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Permit __ J TVS-7g 0r,' r" r - 0.:1: - • / 7/ 7 SiA)r Building Permit Application r% k o 47.`v FOR OFFICE USE ONLY �/� REiew .,EXED D PenmtNo.:131SW Hall lvd.,Ti ard,OR 97223 � 'J C g / Phone: 503.639.4171 Fax: 503.598, ELV /E-? V �tr'Imo'\ /A es' t / Other Permit dj./ j�—c 3q' v 1..� �il • ( Date/By: Inspection Line: 503.639.4175 _ Date Ready/By: ry rods: la See Attached Checklist for Internet: www.ci.tigard.or.us �l♦U� Notified/Method: m /D Supplemental Information ∎ R2v T;:' . REQUIRED DATA I-AND 2-FAMILY DWELLING c �1-,�i}° New construction !II�U`�a ;Eldon Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/re placement ,©Gtl+rr,_ equipment,materials,labor,overhead,and the profit for the s;. CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 6.Q 5/ SO N 1-and 2-family dwelling ❑Commercial/industrial J ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: 3 Job site address: �) 1-71 7 1 ti I. /-t V/n(� (_/ -V New dwelling area: . --).E. square feet City/State/ZIP: 1 i 01 O Garage/carport area: 6( square feet Suite/bldg./apt.no.: Project name: 11a iska.. Covered porch area: Z 0 square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: t eA0•-• \r 'Sic ,■ Lot no.: / Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and t he profit for the DESCRIPTION O ORK 0./"-gam work indicated on this application. ,r p ", \,/ _ I T e/14 C c-E Valuation: $ • Existing building area: square feet --Jo 5-1-7 ON, - 10 d 6(., New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: l 1'r r' t '-7 r .-1 f it/Y vli:.., -J i—h. Type of construction: Address: H 2 5 NW ,4 vl be r5 LeM . ( J u. # 2-0 c Occupancy groups: City/State/ZIP: & vGY��- d)2_,} 'h C t: CI Existing: Phone:( :'_' ) (c y ,; - C, ci b - Fax:(57'),-,) `(t., 72`Z 14 7 I New: UCH ;' ❑ CONTACT PERSON NOTICE Business name: 12_,v,e y 5 i de tin,,,, 5 -;-_,.._x_. All contractors and subcontractors are required to be Contact name: ,4( � <� L licensed with the Oregon Construction Contractors Board Awl - under ORS 701 and may be required to be licensed in the Address: 1'j 2 S Al w Awl h-e,relte,14 11(rLw ,i ,4-e, 2_0 L, jurisdiction in which work is being performed.If the City/State/ZIP: f" applicant is exempt from licensing,the following reasons ty 6-et-of fiy C 2_ '17 U 0(p apply: Phone:( %3) CPy S- 7E) Fax::(cris•J)(G'q 0- 2q 2 E-mail: Curti. I Y •i • Business name: (2_,-v Q r..5l i zi,ic . BUILDING PERMIT FEES* Address: 1125 NyV ,A-roh 'Y � pic AAJ suik 200 Please refer to fee schedule. City/State/ZIP: 10e&V,t.4.-f e VLF O� 17 GL'(( 730 CC� Fees due upon application Phone:(Sc'=7 ) (C r 14 —Q''f S j, Fax:(SIP)) 179 2j- 21 Li Z Amount received CCB lie.: 'ri Date received: 3 CC) Authorized signature: te-)eL77 11,0 (PC ') This permit appli ation pires if a permit is not obtained within 180 days after it has been accepted as complete. IPrint name: I,.(.. UYL kits, Date: 1 L- Z0- 0t� * Fee methodology set by Tri-County Building Industry dService Board. I:\Building\Permits\BUP-PermitApp.doc 12/03 440-46i3T(1I/02/COM/WEB) p /1 1 AK r Plumbing Permit Application FOR OFFICE USE ONE\' �y�p���y y�p City of Tigard Date/By: 3 l& 677.-- PermitNo.:A s Oaxs..0) 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 *'' , Date/By: Other Permit No.: 24-Hour Inspection Line: 503.639.4175 J,l �'_�I 'hills:Date Ready/By: la See Page 2 for Internet: www.ci.tigard.or.us _ 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) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 a 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 399.00 Each additional bath/kitchen 45.00 • ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB BITE INFORMATION AND LOCATION Site utilities Job site address: 2 / / i i V L- i' i i i ./r Catch basin or area drain 16.60 City/State/ZIP:115,A. • 0 -ii a Drywell,leach line,or trench drain 16.60 9 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: �,,a �\s Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: ei\a v f I Lot no.:/q) Water service(no.linear ft.: ) Page 2 Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK =/r m.., .. . Backflow preventer Page 2 34 �. Backwater valve 16.60 Clothes washer I 16.60 Dishwasher Ii 16.60 ■ Drinking fountain 16.60 ❑ PROPERTY' OWNER I ❑ TENANT ° Ejectors/sump 16.60 Name: 12di V. JV i tA.,e. ji(1%'YI/L') , -1 7-x.i • Expansion tank 16.60 Address: " 2 5 Al `,li/ 41 ,, • A A . # ♦ Fixture/sewer cap 16.60 City/State/ZIP: bo jtv,e,y. ,Y, pa, g ioO y Floor drain/floor sink/hub 16.60 Garbage disposal I 16.60 Phone (573) bc7 I Fax:( L`` ) ti°1 C? "=_I - w } s .., v ❑ CONTACT PERSON Hose bib '? 16.60 "" Ice maker 9 16.60 Business name: J v`2A' r t t1 Yt ,� s r-)6.,. Interceptor/grease trap 16.60 Contact name:/,f'GG Lt c--.7/1-- Medical gas(value:$ ) Page 2 -1 Address: l -2,5 jvw Ai" G 2.,..7.,_,, pi,-f,0, ;t- zoo Primer 16.60 - City/State/ZIP: Roof drain(commercial) 16.60 Sink/basin/lavatory 16.60 Phone:( ) Fax::( ) Tub/shower/shower pan 3 16.60 E-mail: Urinal 16.60 ,� CONTRACTOR Water closet I 16.60 Business name: ,Cji-Y ea,lrt 1 1 nc Pi,„,,,;vic5 Water heater I 16.60 Address: 2S DS- -S•U.1. AI .i5 v bt . Other: ific City/State/ZIP: 4 lob h O t 1 77006 Subtotal Minimum permit fee: $72.50 3`( Phone:(5.43 ) 09)8-b 6s 7 Fax:(5 C'' ;7 z- 95 k 3 Residential backflow minimum permit fee: $36.25 �S 03 CCB Lic.: t Y 2 (II Plumbing Lic.no.: 31-1- 370 Q Plan review (25%of permit fee) Authorized sign, : 41 G 6444 State surcharge(8%of permit fee) ' TOTAL PERMIT FEE 1., Print name: 3-04,t4A,tA 8 i i,'I I Date:2-i9-..0,> This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i:\Building\Permits\PLM-PermitApp.doc 12/03 440-4616T(10/02/COM/WEB) JO / Mechanical Permit Application FOR OFFICE USE ONLY Received Perm"so..I• City of Tigard Date/By: 61°7 a- STdCtA—U00)-4 13125 SW Hall Blvd.,Tigard,OR 97223 y Plan Review Phone: 503.639.4171 Fax: 503.598.1960 +I\ Date/By: Other Permit: Inspection Line: 503.639.4175 1 Date Ready/By: Jul15 ® See Page 2 for onfia Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK r COMMERCIAL FEE* SCHEDULE - USE CHECKLIST New construction Mechanical permit fees`are based on the value of the work ❑ Addition/alteration replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value:$ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* El 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building /or spc vial iniorrnation use checklist. ❑ Multi-family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 1 21/ 7 s vv 1�a !/i ( (requires con site p n ho ing placement)site Ian showing lacement) 14.00 City/State/ZIP: lA q0 3 I O CI T and- Furnace 100,000 BTU(ducts/vents) 14.00 Suite/bldg./apt.no.: �,/ Project name:Te``o \1 S'-� Gas heat 100,000+BTU(ducts/vents) 17.90 V� Gas heat pump 14.00 Cross street/directions to job site: 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: ?p lI A \,SiflA_ Lot no.: /(`, Flue/vent for any of above 10.00 >,/`� t Other: 10.00 Tax map/parcel no.: Other fuel appliances _ DESCRIPTION OF WORK Water heater 1 10.00 Gas fireplace I 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 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00 Other: _ 10.00 Name: t et---.3i ii )yYI.E T. N. Environmental exhaust and ventilation i� Address: { Range hood/other kitchen (7S iv IA) li b'r 1 ,(�hl.l.�Lii-."1 # ZU( equipment ( 10.00 City/State/ZIP: !1 C GC V i!Y`j. r) (,)12, ')0& Clothes dryer exhaust 10.00 Single-duct exhaust(bathrooms, Phone:(,-,7 ) r, Fax:(77.1- ) (, .?' -/ toilet compartments,utility rooms) 3 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other. 10.00 Business name: 1,.:__.$V c 'S,(_„1.k• t-kj1-y i, J- 7 )C Fuel Pp t to g Contact name: $5.40 for first four;$1.00 for each additional Address: )�, ' Furnace,etc. c Z /(/��/ ,J�( h �e t.CJ i� # 2 0 Gas heat tun U J pump • City/State/ZIP: 1E'5 e LA,ve, 4,1,ti L q?0 0 Wall/suspended/unit heater Phone:(5) LE Li 5- Ce:?(e)(P' Fax::(g)-3) 00-2 1(•.E Water heater Fireplace E-mail: a_47)u,A f I ✓e. - r(Le j'1ryvte•c ('li„ Range g CONTRACTOR Barbecue Clothes dryer(gas)Business name: l .. M ii r-� H o,a ,p t r c. , .) 11 Other: Address: ..M—� IT u R t n 0 tl e,. e_ R cl ,;,,tt; t MECHANICAL PERMIT FEES* City/State/ZIP: r...:,.�.1,„.„,___, , S � c�1 6 Subtotal lL q Minimum permit fee($72.50) Phone:(,a 3 ) •y 1 _ y'; Fax:(y ) 4:> q 1/ 3=--(5 Plan review(25%o of permit fee) CCB lie.: /.7 7 `i ':} State surcharge(8%of permit fee) TOTAL PERMIT FEE ec, / This permit application expires if a permit is not obtained within 1 0 Authorized signature: -2.:-->-,---- C_ days after it has been accepted as complete. Print name: <` _. ...- v Date: nz f 1 { ` Fee methodology set by Tri-County Building Industry Service Board y /_�c-� rat b ,. is Building\Permits\MEC-PermitApp.doc 12/03 440-4617T(I1/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY • P City of Tigard Received Permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 Dan Review : 0, /r r t/ _, i i , g Plan Review Phone: 503.639.4171 Fax: 503.598.1960 �14r Date/By: Other Permit: Inspection Line: 503.639A175 4"1 I' Date Ready/By: Juns El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW il New construction ❑ Addition/alteration/replacement Please check all that apply: ❑Service over 225 amps,comm'l ❑Hazardous location ❑Demolition ❑ Other: ['Service 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 ❑System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders,400 amps or more ❑ Multi-family E Master builder ❑Other: ['Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: /7 7/ 5 v i /� /' ❑Health-care facility ❑Other. -� i • /k?�/ Lnit 2 sets of plans with any of the above. City/StateiZIP:7r1 Qi ' 0 1 aP4 The above are not applicable to temporary construction service. Suite/bldg./apt.no.: J Project name: `1/ c.tn.� FEE* SCHEDULE , «f� V�v7 Description QD. Fee. 9ma1 Cross street/directions to job site: New residential single-or multi-family dwelling unit. Includes attached garage. 1,000 sq.ft.or less f 145.15 1L��,f 4 Subdivision: �e1 t N ,b Lot no.: /g Ea.add'l 500 sq.ft.or portion 33.40 700.ct 1 Limited energy,residential 7 , 75.00 2 Tax map'parcel no.: 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 Name: 1 ;Y1 601 amps to 1,000 amps 240.60 2 Address: G' ,( - ,-, Over 1,000 amps or volts 454.65 2 l 2 5 Nl'v .A-ry3 b e Cl teNt (''1,U)Lt- # -' C"' Reconnect only 66.85 2 City/State/ZIP: 1 ;t. � °/ ( '�C .t` ; C Temporary services or feeders installation,alteration,and/or relocation Phone: (-3 ) i.-(5 _ ( t"/ tG'. � Fax:(�jt7 V,) to el(,•- 1'1 4` 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 1 6.65 2 Business name: �L i v.f�_�t r i,- i4 G1-yL� �.)_:1C . branch circuit B.Fee for branch circuits Contact name: _A L L; c.,,,,, AA t, without service or feeder fee, A-7.1.-4,-),..e.4,', } each branch circuit 46.85 2 Address: ) j _ Ai I✓t/ l ,1ti p+'t,t4), 4 2 C,(J Each add'l branch circuit 6.65 2 City/State/ZIP: C D -74.)i.:,(;‘.i Miscellaneous(service or feeder not included)r Pump or irrigation circle 53.40 2 Phone:(e-- 7?2) (E Lt 5-(j r-j L(F, Fax: :(SZ j) &,90 767 Li,` Sign or outline lighting 53.40 2 E-mail: i. rti u ‹;r i tr,4.2,1-5I c'C..1L , a,. C C"ti-i Signal circuit(s)or limited- CONTRACTOR energy panel,alteration,or / extension.Describe: Page 2 2 . susiness name: B�At-r ,a/e..C.7`�r� r— C.-- _ Each additional inspection over allowable in any of the above Address- )0 6 ..), 3 g.y Per inspection 62.50 :City/State/Z1 ; p O"` o ,.. n Investigation per hour(1 hr min) 62.50 Industrial plant per hour 73.75 Phone:(r ) 6 ? $ -13 S.s I Fax:(o 3) 6 2 ' -11 O S ELECTRICAL PERMIT FEES* CCB Lie.: 2S�ip I Elecxicai Lic.:2(t ,01c. Suprv.Lic.:3i ,z 6 - Subtotal --3qG.4,(J- Supry Electrician signarure,reauired:e2 `_o t k Plan review(25%of permit fee) Print name: n nn '+r j State surcharge(8%of permit fee) 2 ..`. tray 4 6 l2.Qiti0 t.-e� , Date: 2/2//7` Us- TOTAL PERMIT FE Y 37 Authorized signature: This permit application expires if a permit is not brained within 1 days after it has been accepted as co Print name: Date * Fee methodology set by Tri-County Building Industry Service Board *•Number of inspections per permit allowed. 1 Building i'sr,n:i ELC-I'e:rcit.App.do, C C3 440-4615T(10/02/COM/WEB Electrical Permit Application FOR OFFICE USE ONLY ir City of Tigard Received g Date/B : ► j , Permit No.mS 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Date/By: Other Permit: Inspection Line: 503.639.4175 ''/1 Date Ready/By: Jam; ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental information // TYPE OF WORK PLAN REVIEW Q�1Qew construction ❑Addition/alteration/replacement Please check all that apply: ❑Demolition ❑Other: ['Service over 225 amps,comm'l ['Hazardous location ['Service over 320 amps-rating ❑Buildng over 10,000 sq.ft., °CA R'Y OF CONSTRUCTION ! of 1-and 2-family dwellings 4 or more new residential al-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders,400 amps or more ❑Multi-family 0 Master builder 0 Other: ❑Occupant load over 99 persons ['Manufactured structures or : � . -412'41O tt `_ ,=�I ,r;. ❑Egress/lighting plan RV park Job no.: Job site address: ) 2 7� 7 ciy I)' V o 2. ❑Health-care facility ❑ � � S�bmit 2 sets of plans with any of the above. City/State/ZIP:-+-'f,�J J j/ � ) G� q-7 2'7)__�_ The above are not applicable to temporary construction service. Suite/bldg./apt. no.: �t/1�t/"� Project name: 6,l ' � V ' ��, FEE* SCHEDULE Description 1 Qty. I Fee. I Total ** Cross street/directions to job site: New residential single-or multi-family dwelling unit. Includes attached garage. 1,000 sq.ft.or less I 145.15 4 Subdivision: I / i V}5.4? , Lot no.: / Fa-add' 500 sq.ft.or portion V 33.40 1 Tax map/parcel no.: V I `J / Limit energy,residential 75.00 2 energy,non-residential 75.00 2 DESCRIPTION OF WORK ch manufactured or modular L--MI/U V e) i a . E G c T l v /Ct-t. dwelling,service and/or feeder 90.90 Services or feeders installation,alteration,and/or relocation 2 ��// 200 amps or less 80.30 2 I2' ROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: r i - 1 ■t . t 1C • - 601 amps to 1,000 amps 240.60 2 Address: Z� AAA)v /j y. ))j , ' Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: a/ (ice, ` Gl��r }� 0 Temporary services or feeders installation,alteration,and/or (5 ) €0 , },b19 , (� / L ��LIZ relocation 00 ms Phone: "'C �{v Fax: �- 200 amps or less 66.85 1 Owner installation:This installation is being made on prop- that I own which is not 201 amps to 400 amps 100.30 2 intended for sale,lease,rent,or exchange,according to ORS '7, 9,670,and 701. 401 amps to 600 amps 133.75 2 Owner signature: Dat- Branch circuits-new,alteration,or extension,per panel I .APPLICANT ' 1 "in CONTACT ' o N A.Fee for branch circuits with service or feeder fee,each Business name: Y� Y�/ -�/ ' 1W/ ' ' • branch circuit 6.65 ' 2 Contact name: l 11 ,, / �y B.Fee for branch circuits , � R _ la 1./1.�J l.1 ) 7e 0 without service or feeder fee, �J each branch circuit 46.85 2 Address: l f 2-5 /` i/�/ V/ Each add'l branch circuit 6.65 2 City/State/ZIP: �((Y - / /} " 0 ;C)L LL Miscellaneous(service or feeder not included) Phone:(54- ) �J'(,(:��-C1i 0 Fax: :( ) ' G)-"7 9 Pump or irrigation circle 53.40 2 a1 , or outline lighting 53.40 2 E-mail: Sign. circuit(s)or limited- ___ s; , t aR energy,. el,alteration,or Business name: r � �t extension. a ascribe: Page 2 2 Address: lei Each addition k 'nspection over allowable in any of the above t Z� l�V,/ �7 /G'�1a,(_�l �yLw i� Per inspection � 62.50 City/State/ZIP: /''�1 v I I glut,'ti Investigation per hour 62.50 5-Phone: /��(f Fax: �j Industrial plant per hour 73.75 � ) L �( ( ' � ) �L Z�� ELECrRI• PERMIT FEES* CCB Lic.:iO()V- Electrical Lic.: Suprv.Lic.: Subtotal ?j q S',(cC, Suprv.Electrician signature,required: Plan review(25%of permit fee) Print name: Date: State surcharge(8%of permit fee) 2 8 TOTAL PERMIT FEE ?j7 q Authorized signature: L ) This permit application expires if a permit is not obtained within 180 �� days after it has been accepted as complete Print name: 1 t j . ,� !"! Date:/)i?�t C * Fee methodology set by Tri-County Building industry Service Board *•Number of inspections per permit allowed. i:\Building\Permits\ELC-PermitApp.doc 12/03 440-4615T(10/02/CON/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 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: 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 1111111 _ " Building Division One & Two-Family Dwelling TIGARD Fees Checklist PERMIT INFORMATION: Permit #: J'f A:ve.- Qco,26 Plan #: Date: Site Address: /2 ?/ 7 S4) � Li i...1 c`, L,v Parcel #: Subdivision: 3//4 t' sk Lot#: IS Zoning: Jurisdiction: crick Setbacks: Front: Rear: Left: Right: Class of Work: ' Akw Stories: .3 First Floor: /2 " Type of Use: F Height: Second Floor: /793 0 Construction: 13 Floor Load: Third Floor: / 5-5c31 Occupancy Group: 2.-3 Dwelling Units: Bonus Room: Valuation: of `3(,f 95-3,63 Bedrooms: S Total Floors: 347-7y Bathrooms: 3 Basement: Decks: /CE Garage: 622 Porches: "4 5" Other: FEES: Description: Fee Amount: Amount Paid: Balance Due: Plan Check: Building: i /,'39. 6? 7 So ' ""d ,/ c/Sci. 69 Extra Set: ,v/4- N#s— A-4Q Permit: Building: 1907.-21 �____. Tax: ,,1,2 8 , 81- Metro CET: 6/33. /`/ School CET: 34/7 4/ash Mechanical 90. cp Tax: /0,f,6. Plumbing: `39%.Cv Tax: 4r-,, Gv' Electrical: 3 V .55- Tax: ill y6 Low Voltage: 7S.c Tax: /00 CDC: CDC Ping. Rev.: 4/‘,00 CDC LRP Fee: 6, co SDC: Parks: $,2 I OG _ TIF Res.: 244'0.00 TIF MT: 2yp ,00 Erosion Permit: j/2,00 Erosion CWS: 3 yp Erosion COT: y. 50 Water Quality: ,--- - Water Quantity: 2q50✓ SUB-TOTAL:f /g ,Z8. 16 ir /6 `/78. 96 Sewer: Permit: Inspection: SUB-TOTAL: TOTAL MST & SWR: I:\Building\Foans\ResPlanCheckFees.doc 01/19/07 Page 1 PLUMBING FEES(for special information use checklist) MECHANICAL FEES(residential equipment/systems) Description I Qty. I Fee(ea.) I Total Description I Qty I Fee(ea.) I Total New 1-&2-family dwellings Heating/Cooling (includes 100 ft.for each utility connection) Air conditioning or heat pump* 14.00 SFR(1)bath 249.20 Furnace 100,000 BTU(ducts/vents) 14.00 SFR(2)bath 350.00 Furnace 100,000+BTU(ducts/vents) 17.90 SFR(3)bath I 399.00 Gas heat pump 14.00 Each additional bath/kitchen 45.00 Duct work 10.00 Rain Drain,single family dwelling 65.25 Hydronic hot water system 14.00 Fire sprinkler-sq.ft. 0 to 2,000 115.00 Residential boiler Fire sprinkler-sq.ft. 2,001 to 3,600 160.00 (for radiator or hydronic system) 14.00 Fire sprinkler-sq.ft. 3,601 to 7,200 220.00 Unit heaters(fuel,not electric) Fire sprinkler-sq.ft. 7,200 and greater 309.00 (in wall,in-duct,suspended,etc.) 14.00 Site Utilities Flue/vent(for any of above) 6.80 Catch basin/area drain 16.60 Repair units 12.15 Drywell/leach line/trench drain 16.60 Other Fuel Appliances Footing drain- lm 100' 55.00 Water heater l 10.00 Gas fireplace / 10.00 Footing drain-each additional 100' 46.40 Flue vent(water heater/gas fireplace) 10.00 Manufactured home utilities 110.00 Log lighter(gas) 10.00 Manholes 16.60 Wood/Pellet stove 10.00 Rain drain connector 16.60 Wood fireplace/insert 10.00 Sanitary sewer- 1'100' f 55.00 Chimney/liner/flue/vent 10.00 Sanitary sewer-each additional 100' 46.40 Other: 10.00 _ Storm sewer- 1' 100' 1 55.00 Environmental Exhaust&Ventilation Storm sewer-each additional 100' 46.40 Range hood/other kitchen equipment / 10.00 Water service- 15t 100' / 55.00 Clothes dryer exhaust I 10.00 Water service-each additional 100' 46.40 Fixture or Item Single duct exhaust Absorption valve 16.60 (bathrooms,toilet compartments, y Backflow preventer 27.55 utility rooms) 6.80 Backwater valve / 16.60 Attic/crawl space fans 10.00 Clothes washer / 16.60 Other: 10.00 Fuel Piping Dishwasher / 16.60 **($5.40 for first 4,$1.00 each additional) • Drinking fountain 16.60 Furnace,etc. t ** Ejectors/sump 16.60 Gas heat pump t ** Expansion tank 16.60 Wall/suspended/unit heater ** Fixture/sewer cap 16.60 Water heater / ** Floor drain/floor sink/hub 16.60 Fireplace / ** Garbage disposal / 16.60 Range / ** Hose bib 16.60 BBQ ** Ice maker 1 16.60 Clothes dryer(gas) ** Interceptor/grease trap 16.60 Other: ** Primer 16.60 Total: Roof drain(commercial) 16.60 Mechanical Permit Fees Sink/basin/lavatory ,Z/6/5 16.60 Subtotal: $ 676. 50 Tub/shower/shower pan 16.60 Minimum Permit Fee$72.50 $ Urinal 16.60 Plan Review Fee(25%of Permit Fee) $ Water closet 3 16.60 State Surcharge(12%of Permit Fee) $ 70. E;G Water heater j 16.60 TOTAL PERMIT FEE $ Other: Other: ELECTRICAL FEES Plumbing Permit Fees (residential single-or multi-family) Subtotal $ 3 . .,c Description Qty. Fee Total Insp Minimum Permit Fee$72.50 $ 1,000 sq.ft.or less / 145.15 4 Plan Review(25%of Permit Fee) S Ea.add'l 500 sq.ft.or portion 33.40 I State Surcharge(12%of Permit Fee) $ "/"?. Limited energy,residential / 75.00 2 TOTAL PERMIT FEE $ Each manufactured or modular dwelling,service and/or feeder 90.90 2 Electrical Permit Fees Subtotal: $ 3v5.55- Plan review(25%of permit fee) $ State surcharge(12%of permit fee) $ (-//. 4 TOTAL PERMIT FEE $ I:\Building\Forms\ResPlanCheckFees.doc 01/19/07 Page 2 J 1 2.1 11 S'N Oct Vi vlic-i Lv,., . REC : IVED 3 ( P_,: ....'389. 8,. I .b.oc \ ,•'0 ,, ct,o,, , MAR . 82006 / ''S,3_0 —'''4' 2 .Q6, , SO 0- TIGARD Irilt06 b•• A / # . ......41 • ----/ • 4% ,,,,_ : ---... at VIDIN e DIVISION co , - ...., it. --3-L-t-&----------1., /--- ----------.16) /-' --- .,.... ..5. ------- , - ----------___ : . i - ..-34-2, 0 , SUR°, , . ::-V------ vE.), pn -,;‘.4' v/AL.,:--- ' ___.-y/ --„, Ai /, '''• - .•<""1.1— / /"' "------3-2'*" i• ' ci. -..alli\h,./ • * ...... WV - ,—------ / • '44 '." 1- et I/7 . 1/&'2-01 AW S' IN ^__A'* ■,---:for .L.S i - 0 54 -1.-.:-q Illv ''‘.• <tree+ Or,.''t.-- 4 l'if ---,ill-, 44 r4'to N c SW ; n. -c 4A/Cr ----1.`" ) ti- c ' c C' ' •:(.„11-A 4-4 it- a3114 OC ..... X W1 4-k-I*s -...-: (-4!0:■- a 1-1: ci- OC .... BELLA VISTA LOT 1 8 SCALE: s _ 1" .. 20' "..- ---- o T3 ENGINEERING et LAND SURVEYING ie DESIGNED: \ PREPARED FOR: RJ 0 i ilg N, 5 73 Vcjili 11),/ '' 8835 SW ConYon Ln. DRAWN: RIVERSIDE HOMES /Alt*ix tr,ore\ Suita 402 1925 NW AMBER GLEN PKWY, SUITE 200 Portland' OR 97225 AV dif* 01. SW BEAVERTON, OR 97006 co Q - CHECKED: (503) 645-0986 ... RJ (503) 690-2942 0 4 ...„, /4,4 TAW 4 (503) 291-9398 DA1E: ‘- 0 k 6/20/03 (Fax) 291-1613 \.. .." / . 6 ,....... - 0") CITY OF TIGARD -SITE PLAN REVIEW AZ:tic, 3\C7C BUILDING PERMIT NO.: i o -"C)06,91,4 PLANNING DIVISION: Required Setb ks: (y�,�Approved ❑ Not Approved Side: - Street Side: /° Front. Garage: Rear: - - Visual Clearance: ( ' Approved ❑ Not Approved :'.axintum Building Height feet • '1k" . ,e v• Provider Letter Required: ❑ Yes .1(] No 1 ❑ Receive _ Date: �3/Z Q_,(e�8 F.NGINEEi:ING DEPARTMENT: Actual Slope: % } Approved ❑ Not Approved Site Plan: / Et Approved ❑/lot Approved By: - Date: '3/2- / O Notes: - CITY OF TIGARD-SITE PLAN REVIEW BUILDING PERMIT NO: b-44:,T• 7- Street Trees: Approved ❑ Not Approved Protected Ts: Approved ❑ Not proved By: �bc� / r it— Date' 1, 02 t/C)%1 Notes: _... _._ ._ REalVED 4,-... , c) 94Q3 M k ; 82•:'u p: // s3 86' :� IT1r'QI�TIGAS , . )671..L.TtD.,:tr:INL:.E.1. DIVISION • __,..(i.Do/ i • " -- suYpo 3;0._ S'� /0 / ' i -: --t"---;:p../ =0 ',Y \. \ �, _�, "T, t —Sc 1, _R`7'9'.1/43'''' ''... �5 .,8,�� _� = 8 �1 � .�y •S's '•.0Q .. iv k r . c c SW \ v n �,l V� /'sp a.� N O. c/ C \ T� j E 7. c.• c c cs oc r . . . .... C 3 if u. • cc BELLA VISTA LOT 18 a — SCALE: .. 20' ENGINEERING & LAND SURVEYING ° DESIGNED; PREPARED FOR: RJ o * `�1411\. r 6 8835 SW Canyon Ln. DRAWN: RIVERSIDE HOMES j ®�• Suite 40z 1925 NW AMBER GLEN PKWY, SUITE 200��y„�� 1a Portland, OR 97225 SW BEAVERTON, OR 97006 0 - '�-� CHECKED: (503) 645-0986 i 4 v-e H Inc e RJ (503) 690-2942 0 —...alt.....rt / 2 DATE: o '� • • i 503) 291-9398 6/20/03 % (Fax) 291-1613 J J 0 . c3 L ., '','''a,s1,4i Q.-o C-15/< CITY OF TIGARD-SITE PLAN REVIEW r it BUILDING PERMIT NO.: .H T" ,s '. X006 044 1 // PLANNING DIVISION: Required Setb cks: cik Approved._ ❑ Not Approved Side: Street Side: I Front. 1 S Garage: Rear: Visual Clearance: 7 Approved 0 Not Approved k'.axinrunt Building Height-3S feet tA;': ' ejvi - Provider Letter Required: 0 Yes No Wir ❑ Receives 1 �_--� Date: v;'3 ` N E, iINEE JNG DEPARTMENT: Actual Slope: % .13 Approved 0 Not Approved Site Plan:/ Approved ❑/Iot proved B . � �zt � — Date: arm • Notes: CITY OF TIGARD-SITE PLAN REVIEW • BUILDING PERMIT NO: ,.4 ��A10" I/IfY,_ Street Trees: Approved ❑ Not Approved Protected Trees: Approved ❑ Not Approved By: j 4 P cx�✓ Date! 5 42 /" Notes: ,----- ______ 3S(41 RECEIVEd 3vief MAR 2 5 2008 g • I O 9<0'3, CITYOF TU AD�s3 BUILDING DIVISION tr-t,, .-L / # . 2e,_, • 86, %.46 ....% .4 40cD ' C13, . \ w 3 t‘,.. ..0 0/ ,35'4 ' C 0.T `'� --3.1.141)-----------.-.--- .._ eibil ,,I1r4, I--w ` ` V �..- cw Alagiiiigl7_113\1_ o .4.114,....... k.._ . Ar„.. 1 ww 34°7 i cV - .� SU R / , ' PO8v-7.- ,pli", = TA, _E./. ________°) Z ca -s, sn col �; 8 I"wC `j m(14440, - * f a, o / Z / 9 8')(7 .1 ] o rt ___________ TO ..,_____ Ss ' -°0 Alt rk:LVF ;:zi 43 . •o\ �� Sr�`ti4 '.Yee. kb z z I .,-,, z.,-_,,,.DA / sa , ii V//\/ ` a „Ile.------ LAN .Y C C LC eel �. CITY OF TIC•� D - SITE PLAN REVIEW _ u- r�'t P D.I LD IN G PERMIT N O (b.SEd,rd$'-gO __ c • C ��'LANNING DIVI`I(.,,. c equirect Setbacks. ! a` 4a % Side' - ._ N 17 i'1th" 1(°.: i11I♦._. ICJ J" Lr: i Ut1te rI r "� ' CPARTMENT: \Actual � ... ° Approved ❑ 1' t Appro\I�_ `/ , c Actual Slope /o p Not ' �prov•',�/l r►� � Site Plan:/ • - ❑'Approved ❑ `� ��_ Date: _ , cc •BELLA VISTA • SCALE: 1" = 20 ENGINEERING & LAND SURVEYING l-ESIGNED: PREPARED FOR: 0 RJ Q s 8835 SW Canyon Ln. DRAWN: RIVERSIDE HOMES it •.� R suite 402 SW 1925 NW AMBER GLEN PKWY, SUITE 200 A��\1►a Portland, OR 97225 BEAVERTON, OR 97006 0 ai.7 � CHECKED: (503) 645-09I36 co - �►�•/H)Inc . RJ (503) 690-2942 oG ®� `\` DATE: o �.1., 3 503) 291-9398 6/20/03 Fax 291-1613 I 0 RESIDENTIAL PERMIT APPLICATION REVIEW Permit No.: MST2008- 00026' Site Address: / ,7-3! 7 Soo be, Vi ■tc', 1- ,v. Subdivision: Bella Vista Lot No.: i'g Contact Name: Allison May Business: Riverside Homes Inc. Street: 1925 NW Amberglen Pkwy Suite 200 City: Beaverton State: OR Zip: 97006 As required by the 1999 Legislative action (Senate Bill 587), your residential peunit application and plans have been reviewed to determine if it is complete and if the plans are deemed "simple" or "complex" as defined in ORS 455.467 and 455.469. ❑ The application is complete. [gl The application is incomplete for the following reason: S 'c T/1 /5 e 'T � (foP) iclaT +'l CJ?€ kt ;S - — CiN 5 .iecc) Ica re -4cc4 .e oz t e-v' Ci ev -75c s . k � 1 4". ; i' cue S G c', vi 154 -066 Of' 3 `' 5 is ll2�f e /eiI;c -' ryc ;(. 7 e.); / 3;4c ?fa'' col/Li-our //tics is4e-Lc 4te / / " 7 /( e P 1ec Sc ( Ji5� el2J4t'.C`t TS- fO ac - ?$5 Se %c) f .5 _1' [.'c eruv.J 4 wc� Co cS The submitted plans will be reviewed; however, a permit cannot be issued until the above information is reviewed and /or approved. ❑ The submitted plans cannot be reviewed until the above information has been submitted and /or approved. ❑ The plans are deemed "simple ". pa The plans are deemed "complex ". Signature: -�' �'— of - oa Name: Brandon Shaw Date Title: Plans Examiner Phone: 503 - 718 -2425 E -Mail: BrandonS @tigard- or.gov 1: \Buildin \ Forms \RES- Perm,tAppRevw- Blank.doc 1 /18/07