAND HOMES PHONE #: 635.1343 Inspection Request Scheduled For: Date: 4/15/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 315 Post/beam plumbing 004549 -01 503 - 789.6795 N Corrections /Comments/ Instructions: 4 PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED thir Inspector: Date: 1' � Phone #: (503) 718- , CITY`OFTIGARD BUILDING DIVISION PERMIT #: MST2005-00064 . . 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2g/25 Phone: (503) 639 -4171 : Inspection Requests (24 Hrs.): (503) 639 -4175 � INSPECTION WORKSHEET FOR DATE: 4/16/2006 TIME: 7:08AM PAGE: 91 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: SUBDIVISION: BRETTON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRE I I ON WOODS DESCRIPTION: New SF OWNER: LEE -LAND HOMES, PHONE #: 603.636 -1343 CONTRACTOR: LEE -LAND HOMES PHONE #: 635 -1343 Inspection Request Scheduled For: Date: 4/16/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 004649-02 603- 789 -6796 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 7'1 Date: Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005.00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005 Phone: (503) 639 -4171 h44iP A,, i Inspection Requests (24 Hrs.): (503) 639 -4175 :�� `___ INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7 :14AM PAGE: 42 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: SUBDIVISION: BRE I 1 ON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRL.I ION WOODS DESCRIPTION: New SF OWNER: LEE -LAND HOMES, PHONE #: 503-635-1343 CONTRACTOR: LEE -LAND HOMES PHONE #: 635 -1343 Inspection Request Scheduled For: Date: 4/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rain drain 003988 -01 503 - 789.6795 N Correc ' ns /Comments /Instru io 0 -- �- +NrCUC-i L.■.\ - r-e (--- \-a_ . ( cr-s6 . v(z___e_Q-,- , --\,&s , 10c- 1 L. d6_ \,,,,s, \ J • - L t —vim Q 0 �,e 2 af___ , ..... __\_= Q.,,\Aliva_J--zu --)---- l_Th o__&..,„_:,>.,- r\-0.,,re,„2„.‘ c. n PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED A L�i / Inspector: - Date: l (2 6 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION #: MST2005 00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2005 Phone: (503) 639 -4171 : �� 4m �ypi ' Inspection Requests (24 Hrs.): (503) 639 -4175 ��� INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 40 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: SUBDIVISION: BRETTON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRE.I I ON WOODS DESCRIPTION: New SF OWNER: LEE -LAND HOMES, PHONE #: 503-635-1343 CONTRACTOR: LEE - LAND HOMES PHONE #: 635 -1343 Inspection Request Scheduled For: Date: 4/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 003989-01 503 -789 -6795 N Corrections /Comments /Instructions: 9 / PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ' ILL k Inspector: V l/' C Date: / b Phone #: (503) 718- • • CITY OF TIGARD - - BUILDING DIVISION PERMIT #: MST2005 -000&1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3f29/2005 Phone: (503) 639 -4171 �� A 8744ht Inspection Requests (24 Hrs.): (503) 639 -4175 y ► IR INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7 :14AM PAGE: 41 SITE ADDRESS: 10936 SW BRETTON CT CLASS OF WORK: SUBDIVISION: BRETTON WOODS LOT #: 006 TYPE OF USE: PROJECT NAME: BRE I I ON WOODS DESCRIPTION: New SF OWNER: LEE -LAND HOMES, PHONE #: 5503.635 -1343 CONTRACTOR: LEE-LAND HOMES PHONE #: 635-1343 Inspection Request Scheduled For: Date: 4/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 003988-02 503-789-6795 N Corrections /Comments /Instructions: • PASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED � 1 Inspector: Date: 14 1 Phone #: (503) 718- _