Permit MASTER PERMIT
CITY OF TIGARD
PERMIT #: MST2004 -00185
A "'Sktilti l, DEVELOPMENT SERVICES DATE ISSUED: 10/8/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14145 SW 89TH AVE PARCEL: 2S111A■-09200
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 076 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: MAS22143 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,464 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 832 sf GARAGE: 620 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 TI-IRO: sf RIGHT: 5
VALUE: 230,802.00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2.296 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: , VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner Contractor: TOTAL FEES: $ 7,249.81
FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION This permit is subject to the regulations contained in the
FO R BOX CON FO FOUR
BOX CON Tigard Municipal Code, State of OR. Specialty Codes
PE AVER TON, OR 97075 PE AVER TON, OR 97075 and all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire
if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
Phone: 503 - 590 - 0805 Phone: 503 - 590 - 0805 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 71037 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanica: Electrical Service Low Voltage Water Line Insp Plumb Final
Sewer Inspection Underfloor insulation Electrical Rough In Gas Line Insp Water Service Insp Building Final
Footing Insp PLM /Underfloor Framing Insp Gas Fireplace Appr /Sdwlk Insp
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final
Post/Beam Structural Plumb Top Out Exterior Sheathing Ins K Rain drain Insp Mechanical inal .....
Issued By : ' ■ ' - it Permittee Signature : ; - mi
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne busines- day
I. Sae) U OS/ _ voo6'2
Building Permit Application v FOR OFFICE USE ONLY
CI of TI and �� Received , /
Ty g �O Date/By: 42 /4/ G7 Permit No.: w _00 / 65
13125 SW Hall Blvd., Tigard, OR 97223 `\- Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 : _�
A R , DateB : h 6 • ' - C ' Other Permit. I i II ��/ 740
'� N ip
Inspection Line: 503.639.4175 `' .; J. ' � I ' � _, Date Ready/By: pow ® See Attached Checklist for
Internet: www.ci.tigard.or.us \I ` Qw Notified/Method: ` t / 0 . Supplemental Information
E ---0E—WORK : REQUIRED DATA 1 - AND 2- FAMILY DWELLING
New construction ❑ De molition
Permit fees* are based on the value of the work performed.
P Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
` " 's - r- C ATEGORY OF CONSTRUCTION work indicated on this application.
1 � .ti
Valuation: $
g 1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms: 5
❑ Master builder ❑ Other: Number of bathrooms: 2 //Z
1,114.111104 JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: /41/44c S t.>.). c? ,W 1 A1 42 de.. New dwelling area: 2 2 ?eO square feet
City/ State/ZIP: - 7- 1 , v/. Garage /carport area: 6:2 0 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 2 oa? square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
R DATA: COMMERCIAL -USE CHECKLIST
Subdivision: '"--N,ejlla_iis lost lI 74V Lot no.: 76 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 the profit for the
0: 110 g E 016 *: work indicated on this application.
2 2 /1/ / LISA Valuation: $
� Existing building area: square feet
New building area: square feet
} � ' " • 4` Number of stories:
Name: Fi3C.G 4 2 (2 X7-2-€4,776/6 Type of construction:
Address: Cp ( .9.-
' 5 9 7 Occupancy groups:
City/State/ZIP: q J `
e/3 4x 92 ) 7S Existing:
Phone: (, ` — p— [�, Q s- Fax: (3) SP-)/ 7 &/ New:
m s , � 4"
, y '" * NOTICE
� � � "fir �. s� i . ,�? a�� S.YE. � _ 6 .�wx' > �� _�,.�. 5.. Y k .g 4
Business name: ,192. - g_ •.. u All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: apply:
PP Y:
Phone: ( ) Fax: : ( )
E -mail:
m ,, €* � � rcz 5 r� - 3 a-v, i i,-- Na ,poi
Business name: ` Q ic i r f )9,44)11,e,.., BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/ State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.: 7/ cj3 7
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: � 11 o4 / R ► �pr�v ,ej Date: 6.-. /0 _ 6 y * Fee methodology set by Tri County Building Industry
< / Service Board.
isBuilding \Permits\BUP- PermitApp.doc 12/03 440- 4613T(I1 /02/COM/WEB)
One- and Two - Family Dwelling '
Building Permit Application Checklist FOR OFFICE USE ONLY
Received Permit No.:
City of Tigard Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 A l ❑ Electrical ❑ Plumbing ❑Mechanical
24- Hour Inspection Line: 503.639.4175
Internet: www.ci.tigard.or.us ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. El ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. El ❑ ❑
3 Verification of approved plat /lot. El ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ El
•
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ El
6 Sewer permit. El El El
7 Water district approval. El ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
1 1 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ El
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ El ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable. -
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ El
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ El
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ El
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ El ❑
architect licensed in Ore: on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ El ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ El ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ El ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ El ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ El
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03
. r C C' IV EI)
Electrical Permit Application 2004 FOR OFFICE USE ONLY
1
City of Tigard Received
Permit No.: My [ "
13125 SW Hall Blvd., Tigard, OR 97223 r T�G PR 6 Plan Review
OF Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 G D.V IS l i 1 . Date/B : Other Permit.
Inspection Line: 503.639.4175 _3VILDIN __a ! .L Date Ready/By: Juris El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
X New construction ❑ Addition/alteration/replacemen Please check all that apply:
❑ Demolition ❑ Other:
['Service over 225 amps, comm'l ❑Hazardous location
� , ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
7 7 . ?t. W i of I- and 2- family dwellings 4 or more new residential
j[ 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 0 Master builder ID Other:
b f ■t „: ['Occupant load over 99 persons Manufactured structures or
F 1`OB:, i TIO ..., U - � " a : PE plan RV park
Job no.: Job site address: /4//s S' 4,e., ❑Health -care facility ❑Other:
��� Submit 2 sets of plans with any of the above.
City /State /ZIP: 7 O4 V ' 7 22 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: ; SCHEDULE
Description 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: n ryi S, a 2,4 e `..3 I Lot no.: 7 /j Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential ig 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
- I I,, . '�„ tr _ ",4 Each manufactured or modular
" f�� r - / dwelling, service and /or feeder 90.90 2
5 `-�"" / .. /4'A-' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
I� ' au i -.,-1,..;: x:, ,. tom. 201 amps to 400 amps 106.85 2
a _ _: ,_e .: s� . �, . - ,/' . _ ('- maim 401 amps to 600 amps 160.60 2
Name: t `2 0--6 r, t o Q�s- 601 amps to 1,000 amps 240.60 2
Address: L)- 2 6.2.- /L5 F2 7
Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP:0 /96. - �., pie../ Temporary services or feeders installation, alteration, and /or
relocation
Phone: (5b3 ) ,5 -L)a 6 I Fax: (s1,3) `j, o..-- / ]tom/ 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 si: attire: Date: Branch circuits - new, alteration, or extension, per panel
, ce �, � �s' x �` � * 1 , 0 p , A. Fee for branch circuits with
J service or feeder fee, each 6.65 2
Business name: 2,,,,,,,„,,9.e „9.6 b �/ branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, •
each branch circuit 46.85 2
Address: -
Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
' '. , . : E x :. , V y ' .,, ' w : 4 ° ” energy panel, alteration, or
ro -. -.
extension. Describe: Page 2 2
Business name: T / y�,,,e/e
Address: 7S �', Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: 5O'?Liq�,, d Q 12.22 / Investigation per hour (1 hr min) 62.50
Phone: 3) �7� Fax ( ) Industrial plant per hour 73.75
; „. f ii 1 E ?C1V0At,, -E * , '
CCB Lic.: 93a y Electrical Lic.:2 t 2 ' e Suprv. Lic.3 6 , Subtotal
Suprv. Electrician signature, required: 2.....43.1,-�L ( Plan review (25% of permit fee)
Print name :2 Jb �e a� Date:k,— br D State surcharge (8% of permit fee)
nnnn��� �` TOTAL PERMIT FEE
Authorized signature: yZr /� This permit application expires if a permit is not obtained within 180
` � 1 days after it has been accepted as complete
Print name:c /I� ` D�.�I ,P Date: b- /6 6 * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Perrnits\ELC- PermitApp,doe 12103 440- 4615T(10 /02/COMJWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WbRK�()NLY .
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ B urglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
ftlf
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: -
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pemtits\ELC- PermitApp, doc 04/03
3
Mechanical Permit Application ' FOR OFFICE USE ONLY
City of Tigard ooy Daete Permit No.: 1.49060,4_ 00 ,15 -
S
13125 SW Hall Blvd., Tigard, OR 97223 \ L4 Plan Review
` dI
Phone: 503.639.4171 Fax: 503.598.1960 ‘` j�'. /f,� O°Np�f 1 , °` DateBy: Other Permit:
Inspection Line: 503.639.4175 ` � , C' v + Date Read B Ju ris: El 'I OC -! V i ° ! Ready /By: See Page 2 for
Internet: www.ci.tigard.or.us 1 - '0 \ 1 �� o \ Notified/Method: Supplemental Information
:.1 _' q7 7 ;6 - a � -kO FEE* SCHEDULE - t3SE«CHECKLIST
New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
y i1 -' L * CON CTl 44: Value: $
S1DFNTIA,L I QUIPMENT / SYSTEMS FEES
NI 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. Total
:' ,. j ;l `I l pz i ' '0D U 'I . a , ,,. '= Heating/cooling
Job site address: /, jj �/ -� Air conditioning or heat pump
���� !� ��/ ,, (requires site plan showing placement) 14.00
City/State /ZIP: '7-< , ,,q4/ • b � ?7224{ Fumace 100,000 BTU (ducts/vents) 14.00
c/ / Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: I 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: , nS C.J/9 f AR I Lot no.: 7 Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
r r a a: 3' - a a - ' Water heater 10.00
c te / Gas fireplace 10.00
e--c 4/ Alt-1 -J / X a 4 -ti Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
.u * f� sst 5 , i . , tv J; °r Chimney/liner /flue /vent 10.00
7.41 . 4 r `,f ,� "4,: W es•., , --4,n, . � 'a -i Other: _ 10.00 _
Name: Foci ,t, 7 / _- @-t>' Environmental exhaust and ventilation
Address: C� C� Range hood /other kitchen
j� U. �� As9 7 equipment 10.00
City/State/ZIP: ,(Sly./ O� 7 U 7 S
i Si gle -da exhausts(bathrooms, 10.00
Phone: (513) S'9'b- O S Fax: (STZ 576 - '17 (S toilet compartments, utility rooms) 6.80
r � ��
:. i s ` " . 4 1 " � : M Attic /crawlspace fans 10.00
Business name: n J Other: 10.00
J /g l� 6 U +-__ Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended /unit heater
Phone: ( ) 1 Fax: : ( ) Water heater
Fireplace
E - mail:
Range
4 T .- , n q 4 ,': , � - ' ' -':'' Barbecue
Business name: g ... e ; / - '
Clothes dryer (gas)
� ti J Other
Address: /6 O/ S / U.� F l ,' ' eliAit`TiGAI. vit -f- LES *
City/State /ZIP: /zeS d D3G6z brL 9 7/2 3 Subtotal
Phone: C 3 6 p -S6 e/ 3 Fax: ( ) Minimum permit fee ($72.5
Plan review (25% of permit fee)
)
CCB lie.: 6 (O S7?. State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: ;(� d ow/4a This permit application expires if a permit is not obtained within 180
/ Y ate Nt/¢/li /t',/ s days after it has been accepted as complete.
Print name E � Date: / / L}-d, / * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PermitApp.doe 12/03 440 -4617T (1 I /02/COM/WEB)
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information
Commercial Fee Schedule:
n "
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\ Building \Permits\MEC- PernvtApp.doc 12/03 2
'Building Fixtures rGOw GD
•
• G
Plumbing Permit Application ■ 4 FOR OFFICE USE ONLY
City of Tigard .. .MA- .. ... 0 Rece€iew rm pe t No.:
13125 SW Hall Blvd., Tigard, OR 97223 -{ Y OF n N c 1
Phone: 503.639.4171 Fax 503.598.1960 ' �' \ D a t e B y: J uris:
Other Permit No.:
24- Hour Inspection Line: 503.639.4175 BULL D, ( - " ' ' ,.:I 11
Internet: www.citigard.or.us ... D ate Rea d yBy: H See Page 2 for
g Notified/Method: Supplemental Information
a v ti FE SCHEDLR E
p New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
r. ,`,a i � <k � a . ; 1 ` t ' GO ._<.., . , - SFR (1) bath 249.20
[Ij 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
,e -:c9 Site utilities
Job site address: iY / . lit) c p 9 ,4/ v- Catch basin or area drain 16.60
City /State /ZIP: - 77 , 9/4 / 0 /- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
t o -• lie - %
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: C, g...51w 64e (p,,,, '/ ' 2 I Lot no.: 76 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no
,, a Absorption valve 16.60
- � . a`c., , , , "-t. Backflow preventer Page 2
,01,1 LJ .24w -ze_, Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' :. d .. " ,;, Drinking fountain 16.60
Ejectors /sump 16.60
Name: c e 4 I ?i Expansion tank 16.60
Address: l'' o ' ( 2 9 7 Fixture /sewer cap 16.60
City/State/ZIP: U..AJ 1 D , 2 2 b76-- Floor drain /floor sink/hub 16.60
Phone: (57S L S - `jd ���' Fax: (� ) ,_S 7,5 Garbage disposal 16.60
I .a's t a M °i Hose bib 16.60
Ice maker 16.60
Business name: ` C/9-714,.._ /4. -4'/ o Iry Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: 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:
Uri 16.60
�� e / � ; �� �, �� � � � i s .k4 . * .. " Water closet 16.60
Business name: � Q .24,--,-yi.,e‘ ./Ajy1 Water heater 16.60
Address: i S ,Z s c e ,..c7 .L-S - , V- c.. Other:
City/State /ZIP: /_/ /zS 1j ox__ 97/2(3 Subtotal
/` � Minimum permit fee: $72.50
Phone: (563) bow'2-3` ( Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: ,4 / 9 7 Plumbing Lic. no.: g (/ /y1 Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 1�z c/ L - TOTAL PERMIT FEE
Print name:, / j� /"--01.1.,2_,2...r } (f Dater, -- /0 d f ., 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\PLMF- PermitApp. doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
WO fl Q re9 (ea) , mar S lua oota e . Permit:Tee:-
Footing drain - 1' 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 - 1st 100' 55.00 _7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas S stems:
Water Service - each additional 100' 46.40 .� •€
Storm & Rain Drain - 1st 100' 55.00' prm1 `e•
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $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.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
' 1 41 4 Q uauft _ � unite '4VOkd!fbrme
V . 44 4 �� stirs �;d ., Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley Quantity Total
Comme ;at Isometric or riser diagram is required if fixture quantity
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:' Building\Permits\PLM•PermitApp. doc 3/03
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: MST2004 -00185
13125 SW Hall Blvd., Ti and OR 7223 DATE ISSUED: ?
� `3 1 �/Q
Phone: (503) 639 -4171 io m���r 11 N1i��gp�ipli I �
Inspection Requests (24 Hrs.): (503) 639 -4175 '_-
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 18
SITE ADDRESS: 14146 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 076 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached. 4/11/05: ADDED A/C.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503590- 0805
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720 -7445 MOBL.
Inspection Request Scheduled For: Date: 4/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 004866-05 503 -720 -7445 Y
Corrections/Comments/Instructions:
/ 4 , , j
7
i
v .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
E FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 722‘-6 �
Inspector: Date: ' Phone #: (503) 718-
.
CITY OF TIGARD /
BUILDING DIVISION PERMIT #: MST2004-00185
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/8/2004
Phone: (503) 639 -4171 ,,,,, " 4 /���gp�ir,? I � � ��
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'
INSPECTION WORKSHEET FOR DATE: 4/20/2005 TIME: 7 :11AM PAGE: 9
SITE ADDRESS: 14145 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 076 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached. 4/11/05: ADDED A/C.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503590-0805
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720-7445 MOBL
Inspection Request Scheduled For: Date: 4/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004959 -02 503 - 720-7445 Y
Correctio s /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date / r 2 o J Phone #: (503) 718 -
7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: NiST2004.00186
I 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/8/2(X04
Phone: (503) 639 -4171 4,,, � �il"'HP'��Ci l iI' \
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'
INSPECTION WORKSHEET FOR DATE: 4/21/2005 TIME: 7:08AM PAGE: 8
SITE ADDRESS: 14145 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 076 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO 3
DESCRIPTION: New SF detached. 4/11/05: ADDED NC.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503.690 -0805
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720 -7445 MOB..
Inspection Request Scheduled For: Date: 4/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 005068 -09 503- 720.7445 N
Corrections/Comments/Instructions:
Or ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 4-- Phone #: (503) 718-
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: MST2004 -00165
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/6/2004
Phone: (503) 639 -4171 :w41°1104 � '�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/21/2005 TIME: 7:08AM PAGE: 9
SITE ADDRESS: 14145 SW 69TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 076 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached. 4111/05: ADDED NC.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 5035900605
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720.7445 MOBL
Inspection Request Scheduled For: Date: 4/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 005068-08 503-720.7445 Y
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: 4- -2/ t,S" Phone #: (503) 718-
IP
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ADDRESS: /9/ /5 S, . 8 7ii-
LOT: 76 SUBDIVISION: / Q D / 3 4 2 )c
BY: /7_7 7------- ' J DATE: 'Y 1/
RECEIVED BY: y� DATE: y - /J - (L5 ---
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. CITY OF TIGARD Credit No.: 20 a4 - 000 1-
Date Issued:
RECEIVED
Engineering
'%MU 'II \ Authorization OCT 8 2004
Date: 3- 23 -040 OF TIGARD
TRAFFIC IMPACT FEE
BUILDING DIVISION
CREDIT VOUCHER Land Use
Casefile No.: SUB2003 -00002
In accordance with Ordinance 379 (Washington County Traffic Impact Fee Ordinance) Four D
Construction
developer) (name of
is entitled to $ 44,194 in Traffic Impact Fee Credits that can be applied to TIF charges for
development on lot(s) 1 -27 of the Greensward Park 3 Development. The use of TIF credits are
subject to the rules and limitations of the TIF Ordinance which are listed on the back of this voucher.
WARNING: This voucher must be presented at the time of issuance of the building permit, or if
deferral was granted, issuance of an Occupancy Permit.
Q J � P. � --
Director(
Date Permit Numbers Lot Numbers Credit Used Balance
Beginning Balance $ 44,194
5 - 1 26() ,/— 06637. 8 2.53 0 Ok7
5 -12 -6y 266 `/-otig, 83 253 0 -
0 . - ei .Z.004 -0013) g .2,6 3 `- - 0-0
7-- gI - 64 .zeo -66 i A5:30 3 •
y= 2.3-x'-! 2/�cJY _g 4 7 i :,26 9 D „2._6 3..21
9 -/7 -0,/ Awa- 0o1S8 85 ,2536 ^ �7
23,q `I
9-,7-09 .9041i—wig? $ 4 53 o- — �f 'all 6 '' s' .
Balance carried forward to TIF Credit No.
• Ordinance 379 provides for an expiration 10 years from authorization.
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