12742 SW ROCKY MOUNTAIN COURT c
12742 SW Rocky Mountain Court
CITY
�� �I���� MASTER PERMIT
PERMIT #: MST2001-00489
DEVELOPMENT SERVICES DATE ISSUED: 10/4/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12742 SW ROCKY MOUNTAIN CT PARCEL: 2S109AD-08400
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7
BLOCK: LOT: 028 JURISDICTION: TIG
REMARKS: Construct new single family detached residence. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS __ REQUIRED
CLASS OF WORK. NEW HEIGHT: 23 FIRST: 1,053 of BASEMENT: d LEFT: n SMOKE DETECTORS, Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,312 of GARAGE: 440 of FRONT: 20 PARKING SPALES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 6
VALUE: E::26,074.20
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,37000 of REAR: 30
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: LAUNURY TRAYS: 0 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: 3 GARBAGE OISP: I WATER HEATERS: I WATER LINES: 100 BCKFLw PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1
FURN>■100K 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS _ M18CEl.LANEOUS ADD'L INSPF.C110N9
1000 SF OR LESS: 1 0 • 200 amp: 0 200 amp: WISVC OR FDR: I PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 • 440 amp: 201 400 amp: let W/O SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HMISVCIFDR: 601 • 1000 amp: 601*amp9-t000v: MINOR LABEL:
1000*amolvolt: P'.AN REVIEW SECTION _
Reconnect only: >•4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRILTEO ENERGY
A.SF RESIDENTIAL. B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALA','.'.: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER„ HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL.
GARAGE OPENER: CLUCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA(TELE COMM: NURSE CALLS TOTAL 0 SYSTEMS:
TOTAL FEES: $ 7,337.77
Owner: Contractor: This permit is subject to the regulat,ons contained in the
LEGACY HOMES INC Tigard Municipal Code,State of OR. Specialty Codes and
PO BOX 446 all other applicable laws. All work will be done in
SHERWOOD,OR 97140 accordance with approved plans. This permit will expire If
work is not started 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 the
Oregon Utility Notification Center. Those rules are set
Rqg a 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 INSPEt.T10NS
Erosion Control Insp 8, Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Grading Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Finrli
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low\/oltage Water Line Insp Final inspection
Foundation Insp Footing/Foundation DN Electrical Rough In Gas I.Ine Insp AppNSdwlk Insp
�f
Fermittoe Signature
Issued By 9
Cali (503) 639-4175 by 7:00 p.m for an inspection needed the ext business y
CITYOF TI GAiR D __ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT ,':: SWR2001-00255
'13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/4/01
SITE ADDRESS: 12742 SW ROCKY MOUNTAIN CT PARCEL: 2S109AD-08400
SUBDIVISION: ELK. HORN RIDGE ESTATES ZONING: R-7
BLOCK: LOT: 028 JUf:ISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: L.TPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new single family residence.
Owner:
---- FEES__ _
LEGACY HOMES INC Type By Date Amount Receipt
PO BOX 446 -
SHERWOOD, OR 97140 PRMT CTR 10/4101 $2,300.00 27200100000
INSP CTR 10/4/01 $35.00 27200100000
Phone: 503-925-0506 Total $2,335.00
Contractor:
Phone:
Reg tt:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date Issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Perm
e_
Issued by: �� �� ,� ~� -j
, _ Permittee Signature C! _
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the Wpxt business day
lAilding Permit Application o
"Datereceivcd: y �G J Pernnitno.: j OOS�
City of Tigard
Address: 13115 SW Hall Blvd,Tigard,OR -�, Projectlappl.no.: Expire date:
City of Tigard phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960
Case file no.: Paymenttypc• '
Land use approval 1&.2 family:Simple Complex: v
t
❑ 1 1. 2 family dwelling or accessory ❑Commerciallindustnai U klulti-tanlily ,dNew construction ❑Demolition rp
❑/tddition/alteration/replaccment ❑Tenant improvement ❑Fire sprinkler/alarm ❑Other:
eB'SITE INFORMAT116N
Job address: 2 KI' ' Bldg.no.: Suite no.: (((
Lot: ,Q, I Block: Subdivision:-t Lyc,ri,lkj, Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: '(Floodittalo,septk capacity,solar.etc.)
OWNER
Name:
y ' r s: Pt^(?,0;; IN xI I &2 family dwelling:
Statc: 7_IP: Valuation of work U 1 ............. $
Girdling t res �l l � ................,t....... .
Phone: •00 Fax: I E-mail: No.of bedrooms/baths................................. 11
Owner's representative: ' , I•s , Total number of floors................................ _ z•
Phone: Fax: E-mail: New dwelling area(sq.ft.) ..........................
Garage/carport area(sq.ft.).........................
Covered porch area(sq.ft.)
Name: t1�•1E, ,�,': (r.'►SF.t� . .........................
Mailing address: Deck area(sq.It.) .........
City: _ State I IIP: Other structure area(sq. ft.)......................... �. h
Phone: d a� 1 i til: Commercial/industrial/multi-family:
Valuation of work........................................ $
Existing bldg.area(sq.ft.) ..........•............�.
Business name: (lt;F- ;__
Address: — - � _----- New bldg.arca(sq. ft.) ................................
City: State: ZIP: Number of stories............•..•........................
Phone: Fax: E-mail:
Type of construction. ................................. _
Occupancy group(s): Existing: --
CCB no.: ,New: ,
City/mctn n. Notice:All contractors and subt:ontractors are required to be�
I licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
--- --- =--- - - —
Address: jurisdiction where work is being performed. If the applicant is
�• A�4r'
city: St,ut•_ 711'- � exempt from licensing,the following reason applies:
Contact person:
Phone. Q Fax: C nrtiL�
Name: (intact person: Fees due upon application ........................... $
Address: Date received:
City: State: ZIP: Amount received ......................................... $_.
Phone: Fax: E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit earls•please card jurisdiction for more infornution
attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard
work will be complied with,whether s •cifit,d herein or not,,, I Credit card number
Aires
Authorized sign�turet 4,U
ate: L Name of cardholder as shown on credit card v S
Print name: �Y�YY�GfL ._�_ 1 t.Cs—�; �_Cerdholdersignatute — — moZ unl
Notice:This permit application expires it a permit is not obtained within 190 days atler it has been accepted aS complete. 44nW,II(rruuCOM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
Citynf'fignrd CiQ off' Tl Tigard g U Electrical O Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
TIIE FOLLOWING ITEMS ARE t FOR
I Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot.
4 Eire district.! approval required.
5 Sceptic system permit or authorization for remodel.Existing system capacity
6 Sewer permit.
7 Water district approval.
S Soils report.Must carry original applicable stamp raid signature on file or with application.
9 Erosion control 0 plan 0 permit required.include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 _ Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes.lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed
if copyright violations exist.
1 i Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway;fcxnprint of structure(including decks);location of wells/septic systems;utility locations;direction Indicator,lot
area;building covcrage area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location.
13 Floor plans.Show all dimensions,roost identification,window size,location of smoke detectors,water heater, y
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,roif construction.Mone than one cross section may be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
I s Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must rcllect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
110111-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floorlroof framing.Provide plans for all fioors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation.
19 Basement and retaining walls.Provide cross sections and details showing placement of rcbar. For engineered
_systems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beanr/joist carrying a non-uniform load.
_20 Manufactured Moor/roof truss design details.
21 Energy Code compliance.Identify the 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 be shown to be npplicahlr to the project under review.
J�
Live(5)site plans are requited for item I I abovz.
?5
26
27
28
- , -- —----- _—
Checklist must be completed before plan re%ic%v start date, Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved f'or department use only. eaoar,14((,alcont)
A Mechanical Permit Appliratiorr
--—
Fatereceived: �Ml�per.it
kl r,*O
City Of Tigard Project/appl.no.: Expiredate:
City of Tigard Address: 13125 SW Hail Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Receipti,o.:
— —
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: 13uudiog permit no.• _
❑ I &2 family dwelling or accessory U Commercial/industrial ❑Multi-family O Tenant improvement
New construction O Addition/alteration/replacement 0 Other: -
1 : SITE INFORMATION1
Job address: 1 I a"L )Y'I !CO(,l,.y 1.1t,r ,t Indicate equipment quantities in L,, below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials -.iuipment,labor,overhead,
Tax map/tax lot/account no,: 7.$109 A - 15AOO profit.Value$
Lai: ;.' , Block: I Subdivision: *See checklist for important application information and
Project name: y jurisdiction's fee schedule for residential permit fee.
City/county (;_wr t,i►�iaut.l ZIP; X1` 2.14 DWELLINGi
Description and location of work on premises: 1 t 1 at l t
Est.date of completion/inspection: Descripfion Qty. Res.only Res,onlr
Tenant improvement or change of use:
Is existing space heated or conditioned?O Yes U No Airhandling unit --_e__CFM.
irconditioning(site plan required)
Is existing space insulated?U Yes ❑No --Alteration of existing AC system
1 of er compressors
State boiler permit no.:
Business name: C CW o iA I•i f + _ HP Tons BTIJ/H
Address: 7,1155C) 5E H W Zi' ire smo aamper uc—ls ti�`smokedetectors
City: IW( Stair ZIP: C "IOC`{ Heat pump(site plan required)
Phone: f p 3 1 Fax: (,,3.091 F 1:-mail: Install/replace urnacrlburner /t
CCE)no.: K Including ductwork/vent liner O Yes O No
Fwall,
ep ac re locate eaters-suspended,
City/metro lic.no.: floor mounted
Name(pleotse print): r app lance o cr anfurnace
1 t rra oil ort n:
Absorption unitsBTU/H
Name: Chillers IIP
Address; ' t ('um ressors, HP
nv rontnenta ex aunt an vent Hat on:
City: 4 W t jLwoop _—._- State: i ZIP: ',i i'— Appliance vent -
Phone: ►a E-mail: ryerexhaust
1
Hoods,Type /11
fte.s.kitchewtar.iwit
hood fire suppression system
Name: Exhaust fan with single duct(bath fans)
Mailing address: X , •x gusts stem apart from eaten nr C
LFuelpiping andistribution(up to outlets)
City: State; t
Type. LI'U NU Oil
Phone: Fax: Entail: Fuel pipingeach additional over 4 outlets
aKess piping(schematic required)
Name: Number of outlets
t erlisted appliance or equipment:
Address: Decorative fireplace
City: State: 7_IP: nseri-type —
Phone: Fax: E-mail: oodstovc/pe Ictstovc
Other:
Applicant's signature: L)atr: ter;
Nance (print):
Not all juriuficlions accept credit cards,plena call Jurisdiction rot more informationPermit fee.....................$ _
U visa U MasterCard Notice 'f his permit application Minimum fee.......... .....$ __,..
Cnvda card nurnheti _ __' ' expires if a permit is not obtained Plan review(at _ th'') $ ^__.____._._,.—,_
t;sl, within IRO days after it has been State surcharge(8%)....$
—� Name oicanTholder u s own on creril i-sR __-__ s accepted as complete.
TOTAI. .......................$
Cardholder signature ---Amount
__ d-Yt 4617 itutllTK'OM)
MECHANICAL PERMIT FEES
COMMFRCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Tot<
$1.00 to$5.000.00 Minimum fee$72.50 _ Table 1A Mechanical Code _ Oty (Ea) Am
$5,001.00 to$10,000.00 $72.50 for the first$5,0_00.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or Including ducts&vents _ 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00, including ducts&vents 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or including vent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to$50,000,00 $379.50 for the first$25,000.00 and 5) Vent not Included in appliance permit
$1.45 for each additional$100.00 or 680
fraction thereof,to and including 6) Repair units
$501000.00. 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air
$1.20 for each additional$100.00 or For Items 7.11,see or Pump Cond
fraction thereof. footnotes below. Com • �*
7)<3fiP;ahsorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 1005 BTU 14.00
8)3-15 HP;absorb
Value Total unit 100k to 500k BTU 25.60 _
Description: Q Ea Amount 9)15-30 HP;absorb
Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTU 35.00
ducts&vents 10)30.50 HP;absorb
Furnace>100,000 BTU including 1,170 unit 1-1.75 mil BTU 52.20
ducts&vents 11)>50HP:absorb
Floor furnace Including vent 955 _ unit>1.75 mil BTU 87.20
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater
10.00
Vent not Included in applicance 445
permit 13)Air handling unit 10,000 CFM+
17.20
Repair units 805_ - 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 _ 10 on
to 100k BTU 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 _ 6.80
101k to 500k BTU 16)Ventilation system not included In
15.30 hp;absorb.unit,501k to 1 2,310 appliance ermit 1 10.00
mit.BTU 17)Hood served by mechanical exhaust
30.50 hp;absorb.unit, 3,400 10.00
1-1.75 mil.BTU 18)Domestic incinerators
>50 hp;absorb.unit, 5,725 17.40
>1.75 mil.BTU 19)Commercial or Industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit>10,000 cfm 1,170 20)!?:tier units,Including wood stoves
Non-portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21)Gas piping one to four outlet,
Vent system not Included in 656 540
appliance permit 22)More than 4-per outlet(each)
Hood served by mechanical exhaust _ 656 _ 1,00
Domestic Incinerator 1,170 Minimum Permit Fee$72.50 SUBTOTAL: $
Commercial or industrial Incinerator 4,590 _
Other unit,Including wood stoves, 656 8%State Surcharge $
Inserts,etc.
Gas piping 1-4 outlets 360 _ 2.5%Plan Review Fee(of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
1 OTAL COMMERCIAL r TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and es:
1 Inspections outside of normal business hours(minimum charge-two hours)
$12 Sir per hour
2 Inspect,ons for which no fea Is specifically indicated (minimum charge-half hour)
$72 50 per hour
3 Additional pian review required by changes,additions or revisions to plans(minimum
charge-one-half hour)$72 50 per hour
State Contractor Boller Certification required for units>200k BTU,
"Residential A/C requires site plan showing placement of unit.
I:\dstalforms\mech-fees.doc 10/11/00
JI
' Electrical Permit Application
Tc��,Oo
D/ PermitOGS 9
no.:J'�ST,o�,i—
City Of Tigard Project/appl.no.: Expire date:
CityufTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued-Phone: (503) 639-4171 BY Receipt no
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement.
d New construction U Addition/alteration/replacement U Other: U Partial
Job address: '?
ti �i Oy,!<: Mtn ( .t , Bldg,no.: Suite no.: Tau Ma /tax lot/account no.:
Lot: �,Q, Block_.T Subdivision: U .K,HOJZjl P lC`C L -. TATLS < 109AL
Project name: Description and location of work on premises:
Estimated date of cinulilrtiun/ln rlilit, -- -
1 1 ' 1 SCHEDULE
Job no: FlEE I it 11tax
Business name: W TE fRaT (','1'f?1r. Mncription _ Qty. (ea) Total no.insp
Address: po 50y. -131- New residential-singk-or muhi-family per
41 dnellin�unit.Includes attacha I garage.
('it}" Z AI.EF-1 State: 'l, Servltelncltded:
Phone: 3 y Fax:-N3•`i'1Z I P-mail: 1000 sq,ft.or less 4
CCB no.: 11-117-'1 Elec,bus. lie.no: . Each additional 500 sq.ft.or portion thereof
Limited energy,residential 2
City/metro IIC,no.: Limited energy,non-residential 2
_ Each manufactured home or modular dwelling
§7- Each
ature of su rvisin electrician re uired) date Service and/or feeder 2
sup.r.icct.name(prinU; F.' :r ^?' ,! f(,* ^l, License no: Services or feeders-Installation,
alteration or relocation:
1 200 amps or less 2
Name(print): 201 amps to 400 amps P-2 Mailing address: eD —� 401 amps to 600 amps -
__ 601 amps to 1000 amps -City: two Ct State: 1 ZIP: Over 1000 am s or volts
Phone: rax:,,12 - E-mail: Reconnectonl
Owner installation:The installation is being made on property I own TemporaryserAcesorfeeders-
- —
which is not intended for sal ,lease,rent,or exchange according to in+tallation,alteration,orrelocation:
ORS 447,455,479,670,701. 200 amps or less 2
201 amps to 400 amps - 2
Owner's signature: _ Date: 401 to 600 ams _ - 2
Branch circuits-new,alteration,
Name.:
or extension per panel:
------ A Pee for branch circuits with purchase of
Address: _ service or feeder fee,each branch circuit 2
City: Stale: ZIP: _ B. Fee for branch circuits without purchase
Phone: E-mail:
of service or feeder tee,first branch circuit: 2
Fach additional branch circuit:
I'l %N RVV1r.W(P1eq%e check all that sppl�)_ Mlsc.(.Service or feeder not Included):
U Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle 2
U Service over 320 amps-rating of I&2 U Hazardous location Each signor outline lighting 2
family dwellings 0Building over 10,1100squarefeet fouror Signal circuit(s)or a limited energy panel.
USystem over 600volts nondnal rm)re residential units in one structure alteration,or extension* 2
U Building over three stories U Reders,400aipsormore *Nscri tion,
U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable In any of the alave:
U Egmssnightingplan U Other Perins ection F--T"--1
Submit`-Sets of plans with any of the above. Investigation fee
The above are not applicable to temporary umstructioi:service. Other
Not all imisdictiorn accept credit conic,please call jurisdiction for mote In6,nnation Notice:This permit application Permit fee.....................$
U Visa U MasterCard expires if a permit is not obtained Plan review(at --
%) $
Credit cord number. ( / within 190 days after it has been State surcharge(8th)....$
t poem accepted as complete. 1'OTAI. .......................$
arc o caor a s own on credit card
�• Ca hot r dgnalute �-���-� _3-Amaum-
4W-4615(riR)p�COA1)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Chec'(Type of Work Involve ..
Residential-per unit
1000 sq.R.or less $145.15 4 Audio and Stereo Systems
Each additional 500 sq ft.or
portion thereof $33.40 1 Burglar Alarm
Limited Energy $75.00
Each Manuf d Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders [] Heating,Ventilation and Air Conditioning System*
Installation,alteration,or relocation
200 amps or less $8030 2 Vacuum Systems'
201 amps to 400 amps $106.85 _ 2
401 amps to 600 amps $160.60 2 tf�--II Other
601 amps to 1000 amps $240.60 2 IJ ----- --
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps or less _ $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps $10030 _ 2
401 amps to 600 amps �, $133 75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. Audio and Stereo Systems
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder fee.
Each branch circuit ��— $665 2 Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Fire Alarrn Installation
or feeder lee.
First branch circuit $46.85 HVAC
Each additional branch circuit $665
Miscellaneous M Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $5340 Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuits)or a limited energy Landscape Irrigation Control'
panel,alteration or extension $75.00
Minor Labels(10) $125.00 _:. ❑
Medical
Each additional inspection over
the allowable In any of the above Nurse Calls
Per Inspection $62,50
Per hour $62 50 !,- ❑
In Plant $73 75 �— Outdoor Landscape Lighting'
Fees: [j Protective Signaling
Enter total of above fees $ __.. ❑ Ottler _—
etl:State Surcharge $ Number of Systems
2394 Plan Review Fee No licenses are required Licenses are required for all other Installations
See"Pian Review"section or, $
6nnt of application
Fees:
Total Balance Due $
Enter total of above tees $ _�
ElTrust Account# 8%State Surcharge Sv
-- ----�— Total Balance Due $, ---
i,Wsts�&vnrsklc-I'ces dnc 10/09/(10
Plumbing Permit Application
�Da�tereceive�d: ';'_/" Permit no.: 5TH '0058
/
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
(rry n/I ipard Phone: (503) 639-4171 Project/appl.no.: Expire date: —
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case rile no.: Payment type:
TV PIE-OF PERM IT
O I &2 family dwelling or accessory 0 Con:mercial/industrial O Multi-family 0 Tenant improvement l
J New construction U Addition/alteratior/replacement 0 Food service U Other:
JOB SITE INFORMATIONInformation
Job address: - Description Qty. Fee(ea.) Total
_
—-- — Nem 1-and 2-family dwellings only:
Bldg.no.: I ,uuc mr.: _ _
Tax ma /tax lot/account no.: 7 ,- J (includes 100 ft.for each utility connection)
p �: --- SFR(1)bath
Lot: '?.2) Block: Subdivision: SFR(2)bath -— -- - - --
Project naine: f;`57 a.'(1: _ SFR(3)bath --�—
City/county: 'j i[�Ai' ; YJQ' i{, ZIP: ' 1 ;,l,, Each additional bath/kitchen
Description and location of work on premises: Siteutilities:
Catch basin/area drain _
Est.date of complction/inspectnui Drywells/leach line/trench drain _ —
1CTOR Footing drain(no.lin.ft.) — —_
Manufactured home utilities__
Business name: A Manholes
Address: I J 2)t Rain drain connector _T
City: Hillsborc I state:�:)F I ZIP: 'J'-] Sanitary sewer(no.lin.ft.)
1'It0me: Z i°) I Fax:ZC) J.A I E-mail: Storm sewer(no.lin. ft.)
CCB no.: Zz, Plumb.bus.reg.no: jqJ1.1% water service(no.lin.ft.)
City/metro lie.no.: Fixture or item:
Contractor's representative siprimure: Absorption valve
---- Back flow preventer
Print name: 'T�Wlt. Date: 9• Backwater valve
Basins lavatory
Name: E5gAMt 11 ILK Clothes washer
Address: Farr, x. Aj - Dishwasher
State: 14'. ZIDrinkingfountnin(s)
City: JH ')C I'.
Ejectors/sump
Phone:- 2. • .5n Fax: 11.5•n`1`T1 E-mail: Expansion tank
of Fixture/sewer cap
Name(print): L�CifaG( ��C�f� `j (.,1,,('.. Floor drains/floor sinks/huh
Garbage disposal
Mailing address: x cit• U Hose Bibb _
City: 'T State: ni' 71P: cj- I ce maker
E-mail: Interceptor/grease trap _
Owner irstallation/residential maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s), ays(s)
Owner's sl nature: Date: Sum _
Tubs/shower/shower pan
Urinal
Name: -water — —
-------- --__-.-- _- - closet
Address: ater heater
City: _--� State: ZIP: Other: —
Phone: Fax: I E-mail: 'Tota
Nw all jurishctiona accept credit cards,plena call Jurisdiction for mere InformationMinimum fee. ..............$ _
Notice:this permit application plan review(at �_ �) $
U visa U MasterCard expires if a permit is not obtained
credit card number:__ _.- -.. �J__ within 190 day's allet it has been State surcharge(8%,)....$
F.cpirea
Name ofcardholder es
---- shown on credi----t-cord------ accepted as complete. TOTAL .......................$
�
S
�Cardholder alRnarurc-- — --Amount 440-4616(6AO/COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTUR_E.S (individual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE_ TOTAL.
Sink- 16.60 the dwelling and the first100 ft. CITY (ea) AMOUNT
Lavatory 10.60 for each utilitynn_coaction
One 1 bath - $249.20
Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00 _TT
Shower Only 16.60 Three 3 bath $399.00
Water Closet 16.60 - -- -
SUBTOTAL
Urinal 16.60 - 8%STATE SURCHARGE _
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
--- -----__.. _.
Garbage Disposal 16.60 TOTAL
_ _- -_-_.. ....__--
Laundry Tray 16.60
Washing Machine 16,60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 - PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like kind 16.60 uantity by_Work Performed
Gas piping requires a separate mechanical Fixturo Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New SaNStorm Sewer 46.40 Lavatory
Huse Bibs 16.60 Tub or Tub/Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fix!ures(Specify) 16.60 Urinal
Dishwasher
_
Garbage Disposal
Laundry Room Tray
-
Washing Machine -
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3" --
Sewer-each additional 100' - 46.40 4"
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 7.00' 46.40 Other Fixtures
Seci
Storm 8 Rain Drain-1st 100' 55.00
Storm iS Rain Drain-each additional 100' 46.40 - -
Commercial Back Flow Prevention Device 4640
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr r/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 1660
QUANTITY TOTAL --^
Isometric or riser diagram Is required if --'"-'
Quantity Total is i 9 _ -----
'SUBTOTAL --- - - --
8%STATE SURCHARGE - -
'PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty total Is>9
TOTAL $
Minimum permit fee Is$72 50+8%state surcharge,except Residential Bacl,low
Prevention Device,which Is$36 25+8%slate surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review
I:\dsts\forms\plm-fees.doc 10/10/00
';t_-3F,71,i 1a, TOM MILLER BLUR INr_ PME 02
CITY OF TIGARD
13125 S.W• HAL.L BLVD.
TIG-AKD, OR 97223
IMPORTANT PERMIT NOTICE
Plumbing Signature Form
�,errnit A MLT2001-00489
pate Issuon_ 1014101
Parcel: 28109AD-08400
`lite Arldress- 12T42 SW ROCKY MOUNTAIN CT _.
%iW)diviaiun. ELKHQ" RI[)�� 3TATCS_.
Block I_ot: 028
Jurisdiction' TIG
Luning: R-7
Rrmark�: Construct new single tamlly detached residence, Path
n below and return
Your company hus teen inulcatrd s5 the irlun)hin �ntlrfviduallrornr for the ryulurrcc►Irnpany sig rjited r I�� t�r`ttt'r for t,,e
pliimbing I�armit to be valid, please:tiavE.. lh� appropriate
thio Piumhing Sigr,tttui e Form prior to the start of the work to the addross Hbova, ATTN: Building Dept•
No plurT►Wng InuPeclic7ns will be authorized until this complelad form is received
PLU/JM,O {NG�G)ONJRAC/TOR: /
C)UVNFRFnL.
LEGACY HOMES INC _J
Po BOX 446
44ERWOOO,OR 97140
Phore sf. 503-925-0506 Phone#: S0
- Rog 3y-1 yq P6
AN INK SIGNATURE 15 REQUIRED ON THIS FORMA t
Slyatur -61)Autriodzed plumber
If you havA :any yuegtiun;, plocTse call i5(',1)09-4171, ext # 310
T0 •� L660sZ6£0� '0 '1 '1 'S3WOH A0HO�31 Wd eZ: 60 T007-GO-100
ELECTRICAL PERMIT -
RD
DEVELOhIVIE.P� RESTRICTED ENERGY
CITY OF TIG
'T SER/V�ICES PERMIT #: ELR2001-00273
13125 SW Hail Blvd.. Tiqard, OR 97223 (503) 639-4171 DATE ISSU EDPARL: 2510 AD 08400
SITE ADDRESS: 12742 SW ROCKY MOUNTAIN CT ZONING: R-7
SUBDIVISION: ELK HORN RIDGE ESTATES JURISDICTION: TIG
BLOCK: LOT: 028
Project Description: All encompassing low voltage
A. RESIDENTIAL — B.COMMERCIAL-- — ----
AUDIO & STEREO:
AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
CLOCK: MEDICAL:
GARAGE OPENER: NURSE CALLS:
HVAC: DATAITELE COMM:
VACUUM SYSTEM, FIRE ALARM: OUTDOOR LANDSC LITE:
HVAC: PROTECTIVE SIGNAL:
OTHER: ALL ENCOMP h INSTRUMENTATION: OTHER: 1
TOTAL#OF SYSTEMS: — J
-- – Contractor:
Owner: LEGACY HOMES LLC
LEGACY HOMES INC PO BOX 446
PO BOX 446 SHERWOOD. OR 97140
SHERWOOD, OR 97140
Phone: G03-925-0506 phone: 503-925-0506Reg#: UC 64687
FEES _ Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 10/31/01 $75.00 2720010000
Elect'I Final
5PCT CTR 10/31/01 $6.00 2720010000
Total $81.00
J
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 will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires-yotj to_-fQllow rules adopte by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 - 01-0010 thro OAR 95 -001 008 You may obtain copies of these rules or direct uestions to OUNC at (503)
6-191;7. r
Permittee Signature —.--
I sued by
�.--' OWNER INSTALLATION_ONLY __--
The installation is being made on property I own which Is not intended for sale. lease, or rent.
DATE:
OWNER'S SIGNATURE: _ __—_. —
CONTRACTOR INSTALLATION ONLY _
SIGNATURE OF SUPR. ELEC'N ___�— DATE: —
LICENSE NO:
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Iatcreccived:Mived: p 1/ 4 Permit no.:
City Of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Nall Blvd,Tigard,OR 97223 Date issued: B
Phone: (503) 639-4171 y Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
APE OF 11"FIRT1,111
U I & 2 hotly&Aelliiig or aces.:ury U Cununcrualiirdustnal O Multi-family O Tenant improvement
LJ New construction U Add ition/al teration/replacernent U Other., U Partial
Job address: L—"" Bldg.no.: I Suite no.: ITax map/tax lot/account no.:
Lot: Block: Subdivision: 01&Z
Project name: Description and loCatMA of work on premises: Lin
Estimated date of completion/inspection:
CONTRUTOR
Job no: Fee M1tav
Business name: LN a.0 H 0
Description Qty. 'ex) Total no.hu
-- New residential-shigkormuhifamily[we -- -
Address: t dwellingunkIncludesattaAed"rW.
City: Statex? ZIP: -1 Serviceitcluded:
_Phone:- Fax: E-mail: IWOsq.ft.orless 4
Each additional 500 sq.ft.or rtion thercol
CCB no.: Elec.bus.lir:.no: Limited ener
gy,residential t 2
City/metro lie.no.: _
Limited energy,non-residential 2
Each manufactured home or modular dwelling
SI nature of - (required) _ Date Service and/or feeder 2
Sup.fleet.name(print): License no Services or feeders-Installation,
alteration or relocation:
OWNER, 200 amps or less 2
Name(print): 201 amps to 400 amps 2
--- 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: — State: ZFP: over loco amps or voh5 2
Phone: Fax: E-mail: RcconnectTn l
Owner installation:The installation is being;made on property 1 own temporary services or feeden-
which is wit intended for sale,lease,rent,o,exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 200 amps or less __ _ 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 ams - - 2
Branch circuite-new,alteration,
or extension per Panel:
Nettle. --- A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State' IIP: B Fee for branch circuits without purchase
-" ---- ""-" '-- -- of service or feeder fee,first branch circuit: 2
Phone: Fax: E-mail: additional branch circuit. _ --
7f. Iii&I I KIWI U Misc.(Service or feeder not included):
eover 225 amps-comrnetrial U llealth-care facility "ch pump or imgadon circle 2
er320 amps-rating of I R2 U Nawdms location Each sign or outline lighting 2
dwellings U Building over 10,000square feet four or Signal circuits)or a limited energy panel,
yemover600voltsnominal more resi,+•nrislunits inone structure alteration,or"tension• 2
U Building over three stories U Feeder,400 amps or morn •Descri don
U Occupant load over 99 persons U Manufactured structures or RV park Each additional htspection over the allowable in any of the above:
U Egress/lightingplan U Other --------�____d,._-- Per inspection
Subfnit___sets of plaits with any of the above. Investigation fee
The above are not applicable to temporary construction service. other
Na all jurisdictions accept c,Yd t cards.please can juriuktioo r«more information. Notice:This permit application Permit fee.....................$
U Visa U MasterCard expires if 4 permit is not obtained Plan review(at _ %) S
Credit card numtrr: within ISO days atter it has been State surcharge(8%)....$
— — splres accepted as complete. TOTAL .......................S -
--
Nami c�car a ser as shows on credit e -"'---'--
C older sipature — Amount 4.104615(WYCOh1)
10r29/2,C01 10: ::E "0392509K LEGACY HOMES LL: r-AGE 01/02
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97213
IMPORTANT PERMIT NOTICE
Electrical Signature ForrTi
Permit #: MST2001-00489
Date Issued 10!4101
Par,.el: ;rS109AU-084010
Sita Address: 92742 SW ROCKY MOUNTAIN_ C7 -
-
Subdivisiun: I LK HORN RIDGE ESTATES
RIC) t ul 028
Jurisdiction 't-IV
A-cning R-7
rJemmks Construct new single tamily detached residence. Path 1
Your,;(.-:-,,pany t as '.bmi it dicated as the elmt,Arai contractor for the parmit indlcated above. In ordee tar the
electrical pemriit to be va lw, the signature of the supervising electrician is required. Please have the
appropriate individual from yourcompHny sign below and return this E ectrical Slgilature Form prior to the
start of the vicrrK to thu adc'ress above,A TTN: wilding Do9t.
No eloctrical Inspoctions will bo authorized until this completed furm Is rocolverl
OWNER. ELECTRICAL CCII1 OP:
l_FGACY I-IOhtES INC
PCS BOX 446 -7�
7
SHERWOOD, 0J12 97140 yz-
.�•+ Cern ok
'I,� e t1 503.925-t?5C4 Phare#:
Req#:
AN INK SIGNATURE IS REQUIRED O WIS FOR
x
ignaturu of SupemAn13 Electririen
If you have any quasUons, please cell (503)639-4'7 1, ext. ft 31 C
n �
v 'O
S o t'D
S C
i C
� O
V.-A.
Cl.
o �
\+
R � N
fb
Err
rb
w n
n
N ? �
0
� s
n' v
r
o
T
� ` O
0
Re
O
i
CITY OF TICARD BU" DING INSPECTION DIVISION
24-Hour Inspection Cine: 63:. ,175 Business Line: 639-4. CS� JQ/
--.— Date Requested _AM 6C BLD
Location^ 1 Z ). 2 Y�j �r Suite MEC
Contact Person — � Ph 7N--c-Ple9 PLM _
Contractor Ph S6o1 - kO6 7 SWR _
UILDIN � Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain _
Crawl Drain Inspection Notes: SGN
Slab `
Post&Beam ----. ------ — --- SIT _
Ext Sheath/Shear
Int Sheath/Shear - ----
Framing
Insulation - - --- ---
Drywall Nailing
Firewall
- - -- -
Fir-Sprinkler
Fire Alarm
Susp'd Ceiling �-
Roof ----
Misc: _-
AS PART FAIL
d BIK
Post& Beam - - ----- -- — —�—
Under Slab
Top Out - - - - - --
Water Service
.unitary Sewer
Rain Drains
PASS PART FAIL
ANIC ----
(AIMH
osf-S earn - - - - .-----
Rough In
Gas Line -- - - -
Smoke Dampers ---
n!t - - - - - - ----------._. —.�_
,.PASS PART FAIL
T£C RICAL --
Service
Rough In - - - --— --
UG/Slab
Low Voltage -- �—
Fire Alarm
Final -- - ------------
PASS PART FAIL -- -- ---- --___— - --- —.-._— __ _
SITE
Backfill/Grading - - ----— --- — --_-- _
Sanitary Sewer
Slorm Drain [ J Reinspection fee of$_ required befcre next inspection Pay at City Hall, 13125 SW Hell Blvd
Catch Basin
Fire Supply Line f i Please call for reinspection RE: [ J Unable to inspect- no access
ADA
ApproachiSidewalk
Other Date \' ,� ��� ___ Inspector ✓c,' ��—_ Ext?
Final
PASS PART FAIL. DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUII 'SING INSPECTION DIVISION MST
24-Hour Inspection Line: 639 r 75 Business Line: 639-411
BUP
plate Requested ; ---)�' AM_ PM _ BLD _ —
Location Suite MEC _
Contact Person ��—c:_,,v� ' Ph /),Y X PLM
Contractor _ �'t�C C74r.2. Ph 32;2, SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access
Foundation FPS _—
Ftg Drain _ SGN
Crawl Drain Inspection Notes /;
Slab SIT
Post& Beam
Ext Sheath/Shear -1
Int Sheath/Shear
Framing
Insulation
Drywall Nailing Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final
PASS PART FAIL
PLUMBING
Post&Beam -- -- _ -- — -
Under Slab
Top Out ---
Water Service
3enitary Sewer
Rain Drains
Final
PASS PART FAII._
MECHANICAL —
Post& Beam __..—
Rough In
Gas LinaSmoke Dampers
Dampers
Final --
PASS PART FAIL
ELECTRICAL _ _^
Service
Rough In
UG/Slab
Low Voltage
9Fi farm
n
PART FAIL
SITE
Backfill/Grading - --_ -- — —
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ _ _required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basi,
Fire Supply Line ( ]Please call for reinspection RE: ( ]Unable to inspect no access
ADA I r�
Approach/Sidewalk hate _ '. � Inspector -�"L. Ext
Other
Final
PASS PART FAIL DO NOl' REMOVE this inspection record from the job site.