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Permit
r City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • I1 TIGARD June 25, 2008 Abel Dominguez 12755 SW Da Vinci Ln Tigard, OR 97224 Re: Permit No. MST2008 -00031 Dear Mr. Dominguez: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 12755 SW Da Vinci Ln Project Name: Dominguez Job No.:. N/A Refund: ® Check #57890 in the amount of $146.22. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Refund overpayment of plan review fees. If you have any questions please contact me at 503.718.2430. Sincerely, "( Dianna Howse Building Division Services Coordinator Enc. 1: \ Building \ Refunds \ Administration \LtrRefund- ove:pay.doc 01/16/07 • Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov • TTY Relay: 503.684.2772 1 , 1 City of Tigard TIGARD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Abel Dominguez DATE: 6/11/08 12755 SW Da Vinci Ln. Tigard, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: �0 8- 207 - / /o% Case #: MST2008 -00031 Date: 3176 �/ //' Address /Parcel: 12755 SW Da Vinci Ln. Pay Method: Check Project Name: Dominguez EXPLANATION: Refund overpayment of plan review fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount [BUPPLN] Pln Rv Deposit 245- 0000 - 433000 $146.22 TOTAL REFUND: $146.22 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY �� Case Refund Processed: I Date: I 6;�y /off I By I I:\ Building \Refunds \RefundRequest.doc 05/23/07 Ef il CITY OF TICA.RD 6/5/2008 13125 SW Hall Blvd. 8:08:23AM Tigard, OR 97223 503.639.4171 TIGARD Receipt #: 27200800000000001053 Date: 03/31/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid MST2008 - 00031 [BUPPLN] PIn Rv Deposit 245 0000 - 433000 146.22 Line Item Total: $146.22 Payments: Method Paver User ID Acct. /Check No. Approval No. Flow Received Amount Paid Check ABEL DOMINGUEZ BTT 822 In Person 146.22 Payment Total: $146.22 cltecript.rpt Page I of I CITY OF TIGARD 5/28/2008 N a Fees Associated With 2:33:05PM . 13125 SW Hall Blvd. TI G n R D Tigard, OR 97223 503.639.4171 Case #: MST2008 -00031 2008 - 1o5 `'T - 1 ..`� i ti ,'_ - ' YL�= .� = V�-'- � 4,..,,14; w� �.; .I '- �'i M1.. --���.p�_ _ . ` 7f �: � " - :• ., �1 'I . �. .�1�-•�.__ -.S: l �,ry �.•� '� ; , y „ ;.:A ip , . _ 1 , Y ._ :- p. . i s�.i. -- .".., r i :. r_'1/4 -'C � , �y O � ,i,; 7 M tiN , }: , r y .. r k 5i - .t ic '�'• Y § . 3� y �J -��- - � ' - .�+taac a' "1-:',4;,:, n a'' - _ .�o` - f. � - " ts . .��;! � r '.�,'F: '4'� .,+!tt s i'.- : � C i..,`,,:. 4 _ Y ' i s , " ! ; ,1 7 t.,;?: ` '"� i e ,-2, t e < `aa, 1 e; i 1 ',X�.i1P : .n'.... . p 0 i ti ; • - y `.' . 3 A 7r , . :-:7;;. 7a Y. ; : � �S b' 1 a^M1• ., .... .- . . .._'..._..:w = ?� '�. .... .. ... ._: ...�F:".': .. � �e�l ... ... .s.._. ..__ : ._.. � ... ..:.��a �� . .J _!' .... 'ry'.� � BPLC 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Deposit 245- 0000 - 433000 BLD 3/31/2008 &F 146.22 0.00 CDCP 1/1/1990 12/31/2020 [CDCPLN] CDC Pin Rev 100 - 0000 - 433060 BLS 4/8/2008 46.00 0.00 LRP1 12/28/2004 12/31/2020 [LRPF] LR Planning Surcharge 100- 0000 - 438050 BLS 4/8/2008 6.00 0.00 BPLD 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Balance 245- 0000 - 433000 BLS 4/8/2008 146.22 0.00 BPRT 1/1/1990 12/31/2020 [BUILD] Bldg Permit 245- 0000 - 432000 BLS 4/8/2008 224.95 0.00 SUR1 12/31/2007 12/31/2020 [TAX] Build 12% State Surchrge 100- 0000 - 207020 BLS 4/8/2008 26.99 0.00 TCET 3/1/2008 12/31/2020 [TIGCET] Tig -Tual School CET 245- 0000 - 229205 BLS 4/8/2008 174.00 0.00 MPRT 1/1/1990 12/31/2020 [MECH] MEC Permit 245- 0000 - 431010 BLS 4/8/2008 72.50 0.00 SUR2 12/31/2007 12/31/2020 [TAX] MEC 12% State Surcharge 100- 0000 - 207020 BLS 4/8/2008 8.70 0.00 PPRT 1/1/1990 12/31/2020 [PLUMB] PLM Permit 245 - 0000 - 431000 BLS 4/8/2008 72.50 0.00 SUR3 12/31/2007 12/31/2020 [TAX] PLM 12% State Surcharge 100- 0000 - 207020 BLS 4/8/2008 8.70 0.00 ELCF 1/1/1990 12/31/2020 [ELPRMT] ELC Permit 220 - 0000 - 431510 BLS 4/8/2008 53.50 0.00 SUR4 12/31/2007 12/31/2020 [TAX] ELC 12% State Surcharge 100 - 0000 - 207020 BLS 4/8/2008 6.42 0.00 Total Due: $0.00 1. 1 /lie A/Looll ,e /770"/ /7 y / / o ��e Page 1 of 1 CaseFees..rpt , -14 CITY OF TIGARD MASTER PERMIT PERMIT #: MST2008 -00031 COMMUNITY DEVELOPMENT DATE ISSUED: 4/11/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2 S 109 D D -08600 SITE ADDRESS: 12755 SW DA VINCI LN ZONING: R -7 SUBDIVISION: BELLA VISTA LOT: 016 JURISDICTION: TIG PROJECT: DOMINGUEZ Project Description: Mudroom addition with bathroom. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 0 FIRST: 174 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 1 6,688,34 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 174 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 3 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 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 8, STEREO: VACUUM SYSTEM: AUDIO 8. STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable ABEL DOMINGUEZ OWNER laws. All work will be done in accordance with approved plans. This 12755 SW DAVINCI LN permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97224 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 Phone: Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 992.70 REQUIRED ITEMS AND REPORTS Issued Byt,/ /� ` _/t . - Permittee Signature : %- . r- 1 r � Call 503.639.' 175 by 7:00 a.m. for an inspection that b-,1 ess day. This permit card shall be kept in a conspicuous place on the job sit ■Itil completion of the • oject. Approved plans are required on the job site at the time of each inspection. Building Peermit Applica�n �� /L � Residential ° FOR OFFICE USE ONLY City of Tigar DateB MIL) Permit No.: 4 7 - j t�/ —047 13125 SW Hail Blvd., Tigard, OR 97223 �� � Plan Review sill i Phone: 503.639.4171 Fax: 5 �� � t , .� Date/By: Z. S , q .,k 68 Other Permit: T I G A 1Z D Inspection Line: 503.639 • t l f� Date ReadyBy: p tuns. 0 See Page 2 for Internet: www.tigard- or.gov �� a 1 ` b,� t. ¢• Notified/Method: y / C J p Supplemental Information M t � V . �,3 S ke w LLB /: S TYPE OF WORt\ 0 OV REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Dsakin Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all .2 Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead and the profit for dre CATEGORY OF CONSTRUCTION work indicated on this applicatio / C 8 B . 3 Y ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ -/ r o i 7/ "a., ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 121,55 5 W ) 01 r.1.1 (,r LA �, e New dwelling area: / 7ei square feet City /State /ZIP: ft. '� A1) O g 9 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: A SE L bpyi 1)j bull fi oM E Covered porch area: square feet Cross street/directions to job site: AD))STI r ,4 Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work u erformed. Tax map /parcel no.: Indica • the value (rounded to the nearest doll. of all equipme materials, labor, overhead, and • . profit for the DESCRIPTION OF WORK work indicat • on this application. Valuation: $ Existing building are.. square feet New building area: square feet [(PROPERTY OWNER ❑ TENANT Number of stories: Name: A - L N h' ; ( E Z Type of constru on: Address: 1235 5 ,5W D y N (,= I AN F- Occupancy y oups: City /State /ZIP: —rz G A i C G - -- 22- 4 E ': ng: Phone: ( ) Fax: ( ) New: ❑ APPLICANT Ickto■TACT PERSON NOTICE Business name: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: L l l c L I� A r�l(7 xi T f� under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: C ,5a3 q q3 - 6..5 5 2 , h JJ Fax:: ( ) E-mail: 0 1 5 Wl 1 r ►1'l0 vt -/e ` e /C i ��fl. did i'✓I CONTRACTOR Business name: BUILDING PERMIT FEES* Address: . As PR 0 W/ �i' review d e referree : le) 1 /� 1 ? Structural plan review fee (or deposit): /4/6,9,0 City /State /ZIP: FLS plan review fee (if applicable): -- -- e ---- Phone: ( ) Fax: ( ) CCB lic.: Total fees due upon application: / / . 2 '� Amount 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: --- _ 1' f Date: 03 )31 '� * Fee methodology set by Tri- County Building Industry 0, Service Board. I:\Building ' 14 tts�BUP -RES • 1 itAp. doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE USE ONLY 71 City of Tigard Received Date/By: Permit No.: 1 3125 SW Hall Blvd., Tigard, OR 97223 Associated permits: = Phone: 503.639.4171 Fax: 503.598.1960 0 Electrical 0 Plumbing 0 Mechanical T I G A K D 24 Hour Inspection Line: 503.639.4175 Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A Land use actions completed. See ju ' fiction criteria for concurrent reviews. El ❑ ❑ 2 Zoning. Flood plain, solar bal. I ' - points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 'fication of approved 1 ot. ❑ ❑ ❑ 4 Fire ' rict approva quired. Name of district: 1=1 0 ❑ 5 Septic sys • p , it or authorization for remodel. Existing system capacity El ❑ El 6 Sewer perm' ❑ ❑ ❑ 7 Water • rict ap i , val. ❑ ❑ ❑ 8 Soi eport. Must ca original applicable stamp and signature on file or with application. ❑ El ❑ 9 osion control ❑ plan a` a - rmit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ El basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if cosyright violations exist. 1 , S' a /pl1 flan w I I cale. he �iust show lot and building setback dimensions; property corner elevations (if El ❑ ❑ e - is more than . 4 -ft. do ifferential, plan must show contour lines at 2 -ft. intervals); location of easements I d driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ El El and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ El locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists El El ❑ 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 Ore. on and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. El ❑ ❑ 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. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and accompanied by the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ 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\BUP- RES- PemitApp.doc 03 /21/06 440.4613T(l1 /02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY C Received City of Tigard • Date/By: 377 Permit No .' • 13125 SW Hall Blvd., Tigard, OR 97223 y /!r � Plan Review s: Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Sufis: 0 See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction Ltd Addition /alteration /replacement Mechanical permit 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. CATEGORY OF CONSTRUCTION Value: $ dwelling ❑Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES* and 2-family g ❑ Commercial /industrial For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: f l ,�, Air conditioning or heat pump 12155 "`+ i ( A ]� (requires site plan showing placement) 14.00 City/State /ZIP: -1 L 4' ' \b o R q12_ Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: A -L M , J Luz Gas heat pump 14.00 Cross street/directions to job site: A6 M D 11 X( Duct work 5 10.00 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. 14.00 Flue /vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 M I U.1J Ro 0 so A JD» / T/ o v.[ vv J t - A f fil o O Gas fireplace gas 10.00 U y Flue vent for water heater or as fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 51412 OWNER ❑ TENANT Other: 10.00 Name: ,,f-- - „,,, L U 67 Environmental exhaust and ventilation J Range hood/other kitchen Address: Z7.`S t) \4 1") 74 Vi Jul C I r^ AN F equipment 10.00 City/State /ZIP: -r, ( AR-0 0 R. Q 224- Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) / 6.80 ❑ APPLICANT ICJ CONTACT PERSON Attic /crawlspace fans 10.00 Business name: Other: 10.00 Fuel piping Contact name: k.) l S rA voolvie S $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater F ax :: Phone: ( SU3 ) 1 93 ( ) Water heater Fireplace E -mail: 61,1/'15vIt1 i I'p VVI Ci' PS Oga Range w� 00 - G o CONTRACTOIt Barbecue Business name: Clothes dryer (gas) Other: Address: t r 4s (l�t 3R( R-n( W fJ< MECHANICAL PERMIT FEES* City /State /ZIP: ` ' v T Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: I State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signat e: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: O * Fee methodology set by Tri- County Building Industry Service Board I.\BuildingPe C - PermitAp, , \ 01 /19/0, 440-4617 (I 1/02/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 01/19/07 2 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City ;�`�� Permit No.: 131 of Tigard Hall and Blvd., Tigard, OR 97223 Date/By: / h /37-7--- /n S/ Du cu I = Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.: Inspection Line: 503.639.4175 Date/By: T I G A R D Date Ready/By: luris: 0 See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description Qty. I Ea. j Total ' 'ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 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 SITE INFORMATION AND LOCATION Site utilities Job site address: I Z75 5 ..5 W 'D P Y TNGr L AN F Catch basin or area drain 16.60 City /State /ZIP: 7 A A 1'b 0 7 Cl l 224._ Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: Project name: Zt_1_ 'Dtti I 1J i-8 O F7 Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: On Al) D/ .77 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: _ ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK / Backflow preventer Page 2 MO R 0 0?-4 A ))' / 7 J o) `�/ .6A-riq (' /-1 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Id PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: -k�-1-- 0 y 4 1 x L 0 , % Expansion tank 16.60 ►11�G 1 L �1J G F /sewer cap 16.60 City /State /ZIP: Ti ( A RD b Q 9 7 224- Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ( C NTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: L_ i »S M I 1'1 I' I OES Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory ( 16.60 Phone: (5 (y5 (y5 -1 f� qS - 6,5 2,k, j I Fax:: ( , ) Tub /shower /shower pan 1 16.60 - E -mail: U 1 S i,-1,1 1 ro m G Vl'1 PS € Cc ("WO V(d O, CO 114 Urinal 16.60 CONTRACTOR Water closet i 16.60 Business name: Water heater 16.60 Address: &4\) F l_ A ltl\ 0 WA/ , Other: City /State /ZIP: '\ Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name, Date: 0 x )I/O 3/ Q This permit application expires if a permit is not obtained within V 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I: \ Building \Permits\PLMF- PermitApp.d 12/ /06 440- 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 Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 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: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i: \ Building \Permits\PLM- PermitApp.doc I2/27/06 Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Date/B Received 31 0 6- ( 37 7 —Permit No.: Lw�� - ` i lig • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TI i1 I:1) Inspection Line: 503.639.4175 Date Ready/By: .runs. B See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", , I f �i� I J Six or or more residential R occupancy. Recreational Job no.: Job site address: 2 J �l 4 Rib I r-/�Ny ❑ Six or more residential units. ❑Recreatinal vehicle parks. City/State /ZIP: I r A I D ^ ( 9 Z 4. 0 Health-care facilities. 0 Supply voltage for more than l 1 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: .A A,,,, / Ai L U f__-2_ ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 4-to r- et e 4�LT10 4 Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) �t t ,I` Limited energy, multi - family r' U V) � on . r /r Ab� j W / & ,N / KI residential (with above sq. ft.) 75.00 2 s I Y ' ` ^f Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 &t PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 ��� D 6 I ` ' / U t 2 401 amps to 600 amps 160.60 2 Name: `l� �� J� O 601 amps to 1,000 amps 240.60 2 Address: IZ7 c-. '� V J G ) I_ ,4-)q G L Over 1,000 amps or volts 454.65 2 City/State /ZIP: / I G A- 0 R Cl - 2. 2 4- Temporary services or feeders installation, alteration, and/or r1 relocation Phone: ( ) I Fax: ( ) 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 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I El/CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: l) 1S �I R A K ,1 0 ) 1 E S without service or feeder fee, 46.85 2 L J 1� /'' N first branch circuit Address: Each add'l branch circuit i.- 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: (jO� CI 95 66 2 f I Fax: : ( ) Reconnect only 66.85 2 E -mail: u/t■ IS 14/1 I ✓c ((A OI\'I e' cttAt(00 . (.0 iNN Pump or irrigation circle 53.40 2 CONTRA OR Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited - energy panel, alteration, or Address: 3 )% \ ' I lJ a `�� 1� I Y )v - AS F o ,P� a / v ( f . /Z extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) I Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: I Electri , al ic.: I Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, requ' ed: Subtotal: Print name: I Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: A TOTAL PERMIT FEE: flit Print name: A 1 ji, ti t/ 1 Date: , days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC- PermitApp.doc • ' 23/06 440- 4615T(11/05 /COM/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* F1 Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n C lock Systems ❑ Data Telecommunication Installation n F ire Alarm Installation ❑ HVAC ❑ Instrumentation n I • ntercom and Paging Systems ❑ Landscape Irrigation Control* ❑ M edical n 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 \Pennits\ELC- PermitApp.doc 03/23/06 , City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • T I GARD June 25, 2008 Abel Dominguez 12755 SW Da Vinci Ln Tigard, OR 97224 Re: Permit No. MST2008 -00031 Dear Mr. Dominguez: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 12755 SW Da Vinci Ln Project Name: Dominguez Job No.: N/A Refund: ® Check #57890 in the amount of $146.22. ❑ Credit card "return" receipt in the amount of $ . ❑ Trust account "deposit" receipt in the amount of $ . Notes: Refund overpayment of plan review fees. If you have any questions please contact me at 503.718.2430. Sincerely, ..„(K;)47 _ Dianna Howse Building Division Services Coordinator Enc. I: \Building\ Refunds\ Administration \LtrRefund- overpa 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 City of Tigard TIGARD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Abel Dominguez DATE: 6/11/08 12755 SW Da Vinci Ln. Tigard, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 20 ° /AC J Case #: MST2008 -00031 Date: 3�� y / /"C Address /Parcel: 12755 SW Da Vinci Ln. Pay Method: Check `� Project Name: Dominguez EXPLANATION: Refund overpayment of plan review fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount [BUPPLN] Pln Rv Deposit 245 - 0000 - 433000 $146.22 TOTAL REFUND: $146.22 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager Z (� % / - © If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY, Case Refund Processed: Date: '' 6//y /�� � By: , I: \ Building \Refunds \RefundRequest.doc 05/23/07 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008- 001031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 Alko�if,l1 Inspection Requests (24 Hrs.): (503) 639 -4175 . ' ` :_.. INSPECTION WORKSHEET FOR DATE: 7/2/2008 TIME: 7:01AM PAGE: 14 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 010 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: l Inspection Request Scheduled For: Date: 7/2/2000 . Pour Ti -. Code # Inspection Description Confirm # Contact # Mes-�ge ikr°6 289 Final inspection 072136 -03 603- 713 -7572 Y Corrections /Comments /Instructions: A. , ., f n PARTIAL APPROVAL _ CANCEL ❑ NO ACCESS I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1/' t/2 - : z 6 r 2-g 2 ' . Inspector: Date -7 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200R.00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4111/2000 Phone: (503) 639 -4171 4 4p, Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/2/20013 TIME: 7:01AM PAGE: 16 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/2/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 072136-01 503.713 -7572 N Corrections /Comments/ Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL . ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED j64 Inspector: Date: " l v Phone #: (503) 718- '° CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008 -00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 w�jpn j1 Inspection Requests (24 Hrs.): (503) 639 -4175 _� INSPECTION WORKSHEET FOR DATE: 7 /2!2008 TIME: 7:01AM PAGE: 15 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mucfroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/2/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 309 Plumbing final 072136-02 503 - 713 -757"2 Y Corrections /Comments/ Instructions: • Gil*SS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: ��+ Date: � ! "( Phone #: (503) 718- �� 1 , CITY OF TIGARD l BUILDING DIVISION #: tviST2001B-00031 ' 13125 SW Hall Blvd., Tigard, OR 97223 . ,. DATE ISSUED: 4/1112008 Phone: (503) 639-4171 ., A Inspection Requests (24 Hrs.): (503) 639-4175 ,_-_-1.0- • INSPECTION WORKSHEET FOR DATE: 6/3/2008 TIME: 7:00AM PAGE: 4 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroorn addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/3/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message . 322 Shower pan 070740-02 503-713-7572 Y Corrections/Comments/Instructions: P R c e/ TO ' kA,c,.i c-C S Ivo t--"--"" (-1C.-- ccx(.4.'i t ...1 k o it. t hr...,A e.k, - 1 - , r - A - z, kikcs euv'?L A PASS 0 PARTIAL APPROVAL 0 CANCEL n NO ACCESS El FAIL 0 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 06 ■N m,-J 1 \ 1.4-'4_ Date: (4. 1 3 iciz Phone #: (503) 718- . . , CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008 -00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/27/2008 TIME: 7:01AM PAGE: 18 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: iViudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/27/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 07035E -02 503-713-7572 N Corrections /Comments /Instructions: Co (-n-ft- w�c/ cpa✓ - ✓�'� S� �--1-t i. J e CMnr� i.r C / PAL/ — r Flea,.._ 9 Y Z / a..tic - 1 c. L Z ti az 1A w & J A, v60 r) ❑ PASS PARTIAL APPROVAL n CANCEL I I NO ACCESS n FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: e , Date: ) 2 ltpq Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200R -00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/200f3 Phone: (503) 639 -4171 iV Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/6/2008 TIME: 7:00AM PAGE: a SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: EBE L VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUF7 DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/6/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message I 305 Plumbing underslab 069439 -01 971 - 230.4359 Y Corrections/Comments/Instructions: IA PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS fl FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 0 U 1/WA—A \ \ C Date: iS J 0)11 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: M ST 200L3.0001 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1/12000 Phone: (503) 639 -4171 / m�xWNu�i�ll�ff�l�t Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 611312008 TIME: 7 :01AM PAGE: 8 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: I+udroorn addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/1312008 Pour Time: 1 Code # Inspection Description Confirm # Contact # Message 199 Electeical final 071371-01 511 713 572 Y h i� Corrections /Comments /Instructions: ):1 PASS ❑ PARTIAL APPROVAL (l CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED OA Inspector: Date: I/ We Phone #: (503) 718 - 2 CITY OF ��n u m n�'m TIGARD BUILDING DIVISION � - ~°~~"~~~�"""~� ~°"°"~~"~~"~ . PERMIT #: &4[T2008-00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2000 Phone: (503) 639-4171 . Inspection Requests (24 Hrs.): (503) 639-4176 AN- "E. INSPECTION WORKSHEET FOR DATE: 0J12/2008 TIME: 7:02A&8 PAGE: 5 SITE ADDRESS: 13755 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: B[]1AV1STA LOT #: 016 TYPE OF USE: PROJECT NAME: Q[)NY{MGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/12/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 E]o«tricdfine} 0712W-03 503-713'7572 N Corrections/Comments/Instructions: . | � �� � ^° IVL' �, � �_/���k� � r- ,�� / /~ / L ��-- /� «~ � PASS ri PARTIAL APPROVAL 0 CANCEL El NO ACCESS FAIL KCALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED 4 b/(°14 �y �� � |nope��Inspector: Oate: g Phone #: (503) 718- (70 CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST2008 -00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 /m�„1dg��� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/12/2008 TIME: 7 : 02AM PAGE: 7 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINCUE1, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/12/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message , 120 Electrical rough -in 071294 -01 503113 -7572 Y , (4/0141- �� r Corrections /Comments /Instructions: C6114 ( ;r s Ka, - D- - OA V (Ca- -- • K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I I FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: i Date: 4' ( /z/ , Phone #: (503) 718- 1/0-) CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008 -00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/200'c Phone: (503) 639 -4171 Awing ��''ll� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/12/2008 TIME: 7 :02AM PAGE: 6 SITE ADDRESS: 12155 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: CALLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroow addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/12/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 115 Electrical service 071294-02 503- 713 -7572 N Corrections /Comments/ Instructions: • H PASS ❑ PARTIAL APPROVAL 'CANCEL n NO ACCESS FAIL ❑ CALL FOR INSPECTION �❑ \ ADDITIONAL FEES ASSESSED Inspector: Date: 6 a2/ Phone #: (503) 718 - (�� CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2008- 000:11 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1 'I/2 0 0( Phone: (503) 639 -4171 f ir +�4MA Inspection Requests (24 Hrs.): (503) 639 -4175 '`'IL. INSPECTION WORKSHEET FOR DATE: 6/3 /2008 TIME: 7:00AM PAGE: 5 SITE ADDRESS: 12755 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: E3ELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. • OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/3/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 070740 -01 503-713-7572 N Corrections /Comments /Instructions: I I )S ❑ PASS n PARTIAL APPROVAL ❑ CANCEL O ACCESS X FAIL l CALL FO INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: t! " Date: fe / D Phone #: (503) 718- . CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2008- 011031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11111200t3 Phone: (503) 639 -4171 0flo�iitl Inspection Requests (24 Hrs.): (503) 639 -4175 ...'.,_W ' INSPECTION WORKSHEET FOR DATE: 6}2/20013 TIME: 7:02AM PAGE: 3 SITE ADDRESS: 12756 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/7J2008 Pour Time: Code # Inspection Description o ra#ir Contact # Message 120 Electrical rough -in 070655.01 503-713-7671 Y st - rimE ! I r- ------ , - - ---- Corrections /Comments /Instructions: 2 j C 1~ . Pm tIv3zANAQ oN ►wa W \ N ? cao • Air 11 . () 0 TO CAV\re W4S 1 N S , __ c--\\(-. o1c . PaA t t* • . I , PASS El PARTIAL APPROVAL n CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Iv 6 8 Date: t 0 Phone #: (503) 718- 1-t Y% CITI; OF TIGARD BUILDING DIVISION PERMIT #: MST2008- 00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/29/2008 TIME: 7:00AM PAGE: 14 SITE ADDRESS: 12765 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUE DESCRIPTION: Mudroom addition with bathroom OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/29/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 070526 -01 W3-713-7572 Y Corrections /Comments /Instructions: ? t - (k‘l kutitipt.„ a 9/9%70 wec, k 114\ 6 k?A.., V a p q�,� ♦ �� +� Lam• I I PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G"--' N 6sLt Date: 2 b c41 Phone #: (503) 718 -1i I 4 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008- 00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 a are h ooII°I�I Inspection Requests (24 Hrs.): (503) 639 -4175 ■ INSPECTION WORKSHEET FOR DATE: 5/29/2008 TIME: 7:00AM PAGE: 13 SITE ADDRESS: 12755 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: BELLA VISTA • LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/29/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 115 Electrical service 070526 -02 503 - 713 -7572 N • Corrections /Comments/ Instructions: sztArt In • I I PASS n PARTIAL APPROVAL J i i CANCEL ❑ NO ACCESS l FAIL ❑ CALL FOR INSPECTION ' ADDITIONAL FEES ASSESSED Inspector: �V� Date: Ot Phone #: (503) 718 -li1 L6 CITY OF TIGARD BUILDING DIVISION . - PERMIT #: MST2008.00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 / oo� i (zl Inspection Requests (24 Hrs.): (503) 639 -4175 �°`'., INSPECTION WORKSHEET FOR DATE: 5/27/20013 TIME: 7:01AM PAGE: 16 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: E3ELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINr3UEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL. PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/27/20013 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 070366-04 x: - 13-- N Corrections /Comments /Instructions: 6 5 P e »O g '(?u . t Arvo)• ( -, ic:, i 6 a-C/011 E Qvglk145,451vs Rx=c,,,NSK/f14,. ‘j v j ' paizos.) +® i G„o vr.b c'e,R N) 4 5 gear fr V\ Nal\s .-_.. A ;1a 1t /s Q ' '. r,,,,id k__\_ cc) 10 0 n PASS ❑ PARTIAL APPROVAL l CANCEL ❑ NO ACCESS ii FAIL ►/ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: G.--% N t 6 LF- Date: Cr 21 6 Phone #: (503) 718- ZEL`D CITY OF TIGARD BUILDING DIVISION . . PERMIT #: MST200 000 1 ' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/20)0[3 Phone: (503) 639-4171 : ��a9mii'lI Inspection Requests (24 Hrs.): (503) 639 -4175 �__NV __.. INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:00AM PAGE: 13 SITE ADDRESS: 12755 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: BELLA VIM LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/28/20013 Pour Time: Code # Inspection Description Confirm # Contact # Message 6'15 Mechanical rough -in 070449-01 503.713.7572 Y Corrections/Comments/Instructions: � L' ' _ TiGh c} /S r# ,z - Gr.le r- -�� t c-. (G A/L V 7 2, • - o i i PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED �/ L , Inspector: D ate: .S —a �, Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200B.00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 411//2000 Phone: (503) Jargivl Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/27/2008 TIME: 7 :01AM PAGE: 19 SITE ADDRESS: 12755 SW DA VINCI LW CLASS OF WORK: SUBDIVISION: FELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUa DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUE ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5127/2008 Pour Time: 9:00 Code # Inspection Description Confirm # Contact # Message 22 Slab 070366 -01 503- 713 -7572 N Corrections /Comments /Instructions: - PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 1 — —a 6 Phone #: (503) 718 - a44-3----- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008- 00031 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639 -4171 �� l �l (i Inspection Requests (24 Hrs.): (503) 639- 4175!�i INSPECTION WORKSHEET FOR DATE: 5127/2008 TIME: 7:01AM PAGE: 15 SITE ADDRESS: 12766 SW DA VINCI LN ' CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroom addition with bathroom. OWNER: DOMINGUEZ, ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/27/2008 ' Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 070366 -05 503- 713 -7572 Y Corrections/Comments/Instructions: • PA PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: S'- —os Phone #: (503) 718- (4—`4'J CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST2008- 00t)31 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2008 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/1/2008 TIME: 7:00AM PAGE: 6 SITE ADDRESS: 12755 SW DA VINCI LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT #: 016 TYPE OF USE: PROJECT NAME: DOMINGUEZ DESCRIPTION: Mudroonl addition with bathroom. OWNER: DOMINGUE ABEL PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 5/112000 Pour Time: 2:00 Code # Inspection Description Confirm # Contact # Message 205 Footing 069186-01 971-230-4359 N Corrections /Comments /Instructions: Stab O �i • �r r • '1 U /�� 2d Stab P1(mi\ i t/1e,, c t 145 01/1. , I'1'1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL [l CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: 1 --�•� Date: I Al0i.y0g Phone #: (503) 718 - a