14197 SW 132ND TERRACE Family Room Below �
Loftr
I ------- ---� I 4 Kitchen
M
1
8'-3 1 1 1 BR 3 _ I 101-0 1
_ — ------- - 4'-3 11'-2 1'-4 1-71 5' - L Fwmily 10'-0 1'-2 T-6
Open to above I ------- -
W -11N 14
�. bo ~
in
0�1 '" 00 - -- 3-10 1 0 -
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- --- --� 1 t�✓,�1 + N 4'-61 N
0'-14 0'-111 m �1 N N 1 1
- - 2' On to W.C.
IN - ---- _=] C ------------ 0' - 1'-1G
1-21 �'-11 2'Bill- -0 8'_ T-8
1 MIN
. , 1
9'-5 _3
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1 31 , 1 1 1 1
� 1/2" to W.0 o � 3'-3 3'-l0j i 1'-0
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"IN -� o -• o ► l�xmdry
-� -- pen Dining
;n I 2'-6
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Open to above _--
Open to below
0 11 �'1 - :�-
2'-10
1
0 T-1 Garagein
No Sprinklers per WA 13D
— 1 (V 14 F,
\
2'-611 -1 9'-5 -- .� o -C-I --
Master 52
0
-; Br.2 Living
to r-64
bo
'12Ei - - ---
Meter: 2.5 psi loss
City Supply
UPPER F►_04R PLAN static: 60psi
SC&E: 1/4" =1•4' t Ul) Residual: 55
Flow: 300gpri
- r-
MAIN FLOOR PLAN
5C&E: 1/4" =1'-0"
CITY OF TIGARD
Appr„vcd...............................................(b
Cond+:anally Approved..........................[ ];
For only the work s described in;
PERMIT N().h4WF_
See Letter to:_Fol!aw...................... ........( ].
Attac:h.......
b Adul+��;: ��� �"�• ......
Jo
r' ^ Date: 10- �-d+
NORTH Revisions Symbol Head Count Standard Symbols Standard Symbols Sprinkler Head SyMbols Inspections
General Intallation Notes - -t�� tit of PREFERRED PLUMBING
_ Sprinklers Model De nee I�"�1 -Post Indicator`:alvt � -Alarm Check Valve �- -Upright On 12"Outlet I y Tigard
1.All piping is'type N1 copper as appro%ed by Oregon State Plumbing Board. Star Stealth 5240 Concealed 155 25 -- -- - -
2. Install hangers per pipe manufacturer• rccornrrnendations. - -- - - ---- — pfd Key Operated Valle / Thrust Dock �- Pendant On 1/2 Outlet +
Barnet , t
3.Add InanBcn�as necessary to ensure that there is a han)er within G"of each sprinkler drop. _ } Public Hydrant pip Backflow Preventer Upright On 1"Stubb-up Forest rOVe Oregon
4.Sprinklers must be.W-0"max from amwall,8'-0" minimum from any other sprinkler, -_- q P Fire Dept Connection Q Piendant On I"Drop
18'-0"maximum spacing between any talo sprinklers in the sarne room. -- ---- - - - - -
- -- - -- — —
5. All pipe locations are to be field measured prior to installation by('ontractor, O S 8Y Gate Valve $ Pend On 1"Drop Below Ceiling - - Na Malin and Upper FI9oC Piping Plan - -
6.All pipes and han8en are to be installed per NEPA 131). - - - __ _. - r J Check Valve -0- Upgright And Pendant On Drop Date 10/03/01 Lot oven's Ridge
7. Ilangen arc to be U.1,. Listed and h.N1. Approved. New Underground V_ SldewalI On 1/7'Outlet :gr__- J.Lamb _ 3y Tt ard, Oregon 1 of t
TOTAL THIS PAGE 25 k = -Existing Underground Sidewall On 1"Outlet ie Noted
NOTIC
IMAGE IS I
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ORIGINAL DOCUMENT S �8
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14197 SW 13211`' Terrace
CITY OF rIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION \�1 �O Business Line: (503) 639-4171 MST
�G
Received BLIP
Date
_ Requested - AM___
—. PMLocation —___ _ BLIP
:!22 �
—�
/�1, ` Ite
Contact Person o Ph MEC
-
Contractor_ _ (— ) � �_ PLM
BUILDING ELC
- Ph( -) — -- SWR
Fg —
Tenant/Owner —
ootin - - ---
Foundation
Ftg Drain EL.0
Crawl Drain ELR
Slab 71nspectiorotes: io ty.Post&Beam SIT
hear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation — - - --
Drywall Nailing w ( <
Firewall
Fire Sprinkler Fire Alarmhz� _ -_ hl
Susp'd Ceiling
Roof - --
----
Other:
Final -- --- __
PASS PART FAIL
PLUMBIN3
Pnst&mBe
Under Slab
Rough-In
Water Service _ -
Sanitary Sewer
Ain Drains --
Gatch Basin i Manhole L
Storm Drain -
Shower Pan
Other: -
Final
PASS PART FAIL ---- - -
MECHANICAL
Post& Beam
I�cu.ryh-In --.
Gaff I_u ,
Smoke Uangpers —�
Final
PASS PART_ FAII
ELECTRICAL
Rough-In
UG/Slab
Low Voltage
Fire Alarm\�
❑ Reinspection fee of$
S _ PART FAIL - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S ❑ Please call for reinspection RE:—._
Fire Supply Line — ❑Unable to Inspect-no access
ADA
ApproachlSidewarK Dab —, .� 1- r
Other: - -- Inspector 1 �--
- Ext _
Final DO NOT REMOVE this inspection record from the job site,.
PASS PART FAIL J
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST �Of 4d ��
BLIPReceived _ Date Requested 2 - AM PM BLIP
Location ___ 3 2- Suite_ -.—_—_ MEC
Contact Pcrson Ph( �� PLM
Contractor._._ Ph( ) SWR
BUILDING _ Tenant/Owner _.. ELC
Footing --
Foundation - &e- ELC
Ftg Drain
Access:
Crawl Drain __ ELR -
---
Slab Inspection Notes:
Post& Beam SIT
- --
ear Anchors --
Ext Sheath/Shear
- - -
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
firewall - -- -- -
Fire Sprinkier
Fire Alarm - --
Susp'd Ceiling
Roof
Other:_
Final
PASS PART FAIL_
PLUMBING
Post 8 Beam -- _
Under Slab
Rough-In _
Water Service _
Sanitary Sewer ---_
Rain Drains
Catch Basin/Manhole - - -- -- - ---- -__.
Storm Drain
Shower Pan ---
Other: --
S PART_FAIL_ --
HANICAL - --_-- ---- ---
Post 8 Beam _--_--
Rough-in _
Gas Line -- - - ---— —_-- --_ _
Smoke Dampers —
Final -- -- ----— -- -- - -- — ----------
PASS FART FAIL
ELECTRICAL - -_---- - -�`--�-----
Service -- --_-
UG/Slab
Low Voltage _
Fire Alarm - -` --- -- ---- —
Finr.' - - --
Ll Reinspection fee of$
PASS PART FAIL required before next inspection. Pay at City Hall, 13125 SW Hell Blvd.
SITE) _ ❑ Please call for reinspection RE:- -____
Fire Supply Line - Unable to inspect-no access
AOA p
Approach/Sidewalk Data 0 "'1?2
Other: Inspector
_ R
Final — --- DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIG,ARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST
INSPECTION DIVISION Business Line: (503) 639-4171
p� BUP
Received -__-_ Date Requested__. DI _6 AM_ -_ PM BUP
Location _.-___ _r r , �,—���aZ �yZ4�1/ Suite -. MEC
Contact Person —_ � � Ph( ) " S(o�o PLM
Contractor ._ _-_._ -- -_�-- -- Ph( ) _ SWR
BUILDING Tenant/Owner _ ELC
Footing
Foundation ELC
Access:
Ftg Drain
Craw; Drain `� .YY•� �r �n C.Z�L, ELR
- -- -- -
Slab Inspection Notes: SIT _
Post& Beam - -
Shear Anchors - ---
Ext Sheath/Shear
Int Sheath/Shear � _ —
Framing � i61 4E
Insulation y
Drywall Nailing
Fii owall
Fire Sprinkleryss` -L i�d� 4� 't�L ld-1 C�
Fire Alarm
Susp'd Ceding .,-_
Roof
Other: �?a�ir'� G.�, G1 e"
in
PASS PAR-r"_
AR FAIL
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 _
Post& Bean
Rough-In
Gas Line
Smok,3 Dampers
LASS PART_FAIL
EL ,.TRICAL
Servic,3 - --
Rough-In
UG/Slab
Low Voltage —
Fire Alarm — --�— -- �- - -- _
Final
PASS PART FAIL LJ Reinspection fee or$ —_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
SITE _ Please call for rein,jpection RE _ Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date- 2"G Inspectorut
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 3E 2
INSPECTION DIVISION Business Line: (503) 639-4171 MST
�� /,� BUP -
Received w Date Requested— __ AM __._ PM ___...._- BLIP
Location l y� ' �� �� ��'� -_Suite_ MEC
Contact Person Ph(_- __) �' `'Z PLM
Contractor —_--- --- Ph(--. __) _ --- - SWR --- _
WILDR46 Tenant/Owner __--- -_ ELC
Footing
Foundation ELC
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
r
Z-A
_ --
-PART FAIL
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
Post& Beam - - --�-- - ---- -'----
Rough-In - - --- --- --- ---- - -
Gas Line
Smoke Dampers --- ------- - ---- --- --- ----- -
Final
PASS PART FAIL --
ELECTRICAL
Service --- --- - — -- - --
Rough-In _
UG/Slab -- - - -
Low Voltage
Fire Alarm
Final Ll Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ R Please call for reinspection RE: -�� _ Unable to inspect-no accuse
Fire Supply Line
ADA
Approach/Sidewalk Date S 3 3 Inspector __- _-_ -_ Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
SEE 35MM
ROLL #21
FOR
OVERSIZED
DOCUMENT
CITYOF TIGARD MASTER PERMIT
DEVELOPMENT SERVICES PERMIT #: MST2001-003$$
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: $/13/01
SITE ADDRESS: 14197 SW 132ND TERR PARCEL: 2S109AB-10200
SUBDIVISION: RAVEN RIDE ZONING: R-7
BLOCK: LOT: 031 JURISDICTION: TIG
REMARKS: New construction SF detached. .path 1 Must install fire spr!nkler as per code
_
BUILDING
RFISSUF: STORIES: FLOOR AREAS
REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1.598 sf BASEMENT: sf -
LEFT: ° SMOKE DETECTORS: t'
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1 644 sl GARAGS: l 4
sf FRONT: i8 PARKING SP9C F.S: 7
TYPE OF CONST: 5N DWELLING UNITS: t FINBSMENT: sl
RIGHT: 5
OCCUPANCY GRP: R3 BDRM. 3 BATH. 7 VALUE. t 7uS 757 4p
TOTAL 7�4;p0 of REAR: 1-7
PI-UMBING
SINKS: 1 WATER CLOSETS. 7 WASHING MACH LAUNDRY TRAYS. I
RAIN DRAIN 1np TRAPS
LAVATORIES: 5 DISHWASHERS I FLOOR DRAINS: SEWER LINES. tan
SF RAIN DRAINS. 1 CATCH BASINS.
TUBISFIOWERS. 7 GARBAGE DISP. I WATER HEATERS: t WATER LINES in0
BCt(FLW PREVNTR. t GREASE?RAPS.
MECHANICAL OTHER FIXTURES:
FUEL TYPES FURN<100K: BOIL/CMP<JHP.
VENT FANSCLOTHES DRYFq: t
GAS FURN-100K 1 UNIT HEATERS r
HOODS. t OTHER UNITS: 3
MAXINP blu FLOOR FURNANCES: VENTS
WOOUSTOVES GAS OUTLETS. +1
ELECTRICAL.
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDE.RS BRANCH CIRCUITS
MISCELLANEOUS _ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp. 0 • 200 amp: W15VC OR FDR: 1 PUMP/IRRIGATION,
PER INSPECTION.
EA ADD'L 500SF: 1 201 400 snip201 • 4on amp. let WIO SVC/FDR: rn
SIGN/OUT LIN LT: PER HOUR
LIMITED ENERGY: 401 800 amp. 401 • 800 amp. EA ADDL BR CIR:
SIGNAL/PANEL: IN PLANT
MANU HM+SVC/FDR: 1,01 • 1000 an1p 601-ampl.-1000v:
MINOR LAPEL*
1000.amp/vull
Reconnect only: PLAN REVIEW SECTION
-4 RES UNITS: SVC/FDR,-225 A.. 000 V NOMINAL: CLS AREA)SPC OCC:
---- ELECTRICAL RESTgiCTED ENERGY
A.SF RESIDENTIAL.
B COMMERCIAL
AUDIG&STEREO: VACUUM SYSTEM: AUDIO&STEREO. FIRE ALgHM
INTERCOM/PAGING. OUTDOOR LNOSC LT.
BURGLAR ALARM. OTH: BOILLR. HVAC. LANDSCAPE/IRRI(- PROTECTIVE SIGNL.
GARAGE OPENER CLOCK: INSTRUMENTATION-
MEDICAL. 01HR
HVAC DATA/TELE COMM
NURSE CALLS. TOTAL N SYSTEMS
Owner: Contractor: TOTAL FEES: $ 7,630.36
PALACE HOMES PALACE HOMES INC This permit is subject to the regulations contained In the
27975 S COX RD 27975 S COX ROAD Tigard Municipal Code, State of OR Specialty Codes and
COLTON OR 97017 COLTON,OR 97017 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 the
Pllnne. work is suspended for more than 180 days ATTENTION
Phone: Oregon law requires you to follow rules adopted by:he
Oregon Utility Notification Center Those rules are set
Reg 0: LIC 125eaa forth in CAR 952-001-0010 through 952-001-0080 You
may obtain copies of these rules or direct questions to
REQUIRED INSPECTIONS OUNC by calling(503)246.1987
Erosion Control 1,7sp 8, Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Rain drain Ins
nal
Footing Insp Crav+l Drain/Backwater Electrical Service Low Voltage Water Line Insp Mech3nniicali Final
Foundation Insp Fnoting/Folindatlan Dr; Electrical Rough In Gas Line Insp Sprinkler Rough-In Plumb Final
Post/Beam Structural PLM/Underfloor Fraroing Insp Gas Fireplace Sprinkler Fin!l _ Final Inspection
Issued 13y Permittee Signature
Call (503) 639-4175 by 7:00 p m for an inspection needed the next business day
CITYOF TIGARD _-_SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWF:2001-00193
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/13/01
SITE ADDRESS; 14197 SW 132ND TERR PAR': EL: 2S109AB-10200
SUBDIVISION: RAVEN RIDGE ZONING: R-7
BLOCK: — — LOT: 0?1 JURISDICTiON: TIG
TENANT NAME:
USA NO: FP(TURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL, TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new single family residence.
Owner: — -- ----
-' FEES
PALACE HOMES — --
27975 S COX RD. Type By Date Amount Receipt
COLTON, OR 97017 PRMT CTR 8/13/01 �—$2,300.00 27200100000
INSP CTR 8/13/01 $35.00 27200100000
Phone: 503-630-2099 Total $2,335.00
Contractor:
Phone:
Re0 #:
P.equired Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
180 days from the data issued The total amount paid will be forfeited if the pennit expires The Agency does not
guarantee the accuracy of the side sewer laterals If the sewer is riot located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given If not so loc;ted• the installer shall purchase a"Tap and
Side Sewer" Permi! and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center "Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued by: _ —_ PQrmittee Signature:
Call (503) 639-4175 by 7:00 P :d. for an inspection needed the next business day
x
Building Permit Applicatiuct
City of `i andl j Date received:' Permit no.: C
Ciryoffigmd Address: 13125 SW flail Blvd.Tigard,O .9 �c, Project/appl.no.: Expire date:
Phone: (503) 639-4171 Date issued:
Fax: (503) 598-1960 By: Receiptno.:
Case file no.:
Payment type:
Land use approval: 1&2 family:simple
Complex:
-3 1 &2 family dwelling or accessory O Commerrial/industrial U Mufti-Tamil
U Addition/alteration/replaccment ❑Tenant improvement U P;rc sprinklev;,lanl'New
u t�t��Ncrron U Demolition
110 1 FE WO Brf1TFTFW117
1oh address: s I
Lot: ( Block: Subdivision: "—�-~ i[ Bldg,no.: Suite no.:
----- '1 ax map/tax lot/account no.:
Project name: f�--�-t
Description and location of work on prcmises/special conditions: f _
Name: t
Mailing address: c
City' ( 7
Z", . 1 &2 family dwellin w
State: ',t ZIP:
�
Phone: 7 >_ c�ci' ` Fax: , 7 Valuation of work...........yJ.7�.7(.......... �,r-►r ,�
—.
'�v E-moil: -.
No.of bedrooms/baths.................................
Owner's representative: __._
Phone: _ _ Total number of floors..............
Fax: R nc,il _ ...... .......... _
New dwelling area(sq.ft.)
Garagc/carport area
(sq.f.).....Name: 7�t ........
Mailing address: c ) Covered porch area(sq.f.)
-
.........................
Deck area(sq.ft.)........................................
City: _ State: ZIP: ((her structure area(s . ft.)....................
Phone: - — .....
I':rx: 1 nulla.
1 Valuation ui „urk........................................ $
Businoss name: EAisting bldg. area(sq. ft.) ..... —
New bldg.area(sq. ft.) ....................
City: State: ZIP: Number of stories.......
Phone: Fax: pe of construction. .................................
E-mail:C-retail ................................... _
CCB no.: — Occupancy group(s): Existing: _
City/metrolic.no.: New: -
Notice:All contractors and suhLontractor;s are require--d to ix
Name: licensed with the Oregon Constniction Contractors Board under
Address: f, c n t , i t provisions of ORS 701 and may he required to he licensed in the
1� �. ��`-' �- - jurisdiction where ein work is N
Cit : -- -- g performed. If the applicant is
a n State: 1 7.11>: i exempt from licensing,the following reason applies:
Contact person: J,.
Plan no.:
Phone: r Fax: E-mail: _ ---
Name: �►�� Contact person: , ,. Fees due upon application .................. .
Address: �� �•c' ,, ....... $
City: Q Date received:
mount received .............�— _
Phone• a�� `., A _
0)5 Fax�15 '!� Email: Please refer to Ice schedule.
1 hereby certify 1 have read and examined this application and the Na all11 luriedicu^m r
attached checklist.All provisions of laws and uldinapces governing this U Visa U Me,tercwrd pleax"dr i�rrrdlcu^n r,w "'^eKm.u^n.
work will he complied with.0etherxprcifitedll,eWrtmnot. Credit c;.7+^,,.,nn --
Authorized signature:,, Yom, - Rnl�—
Date: _ _ Name of cura�Tdn�e shown on cr it
Print name:I P , � 7,,,r
Notice:This _.---__C"order iilmure mr
permit application expiry iAmor
f a permit is not obtained within 180 days after it has peen accepted as complete.p 440-461?IROM'(1MI
One-and Two-Farnill� Dwelling
Building Permit Application Checklist Reference no.
City gfTigard City of Tigard Associated permits:
Address: 13125 SW I),ill Blvd,Tigard,OR 97223 U Electrical U Plumbing U Mechanical❑Other.
Phone: (503) 639-4171 —
Fax: (503) 598-1960THE �►
FARE REQUIR
OLLOWING
1 Land use actions completed. .Sce jurisdiction criteria for concurrent review.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of appro wed plat/lot. - --
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-,vay protection,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 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.
I 1 Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more Utan a 4-ft.elevation differential,plan must show contour lines at 2-11,intervals);location of easemenLs and
driveway;fcxtprini ol'structure(including decks);location of wellstwptic systems;utility locations;direction indic )r,lot
area;building coverage arca;percentage of coverage;impervious area;existing structures on site-,and surface drainags,
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
sire and location.
13 Floor plans.Show all dimensions,room identification,window sire,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-mcmixr sires and spacing such as fluor beams,hcaders,.joist.N•,sub-floor,
will construction,roof constmction.Mow than one cross section may be required to clearly portray construction.Show
details of all wall and rool'sheathing,roofing,roof slope,ceiling height,siding material,to otings and foundation,stairs,
fireplace construction, thennal insulation,etc.
15 Elevation views.Provide elevations 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 fort at building envelope.
Full-size sheet addendums showing foundation elevations with cross teftrences are acceptable.
16 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.
I7 Floor/roof framing.Provide plans for all Ihxon/rwf assemblies,indicating member siring,spacing,and hearing
hN:allons.Show;tuc ventil;tion.
18 Basement and retaining walls.Provide cross sections and details showing placement off-char. 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 anti multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
_2o Manufactured floor/roof truss design detalls. _
21 Energy Code compliance.Identify tilt:prescriptive path oi•provide calculations.A gas-piping schematic is required
for lour or more appliances.
22 Engineer's calculations. When required or provided,6.c.,shear wall,roof truss)shall be stamped by an engineer or — LL
architect licensed fit Oregon and shall Ix:shown to fie applicable to the project under re%iew.
23 Five(5)site plans are required fin hem I I above. Site plans must he 8-1/2" x I I"or I I" x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 shove. -- -
25 Building plans shall not contain red lines or tape-ons.
26 Nu rolled,reversed or mirrored 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 in blue or black ink.
Red ink is reserved for department use only. 410-4611(~'OM)
Electrical Permit Application
— PDatercceivcd: 4: Permit no.:
City of 'Tigard �` `'' Project/appl.no.: � Expire date:
Ciryn/Tigard Address: 13125 SW Nall Blvd,Tig d OR 97223 Date issued: By Receipt no.:
Phone: (503)639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
1
:New
2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant impro iernent
construction U Addi!ion/alteration/replacenu•nt U Other: -_ U Partial
[tic
Joh address: 11f(T2 Bldg.no.: Suite no.: Tax map/tax lot/account no.:
Subdivision:
Lot: Block:
Project tame: Description and location of woe•on premises:
Estimated date of com letion/inspection:
SCHEDULE
Fre• !1, I
Job no:
_ - lkuription (hV• (CIL) lirlal no.inp
x
Business name: — C New residenlhd-singleor multi-family per
Address: I t ) n V6 O WA C dwelling,un it.Includesattacim4lgarage.
City: y State: ZIP: _ Senim int h0ed:
1a11
Phone: ' Fax: - E-mail:
,l t less
Each adduwnal500sq.ft.orpart Ihererr
CCD no,: Elec.bus.lic.no: r Limited encrgy.residential -'
City/metro lic.no.: _ Li mited energy,non-residential _ 2
Each manufactured home or urodo:ar dwelling
"- Service and/m feeder 2
---
Signature of supS2±,Ing elecn an(nun.. - Date —
I.i(vmeno. Servlcesorfeedem-•installation,
Sup,elect game(print) alteration or relocation:
1 ibillm 200 amps or Icss 2
r 201 amps to 4W amps 2
Name(print): � _< E' 401 amps to 6W amps 2
Mailing Address: J c f l IS 601 amps to I(XX)amps 2
Z
City: rod c7 SlAte� ZIP: Overl(XX)um amps __ _ I
Phone: Fax: E-in.,i1: Reconnectonly
Owner installation:The installation is being made on property I own Temporary uervlcesorf^edea-
which isnot intended for sale,lease,rent,or exchange according to Installatlon,altemtlon,,,r relocation:200 amps or leas 2
0RS 447,455,479,00,701. 201 amps to 400 amps _ 2
Owner',.; signature: Date: 401 to 6011 ants 2
B•rnch circuits-new,alteration,
or extension per panel:
Name: L I" Lk L- i (n-4 ( Q A ire fur Manch circuits with purchase of
Address: 5 service or feeder fee,tach branch circuit - 2
City: o r- I ti n 1-:4 State:o-, 7,IP: < < 0/ B. Fee for branch circuits without purchase —
of service or feeder fee,first branch circuit: 2
Phone: i t I tx;,iG� rs7�,r 1i Haul: Each additional hranchcircuit
Me.(Service or feeder not Included):
Each unq,at irrigation circle 2
U Service over 225 amps-commercial U llculth cmclacduy 2
U Service over 320 amps-rating of 1&2 U Hazardouslocatinn hachsl norou0hrelighting
family dwellings U Building over 10,(X)0 square feet four or Signal circuli(s)or a limited energy panel,
U System over 6W volts nominal more iesidmtialunits ill one structure alteralian,(it extension•
U Building over three stones U Feeders,4(0 amps or more slkscn inion._
U Occupant load over 49 persons U Manufactured structures or RV park Eich additional Inspection over the allowable in any of the above:
U F.gress/hghtingplant U Other' -- Per Inspection
SubmA—,sets of plans wilh an}of the alcove. Investigation fee
The above arN not applicable to temporar;construction service. Other
_ _.___ ag iPerrt.rt fee.....................$� --
f Nnl all jmiedictinns accept coxhi cards,please cell junrr!icuon ,mnfnrtrullon Notice:This permit application plan review(at — .)
U visa U MasterCard expires if n permit is not obtained
credit card number. within 180 days alter it has been Slate surcharge(8%)....$
_ :xpl1er accepted as complete. TOTAI. . .....................
NUrte o'r c�inldet u siruwn nn c U crJ
Cardholder olpature -S Amount 4104615(6t00ICOM)
Electrical Permit Fees: Limited Energy Fees:
— TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee..........................
Number of inspections e2r permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Cheek Type of Work Involved.
Residential-per unit 4 Audio and Stereo Systems
1000 sq.It or less _ _ $145 15_
Fach additional 500 sq It or I O
portion thereof $3340 Burglar Alarm
49
Limited Energy — $75.00
Each Manufd Home or Modular $90 90 2 u „arage Door Opener'
Dwelling Service or Feeder —__..---
Heating,Ventilation and Air Conditioning Syste '
Services or Feeders m
Installation,alteration,or relocation $80 30 ��'(
2.00 amps or less — ---- 2 l J Vacuum Systems'
201 amps to 400 amps $106,85
401 amps to 600 amps $16060 _ 2 Other
601 amps to 1000 amps — $24060 2 -
Over 1000 amps or volts $454,65— �- 2
Reconnect only $66.85 2
- — - TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Se vices or Feeders
Fee for each system................................... ........... .... $75.00
Installation,alteration,or relocation $66 85 ? (SEE.OAR 918-260-260)
200 amps or less ___
201 amps to 400 amps _ _ $100.30 2 Check rype of Work Involved:
401 amps to 600 amps — $133 75 _ 2
Over 600 amps to 1000 volts, Audio and Stereo Systems
see"b"above.
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits Clock Systems
with purchase of service or
leader foe. 7
Each branch circuit —"-- $665 Data Telecommunication Installation
b)The fee for branch circuits rl
without purchase of service LJ Fire Alarm Installation
or feeder fee.
First branch circuit _ $4685 HVAC
Each additional branch circuit $665
Miscellaneous Instrumentation
'Service or'eoder not included)
Each pump or irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting — $5340
Signal circait(s)or a limited energy Landscape Irrigation Control'
panel,alteration or extension _ $75.00
Minor Labels(10) $12500 v -
Medical
Each additional Inspection over
the allowable In any of the above Nurse calls
Per inspection —^_—__ $6250
Per hour $6250 --_---- El
Outdoor Landscape Lighting'
In Plant -- $7375 _
Fees: F j Protective Signaling
Enter total of above fees $ _. _ Other--
8%
8%Stale Sur charge $ Number of Systems
254,b Plan Review Fee No licenses are required Licenses are required for all other installations
See"Plan Review"section on $ _ —
front of application - Fees:
Total Balance Due -__ _- --
Eater total o•'above fees =�---
Trust Account# J 8%State Surcharge S
-- Total Balance Due s----
i:tdtrtslrnrma\cic-rees,doc 10ro9a10
Plumbing Perinit Application
City of Tigard -,-I Date received: Gj 4j i Permit no.:
i3 Building: B
Sewer permit no. un
Address: 13125 SW Hall Blvd,Tigard,OR 9722:1 B Permit no.:
City ujl7gnrd Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued:
Byy Receipt no.:
Ladd use approval: —__ - Case file no.: Payment type:
Li I & 2 family dwelling or accessory ❑Commercial/industrial Ll Multi-family J (enure( iif]proventenl
j New construction U Addition/alteration/replacement ❑Food service J(Ithcr:
Job address: 177 t
c -2 I)escriplion _ Qtv. 1'ce(ca.) (Dial
Bldg.no.: Suite no.: - Neii I and 2-family dnellings only:---
Tax map/tax lot/account no.: (includes 100 ft.foreachutililyconneclion)
Lot: Block: Subdivision: SFR(1)bath
�� SFR(2)bath
Project name: _ _
SFR(3)bath
Cit —- -- --
y/county: _ ZIP Each additional bath/kilchcn -_-
Description and location of work on premises:_ Siteutilltles:
Cate asirt/area drain
A.date of completion/inspection: Dryv .1 •/leach line/trench drain
F<xriii train(no. lin. ft.) —
Business name: Manl_la%Aured home utilities
__
_Address: Manholes
T IBain drain connector -
City: c f �U P SIate:0�< ZIP: qr (o Sanitary sewer(no.lin.ft.) - --
Phone: Fax: E-mail: Storni sewer(no.lin. —
CCB no.: fJ Plumb.bus.reg,no: Wafer wrviceicc—(no. lin. ft.)- -
City/metro lie.no.: - _ Fixture or Item:
Contractor's representative signaturr: Absorption valve
t Back flow prevcnter—
DPrint name: Sr ,v(JcQ aBackwater valve
--+
— -- --
CONTAIL7 PERSON
Basins/luvatory
Name: , { c Clothes washer -
Addrrss: `l j`l S C o-
City: State: r - Dunking foum'ain(s) -- —
Phone: ZIP:.- O E'ectors/sump --
6' Fax: �Joe E-mail: .
Expansion tank
Fixture/sewer cap -
_Naunc(print): ? b LF. C b`k'pg- �` �. Floor drains/flcxir sinks/hub
Mlttling address: �- +� a Garbage disposal _
nose bibb
City: d�. eti Stale:OR ZIP: Ice maker --
Phone: 9 1 Fax 4,30 Da F-mail: - --- Int..^,-e tor/g re ctraap
—
Owner installation/residential maintenance onh: ]'he actual installation Primer(s)— - --
will be made by me or the rnaintenance and repair made by my regular Roof drain(commercial) —-
employee on the properly I own as per ORS Chapter 447. Sinks),hasin(s), lays(s) -
owner's signature: — _— Date: Sump
lotTuhs/showcr/sh.iwcr pan
Name: 0.4 f o LL Urinal -- —
Address: a - — Water closet
Cil Water heater
Y: o State:()k' ZIP: Other:
Ph22e:e7 -1 E-mail.— - Total
NM
all.111d dictlnna accept credit catch,please call jurisdiction rrw mrwe information. Minimum fee................$
❑visn ']MasterCard Notice:This permit applicotirn ---.
expires if a pennit is not obtained Plan review(at _ 4h) $ _
Credit cord number:_ _ (8�)to State surcharge ••••$ _
spires within IRO days alter it has been
Nine of carrarnlder as shown on credit card accepted as complete. TOTAL .......................$
Cardhol r dartature - Amt
110.1616((SMut kl i
PLUMBING PERMIT FEES:
--- P►ZICE TOTAL New 1-and 2-tami�y dwellings only:
FIXTURES individual — QTY eat__ AMOUNT (Includes all plumbing fixtures in *RETAL
- L_--� 16.60 the dwelling and the first106 ft. OUNT
Sink _ - for each utility connectioJ—
Lavatory — 16.60 One 1 bath —_
-- -- 16.60 Two 2 bath Tub or TublShower Comb S -----— Three 3)bathShower OnlyWaler Closet16.50 —-- SUBTOTAL
16 60 B%STATE SURCHARGE16 60 PLAN REVW25•i�OFDishwasher —_ — - TOTAL _ ___
Garbago Disposal — — 16.60 --- -- —f—
Laundry Tray 16.60 -
Washing Machine - 16.60 -
FloorDrainlFloorSink 2" - 16.60 PLEASE COMPLETE:
3 16.60
4 --- 16,60
r-- __ Ouantit b Work Performed
Water Heater O conversion O li!er kind 16,60 Fixture Type: Now Moved Replaced Removed/
Gas piping requires a separate mechanical _ Capped
porrnlL --- rF —"--
MFG Home Now Water Service Lavatory -
h FG tiome New SanlSlorm Sewer Tub or Tub/Shower
Hose Bibs — Combination
Roof Drains ShowerWater ClosetDrirkingFountain Urinal ---
Ulher Fixtures(Specify) _1C' Dishwasher _ — —
Garbs a Disposal
Laundry Room Tra —
_ - - Washin Machine _
Floor Drain/Sink: 2" — ----
Sower 1007—
w1" —
4 .40 — - —
Seer-each additional 100' — Water Heater -- —
Water Service-1st 100'-- 555.00 ---
Other Fixtures
Water Service-each additional 200' 46.40 (S -L
— -
Stom'T Rain Drain-1st 100 — 55.00 — -- -
Slorm 6 Rain Drain-each add0tonal 10046.40 -- ---
Commercial Back Flow Prevention Device 4640 — --- —
Residential Backflow Prevention Device' 27.55 _--- -�� —
Catch Basin 1660
inspection of Existing Plumbhg or Specially 7e�hOr COMMENTS REGARDING ABOVE:
Re uesled Inspections _ _ �--—
Ra' Drain,single family dwelling 6525 —
Gress:'raps 46 60 - --=— -- -
QU,ANTITY TOTAL `— — -- --
Isometric,or riser diagram Is required it --
Quantity Total Is >9 _ _ — ------ - ----
*SUBTOTAL —_ ----------_--- _
B%STATE SURCHARGE
------ —-
"PLAN REVIEW 25 6 OF SUBTOTAL
Required onlyIf f rixluru 94 Yc l'il is>g --- --
TOTAL —
*Minimum permit lee Is$72 50*8%state surcharge,except Residential Racknow
Prevention Device,which Is$36 25 4 a%slate surcharge
-All New Commerclel Buildings require plans with isometric or riser diagram and
plan review
l:\dsLq\fomes\pilTt-fees,doc 10/10100
Mechanical Permit Application
-- - -- Uatereceived: �''�5 Pcrnut nu.. 1'i,1`-
Cit of Tigard City Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phune: (503) 619-4171 Date issued: Ry: Receipt no.:
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Other:
JOWSITE INFORMATION
Job address: t r o�' P_ _ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/accould no,: profit.Value$
Lot: Zr BI(xk_ Subdivision: �. *See checklist for important application Information and
Project name: jurisdiction's fee schedule firr residential permit fee.
City/county: ZIP: IS- I & 2 FAMILY IFEES(WEDULE
Description and location of work on premises: t 1 1 1 t
F'(r(ea.) Tolal
Est,(late of completion/inspection: 1Dc.cription (1t Res.wily Res.only
Tenant improvement or change of use:
Is existing space heated or couditioned'1 U Yes U No Att handling unit CFM
Air con itioning(siteplanrequired)
Is existing space insulated?U Yes U No A teration of existing IIVAC system - --
ol er/compressors — -
Business name: 4 State boiler l,ermit no.:HP --Tons HTU/11
Address: � 11 rir ;mo a amper, uct smoke detectors
City: ( State: ZIP: r��j� < cntpu-Ff--m�(sitrplanregwrc )
Phone: c F E-maiLnsta-flTreplacc.urn:,, ure7 rner—
2 I
CCB no.: Including ductwork/vent liner U Yes U No
nsta I/rep ace/rc ocate eaters-suspen ed,
City/meta lic.no.: wall,or fluor mounted
Name(pleaseprint): Vent for appliance other than furnace
e gest on:
Absorption units BTU/H
Name: 11.,G( �(;: f. j(:W-(•�-' (" Chillers.- ..---— HP
Address: r i c r i c:, �°�, �c Genn ressurs--__ HP
Envh*oninenlall exhaust and veld at on:
City: OC)L-f la N Statex'• - T.IP: r 1 a r Appliance vent
Phone: („7 0 " Cc'CA I Fax:(."(i D,-)1 E-niail: Dryer cx gust - --
0o s, ypc /rrs, itc te- n/hazinat
hood fire suprression system
Name: 11('E' Ol�l( '- — Exhaust fan with single duct(bath funs)
Mailing address; FXhaust s ;-time a rom tTemin or AC` -
City: State: IP: •ue piping an st ut on(up to outlets)
Type: 1,Pt3 NC Oil
Phone: f rtx: f'. Haul: ucl ,i ting ru -.Uaitional over 4 outlets
rote;s piping(schematic required)
Name: •� , ,, Numhcntl outlet;
`J}— ter st app ance of equ m nt:
Address: 7 [ •� _ Ikcorativefireplace
_City: i6nlr, f ,tiI State:() ZIP:O r
ono stove/pc et stove
Phone: r c � Fax• 6 E- il;
Ot
Applicant's signatuf-:: cr:
�/ Date: -,�I
t er
Name (Print):%._._.,_•�, � c ;: - --- -
Nal all jurisdictions accelo credit card,.Plew call judadirllon for mai lnfamaalon Permit fee.....................$
Notice:This permit application --
U Vi;a U MasterCard Notice: fee......... ......
expires if a permit is not obtained
credit card Hombre --L /— Plan review(al 9h) $
F.xpirex within 180 days after it has been State surcharge(896)....$ _
Namr of cardholder ss shown on card s accepted as complete. TOTAL $
146J611(~OM)cardholder xl`nuure Amoral --
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
_TOTAL VALUATION: FEE: '�---- Description;
$1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Price Total
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and - 1) Furnace BT
to 100,000 FTU----
Cly (Ea) Amt
$1.52 for each additional$100.00 or Indudln duds&vents 14 00
fraction thereof,to and including 2) Fumace 100,000
$10,000.00. indudin ducts 8 vents 1740
$10,001 $25
.00 to ,000.00 $148.50 for the first-$10,000.00 and 3) Floor Furnace --
$1.54 for each additional$100.00 or Includin vent
fraction(hereof,to and including 4) Suspended heater,wall-heater -- _ 14 00
$0,000.00. or Floor molmted heater
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit 14 00
$1.45 for each additional$100.00 or
fraction thereof,to and Including 6) Repair units ---- 6.80
$50,000.00. --
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air 12 15
$1.20 for each additional$100.00 or For Items 7.11,sea or Pump Cond
fraction thereof. footnotes below.
Com ' ••
ASSUMED VALUATIONS PER APPLIANCE: 7)<3HP;abU unit to 100K BTU 14.00
Value Total 8)3-15 HP;absorb --
Descrl tion: CIv al Amount unit 100k to 500k BTU
Furnace to 100,000 BTU,Including 955 25.60
9)15-30 HP;absorb
ducts 8 vents _ unit.5-1 mil BTU
Furnace> 100,000 BTU Including 1,170 10)30-50 HP;absorb 35.00
ducts&vents unit 1-1.75 mil BTU
Floor furnace indudingvent 955 11)>50HP:absorb 52.20
Suspended heater, all heater or 955 unit>1.75 mil BTU
floor mounted healer 12)Air handling unit to 10,000 CFM - - 87.20
Vent not Included in applicants 445
_ermit_�- 13)Air handling unit 10,000 CFM+ 10.00
Repair units - --
<3 hp;absorb.unit, 805
17.20
to 100k BTIi 955 14)Non-porlalle evaporate cooler ---
3-15 hp;absorb.unit, 15)Vent,ran connected to a single duct 1000
101k to 500k BTU 1,700
15-30 hp;absorb.�nu it 501k to 16.80
mit.BTU 2.310 16)Ventilation system not included In '-
a liance permit
30-50 hp;absorb.unit, 17) 1000
1-1.75 mil,BTU 3,400 Hood served by mechanical exhaust
>50 hp;absorb.unit, --- 10.00
>1.75 mil.9TU 5,725 18)Domestic incinerators
Al r handllnQ unit t10 000 dm- 656 19)Commercial or industrial 17.40
Alr handlln unit>10,000 cfm 1,170 type Indnerator
Non- ortable eve orate cooler - 69.95
�--------�---- 858 2.0)Othar units,inch,,'mg wood stoves
Vent fan connected to a single duct -446 _
Vent system not indudod In - - 21)Gas piping one to four outlets 10.00
a liancP permlt 656 -
Hood sewed by mechanical exhaust 858 22)More than 4-per outlet(Path) 540
Domesf_c Indnerator 1 170 I
Commerdal or industrial Incinerator Minimum Permit Fee$72.50 1.00
Other unit,Including wood stoves, 4,590 - SUBTOTP.L $
Inserts,etc. 656
_Gas piping 1-4 outlets 380 8%State Surcllarge I $ "_--
tach addili- oval outlet _
63 25Ys Plan Review Fep(of ssubtotal) $ --
Required for At.l_commerddl permits only
TOTAL COMMERCIAL � -- _
VALUATION: _ $ TOTAL RESIDENTIAL PERMIT FEE: $
_OtIna c 1 ns nd Few:
1her Inspections outside of normal business hours(minimum charge-two hours)
$72 50 per hour
2 Inspec'lons for which no fee is specifically Indicated (minimum charge-half hour)
S 12 50 per hour
3 Additional plan review required by changes,additions or revisions to plane(minimum
charge-one half hour)$72'10 pnr hour
State Contractor Boller Cerrincatlon required for units>200k BTU.
*Residential A/C requires site plan showing placement of unit.
I:kfstsl/orrnsvnech-fees.doc 10/+1/00
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:98
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INVERT
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"l" 6.581 50 fT
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT" PERMIT NOTICE
PREFERRED PLUMBING
3254 SW BARNET ST
FOREST GROVE, OR 97116-8651
Plumbing Signature Form
Permit #: MST2001-00388
Dal.: Issued: 8/13/01
Parcel: 25109AB-10200
Site Address: 14197 SW 132ND TERR
Subdivision: RAVEN RIDGE
Block: Lot: 031
Jurisdiction: TIG
Zoning: R-7
Remarks: New construction SF detached. .path 1 MILIst install fire sprinkler asp er code
Your company has been indicated as the plumbing contra-,tor for the permit indicated above. In order for the
Plumbing permit to be valid, please have the appropriate individual from your company sign below
this Plumbing Signature Form prior to the start of the work to the address above, ATTW Buildingand return
Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER:
PALACE HOMES PLUMBING CONTRACTOR:
27973 S COX RD. PREFERRED PLUMBING
COLTON, OR 97017 3254 SW BARNET ST
Phone 5(13-630-1099
FOREST GROVE, OR 97116-6651
#:
Phone #: 503-359-0560
Rey #: i :r 132604
PI M 34-340PE
AN INK SIGNATURE IS REQUIRED ON THIS FORM
i
91 nature
9 uthorized plumber
If you have any questions, please call (5113) 639 4171, ext. # 310
i
CITY OF 'rIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
W AR ELEC R41k ,7 1C
4524 S� RDONNY AVE
l�D, OR 97124 cA71
Electrical Signature Form
Permit #: MST2001-00388
Date issued: 8/13/01
arcel: 2S109AB-10200
Site Address: 14197 SW 132ND TERR
Sumdivision: RAVEN RIDGE
Bloc,,,: Lot. 031
Jurisdiction: TIG
Zoning- R-7
Remarks: New construction SF detached. .path 1 Must install fire sprinkler as per code
Your company has been indicated as the electrical contractor for the permit indicated above In oder for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN Building Dent.
No electrical inspections will be authorized unti; this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
PALACE HOMES WIRER ELECTRIC, INC
27975 S COX RD. 4524 SW CHARDONNY AVE
COLTON, OR 97017 TIGARD. OR 97224 \
Phone #: 503-630-2099 Phone #-
Reg #: ELE 34-442C
LIC 44087
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of §upervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310