Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00007
,
t iii DEVELOPMENT SERVICES DATE ISSUED: 3/4/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11380 SW SUZANNE CT PARCEL: 1S134DC -12100
SUBDIVISION: CASCADIAN PLACE ZONING: R - 4.5
BLOCK: LOT: 010 JURISDICTION: TIG
REMARKS: Const. new.SF detached residence.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 21 FIRST: 1,266 sf BASEMENT: sf LEFT: 6 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,134 sf GARAGE: 523 of FRONT: 30 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 TwRD: sf RIGHT: 6
VALUE: 237
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,400 sf REAR: 32
. PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 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: 3
' MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 7
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:
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: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v. MINOR LABEL: '
1000+ ampNolt :
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: $ 7,264.72
KEYSTONE DEVEOPMENT INC. KEYSTONE DEVELOPMENT This permit is subject the regulations contained C in the
Tigard Mu
rd Municipal Code, , State of OR. Specialty Codes s 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
Rea #: LIC 71135 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 Insl Rain drain Insp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Plumb Final •
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Service Insp Building Final
Foundation Insp PLM /Underfloor Framing lnsp Gas Fireplace Appr /Sdwlk Insp
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final ,
/
Issued By : _ :.. , ._.,�- :��L� Permittee Signature : �� I�
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n - bus ess day
•
• )-G - f - /G o 3 - 0000
, Building Permit Application
, I Date received: / -7 03 Permit no. f 1374„ )c3 -00 V
mo t r,1 City of Tiga t
� • $ln10 eNlQllnB Projecdappl.no.: Expire date:
City of Tigard Address: 13125 SW a aJTiggb cia15/223
. Phone: (503) 639 -4171 Date issued: By:?; (?) I Receipt no.:
Fax: (503) 598 -1960 E0OZ L 0 Ndf Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
t•C /L\CiiCF: Cu
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family ❑ New construction O Demolition
❑ Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm ❑ Other:
110B SITE INFORMATION
Job address: - / /3R'O 5 (,U .S4 Zit 6 Bldg. no.: Suite no.:
Lot: 10 I Block: (Subdivision: CA- ScfQrOptv•1 P I,ACt. - I Tax map/tax lot/account no.: `r5/ 3 1f -Cf p L
Project name: /(_ Ai 5'' �.N
Description and location of work on premises/special conditions: S
•
_ OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: r- STO i - DFJ P - INC. • (Floodplain, septic capacity, solar, etc.)
Mailing address: Fr) goy. I4-7( 1 & 2 family dwelling:
- City: 1A 11.(3 (X10 F..60 (State: op- I ZIP: all PA Valuation of work $
Phone: (33 G - 1 , 193 to . (Fax: (A' -- Ty (K-mail: No. of bedrooms/baths 1 1:-/3
Owner's representative: .JAM Total number of floors
Phone: 91 Fax: 5,4�� E -mail: New dwelling area (sq. ft.) r r
APPLICANT Garage/carport area (sq. ft.) 0 -
Name: M1 . - Covered porch area (sq. ft.) (O
Mailing address: Deck area (sq. ft.) 100
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industriaUmulti- family:
1 CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: }Anti New bldg. area (sq. ft.)
Atidress: :
Number of stories
City: I State: I ZIP: Type of construction
Phone: I Fax: I E -mail:
CCB`lio.s i I is5 Occupancy group(s): Existing:
New:
CityTmtifro lie. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
_Name: VA S GOO provisions of ORS 701 and may be required to be licensed in the
- Address: 505 NUJ (6-0 jurisdiction where work is being performed. If the applicant is
City: POP r O) I State: C� IZIP: 601.01
exempt from licensing, the following reason applies:
Contact person: I Plan no.: 221 °O .
Phone: /2/ — al t(0( Fax: '225 E -mail:
ENGINEER
Name: pow bl 1 Contact person: Fees due upon application $
Address: 45 Sr_ 02,02 2 Date received:
City: pcei I.ANP (State: ORIZIP: e 11 2 U ( o Amount received $
, Phone: ( 1.-64 —&t12. Fax: 25-11' -17611 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 Jo risdictio more information.
attached checklist. All provisions o and ordinances governing this
O Visa 0 MasterCard
work will be complied with . e t herein or not. Credit card number: / /
Expires
Authorized signature �y�� Date: 11 ( 1 b ( 67 Name of cardholder as shown on credit card
Print name: J AGS M M . 1" -- $
Cardholder signature Amount
Notice: This permit applica in expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (boo/COM)
41- 04/07/2003 11:59 5036254455 HILL ELECTRIC INC PAGE 04
W5 -
Electrical Permit Application
Datcreeelved: Permit noIf1512063 OOOB 7
.ii'�' :1n1_ City of Tigard Project/appl.no.: Expire date:
city of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: 1 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
1' 1'1•: OF I'FIt,NI I l'
1 & 2 family dwelling or accessory 0 Commercial /industrial Cl Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
J011 S i l l ; II\I'O1ttIA1 I0\
Job address: 3 7j .S!(). • 4CZ.Qf)/t e. ` , Bldg. no.: Suite no.: Tax map/tax lot/account no.: .
Lot: I Block: Subdivision: - / ,t . _ ' '
Pro'ect name: Description and location of work on remises: .
Estimated date of com•letion/inspection:
CON I It A("1 AI'PI.ICA1 ION IIT S('111.1)l;l.l:
Job no
L DD M Tod)
Pia
Business name: �' � ' • • LC New reddendil• single ormadr4a nlly
Address: 1 " 5(2) is dwellhn sok Imbeds insetted mime.
City: 341 4 ( I State: /)ZIP: ,-` J /yo • Snvreeio turfed:
Phone: , Z 5 • -'! , , Fax: , Z _ 1 " E -mail: 1000 •, ft, or lass 4
CCB o.: Elec. bus. lie. no: S(pZ4_ h �tio� or • . ion thereof M� •
1 LJ lredenergy,re 500 : identi d
SWIM NM
ler r0 Ill. no.: _ hd energy, non r home or 2
a , , a - - � Each ' Each manufactured homme orr modular dwelling
fv
Si : atur • o supe In : • - - trim : (requ red) Date Service and/or feeder 2
Sup. elect. name (print): i� r , .� t;oenaeno: 3 vSd Seniaa feeders - Installation,
alteration or relocation:
I'ItO11:1111' OWN' It 200 amps or less 2
201 'reps to 4 MI__
Name (print): ;. '_ MEIN
- 401 amps to 600 • _N_ 2
Mailing address: 601 amps to 1000 amps 2
City: IS tate: [ZIP: Over 1000 unpa or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own ibmPartuy a`'f'Aees or feeders -
which is not intended for sale, lease, rent, or exchange according to IgttaOdlogaltaratlon .orrelocation:
200 amps or lets 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's Si: 'lure: —__ -. ,- Date: 401 to 600 amps 2
EN G I N :I :I :It Braoch circuits • new, 'iteration,
or extension par panel:
Name: A. Fee for branch circuits with purchase of
Address: aervlm or feeder fee. each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee. first branch circuit: 2
Phone: Fax: E Each additional branch circuit:
'IAN its• '11:11' (I'Iea <e check sill Alai apple) Mite. (Service or feeder not lncluded):
O Service over 225 amps- commercial 0 Heeith -cat feciliiy Each pump or irrigation circle 2
O Service ore' 320 amps - rating of 1412 0 Hazardous lecadon Eech sign or outline lighting 2
family dwellings 0 Building over 10.000 square feet four or Signal eircuit(e) or a limited energy panel,
O System over 600 volts nominal More reaideMiel units in one aweture alteration. orextenaion• 2
Q Building over threesmriee Q Proders. 400 amps or morn *Description: -
O tkcupent load over 99 persons Cl Manufactured structures or RV park Each edd(t1onal laapectloa over the allowsble In any of the above:
0 Egress/lightingplan Q Other Pa:inspection F I 1 I
Submit _ sets of plans with any of the above. Inc aeon fee
The above are not applicable to temporary contraction service. Other
Not all Juisdicuns oo
ocaps eredh card', please call paidlcdae for mare infomWlm Notice: This permit application Permit fee $
O Yes O MasterCard expires if a permit is not obtained Plan review (at — %) $
Craw card wind= - / I within 1110 days after it has been State surcharge (8%) .... $
F "p 1e ` accepted as comp TOTAL S
Name of cardholder u shown oa credit card
$
Cardholder signature Amount 440.4615 (603ICOM)
FOR OFFICE USE ONLY
Electrical Permit Application Received Electrical
Date/By: • Permit No./fO(2 — 00001
Planning Approval Sign
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 4, Post - Review Land Use
nuF/,� Date/By: No.:
Internet: www.ci.tigard.or.us ■ iJ,, r:! � Contact Juris.: El Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - -" Name/Method: Supplemental Information.
' . TYPE OF WORK : . - -PLAN REVIEW (Please check all that apply) :
▪ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Healthcare facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
a 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure .
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
. JOB SITE 'INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 11 Si&) 502/1 6- FEE* SCHEDULE -
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
New residential- single or multi- family per
Cross street/Directions to job site: 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 1
Limited energy, residential 75.00 2
Subdivision: C'Sei}01f tJ Pi41 CQ. Lot #: I 0 Limited energy, non residential 75.00 2 • Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK • service and/or feeder 90.90 2
Services or feeders - Installation,
0-e.4,0 ' r --- 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
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 0 1 S` 1)l3t. )etJ(. 't..C. Reconnect only 66.85 2
Address: f (per /-116 Temporary services or feeders - installation,
,,{g�� alteration, or relocation:
City /State /Zip: /,11}ia- OSvJ I O(.) -- 6\163,- 200 amps or less 66.85 1
Phone: 6'31 • 1'1 b Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT ` ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: 5/111'42. extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of i
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension - Page 2 2
Business Name: H( f x L Description: .. ,._
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip : Per inspection per hour (min. 1 hour) . 62.50
Phone: &'i5 - SI0 S Fax: Investigation fee: •
CCB Lic. #: Lic. #: Other: Electrical Permit Fees*
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: I Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: I I / 1 b3 180 days after it has been accepted as complete.
*Fee methodology set by Trl- County Building Industry Service Board.
Mme& PI . .
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Plumbing Permit Application Received FOR OFFICE USE ONLY
Plumbing
Date/By: Permit No.MS e7 "
City of Tigard
Planning Approval Sewer
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: / - 2� - R Permit No.:
Phone: 503 639 - 4171 Fax: 503 - 598 - 1960 eview Land Use
Or ; ' i\ Date /B DateBBy: Case No.:
Internet: www.ci.tigard.or.us ,. cal Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 - " Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special Information use checklist)
Riew construction ❑ Demolition Description ) Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
(includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath • 249.20
� 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi - Family SFR (3) bath ' 399.00 7 0 ' 0
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
•
Job site address: (1 -,6D 5-vi SVGAN IJf C.'j • Site Utilities
Bld /A t #: Catch basin/area drain 16.60
Suite #: g p 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
T1 b4() QC.' Manholes 16.60
-rvgN oN G/ -D Rain drain connector 16.60
. t1/2-J 1 O N SO 2A N KM Sanitary sewer (no. linear ft.) Page 2
Subdivision: 6A-SOKYON 1 tA I Lot #: r \) . Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft) Page 2
Tax map /parcel #: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
N1 S Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
['PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: Sri) tre 0Q-Of. 113 C- Expansion tank 16.60
Address: P PD 0 (7b Fixture/sewer cap 16.60
City /State /Zipi L/.2.OSw ; (>i! qj-)(53-A Floor drain /floor sink/hub 16.60
Garbage disposal 16
Phone: 635- LA-73 b ax: Hose bib 16.60
0 APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: SAne.., Interceptor /grease trap 16.60
Medical gas - value: $ Page 2
Address: Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
. - • CONTRACTOR Urinal 16.60
Business Name: S SOC`/0 Water closet 16.60
heater 16.60
Address: Other:
City /State /Zip: Other:
Phone: Fax: Plumbing Permit Fees*
Subtotal $ '`3Qq . 0
CCB Lic. #: Plumb. Lic.#: Minimum Permit Fee $72.50 $
Authorized - l Backflow Minimum Fee $36.25
Signature: D ate: 1 I f 0 3 Residential
Review (25% of Permit Fee) $ Q9 •75
JN' e_S M . Q04 f -- State Surcharge (8% of Permit Fee) $ 3 I • eix
(Please print name) TOTAL PERMIT FEE $ S3f1 • fo7
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 Forms\PlmPermitApp.doc 01/03
Mechanical Permit Application Reeeivea FOR OFFICE USE ONLY Mechanical
Date/By: Permit No.: /)t 'U '000
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: / -W/A . Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Or� �H� '' Post - Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ ee l I Contact Juris.: ® See Page 2 for
--
24 -hour Inspection Request: 503- 639 -4175 -" Name/Method: Supplemental Information.
TYPE OF WORK • ' . . ' - . COMMERCIAL FEE* •- USE CHECKLIST -.. !
[ few 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
CATEGORY OF CONSTRUCTION . mechanical materials, equipment, labor, overhead and profit.
[r & 2 - Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family . • RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
• ' JOB SITE INFORMATION and LOCATION . Furnace - add -on air conditioning** / , 14.00 pt, a
Job site address: i ( 9f2D 9f2 S W .• 0 2 N N� ca Vri Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work I 14.00 /'r.° b
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
116 AP /\\J' Unit heaters (fuel, not electric)
' j VRN OP 6/11.L1) (in wall, in -duct, suspended, etc.) 14.00
•TVR.N 00 SO 2 N Flue/vent (for any of above) f 10.00 /O. OD
Subdivision: uistAPAp pV1C- I Lot #: 1 0 Repair units 12.15
Other Fuel Appliances •
Tax map /parcel #: Water heater i 10.00 lb . "
DESCRIPTION OF WORK - Gas fireplace $ 10.00 ?..0,e'o
14 ,2 Sf()--. Flue vent (water heater /gas fireplace) 3 10.00 "ft _0T)
Log lighter (gas) . 10.00
Wood/Pellet stove 10.00
. Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
s B PROPERTY OWNER ' I ❑ TENANT Other: 10.00
Name: S j DNZ, PeOP• \N C Environmental Exhaust & Ventilation .
+ her kitchen equipment f 10.00 Opp
Address: P0 kr7L LP, Clothes dryer exhaust f 10.00 it , op
City /State /Zip: i- nii --e.. OS lA d 0 I) 1 - 6 1 1 0 1 1
Single duct exhaust
Phone: 63 5- Fax: (bathrooms, toilet compartments, s
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.801-
Name: S.ri_ Attic/crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. I
Phone: Fax: Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater / "
Business Name: 112-) - c. o j7, ' co►s`PNL Fireplace 2• " M.)
Address: 'Range I 0* [.°p
BBQ I i , 00
City /State /Zip: Clothes dryer (gas) 1, *s r . ®�
Phone: I Fax: Other:
CCB Lic. #: Total:
Mechanical Permit Fees
A g atur ed �O k 1 I'"1 f 6 3 Subtotal: $ /6 .
Signature: Date: Minimum Permit Fee $72.50 $
c, t , Pock)' — Plan Review Fee (25% of Permit Fee) $ J/-f • 10
(Please print name) State Surcharge (8% of Permit Fee) $ I o' . ) `i3 3
TOTAL PERMIT FEE $ �` 3 ..5.,
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Trl- County Building Industry Sery ice Board.
180 days after it hal been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 "'
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ASSOCIATED PLUMBING CO
• P 0 BOX 301362
• PORTLAND, OR 97230
Plumbing Signature Form
•
Permit #: MST2003 -00007
Date Issued: 3/4/03
Parcel: 1 S134DC- 12100
Site Address: 11380 SW SUZANNE CT •
•
Subdivision: CASCADIAN PLACE
Block: Lot: 010
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Const. new SF detached residence.
'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 DEVEO INC. ASSOCIATED PLUMBING CO
PO BOX 476 P 0 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
X .�
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
RANDALL HILL ELECTRIC INC
14819 SW BELL RD
SHERWOOD, OR 97140
Electrical Signature Form
Permit #: MST2003 -00007
Date Issued: 3/4/03
Parcel: 1 S134DC -12100
Site Address: 11380 SW SUZANNE CT
Subdivision: CASCADIAN PLACE
Block: Lot: 010
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Const. new SF detached residence.
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
Signa a of Supervising Electrician
If you have any questions, please call 503.718.2433.
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E TIFICATION
TTREE C T EE R S R
• I, , ,M 0 % ()MAI— , Owner /Agent for IL- S1D - 05� � i1.o ("N1etSr I \N td
• (PLEASE PRINT) (PERMIT HOLDER)
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• Do hereby certify that the following location ■
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• meets City of Tigard /Washington County
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• land ■ use and development standards for street tree installation. ∎•
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• ADDRESS: I Inc Ski) SOZ N l CT. ■
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• LOT: � D SUBDIVISION: G AG OI 1J eI,[ C- ■
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BY: DATE: 10110105 ►
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1 RECEIVED BY: DATE: / - /z - 0 3 ■
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CITY OF TIGAR D' . 24-Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 Z Q
INSPECTION DIVISION Business Line: (503) 639 -4171
p BUP
Received 'i'/ —0 3 Date Requested C / "03 AM PM BUP
Location // 3 /0 Su. Z—a44. ..-Q_ � Suite MEC
Contact Person a% wk_ PCB t 1 0.L l< Ph ( ) 6 3 S —4‘7,3ADpusn
Contractor KC–L) S t3Y`' Ph ( ) 5 7 7— t d' 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
Si a.
Fina 11151
.�� 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
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 — / - Inspector _ Ext
Approach/Sidewalk Date -
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Ho -
BUILDING Inspection Line: (503) 639 -4175 MST 3 — DO ° ° 7
INSPECTION DIVISION Business Line: (503) 639 -4171
'3' AM Received Date Re nested 7 — a' AM PM BUP
Location / 13 p C,o Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) (n c2,5— SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg I 6O Y — 3 , -( 7 ELR
Dr ain /' `�'
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation T" �� CI� A\folzp \)y�
Drywall Nailing t \ ) j' a 1
Firewall Pi �! /
Fire Sprinkler u
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:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab E •
ar % Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- AS P • RT FAIL
SITE ❑ Please call for reinspection RE: 111 Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Insp or �/' O ��� 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 —000 a
INSPECTION DIVISION - Business Line: (503) 639 -4171
BUP
Received Received Date Requested d — c AM PM BUP
Location / / 3 gYO Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 3 3/ Os k -- 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
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
Ot er:
S PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 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: ❑ Unable to inspect — no access
Fire Supply Line
ADA
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 \1
BUILDING Inspection Line: (503) 639 -4175 f MST 3 -0o 6 0 7
INSPECTION DIVISION Business Line: (503) 639 -4171
9
BUP
Received Date Requested ! Ad A M PM BUP
Location f/l 3 g6
'4 41.1 6 41-14
�a Suite MEC
Contact Person Ph ( ) 3,5. L( 7 ' PLM
Contractor Ph 577 ; 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 ! // E c 9tJJ/L _ i s 4 C. U G ` / •a
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
PASS PART_
PLUMBING _
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PART FAIL
cMECHANICAJ
Post S Beam
Rough -In
Gas Line
Smoke Dampers
n
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 J Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Q jQ^O
Approach/Sidewalk Date - ? Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL