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Permit kii: C ITY OF T I G A R D MASTER PERMIT PERMIT #: MST2004 -00107 r -1111; DEVELOPMENT SERVICES DATE ISSUED: 4/30/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14272 SW WALNUT LN PARCEL: 2S104BC -BW013 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 013 JURISDICTION: TIG REMARKS: New SF detached. Other mechanical is'(3) gas fireplaces. 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 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRP sf RIGHT: 5 VALUE: 308 80 OCCUPANCY GRP: R3 BDRM: 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: BOIL/CMP < 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 FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 • 400 amp: 201 • 400 amp: let WOO SVQFDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HWSVC /FDR: 601 • 1000 amp: 601 +amps•1000v: MINOR LABEL: 1000+ amp/volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 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 Tigard Muniapal Code, State of OR Specialty Codes 6932 SW MACADAM AVE STE C 6932 SW MACADAM SUITE C PORTLAND, OR 97219 PORTLAND, OR 97219 and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg 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 Insr 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 bli / Issued By : t%„ / � . • W _ . _ Permittee Signature : f r `/ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n) t business day Building Permit A p Olean Received Building Date/By: v ` d Permit No.: r '2 1 cio f -a) le 7 City of Tigard vas ^ LOO Date/By: Approval Other ,,,,,,,.. y ll k Date/By: Permit No.: Q —'t "1 13125 SW Hall Blvd. VA � + Plan Review Other Tigard, Oregon 97223 \`, t Date/By: /"\P. v H - 7y - 0 Permit No.: Phone: 503 - 639 - 4171 Fax: 503 1tr , . ■I `, Post - Review Land Use D \�\ , - 1 I I Date/By: f��eg9/I Case No. Internet: www C+ G - � --- col Contact t/M �t�Q� (� See Page 2 for 24 - hour Inspection Request: 50311M4175 Nam et ' ( Supplemental Information TYPE OF WORK . - . • REQUIRED DATA: - <rr., - ® New construction El Demolition 1 & 2 FAMILY DWELLING : = .,z. r ❑ Addition/alteration/replacement ❑ Other: . CATEGORY OF CONSTRUCTION Note: 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, overhead and profit for the work indicated on this application. 0 Accessory Building ❑ Multi- Family ❑ Master Builder El Other: Valuation $ . JOB SITE I and LOCATION No. of bedrooms:1 . L No.�f baths: 3 Job site address: i ( 7p. 'Ai 0i )a/if Z- Total number of floors d Suite #: Bl /A t. #: New dwelling area (sq. ft.) g• P Garage/catport area (sq. ft.) Project Name: / /A) Covered porch area (sq. ft.) T Cross street/Directions o job site: Deck area (sq. ft.) Other structure area (sq. ft.) • REQUIRED DATA:. • • • : ' • COMMERCIAL -USE CHECKLIST sue,' • _ • Subdivision: I Lot #: f " 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 14. PROPERTY OWNER I ❑ TENANT • • . - . - . - 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 El 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: Eliabeth Moore from licensing, the following reason applies: Address: City /State /Zip: Phone: I Fax: . ... . E -mail: • . • :•BUILDING PERMITFEES• : • • . . Please ieti to`fee scLe"du`le. . CONTRACTOR .- 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. f 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 Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 One- and Two - Family Dwelling I' Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City Of Tigard ❑Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 O Other: Fax: (503) 598 -1960 • IIE: FOLLOW IN(, ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No NIA 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 0 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. .I( RIS1)I(`I' ION : 1. SPE:('I1 1('S 23 Ave (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-4614 t61oaco%u ' 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit ltoeeived � FOR 0I•1•Ic ). i SF NIA 11'"'TT�G�v �- " `'j Electrical oatu8y: Permit NO.: Nraoci-AO(o7 City of Tigard Flemming Approval sign 13125 SW Hall Blvd. MAR Z 4 2°1 DatdR v Permit No.: Plan Review Other Tigard, Oregon 97223 Date/Br Permit No.: Phone: 503 - 639 -4171 Fax; 503-59j11960F TI c . ' D Post Land Use Internet: www,ci.tigardor.us BUILDING s • l.,L I Con D tac , Case Juris.: ris.: : Su See Page 24 -hour Inspection Request: 503 639 - 4175 � for Name/Method: _ Sup„plamerttaI [ntbrmatlmn. :•TYPE'OF WO - P,L•1O •R13YIEW. I ' -- = � i'R earret6gkis7l ;tTmt:eplbb'1':•.... IffNew construction Demolition ❑ Service over 225 amps- ❑ Health-care facility Addition )/alteration/replacement Other: commercial 0 Hazardous location ❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet, ,___; ••.- .. ATEGORTOF'COP4SI;RUCFION 1 & 2 family dwellings four or more residential units in & 2- Family dwelling [] Commercial/Industrial ❑ System ova 600 Volts nominal one sttvcture Accessory $uildinl� Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Occupant load over 99 persons ❑ Manulhetured structures or 1W park _Li Master Builder Other: ❑ Egress/lighting plan 0 Other • 7ottstra <l FOR ATION`IFid LOCAc'I1<ON • __ Submit set.. of plans with any of the above. Job site address: 4�7 a. (�A LP t �T The above are not applicable to temporary construction service. Suite #: � Bldg. /Apt. #: ':. .� ..:...... ... ,:;..,Fire, , �:,x, : '- :,'�: i.,,......(.,;;;4.,,:.:.:,,.:....,;.,: . Number of inspections per permit allowed .Project Name: Description Q Fee tea.) Total I Cross street/Directions to job site: New resldeettaleitcgle or mmttbramily lion i dwelling mate Iodides attached garage. Service iaebded: 1000 sq. IL or l as 145.15 4 _ Each additional 500 se. ft. or portion thereof 33.40 1 Subdivision: --I rp� Lot #• , Limited ene, residential 75.00 ' 2 Tax ma _parcel #: Limited energy, non residential 75.00 2 _P Each manufactured home or modular dwelling DE Service§ or feeders • ittsg 1tL'OLrVY OR K service and/or 90.90 2 • ilatiao. kJ e- Con 5-1 (� ()1 - S/ 9 / C T /71•1 / alteration or relocation: De±a c he d X7■ den c2- 200 amps or has 80.30 201 amps to 400 antes 106.85 to6.as 2 401 amps to 600 amps 160.60 2 .. s o • : O11TuR'IT OWNER :• • ' :. ; le ii ., •: - 601 amps to 1000 amps 240.60 2 Name: D en a.- 1 S (ju S 1 r -- - R Over econnect 1000 of volts . - 454.65 2 F 66.85 2 Address: 10q, J' 6f/ al1 *P. !� ,} , Tern or feeders • instellagon. City /State /Zi : .�1 ��- alteration, or relocation: Po tG / 0 q igf 9 200 amps or leas 66.85 1 PPhon C /43 440-i3 Fax( 44Vel3 2_0 F"11 t,aaoamp, 100.30 , 2 ET PEI N • : • . 1 to 600 erne 133.75 2 Name: �j ' _ Branch etrsutts • new, alteration. or ✓Q.- mss cateonlon per panel: Address: branch A. Fee for bra circuits with purchase of City/Cl /State/Zi service or feeder fee, each branch circuit 6.65 2 State/Zip: B. Fee for branch circuit~ without purchase of Phone: service or feeder fcc, first branch circuit 46.85 2 Fax: Each additional branch circuit 6.65 2 ' E -mail: Misc.(Scrvice or feeder not included): , .. ° ` . . :. Co - , Each grump or Irrigation circle Job No: Each sign or outline IIg tins 53.40— 2 2 Signal cantinas) or a limited energy panel, Business Name: i OSS �`�� alteration or extension Paite 2 2 Address: R8 S k Baal 1 # ;'3 aese„pno>ti .. City/State/zip: Ito !1 S 601-6 , D12 a7/ 23 Each did tgmul inspection over the allowable In an of the above: Phone: Per inspectmon per hour (min. I hour) 62.50 .5k3 6'/ 2800 Fax: 53 Co z_ms,t S Invcstinidon feu: CCB Lic. #: IS73g' Lic. #: 3 36G O oh _ a e" Supervising electrnci • :.:. e�tHe:lpdm jr.::' . ' } Supervising X si n ature re uired' __ ! �^ - ' -� - :.1 Et Subtotal 1 Plan Review (25% of Permit Fee) $ S _ Print Name: I OSS Lic. #: 2 .__ State Stnehai (8% of Permit Fee) , Authorized TOTAL PERMIT FEE S Authorized Date_ Notice: This permit application expires If a permit is not obtained within 180 days slier it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) - 1:\Dst,;lPermit Fnm \ElcPermitApp.doe 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 Mechanical Per ('') 1 scaoa Received Meehaaiat 1 OO oataBv: • permit Na; �ti f6iao c0/0 7 City �7+ ` � , L Planning Approve! Building C111 o 1 ilia d MAR flatrJ6y PeanitNo.: �� �� 13115 SW Hall Tigard, Oregon 97223 C1�Y pF T1GAF1 ?N Ptah Review Other Permit No.: Phone: 503-639 Fax: 50��E31 0 o Nl ,• p c ew Land Use y� Cue No.: i I hilifttatt www.ci.tigard.or.us .••, s. .� , -'I contact tuns.: ($f Sest''age 24 -hour Inspection Request; 503- 639 -4175 - -- - N Sepplementu Intbrmaden. • • , • •; .._: EOFWORK•. ` ;;:,` .._ .•,.:t•::e.CpZVI +CJ 11CREDIT EMSECKECKIAEr :,. ;..,a. if New conanuotion M■ Demolition Mechanical permit fees* are based on the total value of the work l• Addition/alteration/ - .lacement • Other. performed. Indicate the value (rounded to the nearest dollar) of all • ' • • : CATEGO ') Ly ; i ;II i".\ mechanical materials, equipment, labor, overhead and profit. K. 1 & 2 -Famil dwell • _ • Commercial/Industrial Value: S See Page 2 for Fee Schedule MI Accesso Buildin: ■ Deur • don P Fe ea- Total ' Iii Master Builder ■ Other: nesttefilcooung • • : S H E I + • • • N and LOC ( O N .• • : • . • Furnace • add-on air coitditionirig" j 14.00 l Job site .. address: (:'��; MM..l Gas heat pump J } 14.00 Suite #: Duet watt 14.00 Hydronic hot water system 14.00 Pro'ect Name: Residential boiler Cross street/Directions to job site: for radiator or h . route system 14.00 Unit heaters (fuel, not electric) in wall, in,due su nded. de.) ill 14.00 Flue/vent (for any of days) . 10.00 S bd iv i u Lot #: R •air units 12.15 10.00 • • • sion: • , •• DES «: r• ION •F•' •Ax , • • • 10.00 NEW CONSTRU • —ST ' GL - a- I Flue vent (water heaterlpaasfireplace) 10.00 Lo_ li. r = • ; 10.00 DETACHED RESIDENCE Wood/Pelletstove 10.00 10.00 - China► /liner /flue/ ■ 10.00 MIMI 13 TENA/ ''St i! %- Other. 10.00 — �+r = �' ' . Eneironmc tai tabiust& Vetdtr6oa N" e - • - -_ S - „ - • Range hood /other kitchen equipment Address: 6 7 _ SW Mac : __ _,, -_ S . C Clothes dryer exhaust — T :0.00 Ci /State /Zi.: Portland OR ' 721 9 Single duct exhaust Phone • _ • _ • Fax: r (bathrooms, toilet compartments, ■ $n ,CAF x � 10.00 •.•• + • 1 utili rooms 6 Name: David Goloba Other, 10.00 Address: ° e• ----- anISSSAO for first 4. 51.00 nett additional) Furnace, etc. r• Phone: Fax: Gas heat E -mail: Walt/sue • coded/unit heater co,r . Croulz ,. - Business Name: _ - , t . 1• •• AddreSs:2428 SE 105th Ave. • Ill ; C State/Zi. :Portland , OR 97216 Clothes dryer (als1 Phone :503- 253 -7789 Fax:503- 5 -1 b "3 Other WI Total: CCB Lic. #: 481 3 1 a5anted permit Fen' na AufhOriZ ed` , ` � �a • _ U• total: S & Signature —4 Date:►'{ Minimum Penr Fee 40 S David Golob y militdr_'7.r"isti3 z% ofPawutFee) 5 o • - t eel S (P ease print l 7'OTM. r 17. a g Notice: This permit application expires If a permit is not obtained within •ate t10d� ��t -CO A/C r nu� er Industry Scrvie, Board• ISO dov after it has been accepted e complete. ialstslPermit Pat n MeaPetmitApp • 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 $100.00 or fraction • thereof. All New Commercial Buildings require 2 sets of plans. 1:.BuIIdIng1Perrnit FormslMecPenNtAppPg2 09-01 -03.doc • 03/04 16:21 FAX 5036284633 THE MULLEN COMPANY • HENNA VISTA Iiii 002/003 Plumbin Permit A Received Phi fig Ft P e ar Planning Approval S LNa �n/o 7 City of Tigard DU Plan Permit No.: 13125 SW Hall Blvd. R � 4 . 2 Plan Revie tStkt Tigard, Oregon 97223 M A Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1 F It Past-Review land Use Internet: www.ei.dgard.or.us GgY u.44-'''''All I !wis See Page 2 for 24 -hour Inspection Request: 503.639$ - - Name/Method: - I ® Supplemental indar aatioe. -.-.. • .- 'l'YMEM. rtf•' •� t ...o,,,.. IrEIP CRIED. LE.(foripeeralini<OrialtbleM . trr.�T: I New construction f Demolition Deseriptlon I Qtr. I peke. I TWO Addition/alteration/replacement Addition /alteration/replaceent [ Other, • `-' Ter r. •� C• r_I :..•.: E'/ CIFr(` ailR 'T�'�k'4'+E11r1SJRR>QG�'110N a� ' ...: - .:., ' n ,1 filirt� iine ob 4;.. +: �., . ; k SFR (1) bra 249.20 } F1 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 ' 11. Accessory Building Multi -Eam Y SFR (3 } b 399.00 IN Master Builder 8 Other: Each additional bath/kitchen 45.00 • .': ism SSE IN '.ORMATIQItiaitdELOC*T,ION ' ' Fire sp inider - sq. ft.: _ - P w 2 1 ..„.„ Job site address: , (5-0 iJl7A1. a 'r ' • • .... ::' ` - :• • • . A stfe:lltditles : ,:1:, .. l ( .l: ° .... • . Spite #: Bldg. /Apt. #: Catch basin/ea drain 16.60 Project Name: , Drywall/1=h Mennen drain 16.60 hating drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 . - Manholes 16.60' Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: I Lot #: Storm sewer (no. linear ft.) _ P 2 Water service (no. linear R.) Page 2 Tax map/part:el #: iblSCR[PT1LOlTOF WORK Fkttare or item A ; y ` Absorption valve _, 16.60 NF,� , CONSTI2QCTION - SINGLE FAMILY Baddlowprevcnter Page PARTLY DETACHED RESIDENCE Baekwazervalve w 16.60 Clothes washer 16.60 Dishwasher 16.60 , Drinking fountain 16.60 glipROPEl Y OWPOrae ' E . li : , ANT . . _ • . • 6 16.6 Name: Buena Vista Custom Homes • Expansion tank 16.60 Address: 6932 SW Mat dam lout _ srr c Pixttudeewer ea" 16.60 Floor Ci /State/Zi : Portland OR 9721 9 Garbage 1660 tY � Garbage disposal 16.64 Phone: 503 -443 -6033 i FaX:503 443 -2 443 1640 � ' Hose bib , 3i APPLICAINT • . • . ri CON ►'Ci USQN • lee maker 1 6.60 Name: Ray Mullen interceptor/grease trap 16.60 Address: Medical gas • value: S _ Page 2 Ci /State/M.: Puma 16.60 Roordrain (comt►urcW} 16.60 Phone: Fax: _ Sink/basin/lavatory 16.60 E -mail: Tub/shower/shower pan 16.60 rill•! -- 16.60 EOI�flRAGTOR Water closet 16.60 Business Name; ED Mullen Plumbing Water heater 16.60 Address: 24470 SW Rainbow Lane . o sha e: • - City /State/Zip: Hi Ujober SR 9 71 2 7 t�tlt Phone: o - 628 -1 _ F ax: , - . . _ _ • _ • , Subtotal S CCB Lic. #: • . Plumb. Lio. #: -a - • . • _ Minion= - Miniou Permit Fee S72.50 S . Authorized �' /...-C.2 (4 Residential Sackflow Minimr pms34.25 Signature: ✓ ` 1 ' plan Review (2556 of Pamir Fee) S Ray u 1 en State Surcharge (8% of Permit Fee) S !^ (Please print name) TOTAL PERMIT FEE S Notice' Ibis permit application expires Ira permit is not obtained within • AU now commercial buildings require 2 sets or plane with isometric or 180 days after L has been tempted as complete. flue diagram lbr plan review. -Fee tnetisodolom set by Tri- County Bonding Industry Service good. IADSts \Pettnii Forttts\Plnt?ermiiApo.doc 01103 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. • Fee (es) :TotaI.. Square Footage: Permit Fee: Footing drain - I 100' 55.00 0 to 2,000 5115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' S 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 55,001.00 to 510,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture 0`r Itetir ': ; ' Qty. ' '.Fec(ei) :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 525,000.00. Rain Drain, single family dwelling 65 25 525,001.00 to $50,000.00 S379.50 for the first $25,000.00 and 51.45 for each additional 5100.00 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 51.20 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 by (Fixture) VioiricPerformed. Comments regarding fixture work: Fixture Type: • • •••• . , r . • • geR :' - .. New • :Moved `F.ilaNng 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" 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:%Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 /t/I go-oy -c)-* Io7 ® AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAA® ®A®® ®AAAAAAAA AAAA AA ® STREET TREE C Ik> to- 1 A . i . ® I, 7 s,� R € / / , g,„..,,,,_ 12,P, ..4 ® (PLEASE PRINT) 1 (PERMIT HOLDER) ® ; ® Do hereby'cer fy i h ' ap -,,,t' 'e f" 'o wi g location ( . .1.6 ? )7 'La \ A meets f< � t� f i ard%Wa ington �. ounty r ia . ® land use and development standards for street tree installation. 41 Da. 41 rit• ® • ADDRESS: l 2 5 L DI- v; �� ® L OT: SUBDIVISION: L34 00 [ 5, ® BY: � � __... ArAgrii - - - _ DATE: i*-- "sCr 1 — ----"7:/r P> ® RECEI D BY: DATE: 4 " . 7 O V 02. E AV YVY YYVVYYY YYVV VVYYVYYVYYYYVY YYYyyVVVVVVVYTVVVyyyyyyyyyyyyy® CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST V-UO4 _06/6 7 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / � 9' - f t° AM PM BUP Location / y oZ 7 a- �— PztLJJ Suite MEC Contact Person Ph ( ) 1/ — 81 /5 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 '� '- 42111W • 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: a a A 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 ❑ Please call for re'nspection RE: Unable to inspect – no access Fire Supply Line , ADA Approach/Sidewalk Date I 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 c7 - e ) °/ 6 : INSPECTION DIVISION - Business Line: (503) 639 -4171 BUP Received Date Requested 8)— AM PM BUP Location `£ a- LA_DCk Suite MEC Contact Person 0 __■ Ph ( ) 6 2 - Zgw 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 ��� �lla�s���;l�� • 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 Low Voltage Fire Alarm PART�y Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date 8/ A Inspector E xt Other: Final DO NOT REMOVE this inspection record from t e job site. PASS PART FAIL CITi OF TIGARD 24 -Hour , / BUILDING 0 Inspection Line: (503) 175 MST 2.0d �/--6e/0 7 INSPECTION DIVISION Business Line: (50 639 -4171 �y BUP Received 51 Date Requested 7 AM PM BUP Location / %I 2 Z Suite MEC Contact Person P 5l ) '7l g%/ S PLM Contractor Ph ( ) SWR - -1E11 " Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain ' Slab Inspection o s: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear F6Pb # e 6( 4}' 'L O f Framing Ti ! / lJ f� C� Insulation Drywall Drywal � M wall Nailing [ • Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: 41°--: PART FAIL •ost : :eam Under Slab mmo - — — Rough -In Water Servi Sanitary S er Rain D • s Catch min / Manhole Stor Drain S wer Pan er: Final PASS ART FAIL C A AL Post & Beam Rough -In Gas Line Smoke Dampers •ASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date q " l 1 7 ° Inspector Ext Other: Final DO NOT REMOVE this inspection re r om the job site. PASS PART FAIL