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14620 SW 92ND AVENUE N O CN C (D N n D CD c m 14620 8W 92nd Avenue f'� /� MASTER PERMIT CI`�Y O F T i V A R D � PERMIT#: MST2001-00559 DEVELOPMENT SERVICES DATE ISSUED: 12/7/01 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 14620 SW 92ND AVE PARCEL: 2S111AC-01200 SUBDIVISION: PINEBROOK TERRACE_ ZONING: R-4.5 BLOCK: LOT:053 JURISDICTION: TIG REMARKS: Addition of 270 sf for kitchen. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 9 FIRST: 170 el BASEMENT: of LEFT: SMOKE DETECTORS: TYPE OF USE: 9F FLOUR LOAD: 40 SECOND: at GARAGE: el FRONT: PARKING SPACES: RIGHT: 36 TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: at VALUE: $24.462 00 OCCUPANCY GRP: R9 BORM: BATH: TOTAL: 27000 of REAR: 35 PLUMBING SINKS: I WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: t CATCH BASINS: TUB/SHOWERS: GARBAGE DISP 1 WATER HEATERS WATER LINES: BCKFLW PREVNTR. GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100N: BOIL/CMP<AHP: VENT FANS CLOTHES DRYER: FURN>-100K: UNIT HEATERS: HOODS: I OTHER UNITS: I GAS MAX INP: btu f'LOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL REBID EN�IAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1 PUMPIIRRIOATION: PER INSPECTION: 1000 SF OR LESS: 0 200 amp: 0 - 200 amp: WISVC OR FOR EA ADD'L 5009F: 201 400 amp: 201 100 amp: tetWlO SVCIFDR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 •800 amp: 401 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HMISVCIFOR: BOt 1000 amp: 601 rampa•1000v: MINOR LABEL: 1000+amplvoll: PLAN REVIEW SECTION — Reconnect only: >-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREA)SPC OCC. ELECTRICAL•RESTRICTED ENERGY _ — — B.COMMERCIAL A.SF RESIDENTIAL AUDIO 8 STEREO; VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INIERCOMIPACING: OUTDOOR LND9C LT: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNI.: BURGLAR AI:NM: OTH: MEDICAL: OTHR: GARAGE OPENER: CLOCK: INSTRUMENTATION: DATAITELE COMM: NURSE CALLS: TOTAL N SYSTEMS: HVAC: TOTAL FEES: $ 783.26 Owner: Contractor: This permit is subject to the regulations contained in the MCILVAIN,JOHN R+JULIE T KOHL INC Tigard Municipal Code.State of OR. Specialty Codes and 14620 SW 92ND AVE PO BOX 145 all other applicable laws. All work will be done in TIGARD,OR 97224 WILSONVILLE.OR 97070.0145 accordance with approved plans. This permit will expire If work is not started within 180 days of Issuance,or if the work Is suspended for more than 180 days. ATTENTION Phone: Oregon law requires you to follow rules adopted by the Phone: Oregon Utility Notification Center. Those rules are set Reg M: LIC 60139 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 Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Electrical Final Foundation Insp FootinglFoundalion Dr; Electrical Rough In Gas Line Insp Mechanical Final g Framin Insp Insulation Insp Plumb Final post/Beam Structural PLM/Underfloor Reln drain Ins Final Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp P Underfloor Insulation Plumb Top Out Exterior Sheathing Insi Water Line Insp Issued By : 1 I- Permittee Signature Call (503) 639-4175 by 7:00 p.m.for an Inspection needed the next bdsiness day Building Permit Application Date received:�� ) Permit no.: •�-- 9 City of Tigard - Address: 13125 SW liall Blvd,Tigard,UR 9722 Pr°jecVappl.no.: Gxprre�l-ze: C.ityof7igurd ^� Phone: (503) 639 17 z Q,U 1 n X/` Date issued: By& Receipt no.: \ Fax: (503)598-196 V"" 1� (� p �)ft" Case file no.: Payment tyro: Land use approval: V t t 1&2 family:Simple Complex: Li & 2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction 0 Demolition h!f Addition/alter ition/replacement U Tenant improvement U Fire sprinkler/alarm O Other: JOB Sin(NFORMATjON. Job address: 1J/(pBISW Z'' T`/ �]* OK Bidg.no.: Suite no.: LAW S Block: Subdivision: FIN C, T I'I'ax nzap/tax lot/account no.: 0900ssY Project name: #e I AALA (Lle alt oDEL __ Description and location of work on premises/special conditions:. ADD 270 '1D ?q�yrr: d*"- Ffb�/SC' Name ,e�AlAc1 t J✓uzr �W�� Mailing address: c? .Z 1&'l fatally dwelling: _City: TI A P, Z State: IP:97ZZ Valuation of work........................................ $cl tf y Phone: Fax: E-mail: No.of bedrooms/baths................................. 4NNamw ner's representative:p Total number of floors...................... ne: Fax: E New dwelling area(sq,ft.) -mail: ....... Garage/carpon area(sq.ft.)......................... _ OWL., /✓G Covered porch area(sq. ft.) ......................... Mailing address: S- Deck area(sq. 11.) ........................................ _ City: /LSpA, Stale ,07a area ZIP: ) Other structure aa(s . ft.)......................... t h Phone: Fax p mriil: Commercial/induRtrial/multi-family: Valuation of work........................................ $ Existing bldg.arca(sq,ft.) ....../......... -- Business name: pf/( e- Address: p ..... — /'�/ --- - -- New bldg.area(sq. ft.) ............ -- City: {/ --- - State ,�. ZII' AO?p Number of stories............ .__ Phontj 6 P2' Faxb6'l-D E-mail: Type of construction.....................„ ,. Occupancy group(s): . Existing: CCB no.: O J New: _ City/metre tic.no., — Notice:All contractors and subcontractors are required to be licensed with lbte Oregon Construction Contractors Board under Name:_76-W L provisions of ORS 701 and may he required to be licensed in the Address: /p/ W , jurisdiction where work is bring performed. If the applicant is City: Statwf ZIP: Z exempt from licensing,the following reason applies: Contact person: flan no.: - — Phone: Fax: E-mail. -- ------ fiwi port]10 N X Name Ar( -f r tContact person: Fees due upon application ........................... $ Address: Date received: _ City: State: ZIP: Amount received ......................................... $ Phone: Fax: I E-mail: Please refer to fee schedule. 1 hereby certify I have read andex ined this application and the Na all)udsdictiotu rcept credit carte,pleme call)udsdkdon far mcwe inforrtWion. attached checklist.All p sio of aws and ordinances governing Utis U visa U MasterCard work will bx complied it I e r A led herein or not. credit card number �_---- F�eplree Authorized si nature: _--_-__ -- Uate:�� -0 — N. cardho uiTr shown on creta--carr' Print name: - --cs�horrer iiywtrrc 3 Amcwni Notice:This permit ap cation expires if a permit is not obtained within 180 days after it hes been accepted as complete tWt 4611 W1111COM) One- and Two-Family Dwelling Building Permit Application Checklist Reference no.: -- — - -- Assoc iatedpermits: City of Tigard city, of 'rigard U Electrical U Plumbing U Mechanical Address: 13125 SW hall Blvd,'Tigard.OR 97223 LJ Other: _— Phone: (503) 639-4171 Fax: (503) 598-1960 *jIll NJ Q 3102211 I Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. 4 Fire district _approval required. _ 5 Septic system permit or authorization for remodel.Existing system capacity _^ 5 Se"or permit. 7 Water district approval.It Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion n li ontrol U plan U permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 y3 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 he 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 completeJ if co right violations exist. — 11 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if there is mon:than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;f(otprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor Ix)Its,any hold-downs and reinforcing pads,connection details,vent size 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-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross s.ction may he required to clearly portray construction.Show details of all wall and nof-sheathing,roofing,not slop(:.,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal 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 building envelope. I-,ull-sire 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 11011-pircscriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. — 18 Basement and retaining walls.Provide cross sections and details showing placement of rehar.For engineered systems,see item 22,"Engineer's calculations." I9 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over Ill feet long and/or any beant/joist carrying a non-uniform load. 20 Manufactured boor/roof in, design delalls. _ _ 21 Energy Code compliance.Identify the prescriptive paih or provide calculations. A gas-piping schematic is required for four or more a�laiancoa. a 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof miss)shall he stamped by an engineer or architect licensed in Orcgon and shall be shown to hr opplicahle io the project under review. 23 Five(5)site plans are required for Item I I above. Site plans mist he M-112" x I I"or 11" x 17". 24 Two(2)sets each are required for Items 16, 19,20 8( 22 ab owe. 25 building plans shall not contain red lines or tape-ons. 26 No mlled,reversed or t,dm)rcd building plans will he accepted. 2 - 28 Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. itcd ink Is reserved for department use only. 44n4614itsMOMt Electrical Permit Application — 7Caseffile d: Permit no.: q c;j• /.0 City of Tigard .no.: — Expire date: Address: 13125 SW Ball Blvd,Tigard,OR 97223 By: Receipt no.: Coy://if rlyd Phone: (503) 639-4171 .: Payment type: Fax: (503) 598-1960 Land use approval: — ❑ 1 &2 family dwelling or accessory U Commercial/indnslrial U Multi-family ❑Tenant improvement U New construction 14Aricliiinn/alteratilm/replaccmcnt U Other: U Partial 1 1 , Joh address: Q O -J Ali I Bldg.no.: I Suite no.: ITax map/tax lot/account no.:oW$VOv Lot: T3, Block: Subdivision: Project name: i Description and location of work on premises: _ Estimated date of cont Ietion/inspectirm 1 Dtr Mart Job nos v N��rL... _ - Description l)ts. (ca.) Total no.lmp Business name: fl —_ -- -.-- — Newrevtrlential-single ormulli fami!v tier Address: PO &X dwelling unit.I ncludcs attached garap•. Slate:0 ZIP:97 Service included: City: I oxlo%t't.or Ics� 4 Phone: Y Fax 3' E-mail: ---- -- Each additional SW s .Itor or"01)thereof CCB no.:/t/ f / Elco.bus,lie.no: Z9-7NG Limitedenergy.residential 2 City/metro lie.no.: ,� iJ A /,, �(i' Li mi led energy,non-residential 2 ' 1'.ach manufactured home ur modular dwelling 2 Service and/or feeder Signature of supervisin electrician(required) Date J--f- �•3S Services or fceden-Installafton, sup.elect.name(pant I. 7 c K. f-c�/Z. License no. alteration or relocation: Zoo amps or less 2 211 amps to 4W ams 2 Name(print): UmAj 4- I d" _ �Ll.�LJ — --- 401 amps to 600 amps 2 Mailing address: /tIG20 _ 77 40" 601 amps to I(NlOamps 2 City: Slatt00— ZIP:§7Z&A'/ Over I(xN)amps orvolt. Fax: Email: Recunnectonly Phone: Temporary services or feeders Owner installation: i'hr installation is being made (,u property I own Installation,alteration,or relocation: which is not intended for sale,lease,rent.or exchange according to 2W am Not leas ORS 447,455,479.670,701. 2)1amps l0 4W ampsOwner's si'naturc: Date: 401 to 6M ut. 4:;2 Branch circus'.IN I new,aheratlon. or exlensln�i•.r panel: Name. j /uL 1%te� A I,cc for branch circuits with purchase of 2 / �� service or feeder fee,ench branch circuit Address: N. Fec for branch circuits without purchase City: Q State' 11' 12, of service or feeder fee,first branch circuit 2 III One: Fax: li-mail: N.uch ndditionai branch circ•uir Mise.(Service or feeder not Included): 2 F.ucl, um or irrigation circle 2— U Service over:125 coups coon„arc,:rl U Health care facility Hach sign nr outline lighting U Service over''20 amps•rathng of I,'k2 U Ilazaduus location Signal circuital in a limned energy panel. - familvdwellings UBuilding civet l(i,(xl(Isyuarcicctlout nr Signaliitcuit000rali 2 U System river 6(x1 volts nrinunal nwre residential units in one structure — U Building over three stories U feeders.4(NI amps or noire •Ih serition U occupant load over Y9 persons U Manufactured structures ria RV park Each additional Inspection over the allonable I�y of thel l U t Egress/lighnngplan U Other: Per ins tion Submil—sets of plana with tiny of the above. Investi aeon fee The above are not applicable to temporary construction service. Other _ Permit fee.....................$ Not all lurisdicti,uw Mcepn credit cards pleas call lurlulicuon fm more In6xmru,x, Notice:This permit application plan review(at _ %) U Visa U Masietcard expires if n permit is not obtained State surcharge(896)....9i �-- within 190 days after it has been Credit card nund,er - — -- spires TOTAL accepted as complete. Name of canthal r rr shown on c It card S "I4615 1tA101'OM1 C'ardhohktiit{nnturc Amounl Electrical Permit Fees: Limited Energy Fees: - —- - -- — TYPE OF WORK INVOLVED -RESIDENTIAL ONLY [&niplete Fee Schedule Below: —Restricted Energy Fee...................................................... $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq.ft.or less _ $145.15_ 4 Audio and Stereo Systems Each additional 500 sqft or portion thereof $33.40 1 C1 Burglar Alarm Limited Energy $75.00 _ Each Manufd Home or Modular Garage Door Opener' Dwelling Service or Feeder _ $9090 2 Services or Feeders [] Healing,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 Vacuum Systems' 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 2 n Other 601 amps to 1000 amps $240.60 2 ILJI Over 1000 amps or volts $454.65 2 ---- Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIA i JyLY Installation,alteration,or relocation 200 amps or less _ $66.85 2 Fee for each system................................................... $75.00 201 amps to 400 amps $100.30— 2 (SEE OAR 918-260-260) 401 amps to 600 amps $133.75 2 Over 600 amps to 1000 volts, Check Type of Work Involved: see"b"above. ❑ Audio and Stereo Systems Branch Circuits New,alteration or extension per panel Boiler Controls a)The file for branch circuits with purchase of service or feeder fee. Clock Systems Each branch circuit $6.65 2 b)The fee for branch circuits Data Telecommunication Installation without purchase of service or feeder fee. F-1 Fim Alarm Installation First branch circuit �_ $46,85 Each additional branch circuit $665 __.. HVAC Miscellaneous (Service or feeder not!iicludeo) Inst,umentation Each pump or Irrigation circle $53 40 Each sign or outline lighting $5340 Intercom and Paging Systems Signal circull(s)or a limited energy panel,alteration or extension _ $7500 A._ Minor Labels(10) $125.00_ Landscape Irrigation Control' Each additional Inspection over Medical the allowable In any of the above Per inspection $62.50 Nurse Calls Per hour $62.50 In Plant $73.75 Q Outdoor Landscape Lighting' Fees: Protective Signaling Enter total of above fees $ _ Other_____ 8°/.Slate Surcharge $ 25%Plan Review Fee _ Number of Systems See"Plan Review"section on $ ' No licenses are required. Licenses are required for all other installations front of application Total Balance Due $ _ Fees: r- Enter total of above fees S lJ Trust Account rY 81n State Surcharge Total Balance Due i Wsls\rormsteIc-fees,doc 10/09/00 Mechanical Permit Application Date received: Permit no.: City of Tigard — �• �� • Address: 13125 SW Hall Blvd.Tigard.OR 97223 Projecdappl.no.: Expire date: City of Tigard g' Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503)598-1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE 1 U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction ❑Tenant improvement f�iAddition/alter>.tion/rcplacemenl U Other: UPI Job address: L/(p,Zv sre�1+2 Indicate equipment quantities in boxes be Bldg.no.: Suite no.: low. Indicate the dollar value of all mechanical materials,equipment,labor,overhead. Tax map/tax lot/account no.:/j p 5 00/S profit.Value$ Lot: Block: Subdivision: /, i9cU+� *Sec checklist for important application information and Project name: 0 jurisdiction's fee schedule for residential permit fee. City/county. 1 Description and location of work on rcmises:P �' t Est.date of completion/inspection: — heti(c:►.) I oral Description (11y. Res.oni Res.onh Tenant improvement or change of use: 11 Is existing space heated or conditioned?U Yes U Nr, Air handling unit CFM Is existinp space insulated?U Yes U No Air conftionmg(sitepIanrequtre ) -- Alteration of ex sting C system 1 1o er/compressors Business name: f State boiler permit no.: Address:/r/(.r? At 40✓✓mss/O9- A HP Tons 13TU/II ire smo edam er uctsmo edctcctnrs City' QAER StateOe. ZIP9700 Z f cat pump(site p an require ) —- Pho Fax: E-mail: nsta rep ace furnac011urner B CCB no.: O no.:fy7 Including dU ductwork/vent liner U Yes No ' �� — Insta rep ac re ocatc eaters-suspende , City/metro lie.nwall,or floor mounted Name(please print): RomPA"�J' Vent fi,r a ianccother t an furnace KIM e genal on: Absorption units 13TU/H Name: Chillers lip -- Address: --- Com ressors_ NP City: State: ZIP: nv ronmeri ex ust an vert ventilation., Appliance vent Phone: Fax: E-mail: )rycrex aunt — 0o s, 1 ypc res. itc en/hazmal hood fire suppression system _ Name: .F,�,t, . tom_ 04 _ Exhaust fan with single duct(bath fans) Mailing address: 2,0 �w ix aunts stem apart from ,eat n or C' CUL-r76,4017 ZIP, Fuel piping an stn ution(up to out cts) Phone: Fax: E-mail: ly _I.PO N(7 ()ifue i to rac a iuona civet nut cls - rocess p p nR(sc temauc requ re 1 Name• yI_L��dzr Number of outlets Address: /(J/9 s' _� t e— t er st app ance or equ pment: — __ Decorative fireplace C.lty: G/f Slat ZIP: jp;,;A Insert_type — ph -- a [:moil: wDouslovelpellelslovc Applicant's signatur :I Date: ,v/ Ol cr. Name (print): --- ter: NW all)udullcnons accept cnrllt cnrrly,plrnw<cull iurirdicnun Irn mole Infnmmuun Permit fee.....................$ U Viso U MasterCard Notice:'Phis permit application — - Minimum fee................$ Credn cod number expires if a permit is not obtained plan eview(at r %) $ _ ---gym; within 1811 days alter It has been State:wrchar a(8%)••••$ _ Nmnt of cnr'dholaei as shown an cieJU cnnt accepted as complete. g -- C bol r B1 nature s Atnounl TOTAL ...................... $ 441-1617(&U"M) Commercial Sch3dule 1&2 Family Dwelling Schedule ASSUMED VALUATIONS PER APPLIANCE Description y -� of Price Total l Code FFumace to 100,000 BTU 1) F 1AMechani 00BTI _ y 1) Fumax l0 100.000 BTII '14 00 including ducts&vents 955 Mduding 2) Furnace 100.1x10 BTUr 17.40 Furnace>100,000 BTUinclude duds a vents_ 1 170 3) FW Fumace 1400 Including ducts&vents _ includln vent -- _ floor furnace 4) Sus rifted heater,wall heater 1, or Boor mounted healer including vent 955 5)vent not Included in appliance permd 680 suspended heater,wall heater 6) Re,U uncia 12.15 Or(loot mounted heater __ 955 Chec all that apply 'Boiler Heal Air Vent not Included in appliance permit 445 For Hems 1.10,sea or Pump Conal city Price Toll LI)OIK oles 1,2 Com Repair units 805 BTbsorb unN l0 COU -- BTII <3 hp;absorb.unit B)3.15 HP,absorb ur16 to 100k B'TlJ 955 took to sock BTu9)15.00 HP.absorb 3.15 hp;absorb.unit unn.5.1 mil BTU _1700 tOj 30.50 HP:absorb 101k to 500k BTU un6 1.1.75 mil BTU15-30 hp;absorb.unit 11)>50HP,absorb un6>1.75 and BTU --501k to 1 mil.BTU 2310 12)Alr h,ndlingunN Io 10,000 CFM 30-50 hp;absorb.unit 13)Air handling un6 10,000 CFM t17.2011.1.75 mil.BTU 3400ta)Noportable ev,ponle cooler>50 hp;absorb.unit 15)Vent tan cpnneded to,singk dud>1.75 mll.BTU 5725 656 1G)Venl1. all system not included in 1000 Air handling unit to 10,000 cfmunaeperm6 Alr handling unit>10,000 dm 1170 11)Hood served by mechanlal erh— cruel — 10 00 VHood able evaporate collar 656 1 e)tMmeslic incinerators 17.40 connected to a single duct 446 19)comnlerdal or kWuslrlal type Indne"tor 69.95 .not Included In appliance permit 656 70)Other unHs,InGudlrq wood stover 10.00 ved by mechanic��l exhaust656Incinerator 1 170 71)Oes Plpi p ono to lour outlets 5.�0 Commercial or industral Incinerator 4590 22)Morc—than 4 pot°cls(each) 1,00 Mmimllm Pennll Fee 12.60 SUBTOTAL Other unit,Including wood stoves,Inserts,etc. 656 -- 8%SUR Gas piping tat outlets 360 -rwN—R�v1Ew 25x ofsunTotnl Each additional outlet — 63 _ Required for ALL Commercial Permits only TOTAL. Other M,pections and res+ 1 Inryfectiorls oulelde M nanW b„slne%s t_,%fnenM>Nr duras Iwo hour) 177 so per hour ] Intpncedts Ar wlxfr ro tee h%r+rl�Ally eMruted I"Mnw "Or Iult haat 6/2 sow M,e eddltans a revlslms b Plena'"W'"3 M1dd,eW I plan tav Offiwod W dwrpea talion _ f'ec -- chis"" -Jus howl 6)2 W pn Mur •BtaM Conlredra anger eerglicalnn reciWed W.tees acre Plan%MYdng plersml•tll of Un' S1.00 to$5,000.00__M �lininlum 572.50 55,001.00 to 510,000,00 — - - $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof, to and including$10,000.00 $10,001.00 to$25,000.00— $148.50 for the fret$10,000.00 and S1.54 for each additional$100.00 or fraction thereof,to and including$25,000.00 $25,001 b6 to$50,000.0(1 for each additional$100.00 orfrecUo 1 q 5 thereof,to and including$50,000.00 $50,000.00 and ur.. ---_—_-_-- — 5742.00 rot the first$511,000.00 and 51.20 for each additional$100.00 or fraction thereof ___— Plumbing Permit Application Date recei ved: Permit no.: City of Tigard Sewerermitno.: Building Address: 13125 SW Hall Blvd,Tigard,OR 97223 p gpermitno.: City(if Tigard phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503)598-1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: ❑ I &2 family dwelling or accessory U Commercial/industrial ❑Multi-family ❑Tenant improvement U New construction Add ition/aIteration/replacemeni U Food wrvic•e U Other: It SITEINFORMATION1 Job address /t((020 +�' I/e�eriptiun _ Qty. I'ce(ea.) Total New 11-and 2-Ltwily d"mcilings only: — — Bldg,no.: — suite no.: (includes 100 ft.for cad]unlit}conned tiotl) Tax map/tax lobaccount no.: 05' / — SFR(1)hath Lot: Block: Suhdivision E6t1w— T SFR(2.)bath — — Project name: ✓ SFR(3)bath City/county: IAW I ZIP:477Lt-1-Y Each additional bath/kitchen Description and location of work on premises: � Sileutilities: _ er;.� Catch basin/area drain [s't.date of completion/inshr,timi Drywells/leach line/trench drain PLUMBING 1 1 ' Footing drain(no.lin. ft.) Business name: Manufactured home utilities ;vf(✓ PCvrl(�//,uManholes Address Ale e*&LW'aS Gr• AIWO(oXf Rain drain connector City: _ SCI 2!5. jStatc:!?AjzlP1?//z Sanitary sewer(no.lin. ft.) Phone: . l Fax: I E-mail: Storm sewer(no.lin.ft.) CCB no.:/ ,Z Plumb.bus.reg.no: Water service(no.lin.ft.) City/metro tic.no.: S.7,p C);y k..__VVre Fixture or item: Contractor's representative signature: , � � Absorption valve Print name: Dale: — Back flowreventer _ Backwater valve CONTACT1 Basins/iavatory Name.: �jbCj bjpy,�/iJ� _ Clothes washer Dishwasher Address: rAr Drinking fountain(s) _ City: I State: ZIP: Ejectors/sum Phone: Fax: E-mail: Expansion tank 111111010 1 ixture/sewer cap _ Name(print):Jou0_+ Jo14-' f/ l,J Floor drains/floor sinks/hub -- .—.-----_MailingGarbage disposal address: n&Zo Stns Garbage bibh City: 7" //!-p SlateDe 7..IP. Ice maker Phone Fax: I E-mail: Interceptor/grease.trap Owner installation/residential maintenance only: The actual installation Primer(s) �— will he made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the pnmheriv I own as her ORS Chapler 447. Sin (s),basin(s),lays(s) Owner's si nature: _ I salt _ _ Sump gm Tubs/shower/shower pan Name: 7TAEK4e! Urinal Water closet Address:/p/fr — (�_�t,tF Water heater City: ��tlQ _ Stat 7.1PW2!V? Other: -- Phone: E-mail: Total Not all Juridictions weep"credit cods,please call jurisdiction fo more Infomulton. Notice;'Phis permit application M illitilum fee................ U Visa U Ma%lcrCard expires if a permit is not obtained Plan review(at , %) $ Credit card number _ within IRO days allcr it has been State surcharge(11%) ....$ aptre' TOTAL accom Tele. """""'•'••"•'•'•• Name of c of rr u-shown on credo card accepted p S signature —Amount -- — 440-41616100/('oMl P15ME COMP ETE pty Price Totall Fixture Type nua--"nti b Work P Naw Moved Replaced RamoveNCaPPed FIXTURES (individual) — 16,60 _ Sink Sink -_-.------" 16.60 _ -- Lavatory Lavatory 16.60 Tub or Tub/Shower Combination Tub or Tub/Shower Comb. _—___ 16,60 Shower los Water Closet Shower Only 16.60 Urinal Water Closet _�— 16.60 Dishwasher - Garba a Disposal Urinal 16.60 Lound Room Tra Dishwasher 16.60 Washing Machine _ Garbage Disposal 1Floor Drain/Floor Sink 3: 6.60 Laundry Tray 16.60 Water Heater Washing Machine 16.60 Other Fixtures S ci _ Floor Drain/Floor Sink 2' 10.60 3" 16.60 4" 16.60 Water Heater O conversion O like kind Gas pi in re uires a se arale nechani�rmil. 4466.40 MFG Home New Water Service 46.40 COMMENTS REGARDING ABOVE: MFG Home New San/Storm Sewer 16.60 Hose Bibs 16.60 --- — ---- __ Root Drains 16.60 Drinking Fountain 21.75 Other Fixtures(Specify) -- 55.00 ....+... ,,,,® "!we(-1 st 100' 46.40 Sewer-each additional 1 ou__ 55.00 Water Service-1st 100' 46,40 Wale,Service-each additional 200' 55.00 Storm 6 Rain Drain-1st 100' 46.40 Storm 6 Rain Drain-each additional 160 46.40 Commercial Back Flow Prevention Device 27.55 Residential Back low Prevention Device* _ 16,60 Catch Basin 72.56 Insp.of ExIstIng Plumbing or Specially Requested er/hr Ins lions 65.25 Rain Drain,single family dwelling 15,60 Greaso Traps ri. ,., QUANTITY TOTALR Isometric or riser diagram Is requked M OuantMy Total Is -SUBTOTAL ; 8%SURCHARGE ;-PLAN REVIEW 26%OF SUBTOTAL ,t„ Requited?" re qty local Is>9 TOTAL- h�� "t, It Ise is$72.50♦X%aurdrarge.cz:.ept Residential Bsck"prevention •MDervld 0jd,M 176 25 4 fI*urtAr9e "AIL Naw Commetilal Bulidlnq a require plans MMh Isometric a riser diig Dan roview 100.0' - I 00 OD 1 1 rho � I t ^ 1 �� o tl�• �-• `: w a I I I' g w•- t I • � o A rn I I I 20'-0" ------gN------ 13'-6' 35'-6i —# I I I rn I I _ I c 100.0' ' b ? � O � w - J 100'-0' r .t J CITY OF T I GA R D _ ELECTRICAL PERMIT PERMIT#: ELC2000•00490 DEVELOPMENT SERVICES DATE ISSUED: 8/17/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PAROL: 2S111 AC-01200 SITE ADDRESS. 14620 SW 92ND AVE SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5 BLOCK: LOT : 053 JURISDICTION: TIG Proiect Description: Installation of two branch circuits. _ RESIDENTIAL. UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE L'(G: LIMITED ENERGY: 401 - 600 amp. SIGNAL/PANEL: MANF HM/SVC/ FDR: 601+:imps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS _-- --- ADD'L INSPECTIONS 0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: list W/O SRVC OR FDR: 1 PER HO'.rR: 401 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT- 601 - 1000 amp: _ PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAI Reconnect only: SVC/FDR >= 225 AMPS: ___CLASS AREA/SPEC OCC: _ Owner: Contractor: MCILVAIN, JOHN IR +JULIE T PORTLAND STATE ELECTRIC 14620 SW 92ND AVE PO BOX 230933 TIGARD, OR 97224 TIGARD, OR 97281 Phone: Phone: 233-8030 Reg#: LIC 96644 SUP 4125s ELF 26-854C FEES _ Required Inspections Type By Date Amount Recoipt Elect'I Service PRMT DEB 8/17/00 $42.85 0004559 Elect'I Final 5PCT DEB 8/17/00 $3.43 0004559 Total $46.28 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Spedalty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain cop"ofthese rules or direct questions to OUNC at(503) 246-1987. I PERMITTEE'S SIGNATURE -� ISSUEb BY QLfYVI. 1 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: nCONTRACTOR INSTALLATION ONLY SIGNATURE OF Sll9R. ELEC'N: _� _ r� tj ) DATE: LICENSE NO: Call 639-4175 by 7;00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan Ch # 1312513W HALL BLVD. Recd BV, TIGARD OR 97223 Date Recd 1-17-00 Phone(503)639-4171, x304 Date to P E.Date to DST+ Inspection (503)639-4175 Print of Type Permit# Fax(503) 598-1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name(or name of business)__ MC rc. ✓q r N Service included: Items Cost Sum Addresslu U /4(0 Z,1) 5 . VJq 2. --- 4a. Residential-per unit City/State/Zip -Tl C—fr 02Z 1000 sq M.or less S 117 75 4 Each additional 500 sq ft.or portion thereof $ 2675 1 Commercial ❑ Residential Limited Energy $ 6000 Each Manufd Home or Modular 2a. Contractor installation only: i Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance .ipplicants must provide contractor license nb.Services or Feeders infortnation for COT data oase). Installation,alteration,or relocation Electrical Contractor 7 TPtTfi EL i�G 200 amps or less $ 64.25 2 Address P, Q. $0 X 2. 3-093.3 201 amps to 400 amps $ 8550 2 CityT D State (� _Zip 4 7 401 amps to 600 amps $ 12850 2 601 amps to 1000 amps $ 19250 2 Phone No ;-53 —9 03—0 — Over 1000 amps or volts $ 363.75 2 ,lob No. _ Reconnect only $ 53.50 2 Elec. Cont. Lice. No. Exp.Date /0-01-00 4c.Temporary Services or Feeders OR State CCB Reg. No. 9141 Exp.Date02-08-01 Installation,alteration,or relocation COT Business Tax or Metro No. � /S Exp.Date 0 7-O/-0 1 200 amps of less $ 5350 2 201 amps to 400 amps $ 80 25 _ 2 401 amps to 600 amps S 10000 2 Signature of Supr. Elec'n ��-G• 1.�� Over 600 amps to 1000 volts. see"b"above. License Na �� --5 __Exp.Date 4d.Branch Circuits Phone No —'¢ 13 a _ New,alteration or extension per panel a)The fee for branch circuits 2b. For owner installations: with purchase of service or feeder too. Print Owner's Name Each branch circuit __ $ 5 35 _ 2 Address __ _ b)The lee lot branch circuits i -— --- without purchase of service City -- _State,___ZIP_�_... or feeder fee. r/ Phone No. _ _ _ v First branch circuit $ 37 50 /• �d Each additional branch circuit �_ $ 535 , The installation is being made on property I own which is not 4e.Miscellaneous intended for sale,lease or rent. (Service or feeder not included) Each pump or Irngation circle $ 4275 Owner's Signature _ Each sign or outrire lighting _i $ 42 75 _ Signal circuit(s)or a limited energy 3. Plan Review section (if required):* panel,alteration or extension $ 6000 Minor Labels(10) $ 10000 —_ Please check appropriate item and enter fee In section 58. 4f.Each additional Inspection over _ 4 or more residential units in one structure thq allowable In any of the above Service and feeder 225 amps or more Per mspeclion $ 50.00 _ _ System over 600 volts nominal Per hour $ 5000 Plant $ 59.00 __. Classified area or structure containing special occupancy as -- described in N E C Chapter 5 5. Fees: 5a.Enter total of above fees $ Submit 2 sets of plans with application where any of the above apply. 8%Surcharge(08 x total fees) $ Not required for temporary construction services. Subtotal S 6b,Enter 25%of line 5a for NOTICE Plan Review If required(Ser. 3) PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal S ----- IS NOT COMMENCED WIVIIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ 1 rust Account# -, a Z AT ANY TIME AFTER WORK IS COMMENCED �f notal balance Due $ Ito . 2 i�dsts!16rm rlrlrch is dot: CITY OF TIGARD MECHANICAL PERMIT ------------ DEVELOPMENT SERVICES PERMIT#: MEC2000-00324 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 14620 SW 92ND AVE DATE ISSUED: 8/11/00 SUBDIVISION: PINEBROOK TERRACE PARCEL: 2S111AC 01200 BLOCK: ZONING: R-4.5 _ LOT: 053 JURISDICTION: -rIG CLASS OF WORK: ALT _ TYPE OF USE: SF FLOOR FURS: EVA OCP OLERS: OCCUPANCY GRP: UNIT HEATERS: VENTS W/O APDL: VENT FANS: STORIES: BOILERS/COMPRESSORS VENT SYSTEMS: FUEL TYPES -- - HOODS: 0 DOMES. INCIN: MAX INPUT: 3 - 15 HP: BTU 15 -30 HP: COMML, INCIN: FIRE DAMPERS?: FIRS PRESSURE: 30 - 50 HP: REPAIR UNITS: FURN < 100K URE: 50 + Hp: WOODSTOVEs: FURN < 00K BTU: AIR HANDLING UNITS CLO DRYERS: <= 10000 cfm- ---- OTHER UNITS: Remarks: New gas furnace with A/C > 10000 cfm: GAS OUTLETS: Owner: MCILVAIN, JOHN R +JULIE T - 14620 SVV 92ND AVE Type By ;cu TIGARU, OR 97224 ReceiptPRMT RCP5PCT RCf04446'` 04446Phone: ---- Contractor: HARDY PLUMBING + HEATING 14689 NE COUNTP,YS!r)E AURORA, OR �i7002 REQ_ U_ IRED INSPECT_ IONS Phone:222-9654 Mechanical Insp Reg #:LIC 00060947 Cooling Unt Insp PLM 3-234 Duct Inspection Final Inspection This permit is issued subject to the regulations contained ire and all other applicable laws All %,,ork will be done in accordance ',vith approved plans. This permit the Tigard Municipal Code, State of Ore Specialty Codes not started within 180 days of issuance. or if work is suspended for more than 180 days. ATTENTION requires you to follow rules adopted in the Oregon Utility Notification Center. Those r Wil! expire if work is 952-001-0010 through OAR 952-001-0080, You may obtain copies of these rules or Oregon law rules are set forth in OAR calling (503)246-9189 direct questions to OUNC by Issue By. ._ Permittee Signature: _ Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day — CITY OF TIGARD Mechanical Permit Application Plan Check# PP Recd By , rA& _ 13125 SW HALL BLVD, Commercial and Residential Date Recld TIIGARD, OR 97223 1" % Date to P.E. (503) 639-4171, x304 Date to DST _ Print or Type Permit# 6VK,-2Z&) Incomplete or Mee ible a plications will not be accepted _ called 003 Name of Development/Project Description Table 1A Mechanical Code City Price I Amt Job Street Address Sune# i A) Permit Fee 16.00 Address '114.10 5L.l C? 1) Furnace to 100,000 BTUv Bldg City/Stale Zip including ducts 8 vents __ _� 9.65 _ 2) Furnace 100,000 BTU+ Including ducts&vents 12.00 _ Name(or name of business) 3) Floor Furnace Owner -) including vent 9.65 _ Mailing Address 4) Suspended heater,wall heater " M or floor mounted heater 9.65 City/State Zip -rPhone 5) Vent not included in appliance ermit 4.75 _ Check all that apply: 'Boiler Heat Air For Items 6-10,see or Pump Cond City Price Anil Name(or name of business) footnotes 1,2 Com 6)Repair units Occupant Mailing Addiess 8.40 7)<3HP;absorb unit to 100K BTU _ 9.65 City/State zip Phone 8)3-15 HP;absorb unit 100k to 500k BTU 17.65 Contractor Name 9)15-30 HP;absorb ItA unit.5-1 mil BTU 24.15 Prior to permit Mall ng Addres 10)30 50 HP;absorb Issuance,a copy / " /-�f' eLunit 1-1.75 mil BTU 36.00 of all licenses City/State Zip hone 11)>50HP;absorb unit>1.75 mil BTU are required If q 7L9Q ") - _ 60.15 expired In COT Oregon Const Cont.Bard Lic# Exp Date 12)Air handling unit to 10,000 CFbi database 7.00 — Architect N8rt18 13)Air handling unit 10,000 CFM+ 14)Non-port11.85able evaporate cooler - or Mailing Address 7.00 15)Vent fin connected to a single duct f.nCJInCCr CNylState Zip Phone 4,75 16)Ventilation system not included in appliance permit 7,00 Descnbe work to be done: 17)Hood served by mechanical exhaust _ New`{ Repair O Replace with like kind: Yes O No O 18)Domestic Incinerators 7,00 Residential Ir Commercial O Modification O 19)Commercial or Industrial type Incinerator 12.00 Additional Information or description of work: 48.25 A/,r LJ L h r W____1/ h,C eAS RIP/.J 20) Other units,Including wood stoves 7,00 NOTE: For Commercial projects only;Units over 400 lbs.,located on the 21)Gas piping one to four outlets roof,require structural caics. re ared b licensed engineer. 3.75 Type of fuel: oil O natural gas 7 LPG O electric O 22)More than 4-per outlet(each) .75 I hereby acknowledge that I have read this application,that the information Minimum Permit Fee$50.00 SUBTOTAL J�! given Is correct,that I am the owner or authorized agent of _ _ 8%SURCHARGE U th10 er,t t plans/subm4tedaraJn�ornpliance with Oregon Stale laws PLAN REVIEW 25%OF SUBTOTAL 1_ Required for ALL commercial permits only Signature of Owner/Agent Date TOTAL (x� LJ � Contact Person Name Phone� Other inspections and Fees �- 1 Inspections outside of normal business hours(minimum charge-two hours) $50 00 per hour 2 Inspections for which no fee is specifically Indicated (minimum charge-half tour) Foonotes for commercial projects only: $50 00perhour 1. Provide full schematic of existing and proposed gas line and pressure. 3 Additional plan review required by changes,additions or revisions to plans(minimum 2. Provide drawings to scale showing existing and proposed mechanical charge-one-half hour)$50 00 per hour units. 'State Contractor Boller Certification required "Residential A/C requires site plan showing placement of unit I:unechperm.doc rev 11/1/99 CITYOF TIGARD _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2000-00297 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: SITE ADDRESS: 14620 SW 92ND AVE PARCEL: 2S111AC-01200 SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5 BLOCK: LOT: 053 JURISDICTION: TIG CLASS OF WORK: ALI' GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: 1 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 water heater. Owner: __ ___ FEES MCII_VAIN, JOHN R +JULIE T __— Type By Date Amount Receipt -- — ----- 14620 SVS/ 92ND AVE PRMT BLD 8/11/00 $50.00 0004446 TIGARD, OR 97224 5PCT BLD 8/11/00 $4.00 0004446 Total $54.00 Phone 1: Contractor: HARDY PLUMBING -+ HEATING 14689 NE COUNTRYSIDE AURORA, OR 97002 REQUIRED INSPECTIONS Phone 1: 222-9654 Final Inspection Reg#: LIC 00060947 PLM 3-234PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 1 E30 days of issuance, or it work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: 1,` ��; Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential (� Rec'd Byxa TIGARD, OR 97223 � I V Date Rec' �-I l-� Date to P.E. (503) 639-4171 Date to DST Print or type Permit 4600-eoa9 Incomplete or illegible applications will not be accepted Related SWR 1111 Called - "- FIXTURES (individual) QTY PRICE AMT Name of Development/Projecl -- - 11.50 Sink Job Lavatory 11.50 Street Address Gt �,,�F uite U SL,J [a. Tub or Tu bower Comb, 11.50 Address Bldg# City/State Zip Shower Only 11.50 _ Water Closet 11.50 tt -� Name Urinal 11.50 �L Suite Dishwasher 11.50 Owner Mailing Address �p 11.50 t_ S ZJ 'L Garbage Disposal Cit /State Zip Phone Laundry Tray 11.50 L� 6 ay - 1 z Washing Machine/Laundry Tray 11.50 Name11.50 Floor Drain/Floor Sink 2" Mailing Address 11.50 Suite 3" Occupant 4" 11.50 City/State ZIP Phone Water Heater conversion O Ilka kind 11.50 --f Gas i In re uires a se arate mechanical ermil. Name � rn MFG Home New Water Service 32.00 �7L "' MFG Home New SanlSlorm Sewer 32.00 Contractor ailing Addre s Suite Hose Bibs 11.50 , ,, C S rr Nr � Phone Roof Drains 11.50 Prior to permit City/State ZI p �,1 `tlis 11.50 issuance,a copy Drinking Fountain of all licenses are Ore nCon .C nt.Board Lic.# Exp,Dale Other Fixtures(Specify) 15.00 required if - expired In COT Plumbing LI # Exp.Dale datablap 7- :7 a -/ / �=-?L-o Name Sewer-1st 100' 38.00 Architect 32.00 - Or Mailing Address Suite Sewer-each additional 100' Water Service-1 at 100' 38.00 city'State Zlp Phone Water Service-each additional 200' 32.00 Engineer Storm&Rain Drain-1at 100' 3800 Describe work to be done: 32.00 New 0 Repair O Replace with like kind Yes O No O Storm&Rein Drain-each additional 100' Residential Q1 Commercial O Commercial Back Flow Prevention Device 32.00 Additional description of work: Residential Backflow Prevention Device' 1900 Catch Basin 11.50 Are you capping,moving or replacing any fixtures? Insp.of Existing Plumbing or Specially Requested 50.00 Ins actions er/hr Yes O No 6-, 45.00 If yes,see back of form to indicate work performed by Rein Drain,single family dwelling fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I hereby acknowledge that I have read this opplication,that the Information Isometric or riser diagram is required x Quantity Total is >9 given is correct,that I am the owner or authorized agent of the owner,and *SUBTOTAL that lens submitted are In compliance Mance with Ore on Slate Laws 8lghgt roof of O,wnerlAgon) Ooto !1G 8%SURCHARGE Contactporson Name ' Phone r S t •PLAN REVIEW 26%OF SUBTOTAL -_- l / Required only N fixture qty total is 1 BATH HOUSE$178.00 TOTAL 2 BATH HOUSE(250.00 --- 3 BATH 14OUSE$285.00 (This fee Includes all plumbing fixturos In the dwelling and the first 'Minimum permit fee is W+8%surcharge except Residential Backflow prevention 100 foal of sanitary sower storm sewer and water service) Device, All Now Commercial Buildings require plans with isometric or riser diagram and plan review I wists\rorni9%plumapp doc 11118199 PLEASE COMPLETE:. Fixtureype T _ Quantity by Work Perfm ored New Moved Replaced Removed/Capped Sink — Lavatory - Tub or Tu_b/Shower Combination __— Shower Only —. -- --- Water Cios_e_t - - urinal Dishwasher �— Garbage Disposal _ _Laundry Room Tray Washing Machine_ — Floor Drain/Floor Sink 2"____Y__ " __---- 3" ---- Water Heater _ _ ----- — Other Fixtures (Specify) — COMMENTS REGARDING ABOVE: CITY 4F TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 � MST INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received Date Requested— — _-,-- AM — . . PM --_ BLIP Location ---- L/(0 Suite — -- MEC - - �� ' " Z ZZ� - Contact Person _______ -- -- Ph(—) PLM Contractor--. .. - — -- Ph(------ ) — SWR - ----- BUILDING Tenant/Owner ELC _ ---- EL4 -- Foundation Access: ' Fig Drainv ELR -- Crawl Drain SIT Slab Inspection Notes: Post& Beam - Shear Anchors Ext Sheath/Shear - - - Int Sheath/Shear Framing - L L. C f_ - Insulation Drywall Nailing --Firewall Fire Sprinkler Fire Alarm - _— Susp'd Ceiling Other: ae T FAILNGGam -- Under Slab Rough-In Water Service — Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain —��`-- Sho an PASS-_W18L FAIL MECHANICAL Rough-In Gas Line Smoke Dampers -�YtSS P T FAIL Service Rough-In --------_-_�__ �— —- - UG/Slab - Low otag —___-- ----__-._---»— ------ --- Firg Alarm ;4S) Reinspection fee of$ __.required before next inspection. Pay at City Hall, 13125 SW Heli .,Ivd. AFAI Please call for reinspection RE: _---_�__._ _ [] Unable to inspect-no access Fire Supply Line DAoach/Sidewalk D A --- --1 pector --- __—Ext. PP Other: ---- Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE HANNAN'S 19685 NE CALKINS LN NEWBERG, OR 97132 Plumbing Signature Form Permit #: MST2001-00559 Date Issued: 1217/01 Parcel: 2S111 AC-01200 Site Address: 14620 SW 92ND AVE Subdivision: PINEBROOK TERRACE Block: Lot: 053 Jurisdiction. TIG Zoning: R-4.5 Remarks: Addition of 270 sf for kitchen. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: MCILVAIN, JOHN R + JULIE T HANNAN'S 14620 SW 92ND AVE 19685 NE CALKINS LN TIGARD, OR 0722: NEknrEEPC- Ori 971"2 Phone #: Phone - . 503-538-2994 Reg #: PI M 36-88PB 1 ir. 136542 AN INK SIGNATURE IS REQUIRED ON THIS FORM X Si atur of tho ri't tuber If you have any questions, please call (503) 639-4171, ext. # 310