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10510 SW NAEVE STREET s ~ S 89 045'10" W 122.44' --'..' �~ ----A 2.5 FOOT LANDSCAPE EASEMENT SHALL s o• °D EXIST ALONG ALL STRET FRONTAGE. v� s CA ---A 7.5 FOOT PUBLIC UTILITY EASEMENT bAl 39.00' --' HALL eX15T ALONG LANDSCAPEEASEMENT T Ld Z i -- Z c ' Y M I \. ---._--_-_-__- ca r li I V I 3.50' l 3 2Z Ak WK aplb L! .'1 I Q zC ., .�fes►�` - ---f cr o; ­ 5r.1' -S,�' 6dlM ZC.�' -- v cn c V 4 S � :! �" , N 89'4 ' 122.03 i 0' E I 1 � I I t I I � � < N > '"c CE"D .-W ' 4 12 8 Z47,`d,3�. . "AS- I0N � � .......................... SCALE DRA fV!.NTG - LOT 12 ERICKSON HEIGHTS I I S.E. -1 /4 SEC. 10, T.2S., R.1 W., W.M. I I `� CITY OF TIGARD i `S T WASyINGTON I COUNTY, OREGON APRIL 9, 2002 - DRAWN BY: It CHECKED BY: WGDffI Cin t erl i n Q on cep i s SCALE 1 "=20' ACCOUNT # 115 040 3--C M: \ML \L' 2EPICK ve �iccstene, ,..recon SC„ 88 'cx 550_01 ;;p �r ��a.s,.r•, . -.r NOTICE: IF THE PRINT OR TYPE ON ANY I I I I I I I I I I I r I � , r I SII � � III I � III � I I ( I I I I � r rIIII ( III IIIIIII III � IIIIII III III III III III III III III III III IIII � r � r r >i r r I I I I� I I I I I III ► t IMAGE IS NOT AS CLEAR AS THIS NOTICE 1 I I I ! I l 11 I I j ' I I I I jT III I I I I I � 3 4 I 1 �' 1 � . II I I III ITIS D —- ___ ____ � 7 _ I UE TO THE QUALITY OF THE --- --- - g _ _ _ _ 10 _ 1 .1 17 /�' jot/.,) No.36 �� �! •� ORIGINAL DOCUMENT 6I 8t � G�I 9I 9I fiX ET Z [ Tt Ig 8 l l l l l l l l l l l I l l l l l l l I I I I I I I I I I I1 f I I I I I I I 1 I I 1 11111.1 I f I I ILI I I I i l l l l l l l l' [[1116111L S i' E z I ��di3w IIII. 1111 III! Ilil III! IIII IIII IIII illlllllllllll IIII IIII If II IIII 1111 IIII IIII Ilii IIII IIII Illi 111 11111111IIII IlTila Llll 11 �l I Mill lu ltlll�111 l 10510 SW Naeve Street CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)634-4175 MST — INSPECTION DIVISION Business Line: (503) 639-4171 BLIP ---- ---- - Received __ _- . Date Requested _ AM -__ PM BLIP Location >1 fJ_ -�-"!��_._IF- Suite,_____- -- MEC Contact Person Ph(--) �y PLM Contractor -- - Ph( --_- ) — ------- _ SWR - - --- BUILDING Tenant/Owner —._—_ _ —_-- ELC Footing ELC - — Foundation Access: Fig Drain ELR -- -- -- Crawl Drain --- Slab Inspection Notes: SIT Post&Beam --- Shear Anchors Ext Sheath/Shear — Int Sheath/Shear Framing --- Insulation � `i i i �' W Drywall Nailing - Firewall Fire Sprinkler ----- -- - --` Fire Alarm Susp'd Ceiling Roof Other:Final _ --- --`------ Othe -- — _ PASS PART FAIL IX1��Iya I L -- --- - - os eam Under Slab -------- -- -- Rough-In Water Service -------- -- --- -- Sanitary Sewer Rain Drains - -- Catch Basin/Manhole Storm Drain ---��— — Shower Pan Other: ------— -_—-- ----- - - __ PART FAIL ------.�- - --------- - Post&Beam Rough-In - -- -- -- Gas Line Smoke Dampers ----- -- - — — Final PASS_PART FAIL --- ELECTRIC L Service Rough-In UG/Slab Low Voltage — Fire/harm Final PART FAIL_ Reinspection fee of$— required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. AS —�- ] Please call for reinspection RE:--. __ Unable to Inspect-no access Fire Supply Line ADA _� J �/_0_ Approach/Sidewalk Date {�f Inspector _ ___ _Fitt_. Other._ Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL \AAAAAAAAAAAAAAAAAAAAAAAAAAAIAAAAAAAAAAAAAA♦ 14 4F 7d w r y. <� M 44 44 b O ° rU FF1 44 cm 4 � p O 44 rb r� ' `` ►+ �3- o n rD ru U� 44 44 1 o' 44.4 1 ' h b 44 i M a , � ►♦vvivvvvvvvvvivvvvvvvvvivvvvvviivvvvvvvvv♦ ry o o '-T? ° Z ri a F M n ry ' Q• O 71 G � 1 � s� F. a s f m C 0 QT 3 d F � I CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received ` _. Date Requested 2.1 —31 AM . PM BUP - Location _ JCi �LZILc. '_ .177 Suite MEC --- -- Contact Person Ph( ) g =am PLM Contractor_ _____- Ph( ) __ SWR U Tenant/Owner --- -- -- ---- ELC - - ---- 173`571ng ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Nolen SIT Post&Beam - _ - -- -- -- Shear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - Firewall Fire Sprinkler - Fire Alarm Susp'd Ceiling Roof Other: - - - - finn — PART FAIL _ PL JA _---- - Post&Beam Under Slab - Rough-In Water Service - - - Sanitary Sewer Rain Drains — Catch Basin/Manhole Storm Drain - - -- --- - - - - —- Shower Pan Other Final -- - - ---- - - - — Final PASS PART_ _FAIL - - - MECHANICAL Post&Beam — Rough-In - -- - Gas Line Smoke Dampers -- in PART FAIL - RICAL Service Rough-In UG/Slab Low Voltage - Fire Alarm Final � Reinspection tee of� required before next inspection. Nay at City Hall, 13125 SW Hail Blvd. PASS PART FAIL SITE I ] Please call for reinspection E __.--_ _� Unable to inspect-no access Fire Supply Line ADA o -- 751n .-- Approach/Sidewalk (Date Inspector Ext Other: Find �0 NOT!i7EMOVE this Insarctien record from the Job site. PASS PART FAIL CITYOF T I GA R D MECHANICAL PERMIT — PERMIT#: MEC0UU3 00011 DEVELOPMENT SERVICES DATE ISSUED: 1/14/03 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639.4171 PARCEL: 2S110DA-05100 SITE ADDRESS: 10510 SW NAEVE ST SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 012 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESS)RS HOODS: FUEL TYPES _ 0 - 3 HP: 2 — DOMES. INCIN: --- 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS____ OTHER UNITS. FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 0m: Remarks: Install 2 extericr AC units. _Owner: FEES _------ RENAISSANCE CUSTOM HOMES Description Date r Amount 1672 SW WILLAMETTE FALLS DR I AX)8`%n StateTuN 1/14/03 $` 80 WEST LINN, OR 97068 x%91 CIII Pernu1 I ee 1/14/03 S72 50 _ Total $78.30 Phone: 557-8000 - -� Contractor: ROTH HEATING R ',OOLING P.O BOX 1265 CANBY, OR 97013 REQUIRED INSPECTIONS __ Cooling Unt Insp Phone- 503-266-1249 Final Inspection Reg #: LIC 14008 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore Specialty Codes and all other applicable laws. All wog is w ll be done in accordar ce 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 in the Otego Utility Notification Center Those rules are set forth in OAF; 952-001 -0010 through OAR 952-001-0100. You may obtain copies of these rules or di-ect questions to OUNC by calling (503)246-6699.x, , Issued B /�? + , Permittee Signature: � /I Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day Sent by: ROTH HEATING $ A/C 503 288 3478; 01 /09/03 4:48PM;jltFax /t127;Page 2/3 m ocolveo; 9/17/01 12:87PA1, 503y9A1bC0 -> NO'TH M8A't'INQ 6 A/C; page 2 09/17/2'001 13:ua FAX 5035981960-M-7 ! CITY OF TIGAicD Z002 Mechanical Permit Application . i lhalereccivcd. / C Nmalno.: �(:/l City of Tigard t�roleet/ pl.ao,; iraeate: c;tvnl71 a►d Address: 13125 SW Hall�t f[ar 97223 — B phone: (Sa3) 639.4171 ' -7 l Date By: Recaiptno. Fax. (503) 598 1960 ; ;ITV nF riGAFi!) 'Case filcnu: Payment type:- _ Land use approvo; _— Dlylelnt.a 4� tsu,la alt pctmu nn• Ba 2 fa-auly JWL;14UC or at:cc,eory U"omntemiril/mdustriul :J Muld-family U l'eltunl improvement :J Nrw cnnstrur on 3 Otbcr. r Job addseus: eU Q, Indicate equiptuent quj,tntiea in boxes below.ln(hCdlts:the dollar Bldg.no.: Suite no.: value of all merllanical metwials,equipmtnt.labor,oycibead. 1 ax tna /rax lot/accrnin_t tu,,: prubt.Value$ _- LQ __ IMA* 5trbdFvisiun m� 'See checklist fat important applaeution taforrnntion and !fo actt Mr. `��� - jaristiiction's fee :;chedule for res.dential pe"im fee. Ci leatin : _ ZIP' Iloac[I�ti a and lac 'op of work on p mi-ws: Foe(tas.) Total Fist-dew of com icti an/in_s tMrrion: Ar ai' 'tm� y. Ret.onl Scs.salt '1'cnant improvement ur change ut use: VA(::❑No ;!�bandting umt C:FM�- Ir,e'c.istinp::rncr in::ul:utv17 0 Yr.4 q No AircaaAinnntng(site plan requtredj Altnauvn w catttipn�N ryuttnt tiu►�er%t:utcptcs:aus ----- - -- \ S,atc.boilu•prxmu nn Businvu n e: ,h { x HP ___'Tani_-__..—DTU/H Address: imbFe^d--r&Muetcnw a etectorc-- G[y. wt tttnp strep anr:qutr -- �rt,ane. 2 Fax:UJ6.3 t( 1ki li-mlul: lrtstat!/replacehttTtacrPubtrner—� TiliH tnClutiin•ductwGrk/vent llntu Ll Yns lJ Nu CCB no.: Ct /tnOt[O lic. k 37— wall,t:r flow tnonnted Name({!lease buil: - en[ or p + pace nthtr Ilian tura e f3etrl�vahcta� > Absorptionuntt9 _� f?Iii/H _ lip --- Com mmon..------_ tipAddro91: FiRroamriful rslwatri 4113 ve non City: State:—�Z1P Appliunce vent Phone: Fax: F--mail: ryer a xLaust ondS,Tsqpe /rrs,kit0e htiZnint hand rule suppression system Nxme-. 0Lxbaupt Can with min Ic duct(brth fans) T. �_ IVlollttt Addtes : �. l_ •t clas�isi ayiietii ipattfromhcep�of AC City: �LT1�+I+rR6 and IstithUltOft(Lip to 4 AtlUeLf -- _LPG NG Oil Phone: c: Fax: Email »-- _� _ uc pis).n arc a�tttanu over 4 ouUM- 1'tncratjpinnlii —Fchrrr.at,c tecluur.a) y -_ Nutnbet otoulletb Nn'rat'. �.-r'' ►{her liate3 app re or sgwpment: Addtrssl:.-._-�T!_ �.` M --- Otcorarlvttire�ce Cit' StAtc: Zfl<': ns4r�•�t_�G_ -� _.—._V. —" — naustov- ell4tGlove yp iC=Vs signature: Date h�� Name (print): Nn..1q ir.rUNW(ot sttejx Milia aatalt.pteau raft J-606160,for tan#Iaara>r"IIFWt PetTAII fee....... . .. ........ Th UVisa LiMuterCsM Notice; is pexttait application Minimum fee.. ........S ••epir•oc lea n�a nl,talnod Must R:Yiew(qt _ 7b) .b within Ips days after i,h.,Meen smote surcharge(89b) ....S r t:tsar of:aWlol4v M al ourn on c..„ --- - accepted u �t coAlete. TOTAL14cr 7f.Ar tlstarau to _S._.n nom,mow_ ...............,.,,...E 44a-0,7(aw JCAbQ Sent by: ROTH HEATING & A/C 503 266 3478; 01 /09/03 4:48PM;)AL&c #127;Page 3/3 -TE PI I _ I HDti r FEC i low CITY OF TIGARD _ MASTER PERMIT PERMIT#: MST2002-00205 DEVELOPMENT SERVICES DATE ISSUED: 6/4/02 12�011111i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 10510 SW NAEVE ST PARCEL: 2S110DA-05100 SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 012 JURISDICTION: 'f IG REMARKS: Construction of new SF detached residence. Path 1 BUILDING REISSUE: STORIES: 2 FI.OOR AREAS REQUIRED SETBACKS_ REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,590 of BASEMENT: 36400 of LEFT: 8 SMOKE DETECTORS Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND. 1,690 of GARAGE: 635 at FRONT: 23 PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 6 VALUE: S 446.370.70 OCCUPANCY GRP: R3 BORM: 4 BATH: 4 TOTAL: 3,28000 of REAR: 59 PLUMBING SINKS: 3 WATER CLOSETS: 4 WASHING MACH: 2 LAUNDRY TRAYS: 1 PAIN DRAIN: 100 TRAPS. LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 2 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 7 CLOTHES DRYER: 2 GAS FURN>-100K. I UNIT HEATERS: HOODS: I OTHER UNITS: 3 MAX INP: blu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS. 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS_ BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 - 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 10 201 400 amp: 201 •400 amp: tat WID SVCIFIIR: 00 SIGNIOUT LIN LT PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL OR CIR: SIGNAUPANEL IN PLANT: MANU HMISVCIFDR: 601 • 1000 amp: 601+8mp81000r MINOR LABEL: 10004 amp/volt PLAN REVIEW SECTION Reconnect only: >a4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAL: r;LS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYST EM: AUDIO d STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC DATAITELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 9,451.07 RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES This permit is subject , the regulations contained in the 1672 SW WILLAMETTE FAILS OR 1672 WILLAMETTE FALLS OR Tigard Municipal Code,State o OR. Specially Codes and WEST LINN,OR 97068 WEST LINN,OR 97068 all othercewith applicable laws. All work well be done it accordance with approved plans. This permit will expire K 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 you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rep N: LIC 130449 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 Erosion Control Insp 8, Slab Insp A Footing/Foundation Dr; Electrical Rough In Gas Line Insp Water Line Insp Grading Inspection Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Appr/Sdwlk Insp Sewer Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final Footing'r1!ap Underfloor insulation Plumb Top Out Exterior Sheathing Inst Gyp Board Insp Plumb FinRl Foundation Insp Crawl Drain/Backwater Electrical Service Low Voltage Rain drain Insp Final Inspection Issued By : �'�) 639-4175 _� �__—_ Permittee Signature y 7:00 p.m `nr an inspection needed the next usiness day � � CITY OF TIGARD _ MASTERPCRMIT PERMIT #: MST2002-00205 DEVELOPMENT SERVICES DATE ISSUED: 6/4/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 10510 SW NAEVE ST PARCEL: 2S110DA-05100 SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 012 JURISDICTION: TIG REMARKS: Construction of new SF detached residence. Path 1 BUILUING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 v FIRST: 1 9bU sl BASEMENT: !170.00 of LEFT: 8 SMOKE DETECTORS: Y TYPE OF USE: BE FLOOR LOAD: 40 SECOND: 1 r"40 sl GARAGE. 777 at FRONT: 23 PARKING SPACES: 2 TYPE OF CONoT: 5N DWELLING UNITS: 1 FiN3SMENT. sf RIGHT: 8 VALUE $416.36790 OCCUPANCY GRP: R3 BDRM. 4 BATH: 4 TOTAL: 7.:8000 sl REAR: 59 PLUMBING SINKS: I WATER CLOSETS: 4 WASHING MACH. i LAUNDRY TRAYS: I RAIN DRAIN: 100 TRAPS: LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINSSEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 5 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL. FUEL TYPES FURN r,100K' BOILICMP<3HP VENT FANS: 6 CLOTHES DRYER: 1 GAS Y FURN>=TOOK: i UNIT HEATERS' HOODS: t OTHER UNITS: 2 MAX INP: IOU FLOOR FURNANCFS VENTS: 1 WOODSTOVES: OAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS AUD'L INSPECTIONS 1000 SF ON LESS: 1 0 200 amp: 0 - 200 amp: WISVC OR FDR- 1 PUMPIIRRIGATION: PER INSPECTION: FA AOD'L 500SF: 9 201 400 amp: 201 •400 amp: tatWIO SVC/FDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL SR CIR: SIGNAUPANEL: IN PLANT: MANU HMISVClFDR: 601 • 1000 amp: 601•ampe•1000V: MINOR LABEL: 1000♦amplvolt PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: SVCIFDR-22S A.: >600 V NOMINAL: CLS AREAISFC OCC. ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL _ B.COMMERCIAL AUDIO IL STEREO: VACUUM SYSTEM AUDIO d STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA7rELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 9,139.14 RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES This permit Is al Cot to the regulations contained in the 1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR Tigard other Municipal Code,State o OR. Specialty Codes and WEST LINN,OR 97068 WEST LINN,OR 97068 all otherdance with applicable laws. All work will be done it acoQldance wltll approved plans. This permit 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 you to followrules adopted by the Oregon Utility Notification Center. Those rules are set Rego: LIC 130449 forth in OAR 952-001-0010 through 952-001-0080. You may cbtain copies of these rules or direct questions to OUNC by calling(503)246-1987, REQUIRED INSPECTIONS Erosion Control Insp 8, PoSVBeam Strurtural PLM/Underfloor Flaming Insp Gas Fireplace Appr/Sdwlk Insp Grading Inspection Post/Beam Mechanics Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Gyp Board Insp PIuFinal Footing Insp Crawl Drall,.�iackwater Electrical Service Low Voltage Rain drain Insp Firfal nspectior Foundatlon Insp FDotIng/Foundation Dr; Electrical Rough In Gas Line Insp Water Line Insp Issued By : } - '- _f CC{�—_. Permittee Signature Call (.5031639-4175 by 7:00 p.m. for an inspection needed the next business d CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00144 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/4/02 PARCEL: 2S 11 ODA-05100 SITE ADDRESS; 10510 SW NAEVE ST SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 012 _.— JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: 1 GLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL'rYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer cprnmectopm [er,ot fpr mew SF detached residence. Owner: FEES---_— _ ^- RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt 1672 SW WILLAMETTE FALLS DR — — WEST LINN, OR 97068 PRMT CTR 614/01 $2,300.00 27200200000 INSP CTR 6/4/02 $35.0027200200000 Phone: 557-8000 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the n des and regulations of the Unified Sewage Agency The oerrot expires 180 days from the date issued The total amount paid will be forfeited if the permit expires The Agency does not guara,itee the accuracy of the side sewer IF,terals If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from t're distance given If not so located, the installer shall purchase a"Tap and Side Sewer' Permit and the Agency will irstall a lateral. ATTENTION Oregon law requires you to follow r rs adopted by the Oregon Utility Notification enter Those rules are set forth in OAR 952-001-0010 through OAR 952 1-0080. You may obtain copies of these rules or .direct questions to OUNC by calling(503) 246 1�7. } Permittee Signature: Issued by: {_ _ _ Call (503) 639-4171,by 7:00 P.M. for an inspection needed the heX usiness da jT—"r 1 Building Permit Application Dale received: Permit no.(; City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 9722.+ Project/appl.no.: Expire date: City n/Tigard Date issued: B Receipt Phone: (SU3) 639-4171 Y� t no.:;..�; P Fax: (503) 598-1960 Case file no.: Payment type: 0/ Land use approval: _ 1&2 family:Simple _ C niplex: ! _ - OF PERMIT �Q 1 &2 family dwelling or accessory O Commercial/industrial U Multi-family dNew construction U Demolition U Addition/alteration/rcpiacement j'Ivilmll nnrrt ," nn•nt U Fire sprinkler/alarm U Other: Job address: ,s'--� Bldg.aro.: _ Suite no.: Lot: Block: Subdivision: Emir/std,, //,,�14-Yir , Tax map/tax lot/account no.: Project name: Description and location of work on premises/special conditions:----"I, -�..__�e ��-_-__ „�•,,, OIVNE14 FOR SPECIAL 1 Name: rvtu,rla.,ce �Nr�r� �., r,,�s t Mailing address: 14 7 Z 5't✓ v,,//6 e .i/, ,-,VIP 1 &2 family dwelling: City: t,/rf /,.,,n State: 7,IP: �'7,o 6 Valuation of work............. ................. ....... $ /� � ' D /EJ'+/ E-mail: No.of bedrooms/baths.................. _ Phone: i�>T7;+^''� Fax: ............... _Owner's representative: 1 for_ /r u,,I' Total number of floors................................. 3 Phone: L 1,+► g©$q) Fax:C70 ?L63 E-mail: Vew dwelling area(sq.ft.) .......................... �— Garage/carportarea(sq. ft.)......................... Name: Covered porch area(sq. ft.) ......................... NMR ! — Mailing address: Deck area(sq.ft.) ........................................ City: State: Z_IP: Other structure area(sq.ft.)......................... Phone: Fax: F, mail Commercial/industrial/multi-f amlly: ll Valuation of work..................................../. it Existing bldg.area(sq. ft.) ........ ........�.... Business name: a einr e New bldg.area(sq. ft) ... ............. .,.... Address: _ — _ State: Z[F: Number of stories.................... City: .., Phone: mail: Type of construction...................•................ Fax: _ E- —� CCD no.: � r� - Occupancy group(s): Existing: — lit_Z -- _ ___ _ New: City/metro lie.no.. ,,,+ 2 m r, Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contraciors Board under Name: provisions of ORS 701 and may be required to be licensed in the - -- jurisdiction where work is being performed. If the applicant is Address:_ City; _ State: !I{�, exempt from licensing,the following reason applies: Contact person: - �PIan no.: — Phone: l'ax F-mail: Name: _ Contact person: Fees due upon application ..................•........ $ Address: _ Date receiveu: City: State: ZIP: Amount received ......................................... $ Phone: Fax: E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Na all junadictions accept credit earth,please call jurisdiction for more information. attached checklist.All provisions of laws ap#rdinances gave ino this U Visa L MasterC and work will be complied witpl er.4pec 44min or not. Credit card number._ _ / / Authorized 9ignatU Date: d� Name of cardholder as shown on credit cord Expires S Print name: _ / ——� Cardholder si/nature amount Notice:This permit p,,plication expires if a permit is not obtained within 180 days after it has been accepted as complete. 440.4613(6WCOW 0►!,-- and 'f wo-i{'amily Div lling Building Permit Application C:heckliSt Reference,..: -�"�-- — - ----�� Associaledpermits: r,t,,i I1 „,r City o{. li rarci ❑Electrical ❑Plumbing ❑Mechanical Address: 1.1125 SW liall Blvd,Tign,a. OR 9722 DOther: Phone: (503) 639-4171 Fax: (503) 598-1960 THE FOLLO1,RIED FOR PLAN REVIEW Yes No NIA 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. _ 3 Verification of approved plat/lot. 4 Fire district _approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must ;arty original applicable stamp and signature on file or with application. 9 Erosion control J 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 he 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.'rhe plan must show lot and building setback dimensions;pn)lrrty corner elevations(if' there is more than a 4-ft.elevation differential,plan muFf show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of-veils/septic systems;utility Iocauons;direction indicator;lot area;building coverage area;percentage of coverage;imper,,ious 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,rool'conswction.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, ti.Armal insulation.etc. 15 Elevation views.Provide e.!­ations!or new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect:4^acts al 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 rovide specifications and calculations to engineering standards. 17 Floor/roof framing. F-ovide plans for nil 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 ver 10 feet tong and/or any heam/joist carrying a non-uniform load. 2( 5lanufactured 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 it , s appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall.roof taus)shall be stamped by an engineer or architect licensed in Oregon and shall he shown to be applicable to th, ter i t under review. 23 Five(5)site plans are required for Item 11 .Above. Site plans must be 8-1/2" x �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. ` 26 "Reversed"building;plans must meet criteria outlined in the Permit&System Development Fees document. 27 No"mirrored" building plans will he accepted. 28 "Drawn to scale"indicates standard architect or engineer scale. 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 onh. 440.4614,tAnCO t, n "Electrical Permit application �— Ddl',Laved. _ Permit no.:AI,, - City Of 1 11galr(G Project/appl.no: Expire date: rr„/'Ii),urf Address: 13125 SW Hall Blvd,Tigard,OR 97 Date Issued: By: Recciptno.: Phone: (503) 639-4171 — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 1 � &2 family dwelling or accessory U Commercial/industrial J I ,'• )amily U Tenant improvement New construction U Addition/alteration/rcplace ment _j Other: J 1'•nu,il .1011 SI UE INFORMATION Joh address: ZDLl6 SW a/3C 5G— Bldg. no.: Suite no.. 7'ax map/tax lot/accuuni no.: Lot: / Z— Block: Subdivision: E.-r/< 9'ym Project name: �Description and location of work on premises Estimated date of completion/inspectiow CONTRACIfORAPPLICATION FEE SCHEDULE Job no: roe Max - a'— f - -- I)iscription Qtr. (ea.) fatal no.Insp Business name. Newrrsidential-single or multi farnih per Address: po i:' - Z`� dssellini;aril.Inrlurles attacltrvl garage. City: 4!t /ew State: CW 'LIP: `)70/5' lwr,i(eincluded: Phone:. .'s c,' y p;y 2 Fax: E-mail: - IUOO sq.It,or less - Each additional 5W s .ft.of portion thereof _ CCB no.: (� rte[ Elec,bus.lie. no: 3 - 128,e Limited energy,residential 2 City/metro lic.no.: I Z :; _ Limitedenergy,non-residential Fach manufactured home or r^odular dwelling — Signeture of supervising electr cion(required) bale Service and/or feeder 2 ,;;i, 6>t nanetpnnU: L411” (r-• Lictrise no: [,r}J3 services or feeders-Installation, alteration or relocation: PROPER tv OWNER 200 amps or less 2 Name tint : �� /� 201 amps to 4(10 amps _ 2 CP ) t✓.1 a c Ca '^' 401 amps to 600 amps _ 2 Mailing address:: 14-71 S' G✓ is to 1000 amps 2 City: V"4 I Stale: ' Zll�: ��(��.Sj_ Over IWO amps or volts 2 Phone: t, Sf'9jOrif)I Fax: S S 6'E-mail: Reconnect only I Owner installation:The installation is being made on property I own temporary services or feeders- which is not intended for sale,lease,rent,or exchange according to tnsiallation.alteration,orrelocation: , 201 amps or ORS 447,455,479,670,701. less to 211 amps to 4C:;amps 2 Owner's signature: U:ne __ __ 401 to 600 ams Branch circuit-%-new,alteration, o:rxtension per panel: 7cPhon A. Fee for branch circuits with purchase of service or feeder fee,each branch circuit 2 Sl'tie: ZfI': B. Fee for branch circuits without purchase '-- — of service or feeder fee.first branchnrcwt. - Fax: Email: Each—additional branch circuit: PLAN IU VIEW(Please theeleall that appl)) Mlsc.(Service or feeder not Included): ❑Service over 225 apps-commercial U Health-care facility Each pump or irrigation circle _ U Service over 320 amps-rating of 1&2 ❑Hazardous location Fach sign or outline lighting familydwellings U Building over IO,000 square feet four or Signal circuit(s)or a limited energy panel. ❑Sysicmover 600 volts nominal more residential units in one structure alteration,or extension* ❑Building over three stories ❑Feeders.400 amps or more •Descn uun ❑Occupant load over 99 persons ❑Manufactured structures or RV park Each additional inspectloo over the allowable In any of the above: ❑Egressflightingplan ❑Other: - _ Per inspection r j 7-- Submit--sets of plans with any of the above. Investigation fee The above are not applicable to temporary constru:tion service. Other Not all jurisdictions accept credit cads,please call jurisdiction for rrtere irdomrarian. Notice:This permit application Permit tee.....................$ _ U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ Credit cad number ____ __ / / within 1 SP days after it has been State surcharge(8%) ....$ Expires accepted as complete. TOTAL $ Name of cardholder na xhaw n an credit cad Cadholdu signitwe Amount 440-4615(60WOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORit INVOLVED RESIDENTIAL ONLY ------------ ---- Restricted Energy F-:e...................................................... $7.5.00 Number of Inspections per permit allowed (FOR ALL SYSTPMS) Service included: Items Cost Tota! Check Type of Work Involved: , Residential-per unit 1000 sq ft or Ir;ss $145 15 1 ❑ Audio ana Stereo Systems' Each additional 500 sq It or portion thereof _ _ $33.40 1 ❑ t'urglar Alarm Limited Energy $7500 Tach Manufd Home or Modular Dwelling Service or Feeder $9090 2 ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and A­'—onoiu,ging System' Installation,alteration,or relocation 200 amps or less $8030_ 2 S 201 amps to 400 amps _ $10685 2 ❑ Vacuum ys(er*s' 401 amps to 600 amps _ $16060 2 601 amps to 1000 amps $24060 2 ❑ Other Over 1000 amps or volts $454 65 _ 2 Reconnect only $6685 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $75.00 200 amps or less $66.85 _ 2 (SEE 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 Branch Circuits New,alteration or extension per panel ❑ wiler Controls a)The fee for branch circuits w/th purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6.65 _ 2 ❑ Data Tele b)They fee for branch circuits Telecommunication In;taltat nn with out purchase of service or freder fee. ❑ =ire Alarm installation First branch circuit $46.85 Each additional branch circuit y $6 65 i ❑ HV 4C Mlscellanoous (Service or feeder not included) Instrumentation Each pump or Irriralion circle $5340 Each sign or outline lighting w $5340 _ ❑ Inlercom and Paging Systems Signal circuit's)or a limited energy panel,alteration or extension ��—_ $75.00 EllLandscapeIrrigation Control' Minor Labels;101 _ $125.00 Each additional inspection over _ ❑ Medical the allowable in any of the above Per inspection $6250 _ ❑ Nurse Calls Per nour _ _ $62.50 In Plant $73.75 �] Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ _ _ Other 8%State Surcharge $ – Number of lstems 251:Plan Review Fee See"Plan Review"serlion r $ No h:enses are required Licenses are required for all other installafions front of application ---�-- _ Fees: Total B31ance Due $ �`--- Enter total of above fees ❑ Trust Account# 8%State Surcharge Total Balance Due I dosAmnis�e!c fees doc Of,07911 Mechanical Permit Application Date received: I'crnm no.: City of Tigard Project/appl,no.: Expire(late: Cit gf'Ttgurd Address: 13125 SW Ball Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: Building permit no.: TYIPE OF PERMIT U I &2 family dwelling or accessory U Commercial/industrial U Multi-family ❑Tenant improvement U New construction U Addition/altcration/replacement U Other: I SITE 1141FORMATION COMMERCIAL VAIAIATIONt Job address: 16 5— d 5 t✓ /`44 6�wj� .97 Indicate 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$ Lot: /7-- Block: Subdivision: k/,srt, �, b 'See checklist for imprrtant application information and Project name: 0,ie,c-, jr 4 tr jurisdiction's fee schedule for residential permit fee. City/county: , l i 4 /..,I ZIP: Description and location of work on premises: 1' N : tWO I t ..tris✓ Fee(ea.) 'Total Est.date of completion/inspection: Oty. RcS.only Res.only Tenant improvement or change of use: Is existing space heated or conditioned?U Yes U No Air h handling unit CFM Air conditioning(site plan require ) Is existing space insulated?U Yes ❑No A teration of existing HVAC system oiler/compressors Business name: f,� hti^, State boiler permit no.: ... _Aa_ _ HP Tons RTU/H Address: 6.7yl S. 4aafees�j+ ell ire/smoke dampers/duct smoke detectors City: L,t,� State:Or ZIP: 9 7a)/ 1 eat pump(site p an require— Phone: 266 Z Fnx: 2`6 7 E-mail nsta rep^cefurnace/burner BTUM Including ductwork/vent liner U Yes O No _ CCB no.: /y1tre InstalUrep acOrel ocate heaters-suspended, City/metro lic.no.: 4./4 //3 2 wall,or flour mounted Name(please print): / e n cep , Vent fora iance other than furnace e gera on: Absorption units RTU/H Chillers {{I' Com ressors,� -- ^Adress: _ rnv rrnn—me nta ex roust an rent at on: City: _ Mate: ZIP:T Appliance vent - Phone: Fax: I E-mail: ryerexhaust _ Hoods, ype / 1res— itdtccf en/hazmat hood fire suppression system Name: /7r✓1c+,'i an.fe 1 Exhaust fan with single duct(bath fans) Mailing address: 16;11 s w Vf//a,..r�}e _Go/�s Exhaust system apart from heating or Fuel piping an st ut on(up to 4 outlets) City: u/. 14,11 State: -W I ZIP Ili rb V Ty LPG NG Oil _ Phone: s S' tirov(V Fax: 1,S4.16 P, I E-mail: uel piping each additional over outlets Lin lei a I Process piping(sc sematic require ) Number of outlets _ Name: Other listed appliance or equipment: Address: Decorative fireplace City: J - State: ZIP: risen-type _ Phone: Fax: E mail: Woodsto�e/pelletstose Other: Applicant's signature: Date: t �; Name (print): 3-j ;Pve Not all jurisdictions accept credit cards,please call jurisdiction for mom information. Permit fee.....................$ D visa Ll MasterCard expires This permit application Minimum fee................$ . expires if a permit is not obtained Plan review(at _ %) $ Credit card number, _ --l—�— within 180 days offer it hes been E><pims y State surcharge(8%) ....$ _ Name of ran nider as shown on credit card -- $ accepted as complete. TOTAL .......................$ Casdnoldet signature Aniount 4404617 W)n/COMI MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Qty (Es) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts 6 vents 14.00 fraction thereof,to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts&vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or includin vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater $25000.00. or Floor mounted heater 14.00 $25,001.00 to 550,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit 6.80 $1.45 for each additional$100.00 or fraction thereof,to and including 6) Repair units $50.000.00 12.15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: " Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond fraction thereof. footnotes below. comp Minimum Permit Fee$72.50 SUBTOTAL: $ 7)100K<HPabsorb unit to 100K BTU 14.00 8%State Surcharge 8)3-15 HP;absorb 25.60 f unit 100k to 500k BTU 25%Plan Review Fee(of subtotal 9)15-30 HP;absorb _Required for ALL commercial permits onl) I unit.5-1 mil BTU 35.00 TOTAL COMMERCIAL PERMIT FEE: $ unit 1-11.7,75 mil BTU absorb 30 52.20 unit 11)>50HP;absorb 7.20 unit>1.75 mil BTU J ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit t0 10,000 r,FM 10.00 Value Total 13)Air handling unit 10,000 CFV.+ Description: Q Ea Amount _ _ 17.20 Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts&vents 10.00 Fume-n> 100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents _ 6.80 Floor furnace including vent 955 16)Ventilation system not included in Suspended heater,wall heater or 955 appliance pLrmil, 10.00 Floor m-wnted heater 17)Hood served by mechanical exhaust+ Vent not Included In applicance 445 10.00 `hermit 805 18)Domestic Incinerators 17.40 Repair units <3 hp;absorb.unit, 955 1 9)Commercial or Industrial type incinerator to 100k BTU 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stove:: 101k to 500k BTU 10.00 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets mil.BTU 5.40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1.1.75 mil.BTU 1.00 >50 hp;absorb.unit, 5.725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mil.BTU __ --I_ Alr an III -unit to 10,000 cfm 656 8%State Surcharge $ Air handling unit>10,000 cfm 1,170 _ No ortable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent sysWn not Included in 656 a liance ermit other InswdFits: igns and Pe : Hood served b mechanical exhaust 656 1 Inspections outsiuu of normal business hours(minimum charge-two hours) Domestic Incinerator _ - 1,170 _ $72.50 per hour Commercial or Industrial incinerator 4 590 2 Inspections for which no fee is specifically Indicated (minimum charge-Half boon Other unit,Including wood stoves, 656 572.50 per hour Inserts etC. 3 Additional plan review required by changes,additions or revisions to pians tminimwn Gag i Ing 1-4 outlets 360 charge-one-half hour)$72 50 per hour Each additlonel Outlet - 83 "State Contractor Boller Certification required for units>200k BTU. ..Residential NC requires site plan showing placement of unit. TOTAL COMMERCIAL V $ VALUATION: _ __ All New Commercial Buildings require 2 sets of plans. I\dsLg\forrnsVnech-fees doc 08/29/01 Plumbing Permit Application -- �- — Datercccived: Permit no.: _ City Of TigardSewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 Cityq/Tigard ?hone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: By-, Receipt no.: Land use approval: Case file no: payment type: OF I &2 family dwelling or accessory LI Commercial/industrial U Multi-family CI Tenant improvement New constniction U Add ition/alterttion/replace tell( U F,)od x•rvtcv U 00wr .11OR SITE INFORNIA4[ON Fla fULE(for special infamat Ion Job address: l d j O ,j 1,.j ^jef-L✓v 5� Description Y. Tee(ea.) fatal Bldg.no.: Suite no.: New 1-and 2-family dwellings only: Tax ma /taxloUaccauntno.: (Includes 100il.for each utility connection) p SIR 1 bats Lot: /,i Block: SFR(2)bath — Project name: < rm-0 //"' A' ---- SFR(3)bath — - ----- City/county:—, ,y- w�"4 .rZIP: Each additional bath/kitchcn Description and location of work on premises: Q,44 a Site utilities: Catch basinlarea drain Est.date of completion/inspection: Drywells/leach line/trench drain------.- PLUMBING rain -_ ` Footin drain(no.lin. ft.) Manufactured home utilities Business name: r G,H _ _ _ Manholes Address: 7 7,14 Ott Rain drain connector City: State: 7.IP: 9 7 POT Sanitary sewer(no. lin.ft.) Phone:yaj-6 q Fax: — E-mail: — Storm sewer(no.lin. ft.) Plumb. CCB no.: 7q '(c bus.reg,no: -7 _ �/ �, Water service(no. lin.ft.) Fixture or Item: City/metro lic,no.: 2 Absorption valve Contractor's representative signature: — Back flow preventer Print name e". /4 Date: Backwater valve _ _ Basins/lavatory __— Name: ye Clothes washer -- - Dishwasher Address: Drinking fountain(s) City. State: ZIP: — Ejectors/sump Phone: IF;Ix is mail: Expansion tank Fixture/sewer cap /F't�u,>; . ,. <�,.r //n,M Floor drains/floor sinks/hub Name(print): — Garbage disposal Mailing address: 6 7''. / n E r //s r• Hose bibb _ City: (✓pit. 1W.1 State: 'Y� LIP: 7R'T ice maker Phone: S',,n fS1A'n"'C I Fax: E-mail: Interceptor/grease trap Owner instal lation/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 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ Owner's signature: _ Date: Sump Tubs/shower/shower an Urinal Name: Water closet Address: Water heater �- — City: State: ZIP: Other: Phone: I E-mail: otal Not all jurisdictin oaccept credit cards.please call Jurisdiction for more mformauNotice:This permit application on. Minimum fee................$ $ U visa U MasterCard expires it a permit is not obtained plan review(at ,—. �I Credit card number. f_ / within ISO days afler it has been State surcharge(896) ....$ _ Espircs Nerve L.-cardholder as shown on credit card accepted as complete. TOTAL ....................... $ S Grdholder sipature Amount 4414616(6mwomj PLUMBING PERMIT FEES: — PRICE TOTQL� New 1 and 2-family dwellings only: ✓^ FIXTURES (Individual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16 60 — the dwelling and the first100 ft. CITY (ea) AMOUNT 16 60 for each utility connection Lavatory _ One 11 bath $249.20 Tub or TublSower Comb 16.60 Tw_o 2 bath T J $350.00 Shower Only -- 16 60 Three 3 bath $399.00 Water Closet _ 16.60 _ SUBTOTAL Urinal 16 60 8%STATE SURCHARGE _ Dishwasher 16 60 PLAN REVIEW 25%OF SUBTOTAL Garbage Dispos1660 al --- -- __TOTAL _ --- ---- Laundry Tray 1660 Washing Machine — _ 16.60 — t rtr Drain/Floor sink -2" -- —16 60 PLEASE COMPLETE: 3•• 16 60 4•' 1660 ----- --- — Quantity b Work Perfoed_ Water Flealer O conversion O like kind 16,60 rm _ Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ Capped MFG Home New Water Service 4640 Sink _ ___- ---- MFC;Home Ne. San/Storm Sewer 4640 Lavatory -- _ _-.— Tub of Tub/Shower Hose Bibs 1660 _ Combination Rvot brains — 1660 Shower Onl _ Drinking Fountain 16.60 Water Closet Urinal Other Fixtures(Specify) 16.60 Dishwasher _ Garbage Dis osal _ Laundry Room Tray Washing Machine _ Floor Drain/Sink: 2" Sewer-1 st 100' 55 00 - 3" —_— ,ewer each additional 100' 4640 _ 4 Water Service- 1st 100' 5500 Water Heater Other Fixtures Water Service-each additional 200' 4640 _ S ecr — — Storm&—Rain Drain-1st 100' y 55.00 Storm 8 Rain Drain-each additional 100' 46.40 — — --- -- Commercial Back Flow Prevention Device 46,40 2esidential Backflow Prevention Device' 27.55 -- Catch Basin Inspection of Existing Plumbing or Specially 72 50 Requested Inspections _ _per/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 — Grease Traps — 1660 -- --- — -- -- --— QUANTITY TOTAL —_— Isometric or riser diagram is required II _ Quantity Total is;_9 'SUBTOTAL - -- — -- �� 8%STATE SURCHARGE ---- -- ----� ---�� "PLAN REVIEW 25%OF SUBTOTAL — —` Required only it fixture q!yfatal i—s -----••--TOTAL a `-- Minimum permit fee is$72 50•8%state surcharge,except Rasidentlal Backflow Prevention Device.which Is$36 25•s%state surcharge "All New commercial buildings require plan.q with rsometrir or neer diagram and pia,rewnw i ldstslformeAplm-fees doc 10110100 SEE 35MM ROLL # 20 FOR.- OVEII-� RSIZEJ D DOCUMENT