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Permit v 4, CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00104 4r, r f * A DEVELOPMENT SERVICES DATE ISSUED: 4/30/2004 ' � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14234 SW WALNUT LN PARCEL: 2S104BC -BW011 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 011 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: BVH3212 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,402 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,810 sf GARAGE: 440 of FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD' of RIGHT: 5 VALUE: 308,476 80 OCCUPANCY GRP: R3 BERM: 4 BATH: 3 TOTAL: 3,212 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: / VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 3 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 6 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 FOR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st VV/O SVQFOR: 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 ARENSPC 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/1RRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 8 SYSTEMS: Owner: Contractor TOTAL FEES: $ 7,760.77 This permit is subject to the regulations contained in the BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES 6932 SW MACADAM STE C 6932 SW MACADAM SUITE C Tigard Municipal applicable Code, State All l wo work wil Specialty done in PORTLAND, OR 97219 PORTLAND, OR 97219 and all ra cer applicable ed laws. Al. work permit be done in accordance with approved plans. This permi t will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Rea 0: LIC 152235 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 Plumb Top Out Exterior Sheathing lnsr Storm drain Insp Plumb Final Sewer Inspection Underfloor insulation Electrical Service Gas Line Insp Water Line Insp Building Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service Insp Foundation Insp PLM/Underfloor Framing Insp Insulation Insp Appr /Sdwlk Insp Post/Beam Structural Mechanical lnsp Shear Wall Insp Rain drain lnsp Electrical Final Issued By : L _ ._ ./ /411,,,." Permittee Signature : ' ,,,, d At_ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne : business day 1 • vv $uildina Permits a�ionn , .FOR OFFICE: [SSE: ONLY b Received Building 1. / i 0, 9440 �� (4 't004 DaDate/By: ' �� O , Permit No. :t( — OD �f Clt of Ti and MA R Planning Approval Other `Q y - � � y g Date/By: Permit No.:Oa- 13125 SW Hall Blvd. C1fY OF TIGARD Plan Review if Other Tigard, Oregon 97223 u QI NG, DIVISI'' Date/By: Permit No.: Phone: 503 -639 -4171 Fax: 5398 -1960 ' ` 1 1 I '� Post fl /a9 /'/ Land Use Internet: www.ci.tigard.or.us Date/By: Case No. — 24 -hour Ins ection Request: 503 -639 -4175 Contact tt- 142 ,..k �+x-�/ 1u ' . ® See Page 2 for P q Nam et /ate Supplemental Information TYPE OF WORK - - - - • REQUIRED DATA: 1- ® New construction Demolition .. 1 & 2 FAMMIT.Y DWELLING . '` : ' • El 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 _ Master Builder El Other: valuation $ JOB SITE ORMATION and LOCATION No. of baths: Job site address: Iii c �/ 5k/ N o. o b edrooms: &U / fit L4 Total number of floors New dwelling area (sq. ft.) 3:2:1 Suite #: r Bld . /Apt. #: Garage/carport area (sq. ft.) .. / a Project Name: /r /,J r!q/ Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) .... ... ' . , - DATA:. - - ' . Subdivision: : - COMMERCIAL -USE CHECKLIST m . . 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 1 ❑ TENANT - L .- Type of construction Name: Buena Vista Custom Homes Occupancy group(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: E1 iabeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: I Fax: . . • . .. .. . • E -mail: . • BUII.DING.PERMI T FE E S• _ • te r• ,, .a : `` r • CONTRACTOR - ' : Please i�eter,to feeschedule: 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: L/• _ ` Date: Notice: This permit application expires If a permit is not obtained within / 180 days after It has been accepted as complete. •Fee methodology set by TO-County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03 • 4 116 One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City of Tigard City of Tigard ( Associated permits: Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Electrical 0 Plumbing 0 Mechanical Phone: (503) 639 -4171 0 Other: Fax: (503) 598 -1960 • . • 111E FOLLOWING ITEMS ARE REQI'IRED FOR PLAN REVIEW 1'es No N/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. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks): location of wells/septic systems; utility locations; direction indicator, lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing -member sizes and spacing such as floor beams, headers, joists, sub - floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. JI RISI)I( °1 ION: 1. SPE:(IFI( 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or I I" 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. 1+04611 t6/00/COM11 I 1 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit D Received Electrical ,/ Dare+By: Permit No,: /1 7 - CO / City of Tigard MAR Z 4 n a Approval sign 13125 SW Ha11 Blvd 20 Planning Date/ Permit No.: Plan Review Other Tigard, Oregon 97223 Date/By Permit No.: Phone: 503 - 639 -4171 Fax: 503 -5 TD F TIG RD Post - Review Land use Internet: www.ci.tigard.or.us BUILUI G D Dare/By C ris.: : rn Contact Juria.: I ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. •ITYPE-OF WORK : + ' P,iAN: W (Plesteca a7[:ttiatiiplo ":!" � construction Demolition 0 Service over 225 amps. ❑ Healthcare facility ❑ Addition/alteration/replacement _Other: commercial ❑ Hazardous location . , . .� ❑ Service over 320 amps-rating of ❑ Building over 10.000 square feet, • - •. •CATEGOIBYOF'CONSTRIJCEID1.\i'. 1 & 2 family dwellings ttmr or more residential units in A & 2- Family dwelling J Commercial/Indushial 0 System over 600 volts nominal one structure • Accessory Building Multi- Family El Building over three stories 0 Fe 400 am or more ❑ Occupant load over 99 persons ❑ Manufhetured structures or RV park j] Master Builder _E Other: 0 Egress/lighting plan 0 Other IORSIT>ir iNFORMATION•itfltl LOCIETION" Submit sets of plans with any of the above. Job site address: 1�.. ` L. A , 1 — The above are not applicable to temporary tocatruetion service. Suite #: $ldg. /A t. #: .. • . ai :; _ 5' :;:', -; .: :; • • P Number of inspecttotts per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential-single or mah6Amily per dwelling colt. Includes attached garage. Service lncladed: 1000 sq. R. or less 145.15 4 _ Each additional 500 sq. ft. or portion thereof 33.40 I ' Subdivision: of #: Limited energy, residential 75.00 2 Limited energy. non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DE • r • 1�LOIrV K :... service and/or feeder 90.90 2 . I e ■ Cons s . y Ser it es or feeders - Instailetion, �6! - / C f /l� Aeration or relocation: l _- Ch e L T--(1 el/ CJ2-■ 200 amps or less 80.30 2 -- 201 amps to 400 amps 106.85 2 / 401 amps to 600 amps _ 160.60 2 7 PS R L'Y OWNER •• • ' ..I .TE .. ' 601 amps to 1000 amps 240,60 2 Name: l t en c+- 1 �/ S Gar Ql�_- Recover 1000 amps or vole 454.65 ; 2 ntrect only 66.85 2 Address: °?.. Q(1 dam P, C L Temporary services or feeders • instailadon. - or City /State /Zi. + ( 0 0 � 9 .7 -/ alteration, l e relocation: ; per / 200 imps Or less 66.85 1 Phan • 3 -•'. Fax 72 • 5 201 amps to 400 amps 100.30 2 401 to 600 ernes 133.75 ' 2 C �� 1 s Cr Pri 4N• Branch circuits • new. zlteradon. or Name: t /Q, / •55 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 46.85 2 I F ax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included); ' '.:... • , . . .. ' CON; C R • . - Each pump or irrigation circle 53.40 2 Each sue, or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: 0 alteration, or extension Page 2 2 (!L Description: Address: 8 70 .$1.43 i� �t,l fie �# �C 3 City / State/Zip: H i HS 4,0 1-6 . DR /7/23 p3 Each additional itlapection over the allowable In an of the above: Per insyeetion per hour (min. I hour) 6250 _I Phone :513 40/Z Z$00 i F'ax :5* to Z, ,51S Investigation fee: CCB Lic. #:157891 1 Lic. #: 3 94/34.c. Other . Supervising electnci . f " ^ h � ltcalpebm> elf''';•;r.. , : ,,. .: � Al?...:'":;' .a i .. Subtotal__ S X _signature re. + fired. Plan Review (25% of Permit Fee) $ K Print Name: I OSS Lic. #: 2 State Surcharge (8% of Permit Fee) $ Authorized TOTAL PERMIT FEE S 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 fodoury Service Board. (Please print name) - f:\Dsta \Permit FnnrotElcPermitApp.doe 01/03 \ t 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 • , • • . F�_th m[1( f. 1.N1: r_�N1) Mechanical Permit Ap l ion p a„,� City of Tigard REG V Da Planning Approval RFilaIIIIMIIIIII • - 13125 SW Hall Blvd. '1. 4 004 Flan Review . llgIIIIIIIIIIIIII a , Tigard, Oregon 97213 t" 2 Da ' _ . 03 .598 - 1960 Post• ew Land Use Phone: 503 -639 -4171 Fax: 5 R ,.: -+riS. . Bates : Case Internet: www.ci.tigard.or.us WIF T1(3 - :. 4." TA 1 I Combat tuns.: 24 -hour Inspection Request: 56W�1V ' Name/4tothad: • a ,.., - .r ': 4. EOFWORt<'C•.S9.ar:a.. .;,..f,.::•:',:-.••,•.1.1...., ••f7,L::c0StaiBleC y1PREE:SCHEPIILE- t•-:•9 V New construction III Demolition Mechanical permit fees are based on the total value of the work I• Addition/alteration/ - •iacement • Other: pertbrated• indicate the value (rounded to the nearest dollar) of ail F-y . : t '+ L . +1 �i. _. _ "..: mechanical materials, equipment, labor, overhead and profit ' . •� ^������ � ... value: S See Pap 3 for Fee Schedule L 1 & 2- Family dwe11 • ■_ Commercial/lndusttial - y:, a , air 1 - r •:,a+ I Accessory Build' Multi Famil , a F.. y .:� a >�, � MR uxesso Description _20 r FeKeei Total L/ Master Builder El d am: HeatIWCoottoe • • : SITE 1 • • • .. 'MN and LOCKIION •' -: • ::. • Furnace . add-on air conditioning* 14.0 lob site .. address: 1 ?3 - mkt- u•-•1 Gas heat • 14.00 Suite B14. /Ap t.#i: Duct works ''' kc hot water system 14.00 Project #: Name: Residential boiler Gross street/Directions to job site: (for radiator or lt system) _ 14.00 �, ' Unit heaters (fuel, not electric) (in wall, induct, suspended. ctc.) 14.00 Flue/vent (for any of 4bo ) 10.00 R • air units 12.15 Lot #: Subdivision: _ . . Fuel A . • lances Tax • - feel #; Water heater 10.00 •• DES «; t • [ON + F • • RK .. Gas fireplace 10.00 NEW CO STR • -SI ' GL - 17- I ' Flue ven(water heater /pas tat-plan) 10.00 Lo• lighter (tt�) • t 10.00 DETACHED RESIDENCE Wood/Pellet stove 10.00 Wood • - • lace/insert 10.00 • Chinas /liner/ tie/ Mini 10.00 - NV . , }1:5NAPIrlit' •; :'' ° • �- . .. Other, 10.00 Nana: 1PEIt'�'SC�' •' -�� Environmental Ssbwst&Veudindoa Name: B _ = . ,.: • S • • +I • • „ — — Range hood/other kitchen equipment 1 00.00 Address: 6 7 SW Mac - - - ++ _._ - S - C Clothes dryer exhaust 10.00 Ci /State/Zi•: Portland OR _27 21 9 Slagle duet exhaust Phone • _ . - . • Fax: s - , • - _ • (bathroom, toilet eompattmcnts, I■ „ . '1_13t w s .1 •• utili motto • 6.80 '��] lt_ ;_ pfl. • Ate/crawl muse Eons I 10.00 Naiode: David Goloba_ Other. l 1 to.o0 Address: Pad AMR . ----•- City/State/Zip: - **(55.40 fbr fist 4.51.00 deb addidonal) urn Face, etc. •• Phone: Gas he Lu,• •• Wall/sus • ended/unit heater Business Name: _ t . •• Addct:8s:2 SE 105th Ave. BB* C State/Zi.:Portland, OR 97216 Clothes dryers • all '• Phone :543- 253 -7789 Pax:503- 253 - "3 Osten Total: •• III •CCB Lie. #: 4 5131 Medina • Permit Fees* _ Signa u edT,4 C • Subtotal: S Signatures ,Date►fl Mini ,� Permit Fee 57130 S David Goloba y S (P ease p nartte) TOTA1. r r a Notice: Tb1a permit application empires tr o permit is not obtained within *Fee methodology set b; Trt -COYaa Bolding Industry Service Board. 180 dole after it bas been peeept4d as eadtplete. **Site plan required For esterior A/C gaits", i teCFetmitApp.doc 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. • • 1:1Bu11d1ng1Permit Forms1Mec 09.01 -03.doc • A3/04/2004 16:21 FAX 5036284633_ THE MULLEN COMPANY • BUENNA VISTA la 002/003 ' : 'Plumabing Pe ky 'cation Received FOR t"tiF UT■LI' ., 4 TO Datel : � . . -GO /0 , , City of Tigard VOA Planning Approval Dat sewer dBv: Permit No.: 13125 SW Hall Blvd. F T1GAR° Plan Review Other Tigard, Oregon 97223 Gtr O pNISIOS Date/Bv: • emit No.: Phone: 503- 639 -4111 Pali gir' 1 960 ; _ : Post - Revi ICI. Ute Internet: www.ei.d .0 gard.oes I11.. Date/B care No uric; 14 24 -hour Inspection Request: 503•639•4175 " - _ .. • r :: ., w :. ... , CEO - 1VWVPOrM •F'- •:0. •Y^: _•^ • -' . A.4t Va1rW.VirE•(t0r9peCra1'nf .:ti'T.• New construction Demolition Description I Qtr. I Fait? Tons Addition/alteratio laceuleat Other, • • ' °' d`s x:74 iliWd]fidg's�,• - ;; .Li e, ;,DATE('i0R'Yj�F.. _ . ....s... a '+1 aaec'tiioo - ..tr,:. • ^�'•' �. �• "' ` . 0 " SFR (1) bat 249.20 2 1 & 2- Family dwellinfr 0 CoinmerCiaUlndusUia1 SFR (2) belt: 350.00 Accessory Building 8 Mla<lt1- Pa:riily SFR (3) bath Each additional bath/kitchen 399.00 Master Builder Other bath/kitchen 45.00 .': JOB VIE INF.O T101V LOCM1ON Fire sprinkler - SCI. ft.: P e 2 Job site address: / NA) l•�Aruhs3= ... '•.' ' • • - .=:---• • Suite #: I Bldg./Apt. #: Catch basin/arca drain 16.60 - Project Name: Dtywcll/le aeh line/tranth drain _ 16.60 Footing drain (ae. linen: ft.) Pate 2 Cross street/Directions to job site: Manu&cturedhome utilities 110.00 • Manholes 16.60' Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Parts 2 t division: _ Storm sewer (no. linear ft.) Page 2 T a x map/parcel #: water service (no. linear ft) Page 2 Mort or Item . '. ` •'`', • DrseitirrIO OF WORK • •• Absoor tioo valve _l_____I 16.60 NF ,CONSTRUCTION - SINGLE FAMILY Badcflowprevcnter ] I Page FAMILY DETACHED RESIDENCE Backwater valve 1 1 16.60 Clothes washer 16.60 Dishwasher 16.60 DtinkinR fouatoin 16.60 Sl0'ROP1sRT rOVINER ' Ai, E7 . a'. ANT ,.:.. _ •• . Jjectoraliuns - 16.60 Name: Buena Vista Custom Homes Expansion tank • 16.60 Address: 6 9 3 2 SW LKacdam Ave _ S t:p C Flxturc'eawer ca • 16.60 Ci /State/Z . Portland. OR 9 7 219 Floor drain/floor sink /hub ,, l6,60 tY � � Garbs a dis ose 16.60 Phone: 503 --443 -6033 Fax: 503•443-2443 Hose IN=====MME 1640 ►PPLIEA.NJC . v'.r1cONITXi1ERS4N • Ice maker 16.60 ' _ Name: Ray Mullen lnterceptorlgrease trap 16.60 Medical gam • value: S Page 2 Address: Primer 16.60 Ci /State/rZi : Roof drain (commercial) 16.60 Fax: Sinklbasin/Iavatory 16.60 Phone: E-mail: pan 16.60 • rJo , • • • Urinal - 16.60 •-= Water closet 16.60 Business Name: ED Mulleal} plumbing Waterheatcr 16.60 Address: 24470 SW Rainbow Lane Other: City /State/Zip: Hi berg 9 71 .7 • Other. + Phone: 503- 628 --1 632 F ax: 5 r - - . : -a G _ • - :plutnbiesxiletmk • . • . Subtotal S CCB Lic. #: tt Plumb. Lic. #: - - • • - ' • -' Minimum Permit Fee S7I30 S A orized Residential Backflow Minimum Fee336.25 _ Signature: ✓ ` i '" = - /.._6-2(..„fr Plan Review (25% of Pcnnu Fie) S Ray u l en Air State Surcharge (8% of Permit Fee) ,S _ (Please print name) TOTAL PERMIT FEE S Netlret I bls permit application espltes Ira permit is not obtained within • ' U now co;m er buildings require 2 lets of prase with isometric or 180 days slier it tut been steepled as complete. .Fee mn dole ' set by TACounty Bonding Industry Service Board. i:Wsts \Penrlil FonnissPlmPerm1tApo.doc 01/03 Plumbing Permit Application - City of Tigard , - Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) :Total . Square Footage: Permit Fee: Footing drain - I° 100' 55.00 0 to 2,000 S1 15.00 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 - E309.00 Sewer - each additional 100' 46.40 Water Service - Ist 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 510,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and "' Fixtureof Reif '` : `' - . Qty. •• '•Pee(eay :;Total; including $10,000.00. Commercial Back Flow Prevention Device 46.40 S10,001.00 to $25,000.00 S148.50 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 536.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 S379.50 for the first S25,000.00 and $1.45 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 $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. ` ' ' ` - Quantity. bk(Fixture) WorkPerfoimedti Comments regarding fixture work: Fixture Type: .: _ • :: . • .. . .. - New ;Moved •• lalsd = = CsPDed Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic uner p Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refng. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial • - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: iADsts\Permit For ms\PlmPermitAppPg2.doc 01/03 • 1 or 1 It .® -® Ot STREET TREE C 44 lit• ... A . ® 14 I, 1 4 p , 12,„‘ce//, L/ for V ® (PLEASE PRINT) (PERMIT HOLDER) ® f 1 , ,. . It I Do hereb i`c i ' a v; o P it t i a g lo cation ® i ,t A meets t aaf�T� and W 1 on County ■ ® land use and development standards for street tree installation. Bo- 44 10- 44 ADDRESS: L L i V 14. 44 10- 441 LOT: 1 SUBDIVISION: (9 i (-� 0 44 D v. _ / i __ f _ DATE: ?--- ( ---0/..7Z I* ® RECEIVED BY: f/ �7�1� _�� DATE: Q- /— 04- ® ® VYYYYVVYVYYYYYVYYYYYYYY VYYY YYYYYYYYVVVVVVVVVVVVVVVYVVV®®®® CITY OF TIGARD 24 -Hour 4---.6610q BUILDING Inspection Line: (50$) 639 -4175 MSTa O INSPECTION DIVISION Business Line: (503) 639 -4171 c BUP Received Date Requested O z 4° AM PM BUP Location 4- / Suite MEC Contact Person Ph ( ) eagD_ -7_goa 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 Insulation ( CA N N E f: \ r--Pr k(9) 14 C); f 1667 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 C E \ T tl , Storm Drain • ' F \ Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough - In 4/4 1917 iL Sfb UG/Slab Ionia ; _ A4 gaL. • Fire ar•• PAR Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA / Approach/Sidewalk Date �- b 4 / Inspector � �� / -.J i - , , — d Ext Other: Final DO NOT REMOVE this inspection record from the ob site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST V D ((` Od !D INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested O �a 3 AM PM BUP Location l ( Suite MEC Contact Persons Ph ( - ) 7 /' ��� 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 �1 g � ��, EO► - Framing C.oh .Ur� I w T � ��• 10 /4. 1 —d ivY� ✓oa. ✓ � 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 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 ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date q ?.3 1 04 Inspector QP k'mow )' I fti° -- 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 ° e)D INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 7-/ AM PM BUP Location / ��i 3 q Suite MEC -- 4`• Contact Person 4 Ph ( - -) 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 Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: I r a I SDART 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 S • ke Dampers • ' FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 1=1 Please call for reinspection RE: 1=1 Unable to inspect — no access Fire Supply Line ADA � _ U ¢_ Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL