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12743 SW ROCKY MOUNTAIN COURT 127 .3 SW Rocky Mountain Court CITY OF TIGARD 24-Hour , BUILDING Inspection Line: (503) 639-4175 MST � '� iNSPECTION DIVISION Business Line: (503) 639-4171 BLIP Received —_- -_ . Date Requested. _ a AM _ _._-- PM __-- _ BUP __-- Location � J�1_...—_ ,��fff Suite. MEC Contact Person _ _-_ _--__ - - Ph ( _-) 3 q 51 _-�--- PLM Contractor_ _— _. Ph(-- -) __-._ v SWR 'BUILDING Tenant/Owner -_ --- - ELC Footing F_LC Foundation Access. Ftg Orcin �% -- ELF! Crawl Drain �— � =._. �� - - - - Slab Inspection Notes — SIT Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - Insulation Drywall Nailing --- - ---- Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - Roof Other: _ m ASS ` PART FAIL 41 UMB Post& Beam Under Slab — Rough-In Water Service — — ----- — - -- - - ------ - -- Sanitary Sewer Rain Drains -- ----- Catch Basin/Manhole Storm Drain --- — — Shower Pan Other: `--- nal' — S /PART FAIL MECHANICAL Post& Beam Rough-In -- --- —— -- -- Gas Line Srhoke Dampers - ---- --- -- -- — ZS1,9.__PART___ FAIL--------- CLE CTRI L Service ----- Rough-In -- - - ------ ----------- -- — --- UG/Slah Low Voltage --_ _._ __.__—_-----------__-- -- FirwAlarm __r1 n t—I Reinspection fee of$ _-required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. —IfASS.)_PART FAIL _ — n !''lease call for reinspection RE:—_—. _ — [] Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk — � 3 Inspector - - �_ Ext ---- Other: Final — _ DO NOT REMOVE this Inspection record from th - job site. PASS PART FAIL �� I A�� MASTER PERMIT (G•+; PERMIT #: MST2001-00479 DEVELOPMENT SERVICES DATE ISSUED: 2/4/02 13125 SW HMI Blvd., Tigard, OP. 97223 (503) 639-4111 SITE ADDRESS: 12743 S''VV ROCKY MOUNTAIN CT PARCEL: 2S109AD-08100 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK- LOT: 025 JURISDICTION: TIG REMARKS: Construction of new single family detached reside ice. Path 1 GEOTECHNICAL SHALL VIEW AND APPROVE THE SLOPE SETBACKS FOR THE FOOTINGS AND FOUNDATION BEFORE BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: I FIRST: 1,074 of BASEMENT: 79400 of LEFT: 0 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 820 of GARAGE: 556 of FRONT: i0 PARKING SPACES: 2 TYPE OF CONST- 5N DWELLING UNITS: I FINSSMENT: of RIGHT: 5 VALUE: $262,307.00 OCCUPANCY GRP: R3 BORM: 4 BATH: 4 TOTAL: 1,89400 of REAR: 37 PLUMBING SINKS: 1 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY 1 RAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINKS: IOr, SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES- 100 BCKFLW PREVNTR: I GREASE TRAPS OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<10OK: BOILICMP-e 7HP: VENT FANS: 'i CLOTHES DRYER. 1 ('.AS FURN>-100K: I UNIT HEATERS: HOODS: I OTHER UNITS: I MAX INP: blu FLOOR FURNANCES VENTS: I WOODSTOVES: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIHCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 5003F: 5 201 400 amp: 201 400 amp: 1at'NIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL OR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFDR: 601 1000 amp: 601+4mp5•1000V: MINOR LABEL: 1000-ampivott: PLAN REVIEW SECTION Reconnect only: >.4 RES UNITS: SVCIFDR>.228 A.: >900 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMrPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 011-IBOILER HVAC: LANDSCAPFARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAr: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,829.79 This petmit is subject to the regulations Contained in the MILLENNIUM HOMES INC MILLENIUM HOMES INC Tigard Municipal Code,Stale of OR. Specialty Codes and 2208 SE 182ND AVE 2208 SE 182 all other applicable laws. All work will be done in PORTLAND,OR 97233 PORTLAND,OR 97233 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rear: uc 7976C forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling X503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Wlr Proofing Bsm't We Footing/Foundation Dr; Electrical Service Low Voltage Water Line Insp Grading Inspection PosUBeam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Sewer Inspection Post/Beam Mechanica Ftng Drain Bsm't Walls Framing Insp Gas Fireplace Electrical Final Footing Insp Underfloor Insulation Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Foundation Insp Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final Issued By :;�Z- Permittee Signature .ti.t_ Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day CITYOF TIGAR.D _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT #: SWR2001-00250 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/4/02 SITE ADDR--SS: 12743 SW ROCKY MOUNTAIN CT PARCEL: 2S109AD-08100 SUBDIV!SION: ELK HORN RIDGE ESTATES ZONING: R-7 __--___ P,,LOCK: LOT: 025 JURISDICTION: TIG TENANT NAME: USA NO: I`l 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 permit for new single family residence. Owner: — --- FEES MILLENIIIUM HOMES INC 2208 SF. 182ND AVE Type BY Date Amount Receipt PORTI AND, OR 97233 PRMT CTR 2/4/02 $2.,300.00 27200200000 INSP CTR 2/4/02 $35.00 27200200000 Phon 503-348-5602 Total $2,335.00 Contractc Phone: Reg#: Required Inspections 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 riot guarantee the accuracy of the side sewer laterals. If the sewer 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" Perm Issued by: - � �,y Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Permit Application — City of 'Tigard Datereceived: Fl" Permitno.:J�� Address: 13125 SW Hall Blvd,Tigard,OR It,21Projecdappl.no,: Expiredate: CM''t 1 i I-old Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 1&2 family:Simple Complex: I &2 family dwelling or accessory 0 Commercial/industrial 0 Multi-family J New construction 0 Demolition 0 Addition/alteratioi-dreplacement 0 Tenant improvement 0 Fire sprinkler/alarm ❑Other:INFORMATION — JOB SITE Job address: (d )f Bldg.no.: Suite no.: Luc1 Block: ISubdivii Tax map/tax lot/account Project name: Description and location of work on premises/special conditions: O%VNI-It FOR SPECIAL INO]IRMATION, (FlapWftsbpdevspmckysol2r,etc.)' Name: Mailing ddress: (i 1 &2 family dwellin 407 City: ,Al State: 1 ZIP: J;j 3 Valuation ofwork... 5..7,rl/.��................. $ Phone:543 Fax: 7G E-mail: No.oftxdroums/baths................................. Owner's representative: L a C E V, Total number of floors................................. Phone: Fux: .. '� Email: New dwelling areas ft.) .�. .. `70� S C: g (,q. ..... .... APPLICANT Garage/carport area(sq. ft.).....rf.0............. Covered porch area(sq. ft.) ......................... Name: I ( f' Mailing address: •-� Deck area(sq. ft.) ......................�..5`��....... �_;Z�.-- City: Other structure area(sq. ft.)......................... �--� Phone: ; Fax: 1 F,-mail: Commercial/Induntrial/multi-family: i"it 111101 I'll, Valuation of work........................................ $ t Existing bldg.area(sq.ft.) .......................... Business name: ,A wA nYh, t,l �c _ New bldg.area(sq.ft.) ......... Address: Number of stories...................... . ... .......... City: , State: zip: -� Type of construction................. ........... Phone: �� Fax: _5(x C-mail: - - Occupancy group(s): taxi. ' g: CCB no.: New: < --- -----... - ----- -- -- City/metro lic. nu.. Notice:All contractors and subcontractors are required to be ARCHITECTIDESIGNER licensed with the Oregon Construction Contractors Board under Name: _ '-i,,CE provisions of ORS 701 and may he required to be licensed in the Address: Y> C) jurisdiction where work is being performed. If the applicant is City: 'tate: Y'_ I ZIP: exempt from licensing,the following reason applies: Contact person: Phone: vj a,p I'ax: )I U`.t - E-mail: Name: (contact person: Fees due upon application ........................... $ Addre, Date received: ___ City: M _ State: _�IP Amount received ......................................... $ Phone: e Flix: Email: Please refer to tce schedule. I heivhy certify 1 have read and examined this application and the Not all jurisdictions accept credit cards,please call jurisdiction fix more inlonnation attached checklist. All provisions of laws and ordinances governing this c]visa U Mastercard work will be complied with whether s cified herein or not. Credit card number__— __--. r_ �. P ires Authorircd sign re: j. _ --T nte: 9 Name of cardholder as shown on credocard yt] --�v r" s— print name: � !— G �— _ - cwlhwckr st�naiare-- -V Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted u complete. 4/0.4613 ir„aa'Cotitl One- and Two-Family Dwelling Building Permit Application Checklist Reterenceno.. - A;sociatedpern ) City of Tigard Cit of Tigard City garJ Electrical n f'IumhmL J Mechanical Address: 13125 S N Hall Blvd,Tigard,OR 97223 ]Other: Phone: (503) 639-4171 Fax: (503) 598-1960 t t I Land use actions completed.See jurisdiction criteria for c ntcwrcnt reviews. 2 Zoning. Flood plain,solar balance points,seismic soils designation.historic district,etc, 3 Verification of approved plat/lot. _ t. 4 Fire district approval required. JL 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. -- __- — 7 Water district approval x 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control Wplan U permit required. Include drainage-way protection,silt fence design and location of catch-basin protection,cre. 10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state building cot!c•~. 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 he completed if copyright violations exist. I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if there is more than a 4-11.elevation differential,plan must show contour lines at 2-1t. intervals);location of easements and driveway:footprint ol'structure(including decks);location ot•wells/septic systems;utility locations;direction indicator,lot area:huilcling coverage arra;percentage of coverage;inipen,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.Slow all dimensions,room identification,widow 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 artd spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show ` details of all wall and roof sheathing,roofing,cool•slope,ceiling height,siding material,footings and foundation,stairs, �( (;replace construction, thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. _Full-size sheet addendums showing foundation elevations with cross references are acceptable. 1(ii Wall bracing(prescriptive path)and/or lateral analysis pians.Must indicate details and locations:for nun-pre scnptivc path analysis providespecifications anti calculations to engineering standards. X _ 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member siring,spacing,and hearing locations.Show attic ventilation. 18 Basement and retaining walls. Provide cross sectiuns and details showing placement of rebar. For engineered systems,see item 22,"Engineer's calculations." X 19 Beam calculations.Provide two sets of calculations using current code design values for all heanis and rnultiple joist. over 10 feet long anti/or any bearn/joist carrying a non-uniform load. 20 Manufactured floortroof truss design details. .. 21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. _ 22 Engineer's calculations.When required or providedshear wall,roof truss)shall be stamped by an engineer or architect licensed in Otegon and�h:all he shown to h . � pli,,rhlr to thy project under review, t 23 Five(5)site plans:are required for Item 1 I above. Sm, plans must he 8-1/2" x 1 I"or I I" x 17". 24 Two('-),sets Each are required for Items 16, 19.20& 12 above. — 25 Building plans shall not contain red lines or tape-ons. 26 No rolled,reversed or mirrored building plans will be accepted. NIS- Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440.4614 MW_okl) i Electrical Permit Application �Dat!Treccived: Permi'.no.. 1 ,i��,'/: City of Tigard Projecdappl.no.; Expiredatee:: City(if Tigard Address: 131 23 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Case file no.: Payment type: Fax: (503) 598-1960 Land use approval: t I &2 family dwelling or accessory U Commercial/industrial Multifamily U U Tenant improvement U Other New construction ❑Additiotl/alteration/replacement 0 Partial JOB SITE INFORMA-111ON EF Job address: �° Bldg.W 1{ ( no.: Suite no.: Tax map/tax lot/account no.: Lot: Bloc Subdivision: yl r ` - Project name: Description and location at'work on premises: 51 t �' t f.� t t. ��r Estimated date nt•r.ompletiun/inspecti-n. Fee Ml no: --- Description Q (a) Total no.in+ Business flame: New res.idenlW-single or muni family per Address: -A-415 &JL' 1"Al It. I'. I dwelling unit.Include+attachet:guraRc• City: �; (; State: ZIP: C serviceincludrd I Fax: L' I3'l E-mail: I00(1 sq.ft.or less 4 Phone: • I Each additional 500 sq,ft.or porion thereof CCB no.: C 109,01 Elec.bustic.no: d- 15 C Limited energy,residential 2 City/metro tic,no.: ._._ /o't Unified energy,non-residential 2 Fach manufactured home or modular dwelling Date �d I Service and/or feeder Si nature of supervising electrician(re uiredl services or feeders--installation, Sup.elect.name(pnnt). _ License no ✓ alteration orrolocatlon: 1 1 200 amps or less ` 201 amps to 400 amps Name(print): I ( 1 V 401 amps to 600 amps '- Meiling address: p 601 amps to 1000 amps State, " ZIP: ?�` Over Ioffo amps or volts 2 City: K, — Fax: •• E-mail: Recnnnecto nl Phone:'tc C'( Temporary services or feeder%- Owner installation:The installation is being made on property I own Installation,alteration,or relocation: which is not intended for sale,lease,rent,or exchange according to 2W am s or fess 2 OR S 447,455,479,670,701. 201 amps to 400 amps _ Date: �I 1 2 Owner's si nature: z_4 _ 40 °0 600 am s ENGINEER Branch circuits-new,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuli ZIP 11. Fee for branch circuits without purchase City: _ _.State: of service or feeder fee,first branch circuit: Phone: Fax E-mail: Each additional branch circuit. Mist.(Service ar feeder not Included): Bach pump or uriguimn circle 2 C1 5rrvice over 225 amps-commercial C]Health-care facility Each soutline lighting 2 ❑Service over 320 amps-rating of 1&2 O Hazardous location Signal circignor out inin a limited energy panel, famllydweflings 0RuildingoverlO,000square feet four ar B O System over 600 volts nominal more residential units in one snucture ahernticn,orextension" - 2 CO)Building over three stories O Feeders,400 amps or more *Dtscn uan. ._. O Manufactured structures or RV park Each addlNonal Ins ction over the Allowable In any of the above: O Occupant load over q9 persons � — O Fgress/lightingplan ❑Other -- Itermspection 1_!— Submit_sets of plans with any of the above. Investigation fee The above are not applicable to temporary comf4ruction service. other Permit fee.................... Not all jurisdictions accept crexlit earth,please can jurisdiction for more infonnailon. Notice:This permit 11110"1100111 Plan review(at — 96) $ l]Visa O Masle!Card expires if a permit is not obtained __-L_1 within ISO days after it has been State surcharge(8%) ....$ d Credit cunumber: Cu%res accepted as complete. TOTAL ....................... Nww__0rc_A'&oTi u shown on credit card S Cardholder Opsture Amoum 410.1615(6000Mi ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: ------�---`--�-'-- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete FEe Schedule ,below: Restricted Energy Fee.............................................. ....... $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included- Items Cost Total w Check Type of Work Inv-. ed: Residential-per unit 1 11 1000 sq.ft.or less $145.15 5 3 Cl Audio and Stereo Systems' Each additional 500 sq,ft,or portion thereof 3 $33.40 OOraCi 1 ❑ Burglar Alarm Llmit6d Energy $75.00 Each Manuf'd Home or Modular Garage Door Opener' Dwelling Service or Feeder $9090 2 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation $80.30 $U �� 2 200 amps or less Vacuum Systems' 201 amps to 400 amps $106.85 _ _ 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps _. $240.60 _ 2 ❑ Other –- Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders 11 Fee for each system......................................................... 75 U tnstarlation,alteration,or relocation 200 amps or less $66.85 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 ` 9 of Work Involved 401 amps to 600 amps _ $133.75 2 CI ""v Tye 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 wP! purchase o/service or leader lee. — rl Each branch circuit $6 55 2 L J Data Telecommunication Installation b)the fee for branch circuits without purchase of service Fire Alarm Installation or feoder fee. First branch circuit $46.85 HVAC Each additional branch circuit $665 .____ Miscellaneous Instrumentation (Service or feeder not Included) Each pump or Irrigation circle $53.40 _ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s)or a limited energy Landscape Irrigation 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 _ In Plant $73.75 Outdoor Landscape Lighting' Fees: Protective Signaling Enter total of above tees $ �"� b(r Other_ 8%State Surcharge $ -�-�'�5_- -,Number of Systems 25%Plan Review Foe No licenses are required Licenses are required for all other installations See"Plan Review'section on $ fmnt of appllca'+on. Fees: Total Balance Due $ ' S 7.� 00 Enter total of above fees $ , ❑ Trust Account#__—_— $ \? v 8•/.State Surcharge Total Balance Due $-----4-s'—"� i\dsts'dormskic-fses.doc 06117/01 Plumbing Permit Application — — Date received: D G Permit no.: City of Tigard Sewer permit no.: Building permit no.: �~ Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.., Expire date: City of Tigard Phone: (503) 639-4171 Fax: (503) 598-1960 Date issued 11;r: Receipt no.: Case file no,: Payment type: Land use approval: _ e &2 family dwelling or accessory ❑Commercistl/iudustnal J vlulufannl} OTenant improvement ❑New construction ❑Addition/alteration/replacement 0 Food service ❑Other: 1 ' ' Description QtV. lee(ea.) ' Total Job address:' 'f 't 4 ` ( New 1-and 2-family dwellin>;c only: Bldg.no.: I Suit no.: (facludmi0oft.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot; Block: Subdivision: SFR(2)bath Project name: SFR(3)bath City/county: tG w< ZIP: Each additional bath/kitchen Site utilities: Description anoc k on premises: Catch basin/area drain Drywella/leac 1 line/trench drain Est.date of compietion/inspection: Footing drain(no.lin.ft.) _ _1119az9=11111Mt Manufactured home utilities Business name: Manholes Address: t ; $('" �•� �! Rain drain connector City: i(. State: ZIP: Sanitary sewer(no.lin.ft.) Storm sewer(no.lin. ft.) Phone:r' D1 Fax:� 07 E-mail: Water service(no.lin.ft.) CCB no.: I kAr"' 7 7V Plumb.bus.reg.no: Fixture or Item: City/metro lic.no.: __ - Absorption valve Contractor's representative signature: — Back flowprevenler Print natne: 1 "' Backwater valve CON'FAUVIIERSON Basinsnavatory Clothes washer Name: Dishwasher Address: - Dtinkin fountain(s) City: _ _ State: ZIP: _ E'eetors/sum Phone: Fax: E-mail: Expansion tank _ Fixture/sewer cap Floor drains/fl oar sinks/hub _ Name(print): ^t r ' — Garba a disposal Mailingaddress: I Hose bibb City: State: Ice maker Phone-'),r, Fax: �t Email: Interce for/grease u1 Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ Owners si natuDate: sumpre: Tubs/shower%shower an — Urinal Name: _ _ Water closet _ Address: Water heater City: - State: ZIP: Other: Phone: Fax: E-mail: otttl -- Minimum fee................$ Not dl toridictiorw accept credit cards.please call}uris&don for more Intarmatlon. Notice:ibis permit application Plan review(at %) $ 0 V'laa u MasterCard J J expires if:permit is not obtained State surcharge(8%) ....$ _- Credit card number!_-- -- xptro� within 180 days after it has been accepted as complete. TOTAL .......................$ . Name or canlhol .r v shown oo credit card $ C dholduilgrature — Anwuar 44rNR1616UtYCQMI PLUMBING PERMIT FEES: TOTAL !:;0 2-familincludes all y dwellings only: FIXTURES Individual _ TOTAL qTY ea AMOUNT g and thenfirst100 ft.ures QTY PRICE AMOUNT Sink 16.G0 16.60 fortility connection) Lavatory _ th $249.20 Ti;_b or Tub/Shower Comb - 16.60 th ,- $350.00 Shower Only1660 ath _ $399.00 Water Closet 1660 SUBTOTALUrinal 16.60 8%STATE SURCHARGEDishw+sher 16.60 VIEW 25%OF SUBTOTAL TOTAL Garb ige Disposal 16.60 Loindry fray 16.60 Washing'Aachine 16.60 Floor Drain/Floor Sink z" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Healr r O ve conrsion O quantity b Work Performed like kind 16.60 Fixture Type: New Moved Replaced Removed/ Gas piping requires a separate mechanical _ Capped emtit. Sink MFG Home New Water Service 46.40 _ -- i MFG Home New San/Storm Sewer 48.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only 16. Drinking Fountain 60 Water ClosetUrinal Other Fixtures(Specify) 16.60 _ Dishwasher Garbe a Dis osal Laundry Room Troy Washing Machine Floor Drain/Sink: 2" _ Sewer-1st 100' 55.00 3" Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater _- Other Fixtures Water Service-each additional 200' 46.40 Sed Storm&Rain Dmin-1st 100' 55.00 - Stomi&Rain Drain-each additional 100' 46.40 _ Commercial Back Flow I reventlon Device 46.40 `- Residentlal Backflow Prevention Device' 27.55 Catch Basin 16.60 - Inspection of Existing Plumbing or Specialty 72.50 Rnested Ins actions or/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.80 ^_ QUANTITY 1 OTAL -- Isometric or riser diagram Is required if 01�anttly Total Is >9 -- - *SUBTOTAL STATE SURCHARGE - - "PLAN REVIEW 25%OF SUBTOTAL Required o_niy it fixture qty.total Is�,9 _- TOTAL S 'Minimum permit fee is$72 50•B%state surcharge,except Resktentlal Brckfiow Prevention Devlce,which Is$36 25+a%stare surcharge, "All Now Commarclal Buildings require pians with Iso"tric or riser diagram and plan review I:klstsVorms\plm-fees.doc 10/10100 Mechanical Permit Application --- IDatcreccived: 8 i` i/ City of Tigard Project/appl.no.: Expire date: Ciryr,jTigord Address: 13125 SW Hall Blvd,Tigard.OR 197223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: I'aymenttype: Land use approval: Building permit no.: 1 &2 family dwelling or accessory O Commercial/industrial U Multi-family U Tenant improvement New construction _J \ Iit l101L/alterauon/replacement U Other: JORSITE INFORMATION ( SCIIPDULE Job address: �, -C,j W&kAA xi, , ' Indicate equipment quantities in boxes below. indicate the dollar Bldg.no.: Sbitc no.: _ Va.ue of all mechanical materials.equipment,labor,overhead, Tax map/tax lot/account no.: proOr Value$ l..at: Block: Subdivision: y •S 'See checklist for important application information and Project name: jurisdiction's fee %cheduie for residentia; permit tee. City/county: Y ZIP: 34 Description and Icightion of work on premises: `' I—eutt I 19 91101011111111WO 1111 lei e 1 1:,1 i 1 A I'('t'IIJ.) Iwal Est.date of completion/inspection: thycription tpv. Res.only Res.only Tenant improvement or change of use: C' Air handling unit Is existing space heated or conditioned?U Yes U No Air conditioning(site plan required) Is existinn ~pact•insulatt•d')9 Yes ❑No Alteration of existing IIVAC system MECTIIANICAL CONTRACTOR ioi ed ompressors Business name: ' State boiler permit no.: ____ HP Tuns BTU/11 _ Address: j Fire/smoke dampers/duct smoke detecto_s City: I State: I ZIP: C eat pump(site plan required) _ Phone: Fax:I 1/,,?b E-mail: nsta repacefurnace/burner H .I1 Including ductwork/vent liner 'U Yes U No CCB no.: nsta /rep a—e/re locateheaters-suspended. City/metro tic.no.: _ wall,or hour mounted Nene(please print): Vent for illirliance other than furnace PERSON of gerat on: Absorption units ITU/H Name: Chillers— HP Compressors lip Address: Environmental exhaust and ventilation: City: State:^�ZI{': _ Appliance vent Phone: Fax: E mail: Dryer exhaust Hoods, ype res.kite eN azfnat hood fire suppression system Name: Exhaust fan with single duct(bath fans) Mailing address: ' j r Exhaust system a art from heating or AC Fuel piping an s1 uilon(up to 4 outlets) City: State: Z{P: ?,3 type: _ Lix; NG __ Oil Phone:I-5.Idp r l I Fax. ? mail: Fuel fptn each addiuona aver 4 outlets rocrospiping(schematicrequired) Number of outlets Name: -a-twe-r1rited app anceor e�qu pmen11- Addrcs':: Decorative fireplace City: State: ZIP: Insert-type _ Phone: Fax: E-mail: oo stovdpelletsarve o er. Applicant's signature: Date: ter; _ Name (print): _ Na oil Juriwlicuon,accept credit cards.pleux callµmWrctlon for more infomutinn. Permit lee.....................$ -- U Not VisU Ma accept cd Notice:This permit application Minimum fee................$ expires it'a permit is not obtained Plan review(at — %) $ Credit card number: ____ Iapites within Igo days atter it has been - State surcharge(8%)....$ Name nt cardholder as shown on credit cord S accepted as complete. TOTAL .......................$ Cardholder signature Amount i1I1461716A70�CgMl MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: - Description: Price Total TOTAL VALUATION: FEE: - Table 1A Mechanical Code of (Ea) Amt y $1.00 to$5,000.00 Minimum fee$72.50 1) Furnace to 100,000 BTU $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts&vents 14.00 $1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+ fraction thereof,to and including including ducts&vents 17.40 $'O,000.UO. 3) Floor Furnace $10,001.00 to$25,000,60 $1.16.50 for the first$10,000.00 and including vent 14,00 $1.54 for each additional$100.00 or 4) Suspended heater,wall heater frac ion thereof,to and including or floor mounted heater 14.00 $25,300.00. 5) Vent not included in appliance permit $25,001.00 to$50,000.00 $3741.50 for the first$25,000.00 and 6.80 $1.45 for each additional$100.00 or 6) Repair units fraction thereof,to and including 12.16 _ $50,000.00. 50,000.00 and Check all thBoiler Heat Air $50,001.00 and tip $742.00 for the first$ at appy; $1.20 for each additional$100.00 or footnotes Ile es below ee or Com • Pump Cond fraction thereof. _ 7)<3HP;absorb unit 14 00 _ - to 100K BTU ASSUMED VALUATIONS PER APPLIANCE: 8)3-15 HP;absorb 25.60 Value Total unit 100k to 500k BTI.1 Descr!Rh D Ea Amount g)15-30 HP;absorb 35.00 Fun ace to 100,000 BTU,including 955 unit.5-1 mit BTU ducts&vents10)30-50 HP;absorb 52.20 ce Fuma >100,000 BTU Including 1,170 unit'•1.75 mil BTU _ ducts&vents 11)>50HP:absorb 87.20 Floor furnace including vent 955 unit>1.75 mil BTU Suspended heater,wall healer or 955 12)Air handling:u-n -10,00 0 CFM 10.00 floor mounted heater Vent not Included in applicance 445 13)Alr he unit 10,000 CFM+ 1720 Repair units 605 14)Non-portable evaporate cooler <3 hp;absorb.unit, 955 /0.00 to 100k BTU 15)Vent fan connected to a single duct 6.80 3-15 hp;absorb.unit, 1,700 '- 101k to 500k BTU 16)Ventilation system not included in 10.00 15-30 hp;absorb.unit,501k to 1 2,310 appliance permit mil.BTU _ 17)Hood served by mechanical exhaust 10.00 30.50 hp;absorb.unit, 3,400 1-1.75 mil.BTU 5,725 18)Domestic incinerators 11.40 >50 hp;absorb.unit, >1.75 mil.BTU 19)Commercial or industrial type incinerator Air handlin unit to 10 000 cfm 856 66 95 Air handling unit>10,000 cfm 1 170 20)Other units,including wood stoves _Non-portable evaporate cooler 658 10.00 Vent fan connected to a sin Is duct 446 21)Gas piping one to four outlets Vent system not Included In 858 � 5.40 a (lance eimit 22)More than 4-per outlet(each) 1.00 Hood served b mechanical exhaust 1,870 5 Domestic incinerator Minimum Permit Fee$72.50 SUBTOTAL: Commercial or Industrial Incinerator 4 590 $ Other unit,Including wood stoves, 656 81 State Surcharge inserts,etc. - 360 Gas i In 1�outlets 25%Plan Review Fee(of subtotal) $ Each additional outlet 63 Required for ALL commercial permits only - TOTAL COMMERCIAL n RESIDENTIAL PERMIT FEE: j �_L_ VALUATION: _ Other Ing eact ons an.Fees: I Inspections outside of normal business hours(minimum charge-two hours) $72.50 per hour 2 Inspections for which no fee is specifically indicatod (minimum charge-half hour) $72.50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-one-half hour)$72.50 per hour 'State Contractor Boller Certification required for units>200k BTU. "Residential A/C requires site plan showing placement of unit. is\dsts\formsUnech-fees,doc 10111/00 O'Lt 7 a v � T Ilk \ b I �1 r 1' J to � d r' 8 G i .n a CA fi --- -- - 9 r f 9 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE R K ELECTRIC INC 24495 NW OAK DR HILLSBORO, OR 97124 Electrical Signature Form Permit #: MST2001-00479 Date Issued: 214102 Parcel: 2S109AD-08100 Site Address: 12743 SW ROCKY MOUNTAIN CT Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 025 Jurisdiction: TIG Zoning: R-7 Remarks: Construction of new single family detached residence. Path 1 GEOTECHNICAL SHALL VIEW AND APPROVE THE SLOPE SETBACKS FOR THE FOOTINGS AND FOUNDATION BEFORE POURING Your company has been indicated as the electrical contractor for the pai mit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required Please have the appropriate individual frorn your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MILLENNIUM HOMES INC R K ELECTRIC INC 2208 SE 182ND AVE 24495 NW OAK DR PORTLAND, OR 97233 HILLSBORO, OR 97124 Phone #: 503-348-5602 Phone #: 640-1344 Req #: SUP as4Fjs- ELE 34.3750 AN INK SIGNATURE IS REQUIRED ON THIS FORM X( Signati,re of SuupervisFag Electrician If you have any questions, please call (503) 639-4171, ext. # 310 c. C - 7a c � a .r r � Oa o n ro � a � n a' x