7495 SW CHERRY DRIVE v
A �I
�o
I
_ 7495 Sou CHERRX STREET _
SEWER CONNECTION
CITY OF TIG_ ARD PERMIT
PEr2MI7 #. . . . . . . : SWR96-0 :74
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/06/':6
13125 SW Hall Blvd.Tigard,Oregon 97223.81977 (503)839-4171
PARCEL: �S1Q.f DC-0.s101
SITE: ADDRESS. . . : 07495 SW CHERRY ST
SUBDIVISION. . . . : ROLL I NC, HILLS PLAT C ZONING: H-3. 5
BLOCK. . . . . . . . . . : L.OT. . . . . . . . . . . s45
TI_NANT' NAME. . . . . :
USA NO. . . . . . . . . . . FIXTURE UNITS. . . .
CLASS OF WORK. . . :NEW DWELLING UN I TS. . e 1
TYPE OFF USE, . . . . :SI'= NO. OF 9U I LD I i4GS a it
INSTALL TYPE. . . . :L TPSWR I MPERV SURFACE a ¢1 s f
Remarks : SANITARY SEWER LATERAL 10 MAIN LINE CONNECTION & I61%.,ECTION
caner• ____ FEES ____.________.__.
DENNIS WORZNIAK tyr-e amount by date recpt
/495 S. W. CHERRY DRIVE PR11f $ 2200. 00 J*H 06/06/96 96-280269
I NSF-' $ .+`_i. 00 J-1. 06/06/96 96-280269
f 1 GI?RD OR 9 722 3
Phone #: 629.1-2225
MILLER & SONS
L'3880 SW MIDDLETON RD
SHERWOOD OR 97140 --.-___.--_--.----------------------__—__
Phone #: $ 2235. 00 TOTAL
Reg #. . : 003644
-- --- 17,EQUIRED INSPECTIONS ---
This Applicant agrees to comply with all the rules and regulations 5ewe7- Inspection
r the Unified Sewage Agency. The permit expire, 198 days from
the da+,e issued. The total amount paid will he fortei-4ed if the
permit expires. The Agency dues not gliarantev the acrima:y of the
side sewer laterals If the sewer is not loca�'ed at the Wisurpsent
given, the installer shal: prospect 3 feet in all dircctioos from
the distance given. If not so located, the installer shall purchtip
a "Tap and Side Sewer" Permit and the Agency will install a lateral.
...... .... _.__.-..
Permictee Signati.lre :
15 S 1.l a d
CAll for inspection — 639-4175P
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, 0R 97223
(503) 639-4171
�1 (,1.) 11,..
Jobsite Address: Gb�.Q1t
Subdivision: — _ Lot# _ Office Use Only
Valuation: Contact Date I I Initials-
Result
New Construction Only: (Square Footage)
Planck/Rec# _
House. :arage: — _ Permit#_
Reissue of
Comer Lot? Y N Flag Lot? Y N Map&TL# 2-'-�?1 D 1 C C- -"-44k4 3J 0
Zone z 3,5
Owner: Plat# oL�w F l-t1 LL S
Address: ��� J Ajkrovals Required
Planning Setbacks Solar
Enginee.mg
Phone: ( _ Other
ContraL.'or: �� — ltst11�13sQ4t![4Ld
iwdr,oss _ ______ _ Subcontractors
Truss Details_
Other
Phone: (---)- _ Notes — __--
Contractor's License#
(attach copy of current Oregon!ices^e)
Contact Name: _—
Contact Phone.
Subcontractors: Archltect/Engineer:
Plumbing. _ _.— Address
Mechanical.
(attach copy of current OR Contractor's License)
Electrical: Phone.
JOB DESCRIPTION:
Applicant Signatu Acolicant Phone numb.-r
ZReceived by: 64v. Date Received
N�ogniamwsu.o
Permit x Account Descriptiosi Amount Amt Pd. Bal. Duki
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mach. Permit (MECN)
State Tax (TAX)
Bldg:
PIL mb:
Mach:
EleLh"11"I
Plan Check (PLANCK)
Bldg:
Plumb:
Mach:
Sewer Connection (SWUSA) �.Z.�1• --
Sewer Inspection (SWINSP) 1
i
Parks Dev Charge (PKSOC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
r
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional I IF (TIF-IS)
Office TIF (r1FO)
Water Quality (WQUAL)
Water Quantity (WClUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (E.RPRMT)
Erosion Planck/USA (ERPLAN)
Ero.-on Planck/COT (ERn;N)
TOTALS:
0rf
OF TIGARD PERMI'TU##. . . . . FSE: PLM96-01.36
COMMUN!TY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/06/96
13125 SW Hell Illvd.Tigard,Oregon 97223.8199 (503)439-4171
PARCEL. 2S 1'111 DL'--03101
SITE. ADDRESS. . . : 07495 514 CHERRY ST
SUBDIVISION. . . . : ROLLING HILLS FLAT 2 ZONING: R-3. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :45
CLASS OF WORK. . :NEW GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF' USE. . . . :SF WASHING MACH- - . - 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . : 0 TRAPS. 0
STORIES. . . . . . . . : 0 WATER HEPTERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES------------------ LAUNDRY '. RAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . 171 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXTUh2ES. . . . : 0
TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 99
WATER CLOSETS. . : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : ID RAIN DRAIN (ft) . . . : 0
R,?markss SANITARY SEWER LATERAL TO MAIN LINE CONNECTION & INSPECTION
Owner: ----------------- ------------------------------------- FEES
DENNIS WORZNIAK type amoi.Int by date recpt
1495 S. W. CHERRY DRIVE PRMT $ 30. 00 JMH 06/06/96 96-28OL69
5PCT $ 1. 50 JMH 06/06/96 96-2801-69
TICARD OR 97223
Phone #: 62121-2225
("ont ract.3r: -------- --------__-.---_—__-__._
110DERN PLUMBING
1. 1120 SW INDUSTRIAL WAY
T UALAT I N OR 97062 -----------------------------------
Phone
-----------------_.---__._-----_—_Phone #: 691 -6166 $ 31. 50 TOTAL
Reg #. . : 87906
REUUIHED INSPECTIONS ----_.__
This permit 1s issued subject to the rer,ulatlons contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Sn?cialty Codes and all other F'i na 1 Inspection
applicable laws. All work will be done In accordance with
approved plans. This permit will exp>rr if work 1s not started
within 1001 days of issuance, or if work Is suspended for more
than 180 days.
P p r m i t t e e 13i g n a t f-r e:
Issi.led By: " C
Call for inspection — 6:39-4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec #
1-3)125 SW Hall Blvd. Permit # _
Tigard, OR 97223
(503) 639-4171
MINIMUt" $25.00 PERMIT FEE ST. SURCHARGE
N.—W 0...4,me"1�-. ^ New Single Family Resider ces 2nn
PaMt.. ❑ 1 BATH HOUSE:140.00 0 2 BATH HOUSE $195.00
Job D 3 BATH HOUSE$225.00
Address CAylSl.le zm Fee includes all plumbing fixtures in the dwelling and the first 100 feet
of water service, sanitary sEwer and storm sewer. See fees below
Dime ma name of Nuanaai FIXTURES QTY PRICE AMT
S 1'1 )C>/C Z:v t'ce- Sink 9— 00—T
re°r o"'d•'• // r*°^" Lavatory � 9.00
Owner r7 9S "� h f'q?` Tub or Tub/Shower Comb. 900
Zip Shower Only 9.00
•Zn �f Z -L_3 i Water Closet 9.00
""m„”".me°'"'"^°•" -i Dishwasher 9.00
Garbage Disposal 9.00
Occupant M..n,� • Washing Machine 9.00
F,00r Drain 9.00
-
Y'�'•'° " I Water Neater 9.00
_ Larmdn, Room Tray 9.00
N.m. Urinal - 9.00
/ ,�/�/L•t �"^' Other Fixtures (Specify) 9.00
man 1A"... k/I tQ-Qc 'rim, 1 ,? - 9.00
Contractor
; -, C.. 9.00
�t�l cnp8t.,. - zip V 9.00
{^� ,S G"- CA w d•.-�/ U 'e Server 1st 100' 30.00 1
Slae N. _ COY T°.N. -Sewer-ea. Addit. 100' 25.00
Water Service 1st 100' 30.00
I hereby acknowledge that I have read this, application, that the Water Service ea. Addit. 200' 25.00
information given is coi-ect, that I am the cwner or authorized agent of -the owner, that plans submitted are in cornpmiance with Stag laws, that Storm &Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm &Rain Drair Addit. 100 25.00
number given -s correct. (If exempt from ''ate registration, please r _
give ason below.) Mobile Home 5par,e 25.00
/ Back Flow Prevention
Device or Anti-Pollution Device 900
�+•'",•o:.,neM.o•"n — � — r,°'• Any Trap or Waste Not --
Connected to a Fixture 9.00
Describe work new O�addition O afterati,m O repair O' Catch Basin 9,00
to be done residential non-residential O Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing us a of Rain Drain, single family dwelling 30.00
building or property
Residential backflow prevention
devices 15.00
Proposed use of
building or property - - •(Except res dential backflow
prevention devices)
NOTICE 'Minimum Fee $25.()0 SUBTOTAL ( m
PEP,MITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5%SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED -
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 250,b OF SUBTOTAL
TOTAL
Special Conditions
Date issued by ��t`
CITY OF TIGARD SITE WORK
f DEVELOPMENT SERVICESPERMIT �
PERMIT 4. . . . . . . : SIT97---0020
1312E SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 06/30/97
PARCEL: �:S101DC-010?
517.- ADDRESS. . . : 07495 SW CHERRY ST
SUBDIVISION. . . . : ROLLING HILLS PLAT G ZONING: R-3. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :45 JURISDICTION: TIG
(;I.. A SS OF WORK. . :NEW P,AV ING?. . . . . . . . . RESO. NO. :
TYPE" OF USE. . . . :SF GRADING!. . . . . . . . : VALUE. . . $ : 2000
EXCV VOLUME: 0 cy L_ANDSCAPTNG?. . . . :
FIL..L. VOLUME: 0 cy SITF PREP?. . . . . .
ENG FILL?. . . . . . .. STORM DRAINS?. . .
SOILS RPT RF_G!D?: I MPERV SURFACE: 0 s f
L?rim arlt� : Retaining wall
Uwner: ____._._._._.___.__...___..____._._. _..__..____._....._._.._____...____.__._._.___----__.___.____. FRES ------ - -- -------
CHRIS HOLMGREN type amoi.rnt by date recpt
749 SW CHERRY DRIVE PRMT $ ,3C. 50 DRA 06/30/97 97-296617
TIGARD OR 97223 PLCK $ 21. 13 DRA 06/30/97 97-29661.7
5PCT $ 1. 63 IRA 06/30/97 97-296617
Phone #: (503)6EO- 1124
OWNER
Phone #: $ 55. 26 TOTAL
Reg #. . .
__.......__._ RECU I RFD I NSPE'-;T I ON5
This permit is issued subject to the regulations contained in the Er•o s i c)n Cont r,o l
Tigard Municipal Code, State of Ore. Specialty Codes and all other Exr_avat ion Insp
applicable laws. All work will be done in accordance with F i I I Inspection
approied plans. This permit will expire if work is not started St rm Dr•a i n I n s p
within 190 days of issuance, or if work is suspended for more Final Inspection
than 190 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 9`,x-001-0010 through OAR 052-001-0090. Your may
obtain copies of these rules or direct quc ns to OUNC by calling _
I s so-tell b y :- --1__._..___ .....Q �7 — F'e r m r.t t e e S r.g n a t t_r r e
+-44+++++++i4.-1-+++++4-++++++.++-1-+•h+++++++++++++++++++++t++++++++-F++t.+++++++t++++++t
Call 639-4175 by 6:00 p. m. fore an inspection needed the next bl-rsiness day
++++i++++++++++++i-++4.+++++•1-++++•f+ �+++++++++++++-F+++i ++++++++++++++++++++++++-.•4-+
Pian Check r1!'-/Y
'Y OF TIGARD Residential Building Permit Application Recd By - _
.125 5W HALL BLVD. New Construction Additions or Alterations Date Recd -1
;GARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E z 1 + 1
503-639-4171 Pate to DST(
503-684-7297 Permit r i I
Print or Type called
Incomplete or illegible applications will not be accepted
Name of Prt,-,ct ~� - — dame
Job - . 11-
Address site Address Architect Mailing Address
Suj LA t-&I;x Lam, - -
Name C ty/State Zip Phone
Owner Ma lWq Address -" uame
y . I /
C,tylstste Arp Phone Engineer Mai-ling Address
--- Cry/State Zip Phone
Name (�+,
General /1/`/(, ��__ Describe work New O Addition O Alteration O Repair O
�:]
":ontractor Mallft Address to be done*
_ Additional Description of Work:
City/State Zip Phone
Oregon Const. Cont. Board L�c.M Fop. Dais
tittach Copy of
Current COT Busviess Tax or Metro• Exp-Date PRO.lEC
Licenses VALUATION N i "
Nsme
Mechanical
NEW CONSTRUCTION ONLY:
— .- _
Sub- Mailing Address -- - — —' Sq. Ft_ House. Sq. Ft. Garage
Contractor Corner Lot YES NO Flag Lot YES NO
Ciryfstats �o Phone (check one) (check one) _
Oregon Const.ConL Board Ur-O Exp, Date Restricted Audio/Stereo Burglar
Attach Copy of Energy System_ _ Alarm
Current COT usiness Tax or Metro• Exp. Date Installation Garage Door HVAC
Licenses
Nam Opener Systems
—. ---- -
(check all that Other.
Plumbing apply)
Sub- r Nailing address — Will the electrical subcontractor wire for all YES NO�
Contractor - restricted energy installations?
C,tyiState Zlo,' Phone Has the Subdivision Plat recorded N/A YES NO
Oregon Const ont. Board Lic tk EXP Date Reissue Ot MST#- I JGlaf Compliance
Attach copy of _ (Calculation Attached) _
Current Plumes Lac.rt Exp. Date ___I hearby acknowledge that I have read this application, that the
Licenses information given is correct. that I am the owner or authorized
COT Business Tax or Metro 01 Exp. Date agent of the owner, and that plans submitted ari in compliance
Name with Oregon State,laws.
Electrical
So� re of rte`
/Agent pat j
Sub- Mailing Address Contact Persil Name Phone#
Contractor i ` �v I `C.t, -,�C 1,-)11
C.tyrstate Zip I Phone FOR OFFICE USE ONLY:
Plat x: MapfrL#:
Oregon Const.Cont Board Uc o Exp Date
'.trach copy of Setbacks: Zone: Solar.
current E!ecmwl tia>K Exp. Date
Licensor COT Bistnesa tax or Metro M Exp Dote Engineering Approval: Planning Approval: TIF:
-- i:\sfaop•doc(dat) 1/97
Permit Account Description AM= Amt. Pd. Bal. Clue
"o<_ 0 MST. Permit (BUILD) �,r . 'L 3, U
Plum.. irmit (PLUMB)
Mesh. Permit (MECH)
ELC/ELR Permit (ELPRMT) y
State Tax (TAX)
Bldg: !• (_
Plumb:
Mech:
ELC/ELR:
Plan Check _
MST- (BUPPLN)
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS�
Sewer Connection (SWUSA)
,4mbursement District ( )
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion P;anck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS:
l Wapp.doc Idst) 11197
'IY
NO µ ?r4PEQ�y Li►JL � o �
I � �
41(
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�� I!IT : rhe City of Trj3rd, Oregon, or
its employees,shall riot be respnnslble for
(1". pencies which may appear hereiln. Dwpj SPE I z c
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JUN 2 5 1997
!' COMMUNITY DEVELOPMENT
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-Pv•i�1}Nr_Cti,•rracf ��'c.G_ `11? ----_ �_.-_._�___.__
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4
June 18, 1997 /
Chris Holmgren CITY OF TIGARD
7495 SW Cherry Drive
Tigard, OR 97223 OREGON
Re: Retaining Wall
SIT# 97-0020
Dear Mr. Holmgren,
This is a li,,c of items that we need before we can complete our review on your retaining
wall.
1. Which wall design are you going to use?
2. Need total wall freight from bottom of footing to top of wall.
3. Will wall encounter load condition from slopes or structures behind or above the
wall?
4. Will wall be using geogrid soil reinforcement (required if over 6 feet) or other
mechanical anchoring devices?
5. Your base trench must be at least 24" wide. The base leveling pad is to be 6"
i-ninimum.
6. Depth of the keystone block below grade shall be found in the following way.
Take the height of the wall (in feet) times 1.5 = depth of the units (in inches)
below grade.
7. Fill must be compacted in lifts of 8 - 12 inches.
8. How many cubic yards of fill are being used? A permit is required for more than
50 cubic vards.
If you have any questions, please call our office at (503) 639-4171.
Sincerely,
R L. Thompson
Rei` iential Plans Examiner
1?125 SVO/Hall Blvd., Tigard, OR 97223 (503) 639-4171 TDD (503) 684-2172 - --- -- -- - ----J
CITY OF TIGARD
DEVELOPMENT SERVICES PLUM131NG PERMIT
13125 SW Hall Blvd., Tigard,OR 97211 (503)639-4171 PERMIT #. . . . . . . : PILM97-041.0
DATE ISSUED: 06/2P,/97
c-'ITE ADDRESS. . . : 07495 SW CHERRY ST PARCEL: 2SI01DC-03101
SUBDIVISION. . . . : ROLLING HILLS PLAT 2 ZONING: R-3. 5
BLOCK.. . . . . . . . . . . LOT. . . . . . . . . . . . . :45 JURISDICTION: TIG
---------------------
CLASS OF WORI-',. . :ADD G(4RBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :OF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : I
OCCUPANCY GR[-.,. . : R3 FLOOR DRAINS. , 0 TRAPS. . . . . . . . . . . . . 0
! TORIES. . . . . . . . ; 0 WATER HEATERS. 0 CATCH BASINS. . . . . . . : 0
F I X*rURES------------------ LAUNDRY TRAYS. . . . . : 0 5F RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . 0 URINALS. 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . :' " " ' ' " 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . 0
DISHWASHERS. . . . - 0 RAIN DRAIN (ft ) . . . ; 0
Ppniar-ksc- Installation of r-:?sidential backflow prevention device.
Owner: ------------------------------------------------------ FEES
CHRIS HOLMGREN type amount by date r-ecpt
7495 SW CHERRY DRIVE PRMT $ 1.5. 00 JDA 06/25/97 TEMPRF'T
TIGARD OR 97223 5PET $ 0. 75 JDA 06/125/97 TEMP[it I
Phone #: (503)620- 1124
OWNER
-
------------------------------------
Phone #: $ 15. 75 TnTAI..-
Req r'99')9 3
REQUIRED INSPECTTONS
This permit is issued subject to ',hp regulations contained it, the RP/Backflow Prev
Tigard Municipal Code, State of 11-a. Specialty Codes and all other Final InspectioTi
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 if work is suspended for more
th 18@ days. PITFNTION- Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
stt forth in OAR 952-001-0010 through OAR 952A08I-0080, You may
obtain copies of these rules or direct n-qtions to OUNC by calling
(903)246-1987.
r.
ell,
d Bc1 -C-k6)4 Aj W k, Per-mittee
CL 1,
..........................................I.......... ........................
Call 639-4175 by 6:01' p. m, far- an inspection needed the next business day
4 *............................................................................
Permit #: CI' iq 7 ogr �
Address: q
1
z Issued by:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement Before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registrati, 11 under ORS 701.010(7),
need not.submit this statement. This.statement will be filed with the permit.
I'III Ill (lie appropriate blanks and initial boxes I and 2, and either box 3A or 313:
1. I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
l J ;A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. 1 will be my own general contractor.
v.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor. I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of thr contractor.
I hereby certify that the a In ormat ion is correct and that I hate reatl and do understmid the Informat:en
Notice to
Pr erty s ab t Construction Responsihilit ies on the recvrsc side of this form.
(Signature of permit applicant) ( atc)
(White copy to issuing agency permit filr.
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
EMPLOYER RESPONSIBILITIES. !
��� �.1;!'filnl�lin�,t;ta f!I�.•, r, ,.,,.i � !.,.1 i ,.. ., ,11.
•1 v1 t'I f 1 1, 1111, („1 11• 1 ci !v;-.tn, t:t. . it i,v:: f111)'t t�.til1' „ ��tl(1� !.I 1".- 1.,• _•1nn, , „v.�•i
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Will; ,
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ft 1 Sttt>~!29.40411:
OTHER RESPONSIBILITIES ANIS AREAS OF CONCERN:
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I ialpohfi i and (.GIN-.lt l j11111 Ir12.1f!atlt.'ag'.111 W,,v ll V1 :'+'
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f, nd to tit),it htIIIdillr of fir 1;11 lit thr :10m.notiAtt.Owl;so tho?CTnt rorfr(t'ttt the requlrrfl inspection.c.
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l he Bom,l 1, I,',..lr 700,Sutnincr St. 'NE Suite 3(111, in Salem.
CITY OF TIGARD � � c
Plumbing application �� Recd By
13125 SW HALL BLVD. Cornmercial a is Residential �/ Cate Rec'd `
TIGARD, OR 97223 I �J �"— Date to P E }(
(503) 639-1171 / Date to DST
( Permit 0 =4
Print or Type / Related SWR 0 .�
Incomplete or illegible applications will not be accepted Called��1(�_,
Name of CevelopmenuPmlect FIXTURES (Individual) 7TY PRICE AMT
Job 'c-�C � S Sink 900
Address Street Address Suite Lavatory , 900
Tub or rubiShower Lamb. I 9.00
Bldg a C 'Stale ZIP Shower Only
9.00
Name Water Closet 9.00
Dishwasher 9.00
Owner MadiN Address gulls Garbage Disposal j 9.00
1'/' ' ,,", ��!F-F;-' Washing Machine 9.00
Citymate Zip' Phone Floor Dram 2•
9.00
h. J• 9.00
I�� {' 9.00
i occupant 4e0q Address Suite Water Heater
900
Laundry Room Tray 9 00
City/State Zip Phone Urinal
l 9.00
i
Name Other Fixtures(Specify) 9.00
9.00
Contractor i Mailing Address Suite 9
,00
City/Slate Zip Phone — 900
—9-0 i
Oregon Const.Cont. Board Lc-0 Exp. Date 9.00
AdI•cA copy of _ 9.00 �—ff
Lic+^� -15 nbrng L"s Exp. Date Sewer• 1st 100' 30.00
I
Sewer•each adddional 100' 15.00
Business Tax or Metros I Exp.Date j
rn
I Water gece- 1st 100' ( JOAO
Na Water Service•esen additional 200' I ?5.00
Architect Storm d Rain Crain- 1st 100'
tarsi Address Storm d Ram Cram
or I ng S.:e ar-h additional 100' I 25 JO
Mobile Home Space 41500 j I
Engineer I C.tyrState p PhoneI I :5 JO
Commercial Back Pow Prevention Cevrce a Anti-
_ Pollution Cevrce
Describe work 'Jew 'J addition O Arteration O Reoarr C ' Residential BacXllow Prevention Cevrce' 15 CO
^o be done: lesrdennal O von-residentialO I ) S�
Any Trap or Waste Not Connected to a— i 9 00
AQQA,k]rial deSGnCt.tln or work
j Cath Basin 9 00
Insp-of Exlsurg Plumbing I 4000 I
_- oenhr
ns"use of I Speaady Requested Inspections so 000
—WWq a Property, I oenhr I
-- Rain -rain,single family dwelling 30 CO
'roposm use of — Grease Traps I I 9.00
%rlding iX property_
CUANTITY TOTAL
AFC ycL tipping. moving or reolaung any rixtures7 Yes❑ No Isometric or riser anagram.s recumt f Cuarerty Totals >9 I
(If yes see back of form) 'SUB1 OTAL TrIo
herebv ac.Know!ecge:hat I ha.e read this acplicabon.that the informatioh
ven S :orrect. 'hat t am the owner or authorized agent of the owner and 5`6 SURCHARGE i ~-
'at Clans submitted arep Compliance with Cregon State Laws
3ignieture of err crit mate i PLAN REVIEW 25°4 OF SUBTOTAL `
I I 'eeurm wly t'b ure 7tv total s> 3
�7 TOTAL
Contact Person Name Phone I I r
'Minimum permit fees SJ5 - 5'e surcharge. except,Resae.itial Bacxflow
Prevention Cevice. Mhicn.s S15- 5%surcharge
— 'ds;s,pimapp.doc 9/913
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory-T—u!) or Tub/Shower Combination
I Shower Only
Water Closet
rDishwasher
Garbage Disposal
[washing Machine
Floor Drain _ 2"
3"
Water Heater
Laundry Room Tray _
Urinal _
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
CITY OF TIGARD MF:(',[-IANICnL
DEVELOPMENT SERVICES PIE RMT T
2 N j M 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . : MEC97-01 2,:-
DATE ISSUED: 05/08/97
SITE ADDRESS. . . : 07495 SW CHERRY ST PARCEL: 2SIO1DC-03101
SUBDIVISION. . . . : ROLLING HILLS PI AT 2 ZONING: R-3. 5
BLOCK. . . . . . . . . . . 1-01.. . . . . . . . . . . . . :45 JURISDICTION: TIG
---------------------------------------------------------------------------------------
CLASS OF WORK. . :A1-T FLOOR TURN. . . . . 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . -. 0
OCCUPANCY GRP. . : R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. , . . . . . : o
FUEL 0-3 HID- -- 0 DOMES. INCIN: 0
.GAS 3-15 HP. . . . : 0 COMMIL. INCIN: 0
MAX INPUT: 0 BTU 15--30 HP. . . . 0 REPAIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . .- 0 WOODSTGVES. . - 0
GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . - 0
NO. OF UNITS---------- AIR HANDLING IAN I Ts OTHER UNITS. : 0
FURN ( 100K BTU: I (= 10000 cfm : 0 GAS OUTLETS. : 1
FURN )-100K BTU: 0 ) 10000 rfm: 0
Remarks: Installation if furnace and gas pipirn:,
Owner: --------- FEES
CHRIS HOLEMOREN 1;,.,nP Amoi.int by date reept
7495 S. W. CHERRY DRIVE 1:)RMT 25. 00 DRA 05/08/97 97-294322
TIGARD OR 97223 1. 25 DRA L715/08/97 97-294322
Phone #:
Contractor: -------------------------------
COLUMBIA HEATING & COOLING INC
PO BOX 2,30397
TIGARD OR 97223
Phone #: 624-2704 $ 26. 25 TOTAL.
000763
REQUIRED INSPECTIONS
This periit is issued stibiect to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Misc. Inspection
approved plans. This opsit will Pwpirp if work is not started Final Inspection
within 180 dans of issuance, or if work is suspended for vorp t -t 4-"--Frp t
than IN days.
Plerm i t
Tssi.led
Call for inspection 639-4175
Plan Chec
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Rer.d_
TIGARD, OR 97223 Date to P E
(503) 639-4171, x304 �,="-I f"0� ' rzf n "�"� Date to osr --
Permit# J-1-
Print or Type
Call-cd
Incomplete or illegible applications will no: be accepted _
---- Najf evet pmenvProfecit /y y r, Description
/ , 1� Table 1 A Mechanical Code :ry PRICE AMT
Job Street Address ,lpsr A) Permit Fee 0- 0- 10 00
Address ?�Vfr .$lG)• CI�fE./�..fr'' _
Blogs! Zip B) Supplemental Permit 3 r,.0
Name,or name of business) 1 1 Furnace to 100 000 BTU 600
Owner (� % ) ) incl ducts&vents
Mailing Address 2) Furnace 100,000 BTU+ J 7 50
mcl ducts&vents
cyismte Zip Phone 3) Floor Furnace 600
incl.vent
Name for name of business) f' 4) Suspended heater,wall heater 600
1j/"y J f' L,c) a- bm,; k,,-- or floor mounted heater
Occupant Mailing Address 5 1 Vent not incl.in 3.00
appliance permit
C.tyistate Zip Phone 6) Boller or comp,heat pump,air Gond 6 00
_ to 3 HP,absorp unit to 100K BTU
N7 - 7) Boiler or comp,heat pump,air Gond. 11.00
W14G 3-15 HP absorp unit to 500K B711
Contractor Milli Addre s t 8) Boiler or comp,heat pump,air Gond 1500
:7v). 15.30 HP:absorp unit 5-1 and BTU
(Prior to tateZip Phone 9) Boller or comp,haat pump,air Gond. 2250
issuance a copy ) ,1�7 ,� % 30-50 HP,absorp unit 1-1 75 and BTU _
of all licenses are OregoA Const.Cont Board L.e s Exp Dna 10) Boller or comp,heat pump,air Gond. 3750
required if " -
1-7z".
r >50 HP,absorp and 1 75 mil BTU
Pxpired in C O T CO Busness Tax or M tro N Exp Dote 11 ) Air handling unit to 450
_ data base) '') _� / -c 10 000 CFM
F Name —
Architect 12) Air handling unit 7 50
10.000 CTM* __
or Mailing Address 13) Non portable 450
_ evaporate cooler
Fngineer Cityistate Zip Phone 14) Vent fan connected 3.00
to a single duct
I Descnbe work New O Addi.on O Alteration O Repair O 15) Ventilation system not — 4 50
to be done Residential O N n-res deritial O included in appliance permit
Additional Description of work 16) Hood served by mechanical exhaust 450
17) _Domestic incinerators 750
I F, xr;hng use of 18) Commercial or industna". 3000
hu Idinq or property _ _ _-Tincinerator _
19) P,epair units 4 50
rri,uosed use of 20) Woodstove 4 50
building or property _
_ 21) Clothes dryer.etc. 450 _
Type of fuel-oil O natural gas 0 LPG O electnc O 22) Other units 4 50
1 hereby acknowledge that I have read this application,that the 23) Gas piping one to four outle!s 200 ,
informal W even is -orrw.-r;dramintcompliance
he owner or authorized agent of
the r, at plans trubmittiwith Oregon State 24) More then 4-per outlet (each) 50
' u of Owner) gent Date DTY.SUBTOTAL )
'SUBTOTAL
Contact person Name Phone 5%SURCHARGE
PLAN REVIEW 25%OF SUBTOTAL
TOTAL.
ii ldst\mechpmt doc trev 7196) Minimum permit fee.s S25+5%surcharge
��1c) l � I
CITY OF TIGARD MECHANICAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 FERMI T #. . . . . . . : MEC96-038F
DATE ISSUED: 11/05/96
PARCEL: 2S101DC-03101
I*TE ADDRESS. . . : 07495 SW CHERRY ST
.)UBD I V 16 1 ON. . . . : ROLL.ING H I LLS PLAT 2 ZONING: R-3. 5
BI.-OCK. . . . . . . . . . : 1-0 T. . . . . . . . . . . . . :45
FILASS OF WORN:. . :ALT FLOOR FURN. . . . : 0 EVAP COOLERS 0
F YPE OF USE. . . . :SF UNIT HEATERF. . : 0 VENT FANS. . . : 1A
(ICCUPANCY GRP. . :R3 VENTS W/O APP1- : 0 VENT SYSTEMS: 0
':)-TORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : o
I UEL. 0-3 HP. . . . : 0 DOMES. INCIN: 0
: /GAS/ 3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 B1 ti 15-30 HP. . . . : 0 REPA C R UN I TS: 0
F I RE DAMPERS?. . : 30-51Z. HP. . . . : 0 WOODSTOVES. . : 0
IiAS PRESSURE. . . 50+ HP. . . . CLO DRYERS. . : 0
1.1 OF UNITS------ AIR HANDLING UNITS OTHER UNITS. : 0
1URN ( 100V STU: 0 10000 cfm: 0 GAS OUTLETS. : 4
TURN ) =100K STU: 0 10012W., cfm : 0
[remarks : Gas piping
Owner-: FEES
(AIRTS HOLMGREN type amount by date r-eept
W7
, 35 SW CHERRY DRIVE PRMT $ 25. 00 B 11 /05/96 96-286121
1-111ARD OR 97223 5PCT $ 1. 25 B 11 /05/96 96-2861 c:1
r,Fione #: 620-1124
Contr,actot-:
OWNER
----------------------
I)I-Ionf. #: 26. 25 TOTAL
Reg #. . : 13125
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Sp►cialty Codes and all other Final Inspection
applicable laws. All work will be dont in accordance with
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if wrk is suspended for more
than 180 days.
Call for, inspection 639-4175
Plan Check#
CITY OF TIGARD
Mechanical Permit Application Recd Bye Kw-
13125 SW HALL BLVD. Commercial and Residential Date Recd 11 -Q(,
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST_,
Print or Type Permit N E '
Incomplete or illegible applications will not be accepted Called
Name of DevetopmenuProlect _
Description _
Table 1A Mechanical Code OTY PRICE AMT
Job Street Address sudea A) Permit Fee 0 -0- 10.00
Address y�> s0 C,-/,i-'-pv �
Btdgrs Cdy/�srote Zip ) ) B) Supplemental Permit 3 00
Name for name of busrnessi 1 ) Furnace to 100.000 BTU _ —60-0 --
Owner S ,� �G r - incl.ducts&vents
Mailing Address 2.) Furnace 100.000 BTU+ 7_50—
)`
`1 9,: ) s' incl.ducts&vents
Cdyrstate Zip? Phone 3) =1oor Furnace 6.00
0 '? '� incl.vent
rlamC am-of business, 1.) Suspended heater,wall heater E n0
G or floor mounted heater _
Occupant Mailing Address $.) Vent not incl.in - 3
GO
appliance permit
cdyrstate Zrp Phone 6.) Boder or comp,heat pump,air cond. 600
--- _ _to 3_HP;absorp unit to t00K BTU
Name 7.) Boder or comp,heat pump,air cond. 1 1.00 —•
�/Cl/NCrEA7 3-15 HP;absorp unit to 500K BTU
Contractor Mailing Address
_ d) Boder or comp,heat pump,air cond 1 g.00
15-30 HP;absorp unit 5-1 and BTU
Attach copy of Citylstate Zip Phone 9,) Boiler or comp,heat pump,air cond. 2250
Currert Licenses ' -� ),ir ii 4 30-50 HP;absorp unit 1-1 75 and BTU
Oregon Const.Cont Board Lic a Exp Date 10) Boiler or comp,he pump,air cond. 37 50
>50 HP;absorp unit 1 75 mil BTU
COT Business Tar or Metro aErn.Date 11 ) Air handling unit to 4.50 -
_ 10.000 CFM _
Architect Name 12) Air handling unit 7.50
10,000 CTM+
or Mailing Address 13) Non portable
450
Engineer Cdy.state evaporate cooler
Zip Phone 14.) Vent fan connected 3.00 —
to a single dud
Describe work New O Addition O Alteration• Repair O 15) Ventilation system not 4 50
to be done Residential r Non-residential O incl-ded in appliance permit
Additional Description of worke �,A7✓7 n rt,', TT, (,_,4 16.) Hood served by mechanical exhaust 4 50
�'v.vnl,n� C+F75 �',Pf T/,�_ tfti,�l�` iii frwr�•�E
_ 171 Domestic inraWe_rator5 7- _'06i—ng
p -
E ilding use of .8.) Commercial or industrial". 30 00
budding or property incinerator
19) Repair units - 4 50
Proposed use of
budding or property__ 201 Woodstove 450
211 Clothes dryer,etc 450
Type of fuel-clip natural gas iJ —LPG O electric O 22) Other units — 450
I hereby acknowledge that I have read this application,that the 23) Gas piping one to four outlets 200
information givens correct,that I am the owner or authorized agent of
the owner.that plan syprnitted are in compliance with Oregon State 241 More than,'-per outlet (each)
Sig((nature of Owner/Agen Date QTY.SUBTOTAL
'SUBTOTAL
Contact Person Name Phone OC 5%SURCHARGE
PLAN REVIEW 25%OF SUBTOTAL
TOTAL
i'AstVnechpmt dos (rev 7/961 � ----- -�i —
Minimum permit fees S25+5%surcharge