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Permit n CITY OF T I GA R D MASTER PERMIT PERMIT #: MST2004 -00191 � D EVELOPMENT SERVICES D ATE ISSUED: 7/28/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09610 SW PIHAS ST PARCEL: 1S135CD-14000 SUBDIVISION: GREENBURG PINES ZONING: R - 4.5 BLOCK: LOT: 011 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: 1795 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,084 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,456 sf GARAGE: 400 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THR sf RIGHT: 5 VALUE: 245 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,540 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 0 RAIN DRAIN: 100 TRAPS: LAVATORIES: 6 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: BOIUCMP < 3HP: VENT FANS: 5 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: WISVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 4 201 • 400 amp: 201 • 400 amp: 1st W/O SVC!FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: 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: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 8 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,677.96 VISTA NORTHWEST INC VISTA NORTHWEST INC This permit is subject to the regulations contained in the VI I VI BOX NORTHWEST P BOX NORTHWEST Tigard Muniapal Code, State of OR. Specialty Codes PORTLAND, OR 97291 PORTLAND„ OR 97291 and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 531 - 0505 Phone: 503 - 531 - 0505 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 75507 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS • Ersn Cntrl 681 -4444 Post/Beam Mechanical Electrical Service Low Voltage Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final Footing Insp Crawl Drain /Backwater Framing Insp Gas Fireplace Water Line Insp Plumb Final Foundation Insp PLM /Underfloor Shear Wall Insp Insulation Insp Water Service Insp Building Final Post/Beam Structural Mechanical Insp Exterior Sheathing Insr Gyp Board Insp Appr /Sdwlk Insp Issued y : Ct2QC(2./ Permittee Signature : /, i/-- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day 1 , ". , ._ FOR OFFICE USE ONLY Building Permit A I i �® Received / A , Building Date/By: co P ov _ Permit No.:Date/By: T '' 7 / "ee 1 7Q / City of Tigard JUN 2 4 2 0i Date/ By: App oval DateB Other !^_ _ n Permit N nwwei—ODj/ & 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 CITY OF Tin , . Date/By: _ P No.: Phone: 503 - 639 -4171 Fax: 5011 Di V - .^�jp 1` Post - Review Land Use Date/By: ase o. C N Internet: www.ci.tigard.or.us Contact .1 ® See Pa 2 fo � ,...... 24 - hour Inspection Request: 503 639 - 4175 Name/Method: —( /(a Supplemental Information 11 1 TYPE OF WORK REQUIRED DATA: .'i -rNew construction ❑ Demolition 1 & 2 FAMILY DWELLING ❑ Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate �� 1 & 2- Family dwelling El 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 . $ C.t JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: Job site address: 9.,/d 'S' S// � ,-/ / , Total number of floors ` r 5' i New dwelling area (sq. ft.) I Suite #: Bldg. /Apt. #: Garage/carport area (sq. ft.) Project Name: Covered porch area (sq. ft.) IE Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) REQUIRED DATA: COMMERCIAL - USE CHECKLIST _ Subdivision: _ii , t//5 I Lot #: 1/ Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ❑ PROPERTY OWNER . I ❑ TENANT Type of construction Name: ‘.37,3-11- Occupancy group(s): New: Address: / 9 City/State /Zip: c> /e7Z -�v 7 / NOTICE: All contractors and subcontractors are required to be Phone:S; 3/ - c,5"Qer FaX :S��--7/4-/ licensed with the Oregon Construction Contractors Board under ❑ APPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: S/` jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: - City /State /Zip: Phone: I Fax: BUILDING PERMIT FEES* E -mail: Please refer to fee schedule. CONTRACTOR - Business Name: t ,5�� Fees 'due upon application $ Address: City /State /Zip: Amount received $ Phone: I Fax: Date received:_ CCB Lic. #: 7 7 Authorized _�� �,J Notice: This permit application expires if a permit is not obtained within Signature: .// /! // Da e 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i:\Dsts\Petmit Forms\BldgPermitApp.doc 01 /03 • • 4 0 One- and Two - Family Dwelling `, � . ,, 1 / 11. Building Permit Application Checklist Reference no.: City of Tigard City of Tigard Associated permits: g O Electrical 0 Plumbing O Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. f� 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 c original applicable stamp and signature on file or with application. 9 Erosion contuo 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 revi - . JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/00/COM) Electrical Permit Application FOR OFFICE USE ONLY Received Electrical N — Cd / g, Date/By: y: Petmit No.: City of Tigard RECEIVED Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other • Tigard, Oregon 97223 IJUN 24 200 Date/By: Permit No.: - Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use /Iaia Date/By: Case No.: Internet: www.ci.tigard.or.us CITY OF TIG ' a 4 eel 1 Contact Juris.: See Page 2 for 24 -hour Inspection Request: 50 430teli 6 DI � v Name/Method: Supplemental Information. . TYPE OF WORK PLAN REVIEW (Please check all that apply) ..a�ew 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 .e'i & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure Building Multi-Family ❑ Building over three stories ❑ Feeders, 400 amps or more ACCPSSO ❑ Accessory g ❑ y ❑ 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: 6/& �� )/,4 7- 9 v FEE* SCHEDULE Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential - single or multi - family per l dwelling unit. Includes attached garage. Service Included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft or portion thereof 33.40 1 Subdivision � jPel./I/f / �/ 5 Lot #: j/ 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, 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 ❑ PROPERTY ' OWNER TENANT 601 amps to 1000 amps 240.60 2 ���� , a / � Over amps or volts 454.65 2 Name: Reconnect nnect nett only 66.85 2 • Address: (2 7J/ n y Temporary services or feeders - installation, % G v . 9/ alteration, or relocation: City /State /Zip: p 200 amps or less 66.85 1 Phone:53/ e j E c5 Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 ❑APPLICANT 0 CONTACT PERSON . Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: 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: 6 // Signal circuit(s) or a limited energy panel, ��e Description: or extension Page 2 2 Business Name: �5 � //�-� Description: Address: 7.3,0 ,54lJr9..PA /,c/ ClCity/ State/Zip: Each additional inspection over the allowable in any of the above: ty p: /l/_ s,33 2 a 2 / /.3J Per inspection per hour (min. I hour) 62.50 Phone:yZ -_,Z.CC:::› Fax: Investigation fee: v Other: CCB Lic. #: / / rte/ • Lic. #: , ��G Electrical Permit Fees* Supervising electrician , r� ' Subtotal $ signature required: / / l' Plan Review (25% of Permit Fee) $ Print Name;�j"V/ /4 I Lic. #: 3Z, State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized c) Notice: This permit application expires if a permit is not obtained within Signature: /i /� / Dat 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 • Ake 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: • Audio and Stereo Systems ❑ Burglar Alarm El Garage Door Opener ❑ Heating, Ventilation and Air Conditioning System Vacuum Systems ri Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation HVAC Instrumentation ❑ Intercom and Paging Systems Ej Landscape Irrigation Control Medical E] Nurse Calls ❑ Outdoor Landscape Lighting ▪ Protective Signaling Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms 1E1cPermitAppPg2.doc 01/03 Mechanical FOR OFFICE USE ONLY nical Permit Application Received Mechanical 1, , (� � Date/By: Permit No.: 1`( ham (O � ri City of Tigard RECEIVED Planning Approval Date/By: Build Date/By: Permit No.: 13125 SW Hall Blvd. 4 , Plan Review Other Tigard, Oregon 97223 JUN 2 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use ��r�o.'dl/ il' Date/By: Case No.: Internet: www.ci.tigard.or.us IGAR '�' gry pF'f lSl r_ e !' I Contact Case ® See Page 2 for 24 -hour Inspection Request: g "" Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST . .0'Fiew 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 & 2- Family dwelling ❑ Comrnercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 Job site address: 9 j , � ))Z J 4S ...5 Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue/vent (for any of above) 10.00 SubdivisiOn —. 4l '''',VIE—.1 Lot #: /17 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 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner /flue/vent 10.00 ) 21OPERTY OWNER I ❑ TENANT Other: 10.00 Name: J�-- Environmental Exhaust & Ventilation l / ^ � l Range hood/ot kitchen equipment 10.00 Address: /�:x' 5 Clothes dryer exhaust 10.00 City /State /Zip: / p 9 29y Single duct exhaust • Phont .�/ -d Fax: (bathrooms, toilet compartments, 0 APPLICANT ❑ CONTACT PERSON utility rooms) 6.80 Name: Attic/crawl space fans 10.00 Other: 10.00 Address: Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: Gas heat pump ** E -mail: Wall/suspended/unit heater ** CONTRACTOR Water heater ** f Business Name: , s/GZE :e!/ / Fireplace •* Address: Range ** City /State /Zip: / 9 7 Z C Clothes dryer (gas) ** Phone 253 -77 ' ; I Fax: Other: ** CCB Lic. #: i-i/27 / Total: v !`'' Mechanical Permit Fees* Authorized / Subtotal: $ Signature: - Dat _�� ezn 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\MecPerrnitApp.doc 01/03 , pechanical Permit Application - City of Tigard Page l.- Supplemental Information Commercial Fee Schedule: . Total Valuation: ` •.. - . Permit Fee: r _ ' • $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, 50Ik 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: . iADsts\Permit Forms\MecPermitAppPg2.doc 01/03 . limluing r fixtures . Plumbin Permit Application FOR OFFICE USE ONLY #+ AU FOR Plumbing 1V EU Date/By: Permit -eel No.: nwevy 1 i City of Tigard CE Planning Approval Date/By: Sewer Permit No.: i ty g �� s 13125 SW Hall Blvd. 04 Plan Review Other Tigard, Oregon 97223 ,�\3 2, 4 20 DatelBy. Permit No.: ' Phone: 503- 639 -4171 Fax: 03 -598 -1960 Post Land Use D / /nr tl ^ \ AA Date/B Case No.: Internet: www.ci.tigard.or.us �u pF T ►G r „ 6 I II ■ I Contact Juris.: ® See Page 2 for ISI 24 - hour Inspection Request: S 9 ." -- Name/Method: Supplemental Information. TYPE OF WORK . FEE* SCHEDULE (for special information, use checklist) New construction ❑ Demolition Description • . I Qty. I Fee(ea.) 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings - ' CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) 3& 2- Family dwelling _ ❑ Commercial/Industrial SFR (1) bath 249.20 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: 4 J > ,. dg ),j 4F .5' r S Site Utilities Suite #: B l. /Apt. #: Catch basin/area drain • 16.60 Project Name: Drywell/leach line/trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 • Rain drain connector 16.60 • Sanitary sewer (no. linear ft.) Page 2 Subdivision ,e &s.eaP /�.. 5 Lot #:. // _ Storm sewer (no. linear ft.) Page 2 Water service (no linear ft.) Page 2 Tax map/parcel #: • .' DESCRIPTION OF WORK Fixture or Item /' Absorption valve 16.60 1/40eeJ Backflow preventer Page 2 • Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 �6 j:1-PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 ���� / Name: Y �/ �2 Expansion tank 16.60 Address: / " 9/./s"-_9 Fixture/sewer cap 16.60 City /State /Zip: /,'� 9y Floor disposal sink/hub 16.60 Garbage ge dispsposal 16.60 Phonei / I Fax: Hose bib 16.60 ❑ APPLICANT . ❑ CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City/State/Zip: Primer 16.60 Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 - - CONTRACTOR Urinal 16.60 Business Name: , _ ?c/ l fz_� ,e4 Water closet 16.60 // Water heater 16.60 Address: Z-� � , Ci Other: City /State /Zip:/dLD,y ° J � j��� a Other: _ Phone; / -3 Fax: Plumbing Permit Fees* : Pl umb. Lic. Subtotal $ CCB Lic. # .�� 2.. �SyT> �� Minimum Permit Fee $72.50 $ Authorized Backflow Minimum Fee $36.25 � Signature: , ✓ -''. P ate: , 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 Plumbing Permit Application - City of Tigard ' Page, 1- Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1" 100' 55.00 0 to 2-000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specialty 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 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" -4 " Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic 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 SELBY PLUMBING INC. 2373 NW 185TH HILLSBORO, OR 97124 Plumbing Signature Form Permit #: MST2004 -00191 Date Issued: 7/28/2004 Parcel: 1 S135CD -14000 Site Address: 09610 SW PIHAS ST Subdivision: GREENBURG PINES Block: Lot: 011 Jurisdiction: TIG Zoning: R -4.5 Remarks: New SF detached 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: VISTA NORTHWEST INC SELBY PLUMBING INC. PO BOX 91459 2373 NW 185TH PORTLAND, OR 97291 HILLSBORO, OR 97124 Phone #: 503 - 531 -0505 Phone #: 503 - 730 -3437 Reg #: LIC 150252 PLM 34 -397PB AN INK SIGNATURE IS REQUIRED ON THIS FORM XC Signature of Au orized Plumber If you have any questions, please call 503.718.2433. 07/29/2004 13:30 5036425815 ROSS ELECTRIC INC PAGE 01 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ROSS ELECTRIC INC 2870 SW 221ST AVE #203 HILLSBORO, OR 97123 Electrical Signature Form Permit #: MST2004 -00191 Date Issued: - 7/28/2004 Parcel: 1 S135CD -14000 Site Address: 09610 SW PIHAS ST Subdivision: GREENBURG PINES Block: Lot: 011 Jurisdiction: TIG Zoning: R-4.5 Remarks: New SF detached 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: VISTA NORTHWEST INC ROSS ELECTRIC INC PO BOX 91459 2870 SW 221ST AVE #203 PORTLAND, OR 97291 HILLSBORO, OR 97123 Phone #: 503 - 531-0505 Phone #: 503- 642 -2800 Reg #: LIC 157891 FILE 34 -436C SUP 4232S AN INK SIGNATURE IS REQUIRED ON THIS FORM X ?/t/1-3 Signature of Supervising Electrician If you have any questions, please call 503.7181433. //4s oreYf - at, 'cc • r • ► • ► - • ► STREET T REE CERTIFIcATION • R • . • . • A . • . • I, /���f2 /. S����r/ .�/ , „owner / for 5 ,-��- �- /P/ • • (PLEASE PRINT) 9 S. (PERMIT HOLDER) ► • • >, s/ ► • • Do hereby - i h � t ,e` f®l�li , g location \ � V . ► • • meets Cis.. -�.o gardf Wash onCounty C. � ; . o P • land use and development standards for street tree installation. � �� OFD ,0 0\ s ■ • ■ • ADDRESS: 2 .� J /a J� ?_1 J7 ■ • ■ • - ■ • LOT: /7 SUBDIVISION: f: " -/ r' - • • • • i • • BY: . /�. DATE: 79/ • • • j A • RECEIVED BY: / • DATE: / de • • AVVVVVVVVVVVVVVV VVVVVVVVVVVV•VV VVVVVVVVVVVVVVVVVVVVVVVVVVVV7• CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST cVU 1 / V INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Request d — AM PM BUP Location t2 l� Suite MEC Contact Person Ph ( ) 12 " 2-6 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 Framing Insulation Drywall Nailing - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final iI 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 mal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ASS PART FAIL SITE ❑ Please call fo reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA '' 11 Approach/Sidewalk Date / V d Inspector - ■• - - Ext Other: Final DO NOT REMOVE this inspection reco d fro • he Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST , °v INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received c� Date Requested /c - — 3 AM PM BUP Location / t / /) Suite MEC Contact Person . Ph ( )77D — 6 233 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain L 6.d X /v ELR Crawl Drain ` 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 PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: �d PART FAIL 4 ' HANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service • Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date f /( P2 Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 - Hour BUILDING Inspection Li : (503) 639 -4175 MST q r d q1 INSPECTION DIVISION - Business Lin . (503) 639 -4171 �/ BUP Received Date Requested /-- / AM PM BUP Location 9 60 / f . Suite MEC Contact Person .atg�'► ( ) � a O a 3 q 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 ()SAf a O 1 0 AI F/ N 4-L Framing Insulation Lli Drywall Nailing Firewall Thi, Sv L, — n Fire Sprinkler G �� Fire Alarm A " i� f Lc w - �C / � S t - Susp'd Ceiling �� / - m /+ Roof Z 11P /IQ P e-L� J O �y Lr3001 eT Other: Nier cm g Pt, '1 10. I I. oy PASS PART 2 PLUMBING ' "ii cff i / C_S o 1' „� Post & Beam t f , _ / /� 0 i S Lo T P , „ „ n Under Slab � --�Y� Water -�-b C SI �q�r J ©# b Water Service .n G L Sanitary Sewer Rain Drains Catch Basin / Manhole LT:Po � 00 -. - -So o c_t%) Storm Drain / Shower Pan M. r-LH--#4--A 1 — c t , U (.-s J C /- i. P Other: Final PASS PART FAIL .�� % �� jiiiD 1 _ MECHANICAL Post & Beam Rough -In - , - — Gas Line Smoke Dampers - - ! - �� ' • - L 4th' AU • (z PART FAIL E RICAL V Service Rough -In UG/Slab Low Voltage Fire Alarm Final Ei Reinspection fee of $ required before ne a ' pection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE D Please call for reinspection RE: / _ El Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date ic O ` ' Inspector ffilialk Ext Other: Final DO NOT REMOVE this inspection record fr . the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour • BUILDING 0 Inspection Line: (503) 639 -4175 MSToo- ao ( � INSPECTION DIVISION Business Line: (503) 639 -4171 ' ' BUP Received Date Requested / — 1 AM PM BUP Location (,' / l) f - Suite MEC Contact Person e.■//ti-L.6 Ph ( ) 5 D 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 ■- - •G�� Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: y PART FAIL BING Post & Beam Under Slab Water Rough-In 1 Service Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole / - As 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: El Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date / Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL