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Permit • r C CITY OF TIGARD D DEVELOPMENT SERVICES MASTER PERMIT PERMIT #: MST2004 -00065 , � DATE ISSUED: 3/17/04 L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 SITE ADDRESS: 14065 SW 89TH AVE PARCEL: 2S111AA - GP379 SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R -4.5 BLOCK: LOT: 079 JURISDICTION: TIG REMARKS: Model home. SF detached. DEMO CREDITS FROM BUP2003 -00519 TO BE APPLIED TO THIS PERMIT. BUILDING REISSUE: PH2197D STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,269 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,536 sf GARAGE: 726 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 279,064.80 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,805 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: BOIL/CMP < 3HP: i VENT FANS: 4 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: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: 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: 0TH: 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: $ 3,667.55 This permit is subject to the regulations contained in the FOUR D CONSTRUCTION FOUR D CONSTRUCTION Tigard Municipal Code, State of OR. Specialty Codes and P.O. BOX 1577 PO BOX 1577 all other applicable laws. All work will be done in BEAVERTON, OR 97075 BEAVERTON, OR 97075 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. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: Phone: 720 - 7445 MOBL Oregon Utility Notification Center. Those rules are set Sqqp 5 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LI 080 71037 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing InsF Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation Ins. PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Buildi !, inal � j I-sued B ,.: +1 /I „ d ' Permittee Signature : ��� rf� Y ► ,rte _ Call (50 ) 639 -4175 by 7:00 p.m. for an inspection needed the next bu mess day ! . w . , Building Permit Application FOR OFFICE USE s ONLY ctl ?QQ —ooh City of Tigard Receive CE IV E D Date/By: d o� % 7 cy 0 S root) v _ � 965 R ; Permit No.: 13125 SW Hall Blvd., Tigard, O Plan Review , ! Phone: 503.639.4171 Fax: 503.598.1960 " ', �, , I ' Date/By: Permit: y: o`l�r -� 4AA�7 Inspection Line: 503.639.4175 1 9 2004 s _� ' I , Date Ready/By: Juris: ® See Attached Checklist for Internet: www.ci.tigard.or.us FEB 1 Notified/Method: n4 Supplemental Information CITY OF TIGARD 1a ,E ,' ' " = k , ga... Y , 4 -..E 4,, � 3 RE QUIRED DATA 1- AND 2- FAMILY DWELLING IRINew construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all El Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the s work indicated on this application. Valuation: $ Xf 1- and 2- family dwelling ❑ Commercial /industrial # 2,5 g 006 El Accessory building ❑ Multi- family Number of bedrooms: 3 El Master builder I=1 Other: Number of bathrooms: 2 //i - '� 1 ,;.:1, s i, JO SITE INFORMATION AND L `O 1 .° Total number of floors: 2 Job site address: / tip , .45 W 679ze,4. t .. New dwelling area: 2,5:25g- square feet City/State/ZIP: --7—/9/4/21/ area: 726 square feet - r�yar�� vx .�y�. v g 722� � Suite/bldg. /apt. no.: 1 Project name: Covered porch area: / 3e/ square feet Cross street/directions to job site: /M Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: G e j j 4jeciAl (pi9ete 3 I Lot no.: 7 I. 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 .� ''-t s ' y , f ' 0 W t i work indicated on this application. Al-.44 � Valuation: $ ,LJ � Existing building area: square feet New building area: square feet ' .-r�.; * .. b .. e 1,i �l h '�° . 4 - i Number of stories: Name: r ,,,... ) �idh * �.� 4 0 Type of construction: Address: tp� D 1s 7 7 Occupancy groups: City/State/ZIP: 2. ft , ,„,..4,,,_, ,„,..4,,,_, h X_ 9 7 O 7s -7 Existing: Phone: (SIC) _3) 3 — O e t $ Fax: 5f SJ / / S I New: 4 r ml f y ,,, , i � � ,, . tt ' , : ` ,, NOTICE Business name: J 4Z ` A 6 b 0,, All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: / State/ZIP: applicant is exempt from licensing, the following reasons ty apply: Phone: ( ) I Fax: : ( ) E -mail: Business name: S'xt. A 4 h, D 0,4_, BUILDING PERMIT FEES* Address: Please refer to fee schedule City/State /ZIP: Fees due upon application Phone: ( ) Fax:( ) Amount received . CCB lic.: 7/() '37 Date received: Authorized signature: '/ This permit application expires if a permit is not obtained i e within 180 days after it has been accepted as complete. Print name: - 2) 4ze,7,Q ffb27— Date ? --/(L b C * Fee methodology set by Tri -County Building Industry Service Board. i:\Building\Permits\BUP- PermitApp.doc 12/03 440- 4613T(I1/02/COM/WEB) Building Division Ang Plan Submittal Requirement Matrix Commercial & Multi- Family - New, Additions or Alterations City of Tigard Type of Submittal # of Plans (Includes new, additions and alterations) Required at Submittal Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* Fire Protection System 3 ** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i:\Building \Forms \COM- PlanSubReq.doc 12/24/03 Mechanical Permit Application FOR OFFICE USE ONLY Received City of Tigard Date/By: Permit 4 No.�ly �� �W[/ 99 IIYY - 940 / ace . 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 REC i'n,, X1 -'1' Plan \ DateBRey: v iew Other Permit: Line: 503.639.4175 I� Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us FEB 19 11{ Notified/Method: Supplemental Information TYPE % °OF Wf irk OF TIGARD COMMERCIAL FEE* SCHEDULE USE CHECKLIST 0 New construction ❑ Addition /alte S t� ��15' 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. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* f5ii 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special inforniation use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling /, r Air conditioning or heat pump Job site address: / b S, G , 9 /- 4i U.-e/ (requires site plan showing placement) 14.00 City/State /ZIP: - l ,4/2�/" (DX._ < 7 22-C, Furnace 100,000 BTU (ducts/vents) 14.00 ✓ l 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: Cdr i j�, I.ot no.: '7 9 Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION. OF WORK. Water heater 10.00 " Gas fireplace 10.00 Ae titnl /../0- 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 Chimney /liner /flue /vent 10.00 A PROPERTY'. OWNER ' - ❑ TENANT` Other: 10.00 Name: 9U ( 7) Sg et. GT/ p Environmental exhaust and ventilation Address: ? 0, 0,x r7 7 Range hood /other kitchen equipment 10.00 City/ State/ZIP: e , �� 97 0 7 5 - Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: 253— .S90 . 'O80S Fax:53) 5'7c _- / 757 toilet compartments, utility rooms) 6.80 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Q � � H, Fuel 10.00 Business name: U U"'L� Fuel t to P�P� h 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: ( ) Fax:: ( ) Water heater Fireplace _ E -mail: Range „f s F , . . ..,. _ 4 rtft , - `,7,- E ; ...� fig? 4"Ve Barbecue Business name: G Clothes dryer (gas) - / �lly Other: Address: / L 0/ S T! 0...aj"" Zit-- MECHANICAL PERMIT FEES* City/State/ZIP: / 2 7/ ZZS46b 3, 6 9 `3 Subtotal Phone: (�i )'C2 p 6 , Fax: ( ) ! Minimum permit fee ($72.50) J"" T✓ Plan review (25% of permit fee) CCB lic.: 4 g -- 7 ? State surcharge (8% of permit fee) �,y�,f TOTAL PERMIT FEE Authorized signature: ���/4: -ko This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: )a,M f ,VI ` 11/„g p ' /Q —C. • Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Permits \ MEC -Pere itApp.doc 12/03 ! ` 440 -4617T (I I /02/COM/WEB) Mechanical Permit Application - City of Tigard • Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $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\Pernvts\MEC- PermitApp.doc 12/03 2 .Electrical Permit Application FOR OFFICE USE ONLY Cit of Tigard Received Permit No. Y Tigard DateB : / �. � / /j 4 i ✓ 13125 SW Hall Blvd., Tigard, OR 97223 _ Plan Review Phone: 503.639.4171 Fax: 503.598.1960 C r E °" ' K. 1 i s Da�gy: Other Permit: Inspection Line: 503.639.4175 `V 1 . 1 ° • _ 1 . , Date Ready/By: J Ed See Page 2 for Internet: www.ci.tigard.or.us ' I ' Notified/Method: Supplemental Information ' r .. - i .-. ,� n • _ ,a Please check all that apply: ' ❑ Demolition ❑ Ot h er : - 9IM DIVISION ❑Service over 225 amps, commI ❑H FQ New construction ❑ Addition/alt / azardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., .i,��°' W ti �c I t „ °, I� _ of 1- and 2- family dwellings 4 or more new residential 14 1- and 2- family dwelling ❑ Commercial/indust ~❑ Accessory bu ❑System over 600 volts nominal units in one structure ❑ Multi - family El /vi builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more t I ° j b 1 o 4 _ ❑Occupant load over 99 persons ❑ ktured structures or '41 ikttii4J' -�> .t��� ,_. ., ,-. ❑Egress/lightingplan P q ❑ Health -care facility ❑Other: Job no.: Job site address: eft W t / 7 g U-c.' Submit 2 sets of plans with any of the above. City/State /ZIP: 77 ✓ p/ba 0 A-, g 722 if The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: `' R E Description I Qty. Fee. I Total I *" Cross Street/directions to job site: New residential single- or mult - family dwell un Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: r- ln.Je t ���/r - 3 I Lot no 77 Ea. add'l 500 sq. R. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 _ Limited energy, non - residential 75.00 2 -., ° . - g ° • $: # z ff`'+ Each manufactured or modular �,V /' -uj dwelling, service and /or feeder 90.90 2 z j-^ / -76-3 -• Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 �: 201 amps to 400 amps 106.85 2 i ''1'N & $ '' 401 amps to 600 amps 160.60 2 Name: j v u A ash- S72 �G O 601 a mps to 1,000 amps 240.60 2 Address: ( U. e g /57 7' 7 Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: 2 1 ' 2 ,e d,- Q 7 67S Temporary services or feeders installation, alteration, and/or Phone: 5 1). c> p I Fax:L$a3) Seto — 75s/ 2 200 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 a '" m i . I t A. Fee for branch circuits with i � .. - ` 7 . ' "` service or feeder fee, each Business name: S fi yjw Af nA o //C.. branch circuit 6.65 2 / 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: ( ) 1 Fax:: ( ) Pump or irrigation circle 53.40 2 1 Sign or outline lighting 53.40 2 E - Signal circuit(s) or limited - . ,ci.:. _� i ._ " Q > »s -.M< .. . . energy panel, alteration, or Business name: ' extension. Describe: Page 2 2 v6�,e7 E1�71e /C Address: S s 4 -. '/d /j ��, Each additional inspection over allowable in any of the above 7 / `f r' Per inspection 62.50 City/State/ZIP: ep0 �'i L��iz p �►,e, t7 Investigation per hour (1 hr min) 62.50 Phone: (5* )22 ? 76-'4( Fax: ( ) Industrial plant per hour 73.75 CCB Lie.: 9 3 Electrical Lic.: q-23c1 Suprv. Lic.38� S Subtotal Suprv. Electrician signature, required: �fc Plan review (25% of permit fee) Print name: 70/ �, C / LX � a#4 .2�/� Date: _ ��`// State surcharge (8% of permit fee) � � TOTAL PERMIT FEE Authorized signature: �� G LL /jL This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: rk t� ti� An ( ^ Ld Date: 7 /0--041' * Fee methodology set by Tri- County Building Industry Serv Board °° Number of inspections per permit allowed. iMiuildinglPer ita \ELC- PennitApp.doc 17103 440 -461 ST(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTI IL WORK ONLI } j a , Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: toei Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \Permits\ELC- PermitApp.doc 04/03 . Building Fixtures RECEIVED Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard FEB 19 201 Received Permit No.: 7,, Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 T IG • ' D Plan Review Phone: 503.639.4171 Fax: 503.598.1960 CI OF ,, I Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 BUILDING D . •I i Date Ready/By: Juris: 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information 1 1 FEE* SCHEDULE '" l'.14-.,,,. For special information use checklist. X New construction ❑ Demolition Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: ,, 1 - 2- family dwellings (includes 100 ft. for each utility connection) :. i r :,te. � a F ,i �' ., � ' < r� , 249.20 3 v i • ., ,t �s !• 64'e q t ... SFR(1) r"+ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 SFR (3) bath 399.00 El Accessory building ❑ Multi - family Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2 « H ' Site ut Job site address: S, W CP 2 ic (J4' Catch basin or area drain 16.60 City/State/ZIP: l q ,4R� p A. ? 7,22 4 Drywell, leach line, or trench drain 16.60 c/ __ Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: C ..Sz t. ,vg.ei // A'✓ 3 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 //He_ 7>crktodee- Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 (f� _ _ 99fe I Lot no.: 79 Water service (no. linear ft.: Page 2 Subdivision: tom' / ft Fixture or item Tax map /parcel no.: Absorption valve 16.60 , -.4,,,,' , ,,,,,' g ,- ive4` - r ;1 t ' gig; , � _ , . % Backflow preventer Page /. / fll1L -4.-. Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 r ,: w ^,, Drinking fountain 16.60 1 � l . 1 11° ' Ejectors /sump 16.60 Vi' > w; � ' � .�? � . u �._,�. x -'�,� Name: F 25 & STIf e.e cl'Oj(q Expansion tank 16.60 Address: D ' /_.s.-- ? 7 Fixture /sewer cap 16.60 City/ State/ZIP: il ,, a.c 92 c7 ,sue Floor drain /floor sink/hub 16.60 Phone: (Sal ) ..5,9c.,-. 0 Fax: (S .5 7S 9° - /Y Garbage disposal 16.60 Hose bib 16.60 144.474;1174;:"'- tai ` OF. h a v , 3 ...t9 Ice maker 16.60 Business name: S /I fl. fj p (i.e./ Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) I Fax:: ( ) 16.60 Tub /shower /shower pan E -mail: Urinal 16.60 ewi s i 4 � ' Water closet 16.60 Business name: �.,./.. Z P2 (.4 JJ Water heater 16.60 Address: /5 s A 0.'2.„. Other: 7 / Subtotal City/State /ZIP: /Z � ,:l.,1-6, t), 97/2 3 Minimum permit fee: $72.50 Phone: 4 Sz)3 - ` // Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: / 1 9 7 Plumbing Plumbin Lic. no. (l Plan review (25% of permit fee) ' i ��// State surcharge (8% of permit fee) Authorized signature: e C.. TOTAL PERMIT FEE Print name: , /( JJ F Q, Date: . /(� --(� ce This permit application expires if a permit is not obtained within /� a L 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i'\ Building \Permits\PLMF- PennitApp.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: Site Utilities Q ty Fee (ea) Tota Square Footage: Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $115.00 2,001 to 3,600 $160.00 Footing drain - each additional 100' 46.40 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 Systems: Water Service - each additional 100' 46.40 valuation • Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $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 Fi y tllli k tern QtX . ; :Fee.(ea) ;, - Total 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 * . Quantl `,by(FixtureyWorlkPerformed FlxtuY,e' € Pe. Re N :moped F Exsti capped; Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinlcing 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 increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains fees assessed for the sewer increase must be paid before the Oil Separator (Gas Station) Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service 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: is\ Bui lding\Permiu\PLM- PermitApp.doc 3/03 FOUR D CONSTRUCTION CO POST OFFICE BOX 1577 • BEAVERTON, OREGON 97075 • PHONE (503) 590 -0805 • FAX (503) 590 -1751 ACKNOWLEDGEMENT OF RISK & HOLD HARMLESS AGREEMENT The purpose of the agreement is to allow a building permit to be issued for the construction of a model home on Lot # 77 of the Greensward Park #3 subdivision prior to the recording of the plat. 1. The undersigned owner of record, of said subdivision agrees to hold the City of Tigard harmless of any consequences that would arise by allowing Four D Construction Co. to move forward with the building permit and sales facility prior to recording the plat. 2. The undersigned understands and agrees not to assert any claim {s }, Including litigation, against the City of Tigard, its officers, agents or employees based on the issuance of a building permit prior to plat recording. Four Development Dated January 29 2004 By David Deharpport President RECEIVED FEB 19 2004 CITY OF TIGARD BUILDING DIVISION i �Z.sT.� —O ° O �s ► • ►, I ■ TREE C S ► ID • I, ,1,- ' D 'A? I 1 O , wner / Agent f or IZ. CAN s7-RU c ti O s J ■ • (PLEASE PRINT) (PERMIT HOLDER) ■ • ■ • • • • A • • • • Do hereb he following location ■ • r � _ ■ • meets City of T §iard /Washington County ■ ► ■ • land use and development standards for street tree installation. ■ • ■ • ■ 1 • • ADDRESS: Q (D S S 8 cl III ■ • • • • • • • LOT: I S UBDIVISION: R G E tVSWJ 1.t Pp42 ► • • 4 • BY: T DATE: 8 • ^ 9 -- ► • ► • RECEIVED BY: 44' 2 '� DATE: .F -- "7 ��, ► • ■ CITY OF TIGARD 24 -Hour '/ BUtLDING `t Inspection Line: (503) 639 75 MST�OO '0006,S-- INSPECTION'DIVISION Business Line: (503) • •-4171 BUP Received Date Requested 3 - 3 PM BUP Location D • 4/4, .. Suite MEC Contact Person Ph ( ) r7,6 - 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain L-' b" (4 ELR Crawl Drain j Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear A Ina Sheath /Shear f /O •O U Framing (2 C ' Insulation M � Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof CASPC O l er: PART FAIL • f MBING Zig I A soperev Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line e Dampers PART FAIL CTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Ei Please call for reinspection RE Unable to inspect — no access Fire Supply Line ADA • < Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection rec rd from the job site. PASS PART FAIL FOUR D CONSTRUCTION CO 441;111.° POST OFFICE BOX 1577 • BEAVERTON, OREGON 97075 • PHONE (503) 590 -0805 • FAX (503) 590 -1751 August 12, 2004 RECEIVED Hap Watkins AUG 1 z 2004 City of Tigard CITY OF TIGARD 13125 SW Hall Blvd BUILDING DIVISION Tigard, OR 97223 RE: Permit MST 2004 -00065 14065 SW 89 Ave. The final building inspection dated 8 -10 -04 for the permit referenced above indicated there was no documentation of an approved interior shear wall inspection. On 5 -14 -04 an interior shear wall inspection was performed by the City of Tigard, with three deficiencies noted. Rick Keller Construction corrected the three items indicated and I personally inspected prior to the installation of drywall. 4 &* ( 1,z./7 4--- David J DeHarpport Four D Construction Certified Master Builder, 001 MB CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 460 D©06s INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested 7 A-0-e-- AM PM BUP Location ) 7O 6 ! O t Suite MEC Contact Person _` ) ate_ Ph ( ) 7 2 — 74145 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain � ELR Crawl Drain Slab Inspection s: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - AMIN Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL ' ", A �� i'�� Kit PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: tar PART FAIL CHANICAL 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 Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: 0 Unable to inspect - no access Fire Supply Line /� ADA Approach/Sidewalk Date 1 v Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24- Hour - BUILDING Inspection Line: (503) 639 -4175 MST a 00 r 7 'e INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested - AM PM BUP Location / I t ( ) ( QS - 8 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain /� �� /< ELR Crawl Drain Slab Inspection Notes: 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 & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL _ / \ MECHANICAL ��� � &3?) `'-0 Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/SI /! oltag Fire A arm 41101611 S�i PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA / 4 Approach/Sidewalk Date Inspector ' Ext Other: Final DO NOT REMOVE this inspection record from the jo . site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection tame: (503) 639 -4175 MST A Do ' " 4966 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested AM PM BUP Location / O 1p 5 4 8", Suite MEC Contact Person 1)041-€ -- Ph ( ) t 7L f PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain L 130 )( . <S 1< ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler „ v Fire Alarm WA- Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final _�, ����� MECHANICAL PASS PART FAIL C���( ' V �- V' `04.4, Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/SI olta Ak4t Fire A arm S�i PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI E fl Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date _ <0 a `T Inspector f/h Ext Other: Final DO NOT REMOVE this inspection record from the Jo site. PASS PART FAIL