Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00063
l DEVELOPMENT SERVICES DATE ISSUED: 3/14/03
..� �i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13612 SW LEAH TERR PARCEL: 2S109BA - 08400
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 010 JURISDICTION: TIG
REMARKS: New SF detached dwelling.
BUILDING
REISSUE: MAS2229 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,371 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 916 sf GARAGE: 451 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 226,652.50
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,287 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 1 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS 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 FDR: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 4 201 - 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 BR CIR: 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: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,317.25
This permit is subject to the regulations contained in the
HEIGHTS CONSTRUCTION HEIGHTS CONSTRUCTION LLC Tigard Municipal Code, State of OR. Specialty Codes and
P.O. BOX 91249 PO BOX 91249 all other applicable laws. All work will be done in
PORTLAND, OR 97291 PORTLAND, OR 97291 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: 503 209 - 1794 Phone: 503 291 - 2550 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 133745 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins l Water Line Insp Plumb Final
Sewer Inspection Underfloor insulation Electrical Service Gas Line Insp Water Service Insp Building Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Appr /Sdwlk Insp
•
Foundation Insp PLM /Underfloor Framing Insp Insulation Insp Electrical Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain Insp Mechanical Final
By : ,/ Permittee Si nature lf r te /P
Issued y 1r��� 9 .
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
'1 b ?t 3- 5 -03 /""/
FOR OFFICE USE ONLY '''.':•:,., Building Per i`hl; �f�
Received n /e jh Permit No.:
: . wldmg /-1 S TO2 t0d 3 'UQt76
Date/B .`' a.3 '1��
City of Tigard FEB 10 2003 Planning Approval Other S 'n n /'!'
Date /B Permit No.: G(.v2c
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date /B : 3-5 „NIA I/ Permit No.:
1 w ;y�p u rHj .4 Post - Review Land Use
Phone: 503-639-4171 F ��d SIO f '11
- 1
Internet: www.ci.tigard.or.us 2^^ Date /B : Case No. Contact El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: En Su Iemental Information
2.4! s' 'S :K TYPE OF WORK ,:; 4.. ....< = REQUIRED DATA
X New construction ❑ Demolition ,: It& 2 FAIVILY p .
❑ Addition/alteration/replacement ❑ Other:
•.,, j :,a ", CATEGORYYOF CONSTRUCTION ; ` ,a; Note: Permit fees* are based on the total value of the work performed. Indicate
P l 1 & 2- Family dwelling ❑ Commercial /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 ❑ Multi- Family Z.30
❑ Master Builder ❑ Other: valuation ) $ . IliPet
if ' '` : JOBTSIPE INFORMATION °and I oCATIO >.:. No of bedrooms: No of baths: Z /Z
; s
Job site address: 13(0 t 2. s • u3. C ti - e4.4/3G£ . Total number of floors
New dwelling area (sq. ft.)
_ Suite #: LBld /Apt. #: Garage /carport area (sq. ft.) 372 --
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.) 3.1
Other structure area (sq. ft.)
�COMM RC L O USE CHE LIST „ ta
Subdivision: (— (, Lot #: $ ,. .... .�. �. .. t ...... #:
l n,t
Tax map /parcel #: oZS70 9 Q ePyr—e) Note: Permit fees* are based on the total value of the work performed. Indicate
W; `
.: "> `l ` =-' 31 8 01 LION OY ;W iltkl y.`; = ; ?`f : ;l ,R, the value (rounded to the nearest dollar) of all equipment, materials, labor,
=a = -�_ � c .� e.,�,,,,a..- = PT ,_,.. . , e �;z.` t=: S:¢a,...a..
/ overhead and profit for the work indicated on this application.
_ NS. LAD _S .'N6i l �[. 1 .4-w1 ijy Ho..1
/ Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
f2 =:P-ROPERTYOWNER k;1 fibENANT . *,, =,a. : '' t ..F Type of construction
e l €16 - r-5 Occupancy group(s): Existing:
Name: ���'s
New:
Address: Po.. 30,r i12` ei
City /State /Zip: `two tr_. - LA-.►i D OR q7 Z q / -
Phone:(5b ) a0 / 714 Fax (so3)2' , - 2 5 NOTICE: All contractors and subcontractors are required to be
„APPL _, ._, t PS`RSON licensed with the Oregon Construction Contractors Board under
ICANT = i,. y _ 7F. ., y ,,,� CON ACT ... provisions of ORS 701 and may be required to be licensed in the •
Business Name: /./ E, i e f ( .577LV ce- jurisdiction where work is being performed. If the applicant is exempt
Contact Name: v - 8 g i /i from licensing, the following reason applies:
Address: ?c, go), 9/2 1
City /State /Zip: R, - v2. '9 7 21/
Phone( So / 7 Fa x tlo 3 ) 29/ 2 5 5 - ,� . , ,. K mtr, -� , ,�,
t = i ; k BUILDING PERMIT'FEES �
E-mail:
r to f
_ �_ . � ����Please ref er ee sch�e
u � e� � „ `
,�?r,� , : y
Business Name: 1. e // ` /r3 Cp v 571'- 8N Fees due upon application $ 02S o {)
•
Address: P,,c,_ i3.a3c 1/2t1 ei
City /State /Zip: g. _;,Qs• CR . 97 2. '1/ Amount received $ .256 ,0-
Phone #' a 09 - / 71't/ Fax: (5 )a5 /- 2 SSS Date received: aP, /O4
j C CB Lic. #: 3 3 -
Authorized
41, / (Y/ /_2 ®� Notice: This permit application expires if a permit is not obtained within
Signature: "Y ” ,g,......_______ __ _ -Date/ - - 180 days it has been accepted as complete.
3 R. I i/',!'/ /v),c/N *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
-
i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03
•
One- and Two- Family Dwelling h
' n Checklist Reference no.:
--,411? Building Permit Apphcatio C ec
Associated permits:
City ofTigard City of Tigard o Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED :FOR. PLAN REVIEW Yes - No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7' Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
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 show lot and building setback dimensions; property corner elevations (if
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 _Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than oae cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
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 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. •
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)
. u Mechanical P .. (Iv' - I) if liation Received
•
. • FOR OFFICE USE l ONLY ....
Mechanica .
■
Date/By: Permit No.: ifST 5
Citrof • Ti Planning Approval Building
gard FEB 1 0 2003
Date/By:
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGAFIL.) Date/By: Permit No.:
Phone: 503-639-4171 FaappigaGla4VISIOA' fit ,, A Post-Date/By: Review Land Use
Internet: www.ci.tigard.or.us L . lj, 11 =0 11 01(1 1 , • .
641
Contact Case No.:
Juris.: El See Page 2 for
24-hour Inspection Request: 503-639-4175 ' ' Name/Method: Supplemental Information.
:iU'WfZ,tiMkit*ictitkkit)f)*0MMtLtgMfrUitfK'Al ..0-ii:g€,O_Ni.gER-00:TEOlsicHlCD,laiEu,s.V0FIEcKtigt4,3240,,
0 New construction El Demolition Mechanical permit fees* are based on the total value of,the work
El Addition/alteration/replacement El Other: performed. Indicate the value (rounded to the nearest dollar) of all
E•7,-,•,:44-112•0,1:4:05MOGOIttOW(ONSTIIVCOON.ffareMettr: mechanical materials, equipment, labor, overhead and profit. •
ri e & 2-Family dwelling lil Commercial/Industrial Value: $ See Page 2 for Fee Schedule
U Accessory Building 0 Multi-Family 'lid13- VSNiSTENISAFEEN:S,,GDED,MEW:
Description Qty Fee(ea.) 1 Total
111 Master Builder 0 Other: - ' .: IICatitiWcooling ". .
':::,11;.;-;g::41610,M,(1"MF:(0044T Furnace - add-on air conditioning** ) 14.00
Job site address: 13C, 12.. 5..--). t—ire/ 7Zpe:49-ef-c, Gas heat pump 14.00
Suite #: Bldg./Apt.#: Duct work I 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
• Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
Flue/vent (for any of above) ) 10.00
Subdivision: Dr{T-„ /4) ti Lot #: / D Repair units 12.15
' . , ..••• ` .,z.•_OtliVi4ifef,Aptiliiitees': : -.;.:, _ ••!-
Tax map/parcel #: Water heater f 10.00
zolitcm,,,,yfo,,.:-:,tw'scatTrosio Gas fireplace i 10.00
OA L ) 6.,4-5 Rp.,>---4.... 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 I 10.00
9 litaffajtMWOWINMZg if3 IIENOltatt,t:notm. Other: 10.00
..!,,, ,.. - •, "- ' .. E`iniii-soliiiiiirit'attiiira
Name: £( C. e.c.i-: -,,,,,. tyv
Range hood/other kitchen equipment I, • 10.00
Address: Ro., .3c,x ,/2'-t 'T Clothes dryer exhaust - - V 10.00
City/State/Zip: R 01 - - . 2- c i 1 Single duct exhaust
Phone(x l p I," Fa AC 5 ) I - 2. S (bathrooms, toilet compartments,
g„:,3kt;,..v.:,,,,,,,,,..t..--eii0Nzcoirtoso-Nwgqw.;: utility rooms) 6.80
Name: F /4,)//„,,,,,,/ Attic/crawl space fans 10.00
Other: ' moo
Address: ;7 0, 13 x7; cii2ci
. — Fitiel:PiDiii, "' 2 .,„'• ":':,;:',.',„.:::::-
City/State/Zip: ?,, i--) pp, 1? et 7 1 **($5.40 for first 4, $1.00 each additional)
I
Phone().707-17 7 1 if Furnace, etc. ** Fax: **
Gas heat pump
E-mail: Wall/suspended/unit heater **
Iirgt."524eiNfttn;•13 :RXe:TOR Water heater I **
Business Name: t in 167-/A&C,5 /nee/i/m/te Fireplace I **
Address: 12 z- // Iva-- (/ Range **
BBQ **
City/State/Zip: / 7e4-Wo c9a. 97z10 Clothes dryer (gas) **
Phone: 5O3 4 6/-6/g3 Fax..5 ‘ 6 / - «3 4'/ Other: • **
CCB Lic. #: 35 9 , .:, . Total: - 4'3
'.medi-dniac,peeniieyee
Authorized ,. ,,, zi % i_if Subtotal: $
Signature: 7R14- , ,‘, - :-.4 , 9••■-noti Date: /- 25- 03
Minimum Permit Fee $72.50 $
Ateli .1 45rna 53A-- — 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 byTri-County Building Industry Service Board.
180 days after it hal been accepted as complete. **Site plan required for exterior A/C units.
i:\Dsts\Permit Fonns\MeePermitApp.doc 01/03 -- - -
Mechanical. Permit Application - City of Tigard .. t•
Page 2 - Supplemental Information • • • .
.,,, . .
, - -
.,, .
. . ..
Commercial Fee Schedule: ,
• , : ..', ,.', .7 . ingifEee..•.-. , ,;., '. •-,,, , ,,,.; ,,,-, ,,:: •
$1.00 to $5,000.00 Minimum fee $72.50
$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 including $10,000.00. „
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00. • .
. . • `',' • -,
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and , • .,...... , .- .., ,T •
$1.45 for each additional $100.00 or
4 .-'. ' .r,':
fraction thereof, to and including
$50,000.00. .. , .
$50,001.00 and up $742.00 for the first $50,000.00 and . .
$1.20 for each additional $100.00 or
fraction thereof.
. „
. ,
..
frfie'd :Valiiafaiii Ii 400: .=•• • ':.:Y: : '-.. • • , .
, .
Value Total
Description: Qty (Ea) Amount .
Furnace to 100,000 BTU, including 955
ducts & vents .
Furnace > 100,000 BTU including ducts 1,170 • ,. .
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445 .
Repair units 805
<3 hp; absorb. unit, 955
to 100k BTU
3-15 hp; absorb. unit, 1,700
101k to 500k BTU .. .
15-30 hp; absorb. unit, 501k to 1 mil. 2,310 .
,
BTU
30-50 hp; absorb. unit, 3,400
1-1.75 mu. BTU
>50 hp; absorb. unit, 5,725 .
>1.75 mil. BTU . , . •
Air handling unit to 10,000 cfm 656
. . .
Air handling unit >10,000 cfm 1,170
Non-portable evaporate cooler 656
Vent fan connected to a single duct 446 , . . . . . .
Vent system not included in appliance 656
permit
H . ood served by mechanical exhaust 656 . • ..
. .
, .
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc. .
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL :';'•'•k '' 4.:." : :- $
VALUATION: '' - ' •-`
. -
. . ,
i:\Dsts\Permit forms\MecPermitAppPg2.doc 01/03 _. .
■
Building Fixtures
Plunthin • Pe _
FOR OFFICE
II ' • I 1 lication Received Plumbing USE ONLY
.
; : . V . Date/By: Permit No.://3 - 6 004,2
C of • Tid Planning Approval
Date/By: Sewer
ity gar
Permit No.:
13125 SW Hall Blvd. FEB 1 0 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fg:TYOQE9 0 h ettif 4 i 3t . Post-Review Land Use
Internet: www.ci.tigard.94M-DING DIVISION, 41;111 Date/By: Case No.:
Contact Juris.: El See Page 2 for
"
24-hour Inspection Request: 503-639-4175 '' --"" Name/Method: Supplemental Information.
' .
. ';',.°ZM'Z;=lMZtrnF2ATYPttDF'NV.ORKCI.;.:;TkZ.,s'Iqt";M.aig ira-PEgtTSOltgfiatAaNeeiAtilfOWki0*1ireA'Rr4ktAVI
,121\lew construction 111 Demolition Description I Qty. I Fee(ea.) I Total
El Addition/alteration/replacement 0 Other: kiIii],A1'6',YAgnisWi'4',:1244:iiii673-0relliiiiiii,NitOMIZP,t
te:'16 iaiii
-NMAktiEgeAVE,GORVCIFICO:NS,TfiRcral(Ke M i
ntti '' '''''''''-' ' ' - ' '
SFR (1) bath 249.20
Z1 & 2-Family dwelling 111 Commercial/Industrial SFR (2) bath 1 350.00
E]Accessory Building DI Multi-Family SFR (3) bath .4gr 399.00
El Master Builder 0 Other: Each additional bath/kitchen -. 2g- 45.00
ZADZ:*00:BISIVIOINFORNATICIStriadYEGOACTIGNU.3140 Fire sprinkler - sq. ft Page 2
Job site address: L 3c,, . ._, 5 „ IA ) . L. 64+4 Te_. . Z3' - Oaf ifillaslISERMSJf alrag: 4
Suite #: 1 Bldg./Apt.#: Catch basin/area drain 16.60
Drywell/leach line/trench drain 16.60
Project Name: Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Alfiso 'Z... Li 1 E. LA) 1.:., LA 1
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) ArVPa.e 2
Subdivision: b,4_.p4 ct ,r t i.__ Lot #: 10 Storm sewer (no. linear ft.) /0) Page 2
Water service (no. linear ft.) /ey, Page 2
Tax map/parcel #: - - iVjF'drkf=N7Wgi,:E:i?'''v,'','',:Wt'fiItrretbT:ItbTffE A:6,? :,:ffiffSMINtoRt
Absorption valve 16.60
- Pi,,, 1,%-)9 Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 1 16.60
Dishwasher 1 16.60
Drinking fountain 16.60
tPlatiMittYrOwoui,::?d I n ITENATOPYAMOCVAR Ejectors/sump 16.60
Name: get 6/47 60,4 7r Expansion tank 16.60
Address: P 2,.„,, 91..,Lic3 Fixture/sewer cap 16.60
City/State/Zip: Pr/JO ex. , 7 01 / Floor drain/floor sink/hub 16.60
Garbage disposal 1 , 16.60
Phone: (503),2o1- ii9 p ti Fax5 ..21/-2.55 Hose bib 16.60
!Ti Cj . 7AN Ice maker 1 16.60
Name: B fa■S H 64,1s:+-J Interceptor/grease trap 16.60
Address: Pa il fti,11 Medical gas - value: $ ' Page 2
Primer 16.60
City/State/Zip: p ex. q-7 2
Roof drain (commercial) 16.60
Phonesol Jo, --/ '7 9i/ Fax( Sbi /Xt. 2 cc Sink/basin/lavatory ;lip 16.60
E-mail: Tub/shower/shower. pan 16.60
Urinal 16.60
Water closet 1 16.60
Business Name: i '', ,,4 5 ?. 6,
Water heater I 16.60
Address: ?-0, Tg, - 1 1(, 0 a Other:
City/State/Zip: 4/01--/4- '6 12._ 54grtDo-1 Other:
Phonec 5 c) - 3) ( L.113 341 Fax: 5 ) ( - % 37_, ENNMatnia:!':EViiiii101raiiitliakatignallIM
Subtotal $
CCB Lie. #: - 7 i 130,D Plumb. Lic.#: 3 1.Z c PD
.4 Minimum Permit Fee $72.50 $
Residential Backflow Minimum Fee $36.25
Signature: 7.. EZ ,14- 7 - 7 .-----r---"bate: / - ?....7- 03 Plan Review (25% of Permit Fee) $
.
Figl le- //Yr State Surcharge (8% of Permit Fee) $
(PI ase 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.
i:\Dsts\Permit Forrns\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard •
• .
• Page 2 - Supplemental Information
- • . • .
•
Fee Schedule: Residential ,Fire, Suppression Systems:
Tsfellitl:I4O Atyp prie:#7.00 i',1! :8444i.i1FAIt0i:, ,• , :4,itinjiilliieT
.„
Footing drain - ls 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
7,Waltiation:ke' ..-.. ;, 4 ,--, z: Jleirinit,-)Fee:1-,e7,4•Aq-- e-,,,
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
,E2itgt.,';ifrktigetqi':,IfOrj'MrR2:aT" .K97:0 , ;:f.„q*og urif4,1q 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 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 $50,000.00 and $1.20 for
. . Subtotal:
, - each additional $100.00 or fraction' therVof.
. .
. ,
"'" • I , • ,
• . •
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*.
"' -'''-'m: . '" 0 :'-'-r‘; KvOliiiril yOlitir48VATeRaifireit'V
ri '•tx,p:-.•..t.•Agi'ig4 -,: ....,,„ , t .b , r e 0 e „, ,.: Comments regarding fixture work
p A,,
,#aSikmei,g•1„; '5, 11.10!..,;:z4 e :', , zWeeiti WOW ei
i;Wr.il -
A'&72*:-',1K. ::tR4:%44;:`ip.i:a4:5V, !:'.',:N6v`..X Move
. ;:a'del IttrEiiitiita Lf:10d . .
. Baptistry/Font . .
Bath .-Tub/Shower . , _ , ‘,.•
-Jacuzzi/Whirlpool .
.
Car Wash -Each Stall .
-Drive Thru --- .
-
Cuspidor/Water Aspirator . .
' • .
Dishwasher -Commercial . . .
• -Domestic , • . % - k ■ •
Drinking Fountain •
Eye Wash . , ,
- •
,
Floor Drain/sink - 2" .
. . . ,
' • ' - •
._..
. ' , , . •
,
Car Wash Drain i , • •
• *Note: If the fixture Work under-ibis pei'Mit results in an
Garbage -Domestic
Disposal -Commercial, ,, . increase of sewer EDUs, a sewer peiiiiieWill be issued and
-Industrial " - fees assessed for the sewer increagelnusi 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 , .
•
-Service .
. . •
Swimming Pool Filter ,, . ■
Washer - Clothes .
Water Extractor • .
Water Closet - Toilet
Urinal •
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
. . .. .
. .
_Electrical a , .. ' . t M .� ' . r . L I :3.. � .
44. r f:.
Ontereccivcd: Permit no' , _4 i ' '
—
, 3414 1 11 . :,;. City of Tigard FEB 10 M3 lsro ppl.n o.: ^ Expire due:
g., Reoei t no.:
Ciro ofriga Address: 13125 5�V Flail Blvd, Tigard, OR 4 Date issued: Sy: p
Phone: (503) 639 -4171 CITY OF TIGARD
Fax: (503) 598 -1960 BUILDING DIVISION Case file na.: Payrrtcmtype:
Land use approval: „
, , TVPL,Q)<' PTi2MIT �< i ,.k... 0f .) .. 'r' ::�
.B & 2 family dwelling, or accessory U Commercial /industrial O Multi - family 0 Tenant improvement
w construction 0 Addition /alteration /repiaeemmm Q Other: ,,,_ O Partial
>n cr+ + . 4 x t
�, �r e r i:l(jj0,1 111.E iNrdRMAT[ohl , �'„ . t ,+ _ , . z - ..
lot' address: t 3 Z S- . . L 8-4,1 g/1✓t.p Bldg. no,: i Suate no,; Tax. map/tax lot/acc0unt no.:
1,01: i U I131ock: 'Subdivision: • w >cy., 111 .
Protect name. ! !Description and location of work on premises: -- ,_,,,,,,,,_
Estimated date of completion/inspection
CONTRA- QR APP i , s ' ,` = ' , , -. t . .. .E.., .. . Y
c .
r�r � ca[lrnutr � t R ...
• N
tee Max ,lab no: _.. _
T USinC.ss name: (} �� R QM. _ • I^� �� - _:, ___ than Qt , err) Total no. Mt!!
F New retidentlal -On& ar molls - funny per
Address: p r dwelling omit. Includes b(MChe+lp?trim.
City: H IL L S 6 D R D State' Q p ZLP: 9 712 3 Servteoinatnrted: I
Phone: 8 4 8 - 514 Fax - 9 2 E-mail: ' non l g. tt.. or 1 CM _ _ a
–• no: 3 Each additional 300 q. ft. or porlian thc:cof f
CCJ3 no,: 3 6 U 5 �F�1c.c. bus. lie. rat 3 q ^. '1 '] 9 I imitcd cnor resident 2 2 R
1, City /metro lie. no.: 1 I • 3 i I_ imilrrJcnergy , non • restdcntia! 2
O r... Y Each tnanufactvrad her r of n:edutr.r ('.welling
S
1 11111
ignvture of st ervisitip *iectrJcistn Ir .rota) Date Service d /nrfcc sr te ttgtl 2
Sa elect. mune ( 9 7 7 S Servie fe r . d tP aR
p p ant )D A V I D A J E R Q M F License nn z eltct"tlinn ar rc�O *tiHR: i
,. ; , _ t i s .t 1'ROPFRT ,O ' '. `w,., 200 amps ortete 1 2
Name rtnt a 20l amp < to 400 am 2
401 amps to de° amps �_
Mailing .Rrl�Ires3; Pte, 6:.;,c, Z-\ _ 6 0 1 amps to 1 000 amps r_ 2 .
City' p�- t- �,4�.t o Stata:Q;? I ZIP: - �I Omr 1000 ampnnrvolts = '
Phon F 5a3 4/ aii; 4 ltcaanncctonl
Owner test - at Jatit?n: The install at.ic�n is being made on pralx;rry I ,awn
Tonipat'nry services or feeders -
Which iS ON intended for sale, lease, rent, Or exchange Recording to installation,attc atInn,arreIOeAtiaa: 2
ORs 447, 451, 479, (10, 70.1. 200 amps or legs 21)1 ships to 400 amI!s _ _ _ 2 __ _
Owner's silrnture Dale: _,. —„•` 401 tp f;00 EMI_
TN(1NI T,R s, � arsine' Orville's - new, aitCrAtit74,
... '' - - - or *)ticnSloa per pAncl:
Name:
A, Fec for branch circuits w'ttt purchase e' i
Address: service ov feeder fcc. each branch c:rciit! ', 7
City St ZIP la. Fee fn- branch circuits w thout purchase
PilanC iA 1" mniJ; otacrv:ce or (cc c (en, firs: branch circuit + I III '2
wttw W
Lich Oddii;ornl I•ranch cirovu:
? fi PLAN R ebetk all tlrtevnp`Iy) " Misc. (Service or feeder root tnc1ttde 1111111
U
Service over 2:a arnps- mrerncreial C1 icalth -care facility Each pump or ler:garnr circle 2
R lighting Istii __ 2 .
Service over 3 Oamps- rating of l,Rc2 4 Haau L ech sign dous location E n or outline R F _
family dwelltop C.J Building Over (0,000 square feet f ou r nr Signal ci(coit4) 4r a l oncrgy panei.
ClSystemn•,er6OCr vol ts nominal more residential units in one s:n :ctcre altcratian,nr �T 2
U Building euce three trories U Feeders, 400 amps or r*n-0 *pc%eriiation, .,,,,,„, __ _— _
U Oecui:ant Inad Ovrr persona ❑ Manufactured structures nr RV park '
Each ariditinnat fnsparlien aver Its* anevv>hte in a ny o f the slime:
Cl EVesSilighfingplan Q Other; - - -- Perin ecticn — -- _I—_:.-1--1. I
£'iabrnit _ sets ofptans esi',h any or Above. InvcsdFulou fcc
L. .. The above are not applicable to temporary construction service. Other V _ _ _
so' Oil uri'' ictinnc acceno CMJ11I anrd•, Pertrttt fee ..... .......... ...... $„,
..�,.."
1 j+lvrre call ,lurtaA:edun ( ne m nrn iofn•++.�+�on�� Notice: '111 i;t permit application
0 V;ss O NInzterCard expires if o permit. is not obtained Plan re"✓icw (at —. `60) -
' Creditcrd nnrtss; _J L__ within 140 days oiler it has been State surcharge (8%) .... $
xpircn aceepted as complete. 'DOTAL $
• me "
m of cardholder ag s nn ore.dit cars '
Cardh,itder ei,gna(arc --- - - - --- ..,`,Ttnnnt 410.461s" (GN( OtA)
•
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 ov
IMPORTANT PERMIT NOTICE 1\R 1 1
DAVID JEROME ELECTRIC ■O11 B \CN
PO BOX 751 i3 U �L �� NG O
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2003 -00063
Date Issued: 3/14/03
Parcel: 2S109BA -08400
Site Address: 13612 SW LEAH TERR
Subdivision: DAFFODIL HILL
Block: Lot: 010
Jurisdiction: TIG
Zoning: R -
Remarks: New SF detached dwelling.
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:
HEIGHTS CONSTRUCTION DAVID JEROME ELECTRIC
P.O. BOX 91249 PO BOX 751
PORTLAND, OR 97291 HILLSBORO, OR 97123
Phone #: 503 - 209 - 1794 Phone #: 648 -5144
Reg #: LIC 36051
SUP 2877S
ELE 34 -119C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X Ae
Signature of Supervising E ectrician
If you have any questions, please call 503.718.2433. _
•
.44 c-77 7
® AAAAAAAAAAAAAAAAAAA AAAAAAA AAA AAAAAAAAAAAAAAAAAAAAAAAA
R
CERTIFICATION
el 10-
411 110.
5 }
® b r / �%
® I, 3g � 7/ /17 , owner /Agent for C <�—
I
(PLEASE PRINT) (PERMIT HOLDER)
® Do hereb f 1 y ' ' the location ,�
4 y� f �ht� ,, ; g ''
I r i1, , .( i
i meets Cagy of Tigard /Washington County
® rqr r �m� ;�C7Wkx.,,w, ., n,�.. , .aF . w^ �s..Gn 'tv �'wc+ua+m�r:r,
1 land use and development standards for street tree installation.
A
A �--
® ADDRESS: ( (c 12 5 �Jt L i<frl Z ef-i?
.41 • LOT: / '' l SUBDIVISION: 14- f- b> Cr /
® BY: Ar. IrAr .r / DATE: G C � /- Or
.34 • RECEIVED BY: DATE:
%yyyyyyyyvyvyyyyyyyyvvvyvvYYvvYvYYYvYvYYvYYv v y ®vim
CITY OF TIGARD 24 -Hour 3-00061_3
BUILDING Inspection Lrnb.: (503) 639 -4175 MST �
INSPECTION DIVISION ' Business Li (503) 639 -4171
BUP
Received Date Requested A — — AM PM BUP •
Location / 3 e / :Z- Suite MEC
Contact Person Ph ( ) 0207 / �' PLM
Contract Ph ( ) SWR
UIL Tenant/Owner ELC
Footing ELC
Foundation Access: pr
D
Ftg rain G /� l / ELR
Crawl Drain v ,
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
* inal r
4 ,; 6 6,1310._ ' FAIL •
osrrS - earn
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot
in
AS phly3T FAIL
HAAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
ke
PART FAIL
ELECTRICAL
Service
Rough -In
ge
Fir arm •
111
ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS FAIL
SIT ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA 07 L/
Approach /Sidewalk Date Inspector C( Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL