11830 SW KOSKI AVENUE .,a
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11830 SW Koski Avenue
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
;NSPECTION DIVISION Business Line: (503) 639-4171 MST
BUP ---------- --
Received Date Requested -7 -1 AM______ PM _—_ BUP
Location ---- 30 k - --- - —Suite MEC ---
Contact Person _ Ph( ) 2 3 6 "52 v PLM -3 – 3
Ccntractor___— _—_ -_ Ph(.-------) -- - –T_ _.-- SWR �–
BUILDING_ Tenant/Owner _ ___--- _ ELC _
Footi icd
Fou,idation Access: -"`- PLC
Ftg Drain ELR
(gaud I;ralr
slab Irspection Notes: SIT --_
Post& Beam --- - ---- -
Shear Ancn --- -- - - ---
Fxt Sheath Sar
Int Sheath/Shea-
Framing - -
Insulation
Drywall Nailing --- - - - --
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - -- ---
Roof
Othor:._ /
Final
PASS PARI' FAIL , � t✓J��- ------
PLUM_BING
Post& Beam --—_ --
Under Slab _-- - -----_- __..---- -
Rough-In
Water Service - -•- _ _ __._._..__..
Sanitary Se ver
Ram Drains -
Catch Basin/Man;-,)Ie
Storm Drain -
Shower Pan
Othat:
-f"tnai-'
/PA_SSS, PART FAIL
HANICAL
Post& Beam
Rough-In --
-------------
G;Is Line
Smoke Dampers - - - -
Final
PASS PART FAIL
ELECTRICAL
Service — - - --------._.._.._._-------- — --- -----__._� - ------_--
Rough-In
UG/Slab
Low Voltage
Fire Alarm _
Final C7 Reinspection fee of$__- ____-- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ — C� Please call for reinspection RF: _ I Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date _-_ Inspector./,
Other:
Final - DO NOT REMOVE this Inspection record from the, job sko.
PASS PART FAIL
r
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003-00036
DEVELOPMENT SERVICES DATE ISSUED: 2/20/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE PDDRESS: 118'10 S\N KOSK: AVE PARCF!: 1S135CD-12100
SUBDIVISION: KALltMVUKA ESTATES ZONING: R-12
BLOCK: LOT• 008 JURISDICTION: TIG
REMARKS: N
L UILDING
REISSUE: STORIES: _ Ft 00'l AkEAS —REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: r / of BASEMENT. sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: •1[ SECOND: f 12 s1 GARAGE: 304 sf FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: TMpID sf RIGHT: 15
V..LIIE: 13i 426 60
OCCUPANCY GRP: 123 BDRM: 3 BATH: 3 TOTAL: 1,429 of REAR: 15
__PLUMBING
SINKS: 1 WATER CLOSETJ: 3 WASHING MACH: 1 LAUNDRY TRAYS 1 RAIN DRAIN: 100 TRAPS.
LAVATORIES: 3 DISHWASHERS I FLOOR DRAINS. SEWER LINES. 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISi'OWERS: • GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES
MECHANICAL
_ FUEI TYPES FURN<100K: I BOIL/CMP<3HP. -NT FANS: 4 CLOTHES DRYER: 1
FURN>•100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP. htu FLOOR FURNANCES: VENTS: I WOL DSTOVES: 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 FDR: PUMPIIRRIGATION: PER'NSPECTION,
LA ADUT 500SF: 201 400 a tp: 201 400 amp: tat W10 5VC/FOR: SIGNIOUT LIN LT• PER HOUR:
LIMITED ENERGY: 401 600 amp: 4ul Sao amp: EAADDL BR CIR. SIGNAUPANEL: IN.' 1NT:
MANUHMISVCIFDR: 001 1000amp: 601+amps-I000 , MINOR LABEL:
1000+amp/volt:
PLAN REVIEW SECTIOtJ
Re,.nnnect only:
>•4 RES UNITS: SVC/FDR),-225 A. >$00 V NOMINAL. SL9 AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 0 STEREO: x` VACUUM SYSTEM: X AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING. OUTDOOR LNDSC LT:
BURGLAR ALARM: X OTH: ALL E.NCOMP BOILER: HVAC: l ANDSCAPE/IRRIG: PROTECTIVE SIGNL:
G?P.AGEOPENER X CLOCK: INSTRUMENTATION MEDICAL: OTHR:
HVAC, x DATAlrELE COMM: NURSE CAS LS TOTAL a SYSTEMS:
Own9r. Contractor: TOTAL FEES: $ 6,603.02
ECK CONSTRUCTION INC This permit is subject to the regulations contained in the
ECY,CONSTRUCTION,INC.
P.O. BOX 204 EC BOX 204 Tigard Municipal Code,State Of OR Specialty Codes and
SHERWOOD OR 97140 SHERWOOD,OR 97140 all other applicable laws A work be done in
accordance
permit acrdance with approved pianc 71TIs peitwitl expire N
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Oregon law requires you to followru!es adopted by the
Phone: X03-625.1305 Phone: 625-1305 Oregon Utility Notification Center 'those rules are!�c;
forth in OAR 952-001-0010 through 952-001.0081" You
Rog 0: LIC 11475 S may obtain copies of these ules or direct quer,eons t
OUNC by calling(503)24F 1987
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor Insulation PIUmb Top Out Exterior Sheathing Insf Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final Inspection
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwlk Insp
Post/Beam Structural PLM/Underfloor Framing Insp Gas Firen'dce Electrical Final
Issued By : � 1iL � _ Permittee Signatures
Cail (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD __ SEWER CONNECTION PERMIT
DEVELOPMEN't SERVICE3 PERMIT#: S`NR2003-00035
13125 SW Hall Blvd., Tigard OR 97123 (503) 639-4171 DATE ISSUED: 2/20/03
SITE ADDRESS; 11830 SVJ KUSKI AVE
PARCEL: 1 S135CD-12100
SUBDIVISION: h-11,AMc�IIKA ESTATES ZONING: It-12
BLOCK: LOT: 008 ,JURISDICTION: Ilr[_� _
TENANT NAME:
USA NO: FIXTURF UNITS:
CLASS OF WORK: NFW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILJINGS:
INSTALL TYPE: LTPSWR IMPtr'V SURFACE: S"
Remarks: S
Owner: ----- ------------ —_ — -
FEFS
ECK CONSTRUCTION, INC Description Date — Amount
P.O. BOX 204 _ _ _
SHERWOOD, OR g7140 [SWUSA]Swr Connect 2/20/03 $2,300.00
[SWUSA] Swr Connect 2/20/03 $0.00
Phone: 503-625-1305 [SWINSP] Swr Inspect 2/20/03 $35.00
[SWINSh]Swr Im;pect 2/20/03 $0.00
Contractor: ---- -
-���� —�— Total $2,33500
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulationr r f the Clean'Nater Services. The permit expires 180
days from the date issued. The total amount paid will be forfeitp a it the permit expires. The Agency does not �
guarantee the accuracy of the side sewer laterals. If the sewttr 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 ano
0 dL� Sewer' Permit and the Agency vrul install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center 'ncose rules are set forth in OAR 952-001 0010 through OAR 952-001-0100
You may obtain co les o`these rules or direct questions to OUNC by calling(503) '-146-6699
i
r'
Issued by: j ' J Permittee Signature. _
Call (503) 639-4175 by 7:00 "I.M. for an inspection needed the next business day
Building Permit supplication
Datereceived: ; ,' Permit no L7L,/'[, 117,1 -
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 972 Prolcct/appl.no.: Expire date:
('ire /7ii;.,rd Dtteissued: y• Receipt no.:
B '.
Phone: (503) 639-41'71 ��
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: 1&2 rnmily:Simple [Complex. J
all I To a 01
I &2 family dwelling or accessory U Commercial/industrial U Multi-family )(N
AU
construction ❑Demolition
U Addition/alteration/replacement U Tenant improvement U Fire spcinkicr/alarm U Other: _
Job address. ' ACL.-�� Bldg.no.: Suix no.:
Lot: Blrxk: Subdivision �.?!�1/�IGr�/t' ,-J?! Tax map/tax lot/account no.: S�? C'!
Project name:
U,!scripuon and location of work on premises/special condition;:
011 MIR FOR SPECIAL INFORMAsIVION, USE CHECKLISY
Name,_S.' -! -� '
Woodplalia,septic capacity,solar,etc.)
Mailing address: ( s amity dhelling: L(� ✓�
r'ity: State: 7,[I': Valuation of work....... .:.:a..,.. .... ..r.......... $
Phone: Fax: E:-mail: .�
No.of bedrooms/baths................................. • ..
Owner's represent<tive: Total number of floors.................................
Phone. fax: I n,,nl. New dwelling area(sq.ft.) .......................... _1
Garage/carport area(sq. ft.)....... ....... 'J-
Name: Covered porch area(sq,ft.) ........................ �--
Mailing address: " - Deck area(sq.ft.) ........................................ 41!P --
City: State: ZIP: Other structure area(sq.ft.).........................
Phone: lox C snail: �+ CommerciaUindnstrial/multi-family:
V rluation of work........................................ $,
Business name: �pfExisting bldg.area(sq. ft.) .......... ...............
,C Y .i rte/ - --�
-- — New bldg.area(sq.ft.)
Address: el O d411Number of stories
City: State: LIP: ................... ..........
1 .
Type of construction..............r..................
Phone: Fax E-mail:
CCB no.: Occupancy group(s): Exiting: _
� �-.5-_ New: _
City/n,r•trtr lie.no.: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Niune: �L,�l� -� �✓ /yt� provisions of ORS 701 and may be required to be licensed in the
Address: y��_^L! jurisdiction where work is being performed. If the applicant is
City: ' State: LII': '�
exempt from licensing,the following reason applies:
Contact person: _ Plan no.: ----
P1.une:�!/- .>�^ Fax r
on, person: Fees due upon application ..
Address: J /1' Date received:
City: — State LI P: Amount received .........................................
Phone:S f'�' S 7`/ Fax: E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards,piece call jurisdiction for mote infommion
attached checklist.All provisions of laws and ordinances governing this U visa U MasterCard
work will be complied with,whether specified herein or not, credit card aan,her __ __ _�__ _ E, l t
Expires
Authorized signature: �� �•:: Date: _ -- Name o1_cardholder as shown on credit nerd
Print name: L�>r — _ — Cardholde,siPatWe Amount
Notice:This permit application expires if a permit is not obtained within 180 days ager it has been accepted as complete. 4*R-413(tnWCOM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits.
(:iryuJTigurd Ci of TI and
`•r J Electrical U Piumbing U Mechanical
Address: 13125 SW liall Blvd,Tigard,OR 97223 U Other.
Phone; (503) 639.4171
Fax: (503) 598-1960
1 Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 'Zoning.flood plain,volar balance points,seismic soils designation,historic district,etc.
3 Verification of approved platilot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report.Must carry original applicable stamp and signature on file or with application.
9 Erosion control U plan U permit required. Include drainage-v.,ay prote,lion,silt fence design and location of
catch-basin protection,etc.
10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and conni.ctions trust be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plat,location and details. Plan review cannot be completed
if copyright violations exist.
I I Sltelplot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a O4 elevation differential,plan must show c ntour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot
arca;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drains e.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing rids,connection details,vent
size and location.
13 Floor plans,Show all dimensions.room identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,root'construction. More than one cross section may be required to clearly portray construction.Show
details ofall wall and roof sheathing,roaring,roof slope,ceiling height,siding material,footings and foundation,stairs,
_ fireplace construction, thermal insulat� ,n,etc.
15 Elevation views,Provide elevation for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cruss references are acceptable.
10 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
_ non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Sho44attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered
systems,see item 22,"Engineer's calculations."
19 (team calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
�1%er 10 feet long and/or any beam/joist carrying a non-uniform load, _
20 Manufactured floor/roof truss design details.
21 Energy Code compliance.Identify die prescriptive path or provide calculations.A gas-piping schematic is required
for four or more appliances. _
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall he shown to be applicable to the project under review.
2 t Five(5)site plans are required for Iter► I I aho.e. Sits•plans must be H-1/2">. 11"or 1 I"x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above. _
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or min•ored building plans will he accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be it, blue or black fi: .
Red ink is reserved for dcr.viment use only. 440.1614 to"oM,
Electrical Permit Application
—' .)ate received: Permit no,:/1ST;p0 Voi 40
Cit' of Tigard Project/appl.no.: Expire date:
Cifynj1'igard Address: 13125 SW all Blvd,'ri►:.,rd, .W 97223 Phone: (503) 639-4171 -
Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: I Payment type:
Land use approval:
)41 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
�N(New construction U Addition/alteration/replacement O Other: _ U P-atial
W IV I
1
Joi,addre>;S: 1Q1i�C1_lil lg.no.: I Suite no.: Tax map/tax lot/account no.:
=Lot Block: subdivision:
Project name: Description and iocation of work on premises:
Estimated date of con,pletiunhll.lw 11-1
NTRAj`TO11 APPLICATIONt
Job no: tee Max
— � f–�
7' 4W D Kcription Ul1'• (ea.l Ictal no.insp
Business nat�te: _ � 4� _ hc.w rcildcutlal sfngk ormulti-famllr I,cr
Address: tJ� _ O _ dwelling unit.Includes attached garage.
City: S Y/� State' ZIP: -- Service included:
Phone; Fax: 1:-mail: 1000 Gil n.or less 4
C Each additional 5W s .ft.or portion thereof
CC a no.: YJ:r Elec.bus, lie.no: �.-}'�� Limited energ),residential 2
City/metro lic.no,; _ Limited energy.non-residential 2
Each manufactured home or modular dwelling
Service and/or feeder 2
Signature of supervising electrician(required) pate
License no Services or feeders–Installation,
Sup.elect.name(print): alteration or relocation:
1XII11111101 on 200 amps or less 2
201 smps to 400 amps 2
Name(print): 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: _ Stale: ZIP: Over 1000 amps or volts _ 2
Phone: Fax: E-mail: Reconnec,only1
Owner installation:`Ihe installation is being made on property I own Temporary services or feeders-
which is not intended for sale, lease,rent,or exchange according to Installation,alteration,urIelocabun:
200 smps or less 2
ORS 447,455,479,670,70]. 201 am s to 400 amps
2
Owner's si nature; _ Date: 401 -
101 at 01! Hronch circults-new,alteration,
or extension Iwr panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit f 2 _
City; StalC: ZIP: B. Fee for branch circuits without purchase
--— of service or feeder fee,first branch circuit: _ 2
one: Fax:
Ph
E-mail: Each additional branch circuit.
IIIAN 1tl.',VlEW(Please 'check all flint apply) Mkc.(Service or feeder not included):
U Service over 225 amps-commercial Cl Health-care facility B'sch pump or irrigation circle
•Service over 320 amps-rating oft&2 UHezardouslocation Each sign oroutlinelighting
familydwellings U Building over 10,000 square feet four of Signal circuits)or a limited energy panel.
Li System over 600 volts nominal more residential units in one structure alteration,or extension* _ 2
LI B gilding over three stories U Feeders,400 amps or more *Description: --
•Occupant load over 99 persons O Manufactured structures or RV park Fach additional Inspection over the allowable in any of the above:
•Egress/lightinitpinn U Other. _ Perinspection
subnnit sets of plans with any of the above. Investigation fee _
The abuse are not applicable to temporary construction service. Other
--- -- Permit fee.....................
Not all jurisdictions accept credit cards,paean tail jurisdiction for more Information. Notice:This permit application Plan rCVICW(at — 96) $ _
U Visa U MasterCard expires if a permit is not obtained
Credit cud number:____ / I within 180 days after it has been State surcharge(8%) ...,$
Expires accepted as complete TOTAL .......................$
Nuns�u older u shown on c 1 card s
Cwdholdetsignature — Amount 410-4615(MCOM)
Plumbing Permit Application
Datereceived: Permit no//17-,�;>;l?
City of Tigard Sewer pertnit no.: Building permit no.:
Address: 13125 SW Hall Blvd,'I'igard,OR 97223 --
City njTigard Projec
Phone: (503) 639-4171 dano
ppl. .: Expire date:
Fax: (503) 598-1960 Date issued: By- --c eiptno.:
Land use approval: Case file no.: Payment type:
1
X1 &2 family dwelling or accessory Commerciallindustrial U Multi-family U Tenant improvement-
New construction U Add ition/alt,.ration/replaccment U rocxl servir.e J Other:
Il 1
DescrJob address: 2-family
tion (1tv. Fee ea. Total
Ncw 1-and 2-ffamily dwellings only:
Bldg.no.; Suite no.:
(includes 100 R.fur each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block: I Subdivision: SFR(2)bath -
Project name: SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
_ Catch basin/area drain
Est.date of completion/inspection: D wells/leach line/trench drain
Footing;drain(no.lin.ft.)
Manufactured home utilities
Business name: A171f .� Manholes
Address: l,/ ["_��C ,P Rain drain connector -
City: Stat ZIP: SwiiLuy sewer(no.lin.ft.)
Phone: Pax: E-mail: Sturm sewer(no.lin.ft.)
CCB no.: I'lumb.bus.reg.no: Water service(no. lin. it.)
City/metro lie.no.: _ _ - tUture or Item:
Contractor's representative signature Absorption valve
Back flow preventer
Print name: Date: Backwater valve.
1
Basins/lavatory
Name: Clothes was ter
Dishwasher
Address: Drinking fountain(s)
City: State: "LIP: Ejectors/sum
Phone: Fax: E-mail: Expansion tank _
Fixturc/sewer cap
Name(print): Floor drains/floor siaks/bub
Garbage disposal
_Mailing address: Hose Bibb
f;ty: StatZIP: ice maker
Phone- 412 Fax: I E-mail: Interceptor/grease trap
owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the main.enance mid repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sinks , asin(s), ays(s)
Owner's signature: Date: Sum
Tubs/shower/shower pan
Urinal
Name: Water closet
Address: _ Water heater _
City: State: ZIP: (Jthcr:
Phone: Pax: E-mail: Total
Not all)unkfictiom swept cterht cards,please ca11 judu kdon fur mm tnrornutiorr. Notice:'this permit application Minimum fee................$U Visa O MasletCerd expires if a permit is not obtained Plan review(at _ %) $
Cmdit cvd numb«: within 180 days eller it has been State surcharge(8%)....$
Expires
Ntunc of cardttolrkr u shown on credo card
accepted as complete, TOTAL .......................
S
Cwdholdu slVmwv Amount 410-4614(610=M)
11r
X003 -DO
Mechanical Permit Application
D6teteceived: Permit no. 7,10 q �G03
City of "Tigard Project/appl.no.: — Expire date:
(7n ofTi,4urd Address: 13)25 SW I IalI 131vd,Tigard,OR 97223
Date issued: By. Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: - Payment type: —
Land use approval: _ ��uildingpermit no.:
E [flown
I k?la roily dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
Ne.w constnrctWll Ll Additiotl/alteration/replac-nrent U Other:._
1
Job address: ' /-�' Indicate equipment quantities in boxes below. Indicate the dollar
R1dg.no.: Suite no.: —^ _ value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value
Lot' 13lock: Suhdivision: 1��1� ' *See checklist for important application information an
Project Hume: ilirisdiction's fee schedule for residential permit fee.
City/county: ZIP:
Description and location of work on premises:----..-,
Ger(ea.) 'Total
Est.date of completion/inspection: --- Descr•i ion Qly. Res.onl
Res only
Tenant improvement or chane::of use: Air handling unit ---CFM--
Is
FM-,Is existing space heated or conditioned'?U Yes U No Airc—fit Hing(,tie p an requtr ) _
Is existing space insulated?U Yes U NtAtaon o existing i syetem —
o.er cornpressors
�tn:e boiler permit no.:
Business name: UP _ _Tons BTUAI
Address: 7
it smo a amper, udsmo c electors
City: — State: ZIP: eat pump(slie p-Ton
Phone: - Fax: E-mail osis rep ace furnace urner U
Including ductwork/venl liner U Yea O No
CCI no.: 2 ll tea ri�cc7rcTocate It e it ters-s u spc nd ed,
City/metro lic.no,: _ wall,or floor mounted
Name(please print): cot ora iance other th-a-n7urnace
e gera on:
Absorption unitsBTU/U
Name: Clullcrs_... — tip
-- _— — — Coro,ressors
Add', s: — �nr IIE—ta ex hand an ventilation:
Pity: — State: 7.1P — Ar,pliancevent _
Phone: — hex: E-mail: rycrex aust
o s, ypeT sAitchcWhazinat
hood fire supprc. n system -- --
Na;r !�' _ — Exhaust fan with single duct(bath falls)
Mailing address: Q .L'� - x gust s stem a art rom eaun or
Fuelpiping an ut on up to out ets)
City: Slate: 'Z!P: Type: LI'C; NG oil
Phone: 6 I�ax E-mail: fupi>in�each aTditianaTcivLr�outlets
rocessp p np,(schematic required)
Number of outlets
Nan- _ � Other r listed applEwce or equipment:
Address: Decorative fireplace
City: State: ZIP_ - -~ nserl-type — —
— o tov c1pe I I et stove
Phone: Fax: I E-mail: -
Applicant's signature: Date: -_ _ t her:
Nd VI Jtuiadktloru acceQt carat cards,please call juridkdon for stare infam aaoa. Permit fee.....................$
Notice:"Phis permit application Minimum fee................$ _
U Vise O MaaterC'atd expires if a permit is not obtained —
cud numtnrr:-- — _ Plan reVICW(al %) $
Credit c
x fel - within 180 days after it has been State surcharge(8%)....$
— ---- --- ted tete.
Warty or c tolda u shown nn credit card s ecce p as com p
Crraatda algwue -- Amount 411.4617(GWCOM)
4
30,44' /78
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SUNTEL HOME DESIGN,INC.IS NOT
LIABLE FOR THE ACCURACY OF THF
TOPOGRAPHY INFORMATION IT IS
THE SOL RESPONSIBILITY OF THE
BUILDER ">V'WY ALL SITE !I.«•^^
-ONDITIONS,IF CLUDW ANY FILL 46 —
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PLACED ON THE SITE, AND PFOI?M
;lWNERS OF ANY POTENTWI,FELD L 4� DIFICATIONS.
1
CITY OF TIGARD
13125 S.;",i. F'A'_L BLVD.
TIGARD, OR 9',"-'23
IMPORTANT PERMIT NOTICE
NORTH STAR PLUMBING
1445 SE OREGON STREET
SHERWOOD, OR 97140
Plumbing Signature Form
Permit #: MST2003-00036
Date; issued.
Parcel: 1 S135r.D-12100
Site Address: 11830 SW KOSKI AVE
Subdivision: KALAMOIIKA ESTATES
Bloci<- Lot: 008
Juriscictior: TIG
Zoning: R-12
Remarks: N
Your company has been indicated as the plumping contractor 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 plutobing inspections will be authorized until this completed form is received
OWNER PLUMBING CONTRACTOR.'
ECK CONSTRUCTION, INC. NORTH STAR PLUMBING
P.Q. BOX 204 1445 SE OREGON STPEET
SHERWOOD, OR 97140 SHERWOOD, OR 97 140
Phone #. 503-625-1305 Phone #: 625-2679
Reg #: LIC 00090697
MET 00002694
PLEA 34-255PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
`sign ture of Authorized Plumber
If you have any questions, please call (503) 639-417 1, ext. # 310
CITY OF TIGARD
13125 S W. HAI bLVD.
TIGARD, OR - 223
IMPORTANT PERMIT NOTICE
WILLIAM BUTTERFIEL.D CONTRACTING
PO BOX 305
13120 SW MORGAN RD
SHERWOOD, OR 97140
Electrical Signature Form
Permit #: MST2003-00036
Date Is>ued:
Parcel: 1 S135CD-1:.'100
Site Address: 11830 SW KOSKI AVE
Subdivision: KALAMOIIKA. ESTATE:.
Block: Lot: 008
Jurisdiction: TIG
Zoning: R-12
Remarks: N
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrrcar permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your cornpany sign below and return this Electrical Signature Form prior to the
atart
Of tl19 work to the address above, ATTN Building Division
N- electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL. CONTRACTOR:
ECK CONSTRUCTInN, INC. WILUAM BUTTERFIELD CONTRACTINC
P.O. BOX 204 PO BOX 305
SHERV`.00D, OR 97140 13120 SW MORGAN RD
SHERWOOD, OR 97140
Phone #: 503-625-1305 Phone #: 503-F25-6773
Req #: r_rc 118554
ELE 3-548(
SUP 10435
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising rlectrician
If you have any quesuons, please call (503) P59-4171, ext. # 310
CITY ®F ^I I GA R D — PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PI-M2003-00313
13125 SW Hall Blvd., Tigard, OR 97223 (503) 63ti-4171 DATE ISSUED: 6/30/03
PARCEL: 1 S135CD-12100
SITE ADDRESS: 11830 SW KOSKI AVE
SUBDIVISION: KALAMOIIKA ESTATL_:S ZONING: R-12
BLOCK: LOT: 008 JURISDICTION: HG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
1 fPE OF USE: MF WASHING MACH: RACKFLOW PP,EVNTRS: 1
OCCUPANCY GRP: P.3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
__ F_IX_TU_RES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: �^ URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISFIOWERS: SEWER LINE: it
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of irrigation backflow preventer.
FEES_
Owner: —�-- "J --
-- - Description Date J Amourt
ECK CONSTRUCTION, INC --'
P O. BOX 204 11'LUMB] Permit I CA' 6/30/03 $36.25
SHERWOOD, OR 97140 11 Ax] H"„Stare I a6!30/03 $290
Total $39.15
Phone : 503-625-1305
Contractor:
GROVER'S LANDSCAPE SERVICES
26A85 S MERIDIAN RD.
AURORA, OR 97002 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : 503.678-1796 Final Inspection
Reg#: LIC l 1 xo?
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work wil! be done in accordance with approved plans
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952_-0001-0100.
You may obtain copies of these rules it direct questions to OUNC by calling (503) 246-6699
Issued By: y a ;_. ... .T `.. Permittee Signature: .K
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Buj!o.aiing r ixtures l
Plumbing permit Application 7Datc
� 'Z OFFICE USE' ONLY Plumbing_-�li'G PermitNo.: (� JGuIt of Ti and pproval Sewer
yg Permit No.:
13125 SW Hall Blvd. Plan Review — Other
Tigard,Oregon 97223patp�HiL Permit No.: -
Phone: 503-6394171 Fax: 503-598-1960 Post-Revicw band Use
Internet: www.ci.tigard.or.us Date/By: Case No.:
Contact Juris.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Namc;Method: T (1- Sn) lemental Information.
TYPX OPIWO — - - _FEE"SCHEDULE(f)r special Information use checklist _
ew construction Ueinolitic)n Description __ =�Fee(ea.) total
_❑ Addition/alteration/re lacement Other: New i &2-family dwellings
CATEGORY OFCONSTRUCTION Includes 100 ft for each u ility connection
4 1 &2-Family dwelling CommSFRI bath 249.20ercial/Industrial SFR 2 bath 350.00 _
Accessory build_ Multi-Family SFR 3 bath 399.00 _
_Master Builder Other:_ Each additional bath/kitchen 4r 00
JOB S11 E INFORMATION and LOCATION Firesprinkler-sq. ft.: _ Page 2
Job site address: ffK3 a , C.w Xes &i Site Utilities
Suite#: Bid ./A to Catch basin/arca drain 16.60
Project Name: Urywcll/leach line/tench drain I0_.60
Fooling drain no. linear R. Page 2
Cross strect/Dircetions to job site: ,f Manufactured home utilities 110.00
t
Manholes I6.60
Rain drain connector 16.00
Sanitary sewer no, linear ft. Pae 2 _
Subdimion: Lot#: Storm sewer(no. linear ft.) Page 2 _
Tax map/parcel #: Water service no. linear ft. Page 2
DESCRIP i ION Uh WUie Fixture or Item —
-7--- Absorption valve _ 16.60
_T_ _ C i'eBackilow preveriter _ Pae 2 —
"j�-n--y q--iT`i��— s.-f s i d--y v Backwater valve — 1660
i Clothes washer 10.60
Dishwasher 16.60 _
PROPERTY OWNER TENANT Drinkingfountain 16.60 -
----- E'cctorwaum 16.60 T
Name: _C �=- re s T,� c � ,�.,. -- --
_--_ Expansion tank I6.60
Address: Fixture/sewer cap 16.60
City/State/Zip: Floor drain/floor sink/hub 16.60
- - Garbage disposal 16.60
Pl1Cne: _ 1'a't _ Hose bib — 16.60
APPLICANT _ CONTACT PERSON _ Ice maker _ 16.60
Name: Interco tor/ reale trap 16.60
Address: I Medical gas-value: $ Pae 2
Cil /State/ZI — --�---- ----- Primer _ 16.60
Roof drain(commercial) 16.60
Phone: FaXu _ Sm_k/basm/lavatory _ u 16.60
E-mail: Tub/showc0showet pan 16.60
-----CONTRACTOR Urinal _-�= 16.60
Business Name: , Z;t,C Water closet 16.60
Address:_ ��-Y wt aa-.+tiv�.�A-�� ��7, Water heater 16,60
Other:
City/St te/ZiOCAf(L -- Ct7616Z Other: -- --
Phone: _ ah- X: {_• Plumbing Permit Fees*
-- - Subtotal 3
CCB LIC. #: Pl mb. LICA Miaimum Permit Fee 572.50 S
Authorized Residential Backflow Minimum Fee$36 25
Signature: —Date: ' 3C .UL Plan Rcview(25%of Permit Fee S _
s State Surcharge(8%of Permit Fcc) S —
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a p-i-mit i%not tit(aitled wititlo All new commercial buildings require 2 sets of plans with F,,metric or
180 days after it has been accepted as conq lete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
i\psL-Termil Forms\PlmPermi►App.doc 01103
CITY OF T'IGARD 24-Hour
BUILDING Inspection Line: (503)639.4175
MST 3.:3 2
INSPECTION DIVISION Bu-ineSS Line: (503)639-4171
BUP _
Received __—_—_ Date Requested—.7 AM___�— PM _—_—___ BUP --
Location __—� Z > � _ 16 04 '1 ___-- _--Suite--_. __ MEC
Contact Person —_ �� Ph(--) PLM
Contractor _ _— Ph (_�—) — __ SWR —
$UILDIN, Tenant/Owner _— ELC —
Footing
Foundation Ar cess: ELC _----- -----_...__
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
insulation
I;rywall Nailing -- ------ ----- ----------.___�____-.—
Firewall
Fire Sprinkler ----.---------..--------_
Fire Alarm
Susp'd Ceiling
Roof
Other:
>=rnat
_ PART_ FAIL ---
PLUMBING
Post& Beam --
Under Slab -_----
Rough-In
Water Service -- - - ---�_-.--- . -- --- -----
Sanitary Sewer \
Hain Drains --- ---- --
Catch Basin/Manhole /
Storm Cain _--
Shower Pan %
Other: --- -
Final
PART FAIL
Post& Bearn----— --
Rough-In - -----
Gas Line
Smoke Dampers - - - --- -- - - --- -- -
PART FAIL. ------- -------- - - --
EL CTRICAL
Service
Rough-In
UG/Slab ,----------- - --..—___ _._.—` ---- -..—.— - ---- --- -- --
Low Voltage
Fire Alarm
Final Reinspection fee of$ _required before next inspection. Pay at City Half', 13125 SW Hall Blvd.
PASS_ PART FAIL
SITEPlease call for reinspection RE __-- - - [] Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date _ 7 _[ �._ Inspector-<�_. _._ Ext ____
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 75 —,n6 d 3�
INSPECTION DIVISION Bus;ness Line: (503)639-4171 MST
BUP
Received ___ _ Date Requested 7 AM . PM BUP
Location ___c� ' r_: S„�— �_Suite MEC
Contact Person -tJ-�: Ph(—) W,?d -'37?? PLM
ContractorPh(—) SWR
BUILDING Tenant/Owner — ELC
Footing ELC
Fourdation 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
ire Sipa;kier -- — ---
Fire A!arm
Susp'd Ceiling _---
Roof
Other: _ -- -- - ----- --- - --— - -- - ---- --
Final
PASS PART FAIL J----- - ------ ------ -----------
PLUMBING —
Post&Beam
Under Slab —- -- ---- --- _—_—�__-- -- - - -
Rough-in
Water Service -- -- -- - - ---------. ----- - - -
Sanitary Sewer
Rain Drains -- _ -- ---- —- - �._-— - - -- - - -- - -
Catch Basin/Manhole
Storm Drain ----------- ---- ..___ —.--_ --- - - -
Shower Pan
Other:_ — --_. --_-._ -
Final
ASS PART FAIL
MECHANICAL — - - ------ --_--. -- .- -
Post& Beam
Rough-In ------- --- -. -- --
Gas Line
Smoke Dampers —_— — — -_ -- -- - - --
Final
PASS --P RT FAIL -
ELECI'A1GA
Service
Rough-In -
tow�Tol�i�e
Fire Alarm
Ftn 1:1 Reinspection fee of$__. required before next inspection. Pay at City Hall, 13125 SW I lall Blvd
AMW PART FAIL
p _ —___ -� Unable to inspect- no access
SITE Please call for reinspection RF —_.____-
Fire Supply Line
ADA -� 1
Approach/Sidewalk Date _/ = :napector Ext
Other:
Final DO NOT REMOVE this Inspection record from the 166 site.
PASS PART FAIL