Permit i-i., ,, ' ., ; , q CITY OF TIGAR® MASTER PERMIT • F:. COMMUNITY DEVELOPMENT Permit #: MST2008 00124
7tGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/11 /2010
Parcel: 2S109DD09200
Jurisdiction: TIG
Site address: 12658 SW REMBRANDT LN
Subdivision: Lot: Z 2_
Project: BELLA VISTA
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 863 sf Basement: sf Left: 5 Parking Spaces:
Height: 24 Bathrooms: 3 Second: 1182 sf Garage: 380 sf Front: 20 Smoke
Dwelling Units: 1 Third: sf Right: 5 Detectors: Yes
Total: sf Value: $211,986.78 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 100 Catch Basins:
Lavatories: 4 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: 4
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 1
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
NAT Heat Pump: N Hoods: 1 Other Units: 3
Fum <100K: Vents: Woodstoves: Gas Outlets: 5
Fum > =100K: 1
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add', 500 sf: 3 20 1 -400 amp: 201 -400 amp: 1st W/O Svc /Fdr:
Limited Energy: 401 -600 amp: 401 -600 amp: Ea add'I Br Cir:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
•
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
RIVERSIDE HOMES, INC. STREAMLINE PLUMBING
1925 NW AMBERGLEN PKWY, #200 2505 SW AUGUSTA DR.
BEAVERTON, OR 97006 ALOHA, OR 97006
PHONE: 503 - 645 -0986 PHONE: 503 - 888 -6657
FAX: 503- 379 -9543
Total Fees: $14,655.66
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 t oug OAR 952- 001 -0100. You ma btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: `-' , A.i' Permittee Signature: , --t4 „ —e....` r/ 2_ (( —10
/0. G SY 5u). i-ern bray# ,
Building Permit Application; FOR OFFICE USE ONLY •
", �{
City of Tigard ° Received Q
7_ Permit No.: r r�...���
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie 0 ��
UY . "+ S
Phone: 503.639.4171 Fax: 503.598.1960 P� e '-rl�I Date /B : / �• 8 O ther Permit - �� • 'a
Inspection Line: 503.639.417 `o I • Date Ready/By: ! �� 0 See Attached Checklist far
G
Internet: www.ci.tigard.or.t� ‘. j�
; 4 ,, v} ,, F vs ,' ,`� • "� Notified/Method: Lf r ) � A Supplemental Information
"'
,
/ /NSTA l6� ,1..ia' , t _ -e jai / /t.�
�,l1aa /o + " TYPE OF* RIC REQUIRED DATA 1- AND 2- FAMILY DWELLING
® N w construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rou nded to the nearest dollar) of all
❑ Addition/alteration/re placement ❑ Other: equipment, materials, labor, overhead, and the profit for th3S
CATEGORY OF CONSTRUCTION
work indicated on this application + g /) 9 . -98
Valuation: $
1- and 2- family dwelling ❑ Commercial /industrial 1
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: Z
lob site address: j Z s w m b ray) L - New dwelling area: :. i 0 0 20 feet
City/State /ZIP: �garri Oe q 1 a,a1-- Garage /carport area: 3e0 square feet
Suite/bldg. /apt. no.: J 1 Project name: f ,11a v 1 ,- Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: ? e \S c , \T, G Lot no.: z2..... Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and t he profit for the
DESCRIPTION OF WORK work indicated on this application.
n .Q 1 7 S U Valuation: $
• 1\1 e Existing building area: square feet
�� New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: t 3 v fx I d t_ NC'n'I.Q `.) J l C - Type of construction:
Address: 1 Ct 2 5 AAA/ "4.11,1 b`Pi1' 1 t e-v. - is/VW v 4 2 O o Occupancy groups:
City/State /ZIP: 13, , kV{iy MCC (P Existing:
Phone: ( 7,5) (F L - c ci (Ae Fax: (50?") (g2Cf0 ._ 2 L( 2. New:
❑ APPLICANT I/ ❑ CONTACT PERSON NOTICE
12:, V-
Business name: 1 },51 t' . CiG'w1 `> j y>- All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
,4_ L (- <:71',1,1 A4 ci-L i - under ORS 701 and may be required to be licensed in the
Address: 1 C 2 ' Ai w 1,K ro ID rc,w L.,k $ 'd 1-c 20 ( _ j jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: 8 r'ct y .e.,-y- �-c y�_ c i2 ( 4 -i U 0 (9 apply:
PP Y:
Phone: (E`3) (.P4 5 - U 7 P i L , Fax:: ({P,) (. 0 <l 4Z
E -mail: , r m 1 c -() r , V S i ciR k r )14 R .. ( • J
CONTRACTOR
Business name: 1 t/ G' -e ITS - -OIL - BUILDING PERMIT FEES*
Address: 1 ,WvV /Q7 b1 pkA,C) L J I-'1f 2 C
Please refer to fee schedule.
City /State /ZIP: e 4_V e.r-'r -.yL, o0) (p Fees due upon application -----°.
Phone: (gi - (P 4 S - G ° l v 1F Fax: (Sli;) i,12;-- 2
4 Z' Amount received 777 , r
CCB lic.:
Date received:
Authorized signature: C (- e h��� ( P C ' This permit application expires if a permit is not
within 180 days after it has been accepted as c
Print name: t )cis(, ,(it Date: 12 - 2 U - U C� * Fee methodology set by Tri-County Building Inc'
( Service Board.
i:\Building\Permits\BUP- PermitApp.doc 12/03 440- 4613T(11 /02 /COM/WEB)
L3 fL t— cv -5 ® 'V //
Plumbing Permit Application - .y) FOR OFFICE USE ONLY
City of Tigard - w , Received
I y Permit No.: . • 01
13125 SW Hall Blvd., Tigard, OR 97223
'\\__, ( Plan Review �M� l
Ph 503.639.4171 Fax: 503.598.1960 U /dr "" � Date /By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 P� r tI I - Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us f �. b • a' .$, � ntifed/Method: Supplemental Information
TYPE OF WORK % . y FEE* SCHEDULE
New construction ❑ Dsntc)Iition For special information use checklist
Description I Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Q 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / Z 5 b S IA i'Yl b K4,14 N -f l v vi Catch basin or area drain 16.60
City/State /ZIP: '�' a.i / I Q e an aa�l . Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 1 Project name: ,\\a \I t S•(X, Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: v-i,e," V W I Lot no.: 2 Z Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK �* . �'
Backflow preventer Page 2 3( �
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
'I Ejectors /sump 16.60
Name: 12,i v-Pi1- (Le_ t1(7Yl'(.Q4) Expansion tank 16.60
Address: rei 2 5 ,VV j h a `t,'L, 1 -, j It -7 or) Fixture /sewer cap 16.60
City/State /ZIP: ; kY .�.�, if, J q -jGu (•e' Floor drain /floor sink/hub 16.60
Phone: ( 5 ) 1p 4 S _ ( ) y , ( Fax: (cel- ) 1/`4 U -, j! L4 Z Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 1( 1i'X71 at HvyI'tPS T Interceptor /grease trap 16.60
Contact name: A( GI' 1)Gyt_ IVc4..-k) i Medical gas (value: $ ) Page 2
Address: j Ci 25 Aiw Ain / i / p rLWL . ) Ai Z p(,) Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: J`i-vPa, 1 1 ' 4 c pl v vii bf $15 Water heater 16.60
Address: ?S DS - • S • (Al - A t)5 t) lJt • Other:
City/State /ZIP: 41,6k4 ot O t 6 ) 700(0 Subtotal
Minimum permit fee: $72.5 0
Phone: (543 ON3 - b 65 7 Fax: (5 D3 ) •If 2.- 95 y 3 Residential backflow minimum permit fee: $36.25
CCB Lic.: ( 2 I I 1 Plumbing Lic. no.: 3 Li - 370 p 4 Plan review (25% of permit fee)
State surcharge (8% of permit fee) .Z gar,
Authorized signaturrc"- G 4 TOTAL PERMIT FEE J9 �s
Print name: jOkut4 A h 8 f t l Date: 2 - �J -- 05- This permit application expires if a permit is not obtained within
- 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLM- PmnitApp.doc 12/03 440 -4616T(10 /02 /COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
Received
City of igar(� - � � Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 A : y yrr• r� Z
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ' j A - . Y ' 1 4 1s Date/By: Other Permit:
Inspection Line: 503.639.4175 - '". � : I -
Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us , L Notified /Method: Supplemental Information
,ti . ..1
TYPE OF WORK 4 ^ y', t ' 1 `i , `: ♦ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
New construction ❑ AdditiQ to tcratiat /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other` mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: 5
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty.
Ea. Total
JOB SITE INFORMATION AND LOCATION �/ Heating/cooling
Job site address: ) Z t, 51 \ 1 bra,v7 /� _ Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: -- 90 "„..6 I o e_. 01-7,a24- Furnace 100,000 BTU (ducts /vents) 14.00
e,Q Nisk�
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Vi Lot 2 Z Flue/vent for any of above 10.00
Y `� Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater / 10.00
Gas fireplace ( 10.00
Flue vent for water heater or gas "
fireplace /r 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER ' ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: ej i'e . (.t L 1-1 , - c Environmental exhaust and ventilation
�,, y Range hood/other kitchen
/A
Address: "! 2 5 �lV�AAA./ Ay»rTri1'Gj 1_ �� �V ( ZU� equipment 10.00
City/State /ZIP: 0 <4 V .e y 411 Oa: C r 7 (i & (" Clothes dryer exhaust i! 10.00
Single -duct exhaust (bathrooms,
Phone: (Gt ) ) ) 424S }5 - 0 1 bi. Fax: (9 ) eo y 0 - 29 '-/ Z toilet compartments, utility rooms) ,.t 5 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
/ ✓ u Other: 10.00
Business name: j2, V �YC�� i F
S / 7 2,S _l�nC . Fuel piping
Contact name: .A Lt_„ L-,cwt All w •
'_ I Furnace, $5.40 etc. for first four; $1.00 for each additional
1
Address: 1 2 Ni VI Ar✓1V R' Pfi . 1 # Z C Q
/n „J � iw Gas heat pump
City/State /ZIP: r) e 1 , V �4o y � l.7 a . q-7 00 (p Wall/suspended/unit heater
Phone: (5L?,) te 14 5 - 09 rU" L Fax:: (a)-3) 0 0 - 2 e 4 2 Water heater 1
Fireplace
•
E -mail: �l.rY1[(�Q( J t�/ r 1 ✓P (/SIC/�-�.{��► to • C C Range e '
-)
CONTRACTOR Barbecue
l ', 1 Clothes dryer (gas)
Business name:
k ` - /A ,i_A� r ® F1 R a-�, n. c 1.r. G 4
II Other:
Address: 4 M� 1 Z D, '2 8 4 'U c k e; 4..m 1 d S . 1t A ±. 6 MECHANICAL PERMIT FEES*
City/State/ZIP: ( r•.- s c "- t 6 (C B-
Subtotal
Phone: (S . 3) • 1 „ s/ 5- S q Fax: (y'o 't) 5 q. si - 32. 5 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: / 5 Z 4 1 3 4- State surcharge (8% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature:, } �- C days after it has been accepted as complete.
Print name: ¢.,,, S ,, _, .a--c r Date: Oz. J c 0, I b j * Fee methodology set by Tri -County Building Industry Service Board
\
is\Building\Pe mitsMEC•PermitApp.doc 12/03 440.4617T (11 /02 /COMM'EB)
•
Electrical Permit Application iFOR^OFFICEIUSE"ONLY
City Of Tigard Received
Dale By: Pennit Not D — a�8. 001 r
3l25 SW Hall Blvd., Tigard, OR 97223 Cr -- .;� t ' -- Plan Review 1 L�Al "'C
Phone: 503.639.4171 Fax: 503.598.1960 V, -\,, � j I ` Date /By: Other Pennit:
Inspection Line: 503.639.4175 p <, Date Ready By: iu„s El See Page 2 for
Internet: www.ci.tigard.or.us i` Notified /Method: Supplemental Information
A
TYPE OF WORK ` , s'. PLAN REVIEW
h
all k hec a that apply:
New construction ❑ Addition /�Itcratiotilfeplacement Pl check pp 5 '
�
a tm
"' ❑ Service over 225 amps, con'l ❑ Hazardous location
❑ Demolition ❑ Other:
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft..
CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
Q 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑Master builder
❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SiTE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park
Job no.: Job site address: J 2 W 6 Sy t/ v er i r � ,� f L L ❑Health -care facility of ❑Other:
wr R..f i-- ��ubmit 2 sets plans with any of the above.
City/State /ZIP: 7, Q, J �y ) D l aoL, The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: ' e. FEE* SCHEDULE
\la + Description Qty. Fee. Total
Cross street /directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: a �
- "tea Lot no.:2 Z Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: pi y',. h��l (-.,1.- 1-- I6:}1,t. ; -) ., 601 amps to 1,000 amps 240.60 2
r 4'i r r Over 1,000 amps or volts 454.65 2
Address: "' i 2 i -
c iVt .v ' Gt L c� t 1 t,L(
, L., —
Reconnect only 66.85 2
City/State /ZIP: /3e ct l /'t 1 1 - CiL J G ' 1 7(,.:t. ((' `' Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( - 1 - y'� `, t ) ( - L ' j' r Fax: (Si )-,) (; el C,:-- -t _ , t 1
Li L 200 amps or less 1 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: !` 1 V-0( I J .1' J ` Lyyte_ , _4 i branch circuit
B. Fee for branch circuits
Contact name: ,( � / without service feeder f
ce o r eeer ee,
J { lri '� \'l �Vltut i 46.85 2
t .1 each branch circuit
Address: i f3.- �{ >i� 1
Ai ! 1 N)(ri t1 7� {. s (�l, -' Each add'I branch circuit 6.65 2
City /State /ZIP: Pee v - e , r .4. 6'Y-1 O Z --77,:,L, ." Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ('2) (e L.1.5 -Oct t c, Fax: : (t : )) / 7L) _ 7 1 4- ` Sign or outline lighting 53.40 2
E -mail: (4 ---rYI ct,(. 6-; r I lisa- V 71 Oti kGYI _ • C c'l1'1 Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: g� fir N f e. Lr0
e_60 • Each additional inspection over allowable in any of the above
Address 0 Q14 3 0. y Per inspection 62.50
City/State/ZIP: Investigation per hour (t hr min) 62.50
Industrial plant per hour 73.75
Phone: (r 2 ) G 7 $ -1 3 S s 17ax: ( 115 3) 6 2 $ -1 J o $ ELECTRICAL PERMIT FEES*
I •
CCB Lic.:
2.8 fir Electrical Lic.: 2 t�� / *‘. Suprv. Lic.: 31 4, 2' Subtotal
Supry Electrician signature, required: Plan review (25% of pennit fee)
Print name: J State surcharge (8% of pennit fee)
Q Q , ��, 6 g.g,• t.-� Date: 2 `7 0s
/ TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Prim nazi: • Date: • Fee methodology set by TO -County Building Industry Service Board
- • • Number of inspections per pennit allowed.
i:\ Building \Permits \ELC- PetmitApp.doc 1 440- 4015T(10 /02 /COM/'EB
Electrical Permit Application ti i" ' `' " 4^
r , r ±� 7 � . ,� + yl OR nl I ICI U5L 011 1 � 4
, v y t ` A 4441 ; � �
'#r. .. 3 , ,: . : .i. - r , . .;ti t ', . 4 .d.: < .4 "; . `_'` L' .. " t
�,�` ` - " ' Received
City of Tigard r l t ! ' DateB : PermitNo.: oh w 2Cf.$, ••
13125 SW Hall Blvd., Tigard, OR 97223 ■ i .�tl;,# Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,.� : "' a Other Permit:
t ��� I I ,_ DateB
Inspection Line: 503.639.4175 `1 _ ` ,: ,.`- ___ Date Ready /By: Jury El See Page 2 for
Internet: www.ci.tigard.or.us r,�U - Notified/Method: Supplemental Information
TIT., E OF WORK? ,, s t' ` eyt PLAN REVIEW
e w construction ❑ Addition /alterat 1r lepla ieni' `' -v Please check all that apply:
❑ Demolition ❑ Other: to 'l ❑Service over 225 amps, comm'I 1:3 Hazardous location
Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION . of 1 and 2 family dwellings 4 or more new residential
: 2
nd 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Building over three stories DFeeders, 400 amps or more
❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE. INFORMATION AND. LOCATION ❑ Egress /lighting plan RV P ark
r
Job no.: 1 Job site address: l (� s � /4 1- / � , Submit h -care facility ❑Other:
! V 1 Submit 2 sets of plans with any of the above.
City/State /ZIP: - '.I 1 � 1 - 1 The above are not applicable to temporary construction service.
IL S . T 1. 11 , 1 Suite/bldg. /apt. no.: Projec name: � ` ` v ?�j`� FEE* SCHEDULE `k
L Description I Qty. I Fee. I Total
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: r A 1 j � � Lot no.: ZZ Ea. add'] 500 sq. fl. or portion 33.40 1
Tax map /parcel no.: v Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
) -{i V lJ V ^"� ^ t VC) fie-61 c"( j E /„ - / c . ( dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
PROPERTY OWNER ( ❑ ,TENANT' 401 amps to 600 amps 160.60 2
Name: / v/ i 1 1 ft 601 amps to 1,000 amps 240.60 2
2 Address:
i.. mni / &v � W�w1/ Over 1,000 amps or volts 454.65 2
J Reconnect only 66.85 2
City/State /ZIP: Ll- Vto Y ' = � � GZ -! J� - 7 0 0 l Temporary services or feeders installation, alteration, and/or
� relocation
Phone: ( 5 j ( � j ) (041- J ` -()� C./, ^ Fax: (c6
, ) V / L - 251 L4 Z 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
' (� A PPLICANT I ❑ CONTACT: PERSON A. Fee for branch circuits with
� , LM service or feeder fee, each
Business name: 1 Y `/ , y b , I. 11. J J ,y)( branch circuit
• Contact name: A ® ' r B. Fee for branch circuits 6.65 2
• /Vl, " L 7vi; without service or feeder fee,
Al /,, le4 each branch circuit 46.85 2
Address: it Z5 /l W Ani PK
6� � 0 W � Each add'1 branch circuit 6.65 2
City/State /ZIP: "v v C� 7 00 Miscellaneous (service or feeder not included)
/ ✓`` pp``//,� Pump or irrigation circle 53.40 2
Phone: (5/172) O/ /' ' -(3 947 Fax:: (9:5)� 2 q
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
.
. CONTRA OR _ • . : ' energy panel, alteration, or
extension. Describe: I Page 2 2
Business name: CU i/'/'- (/ / 1 IT ,
J Aim' A-44 !vein/11 O' (.�/ w �' Each additional inspection over allowable in any of the above
Z
Address: IC)
Per inspection 62.50
City/State /ZIP: i V e/y r/1 } ' / 7�) t L( Investigation per hour (1 hr min) 62.50
Phone: () S Fax: (9 ) 4` / -2.,_?/4.- Z Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:` 1) u5 Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: C a ) This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Ail, J G / " / ' 6� Date: / , A, L ■ Fee methodology set by Tri-County Budding Industry Service Board
" Number of inspections per permit allowed.
i:\Bui lding \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM /WEB
857309
L IST IN G W
PNWS -AWWA BACKFLOWASSEMBLYTESTREPORT 0 REMOVED
PROPERTY �ti vet 5t J „ , l
❑ REPLACEMENT
OWNER: h \ - \ O 1�► { C PHONE:
MAILING
ADDRFSS:
CITY STATE ZIP
ASSEMBLY 1 �J • ` 2Q phatI Lm. �is4vA 6L
ADDRESS:
STREET
❑R.P.B.A. 0 ' D.C.V.A. ❑ R.P.D.A. ❑D.C.D.A. ❑P.V.B.A. ❑S.V.B.A. ❑A.V.B. ❑AIR GAP
SIZE: 1 1 l J. O OI MAKE: (kJ Ilk-LW:. MODEL: C IS0 XL
WATER
PURVEYOR: Ci 41 4 ID; 4iv{ NUMBER: �.�I 0 Z !
ASSEMBLY ��� pp s j
LOCATION: S. w- Si� 441) t. 1 h IRIF-idVSI
REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
NI CHECK I "DOUBLE;.CHECK` = AlR CHECK PASSED
PRESS DROP (Al CHECK #1 INLET FAILED ❑
INITIAL OPENED AT
(B)ITIGHT V • 7 •N OPENED AT: PRESS DROP
TEST MIN 2 PSID PSID DATE:
RESULTS BUFFER LEAKED ❑ L in / l O
I CHECK #2 PSID PSID
MIN 2 PSI 1,,, 1
RELIEF VALVE ITIGHT L 7.9 DID NOT FAILED SYSTEM
PASS ❑ FAIL ❑ !LEAKED❑ PSID OPEN ❑ ❑ PSI GS
•
COMMENTS
REPAIRS
AND /OR
PARTS
REDUCED PRESSURE ASSEMBLY P. V.B. A. /S. V.B. A. AFTER REPAIRS
NI CHECK - •D:C.V A
PRESS DROP (A) I DATE:
TEST CHECK #1 • RELIEF I OPENED AT PRESS DROP
AFTER OPENED (8) TIGHT ❑ PsID
REPAIRS BUFFER 'm°' °� ( CHECK #2
A•B- .mnvs: TIGHT ❑ PSID PSID PSID PASSED ❑
IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND, - REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CA N DATE WI h / In DETECTOR METER, READING
TESTER SIGNATUKE` CERT
3 *+,.: A. 1 id, team c5k6112zz v
TESTERS PRINTED ` /. Av,„ GAUGE 4
e5 7 al'� fit' l�i�� �'a3. 494,8 - 66 7
TESTERS ADDRESS ' PHONE #
41 r I4o L Rand '5c4, _
COMPANY NAME
(SERVICE RESTORED
REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER)
WHITE - Water System Copy r PINK • Customs Copy YELLOW - Testa Copy
Oregon Residential Specialty Code N1107.2
HIGH- EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: M 5 i Z0 B 00 (24 Jurisdiction: Ti' r Q
q
Site Address: 1 Sk) REt�bra i&�+ La ,Ae � Q
J
Subdivision/Lot #:
-e1l0. U t S4 a. io- 22
and /or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code Ni 107.2)
Signature: CDate:��� /0
Owner /GenConnt orized Agent
VMS i C H cry.A.e -S
L e.e.-_ Print Name: ) e
ORSC Section High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
1: \ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08
MS r /(}c) :oI $
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
1, R I V e s l de_ H o vin e _ S L L C_ , am the general contractor or the owner - builder
at the following address:
Site Address: L
12.65$ SW RembratAokA L hC.
City:
r ;jar
Permit #:
f\A 12.Oo$— Oo1L4-
Subdivision/Lot #: be-( k W
/ I f.� (_ 4 3-a
and /or V
Map and Tax Lot #:
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture- sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: r,t, /A Date: -z- _ i a
General Con a ctor or Ow uilder
RI ✓e c.5 de.. m es 1.1,-6i
l:\ Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08
_ _
--Jr-
ST ;; , , ET T . ' 4 C ERTIFICATION :,:rilITIF ICAT I ON
..0
, __________ . _________
, ,
1_ I, 1! Se, Hy , O wner /Ag ent for � 1J E K 5 t b E H o wt E S U__C_
(PLEA PRINT) - } I r (PERMIT HOLDER)
_
Do hereby; certify, that the following location meets
City of Tigard land use and ide standards
for - street tree installation.
1
i f f i 1 ,
i 1 V r\,\ )..;} 1
ADDRESS: I Z Co 5 Sl,.) R evrt h ref d.`F Lc, e
SUBDIVISION: .5e (( U S4-c LOT: Z Z
SIGNATURE: DATE: 4 -Z 9_ lD
pi Y j ." /AGENT)
RECEIVED BY: DATE:
(CITY OF TIGARD)
AIRECIP
1:\ Building \Forms \StrcctfrccCcrtificatc 01/19/07