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Permit c` C ITY OF TIGARD MASTER PERMIT A PERMIT #: MST2004 -00099 '°}�I� DEVELOPMENT SERVICE D ISSUED: 4/21/04 11,L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 • SITE ADDRESS: 14179 SW WALNUT LN PARCEL: 2S104BC -BW006 SUBDIVISION: BAILEY WOODS ZONING: R -7 BLOCK: LOT: 006 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: BVH2550L STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,121 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,429 sf GARAGE: 640 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5 VALUE: 252,168.00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,550 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: 0 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 W00DSTOVES: 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: EAADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: . SIGN/OUT UN 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: 801 +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: $ 7,336.10 BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES This permit is subject to the regulations contained in the 6932 SW MACADAM STE C 6932 SW MACADAM HOMES al other r applicable Code, State work k w Specialty 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 Ins F 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 lnsp Water Line Insp Plumb Final • Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical lnsp Shear Wall lnsp Insulation Insp Appr /Sdwlk lnsp (- I',, Is ued By : ! : %_!� �_ b. _ I/ ,A' , /4.2..: Permittee Signature r Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b i . iness day • Build ing Per ion FOR OFFICE: USE: ONLY F Received Building N r Date/B : /�ii � � Permit No.: 5 il0 - -- "A0 4 09 '° ' City of Tigard Planning Ap. •val Other City ll L4 2004 Date/B Permit No.: �.! �/1� "i 13125 SW Hall Blvd. MAR Plan Review Other Tigard, Oregon 97223 Date/B :MA V - /S - o Permit No.: Phone: 503 -639 -4171 FG1TY0E5 - §3 ! 1 - ...'�' ii ∎I. Post -R view's ©d pa La Noe >�LD Use www.ci.tigard.oBLING DIVISI • N J. Contact See Page 2 for 24 - hour Inspection Request: 503 - 639 - 4175 Name/Meth. • i • _ Su .. lemental Information 0 ' TYPE OF WORK - - ' • _ .-,. ,• -: -. • . �,... , ® New constriction El Demolition - 1 & 2 FAMILY DWELI.IIYG,. • • •• ', ;, : ❑ 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 ❑ 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 $ : No. of baths: JOB SITE INFORMATION and LOCATION No. of bedrooms / OCATION Total number of Boors Job site address: W 7qktf !�a! /f New dwelling area (sq. ft.).... .. Suite #: I Bld /Apt. #: Garage/carport area (sq. ft.) ... R Project Name: [a /OW Covered porch area (sq. ft.) Cross street/Directions to ob site: Deck area (sq. ft.) Other structure area (sq. ft.) I. • ' ' , -•- REQUIRED DATA:. ._ • ' - COMMERCIAL =USE CHECKLIST •. ±;;' • • . Subdivision: I Lot #: r0 . . . 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 { ❑ 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 to be licensed in the Business Name: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: El iabeth Moore from licensing, the following reason applies: Address: City/State /Zip: Phone: I Fax: - .• - . - . _ • E -mail: 3B - . UILDING PER •. FEES*.-?... : .. • • • CONTRACTOR Please refer to fee selzedule. r 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: Ll• _ Date: Notice: This after it has been p permit Is not obtained within as complete. •Fee methodology set by TA-County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forts \BldgPermitApp.doc 01/03 • One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City ofTigard City of Tigard Associated permits: 0 Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other Phone: (503) 639 -4171 Fax: (503) 598 -1960 111E FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e 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 0 plan O 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 —1-3 size and location. 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. II: RISDI('fION:V, SPF:(IFICS 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. ++04614 t&VOICOMu 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 r s, �n- Electrical Per�ebt �Y ion Received El 4 20 Oate/B : Per No • rt /r — ooh 9 9 City of Tigard MAR Planning Approval Sign Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other —' Tigard, Oregon 97223 CITY OF TIGAR Davy Phone: 503 639 - 4171 F IO Post-Review Pan e �UASD1{4�A� Land Use Internet: www.ci.tigard.or.us DateJBy: , Case No.: Contact Juris.: I ®See 2 for Page 24 -hour Inspection Request: 503 639 - 4175 Name/Method: SaLrple Page [n[brmatiao. •'• -•• •. :. ;TYPE ;OF WORK ' •.. ..;.• • . . ...... :; ...�,, : lP,[:Jt;KR>gVIEW (Y1eoa� Tt�i8l�a7t;'tbat:�i�: `.: • ... New construction - Demolition ID Service over 225 a mps- 0 Health -we facility ❑ Addition/alteration/repact;me e nt Other: commercial ❑ Hazardous location :L ...- ... " 'C.ATE60RY laceme S pCEIC}L. - ••. ❑ Service over 320 amps rating of ID Building over 10.000 square feet. 1 & 2 family dwellings tbur or more residential units in & 2-Family dwelling 0 Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three Feeders, 4 00 Accessory Building amps or more o Multi- Fam ily ree stories ❑ Master Builder 0 Occupant load over 99 persons ❑ Manufactured structures or RV park _ Other: ❑ Egress/lighting plan ❑ Other: _ .' '. To1EtstrE INFO ATTtc�Ntet[ LOC'/ 1101 `. Submit _ sets of plans with any of the above. Job site address: ( �}u ( ,���k -r- The above are not applicable to temporaryeonstnsctlon service. Suite #: $ldg. /Apt. #: '•; �.• .. , .. :..;.• 'FBE'! .� ::xr; : -:.,...i...:•; ;• °:-•(:;_c-,z;^•:,...• . •:••-;:: Number of Inspections per permit allowed _ .Project Name: Description - Qty Fee (ea.) Total 1 Cross street/Directions to job site: New resideotbtt tingle or mah4hmily per dweUitlg watt. belittles attached garage. Service Waded: 1000 sq. R. or less 145.15 4 Each additional 500 6-q. R or portion thereof 33,40 1 Subdivision: Lot #: tnaited energy, residential 75.00 2 Limited energy. non residential 75.00 2 Tax map/parcel #: Each manufactured home or modular dwelling • • DE KOF'WO ; • . • •• service and/or feeder 90.90 2 _kl '1 II J r Services or feeders - installation, e. '' Gong -7 u G1161 - S140/ C Mini /y alteration or renocatbn: De *a Gh e d x,71 den cam-- 200.030r has 80.30 2 201 amps to 400 amps 106.85 2 �/ 401 amps to 600 amps - ' 160.60 2 ril4tOPJERTY• OWNER • : '•'1; " 'fE ' 601 senor tot 000 one 240.60 2 Name: 1tu en a_ 1/I S (2U.. Reco 1000 amrd or votes a 66 . 85 2 Reo mteet only 66 s6- 2 Address: Tern Temporary GC CiG/�7 � � L Pq ry services nr feeders - installation. City /State /Zi • : par +(0 0 a— 'j 1 -/9 alteration, 00 ms le relocation: amps or leas 66 .85 I Phon -. • if 3- "' Fax • • 3 201 amps to 400 amps 100.30 . , 2 In : C ii R • 1. ae a 4011°600=r 133.75 2 ! �_�`T N Branch circuits • new, 'Herndon. or Name: S4 i/Q, / • SS extension per panel: Address: A. Feo 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: service or feeder foe, first branch circuit 46.83 2 Fax: Each additional branch circuit 6.65 2 • E -mail: Misc.(Service or feeder not included): ' •:" " +; ... 'rRA roes •• ., _ � . Each prang or ir r i g at i on c 5 3.40 .. Job No: -- Each s or outline lhihtina • 53.40 2 2 Signal circuit(,) or a limited energy panel, Business Name: A 053 alteration, or extension _ Page 2 2 Q a7o 50 �A , #' a43 Deseripden: Address: 11 , . City /State/Zip: f'rt it S ‘,01-6 , DR q7a 23 Each additional inspection over the allowable In an of the above: Per into lion per hour (min. 1 hour) 62.50 Phone :51.3 (0 a/Z 2500 Fax: 5,3 & z_b S' Investi fee CCB Lic. #: 16 - 7891 Lic. #: 3 3&e. . cm. Supervising electrici • i LIetE>etl�I Pi3imlr3' .:: ,: ::: :ik: X si a Permit S _ _ Pla Review (25 % of Permit Fee) S Print Name: ' g OSS IMCW 2 State Surcharge (8% of Permit Fee) S Authorized TOTAL PERMIT FEE S , Notice: This permit application expires If a permit is not obtained within Signature: Date: — 180 days alter it has been accepted as complete. *Fee methodology set by Tri- County Building industry Service Board. (Please print name) -- 1 :\Dsha \Permit Fnrn \ElePermjtApp.doc 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 t • Mechanical Permit Applicat on Received Mechanical Dittos . - Permit Me,. H•grxz • -a Planning Approval B lama 1 3 1 S of Tigard w �'� C G D Da _ Plan Review Na.: 13125 SW Hall s T � C • ther Tigard, Oregon 9 DA' PrtrnitNo.: Phone: 503-639-4171 244-5M4960 _ Post- Review Land Use s • Date/B : Coat Nu! Internet: www.ci.tigar 1D 6 — �, 40 Comsat kris.: See Page 24 -how Inspection Request: 503-639-4175 - Namelbtethed: Se. • . eai latbrmadon• • CITY NG 1 V • r , .,•, �lU1L E OFW r, ?e •, . 4,1, :', :.•. a :'•r•: ',,,:_Co. _ .. i .. • gEBB1212101011091V. ` •,'t If New Construction ■ Demolition Mechanical petnuc toes• arc based on the total value of the work 12 I• t, t•„ E aar W • : r f • t • Other: Performed. Indicate the value (rounded to the nearest dollar) of all ;., . mechanical materials, equipment, labor. overhead and profit Li; 1 & 2- Fatnil dwell ! III• tML value•. S See Page 2 for Fee Schedule till Accessory Building MI Multi Faztil Dscripdon Qtr Fee(ea.) Total lr Master Builder Other: 13eadeiyCoorarl • : SITE Df1FORD►IA •ION and LOCATION •" •:: • Furnace • add-on air cottdi i .,, i, • *• 14.00 u -Job site address: Iir'"'Th 1a 1. _ � w 14.00 Suite #: B1d4./Ayt. #: _ Duct work r 1•00 — Hydroaic hot water system 14.00 II Project Name: R•esidendal boiler Cross street/Directions to job site: (ibr radiator or h s�ce� 14.00 Unit heaters (fuel, not electric) (in wall, induct, sumsended. etc.) 14.00 _ Flue/vent for an of above 10.00 Lot #: Re units 12.15 Subdivision: I - Fuel A , • Banco Tax • - • • el #: Water heater 10.00 ''•DESCSHVON *F• •RK ' •+ • ' . 10.00 - NEW CONSTRUCTION —SI ' GL - F • I Iffin== 10.00 10.00 DETACHED RESIDENCE Waod/Pelletstove 10.00 Wood 6tep ace/insert 10.00 Ili • Chitral /liner /flue /vent, 10.00 •ra.q: ; Other. 10.00 • : ' PEI a - , I , . ...' �' _ AZ7X'a • Eaviroames ial exhaust& VeatlleGoa J. la _ .. ; 's - . .1. • • „ - - Range hood/other kitahee equipment 10.00 Address: 67 _ SW Mae -: = S . - C Clothes dryer exhaust 10.00 Ci /State /Zi • : Portland OR _• 7 21 9 Single duct exhaust Phone • _ • ... • Fax: ► • _ • • (bathrooms, toilet compattm nts, I. •'' LICALP4t •. . 2 c7 y:/'r _',, ...- utili rooms • 6.80 Attidcrawl�aee fans 10.00 Na»af3: David Golobay Other; 10.00 ' Address: •,t�,AO first q, 5100 cacti additional) Ci /State/Zi • : Furnace, etc. 1 • • Phone: Fax: Gas heat u,,,,,• •• E -mail: Wallis : • euded/unit heater •• :,:.'.:• ness Name: Co CT . ' • I.: . H n� Bus Address:2428 SE 105 A.ve. age - BSQ •• Ci /State/Zi•:Portland, OR 97216 Clotttesdryersg!) •• FaX:503- 5 - • b T. Ot her: • Phone: 503- 253 -7789 • Total; CCB Lic. #: 48131 M - • - Penult epees° Authortaed` • u • total: Signature: 1 ��+ � Datel_SW2RID4 Minimum Permit Fee S72.50 David Goioba y - ;i z% ofPermit Fee) 5 S (Please print nacre) TOTAL r . set Notice: This permit application expires V a permit is not obtained within **Site lo f Trt- CoutuC y 1 i� tadustry Service Board. 180 daps after it has been aeeeptad as complete. inistsT rmit Pam kMeePent irApp .doe 0UO3 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. i:18updingWermit FommsiMecPermitAppPg2 09- 01 -03.doc 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY • BUENNA VISTA QI002/003 l PIu>Dnbing Permit Applittu. .iced • R Ing p�O ' 00 Date/BY: Permit Na. Pls:ming App' Sewer City of Tigard Date lay: Permit No.; 13125 SW Hall Blvd. MAR A2004 Plan Review Other ' Tigard, Oregon 97223 Date/Bv: Permit No.: Phone: 503 639 - 4171 Fax: 303 - 598 1960CITY, ', • o Past•Raview [end Ute se New: Internet: www.ci.tigard.or.us BUIL r . ;), J, .N ca mas ty D JB : luris; See Page 2 for • 24 -hour Inspection Request: 503. 639.4175 - - -- Name/Method: I 9upplomeoW tnihrmatioe. • •'.v *F. 1 1_4: r'!•' • : :o.•; , ,-^ _ -_ -TEIVSCEnto.taxitoripeeritinfiaithilatrilei ,F'•7 New construction IN Demolition Dose don Qty. P es• Total KM Additior/alteratio •tacernent RN Other, ...'. "'' �. 1,., . ; ,- ft; l `Ilidio . :. ;' • w; s : k r •: Mt 1:-.N: 7 I3I' .1- S 1, 7 1 & 2-Family dwelling Cornmercial/indusLrial FR(1)bat 350.00 _ Y SFR (2) bath 350.00 FM Accessory Building Multi - 1 atniy SFR (3) bath 399.00 [r Master Builder 8 Other: Each additional bath/kitchen 41.00 • .: •.YQBSi[1; lA'tlQlVoind�bOC.A4'!E'IOK Fireprinklcr - art• ft.: P , e 2 Job site address: ) F.U>l q 17 ? (, LiQu s_ __ ' •• :• • • • >, StUtl fauttes: 4,„•4 s> - • . •_.. . Suite #: I Bids./Aot. #: Catch basin/arm drain 16.60 Project Name: Dtywell leach lineftretuh drain 16.60 Footing drain (an. linear ft.) Pace 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 SL1bdiviSion: Lot #: Storm sewer (no. linear ft.) - Page 1 Tax map/parcel #: Water service (no, linear ft) r em . . Page ' . , D1rsCR iom WORK • • Absorption valve 16.60.` NF, ,CONSTRU - SINGLE FAMILY , Racldlowpreventer Paget FAMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 T711 = T ' O • t . L SI ' AEPIT 'eotors/aurn - 16.60 Name: Buena Vista Custom Homes Expansion tank 16.60 Address: 6 9 32 SW Mace Flxturereewer CO I 16.60 Floor City /State/Zip: Portland. OR 9721 9 Garbs e d i sp oarsirtkJhub 16.60 Garbs dis sal 16.64 Phone: 503.443 -6033 FOX: 5030443-2443 Hose bib _ 16.60 Uti �IPPL.ICAPIT . . '. CONTA•1 4N • • Ice maker 16.60 _ N Ray Mullen Interceptor /grease Dap _ 1660 Address: Medical gam • value: S Page 2 16.60 City /State/Zip: R R ,000fm aln (eommerew) 16.60 Phone: I Fax: Sink/basin/lavatory 16.60 E-mail: 'Tub /ehower/shower Part • 16.60 EO1�F1RAChOR • . `� •. Urinal 16.60 Water closet 16.60 Business Name: ED Mullen plultli.ng _ Water heater 16.60 Address: 24 47 0 SW Rainbow Lane Other: City /State/Zip: Hi ],saber [lg 971 7 7 Other. . Phone: 0 -628 -1 . F ax: , _ . : - _ . . • :Pltttabiet>cl(!u : total S • , ., Subtotal S , CCB Lic. #: . 2 A a 9 Plumb Lic. #: _ • . 0 O. _ Minimum Permit Fee 57250 S Authorized . i / Residential Back low Mistlmun) FeL536.25 Signature: ✓ A ' Plan Revio* th6 of Permit Fee) S Ray ul en Stste�harge (8% of Permit Fee) S (Please print name) TOTAL. PERMIT VILE 5 Negev This permit ■pplladon expires Ira permit is not obtained within • All now commercial r ilbss regales S sets of phas with isemetrie or 180 days after Is has been accepted ss Complete. m plan •Fee methodology set by Tri- County Widths Industry Service board. IADOS\Pesmit PormotmPermttApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information 4 • 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 S1 15.00 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 $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to S10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Future Ot Itetai` ' , " • Qty ' Fee(ea) < ;;Total; additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 510,001.00 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 S1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or 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 *. • Quantityby (Fixtitre).WorkPerformed. Comments regarding fixture work: Fixture Type: r Raptue ^ : d - - . - '. • .. . . _. • , New } "Moved &ta int :Gipped. 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 *Note: If the fixture work under this permit results in an Garbage - Domestic P 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 MachiRefrig. 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 A 67 - cr6 1 ■•••••■•••••••••••••••••••••••••••••••••••••AAAAAAAAAAAAA. . • • • • ■ - • ■ STREET TREE CERTIFICATION . . • . • . • • , , . • , , . • , ----- i /e„.... I, \114 Ne e ,,Ownerl for gee_ e 1 ,_ /--.4_ • (PLEASE PRINT) Utt . • . (PERMIT OLDER) II • \ 1% " • ' • i . • • • • / I : ''--i-r- 1 4 • Do herebytdictiff> illia,ahifollOwing location ■ • i'tif L'''-.)P6:,\,-; i i ■ • meets ■ • • ■ • land use and development standards for street tree installation. ■ • ■ • • ■ • ■ ■ • ADDRESS: /W 7q tiAirtcit.f z, /V . • . • . • . • , , . - • LOT: SUBDIVISION: . • . • . , • DATE: g — 0 y . • • / • • • 1 RECEIVED BY: j /.: ,r111 DATE: ' - / 9 - 0 4-- • • • • IVVVVVVVVVVV•••••••••••••••••••••••••••••••••••••••••••••••11k CITY OF TIGARD - 24 -Hour • BUILDING Inspection Line: (503) 639 -4175 MST � POO ?' INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested — AM PM BUP Location / � ] � � � Q- [�.�'�(1.1� Suite MEC Contact Person odiA c ./> Ph ( ) 1p Z ' Z 'C v 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 Ina Sheath/Shear Framing L.DW "a A — k - S o y\C . Insulation • Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS P RT FAIL UM B Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Ot er: • ' 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 l ap Air CD PART FAIL D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Inspector N t�-� 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 �► DD — O°a99 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested -/r AM PM BUP Location - _ LI/ _ / Suite MEC Contact Person Ph ( ) 7/6- ,/t S" 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 ht F amingth/Shear ar i eSz-c_ � i y -- k v 6cJVT -- ■ l t 46 Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: er vPASS 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 in 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: Unable to inspect — no access Fire Supply Line Q l c ADA Date o – < U — 4 4" -- Approach/Sidewalk Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGA R D • 24 -Hour • BUILDING Inspection One: (503) 639-4175 MST s�ppG(— 4564:55 4564:55 INSPECTION DIVISION Business Line: (503) 639 -4171 q BUP Received Date Requested Z 1 l AM PM BUP Location / Suite MEC Contact Person 9/14Qt2 s Ph ( ) 7/6 — DG R / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC 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: • RT FAIL 77-7 BING 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 S^► Dampers /!� ART FAIL EL . CTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final 0 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 D Approach/Sidewalk Date C -1 if - d " Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL