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14640 SW 120TH PLACE 14640 SW 'r 20'x' Place CITY OF T I �;A R D ____MASTER PERMIT A \ 6`_ PERMIT#: MST2003-00074 DEVELOPMENT SERVICES DATE ISSUED: 3/14/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.11171 SITE ADDRESS: 14640 SW 120TH PL PARCEL: 2S110BC-02700 SUBDIVISION: WALL rt,RTITION/MLP2001-00006 ZONING: P-7 BLOCK: LOT: 002 JURISDICTION: I I(i) REMARKS: Const. new SF deteched residence. BUILDING _ REISSUE: MAS2223AD STORIES: FLOOR AREA`, REQUIRED SETBACI(S REQUIRED CLASS OF WORK: NEW HEIGHT: :".! FIRST: 1,383 sf BASEMENT: at LEFT 11 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: ao SECOND: 1.437 sf GARAGE: IX sf FRONT 7n PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: I Tww• %f RIGHT 5 66J'1�1 OCCUPANCY GRP: R3 BDRM: 4 BATH: TVALUE JJa OTAL, I H7n st REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS. 3 N'4SHING MACH I LAUNDRY TRAYS, I RAIN DRAIN: TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS SEWER LINE!: 1 SF RAIN DRAINS. 1 CATCH BASINS: TUB/SHOWERS, 3 GARBAGE DISP: I WATER HEATERS. I WATER LINES, I BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ _ FUEL.TYPES FURN<100K: BOILICMP<3HP: VENT FAITS: CLOTHES DRYER: 1 (;AS --_ FURN>•100K: 1 UNIT HEATERS: HOODS: I OTHER UNITS: 2 MAX INP. btu FLOOR FURNANCCS: VENTS: 2 WOODSTOVES: GAS OUTLETS: 5 ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCI'FEEDERS _"-RANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 jrnp: W/SVC OR FOR PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF. 5 201 - 400 amp: 201 - 400•np: 1 st WU SVCIF DR. SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 000 arnp: 401 - e00 amp: EAADDL.SR CIR. SIGNAL/PANEL: IN PLANT: MANU Hi41SVCIFDR: 001 1000 amp: 601+amps-100037 MINOR LABEL: 1000•amp/volt: PLAN REVIEW SECTION Reconnect only: -4 RES UNITS: 9VCIFDR>•225 A.: >000 V NOMINAL: CLS AREAISPC OCC: _ ELECTRICAL•RESTRICTED ENERGY _ __- A.SF RESIDENTIAL - B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO FIRE ALARM: INT ERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC- LAND51CAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: A LL �d G S I f1J� CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: C Nl r11 IfV�J`1]"�G'•� DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: TOTAL FEES: $ 8,162.60 Owner. Contractor: This permit IB subject to the regulations contained In the MASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUC-ION INCTlgard Municipal Code,State of OR. Specialty Codes and 1F,435 SW ASHLEY DRIVE 14225 SW 128TH PLACE all other applicable laws. All work will be done in T'GARD,OR 97223 TIGARD,OR 97224 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: Oregon law requires you to follow rules adopted by the Phine' 50?-167-6730 Phone: MBL.860-3298 Oregon Utility Notificatiun Center. Those riles are set forth in OAR 952-001.0010 through 952001-0080. Yr)u Rayl N 13149010ma obtain copies of these rules or direct questions to OUNr ty calling(503)248-1987. REQUIRED INSPFCTIr1NS Erosion Control Ins, q, Pat loam Mechanica Plumb Top Out Exter!c r Sheathing Inst Rein drain Insp Mechanical Final Sewer Inspection Una floor Insulation Electrical Service Low Voltage Water Line Insp Plumb Final Fooling Insp Crawl Drain/Backwater Electrical Rough In GPs Line Insp Water Service Insp Building Final Foundation Insp PLMII lnderlloor Framing!nsp Gas Fireplace Appr/Sdwlk Insp PosVBeam Structural Mechanical Insp Shear Wall Insp Insul.ltlon Insp Electrlrjl F:nal Issued B Permittee Signature Call (503) 639-4175 by 7:00 p.m. for an inspection needed the neKf- business day �I�� SEWER CONNECTION PERMIT _ CITY OF PERMIT#: 13WR2003-00066 DEVELOPMENT SERVICES DATE ISSUED: 3114103 13125 SW Hall Elvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110BC-02.700 SITE ADDRESS; 14640 3W 120TH PL ZONING: R-7 SUBDIVISION: FALL PARTI'viON1/-MT 200200006 3URi3DLCTION: TIG _ BLOCK: TENANT ND.ME: FIXTURE UNITE: 1 USA NO: DWELLING UNITS: CLASS OF WORK: NEW NO. OF BUILDINGS: TYPE OF USE: SF IMPERNI SURFACE: INSTALL TYPE: L_1 PSWR Remarks: Sewer connection for new SF dwelling_____ FEES — -- Owne—!_,�— — ---- Amount Description Date __ MASTERPIECE CONSTRUCTION INC ----' $2,300.00 15435 SW ASHLEY DRIVE 3114103 $0.00 1 IA35 S. OR 97223 [SWUSAJ Swr Connect 3114103 [SWUSAJ Swr Connect 3114103 $35.00 [SWINSPJ Swr in, 3114103 $0.00 Phone: 503-267-6730 [SWINSPJ Swr Inspect -- Total $2,335.00 Contractor: _-- Phone: Reg#: Required Inspection ___� permit expires 180 This Applicant agrees to comply with all tohfntule d will ue forfeitedL' regulations Ifthe pethb en t expirres.an Water erv'ces. The The Agency does not guarantee days from the date Issued. The total am PP not the and Side Sewer' Perm the accuracy of the side sewer laterals. If giver.. I not so loclated hetinstaller shall purchase a 1Tapnst d Si shall prospect 3 feet in all directions from the distance giver. If no I issued by: ,� Permittee Sig"ature' Ca!l (503) 639-4175 by 7:00 P.M.for an Inspection needed the next business y �-- 3- i0-n3 TSE Buildin Permit Application Received Building , NLY pp ---- Dete/B - -O Permit No.: 7` City of'Tigard Planning Approval - Other E C�E I V E D PlanDateR Permit No.: 13125 SW Hall Blvd. RECEIVED Plan Review Other � 'Tigard,Oregon 97223 Date/By: Permit No.: 113-639-4171 Fax: $ SSgB- 9 Post-Review Land Use Phone: 5 I�O � f Date/By: Case No. Internet: www.ci.tigard.or.us Contact Juris.: D9 See Page 2 for 24-hour Inspection Kcquest;A93i qP-glIUARD) I Name/Method. I Supplemental Information HIJII-DING DIVISION t_t _ TYPE OF WORK REQUIRED DATA: New construction_ I Demolition _ I &2 FAMILY DWELLING �, l Addition/alteration/replacement J [j 9ther: -�— —`— CATEGORY OF CONSTRUCTION _ Note: Permit Ices*are based on the total value of the work performed. Indicate 1 &2-Namily .WClhn r Commercial/Industrial the value(rounded to'6e nearest dollar)of all equipment,materials,labor, ovcrheau and prufit for t,e work indicated on this application. - Accesso E, Min Multi-Funnily— 6Z7� 55 Master Builder Other: Valuation..................................................... S L_ -4No.of bedrooms: No.of baths: Zf/t JOB SITE INFORMATION and LOCATION �- - t Total number of floors...........2..,.......,. .:. Job site address: --- S � LO New dwelling area(sq.ft.)...�.,,.�'�"........... �-'1 Bld ./A t.#: ----- Suite#: �_._ Garage/carport area(sq,fl.)....�.. .. ... ...... Project Name: l._,W k� E'�IE3 \ t{!� Covered porch area(sq, ft.)............................. Cross street/Directions tQ job s'te: r 1 Dcck area(sq.ft.)............................................ 1n v \ if � k Z Other st•. rr:, area(sq.ft.)............................ REQUIRED DATA: COMMERCIAL-USE CHECKLIST l� Subdivision: _ —_-- [mot#: — — — TaX map/parcel#: Note: Permit fees*arc based on the!otal value of the work performed. Indicate DESCRIPTION OF YVORK the value(rounded to the nearest dollar)of all equipment,materials,labor, - - overhead and profit for the work indicated on this application. Valuation......................................................... S -- ----- Existing building area(sq.fl.)......................... New building area(sq. ft.)............................... _ Number of stories............................................ ROPERTY OWNER TENANT Type of construction....................................... Nafne m Yti- R-S \ t ^ Lr Occupancy group(s): Existing: _��_`-. c�"-L'C -} New: --- ------ Address: t q 't—'1_� j.�r�T`1" __ — Cit /State/Zip_T` °O 12-IL R-- - �- "' C Fax: _V -S LSI - y'�__] � NOTICE: All contractors and subcontractors are required to be Phone: �5- APPLICAN .ONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: _ jurisdiction where work is being performed. Ifthe applicant is exempt Contact Name:' — _- from licensing,the following reason applies: Address: -- Cit /State/Zip: _ --� -- ----f — Phone: _ — _ _ Fax. BUILDING PERMIT FEES* - E-mail: Please refer to fee schedule. — CONTRACTOR - —-- -... --- --- Business Name: _ � _L Fees due upon application.... ......................... $ Address: Llt /State/ZI Amount received......... ................... ...... Phone: =ax: __ Date received: CCB Lic. #: CD Cl U-- --- ----.--.__-_ Authorized ��` -�y-�� Notice: This permit application expires If a permit is not obtained within Signature: _C -_� Date:Z 180 days after It has been accepted as complete. -� J `s\'e-& n lU\ill R- ,_` *t'ee methodology set by Tri-1:7ounty Building Industry service Board. (Piees!print name) i:\t)sts\Pemnt romrs\BldgPcrmitApp,doc 01/03 One-and Two-Family Dwelling Building Permit Application Checklist Associate pe -- Associated permits: CrryafTigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other: Phone: (503) 639-4171 Fax: (503) 598-1960 I'OLLOWING 1 4 1 =1 ' L WWI I Land use actions completed.Sec jurisdiction :rltcrui Poi ioui urre nt 1C1'1CN'S. 2 Zoning.flood plain,solar balance points,seismic soils designation,historic district,etc. i Verificatf,)n of approved plat/lot. 4 Urc district approval required. 5 Septic system permit or autF orization for remodel. Existing system capacity 6 Sewer permit. _ 7 Water district approval. _ 8 Soils report.Must carry original applicable stamp and signature on file of with application. _ 9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. _ 10 3 Complete sets of legible plan.Must Ix drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a sepatate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if co yright violations exist. 111 Sitelplot plan drawn to scale.The plan must snow lot and building setback dimensions;property comer elevations(if there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easement~and d'iveway;footprint of structum(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. I'. Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pad r,connection details,vent size and location, - I I Floor plans.Show all dimensions,room id(ntillcation,window size.location of smoke detectors,writer heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)al:d details.Show all fram-mg-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, ±ff lace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two t lecations for additions and remodels. Exterior elevations must reflect the attual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. _ 16 Wall bracing(prescriptive path)and),^,r lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide 9pecitications and calculations to engineering st^.-dards. _ 17 Floor/roof framing.Provide plans for all noors/rxrf assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,see item 22,"Lngincer's calculations" 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet lung and/or any Pram/joist carrying it nun-uniforn+load. 20 Manufactured floorlroof truss design details. _ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more a lianas. 22 Engineer's calculations.Whtn required or provided,(i.e.,shear wall,roof truss)'hall he stamped by an engineer or architect licensed in Oregon and shall he shown to hc• aleph,ahlr 1,1 Ihc•proick I under recicw. 2.1 Five(5)site plans are required for Item I I above. Site plans must he 8-I/2"x I I"or 11"x 17". _ 24 Two(2)sets each are required for Items 16, 114,20&22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COTS(rect Tree List. Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is :.served for department use only. 440-4614 cA OVIIsr) Building Fixtures 111umbin 1'ermit Application Received Plumbing Date/E!✓: Permit No.: Planning Sewer City of Tigard / Datc.43 : PerntitNo.: 13125 SW Hall Blvd. / Plan keview other Tigard,Oregon 97223 Date/By: Permit No.: Post-Review Land Use Phone: 503-639-4171 Fax: 503-598-1960 Date/By: Case No.: _ Internet: www.ci.tigard.or.us Contact luris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Sunnlentcntal Information. _ TYPE OF'WORK - FEE'SCHEDULE fors►ectal information yse checklist) New construction Demolition Description Qq. Fee(ea.) 'total New 1-&2-family dwellings Ad dition/alteration/re laeement Other' includes 100 ft.for tacit u llity connection CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 _ 1 & 2-Family dwellin r Commercial/Industrial SFR 2 bath 350.00 Accessory Building__ Multi-FamilySFR 3 bath _ 399.00 Master Builder' ❑Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Firesprinkler- . ft.: _ Pa e 2 Job site address: `- j 1 20�*-p( _ site utilities Catch basin/area drain 16.60 Suite#: Bld ./A t.#: Dr ell/leach limatrench drain 16.60 Project Name: 1ti`+>, �� P fl 0.r_�� t a Footing drain no.linear fl. Pae 2 Cross street/Directions for job site:l .r 11� Manufactured horrte utilities166 V'A rv. l Manholes .660 Rain drain connector 16.60 Sanitary sewer no. linear ft. Pa e2 Storm sewer(no.linear fl.) _ Pae 2 Subdivision:IN�Z PO&TJ Lot#. Z_ Water s.rvice no. linear ftpPee 2 Tax map/.parcel#: Fixture or Item DESCRIPTION.-OF WORK Absorption valve______ 10.60 KNI C ^---- - Backflowrp eventcr _ ✓ Page 2 --+-= Backwater valve 16.60 -- Clothes washer _ I 16.W __ ----- Dishwasher 16.60 Drinking fountain 16.60 PROPERTY OWNER TENANT E•ectors/sum 16.60 Name:_ ,ftr-5��ilc f I`c r - Ex ansion tank 16.60 Address:( � "L1� t... p __ Fixture/scwer cap 16.60 Floor drain/floor sink/hub _16.60 Lit /State/7.j�: i Garbage disposal i 16.60 Phone: _ S"( Fax:SU�- y--�-(�•lI rinse bib 16.60 PLIC .ONTACT PERSON [cc malccr 16.60 Intcrcc for/grease trap 16.6n Name: �5-_______ Medical -value: S Page 2 Address: -- Primer 16.60 Cit /State/h _ _ Roof drain commercial 16.00 Phone: Fax. Sink/basin/lavatory 16.60 -- Tub/shower/shower an :. 16.60 E-mail: Tub/shower/shower 16.60 _ _ CONTRACTOR 16.60 Water closet Business Name: _� __ Water heater ! 16.60 Address: ^L4.v, J Other: Cit /State/ I :C=L-'V'Cl1 1661" Other: Phone: 1 "• 1,'� Fax: '� Plumbing Permit Fees* };�. Subtotal s CCB Lic. #:r Plumb. Li- c.#. Minimum Permit Fee$72.50 S AuthorizedResidential Backflow Minimum Fee$36.25 Signature _01 6-� _ _ bate:'L-?:L4'♦1 Plan Review(250i1t of Permit Fe! State Surcharge(8%of Permit Fee) 3 ---t -� -�_ TOTAL PERMIT FEE $ (Please print name) Notice! ThH permlt application expires if■permit 1%not obtained N itttht All new com•nerclal buildings require 2 sets or plant with Isometric or IPO days after It has been accepted n complete. riser diagram for plan review. 'Fee methodology wt by .rWounty Building Industry Service Board. i\Dtts\permit Forttta\PlmPemntApp doc nl't't Plumbing PertiAt ApIiQ cation - City of Tigard Page 2 - Supplemental Information Fee Sekiedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(en) Total Square Footage: Perrnit Fee: Footing drain- 1" 100' -� 55.00 0 to 2,000 $115.00 2 001 to 3 600 Footing drain-each additional 100' 46.40 3,601 to 7,200_ $220.00 Sewer- I st 100' J 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-1st 100' 55.00 Medical Gas Mems: _ Water Service-each additional 100' 46.40 _ Valuation: Permit Fee: Storm&Rain Drain- Ist 100' $S.INI $1.00 t. �,5!'J0.00 Minimum tee$72.50 Storm&Rain Drain•each additional l OW 46.40 $5,001.04 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction the reof,to and Fixt.,re or Item Qty. Fee(ea) Total including S10,000.00. Commercial Vack Plow Prevention Device 46.40 $10,00 1.00 to$25,000.00 5148.50 for the first 510,000.00 and$1.54 for I each additional$100.00 or fraction thereof,to Residential Backflow Prevention Device �L and including$25,000.00. minimum permit fee$36.7.5 27'55 $25,001.(10 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for Rain Drain,single family dwelling 65.25 each additional$100.00 or fraction thereof,to Inspection of existing plumbing or and including$50.(M.00 s ciall requested ins ctions- r hour 7250 $50,0(1L(10 end up 5742.00 for the first$50,000.00 and 51.20 for Subtotal: each additional$100 00 or traction thereof. Fixture Work: Are you capping, nuovinl;or replacing existing fixtures? If "yes",please indicate work performed by fixture. P'ailure to accurately report fixtures could result in increased sewer fees*. Comments regarding fixture��ark: Quantity b Fbiurc Work Performed g g Fixture Type, Replace — _-- New M rved Existing (:a red (t:c ust /Dunt — --- 13ath -7'ub!Showcr -Jacuzzi/Whirl ool Car Wash -Each Stall -Drive Thnc _ — Cus idor/Water Aspirator Dishwasher -commercial - -Domestic — Dnnking Fountain Eve Wash 1'Irx,r Urairt/sink 2" — 4" - ('ar Wash[)rain -- *Note: If the fixture work under this permit results in an (,arbage -Domestic — — increase of sewer FDI!s,a sewer permit will be Witted Hill] Disposal -Commercial — fees assessed for the sewer increase mr.st be pai(i before the -Industrial Ice Mach./Refti .Drams plumbing permit can he issued. Oil se�arutor Gas Station Rec Vehicle DuniStation — Shows •Gang -- -Stall Sink -tsar/Lavatory -Bradley -Commercial -Service Swimming Pcxrl Filter Washer.Clothes Water Extractor Water(loset- I oilet Urinal -- --- Other Fixtures i\Data\Pemiit Fomu\PlmPcmn1AppPg2 doe 01103 Mechanical Permit Applicado!n Received Meehan all -- Date/By: Permit N_, Planning Approval Building City of Tip,%rd Date/By: Permit No.. 13125 SW flail Blve Plan Review Other Date/By: ermit No.. Tigard,Oregon 97223 P Post-Review Lend Use Phone: 503-639-4171 Fax: 503-598-1960Daie/B : Case No.: _ Internet: www.ci.tigard.or.us Contact auris.: N See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Su lemcutal Information. TYPE OF WORK —� COMMERCIAL FEE*SCHEDULE-USF CHECKLIST �� New construction Demolition Mechanical permit fees•are based on the total value of the work _ Addition/alteration/replacement Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF cementONSTtUCTTOt�` mechanical materials,equipment,labor,overhead and profit. Value: SSee Page 2 for Fee Schedule I &2-FamilydwellingCommercial/Industrial RESIDENTIAL Fes( UIPMENT/SYSTEMS FEE*SCHEDULE Accessory Buildin Multi-Family Description Qtv Fec(ea.)� Total Master Builder Other: — Heath linst JOB SITE INFORMATION and LOCATION Fumace-add-on air conditionin •• 14.00 Job site address: _ _ Gas heat um 14.00 _ /A t#: Duct work "' 14.00 Bid • Suite#: -� g• p - H dronic hot waters stem _ 14.00 _ Project Name: - Residential boiler Cross street/Directions to job site: for radiator or h dronic system) 14.00 Unit heaters(fuel,not electric) in wall,in-duct,suspended,etc. 14.00 _ Flue/vent for an of above 10.00 Re air units 12.15 Subdivision: _ — Lot#: —_ Other Fuel A dances Tax map/parcel #:— Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 _ Fluc vent(water heater/ as fireplace) 10.00 _ ---- ----- -- ----- -Lo 9 liphtcr a-9 _ 10.00 - - ___ Wood/Pclletslove 10.00 Wood fireplace/insert 10.00 Chimney/liner/flue/vent 10.00 PROPERTY OWNERT TENANT Other; 10.00 Environmental Eahsuat&Ve tlistlon Nanle_ - - —. Range hood/other kitchen equipment 10.00 Address: _- - Clothes dryer exhaust / 10.00 City/State/Zip: _ Sinple duct exhaust Phone: Fax: (bathrooms,toilet compartments, APPLICANT CONTACT PERSUN _ utilit rooms) 6.80 -- Attic/crawl space fans 10.00 Name: _—_______ Other: 10.00 Address: _ Fuel Piping City/State/Zip: *135.40 for Ilrst 4,51.00 each additional Furnace,etc. _ •• Phone: FaXx — Gas heat!umL_ •• E-mail: __ Wall/suspended/unit heater •• CONTRALTO Water heater •• - -' � Fire •• Businas Name: 7 T t +- '—lace Range Address: ,V Ib� 2- B9Q •• Cit !State%7_i _s � I -.J _—_ Clothes dryer(gasp •• Phone:- lY�- �-_h�.Z-O FaX: —- - Other: Total: CCB LIC. #: 'S'ILA 4 — - Mechanical Permit Fees• Authorized 1v�� Subtotal: S _ Signature:CLQ�!t bate:! " -- Minimum Permit Fee$72.50 S _ F`% �- Plan Review Fee(25%of Permit Fec) S wC(Please pNnl name) Stat:Surcharge 8%of Permit Fee $ _ -- TOTAL PERMIT FEE S Notice: 1 hl+permit application expires If a permit Ix not obtained within *Fee mN:oodology set by Trl-County Building Industry Service Board. 180 days after it has been accepted as complete. "•v:ie plan required for exterior A/C unim i\hats\l'emiit Forma\MecPcrmitApp.da: 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: _ Total Valuation: _ Permit Pee: $1.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 fur 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 first$10,000.00 and $1.54 for each additional$100.00 or fraction thereof,to and including _ v-5,000.00. $25,001.00 to$50,000.00 $379.50 N—the first$25,000.00 and $1.45 fr,r each additional$100.00 or fractioni thereof,to and including $50 00x.00. $50,001.00 and up $742.00 for the first$50,000.00 end 51.20 lot each additional$100.00 or fraction thereof. Assumed Valuation:Per APO nee: f ValuTotalDescri do,: t FaAmount Furnace to 100,000 BTU,including 9ducts&vents Furnace>100,000 BTU including ducts 1,1 &vents Floor furnace including vent 955 Suspended heater,wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 <3 hp;absorb,unit, 955 to 100k BTU _ 3-15 hp;absorb.unit, 1,700 101k to 500k BTU _ 15-30 hp;absorb.unit,501 k to I mil. 2,?10 BTU 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handiing,uti-,to 10,000 cfm 656 Air handling unit>10,000 cfhi _ 1,170 Non- ottable evaporate cooler _ 656 Vent fan connected to a single duct _ 446 Vent system not included in appliance 1 656 !mit _ Hoodserved by mechanical_exhau-. tEff Domestic ininerator _ Commercial or industi ial incinerator 4,590 Other unit,int luding wood stoves, 656 inserts,etc. Oas iptng 1-4 outlets-- _— —— 360 Each additional outlet 63 TOTAL COMMERCIAL s j VALUATION: I L I.\Dsts\Permit Forms\MecPen nitAppPg2 doc 01103 Electrical Permit-Application Received Electrical _Date/By: _ Permit No.: PI:nning Approval Sign City of Tigard Datv13 : Permit No.: 13125 SW Hall Blvd. Plan Review other Date/By: Permit No.: Tigard,Oregoa 97223 Post-Review Land Use Phone: 503-639-4171 Fax: 503-598-1960 Date/By: Case No.: Internet: www.ci.tigard.oi.us Contact luris.: I M See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: _ Ranplemental Information. TYPE OF WORK PLAN REVIEW(Please check all that apply) :9 Demolition Service over 225 amps- 1lcalth-care facility New construction --- commercial ❑Hazardous location Addition/alteration/replacelncnt Htither: []Service over 320 amps-rating o1' ❑Building over I0,000 square feet. CATEGORY Ol.'C ONSTRUCTION Ei B 2 family dwellings four or more residential units in ❑Sys.em over 600 volts nominal one structure "1 &2-Family dwelling Con,inercial/Industria.l [I Building over three stories ❑Feeders,400 amps or more ACCCSSO Buildin Multi-Family ❑occupant load over 99 persons ❑Manufactured structures or RV park Other: ❑1-gress/lighting plan ❑Other: Master Builder Submit _sets of plans with any of the above. JOB SITE INFORMATION and LO_C�ATTIOONom---- _ The above arc not applicable to temporary constrnetion service. Job site address: I�1 _�-( t~' (� t ` w 1 -- _J FEE*S_CHEDUE Suite#: Number of ir.s ections�ie-u-,F allowed Description Qty Fee(ea.) Turat Project Name:LL�� New resldcntlxl-single or molt. family per Cross street/Directions t0 job site: dwelling unit.Includes r ttached garage. 1 1'ti T K I Service Included: p �2(17 Lp 1 l )()!_q 0 Or leve 145.15 �_ 4 Each additional or rtion thereof 33.40 1 75 ,012 FLLimited ener ,residential .00 2 Subdivision: LOt#__ �- Limited ener nun residential 75.00 2 Tax ma / arcel #: _ Each manufactured home or modular dwelling service and/or feeder 9(1,9U 2 DESCRIPTION OF WORK Services or feeders-Installation, w C alteration or relocation: — 200 amps or less 80.30 2 _ — 201 amps to 400 amps 106.85 7 -- — 401 am to 600 amps _160.60 2 601 am to 1000 amps 740' 2 PROPERTY OWNER TENANT over 1000 am s or volts 454.63 2 Name: rA ST e K P t cti.• C r 1►�fT 1 w Itcamnect Onl ---_ - 66.85 2 Address: I y'LZ s v 1" p I 'temporary services or feeders-1-1111101011. alteration,or relocation: _66'+S i Cit /Slate/Zip_ \ it�_—�2 '� I 200 amps or less _— _ -- 201 am to 400ms a 10.30 2 Phone:5ti �� 1 ` 00 t`� PAX: -;� y-`t3'1 l 401 to 6ams -- 133.75 2 PLICANT ONTACT PERSON Branch cl:cults-new,alteration,or Name: N'- _ extension per panel: _ A.Fee for branch circuits with purchase of 6.65 2 Address: service or feeder fee each branch circuit City/State/Zip: B.Pee for branch circuits f without purchase of 46.85 _ 2 service Or feeder fee,drat breach circuit Phone: Fax: Each additional branch circuit 6.65 2 Misc.lServicc or feeder not inciuded): E-mail: Eachpmp or irrigation circle _ 53.40 2 _ -----CONTRACTOR-- _ Each si urouthneliahtintt S3•40 2 JOb No: __ Signal circuit(s)or a limited energy panel. eration,or extension _ _ Use 2 2 alt Business Name:G 1� l?wr C PR`S t fkacrlption. Address: (, 0 f ach additional inspection over the allo77P71� Cit /State/Zip:C I4 Lk tr/v t1 Per ins ction r hour min. I hour Investigation fee:Phone:S!Qi Fax' caner: — CCB Llc. #: i�1 Lic. #: 31 2 Electrical Per It ed* Supervising electrician _ subtotal S ai nature required: Plan Review(25 /a of Permit Fre S t L1C.#: I State Surchor a e%of Permit Fee S Print Name:LO�t_ _ - TOTAL PERMIT FEE S Authorized ��-`1-A•t Notice: This permit application explrrs If a permit Is not nhtained within Signature: Ci- Date: 1110 Jaya ager a has been Tri-County as complete. *tee methodnl.ng,sen by Trl-('vont) Building Industr r tirrrlcr aortal. (Please print name) is\beta\Permit Forms\ElcPermitApp.doc 01103 Electrical Perntit ADDlication - City of Tigard Pale ? - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: I'ee for all systems............................................................ $75.00 Check Type of Work Involved: RAudio and Stereo Systems* UBurglar Alarm ElOurage Door Opener* I leating,Ventilation and Air(.onditioning System"' Vacuum Systems* Other___--_ COMMERCIAL.WORK ONLY: _ Feefor ea h system.......................................................... $75.50 (SFF OAR 919-260-260) Check Type of Work Involved: MAudio and Stereo Systems Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation IIVAU Instrumentation Intercom and Paging Systenti9 El [Andscape itrigat on Control* Medical NI-rse('alis DOutdoor 1 andscape Lighting* Protective Signaling F-1 Other --- Number of f ystems * No licenses are required. Licenses are required for all other installations i:\tNt,\Permit Fomu\FlcPermitAppPg2 doc 01'03 03 Fab 20 09:44:87 R:\LT\P2•AD.dwg MRR r J'% 20' WIDE S.SE & SDE. S 0'37'30" W I � I 07 O N N N - t 1 ' 1 I I MAIN FLOOR u,l EL :'i00 0' 31 In fV N � a Do m ( / 1 GARAGL _995' _ I II 1 T W •" :ONC OHWEWAY Lo I $� 13500 P S I I ( bl m n D + V�)col— _ N0Mo ' " Ec � ___= --------- -- �q L 11 0 S W 1201-H PLACE S C A L E _ t -__2.0'_0 .. aro star CI lot INC r Not CI1V OF 11GRAD 1 J nr�txUAcr or ttr toroorwn� PARCEL 2 J,J WORM?00 It r rw tOlt r[t►Wtrl�tr 0,t� rFMt ALL Ott COIOIK04 trauDw 0126MM . RACED Or III Ott wO rotas nI L01P Ar.PptfNIAL PILO IOOsc�tartBY MASTERPIECE C0NS1 °aMrM Aa�oaA>rtr.rPe ( x,985 SQ. Fl) w o s �nw w�nw wu CITY OF TIGARD 'la125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTAN" PERMIT NOTICE PREFERRED PLUMBING 3254 SW BARNET ST FOREST GROVE, OR 97116-8651 Plumbing Signature Form Permit #: MST2003-00074 Date Issued: 3114103 Parcel: 2S110B C-02700 Site Address: 14640 SW 120TH PL Subdivision: WALL PARTITIONIMLP2001-00006 Block: I-ot OU2 Jurisdiction: TIG 7%nii.y: R-7 Remarks: Const. new SF detached residence. Your company has been indicated as the plumbing contractor for the pern;'.t 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 Division. No plumbing inspections will be authorized until thiscompleted form is received OWNER PLUMBING CONTRACTOR: MASTERPIECE_ CONSTRUCTION INC PREFERRED PLUMBING 15435 SW ASHLEY DRIVE 3254 SW BARNET ST 23 FOREST C ROVE, OR 97116-8651 TIGARD, OR 972. Phone #: 503-267-6730 Phown It: 50 3-359-0560 Reg #: LIC 132604 PLM 34-340PB AN INK SIGNATURE IS REQUIRED ON THIS FORM �2 OuAu odr ted Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GAGE ENTERPRISES INC PO BOX 1429 CLACKAMAS, OR 97015-1429 EIP::trical Signature Form Permit #: MST2003-00074 Date Issued: 3114103 Parcel: 2S110BC-027'00 Site Address: 14640 SW 120TH PL Subdivision: WALL PART ITIONIMLP2001-00006 Block: Lot. 002 Jurisdiction: TIG Zoning: R-7 Remarks: Const. new SF detached residence. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, A'TTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR; MASTERPIECE CONSTRUCTION INC POA BOXENTERPRISES29 INC 15435 SW ASHLEY DRIVE TIGARD, OR 97223 CLACKAMAS, OR 97015-1429 Phone +1: 503-267-6730 Phone #: 503-657-0142 Reg #: SUP h18S LIC 34544 ELE 3-1280 AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Supervising Electrician It you have any questions, please call 503.718.2433. CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST - > BUP — Received __ _ — Date Requested_ 6 r-� v'I PM___.__ Bt!P _— Location __.____ f ` ! --�, ' `f t• r�� Suite -- MEC _ —_-- Contact Person Ph( ) VS '_ s:5 PLM —_V --- Contractor_ �___�-----_.-_-_ Ph(—) _— SWR _ BUILDING Tenant/Owner __— ELC Footing Foundation Access: ELC Ftg Drain LELRCrawl DrainSlab Inspection Notes:Post& BeamShear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation �+,� Drywall Nailing Firewall t lA r-2 • 1 , r=�e�2. T C Ria Sprinkler Fire Alarm Susp'd Cei,„g Roof Other: — ---�- rPASq) PART FAIL � ------ _ Post& Beam Under Slab _ Rough-In Water Service Sanitary Sewer Rain Diains Catch Basin/Manhole Storm Drain — --------- —__ Shower Pan Other: Final — PASS_ PART FAIL --- — MECHANICAL Post& Beam — Hough-In - -- - _ Gas Line Smoke Dampers Final PASS PART FAIL -- -- — ---- — -_ __ ELECTRICAL Service ------- -------T__------ --- -- -- -- — Hough-In LIG/Slab ---- --- --------_- --- -- -- — Low Voltage Fire Alarm _ ---- -- - - - Final F] Reinspection fee of s_—__. - recuired before next inspection. Pay at Citv Hall, 13125 SW Hall Blvd. PASS PART FAIL Lj Please call for reinspection RE_- �_ Unahie to inspect - no access Fire Supply Line ADA 9r -� Approach/Sidewalk Daft-- �� c' _7 Inspector ' f Ext Other. Final VO NOT REMOVE this Inspection record from the job site. PASS PART FAIL LAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA : o a i ) i ► : i rD rD rD let Poo. y 4r-t <d .� o n , r ► t r rb rri Old � --.'1 V � O O ► a i i �••� ! ► : ' �' '► ! ro ry O c� a 0 ocrrt c 97 rt + � O a n p I 0 O !V QI ti �0 I+ I I CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-075 7..� 17 INSPECTION DIVISION Business Line: (503)639-4171 MST 3 -d40 7 BUP — Received _ —____Date Requested.,_ -- AM----PM BUP Location _1-4--4'4"y /,/-'J 156 ---Suite- _ MEG ---.- - Contact Person - 11 ___—_____ Ph(- _) 75 00 5�� PLM —_—_ Contractor -- _-_--.___ Ph (- __) _-_-_ SWR BUILDING Tenant/Owner ELC Footing - ---- - ELC ---- -- Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post& Beam - ------------ - Shea; Anchors - ----__-- ----- __.._� — Ext 5 ieath/Shear Int St Bath/Shear Framing -- --- - ---_-- — - - _- Insulation -i- k Drywall Nailing �_�L1� �1 a� ✓r� Firewall Fire Sprinkler — Fire Alarm Susp'd Ceiling - ----_ _._----------___ - �_ Root Other: - ------ ------ — ---__--�------- Final PASS PART FAtI PLUMBING_ - - ------ - -- - -- ._.._.- ---------_.-_ ...� ---------- Post& Beam -- -- - Under Slab - - - --- --- - - ---- - - --------------------- Hough-In Water Service -- - --- - ------ Sanitary Sewer Rain Drains --- ----- --- - ------- - _ Catch Basin/Manhole Storm Drain -- ---.`._ - -------- --- .._- ---- Shower Pan fir., --_ - - ------------ ---__ 4�pinal PART _FAIL MECHANICAL Post& Beam Rough-In --- --- ---._--_-- - --- __ Gas Line Smoke Dampers - -- F PAS PART_ FAIL -- -- ----- _ ---- ---- -- ELECTRICAL Service -- --------------------- --------------------_- ----- - Rough-In - ------ - --- ---- --- - ---._.___— --_�_ UG/Slab Low Voltage Fire Alarm Final Reinspection fee of$ required before next inspection Pay at City Hall. 13125 S%':'Hall Blvd. PASS PART FAIL _ SITE - C� Please call for reinspection RE_ —,_. -_— L-� Unable to inspect--no access Fire Supply Line ADA � �� Approach/Sidewalk Date 9-�--)_0_3 Inspwctor�_ �1/'"� __ IExt ---- Other Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL u CITY OF TIGARD 24-Hour BUILDING Inspectio Ine: (503)639-4175 MST INSPECTION DIVISION Busin s�te: (503)639-4171 SUP g - Received --------.-Date Requested_ 5' AM _ PM- _. BLIP - -_ Location Y& _Suite - MEC _- Contact Person -----_-- Q -Q ^ - Ph(---) - l S-�5 � PLM W ------ Contractor__ - __-- _ Ph(_ ) SWR _ _ - BUILDING Tenant/Owner _ _ - -__ EL,C Footing Foundation ELC _ Access: --__-- Fig Drain ELR — Crawl Drain Slab Inspection Notes: ��) SIT _-- Post&Beam Shear Anchors — ---------.-.._— Ext Sheath/Shear' _-- Int Sheath/Shear1A Framing �� D Insulation Drywall Nailing -lam — Firewall � �-✓� � �', G.--� � C.P� i c�/�I Fire Sprinkler Fire Alarm / • Susp'd Ceiling Roof Other.— ,— — ---- PASS PART F_A _ PLn ----- UMBING �� RX_ ' Post& Beam Under Slab RoughService e Water Se rviceSanitary Sewer Sewer Rain Drains - -Catch Basin Basin/Manhole _ - �� / 2, Storm Drain �-----ShowerPan ylfial PA§S* PART FAI MECHANICAL _ Post 8 Beam ----- —•------ Rough-In -__- --- ,— Ras Line Smoke Dampersiff n ASS PART FAIL - -- - - - --- -- TRICAL Service _ - ------ --- --------- Rough-In UO/Slab - — Low Voltage Fire Alarm — — — Final l_J Reinspection fee of$___-_____—__-_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE - C1 Please call for rr rspection RE: _-_--- CJ Unable to inspect-no access Fire Supply Linev - ADA Inspector Approach/Sidewalk t /6 Date _ / / AppApproach/Sidewalk - ,.� _---- �-yl- ---- -z" --- tett------- Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL ori . CITY OF TIOARD J ',�' Inspection Lloei (503)639-4175 BUILDING / MST _ INSPECTION DIVISION Business Lire: (503)639-4171 BUP — Received _- __ Date Requeested � l��2- - AM__ - PM.__-_-- BLIP —j� --0Lei� -fD ---Suite _- - MEC Contact Person wu_ Ph( ) �_ PLM - _._ --- ---- i - Contractor --- ----- Ph I(—) ----- -- - - SWR --- - BUILDING Tenant/Owner - __-___-_- - ELC - Footing ELC Foundation Access: Ftg Drain �Y ELR -- Crawl Drain ---- SIT Slab Inspection Notes: Post& Beam --- - ---- --_-- -------------- ---- .. Shear Anchors -- Ext Sheath/Shear - ------- Int Sheath/Shear Framing -- -- ----- --- ------ -------------- - ---------- Insulation Drywall Nailing ----—_._ .-._._-�_---------�------_------Firewall Fire Fire Sprinkler __------.. - ---�------ ------------- --- Fire Alarm Susp'd Ceiling --------- --- --- - -------- ------------ Roof ---_-___ Other: Final PASS PART FAIL Post&Beam Under Slab - --- - Rough-In Water Ser-Ace - ---- ----- ---- ---- - Sanitary Sewer Rain Drains --- --- _-------- ---- Catch Basin f Manhole Storm Drain _------__..-.-_�_- - ---- -- -- --------- Shower Pan _. Other: ------ - Final - - PASS PART FAIL ----- MECHANICAL ------ --- -- -- __-- _._--._ Post& Beam - Rough-In Gas Line Smoke [)arnpers --- Final -1sAA1 FAIL - -- --- ELECTRICAL ____ ServTcar - Rough-In ---. - UG/Slab Low Voltage --- Fir arm PAS PART FAIL n Reinspection fee of$- required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE - [] Please call forreinsp tion RE __- Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date -Z _ 11e1specto Other: Final DO NOT REMOVE this Inspection record from the Jab site. PASS PART FAIL