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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00006 � DEVELOPMENT SERVICES DATE ISSUED: 2/10/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11450 SW GALLO AVE PARCEL: 1S134DC -11600 SUBDIVISION: CASCADIAN PLACE ZONING: R -4.5 BLOCK: LOT: 005 JURISDICTION: TIG REMARKS: Nil() d``• BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 18 FIRST: 1,653 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 898 sf GARAGE: 608 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5 VALUE: 251,682 00 OCCUPANCY GRP: R3 BDRM: 4 BATH• 3 TOTAL: 2,551 sf REAR: 46 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS. LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS' SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS' TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS. 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN 5=100K: 1 UNIT HEATERS: HOODS' 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 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 FD R: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp. 1st W/O SVC/FORW SIGN /OUT LIN LT: PER HOUR. LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp. EAADDL BR CIR: SIGNAL /PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps -1000• MINOR LABEL. 1000+ amp /volt PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: s 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,428.99 This permit is subject to the regulations contained in the KEYSTONE DEVEOPMENT INC. KEYSTONE DEVELOPMENT Tigard Municipal Code, State of OR Specialty Codes and PO BOX 476 PO BOX 476 all other applicable laws. All work will be done in LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone' 503 635 - 4736 Phone: 503 - 635 - 4736 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 -001 -0080. You Reg #: LIC 71135 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control lnsp 8 Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insc Rain drain Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection Fou ion !nap Footing /Foundation Dn Electrical Rough In Gas Line lnsp Appr /Sdwlk Insp ?.�JBeam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final 0 i / Q. ) 6 ( 4 _ Iss \ed By : = ' I Permittee Signature :.- ,N"...7,--____ Call (50 639 -4175 by 7:00 p.m. for an inspection needed th - ext b - iness day ` Building Permit Application .. -- y = _ =` ". -;� Date received/ __7-0,f, Permitno :45 0,pi� City of Tig . � �4 � E ® Project/appl. no.: Expire date: City of Tigard Address: 13125 SW , ' Pfgard, Olr 97223 Phone: (503) 639 -4171 Date issued: By ► Receipt no.: Fax: (503) 598 -1960 JAN 2003 Case file no.: Payment type: , v t Land use approval: CITY OF IGARD 1 &2 family: Simple Complex: a ■ • ISION - - ' , TYPE OF PERMIT t• 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family I: ew construction 0 Demolition 0 Addition/alteration /replacement O Tenant improvement 0 Fire sprinkler /alarm 0 Other: , l .. ,. 1 . 2 . , . � , . _. . 'JOB SITE INFORMATION � � t,� , , • • Job address: (1 4 60 VJ 6,91.1.4f2 iU..© /l'/' • • Bldg. no.: Suite no.: Lot: 5 (Block: (Subdivision: Cf� SAC., I Tax map /tax lot/account no.: AS' /.3 —ci 25 Project name: �< S Description and location of work on premises /special conditions: N S - 'OWNER s , . - ; FOR SPECIAL, INFORMATION, USE CHECKLIST �� Name: S`('n�� O''\) D r. It Je. , -., `. ( Floodpl , septic capacity,'solar, etc .) i Mailing address: rO 121Y L1 tv 1 & 2 family dwelling: ll City: LA K.Q -osv O-o I State: OP- IZIP: of - to�j4 Valuation of work $. S 4� 3. c ? Phone: b35 -4 (Fax: Yk■ 11O IIE E-mail: No. of bedrooms/baths 1 Owner's representative: 4 7 n ,OO Total number of floors 7 ■ Phone: S • Mi Fax: E -mail: New dwelling area (sq. ft.) t5 1 • ' =. ,�: . APPLICANT ;f • Garage /carport area (sq. ft.) Si (o Name: S9N1e■ Covered porch area (sq. ft.) 1 Mailing address: Deck area (sq. ft.) City: I State: I ZIP: Other structure area (sq. ft.) Phone: Fax: E - mail: Commerciallindustriallmulti- family: { .. " ,W - CONTRACTOR Valuation of work $ � Existing bldg. area (sq. ft.) Business name: New bldg. area (sq. ft.) Address: City: IState: IZIP: Number of stories Phone: I Fax: I E -mail: Type of construction .. . Occupancy group(s): Existing: CCB no.: IN 1 1115' i - l q _ p New: City /metro Ile. no.: Notice: All contractors and subcontractors are required to be " •.:' r. ARCIIITECT /DESIGNER . • L, 'L :,..,, licensed with the Oregon Construction Contractors Board/Under Name: IN1SCOP0 , provisions of ORS 701 and may be required to be licensed in the Address: 1305 NW l&Tyk jurisdiction where work is being performed. If the applicant is City: O1 State: OF- IZIP: q'12ol exempt from licensing, the following reason applies: Contact person: Plan no.: 22lf211- e2 Phone: 2'L 3 -116% Fax: 1 4...- 0933 E -mail: < t, , ;, ' `, 3 qi ° ' . ENGINEER' { '' ,,. " Name: 1 1.-[..- Contact person: Fees due upon application $ Address: iKIrj) Date received: City: pof2_1 1. IState:0P- IZIP: T121t Amount received $ . Phone: /2.Cj k —0-1, Fax: 25 E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call junsdiction for more information. attached checklist. All provisions o . and ordinances governing this 0 Visa 0 MasterCard work will be complied with, whe 8 - t i i d herein or not. Credit card number / / t ('f - Expires Authorized signature- ,^ /p Date: ,( h 5 1 "v Name of cardholder as shown on credit card Print name: �i ( r`w �N ' $ Cardholder signature Amount Notice This pemut applic. 'on expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00 /COM) 04/07/2003 11:59 5036254455 HILL ELECTRIC INC PAGE 02 ,4 _ N - . Electrical Permit Application IMIIMIIIIIIIIIIIIIIIIIIIIMII Date received: Permit no.: m5 O - O k (, ►'i'U City of Tigard Project/appl. no.: Expire date: City n(Tigard Address; 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: - Land use approval: '1'1•i is OF l'I:ItMI I I & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial Jolt SIT INFORMATION O1RMATI0N Job address: AniggihrIMWM11.0111 Bld:. no.: Suite no.: Tax map/tax lot/account no,: Lot: Block: Subdivision: Project name: Dosed •tion and location of work on • mixes: d� Estimated date of corn .letion/inspection: CONTRACTOR AP1'1.1('A ION FEE SCHEDULE Job no: pascal Ice Tatal ar , rj 1 i J/ m ew reddeNlxl drt� of Moat. Ic -lardly PcT Address: �' _ dweffla tat1Lhseluderatiadsodgarge. 1611 l P . J r.�,. i/ _ Service Included: � 1' sq. k or less 114 Phone: .: j ��i "�: ' Each additional 500 • . ft- or •onion thereof -- CCB no.: 1,, ,' IN Elec. bus. lic. no: �� Limited ener ,residential I1.Illa.It 2 ` _ metro t � , n0.: , Limited , h i) _ �� � ' —r , - . - a_3 Bach manufactured red home e or or modular dwelling .. m Date Service and/or feeder 2 ore of s • isle elactri tan "1,:, wet Services orf.• - — htrnllaUoo, 11111. s - FM Li «nee no: 3.6 alteration or relocation: ?RA' l' OWNER 200 amps or less 2 201 amps to 400 amps = - MIMI Name (print): d ' .J/a" 401 imps to • • • amps 2 Mailin _ address: • • 1 amps to 1000 amps MIMI 2 EaMIIIIIIIIIIIMIIII on State: ZIP: Over lo amps or volts w I=MIll 2 Phone: rESIMEMI E - mail: Reconnect onl 1 � scrubs rs - or feeders installation: The installation is being made on property 1 own llmpo Irsaralla tiot rf serriews feed eoeartOnr which is not intended for sale, lease, rent, or exchange according to 200 am • or leas _ III ORS 447, 455, 479, 670, 701. 201 am• to 400am•e 2 Owner's si:. = tore :.. Date: 401to600arn. ME � � 1 ?N( :1NE Branchcircuis - new,alteration. or eahensloa per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 Stare: ZIP: El. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 1.111 2 Phone: ' Each additional branch circuit: ■� PLAN laIVll•'W Ora all that aPPI9 Mlle .(Service orfeeder no notbacluded): - or irri: awn circle Each •um 2 C3 Sarvi «over 225 snips- commercial 0 }lealth•c B trrefacility Eac 2 0 Service over 320 amps-rating of Ie2 0 Hazardous __ location Signal clecuit(a) or a limited energy panel. ■l family dwell ings 0 Building ildingover 10 ,o00squarefeetfouror g 2 O System over 600 volts nominal more residential units in one structure alteration, or extension* O Building over three stories O Feeders. 400 amps or more •Deacri • on: — O Occupant load over 99 persons lO Manufactured structures or Rv park _��� O Egress/hghtiingplan O Other Submit sets of plans with any of the 4hove. The above are bat ap • Utable to tem . • rnt'y construction service. Other Permit fee $ Na all }Lai/Actions accept credit cards. *are call jurisdiction roe more information, Notice: This permit application Plan review (at %) $ R Visa R MasterCard expires if a permit is not obtained Credit card Dumber I / within 180 days after it has been State surcharge (8%) .... $ Expires TOTAL as complete. 1 OTAL N ance of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6g0ICOM) Plumbing Permit Application F OR OFFICE USE ONLY Received Plumbing �`� , - Date /By: Permit Not FS /0/005 6 City of Tigard Planning Approval Sewer Date /By Permit No. 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By Permit No.. Phone: 503- 639 -4171 Fax: 503-598-1960 A, . , ‘ Post-Review Land Use Internet: www.ci.tigard.or.us I Date /By Case No.: Contact Juns. ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. ti, %' - °,;g ' TYPE OF WORK. .'., : • 5'k FEE *;SCHEDULEn(for 'special infoi checkli`s`t)' E New construction ❑ Demolition Description I Qty. I Fce(ea•) I Total �•" "�'New�I = &2� family dwellings;` El Addition/alteration/replacement 111 Other: • _ _ . inC%aes 0.0 ft. :ea connection .' "./ " %' , CATEGORY OF „CONSTRUCTION ., _ ( y ) � SFR (1) bath 249.20 [r 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi - Family SFR (3) bath / 399.00 ❑ Master Builder ❑ Other: Each additional bath /kitchen 45.00 ;JOB -SITE INFORMATION and "LOCATION , - , Fire sprinkler - sq. ft : Page 2 Job site address: 114 :so Su° 6,11, --0 - -" ,i ;:. ' 4 '' - , : ;Site Utilities r ' ,,:-;(:: .; - .,'4 , - - Suite #: Bld • . /Apt. #: Catch basin /area drain 16.60 J' Si �N Drywell /leach line /trench drain 16.60 Project Name: C�IS/�N/tOE SUBnI' ) Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 T (j/ O r- Manholes 16.60 - � ( 2 -I' 1 O IQ 6/) L%-D Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Cf1 Sc4p1f■N YU Of Lot #: (, Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) Page 2 Tax map /parcel #: . ''':•,;,,. - , _ .,. '.Fixture or itein- ' 'x _. - DESCRIPTION OFWORK sue;i=`, , ._ '_' �'� 1--'12- Absorption valve 16.60 N evJ S Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ® )PROPERTY OWNER ',.I M ITEN ANV ,, -_ : Ejectors/sump 16.60 Name: jLf,?STDNE Qg iP• N Expansion tank 16.60 Address: Pd &DTL (-11i=, Fixture /sewer cap 16.60 City /State /Zip: ‘,./) p$Wl= s� 1 DP- 1-704 Floor drain /floor sink/hub 16.60 Garbage disposal 1 6.60 Phone: G3S - 415l Fax: Hose bib 16.60 6 °APPLICANT n, , -! `M= - ❑:CONTACT PERSON' Ice maker 16.60 Name: /qME--• Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone:. Fax: Sink/basin /lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 _ :!- . - " ACONTP CTOR ' _ .. - Urinal 16.60 ‘ Water closet 16.60 Business Name: SIM.' - 6FN L Water heater 16.60 Address: PLUMP t' • Assoc. ''t-U Nfb■I`r Other: City /State /Zip: Other: „ _ `' P lumbing Permit, ,, Phone: Fax: , , � .�.`� .. � - - , Subtotal $ CCB Lic. #: Plumb. Lic.#: Minimum Permit Fee $72.50 $ Authorized I Wt1 W �1 D at e: /( Residential Backflow Minimum Fee $36.25 Signature: Plan Review (25% of Permit Fee) $ V`A S l./I - POI- AY- State Surcharge (8% of Permit Fee) $ (Please pnnt name) TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. - *Fee methodology set by Tri- County Building Industry Service Board. r \Dsts \Permit Forms \PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: • Site Utilities'' Qtya4' Fee (ea) o ° rotalr;; Square Footage: - Permit Fee: Footing drain - I ' 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55 00 $1 00 to $5,000.00 Minimum fee $72 50 Storm & Rain Drain - each additional 100' 46 40 $5,001 00 to $10,000.00 $72.50 for the first $5,000 00 and $1 52 for each additional $100 00 or fraction thereof, to and . • Fiiture or °Itettl :'' Qty . 'Fee (ea) including $10,000.00 Commercial Back Flow Prevention Device 46.40 $10,001 00 to $25,000 00 $148 50 for the first $10,000 00 and $1 54 for Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to (minimum permit fee $36.25) 27 55 and including $25,000.00 Rain Drain, single family dwelling 65 25 $25,001 00 to $50,000.00 $379.50 for the first $25,000 00 and $1 45 for 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 $50,001.00 and up $742 00 for the first $50,000 00 and $1 20 for Subtotal: each additional $100 00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. , ; Quantity:by'(Fixture).Work Performed .; Comments regarding fixture work: Fixture Typei Replace _ <_ - New Moved Existing '.'Capped: Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3" - 4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach /Refng. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is \Dsts \Permit Forms\P1mPermitAppPg2 doc 01/03 FOR OFFICE USE ONLY Mechanical Permit Application lication Received Mechanical ��,,nn�� b f _ Date/By: Permit No.:i51 -2003 — axe Planning Approval Building ' City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By Permit No : Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use u "I �i�� t Internet: www.ci.tigard.or.us - , :e. ° ( , Date/By: Case No Contact Juns.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 " --"' -W ' Name/Method Supplemental Information. ", .° - TYPE`OF'WORK; t/ ry _ .. '147 -':: ;' J ' 1 `, COIVIMER,CIAL ?FEE* SCHEDiJI�E a''USE CHECKLIST ;" "; `_ _, . New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all mechanical materials, equipment, labor, overhead and profit. ' '= �: s �CAT` EGORl' OF'°' CONSTRiJCTI 'ON-:- ''i::�: =� �t- �`_ Q'1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family k ` ::RESIDENTIAL- EQUIP -- IENT /S"YSTEMS FEE * >;SCIIEI)ULE ;. €.;; ", Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling.. ' '" ;JOBfrSITE-INFORMATION iiiii1OCATION`r '':'''4, Furnace - add -on air conditioning ** / 14.00 Job site address: i145-0 5 vJ C ,A1.--1- v Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Hydronic hot water system 14.00 Project Name: c- A SG) -D/pJ et-RGz Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 T1 7 J 1� Unit heaters (fuel, not electric) IV, N ) 6), UA"1.1.-O (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) / 10.00 � R u nits 12.15 Subdivision: C�tSG's�AI� �AC Lot #: �v - OitieifTitel Appliances >. . ' ' . Tax map /parcel #: _ . Water heater / 10.00 ;i:W �- V,N-':' ; R z =. ,. .. " . 10.00 , ,:;�: ,..:.. ". _ :," "DESCRIP'TION„�OEW. ,,�;�i; == `>��" �`tY: Gas fireplace r n) �i) S F� Flue vent (water heater /gas fireplace) / 10.00 ` Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner /flue /vent S 10.00 - '?❑)PROPERTI';OWNER:= ='.;.` ° t " '` Other: 10.00 �= °,TENANTS � ; °, ". � �; - �.'.:.��;E ��_ - _ :, - 41iVii^oniiiiiifal Ezhiusf iWilitilitiiiii ' = P .=d ._ Name: Y- 'STbN i� J � l � Range hood/other kitchen equipment / 10.00 Address: PO 00s-4, 41(0 Clothes dryer exhaust [ 10.00 City /State /Zip: l tA C7S W t 0(=- 17ci- Single duct exhaust Phone: 63 413G Fax: (bathrooms, toilet compartments, APPLICANT''_;" `r,U'';` >.' c l:rg ICONTACTPERSONN''.; utility rooms) 4 6.80 Name: SA -N1\% Attic /crawl space fans 10.00 - Other: 10.00 Address: _ . _ : Fael-Pi i g -, - City /State /Zip: _ * *($5.40 for first 4, $1.00 each additional) Furnace, etc. / ** Phone: Fax: Gas heat pump ** E -mail: Wall /suspended /unit heater ** ': ;::, - 3 >µ g5.` t `3 N'p' ,: OONTRACTQR n ..... a ° - .` . Water heater I ** Business Name: SA /v - - 6(\•) (- Fireplace ? / ** Address: - (12 \ - �ov>J i -1- ! 66,01-0.0L Range ** BBQ ** City /State /Zip: �- I -/ � Clothes dryer (gas) ll* ** Phone: Fax: Other: ** - Total: CCB Lic. #: Mechan Permit Fees* Authorized �� {^ 1 I , I p3 Subtotal: $ Signature: yVvs tt�J (I Date: I Minimum Permit Fee $72.50 $ ill MSS M 1 t»W - Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. is \Dsts\Permit Forms\MecPermitApp.doc 01/03 _ CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RANDALL HILL ELECTRIC INC 14819 SW BELL RD SHERWOOD, OR 97140 • Electrical Signature Form Permit #: MST2003 -00006 Date Issued: 2/10/03 Parcel: 1 S134DC -11600 Site Address: 11450 SW GALLO AVE Subdivision: CASCADIAN PLACE Block: Lot: 005 Jurisdiction: TIG Zoning: R Remarks: N Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: KEYSTONE DEVEOPMENT INC. RANDALL HILL ELECTRIC INC PO BOX 476 14819 SW BELL RD LAKE OSWEGO, OR 97034 SHERWOOD, OR 97140 Phone #: 503 - 635 -4736 Phone #: 625 -5606 Reg #: LIC 56501 SUP 3051S ELE 3 -257C AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of 5u ervisin Electrician g upervising If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ASSOCIATED PLUMBING CO P O BOX 301362 PORTLAND, OR 97230 Plumbing Signature Form Permit #: MST2003 -00006 Date issued: 2/10/03 Parcel: 1 S134DC -11600 • Site Address: 11450 SW GALLO AVE Subdivision: CASCADIAN PLACE Block: Lot: 005 Jurisdiction: TIG Zoning: R Remarks: N Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: KEYSTONE DEVEOPMENT INC. ASSOCIATED PLUMBING CO PO BOX 476 P O BOX 301362 LAKE OSWEGO, OR 97034 PORTLAND, OR 97230 Phone #: 503 - 635 -4736 Phone #: 331 -0582 Reg #: MET 00001881 LIC 57890 PLM 26 -412PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Authorized Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 ( ';;AAAAAAAAAAAAAAAAA A AAAAAAAAAAAAAAAAAAAAAA 1 AAAAAAAAAAAAAAAAAA rl V 1 00- -I 0> 441 LtA. STREET TREE CERTIFICATION .. .., i .. i 11 . , .. i .. .., I, JA 0 t5 V\ . Pot* „O wner/Agent for K..P2-f Srio Ne_ D V.\61,{) P viel)1 ■Nc.) . o. I (PLEASE PRINT) (PERMIT HOLDER) 0> 1 „. 44 , , 0> 44 , 0> 44 2. 1 / , '4 <,-, 0> I 44 Do hereby?Olfy - i4at 4108116wing location 44 meets gitr county ,a1:4Wn: Os- 1 0 44 44 land use and development standards for street tree installation. 44 0> I 0> 1 0- 1 ( t4 5o ‘A3 G LI ,0 Av 41 ADDRESS: 0 44 kt- 1 S i LOT: SUBDIVISION: (A5C- OtAy4• ri-Ac,r-- 0. A . 0- I , 44 I 61(ii 01 I 3 1 D, 0> DATE: 1 BY: . 0'. 44 y 44 / _....„;,,i 0> 44 RECEIVED BY: - /AIK.4 7 /,, / 0 DATE: 14----e S 1 - I A VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVY v VVFVFYNk. CITY OF TIGARD 24 -Hour BUILDING i - Inspection Line: (503) 639 -4175 MST 3 206 0 a c INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested g / i t AM PM BUP Location 7/ L tSD Suite MEC Contact Person Ph ( ) (03 (r 73i- PLM Contractor Ph (_) S - 7 - -- c / 4 1- - g SWR BUILDING • Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation • Drywall Nailing Firewall Fire Sprinkler Fire Alarm • Susp'd Ceiling Roof Ot a - 1 ,112, PART FAIL • ' : ING ., . Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL . MECHANICAL a' Post & Beam Rough -In Gas Line Smoke Dampers PA PART FAIL LECTRICAL ° . Service Rough -In _ UG /Slab Low Voltage Fire Alarm Anal 0 Reinspection fee of $ required before next inspection. Pay at City Hall 13125 SW Hall Blvd. PASS PART FAIL SITE : ' . ❑ Please call for reinspection RE: I I Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk • .Date F - / `/ ---6' - Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. • PASS PART FAIL CITY OF TIGARD 24 -Hour • BUILDING Inspection Line: (503) 639 -4175 MST 3 —b� , INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received ` ct Date Requested 7-73 AM PM BUP Location [ I SCE Ps-C1-e— Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( -) 3 3 /-06--e .2- SWR BUILDING Tenant/Owner ELC Footing Foundation ELC ess: Ftg Drain - ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing O Insulation / /� a Drywall Nailing (/ C Firewall S1 f Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING' Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: 41111 PART FAIL HANICAL "' s Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for einspection RE: Unable to inspect — no access Fire Supply Line ' � ADA 3 Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour 0 b BUILDING Inspection Line: (503) 639 - 4175 --d °•Piel INSPECTION DIVISION " Business Line: (503) 639 -4171 MST BUP Received J Date Requested P J a �P AM PM BUP ' ( Location I I 5 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) a S 5 06 SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: FtgDrain / 8DX ��/ ELR Crawl Drain L (o Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final r PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin /Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL • Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL / / / d a3 7 Service Rough -In LowSlob (2 ,l� C 1 �j d Low Voltage J L-� 3 3 I) Fire Alarm ART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI Please call for einspect'.n RE: Unable to inspect – no access Fire Supply Line / ADA Date r b 6 I nspe ( �J' ^� }� Ext Approach /Sidewalk -- Other: Final DO NOT REMOVE this inspection record/from the Job site. PASS PART FAIL