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Permit " CITY OF TIGARD MASTER PERMIT' A PERMIT #: MST2004 -00095 v l;• DEVELOPMENT SERVICES DATE ISSUED: 4/16/04 .. I ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14255 SW WALNUT LN PARCEL: 2S104BC -BW002 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: New SF detached Other mechanical units are (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 of GARAGE: 440 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5 VALUE: 308,476 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 W00DSTOVES: 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: 1st W/O SVCIFDR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: • EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: I 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 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: $ 8,221.61 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 all other r applicable Municipal Code, State work k w Specialty Codes and all other applicable law All work Th 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 Re g 6 : 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 InsE Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation lnsp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical Insp Shear Wall lnsp Insulation Insp Appr /Sdwlk Insp Issued By : Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne bus'ness ay • . . Building Permit Application Received Building l RECEIVED Date/By: � 7 Permit No.:R,r00 VeQ _._ City of Tigard Date/By: Permit Other 5140951 y g Date/By: Permit No.: e�- 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 MAR Z 4 2004. Date/By: Mk tl 1 1 - / 3 - 0b/ Permit No.: Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 ' " I ' Post - Review Land Use Internet: www.ci.tigard.or.uGITY OF TIGARD l,L -.I I Date/By: Case No. 24 -hour Ins ection Re uesstNQ1311B Rl 1O J No J Su See Page P q Namm /t e/Method: I //a Supplemental Information • TYPE OF WORK - - _.- _ . REQUIRED DATA: _ _ _ - IN New construction [ Demolition _ 1 & 2 FAMILY DWELLING ~ - • • ' - ❑ 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 S . JOB SITE INFORMATION and LOCATION No. of bedrooms: LI-I— No. of 3 of f baths: Job site address: /t/g5 tilt idelyd - 1-4 Total number of floors New dwelling area (sq. ft.)... Suite #: Bldg./ pt. #: Garage/carport area (sq. ft.) Project Name: 5. afte' d 8 c Covered porch area (sq. ft.) of Cross street/Directio s t ob site: Deck area (sq. ft.) Other structure area (sq. ft.) it . • ' ' REQUIRED DATA: . -.. ' Subdivision: ' - , COMMERCIAL =USE CHECKLIST 3 1;: Lot #: 2 -". . • 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 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 I 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 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: • 'BUILDING PERMIT FEES' : . • CONTRACTOR ' • Please refer to fee ic6edule_ . 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 il _ Signature: C4. CDT 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 Trl- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \B1dgPermitApp.doc 01/03 • • One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City of Tigard ` City of Tigard Associated permits: D Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 OOther: Phone: (503) 639 -4171 Fax: (503) 598 -1960 IIIE: FOLLOWING ITEMS ARE REQI'IRED FOR PLAN REVIEW Yes 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 ❑ 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 sections) 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 WaU 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. .11 RISI)l( [IONAI.SPE(•IFI(•S 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x I I" 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. 4+0-4614 (6V0/COM) 03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical PermllED Received Electrical DatuBy: Permit No.:, `S City of Tigard Planning Approval Sign MAR 4 200 Date/13y: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard Oregon 97223 Date/By Permit No.: Phone: 503- 639 -4171 Fax: 503QW8Y1C T IGA Post-Review land Use Internet: www.ci.tigard.or.us BUILDI DIV ��� j asc N0 'i ® Page 2 for 24 -hour Inspection Request: 503 - 639 - 4175 Name/Method: Suj1plemental infbrmatian. :` .• TYPE'OF WORK ' - • ' ., .. • ' :. ' KANREVIEW (Please chteca7y';elat':aipbt New construction — Demolition ❑ Service over 225 amps- 0 Health-care facility ID Addition/altt ration/ replacement Other: commercial over ❑ Building Hazardous location CI Service over 320 amps-rating of ❑ Building over 10.000 square feet. •. '•CATE6'____ F'C©YQ$ EtCtE7ON. - 1 & 2 family dwellings four or more residential units in & 2 -Famil dwelling DI Commercial/Indushial ❑ System over 600 volts nomina one structure sory Building Multi-Family ❑ Building over three stories El Feeders, 400 amps or more Acces ❑ Acces yiBui 0 Occupant load over 99 persons ❑ Manufactured structures or RV park Other: ❑ Egrest/iighting plan Other: _ ZOOSIT& oRMATIoN`atitL Jch' TION •• ' - Submit tece of plans with any of the above. Job site address: W/Q'LIJtt� The above are not applicable to temporary construction service. :. . • .. 'FEE! ell: i:Yi •: ' i`:::: ':i ;;A Suite #: Bld ./A t. #: Number of inapectionsper permit allowed Project Name: Description Qty Pee (ea.) Total , Cross street/Directions to job SitC: New resldentlal.singlo or mott4family per 1 dwelling unit. toeledes attached garage. Service Whirled: 1000 se. It or less 145.15 4 Each additional 500 sq. R. or portion thereof I 33.40 1 Subdivision: ` — I Lot #: Limited CAer�': residential 75.00 2 Lid energ non residential 75.00 2 Tax map/parcel #: Each manufactured home or modular dwelling DE • - r • K OF' WORK • • •` . • .. ..,: 7 service and/or fader 90.90 2 Services or feeder - Installation, ��'v Gons S//19/t, 18/)11 /lJ alteration or relocation: - p. t c .-h e c b 200 amps or less — 2 E n C�� 06 201 amps to 400 amps 106.85 2 401 amps to 600 amps _ 160.60 2 OP.FtRTY OWNER •. • ::: }. O•'PR15P J •• - 601 sums to 1000 amps - 240.60 2 VII S L S � L �, .. Over 1000 amps or volts 454.65 2 Name: en a y 1 u. �� ile9�yCJ Reconnect only 66.85 2 Address: a(&c%71 Aye, 5I Temporary services or feeders - installation. City /State /Zi • : poi - f(0 / 0 gig/9 alteration, or relocation: / ( 200 amps or lesv 66 85 I Phon . • 3- ,•-• Fax :.G • 3 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 _ 2 C 11111 s pp •,: s N Branch circuits • new. aiteradoa, or Name: 'E 4e VQ.. / .s5 extension per panel: Address: A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State/Zip: B. Fee for branch cinvits without purchase of Phone: service or feeder fee, first branch circuit 46.85 , 2 I Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): . - • • cop mfA 13R = -. .. �aeh proem or hrigation circle 53.40 2 Eachlip or outline lighting _ 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: ji O alteration , or ascension _ Page 2 2 Descrnption: Address: a s o l � cal B) ewe **-9103 City / State/Zip: `l-t )1S 4p0► -6 , 0/2 f 7t p 3 Each additional inspection over the allowable In en of the above: Per inspection per hour (min. 1 hour) 62.50 Phone :$23 (o f`l 2800 _ Fax: 5173 4 z,6-51 s- investigation fee: CCB Lic. #: I5 Lic. #: 366 Other: Supervising electlici • .:.:. 8tetelleStL elrmtlb - ,i 7 : • ;... ; °•!• is X signature required Subtotal - S Plan Review (2.5% of Permit Fee) S Print Name: ROSSI Lic. #: 4 123 S State Surcharge (8% of Pemtit Fee) S Authorized TOTAL PERMIT FEE S Notice: This permit application aspires If a permit is not obtained within Signature: Date: — 180 days after it has been accepted as complete. •Fee methodology set by Tn - County Building industry Service Board. (Please print name) - (:\Dstx \Permit Fnr ev \ElcPermitApp.doe 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 Mechanical J[ ermi On Recdved Mechanical LL__,..,_ 5 — 7J , R Date43 , P I L City of Tigard Planning Approval 9 u Wing — 01, Review it *Le 13125 SW Hall Blvd. 4, MA R 4 2 0 't per, i�i� A Tigard, Oregon 97223 DiataBr. Permit No.: Phone: 503 - 639 -4171 Fax 503- IGA- .6.,•�,• Post- Review Land Use 1no0rttiet: www.ci.tigard.or.us G gard.or.us pIV ,� ; ` 1 ! Comet kris.: 031 See Page I for 24 -hour Inspection Request: 50$ 9= 75 Nam /Method: 1 Sepplenoe.al tnrormaeod. • ,... , -, E OF WORK.. 0:lei" :,- ;,..:. :. :: Q:•.;,. : ,,;.r..estCOV ashat a..•113E+SC IILEe ;. ; •..a. V New construction Demolition Mechanical permit fees* are based on the total value of the work Di Addition/alteration/ • lacement ■ Other: performed. Indicate the value (rounded to the nearest dollar) of 811 :. 'lsGORT" s 4 . t . _ . r:�, .. mechanicai materials, equipment, labor, overhead and profit ILi I & 2 -Famil dwell : LI Commercial/industrial value. S See • :, 2 for Fee Schedule 10 Accessory Building III Multi Fartlil — DeserWen Qh I Fee(a.Z k dotal L% Master Builder ❑ Other: eaatIWCwhaa • .: 'SITE ' + • • • TION and LOCA ON • :: • Furnace • add-on air Conditioning"' 14. i Job site address: A ib �� MA Gas heat pump 14.00 Suite #: BldjJAt. #: Duct work _ 14.00 Hvdroaic hot water system 14.00 •'CCt Name: Residential boiler Cross street/Directions to job site: (ttr radiator orhydronio system) __ 14.00 ' Unit heaters (fuel, not electric) in wall, induct; suspended. etc.) 14.00 Flue/vent (for any of above 10.00 Lot # Rep air units { 12.15 i Subdivision: I Other Fuel Ap tiaateay Tax , .. - el # Water heater 10.00 .. • . DES el : a• [ON , F RK • -a • .. cos fireplace: 10.00 • NE . _ - e Flue vent (water Mater /tat tireptace) 10.00 Loglehrcr (Rao • ! 10.00 DETACHED RESIDENCE Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/1iner/lluelvent _ _ 10.00 _ 3; • : 1 ' 3 ' :a : , Other ,— 10.00 1 _ e>ariroa� tai exhaust a. Veetliaeoa Name: - _ = r - . • I I = ` Range hood/other kitchen equipment 10.00 Address: : __, _ _ - C lothes dryer exhaust 10.00 Ci /State /Zi i : Portland OR ! 219 Single duct exhaust Phone r . • Fax: • • – _ (bathrooms, toilet compat, nts, R _ _ . 11 P CONT fi x •., utility rooms) . 6.80 NOW Auidcraw1 Pace fans 10.00 David • • Other; L - 10.00 Address: Fad )aping ie(SSAA [or first 6. 51.00 tub ad(itional) Fuettaee, etc. ' • Phone: Gas hest pump •• E -mail: Wall/suspended/unit heater ` •• .■ COMPACTOR .. . Water hearer •• Business Name: Su>p_GLow Fireplace _ y . •• Address:2428 SE 105th Ave. Range •• -- BB Q City/State/Zip :Poxt1and, OR 97216 Clothes dryer(gres •" Phone: 583-253-7789 Fax:503- 5 - rb "3 Other •� Total: CCB L1C. #: 45131 M eebasleal Permit Fes' 3ignatures „ Datc:23;ap►+ Minimum Rettnit Fee S?190 • S David Goloba y plan Review fee 9 of t 1=e S ease p trouts) Sidle TOTµ Ofd S (P e trnl Pee) S Notice: Thu permit application expires if a permit is sot obtained within .Fete e t odology set br est -Co A/C uni er try She Ord. 180 days after it has bees accepted as complete. 1;tpyIlPeamit FerrnOteaPeemiiApp.doc 01)03 - • 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 $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. I:V3ullding\Permit Forms MecPermitAppPg2 09- 01- 03.doc • 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY i BUENNA VISTA 1th P lumbing Permit Application p �g,� Plumbing I City of Tigard Planning APprova Sewer Datd9v: Permit No.: 13125 SW Hall Blvd. Plan blew Caber Tigard, Oregon 97223 RECEIVE ► Date/By: Permit No.: . Phone: 503 639 - 4171 Pax: 503- 598 -1960 ' Po- uview Land Use R � 4 i st IInternet www.cl.tigard.or.us MAR . - J J Date/13 : rue No.: , Contact Atria.: See Page 2 for 24 -hour Inspection Request: 503•61•4175 Name/MAW: SupplootestslInfermatioe. CITY OF TIGARD e { ViQ1001� - �l % �$* ,��:D.IfJL$ (t�C apedal`inttllia"�i�i[si'" '�i ' .:� IIP New construction III Demolition Description I Qty. I Pco(ea, I Total III Addition/alteration/replacement MI .R r; #411d n / •• "� u v , :,e, co> ?o : i.; ,r�aio 11d1� 6Sliar t 1iti.+��itr�eoiiise ionl ::c' { SFR (1) bath 249.20- C7 1 & 2- Faraiy dwelling El mm Coercial/Industrial SFR (2) bath 350.00 FIN Accessory Building 38 Multi-Eantiy SFR (31 bath 399.00 . IN Master Builder Other: Each additional beth/kitchen 43.00 .': .YOB SITE 1101 ORMATIQNlan L'OCR+T1ON F re sprinkler - so, tk: Page 2 Job site address: / 4 95S b) bohute1 ` _ ' .. •••• ' ', : • . • • • Stti.Vtiattes : , ;, :, �a? . C aoch basin(ar s drain 6 .60 Project Name: .. Dfywelllleaeh line/trendt drain 16.60 Footing drein1 e. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 • Manholes T 16.60' Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 — Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Water service (ao, linear ft.) Page 2 Tax map/parcel #: , , Fiirtuza or I cm : :. . : • . ' . , bFSCRirrIu4 of WORK Absotptioe valve l6 60. NF, ,COl!TSTROCT ION — SINGLE FAMILY Baddlow prcventer Page 2 • •'AMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher _ 16.60 Drinking fountain 16.60 gl ' ' :rl< El • '- • ANT , z.. _ e .. . , Ejectors/1=P 16.60 Name: Buena Vista Custom Homes Expansion tank 116.60 Address: 6932 SW l(aceam Atrp • S tp c i Firth / saver cap 16.60 Ci /State/Zi : Portland OR 9 7 21 9 Floor dram /floor loor sink /hub 16,60 tY Garbage disposal 16.60 Phone: 503 --443 -6033 Fall: 503+1463 -2443 Hose bib • 16.60 APPLICANT . . • . CQNTACE' b'ON . • Ice maker 16,60 ' _ Name: Ray Mullen Interceptor/grease nap 16.60 I Address: Medicos Rae • value: S - Page 2 Primer 16.60 Ci /State/Zi • : Roof drain (commercial) 16.60 , Phone: Fax: sink/basin/lavatory 16.69_ _ E -mail: Tub /ahower/ahower_pan 16.60 r; ?•: EOPF.1[RECCTOR Urina 16 60 Business Name: ED Mullen plumbjna ~ Waec 16.60 Water zer h heaeater 16.60 Address: 24 470 SW Rainbow Lane Other: City /State/Zip: Hi 1.11315nr . nR 9 71 23 Other. .-----. Phone: 503- 628 -1632 Pax :5 1- 628 -4c11 -� :platabietC le]i�[itie.. •� Subtotal S _ Q • CCB Lic. #: a 4 Plumb. Lio. #: 3 9 — L6 0 FB • Minimum Permit Fee S72S0 S - Authorized - (� Residential Backflow Minimum F 536.25 Signature: .4.41 A =- •"..: ✓ Plan Review (ZS% of Permit Fee) S Ray ul en State Surcharge (8% of Permit Fee) S ...^ (Please print name) TOTAL PERMIT FRE _ S Willem •Tbls permit appltadon expires If a permit Is sot obtained within • ' U now u r pulre 100 or pla.ne with isometric or 180 days slier It has been accepted u complete. .Fee mee ho dolog set by Tri-County Bonding Industry Seneca Beard. IADsts Pesnil Fartns\PlmPerrehAPP.dee OW 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 - l 100' 55.00 0 to 2,000 $1 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 $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 a • rota! ' additional $100.00 or fraction thereof, to and - Fixture oi'Itetii' ' ;'`' - ' Qty. •' , Feg e ( , - 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 Bacldlow 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 SI.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including 550,000.00. 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 *. • • . • . : Quint) by(Ft:wre),WerkPeifoettied. -.: Comments regarding fixture work: Fixture Type: • .� r : • . t . , :.:' t: ^ r �:�,• New Moved 'Pstifing >:Ca 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 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: i:\Dsts\Permit Forms\PlmPernitAppPg2.doc 01/03 yt4 5T"cy , 1 II 111 l■ STREET TREE C 4. 1 A . ® I J A ke ZA-ss e h , Owner/ gent for e t e A 4 V 4' �/-1 ® (PLEASE PRINT) g (PERMIT HOLDER) 1 lit* .® 11 ti* ® Do hereb "f r � t t > li via g location ® meets , f< x p : and . eon County ® l and use and development standards for street tree installation. _® I. ® ADDRESS: /i(2 SS' W 4' /ri L fL) 0. ® LOT: 2 SUBD IVISION: ► t/ 0 ci � � S ® 1„Jo _4 BY: / /� DATE: ' /6 — O el tii. ix- ® 41 RECEIVED BY: 4, , / < � DATE: 8 -1 9 - O-4— CITY OF TIGARD 24 -Hour • • BUILDING Inspection Line: (503) 639 -4175 MST dDUc- v0t15 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested C� 4. AM PM BUP Location l f a sss Le..)in i47 ,j Suite MEC Contact Person Ph ( ) 7/) - 8 iiS 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 1/ ( Firewall Fire Sprinkler 6 /1 Fire Alarm Susp'd Ceiling Roof Other: e ?"*".--Y6-*- 2 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: •ASS 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 Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 11 Please • II for re spection RE: Unable to inspect - no access Fire Supply Line ADA / / / / Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD. 24 -Hour . BUILDING Inspection Line: (503) 639 -4175 v CD INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Req ested AM PM BUP Location / 7 3.-5c L? Suite MEC Contact Person [ iltALD Ph ( ) to it ?- - Zt o r PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing ` _1 Insulation W fiV.vmp \ 1 3 ' 2 - 0 r Drywall Nailing Firewall Fire Sprinkler Fire Alarm r '�61� tl ° �1 13 q / C ( Susp'd Ceiling Roof \)94-41) Other: Final PASS MRT FAIL P Post &Beam P ` -r V L l A ti ct b Under Slab , \ n 1 $Q ►/ kka Water 1 N � f t� V i � 4 ^CJ Water Service ' Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Oth = r: (Er' PASS PART FAI MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS RT FAIL CTRI L Rough -In UG/Slab Low Voltage Fire Alarm ar. MP PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 411/100 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA n n, — IA Approach/Sidewalk Date 1 Inspector ' v 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 MSTAOai —D a INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested �✓ �� AM PM BUP Location / q .� Q ' - r l U . , • Suite MEC Contact Person 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: 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 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 Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour p on dine (503) 639 qr. BUILDING MST -3 6 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested g AM PM BIJP Location � f � Suite MEC Contact Person 9411_ Ph ( ) 71 D bev 9/ 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: ( S PART FAIL • NG 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 - SS , - RT 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 1=I Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date b – 1 n l ""D / Approach/Sidewalk Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL