Permit 4 V
CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00543
. f i�� ; � DEVELOPMENT SERVICES DATE ISSUED: 2/2/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14627 SW 126TH AVE PARCEL: 2S109AD -10000
SUBDIVISION: MCCLINCY MLP2001 -00008 ZONING: R -
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Construction of new SF dwelling.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,927 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 945 sf GARAGE: 440 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5
VALUE: 276
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,872 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES: 0
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: j 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: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: 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: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 8,307.50
CRINO CUSTOM HOMES CRINO CUSTOM HOMES LLC This permit is subject to the regulations contained in the
CR
3 INO CUSTOM
PKWY STE HOMES P 3 CRINO CUSTOM
PARKWAY M HOMES Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in
PMB 335 STE. P, PM B335 accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 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: 503 244 - 0052 Phone: 503 244 - 0052 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 155648 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 Insr Gyp Board Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
� .: -. . — - ----,)
Issued By : , . - 1 � - _// ®. ii Permittee Signature . / // A
Call (503) 6 9 -4175 by 7:00 p.m. for an inspection needed the next business day
1
Building Permpleezipme FOR OFFICE USE ONLY
Received Building M ,
DDate/By: / 0 4 /010 . Permit No.: �� l L jj �(� 5-004,3 ,3
City of Tigard DEC 1 2 2003 Planning Approva Other A
y g !. L Date/By: Permit No.6 w Q...439.3 -O0V00 t
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGAR ' Date /By: Permit No.:
Phone: 503- 639 -4171 FaSU DIMS " `'' A hiliiI ‘i‘\ Post- Review Land Use
Date/By: Case No. r,
AI"
Internet: www.ci.tigard.or.us Contact Juris.: ® See Page 2 for "C'
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Ti (k Supplemental Information
x_ , . 3 .,_ aa' !s . ,
e ffi 1 la
� t
IN construction III
1: a il ®� �� t� � � � V.
r
. Additlon/alteratlon/re.lacement ❑Other.
° - ,,t a ,, tt 3 ' . 1 . Note: Permit fees* are based on the total value of the work performed. Indicate
�p 1 & 2- Family dwelling 1j1 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ �F`1 Accessory Building ❑ Multi- Family J �- `
❑ Master Builder ❑ Other: Valuation $
;;> 'i,, , , n 1 ` M r t �E c , M a
No of bedrooms: I I" No of baths: S
Job site address I (, .1 S L , I A (r 4 '- 4.1a_... : Il Total number of floors
New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage /carport area (sq. ft.) r
Pro . ect Name: Lo +. I I ∎ kit G A - ,,'r.w Covered porch area (sq. ft.) Aft
Cross street/Directions to job site: Deck area (sq. ft.) ; /.1
Other structure area (sq. ft.) I «ig
Subdivision: Irgi V „ !!.�t,.'fm of #: 1
Tax ma. /. arcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
7 , l e 1M f , the value (rounded to the nearest dollar) of all equipment, materials, labor,
m_ - .rr�.�
overhead and profit for the work indicated on this application.
_,..
Valuation $ • L Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
6 . , 7} e Type of construction
Name: y Y\A0 C 2- hn l •
`� Occupancy group(s): Existing:
Address: Y1�byi ro f ku� $d-e_ Iii 335 New:
City /State /Zip: LaA,e, 02.0 / at C(l-crif
Phone:Sol ^O-o C Fax: 1.o 3 - d. o C S ot NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
l�� "rte �'�� n provisions of ORS 701 and maybe required to be licensed in the
Business Name: C n (JuLm IT,. M s , ts, , jurisdiction where work is being performed. If the applicant is exempt
Contact Name: '}/lam a l. ...V. C h 0 from licensing, the following reason applies:
Address: - �„, _ c -
City/State/Zip:
Phone: Fax: ',E s g 1
E -mail: r soy) W t
8x 4 . A 'Y z
Business Name: -
, Fees due upon application $
Address: Pt - wt ctia--0
City /State /Zip: Amount received $
Phone: [Fax: Date received:
CCB Lic. #: l0 0
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: �/ / D • q D�
ro 180 da after it has been accepted as complete.
Lam 41 A *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03
I
One- and Two - Family Dwelling -
4, Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard Cit of Tigard Y g ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 O othera (w
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. X-
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 0 plan 0 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 'S
t11 ,
if copyright violations exist.
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 X
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, k
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. 7
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. x
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 ite 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 (6/00 /COM)
Mechanical Vietttewebation FOR OFFICE I sF: ONLY
Received Mechanical
Date/By: Permit No. ` C06`4
Cit of Tigard Planning Approval Building
Y g DEC 12 2003 Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TI ' D Date /By: Permit No.:
Phone: 503-639-4171 ,{{� qq,Q� . 1 Post- Review Land Use
�n`t�l7l Q(Va i DateB Case No.:
Internet: www.ci.tigard.or.us 1 4I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
® New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
[S 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: 1 L f ( Jr}- % . (. 9 , 1,16 14 % . i-c„ i _j . Gas heat pump 14.00
Suite #: Bldg. /Apt. #: v Duct work 14.00
c n 4 r-744 hot water system 14.00
tat. b
Project Name: � T ' tl� Residential boiler
Cross street/Directions to jot site: (for radiator or hydronic system) 14.00 •
- 0..n/V1 Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: N c_ el 0Blr). , Lot #: ( Repair units 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
----gl Y -s r--- 51 ,71.1.4.4.-P L-SCJ(1 -gtitr---1:418.1141-- Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
1 PROPERTY OWNER . 1 [TENANT Other: 10.00
Name: ( �,p Environmental Exhaust & Ventilation
Address: 3 yVb� � � �7C.. S Range hood/other kitchen equipment 10.00
j r Clothes dryer exhaust 10.00
City /State /Zip: �� g p &IL. 41-D is
Phone cj 3 . J l -(L f o e s ,- 0 , a at�t(_ s ,(_ Single exhaust
(bathrooms, oms p
Fax. ahroms, toilet compartments,
51 APPLICANT (J CONTACT PERSON _ utility rooms) 6.80
Name: b N Cza R.61441 . ( Attic /crawl space fans 10.00
r,� o...10-44-t_ Other: 10.00
Address:
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump * *
E -mail: WalUsuspended/unit heater **
CONTRACTOR Water heater **
Business Name. r ., te. k , 1ke .., - Et 4,-c_ Fireplace **
Address: � t- ii '7 y . S E. t,t4 ',_I et-o- le ► . BB Range **
**
City /State /Zip:: p :0-, -,ak, v IQ C-Oi S„ Clothes dryer (gas) **
Phone -5- ; 4., 4_ - '731 fFax:' Other: **
CCB Lic. #: Total:
Authorized Mechanical Permit Fees*
Subtotal: $
Signature: Date: Minimum Permit Fee $72.50 $
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 is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01 /03
Mechanical Permit Application - City of Tigard , : Yi, S73 }
Page 2 - Supplemental Information L.€ ..- V fl
Commercial Fee Schedule: - � `s,:a \I AD
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.
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
El Permit Application FOR OFFICE USE ONLY
Application Received Electrical /
Permit No.IVIS1 r > �- - 00 `J 43
Date/By:
City of Tigard RECEI VEn Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DEC n Zoo 3 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax 3- 9 8 - 6 Post- Review Land Use
Internet: www.ci.tigard.or 1 Y OF riGAR ! / • 1 */4011110 l Date/By: Case No.:
- • •/ � � Contact Juris.: ® See Page 2 for
24 -hour Inspection Reques tflSt. 7 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
NI New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location
❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
❑ Building over three stories
El Feeders, 400 amps or more
Accessory Building ❑ Multi- Family El Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1 4641 S .60. 3-6 �•-rc . 716, FEE* SCHEDULE
Suite #: Bldg. /Apt. #: - Number of inspections per permit allowed
Project Name: 1. 4 1 VV` C. C l (�1 Description Qty Fee (ea.) Total
/ New residential - single or multi - family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
': � _ n A I� Service included:
Y�V ✓ tt 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40
Subdivision: VIA CC 1. NI, GI 4.- L ot # : ( Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
a�..a AIM i4I111 .st — Ali 0....—.—...i alteration or relocation:
200 amps or less 80.30 2
e_ 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
E PROPERTY OWNER I 0 TENANT 601 amps to 1000 amps 240.60 2
ln_____C_Jr_ II ,,,, .. /n) 1 ps or volts 454.65 2
11�1,[� Cp' S/�im �4 (_l..0 Reconnect only 66.85 2
Address: , het 91r1 I " er e_ p ‘...I.c. / ,.. Nitai s Temporary services or feeders - installation,
City /State /Zip: t.4,(Le ,�, g , n alteration, 00 ms o le or ss 66.85 1
relocation:
I`�/L 9�-0� S 200 amps or le
Phone: spy 44 .00S4._ Fax �t.i- - 80 X 201 amps to 400 amps 100.30 2
APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
ame: (Li._ 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
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: J ^' Signal circuit(s) or a limited energy panel,
Business Name: �h h7
� b"'1^'-e- � v P� or extension Page 2 2
' D Descriescri ptti on:
Address: 9 . 0 x 314,..,
City /State /Zip: 6 l, oQ . c y Q_- �, dill Each additional inspection over the allowable in any of the above:
I Per inspection per hour (m
er hour (min. n. 1 hour) 62.50 _
Phone: 03 + $57' i Fax: Investigation fee: II}—
CCB Lic. #: I'-( l' Lic. #: zit..., , Q Other:
/C/1641 Electrical Permit Fees*
` Q V
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: , ` -- % State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized �9� � L Notice: This permit application expires if a permit is not obtained within
'
Signature: Date: AO/ // 7 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information �� 1 ,.�
LIMITED ENERGY PERMIT FEES: 3:1
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved: v1C7Sc 4vEo 00100,18
Audio and Stereo Systems
t5K1 Burglar Alarm
Garage Door Opener
Heating, Ventilation and Air Conditioning System
• Vacuum Systems
• Other
COMMERCIAL WORK ONLY:
Fee for each system ... $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
E Clock Systems
D Data Telecommunication Installation
F Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
• Landscape Irrigation Control
Medical
n Nurse Calls
Ti Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
Building Fixtures
Plumbing Permit Application FOR OFFICE l'SE ONLY
Received Plumbing _
RECEIVE D Date/B : Permit No.:6n S I �7c - 0171 City of Tigard Planning Approval Sewer
Date/B : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DEC 12 2003 DateB : Permit No.:
Phone: 503 -639 -4171 F . I gip yq ( Z� 7� h B Case No.:
Land Use
T�1� ,) D ate nim Internet: www.ci.tigard. l Post - Review
P j OC 1Q 1_, i �✓�n l , '' � � Contact Juris.: ® See Page 2 for
24 -hour Inspection Re Q u S . 7 O 9 4 Name /Method: Su • . lemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
2 New construction ❑ Demolition Description I Qty. J Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
1 & 2- Family dwelling ❑ Commercial /Industrial SFR (1) bath 249.20
Accesso Building SFR (2) bath 350.00
ry g ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address:( 46 J."( .S . (..L . 141) i '`' Site (: d Site Utilities
Suite #: Bldg. /Apt. #: C atc h basin/area drain 16.60
Project Name: L.+ •l, ( \mcl, . 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: AMC (,({�l► a) r • I Lot #: 1 Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fixture or Item
t. • Absorption valve 16.60
i
-`� 041 - 1...' Backflow preventer Page 2
� � Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
is PROPERTY OWNER 1 ❑ TENANT Drinking fountain 16
, r Ejectors/sump 16.60
Name: t, �J - _>vA� Au g_, ! l..l. Expansion tank 16.60
Address: 3 �, p er 0 Ll� I t •• 4 3 2 5 Fixture /sewer cap 16.60
City /State /Zip: L Al A 9 ' O is Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone:50 ^A O Fax:�3 -� -DOC� Hose bib 16.60
12 APPLICANT ❑ CONTACT PERSON Ice maker
/ �� 16.60
Name:
l.� M.D L,(_ Interceptor /grease trap 16.60
Address: S Medical gas - value: $ Page 2
City/State/Zip: b ,� Q �p � 3 S Primer 16.60
�I�e . 8 ' Roof drain (commercial) 16.60
Phone:�.e8 4444:. 3_ Fax.�3 - 44t4 --C.e S j. Sink/basin/lavatory _ 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: q a2,4- (, ate f .• p � Water closet 16.60
Address: ( 1 0 • E . 11 D ot pi Water heater 16.60
Other:
City /State /Zip: iloy+Co pi? c ( �3.o Other:
Phone: 4 • &4-( oq Fax: Plumbing Permit Fees*
CCB Lic. #: L o15.4. l Plumb. Lic. #:ab • 9.2 Subtotal $
Authorized Minimum Permit Fee $72.50 $
Residential Backflow Minimum Fee $36.25
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) S
(Please print name) TOTAL PERMIT FEE S
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 by Tri- County Building Industry Service Board.
is \Dsts\Permit Forms\P1mPermitApp.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 - 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $il 60A0
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 Pe rformed 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"
-4"
Car Wash Drain
Garbage Domestic *Note: If the fixture work under this permit results in an
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
I: \Dsts \Permit Forms \PlmPermitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
SUNWARD CONSTRUCTION INC
PO BOX 336
GLADSTONE, OR 97027 -0336
Electrical Signature Form
Permit #: MST2003 -00543
Date Issued: 2/2/04
Parcel: 2S109AD -10000
Site Address: 14627 SW 126TH AVE
Subdivision: MCCLINCY MLP2001 -00008
Block: Lot: 001
Jurisdiction: TIG
Zoning: R -
Remarks: Construction of new SF dwelling.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
CRINO CUSTOM HOMES SUNWARD CONSTRUCTION INC
3 MONROE PKWY STE P PO BOX 336
PMB 335 GLADSTONE, OR 97027 -0336
LAKE OSWEGO, OR 97035
Phone #: 503 - 244 -0052 Phone #: 761 -8787
R #: MET 2940S
LIC 00038173
ELE 26 -469C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
EAST WEST PLUMBING INC
621 NE 170TH PL
PORTLAND, OR 97230
Plumbing Signature Form
Permit #: MST2003 -00543
Date Issued: 2/2/04
Parcel: 2 S 109AD -10000
Site Address: 14627 SW 126TH AVE
Subdivision: MCCLINCY MLP2001 -00008
Block: Lot: 001
Jurisdiction: TIG
Zoning: R -
Remarks: Construction of new SF dwelling.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
CRINO CUSTOM HOMES EAST WEST PLUMBING INC
3 MONROE PKWY STE P 621 NE 170TH PL
PMB 335 PORTLAND, OR 97230
LAKE OSWEGO, OR 97035
Phone #: 503 - 244 - 0052 Phone #: - er 9
SZ) Reg #: MET 00003548
LIC 102521
PLM 26 -532PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Auth ized Plumber
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 6404175 MST aa03 oo
INSPECTION DIVISION Business Line: (50=41 1
BUP
Received rr // Date Requested ✓ J3 AM PM BUP
Location / T ( 4' ;" l ° '� Suite MEC
Contact Person Ph ( ) 3/01- _o 6 6 0 PLM
Contractor Ph ( ) SWR
Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation '
Drywall Nailing 1"'6 7 1,61,", ��
Firewall
Fire Sprinkler 51,
Fire Alarm L L
Susp'd Ceiling T — 7 {#T
Roof
Other:
r
•A 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
Post
Rough -In
Gas Line
S If e Dampers
PART FAIL
ECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /
ADA Approach/Sidewalk Date 7 a?"-0 V Inspector 47h 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 Pe.3 -6061E3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received //-- Date Requested ' — ? AM PM BUP
Location / � L° a 1 1 a 6. se-t -t Suite MEC
Contact Person Ph ( ) �� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC k
Ftg Drain Access R - ,� n'.t
Crawl Drain
Slab Inspection Notes:
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 PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line �\
ADA
Approach/Sidewalk Date --C7 " �� 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
MST .o.ge a6,5"- ci 3
INSPECTION DIVISION Business Line: (503) 639 -4171
c� BUP
Received 1 Date Requested 7 —9' AM PM BUP
/
Location /46, o Z 7 /.=,\ Co A-c>-e _ Suite MEC
Contact Person T Ph ( ) - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall r Fire Sprinkler _ ,,/ , �� ���� . �'' �
Fire Alarm '
Susp'd Ceiling i
t
Roof ���� ��,
Other: - /
Final C.
�
P � A rrr, P . RT FAIL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Ma ole
Storm Drain
Shower Pan
Other: `/
d° ,I T FAIL — "
c...siji,5r,,,e,,,..,,......,,,.„...._____. A77-1
1.
'o • :eam
Rough -In
Gas Line
a mpers
ina
PASb PAR FAIL
ELECT _
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 D Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line .
i
ADA J
Approach/Sidewalk Date 6 Inspector / j Ext
Other: (( i
Final DO NOT REMOVE this inspectio record from the Job site.
PASS PART FAIL