12991 SW 116TH PLACE N
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12991 SW 116"' Place
CITY
�� ������ MASTER PERMIT
PERMIT#: MST2001-00406
DEVELOPMENT SERVICES DAZE ISSUED: 7/24/01
13125 SW Hall Blvd.,Tigard, OR 9722.3 (503) 639-4171
SITE: ADDRESS: 12991 SW 116TH PL PARCEL: 2S103BD-09300
SUBDIVISION: HUNTER'S WOODLAND ZONING: R-4.5
BLOCK: LOT:005 JURISDICTION: TIG
REMARKS: New SF dk.,ached. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 790 of BASEMENT: of LEFT: 7 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR,LOAD: •10 SECOND: 1.:29 at GARAGE: 448 a1 FRON': 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: at RIGIr': 5
VALUE: $184,62300
OCCUPANCY GRP: R3 DORM: 4 BATH: 3 TOTAL: 1,91900 at FIFO R: 30
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIt,: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS* 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: 2 GARBAGE DISP: I WATER HEATERS: I WATER LINES' 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<TOOK: 1 BOIUCMP<3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN>000K: UNIT HEATERS: HOODS: I OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER -TIM^SRVCIFEEDERS r BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FOR: 1 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 3 201 400 amp: 201 •400 amp: tat WIO SVCIFDR. 00 SIGNIOUT LIN LT' PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp' EA ADDL BR CIR: SIGNAUPANEL: IN PLANT
MANU HPAISVCIFDR: 601 • 1000 amp: 601+2mos•1000v: MINOR LABEL:
1000+amp/volt!
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS; 9VCIFUR>•225 A.: >600 V NOMINAL: CLS AREA/SPC UCC:
ELECTRICAL•RESTRICTED ENERGY
_ A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM AUDIO 6 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION, MEDICAL: OTHR:
HVAC: DATk1TF.LE COMM: NURSE CALLS: TOTAL 0 b'STEMS
Owner: Contractor. TOTAL FEES: $ 6,692.70
MEL WAYMIRE MEL VIN WAYMIRE This permit is subject to the regulations contained in the
P.O BOX MIRE ME BOX W MI Tigard Municipal Code,State of OR Specialty Codes and
P 0 BO, 23 164 TIGARD,OR 97281 all other applicable laws All work will be done in
accordance with approved plans This permit will expired
work is not started within 180 days of Issuanco,or if the
work is suspended for more then 180 days ATTENTION
Phone: Phone: Oregon law requires you to follow rules adopted by the
J ngon Utility Notification Center. Those rules are set
Rag 0: Lit; 35919 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 Shear Wall Insp Insulation Insp N4�cna tical Final
Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plurru Final
Footing Insp Crawl Draln/Backwater Electri.:al Service Low Voltage Water Line Insp Final inspection
Foundatlon Insp Footing/Fuundation Dr; Electrical Rough III Gas Line Insp Appr/Sdwlk InsF I
Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Issued By : 1' •. J•� Permittee Signature
Call (303) 639-475 by 7:00 p.m. for an inspection needled the"next busirfess day
�V rWER CONNECTION PERMIT
CITE' OF TIGARD
DEVELOPMENT SERVICES PERM11 #: SWR2001-00207
13125 SW Hall Blvd., Tigard, OR 97223 (503) 63s-4171 DATE ISSUED: 7/24/01
S11 ADDRESS; 12991 SVS/ 116TH PL PARCEL: 2S103BD-09300
SUBDIVISION: HUNTER'S WOODLAND ZONING: R-4 5
BLOCK: _ _ LOT: 005 _ JUR!SDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS Or' WORK: NEW DWELLING UNI;S: 1
TYPE OF USE: ;SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached.
..wner:
MEL WAYMIRE FEES
F.O BOX 231164 Type By Date Amount Receipt
TIGARD, OR 97281 PRMT CTR 7/24/01 $2,300.150 27200100000
INSP CTR 7/24/01 ;35.00 27200100000
Phone: 503-521-9092 -- — - —
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 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 installer shall purchase r"Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rulec. adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling(503) 246-1987.
Issued by: �� � r
_.s�_�lcl Permittee Signature: ,-
Call
ignature:,Call (503) 6394175 by 7:00 P.M, for an Inspection needed the next business day
ccJA Z 'A 7
Building Permit Application �
City Of Tigard ?'/6 Uatereceived 7 / Permit no./r/ST?o0/-(f
Proiccl/appl.no.: Cxpiredate:
City nfTigard Address: 13125 SW Ball Blvd,Tigard,OR 972 .
Phone: (503) 639-4171 Date issued: B eceipt no.:
Fax: (503) 598-1960
Case rile no: Payment type: �
Land use approval: l&2 family:Simple Complex:
WWI MJAM�
I &2 family dwelling or accessory U Commercial/industrial U Multi-fancily IWKW construction U Demolition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other:
3011 SITIE INVORMATION
Job address: ,/" VC11 u If<--7 _ Bldg.no.: Suite no.:
Lot: � Block: Subdivision:11ynT S �tl�«+ < Tax map/tax lot/account no.:;Z,S/o.3,rj, O
Project name: -r. ,S 1416 - 3 t Z
Description and location of N, I,on premises/special conditions: — _C,Je r W AV
1 e
Name: ,4Vel -
_Mailing address: 0 1 &2 famlly dwelling:
City: , JS(ateoA JZIUValuation of work.................................... ... $ 'r
Phone: c Fax: E-mail: No.of bedrooms/haths.................................
Owner's representative: ,r, C2 �. t Total numbL r of floors................................. ,2..-
I'lun)r: New dwelling area(sq.11.) .......................... 1919
Gamge/carport area(sq.ft.).........................
Name: jet h, e ca i �t � e Covered porch area(sq. ft.) .........................
Mailing address. Deck area(sq. fl.) ........................................
Other structure arca(s . ft.).........................
City: S+atr: ZIP:
_— —-- — - ('onmlerrial/industrial/multi-randl
Phone: hax: I wail: y:
Valuation of work........................ ...............
Existing hidg.area(sq. ft,� ..... ........ ........
_Business name: ec S a o New hl1g.area(sq. A.) .r...............
Address:
— — Number of slories... .... .... ......
. ... .
City: _ State: ZIP: Type of construction.,.L......
Occupancy group(sl: Exist
Phone: Falx: &mail:
_ ,S 9_J�_ g:
CCB no.: � ___ '/;;/n_— --
City/metro lir.no.: Notice:All contractors and subcontractors are required to he
licensed with the Oregon Construction Contractors Bond midt-i
Name: / / provisions of ORS 701 and may he required to he licens d in the
/tt., .6
� �-' ,+ • jurisdiction when work is being performed. If the applicant is
Address: /3L � i,; ay.
f'it �i ' " �< exempt from licensing,the following reason applies:
Contact person:. �. Ilan no.:
Name: CAL,c i Contact person: , r�/ Fees due upon application ........................... $
Address: Date received:
Cit s'r Stag ZIP: 2t2/ — Amount reveived .........................
_--- --
Phone: sc/
Fa asr_Q(, / li-mail: �_— _Please rcler to tee schedule.
IllewhycetlifyIhave read and examined thisapplication alltlthe NntAll futimlictions&,epi cn•ddInds,pleascullImMitu;e+l.nmoleInImmntlon
attached checklist. All provisions of laws and ottthuulcrs 1 overning this U vtso U MuaeWard
work will he con lied%0. he ccr s coined he►Y•nl or n c•tedii nod number
p It.
1,AUlhorlred 51gIlaplret �� 11�IIC � �</ Nmne of�t /Prilll naml': /f'i�- t_ - -------Ciudiwlder Otlnalure - --�- Amount -
Notice:111is permit application expires il'a pennil ie and ohlained Il ithin 1110 days alter it has been accepted as complete. 4-0114.11(hnMWOM)
One- and Two-IA'amily Dwelling S
Building hermit Application C;iccklist Reference no
Cm,,q — Associated permits:
�'�ir',r.a' City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 0 Electrical U Plumbing U MechanicalU Other:
Phone: (503) 639-4171 Fax: (503) 598-1960
7Firee actions completed.Sec jurisdiction criteria for concurn•r� reviews.
.flood plain,solar balance points,seismic soils designation,itistorir.district,etc.
ation of approved plat/lot.
trirt approval required.
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit.
v
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,sill fence design and location of
ca -h-basin protection,etc.
I0 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to applicahle-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.flan review cannot be completed
copyrigh(violations exist.
I I She/plot plan drawl)to scale.The plan must show lot and building setback dimensions:property comer elevations(i1'
there is tnrre than a 4-11.elevalion uifferential,plan mist show contour lines tit 241.intervals):location ofeasements and
driveway;footprint of structure(including decks);location of wells/septic system;,,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 bolts,any hold-downs and reinforcing pads,connection devils,vent
size and location.
13 Floor plans.Show tall dimensions,room idtit iIication,window size,location of smoke dctcctors, i;er heater,
furnace,ventilation fans,plunihing fixtures,halconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show till framing-meniher size and spacing such its floor heams,headers,joists,orb floor,
wall construction•roof construction.More than one MASS srnnxl may he required to clearly portray construction Show
details ul'all wall:end Aol'sheathing,poling,roof slope,ceriniro height,siding material,footings and foundation,~lairs,
lire place construction. thernial insulation,etc.
15 Elevation views.Provide elevation:;for n,.w 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
Full-sire shect addendums showing foundation elevations wish cross references are acceptable.
I6 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate derails and locations:for
non-prescriptive path analysis provide specifications and calculations to engineering standards. u�
17 Floor/roof framing.Provide plans I'or all floors/roof assenthhes,indicating member sizing,spacing,and hearing
locations.Show attic ventilation,
18 Basement and retaining walls.Provide cross sections and details showing placement of rehar. For engineered
systems.see item_22 "lingincer's calculations."
on
19 Beam calculatis.Provide Iwo sets of calculations using Murre.rr,axle design values for all hcams and ntultiple.joi%l
_over 10 feet Iona and/or any beam/joist carrying a non-uniforn load.
20 Manufactured floor/roof truss design details. — — --
21 Energy Code compliance.Identify the prescriptive path ur provide calculations. A gas-piping schema is required
_
for four or more appliances.
22 1?11gineer'x calculations.When required or provided.6.e.,shear wall,nxrf truss)shall Ix staniped by an enginecr or
architecl licensed in Or and shall he shown to be applicable to Ilse 111(1 ureter wview.
2 1 Liven(5)sue plans are tryuord for Item I I above. Site plans must be 8 112"x I("nr 1 I" x 17".
24 Two(2)sets each are required for Items I6, 19,2O,@ 22 above.
25 Building plans shall not contain red lines or tape-ons. —
26 No rolled,reversed or n i i i it,real building PI it s will IV accepted:
27
28
Checklist roust he completed before plan review start date. Minor changes or notes on submitted plans maN he in blue or black ink.
Red ink is reserved firr department use only. aur 4614 umxrn onrr
1'i+'Iechanical Permit Application
Cit),, of Tigard �Ty6; Datereceived: 7 51,41 Permit no.: yo
Address: 13125 SW Hall Blvd,Tigard,OR 97223 ~� Projecdappl.no.: Expire date:
City gTigard _
Phom.: (503) 639-4171 TD-111 issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.:
Payment type
Land (Ise approval: Building permit no.:
0
2 family dwelling or accessory U Commercial/industrial
ly New construction J Aldilion/alteration/replacement U ther-tantlly U Tenant improvement
Luo kilo 1:1111
Joh address: 1,9 5�1/ S /
/,,< e- indicate equipment quantities in boxes below, Indicate the dollar
Bldg,no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: Sip �. � p profit. Value$
L.ot: Block: Subdivisiow •tics checklist for important application information and
Project pante: jurisdiction's Ice seheclule for residential permit fec.
City/county: cc 'LIP: Z Z 3 t
Description and Iocation or work on premises:
_ r
Est,date of completion/inspection: {ev(Ca.) f oral
Il,Ycriptfon Qty. Rex.only Rcs.onl�
Tenant improvement or change of use:
Is existing space healed or conditioned?U Yes U No AirliQling unit _._ _CFM
Is existing space insulated?U Yes U Net Air con itionmg(silep an required) -
teration o existing _system
Boiler compressot:s
Business name:-�( ,�, �e�si4 c Slate boiler permit no.:
Address: p u 1 Tj ` c 6Ptons BTII/H
Cil - tre/snw c nrnper ucl Gm—0 a clecIors
y' o a� Slut ZIP: QG ctrl pump(site plan required) — --
Phone: C 11;1x; _ -- E-mall: '— /rep acc furnac hurner__B / — —
CCB no.: Including ductwork/vent liner U Yes U No
City/metro he.no.: Install/rep ac re ocate eaters-suspen c ,
Nance(please print): _� wall or floor mounted _
/� ' col}or tI i iar,x of ux t nn furnace —
{ { e goat on:Absorption units _ H'Itl/II
Name: " 11 O� Chillers IIP —
Address: " O ,( "` ('omtressorx HP
City: State �Ip;c :nv ronMenta ex ust An vent a1 on:
Pholte;rO „2 nG' Appliancevenr
pp Fax. E-mail: ---
)rycrcx aunt
{ T It s, Ype rc.,. Ile c tnzmnl
Narnc: hood fire suppression system
Gxhau;t fan with single duct(bath fans) --
Mailing addn ss: ) y 3�� y x taunt s stem- art tom entin or C'
�'
— 5ltueCJ LII':: 'pe P p ng an td ut on(up to out cis)
Phone: ,2 Fax: E-mail: T'y x: - I,1'G NU oil
uc i un�enc t a it ona over outT--
m",;piping(sctematicrequired)—
Name: Number or outlets
�1
Address: -- er tt app anee or equ pmenl:
City: Dccorrtivc fireplace
Slate: 7_11': nsert- type
1'Itone Fax: I mail• rn slat/ -
pC CI AIO1'C
Applicant's signutwr Ut ter: -
Nance rine ter:
(print): l wr �-w d
Nevi all IanwOellrxtr aLvepl rtedit cardx.pleaw I-Al I111t.1i,Ilion int unae udrani.unm 1
Notice l his permit appliewion Perntq lie.....................$
U Veva U Mnvtcr("nrd -��
r'redit card nunelK•r espires iia pl rntit is not obtained Minimum Ice.... ...........
._.__._. Plan review(at
—_-- I
plh� wilhin I8(I days after it has been
sli" al card o rkr
to xhr wn im i rr�cnrd accepted as contplek. Stale Surcharge(8%) •„•$
----- -_ - TOTAL .......................$ _
1'melhnlder�i�nniun. _— -” '_ S
Ammutt _
•tan 4n 111rvtWW IM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
( Description: e Price Tntal
TOTAL VALUATIONS FEE: Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to$5,0_90.00 _ _ Minimum fee$72.50 1) Furnace to 100,000 BTU
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and including inciuding ducts&vents 17.40
$10,000.00. ) Floor Furnace
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and including vent 14.00 _
$1.54 for each additional$100.00 or heater,eater,wall heater
fraction thereof,to and Including 4) or floor Suspended
had heater 14.00
$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000 00 and 5) Vent not Included in appliance permit
$1.45 for each additional$100.00 or
fraction thereof,to and including 6) Repair units
12.15
$50,000.00.
$50,001.00 and up $742.00 for the first$50_,000.00 and Check all that apl'• Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,ser: or Pump Cond
fraction thereof, footnotes below. _ comp* "
_ - 7)<3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS P_ER APPLIANCE: 8)3-15 HP;absorb
Value Total_ unit 100k to 500k BTU 25.60 _-
Description:
Qty Eat Amount 9)15-3G HP;absorb
Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTL' 35.00
ducts&vents _ 10)36 50 HP;absorb
Furnace>100,000 BTU including 1,170 unit 1-1.15 mil BTU 52.20
ducts&vents - 11)>50HP:absorb
Floor furnace including vent _ 955 unit>1.7;mil BTU _ 87 20
Suspended heater,wall heater or s55 12)Air handling unit to 10,000 CFM
floor mounted heater
Vent not Ir.1,ded In applicannce --� 445 13)Air handling unit 10,000 CFM+
ermit �� 17.20
Repair units4 __ e-855 - 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 10.00
to 100k BTU15)Vent fan connected to a single duct
3-15 hp;absorb.unit,--
-1,700 6.90
101k to 500k BTU ---- 16)Ventilation system.not included In
15-30 hp;absorb.unit,501k to 1 2,310 appliance permit 10.00
mil BTU - 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit, 3.400 10A0
1-1.75 mil.BTU - _5,725 18)Domestic Incinerators 11,40
>50 hp;absorb.unit,
>1.75 mll.BTU --- 19)Commercial or industrial type incinerator
Air handling unit to 10,000 r:fm _656 - 69.95
Air handliMunit>10,000 cfm_ 1 170 20)Other units,including wood stoves
Non:2i! ble evegorale cooler 656 10.00
Vent fan connected to a single duct 446 i _ 21)Gas piping one to lour outlets
Vent system not included in 856 5.40 _-
ej) Ip lance permit 22)More than 4-per outlet(epcnj
Hood served by machanlcai exhaust 656 100
Domestic incinerator 1,170 _ ___ Minimum Permit Fee$72.50 SUBTOTAL: $
Commercial or industrial Incinerator 4.590E
Other unit,including wood stoves, 656 8%Stale Surchar,;e $
Inserts,tilc. _ ------- --
Oas Ipa1.4 outl09 360 _-_ 25%Plan Review Fee(of subtotal) E
Each additional outlet 63Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION: _._- ------- -----
____ Qtherlmosctlonssrgd,jej;
1 Inspections outside of normal business hours(minimum charge two hours)
$72 50 per hour
2 Inspections for which no fee is specifically indicated (minimum charge-halt hour)
$72 50 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
charg"ne-half hour)$72 50 per hour
"State Contractor Boller Certification rsqulr:4 for units 40ek BTU.
"Residential AIC requires site plan showh#g placement of unit.
i\fists\forms\mech•fees doc 10111/00
Electrical Pe1i•mi±application
- Dais received: Permit no l� •��
City of Tigard rroject/aMl.no.: Expire date:
Ciryaf'ligard Addmm: 13125 SW Ifall Blvd,Tigard,OR 91223 fate issued: Hy: Roceipt rho.:
Phone: (503) 639-4171
Fax: (503)598-1960 Case file no.: Payus:tt type:
v
Land use approval:
I &7.fnmiiy dwelling or accessory 11 Comrnercial!iodu:ariul Cl Mufti family '1 'tenant improvement
New construction 11 Addition/alteratiunireplacetmnt i' Qthm _ _- U Partial
Jath a"um- 1299 1 � W 116 ' Place City:1 i .��.. -Lulte two.. tar wap,lax lot/nccount no.--')S 10361) 300
Lot: 5Hlock.:N/A subdiviauaa Hunter's Woodland _
Project name: _ Description and location of work on E2mises:
1--gitnmtcddate ofcom hletion/m.9pee,.o—
Job no: 03-ZUOI Vee 'Nal
l3usinessname: Ideal Electric Company 'IP�" __ (m) Total tto.iaa
Now realdealial tater}r a aha"mokly ps
Address: 18888 S TerryMichael Drive
__ _ dtrrn.a aW. Urladri aa►:,rd prate
City: Ore on City _ State OR ZIP: 97045 Frrirrari.rkd!
Phone:307461 fax: -- ___iE-mail: -- 1�W Rona. 110. -- 4
CCH no m _ Flee.bus.lie.no: - �'oldhioml 500 mi. thaeor 30
_ Limited tmM,1&2 Family 30. 2
City/metro IIC.no'N/A Limited atony,Muhl-Family 45 2
%� /(!/ /rl / Each menut. ,.umd home a modulardwellins
tsartrnra rvtd— aln»irlra r nllt U7/(15�01-- %cr is vWorkedet 75. 2
Su .elco name print): I.itxmcno &ts o
rer iatrtdlalbe,
altaaNanaaar
2_0_,0 65 2
201 --i --- S 2
Name( int):Mel Waymire _ ""�' aa�`
Mai addmss:P U Box 231164 601 to boo 130. 2
bnl.nytstel000 Ilan, z
City:Tigard .___-_--- stale ZtP:97218 raver 1000 ami at volts 65 7
Phone:50 52 I-90y'� Fttx Kcumne on 55 t
thpa w bund minim.The installation is being trade on property I own trmponry wrvlref or frederr-
which is not intended for sale,lease,rent,or exchange according to inUaalon,darrattoa,orrekwadoa:
I ('RS 447,455.479,670.701. miamp n 400 amps T 80A z
--
()vtmeeq si nature: _ Dale: 401(a 600av 110.01 2
Sraaeb drealb-arw,dkndm
Name: or nMrnloe prr paaA:
—_--- A.For.6w branch cisco tl with pwchaac of
Address onvice or realer fee.each branch cmron 6.01 2
(,fly. -- $tate: 7!F: H Far branch c"mits whbmt r.rehme
chane - Pax: g.n,r31; of raviot or keds tee,fuss branch West: 40 2
FA&adwiond branch eirasic 6.001
m1+r.I&rIkI or kens hoar imck deo.
U Service nja►221 arern-mwhmwrctal n Noahh.we ateilhy Pad or irri ohck 45. 2
0 Setvier mer 120 amm aavhna of i R) 0 Hadird"bo OM L•ach"rar outline li 45.— 2
fbniiy dwellinp U Ralldina om 10.000 m"W Rich Mir a atW 3icirmit(s)a a l"namd emsy pond, —
0 Syslem over 6W 6rob 1%1"o, arae ftmikotid umb is car anuctm new,aMantwn,at stdataoa• 45. 2
0 Build"*(me acme tame; 0 Patdaa AIM atp OF acme •pasgi - -- --
U t loragwt Ined avis 99 rwmw s 0 M nullm mW dnaa m at RV laid F"li 1e0Nea@1 hapeesMa n+e.th.dM.Mk to No atdw aMr:
U Fj►aa A*hh M plan 11 Other. Phis urpec-tian
1 1 75 Mi
SabasN 2 seta of plana with any of the above. liffellitalm fee r
The above are nal applicabk to wasporary commaraetba mrvlee. Ot ar
ivo�kv: t;b����m Permit the......................S
Plan review(M 25�(i)....:
ViaI1 modacad eq*"i/a pumice h Nov —
crodn cavi aavabav 81allmo d talo 6 Iia 44"4100'it State stlydwse I moi).....S
w Ana tAaaw somirom4•ce.rpLrw TOTAL ...............
Ntimc cif-w�i men e+a�ii�—
S
44o 11(7mwcoM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
— — —_—R TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Complete P=ee Schedule Below: -��-
Reslriclecl Ener fly Fee...................................................... 573.00
Number of Inspections per pe.-mit all. (FOR ALL SYSTEMS)
Service Includ9d: Items Cost_ Total Check Type of work Involved:
Resi1000 aqr t, -per unit I ❑
100(1 nal ft.Or kiss 5145.15 4 Audio and Stereo Systems*
Each additional 50C tq P or
portion thereof $2'c 40 1 Burglar Alarm
Lhnttrri Energy :;5.00
Eac41 Manutd f4ome u Modula ❑ Garage Door Opener*
Dwelling Service or Feeder _.__. $90.90 2
Services or Fewtlars Heoting,Ventltatlon an.Air Conditioning System'
Installation,a.M.eratirn,or reiuc:ati0n
2()n amps or less $110 30_ 2Vacuum Systems'
201 arms RD 400 amps _ —�_ $106.65 _._ 2
401 arrhns su 600 amps 5160.60 r 2
601 amps to 1000 amps �^ 140.00 2 Olher-- -- _�----
Over 1000 amps or volt-, $454.65-- 2
Roc�nett o,AY ._.__.__ 566.85 2
feRwos-. y Services or Fenders TYPE OF WORK INVOLVED-COMMERCIAL ONLY
Forri latnn Service o rrlr ed r, Fee for each system........................................................ $75.00
Insta
200 amps or k+rs Stili 65 2 (SEE OAR 918-260 260)
701 amps to 400 amps _ _ $100 30_ 2
401 amps to 600 amps _ _ $133 75 _ 2 Check Type of Work Involved
CM1 600 amps 10 1000 Volts, ❑
S""b"above. Audio and 5lereO bYslenls
Branch Circuits ❑ golfer Controls
New.ettemtkxl or extension per panel
a11he foe for branch circuits
wnh purcrwse of service or Clock Systems
feeder(en.
Fadi branch circAid -' $6611_ 2 ❑ Data Telsoorrinrunicatlon Installation
b)1 he fee for branch circults
wteho:rt prrrcrrase of service Fin Alarm Installation
or feeder fes.
First branch circuit $46.85 HVAC
Each additional hranch cimuit $685
11R44WIaneous Instrumentation
(Servioa or fecrlar rKd in(hided)
Each pump or vrpntixl Urias $53.40 - Intercom and Paging Systems
EAch sign or ourinr llghting _ $53.40
Sional O uitlsl er a limited eneruv
panni,alteration,V eAtenston — --- SIS 00_--- C] Landscape irrigation Control'
Minor Lobeis(10) — ,_ $12500 ❑
r',ch addition:Inspection aver MsdfCat
the allowable Ir my of the above r l Calls
in"cliorl .--_-- $r)1 50 — – LJ
Par hourSee 50 —
In Plant - $13 15_ Outdoor I-andscape Lighting
Fees: [] molar"sw alkbg
1 Enter total of above fess $ �] Other
ex%tar 31•nll"'Vo $ NuM'Jer of Systems
75'%Plen Review Fed ' No licenses are required Uoenses are rquked for ati other kSWWAMN
'+ne'1'ion on S
flonlolarlp"Unil Fees:
Total Balance Duo $
Enter tttAal of above faM :
❑ Trust Ac citnint 0 0%State Surcharge :
Total salanco Due _--
41nr\rnrn+e�tl<-t. :dam. r1fJn?Int
Plumbing Permit Application
Date received: Permit no--*/S-rzx - Q
city of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Ifall Blvd,Tigard,OR 97223 _ - -
City q(Tigard Phone: (503) 639-4171 Projecl/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
fill W
1 2 family dwelling or accessory U C•onuncl talhndu,uial U Multi-family U'renant improvement
W'New construction U Add ition/al teration/repl acernent U Food service U Other:
r.0011 SI I EINFORMA]ION ,
Joh address: /254-3 cz .`C._ __, _Ile1(riptiun - Qty, hee(ea.) rulal
Bldlr,. no.: _ Suite no.: Ne(+ I-and 2 famil}d►vellingS only:
- - (Inchrdt�IOil ff.for each utilityconnection)
Tax map/tax lot/account no.: /Q a 3 oei SFR(1)bath
Lot: Block ISubdivisiolch SFR(2)bath
Project name: _ SFR(3)bath
City/county: ✓ ZIP; 23 Each additional bath/kitch�n —
M-scription and location o1•work on premises:- Site utilities:
Catch basin/arca drain
Est.date of completion/inspection: Drywells/leach line/french drain
M Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: -moi ui _ Manholes
Address: V Rain drain connector _
City; �Q State 7.1 P: Q6' Sanitary sewer(no.lin.ft.)
Phone 6 S`� Fax: E-mail: _Storm sewer(no.lin.ft.)
CCB no.: S'6 LPlumb.bus.reg.no:3Y'-3 Water service(no.lin. ft.)
City/metro lie.no.: 2-7y -- Fixture or item-
Absorption valve
Contractor's representative ignature: Back flow preventer _
Print name: — J, Date: Backwater valve
t Basins/lavatory
Name: '/po Clothes washer i
-Address: Dishwasher _
Drinking fountain(s) _
City: a1 State QIP: -
_ Z 7 Ejectors/sump -
phone:: 3E� 6 I - E-mailr---- -Exp►nsion tank
Is I ixturc/sewer cap
_Name( rint): I'loor drains/floor sinks/hubP �� � � �y�9ris�-t --- -- Garbage dislxrsal _ I
Mailing address: /L 11 Ise bibb _
City: 77a,,,-dStale CK 7.I P: „Z �' Ice maker -
Phone: Q Fax: -- I mail Interceptor/grease trap
- -
Owner installation/residential maintenance only: Tile actual installation Primer(s)
will he made by me or the maintenance and repair made by my re pular R(wf drain(commercial)
_-
employee on the pm I »Villas per ORS Chapter 447. Sink(s), asin(s), ovs(s)
Owner's signalure: - Sump
7'ubs/shower/s ower pan __
)anal
Name: _.
- ----- W atcr c oset
Address: _ _ Water heater --v----� -- �_-
City: State: 7.1 P: Other:
Phone: _—^ Fax: _ rr,ail: —_.-__ Total J
--_---- Minimum tee ...............R _
No all iudenccann,accept crrdlt code,pleaw call lunuacuur•uu t",*r nnan"n N„ncr I Itis permit application
I1f►n rCtICW(al _— 'ff�) $ _
U Visa U Masleward c,trires if a permit is not obtained
,•,edit cnrd nurnher --_--_----.—_ - __1 / to ithin 1811 days alter it has been State surcharge(8%) R
t iriie,
.__�.--- accepted as complete. TOTAL .......................S
Name of co nl t as ehnwn nn crrdiI cod
— Canlhu der siiinaotrc Amount 4*0 4616 MAXWOM)
PLUMBING PERMIT FEE):
-1-- -
PRICE TOTAL New 1 and 2-family dwellings only:FIXTURES (individual) QTY ea AMOUNT
Sink ' --' ..._- (includes all plumbing fixtures in PRICE Tr T-,
16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility c:onnectioJ_ _
One 1 bath
Tub or Tub/Shower Comb. 16.60 Two 22)--{ --- $249.20
_ -__ bath _ $350.00
Shower Only 16.60 Three m _ath $?49.00
Water Closet 16.60 _
Urinal I 16,60 -. -- SUBTOTAL
_ 8%SPATE SURCHAA;;E
Dishwasher x16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage DisF osal 16.60 TOTAL
Laundry Tray 16.60 -
Washing Machine 16.60
Floor Draln/Floor Sink 2"- 16.60 -
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like kind 16.60 Quantity b Work Performed__
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
eermil. Capped
MFG Home New Water Service 46.40 Sink
MFG Home Now San/Storm Sewer 46.40 Lavatory -
Hose Bibs 16.60 Tub or Tub/Shower -
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 16.60 -- Urinal _
--- Dishwasher
Garbage Disposal
Laund Room Trra
--
Washing Machine
Sewer-1st 100' 55.00 Floor Drain/Sink: 2"
3„
Sewer-each additional 100' 46.40 4„ ---
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
_
Storm&Rain Drain..1s1 100' 55.00 (Specify)
Glorm 8 Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50 -
Re uested Ins ectlotts ler/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 -
Grease Traps 16.60 '-
QUANTITY TOTAL - - -
Isometric or riser diagram Is required If -
Quantity Total Is >g _-
'SUBTOTAL _
------
"PLAN REVIEW 25%OF SUBTOTAL
Required onlYil Bdureg lofal Is�9 _
TOTAL f
"Minimum permit fee is$72 50 4 8%stale surcharge,eweopt ResideMial Backflow
Prevention Devlr-e,which is 138 25 1 8%stale surcharge
"All New Commercial Buildings require pians with isometric or riser diagram and
plan review
l:\dstvlformslplin-fees.doc 10/10/00
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MEL, WAYMIRE, BUILDER
P 0. BOX 2311 Com• Z
TIGARD, OR 97281 - -I
503 521 9092
246 tl0 or EROSION CONTROL FENCE
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LOT 5166 SF x
BUILDING PAD LINE $ I ti 246.00
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST ,��,✓� eZ vow
24-Hour Inspection Line: 639-4175 BLISiness Line: 639-4171
BUP
Date Requested___ / - / -? AM PM _ SLp
Location_ `1 `" _ Suite MEC
Contact Person _ �i� _ Ph S�� [ 1 G �I PLM
Contractor _ Ph �l 1 I SWR -
BUILDING Tenant/Owner ELC
Retaining',Nall v ELR
Footing Access:
Foundation FPS
Fig Drain ;GN
Crawl Drain Inspection Notes: — --
Slab -- - --- - - SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _..____--_------.-.___---— .---- ------ -
Firewall
FireSprinkler ----- -- - - --------- -- --- -._._T --- -----__-...._..-------
Fire Alarm
Susp'd Ceiling - -- -- _ -------- - ----- - -- - -- - - --
Roof
Misc:
ASS' PART FAIL - -- -- -- - - - --- - ---- - ----- .-
P VMING
Post& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post& Beam _ -_ --- - - - - -
Rough In
Gas Linc
Smoke Darnpers
(PASS) PART FAIL
ELECTRICAL - -
Service
Rough In
UG/Slab --
Low Voltage
Fire Alarm _-- - --- --- — ---
Final
PASS PART FAIL ----- - -
SITE
Backfill/Grading —..- ----- -
Sanitary Sewer
Storm grain [ J Reinspection fee of$ -required betore next inspection Pay at City Hell, 13125 SW Hall Blvd
Catch Basin
Fire Supply Linty ( J Please call for reinspection RE _ _-, [ J Unable to inspect-no access
ADA
Approach/Sidewalk Date 12-
Other .. Inspector Ext
-- - -- - — — --
Final
PASS PART FAIL. 00 NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUIL ^'NG INSPECTION DIVISION MST Zvi (Do �D
24-Hour Inspection Line: 639-4, 5 Business Line: 639-417
BUP _
Date Requested _ 3(-) AM _ PM _ BUP
Location_ / Z, `i lj —�'/ � �L Suite MEC
Contact Person _ )]may J Ph j -;t,/ C; I Z PLM
Contractor �— Ph / �j �' 7 f SWR _
BUILDING Tenant/Owner ELC
Retaining Wall -- ELR
F noting —
Foundation ACCe5S: FPS _
F;g Drain __ W
Crawl Drain Inspection Notes _ SGN
Slab
SIT
Post&Beam _--
Ext Sheath/Shear
Int Sheath/Shear --` - -- - �_----
Frarning
Insulation _
Drywall Nailing
Firewall
Fire Sprinkler _- -1
Fire
Fire Alarm
Susp'd Ceiling
I•toof
Mises -
Final
PASS PART FAIL --- -------------- _. __��
PLUMBING
Pest& Beam -' --- - -- —
Under Slab
Top Out
Water Service
Sanitary Sewer --------__._� __�A__--------- •- — —_-__�. -------
Rain Drains
Final
PASS PART FAIL
MECHANICAL - - -- --- •- -- _.—. _._.._--
Post& Bean
Rough In
Gas Line - - ------
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ----
Service
Rough In --__--
UG/Slab _
Low Voltage —
Fire Alarm14&A6QW --
ART FAIL
MTE
B.ickfill/Grading — --- -- ---- ---
Sa-Aary Sewir
Stour Drain ( (Reinspection fee of$ required before next inspection Pay at City Hall. 13125 SW Hall Blvd
Cat:h Basin ( Please call for reinspection RE:
Firs Supply Line __--_ __--_._— — ( (Unable to inspect-no access
ADA
IApproach/Sidewalk Date _ r%``1�Inspectors —' `"
Other L' c Ext
Final /j'✓ � _�—'--
PASS PAI; FAIL DO NOT REMOVE this Inspection record from the job site,
CITY OF TIGARD BUII r)ING INSPECTION DIVISION
24-Hour Inspection Line: 639--. ,75 Business Line: 639-41, , MST
BLIP
Date Requested � -A,-, AM
l f � - --PM _ BLD
Locationf,L
.; c� f - Suite _ MEC _
Contact Person — _ '�'Y�� Ph 3% '( J -2 PLM
Contractor Ph SWR —
BUILDING Tenant/Owner ELC _
Retaining Wall ELFT
Footing Access: --i - --
Foundation FPS
Ftg Drain -- — ---
Crawl Drain Inspection Notes: SGN
Slab
--___------ -_.._--_.__---_.-- --- -
Post& Bearn SIT
----- -- — --
Ext SheathiShew —
Int Sheath/Shear ----- - ----- -------
Framing
Insulation --- - - - - - ---- --
Drywall Nailing
Firewall ---__.-- -- - _
ire Sprinkler
----
ire Alarm - -
Susp'd Ceiling - -_-
Roof - - -
Misc:
Final - -
PASS PART FAIL --- -_ -- --
PLUMBING - - --
Post& Beam - - - - -- - -
Under Slab
Top Out - -_
Water Service
Sanitary Sewer -- —_.---
Rain Drains
PA PART FAIL
MECHANICAL --
Post& Beane -
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
Storin Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
catch Basin
Fi.e Supply Line [ J Please call for reinspection RE:— ( J Unable to inspect-no access
ADA
Approach/Sidewalk U7 / fL
Other Date Inspector '_/`' Ext
Final '--
PASS - FAIL DO NOT REMOVE this, ir,spertion record from the job site.