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Permit ,,,,„ .: CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00106 =h'�y� DEVELOPMENT SERVICES DATE ISSUED: 4/30/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 14250 SW WALNUT LN PARCEL: 2S104BC -BW012 SUBDIVISION: BAILEY WOODS ZONING: R - BLOCK: LOT: 012 JURISDICTION: TIG REMARKS: New SF detached. Other mechanical include (2) gas fireplaces. BUILDING , REISSUE: BVH2550 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,121 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.429 sf GARAGE: 640 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRE sf RIGHT: 5 VALUE: 252 00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,550 at REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 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: BOILICMP < 3HP: ' VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/Fa2: 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 AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,336.10 This permit is subject to the regulations contained in the BUENA VISTA CUSTOM HOMES BUENA VISTA HOMES Tigard other applicable State All l wo work wil Specialty done 6932 SW MACADAM AVE STE C 6932 SW MACADAM SUITE C and all other applicable laws. All work will be done in PORTLAND, OR 97219 PORTLAND, OR 97219 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: 503443 - 6033 Phone: 503 443 - 6033 ATTENTION' Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Ro g #: 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 InsF Rain drain lnsp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Service lnsp Building Final Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Appr /Sdwlk Insp Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final • Issued B Y - I / Permittee Signature : t/ L./ V Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne 1 busin : ss day • . + v Building Permit A n FOR OFFICE. I ONLY tl Received / n. / , Building aE DateB : ./ OW /A Permit No.: ■ J1 AO of Tigard Planning Approval Other City ll 4 1004 Date/By: Permit No.: ),P", -o ff 13125 SW Hall Blvd. 0 Plan Review Other Tigard, Oregon 97223 Date/By: ry,,t v H -a-g- at Permit No.: - 4171 Fax: 5 lder . RO �` ' ' ' ` 'ry'$ ' ` Date/By: /0 Case Ng. Internet: www.ci.tigard.or.us ,uLD1N • 11 I " Contact � Phone: 503- 639 Land Use 24 -hour Ins ection Re uest: 5( = 639 -4175 �1 Su See Page 2 for P q Name/Meth Supplemental Information TYPE OF WORK - - - • • .- - REQUIRED DATA: _N .:,. _ - ® New construction [ Demolition i & 2 FAMILY DWELLING : ;i_ , ❑ Addition/alteration/replacement 1 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. Z Accessory Building ❑ Multi- Family Master Builder El Other: Valuation $ . JOB SITE WORMATION and LOCATION No. of bedrooms No. obaths: Job site address: f 1 2. b No 4y Z-17 Total number of oors Sttte #: Bld / t. #: New dwelling area (sq. ft.) c. j '- o g P Garage/carport area (sq. ft.) 0 7 A v Project Name: / pt D Covered porch area (sq. ft.) ...'/ Cross street/Directions -I lob site: Deck area (sq. ft.) / Other structure area (sq. ft.) I.e r .••- REQUIRED DATA:. :. ' COMMERCIAL' =USE CHECKLIST . Subdivision: I Lot #: fZ . 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 P: 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: E l i abeth Moore from licensing, the following reason applies: Address: City/State /Zip: Phone: I Fax: . E -mail: - BUILDING PERMIT.FEES• = . - CONTRACTOR " • ' • - . Please • refer fee scLedW� • •: ~ . Business Name: Buena Vlsta 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: � t . 71 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\Pernit Forms'.BldgPermitApp.doc 01 /03 • One- and Two - Family Dwelling Building Permit Application Checklist • r eference no.: City of Tigard City of Tigard ssociated permits: Address: 13125 SW Hall Blvd, Tigard, OR 97223 Electrical ❑Plumbing O Mechanical Phone: (503) 639 -4171 Other: Fax: (503) 598 -1960 TIIE. FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Rood 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. II; RISDI(TIO \:V. SPI ('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. 440 4614 t& OICOMu 03/.4/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 - . 1. Electrical Permit AIMED Received Electrical DattsBy: Permit No.: i� Z' o f City of Tigard MAR 4 4 21,01 Date/ y Approval Sign Permit No.: 13125 SW Hall Blvd. plan Review Other Tigard, Oregon 97223 T O F Ti - 7. a Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -599 k w G • post•Review [and use Internet: www.ci.tigard.or.us i J l _ Contac C ontac t Case No.: leis.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. TYFE'OF WORK ' . •... ' • : ,......,'• • ' MAKUMW •(Plea thetk,fa7Fthrit ly);:•..: • • • •._ New construction Demolition ❑ Service over 225 amps- 0 Health-care facility ❑ Additiotl/altt ration /t'eplacement Other, commercial ❑ Hazardous location ,� ❑ Service over 320 amps - rating of ❑ Building over 10.000 square feet. CA.TEGORYCIF'CONSTRVCEI0itf. 1 & 2 family dwellings four or more residential unite in l _ & 2- Family dwelling �Commercial/Industtial ❑ srscem over 600 votes nominal one structure Accessory Building Multi- Family ❑ Building over three stones El Feeders, 400 amps or more [] Occupant load over 99 persona ❑ Manuftcturcd structures or RV park Master Builder Other: 0 Egress/lighting plan ❑ Other •• • •: ; 10ItSITE MORMATION`tWE I:OCA" I'ION • • Submit tete of plans with any of the obove. Job site address: / 5 w�}l..4U.r The above are not applicable to temporary construction service. • 'FEE'*. .of :::x, 9: : . ' **;: �h; ' ' • Suite #: Number ; -,.. umb of inapecdoasper permit allowed Project Name: Description - Qty Fee (ea.) Tetal . Cross street/Directions to job site: New restdertfat eingle or mah4hmily per + dwelling malt taelade, attached garage. Service Included: 1000 sq. ft. or less 145.15 4 _ Each additional 500 sq. It. or portion thereof 33,40 1 Subdivision: - I Lot #: Limited energy, residential 75 , 2 Limited energy non residential 75.00 Z Tax map /parcel #: Each manufactured home or modular dwelling • • • •' • ' • DE • . r. , KOFWoRK • • • • • • • service and/or feeder 90.90 2 '' 11 t Service, or feeder, - installation, ._Ne'� Ons 149/ t... /f ii9 alteration orMr/code:1: De.-Fd (-he c "P.Q,7■ 2 D 0 ps or leas �n C�_ am 201 amps to 40(1 amp, 106.85 1 401 emps to 600 amps 160.60 2 80rwTY • OWNER ; at 'FE 601 amps to 1000 anus 240.60 2 e: a 4 , -- Over 1000 amps or volts 454.65 2 e a - u • d' Reconnect only Address: G1 ,'5 5U/ 1 ac clams ' (. Temporary services or feeders - installation. 66.85 2 City/State /Zi. ; to +to / 0 9 1 o' -/q 2 w im ps or o leaa eloetltion: 66.85 1 Phon =. • 3' -•'• Fax .2e; - 3 201 amps to 400 amps 100.30 2 • C 1♦ �+1'.`k x�, n . , 40 1 to 600 amps 133.75 2 '� � N : . Branch circuits - sew, alteration. or Name: a"1e ✓Q'- / • 55 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 circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: I Fax: _ Each additional branch circuit 6.65 2 E -mail: Mise.(Scrvice or feeder not included); :••• .. :. •. . •• i[ opergAcroa• • • Each pump or irrigation circle 53.40 2 Each sign or outline Il$ dng _ 53.40 2 Job No: Signal circuits) or a limited energy panel, a ttention. or extension Business Name: j� O55 _ Pap 2 2 Address: 370 5k) et a ##` v' o3 ;rn City/State/Zip: M't 11 rj b0 i•-• f DR '17/ 9.3 Each additional inspection over the allowable In any of the above: Per inspection per hour (min. I has) 62.50 Phone :,t3 too s/Z z3L0 Fax: Sly . investigation fen. CCB Lic. #:1 $7841 3&6 Other: ' Supervising electrici . i it..,._ )� >E teal Pelem t a ' I ;.,; . : + :; : , a X sii l ature re • uired• _ __+ Plan Review (25% of Per r(�'� S lit Fee) $ Permit Fee) $ Print Name: / OSS Lic. #: State Surcharge (8% of Permit Fee) S Authorized TOTAL PERMIT FEE S Notice: This permit application expires Ir permit is not obtained within Signature: Date: _ 180 days after it has been accepted as complete. • Fee methodology set by Tri County Building industry Service Board. (Please print name) - I :\Data \Permit Fnnrte.E1cPermitApp.doc 01/03 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 Mechanical Permit A E� !'cation it OF F" P. i 1 -'\t' R eceived Mechanical RE Date/13 : • Permit We: * Date/13 V - t•10IPS City of Tigard G Planning Approve' Building Da � = Permit Na: • 13125 SW Hall Blvd. . Plan - 1G°' • Tigard, Oregon 9722.3 MAR 4 20 04 p Land Use Phone: 503- 639 -4171 Fax: 503 -598 -1960 s• d Use 1 n t ri et: www.ci.tigard.or.ub CITY OF TIGAR i� ,.,• Lan Comsat kris.: 24 -hour Inspection Request la31413RdeTSVIS ' Name/Method: _., . .r,...,. EOFWORK•,fy2pg:..::. e,•. ,, :aecp F8Ek8tnitEDIILKL .:a It New construction I• Demolition Mechanical permit fees' arc based on the total value of the work •- performed. Indicate the value (rounded to the nearest dollar) of all �■ Addition/alteration/ : '4 al1G' �')��~ - �laccmetlt si O mechanical materials, equipment, labor, overhead and profit. ^�� n ' ~ illillil Value: S See Page 2 for Fee Schedule Ip Accesso Buildirl_ ■ Multi -Famil Deser e'en Qty 1 Fee(ea.) I fetal II Master Builder • Other: Brass.. are. • .J0 : WE FORMATION 2nd LOCH ON . _ . .: Furnace • add-on air condi. • ■ i, • *' 14.00 Job site address: L' Suite* IMMIIIMI11.1 Duet work 14.00 dronic hot water tem ■ 14.00 Pro'ect Name: Residendal boiler Cross street/Directions to job site: 14.00 Unit heaters (fuel, not electric) in wall. induct, suspended etc -) Flue/vent (for any of 4bo ) 10.00 Lot #: R • air units Subdivision: 16=71r Water IteselliMill= 10.00 • • • .• DES M: r [ O N •f?•• •RK . • 10.00 NEW CONSTRU • -ST GL F' ' I ' - ' DETACHED RESIDENCE Wood/Pelit -sue 10.00 �r IZEIMMEEI 10.00 Chitral /liner! net ■ 10.00 — a : 13i : A1! riltkg % : ::r % Other: NMI 10.00 N ame: g - 1 • - „ - • �� - - ... Address: 6 SW Mac - : _ ±I = - S - C Clotho dryer exhaust 10.00 Ci /State /Zi•: Portland OR • 721 Single duct exhaust Phone • _ . _ • Fax: t - • . - 111■ V7 •ti , 4 . 0 ,,. .. • Attic/crawl •ace Earls 10.00 Nam e: David Goloba , , A r Address: •* Aa for first 4, 5'100 area addidonal Phone: Fax: Furnace etc. III �� E-mail: . .... • CO di • CTOR . . . • . -I Business Name: _ , •• / Address:2428 SE 105th Ave. •' ::; Ci State/Zi.:Portland, OR 97216 IIIIIIIIIEIIII•111 / Phone: 503- 253 -7789 Fax:503 -25 -, to : Crate — Total: . CCB Lie. #: 4 51 31 • Memanleot tern* Fees' - Authorized . . • Subtotal: S / »a t�,my �� s Signature: David Golob y S / •% of Permit Fee S / (Pease print name) .. r ,1 Notice: Tltts permit application expires If a permit is not obtained within *Fee Fete p ° required set for by T t -Co nty 'Wilding in ry $rd. 180 dare after it as been meceptad as complete. inistsVermitFarrtr lMesPesmitAppdoe 01.103 r • / 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. 1:18upding1Permit Forms MecPemdtAppPg2 09-01 -03.doc 03/04/2004 16:21 FAX 5036284633 THE MULLEN COMPANY ' BUENNA VISTA la 002/003 P Pe , , " - •. ; ► cat Received , ng N y • ^ c o y DatrJBy: Permit N o e --cote • City of Tigard L } L plying Approval Sewer agard VA DawnivI Permit No.: 13125 SW Hall Blvd. M R p Platt Review other Tigard, Oregon 97223 Y OF I 1 Date/13v: Permit No.: Phone: 503- 639 -4111 Fax: 50 9bh' i _ ; Postaeview Land the . t Case No.: Internet: www.ci.tigard.or.use, ■ J ''� i I Date/B Contact 'uric ® See Page 2 for 24 -hour Inspection Request: 503•639•4175 - - - Nnrne /Method: _ I Su0YleutcOO�rt t tnnatloo. .. ...7....v..• .. - . • 1 J - _ L o y f• q •i " •• FEE' c •ubz. ' 1; • _ - infti . . '.1.. ' . In New construction Demolition Descrl • don Qty. ] row IM Additiorialteration/r 'tacerneut I. Other, • • 4.. ' r d , ;. -% ,+ F " `�' J; ! te a �y A1EGOR y� ' r :-, 2'• 1]1 .. , ' 'tie lb ~� t�PA , `iiiacdhoo ..mot" : w• ' �:c'• :'w i' '1.'4' ..CIOP: ! H : • •' r l .. F'.7 1 & 2 - Farnil d wellin_ ❑ Comrnercial/Indu -,a1 SFR ( 3 _ SFR (2) bath 350.00 1iY �• B t 1. t 1:11. ■ M - ..t1 1 SFR (3) bath _ 399.00 IN Master Builder ■ Other: Each additional bath/kitchen 41.00 ' .•'. , OR SITE LNFQR IA'IrIONandkOC'.A4TION Fire szinkler - so. !k: Pa, 2 Job site address: /i 4 Z)At.+JWr Li.) • ' •• ` - ... • • ... Sttalltilltles: :.:0:A ;':.' '.' . •_. _ . Suite #: l B1dgfAut. #: Catch basin/area drain 16.60 Project Name: Drywall/leach line/nosh drain 16.60 Footing drain (fie. 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 u- division: I Lot #: Storm sewer (no. linear ft.) Page 2 Tax map/parcel #: Water service (no, linear ft) Page 2 • • 1 • .....:...1 Fixture or Btem • ' 1 . • • C. bli:SCRfr'r1ON Ot; WORK Absorption valve X6.60 NF, ,CONSTRUCTION - SINGLE FAMILY Beddlow preventcr Page 2 j1MILX DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Prinking fountain 16.60 EX kOPE»TY'OAltNEt : " :, = AWE : S:.. _ Bit:otors/aumD 16.60 Name: Buena Vista Custom Homes Expansion - teak 16.6 Address: 6 9 3 2 SW Mac Adam Ave _ s tp C Fixture/eewer ca • 16.60 City/State/4x Portland, OR 9721 9 • Garbage ed i sp oarsf,rk/hub 16.60 Garbage disposal 16.60• Phone: 503-443-6033 Pax: S030443-2443 Hose bib _ • 16.60 , Ai iAPPL CMlT 1 - . fl („ ONT > ON ice maker 16.60 Name: Ra Mullen interceptor/grease clap 16.60 i Address: Medical gag • value: S Page 2 Ci /State/Zi • : Primer 16.60 Roof drain Commercial) 16.60 Phone: Fax: Sink/basin/lavatory 1640 E -ma Tub /ahowerfahower_paa 16.60 • . CONTRACTOR. • • • .. . •. . Urinal 16.60 , Business Name: Ep Mullen Plj.,na _ Water h atcr 16.60 16.60 Address: 24 47 0 SW Rainbow Lane Other: City /State/Zip: Hi 1] j lbor . r nil 0 71 2 7 Other. _ _ . 4 Phone: 0 -628 -1 . _ F ax: i _ . : _ _ . ..:Pltttabiet>+'Pu Subtotal B s�; Lic. #: Subtotal S , CCB Lic. #: • Plumb. - . • 0 = Minimum Permit Fee 57 S Authorized �. R esidential Badt#low Minimum Fgg)36.25 Signature: ✓ A L =-- 01' Plan ROVieW�2S96 of Ptxmic Fee) S _ air R ul en Srate (846 of Permit Fee) S .... (Please print mane) TOTAL PERMIT FEE S rretleet T11la permit application expires Ir permit is not obtained within ' AU newcemmercld buildings rageire S acts of plane with isometric or 180 days after it has been accepted ss complete. riser diagram r plan mien. , F re methodology set by Tri Banding Industry Service Board. h Daa\Pertnit Pa PImPermhApa.doe 0l103 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information ' Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee 0 Total:. • Square Footage: Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer 3,601 to 7,200 $220.00 ewer - 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 $I.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 F OrItetis .Qty- Fee (ear, a °'= ` Tote! additional $100.00 or fraction thereof, to and . including 5!0,000.00. 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 $379.50 for the first $25,000.00 and 51.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to requested ins coons - and including $50,000.00. specially 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 bk (Fl:titre);VHo'1cPerfoemett - Comments regarding fixture work: Fixture Type: - • • -- ri . Reptae : ry .•.: ;, , . .. . . .. • • New ; MOVed . • pxts ` 4 ~ 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. /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 Forrns PlmPermitAppPg2.doc 01/03 ILAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Al 1 ► 1 ® STREET TREE C Itt- rf , ,, „. ® I, J,4-e 1� kGt65- e ! / , caner/ ' gent f or 6 �„ e ,¢ i / , 5-1---6-- it. g A (PLEASE PRINT) (PERMIT HOLDER) kto A h :° ® Do hereb �s b o - ;o It' ink location Iti A meets '< x ' io and' " I .. rb, on Count ■ ® e County l and use and development standards for street tree installation. ® ADDRESS: / Wft/Iit'u L i ® t /34 LOT: l SDIVISION: 1 l` /� // ,,� 41 BY:' DATE: ?"— (----- ® RECEIVED BY: '‘, Ai �� � ,� �O r DATE: 8- Z4- cam- A VYYYYYYYYYYYYYYYYYVYVYVY®® V® ®®VTVTTVVVVTVVVYTVYVYTYYYTYVVVT CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 1 14;s3.-- BUP / Received v Date Requested ° 7" AM PM BUP Location / -- gi Suite MEC Contact Person C3rjlae Ph ( ) 7/o — 8 r lS 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 4 ART FAIL P UMBING - 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 Final 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 8-Z4--04-- 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 � D� ' _ ��� INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested F 3 AM PM BUP Location / 2 5 - 0 r Suite MEC Contact Person Ph ( ) "7/D — (5— PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: "-A_ SIT Post & Beam Shear Anchors • Ext Sheath/Shear Int Sheath/Shear p // / , Framing 0R T O '! L� 'o4 (K S 'Z o• K S Insulation =S SUL= rS Drywall Nailing Firewall 41 (v -! - Fire Sprinkler Fire Alarm Susp'd Ceiling Roof / Other: SASS AIy PLUMB! ✓ 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 ASS PART FAI CTRICAL ✓ Service Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA ('� Approach/Sidewalk Date d - 3 - D 4- 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 aDo T C/ `"ovmA INSPECTION DIVISION ' Business Line: (503) 639 -4171 BUP Received Date Req ested g— 2-e AM PM BUP Location / 1 5 Z ) Li 2 4.0 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC ``__` Footing ELC \ Foundation Access: Ftg Drain ELR NAM Crawl Drain / /� Slab Inspection Notes: SIT �� Post & Beam w, Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PART FAIL I. 1� Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: `♦ PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS A RT FAIL r AL • ce Rou. ' - UG/SI Low Volta Fire Alarm ma El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. — PASS PART AIL SITE ❑ Please call for reinspection RE: 0 Unable to inspect – no access Fire Supply Line ADA .� Approach/Sidewalk Date ^04) Inspector w Ext Other: Final DO NOT REMOVE this Inspection rec rd from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 0 ,20 INSPECTION DIVISION • Business Line: (503) 639 -4171 BUP Received Date Requested — 1 ( .° AM PM BUP Location /t7 a C.Q )Q .( Suite MEC Contact Person - Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT / 4 Post & Beam /w" Ext Shear Sheath/Shear Anchors =� r# Ext eah/h Eff Int Sheath/Shear .�, Framing K 1 ►' W a I a.0•1 Insulation v � a , a 6 °a Drywall Nailing J Firewall iM a s A6Atk 66 :a 6 F Fire Sprinkler 1 Fire Alarm Susp'd Ceiling Roof Other: Final �� Q �'�'� PASS - , T FAIL \\ ST �^ / �' ^ 1\C � D ® � --.)4 R& Il Post & gr Slab R ) v Under F 4►-� J—�� �JE� Rough -In Water Service , f Sanitary Sewer PCLO v I C CsaJ S I fl nu) V IT W bfig itA3s Rain Drains Catch Basin / Manhole Peat (IV Storm Drain Shower Pan Ot • ina SS PART I MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS _P AU FAIL .ECE`CTRI Rough -In UG/Slab Low Voltage Fir= larm a r41, Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL S Please call for reinspection RE: Unable to inspect — no access Fire Supply Line V ADA Date . C - Inspector Ls. f Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection recor from the Job site. PASS PART FAIL