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ELKHORN RIDGE LOT - 13 � �� ffj"O" �B
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14253 SW 128"' Place
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CITY OF TIGARD BUILDING INSPECTION DIVISION MSTor,p—����,�
24-Hour Inspection Line: 639 'S Business Line: 639-41
BUP
Date Requested_��'� -0� AM PM BLD _
Location 7 S ite MEC _
Contact Person �,-� �. .o�
�Cti4� ,P �(� i PLM
Contractor c _ r ,� ' J Ph `'� - % /:� SWR
BUILDING Tenant/Owner ELC —
Retaining Wail ELR
Footing Access,
FPS
Fig Drain
Crawl Drain Inspection Notes.: SGN
Slab _
Post& Beam -"— SIT --
Ext Sheath/Shear
Int Sheath/Shear - —
Framing
Insulation r / ,7 --------- -
Drywall Nailing --
Firewall
Fire Sprinkler - ---_ -- --- - ------ -
Fire Alarm
Susp'd Ceiling
Roof
Final
PASS PART FAIL.- - --- - --_------- — -- - ---
PLUMBING
Post& Beam -.---- - -- ---- -- _-__-
Under Slab
Top out
Water Service
Sanitary Sewer _-— ------- - -- --- -----.
Rain Drains
Final -
PASS PART FAIL
MECHANICAL -
Post& Beam
Rough In
Gas Line - ---- --- --- --_ -_
Smoke Dampers — --
Final - ---- - --
PASS PART FAIL
ELECTRICAL -
Service
Rough In - - ---- - --_____ --------
jG/Slab
Low Voltage ---- --
*eA rmPART FAIL
Backfill/Grading - - -- - - - - --
Sanitary Sewer
Storm Drain [ )Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
('etch Basin
Fire Supply Line [ )Please call for reinspection RE: _ I j Unable to inspect-no access
ADA
ApproachlSidewo'k
Other Date
Final
- —D� Inspector i� �— � Ext
—
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 631. 175 Business Line: 639-4 -
BUP
Date Requested_ -�— AM PM BLD
Location_1 3 / ,�f ,�'`� Suite _ MEC
Contact Person — � �iy, Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR _
FootingcceSs
Foundation -- _ f`'l�L FPS
Ftg Drain SGN
Crawl Drain Inspec
Slab 'n SIT
Post& Beam > -
Ext Sheath/Shear —
Int Sheath/Shear ,
Framing
Insulation
Drywall Nailing
Fire.iall —
Fire Sprinkler -- - ---------- -- ---- - - ---
Fire Alarm
Susp'd Ceiling
Roof
Misr: - - ----- -- -- ---
nP4 PART FAIL --__--_--
PLUMBING
Post& Beam
Under Slab
Top Out d- ------ -
Water Service
Sanitary Sewer --- - -- -
Rain Drains
Final
PASS PART FAIL
MECHANICAL ----------__--- - ____.�.___-- -_._-_----- .-
Post& Beam -. ----- --- -
Rough In
Gas ' ine __.._-- ---- -_ _.._ ----- ---_---- ---
,moke Dampers
inal' ------- -- - -------_
PART FAIL
TRICAL _. . ---- --- ---- -- -- ----
Service
Rough In _ -- _- --- ----------- ---- --
UG/Slab
-- -- --------------___.____.---
Low Voltage ---- ---_ -- ---
Fire Alarm
Final - -------------- ---------
PASS PART FAIL -_
SITE
Backfill/Grading - ----_� -----_----- -_- -- -
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW halt Blvd
Catch Basin
Fire Supply Line I ]Please call fog reinspection RE' __- — ( )Unable to inspect- no access
ADA
Approach/Sidewalk Date Ins ector Ext
Other — ��_-- P _ - ---- _
Final _--
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 63 175 Business Line: 439-4 ! MST �� vC�/DO' Z 2
Date Requested AM `-E -FM ✓ BLIP
BLD
Location / �� '� Z �,L�. L Suite
— MEC
Contact Person _ ��— Ph ? .) .3 5 5�5 7 PLM
Contractor Ph SWR
BUILbING --- Tenant/Owner — ELC
Retaining Wall - -------
Footing ELR
Foundation eSs nyj
Ftg Drain FPS -_
Crawl Drain `fzt,t-r
Inspec
Slab tion Notes: SGN
Post& Beam - SIT
Ext Sheath/Shear (lam L
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling -__-.___ -
Roof
Misc:
Final
PASS PART FAIL_ --__-_-.-
FUnderSlab
G - —
- - -------- --
Water Service Y -
Sanitary Sewer - - - -----
Rain Drains - -
-in
_21
S PART FAIL
MIRRANICAL -
Post& Heam --- --
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 Pa at City Hall, 13125 SW Hall Blvd
Catch BasinY
Fire Supply Line ( ]Please call for reinspection RE:
[ ]Unable to inspect- no access
ADA ----~'-
Approach/Sidewelk
Other Date �� � � Inspector ✓t--` --"�--- Ext
Final - -
PASS PART FAIL DO NOT REMOVE this inspection record t;om the job site.
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CITY OF TIGARD MASTF.RPERMIT
PERMIT M MST2001-00222
s DEVELOPMENT SERVICES DATE ISSUED: 4/24/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 14253 SW 128TH PL PARCEL: 2S109AA-04700
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7
BLOCK: LOT:013 JURISDICTION: TIG
REMARKS: New SF detached dwelling. path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS _ REQUIRED SETBACKS REQUIRED _
CLASS OF WORK: NEW HEIGHT: 15 FIRST: 1,'361 sf BASEMENT'. sf LEFT: 10 SMOKE DETECTORS: Y
TYPE-OF USE: SF FLOOR LOAD: 40 SECOND: 1,010 at GARAGE: 550 sf FRONT: 10 PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 9
VALUE: $238,237.30
OCCUPANCY GRP: R3 FIDRM: 3 BATH: 3 TOTAL: 157100 s/ REAR: 19
PLUMBING
SINKS: ' WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TR".YS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: Ii DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
CUBISHOWERS: 3 GARBAGE UISP: I WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 L:<EASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES TURN<100W BOILICMP�3HP: VENT FANS: 4 CLOTHES DRYER: 1
;AS FURN>=1100K: I UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I
_ ELECTRICAL
RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDFRS BRANCH CIRCU175 MISCELLANEOUS _ AOD'L INSPECTIONS
1000 SF OR LESS. 1 0 - 200 amp: 0 200 anip WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPECTION:
EA ADU'L 5005F: 5 201 400 amp: 201 400 amp1st WIO SVCIFDR, 00 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL SR CIR. SIGNAL/PANEL: IN PLANT:
MANU HMISVCIFDR: 901 1000 amp: 601-amps•1010v: MINOR LABEL.
1000-anlplvolt
PLAN REVIEW SECTION
Rsconnactonly
?=4 RES UNITS: SVpFUR>=225 A,: ?600 V NOMINAL: CLS AREA/SPC OCC:
_ ELEC TRICAL-RESTRICTED ENERGY
_ A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO FIRE ALARM, INTERCOMIPAGING. OUTDOOR LNDSC LT'
BURGLAR ALARM OTH: BOILER: HVAC: LANUSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK. INSTRUMENTATION: MEDICAL: OTHR:
MVAC: DATA/TELE COMM: NURSE CALLS. TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,952.45
MASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUCTION INCThis permit is Subject to the regulations contained in the
Tigard Municipal Code. State of OR Specialty Codes and
15435 SW ASHLEY 15435 SW ASHLEY DR all other applicable laws All work will be done in
TIGARD,OR 97224 TIGARD OR 97224 accordance with approved plans This permit will expire A
work Is not started within 180 days of issuance or if the
work is suspended for more than 180 days ATTENTION
Phone Phone Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Rug N: 11'-, s9o1'1 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 Structural PLM/Underfloor Framing Insp Gas Fireplace Mechanical Final
Sewer Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Plumb Final
Footing Insp Underfloor insulation Plumb Top Out Exterior Sheathing Insl Gyp Board Insp Final Inspection
Foundation Insp Crawl Drain/Backwater Electrical Service Low Voltage Rain drain nsp Building Final
Wtr Proofing Bsrn't Wa Footing/Foundation Dr Electrical Rough In Gas Line Insp Water Line Insp
Issued B -,e1 _ Permittee Signature
Call (t03) 639-4175 by 7:00 p.m. for an inspection deeded the next business day
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-00145
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/24/01
SITE ADDRESS; 14253 SW 128TH PL PARCEL: 2S109AA-04700
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7
BLOCK: LOT: 013 .JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached dwelling.
Owner: FEES
_
MASTERPIECE CONSTRUCTION INC Type By Date Amount Receipt
15435 SW ASHLEY
IIGARD, OR 97224 PRMT CTR 4/24/01 $2,300.00 27200100000
INSP CTR 4/24/01 $35.00 27200100000
Phone: 503-524-4371 Total $2,335.00
Contractor:
Phone:
Reg#:
Required Inspections
This Applicant agrees to comply with all the rules and regulatinns of the Unified Sewage Agency The ,,er nit expires
180 days from the date issued 1 he total amount paid will be forfeited if the parmit expires Tha Agency does not
guarantee the accuracy of the side sewer latera!s If the sever is not located at the measurement given, the installer
shall prospect 3 feet in all di ections from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and ,he 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 through OAR 952-001-0080
You may obtain copies of these i ules or direct questions to OUNC by calling (503) 246-1987.
Issued by: ✓.��1 �^ _ _ Permittee Signature:� V ,--,`
Call (603) 639-4175 by 7:00 P.M. for an inspection needed the next business( ay
Building Permit Application
Date received: Permit n0-&(7 �pG� �
City of Tigard
Project/appl.no.: Expire date: }
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 9722 --'
Phone: (503) 639-4171 Date issued: BY: Recei,t no.:
Fax: (503) 598-1960 1 & Case file no.: Payment type:
Land use approval: M2 family:simple Complex: �
L-1
I &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/ahcrttion/replacement U Tenant improvement U Fire sprinkler/alann U Olher:
Job address: �'S_i _SGJ /c �f �- Bldg.no,: Suite no.:
Lot: / 7 Block: Subdivision: p �/
- _ ax map/tax lot/account no.: ;2S/j!2 9719-4 OD
Project name-. _ — - A" R- ��� V
Description and location of work un premises/special conditions:Ai
1
Name: MAS TE P—IP 1
Mailing address: 1 do 2 family dwelling:
City: tl �Stst_e:n II ILIP: Z Valuation of work........................................ $ L(j
.......................Phone: Z _ Fax: IA-t � No. fbds/baths
Owner's representative: SVN M.Q. Total number of Floors................................
1
Phone: " _ Fax: E-mail: New dwelling area(sy. 1't.) _.—
Garage/carport area(sq. ft.).......... .............. > S , —
Name: /h A S I 1! /1 1_ Covered porch area(sq.ft.) .................. ...... 0 1�
Mailing address: Deck area(sq.ft.) ........................................
City: State: 7..IP: Other structure area(sq.ft.)............ ............ _
Phone: Fax: 1:m,ul ('ommerciallindtrstriai/multi-family:
Valuation of work................... .................... $ --
Existing bldg.area(sq.ft.) .......................... —
Business name: . 1 New bldg.area(sq.11.) ...............
Address: - Number of stories ......................................
City: Slate: 'ZIP: Type of construction
Phone: Fax: _ E-mail: Occupancy group(s): Existing:
CCB no.: New:
City/metro lic.no.: Notice:All i ntractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: (1'\f\1z' t(' OIL provisions of ORS 701 and may be required to he licensed in the
jurisdiction where.work is being performed.If die applicant is
Address: ' 1 S tv S �' '"�'` exempt from licensing,the following reason applies:
City: 10 A- w State I'C IZIP.T
Conlact I rson: IC_ -- Plan no.: -'
Fax: E-mail: --
Name: Contact person: l t� Fees due upon appii:�etion ........................... $
"�,\ ----
Address: L FV Date received:
i
State ZIP: Amount received ......................................... $
City: , >w _
Phone: -Qi '21. oa';: ' Email: Please refer to fee schedule.
hereby certify I have read and examined this application and the N+a ell iur s_cfictinnm accefa c"t cad+ please call puiadleann far mae INarmaion.
attached checklist. All provisions of laws and ordinances governing this U Visa U Mastercard
work will be conipli wheth specified herein or not. ''�"Baa"""'�" -- - -
\, Eaplrea
t ()pie; Name of cardholder ase arwan on credal can/
Authorized signatu ._ ��— f _
Print name: �LI�� A --- cadnalder.11naure _ AnwoN
Notice 11tiq permit application expires ire permit is not obtained within 190 days a(lcr it has been accepted as complete. 410.4611(fiWK'oM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
— Associated permits.
l iiv f fay,'""1 City 01r Tigard U Electrical U Plumbing U Mechanical
Address: 13125 SW Fall wvol.Tigard,Oil 97223 U Other:
Phone: (503)639-4171
Fax: (503) 598-1960
MMIK11111i
1 Land use actions completed.See jurisdiction criteria lire concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot. -
4 Fire district approval required. --_-
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer pernrh. -tWailer district approval.report- Must carry original applicable stamp and signature on file or with application.
sion control U plan U permit required.Include drainage way protection,silt fence design and bcallon of
catch-hasin protection,etc. _
10 _,L Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
_ if copyright violations exist.
I I Slte/plol plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,phut must show contour lines at 2-ft.intervals);location ofeawnients and
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot
area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. —
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location. - ---
13 Floor plana.Show all dimensions,room identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans plumbing fixtures balconies and decks 30 inches above grade,etc,
14 Crow,secNon(s)and details.Show all framing-memher sizes and spacing such as Moor beams,headers,joists,sub-floor,
wall construction.root construction. More shun one cross sectirn may he required to clearly portray construction.Show
details of all wall and roof sheathing,ru,o ing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fire glace construction, thermal insulation,etc. -- --
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Extcrior elevations must reflect the actual 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/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Hloor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining wells.Provide cross sections and details showing placement of rehar.For engineered
s stems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for al!beams and multiple joists
uvet 10 fret long and/or any l .anVjoist carrying anon-uniform load.
2(1 Manufactured
floor/roof truss design detall•.
21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for lout ur more appllaiices.
22 Engineer's .Whe,i required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or
architect licensed in Oregon and shall fx shown to he applicable to the pt100 ander review.
23 Five(5)site plans arc required for Item I I alcove. Site plans must be K 112"
24 Two(2)sets each are required for Items 16, 19,20&.22 above. —
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or mirrored building plans will he accepted -
27 - — ---
28 -- - —-
Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Red ink is reserved for department use only. W-4614 0"'"' OMI
Plumbing Permit Appikation
City of Tigard
Datereceived: Permit Address: 1312 Sewer permit no.: Building SW Hall Blvd,Tigard,OR 97223 p g permit no.:
tl`tD°f7tg°Y� Phone: (503) 039-4171 Project/appl.no-: Expire date:
Fax: (503) 598-1960 Date issued: By: Receiptno.:
Land use approval: _— Case file no.: Payment type:
U I &2 family dwelling or accessory U Coin merc;al/industriat U Multi-family U Tenant improvement
U New construction U Add iIion/altcr-ition/replace merit U Food.service U Other:
1011 SITE INFORMATION FEIF S(.Iil.:I)I,I,E(for special in.forination ti%e cliecklio)
Job address: / Z Z 11k4crf tion Fee(ea.) Total
Bldg.no.: Suite no. New 1-and 2-family dwellings only:
(includes 100 It.for each utility connection)
Tax map/tax lot/account no.: .2-5--/ �I')� 1
- � SFR R(I)bath �
Len: Block Subdivision: -twkt 10 SFR(2)bath I —�
Project name: _.c• q,, SFR(3)bath_ - --
City/county: kl _ (u h 71P: -11 Each additional bath/kitchen
Description and location of work on premises:_ �L c,..,-w- A Siteutilities:
Catch basin/arca drain
F,,1.dale of c(lmpletion/inspection: - Drywells/leach line/trench drain
Footing drain(no. lin. ft.) -
` �' P V M N
Manufactured home utilities
Business name: —
-�—�._� Manholes _
Address: 14 c— - --- Izain drain cont ector
City: .h C. �- state: QK- ZIP: ��7 i y Sanitary sewer i no.lin.ft.)
Phonc:w_, --4 p l Fax: E-mail: Storm sewer(nc, lin.ft.) -
CCB no.: Plumb. bus.reg. no: 2- 0 2- Water service(nes, lin. ft.)
--
City/metro tic.no.: _ �_ ,� I Fixture or Item:
Coretr•actor's representative signature: STu �? P (�T( t, Absorption valve -
Print name: a Back flow preventLl
�, v 3-(( '? L�7lC: —7�) d Backwater valve
Basins/lavatory
Name: _ S LL Clothes washer
Address: r T — Dishwasher
City: ----[State:
State: ZIP: Drinking fountain(s)
— _ Ejectors/sump
Phone_ Fax: E-mail:
Expansion tank
Fixture/sewer cap
Name(print): Floor drains/floor sinks/hub - -
Mailing adre
dss: _ q - Garbage disposal — -- _—
Ilose bibb
City: State: _ ZIIce maker
Phone: -- __-�I a.r: - -- I' -mail: PP Interceptor/grease trap - —
0wncr installation/residential maintenance only: The actual installation Primer(s) - —
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) - --
eniployee on tine fimperly I owe as per ORS Chapter 447. Sink(s),basin(s),Iays(s)
()%kner's signature: -- _ Date: Sump
Mau Tubs/shower/shower pan
: e W. � ��V?�'� -- Urinal
Name - - -
Address: �'L N (j I V 'k, T6 - Water closet
Water heater
City: Statet/L I 7.IP: - �O Other: -- --
Phonc;,rT 17-- n ail: Total
Not an jun"cliole accepi credit cure,pleau coli juriudiclion rut more infonnalion. Minimum fee................
Noucc Iles perrnil applicatinli %) $ ---
U Visa U MasterCard expires if's pemiii is not obtained plan review(at — — ----
Credit cwt number. ,------ — __1—.1— Stale surcharge(8%) ....$ —
rspiree I TOTAL $within IRO days after it has been B
+- -- accepted as complete. ....................... --
Nunr of cudholckr M rhrwn oil credit cwt p ---
Cuditol det lipase Amount ")4616(6AXWOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual) QTY ea AMOUNT the lodesall binflr fixturest100 In QTY PR)E AMOUNT
TOTAL
Sink 16.60dwelling and
16.60 for each utiii connectlon�
Lavatory _ One 1 bath $350
_ .20
Tub or Tub/Shower Comb. 16.60 Two,(?)bath 3350.00
Shower Only
Three(3)bath $399.00
Water Closet 16.60 — SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE _
Dishwasher — 16.60 PLAN REVIEW_ 25%OF SUBTOTAL _
_ TOTAL
Garbago Disposal 16.60 —' �T-
Laundry Tray 16.60
Washing Machine 16.60 _
Floor Drain/Floor Sink 2"-- _ 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Quantity b f Work Performed
Water Heater O conversion O like kind 16.60 Fixture Type• New Moved Replaced Removed/
Gas piping requires a separate mechanical Capped
permit. !r
MFG Home New Water Service 46.40Sink —
46.40 'Lave :� _--- --
MFG Home New San/StormSewer _ fob or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only.. _
16 60 Water Closet
Dlinking Fountain _ _ Urinal —
Jlher Fixtures(Specify) 16,60 Dishwasher—
Garbage
ishwasherGarba a Disposal___
-- '— `-
Laundry Room Tray
_ — �- - --—
Floor Floor D Machine —
Drain/Sink: 2"
Sewer-1st 100' 55.00 3" _—
Sewer-each additional 100' — 46.40 y 4"
Water Service-1st 100' 55.00 — Waler Healer
_ — Other Fixtures
Water Service-each additional 200' 46.40 (Specify)
_
S'orm&Raln Drain 1st 100' 5500
Storm 9 Rain Drain-each additional_100 ___4C_40 — —
Commercial Back Flow Prevention Device 46.40 _ —
Residential Backflow Prevention Device' 2'.55 —� — ---_
Catch Basin 16.60
Inspiec:ion of Existing Plumbing or Specially 72 50
Re uesteo inspectionsper/hr _—_ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 6525
Grease Traps �— 1660 — " --- -- --
QUANTITY TOTAL
Isomelric or riser diagram is requiied If
Quantity Total is >9
'SUBTOTAL ----�--- — __ _
8516 STATE SURCF'ARGE - —— ^— -
"PLAN REVIEW 25%OF SUB-OTAL
Required only it nature qty to,l is>9
TOTAL 5
*Minimum permit tee is$12 50-s%state surcharge,except Residential Backnow
Prevention Device,which is$36 25-B%state surcharge
"All New Commercial Buildings require plana with isometric or riser diagram and
plan rrview
I:\dsts\fofms\pim-fees.doc 10/10/00
Mechanical Permit Application
Datereceived: Permitno.V v7�
City of Tigard Projecl/appl.no.: Expire dale:
City uJTigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: BY: 12ec•eiPtno.:
��.
Phone: (503) 639-4171
Fax- (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
all W XM EjLw�
1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
taw construction U A(I(lition/al(eration/replacement U Other: .__ _ -- -
lob address: j y 2__j'� c c Y� :dusty equipment quantities in boxes below. Indicate the dollar
Bldg,no.; Suite no.: value of all mechanical materials,equipment,labor,overhead.
Tax map/tux lot/account no.: �5/ �/� - 0(-i b'0 profit.Value$
Lot: ( Block: Subdivision: L W •See checklist for important application information and
t tom, 1 jurisdiction's fee schedule for residential permit fee.
Project name: 2
City/county:
Dr cription and location of work on premises:_A [ - �'%^-
Fec(ea.) TMaI
Est.date of completion/inspection: _ Descrf ion Qty. Res.onlRes.onl
Tenant improvement or change of use: Air handling unit _- CFM _
Is existing space heated or conditioned?U Yes U No Air con itioning(site plan required) _
Is existing space insulated?U Yes U No A teration o existing I AC system
1,,)i er compressors
Su is boiler permit no.:
rBusincssname: `z Z` HP Tons BTU/H
ii•smo a clamper duct smoke detectors _
Ct(y 5tnte l.IP: 36— Ilea(pump p(site Plan require )
f nstal/rep ace urnac urner
Phon
L Fax; Email: Including di-twork/vent liner U Yes..j No
CCB no.: _ -n7,5Ta Jrcplacr re oca(cheaters-suspei:
City/metro Ilc.no.: wall,or floor mounted
Nwne(please print): V L ( Vent forappliance olncr(Tian furnace
Reffigeratillon..
Absorption units
Chillers—__
Name: - Comnrssors
Address: _ _ v ro�raeota ex usl an ventilation:
City: ` State: ZIP: Ap lianccvent
Phony - _-- - - Ivt� E-mail: erex aust
cx s, ype /res.kilchenthazinm
hood fire suppression system -
Name: t),-f-t4�U Exhaust fan with single duct(hath fans)
Mailing address: A gust system a anTrom�tin or CC
—
pz:
ue p p np andistribution(up to Outlets)
C1ly; State: ZIP: lylx _1,;'c; _ NG Oil —
Phone; tax: E-mail: -ueT-ist�cFi a itiona oser outlets
toecapiping'schematic require()
_ Number of outlets
Name: l ' U V ir- Other d app ce or equT-pmeM:
Address: ( 1 t<.i (( ' (UI k t U l [h urativefire lane _! _
City: (�2 V` State:pP ZI - nsetl .type --
Phone 2-.,S'- "1- Fare J E-mail: oo stov pe et stove -
_ cr:
Applicant's signature:
Namc(Print):
Permit fee.....................$
No,sit iuridktions rreM credit coda,please call iurisdicticn fm nrre informolon Notice.Thisrmil application Pe PP Minimum fee................$ -_
U visa U MmorWard expires if n permit is not obtained
('(edit cod numbn J _ _ _�. Plan rcVICW(al __ 96) $
within 180 days aper it has been
Ejpi�a Y State surcharge(896) ....$
Namc�f ccar�C rider is.rw+n on c tri sard--- accepted as complete. TOTAL .......................$
S
--Cardholder aisrtalum AI11b1MN 44114617 IMxNCOM)
aaa��ilf
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 i&2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALLJATIUN: FEE: _ Description: Price Total
---- Table 1A Mechanical Code Qty
(=d) Amt
$1.00 t $$5 , 0.00 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 R vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and including including ducts 6 vents 17.40
_ $10,000.0c. _
and 3) Floor Furnace
$10,001.60 to$25,000.00 $148.50 for the first$10,000.00
$1.54 for each additional$100.00 or including vg ent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
__ $25,000.00. or floor moun'ed heater 14.00
$25,001 AO to$50,000.00 _ $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit
6 80
$1.45 for each additional$100.00 or
fraction thereof,to and including 6) Repair units
1`.15
$50,000.00. -
$G0,001.00 and up $742.00 for the first$50,000.OU and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnote,below. Com
-`-� - 7)<3HP;abscrb unit
_ to 100K BTU 1400 -_
ASSUMED VALUATION_ S PER APPLIANCE: 8)3-15 HP;absorb
Valub Total unit 100k to 500k BTU 25.60
Descri fion: Q Ea Amount g)15-30 HP;absorb
Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTU 35.00
ducts 8 vents 10)30-50 HP;absorb
Furnace>100,000 D U Inr•.luding 1,170 unit 1-1.75 mil BTU _ 52.20
ducts 8 vants - 11)>50HP:abscrb
Floor furnace Including v, nl A55 unit>1.75 mil BTU _ 87.20
Suspended heater,wall ieater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not Included in applicanee 445 13)Air handling unit 10,000 CFM+
permit _ - 17.20
Re air units _ 80514)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 _ 10.00
to 100k ETU! _ 15)Vent fan(:onn(cued to a single duct
3-15 hp;absorb.unit, 1,700 6 80
101,k to 5171k BTU - - 16)Ventilation systemnot 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 10.00
1-1.75 mil.BTU 18)Domestic Incinerators
>50 hp;absorb.unit, 5,725 17.40
>1.75 mil.BTU - 19)CommerHal or industrial type Incinerator _
Alr handling unit to 10,000 cfm 656 6995
Air handling unit>10,000 cfm 1,170 2U)Other units,Including wood stoves
Non- rtable evaporate cooler_ 658 1000 _
Vent fan connected to a single duct 446 21)Gas piping one to lour outleLn
Vent system not included In 656 5.40 _
appliance permit 22)More than 4-per outlet(each)
Hood served by mechanical exhaust 656 1.00
Domestic Incinerator 1.170 Minimum Permit Fea$72.50 SUBTOTAL..:
Commercial or industrial incinerator 4,590
Other unit,including wood stoves, 8%State Surcharge $
I Inserts,etc.
tut Gas iping_14 outlet, 360 25%Plan Review Fee(of subtotal) $
Each additional ouLit_- 63 Required for ALL commercial permits only
TOTAL COMMERCIAL -_ $ TDTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
pthor Inspectlo�s and Fees:
1 Inspections outsid3 of normal business hours(rninimum charge two hours)
$72 50 per hour
2 Inspections for which no fee is specifically indicated (minlmu n charge-half hour)
$72 50 per hour
3 Additional plan review required by changes,additions of revisions to plans(minimum
charge one-half hour)$72 50 per hour
'State Contractor Boller Certification required for unitt>200k BTU.
"Resldentlal A1C r"utres atte plan showing placement of unit.
0dstsvoml8~-feee.doc 10/11/00
Plectrical Permit Application
I'atereccived: Permit no.:H-�1-900/ 00.,V
City of Tigard Project/appl.no.: Expire date:
tyre, /y•,�,�r� Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: (Receipt no.:
Phone: (503) 639-4171 --- -- -
Iax: (503) 598-1960 Case file no: Payment type:
Land use approval: _
❑ 1 &2 family dwellin),or accessory U Commercial/industrial U Multi-Gamily U Tenant improvement
U Nuw construction U addition/alteration/replacement U OTher: U Partial
1
Job address: I Li ] LAJ I 2-j-t- Itldg. no.: silo nn.: J"I ax map/lax lot/account no.:
I_ut: Block: Sulxlivision: k k4,Lt,, R, �?- !0—q 0
Project name: I`1 K"L I Description and location of work on premixes: N G4./ ��M L3
Eslinialed date of completion/inspection:
Job n0: �a i Foe Max
i/escri Nlon 01y. (ca) 'total I no.ins•
Business name' ( New residential-single ormulti-family per
Address:
dwellingunit.Includcc attached garage.
C!ty: 3 N (2 Statc: "IP, (6- serviceinciuded: )
P!tone:L 5 — I 2 ax: E-mail: I lxx)sq.ft.or less 4
CCB no.: Elec.bus,lic.no: 2� _ Each additional 500 sq,fl.or portion thereof 3
Limited energy,residential 2
City/metro lic.no.: Limited energy,non-residential _
Bach manufactured home or modular dwelling
Signature of supervising electrician(required) bate Service and/or feeder
Sup.elect.name cprinuCLicense no-
Services orfeeders-Installation, — --
■laerstion or relocation:
200 omps or less ( I _ 2
Name(print): M� 5•j \?W-Pt,.^,c 201 amps to 400 amps _ 2
401 amps to 600 amps 2
Mailing address: �-�� w rA S h T 601 amps to IW)amps 2
Cit): - ` Slate:Q� ZIP: x L Over 1000 amps or volts 2
Pbane: Fax: 2kL E-mail: Reconnectunly I
Gwncr installation: the installation is being made on property I own Temporary services urreerlerx-
which is not intended for sale,lease,rent,or exchange according to htatallatlon,alteration.(or relocation:
ORS 447,455,479,670,701. 21x)amps or less
(r 201 amps to 400 amps 2
Owner's si nature: -�' bate: _ -`�- 401 to 600 ams -- — 2
Branch circuits-net►,alteration.
or exterrslon per panel:
Name: 't �(�l,J h-'1 77A [-cc For branch circuits with purchase of
Address: b N service or feeder fee,each branch circuit 2
City: A/t_�. O Slat ZIP: ] 2 QIf Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: Email: gEachadditional branch circuit:
Misc.(Service or feeder not Included):
ie`eeCer idi `mineteiat U I ee'th-cele facility Each pump or Irrigation circle _ 2
U Service over 320 amps-rating of 1&2 U Hass,sous location Bach sign or outline lighting 2
familydwellings U Building over 10,1xx1 square feet four or Signal circuit(s)or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration,or extension* 2
U Building over three sturies U Feeders,4W amps or more "Description.
U Occrpant load over 49 perums U Manufactured structures or RV park Each additional Inspection over the allo"able In any of the above:
U Egress/ligiuingplan U Other: ___ perinspection l
Submit Sett of plans .,Ilh apy or the above. Investigation fee
The above are not applicable to temporary construction service. Other ^�
Not all jurtxdictiom accept credit cads.plow cctl)udsdiclian for more Information. Notice:This permit application Permit fee.....................$ _
U Visa U MasterCard expires if a permit is not obtained Plan review(at __— %) $
Cradh cad number: -__ _ - / / within ISO days after it has beet. Stale surcharge(8%) ....$
Expires accepted as complete. 'TOTAL . . ....$
-- -
--Nunn d—�Inldrr a shown on cite IIcad
S
Cardholder dRnsture Amount
4411 1615 16A 0 0'WA
Electrical Permit Fees: Limited Energy Fees:
— TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00
Number of Inspections per fz., nit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total Check Type of Work involved:
Residential•per unit
1000 sq it or less $145 15 4 Audio and Stereo Systems
Each additional 500 sq,it or
portion thereof $33.40 1 Burglar Alarm
Limited Energy ---__ $75.00
Each Manufd Home or ModularGarage Door Opener'
Dwelling Service or Feeoer $9090 2
Serv,ces or Fneders Heating.Ventilation and Air Conditioning System'
Installatw ,aiteratwn,or relocation
200 amps or less — $80.30 —_ 2 ❑ Vacuum Systems'
201 amps to 400 imps $10ti 85 _ 2
4u1 amps to 600 amps $16060 _ 2 ❑ Other
601 amps to 1000 amps _ $240.60 2 --- -----Over 1000 amps or volts $454.65 _ 2
Reconnect only $6685 2
TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system.......................................................... $75.00
Installation,alteration,or relocation
200 amps or less $6685 2 (SEE OAR 918-260-260)
201 amps to 400 amps __ $100 30 2 Check Type of Work Involved
401 amps to 600 amps $15375 2
Over 600 amps to 1000 volts, Audio and Stereo Systems
see"b"above.
Branch Circuits Boiler Controls
New,altoration or extension per panel
a)The fee for branch circuits Clock Systems
with purchase of service or
feeder lee. - — - ❑
Foch branch circuit $6 65 2 L Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service Fire Alarm Insta-lation
or fb.rder fee.
First branch circuit _ $4685 _-- HVAC
Each additional branch circuit $6.65
Miscellaneous Instrumentation
(Service or feeder not included)
Each pump or irrigation circle _—� $53.40 _— _. Intercom and Paging Systems
Each sign or outline lighting $53.40 _
Signal circutt(s)or a limited nnorgy Landscape Irrigation Control'
panel,alteration or e,tension —__ $75.00
Minor t abets(10) —__ $125.00 r�
Medical
Each additional inspection over
l_J
the allowable in any of the above Nurse Calls
Per inspection $6250
Per hour --__, $62.50 _ ❑
In Plant $7375 — Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8%State Surcharge $ Number of Systems
25%Plan Review Fee ' No licenses are required Licenses are required for all other installntions
See"Plan Review'section on $ _
Iront of application —
Fees:
Total Balance Due ___
-- Enter total of above foes
❑ Trust Account# -- 8%State Surcharge
'Total Balance Due -- —
i 41sts\fonnsklc-tees duc 10/09/00
04/06/2Fjfd1 12:55 5035988705
GEOPACIFIC ENG PAGE 0110]
GOOPadit Engineering, Inc.
17700 BW Upwr Boone Fury Roel,Sults 1La
PcMnrd,Oregon qm4
Tel(5o3)59&SW • F*x(ggrn W44705
April 6, 2001
Masterpiece Hom96
1543.5 SW Ashley
Tigard, OR 97224 RECEIVED
Fox No. (503)U4-4371
Attention: Allen r)anforth APR 0 9 2001
SOIL ENGINEER'S PLAN REVIEW COMMUNIiv DHFP)PMFNT
Project Elkhnrn Ridge - Lot 13
Tigard, Oregon
GeoPar;iflc'e PrInctpal Enghew, Jim Imbrle, has reviewed the plane dated July 2000 (rev. 9J3
Prepared by Mark Stewart and Aaeoaates, Inc. for the proposed single ramlly twnle at t8►n1
he above
rrllwenc9a �Ot. The Pian showb a 2- story hoa hone with ris I'
sloping lot_ True krt Is bAlievdd to have some nonengineered IWI basement cut Iaced nco the gently tvwwdly
is deaired to get below this possible fig. ewr it, thereft * wart into the lot
1311sed nn our review of the pLguis, it 18 our opinion that the propOoed single family home 14 fleOtechrih alty
1e38iWe Dremcled OeOPacik rtrvlow,thw excavated subgrrado prior to PourirV bundatInne
If you have any questinn.ct,pieese c.111.
9inceruly,
000PeCIf1C Cnglneerrng,Inc.
�`�as �r►Qi1RE'lr�, ��,
14745 yr`
OREGON
James D. Imbrie, P.F.. C E p.
Geuterdrnitzt Rnglneer
3
SEE 35MM
ROLL #21
FOR
OVERSIZED
DOCUMENT
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS, OR 97015-1429
Electrical Signature Form
Permit #: MST2001-00222
Date Issued: 4124101
Parcel: 2S109AA-04700
Site Address: 14253 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot: 013
Jurisdiction: TIG
Zoning: R-7
Remarks: New SF detached dwelling. path 1
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL_ CONTRACTOR:
MASTERPIECE CONSTRUCTION INC GAGE ENTERPRISES INC
15435 SW ASHLEY PO BOX 1429
TIGARD, OR 97224 CLACKAMAS, OR 97015-1429
Phone #: 503-524-4371 Phone #: 503-657-0142
Req #: SUP 618s
LIC 34544
ELE 3.128C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
J �(p�
X �L1 l - - -
Signature of Supervising Electrician
If you have an questions, lease call 503 639-4171, ext. # 310 I
Y any P � )
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PETRA PLUMBING CO
'14775 SUNSET BLVD
SHERWOOD, OR 97140
Plumbing Signature Form
Permit #: MST2001-00222
Date Issued: 4/24/01
Parcel: 2S109AA-04700
Site Address: 14253 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot: 013
Jurisdiction: TIG
Zoning: R-7
Remarks: New SF detached dwelling. path 1
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be vali, please have the appropriate individual from dour company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN.. Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER PLUMBING CONTRACTOR:
MASTERPIECE CONSTRUCTION INC PETRA PLUMBING CO
15435 SW 'ASHLEY 14775 SUNSET BLVD
TIGARD, .)R 97224 SHERWOOD, OR 97140
Phone #: 503-524-4371 Phone #: 625-4018
Reg #: I Ir 70893
PI M 34-221 PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authori,-.d Plumber
If you have any questions, please call (503) 639-4171 , ext. # 310