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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00113 ���� DEVELOPMENT SERVICES DATE ISSUED: 5/5/03 13125 SW Hall Blvd., Tigayd, OR 97223 (503) 639.4171 SITE ADDRESS: 11680 SW 95TH AVE PARCEL: 1S135DC - 03500 SUBDIVISION: FIRDALE ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG REMARKS: New SF detached dwelling. BUILDING REISSUE: SUN52196H STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 945 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,351 sf GARAGE: 410 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 223,358.40 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,296 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 1 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN <100K BOIL /CMP < 3HP: VENT FANS: 3 CLOTHES DRYER:. 1 GAS FURN > =100K' 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCESI VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 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: $. 7,768.84 This permit is subject to the regulations contained in the LANDRISE DEVELOPMENT LANDRISE DEVELOPMENT LTD Tigard Municipal Code, State of OR. Specialty Codes and P.O. BOX 1212 P O BOX 1212 all other applicable laws. All work will be done in LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97305 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 246 - 5662 Phone: Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 116797 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. ` pbo_(S I _V/IP�/ REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Rain drain Insp Mechanical Final Sewer Inspection Underfloor insulation' Electrical Service Low Voltage Water Line Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Fireplace Insp Water Service Insp Building Final Foundation Insp PLM /Underfloor Framing Insp Gas Line Insp Appr /Sdwlk Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final f Iss -d By : 111• . .O _ J Permittee Signature : �' Call (503) •39 -4175 by 7:00 p.m. for an inspection needed the next business day ^�/ -- • i .r n II q h: , : ."'-FOR OFFICE °USE ON ' _-.; / Building Permit iA.0 ` 0 I U,e t l � 'j _ Received Building pp ��. 7.: —► Date/By: J/ fog Permit NOM iak0 � ,. � "OD / I. Planning Approval Other jp City of Tigard MAR 9 4 2003 Date/By: Permit No '& /e O3 — D009S il 13125 SW Hall Blvd. Plan Review Other / �" Tigard, Oregon 97223 CITY O TIGAF,D Date/By: 1114V 3/2& 3 Permit � � (7e 7 r" j" nI^' '•, ^I Mt b I\ Post - Review Land Use I l't Phone: 503 639 - 4171 Fax: 503 598 1950 DIV I �!,,''� Date/By: Case No. 01 t Internet: www.ci.tigard.or.us .... Contact • )liras-:'- -._® See Page 2 for 1 1 24 - hour Inspection Request: 503 639 - 4175 Name /Method: n 116- supplemental Information • ' 11 . r °.V"! c,,�- +ax:. tt�?a':ht.• xi�ie it ^ "` s; k .� - nr__s....y . �..,, . :1: - 'sy Sii'ag�. i .. t :Ti:: pr i. - _'3 *• - - ,�t..a� °. 1.° 4� , a,'�'. .j�':.; - r'. � `: :rT�:.vi�. - Sk. -�xi'a; ae.,, ,,_ , ,. r::_ 4;_.:, <: a. DDATA .,.. T. - �;� � �;; >.�.,. p ,..�,TYPE'QF,_WORK.r �3 : =� .�,:• `6:. , • .# .�..�REQUIRE - : �;;W » :: ?t s,�. ' r � �. ' .. xr,cc _i�•x . g:r.X' •::x� 3 ?:jti•,;; ;•s ;y,�t- r ta _r.. s ` ,r, ,: ,_ _ ` <.>l &s2 FAMILY?DWELLIIYG; ^;s� & '� : . `;' > [� New construction Demolition a ;. •. , ._ . ` fy� � '. ° .? L'£+ s; iti ::l,�:daa?i!. +,5wnE:_.y <iiEi ;�_... :�: ���- 2i£:..:�.:. ?::: �i:_...; -• : '� \ ❑ Addition/alteration/replacement II Other: F r I' i v.�k +:Y s .CATEGORYFOFCONSTRUCTION;- ''';'.�= : - `' -:� a?� Note: Permit fees* are based on the total value of the work performed. Indicate :.%,..'1:::'`.-.. .� : �= :� " 1 & 2-Family dwelling n Commercial/Industrial labor, the value (rounded to the nearest dollar) of all equipment, materials, :.%,..'1:::'`.-.. . ".r )' g overhead and profit for the work indicated on this application. 1 III Accessory Building n Multi - Family X Y1=0'41504 �8, 3 III Master Builder n Other: E1 valuation... 7 • F. ,, . INEORiVIATIONand;LOGAT •._ ",,'4'- No. of bedrooms: y -No. of baths: 3 number of floors / � Job site address: 64A7-4—s€0 �'� �� New dwelling area (sq. ft.) / g 1 Suite #: / % & $'D' Bldg. /Apt, #: Garage /carport area (sq. ft.) 14.1. ,.60... 1 Project Name: Covered porch area (sq. ft. 7 Cross street/Directions to job site: Deck area (sq. ft.) P/A.. 9 E,v' v FF (jreer■bu a Other structure area (sq. ft.) PIA '•f yy,� .r:7' - i<: F F.�`C. 'F: � ,.. v : � , N r F {} I . :REQ DATA: :` = � °.3 , " . • :'*i '3•if UIRED ; we .X;p• e t pp•a.e.4'rroar::c•,�:.,:. Ws•4M�.- vst4, :M {=3 ,.. - :i , ; ; COMMER G IA7. - USE:CAECKL'IST - • . _: `; ,. •. _ ; � -g "• • ,- 7- tt:! e.!• �a., t ,n::e. 2ri;�a;: •.�..:. •. _.er3;.. Subdivision: I Lot #: Tax map /parcel #: 15 )35 DC_ —0 35 PO Note: Permit fees* are based on the total value of the work performed. Indicate F ' the value (rounded to the nearest dollar) of all equipment, materials, labor, ;°I j1 DESCRIATION QF`WORK!ciat ;; ; "; ;`; :,:_•:;_ .. � � 6q 64\ o ver h ea d an pro fit f or the , work indicated on this application Np,.I,J C�OA*t 0A of I Valuation l S i • tl Existing building area (sq. ft.) New building area (sq. ft.) Number of stories 1 �, TEN NT1 F` '` -' :' i'1Y` s " %'' of construction / • tPROP NyNERaag14 El Ai 1 .' .•..., - ..-;._,.",fir' I j Occu Type g roup(s): Existing: Name: �,� �, Op it�opU►�ir1+' New: Address: p,O 12)p•i 4 WI, City/State/Zip: • y► y p I, O 5 �� `lc�� 1 I NOTICE: All contractors and subcontractors are required to be Phone:503- -lL",5 ' 'x: E3 a licensed with the Oregon Construction Contractors Board under APPLICANTS r.. .:, t<:I a4 kti 0 sCONTAC-TpiPERSON' wil provisions of ORS 701 and may be required to be licensed in the Business Name: ; ,�, f�zj�t1n, jurisdiction where work is being performed. If the applicant is exempt Contact Name: c", ,�,5 1,2,,,I\ ,S I I from licensing, the following reason applies: Address: Pic), 6 ©jc Icl.lik I City /State /Zip: (. . 33I,J� 1 6, q7035 �y���j i Phone: "' �oo�s, 1 Fax. J .50 .3.-- 1 � L wag : 6 1 , Y; ` F rwt•: er_•. a „;. ryist+z:, ='-fir s: ..°w' L hS-,.'4.4a as!.. a2! te= "``,,` ^., : i .:•.< 5 : • . B lj,„ --FEES* �• . '' r i ,, E -mail: •j •�"G';-4`•' -: ~ 3 P,le a seireferito;fee:sclie d ule. „. t ''.. .`' .. - - - - �- - _.i r I -;-0-..,---,--,'.. 4-1L: d os �:S :..x•.P1• _.. . - . `fG l ::?�;,:+ �f�._ ,r : :!�'a.�4'- = . -. m'J: -.� . Y t .d+e, . , ',+�.• •.. :- :d ^ ^ ?:tir1:t52.a{+.'_�' dt. !>�>�' -. Y =r i' " q? 4• • x,r . �. l •. - r A it a� x _a"`W,+'Wa:: : :' FS�;. F?,. 'S tw ..., -.. v. ,•.;:-F� =a! A ?;;fl?�;$x;:5x. «..,. .,.,.s•,*i_•CONT,RACTOR� ��= �! :� - tt.��•� _ TMe� • Business Name: l © �40is�, �'^ �+ Fees due upon application $ �.Sa. 407) .1.),.1.),() 97 Address: , r 0•y. al V' I Amount received $ City /State /Zip: L04412_, OSv. j 0� 9 Phone :.c3— ,Zy{, - 5'6'. Fax: 05 15 ` �-00 a ( Date received: CCB Lic. #: III �, Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. CIA" S 1.--eL. yks *Fee methodology set by Tri- County Building Industry Service Board. , (Please print name) - is \Dsts\Permit Forms\BIdgPermitApp.doc 01/03 ` 1 1) P t It • 07.T87707-1-3:56 i e t� f J CE LEWIS & ASSOC.LLC PAGE 62 503459682>3 ' -- Et�l • ,. - �itiia.ti.0 0A-aa s. •.a &aa. ,4--lkokiaw.aakayaa Received Permit No.: STQ�0 �DDi PAR 2 4 LUUJ Date/By: -, - Planning Approval Sign of Tigard DatrlBy: PertretNo.: 13125 SW Hall Blvd. C I Y OF T I G P r'3 ,) Plan Review • ^ Other No.: _ _ Tigard, Oregon 97223 BUIL INC DIVISION Po Date/By:, -v- ante Phone: 503-639-4171 Fax. 503-598.4960 Date/By: Case No.: . Internet: www.ci.tigard.or.us lucks:: I Supplame ® Sec Pa B , . � ,•���� CanWtt ,il`1 'Intbrmotion. 24 -hour Inspection Request: 503 - 639.4175 Name/Method: . T E y h Y :'ireK,Tttr,'MIAN' tEVIEW sc°C ".111EVE�•) - '1 : J s7d -� , .;'.:i `�.:�. .. .. ,�'• �`tls.F.�1C,'x1y .���:.:4•. ,'{.��,�Lk:.n3�;..• ,e^.:,.:..� l �r`° ..- P. New colistruction I Demolition ❑ s commercial mict over 225 amps Healthmre facility Hardous location 0 za • /A,ddltiOn/Slte attOnireplaeernent !L Other: 0 Service over 320 amps- rating of ❑ Building over lt),000 sgtmre feet, ti�'.;� ' , tt , l ECORY•.01F_O NSc2RUJtT1OH .: Y;- j •- t; i- :... . i & 2 family dwellings four or mote n:s idanial Units in I] 1 & 2—Family dwelling ❑ Commercial/Industriat El S over 600 volts nominal one structure D Building over three stories ❑ Feeders, 400 'turps c r miare LI Accessory Building 0 Multi - Family ❑ Occupant toad over 99 persons 0 Menuractured structural or RV park ❑ Master Builder CI Other: D Egress/lighting plan ❑ Other: _ Submit _ sets of Plato with any of the a bow!. ' "i rd a y tl ?IPiFORMX� IOl!T iiid: 's c • 7[70N? +" -. . - The abo are not a ieablc totem cntt 1 service. Job site address: / /6.%) I P 5 •1' , . ' - . T1?w" *•: FEE SL jn:E'i �r` '. `''' ~" ':'..:7 :,•' ; ' - • • a Suite #: I Bldg./Apt. #• Number of inspection: ) r tt allowed Project Name: I Description Qty ' Fie Na.) .) I Total I i New vesldentla) stele or rank( per Cross street/Directions to job site: dwelling nail includes attached garages 5+h eve-- etentwo la Service Included: 1000 ce A. u ed: 143.13 i 4 Each additional Soo sq. R or portion thereof __ 330 . I Limited enemy, residential 75.0) i 1 2 Subdivision: [Lot #: Limned energy. non residential _ _ 75 03 2 Tax map/parcel #: 5 /..5 �D S Fach manufactured home o: modular dwelling _ y: service andrer feeder 90.93 2 - ESORIPTI MORIC-0.4 ..'i1 i'.:: _ ' =^::,. Services or feeders - Installation, • L ,c tt., WO1 tr alteration or relocation! 80.33 i 2 'V - a 200 ear or less _ . e 4.J . t 201 amps t o 400 amps - 106.0 5 , 2 401 arrt,�s ro 60o amps ^460.6D , 2 a o : `.;t! r.' (` I )M:N/'C111T.` .. ; . ''"G Over 1000 mom or volts _'3° s 2 Name: r . ` ' ., 'i . I ,.. Reconnect only _ 2 Address: P C) t Pictx Ic1.14), I Temporary services or feeders - installation, alteration, or relocation: Ci /State/Zi r : . _ 4 te. . • • ' e • Mims or less 100.70 : J 2 201 amts to 400 amps Phone: - Fax: ;. - 59- �. 401 to 600 atnps :73.75 • 2 • .�. Su�..� �i P. ! ? Branch tlreultl - neve alteration, or ame: L 'h5 I !~„S Q I lil •: • � extension per panel: {, A. Fee for branch circuits with purchase of 6,t 5 2 Address: I ,C,, �)( b,J .-n-k. or feeder fa an , each branch circuit -- B. Fee for bench circuits without purchase of City /State/Gap. Lw��2 , OS - - .. Q A. c service or feeder fcc. first branch circuit _ 4615 : 2 Phone:— Z , 566 -,. i Fax: 15,03- 4M ia•g EX/1 additt0aa1 branch circuit _ 6.as • 2 Miac.(Setvice or feeder not included): 33.40 2 E-mail: tit!' pump or frriaanoo code _ " �, s ^ _.r t_:'rr r; � Each m __ 53.40 2 Job No: I _ • Signet cirmirts) or a Limited energy panel. 2 -Business Name: t.)/-7 f, r . 1,4,071,-...,1- � id -A, 4-' n r extension • :. _ '' Address: '7S' 5� 5 2-4l d ,1 . Each addition inspection over the allowable in any t e ave: 17 City/State/Zip: � c ) -."I ra.r..d eNL2 C Y1 1 Per inspection hour ection per to (min. 1 how) of - 6250 Phone: ''1? Z. 3O cI Fax: I � i l. ` L L )Q .k Other trweatiganon fee: ` -1, CCB Lic. #: 1 5 -S'do 7 I Lic. #: -7 '— 0 other: ' Y ^i . ,. (: c....._ II r yam` � . ,. Supervising elcctcieian ) �-^ ' Subtotal S / signature required: G•-- i 1 10 plat, Review (25% of Permit Fee) _$ Print Name: ' i f '. 71►v 1 C. • 'r iti1 7 j S State Surcharge (8% of Permit Fee) S , TOTAL PERMIT FEE 5 Signal eel 7/ O -a Notice: This permit application expires lie permit Is not olstaintd within Signature: /� Date: 3 /' / / — 100 days alter It has been 'tempted as anapteta. ri,, , , !it I 'Fee mcthodofegy set by Tri- County Building Industry Service ear t • .• - (Please print name) • • i:\puts\Pcrrnit Famtali]ePerndhApp.doc 01/03 • a •d d9T :c10 CO GI Jell _ FOR OFFICE USE ONLY ' L -'. MecIi tnical Pei mit Application Received Mechanical • t[ l� U b " ' Date/By: Permit No.: �5 /'�0 `,- Planning Approval Building I' City of Tigard MAR 2 1 003 Date/By: Plan 13125 SW Hall Blvd. Plan Review Other Date/By: Permit No.: Tigard, Oregon 97223 CITY OF TIGARD Post- Review 4 . Land Use ; 4 f ` j ° Phone: 503-639-4171 �F cL �50 v 9811�60OIV � �� t\ C ontac t Case No.: Internet: www.ci.tigard.or.us o f I Contact Juris.: ® See Page 2 for • 24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information. .�,.. �ne:.:���M"`°b: .;.t1r x,.l� s'a�v,'{�i:s "`'s` iaS wa?iFS3M• ^a : `. x § I t�ce� M ..... ,. �'�� _ "' "' }• *.: M= m� ;��,�- =a;�=r�1(�TYPE'OF.,;WORK 1:- ;.ti,1aCOM1VIERGIAI; FEE SCHED. ULE•_ „USECHECKL:ISTi�=��;3 f LNew construction I❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement I❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all __ _ �,,:�, -,. __ -. _- ,,,„;..,..,,., , ; ;:;,.:,, mechanical materials, equipment, labor, overhead and profit. F3 ?,',_:�,��'.;,,; _CATEGORYSOF' CONSTRUCTION : {,..�:u„ra�:r;, =r- F - -et' = $ See Page 2 for Fee Schedule ❑ 1 & 2- Family dwelling El Commercial/Ind V ustrial l e i ❑Accessory Building ❑ Multi- Family .' 'iRESIDENTIAV EQUIPMENT /S.YSTEMSfEE* SCHEDULE Description I Qty I Fee(ea.) Total ❑ Master Builder . ❑ Other: . Heating/Cooling yJ; t +0'.a'JOB''SITEIINFORMATI'ON, aril L;OCATION,f' :W= Furnace - add -on air conditioning I 14.00 1y, Op Job site address: / / 4V 51,J 4'5711 Gas heat pump 14.00 Bld /A t #: Duct work 14.00 f V, 00 Suite g' ' Hydronic hot water system 14.00 Project je oject t Name: I Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 �,L k � 9 Pee^ 4 Unit heaters (fuel, not electric) r (in wall, in -duct, suspended, etc.) 14.00 Flue/vent (for any of above) 1 10.00 I , ka Repair units 12.15 0 Subdivision: Lot #• , -• .: • - - Other .Fuel Appliances'... :�-` ": = N Tax map /parcel #: 15 135X" 03Sp Water heater I 10.00 10.00 �•.... n S "H; o ' I 10.00 1 0, i�0 1...:i "i;��µ- r.•i;`.:":�f�; DESCRIPTION'.` OF.- 1WORIC', 'aa�"�'.��r,.�a-%'.,,.�,;��,: =� Gas fireplace 10.00 JAI t tt fir\ j {� .f. ��(pQlcktc Flue vent (water heater /gas fireplace) 10.00 � N, °tte� U 1T � Log lighter (gas) 2JP�0en V2 j hG �ht J i� `�' Wood/Pellet stove 10.00 I Tt ►f _ � v r C . dr >1nt.�,� Wood fireplace/insert 10.00 � r Chimney/liner /flue /vent 10.00 I(JPROPERTI'xOWNER":''` ::I� "' M "ci Oth er: 10.00 t '��.,- . _' ® �' TENAi1VT�,���;1":��'� .. z»s. ... . ' °Envir Exhaust &Ventila -.,a: � � •'�'•'{ -`- Name: � 0/0100m64- Range hood/other kitchen equipment 1 10.00 K9 i &t, • Address: p, 0t o% 16-14. I Clothes dryer exhaust 1 10.00 /0,00 City /State /Zip: La O5w o, 6g, 87035 Single duct exhaust . Phone: 503 -14,6 --566x. I Fax: So3 --0045 (bathrooms, toilet compartments, 6.80 7, 20 a a J r.., (, � F ° z" ti I ,;. ° CO T ACT{PERSO Name: N�. 1 4 utility rooms) 7 . ,[ aPPiic�:N.,.:. < -.:. 10.00 � 0.5 6 e- 6.2_1/446 � � G1dt -5 I-Q,v A5) Attic/crawl space fans Lc u Other: 10.00 Address: Pt0. god 10- l',3-, II .. - - 'Fuel Piping .: : •:r> i;o-V: ....L... . City /State /Zip: Lc. _ O-SwQl C)K. c * *($5.40 for first 4, $1.00 each additional) .! � Furnace, etc. � " Phone: 52.3-2 -'S�r Fax: 5o 3 - L .--O . Gas heat pump ** E -mail: t WalUsuspended/unit heater ** .mow .��:.��,: 'it: .s..r.'=• �,^ 1, ..; _ • fr`„`';' 1` w�: �," �C�'. ���... t, �° r�CONTRAC, T, OR:,;. �";�;��:��::�<:��;l��fi�'._.�r. _�1'�.,,- Water heater ** ... - -- Fi 4` Business Name: Su h glow a ** Address: Zt{a V /0S1-1.‘ Range --'' II , /� , r BBQ ** City /State /Zip: dl41 0 � 1 7aih Clothes dryer (gas) ** Phone:503 �53-)7ty I 'Fax: ;Sp3 753 Other: ** �1 Total: CCB L1C. #: 'i S, 3 Mechanical Permit` Fees* ;''. . Authorized Subtotal: $ Signature: i Date: / I! Minimum Permit Fee $72.50 • $ Ci tl/' ...S e' Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ • TOTAL PERMIT FEE $ Notice: This permit application expires if a permit t is not obtained within *Fee methodology set by Tri County Building Industry Service Board. 180 days after it has been accepted as complete. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information • i k Commercial Fee Schedule: Total. Valuation:,:,, ;{ :PermitFee:e., $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or • fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00_ $379.50 for the first $25,000.00 and • $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • .Assumed ;Valuations Per'Appliance: . • • Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater,zwall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to I mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU • Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL ='S- =_:. . • $ VALUATION: i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 I 03%1812003 14:01 5034590028 CE LEWIS & ASSOC.LLC PAGE 02 i i EC E ll V ID colt ok <t tC> t'tit: oNt.1' is ]�IC$�0�1 Reecivc0 Plumbing ` 4 9 . �/ patrls : Sewer City MAR 2 4 2003 P ate/B : prCVa! Permit No.: _ - Date/13 al(d Plan Review Other - • L3I25 of H Othe r`'s° ' 13125 SW Hall Blvd CITY OF T.GARD pat t ' Land Use 97223 BUILDING DIVISIO Pori g - Tigard, Oregon Fax: 503- 598 -196 0 .,, natde • v ,� Sec Pape a : or Phone: 503-639- .,,�� j�j Piton Su• ec rag 3•.' or r�ation Internet: wtvw.ci.tigard.or.us 24 hour Inspection Request: 503-639-4175 - E/ foi'itiation`:11s �itieltllst •• ,•' F E•' SC_ HEDPL for.',';: `diit lri e c ee Ist) - OF 5 {air :- rr'. ,. HED ti0 Fee(ell_f t: TL::; � .: �t z�:u�:::TYPB mOliti0' . • -._ . ,. A & 2- fot • .. 1 11/ N Coil CtiO Other: y y Y ,� . • ..nitutks,104 u co ,:• . alteration/r • laoement � � O - _a. 249.2 1111 Addition/ ',AC— :' 350.0:> •; ri^ f^ �.; �.; �s��� 1�'EGORYO�GO�ISTRUC:T101�;u,�_ tiustrial SFR 2 bath 399.OD • ' 1S 1 & 2- Fatah dwellin: HI ColsimcrciaUfn bath en 45.00 'I Master Buildin: I■ Each addition ti r Pa• c 2 Master Builder 1 Other: �. - -• DI QIFORMA ON'and'� N LOCATIO4 i � n 1 i •. ,�y gitl.[ItGlllk ' -::',' r ': s it e ia dd r ess :E 71 ___ illt u !6_f4 I Job site address: 16,t10 $ld : Jf� • t. #: V e l Vleach line/trench drain Pa ;< 2 — Footin: drain no. linear ft. - a '11 2 Pro ea Name Manufactured home utilities hi:�0 Cross streetNirections to job site: Manholts MI 1 x A q G Ave_ 401 G1�en Ram Aram connect 1L1 Pag�:2 �_— _ ` Storm sewer no. linear R. 111 Pa 2 , Lot #: W service no. linear ft. QM Pal {i:2 Subdivision: .* r i ., ," . :a:' ^ r 2 -x #: 5 / ' O ;,,- 16.60 TaXtna•/•arcel '`I' • •"- jf,t Abso .tion a ,. ty. O,W;ORIi~< .N Pale � � � I .60� MUM h' i NM k6 -60 �1; '� • �' t NM r, 96.60 S . �O Dishwasher 16.60 ■• Drinkin. fountain O ERp "'-::Cxs � E eetorss>nn • Iti.60 16.60 1111111•1111 6-'3 ItOP>cREY' j %+= 1u�s"''r in t ii.60 A r : .1 - ' r ' I Fixture/sewer ca • 1 ei.6 Address: • : • Floc d d i , . drain/floor sink/hub 1560 MI W . r n ' Mgt Floor t i. loot 16.60 Cit /Statel"Lt • : - _ � _• � ,.,. , Hose ib � ,' 16.6G �j Phone: G 1 �@ CpNi ACT PF�RSOI!Tt' ?tai'% b M 16,6(1 M edical , as "v alor. S alio r 96 l Address: t r • r . -_ i G.6+) • • tm r - 1616 lil Cl Phone. , — • : ,- (r rJC' o Roof drain o _16.6)' S Illf. • — Soo n . FaX • ••• 1-161i-071.'1 SinWbesinnavat., Phone. ,. — Tub/showcr/sho . r 16.6o 15Y:.:•.''.3:�C " 7ta sk:7ti: : !n ee :;. l' ,I YlG�1HfRACTOR t _ fik - I $ Add ess Name: 4 Y 1 - ^ """ i Other; ' fires: • i ✓�. -' 0 — o ther p1u�S ° ._Ec ': .f, �'F— s:e; ,:'.: Phone: ' # '- ''� I Plumb. Lic. #: aG — ./ -.e Minimum Permit Fee 572.50 9 CCB Lit:. ##: 7..o Residential Backflow Minimum Fee 436.25 Authorized 1'1 p`{ / 03 Plan Review 25%ofPermitFee 5 ' ,.._. / . Signature: • State Sur ; e 8% of Permit Fee S ea_ _ r sel L TOTAL PERMIT FEE an i xitA isometric or ( lion a print % f p All new com mercial buildings require2 sets of p runt • iuuan expires H s perrei! is not obtained within riser for plan review. diagram a std. Notice: This Pe application at eempteee. methodology by Building industry Semite 1aa days after It has been accep • ser diagram as b Tr C i:lDStslPermit FatmslPltnPccmitAPp• 01I 103 n.= T • d Tz66- 698 -EOS It—lei i .ioutw dT r9 60 BI Jeki FORM No. 926 — EASEMENT. COPYRIGHT 2001 STEVENS NESS LAW PUBLISHING CO.. PORTLAND. OR 97214 Er; - EASEMENT STATE OF OREGON, County of 1 certify that the within instrument was Between received for recording on LANDRISE Development Ltd. at o'clock .M., and recorded in 1 -- Box 1212 book /reel /volume No. on page Lake Oswego, Oregon 9705 SPACE RESERVED and /or as fee /file/ instrument /microfilm /reception And FOR No. , Records of this County. Al M. Degrood and Virginia E. Degrood RECORDER'S USE 2273 S.W. Chapman Rd. Witness my hand and seal of County affixed. Sherwood, Oregon 97140 After ording, r rn to ame, Address, I ): NAME TITLE Landrise ueve!opment Ltd. F:ff:- �oz -72i2 By , Deputy. Luke Oswego, - Oregon 97035 THIS AGREEMENT made and entered into on May 1 , 2003 , by and between Landrise Development, Ltd. an Oregon Corporation hereinafter called the first party, and All M. Degrood and Virginia E. Degrood , hereinafter called the second party, WITNESSETH: WHEREAS: The first party is the record owner of the following described real property in Washington County, State of Oregon, to -wit: Real Property in the County of Washington, State of Oregon, described as follows: Beginning at the Northwest corner of the John L. Hicklin Donation Land Claim in Section 35, Township 1 South, Range 1 West, of the Willamette Meridian, in the City of Tigard, County of Washington and State of Oregon; thence Soil th 89 °34' West 21.30 chains; thence South 14.24 chains to the center of County Road; thence South 229147 feet; thence South 89 °13' West 158.66 feet to the true point of beginning; thence South 90 feet; thence South 89 °13' West 238 feet to the East line of a County Road; thence North along the East line of said County Road 90 feet; thence North 89 °13' East 238 feet to the point of beginning. EXCEPTING THEREFROM the Northerly 75 feet of the Westerly 115 feet. Tax Parcel Number R276631 and has the unrestricted right to grant the easement hereinafter described relative to the real estate; and the second party is the record owner of the following described real property in that county and state, to -wit: Real Property in the County of Washington, State of Oregon, described as follows: Beginning at the Northeast corner of the John L. Hicklin Donation Land Claim in Section 35, Township 1 South, Range 1 West, of the Willamette Meridian, in the City of Tigard, County of Washington and State of Orego h ; thence South 89 °34' West 21.30 chains; thence South 14.24 chains to the center of Greenburg Road; thence South 21.27 feet to the true point of beginning; thence South 298.2 feet; thence South 89 °13' West a distance of 158.66 feet ; thence North 357.82 feet to the Southerly line of Greenburg Rd; thence South 70 °05.5' East along the Southerly line of said Greenburg Road a distance of 168.74 feet to the true point of beginning; Except that portion conveyed to the City of Tigard by deed recorded December 31, 1990, Fee No. 90- 71242. 1.00 NOW, THEREFORE, in view of the premises and in consideration of $ by the second party to the first party paid, the receipt of which is acknowledged by the first party, it is agreed: The first party hereby grants, assigns and sets over to the second party an easement, to -wit: line An easement for ground water drain A _ along the Southerly 8.0 feet of the below described parcel: Real Property in the County of Washington, State of Oregon, described as follows: Beginning at the Northwest corner of the John L. Hicklin Donation Land Claim in Section 35, Township 1 South, Range 1 West, of the Willamette Meridian, in the City of Tigard, County of Washington and State of Oregon; thence So i th 89 °34' West 21.30 chains; thence South 14.24 chains to the center of County Road; thence South 22947 feet; thence South 89 °13' West 158.66 feet to the true point of beginning; thence South 90 feet; thence South 89 °13' West 238 feet to the East line of a County Road; thence North along the East line of said County Road 90 feet; thence North 89 °13' East 238 feet to the point of beginning. EXCEPTING THEREFROM the Northerly 75 feet of the Westerly 115 feet. Tax Parcel Number R276631 • (Insert a full description of the nature and type of easement granted by the first party to the second party.) (OVER) 0 • ... • he • .. '. .. . • .. • - I. •• • . • . . - - •_ : • . •. . • ' _ -. - ... t thereto. . Except as to the rights herein granted, the first party shall have the full use and control of the above described real estate. The second party agrees to save and hold the first party harmless from any and all claims of third parties arising from the sec- ond party's use of the rights herein granted. The period of this easement shall be Per , always subject, however, to the following specific con- ditions, restrictions and considerations: This easement is for an existing groundwater line connecting to the public disposal system in S.W. 95 Ave. The easement is for the benefit of the real property described here in as the Second Party. The Second Party is not to make any additional connections to the subject drainage line. The First Party may connect additional sources to the line, including but not limited to, ground water drains, rain drains or catch basins to the existing line. First Party may modify or change the placement, size and type of pipe of the subject drainage line. The easement is subject to the maintenance agreement executed between the above named parties. • During the existence of this easement, maintenance of the easement and costs of repair of the easement, if damaged by nat- ural disasters or other events for which all holders of an interest in the easement are blameless, shall be the responsibility of (check one): ❑ the first party; El the second party; gboth parties, share and share alike; Cl both parties, with the first party responsible for % and the second party responsible for %. (If the last alternative is selected, the percentages allocated to each party should total 100.) During the existence of this easement, holders of an interest in the easement who are responsible for damage to the easement because of negligence or abnormal use shall repair the damage at their sole expense. This agreement shall bind and inure to the benefit of, as the circumstances may require, not only the parties hereto but also their respective heirs, executors, administrators, assigns, and successors in interest. In construing this agreement, where the context so requires, the singular includes the plural and all grammatical changes shall be made so that this agreement shall apply equally to individuals and to corporations. If the undersigned is a corporation, it has caused its name to be signed and its seal, if any, affixed by an officer or other person duly authorized to do so by its board of directors. IN WITNESS WHEREOF, the parties have hereunto set their hands in duplicate on the day and year first written above. ® M- ' �roNgA /SS ST PAd C ' ry/11" e.'1 � FIRST PARTY f STATE OF OREGON, County of (A., Gk S k 1 vin_40 r1 ) ss. This instrument was acknowledged before me on S I. O by _ C.k .-r 1 5 € • Lzf vJi by Char es This instummnt ewis was acknowledged before me on , as President of Landrise Development Ltd. • , OFFICIAL SEAL �' , __�t.L GCn'K� "° TRACEY L. DOM 4 • • RY PUBUC- OREGON ENICON ry Pu. • for Ore!. '1-31- V 3I _ 0 tISSION NO.. 359977. My commission expires \.Y'. XPIRESIJ aLY 31 006 itir COND PARTY STATE OF OREGON, County of LJQ1_1 X ) ss. A1Tiis i ?Agroo t d w ana c "Virg%ia ' by 1 . Tli• strument was acknowled ed before me on ___ a 6 3_ � , by _�l!_ i _ - �__e_e_r_wci____ __V fo eu_a-- - L� --_GI-Do - f _ as of 1 . Pu r I •. My commission expires 7 (..0 CITY OF TIGARD 1 24 -Hour BUILDING ' Inspection Line: (503) 639 -4175 o INSPECTION DIVISION Business Line: (503) 639 - 4171 MST 3 BUP Received Date Requested / / AM PM BUP Location /[ / 6 861 l Suite MEC Contact Person • e4tAjt Ph ( ) 5 7 -3 S 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing . !`' \� ELC Foundation Access: � ii39 Ftg Drain /L � C/S— ' ELR Crawl Drain - Slab Inspection Notes: /-' SIT Post & Beam µeC 4424M lle...e Shear Anchors Ext Sheath/Shear . Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler " Fire Alarm Susp'd Ceiling Roof • Other: � Fin -P ART 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 1MECHANICAL Post - &Beam Rough -1n Gas Line Smoke Dampers "Fin AS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage • Fire Alarm Final Reinspectio 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 // Inspector Ext Approach /Sidewalk Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OFTIGARD • 24 -Hour BUILDING Inspection Line: (503) 639 -4175 00//3 INSPECTION DIVISION - Business Line: (503) 639 -4171 (OA 'L BUP Received I 'z t5Sj / Date Requested / O / AM PM BUP Location (L (0 D Suite MEC Contact Person 0. (n.v'—C l_EuJ i 5 Ph ( - - -� PLM Contractor Ph ( SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Sr ea S Ext � , Ext Sheath/Shear � C / Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PA T FAIL LUMBING — • Post & Eeam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot I - 400 PART FAIL ANICAL Post -& Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage I 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 0/Z,/4O3 �y ADA Date ( Inspector 3i�/ `/ Ext Approach /Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour • BUILDING + Inspectiontine: (503) 639 -4175 3 00 3 INSPECTION DIVISION Business Line: (503) 639 -4171 - MS �_ � BUP Received Date Requested AM PM BUP Location C l (Q e) 9 Suite MEC Contact Person «4(j. Ph (yd 3 & t' Z 2�CJ77 PLM Contractor i�C��?�. " 2 e4 . Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Q Ftg Drain `7 ELR Crawl Drain Slab Inspection Notes: S IT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing I' Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling 011 I PART FAIL PL MBING 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 arm � `ri%— Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. P ART FAIL Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA Approach /Sidewalk Date 2 V 3 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL • STREET TREE .. .. f ��£- I, , Owner /Agent for (PLEASE PRINT) (PERMIT HOLDER) , RECEIVED . NOV 3 2003 Do hereby certify tht�thefollowin g location cITY OFTIGARD y ` =yy i '- `" BUILDING DIVISION meets City of T /Was ngton ` County O. l and use and development standards for street tree installation. Ps- ADDRESS: (14 O / / J 6 l Y -570 * 5 . l /. D LOT: SUBDIVISION: BY: DATE: - 1 /07 5- 4e. 44 t47 4- c 6 I M,---# i< ' ''''Ll-)/ ,, 'b' — .4 - 7/6 , ,Az.f_,/ 7/ RECEIVED BY: ' tte- --Le- 7 l Q • DATE: A