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16205 SW PALERMO LANE am 0 .113 3 0 r 0 c� 5 E i ` `k i t 4 f f f 16150 SW Palermo Lane e- COTY OF T.C,a< RD 24-Hour BUILD'Nr Inspectio,i line: 639-4175 MST INSPECTION DIVISION Business Line- ()639-1171 - [� BUP _ Receiver) �__- _ Date R uest d I AM 1 - - _ PM -__ _ Bt1P � ----------------- Location _ _Suite __. ME^ Contact Person ——-- — Ph PLM - --- ---- - Contractor ---- - ( ) - - - - - - ---- -- ------ - ------- h SIKH BUILDING_ _ Tenant/Owner -- -- - ----- - - - — ------ ELC - - -- Footing — - ELC Foundation Access: — Ftg Drain ELF! _ Crawl Drain _ Slab Inspection Noes: —� M - + SIT Post&Beam - - - - - - Shear Anchors — -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation _ Drywall Nailing — p �"`-`� --- Firewall �S'1/�-�-��l.t-,n �.,p�---�' � ,�C..,pr._�C- 1.�.►., — I �Cg) Fire Sprinklfa- - ---- Fire Alarm Susp'd Ceiiiny Roof Otha>j ---- - — — S PART FAIL — MBIN_G — - -.--- Post& Beam Under 51ab Rough-In 7 Water Service -- - ---- - - —-- --- `- Sanitary Sewer Rain Drains C — Catch Basin/Manhole Storm Drain - — - +11111f----------- Shower Pan �< Other - -- -_ Final PASSPART _FAIL MECHANICAL ___ Post&Beam Rough-In -_- -_ Gas c,..e STQk,e Dampers - - - - RT_RPART FAIL 64L Service - -- Rough In UG/Slab - - -- - -_—. - Low Voltage —__--__- Fire Alarm -- -- Final Reinspectioo fee of s _.required before next Inspection. Pay at City Hall, 13125 SW Hall BI. 1 PASS PART FAIL —---_FAIL .. SITE Please call for reinspection RE:__ __.. _-_ �� Unable to irzpect-no access Fire Supply Line ADA Approach/Sidewalk Date_ Inspector �� Other: ----- \ Final DO NOY REMOVE this Inspection record from the job slte. PASS PART FAIt- �� r AAAAA AAAAAA/ ' sAAAAAAA ►AAAAAA tAAAAAAAAAAAAA � p � p A ► i p vi � � o ® u E Nn o ► pop7 4.1 44 U v � \ ► ® O O 4., �► �- i N O ► �S -b i O `� tiA N .� ► 4.4 o °' O 01. 44 WQ 44 u c a . u 71 P4 -1� `r 'd ' � i O A Q � � ► J i V) 0. � � ,1 W b ► i C 44 ► 44 i44 ► -4 Full, � . Q W ► r O ti ti � G r+ o G C 7 � � f7 O W ry con r !'1 � �a y CPO N rT r' A f � y t J 0 IxU � I I CITY �� _ MASTER PERMIT (✓' PERMIT#: MST2003-00144 DEVELOPMENT SERVICES DATE ISSUED: 5/9/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 15250 SW PALERMO LN PARCEL: 2S105CC-T0021 SUBDIVISION: TUSCAN( ZONING: R-7 BLOCK: LOT: 021 JURISDICTION: URB REMARKS: New SF detached, Path 1. BUILDING REISSUE 1-ri,H11T STORIES: FLOOR AREAS REQUIRED SETBACKS REOUIRED CLASS OF WORK: NEW HEIGHT FIRST. I Z,, Sf BASEMENT: of LEFT: .t SMOKE DETECTORS: r' TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1 1,1' Sf GARAGE: 440 of FRONT: 15 PARKING SPACES TYPE.OF CONST: SN DWELLING UNITS: I TAM Sf RIGHT. I VALUE: 271,709 60 OCCUPANCY GRP: R3 SDRM: 5 BATH: 3 TOTAL: 2,811 of REAR. 15 _ PLUMBING _ SINKS: I WATER CLOSETS: 3 WASHPIG MACH: I LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS. 7 GARBAGE DISP: 1 WATER HEATERS. 1 WATER LINES: 100 BCKF!:M PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FURN<10011: BOILICMP<3HP: VENT FANS: ., CLOTHES DRYER: 1 ,n FURN>•100K: 1 UNIT HEATERS: HOODS: OTHER UNIT'S: I MAX INP btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RFSIDENTIAL UNIT _SERVICE FEEDER _TEMP SRVCIFEEDEP,S BRANCH CIRCUITS MISCELLAI` :OUS ADL'L INSPECTIONS 1000 SF OR LESS: 1 0 200 Amp: 0 200 arty. WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION: EA ADO'l.500SF: 5 201 - 400 Amp: 201 - 400 amp: lot WIO SVCIFOR. SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 600 Frnp: EAADDL OR CIW SirNALlPANEL: IN PLANT: MANU HMISVCIFDW 601 1000 amp: 601+ampo•t000w MINOR LABEL: 1000'•amplvolt PLAN REVIEW 9[CTK1N Reconnect only: >e4 I:E9 UNITS- 9VCIFOR>=225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RES;DENTIAL _ _ B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM` AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LM"—;!.T: BURGLAR ALARh. OTH BOILER: HVAC: LANDSCAPEIIRRIO: PROTECTIVE al4NL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: T OTAL FEES: $ 5,784.36 CENTEX HOMES CENTEX HOMES This perinll is subject to the regulations contained in the 16520 SW UPPER BOONES FERRY RD 16520 SW UPPER BOONES FERRY all other Municipal Code,State o OR. Specialty Codes and PORTLAND,OR 97224 #200 all G leer ce with ble laws. All work will be done it PORTLANb.OR 97224 accordance with approved plans- This permit will expire ff 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 follow rules adopted by the Phone: 503-608-3060 Phone' 503-608-3060 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0080. You Re0" LIC 12x490 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Bearn Mechanica Plumb Top Out Exterior Sheathing Insl Rain drain Insp Electrical Final Sewer Inspec'ion Underfloor Insulation Electrical Service Low Voltage Roof Nailing Mechanical Final Footing Insp Crawl Drain/Backvlater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Be trvetural Mechanical'nsp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp \,r (SSII d B t 11t ) C1Uli 2 Permittee Signature Y — Call (503j 39--4175 by 7:00 p.m. for an inspection needed the next Il'usiness day SANITARY,* Q o ( 1canWiter Services 0r.,97124 SURFACE WAI ER J 1 C,0NNE:CT.ION PERMIT ISSUE DATE 050903 EXPIRATION DATE: .110503 EC EXP DATE 050805 PERMIT 124061 STRUCTURE ADDRESS 16250 PROJECT 8610 ;TRUCTf1RE; STREET SW PALERMO LANE LOT 21 BLOCK YPE CONNECTION— NEW OF TUSCANY SUBDIVISION I'YPE INSTALLATION- f 191 BLD SWF./ER0 CON/sUC 'YPE.. O^CUPANCY- ( 1 ) SINGLE FAMILY PARCEL 251 5CC 11700 QTR SEC 4413 MH 2 4 W ')WNER CENTEX HOMES ADDRESS 1.65241 SW UPPER BOONES F—ER 'TREATMENT PLANT DURHAM PORTLAND OR 97224 RHONE 503-:.308- 1060 WATER DISTRICT TIGARD IXTURE- W--�- EQUIVALENT- -- DWELLING RESIDENTIAL, ►NIT'S SERVICE UNITS 0 .0 UNITS 1 SERVICE UNITS I CONNECTION FEE:3 SURFACE WATER DEVE;LOPME14T FEES SEWER CONNECTION 2300 . 00 WATER QUALITY 17.5 . 0111 LF.;SS CREDIT < 225 .00r 'nATER QUANTITY 275 . 00 LESS C:RFDI'T' <' 0 . 00> EROSION (,ONTROL INSPECTION F4 .00 PLAN CHECK 41 . 60 SUBTOTAL, 2300 . 00 SUSTOTA!, 580 . 60 TOTAL, 2680 . 60 APPL NAAE: MIKE PHONE lF'FILLIATION REP +7MARKS LOT 21 , TUSCANY , #8610 " Nunth� t 1 :I t` •cox INSPECTION-846-8444 . • , • , iC;NATURE _ ,.�L_...C. - 1L1_----...___._..__....._.. ISSUED BY WILSONM t Permit Conditions: The applicant a,arees to comply with all rules and rNtilations of the Unified Sewerage Agency. When calling lot an inspection, Please refer to the Permit Number The Pornit expires one hundred eighty (IBil) days from the date of issuance. The Agency does not guarantee the accuracy M the locate,n of side sewer laterals. M3 WHITE — USA, t.LUE Accounting, GPEEN —inspection, YELLOW — Customer o r))7- 5-S_ 7,03 Building Permit Application " City of Tigard Date received: Permit no.:W -,z,1414 city of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Tie_lt/appl.no,: xp1 49,te; Phone: (503) 6394171 `, Date issued: B • Receipt no.: t Fax: (503) 598-1960 Case file no.: Payment type: J Land use approval: 1W,family:Simple komplex: O I &2 family dwelling or accessory O Commerclal/industrial O Multi-family )(New construction O Demolition ❑Addition/alteration/replacement ❑Tenant improvement U Fire sprinkler/alarm O Other: — JO B SUE ' Job address: � Z�v p t_�°k AJC __ Bldg, no.. Suite no.. 'Z. Lot; Block: Subdivision: 'Tate AI4 Tax map/tax lot/arcou t no.: Project name: 'T0SCIrs1%4. Description and location of work on premises/special conditions:--_- Name: 'ENTE,/C Mailing address: 0 5 1 &2 family dwelling: City: F0KTWV1D . State: ZIP; `J Valuation of work ... $ Z-7e)j yZB.yO w Phone: -30(v C) 1 Fax:(p $- E-mail: No.of bedrooms/baths S 2 G Owner's representative: MJ E_ _(V I Total number of floors ................................. Phone -�'- I ax TI- mail New dwelling area(sq. ft.)............................ _ Olt Garage/carport area(sq,ft.) 1 YQ__ I Name: —CL E Covered porch area(sq. ft.) .......................... Mailing address: Deck area(sq.fl.) .......................................... City. State: Z1P: Other structure area(sq.ft. . j � - Commercial/industriallmulti-family: Phone — t, r __FEmail: y: Valuation of work ......................................... S Business name: . Existing bldg.area(sq. fl.)........................ Address: -- New bldg.area(sq. fl.) .................................. �. City: -- State: ZIPNumber of stories.......................................... — : Type of construction Phone; Fax: E-mail: ..................................... -- CCB no.: �, ---- Occupancy group(s): Existing: City/metro tic,no - —'— New; ARCHrrECF1Notice:All contractors and subcontractors are required to be t ' licensed with the Oregon Construction Contractors Board under Name: _-_ �� provisiot)s of ORS 701 and may be required to be licensed in the .Address: jurisdiction where work is being performed,if the applicant is City: — State: ZIP: exempt from licensing,the following reason applies: Contact person: _ _ Plan no.: -- -- Phone: Fax: F-mail: I — - Name: �PN14 �LfTA/ IContactperson: Fees due upon application.............................S _ Address: _ Date received: City. State: ZIP: Amount received........................................ .S 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 cords,pleuse cult Jurisdiction for more inronnution. attached checklist. All provisions of laws and ordinances governing this U visa w Maetertrard work will be complied with.whetherAne irdhetemornntf Credit card number:. _ N e7 03 _— --�ir Authorized stamaGr. t! Date: Meme blr ea uo der a shown on credit card Print name: S Car o er silneture Amount Notice:This permit application extnres if a permit is not obtained within 180 days after it has been accepted as complete. 440.4613(6/00/COM) Electrical Permit Application ' Date received: q//4/ Permit no.: 7 ' - , City of Tigard Proiectlappl. no.: �Expire date: Cloy of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) $98-1960 Case file no.: Payment type: Land use approval:_ _ OF IaElltm�'r 7: 1 &2 family dwelling or accessory 0Comm ere'alhridustrial U Multi-family U Tenant improvement New construction O Addition/alt;:ration/replacement U Other: _❑Pattial JOB SITE INFORMATION Job address; 7'5L LASI Bldg. nn_ I suite no.:A Tax map/tax lot account no: Lot: 2 Block: Subdivisio— 11 Project name: J- Description and location of work on premises:NENV tA N 41 L E::Tl I D N_IAL. Estimated date of compiction/incp,ciion 1 a 1 l Job no: � Fre M Jss Description Qty. (ea.) Total no.lns Businessnamel_ -- New residential-single or multi-ism!lyper A ddress: dwellingunit.lnclude s attached garage. City: State: 71P:97M, 5 Serviceincluded: 1000 eq.A.or less 4 Phone: 9�- Fax: $ E-mail: Each additional 300 sq.ft.o-portion thereof CCB err_: Flec.bus.Iic.nu: -(- y 5 �j (, 2 i{ Lir,itcd energy, residential City/metro lie.no.: Limited energy, non-residential 2 Each manufactured home or modalar dwelling Sigrsturc of supervising electrician (required) Dale Service and/or fcedcr _ _ 1.iccnse no: S Services or feeders—installation, Sup.elect,name(print): �( 1. �'�1�„” yb atter.tion orrelocation: PROPEKUY OWNEIR 200 amps or less _ 2 Name(print): 201 amps to 400 amps 2 iJ 401 psi 600 amps — — 2 Mailingaddress: � 601 amps to 11100 amps 2 City: State: ZIP: over IBG3 amps ur volts 2 Phone: Fax: (P E-mail: Reconnect only 1 Owner installation: The installation is being made on property 1 own Temporary services or feeders- Installation,■llerativn,or relocation: which is not intended for sale,lease,rent,or exchange according to 200 amps or less 2 ORS 447,455,479,6 701. +-- - _� � 201 amps to 400 2 Owner's sigstJire '� llate: O-1 401 to 600 amps 2 s [french circuits-new,alteration, or extension per panel: Name: _ A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit City: State: ZIP: _ B. Fee for branch circuits w!thoul purchase of service or feeder fee,Ent branch circuit 2 Phnne: Fax.— E-mail: Each additional branch circuit: PLAN REVIEW(Please check all 11113111 aPply) Misc.(Service or feeder not included): ❑Health-care facility ur Each pm oirrigation chcle LI Service over us ampstarturtereial -�–.--- — --2 U Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting hrtdly dwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel' U System over 600 volts nominal more residential units in one structure alteration,or extension* _ �_1__=_— U Building over thrre stories U Feeders,40P amps or more •Descriptio — O Occupant load over 99 persmn U Manufactured structures or RV park Each additional Inspection over tbe.11.w.b,,In any —o7fftthe —above: U ligres✓Iighting plan U Other ____ per inspection Submit v sets of plana with any of the above. Investigation fee _ 'f'he above are not applicable to temporary construction nerv)ce. Other _. Pctmitfre ......................5 Not d'jurisdictions accept credit car J1,please call hdsdictint for more information Notice: This permit application plan it frErevie . (at_ %) S Not all U MasterCard cxpites if a pei.nit is not obtained Credit card number. _ _��L-- within 180 days after it has been State surcharge(18%).....S "--- i Expres _ accepted as complete. TOTAL......................... Name of cardholdef as shnw�on chit card Card holder signsturc S Amount— 1404615(6/001com) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: — — —.... $ --- F.estricted Energy Fee............. ....................................... $75.UD Number of Inspections per pormit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-par unit 1000 sq.ft.or loss $145.15 4 ❑ Audio and Stereo Systema' Each additional 500 bc.fl.or portion thereof $33.40 1 Limited Energy $75.00 ❑ Burglar Alarm F.;,h Manufd Hume or Modular I)Nelling Sorvl m or Feeder $90.90 2 ❑ Garage Door Opener' Sorvlcas or Feedors ❑ Heating,Ventilation and Air Conditioning System' 'nstallation,alterallon,or relocation 200 amps or less $80.30 7 201 amps to 400 amps _ $106.65 ❑ Vacuum systems' 401 amps to 600 snips $160.60 v 2 601 amps to 1000 hnips —_� $240.60 — 7 ❑ Other Over 1000 amps or volts _ $45•1.65 _ 2 Reconnect only _ $66,85 2 Temporary Services,or Feeders TYPE OF WORK INVOLVED-COMMERCIAL ONLY Installation,alteration,or ruim.alior. Fee for each syatern........................................................., $75.00 200 amps or less —�— $66.85 _ 2 (SEE CZAR 918.260.260) 2C1 amps to 400 amps $100.30 _ 2 401 amps to 600 amps _ $133.75 i❑ 2 Check Typ.f of Work Involved: Over 600 amps to 1000 volts, see"b"above. ❑ Audio and Stereo Systems Branch Circuits New.alteration or extension per panel ❑ Boller Controls a)The fee for branch cirrults _ with purchaso nfservlce or LJ Clock Systems feeder fse. Each branch cirrult $665 — 2 ❑ [l bl The fee for branch circuits ata Telecommunication Installation without purchise of service ❑ or feeder fee. Fire Alarm Installnlion i irst wrench circuli _ 146 05 _ Each additional branch circuli $6.65 __ ❑ HVAC Miscellaneous ❑ (Service or feeder not Includeo) Instrumentation Each pump or Irdgellon drele _ $5.140 _ Each sign or outline lighting _ _ $53.40 J— ❑ Ineercom and Paying Systems Signal circuil(s)or a limited energy panel,alteration or extension $75.00 — El Landscape Irrigation Control' Minor Labels(10) $125.00 Each additional Inspection over ❑j Medical the allowable in any of the above Per Inspection — _ $62.50 — ❑ Nurse Calls Por hour _ $62.50 _ In Plant _ $73.75 — ❑ Outdoor Landscape Lighllr g' Fees: ❑ Prolortive Signaling Enter total of above fees $ ❑ Other 8%State Surcharge $ of Systema _ Pled Review Fee Soe'Plan Revlew'eaction on $ No licenses ere required. Licenses are required for all other Installations tronl of application. -_Fees: Total Balance Due $ —� Enter total of above fees ❑ Trust Accourrt# 8%State Sr,rrchsrge S All New Commercial Buildings require 2 sats of plans. Total Balance Dura — iAdsts\forms\etc-feea.doc 02/05/02 Plumbing Permit Appliatian 7Dateissued: ed; /� 03 Permit no.: �j p9.�• / Cit of Tigard Y g Sewerit no.: � Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- --- CttyofT'S ord phone: (503) 639-4171 l.no.: 7xpire date: Fax: (503) 598-1960 By Receipt no.: Land use approval: _—i Case file no.: Payment type: • 1 &2 family dwelling or accessory n Commercial/industrial Cl Mul-i-farnily U Tenant improvement U New construction O Addition/alteration/replacemeuL O Fond service 0 Omer. s : s i t Joh address: b ��eg NAV (,�rJJ� Description Qty. Fee(ea.) "Coral New Bldg. no.: -'TI Suite no.; 1-and 2-family dwellings only: (Includes 100 k.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: _ SFR�3)bath City/coun : ZiP: Each additional bath/kitchen Descriptioi and location of work on premises: _` Site utilities: _ Catch basin/area drain Est,date of completion/inspection: Drywells.'.ach line/trench drain PLUIVIONG s s Footing drain(no. lin.ft.) Manufactured home utilities _ Business namecp g { �st Manholes _ Address: OD SW � _ Rain drain connector _ City: TI C-7 State: ZIP: Z� Sanitary sewer(no.lin,ft.) _ Phone:C; Ig-L Fax:b ALA E-mail: Storm sewer(no.lin.ft.) _CCB no.: (5 3 Plumb. s.reg. no:3c}-3S 6'P8 Water service no.lin.ft.) City/metrolic.no.: (.OFixture or Item: Contractor's representative signature: --- Abso tion valve Back flow preventer Print rtamc: UL- STDQ Date: I 1 10, Backwater valve CONTACU PERSON 13asins/lavatory — `- Clothes washer Name: A Y } A`(�G� e.n Dishwasher Address: t 13170 S 2 Drinking fountain(s) City: -T-; mnkfa State: Ejectors/sump _ ^none: HJJW Fax:So3-1o39a4 -mail: Expansion tank s Fixture/sewer cap Name(print): MTEX HOMES Floor drains/floor sinks/hi-,b Mailing address: Garbage disposal Hoae bib City: State ZIP:"-V7 Ice maker Phone10(d) 1Fax: - Email Interceptor/grease tragi Owner install ation/residential maintenance only: The actual installation primer(s) _ will be made by me or the maintenance and repair made by my regular Roof draincomtnerc ial employee on the property f own as per ORS Chapter 447. Sink(s),basin(s),lav (s) Owner's a gnature: _ _ _ Dnte: _ __ Sump Tubs/shower/shower pan V _ Urinal r_ Name: Water closet Address; _ Water heater City: State: ZiP: Other: Phone: Faxes__ E-mail: �i Total N.a all Judi divions accept credit cards,please call Jurisdiction rvr.vera informrtionNotice: This permit application Minimum fee................ S sib) S 0 Vicat 0 MasterCard expire! if a permit is not obtained plan review(at— Credit card nttmbec _ Fa ire — within 18U dastate surcharge(11%).... S days nfler it has been - p TOTAL........................$ Name of cardholder u shown or credit card accepted ea complete. Cardholder signature { Amount 140-4616(&nNCO"ii PLUMBING PERMIT Z=EES: PRICE TOTAL New 1 and 2damlly dwellings only: FIXTURES Inrllviduai Q'Y ea Ah'OUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwblling and the first100 N_ QTY .ea) AN,JUNT Lava:ory 16.60 for each utilityconnection _ One 1 bath _ _ $249.20 Tub or Tub/Showgr Comb. 16.60 `- ---`-`� Two 2 bath _- $350.00 Shower Only 16.60 Three!3 bath 5399.00 Water Closet 16.60 - __ SUBTOTAL _ Urinel 1660 8%STATE SURCHARGE pishwasher _ - 16.60 PLAN REVIEW_25%OF SUBTOTAL _ Garbage Disposal 16.60 - _ TOTAL _ - Laundry Tray 16.60 _ 'hashing Machine 16.60 Floor Drain/Floor Sink 2 16.60 3' - 16.60 PLEASE COMPLETE: E: 4'� 16.60 Water Healer O conversion O like k nd 16.60 _ Quante b f Work Performed Gas piping rayuires a soparale mechanical Fixture Tyne: New Moved Replaced Removed/ armit. F_ Ca wed_ MFG Home Now Water Service 46.40 Sink MFG Horne New San/Storm Sower 46,40 Lavalo - _ Tub or Iuh/Shower Hose Bibs 16.60_ Comblcatlon Showrr Orly -- _- Drinking Fountain `- 16.60 Water Closet - Olhar Fixtures(Specify) 16.60 -' Urinal Dishwasher _Garbago Disposal - I aundrRo�m Tra - - Washing Machine Floor Drain/Sink: 2' Sewerlst 100' 55.00 3' Sewer-each additional 100' 46.40 4' Water Service-13t 100' 55.00 - - Water Heater _ Wrtor Service-each additional 200'` 46.40 Other Fixtures - (Specify) Storm&Rain Drain-1st 100' 55 00 _ S arm 8 Rain Drain-each additional 100' 46.40 -- Ccmmerclal Bick Flow Prevention Device 46.40 - - Residential Backflow Prevention Device' 27.55 - - - Catch Basin - - 16.60 Inspection of[xisting Plumbing or Specially 62.50 Requested Inspections or/hr _- COMMENTS REGARDING A90VE: Rain Drain,single family dwelling 65.25 - Grease Traps 16.60 ---- QUANTITY TOTAL: ---T --� -� Isomelrlc or riser dlegram is required If '�-� ----------` QuantittTclel Is >9 _ ------ --� +--- 'SUBTOTAL: -- -- 8'/a:,TAT[SURCHARGE: - - - -- "PLAN REVIEW 25%OF - -- SUBTOTAL, Required onl If Axhrra qN total is, --_ TOTAL PERMIT FEE: 'Minimum psrmil fee is$72.50•3%state surcharge,except Residential eacxAow Prav&,ilcn P.evlce,which la S.18 25+8%state surcharge. -All Now Commercial Buildings require 2 seta of plans with Inomelrle or clear diagram for plan ravlow. I:\dsta\formslpirt-fens.dcc 02./05/02 Mechanical Permit Application Oki NK2m - - Date received: w 0 j Permit no.: City of Tigard Project/appl,no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval:— - _ Building permit no.: I &2 family dwelling or accessory ❑Commercial/industrial ❑Multi-family Li Tenant improvement >13(New construction ❑Addition/alteration/replacement 0 Other: -- 1 : 1 1 ! 1 ULE Job address: h j�:� A��12Mc) L.AI,1F. Indicate equipment quantities in boxes below.indicate the dollar —L �- - value of all mechanical materials,equipment,labor,nverhead, Bldg.no.: Suite no.: Tax map/tax lot/account no.: _ profit.Value S Lot: Z 1 JBIock: Subdivision: "See checklist for important application information and Project name: u T__ jurisdiction's fee schedule for residential permit fee. City/county: ZIP_ � .131 Description and location of work on premises: - _ Estdate of completion/inspection: -_..- Description - illy. Res.onl Res.oni Tenant improvement or change of use: �— Air handling unit_. CFM Is existing space heated or conditioned?0 Yes LI No Air conditioning(site plan required) is existing space insulated?0 Yes O No Alteration o existing system ° of er/compressors 111111117 101411 KIM State boiler permit no.: _Business name: ENS �j HP Tons---B7'UnI _ Address: it smo a damper uct smoke detectors City: �j)!'jj�pj(,1 State: ZlI�70-� sotpump site p an regwre _ I Phone: Fax: E-marl: Install/replace Furnace tuner --BTU/T aa_ a8 _ - _ -.-. - _---- -- Including ductwork/vent liner O Yes 0 No _ CCB ..�.: _ assts repace re- u�aRrs-suspenn eF,- Citymetro lic.no.: _ wall,or floor mounted Name(please print): - Vent fora fiance other than furnace - e r gest on: ' � ! Absorption unite_ -.___._ BTU/H _ Name: Chillers — }IP - --- Compressors F:P AddrAss: nv ronmenta exhaust an rent at on. Uty: - -- State ZIP:-- - Appliance vent Phone: Fax: E-mail:Am I D er exhaust - Ho s,Tyle(/II/res.kttchen/harmat hood fire suppression system — - Name:� � �a5 Exhaust fan with sine duct(bath fans _ Mailing address. L.' Exhausts stem apart from lieetin or AC _ State: ZIP. Fuel piping an Ntr ut on(up to outlets) City: �� - �� Type: LPO_ NO Oil - Phone. .(� p Fax; E-mail: Fuel i m sac n loons over out els Not 2111711"11 rocea piping Ise erratic require ) Number of outlets Name:, appliance or equipment:-- Address: _ jti rative fireplace - Ci Zip: -type ty' ist`oveTpe at stove - Phone: Fax: Email. Other: Applicant's signature.-_ Date: J _ - ter: Flame(print): ` dlotions accept vedit cards,please rail jurisdiction for mom int�rrns6on. Permit fee ...............S Not all jurisa O MutetCard Notice: This permit application Minimum feeee................S O Vi .xpires if a permit is not obtained Plan review(at_- %) S _ Credit aro number: - / / - within 180 days after it has been e _ Expires Y State surcharge(8/o)....S -- - accepted as None or—cord folder a shnwr an credit card I complete. TOTAL........................S ----- C of er slansture Amount 440-4617(6100/COM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: - Description: $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code $5,001.00 to$10,000.00 $72.50 for the first S5,Of10.00 and 1) Furnace to 100,000 BTU $1.52 for each additlondl$100.00 or Including ducts&vants _ 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 5148.50 for the first$10,000.00 and 3) Floor Furnace 51.54 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 addlflonal$100.00 or --� 6_80 fraction thereof,to and including 6) Repair units $50,000.00. 12.15 $50,001,00 and up $742.00 for the first$50,000.00 end Check all that apply: Boilor Heal Air $1.20 for each additional$100,00 or For Items 7.11,se,it or Pump Cond fraction therdof. footnotes below. Comp •• Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit to t00K BTU _ 14.00 8%Sims Surcharge $ 8)3-15 HP;absorb unit 100k to 500k BTU _ 25.80 --- - 9)15-30 HP;absorb 257E Plan Review Fee(of subtotal) $ unit.5.1 frill BTU 35.00 Required for_4LL commercial permits only -- - TOTAL,COMMERCIAL PERMIT FEE: $ 10)30-50HP;absorb unit 1.11.7.75 mil BTU 52.20 _ _�,--- -- -- 11)>50HP;absorb -- - unit>1.75 mil BTU 87.20 _ ASSUMED VALUATIONS PER APPLIANCE: 12)Alr handling unit to 10,000 CFM 10.00 Value Total Description: Ot Ea Amount 13)Air handling unit 10,000 CFM+ 17.20 Furnace to 100,000 BTU,Including 955 ducts!i vents 14}Non portable evaporate cooler 10.00 _ Furne:e o 100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts 6 vents 6.80 Floor furnace Includingvent - 955 16)Ventilation system not Included in Suspended heater,wall heater or 955 appliance *,mit 10.00 floor mounted heater 17)Hood served by mechanical exhaust Vent not Included in applicance d45 10.00 permit Repair units- 805 -- 18)Domestic Incinelawrs 17.40 <3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator to 100k BTU 69.95 3-15 hp;absorb.unit, 1,700 - !01k to 500k BTU 20)Other units,including wood stoves 1000 15-30 hc;bscirb.unit, Willits to 1 2,310 _ mil.BTU 21)Oas piping one to four 5.40 30-50 hp;absorb.unit, 3,400 -- 1.1.75 mil.BTU 22)More than 4-par outlet(each) 1.00 >50 hp;absorb.unit, 5,725 +1.75 mil.RTUMinimum Permit Fes$72.50 SUBTOTAL: $ _ Air handlin 1 unit to 10,000 cfm _ 658 Air handlin] unit>10 000 cfm 1,170 8/o State Surcharge $ Non-portable evaporate cooler 658 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 448 Vent system not Included In 656 applIanctpermit Hood served by mechaneel exhaust _ 858 Stihl!nn pection o and Fees: Domestic Incinerator 1 170 1. Inspections outside of normal buelrase hours(minimum charge-two hours) $62.50 per hour. Commercfill or Industrial Incinerator 4,590 2 Inepedlone for which no fes Is specifically Indicatod (minimum charge-half hour) Other unit,Includirib wood stoves, 656 $62.50 per hour Inserts,etc. 1 Additional plan review required by changes,additions or revisions to plana(minimum Gas pipin 1-4 outlets _ 360 charge-one-half hour)$62.50 per hour Each additional outlet - 83 - - 'State Contractor Bolls►Certification required for units>260k BTU. TOTAL COMMERCIAL $ "Residential AJC requirer aIle plan showing placement of unit. VALUATION: _ 1 All Now Commercial Buildings require 2 sets of plans. I:IdstsVorrns\meci-fees.doc 02/05/02 CEIvED -- - --- --__ __- - --- PR 1 SCALE OF NG C- "CAMERON r,OURT"I "THE WOODS" PUBLIC ITORM STM LAT- DRAINAGE I C=8.0' \\ EASEMENT 50.00' -v--- 361.18 -----15,- — ---- --- 363.12 --- --- --- /� 383 WOOD N[r CE LOT 21 5,7?.85F d \ 1 \ I \ I I BUILDING- SETBACKS - n-- - -- 5' I i "HEI6HTY Ii M 5,25'_._A_ 39.50' 'S.a6' o (._O T 22 r= .._ I I I I ` I I \ I I � I I I I 1 I WA TER METER UTILITY RISER5-LOT 21 I I I I 362.2? EL-CTRICALPFDE5TAL N L 1 Zrn — UNDER6ROUND N N I �- UTILITY VAULT L - # ^' - 362.68 " TC=..36.5.17 -__-- PROP05ED - - LANDSCAPING TC=.362.53 5.W PALERMO r, DRIVE S TREE(TVP.) CENTEh DOMES �� Tv5CANv 1651 7)UPPER 800NE5 FERRY AOA0 16250 5.W. PALERMO LANE sur.TE 200 ---- - ------ .. ._.. ----- rn Popn.AND,ORE60N 97224 (503)609-3060_ LOT 21 PLAN 2811 A � _u CM OF TIGAY.D- SITE PLAN RCVIF?' (�tliLLllNi; PERMIT 0. L�7-�� PI,ANNINU DIVISION: Required Setbacks: 0 Amoved (.:J Not Approved ` side 5_._. 5trzct `;ck -- Visuaa Ckmarance: WIT ,. } Maximum Buildink I fe,. nt .�. C:WS Serviee Provider i..ctter Regvir:,,' E;NMNEERINO MPA(, -1>11--, f Act;,al S!cjpe'1 S",o ',,!� 'ppr,wed �! ?�;r1 A inpr,:k ed Site Ilia rr: ��i Approved 01PNO1,Appruveo lav: �......._..,....... ate: lor03 .. C;iTY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST p_ BLIP _----__--- Received f I'ieq�u�ested S�-1.3 AM------ . PM __ - BUP LocationDti� .--Suite --- - MEC -- ----- -- U(Co.s Contact Verson _ � � _ Ph(—_—) �—.__,_� PLM Contractor— -�— -- -- --_T_._ Ph ( ) --- -_ SWR _._-- BUILDING Tenan; `)%A In r _ _—_ ELC Footing --- ELC ---- Fo.indation ACCESS: — Fig(Drain ELR _ Crawl Drain - Slab Inspection Notes: SIT _ Post& Beam Shear Anchors _ -_ -------_-, Ext Sheath/Shear _ Int Sheath/Shear Framing Insulation Drywall Nailing — Firewall Fire Sprinkler _ --- -_-----__. Fire Alarm Susp d Ceiling --- -- �-- — ---- --- -——-- Roof Other: -- - Final __---------- PASS PART FAIL PLUMBING Post&Beam _ Under Slab -- _ Rough-In Wafer Service - Sanitary Sewer Rain Drains --- --- Catch Basin/Manhole Storm Drain -- — -- - Shower Pan Other: -- --- - Final -- --_� -PASSPART _FAIL MECHANICAL Post& Beam -- Rough-In _ Gas Line Smoke Dampers Final PASS PART ELECTRICAL Service !dough-In IJG/Slob Low Voltage Fire Alarm SASS_ PART FAIL El Reinspection fee of$ _ — _ required before next inspection. Pay at City Mall, 13125 SW Hall Blvd SITE Please call for reins action RE: Unable to inspect-no acces Fire Supply Line ADA Approach/Sidewalk Date --� _ Inspect Ext Other: Final DO NOT REMOVE this ;nspection record from the b site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (502&W-4175 MST ( — INSPECTION DIVISION Business Line: (d3M-.A&7l BUP Received ----DateoZ Requeste — BUP __ _Location Suite__ __ MEC Cortaci Person .�-- _ Ph( ` -7 5a ( `P S� PLM --------__--- Contractor __ __�_ ____-- �__—�_ Ph (---) �- SWR - ----- -- rBUILDING Tenant/Owner ELC I Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain - slab Inspection Notes- / � 0 SIT — Post&Beam -/-`�------ - — --- Shear Anchors Ext Sheath/Shear -- -- Int Sheath/Shear Framing ---- --- - -- --- -- Insulation _ Drywall Nailing - Firewall Fire Sprinkler --- --- -_.--- -- -- - _ ------ Fire Alarm Susp'd Ceiling - Root Other- Final therFinal PASS PART FAIL PLUMBING _ Post 8 Eleam Under Slab - Rough-In Water Service - - - Sanitary Sewer Rain Drains - Catch Basin/Manhole Storm Drain -_ - Shower Pan V PART FAIL IGAL _ - -- - Post d Beam Rough-In - Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL 'iP,fVICP.-------- - Rough-In UG/Slab Low Voltage --- — -- -- - - Fire Alarm Final L� Reinspection fee of$ requi,ed beforo next inspection. Pay at City Hall, 13125 SW Hall Blvd PASS PART FAIL Please call for reinspection Unable to inspect-no acc:ss Fire Supply Line �/ ADA ✓�.^ �. Ext Approach/Sidewalk Date Ar�sp,�c9�r - "'--s--- - Other. Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL.