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Permit 1 1, CITY OF TIGARD MASTER PERMIT PERMIT #: I DEVELOPMENT SERVICES DATEISSUED: 4/21/04 MST2004 /2 /0404 00100 - I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 SITE ADDRESS: 12610 SW BAILEY TERR PARCEL: 2S104BC - BW007 SUBDIVISION: BAILEY WOODS ZONING: R -7 BLOCK: LOT: 007 JURISDICTION: TIG REMARKS: New SF detached. BUILDING REISSUE: BVH2342 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,372 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: V TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 970 sf GARAGE: 528 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 229 231.20 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,342 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: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 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: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION . Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,580.88 BUENA VISTA CUSTOM HOMES INC BUENA VISTA HOMES This permit is subject to the regulations contained in the 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES Tigard other r applicable cal Code, State work k w Specialt Codes and all other applicable law All work will be done i PORTLAND, OR 97219 PORTLAND, OR 97219 t 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: 503 443 - 6033 Phone: 503 443 - 6033 Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through 952 - 001 -0080. You Reg #: LIC 152235 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 Rain drain lnsp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line lnsp Plumb Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation lnsp Appr /Sdwlk Insp Issued Permittee Signature : r ((( �Jt ___/ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b siness day Building Perm•t _,..1,,, IV il n FOR_ OFFICE: USE 'ONLY Received /®ff�yr Building t d —45, '� Date/B : i / / Permit No.: 7;,-'4,. CIt of Ti il['CI ) I . d Planning Other DD y g � ZOO4. Date/B : Permit No. WL ,,,,go, o ' j 13125 SW Hall Blvd. MAR Plan Review Other Tigard, Oregon 97223 Date /By: AA VI- - 4y Permit No.: Phone: 503- 639 -4171 Fax: (10! 3-11 "ARD �°"' i11' I ' Post- Review Land Use Internet: www.ci.tigard.or.u$IJILDING DIVISIO LJ ,•� �� Dace/By: 'y Case No. Contact 5�,, �e lL . * 0 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Meth G( � (' r Supplemental Information • • .TYPE OF WORK. ..... �..,. . :. ' j EQ .. DATA: ^:.`,. :' `.-..,:.:;:,:,..i., . ❑ Demolition 1 & 2 FAMMII YDWELLING,. ;, :.'�_ ___: •, _ New construction ❑ Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION '. Note: Permit fees• are based on the total value of the work performed. Indicate © I & 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 ❑ Master Builder ❑ Other: Valuation $ JOB SITE INFORMATION ad LOCATION. • No. of bedrooms: No. of baths: 3 Job site address: 1� � u 0 .) 9jL -> �Eze. Total number of flo rs -- - New dwelling area (sq. ft.) c9"3y' ?"' Suite #: I ldg. /Apt. #: Garage /carport area (sq. ft.) 0 Project Namelx.,� Covered porch area (sq. ft.) 1 7 11 Cross street/Direction to job site: Deck area (sq. ft.) Other structure area (sq. ft.) 4' :., •':REQUIRED DATA: - . :,.:' ; : -•:. ' -. -: - COMMERCIAL, - USE CHECKLIST... • Subdivision: Lot #: 7 .. ` _.. .. 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, NEW CONSTRUCTION — SINGLE FAMILY RES. overhead and profit for the work indicated on this application. DEATACHED RESIDENCE Valuation S Existing building area (sq. ft.) New building area (sq. ft.) Number of stories 1 3 PROPERTY OWNER • .1 TENANT:;... • • ••• • . . Type of construction Name: Buena Vista Custom Homes Occupancygroup(s): Existing: Address: 6932 SW Macadam Ave. Ste C New. City /State /Zip: Portland, OR 97219 Phone: 503-443-6033 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be 0 APPLICANT 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: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: Eliabeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: _ Fax: E -mail: CONTRACTOR - BUILDING.PERMIT:FEES *.:.. • `, ... :.. : : :.. , ... .. •: •.„ Please refer to fee°schedule: Business Name: Buena VIsta Custom Homes Fees due upon application S Address: 6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 97219 Amount received S Phone: 503- 443 -6033 Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized /? y ��jSi nature: ( A' p/ Date: Notice: This permit application expires if a permit is not obtained within Signature: 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 \BldgPermitApp.doc 01/03 • One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City of Tigard City of Tigard Associated permits: ❑ Electrical ❑ Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 'ME 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 Cl 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. 110-4611 t6IOOICOMri 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical .' licatlon FOR OFFICE [SF ONI.l , /'� Received Electrical M AR Lt DatcB : Permit No,: I A l A .44, `// / /i City of Tigard Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. C1TY OFTIGAPD Plan Review Other Tigard, Oregon 972236 I DING DIVISION Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use Internet: www,ci,tigard.or.us [Ysu/By; Case No,. Contact Juris.: 121 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Su rjplemental Information. • • . - _TYPE;OF WQRK . .. , . '. '. ' l ►Ftf 1 W (p Its St:' CrteC(c it71';tUsti>aePtib' l' .`` ... .. New construction Demolitiott ❑ Service over 225 amps- ❑ Health-care facility ❑ Addition/alteration/replacement Other: commercial 0 Hazardous location ❑ Service over 320 amps rating of ❑ Building over 10.000 square feet. . .. CATEGORY.OF'COP1SI KETCFION. : 1 & 2 family dwellings four or more residential units in & 2 -Famil dwellin Commercial/Industrial ❑ S over 600 volts nominal one structure $uildin ❑ Building over three stories El Feeders. 400 amps or more Accessory , _n Multi- Family Cl Occupant load over 99 persons Master Builder 0 Manufactured structures or RV park Othe 0 Egress/lighting plan ❑ Other: .:. ' JOBSITE INFORMATI a N•itlltl '' Submit sets of plans with any of the above. Job site address �/ /D / L�� �� The above are not applicable to temporary construction service. Suite #: Bldg./Apt.#: `FEE!!:SGI�>E1��.:;:':.;° i...,:'• ;;f.-:�;•:; „-•::. • Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total i Cross street/Directions to job site: New residential-single or multi-family per dwelling unit includes Attached garage. Service Included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft or portion thereof 31,40 - 1 ' Subdivision: Lot : Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling ' .. `DE I • ONOFWOXtK service and/or feeder 90.90 2 ' Ne-&-v Cons . so . t -fhil/ aleralonor g'—k OA L Y 12 den Ck— 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps • 160.60 2 oPERTY OWNER TEN . !' 601 amps to 1000 amps 240.60 2 i, Over 100D am or volts 4 54.65 2 Nam e: ate et_ ti. 1(�fi Reconnect only 66.85 2 Address: q'� J lf,/1 a _, ,_,k Aye, 51L•t Temporary services or feeders - installation. City /State /Zi.: Per O 0 9 9 alteration, relocation: / 200 amps or le ss 66.65 I - Phon =. • 2 / 3- (.ES Fax ^ 1 .. 3 201 a to 400 amps 100.30' 2 Pd je ll 401 to 600 am 133,75 2 M till�1l • NIT • C•h: PP! '` , ON' Branch circuits - new, alteration, or Name: S if Q., / • SS extension per panel: Address: A. Fero 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 Phone: ice or feeder fee, first branch circuit 46.85 2 Fax: Each additional Mauch circuit 6.65 2 E -mail: Misc.(Scrvice or feeder not included); CONZICR Each pump or irrigation circle 53.40 2 --' Each s or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Nae: "8 O 53 eta) J µ alteration, or extension Page 2 2 .:28 5 k) e ta) rT�C � F OC 3 Desttiption: Address: � _ City/State/zi : p 1 }f_ t i ” i, 2 , pg 477/a3 Each additional inspection over the allowable in any of the above: Phone:,$c2 -3 !o ( Per in, lion hour min. I hour 62.50 �2 � Fax: V�3 �t1 S lnvesti �tion fee: CCB Lie. #: is Lie. #: 3 3(. Othcr: Supervising electricia hiacftirahPekmtf to ' 1 ., 'a;;. X sSnature required Subtotal $ Plan Review (25% of Permit Fee) $ s/ Print Name: S Ve ► OS Lic. #: t/23 2S State Surcharge i % of Permit Fee) S Authori zed TOTAL PERMIT FEE S 4 Signature: Date: Notice: This permit application expires Ir permit is not obtained within 180 days after it has been accepted as complete. 'Fee methodology set by Tri- County Building industry Service Board. (Please print name) i :\Dsts \Perrnir Fornts 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 Mechanical Permit Application �, � �,.� �,,, Received MechMtcai 1 '� / oatati3v: Permit Ne,: J'i 'r.1Lleo City of Tigard C��� Planning Approval Building Date/t3y: Permit Na.: 13125 SW Hall Blvd. �� P1art Review Other Tigard, Oregon 97223 QQT1 Dater Permit No.: Phone: 503- 639 -4171 l; to 3- 960 _ Post- Review Land Use Internet www.ci.tigard.or. , A I Contact kris:- IX[See Page I for 24 - hour Inspection Request IO Nae/'.4tethod: 9apptemenea1 iolbrmation, • 0 G DN1S a , v j1t-D1N • _c •... as 01rWORK. s .3i <r - . • .; • r *' • et CIA,X.. FEE +:BCIXED[7RE =`ontcauclotasr* ;...;:k:. Lf New construction 1110 Demolition Mechanical permit fees* arc based on the total value of the work lii Ad ditaon/alteration/re • lace ment • Other: performed. Indicate the value (rounded to the nearest dollar) of all - `„CATEGOR . �C?F:COk�S�UC a e L , � mechanical materials, equipment, labor, overhead and profit. . . . ''' L 1 & 2- Family dwell • i Commercial/Industrial value: 5 See Page 2 for Fee Schedule 111, Other; Accesso Buildin: • Multi -Famil ` 'F' ) Lr Master Builder ❑ De,cr't�Gon I Oh' 1 Fee(ea I Total _ Bating/Cootiag • .,Ja : SrrE �'ORMATIdN di LOCATION . •- : , . • Furnace • add-on air conditioning ** 14.00 Job site address: /144/0 • ' / Lf.s/ / Gas heat 1 Suite .a#: Bid : .lA• t.#?: Duct work 14.00 NM Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hronie system) _ 14 -00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended. etc.) 14.00 Flue/vent (for any of dais) I 0 -00 —� Lot #: Repair units .1 Subdivision: _ • • Fuel A t 12 ees Tax map/parcel #: Water heater 10.00 • . - DES «- I COON ' F WORK ' ' • • Gas fireplace 10.00 NEW CONSTRU TION -SI GL' F • I ' Flue vent (waterheatorl: fireplace) 10.06 DETACHED RESIDENCE - Lo: li• ter _ -. • 10.00 MEM - Wood/Pellet stove III 10.00 1M Woad . : • lace/icsert 10.00 '-" Chit= /liner /flue /vent MEN 10,00 gia.`• a PERM a •' ' :a RIB :1€ NAFQx'iwA - . • Other: Eavironmmtal IEzltauscMI 10.00 MEIN tatGo .Ta1Tle: E _ = -_ f_ V i s - .. . - I' • a, It Range hood /other kitchen equipment 10.00 Address: 6 7 SW Macao —.,+ • V - S . - C Clotho dryer exhaust 10.00 Ci /State /Zi • : Portland OR 9721 9 single duct exhaust Phone a _ Fax: / - , . _ , • (bathrooms, toilet compatuncnts, li .. . , _ * e tN CONT : • ) SON ' '• ' utility mont9) • 6.80 O tticrcrawl •ace fans 10.00 - IMME Nazti�: David Golobay Other; 10.00 Address: M = 11*(S&4o for first 4, 51.00 each additional) Phone: Fax: Furnace etc. • .. Gas heat • * * E-mail: • WatVsue • euded/unit heater . E UN %'RACTOR Water heater MINI MM Business Name: car$ GIB ow 9.. Fi • • late MIESNIIMI Address:2428 SE 105t:h . Flange - *. BSQ "' Ci /State/Zi• :Poxt1ar1d, OR 9721 Clothes• er as ** F 8.X:503 -25 , • b : '� Otter: m* Phone: 503 253 -7789 - Total; •CCB Lic. #: 4 51 31 Mechanical Permit Fee' Authorized • Subtotal: S signature: ... Date: i c a D l + Minim m Permit Fee 572.50 S David Golob y Plan Review Fee 5%ofPermit Fee) _ .. ' s (Please print name) TOTAL PE - IT FEE S Notice: Ws permit Application expires If a permit is not obtained within *Fee methodology set by Trl -Couery Building Industry Service Board. 180 ogre after it has been accepted at C *•Site ptan required for exterior A/C unit,. i;tpsts fc mit Fatms1MetPermitApp •doe 01.4.3 • • • Mechanical Permit Application - City of Tigard • - Page 2 - Supplemental Information Commercial Fee Schedule: 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. 1:1BuiidingTermit Forms MecPermitAppPg2 09- 01- 03.doc 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY i BUENNA VISTA 1 002 /003 Plumbing Permit Application Received Plumbing G �� Approval � Planning : Permit Na.: % /A nn City of Tigard E�E Dan ng Sewer Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Id' 2, 2 0 Date/Bv: Permit No.: . Phone: 503- 639.4171 Fax: 503-Sr-t960 Post - Review Land Use � Case No -. Internet www.ci.tigard. F '(1 '. aLii; ' -41! Dare/Date/13 : Contact Juris.: See page 2 rbr 24 - hour Inspection Request: 503.68 G Ol t •. -- Name /Method: Su • • lemeotai lnformatioa. • - TYPE O8 WORK.' EE'SC DULE for . - infOlvisitaVallea J.P:� :l2` .•, New construction Demolition Description ,_ Qtr. I Foe ea. I Total Addition/alteration/replacement Other 'uP q' : 7..fa> i at `e °s< `, ,,: : �.. - , , • r. • • CA TEfiiQ - R'YTIF., ' �i •:;;;;;.' L o :Y IA I t . eo `sa tetiTo o . : _.: y: r • SFR 1 bat ••, !. KyN: D 171 •' h 1 & 2 -Family dwelling ❑ Commercial/Industrial SFR (2) bath 3.50.00 Accessory Building Multi -Famiy SFR 3 bath 399.00 •I Master Builder DI Other: Each additional bath/kitchen 45.00 SOB STIR VF...ORMitiTlQNdudL'f)CA TIONt ' • Fire sprinkler • sq. ft,: Pa e 2 _ Job site address: . /O 1 71/./2_,. ; 71/./2_,. - • • . - siteVuaties '• „• , ,•. '' :„ �?'a'.�: • .:', Suite 7h Bldg. /Apt. #: Catch basin/arca drain - 16.60 Project Name: e ellileaeh line/trench drain 16.60 Footin_ drain no. linear ft.) Cross streeVDireotiors to job site: Manufactured home utilities 110.00 Manholes 1111 16.60• Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no, linear R or Item Page 2 ' DESCRIPTION OF WORK Absorption valve 16.6 . NNW, ,CONSTRUCTION — SINGLE FAMILY Backflow prevcnter Page 2 FAMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 N'pg tpERFY'o1 1 : r : 93 'FE1sFA NT . _.. _ E'ectors/eum- 16.60 Name: Buena Vista Custom Homes Ex• ansion tank I 16.60 III Address: 6 9 3 2 SW Ma r:A d am AVe. p c Fixture/Sewer cap 16.60 City /State/Zip: Portland r OR 97219 Floor -e d i s •our sink/hub k/hub — _ 16.60 Garba • e dis • •sal 16.60• Phone: 503_ 443 -6033 Fax: 5030443 -2443 Hose bib 16.60 nil APPLICANT - • , , • .ncoNme nRSCN • ' Ice maker 16,60 Name: Ray Mullen interceptor/greaser= 16.60 Address: - Medical : as • value: S Pa • e 2 Primer 16.60 Ci /State/Zi • : Roof drain ( commmercial) 16.60 Phone: Fax: Sinklbasin/levato 16.60 E -mail: Tub /shower /shewer pan 16.60 • . CONTRACTOR :. . Urinal 16.60 Water closet 16.60 Business Name: ED Mullen Plitmbj.nct Water heater 16.60 Address: 24470 SW Rainbow Lane , Other: City /State/Zip: ail 1. bet .. slR 07 1 21,_ irihilin Phone: . 0 — 628 - _ Pax: a _ . . CCB Lic. #: • 2 6 E 9 Plumb. Lic. #: 3 4 _ L6 OF$ ' . Minimum Permit Fcc 57250 Authorized '• i„ 4 Residential BacIcflow Minimum Fee $36.25 Signature: " A 1/ ' C: Plan Review (25°.6 of Permit Fee) Ray ul en State Such • • e 8% of Permit Fee (Please print name) TOTAL PERMIT FEE S Neelee, This permit application expires Ira permit is not obtained within All now commercial bulldlep require 2 sets or puns with isometric or lao days after h has been accepted as complete. riser diagram (Or plan review. •Fee methodology set by Tri-County Building Industry Service Board. i:\DsLs \Petmit Fort ne\PlmPermiWpp•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 - I" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer - 1st 100' 55 3,601 to 7,200 $220.00 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 Fixture orItetir`,� � ' •. _. •� ` "•'Fee ea " � ;Totat 4 additional $100.00 or fraction thereof, to and ' 1 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 $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. uantl b re VHorkYeitoruied • Comments regarding fixture work: g g Fixture Types • . . •. New Moved EiLtttn "; .ySCipped ;:: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" - 3" -4" Car Wash Drain . Garbage Domestic *Note: If the fixture work under this permit results in an Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial • - Service • Swimming Pool Filter Washer - Clothes Water Extractor • Water Closet - Toilet Urinal Other Fixtures: i:� Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03 • .- P R ST EET TREE CERTIFICATION ::. x£ _ Wy \ . I, EM PENAL C ,,Owner /Agent for gUEWf UJ>Th NE- womE$ (PLEASE PRINT) , (PERMIT HOLDER) Do hereb � '��.� � µ ',, W � Q ;� �; y „ ier"tit y t iktfite following location ,*711 , 4>,, , ' d , ^ . following meets City of"Tigard /W ` County l and use and development standards for street tree installation. ADDRESS: - O - LOT: SUBDIVISION: 4 l (e Q0 0/5 BY: 77/1---P DATE: . 7 /f 5 / 0 RECEIVED BY: e 9 DATE: —y-4f--- L. CITY OF TIQARD J 24-Hour con Line: 50� 69 -4175 // BUILDING p ( MST and od/d6 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP • Received Date Req'&sted AM PM BUP Location Suite MEC Contact Person Ph ( ) 7 ( U - g / -5 ' PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing -tie/ zinc C �� — — ©' C " ,/V Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: FART FAIL • MBING _ Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers digt PART FAIL ELECTRIC AL _ Service Rough -In UG /Slab Low Voltage Fire Alarm Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA S _ � � D r Approach /Sidewalk Date 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 . Y-46/406 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested ( AM PM BUP Location d■. (n - Suite MEC Contact Person 90 / Ph (- ) 7/ D - /c PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR jam Crawl Drain /A1 Slab Inspection Notes: SIT Post & Beam / �/�� Shear Anchors Ext Sheath/Shear lid Int Sheath /Shear 4g g �, ®�I , r . yn a .`-i Framing r V 1V� O '7 Insulation Drywall Nailing Firewall `�,,, Q ,t °"r : 21' LJ n I 1-p � t c ` 4C.. �kS 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: i PART FAIL ANICAL 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 El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line p� c �Q ►!' ADA — �. Inspector � V `� ` 1A Ext Approach /Sidewalk Date ector P Other: Final DO NOT REMOVE this inspection rec rd from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour • /do BUILDING ' Inspection Line: (503) 639 -4175 MST - q_a d • INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received / Date Requested / � � � -S AM PM BUP Location ! o- 6 / D L-ri C . -(vYl� Suite MEC Contact Person -4C1 Ph ( ) f a ' 28Dl) PLM Contractor Ph ( ) SWR __ BUILDING Tenant/Owner ELC ,_ Footing Foundation ELC Ftg Drain Access: ELR . ;9"A Crawl Drain ,,/' �' Slab Inspection Notes: SIT (.1 Post & Beam Aiffor Shear Anchors Ext Sheath /Shear Ina Sheath /Shear SA (L � L4)\ �' �J (t� YY�R )11 Framing M� � Insulation Drywall Nailing Fi rewal I 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 41/*__ � Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. [11 PART FAIL SIT ± E Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ,I� ( ��Q, ADA ' � -- ° Inspector � ` ' tv 56 L Ext Approach /Sidewalk Date ! p Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL