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InitiallyGood 1.. 941) ti«' 1II3''� ;1Nc CITYOF T I G A R D ELECTRICAL PERMIT'O' DEVELOPMENT SERVICES DATPERMIT L:: ELC20 0t,)O 01 'r E ISSUEu: 05/25/2000 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S111CB-00900 SITE ADDRESS: 14940 SW 103RD AVE SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R-3.5 BLOCK: LOT : 008 JURISDICTION: TIG Project Description: Installation of one 200 amp service or feeder and 9 branch circuits Job No 12.0163 RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS ��1R1 Ems— 0 - 200 amp: A PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): T SERVICE/FEEDER BRANCH CIRCUITS -- ADD'L INSPECTIONS 0 - 200 amp: 1 W/SERVICE OR FEEDF71 -201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD't- BRNCH CIRC: 9 IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION 1000+ amp/volt: >_ > .• -- , 600 VOLT NOMINA --- Reconnect only: !—_ SVC/FDR. -=225 AMPS: CLASS A_REA_/SPEC OCC: Owner: Contractor: THOMAS, DON W BONNIE I. TICE ELECTRIC 14940 SW 103RD AVE PO BOX 15009 TIGARD, OR 97224 2.139 SE BEL.MONT ST PORTLAND, OR 97293-5009 Phone: Phone: 233-8801 Reg #: LIC 00000166 SUP 2586S PLM 2586s ELE 26-126C FEES---- Required EESRequired Inspections Type By Date Amount Receipt Rough in _RMT DEB 05/22/200 $112.40 0002347 Elect'l Service 5PCT DEB 05/22/200 $8 99 0002347 Elect'I Final Total----$121.39 - r-yPiprn 1 his Permit is issued subject to the regulations contained in the Tigard Municipal Codo,Stale of OR Speciaty odes and all other applicable laws All work wil `ie done in accordance with approves dans. This permit will expire if work is not started within 180 is of ssuance,or A worts is suspended for more than 180 days ATTENTION Oregon aw requires you to follow rules adopted by the Oregon Utility Notifl ration Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001 0080 You may obtain copies of these rules or direct questions to OUNC at(503)246-1981 PERMITTEE'S SIGNATURE ISSUED BY ovum 8 1 BUP - Build ncx'ermit _ ELC - Electrical Perr»it —Inspection Descee tion Date Passed B Inspection Descri tion Date Passed B Footing/Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough-in v Slab Electrical service f Crawl drain Elea:ical final Underfloor insulation — Post/beam structural Shear walls/anchors _ ELR - Restricted Ener v Permit. Roof nailing Inspection Description Date Passed B Firewall Low volta e Tilt-up panel _ Electrical final A'asonry/Reinforcement Framing MFG-Structure set-up MEC - Mechanical Permit Insulation r Inspection Description Date Passed By Drywall nailin Post/beam mechanical Suspended ceilin Gas line Engineered soils Mechanical rough-in Welding Lab Final Fire dam i Concrete Lab Final Duct work Bolting Lab Final _ Smoke detector Fireproofing Lab Final Mechanical rinal Structural observation Final inspection _ PLM - Plumbing Permit_ inspection Description Date Passed B BUP - Fire Protection System Permit Plumbing underslab Insection Description Date Passed By Crawl drain Sprinkler underfloor/slab _ Post/beam plumbing Sprinkler rough-in Plumbin top-out Sprinkler final RP/backflow preventer Fire alarm final Rain drain _ _ Storm drain Water service SIT - Site Pernuf Sanitar sewer) Inspection Description Date Passed B _ Culvert/catch basin - - Pum /fill septic tank _ Footings — F[Plumbing final Foundation walls _ Sprinkler supply lines F1 — Sprinkler underfloor/slab Catch basin/Manhole _ SWR - Sewer Permit Engineered soils Inspection Description Date Passed By Engineering acce tance _ 5anitar sy ewer Final inspection _ Iiinal ins ction _ INSPECTION RECORD - BUP, PIAL SWR, ELC, ELR, MEC, SIT PERMITS i \ CITY OF ! K0 ARD _ MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2000-00180 DATE ISSUED: 5/11100 13125 SW Hale Blvd.,Tigard, 10R 97223 (503) 639 4171 PARCEL: 2S111CB-00900 SITE ADDRESS: 14940 SW 103RD AVE SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R-3.5 BLOCK: LOT: 008 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: FVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES —�s�� .� DOMES. INCIN: _-_-- -- ---- 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE D aMPERS?: 30 - So HP: WOODSTOVES: GAS PRESSURE: 50 + HP' CLO DRYERS: FURN r 100K BTU: AIR HANDLING UNITS _ OTHER UNITS: FURN >=1UOK B1 U: <= c m: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of 20 feet of gas line and 2 outlets Owner: _ FEES HOMAS, DON W BONNIE L Type By Date Amount Receipt 4940 S'N '103RD AVE VNRMT DEB 5/11/00 $50 00 0002098 iGARD, OR 9722.4 SPC i DEB 5/11/00 $4.00 0002098 Total $54.00 Phone: -- Contractor: ETEMPLE COMPANY INC 951 NW OVERTON ST ORTLAND, OR G7209 REQUIRED INSPECTIONS Gas Line Insp Phone:227-2641 Mechanical Insp Reg M LIC 2510 Final Inspection m F)fP� r� C3 Q Q This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of()re Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is O 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 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189. Issue By: Permittee Signature: Call (503)6394175 by 7:30 P.M. for inspections need3d the next business day BUP - BuildingPermit ELC - Electrical Pcen it Ins ctian Descrt tp �n_ Date Passed B Inspection Description Date Passed By Footing/Setback Under round cover Foundation walls Wall cover Footing drain Cei in „over _ Waterproof bsmt walls Electrical rough-in — Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural _ Shear walls/anchors ELR - Restricted Enery Permit Roof nailing Ins ection Description Date Passed B Firewall Low voltage _ Tilt-up panel Electrical final Masonry/Reinforcement Framing MFG-Structure set-up MEC - Mechanical Permit Insulation Ins ction Descri�!on _ hate Passed B Drywall nailing Post/beam mechanical Suspended ceiling Gas line _ En ineered soils Mechanical rough-in Welding Lab Final Fire damper ' Concrete L b Final Duct work _ Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical finalJ� - - Structural observation Final in ction PLM - Plumbing Permit Ins ection Descrt tiun Date Passed B . BUP - Fire Protection System Permit Plumbin underslab Inspection Description_ Date Passed By Crawl drain ^ Sprinkler underfloor/slab Post/beam Plumbing Sprinkler rough-in Plumbing top-out.. Sprinkler final RP/backflow reventer Fire alarm final Rain drain — _ Storm drain — Water service SIT - Site Permit Sanitary sewer _ J IuSpection Description Date Passed B Culvert/catch basin Footings Pum /fill se tic tank Foundation walls Plumbing final Sprinkler Supply lill L — — -- - Srinkler underfloor/slab Catch basin/Manhole SWR - Sewer Permit Engineered soils Ins _tion Description Date Parsed B _ Engineeriq acceptance Sanitary sewer Final ins ection Final in ection INSPECTION RECORD - BUP, PIM, SWR, ELC, ELR, MEC, SIT PERMITS CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT SWR2000-00303 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/19/00 SITE ADDRESS; 14940 SW 103RD AVE PARCEL: 2S111CB-00900 SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R-3.5 BLOCK: LOT: 008 _ _ JURISDICTION: TIG TENAN C NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS' 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sever connection and payment for reimbursement district#16 of$8,000.00, on 9/19/00; receipt #2000-531. dlh Owner: _ THOMAS, DON W BONNIE L FEES - 14940 SW 103RD AVE Type By Date Amount R_ceipt TIGARD, OR 97224 PRMT CTR 9/19/00 $2,30C.00 27200000000 INSP CTR 9/19/00 $35.00 27200000000 Phone: — —. Total $2,335.00 Contractor: Phone: Reg #: Required Inspections Sewer Inspection 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 it the permit expires The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the installer shall prospect 3 feet in all directions from the distance given. If not so located, the instiller shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throigh OAR 952-001-0080. You may obtain copies of these rules or direct questiors to OUNC by calling(503) 246-1987. Issued by!�' Permittee Signature:_ Call (503) 639-4175 by 7:00 P.M. for an inspection neaaed the next business day CITY OF TIGARD PLUMBING PERMIT PERMIT#: PLM2000-00346 DEVELOPMENT SERVICES DATE ISSUED: 9/19/00 13125 SW Hall Blvd.,Tigard, OR 97223 '503) 639-4171 PARCEL.: 2S111CB-00900 SITE ADDRESS: 14940 SW 103RD AVE ZONING: R-3.5 SUBDIVISION: DEL MONTE SUBDIVISION JURISDICTION: TIG BLOCK: LOT: 008 — CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFI-OW PREVNT-IS: FLOOR DRAINS: TRAPS: OCCUPANCY GRP: R3 CATCH BASINS: STORIES: WATER HEATERS: FIXTURESG , — LAUNDRY TRAYS: RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: "rUBISH')WERS: SEWER LINE: 170 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of sewer line _ FEES _ Owner: — — Type By Date Amount Receipt TJ-lOMAS, DON W BONNIF L PRMT CTR � 9/19/00 $101.40 27200000000 14940 SW 103RD AVE 5PCT CTR 9/19/00 $8.11 27200000n00 TIGARD, OR 97224 Total $109.51 Phone 1: Contractor: _ CANTRELL &SONS CONTRACTING 6860 SW NORSE HALL RD TUALATIN, GR 97062 REQUIRED INSPECTIONS i Sewer Inspection Phone 1: 503-638-0800 Final Inspection Reg#: LIC 97005 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires 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: Permittee Signature: ..,_ "` — Call (503)639-4175 by 7:00 P.M.for an inspection needed the next ousiness day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Recd By TIGARD, OR 97223 Date Recd (503) 639-4171 r�r Date to P.E. Print or Type Date to OST_ Incomplete or illegible applications will riot be accepted Permit#&"fZ4�e - 6-, '/,,'Related SWR#_='A 00 —Gb�0��/ Called _ N. ,of Development/Project FIXTURES (Individual) QTY PRICE AMT Job Sink 11.50 F,4,;dress tre t Address Suite Lavatory 11.50 "M � ') Tub or Tub/Shower Comb. 11.50 Bldg# 41/State Zip Shower Only 11,50 ame Water Closet 11.50 5 Urinal 11.50 Owner ai Ing Address Suite Dishwasher 11.50 —)&s(i. Disposal 11.50 r 'y/State % Ci Zip Phonev Laundry Tray 11.50 Nam Washing Machine/laundry Tray 11.50 Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 City/State Zip Phone 4" -- 11.50 Water Heater O conversion O like kind 11.50 Aame �— Gas poping requires a separate mechanical permit. l � MFG Home New Water Service 32.00 j Contractor ailing Address uite MFG Home New San/Storm Sewer 3200 t Hose Bibs 11.50 Prior to permit CI S a Phon n Roof Drains 11.50 Zlp Issuance,a copy t r ► / 'J1 _ Drinking Fountain 11.50 of all(/cerise:are Oregon Const.Cord.Board Llc# Fxp.Date required if r [� f _ `r Other Fbtures(Specify) 15.00 expired In COT Plumbing Lic.# Exp.Date database Name Architect Sewer-1st 100' i r — Or Mailing Address Suite 3 Sewer-each additional 100' r 1 3 En (neer City/State Zlp Phone Water Service-1st 100' 38.00 g Water Service-each additional 200' 3200 Describe work to be done. Storm&Rain Drain-1 at 100' 38.00 New )' Repair O Replace with like kind Yes O No O — — Storm 8 Rain Drain-each additional 100' 3200 Residential' Commends/ O _ Additional description of work — Commercial Back Flow Prevention Device 32.00 Residential Backnow Orevention Devices 19.00 Catch Basin 11.50 Are you capping,moving or repla Ing any fixtures? Insp of Existing Plumbing or Specially Requested 50.00 Yes O No inspections perthr If yes,see back of form to Indicate work performed by Rain Drain,single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. I hereby acknowledge that I have read this application,that the information QUANTITY TOTAL given Is correct,that I am the owner or authorized agent of the owner,and Isometric or riser diagram Is required M Quantity rdtai is >9 that plans submitted are in com (lance with Oregon State Laws 'SUBTOTAL Slonsture 010ymerlAgent D e/ ' 8%SURCHARGE / C 1tpct orsion Narpe P pq�q _ E�. �' '. ! ! b%f�4- 1 "PLAN REVIEW 26%OF SUPTOTAL BATH HOUSE$178. 00 Requited oni it fixture qty total is,9 2 BATH HOUSE$250.00 IrOTAL 3 BATH HOUSE$285.00 1 (This fee Irr;ludes all plumbing fixtures In the dwelling and the first 'Minimum permit ha is$50•9%surcharge,except Residential Backflow Prevention 100 feet or sanitary sower stomr sewer and water service) Device,which is$25•a%surcharge All New commercial 1301dings require plans with isometric or riser diagram and pian review PLEASE COMPLETE: Fixture T— -- - Quantity by Work Performed Sink — — --_ RPW_ Moved Replaced Removedr'Capped Lavatory -- -- Tub or Tub/Shower Combination Shower Onl - - Watei- Clos t— - _ Urinal - Dishwasher Garbage Disoosal -- Laundry Roorn Tray - - Washing Machine ____----- ---- Floor Drain/Floor Sink 2" _-- - Water Heater — --_. Other Fixtures (Specify) — COMMENTS REGARDING ABOVE: 1 Mtelellormllplumepp Aa-I IIIEVT) CITY OF TIGA,RD BU LDING INSPECTION DIVISION MST 24-Hour Inspection Line: 6394175 Business Line: 639-4171 _ — — SUP Date Requested 7-,2-V AM__ rim -- SLD _ Location �t� y S Suite _ MEC _ Contact Person Ph 233 6'8 D( -- PLM — Contractor r'h _ SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: c'",bSIT _ --- ----- ------ -- F-st&Beum - — Ext an :^ath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler — Fire Alarm Susp'd Ceiling -- — — — --- --- — Roof Misc:_ -- - -- -- -- — _-- _ Final -- PASS PART FAIL --- ----- -- --- PLUMPING Past 8 Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final ---_.—.------------ —__..._...— ------- ----- ------- PASS PART FAIL MECHANICAL Post& Beare — --_-- —. —-- - --------- Rough In Gas Line -- -- ----- ------- --- — ------- Smoke Dampers Final ---- Pa§A= PART FAIL LEC ----- —__---- - ----- ---- ----- --- ------------------ Se rvice Rough In I-IG/Slab Low Voltage Fi Alarm PART FAIL _—_ ---. _------ - --- —. —.- - ----_ —_ SITE Backfill/Grading _ _ -- --- — -- -- - — --------- - _-� Sanitary Sewer Storm Dram [ J Reinspection fee of$ -required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( J Please call for reinspection RE: —_ ( ]Linable to inspect no access ADA Approach/Sidewalk ,Other _ Date _ GLV 0011-_ .:pectar Ext _ Final PASS PART FAIL) DO 'OT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST — 24-Hour Inspection Line: 639-417G Business Line: 639-4171 BUP Date Requested 1> AM _PM gLp Location.— I ' a D / 0 ?) "tc Suite MEC Contact Person s ,l/�.- Ph S��' S PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: FPL Foundation - Ftg Drain SGN Crawl Drain Inspection Notes: - Slab _._. — SIT Post&Beam Ext Sheath/Shear — Int Sheath/Shear Framing --- Insulation Drywall Nailing - - ----- - -' Firewall Fire Sprinkler — — �- Fire Alarm- � Susp'd Ceiling Roof Mise Final PASS PART FAIL PLUMBI Pos &'Baru Under Slab - op - er Service — Sanitary Sewer _ Rain Drains - - F ART FAIL _ --- HANI cost&Beam -- --- -- WGtLhl.a - Gas Line Smoke Darnpert; PART FAIL -_ PCTRICAL - —� Service -.- -- -- - - - -- - Rough In UG/Slab __-- --__---- --- Low Vnitage Fire Alarm - Final PASS PART FAIL --- --- --- -- --- - SITE Backfill/Grading - Sanitary Sewer Storm Drain I J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW H Catch Basin Unable to Inspect-no as Fire Supply Line I 1 Please call for reinspection RE _ I 1 P ADA 'y / Approach/Sidewalk ,� Other _ Date--t) � _Inspector Ext � � Final PASS PART FAIL DO NOT REMOVE this i.ispection record from the job site. CITY OF T I G pH RD _ PLUMBING PERMIT PERMIT #: PLM2000-00148 DEVELOPMENT SERVICES DATE ISSUED: 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S111CS-00900 SITE ADDRESS: 14940 SV4 103RD AVE ZONING: R-3.5 SUBDIVISION: DEL MONTE SUBDIVISION JURISDICTION: TIG BLOCK: LOT: 008 GARBAGE r)ISPOSALS: MOBILE HOME SPACES: CLASS OF WORK: ALT WASHING MACH: E —KFL< N PREVNTRS: TYPE OF USE: SF FLOOR DRAINS: TRAPS: OCCUPANCY GRP: R3 WATER HEATERS: CATCH BASINS: STORIES: SF RAIN DRAINS: _ FIX'TURES _ LAUNDRY TRAYS: GREASE TRAPS: SINKS: 1 URINALS: LAVATORIES: 2 OTHER FIXTURES: 1 TUB/SHOWERS: 1 SEWER LINE: ft WATER LINE: ft WATER CLOSETS: 1 DISHWASHERS: RAIN DRAIN: ft Remarks: Kitchen/bath remodel, installation of 1 sink, 2 lays, 1 shower/tub, 1 water cloFEES 1 ice maker. Ownar: Type By Date Amount Receipt THOMAS, DON W BONNIE L PRMT DEB 5/11/OU $72.50 Or)2098 14940 SW 1C3RD AVE 5PCT DEB 5/11/00 $5.80 0002098 TIGARD, OR 97224 Total $78.30 Phone 1: Contractor: DETEMPLE CO INC 1951 NW OVERTON ST PORTLAND, OR 97209 REQUIRED INSPECTIONS .'op-out Insp Phone 1: 503-227-2641 Final Inspection Rcg#: LIC 00002510 PLM 26-25PB V This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all ether 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 tlth 952Oregon -0001-0080 Notification Center. Those rules are set forth You may obtain copies of these rules or direct questions to OUNC by calling1503) 246-1987. 1 �� C.CCki�1y ! Permittee S g nature: > ✓� � Issued By: J\. Call (503) 619-4175 by 7:00 P.M. for an inspection needed the next business day CITY OFeTIGARD Plumbing Permit Application Plan 13125 SW HALL BLVD. Commercia' and Residential Recd B _ TIGARC, OR 97223 Date Recd Date to P.E. (503) 639-4171 Print or Type Date to D T -- Permit# Incomplete or illegible applications will not be accepted Related SWR# Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job i h ft)as ( .d r�r_ sink 11.50 I,50 Address Street AddreFs_ err( Suite Lavatory 11.50 ?i], y t� 0 - Tub or Tub/Shower Comb ) 11.50 ,1j1) Bldg# City/StateZip Shower Only 11.50 a7 A � C I Z-` 3 Water Closet ( 11.50 Name �d w e 2 S a t U v� Urinal _ 11.50 Owner Mailing Address Suite Dishwasher 11.50 I ' Garbage Disposal 11.50 City/Slate Zip Phone Laundry Tray 11.50 Name r � Washing Machine 11.50 V`S Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address Suite _ 3" 11.50 I r 14" 11.50 City/State Zip Phone ! r Water Heater O conversion O like kind 11.50 Gas piping requires a separate mechanical permit. Name - MFG Home New Water Service 32.00 P -m�''1ojul --- MFG Horne New San/Storm Sewer 32.00 Contractor Mailing Adress �-,�,n Sidle C�) ^ on OV e rton- Hose Bibs 11.50 Prior to permit G.y/State Zi P one Roof Drains 11.50 issuance,a copy 'p r�(1'.lm X11 Z 0") L l 7-2&w-4 Drinking Fountain 11.50 of all licenses are Oregon Const.Cont Board Lic# Fxp.Date Other Fixtures(Specify) 15.00 required if Z.X71 (� �j7 7- expired In COT Plumbing Lic.# Exp.Date i V1 database L S? (3 3U oU Name Architect Sewer-1st 100' 38.00 Or Meiling Address Suite Sewer-each additional 100' 32.00 Water Service-1st 100 38.00 Engineer Clty/state Zip Phone Water Service-each additional 200' 32.00 Describe work!o be done: Storm&Rain Drain-list 100' 38.00 New O Repair • Replace with like kind. Yes 4D No O Storm&Rain Drain-each additional 100' 32.00 Residential • Commercial O Commercial Back Flow Prevention Device 32.00 Additional description of work. Residential Backflow Prevention Device' 19.00 Catch Basin 11.50 Are you capping,moving or replacing any fixtures? Insp of Existing Plumbing or Specially Requested 50.00 Yes • No O Inspectionsper/hr If yes, see back of form to indicate work performed by Rain Drain,single family dwelling _ 45.00 fi.-ture. 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 application,that the Information Isometric or riser diagram is required if Quantity Total is >9 given is correct,that I am the owner or authorized agent of the owner,and that plans submitted are Inc Ifance with Oregon State Laws. "SUBTOTAL h /rto a of O jrnr/Agan Gry Date 8%SURCHARGE iduL ; , Q ntact Person Nem n Phone lY C'Reye T1 W)LIS.f- ' I Z G' 11 "PLAN REVIEW 26%OF SUBTOTAL -- Required only H fixture gly total is>9 1 BATH HOUSE 5178.0 TOTAL 7, 2 BATH HOUSE$250.00 3 BATH HOUSE X285.00 (Thla fee Includes all plumbing 1`10irrs In the dwelling and the first •Minlmum permit fee Is$50+8%surcharge.excepl Residenlial Backflow Prevention 100 feet of sanitk ry sower storm sower and water service) Device which is$25+8%surcharge "All Now Commercial Bulldlnps require plans wMh isometric or riser diagram and plan review I ldslslforms�Wmnp{'gib^ +:"""''' PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed/Capped Sink -- Lavatory -- Tub or Tub/Shower Combination Shower Only Water Closet --- Urinal - DishwasherGarbage Disposal Laundry Room Tray Washing Machine - Floor Drain/Floor Sink 2" - 311 411 Water Heater___ _ --- Other Fixtures (Specify) COMMENTS REGARDING ABOVE: CITYOF TIGARD _ MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2000-00180 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/11/00 PARCEL: 25111 CB-00900 SITE ADDRESS: 14940 SW 103RD AVE SUBDIVISION: DEL K40NTE SUBDIVISION ZONING: R-3 5 BLOCK: LOT: 008 JURISDICTION: TiG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS V%'/O ADPL: VENT SYSTEMS: STORIES: _BOILERS/COMPRESSORS _ HOODS: FUEL_TYPES V 0 - 3 HP: DOMES. INCIN: LPG 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOOD GAS PRESSURE: 50 + HP: FURN < 100K BTU: AIR HANDLING_ UNITS CLO DRYERS: OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: > 10000 cfm: GAS OUTLETS: 1 Remarks: Installation of 20 feet of gas line and 2 outlets Owner: FEES THOMAS, DON W BONNIE L Type By Date Amount Receipt 14940 SW 103RD AVE PRMT DEB 5/11/00 $50.00 0002098 TIGARD, OR 97224 SPOT DEB 5/11/00 $4.00 0002098 Phone: % -� r Total $54.00 Contractor: DETEMPLE COMPANY INC 1951 NW OVERTON ST PORTLAND, OR 97209 REQUIRED INSPECTIONS Gas Line Insp Phone:227-2641 Final Inspection Reg#:LIC 2510 This permit is issued subject to the regulations contained in the Tigard Municipal Cod State of Ore Specialty Codes and all other applicah!e 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 clays. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-OQ10 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by t7�lliny (503)246-9} 1 I ) 00 Issue B�: �._ )�"'-, _,; ,Permittee Signature: _ Call 503 636-4175 b 7:00 P.M. for inspections neede a next business h ( ) Y p Y Plan Che CITY OF TIGARD Mechanical Permit Applicatiotd Rec'dBy # 13125 SW HALL BLVD. Commercial and Residential Date Recd TIGARD, OR 97223 Date to P.E. (503) 61,94171, x304 Date to DST Print or Type Permit# t�pC°: -oo Miro Incomplete or illegible applications will not be accepted Called Name of Development/Project�� Description T-h 0al6 SS ,�S) '1 r Table 1A Mechanical Code _ O Price Amt Street Address 5uMetY A) Permit Fee _ 16.00 Job d, I1) Furnace to 100,000 BTU �— Address u 9y 0' �� J _ including ducts&vents see footnote 1,2 _ _9.65 Bldg* Cny/State tip 2) Furnace 100.000 BTU+ Ti ("a ��Zai including ducts&vents see footnote 1,2 1200 Name(or name of business) 3) Floor Furnace — !� Owner G{, �- including vent see footnote 1,2 9.65 _ Vim- Mailing Address 4) Suspended heater,wall heater r 1 or floor mounted heater see footnote 1,2 9.6_5 _ 5) Vent not included in appliance ermit _ _ _ 4.75 citylstato zip Phone Check all that apply 'Boiler Heat Air ( _ .. For Items 6-10,see or Pump Cond Qty Price Amt Narnq(or Homo 01 business) footnotes 1,2 Com _ i l c. 6)<3HP,absorb unit to LLL—Lt t_ i 00K BTU_ _ _ 965 OCcuipant Mailing Address 7)3-15 HP,at. i nit I I 00 to 500k 17 65 _ crtylstale zip Phone 3)15-30 HP,abs u r unit 5-1 mil B i U _ 24 15 NaP)30-50 HP,absorb Name Contractor �A'�("!'�^ unit 1-1.75 mil BTU — 3600 l' I f 1 • 10)>50HP,absorb unit Prior to permit Mailing _ dr u >11.75 mil BTU -- 60 15 _ issuance,a copy ��V G( OVA •- 11 Air handling unit to 10,000 CFM of all lice.,__ cn�yi tatetip Phone 700 are required if 1 t�r+-11a np� Z D� IL 7 26,91 12)Air handling unit 10,000 CFM+� expired In COT Oregon Const.Cont.Board Lic* Exp.Date 11 75 databaseG 2 It 1 13)Non-portable evaporate cooler Architect Name 1 7 00 1) /A 14)Vent fan connected to a single duct 4.75 or Meiling Address -- -- 15)Ventilation system not included in� -apliance permit _ 7,00 Engineer CIIy/Slate zip Phone 16)Hood served by mechanical exhaust _ 7.00 Describe work to be done17)Domestic incinerators _ 1200, New O Repair O Replace with like kind Yes O No O 18)Commercial or industrial type Incinerator Residential• Commercial O — 48 25 19)Repair units Additional information or description of work: 1 840 Z PHD gA S prFr►1!1 V4/,g C(,ttlfts { f vturf 20)Wood stove/gas Mother units/clothe dryer/etc 700 NOTE: For Commercial projects only;Units over 400 lbs requireUS 21)Gas piping one to four outlets ) 1� structural gas talcs See footnote 1 ,, 3.75 Type of kel: oil O natural gas 0 LPG O electric O 22 More than 4-per outlet(each) .75 _ Minimum Permit Fee$50.01 SUBTOTAL "G, I hereby acknowledge that I have read this application,that the information F%SURCHARGE given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL the owner,that plans submitted are in compliance with Oregon State laws _ Required for ALL commercial permits onl TOTAL S16n re of Owner/Age /� Date __ __________ /f J Other Inspections and Fees: 4 v 1 Inspections outside of normal business hours(mininum charge-two Contact Person Namo ell Phone hours) $50.00 per hour 2. Inspections for which no fee Is specifically Indicated (minimum charge-half hour) $50.00 per hour Foonotes for commercial projects only 3 Additional plan reviev;required by changes,additions or revisions to 1. Provide full schematic of existing and proposed gas line and pressure plans(minimum charge-one-half hour)$50.00 per hour 2. Provide drawings to scale showing existing and proposed mechanical units. _ 'State Contractor Boiler Certification required "Residential A/C requires site plan showing placement of unit ["echperm.doc rev 02/4/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST ' �- 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP Date Requested i - '7 AM PM BLD _ LocationL 1. q0 Suite —_ MEC Contact Person _ _ Ph SJ y- S' Z- PLM Contractor Ph SWR rBUILDING — Tenant/Owner _ ELC (Retaining Wall w ELR (Footing Access: Foundation FPS Ftg Drain —__ -- SGN Crawl Drain Inspection Notes ---- -- -- Slab --- ---- -- --- SIT Post& Beam - -- ------ Ext Sheath/Shear Int Sheath/Shear Framing -- Insulation Drywall Nailing - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling _ — Roof Misc: Final PASS ART FAIL — -- — - - UMBING os . ki:r�un Under Slab Top Out — -- Water Service Sanitary Se,.vr+r Rain Drains gL c-PAO PART FAIL ANICAL Post& Beam ------- --- — Rough In Gas Line Smoke Dampers Final — PASS PART FAIL ELECTRICAL -- Service ----- Rough In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL ---�� SITE Backfill/Grading -- — — Sanitary Sewer Storm Drain [ ]Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ J Please call for reinspection RE: _ [ J Unable to Inspect no access Fire Supply Line ADA i Approach/Sidewalk l.¢ I l� r , 1, J�° Other Date Inspector— r �- :.i Ext' Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.