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Permit 410 CITY OF TIGARD MASTER PERMIT i D EV ELOPMENT SERVICES DAT ISSU 9/16/03 003-00374 /16/0003 00374 ;6 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13165 SW HOODVISTA LN PARCEL: 2S109AB -10000 SUBDIVISION: RAVEN RIDGE ZONING: R -7 BLOCK: LOT: 029 JURISDICTION: TIG REMARKS: New SF detached, Path 1. BUILDING REISSUE: SSN3142 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,630 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,512 sf GARAGE: 697 sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5 VALUE: 309,415.90 OCCUPANCY GRP: R3 BDRM: 3 BATH: 4 TOTAL: 3,142 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 4 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: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BRCIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,239.91 This permit is subject to the regulations contained in the PEVZNER CONSTRUCTION PEVZNER CONSTRUCTION LLC Tigard Municipal Code, State of OR. Specialty Codes and 13470 SW TAPADERA ST 13470 SW TAPADERA ST. all other applicable laws. All work will be done in BEAVERTON, OR 97223 BEAVERTON, OR 97008 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 - 888 - 6405 Phone: 503 313 - 2466 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 -001 -0080. You Reg #: LIC 148853 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp B' Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Gyp Board Insp Sprinkler Rough -In Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Sprinkler Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Appr /Sdwlk Insp Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Ele,r Final / � Issued By : : Permittee Signature : ∎ r./ / Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the,/x business day Buildin I P t, O i' YA M+ do n . . , . FOR OFFICE USE ONLY . Received - +� Building 2 / Date/By: /l �� U3 Permit No.: l l /p 3 QS J 7z City of Tigard 2 Planning Approval Other q^ 2003 Date/By: Permit No.: o/.oK- 3 — Ca y ! 13 SW Hall Blvd. " JU L R p Plan Review Other N o Tigard, Oregon 97223 G�TY O F TIG ' 1ON Date/By: B 7 �' —/ - U 3` , Permit No.: N Phone: 503 - 639 4171 ��10 /' Il�i��N���. '1I Post- Review Date /By: Land Use 1 Q Case No. Internet: www.ci.tigard.or.us ^ -^ °' Contact __4 dns. ®See Page 2 for p 24 -hour Inspection Request: 503- 639 -4175 Name /Method: / /Co Supplemental Information A r ;'��+- -- '. -:�. t`� ern �- a ? ,? n�°.. . *�," ��ti „'- -;'' *�� .",��; «s.;,a =�:- ;t. „,• t,:,:. -�, I.e e; 1;;; �r:` .P ” - ..,TYPE OF WORK . .i.:' �.°:'� .. _ .... :`. f A ° : �� ���A � '� � �, � � ` R EQUIR ED D,,,..,,,,,,,d,, TA �� �' � ,1; r ,,,= ,; New construction El Demolition i & 2 FAM ; VLLING t .I Addition/alteration/replacement ID Other: ' , "; `: ,: , `� CATEGORYOF CONSTRUCTION T;. ` Note: Permit fees* are based on the total value of the work performed. Indicate 1 & 2- Family dwelling 111 Co Miam al Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Accessory Building CI Multi- Family III Other: Valuation /2 .�G y , ❑ Master Builder v 3 p � $ L/( y - r . No. of bedrooms: 3 No. o baths: Z :, �,., JOB�SIT; �II �IFt I Rtur. . A�! rrnrAx�r ;�� . .� Job site a dres : i1 1 .5, 614) f�kxa7J. ' '3— Total number of floors ............ New dwelling area (sq. ft.) 3 % �1 Z Suite #: vQj Z , )� Garage /carport area (sq. ft.) . _ 4 cf 7 Project Name: Covered porch area (sq. ft.) ,�22 Cross street/Directions t: j b site Deck area (sq. ft.) -F- J 3 0 C O n W /'[ / 1 � ^ , t, / / 3 2 7-P� Other structure area (sq. ft.) Ofrv,9/( 1 fl.- 0,9 / W (/ ( S'k 6 I'9 at e - ` ` `,f q . ' REQUIRE DAT �- ri . . . . ... :, „. C,,a"....' . � , a te - m,,, _ Ri a^ f COMMERCIA i1SE CHECKIIIST , . ��� Subdivision: 44- V r -t v � 1 Lot #: 2 } Tax map /parcel #: G2 //'�1 . ID�1 3L7Note: Permit fees* are based on the total value of the work performed. Indicate ;cg ' the value (rounded to the nearest dollar) of all equipment, � .. . � >� :; DESCRIPT�ION WO ..�: �. . ,.� ,���. ( ) materials, labor, q p overhead and profit for the work indicated on this application. Valuation S Existing building area (sq. ft.) New building area (sq. ft.) ' Number of stories ia tit PROPS T Y OWNER $ ' ;: I,TENANT : ;,:t ' ,u'.. ; ='i`°' Type of construction ame: /",�' V ,-ti E S ✓ Occupancy group(s): Existing: �` New: Address: 714 7O .S lt/ f+ l � �/ � City /State / I �4t , 0 q 7 R Ai P, 6 "'Fax ,53 : "O 3 Ef NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under %APPLI NT ,_;' , . , ;�' CONTACT �PERS,ON ;' provisions of ORS 701 and may be required to be licensed in the B usiness Name: _? � t/Ej2 C0�$" jurisdiction where work is being performed. If the applicant is exempt Contact Name: E' L./ 4 4 o f • p E ki-/ � from licensing, the following reason applies: Address: / 3 2 O S / S9 �/ e.r�e . City /State /Zip: Ti • '- (Q le 9 TZ 2 , Phone• -• ' ax: 3- 5 )' 4- O „ 3� , m , tLitaltl , v , � � � BUILDING PERM FEES -maild/ /20 PEG� 6(It �i�'Ef� �' / Ot /1-+Y ! I ' G� ' please�refer to ° ule "..� r�..����,,...a �CQNtTRt1CT�OR� °...� .:,.: a .� � ��° � . �E "� .... , o Business Name: PE V�-/V E r2 t..•i'"��✓ S � 'P'rses due upon application $ Address: j 3 117 s lc 0 / I719�} j 2,4 j 2 S Cit /State /Zip: )3.676t v-e42_ J`U/(/, 0/2. 9706 ' Amount received $ Phone: 0 - 7 03 62 Fax: P — ' 7g a. Date received: CCB Lic. #: Lag Authorized f 2 O 3 Notice: This permit application expires if a permit is not obtained within Signature: y �� Date: D ( 180 days after it has been accepted as complete. �� !2 Fo( i *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms \BldgPermitApp.doc 01/03 • • t One- a Two - Family Dwelling ' "' r �. :. - . • 1 > ►�: i Buildin PermitA hst , Reference°°.: . ta� �.. g PPlication`Check • City of Tigard Associated permits: " C lty of Tlgard- . -. - .. 'o Electrical ❑ Plumbing ❑ Mechanical Address: 1312,5'"§ Blvd, Tigard, OR97223 O Other: Phone: (503) 639 -4171 = . Fax: (503) 59,8 =1960 • .. a. ` ' : ' ` THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction crit for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismiesoils designation, historic district, etc,. 3 Verification of approved plat/lot. - - V 4 Fire district approval required. . 5 Septic system permit or authorization for remodel. Ezis ing system capacity . 6 Sewer permit. 17--'.3 1/ • 7 Water district approval. S V 8 Soils'report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control 11 plans ❑permit required. Include drainage -way protection, silt fence design and location of . V . catch -basin protection, •ete. ' F a>y ' . ' . - . " ', '0 . 10 3 `Complete sets Of regible plans. Must be drawn to scale, showing conformance to applicable local:and state _ s' w .� 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. . 11 Site/plot plan drawn to scale. The plan must'sliow'1ot and building setback dimensions; property"corner elevations (if t ��� there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and v/ ' 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 and location. - - v 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 constriction, thermal insulation, etc. '. ' • 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. 1i r " Exterior elevations must reflect the actual grade if the change in grade`iisgreater 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 details and locations;for V non - prescriptive path analysis provide specifications and calculations to engineering standards. ' ; - 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating membersizing, spacing, and bearing _ �. • locations. Show attic ventilation. • - , V p 18 Basement and retaining walls. Provide cross sections and details showing-.placement of rebar. For, engineered V* .... systems, see item 22, "Engineer's calculations." •• • , . -- -, - 1 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: ' '` '4 _ t.; 't"`54% , . • ' , . . , i 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• architect licensed in Oregon 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 x.17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. ' S " . 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6 /00 /COM) • Ju1 17 03 11:23p Viktor Dratkov 5036907923 p.1 FROM : EDUNPD FAX ND. : 5.03590 Jul - 16 2003 04: 28P11 PI - Mechanical PIE& 11 ., E0:x.u1 l IC k P ar.o`L1 k eccieed Mechentcai u City JUL 2 2 2003 Delo/Hy: Pennit No, 1 03 00 CI of Tigard k I YlennrngApo:vdel _.. AuilGing 13125 SW Han Blvd. LDatejb_ -- - GtbcrtNo.. Oregon Tigard, Oren 97223 CITY OF TIGARD X. ) Plait Retcw ( Dalefdt': pemit 1 Phone: 503-63Y-41"n 1 DUI ®I I Ha' I V 1St Poe:- Krvica' Land Use Internet: www•.ci.ti ard.or.us F r ` � 1 , Dtte tly: Case No.: mi . Contac 34- hour lnsprction Request 503 -6.9 -4175 s r? >t, _( fuia -: j ® :a ra;o2 tor t N amel h deUpG: 1 Sorplemental Infomtction. TYPEOF•WORK : : :',... Y 1, : - : - :.iC.t)M efE Ire :,*L FEE! :SEH�EA1;.LlE" r�FS,: ( eNfi7iSTc s: , ' -77. . New construction Demolition � permit fees* are bus :d on the total value or the work Addition /alteration /replacement 0 Other: performed. lndis.atc the value (rounded to the nearest dollar) of all . , •,.," AXEC.t3ilY...QF :COsucC:Tft7N'; ... :• ::ii nea han cal materials, equipment, Tatar, overhead and profit 1 & 2-Family dwelling Coratrser�ia /Industxlal Value: $ See Page 2 for Fee Schedule Accessory Building _ [ Multi- Falnil L'''' _ . ,5 . ,',' ► : ' ;'• Description a ' Ee . es. 'Fetal Master Builder >r oiler: : Haiti Coon,'•: _ ?L?RM49IIOtPdan ti " ;•,; T LFurr�ce • add -on aircond :rionira 14.00 Job site a.dr_ ss :• /i l(,5 , Si,9-L� Gas heat .urn - i 4.00 Suite #: .i, i- 6 .1.r >: • - ✓ . Eruct work Itl♦ 1 4-10 Project Name:; 1 H . oaic hot water system MI 14,00 eatlDirectio2l5 t0 ]D site: I I E ecu ; ��QQQQ ) fot ra III 6yl . � ®�a / � ! /`1- lJ A w e r� mail lt nets s us. ,ded . ; 4.0 -- 4wa � tai/ s / ' yv ' {i, wall, inwduet, s ,dad (1 Fludvent for any of above) • 10.00 1 I � � ��� i i It .air alone 12 Subdivision: ' fir' its Lot #: . / � ,la .. dhtieriPil:d" ', >a •,. ; ;.` . ,` r '. 0A- 7 T1 tctlic 10.00 : ,4 ''' . R" 0 :OFWOR) . .. ...,t', " r xsfirt 1uce 10.00 MEI Flue vrayt water he tcr t.- s 0 • lace) 10.00 ---- - - - -_. - • - -- — "— I Log liglrte: (lords) 111111 10.00 E - --- Wood/Pellet stove 10.00 Wood faeplae fw crt I 10.00 Chimae ninetiflueivent 10.00 tiF .tee :. 'o r 'E$L :, : :to B`1 Pint•'!`?.' : Other 10.00 Name: �,� V �-N fti CK11t �� � .•, 'gnvi Exiiart S ViiitTIS ..,� ,XY., „i"; :.... . Address: l . , 7 n 4 Range hard/0t eeskitchen equipment i 10.00 `�r t% Clothes dryer exhaust 10 -00 CI . ty 1- /State /Zi.: i/-e4 - •• t , a40 /i single . uct exhaust � Phone: 1P .3— , •/ + ? ax: 3o3 —E O 3 2 (batiteoonS, toiler compartments, I Si '4I$i[ d :. :d,r, = :,. :r ' o'riq C:11.4 I(561 : :: ` unlit room s 6 so Name: ° `I " " 0 2 CC/t S f Att a /crawl .. fun 10.00 Address: '7p ' / . 7 ri2 A' ► otrtx ; ::,..,:;:.1',, .. Yue1.Plpiag 10 MEM 00 City/State/Zip: y e • • o� ! ,l ¢ a o, -- °•(33.40 For Trim 4 31.00 each additional Phone: D '- ; A A - 6� •, Eax: S 7 B 03 2 Gas h eat m E-mail: Wall/suspended/unit heater IIIIII 'r;c,y' a : +a Z•.'f,:.,!; :; -._ .c. .Cl?NTRACTOYt: •i !' S.... ° Web:theater Business Name: . <� a . ar. ,. a . , V Fireplace • Address: . z ;r' Avg Rae- J" Ea. Ci /State t!• V Q. 0. /D'" Clothes dryer (gas) i1i� Phone: 0'0 . -3 /9 Fax: 6 `t fail other: � - I CCB Lie. #: lsso 12 o. Total: Authored - .- .Vieshaaical'PvmitiCce Si tature: �/ �.. It . Dare: )'417'03 Subtotal: S Minimum Permit Fee $72.50 V i k /Oat /312 #41T3(.a✓ _ Plan Reeicw Fee (25%of Permit Fee (PSe print n) State Surcharge (0% of Permit Feed ente TOTAL PrAtipity FEE Al.tiee: Tills permit eppleaoan sepires if a permit is oot obtained with[, 'Fax methodology set by Tri.Conaty Banding la4uetry Ser eitc Board. 1110 days after it has assn accepted as caeaplets '''Site pleb na.mire4 for pattxior : waits. i:tOrtaPey trit FerensWedYemitApp.dre 01/13 • • Plumbing Permii tp A Received FOR OFFICE USE ONLY Plumbing , . Date /By: PermitNo.: fl eJfo4G�D3 7 '3'7 City of Tigard JUL 22 2003 Planning Approval Sewer Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 CITY OF TIGA ' 0 Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 5O6 DIV -ti Q Post Review Land Use l iiu / 4 1 s Date /By: Case No.: Internet: www.ci.tigard.or.us c' A II Contact , J� 5 i ® See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 Name /Method: 1 An Supplemental Information. " ? ;. r TYPE OF. WOIM R6 ; K; � FEE* SCHEDULE(for special checklist) '3 Description Qty. Fee(ea) Total New construction ❑ Demolition P Addition/alteration/replacement ❑Other. ` ( in fly y tl igs , yir �P New ltl 2 dw • � ,, n:CATEGQRY QF C(3NSTRUC , , ' A clud0110 . for,ea obit . 3 connection), ; ; ,:, SFR (1) bath 249.20 i ■ ∎ 1 & 2 -Famil dwellin • ❑ Commercial/Industrial SFR (2) bath 350.00 • Accessory Building ❑ Multi- Family SFR (3) bath 3 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 4 IOB SITE INFOR401- N n471 OCATIQN j ;, Fire sprinkler - sq. ft.: Page 2 Job site address: ax /65 ,v'O ,4 xc� ✓�''i i L.. n << . ., S>te ti ilii es; . ;.iff _ , , .. ". . Suite #: I/y0" ' 2' • Catch basin/area drain 16.60 Project Name: / line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions t b site: t"� Manufactured home utilities 110.00 CO4Q.rL _- rij , 32� � ��� Manholes 16.60 �°�B'( S , / ) A Acz o �� � ` _ r f 44-,,,,.. Rain drain connector 16.60 (�✓ !�( `�I /t/ 7 s n U` _ / Q Sanitary sewer (no. linear ft.) Page 2 Subdivision: RA ✓ V1 I2 r d f Lot #: 49? �t Storm sewer (no. linear ft.) Page 2 Tax map/parcel #: /I x ii'/ �C.9 Water service (no lin ft.) � Pag 2 e e Page - „ E rkifitoratem �, ....:; it DESCRIPT1®N,OFEWOR a'. °. o , . t. , . Y` _ ° . � �_" _ _r .� . - � Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ''ROPER �, .- 1EN AIV;Iii . , ; Ejectors /sump 16.60 Name: °' (r2Z/l/E �L I r .4071--1 Expansion tank 16.60 Address: /3 t-/ ? O w 4 Fixture /sewer cap 16.60 - City /State /Zip: � o,P ( Floor drain /floor sink/hub 16.60 Garbage disposal 16.60 Phone: S 3 i g -(403-Fax: 579-036-2- Hose bib 16.60 g Ell APPLIC-" T , : gCONTACTPERSON ,`irx Ice maker 16.60 Name: f " T 1/271-- i' / / S irt'�- e �� Interceptor /grease trap 16.60 Address: /2 Sri/ 9- ,1E fl V, Medical gas - value: $ Page 2 Cit City/State/Zip: °X 9-7a-"De � Primer 16.60 5' p ��� ) Roof drain (commercial) 16.60 Phone: ''� - i4111 - Fax: 5 N- r2 Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 aN Mi : W ONTMOT:0 X g t;sw Urinal 16.60 Business Name: .� ,e _g t� (, �, op2._ Water closet 16.60 Water heater 16.60 Address: / 3 3-e7 ,-44/ ,6 ri Oc cP .` iW Cl� Other: City /State /Zip: v F /Z o 57c- 0 7- Other: Phone {5 QZ) G Y4' -g3 � r Fax: .u%__ /3 3.\ Subtotal $ CCB Lic. #: . � Plumb. Lic. #:, � � � Minimum Permit Fee $72.50 $ Authorized �E' / Residential Backflow Minimum Fee $36.25 Signature: c Date: 0 _ 3 Plan Review (25% of Permit Fee) $ � R NIP State Surcharge (8% of Permit Fee) $ (Please print 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. is \Dsts\Permit Forms\PlmPermitApp.doc 01/03 . . Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee, Schedule: • Residential Fire Suppression Systems: WigAttfiOi ';`10100 BITOVN ;_.$iiiiii-iFo,otage:-' Permit e. . •;.- : .,,, Footing drain - l' 100' 55.00 0 to 2,000 $115.00 •i , 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 N - '. . , n'tliiit'F,O;)„•t.',.`,:.,:?, .:it 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 000. . 9 r004).111 additional $100.00 or fraction thereof, to and ri: .. E0: . . 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. ' s 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, ''• _ - • $742.00fonthefirst450,000.00 and $1.20 for Subtotal: each additional.00 or fraction thereof. . . . ,.. - ., .„.., , . .. - ..- . , . - . ' • : •,), . ,, , t . • • ,, .. . ' Fixture Work: -' . • • , ., . I ' • . • 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*. jigliiIiiiiiyby(Ffilier:0):Wiiiiii`ipiitaiiiaiIi: Comments regarding fixture work: :•F•i'ih'iii:e*jig'=;,*•fL'i4., LT ik4veati41.1 -:7;_itifilicex ksW%,' mainiggi!f 1..A:.ioa , :4i 4citrifira 'W4061 . .._ • . Baptistry/Font - Bath Tub/Shower , • • , . -Jacuzzi/Whirlpool Car Wash -Each Stall ; ' ' - . -Drive Thru - • .k . Cuspidor/Water Aspirator - . • , . Dishwasher 7Commercial ■ I •• • -Domestic , . , • „, . - . : Drinking Fountain - . ; ' - Eye Wash ' . . . ' • Floor Drain/sink - 2" • , . • •. • , , - 4" - • „ ,. . • 0 ., • . Car Wash•Drain . , - . *No k te: If the , e fixture work under this Permit results in an Garbage -Domestic , Disposal -Commercial - '' •. increase of sewer EDUs, a sewer permit it will be issued and -Industrial . fees assessed 'for the sewer increase must be paid before the . Ice Mach./Refrig. Drains . plumbing permit can be issued. • Oil Separator (Gas Station) - . • , Rec. Vehicle Dump Station ' • . . ' , - Shower -Gang , . • , . -Stall • . , ' • . • Sink -Bar/Lavatory . . • . • ,,,, • . , . -Bradley , • . ' . . ., '-Commercial • 0 • - . . • . . . -Service . • . . , . . • .: . , Swimming Pool Filter , , . • Washer - Clothes • - , ' - Water Extractor ;- . . . - • • . . Water Closet - Toilet • : . • Urinal ' . 0 ,0. • , • Other Fixtures: ,. •.. . • . . • ) ' • . . . ' • • . • i: \ Dsts \Permit Forms \P1mPermitAppPg2.doc 01/03 • • FROM : ®URRD FAX NO. : 5035907916 Jul. 17 2003 07 :59RM P1 Electrical `r .. ` F(aTt)f I L UtiL:fUtiL , : ;.,, 'r i r . �l�B.�II icaJ �-�� 1 , A �� Received s I( aleetric21 N JUL 2 2 2003 [ >arel8r. _ Pernik NO,' llh i0 /� 371 Ci O T1 �C(� C� D ann 'Approval Siam pate Perrntt No.: 13125 SW Hall Blvd. - Fl.n Rav:Qa Other • Tigard. Oregon 972 tt��CC� � ITYY ti O F T I G D Datelkiv. Penn.: No.: Abode: 503-639-4 l 71 t�l rB�1LRJ 8c1lY0t$IO Post- Review rand Use '. �, iMte/$x:� Oise No.. Internet: www.oi,ttg2rd.or.ua n 1 ^, Cunt2ef !el.: El Soo rage 2 far — 24Request: hour Inspection Re 503.639.4175 -'' Nante/mothed: S>en„pt_ •, . : :wr..::: , q , ' ;' �: OF ;" ..,;,.,.., . -_ . ; °���� 4 � :VI'fD6t.K ,_ . . 7 , °;:., a> .: , �REVI!�'4!?''it�sso •"icsiiCrc ;�' ' , New o n5h iaetiOre ,� Demolition ❑ Sdrvisr Owe 225 amps- Iii Rtralth -care reoill y coramar�;al ❑ Iioaz�rdous lastioi ,4dclit of I iecrarrQII/r � Iacemcnt Other: 0 getviad over 320 amps - rating of' 0 Ruiid3hg over WC,000 tqt arc feat, , ^ . 1 . .., ' four or more retidooti'a1 liniti in :f 1 " & r " �� F (1 l r11 5 ' I C.r, rurneercaUlndustr!al I & 2 family dwelling; i � Yip ©SySIEm] over 4 trolls nominal one 5til7FttJfC Buildintt o4or thrm storief a Pecdcrs, 400 amid: Dr mar, e" ❑ Accessory Building 1* Multi - Family Ocevpant load over 99 persons ❑ Mat a esttOCE Qeseurot or RV park Master Builder 0 Other: Egrosilitghti p 0 Other: , ....... � ... .. pn a of plans with lily of the above '� ; yr Kt „4j'. f3'1'}ar(1•'1'd .e.v8 a:YSf'f �t+Tal`tA1:: ;• ., optZ set • /J /`_ `` �� /� The above are not a • cable to in rar con freedom comic _ L _a /,o'J L v rrr -G� I �7 Ti/ 'r � - 1+” i .:. ri t ; till �t, r � , j L, "'� ao ;.:I. .Ib�l Site YW � � SS: • ^i i . � �. ` : K I l eLt L � ' 4• Suite : �' I a _ — Number of - K' . ermit alloy Project / Deacri. 'on Qta acznammmIs Cross gtreetiDirections to job site: ,---., New r ;,� < , single or ettiuld- famei?y per ,, L /� i dwrilteg min. beriudea methodEm aga 1 Co— Co -e-1 e� L J 2 )v ) it Service incinded: I 1000 s .. Pt '3' less 145,15 A-1 4.) Q.a . % S ' /9 N r arwe raridittonal • r tt. o • Wien ri - 11101 33.40 _p J. imtted s4trtl t :r T�7/. 755.00 �© Subdivision: 3" Lei #: �; Lyn' en• _, etwesrt etu;al 75 MI Tax 1 rim eel #: a h rnim toontred home ur tnmdutn.r eaelt�gr r ,.i: u 1Dl ?k r?. ` ;�� ry- }w�...�. • i� Bac axvat ar�ar row- 90.90 MEM i, ^'� arA11 . a '6 6 i; O \, i; "t. :. ,.1 S' Serv(cnaOr dery - installation, 1 atteratida or ral0Lctient i 200 am •• Cr ier8 8A.30 2 — - 201 arn.a to 440 .•, IIIIII 106.55 - I ;cS'i" cwt; ' g'�`P ` 2 2 4014m. to •a 1•' 'w° km', • Or v Address: I a'✓ ' ? I /• f.! GIF:a/S% Tampa—an tatvicat or Seeders - iastaAaticn, I _ alteration. or reiocstionr C. /State) .': ! i i - , K% - e . . i 7 11' Dam -.. or leas 56,85 1 i 201arn•sw400atrt• ]00.30 Phone 37)3 '' , 4 0 ' 'F ax: . c7 g -a3 c 4 �oa —__�.. 133,75 gilt n S t9tt'� ._. '.-1�- sR C$�NTAa °T. PERSO� f ` Branch tweak: - new, .hera4loa, os 1 Name: J'Yf • ._ ' _ ' t />•J�A' siunp erpa nel; I Address: • 0 Brief 4 Y ' ' / { Fee for branch airold*a wall p add!' of pert•iccar Lhreacheitoalt 4.65 2 CI /State/Zi ,�a� -- f� - �. Q / M 0�., ` ¢e tar mene cr ews witheuraurebate nr �f I��.iZY.lrS! F service or f ine d 4� „te si fl J I< 1r +utchc�ccuh - --- -_ 46 iiill Phone: , , /_ 0 Pa ck additional branch tired � E-mail: mnail mid Service or fe de not � l =r ter . ' ' ., Whit *'4C 'C OR ,i_If.ir?i�: 0 • * ^ _ . .. ,. .... ,E. , . E ?dr.''' OruY' i m 53.49 _ r01? NO: s Signal c ircwA(s) or a limited ornut[ :glaring t 53.40 vamp vamp L`ann1, Bushier': NaTne: . o r2 6-04/// G7 � raton. w extension �� Address: c� • i (E A . �+ Z' f 111 , Ci iSt i s : ._ , Ir t or4 ©R - Each odd itt00 ln npcttian over the elloWabk in a, of the above: Phone: lac! 6 y •• 7 Fax: y 3ci — 67 6 s lreestiption fix: _ ... = =- CO3 Lic. #: 1{97 7 Lie. #: 3 ., !O Other. r ,:,: 1" s .: :; Supervising electrician ' +/ Submrai $ sib Curt -suited: � . -. .i # A "i Not Rcvicw (25% of Pena& Fee $ Print Name: A .� r H it _ ' • 4 r ( S ltt.re 5trtcharg (8% of i'trmit Free S TOTAL F Fi€$ S Authorized �, otter: Thii permit application . -, - .- 1 a -, Ulm*. • trained with la Signature: .,, I 4411, Date: 1/ 2� /� 80 days atter k has been accepted as complete. ' • Fee methodology leo by Trti.Caneity Banding 1 ditetty Service Board- - r ------' (Please print narne) i Vitt\ Pemeit rnrtrtt+EThPereturapp.doc 01/03 IC 3EVd NIAG09 i3or 5E0t 90 :60 Z00Z /90 /E0 LAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA T EE CE STREET TIFICATION R R i :.. i ,,, .. i , , „ ... I qa. Pe_,va.,?1 O wner /A ent for PflP C'4 i„u- 0. (.ASE PRINT) (PERMIT HOLDER) Do hereb certify thttkefollowin location ® meets City ' of;Ti ar-d /Washiri on 'County ® land use and development standards for street tree installation. ADDRESS: , / �Ss / < 4 -la -e � O � rt D i i -44 ,e 0- • LOT: �_ J SUBD IVISION: y • BY: � DATE: 0 1 /2_772 -040 • RECEIVED BY: _�,� _ DATE: /Y-04 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 v ®® 7 . INSPECTION DIVISION ' '� Business Line: (503) 639 -4171 -- -, Received Da a Requested �°'f" ® PM • - — BUP Location t �\ ( Q S LP Suite MEC Contact Person Ph ( ) 1 -1-`11 ( L PLM Contractor Ph ( ) # SWR 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 04 - it = • . - Susp'd i %eiling Roof Oth - t PART FAIL P ""' BING il.si, Post & Beam Under Slab ./ _ � , ` ► Rough -In '' Water Service Sanitary Sewer Rain Drains is . Catch Basin / Manhole Storm Drain Shower Pan =? Other: Final PASS P RT FAIL _ ' ''`- M C L f Post & Beam Rough -In Gas Line S • _- tampers J ' PART FAIL TRICAL , Service Rough -In UG /Slab Low Voltage Fire Alarm Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE n Please call for reinspection RE: n Unable to inspect — no access Fire ADA V 27("O - / 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 BUILDING Inspection Line: x(503) 639 -4175 MST o3- ( INSPECTION DIVISION ., C Business Line: (503) 639 -4171 BUP Received , Date RequestedL\'\\ y AM PM BUP Location ' 3 1 \.D \/1 Suite �7 MEC Contact Person CPh (S 1 r 7 L2 �.-, ( !� ci !, PLM Contractor Ph (. ) f',, Cp. SWR BUILDING Tenant/Owner ELC Footing ELC Foundation 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 j„1 0 41. 0 . Susp'd Ceiling Roof Other: Final t $ `J Jv � h 1 'h + ►'� L),-- POa el PASS PART FAIL ,� 1 PLUMBING 8 ` P : : (- 1 �r LI" 1�1 fel • a.) 4 )f , ,th.4), Post & Beam \ ` .1 . D Q IA Wit) 9 it) Under Slab l�I J �'J "1� f J Rough -In " `1 �� Water Service RS-lib `' A '4-� �� % J)` Sanitary Sewer Rain Drains Catch Basin / Manhole 0 Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL CILECTIAIC Service Rough -In UG /Slab Low Voltage Fire Alarm ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date .4/' / a Inspe ©� ✓�.� �J Ext - Other: Final DO NOT REMOVE this inspection record fro the Jo site. - PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line:.(503) 639 -4175 3-- v 37 4-/- INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested Lf — 1 AM PM BUP Location / 31 r� �' ie '-��J �t Suite MEC Contact Person 400 #J 4 Ph ( ) 3�,3 y6 PLM Contractor Ph ( ) 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 ,1 ��l 0, Lot, r gi p,- v� `"i��`�G �, -�_� I ta. Insulation Drywall Nailing Firewall iZt." t .,v, „, i.-� ,. i, i .i-- -. j 0-101,1 .s AAP. � ,.) t ? T Fire Sprinkler Fire Alarm Lk if A-'t' 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: inaT' A PART FAIL MECHANICAL 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 reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date di 1 ak Inspector' R k.,,Ga i t l y a Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL