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Permit C OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00238 L , DEVELOPMENT SERVICES DATE ISSUED: 7/17/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 _ SITE ADDRESS: 14601 SW 126TH AVE PARCEL: 2S109AD -09800 SUBDIVISION: PARSONS MLP97 -0017 ZONING: R -7 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: Const. new SF detached residence. BUILDING REISSUE: MAS2223AF STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1.387 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,715 sf GARAGE: 542 sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 299 795.40 OCCUPANCY GRP: R3 BDRM: 4 BATH: 4 TOTAL: 3,102 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: ! VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 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: ALL-ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,505.58 This permit CRINO CUSTOM HOMES LLC CRINO CUSTOM HOMES LLC Mu is subject Code, to the regulations contained C o i the Ti 3 MONROE PARKWAY STE P 3 MONROE PARKWAY all other Municipal a law State s. All work w Specialty be don e in Codes and PMB 335 STE. P, PMB335 all oher applicable laws. won LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 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: 503 244 - 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. •c ) —*4(4141.. REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins F Rain drain Insp Appr /Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing 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 - ice Insp Building Final Issued By 6 J &7/ f-�GC�h , Permittee Signatur . // AA / Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day T o 1-r: 7'15 7 ' ) 1 1 M , t. 1 , — ` ■ 0 ..:r• •ov Building Permit Application FOR OFFICE USE ONLY Received Building Date/B : i - , —/ • I/ PermitNo.:/ ,_' -0va ,\ Planning Approval Other City of Tigard Date/B : PermitNo.: ti 13125 SW Hall Blvd. Plan Review ,p r Other Tigard, Oregon 97223 ; ti ' Date/B : 7— —. Permit No.: i� r Post- Review Phone: 503 639 - 4171 Fax: 503 - 598 - 1960 �l' {'' DaDate/B Land Use Case No. Internet: www.ci.tigard.or.us - ,�'�� "'a''i..° `- Cont Juris.: 0 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Su Iemental Information t DING 1\1 DIMS1 'n n �` '$' ts M f ' 4 � 1 4 - }N i { s0101 i { t ,.. t ai' '' ( 4_t ,, : Ire ! � ,� � a . <l G`k�klii.. .. A rare �� i :f'� } { +,s ?'i.i }il� 1: l } { � . i gyp' �i���� = r i w � � l � 0 A 77 t 1 t i , } 1 � .:: }� ,�+ t 1 l � t 1( 1 R b � \ • \ J I ∎ . , , w �t q. !-, ,., , ';t b s' ` loi P t� a : # :' i . i i *i } 1 i l New construction ❑ Demolition " � il:41: '" i ii ' t{ 't a „ 1: itti ,tt .. a �11 ,� kttil = t.' • Addition/alteration /re • lacelnent ❑ Other: \� . , , , ' "g °' Note: Permit fees* are based on the total value of the work performed. Indicate Q„ 1 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building [] Multi Family Ej Va luation $ 3 -0 6 1 oe' Ma Builder [ Other / i "; „`lt �L' OB' )i Trl i t ' l r ” o ; ! f a i:lC. }Iri;l d� No of bedrooms: L/ No of baths: Z.S 1 ' { ' ` r - - r T o tal number of floors Job site address: / ''(�O f ) /7_, tc 77i ye Ne dwelling area (sq. ft 3 ! c Z Suite #: e--"' r" - s 1 Bldg. /Apt. #: Garage /carport area (sq. ft.) 5'4 2.. Project Name: j2(. ,--t ( �?tS !l7,e,u & Covered porch area (sq. ft.) 0 Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) / )q ����-��� JS � I�I tt tlI � �tl l 6 1" -411 � i i i 111: og i [� / : } { , � €tI , 1: ; ; l i ' � I-,� A ' "'� T� ,, j( �_{ �, �°� 3 , ) , � i '� . t 1 IR S ( �/ 7_ © bill 4 ' i i �, 11 5. ttl'"i::� "ik Nv ii i J( t tl`ra Atil t til{I3 l flA W Flta fii 1l:iik i ,i t I i 0'! : , Subdivision: 1 Lot #: Tax map/ parcel #: 5 /C' f} .o0 Note: Permit fees* are based on the total value of the work performed. Indicate �ri R , nl t,' 1 . i 4 t�liggar ( } I gi the value (rounded to the nearest dollar) of all equipment, materials, labor, n, a rot l E " 19_t) tl overhead and profit for the work indicated on this application. Valuation $___ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories >t t1' ®. . TI iA. M EIR t , I Et { Type of construction Name: 0 i 4 r ll S 1.1-C. Occupancy group(s): Existing: New: Address:Zkpu f44,441 044/ Su�T P � {�I-cB 33,� ri City/State/Zip: c,4 -et €.6o v12-. 1'7 o3 Phone: to t_t[- B 7G 4 -on - NOTICE: All contractors and subcontractors are required to be t j � Fax 2_ licensed with the Oregon Construction Contractors Board under 17'J� .tS is {,1I2 i}:71tE1`.. `. alli sfig- ., V . � � � � provisions of ORS 701 and maybe required to be licensed in the Business Name: A-4:9 6-ix.-.S t ? -i-r /.f- 0? 1e3 . jurisdiction where work is being performed. If the applicant is exempt Contact Name: f j/ y ? CL IA-1 U from licensing, the following reason applies: Address: City /State /Zip: .fritE 0 -- Phone: I Fax: f t, r .l awl , i Iift „ _ + ; r4 sit' " O a'l t n I i , Gi. {{ t �ii`�� � 1 � t �t o � R � l t r� �� � � � �l � t le i mail: l� 2l na? 1' j,.A ,40 3e_ r • Ill '} I ,;:t n [ti 141 ' ' 1i It+l e t it a / 111;•J' f ii , 1 ' 014 l q j�` , :t.t�fu I` 'S , i M 7 f S:n 1 ` ' 4 fl }it L 1 ' ' "'lit" ; 99. ' F1" ' !' " i '- lull { ., l �I. , :! s��.�':1 I �` �` ���a3�� .���f11��1`��'�.�,I(��1� {= ,� ;: at , l � l�,� . �1.,� ���'� , Business Name: Fees due upon application $ Address: O � City /State /Zip: 011 r Amount received $ Phone: Fax: Date received: CCB Lic. #: Ks - 641e, 6- 1°1 -(o5 Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: k / `f 70...3 180 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\B1dgPermitApp.doc 01/03 ,,;, r N l FOR OFFICE USE ONLY Mechanical Permit Application Received Mechanical =C Date/By: _ Permit No.: rnS 1 4.�1o3- DUZ-PJ Planning Approval Building City of Tigard Date/By. Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Post - Review Land Use Phone: 503- 639 -4171 Fax: 503 - 598 -1960 htnyid 1O�i� Date/By: No.: Internet: www.ci.tigard.or.us . 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 ,a. 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. '-1 1 & 2 Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE El Accessory Building El Multi Family Description I Qty I Fee(ea.) Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add - on air conditioning ** f 14.00 Job site address: " .55(.c9 I Z is rtr A-VC Gas heat pump 14.00 Suite #: - 7 g' p ' Bld /A t #: Duct work 14.00 Hydronic hot water system 14.00 Project Name: /✓1 C �� IZC� ;Dee-1'6e- Residential boiler Cross street/Directions to job site: Si,,, st UI 0.1.�: pi) (for radiator or hydronic system) 14.00 1-7) . C.-) 1 a brki /9 1 :I1,>/t bl L j Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Repair units 12.15 Subdivision: Lot #: Other Fuel Appliances Tax map /parcel #: Water heater / 10.00 DESCRIPTION OF WORK Gas fireplace 7, 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 .PROPRRTY:. 1 ❑ TENANT,.. Other: 10.00 Environmental Exhaust & Ventilation Name: ai AiU C(i/.51'D7i 1`Forte rC = Range hood/other kitchen equipment / 10.00 Address: f-�r c�2c hK�� 1� u-i rE P .6 *3 Clothes dryer exhaust / 10.00 City /State /Zip: `A-,v. QSw a Di • X7035 Single duct exhaust Phone: 2c4 D c SZ ax: a 4 L4 OD.SZ (bathrooms, toilet compartments, 5-APPLICANT -,---70 CONTACT PERSON. utility rooms) 5 6.80 Attic /crawl space fans 10.00 Name: �r Other: 10.00 - Address: 4-- kk I/ Fuel Piping City /State /Z t- �' ✓ * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: Gas heat pump ** E -mail: H C Q; -tic e D2tyo ,S .13,57, C B71 Wall/suspended/unit heater ** CONTRACT OR Water heater ** Business Name: " 'p X35 j / ,4 -7N6 Fireplace ** ` /�� . Range ** Address: yy 7 q E Yr c/ru,c to .Got— RBQ ** City /State /Zip: 1 . . ///) 5 /OL Clothes dryer (gas) ** Phone:. Z _,?, X331 Fax: Other: ** Total: CCB L 1C. #: Mechanical Permit Fees* Authorized 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 Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $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, wall 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 1 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 $ VALUATION: is \Dsts\Permit Forms \MecPermitAppPg2.doc 01/03 Building r fixtures Plumbing Permit Application FOR OFFICE USE ONLY Received Plumbing Date/By: Permit No.:/115;1 u C%t- - i' ` Cl of Ti and Planning Approval Sewer ty g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 DateBy: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use 503-598-1960 //0110 i.4 Date/By: Case No.: Internet: www.ci.tigard.or.us • e • Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 -' - "" Name/Method: Supplemental Information. TYPE OFWORK FEE* SCHEDULE (for special information use checklist) N New construction ❑ Demolition Description ` Qty. 1 Fee(ea.) 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) 2-Family dwelling Commercial/Industrial SFR (1) bath 249.20 ® 1 & il y g ❑ C il/Idt SFR (2) bath 350.00 ['Accessory Building ❑ 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: n /2 (-- p- t f,4w //; _ Site Util , ..:s ., 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: /3c'- ( " - P - Manufactured home utilities 110.00 . 1 - ' 5 c,..2 / & n4 /1-1;'t; D o.M C, Fir Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) j Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) ( Page 2 DESCRIPTION OF WORK : tur.efor l(fem.. Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer / 16.60 Dishwasher / 16.60 _„ Drinking fountain 16.60 PROPZRfTY OWNER - ,.. TEN;- ' lT' A Ejectors/sump 16.60 Name: A-/C. (44-3i?Jjt- P 41.. , Expansion tank 16.60 Address:3s-t PP y St t i r-E.. p, pi■16 % 3 5- Fixture /sewer cap 16.60 City /State /Zip: L,,L, ko-E66 et . g `] 036` Floor drain /floor sink/hub 16.60 Z Fax: 2 4 A9S 5� Hose bib disposal / 16.60 Phone 714 3S Hose bib z 16.60 E: . . P,T� O T o.� `, P . ; .; Ice maker / 16.60 Name: Interceptor /grease trap 16.60 Address: N �1- Medical gas - value: $ Page 2 City/State/Zip: Primer 16.60 Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory / 16.60 E -mail: 04 f 2, /Li� ofne,c (.6 , eel/ Tub /shower /shower pan 3 16.60 '� CONTRACTOR __ 1'_ Urinal 16.60 Business Name: 514 1/ (42 fLjc, -/ & /�l fq Water closet y 16.60 J Water heater / 16.60 Address: Other: City /State /Zip: Other: Phones03 ~ 6 N3 - -7Cv I i Fax:503 /3 - 70 2.0 .' Plumbing Permit Fees* _ CCB Lic. #: Plumb. Lic. #: Subtotal $ Minimum Permit Fee $72.50 0 $ Authorized Residential Backflow Minimum Fee $36.25 Signature: Date: Plan Review (25% of Permit Fee) $ 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 by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03 PlumbingPermit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. ` Pee (ea) Total .' Square Footage: Permit Fee: Footing drain - 1' 100' 55.00 0 to 7,000 $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' f 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 '' � Y'; (lea) additional $100.00 or fraction thereof, to and ,Fixture or Item '‘,16.01.7 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 specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 e - Reistace New . Moved " rAting Gapped Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic P Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 . Electrical Permit Application Received FOR OFFICE U US a E ONLY Elec Date/By: Permit No.:f 7 WI. — CIt of Ti and Planning Approval Sign y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: - Phone: 503- 639 -4171 Fax: 503 -598 -1960 riA0 Post- Review Land Use ' Date/By: Case No.: ' i" Internet: www.ci.tigard.or.us ■ ry1 ��.f I Contact Juris.: Z See Page 2 for 24 -hour Inspection Request: 503- 639 - 4175 c " "" Name/Method: Supplemental Information. TYPE OF WORK PLAN REVIEW (Please check all that apply) gi.New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan 0 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: . _ <4.9 I Z A 6 fli -1 /e FEE* SCHEDULE Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: f✓l( l? t f 4.-0,./61..t_ Description Qty Fee (ea.) Total Cross street/Directions to site: New dwelling iIncludes attached multi- family per t �yy j �t ,/! it./7 Q dwelling unit. Includes attached garage. 7- ...5,- ! C:6, r # n 1Jh Q � # - f Le Service included: T " J 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service an 90.90 2 Services or d/or feeders feeder - installation, alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 !'4 PROPERTY oW , ;.❑ TENANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: ( MO £-4'7D'1 /71b { � 1,1,� - Reconnect only 66.85 2 Address: 3 1 7�-U� E P K y $(,t_t r -P, ►'r413 *S3 s Temporary services or feeders - installation, alteron or relocation City/State/Zip: L.A L e - DS L - 'O Pk_ q Z 200 amps or less 66.85 1 Phone: Zt/i-i -0052 Fax: ZLo 00 5-2 201 amps to 400 amps 10030 2 ® APPLICANT ❑ CONTACT PERSON ` Branch n h circuits amps 133.75 2 Branch circuits -new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: /' �„ - lam. service or feeder fee, each branch circuit 6.65 2 City /State /Zip: r- �l (� 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 kJL at9nrS SST t G 07 ' Misc.(Service or feeder not included): ! E-mail: aii Ll2c B Each pump or irrigation circle 53.40 2 OONTR E ach sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, nn ^^ ,�11 ` ^' , �' alteration, or extension Page 2 2 Business Name: l� 17' X.l� t�iL�! �'' � Description: Address: p O. 36 336, Each additional inspection over the allowable in any of the above: City /State /Zip: btA-.DS (/4 � , ,. a ) ! 7 CPy < Per inspection per hour (min. 1 hour) 62.50 Phone: V , ,c51 - 3 t9`i`-! Fax: ` o' 1 Inv Other: 7 a (o Ligation fee: CCB Lic. #: 3� '� Lic. #: ' y Cr Electrical Permit Fees* Supervising electrician 1) .9,./ Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: Lic. #: ji(OS State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: E Audio and Stereo Systems Burglar Alarm Garage Door Opener I T Heating, Ventilation and Air Conditioning System Vacuum Systems E Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: 0 Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation IT Intercom and Paging Systems n Landscape Irrigation Control n Medical E Nurse Calls n Outdoor Landscape Lighting n Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03 bb /lb /20b2 22:07 5032440052 CRINO CUSTOM HOMES PAGE 02 FIN g JUN 1 9 2003 JJ CleanWat Services - File Number 1 3/55 Our comritiFlticrrt is clear. By Sensitive Area Pre - Screening Site Assessment Jurisdiction l l Date 6' /1 7)3 Map & Tax Lot 2.S /09 47> £19 o0 Owner ,�� ` tea 444 S r2971 Site Address lyb p j 50 12loru J (/C_ (AMU), et. 2'1 'Z Z ti Contact 04-it C -era Proposed Activity Co, r te-r,(9}t Giie A Address 3 p M-4 . P wky,S ;1I eticaz iA -(yes- F4 — t' o-4 eL • t/ U Phone d� Official use only below this line Y N NA '{ N NA ra LI ❑ Sensitive Area Composite Map n ❑ LI Stormwater Infrastructure maps Map # ?, QS # 'i /6 Y N NA Y N NA ❑ [� Locally adopted studies or maps ❑ ❑ IM Other Specify _ Specify Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 00 -7: n Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT M ST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the sit or within 200 feet on adjacent properties, a Natural Resources Assessment Report may Iso be required. I Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect wate quality sensitive areas If they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. M The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: i cZ i Q - Cr - '5. v Lie -e / 44/4./ v5' 9 - , , r r e :t a ./o ,w .,. • Reviewed By: � � „/ ��--- , Date; Returned to Applicant 11�ai1 Fax Counter 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Date 67, /p 3 By Phone: (503) 846 -8621 • Fax: (503) 846 -3525 www:c Icanwggrservices.org 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 -00238 Date Issued: 7117103 Parcel: 2S109AD -09800 Site Address: 14601 SW 126TH AVE Subdivision: PARSONS MLP97 -0017 Block: Lot: 003 Jurisdiction: TIG Zoning: R - Remarks: Const. new SF detached residence. 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 LLC SUNWARD CONSTRUCTION INC 3 MONROE PARKWAY STE P PO BOX 336 PMB 335 GLADSTONE, OR 97027 -0336 LAKE OSWEGO, OR 97035 Phone #: 503 - 244 -0052 Phone #: 761 -8787 R #: MET 00003183 LIC 00038173 ELE 26 -469C AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Supervising Elect ct' h If you have any questions, please call 503.718.2433. 08/19/2002 23:05 5032440052 CRINO CUSTOM HOMES PAGE 01 Aug 14 03 06:29p Al Stre 503- 262.8409 p.1 08/17/2002 21 :24 5032440052 CRINO CUSTOM HOMES PAGE 01 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 #: MST2003.00238 Date Issued: 7117103 Parcel: 29109A0-09800 Site Address: 14801 SW 125TH AVE Subdivision: PARSONS MLP97.0017 Block: Lot: 003 Jurisdiction: TIG Zoning: R -7 Remarks: Const. new SF detached residence. 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: Budding Division_ No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: CRINO CUSTOM HOMES LLC EAST WEST PLUMBING INC 3 MONROE PARKWAY STE P 621 NE 170TH PL PMB 335 PORTLAND, OR 97230 LAKE OSWEQO, OR 97035 Phone #: 503 - 244 -0052 Phone #: 503 - 284 -2207 Reg #: MET 00003548 LIC 102521 PLM 26 -532PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X // J // Signature of utho ed Plumber If you have any questions, please well 503118.2433. 4Lit_ 7 l ip - - 5P{�_ /Q • l / AAAAAAA®® ®A®®®®AAAAAA® �r°5— DD S ■ STREET T EE CERTIFICATION I R w I, _ � P } / ( - ( O , Owner/Agent for ( t A( e? ► • (PLEASE PRINT) (PERMIT HOLDER) O• ► Do hereby', z :1 . towing location ■ 4 f ■ meets - < : , rd w t " on County RECEIVED ■ l and use and development standards for street tree installation. DEC 11 2003 CITY OF TIGAR 10. 1 BUILDING DI • .® ADDRESS: l L�' () ` 7� 2,( `e_ ■ LOT: V SUBDIVISION: , 1-(S h ninkf ■ ■ ■ BY Ajar, Al . :)___ DATE: ZO /t b 0- 1 • `� � •D RECEIVE BY. c DATE: �3 VV VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV VVVVVVVVVVVVVVVryyyy\ CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 3 vd �3 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 3 — Z 3 AM PM BUP Location / L 6. / / o - 6 # I €. Suite MEC Contact Person (Y\ e ± Ph ( ) 3/° — 06.6c0 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear '�(Zo tiD b" t,L �, $ A2 x Q C? W- V t.-ak a0 Framing 1� Gli �J Insulation Du y�`n INAATR k w C O _`� Drywall Nailing a �' pot C?O V Firewall Fire Sprinkler Fire Alarm � 1\10\ � N U-4-114& Susp'd Ceiling Roof G r )61 4 ()XL t44 Other: AS 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 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: 0 Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Z3 Inspector Nu ) Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING 0 Inspection Line: (503) 639 -4175 # MST 3 -'d 2-3/ INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested /a te " - / / ) AM PM BUP Location / (ice C) / la�P r�z Suite MEC Contact Person �y� Ph ( ) 3 /a - 46 � 0 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain rt ELR Crawl Drain m T"["' Iw (� -yt. T Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final T FAIL LUMBI Post &Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot 1 PART FAIL AN SAL -- • :earn Rough -In Gas Line Spokq Dampers mall PART FAIL RILL Service Rough -In UG/Slab Low Voltage Fir- larm 441. • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. i Jam% PART FAIL SIT El Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Date / 0//0/03 Inspector / I27 Ext Approach /Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL