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Permit ( e/iii/D 4-e-1 �� CITY OF 4 GARD MASTER PERMIT PERMIT #: MST2003 -00552 �Ir Iii DEVELOPMENT SERVICES DATE ISSUED: 1/30/2004 " '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14320 SW 114TH AVE PARCEL: 2S110AB -06100 SUBDIVISION: HELLER PARTITION /MLP2003 -00007 ZONING: R - 4.5 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: New SF detached. 6/4/04, a/c unit added. BUILDING REISSUE: MS1500 STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 14 FIRST: 1,696 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 440 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD sf RIGHT: 5 VALUE: 168 OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 1.696 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: 1 VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 2 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: 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: $ 7,458.66 HELLER, ARLENE RAE ECK CONSTRUCTION INC This permit is subject to the regulations contained in the HEEL HELL R, ARLENE gard Municipal Code, State of OR. Specialty Codes 14340 S , 114Th Th AVE. A A P VE. EC O BOX BOX 2S 204 4, OR 97140 and all other applicable laws. All work will be done in 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: 503 639 - 3120 Phone: 625 - 1305 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 114755 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 Structural Plumb Top Out Framing Insp Low Voltage Rain drain Insp Sewer Inspection Post/Beam Mechanical Electrical Service Shear Wall Insp Gas Line Insp Storm drain lnsp Footing Insp Crawl Drain /Backwater Electrical Rough In Shear Wall Insp Insulation Insp Water Service lnsp Foundation Insp PLM /Underfloor Electrical Rough In Shear Wall Insp Insulation lnsp Appr /Sdwlk Insp Slab lnsp Mechanical Insp Framing Insp Exterior Sheathing Insr Gyp Board Insp Electrical Final Iss ed By : . Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day S } l /y. © 1(( M��� Buildin Per ' lication FOR OFFICE USE ONLY Received ,, Building i®. Date/By: /� // Si Permit NO l5 r3oa 3 —pO �5S� Planning Appro al Other City of T i g a r d r Date/By: Permit No.: S t . ) 3-003 - �Qqq// 13125 SW Hall Blvd. �CC 2UQ A Plan Review Other r Tigard, Oregon 97223 Date /By: Permit No.: (Vit.gg0V3 -0 0007 Phone: 503- 639 -4171 t �EDVTnNgyrev l , Post - Review [and Use � ' Date /By: Case No. Internet: www.ci.tigard.o . �$� Contact Juris.: El See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: El New construction ❑ Demolition 1 & 2 FAMILY DWELLING ❑ Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate ® 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building p Multi- Family ❑ Master Builder ❑ Other: Valuation $ /4� 47 ,5 . JOB SITE INFORMATION and LOCATION No. of bedrooms: 3 No. of baths: Z Job site address: /9'3-x® jai //‘7 ,096/-C Total number of floors ,/ ® .. Suite #: Bld /A t. #: New dwelling area (sq. ft.) �6..;/ g p Garage /carport area (sq. ft.) ..0 Project Name: Covered porch area (sq. ft.)Q Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) Q REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: 17/e //�.- A ® 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, overhead and profit for the work indicated on this application. Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories PROPERTY OWNER { 0 TENANT Type of construction Name: /Qr/e,j fiQ e /7' l/ -,--- Occupancy group(s): Existing: New: Address: / VD _ca.) //V rr! mil Z City /State /Zip: 729e,,, a4 97-22 y ' Phone: 6, 3r-- 7/zo F ax: NOTICE: All contractors and subcontractors are required to be ❑ APPLICANT ID 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: jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: BUILDING PERMIT FEES* . E -mail: Please refer to fee schedule. CONTRACTOR Business Name: e- C1577J /' _,Z 4 ' • Fees due upon application $ Address: / - . ,BOfc ,z05.- City/State/Zip: %/j -Gvpe l O/ q'7 /y0 Amount received $ Phone: GZ,S - /3Dr 1 Fax: ,CZS= ,x,5 8 Date received: CCB Lic. #: // ' 7 Ss-- Authorized Notice: This permit application expires if a permit is not obtained within Signature: 'i / Date: /Z — ���. 180 days after it has been accepted as complete. '7 `�� !. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms \BldgPermitApp.doc 01/03 One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/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 carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-4614 (6100 /COM) OW CD/ Li7t73 1 ti: L4 Ot737t5LCLi54 I\ N I r , rit:H t 11'17 t'HUt r91 S*p 25 03 05.08p ECK Construction Inc. (503) G25 - 2553 p.2 Mec Perm;ft A�l><cat>ton .4Kd P �t lsT o 7 _ s Datc/8y: RE + Detei Manning Approval I Building City of Tigard G IV b Dalai I pe�t;t No.: in Review Other 3125 SW Hall Blvd, Date/By: Permit No.' Tigard. Oregon 97223 Pose Review Land Use Phone: 503 - 63941 Fax: 503 - 598 -1960 70 , , p ease No. r - Internet: www,ci.tigard.or.us _ i Contact Juns: I See Paget for 24-hour Inspection Request: 9t ,..•• . Neme/Method: 1 Supplemental inferrnatisn. , BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE' SCHEDULE - ICE. CBEeJLTST New construction IC Demolition Mechanical permit fees' are based on the total value of the work performed. Indicate the value (rounded to the nearest dollar) of all AdtiittONalteratioNre laeetntltt Other: mcchanlea! materials, equipment, labor. overhead and profit f A EGORY •OF CONSTRUCTION Valoe: S _ See Page 2 for Fee Schedule 1 & 2-Fa tril dwellin Commcrcial/Iltdu RESIDENTIAL EgUIPMEIVT/SYST1cM 2f SCHEDULE Accessory Building Multi - Family_ Desert Don a Fes e■. Total Master Builder Other. Hestia-. Cowin ��_ ' JOB SITE INFORMATION and L CATION Furnace - add-on air cnrtditiariin " 14.00 Job site address: '/ • OP ,54..,) j/" Lt' Gas heat . t 14.00 I Rlds. /A t. #: Duct work 14.00 Suite #N P Hydronic hot water system 14 00 _ project Na _ Residential Mailer Cross street/Directions to job site: for radiator or h • onic s • em 14.00 Unit heaters (fuel, not electric) (m wall, induct, suspended, etc.) 14.00 Flue/vent for an of above 10.00 Repair units 12.15 SagilVISlarl: ^ A l�� � r i' L ot #: Other Fuel A • • lancet Tax map /parcel #: water healer 10.00 DESCRIPTION OF WORK • • Gas fireplace 10.00 , Ffue vent waterheateti :as fir .aacc) 10.00 Lo_ li, ter t ats 10.00 W ood/Pcl let stove 10.00 Wood fire.laee /insert 10.00 Chimne /liner /fluc/vcnt 10.00 Si PRC.IPERTYOWNER • I QTENANT Other 10.00 Eovtrenttteatal Cthaurt & Ventiletba Name: ------ Range hoodiothet kitchen equipment 10.00 Address: Clothes dryer exhaust 10.00 City /State/Zip' Single duct exhaust Ph FFax (bathrooms, toilet compartments, R'LICA1itT I LJ CONTACT PERSON utility rooms N l t, 0 Name: Attic /crawls .ace fans EN Other: 1 0.00 Address: goal Plying City /State/Zip: 5.40 for Ord 4. S1.00 each additional Fumaee etc. a- Phone: ]Fax: Gas heat pump U '• .• E - mail: Waft/ us.endedlunit heater CONTRALTO Water heater i •• Business • t (,i�Rwctdit T t.. - F ireplace . Address: ''0 _ B d33 - R o .c Cjty /5tiitC /Zlp,WA,.:*•il,,/.0..n Q ° 7fl1I Clothes d cr gas) a' f Phone: • Ioo Z Fax Sol - a — ti Other CCB Lic. #_ (p3 belt 1 __- _ Total: I � Metbank•I Permit Feet Signature. re J� fla re: ci Subtotal: S Signature• _J r jCC�'r` 7 Minimum Permit Fee $72.50 $ j 1 4M— Plan Review Fee (25% of Permit Fee) S (Please print name) State Sr charge (8% of Permit Fee) , 5 T OTAL PERMIT FEE S Notice: This permit appltcadna expires ire permit is tint nbtined within ' Yee methodology ant by Trl- County building Industry Service Il.iard. Ma days arcr It hat seen accepted as complete. ' pl.., regaircd for txtwtar A/C units. is \Pste \Permit form,\ ieceermitAatO.doc 01/03 FROM : TAURUS POWER FAX NO. :503 692 9273 Sep. 25 2003 05:40PM P2 Rep t.1 UJ U3t1dp ELK Construction Inc. (5031 62S -2553 p.2 • • Electric e atio • ion C►Fttt. I.1'tih t►., ltcse:vsd City of Tigard 1 1�� Na Y' lcift Naming Approval BRARIBMIEM .- c tlatd9y: 13125 SW Hall Blvd. QG GPCA I Plan Renew Ober Tigard, Oregon 97223 F ‘QN Dalort3 : TotsoitNo.: Phone' 503.539 � h i Poec- Rev:ew Land Ilse ` -' "- 111tcm R' ct WW.G4 t ff� „`� ,patcrDY: Cana 14. 24 -hoe nspectio 3 03 -639 -4175 '''''. 1M r Ccnl ms ._, . ■ liuuenit.too4. ',.. ai:, ' .1.. .Y: .' `} 7....,e. a'. ,._ ,c. ..t 4, "2.t. :`'. . ' "' , ►~ New construe: Stry cr rn tar llS . -i ) ''t s 1 ,t , • •... ;i.;� , � construction • DCtt1i)llhon i Ps Healthy:: oratality ■ Addlttoahlterat"onlr IBCe,af�t • Other: —, i earfrrnet••.u1) 0 N.arttna location y , ! at? • c Seivitr. ota^t 32U aatpt rating et ❑ Building over 10,000 square feet, -t. __ t� �: : r c , '. ! s v ► rr_3 . ,�1 . V, 1 I al 2 Lira/ dwdliNiS Ows yr tnare:eaIdands►urdS in �r " ' ly .� m f■ Cuuutleicial/1lidustrial 1 ! ❑ Syatom wKr 600 vole ow Malay nominal oe ; ! U Building o ral dm.. maxim Peodcra, 404 amps or mere III r A �eS e r _ B I. r e: (A Multi- FaAlll ' ❑ Occupant bad o sr 9l persona �teratfaeaawd ahuoturos or RV perk RU Mxottt Builder r■ Other: I L.1 P.lacialii;ltUne plan Other: 1 . ii . : ' I : f r ' - ? . 1 ! .a! �!a ` ! " .1< , ^ 1 . r ; 4 So Mil: Ma of llama with ea, of de abeee Job site address. _ / 2) . - � , The abo we not a , Sea to � t Mee service. _� urobcr of his - • gas - "gait allow Project Name: . Du • , lion MI Tortes.) . Teel 11. tor rolitkotill.oliasio w• etakI- faselty per Cross street/Directions to job site: pollens nit. racbdtl attatbed aeraee. Sertke Whirled . 1000 te. R or . 145.13 . . 4 Each additional ie. h. a portion thereof 33.49 . . I r��� "are.' AR Lot #: - -~ ere red aratt, rcdd4 - 71.00 Subdivision , T iovtrt!e n v , n 6.irende e nt 73.00 . 2 Tax ma y l. Reel 1i: Etch manuhtAxcd homer modolu dwelling • 0... r ' ? • 0'.• 4 , - - .. ., 4," M , 'ervv_nn_ feeler 90.90 i 2 ' • ' tersdess or feeders . imtahaiion, T alarstloe w relocation! 100 amp a iest . t0.30 1 • - 10: urns to 400 amp 106.15 j • 401 acme io arm ya 160.60 . . 7 i. ._ r a< i c , 601 em w _0(KI ant '.. ,i �e'i ) .a4 r .. ^ / .. .:•! } „t; Over:, OW. 'P ., . 6 1 Name: PiOi1Oh' _. _ ._ . '4 1 Reconne ct:mly WM 2 . Address: , Temporary services or feeders - inataiedee, alteration. or retetetton: CitY la jcili17: -_- • 200 ay' or kss 6ti.f 1 Phone: Fox 20; aatp1 H/) Nana • ton to . a ��' .'� i-7•2‘.-- ;:6 ! a ,;r 110!. I.. a rif O.0.1e 177.75 1 _ 7 - Breach circuits - new, aiteradoa, or . Name: aa,o. ion per pencil t t• Address: A . Pee for brawls tecaita urnth porramo of Adds: tervica or feadurk acts ttranc6 circuit 6 ICS 7. . City/Statezip: A. Pee farb.-aneh elan: without profuse of Noma. or had: f••, run bnwch cirerit 46. ti .. 2. Phone: J Fax ,inch at intro: erwah arslit 6•65 2 E-mail: tdirc,(tlars co N roodor Rite achrded)c . “1,; ; ,� , 11 _ 2 i �- �• � .. 1 +) .. C. � _•. ; ,. _,. . "`lb g l' �S �. , r a +.11•txnuck _ — f3.4Q .. - • .444,11;,j 0: / / r/ ai4ia4vr m t l 1 Business Name: h r:,ii'11f1.r/.Ot /, rB.1 1 p,,, -- - • • '� Atldrona: ' • ice ----- f ( . Ci /StateJ!.i + :'� /iii ,I . !! p pleb +ddjlteltat ttuetR,on aver the allowable to an arose above _ . , 1 .4.. . _ . .... —_ pa ivx:tiou per boo (teal i hoar) l 02.50 r Pha ,r . � I F- x: p; � 7 • .0 ' 7 ( JatestiPa +ice. ' _.__ - ! T C CB Lic. #: 0 Lic. if � 2- .. L _ "'�` Supwisirg CCtr , :3u $ sl ! nature . uired :. , • I t i : ,It s:...4'0 4 'n / W PLul Review (253& of Permit Pea Print Name: 1.4 wp:c , � • r eeler(//.' Lu%• #: I '' $'earnSerottargo(8%of l $ TOTAL PERMIT FEE 1 $ Authorized Notice: TM, parnlc spplleadot► empires Ifs gerrrkt Is not ebtaleed within Cigpat ate: Datol 1110 days:Acr it has beam scooped as cea+ptata. 'Fla nabodoloby sor try TrI County Et& ldntt Weary Service Board (?lease print name) • i•1>3nt4'erttae Enntti Itronriuktp.doc 01103 • Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY y. � Received Plumbing I t V t i Y t U Date/By: Permit No.: VYLS 7 O -0 U City of Tigard Planning Approval Sewer y g Date/By: Permit No.: 13125 SW Hall Blvd. DEC i 0 1003 Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Y55�� Post- Review Land Use Internet: www.ci.ti arp ��"�'"'' 4 " I ` ` Date/By: Case No.: g BUILDING DIVISION ■ -' I Contact Juris.: El See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. TYPE OF WORK FEE* SCHEDULE (for special information use checklist) New construction ❑ Demolition J Qty. Fee(ea.) I Total Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) 18,1 SFR (1) bath 249.20 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi-Family - (3) bath 399.00 ❑ Master Builder El Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: /5'/J,?Q Skil / /y/�' "9c9 Site Utilities Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell/leach line /trench drain 16.60 Footing drain (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: ,q -,. 1 /c;Z, Lot #: / Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) Page 2 DESCRIPTION OF WORK Fixture or Item . Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: '9r // 71 e. fiQ c fl al /c r Expansion tank 16.60 16.60 16.60 Address: /y 3 y 0 3 ylf 1/41 Fixture /sewer cap City /State /Zip: 7- i' ��, d �i � 9 a 5l Floor drain /floor sink/hub Garbage disposal 16.60 Phone:5o3 - (� 3 q Q3 1 a v Fax: Hose bib 16.60 ❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City /State /Zip: Primer 16.60 Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: 0 0) /0 /-- Water closet 16.60 Water heater 16.60 Address: Other: City /State /Zip: Other: Phone: Fax: Plumbing Permit Fees* CCB Lic. #: Plumb. Lic. #: Subtotal $ Minimum Permit Fee $72.50 $ y Authorized Residential Backflow Minimum Fee $36.25 Signature: ( pp GJLo .Date: /o? - ii- 03 Plan Review (25% of Permit Fee) $ �/G71 e- f Q h7 e- g . r State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set byTri- County Building Industry Service Board. is \Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard - Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1S 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' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 _$1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $ 100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped 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" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic un 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: is \Dsts \Permit Forms\PlmPermitAppPg2.doc 01/03 V S TREET T EE CERTIFICATION R .. I �i�� , Owner/Agent for ���,� /� 0. (PLEASE PRINT) (PERMIT HOLDER) 1 i \ 0. gi b.' . Do hereby certify that the following location 1 meets City of Tigard /Washington County 44 0i, land use and development standards for street tree installation. I ® 0. ® ADDRESS: /V320 7`� ® LOT: SUBDIVISION: �`. -- __ 0 . 1 ®` BY: y,� _ DATE: � .1/ RECEIVED BY: ` V� 1 DATE: 6 O. s yyy yyyVVV I YYY YYY YYY Yr ♦♦YYYVVVVVV®yy®7yyr®®y®®yyy®ye\ CITY 'OF TIGARD 24 -Hour BUILDING • • Inspection Line 03) 639 -4175 INSPECTION DIVISION Business Li (503) 639 -4171 MST o3 'D DSv T v� BUP Received Date Requested AM PM BUP Location /930,o /l ./ 9401 A— (/`'e— Suite MEC Contact Person 31 •c Ph ( ) 6 -026 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation tccess) / Crawl ELR Dr ain ■D 0 [ c /f / Srl Dr `7 �7f n Slab Inspection Notes: C / . �j�/ Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear _ Framing air'O .04/1/k.4 / • O K • • Insulation Drywall Drywalywal l Nailing Fi reveal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof • 1 :: • PART FAIL CA UMBING 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 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: a to inspect — no access Fire Supply Line ADA a Approach/Sidewalk Dat • v Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING ' . Inspection Line: (503) 639 -4175 MSTO SZ INSPECTION DIVISION Business Line: (503) 639 -4171 e-�// BUP Received !_() 7 Date Requested ( Z 7`AM PM BUP Location ! c 2 0 / Suite MEC Contact Person Ph ( ) ? - 2 - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation ACCeSS� 6X r � � Ftg Drain ELR Crawl Drain 1 (' Slab Inspection Notes: L SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS CTRICAL Rough -In UG/Slab Low Voltage Fire Alarm • ASS PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE E Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Date Ins actor Iv Approach/Sidewalk p Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING - Inspection Line: (503) 639 -4175 MST o?f03 – ‘ 70 53: 2 . INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received 1 Date Requested -' — AM PM BUP / Location �Jo�O /1 I�t-t� -- _ Suite MEC Contact Person Ph ( ) 5 - - as0 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspectio otes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation !� Drywall Nailing Firewall r` /�fr --rwr Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot •A - PART FAIL CHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: E Unable to inspect — no access Fire Supply Line ADA � ZjLL /� Approach/Sidewalk Date , Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL