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14333 SW 128TH PLACE w w w N N 00 pf n CD I 14333 SW 12.8"' Place CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST — � INSPECTION DIVISION Business Line: (503) 639-4171 ---- - BUP Received ` 3 Daie Req✓ /3stedti 3_� __ ,4N1----- - P�1 ----- -- BLIP Location --- - _ -� 3 oC C/ Suite _ ?JEC --_—_--_-__ Coriact Person _ Ph(�_) 9 �PLM Contractor_ Ph BUILDING Tendnt/Owner - ELC Footing T Foundation --.o. ELC -- - - - Ft Acs. c5' g Drain 'f 9" ' ELR Crawl Drain —r. , Slab I .spection Notes: SIT ------ Post __Post&Beam Shear Anchors ------ - ---- Ext Sheath/Shear Int heath/Shear Framing - -- - - Insulation Drywall Nailing Firewall _. - ------- Fire Sprinkler Fire Alarm Susp'd Ceiling - - - Roof Other:_ --- - Final PASS ART FAIL BI 5 �/� ��lU t eJ P 7�/:71j? eci� -- ------ eon, Under Slah Rough-In Water Service —_— Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain --- Shower Pan in _PASS_ VARYFAIL - - MEC11ANIJAL Post Beam Rough-In Ct r`, F Cr N/ Gas Line Smoke Dampers PASS PART Service ------- —.—.-- .---� ._ _ Rough-In UG/Slab -- Low Voltage Fire Alarm ------ ---- --�-r nal ~ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd, PART FAIL -_V, E __ F1 u Please call for reinspection E: Unable to inspect-no access Fire Supply Line �----- ADA �1 �, 3 Approach/Sidewalk Date 1 ! Inapoctor _ _ __-- ad Othor: Final DO NOT RERIjOVE this Inspection record from t e Job site. PASS PART FAIL CITY OF TIGARD 244, ,)ur BUILDING ins rection Line: (503)639-4175 INSPECTION DIVISION Bu?iness Line: (503) 639-4171 MSTOr--_- �/ BUP -- ---- Received _ _ Date Requested_ !__ - _ AM------- _ PM -_. BLIP Location —__ �`✓3� � � 0Suite __ ___ - __. MEC Contact Person —_—,_- --- Ph(----) PLM Contractor - _-_-- -- Ph(--_ ) SWR - BUILDING Tenant/Owner _ - _. - --_ ELC Footing ---- ELC _ Foundation Access: .__. Fig Drain ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors _ Ext Sheath/Shear Int Sheath,'Shear Framing - - - - - - Insulation Drywall Nailing - ------- ---- --- Firewall Fire Sprinkler - - - - Fire Alarm Susp'd Ceiling - -- Roof Other: -- — PART FALL - - -- - --- Post&B-am Under Slab -- - - ------.Rough-In Water Water Service -- - ------- --- - Sanitary Sewer Rain Drains - --- - -- - --- Catch Basin/Manhole Storm Drain - ------ - — - Shownr Pan Other: nal- -- ---- 3S, PART FAIL _REMANICAL - ------ -- -- - - Post& Beam Rough-In -- Gas Line Smoke Dampers ----------- - ---------- ------- --- - i AS PART FAIL -- - - ----__ _ - —_ TRICAL__ _ Service Rough-In - -- ----- -- _ --- -- UG/Slab Low Voltage ------_— -----.. - --- --- Fire Alarm - — - Final L1 Reinspection fee of$_-__�_.__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL- SITE AIL SITE — F� Please call for reinspection RE:- -- —__- Unable to Inspect-no access Fire Supply Line ADA r/ + D17Approach/Sidewalk Date � L ' Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL, LAAAA♦♦voAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAA A'Ar r� r M .� 0 O Ill. i ► ; til tj Un 44 zLn o PLR- > a a M tTf ►mss O ► 44 rD ► * o 0 t � ► 1 o ► a o ► a ► a � ► t ► t R a r CL 3 ?T Cl. o CA rb Ei N �o O et It � v a c a d s CITYOF TIGARD _ MASTER PERMIT PERMIT#: MST2002-2`11/12 DEVELOPMENT SERVICES niATE ISSUED: 10/14/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 14333 SW 128TH PL PARCEL: 2S109AA-04500 SUBDIVISION: ZONING: R-7 BLOCK: LOT: 011 JURISDICTION: I1(; REMARKS: New t detached Path 1 _ BUILDING REISSUE: 51JRIES. 3 FLOOR AREAS_ REQUIRED SETBACKS _ REQUIRED CLASS OF WORK: NEW HEIGHT, 20 FIRST: 1,860 at LASEMENT: 610.00 sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,945 of GARAGE: 730 of FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: SN DWELLING UNITS: 1 FINBSMENT: of RIGHT: 5 424.20 OCCUPANCY GRP: R3 BDRM: 3 BATH, 3 TOTAL: 3.813 0l VALUE: 426, REAR: 52 PLUMBING SINKS: 2 WATEk CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: I RAIN DRAIN: :00 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: ' CATCH BASINS: TUBi3HOWERS: 5 GARBAGE DISP: I WATER HEATERS: 1 WATER LINES: 100 BCKFI W PREVNTR: 1 GREASE TRAPS: OTHE't FIXTURES: MECHANICAL FUEL TYPES FURN<t00K. BOIL/CMP<AHP: VENT FANS: 6 CLOTHES DRYER: 1 FURN>000K: I UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 :NOODSTOVES: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT. SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 Sr OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMP/IRRIGATION: PER INSPECTION: EA ADC'L 50OBF: 9 201 •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: SIGNAL/PANEL: IN PLANT: MANU HM/SVC/FDR: 601 • 1000 amp: 601♦ampa•1000v: MINOR LABEL: 10004 amplVOR Rac nmact only: PLAN REVIEW SECTION >-4 RES UNITS: SVC/FDR>-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: INTERCOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER. CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAIT4LE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 9,167.16 This permit is s!tbject to the regulations contained in the PAUL R CARNEY INC PAUL R CARNEY INC Tigard Municipal Code,State of OR. Specialty Codes and 1480 NW 102ND AVE 1480 NW 102ND AVENUE all other applicable laws. All work will be done In PORTLAND,OR 97229 PORTLAND,OR 97229 accordance with approved plans. This permit will expire If work is not started within 180 days of issuance,or If the work Is suspenders for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone. 503-297-9406 Pholl" 503-297-9406 Oregon Utility Notification Center. Those rules ale set forth In OAR 952-001-0010 through 952-001.0080. You Rag M' CIC SG852 may obtain copies of these rules or direct questions to UUNC by calling(503)246-1987. REQUIRED INSPECTIONS Emalon Controi Insp 8, Post/Ream Mechanlca Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Se.. •Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final Fjoting Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final inspection Foundatlon insp Footing/Foundation Dr; Electrical Rough In Firbplace Insp Appr/SdWk Insp Post/Beam Struct, PLM/Underfloor Framing Insp Gas Line Insp Electrical Fi Issued By : �i✓c l( �`-- Permittee Signature Call (503) 639-4175 by 7.00 p.m. for an inspection needed the next business day .use CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SVVR2002-26001 DATE ISSUED: 10/14/02 13125 SW Hall Blvd., Tigard, OR 97223 (5:13) 639-417 i SITE ADDRESS; 14333 SW 128TH PL PARCEL: 2S109AA-04500 SUBDIVISION: ZONING: BLOCK: LOT: // JURISDICTION: TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connedon for new SF Owners � FEES _ PAUL R CARNCY INC 1480 NW 102ND AVE Description Date �— Amount PORTLAND, OR 97229 [SW USA] Swr Connect '10/14/02 $2,300.00 [SWINSP] Swr Inspect 10/14/02 $15,10 Phone: 503-297-9406 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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 insta'ler shall prospect 3 feet In all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm Issued by: A, 'lt. Permittee Signature: �--� Call (503) 639-4175 by 7:00 P.M for an inspection needed the next business day Building Permit Application lI Date received:' �''S Permit no.:O� g City of Tigard `' Projeci.'appl. Expire date: Y ofTigard Cit o Ti and Address: I X12` SW Hall Bl gtKdr OiUU 71223 Phone: 1,503) —i9-4171 / L Date issued: _—_ Ley:? Receipt no.: -_ Fax: (503) 598-1960 ,t Case file no.: Payment type: Land use approval: _-.�_--_ _-_ 1&21'amily:Simple TXPE 1PJERM IT < C] 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family 0 New construction U Demolition U Addition/alteration/replacement U''.nant improvement U Fire sprinkler/alarm U Other: J1 —_ JORSI)MINFORMATION Job addirss: I LY,i!- t '(__ _Suite no.: Lot: Block: JSubdivision:E1.t4.004,J r-1066 i=J�T S I Tax map/tax lot/account no.: Project name: �-' Description and location of work on premises/special conditions: S�r N E1 M��y �"' " �q•�O. 1_r___, — `- 1 e Name: V>AU L- Mailingaddress: 1160 /00vy/00vAV I &2 family dnelliug: City: eNE I-A?JQ State:erg ZIP: cf7 ZZ Valuation of work........................................ $ Phone: b Fax:Z 6 J E-mail: No.of bedrooms/baths................................. Owner's represcntative: qv (A,1t+Ay Total number of floor:;................................. — 3 Phone 9 - ybfo Fax: 2% 14Ir-mail: New dwelling area(sq. ft.) .......................... Garage/carport area(sq.ft.)......................... Name: �3 oV Covered porch area(sq.ft.) ......................... Mailiv.g nddress, Deck arca(sq.ft.) ........................................ -------- City: Other structure area(s . ft.)......................... — State: LIP: �-• Phone: hope: — E-mail: ('ommercial/industtiallmultl-family: Valuation of work........................................ ffIL11,01 I trill to, �� Existing bldg.nrea(sq.ft.) ..... ... .......Business name: ' New bldg.area(sq.ft.) ................ . .... _A_ _ Address: Number of stories City: --- State: ZIP: ............... .........1........,. — _ — Type of construction. Phone: I ax: 1;-moil: Occupancy group(s): Existing: — CCB no.:_ _ _ New: _ City/metro lic.no.: Notice:All contractors and subcontractors are required to be r r licensed with the Oregon Construction Contractors Bonrd under Name: ��/�1QC �<j Iti�tC f provisions of ORS 701 and may he required to be licensed in the jurisdiction where work is being performed. If the applicant is Address: 137 s,M/—�' -JyE- exempt from licensing,the following reason applies: City: nLdrrN Statc: b ZIP Contact per::on: L i t_w, 'r Plan nu.: 2 3 I V iZE -`-------- - -- Phone: -e Fax: 5. 77 1-rt 1 E-mail: _ — Name: (AJ Nova Contact person: Fees due upon application ....................... - Address: Date received: _. City: State: ZIP: Amount received ......................................... $-- phone; Fax: E-mail: —_ Please refer to fee schedule. — hereby certify I have read and examined this application and the attached checklist. All pr(!yi#qo0P of laws and ordinances governing this work will he co it lied will et r specifrcd herein or not. Or Authorized sigt)Ettu -1 Date: P1 nt name: �J Notice:Phis permit application expires if a permit is not obtained within 180 days aIle One-and Two-Family Dwelling Buiilding Permit Application Checklist Reference no.: CirynfTigard City of Tigard Associated permits: Address; 13125 SW Hall BhU Electrical U Plumbing U Mechanicald,Tigard,OR 97223 LJ Other: Phone: (503) 639-4171 _ --- - Fax: (503) 598-1960 1 land use actions completed.Sec jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved platllot. -4-Fire district approval required. 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. - 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,silt fence design and location of _ catch-basin protection,etc. 1q 'omplete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state 4WMing 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 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if there is more than a 4-ft.elevnuon differential,plan must show contour fires at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area,, rcentage 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 plans.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 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and morsheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fire lace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptahlc. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analyAs provide specifications and calculations to engineering standards. 17 IH7oor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations,Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rchar.For engineered systems,see item 22,"E ngineer's calculations." 19 Ream calculations.Provide two sets of calculations using current code design values for all heams and muNple joists over 10 feet L.iig and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shrnr wall,roof truss)shall he stamped by an engineer or architect licensed in Oregon and shall be shown to he applicable to the hmlrcl ttndrr r•N.ii•u 23 Pipe(5)h itc plans are required fur Item I I above. Site plans must he 8-1/2" x i I- I I 24 Two(2)sets each are required for Items 16, 19,20&22 above. "Mirrored"building plans will be not accepted. d in the permit&System Development Fees document. icer scale. ,ed project street tree plan(if applicable),and COT Street Tree List. rt date. Minor changes or notes on submitted plans may he in blue or black ink, is reserved for department use only. 440.4614(6610tvc'oM1 rri Electrical permit Application_ � � Datereceived4I aL- Permit no.: City of Tigard Project/appl.no.: Expiredate: City(?f Tigard Address: 13125 SW Hall Blvd,Ti---d O�PIRI? Date issued: _ BY: _ Receipt no.; Phone. (503) 639-4171 5r1' , — Fax: (503) 598-1960 Case file no.: Payment type- Land use approval: I 1 ' U I &2 family dwelling or accessory U Conurercial/industrial U Multi-Ianuly U Tenant improven)cnt U New construction U Addition/alteratiorJreplacement U Other: U Partial 1 ' 1 Job address: '33-� L✓ J2�s Jf L Bldg.no.: 11 Suite no.: Tax map/tax lotlaccount no.: Lot: Block: Subdivision: L >,Q� J74k� — Project name: I Description and location of work on premises: Estimated date of completion/inspection: ('ONI'Rk('rOk APPLICATION Job no: I Fer nice. Business name: — — Descriplion Qly. (ea.) 'lbtal no.insp f -- Ne"msidrnlial Angle or muhl-fxmlly per Address: dnrllinp,unir lnclotkvattachedgurage. City: Stale.: ZIP: Servicincluded: — I OOH)sq.ft.or less 4 Phone: hue: F,-maiL• —_ -.-_--- _-- CCB no.: Elec.bus.lic. t 1, : Each additional SW sq.ft.or union thereof -- — - ,.intitedenergy,residential _ 2 City/metro lic.no.: Limited energy,non-residential 2 F.ach manufactured home or modular dwelling Si nalurn of supervising electrician(required) Cale Servir,and/or feeder 2 Sup.eteo.name(pi ino License no: Services or feeders—Installation, �PRalteration or relocation: 1 ' 1 2W amps or less 2 Name(print): Ji. a I wa 201 amps to 400 amps -- 2 Mailin address: ( pb 401 ampa to 600 amps _ 2 601 amps to 1000 ams _ 2 City: State: ZIP: Over IOW amps or volts 2 Phone:y47-qy1oG I Fax:j (r-0,j.01 E-mail: Reconnect only I Owner installation:The in.riallalion is being made on property I own T.emporaryservlcesorfreders- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orreloc•nlion: ORS 447,455,479,670.701. 2(91 amps or 1-ss - ----- 2 201 amps to 400 amps _ _ 2 Owner's si nature: Date: 401 to 6W strips 2 Branch circuits-new,alteration, ,t or extension per panel: Name: fIC ST 1`ln/ 4 A. Fee f,r hranch circuits with purchase of Address: t S frJ ;y,QC A service or feeder fee,each branch circuit 2 City: I State:Q , IP: 7(55 6-L H. hee for branch circuits without purchase Phone: QP r)'1 1 f'ax:ST7 y1 3 Z I Email: of service or feeder fee,first branch circuit: 2 — — Each additional hran.h circuit. PLAN RVV11r1V(1`leh%e check all that appl.0 Misc.(Service or feeder not Included): U Service over 225 amps-commercial U Health-care facility Bach pump or Irrigation circle 2 U Service over 320 amps rating of 1&2 U Hazardous location Each sign or outline lighting 2 farm ly dwell ingi U Huilding over 10,000 square feel 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' 1 2 U Building over three stories U Feeders,4W amps or roots *Description: _ xm U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspectlon over the allowable in any of the above: U Fgress/lightingplan U tether: Perini tion Submit—_ sels of plans with any of the above. Invests ation fee The above are not applicable to(emporary construction service. Other - N w nil lurisdictiau accelm credit cards,please tali jurisdiction fur mac information. Notice:This permit,;nplicatlon Permit fee.....................$ _ ❑MasterCard expires Wit permit is pot obtained Plan review(at _ %) $ _ X007 13 within 180 days after it has been State surcharge(11%) ...$ on a c� x rcr accepted as complete. foTAL .......................$ S -- Cr erTwae Amuum 44b4615(dRIaK't i ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: - ---`� TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee... .................................................. $75.00 Number of Inspections per permit allowed )I (FOR ALL SYSTEMS) Service 'Included: Items Cost Total y Check Type of Work Involved. Residential-per unit 1 ❑ 1000 sq.ft.or less $145 15 _ _ Audio and Stereo Systems' Each additional 500 sq.ft.or r� portion thereof $33.40 _ L J Burglar Alarm Limited Energy $75.00 Each Manuf d Home or Modular Garage Door Opener" Dwelling Service or Feeder _ $90.90 _ 2 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 2 200 amps or less $80.30 _ Vacuum Systems` 201 amps to 400 amps _ $106.85 2 401 amps to 600 amps _ _ $160.60 601 amps 10 1000 amps ___ $240.50 � 2 ❑ Other Over 1000 amps or volts _ $454.65 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Feefor each system......................................................... $75.00 Installation,alteration,or relocation 2 (SEE OAR 918-260-260) 200 amps or less $66.85 201 amps to 400 amps $100.30 _ 2 401 amps to 600 amps $133 15 2 Check Type of Work Involved: Over 600 amps to 1000 volts, ❑ Audio and Stereo Systems see"b"above. Branch Circuits ❑ Boller Controls New,alteration or extension per panel a)The fee for branch circuits ❑ Clock Systems with purchase of service or feeder fee. 1 ❑ Each branch circuit $6.65 _ Data Telecommunication Installation b)The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85HVAC 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 circuits)or a limited energy El Landscape irrigation Control' panel,alteration or extension $75.00 _ Minor Labels(10) $12500 ❑ Medical Each additional Inspection over the allowable In any of the above ❑ Nurse Calls Per Inspection $62.50 _ Per hour $62.50 — ❑ In Plant $73.75 Outdoor landscape Lighting' Fees: ❑ Protective Signaling Enter total o1 above fees $ Other_ -- 8%State Surcharge $ — _Number of Systerns 25%Plan Review Fes No licenses are required Licenses are required for all other installations See"Plan Review"section on $ _ — front of application. - � Fees: Total Balance Due $ _. rr—�� Enter total of above Ices s-- El l I rust Account 0 e%State Surcharge -.-- — Tota!Balance Due All New COmmert;al Buildings requi:u 2 mol- -f plans. I jsts\fomv\elc-fees,doc 08130/Ui Mechanical Permit A#p cation Datereceived: Permit no.:� City of Tigard Project/appl.no.: I xpirc date: (.i,%. f Tigard Address: 13125 SW Ifall Blvd,Tigard,OR 97223 Date issued: By: - Rccciptno.: Phone: (503) 639-4171 — Fax: (503) 598-1960 Case file no.: �Payment type: Land use approval: Building permit no.: TYPEOF U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/altcration/replaccment U Other: t t e Job ` 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.: profit.Value$ I '-1-- _ � Nrj �n66 *See checklist for important application information and Lot: Block: Subdivision: P pp jurisdiction's fie schedule for residential permit fee. Project name: 1 of q City/county:TwA ZIP: 7 I t Description and location of work on premises: MEW � -« i _ 5IN6LC �rtL.j 1'mr(ca.) rrNa1 Est.date of completion/inspection: IY_.r ription Uty. Itcs.Duly Rm�.om►h 1 A Tenon!improvement or change of use: Air handling unit CFM _ Is existing space heated or conditioned?U Yes U Nn Air conditioning((site p an required) Is existing space insulated?U Yes U No Alteration of existing C system Boilericompressors State boiler permit no.: Business name: IF t 1- 4 Ilk"IN6 +AC. HP Tons BTU/H Address: L p(Z Fire/smoke amper uctsmo a detectors City; felt-t-t-Ar to State:0N ZIP: eat pum (site plan requ to ) nsta rep ace furnace/burner— Phone:/ N - (, 7,a Fax 61B A b 9 P E-mail: Including ductwork/vent liner U Yes O No CCB no.: _ _ nsw rep ac re ocate heaters-suspended, City/metro lic.no.: wall,or floor mounted Name(please print): Vent or a iance other than furnace e geral on: CONTACTPFRSON Absorption units BTU/I I Name: V/)1 J 6. i ,...,m j Chillers - lip Coto ressnrs� IIP Address: ( 8o wJ T,7,11 nv runmt tits eximust and vent ailon: City: 15C ri../'fr0 State: 01- 1 ZIP: '7Z,L Appliance vent Phone: r7 -Wo.+ I Fax:z7f416 E-mail: DryerexhaustIRV __ Hoods,Type res. tc en azmat hood fir--suppression system Name: f 1146 I've) Exhaust fan with single duct(both fan.) Mailing address: Exhaust system apart from cat n ,or AC Stale: ZIP: Vue piping andistribution(up to Outlets) City: Type: LPG NO Oil Phone: Fax: C-mail: e m sac n it ono ov�out cis Process piping(se emat c requ re ) Number of outlets Name: NjLtL S 1�`Wi4 �' Q 534 •,A. 5 ter stcd fance ippior equ pment: Address: t' 7 � Decorative f ircrilace City: FL A IA T 10-i State:'(1.- ZIP: d(.C Insert_type S'. jy ''] F E-mail oo stov et stove Phone: Other: Applicant's signature: Date: 3 OZ ter: Name (print): /fZ /' Permit fee.....................$ _-- rot vt jurisdictions accept cmdn cant.plewe ut1 jurisdiction for more Information Notice:This permit application Minimum fee........... ....$ Ifyjsa U Mastercard _vo -(vo?t expires if a permit is not obtained � 11. 3/�� Plan review(tit _ 7t+) $ ! within ISO days atter it has been __ _� sr�rea Y State surcharge(896) ....$ r uSn Ides w own on credit card s accepted as complete. TOTAL .......................S -- t'wdholder dptaluie — Amount "04617(6MCOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: '0 & 2 FAMILY DWELLING FEE SCNF"-ULF_: TODescription: �ricc i ctal TOTAL VALUATION: PERMIT FEE: Table 1A Mechanical Code City (! ) Amt $1.u0 to$5,000.00 Minimum fee$72.50 1) Furnace to 100,000 BTU $5,001.00 to$10,000.00 X72.50 for the first$5,000.00 and Including ducts&vents 14M _ $1.52 for each additional$100.00 or Furnace 100,000 BTU+ fraction thereof.to and including 2) ducts&vents 17.40 _ $10000.00. Including 3) Floor Furnace $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and including vent 1400 __ $1.54 for each additional$100.00 or 4 Suspended heater,wall heater _ fraction thereof,to and including ) or floor mounted heater 14 00 $25,000.00. -"- $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 a]nd 5) Vent not included in appliance permit $1.45 for each additional$100.00 6 30 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 aCheck all that apply: Boiler Heat Air $1.20 for each additional$100.00 For Items 7-11,see or Pump Cond fraction thereof, footnotes below. Comp 7)<3HP;absorb unit Minimum Permit Fee$72.50 SUBTOTAL: $ to 100K BTU - 14.00 8Y.State Surnharge $ unit 100kk to 500k BTU 6) 15 absorb 25.60 t t _ _ 25•/.Plan Review Fee(of subtotal) unitt.5$ 9) HP;absorb 35.00 .5-1 1 mil BTU - Required for ALL commercialpermits only 10)30-50 HP;absorb TOTAL _OM1 PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 M 11)>50HP;absorb _-- unit>1.75 m!I BTU 87.20 12)Air handling unit to 10,000 CFM ASSUMED VALUATIONS PER APPLIANCE:_ 10.00 Value Total 13)Air handling unit 10,000 CFM+ Descri tion: Ol Ea Amount 17.20 Furnace to 100,000 BTU,including 955 14)Non portable evaporate cooler ducts 8 vents nn• __ 10.00 Furnace>100,000 BTU Including 1,170 15)Vent fan co ^-�d to a single duct ducts 8 vents 8,80 Floor furnace including vent 855 16)Ventilation system not Included in Suspended heater,wall heater or 955 a IlanCe Dermit _ 10.00 floor mounted heater 17)Hood served by mechanical exhaust --I Vent not Included In appliance 445 10.00 ermit 16)Domestic Incinerators 805 Repair units _ 17.40 <3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator to 100k BTU _ 69'95 - 3.15 hp;absorb.unit, 1,700 20)Other units,including wood stoves 101 k l0 500k BTU 10.00 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets mil.BTU 5.40 30-50 hp;absorb.unit, 3400 22)More than 4-per outlet(each) 1-1.75 mil.BTU 1 00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mill.BTU - _ Air handlingunit to 10 000 efm 656 8%State Surcharge $ Air handlin unit>10,000 cim 1 170 Non-portable evaporate cooler _ _ 656 _- TOTAL RESIDENTIAL PERMIT FEF: $ Vent fan connected to a single duct 446 Vent system not Included In y 656 --- - appliance permit ----- O her ns ectlo s an Fe Hood served b mechanical exhaust 656 1 Inspections �� y 1 170 1 Inspecllons outside of normal business hours(minimum charge-two hours) Domestic incinerator �_ _ - $62 50 per hour Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee Is spaGBcelly indicated (minimum charge-half hour) Other unit,including wood stoves, 656 $62 50 pat hour Inserts etc. 3 Additional plan revinw required by chvur!as additions or revisions to plans(minimum Gas I e 1.4 OUti819 360 charge-one-hell hour)$62 50 per hour Each additional outlet 83 'State Contractor Boller Certification regdired for units 3-200k BTU. "Residential A/C requires site plan•.mowing TOTAL COMMERCIAL i VALUA'T'ION: A:I Now Commercial Building-i require 2 sets of pians. i:\dsts\forms\mech fees doc 02/11/02 Building Fixtures Plumbing PerWt Application ' Date received: Permit no.:7 ,771 7 Cit of Tigard '�°"� • ' �' g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,TipA6drQPq(a2 f1'? project/appIno. Expire date: pt•o1 PP Citi of 71ywd Phone: (503) 639-4171 ��jj�tr __ Fax: (503) 598-IQ60 UI i Date issued: By. Receipt no.: ^fir ' - - _ rase file no.: Payment type: Land use approval: . __ - ---- TYPE &F PERMIT ❑ I &2 family dwelling or accessory ❑Commercial/industrial ❑Multi-:amity ❑Tenant improvement U New construction J Addition/alterationireplacement J Food sere ce U Other. C : INFORMATION + t �' ) L`es:ription Qty. Fee(ea.) Total Job address: S L - f - New—landfa - 2-family dwellings only: Bldg. no.: Suite no.: (Includes IPt,11.Pw each utilith connection) Tax map/tax lot/account no.: SFR(!)bath Lot: Block: Subdivision: 040 9t0 e + SFR(2) Project name: SFR(3)bath City/county 1-1 1 WA I VvASN ZIP: Each additional bath/kitchen _ Description and location of work on premisos: pjgfj Site utilities: -_ � F!At 1L.,%.r Catch basin/area drain - Niwells/leach line/trench drain Est.date of completion/inspection: Footing drain(no. lin. ft.) PLUMBING R. Manufactured home utilities _ Business name; f4 4 L4ji- pt V14MVi� Manholes Address: Rain drain :onnector �. Sanita sewer no.lin. EEI City: State: ZIP: rY ( - --- Phone: - _ Fax: E-mail: Storm sewer(no,lin. ft.) Water service no.lin. n. CCB no.: !� _ Plumb,bus.reg.no: — Fixture or item: City/metro lic.no.: _ — Absorption valve _Contractor's representative signature: Back now preventer Print name: S 1 pAL-. Date: Backwater valve CONTACt-PERSON" Basins/lavatory Clothes washer _Name: Dishwasher Address: I �1 ADrinking fountajn(s) _ _ Cit _ Stat ZIP: Z. Ejectors/sump Phone: '7- p15 1:,x' l 1. 968 E-mail• Exri sion tan _ Fir' a/sewer c �O! FL,. ,rains/floor sinks/hub Name(print):___ Qarba a dis osal Mailing adoress_ Hose bibb City: ZIP: Ice maker Phone: Fax: E-mail: Interceptor/grease trap Owner 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) _- employce on the property I own as per ORF Chapter 447. Sink(s),basin(s),lays(s)— Owner's si mature: Date: Sulnp — Tu s/s lower/shower pan A f f Urine Name: Ck SLt v"Ati- r Watercloset Address: I � .tie .e- ater eater City: 4'TI State:oh-1 ZIP: q1 6(AZ Ot er. Phone: S -$3 7 Fax' 'yi 3 E-mail: ata Minitnum fee.......•..•.....S - Not ail Jurisdictions accept credit cant,plena call jurisdiction rot more Information. Notice: This permit epplication o Plan review(at _ /o) S 7 Via U MasterCard expires if a permit is t of obtained , S I ti'e's-ito31 -(.r17� f !. 6Y State surcharge(8%).... _— _ within 1 R0 days after it has been , aitrea 1 QTAL........................ I;4��,,dhuldet -•— accepted as complete.et assho one it car — si`naturc S Amount J�oJ6161t COM1 PLUMBING PERMIT FEES: T-PRICE TOTAL New 1 and 2-family dwellings only: T�- FIXTURES Individual QTY ea AMOUNT (include:. 11 plumhlnp fixtures In PRICE TOTAL Sink 1660 this dwellrr,d and the first100 ft. QTY (sa) AMOUNT Lavatory 16.60 - for each utility connection) Tub or Tub/Showar Cornb. - One 1)bath $249.20 - 16.60 Two(2)bath- -- --�- ---- $350.00 -- - ---- Shower Only 16.60 Three 3 bath -- - - - - - -- V1'ater Closet - - - ---- -- - - - - $399.00 — -- - 16,60 -- - -- _ _ UrinalT- 16.60 --- -- __ SUBTOTAL - -- -- 8%STATE SURCHARGE -- Dishwasher 15.60 KLAN REVIEW-2g,-/.OF SUBTOTAL_ _ Garbage Disposal 16.60 -_ TOTAL - LaundryTray-- -- - 16.60 - Washing Machine - - 16.60 Flory Drain/Floor Sink 2" 16.60 16-so — PLEASE COMPLETE: 16.60 _ Water Heater O conversion O like kind 16.60 uantity b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved ReplaJdRoved/ permit.MFG Home New Water Service ped 4640 Sink MFG Home New San/Storm Sewer 46,40 LavatoryHose Bibs 1660 TuborTub/Shower Combination Roof Drains - 16.60 ---- __ _ ___ Shower Only Drinking Fountain 16.60 Water Closet -'- Olhe Fixtures(Specify) 16.60 Urinal - - - - - Dishwasher Garbage Disposal - Laund _Room Tra -�Washing Machine Machine - Sewer-1st 100' -- 55,00 --. Floor Drain/Sink: - _ _ 3" Sewer-each additional 100' - 46 40 4„ 'iter Service-1st 100' 55.00 Water Heater - Water Service-each additional 200' --46- 40 Other Fixtures -'- Storm 8 Rain Drain- 1st 100' 5500 Sp eci - -- Storm 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device q6 40 - - Residential Backflow Prevention Device' 27.55 - Catch Basin 16.60 - I speclion of Existing Plumbing or Specially 62,50 - - Re uesled Inspections er/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling - 16 25 16 - -- -- -_ — Grease Traps .60 QUANTITY TOTAL Isometric o, .er diagram Is required i. _—__0ijantity Total Is >9 `— °SUBTOTA_ _ H%STATE SURCHARGE - ---- "PLAN REVIEW 25%OF SUBTOTAL^ -- - - Required only l.fixture city lata1 Ism-9 TOTAL $ °Minimum permit fee is$72 50 r B",�state surcharge,except Residential BarF new r4evrnlion Device,which is SM 25•8%slate surchnige **All New Commercial Buildings require 2 sets of plans with Isometric nr riser diagram for plan review. I ldstsUorms\plm-fees doc 12/26/01 TI f rr vil _ I MAT LINE` STA. + S GR4N N — .LD DR. e, CITY OF TIGARD 1312 S.W. HAIL BLVD. TIGARD, OR 37223 IMPORTANT PERMIT NOTICE FRANKLIN ELECTRIC INC �C ; 1031 SE 23RD COURT GRESHAM, OQ 97080 .r Electrical Signature Form Permit #: MST2002-26002 Date Issued: 10114/02 Parcel: 2S 109AA-04500 Site Address: 14333 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Block: L.ot: 011 Jurisdiction: TIG Zoning: R-7 Remarks: New SF detached 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 Division. No electrical inspections will be authorized until this completed form is received OWNER: LECTRICAL CONTRACTOR: PAUL R CARNEY INC FRANKLIN ELECTRIC INC 1480 NW 102ND AVE 1031 SE 23RD COURT PORTLAND, OR 9729 GRESHAM. OR 97080 Phone #: 503-297-9406 Phone #: 492-4651 Raq #: I rc' 140170 I:I F 26-10410 s1'P 22605 AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of uper ising Electrician It you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MAL.MEDAL PLUMBING INC 111 S 18TH AVE CORNELIUS, OR 97113 Plumbing Signature Form Permit #: MST2002-26002 Date Issued: 10/14102 Parcel: 2 S 109AA-04500 Site Address: 14333 SW 128TH PL Subdivision: Block: Lot- Jurisdiction: Zoning: Remarks: New SF detached Path 1 Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, AFTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: PAUL R CARNEY INC MALMEDAL PLUMBING INC 1480 NW 1 C'2ND AVE 111 S 18TH AVE PORTLAND, OR 97229 CORNELIUS, OR 97113 Phone #: 503-297-9406 Phone #: 503-310-9795 Reg #: MET 4232 LIC 102535 PLM 34-276PB AN INK SIGNATURE IS REQUIRED ON THIS FORM 47, Signatl_ire of Authorized Plumber If you have any questions, please call (503) 639-4171, ext. # 310