Permit ?' MASTER PERMIT
4 1 111 CITY O TIGARD PERMIT #: MST2005 00075
i DEVELOPMENT SERVICE DATE ISSUED: 4/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CD RM001
SITE ADDRESS: 07937 SW CAROL ANN CT ZONING: R -12
SUBDIVISION: REBECCA MEADOWS LOT: 001 JURISDICTION: TIG
Project Description: New SF detached.Demo credits applied from BUP2004 -00486 for TIF and Parks.
BUILDING
REISSUE: PH24 -030 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 669 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,024 sf GARAGE: 231 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 162,577 70
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,693 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: 1 BOIUCMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 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 FOR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 2 201 - 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 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: 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 Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
KEYSTONE DEVELOPMENT INC KEYSTONE DEVELOPMENT INC. applicable laws. All work will be done in accordance with approved
PO BOX 476 PO BOX 476 plans. This permit will expire if work is not started within 180 days
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules 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 direct questions to OUNC by calling 503 - 246 -6699
Phone: 503- 635 -4736 Phone: 503- 635 -4736 or 1 -800- 332 -2344.
Reg #: LIC 71135
TOTAL FEES: $ 2,704.87
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
•
.---77 �A �'
Issued By : -- )7 /CO ���
� � ..Q� Permittee Signature (.�V� C
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that b iness d :y.
This permit card shall be kept in a conspicuous place on the job site until c• • etion of the project.
Approved plans are required on the job site at the time of each inspection.
(
•
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FR OFFICE.'USE ONLY . ` '
Buildin Permit ,. _ . .,
, ,
Cit of TI card t 9 -. k t ` Received
Permit No.�y /0
Y g Date /By: � / v 4 6 --- A� "��O�U6 0(J 75
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 8.19 Date/By: i1 Other ermit
�t�� y � 2005 P'II� � � `( - S h P Sw
Inspection Line: 503.639.417 Lw Date Ready /By: Juris: m See Attached Checklist for
Internet www.ci.tigard.or.us Notified /Method: - O5 / /6,_ Supplemental Inlormation
CITY OF TIGARD
' , BUILDING S � 0 � ' 2. W `� \M-
-DI SION
TY PE OF,WORK REQUIRED.DATA:,I - 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
5 '' C CON . . , ' , • wort: indicated on this application.
:' . , . • , Valuation: $
g 1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder 111 Other:
Number of bathrooms: 2 1 11j
. ; ., ., a,- . •,• x�• Total number of floors:
" 4:• ,,;u:JOI3'. SITEINFORIGIATION: •
A D�p LOCATION
Job site address: ' J 7937 Sw ergot, ,At--)N G I . New dwelling area: itoel' square feet
City /State /ZIP: Ti‘', , op- q-7223 Garage /carport area: `_9) i square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 32 square feet
Cross street/directions to job site: ( CO ( 4--v0 14114 WO Deck area: square feet
' Other structure area: square feet
REQUIRED DATAa,COlytly: ERCIAL= USE ,
Subdivision: p..pj A ot. w.JS Lot no.: i 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.: Q.b l t CP /i" LOT i IGO equipment, materials, labor, overhead, and the profit for the
` %' , - ' application.
a - 'DESCRIPTION OF WORK °. - ... work indicated on this a pP
N fP oRT'Acke9 Valuation: $ .
Existing building area: square feet
' New building area: • square feet
I r `0- . ;w , ® TEN Number of stories:
Name: V.. (STON t P O' 11 l NC, Type of construction:
Address: PD 09* qi & Occupancy groups:
City /State /ZIP: �.� OSVJ �&o, op- elioa " l , T � _ Existing:
Phone: (�3) 6‘3 ' t
5 -41 Fax: ( 5D3) (Aq -114-t New:
�; APPLICANT E t ®- CONTACT PERSON, ' N
Business name: L )-' DI,). P T M 1 \("C • All contractors and subcontractors are required to be
Contact name: Po poNc 416 — ,,Was Po ` V- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: '> o o� 91034' jurisdiction in which work is being performed. If the
City /State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) ' PA-e-- Fax: : ( ) S -
E -mail: •..1 PDIA'K-3 Co t "e6T. on-- • .' - i,,,, ,rk, . CONT Y' : -
Business name: i' OE, p.N,if.-LvfM ` l vG ' ,: . I BUILDING ` PERMIT FEES*
Address: •e, AS AsseDo i e Please refer to fee schedule.
City /State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB hc.: 1 II y *' _ - "VI it.
Date received:
Authorized signature: A l This permit application expires if a permit is not obtained
. , within 180 days after it has been accepted as complete.
Print name: /,A(fl p N ?Dial -- Date: 3 I i o IO'5 * Fee methodology set by Tri- County Building Industry
111 Service Board.
is \Building \Permits \BUP PermitApp doe 12/03 440- 4613T( II /02 /COM /WEB)
One- and Two - Family Dwelling I, •
Building Permit Application Checklist , FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Y
g A ssociated permits:
Phone: 503.639.4171 Fax: 503.598.1960 ienwillm 1/
24- Hour Inspection Line: 503.639.4175 61 W 0 Electrical 0 Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us ❑ Other:
. 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. El El ❑
3 Verification of approved plat /lot. ❑ El ❑
4 Fire district approval required. Name of district: ❑ ❑ El
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El
6 Sewer permit. ❑ _ El El
Water district approval. ❑ ❑ El
8 Soils report. Must carry original applicable stamp and signature on file or with application. El El El
9 Erosion control El plan El 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 . El El ❑
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.
I I 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 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- El El ❑
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 ❑ ❑ El
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 El ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the .roject under review. _
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 1 1 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 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ El
27 "Drawn to scale" indicates standard architect or engineer scale. i ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard El ❑ ❑
Street Tree List. .
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ El ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995. .
i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03
Mechanical Permi� r , W fo® - , FOR OFFICE USE ON
Alpli
- City of Tigard Receivved Pem,it No.: '',n 5
• g 13125 SW Hall Blvd., Tigard, OR 971y* 10 2005 Date/By /r ` - '�, "WO
Plan Review
Phone: 503.639.4171 Fax: 503.598.1 I Dat / Other Permit:
Inspection Line: 503.639.4175 .. Date Ready/By luny Ei See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR®
g Notified/Method: Supplemental Information
BUILDING DIVISION
•
w, ,p <T;YPEf;OF''WORK'` ...COMMERCI FEE* SCHEDULE -•USE CHECKLIST
New construction ❑ Addition /alteration /replacement Mechanical pel,mit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- - c r rP- - t., a.. � 3 � _ Value:
` C ATEGORY ; OF - ' GON°STRUCTION 1= '
. .-RESIDENTIALEQUIPMENT'/ SYS
'gl - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total
. ! .., ;:1 -JOB SITEy.INFORMATION 'AND LOCATION ` Heating /cooling
,. i s �a Air conditioning or heat pump
Job site address: 79-37 „,) 6Al20 L- RN G'T • (requires site plan showing placement) 14.00
City /State /ZIP: T IN I Of '11 0:5 5 Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt. no.: Project name: SEA McAPtAx) 5
Gas heat pump 14.00
Cross street/directions to job site: IJ w Pip P-o! O, � X. — N. Duct work 14.00
�
Hydronic hot water system 14.00
01\3 S u `� � O l G � Ao 0 Residential boiler (radiator or
. hydronic) 14.00
Unit heaters (fuel -type, not electric),
••., in -wall, in -duct, suspended, etc. 10.00
Subdivision: R)� C�,� 615405.0S Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
„4 +,. :,' - Water heater 10.00
,. y t --: #..Y M _ , s DESCRIPTION OF WORK =. -: Gas fireplace 10.00
O edu l S� f pe-lAckieD 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
0
at ,a Chimney /liner /flue /vent 10.00
- m 7 0411RTI ONR' , / . F,0 TENA } °ri ;, %.<
• WE g � - � T Other: 10.00
Name: _ I -' ' TOO E1 .p1^�J R4,00 1% r I \ IN Environmental exhaust and ventilation
Address:
P O 6 1 4 - 16 � Range hood /other kitchen
equipment 10.00
City /State /ZIP: LA-y--e, OS\k)eG J l € _ o 4- Clothes dryer exhaust 10.00
�� Single -duct exhaust (bathrooms,
Phone: (55 ) tee � - L 1 �tp Fax: (5) Vi I -- I H toilet compartments, utility rooms) 6.80 .,_
):' LI ° "` ='i `.`Y :'I "' ".= Y °' " Attic /crawls ace fans 10.00
'�';�tt, �� -r �,. _- APPLiCANTt� � ..: "�, .�,� _ CONTACT, PFR9dN� ��as P
Business name: Ko OE_ p\I a l oo k jG Other: 10.00
1 Fuel piping
Contact name: 3P11\1 Po - $ for first four; $1.00 for each additional
Address: Me As r D\ �v Gas Furnace, h p
Gas heat pump
City /State /ZIP: I' II Wall /suspended /unit heater
Phone: ( ) ik II Fax: : ( ) , Water heater
,. Fireplace .
J
E -mail: ( O A Y 3 (, 6gg AGAs 1 - s i\ -- Range
'`_`A I �r , : `_C;2;;: `, i, _ - ,., ,, ` .: Barbecue
/� Clothes dryer (gas)
Business name: � WIW/ 1V-
/ Other:
Address: ' ""t= `' `` " :MECIJANICAL` PERMIT FEES* ..
City /State /ZIP: C..-44-€4.. e• v 1a . Subtotal
Phone: (Sa ) Fax: ( ) Minimum permit fee ($72.50)
7 Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
Authorized at days after it has been accepted as complete.
Print name' / U Date: <�l�� ' Fee methodology set by Tri- County Building Industry Service Board
t. \Buitdine \Permits \MEC- PermitAno.doc 12/03 440 -4617T (t1 /02 /COM /WEB)
Mechanical Permit Application - City of Tigard `.
Page 2 - Supplemental Information
•
Commercial Fee Schedule:
� • . °j!::,;,
Total,Valuat><on .f: :. ., �hEerm:<t .P.g _.,
$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.
is\ Building \Permits\MEC- PermitApp.doc 12/03 2
_ i
Plumbing Permit Ap s T it ; • FOR OFFICE USE ONLY
City of Tigard MAR 1 2005 ! EICW Permit No.TT o -oo -1 13125 SW Hall Bd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 �" 6.. ,. r I t4 Date /By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175OITY OF TIGARD . `I it Date Ready /By• .tons- ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified /Method: Supplemental Information
,. w TYPE; t .. , ., FEE*, SCHEDULE'
New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
, ;''','r; 'CATEGORY OF' CON • SFR (1) bath 249.20
0 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
F '' r ; . ti JOB; SITE INFORMATION AND LOCATION `
Site utilities
Job site address:"N 3 - 3 5 W 6 /aN L`1 - Catch basin or area drain 16.60
City /State /ZIP: 1 I o \10..23 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
S(j RP -1W\ P I----Of--1
Manufactured home utilities l 10.00
Cross street/directions to job site: +'vrTU^U" ,
��p , , Manholes holes 16.60
0_0 S14J x fl tQIi CT' Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Q � p. � /� Storm sewer (no. linear ft.. ) Page 2
Subdivision: 'JA M i�QJ 1 Lot no.:� I f Water service (no. linear ft.: ) Page 2
\� Fixture or item
Tax map /parcel no.: '
Absorption valve 16.60
- f D OF : WORK Backflow preventer Page 2
!vei SFR -- P15 P Ck\ e,2 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
a _ « • �,. f , • C g, , r Drinking fountain 16.60
„ ., „`r _ ; - PR EVEL�',,,PME VAI , z ' t-, -
'�Q - Ejectors /sump 16.60
Name: P_n. Box 476 97034 Expansion tank 16.60
Address: Lake Oswego, OR 97034 Fixture /sewer cap 16.60
City/State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( Y3) G55 - ii Fax: ( 69i -114 I Garbage disposal 16.60
" v r �r� ` y ∎ , kk , y° € ® ERSON y . Hose bib 16.60
+,' a APi14AI!1T r1/ t°r ; : CONTACT P Ice maker 16.60
Business name: KEYSTONE DEVELOPMENT Interceptor /grease trap 16.60
' Contact name: P.O. Box 476 Medical gas (value: $ ) Page 2
Address: Lake Oswego, UR 97034 Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
s Sink/basin /lavatory 16.60
Phone: ( ) ' i
Y', Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: J O( Urinal 16.60
1 rf , ?, _< ` GOIY �TRACTOR t . _ Water closet 16.60
Business name: / � O ( s.e AP�1Y1, Nor bl/f Water heater 16.60
Address: Po »X a?33 3$ Other:
ty 9 t r 4 t ! 7��� -
Subto
Ci /State /ZIP
/ M perm f ee: $7 2.50
Phone: (.93 (Dv? Cf - 0_5 Fax: („ y`43) 67,2 c/-03-75- .7- Residential backflow minimum permit fee: $36.25
CCB Lic.: / 3 577d.. Plumbing Lic. no.: 31-/-35/6758 Plan review (25% of permit fee)
State surcharge (8% ofpem3it fee)
Authorized signature:����A�� , / / / TOTAL PERMIT FEE
Print name: 111 / c J p j jp //// //0 Dat ®/ 5 This permit application expires if a permit is not obtained within
M C "7 !! 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 12/03 440-46t 6T( l 0 /02 /C0M /WEB)
•
Plumbing Permit Application - City: of Tigard
Page 2.- Supplemental Information, ,
Fee'Scliedule: Residential Fire Suppression Systems:
,Sate , tilit esi „` .._; ": Qty Fee,(ea) = V.Total,r. ;S;quare- Footag Per
Footing drain - 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 . .. .. r mit
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 $ I.52 for each
Fee�(ea) (; Totah. additional $100.00 or fraction thereof, to and
. & . - . =r - .., - : 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 $254)00:00 and $1.45 for
each additional $100.00, or fraction thereof, to
Inspection of existing plumbing:or - =s - • • and including $50,000.00.
specially requested "inspections - per hour 72.50 $50,001:00 and 1115 $742.00 for the first $50,000.00 and $1.20 For
Subtotal: • - each additional $100.00 or fraction thereof.
•
•
•
d•
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 * .
P Qua ntity Work'4Performetl , •
Fixture Type 4 t y4 } R ep l a c e
�'', � a �,eW x Mooea� �, EXtst�a tdCapriea4f, 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"
4 „
Car Wash Drain •
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit canbe'issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
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:
is \Building \Permits \PLM- PermitApp doc 3/03
03/07/2005 OS: 37 5036254455 LIGHTHOUSE ELECTRIC: PAGE 01
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(PLEASE PRINT) (PERMIT HOLDER)
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meets ¢ .ty of Ti and (*as on county
1. land use and development standards for street tree installation.
4,' I--aT / / ,e/Y/ /T v M 57 c2Oo7
- ADDRESS: q 3 "7 c6i/ C c�c.. .1 A i
LOT: 7 / SUBDIVISION: yE,ggc_cA X47,4 -,00 S
BY: .� - .- - DATE: fir' o ff ° '
RECEIVED BY: W ., DATE: £ - - ,5 - �,
V ' ' V V
CITY OF TIGARD
BUILDING DIVISION `� PERMIT #: MST200&00075
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2006
Phone: (503) 639 -4171 : ili /100ipE� 111
Inspection Requests (24 Hrs.): (503) 639 -4175 ,�,...
INSPECTION WORKSHEET FOR DATE: 8/9/2006 TIME: 7 ;05AM PAGE: 53
SITE ADDRESS: 07937 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 001 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached.Demo credits applied from BUP2004 -00486 for TIF and Parks.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 5O3 -635 -4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503 - 635.1736
Inspection Request Scheduled For: Date: 8/9/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 013159 -01 503 -704 -9506 Y
Corrections /Comments /Instructions:
•
,rte - ASS I 'ARTIAL APPROVA ❑ CANCEL ❑ NO ACCESS
❑ FAIL IrA .1 FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
//
Inspector: Date: 0 ''- ° S Phone #: (503) 71B-
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: MST200G-00076
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 ingpvl t
Inspection Requests (24 Hrs.): (503) 639 -4175 - I
INSPECTION WORKSHEET FOR- DATE: 9/8/2005 TIME: 7 : 07AM PAGE: 513
SITE ADDRESS: 07937 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 001 TYPE OF USE:
PROJECT NAME: A REBECCA MEADOWS
DESCRIPTION: New SF detached.Demo credits applied from BUP2004-00486 for TIF and Parks.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503-635-4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503- 835..4738
Inspection Request Scheduled For: Date: 002005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013044 -01 503-704-9505 N
Corrections /Comments/ Instructions:
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: � q Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005.00076
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/8/2006 TIME: 7:07AM PAGE: 99
SITE ADDRESS: 07937 SW CAROL ANN CT CLASS OF WORK: • SUBDIVISION: REBECCA MEADOWS LOT #: 001 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION:
New SF detached.Dema credits applied from 13UP2004 -00486 for TIF and Parks.
OWNER: KEYSTONE DEVELOPMENT INC, . PHONE #: 503 --635 -4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503.635 -4736
Inspection Request Scheduled For: Date: 8/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 012907 -01 503.704 -9505 N
Corrections /Comments / Instructions:
•
)0 PASS jfi 'ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL j , LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Date: 8 Phone #: (503) 718 -
•
'CITY OF TIGARD ) ..
BUILDING DIVISION s `, PERMIT #: MST2005 00075
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 h iiN� �mtGlj��;l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7:08AM PAGE: 41
SITE ADDRESS: 07937 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 001 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached.Demo credits applied from BUP2004- 00486 for TV and Parks.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 603 -635 -4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503-635-4736
Inspection Request Scheduled For: Date: 7/2802005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 012320 503 - 582 - 9600 N
Corrections /Comments /Instructions:
If ✓e_ L ter dyC f Z C C9 Ze-- -
� �� te a - - 1 154- c �1 0� _ �� .
d
k
SS ❑ PA' IAL APPROVAL ❑ CANCEL n NO ACCESS
❑ , LL F FAIL • .' ' FOR I R: P '%1 El ADDITIONAL FEE ASSESSED
.. 41,1..
Inspector: Date. e Phone #: (503) 7182