11400 SW LAUREL GLEN COURT 0
0
cn
c
1
YI
n
0
c
1 ,
i
11400 SW Laurel Glen Court
CITY OF TIGARD 24-Hour
BUILDING Ir sPection Line: (503)639-4175 MST'_1.016.5 O-Z-51/3 c')
INSPECTION DIVISION Easiness Line. (503)C39-4171
?W /,- ' /r I'/� i BUP _
Received ___— . Date Requested. -�U '�`�AMPM ___ BUP
Location MEC _
Contact Person - _ ��- �' Ph(—) 2! � P'-M - —
Contractor _ -_ _-_ Ph( ) SWR
BUILDING - Q Tenant/O-Nier _ ELC
Footing
Foundation - ELC
Arcess: - - .
Ftg Drain �� ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear ,
Framing u � ►� "t/>,:
al
Drywall ivycSJ L�, C�1c(.,4 L /-r..!/jC_ . l EL /t T c •vc5i� O
Drywalll Nailing - -�---.-�---��
Firewall
Fire Sprinkler E�C7 (�C" e.tA L PO - O— -_ - A, ---
Fire Alarm
Susp'd Ceiliny ---- -
Roof
--------------------
I=inal
BING _
Post& Beam
Under Slab
Rough-In — - - --- --- _ --
Water Service ----_._-- --------_--___-- -- _-- _ __--
Sanitary Sower
Rain Drains
Catch Basin/Manhole
Storm Drain --- ----- -- - - ----- - ---
Shower Pan
Other: -----.___--
Final -
PA.%S--"AT-, FAIL
Post& Beam
Rough-In - ---- - -- --
Gas Line ------ -- ---------
Sm a Dampers -- ----- - --- ---- — --in
gS ) PART FAIL - - --- - -- -- - -
CTRICAL
Service ---- -- - -- --------_—__._ __ _-
Rough-In
UG/Slab ---_
Low Voltage
Fire Alarm
Final Reinspection fee of g required before Mt inspection. Pay at City Hall, 13126 SW Hall Blvd.
_PASS PART_ FAIL
SITE Please call for rc in�.pection FlE.___ _- Unable to inspect-r access
Fire Supply Line
AD.A
Approach/Sidewalk Date S_. Z G" d 4'- InsPactor-.__: - _ Ext
Other,
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
:AAAAAAIAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
w r ►4 �ti o
t � y b �� �
'4I No.
4 C7 •`!, ►
t `� ►.
11� ►
t �� ►
4 V
j
. f, � ►
C�
4 d ►
•4 ( ►
1 ?� ►
44
ITJ ►
. 7 r * ►
. R ` A ►
44
( cra ►
� ] • ' loo-
CD 1 � ►
�I O ►
.44
G
. mayI I Poo.
• `-4 ~+ ►
0 4
j (A � � ISI ►
44
►
�FTYVV VVVTVVVVTVVVTVVvvvvsvivvvvvvvvvvvvvvvv,�
7
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 sT�� ��/ �
INSPECTION DIVISION Business Line: (503)639-4171 BUP
Reserved ---_Date Request d____ AM__�._—_. PM __— BUP
Location
suit(
--- --- MEC --- ----
Contact F arson _-- _— ��-..---- ----- Ph ( f PLM
Contractor --
Ph (-- ) - SWR .
Contractor ,_--—_�_ __ ----- ---
BUILDING� TenanUowner _ _ ------_.--- — -- ELC __------_---
Footing ------�— ELC
Foundation I Acc-Gs:
Ftg Drain 9 ELR °--
Crawl Drain
Siab Inspection Notes: SIT
Post& Beam
Shear Anchors - - - - —
Ext Sheath/Shear - -
Int Sheat:/Shear
Framing - - --- -- - --- --
Insulation
Drywall Nailing - -- - - -- -.._. ---- ---- --- - - --
Firewall
Fire Sprinkler r --- --- -- - --- -- ---_- ---- - ----�___.—.—
Fire Alarm
Susp'd Ceiling - --
Roof
Other- -------
Final
PASS PART FAIL
- --
Post& Beam �—
Under Slab - - -- - - - --
Rough-In
Water Service —
Sanitary Sewer
Rain Drains - - --- --- -__
Catch Basin/Manhol
Storm Drain _- -- - - --
Shower Pan -
Other: --- - - -
Final
PASS PART FAIL
MECHANICAL - -_ - -
Post& Boam --
Rough-In - -
Gas Line
Smoke Dampers - -
Final
PASS PART FAIL - - -- --- - -
ELECTRICAL
- - --- - _...--------._-_--- ---
Service
Rough-In
UG/Slab
Low Voltage -- - ----- -.... .. --- ------- -IF e
L] Reinspe,tion fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
PART FAIL�—� 1-1 Please call for reinspection RE:_—__ _--__—^_ -_—_ Unable to inspect-no access
Fi-e Supply Line q ,
1 Q�J�.fJ`I(
-- _ . Ext -
Approach/Sidewalk Datfa - 1.�1 `� 0 � - Inspector ��` ' --- -`/- J�
Other-
F!,-al
therFinal DO NOT REMOVE this Inspection record from the job site.
PA SS PART FAIL
CITY 4F TICARD 24-Hour
BUILDING Inspection Line: (503)639-4175MST �-/)O00
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received __- Date Requested_ "� �_AM - __ PM ________ BUP
Location �f 7LOO G���- C"�r Suite MEC --- --
Coltact Person _ __ i�= _.__ Ph(—) 3 ��� PL1,A
SWA ----- --- -
3UILDING Tenant/Owner -_ ELC
Footing ------------ ELC
Foundation Access: •!�� �—
Drain 1- r` 76- ELR
Cr
Crawl Drain /��-
Slab Inspection Notes: SIT
Post&Beam ------ - - _" - ---- ---- ---
Shear Anchors - ----- ---
Ext Sheath/Sha�r _ _
Int Sheath/Shear yw •�1 /�.� N�� � __ IRtO� — uW.---
Framing - ----- --- -- ------ —
Insulation
Drywall Nailing ---- -- -- - - _,--- - ----- -----------
Firewall
Fire Sprinkler - . _ - --- -- - - - — ---- ------ - - -
Fire Alarm
Susp'd Ceiling -t1
Roof E �.Tr,G.�T CL! 1`Y 0 4 O vim.
Other:
Final
PASS PART FAIL
T.-till[� ►r11 NEXt- L-A6L . ��? - .
`r
Uider Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin i Manhole
Stern,Drain - _.— -------------- -______..
Shower Pan
Other: ---- - ----__
fA_JS 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
ina Reinspection fee of$ iequireO before nem inspection. Pay at City Hall, 13125 SW Hall Blvd
`PAS PART AIL
SITE —i_ Please call for reinspection RE: Unabie to inspect-no accPs3
Fire Supply Line
ADA
Approach/Sidewalk Dater ` ` U .�_ Inspe for _ .vel] t ____Ext
I Other
Final DE, NOT REMOVE this Inspection record ►:om thf Job site.
PASS PART FAIL
ASTER
ERMIT
/A CITY OF TIGARD - PERMIT
MSI2
/ \ PERMIT#: MS1'20U3-OU130
DEVELOPMENT SERVICES DATE ISSUED: 5/7/03
13125 SW Hall Blvd.; Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11400 SW LAUREL_ GLEN CT PARCEL: 2S110AC-01800
SUBDIVISION: LAUREL GLEN ZONING: R-4.�
BLOCK: LOT: 001 JURISDICTION: TIC
REMARKS: Const. new SF detached •'_I;�nr�,
✓ BUILDING
REISSUE CUSTOM aTORIE5. FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT. '4 FIRS': 1,288 of BASEMENT: of LEFT: SMOKE DETECTORS: v
TYPE OF USE: SF FLOOR LOAD. n' SECOND: 1,391 of GARAGE: 825 of FRONT 10 PACKING SPACES
TYPE OF CONST: 51`1 DWELLING UNITS THRU of RIGHT: 16
OCCUPA,NCYGRP: R3 RDRM. 3 9VALUE: 487,142.70
ATH TOTAL: 2,879 of REAR.
PLUMBING _— -
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS I RAIN DRAIN: 1130 TRAPS:
LAVATORIES: 5 DISHWASHERS 1 FLOOR DFAINS: SEWER LINES: 100 SF RAIN DRAI'IS: 1 CATCH BASINS:
7URIShOWERS: J GARBAGE DISP: I WATER HEAT 3RS. 1 WATER LINES: 1C0 BCKFI'.'.rw-.VNTR: GREASE TRAPS:
OTHER 9xTURES:
MECHANICAL
FUEL TYPES FURi'<100K: BOILICMP<3HP VENT FANS: 1 CLOTHES DRYER: I
t;A S FURN>•100K. 1 UNIT HEATERS HOODS: I OTHER UNI-3: I
MAX INP: btu FLOOR FURNA'4CES. VENTS. I WOODSTOVES: GAS OUTLETS. 4
ELECTRICAL _
RESIDENTIAL.UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS _MISCELLANEOUS_. ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 -200 amp: n - 700 amp '"/SVC OR FD PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF201 400 arnp: 201 - 4n0 amp 1st WIO SVC/F DR-. SIGNOUT LIN LT. PER HOUR:
LIMITEn ENERGY 401 800 omp: 401 - 500 arnp EAADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HMISVCIFDR. 801 1000 alp: 001 ramps-1 Ol1Ov MINOR LABEL
1000+amplvolt
PLAN REVIEW SECTION
Rocomuct only:
>=4 RES UNITS SVCIFDR>=225 A. >000 V NOMINAL* CLS AREA/SPC OCC:
_ ELECTRICAL•RESTRICTED ENERGY
RESIDENTIAL _ B,COMMERCIAL
AVL 10 8 STEREO. VACUUM SYSTEM: AUDIO A STEREO: FIRE At.ARM: INTERCOMIPAGING. OUTROr .<LNDSC LT:
BURG,AR ALARM. OTH: BOILER HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION, MEDICAL: OTHR:
H'AC DATA/TELE COMM: NURSE CALLS: TOTAL-0 SYSTEMS:
Owner: Contractor: TOTAL '.EES• $ 7,832.56
ALPENGLUW HOME , ALPENGLOW HOMES This permit Is sul• act to the regulations contained in the
Tigard Municipal Code,State of OR. Specialty Codes and
5620 SW KELLY AVE. 5620 SW KELLY AVE. all other applicaole laws. All work will be done in
PORTLAND,OR 97201 accordance with app.oved plans. This pf'rmit will expire If
work is not started within 180 days of issuance,or If the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adupted by the
P"one: 503-79.1-38.,6 P"pno: 503-245-7720 Oregon Utility Notification Center. Those rules are set
forth in Of 2 952-Of 1-0010 through 952.001-0080. You
Rep N: LIC 111912 may obtain copies of these rules or dire;t questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Mechanica Electrical Service Low Voltage Roof Nailing Electrical Final
Sewer Inspection Underfloor insulation Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Footing Insr Crawl Dre.in/Backwater Framing Insp Gas Firepla;a Water Line Insp f3lurnb Final
Foundation Insp Mechanical Insp Shear Wall Insp Insulation losp WLter Service Insp Building Final
Post/Beam Structural Plumb Top Out Exterior Sheathing Ins[ Rain drain Insp Appr/Sdwlk Insp
Issued By: � cti r_.2� Permittee Signature : -
Call (503)639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES
PERMIT#: 5/7/03SWR2300104
�� ''t'il 639-4171 DATE ISSUED: 517/03
13125 SW Hall Blvd., Tigard, O.. 97223 (..•
PARCEL: 2S1 1 OAC-01 800
SITE ADDRESS; 11400 . +V LAUREL_ GLEN CT
SUBDIVISION: LAURcI_GLEN ZONING: R-a.5
BLOCK: LOT: tNil JURISDICTION: 'I[(I
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL T)'PE: L 1 r SWR IMPERV SURFACE:
Remarks: Sewer connection for new detached.
Owner: �—_ _ FEE_S _
ALPENGI.OW HOMES Description Date Amount
5620 SW KELLY AVE. —
PORTLAND,OR 97201 jSWUSAI Swr Connect 5/7/03 $2,300.00
1'4\VUSAJ SwrCot..iect 5/7/03 $0.00
Phone: S03-793-3866 ISWINSP) Swr Inspect 5/7/03 $35.00
ItiWINSPj Swr Inspect 5/7/03 $0.00
Contractor. _ _ Total $2,335.00
Phone:
Rr!g#:
Required Irspections _
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. Tne 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 installer shall prospect
3 feet in all directions from the distance given. If net so located, the installer shall purchase a"Tap and Side Sewer" Perm
Issued by: ,�,. % :4: Permittee Signature:
1a _
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
tt�
FOR OFFICE USE ONI'N'
Building Permit Applieajloll D Received Burldir.g
Q f)ate/H : '� Permit Not)eo�Ay3 -LQ
It ' of Tigard(� Planning Appro\ Other
Date/li Permit N .�� 03 - y/
13125 SW Hall Blvd. APR 2 Plan Review Other
Tigard,Oregon 972: , Date'B : V T:ff�3 Permit No.:
Phone: 503-639-4171 Fax: 503-5111xM460( 1 I' Post-Review Land Use
Contact
Internet: www.ci.tigard.or.us SUI1_DIN" C : — Case No. \
g Contact Juris.: See Page 2 for n
24-hour Inspection Request: 503-630-4175 Name/Method: — supplemental Information uJ
TYPE OF WORK _—_ REQUIRED DATA:
New construction Demolition— I&2 FAMILY DWELLING
❑ Addition/alteration/replacement Other:
CATEGORY OF CONSTRUCTION _ Note: Permit fees*are based on the total value of the work performed. Indicate
1 &2-Family dwellin L1 Commercial/Industrial the vale(rounded to the nearest dollar)of all equipment,materials,lahgn,
— overhead and profit for the work indicated on this application. (-r
El Accessory Buildin 11 Multi-Family
❑ Master Builder _ Other: Valuation...................................................�, $_ -
3011 SITE INFOP'li1AT10N and LOCATION No.of bedrooms �� No,of baths:,�_k
_ -----
Total number of floors.......................
Job site address: J uU V �W !a•(.rel_ (� s►� _ e'.a.... -- —-
-L-`1-- ----- New dwelling area(sq. ft.)....�a't.. .
Suite#: Bld,/,A t.#: Garage/carport area(sq.ft.).,...� U............
Project Name: Covered porch area(sq. ft.)..... `.?............
Cross stt'eep
Deck area(sq. ft.)........ ..................................
trecttons to Job site: father structure area(sq.ft.)
............................ -- ----
1+�,Kn� G�leh C4.
REQUIRED DATA:
_ COMMERCIAL-USE CHECKLIST
Subdivision: IA,4,tl 64..E Lot#_
Tax map/parcel #: /f •4' < r f'oc) Note: Permit fees*are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value(rounded to the nearest dollar)ol'all equipment,materials,labor,
--- - — overhead k nd profit for the work indicated on this application
Valuation............................................. ..........
- - ------. _----------W Existing Buildin^area(sq.ft.).........................
--- --- ------- — — New building area(sq. ft.)...............................
_ Number of stories...................... .....................
PROPERTY OWNER 1 T::NANT Type ol'constructIUn........
Name: 1}1oatn uJ �Q�1)/� Occupancy group(s): ExistNewing -�--_-
Address: — _ G�� 5� -ell —
Cit /State/ZiE. _ 4 0 ii.- 1 7 7,3
Phone: 713-381(' Fax: ., 774 NOTICE: All contractors and subcontractors are required to be
APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Namc: - & X JpvjJ#L'#.' I4O nve jurisdiction where work is being performed. If the applicant is exempt
Contact Name:---_T—T,-C W from licensing,the following reason applies:
Address: - ---- -_
City/state/Zip: --3�+�-E----- — ---- -- - -- -- ------------
Phone: FI3ll�l-- Fax_ Lys_ 7763_ ---- - - ---
- I3UIIAINC;PERMIT FEF,5*
_.E-mail: - _ Plcase refer to fee schedule.
_
CONTRACTOR -----
Business Name: wtFees due upon application............................ g
Address:
City/State/Zip: Amount received............................................
Phone: — Fax —� Date received:—
CCB Lic. #: -- °13 L �_r^ - - -- -- -
Authorized Notice: 1 hie Permit applicallon espires if n permil is nut obtained ssilhio
Signature Si ( - L y�z"�
B Date: � Ixtl dn\s eller It ha. been accepted ac canydrle.
if *Pee melhudoioa; et by I ri-(411111(} Building;I11duslry Sersire Board
(Please print name)
is\bsts\Permit Fonns\nldgPermitApp.doc 01/03
i
Commercial Plan. Submittal
Requirement Matrix
City of Tigard
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building
Fire Protection System k*
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
Plan review is dependent upon submittal of a completed application ane', plans. After
t.;an review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor. City of Ti7ard,
Washington County, and Tualatin Valley Fire & Rescue). V
*For over-the-counter commercial tenant improvements, submit 2 sets of plans.
**"New" fire protection systems require that plans bear the r)riginal seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i\dsts\forms\C0M-mat0x.doc 9124/01
flpr 02 03 06: 37a Matt Weber 503 620 G019 P. 1
Werhesday,April 02 2003 6 33 AM Boo McCurdy(503)245-7765 p 01
Electiric.9l Permit Application Rrcr� Electricil
— �1�.� _�_ Pr!rrtot Nc.��•II��,r1TY3L. Cy))-70
PlanningApptovel —
city or Tigard 1�tdBy --- - PenmI No
13125 SW Hat!Rlvd Piun Bev err Other
I igard,Orr.Lon !7223 �QeccrHrf_, Ptrrnrt No _---._-_----
Phone 503-639 4171 Fav SUS-S9a-19(7U pose-Ne+new - Can
LIM;:
ms_ _ Gu No,
lnlcmet- wA.%%,cr trgerd.or.f7s r•Pry 2 for
24 firm inspection Request. 503 635 4171 /Merhod ---_J Sup I�emmt,l lnMrTNion.
L_ Sr 225 t nf-vlC
W aAe eled— - enf wok New construction Dcvq):ttun teal aTHPly�- -
-
Heahhaere 4utiry
--- cntnrtletc al ❑Nvardouf Incanon
1 ' alleratOnf t8Ce1TCnI ULl1CC _ _ q owi 770 arrp,ry ric of C�Building uvt+IQOIIo square ket.
Add race/ _��7
-,S•CA Y (jQ(S Tj�^'�'�(jt�1v- - _- I 1&2 Umly d,K-R;npt four m more reudrniml tn,ts to
] &2 Fattll dwelling CurnmercialRndushtal CJ Syuern ow,67,"1 vona rinTtnal nm rnurrue
._.___ ---- r,]BuOd-ns ow, 'ser stairs ❑Feeders.400 amp,or mote
ACCtssm BW1dUlg M l]r'F'MTr� l.3 occupr r w4i ov.r a pertont (]Manufuuned structure%nr RV park
_
Master Bullder _ Othcr-� D Ferasr'trhtnte pint U ober:_ --
{r, JbB 501 F.INEJRIYIA land Af in" " Suhw,tl -__aI a(plae% vMh any erlha acre.
Tk a e,rwY a are net a r;cehk t0 teTYnrarT cdrralruetloat amrc_ y_
Job site addre is I DO �W LtK�I - -- - l --
Suite M: 8�_-Apt*-, - _..__ _ _�_Namlxi of ice e-__ r errrlN allswe
Desciptas Fe lea-I .N.•1�
Pru CC 1tifle: - — ryt,,rtfiAeerlal-sleek yr TrW-belly par �_
Dolls&fteVDv=1miojoh site: dwrltlat aau.lecledt%an,ttndtww-
Srnkt leekrde --
100(%% 11 ,r lett t '4
Each jt1dw^ou S22 lj,_11V09 parties tboteor _ ).
-- �m,ft�aoer�,vmidaMgl 75.00 •,�
Su11dIVI51on: t_a_�•tYIL_ r1 �' ► !I'•Jtt : -l.fmnedeneto•Tft
'fax map//7a rce)�l v e T.nurrnutA vers a ar feudal,% ve
•�- :Alt.SCRIr'h'IU�I•.OIF:I'14dRK_ +a1�6!�:_. ,:i'_- , srr.ne andlot(cede _ _ _ 10-
-------- - Strvkaorhtdm in.•a1LIMe.
alkraMoe ar relscuron•
— — - _.J..�-- _.------ 700�e ur lef•__ _,___ 10.70
701 J00 tetye 105.
nn� f1i0AO
wl aTfe to A00 ctrl_-Lf_—�• .—
,r Il 'R. 7' - r t:1.�.:_.••1 AdamIo1100a _ 'K0.
(tvur IOIOimp-mvoh-_ 474Af
Nffil0� 0 an/ I wl�s _ Rewnne_xt o r�_�_ f4 85
Ttmporsr7 aerv,crt sr feedtn-Issttdletlee,
Address:
eN reBoe,0 relaratio"
City/StetelZi _. Q ?� '-� :�, nrk%
l
Phone 711- Fax: 1I.--_ .S al N:
'r,)17,7�/U�;�—,f:!� N Nreec►tiscakt•eea.rnaralhn.or
Name: ralenrlan per penal:
A Fee Kx tfran;h oreutta w h purehue 3J
Addresservi
cca of fiehi Tree_ rh Manc"
Mil cun_ A 6s
(✓1ty�lA1C/ZiQ: W B.Fac for I,S ,A&,,a.,, ist purekw or _
tervice -
or leader ht,r9!!brancircult 46.eS
Phone: rax: _ avitoNtb.nt►ercuit 6.65
---.1 (sha(Sewire a feeder nm tfc:irdr�'
E ti r, hot of n�allancirtle }1s.10
r; '4 hamar Aline b f]A
Sub A10: Signal chcuills)or a IbnOed !r f�
aller2
Business None: .�( ,G eTerL__ -- =L
AddreS a Vaal 1p, !dote ova the easwehk u a • the e0eae:
�City/State/Zip To tIl Q-__7
Phone -j1 11stLp_ F'•x� -b
CC13 Lit:.A�h� __-An-q,��s� 4�t:,r r•
Supervising electrrco,a�rl __Sulitotal S
pawre requirt�: ___•_ Plan Revkw1tlli of Pemrn Fee ~h- _
Print Name 1 'C� i — Stwte Surchu a 115 of Perenll Fee S
Llc M - - -{------LF
>N - 1�� _TOTAL PERMIT FEE S
Aulhomr-ed Nat.rr: 7811 permit opplka at eapire%K it wfn1,sot nbulard ivithle
Si .lure _ Dow'�-- 190 rrava anet-It bea lsere acceplyd as Complete.
-------- - - - _---- _- aF.,,n,•thod3lupv ert by Tri-Coenty 115n0"Inducart Servlet Board
.. - IPleate pant name)
t Uktr%]'ernat Fortm%mPemulAtfp dnt: 01703
r
Apr 02 03 09: 49a PLU. cnN. INC. (5031658-5232 P. 1
Rpr 02 03 19: 29a Bob Mccurdto 1503)P45-77G5
P. )
Building Fixture!,
PlumhinyPermit A pplication Rett,vrd �
- Mambme
Kumasi MMM
DudDY_ rr,,,n�Nw..:�,�,`�8dJ3-Ql1L•'•1
City of Tigard PlavAtir A(gtnnal - Starr
)stem
131?S%w Hall Blvd, p ---
- Permit Nv
- --
llgard•Oregon 97223 Ua-d L-
Phone ',01-639.1171 Fax: 543 598-1960 Ptnt•Rcv t% Ia,M Use - �-
Interna www ci ugard.or us Datels _ - Case No _
)arta Ser tape 2 for
24 haat Ilnptcltun P-quest )UJ 63Y-41!) Na
lonuci Eflhotl Su Iemeaid infdrwethn,
YPE UF'WORK -- _ RIE`WHEDULE(foryedal information we tbeeN11s1l-
New construction - Demolition Dascriptiun Qfy.14".) Ta1a1
Add MoNallerauon/replacemenl Qlhet I - New I.d;1-farally dvrtrusat
_�AjECORY OF CONV IX.'TIO�— taclula te6 A.Ar cath aidity ceaaecgm
I &2-Family dwelling m ercialMdustnal srR 1 bath ldy 70
- SrR2 bathJ��
I
Mon
Accessary Building _ Multi-familyL -- ----
SFR 3 hrlh_ !Yy 00
Manter Builder ether, - F.ach atldmo I balWkdclten -� 4500
JO/ TE INFORMATION aad LOCATION Fire nnkler• .A
-. _ _ _-- .�.__ ?9 _.. _ _-
Job site addreaa 1�ypC Jt,� LA44 y� Ste.ueulslee
Bld / t.N Cahh buln/ara drain Ifi 60
-�-y �'- br IUkath Nne/ttenc',drain 16 60
r_g5ct Name `Ru✓ ! �eK-�11� Ftwun tinm m tr a ei i, e 2 +�
Cross streeK)irechons to job S,tc. Fto unit herrn tear i) I It,00 -
'S.tt.�t� ••, 91 � 62,'5 k�- off IJtd i 1 l'Al . Manholes
�5��' e. 11q tr-4 e.n Lart/er/ew, �, Run dnitieannenor
L�
_ I Saniur sy fMHf(no imca A► Pae 2
Subdivision: fir, _ `- ,- �p(# Stam sewer(no.linear 0.) Pat';
f 1 vt red,_M _T Wali smv,ce(no linear R.) t e 2 I
DESCpIrTION 0 WORK,--_ Fltture or Itepi
Aha+ ,on valve __ 10 60
Backllowpmvenlet _- Page 2
-- -- - ----.1 FJackweret Valu 1660
Clothes washer 16.60
Ihahwash" 16.60_
— - DrinkkM fountain 1660
PROPERTY OWNEk_ T$IVAN 1 Arctwww�. 16 60
Name_ /�4 Uponson lank
Addroet S`to f , 1�• tie F1xwrNsewerwn _. — - 16.60 -
ri /Stale/Zip pl ) 7 95i" Floor dram.'tinot vnk/hub 16.60 _---
Ti t - - .--94�- - �� Garbage disposal _ 1660
Phone: 7 4G. -- Fax.L45-17LS Huse bib 16.60 --
PPLICANT^ ON•M(;T PFRS_UIV
lfuerceplonfncase tray 16.60
Address: /05 Sw -7/7/t,4�{
r_ . Mrt1Ka) value s __ P:a 2
tall /$tatC/Zi C/� . Z.2 �- Primer . 16.60
_ � ._L_ _ _ .. S Roof drain(commercial)
nk/b
__ Fax: Zt Y$='l7ti S. StJwloavatory -_ 16- l
E-mail. dao�,r w c Ler. .cow%^ I ubkhowe'rshowespan�--- 10 60 --
CON•t 4CMR _ - urinal 1660
Susines3 Namc: l ,tr water CI09el _ .- 16,60
,,�,;-.y-_.�trri+"s.-?x . —� Witte,h -- — 0
addf�: �o aax /Ori— tither ealer 166- —City/Stale/Zip _—
Phoete lbj-& 6t s 31
Rt
F'hriblptPernUtFe".
Sublotal S
CC9 Lit. +tl: f?j ��_ ,Plumh Lic# �gap(j M nmtum Pcrtrlil Fee 57210 s - --`-
AutlWnred_ Mir Rea,dential Natkllow Minotxrm Fee S36)S
ftn�F• --�-"~�• — _ Ytat,Renew(:51:of('Crows Fec) F
!_"2 zvemad ---_ -- Slate Sulite_rehar a of Penral K S -`
Pitste-Mtm ttane) TOTAL PERMIT
MM". TAU permi,applltMtos"Arse its permit it aM tiWalmd arwis AN nrw restmerekl balldirmo require 2 wit of plan.wilb Ps"rk at
Ih Nrt after it Mt boos40W of tompkttr ;1tt,dtatr"for plan It,,,or,
*tee methoddeey col hr Tri•Coutov Ni lidisa IodetNry st"We award.
V)ttstPt-tnilFmm�Wlmt::nsiApp,kK nUnl
Mechanical Permit Application Received Mechanical`
Date/By. _ Permit No.:l/���
City of Tigard ai:Approval Building
DPlanning
ate/e/B Permit No.:
13125 SW Hall Blvd Plan Review Other
'Tigard,Oregon 97223 Datc/By: Pemut No.
Phow: 503-639-4171 Fax: •503-598-1960 Post-Review land Use
'''' Date/9y: Case No.:
interaet: www.ei•tigard.or.us Contw t Juris.: See Page.,for
24-hour Inspection Request: 503-639-4175 Name/M Su lemenld Information._
'TYPE OF WORK V CnMMERCIAL FEE*S, ►1FDULE-USE CHECKI 7ST
New construction Demolition Mechanical permit fees*are bas::d on the total value of the work
Addition/alteration/replacement ❑Other: _ performed. Indicate the value(vounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead and profit.
CATEGORY OF CONSTRUCTION
_ 1 & 2-Family dwelling ❑ ('ommercial/Industrial - value: s_ See Page z for Fee schedule
RESiDENTIAi,EQUIPMENT/5YS'rF,MS FEE*SCHEDULE
Accessory Building, Multi-Family
Dcscriptiun 'Total
Master Builder Other: Heaton 11"11
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditionin ••` 14.00
Job site address: I I y do S w L k-ej _ Gas heat pump — _ 14.00
Suite#: 131dg./Apt.#: Duct work _ 14.00
I'ro act Nanie: H dronic hot water system — 14.00
�--- — Residential boiler
Cre-s street/Dircetions to job site: (for radiator or hydronic system) 14.00
Unit heaters(fuel,not electric)
in-.all,in-duct,suspended,eta 14.00 _
Flue/vent for any of above 10.00
Subdivision: Lx-A•�l &k-% X14}es Lot#: 1 Re A r UtlltS _� 12.15
_ — Othc_r Fuel Ap liances _
Tax neap/parcel #: _ Water heater -- 10.00
DESCRiPTIO_N OF WORK— Gas,ire Ip ace 10.00 _
Flue Nent(water heater/gas Fireplace) 10.00
Log lighter as 10.00
— -- — --- Woo.1/Pellet stove _ 10.00
Wocd fireplace/insert
Chirine !y liner/flue/vent
,'ROPERTY OWNER TENANT' Other:
Environmental Exhaust&Ventilation
Name:---- .,K 44,o m s 4 �-_ Range hood/other kitchen equipment 10.00
Address: —2 0Clothes dryer exhaust 10.00
City/State/Zip::_ f j V 0 Single duct exhaust
Phone: 793-384�, I Fax: ZH –77(, S (bathrooms,toilet compartments,
AE'PLICANT
CONTACT PERSON utility rooms)
Name: vY Attic/cravrl!Race fans �— y 10.00 1—�
Address - — —_ Other: 10.00
City/.State/Zip: (55.40 for first 4,$1.00 each additional)
Fax: _
Furnace,etc. **
Phon.,. ^_ Gas heat pump�_ �_ •• _
E-mail:— Wall/sus ended/snit heater ** _
CONTRACTOR Water heater ••
Business Namt.- Ars- M, Mttfxif i Fireplace •*
Address: __ 684 11/ RangeBBQ
*•
City/state/Zip: Qor - 4 JR-• q 7007 -- -- Clothes d1n!A&as__q •• _ 1
Phone: s/ s77(, r 7flFax: 5" Other:— -- •*
Total:
CCA Lic. #: I Z Y 7 Mechanical Permit Permit Fees"
Authorized ���.�j Subtotal: $
Signature: _ � ^ Date: Minimum Permit Ft.-!$72.50 $
Plan Review Fee(25%of Perriit Fce $
T (Please print name) State Surcharge(8%of Permit Fee) $
__ TOTAL PERMIT FEE $
Notice: This nerndt application exph es if a permit Is n4,1 obtained within 'Fec mcthndology set by Tri-County Building Industry Service hoard.
I>a days after It has been accepted as ct mplele. '"Site plan requirrd for exterior A/C units.
\DstsTermit i•unns\MecPcrTv1App.dx 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$5.000.00 Minimum fee$72.50
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52
for each additional$100.00 or fraction
thereof,to and including$10,000.00.
$10,001.00 t $$25,000.00 $148.50 for the first$10,000.00 and
$1.54 for each additional$100.00,)t
fraction thereof,to and including
$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
$5-0,000-00. _-
$50,001.00 and up $742.00 for the first$50,000.09 and
$1.20 for each additionai$100.00 or
fraction thereof. _
Assumed Valuations Per Appliance: _
—'-- _ ( Value Total
Description: O;v _ Ca Amount
rurnace to 100,000 BTU,including 955
ducts&vents _ ---
Furnace>100,000 BTU including ducts 1,170
&vents _ ------
Floor furnace including vent 955
Suspended heater,wall heater or floor 955
mounted heater
Vent not included in appliance etmit 445
Repair units _ 805
<3 hp;absorb.unit, 955
to 100k BTU —
3-15 hp;absorb.unit, — 1,700
101k to 500k BTU -
15-30 hp;absorb.unit,SOIk to I mil. 2,310
BTU
30-55-hp;absorb.unit, 3,400
1-1.75 mil.BTU
>50 hp;absorb.unit, 5,725
>1.75 mil.BTU
Air handhng unit to 10 000 cfm 656
Air handling unit>10,000 cfm 1,170
Non-portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent syr em not included in appliance 656
rmft _
Flood serves 1,mechanic it exhaust 656
Domestic iminerator 1,170 _
Commercial or industrial incinerator 4,590
Other unit,i c!udmg wood stoves, 656
inserts,etc.
Gas i ink 1-4 outlets 360 `
Each at.' ,onal outlet _ 63
TOTAL COMMERCIAL $
VALUATION: —
is\Dsts\Permit Fotms\MccPcmiitAppl'g2.do: 01/03
/
1q00
S.W. LAUREL GLEN UT.
'O /,wry/y1 v'�I r+wa+.�,--.+.Yy• � 7y -__. �.�+ir -- V rep
vL
r� cf
cm
o \
2Rj
cu
a +� 15.17
d.2
ENTRYH Wo
W18
Q
I r
5.00
C!)
17.78
I /
L AR PAJ10 &PORGH. jl
I �� � - �•, .OHO
7 �
r
� cel _ ---'"—•_.-_. (.,
SCALE 1 16 1 0 PLAN 7,200 SQUARE FEET A
UA E EE LOT ARE
-w LAUREL GLEN 2,280 SQUARE FEET LOT COVERAGE
L"' # WASH of
UCOUNTY, OREGON NCLUDING PORCHESE
s
M
fD .-q f7
o (�
o
n
n �
a
s � f
b n
� w
a �
0
o
O
r. r
o
a (�
�y 1
a
O
;e
r