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Permit I „ r C -∎ CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2004 -00203 Zillit' DEVELOPMENT SERVICES DATE ISSUED: 8/18/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15152 SW 94TH AVE PARCEL: 2S111 DB -KE216 SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R -4.5 BLOCK: LOT: 016 JURISDICTION: TIG REMARKS: New SF BUILDING REISSUE: BVH3684 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,652 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 2,032 sf GARAGE: 782 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 15 — — — VALUE: 361,595.40 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,684 sf REAR: 15 PLUMBING SINKS: 2 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 0 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: EA ADD'L 500SF: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/ 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: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,199.46 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 Insi 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 Final inspection Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp o " Issued By . i.r /1� P ermittee Signature :,Q Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day USE �� FOR OFFICE ONLY Permit Application Received Building I l�� RECO V[ � D DateBy1 /! /D1 Permit No GT 9004 - 00.2 City Of Tigard Planning Appro 1 Other Y g an Date/By: tka Permit NO3W Ca-On q ■ OU -1, 1-- 13125 SW Hall Blvd. iE l [ ' 1f Plan Review Other Tigard, Oregon 97223 . . . - y Date/By: /IAA J `s' /6-0y Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -1960— Ti 'l ; i' I , a Post - Review Land Use Internet: www.ci.tigard.or.us ( ri e t ..t T ^ a '' I I Date/By: Case No. RI 111 DING :.r . - "° Con tact J ' El See Page 2 for — 24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information E OF WORK. . •:r:...::. : : © New construction ❑ Demolition 1 & 2 FAMILY DWELLI N_G El Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees' are based on the total value of the work performed. Indicate © I & 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 o/ $ : and JOB SITE INFORMATION LOCATION . No. of bedrooms: No. of baths: 2 q9 , Job site address: 1515 4 &" . Total number of fl ors . New dwelling area (sq. ft ).. Suite #: Bldg. /Apt. #: 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:. : - .. Subdivision: z. C OMMERCIAL - USE CHECKLI •: ST : - ' F.Ejr L `: L.. 1 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 $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ® PROPERTY OWNER { .❑ 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 ❑ APPLICANT ( CONTACT PERSON licensed with the Oregon Construction Contractors Board under 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 i abeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: E -mail: BUILDING,PERMIT:FEES *. .. CONTRACTOR -- Please refe'r�to.fee °schedule: - . - :. - . 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 54 t '. - Notice: This permit application expires if a permit is not obtained within Date: 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 • i 4 , ,,„. , One- and Two-Family Dwelling tiL `T1' Building Permit Application Checklist Reference no.: J City ofTigard City of Tigard Associated permits: Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑Electrical O Plumbing O Mechanical Phone: (503) 639-4171 0 Other: Fax: (503) 598 -1960 _ _ THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW __ ._ Ves No `/A 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 carrx original applicable stamp and signature on file or with application. 9 Erosion control 0 plan ',I permi6.cgquired. Include drainage -way protection, silt fence,,desiiin ar aocaion of..- A .. catch -basin protection, etc.__ �' ti .% .. �a ` ,\ t.... k - ,, k� 10 3 Complete sets of legiliyplaiis. 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; directioidicator; lot , area; building coverage area percentage of coverage; impervious area existi ctures on sit'e;' srit#a0 ram ge.;1_;; : i . , 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and rein q cing 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 items, 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. 440-+6i4 (6/00/coxn 1 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 r / fUkctFFf(k t •Sr. Fat. • Mechanical Perm A p ion ini 1, , l�9 t ii v E J Datel�I r P ride � .. . 00 y- OD rt 0 Planning ,7 .prov City of Tigard Dat = 13125 SW Hall Blvd. I I i 1 S A 7004 Plat Review li Tigard, Oregon 97223 �, Da ' phone: 503 - 639 -4171 Fax: 503- 59$- 1960TY C• :Pr', ,RD Post - Review Land Use DitetS ate/9 : Ca &e No,' Irmtertlet: www,ci- tigard.or.us BUILD' p ;,' ° ; 11 71V Ot lu _• 24 - hour Inspection Request: 503 - 639 -4175 Naar-Method: • .. .•.. .•l :k "., .. s73i;- r.;;..,: �. :••... _n . .:::',, ,,1.*.a eOMMERC -FEE •.fiCBOeDIAZ = cBec1 ,.; .,:k. I f Nw c,, onstr TIME O FRI'O R K • : u MN Demolition Mechanical permit fees" arc based on the total value of the work NU Addition /alteration/re •lacement • Other: performed. Indicate the value (rounded to the nearest dollar) of all mechanical materials, equipment, labor. overhead and profit. `:: CA' TEGf} JELXr�[?F:CONSTH>EI"CTTC?11+7,; 5 �: -'� -� •;: = ' ".: Value.: S See Page a for Fee Schedule 14 1 & 2-Emil dwell • Commercial/lndustrial � NI - . � ' - _.• t 1 1' 1 N ' '1 : • I. �� Deur' • don * Fe ea, 'dotal 111 Master Builder Other: • ...TO SITE ORMAT[ON and LOCATION ..: ' ; • . .. Head • • '' Job site address: /616%2, 9 .ii 7 • _ Gas heat • „ 14.00 Bldg. /Apt.#: Duct work 14.00 I Suite 0: H drunk hot waters tern ° 14.00 Project Name: _ Residential boiler Cros8 street/Directions to job site: for radiator or h • reale systern I. 14 -00 Unit heatcrS (fuel, not electric) in wall, in•due su tided. ctc.) Ill 14.00 Flue/vent (f or any of above 0.00 R .air un S ubdivisio n: � t�, ,,,. , • 10.00 MIMI . ''• DES .1- •• [ON ski WORK •,., •_... - 1E11=I=IIIMIMMMM 10.00 NEW CONST tRU 'TON —ST GL' ]: • I ' Flue vent (water ccatorl_. fireplace) 10.00 _ 10.00 DETACHED RESIDENCE Wood/Pellet 10.00 ... 10.00 Mom WM 10,00 ElPERSVO ;e • , -r 1111 :113~NAI't'>C"tir..4:4w • 10.00 Eirritonmenta Exhaust Ss Veladlema NaMe: 13 _ = / -� viS - . .. 0 u . • It - Range hood/other kia . . 10.00 Address: 6 7 SW Mac = -11 • v- S - C Clotho dryer exhaust 10.00 Ci /State /Zi•. Portland OR 97219 Single duct exhaust Phone • - 4 • - •e Fax: a _ . _ :, ■� 2n .C� - PERSON 1 ►1 NUM David Galoba Other; 1 1 Address: Fuel =�' .: Ci /$t3tP/Zl • : •* AO for first 4. 1`I nett a • aortal � Phone: Fax: .: 11 _1 12 . t E-mail: wall/sus • euded/unit heater Mr' Business Name: .... G • :. ��� Address :2428 SE 105th Ave. FLauBB. Ci /State/Zi•:Poxtia>tc1, OR 97216 Clothes . er !as EN= Phone: 5D3 -253 -7789 Fax:5o3 -25 , , ia. Otter: .— Total; CC'S Lie. 'i#: 45131 — Mechanical fairer Fees" _ Authorized 1 . Subtotal: S Sia,,mature; � �' `dot D ']gym ( Minimum P ern,it Fee $77..50 rallIMMINIMI David Golob y Flan Rcvie‘'MIIIIof13crtnit Fee) MEI , State Sure ar:e 8141 of Permit Fee S (Please print name) TOTAL PERMIT FEE Notice: TbU permit application expires Ira permit is not obtained within *Fee methodology set by Trt- County Building industry Senile* Board. 180 dale tarter it has been accepted ms complete. "'Site plan required for exterior A/C units. is\Asts\Fermit Fartru\MeCPerr itApP,doc 01)03 • 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. Minding Forms MecPermitAppPg2 09- 01.03.doc . 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit Application . . . FAR 01.1.1(4 L '4 ti NI : • In U i , L = u 11 // it . J Dat Received Permitcal e� 0 0 `V' uB Permit O., ,/'- -r/r/,- 0 ,5 City of Tigard Planning Approval sign Dete/B : Permit No.: 13125 SW Hall Blvd. .10 _:_ 4 2PJk Plan Review Other Tigard, Oregon 97223 Date/B - Permit No.: Phone: 503- 639 -4171 Fax: 503- 5 TIC. AR[� Post - Review Land Use ,•.,. ~:'; Datc1B Case NO,: Internet: www.ci,tigard.or.us BUILDING r4'; Contact Juris.: CI See Page 2 for 24 -hour Inspection Request: 503- 639 -41 Name/Method: Su .lementalInformation. TYPE;OFWORK ,.. • . '• .;•...; •.: <PI AhFE W.(Pleasii'th itlttliat:iililib'}< :.: .. New construction Demolition ❑ Service over 225 amps- ❑ Health -care facility Addition/alteration/r IaCement Other; commercial ❑ Hazardous location • .. • ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet. .. XATE OR`ICOF'CONS IEWCFION ' _ 1 & 2 family dwellings four or more residential units in F3 & 2- Family dwelling CI Corrlrnercial/Industiial ❑System over 600 volts nominal one structure • Accessory Building__ ID Multi-Family ❑ Building over three stories 11 Feeders, 400 amps or more • Acces Master Builder Other: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park I] Egress/lighting plan ❑ Other: 3OB`_SMTE INFOEtMAcTnON'•andLOCATION . Submit sets of plans with any of the above. Job site address: 15 i 5 Z 9 L f r° The above are not applicable to temporary Construction service. • Suite #: Bldg./Apt.#: - F t r..S 1I 1 !..0 �;:;;;'(- .. Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site: Ncw residential-Ante or mattt.rantily per 1 dwelling unit includes Attached garage. Service Included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft or portion thereof 33.40 I Subdiv Limited energy, residential 75.00 2 Limited energy, non residential 75,00 2 Tax map /parcel #: Each manufactured home or modular dwelling service and/or feeder • >.. „ ... , .. �E , ' t' 01�I'OE`WQ1KK >.' ::::. 90.90 2 "�'� Services or feeders - installation, _JJ CO / S 1L �- -.- S / � C, /)`! _ alteration or relocation: p-e.-}� a L J' d (--2.--- 200 amps or less 50.30 2 201 amps to 400 antes 106.55 2 401 amps to 600 amps 160.60 2 •' ire''. 10P RTYON.V.P ER i : • :,': :.SIB 'FEN . 7.7 77 7 ...". -- 7. 601 amps to 1000 amps 240.60 ale e Q S Over 1000 amps or volts 454.65 2 Name: �:.t t Cl a , r - Reconnect only Address: , Gj ? j - L{/ 1 a ..acIo ' e, L G Temporary services or feeders - installadon. g5 2 City /State /Zi s : po G C 2 00 a J9 20ps or le relocation: / ° 0 amps r ess 66.65 1 Phon • .3- (Ata Fax au !f 5 201 am ps to 00 amps 100.30 2 lR .. : '. ' C' e�,`_ oa 1+ s. ON' 401 to 600 amps 133,75 2 l_ . Branch circuits - new, aiteradon, or Name: S . VC'. / • 55 extension per panel: Address: — A. Fee For branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of Phone: service or feeder fcc, first branch circuit 46.95 2 Fax: Each additional branch circuit 6.65 2 E -mail: Misc•(Scrvice or feeder not included): • . • , . '(1'dR ` pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No Signal circuit(s) or a limited energy panel, Business Name: 1 053 Eft: o alteration, r extension Page 2 2 Address: a S ?O 50 ota"t,J (ewe " 903 Description: p, `i s b0 O 176 - Each addi tional inspection over the allowable in any of the ahove: C i /State /Zi / 1 Per in, lion hour min. 1 bola 62.60 Phone:543 to t{Z Z800 Fax: &3 ( 1S' investigation fee: CCB Lic. #: 1573q/ Lic. #: 3 ei- 36'G Other: �/ Supervising el d ciarl r7 _ w� EtiticYcical lae3ri 3`'ta ::::`,..,,...•::;'..!'s: S ' 'r.• ,: ;.: !� ....C� 1'l� ^' t signature require Subto Plan Review 25% of Permit Fee S Print Name: Si—WC DOSS Lic. #: 4 1232S State Surcharge (8% of Permit Fee) $ Authorized TOTAL PERMIT FEE S Notice: This permit application expires If a permit is not obtained within Signature: Date: ISO days after it has been accepted as complete. "Fee methodology set by Tri- County Building industry Service Board - (Please print name) - i:\Dstss \Permit FormslElePermitApp.doe 01/03 03/04/2004 16:21 FAX 5036284633 s THE MULLEN COMPANY i BUENNA VISTA II 002 /003 . Plumbing Permit Application Received Plumbing H tU U V 1`t D Date/ By: Permit Na. TP-®p • nQ.D.-0 City of Tigard Planning Approval Date se`"'er /By: Permit No.: 13125 SW Hall Blvd_ I I ,1 : 4 20S4 Plan Review - other Tigard, Oregon 97223 Date/13y: Permit No.: Phone: 503 639 - 4171 Fax; 503 - 598; �196)F TI(.ARD., Post - Review Land Use Date/By: Case No.: I www.ci.tigard.or.us BUILDING r - .. - A it Cantaet Avis.: SSee Page 2 for 24 - hour Inspection Request: 503.639.4175 Narnc /Method: Supp1 u west Information. •' -TYPE OP.WORK "'`'' '•PE$ *$ DUI ,E(foripecral'infol'mat lr; , x• New construction Demolition Des I Qty. Peo(es.) Total d ti/ Adition/alteraonr la men ••wh,•,� T.,.,:. ?,:+•;ac,;, +•: ep e e t Other • ::, �. ' r ,�A`'F:�Br: �,.fatuDF �!'elliug� °;r •. �? �•, � l.: :.� .. r -,, OFI;ILCUR'SCaDR, a�� •-.•. - . ..: ii : NOelitib . •e oa neeibtob.•:'1" ", ." '. ` SFR (1) bath 249.20 - ugi I & 2- Farni dwelling 171 Commercial/Industrial SFR (2) bath 350.00 II Accesso Buildin • Multi- FarnilY SFR (3) bath 399.00 II Master Builder 8 Other: Each additional bath/kitchen 4.00 • 110B Sr= INFORMATION aiiottLOCATION ' Fire sprinkler - sq. ft Pa e 2 — - Job site address: 1€) 5 2. (4441-1-1 ' . • '. • • ' ,:, • • . ScteiJtiatles '. ....A,......410.1:-.., - .. . Site #: I Bldg, /Apt. #: Catch basin/arca drain 1 6.60 Project Name: - Drywell/leaeh line/trench drain 16.60 - Footinkdrain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities _ 110.00 - Manholes 16.60' Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #; , Storm sewer (no. linear ft.) Pal 2 Tax map /parc #: Water service (no linear ft Fixture o r Item ... Page 2 DESCRIPTION OF WORK . .. — Absorption valve . N ,CONSTRUCT ION — SINGLE FAMILY Backilowprevcntcr Page FAMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 1 6.60 Drinking fountain 16.60 N 'i ?ROPERTY'OWNF ' •.: -Va TEN T Eieators'sump 16.60 Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6 9 3 2 SW Kacac�am _A3s'_ __ —Fin C FixtwNlewer cap 16.60 City/State/Zip: Portland OR 9 7 21 9 Floor deaiNtloar sink/hub 16,60 Garbs- edis..sal 16.60• Phone: 503 --443 -6033 Fax:5030443 -2443 Hose bib • 16.60 Di ;APPLICANT , , . .11 CONTACIVERSON , • ' Ice maker 16.60 Name: Ray Mullen Interceptor /greasettab 16.60 Address: Medical gas • value; S Page 2 ' Primer 16.60 Ci /State/Zi • : Roof drain (commercial) I6 - 60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower / shower pan 16.60 • , CONTRACTOR , ' - - • : ; , • Urinal 16.60 Water closet 16.60 Business Name: ED ritalen Plumbing Water heater 16.60 Address: 24 47 0 SW Rainbow Lane Other: City /State /Zip: Hi 115b - r .. 013 9 71 2. Other. v ..- Phone: 50 - 628 - 63 i 628 - Subtotal i ' S'. CCB Lic. #; 1 . ; Plumb. Lic. #: • - _ . . •0. • Minimum Permit Fee S72.50 S Authorized Residential Back flow Minimum Fee 536.25 Signature: . ` ' • c: - - Plan Review (21% of Permit Fee) S Ray ul en State Surcharge (8% of Permit Fee) _ S (Please print name) TOTAL PERMIT FEE S Notice' Thla permit application expires Ira permit is not obtained within All now commercial bulldlnp require 2 sets of plans with isometric or . 180 days after it has been seeepted as complete. riser diagram for plan review. .Fee methodology set by Tri County Bonding Industry Service Board• iAD55ts\Pestnit Fornu\PltnPermltf,pa.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) TotaE Square Footage: Permit Fee: Footing drain - I 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55. 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 Fixture or Itetir `:: _ Fee ea " ..TotaE, `" �' ` : _ �( �,. . 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 SI.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 *. • Quantity .by(Fiiture)WorkPeiforuied: =:: Comments regarding fixture work: Future Type: • . .: . New ":'Moved F.iLattn�' » ,'iCfpped' 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 *Note: If the fixture work under this ermit results in an Garbage - Domestic p 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\Permit Forms \PlmPermitAppPg2.doc 01/03 • CITY OF TIGARD ja , 24 -Hour EtIILDING ( Inspection Line: (503 639 -4175 410 INSPECTION DIVISION Business Line: 503' 9 -4171 MST -000-0 BUP Received Date Requested / —/ PM BUP Location / 5 Suite MEC Contact Person Ph ( ) / `8' /S PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear '0 17 -- Framing r' I �� r Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Ot - r: S PART FAIL PLUMBING' ' _ /��_. Post & Beam Under Slab Rough -In -Z: rt:: 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 ri PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final El Reinspection fee of $ required before next i s pection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 111 Please call for reinspection RE: - ,/ Unable to inspect — no access Fire Supply Line // ADA l A roach/Sidewalk Date / O Inspector Ext PP Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (50 .) 639 -4175 MST ' /2 ! `ti / ' 0 3 INSPECTION DIVISION -,' Business Line: (5 ►, 4) 639 -4171 BUP Received Date Requested c� AM PM BUP Location / 5 ! � , " 'uite MEC Contact Person Ph ( ) 6 `. " ZO p d) 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 P� — �.o. Framing • --�_ Insulation Drywall Nailing � r TS 7 ---- s7 --- l Firewall i 1 K > LI D t/ Fire Sprinkler 1 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 Post & Beam Rough -In Gas Line • Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fir- ' larm • -.10 Reinspection fee of $ required before n inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL E l Please call for reinspection RE: , ❑ Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date S Inspector g ire` Ext Other: Final DO N T REMOVE this inspection re Ord .om the job site. PASS PART FAIL • CITY OF TIGARD. 24 -Hour BUILDING Inspection Line;. (5031. -175 _ 3 INSPECTION DIVISION Business Line: (5' 1 BUP Received Date Requested l -- AM PM BUP Location / e Suite _ MEC Contact Person Ph ( ) 7/ o - gf /3 PLM Contractor Ph ( ) 4 i P-0d ?-6 BUILDING Tenant/Owner -mow 4 Footing OW) foga Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: At c kiS To SIT Post & Beam ' Shear Anchors l -Z Ext Sheath /Shear �! ' Int Sheath/Shear Framing Insulation ) � � \-- _c\ ��� li ✓� / - Drywall Nailing FirewallM C W \ ✓� ���(��'�/ Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PII('- Post & Beam Under Slab . Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O. - • • 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 VS- Approach/Sidewalk Date / Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL h k .A AAAAAAAAAAAAA§AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA4AAAAAAA 1 1.- I floi' b• 1 n w r ' ID rill Dil' 1 .4 1 1 ST ..[ _.,. JD ilL TREE CERTIFICATION ., 0 1 ..t. is. It. 1 . , 'h_ , to 1%- to- ji-e/- / 4 ,1(= %C---(6 for pe.a.. ,i, ... 1,11,y‘.., I (PLEASE PROM , (PERMIT HOLDER) 10* 1 I A / I I i . _ . . __- , _ -. - - - A _ = ‘, , ,...4. -,.........- , 100 . Ma. - 7, 7 .- '.7: -_•• I - . .,.= _ i Do hereb _.-:,: -4, ,--:t, - nitg location _,:; . f '-'. :-. ; ti, • s ; meetsAa on county 110. If .44 1-'4,4 vIC A.avr.alr-b. Irem.rwriver .-.--.---,4--i- 47—, ne-,,,..- ........,..„ installatio Am-LA..6 ob.a...7e., casams usa... v .4...1. standards lt.11. JIL.21.....i. 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