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15520 SW Empire Terrace i
r MASTER PERMIT
CITYOF TIG ARD PERMIT#: MST2001-00123
DEVELOPMENT SERVICES DATE ISSUED: 4/3/01
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171
SITE ADDRESS: 15520 S10 EWRE TERR PARS'" : 2S111DA-14400
SUBDIVISION: APPLEWOOD PARK NO. 3 ZOINING: R-7
BLOCK: LOT: 137 JURISDICTION: TIG
REMARKS: New SF detached. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 927 of BASEMENT: of LEFT: 19 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.227 of GARAGE: 479 at FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: I FINSSMENT at RIGHT: 5
VALUE: S 196.763 00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,154 00 of REAR: 16
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS
TUBISHOWERS: 3 GARBAGE DISP: I WATER HEATERS: 1 WATFR LINES: 100 BCKrLW PREVNTR: GREASE TRAPS
OTHER FIXTURES.
MEC14ANICAL
FUEL TY?ES _ FURN<100K: BOIIJCMP<3HP: VENT FANS: 5 CLOTHES DRYER: I
GAS FURN>-1001(: 1 UNIT HEATERS- HOODS: I OTHER UNITS: t
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOOnSTOVES: GAS OUl LETS. 1
ELECTRICAL
RESIDENTIAL UNIT SER'r:''E FEEDER TEMP SRVCIFEEDERS _BRANCH CIRCUITS _ MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 400 amp: 201 400 amp: 1rt WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: FA ADDL BR CIR: SIGNALIPANEL: IN PU1f;I:
MANU HMISVCIFDR: 601 • 1000 amp: 601*ampo•1000v: MINOR LABEL:
10004 amplvolt
PLAN REVIEW SECTION
Reconnect only:
>-41 RES UNITS: SVCIFCR,-225 A.: >600 V NOMINAL: CLS ARE VSPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: f IRE ALAR"a: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATArTELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractcr: TOTAL FEES: $ 3,982.76
This permit is subject to the regulations contained in the
LEGEND HOMES LEGEND HOMES CORP Tigard Municipal Code,State of OR Specialty Codes and
12755 SW 69TH AVE 12755 SW 69TH AVE#100 all othor applicable laws. All work will be done in
PORTLAND.OR 97224 TIGARD,OR 97223 accordance with,approved plans This permit will expire H
work Is not Marted within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION.
Phone: Phone: Oregon law requires you to follow rules adopted by thr,
Oregon Utility Notification Center. Those rules are set
Rep#: LIC 60563 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
Erosion Control Insp 8, Post/Beam Mechanica Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Final Inspaiction
Footing Insp Crawl Drain/Backy•ater Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Building Fi,lal
Foundation Insp Footing/Foundation Dr; Framing Insp Gas Fireplace Electrical Final
Post/Beim Structural PLM/Underfloor Shear Wall Insp Insulation Insp Mechanical Final
Issued By : _ Permittee SignatLI*:__-6'' •- . . ;_c_ ____
Call (503) 639-4175 .,y 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD _ EWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-00070
13925 S1v Hall Blvd.,Tigard, OR 977.23 1,503) 639-4171 DATE ISSUED: 4/3/01
SITE ADDRESS; 15520 SW EMPIRE TERR
PARCEL: 2S111 DA-14400
SUBDIVISION: APPI EWOOD PARK NO. 3 ,ZONING: R-7
BLOCK: LOT: 137 JURISDICTION: TIG
TENANT NAME:
USA 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 detached dwelling.
Owner: �-
FEES
LEGEND HOMES Type By Date Amount Receipt
12755 SW 69TH AVE
PORTLAND, OR 97224 PRMT CTR 4/3/01 $2,300.00 27200100000
INSP CTR 4/3/01 $35.00 27200100000
Phone: 503-620-8080 Total $2,335.00
Contractor:
Phone:
Reg#:
Required Inspections
This Applicant agrees to comply with all the rules ar.d regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the pen-nit 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" Pern0t and the Agency will install a latr:ral. 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:/�J�? y � Permittee Signature:
Carl (503) 639-4175 by 7:00 P.M. for an inspection needed the next but;biess day
A,A Building Permit Application
Date received: Permitno.:/°j�l�'L/��C�';
City of Tigard
Address: 13125 SW Nall Blvd,Tigard,OR 972.23 ProjecUappl.no.: Expire date-.
C'irynj7"igtard Phone: (503) 639-4171 Date issued: By:.,-- Recciptno.:
Fax: (503) 598-1960 case file no.: Payment type:
I&2 family: Complex:
Land.use approval: _ -
&I W1
&2 family dwelling or acressory Cl Commerciallindustrial ❑Multi-family 2rNew construction LI Demolition
U Add iLion/al teratioidreplacement O Tenant improvement U Fire sprinkler/alarm ❑Other._
JORSITEINFORIMATION
Joh address: c� � u ' �/ (�lF�'L ��� _ Bldg.no.: _��trite no.:
Lot: ; Block: Subdivision: �Alf 11t r,.`6,2_� Tax map/tax lot/account no.:
Project name:
Description and location of work on prernises/srecial conditions:
OWNEU11.11 ION, USE UIILUKLI� I
Narne_ p
Mailing add ss: / ,S 1S- I &2 family dwelling:
--- - -r- /yt;, !. �
City l f Staic:p ZIP: f 702 L Valuation of work..................... ......r✓........ s
Phone: Fax Q) E-mai!: No.of bedroorrs/baths.................................
Owners representative: { C: N I LL f`01—1 Total number of floors................................. L
Phone: - — -
�> b` �`0 E-mail: New dwelling area{sq. ft.) .......................... -
Garage/carport area(sq.ft.)......................... 4-j Ci
Name: / ,��� M'Q Coveted porch area(sq.ft.) .........................
Mailing add ss: �� 5 /P Z-1 Deck ama(sq.ft. ........................................
city: Stair ZIP:9 7 OUrer structure area(sq. ft)......................... _
Phonc: �� Faxes E-mail: Commercl&Mndttstrial/multi-family:
1 Valu ation of work........................................ $ —
Existing bldg.area(sq.III-) ................ .f..
Business name: Z �� U� ..
Address:)aL 7J1�5 _eta _ - New bldg.area(sq..�).......... ........ -- --
Number of;tones ...
City: p Staterlr ZIP:9 7» _ 7
Phonc: O G Fax�y Email: Type of construction...........s,6.....................
'- Occupancy group(s): Existing:
CCB no.:
_�_tv 9 3`r0 3 New-
City/metro lic.no.: ;7 Notice:All contractors and subcontractors are required to be
11(1111 IRE 111116111211111 licensed with the Oregon Construction Cortractors Beard ander
Nam p provisions of ORS 701 wid may be required to be licensed in the
jurisdiction where work is being performed. If the applicant is
exempt from licensing,the following reason applies:
City: 'ted o _ Stater 'LIP: �)
Contact person: cr tj V z$deilq Plan no.: —� -" ---`
Phonc:(r,Zp ' o Faxk5E-mail: — -- ,- - ---
Name: -,.,G� _ Contact person: _ Fees due upon application ........................... $
Addrrss:4 f/�y�— p Date receiveo: ___ __
City: �.- State:t ZJP: f 7,� _ Amount received ......................... ............ $—
Phcne: E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not dl juriatictiom scxot credit cards,please call jurisdiction for more infcnnstim
attached checklist. All provisions of laws and ordinances governing this ❑visa ❑MasterCard
work will be complied with,whether sj;Lcifued he in or not. Credit caul numl,n -
Esplres
Authorized � nature: ate: _�L L _ _ Name of cardherder U shown on credit card
Print name: ____ — Cardholder signature _ — Amoun.
Notice:This permit applicat' n expires if a permit is not obtained within 190 days after it hes been accepted as complete. 44G4613(6A OMM)
Mechanical Permitt Application
Date recei ved: Permit no.:
City of Tigard Project/appl.no.:
_ Expire date: -
City ojTigard Address. 13125 SW Hall Blvd,Tigard,OR 97223 Dateissucd: By: Receipt no.:
Phone: (503) 639-4171 — --{{
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: — _ , Building permit no.:
k TWE OF PERMIT Ir
E� &2 family dwelling or accessory U Commercial/industrial U Multi-family Ll Tenant improvement
" New construction U Add ition/alieration/replacement U Odier:
A
Job address: / ,(Z L✓ Indicate equipment qulntities in boxes below. Indicate the dollar
Bldg,no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax account no.: profit Value$
lot/ _
L.ot: I ), .J Block: Subdivision `See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP:
Description and I dtion of work on premises:
Fee(ea®R .,Iy
Est.date of completion/inspection: Description . Rev.oW
Tenant irnproveme r change of use: _ — r
Is existi space heated or conditioned?O Yes U Nc: handling unit —_—__CFM_
Is e ' m space insulated?O Yes U No con tuon xi(sue p an requireT-
B�P A letauon o exdsung C system
ZMEMMMUM oilerer c�essor
Business name: " State boiler permit no.:
jx� vw ----- _ HP _Tons_ _BTU/H
Address: G p,S ra smo c-ramper uct smoke e-7 sectors
City: �, �[ Stag ZIP: 970? Teat pumpTa tri-�en req-aired)
E-mail: nsta umpl cefurnac urner__
Phone: -7 ) [a.x: �7�y Including ductwork/vent liner O Yes O No
CCB no.: 1 _ nsta replac re ocate eaters-suspen e ,
City/m,:ru lic.no.: 0I 1,y _ wall,or Floor mounted
Name(please print): D poz, -Vent forappliance o tertnan7urnace --
e gera on:
cos:rn 110
Absorption units
Name: /G�/)e-z Chiller-- -_,- lip - - -- -
Address: t cT--S W Compressors - HP
-r onlmentaleexh mt avid ventilation:
City: po State:0/Z ZTP: 7_44 'l Appliance vent
J-- J� _�—
Phone- -j,7 Fax 7G E-mail: ere gust i
�,'�ype i 111res. itc a azmat -
hood fire unprrssion system _
Name: P ,yzJ� ��Q S _ Moll_ Exhaust fan with single duct(bath fans)
Mailing address: /j 7,3-D- C om.l� 4 oilExhaust system a art from eating o- AC
City: yt" G _
Statra7 ZIP:9 Tuelp ng an ut on(up to ou ets)
rye. LPG NO Oil _
Phone: - D d Fax'_ - E-mail: Fuell m each additional over-4 outict%
rap tematicrequi•e ) _
Itts
Name: ' /f -� b-I-er of outppli
t�erllat�pZfrince or equipment:
Address: G, e,) p� A1111_ - Decorative fireplace
City�. _ State: ZIP: nTsert-type
Phone: fvr l- �Gb Fax: E mail WoaTtov pe et stove —� -
er.
Applicatit's_signatur_e: P a ( ter:
Name (print): Feoy, -__
Permit fee.....................$
Na all)urisdetinne weep c edit cards,pw,4 can luriadluloo—m novae Intnmadan. Notice This rmit application licatiort —
❑Visa ❑MasterCard � rP hidn:mUr'.fee................$ —
expires Oft permit is not obtained Plan review(at T_ 9b) $
Credll card rumba:,,__----__---_` _._.L__L– —
Expirn within ISO clays after, s been State surcharge(8%)....$ _
- --
Name or cardholder ere shnwo on credit card acct nr: m complete.s pete.
TOTAL .......................$ - --
- Cardholder aignatme — �� Amount 440-4617(WICiNt)
Commercial Schedule
1&2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Oesalprbn '--- ---
Furnace to 100,000 BTU Table 1A Mechanical code _� City Pries Taw
b
Including ducts&vents 955 t) Furnace 100.000 era
ind duds&vents 14,00
Furnace>100,000 BTU 2) Fumaos+00.000 BTU;
_ Mdudd�xts -
kfg 8 vents 17.40
Induding ducts&vents _ 1,170 a)Floor;umaa
floor furnace 1en( :4.00
4) SusparWed heate,was heater --
Indudicg vent 955 «!foot mo.at(ed neater _ 14.00
suspended heater,wall tfeatrr 51 Dent not ktdtded in appliance pennp e,ao
or floor mounted heater 955 6) Repair units - We
Vent not included In appliance permit 445 Check a1 that appy. emkr Heal Ak
For Kama 7.10.see or f,ump Gond Qty PdW Total
Repair units n0J' footnotes 1,2 camp
7)4HP;absorb unit to
<3 hp;absorb.unit 100K eTU 14.00
8)3-It!IP;absorb unit
to 100k BTU _ _ 955 000110 WM BTU 25.60
3-15 hp;absorb.unit 9)1S30 HP;absorb
unn.5-1 m4 Btu 35.00
101k to 500k BTU 1700 10)s0-50itP;atnorb -
- unit 1.1.75 mil BTU 62.20
15-30 hp;absorb.unit 11)>SOHN;absorb unt>t.75 rn B'R!
501k to 1 mil.BTU 2310 12)A 6720
r rdN
furtp txeK b tU,000 CFM
30-50 hp;absorb.unit 10.00
1 J)AY harldNnl unit 10,000 M+
1-1.75 mil.BTU 3400 17.20
>50 hp;absorb.Unit 141 Non-pohahfa m•.pnnle oaalnr "-� -
10.00
>1.75 mil.BTU 5725 15)Vent(m connected to a single d5a
Air Dandling unit(0 10,000 da.aom 656 18)VeM44m system not rtdudad ri
Air handling unit>10,000 c!m 1170 • Ice � 10.00
17)Hood salved by mechanical exhaust
Non-portable evaporate colter 656 rrt10.00
16)Doastk rdrt
teralors
vent fan connected to a single duct 448 17,40
19)Commsldal or kdtutrlal type rtctrterator
Vent syst.not Included In appliance permit 658 119.15
Hood served b mechanical exhaust 656 20)OUw unto, dudrll woos.boas
10.00
Domestic Indneralor 1170 21)Cas p"V one to fine oudeu -
6.40
COmnlerdal or Ird�rstral Indnerator 4590 22)Moro than 1-per 0"(each)
Other unit,Inddding wood stoves,Inserts,eta 656 100
Minimum Permll Fee SILS0 SuaTOTAL
Gas piping 1-4 outlets _ 360 e%SURCHARGE
Ead1 additlonal outlet 63, PLAN REVIEW 25%OF SUBTOTAL
Rpulred for AL1 commmetal parmlh only
TOTAL -I- uw�
Oenr kwpecdmn end r. :
1. Infpe ntimn&AsWo or hamar Mni,ess ho,s(mYJnn chsrW rwe ht a j
$72.50 pw hour
2. tnsp-kna for w*"o M Is sp Jnob Mksu.f(nrnln du.9.kit 1w 1
Total Valgfl $72.50 per hwv
.L]I!!Ls a+-.-1191.E _ FCE ] wtlaorW Man nww"ked M dam".wWUom m m/sbm in town(minw,
ch*V a lW twun$72.50 ps,hdr
_ •sta1.Cori vaclnr Bow.ArYh•.aon r"Ared
S 1.0E to S5,000.00 Minimum$72.50 "ae,lde e.r�.ti"a"K'"•" M «M d r.a
i5,001.0610$10,000.00 572.50 for the first$5,000.00 and$1.52 for
each additicnal S 100.00 or fraction thereof,
to and including$10,000.00
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54
for(,ch additional$100.00 or fraction
thereof,to and including$25,000,00
$25,001.00 to$50,000.00 $379.50 for the fust 525,000,00 and$1.45
for each additional$100.00 or fraction
thereof;to and including$50,000.00
$50,000.00 and up t $742.00 for the first$50,000.00 and 51.20
for each additional$100.00 or fraction
thereof
Electrical PermitAprlication
-'- Date received: Permit no.:
City Of Tigard Proiect/appl.no.: Expire date:
City ufTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 new issued: By: Receiptno.:
Phone: (503) 639-4171 — -
Fax: (503) 598-1960 l Case file no.: PL vment type:
Land use approval:
OF
!rl &2 family dwelling or accessory ❑Commercial/industrial ❑Multi-family U Tenant improvement
New construction 0 Addition/alteration/replacement U Other: _ Q Partial
Job address: Z !pt.) -IOZ 2At6 1i1d1.nu.: Suite no.: ITax map/tax lot/account no.:
I.ot l Blo,k: Subdivision: Pt_L--u 1t. •`lam f I
Project name: ,Description and location of work on ptenuses:
Estimated date of co,npletion/'inspection: _
1-',no: Fee h.ax
I?acripllon (tty. (ca.) Total no.insLj
Business name: p/ ryewU-xbwgcormalti-familyper
Address: L5'' dwetw,g,udt u,cti�'rathchatgerage.
City: Statep Z1P: ServLelncluded
Phone/ - Fax:G —�9,1J -mtW: 1000 sq.ft.or leas _ 4
C o.: S Elec.bits.tic.no. 8 .3 Fact additional 500 sq.ft or portion thereof
[.united energy,residentilt 2
,'4itY1r0hJiQ0V.1. 3 7075 I-Amited energy,non-residential 2
; Each manufactured home or modulardwe'ang
taro SUP&13 g el trician required Dotof Service and/or feeder _ _ 2
Sup.elect.name(pdny - r+�---o�; a Senka or feeders-Installation,
alteration or relocation:
200 amps or less 2
201 amps to 400 amps 7
Name(print): B/I1� S
401 amps to 600 amps 2
Mailing address: 73- ' �, ' f'l� 2, 601 amps to 100(1 amps 2
City: - StateL'3 �: Over 1000 amps or volts 2
Phone:(,dP- elfa Fax:5-9 - E-mail' Reconocxtonly
Owner installation:The installation is being made on property I own Temporary serviced or feeders-
which is not intended for sale,lease,rent,or exchange according to 4laUtllation,alterntion,orrelocatiori:
200 amps or less 2
ORS 447,455,479,670,701. _
/J 201 amps to 400 sups Z
C)wnet's signah're: V a �1ti'' ate: 401 to 600 ami
$ranch clrenik-ncw,alteration,
or extension per panel•
Neale' ' A_ Fee for branch circuits with purchase of
Address: / service or feeder fee,each branch circuit _ 2
City' oil'4Yq StM04 12119% B. Fee for branch circuits without purchase
Phone: �- Cev Fax: E-mail: of service or feeder fee,first branch circuit: _ 2
Each additional brands circuit:
Mlsc.(Service or feedk:r not Included):
O Service over 225 amps comrwlelal U Health-are facility Each pump or irrigation circle 2
U Service over 320 amps-ruing of 1 dt2 U Haranbus location Each sign or outline lighting 2
family dwellings ❑Building over 10,000 square frit four or Signal circuit(s)or a limited energy panel,
Q System civet 600 volts nominal more residential unite in one atructum alteration,or extension* _ 2
•Building over duee stories O Feeders,400 amts or mom •Dinicri don:_
G Oaupent load over 99 persons ❑Manufactured structures or RV parte Each adds lonal hsp.•ct{on over the allowable In any of the above_
Q Egteaall'ghdngplan U Other. Perinspection
Submit_sets of pleas with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Na tit knisdlctiom.eapt credit cards,pined art judtdkdon for more ids"ration. Notice:This permit application Permit fee...(..............,$ _
U Visa U MasterCard expires If a permit is act oNsined Plan review at _ 96 $
rmdlt cart)number:._, within 180 days after it has been State surcharge:(8%)....$ _
Expires accepted as complete.
TOTAL.......................
Name of caAcIlier as shown on aedii cO
_ S
carbotder dpwwe Amour" 440-4615(OWCOM)
--------- -- --`- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
4. Complete Fee Schedule Below: _
_Number of Inspections per permit allowed Restricted Energy Fee........................................ $75.00
Service included: Items Cost Total (FOR ALL SYSTEMS)
4a. Residential-per unit Check Type of Work Involved:
1000 sq.ft.of less �`- $147.1b `- 4 E]Each additional 500 sq.ft.or Audio and Stereo Systems
portion thereof $33.40
I.Imited Energy -� - $7.5.00 ---- _- Burglar Alarrn
Each Manurd Home nr Modular
Dwellin,SeM,-t or Feeder �`- $90.90 2 Garage Door Opener'
41J.Services or Fe4ders
Installation,alteration,or relocation Heating,Ventilation and Air Conditioning System'
200 amps or less $80.30 _ 2
201 amps to 400 amps _- $106.85 2 ❑ Vacuum Systems'
401 amps to 600 arr;.s $160.60 _ 2
601 amps to 100,amps $240.60 -_� 2 Other_____-,_.
Over 1000 arr,rs or volts J__ $454.65 2
Reconnect only _ - $66.85 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY
4c..Temporary Services or Feeders -
Installation,alteration,or relocation fee for each system......................................„.,.... i;5.00
200 amps or Mss _ $66.85_ 2 (SEE OAR 918-260-260)
201 amps to 400 amps Y_ $100.10 � 2
401 amp,w 600 amps _- $133.75 2 Check Type of Work Involved:
I Over 600 amps to 1000 volts,
II see"b"above. Audio and Stereo Svstems
4d.Branch Circuits ❑
New,alteration or extension per panel Boller Controls
a)The fee for branch dreulls
with purchase of service or Clor*Systems
feeder foe.
Each branch drmlt `- 56.65 2 ❑ Data Telecommun-cation Installation
b)The fee.for branch circuits
wta:out purchase of servfce Fire Alarm Installation
or feeder fee.
First br:rnr!h cira4l _ $46.85 ❑
Each addilion¢I banch drm;t $6.65 HVAC
r
4e.Miscellaneous instrumentation
(r;ervic a or feeder not hcl-A,d)
Each pump or rnigalion circle $53.40 Intercom and Paging Svstems
Eadr sign or outline lighting -- $53.40
Signal cir,xrtt(s)or a limited energy Landscape Irrigation Control"
pane+,#,iteration or extension $75.00
Minot labels(10) - - 5125. 0 ❑
Medical
4f.Each,additional Inspection over
the allowat.!c hr any of the above Nurse Calls
Per Inspection $62.50 --__.--
Per hour ,- $82.50-_-
Outdoor Landscape Lighting'
In Plant $73.75
5. Fees: ❑ Protective Signaling
Sa.Eder total of above fees $ _-
8%swcharge(.08 X total fees) $ __-` Other --- - -.- - _---
Subtotal $ -.------
5b Fnler 25%of line 53 for _--_�NUmber of Systems
Plan Review If regu I(Sec.31 $ !J
-
_. o Ncerh+es are reoulred. Licenses are required for all other installationslaricinstallationsSubfotal $
FEES:
❑ Trust Account p
Total balance Due $ ENTER FEES 5------ ---
- - - 8%SURCHARGE(.08 X TOTAL ABOVE) S
TOTAL $
/ Plumbing Permit Application
Date received: Permit no.:
City of Tigard Sower permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of T'gard Phone: (503) 639-4171 Project/appl.no.:— Expire date:
Fax: (503) 598.1960 Date issued: By: Receiptno.:
Land use approval: —. — case file no.: Paymeat type:
OF
l &2 family dwelling or accessory LlCommercial/industrial 0 Multi.-family O Tenant impmvement
G]Flew constmctifjn ❑Addition/alteration/replacement ❑Food service O Other:
11 t r r �
Desca•i ction Qty. ren ea. Total
Bldg.no.: Suite no.: _ New I-•and 2-fancily dwellings only:
(Includes 100 ft.foreach utility connection)
Tax map/tax lottaccount no.: SFR(1)bath
Lot: I;V1 lBlock: Subdivision: SFR(2)bath --
Project name: AfAWA�&W C.ap SFR(3)bath --
City/county: r Each additional bath/kitchen -
Description and lo6ation of work on premises: SiteutWtles:
Catch basin/area drain
Est.date of compledon/inspection D wells/leas line/trench drain
Footing drain(no.lin. ft.)
Manufactured home utilities
Business name: o - Manholes —
Address: (� pD _ R—Ta n dwin connector —
City: of State:Q Z>P: 7p Sanitary so --.(no.lin.R) - — --
Phone: (, Fax:GG 7_9 E-mail: Storm sewer(no.lin.ft.)
CCB no.: 21Y I I Plumb,bus.reg.no: p Water service(no.lin.R) --
City/metro lic.no.: d Flrittre or item:
Contractor's representative signature: Q!jjFr on Absorption valveOf —
Back flow preventer _
Print name: O d di7 Date: Backwater valveU 146-1 -
asimtlavatory — -
Name: dor P a- _ Clothes washer
Dishwasher
Address: ee A dLelew 7 Drinking --
city: sb— state Drinking fountains)
ZIP: �3d inkinum -
Phone: Fax: E-mail:
Expansion tank
=I INMI Fixtu sewer cap
y Name(print): 1. p p #0PS. Floor drainstfloor sinksthub
Ga
rbage disposal
Mailing addrts3: �,�-- G Hose bi
bb
City: IState:m R 1 ZIP: 97.4 [ce m-a er - --Y
Phone: -A-'o 7hitEmail: fntercepto grease tri
JHmer installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own Is per ORS Cha ter 447. SaLk(q),basin(s),lays(s)
Owner's signature: e: Sump
Tubs//ss►ower/shower pan
Name: Urinal --
----- Water closet
Address: Water heater --
City: _ State ZIP:1 Other.
Phone: _ QOj-- Fax: E-mail: Total
Nd an juritdiniau secerpl credit-.■a.,�CAI itvisracwM for mm Inf«,w►oa Notice:This permit application Minimmn fee................$
0 Visa [I mastcd2sm expires if a permit is not obtained Plan review at —_. %) $
Crertlt and numbu. EaPlre�— within 180 days ager it has been Stale surcharge(8%) ....$ —_- —_
Nuw c&riW1 c�r u 9W ,;credit card
accepted as completc. TOTAL .......................$ ---
_ S
cai w�der ripature Amount 'AG-1616(W_OM)
el-EA ECOMPLETE:
FIXTURES•(Individual)• Total d (
Sink 16.60Fixture Type -" Ye.k performed
-
Nw+ Moved Roplauq RamovadlCappN
Lavatory 16.60 Sink
Lavato
Tub or Tub/Shower Comb. 16.80 Tub or Tub/Shov er Combination - -
Shower Only 16.60 Showor Only --
Water Closet _ 16.60 Water Closet -_
Urinal - -
Urinsi 16.60 Dishwasher
Dishwasher '- 16,80 G'rba_ dp Disposal _ - ----
Laund r Room TTY -
Garbage Disposal 16.60 Washing Machine - -------
Laundry Tray 16.60 Floor Drain/Floor Sink 2' ~----
3'
Washing Machine 16.60 ----- 4. -
Floor Drain/Floor Sink2- 16.60 Water Heater - -
k4'
' 18.80 Other Fixtures
16.60 -
Water Heater O conversion O like kind 16.80 - - ------ - _ -
Gas piping requires a separate mechanical permit. --- --
MFG Home New Water Service 48.40 �-- -
MFG Home New SaNSlorm Sewer 46.40
Hose Bibs 18.60 COMMENTS REGARDING ABOVE:
Roof Drains 16.60 -
Drinking Fountain 16.130 --- -`
Other Fixtures(Specify) 21.75 `-
Sewer-1 st 100' 55.00
Sewer-each additional 100' _ 46.40
Water Service-1 st 100' 65.00
Water Service-each additional 200' 46.40
Sloan b fain Drain-I at 100' 55.00
Storm P.Rain Drain-each additional 100' 46.40
Comnkrrdal Back Flow Prevention Device 48.40
Residential Baddlow Prevention Device* - 27.55
Catch Basin 16.60
Insp.of Existing Plumbinq or Spedally Requested 72.50
Inspections perthr
Rain Drain.shgle famlly dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or rt_:er diagram Is required r Quardity,Tow Is 3-9
*SUBTOTAL
8%SURCHARGE .'
`r#
"PLAN REVIEW 25%OF SUBTOTAL
Required ony r fixture tity.total Is>9 _
TOTAL
'Mintmum permit fte Is$72.50+a%uxr3uuge,a -xpt Residential nackllow Prevention
Devke,YA"Is$-',.i.25 a 8%sunfiarge.
All New Comme-clal Bundings wrAe plans with Isometric or riser diagram and ptan review.
PL OT FLAN
LOT 1*1 ]31 AFFLEWOOD f=AR<
RIP[) 251 11 DA
TAX LOT 014000
19 WATER METER
15520 5W EMPIRE TERRACE W------- WATER LINE
9S— — — — SANITARY SEWER
S.E. 1/4 OF SECTION 11, T.2, R.1W, W.M. SD— - - - STORM DR..iN
G I TY OF T IGARD t OF STREET
MANHOLE
WA5N INGTON COUNT`.', OREGON ® CATCH BASIN
PROPOSED
STREET TREES
LIEG 11'11'LL`��, 1 �� D STREET LIGHT
` ' 0 FIRE HYDRANT
s 111111 I P2755 at 59th AVKM surra too
orrics (509) e20-5050 T(OARD. OR. 97229
PAX (501) 595-5900 CCB/ 50559
s
I I \ \
44.48'
I I W ; ��D•� � ,
41 k
I
PROVIDE EROSION I I I Q/ ' , 1394' _
CONTROL FENCE U i �� / % X-_ 202-VPER COMMUNITY
EROSION PLAN L
/SLOT 137
4,165 90. FT.
a- NARCOUR7 11 A I �
I I
I i I �' %,FIP�. FLR •
2p3.2// II io
W1 I GAR,46E FLR. 202.4'/ I! I
II
202.2'
tn
189'1'
I i (—W
6230' — u, II-t
i -a -I ►= LOT 136
0 6 IVUTILITY
,., EASEMENT
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TUALATIN VLY HWY #C
ALOHA, OR 9 700 6-1 249
Electrical Signature Form
Permit #: MST2001-00123
Date Issued: 413101
Parcel: 2S,1-I-IDA-14400
Site Address: 15520 SW EifiPIRE TERR
Subdivision: APPLEWOOL: PARK NO. 3
Block: Lot, 137
Jurisdiction: TIG
Zoning: R-7
Remarks: New SF detached. Path 1
Your company has been indicated as " electrical contractor for the permit indicated above. In order for the
electrical permit to be v the signatt )f the supervising electrician is required. Please have the
appropriate individual from your com, sign below and return this Electrical Signature Form prior to the
start of the work to the address above, H TTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
LEGEND HOMES GARNER ELECTRIC
12755 SW 69TH AVE 21785 SW TUALATIN VLY HWY #C
PORTLAND, OR 0,7224 ALOHA, OR 97006-1249
Phone #- 503-620-8080 Phone #: 503-648-4552
Req #: Lac 121159
SUP 3707S
ELE 34-305C
AN INK SIGNATURE IS REQUIRED ON THIS FO�M
_
X61� lilloll
—
of Supervising Electriciao
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD BI IILDING INSPECTION DIVISION MST
24-Hour Inspection Line: L j-4175 Business Line: 635 .171
BLIP
Pate Requested W-/1-0/ AM _PM BLD
Location 155-2,0 Suite MEC
Contact Person -TL,-I? Ph PLM
Contractor Ph _ SWR
BU O — Tenant/Owner ELC
Retaining Wall— ELR
Footing Access:
Foundation FPS
g Drain SGN
Crawl Drain Inspection Nntes: — -- -
Slab _ SIT _
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
CEi
Framing
Insulation �J
Drywall Nailing — --
Firewall
Fire Sprinkler — -
Fire Alarm
Susp'd Ceiling - - --- -- ----- -- -----
Roof
Misc: --
PASS I PART) FAIL -- - -- �-
PLUMBING
Post 8 Beam __�..--.- —_--
Under Slab
Top n r —
Water'ervice _
Sanitary Sewer —
Rain Drains
Final
PASS PART FAIL
AN
Post&Beam —
Rough In
Gas Line
Smoke Dampers
PAS PART FAIL _
CTRICAL
Service -
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL _ —
8
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspectlon. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Unable to inspect-no access
Fire Supply Line [ J Please call for reinspection RE:_ [ ]
ADA
Approach/Sidewalk
Date _� s-1'/ _ -,Inspector _ Ext
tither
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the Job site.
CITY OF TIGARD RIJILDING INSPECTION DIVISInN MST
24-Hour Inspection Line: 9-4175 Business Line: 63„ .171 =
BLIP _
Date Requested �- __--AM PM _ _ BLD _
Location s Z U Suite MEC
V_ –.-
Contact Person Ph _ 2--d 2.33 PLM
Contractor Ph _— SWR
BUILDING Tenant/Owner _ ELC
Retaining Wall ELR _
Footing Access: �-
Foundation FPS
Ftg Drain ------_---____._
Crawl Drain inspection Notes SGN
Slab - ------------- - - SIT
Post&Beam — ----------
Ext Sheath/Shear
Int Sheath/Shear ------------ _-�_.__
Framing
Insulation ----- -._.__..-�.—__.--------- ----- - ---------
Drywall Nailing __- -----,.--`------�----�_-
Firewall -
Fire Sprinkler _ -
Fire Alarm /
Susp'd Ceiling _ / A�e_
Roof
Misc ---- ---- ------ ----
Final
PASS PART FAIL --- ---- - ---- --- -- ---------
PLUMBING
Post&Beam
Under Slay
Top Out - - ------- - ---
Water Service
Sanitary Sewer - -- --_-"
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Pout& Beam - - - --
Rough In
Gas Line - --- --- _ _.-
Smoke Dampers
Final ---
PASS PART FAIL_
ELECTRICAL - -- - -- ---
Service
Rough In -- ------ -- -- -- _�
UG/Slab _
Low Voltage
Fire Alarm
PASS ART FAIL
J
Back ill/Grading _- - --_---- - — --
Sanitary Sewer
Storm Drain ( j Reinspection fee of$_ _required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ]Please call for reinspection RE:__ __ [ ]Unable to inspect-no access
ADA
Approach/Sid walk Date r Inspector Ext
Other ----_ p _
Final
PASS PART FAIL_ DO NOT REMOVE this inspection record f-om the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISK''V MST Dov( .�G!
24-Hour Inspection Line: .1-4175 Business Line. 635-.#171
BUP
Date Requested_ ,AM_ PM _ BLD _
Location 57s Z U
Suite _ MEC _
Contact Person Ph 2 C% PLM 4
Contractor Ph SWR
BUILDING Tenant/Owne- ELC
Retairing Wall ELIR _
Footing Access: —�
Foundation FPS
Fig Drain SGN —
C awl Drain Inspection Notes ---- _
Slab
__-- -------------------------_------- SIT
Post&Beam --
Ext Sheath/Shear
Int Sheath/Shear
Framing -- ---- -- -------_—_—_ __ _______
Insulation — —---
Drywall Nailing
Firewall
Fire Sprinkler - - ---- ._—_-- --- --- ------- — ------ ----
Fire Alarm
Su sp'd Ceiling
Roof -- -._ —_—___—�-------_-- -------____—_
Misc: -- ------- -----_._ _ --- — -----
Final
PASS PART FAIL - -- --- -- - - ---------------- -------- -- _-_—
PLUMBING
Post&Beam -- T-- -- --T---
Under Slab
Top Out ---
Water Service
Sanitary Sewer
Rain Drains
S PART FAIT_
CAL
Post&Beam --- ---- -- -- --- ---—- - — ---------
Rough In
Gas Line -- - ---------- ----...- ..--
Smoke Dampers
Final —- - -
P!,SS PART FAIL
ELECTRICAL
Service
Rough In --_ ——----
UGiSlab
Low Voltage --- --------- ------___—.
Fire Alarm
Final --__ - ----------�_ .- ---
PASS PART FAIL
SITE
Backfill!Grading --___ --------------_- _-- -___ _--_--
Sanitary Sewer
Storm Drain I ) Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line f I I'lease call for rein-on t rn RF ( )Unable to inspect-no access
ADA
Approsch!Sidewalk
Other ate Inspector — y (.� Ext
Final —
PASS PART FAIL DO NOT REMOVE this inspectiu.. i ecord from the job site.