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Permit J, 1• CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00364 �i�l DEVELOPMENT SERVICES DATE ISSUED: 12/11/03 R--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13991 SW RIDGEFIELD LN PARCEL: 2S104DD -09700 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 039 JURISDICTION: TIG REMARKS: New SF detached, Path 1. BUILDING REISSUE: MAS2146K STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 730 sf BASEMENT: 730 sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 920 sf GARAGE: 400 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. 923 sf RIGHT: 5 VALUE: 250 OCCUPANCY GRP: R3 BDRM: 5 BATH: 4 TOTAL: 2,573 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: BOIL/CMP < 3HP: VENT FANS: 4 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 FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'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: $ 7,921.86 This permit is subject to the regulations contained in the PAUL R CARNEY PAUL R CARNEY INC PAUL R CARNEY AVE PAUL R CARNEY AVENUE Tigard Municipal Code, State of OR. Specialty Codes and 1480 PORTLAND, OR 97223 PORTLAND, OR 97229 all other applicable laws. All work will be done i accordance with approved 'This ed plans. is 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: 503 939 - 7285 Phone: 503 297 - 9406 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 56852 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp 8 Wtr Proofing Bsm't Wa Footing /Foundation Do Electrical Service Low Voltage Storm drain lnsp Sewer Inspection Post/Beam Structural PLM /Underfloor Electrical Rough In Gas Line lnsp Water Line lnsp Footing lnsp Post/Beam Mechanical Ftng Drain Bsm't Walls Framing Insp Gas Fireplace Water Service lnsp Foundation Insp Underfloor insulation Mechanical lnsp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Slab Insp Crawl Drain /Backwater Plumb Top Out Exterior Sheathing InsF Rain drain lnsp Electrical Final , .-'-' A .---------- Issu By : 7.'i I , / ., �( � Permittee Signature : Call (50 639 -4175 by 7:00 p.m. for an inspection needed the next business day 07/14/2003 17:01 FAX 5035981960 CITY OF TIGARD 11002 . v . T • - 5 - O 'er Fl)R OFFICE LSE O�LI' Buildi Per A lication Received / P� -oo3 Date/By �, °3 Permit No.: _ Plarming.Approval Other 3^DDo? City of Tigard RECEIVE . ri . panning Permit No.: � r�Rao� K, 13125 SW Hall Blvd. Plan Review Other DateBy : � _ / �� • U 3 , Per No.: Tigard, Oregon -4171 I I I I 1 Post Reviow Land Use Phone: 503 -639 -4171 Fax 503- 998 -19'6 � � %r 15, ,.��� ��p C ase No. Q Internet www- ci.tigard.or_us � Contact puns.: S ce Page 2 for [ " TI n Name/Method: _ Supplemental Information �!" 24hourpnspectionRequesl SQ DIVISI f� _..., - .,a:: .�.... ,�:..r. • ;F - ;. �.t2 r. : ii �- �:'E�ti�:': -_ : ?i: ^ �• !�t�E� '�L -'���; � �. ;f '. a'; _ .l::F: .�'�!': r.5:. •��:., ? i � L u :_� A �,�'' Ii:'. ,. A ::': _ �.' ., .1 ?-1, '��,: .,.r• „.._... .,..:::;.:::. ... .. Rl�.. •. � . . y ;ri,.l_�a #1,.� I. IIIr: -.r•; �!,�c• mi r-�.. _ '; q�"r : ; SSA p Pit New construction Demolition ....u.:: .., ; :I:' a;; ; I' .. ,t:: ,.. .>:;�:.....e r.. - Addition/alt l acement ❑ Other: _a•+rk ; :_-: ,t ?•::: CAri oRY OF,+CONS'ERJCT > �i !i �':�; I"'= Note: Permit fees* ate based on the total value of the work performed Indicate ' the value (rounded to the nearest dollar) of all equipment, materials, labor, 1. & 2-Family dwelling Commercial/Industrial and profit for the work indicated on this application. • Accessory Building Multi- Family $0 7,r,5: Master Builder Other: Valuation :0,1:0:';2:' ? =!l, c , . o Bl 1 'IlRoIl1: •; ' hs:o 6' ' `'I'I o ..0 , .,-,.1 No. of bedrooms: S` No. of baths:_____ $ �-- F/e — New dwelling area ( sq. f -) Job site address: t 7_ 5 C: S. ‘\.. - Suite #: J Bldg./Apt. #: Garage /carport area (sq. ft) ' al el O Project Name: Covered porcb area (sq. ft) 9 0 — Cross street/Directions to job site: Deck area (sq. ft) /( U Other structure area (sq. ft.) ()) ,, r : ; . 9�!14 1 7 : r” :�i.i.i'•i _� 'I�tr'�F = {.. .;.r :.•� '• _ 7 3-6 . U):�2t'a "• � 1 '.1. I r . 1 � I'1..;:::: : - . 1 . ^ 1' i �, t . `!� . � " !,F,I9iUi'• rt �, 41�':S l n:. illl':.i ._ ,. � 't � "f• � rIY� 4�y. i � ' :': 2 . ... + Subdivision: �l lz I tvttr 1t4 W� I Lot #: 3eI Tax map/parcel #: Note; Parrot fees' are based on the total value of the work performed Indicate I,,!'a"r' !- ^•. z•;• .. ;i_ r . '''l` ` 4 the value (rounded to the nearest dollar) of all equipment, materials, labor, Of?: e9 p� ;, �;: . . yr;'Vl:i:;. • r_ � t��6_t3i{1 +OI*1' �Ol�•..- :��.: -• . �i:.� : ri:t:,u4 -:.�': overhead and profit for the wor indicated on this at • licatim,. • • Valuation $ Existing building area (sq. ft. .. New building area (sq. ft.) Number of stories L ;+ c St:4r r u .' ::75f : i s ' , i _iI - .. WI 'l.•: ' i5r dr!il 4111 Type of construction. Name: ? L R C,.6.-2.3401 N� Occupancy group(s): Existing: _ Address: 0-if o N W 1 o z_ a 0 _ City/State/Zip: ( L4v (3 e � i Phone: 9'72 -O.� Fax: 8149—C635- NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under '_F:�` �'t:......' IiFh:,: : 5:= :. ?y 01! x" . A ', . provisions of ORS 701 and may required to be licensed in the Business Name: Pp., e. !Z CA-12ti--112 -1 jurisdiction where work is being performed. If the applicant is exempt Contact Name: ('4I - Ili C . p _ from licensing, the following reason applies: Address: cAr' A-) AR c - City /State /Zip:. . Phone 1 Fax: • I ,. }:; $ ,� ' � , r. ° , '�s� ... s MNry ...IV " e:-.'7':1191.. : E 9r-'YIp eW 1 �IIk 7: I :, C -mail: . Z 1 h X44 (+t a t•1' f6ifsC ' . y , :V . t , ' e• i ,(• , r, t i :' • 19` a ;' i ' ''.,:.•1•1 f1 0;i1∎ l�� • ': , " . h• I., .: } ,:: 11i !IIR:0 i':,i,:f e"'.;:i:!.I::'E . J .,, : { E +'_ - 0:}t i: . ::".'c Je�►' •: .''ai'. .I • �•'! ' is L ''„•;; .' O ru' �•�R�i' rk h, " -4 r • • Business Name: {,� 2 Zr Fees due upon application $ Address: SA-1--) ,n.—S 4 30L4.- City /State /Zip: Amount received $___. Phone: I Fax: Date received CCB Lie. #: Authorized j Notil e• This permit application expires if a permit Is notobtained within Signature: Date. 180 days after It has been accepted as complete. .. • "Pee methoddlogy sat by Tri -County Building Industry service Board. (Please paint name) i:tDststPemdt Fot ms'.BldgPermitApp.dac 01/03 07/14/2003 17:02 FAX 5035981960 CITY OF TIGARD R] 004 • Building Fixtures FOR OFFICE. USE O \L1' PIui1(;lblil Per Received • Plumbing ,,n �� _, 2 GY Date/By Permit No.;M Planning Approval Sewer City of Tigard JUL 1 6 2003 Dates ' PcrmitNo.: 13 125 SW Hall Blvd. Plan Review Odle! nate/By: . Permit No -: ' Tigard, Oregon 97223 CITY OF F Date /Review Land Use Phone: 503 - 639 - 4171 Fats 3 o6n, ISI r < •;, , , , Dates . Case No.: • Internet: www.ci.tigardor,us {.� �� I ) Contact Iun e.: :. See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 �`"" ' ^ Name/Method: Su ' letnental Information. _ @ F ORIC .- .,' :: a.. t _ : : .. V ,' ubn - J;r. +.: I Qty jFee(a•) ( Total ,' ew construction Ili Demolition Description afo 7•� :; ':14T a �' ii' 01 t ,MiY 4 .1D. - 's ,5 ' : t . . , . ' .ff':s A :g; III dition/alteration/re • lacement MI Other: 1 _ r tilt Milli lad, i;� v441 . • ' ` fi i!O ' '. , • : is)4 ' a '4 u1ta11attig4! ¢!� iii + h 249.20 " "�_ .. SFIt (1) bath : .,3 4: ••• 1.vp/tZ1itC41 El-Commercial/Industrial SFR (2) bath 350.00 II. a - . so Buil . - • : • Multi - Famil SFR (3) bath 399.00 III Master Builder I Other: Each additional bath/kitchen . e 0 C ,1016 t •,o'•'r Ili '',': 0'c'. '' :ex'''=it' ", Fires. 'elder ft.: �� st s 1 ( Co 06 �f Liu : ::, mow av �r " litil: iii t : t t � �;;_:,s ,� «r,.Y :i;. . Job site address: �'� � °•� " •• , ' t 16.60 �Bld ./ t # Catch basin / area d ra i n Suite #: ,_ B Drywell/leach line/trench drain 16.60 Project Name: Footin, drain no. linear ft. Pale 2 Cross Street/Directions to job site: Manufactured home utilities 110.00 Manholes . 16.60 Rain drain connector 16.60 • Sanitary sewer (no. linear ft.) Page 2 • Storm sewer no- linear ft, Pale 2 Subdivision: 14,512.a �Cl'Jb[S [ Lot # : (no. linear ft. Pa :e 2 Water service (no Tax rna • . arcel #: ' l l „ sa ro '",yz. °sue` .... ," [c :77'�t : o r !iy/'ri .b°ir•F''; g31',r.:,: ';r 1� Absorption valve 16.60 Backflowitreventcr . Page 2 Backwater valve 16.60 - Clothes washer 16.60 Dishwasher 16.60 . � ! � p � pyp Drinking fountain . 16.60 - (:!1 , i,t:,�.; :i E C, -:-m G;i: t. !F( r C1ki7St> Ejectors/sump 16.60 • Name: ,A./ ( Expansion tank 16.60 Address: Ly 80 N L, tt:ra 'L Fixture/sewer cam 16.60 City /S•tate/Zi • : ` Aso O _ Q -7Z �3 Floor drair✓tloorsink /hub .16.60 Garbage disposal 16.60 Phone: ' 9- Z$ Fax: ore -c - Hose bib 16.60 _ .ti' °'. tt ,•re t , " II .,t ilr 1 , (v ,1)...I :,-)lo F a u n Ice maker 16.60 • N ame: Interceptor /grease trap - 16.60 , Address: Ae6 ✓' Medical gas - value: $ Page 2 Primer 16.60 City/State/Zip: • Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatorr 16.60 Email: Tub/shower /shower, pan 16.60 w :!:''',ii ii: i' J c, q) 1, I : y'� 1 i> Tir Q,y tll 7 Urinal 16.60 -. a' � `- ' : •� Water closet . 16.60 - Business Name: J -i M 1% . ,44.- CA-Lai Water heater 16.60 - Address: • to o G - Other Ci /State /Zi : ' . /i 5 o /Z - I Other: F ax Talf2 C'.It6 1.1 i� ;;1i1{` j _ .YS :: :� l���t Phone: Jc9 --q7 5 Subtotal $ CCB 1..1C. #: 3 Plumb. )r iC. #: Min imum Permit Fee $72.50 $ 5 Signature: 76PR Residential Backflow Minimum Fee $36.25 _ Signatu Date Plan Review (25% of Permit Fee) $ P Vb State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE _ S.. • . Notice: This permit application expires If • 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 Forms\PlmPermitApp.doc 01/03 Electrical Permit Application FOR OFFICE. USE' ONLY• 4 -. - ,., :F Received Electrical Date/By: Permit No.( )4e a -6(4 0 f City of Tigard Planning Approval Sign 13125 SW Hall Blvd. Date /By: Permit No.: Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Namme // Method: e Post- Review Land Use Internet: www.ci.tigard.or.us Date /By: Case No.: 24 -hour Inspection Request: 503- 639 -4175 ''"- 1--a Na luris.: Su See Page l for Supplemental Information. ," . `_: ,< <'- tin,i :ITYPEf0E WORK ,= > e l • 11 New construction '' M``'° PLANkREVIEW P•,leasecfie Demolition El Service over 225 amps- �� ck?al ac apply) ° :`; ,; III ❑Health -cara facility Addition/alteration/replacement E] Other: commercial ❑ Hazardous location '.:n ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, s 7, °, aCATEGORY OF CONSTRUCTION,' "' ,'. " ; °'r: ' ','_: 1 & 2 family dwellings four or more residential units in & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure Building over three stories Feeders, 400 amps ❑ Multi- Family ❑ Occupant load over 99 persons ❑ 0 ps or more Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: factured structures or RV park ya' •'' ,: JOB=SITE"'INFORMAT v a "'« ` IONaii'd I O.CATION `;;`:' `. _:' ° 'w Submit sets of plans with any of the above. Job site address: The above are not applicable to temporary construction service. Suite site Bldg. /Apt. #: ; -t r , °b� rFEE *SCHEDULE .: I V�t, ., f ._ ; ...r m .,> :. c k :ice.., sE`."SR "i: , QI�$ . t. ,rl Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total f Cross street/Directions to job Site: New residential - single or multi - family per 1 dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 I Subdivision: OE1 - 44.-,1& `_t.0Q„[S Lot #: 3 I Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling ' ; . 4. -'' *"_ , , , ' tDESCRIPTION /OF: WORK' r,`'4 :" ° . "., : ,,.,, service and/or feeder 90.90 2 �-�t � . � Services or feeders - installation, �n t- $1 r l'L>r t� 4-6 -7 Li alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 f❑ PROPERTY OWNER � � TENANT 'S ; {_.„, i S oil` y: l i 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: „ t e_ C,�.fzvL�j 1-� c, Reconnect only QQ 66.85 2 Address: 1 Li Cb 102 `— Temporary services or feeders - installation, City /State /Zip: CtZ- 22 alteration, or relocation: "'���l- A � 3 200 amps or less 66.85 Phone: SL- 2 01 amps to 400 amps 1 3 -2 rt � - � Y�+� Fax: ,��• -2�y -- IL - el P P A'PP..EICANT, 0 amp 100.3 0 2 _` a'- aCOIYTACT'PERSON " - u4 . s 133.75 .2 Branch 401 to 60 circuits - new, alteration, or Name: // extension per panel: Address: /2 A. Fee for branch circuits with purchase of . service or feeder fee, each branch circuit 6.65 2 City /State /Zip: / B. Fee for branch circuits without purchase of Phone: /j service or feeder fee, first branch circuit 46.85 2 Fax: Each additional branch circuit 6.65 E -mail: / # 2 Misc.(Service or feeder not included): " .a`s��'II _ ' t . r:4 CONrTRA'CTOR'i :/ _-: ' <x 4 Each pump or irrigation circle 53.40 2 Each sign or outline lighting Job No: ;- C - g` f(El, —t 53.40 2 / G�- L�'t~1!',4t.. Si circuit(s) or a limited energy panel, Business Name: 1/ • alteration, or extension Page 2 2 i Description: Address: 55t 5L. Ilbt . City / State /Zip rLA,Jra G 601.i 17 Z3 Each additional inspection over the allowable in any of the above: Per inspection per hour (min. 1 hour) 62.50 Phone: 5 .- t.l _2j :g: Fax: Investigation fee: CCB Lie. #: ?7 -13� L. other: Supervising �� ,-/ ,Lic. #: t= � C ��, ;_ >. ervising ele n ;: ,4: s ,,i 1- -4� . ; _ ealTP eal fikO x =`f , electrician t•s - Elect�i emit " °F �` .,,YA ., signature re. uired: Subtotal $ _ Plan Review (25% of Permit Fee) $ . Print Name, r 4 , . Lic. #: •Z2_ O - State Surcharge (8% of Permit Fee) $ Authorized // TOTAL PERMIT FEE $ i ` t �� Notice: This permit application expires if a permit is not obtained within ! Signature: Date: J - 180 days after it has been accepted as complete. / /i- ( re 7e ' *Fee methodology set by Tri- County Building Industry Service Board. [ (Please print name) l is \Dsts \Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: n Audio and Stereo Systems n Burglar Alarm n Garage Door Opener Heating, Ventilation and Air Conditioning System n Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) • Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls 0 Clock Systems n Data Telecommunication Installation El Fire Alarm Installation • El HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control n Medical n Nurse Calls 1 - 1 Outdoor Landscape Lighting* n Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations is \Dsts \Permit Forms \ElcPermitAppPg2.doc 01/03 07/14/2003 17:02 FAX 5035981960 CITY OF TIGARD Q005 FOR Mech M 1 _:, S E O. NLY 4V 3e1311111CA" Date/By: Permit No.✓ 4 f -owl • City of Tigard JUL Approval Building ' JUL 16 2003 Permit No.: 13125 SW Hall Blvd. p vie Other Tigard, Oregon 97223 T V OF tIGARD Datc/By.:• Permit No,: Phone: 503- 639 -4171 p� p� Date /By: Land Use l � M bt4 r' ' Post -R y: Case No.: Internet: www.Ci_ti s I A i 1I Contact Juris.: 0' See Page 2 for 24 -hour Inspection Request: 503-6394175 "' J Name/Method: Supplemental Information. • • `F4"P 4iii111!1A.11: ' -"y: r :I: c) , 11:. , ,,122 - . , y, .If. F'l,:.' . ?. r ik .. :tzi : ;1i.: :: : ...'''n'.°F' t. New construction • Demolition Mechanical permit fees* are based on total value of the work Addition/alteration/r .lacement II■ Other: performed. Indicate the value (rounded to the nearest dollar) of all .i 4 it J . r I; J C f ` (- j I (. C, , r yl F.; , mechanical materials equipment, labor, overhead and profit jii. ► rali77.2 11 ❑ Commercial/Industrial value: S See Page 2 for Fee Schedule .I . �C1. 17 i�1 ;:), � .ti.. : '_;41,:0 11 X,/ ?; )1• .„,,,,. _ ❑ Accessory Building R Multi- Family Best . flan , F Total ■ Master Builder • Other • :• • .. •:!; ... •:Heaiunat ,' i,ia`: t s • ,, „, . ,.:f,r,,: f I , S_a _�'__�_ : I cL i ��'1;�9 r e; i eti� ,:: Furnace - a air Conditioning” 14.00 , Job site address: 1 3 "/ I.17.45fit`20 L A! Gas heat pump _ 14.00' 14.00' Suite Bldg ./Apt. #: Duct work • 14.00 Hydronic hot water system .14.00 Project Name: job site: Residential boiler Cross street/Directions to J (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: -44 poi-1./ A966' I Lot #: 3 c1 Repair units 1215 .; , . •• Orrier.Fiid; l v ' his `. ` .. _. Tax map/parcel #: Water heater 10.00 �*.iai: -2 tell ; d y ka:': e!: :' _`l;;1i;:- Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fire_placc /insert 10.00 V, Chinmey/liner /flue/vent 10.00 ..,�__`- I 1 ~ 9J p `t `f � �. 'i.,4 1- I•_. , V, - t ki!iillEf' rd.eil;:t. Other: 10 -00 ame . _i : :E;ovr ? renrite6tii Eicli unit/- t 4ii i1 telii ::.sa' ' _, F`� ! � ` Range hood/otherkitchen equipment 10.00 �� Address: I q 9 /4 1&) l 2.621 Clothes dryer exhaust 1 0.00 • City/State/Zip: Fbiz..T .A1y CS f Z- q 1221 Single duct exhaust Phone: : 7 29 Fax: 8't c i — c i (0 3 (bathrooms, tolet compartments, 7 f.:: (1; u <::c_;i.G , er.2..4f :l,: ts 'ir. '' a... .):, utility rooms) 6.80 ■ Name: �A.hir y-.5 itkablIe. Attie/crawl space fans 10.00 Other 10.00 • Address: . ; .,, ...� 4;, . r.' .... . .... '.;i:.`FSietTijiii*^.ir:: ''St'. •. ."ii " ... -:i' City /State /Zip ` - .*(15.40 for drat 4, 51.00 each addi Phone: I 'Fax: Furnace, etc- •s Gas heat pump •• E -mall: _ Wall /suspended/unit heater 1 b ° x' ::: G i,P.i, 7::•: :'i z:5.i'a l . il ;i: !wit ::` r`'3; : Water heater ** Business Nam g L g -r ,J 6 Fireplace •• Address: 2_9017_ ` v . Range •• BBQ ss City /State /Zip: BILL$ Coez, 61Z- ° - 1123 Clothes dryer (gas) •• Phone: 628 - S6 Zo I Fax: Other: •• CCB Lic. #: ., 1 ys 9 Total: Meehaarallgriimitifee"e . : _ . . . Authorized — Subtotal: S Signature: Date: Minirmmt Perrot Fcc $72.50 S Plan Review Fee (25% of Permit Fee) S (Please print name)' State Surcharge (8% of Permit Fee) S TOTAL PERMIT PEE S Notice: This permit application expires if a permit is not obtained within "Fee methodology set by TA- County Building Industry Service Board. 180 days atter It has been accepted as complete. • *5tte pine required for exterior A/C units. i:\Dsu\Pemiit Pormr MeePermitApp,doc 01/03 CITY OF TIGARD 13125 S.W. HALL BLVD. • TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MALMEDAL ENTERPRISES INC 42405 NW OVERLOOK DRIVE BANKS, OR 97106 Plumbing Signature Form Permit #: MST2003 -00364 Date issued: 12/11103 Parcel: 2 S 104D D - 09700 Site Address: 13991 SW RIDGEFIELD LN Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 039 Jurisdiction: TIG Zoning: R - Remarks: New SF detached, Path 1. 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: PAUL R CARNEY MALMEDAL ENTERPRISES INC 1480 NW 102ND AVE 42405 NW OVERLOOK DRIVE PORTLAND, OR 97223 BANKS, OR 97106 Phone #: 503 - 939 -7285 Phone #: 503 - 310 -9795 Reg #: MET 4232 LIC 102535 PLM 34 -276PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X 1 r 4g Signature of Authorized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RECEN DEC 15 2003 ALPINE HEATING & A/C & ELECTRICAL 27150 SE STONE CITY OF TIGARD GRESHAM, OR 97080 BUILDING DIVISION Electrical Signature Form Permit #: MST2003 -00364 _ Date Issued: 12/11/03 Parcel: 2S104DD -09700 Site Address: 13991 SW RIDGEFIELD LN Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 039 Jurisdiction: TIG Zoning: R - Remarks: New SF detached, Path 1. 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: PAUL R CARNEY ALPINE HEATING & A/C & ELECTRICAL 1480 NW 102ND AVE 27150 SE STONE PORTLAND, OR 97223 GRESHAM, OR 97080 Phone #: 503 - 939 -7285 Phone #: 971 - 235 -5900 Reg #: ELE 3 -572C LIC 37344 SUP 2260S AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Supe ising Electrician • If you have any questions, please call 503.718.2433. kAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA v /S ST 3 - c. 3-6 .y I STREET TREE CERTIFICATION �" I, ?Al � Q.ww'( , Owner/Agent for p. , ` CA-Cr 0. (PLEASE PRINT) ,, (PERMIT HOLDER) f /", Do hereby;:e -rtf td following location A 414 , z i : war :: �� meets Citby Ho Tigard / a C ounty ... , ..,, land use and development standards for street tree installation. ADDRESS: S 4,./ 12f o c Pte° -11 LOT: SUBDIVISION: IL r-l.g-k--) 0. A z ,./}7 A____----__________ 0> BY DATE: f 2 — ° Y I A / .> 0- RECEIVED BY: DATE: /2- - ` 7" ozf CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (5 i C ', 175 MST �ad3 - �..3 � INSPECTION DIVISION Business Line: 1 BUP Received Date Requested / _g AM PM BUP Location / 3? ! / d /1 e Suite MEC Contact Person Ph ( ) 53? 7 ZS PLM Contractor Ph ( ) SWR BUILDING • Tenant/Owner ELC Footing Foundation ELC :Access: Ftg Drain ELR Crawl Drain _ Slab Inspection Notes: — SIT Post & Beam //Cf Shear Anchors 7 /01-0 o Ext Sheath/Shear Int Sheath/Shear // S / Framing Insulation Z /„,›V Gk. Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling • Roof Other: Final PASS „ART FAIL Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan 0 er: arie ART FAIL ANICAL °: Post' & Beam Rough -Ih • 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 j U Approach/Sidewalk Date y Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. • PASS PART FAIL CITY OF TIGARD 24 -Hour "BUILDING Inspection Lin • (503) 639 -4175 MST r �Ov INSPECTION DIVISION Business Lin . (503) 639 -4171 BUP Received Date Re nested l a AM PM BUP Location / 3 4?l /'( - .e Suite MEC Contact Person � Ph ( ) 93 2 7 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 r r 6-o O Z f Framing - -- !� Insulation — s s (t_� Drywall Nailing • ( 1 Fi rewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: -�� P- e o I _ .. Gil• - - "dr •AS PART FAIL M BING. ° : ... !'J Lrn'l t3c_P (Jlke1 t_A Post & Under Slabm NI 0° V! S u 41— —g a ice( 1 O I, Water1Service Z) 'PR ov/b C Po<S !T7 k/ A/Ai ez r /.6 lam©s 4 Sanitary Sewer ,'•a CBN AIL -- C> . VA/ b Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final �(`��(�(•� '1- c: i Q 1 A-a.c31 PASS PART FAIL _ MECHANICAL :,:: ?r ° ' /\167 b 4 Su se M Post& Beam Rough -In I�..��nlC: ! /Nl Ci �_ Z-C /4 Gas Line Smoke Dampers • ASS PART FAIL TRICAL 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 Inspector ` Ext. Other: Final DO NOT REMOVE this inspection recor 0 from the job site. PASS PART FAIL