15543 SW HARCOURT TERRACE 1 �
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155A3 SW Harcourt Terrace
CITY OF TIGARD ---- MASTER PERMIT
P`:RMIT#: MST2000-00198
DEVELOPMENT SERVICES DATE ISSUED: 11/13/00
13125 SV.'Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE .'UDDRESS: 15543 SW HARCOURT TF_RR PARCEL: 2S111 DA-13000
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R-7
BLOCK: LOT: 123 JURISDICTION: TIG
REMARKS: Construction of new single family detached residence, Path 1.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAA REQUIREO SETBACKS REQUIRED '
CLASS OF WORK: I;FW HEIGHT: 16 FIRST: 1,608 at E4SEMENT: aI LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: 3F FLOOR LOAD: 40 SECOND: at GARAGE: 435 sl FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMFNT: at RIGHT 5
VALUE: S 150.365 00
OCCUPANCY GRP: R3 SDRM: 3 BATH: 2 TOTAL: 1,608.00 st REAR. 22
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: I L14UNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 3 DISHWASHERS I FLOOR DRAINS: SEWER LINES: 100 SF RAIN GRAINS: 1 CATCH BASINS:
TUB/PHOWERS: 2 nARBAGE DISP: I WATER HEATERS: I WATER LINES: '00 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: BOILIC 0<3HP VENT FANS: 4 CLOTHES DRYEP I
GAS FURN—100K. I UNIT HEATERS: HOODS: I OTHER UNITS: +
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: +
ELECTRICAL
RESIDENTIAL IINIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCh CIRCUITS - MISCELLANEOUS A00'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 3 201 400 amp: 201 -400 amp: 1st WIO SVCIFDR: 00 SIGN OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 •800 amp: EA ADOL BR CIR: SIGNAL/PANEL: IN PL VT:
IAANU HMISVCIFDR: 601 • 1000 amp: 601avlps-1000v: MINOR LABEL:
1000+amplvolt:
^L.AN REVIE'.a SECTION
Reconnect only:
>-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREAISPC OCC
FLECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL _ B.COMMERC AL
AUDIO 6 STERFO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: H%'A.: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTA.nON: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL R SYSTEMS:
Owner: Contractor: TOTAL FEES: $ ?,458 46
MATRIX DEVELOPMENT CORE LEGEND HOMES CORP This penult Is subject to t'Te regulations contained In the
6900 SW HAI.NES ST STE 200 12755 SW 65tH AVE Tigard Municipal Code,State of OR Specialty Codes and
TIGARD,OR 97224 TIGARD,OR 97223 all other applicable laws All work will be done in
accordance with approved plans. This permit will expire if
work is not started within 160 days of issuance,or if the
work is suspended for rnore than 180 days. ATTENTION:
Phone. Phone: Oregon law requires you to follow rules adopted by the
Oregon utility Notification Center. Those rules are set
Reg N: UC 00060563 forth in OAR 952-001-0010 through 952-001-0090 You
may obtain CODieS of these rules or direct questiors to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Shear Wall Insp Firewall Insp Plumb Fin•31
Sewer Inapection Underfloor Insulation !Mechanical Insp Exterior Sheath;ng Inst Rain drain Insp Final inspection
Footing Insp Crawl Drain/Backwater Plumb Top Out Low Voltage Rain drain Insp Building Final
Foundation Insp Footing/Foundation Dn Electrical Rough In Gas Fireplace Electrical Final
Post/Beam Structural PLM/Underfloor Framing Insp Insulation Insp Mechanical Final
Issued By 1 i Z`1c.-3 t; Permittee Signatur,a_: C s �—
Call (503) 639.4175 by 7:00 p.m. for an inspection needed the next buss ess day
CITYOF TIGAR® SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2000-0034(3
13125 SW Hall Blvd., Tigard, OR 97223 (5031 R3°-4'i'1 DA i E ISSUED: 11!13/00
SITE ADDRESS; 15543 SW HARCOURT ]-ERR PARCEL: 2S111DA.-13000
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R-7
BLOCK: LOT: 123 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 connect, permit for new single family residence.
Owner: FEES -
MATRIX DEVELOPMENT CORP —� — —
6900 SW HAINES ST STE 200 Type By Date Amount Receipt
TIGARD, OR 97224 PRMT CTR 11/13/00 $2,300.00 2720000('000
INSP CTR 11/13/00 $35.00 27200000100
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection —^ — - -
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the instal lei
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer' Permit and the Agency will install a 'ateral ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those f ules are set forth in OAR 952-001-0010 through OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued by- Permittee Siynatare: I/ L c ( `SQL Loll
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
Date received: Permit no.:/5_' 0 �0 gPs,v1
City of Tigard
Ciof Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 �t'1�tiappl.no.: Expire date:
ry
Phone: (503) 639A I71 /,/ Date issued: By: Receipt no.:
Fax: (503)598.1960 Case file no.: Payment type:
Land use approval: _ 1&2 family:Simple Complete'""' '
TYPE OF PERMIT,
WTI &2 family dwelling or accessory ❑CommerciaUindustrial U Multi-family eNew construction El Demolition
U Add ition/al leration/replacement U Tenant improvement U Dirt-sprinkler/alarm U Other:
11 4149 INFORMATION
Job address: j ) -
l_? __ Bldg.no,__ I Suite no.:
Lot: Block: Subdivision: Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
Name:
Mailing add ss: 3-' 1&2 family dwelling:
City: G _ _ State:p ZIP: f 7 Valuation of work........................................ $ 72
Phone: 4,2O,Po 1Fax�S'V-dP,?G6E-mail: No.of bedrooms/baths.................................
Owner's representative: _ _ Total number of floors
Phone: I ax: -�f -+n+il: New dwelling arta(sq.ft,) .......................... -
Gamge/carport area(sq.fit.)......................... 6
Name: p� _��'��-J-,P�- _
Covered porch area(sq,ft.) ......................... 1 7/
Mailing add std s: /,-I — ly r _ Deck area(sq.f•)........................................ _^
City: State4 ZIP: Other structure area(jq. ft.)......................... —
Phone: (,.. O 1-,ax
E-mail: CommerciaUindustriaUmulti-family:
0=01211121111M Valuation of work........................................ $----
Existing bldg.area(sq.ft.) ..........................
Business name: New Z �y1 rctS bldg.area(sq.ft.) -� -
................................
JAi 7J� �y
Address: -I,.- - Number of stories.. ....
City: cy Salted ZIP:T 7.2,L
Type of construction....,............,..,/r........ ........... -
Phone: O 6" Fax%y- Email ---
CCB no.: Occupancy group(s): Existing' _-_---__-_----
�16 0 2.) — New:
City/metro tic.no.: t7 - j 4 Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name:�P ,9 yp dljw,/- provisions of ORS 701 and may be required to be licensed in the
_Address:/ s_ �',�7- 1'3 __ jurisdiction where work is being performed.if the applicant is
City: Pa'a 6 o ctate& ZIP: exempt from licensing,the following mason applies:
Contact person: Xcy ,,,.sd09F1 Plan no.: _ —
Phone:4,,lC' ."3c9(f& Fax:3 _ E-mail: -
Name: �,,`o Contact person: Fees due upon application ........................... $ _
Audress: lj �y o Date received: _
City: Amount received •........................................ $ --
Ph( E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Net all jurisdictions". credit cards,pleam call jurisdiction for mote information.
attached checklist.All provisions of laws and ordinances govcrning thi,, U Vise U MasletCard
work will be complied with,whether specified he in or not. Credit ctrd number:
Authorized ' nnaatuure: - Name of cardholder u Eapires
shown on credit card —'
Print name / — _._ s
cardhotaer dputuce Amount
Notice:This permit apphcaC n expires if a permit is not obtained within 190 days after it has been accepted as complete. 444013(WOMM)
Mechanical Permit Application
_ Date received: Permit no.:
City of Tigard Project/appi.no.: —A— Expiiedate: v
Cify of Tigwd Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued:_ _ By: I Receipt no..
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
Building permit no.:
!_.^
TVPE'
t
X11 &2 family dwelling or accessory U Commer6al/indust ial U Multi-family U Tenat,r.improvement
U New construction O Addition/alteration/replacement U Other.
MIJAWLILU tCIVIL-to
Job address: Indicate equipment quantities in boxes below. Indicate the dollar
Bldg,no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
profit.Value$
Tax map/tax lot/account no.:
Lot; Block: _ Subdivision: *See checklist for important application information and
Project n e: — jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: IC:
ININNt N411t 1 ,
Description and I tion of work on premises:
l a(ea.) 1'otsil
Est.date of completion/inspection: Description -T
Res.only Res.unly
Tenant improveme r change of use: Air handling unit ___ CFM
Is existi space heated or conditioned'?U Yes U No it con fuoning(sue p an require ) _
Is e ' mg space insulated?U Yes U No A ter— a n of existing HVAC system
of er compressors
State boiler permit no.:
Business name: HP Tons BTU/H
Address: t 0 5- ire smo a amper uct smo a etectors _
City: v Statg;J ZIP: 970? _ eat pump site p an requir
E-mail: Install/replace furnace/burner
'
Phone: -7 7 Fax ��'7G9 Including ductwork/vent liner U Yes U No
CCB no.: Instal replac re ovate heaters-suspended,
City/metro lic.no.: wall,or floor mounted
7 - ent ora Tiancoo er ar. urnace
Name(please print): G
/-);�cr- A Rehigeiration..
Absorption units ._ BTU/H _
Chillers __ HP
Name: /_��Qf - — Com ressors HP
Address: 4 41jj tj —rp- sn ronmenta exhaust vent too:
City: pv e-" � State:-0- ZIP: 911 Appliance vent
Phone -77
Fax' - 7G ;T E•'nail: er e� aust
s, ype res. tchen/hazmat
hood fire suppression system
Name: .p Exhaust fan with single duct(bath fans)
KC-4 — j
address: 1 7J J_ �- x ousts stem a art om uaun or
Statco ZIP:92,W ae pp g an ut oo up to nu ets
City: Type: LPG NG ___ Oil
Phone: p z Fax 't - E-mail: ase i in eac a itiona over out ets
ess p p ng(schematic requir )
Number of outlets
Name: &ee C — _ ter listed a;rp nceorequ.., Oil'
Address: G, Decorativefire lace
City: State: 7►P- _ nsert-type
tov pe etstove
Phone:Cs'�l- � Fnx: FE-mail: - er: -. _
Applicant's signature: ate: _ ter; �'-
Name(print): -
Permit fee.....................3
Na all jurtmactlons accept aedir cards,pk cdt jurisdktion Gx dnnR inform«ian. Notice:This permit xpplicartron Minimur•fee................$
U Visa U MasterCard expires if a permit is not ubtained Plan revtt tv(at _%) $ _—
crodit card number. — - s within 180 days after it has b::en State surcharge(8%) ....$
---- accepted as complete. TOTAL
Name of cmdholrkr u shown on nafh card s
Cudholdet si6naiurc A 411617(6MCOM1
Commercial Schedule
1&2 Family Dwaliing Schedule
ASSUMED VALUAnONS PER APPLIANCE
Fr riptica
unlace to 100,000 BTU TTaWe IA Mechanical Code Oly Price Total
;ncludin ducts&vents 955 1)Fumaa:to clsI00&v BTU
_ 9 Mldudi r�duds a vents 14.00
Furnace>100,000 BTU 2) Fumroe 100,000 eTu.
Md•Ai g duds d vents I7A0
including ducts&vents 1,170 3) Floor Furnace
includirwj vent 14.00
floor fumace 4) Suspended heater,wag heater
Including vent 955 or lbor mounted heater 14.00
suspended heater,wall heatar 51 Vent not Included inMli 2Tpemn"- 6.00
or floor mounted heater _ 955 6) sk snits 12,16
Check all that appy *Boner Heal Alr
Vent not included in appliance permit 445 For Nems 7-10,see a Pump ccnd oty aloe Total
Repair units 805 footnotes 1,2
Uornp
p - 71<3HP;absorb ung to
<3 hp;absorb.unit 100K BTU _ 14.00
to 100k BTU _ _955 I�,10 P:absorb
u ung 25.60
3-15 h absorb.unit d)15.30 HP;abs,-t
p' unit.5.1 mil BTU 35.00
101k to 500k BTU 1700 10)30ao IIP;A'•wrb
unit 1-1.75 mg rrTU 5220
15-30 hp;absorb.unit 11)>50HP;ob 20rb ung>1.75 mll BTU
501k to 1 mil.BTU 23106726
12)Au hanlling ung In 10,000 UM
30-50 tip;absorb.unit 10.00
13)Ale handling unit 10,000 CFM
1-1.75 mil.BTU 3400 17.20
14)Hon-portable evaporate cooler
>50 hp;absotJ.unit 10.06
>1.75 mil.BTU 5725 15)Vent tan connected to a single dud
6.80
Air handling IInit to 10,000 cfm 656 16)Ventilation system not kw*Wed In
appNance perm" 10.00
Air handling unit>10,000 dm 1170 17)Hood served by nwhanlut exhaust -
Non-portable evaporate roller _ 65610'00
� I� _ 16)Docrlealk:Incinerators
vent fan connected to a single 4uct 446 _ _ 17.40
Vent syst.not included in appliance permit 656 Eta)comrmarctal or industrial type Incinerator 69.95
Hood served by mechanical exhaust 656 20)other trigs,inducting wood stnves 10,00
Domestic Incinerator 1170 21)Gas po n9 one to bur outlets
5.40
Commercial or Industral incinerator 4590 221 More than 4-per outlet(each)
I.00
Other unit,Including wood stoves,Inserts,etc. _ 656 Minimum Permit Fee$72.50 sueTOTA
-17
Gas piping 1.4 outlets 360 e%suaCIMOF
Eati1 additional outlet 63 KAN REVIEW 25%OF SUBTOTAL
_ Requlrsd for ALL commercial Pentrax Only
TOTAL
r2esr Inspections end Foes:
1. MPedk3M mdsida N normal business hos s(n*gnx^d-ye Mn h,wn)
t 72.50 Par h-
2 ImP.Owd IN-,&Hh-see n sp-01weM YtMnnled(ndnerrxn cK nie has Mu)
f72.50 pro hour
Total Valuation Fee 3 neegwwpl'n�"naw«nbyd-W1.Wdd-e«re.+et�%WPt"
1�nn
-- dwpeo -sa hos)672.so M ha.
'Spee C.«wMer Briar coMkstion reaWred
S 1.00 t, $5,000.00 _ Minimum 572.50 W,eQ w"'me den t "pw--4 d W
$5,001.00 to S10,000.00 S72.50 for the first 55,000.00 and 51.52 for
each additional 5100.00 or fraction thereof,
to and including 510,000.00
S 10,001.00 to$25,000.00 $148.50 for the fust S 10,000.00 and$1.54
for each additional$100.00 or fraction
thereof,to and including$25,000.00
S25,001.00 to$50,000.00 5379.50 for the first 525,000.00 and fl
for each additional$100.00 or fraction
thereof,to and including$50,0110.00
$50,000.00 and up 5742.00 for the first$50,000.00 and$1.20
for each additional S 100.00 or fraction
thereof
Plumbing Permit Application
of Tigard
Datereceivcd: Permit no..
City -� --- -------
�
Address: 13125 SW Hall Blvd,Tigard,nR 97223 Sewer permit no.: Building permit no.:—
City of Tigard Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: Hy:__ Receipt no.: i
Land use approval: _ Case file no.: � — Payment type:
1
1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
L,rNew construction U Additiort/alteration/replacement U Food service U Other:
JORSITE MP111511ATION IrEE SCUEDULEtInforlontion' use check ist)
J_ob address: Id/ ef 7 j / � �� IlescripNon Qty. Fee(ea.) 'Y'otal
New 1-and 2•family dwellings only:
Bldg.nSuite no.: (includes 100 ft.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block:_ Subdivision: SFR(2)bath �—
Project n e: SFR(3)bath
City/county:Zr 14�— I ZIP: T-7,2,IJ Each additional bath/kitchen
Description and l(kation of work on premises:_ _ Siteutllities:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drainPLUMBING CONTRU-11-01t
Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: (,��Co 2� Manholes _ -
Address: a ee Rain drain connector
City: h0� State;p ZIP:97o� Sanitary sewer(no.lin.fQ
Phone: 7_ Fax:6b 7-9 E-mail: Storm sewer(no.lin.ft.)
CCB no.: j 3 Plumb.bus.reg.no: (O.20,YAW Water se ce(no.lin.ft.)
City/metro lic.no.: Fixture or Item:
_Contmctoes representative signature: p cwt Absorption valve _
Print narrc-. Date: Back flow preventer
Backwater valve
CONTArr PERSONBasins/lavatory
Name: /or i'a Clothes washer —
Dishwasher _
Address: o dcoh,100 7 Drinking fountain(s)
City; State(' 3d E'ectotslsump
Phone: Fax: E-mail: —Expansion tank _
' y Fixture/sewer cap
Name(print): �'.. cq Q S Floor drains/floor sinksthub
Garbage bis
Mailing address:/ _j-. - G Fi sal
ase Bibb
City: o� _ State:e ZIP: 9 d 7ee maker
Phone: -A m Fax, I E-mail: lntetLe todgreme trap
Owner installation/residential maintenance only: The actual installation Ptimer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own per ORS Chapter 447. Sink(s),basin(s),lays(s) _
Owner's signature. Sump
Tubs/shower/shower pan _
Veinal
Name:_e Water cloret
Address: TT^ — -
Water heater
City: StAeo ZIP:i 7 Other.
Phone^ _ coos'' : E-mail: I Total
Not all juriedictiom amvp cndt cards,pleue call luded dm for mac inrarttuden Minimum fee................$ _
Notice:This permit application plan review(at u 96) $
O visa O MasterCard expires if a permit is not obtained
Credit card numbs: / / within 180 days after it has been State surcharge(8%)....$ _
Expifes ....
--'1�amb of�u�hnwn nn ueAil cud
accepted as'complete. TOTAL .................. $
_ S
^_ Cardholder tiVuture _-- —Amount 4404616(WWOM)
PLEASE COMPLETE:
FIXTURES (individual) • :,Qty Price:,$, Total Fixture Type----- Quantltyb�RE@plsc-ed
Work performed
Sink 16.60 New Mov0d Removedlcsppe.
Lavatory 16.60 Sink - -
Tub or Tub/Shower Comb. 16.60 Lavatory
Tub or Tub/Shower Combination
Shower Only 16.50 Shower Only
Water Closet 16.60 Water Closet
Urinal
Urinal 16.60 Dishwasher
-Dishwasher 16.60 Garbage Disposal
Laundry Room Tray ---
Garbage Disposal 16.60 Washin Machine `
Laundry Tray 16.60 Floor Drain/Floor Sink 2'
3•
Washing Machine 16.60 4•
Floor DrairVFloor Sink 2- 16.60 Water Heater
Other Fixtures S 1 "-
3• 16.60
4• 16.60 _
Water Healer O conversion O like kind 16.60
Gas piping requires a separate mechanical permit.
MFG Home New Water Service 46.40
MFG Home New SardSlorm Sewer 46.40
_ COMMENTS REGARDING A11OVE:
Hose Bibs 16.60
Roof Drains 16.60 -
Drinking Fountain 16.60 - -- - -- --
Other Fixtures(Specify) 21.75
Sewer-1s1100' T J5•00
Sewer-each additional 100' 46.40 "• ...
Water Service•.1st 100' 55.00
Water Service-each additional 200' 40.40
Storm 6 Rain Thain-1 sl 100' 55.00
Storm 6 Rain Drain-each additional 100' 46.40
Commercial Bach Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Flasin 16.60
Insp.of Existing Plumbing or Specially Requested72.50
Inspections Perlhr
Rain Drain,single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
lso_mwtrk or riser diagram Is required$Quantity Total Is >9
F .�Iw
'SUBTOTAL '.;
8%SURCHARGE
�rIt.
"PLAN REVIEW 25%OF SUBTOTAL
ReWW only rbdure qty.total Is>9 1S'n
s TOTAL
'Minimum permit fes Is$72.50♦6%vidu+rpe,except Residential Bsddlow Prevention
Device,which Is$.76.25♦6%surcharge.
AN New Commercial Buildings require plans with bornetrlr or riser diagram and plan review.
Electrical Permit Application
City
bale received; Perini;no.:
-
y of Tigard Project/appl.no.• Expire date:
City ofTigard Address: 1312.5 SW Hall Blvd,Tigard,OR 97223 bate issued:
Phone: (503) 6394171 _ By; Receipt no.:_
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval .�
1
I &2 family dwelling or accessory El Coin merciallindustrial 0 Multi-family O Tenant improvement
C1 New construction LJ Addition/alteration/replacement ❑Other: ❑Pima)
'jOBrSjj* -ION
Job address: /-�" ,, j�>, Bldg.no.: Suite no.: Tax.map/tax lot/account no.:
Lot: Block: Subdivision:
Project name; ,Q ��� ,/(' I Description and location of work on premises:
Estimated date of c mpletiurJinsptarficm: -��---
Job no: a Fee Max
BU9ine89 name: Description_ Qt (ea.) 'total no.Ins
Address: —� iVew'redderdial-single ormulti-fondlyper
Welling Will, gura .
City. 1,9 Stated ZIP: sr„ct„dedanachcdge
Phone - tj Fax:G -79.1j mail: i-0 aq.ft-or less _ 4
C o.: S Elec.bas,lic.no: ,3 :S c Each additional 500 sq.ft or portion thereof
Umited energy,residential 2
lty 3 0 Limited energy,non-residential 2
Each manufactured home or modular dwelling
""ii
n(required) Date Service and/or feeder 2
I.icrnseno U Services or feeders-Installation,
alteration or relocation:
200 straps or less 2
Name(print): 201 amps to 400 amps _ 2
4O amps to 600 amps q—
Malling address: J-5' w �'`2 2 601 amps to 1000 amps - ^� 2
[.itY• o v Statel3' ZIP:A"J�(� Over 1000 amps or volts 2
Phone: Lam- �d'O Fax:S�J- - E-mail: Reconnectonl _ -` I
Owner installation:The installation is being made on property I own Temporvry eerr(car or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrelo"tdon:
ORS 447,455,479,670,701. 200 amps or Ics _ 2
�J �J 201 amps to 400 amps — - -2
Owner's signature: ',/ �' or r '"9.-Date: 401 to 600 amps 2 --
Branch circuits-new,alteration,
Name: f or extension per panel:
A. Fee for branch circuits with purchase of
Address: o- service or feeder fee,each branch circuit 2
City: ,, _ Stated ZIPCf 7 B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: - a7 -' Fax: 1'-mail: _ -- _.
riach additional branch circuit:
Me.(Service or feeder not h,ciuded):
O Service over 225 amps-commercial U Healthcare facility Each pump of irrigation circle 2
O Service over 320 amps-rating of 1 R2 CJ Hazardous location Rauh sign or outline lighting 2
familydwe-Ilings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteratit,n,or extension' 2
O Building over three stories O Feeders,400 amps or more .Description:
Q Occupant load over 99 persons O 1'anufactured structures or RV park
O Egresn/I'ghtin,plan O Other Bch additional Yugsectlon over the allowable In any of the above
-- Perinspection
Submit_—sets of Pham with any of the above. Investigation fee _
The above aro not applicable to temporary coastruetion service. �orher -
Not all Jurisdictions accept credit card,.please call Judocden for more irdametbn. Notice;This permit appli,:ation Permit fee.....................$ W
❑Visa O MasterCard expires if a pennit is not obtained Plan review(at _ %) $
Credit card number: (� within I80 days atter it has been State surcharge(8%) ....$
-of -
S
signature Amount acccpled as complete. 1 OTAL $
Nems cardholder u shown on c e c
- 1
Cardholder a40-4615(ISABIt'OM)
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
4. Complete Fee Schedule Below:
Number of Inspections per permit allowed Restri ted Energy Fee........................................ $75.00
Service included: Items Cost Total (FOR ALL SYSTEMS)
4a. Reside ilial-per unit Check Type of Work Involved:
1000 sq fl.or less $14--15 _ 4
Ench additional 500 sq ft or L] Audio and Stereo Systems
nmtion;hereof _ $33.40 1
Limited Energy $75.00 Burglar Alarm
Fach Manufd Home or Modular
rmelling Service or Feeder $90.90 - 2
C;arage Door Opener'
41).Services or Feeders
Installation,allegation,or relocation Heating,'.-entilation and Air Conditioning System'
200 amps or less $80.30 _ 2
201 amps to 400 amps $106.85 _ 2 ❑ Vacuum Systems'
401 amps to 600 ams $160.60_ _ 2
601 amps to 1000 amps _ $240.60 2 Other
Over 1010 amps or volts �- $454.65 2 -
Reconnect only -�-_ $66.85 - _ 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY
4c.Temporary Services or Feeders
installation,alteration,or relocation Fee for each system.............. $75.00
................................
200 amps or less --,-_- $66.C5 _ 2 (SEE OAR 918-260-260)
201 amps to 4W airhps _ $100.30 2
401 amps to 600 snips _ $133.7.5� 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"abose. Audio and Stereo Systerns
4d,Branch Circuits
New,alteration or extension per panel Boiler Controls
a)The fee for branch circuits
with purchase of service or I-j Clock Systems
feeder fee.
[ach branch circuit $6.65 2 ❑
Data Telecommunication Installation
b)The fee for branch circxhits
without purchase of service O
or feeder fee. Fire Alarm Installation
First branch circuit _ $46.85
Each additional branch clicuil $6.65 HVAC
4e.Miscellaneous
(.service or feeder not included) Instrumentatic
1-ac h pump or inigalion circle $53-40
L ach sign rx ocdline fighting - ^ $53.40 Inturcom and Paging Systems
Signal clrcutt(s)nr a limited energy
panel,alteration or extension --�_ $75.00_ Ej Landscape Irrigation Control'
Minor Labels(10) $125.00 _
4f,tach additional inspection over I Medical
the allowable In any of the above ❑
Per inspection $62.50 _ _ L Nurse.Calls
Per hoar $62,50
In Plan( $73.75 U Outdoor Landscape Lighting'
5, FeeS: Protective Signaling
5a.Enter foist of above fees $
a%Surcharge(.08 X total fees) $ --- �� Other —
Subtotal $
6b.Fnter?5%of line ba for ___-__—,_`Number of Systems
Plan t.c.Aew if reardred(Sec.3) $
Subtotal $ ! No Manses are required. licenses are required to all other Installations
jl__J Trust Account ly_-_--�--_---- -FEES:
Total balance Due $ ENTER FEES $
------ -�-- -- --- -'- "-^- 8%SURCHARGE(.08 X TOTAL ABOVE) $
TOTAL $ --
FLAN
OT I AN
LOT 1*121 , AFFIL E WOOD FAR<
F,IFD 251 11 DA
TAX LOT *12800
15491 SW N,4RCOUF,'T TERRACE Ome ; aerr) - 00S'd
S.E. 1/4 OF SECTION 11, T.2, R.iW, W.M.
CIT'' OF TIGARD
W,45HINGTON COUNT', OREGON
LEGEND 6m WATrR METER
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H
OM
E SITE 100 55— r—— So"NITARY 5EWER
16rjGI— — — — STORM DRAIN
r �)+�llieil OFFICF. (503) 820-8080 TIGARD, OR. 97223
FAX (503) 598-8900 CCU# 00583 t OF STREET
MANHOLE
® C.ATCH BASIN
PROPOSED
STREET TREES
® STREET LIGHT
FIRE HYDRANT
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PROVIDE EROSION
CONTROL FENCE } Z
PER COMMUNITY W
1" 20'-0" EROSION PLAN f W �
cy
L07- 120 '�w I u
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89'54'25" E 208.5' 208.3'
93.Zi' N i1.
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May-10-00 10: 21A Wolcott Plumbing 503 667 9891 P.02
h
F
WOLCOTT 2050 N.W.Burnside P.O.box 2007
Gresham,Oregon Gresham,OR 97030
PLUMBING (833)d67.17A1 Fax(503)607-9891
CONTRACTORS, INC. cce 614547
May Id,200 n . �
Building Departi'acnt
City of Tigard
13125 SW Hall Blvd. -
Tigard,OR 97223
Wolcott Plumbing ContrucLOTS,Inc. docs hereby authorize a representative oaf Legend
Fornes to represent this firm when applying for plumbing permits inside the jurisdiction
or The City of Tigard. Wolcott Plumbing Contractors, Inc. rcahze the; should the
agreement with Legcnd Homes terminate, we have the right to withdraw our consent.
Narw Title
ignaturC Dale
26208P13 _. 4281 _
State Plumbing License City License
r
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 9722.3
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TUALATIN VALLEY HWY S
ALOHA, OR 97006•-1248
Electrical Signature Form
Permit #: MST2000-00498
Date Issued: 11113/00
Parcel: 2S111 DA-13000
Site Address: 15543 SW HARCOURT TERR
Subdivision: APPLEWOOD PARK NO. 3
Block: Lct: 123
Jurisdiction: TIG
Zoning: R-7
Remarks: Construction of new single Family detached residence, Path 1.
Your company has been indicated as the electrical contras;tor for the pe,mit 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
OWNFR ELECTRICAL CONTRACTOR:
MATRIX DEVELOPMENT CORP GARNER ELECTRIC
6900 SW HAINES ST STE 230 21785 SW TUALATIN VALLEY HWY S
TIGARD, OR 97224 Al r)HA, QR 47nnn_1 ?Ag
Phone #: Phone #: 591-1320
Req #: LT 121159
SUP 3707S
ELE 34-305C
AN INK SIGNATURE IS REQUIRED O --THIS FOFR
X_ _
Signature of Sup)rvising Electrician,
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD BUILDING INSPECTION DIVISION MST r - 6c- y� K
24-Hour Inspection Line. 639-4175 Business Line: 639-4171
BUP
_Date Requested AM1 !/ F��A BLD _
Location ! �.� 1� t v t Suite — _ MEC _
Contact Person _ Ph2/Y ~ �3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR _
Footing Access:
Foundation FPS
Fig Drain SGN —
Crawl Drain Inspection Notes: -- — — -
Slab -- -- ---- - -- SIT
Post& Beam -------- ---- ----- - — -----.._.��
Ext Sheath/Sheer
Int Sheath/Shear
Framing ---- -- — --- ------------ --------- ----- --
Insulation
Drywall Nailing
Firewall ------ ----- ---�---
Fire Sprinkler --- . ----- ---- —_ ----------- -------- --------- ---- -- --
Fire Alarm
Susp'd C Aing
Roof
Misc: -
Final �^
PASS PART FAIL ----- ---- -- �__..--------.___--� ____ _--
PLUMBIN(�_
Post& Beam _-
Under Slab
Top Out ---
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL_
Post&Bea,;i--- - -- -- ------ - _
Rough In
Gas Line -- _.-— ---- -- -
Smoke Dampers
Finzl — -
PASS PART FAIL
ELECTRICAL - - -Service
Rough
- - - - - - --
Rough In -
UG/Slab _
Low Voltage
Fire Alarm
Final
S PART FAIL
SI'f
ti9
ckfill/Grading I - - ���- ------- - --- --- -- --. -------- —
Sanitary Sewer
Storm Drain i Reinspection fee of$ _required before next inspection. Pay at City Hail, 13125 SW Hsll Blvd
Catch Basin
Fire Supply Line f ]Please all ier rei pertion RF [ ] Unable to inspect no access
AD,A______- n
proachlSidewalj/ (� I � (. I Ext
_.�--- Date Inspector _i _
PASS) PART FAIL NOT REMOVE this inspection record from the Job site.
CITY OF TIOARD
Residential Certif icah, O f' Occ,f/)(1/I c-V
Permit No.: `�l��t f� Address: /S5'4 3 aokjzt1a u,6,r- ---- ---
Owner/Contractor:
�: incl Inspection: �-8 a/ Inspector: CfL7 �r —� ----
Date of F p
his structure has been found to he in substantial compliance with the provisions of the Sate of Oregon One& Two FamilY 0svellin,q �1
Specialty Code and is hereb approved for occupancy. — J
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4176 Business Line: 639-4171 BUP
MST
_Date Requested__ _ AM� PM — BLD
Location [ � S�-<-' �=« Suite ;� � MEC _
Contact Person Ph /�J '"� G-3 PLM
Con -- Ph _-_ SVR41
B'111—DING Tenant/Owner ELC
Retaining Wall i ELR _
Footing Access'. '^
Foundation FPS _
Ftg Prain ----- SGN ---
Crawl Drain Inspection Notes: — -----
Slab - - -- — ---------- - SIT
Post&Dearn
Ext SheathiShr.ar
Int Sheatn/Shear
Framing _----- -------- ---- --------_� --
Insulation
Drywall Nailing --------
Firewall
__ _Firewall
Fire Sprinkler ---- ---_--- ---- --- — - — ------
Fire Alarm
Susp'd Ceiling
Roof ----- --------�
mi
,tPAS,,S PART FAIL ----- -- ---...----- - -- -- -
FLUMF31NG
Post& Bearn ---...�- -----_—
Under Slab
Top Out -_..-------
Water Service
Sanitary Sewer _�_�------_-.-----_--.--
Rain Drains
Final ----------_.___-
PASS ART FAIL
----.s--_--
Post & Hearn _-- -----___-- _.- -- -------------____
Rough In
Gas Line - ---
Sr"Dampers
A';S :`PART FAIL
ELECTRICAL -
`iP.fVIr;P,
Rough In --____—
UG/Slab
Low Voltage --------
Fire Alarm
FinalPASS PART PART FAIL
SI1 E
Barkflll/Grading - --—_— - ---- -- - ----._ --- -------
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$-- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: , — [ )Unable to inspect- no access
ADA
Approach/Sidewalk �+
Other Date > - c ��/ Inspector _ Ext
Fina: _ —
PASS PART FAIL DO NOT REMOVE th'iis inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST '���_��,
24-Haar Inspection Ling: 639-4175 Business Line: 639-4171 �-�-
BUP
Date Requested -3 'L' AM L— PM _ BLD
Location _(S'� uz, 17�u�'G�ivti�' _ Suite MEC -
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall EL.R
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes ----
Slab - --- ---- - -_.� -----— ---- SIT
Post&Beam —�
Ext Sheath/Shea;
Int Sheath/Shear — _Framing
Insulation -..- -- _ ---------- ------ --- ----------
Insulation
Drywall Nsiling _
Firewall -
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling -- -- --- ,__.� ---- ----- ---
Roof
Misr•,: -...--------_ -- - ----- _ -- _ ----- - --------
Final
PASS PART FAIL _ - ------ --- --------�.. - - — ------ ----- -
Post&Beam _--
Under Slab
TopOut - ---- ----------- ----- -- --------------------------------- ------ -----
Water Service
Sanitory Sewer -_ ----- . --- - --__ �._-_-------_.�____.----_------- _
Rain-Dra
kt tAS PART FAIL
ME HANICAL
Post&Beam ---
Rough In
Gas Line - - - --- -- -- - -
Smoke Dampars
Final - --- ---
PA` S PART FAIL
Et_ECTRICAL - --- - - - ----....--- --
Service
Rough In
UG/S;'b
Low Voltage —-- --- ------- --- --- ---- .
Fire Alarm
Final
PASS PART FAIL
31TE
Backfill/Grading - -- -- ------- -----
Sanitary Sewer
Storm Drain I ) Reinspection free of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Basi
asln
Fire Basi t.Ine f ) l'Ir�ase rail for reir„ rfi
henn RE: [ J Unable to Inspect-no access
ADA
Approach/Sidewalk
Other Date - - �` -_ Inspector Ext
- -
Final
PASS PART -FAIL- DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPcCTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
BUP _
Date Requested G --__AM 1'� PM _ BLD
Location l 5�/ 3 _5 /��� Co��-.� 7'`� ✓ y Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes
Slab ------- --- - - - SIT
Post& Beam _.------.. -------- --- -- ------ -
Ext Sheath/Shear
Int Sheath/Shear - -
Framing - - __- -_- --------.._- ---------
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _..- - _- --�_-_----a --�-�
Roof
Misc: -----
F incl
PASS PART FAIL -..--- -- ------------,--_-__.-�
PLUMBING ►.
Post& Beam - -- --�- - -
Under Slab
Top Out �-
Water Service
Sanitary Sewer -
Rain Drains
Fir i --
r r,oS PART FAIL
MECHANICAL
Pm,t& Beam I -- .-- - - -- ---- _- --- - ------- --
Rough In
Gas Line --- -- -- -- ----- --- ---- -
Smoke Dampers
Final -- - ---- ---
PART FAIL.
tLICMCSL _._. --.__—_ - _ -- ----- -------- ------- ---
Service
Rough In -
U(3/Slab
Low Voltage
PASS )Pt,RT FAIL --- - ------- ----- -�-.� - - ------SITE
Backfill/Grading - -- --�- __— - - -----� -
Sanitary Sewer
Storm Drair ] ]Reinspection fee of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basir,
Fire Supply Line ( ]Please call for reinspection RE [ ]Unable to inspect-no access
ADA
Approach/St'dewalk pate C
Other _._. _. Inspector_1�` % »'L�J1 _ Ext _y
Final
PASS PART FAIL I DO NOT REMOVE this inspection record from the job site.