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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00094 2 :p DEVELOPMENT Tigard, PMENT S RVIC 9 171 ES DATE ISSUED: 4/16/2004 13125 SW � SITE ADDRESS: 14277 SW WALNUT LN PARCEL: 2S104BC -BW001 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: New SF detached. BUILDING REISSUE: BVH2550 -4 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,121 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.429 at GARAGE: 640 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THR0. of RIGHT: 5 VALUE: 252,168.00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,550 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 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 < SHP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 • 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVO'FDR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601+amps- 1000x. 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: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL S SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,771.87 BUENA VISTA CUSTOM HOMES INC BUENA VISTA HOMES This permit is subject to the regulations contained in the 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES Tigard Municipal Code, State of OR. Specialty Codes PORTLAND, OR 97219 PORTLAND, OR 97219 and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or rf the work is suspended for more than 180 days. Phone: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg ft: 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 Low Voltage Storm drain Insp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Gas Line Insp Water Line Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service Insp Building Final Foundation Insp PLM /Underfloor Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Post/Beam Structural Mechanical Insp Exterior Sheathing lnsf Rain drain Insp Electrical Final Issued By : 454..r'L.l•L6 Permittee Signature: G��k V aCi Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n business d y Buildin g :11 n Permit Ap��l FOR OFFICE l'SE:ONLY EL Received Q 2 Building i Q Date/By: d a ' J Permit No.: rt 5T,',Q4 -D OO W City of Tigard \ Planning Approval Other �AR 20 1 1 Date/By: Perrnit No.:O Q�1D0I' C 9 3 13125 SW Hall Blvd. 2 3 Plan Review � Other Tigard, Oregon 97223 T RD , Date/By: "V ✓ - 1 1-13 - I Permit No.: Phone: 503 -639 -4171 Fax: G18 $ 1 i ''.y ' fI�' Post-Review Case No. Internet: www.ci.tigard.or.uBU1t.DIN � � - C ontact 24 -hour Inspection Request: 503 -639 -4175 yp�� Su See Page for P Q Name/Method: / /0)• Supplemental l Information . TYPE OF WORK . • ' - _ ': REQUIRED DATA: _ [] New construction [ Demolition 1 & 2 FAMILY DW_ ELLIIYG - ° ❑ Addition/alteration/replacement [ Other: CATEGORY OF CONSTRUCTION . Note: Permit fees* are based on the total value of the work performed. Indicate © I & 2- Family dwelling El 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 El Multi - Family ❑ Master Builder ❑ Other: Valuation S . JOB SITE IOVORMATION and LOCATBAN No. of bedrooms:— No. of baths: 3 Job site address: 11-42, LOA- L. ki uT Total number of floors Suite #: Bld g p /A t. #: New dwelling area (sq. ft.).. .. ::. Garage/carport area (sq. ft.) Project Name: i 5 p 1 LF. y 1.,000 Covered porch area (sq. ft) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) . 4- - . ; , •,-•REQUIRED DATA:. . - • ' • COMMERCIAL_ =USE CHECKLIST..;g• . Subdivision: I Lot #: I . 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 . . I ❑ 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 El 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: El iabeth Moore from licensing, the following reason applies: Address: City/State /Zip: Phone: I Fax: . E -mail: • . .. BU1! DING.PERMIT iii*..::: : • CONTRACTOR • ' • . •- Please iefe torfee sehe"tdih • Business Name: Buena VIsta Custom Homes Fees due upon application S Address: 6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 9721 9 Amount received S Phone: 503- 443 -6033 I Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized - 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 Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Fomts \BldgPemtitApp.doc 01/03 • One- and Two - Family Dwelling • Building Permit Application Checklist Reference no.: City ofTigard City of Tigard Associated permits: 0 Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 IIIF: FOLLOWING ITEMS ARE REQt IRED FOR PLAN REVIEW Yes No N / :S 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. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub - floor, wall construction, roof construction. More than 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. 1l R MDR `I IO \:V. SPE( Ill( ti, 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. 4404614 twoacostr 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit ' tion FOR t,l l'1( h. l SI. aReceived Electrical B : Permit .,,.: . ' � ,•r� �i 4 City of Tigard R C Oatu Planning Approval Sign Date/Dy: Permit No.: 13125 SW Hall Blvd. t, � D 2 2004 Plan Review Other Tigard, 6 97223 I� O R I1 � p CW Land Use Phone: : 503- 503 -633 9 -4171 F , f Internet: w,ci.tigard.o� NG pI C : ww 24 - hour Inspection Req ; : = 63 9 -417 5 C Name/me/ Ju ris•: S ee Page for Methad: Str rVolemental Information. :;TYPE'OF W .OI K •' :•.; PLANRBV1EW (Pleast•e8i:aa7FtIrat : i ptly)� . •: hi N ew construction .E_Demolition ❑ Service over 225 amps- ❑ Health-care facility 1:3 Addition/alteration/replacement Other: cemanercIal ❑ Hazardous location ❑ service over 320 amps - rating of ❑ Building over 10.000 square feet. • . TEGORYOF'CONS$8 110EION. 1 & 2 family dwellings tour or more residential units in & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure Accessory Building Multi- Family ❑ Building over three stones Feeders, 400 amps or more [] Oc cupant load over 99 persons U Manufactured structures or RV park ,.. Master Builder Other: ❑ Egress/lighting plan 0 Other ::' '' '• TO10.SI•I'E t I ORMATI04W4wtl•EOCA"IYON • Submit seta of plans with any of the above. t • IA-1— _ The above are not applicable to temporary construction service. Job site address: LP:'�i Suite #: Bldg./Apt. #: : . . . • � • ' — . 'FED! a, :::� , -.` ; •�� ; 5• ., :v ,- ;;,;-:41:7. : '-•: ; . •� •;'; Number of inspectloas per permit allowed _P__ r oject Name: Description Qty Pee (as.) Total I Cross street/Directions to job site: New restdeattat- eiagle or matt4hmUy per + dwelling trait itrendel attached garage. Service Iachded: 1000 sq. R. or less 145.15 4 — Each additional 500 sq. R or pardon thereof 33.40 1 Lot #: Ltrnited cner residcnti Subdivision: t 75.00 2 Tax map/parcel #: Limited " . . • •DE ' • • . r . • e K OFWORK • • • ' .. service 2 � ` i sem,. or feeders - installation, �� GOlI s — S /���C �pI711 /y alteration or relocation: • > ±t Lh e 3. en Cam-- 80.30 amp¢ or less 80.30 2 201 amps to 400 amp: 106.85 2 401 snips to 600 ernes 160.60 2 O)R�RTy OWNZR :. , . it - : - 601 rips to 1000 ame 240.60 2 Name: en a 1 S �� S Over 1000 amps or volts 454.65 ' 2 Reconnect only 66.85 ' 2 Address: '', a(1(,lp/n Aye, l� f�. Temporary services or feeders - installation. Cit /State/Zi : 'Or+(G 012 ' ` ThL /Q alteration, p e relocation: amps or less 66, 65 1 Phon • t/ 3-- -.', Fax , - 3 201 amps to 400 amps 100.20 2 II - • . _ C —..,. t�_ a e 4 ':'4N . • 401 to 600 ears 133.75 2 �. -� Branch circuits -new, alteration. or Name: c� 1. / • SS extension per panel: AddreSS' A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State/ZiT): B. Fee for branch circuit without purchase of Phone: =Tyke or feeder fee, first branch circuit 46.85 2 I Fa Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included); ' 1. . - • CE1Z1litR Each ptatrp or trriRation circle 2 Each a or outline lighting 53.40 2 Job No: Signal cireuit(s) or a limited energy panel, Business Nam;: 05,5 0 Etz . alteration °r extension p 2 _ 2 QS S 5 k) *Ai $4 `r;pt;ore Address: City /State/zip: Ili Ks g , DR 171a..3 p Each additional iaspection over the allowable In an of the above Per inst eztion per hour (min. 1 hour) 62.50 Phone:.$b-3 (o '/Z Z300 Fax: 6i'3 4, z 1 15- investiaation fee: CCB Lic. #: I57,39/ Lic. #: 3 3& . • Other Supervising electrici - • .. :- . •Llizstileal;Pdrmlt , :,,: ;h � :. :• . . X _signature required. �`" ' , : Subtotal �' . . � Plan Review (25 °� of Permit Fee) $ 5 ( Print Name: .sfe..ve ROSS) Lic. #: yz3aS State Surcharge (8% of Permit Fee) $ Authorized TOTAL PERMIT FEE S Notice: This permit appgettion twirls It a permit is not obtained within Signature: Date: — ISO days after it has been accepted as complete. *Fee methodology set by Tn -County Building industry Service Board. (Please print name) - i:OstaN Perth Forn lE1ePermitApp.doe 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 Mechanical Permit A lica inn Received V Woe : - 000 J GE Planning Approved of T'r L ,,., GG1 Da.. • ROIIIIIIIIIIMI 13115 SW Hal B A Prat Reviiew • 1 Tigard, Oregon 97223 Q ?, 100 °°' Phone: 503 - 639- 417�11AP= 503 - 960 Po ea, Ilemefetet: www.ci.ti ,qr SlG Q j� _ ���:� Coot= kris.: Seepage f) 24 -hour Inspection � 9+4I75 , tantdMeth oet: Se, � u..: • tei Inrbrmattow • BO • ,. • . . " - ,_e :;.., :, ...:a:-r'F:. , : t:: Cpl{ Mli:Ral,L•tritEe. SCIINZIIILE er.gfiR.CRIliallISr ; ; •-:" OF LI! New construction • Demolition Mechanical permit fees* are based on the total value of the work L Additi • alt . ,, . • . : r , • Other: performed. Indicate the value (rounded to the nearest dollar) of all . - .. ,•CATEGO • . e '.1C -y.t; . nip y VI, \_: ='" `'''•; = mechanical materials, equipment, labor, overhead and profit r4 , ►•:.lur�11. .. . Value. S See • 2 for Fee Schedule ,, :/ � � � �ks�a�rrlt�t� rn s>�s1ae�:= • -:,A,» . M Accessory Buildirl_ r Multi Famil Deseriptlon Qtr T Fee(ca.) l Total • Master Builder Other: Hatt WCuurne .JQD SuE TIQN and LOCATION •:.. • Furnace • add -on air condi . .,, i, • *' 14.00 t Job site address: 4a7 _ it) » i •J t ccr >A — " Suite #: Bl • - A. t. #: Duct work NM 14.00 — ,, „ 14.00 Proj Name: Residential boiler • Cross street/Directions to job site: kr radiator or hddronie system) _ 14 Unit heaters (fuel, not electric) in wall, in.duet, suspended ctc.) 14.00 Flue/vent for an of above 10.00 Lot #' Repair units 12.15 Subdivision: ' • . Fuel A . • ltaaed Tax map/parcet #: Water heetet 10.00 • ' • . '• DES or: rd. ION + • ' • RK • ., • Gas fireplace 10.00 NEW CONSTRUCTX• —SI ' GL - F. I Flue vent (water heater/ • ti ' e) 10.00 Lo_ li , r 10A0 DETACHED RESIDENCE Wood/elelletstove 10.00 10.00 . Chimney/lined ue/vent 10.00 NW 7,7=e ' : Nang XI TENANT: 2 r ,..•:.. Other. 10.00 P.ettvamental eximusc dr. Ventilation _ Range hood/other kitchen equipment 1 10.00 Address: 6 7 _ SW Mac - . _ ±+ _&_ - S - C Clothes dryer exhaust I 10.00 Ci /State/Zi 0. Portland OR ' 219 Single duct exhaust 1 Phone e _ . e Fax: s . _ . (bathrooms, toilet cosnp tttmcnts. sw _ . ail corn , t • •' 5", t will rooms . 610 Attie/crawl •ace Eons _ 10.00 Nom David Goloba Other; 10.00 Address: smINNIIIIIIIIMINIIM *�(SSAO for first 4. S'1-00 Mb additional) City /State /�i�_ Foresee, nee. . 1.0. phone: Fax: _ Cress heat Liu- ** E -mail: Wall/sus • elided/unit heater CONTRACTOR • Business Name: r _ � A&hess:24 28 SE 10 5 t.h Ave . BBQ •• City' /State/Zip :Port13fd OR 9721 6 , Clothes • er -es `" Phone; 503 253 - 7789 � Fax 5O3- 253 -fib ". Other: —� Total: BIII . CCB Lic. it: 481 3 1 Meeba • r'i Permit Fees* AuthorlZ . gob •• S Si tre Dates 12=y Minimum Permit F - 50 IMEMIIMEMIN David G lob y x ' 5 State w • : o Penmt Pee S (P ease print name) TOTAL • - 71 - m a IMIMIIIMIll expires If a permit is not obtained within *Fee methodology yes by 'Di-Courtly Building Industry Service Board. Notice: rat Tins It ba s application esp ••She ptan required for esterlor A/C %mitt. 180 dare after it bas bees emoted d O C �enplete• i:Vsts%Pcrrnit FartnnMer:PetmitAtm • 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. I:113uilding\Permit FormssMecPer nitAppPg2 09- 01- 03.doc • • 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY •► BUENNA VISTA a 002/003 Plumbing Permit Application eived Plumbl ^8 �h a CO ' 9 Date/By: Permit Na.: 2 City of Tigard PAS Approval Sewer Date/5v: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Until No Phone: 503 Pax: 503 - 598 - 1960 Post.Raview Land Use Internet www.ci.tigard.or.us _1_ oate(B : Cue No.: Contact Juria-i See Page 2 for 24 -hour Inspection Request 503.639 ■4175 J Name /Method; 9ueolom °e of tnWrmation. .. • . . •' ,1 : 4 : ' f'' _' " - . r - • '1 . t SC D.ULE•(far tiafo dbltr:l�e" LilM I New construction • Demolition Desert thin Qty. ea. Tula IM Addltwn/slteratto •tacernent `ill Other. -.: ^� y� • i1, +�. /►�a+uws ,?�'' 'Ii i .r,.4. ..CA EGOR O .ii17. Kti N' ➢ 1)1`.• fNORI t......�.w J -'«•�' SFR(1)bath 249.20• r.'7 1 & 2 -Famil dweIlin: IN Commercial/Industrial SFR (2) bath 350.00 L i r ► 01•4= Karr ri_largil SFR (3) bath 399.00 1r Master Builder ■ Other: Each additional bath/kitchen 45.00 OR SITE 1. PORM&TIQP>aaindL'OC*T,IONI ' ' Fire ezinkler • so, ft.: P e 2 Job site address: , , `) W L _ . _, ... ` :. • • ... Eta ; , :�_, :, :, • , ty - ... . Snipe #: Bldg./Apt. #: Catch basin/arca drain 16.60 Project Name: Drywall/leaeh linehreneh drain 16.60 I Foods drain (no. linear ft.) Page Cross street/Directions to job site: Manufactured home utilities _ 110.00 • Manholes 16.60' Rain drain connector 16.60 Sanitary sewer (no. linear ft. L Page 2 , Su- division: Lot #; Stern sewer (no. linear ft.) Page 2 Tax map/parcel #: Water service (no. linear ft.) tam . . • Page 2 - , Mercer' ` bESCI ) TIOIWOF WORK Absorption valve x.60.' NF,iN CONSTRUCTION - SINGLE FAMILY Backflowprcvcnter _ Page2 FAMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 X' '7 :L ' t ' I •.:1- ', .'0 : ANT • ... 16.60 $1t•ot0re/sutrtp Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6932 SW Macdam Ave: SID C Fixtureleewer ca - 16.60 Ci /State/Z1 Portland. OR 97219 Floor • di s lour sink /hub 16.60 �� Garber • dis • •sal 16.64 Phone: 503-443-6033 Fax: 503o443 -2443 Hose bib • 16.60 €dti 9APPLICANI . . '. R _ ° , • • A4 a' :...N . lee maker 16.60 ' Name: R a Mul len Interceptor/grease trap 16.60 Address: Medical Rae • value: S Page 2 Pier 16.60 Ci /State/Zi • : Roof drain (commercial) 16.60 Phone: FaX: Sink/baeieflavatory 16.60 . Tub /ehower/shower pan 16.60 • ' : • • . CONTRACTOR : • • • • • • : • . Urinal 16 -60 Water closet 16.60 !- Business Name: ED Mullen Plu n W ater heater 16.60 Address: 24470 SW Rainbow La 13e Othe r: City /State/Zip: Hit bar . nR 971 21 Other. - Phone: X 503 -628-1 32 Pax :5 t - . S -4G •.:PluwbietlEecmkl dse.:s'• Subtotal CCB Lic. #: . 2 g g 9 Plumb. Lio. #: - . ' • 0 . • I: ' ' Minimum Parcel Fee rasa S Authorized / Residential Backflow Minimum FEW 4.25 Signature: -LA/ A ' •• ' Plan Review (2596 of Pacer Fee) S Ray ul en State Surcharge (895 of Permit Fee) S (Pleas. print name) TOTAL. PERMIT WEE . S Netker This permit application aspires Ira percale is Dot obtained within • All owcommercial buildings require 3 sets of plans with isometric or 180 days after L hat been accepted as complete. •Fee methodology set by Tri- County Bonding Industry Service Beard. l ADsts \Permit Fortns\PlmPenxltApet.dec 01/03 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 S115.00 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 51.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to 510,000.00 572.50 for the first S5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and • _Fixture or!ten) ' ': V • • Qty. ' • Total, ; including $10,000.00. Commercial Back Flow Prevention Device 46.40 510,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Bacldlow 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 65.25 525,001.00 to $50,000.00 S379.50 for the first $25,000.00 and 51.45 for each additional 5100.00 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 *. 'Quantity by(Fixtttre),W kPerfoimed.t Comments regarding fixture work: Fixture Type: _ ' Replaee - . New . : Moved • Eitsdi :Gipped 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" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic 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 MachiRefng. 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 FormsTlmPermitAppPg2.doc 01/03 sraovy- 9y ®AAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA 1 __ 1 1 `► TREE CS Al Itt* Al It* ,.. ® I, 'TRy P EN I U IC caner/ gent for J. UE J PI V 1 CPA CM /Nvl B OMES (PLEASE PPJN7 ) (PERMIT HOLDER) � A- I � -A Do hereb A a F o ; a 'l Owing location ;,,,A 44 meets ,t, 'x0. "Tai _ d - g ton count I. 1 land use and development standards for street tree installation. Ofo 1 It- 44 IP. - ADDRESS: f 'y Z 7 7 - $ L/ Uri `,4J f L. NI R. A LOT: I SU BDIV ISIO N: '�..). f l G�/ (J d s DI- 411 It* BY: 77A-PJA-4 DATE: 7/15/ RECEIVED BY: '1 , ��/:. ...oar,/ DATE 7- l4- 04- 0. 41 CITY OF TIGARD 24 -Hour ,, // c� BUILDING Inspection Line: (503) 639 -4175 MSTt��t `7' - / g INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested 7 —;.- AM PM BUP Location I 6 11 (../3d-CAuct fyi Suite MEC Contact Person Ph ( ) 6 — 2-Rd 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 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 Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 4107 PART FAIL S El Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line t ADA 14 NV0 Approach/Sidewalk Date - o 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) 639 -4175 ' MST °° °° 4 7, 1 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested ( AM PM BUP Location / % 1' 7 7 (, �� -� Suite MEC Contact Person Ph ( ) 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 "� ���� 4100- Fire Alarm Susp'd Ceiling Alf Other: 40' 4101" Final / PASS PART FAIL PLUMBING 2 • Post & Beam Under Slab - Rough -In / Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: A 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for r-'nspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Data Inspector Ext Other: Final DO NOT REMOVE this Inspec cord from the job alts. PASS PART FAIL CITIi3OF TIGARD 24 -Hour 39 -4175 503 Inspection Line: 6 UI�DING ' p ( )' MST .0-ae Y -ode 9Y INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received 4 L/ l/L /4/ Date Requested �� -?, d AM PM BUP Location / K 2- 77 3t / , � �t/ ��h Suite MEC 7414e-- Contact Person C. Ph ( ) 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: in ,BASS ART FAIL ING 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 • �nal 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 �55 Approach/Sidewalk Date ? — GU— dc--- Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL