11262 SW 84TH AVENUE j
I. PROV,DE A `11NIMUM 8' G>EEP GRAVEL BASE FDR ALL
DRIVEWAY AREAS.
2. MAXIMUM DRIVEWAY SLOPE SHOULD BE VERIFIES WITH
THE BUILDING DEPARTMENT CONSTRUCTION.
• E
C")
PROVIDE dA MINIMUM 4' DEEP GRAVEL F3A5E FOR ALL
SIDEWALK AND PATIO AREAS, a,
4. PIPE ALL STORM DRAINAGE FROM THE BUILDING TO A o
�.t
DISPOSAL POINT APPROVED BY THE BUILDING U ,_
DEPARTMENT. o
0
5. PROVIDE AND MAINTAIN POSITIVE DRAINAGE AWAY ci at
FROM BUILDIr,G CSN ALL SIDES.
Z
—
6• THE BOUNDARY AND TOPOGRAPHY INFORMATION 4' ABS SANITARY SELLER--1 3' ABS STORMLINECONNECT TO Em
HAS BEEN PROVIDED TO POLLARD - H05MAR CONNECT TO CITY'
CITY APPROVED rn
DESIGNERS, INC. BY THE C::,�N•T'RACTOR, OWNER OR APPROVED SEWER STORM DRAIN
�dGINEERiNG CONSULTANT. POLLARD - H051"IAR N
SILT % �
DE51GNEF INC. WILL NOT BE HELD LIABLE FOR THE / FENCE
ACCURAC OF THIS INFORMATION. IT IS THE SOLE �8, _ w N SS041'49' W �D� o
RESPONSIBILITY OF THE GC�NTRAGTOR TO VERIFY � � 1162b' � �•--
ALL SITE CONDITIONS INCLUDING ANY FILL PLACED _ _r _ - - �� x
ON THE SITE. THE CONTRACTOR MUST INFORM THIS IFu - - -- - - '- - -
LL-
OFFICE OF ANY PO i ENTIAL FIELD MODIFICATIONS ;` f ,,{{ O►LONGWA� ....._.. ...l...... PLAN' e'`''F'S I' .. F - •
NOT SPECIFIED ON THE PLANS. �" "
............
".:.:..:..:.:.:.'`;....... F.F.E. 1450' .... . ............. �n
(22 5Q. FT.) L= �...•.......... ' c�
NON-5 T ABILIZED FILL MUST NOT EXCEFD 2:1 SLOPE : �.. ......:: :
1........ .. ...... I FaT10 .cC
L_ .•.. �_ .... ... .... .. ...... I d-
-.-. ,: . .. J , N
EXCAVATION MATERIAL REMAINING ON SITE 15 TO � � ....................... ..........
c - `�rr-- -.--------- , - ......'. .... ...•.• . J
BE CONTAINED BY AN APPROVED .->=DIMENT BARRIER. u1 �fi b
(FILTER FABRIC TENSILE, :STRAW BALE SEDIMENT BARRIER �r i- 1 .. :.:::::::1::": :"::::::.":::::::::....:. -
OR EROSION BLANKET WITH ANCHORS THE GOt`ITRACTOR 1>
m " . I r . .. 'n
-
Q :.. GARAGE ..:-:l. I 0
MUST VERIFY LOCATION WITH APPROPRIATE BUILDING w - �------------.,. •" , �� ':::.:.:•::..: II OFFICIAL, , m :rry . ` . �:": .................... ... . . ..... ... Z M
X8,_3' # N
:. , . .. i I: :` 8. . . .. N
PROTECT STOCK PILES FROM OCTOBER let T+-I{�U ' Z
APRIL 30th PER THE EROSION CONTROL HANDBOOK. r T 1 .. -
I' PVC WATER LIN _ _ p
NO CUTTING OR FILLING SHALL TAKE PLACE WITHIN
THE DRIP LINE OF AN EXISTING TREE UNLESS THE
EXCEPTION IS APPROVED EY THE BUILDING DEPT. �<0 2@'-@' + + ___.. N 89'41'49' W
AFTER COMPLETION OF CONSTRUCTION, THE CONTRACTOR IV-@' WIDE '
4' THICK o
MUST EITHER LANDSCAPE THE SOILS, MULCH THE SOIL OR o
CONC. DRIVE cam►
(411 SGS. FT.)
cn
•
ER2510N CONTROL PLAN
I. SILT FENCE TO BE INSTALLED AT LOW z
SIDE OF LOT 0Ali c-D
2. DRIVEWAYS AND SIDEWALKS TO BE GRAVELED.
act
N
I T E F L A N
I/ib I'-0,
LOT 3 ASH CREEK MEADOWS LOT
•�CITY OF TIGARD, OREGON
MAP 1 4 TAX LOT ZONE R-1 5,000 SQ. FT.
BUILDING FOOTPRINT 1,305 SQ. FT. _ 2ed% COVERAGE CONTRACTOR
AREA OF LOT = 5,000 SQ. FT.
E5LINGER P1421-0522
ROOF AREA - 1,5@'1 SQ. FT. 115-15 SW PACIFIC HWFWOOY. MB @ ING .
TIGARD, OR 9/b/ml KAK
"ON
oil I'llr
NOTICE: IF THE PRINT OR TYPE ON ANY rl-I-( III 111 ( 111 1111111 II ! �� � III , 111111 1Cr 1 ( rrl1 1-I �� rhe rh rl1- •�,�1 I � 1 X11 11 � II1 . ( � I � t �III � Ir III ill � � r � I ► IIS rIr iIt i 1II i I I�f I ► 17 i i I i i i I i i
( 1 I I III I 1 1 � 1 � I r 111 I I IIII
IMAGE IS NOT AS CLEAR AS THIS NOTICE
1 I I I I
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ITIS DUE TO THE (.QUALITY OF THE _ �- ��— -- --�--- -
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ORIGINAL DOCUMENT E OZ gZ Lc; 9Z 5Z - � Z EZ ZZ iZ OZ 36
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11262 SW 84"' Avenue
CITYOF TIGARD MASTER PERMIT
PERMIT#: MSI-2001-00502
DEVELOPMENT SERVICES DATE ISSUED: 10/5/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11262 SW 84TH AVE MODEL HOME PARCEL: 1S136CB-ACM03
SUBDIVISION: ASH CREEK MEADOWS ZONING: R-7
BLOCK: LOT: 003 JURISDICTION: TIG
REMARKS: New SF detached (model home) Path 1
BUILDING
REISSUE: STORIES. FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: "I FIRST: 835 at BASEMENT: at LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,113 of GARAGE: 460 of FRONT: 20 PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS'. I FINBSMENT: of RIGHT: 5
OCCUPANCY GRP: R3 BORM4 HATH. -I TOTAL: 1,948.00 at VALUE: $187,436.60 REAR: 48
PLUMBING
SINKS: I WATER CLOSETS: ! WASHING MACH 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASi4S.
TUBISHOWERS: GARBAGE DISP'. 1 WATER HEATERS. 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
MECHANICAL OTHER FIXTURES.
FUEL TYPES FURN<100K: I DOILlCMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN>=100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FI OOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS_
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPECTION:
EA ADDL 500SF: l 201 400 amp: 201 400 amp: lotWlO SVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY 401 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HM/SVCIFDR: 601 • 1000 amp: 601-anms•1000y: MINOR LABEL
1000.amplyolt:
Reconnect only: PLAN REVIEW SECTION
>=4 R-S UNITS: SVCIFDR>=225 A.: >$00 V NOMINAL: CLS AREAISPC OCC:
_ ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL W 8.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCCM)PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEARRIG, PROTECTIVE SIGNLI
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL. OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS 1 OTAL N SYSTEMS:
Owner Contractor: TOTAL FEES: $ 6,720.30
ESLINGER BUILDERS INC ESLINGER BUILDERS INC This permit is subject to the regulations contained in the
11575 SW PACIFIC HWY 11575 SW PACIFIC HWY Tigard Municipal Code,State of OR. Specialty Codes and
PMB 160 TIGARD,OR 97223 all other applicable laws. All work will be done in
TIGARD,OR 97223 acoordance with approved plans. This permit will expire 9
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 rollow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg 0: LIC E2363 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 INSPECTIONS
Erosion Control Insp 8, post/Beam Mechanica Mechanical Insp Sheal Wall Insp Rain drain Insp Plumb Final
Sewer Inspection Underfloor insulation Plumb Top Out Low Voltage Water Line Insp Final inspection
Footing Insp Crawl Drain/Backwater Electrical Service Gas Line Insp Appr/Sdwlk Insp
Foundation Insp Footing/Foundation Drl Electrical Rough In Gas Fireplace Electrical Final
Post/Beam Structural PLM/Underfloor Framing Insp Insulation Insp Mechanical Final
Issued By : s ' , : 1 f/.l',f[ L Permittee SignaturQ
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD Sr-WERCONNECTIONPERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-00268
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/5/01
SITE ADCRESS; 112.62 SW 84TH AVE MODEL HOME PARCEL: 1S136CB-ACM03
SUBDIVISION: ASH CREEK MEADOWS ZONING: R-7
BLOCK: LOT: 003 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new SF residence.
Owner: —
FEES
ESLINGER BUILDERS INC
11575 SW PACIFIC HWY Type BY Date Amount Receipt
PMB160 PRMT CTR 10/5/01 $2,300.00 27200100000
TIGARD, OR 97223 INSP CTR 10/5/01 $35.00 27200100000
Phone: 503-620-9515 Total $2,335.00
Contractor:
Phone:
Reg #:
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 riot guarantee
the accuracy of thy; 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" PE-m
Issued by:._ .1 .4cdtle Permittee Signatures
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
^— Date received:r� / I'ernut no.: l� ti71 -QO6do1
City of Tigard
Address: 13125 SW hall Blvd,Tigard,OR 97_") ProjecUappl.no.: Expire date: _
f'lo'(Of'figurd phone: (50:3) 639-4171 Dale issued: tiyr Receipt no.; �
ax (503) 598-1960 _ %'ase file no.: - — Payment type:
l.acid use approval: I.\?(atnih"Bantle CunlplCx.
TYPE OF PERN1111-11
U I ,: 2 lanuly dwelling or accessory U Commercial/industrial U Multi-fancily XNew c,ntNtructi(m U Demolition G
U Addti(ut/alteration/replacement U Tenant improvement J hit- ,piinkler/alarm U t hltrt:
INFORNIATION
Joh addict~: I;Id- no,: Suite no.:
: � 1,3e&
- -
Lot - 13hxk: Subdr,ivision: peTax ntap/tax lot/accounl no.: 5 f3e&CB7 ,
Project name /1c1- 7 AGMO
Description and location of work on premiscs/special conditions: _ !✓IQ ( Il._(� _�Yh -
OWNER FOR SJ1Ir'('11AL1 ' 1
N, tT SE CHECKLIST
- F- --Name: 1
�( C,, ' '
Mailing address:J14& 1 &2 family d"elling:
City: Stulc: 7.IP: Valuation of work.............. ......................... $JS I. .0�
Phone: Fux• 7 '-ncatl: No.of bednxnns/both%.................................
Owner's representative: walwim P t^ Total nurnhev of floors................................. _
Phone: Fax: G-mail: New dwelling arca(sq.ft.)
Garage/carport arra(sq. ft.).........................
Name: r 18U f lCr�e-,` Covered porch arra(ul. ft.) ......................... -� ---
Mailing address: ` raCl. W C0- e-
-E7-)----
—
Deck arca(sq. ft.) .................................... ...
-- -" Other structure area(tip. I't.
CyState: ZIP: )
phone: I nail Commerclalllnda5trial/muhi-family:
1 1 ' Valuation of work.............................. .... .... $ __
PA
iness name: ' , a I,xisling bldg. arra(sq. fl.) ..........................
1 zp New bldg.area(sq. ft.)..................I.........
....
ress: 1: Stale: 7.1P: Number of stories........................................
Type of construction............ ........I..............ne: I�a� �[?-mail: th.cupancy group(s): lixisting:nil.: 613Ce3 _ New:
Notice:All conttdctors and subcontractors are required to he
ARCHirurrarsIGNERlicensed with the Oregon Construction Contractors Bonid under
Nance: LIL C O�Ibl v rG�G , provtsinns of Ultti 701 and may be required to he licensed in clic
Address: 7jJurisdiction where work is lasing performed, If the applicant is
Cit stile l.IP: Z exempt from licensing,the. following reason applies:
Contact lcr on: a Plan no.: --
One:
One: ? J r I`ax: I nsul __ ___ - ----. __Y_.-__.------..._
Nance: ( . )• t untact Ix tato: hers due ulxcn application ............. ............. $
_--�---_ _
Address: 'S[] Ih1 �. Q 5 L? ► _ Dale received: ..�-
City: State: 'l.II': A mount received .....................•..•................ -_-
Plnnte: E-mail: Please refer to fee schedule.
I hereby certify I have read, id examined this applicalwit and Ill('- Nte all Intiultcltons rcept ordit came,pteae cell potulicom Gx oauc inRamm�un
attached checklist. All pro%%,,ions of laws and ordinance,governing this U Vtsa U AlasterVatd
work will he compGrWi r i' sfl herein or -
Authnrirrd 5igtlaltlrr11:ItC: J Natnr of cnrJFoTr as ehciwn on credit cath"�—
Print name: .r i _ ___ -"-C iuilhatiter cl nuure -`- S._nrtwani-
Notice Ibis permit application expires it a pennit.. not obtained%%thin 180 days atter it has been accepted as complete 44o 4ht 1 16ttrtn•o,u
One-and Two-1'tinily Dwelling
Building Permit Application Checklist Reference no
-
_— — -- Vo,ocraedpet nuati
('try of Tigard ( jay' of Tigard rd J I Irclrcal -J I'lombing LIMechanical
Address: 13125 SW I lalI Ilh of I I'ard,()It 97223
Phone: (Sir;) 639-4171
FaX' (511 i i SVR-I�)RO
THE
FOLLOWING 1 1 F04PLAN
1 Land u%e actions completed. 'wc jurisdiction criteria for concuucnl rcva•ws.
2 Zoning. Flood plain,solar balance points,seismic soils design:w,m,historic district,etc.
3 Verification of approved platllot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel, I3xisting 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-way protection,silt fence design and location of
protection,etc.
�,,O_qatch-basui
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 a.,tnpleted
if copyright violations exist.
l-1 Site/plot plan dram to scale.'llte plan nimi show lot and building setback dimensions;property corner elevations(if
'!Bert.is molt.Wa an 4-h.elcvalwn dlficu•ouaal,plan must show contour lines at 2-11.intervals);location of easements and
Ike. d 'veway;footprint ol'structure(includim,decks);location of wells/septic systems;utility locations;direction indicator;lot
alca;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface.drainage. -
i foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
sily ,rid bn ali"11
_
13 Floor plans.Show all dimentiions,room identification,window size,location of smoke detectors,water heater. _--
furnace, vcnlalatinn rams,plumbing fixtures,balconies and decks 30 inches above grade,etc. _
14 Cross sections)and details.,Show all framing-member sizes and spacing such as floor beams,headers,Joists,still III I,n, _
wall consina ion,roof construction.More than one cross section may he required to clearly portray construction.Slw%
details of all wall and roof sheathing,roofing,roof slope,ceiling,,height,siding material,footings and foundation.stair.,
fireplace construction, lhennal 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 foot at buildinp em a•Iigw.
Pull-sine 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
non-prescrl,iuvr path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roil'assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation._
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered
systems,see item 22,"Engineer's calculations." _
19 Beam calculations,Provide two sets of calculations using current code design values fur all beams and multiple joists
over Ill feet lung and/or any beam/joist carrying a nun-uniform load. -
20 Manufactured floor/roof truss design details. _ _
21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four ur more appliances. _
22 Engineer's calculations.When requimd(it provialed,(I e.,shear wall,roof truss)shall he stamped by an engnn•ca 4
MC1111ecl In cnscd til()II!rI III,and slcall hr shown 1"I ,I,I,I � .1110 to the p,rojccl ni 11Irr revir%�
JURISDICTIONAL
23 I-ive.(5)site plans ore required for Item I I above. Site plans nmst be 11-Ill" x I I"of
24 Two(2)sets each are required for Items 16, 11), 20& 22 above.
25 I'luflding plans shall not contain red line%or tape-ons.
26 "Reversed" building plans must meet criteria outlined in the Perrot& System Development Pees docunlenl.
27 No"mirrored"building plans will he accepted
28 "Drawn to scale" indicates standard architect tit engineer scale.
Checklist must he completed before plan re%iew start date. Minor changes or notes on submitted plans mar he in hlue or black ink.
Red ink is reserved fior department use only 44141,14 001 Wi NI
Plumbing Perin it Application
---- Daterecctved: Permit no. v o y
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
City of Tigard Phone: (503) 639-4171
Fax: (503) 598-1960 Date issued: By: Receipt no..
Lind use approval: case file Payment type:
e no.:
t '
U 1 &2 family dwelling or accessory U Commercial/indusc,ial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Food service U Other:
}�� Description _ Oty. Fec(ea.) Total
J�addrss: _fes") , - - _�_ ----. New I and t-tamih dwell8ngs only:
Bldg.no.: Suite lw.:
(includes 100 ft.for each utility connection)
Tax map/tax lot/account no.: t✓B / i SFR(1)bath
LAW Block: Subdivision: FR(2)bath
Project name: SFR(3)bath
City/county: ZII': 7� Each additional batlm/kitchen
Descri tion and Io64tion of work o remix s:� Sheutilities:
Catch basin/area drain -
me Ntil ��� _ Drywells/leach line/trench drain
Est.date of conmpletiot speclion: '-- Footing drain(no. lin. ft.) - —
II It Manufactured lion c utilities
Business name: -f'f r Manholes -- _
Address: — / Rain drain connector
Cily: Sate: IIP: SaniUt sew ljo
I'hone: Fax: yke E-mail: Storm sewer(no.lin. rt.)
C►� Plumb.bus.re no: Water service(no. lin.it.)
Cl'.B no.. g' 1''ixturr or Nem:
City:1metro tic.no.: '; �� Absorption valve
Contractor's representative signature: Back flow pn venter
I'•inl 11,11111
?. r I)tlr Backwater valve
t t Basins/lavatoryI � , Clothes washer -
Dishwasher
Address: /lWet Drinking fountain(s) _
City: _--- ----- State: -j/III -- _ .jeclors/sump
Phone - I,t� li 111:111: Expansion tank
Fixture/sewer cap
Floor dntinslllrtor sinks/huh
Name(print): '✓teaGC I l�f�_+_ Garbage alis sal
Mailing address: Hose hibb _
City: r C State: ?.I 70 Ice maker
Phone: Fax: _ E-mail- ---- ntcrce tor/ rcase Ira11
Owner installation.'residential maintenance only: 'Ilene at•ulal installation Primer(s)
will he made by me or the maintenance and repair made by my regular Rixif drain(commercial)
employee on the prorwiiy I own its per ORS Chapter 447. Sink(s),ba sin(s),lays(s)
l)wnrr', ,iEJtnlute — --- I%ate: r Sump
Tu s/s lower/shower pan
Jrinal
Name: — Fifer clusei—� --
Address: atrr hrutcr_
City: State: �� Uthei
Phonc: Fax: E-mail: oU
Minimum fee................$ --
Nd all jUosdicti,mq rcrpt credit cants,pin se call luriiub ti m ttn mtxe infntnmtlno
Notice Ibis permit application plan rl'Yll'w'(ill �') $
U Viaa U Alastrr<'atd - �—
expires if a pernut is not obtained Stale surcharge(8tk)...
trditLaid nunttwl _. __.____.-.._._ _.._. _ Expires�.__ within Igo day salterittalcbeen TUTAI, ...... $
accepted as complete �--"---
Nantr of cal,61"Urt ax xhn vtt ten credo card
- -- $
rodliuldet signninte _� Amount 4Mt 46 16(MXut' IMI
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES individual QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT
16.60 for each utility connection
— _.-..
Lavatory _ One 1Lbalh - ----- $249.20
Tub or Tub/Shower Comb. 16.60 Two(2)bath $350.00
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
__�—_.._�— __--- TOTAL
Garbage Disposal 1660 —- -- --- - — - -
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3^ 16.60
q" 16.60 _
Water Heater O conversion O like kind 16.60 Quandt b Work Performed
Gas piping requires a separate mechanical Fixture New Moved Replaced Removed/
Type:
permit. Capped
MFG Home New Water Service 4640 WFHome New San/StormSewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 'S 60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain e 1660 Water Closet 3
16 60 Urinal
Other Fixtures(Specify) Dishwasher
Garbage Disposal
—�
Laundry Room Tray
---
Washing Marhine
Floor Drain/Sink: 2"
Sewer-1 at 100' - 5500 3"
Sawer-each additional 100' 4640 4"
Water Service-1st 100' 5500 Water Heater
Other Fixtures
Water Service-each additional 200' 4640 (Specify)
Sldrm b Rain Drain-1st 100 35.00 _
Storm 8 Rain Drain-each additional 100' 46.40 —
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevenllon Device' � 27.55 - —
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 7250
Ro uested Ins actionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain•single family dwelling 65.25 —
Greeae Traps 16.60 --- --
QUANTITY TOTAL _
Isometric or riser diagram is mquirnd if
�uanlfiy Tolal Is >9
*SUBTOTAL
8%STATE SURCHARGE _
•`PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty total is>N
TOTAL S
.Minimum permit Ne is$7250•a%state surcharge,except Residential Backflow
Prevention Device,which is$3e 25•a%state surcharge
"All New Commercial Buildings require 2 sets of plans with Isometric a-r riser
diagram for plan review.
I\dsts\forms\plrn-fees.doc 06129/01
Mechanical Permit Application
- --- T— - Date received- Perinitno.:p _ D
City of Tigard Pruject/appl.no.: Expire date:
C'irvu/Tigurd Address: 13 125 SW Hall Blvd,Tigard,OR 97223 Dale By: I Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type
Land use 61:proval:
limiditir permit no.:
U I &2 family dwelling or accessory U Commercial./industrial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Other
Job address: Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suitc.no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax*IoVaccountno.: profit. Value g Subdivision' rCG �� •Sec checklist for important application information and
Project nameiuri•;diction's fee schedule fnr residential permit fee.
City/county: ZIP: �3 '
Uesc i tion and Ic cr;tion work a premj.es:
fit f
Fsi,dateofcompletioninspection:
?, Ikuripliun — 111 y. Kts.nal/' Rt s.onl)
Tenant improvement or change of use: Air hamii i,unit t I NI
Is exist ilip space healed or conditioned?U Yes U No A+, „+nlu nin�(silep anreywic,li -
Is exist,,,), 1,1k of.ul,itrJ ' j Yes U No _11"Tt VKcsyste.
CONTRACTORNECHANICAL li,ulc+h,gnlnc•,tiul3
Slate hailer permit no.:
Business name:
Address: , $ I ire/snit a dampers/duct smoke electors
City: 7 Stutc� %I I'. -w.-,Flump(rile p an require. )
-ha+x:�Tmail: Install/rcpnrcfurnac urncr_�
F'hot'c: p_J�.L Including ductwork/vent liner U Yes U No
CCR no.: _ Tnst-a l/rep ac re tate caters-suspen e ,
City/metro lic.no.: ►3:� ~ wall,or floor mounted
enfur a (,o
l nce other t arta urnace
Nance( leas' III inn: r _lee, C e gerat on:
Ahsorplionutws.-___--___-_— IlTUAI
Name: +' .-- t'tnu,rrssnrs_
✓ ?nr ronmenta exhaust an ventilation:
City: State: 'LIP: _ Applimuevent
Phone: fox: L' moil: )ryes exhaust
llc+tx s,Type 1111/res. ik li�he nazmat
hood lire suppression system --
Name: 5(i,.t t?�V S C. Exhaust fan with single rine((hath fans(
Mailing address G m � .x musts slept a part from hei+lin or At
JAI :_ •ue p p ng an str cul on lop to outlets)
5UNc:
City_''" ✓ . ---- , _3-- Tylic I.I'C i NI;
I'lutnt•; I axf� �y anal(: 7_110-1111 n t each adtlilnuial o�ct 4 uullets
recess p p ng 1 schcmau;r rqun cd i ___
Number of outlets
Nano: 1 _ ter filited app ancc or equlpmrnt:
Address: _ hecurn+velneplace
-- —
Cit Stale.: 1.11': Tsert type _-
City: ----- ooc slove pe et stove
Phone: I;rt; - I. arta,(:
Ol ICI.
Applicant's signature: fT,+le: C' Other!_
Nan)C (print): L'!' '✓""✓� / 1 _..
Pernul Ire.... ................
NO all pn+dirnan%mcep+cin81 cant'.plea'"call)u+tatic+i,m ern none Inhxntnton Notice I Iris perntll applicalinit
�tnnnnnu Ire.................
UVisit U MaslerCiffd Cxpncs it it perms 1�not ohlaincd
/ �.__ I'Inn rc'vlres (al -
I ,,,., tvultin 1ROdays alter it has been
_ i til,+lr surcharge(87I�) ....
-r,emr i;r cudiinGieI ei v n,wu oil rWTii rad-- S accepted its complete 1'O'I AL . ..................... _..--
---
- _.._..—...-.--..�_ _. Amour+
t'atdltolde rlrnamn, — 0+407 Uw nil,1
MECHANICAL PERMIT FEES L
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION PERMIT FEE: Description: - Price Total
$1.00 to$5,000.00 M nunum fee$72.50 Table 1A Mechanical Code _ Oty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or Including ducts 8 vents 14.00
fraction thereof,to and Including 2) Furnace 100,000 BTU+
$10,000.00. including ducts 8 vents 17.40
$10,001.00 to$25,000.00 $148.50 hr the first$10,000.00 and 3) Floor Furnace
S1 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 Orsi e25,000.00 and 5) Vent not included in appliance permit
$1.45 for each addition,.:$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 and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For items 7-11,see or Pump Cond
fraction thereof. footnotes below. Com '
7)<3HP;absorb unit
Minimum Permit Fee$72.50 SUBTOTAL: $ to 100K BTU 14(10
--- 8)3-15 HP;absorb
8%.State Surcharge $ unit 100k to 500k BTU 25.60
25'/.Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb
unit.5-1 mil BTU 35.00
Required for ALL commercial permits on) 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
- 11)>50HP:absorb
unit>1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM
_ 10.00
Value Total 13)Air handling unit 10,000 CF"M+
Description: Qt _LEa)_ Amount 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooter
ducts 8 vents 10.00
Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct
ducts&vents 6.80
Floor furnace including vent _ 955 16)Ventilation system not Included in
Suspended healer,wall heater or &55 appliance permit 1000
floor mounted heater 17)Hood served by mechanical exhaust
Vent not included in applicence 445 10.00
permit -- 18)Domestic incinerators
Repair ur;ls 805 17.40
<3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator
to 100k BTU _ 6995
3-15 hp:absorb..unit,-� 1,700 20)Other units,Including wood stoves
101k to 500k BTU _ 1000
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
mil.BTU 5.40
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(eaa':)
1-1.75 mil.BTU 1.00
>50 tip;absorb.unit, 5,725 _ Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU_ _
Air handling unit to 10,000 cfm 656 8•/.State Surcharge
Air handling unit�•10,000 cfm i"110
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: F
Vent fan ounnected to a sin le duct 446
Vent system not included in 656 _.
a /lance Dermit Qfher Ing eeclIons and Fees:
Hood served by exhaust - 656 _ 1 Inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator_ 1 170 $72 50 per hour
Commercial or Industrial inc neral0r 4 590 2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
Other unit,Including wood stoves, 656 $72 50 per hour
Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plane(minimun
Gas1ping 1-4 outlets �_! charge-one-half hour)$72 50 per hour
Each additional outlet _ V _ 63 _ *State Contractor Boller Certification required for units>200k BTU.
TOTAL COMMERCIAL _- '- -Residential AIC requires site plan showing placement of unit.
VALUATION:
i\dstsUorms\mech-fees doc 08/06/01
Electrical Permit Application
- ---- - U:dereceived Permitno.:/�,
City of 1 igard Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Rlvd,Tigard,OR 97223 Date issued
Phone: (503) 639-4171 _-- By: Receipt m,
Fax: (503) 598-1960 Case file no Payment type:
Land use approval:
INPE.OF
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/aheration/repLu,mount U()thrr _ U Partial
1 ' SITE INFORMATION
Jobaddress: ilial n.,.: tiuite nth: Tax map/tax lot/account no.:
Lot: Blrxk: tiu ivisL6 0 LA3Ga
Project Warne: �e—__ Description and location of work on premises: KLoLIE-stinialed date of Comillction/inslxxtion�APPLICATION -
1
Job no: Iev ata.
Business name: )� r Ikscription QIr. (ea.) total no.imp
Nen tttii(k-inial-shtkle m nadri-family per
Address: dhrlling unit.lnelutky artaclrcd garage.
City: I Oro Slate: ZIP: Servicehu•luded:
{'hone: A„�r,1- 41 Fax: I E.-mail: 1000s4 It „iesN t
CCB no.: Q Glee.bus. tic,no: 3
Hach additional 500 sq ft,or portion thereof
Limited energy,residential 2
City/metro I IL.lu►•: Limited energy,non-residential 2
_ Each manufactured home or modular dwelling
Signature of supervising electrician(required) 17nte - - Service and/or feeder 2
Sup.elect.namc(priv): License nor — Servlcesorfeeders-Installation,
attention or relocation:
1 200 amps or less 2
n
Name(print): f r„ S ( -r-% Ir- 201 amps to 4lx)amps 2
--- 401 amps to 600 amps
Mailing address: S _ G (40 2
601 amps In IOOOams 2
City: v' Slate ZIP: (Aver Iwx)amps orvotes 2
Phonc: Fax' ,Q :-mail: Rec.11111VC1 only I
Owner instal alion:The installation is being matte on property I own 'temporary servkmorfeedem-
which is not intended for sale, lease,rent,or exchange according to indalbalion,ablerallon,orrelo(ation:
OR'.447,455,479,670,701. M)ampti or Icss 2
_201 amps l00 romps 2
Owner's signature: Date: 401 to 6tx)ams -- - -
Branch circuits-new,alteration,
or exlenslon per panel:
Name: - A Fee Inr branch cucuils with purchase cat
Address: service or feeder fee,each branch circuit 2
City: Stale: /III H. Fee for branch circuits without purchase
Phone: l�ae F snail
--- of service(it feeder fee,first branch circuit. 2
Bach additional branch circuit:
Mise.(Service or feeder not Included):
UService river 223omps-conmMrcial Lt I1,,wh .n� 1.,�11,(, Fachpump tit urrigauoncircle 2
U Service over 320 amps-rating of I&2 U I lazardom lm mbuo Tach sign or outline lighting 2
famiIydwell mgs U Building over 100m)square feet four or Signal circuit(s)or it limited energy panel. - - --
USystem over 6Wvoltsnominal nam residential units in one structure alterauon.(it extension• 2
U Building over three stones U!,ceders,4M amps or more •I kscn,ornu _
❑(kcupant load over 99 persons U Manufactured structures or RV park 1'ich additional Inspection over the allowable In any of the above:
U Lgressllughnngplu) U l)lher _-_
Submit vols of t►lam with any of the above. Investlgalian fee
Ilie al►oye are not applicable to temporary construction service. Other —
N,N all)unklicnans accept c,edlu cods,please call)udrdkuon ha nvrte inhxtnnuoa Noliee:11tis pCrn►il application Permit fee.....................$
-----
U Visa U Masiert'ar,l expires if a pemtit is not obtained Plan review(at r)f) $
Credo card number I L_ within Igo days abler it has been State surcharge(8%) ....$ _
accepted as complete TOTAL ........... ...........$
--Namr of cur n u u a awn on c II car - —-.-
1 antler signature Anunuu
44r N,I s Iu5A111/t'()MI
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Restricted Energy Fee.... .......................
Number of Inspections per permit allowed $75.00
(FOR ALL SYSTEMS)
Service included: Items Cost Total
Residential•per unit Check Type of Work Involved:
1000 sq fl or less $145 15 4
Fach additional 500 sq it or — -- LlAudio and Stereo Systems'
portion $3340 1
Limited Energy $75.00 �— ❑ Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder _ :090.90 2 ❑ Garage Door Opener'
Services or Feeders
Installation,alteration,Or relocation L] Healing,Ventilation snd Air Conditioning System•
200 amps or less $80.30 2
201 amps to 400 amps _�` $106.85 2 �� Vacuum Systems'
401 amps to 600 amps _ $16060_ 2
601 amps to 1000 amps $24060 2 C Other_
Over 1000 amps or volts $45465 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 ano Stereo Systems
Branch Circuits
New,alteration or extension per panel ❑ Boiler Controls
a)The fee for branch circuits
with purchase of service.or ❑ Clock Systems
feeder fee.
Each branch circuit _ $ri 65 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service
or feeder fee. ❑ Fire Alarm Installation
First branch circuit _ $4685
Each additional branch circuit $665 V ❑ HVAC
Miscellaneous
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle _ $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s)or a limiled energv
panel,alteration or extension _v $75,00 ❑ Landscape Irrigation Control'
Minor Labels(10) $125.00_
Each additional Inspection over ❑ Medical
the allowable in any of the above
Per inspection $6250_ ❑ Nurse Calls
Per rtnto $62.50
In Plant $7375-- ❑ Outdoor Landscape Lighting'
Fees: [_] Protective Signaling
Enter total of above feet $_ ❑ Other
8%Slate Surcharge $
—`T _Number of Systems
25%Plan Review Fee
`wr.'T'kut tirview"sry bon ru $ ' No licenses are required Licenses are requlred for all other Installations
IrJnl nl apphcaUnn
Fees:
Total Balance Due $
❑
Trust Account q Enter total of above fees $
-- 8%Stats Surcharge =
All New Commercial Buildings require 2 sets of plans. Total Balance Due :
I Agts\fomuklc-fres doc 09,.It)n l
SEE 35MM
ROLL #21
FOR
OVERSIZED
DOCUMENT
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
DAVID JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2001-00502
Date Issued. 'I Oi510i
Parcel: 1 S136CB-ACM03
Site Address: 11262 SW 84TH AVE MODEL HOME
Subdivision: ASH CREEK MEADOWS
Block: Lot: 003
Jurisdiction: TIG
Zoning: R-7
Remarks: New SF detached (model Home) Path 1
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONI RACTOR
ESLINGER BUILDERS INC DAVID JEROME ELECTRIC
11575 SW PACIFIC HWY PO BOX 751
PMB 160 HII_LSPOPO, OR 97123
z[GARV,, OR 9712
rr one 503-620-9. 15 Phone #: 648-5144
Reg #: LIC 36051
SUP 2877S
ELE 34.119C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X �
Signature of Supervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business line: (503) 539-4171 MST ?--
ReceivedDat —_ BUP
_ e Requested. -� AM PM _
Location BUP
- SuiteMEC --
Contact Person _ Ph( -) _� � (,,,5
Contractor PLM
FSprinkler
ILDING �-- _ Ph( ) _ SWR
__ Tenant/Owner - _ting - -- ELC
dationrain Ce S JELCl Drain I LELR Inspection Notes: —
$Beam S!T
r Anchorsheath/Shearheath/Shearing / Sc�tion - .1a I i:atlingallprinkler -
Fire Alarm —
Susp'd Ceiling --n—- -
Roof —
Ot
-- - -- - -
ma - -
ASS PART FAIL
PLUMBING
- -
r ost&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain -�
Shower Pan
Other: —
Final —
2PASS- al FAIL
MECHANIC _ -_-- -
Post eam ----
Rough-$ BIn --
Gas Line
Sawke Dampers --
� Ina
AS PART FAIL
ELEff—RICALL77 -
Service
Rough-In
UG/Slab --
UG/Slab __—
Low Voltage
a
Fire Alarm
Final �-� ---
PASS PART FAIL ❑ Reinspection fee of$ _ required before next inspection. Pay at City Hall, 1312.5 SW Hall Blvd.
SITE ❑ Please call for reinspection RE:
Fire Supply Line - - _ ❑ Unable to Inspect-no access
ADA
Approach/Sidewalk Date
Other: - Inspector
--.__— -`---------—._--____ ----Ext-_.._------
Final � DQ NOT REMOVE this Irr� � .
PASS PART FAIL pect1()" recor(I from the job site.
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CITYOF TIGARD — PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00310
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/30/03
SITE ADDRESS: 11262 SW 84TH AVE MODEL HOME PARCEL: 1S136CB-09900
SUBDIVISION: ASH CREEK MEADOWS ZONING: R-7
BLOCK: LOT: 003 _ JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of backflow prevention device for irrigation system.
Owner: FEES
—� Description Date Amount
JAMES E. BRISBEE
PO BOX 1566 HI I'rrniit FCC 6/30/03 $36.25
LAKE OSWEGO, OR 97035 fay 6/30/03 $2.90
Total $39.15
Phone : 503-635-3105
Contractor:
TREE CARE UNLIMITED
P.O. BOX 1566
AKE OSWEGO, OR 97035
REQUIRED INSPECTIONS
Phone : (015-110 RP/Backflow Prevenler
Final Inspection
Reg #: I It 5051)
%it 1 110002002
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applic Ne laws. All work will be done in accordance with approved
plans. This permit will expire if work .s not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Iss ed By: J � 1_% permittee Signature:
Call (503) 639- 75 by 7:00 P.M. for an inspection needed the next business day
P.l mbingPermitApplication
city
¢p Date reccnrod �+e u eo:. e"3
�-it of Tigard Sewer permit uc.: Building permit no..-
Address: 13125 SW Ball Blvd,Tigard,OR 97223
Ciryogard .bone: (503)6394171 Projectlappl.no.: Expire date:
Fax: (503) 598-1960 DnreiSsued: By: Recciptno.:
Land use approval: Grse file no.: Payment type
TYPE OF
1 do 2 family dwelling or aecewory 0 CommerciaUindustrial 5 biulu-£amily O Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Food service 0 Other. ---
JOB
INF6RMkr1ON FEE SCHEDULE(for special infonriation use checklisi)
Job address: // Z.-(v 2 �.w 84/ - �V Dcuri tion Qty. Fee(ea.) 11Total
Bldg-no.: Suite no.: — _— New 1-and 2-family dwellings only:
(includes 100 R.for each utility mauection)
Tax map/tax lodaccount no. _ SFR(1)bath
Lot Block: Sublivision: _ SFR(2)bath
m �-—�—�
Project nae_ A SFR(3)bath — — -
_City/county: C1"I-C-./ ZAP. Each additional bath/kitc_hen
Desai bort and l ion of work o premises:Z"rr i 94 1�N'� Site atWHes:
3jai / Catch basin/area drain
Est.date of rompletion(urspection:"'j—/� Q Drywelis/leacti lindtrench drun
t Foobtig draw(no.ho.ft.) —
R. Manufactured home utilities
Business mune:
1Tec Cure_/,, Zl2bdzi _. Mrwhole5 _ -
Address: /Sr"Ce Rain dram connector _—
City: by E' U Statc_( . 211': -)fJ S salutary sewer(no-tin.tt)
Phone ,3 GS S-%s Email: WStormer,ewer(no.lin.ft-)
CCB nom (Q�� Hs. r -water service(no.lin ft)
,Z S Plumb. reg.no:S >+i
City/memo lie no. Q AbsoWL>rption
re or item:
.��--�-- � Absorption valve
Contractor's representative signature: Back flow EEventer
Print name:imar& j Dam' - I3W_l water valve
flowl JUL,] Basu,w1avatory
cl�� _
Name-. Mli r !3n a be�- wrishcr
Dishwasher
Address: Drinintify,lountwn(s)
City: State: ZIP. EiWors/sump —
Phone:' /C.. S E taail: 'bxpansioat tank --
Fixt ue/sewer cap
/ -- -- Floor draias/Dloor sinks/huh
Name(print):— IYl (_bflml,r disposal
Malling address: 1( Hose brbb
air- - 8tnte DR _ ruakta --
phom •-rail:
Owner installationhesldential maintenantx only: •Ila actwnl iaatallation Phruer(s)
will be auk by me or the mai ntenancc and repair made by my rcPular Roof drain(comtnert:ial)
employee cm the ptuperty I uww m per ORS Chapter 447. $inlc(s;,basin(sl,tays(s)
owner'seipftahue L Dace: ---
iltbslnhowerlshower
Utltral
Name._ _ -__._ -- Watrrcloset
Addmss:
Waco heater
City --
_ �Stnte ----
Phone_—
nMre ---...... S
Not dl jwiradhm ecgtdCaTh.ri"ria juddds fr pe hvat� Nutia:Tltie prxrit application Man review(tit — h) —.
$
O46irr U MasterCard – -- --- acplrr--if a Permit it not obtained State gurcharge(8q6).._$ —
�W&c.d M 6W — within 190 dqx after it h-teen
TOTAL
.a.tgidr�ioornwp
JUN-04-2002 11:1e 5035SE11960 P.CI
CITY OF TIGARD 24-Four
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BUP —
Received `_? ?' _ Date Requested__ - AM- PM_-- ___ BUP
Location (��i �> 7 _ Suite MEC
Contact Person —------ Ph(---- —)l �' �a/�o5 -___ PLM `� —�L��/(.�
Contractor _ __ __ --_ Ph (_ ) — SWR
BUILDING Tenant/Owner _ - -__ _
_ __ ____ ELC __.--
Footing --- -- --
Foundation ELC
Access: �
Ftg Drain ELF!
Crawl Drain
Slab Inspection o es: 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
KOM
Post eam - —
Under Slab
Rough-In
Water Service —
Sanitary Sewer
Rain Drains —
Catch Basin/Manhole
Storm Drain --
Showe r//P�n
Other. I - --- —
igal:a
MP��AS�SSPART _FAIL
ECHANICAL _
Post&Beam
Rough-In - - ---
Gas Lina
Smoke Dampers — --- ------- ---
Final
PASS PART NAIL
ELECTRICAL
Service — --
Rough-In
UG/Slsh ---- - —
Low Voltage _-
Fire Alarm
Final Reinspection fee ofrequired before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PAF T FAIL
SITE _— [] Please call for reinspection RE:_ — �� J Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewall Data Inspector
Ext —
Other:_ _
Final DO NOT REMOVE this Insp.+ction record from Che job site.
PASS PART FAIL
CITE' OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00229
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/6/03
PARCEL: 1 S136CB-09900
SITE ADDRESS: 11262 SW 84TH AVE MODEL HOME
SUBDIVISION: .ASH CREEK MEADOWS ZONING: R-7
BLOCK: LOT: 0U3 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNI-, HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILERS/,_OMPRESSORS_ HOODS:
FU_EL_T_YP_ES 0 3 HP: 1 DOMES. INCIN:
m� 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: r<tPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
OD
GAS PRESSURE: 50 i HP: RYS:
ER
C
TURN < 100K BTU: All". AANDLNG UNITS CLO DRYERS:
OTHER UNITS:
FURN >=1COK BTU: <= JO cfm:
> X00 cfm:
GAS OUTLETS:
Remarks: AC'add-on. ACcannot be placed in the o ethacks.
Owner: -- -- FEES ------- - _
BOBBY GHAHERI Description `Date Amount
11262 SW 84TH AVE. X11 I I I''111111 I rc 5/6/03 $72.50
TIGARD, OR 97224
I AX I S '�taic I ax 5/6/03 $5.80
Phone: 503-684-1212 __ Total $78.30
Contractor:
ROTH HEATING &COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: so3-266-1249 Cooling Unt Insp
Final Inspection
Reg #: LIC 14008
This permit is issued subject to the regulations contained in the Tigard Municipal Code, SW of Ore.
Specialty Codes and all other applicable haws. 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 you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699.
Issuod By t4,L,` 4t},;may Permittee Signature: 6--yk �
Call (503) 639-4175 by 7.00 P.M. for inspections needed the next t"Iusiness day
Sent 'by: ROTH HEATING & A/C 503 266 3478; 05/05/03 1 :46PM
,J4LE8A—#327;Peye 4/5
HWCh:Lvgq; 9/17/01 12.61tP.M; 'SU15991950 -> ROTH HEATING t4 A/C;
Page 2
09/17/20UI 13:0e FAX 503508196o CITY OF TIGARD
t 14002
Mechanical Permit Applicafion
City of Tigard PCDjaCt/gppt I1D.:
Address: 13125 SW H&D Blvd,Ti ard, OR 97223 Expucdate:
City oj77gani g
Phone: (503) 639-4171 Date issued B Recetprno.
Fax; (543) 598-1960 p c file no,: Payment type:
Land use approval: -5-(33 ildmepcttnitno,:
&2 family dwelling or accessory l:7 CommenciaUPndustnal U Multi-family 4 Tenant talprovement
D New canstruction ` d►hedaltctttoonhcpluccmt nt Q Other.
I
Iuls address. I I Z��C ,,� y`h y _ Indicate equipment quantities in boxes below.Ltdicace tits dollar
IMF. no.:_ Sttite no: value of BE mechanical materials.equipment,labor.ovcrluad.
Tax map/tax/t lot/4rc,_mt.no.: profit. Valuc S
Lot: 131ach "Subdivision, •See checl-liat for lmpattant application informs an writ
?'solea name: i- 8 L Jurisdiction's fee schedule for residential permit fee.
Ciry/court : ZIP 17-7
Description and t ration of work on premises:
Fte(ea.) Total
Ii9G(late Of L0iTj rlAtlAn/lAB dAA: Dtycaf 'em �r� Itn,wdl Ras.tuilr
'Tenant improvement or chanfe of raise:
Is cxtcting space heated or rondldoned? as Q No Airbagdlinjt unit
[snxistltl s acainsulatud es Q o mac— o=1111=1 Wiwi=
k�nrn� safe plantequsred)` "
Alttrannnu cxlan�tl_ syttcm
13oj1riTcuiiiyi saris: -
Fusiness naral �i��N _T- State buds-r pCmut no
Addtras: HP _ Tons—_ ,BTU/N
irr/emeke am rvdu bmbmok4 derwors — -
State: ZIp: X01 catpump s�tcptanr u r --
Phone:563 1 Fax - '
,� :_�4G-�y7 E-maii. talUreplacehtrn�ce/Gurner lT/H
_CCB no.: J40O$ lncludinLi ductwork/ventlinet U YmQNo
---.- ata rep ace tr,u�ak laateib�yuspanr �'—
City/raGtra IJe.-- ~__ _ wall,nr dour Mounted
Name(plea►e ' t); yl'11nc eat for up p I,nnceo rr1anftitnace
Abrwptiununitn___ _� _� BTU/MM
Name; Or 6n,4-(.l CSiIJt rs,_ lip
Address:
--- !rtnrasmenta exhaust ein reu on:
-a�' State: 1111' n hlJnncevrnt '
Phone: Q- Fax' &tn>til: Hivel Fzaust
t tnntt„Tvve res. Itchen/haztnat "
�b hood lue supprersion System
Name: `l a�1���__ ._ Exhaust fin With single duct(bath funs)
Maihn FKhdU6t sysretn a P an flake-it 6-
rd--city; Ste. 29L, c ptlnnt: 0iW o—ah(up re a auueu
Phone.• -I f'ax. E-mail: - type. LPG —._"NO .._— Oil
Ti7r J)w- cue t t,oniu Ovet 4 pRletd
Process plptng(tchr.,nat(r.>rculrecl)
Name: Number of o,'tltsu
Address: - - (/IhtrlirtearppTwttr•earequipment.
rcatYtuve t;er�rc�_
--- __
Cir S --•.--_
. Utte: �': nerd--type
Phone. lie: E-mail: wooaatnv pal et stoves
A plic,utt's sis;uuture. bate; Cxtset:- --
Name(printf; C��L11;f�—ft'.�1
auk
Not yl itute4lctlotu tiCclll C,txtle t,pde,rleaee call junwa ioa toe tnaiee W/RWid Pertnit frc.....................S =[
0 Vito U Maize r^.ord Notice:This permit application
MiNmwn fee................$
t:r%41t cacti m mbw Mime if a parmit la not obtained Plan review(ac 76) is
within 190 days lifer ft has been $talc surcharge(896) ....$
Ham.�I carton qac a ehawn Nn ere it wA 46ceptad a9 Complete. TOTAL
.......................
41x4617(WIVA DM)
�r"s-
Sent by: ROTH HEATING & A/C 503 266 3478; 05/05/03 1 :47PM;Jetf# #327;Page 5/5
I
IE PL�
I
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q
1 l D U El
I I L71QL'L"`TION
30
STREC?1 , gqAv,s
.A DR E S9 It Z 6 2 SCJ (9 L/ 4 o /'16,44D
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BLIP
Received Date Requested�L AM PM L -_ BUP
Location __ L - 1.�1, c3Q '�l�-e_, Suite)) _. MEC
Contact PE;rson / Ph 6a — f! 27 PLM _
Contractor_ DPh( ) SWR
BUILDING Tenant/Owner� �A Pte-[� �--- `� r� � � 0� �� ELC
Footing �- ELC
Foundation Access:
Ftg Drain ELR
Crawl Dre.in _
Slab Inspe tion Notes: SIT --
Post&Beam i
Shear Anchors -- - - --
Ext Sheath/Shear
Int Sheath/Shear
Framing 47! -:
Insulation
Drywall Nailing - ---G�`* _�f G6�a►s2r: - -
Firewall
Fire Sprinkler --- -- ---
Fire Alarm
Susp'd Ceiling
Roof
Other._ -- - -- -
Final
PASS PART FAIL
PLUMBING
Post& Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other
Finui
PASS_ PA_RT_FAIL__
MECHANICAL_
Post&Beam
Rough-In
Gas Line
Smoke Dampers
frnjl�}-�
AS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltam
Fire Alarm
Final J Reinspection fee of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: [j Unable to inspect-no access
Fire Supply Line
ADA c� "S=G
Approach/Sidewalk Date �_. inspector
Other
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL