Permit CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00441
�I�; DE VELOPMENT SERVICES DATE ISSUED: 9/30/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
•
SITE ADDRESS: 13825 SW SANDRIDGE DR PARCEL: 2S105DD -07500
SUBDIVISION: COSTIUC- MLP2001 -00005 ZONING: R -
BLOCK: LOT: 002 JURISDICTION: TIG
REMARKS: New SF detached, Path 1
BUILDING
REISSUE: DRH2587B STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,454 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,133 sf GARAGE: 775 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 TNIe, sf RIGHT: 5
VALUE: 261
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2.587 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: 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 FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 - 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 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL - ENCOMP - BOILER: HVAC: LANDSCAPE/1RRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 8,063.56
D R HORTON INC D.R. HORTON INC This permit is subject to the regulations contained in the
4386 SW MACADAM AVE #102 4386 SW MACADAM AVE. Til other Municipal Code, State work w Speco Codes and
a
PORTLAND, OR 97201 SUITE #102 all other applicable laws. All woo rk will be done i
PORTLAND, OR 97239 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: 503 222 - 4151 Phone: 503 222 - 4151 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952- 001 -0080. You
Rea #: LIC 130859 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insf Rain drain Insp 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 Insp Plumb Final
Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Issued By : A. ,1./. i. . 4_0_... Permittee Signature : ill
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
f 7'1 5- ?`7 -G3 ,AAV
., D FOR OFFICE USE ONLY
Buildi C ermlt 1��1A Received p Building �/
Date /By: O - . Q �_ Permit -No : , rilrget 3
City of Tigard "AUG 1 5 2003 Planning Approval Other .r
Permi q
Datening YNo.:o �U��00 �ID�/
13',125 SW Hall Blvd. Plan Revie q Other
Tigard, Oregon 97223 CITY OF TIGA' '� Date /By: ` /- /0- 03 Permit No.:
/ /w.i�I ,� Land Use
Post - Review `, ' A OD:
Phone: 503 -639 -4171 Fax: 5 1�L�1�1� ®jVl - 1 ' Pe 1 Date/By: Case No. M " !° �' _
Internet: www.ci.tigard:or.us Coritact 7 ' " : (8:1 See Pagel for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Cp- Supplemental Information
•
l " r rw1 =r .t_- , `11170,E OF 0170CR a `x M l ' .t41 l 'f# � ERE Q DATAIN.,4 - s ` - + `�
New construction ❑ Demolition . � y� .. = g 41 & , 2 FAMIT R4 ' ?
• Addition/alteration/replacement ❑ Other: -
.,, 4- : wM , hCATE�G„ORY,`QF CONSTR LCTION ' f e N ote: 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, !�3"
overhead and profit,for the work indicated on this' application.
Accessory Building ❑ Multi- Family
El 1 vac: 5:-P $
Master Builder ❑ Other: Valuation
,.� t f s� - No of bedrooms: 4 No of baths _.- S.
a „30B SITE =IlV'I+ORMATION,and�,I,O`CIO1V� T number of floors Job site address: , /,58.25 b� - ;41. 'Da f: b2 num m
New dwelling area (sq. ft.) 72V1
Suite #: I Bldg. /Apt. #: - Garage/carport area (sq.- ft.), •
Pro Name :, "go h 'i5'f` _ - Covered porch,'area:(sq: ft.)-
Cross street/Directions to job site: Deck area (s ft.) Z.3 7
Other structure area (sq. ft :) _ •
• ` ,t g E' ` iyiiii D '. 4 -Vt ' '
aT cL a.— )11., - e a, ,� U ® 1 RC S ' C $ EC KLT3T � � t ` ' -
Subdivision:
Lot #: 7% 14
Tax map / #: Note: Permit fees* are based on the total - value,of the work performed. ndicate
_ °.�C;T tit a,= QFORK'; ; - - „�•_� .4r a.� , .1, :; g the• value (rounded to the nearest dollar) of. all equipment, materi • , a. or,,
F., ,nDESCRIPTIOIY:. ••;,.
overhead and profit for the work indicated on,this applic .. .
put 4v Valuation - "5
Existing building area (sq. ft.
New ; building area (sq.
,__ , : �� of,con tbries • ' ' . D
. .,
Number
PRUFERTY OVKNERw, t„ .r „TENANZ" , , � / ;,o .; y.= P Type . . ction
� R R Y'�fyi 1 h(/ �f a /'t !�f Occup • • group(s): t
Name: Exising
Address: !� SliU y��G h� /hK` '(6a"
City /State /Zip: , f r 7Ifnd D/e g72I
Phone 03 ; '// 1_•7 3 - -,3? /? NOTICE: All contractors and subcontractors are required to be ,
licensed with Oregon' Constructiorr Contractors Board Cider
1 , El APE$CA 001.4 4 i4 1Fax;
,CO NTACT QERSOiNN - provisions'of ORS, 701 and be required to be licensed the
,Business Name: •� • /f ' I /4( - 1 /) V -fgh, / jurisdiction:where'work'is being performe If the applicant is exempt
Contact Name: N.l •
I 0 lei f H from licensing, the following reason applies:
Address: y?�(o .314) y aeale/v,a /We h6p—
City /State /Zip: 9,Kekid i Pl4 47N/
Phone: 03 222 -y/ri l I Fax: V3 '4Z- 37/7 a ; • � _ �°
z r -`'``" ' t , BUIL`" l* iri FEES* d y �� i
_E ^ , 1 Y�_ "° 7Ple4.FIF .. t o4,fee schedule z ' i
'v . f.r y a A,GONaT'RACTOR,.rk: X:<::P / � ..3.,<.�
Business Name: p• • /011)-7 /JJ e - /vY Fees due upon application $-
Address: / 'k Se f!I * A*/ - '/07' -• -
City /State/Zlp: /0 p ,0 Amount received S
Phone: 3 - y »y - q/6' Fax: 03 - 2x»'-31 17 Date received:
CCB Lic. #: /01
Authorized Q / � Notice: This'permit'application expires if a permit is not obtained within
Signature: - Date: pI� V 480 days after it has been as complete.
IV/ '"IG HAW- *Fee methodology set by Tri- County Building Industry Service Board.
(Please.print name)
'ii \Dsts\Permit Forms \B IdgP,,errnitApp.doc 01/03.
•
92/29/2993 16:15 5936422899 ROSS ELECTRIC PAGE 91
02/20/2003 16:10 50REC DR HORTON PDX CONST PAGE 02
Electrical Permit A 'c '' Bleetticot FOR OFFICE USr: ONLY
IJb e+�} R eceives 1-f 3- '00f41/
�] 1 ( ga}c/Bv Patnit No.:' /
City of Tigard
Planning Approval Sigel
Conte/By: permit No.:
13125 SW Hall Blvd CITY OF TIGAR % Plan Review other
Tigard. Oregon 97223 BUILDING DIVI - 0 Datolsy: PermltNo.:
Phone: 503- 639 -4171 Fax: 503598 -1960 Pont Land use
rntemet www.ci.ty arrLor.us "`' , b3,7 •t I '�" . Date/1 JunI.: .:
r :ti Co1101et Juris.: ® See Para 2 for
24-hour I218pectioa Request: 503 - 639175 J 1VameJMerhod: Supplemental Information.
I
"0 ;51 ;• l' ri:!Cltir.J::t:: t ��•, , ,a(�",• 1[ Pet II Ii :
" u u:p i • �. 1 �� �._ . •� ? ?•..,.., :,;•
. �.; . r. - a, - i'; �')D� 0 ' . � � ' ��� . �n.c "�1�ti { 1 iJc I , J., I.� I�a,� I n'' iF ! farrJ��B � tear _ i�+�l � ' e ��I .�,'�t.' �,
•I New construction II Demolition 8etviee over= amps- 1 Nealth -care facility
commercial C Hazardous loation
IN Addition/alttxation/r • .laoement U Other: C service over 320 amps- rating of ❑ 'Building over 10.000 squano feet,
?11u11d^,'9jr 'ia4... `151i1TE c'P" .:'O 0 ,r0 '7L;"• `'S ;i e:7 t P. t & 2 family dwelling four or more residential units in
1174 & 2 -Fat oil dwell' - Ill Coramercial/Indu .striai 00 System over 600 volts nominal one Stater=
ACt:C954 $IJ Jld3n 111 Multi- Falnil Building over three stales 0 Feeders, 400 amps or more
Occupant load over 9) persons C Menufle wed struetures or RV park
• Master Builder • Other: [� Egress/IIght ng plan ❑ Other
(fillhilr,""; ., •Ja :.!5 • , e 1 o • u. 1:1 ai 1Y.cindlL o 0010tc':' =• ;?:;'•.!;„' 1:1 Submit sets of plans with any of the above.
The above aro not applicable to tempos COnstractlott service.
Job site address: - / 3 Si 2 w a-rra se ', a �, , ;,. , r,,� �, l ��;� , �.•.
b Si�J�I'rJ , ; 1�;( n„ 1G) I; i... �( 11 .i:�.��:':.�+t!i>ii]+��E��Q�'D� � 3'' f1�4nra�! rc."'�'1�i1h"�iEzrk;rllgn
• Suite #: _ I BldgJApt. #: Number of inspectioas Per permit allowed
Pro 'cot Name: :' 1 i A Description go I Rao WO , Total 1
Cross street/Directions to job site: New resIdanteti sf egle or multi- femrir per
1 dwelling mit. Naiades attached garage.
Service include&
1000 sq. R. er less 145.15 4
Each Additional 500 tg. R or portion thereof 3340 l
Subdivision: Mill 6, ofer I Lot #: v l itnl ed t � .s, 7s.00 2
limited horn teaidOptial i 75,00 2
Tax map/parcel #: .. Book lnawfachued home or nodular dwelling
'.r;' 7 hMVREi;9�,��ieDBP• E , I '•.VVORSCi,rt ^i; '11 ` «YINii serviceanrUortheder 90.90 • 2
Services or feeders • Intonation,
alteration or relocation:
ii Rr l r4El- / 290 emyr. er 1e a 80.30 2
201 inn to 400 amps 106.85 2
401 mope in 600 aunp4 J 60.60 - 2
r „W`.R79'P" :b t: • lettnili ` 'Il : a / dl�'::S k'- ,1, 6 =PI to1000emys 2 , 2
sore: 1 It 114 I / Al over 1000 amps conies 454.65 2
. Reconneetest 66.85 2
”
Address: •r , //, , e / 7. Wit, 4!0 Temporary servicesor - installation
% M alteration, or relocation:
/ j� 200 amps or lets 6615 ' 1
hone: I:F 201 amps to 400 snips _ 100.30 : - 2
R. 133.75 2
11 'Rilr ?•`• ?` i :Ilgti r > i.. :itC re07.11�x /W. .r!PRR.S 0 .111,140:44 . : •, 401 to 690ampe
q Breach
circuits - new, alteration, or
Name: k I e „g exeeosionper panel:
' e ` i Z ; I /I 1 / ' • ' iii #' G7-" a service or feeder foe oe with branch circuit 6.65 2
• Ci /Statc/Zi • : j /.4(, L . / / / 7D B. Fee for branch circuits without purchase of
service or Rader the, first branch circuit 46.85 2
Phone: '9 g - 7 1 Each addttiooel brand circuit 6 G5 2
• E -mail: Miso .(Scrvfecm feeder not included):
d' �� 'I. JI " 1 • a i " ` ; ; nl> L e.TO! { "' " •" l,. K l' B'' Eath pum12 °r ifrlaation circle _ _. 53.40 2
rl r. l c t' �• 1 : ' C`l. ., ?• '
4 "fF i u Rte.. .( Bash sign or outline liglrtinrs 53.40 2
Job No: signal eircuil(a) or a limited energy panel,
Business Name: /QQ 0./a71,7'4.- _ alter+ut; or extension Page 2 , 2
Description:
Address: -2 3Zr/ 0 3 w 0 rei, lee. C,N _
City /State /.zip: Hi 115 fo0 r 0 /2 Each additional in bon over the alio+reble in ant of the above: _
)Sr ie+speetl0lt pet hoot (min. l how) 62,50
Phone : 4Y 2 - 2-Elc cJ Fax: 5'03 - C.YL -SW 5 _inveselgaaoo fm
CCB Lie. #: IL fS g al Lic. #: 3 -y e, C- Dmen
l s4N,7.„ �;tm��� Jfr1!; i.6: niii!�E IthrEi'4,' " f11I {1u�;.i
rati:0 a:ltiMii*
Supervising eleetrieitita Subtotal S
si tare re aired: Pins Review (25% of Permit Fee) S
Print Name: Stet/ -( . 205S • Lic. #: 'P. 3 a_ 3 Sure Surcharge (8% of Permit Fee) 1
TOTAL PERMIT FEE $
Authorized Notice: This permit application explrve if a permit it not obtained within
Signature: Date:- J 180 days after it hes been accepted as complete.
/ /Il
�j1 j l r 'Fee methodology set by Tri- Couetty Building Industry Service Board.
(Please pprintname)
�fe /,
i;\Dstt\Permit Porms \E1cPcmetApp.d.or 01/03
FEB -20 -2003 16:15 5036422800 974 P.02
92/21/2993 96:53 503-644-5989 CRAFTWORK PLUMBING PAGE 92
02/20/2083 16:08 503-222-2675
-. ..... -. DR HORTON PDX CONST PAGE 02
13uilding Fixtures n)
FOR OFFICE 13SE ()MN
Plumbing Permit Received Plumbing _,.
Datail3 ... P 11 r o .
"lining Aporovol smer
City of Tigard MIS i 5 2 k3 Date/By: pt No.: ,
13 1 25 SW Hall Blvd. Plan Revicto Othe.-
Tigord, Oregon 97223 ' Dow/By. • Permit No.!
Post-Review ' Land Use
Phone: 503-639-4171 Fax: 503-59800 OF i ■11°., •
Internet: www.citigartior.us Bl)111301 i i I Contact Ault: See Page (Of
24-ho tn Inspection Itequesc 503-639-4175 ' --- ' .'"- --- i NemcAlethed: supplemental Intormation.
*. r• : . ; '..:.7;illitirrtiii r ii !Olt;e.n!lt..473iVE-c- ',IVO:AK:1141.Si i3O10.1. 2s11:;40..caU, r, if, :, t zolterxas ray '.:MFM
C2 New construction ii Demolition Desert • tion Qty. Fee(ea.) Total
• Addition/alteratiOn/replacement • Other: 1.011:1WITIaget.-40VERO OlDit...;
'.0001fhlivrifilaitiaiiikeaCig lioat.''.
f:' :clisgic,"vitr.,MOR.41 P ' •OINSTI:k .CATON r.t1;:;•,F,' c''..,i1, SFR (1) bath 249.20
g 1 & 2-Famil dwellin: 0 Commercial/Industrial sflt (2) bath 350.00
• Acoes s • Buildin: 0 Multa-Farnily SFR (3) bath 399.00 •
• Master Builder • Other: Each additional batb/icitehen 45.00
1.i.:•v.!:',;17'st02.TtrOlg,UQ:,1.-CCIE1VIAITIorllit't1; 4-90111[Cia'.i-iff.:11C'i,d'.'. Fire s • rtrilder - c.. ft.: Pa: e 2
Job site address: / 38.„2,5 $ c5i9.ALD 4 14, ; e'' ",'7% 11 MITEEMEMEEZEMEREM
Suite #: 1 BilitiApt.#: . . Catch basin/arra drain 16.60
Drywc11/1eaoh line/trench drain 16.60
Pro'eot Name: (ti C/recyr FOoting drain (no. linear ft.) Page 2
Cross strect/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain com3ector 16.60
. Sanitary sewer (no. linear ft.) Pagc 2
Subdivision: agaMirjrailii Lot #...- Storm sewer (no. linear ft) Page 2
Water ServiCe no, linear ft. . Page 2
Tax map/parcel #: .
gagEgt,',3:,,, qg
!in ., o -, fair,i;NVORECi.Ae3:zi,k;:xi,2:, Absairjun wave . 1 6 60
- • Baokflow preventer . ' Pa . 2
l.* --' Backwater valve 16.60
11111111111NENINION1111/111111/ 1 Ckthes shrr 16.60
wa
Dishwasher 16.60
, , • Drinking fountain • 16-60
ETi17-21,10,:glEMOIllittr..jfiNE2MEMI Ejectors/sump 16,60
ame: p. : - of 44 ' n ONTrra.i411111111 • Expansion tunic . 16.60
Address: ,,..; :., Ai 4, , , , 4 f, I, ,‘ v d e?--- Flxturelsewer cap 16.60
Ci /Stat- Zi .: . 'Pre . ;,,4 % A ,f. / go/ Floor drandfloor sink/huh 16.60
Garba:. dla.nsal 16.60
Phone:93 .., g--: - Hose bib 16.60
'A r:2 ....: ' LI ".. a ,_ Cl) !is el -ii;'.'5.0 C 1 '.'. ' ' I • 21' ONttlAigi ice maker 16.60
arne: k AP it ofil :41 Interegtorkease nap 16.60
Address: . 1 2 . 1 / b 4 .4 ii 4/, Medical gas - value: S Page 2
Prima 16.60
drain (commercial) 16.60
Phon • • .
IgNirIBMIIIIII Sink/basin/1v: • 16.60 • E-mail: Tubishowerishower. ao 16.60
0 :,: )14:Ii.lIt!!, Urinal II 16.60 III
- • Water closet 16.60
Business Name: ' te, / , • ! ,, / e Lt .4,.. water heater 16.60
Address: 77 S ifiar
Other. _
Ci /StateiZis: - / , f/ 0 ' q X» Other: ,
Phone: (4-M9 Fax: yy-s
CCB Lie. #: ef&& G Plumb. Lic.#:.20-fqrelf Subtotal S
Minimum Permit Fee S72.50 S .
Authorized , Residential Eackflow Minimum Fee 336.21
Signature A ,..... Date:MD R
3 Plan Review (25% yin-mit Fee) 3
+et P, 1/, Ad State Surcharge (8% of Permit Fee) S
• (ple print vane) TOTAL PERMIT FEE, S
Notice: Ms pariah application explret it a permit is not obtained withio All new commercial building§ require 2 sots of pleas with isometric or
ISO days after It has beta accepted as complete riser alarm for pain review.
. A tee metbadolor set by Trl-County Building Industry Service Board.
i:NDstacemit FormArimPermitApp.doe 01/03
• .
FEB-21-2003 06:49 503 644 5999 96% P.02
• Mechanical Permit Application FOR OFFICE USE ONLY
Dace Mechanical 3 _
Date/By: Permit No.: I` T 5iy/
City of Tigard RECEIVED Planning Approval
Date/By: Build Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 AUG 15 2003 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
ii� i t4' , DateB Case No.:
Internet: www.ci.tigard.or.us OF TIGAR r_a L1 ,- `lI � Contact Juris.: ® See Page 2 for
f ^2^ J
24 -hour Inspection Request: atC� • Name/Method: Supplemental Information.
' TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST - ...
L__I 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 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
0 Accessory Building El Multi- Family • RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
El Master Builder ❑ Other: Heating/Cooling
. JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: /?j$ AS AL ,4-,..).t.41 - D Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: QQ /�'f(, /ire' r" Hydronic hot water system 14.00
T �/ 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: Faun(' units 12.15
,f ( �/r�C✓ I Lot #: {' ?/ 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
()A/1(W ; Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
PROPERTY OWNER I ❑ TENANT Other: 10.00
El' ame:
//^ - �01 K A Environmental Exhaust & Ventilation
. � i1--in � I' ( l�li? Range hood/other kitchen equipment 10
Address: N 6 44 ,Gtm /t ' - ft ? . -
Clothes dryer exhaust 10.00
City /State /Zip: MVP/ , 6g / ( Single duct exhaust .
Phone: 5b3 cim Fax: ,O? - "2J-2,7/ 7 (bathrooms, toilet compartments,
❑ APPLICANT ilitCONTACT PERSON utility rooms) 6.80
Name: fi k0 1f/ filth-14 Attic /crawl space fans 10.00
�� ,/ �}yp Other: 10.00
Address: 1434 5141 /Ma'am ' +R�D� • Fuel Piping -
City /State /Zip: PM' apt #(, 4L lin / * *($5.40 for first 4, $1.00 each additional)
Phone: - yJ uy/ Fax: 673 -) as —3"J l 7 Furnace, etc. **
7 Gas heat pump
E -mail: Wall/suspended/unit heater **
• CONTRACTOR Water heater ••
Business
Fireplace 4.* N / � y ,, / ,, � 11 j � � T p
c l��� r5 4) 0/./17 �q� Range **
Address: BsQ ••
City /State /Zip:AIMX i. p g- 470p7 W 7 Clothes dryer (gas) **
Phone9, - (�� —,3 0 Fax: Other: **
CCB Lic. #: 0/70 Total:
Mechanical Permit Fees*
Authorized Ir1o' Subtotal: $
Date: S Signature: /� �� Minimum Permit Fee $72.50 $
AO j4 S V, Plan Review Fee (25% of Permit Fee) $
(Please ri name) t 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 -
7457 - a - a 3- �i .
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STREET T REE CE R TIFICATION
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• • I, ��/�"{ rn � ,Owner /Agent f or 17-F-- HMV ■
• (PLEASE PRINT) (PERMIT HOLDER) ►
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• Do hereby certify that 'the following location ■
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• meets City of Tigard /Washington County ■
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• land use and development standards for street tree installation. ■
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• ADDRESS: � 'l/ 2 5 �� • D Itz E DI�I V� ■ •
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• /� P AI LOT: ( O SUBDIVISION: Igo � � •
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BY: 4 DATE: 1121101 ► •
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1 RECEIVED BY: A M1111 DATE: I c ¢- •
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 OP 3 '00<lq,
INSPECTION DIVISION Business Line: (503) 639 -4171
G � BUP
Received ,V Date Re uested "" P-22/6 �� C / AM PM BUP
3
Location / 2 -� ��� Guu d '. Suite 4- MEC
Contact Person . i� -' J _ - /_ - ._.� Ph ( ) $ �� l PLM
Contractor t/,, �',,�nz- 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final
PLU ?? W��'ART 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 — 6PQ
Post & Beam
Rough -In
Gas Line
Sm •Dampers
PART FAIL
LECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1' Z - O Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
— i
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3---die yci
INSPECTION DIVISION - Business Line: (503) 639 -4171
BUP
Received Date Requested ( — AM PM BUP
Location a I,..or Suite MEC
Contact Person f%yyLo Ph ( ) �( -?,340/ 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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
CHANICAL
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 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 ?- 1 4 /1
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location /3 g Suite MEC
Contact Person Ph ( ) 3 —93 C4 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: 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:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab itmai •w Volta•
Fire arm
/S T FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA — / p — O L/ Inspector Ext
Approach/Sidewalk Dat / p
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARC 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 . ._;QQ «q,
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received 7 / 5 FY Date Requested //64)'V AM PM BUP
Location 1,3 S 2-5 Suite MEC
Contact Person OAA .ems Ph ( ) C 9 PLM
Contractor IQ 2 q- Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: 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 ; r
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL !� <c CC S �
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
\ \/ N
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/ ab
ow Volta.
O arm
al 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 / ` 4 U Inspector ! Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL