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15490 SW EMPIRE TERRACE c� M 3 1� ro ro 0 ro I A 15490 SW Empire Terrace CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - BUP _ _Date Requested_ _AM �PM BLD Location /� y yy S w Suite MEC Contact Person _ Ph0:0.9-3 3 7 PLM _ Contractor Ph _ _ i — SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Accr?ss: --- - -- `- Foundation FPS Fig Drain SGN _ - Crawl Drain Inspection Notes: SlabSIT Post&Beam - _ - —�_._------ Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing _ Firewall _ Fire Sprinkler - Fire Alarm Susp'd Ceiling Roof Misc: -- Final PASS PART FAIL ----- - -- ---- - ---._ �...- PLUMBING Post a Beam Under Slab Top Out ---- Water Service Sanitary Sewer --—--- -- --- __ - - ------------------- Rain Drains Final PASS PART FAIL MECHANICAL Post& Beam -------- -- Rough In Gas I.Ine --- - -- Smoke Dampers Fir.-1 - -- -- -- - PA5a PART FAIL. >,ervice IRough In JUG/Slab Low Voltage F Alarm ASS PART FAIL Backfill/Grading - -- --� Sanitary Sewer Storm Drain ( Reinspection fee of$_ __ _—required before next inspection. Nay at City Hall, 13125 SW Hall Blvd Catch Basin ( )Please call for reinspection R!-.. ( I Unable to ln%pert-no access Fire Supply Line ADA Approach/Sidewalk Date G� -�� Inspector Ext Other - Final PASS PART FAIL DO NOT REMOVE this inspectioh record from the joh site. Cf i OF TIGARD BUILDING INSPECTION DIVISION MST -2G66 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP ' Date Requested 5._ 2 AM **" PM BLD _ Location // U Suite _ MEC Contact Person Ph ,t2e, 33 76' PLM Contractor Ph SWR _ Tenant/Owner ELC Retaining Wall ELR Footing At cess: Foundation FPS Fig Drain SGN ----- ----- _ Crawl Drain Inspection Notes: -- - -- - Slab SIT Post&Beam --�- Ext Sheath/Shear Int Sheath/Shear Framing _ Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof AP S PART FAIL PL MBING Post % Beam Under Slab Top Out Water Service Sanitary Sev er Rain Drains Final PASS PAR'i FAIL ANIC Post&Beam Rough in Gas Line - - - --- §jnokeDampers PART FAIL ELECTRICAL Service Rough In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill/Grading - -- -- --- —' –� Sanitary Sewer Storm Drain ( j Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( ]Please call for reinspection RE: ( ]Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Other Date S 1 —Ol Inspector Ext Hi ,al PASS PART FAIL-j DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST -� - 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP Date Requestedt 'l _AM _PM ---- QLD Locations 7--r'r✓ Suite _ MEC --- Contact Person Ph 2V —}.316) FLM __— Contractor Ph SWR WILLING _ Tenant/Owner ELC Retaining Wall ELR Footing ACC@SS: c --------_�---- Foundation l r 4 A-A, -3 P—TTLL�� YST FPS Ftg Grains W s �� C�.�a i SGN --- -- �— Crawl Dra.n Inspeciion Dotes: Slab — SIT Post&Beam _-_.- Ext Sheath/Shear Int ShedthlShea- ---------- ----------_�._-- Framing --------- -- Insulation Drywall Nailing ------- --- Firewall — -- -------- -__--_ ----_____. Fire Sprinkler Fire Alarm Susp'd Ceiling --- Roof Misc: Final PA PART FAIL -----_----_—.--- 6' Post& Beam -- —---- —� --- Under Slab Top Out --- ------ --- - — Water Service Sanitary Sewer a _ S PART FAILS p ! S MErRANICAL Post& Beam -- - - — Rough In Gas Line Smoke Dampers Final -— — PASS PART FAIL ELECTRICAL —'— — Service _ Rough In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL _ SITE Backfill/Grading — Sanitary Sewer Storm Drain [ j Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ j Please call for reinsper.lion RE!___ __ [ j Unable to inspect-no access Fire Supply Line ADA Dia S.•�1 Approach/Sidewalk p 9_ �/�' Ext Other Date / - Inspector _ _ - --� Final PASS PART FAIL 00 NOT REMOVE this inspection record from the job site. n � 0 0 b a N R Co� Sr S. n C. r o � � z O o n o � � v 4 \� 0 t 3� a CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTAN'T PERMIT NOTICE GARNER ELECTRIC 21785 SW TUALATIN VALLEY HWY S ALOHA, OR 97006-1248 Electrical Signature Form Permit #: MST2000-00543 Date Issued: 1/5/C ' Parcel: 2S111 DA-14500 Site Arldress: 15490 SW EMPIRE TERR Subdi JF ion: APPLEWOOD PARK NO. 3 Block: Let: 138 Jurisdiction: TIG Zoning: R-7 Remarks- S/F PATH I Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the addrF\ss above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received 0\NNFR ELECTRICAL CONTRACTOR: MATRIX, DEVELOPMENT CORP GARNER ELECTRIC 6900 SW HAINES ST STE 200 21765 SW TUAL.ATIN VALLEY HWY S TIGARD, OR 97224 ALOHA, OR 97006-1248 Phone #: Phone #: 591-1320 Req #: L'c 121159 SUP 37075 ELE 34.3050 AN INK SIGNATURE IS REQUIRED ON IS F9RM,, � w X Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD MASTER PERMIT PERMIT#: MST2000-00543 OEVEL.OPMENT SERVICES DATE ISSUED: 1/5/01 '13125 SV'/Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 15490 SW EMPIRE TERR PARCEL: 25111 DA-14500 SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R-7 BLOCK: LOT: 138 JURISDICTION: TIG REMARKS: S/F PATH I BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED -_ CLASS OF WORK: NEW HEIGHT: 23 FIRST. 802 of BASEMENT: at LEFT: 5 SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 840 it GARAGE: 454 of FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 51`1 DWELLING UNITS: 1 FINBSMENT: at VALUE: $152,011 00 RIGHT: 17 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,642.00 of REAR: 12 PLUMBING SINKS: I WATER CLOSETS: 3 WASHING MACH: i LAUNDRY TRAYS: FAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS: TUBISHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAP:,: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: GOILICMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN>-100K: I UNIT HEATERS: HOODS: 1 OTHER UNITS: I MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCE!I.ANFn11c ADD'L INSPECTIONS 1000 EF OR LESS: 1 0 200 amp: 0 200 amp: WR. 'C OR FOR: 1 PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 3 201 - 400 amp: 201 400 amp: tat WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 000 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HMISVCIFDR. 601 1000 81np: 001+ompa-I00Ov. MINOR LABEL: 1000+amolvolt PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVCIFDR>-225 A.: >000 V NOMINAL: C'"AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERIIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO. FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATARELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Contractor: TOTAL FEES: $ 3.649.82 Owner: This permit is subject to the regulations contained in the MATRIX DEVELOPMENT CORP LEGEND HOMES CORP 'Tigard Munir'pa'C orla State of OR Specialty Codes and 6900 SW HAINES ST STE 2.00 12755 SW 691 H AVE#100 all other applicabb laws All work will be do!,9 in TIGARD,0I4 972.24 TIGARD,OR 97223 accordance with approved plans. This pem 4 will expire H work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. ATTENTION Phone: Phone: Oregon law requires to follow rules adopted by the Oregon Utility Notifi, n Centcr. Thom rules are set Reg 0 L.IC 60563 forth in OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direc!questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Framing Insp Gas Fireplace Electrical Final Sewer Inspection Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Footing Insp Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Ins{ Rain drain Insp Plumb Final Foundation Insp Footing/Foundation Dr; Electrical Service Low Voltage Water Line Insp Final inspection Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Building Final Issued By : _ __ Pet mitt ee Signatu�� Call (5 3) 639-4175 by 7:00 p.m.for an inspection needed the next bLAIness day CITYOF 'rIG /e RD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2000-00370 13125 SW Hall Blvd., Tigard, OR 97223 (503) C39-4171 DATE ISSUED: 1/5/01 SITE ADDRESS; 15490 SW EMPIRE TE:RR PARCEL: 2S111DA-14500 SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R-7 BLOCK: LOT: 138 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF dwelling. Owner: _ FEES MATRIX DEVELOPMENT CORP Type By Date Amount Receipt 6900 Sqn HAINES ST STE 200 TIGARD, OR 97224 PRMT CTR 1/5/01 $2,300.00 27200100000 INSP CTR 1/5/01 $35.00 27200100000 Phone: Total $2,335.00 Contractor: Phone: Reg#: Required Inspections Sewer Inspection I This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located a'k the measurement given,the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95'1-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503) 246-1987. Issued by: - - _ Permittee Slgnature�__..4L Lf4 Call (903) 639-4175 by 7:00 P.M. for an inspection needed the next business day ISI 2000 - co-3�70 Building Permit Application Date received: a tjJ P — City of Tigard Project/appl.no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd,'Ligard,OR 97223 Phone: (503) 6394171 Date issued: _ By: Receipt no.: „ Fax: (503) 598-1960 Case file no.: Payment type: Lard use approval: 1&2 family:Simple Complex: L IL 1 I ' 51"1&2 family dwelling or accessory U Commercial/industrial 0 Multi-family erNew construction 0 Demolition r 1 Addition/altemtion/replacement 0 Tenant improvement 0 Fire sprinkler/alarm 0 Otho-. 11 SITE INrd][INIATiON Job address: (SI(°L Cj `Jt� ��l Gy�/LY��Z= Bldg.no.: Suite no.: Lot: ( Block: Subdivision_ �J L Tax map/tax lot/account no.: Project name: Description and location of work on premisestspecial conditions: Z 3 4 2/ 3 32- 011 NFII FOROP CiAL INFOANIATION: Name: G P p ' , lain,se.pilecapoelly,,solar,etc.) Mailing add ss: /,g i3 3` 1 d L family dvr•,lling: City: U State-.p ZIP: j7 Valuation of work........................................ $ Phone: 4,022,�OFax E-mail: No.of bedrooms/baths................................. 3— Owner's representative: J Total number of floors................................. Z Phone Fax: E-mail: New dwelling area(sq. ft.) . ........................ Oaragetcarport area(sq.ft.)......................... 4-- Name: Covered porch area(sq ft.) ......................... _ Mailing add ss• :%��L�* Deck area(sq.ft.)........................................ _ City:--,, Statep ZIP:9 7 Other structure area(sq.ft.)......................... _ Faxes E-mail: CommerclaUlodustrial/multl-family: Phone: p_ o Valuation of work........................................ $ — Ea;sting oldg.area(sq.ft.) .......................... Business name: L v h,25 New bldg.area(sq.fL) Address:I.L 7J- Number of stories........................................ — City: pStated ZIP:'Y 7.2. Type of construction.................................... Phone: O a Fax E-mail: Occupancy group(s): Existing: CCB no.: (p p _� New: City/metro tic.no.: 2-.1 Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: / provisions of ORS 70', and may be required to be licensed in the Address: GJ jurisdiction when.work is being performed.If the applicant is S exempt from licensing,the following reason applies: City: '�d 5tatom ZIP: 97 Contort person: at�9 Plan no.: r Phone:&20 - e d I Fax:s— E-mail: -- Name: ��,��/,.G/� Contact person: _ Fees due upon application ...........................$ Address: -- o Date received: City: csi Statee ZIP: f 7 .1 Amount received .........................................$ Phone: , pqs Fax: E-mail: Please refer to tee schedule_ I hereby certify I have read and examined this application and the Na wt kAts"aw wcW cr"I cuds,*m call jwiWkdon for nae infamwim attached checklist.All provisions of laws and ordinances governing this O visa O MasterCard work will be complied with,whether specified h- in or not. 'cud"""' E.pir Al 46 t.v Authorized nature: �12oY 7Date: Name of mdholdw u dwwn ca cmdii cora S Print name: stirs � ^' Notice:This permit applicat' n expires if a permit is not obtained within 190 days after it has been accepted as complete. 410-4613(60M0OM', Mechanical Permit Application and Ci of Ti Date received: Permit no.: 46 W" --- -� —-- g Project/appl.no.: Expire date: City ofTigurd Address: 13125 SW Hall Blvd,Tigard,')R 97223 Phone: (503)(503)639-4171 Date issued: P,y. I Receiptna.: Fax: (503)598-1960 Case file no.: Payment type: Land use approval: Building permit no.: OFARIVI 11'11 1 &2 family dwelling or accessory El Commercial industrial O Multi-family U Tenant improvement New construction U Addition/alteration/replacement U Other.`_- 1 Job addres3: 0 "AIn-'icate equipment quantities in boxes below.Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ I.ot. (3Cj Block: Subdivision: ::ii •See checklist for important application Information an•1 Proje:t name: iurisdiction's fee schedule for residential permit fee, -- City/county: �'r Val, _ZIP: 9 71,197110 Description and to tion of work on premises:_ I IBM e 1 Est.date of completion/inspection: �tFee(eaJ fatal lon Qt . Res-only Res.only Ten, it improveme IF change of use: Fxwr.._— Air handling unit CFMA Is existi space heated or conditioned?Q Yes ❑Nr ir con tuomng ariaan requue ) - Is e ' ng space insulated?O Yes O No A coca o ex ung aysZ iem 1 or a compressors Business name: brat^boiler permit no.: - -- — HP —Tons BTU/H Address: p3- silo a a-- uctsmoke detectors - City: Is ZIP: 17 eat Pump(site plan required) Phone: _7 7 Fax: 7Gy E-mail: tnsta rep ace urnac urner—ff'I'O7R- CCB no.: 13 Including ductwork/vent liner U Yes O No - nsta rep ac re orate eaters-suspen e , City/metro lie.no.: -42 wall,�. wall,or floor mounted Name(please print): L(i I vent forappliance other than furnace — 1 1 e era om Absorption units _ BTU/H Name: / Chillers_____ NP - Address: _t,/�� Co nessors HP - _— Environmentalrut aniTent too: City: �v State:OQ ZIP: Appliance vent Phone -7) Faxes J ,'L `j E-mail: erex aust -- s, ype res. ttc a azmat hood fire suppression system Name: �P D/y Q _ Exhaust fan with single duct(bath fans) Mailing address�„1�J Jy 2 gusts stem o arl from heating or AC -'— City L<7 ) Statr� 71P:97,,�j - Fuelpiping an st ut oo up to outlets) Type: LPG _- NG Oil Phone: _ p Fax - ,WE-mail: __ uF ei i m each additional over 4 outlets - Process piping(schematic F;ju`1 ) _ Name. /= Je Number of outlets r �r Address: — ter app. ce or equipment: Duorat:ve fireplace City: �_ — _ State: ZIP' Insert-type- - - Phone:W Gb Fax: E-mail: - - tov pe etstove _ _ Applicant's signature: ate: t err: — Name(print): IF --_ —_ Not all juti"cdoru accept credit c",pW6 call jurisdiction fa moxa irdarmatlon. Permit fee.................. $ Notice:This permit application Visa O Muter<:'atd Minimum fee................$ expires if a permit is riot obtained Credh card number:— _�_L Plan review(at 96) $ Fapira within 180 days after it has been State surchprp-(8%)....$ —�Name of cardhoidv uu hw sa on reedit era accepted as complete. -- -- ----- S _ TOT�. .......................$ Crdhotder siptatre Amount 440.1617(60alCpl.q) Commetcial Schedule 1&2 Family Dwelling Schedule ASSUMED VALUATIONS PER APPLIANCE Description Furnace to 100,000 STU Table 1A Mechanical Code _ oty P,ee Tool 1) Fumarx to 100,000 BTU Including ducts&vents 955 klFaudi dude 6 vents 14.00 Furnace>100,000 BTU 2) Furnace 100,000 BTU. Including duels&vents 17.40 Including ducts&vents 1,170 3) Floor Fumsoe floor furnace-. _� includingvent _ 14.00 4) SusperldW healer,wall Mater Including vent 955 or Noor mounted Mater` _ 14,00 suspended heater,wall heater 5 Vent no(kldnded N appliance emN _ 6.80 or floor mounted heater 955 6 Ir units 12.15 lienee permit 445 Check all that apply. •Boner flea Air Vent not included Ina PP Pe For Nems 7-10,men or Pump Cond Oty Price Total Repair units 805 10olrlotes 1,2 cornF _ 7)4HP;absorb unit to <3 hp;absorb.unit 1o0N BTU 14.00 6)3-15 HP;absorb unit _ to 100k BTU 955 10(&to 500k Biu 25.60 3-15 hp;absorb.unit911.61.6 a°HP;absorb unit.5.1 mit Biu 3s,00 101k to 5COk BTU 1700 10)30.50 HP;sbsortl unit 1-+.75 mill BTU 52.20 15 30 hp;abstxb.unit 11)--$OHP;sb b unit>1.75 mN OTU 501k to 1 mil.BTU 2310 _ 6720 12)Ait handNnq unit b 10,000 CFM 30-50 hp;abscub.unit 10.00 1-1.75 mil.BTU 3400 13)AN harldNrg unit 10,000 CFM. - 1720 141 Non-porfabN evaporate scoter >50 hp;absorb.unit 10.00 >1.75 mil.BTU 5725 15)Vent isn connected to a single dud 6.60 Air handling unit to 10,000 dm 656 +6)Ventilation system notIncluded in appliance permit 10.00 Air handling unit> 10,000 dm 1170 17)Hood served by mechanical exhaust Non-portable evaporate culler 656 1000 16)Domeslr.kldrwrators vent fan connected to sa single dud 446 17.40 Vent syst not II tciuded Inappliance permit 656 19)Commercial Of k,dd,tnal type Indy erstor 69.95 Hood served by mechanical exhaust 656 20)Othei units.including wood stoves +o.00 Domestic Incinemlor 1170 21)Gas piping one to iwr outlets 6.40 Commercial or Industral Incinerator 4590 22)Mea than 4-per oulM(each) Other unit,Includingwood stoves,Inserts,etc. 656 _ 1.00 MlMmlan Permit Fee 72.60 SUBTOTAL Gas piping 14 outlets 360 _e%SURCHARGE _- Each additional outlet 63 PLAN REVIEW 25%OF SUBTOTAL Required for ALL commercial permits only TOTAL Other Irop-o-end F- I MW-VOM cede.d roan"bMnlneee hen(erenYrexn cfwpe-hvo houn) ST2.ad per hou �,,�' �' 2 irwlwceim lar which m tf n w"bri iM kvaceled(mhwnurn doge heli hour) IQUayaluaho 17190pertau 1>_ Fee 2 AdtlNt«W plM+r..ew nxluraA bF durwee,addaane«revVebne h plan)(rnirvrr.m duvpe wwfiae houq 177.1e PN hour •Slee C«t licb.Ilona('.Milkaaon required S 1.00 to$5,000.00 Minimum$72.50 `R*%Mw "An A.rUn tA01M1q plecenwrq d um 55,001.00 t0 310,000.00 572.50 for the first$5,000.00 and$1.52 for each additional 5100.00 or fraction thereof, to and including 510,000.00 $10,001.00 to$25,000.00 S148.50 for the first$10,000.00 and 51.54 for each additional$100.00 or fraction thereof,to and incl-tding S25,000.00 525,001,00 to$50,000.00 $379.50 for the first S:5,000.0t1 and$1.45 for each additional S 100.10 or fraction thereof,to and including 550,000.00 550,000 00 and up $742.00 for the first$50,000.00 and 51.20 for each additional$100.00 or fraction thereof Plumbing Permit Application Datereceived: Permit no.: City of Tigard ~ A4 Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer oertnit no.: Building permit no.: Cify ofTigard Phone: (503) 639-417 t Project/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: _— By: Receipt no.: Land use approval: Case file no.: Payment type: t 1 &Z family dwe'Lng or accessory U Commerciallindustrial U Multi-family O Tenant improvement e'Ncw construction U Addition/alteration/replacement O Food service U Other: r l t Job address: Description Qty. Fee ea. Total I5 o Sew�f3 t't.� 'TtcYl/?,I�GC Fee(ca.) Bldg.no.: I Suite no.: Hew 1-and 2-family dwelling-1 a:Jy: (includes 100 ft.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: IBlock: I Subdivision:PoMIG. SFR(2)bath _ Project name: SF R(3)bath City/county: ZIP: _ F;c:h additional bath/kitchcn Description and lotation of work on ptemises: Site utilities: Catch basin/area drain Est.date of completionrinspection: Drywells%leach line/trench drain PLUMBING CONTRACTOR Footing drain(no.lin.ft.) Manufactured home utilities -- Business namt: o Manholes _ -- Address: ' (3 o k c2OD _ Rain drain connector — City: j.Q,nyState:p 7.II': 7p3� Sanitarysewer(no.lin.ft.) ---- Phone: 7- Fax:6b 7_9 E-mail: Storm sewer(no.lin.ft.) CCB no.: A 3 Plumb.bus.reg.no: p Water service(no. fh) City/metro lic.no.: Fixture or Item: Absorption valve Contractor's representative signature: PQf Back flow i)mventer Print narrte: Date 1, G a U Backwater valve -- -- asins/lavatory Name: /pr Clothes washer Address: eo 7 Dishwasher _ d Drinking fountain(s) ._ City: nThpyn State ZIP: ��3D Ejectors/sump Phone: Fax: E-mail: Expansion tank Fixtureiscwer cap Name(print): L p Q S Floor drains/floor sinks/hub Mailing address: 7j— G t, Garbage disposal Hose bibb City �C'e4 laglkState:o RI ZIP: Ice m er Phone: . m Fax:d E-mail: _Interceptor/grease trap -- Owner installation/residential maintenance only: The act" installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own per ORS Cha ter 447. Sin (s),basin(s),lays(s) -- _ OwncCs sig•,ature: �,>pate: I Z by Sum Tubs/shower/shower pan Urinal Nance r _ Water closet — _ - Address: ,� Water teeter City: Statep ZIP: Other. _ Phone: ne'a poU Fax:_ E-mail: Total Not dl lroiad"om accept credit cards,pkne can Jurisdiction formore Mrhrtnauerr Minimum fee................$ -- Notice:This permit application O Visa U Muurt and Plan review(at __ 96) $ expires if a permit is not obtained crani cud number: x—L within 190 days after it has been State surcharge(8%) ....$ M TOTAL ...$ Mon ar c"��r u mown on credit accepted as complete. .................... --— I, ca'aholdersiaoalure : Amount I FIXTURES (in dividual) ;Qty vP:Le i. Total Fixture Type Quant i b work Perlorrned Sink J 16.60 Naw I Moved Rr Wced Ramo -Capper !_avatory 16.60 Sink - Lavatory Tub or Tub/Shower Comb. 16.60 Tub or TuWShower Combination Shower Only - 16.60 Shower Only - Water Clusel 16.60 Water Closet - Urinal Urinal 16.60 Dishwasher sal Dishwasher V 16,60 Garbkee Dts e - Laund Room Tray Garbage Disposal 16.60 Washing Machine 1-sundry Tray 16,60 Floor DrairvFloor Sink 2' -' � -__ 3' - Washing Machine 16.60 4• Floor DraiNFloor Sink 2' 16.60 Water Heater 3' 18.60 Other Fixtures(Specify) 4' 16.60 Water Heater O conversion 0 like kind 16.60 -- - Gas piping requires a separate mechanical permit. - MFG Home New Water Service 46.40 - -- MI'U Home New SanlStorm Sewer 46.40 Hose Bibs 16.80 - COMMENTS REGARDING ABOVE: Roof Dtalns 16.60 Drinking Fountain 18.80 - - - -- -- Other Fixtures(Specify) 21.75 Sewer-1 at 100' 55.00 Sourer-each additional 100' 46.40 �'"�^� Water Service-1 at 100' 55.00 Water Service-each additional 200' 45.40 Storm R Rain Drain-Is(100' 55.00 Storrs d Rain Drain-each additional 100' 46.40 Commerdal Back Flow Prevention Device 46.40 Residential Backflow Prevention Device" 27.55 Catch Basin - 18.60 Insp.of Existing Plumbing or Specialty Requested 72.50 Inspedlonsper/hr Rain Drain,shgie family dwelling 65.25 Grease Traps 16.80 QUANTITY TOTAL I toren or rber diagram Is required I Ousnilly Total to >9 'SUBTOTAL 8%SURCHARGE „ AI "PLAN REVIEW 25%OF SUBTOTAL R onI fixture .Wel Is>9 TOTAL ' *Minimum permit fee Is $72.50+a%surch"e,except Reskk4"Raddlow PreveMkm Device,which b$36.46 r a%wrchu". '•An New Commercial 6u6dings requite p4ans with tsomeirk or rtw dlograrrt arni pitan revkw. Electrical Permit Application Date received: Permit no.: City of Tigard Project/appl.no.: Expire date: Addre:.s: 13125 SW Hall Blvd,Tigard,OR 97223 City of'1-ibarJ bate issued: By- Receipt no.: Phone: (503) 639-4171 -- Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 1 &2 family dwelling or accessory ❑Commen-ial/industrial ❑Mul:i-family ❑Tenant improvement New construction ❑Addition/alteration/replacement U Other:^— _ ❑Partial 1 Job address: U ylN 1 T'FlQC 1�CMA Bldg.no.: Suite no.: iTax map/tax lot/ar:ount no.: --�_ Lot: Block: Subdivision: QLrci C7LV MAV__ Project name: Description and location of work on premises: _ Estimated date of completiordins ction: 110 7es Fee Max Desai titin Qty. (a) 'total no.Ins �� G--- New residential-single or muNi-fandly per / �� dwelling unit.Includes munched gxrmg=Slatt. ZIP: Servicelncludea 1000 sq.11 or leas Phone /- L1 Fax i -7gjj mail: _ 4 C, o.: LS _ Elec.bus.lic.no: r— Each uldf;ional 500 sq.ft.or portion thereof - - - Urnitedenergy,residential itY 3 70 7 -_--__-_ Lin uted energy,non-residential 2 s Each manufactured home o.modular dwelling n tore su rv!s g electrician(required) Dnte Service and/or feeder - 2 Sup.elect.name(prim): .c License no;- � Q Servicesorfeeders-InstaWtion, alteration or reloatlon: 200 amps or leis _ 2 201 amps to 400 snips - 2 Name(print): ®�1 v� 5 -_----___ 401 amps to 600 amps -- _ 2 Mailing addres! X_ 601 amps to 1000 amps - 2- City: 'p o Statet3 ZIP: J j,a j Over 11000 amps or volts_ --- — 2 Phone:Gam- Orf) Fax:sl. r E-mail: "econnectonl I Owner installation:The installation is being made on property I own Temporary servic"or feeders- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrelocation: 200 amps of leas _ 2 ORS 447,455,479,670,701. 201 amps to 400 amps 2 Owner's signature: fi0 Date: D 4(1 1 to 600 amps z Branch rimults-new,alteration, or extension per panel: Name: r �n ar r . A. Fee for branch circuits with purchase of Address: q / 'gyp-'7-- service or feeder fee,each branch circuit 2 City:.• - StateO ZIP.g7 _ B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: Fax: E-mall: L..',addit.anal branch circuit: Mbc.(Service or feeder not Included): U Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle 2 U Service over 320 amps-rating of 1&2 U Ha:irdous location Each sign or outlire lighting -_ _- 2 family dwellings U Building over 10,000 square feet four or Signal circuitts)or a limited rnergy panel, U System over 600 volts nominal more residential units in one structure alteration,or extension* 2 U Building over three stories U Feexters,400 amps or more *Description: -- U Occupant load over 99 persons U Manutactured structures or RV park Each addltlotral Inspection over the allowsble In any of the above: U Fgrt Aightingplan U Other Perinspectior Submit__-wits of plats with any of the above. Investigation Fee The above are not applicable to temporary condrutrtlon service. Other —--- --- Permit fee............. $ Not all iudsdictiam accept cm It earth,please alt)-i•4"on for more iammation. Notice:This permit application ""'... -- U Visa U MastrCard expitcs if a prrmit is not obtained Plan review(at — %) $ _ Credit card numtzr: -__ within 180 days atter it has been State surcharge(8%) ....$ Fxpir`a accepted as complete TOTAL. .......................S Nsne of c�ol�as shown on c.edii cud — -- Cardholder aiiinature -- -- -- - Amuur.l -- 44" .,(6n/Com) 4. Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Number of Inspections per permit allowed Restricted Energy Fee....... $76.00 Service included: Items Cast Total (FOR ALL SYSTEMS) 4a. Residential-per,mit Check Type of Work hrvolved: 1000 sq.R.or less $147.15 4 Each additional 500 sq ft.or ❑ Audio and Stereo Systems portion Ihereol _ $33.40 1 Limner)"nergy _ $75.00 ❑ Bury:x Alarm Each I anufd Home or Modular Dwelling Service or feeder - S9u.53 2 ❑ Garage Door Opener' 4b.Services or Feeders Installation,alteration,or relocation ❑ Heating,Ventilation and Air Conditioning System' 2.00 amps or less $80.30 2 201 amps to 40G amps $106.85 2 ❑ Vacuum Systema' 401 amps to 600 amps $160.60 2 601 amps lio 1000 amps --_ $24060 _ 2 ❑ Other_ over 1000 amps or volts $454.65 2 - -- Reconnect only - _ $66.85 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY 4c.Temporary Services or Feeders � - Inslallalion,alteration,or relocation Fee for each ,ystem.............................................. $75.00 200 amps or less i $66.85 2 (SEF_OAR 918-260-260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps __ $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. ❑ Audio and Stereo Systems O(i,branc.,.Circuits hdew,alteration u,extension per panel Boller Controls a) F he fee for branch dimits wit"purchast of service or ❑ Clock Systems feedarfee. tach.)ranch dicuit - -_ $5.65�,- 2 ❑ h)The Ire for bran ch circuits Data Telecommunication Installation wlthc of purchase of service ❑ or fender fee- Fire Alatm Installation First branch d;cuit $46.85 _ Each sddiliorat branch circuit $6.65 V _ ❑ HVAC 4e.Miscellaneou; ❑ (Service or feeder not Included) Instrumentation Each pump or Irr gation dude $53.40 _ Each sign or outline fighting __ $53.40-^�! ❑ Intercom and Paging Systems F:gnal circuft(s)or a limited energy panel,alteration or extension -�_ $75.00 ❑ Landscape Irrigation Control' Minor Labels(10) $115.00 4f.Each additional Inspection over ❑ Medical the allowable In any of the above Per Ihspeclion - -� $62.50 _ �� Nurse Calls Per hour $62.50 In Plant _ $73.75 ❑ Outdoor Landscape Lighting* 5. Fees: ❑ Protective Signaling 5a.Fritef total of above tees $ e%Surcharge(.08 X total fees) $ ^ ~ - ❑ Other-�-- -- -_ ---_-`�_--..- Subfofil $ 6b.Enter 25%of fine 5a for � __-Number of Systems Ilan Review llfreqyired(Sec 3) $ Subtotal $ No licenses aro required Licenses are required Ix all other Installations Trust Aunt p FEES: Toeal balance Due $ ENTER FEES $ --.- - --- 8%SURCHARGE(.08 X TOTAL ABOVE) $ TOTAL $ -------._.-- FLOT FLAN LOT 1*130, ArF-IPL E WOOD PARC RIF-"D 251 11 DA TAX LOT '014EZO 154130 5W EMPIRE TERRACE S.E. 1/4 OF SECTION 11, T.2, R.]W, W.M. CITY OF TIGARD W,454tCGTON COUN. TY, OREGON C N D WATER METER I�NI laom s uJ------- WATER LINE ,,�, 100 S$---- SANiTAR Y SEWER Q '� 12765 SW 69th AVENUE SUITE72 gp- - - - {� w,JUN OFFICE (503) 820-8080 PORTLAND, OR. 9722: STORM [DRAIN FAX (503) 598-8000 CCB# 80583 �.-------- 4 OF STREET • MANHCLE ® CATCH BASIN PROPOSED STREET TREES STREET LIGHT ? F- FIRE HYDRANT Q I I ! W l LOT 138 201.0' L,. ...}}-53-} - -"I / / / -•131--� JU I I {N uj v '/'a rW � e� wr , N ! � � - ISI I < .21 1" 20'-0" 9 '54'25"W 159.0' I 5.25' PROVIDE EROSION ; CONTROL. FENCE ( 1 PER CCMMUNITY EROSION PLAN - 5W ASHFORD $T - E