Permit CITY OF TIGARD
4 i
MASTER PERMIT
PERMIT #: MST2003 -00128
i DEVELOPMENT SERVICES DATE ISSUED: 5/7/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14270 SW 128TH PL PARCEL: 2S109AA -05300
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7
BLOCK: LOT: 019 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: SUN10595J STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 21 FIRST: 16,354 sf BASEMENT: 1,003 sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 430 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 263,927.80
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 16,354 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 1 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 3 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:
EAADD'L 500SF: 4 201 - 400 amp: 201 • 400 amp: 1st W/O SVCIFDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL 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: $ 7,848.58
This permit is subject to the regulations contained in the
PAUL R. CARNEY PAUL R CARNEY INC Tigard Municipal Code, State of OR. Specialty Codes and
1480 NW 102ND 1480 NW 102ND AVENUE all other applicable laws. All work will be done in
PORTLAND, OR 97229 PORTLAND, OR 97229 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: 503 939 - 7285 Phone: 503 297 - 9406 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 56852 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp & Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insj Rain drain Insp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Service lnsp Building Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Appr /Sdwlk lnsp
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electri nal
Issued B Y : 6.4../4-e:4_ ,r . .4._--- Permittee Signature : ' /L- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the xt business day
04/02/2003 09:01 FAX 5035981960 CITY OF TIGARD 0 001
Building Termfi• 6eltii19#13, FOR OFFICE USE ONLY
Received ,/
Datc/B : , ,4 3 ENIEMPENII
— , o. ,....
. City of Tigard Planning Ap74;T:!15_ ,o 0 _. ° t N o ; ctl./.
13125 SW flall Blvd. APR 02 2003 Date/By:
Plan Revi Other _
, , ,-.1
Tigard, Oregon 97223 Dasili3 : Av „ ,i,,,, Permit No.:
Phone: 503 Fax N t ( ) 5 1 4 : iriqi i egi A - ,1 R lI ''' Post-Review i n g 0.5 Land Use
Internet www.ci.tigard.or.us ' !i 1
S ,, - , — !._ 1 4' --. Date/B : -1 '''' Case No.
Contact Ti See Pige 2 for
24 Inspection Request: 503 Name/Meth • ■ : / , / - Supplemental Information
I ,
a,
•.:,:i .. .1::,:.'-:',. ,:•. ;,:' ,: '..,.7 ack90t'ir , .: ,-, 7•,;:;‘ , 7-ATxi'gcs . :'..0 . .. , $.1:, •
El New construction • D emo li t i on :: . 4 Ti:1 ''.:*:','-i' IL-„,ii '' ' .",' • ,''', ..,1;, ' "" V.." ?Att;t!!':?: i'.:::; ;-,-;:,;.cii
1::;;
• Addition/alteration/r • lacement • Other:
F''i..:...(....:-..."-. :,CATMCMY.JI9r.••(;) s1. • , Is • . . . 7''.!;: f.ii ,: Note: Permit fees* are based on the total value of the work performed, Indicate
1111 1 & 2-Family dwelling DI Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
,--- overhead and profit for the work indicated on this application.
IIM Accessory Buildtg E Multi-Family
0 Master Builder U Other Valuation S
2:..;...:; I NIIVTA,711191 r ,... f . 0,,,.,. ::,...;',. No of bedrooms'. No of bothr.—
Total number of floors
Job site address: I 4-12 5, W, 12.0' LAC-6. New dwelling area (sq- ft-)
Suite #: I Bldg./Aot.#: Garage/carport area (sq. ft)
Project Name: _ Covered porch area (sq. ft)
Cross street/Directions to job site; Deck area (sq. ft.)
Other structure area (sq. ft.)
. ; ij ; 1 : ? ,•;;; ,,,,% i t'IV. 'NI . 4 ' p '. ' I I; ',' Ai :
.9 _iii , . , ' ! i P., rdi .-. ':,L t.:3L, ::! `I ';' :i ii,:,q1■:.,'
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SUbdiViSiOn.,,14 ; il ., .::
...0
4-• PC) 1 e-10 " Lot #: I i ----
Tax map/parcel #: Note: Permit fees* are based on tbc total value of the work performed. Indicate
,...F.1....:i:,!lilti",11in)EiSang010F(311013R,K;.::..!;,V.:i.;,*:!!;,,'.;,..q1::. . 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 •
Kirr,TFirt )7i q i- 71 :MSEINgt- Ti r 1 =11,1 1 ; 1 . ..!:.1 ',i.„-;--:Lr....: Type of construction.
_ — • , . Occupancy group(s): Existing:
Name: _ 27_,,,_., "::. - - ____ 1 _-_- -- - -_-:::.. -1".7 - -
New:
Address: / LI o /■-) k..) i o - .7.- 1 - - - 1 -- • — • • .
City/State/Zip: ( p 047.- 1722,9
Phone: " 3ci- 72, , Fax: 4 1 : Li , ,-- I 4:,3 NOTICE; All contractors and subcontractors are required to be
, , . , licensed with the Oregon Construction Contractors Board under
01' ,: 1 : ;;'ii■•! Ie .. 0 : '. ACr ' ' ' ". 'el ' I :'...r provisions of ORS 701 and may be required to be licensed in the
Business Name: .,•...r a - A- ...vd jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address: -
—
City/State/Zip: . _,____..... _
Pho Fax: ,,, :,,, - ,,,,•:..,, . 'Of 1 - ,W - . 14144
. V 1j 0
,,,i,: .Y: . :1 E I lig: 6 t -
L ' L'i ZE0,1 LE r v:t.... le ,,,,,"...,-,-....,.....,,Ifii,
: • d -.-Ipt.t.mtvi.411,: ;.•41,..: 7 t , ,
E-mail , 1,• - .q-7 :4 4,•-•;•••, .........
• . ':;;:i' '.1i :.'W . ••• '.•:, ,: iti- ':51:til;;': .; .-z ,,, -,,,. ..:,,,, i ...._ .:. , .....o.5. ..........:-. . ..... .,.1
Business Name: - 02‹, Fees due upon application $
Address; ..
Cityl_S_tate/Zip: . Amount received.
. $
Phone: _ I Fax: Date reetived:
CCB Lic. #: S-(09S-2- .
.
Authorized 2,_
Signature: __, Date: 2/053 Notice: This permit application expires if a permit is not obtained within
litft days after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board,
— (Please print name)
i:\Dsts1Permit Forms1BldsPermitApp.doe 01/03
04/02/2003 09:04 FAX. 5035981960 CITY OF TIGARD 0 007
• FOR OFFICE USE ONLY
Electrical Permit Application ./
Rcctived Electrical
Date/13 7 ' JP D 3 : Permit No.-,0000 4O /on° Sign
City Of Tigard Planning : Appr oval
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Dar : : Permit No-:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 .. Post- Review Land Use
Internet: www.ci.tigar'd -or.us ...„ t,, - ,_ Contact : 7 Case No.: ® See Page 2 for •
24 -hour Inspection Request: 503-639-4175
- - - Name/Method: Supplemental Information.
i C.. ,.:;..4 k:! d 9eI'IS' Oh' 0313.1 ., ! ,. a I4; i .: 1, i s 1 . -' i ' . 7:P A `B.EVI 'VP . 4 ;decked eall it .. tee 3^ ' fit—
[New construction _ Demolition m Serv over 225 amps- • Health-care facility
Q Addition/alteration/r lacement_E Other eOn"1er`ia1 ❑ Hazardous /oration
❑ Service over 320 amps-rating of ❑ Building over 10,000 square feet,
!r; ,C ,l' (E(O,XY'OOICO ?STjRit. ON ., , J . 1 & 2 family dwellings four or more residential units in
IBC 1 & 2- Family dwelling El Commercial/Industrial 0 System over 600 volts nominal one suvcture
❑ Multi -Famil
['Building over three stories CI Feeders, 400 amps or more
❑ Accessory Building Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ lgresss/lighting plan ❑ Other: -
I ,i Submit sets of plans with any of the abort•
ii; isi; C13$ 1T) E' I1�10! RMi4Ti( 1SC ;iniri;lLl3Y"AOIIii`.l;;i.j ?; .,f
2.7 , 1'VI The above are not applicable to temporary construction service.
Job site address: I y L7 O S . 12_8 - r-k` Pi_ _ I` `� J ,1 i C1H E f".`, I 'I 1 �I i!i45�iri.3 ":, 9: T 3
Suite #: I Bldg. /Apt. #: 4,...-r a 19 Number of inactions per permit allowed
Project Name: ELK N t,.t f-i Rip L e >1 v-TE 5 Description Qty Nee (ea.) total 1
Cross street/Directions to job
New residential-single i. Includes a multi- t9awtiy per
b site:
J dwelling unit. Iodudis attached garage.
Service included:
1000 sq. ft. or less , 145.15 4
Each additional 500 sift or portion thereof 33.40 1
Subdivision: �ZIL ti- lL O6L Lot #: 19 L Uwe. uoideutig HcL f t1C'lf� 75.a1 l t
._- umiled energy, nonresidential 75.00' 2
Tax e . e r aroel #: Each manufactured home or modular dwelling
:''e %* '' a.; +r, IA a t •. 1 °' and/or feeder 90 -90 2
'it': ' O�RtiO1i: ; p
�' " �' ` ''�" Servi a Strviees or feeders - installatioa,
alteration or relocation:
200 amps or lees 80 30 2
201 amps to 400 amps _ 106_85 2
401 amps to 600 amps . 160.60 2
' 't l �'' :. . dOi carps to 1000 amps 7.40.60 2
f f, 1 A�' � .ti .:.111 .1 tl :. y , V . , .. ,. a. ..ci :., ... . :.. . ';silt' 454.65 2
Over 1000 amps or volts
Name: ,AU (_ r C A0-)e? 12econnect onl 66.85 2 '
Address: i tifio 0 4.1 i 02 St,-/ _ Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zii 1>cr 'b L 9 72 200 amps or leer 66.85 • 1
9 A - Phone: a mps o 400 amps 100.30 2
Phone: 772.05 Fax: �r S - B i Ie 3 t
��;r ,�{ 801 to 604 amps 133.75 2
A ,' b 1 .040Z111t , !; r;ii' ':�; i' ' ii❑ ONT CT FE SO$ ,,, Branch circuits - new, alteration, or -
Name: 1/ .5,41'r6 as 4 V F extension per panel:
A Fee for branch circuits with pur hale of
Address: 1/ service or feeder fed each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without chase of ,
--- service or feeder f - first branch circuit ' 46.85 2
Phone: I Fax : Each additional branch circuit - 6.65 2
E- '111011 Misc.(Service or feeder not included):
i Each . . ,� a irri *In. cirtie 53.40 2
rr t v " E , ; ! ' ?a+ �'. IF ai �� ��T�ll �l 9 : i 1. " Each signor outline lghting 53.40 2
Job No: _ signal circuit(s) or a limited energy panel,
alteration, or extension MVO 2
Business Name: 1ZAN tLLtr.J 0LECA t C De
Address: /b 3 i SE Z 3 rre Cr
1 ' Each additional inspecdou over the allowable in any of the above:
Ci /State/Zi a : to _ 3 -. r-1 62. / O -0 Per' ion • hour mm. 1 hour 62.50
Phone: N 92 - '4S/ Fax: InveatipAtion fee: - —
Other CCB Lic. #: Mb/ 7 Lic. #: - -, ti , � ' , i ,, , '1... r, , i Z r .!,,; ;, ; '.ii'4
�'�,. ���t��� , , l �,,,,i,�k :;r;';�� :;ice I, IL e.
Supervising electrician Subtotal $ _
si to r req uired: _ Plan Review (25% of Permit Fee) S
Print Name: I Lic. #: _ State Surcharge (8% of Permit Fee) $ _.
- TOTAL PERMIT FEE $
Authorized Nod= This permit application expires if a permit is not obtained within gignantre �— Date: Z ei3 180 days after it has been accepted as complete.
*Fee methodology seedy Trl- County Building Industry Service Board.
(Please print name) - .
iADsts\Permit Forms\SloPernvtApp.doc 01/03
•
04/02/2003 09:03 FAX. 5035981960 CITY OF TIGARD Ui005
Mechanical Permit Application R o. Mechanical
i,sr , 3 dd /.,Pr . _
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd Plan Review Other
Tigard, Oregon 97223 Date/B r�'. , Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 „ .. c. Post Review Land Use
, :
Internet: www.eLtigard.Or.us ' 1 Dat
1 Con June No - See Page 2 for
24 -hour Inspection Request! 503- 639 - 4175 Name/Method: Supplemental Information.
•-•! T iiien°4.F (AUC: I I , ' _, :. : f Ti 0!' 1 7 1 : t: CM W
❑ New construction Dem Mechanical permit fees* are based on the total value of the worst
• Addition/alteratia - .lacement Other: performed. Indicate the value (rounded to the nearest dollar) of all
1 . !421 ' 2 Corot 01111 ii e' 1ST L - ,IOi1T ,.;i 0 :
mechanical materials, equipment, labor, overhead and profit.
V alue: $ See Page 2 for Pee Schedule
❑ & 2-Family dwelling ❑ Cornmercial/Iildusttzal _ :AN c o r t o i e „: gig �r +” tiff; c� a E�i c• t,c
❑ Access I3uildin ❑ M - Family
CT- Description Qty Fee(ea.) Total
❑ Master Builder ❑ Other >atcncoou,ra :..
„ 7 ' I. ,.- OI i41tM 11 -i]1�I ai�tE, 1147[4 x � :t `_ 14.00
Furnace - add-on air conditioning**
Job site address: 1 4770 S W 12 Pt.. - Gas heat pump _ 14.0
Suite #: _ I Bldg. /Apt.#: Duct work ._
�— fiyd hot water system 14.00
l x'14} Name: -- Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
in wall in -duct, su ded, etc. 14.00
clue/vent for aniof above) 10.00
Subdivision: VAL 14-DR- i'Z -t+0 I Lot #: 19 1215 •
Tax ma eh . • ei #: water heater , ,,
'. iii r :.',i, - 1.., ' e •; " "� s ;.;
� $K re's :' :� ! i tt .
10.00
Log lighter (ass) heater/ '10,00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
,1 IR 3 i :I ,-,-77717.':,'L � i J�' BL C,xp� i � ,:,,, � un...,, '.'t) � - - ih9�t�dE '=a
c -Other: 10.00
#lttvift lmCatal E . , Vez ►twa -: ...
Name: � ��t- 2 1� Range hood /other kitchen equipment 10.00
Addr 4 gb 1.g_W 1DZ — — Clothes dryer exhaust - 10.00
City /State/Zip: logs LA-PD eg, el 7 22. g ;ngle duct exhaust -
Phone: 57)3- 85t 5Y1 -7z8S Fax: 81 S — 0 11 03 (bathrooms, toilet compartments,
� a;: i 6.St)
.,��? :�� � . 7�.'i' ,_i;��s��i';i;� ; :��, I' :�1!�'A�!D�'E *.,1,1_..;, utility :
Name; S r �. - A5 Attic/crawl s ace fans 10.00 •
Other:. 10.00
. > , .. .....
Address: ... . ..._, stack Plpitu[:.
City /State/Zip: * *( 35.40 for first 4, $1.00 each additional)
Furnace, etc.
Phone: Fax: — Gas heat putn__ **
E-mail: Wall/: :. ; ded/unit heater **
.-- Nrg: .. ;: i:`` - _ w :!:4:"f ' - Water heats
Business Name: E L. tie -14- i,J (o -- Fireplace . olio
Address: 2,?fOl2 5.%,,j, E' 21:: Q _:
City /Sta /Zi1_?: i - 11ILS Bb�e_aIL, o f i 12 3 — C lothes as ��
Phone: $a3 -0-8 -.S 620 Fax: t ='
Total:
CCB Lic. #:
• . like. iumia t PerinitFeee . •
Authorized Subtotal: S . —
Signature: Date: - - Minimum Permit Fee $72.50 $
Plan Review Fee (25% of Permit Fee) $
lease print name) State Surchj % - o Permit Fee) $
TOTAl.. PERMf 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:lDsts\Pcrmit Forms 11tdeePermitApp.doc 01/03
04/02/2003 09:02 FAX 5035981960 CITY OF TIGARD 0 003
Building Fixtures
Plumbing Permit Application Received I 0 R OFFICE USE ONE\
Plumbing i b ,-,7___
Date/By /63
Permit No.:T797
City
f Ti g Planning Approval
Sewer
o ard Date/By:
Permit No.:,
13 125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/fl: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 ,„;,.,„. i;,, . -?. I , , post-Review . Land Use
I: gnfd.Or.US . _ 4 _11., Nlii , Cont ct Datr/By:
a Case No.:
nternet wWW.Ci.li
Juris.: CE3 See Page 2 for
24 Inspection Request: 503 - ft' - ' - ' ---• , Name/Method: Supplemental Information.
7 .:•- - ..: :;o; l'.1,;',.•:.:. ;i' EteliZt4J1 fiii:- ': infailittiOtiikeek. '•;:','.::'
New construction Demolition Description Qty. Fee(ea) Total
17-Addition/alteration/rep1acement Other: /2-401,44W0014,?IiikWrw:..,:.:'::::;,.,i,?'
x;:/i4Kiosariiiaiiiiiit:iii§iiiiiiiiiilW V
a ' .:;, k: ..• ,; . ,
• Y'OF .C. Ca- TRUCTIO11 i:....;: : :, .:.;i; .; .,, „;:,;, ;...;
_Fli 249.20 '
1 & 2-Family dwelling 1U Commercial/Industrial __ - -
SFR (2) bad' 350.00
MI Accessory Buildini 0 Multi-Family SFR (3) bath 399.00
• Master Builder D Othcr: Each additional bath/kitchen 45.00
'...'.1'-'..'.: '.:Iii! '''''J a 0 SITitillifORMATibli ,iiiEFCA 1O4 O iit;:i!:!:::: : Fire sprinkler - sl. ft 1 1 Pale 2
Job site address: 14 76 S I _:: Pi- r,'..1:1:,',.''IY.'ic;r2e,.(itl.!!'i Stiiaiiiiiiii.,.;,iii
Suite #: Bldg./Apt#: Catch trasin/arca drain . 16.60
D ell/leach linc/trcnch drain 16.60
Project Name: _ - Footing drain (no. linear ft.) II Page 2
Cross street/Directions to job Site: Manufactured home utilities 110_00
Manholes 16.60
Rain drain connector 16.60
Sani , sewer no. linear ft. 11111MEM1
Subdivision: at- 4-kbe4-) Rko‘d I .1-_015: 61 _ Storm sewer (no. linear ft) 11111Effral
Water service no. linear ft. Pa: 2
Tax niiicei2t -:::giii,i:iia4,;''IZ IV 'T, •1. '''elfrirr ' 7:4057:
...ii EiSCRIENT(0)Ii1000.011.1 Abse . don valve MIN 16-60 _
Backflow , - venter P , 1 2
Bacicwater valve 16.60
- - - Clothes washer • 16.60
. - Dishwasher 16.60
DrinIciril fountain 16.60
D,IILTilin :rtlieffiEL":4 V...,..', - 2 , 'orriot Feetors/sum. 16.60
Name: - p A ,,,... tz_ CAR jo y E . , -ion tank 16.60
Address: H $0 KS 111/4) I 02--nj Fixture/sewer cap .16.60
City/State/Zip: P.,,,f_1-1.P.i.- 52_ ot 1 12.41 Floor drain/floor sink/hub 16.60
Garb , :e d .osal 16.60
Phone: et 3 ci -12.55 Fax: 8 LI 9 -' 4 .3 Hose bib 1660
,iallaepuci eir Ice maker 16.60 -
Name: STA/4 g" A-5 A- Rc,-As Interc . ,. I. :,...: " i ... .11.1 16.60
Address: Medical gas - value: S Page 2
.- Pruner 16-60
Ci /State/Zi • : Roof drain commercial 16-60
Ph011e: Fax: Sink/basin/I avat . 16.60
E-mail; Tub/shower/shower.ain - 16.60 --
i.11:!:i•':::' :':-N1..::?,....00111TitigirtaiEP::,; F:!!!;'. :,..:,'-' .::',..,:•; -i!!•? Urinal I 16.60 •
Water closet 16.60
Business Name: CAkiti vie“....Avica.L.,_ t_ Water heatcr 16_60
Address: ?.. g b - t . 2_6 Other_ .
City/State/Zip: 1 biz. gt-i to 6
Phone: - 31v - q 1 45 Fax:
- Subtotal S
CCB Lic. #: t 02 sic Plumb. Lic.#: cLi-i p g _
- Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: _ Date: Plan Review (25% of Permit Fee) $
Stele Surcharge (8% of Permit Fee) $ -
- .
(Please pr name) S TOTAL PERMIT FEE $
Nodee: This permit application expires if a permit is not obtained within A0 new commercial buildings require 2 sets of plans withisometrie Or
150 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-Connty Building Industry Service Board.
IADsts\Permit Forms1P1mPermitApp.doe 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MALMEDAL ENTERPRISES INC
42405 NW OVERLOOK DRIVE
BANKS, OR 97106
Plumbing Signature Form
Permit #: MST2003 -00128 _
Date Issued: 5/7/03
Parcel: 2S109AA -05300
Site Address: 14270 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot: 019
Jurisdiction: TIG
Zoning: R -
Remarks: New SF detached, Path 1.
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:
PAUL R. CARNEY MALMEDAL ENTERPRISES INC
1480 NW 102ND 42405 NW OVERLOOK DRIVE
PORTLAND, OR 97229 BANKS, OR 97106
Phone #: 503 - 939 -7285 Phone #: 503 - 310 -9795
Reg #: MET 4232
LIC 102535
PLM 34 -276PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X /
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.
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CITY OF TIGARD 24 -Hour
BUILDING % Inspection Line: (503) 639 -4175 1111 40 -- �24 l "
INSPECTION DIVISION Business Line: (503) 639 -4171
l BUP
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Received . S7 D ate Requested � / � 3 / � AM PM BUP
Location / -- 70 /2J Suite MEC
Contact Person 01`41A- Ph ( ‘F3 g — 7'zd'S PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /�� A#14_ (-/& SIT
Post & Beam C 1.�a
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear l) C —' .�� �� C ,. -- l
Framing �L � C�
Insulation 2 4- /ASV LA- - o N �� � !
Drywall Nailing ��/
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
illiPM _P
PART FAIL
MB
Post & Beam
Under Slab
Rough -In %
Water Service
Sanitary Sewer i /
Rain Drains
Catch Basin ! Manhole ■ �i ' i ` A
Storm Drain INALM1 - -.�- Shower Pan -
Other: l
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
S =Dampers
Fi -
_ ; PART FAIL
E CTRICAL
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: 0 Unable to inspect - no access
Fire Supply Line /
ADA _
/'�, ..�.
Approach /Sidewalk Date '✓ Inspector _ LIB • ''
Other:
Final DO NOT REMOVE this inspection record om the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 lb 3 ---6)6/
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received r e `+) 7 Date Requested AM PM BUP
Location / 4 7 7 Z d am ' Suite MEC
Contact Person Ph (z5 ) — 2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
ACC @SS:
Ftg Drain ' ; ELR
Crawl Drain
Slab Inspection No • SIT
Post & Beam 1 s o rl( f
Shear Anchors 7
Ext Sheath/Shear
Int Sheath/Shear )Z :�rt
r4' (o; c. ✓ 4
Framing �'�'
Insulation No a/0 � �, �� � f
Drywall Nailing �/ OC 1
Fire wall t " S f.� ,�. e
Fire Sprinkler \
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
ICTit
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
iri
S ART FAIL
M HANICAL
Post & Beam
Rough-In Line
Gas line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
F rm
F Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA [/ / /
Approach/Sidewalk Date 2 / / v 7 ' Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL