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Permit . -, 4?4 CITY OF TIGARD MASTER PERMIT • PERMIT #: MST2004 -00184 jiff'' DEVELOPMENT SERVICES DATE ISSUED: 7/14/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15050 SW 93RD AVE PARCEL: 25111 DB -KE004 SUBDIVISION: KESSLER ESTATES ZONING: R -4.5 BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: New SF BUILDING REISSUE: BVH3465 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1.455 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 2,010 sf GARAGE: 655 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 337,410.50 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,465 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: D VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 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: 7 201 - 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: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIE W S ECTION 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: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: , TOTAL FEES: $ 8,450.77 This permit is subject to the regulations contained in the BUENA VISTA HOMES BUENA VISTA HOMES Tigard other Code, State of All kwil b Codes n 6932 SW MACADAM #C 6932 SW MACADAM SUITE C and all other applicable laws. All work will be done in PORTLAND, OR 97219 PORTLAND, OR 97219 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: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 152235 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 Mechanical Plumb Top Out Exterior Sheathing Insj 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 Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp ,--' / i Issued By : L.��i �� .4 Permittee Signature : - 4 Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n I busin: ss day Building Permit Application FOR OFFICE USE ONLY Received / o f / Building ` / (� Date/B :I(/ j 10, j Permit No.: j4 ova 5 - 603 t • City of Tigard RECE�� l[=® Planning • ppro al Other Q Date/By: Permit N 0 R-v�4 V —OP/ 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Ii l. rt Date/Byly i v 7- 7 0 Permit No.: • Phone: 503-639-4171 Fax: 503E 1� >70 598 -1960 " � -, I" \ Post Review Land Use Internet: www.ci.tigard.or.us„IT ^ OF TIGF�R� � Date/By: Case No. Contact 1 .• IS See Page 2 for 24 -hour Inspection Request6602 63�9�,4�j7t5JISION Name/Method: �(x Supplemental Information . • • • TYPE OFWORK : _.. ,,..,., .. © New construction . ' REQUIRED - DATA : �:`': ••,:.,:••••-. , ••.._ •,_: ❑ Demolition ^1 & 2 FAMILY. DWELLING. - . ❑ Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees" are based on the total value of the work performed. Indicate © 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation $ . JOB SITE INFORMATION and LOCATION No. of bedrooms: 1 No. of baths:Z{ Job site address: 15" 05e .W ,:5 - Ave-, Total number of fl rs .9- Suite #: Bldg./Apt.#: New dwelling area (sq. ft.)..5 "._ g / �t. #: P Garage/carport area (sq. ft.)....( .. Project.Name: Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) •.. . :.. REQUIRED DATA:.:_. : / �__ f f ' ' •:' COMMERCIAL, =USE CHECKLIST r. - : Subdivision: S(•kl �s1f / Lot #: 4 Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK • . • • the value (rounded to the nearest dollar) of all equipment, materials, labor, NEW CONSTRUCTION — SINGLE FAMILY RES , overhead and profit for the work indicated on this application. DEATACHED RESIDENCE Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ® PROPERTY OWNER .• • . j :0 TENANT - . -. ; : • . Type of construction Name: Buena Vista Custom Homes Occupancygroup(s): Existing: Address: 6932 SW Macadam Ave. Ste C New: City /State /Zip: Portland, OR 97219 Phone? 503-443-6033 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under APPLICANT 0 . .Q CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: El iabeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: , Fax: . :;. UI :. NG R E-mail: BUILDING.PERMIT:FEES* ::., :Please refer ` . CONTRACTOR - Business Name: Buena VIsta Custom Homes Fees due upon application S Address:6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 97219 Amount received S Phone: 503 - 443 -6033 Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized _ Signature: U Date: Notice: 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. (Please print name) i:■Dsts\Permit Forms \BldgPermitApp.doc 01/03 One- and Two - Family Dwelling ;:,y Building Permit Application Checklist Reference no.: City of Tigard City Of Tigard Associated permits: Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Electrical O Plumbing 0 Mechanical Phone: (503) 639 -4171 ❑Ocher: Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No NI. 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control Cl 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. 11 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 and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, 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 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 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 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 architect licensed in Oregon and shall be shown to be applicable to the project 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". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 4.0 -461 (6/00/COV) 03/04/2004 16:26 5032537693 SUN GLOW INC r PAGE 02 ,•,. !, (..... Mechanical Permit A lication _ FOR OFFICE 1:SI: ()NIL Received Mechanical REGE Oateilk._ - Permit Nio4016_7-gWZ/- 6 City of Tigard Planning Approval Building De : : Permit No.: 13125 SW Hall Blvd. Plan Review EEIIIIIIMIIIIIII Tigard, Oregon 97223 JUN 14 201A Datef111 Phone: 503-619-4171 Fax: 503 ,:g 8 ( -1 3f' -° T I G 1 .. Cue No.: .s..:•••• ,i Post-Review Land Use Date/13 : Lntemett www.ci.tigard.or.us Contact kris.: 'Ill See page I roe 1 PINIG -.A-... ' AIL 24-hour Inspection DI% Request: 503-639-4175 - ' NarncA4ethed: Supplemental Inibrinalon. . . -:.. .. ..... r . :,..., : E or woRK. , ; ;;,,4 , i:•(.. , c 4 :..-: .:.: .P.MC .....____141... E ...W.___________IVE SCHED MEXCBXCICEIST? ;..-::■,... If New construction 111 Demolition Mechanical permit fees* arc based on the total value of the work • Addition/aiteration/re.i.ement II Other: performed. Indicate the value (rounded to the nearest dollar) of all . - -..C.ALTEGOR : virscoNgratreita N...''iTZ'',,'':*;,,!,,,:: .•... mechanical materials, equipment, labor, overhead and profit. • 1 & 2-Faunil dwellin: ■ Cornmercialfindustrial Value.: S See Page 2 for Fee Schedule 11. . . • 1. 11111MEROMINIIII .., Rormatatow_kartisTsrEms:PsRoxtteDtax ... Description i QtY_Lfee(01-1. l Total 1 Di Master Builder 111 Other: acad.. cctaiin • • „JO : INFORMATION diid LOCATION ' . • . ' . • Furria.ce - add-on air conditionin." 14.00 I Job site addresS: Gas heat • ,• 1 MOME111111.111 Bld, JA. t.#: Duct work 14.00 111 PrO'ect Name: , Hydronie hot water system 14.00 Residential boiler Cross Street/Directions to job site: for radiator or h . ronie system 14.00 ' Unit heaters (fuel, not electric) (in wall, in-duct, suspended, etc.) 14.00 Ell Flue/vent for an of above 10.00 Subdivision; Lot tt: R .air units 12.15 11/11111111111111MINIMINEMM , EIMMFPIMDIMIIIIII.."IllIlIlliM" Water heater 10.00 III • ' • . '. DES' r LON 'F WORK ,.' • L.i • - . - Gas fireplace _ 10.00 NEW CONSTRU TION -SI GL r. I Flue vent (water heater/ Vreplace) 10.00 DETACHED RESIDENCE Lo:, li. ter : - 10.00 MINIM Wood/Pellet Wood. stove - •lace/insert 10.00 Mill 1 0.00 NM. .Y1 Chimney/liner/flue/vent Mil 10.00 111111 V" * OPERI 11111111IMMIIIIIII". VO ' 54 . 7'.....:* lit 13314A14rin . ,;( ' :-.;! Other MO 10.00 Environmental Exhaust & Ventaletlatt N am e: 13 _ = ,s_ , Vis - a 11 - • n - Range hood/other kitchen equipment 10.00 Address; 6 ,. SW Macao.. -A, . .,./ -, S - C Clothes dryer exhaust 10.00 Ci /State/Zit: Portland OR 9721 9 Sitgle duct exhaust Phone , _ _ . , Fax: 1 _ a . _ , . Cloathroorrs, toilet compartments, IrirgagUallIMMININP .CON1 . • PERSON . t . • wilily rooms) . 6.80 Name: David Goloba. Artic/crawl space Buis L_ 10.00 Other: r 10.00 Address: fuel 1.1,, for first 4. 5-00 each addi i43 1tional Phone: Fax: IMErartin111111111.111111.01111111111 x, .4 Furnace, etc. iir No .. Mi ll.11111011111."11111M". Gas heat . Wall/suepeuclediunit heater Water heater Business Name: _ , G .34 .. F1 . .lace R_ Address:2428 SE 105th Ave. gau*._ IMMIONMMOMI It* BB* Ci /State/4 • :POrtialld , OR 9721 6 Clothes dryer :as MINISMIMIN Phone: 5 o 3 - 2 53 - 7 7 89 Fax:5 0 3-25 -', b t'.; other: .. Total: CCB Lie. #: 451 3 1 . - Meebanleal Permit Feel _ AULISOCIECCI . 4 .,...,. , Subtotal: S ' sisnature Dale tSltml-k --.........----...-.....-....--....-- Krafft= Parrot Fee S72.50 S David Golob y Plan Review Fee (25% of Permit Fee) S ■■■••■■■■••■•••■••■•••=-..■••••■••.■ State Surcharge (8% of Permit Fee) S (Please print name) TOTAL PERMIT FEE 5 Notice: Tits permit application expires if a permit is not obtained Within 'Pee methodology set by Tr(-County Building Industry Service litoard. ...Site ptan required for exterior AJC units. 180 days arta-it has been acacptod as complete. 1APV.APermit ferroatecPermitApp.doc 01103 • 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. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. • 1: 18uilding\Permit Forms\MecPermitAppPg2 09- 01- 03.doc 03/04/2004 18:21 FAX 5036284633 THE MULLEN COMPANY 4 BUENNA VISTA la 002/003 Plumbing Permit Application Rc..iyed FOR OFFIcE l'st ONLY Date By : , D PI a ann wa irt y n : Approval Plumbing ,,,,, Permit Na .ift..) - /S City of Tigard Sewer 13125 SW Hall Blvd. RECENEA p,„ Review Permit Na.; Other Tigard, Oregon 97223 Date/By: Penni; No.: Phone: 503-639-4171 Fax: 503-59849,50) 11.1r,-.AW Post.12aview Land Use ft ::`, .' ' Lu - •--..r' I Date/By: Case No.: Internet: www.ci.dgard.or.us ' .1,L - -All Contact !aria.: El See Page 2 for ---" 24-hour Inspection Request: 503..!6 9,417.51" I G I :, " Name/Method: i Suoolomencei Information. BUILDING DIVISION ----- • . - •:: - .: - v.: - - rem oYvv0,9 - .31v - scREovuroaripeeratinfaivigrovideedalf: New construction Demolition Addition/alteration/replacement B Other. Descri Sion Qtr. Poa(en.) Total - : ' .''''.;" ': . ithifei A • .-----..:- A ' . . .t,.te.. 1 4.:::.... 1 1 . 6 I .':■ .!.efiTEGORTMCODISTRuellOW i , ' • ' • SFIk (1) bath_ 249.20. M1 & 2-Farnil dwellin 171 Corn_mercia dustriallan SFR (2) bath 330.00 N Accessor Build A Multi-Family_ SFR (3) bath 399.00 IIII Master Builder Other: Each additional bath/kitchen 45.00 . s . .30B STIE INF.C1RisfATIMMIdLOCATION ' " . Fire sprinkler - sq, tt: Page 2 Job site address: „ ••.• •:.:•,.:, • • .:.: Sitelltilitles : ',. ,;:;:,,.;.;',..:,Mt: :7. .. ..1.... • . Suite #: I BldgfApt.#: Catch basin/arca drain 16.60 My-well/leach line/trench drain 16.60 Project Name: . Footing drain (no. linear ft.) Page 2 Cross street/Directions CO job site: Manufactured home utilities 110.00 . Manholes 16.60 Rain drain connector 16.60 Stull tary sewer_(no. linear ft.) Page 2 Subdivision: I Lot #: Storm sewer (no. linear ft. Pa es 2 - - Water Water service (no. linear ft.) Page 2 Tax map/parcel #: • . i ,..'":'' ' - Fixture or 3 em • - . '4' • . •''''':: DESCRIPTION OF WORK ' -• A.bwrptioo valve 16.60. NN, ,CONSTRUCT ION -SINGLE FAMILY Baokflow prcvcntcr Page 2 ... FAMILY DETACHED RESIDENCE Backwater valve , 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 •q1PROpERTY'OWNER ' TENAlsIT .- ,:. . ,'' :','..:-.: • :. • •: Electors/amp 16.60 Name: Buena Vista CustoM Homes Expansion tank 16.60 Address: 6932 SW M.a ceam Alm •- s tr. c fixture/sewer cap 16.60 _ 16.60 City/State/Zip: Portland, OR 9721 9 • Garbage dispos Floor drain/floor al sink/hub 16.60. Phone: 5 03 - 4 4 3- 6 03 3 FU: 5030443-2443 Hose bib . 16.60 UN ;APPLICANT- . . . '•. ',' .0 CONTA-CrnaWN ' , ' Ice maker 16.60 ' Name: Ray Mullen interceptor/grease tan ! Address: Medical gas • value: S Page 2 Primer 16.60 City/State/Zip: Roof drain (ccnvnercial) 16.60 Phone: Fax: siddbasiiviaortory 16.60 --- E-mail: Tub/shower/shower pan 16.60 Urinal 16. 60 ..r,' ?.: -• . ' • . CONTR.ACEOR : ' ' • - . • :-': _ , .. , Watcr closer 16.60 Business Name; ED Mullen ID lij_mhimg - - _ Water heater 16.60 _ Address: 24470 SW Rainbow Lane Other: City/State/Zip: Hi 1 1 _ .. • • ; • Othcr. • . ,: .. ' .. ..m ..,...:Placoblitsateclk iideee* .•' ..'. ••.' '''.: .. • ' . .. .. Phone : 0 - 6 2 8 - 1 - _ Fax: I -. : - • • Subtotal S CCB Lk. #: , . ; • Plumb. Lic.#: 3 4 -L6 01:'8 *. tvtininirat Fee vas° S Authorized / ,o- (4 Residential litanIctlow Minimum Fee 536.25 Signature: S _da... i ..,.... 1 c:,--V P Plan Review (2534 of Permit Fee) S Ray ul en - State Surcharge (8% of Permit Fee) S TOTAL PERMIT FEE S (P1 me print name) Notice' Thie p41101I applhation expires Ira permit is not obtained within All new COttlftleltild b111141146 require 2 sets or plans with isometric or Igo days after Ii has been eeeepted u complete. risir diagram for plan review. Fee methodology set by Tri-County Bollding Industry Service Board. 1:\ Dsts \Permit Forms1PimPerniltApo.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) : Square Footage: Permit Fee: Footing drain - l° 100' 55.00 0 to 2,000 $1 15.00 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 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 EiYtu�e Qty. Fee(ea)'; •_.'.Tiitat; 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 $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 *. • Quantity b•(Fixture)•Koik.Peiforaied;:; Comments regarding fixture work: Fixture Type: 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 *Note: If the fixture work under this permit results in an Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial • - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: I:\ • Dsts\Petmit Forms \PlmPermitAppPg2.doc 01/03 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit= App:li_cation Received Elettr;ca, hI .LP ti V I.0 OatcBy: Permit No.: ---00, City of Tigard Planning Approval Sign JUN 2 00 Date/By: Permit No.: J 13125 SW Hall Blvd. U N r Plan Review Other Tigard, Oregon 97223 nt Date/By: permit Phone: 503- 639 -4171 Fax: SO 3ds.R196o Post- Review Land Use Internet: www,ei.tigard.or.us , BUILDING DII f • . . 13'/BY' Case No,: Contact �nj a ati► .funs.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. TYPE;OF WORK ... , .,. • .. , ; REVIEW:( Pleosx 'CSetfcitlC ;tliatiiPplYk':" .. Ncw construction 1 • Demolition 0 Service over 225 amps. 0 Health -care facility ❑ Addition/alteration/replacement �■ Other: commercial 1=1 Hazardous location • ❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet, • ATEC�C11[ YOF'CON STRUCTION'. 1 Rc 2 family dwellings � ' ' � Y four or more residential units in iii 1 & 2- Family dwelling ❑ Commercial/Industijal 0 S over 600 volts nominal one structure • Accesso Buildin �Iblulti- Fat riily 1:1 Building over three stories ❑ Feeders, 400 amps or more ❑ Master Builder ❑ Occupant load over 99 persons 0 Manufactured structures or RV park Othe 0 Egress/lighting plan ❑ Other =: :. JO>O'S1;CE INFORMATION•ati LOCATION' • � Submit seta of plans with any at the above. Job site address: The above are not applicable to temporary construction service, Suite #: $ldg. /Apt. #: — •'k " SCT TAF.Z..; y c: " ::; `' : : , .:':'•::: •- • :. • Number of inspections per permit allowed Project Name: Description _ � Qty Fee (ea.) f Tutor Cross street/Directions to job site: New resldenttayfngle or snottI-family per dwelling unit. Includes attached garage. Service Included: 1000 sq. R. or less 145.15 4 Each additional 500 M. fk or portion thereof 33,40 1 Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75,00 2 Tax map /parcel #: Each manufactured home or modular dwelling 1 ` Q. DE t' ON.O � WORI{ 7 service and/or feeder 90.90 2 .N''' P ons ME - 6 /4 ' C� v//i/ Services or relocation: orreelectt[nntaltatlao, .— alteration ' C.� • 19�-k Lh e L � � i CI e n u.— 200 amps or Tess 80.30 2 . „ _ 201 amps to 400 amps 106.95 2 401 amps to 600 amps 160.60 2 • 240.60 2 to 1000 a • h[O;P1< R'I X' O�!V1rFER // .'FE/V .. , . ' 60) amps mps Name: at en a- �l S � :a �� • : •' . R e o I1 amps or voles 454.65 2 Reconnect only 66.85 2 Address: cp' , �j � l3U J a La r ifi Temporar services or feeders - instillation. Ci W e ( G /State /Zia ; 0 q ---/P19 alteration or relocation: / 200 amps or teas 66,85 1 1 W Phon .. • / 3- epaD.a3 Fax • 3 201 amps to 400 amps 1 100,30 z 401 to 600 amps 133,75 2 C �� a '•, ON Branch circuits - new, atteradnn, or Name: S v't✓ .55 extension per panel: Address: A. Fen For branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 Ci /State /Zi B. Fee for branch circuits without purchase of Phone: Fax: service or feeder ki first branch circuit 46.85 2 Each additional branch circuit 6,65 2 E -mail: Misc,(Service or feeder not included); .• - .croR . Each pump or irrigation circle 53.40 2 Each ii or outline lighting 53.40" 2_ Job No: Signal circuit(s) or a limited energy panel, Business Nam O$55 4Z' c- alteration, or extension Page 2 2 Q $ - .S LO e 4di g' Description: Address: K J Is #' ( 203 City /Sta / Zip: Li S (. ob e> .q7/9.3 Each additional inspection over the allowable in any of the above: Per inspection per hour (min. 1 hour) 62.50 Phone :523 Co a{z, 7$OO Fax: .5_3 4 S Investi., tion fee: CCB Lic. #: IS Lie, #: 3 34.6 Other •.. .' . EIe ricalYeYm ;..,r Supervising elccttici � . ' � . Fee?X":., , ,.� ; ;�:. ,. .....: �... Subtotal 3 X signature re uired' Plan Review (25% of Permit Fee) 5 Print Name: ROSS Lic. #: 4. / 2 3 , 9_,S_____, State Sunhat 8 % of Pertn Fe $ Authorized TOTAL PERMTT FEE S , Notice: This permit application expires If a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tn - County Building industry Service Board. (Please print name) - i:\Dsts \Permit Fnrnas \E1cPermitApp.doe 01/03 CITY OF TIGARD 24 -Hour BUILDING _ Inspection Line: (503) 639 -4175 MST ..66 1 Ry INSPECTION DIVISION - • Business Line: (503) 639 -4171 BUP Received Date Requested / 0 AM PM BUP Location /-5 . 0 -S — a 93 4 - uite MEC Contact Person i '• _ Ph ( 77 ({/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear hit Sheath/Shear - mo.. Framing ' i !rte' C- l! v J Insulation rA 6 l Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Ot er: /7X , • PART FAIL • o BING Post & Beam Mr ei - - �_ 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 Smoke Dampers /1%jG''i PART • FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage - F = • arm in Reinspection fee of $ required before next ' pection. Pay at City Hall, 13125 SW Hall Blvd. 40 k PART FAIL El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date i t e Inspector .- Ext Other: Final DO NOT REMOVE this inspection recor 0 the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST Z J1 gY INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 1 � r �� AM PM ` BUP Location Suite MEC Contact Person Ph ( ) 7/1 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 .._ • 6 7 PART FAIL ECHANICAL 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 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA �" /� Approach/Sidewalk Date it v Inspector /0 Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL STREET TREE C .. .. .. i .. it, . ?/ I, eA„ A H o I, �A ent for LQ �� � _ Owner / �g IIJw..,a� l o A. ,tea ai'+ --, 40,4, (PLEASE PRINT) (PERMIT HOLDER) % � x , k ^' ` I Do here "' �- %: .� � by ,. ' tha - e` following location ' ' ,.a ' 4 . F: " ins" ft meets :City- ,ofµ�Tg W as h i`ri gton County -44 land use and development standards for street tree installation. Do- ADDRESS: !; 5 Sw 9 3 /' 6 LOT: 4 SUBDIVISION: c .s 1 c V et. BY: At / DATE: /p/ j .. iff RECEIVED BY: DATE: - 2� ' f/ ® VVVVY vVYVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVN