Permit 1.
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00169
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. 1t DEVELOPMENT SERVICES DATE ISSUED: 6/1/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S115BD -00100
SITE ADDRESS: 11584 SW ROYAL VILLA DR ZONING: R -12
SUBDIVISION: LOT: JURISDICTION: URB
Project Description: Placement of new SFM.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SFM FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: THRD: sf RIGHT:
VALUE: 0
OCCUPANCY GRP: BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 • 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 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 & STEREO: VACUUM SYSTEM: AUDIO A. 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: This permit is subject to the regulations contained in the
Tigard Municipal Code, State of OR. Specialty Codes
CAL -AM PROPERTIES PRO HOMES INC and all other applicable laws. All work will be done in
11200 SW ROYAL VILLA DR PO BOX 322 accordance with approved plans. This permit will expire
TIGARD, OR 97224 DONALD, OR 97020 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
Phone: 503 968 - 1280 Phone: 503 730 - 8220 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
TOTAL FEES: $ 327.54 Reg #: LIC 103057 direct questions to OUNC by calling 503 -246 -6699 or
1- 800 -332 -2344.
REQUIRED ITEMS AND REPORTS
Issued By : Permittee Signature : /Jn/ /1/
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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lgasadactured Dwelling �
Placement Permit Appli v FOR OFFICE USE ONLY s
City of Tigard 1 ne iB J 1 " (},j V� Nunn No. e' ' ' �i2C(/W � D l Kg
13125 SW Hall Blvd., Tigard, OR 97223 20 Plan Review
CITY OF TI
Phone: 503.639.4171 Fax: 5Q3.598.1960 °'oi; � l '' . Date/By: OP V – S ti_o� 0
Inspection Line: 503.639.4175 1xv „•) — Date Ready /By: iuru• See Plan Submittal
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Internet: ww.ci.tigard.or.us BUILDING DI .�M – • Notified/Method: O I �� Requirements
.1011 SITE INFORMATION OWNER INFi))nivIATION _
L
Site Address: I ‘ 584, E � n l U I Imo -or- Name:
n �. 1 - � ` •
Park Name: p4G.l rYto(0 l Q- _ ` I l 4.5 Address: Jr l� �p f) 1 /' `
Subdivision & of #: I I goo SW l,) "ReNal 1i LIcl- "br
Directions to inspection site: p11C2 inn EoLj(�l ul 1 10. 1 u.ks.- City: 7 . c rCt. I State: D p � ZI 7 I t
V i_. 4 '�(� t1 Q. t d O niZ) Circle 43. Phone: I Fax•
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Is property inside city limits? INI Yes ❑ No E -mail: SO3 %$ / ago , •3 q ..1c /2 LS
LOCAL GOVERNMENT APPROVALS
Zoning Sanitation
Signature: . Signature:
Jurisdiction: S. Jurisdiction:
Date: Date:
MANUFACTURED DWELLING PLACEMENT PERMIT FEES
Cost (each) No. of Sum
(1) Installatlon/re- inspectloa Items
(a) Placement (includes placement, electrical feeder, 30' of water /sewer connection) $ 275.50 $
(b) State surcharge at 8% $ 22.04 $
(b) Re- inspection (includes inspection and 8% state surcharge) $ 62.50 $
Placement permit to be obtained only by homeowner, or Oregon - licensed manufactured dwelling installer.
(2) Electrical
(a) Service and/or feeder (new service installation or alteration/relocation of existing service). $ See Electrical Permit Application
Electrical service permit to be obtained only by homeowner performing work or signing supervisor of Oregon - licensed electrical contractor
performing work.
(3) Plumbing
(a) New water service (for services over 30 lineal feet) $ See Plumbing Permit Application
(b) New sanitation/storm sewer or rain drain (for services over 30 lineal feet). $ See Plumbing Permit Application
Plumbing permit to be obtained only by homeowner performing work or Oregon - licensed plumbing contractor performing work.
(4) Miscellaneous fees
(a) Administrative fee. $ 30.00 $
(b) System development fees (sewer connection, storm water, parks development & traffic impact). $ See Permit & System Development Fees
SUB -TOTAL $
SET -UP OR INSTALLATION CONTRACTOR APPLICANT L
Name: rvainaz Name: /' „ Q _ yZ 9 Y 17 e_A
Address: Address: ZO 12 t/ pv
City: Z S tate: ZI P: q —j Olio C ity: / ! (r+' I Stat c w - ��
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Phone: 3 7 30 7- 2.2.0 Fax: 5 to t 7 Phone: 967 S i2:8 I Fax: <- L , f al, S
CCB No.• ! 0 305 7 MDI No.: ! U 1---- E- Mail U �
SKIRTING CONTRACTOR
Name: I hereby certify that the information above is true and correct.
All work to be performed shall be in accordance with all
Address: gove ning " and rules .
City: I State: ZIP: A .i . i . ,���/: a 7/
Phone: Fax: r„uutorized Si ? Date
• CCB No.: I MDI/LSI No.: Print Name: iiA
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