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11760 SW KOSKI AVENUE w a rn 0 N 0 D 0 c 0 11760 SW Koski Avenue MASTER PERMIT - CITY OF TIGARD PERN,'T#: MST2002-00487 DEVELOPMENT SERVICES DATE ISSU, D: 1/17/03 1317.5 SW Hall B' H.,Tigard,OR 97223 (507)639.4171 PARCEL: 1 S13;iCD-11700 SITE ADDRESS: 11760 SVV KOSKI AVE 1.ONING: R-12 SUBDIVISWN: KALAMOIIKA ESTATES LOT: 004 JURISDICTION: fIG BLOCK: REMARKS: PJew SF detached residence, PC' 1.BUILDING — FL.UOR AREAS REQUIRED SETBACKS _ REQUIRED REISSUE: STORIES 2 — SMOKEDETEC10Rf: CLASS OF WORK NFW HEIGHT: 23 FIRST Stn sr BASEMENT sr LEFT TYPE OF 11SE: 9F FLOOR LOAD: 40 SECOND 1,065 at GARAGE: 403 it I RONT. PARKING SPACES: twat` sl RIGHT 5 TYPE OF CONST: SN DWELLING UNITS: 1 VALUE 19:!,413.00 REAR. OCCUPANCY GRP: R3 BDRM: 4 BATH: TOTAL 1.919 sf PLUMBING RAIN DRAIN100 TRAPS: SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: . SEWER LINES: 100 SF RAIN DRA-NS CATCH BASINS: LAVATORIES. 4 DISHWASHERS: i FLOOR DRAINS: GREASE TRAPS: TUBISHOWERS. 3 GANHAGE DISP: t WATER HEATERS: 1 WATER LINES: iii" Bf,KFI_W PREVNTR: 01 HER FIXTURES: MECHANICAL _ — < VENT FANS: CLOTHES DRYER: 1 _ FUEL.TYPES FURN<100K: t BOIUCMP 3HP: FURN>■100K: UNIT HEATERS: HOODSOTHER UNITS: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2 MAX INP: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVL'OEEDERS BRANCH CIRCUITS _ MISCELLANFnU:, AOD'LINSPECTION!1 - - WISVC OR FD R: PUMPIIRRIGATION: PERIN4PF';TWN: 0 200 amp: 1 0 200 a1T1p 1000 9F OR LESS: t PFR HOUR: 201 - 400 amp: 201 - 400 dp n1N WIG 9VCIFOR: SIONIOUT LIN LT: EA ADD'L 500SF: 4 IN PLANT: euc^O•; 4,11 600 amp: 401 WOT P EAADULORCIR: SIONAUPANEL: LIMITED MINOR LABEL: FAANU HMISVCIFDR: 001 1000 amp: 601+ainps-1000": 1000+arnolvolt: PLAN REVIEW SECTION Recannact only: >.4 RE SVCIFDR>-225 A.: >Son V NOMINAL: CLS AREABPC OCC. ELECTRICAL•RESTRICTED ENEPGY B.COMMERCIAL --A.SF RESIDENTIAL .. AUDIO 8 STEREO' x VACUUM SYSTEM: % AUDIO d STEREO: FIRE ALARM: INTERCOMIPAGINO: OUTDOOR LNDSC Lt: BURGLAR ALARM: x DTH: ALL ENCOMP BOILER: HVAC: LANDSCAPE/1RRIG: PROLECTIVE SIGNL: CLUCK: INSTRUMEN"ATION: MEDICAL: OTHW GARAGE OPENER: X NURSE CALLS: TOTAL N SYSTEMS: HVAC: X DATA/TELE COMM: TOTAL. FEES: $ 6,888.12 Owner: Contractor: This p.rmit is subject to the reculatlons contained in the ECK CONSTRUCTION INC ECK CONSTRUCTION INC Tigard t0inicipal Code,State of OR. Specialty Codes and PO BOX 204 PO BOX 204 all other applicable laws. All work will be done in SHERWOOD,OR 97140 SHERWOOD.OR 97140 acoordance with approved plans. This permit will expired work is not started within 180 days of Issuance,or if the work is suspended for more than 180 days. ATTENTION: Oregon law r-iquires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Phone: GZ5-1305 503 625-1305 forth in OAR 952-001-0010 through 952-001-0080. You may obtain cople-s of these rules or direct questions to Rea n: LIC I I OUNC by calling(503)246-1987. RECIUIRFD INSPECTIONS Erosion Control Insp 8 PostlBeam Mechanics Plumb Top Out Exterior Sheathing Inst Water Ling Insp Plumb Building nFinal Water Service Insp 9 inal Sewer Inspection Undurfloor Insulation Electrical Service Low Voltage A rlSdwlk Insp Fonting Insp CraM1 Drain/Backwater Electrical'.ough In Gas Line Insp PP Framing Insp Insulation Insp Electrical Final Fourdation Insp PLMldriderfloor Rain drain Insp Mechanical Final Post/Beam Structural Fing Dr Bsm't Waif Shear Wall Insp Permittee Signature : +' - Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next bu+finess %ay ^� CITY OF TIGARD _ SEWER CONNECTION PERMIT_ DEVELOPMENT SERVICES PERMIT#: 1/ 7/0002-00338 DATE: ISSUED: 3 1/ 7/0 13125 SW Hai: R!vd., Tigard. OR 97223 ;503) 639-4171 PARCEL: 1S 135CD-11700 SITE ADDRESS; 11760 SW KOSKI AVE SUBDIVISION: KALAMOIIKA E:STA]I ti ZONING: R i2 BLOCK: LOT: 004 � JURISDICTION: "t IG _ TENANT NAME: USA, NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF Owner: _. _ FEES ECK CONSTRUCTION INC Desc�iption v Date Amount PO BOX 204 — SHERWOOD, OR 97140 Wl!SAI SwrConnect 1/17/03 $2,300.00 S W USA I Swr onnect 1/17/03 $0.00 Phone: 501-625-1105 ISWINS111 Stir Inspect 1/17/03 $35.00 1SWINSI11 Swr Inspect 1/17/03 $0.00 Contractor: _ Total $2,335.00 Phone: Reg #: Required Inspections This Applicant agrees to ccmply with all the rules and regulations of the Clean Water Services. The permit expire 180 days from th�� date issue.'. The total amount paid will be forfeited if the permit expires. The Agenry does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement giver., 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" Perm Issued by. i Permittee Signature: ___ Call f503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Permit Application City of Tigard PECEI Datercceived: Permit no.: -5r' cf Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: p ate: City of Tigard Phone- (503) 639-4171 DEC 0 9 2w Date issued: By Receipt no.: Fax: (503) 598-1960 Case file no.: -Payment type: it Land use approval: CITY OF T�IaA�oN_ 1&2 family:Simple Complex r all 1111111 a Om_ TTS- J 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family New construction Demolition ❑Addition/altcration/replacement U Tenant improvement U Fire sprinkler/al>� U Ll Other: 111011 go]Ilk]51111[ilk, Job address: I Bldg.no.: Isuite no.: Lot: ►',t ck: Subdivision: a r, 5 f Tax mnp/tax lot/account no.: Project name: f - Description and location of work on premises/special conditions: Name:3.11 �CJ-C �c (HotKiplaill's � Mailing address: ( I &2 fandly dwelling: City: _ state: 7..IP: Valuation of work....:.................................. $—`�"iG_Cs Phone: "ax:-- -�Gmail: Nc of bedrooms/baths................................. Owner's represen five: Total number of floors............I.................... Phone: fax: L rriT aft: ----- New dwelling area(sq.ft.) .........:................ -- --- Garage/carport area(sq.ft.)......".......:.......... t� Name: _1--- covered porch area(sq.ft.) ......................... Mailing address: Deck area(sq. ft.) ............................I........... --�-- - — Otlrcr structure area(s . ft.)......................... city. State. ZIP: _ ----- _moi Phone: �C Fax: E-mail: Commercial/IndustrinUmulti-family: Valuation of work........................................ Business name:rc Dnf �,�/�' Existing bldg.area(sq.ft.) .......................... i Address: ® _�k' -?O .L - bldg.area(sq Num►er of stories.................................. . .. . Ctlj State: ZIP: Tvpc of construction.................................... Phonc:G2J=/­fo -mail: CCB no.: E Occupancy group(s): Existing: t9� _ — -- New: City/metro lie,no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: .. /G ), �' e✓ 4 --_ provisions of ORS 701 mid may be n yuired to be licensed in the Address: 7i�s' .J L,'�' jurisdiction where work is being performed.If the applicant is City: ' State:dje I ZIP f exempt from licensing,the following reason applies: Contact person: _ an no.: Phone: ,/- S- Fax: E-marl: - - -- ---- --- Name: _Z'e /;,•def"� C.ontac_t person: ?ccs due upon applica,ion ........................... $ . Address:j �/ J 1' - Date received: - - City: _ ^tat ZIP:Q7' � Amount received ......................................... $ Phone: '' �J Fax E-mail: Please refer to fee schedule. - I hereby certify I have read and examined this application and the Na all jurirdic•.au accept credit cmb.pave call juri"coon for nhore info"muon attached checklist. All pmvisions of laws and ordinances governing this U.visa U MasterCard work will be complied with,whether specified herein or not. credit card number:_--_--- -—__--_-._-.. _-_-._.L_/ - p � � r:rpaeh Authorized signature�;�-„� ==�. -g Date: _ - Nan,it cardholder as drown a;creair a -- Print name: Sfi�r� �-I _ -- -- s - yaisnarare �Arroua Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4611(6W/C'oM) ad Mechanical Permit Application _ Daterm.nived: /pAL q Permit no.:f� r City of Tigard Project/appl.no.: ppiredate ' Cifyo fiKard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Dateissuad: G Receiptno.. 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 l-1 Comn, -cial/industrial U Multi-family LIT- a ;mprovement ti..w consincchon U A(I(Iition/alterttioulreplacrmt•nt U()tile!: --- COMMERCIAL VALUATION1>011EDULE J address: /�/� Ad-� Indicate equipment quantities in bnACS below. Indicate the dollar value of all mechanical material:,,equipment,labor,overhead, Bldg.no.: Suite no.: Tax map/tax lot/account no.: _ profit.Value$ l.oi: el - Block: Subdivision: 'See checklist for important application information and ,jurisdiction's fee schedule for residential permit fee Pt+liect name: 16 I 13 114� City/county: ZIP: t ` Description and location of work on premises:_ _ Fee(ea.) Total ` -- Dmri ion (?ty. es. I Rcx.only Est.date of com Ietionlinspectien: - Tenant improvement or change of use: Air handling unit _� CFM Is existing space heated or conditioned?U Yes U No tr con tuonmg�nc p1-an requite ) Is existing space insulated?U Yes U No Alteration o ex sung system of er compressors L tate boiler permit no.: Business mnnc: ��/��'f'C_ Z�Ce� HP _.__Tons RTU/H Addirss: 'it smo a amper, uct smo a electors _ L(C y: TI_S`_t_ale: ZIP: eat pump(sue p an require ) _ i ax; E-mail: nsta I rcp ace urnacc76urner j - Includingtductwork/vent liner U Yes l]No B no,; nsta re ac relocate beaters-suspended, it /metro lic.no.: -_ _ _ wall,or tl(x�r mounted Nmne(pleaseprint): Ventfora� ianceo err an urnace e r gera on: Absorption,units _ BTU/14 (..hillers_—_ -__ lip Nar»c: -- - --- - Com ressors {{p Address: -� v ronmenttt ex ust ad vent ton: City: - _ Slate: ZIP: Appliancevcnt Phone, Fax: E-mail: PrycrexF.Ust __ s, ype /res. ache ,azmat hood fire suppression system -- - •y Exhaust fan with single duct(bath fans I -`- 7 x aunts stem a.anZrocn rating mg eddress: L_Q _ �`� ue p p ng st ut on up o out els) ( _ State: 'ZIP:!5? Type: __LM NO j:. fax: - E-mail: Fuel t m eaci-ad 5onaT over out cis ^^ Process piping(sc lematicregvirec) Number of outlets _ _ Name: _ - )t er-1l�Ta ap-pllance or equ pment: Address: Decorative fireplace__ City: State ZIP: nsett--t x _ -� �---` no stov pe et stove Phone: Fax: E m al: t er. Applicant's signature: Date: ter: Name(print): -- _ Permit fee............ .. .... $ ---- —.-_ Not all jwt6&d(n% cesp cwedit cam,ptwe colt luriutiction row mm infamletlon. Notice:This permit application Minimum fee................$ - U Visa U MmterCCerd -L oxpires if n permit is not obtained Plan review(a, _ %) $ -- credtr card numtKr _-__ _----- �,ptre, within ISO days after it has been State surcharge(8%)....$ - --- N-"-"�er,e r order u�(wn--c t cae accepted as complete. 3 TOTAL .......................$ -- Crdholder ifgauu(t -- Atnount 44046:7(6001COM) i �_cao338 Electrical Permit Application Date received:119F Permitno•: 1"1f/ACiAi 50;/g City of Tigard Project/appl.no.: _ _ e date: Cityu%/igard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: B} Receipt no. Phone: (503) 639-4171 - Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: t X-1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement _XNew construction U AdditioiValteration/replaccutuiit U Other: U Partial Job address: �(�; Bldg.no.: Suite no.: Tax map/tax lot/account no.: Lot: Qlock: i Subdivision: Project name: I Description and location of work on premises: Estimated date of completion/inspection: t tSCUEDULE Job no: Fee M1iax Business name: * rr �. r /IY Description illy. (ca.) Total no.insp New res deolial-singe or multi-family per Address: AJC 0-r dwelling unit.Includes attachedgarage. City: — State ZIP: Service included: Phone: =r.. I E-mail: loot)sq.ft.or less – 4 CCB no.: 8�,}� Elec.bus.tic.no: ,f�.ty�� Each additional 500sq.ft.or portion thereof Limited energy,residential 2 City/metro lic.no.: Limiteden,rgy,non-residential _ 2 En.anufacturedtured home or modular dwelling Signature of supervising electrician(required) 1�,oc r feeder 2 Sup.elcct nanre(ptinl) Ii,,.,„,..,,, eders-Installation, relocation: t t ess 2 Nance(print): 201 amps to 400 amps 2 ---- - ---— -- - 401 amps to 600 amps 2 Mailing address: __- 601 amps to 1000 amps 2 City: Slate: LIP: _ Over 1000 amps or volts 2 Phone: Fax: Email: Reconnect only I Guarder installation:The installation is being mado on property I own Temponryseralteratio,orrelrs- which is not intended for sale,lease,rent,or exc!lange according to Installation,less tlan,orrelocallon: ORS 447,455,479,670,701. 200 amps to less 2 201 amps to 400 amps 2 Own'-.1's signature: Dale: 401 ut 600 ams 2 Branch circuits-new,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 ---- City' — State: � L7.11' B. Fee for branch circuits without In,-chase T77 - -- of service or feeder fee,first branch cir uit: 2 Phone: Each additional brwuh circuit: Misc.(Service or feeder not Included): O Service over 225 amps-comnurcial U Hen)th-care facility Each pump or irrigation circle 2 UService over 320amps-rating of 1&2 U Hazardous location Each sign or outline Iiglaing _ 2- fancily dwellings U Building over 10,0)0 squwn feet four or Signal circuit(s)or a limited energy panel, U System over 600 volts nominal more residential units in one structure alteration,or extension* 2 U Building over three stories U Feeders,400 amps at more "Description; _ O Occupant load over 99 person. U Manufactured structures or RV park teach additional inspection over the allowable In any of the above: O F.gres0ightingplwt U Other — ilei inspection Submit__sets of plans with any of the above. Investigation fee _ The above are not applicable to temporary construction service. other NW all—jurisdictions reels credit cards,please call Jurisdiction for more Information Notice:This pemltl application Permit fee.....................$ U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ credit card numucr:_. ___— within ISO days after it has been State surcharge(8%)....$ spires accepted as complete. Nestle of c I r u shown cm credo rwd _ $ Cardholder signature' AnwuM_� 440-4615(&MCOM) Plumbing Permit Application y� Datereccived: �2. °'9,2. Permit no.:Hy IA-V.Q_6WO e7 City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 city ofTigard phone.: (503) 639-1171 l'roject/app'.no.: � Expiredate, Fax: (503) 598-1960 Date issued: _ 13y: — Receip.no.: Land use approval: - Case file no.: _ Payment type: 1 & 2 faintly dwelling or accessory U Commercial/industrial U Multi-family U'tenant improvement Ncw construction U Addition/alteration/replacement U Food service ❑Other: .1011 SITE INFORANTIor�' Job address: De scri tion Qty. Feo Total ldg.no.. Suite no.: New I-and 2-family dwellings only: D Tux map/tax lot/aLCOunt no.: v - (Includes 100 ft.foreach utility connection) SFR(1)bade Lot: t - ick: subdivision: SFR(2)baUi — Project name: _ _ SFR(3)b.11h -- - City/county: _ ZIP: T - Each additional bath/kitchen D.scription and lo.ation oi'work on premises: _ SiteutWtles: Catch basin/area drpin Est.date of coin plction inspection: Drywells/leach line/trench drain Footing drain(no.lin.ft.) Manufactured home utilities Business niune:- QL� 4r, 411�;/�tj /! Manholes Address: l�" -.� �' _ Rain drain connector City: Stat ZIP: 7/ Sanitary sewer(no.lin.ft.) Phone: Fax: (:-mail: Storm sewer(no.lin, ft.) CCB no.: _ _ Plumb.bus. Np. uo: Water service(no.lin.ft.) City/metro lie.no.; —' Fixture or Item: lve Contractor's Mpresentative signature: Back tion neve Back flow reventer Print name: Date: Backwater valve IISON Basins/lavatory Clothes washer• Name: —� Name ss: Dishwasher AddivDrinking fountain(s) City: _ ;tale: ZIP: E'cctors/sump _ Phnitc: M Fax: E-mail: Expansion tank Fixture/sewer cap Name(print): Floor drains/floor sinks/hub - �t� s: ----- -- Garbage disposal Mailing ad ty:c�� —zp'ciHose bibb Suet �II_ iZ('!/,� [ce maker P11-me Fax_: _ E-mail! Interceptor/grease trap Owner installation/residential maintenance: only: The actual installation i'rinier(s) will be made by me or the nuuntenance and repair made by my rcg;.lar Roof drain(coin—me— al) - — employee on die property I own as per ORS Chapter 447. Sink(s),bas—in—(`s)—,Ta—vs(s) _ Owner's signature: _ Date: _Sump Tubs/shower/shower pan Urinal _ Name: Water closet _ Address: Water heater City: State: r ZIP: Other - — - Phone: Fax: I E-mail: Tidal Na W Jurisdictlau raept ctMt cant,please call Juriadktloc ror nwre ioromaaon Notice:This permit application Minimum fee................ O Visa O MasterCard expires if a permit is no!obtained Plan review(at —_ %) Crease card numbs: / / within Igo days after it has been State surcharge(8%).... Eapirca - accepted as complete. 'TOTAL .......................$ ne Niar cardbotda as abown on cfrAt card S Canlhc4der sianstws —�—�— -- Amount __ 4404616(WICOM) W 4800 LOT 4 I, 1 -- i r Ltt OF SET CK PROPOSED I I RESIDENCE PLAN M 112808 I GARAGE I �r� I ^.hfCI( P, I < ami I ' -- h� I . Z 48.04' - 0b m LoN Y �I O di C S.W. KOSKI DRIVIP _1 ECK _ CONSTRUCTION P.O. Box 204 Sherwond,OR 97140 �u-r r ct SUNTEL HOME DESIGN,INC.IS NOT LIABLE FOR THE ACCURACY OF THE �e� ���� -� TOPOGRAPHY INFORMATION. J IS IW SOLE RESPONSIBILITY OF THE TO BE ATTACHED BUILDER TO VEWY ALL SITE MIF=_ CONDITIONS,IJCIUDNG ANY FILL - PLACED ON THE SITE,AND INFORM x. OWNERS OF ANY POTENTIAL VELD P MODIRCATIONS. •MD CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE NORTH STAR PLUMBING 1445 SE OREGON STREET SHERWOOD, OR 97140 Plumbing Signature Form Permit #: M5T?.002.-00487 Date Issued: 1/1710" Parcel: 1 S135CD•1 1700 Site Address- 11760 SW KOSKI AVE Subdivision: KALAMOIIKA ESTATES Block: Lot: 304 Jurisdiction: TIG Zoning: R-12 Remarks. New SF jetached residence, Path 1. Your company has been indicated as the plumbing contract,,r for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER PLUMBING CONTRACTOR: ECK CONSTRUCTION INC NORTH STAR PLUMBING PO BOX 204 '1445 SE OREGON STREET SHERWOOD, OR 97140 SHERWOOD, OR 97140 Phone # 503-625-1305 Phone #: 625-2679 Reg #: LIC 00090697 MET 00002694 PLM 34-255PB AN INK SIGNATURE IS REOUIR -D ON THIS FORM Sign re of Aut ~ariz—e'd Plumber 1 If you have any questions, please call (503) 639-4171, ext. # ;; 10 i r CITY Or TIGARD 13125 S.W. HALL BLVD, TIGARD, OR 97223 IMPORTANT PERMIT NOTICE WILLIAM BUTTERFIELD CONTRACTING PO BOX 305 13120 SW MORGAN RD SHERWOOD, OR 97140 Electrical Signature Form Permit #: MST2002-00487 Date Issued. 1117103 Parcel: 1 S135CD-11700 Site Address: 11760 SW KOSKI AVE Subdivision: KALAMOIIKA ESTATES Block: Lot: 004 Jurisdiction, TIG Zoning: R-12 Remarks: New SF detached residence, 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 s',lrt of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRIC,%L CONTRACTOR: ECK CONSTRUCTION INC WILLIAM BUTTERFIELD CONTRACTIN( PO BOX 204 PO BOX 305 SHERWOOD, OR 07140 10 1w - SHERWOOD, OR 97140 Phone 503-625-1305 Phone # 503-625-67.73 Req I Ic_ 1185i;4 I I F: 3-5411( AN INK SIGNATURE I0 REQUIRED ON THIS FORM X l --- Signaturc of Supervis4�_ ician If you have any questions, please call (503) 639-4171 , ext. # 310 CITYOF TIGARD _ PLUMBING PERMIT _ DEVELOPMENT SERVICES _ PERMIT#: PLM2003-00257 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/10103 SITE ADDRESS: 11760 SW KOSKI AVE PARCEL: 1S135CD-11700 SUBDIVISION: KALAMO!IKA ESTATES ZONING: R-12 BLOCK: LOT: 00.1 JURISDICTION: TIG CLASS OF WORK: GTH GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: FR3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CA t u r i BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: �- - SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES- TUBISHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: lw tall irrigation backflow prev"iL-,,. _ v �_�----- Owner: - -- —FEES Description Date Amount ECK CONSTRUCTION INC PO BOX 204 I'I 1'ti113j I'crmit Fee 6/10/03 $36.25 SHERWOOD, OR 97!40 I 1-NX1 x",,State'la.r 6/10/03 $2.90 Total $39.15 Phone : 503-625-1305 - Contractor: GROVER'S LANDSCAPE SEf,'VICES 26485 S. MERIDIAN RD. AURORA, OR 97002 REQUIRED INSPECTIONS Phone : 503-08-1796 RP/Backflow Preventer Final Inspection Reg#: LIC 11907 This pert-nit is issued Subject to the regulations contained in the Tigard Municipal Code, State o; OR. Specialty Codes and all other applicable laws. All work will be done in accordance .uith approved plans. This permit will expire if work is not started within 180 days of issuance, or ;, work is suspended for more than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the Oregon C , Issued By: _��_ C _ Permittee Signature: f Call (503) 6?q-4175 by 7:00 P.M. for an inspection needed'the next business da°y r Bullialing i fixtures Plumbin, eermit Application 7Date/B City' OT TI and pprovel Sewer Permit No.: 13125 SW Ball Blvd. Plan Review — Other Tigard,Oregon 97223 Da%&. __ Permit No.: _ Phone: 503-639-4171 Fax: 503-598-1960 Post-Rc%iew land Use Internet: www.ci.tigard•onus Date/B : _ Case No.: 24-hour Inspection Request: 503-639-4175 contact r to) See Page 1 for P 9 Name/Method: /9r Supplemental Information. TYPE OF WORK _ —__ FEE*SCHEDULE tra special Information use checklist New construction_- — El Demolition Ucscri tart Qh. Fec(ca.)T Total Addition/alteration/re)la(:cment C)ther: New 1-&2-family dwellings CATEGORY OF CONSTRUCTION Includes 100 fl.for each u llity connection �& 2-Fatnily wellin Commercial/hrdustrial SFR I bath 24920 Buildin r — SFR(2;bath 350.00 — �_ _ — Multi-Family _ SFR 3)bath 399.00 Master Builder 70ther: Each additional bath/kitchen _ — 4500 — JOB SITE INFORMATION j1pid_LO_CATIO_N Fires rink.ler-s . ft.: Pa gc 2 Job site address _ C , _` �:[ /� _ Site Utilities Suite#;� Bld ./A t.#: Catch basin/area drain 16.60 Project Name: Dr ell/leach iine/trench drain 16.60 Footing drain no. linear fl. Pae 2 Cross street/Directions to job Site: j`t-- Manufactured home utilities _ 110.00 �.•� �j l� Manholes I6.60 Rain drain connector 16.60 SnnitRry sewer(no. linear fl.) Pa c2 Subdivision: —__ __— Lot#: Sterni sewer no. linear ft. Pa c2 Tax neap/parcel #: Water service(no. linear ft ) _ Pa e2 DESCRIPTION OF WORK Fixture or Item Absqjrption valve 16.60 �'� ow�mvcrilY'r Pae 2 — /' �.- c�iL' o ac wa er va vc !6.60 Clothes washer 16.60 — --- -------- Dishwasher 16.60 P OPERTY OWNER _ TENANT _ Drinkingfountain 16.60 -- ---�--r- Ejectors/sump — _ 16.60 Name: u' cry„ ri'[ - c t_iy Expansion tank 16.60 Address: Fixture/sewer cat I6 6v Cit /State/Zi Floor drain/floor sink/hub 16.60 _ .. �. -- - - -_ Garbage disposal 16.60 Phone: _ Fax: Hose bib 16.60 APPLICANT 0 CONTACT—PERSON Ice maker 16.60 Narne: _ Interceptor/ ease trap 16.60 Address: �! Medical gas-value: S Pae 2 Cit /State/ZI - — - --_-- — - Primer — 16.60 -- ------- Roof drain(commercial) 16.60 Phone: --� FaX:-------��_- Sink/basin/lavatory _ 16.60 E-mail: P; /shower/shower pan _ 16.60 CONTRACTOR — Urinal r 16.60 Water closet 16.60 Business Name: — Water heater 16.60 Address: S - ii_i ` '_-.` �?" /i?r.1, Other: - ---- City/State/Zip: tA;,y.y� C'>2 7r%C Gihcr: �— Phone:)?_5-, 7 =_ 7k6 I Fax S-4 Plumbing Permit Fees* Subtotal $ CCB Lic.#: / .Plu Lica: — — — Minitnum Permit Fee$71.50 S Signature: t�P__tC2 DaAuthorize �`''` � Residential f3acktlow Mir i*ntum Fee S36.25 Plan Review t_5/o of Permit Fec S ,1? State Surcharge 84'0 of Permit Fee) S (Please print name) __'roTAL PERMIT FEE S Notite: 'rhls permit application expires If a permit Is not obtained Nlthin h.l ucs, cornmet clal building-require 2 sets of plans with isometric or IAO da}s after It has been accepted as complete. r icer dingy ant for ;clan rec ic�i. "I cc rneihodoiog� cut try I ri-(owit.% Building Industry Service Board. 0111sts\Permit Forms0111mPermitApp.doc 01103 Plunintng Permit Aphlication - City of'I'ligard Page 2 - Supplemental Information Fee Schedule: _ Residential Fire Su ression Systems: Site Utilities t�ty. FCC(CA) Total S !are Footage: Permit Fee: Footing drain- 1"100' -- -- ti�.00 0107,000 $1 15.00 _--- Footing drain-each additional 100' 46.40 r 2,001 to 3,600 $160.00 --�--- Sewer-1st 100' 3 601 to 7,200 -__-� $220,00 - -- -- 55.00 7,201 and cuter $309.00A ---- - Sewer-each additional 100' 46.40 - -— ---- Water Service- 1st 100' ;).00 - Medical Gas_S stems: Waa Service-each additional 100' 46. () V- Permit Fee: Storm&Rain Thain- Ist 100' 55,00 $1 00 to$5,000,00 Minimum fee$72.50 �— Storm&Rain brain-each additional I oil' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each Fixture or Item Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and includinLE1000.00. Commercial(Sack How I'revention Device It d0 $10,001.00 to$25,000.00 $148.50 for the first$10,00000 and$1.54 for IeL9idenlial Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 _ '7.55 _ and including$15,000.00. _ Rain Drain,single family dwelling 025 $25,001 00 to$50,000.00 $379.50 for the first$15,000.00 and S 1.45 for Inspection of existing plumbing or — .-- each additional$100.00 or traction thereof,to specially requested inspections-pet hour 72.30 1and including$50,000.00. Subtotal: -- $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for - each additional$100.00 or fraction thereof. Fixture V1'ork: Are you capping,moving or replacing existing fixtures? If "yes",please indicate work performed by fixture. Failure to accurately report fixtures could •esuft in increased sewer fees*. uantlt b Fixture)'Work Performed Contnlents regarding fixture work: Fixture Type: Replace New ,Moved Existing CVpd lt,�i.tr_� Huth -'fuh/Shower ----- -Jacuzzi/Whirl 001 Wa811 -lillch titan .- -Drive Thru -- C'us idor/Water As irator Dishwasher -Convnercial - -Domestic -- -�-Drinking Fountain Fountain - ---- -___ E c Wash `-- I-Ionr Drain/sink 2" -- --- —- 4„ — Car Wash Drain Garbage -Domestic *Note: If the fixture work under this permit results lit an Disposal -Commercial _ -- increase of sewer FDUS,a sewer permit (sill be issued and -t�.dustrial _ fees assessed for the sewer increase must be paid before the Ice Mach`/Hefri .Drains - plumping permit call be Issued. Oil Separator(Gas Station) — Rec.Vehicle Dump Station Shower -gang -Stall Sink -Bar/Lavatory - .Bradley --- -Commercial -- -Service Swimming Pool Filter _ Washer-Clothes Water Extractor Water Closet-Toilet _ Urinal _ -- ©tiler Fixtures: i\Dsts\Permit Fonns\PlmPcrnmitAppPg2 dnc 01103 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639.4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP - Received Date Requested. _ le -I!-- AM_ ___ PM .- - 1UP Location Suite _ MEC Contact Person _—_. , - - Ph PLM Contractor ___ Ph( ) __--__—__— SWR BUILDING_ __ Tenant/Owner _ __._..___—_____ ELC Footing — ELC _ Foundation Access: Ftg Dr n ELR Crawl Drain Slab Inspection Notes: SIT --- Post&Beam Shear Anchors _-- Ext Sheath/Shear _ Int Sheath/Shear Framing ------ - - - - - ------ -- Insulation Drywall Nailing --- -- - — -- _ Firewall / Fire SprinklerFire Alarm Alarm Susp'd Ceiling —� - Roof ---- Other: ------- -l?/// - -- --- - Final PASS PART-FAIL -- P1 UMBING__ ----- - -- -- Post& Bearn Under Slab �.-- ----- - --- - ---- — ------ Rough-In Water Service -- - - - - - - - --- ----- Sanitary Sewer Rain Drains -- Catch Basin/Manhsle Storm Drain - — -- ------- ------- - ----- Shower Pan Other: -_- Fir iW I'VA � PART FAIL ---T-- __—_ ECH_A_NIC_A_L - Post& Beam Rough-In — ------------- Gas Une Smoke Dampers -- --- ----— -----.^— —..---- Final PASS PART FAIL ELECTRIL.AL Service - - -- —-----____ - -- -------__ —__. Rough-In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of$_ requi-ed before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE — 1 Please call for reinspection RE: -J Unable to inspect-no access Fire Supply Lina ADA Approach/Sidewalk fete Inspector_--__ / _.._Ext �------ - Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST 41407 INSPECTION DIVISION Business Line: (503)639-4171 r BUP — Received ____ �7 Date Requested___ AM PM — BUP — Location _______- 1_ _ _ — _Suite Nla; _ Contac Person _— Ph( _) —_—_—__ PLM Contractor--- ------ - ------- Ph(----) ----- -- _ SWR - ---- _BUILI.DING — Tenant/Owner —� ELC Footing ELC Foundation Access: ----- - ---- Ftg Drain ELR Crawl Drain ------ Slab Inspection Notes: SIT Post& Beam Shoar Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing - - ---- - --- ---_-_- ---- -- --- Insulation �j-G•�,-�����:��.. Drywall Nailing _ LJ, -._ _ - -- ----- --- --- - -- - Fire C� � Sp -�- Fire Sprinkler Fire Alarm �>1 `X, Susp'd Ceiling -y..r--t�_. -- Roof Other: - ----- &BING PART FAIL - -------- -__ _ -_____- ---- - Post&Ream - -- --- Under Slab - - --- ------- _..--- --- - - --- Rough-In Water Service -- Sanitary Sewer -- - -- ---- - _-_-- Rain Drains --- - - - Catch Basir./Manhole — - - Storm Drain _.._�-- ----- --- - -- _-- Shower Pan Other. ---- --- - -._- --- -- -- - t Final t PASS PART FAIL ------ MECHANICAL - Post& Beam - Rough-In Gas Line Smoke Dampers - - fin I�FA PART FAIL -_----- - - - - -- - _. -- ----. - - -- --- - ELECTRICAL Service --- - --- Rough-In ---� Low Voltage Fire Alarm - -- --- - Final F1 Reinspection fee of$ required before next inspection Fay at City Hall, 13125 SW Hall Blvd, PASS PART FAIL SITE ___ [I Please call for reinspection RE -__ F�] Unable to inspect--no access Fire Supply Line n ADA ()DateApproach/Sidewalk _ ` _- Inspector __-- -_. Ext -_- Other: _ _-- Final DO NOT REMOVE this insl;ectlo, record from the job site. PASS PART FAIL iLAAAAAAAAAAAAAkAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA A Pool ► �1 `J ► poll 4-1 t l� ► V E o o , a � ► a b�A `-+- \ \� ► . O ' an ► A ' t v ► . °J -� ► IPl U ' u pop : r. Cl pool F�■I � i w Q w -r ,� co c� ► y � d O rD : ro G O ? a w 0 a �-�+ COO) 5 h � n ro VI V. r� CD O O o � o 2 .v A 3 v i� CITY OF TIGARD 24-Hour �p BUILDING Inspection Line: (503)639.4175 MST � INSPECTION DIVISION Business Line: (503)639-4171 BLIP — _ Received —_ _. Date Requested .3 AM ___ PM BUP — Location - Z!—_Suite__ -- MEC ___.___�_____-._____ Contact Person 2 " Ph ) _ W1910 -3 PLM Contractor Oia r3��tlf ���a C ['�r.i / �v'Ph'�-- -) q�Jr�1 %3cp _. SWR __.-- -- BUILDING Tenant/Owner _ _ -� i / / 5 / ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam -- Shear Anchors Ext Sheath/Shear ----- - -------._.__--_- Int Sheath/Shear Framing _ --- _ - -- . - ---- ---- Insulation Drywall Nailing - - ---- --- _._.------ -------- - --.�__..._ Firewall Fire Sprinkler ___ ----- - - --- - -- - ...-- -— . ---- -- ----- Fire Alarm Susp'd Ceiling -- -- - - - ----- - --- -- -- Roof Other: - - - ---- - _ - - ---- - ----------_--- Final F PASS PART FAIL _ -_ _ ___- - - _----- - ----- ---- - ---- __ __ --- IL - PLUMBING Post&Beam Under Slab -- Rough-In Water Service - - ----- - -- -- - Sanitary Sewer Rain Drains -- - - - - - - - --- ---- -- Catch Basin/Manhole Storm Drain ------ - --- - - - - - --- -- .- Shower Pan Other Final PASS PART FAIL _MECHANICAL Past&Beam Rough-in - - - - - Gas Line Smoke Dampers - - - - -- - -- -- - - -- Final PASS PART FAIL - - -- - ELECTRICAL Service Rough-In UG/Slab Low Voltage _-- Fi_ larm �n F_j Reinspection fee of$___- required before next inspection. Pay at City Hall, 13175 SW Hall Blvd PART FAIL f SITE _ � Please call for reinspection RE _ �] Unable to inspect no acnes_, - - Fire Supply Line ADADate- -� Inspector 'rll.r }__-.�� _ t Approach/Sidewalk _ - Other: Final _ DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 SUP Received _______— Date Requested ` --AM PM - _ BUP I_ocation Suite MEC Contact Person -__ _ Ph(----) — ____ PLM Contractor —__ --- ___-- Ph (_,_--) __ _ SWR -__ - BUILDING Tenant/Owner ELC -----_____-- Footing ELC __ Foundation Access. Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post& Beam Shear Anchors Ext Sheath/Shear --- - Int Sheath/Shear Framing - - ---- ---- -- Insulation Drywall Nailing ----.._.. - -- - -- --- ---- - Firewall Fire Sprinkler - - Fire Alarm Susp'd Ceiling -------- Roof Other. Final _- _ PASS PART FAIL �----- �---- -------- PLUMBING _---- Post& Beam Under Slab - --------- - — - ---_ -----. -- ----- Rough-In Water Service ----- Sanitary Sewer Hain Drains ----- --- —_.___.- .--- Catch Basin/Manhole Storm Drain __-- Shower Pan Other fin-- - --------- - - - - -- AS PART FAIL Post&Bearn _ Rough-In - - -- Gas Line Smoke Dampers - - - F'Mal PASS PART FAIL - - _ -- - ELECTRICAL Service - - Hough-In - - - UG/Slab - - - Low Voltage _ - -- - Fire Alarm Final Reinspection too of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE —_ L-� Please call for reinspection RE: Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dates Ext - y�d� ____ llptprCtOt__—_.. _ __- Other_._--- Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL