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Permit �, MASTER PERMIT CITY OF TIGARD PERMIT #: MST2004 -00097 �,�4,r� DEVELOPMENT SERVICES DATE ISSUED: 4/16/04 ��� Ii 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 SITE ADDRESS: 14203 SW WALNUT LN PARCEL: 2S104BC -BW004 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: BVH3212 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1.402 sf BASEMENT: 51 LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,810 sf GARAGE: 440 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 Tromp. sf RIGHT: 5 VALUE: 308,476.80 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3.212 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =10OK: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 3 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 6 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/F DR: 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,760.77 BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES This permit is subject to the regulations contained in the 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES l th er r applicable cal Code, State work k w Spedo Codes and a o PORTLAND, OR 97219 PORTLAND, OR 97219 all othplicable laws. All work will be done i accordance with approved plans. Th 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: 503 443 - 6033 Phone: 503 443 - 6033 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg 6: LIC 152235 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain Insp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line lnsp Building Final Foundation lnsp PLWUnderfloor Framing Insp Gas Fireplace Water Service Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final Issued By : Permittee Signature : /, Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne b siness day , . , . y B Permit Application Received FOR OFFICE I.:SF OM,N n , CEw ED Date/B : a- a , . i�t'�i City of Tigard RE Planning Approval - Other Date/By: Permit No,.., . ° ,-,.. Ii/ a i 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 MAR 2 4 200 /h Date/By: fw L/- / S- a/ Permit No.: Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 , �ti� r 1 I Internet: www.ci.tigard.or.usCljy OF TIGARD -'11. 1 \ Post - Review Land Use Date/By: Case No. 24 -hour Inspection Re uest: EK3018 Rl' SIO Name/Contact 11,,,,��,ss- 1:8:1 See Page 2 for P 4 grew Method: (,,, Supplemental Information TYPE OF WORK • - - ... - i , :..-.. _. • ._• :, : • • • New construction . _ "• REQUIRED �' � �_ _ > :' : De molition 1 & 2 FAMILY DWELLING - . = • ❑ Addition/alteration/replacement [ Other: CATEGORY OF CONSTRUCTION Note Permit fees* are based on the total value of the work performed. Indicate © 1 & 2- Family dwelling ❑ CommerciaVlndustrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. El Accessory Building E Multi - Family ❑ Master Builder Other: Valuation S JOB SITE INFORMATIO and LOCATIVDN, No. of bedrooms: Total number of floors N baths: Job site address: / �k/n New dwelling area (sq. ft.)...32 Suite #: ` Bld /Apt. #: Garage/carport area (sq. ft.)...... D Project Name: , / 1 je') 1) Covered porch area (sq. ft.) .... Cross street/Directions t job site: Deck area (sq. ft.) it Other structure area (sq. ft.)..... //.'¢ ;', - '-REQUIRED DATA: " .. ' COMMERCIAL•_ =USE CHECKLIST ��' . . Subdivision: I Lot #: 4 Tax map /parcel #: Note: Permit fees' are based on the total value of the work performed. Indicate "DESCRIPTION OF WORK • . the value (rounded to the nearest dollar) of all equipment, materials, labor, NEW CONSTRUCTION — SINGLE FAMILY RES , overhead and profit for the work indicated on this application. DEATACHED RESIDENCE Valuation S Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ® PROPERTY OWNER . .1 ❑ TENANT - • • . Type of construction Name: Buena Vista Custom Homes Occupancy group(s): Existing: Address: 6932 SW Macadam Ave. Ste C New City /State /Zip: Portland, OR 97219 Phone: 503-443-6033 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be ❑ APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: Eliabeth Moore from licensing, the following reason applies: Address: City/State /Zip: Phone: I Fax: • . • _ . ..- .. . • • E -mail: 'BUILDING. = ' .. CONTRACTOR -' • . . • . . Please refer refer to fee schedule. : . . Business Name: Buena VIsta Custom Homes Fees due upon application S Address: 6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 97219 Amount received S Phone: 503- 443 -6033 1 Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized /3 7y - • Signature: U. Date: Notice: This permit application expires If a permit is not obtained within 180 days after It has been accepted as complete. *Fee methodology set by Trl- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03 • •, One- and Two - Family Dwelling Building Permit Application Checklist. Reference no.: City ofT City of Tigard Associated permits: 0 Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 I IIF: FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N /% I 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 0 plan Cl 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. 1 I 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 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 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 Boor /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. II:R lSDI(TION.. 1 . SPl:('II1( 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. 4+0-4614 (6/o0/CO.1) 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 • Electrical Permi n FOR 01.1.1(I. t S I 0 N 1.1 R Reee;ved Electrical oatc,By: Pt No.: N raao� -aoa�7 City of Tigard Planning Approval Sign 13125 SW Hall Blvd. �, 4 2 004 Date/By: Permit No.: MA Plan Review other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax; 93 VONFID Post Review Land use Internet: www.ci.tigard.or.us ul '' nn11 pIVIS duns Dam/By: Case No.: Contact I ® See Page 2 for 24 -hour Inspection Request r - 39 -4 175 Name/Method: Simplemental intbrmatian. `•TYPE'OF WORK ' : % PIAKREVIEW ( Please bt >a�Ftiiat•ajtitil } <" [� N ew construction Demolition ❑ Service over 225 amps. ❑ Health-care facility Addition/alteration/replacement Other: ❑ commercial ❑ Haaadous location Service over 320 amps - rating of ❑ Building over 10.000 square feet, • • •C . • 1 & 2 family dwellings four or more residential units in F! ' & 2- Family dwelling Q Commercial/Industiial ❑system over 600 volts nomina ono structure — ■ Accessory Building Multi- Family ❑ Building over three stories GI Feeders, 400 amps or more 0 Occupant load over 99 persons ❑ Manulhetured structures or RV park • Master Builder ,� Other: 0 Egress/lighting plan ❑ Other. SOBS • : INFORMATION• td L . : ON • • Submit aeb of plans with any of the above. Job site address: Eft 3 �i The above are not applicable to temporary construction service. Suite #: Bldg. /Apt. #: .. ei :: x,:: ..�: ': • ( :, .�.w` ? • Number of inapecdons per permit allowed Project Name: Description Qty Per fn.) T•td 1 Cross street/Directions to job sits: New residential.shgic or maul family per dwelling auk. taelades attached prage. Servke leeleded: 1000 sq. tt. or less 145.15 4 Each additional 500 sq. IL or portion thereof 33.40 . 1 Subdivision: L Lot #: Limited energy, residential 75.00 2 2 Limited energy, non residential 75.00 Tax map/parcel #: Each manufactured home or modular dwelling '•:: • DE PLOF - WORK • " • s ervice and/or feeder 90.90 2 ^ // services or feeders - Installation, de cons u1/ - s/44/t. R/11l/ aberaHonorreloeatlon: 4 a - Gh e d 1 den ( ...Q____- eon amps or leas 06.35 2 201 amps to 400 amps 106.85 a ,.,�L 401 amps to 600 amps _ 160.60 2 ° o RTY• OWNER : • ' ::.i., •'FEN • :'• .: •• - 601 =VS to 1000 amps ( 240.60 2 Name: t en e- i S , _ / L., S aa,, Over 1000 am ._, Volta 454 2 lO�.'S� 5W 'acacio,r, Life ` Reconnect services or feeders - instailadon. h 2 Address: � 0 l� Temporary po f•-+ -1 � 9 1 — p / alteration, car relocation: • : i 200 awe or less 66.85 I Phan , . so 3- - • -, Fax ::c 3 2rOi amps to 400 amps 100.30 1 401 to 600 amp. _ 133.75 a i C �>r•l':x7t _?:" N Branch eitroutts • airy., alteration. or Name: 6-re i / • 5S extension per panel: Address: - A. Fee for branch circuits with purchase of service or fader fee, each branch circuit 6.65 2 City /State/Zip: B. Fee for branch circuits without purchase of service or feeder icc, first branch circuit 46.85 2 Phone: I F ax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included); - COP TRA1 3R Each Damp or hviW circle 53.40 2 Each sin or outline lighting 53.40 2 Job No: Signal circuits) or a limited energy panel, Business Name: ji pa5 .. alteration, or extension _ Page 2 2 Lksehption: Address: S70 5 k) azt,i �# 3 City /State/Zip: y1 it s 601-e , D/2 417123 Each additional iospectioo over the allowable in an of the above. Per in 'on erhour min. 1 hour) 6a.50 Phone :56-3 !o 'j2 2300 Fax:6 '3 15 tnvesti on CCB Lic. #: 15789/ Lic. #: 34G Other Supervising electrici • Efe�ittstl PelemlC Subtotal ' ;:.::.: ;1;�: .. :: : . s_ i&tlature re • aired' + Subtot 3 Pe _ Plan Review (25% of mdt Fee) S Print Name: 1 OSS Lic. #: — _ State Surcharge (8% of Permit Fee) S Authorized TOTAL PERMIT FEE S ■ Notice: This permit application etplta If e permit is not obtained within Signature: Date: _ 180 days after it has been accepted as complete. *Fee methodology set by Tri• County Building industry Service Board. (Please print name) - i:\Dsta\Pcrmit Forms\ElcPermitApp.doc 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 4 Ilb i. • (OR (1141( F. I ".1 t_INt 1 Mechanical Permit A el 1 , : ;: I WE • Received Oatarti : • FREIMM -COO ' City of Tigard MAR .4 4 2004 Planning Approval KOMIIIIIIIIIIII DI ; . 13125 SW Hall Blvd. Plan Review EiagillIMIIIII Tigard, Oregon 9722_3 CITY e TI t . RD Da , . Phone: 5M-639-4171 Fax 503-598-196111LD . , p 1 ..10N Post- • e9.111 ..,../11111111111 Land Use lIrr'.c_4 Oule No.: LutOrliet: www.ci_tigard.or.us JAI:::'10 Contact kris.: uggyiElime 24-hour Inspection Request; 503-639-4175 - -. Name/Method: . ".. ... •• •. :1" '1,:: :;.'„ 4 E cerwoRK.,.54,.;w4:t. . 4 ,I..., ...,:./...eit sr I. t - i• ' ..,..,• n . WW1) 3 _ %. Z.••••:Tv. if New construction III Demolition Mechanical permit fees* are based on the total value of the work ItilacemelIt I Other: performed. Indicate the value (rounded to the nearest dollar) of all • . . . - ... xgriso .` :tir.1, t.ii:,i mechanical materials, equipment, labor, overhead and profit litilkanigia.ik2141 • Commercial/Industrial war: s $ ee . , 2 for Fee Schedule L Accessory Building INI Multi-Farnil ..-: RESWENOADIT/S1(6218M5 a :A : .SCDEDI1LE • ' Deserlotle Q171 Fee(e0 i Total U Master Builder Other: HestlisfiCosdisg JO : SITE 1 t • • TIO4 and LOCATION • ' ._., • • : • . Furnace • add-on air conditioning" 1 4.00 I Job site address: 9-0 3 - I nIA-L4-)u.z. I ni Gas heat • •• 14.00 Suite 0: 81- , ./A- t.#: Duct work 4. 4 ° O: drank hot water system PrO'ect Name: . Residential boiler Cross street/Directions to job site: for radiator or hArottio swum) ' Unit heaters (fuel, not electric) in wall, in•duc su . nded. etc.) 14.00 Flue/vent (for any of above) I 0.00 R • air units 12.15 Sttbdivision: Lot 0: Wser Fuel Ais • names Tax , - - erect 0: Water hestet 10.00 • • • '• • 'DES.: l• ION =Iv • RK .•••1•i • • .• Cas Ii • lace 10.00 NEW CONSTRU 0 -SI 'GL - r • I - Flue vent IIIMIRIEffill hater/ fr e) '0.00 DETACHED RESIDENCE li • , _ • 10.00 MEM Wood/1 III 10.00 111111 Wood • - • lace/insert 10.00 Chiming/liner/Flue/vent _ 10.00 3;7. ■ 1 ',_ 3 pEgrit • , Other ,. : , 14 MI TENANINe44'2%,:.k.!;..::;? . : 10.00 . facironmesta exhaust & Veelltteas - Name: B _ ,--- 9. _-_.. 1 . ,. . r, . . It - Range hoodlother kitchen equipment 10.00 Address: 69_12 SW Mac . • -_,, __ -_ S - C Clothes dryer exhaust 10.00 Ci /State/Zii.: Portland OR • 7 21 9 Single duct exhaust Phone • _ . . _ . I Fax: 1 _ , . - , . (bathrooms, toilet compaterncres, a _APPLICAN• . .,_ • . am WIstr._, • 2E WE rooms • 6.80 Name: David Goloba Attick wl • ace fans - ,- 10.00 Other; 10.00 Address: City/State/Zip: 1 * AO Ow first 4. MOO IMO addidons1 Phone: _ Fax: Furnace etc. III •• •• Gas heat .. Mg E-mail: Wallis eunt heater 1111.11ail • • • :•'`.. : . ••• L... corrourroR ,., :..;...: :,. : • ' .. .•. water heater •• Business Name: _ . .7 9. R • lase so 1=r111.......11.1.111 •• AddreSS:2 4 2 8 SE 105th Ave. lal BS9 •• Ci /State/4 • :POTtland, OR 97216 Clothes . er 1 ss ••• Phone: 5 03- 253-7789 FaX:503- 5 -.". 6-3 other: III II . CCD Lic. 0: 45 1 3 1 . Total: Meebadield Peri* Fees * -- Authoriz • u • total: S si GuiJci u DatcLI4 I2gigoi Minienttnit Fee S71.50 S David Golob y Plan Review Fee (25% of ?emit Fee) S State Sure-hive 0% of Permit Pee) S (f. ease p-----------r--7-----------int nazne) TOTAL PERMIT Notice Thts permit appheatIon expires If a permit is not obtained within • Pm methodology set by Tr-County Building Industry Servile* Board. t80 slikfo after It be been aerepted as complete. **She plan required kr esterlor NC unit!. ialatesPcnnit Porms1MesPermirApp.doc 0143 • Mechanical Permit Application - City of Tigard • Page 2 - Supplemental Information • Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to $2,000.00 Minimum fee $72.50 - $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each - additional $100.00 or fraction thereof, to and including $5,000.00. - $5,001.00 to $10,000.00 - $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $1 00,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. • • I18utldingPermit FormsVNecPermltAppPg2 09- 01 -03.doc 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY + BUENNA VISTA 21002/003 . Plumbing Permit Application FoR m-Fi i. l';t U:\LI' R CEIV ..::: : i ' 9 • T. ing Approval Sewer City of Tigard p av: P erm i t N 13125 SW Hall Blvd. I 4 2n i RIa R iew Other Tigard, Oregon 97223 MA ' t e•. Use Phone: 503-639-4111 Fax: 503 -598 -1960 _ I:._ Land Land too Internet vvww.ci.tigard.or.us . ".i'J i TIGA' ` hur ls: .- See Page 2 for 24 -hour Inspection Request: 503.639.4175 - - : , - a IVIS 4 99 Su • lemeom Inlbraatioo. •L . 0114: r /. _•.o.•� 7.Y "�- - . r '•IFEB 1hi$' (forapeigatintO t O �.;.�1 1i . - • . DemOlitiOn Description I Q4• I react I Toad IN .. • t i k +Bl.7'a111t1c+ 211v...r .: ;, a•.�. r a s; ! , n : ' 'taade OPte far Id bbffitsebbeane ooPt t • 4.- F.1 III SFR (1) bath 249.20 - - SFR (2) bath 350.00 Ill Acces: • Build _ ■ i ni SFR (31 bath 399.00 III Master Builder 11111 Other: Each additional bath/kitchen 41.00 O B S l T E 1 r ! I F Q P . 1 1 4 A T I O N i i i d L ' O C A I T I O N . F i r e ft.: _ P e 2 1 Job site address: , . 134- u T _ .. ",' -, :. • • .... Slte>`lt ea', .; ,„.• ;':. :, ' if•1: ° - • . , Site #: B1dRJApt. #: Catch basin/arca drain 16.60 - Project Name: h line/trendt drain 16.60 Footing drain (co. linear ft.) Page 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.) Pate 2 Sri- division: Lot #: Storm sewer (no. linear ft.) Page 2 Tax ma • creel #: Water service (no, linear R.) _ Page 2 I • Fixture or Item •, ' , DESCRIPTION OF WORK • • Absorption valve l660. 1 ' CONSTRUCTION Backflow premier Page 2 PARILY DETACHED - • Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 : %e TA ...1 1.7 GINNER ' ., :* , Et • a • ANT : s.... . . :'eatortiautu- 16.60 Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6 9 3 2 SW l(aca eiam Ave: alp c „Ftxturrreewer cap 16.60 Ci /State/Zi • : Portland OR 97219 Floor drain/floor stilt/hub 16.60 Garbs - dis • . sal 16.60 Phone: t • ' ' Hose bib • 16.60 E B 3 r d ._. ice maker 16,60 Name: R a Mullen lnterceptorrase oats 16.60 Address: - Medical gal • value: S Page 2 Primer 16.60 Roof drain (contrnetct l) _ 16.60 Phone: Fax: Sink/basin/lavatorY 16.60 E -mail: Tub /ahoweds)ower pen 16.60 ' :: , • • . CONTRACTOR .. ' • - • - :"': Urinal 16.60 Water cloet Business Name: ED Mta7.ld;Ir1 Plumbing ,waterheatcr 1660 16 - 60 . Address: 24470 SW Rainbow Lane Other: City /State/Zip: Hillpber nR 971 21 Other: Phone: 503 -628 -1 632 . p ax :5 r -6 B - ae a 4 . :Plambie unit - - •. . Subtotal S CCB Lic. #: 1 , Plumb. Lio. #: - • . 0 - -- Minimum Permit Fcc S72.50 S Authorized / . • • .. . /..Z,9 4 Residential Bacidlo MMinimum Fee)36.25 Signature: j�rrt/ ✓ i _ - ' Plan Review (ZS%6 of Permit Fee) S Ray ul en State Surcharge (S% of Permit Fee) S .,..- (Please print nano) TOTAL PERMIT WEE S Notices Tbls penult applicatlon expires Ira permit is not obtained within • All cow eominerdal buildings require 2 sets er plane with isometric or 180 days s@er L has bees tempted u complete. riser diagram (br plan review. .Fee methodology set by Tri Bonding Industry Service Beard. IADOta\Pettnit Port nsPlmPermllApp.doc 0lio3 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information - - Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) " :> Square Footage: Permit Fee: Footing drain - I 100' 55.00 0 to 2,000 $1 15.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater - $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 S72.50 for the first S5,000.00 and $1.52 for each Future oiltem Qty ° ;Fee ( ei)K = ,Total ` additional $100.00 or fraction thereof, to and including $(0,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65 25 $25,001.00 to $50,000.00 S379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. • . • • ` Qtiantityby (Fixdae).WoticYecfomied:< Comments regarding fixture work: Fixture Type: - • _ Eteptue - • - . . New - :Moved ;'Fsts<fing - - ;'Cappca.% - Baptistry/Font - Bath - Tub/Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic P Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /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 A ► Al ► A IS STREET TREE C i ,,.. i A ► A I, I ktt , ®cane /' ent f or &eI V 5+4 I I . g � � 0. ® (PLEASE PRINT) PERMIT HOLDER) ► 4 4 It• ® 1s• il it ® 141. A Do hereb 4 a5ct f lie . ing location 01. ® � meets c x - ' • and _ . _ . e o n ounty ► A l and use and development standards for street tree installation. ® ► ® E 41 li■ ® ADDRESS: / V 6 / - 2 ® LOT: r ( SUBDIVISION: 8,, l A / ► ® BY: � , . /' w DATE: 7 Z. 0 ! 41 E 1 lit. ® RECEIVED BY 4,� �.i� % � / 4 DATE: 9 - / 4 — 0 CITY OF TIGARD 24 -Hour / BUILDING • Inspection Line: (503) 639 -4175 MSTO1 r 7 .- oq' INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested Zl.3 AM PM BUP Location / e 3 U ! / Suite MEC Contact Person �=� 1 /1.00 Ph ( )' qa -2 PO PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC IV_ Footing ELC 'M" Foundation Access: Ftg Drain ELR I ; Crawl Drain Slab . Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear 1-12-0 _ ' 2 c-) . ct °F- mp,x) . Framing I Insulation J do \<-1-t _ IA 5 -i \ ( Drywall Nailing 1 �( �rl" lv Firewall Are Sprinkler "a �' ��w� (�� a ' Fire Alarm G--; r-v vJ (L ` Q41`��', Susp'd Ceiling Roof Other: Final PART FAIL Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Othe . �nal� - S PART AIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage • larm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line Q� r V Q ADA Approach/Sidewalk Date t 1 Inspector ��1 Ext Oth er: Final DO NOT REMOVE this Inspectio ` rd from the Job site. PASS PART FAIL • CITY OF TIGARD 24-Hour q • BUILDING Inspection Line: (503) 639 -4175 MST / INSPECTION DIVISION Business Line: (503) 639 -4171 BUP ' Received Date Requested 1'fCf AM PM BUP Location / L /O9 a / Gk, Suite MEC Contact Person 1 Ph ( SZ 7/ O 069/ 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 Insulation Drywall Nailing // Firewall \ :t= 0 Fire Sprinkler Fire Alarm Susp'd Ceiling ` f 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 • :• PART FAIL - ' ANICAL 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: 0 Unable to inspect — no access Fire Supply Line ADA �{ Approach/Sidewalk Date 7/ / J e G" Inspector: Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING ' Inspection Li3) 639 -4175 MST ^�� 7 INSPECTION DIVISION Business /fr (503) 639 -4171 BUP Received Date Requested 1 7 — ' • AM PM BUP Location I L f a 0 3 (._) Suite MEC Contact Person edit .A.c0 Ph ( ) 6 4/.2 - zpa PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner r ) 118 ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear f ( �,n1 �a 1 `� \ n �i '� F z.b`(�� 6 , f _ Framing J 1 1`a, Ya `�► L. Y� Insulation 2 . �,�' (1 tt y �„ Qk(9 1a� �5 Drywall Nailing ' , l 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 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 F ire Alarm — PASS PART MN El 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 _— -- Y Approach/Sidewalk D Inspector Ext Other: Final j DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour S BUILDING Inspection Line: (503) 639 -4175 MST ra k e - eeno 4 1 7 INSPECTION DIVISION Business Line: (503) 639 -4171 E BUP Received ! Date Requested O �6 AM PM BUP T Location / a 0 3 c-c, Suite MEC Contact Person 9 Ph ( ) //D - 3 ll." PLM Contractor Ph ( ) 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 Oth: : si di P PART FAIL - • ' BING 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 Dampers PART FAIL E R ICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final Ei Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA G3 Approach/Sidewalk Date � �� B4 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL