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7435 SW HERMOSO WAY 7435 SW Hermoso Way CITY OF TIGAHO ,ti 24-11our BUILDING �.i Inspection Line: (503) 639-p t75 MST INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received Date Requa ed t;1 .r AM PM BLIP Location -� 5 ,111�YYt-B-�- SUite _-- MEC Contact Person -_ C��►'YL-�''�t• Ph( < 4 _`1 ! PLM—) --- - Contractor -_-__ — Ph(—) __ SWR BUILDINGS Tenant/Owner - ___ - —_ ELC Footing EVC Foundatic.i Access: Ftg Drain ELR _ Crawl Drain ----- Slab Inspection Notes: SIT _ Post&Beam Shear Anchors - Ext Sheath/Shear - ----.-- Int Sheath/Shear Framing --- - — -— - - -- Insulation Drywall Nailing — - -- Firewall Fire SprinlJor — Fire Alarm Susp'd Ceiling - --- - --.. - Roof Other: -- - _ Final PASS PAST FAIL PLUMBINGi— — -- --------- Post&Beam Under Slab - - Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other: Final — - _-- _PASS PART FAIL - MECHANICAL --- ----- - -- --- �.�- - ------ Post&Beam Rough-In — -- ---- ----- — - Gas Line Smoke Dampers -- ----- -- — — Final PASS PART FAIL — - ELECTRICAL Service Rough-In — — UG/Slab Low Voltage - - --- Fire Alarm S3 PART FAIL Reinspection fee of$-`—_ required before next inspection. Pay at City Hall, 13125 SW Hall Bivd. Please call for reinspection RE:______— __ ❑ Unable tj insract-no access Fire Supply Line ADA Approach/Sidewalk Date - �- Inspoeter— — axt Other:—_�__ _ Final DO NOT REMOVE this inspection record from # job site. PASS PART FAIL ELECTRICAL PERMIT CITY OF TIGARD PERMIT#: ELC2001-00534 DEVELOPMENT SERVICES DATE ISSUED: 1112/01 131:.5 SW Hall Blvd., Tigard, OR 97223 1503) 639-4171 PARCEL: 2S101AE3 01403 SITE ADDRESS: 07435 SW HEkMOSO WAY ZONING: MUE SUBDIVISION: HERMOSO PARK LOT -. U06 JURISDICTION: TIG BLOCK: Project Description: Meter service and main panel with sub panel and transfer serv. RESIDENTIAL UNIT _ TEMP SRVCIFEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMPIIRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTC.: LIMITED ENERGY: 401 600 amp: SIGNALIPANEL: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (101: SERVICE/FEEDER _ PRANCH CIRCUITS^ ADD'L ItISPECTIONS 0 - 200 amp: 2 WISERVICE OR FEEDER: PER INSPECTION: list WIO SRVC OR FDR: PER HOUR: 201 - 400 amp: IN PLANT: 401 - 600 amp: EA ADD'L BRNCH CIRC: 601 - 1000 amp' — PLAN REVIEW SECTION 1000+ amolvoit: >=4 RES UNITS: > 600 VOLT NOMINAL: �— Reconnect ons SVC/FDR >= 225 AMPS: _ CLASS AREAISPEC OCC: _-- -- — Owner: Contractor: GREGORY COLDWEL L (GARY)COOPER ELUCTRIG 7435 SW HERMOSO 11845 SE 34TH ST MIL_WAUKIE, OR 9722 Phone: 503-646-3872 Phone: 653-8803 Reg#: SUP 2965S LIC OOG42.-i 6 ELE 3-191C FEES Required Inspections Type By Date Amount Receipt Fough-In Well Cover PRMT CTR 1112101 $200.50 2720010000( Elect'I Service 5PCT CTR 1112/01 $16.04 27200100001 Elect I Final Total _ $216.54 This Permit is issued subject to the regulations contained In the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws. All work will be done 1n accordance with approved plans. This permit will expire if work 13 not sti rted within 180 days of Issuance, or work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to Issued By: Permit Signatr.rre, _ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lecise, or rent. _ OWNER'S SIGNATURE: DATE: CONTRA-TOR INSTALLATION ONLY - --- -- _ DATE: SIGNATURE OF SUPR.ELEC'N: — — LICENSE NO: — Lall 639.4175 by 7:00pm for ail l,, pection the next business day Electrical Permit Application Gate received:i 12,1() 1 Permit no.: j { r Vity Of Tigard r 1--- 1 projecUappl.no.: Expiredat- Ciryn�/'igard Address: 13125 SW IIa11 Blvd,Tigard,OR 97223 Date issued: Bye' Receiptno.: Phone: (503) 639-4171 - Fax: (503) 598-1960 Case file no.: Payment type: Land use approval- TVPE OF PERMIT I &2 family dHelling or accessory U Commercial/industrial U Multi-lanuly U Tenant improvement U New construction U Addition/:tltrrntirni!rrltl:urnn'tit U f)tlu-r: U Partial O; WE INFORMAlf ll-ON Joh address: _ Blclg. no IsuitelloT.: Tax,nap/lax iot/account nu.: Lot: Block: _ �Suhdivision: 14 - Projecl Description and locati of wor n prcmiscs�— � - - CA- + f:stirnated date of,com lotion/ntipection: A-,A G,p u p_„tr, Job no: Fee Mat Business name: tS -- - —� __ tlescnptlun tlty. (ca.) Total no.Inst Address: M1en residential single or multi-famlly per 4( dwellirtgunit.Indalesetlaclredgnregr. City:AA,L4211 i6.k e Stale Zlf Service Included: Phone./,%-.1 < Fax: Email: 1000sq ft of ICN" -- 4 Each additional 5(X1 fig.ft.or portion thereof CCB no.: (Z Flec.hus.lic.no: ,5�5'S Limited energy,residential — 2 Ci!y/metro hc,no.: Intrude-acrgy,non-residential 2 Each manufactured home of modular dwelling Si endure of supervis n electric, rare uired) Iruc Service and/or feeder 2 Su -Whill: 4Lou I.iccnsett„ �� Services or feeders-Installation, PROPERTV OWN I It alteration or relocation: 2(X)amps or less 2 Name(print): rC r' 201 am7%to4(X)amps -i _ 2_ 401 tuups to 6W amps Mailing address: r 601 amps to I(XX)amps —' City: Stale: ?.1P:�2Over I WO strip%or volts — -- i Phot1C: 1'aX: mail: Recounectonl I Owner installation:The installation is tieing made on property I own Tertirwo ryservicesorfeederx- which is not intended for sale,(case,rent,or exchange according to InstAlation,alteration.orrelocation ORS 447.455,479,670,701. 2(X)at. is or less _ _ � __ 2 201 snips to 4W amps Owner's Owner's si nature: Date: an - ,(a um , - 2 Branch circuits-new,alteration, or extension per panel: Name: __— A. Fee for branch circuits with purchase of ,t Address: _ _ service or feeder fee,each branch circuit 4"1 2 City: Stale: ZIP: B. Fee for branch circuits without purchase ---ttt F of service or feeder fee,first branch circuit: 2 thon�• Fax' f:-snail: -- . Bach.(Servicetional branch circuit MUS.(Norelco or feeder not Included): U Service over 225 amp• •muttercial U Health-carefac-'its Fach pump or irrigation circle 2 U Service over 320arnps uuutgof 1&2 U Harotdouslocauun Hach sign or outline lighting 2 family dwelling% U Building over 101100 square feet four w Signal circuit(s)or a limited energy panel, U Systeni over 600 volls nominal morcresidential tothsinone structure ,ration,orexiension• 2 U Building over three stories U Feeders,400 amps or more I U Mcupwtt load over 99 persons U Manufactured structures or R`v park F ach additional Inspection over the allowable In any off 1tx altore:! U Fgrrss/lightbtgplait 1.1 Other Per inspection Submit sets of plans with any of the above. Investigation fee he Above are not applicable to temporary construction service. Other -i ----- . NM all}urirdlctluna sccepl credit cards,please call jurisdiction for more infunnatiun Mike:'1'hls pernitl application fee.. ..................$ On =--- U Visa U MasterCard expires if a pennit is not obtained Plan review(at ____ %) $ _ Name of cardholder ecrown on credit carte Credit card number. — __.L�_- within 180 days after it has been State surcharge M) . ..$ Espires accepted as complete. TOTAL ................... Is <P � • 5H � _ _s 17- Cardholder signature - Amount 440.461'(6MrWCOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: i Restricted Energy Fee......................................................_ $75.00 Number of Inspections per permit allowed I (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Res'dential-per unit 100( sq it or less _ $145 15 _ 4 ❑ Audio and Stereo Systems' L:act,additional 500 sq it or pon'on thereof $33.40 — 1 ❑ Burglar Alarm I lmL'ad Energy $75.00 Each Manurd Home or Modular Dwelling Service or Feeder $90.90 2 I ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilatlor and Air Conditioning System' Installation,allerafion,or relocation 200 amps or less $8u'0 �;oD 2 201 amps to 400 amps $.ua.85 i_ 2 ❑ Vacuum Sys�ems 4n1 amps to 600 amps $160.60 2 6,)1 amps to 1000 amps _ $240.60 2 ❑ Other Over 1000 amps or voltF $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $7`00 200 amps or less $65.85 2 (SEE OAR 9113.260-260) 201 amps to 400 amps $100.30 2 401 amps 1,,600 amps $133 75 2 Check Tyoe of Work Involved: Over 600 amps tr,1on0 volts, see"b"above. ❑ Audio and Stereo Systems Branch Circuits [--jNew,alteration or extension per panel Boller Controls n I I he fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit _ $6.65r"LD 2 ❑ Data Telecommunication Installation b)The fee for oranch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit _ $46.85 Each additional branch circuit $6.65 ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or Irrigation circle _ $53.40_ Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circult(s)or a limited energy panel,alteration or extension $75.00_ _ ❑ Lnndscape Irrigation Control' Minor Labels(10) $125.00 Each additional Inspection over E] Medical the allowable in any of the above ❑ Per inspection _ $62..50 Nurse Calls Per hour _ _ $62.50 _ In Plant _ $73.75 ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ _. __ ❑ Other 8%State Surcharge $ Number of Systems 25%Plan Roviaw Fee See"Plan Review-ser.frcrn on $ No licenses are required. Licenses are required for all other Installations front of application Fees: Total Balance Due $ — -- - Enter total of above fees 1 L_1 Trust Account# ----- 811.State Swcharge = Total Balance Due $ i�dsls\romis\elc-fres doc 00/07/01 CITYO F T!G A R D _ MECHANICAL PERMIT DEVELOPMENT SERVICES PERMITM MEC2002-00190 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6"39 4171 DATE ISSUED: 5./8'02 PARCEL: 2510146-01403 SITE ADDRESS: 07435 SW HERMOSO WAY SUBDIVISION: HERMOSO PARK ZONING: MUE BLOCK: LOT:006 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEAT RS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS_/COMPRESSORS HOODS: _ FUEL TYPES_ 0 3 HP: 1 DOMES. INCIN: I_—PG 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + FIP: CLO DRYERS: FURN < 100K BTU: I Alii HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Repiaceinent of gas furnace and addition of exterior A/C. Cannot be placed within the requirid setbacks. Owner: FEES GREGG COLWELL Type By Date Amount Receipt 7435 SW HERMOSO WAY PRMT CTR 5/8/02 _ $72.50 2720020000 TIGARD, OR 97223 5PCT CTR 5/8/02 $5.80 272002000C Phone:503-620-8907 Total 4_ $78.30 Contractor: CLASSIC HEATING & AIR, INC. PO BOX 132 CORNELIUS, OR 97113 REQUIRED INSPECTIONS__ Mechanical Inch Phone:503-359-5282 Heofing Unt Insp Rog#: Cooling Unt Insp Final Inspection This permit is issued subject to the regulations contained in the Tiga-d Municipal Code, State. of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or it work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct que-itions to OUNC by cilli J ec; � � n »aF_a � ; � - � Z Issue By: dam ._ Permittee Signature: Call1 5031 619-4175 by 7:00 P.M. for inspgctir ns needed the neo business day Mechanical Permit Application i/G i Datereceived: -- $ 0>- Permitno.: 6 U City of Tigard Project/appl.no.: Expire date: CtrY JrTo i Address: 13125 SW Hall Blvd,Tigard,OR 97223 8and Phone: (503) 639-417 Date issued: B�" P� Receipt no.: Fax: (503) 598-1960�0,4 22 C b - - 0 fJ �/ Case file no.: Payment type: Land use approval: Building permit no.: U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alterationplacement J Other: Job address: 5/ F 1l1 ? t r o,u A t ' Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead. Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivisi.,i.: 'See checklist for important application information and Project name: iurisdiction's fee schedule for residential permit fee. k' City/county: j, Cad' /2 ZIP: J S Description and ltion o work on premises:oo /f41 l�Al .� ��rL) r1' ('" ct4f ,��1,�� Fee(ea.) ToW Est.date of completion/inspection: lkwtr�ition . Res.only Res.onl Tenant improvement or change of use: "0 Is existinr space heated or conditioned?U Yes U No Air handling unit space insulated'?U Yes !_J No Air condition-ir Is existing t tc p an g s P Iteration of ext .sys,em Boller/compressors i Business name: C L4 I) - / �-�� State boiler permit no.: // r HP Tons BTU/H Address: c / 'ti / Fir smo c amper. uct smoke detectors City: /;�"/t i State:oL ZIP: // r" eat pump(site P un require ) - Phone:j l ' 1. Fax:Sf/n e E-mail: P,r I• nsta l rep -,ace furnace/ iT CSB no.: !- _ Including ductwork/vent liner U Yes U No -V nsta rep ac re ocateheaters-suspen e , City/metro lic.no.: wall,or(lour mounted Name(please print): // I•' Gt' �tt ant fora iancc__thcr—Tan furnace e gena on. Absorption units..__ BTU/H Name: Chillers HP --- -- - - Com vessors HP Address: _ ER Citi: State: nv ronmenta ez ost an rent on: St Appliance vent Phone: Fux: E-mail: )ryercx iaust Hoods,' ype I res.kitcheii7hazmat hood fire suppression system k Naine: �� L l L _ _ Exhaust fan with single duct(bath fans) Mailing address/,<�� L �/ j v 1 u t r., x ausiss stem a art irom eatin or AC� City: ' ' �/lr Stale: ZIP: Fuelpiping andistribution(up to out ors) .,�lL� _ Type: ,_LPG NU Oil aw 26 t• i� 1 min cac aail' (� ` uel i titiona over outlets racess piping(scerratic required) Name: Number of outlets _ — other lRed appliance or equipment: Address: Decorative fireplace _ City: _ i State: ZIP: v nseri-type Phone: Fax: E-snail: Woodslov0pelletitove Other: Applicant's signature.: _ Date: Other. — N: 1. riot): NM dl}uriadicaon+ircepr credit cartL,pleare call Juried6:Ual fa mac Infarrutlon. Permit fee.....................$ �... U Visa U Masterclu l Notice:This permit application Minimum fee................$ expires if a permit is not obtained Plan review(at __ % credo cant number ___�_—_____ -_ e>< iJ within 180 days after it has been ) $ ►' State surcharge(8%)....$ 0 Natne of cardhol r a shown on credo cad $ accepted as complete. TOTAL $ `7 5� Z�y Cardholder signature Amount 110411(&WCOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION:_ PERMIT FEE: _ Description: PikeTotal - $1.00 to$5,000.00 Minimum fee s/2.uu Table 1A Mechanical Code _ Qty (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 LITU+ $10,000.00. inraudin ducts&vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.90 and 3) Floor Furnace $1.54 for each additional$100.00 or including vent 14.00 fraction thereof,to and Including 4) Suspended heater,wall heater _ $25,000.00. _ or floor mounteJ Imater _ 14.00 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included in ap)liance pdrmil $1.45 for each additional$10C 10 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 Check all that apply: Boller Heat Air $1.20 for each additional$100.00 or For Items 7.11,see or Pump Cond fraction thereof. footnotes below. Comp •• Minimum Permit as$72.50 SUBTOTAL: 7) absorb unit $ to 1100K00K BTU 14.00 6'/.State Surcharge $ - - 8)3-15 HP;absorb unit 100k to 500k BTU 25.60 9)15-30 HP;absorb 25%Plan Review Fee(of subtotal) $ unit.5-1 r,nil BTU 3500 Required for ALL commercial permits only - TO1 AL COMMERCIAL PERMIT FEE: $ 10)30-50 t'P;absorb unit' 1.75 n II BTU 52.20 t ----- -- _- - - -- - 11)>50HP:a)sorb unit>1.75 mil BTU L87.20 A_SSUMED VALUATIONS PER APPLIANCE: 12)Air handlfr,,!unit to 10,000 rFM 10.00 Value Total :)escrlption: __ Ot Ea Amount 13)Air handling unit 10,000 CFM+ 17.20 =umace to 100,000 BTU,Including 955 _ 14)Non-p•ir'.able evaporate cooler Ducts&vents 10,00 =umace>100,000 BTU Including 1,170 15)Venf fan connected to a single duct ducts&vents 6.80 _ Floor furnace Includin v� ant 95J - 16)Ventilancn system not included in Suspended heater,wall heater or 955 a liana pirmit 10.00 floor mounted heater _ Vent not Included in applicance 445 17)Hood served 0v mechanical exhaust 10.00 _ permit 18)Domestic inclnera►ors Repair units _ _ 805 1740 <3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator to 100k BTU _ 69.95 3-15 hp;absorb.unit, 1,700 - 101k to 500k BTU 20)Other units,including woad stoves - 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, 3,400 22)More than 4-per outlet(each) 1-1.75 mll.BTU _ _ 1.00 _ >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Minimum Permit Fee$72.50 SUBTOTAL: $ _ AIr handling unit to 10,000 cfm 656 - - 8`/.Slate Surcharge $ Air handling unit>10,000 cfm _ 1,170 Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent system not Included in 658 appliance permit Hood served b mechanical exhaust 656 ether InspeIneRections o tsd Fees: Domestic Incinerator 1 170 1 Inspections outside of normal business hours(minimum charge-two hours) $82 50 per hour Commercial or Industrial incinerator 4,590 2 Inspections for which no fee Is specifically indicated tn,- imuwn charge-half hour) Other unit,Including wood stoves, 656 $62 50 f jr hour Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plane(minimum G88 piping 14 outlets 380 charge one-hell hour)$82 50 per hour Each additional outlet _ 63 'Slate Contractor Boller Certllicatior required for units>200k BTU. -t-OTA--'COMMERCIAL $ - **Residential A/C requires Mite plan showing placement of unll. VALUATION: _ _ All New Commercial Buildings require 2 sets of plans. lmststformstmech-fees.doc 12/26/01 ■i= m Em No MOM No on is " moo MEN IN oil am NONE 0 ME momm ME No 0 0 CITYOF TIGARD __-- PLUfiSINGPENMIT PERMIT#: P11-2002-00144 DEVELOPMENT SERVICES , ''E ISSUED: 5/1/02 13125 SW Hall Blvd., Tigard, OR 972.23 (503) . " 1171 PARCEL: 2S 101 AB-01403 ,:,ITE ADDRESS 07435 SW HERMOSO WAY SUBDIVISION: HFQMO SO PARK ZONING: MUE BLOCK: LOT: 0()6-__ _ _ _..___ JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSAL.:;. MOBILE HOME SPACES: TYPE OF USE: SF WASF.w11G Mi.C, . BACKFLOW, PREVNTRS: OCCUPANCY GRP: R? FLOOR DRAINS: TRAP: STORIES. WATER PEATERS: 1 CATCH BASINS: FIXTURES _—_ LAUND41Y TRAYS: SF .:N DRAINS: SINKS: t1R,NihLS: GREASE TRAPS: LAVATORIES: OTHEF. FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: ;DATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacing gas water heater with electric water heater. FEES Owner: Type By Date — Amount Receipt Gr'EGG COLWELL PRMT CTR 5/1/02 $72.50 27200200000 7435 SW HERMOSO WAY 5PCT CTR 5/1/02 $5.80 27200200000 TIGARD, OR 97223 — — Total $78.30 Phone 1: 503-620-8907 Contractor_ OWNER REQUIRED INSPECTIONS Top-out Insp Phone 1: Final Inspection Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. . l Issued By: Permittee Signature: Call (503) 339-4175 by 7:00 P.M. for an inspection needed the next b6siness day Plumbing Permit Application "Datemceived: Qty Permitno.: City Gf Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,JR 97'.,3 CiryojTigard phone: (503) 639-4171 ProjecUapfl.no.: re date: Fax: (503) 598-1960 Date issued: By Receipt no.: Land use approval: Case file no.: Payment type: r' 1 , 1 &2 family dwelling or accessory U Conunel- al/ilidustoal ❑Multi-family U Tenant improvement U New construction U Adclitionlalteration/replacement ❑Food service U Other: JOBS111EINFQ111NINTION FEE-S( I I EDULEt Jab address: � jS- t J-(�{,y (it� Desrrflmon QNy.I Fee(ea.) 'Total Bldg.no.: _ Suite no.: Nen I-and 2-family dwellings only: r 'fax nu. 'tax lot/accounl no.: -- - -- (includes 100R.foreachutllitq connection) SFR(1)bath Lot: BIoc�Subdivision: SFR(2)bath ---- Project name: _ SFR(3)bath _ City/county: ZIP: �� _ Each additional bath/kitchen D-script'on and locton of oril J pr- _i Sileutilities: k U Catch basirdarea drain Est.date of completion/iry:pection: Cj p 2, Drywellbleach line/trench drain ill I NI IIING Footing drain(no. lin.ft.) 1 Manufactured home utilities _ Business name: �� /�' Manholes Address: Rain drain connector _ City: _ State: ZIP: --- - - Sanitary sewer(no,lin.f(.) Phone: Fax: E-mail: _Storm sewer(no.lin. ft.) _ - CCB no.: I'lumh. hus.reg.no: Water service(no.lin.ft. City/metro lic.no.: Fixture or item: Contractor's representative signa.ure: Absorption valve --- Back flow preventer Print name: t'l'' Backwater valve _ Basin%Aavatory Name: Clothes wash^.r - Address: Dishwasher ----- -- -- -- -- Drinking fountain(s) Ejectors/sump City: Statc: ZIP: t -- -�---- — -_- ors/sump Phr.ue: F-ax: E-mail: I Expansion tank Fixture/sewer cap Name(print): t Cp I„ -a( Floor drains/floor sinksniub Mailing address: Garbage disposal Hose hibF _ City: � ? _ State I ZIP: Ice maker Phone: o - Fax: b mail: elldell . Interco tor/ tease trap - _ owner installation/residential maintenance only: The dual insla lationL mer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the pro I own as perO S Chapter 447. Sin (s), asin(s), ave s(s)— Cwner's signature _ l%+1>tte: Sum Tubs/shower/shower pan Urinal _ 7Phone Water closet_ Water heater State ZIPother: : Fax: E-mail: Tota NM all jurisdictions accept credit cards,please call jurisdictirm for more infor anonNotice: this permit application Minimum fee................$ ZLI_ Plan review(at — %) $ U Moa O MasterCard expires if a permit is not obtained -�- - Credit card number wi.sin I80 days after it has been State surcharge(8%)....$ - . 130 [:spires Name of ctudho der u shown no ere It card — accepted as complete. 'TOTAL .......................$ 14 3 Cardholder signature Amo,..: 440.4614(6KI OM) 'Armra PLUMBING PERIVU FEES: ---- PRICE TAL New 1-and 2-family dwellinq,--,only: 1 SFIXTURES Indivldual) _ QTY ea AMOUNT (includes all plumbing fixture In PRICE TOTAL ic — 16.60 the dwelling and the first100 fl. QTY (ea) AMOUNT 16.60 for each unlit connection Lavatory One 1 bath $249.20 Tub or Tub/Shower Comb. 16.60 Two 2 bath $356.00 _ — Three 3 hath $399.00 Shower Only 16.60 Water Closet 16.60 SUBTOTAL _ Urinal 16.60 8'/a STATE SURCHARGE Dishwasher — 16.60 PLAN REVIEW 25%OF SUBTOTAL _-_ TOTAL Garbage Disposal Laundry Tray 16.60 Washing Machine v 16.60 FloorDrainlFloorSink 2" 16.60 PLEASE COUIPLETE: g» 16.60 4» 16.60 ------- — — "--- Quantit b Work Performed_ Water Heater O conversion O Tike kind 16.60 Fixture Type: Now Moved Replaced Removed/ Gas piping requires a separate mechanical Capped ermit. - Sink MFG Home Now Water Service 46.40 46-0 Lavatory -- — MFG Home New San/Storm Sewer Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 18.60 Shower Only 1660 Water Closet — brinking Fountain Urinal — Other Fixtures(Specify) 16.60 Dishwasher Garbs a Dis osal Laundry Room-fray Washin Machine Floor Drain/Sink: 2" — ewer-1st 10055.00 3" 99wer-each additlonal 100' 46.40 4„ 55.00 Water Heater Water Service-1st 100' Other Fixtures Water Service-each additional 200' 46.40 (specify) Storm 8 Raln Drain 1st 100' 5500 Storm 8 Rein Drain-each additlonal 100' 4_6 40 — — Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Devine- 27.55 Catch Basin 16.30 Inspection of Existing Plumbing or Specially 62.50 COMMENTS REGARDING ABOVE: Re nested Ins actions _ or/hr Rein Drain,single family dwelling 65.25 __ ------ T 16.(i0 Grease Traps QUANTITY TGTAL Isometric at riser diagram Is required It Quanlit Total is _g `SUBTOTAL — 816 STATE SURCHARGE "PLAN REVIEW:5%OF SUBTOTAL Re E'-d only If nxtura qty total Is y U _ --� TOTALj_ S r `Minimum permit fee Is$72 5o.8%state surcharge,except Rvtdentlal Becknow Prevention Device.which la$38 25+s%state surcharge ..All New Commercial Buildings require 2 sets of plans with Isometric or riser diagre'n for plan review. is\dsts\forms\plm•fees.doc 12/26/01 11 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received Date Requested ^___AM— PM—_-- BUP Location _ — ��j�� k'Y'��+-�--�+ r MEC cl C? Contact Person __— ^ Phr oar '(1/ PLM Contractor Ph( ) --_ _ SNR _ BUILDING Tenant/Owner ELC Footing ELG Foundation Access: - Ftg Drain ELR — Crawl Drain - _- Slab Inspection Notes: SIT -- Post&Beam Shear Anchors -- -- - --- Ext Sheath/Shear _ Int Sheath/Shear - Framing - --- - -- - ---- -- - Insulation Drywall Nailing - ------ ------ _— __- Firewall Fire Sprinkler - ----- - -- -- - - - -_�_ Fire Alarm Susp'd Ceiling ------------ - -- -----_ Ro.-' Other: --- ----- ----- ------ --- F'inal ----- _PA3S PART _FAIL _PLUMBING Post 8 Beam - --- -- - ------------ -- — - Under Si.-ib _-- -- _.__- _---------_-_ _ Rough-In - - ---- ---------- Water Service Sanitary;ewer Rain Drains _-- Cstch Banin/Manhole Storm Drain - -- ----- - - -- ---- - -- - ShowerPan Other:_ --._---- --- - - - - - - Final *.__---- FAIL -- -- ------------ MECHANICA Pest&Beam ^- ------ _ ._------ ------------ ---- Rough-In - - - -- -- -- ---- - Gas Line Smoke Dampers ------- --- -_ - �Flf al S _PART FAIL — ------- ------ ----- __ECTPt�AL Service - ---- -- - - --- ---- -- - - -- Rough-In _ UO/Slab Low Voltage __--- Fire Ale•m - Final Reinspection fed of$___— _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL_ SITE _ [] Please call for reinspection RE: —_ L J Unable to inspect-no access Fire Supply line ADA Approach/Sidewalk Dr��--�-L Z----- Inspector _. Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24.-Hour BUILDING Inspection Line: (503)639•4175 r INSPECTION DIVISION Business Line: (5x73)639-4171 MST — BLIP l _ � R,aceived Date Requested / _ AM V- PM __ BUP Location Suites _ __ __ MEC _ Contact Person _ \ a-,,, I LX v szi Ph f—_-._) ��1 PLM CCS cc y Contractor , _ __. Ph SWR _ BUILDING Tenant/Owner _ ELC Footing 4 ELC Foundation Access: Fig Drain _7 L��r^ Z% ELR Crawl Drain _ - Slab I Ipection Notes: SIT - _- Post&Beam - - - - __ - -- —-- — - ---- Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - --- - _ Insulation Drywall Nailing — _ ----- - _- - -- Firewall Fire Sprinkler - — —. Fire Alarm Susp'd Ceiling - - Root ' - - - Other: Final -- - -- -- PASS PART FAIL PLUMBING -- Post& Beam Under Slab --- -_..---- - - - - --- - Rough-In Water Service - - - - - --_ - Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Show it Pan Other: rna aXAW�N_ICAL ART FAIL _ Post&_Beam Rough-In Gas Line Smoke Dampers Final PASS PART_ FAIL ELECTRICAL �_— Service Rough Ir UG/Slab - Low Voltage — Fire Alarm Final [] Reinspection fee of�_— required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd, PASS PART FAIL gjTE i Lj Please rail for reinspection RE: _ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date�_._ -�� _�` Inap®ctor Other: Final — DO NOT REMOVE this Inspections record from the job site. PASS PART FAIL