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Permit ` A t MASTER / CITY OF TIGARD PERMIT #: MST2004 -00098 _1F�I�� DEVELOPMENT d SERVICES 639-4171 DATE ISSUED: 4/16/04 13125 SITE ADDRESS: 14191 SW WALNUT LN PARCEL: 2S104BC -BW005 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 005 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: PH2755R STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,226 at BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,529 sf GARAGE: 668 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 DIM: sf RIGHT: 5 VALUE: 271 780.40 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,755 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 < SHP: VENT FANS: 4 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 FO PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 800 amp: 401 - 800 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 801 - 1000 amp: 601 +amps - 1000x. MINOR LABEL: 1000+ amp/volt : PLAN REVIEW SECTION . Reconnect only: RES UNITS: SVC /FDR> =225 A.: > 800 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 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: $ 7,419.65 BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES This permit is subject to the regulations contained in the 6932 SW MACADAM AVE STE C 6932 SW MACADAM HOMES Tigard Municipal Code, State Specialty Codes and all other r applicable PORTLAND, OR 97219 PORTLAND, OR 97219 pable laws. All work will will by d done i 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 0: 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 Gyp Board Insp Appr /Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final Issued By : Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne t busines day • Building Permit Application FOR OFFICE USE ONLY RECEI ,:� Received Building ` `( J _ Date/B : ', �' i Permit No.: POT %i se:66 g Cit of Ti and PlanningAp•rova Other `, y g Date/By: Permit No.: 1 t'2r 4/ - t 77 13125 SW Hall Blvd. MAR 2. 4 2004 , Plan Review Other Tigard, Oregon 97223 Date/By:f4AV � ` -0°/ Permit No.: Phone: 503 -639 -4171 Fax: 5 � �'� ' .-� I , ' Post - Review Land Use YCrAR► I1 Internet: www.ci.tigard.or.us _' -' Date/By: Case No. 24 -hour Inspection Request: 75 ection Re uest: 5113- 1 VI N Name/ Su See Page l for e/ Method: / La. _ Supplemental Information TYPE OF WORK • - • - •... '.::. ��.:. REQUIRED, DATA:-.:. �' :..-.. . .._. . , • � El New construction Demolition • • - " - - - _ I &2 FAMILYDWELLING,.. - . -_" : :_' - . , • Ell Addition /alteration/replacement E Other: CATEGORY OF CONSTRUCTION '. Note: Permit fees' are based on the total value of the work performed. Indicate ©1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family El Master Builder ❑ Other: Valuation S JOB SITE INFO ON and,LOCA ON No. of bedrooms: No. of baths: Job site address: / g// ft , ,w tug LO Total number of flo rs ,V Suite #: Bldg./ pt. #: New dwelling area (sq. ft.)...0.7,5 Garage/carport area (sq. ft. Project Name: It) j D Covered porch area (sq. ft.) It Cross street/Directions /. 1 job site: Deck area (sq. tt.) Other structure area (sq. ft.) AF -•-.. ' . ' ",- REQUIRED :. ' - COMMERCIAL -USE CHECKLIST :..*;-II Subdivision: I Lot #: -" 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 ® PROPERTY OWNER . { 0 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 ❑ APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required tb 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: I Fax: - .. • E - mail: • . • PI 'BUILDING.PERIITF E E S* - .. • - - CONTRACTOR ease retei to fee ' - - . ' • 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 I Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized _ Signature: 3 4 T a, _ ( Date: Notice: This permit application expires if a permit is not obtained within J 180 days alter 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.: A permits: CiryojTigard City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Electrical 0 Plumbing 0 Mechanical Phone: (503) 639 -4171 0 Other: Fax: (503) 598 -1960 ' 1111.: FI.ho %IN(: FLF ;%lS ARE REQUIRED FOR PLAN REVIEW \es No \/A I 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 O plan 0 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. I I 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. ,I1:RISDICI IONAI. 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 -w14 tdoo/CO.t 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical PermiREOEfihrfr@ Received Eleettital oatciBy: Pant, (o.: 1117:0960 I)a -1C O D City of Tigard MAR '4 4 2004 Planning Approval Sign 13125 SW Hall Blvd. Permit No.: Tigard, Oregon 97223 Date/By Review Permit No.: ITY OF TIGAR Phone: 503- 639 -4171 Fax; Posl•Revicw Land Use IVI Date/By. Case No.: Internet: www.ci.tigard.or.us Contact Juria.: I ® See Page 2 for 24 -hour Inspection Request: 503 Name/Method: l Soulemeatal Information. j YPE - OF CORK •' : P, LNCPFR)3VIEW(Pleaaiebetk t11';tltatsiowy N ew construction Demolition `w 0 Service over 225 amps- 0 Heal h-care facility ❑ Addition/alteration/replacement Other: commercial 0 Hazardous location n ❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet. C,ATEGCJXYOF'CO SRUCTION. 1 & 2 family dwellings fur or more residential units in & 2- Family dwelling El Commercial/Industrial ❑ s over 600 volts nominal ono swcture Accessory Building — Multi- Family 0 Building over three stories CI Feeders, 400 amps or more ❑ Occupant load over 99 persons 0 Manulhetured strictures or RV path ❑ Master Builder Other: ❑ Egress/1ighting plan ❑ Other TOI�SITIIr INFORMAff N ailil'I;QCAf'IOI4 Submit _ sets of plans with any of the above. Job Site address: �((q ( tWlF.t.5uf N The above are not applicable to temporary construction services 'FEE' et :: ;x r : ' •:. i `.::1' 5 : ;, +;," • Suite #: Bldg. /Apt. #: =•• < Number of inspections per permit allowed Pr oject Name: Description Qty Fee (ea.) rot.t 1 Cross street/Directions to job site: New residential-single or maft4fantily per dwelling unit. Includes attached garage. Service laeleded: 1000 sq. It or less 145.15 4 _ Each additional 500 sq. It or portion thereof 33.40 1 Subdivision: , Lot # L ied energy, rtral 7500 - 2 Limited non es ited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling •• `DE N OFW©RK . • • • service and/or fader 90.90 2 ServIvea or feeders - tnstaaadon, Gorr s c t;� S I49I e-- Rfi, l & alteraton or reloeaton: -M i✓h e d b- d ent: --- 200 am.. or leas 80.30 201 amps to 400 amps 106.85 2 401 amps to 600 amps _ 160.60 2 OPERTY OWNER ... , 88 FE • . • .. . '601 am so pe to 1000 sops 240.60 2 Name: ttr u e a- ' • i , f II , i' • ----- Over 1000 �� amps or volts a 66.85 2 66.85 2 Address: . q 5'g... !j i.e ach'ddo , ' r, 61- Temporary services or feeders - installation. City /state /Zi.: 7Or +(0 0a- gig/9 alteration, 200 amps or l le relocation: / "I le relocation: 66 85 1 Phon =. • 3- -•'i Fax a 3 201 snips to 400 amps 100.30 ' 2 401 to 600 am 133.75 2 NI C . ��� /� err 1 % :� s N. Branch circuits • new, alteration, or • Name: 1/Q. / -55 extension per panel: Address: A. Fco 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 pu chase of Phone: service or feeder foe, first bnuteh circuit 46.85 2 F ax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): '; - , :• ERA • _ .. • . . Each pump or Irrigation circle 53.40 2 Each sipl or oudbm lighting 53.40' 2 Job No: Signal circuit(a) or a limited energy panel, Business Name: O alteration, or extension Page 2 2 Address: �3 ?O 5k) etas fi Description: City /State/Zip: I s S , r-e• , oft 4/17123 Bach additional inspection over the allowable in any of the above: Per inspection per hour (min. 1 hour) 62.50 Phone :,43 to 2$00 Fax: 5* o . IS' Investigation fee: CCB Lic. #: / IBEEKLY.73e. other: Supervising electrici. - "�;' '';� •is : "':'. • X signature - • uired• � a Subtotal a Plan Review (25% of Permit Fee) s Print Name: I OSS Lic. #: 2 State Stmha*Ae (8% of Permit Fee) [s TOTAL PERMIT FEE ff S Authorized Notice: This permit application expires If a permit is not obtained within Signature: Date: — 180 days after It has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. (Please print name) - (:\DstalPermit Fnr s\ElcPertnitApp.doc 01/03 03/ 04/ 2004 16:26 503 tlECEIVED SUN GLOW INC • PAGE 02 Mechanical Permit Alliblidajlon 1 OR OF F I( h I , ,i i_INI_ Rec eives . Datailii : - Egall 2 M 7-00dif City of Tigard CITY OF TIGA - a Planning Approval WIIIIIMIII. Da ■ ; • 13125 SW Hall Blvd. BUILDING DIVI*, 4 Pion Review Tigard, Deegan 9722.3 Phone: 503-639-4171 Fa:c 503-598-1960 ._, „ Post- - ea. Internet: vAvw.ci_tiga -41 rd.or.us Ai: i Datellii : Fkris.: RIIIIIIII.11 Contact C See Pagel tar 24 Inspection Request: 503 - - - - - -- Nametbtethod: Sn • • easement Infbrreadon. . • . •• • : '... :r : r•';. 4 E OF WORK.. ri._le .R... • 4.. ..'•.: '..',•0:41CONDSitRICIA.T...1,11E6.SCIONDLILK3.1SIRCEDICICIZStr• :•.-,:k. If New construction • Demolition Methanioal permit fees* are based on the total value of the work 11 11 Mdition/siteration/ .lacement • Other. perforated. Indicate the value (rounded to the nearest dollar) of all :. -. -"..0a703—_OWEI)_N1=9.1_100010-AUMMENMEN mechanical materials, equipment, labor, overhead lad Profit IL 1 & 2-Famil dwell litlErrilribMtIrill Value: $ See • -, 2 for Fee Schedule IN Accessory Building VI 1 =MM... •..: REsumget... _._,.. , I' , 1 •.: . f. :I N 1 ,scimpum ... Desert .t7 I Fee(nel. 1 Taw Li tviaster Builder El Other: lleatinWCoolian • .. • : 5 1XiORMATION Said LOCATION - •• • ' • .' . - furnace • add-on air condi :Doi i • ** 14.00 1 Job site address: / / 9/ MEM fmnmmill1111011.1111=1 14.00 Suite* • , . Duce work MOO NM= roject Name: . , dronic hot water. P - Residential boiler 14.00 Cross street/Directions to job site: fist radiawr or h . ronie settern (4.00 Unit heaters (fuel, not electric) in wall, in-duct, suspended. de-) 14.00 III Flue/ventifor any of above) 10.00 Subdivision: I Lot #: R . air units 12.15 — mlialt:EMEI: Tax - -steel #: Water heater 10.00 . . • ' • • .. DESCRIFTION Of ' • RIC •.' ' ....i • - • • Gas fireplace _ 10.00 NEW CONSTRUCTION-SI ' GL - r . I Flue vent (Water lumen ti • o) 10.00 DETACHED RESIDENCE Lo:. ii: n r _ - 10.00 Mil= Wood/Pellet stove 10.00 Wood fireplace/insert 10,00 Chimng/linerlflue/vent 10.00 1 PERT1* ' -4 : • "! •- •‘:''..r.: ;_. NJ • r-i ANT".0.44 '.:.,':i."! Other. 10.00 . Eadiroomaleof tabula & Ventilator* Nam Burma Vista_ ... ..u-- Range hood/other kitchen equipment } 10.00 Address; 6932 ta- SW Macau .._ - S - C Clothes dryer exhaust 10.00 Ci /State/Zi . : Portland OR 7 21 9 Single duct exhaust - - Phone • _ • • - . • Fax: 1 _ , . _ . (bathrooms, toilet compattmcnts, gi . ,,M3Turii10•111•11 CONT .... ' ? '‘. I . '• ' utili mono . 6.80 Name: David Goloba IMTMTMETMIOMMMINIO 10.00 ---- Other; 1_ 10.00 Address: Fed kleitiR -- Ci /State/Zi . : " Afi for first 4.51.410 each addidonal Phone. Fax Forum etc. am •• Gas E-mail: wasus. .ded/unit heater 11E11111 Water heater •• Business Name: Sup. GI. ow inc - 11=11111.111.111MMIlalligailMI Address:2 4 2 8 SE 105th Ave . &Inge •• BBQ •• Ir CiVState/Zip:Port land , OR 9721 6 clothes thyer (*A •• - - Phone: 503-253-7789 Fax603-253- " .; Other: sli Total: li CCB Lic. #: 48131 . Mesbardesi era* Fees* Authorized--_-..... I e-. . % . . ti • total: S Signature: 4--&-.- '-1- 1/4=&' Date4123:0 Minimum Permit Fee 372.50 S David Golob y OIRIGMTEMZOi . - - s rate u - a;e (8% of Permit Pao) 5 (Please print narne) TOTAL PERMIT FEE $ r:Ditto: This permit application expires Ifs permit is not obtained within • pee methodology set by Tet-Ceunty Building tallowy Scrvies Soard. 180 der; after it eras been accepted is complete. **Site ptaa required for etterior WC unit!. inntiVermit Farms\ MeaPermilApp.doe 01.103 . , Mechanical Permit Application - City of Tigard , Page 2 - Supplemental Information Commercial Fee Schedule: . e $ TOTAL VALUATION: PERMIT FEE: $1.00 to $2,000.00 Minimum fee $72.50 . 12,001.00 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 S100,000.00 $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 $100.00 or fraction thereof. • All New Commercial Buildings require 2 sets of plans. • 1:18uIIdingWermit Forrns MecPertnItAppPg2 09-01 -03.doc 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY ' BUENNA VISTA 1 002/003 Plumbing Permit Application Received P I Ins - � o � • City of Tigard Plannin Approval Sewer 13125 SW Hall Blvd. REce -V: D Dale/@y: Plan Review Permit No.: Other Tigard, Oregon 97223 DawBv: Penxlt No.: Phone: 503- 639 -4171 Fax: 503- 598 -19MAR ' , . Post-Rrview • Use Da : Cue No.: Internet www.ci.tigard.or.us .14:41 ,tact June.: See Page 2 for 24 -hour Inspection Request: 503.639•47 Name /Mlitiod; _ 9uooloutaam na Into OF TIGAmD BUILDING DIVISION , •- TYQBOF. ':°., r'r .• r PEE ISItorepeefariaiobniitibi s'" stMit In New construction Demolition Desert sloe Qty. P es, Total • Addititm/alteration/r tace Other : , ;�; "I*;' to • aaeebTo'''' j x %�'%ii :1,.:. :,CIy11P.GORI 47$ C•atei!�''',at 'l . L i : . - • 1 'llf: •�CO: ' o ...de "'• ' /' " ' ' SFR 1 bath 249.20 • i 7 1 & 2- Family dwelling Q Commercial/Industrial SFR (2) bath 330.00 Pi Accessory Building Multi -Fa pit ry _ SFR (31 bath , 399.00 • Master Builder 8 Other: Each additional bath/kitchen 45.00 4OB SITE INFORMATION ild TION 1 Fire sprinkler - t o. ft.: Peke 2 • Job site addre yL�/l feu) � ... •••• ' %+ Stttsl lt3BtteS ' - •:i:...'. ; , .•� :a �;�..',sai�l+l: Suite #: I BidgIAut. #: - Catch basin/arca drain 16.60 Proiect Name: Drywall/leach line/ten h 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 $anItary sewer (no. linear ft.) Page 2 A Su- division: I Lot #: _ • Storm sewer (no• linear ft.) Pip 2 • Tax map,/parcel #: Water service no, linear & r Item .. p • 8 2 . + ozscar ifor of WORK • • Absotpdoe valve 16.60. NNti, ,CONSTRUCT ION - S INGLE FAMILY Baddlowprcventcr _ Paoe2 FAMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Prinking fountain 16.60 • It.PERTT'O1!(NER ' :; g7 • a :. Kr4T :.... - Biectorthutno 16.60 Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 69 32 SW tiaca$am _Axe ' s+ c Fixtureilewer ea • 16.60 Ci /StatelZi : Portland OR 9721 9 Floor dreiratloor sink /hub 16.60 Garbs dis sal 16.60 Phone: 503-443-6033 Fax:5030443 -2443 Hose bib 16.60 IS APPLICANT • . • •.'. 0 cezer,¢ "J1 4N ' ' • lee maker 16.60 Name: Ray Mullen Interceptor/grease tine 16.60 r Address: Medical ae • value: S Pa e 2 Primer 16.60 City / State/Zip: - 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 Water closet 16.60 Business Name: ED Mullen Plumbing Water heater 16.60 Address: 24470 SW Rainbow Lame Other: City /State/Zip: Hi jberp n8 Q 71 73 Other: . 1 Phone :50 - - 628 -1 P ax : fi '32 543 -628.4.fi3_3_ �" - •' •'- ' �Piatab cml Subtotal ~ S ^ CCB Lic. #: t 9014 Plumb. Lic. #: _ - • . • = •• - Minimum Permit Fee S7230 S - Authorized ' / ...-42 / Residential Backflow Minimun Fet 6.25 Signature: -LA( A L �i Plan Review (2556 of Petrnit■ S Ray ul en State i harne (89'6 of Permit Fee) S (Please print name) TOTAL PERMIT FEE S Notices This perton application expires Ira permit is not obtained within • AU naw cemrtserdal bulldlnse require 2 sets of pleas with isometric or 180 days atter it hat bees tempted ss complete- riser diagram (Or plate raviewr- -Fee methodotepy set by IA-County Bonding industry Service Beard. iADSIS \Permit PedmePlmPermltApo.dec 01103 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 - 1 100' 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' 55.00 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 55,000.00 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 Fee ea ~ Totat : additional $100.00 or fraction thereof, to and Fixture Of Item - - • • ; • Qty. " ( ) r 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 5100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and S 1.20 for Subtotal: 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 *. . "' Qtiantlty (Fb:tirre)WorkPerfolizied: Comments regarding fixture work: Fixture Type: • . • - . New . Moved 'Etla_ng ;: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 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 ADsts\Permit Forms\PlmPermitAppPg2.doc 01/03 ,v/S T a°23 `-1-6 - 0 c' g • • • a- • ► I EET T EE CE TIFICATION T R R S R ► r , . • I J4 tL 5 , �Owner/� ent for 51A- C 4A- / s 1,4 ■ • (PLEASE PRINT) (PERMIT HOLDER) • � ► • r /-, l • • • Do hereb. .c ° y t t e` fol'lowir{g location ■ • meets��r< f��Ti /W ■ • land use and development standards for street tree installation. ■ • ■ • / ■ ■ • ADDRESS: / C qi S C.,/ C./A L IV t ► ■ • • LOT: ,� SUBDIVISION: /34 Li 0 0 k• t ► • • BY: , . w y_ DATE: t ■ 1 • 1/ ► ■ • RECEI D BY: ,w/A DATE: 8-j - 4 4_ ■ / YVYVVVVVVYYYVVVYYYVYYY••••••••••••••••••••••••••••••••••••■ CITY OF TIGARD 24 -Hour BUILDING Inspection Llne: (503) 639 -4175 MST oR0 - 0007? INSPECTION DIVISION Business Line: (503) 639 - 4171 c / BUP Received Date Requested o � p AM PM BUP Location ) 1/' / 'a__ 2/ ja t Suite MEC Contact Person ) Ph ( ) 7/D ^ gll 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 r2� -.i r W C –�c:� -- �+a�.r S \/, 10`r Insulation Drywall Nailing — Firewall . „ Fire Sprinkler .� Fire Alarm Susp'd Ceiling Roof Other: PART FAIL ' I 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 RT FAIL 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 Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date ? — /C' O *- 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 4RdO 400q' INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested AM PM BUP Location l / ? ( 1A)C0../Mi Suite MEC Contact Person Ph ( ) c' ( iZ — li ZOO PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing APAI Foundation Access: ELC / Ftg Drain ELR 'PA Crawl Drain Slab Inspection Notes: SIT 17" Post & Beam ��J'/ 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 C Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Othe PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PA RT FAIL CTRI L Service Rough -In UG/Slab Low Voltage Fire Alarm �L'v fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • - PART FAIL - sr Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA Date � Inspector �`��� Ext Other: Final DO NOT REMOVE this Inspection recd from the job site. PASS PART FAIL