10975 SW MIRA COURT-1 13 VSIW ARS SLSOi
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10975 SW MIRA CT
/ \ �.D __ ELECTRICAL PERMIT
CITY OF TIGA
PERMIT#: ELC2004-00121
DEVELOPMENT SERVICES DATE ISSUED: 3/17/04
13125 SW Hall Blvd..Tigard.OR 97223 (503) 63S-4171 PARCEL: 2S103DA-06600
SITE ADDRESS: 10975 SW MIRA CT ZONING: R-4.5
SUBDIVIS:ON: MIRA PARK
BLOCK: LOT: 004 JURISDICTION: TIG
Project Description: Remodel Bathroom
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 409 - 600 amp: Si.3NAL/PANEL:
MANF HMI SVC/FDR: 601 -amps-1000 volts: MINOR LABEL (10):
_ SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVCIFDR>=225 AMPS: CLASS AREAISPEC OCC:
Owner: Contractor:
FRANK COLLETT HEBERLE ELECTRIC
10975 SW MIRA CT 7456 SW BASELINE RD#414
TIGARD,OR 97223 HILLSBORO,OR 9712.3
Phone: 503-620-7314 Phone: 503-628-2095
Reg#: SUP 3053S
LIC 132342
FEES ELF 34-160C
Description Date Amount Required Inspections
JFLPRMT]ELC Permit 3/17/04 $60.15
U TAX]S%State Surcharge 3/17/04 $4.61 Rough-in
F
Elect'l Final
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Gcdes 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 K work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center, Thosa rules are set
forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246-6699 or
1-800-332-2344.
Issued By: xl. _ Permit Signature
� T-
_ _ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
J_
m OWNER'S SIGNATURE: DATE:—
_J
ATE: _
.WJ CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: — __ DATE:
LICENSE NO: —
Call 639-4175 by 7:00pm for an Inspection the next business day
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city of Tigni'd plan l(rview ntln
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'Tigard,Oregon 97223 M I Vit-Revlaly l,ar,d Use —
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Fax: -se•Pate 1 fo—rplu)nr: 503.639-417f (snout
Intertict: www•ci.tigarduts Non)e -
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14-hour Inspection Requrrt; 503-6394175 Q
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air vica or futnl'l foe:Ci[bt�fannh circuit 6.63
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CITY OF T I G A R D PLUMBING PERMIT
(DEVELOPMENT SERVICES PERMIT#: PLM206 '-00109
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 DATE ISSUED: 3/17/04
SITE ADDRESS: 10975 SW MIRA CT PARCEL: 2S103DA-06600
SUBDIVISION: MIRA PARK ZONING: R-4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHI,"AG MACH: BACKFLOW rREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH 13ASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE. ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Bathroom remodel _
Owner: FEES —
Description Date Amount
FRANK COLLETT '-'—
'10975 SW MIRA CT [PLUMB]Permit Fee 3/17/04 $72.50
TIGARD, OR 97223 [TAX 1 9%)State Surchar► 3/17/04 $5.80
Total $76.30
Phone : 503-620-7314
Contractor:
GEORGE DAVIDSON CONSTRUCTION
2265 NW 113TH AVENUE
PORTLAND, OR 97229 REQUIRED INSPECTIONS
Phone : 503-641-2771 Rough-in Insp
Top-outlnsp
Reg#: LIC 136682 Final Inspection
PLM 34-357PB
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oJ—o This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
ca 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 '80 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law require., you to follow rules adopted by the Oregon
Issued By: Permittee Signature: �tSOR.G,� z
Call (50 6)639-41.'5 by 7:00 P.M.for an Inspection needed the next business day
1►.
Building Fixtures
Plumbing Permit Aipfaf&FIVED
City of Tigard Roc permit mit No
Doc
1317.5 SW Ilall Blvd.,Tigard,C'2 97223 MAR 17 2004 plan Review
Phone: 503 639 4171 Fax: 503.598.1960 Date/By Other Permit No.e&A'v
24-Hour lnspcctiot.Line: 503.639.4175 CITY OF TiUA Date Ready/By taf° ® See Page 2 for
kw%, k Internet: wwwci.tigard.or.us V LDING n)V1 1 Notined/Method Supplemental Information
N OV
�y
New construct a + 11 a[D ,; , ..s_ -_�.:k; �' j ,. .,,
[] ion �] en.clition For1a!information use checklist
-- Description Qty IE�_ Total
Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 P for each utility connection)
SFR(1)bath 249.20
I- and 2 family ,
y dwelling` C]Commercial/industrial SFR(2)bath 350.00
Accessory building SFR(3)bath - J99.00
❑Multi-family
--- Each additional bath/kitchen 45,00
❑Master builder ❑Other; Fire sprinkler(__sq.ft.) Page 2
Site utilities
Job site address: It T - Catch basin or arca drain _ 16,60
City/State/ZIP: "T t(1OQ D 2 2 Dtywell,leach line,or trench drain 16.60
5uite/bidg./apt.no.: Project name: /s� �(� Footing drain(no,lin_ar ft.:_� Page 2
— tt�i�u -- Manufactured home utilities 11000
Cross street/directions to job site: _ Manholes 16.60
MI1 /d eT _ Rain drain connector_ 16.60
Sanitary sewer(no linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Wster service(no linear ft.:_� Page 2
Subdivision: Lot no.:
Fixture or Item _
Tax map/parcel no Absorption valve 16,60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 1660
- _—_ Dishwasher --- 16.60
Drinking fountain 16.60
t Ejectors/sump 16.60
Name: /�j�,ON�I -� 1'r. Expansion tank -_ 16.60
Addt,-ss: �L. tm►(,� (r Fixture/sewer cap 16.60
City/State/ZIP: F'nordrain/floor sink/hub 16.60
Phone:( ) Fes;( Garbage disposal _-16!60
c ry Hose bib - t 5.60
Ice maker
1660
Business name: 1"` OAS//Imod &KV7'0f7'AV i << Interceptor/grease trap 16.60
Contact name:Grp{t(� Medical gas(value:S ) Page 2
n'
Address:71,J1 r♦
"Pi � '7j � Primer 16.60
�
F City/State/ZIP: f,/"�'� Zo DE r 7 2 t Roof drain(commercial) 16.60
N
, ) 3 Sink/basirt/lav—atory -
1660
PQ Fax::�'3)� Tub/showe/hower pan 16.60
&.Phone:c ►-
i
E-mail: Urinal 16.60
F' .
Water closet 16.60
CONTRACTOR
W Business name: r u��;" �41vN GAN "ater heater 1F.60
Address: 77 AN,W & T� _ Other: _
Subtotal
City/State/ZIP: Pf�" Z Minimum permit fee. $72.50
Phone:( ) 64�� 6// Fax:( ) ;Q _ Residential bacl.flow minimum permit fee: $36.25
CCB Lic.: ( Plumbing Lic.no.: IO Pr7 - _ Plan review (25"/0 of permit fee)
State surcharge(8"/"of permit fee) 5,
Authorized si re: TOTAL PERMIT FEE ,
Print name: 4,, Date ft ® This permit application expires if a permit Is not obtained wit n
180 days after it has been eceepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
i lBuilding\PemiitnTLMF.Pemm tApp doc 12.103 440-4616T(10/02/COMMEB)
I '
Plumbing Permit Application - City of Tigard
Page 2 -Supplemell.tal Information
Fee Schedule: Residential Fire Suppression Systems: _
Footing drain-1 100'\ 55.00 0 to 2,000 1 $115.09
Fcoting drain-each additio 100' 46.40 2,001 to 3,600 16000 _
Sewer-I st 100' 55.00 3,601 to 7,200 5220.007101 end eater _$309.00
Sewer-each additional 100' 46.40
Water Service-1st I00' 55.00 edical Gas Systems:
Water Servicc-each additional 100' 46.40
Storm&Rain Thain-Ist 100' 55.00
$1100 to S5.000-00 Minimum fee 572.50
Storm&Rain Drain-each additional 100' 46.40 - S ,001 00 to 510,000.00 1 $72.50 far the first 55,000.00 and$1.52 for each
f ; a + q additional$100.00 or fraction thereof,to and
$+ .3Y
including S10,000.00.
Commercial Back How Prevention Device 46.40 Win%25,0 00 $148.50 for he first 510,000.00 and$I 54 for
Residential Backflow Prevention Device each additional 5100.00 or fraction thereof,to
minimum permit f r 53615) 2 55 and including 525,000.00.
Rain Drain,single family dwelling 65. 25,001.00 to$50,000.00 5379.50 for the first$15,000.00 and$1 45 for
Inspection of existing plumbing or
' each additional S 100.00 or fraction thereof,to
specially requested ins ections-per hour 72.50 and including 550,000.00.
Subtotd: $50,001.00 end up $742.00 for the first 550,000.00 and$1 20 for
each additional$100.00 or fraction thereof
Fixture Work:
Are you capping, uneving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
\C-ommeregarding fixture work:
Ba tis /Font _
Bath -Tub/Shower --
-lacuzzi/Whirl ool _
Car Wash -Each Stall
-Drive Thru ---
Cuspidor/Water Aspirator — —
Dishwasher -Commercial _
-Domestic _ — -
Drinking Fountain
Eye Wash
Floor Drain/sink 2"
4"
IL Car Wash Drain
Garbage -Domestic
Disposal -commercial *Note: If the fixture work undo this permit results in an
�
-industrial
Ice Mach./Refri .Drains increase of sewer F.DUs,a sewer rmit will be issued and
Oils arator Gas Station fees assessed for the sewer increas ust be paid before the
J Rer. chicle Du station _ plumbing permit can be issued.
Shower -Gang
Ul -Stall -_
•.,,,t Sink -Bar/Lavatory Qf tity Total
-Cradle} Isemetric or riser diagram is required if xture quantity
-Commercial g q q Y
-Service total is>9.
Swimming Pool Filter
Washer-Clothes
Water Extractor _ Plan Review
Water Closet-Toilet _ Plan review is required if fixture quantity total is>9.
Urinal _ _ —
Other Fixtures:
i.1HwIdinaTemiuTI.M-Pmmit App dm 3/01
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
OUP -___—.—
Received _Date Requested_`__-�_, -E ���� AM .PM BUP _
Location Suite —_ MEC
Contact Person .__ Ph(_ 0-) ) -moi� —_ do
Contractor. _—_— _- __ Ph( g 19 SWR
BUILDING Tenant/Owner
Footing SLC
Foundation Access: ,
Ftg Drain �/j/�ti, ELR
Crawl Drain
Slab Inspection Notes: Ar SIT - -----
Post&Beam
Shear Anchors --
Ext Sheath/Shear �_-
Int Sheath/Shear
Framing --- - ------- -^_r.-- ----
Insulation
Drywall Nailing
Firewall
Fire Sprinkler - - - - - -- -
Fire Alarm
Susp'd Ceiling ---
Roof
Other: -
Final
_PASS T_FAIL
Post&Beam
Under Slab -- 0 --�-- --- --
Water Service •----
Sanitary Sewer
Rain Drains - - -- -- --
Catch Basin/Manhole
Stora, "rain —
Shower Pan
PASS PART FAIL - - —-
MECHANICAL_
Post&Beam -
Rough-In - -- -- - - --- -- -
4. Gas Line
Smoke Damper. ----- - --- -
Final
} PA T FAIL
=j / Serv,ca t - ---- --- -
m Rough-In
W
� UG/Slab -_.._-. — --------- ---_- -- -
1 J Low Voltage
Fid Alarm
S T FAIL
.pectior,fee of$ _ rerauired before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_
SITE _-- 0 Pie se-all.for reinspection RE: -_ -_ Unable to inspect-no-access
Fire Supply Line
ADA
Approach/Sidewalk DOU -___ Inspoctar
Other:
Final DO NOT DE OVE this Impaction record fro the)* she.
PASS PART FAIL