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Permit t„, ,.. ,.. CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00096 � 1� .1I DEVEL a , SERVICES 94171 DATE ISSUED: 4/16/2004 97223 SITE ADDRESS: 14237 SW WALNUT LN PARCEL: 2S104BC -BW003 SUBDIVISION: BAILEY WOODS ZONING: R -7 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: PH2755R STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1.226 of BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,529 sf GARAGE: 668 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 DOM sf RIGHT: 5 VALUE: 271,790.40 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,755 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: 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 UNfT 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 FOR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: let V/OSVOFOR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 800 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps•1000v MINOR LABEL: 1000+ amoNolt : 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: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL /I SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,879.20 This permit is subject to the regulations contained in the BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES Tigard Municipal Code, State All l OR. work wil Specialty o ne i n 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES and all other applicable laws. All work will be done in PORTLAND, OR 97219 PORTLAND, OR 97219 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. Phone: 503 - 443 - 6033 Phone: 503443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg 6: LIC 152235 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You 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 Ins Gyp Board lnsp Appr /Sdwlk lnsp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final Foundation Insp PLM/Underfioor Framing Insp Gas Fireplace Water Line Insp Plumb Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final 6 r Issued By ' Permittee Signature i Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b ess ay Building Permit Applic 't Receive Building ►, Date/ G d Permit No.: I i ST� ,10 i-GiCo4, Planning Approval Other City of Tigard fEC Date/By pp Permit No.14 / �S 13125 SW Hall Blvd. 7, 1 .OQy A Plan Review Other Tigard, Oregon 97223 kit p►R Date/By: ,AM y /3 . ® y Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 d�A`''�'�'�y "ill`` Post - Review Land Use Internet: www.ci.tigard.or.us GCS G v .;_'_;14" -- CD ate/By (, ase No 24 -hour Inspection Request: 503�310'l Name/Method: , / .p � Su See Page for t l Information _ Supplemental Information TYPE OF WORK . _ •. - . REQUIRED DATA :. ® New construction ❑ Demolition i & 2 FAMILY DWELIDIG_ ` ' ' • - ❑ 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 ❑ 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 El Master Builder ❑ Other: Valuation S JOB SITE INFORMATOr and LOCATION No. of bedrooms: No. of baths: 3 Job site address:/I 37 , I W 4 0/ L!i Total number of floo New dwelling area (sq. ft.) � Suite #: Bldg./ pt. #: Garage/carport area (sq. ft.) Ca Pro Name: �/.r1 I/0d - O(/ Covered porch area (sq. ft.) ' Cross street/Directionsi . ob site: Deck area (sq. ft.) ?l Other structure area (sq. ft.) ' _ ', i - REQUIRED DATA:- : , • • ' Subdivision: . - - - COIMMERCIAL := 1JSE,CHECKLIST ` ^_ . Lot #: 3 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 - { ❑ 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 PERMIT FEES• : . • - • . CONTRACTOR - • • • Please refer to`fe. .- ., 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 I Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized //i� _ Signature: G/• f 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 Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Petmit Form s \BldgPermitApp.doc 01/03 • t• One- and Two - Family Dwelling • ;; :,,, Building Permit Application Check list : Reference no.: City ofTigard City of Tigard Associated permits: O Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other: Phone: (503) 639 -4171 • Fax: (503) 598 -1960 • HIE FOLLOWING FILMS ARE REQUIRED FOR PLAN REVIEW Y es No N / :\ 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 0 plan 0 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. II 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 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. II; RISDI('TIONAI. 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. 440a614 (6/00/CO51 - 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 82 �r ra s y —oerc9ta Electrical Permit ADDIelym FOR 01 L SI: NI Received Electrical ecG P Per nit No.: City of Tigard �G Planning Approval sign Date/By: Permit No.: 13125 SW Hall Blvd. 'I, 4 2 Plan Review Other Tigard, Oregon 97223 Mpg Date/By: Permit No.: Phone: 503 - 639 -4171 Fax: 503 - 598 - rftpZik Post Review land Use Internet: www.ci.tiganior.us Or( .. . 0 1/l Dam/B , Case No.: Contact 24 -hour inspection Request: 50 Juris.: Name/Method: I ® See Page 2 for Supplemental Inlbrntatian. •. TYPE'OF W ' ' '',...'. ' P,I.1►1f,REVIRW.(PIep ere' ebtaio<Vtltat:iip�Ib1 :•: y .! ew construction Demolition ❑ Service over 225 amps- 0 Health-care facility ID Addition/alteration/ lacement Other: commercial ❑ Hazardous lactation Service over 320 amps.rating of ❑ Building over 10.000 square feet, t.ATE60BYt�FCO1 1E1 ., ❑ 1 & 2 family dwellings foor or more residential units in A & 2- Family dwellin Commercial/Industtial ❑ System over 600 volts nominal one structure • Accessory Building H Multi - Family ❑ Building over three stories El Feeders, 400 amps or more El Master Builder O — cupant load over 99 persons ❑ Manulketured structures or RV park Other: ❑ Egrest/lighdng plan ❑ Other: :. •• ' JOBSITE rORMA'1'ION - and L ON' • • . Submit set+ of plans with any of the above. Job site address: 1 ( J ate above are not applicable to temporary eoa■tnretlon service. Suite #: Bld ./A t. #: Number of ina�pecdons per permit allow Project Name: Description Qty 1 Fee (ee.) Total 1 Cross street/Directions to job site: New residential-single or multifamily per dwelling auk. includes attached prage. Service lecleded: 1000 sq. R. *Hess 145.15 4 Each additional 500 eq. R. or portion thereof 33,40 1 ' Lot #: f hnited ever resi d ential Subdivision: 75.00 ' 2 Limited energy, non residential 75.00 2 Tax map/parcel #: Each manufactured home or modular dwelling • • • • DE • • t • • Pi •OFWORK s. • ....• •. service and/or feeder 90.90 2 • v Services or feeders - hutaltatioa, �eV GO/75 — S / /9IC R/)iiiJ alteration orrelocadon- De±1 Gh e c T...o, en e2-- 200 amps or leas 80.30 2 201 amps to 400 amps 106.85 2 col amps to 600 amps 160.60 2 f , T..: O P E R T Y O W N E R . ' ... . I I • ' • : . 601 a,nm to 1000 cops 240.60 2 Name: 1(h l e a - }z1, ■ Over 1000 amps or volts 454.65 2 Reconnect only 66.85 2 Address: , '2,.. ] acacia d e, 6te.` Temporary services or feeders - installation. City /State/Zi i : Per - f (� 0 t2-- 200 am ioa, or relocation: 9 - 1/9 200 amps or tesa 66.85 t Phon • y 3-- -. -, Fax :.t 3 201 amps to 400 amps 100.30' 2 401 to 600 amps 133.75 2 II ::.. - C. . . - la svx 4- s N Branch circuits • new. alteration. or Name: 'S - V4. / • SS extension per panel: Address A. Fco 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: service or feeder fee, first branch circuit 46.85 • 2 Fax: _ Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included). "+ . )TRA OR • Each pump Of Irrigation circle 53.40 2 Each sign or saline lighting 53.40 2 Job No: Signal circuits) or a limited energy panel. Business Name: j1 0SS alteration, or extension Page 2 y� Description: Address: 870 50 Zi t= 003 _ City / State/Zip: if i HS k t-O , DR 171a3 Each additional inspection over the allowable In any of the above: Per inspection per hour (min. I fora) 6240 Phone:5213 (e Liz Z300 Fax: 6;:3 is- Investigation fee: CCB Lic. #: iS75$/ Lic. #: 3 36G . Other — Supervising elec a ciao . : =_: ; ' • Lit iit��eleml i Subtotal ;A,.: ;� �: ; . ' 1(�� Stotal 3 X signature re ire T� Plan Review (25% of Permit Fee) S p( Print Name: S) !e ROS J Lic. #: 4 121 9 7S State Surcharge (% of Permit Fee) S Authorized TOTAL PERMIT FEE S , Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been ateepted as complete. *Fee methodology set by Tri- County Bundles industry Service Board. (Please print name) l:\Dsts \Permit FnnnalcPermitApp.doc 01/03 03/04/2004 16:26 5@32537693 57�� are 74O N GLOW INC PAGE 02 Mechanical Permit Appl>tcation Received Mechanical _ Oateniv: Pent* Ne.: City of Tigard Planning Approval Bo!tdieg • ® Date/BY Permit Na• 13125 SW Hall Blvd. R EC E. D � Flan Review Other ~� Tigard, Oregon 97223 r Permit No.: Phone: 503 - 639 -4171 Fax: 503 , - ' F teen eW Land Use Dot fB : Internet: www.ci.tigard.or.us MAR . ,t:' ` � er Cas orris.: N o.: Sag Ihr 24 - hour Inspection Request: 503 Namehile tod: Sopptemmeetai inlbrmadoo. CITY OF TIGARD • -.•.. , y -. •:• FWORK•:Tr,3 - 44. -', ,. ,.•..• '' _ ::Y. •PE8C .._. If New construction IN Demolition ' Mechanical permit tees* are based on the total value of the work to A. • • alteration/ " • lacement • Other: performed. Indicate the value (rounded to the nearest dollar) of all Z'Erd a` � z ; �titi i mechanical materials, equipment. labor, overhead and profit. 4 1 & 2 -Famil dwell , _ • Commercial/Industrial Value: S See Page 2 for Fee Schedule l/ Accesf;o Buitdin_ MI Multi Famil Description i Qtr f >ceKee.) 1 Tow ail Master Builder Other: Beads.%Cootiag •,JO : • srrE lrilFOPMAT[obt and LOCATION • '; :. • _ Furnace • add-on air conditioning" 14: 4.00 r Job site address: FIMIEMIP.......MIIMIIII Gas heat pump 14.001 Duct work 14.00 Suite Ydronic hot water system 14.00 Pro'f►ct NName: _ Residential boiler Cross street/Directions to job site: (kr radiator or h system) 14.00 Unit heaters (fuel, not electric) (in wall. induct, suspended cm) 14.00 Flue/vent (for any of above) 10.00 Lot #: Repaar units I 12 Subdivision: _ (Vier Fite' ...,____1_1.25__ llama Tax - • arcel #: W r` heater 10.00 '• DES ei : I (0N'F•' •RK .• . • • ons lacc _ - 10.00 NEW CONSTRU 0 -SI ' GL - F • I ' Flue vent (water hater /ass fireplace) 10.00 _lig (eat) 10.00 DETACHED RESIDENCE LogWood/Pelletstove 10.00 _ Woad plant/insert 10 .E ,- _ ^ . Chimney/liner/flue/vent 10.00 MAIM ir ' •r• Other. 10.00 �F �' p1�R'S'Tf a :a ! – Enattonmeoml exhaust & Veatt*Boa �. Name: B _ _ ,- ; ' • , . • Range hood/other kitchen equipment 1 10.00 Address; 69_12 SW Maea: _ ±, _ _ - S - C Clotho dryer exhaust 10.00 Ci /State /Zi . : Portland OR ' 7219 Single duct exhaust Phone e _ .. _ . , Fax: t _ I ,. • - • (bathrooms, toilet compaturtcnts, LICAPFI' •. • • *n CONT ' x'. r .' utility rooms • 6.80 Attic/crawl 10.00 Name: David Golo Other: 1 10.00 Address: t l ' : City/State/Zip: AO fbr first 4. S1.00 tacit additional Fume etc. " Phone: Fax: cos heat : � _ =up MINI " E -mail Wall/surpeoded/unit heater ` ` Co • CTOR ••'':. •. . • • • ME . • ., ::• • • • ;..: Water heater .• Business Name: _ _ . .. Fireplace t . •• Address:2428 SE 10 Ave. Raamfle BB. CivIState/Zip:Port1and, OR 9721 Clothesdryerskts) Phone: 5 0 3- 2 5 3 - 7789 Fax:503- 5 - b -.3 Other: Total: . CCB Lic. #: 4 81 31 Mechanical Penult Fees' _ A ed ` � � Subtotal: S Signature: + - _Date 7smt`I Minimum Fannit Fee 572.50 S David Gol Plan Review Fee (25%of?amitFee) 5 State Surchart a (8% of Permit Pee) S _ (F ease pr int nattte) TOTAL PLOW FEE S Notice: This permit application expires If a permit is not obtained within **Site methodology � :\D Bunk Industry Service Board. t80 days lifter It tun bees accepted d complete. istaTermit Fannst McSFermitAPP 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 $100,000.00 $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 $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. 1:18uiidinglPermit Forms1MecPermitAppPg2 09- 01- 03.doc • 03/04/2004 16:21 FAX 5036284633 _ THE MULLEN COMPANY + BUENNA VISTA a 002/003 /// .J02G y - C U ? Plumbing Permit Application ja i, City of Tigard RECEIVED Date/13 : Planning Approval Sewer j Dau/av: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 MAR Z 4 2004. Date/Bv: Permit a: . Phone: 503 639 - 4171 Fax: 503-59g-1960 Pas - zview the _ ` I Date/I3 : Cue No. Internet: www.ei.tigard.or.us C yGq J J See Page 2 for 24 24 Inspection Request: 1I luris: IVISI i !� J L 9u • • • • a • • ntr,rtaatioa. . _ ..s.e. • • - • • • • 111 ., , r /'.- ; :o. 1 , r••_ _ _ 1711rICHED JLE'fOra ini(Ol' "ii 6lietit icy 4:. I New construction ■ Demolition Description Qty. P ea. Total lU Addition/alteration/replacement ■ Other, - • ti � Y , w' °r.I *': ; • "' • ':' -� �` �'� �If F$�;� �?7: s : �$:r�` ' •' : •..CA EGONI ?OT: pNl I ..... . , :: M ''0oetu , 0 lbr tb assiYreo`aaed'tToe e ''+; •. ; %,• SFR (1) bath h 249.20 I & 2 - Family dwelling ❑ Commercial/Industrial SFR (2) bat 350.00 gin Accessory Building B Multi- Earnijy SFR (31 bath 399.00 it Master Builder Other: Each additional bath/kitchen 45.00 OB SITE INP..ORMA:TIt� AISL'OC:*T,ION • " Fire spinkler - ea. Et,: Pae 2 Job site address: /' 9-3 7 WA-1. tiu r 1--L) ' .. ••• • • . . SttWVtiaties ; ', ...� ti':.',2iYi'.t. ' - • • . Suite #: 1 Bldg. /Avt. #: - Catch basin/arca drain 16.60 Project Name: , Drywall/leath line/trend( drain 16.60 Footingd (ne. linear ft.) Pace 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 Subdivision: - 1 Lot #: Storm sewer (no. linear ft.) Pare 2 Water service (no, linear ft) Page 2 Tax map/parcel 4: , bIPSCRirtioN -oFwon - - Absorption Absorption valve 16.60. NF, ,CONSTRUCT ION - SINGLE FAMILY Baddlow preventcr Paste 2 FAMILY DETACHED RESIDENCE Bae&watervalve 16.60 Clothes washer 16.60 Dishwasher 16.60 16 60 ro 'PitOPERIY'bl0ltN ' •. +k g7 ANT : Drinking fountain 16.60 �eotorslDUmD Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6932 SW l(ac dam Ave _ ste,_ c Ftxtureleewercar 16.60 ' Floor Garbage 16.60 City/State/Zip: Portland, OR 9 9 • Garbage disposal _ 16.60 Phone: 503 -443 -6033 Fax: 503..443 -2443 Hose bib • 1640 .. �APPUICA,NT • . '••" ceinfac $4N • • • Ice maker 1 6.60 ' _ Name: Ray mullen Interceptor /grease bap 16.60 Address: Medical au • value: S Page 2 Primer 16.60 C /State/Zi • : Roof drain (commercial) 16.60 Phone: Fax: _ stoic/basin/lavatory 16.60 E -mail: Tub /shower/shower pan 16.60 . CONTRACTOR • • Urinal - (6.60 Water closet 16.60 Business Name: ED Mullgn Plumbing Water heater 16.60 Address: 24470 SW Rainbow Lane Other: Ci /State/Zi • : _ . . . • : - Other. • Pluaddi f tole: e a • • Phone: 50_1-628 -1632 - ex: 5Q3- 6 2R -a Subtotal f1q �� S _, CCB Lic. #: 1 Plumb. Lio. #: - - • . 0 - ' • Minimum Petmlt Fce S77-50 S Authorized .5. .. Residential Bacltflow Minimum ktg36.25 Signature: ✓ ` ' Plan Review (2396 of Permit Fee) S Ray ul en State Surcharge (8% of Permit Fee) S (Please print name) TOTAL PERMIT FEE S Modem This permit application expires Its permit is not obtained within All nowcominerdal bulldleas requital Bets of plane with isometric or 180 days after It has been accepted u complete. riser diagram (br plan review. • Fee methodology set by TN -County Bonding Industry Serried Board. 1 :tDsts\Pertnil Forins\Plmt+ermltApt 01103 Plumbing Permit Application - City of Tigard . • • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) ' '-.Total . : Square Footage: Permit Fee: Footing drain - l 100' 55.00 0 to 2,000 5115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 5160.00 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 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and • Fixture orltetir' ": `. ' _ ; . Qty. ' ;Fee(ea)? <.; Totat 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 S25,000.00. Rain Drain, single family dwelling 65.25 S25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 51.45 for each additional S100.00 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 S742.00 for the first $50,000.00 and 51.20 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 *. . Quantity by (Fixture) WoricPerfoimed...; Comments regarding fixture work: Fixture Type: Replace` - . • .. • New -_ : Moved - 7-fCip •G 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" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic uner 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. /Refng. 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 ®® AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAA !, A '1,, ' • AT ION �t TIFIC CER ET TREE THE S i ® ill ® / ;jp • I , P E PE N 11 4I , 6w ner " g e nt . f o r 8UFN ��5 GUS�M ftDM5 E (PLEASE PRINT) i 1, (PERMIT HOLDER) I .. eb ® G ~ ,. 1 • D hereb Er I � J qv n e rq w1I�}g location 1 ® meets <% " - E" ._ = rd/Kl h'" ,ion Count y Jiii 1 land use and development standards for street tree installation. 4 ,, • io, • 2 7 U 4 /i/iLit* N pit 4 ADDRESS: ro 0 1 kb i LOT: SUBDIVISION: A l z° 00 0 4 , ' 0 i D ATE: 5 /0 Li itro ® BY: Lac. ' y.. 0 ® DATE: � � � RECEIVED BY: mil. - 0 ® rYYYYVV!YVY VVYvY VVV VV VVYY YVYVVVVYVVVVVVYVVYYVYVYYVYVYYVY CITY QF TIGARD 24 -Hour BUILDING Inspection Line: (503) 6 • 175 MST ,--206) ,--206) i_ de) •G� 6 (,„ INSPECTION DIVISION Business Line: (50 .39 -4171 t BUP Received Date Requested - AM PM BUP Location l a _ i . Suite MEC Contact Person %� �L ( - ) 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 �� � FramingO _ d4r—, "' =`% va Insulation '7 Z - D / 1-<5 Drywall Nailing Firewall Fire Sprinkler ` � �'� - Fire Alarm Susp'd Ceiling CASC Roof Other: da, PART FAIL i 1 VT �� 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 _ ICAL Service Rough -In UG/Slab Low Voltage Fire Alarm a • 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 ` A Ext Other: Final DO NOT REMOVE this inspection reco from the job site. PASS PART FAIL CITY OF TIGARD 24 - Hour BUILDING - Inspection Line: (503) 639 - 4175 7 r (f,. 00 a , INSPECTION DIVISION Business Line: (503) 639 -4171 ,n, BUP rr Received `� 5 Date Requested / � AM PM BUP Location 231 L & t- Suite MEC Contact Person I -l-(J2. Ph ( ) • 0 " 04 I 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 1 412, Fire Sprinkler (/ Fire Alarm \_ Susp'd Ceiling / Roof l/! JV Other: 11 Final PASS PART FAIL q' c UMBI l Pos cam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot ` _F ART FAIL ICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date .4-5/e Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 6394175 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 7/5 AM PM BUP / Location - _ • '_.. a Suite MEC Contact Person C. 9 Ph ( ) Z'' ' a 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 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 Fir Alarm PAS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line - ADA TJ , Approach/Sidewalk Date `--71:; / Inspec Est Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL