11810 SW KOSKI AVENUE 00
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11810 SW Koski Avenue
CMASTER PERMIT
CITY OF TIGARD
PERMIT#: MST2002-00172
DEVELOPMENT SERVIC►-.S DATE ISSUED: 12/18/02
12125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171
SITU ADrIRESS: 11,910 SW KOSKI AVC- PARCEL: 1S135CD-K11007
SUBDIVISION: KALAMOIIKA ESTATf:S ZONING: R-12
BLOCK: LOT: 007 JURISDICTION: I•IG
RE"WKS: Construction of nPw SF detached dwelling. Path 1
BUILDING
REISSUE T STORIES. LOOR AREAS __ _REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT. .. FIPsT. _1 f BASEMENT: st LEFT: 5 SMOKE DETECTORS.
TYPE OF USE: SF FLOOR LOAD 40 9F-CnN0. 14, st GARAGE' Ono sf FRONT: 20 PARKING SPACES:
TYPE OF CONST: 5N DWELLING uNirs: t TRW sl RIGHT:
VALUE: t 77.bnh nn
JCCUPANCY GRr: R3 BDRM: 4 BATH: TOTAL. t ",S st REAR: 15
PLUMBING _
SINKS: , WATERCLOSETS: -+ WASHING MACH 1 LAUNDRY(RAYS: RAINDRAIN 11,o TRAPS:
LAVATOWE S: 4 DISHWASHERS: t FLOOR DRAINS- SF'NER LINES: too SF RAIN DRAINS I CATCH BASINS:
TUBISHOWERS: .i GARBAGE DISP i WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: t GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL _
FUEL TYPES FURN<100K: BOILIt:MP<IIHP. VENT FANS: CLOTHES DRYER: 1
GAS FURN>=100K: UNIT HEATERS. HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES VENTS' 1 WOODeTOVES: GAS OUTLETS: 1
_ ELECTRICAL
RESIDENTIAL UNIT SERVICE.FEEDER TEMP SRVC,I LLUERS BRANCH CIP.CUITS MISCELLANEOUS ADD'L INSPEC'IONS
1000 SF On 1-cSs: 1 0 - 200 smp 0 200 amp: WISVt-,OR FOR: PUMPIIRRIGATION: PER INSPECTION:
EA ADU'L 500b:- 1 201 400 amp. 201 400 amp: 1 st Wo SVCIF OR: SIGN/OUT LIN LT: PER HOUR:
LIMIT En 17111:RGY: 401 600 am0l 401 - 000 amp: FAADDL BR CIR' SIGNAL/PANEL: IN PLANT:
MANU HWF1VCII'DR: 001 1800 amp: 001+amps•1000V. MINOR LABEL:
1000+an01/volt- PLAN REVIEW SECTION
Reconneel only >600 V NOMINAL: CLS AREA/SPC OCC:
:•=4 RES UNITS: SVCIFOR>•225 A.•.
ELECTRICAL•RESTRICTED ENE:,GY r
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: x VACUUM SYSTEM: x AUDIO 8 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: A OTH: Al' ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL.
r,ARAGE OPENER: x CLOCK: INSTRUMENTATION MEDICAL OTHR:
HVAC: X DATAITELr COMM: NURSE CALLS TOTAL N SYSTEMS:
TOTAL FEES: $ 6,865.14
Owner: Contractor: This permit is subject to the regulations contained in the
STEVE ECK CONTRUCTION ECK CONSTRUCTION INC Tigard Municipal Code,State of OR. Specialty Codes and
PO BOX 204 n0 BOX 204 all other applicable laws. All work will be done in
SHERWOOD,OR 97140 :1HERWOOD,OR 97140 acoordance 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
P11ons 625-1305 Oregon Utility Notification Center. Those rules are set
Ph—.
503-625-1305 for'h in OAR 952-001.0010 through 952.001-0080. You
Rep N: I.I(• I I�1'� may obtain copies of these rules or direct questions to
OUNC by calling(503)248-1987.
REQUIRED INSPECTIONS
Erosion Control lusp 81 Post/Beam Mechanica Mechanical Insp Exterior S' :athing Inst Rain drain Insp Plumb Final
Sewer Inspection Underfloor insulation Plumb Top Out Low Voltage Water Line Insp
Fooling In,, Crawl Drain/Backwater Electrical Service Gas Line Insp ApprlSdwlk Insp
Foundatior Insp Footing/Foundation Dr; Electrical Rough In Gas Fireplace Electrical Final
Post/B erlrSMtura( PLM/Underfloor Framing Insp Insulation Insp Mechanical Final
Is ed Sy-; !(✓lMLik Petmitterf, Signature
Call (503) 639-4175 by 7:00 p.m. for an :nspecluon needed the next business day
CITYOF TI GARD _ SEWER CONNECTION PERMIT
LEVEL)PMEN-r SERVICES PERMIT#: SWR2002-00316
13125 SW Hall 'Blvd., Tigard, OR 97223 (5031 C39-411i 1 DATE ISSUED: 12/18/02
PARCEL: 1 S135CD-KM007
SITE ADDRESS; 11810 SW KOSKI AVE
SUBDIVISION: KAI.An1ctIIKAESTATLS ZONING: K I'
BLOCK: LOT: 007 JURISDICTION: II(
TF;JANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
WS TALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached dwelling.
O tuner: _ - _ FEES
STEVE ECK CONTRUCTION Description Date Amount
PO BOX 204 --
SHERWOGD, OR 97140 ISWUSAI Swr Connect 12/18/02 $2,300.00
s W USA) Swr Connect 12/18/02 $0.00
Phone: 503-625-1305 1 ,%VINSP]Swr Inspect 12/18/02 $35.00
ti\VINSP)Swr Inspect 12/18/02 $0.00
Contractor: Total $2,335.00
Phone.
Req #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clear Water Services. '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 sews is not located at 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' Peng
Issue by: %. Permittee Signature:
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business clay
Building Permit Application
City of Tigard Dare received: „ j Pemtlt no. } C
Address: 13125 SW Hall Blvd,Tigard, 9722 �ojecr/appl.no.: Expire date:
CirvrjTigarr/ phone: (503) 639.4171 .� ` Date issued: By:.,Y Receipt no.:
Fax: (503) 598-1960 , Case Ileno•: Paymenttype:
1&2 family:Simple Complex:
Land use approval: _� - 1,
&{I &2 family dwelling or accessory 0 Comm*)" ustrial U Multi-family New construction ❑Demolitierr.
✓U Acldition/alteration/replacelnent U Tenant improvemc It U Fir. sprinkler/alarm U Other:
Job address: Bldg. no.: Suite no.
Lot: PI'm k: Subdivision: q/ari�rU_1 f Tax rnap/tax lot/account no.:
Project name: —
Description and location of work on prernises/special conditions:
PIP— OWNER FORSPECIAL INFORMATION, USE 611ECKLIST
r
dplaill septic captivity,solar,etc.)
tPh
g address: ( Y do 2 family dwelling:— Valuation of work......1.7L �......................Fax: E-mail: No.of bedrooms/baths.................................
r's represen five: Total number of floors................................. r Z
-----
Phone: Fax: New dwelling area(sq. ft.) ..........................
1 11 152 Garage/carport area(sq. ft.)......................... Grd
Name: Covered porch area(sq.ft.) ......................... 4
-_ - - -` Lick area(sq.ft.)
Mailing address: .........................•..............
— h
Ote.structure area(s
Cit,: State: ZIP: y.ft.).........................
Phone: Fax: E-mail: Commercial/industrialrmulti-family:
Valuation of work........ I
. . . .. ...... ... $ -
Existing bldg.area(sq. fid.. ....... ..........
Business name: ` /�!L'" /��� New bldg.area(sq.ft.)
Address: 0 tO -2c� ............. ........... --
--- Number of stories
City: State: ZIP:
Type of construction................ ................... _
Phone: p ' Fax Email_ Occupancy group(s): Existing:
CCB no.: / 91 S� _ New:
City/metro lic.no.: i —Notice: contractors and subcontractors are required to be
licensed with the Oreton Construction Contractors Board under
Name: r S�%/�!�� �✓ ��� _—_ provisions of OItS 701 and may h.required to be licensed in clic
Address: 7 _ jurisdiction where work is being performed.If the applicant is
16-r a�� exempt from licensing,the following reason applies:
City: I StateLIP:
Contact Pen•n: Plari no.: - -- - - --
Phone " Fax: -TE-mail: I
1119M 10 A Pit um
Name: L'/1 /•f `person: Fees due upon application ........................... $_.
1� Date received: — _ —
City: 11dCr1� _Stat ZIP:97.x 7 Amount received ...
Phone:,I �7/ Fax: _ Email: Pease refer to fee schedule.
I hereby certify 1 have read and examined this application and the Not all Jurisdictions recd credit cards,pleau call)uriv icuon far mree inr<xm:ion l
attached checklist. All provisions of laws and ordinances governing this ❑visa 0 Mute Cord I
work will be complied with,whether specified herein i.;not Cr Ml cvd oumher: __._____________ .—E1phespha
-+ - --
Authorized signature: �''�" "�!DIIte: _ Il Nutrc d eudholder a awn on credit crd�
Print name: �, �c/r' ;� — --- — I S
l synrture Amount
Notice:This permit application expires if a permit is not obtained within 180 days dicer it has been accepted as complete. WO ol.1(WWOM)
One-and'Two-Family Dwelling
Building Permit Application Checklist Reference no.:
--- —— Assocwu edpeiv&s:
(Yrv,fT'i�,,rd City of Tigard O ElectriLdi r-1 Plumbing O Mechanical
Address: 13125 SW Hall 131vd,'I igard,OR 97223 UOther:
Phone: (503) 639-4171
Fax: (503) 598-1960
r
1 Land use actions completed.See jurisdiction criteria for concurre,t ,views. ^_
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('r with application.
9 Erosion control ❑plan ❑permit required.Include drainage-way protet 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 codtm Lateral design details and connections must he incorporated into the plans or on a separate full-sine
sheet attached to the plans with cross references between plan location and details.Plan review cannot he completed
if copyright violations exist. _
I I Sitelplot plan drawn to scale.1 he plan must show Wand building setback dimensions;property comer elevations(if I
there is mon!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 welfVseptic 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.Shoo all dimensions,room identification,window sire,k ration 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,root construction.More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sheathing,rooting,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thennal insulation,etc.
15 Elevatiop 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 addendum,,showing foundatier, :!cations with cross references are acceptable.
10 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 beating
IoLations.Show attic ventilation.
I(s Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered
systems,see iter,22,"Engineer's calculations." _
119 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 complivnce. 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
archiiect licensed in Oref�on and shall be shown to be applicai,le to the project under review.
23 Five(5)site plans are required for Item I I above. Site plans,just Ix?1 112"x I1"ua 11" x 17".
24 'rwu(2)sets each are required for Items I o, 19,20&22 above. _
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or mirrored building plans will be accepted.
27
28 _
C'recklist 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 rise only. 4404614(WWOM)
Electrical Permit Application
Date receivid, Permit no. e,T 90Lk; -OU{
City of Tigard Project/appl.no.: Expire dat_-
: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By. Receiprrrc_,:
Crryrr(Trgard Address
Phone: -
(503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: .
Xi &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement ❑Other: _ U Partial
11 1
!ab address: _ ` likip no.. Suite no.: I Tax map/tax lot,account no.:
Lal, Block: Subdivision: '
Project name: Description and location of work on premises:
Estimated date of con letiomlins ction:
CON I 11ACI Olt APPLICATION FEE SCIIEDtILE
Job no: Ire Max
Ikscriplion c)n. lea•1 ll.!al no.insp
m
Business nae: �2/ a �< Je5 New residential-single or multi-family per
Address:P, ell p O dNCIIi11g 11111.I111')Ildet;atfAt IN-d garala•.
SlalC'
service included:
Phone: Fax: E-mail: IOOO sq.ft.or leers _ 4 _
Each additional 3Cd a .ft.or portion thereof
CCB no.: 8s� Elec.bus. Ile.no: �'.�'y�e— Limited energy,residential 2 _
City/metro Nc.no.: Urnitedenergy,non-residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician(required) Urate _ Service and/or feeder _ 2
Sup,elect.name(print): License no:
Servlcesorfeeders-installatlun,
alteration or relocation:
PROPERTY200 amps or less 2
Name(print): zol amps to 400 amps 2
--- - 401 amps to 600 amps
Mailing address: 601 amps to IW)amps _ 2
City: SlalC; lip: over 1000 amps or volts 2
Phone: _ Fax: E-mail Reconnectonly 1
Owner installation:The installation is being made on property I own Temporary serfIces orfeeders-
which is not intended for sale,lease,rent,or exchange accorddng to Installation,alleratIon,orrelocalien:
100 amps or less _ 2
"Owner's
479,670,701• 201 amps to 400 amps 2
nature: _ Date: 401 to 600 ams 2
M 10111111101 Grinch circuits-new,alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
city:
State: ZIP. B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone Fax E-mail; Each additional branch circuit
Mile �61 Misc.(Servica:or feeder not included):
❑Service over 225 amps•commercial U Health-care facility al It pump or irrigation circle 2
❑Service over 320 amps-ralinN of I lfe2 U Hazardous location Etc).signor outline lighting
2
fartulydwelling3 U Building over 10.100 square feet four n, Signa,circuli(%)or a limited energy panel.
U System over 600 volts nominal more residential units in one structure alteration,or extension' 2
U Building over three stories U Feeders,400 amps or more "Description:
U occupant load over 99 persons U Manufactured structures or IDV park Fich additional inspectlon over the allowable In any of the adore:
U Egress/lighfin(r pl s„ U Other: __ ^___ _ Per inspection (— —r--T
Submit sets of plans with any of the above. Investigation_fee
I he abose are not applicable to temporary construction service. r Other
—
Not all junsdictions accept credit cards,please call judsdiction for mc"infolmalinn Notice-This permit application Permit fee.....................$
U visa U MasterCard expires if a Hermit is not obtained Plan review(at _-. %) S ____
Credit card number _ within 190 day.,atter it has been State surcharge(8%)....$ _-_-
"pin' accepted as corn piece TOTAL $
'�Name of c der as shown nn reel 13 t caA��
$
'Casal der si6nuure _— ^�Amount 440-4615(610DICOM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED -RESIDENTIAL O
—�—. �__�- -- ,
Complete F@@ Schedule Below: Restre.icted Energy Fee........................................ . ....... $75.00
Number of ins ectrons er ermit allowed (FOR ALL SYSTEMS)
Service included: Itenis Cost TotVI Check Type of Work Involved.
Resld,intial-per unit Audio and Stereo Systems
_j sq.it or less __ $145.15
Each additional 500 sq ft or 1 ❑
portion thereof $33.40 Burglar Alarm
Limited Energy $75.00
Each Manurd Horne or Modular El
Garage Door Opener'
Dwelling Service or Feeder $9090 —
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $60.30 2 Vacuum Systems'
201 amps to 400 ampb $106.85 2
401 amps to 600 amps $160.60 2 ❑ Other
601 amps to 10u0 amps $240.60
Over 10u0 amps or volts $454.65 2
Reconnect only $66.85 2
TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system.......................................................... $75.00
Installation,alteration,or relocation 2 (SEE OAR 918-260.260)
200 amps or less $66.85
201 amps to 400 amps $100.30 i 2 Check Type of Work Involved:
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Audio and Stereo Systems
see"b"above,
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits Clock Systems
with purchase of service or
feeder foe.
Each branch circuit _ $665 2 ❑ Data Telecommunication Installation
b)The fee for branch circuits
wlttrout purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit _ $665
Miscellaneous Instrumentation
(Service or feeder not Included)
Each pump or irrigation circle i $53.40 Intercom and Patting Systems
Each sign or outline lighting _ $53.40 —
Signal circuit(s)or a limited energy F-1LandscapeIrrigation Control`
panel,alteration or extension $75.00
Minor Labels(10) _ $125 00 — Medical
Each additional Inspection over
the allowable In any of the above Nurse calls
Per inspection _ $62.50
Per hour $62.50 Outdoor Landscape Lighting'
In Plant $73.75
Fees: Protective Signaling
Enter total of above fees $ Other J �_
8%State,Surcharge $ _ —Number of Systems
25%Plan Review Fee $ No licenses are required Licenser are required for all other installations
$ee"f'Inn RPwev/'�t�dinri m _ _
front of applic:alr"r, Fees:
Total Sn/ance due $ Fnter total of above fees $
❑ Trust Account# 8°-e State Surcharge S
---- �.. - ---
Total Balance Due -
Plumbing Permit Application
Datereceived: Permit n '�� {-,.'. -b.;r
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
Py of Tigard "hone: (503) 639-4171 I'rojecUappl.no.: Fxpiredate:
Fax: (503) 598-1960 Date issued: By. �Recciptno.:
Land use approval: -_� Case file.no.: Payment type:
A1 &2 farnily dwelling or accessory U Commercial/industrial U MUILi-farniiy U Tenant imp „•.:mens
New constriction U 4ddition/alteration/replacement 0 Food service U Other-
.161111,411TE INFORMATION 1 y1mr-1—Tim - F7 155
Job address: clle'2 Jescri tion Qty. Fee(ea. Total
Bldg.no.: Suite no.: New 1-and 2-family dwellings only:
(htciudm 100 R.for each utW(y connection)
Tax map/lax lot/account no,: SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath
Project name: __.___.__ SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
Description and location of work on premises: ___ __ SiteutWtles:
Catch basitUarea drain
date of completion/inspection: D wells/leach line/trench drain _
Fooling drain(no.lin. ft.)
Manufactured home utilities
Business name: Manholes
Address: l _ �P ,S Rain drain connector
City: Stat ?.l P_ �j�l f/� Sanitarysewer(no. lin.l't_)
Phone: Fax: Gm ail: Storm sewer(no.lin.ft.)
CCB no.: Plumb.bus.reg.no: Water service(no.lin.It.)
city/metrolie.no.: - Fixture or Item:
Absorption valve
contractor's mpresentati.-signature: Backflow reventer
Print name: bate: Backwater valve
Basins/lavatory _
Name: Clot es washer
- Dishwasher _
Address: Drinking founlain(s)
City: State: ZIP: E'ectars/sum
Phone: Fax: E-mail: Expansion tank
Fixturelsewer cap
i Floor drains/Iloor sinks/hub
Name(print):
Mallin address; Garbage disposal
B Hose bibb
City: Stat ZIP: Ice maker
Phony Fax: E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual 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 as per URS Chapter 447. Sink(s),basin(s)-,Ta-vs(s)
Owner's signature: Sum
Tubs/shower/shower pan
Urinal
Name: Water closet
Address: Water heater _
City: _ State: LIPS Other:
Phone: Fax: Email: Total
Not all judo lictlow ecOW cmdii cadr,please callurisdiction for more inronnellon. Minimum fee................$
j Notice:Ibis permit application
O visa ❑MuterCard expires if s permit is not obtained Plan review(al — %) $ _
credit cod number: .— _ within 180 days after it has been State surcharge(8%)....$
Name at eetdhaldd u claw"on credit card
p accepted as complete. TOTAL .......................$
$ —_
c •e e Amount 4"16(6 AWM)
et...
Mechanical Permit Application
--� Datereceived: Pcrmitno,:
City of Tigard Project/appl.no.: — Expire date:
CiryofTigard Address: 13125 SW Ifall Blvd,"I'igard,OR 972.2:1 _ --
Dateiss,:et1: By: keceiptno.:
Phone: (503) 639-4171 ---
Fax: (503) 598-1960 Case file no.: — Payment type:
Ladd use approval: _ Building permit no.:
[ I &2 family dwelling or accessory U Commercial/industrial U Multi-farnily U Tenant improvement
�69 New construction G Addition/alteration/replacement J Other.JO B SITEINVORMATIOW WIN IN 111111
1
Job address: -tr` Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: ite no.: value of all mechanical materials,equipment,labor,overhead,
profit.Value$
Tax map/tax lot/account no..
Lot: Blot:k: Subdivision: 'See checklist for important application information and
— jurisdiction's fee schedule for residential permit fee.
pro}ectname;
RALUN 101W
City/county: ZIP:
Description and location of work on premises: IN t
Fee(".) 't otal
Est.date of completion/inspection: DevcrilNion thy. Rrw.on:y Rcs_onl�
1 Tenant improvement or chi,nge of use: Air handling unit
Is existing space heated or conditional?U Yes U No it co,i it &m$(site p an required) _
Is existing space insul.ted?❑Yes U No A terauon of exist ng�AC system —
Bot er compressors
1 late boiler permit no.:
Business Hume: 1277_ C 0117rd 4- HP Tons__—BTU/H ---
Address: -ir smo e amper.. uct smo a etec'ors
C1 �—— Slate: I_I I' eat pump(site p an r, uire ) _ —
Phone: - ,� Pax: E snail: Install/rep nee mnac urner
__-- Including ductwori7vent liner (�Yes U No
CCB no.. _ _- __.— nsta rep ac re locate eaters-suspen cd,
City/metro lie.no.: — _— _—_ wall,or floor mounted
Name(please print): ent for u iian.e other than furnace
efitgera on: r+
Absorption units-----. BTI!/H J _
Chillers.__ III' _ —
Ntune: -- - --- -- --- rA
sors HP
Address:
Environmental exhaust an ventilation:
City: 7.IP: event_Phone: ax: G trail: y ape l re..Rttc en/ azmatsuppression systemName: —_. fan with single duct(bath fans)
s s�cm a aitT6. caun Mailing address: ®4 — Tn-_9 j ��4 o nR rtn sl ut ou up to out ell
lh
y: _-- Stale: 1Sy:� ��/Q Type: LF'G NG -,— oil -- _
one: fax: F-mail: f ue i tin eac i ac itiona over outlets
rocesspiping(schematic require )
Number of outlets
Name: _— __ __ t to stwpp ce or equ pment:
Address: Decorativefircplace
St. ZIP: insert-ty _ — --
Wodstov pc etsto '!
Phone: Fax: E-mail: er. ------ —
Applicant's signature: Date: t ter: _ — --
Nance(print): _
Permit fee................. ...$ _
Na all Jurtadtdtioru aceept credal canlr,please 311 jur'"ctton fur mag information Notice:This permit application Minimum fee... ............$
O Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $
C"t card number ,___ - -E pir—�— within ISO days atter it has been
State surcharge(8%)....$
Name nr oldu n anown on c t c -- accepted as complete.
TOTAL .......................$
l-- ---- _ -_.
croolder signature Amount 4Kr�617I�m"^MI
ECK
CONSTRUCTION
P.O. Box 204
Sherwood, OR 97140
ELE V 48.00' EL EV:
L I
ll r X� 15' rJ_f F
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110 p4
PR(�
� RESIDENCE
PI AN N IVE101 I C�
F� tas
4'THICK I UT
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LEV: �48.O4' l 177 OF) 0(�j
17
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Lu
S.W. KOSKI DRIVE
0
c/7-V 2002
evl�l
DESIGN, �I
SUNTEL HOME C ESIGN,INC.IS N A.
LIABLE FOR THE ACC!r ACY OF THE LMAL X/CWT"
TOPOGRAPHY INFORMATION. 11 IS
ME SOLE lsf SPONSIBILITY OF IHF TO BE /1TTACH
BUILDER TO VERIFY ALL SITE '^
CONDITIONS,INCLUDING ANY FILL Ise a PLACED ON THE S11F.,AND INFORM
OWNERS OF ANY POTENTIAL HELD ». 1
MODIFICATIONS.
1
CITY OF TIGARD
13123 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NORTH STAR PLUMBING
1445 SE OREGON STREET
SHERWOOD, OR 97140
Plumbing C-?nnature Form
Permit #: MST2002-00472
Date Issued: 12/18/02
Parcel: 1 S135CD-KM007
Site Address: 11810 SW KOSKI AVE
Subdivision: KALAMOIIKA ESTATES
Block: Lot: 007
jurisdiction: TIG
Zoning: R-12
Remarks-. Construction of new SF detached dwelling. Path 1
Your company has been indicated as the plumbing contractor for the permit inc!icated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
STEVE ECK CONTRUCTION NORTH STAR PLUM511NG
PO BOX 204 1445 SE OREGON STREET
SHERWOOD, OR 97140 SHERD IOOD, OR 97140
Phone #: 503-625-1305 Phone #: 625•-2679
Reg #: LIC 00090697
MET 00002694
PLM 34-255PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signa re of Authorized Plumber
If you have any questions. please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HAIL BLVD.
TIGARD, OR 572:3
IMPORTANT PERMIT NOTICE
WILLIAM BUTTERFIELD CONTRACTING
PO BOX 305
13'120 SW MORGAN RD
SHERWOOD, OR 97140
Electrical Signature Form
Permit #: MST2002-00472
Date Issued: 12/18/02
Parcel: 1 S135CD-KM007
Site Address: 11810 SW KLISKI AVE
Subdivision: KALAMOIIKA ESTATES
Block: Lot: 007
Jurisdiction: TIG
Zoning: R-12
Remarks: Construction of new SF detached dwelling. Path 1
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 address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed forrn is re,;eivc!d
OWNER: ELECTRICAL CONTRACTOR:
STEVE ECK CONTRUCTION W*.'-' IAM BUTTERFIELD CONTRACTIN(
PO BOX 204 PO BOX 2(15
SHERIA OOD. OR 97140 13120 SW MORGAN RD
SHERWOOD, OR 97140
Phone #: 503-625-1305 Phone #: 503-625-6773
Req #: 1 II 118554
1.1 1 3-548(
SIT 30935
AN 1144 SIGNATURE IS REQUIRED ON THIS FORM
Signa ure of 8upervising Electrician
If you have any questions, please call (503) F39-4171, ext. # 310
/ CITY OF 1 IGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00189
13125 SW Hal! Blvd., Tigard, OR 9722.3 (503) 639-4171 DATE ISSUED: 5/8/03
PARCEL: 1 S 135CD-12006
SITE ADDRESS: 11810 SW KOSKI AVE
SUBDIVISION: KALAMOIIKA ESTATES ZONING: F-12
BLOCK: LOT: 007 _ _ JURISDICTION TIG
CLASS OF WORK. OTR GARBAGE DISPOSALS: MOBILE HUME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS.
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of residential backflow prevention devise for irrigation systern.
_ FEES
Owner: "
--- - Description Date Amount
STEVE ECK CONTRUCTION IN I \1111 IY111111 FCC 5/8/03 $36.25
NO BOX 2.04
SHERWOOD, OR 97140 I; ,i
1\! ti� ir I,i\ 5/8/03 $2.90
Total $39.15
Phone : 503-625-1305
Contractor: _
GROVER'S LANDSCAPE SERVICES
26485 S ME=RIDIAN RD.
AURORA, OR 97002 REQUIRE=D INSPECTIONS
RP/Backflow Prevenler
Phone : 503-678-1796 Final Inspection
Reg #: LIC 11907
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Statc; of OR.
Specialty Codes and all other applicable laws. All work wily be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the Oregon
i
Issued By: x-'x,�A4 Pennittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Piumbina Permit Application Received Plumbingq
Date/By. S �/o permit No
��D�'� g/
Planning Approval Sewer
City of Tigard Datc/B : Permit No.
13125 SW Hall likd. Plan Review Other
Ti:r,ard,Oregon 97223 Date/By: _ Permit Na.
Phone: 503.639-4171 Fax: 503-598-1960 Datc/ate/B y:Post-Revland Use
Case No.: ---
Internet: www.ci.tigard.or.us Contact J Sec Pag. 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: �- Su Icmcnta. Information._ _J
fr _ TYPE OF WORK FEE;*SCIIE:DIJLE(for special Information use checklist►
INew eonstr_uction _- Demolition Description --�1t). Fee(ea•) 'Intal
FA- --- - New 1-&2-family dwellings
Additiun/alteration/re lacement ___Other: (Includes 100 ft._for each unlit connection)
CATEGORY OF CONSTRUCTION SFR(1)bath249.20
I &2-Family dwelling Commercial/Industrial SFR 2 bath _ 350.oe
Accesso Buildin Multi-Family SFR 3 bath 399.00
Master Builder Other: Each additional bath/kitchen _ 45.00
JOB SITE INFORMATION andLOCATION hire sprinkler-sq.fl.: Pae 2
Job site address: 1 VS-1 6 - 1_ Site Utilities
Suite#:_ Bldg./Apt.#: Catch basin/area drain _ IG.GO
Drywell/leach line/trench drain 16.60
Pro'ect Name: - Footing drain no. linear fl.) Page 2
Cross street/Directiol}s to job site: f�j' fa Manufacturer)home utilities 110.00
Manholes - 16.60
Rain drain connector 16.60
S ki
Sanitary sewer Ino. linear fl. I'a�2
of#. Storni sewer no. linear R. Page 2
Subdivision: _ Water service(no. linear(1 ) Pae 2
Tax map/parcel #: _ Fixture or Item
DESCRIPTION OF WORK Absor tion valve __ 16.60 _
17'- A �V'a' � '>� ack(low rcvcntci.� Page2
Bat:kwater valve 16.60
Clothes washer 16.60
-- Dishwasher 16.60
Drinking fountain _ 16.60
"PROPERTY OWNER _� TENA _ _ E ectors/sum� _ 16.60
Name: /--: ---- Expansion, . 16.60
Addrt,ss. I:ixturc/sewer cq" 16.60
Cil /Stale/Zl Floor drain/floot sink/hub 16.60
�_�__ ___ Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
�APPLICANT� CUNTACI'PERSON Ice maker 16.60
Name: _ Interceptor/grease trap 16.60
Address: --- -- - - Medical as-value: 5 _ Pa e 2
-- Primer 16.60 -_
Cit /Slate/Z1 Roof drain commercial 16.60
Phone: Fax: Sink/basin/lavatory 16.60
F mail: Tub/showeNshe vcr an n 16.60
CONTRACTOR _ Urinal_ _ 16.60 _
-;'- Water closet 16.60
Business Name: 1''L,a��A-'���� rl water heater 16.60
-17
Address: mil �-�r n %f; ,'" ` . Other: _ _ --
CSiate/Z►p: - 0 Z- Other: _
Phone: ; 05 (`7 1 7 k(" _aX: S r► Plumbing Permit Fees* _-
Subtotal 5
CCB Lie. Plumb. LicA Minimum Permit Fee$72,50 5
Authorized A fl, �1 z Residential Backilow Minimum Fee$36.25 3 _
Signature: - =•v Date; J Pian Review 25°,b of Permit Fce $
State Surcharge 8°'a of Permit Fee 5 _
1 (Please print name)
PERMIT'FEE 5
Notice: 1111.1 pek mli application etplres If a permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
ISO docs after It has trcen accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
I tsiti Pcnnit I nrms`vinil'crnwAlip doe 01/03 !�
PlulmbingPermit Ap >tPkation - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup ression Systems_
Site Utilities Qty. Fee(ea) Total Square Footage Permit Fee:
footing drain• I" 100' 55.00 0 to 2,000 _ $115.00_
46.40 2,001 l0 3,656--_— $1 u0.00 _
footing drain-each additional 100' 3,601 to 7,200 5220.00
Sewer-I st 100' 55.00 7,201 and�euter_. $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' _ —Mix—) Medical Gas ,'Stems:
Water. -each additional IINI' 46.40 Valuation: Permit Fee:
Sturm&Rain Drain•I st 100' 75 00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 1011' 46 40 $5,00100 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for euch
additional$100.00 or fraction thereof,to m,d
Fixture or Item Qty. Fec(ea) 'total including$10,000.00.
Ominicrcial Back flow Prevention Device 46 40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 C.r
---- each additional 5100.00 or fraction thereof,to
Residential Backflow Prevention Device and includin-$25,000`00.
mtnirnum permit fee$36,25 1 SS -- $25,001 00 to$50,000.00 $379.50 for the first 525,000.00 and$1.45 for
Rain Drain,single family dwelling 4Y)
—
_ _ each additional$IOO.IHI or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00.
s eciall re uested ins ectiuns-per hour p550,001.00 and up $742.00 for the fist$50,00(l.00 and$1.20 far
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
",yes",plep%e Indicate work performed by fixture. Failure to
accurate! rc-;ort fixtures could result in increased sewer fees*. ('omnlcnts regarding fixture iNork:
uantlt b (Fixture)Work Performed
Fixture'rype: Replace
New Moved "Or"
Ca cd — --"- -�
tiaptistr /Font
Bath •Tub/Shower ------- - -
-jacuzzi/Whirlpool --- - ---- ---�---------_---
Car Wash -Each Stall -------�-- --
-Drive T hru -
Cus idor/WaterAmiratur -- - - _
Dishwasher -Commercial - -._ -- -- --- -------
-DonlesliC _ -- - - -
-
E -------
floor Drain/sink 2" - - -- -_----
4,. -
Car Wash Drain *Note: If the fixture work under this permit result% in all
Garbage -Domestic _ increase of sewer ED11s,a sewer permit will be issued and
Disposal -Commercial — _ — fees assessed for the sewer increase must he paid before the
-Industrial - ---
ice Mach./Refri .Drains — _ plumbing perulit can be issued.
Oil Se oratorGas Station
Rec.Vehicle Dam Station --
Shower -Gang --
-Stall --
Sink -Bar/Lavatory t
-13radley — -
-Commercial ---
•Service - -
Swimrnin Pool Filter
Washer-Clothes -
Water Extractor
Water Closct-Toilet ---
urinal_ —
Other Fixtures
i.\bsts\Perniit Furrmt\PImPc,nutAppl'g2 d w til 04
CITY OF TIGARD 24-Hour
BUILDING Inspecuon Line: (503)63P-4115
MST
INSPECTION DIVISION Business Line: (503)639-4171 BUP
Receivedll. yy Date gepested_, J Y AM--. PM ____-_ BLIP _.-_- -�--
L.ocation _--___��J& _-_Suite -- - MEC ---
Contact Person __._-- Ph PLM
Contra,tor -_ —_--. -____ _ Ph(—) SWR
BUILDING Tenant/Owner -_-�_ - __.____._-_- ELC
Footing- --- ELC ------__-_--
Foundat on Access:
Fig Drain ELR -_-- __--
Crawl Drain
Slab Inspection Notes: SIT
Post& BearnShear Anchors
Anchors - - - --
Ext Sheath/Shear
Int Sheath/Shear -
Framing -- ------ - - ------- _..---- -- ---- ---- - ------ - - ---
Insulation
Drywall Nailing ------------ ---- - -- -....- - - - - - ----
Firewall
Fire Sprinkler --.- -- _.._ -- ------ - -- - -----.. - -
Firo Alarm
Susp'd Ceiling -------___ _--- --- -------- ___--- - ----------
Roof
Other. - ----- ---- -____-- - --- ---__- —..,_-- -.- --
- -- _ --
Final
PASS PART FAIL
PLUMBING -- ------- - ---- _ - --- ---- ------ -- -
Post&Beam
Under Slab ---- -- - - -- -- --------- -- - ------
Rough-In
Water Servic ---- ------ - - --- - -- ---- - - _ _ _ ----- -
Sanitary Sewer
Rain Drains --- __-._ - ---- ----- -- --- - -----
Catch Basin/Manhole
Storm Drain -------_ - - - -- -- --- --- --- --
Shower Pan
Other
- --
F'
PAS � PART_FAIL ------------ -----_...... ___ ---------------- ----------- --- -------
- ANIC_A_L -._.
Post& Beam
riough-In ----- - - --- ----- __ - --- -------- - -- ---
Gas Line
Smoke Dampers -�- -
Final
ART FAIL -- -- - ---- - ----- - --- ------_ __-- -------
1114AL
Service
Rough-In
UG/Slab
Low Voltage _- _ - -- ------ --- - - -
Fire Alarm
Final Reinspection tee of$___- _--roquired before next inspection Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
-- -- -
SITE Please call for reinspection RE:---- -_ -_-----____- .._ - C Unable to inspect-no access
Fire Supply Line
ADA '" Ext
y
Approach/Sidewalkwalk Date _S ���- - _ - Inspector ..-----� ''� -- -- - --
Other: --_
Final 00 NOT REMOVE this Inspection record from the Job site.
PASS PAST FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 -Z _ Q p 22-
INSPECTION
ZINSPECTION DIVISION Business Lira: (503)639-4171 - --
` BUP
Received I _ Date Re 'sted l� AM_—__� PM __ BUP
Location _ – _.___ _ _SuiteMEC
Contact Person Ph(--- _.) -___ -- P,.
Contri3ctar. -- — - Ph( ) ------- _-- SV. - ---- –--
UILD 0 Tenant/Owner ___. ELC
Foo ing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT --.—_-- --
Post&Beam _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing _._._ ------- ---- - - _---- -------- - - ----
Insulation
')rywall Nailing - ----- - --.- ... ------ -
'_firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -- ---- - -_ -- --- -
Root
Other: -- - -- - --
a6-)
PART FAIL ------ -- --- - - --- - --- - -
- --
PIL RING
Post&Beam
Under Slab --
Rough-In
Water Service _
Sanitary Sewer
Rain Drains - --- - -- --------- ------ ---- ----
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
- - --- --
Final
P RT FAIL
-- CHA AL _-- -.__..
-------
Post
-Post& Beam
Rough-In ----- --- -- - -- --- �. ---
Gas Line
51Dnke Dampers - --- - - - ---- ---- -- -- -- - - --
�i
S PART FAIL ----- -------- --
"
------ -----------
Service - _---------
Rough-In
UG/Slab
Low Voltage
Fi!e Alarm
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE —` �j Please call for reinspection RE:__-- —_ ___ __-_ j Unable to inspect-no access
Fire Supply Line
ADA 5'-:- �(, :per,
Approach/Sidewalk Date _—_ __. Inspector, __ ._ Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP _
Received Date IRPuested. S � AM PM_ BLIP
Location .- 1 j �� n __k —Suite��j� MEC
Contact Person ____ 4- 1 =' -_ _— Ph( ) �'�" �`3 PLM
Contrador Ph(— ) — .-- SWR — —�
BUILDING Tenant/Owner _ _- _-___.- W... ELC
Footing— ELC
Foundation Access:
Ftq Drain ELR
Crawl Drain --
Slab Inspection Notes: SIT
Post&Beam - ----- - ---- - ---- -
Shear Anchors --
Ext Sheath/Shear
Int Sheath/Shear
Flaming -.� — -- - - --------- - - ---- - — -
Insulation
Drywall Nailing --
Firewall
Fire Sprinkler - -- - ------ -...--- ------- -- ---- - -- - - - -
Fire Alarm
Susp'd Ceiling
Root -
Roof
Other: --------_..__ -- -------- - _.. _ - -- --
Final
_PASS_PART FAIL
PLUMBING
Post& Beam
Under Slab - -
Rough-In
Watr i Sc-rrice --- ——-- -- _ -- - ---- -- --- - - - -
Sanitary Sewer
Rain Drains - - ---- -
Catrh Basin/Manhole
Stogy m Drain
Shower Pian
Other -
- ---
SS PART FAIL
V _ IC_AL
Post&Beam
Rough-In - -- - -- -- - - - - ---- - -- -
Gas Line
Smoke Dampers _ __ ---- - - --- - - - -
Final
PA f*RT FAIL --- ---- -- - - - - _
Service
Rough-In
UG/Sleb
Low Voltage - - ---- - - - - - - ---
F' rm
i
n El Reinspection fee of$ —�____ required before next inspection. Pay at City Hall, 13125;W Hall Blvd.
PART FAiI.
Please call for reinspection RF: _- _-_ _ ( Unable to inspect- no access
Fire Supply Line
ADA (� /
Approach/Sidewalk Date __ ,9 0�- Inspector ,f �.' �" 1 - -_ - _ Elft,____
Other: _,..
Final Lao NOT REMOVE this Inspection record from the job site.
PASS PART FAIL