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8627 SW LOCI LANE
CITY OF TIGARD M"ISTFR FIERMIT
DEVELOPMENT SERVICES h,ERMII #. . . . . . . : MST97-090
1312.5 SW hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 10/02:, 97
F,ARCFL-: 2S 1 1 1 DA--AF,1408
S;I TE ADDRESS. ,. :Vi8F�0'7 SW LC'D I L.IV
SUED I V I S;I ON. . . . ;APPL EWOOD PA14< NO. 1 ZONING: R--1 FAD
BI..00K. . . . I. . . . . . l-OT. . . . . . . . . . . .T1.1RTS0T(,TT0N: TIG
Remarks: New SFD PATH I
----------------------------------------------- - -- --- BUILDING --------
,tISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REOUTRED SET.,ACKS----- REXIPED-------------
CLASS OF WORN.:NEW HEIGHT........: 23 FIRST....: 1034 sf GARAGE.....; 495 sf LEFT..........: 13 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1286 sf FRONT.........: 25 PARKING SPACES: 2
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RGHT.........: 5
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 2320 sf VALUE../: 16.3960 REAR..........; 15
----------------------------------------------------------------- PLUMBING ------------------------- ------- --------
SINKS.........: i WATER CLOSETS.: 3 WASHING MACH..: 1 LAUNDRY TRAYS.: 1 RAIN DRAIN ft: t00 TRAPS.........: 0
LAVATORIES....: 4 DI94 ASHERS...: I FLOOR DRAINS..: 0 SEWER LINE fc: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0
TUB/SHOWERS...: 3 GARBAGE DISP..: I WATER HEATERS.: I WATER LINE tt: 100 BCKFLW PREVNTR: 1 GREASE TRAPS..: 0
OTHER FIXTURES: 0
------------------------------------- ----------------------- MECHANICAL ----------------------------------------------------------
FUEL TYPES---------- FURN 1 10011 ..; 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1
GAS FURN )=IOW, ..: l UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.. ......: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1
-
---------------------------------------------------------------
ELECTRICAL ----------------- ---------------------------------•------------
--•RESIDENTIAL UNIT--- ---SERVICE/FEEDER----- --TEMP SRVC/FFEDFRS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS----- --ADD'L 1NSPFCTIONS--
1000 SF OR LESS: 1 0 - 200 amp..: A 0 - 200 amp..: 0 W/SVC OR FDR..: 0 P0)/IRRIGATION: 0 PER INSPFCTION: 0
EA ADU'L 500SF.: 4 201 - ti00 alp..: 0 201 - 400 amp..: 0 1st W/0 SVC/FDR: 0 SIGN/(TJT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 `Q1 - 600 amp.,; 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL./PANEL...: 0 IN PL.ANT......: 0
MANE HM/SVC,FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: MINOR LABEL -10: 0
1000+ amp/volt.: 0 ------------------------------------- PLAN PLAN REVIEW SECTION -- -----------•-
Reconnectonly : 0 --- )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
----------------------------------------- ELECTRICAL - RESTRICTED ENERGY --------- --
A. SF RESIDENTIAL----------------------------- B. COMMERCIAL-------------------------------------------- ---------------- ---------------
AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: OTH: :: k BOILER......... : HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
[ARAGE OPENER.. : CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: DATA/TELE COMM.: t01RSE CALLS....: TOTAL N SYSTEMS: P,
Owner: -----------•------------ Contrar7tor: --- - -- -
--------- rOTAI FEE5:f 3050.95
LEGEND HOMES LEGEND HOMES CORPORATION This permit is -tbject to the regulations contained in the
0300 SW HAINES ST 7150 SW HAZELFERN RD. Tigard Municipal Code, State of Ore. Specialty Codes and all
T16ARP OR STE 100 other applicable laws. All work will be done in accordance
TIGARD OR `)722'1 with approved plans. This permit will expire if wark is
Phone 11: 620-MBO Phone 0: 62f.-8080 not started within 110 days of issuance, or if the work is
Reg N..: 000Fi0h suspended for more than 180 days. ATTENTION: Oregon law
-,--------- requires you to follow rales adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 9`i2-001-0010 through OAR 952-001-0080. You may o:+tain copies of these rules or
dirrct questions to OU1NC by calling (503)246-1987.
----------------------------------------------- ----------- RFrA1lh'FD INSPECTIONS ------------------------------------•-------------------
Erosioi Control Cr3wl Drain Electrical Rough Gas Line Insp Water Line Insp Plumb Final
Fnoting 'nsp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr/gdwlk Insp _
Lost/Bear Struct Plumb Top Out Low Voliage Gyp Board Insp Electrical Final
Post/Beam Mechan Electric ervi Fireplace Insp Rain drain Insp Mecha cal Final
'� �--� y
Iss�_ied I3y : � Perm>,tteu Signati_ir^e •
+ 1 + ++++++1 ++++ + f+i-•}++++ . ++++ 4-++•i-++++++++++++++ +++-++•+ �- �• + 1� 4 4-+++ 4
Call 639-4175 by 7:00 P. M. for an inspection needed e < bl_isiness day
,
CITY OF TIGARD
DEVELOPMENT' SERVICES SEWER PERRMIT CONNECTION
ION
13125 SW Hall Blvd., Tigard,OR 97223 (50?)639.4171 PERMIT #. . . . . . . : SWR97•-0398
DATE ISSUED: 121'0c/9'7
PARCEL: 2S111DA-AF'W08
SITE ADDRESS. . . :0862'7 SW LODI LN
SUED I V 19 I ON. . . . :APPLEWOOD PARK h,0. 1 ZONING: R-7 PD
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :008 JURISDICTION: TIG
TENANT NAMH. . . . . :L.EGEND HJMES
L15A NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
CLASS OF WOPK. . . :NEW DWELLING UNITS. . : :1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL_ 'TYPE. . . . :BUSWR I MPERV SURFACE: 171 s f
Remarks: New SFD
Owner,- ________.._______________.__._.._-_____.________.___.___.----._ FLES - ----- -
LFGFND HOMES type amount by date recpt
6900 SW HAINES ST PRMT $ 220121. 00 P 12/02/97 97--301366
TIGARD OR INSP $ x,'5. 00 H 1=/02/97 97-301.:366
Phone #:
Cantr-actor: - ----
L.EGE.ND {-COMES CORIDORAT I ON
7160 SW HAZ.FLf'ERN RD.
STE J 1210
TIGARD OR 97224
Phone #: 6201-80801 $ 2235. 00 TOTAL.
Req #. . : 001P1rT01F,
REQUIRED T NSPECT I ONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Serage 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 .aterals, If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from _._ _ _.,._--____
the distance given. If not s` to^ated, the installer shall purchase
a "Tap and Side Sewer" permit and the Agency will install a lateral.
ATTENTION: Oregm law requires you fo follow rules adopted by the
Oregon Utility Notification Cente- These -ules are set forth in OAR
952-011-010 through OAR 952-Mi "58. You may obtain copies of
these rules or direct nuestions tl, IMC by callino (503)246-1981.
1Fci hy : __
C�i Permrttee 5i nat�_Ire • 1�
+++•++++++++i +++++++++++++++i-++++++•1-++++++++f-++++++++++++f•+++++++++++•+++•+++-f-++•+++
Cal. 1 639-4175 by 7:00 p. m. for^ an inspection needed the next bl_fsiness day
a ++++•-1• h++++-f-+++•1-+++ i ++h+++++++y f++++++++++++++•t+++-F++++++i-++++++++++-F-++++++++4 + I
Plan Check l
CIT`! OF TIGARD Residential Building Permit Application Recd By
13125 SW HALL BLVD. New Construction Additions or Alterations Date Rec'd�
TIGARD, OR 97223 Single Family Detached or/attached (Duplex) Date to P.E.
V 501-639-4171 Date to DST
F 503-684-7297 Permit#Mc," I —pt�y'D
Print or Type Called 11 5w r-il_
Incomplete or illegible applications will not be accepted
Name of Projw I Name
Joh c? >1� G' L , L
Address site Mi6ress ,
Architect Mailing Address
Name City/State Zip Phone
�L
Mall n Address Name y'
Owner , �
` �• En infer Mailing Address /
City/State Zip Phone g
CStste Zip Phone
,eneral Name r�( J�t�✓
Contractor �' �at� ;� /✓ y� ^es, work New G*' Addition O Alteration O Repair O
Mailing Address —+ I
Prior to permit i I Ad. tai E scription of Work:
issuance, a copy City/State Zip Phone
of all licenses // U
are required if Oregon Const.Cont.Board Exp. Date PROJECT • y
expired in COT LIC# ., VALUATION $ i
database
Mechanical Name — NEW CONSTRUCTi!)N ONLY:
Sub- SI �,n1 -'; -� Sq. Ft. House. Sq. Ft. Garaqe r.
Contractor Mailing Addr"s C� J 024
Prior to permit r Corner Lot YES NO Flag Lot YEZ' NO
issuance,a copy city/StateZip Phone JI (check one) ` 41P ch :
one) �_
of all licenses ' ; I ' '
" Restricted Audio/Stereo Burglar
are required if Oregon Const.Cont Board Exp.Ddte )
expired in r- uc Energy r j System Alarm
database_ r% ) ! I - l 9 Irtstallati Garage Door HVAC
Plumbing Name _ _ Opener vY Systems
Sub- �;';' (check all that Other:
Contractor Mailing Address apply) _.—._
I Will the electrical subcontractor wire for all YES NO
1. restricted_energy installations? % r
Prior to permit Citwstate Zip Phone
issuance,a copy Has the Subdivision Plat recurde.-4? N/A YDS NO
� � i �
of all licenses are Orsgon Const.Cont.Board Exp.Date
required if Lic.# r)G / Reissue of PAST"# Solar Compliance
expired in COT )' ,� ///,/_11e_ _ _ (Calculation Attached) _
database Plumbing Lic.# Exp.Date I hearby acknowledge that I have read this application, that the
information given is correct, that I am the owner or authorized
Name agent of the owner, and it at plans submitted are in ,ompliance
with Oregon State laws. _
Electr,^al 7 , -A 21 i Signature of Jw�er/Agen3 � Date
Ir
Sub- Mailirg Address , /" / nej ,
-
Contractor f ' / - T 1 /�� Con ct Person as—ole 1 Phone#
CitylState Zip Phone,
Prior to pertnit7, FOR OFFICE USE ONLYS _
issuance,a copy r ,` ��- �f Plat#
of all licenses are Oregon Const.Cont. Board Exp Date ' ��p{rL 0 ,
required if L c#
:.b"r` Setbacks; ` �'
expired in COT t 7 , i ��^ _ )i Zone �//1 $plar:
database Electrical Lia # Exp.Date - /
Engin ri Ap vel: Planning Approval: TIF:
1�' LSFREM GUC (DST) 4197
Solar Balance Point Standard Worksheet
Address ';
Box,A kmIculations: North-Sou'h dimension for the lot. Box A:
Thi; dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicul.v to that point.
First, determine which property line is the North lot line. The North lot line is the line
with the smailest angle from a line drawn east-west and intersenng the northern most
point of the lot
N \ North-South
Dimension for lot_
Measure rhe distance from the midpoint of the North lot line to the South lot line along
the riescibed 5ne.
feet
t
tV
PdCWH- uN CRAaea.
Bax B calrivlatiors: Shade point height for your residence.
Box B:
1. Determine whether measurements will be based on the peak or eave of your
siructum-. The orientation of the ridge is also important Which describes
your residence?
1a: If the roof line runs Nor+h-South, measurements will (cirde one)
be lased on the peak of the roof. o MOW
0 .�
1A 18 1C
ON-
b:
Nb: If the roof line runs East-West anc the roof pitcl- is
less rnan 5/12, measurements %vill `;e base-' c.i :fie I�
1c: If the rcof line runs East-.Vest and the roof pitch is
3i12 or steeper, measurements will be ba-ed on the ,......
peak. ❑----C
Box B. continued Box B:
2. Yeasui-e change in elevation from frc -t property line to tinished floor elevation. If
the lot slopes up from the front lot lin to the foundation, the Figure is positive. If
the lot slopes down from the front lot line to the foundation, the figure is negative. ft
3. Measure distance from finished floor elevation to the affected peak/eave. + ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, --- ft
deduct nothing.
S. Subtract one foot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing, k
6. Total figure for box 6: _ ft
Box C. Distance to the shade reduction line. Box C.
1. Measure the distance from the North propert�t tine to the foundation near the - (t
affected peak/eave.
2. Measure the distance from the foundation to the affected peak or eave. +
��
3. Total figure for box C: 3 ft �
it 6 most useful to draw a vertical rine to represent dw appropriatr fligum fcxmd in box'A'and a horizontal line to represent the
appropriate figtue found in box'C:'.The interseaxxt of the vertical and horizontal Puns determines the value found in boot'CY. The value
in box 'U'shooid be compared to the value in box 161; if the value in bar•B'is lea than or equal to dw value found in box'n', then
the building is in compliance vnth the solar halance cr)de. if you have any questions, pleaw contaa us at 639-4171,x304 or at the
Ccxnmunity Cevelopnent Counter.
MAXIMUM PERMITTED SHADE POINT HEIGHT (In Feet)
Cktanc:e to North-south lot dimension On feed
Oiade 100+ 95 90 85 80 75 70 �5 60 55 50 45 40
reducdw rine
from northern
tet 5ne tin fent
70 40 40 40 41 42 43 44 -
65 38 38 38 39 40 41 42 43
60 36 36 36 37 38 39 40 41 42
33 3-t 34 34 35 36 37 38 19 40 Al
30 32 32 32 33 34 35 36 j7 38 39 40
-3 30 30 30 3- 32 33 3s 35 36 37 38 39
.0 :8 28 28 29 30 31 32 13 34 35 36 37 38
33 .5 26 26 27 28 29 11 32 33 34 35 36
30 24 24 24 25 26 27 28 9 30 31 32 33 34
S 12 L' 22 23 24 25 26 17 29 29 30 31 32
:0 20 20 20 21 22 23 24 5 26 27, 28 29 30
13 18 18 18 19 20 Z1 2-1 3 24 75 26 27 28
10 16 16 16 17 18 19 20 1 22 23 24 25 26
t _ 14 14 14 15 16 17 18 9 20 21 22 23 24
Box D. klaximum allowed shade point height_ �Y feet
h Ador4unc�k-rtty,a,olt►ctio
Revised ='2fv'9S
Nov 06-97 02 : 35P P _ 03
'LOT FLAN
LOT 00a, AFFLEWOOD PARK
R-1 2 51 11 D4 A/I 1" 51 �
&(o 2l SW LOD I LANE U WATER METER
5-E. 1/4 OF SECTION 11, T.2, R.1W, W- I. W-- — -- WATER LIN
CITY OF T IC�ARD 55— —— SANITARY SEWER
oJr,.P-- _ ._ —. !STORM DRAIN
WASHINGTON COUNTY, OREGON ` OF STREET
MANHOLE
®
CATCH L'S SIN
LEGEND HOMES 10POSED
egoo S.W. BAUM S1RIMT TIGA", otracoN STILET TREES
PLAZA 2. SUM "O 97=-251.4 STREET LIGHT
orrIct (503) 620-0090 nut (503) 509-etwo TIRE HYDRANT
I I I I ti
I � I
I E it
j I I LOT 06
1,3'7; I91 N 09'54'75" E LOT 07
72 00'
IR J
�l I L O t ray
1916' QJ
50,
/' LOT 08/ PRO1111IDE EROSION
G 4611 . FT. / Uh
W 1 I / CONTROL FENCE
C3 l i /REGENT IIA j n TER COMMUNITY
I V I I 'FIN. FLR . 198.1ERr791CN PLAN
I I '; i I G.4RAC+E FLR • 1918' 5�'
4,
I E • � - � � //i // 191.4-
1
I 130SETBACK
I 0LINP
1589' EllEAEEMFNT
8, UTILITY
I _
/ I N B9'Q.4'15" E
55.00 aICEWALK
CURB
W LOCI LONE
CITY aF mrIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171
CERT IFICATE OF
OCCUPANCY
PEPM I T #. . . . . . . s MST97-0490
DOTE TSIAJE.Dt 04/01-11M
iJE ADM7SS. . . 006217 SW 1-01)] LN PARCELt ;."GIIJ.DA...0 1,,?00
�)BID I V I F;I MI. . . . a APPLE WOOD POP;', NO. I ZONING:R---7 VIT)
COCK. . . . . . . . . . c LOT. . , . . . . . . . . . . z00A JURISDICTIONsTTG
PSO OF WORK. cNE-1.)
I v'PE CW USE. . . :SF
TYPI.E, OF CON5TR:5N
UCCUPANCY GRP. a R3
OCCUPONCY LOAD:2
-markst M@wSrP PATH
LEGEND HOMF.-'''
6900 G- W HAINEF3 ST
I' Irj(4FD OP
Phone #.- 6c'el-8080
t ontractor v
LEGEND 140MES F.ORP/MATPIX
F)I..()ZA II, sui-m
6900 SW HAINES 17JREET
I'MARD OR 97223
V-1honow *. 620-1*1kiso
Pea #. . : 000006
This Cootificatp prantq ocQupAtincy Of the MbOve v-&frv-@"C&0
therouf .and confiriffs that the bk.tilding has bean insr)ectetf for '7:rjmpJian(.' (b with
the StateofOv,agon Specialty Lodes for j,he t3?-Oklpq Of-VUp8kr1C.'$', and .ive ointipt,
which 0 t-
h i L r e f er e nc ed p�v-vjt wAs i% 3kipd.
2 X
BUILDING INSPE 1 1,;t.,'Ff
T 0 R C;P.J"T"' 11
IJ06T IN MWPICUOUS PLACE
91,5,3 3
3, 1 „�
�' CITY OF TI GARD BUILDING INSPECTI::ON�DIV ION
j1j, 24.Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested:
C ` " P.M. MST: c? 7 C-'7 /C.'
Location ���� �%(� �_( l •� BIJP:_---
Tenant _. Suite: _Bldg: MFC:_
/ y Phone: - �� 0��-3 PLM:
Contractor-_y _ — —
ELC:
Phone:
Owner: �� ! rff
Ji'-Y, ELR:J-----
_ Sfl':
BUILDING DG on't) PLUMBING_ ,? ECHAIVICAL _ .' ELECTRICAL. SITE
Site 'PSsi/13ei m 1fi91�#M � Po—e—am Sewer/Storm
Footing Roof Undl-l/Slab Rough-In ('citing Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vault
Bsml Damp Drywall Storni Furnace Temp Service MISC.
Masonry Ceiling Rain Thain A/C l IG Slab
Shear/Sheath Fire Spklr/Alm Crawlil'ound Ih I leaf Punrp Low Volt
oved roved ov• Approve Approved
Appt/Sdwlk N _ roved pproved ved roved Not Approved
IAL , TINA FINAL
C3 Call for reins O Reinspection fee ot':' -`required before next inspection C7 Unable to inspect
Inspector:— Date: 1171 J __ Page _of
CITY OF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT#: PLM28/7/03 3 00409
13125 SW Hall Blvd., Tigard, OR 972.23 (503) 639-4171 DATE ISSUED: 8/7/03
PARCEL: 25111 DA-01200
SITE ADDRESS: 08627 SW LODI LN
SUBDIVISION: APPLEWOOD PARK NO. 1 i ONING: R-1
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PRFVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATFR CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential i)ackflcw prevention device for irrigation system.
FESS
Owner: _
Description � Date Amount
CNA, ERIC I + S-I EPHANIE W i PLUMBI 1'criiiit I cc 8/7/03 $36 25
8627 SW l_ODI LN of;„„hitrI„ 8/7/03 $2.90
TIGARD, OR 97224 i'I'AX] R _
Total ' $39.15
Phone
Contractor:
AMERICAN GREEN LLC
10389 NW HELVETIA RD
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : 047-0027 Final Inspection
Reg#: I It' 6291
This permit is issued stabject to the regulations contained in the Figard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This peri nit 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
� J
Issued By: 1.' x c / Permittee Signature: -elCall
r--
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building fixtures
Plulmbinp, Permit Application '
Received n Plumbing
Date/By: l Permit No.: I
City Or Tigard Planning Appr val Sewer
y g Date/By: Permit No.:
13125 SW Hall Bld. Plan Review other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review band Usc
Date/By: Case No:
r
.ntcmet: www.ci.tigard.or.us Contact J iris., See Page 2 for
24-hour Inspection Request: 503-6394175 Name/Method: Supplemental information.
TYPE OF WORK _ FEE*SCHEDULE forspecial Information use checklist
Nev construction Demolition D^seri tlnn Qty. Fec(ea.) total
Addition/alteration/rel.jaccnlent Other: New 1-&2-family dwellings
CATEGORY OF CONSTRUCTION Includes 100 ft.for carr: cottncctlon
�—
1 & 2 Family dwellitn ❑ CommSFR(1)bath 249.20
ercial/Industrial — —
SFR(2)bath 350.00
Accesso Build_ ing__- �] Multi-Family SPR(3)bath 399.00 _
Master Builder _❑ Othe-: Each additional bath/kitchen 45.00
_ JOB SITE INFORMATION and LOCATION Fu c sprinkler-sq. ft : Pae 2
Job site address:: b�7 �o L•r). _ Site Utilities
Suite#: j3]d #; Catch basin/arca drain 16.(i0
Dr ell/leach line/trench drain 16.60
Project Name: _ -—
Footing drain no. linear ft. Page 2 _
Cross street/Directions to job site: Manufactured home utilities 110.00 _
5-aWdAe Manholes 16.60 _
Rain drain connector 16.60
Sanitar sewer no. linear ft. Pae 2 —_
Subdivision: — Lot#: Storm sewer(no. linear ft. _ Pae 2
Tax map./parcel #: — Water service(no linear I'l Paize 2
DESCRIPTION OF WORK Fixture or Item
— Absorption valve _ I6.60 _
-----------_---_---_-,_-- _-.__-.-_- ---.-_._�___-- Backflow prcventer Pae 2
Backwater valve _ 16.60
-- —- ---------- --------- Clothes washer _ I(i.GO —_-
----- — Dishwasher16.60
g
Drinkin fountain _ 16.60
PRAPERTY OWNER _ / TEN—ANT _ Ejectors/sum 16.60 —
Name: _-- -- -- Expansion tank 16.60
Address: Fr-107 .4,d/ ,4,9 Fixtury,f-ver cap 16.60
CIl)/Statf'/Zip: / 4y!Jz?mac/ _ Floor drain/floor sink/hub 16.60 Y
Garbage disposal 16,60
Phone: Fax: Hose bib — 16.60
APPLICANT I Ll CONTACT PERSON Ice maker _ _ _ 16.60
Name: &ens LLC' Interco tor/ rease trapv _16.60
Address: /a>ff ,e�te� �C(,/ �j ��� Medical gas-value: S Pae 2
City/State/Zip:— �� f ��z � - Primer 16.60
� � —
Roof drain(commercial) 1660
Phone:67p j toy 7 5i Z7 I Fax:so: 41e-7_660ZSink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan _ 16.60
CONTRACTOR Urinal 16.60
Business Name: — Water closet 16.60
Water heater 16.60
Address: other:
City/State/Zip:—��— Other:
Phone: x 71 Ptt,.abing Permit Fees*
CCB Lic. #: �zY,3 Plumb. Lic.#:
__ Subtotal S
—=— Minimum Permilred*+�SQ $ e
Authorizzeded Residential Backflow Minin I-.e$36.25 p v
Signature:
(�jt,e Date: ��
r �� 03 Plan Review 25%ofPcttnit Fee) S
�4 Oi9l� 2L LOM-- State Surcharge 8%of Permit Fee $ D
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application explres if a permit Is tint obtalnrd sslthin All new commercial buildings require 2 sets of plans with Isometric or
Igo days after It has been accepted as complete. riser diagram for pian review.
*Fee methodology set by Tri-County Building Industry Service Board.
is\DsLs\Permit Forms\PlmPermitAf.p doc 01/03
Plurgpin2_Permit implication,- City o!'Tigard
Page 2 - Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
Site utilities_— Qty. Fec(ca) Total Square Footage _ — Permit Fee:
1-, t,ng drain- I" 100' 55.00 0 to 2,000 $115.00 --—- -
Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer- Ist 100' `5.00 7,201 and greater _$3,09 00
Sewer-each additional 100' 46.40 —
WaterService-Ist 100' 55.00 Medical Gas S 'Stems•
Water Service-each additional 100' 46.40_ Valuation: _ _ Permit Fee:
Storm&Rain Drain-Isl 100' 55.00 $1.00 to$5,000 m0� Minimum tee$72.50
Storm&Rain I`min-each additional 100' 4640 $5,001.00 to S.',000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(es) Total including$10,000.00.
Commercial Back Flow Preacntion W.N icc 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow l,rcveu'ion Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 27.55 __ and including 1425,000.00.
Ruin Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the First$25,000.00 said$1.4r for
_ each additional$100.00 or fraction thrrcof,to
Inspection of existing plumbing or ,nd including$50,000.00. _
specially requested inspections-2ei Hour 7250 $50,001.00 and up $7.12.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping.nu0Vill9 or replacing exisdug,fixtures? If
,,Ves",please intlicale work performed by fixture. Failure to
accurately report fixtures could result ill increased sewer tees*.
Ua111It t bV�FIXtUrC Work Perforincil O111IIIL`IItS I-CI;:11'dlllt; rlxalll'l'11'111-k.
Fixture Type: Iteplaee I
+------- -- - - -New Moved Ca ed
Ba tilt /Font — -- ---- -------- —
Bath -Tub/Shower
-Jacuzzi/Whirl pool - -- -- -— -- - --_ -
('at Wash -Each Stall _ — _--- �---- -----.--- -
-Drive Thru I —_
Cuspidor/Water Aspirator _ —^ -- ----_--- -------------- -----
Dishwasher -Commercial -- — ----- ------- --- --
-Domestic
Drinking Fountain _ ----- --� �—Eye Wash -----—-- -- ..
Floor Drain/sink .2.,
-4„
Car wash Drain *Note: If the fixture work under this permil results in at-,
Oarbage -Domestic increase of sewer EDI is,a seller permit will he issued ;111(1
Disposal -Commercial
-industrial fees assessed for the sewer increase must be paid I)ernri 'lie
Ice Mach./Refri .Drains plomhink permit can he issi—d.
Oil Separator Lias Station _
Rec.Vehicle Dump Station
Shower -Clang
-Stall
Sink -Bar/Lavatory
-Bradley _
-Commercial
-Service
Swimming Fool Filter
Washer-Clothes _
Water Extractor
Water Closet-Toilet I
Urinal _
Other Fixtures:
ilDsts\Permit Forms\PlmPerrnitAppPg2.doc 01/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 ,
INSPECTION DIVISION Bus*nes Line: (503)639-4171 MST
BUP _
Received Date Requested__ if_ _r_� AM--.--- PM--- BUP
Location �� �cL1 ��G� 4- -__---_ Suite_ MEC
Contact Person ___ � _ ..___ Ph( '3 .) a%� S�_ PLM ,, c
Contractor_ - _ Ph (- ) _ SWR -- -—_—
BUILDING Tenant/Owner _ ELC
Footing
Foundation ELC
rinc�
cess:
Fty Drain fG ELR
Crawl Drain
Slab peton es: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing --- -- ------ ---
Firewall
Fire Sprinkler -- - --
Fire Alarm
Susp'd Ceiling -- - - -
Roof - ---- — -
Other: . ---- - ---- - - - _-_
Final ✓
PASS_PART FAIL - -
PLUMBING
Post 97 Beam ----- _- -- --- -- -
Under Slab ___ _--
Rough-In
Water Service - - ---. ---
Sanitary Sewer
Rain Drains - - - - -- -------
Catch Basin/Manhole
Storm Drain --
Shower Pa ;
OlhX. --- - - ---
ASP PART FAIL --
HANICAL __ _
Post& Beam - - - -- -
Rough-In -- ---- - _ ---- -- - --- -
Gas Line
Smoke Dampers -- - -- -
Final
PASS PART FAIL
ELECTRICAL
Service ------- _.._ - ------- --- --
Rough-In
UG/Slab
Low Voltage -- - -- - ---- -. -—
Fire Alarm
Final Reinspection fee of$ _ -.__._.required before next inspection. Pay at City Hail, 1312.5 SW Hall Blvd,
PASS PART FAIL
SITE _ _ U Please call for reinspection RE:-_ n Unable to inspect- no access
Fire Supply Line -
ADA '- f
Approach/Sidewah< Date_- Inspector � _ Ext _-
Other
Final - DO NOT REMOVE this Inspectloh record from the Job site.
PASS PART FAIL
489 q F 5
�•\ -ANEW
?NWS-AV!WA 0 FN'IQTING
BACKFLOW ASSEMBLY TEST REPORT 0 REMO�ED
PROPERTY 0 REPLACEMENT
OWNER: —PIIONE:
MAII[NO
CITY BTATE
zip
ANSIABLY
ADDRESS:
STRI'l."T
OR P.B.A. 01DI %'.A. 0 R.P.D.A GD.C.D.A.' C3PV.13.A. L-ll,,V.B.A. CIA.V.13. CIAIR OAP
SIZE: LJJ�J MAKE: MODEL:
WATER SERIAL
PURVEYOR: NUMMW
AWMBLY
LOCATION!
ha
REDUCED PRE.SSURF. &SSLM131,Y P Vfl A. S V.H.A INITIA;, rEs7r-
11CHECK (DOUBLE CHECK IAIR CIIECK PASSED 0
PRESS DROP (A)I CHECK #1 IINLET FAILED 0
INITIAL RELIEF VALVE
TEST
OPENED AT (11)1-1.lc.,IIT 0 OPENED AT PPE-',, DROP DATE.
RESULTS -PI—N2 7s—t5
R u .AKrD
BUFFER ------- t
A-B CiIECK N2 PSID PSID
RELIEF VAI.VF ITIGIIT .-O- c DID NOT I All,ED SYSTEM
PASS [I FAIT, PSID ()I";N El El PSI
REPA,
AND/OR
PARTS
as
REDIATI)IIRLSSURF.A,"'MHI,Y
01 CHECK P V.R.A./S V B.A AFTER REPAIRS
PRESS DROP (A) D.C.V-A. -7—— DATE,:
TEST RELIEF IcIIICK #1 OPENED AT PRESS DROP
iwmll OPENED (13) TIGHT_ Cj -TS-11)
REPAIRS A R- #2
HUFFER tC 11 Tk
7—sm
PSID P:'Ib PASSED 0
IN COMPIXtING MD SUBMITTING TiiisTFYrREPoRr.TIIETESTER CER-nF[P-li:Ai--niF
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL A IPLICARLF
RULES AND REGULATIONS S)F -nit. WATER SYSTEM, AND STATE. REnu.,TIONS
GAUGE CALIBRATION DATE .�L �, DETECTOR MrTf-.R READWO
TESTER SIGNATURE
FRTO
1FS7TRS NAME PRiNTrr)
(-,AtJCL 4
ItSTERS ADDRESS
PHONE N
COMPANY NAME
V rPoRT RECEIVED nBy' (RrpPrsrNTATIVF OF OWNER) ❑srRvicp RFsl'ORED
WHITE Wet"syslem Copy PINK-Customet Copy Tesler Copy