14392 SW 128TH PLACE 14392 SW 128►" Place
MASTER PERMIT
/
CIT Y OF T 1 G A R® PERMIT#: MST2002-00162
UEVELOPMENT SERVICES DATE ISSUED: 4/5/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-417^.
PARCEL: 2S 109AA-05600
SITE ADDRESS: 14392 SW 128TH PL ZONING: R-7
SUBDIVISION: ELK HORN RIDGE ESTATES JURISDICTION: TIG
BLOC;:' L�f. 022
REMARKS: Nt .J SF Path 1
BUILDING
'�— FLOOR AREAS REQUIRED SETBACKS REQUIRED
REISSUE: STORT_S: 3
SMOKE DETECTORS-.
CLASS OF WORK: NEW HEIGHT: 30 FIRST: 1,387 a1 BASEMENT: a1
LEFT.
TYPE OF USE: SF FLOOR LOAD: 40 SECO"'J: 1,734 51 GARAGE. at FRONT:
PARKING SPACES:
of
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSM_'NT: VALUE 5 301 '9'GO
REAR
OCCUPANCi GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,12100 a1
PL JMBING
TRAPS:
SINKS: t WATER CLOSETS: 3 WASHING MACH: LAUNDRY TRAYS: I RAIN DRAIN: 100
LAVATORIES: 4
DISHWASHERS: I FLOOR DRAINS: SEWER LINE:: 100 SF RAIN DRAINS: I SATCH BASINS:
TUB/SHOWERS: 3 GARBAGE DISP: I WATER HEALERS: I WATER LINES: 100 BCKFLW PREVNTR: I GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL --
FUEL TY{ 'F FURN<100K:
BOILICMP<3HP VENT FANS: 5 CLOTHES DRYER: 1
—' - UNIT HEATERS: HOODS: 1 OTHER UNITS: t
GAS FURN»100K; 1
MAX INP: btu FLOOR FURNANCES:
VENTS: 1 WOODSTOVES: GAS OUTLETS:
rLECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP 9RVCIFFEDER3 BRANCH CIRCUITS
MISCELLANEOUS ADO'l-INSPECTIONS
0 200 amp: 0 200 amp: WISVC OR FOR: I PUMPIIRRIGATION: PER INSPEC I ION:
1000 SF OR LESS: 1 PER HOUR
EA A)D'L 500SF: 6 201 400 amp: 201 400 amp: tat WIO SVC/FDR: 00 SIGNIOUT LIN LT:
401 800 amp: 401 800 amp.
EA ADDL SR CIR: SIGNALIPANEL: IN PLAN.
LIMITED ENERGY
MINOR LABEL:
MANU HMISVCIFDR: 801 1000 amp:
8014amps•1000v:
1000.amplvolt: PLAN REVIi'N SECTION
Reconnect only: 1.4 RES UNITS: SVCIFDR>•225 A.: >boo V NOMINAL: CLS ARE!JSPC OCC.
ELECTRICAL ?:STRICT ENERGY
B.COMMERCIAL
_SF RESIDENTIAL _
AUDIO d STEREO; FIRE ALARM: ..ENCOMIPAOINO: OUTDOOR LNDSC LT
AUDIO S STEREO VACUUM SYSTEM:
BURGLAR ALARM:
OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNI.
CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
GARAGE OPENER
DATARELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
HVAC:
TOTAL FEES: $ 7,990.04
Owner: Contractor: This permit is subject to the regulations contained in the
PAUL R CARNEY INC PAUL R CARNEY INC Tigard Municipal Code,Stale of OR. Specialty Codes and
1480 NW 102ND 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 suspended for more than 180 days. ATTENTION:
Phone: Oregon law requires you to followrules adopted by the
Phone: Oregon Utility Notification Center. i hose rules are set
Rep N LIC bue52 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, Wtr Proofing Bsm't We Footing/Foundation Drl F.!actrical Rough In Gas Fireplace Appr/Sdwlk Insp
Grading Inspection PostlBeam Structural PLM/Underfloor Framing Insp Insulation Insp Electrical Final
Sewer Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp Firewall Insp Mechanical Final
Plumb Top Out Extarlor Sheathing Inst Rain drain Insp Plumb Final
Footing Insp Underfloor Insulation Water Line p Final Inspection
Foundation Insp Crawl DralnlBackwater Electrical Service Gas Line Insp
Issued BysJ�>Ll� � - I Permittee Signature —
Cail (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
^� 1
CITYI+. o r TI GA,RD SEINER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00113
13125 SW Ha,: Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED. 4/5/02
SITE ADDRESS; 14392 SW 128TH PL PARCEL: 23109AA-05600
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7
BLOCK: LOT: 022 JURISDICTION: TIG
TENANT NAME:
U$A NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNIT- 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF
Owner: — __ FEES —
PAUL R CARN`=Y INC Type By _ Date Amount Receipt
1480 NW 102ND --
PORTLAND, OR 9729 PRMT CTR 4/5/02 $2,300.00 27200200000
INSP CTR 4/5/02 $35.00 27200200000
Phone: 503-297-9406 Tetal $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Ac,ency. The permit expires 100
days from the date issued. This total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Perin
Issued by: _ I Permittee Signature: _
Call (503) 63(,-4175 by 7:00 P.M. for an inspection needed the next'business day
17
Building Permit Application �
Date received: 0?- Permit no.Y6r-A't"A.Gv/b 2
City of Tigard -
Projectfappl,no.: E_Wwr,date:
City of Tigard Address: 1-;125 SW Hall Blvd,Tigard,OR 97223 —
I Dine: (503) 6394171 Date issued: By Receiptnu.:
Fax: (503) 598-1960 Case file no.: ment type:
Land use approval: _ 1&2 family:simple Complex: 1,
TYPE 1
0 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/alteration/replacement U Tenant improvement IJ Fire sprinkler/alarm U Other:
It SJU.INVOlk MATION
Joh address: 111M? I Blig.no.: Suite no.:
Lot: Block: Subdivision: ;.� /,.. -�__ Tax map/tax Iot/accourrt no.: . /
Project name:
Description and location of work on premises/special conditions:
' 1
Name: . r
Mailing address: U Jr ry f &2 famHy dwelling: �. f
City: �_ Stater' ZIP: ° > , , " Valuation o1•work........................................ $ .3r10
Phone: 1 ax l:-mail: No.of bedrooms/baths....................... ... .! 30
Owner's representative: Total number of floors.................................I2-
Phone:
Phone: G mail: New dwelling area(sq. ft. 3 .:.*v....... b
age/carport arca(sq. A.) .'.Ir./.,.Y......
Name: i cred perch area(sq. Il.) ........................ � G
Mailing address _ Occk area(sy.ft.)........................... ............ l --
Other structure area(sq.ft.)........ ................
City: Slate: ;"II' M.
- ---- -- Coln rclpUindrutriaUmutti-frtmily:
Phone: rax: I:-mail:
1 Valuation of work........................................ $ ----
Jim I
Existing bldg.arca(sq.ft.) ....... ..... .......... _
Business name: - New bldg area(sq.ft.)
Address: ............ ............. - --
Number of stories
City: State: ZIP: ------
Type of construction............. ......... ............ _
Phone: Fax: E-mail: Occupancy group(s): E fisting: —
CCB no.: _ New: _
City/metro lic.no•: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: / provisions of ORS 701 and mey he required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
Add State: ZIP: exempt from licensing,the following reason applies:
r ',fit
Contact person: Plan no.:
Phone: rax: - F-mail: -� v- --- —
Name: t-'onurct person: Fees due upon application ..... .... ................ $_
Address: Date received:
City: State: ZIP: Amount received .........................................
Phone: Fax: E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the N,r aii jurimisction,wcerN credit crit+,pleat call jurisdiction fa more infonraUon.
attached checklist.All provisions of laws and ordinances gover i.ng this U Visa U MuterCard
work will be complied with.whethat specified herein or not. credit cord number'
Authorized signature:--_ _ Date: __Nww or eidhadet u shown nn credo' coir ---
$
Print name: — —". — -- CrdholdeislRnaturc —� — — Amount
Notice:This permit application expires if a permit is not obtanic!within 190 days after it hes been ec cepted as complrr?. �^ 440-461-1tiAlaOnM)
One-and Two-Family Uva elling
Building Permit Application Checklist Reference no.:
Associatedpernits:
CitynjTigard �.;Ity of Tigard
Address: 13125 SW fU Electrical O i lut^bing U Mechanicallail 131vd,Tigard,OR 97223 )Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
1 tum M111 t2dwil ti1gm
I (Land use actions completed.Sec.jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Veriflcation of approved pintllot.
4 Fire district____approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 .fewer 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 Hermit requir.d. Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to appli.;able local and state
building codes. Lateral design details and connections must he incorporated into tl,e plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. , .an reviisw cannot lie completed
if copyright violations exist.
I I She/plot plan drawn to scale.The plan must Show lot and building setback dimensions;property comer elevations(if'
there is more than a 4 11.elevation differential,plan mart show contour hoes at 2-11.intervals);location of easements and
driveway;footprint of structure;(including decks);location of wells/sepuc systems:utility locations;direction indicator;lot
area;building coverage area;percentage of coverage;impervious area;existing siructu;cs on site;and surface clr mage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-d, .'ns and reinforcing pads,connection details,vent
size and Iocation. _
13 Floor plans.Show all dimensions,room identification,winu. sire,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches-11-1ve grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-fluor,
wall construction,roof construction.More than one cross section may he required to clearly portray constructinn.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
Fireplace construction, Ulerrmal in ,ation,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 addendum;showing foundation elevations with cross references are acceptable,
16 Will bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for
non-prescriptive path-.nalysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rehar. For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any bcam/juist 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.,shear wall,roof truss)shall be stamped by an engineer or
archirrcr licensed in Ore}!nn and shall hr slit 1wn In hr,rpphcahl"10 the proircr un ler ry few.
2.+ I:i (5)'4IC pl;ws ate requn,•d I Item I I ah-T- Sire plans muv.I hr ti 1/ " x I_1-or I I" x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plants shall not contain red lines or(ape-ons. "Mirrored"building plans will he not accepted.
26 "Reversed"building plaits 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 plats(if applicable),and COT Street Tree,List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. ")0,14lrvl K one,
Plumbing Permit Application
"Dateeved: , re�- Permit no.-
CitySewerpetmitno.: Building
of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223
Ciryn(Tigard phone: (503) 639-4171 ProjecUappl.no.: _ Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: _ _ Case rite no.: Payment type:
ITYPE OF-PEIIMIT..
U1 &2 family dwelling or acccssmy U Conitnercial/industrial U Multi-family U Tenant improvement
U New cunstructiun U Add ition/altera,ion/repl,,icemeut New -3 service U Other:
t
Job address: 12tkQ If;H' L' _ Oestri itou, Qty. Fee(ea.) 'Total
Bldg.no.: Suite no.: New 1-and 2-family dv,eflings only:
(include 100 ft.for each utility connection)
Tax maFtax lot/account no.: _ SFR ;1)bath
Lot: Block: Subdivision: SFR(2)bath ----
Project name: __ SFR(3)bath
City/county: ZIP: _ Each additional bath/kitchen
Description and location of work on premises: Siteulilities:
Catch basin/area drain _
I?st.date of completion/inspection: D wells/leach line/trench drain
t Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: Manholes
Address: I tT-6 I` 4- H'Ve, _ Rain drain connector _
Sanitary sewer(no.lin.ft.)— -
Phone; I Fax: E-mail: Stolen sewer(no.lin. rt.) _
CCB no.. /U;t` 7, 5 Plumb.bus.reg.no: - 7 Water service(no. lin. I't.)
Fixture or Item:
City/metro lie.no.:
Absorption valve _
Contractor's representative signature: __ Back flow preventer
Print name: —�I�'t'" Backwater valve
Basins/lavatory
Name: Clothes washer _
— - Dishwasher
Address: Drinking fountainO
-- —
State: 71P: Ejectors/sump
Phone: Nax: E-mail: Expansion tank _
Fixture/sewer cap
Floor drains/floor sinks/hub
Name(print): _ ---- Garbtt a disposal
Mailing address: Huse bibb
City: State: ZIP: lee maker _
Phone: Fax: I E-mail: Intercc tor/ reale trap _
Owner installation/residential maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s).lays(s) __-
Owner's signature: _ Date: Sum _
-- 10 11 Tubs/shower/shower pan
Urinal
Name: _ --- Water closet _
Address: _ _ _ Water heater _
City: State: ZI"_ Other. —
Phone: Faz: E-mail: total
Nd dl jmiakiom accept credit c",pleue tail jurisdiction fa mote Infamutlm. Notice: This permitepphcation Minimum fee................$ _
Plan review(at „r %) $ _
U vise U Me.terCrrd expires if a permit is not obtained
Credit card number _ within 180 days after it has been State surcharge(896)....$
t plre�
— accepted as complete. TOTAL .......................$ _
None or cardholder as shown on credit cwT
_ $
Crdrroldet signature Amount 4404616(60YMM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 'family dwellings only: -
FIXTURES iudividual� r' -_ QTY ea AMOUNT (includes all 11'umbinp fixtures in PRICE TOTAL
Sink - ► 16.0 I the dwell;ng and the ffrst100 ft, QTY (ea) AMOUNT
Lavatory - 16 60 --- for each utility connectior�_
Tub or Tub!Shower Comb. - One 1 bath $249.20 -
1G.60 $350.00 '
Shower only 16.G0 $399.00
Water Closet - + 16.60 -- -- -._-
Urinal -- - --- __ SUBTOTAL _ ___
16.60 _8%STATE SURCHARGE
Dichwasher 16.60 - PLAN REVIEW 25%OF SUBTOTAL
Garbago Disposal 15.60 TOTAL
Laundry Tray 16.60 -
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3.1 is so
PLEASE COMPLETE-
3.1
16.60 - -
Water Heater O conversion O like kind 16.60 -^ Quanti y Work Pertormed
Gas piping requires a separate mechanical Fixture Type: New Movrd Replaced Removed/
permit - Capped
MFG Horne New Water Service 46.40 Sink
MFG Home New San/Storm Sewer gF,,40 Lavalo
Hose Bibs 16.60 - Tub or Tub/Shower
Combination _
Roof Drains - 16.60 - Shower Only -
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) ^�- 16.60 -- tlrinal - -
Dishwasher
Garbage Disposal -�
Laundry Room Tray
Washing Machlne --
Sewer-1st 100' 55 00 - Floor DrainiSink: 2" - - -
-- 3"
Sewor-each additional 100' 46,40 - 4" - -- - - -
Waler Service-1 st 100' 55.00 Water Heater _ ---
Water Service-each additional 200' 46.40 ---- Other Fixtures -
S e
Storm 8 Rain Drain-1st 100' 5500 -- --- --
Storm B Rain Drain-a,ich additional 100' --
Commercial Back Flow t rgvenlion Device 46.40
Residential Backnow Prevention Devico' 27.55 -- _
Catch Basin 16.60 -- - ---
Inspection of ExistingPlumbing or Speclally 62.50 '-
_Requested Inspections erlhr _ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 --- -'--- -T- --- _
QUANTITY TOTAL - ------ - -
Isumetric o;riser diagram Is required If -- _
_ Quantity Total Is >9
'SUBTOTAL -
8'/a STATE SURCHARGE -
;'PLAN REVIEW 45%OF SUBTOTALRequired only if fixture qty total is>9
TOTAL
`Minlmum permit tee Is{72 50•8%stale surrharge,except Residential 110,1'ftnw
Prevention Devine,which N$36 25+A%state surcharge
~All New Commercial Buildings require 2 sets of plans with Isometric.oa riser
diagram for plan review.
1:ldstslforms\plm-fees doc 12/26/01
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
-- -- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fe: Schedule Below: -__--
Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq.ft.or less �_ $145.15 _ 4 I Audio and Stereo Systems'
Each additi. -il 500 sq.ft or
portion thgr.of ^— $33.40 1 Burglar Alarm
Limited E. ,;gy $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 C'anditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 Vacuum Systems'
201 r ns to 400 amps $106.85 _ 2 El
401 amps to 600 amps $160.60_ 2
601 amps to 1000 amps $240.60 _ 2 Other
Over 1000 amps or volts _ $454.65 _
Reconnect only $66.85 _ 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration.or relocation Fee for each system........................ ............................ .... $75 00
200 amps or less _ $66.05_ 2 I (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 _ 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. C7 Audio and Stereo Systems
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits
!th purchase of service or Clock systems
feeder fee.
Each branch circuit $665 _ 2 Data Telecommunication Installation
b)The lee for branch circuits
without purchase of service Fire Alarm Installation
or feeder too.
First branch circuit _ _ $4685 _ ❑
Each additional branch circuit – _ $665 _ HVAC
Miscellaneous instrumentation
(Service or feeder not included)
Each pump or Irrigation circle $53.40 Intercom and Paging Systems
Each sign or outline lighting _ $5340
Signal circuit(s)or a limited energy
panel,alteration or extension $7500 Landscape.Irrigation Control"
Minor Labels(10) $125.00
Each additional Inspection over T ❑ Medical
the allowable In any of the above
Per inspection _ $6250 Nurse Calls
Per hour _ $62.50
In Plant __ $73.75 Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ _. __. Other.-
8%
ther.___8%Slate Surcharge $ _ T Number of Systems
25%Plan Review Fee ' No licenses are requlrsd Licenses are required for all other installations
See"Plan Review"section on $
front of application ----
Fees:
Total Balance Due $
--"- --- Enter total of above fres
❑ Trust Account q 8%State Surcharge
���-------------------v_� -- Total Balance Due
All New Commercial Buildings require 2 sets of plans.
i\dsu\formsklc-fees.doc 08/30/01
Electrical Permit Application
--r
pDatereccived:," ll9 Permit no. r City of of Tigard N-oject/apfl.no.: Expire date:
City of ligand AddreJs: 13125 SW Hall Blvd,Tigard,OR 97223 hate issued: By: Receipt no.:
Phone: (503) 639-4171 ----
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U'l &2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Vcmint in)hroventcnt
U New construction U A(ldition/alteration/replac•ement U Other: U Partial
1 ' SITE INFORFATION.
1lidg. no_ - Suite no.: Tax map/tax lot/account no.: --_-_
Lot: - — Block: Suhdivision: r/X /Y')
Project name: _ [k cription and lorsit—ion Ynff*work on premises:
Estimate::date of completion/inspection.
Job no: ree MAY
Description (fly. (est.) TWA no.ins
Busrn
Business name:
_ New residential-single ormulli-fNmih twr
Address: L ^
G 112f, dwellinRwrn.tnclmk•sAnaclayit;Aragc.
'_'Ity: [ State:41 zip: 970LF,0 Service Included:
Phone: Fax: E-mail: la()sq.tc nr toss _ 4
CCb no.:14617,0 Elec.bus.Ilc.no: Each additional 500 sq.ft.or portion thereof
Limited energy,residential 2
City/metro lic,no.: Limited energy,non-msidentiall 2
Each manufactured home or modular dwelling
Si nalute of supervising electrician(required) Date Service and/cr Neder
u 2-
Sup.elect.name(prin _ Licenseno:p? c Services or feeders.-It lallation,
alteration or relocation:
1'1160114V OWNER 200 amps or less _ 2
Name(print): 201 amps to 400 amps _ 2
-- 401 amps to 600 amps 2
Melling address:_ 601 amps to 1000 amps 2
City: State: LIP: Over 1000 ,raps or volts 2
Phone: I F-mail: Reconnect only !
Owner Installation:The installation is being made on property I own T-mporary oervices or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation-
ORS 447,455, 479,670,701. 200 amps or Icss — _ 2 _
201 amps to 4(10 amps _ 2
Owner's sl nature: Date: 401 to 600 an, s 2
Branch circuits-new,alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: 7service or feeder fee,each branch circuit _ _ 2
City: B. Fee for branch circuits without purchase
Phone: Fax:
of service or feeder fee,first branch circuit- 2
I'. m,ul
Bach additional branch circuit:
7"aarammmmlwmu _ Mlae.(Service or feeder not Included):
.qe,,lce 5 amps-commercial U health can+facility Bach pumpor inigation circle 2
0 amps-rating of 1&2 U Hazardous location teach sign or outline lighti� 2s U Building over 100YJ square feet four or Signal circuit(s)or a limited energy panel,
0 volts nominal more residential units In one structure alteration,orexlensintt• — 2 _
U Building over threesluries U Feeden,40(lamps ormore •Desai tion:
O(kcupant load over 99 persons U Manufactured stnuturea or RV park pjch additional Inspection over the allowable In any of the above:
U F.greas/Itghlingplan U"her: _ --- Per inspection --
Submit-_seta of plans with any of the above. Investigation fee —
The above are oot applicable to temporary cossttuctlon service. Other —
Not ail jurisdiction accept nada ends,please call jurisdiction for more information Notice:This permit application Permit fee.........•...........$ ._.
U visa a MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credo cud number _—_ within 190 days after it has been State surcharge(8%)....$
•a fat- accepted as complete. TOTAL .......................$
-- Name 04 C"&0l r M%tA7Wm on t CiF— —--
S
- - Crdholdef sijiruture Amount 440-46151~NN)
I
Mechanical Permit Application
Y Datereceived:;X? M C9- Permit no.-
City of Tigard -_
Project/appl.no.: Expire date:
CitvnjTigard Address: 13125 SW Hall Blvd.Tigard,(W 97221
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: .__ _ =Building permit no.:
al W 0
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ly dwelling or accessory U Commercial/industrial U Multi-family U Tenant irnpnrvenicnt
metion J,lddition/alteration/replaceiiient U Other-
1VALUATION-
Job address: 1 q 3 q;\ '` Indicate equipment quantilics u)boxes below. Indicate the dollar
Bldg.no.: auite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: ' I Block: Subdivision: `; / *See checklist for important application information and
Project name: jurisdirt':on's ice schedule for residential permit fee
City/county: TZIP. gig
_ 1
Description and location of work on premises: — l 11W11114LI JKU I1
+ L Fee(en.) Total
Est.date of completion/inspection: _ Description Qly. Res.only Res.only
Tenant improvement or change of use:
Is existing space heated or cc itioned?U Yes U No Air handling unit CFM
Air conditioning(cite plan required)
Is existing space insulaled9"Yes U No teration o existing HVAC system -"
I go 1101 x ri it Boilertcomprcssors
Business namState boiler permit no.:
Address: � ev A yet, &'el,fZ tj Na- --Tons Btors
`I ire smo c ampers ct uTU
smoke detectors
City: .,T l 4.L5 r/iL j 5tatc:( Gtr. 9��'�3 Acnt pump(site plan required) — -
Phone: Fax T F,-mail: nsta rep ace urnac urner
CCB no.! /G',��'7� _i i -- Including ductwork/vent liner U Yea U No
nsta rcTTac relocate testers-suspended,
City/metm lic.uo•: wall,or floor mounted
Name(please print): V antorappliance other than urnace
e err on:
Absorption units_ BTU/H
Name: Chillers HP
Address: - Com lessors — _ HPEnv —
City: _ IT/11, pp hon ex gust an vent al on:
---
Appliancaventvcnt
Phone: Dryevexl-aust —�
Hoods,Type res. Ito a azmat -- - —
hood fire suppression system _
Name: Exhaust fan with single duct(both fans)
Mailing address: Exhaust system apart from heaun or C
Fuel piping a on up to outlets)
City:
Stale: ZIP: _y TLPG NO __ oil
Phone: Fax: E-mail: ue Ylx�piping additional over-4 outlets — —
rocess piping(ac ernat c required)
Name: Number of outlets
—� _--
Other listed oppilince or equipment,
Address: _ _ Uecorativcfireplace
City, Stut1: ZIP: Insert-tyre —
I'hone Fax: Y E mail: oo stave pe et Move
Applicant's signature: Date: Other
Name(print):
Nra all)urdiclinm accept credit colds,platy call Juridlcilon for mare InrormMbn Permit tee.....................$ --_- -
Q Visa U MasterCard Notice:This permit not obtain Minimum fee................$
expires if a permitis not m obtained pian rrview(at — %) $
Credlt card nnmher —
�L-- within 180 days eller it bar been Slate surcharge(8r�) ....$ _
s G oil WX `der avuwn on c t c accepted as complete. --
i s TOTAL ......................$
C holAer albnature Am pm 440-4617(NOotroM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: P;ice Total 1
$1.00 to$5,000.00 Minimum tee$72.50 Table 1A Mechanical Code __ Oty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or including ducts&vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
_ $10,000.00. includiog ducts&vents _ 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnaco
$1.54 for each additional$100.00 or including vent _ 14.00
r ,Alon thereof,to and including 4) Suspended heater,wall heater
.625 000.00. _ or floor mounted heater 14.00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included in appliance permit
$1.45 for each additional$100.00 or _ 6.80
fraction thereof,to and Including 6) Repair units
_ $50,000.00. _ 12.15 _
$50,001.00 and up $742.00 for the first$50,000.00 and Cheek all that apply: Boiler He:l Air
$1.20 for each additional$100.00 or For Items 7-11,see or Duma Cond
fraction thereof. _ footnotes below. comp -
Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit
to 100K BTU _ _ _ 14.00 _
8%State Surcharge $ 8)3-15 HP;absorb
unit 100k to 500k BTU 25.60 _
25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb
Required for ALL commercial permits only unit.5-1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ 10) 1-1.7 HP;absorb
unit 1-1.75 mil BTU 52.20
11)>50HP;absorb -
unit>1.75 mil BTU 1 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM
Value Total 10.00
Description Qt Ea Amount 13)Air handling unit 10,000 CFM+
17.20
Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler
ducts&vents _ 10.00 _
Funiace>100,000 BTU including 1,170 15)Vent fan connected to a single duct
ducts&vents 6.80
Floor furnace including vent 955 -
Suspended heater,wall heater or 955 16)Ventilation system not Included In
floor mounted healer appliance permit 10.00
Vent not Included in appllcance 44.h 17)Hood served by mechanical exhaust
rmit 10.00
Repair units 805 18)Domestic Incinerators 17.40
<3 hp;absorb.unit, 955
to 100k BTU 13)Commercial or Industrial type incinerator
89.95
-15 hp;absorb.unit, 1,700
3
3-15to 500k BTU 20)Other units,Including wood stoves
101k10.00
15-30 hp;ab3orb.unit,501k to 1 2,310
mil.BTU 21)Gas piping one to four outlets
-- 5.40
30-50 hp;absorb.unit, 3,400 -
1-1.75 mll,BTU 27.)More than 4-per outlet(each)
.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU
Air handling unit to 10,000 cfm 656
Alr handling unit>10,000 cfm 1,110 8%State Surcharge $
Ncn:portable evaporal�ler 658 1 176TAL RESIDENTIAL PER "11 FEE: $
Vent fan connected to a single duct 448
Vent system not included In J56 _ __
appliance permit
Hood served by mechanical exhaust 656 omer inse9sjLqqLjird Fess:
Domestic Incinerator_ I 170 1 Inspections outside of normal business hours(minimum charge-two hours)
$02 50 per hour
Commercial or industrial Incinerator 4,590 Inspections for which no fee Is specifically Indicated (minimum charge half hour)
Other unit,Indudirg wood stoves, 656 $62 50 per hour
Inserts,etc. 3 Additional plan review required by changes,additions or^vI-Inns to plans(minimum
(.a8 piping 1-4 Outlets 390 charge-one-half hour)$02 50 per hour
Each additional outlet _ 63 *State Contractor Boller Certification required to-_oOs*200k BTU.
TOTAL COMMERCIALS "Residential AJC requires alta pian showing placement of unit.
VALUATION__ All New Commercial Buildings require 2 sets of plans.
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Melissa
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)539-4175 j
MST
INSPECTION DIVISION
Business Line: (503)639-4171
BUP
Received _ Date Requested- Z AM—
PM.- BBLIP
Location /"y �- Suite F"'
Contact Person
Ph (.-_) PLM
) -1�j �� - --^�---
Contractor__- ----__.-. --- _-- Ph(__--) -_ SWR --
BUILDING — Tenant/Owner ELC —
Footing -- - --------�-
Foundation Access: ELC
Fig Drain -- -
Crawl Drain _ �' 1 �) ELR
Slat, InspIV
Post& Beam
ection otes: SIT
-----
Shear Anchors -- ------ -- - - --
Ext Sheath/Shear
Int Sheath/Shear
naming --
Insulation — -- — --- _- _
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm ---`—
Susp'd Ceiling
Roc! --- --
Other: -- --_--_ -
SS _ART FAIL --
_
Post& Beam
Under Slab
Rough-In
Water Service
Se,iitary Sewer
Rain Drains
Catch Basin/Man',ule
Storm Drain
Shower Pan 1 4
Other: - - -
WA
PART FAIL
NICAL
Post&Beam
Rough-In
Gas Line --
Smoke Dampers
P SS PART FAIL
- ---
Service -�---
Rough-In -
UG/Slab
Low Voltage
Fire Alarm
PADASS PART FAIL I•-� Reinspection fee o}$_� requiredbefore next instiection. "ay al Cily Nall, 13125 SlV Hall Nlvd.
T Please call}or reinspection RE:
e Supply Line -- f Unable to Inspect--nn access
11� //1 il
Approach/Sidewalk Date 1 ((��
Other: I ----- �11spOetor —_—.
Ext
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MALMEDAL PLUMBING INC
111 S 18TH AVE
CORNELIUS, OR 97113
Plumbing Signature Form
Permit #: MST2002-00162
Date Issued: 4/512002
Parcel: 2S109AA-05600
Site Address: 14392 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot 022
Jurisdiction: TIG
Zoning: R-7
Remarks: New SF 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 i,,ave 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
Dept.
No plumbing inspections will be authorized until this completed form is received
OWNFR PLUMBING CONTRACTOR:
PAUL R CARNEY INC MALMEDAL PLUMBING INC
1480 NW 102ND 111 S 18TH AVE
PORTLAND, OR 97229 CORNELIUS, OR 97113
Phone #: 503-297-9406 Phone #: 503-310-9795
Reg #: LIC 102535
PLM 34-276PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
l
X
Sign turf of Authorized Plumber
If 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
FRANKLIN ELECTRIC INC
2889 SE 18TH CIRCLE
GRESHAM, OR 97080
Electrical Signature Form
Permit #: MST2002-00162
Date I33u0d: 4115,02
Parcel: 2S109AA-05600
Site Address: 14392 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTA1 ES
Block: Lot: 022
Jurisdiction: TIG
Zoning: R-7
Remarks: New SF 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 elect:ician is required. Please have the
appropriate individual prom your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dep .
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL_ CONTRACTOR:
PAUL R CARNEY INC FRANKLIN ELECTRIC INC
1480 NW 102ND 2889 SE 113TH CIRCLE
PORTLAND, OR 97229 GRESHAM, OR 97080
Phone #: 503-297-9406 Phone #: 492-4651
Req #: LIC 140170
EL.E 26-1041C
SUP 2260S
AN INK SIGNATURE IS REQUIRED ON 1 HIS FORM
X
Signature o pervising Electrician
It you have any questions, please call (503) 639-4171, ext. # 310