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Permit / MAST PERMIT Ay,. . C T OF T I G A R D PERMIT #: MST2004 -00204 �.�!� DEVELOPMENT SERVICES DATE ISSUED: 8/18/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15126 SW 94TH AVE PARCEL: 2S111DB-KE217 SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R -4.5 BLOCK: LOT: 017 JURISDICTION: TIG REMARKS: New SF detached. 9 -21 -04 Add all encompassing low voltage. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,463 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,841 sf GARAGE: 631 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 322 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,304 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: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: 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 FUR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 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 REVIEW SECTION Reconnect only: • > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL - RESTRICTED ENERGY ___A. -SE IDENTIAL -- B. COMMERCIAL UDIO & STEREO: X VACUUM.SYSTEM: -X AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X 0TH: ALL ENCOMP J BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,033.42 This permit is subject to the regulations contained in the BUENA VISTA HOMES BUENA VISTA HOMES Tigard Municipal Code, State of OR. Specialty Codes 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 Ins K Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation lnsp PLM /Underfloor Framing lnsp Gas Fireplace Water Service Insp Building•Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation lnsp Appr /Sdwlk Insp Issued By : / t �,,C',/z/ ., (3ifs Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day ;i ` / Electrical Permit Application . OFFIE US O NLY - t4 . City of T Recei eivea l 0 Permit No.: 6 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 i.e le '" iii Datei Other Permit Inspection Line: 503.639.4175 z11 ' Date Ready/By: J Juris: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information i`.'?�t : - Wf -'' = °.st: i �.r� 74 ;i- a:a* . • +rr; °. . -, AaK :^ ' ., i V. . - . +F ,. . ;. '-, s = ; - , C�';5 -,. _•� _.� �:( w` .3 #.'7'^:r9t'�` i': Vx il.,,: ,.r ^,i s% x s. $r;:. :Y . ii ` 1 u.tk 1-x... ' _ ' -'. .�7 -L' ;'- "': fia; � ��Z' P;E �;,�?OR -•.� �::. :� .,_ .�s; . �:: : : - � ,, ": »�'�-� a . '� �'� - �`"��,�'�u ,emu- �,�= �r���.�ra..,� "�s��,s"�o�.3r _ �- �;���.,� .w�rH - -- w . x _.. _ _ _ . _ w , ; .�� : -� '. _ , ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑ ❑Service over 225 amps, comm'l C) Hazardous location <x _ . of o a ad r � -t`= �. _ w:��� , u : ,� :; .7, Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., . ,. , e ' » { >�Aa GOR> OLD CONS R > O`P):O 0 4 ; ..., r ` -� ; _ ., , -, , 4�, ` �.- y F _, �. , T .t ' (Y Mg . :? ° ,:r h„ ; of 1- and 2- family dwellings 4 or more new residential 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure CI M ❑ Master builder El Other: ❑Building over three stories [Weeders, 400 amps or more Multi-family y z _, ,, . ter ❑Occupant load over 99 persons CI Manufactured structures or , � 1 �. QB I.,, ..OFk fiL40: .,a_ rcti O1V4 v 1 ❑ it i- Egress/lighting plan RV park Job no.: Job site address: i C i / � 4j yti, 4 �] / � _ ❑Health -care facility ❑ Other: [C / V Submit 2 sets of plans with any of the above. City/State /ZIP: ` `� r4 ) o � 9 7 2 z The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: P roject name: (/�/ / �// S '� e ' ktH D E ; m' . . _ • �7S 7!v i S � 7 Description Qty. Fee. Total Cross street/directions to job site: /7 / I 4-0 4 4-1.t V New residential single- or multi - family dwelling unit. �� I Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • 1 Tax map /parcel no.: Limited energy, residential 75.00 2 l W :ex £ w ' ° .. >n ::,, .WC - , •t: ma=r .t . , r ?'.. . _ Limited energy, non - residential 75.00 2 .. 4,„. S ;x.° a : ; ES tT'0 3:61 15 r '. ` '� ,. ',"' ~.` 1 h Each manufactured or modular dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 t; _; ' ig , ;- Uv,IY P r -: �s:, ER' .. 3 < leg . - m T4 vi .A, : , e;,.�.a 201 amps to 400 amps 106.85 2 Pik I ' ® _, .,,, ,. a � 401 amps to 600 amps 160.60 2 Name: c4 _ i � � y � 601 amps to 1,000 amps 240.60 2 Address: � m t/' " I , v Over 1,000 amps or volts 454.65 2 t-f i ''� A / Reconnect only • 66.85 2 de City/State /ZIP: 0 2 67 2 Temporary services or feeders installation, alteration, and/or Phone: (n ,C f L ' _ 0 1 7 , 7 7 I F ax: ( ) 5 relocation ��f 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 exchan e, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signatur _ Date: ' Branch circuits - new, alteration, or extension, per panel A sa ' � ;��v. ,� c�- - mt� s�x x . 4 U ARI' eeMN ,, , ' ® tiVf P O a, r, A. Fee for branch circuits with circuit Business name: branch feeder fee, each 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, Address: each branch circuit 46.85 2 Each add'1 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- . " ' a m wita ti , ' , „ r energy panel, alteration, or extension. Describe: Page 2 2 Business name: I Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (i hr min) 62.50 Phone: ( ) F ax: ( ) Industrial plant per hour 73.75 CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 7 Suprv. Electrician signature, required: Plan review (25% of permit fee) / State surcharge (8% of permit fee) Gi '-- Print name: Date: �/ TOTAL PERMIT FEE I Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board •* Number of inspections per permit allowed. is\ Building \ Permits \ELC- PcmdtApp.doc 12/03 440- 4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information '- LIMITED ENERGY PERMIT FEES: 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: , NiTaTaloWAMOWW 111 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 ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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 \Pernuu\ELC- PermitApp.doc 04/03 i CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00204 1 DEVELOPMENT SERVICES DATE ISSUED: 8/18/2004 '�) 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15126 SW 94TH AVE PARCEL: 2S111DB SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R -4.5 BLOCK: LOT: 017 JURISDICTION: TIG REMARKS: New SF detached. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,463 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,841 sf GARAGE: 631 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD sf RIGHT: 5 VALUE: 322 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,304 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: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: 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: EAADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/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 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: BOILER: HVAC: LANDSCAPEJIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: • MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,952.42 • This permit is subject to the regulations contained in the BUENA VISTA HOMES BUENA VISTA HOMES Tigard Mu State of All work 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: 503443 -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 Ins 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 / 7- . . .. Issued By : •�� , , _we. ." 0 ./_ i_ Permittee Signature : .0 -. #:/ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day 4 ' , Building Permit Application . FOR OFFICE USE ON N LA . Received-- ��, Building Date/By:/ ' / O' a Permit No.:0151 o n2-1 , g City of Tigard Planning ppro al Other 13125 SW Hall Blvd. • Date/By. Permit No .S�(/ -(�e�G —cPao3 �� � P Revi 1171/ k J Other Tigard, Oregon 97223 � Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 5A3 98.1960 /u+. y l�i I , ' a Post - Review Land Use Internet: www.ci.tigard.or.us \ ; � A 11 Contac Case No. • Contact Juris CI See Page 2 for 24 -hour Inspection Request: 503- 639 - 41 \�Pp,0 Name/Method: "FM Supplemental Information • TYPE OF WQRK1,V" • Q New construction ° Demolition . REQUIRED DATA: ••.;:. ., • , :�; :; ❑ 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 . ... S . JOB SITE INFORMATION and LOCATION No. of bedrooms. No. of baths: Job site address: r 5►2 (p ! Ave Total number of ors New dwelling area (sq. ft.).... Suite #: 1 Bl g /Apt. #: Garage /carport area (sq. ft.) „1. - Project Name: Covered porch area (sq. ft.) / O Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) REQUIRED DATAc.' Subdivision: : • COMMERCIAL =USE CHECKLIST ; �' Lot #: 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 S Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ® PROPERTY OWNER •. . .1 TENANT "r : : . . • . 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 F 5 0 3 — 4 4 3 — 2 4 4 3 NOTICE: All contractors and subcontractors are required to be APPLICANT licensed with the Oregon Construction Contractors Board under CONTACT PERSON provisions of ORS 701 and may beiequired 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: . . E -mail: ' . • �BUILDING.PERMIT•FEESi = . CONTRACTOR • • . ,- Please refer to hed fee. scule 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 1 Fax' 503 443 - 2443 Date received: CCB Lic. #: 152235 7 ( i1Io o Authorized /n� 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 Fomu \BldgPermitApp.doc 01/03 • , 03/04/2004 16:26 5032537693 SUN GLOW INC ... . PAGE 02 . . • Mechanical Permit Avplicatiort Fop. OW( k. I .•:I. l'. It 1 Received Mechanical Oate/13 : . Permit Me.: City of Tigard Planning Approval Bulkling Pat : : Permit No.: 13125 SW Hall Blvd. 41°0 Pun, Re leigli Tigard, Oregon 97223 Datenit . Post Phone: 503 Fax: 503 ...,,, Land Use Datent : Internet www Case No.: .ci.tigard.or.us 4;--;e0 Contact Juris.: 1144FRERIMI 24-hour Inspection Request 503-639-4175 ---- ---" - Name/Mothod: . . . • . ' • . Iv ' • 'I. ; ;',. : E OF WORK.. ,,:ii .;.:',.:,:. ....::,,,, - :..,., .., ,•,. ',. t• If New Construction 11111 Demolition Mechanical permit fees* are based on the total value of the work II AdditionialteratiOn/re•laCement • Other: performed. Indicate the value (rounded to the nearest dollar) of all . . ' •• '.„.CATEGOR: .0F.COM:FR1Eltil 4 1.: i ::',' •-:: mechanical materials, equipment. labor. overhead and profit. gti 1 & 2-Famil dwell 1 il Comxnercial/Industtial Value: S See Pale 2 for Fee Schedule II Access° Buildini IN FEMM31/.1111111 ,.:: RESIDENTIALEQUIPMNT/STSIENZEIRE.:SCIffirall .0 LI Master Builder II Other: Description i Qty { Fee(ea.) 1 Total ' • End . Cootie _ JO : ME INTORWLATION and LOCATION' ' - ' , ' . • Furnace • add-on air conditioning" III 14.00 Job site address: / / ,P-i(o Goa heat • - 14.00 IIMMEIMINNOON aid, ./A.. t.#: Duct work •• NMI 14.00 IIMIMIIII PrO'ect Name: . H . saw hot s : 14.00 Residential boiler Cross street/Directions to job site: for radiator or h . ronie ryttern (4_00 Unit heaters (fuel, not electric) in wall, in-duc su • nded. etc.) 1111 14.00 111111 Flue/vent (for any of abov3) 10.00 Subdivision: Lot #: R .air units 12.15 (NFL- Fuel AP Hams lBMVIZE11.1.11.11111111111111111.rall Water heater 10.00 , . • . ' • • - DES el I. EON * F WORK ,. ' - • - - ass fireplace 10.00 NEW CONSTRU TION-SI GL r' I' ' Flue vent (water heatertstai tirePiact) 10.00 DETACHED RESIDENCE Lo: li. ter .:- - , 10.00 Wood/Pellet stove (0.00 Wood. - • lace/insert 10.00 IMMEMM IIMIIIIMNIMIIIIIIIMMIIIIIIIIIIIIIII Chi= /liner/flue/vent IMO 10 MIMI ii ' • OPERTT a • ' JuLARIIMPO 'FIDIANT:irekeAi.'; ,,'• .:;? Other: 10.00 Environmental Exhaust & Vesselletlata Name: B _ .=. 9_ ., V i. s . .0 .4.14- Range hood/other kitchen equipment 10.00 Address: 6 7 SW Mace14. -,I . V -_ S - C Clothes dryer exhaust 10.00 Ci /State/Zi.: Portland OR 97219 Single duct exhaust Phone , „ _ i Fax: 1 _ , • - J . (bathroorrs, toilet compartments, 111-1M22fitMllaININP .cor■rr -. •ratsort . utility rooms) . 6.80 Name: David Goloba Artie/crawl space fans 10.00 Other: . .... a_ (0.00 Address: F IniMENIMINIMIMINIMINIMIlli urmsce t for first 4'. 51.00 each addidonall F, . • .. Phone: Fax: - •• Gas he at . • E-mail: Wall/suSpendedlunit heater 1D111 Water heater • .. Business Name: , G , , Fl • • laee AddreSS: 2 4 2 8 SE 105th Ave. MOMMINIMIIIIIMINIMININSIMMO NM 1 Ci /State/4i :POrtiarld , OR 97216 Clothes dryer f • as) phone: 503-253-7789 Fax:503-25 -1 & "3 otter. Total; 1.111111111 CCB Lic. #: 45131 . Methaaleal Pertnis Fees' Authorized ---- d _-, 1 ,--. . Subtotal: S Signature; .„.1---•-•-•• 4 k.....-L•=10 a.....1 Datc:_,S012=4 Minimum Partnit Fee S72.50 S David Golobly Plan Review Fee (25% of Permit Fee) S State Surefintge (a% of Permit Fee) S (P eaSC print =Ile) TOTAL PERMIT FtE S Notice: This permit application expires If a permit is not obtained within • Fee methodologx set by Tel-County Building Industry Service Board. ...Site plan required for eataior A/C unit,. UM 640 after it has best accepted as complete. i;aPstsWermit ForrnsaMetPermitApp.doc 01/03 03/04/2004 15 :11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit AppllicatioII FOR 111'1.1(1:1 SF. t) \l.1 �" Received FOR Date By: Permit No,: City of Tigard Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other —' Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use Internet: www,ci.tigard.or.us P Cue No,. Contact Juris.: 10 See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Inlbrmatien. :.. .. . : •TYPE: OF WORK ' . .. :.: + .: • . • ., . IE rIEW (PI • New construction Demolition fl Serviceover 2 1 � 25 1 a ���fac ~ <' • amps. 0 Health-care facility Addition /alteration/rea ? lacetnent Qom; commercial p Hazardous location ❑ ❑ Service over 320 amps•rating of ❑ Building over 10,000 square feet. CA TEGCY Y. N. 1 & 2 family dwellings four or more rrsidentiat units in i & 2 -Famil dwellin. C Commercial/Industrial 0 S over 600 volts nominal one structure Accesso $uildin' • Multi-Famil ❑ Building over three stories 0 Feeders, 400 amps or more Occupant load over 99 persons 0 Manufactured structures or RV park • Master Builder • Other: 0 Egess/lighting plan 0 Other: . ` :•: JO1 S1TE INFORMATION :aiid L 'TION sets of se of plans with any of the above. Job site add ress : �.rz( The above are not applicable to temporary construction service. Suite #: Bldg./Apt.#: :'FEr.:SCHIEfi>t LE.. .::: ;'.': 1 ;. ;.; ; •',: ; •' ;' Number of inspections per permit allowed Project Name: Description QtY Re (ea.) Total Cross street/Directions to job site: New residential-single or mold - family per dwelling sort. tnciedes attached garage. Service lneleded: 1000 sq. R. or less 145.15 4 Each additional 500 sq. R. or portion thereof 33.40 - 1 Subdivision: _ Lot #: / '� Limited enerit residential 75.00 .. 2 Limited energy, non residential 15.00 2 Tax map /parcel #: Each manufactured home or modular dwelling - • • .. • • t • O1NL OF` WORK :, • service and/or feeder i Services or feeders - lnitaRation, 90.90 2 •F�V C-0/15 S /4 . C 'J 1 / /� alteration or relocation: • at et T..a: den c-Q -- 200 amps or less 80.30 2 201 amps to 400 antes _ 106.85 2 401 amps to 600 amps 160.60 2 'Sjel4LOPE'RTY OWNER • :.:.., �}; .TEN • 601 amps to 1000 amps 240.60 2 Name: VIA en Q 1 S L / S Over 1000 amps or volts 454.65 2 Y 1 Zt. �- Recomteet only 66.85 2 Address: , , •2... A a Q cIO,'n Aye, 6k L. Temporary services nr feeders - installation. • City /State /Zi : po -( o 0 ? "' -/ Alterati or relocation: 200 ps or leas 66.85 I Phone.7 4 /43 - (40 Fa l • f l�z�t. f •• / � � Branch circuits - new. a tertiden. or Name: v le �- /�o$S _ es per panel: Address: A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit - 6.65 2 City /State/Zip: 13. Fee for branch circuits without purchase of • Phone: -- service or feeder fcc, first branch circuit 46.85 2 Fax: Each additional branch circuit 6.65 2 E-mail: Misc.(Service or feeder not included); • • . _ . - :'CMTRA roR' Each pump or irrigation circle 53.40 2 Job No: Each awn or outline lightint _ 53.40 2 Signal circuit(s) or a limited energy panel, Business Name: 053 _iz , alteration. or extension ( 2 2 Description: Address: Q 8? O 5 k.) cial I3 ## ac,,3 City /State/zip: its is S bQ 1-6. , e>/2 17/ Each additional ins 'on over the allowable In an of the above: Phone:$Q3 (o (� Per in • lion per hour (min. 1 hour) 62.50 �O ' F a73 & , s- lnvestigstion fee: CCB Lic, #: IS75g1 Lie. #: 34iG O t h . _ Supervising electnci • // �+ 1 � : X signature required y 1/ "� Subtoral - S Plan Review 25°i6 of Permit Fee) $ Print Name: i (ROSS Lie. #: y o2S sta Surcharge 8s /a of Pe rmit Fee S Authorized TOTAL PERMIT FEE S , Signature: Date: Notice: This permit'optl�eion expires If a permit is not obtained within 180 days slier it has been accepted as complete. •Fee methodology set by Tri- County Building industry Service Board. (Please print name) — i:\Dsts \Permit FnrnseE1cPcrmitApp.doc 01/03 • 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY 4 BUENNA VISTA fZ002 /003 ..' . J.. Plumbing Permit Application FoR <lrric u. t'tit uSLt• ., Received Plumbing DatrJR : Permit No.: , Planning Approval Sewer City of Tigard DateJBv: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/13v: Permit No.: Phone: 503- 639 -4171 Fax; 503 -59S -1960 Post.Rsview Land Use 1 Date/B : Cue No.: Internat: www.ci.tigard,or.us J f I .. � � � _ _;, Contact Jam: 0 See Page 2 for 24 -hour Inspection Request: 503.639.4175 - -' Name /Method: Su • • !omeotot tntarmatioe. ���'''ttt - TIME � -W� .. • ll$1�* S .�..�.�'+11� -'(te C �Sl' llIIftll'>�t1,0l'�� ;'.•.x New construction Demolition Desch don ... . .. ... Qtr. Pec(ca.) Total Addition/alterati�on/repiacement Other :; " ",''''•• , , � welli : ; ; J r. >; , 1 1 . 1,.. •,liF1T�V4r "� .. !.. I:y N: p r I I I 1 . ' ...,. , +i lii: •i tt$gt:tlhlli .t k.4 : : •l'i 1 & 2-Family dwelling El Commercial/Lndustrial SFR (1) bath 249.20 SFR (2) bath 350.00 Accessory Build er A4 u1 �] SFR 3 bath 399.00 II Master Builder _ Other: Each additional bath/kitchen 45,00 ,:IOB SITE ENIF.OP.MAXIMAisdLOCATION ' Fire sztinkh:r - an, er.: Page 2 Job site address: cat.° 7/7 . • ..... Slt�Utilities : , :6',.•,';.. a� : ', - . . . Suite #: Bldg. /Apt, #: Catch basin/arcs. drain 16.60 Project Name: • Drywall/1=h line/trench drain 16.60 Foetltt drain (no. linear ft.) �1 Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 • Manholes 16.60' _ Rain drain connector 16.60 Sariltery sewer (no. linear ft.) Page 2 _ StlbdiMMSlOn: I Lot #;17 Storm sewer (no. linear ft.) Pas 2 Tax map /parcel #: Water service (no, linear R.) Page 2 • Fixture or Item : :.' ., : , . _ DESCRIPTION OF WORK " •• Absorption valve _L 16.60. , NF., ,( • ,CONSTRUCTION — SINGLE FAMILY Baddlowprevcntcr _ _1 Pa e PAg LY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 .01PROFERT•Y'O�PI NER ' •.: = JT'ENAIWE = . , _ Drinking fountain 16.60 ' ''- Eit:torslsump 16.60 Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6 9 3 2 SW tt'tacdam Ave _ gyp_ C Fixture/sewer ca- 16.60 City /State/Zip: Portland , OR 97219 Floor drain/tow sink/hub 16,60 Garbage disposal L 16.60' Phone: 503-443-6033 'Fax: 5030443-2443 Hose bib 16.60 • Z APPLICANT . , • '. f CONTActri lMON • ice maker 16,60 ' Name: Ray Mullen Interceptor /grease trap 16.60 Address: Medical Rae • value: S Page 2 i /State...._ Primer _ 16.60 C Roof4rain (commercial) 16.60 Phone: Fax: - Sink/basin/lavatory I6.60_, E -mail: Tub /showeeshower pan 16.60 r,• ?.: • . CON IRA:CTOR , . ' • • , , Urinal 16.60 Business Name; ED mu],len Plumbing Watet 16.60 ate heater 16.60 Address: 24470 SW Rainbow Lane Other: , Ciy /State/Zip: Hi lapbcnro . [1R 0 71 7, Other. Phone: 0 — 6 2 8 _ 1 Fax: r _ • . - • • • .' .'.' : Pluwblaa;'Pacm3erP* •.' • . • • • • • Subtotal s CCB Lic. #: . ? 6 R 9 Plumb. Lic. #: - . • . 0 • = • • -- Minimum Pettnit Fcc S72.50 S Authorized i . e9 / Residen Bacldlow Minimum Fee 536.25 Signature: ...t." A ti l' , c: I Plan Review (2554 of Permit Fee) S _ Ray ul en State Surchatge (8% of Permit Fee) S (Please print name) TOTAL PERMIT FEE I S Notice' Tbls permit applIcadon expires Ira permit is not obtained within nu now commerdal buUdlnae require 2 sets of plane with isometric or ISO days after L has been tempted ss complete. clue diagram ibr plea twig*. Fee methodology set by Tri - County Bonding Industry Service Board. l: \Dsts\Pettnil ForRyNPimPemllApp•doc 01/03 12/09/04 THU 10:20 FAX 503 684 0954 CARLSON TESTING 21002 Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 Carlson Te s Ling "Inc. Phone (503) 684 -3460 Phone (503) 589-1252 Phone (541) 330 -9155 9 FAX (503) 684 0954 FAX (503) 589 1309 FAX (541) 330 -9163 Special Inspection FINAL SUMMARY LETTER December 9, 2004 70406521.0 • • FILE COPY City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 -8199 Attn: Building Department Re: Kessler Subdivision — Lot #17 15126 SW 94 Avenue _ Tigard, OR --- Permit No.: MST2004- 00204 Dear Sir or Madam: This is to certify that in accordance with Section 1701 of the Uniform Building Code, Title 24, we have performed special inspection of the following item(s) per our inspection reports only: Installation of Adhesive Anchors All inspections and tests were performed and reported according to the requirements of Project Documents and, to the best of our knowledge, the work was in conformance with the approved plans and specifications, approved change orders and applicable workmanship provisions of the State Building Code and Standards, as well as the structural engineer's design changes, approvals and verbal instructions. Our reports pertain to the material tested /inspected only. Information contained herein is not.to,be reproduced, except in full, without prior authorization from this office. if there are `y further questions regarding this matter, please do not hesitate to contact this office. Respectf y submitted, CARLS• T - 'PING INC. J s F. Hietpas _ rations Manager J H /mbw cc: Buena Vista Custom Homes — Mark Bartholemy Butler Consulting Inc Barry R Smith Architect (,CITY-, OF TIGARD 24 -Hour BUILDING 0 Inspection Line: (5!,3) 639 -4175 0 INSPECTION DIVISION Business Line: (1 +3) 639 -4171 MST r200 'p 6,-)- BUP Received Date Requested — Z Z AM PM BUP Location a " A Suite MEC Contact Person J Ph ( ) 2/ — gq /S — 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 - I _ .hi /_ l �. I" d L Insulation K`) Drywall Nailing // Firewall )t -o i`"'l Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: PASS PART FAIL • LUMBING Post & Beam �• Under Slab _ Rough -In Water Service Sanitary Sewer 4 p Rain Drains - Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL 'MECHANICAL =` 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 Date ," / ZZ O Inspector Ins Ext P 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 6T7) `f`J av INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested _ AM PM BUP Location - Suite MEC Contact Person C P ) 7/0 E9 /S PLM Contractor P , ) 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 Int Sheath /Shear EP6 , /g u Framing Insulation K`e• Drywall Nailing Firewall Fire Sprinkler ` �"� � { Fire Alarm Susp'd Ceiling Roof Other: * ASS 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 Post & Beam Rough -In Gas Line Smoke Dampers 4f-40 PART FAIL • TRICAL 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: Q Unable to inspect — no access Fire Supply Line ADA Date /7 69 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 .$06 MST d -da INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date. Requested (— AM PM BUP Location 1� /� 9/v^., Suite MEC Contact Person Ph ( ) 7l — 8 4 1 rS 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 Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling / D Roof / ",� / Other: Final PASS PART FAIL /� ,7 Cj PLUMBING '„' Post & Beam Under Slab Rough -In / f 767 Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O�t '- r: PART FAIL HANICAL Post-& Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL ' _ Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City 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 Dat 1 ) V J 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: (51 .) 639 -4175 MS6'6/ INSPECTION DIVISION Business Line: (.43) 639 -4171 J BUP Received Date Requested / / O AM PM BUP Location �...` Suite MEC Contact Person 04/1 /1 Ph ! ) cot/2- 7- 8oC PLM Contractor • ( ) 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 Y Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: • Final PASS PART FAIL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service _ Rough -In C) Ae--• (.)•/V /f UG /Slab Low Voltage . Fire rm AS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: ] / Unable to inspect — no access Fire Supply Line �/ ADA Approach/Sidewalk Date 00 Inspector _Ara Ext Other: Final DO NOT REMOVE this inspection recok m the job site. PASS PART FAIL • tkAAAAAAAAAAAAAAAAAAAAAAAAAAAAI1AAAAAAAAAAAAAAAAAAAAAAAAAAAAA V A 1 0- I 1 01. STREET TREE CERTIFICATION ix- - 4i 1 Ot° I, Z A C / G .---7 , Owner/Agent for 0 44 (PLEASE PRINT) (PERMIT HOLDER) i ! 1 , I 1 16i 100- ;i 4 1 Do herebygatity fOtWe' f014wing location 4- -.411 '' 43 meets Citp of TigclAVaiiiiitionCounty 4. 44 40 0. l'arri use and development standards for street, tree installation. kt. 411 4.- 4111 kg- ADDRESS: 44 7337 /2/./4'7.- 1 10- 40 44 LOT: IT? SUBDIVISION: / ---) ' 7"' ' ) 44 1 1 BY: ___,___sce, - .)- 1 DATE:_ji121K - 44 R. .4 0- RECEIVED BY: DATE: // 4 / 44, III al bk. VVVVVVVVVVVFVVVVV -- ' 7 4 7 :. --' VVVVV7VVVVVVVVVVVVVVVVVVV VVVVVVVVVVVV1 .1