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Permit CITY OF TIGARD SEWER CONNECTION PERMIT 11111 = COMMUNITY DEVELOPMENT Permit#: SWR2013-00153 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/20/2014 Tr GA u f7 9 Parcel: 1S136CA09900 Jurisdiction: TIGARD Site address: 11088 SW LEGACY OAK WAY Project: White Oak Village,Lot 20 Subdivision: WHITE OAK VILLAGE Lot: 20 Project Description: Sewer connection for new SF Contractor: Owner: ANDERSON HOMES&CONSULTING LLC 5357 LAKEVIEW BLVD LAKE OSWEGO, OR 97035 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 02/20/2014 $4,665.00 Sewer Inspection-Residential 02/20/2014 $35.00 Type of Use: SF Class of Work: NEW Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $4,700.00 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a cop .f - les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 111Pt 41/' Issued By: Signature: Call 503.63 . .00 a.m.for the next available inspec on • te. This permit card shall be kept in a conspicuous place on the job site until c• pletion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Applica ' F' NED FOR OFFICE USE ONLY Residential '1n1 2 2013 AN Received edE PennitNo.: , 3-tom/(p City of Tigard Date/B q 13125 SW Hall Blvd.,Tigard,OR 9 0 IGPt O Plan Revie �! r Other Permit: Q�O/�—OC/S3 Phone: 503.718.2439 Fax: 503.59tit1ltiU ��±± ISION Date/B : .�j�'����� Iuris: E�J See Page 2 for Inspection Line: 503.639.4175 �uILOw�?Ot Date Ready/By: I TIGARD p Notified/Method: t Supplemental Information asInternet: www.tigard-or.gov �nnVo l_l Tk /2-61-7 TYPE OF WORK REQUIRED DATA: 1-AND 2-FAMILY DWELLING 2� ❑Demolition Permit fees*are based on the value of the work performed. ew construction Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other. equipment,materials,labor,overhead,and the profit for the work indicated on this application. CATEGORY OF CONSTRUCTION S 2 t54_ 7 j.- I �: Valuation:1-and 2-family dwelling ❑Commercial/industrial - I • Number of bedrooms: El Accessory building ❑Multi-family ❑Master builder ❑ Other: Number of bathrooms: ,9 .C- JOB . �gr SITE INFORMATION AND LOCATION Total number of floors: Job site address: //a gl /f( y (2 /,44 / New dwelling area: I, (Q a square feet City/State/ZIP: /j ¢,24, D,,,72- )7 233 Garage/carport area: 111 square feet Suite/bldgJapt.no.: Project name: 1Jf/-/7J(f `J/c i..../rd-E_ Covered porch area: sJ15 square feet Cross street/directions to job site: Deck area: �`� square feet a Other structure area: • 7� square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: /ay/7-1. (,., Lot no. Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: /s- /3z;CSI Q equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. ^` /�' Valuation: $ 49'n '27 G� ,�%:' J-0(V-e {71 j/X-7 /447/2 Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) / Fax:( ) New: ri APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: /AA 57-6 440 _,L.,,',7V 577/i 5 /At_ Structural plan review fee(or deposit): Contact name: (2013 4-4,0e565,,,, ,//� � JO,e//Ll� FLS plan review fee(if applicable): Address: /0)6 7g 5� 6$ ._,:x __ Total fees due upon application: City/State/ZIP: 6-fF/ , 7 Z-23 Phone:(S J ) 573--0--ry( Fax::97 )5--qPj'9 0 / Amount received: 'CU FEES* PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES E-mail: � ;�J�o�C � 4�jL CGy/Uj/ C. mercial and residential prescriptive installation of CONTRACTOR roo- ;•mounted Photo Voltaic Solar Panel . - m. Business name: wasi "� --14 Submit • 2)sets of roof plan wi : • ection details 'C.s� y and fire dep• i sets t access, - • • with the 2010 Oregon Address: I T 0 c /_e _l 4(M Solar Installation y- .; Code checklist. �O I V Permit - mclu Ian review $180.00 City/State/Z1P� (,* � 7���2j and administra' e fees): . Phone: ) -� � Fax:(93{ cr e-q—cielp I State surcharge(12%of permit $21.60 CCB lic.: , 307.E Total fee due upon application: $201.60 Authoriz-. ':I•.••. — " This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Pluir- *Fee methodology set by Tri-County Building Industry t nan i , ' 'nt .1-0, '1 kr Date: 6 . • 17 Service Board. --_.._ . gl.i►.a r 1 ,t I:\Building\Penni \BUP-RESPennitApp.doc 02/24/2011 440-4613T(1 1/02/COM/WEB) / E1VEDElectrical Permit ApplictiQ> ..,),„..,,:,,,, ,,s,.:0„.,,, City of Tigard D�e�ea IP Permit No.:• AK, 3—e2D0 3 ;� • 13125 SW Hall Blvd.,Tigard,OR 97223 7 2013 Plan Review Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit: 5a3-Y'/5-3 Inspection Line: SO<3.639.4175 Date Ready/By: Suns: ® See Page 2 for 1 I A{t I l p GUY Y OF TIGARD Notified/Method: Supplemental Information Internet: www.tigard-or.gov !p T'1 11'n �ASIBR PLAN REVIEW TYPE OF Please check all that apply(submit a sets of plans w/items checked below): New construction ❑Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or ❑Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","1-3", ��) 100HP or more. occupancy. Job no.: Job site address/O Y yS L£ay.O y ❑Six or more residential units. ❑Recreational vehicle parks. YO`` 7 ! ❑Health-care facilities. ❑Supply voltage for more than 6 City/State/ZIP: �� L��1j�7 ❑Hazardous locations. 600 volts nominal. Suite/bldgiapt.no.: Project name: jai rrc 0/4-e. I//e --4-6 ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qt. I Fee. I Total I • New residential single-or multi-family dwelling unit. Includes attached garage. �jJ/,ftrc O4g 1/11,1-46-E- Lot no.: 1,000 sq.ft.or less 1 168.54 4 Subdivision: 1/� ? 33.92 I Ea.add'1500 sq.ft.or portion � Tax map/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) 6A/577410r— Limited energy,multi-family 7500 2 4/1-to 6-C e /��c residential(with above sq.ft.) /�' /� Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or City/State/ZIP: relocation Phone:( ) Fax:( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Branch circuits—new,alteration,or extension,per panel Owner signature: Date: A.Fee for branch circuits with above service or feeder fee, 7 42 2 APPLICANT 0 CONTACT PERSON each branch circuit Business name: B.Fee for branch circuits without U(/�5re � �4/0v57"�l E_s service or feeder fee,first 56.18 2 Contact name: goh AN DERselli/T/rn 57797140/2"A-. — branch circuit Each add'I branch circuit 7.42 2 Address: t/s_6-70 Sea 68_4` �F� $ ire_ 4 2 Miscellaneous(service or feeder not included) Each Each manufactured or modular 67.84 2 City/State/ZIP: tie/ ©� -1 7�3 3 dwelling,service and/or feeder Phone: (4-03) �j O Reconnect only 67.84 2 �i�7 ) � -tJ � Fax: / Pump or irrigation circle 67.84 2 E-mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s)or limited-energy panel,alteration,or extension. Page 2 2 Business name: et.£ene/( -- Zt; ff-1-7ov s Each additional inspection over allowable in any of the above Address: Additional inspection(1 hr min) 66.25/hr Investigation(1 hr min) 66.25/hr City/State/ZIP: , r4i' SCi/5 ' 44 970/9 Industrial plant(1 hr min) 78.18/hr Phone:(6-3:5) 35 73 1 C,g Fax:(8 71)lib-0180 Inspections for which no fee is 90.00/hr specifically listed(Vs hr min) CCB Lie.: � 69(� Electrical Lic.: ,. J7 , Suprv.Lie.:7 ELECTRICAL PERMIT FEES Subtotal: Suprv.Electrician signature,required: Plan review(25%of permit fee): Print name: /( Date: State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signs e: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date:6 (3 p .,,,,A.-• * Number of inspections allowed per pennit. I:\Building\Permils\ELC•PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB --arm Mechanical Permit A li rc)R OFFICE l'sl: c)\l l City of Tigard Received /��� g 13 DateBy: /)7 , / Permit No.:/7 re9e.v"7—6e / - :i • 13125 SW Hall Blvd.,Tigard,OR 972,� N 2 7 20 Dn^ `v Plan Review ,W l 1 Phone: 503.718.2439 Fax: 503.598. �1 Date/By: Other Permit: �J—DC) la i.i c,A R 1� Inspection Line: 503.639.4175 ITY OFTIGARD Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov C �G DIVISION Notified/Method: Supplemental Information BUILD TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work f New construction El Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* RI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder El Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: /� Air conditioning Job site address: ei3 2f " (requires site plan showing placement) 46.75°3167 City/State/ZIP: I( (J�' t Furnace 100,000 BTU(ducts/vents) 46.75 TO<PNI) ® a? 2 1 Furnace 100,000+BTU(ducts/vents) 54.91 _ Suite/bldg./apt.no.: Project name: 1 1!,� OA-to r fr� Heat pump V`t (J7 �� V (requires site plan showing placement) 61.06 • Cross street/directions to job site: Duct work 23.32 Hydronic hot water system _ 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Subdivision: W "(G 0/ — ill ld/. Q7 6 I Lot no.: Flue/vent for any of above 23.32 il �'r Other: 23.32_ Tax map/parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater ` 23.32 Gas fireplace/insert ( 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 _ Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 1 33.39 City/State/ZIP: Clothes dryer exhaust 4 33.39 Single-duct exhaust(bathrooms, Phone:( ) Fax:( ) toilet compartments,utility rooms! ' 23.32 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32 tS, / �Y a Other: 23.32 Business name: XI" �1 i �"'+r Fuel piping: Contact name: a' 1t v �pi/ =jj+. If 111 -1'' +II 514.15 for first four;54.03 for each additional Address: i zoo c u ' 7! �„6 t(LW/ Furnace,etc. Gas heat pump 1 City/State/ZIP: "11 U b 0. a' Z.? 7 Wall/suspended/unit heater Phone:(O1�) N 5 D b 2 4 0 Fax::( " `Q 46q( Water heater I Fireplace E-mail: Range ` • CONTRACTOR Barbecue ,Qr! /"grn L 0 Clothes dryer(gas) Business name: /We 1 I l 1 v' • Other: Address: I ' OQ'1 t W 11S 1 s t 6-5 Q��-+� /7 MECHANICAL PERMIT FEES* City/State/ZIP: l 1)�( O 'v Q7 CC Subtotal Phone:( ) / v Faxes(!J ) Minimum permit fee($90.00) Plan review(25%of permit fee) CCB lic.: I R 7 4 l 9 State surcharge(12%of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized Signature: days after it has been accepted as complete. Print name: .tSrr th7g Date: r ..� v • Fee methodology set by Tri-County Building Industry Service Board t/ '- I:\Building\Permits\MEC-PermitApp.doc 03/07/12 440-4617T(11/02/COM/WEB) 'r • 1 Plumbin Permit A 1' • Building Fixtures �.1 4 Ep r��►i OH ►� ►� HSI, ��.�►,) g City of Tigard 7 2013 Da eB (f;7 13 • , Permit No.:i!/1/3 00143 Iii • 13125 SW Hall Blvd.,Tigard,Olt Plan Review Phone: 503.718.2439 Fax: �Q Date/By: Other Permit No.: av3 Inspection Line: 503.639.4179VvIGARD Date ReadyBy: luris: 6J See Page 2 for T n It I> Internet: www.tigard-0r.govBUILDING DIVISION Notified/Method: Supplemental Information• TYPE OF WORK FEE* SCHEDULE • For special information use checklist New construction ❑Demolition Description I Qty. 1 Ea 1 Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 Id 2-family dwelling ID Commercial/mdustrial _SFR(2)bath 437.78 SFR(3)bath 11 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler L_sq.ft) Page 2 JOB SITE ORMATION AND LOCATION Site utilities: n f ))) Catch basin or area drain 18.76 Job site address: �/V f z�( . why/ / Drywell,leach line,or trench drain 18.76 City/State/LIP: / / t �� � q L Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: W. Ont. aid6c Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) ( Page 2 Storm sewer(no.linear ft.:_) I Page 2 Water service(no.linear ft.:_) 1 Page 2 Subdivision: O �fa7�, I Lot no.: Fixture or item: Tax map/parcel no.: / ` / 76 c f' Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK - 25.02 X, - , { F,� h Clothes washer 661k 5r 4/1 ,vG puY�2.C. fG y��11� Dishwasher f 25.02 /// Drinking fountain 25.02 . Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: 25.02 _ Floor drain/floor sirddhub Address: Garbage disposal j 25.02 City/StatetLlP: Hose bib 7. 25.02 Phone:( ) Fax:( ) Ice maker I. 12.51 1.0'4PPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 ��� ,F? %e�� Medical gas(value:$ ) Page 12.51 Business name: r�(, �- _ -Primer Contact name: O�l'��•�'1 (commercial) 12.51 Roof drain(commercial Address: ( �9v 6S V/etYg Sink/basin/lavatory C 25.02 City/State/ZIP: --77 h it- Q77-'2,-, Solar units(potable water) 62.54 Phone:(615;) ?7n -DA yk, Fax..( gin._gGTub/shower/shower pan y 12.51 Urinal 25.02 E-mail: J V 5 � rCi1''`P /, '/GJ Jl Water closet 25.02 CONTRACTOR Water heater l 37.52 Business name: /6,06.- r t 4, t" ( t-5 Water piping/DWV 56.29 Address: I 1 ) Other: 25.02 (17 �D n Subtotal City/State/ZIP: eSf�b G).7/ b Minimum permit fee: $72.50 Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lic.: s, Plumbing Lic.no.:.3 -7.6,5-0- State surcharge(12%of permit fee) Authorized signatu' . i . r'/ TOTAL PERMIT FEE 1 �V I L Date a . This permit application expires if a permit is not obtained within 180 days Print namdl?�'' ' (� 0 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 440-4616T 10/02/COM/WEB) I:Building\PermitslPLMU-PermitApp.dac l0/01/09 t