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15450 SW EMPIRE TERRACE w 0 m v m a� 0 f a• i 1 15450 SW Empire Terrace CITY OF TIGARD BUILDING INSPECTION DIVISION MST 2000-00 24-Hour Irispe.tion Line: 639-4175 Business Line. 639-4171 — —� BLIP _ _ Date Requested G _ AM_ t/ PM BLD Location / 5-!/J- 5 w �.- — Suite MEC Contact Person Ph - 3 7 ca PLM Contractor _ r h ,— _ SWR BUILDING Tenant/Owner ELC — Retaining Wall ELR Footing Access Foundation FPS Ftg Drain - SGN Crawl Drain Ins,)ection Notes: - ---- -- -- SlabSIT Post& Beam - --------------- - —-- ---- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling --- ----- -- ----- Roof Misc: --- -- ---- ------- ---- - ------ Fiiial 1--- --- -- P PART FAIL ------- --- ---------_-.---- - -- - - --- PLUMBIN Post& Beam -------- - -_.__-_--_�. ----- ---_ Under Slab _ ---_—__-- _--_-- --------_�_.____ _- Top Out Water Service Sanitary Sewer RaitMiains ----- ----------- ----------- -- — F- PAS PART FAIL ANICAL Post& Beam ------ ---------_ __ - -- -- ------ Rough In Gas Line -- --- -- --- —_--- Smoke Dampers Final -- ------ - _.._ - -------- --- - — ----- ---- P!," PART FAIL ELECT - ---------_._.__. .-------------- -------- Service - Rough In UG/Slab --- -- ---- -- --- Low Voltage .-^------. _- —�- Fire Alarm F PAS PART FAIL Becl,fill/Grading — - - — �— Sanitary Sewer S'-3rm Drain ( ]Reinspection fee of$ required before neat ispection Pay at City Hall, 13125 SW'lall Blvd Catch Basin Fire Supply Line ( ]Please call for reinspection RE:_ — [ ]Unable to inspect-no access ADA 1, Approach/Sidewalk Date " i" \ Inspector Ext Othf w_ — Firr l P ,SS PART FAIL DO NOT REMOVE this inspection record from the jot+ site. CITY OF TIGARD BU''-DING INSPECTION DIVISION MST ,7000--6-0Sy/ 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP--_-- -_- —Date Requested_- J� _-- AM �_�PM �- BLD —'--`- Location—LS _v Sc.. ter.- Suite — —� MEC _ -- Contact Person Ph 02-0 — 3 3 7 li PLA1 Contractor Ph Ph SWR _— _ Tenant/Owner ELC Retaining Wall FLR Footing Access: ---- -----__- Foundation FPS Ftg Drain SGN -----�-- --.----- Crawl Drain Inspection Notes: --- — ------ Slab SIT Post&Beam ---� "--�—— Ext Sheath/Shear Int Sheath/Shear Framing Insulalior Drywall Nsilirig Firewall Fire Sprinkler _ Fire Alarm Susp'd Ceiling Roof 0in PA RT FAIL - - ----- -- -- PLUMBING Post& Beam Under Slab Top Out Water Service Sanitary Sewer -- - Rain Drains Final PASS PART FAIL_ Post& Beam — Rough In Gas line Smoke Dampers AS PART FAIL ECTRICAL - -- __— -- - Service Rough In UG/Slab Low Voltage Fire Alann Final PASS PART FAIL SITE Backfill/Grading -- — - Sanitary Sewer Storm Drain ( ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( J Please call for reinspection RE: [ J Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewal! Other Date Inspector Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GARNER ELECTRIC 21785 SW TUALATIN VALLEY HWY S ALOHA, OR 97006-1248 Electrical Sigrnatrare Form Permit #� RIST2000-00 91 Date Issued: 115101 Parcel: 25111 DA-14600 Sitq Address: 1545C SW EMPIRE: TERR Subdivision: APPLEWOOD PARK. NO. 3 Block: Lot- 139 ,Jurisdiction: TIG Zoning: R-7 Remarks: SIF PATH 1 Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received M'NFR: ELECTRICAL CONTRACTOR: MATRIX DEVELOPMENT CORP GARNER ELECTRIC 6900 SW HAINE S ST STE 200 21785 SW T'UALATIN VALLEY HWY S TIGARD, OR 97224 ALOHA, OR 97006-1248 Phone # Phone #: 591-1320 Req #: LIC 12119 SUP 3707S ELE 34.305C AN INK SIGNATURE IS REQUIR'-D ON'THIS FORM X Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 w 0 � � n a o � _ F � e V) a o � O o � .Z O y� y Q0 oll tit 3 O z TIGARD PERMIT CITY OF �I� PERMIT M MST2000-00541 DEVELOPMENT SERVICES DAIS ISSUED: 1/5/01 13125 SW Hall Blvd., Tigard, OR 97123 (503) 1639-4171 SITE ADDRESS: 15450 SW EMPIRE TERR PARCEL: 2S111DA-14600 SUBDIVISION: APPLE=WOOD PARK NO. 3 ZONING: R-7 BLOCK: LOT: 139 JURISDICTION: TIG REMARKS: S/F PATH 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED _ CLASS OF WORK: NEW HEIGHT: 24 FIRST: 927 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE, SF FLOOR LOAD: 4C SECOND: 1,227 at GARAGE: 479 at FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINSSMENT: at RIGHT: 4 VALUE: $196,763,00 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2.154 00 at REAR: 19 PLUMBING _ SINKS: 1 WATER CLOSETC 3 WASHING MACH: 1 LAUNDRY TRAYS: 0 RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS. SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUPISHOWERS: 3 GARBAGE DISP: I WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 R^LASE TRAPS: OTHER FIXTURES: MECHANICAL FUE'.TYPES FLIRN<100K: BOILICMP<3HP; VENT FANS: 5 CLOTHES DRYER: 1 GAS FORN>•100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS 1 MAX INP: Ulu FLOOR FUFNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 _ ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER_ TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FOR: 1 PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 4 201 400 amp: 201 400 amp: tat W/O SVCIrOR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 •600 amp: 401 600 amp: EA ADDL OR CIR: SIGNAL/PANEL: IN PLANT: MANU HMISVCIFDR: 601 • 1000 amp: 601+1Impa•1000v: MINOR LABEL: 1000+amp/volt: PLAN REVIEW SECTION Reconnect only: >•r r ES UNITS: SVCIFDR>=226 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM S19TEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOl"AL FEES: $ 3,982.76 This permit is subject to the regulations t•nntained in the MATRIX DEVELOPMENT CORP LEGEND HOMES CORP Tigard Municipal Code,State of OR. Specialty Codes and 6900 SW HAINES ST STE 200 12755 SW 69TH AVE#100 all other applicable laws. All work will bft done in TIGARD,OR 97224 TIGARD,OR 97223 accordance with approved plans. Thi,,permit will expire if work is not started within 180 days of issuance,or it the work is suspended for more than 180 days. ATTENTION Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set Reg#: 111' r05G3 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 REIUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Framing Insp Gas Fireplace Electrical Final Sewer Inspection Underfloor Insulation Mechanical Insp Shear Wall Insp Insulation Insp Plumb Final Footing Insp Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Insl Rain drain Insp Final Inspection Foundation Insp Footing/Foundation Dr; Electrical Service Low Voltage Water Line Insp Building Final Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp -- c..� .- Issued By : ��% _ Permittee Signatur2-�_ Call (501) 639-4175 by 7:00 p.m. for an Inspection needed the next business day CITYOF TIGARD SEWER CONNECTION PERMIT` DEVELOPMENT OPMENT SERVICES PERMIT#: PINR2000-00368 13125 SW Hall Blvd , Tigard. OR 97223 (503) 639-4171 DATE ISSUED: 5/01 SITE ADDRESS; 5^.50 SW EMPIRE TERR PARCEL: 25111 DA-14600 SUBr:iviC'!0N: APPLE0.10CD PARK NO. 3 ZONING: R-7 :NOCK: LOT: 139 JURISDICTION: TIG _ TF.NAN'r NAME: JSA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF dwelling. Owner:__ — FEES LEGEND HOMES Type By Date Amount Rcr:eipt 12755 SW 69TH AVE PORTLAND, OR 97223 PRMT CTR 1/5/01 $2,300.00 27200100000 INSP CTR 1/5/01 $35.00 27200100000 Phone: 503-620-8080 Total~ $2,335.00 Contractor: Phone: Ran!t, J Required Inspections Sewer Inspection This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency Will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued by: I _-- Permittee Slgnatur� z-,/, Cal (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day 5 g Building PQrtWt Applica::on w(Z2000 —0o LDatreceived: .!�d�City of Tigard —Chy of TigardAddress: 13125 SW Hall Blvd,Tigard,OR 97223ect/appl.no.: Expire date: f Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: �u Land use approval: ^- I&2 fa vly:Simple Complex: �/ f Ur"I &2 family dwelling or accessory U Commercial/indus Tial U Multi-family grNew construction O Demolition U Addition/alt,,iadori/replacement U Tenant improvement O Fire sprinkler/alarm U Other: j- OI SITE INFORMATION, Job address: reuoPiT(LE 'rt&(Z_ Bldg.no.: Suite no.: Lot: I Block: Subdivision: Tax map/tax lot/account no.: Project name: Description and location of work on premises/special conditions: J_ :Name: (!5j,213,31p + + Mailing addr6ss: ,5 1&2 family dwelling: Citu State:p ZIP: J 7 Valuation of work........................................ Phone: (0,0 o Fax - ,�2) E-mail: No.of bedrooms/baths................................. Owner's representative: _ Total number of floors................................. Phone: fax: E-mail: New dwelling area(sq.ft.) ..........................APPLICANT Garage/carport area(sq.ft).............. .......... �-'7`f - Name: T Covered porch area(sq.ft.) ......................... Mailing add as: 02 -%- Deck area(sq.ft.)........................................ City: Istatep ZIP Other structure area(sq.ft)......................... -- Phone: ( o Fax E-mail: Commerelal/industriai/multi-family: Valuation el work................................ a Existing bidg.area(sq.f.) ...... . .......... - Business name: z ,Q �� ' - New bt area R Address:70L 7s' f�- �g• (sq. ).................JSP,... ...... _ City: pr Stated ZEP: 7aoL NumLer of stories............... Phone: D ........... . /.....\..,�.... -- Type of construction............1................. o Fax: ' E-mail: �. CCB no.: jp(o pr_ - -_---- �� Occupancy group(s): Existing: -- New: City/retro tic.no.: 11 Notice:All contractors and subcontractors are required to be 1 licensed with the Oregon Construction Contractors Board under Name: L Pey O j provisions of ORS 701 and may be required to be licensed in the Address. 3- - jurisdiction where work is being performed.If thu applicant is City: e — Stately - exempt from licensing,the following reason applies: o. Contact person: x.109 Plan no.: _ — Phone:4, p , O D I Fax:S '- ',,r E-mail -- lfi�_40111101401M --- Name: -.,,e lContact person: Fees due upon application ........................... $ Address Gtigf2yw t o Date received: _ City _ Stated ZIP: 2.�_)3 Amount received .........................................$`- Phone24as-- Fax: E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurie ictlom secept credit cud&*m cdl juria&Cdon for more infomodoa attached checklist. All provisions of laws and ordinances governing this 0 visa ❑MutetCud work will be complied with,whether s ified he ,in or not., Credit card number:— / / Expires AuthorizednAture: ate: Name of cardholder u drown on credit cud Print rams: -- _ $ cadhotder sipmure Amamt Notice:71is permit applicat n expires If a permit is not obtained within 190 days after it has been accepted as complete.i 44°4613(eWCOM) Mechanical Permit Application -` — Date received: Permit no.: City of Tigard Projcct/appl.no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd.Tigard,OR 97223 Date issued: By: Receipt no.. Phone: (503)639-4171 — Fax: (503)598-1960 Case file no.: — Payment type: Land use approval' _ Building permit no I�&2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant improvement New construction U Addition/alteration/replacement Zl Other. Jobaddress; /S J'l.-t"'1�1 R� _r. t R- Indicate equipment quantities in boxes below.Indicate tl,�e dollar value of all mechanical materials,equipment,labor,overhead, Bldg.no.: Suite no.: Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: ' *See checklist for important application information aid Proact name: jurisdiction's fee schedul.for reside.tial permit fee. City/county: •-"r ZIP: Description and Iodation of work on premises: t Fee(m) Totals Est.date of completion/ins ction: Ds�crlption t` Rea.ow Res.only Tenant improve-mer change of use: Air handling unit CFM Is exitpespace heated or conditioned?to Yes U No it conditioning site plan require Is e ' ng space insulated?O Yes Ct No teration of existing HWAC system t ore compressors State boiler permit no.: Businest,name: HP _,Tons BTU/H Address: 6 pS Fire/smo a uctsmo c electors City: �, Stattir7i,r ZIP; 7g eat pump(site plan requ.re nstarep ace Phone: -7 7 Fax: �7(,y1 E-mail: urnac Including ductwork/vent liner O Yea O No _ CCB no.: I —_ nsta rep ac rc orate heaters-suspen , City/metro lie.no.: 2 7 40, wall,or floor mounted _ Name(please tint): pl7 a. ent ora appliance oiFier an furnace c era an: Absorption units BTUttl Name: / Chillers HP _ r1-� CO re330r9 HP Address: If nment exhaust as rent ton: City: �v State:r�� ZIP: 9J.b4.3 A pliancevent Phone; -J J Fax y' -70E-mail: erex gust __ loods,Type res. 'tc a azmat hood fire suppression system — Name: Exhaust fan with single duct(bath fans) Mailing address: L,•? x aust s stem�rom FeaungorAC tie g and distribution up to 4 outlets) City: LPG __ NG oil Phone: - 0 0 117ax•' - E-mail; ve tin ear aaaditi�na over autlet" ass piping schematic mqui ) Number of outlets Name: ter -ea n—F ante or equipment: Address: De:orWve fireplace City: 0�7 State: ZIP: nseit-ty Fax Email tov pe ctsrove er: AFplicant's_signature: a n _ Name(print): e Permit fee ................S all Jurisdictions�credit cud,.pkse call jtui3lction f«mM int;;Z0 fee Nes Notice:This permit application Minimum fee................$ ❑Visa ❑MasterCard ,- /_l— expires if a permit is not c: dined plan review(at _9D) credo cart!number: Exp1fes within 180 days after it has been State sumharge(8%)....$ Name of c•rdhoider u I on credit card accepted as complete. _ TOTAL .......................$ Cardholder diamine -------- 4161617(6AOICOt� Commercial Schedule 1&2 Family Dwelling Schedule ASSUMED VALUATIONS PER APPLIANCE Description Furnace to 100,OCO BTU Table IA Mechanical Code aY Prla Twat Includingducts&vents 955 1) Furnace to 100,000 BTU _ anduding Buda 6 vents 14,00 Fumace>100,000 BTU 2) Fu so' 100.000 BTU+ kldudk dada 6 Voris 17,,x0 Including ducts&vents 1,170 3) Floor Furnace floor fumaceIndus Vent 14.00 4) Suspended healer,wok healer indUdinp vent 955 or Noor mounted heater 14.00 suspended heater,wall heater s veot not Ildudad in ppl!ance permit 0.60 or floor mounted heater 955 a akunits 12.16 Check all thatsppy: 'Botkr Heal Ak Vent not Induded Ina li nue permit 445 For kem■7.10,see or Pump cone ay Prkx Total Repair units 605 rootr2obs 1,2 CWnP 7)CHP;absorb unit to <3 hp;absorb.unit 100K BTU 14.00 6)3-15 HP;absorb unk to 100k BTU _ 955 100k to sock BTU 25.60 3-15 hp;absorb.unil 9)15-30 HP;absorb unit.5-1 mit BTU t 35.00 101k to 500k BTU 1700 10)30-50 HP;absorb unk 1-1.75 milBTU 52.20 15-30 hp;absor' .unit 11)1,50HP:absorb unk>1.75 mi(BTU 501 k to 1 mii.BT U 2310 67.20 - 12)Al•;urdNrng unit to 10,000 CFM 30-50 hp;absorb.unit10.00 _ 1-1.75 mil.BTU 3400 13)Ale handiing unit 10,000 CFMti 17.20 >50 hp;absorb.unit 14)Non-pottable evaporate croler 10.00 _ >1.75 mil.BTU 5725 tb)Vard ran connected to a single dud O.eo All,handling unit to 10,000 Cfm _ 656 1e)Ventilation system not.,eluded In 10,00 Air handling unit>10,000 d ■ liana rmil dm Appliance 17)Hood served by lnaduniul exhaust Non-portable evaF„rate roller 658 10.00 -- la) ir,ck,enton' vent fan connected to a single duct -'46 17.40 19)Crxnrtnerclel Of Industrial type indnaratu Vent cyst not Included In appliance permit 656 09.95 Hood served by mechanical exhaust 656 20)Other unks,Including wood stoves _ ._ 10.00 _ Domestic Incinerator 1170 21)Qu p"one In kur outlets 5.40 Commercial or industral incinerator 4590 22)Mon,than 4-per outlet(esdl) Other unit,Including wood stoves,Inserts,etc. 656Minimum Pernik Fee(72.60 9UETOTI L Gas piping 14 outlets _ 360 ex suacruaoE Foch additlonal outlet 63 PUN REVIEW 25%of SUBTOTAL - Required for ALL commercial permits only TOTAL OIM.inap•dlene erd f••r I M{r,Nam rxeelde of norma huli-S.hen(rrwwr•wn Aurpe tots I-) f 72.A Per hat 2. ,nWetew lex v hi h M ree Is rpe-IoM Mi-Wd(mins -vuNe Me h-1 uu�i Total`',,1..-. %%a0 per hone y�yVl on FEE 7 MdW.W oM rye e. M WW by ourMie�.•dd•bM ar-A.-lo W-(fin ....-. rfurp•.nn W haul 612.50 Pre Mux 'Stale Conked x Bolo CMUrwaban rwpuwed S1.00 to$5,000.00 Minimum372..,n - "h •�^�^ +.a.plea uV+*W o1•r,r-N a urs 55,001.00 to 510,000.00 $72.50 for the first 55,000.00 and$1,52 for each additional$100.00 or fraction thereof, to and including$10,000.00 $10,001.00 to$25,000.00 S 148.50 for the first$10,000.00 and$1.54 for each additional$100.00 or fraction thereof,to and Including S25,000.00 $25,001.00 to 550,000.00 $379.50 for the first$25,000.00 and$1.45 for each additional S 100.00 or fraction thereof;to and including$50,000.00 550,000.60 and up $742.00 for the first$50,000.00 and$1.20 for each additional$100.00 or fraction thereof Plumbing Permit Application Date received: Permit no.: Ci of Tigard w - `� g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd.Tigard,OR 97223 — Ciiy of Tigard phone: (503) 639-4171 Project/appl.no.: date: Fax: (503) 598-1960 Date issued: By: Receiptno.. Land use approval: –_- __-- Case file no.: Payment type: TYPE OF PE11WIT k7 I &2 fauuly dwcllinl nr accessory ❑C:uuunenciaUiudustrial Ll Multi-family U Tenant improvementL< New constructit n U Addition/alteration/replacement O Food service ❑Other: It SITE INFORMATION1ULE(for special illIfOrt,111111611 I)escr Joh address: i�rNon Qty. Fee(ea.) Tolal New 1l-and 2-famlly dwellings only: Bldg.no.: __ Suite no_�_ ('dudes1001t.forachutility connection) Tax map/tax lot/account no.: SFR(1)bath _ Lol: ( Bltx k: ( )Subdivision: i�13b 1 SFR 2 bath -- Project name: _ SFR(3)bath _ Citv/county:, �P: ��e22 Each additional bath/kitchen Description and lokation of work on premises: Site utWtles: Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drainPUM Footing drain(no.lin.ft.) t CONTRACTOR _Manufactured home utilities Business name: (,�d��oManholes Address: PO Bek c2,207 _ _ Rain drain connector City: h cy y �- _ Stater Z_IP:C� 70 3 — Sanitary sewer(no.lin. ft.) Phone: FStorm sewer(no.lin.ft.) CCB no.: q_ Plumb.bus.rrg.no:rel`(off Water service(no.lin.ft.) City/metro E'lxture or Item:lie.no.: Absorption valve _Contractor's representative signature: a ('ryt Back flow preventer Print name: Backwater valve UON*FA(7r PERSON ins/lavatory _ Nante: (p Joy �`a Clothes washer Address: e 8 e Lg- eo 7— - Dishwasher _Cit Drinking fountains) City: [� n_s�t�17 Statco �IP: �?3IJ Ejectors/sum 6 Phone: Fax: F,-mail: Expansion tank 111111011111 Fixture/sewer cap — Name(print): t p Q _ S — -Floor drains/floor sinks/hub Mailing address: / 7j 3- cf7.v� Garbage di, sal Hose,bibb City: �, d state:o k ZIP: 9?�:�s'_— Ice maker Phone: oke Fax: E-mai{: —_— Interceptor/grease trap_ _ Owner installation/residential maintenance only: The actual installation Primer(s) _ will be made by me or the maintenance and rrpair made by my regular Roof drain(commercial) employee on the proMICK�=Z: C7. Sink(s),basin(s),lays(s) Owner's signature: (01c)o Sump Tubs/shower/shower pan Urinal Name' - r 6 Water closet Address: —heater— City: - — — _.�o� � Water heater City: _ Statev ;;!PP Sy Other. _��-- -- — - Phone OS Fax: Email: ----- Total Na all juri"ctlnns aceto credit cant,pleam call jurisdiction for mrae Inforrtution. Notice:This permit application Minimum fee................$ ❑Visa ❑MaslerCard expires if a permit is not obtained Plan review(at __ %) $ Credit card number: within 1SO days ager it has been State surcharge(8%) ....$ Expires accepted as complete. TOTAL ....................... --— — Name tK t�l�eru Chown on crcd1.:ard _ S _ —_ -Cardholder sianalum-- — —, a Amount 440J616(600iCOM) _ PLEASE COMPLETE: FIXTURES (individual) qty Price,';- Tota6 _ r" Fixture Type Sink 16.6.600 YP Quantl b Work Performed _ New Mov*d Replaced Removed/Capp« Lavatory � 16.6U Sink Tub or Tub/Shower Comb. 16.60 Lavatory Tub or Tub/Shower Combination Shower Only 16.60 Shower Only Water Closet16.60 Water Closet Urinal -- Urinal 16.60 Dishwasher Distiwasher 16.60 Garbage Dis sal Laundry Garbage Disposal 16.60 Room Tray Washin Machine Laundry Tray 16.60 Floor Drain/Fluor Sink 1' Washing Machine 16.60 3- 4' Floor DrairVFloor Sit* 2' 16.60 Water Healer 3- -i6 6-0 Other Fixtures(S�ecify) 4- 16.60 Water Healer O conversion O like kind 16.60 Gas IEing ra fires a separate mechanical permit. - MFG Home New Water Service 46.40 -- --- -- MFG Home New San/Storm Sewer 46.40 - - Hose Bibs s 16.60 COMMENTS REGARDING ABOVE: Roof Drains 16.60 —_ -T'-_- Drinklnq Fountain 16.60 —y---- -�. Otter Fixtures(SpeGh) 21.75 -- Sewer-1 st 100' --55 00 -----—1 - �- _ Sewer-each additional 100 46.40 Water Sen4ce- I at 100' 55.00 Water Service-each additional 200' _ 46.40 Storm&Rain Drain-1 st 100' _ 55.00 Storm 6 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevendon Device - 46.40 Residential Backflow Prevention Dovice' 27.55 Catch Basin a 16.60 Insp.of Existing Plumbing or Specially Requeslecd 72.50 Inspectionsper/hr Rain Drain,single family dwelling 65.25 Grease Traps 16.60 _ - QUANTITY TOTAL 1pit: Isometric orb �riser diagram required r quantity Total Is 9 Eli 'SUBTOTAL 8%SURCHARGE til "PLAN REVIEW 26%OF SUBTOTAL Required onto(Wure qty.Idol Is>9 —^ TOTAL 'Minimum pormh roe Is$72.50 s a%surcharge,except Residerdlal Baddkm Preventtrxr Clevloe,whkh 1%136 25 4 e%suntrarge All Now Commorclal Buildings mqu"plans with Iserneirfc or riser diagram and Plan Rvlew Electrical Permit Application -- Date received: Permit no.: City of Tigard Projec6/appl.no.: Expir•edate: City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no. Phone: (503) 639-4171 — — Fax: (503) 598-1960 Case file no.. I Payment type: Land use approval: iL&2 family dwelling or accessory Q Cc rr nierciaVindustiial Q Multi-family ❑'Tenant improvement iJ New construction U Additioii/alteration/replacement ❑Other: — Q Partial JOB SITE INFORM%I ION Job address: j Bidg.no.: j Suite no.: Tax map/tax lot/account Po.: Lot: ( I Block: Subdivision: AW LVv-j 9-- Project Project name: I Description and location of work on premises: Estimated date of coo letionrins coon: Job no: Fee Max Business name: Description cpy. (ea.) Total no.las New residential single or multi-fami.y per Address: ��. dtyellhig anh.Inclod"attached garage. City:14 IQ Stated ZIP: Servicetnclnded: Phone Fax:G -7flj -msil: 1000 sq.ft.or less _ 4 C o.: Elec.bus.lic.no: 8 3 Each additional 500 sq.ft.or portion thereof _ - Limited energy,residential _ 2 ity ,3 Q Limtdtei energy,non-residential 2 1 p U Each manufactured home or modular dwelling n tura su rvrs g el trician(requDate I Service and/or feeder 2 -�--- Services or feeders-installation, Sup.sleet.,rams(print): .L .t- I.icensc no:_ C) alteration or relocation: _200 amps or less _ _ 2 7amet): �,� _ 2aI ampv to 400 amps 240l amps to 600 amps 2 dress: 3_ ' GlJ f'l 601 amps to 1000 amps 2 $tatC� ZIP: ,1j4 3 Over 1000 amps or volts - ' _ 2 Phone:/.dp 44'd Fax:,s•y - E-mail: Reconnectonly I Owner installation:The installation is being made on property I own Temporary services or feeders- whl6 is not intended for We,lease,rent,or exchange according to installation,alteration.orrelocation: 200 amps or less 2 OP.S 447,455,479,670,701. —-- 201 amps to 400 amps 2 Jwnees signature: Os'/f/� �Y L' Date: 401 to 600 amps 2 Branch circuits-new,alteration, or extension per panel: Name: n A. Fee for branch circuits with purchase of �dldtESg: � p/ service or feeler fee,each branch circuit - 2 $ � �pyy, B. Fee for branch circuitswithout purchase PhOnC' - l� Fax: E-mail: of service or feeder fee,first branch circuit: 2 Each additional branch circuit: Mhc.(Service or feeder not Included): ❑Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle 2 ❑Service over 320 amps-rating of 1 R.2 ❑Harirdous location Each sign or outline lighting - 2 family dwellings ❑Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel, ❑System over 600 volts nominal more residential units in one structure alteration,or extension• 2 ❑Building over three stories ❑Feeders.400 amps or more *Description:- ❑(ke.•upant load over 99 persons ❑Manu'actured structures or R V park Each additional Inspection over the allowable In any of the above ❑Egress/lightingplan U Odtee: _— Perinspection _ Submit___sets of plass with Say of the above. Investigation fee The above are not applicable to temporary comtructlon service. Otter — Not all)udsdictions accep credit cads,please earl)udoocuon For more information. Notice:This permit application Permit fee.....................$ O Visa ❑MasterCard expires if a permit is not obtained Plan review(at _ %) $ —_ Credit card number:___. _ / / within 190 days after it has been State surcharge(8%)....$ Expires accepted as complete. ----- TOTAL .......................f ----- Name of cardholder u shown on er�l cars S - Cardholder signature Amount 4aQ461I(6MMl 0nn TYPE OF WORK INVOLVED-RESIDENTIAL ONLY 4. Complete Fee Schedule Below: Number of Inspections per permit allowed Restricted Energy Fee........ `---------- Service included: Items Cost Total (FOR ALL SYSTEM!�) 4- Residential-per unit Check Type of Work Involved: 1000 sq.fl.or less _ $147.15 _ 4 Each additional 500 sq.ft.or --- �� Audio and Stereo Systema portion thereof _ $33.40 1 Hmifsd Energy _ $75.00 ❑ Burglar Alai m Fadi Manuf d Hame nr Modular Dwelling 5eryce or Feeder $90.90 2 --- Garage Door Opener' 411.SmIrrs or Feeders Installation,alteration,or relocation Heating,Ventilation and Air Conditioning System' '7..00 amps or less _ _ $80.30 2 201 amps to 400 amps _�--_ $106.85 _ 2 ❑ vacuum Systems' 401 amps to 600 amps 5160.60 2 601 amps to 1000 amps $240.60 2 U Other Over 1000 amps or volts T $454.65 2 ---- -- Reconnect only $66.85- 2 TYPE OF WORK INVOLVED - COMMERML ONLY 4r.Temporary Services or Feeders -- Inslallallon,al(eration,or relocation '-' Fee for each system...... 200 amps or less $66.85 2 ....................................... =75.00 -- 201 amps 4o 400 amps M _- $100.30 2 (SEE OAR 918-260-260) 401 amps to 600 amps _ $133.75_-�- 2 Check Type of Work Involved: Over 600 arrps to 1000 volts, see"b"above. ❑ Audio and Stereo Systems 4d.Branch Circuits New,alteration or eMenslon per panel Boiler Controls a)The fee for branch circuits with,olurchase of service or ] Clock Systems feeder fee. Each branch circuit $6.55 __ 2 ❑ b)The lee for branch circuits Data Telecommunication Installation without purchase of service or feeder fee. ❑ Fire Alarm Installation First brandi circuit _ $46.85 Fadi additional branch ckcu.t `-_ $6.65 HVAC 4e.Miscellaneous L� instrumentation (Servk*or feeder not Included) Each pump ur inigalicn circle $53.40 _ Each sign of ou line fighting $53.40 _ ❑ Intercom and Paging Systems Signal cirmll(s)or a limited energy - -- panel,atleration or extension $75.00- �� Landscape Irrigation Control' Minor Labels(10) $125.00 _ 4f.tach additional Inspection over �'_ �� ❑ Medical the allowable In any of the above P ❑ er inspection $62.50 Nuise Calls Per hour __ $62.50 In Plant $73.75 - ❑ Outdoor Landscape Lighting' 5. Fees: ❑ Protective Signaling 5r.Enter total of above lees $ 8%Surcharge(.08 X total fees) $ -^-Y-� L, Other -�_- Subfofal $ 6b.Enter 25%of trio 62 for � Number of Systems Plan Review it required(Sec 3) $ - -- - ---- Subtotal S No licenses are required Licenses are requlred for all other Installations 11 El Tnrst Account p - FEES Total balance Due $ _ `u+ ENTER FEES $ -" --"-- --- 8%SWICHARGE(.08 X TOTAL ABOVE) $ TOTAL $ 1~L Off' FLAN LOT #1.03" S, APPLE WOOD FARK RI FE) 251 11 D,4 TAX LOT 1014(o 00 15450 5W EMPIRE TERRACE -),E. 1/4 r)r- 5ECTION 11, T.2, R.IW, W.M. CITY OF TIc.ARF W,45�4 INGTON COUNTY*, OREraON L " G ND ID WATER METER HOM S W---------- WATER LINE _ �� 100 55-----—' SANITARY' SEWER Q 11 " 12755 SW 69th AVENUE SUITE STORM DRAIN ;;�a'=��! OFFICE (503) 620-8080 P(�' CLAND, OR. 97722 2: — — — 4 OF STREET FAX (503) 598-8000 CCB# 60563 MANHOLE ® CATCH 15A51N PROP05ED STRFETTREE5 ® 5TREET LIGHT FIRE HYDRANT ~ LOT 140,2 ul Ul 0 I `� t I 589'54'25"W' sp I(n 7 rW 1995'. wl L .-I I" • �m'-m" � � C� N I i 0) Z3 (Y /� DELL �QW ILCL31 0 1998' e ._. 1III it `_ 1p PROvIDE EROSION I i I � '?' , s 66.24'5 W1 b 1995' / CONTROL FEr:CE PER COMMUNITY EROSION PLAN ( LOT I3$ l �. i ''