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10885 SW DERRY DELL COURT CD 00 00 L" V) Q m v m r- r n f I 10885 SW DERRY DELL CT CITY OF TIGARD 24-flour BUILDING Inspection Line: (503)639-4,175 MST INSPECTION DiViSION Business Line: (503)639-4171 -�– BLIP 1 b Received —.- Date Requested_— r ( AM_ PM BLIP Location / ` �.�C.-L- T' e `.�_Ik_Suite _-- MEC Contact Person Ph PLM ContractorP.r ---- ---- BUILDING Tenant/Owner -_ _ - ELC _ Footing Foundation ELC Ftg Drain ELF! Crawl Drain SlabInspection Notes: SIT _ ----- - - Post&Beam - - -- - - - ..- - Shear Anchors - -- - - Ext Sheath/Shear 16— int Sheath/Shear Framing Insulation Drywall Nailing - - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -'Ut_ L. Root Other: - Final - PASS _PART FAIL -- - - --- ------ PLUMBING Post& Beam - Under Slab Rough-In Water Service ---------- Sanitary Sewer Rain Drains --- --- - - - _ _ Catch Basin/Manhole Storm Drain - —-- --- --- -- _— Shower Pan Other: ----- --- —,.�- Final PA S-� PART FAIL -- -_- -- --�-- MECHANICAL Post&Beam Rough-In `-_---_-----_-_-_- G 3s Line ------ -- Smoke Dampers Final PASS PART FAIL - ---- ---- --- ---- _ _- ELECTRICAL _ Service ---------- - ------------------ - - -- Rough-In Ur,/Slab ------ - --- -_-_------ ---.�- - --- i Low Voltage Fire Alarm --------�-- - -- -- — — . Final ❑ PASS PART FAIL Reinspection fne of$ p y N— required before next inspection. Pa at Ci Mall, 13125 SW Hall Blvd. _ SITE _ PIE call for reinspection IE:-. _ ❑ I . ._ _-� F] Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date _ Inspectee i' • \ k _ Ext Other: Final DO NOT REMOVE this Inspection rece!rd from tho job site. PASS PART FAIL CITYO F T I GA R D _ PLUMBING PERMIT DEVELOPMENT SCRV�CES PERMIT#: PLM2004-00274 DATE ISSUED: 6/18I2004 13125 SW Gull Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 10885 SW DERRY DELL CT PARCEL: 2S103DA-02100 SUBDIVISION: DERRY DELL PLAT 2 ZONING: R-3.5 BLOCK: LOT: 022 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME 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: 80 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN GRAIN: ft Remarks: 80'of sanitary sewer line, connecting to sewer lateral but capping at house and not actually connecting to service. To still remain on septic service at this time. _ Owner: FEES -- — -- -- — — Description Date Amount KOOL, SCOTT D +CELIA C I PLUBMPermit Fec 6/18/2004 $72.50 10885 SW DERRY DELL CT I TIGARD, OR 97223 I I'nxJ 8' SlawSurrharl 6/18/2004 $5.80 1 �— Total -- $78.30 Phone : Contractor: ARTS EXCAVATION LLC 4004 SE GRgNT ST PORTLAND, OR 97214 REQUIRED INSPECTIONS Phone : 503-888-3664 Sewer InspectionFinal Inspection Reg#: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will 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. AT-1 ENTIM Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Issued By: � �. ( _ Permittee Signature: 6.L" Call (503) 639-4175 by 7:C0 P.M. for an inspection needed the next business day CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERM:(#: SWR2004-00184 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417' DATE ISS-UED: 6/18/2004 SITE ADDRESS; 10885 SW DERRY DELL CT PARCEL: 2S1031W,-02100 SUBDIVISION: DERRY DELL PL,1 I ,ZONING: R-3.5 BLOCK: LOT:-02' V_ ,!JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE= UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: t_TPSWR IMPERV SURFACE: Remarks: Install sewer line work and tap sewer lateral but not connect to house at this time. Owner: _ FEES KOOL, SCOTT D +CELIAC — 10885 SW DERRY DELL CT Description Date Amount TIGARD, OR 97223 [SWUSA]Swr Connectir 6/18/2004 $2,400.00 [SWUSA]Swr Connectir 6/18/2004 $0.00 Phone: �SWINSP]Sewer Inspeci 6/18/2004 $35.00 Contractor (SWINSPJ Sewer hispect 6/18/2004 $0.00 _ _ Total $2,435.00 Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rule-an+ regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount pi .i will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, thn installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Issued b {' V .. Y 1\ d. . , Permittee Signature: Call (503)639-4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Permit Application FOR OFFICE USIE City of Tigard Received r Pcrtmt Nu. I'[,� �0 13123 SW Hall Blvd.,Tigard,OR 97223 Date/By: Plan Review — Phone: 503.639.4171 Fax: 503.596.1960 r, DateB ; Other Permit No "e »-Hour Inspection Line: 503.639.417: Date Ready/By: fur ® See Page 2 for Internet: www.ci.tlgard.or.us Notified/Method //O Supplernenlal Information TYPE OF WORK --- --^ FETE" SCHEDULE ❑New construction - ❑ Dew-liuon For special information use checklist. ----- -- - - Description I Qty, I Ea. I Totai ❑Addition/alteration/replacement ❑Other New i-2-family dwellings(includes 100 ft.for each utility connection) • -Y CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 ❑ I--and 2-family dwelling - ❑Commercialfindustrlal SFR(2)bath 350.00 ❑Accessary building ❑Multi-family SFR(3)bath 399.00 El Master builder -- Each additional bath/kitchen 45.00 -_--_ ❑Other: Fire sprinkler( sq ft.) Page 2 JOB.SITE INFORMATION AND LOCATION Site utilities Job site address_ 11019155 S W b y DT--LL L3- Catch basin or area drain 16.60 City/State/ZIP.,TG tip 2- 9 7!:; 3 Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Project name: i"o e'_ Footing drain(no.linear ft. ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: — Manholes 16.60 _ Rain drain connector 16.60 -� Sanitary sewer(no.linear ft.: 94 1 Page 2 Storm sewer(no,linear ft.:_1 Page 2 Subdivision: Lot no.: Water service(no linear ft. _) _ Page 2 - Tax map/parcel no.: Fixture or Item y Absorption valve 16 60 Backflow preventer Page 2 +vl nl'-E. THL S s N1�rt- TA P �q_ZL JE w Bac kwe[er valve 16.61) __-!- 1IA.AL Tj Q5-T tL -rNF- A fl.d 0) 0'1 N(t Ta Clothes washer _— 16.60 LV Dishwasher 16.60 -V - [pinking fountain ❑ A -PROI'F.RI'Y OWNER [] TENANT t : -- " Ejectors/sump 16.60 Name: 5 Co-rT—D C t 4 0 O l.____ __ Expansion tank 16.60 Address: l O $ - Fixture/sewer cap 16.60 City/State/ZIP: TT (.a,. O(- Z�L3 Floor drain/floor sink/hub 16,60 Phone:(5 p j) 4-7Cs10,53 Fax:( ) Garbage disposal 16.60 0 40LICANT' ❑ 6NTACT PERSON Hose bib 16.60 a — - — ---- , Ice maker 16.60 Business name - -- lntetceptor/grease trap 16.60 Contact name: Medical gas(value 3 ) Page 2 Address: Primer _ 1660 City/State/ZIP: - -- ---- Roof drain(commercial) 16.60 Phone:( ) rFax::( ) Sink/basin/lavatory 1660 - -- - - - - Tub/shower/shower pan 16.60 Email Urinal 16.60 Water closet 1660 Business name: A&3'5 r-)LCA V^TI p ty L.L L Water heater 16.60 Address: Other: - �}on 4 S 5. Crr'l/t N1 $T _--_ -- Subtotal�`- City/State/ZIP: rf, tV (L9 7Li — Minimum permittee 572.50 �J Phone: Fax ( Residential backflow minimum permit fee S36 25 (50- ) _ - CCB Lie.: 1 �j f}- Plumbing...c.no.: 3-Aq&_ Plan review (25%of perms!:ee) Authorized signature: �i /,� -/.� State surcharge(8110 of permit fee) !� 1.C"""' TOTAL PERMIT FEE Print roe: CEl_l A C .k 0 OL Date: 6 •(� This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. *Fee mellhodolo y set by Tri-Counry Building it�asstry Service Board i�Buildina�Pemtiu';I.MF•Per"ntAppdoc 12193 ar0•a616T(10'021COM/WBBI 1/ 1 t�r• 7► 'j Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information FCC Schedule: Residential Fire Suppression Systems: Site Utilities -� Qty. Fee(e i) Total Square Footage: Permit Fee: Footing drain-1"100' 55.00 0 to 2:000 $115.00 Ft-ting drain-cach additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,2.00 _ $220.00 Sewer-Ist IOC' 1 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-1st 100' 55.00 Medical Gas S stems: Water Service-each additiowl 100' 46.40 -at Valuation: Permit Fee: _ Storm&Rain Drain-1st 100' 55.00 $1.00 to$5,000 00 Minimum fee$72.50 Stumm&Rain Drain-each additioral 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$152 for each Fixture or Iter Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and including$10,000.00. t ,,mnicrcial liack Flus% Pi-wentwn Device 46.u, $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27.55 and including$25,000 00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for each additional$100.00 or fraction thereof,to Inspection of existing plumbing or and includin $50,000.00. s eciall.requested ins ections-per hour 72.50 $50,001.00:nd up $742.00 for the first$50,000.00 and$1.20 for Subtotal: each additional$100.00 or fraction thereof Fixture Work: Are you capping,moving or replacing existing fixtures? If "Yes",please indicate work performed by fixture. Failure to accurately report fixtures could result in Increased sewer fees*. Qua Ulf ty b (FI xture)lvorkPerformed, Fixture Type: Replace New Moven .'fisting tapped ('1,i1111jents regarding lixture w111IL: lla ustr +unt Bath -Tub/Shower _ -Jacuzzi/Whirlpool - --- Car Wash -Each Stall -[hive Thru Cuspidor/water Aspirator Dishwasher -Commercial -Domestic Drinking FountainEye Wash Floor Drain/sink 3" -- 4„ Car Wash Drain --- - - ---- - -- Garbage -Domestic Disposal -Commercial *Note: If the fixture work under this permit results in an -Inaust.nal Ice Mach./Refri .Drains increase of sewer EDUs,a sewer permit will be issued and Oil SCPArator Gas Station fees assessed for the sewer increase must be paid before the Rec.Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink -Bar/Lavatory _ Qantity'fotal -Bradley Isometric or riser diagram Is required if fixture quantity -Commercial -Service is>9. Swimming Pool Filter _ Washer-Clothes Water Extractor Plan Review Water Closet-Toilet _ _ Plan review is required if fixture quantity total Is>9. Urinal _ t Other Fixtures: J ,,Bwidtna\PemitsmPLM.PmrnApp do, 3103 1 CITY OF TIGARD June 17, 2004 OREGON Scott and Celia Kool 10885 SW Derry Dell Ct Tigard, OR 97223 This letter grants authorization to make the sewer tap to the sewer lateral and install the yard piping to the dwelling on this property. It does not grant approval to connect the yard piping to the house drain. Approval to connect to the house drain can only be granted after the sewer reimbursement district has been approved and all associated fees have been paid to the City and an additional plumbing permit obtained for this subsequent work. In order to allow this work to occur, a sewer permit and plumbing permit shall be obtained from the C:ty of Tigard Building Division and all fees paid. Inspections for the connection to the lateral and all associated underground piping shall be inspected by the City of'rigard Building Division inspection section prior to covering the work. Th'3 yard piping shall be capped to prevent any sewage backflow. This shall be verified during the inspection process by the City of Tigard. Any work beyond the scope of which is allowed by this letter will not be permitted until such time that sewer reimbursement fees are paid, associated permits issued and the required inspection are performed and approved. If you have questions, please call me at (503) 718-2448. Sincerely, Gary Lampella Building Official C. File 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 TDD (503)684-2772 --- CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received D e Requested _ AM_ PM_ -__ BUP Location ��; 8'gS _Suite _— MEC _ Contact Person _ Ph(_ ) __ PLM Jontractor._ — _ _ Ph( ) SWR _ UILDING _ TenanUO ner — ELC o _ �� __ ELC Foundation Access: Ftg Drain ELR _ Crawl Drain Slab Inspection Notes: SIT Post A Beam _-__--- Shear Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing -- -- _ ...... Insulation Drywall Nailing — Firewall Fire Sprinkler Fire Alarm Susp'd Ceil' g ----- \—`. ------ -----—___. -_....-- —— --- Roof —__ " f Other: -- --- ---- — Fin PART FAIL -- U G 11-6-sYl Beam ----------------- -- — ------ - ----- ---- Under Slab Rough-In Water Service ---- ---- Sanitary Sewer Rain Drains ---- - Catch Basin/Manhole Storm Drain — Shower Pan O L, — inal PART F IL --- ANICAh — --- — ---- -- Po�[s S13t3eTfi Rough-in — — — —_--__— Gas Line S oke Dampers - - -- _— ins A SRT FAIL — -- EPEMICA S -L - Rough-In UG/Slab Low Voltage Fire Alarm PART FAIL u Reinspection fee of$— ;equired bF fore next inspection. Pay at City Hall, 13125 SW Hall Blvd. S _ Please call for reinspection RE: _�. — Unawe to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dam Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL MASTER CITY 0F TIGARD PERMIT#: MST2004-00149 DEVELOPMENT SERVICES DATE ISSUED: 5/21/2004 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 SITE - ORESS: 108P5 SW DERRY DELL CT PARCEL: 2S103DA-02100 SUBDIVISION: DERRY DELL PLAT 2 ZONING: It-3 5 BLOCK: LOT: 012 JURISDICTION: TIG REMARKS: Kitchen remodel. BUILDING REISSUE. STORIES: _ i FLOOR AREAS _ REQUIRED SETBACKS _ RIEQUIRED CLASSOF WORK: ALr HEIGHT: FIRST: at BASEMENT at LEFT: SMOKE DETECTORS TYPE OF USE: SF FLOOR LOAD: SECOND: xt GARAGE sl FRONT: PARKING SPACES TYPE OF CONST: DWELLING UNITS: TIN10: st RIGHT: VALJE, OCCUPANCY GRP: R3 SDRM: BATH: TOTAL: st " REAR: PLUMBING SINKS: WATER CLOS'TS: WASHING MACH LAUNDRY TRAYS: RAIN DRAIN TRAPS: LAVATORIES: DISHWASHERS: 0 FLOOR DRAINS: SEWER LINES. SF RAIN DRAINS. CATCH BASINS: TUBISHOWERS: GARBAGE DISP: I WATER HEATERS: V.ATER LINES: BCKFLW rREVNTR. GREASE TRAPS: OTHER FIXTURES: I MECHANICAL FUEL TYPES _ FURN<10OK: BOIL/CMP<3„P: VENT FANS: I CLOTHES DRYER. FURN>000K: UNIT HEATERS: HOODS: 1 01 HER UNITS: MAX INP: btu FLOOR FURNANCE3 VENTS: WOODSTOVES GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER,_ TEMP SRVC!FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS. 0 - 200 amp: 0 200 a.np: WISVC OR FDR: PUMPIIRRIGmTION: PER INSPECTION: EA ADD'L 5003F: 201 400 amp: 201 400 amp: let VNO SVCIFDR: Ix1 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 600 amp: EA ADOL OR CIR: :I M SIGNAL/PANEL: IN PLANT: MANU HWSVCIFUR: 601 - 1000 amp: 1101+amPa-1000v: MINOR LABEL: 10004 amp/volt PLAN R_E_VIEYJSECTION � _ _- Reconnect only: .••4 RES UNrrS: SVCIFDR>•225 A.: 600 V NOMINAL. CLS AREA/SPC O-C: ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM INTERCOM'PAGING OUTDOOR LNDSC LT: BURGLAR ALARM: OTH- BOILER: HVAC: LANDSCAPFIIRRIG. PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR� HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Cuntractor. TOTAL FEES: $ 337.18 Owner: This permit is Subject to the regulations contained in the KOOL, SCOTT D +CELIA C OWNER Tigard Municipal Code,State of OK.Specialty Codes 10885 SW DERRY DELI.CT and all other applicable laws. All work will be done in rIGARD,OR 97223 accordance with approved plans This permit will expire if work is not started withrl 180 days of issuance,or H the work is suspended for more tt an 180 nays Phone: Phone ATTENTION Oregon law req,lires you to follow rules adopted by the Oregon Utility Notification Center. Those Rog a rules are set forth in OAR 952-001-0010 through 952-001 0080 You may obtain copies of these rules or direct questi,)r,s to OUNC by calling (503)246-1987 REQUIRED INSPECTIONS Electrical Final Mechanical al Plumb Final Final Inspection Building Final Issued By : d/ �' 1 _ Permittee Signature Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day Building Permit Appligation City of'Tigard INW[Be eceivd _ Permit No- �j/��_co '3125 SW Hall Blvd.,Tigard,OR 97223 n Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit lnspee4ion Line: 303.639.4175 r ua�,Reedy/By �Ytie 0 Cee Attached C4eciclld Ibr �� Internet: www.ci.tigard.or.ua Notified/Method SupplrmentaI information h TYPE OF WORK - REQUIRED DATA:1-AND 2-FAMILY DWELLF G ❑New construction ❑I)emohtinn_T..�� Permit tics'are based on the value of the work performed. Addition/alteration/replacement-MTLD/1 her __- _- Indicate the value(roundo.;to the nearest dollar)of all t equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONS,RUCTION work indicated on this application. _ <' 1-and 2-family dwelling rl Commercial/industrial Valuation: S 91Z•69 ❑Accessory building ❑Multi-fan . _ Number of bedrooms: �]Master builder ❑Other: Number of bathrooms: - JOB SITE INFORbIATION AND LOCATION - Total number of floors: � Job site address: 1Q 885 SIS Ep3-y L)W- C- - - New dwelling area: square(feet City/State/ZIP: ^� 01- -9-7Z-2--3 Gan go/carport area- square feet r Suite/bldg./apt.no.: Project name: 11c,0 OL-R-F- URCE Covered porch area: square feet Cross street/directions to job site: n LIIC-. beck area: square feet Other strut ire area: -- square feet REQUIRED DATA:COMMERCIAL.-USE CHECKLIST Subdivision: � rLot no.: ZZ Permit fees•are,based on the value ofthe work perlbrmed. Tax ma i arccl no.: Indicate the value(rounded to the nearest J, Iar)of all P p �6 RRA �>,l l_PLAT 2 equipment,materials,labor,overhead,and the profit for the DWRIPTION OF WORK work indicated on this application. LNST/1 LL - �+ Valuation: $ �r� -> Z uP�cAi rt S Existing building area: square feet -_ New building area: square feet _ Lr7 Pat LPER1 X OWNER �- ❑ TENANT Number of stori.rs: Nemo: St 'T D CELL C kn of Type of construction: Address �O$$5 5w D& ng„i+ P)`1 1 CT _ Occupancy groups: City/State/ZIP: 1 l cr^&Z Qf? T77-2-3 ------ Existing: Phone:(543) 9.70 P S j rax ( ) New: -❑ APPLICANT-��-- ` WCONTACT PF,RSON -- - NOTICE Business name: -_ — All contractor. and subcontractors are required to be Contact name: U A 6:40 OL licensed will the Oregon Construction Contractors Board -- under OFF Pil and may be required to be licensed in the Address' If 00,8S Sw A GllR�11=1.(.- CT jurisdiction in which work is being performed. If the City/State/71P: 1l Cr^ILD OIL ZZ applicant is exempt from licensing,the following reasons � apply: Phone:( r Fax::( ) _— E-mail: 1CD(:'-'1C_ S Pl 2JTo lVE CC,M _ -- --- - -- CONTRACTOR -- — - - ---- - - - Business name: ti -- S L v/- ---- -- - BUILDING PR,R141I1' FEES* Address: --- -�- --- - - Please refer to lee achedide City/StstdZlP: - - -- -- Fees due upon application Phone:( ) Fax:( ) Aad. 13 -` Amount received CCB tic.: _ ----� Date received � --- -- �— Authorized 9ignature:�A Z / /J�� Thle permit rpplicnNon czpltrs If a permit is not ohtaln.a. lJ��t/y lam_ within 1811 days after It has been accepted as complete. Print name: Clot 4 C- oV _ Uate_5 Q, Q4 • Fee methodology sat by rri-County Building Industry Electrical Qermit Application 7D&te ved Permit No.. City Of Tigard Date/By 13125 SW Ifail Blvd.,Tigard,OR 97223 Review _-- --- Phone: 503.639.4171 Fax: SW.19g.1960 B Other Permit Inspection Line: 303.639.4173 Ready/By 1MIA 0 See Page 2 for Internet: www.ei.tigard.or.us Notified/Method - SupplementallnformAon TYPE OF WORK --- r—' PLAN REVIEW ❑New construction �Addilion/alterutioii/replacement-R-&-Talo A(n i V E Please check all that apply: ❑ Demolition ❑Other: []Service over 225 amps,cotmm'1 []Hazardous location _- ❑Service over 320 amps-rating ❑Buildng o,-zr 10,M)0q.ff., CATEGORY OF CONSTRUCTION of 1-and 2-family dwellings 4 or more new residential I-turd 2-family dwelling ❑Commercial/industruti ❑Accessory building ❑System over 600 volts nominal unity in one slrudure ❑Building over three stories ❑Feeders,400 amps or more ❑Multi-family ❑Master builder ❑Other: ❑(kcupanl load over 99 persons ❑Manu fact aired strictures or JOB SITE INFORMATION AND LOCATION ❑Egres.Oightingplan RV p� Job no.: Job site address: ❑Health-core facility ❑0Iher - 1 O 4+ 6 5 W D F 'Ell. "T Submit 2 sets of plans with any of the above. City/State/LIP: -Vic,-A e.D 09- 'Y72z3 The above are not appli,•able to temporary construction service. Suite/bldg./apt.no.: Project name:V,,00LtCu1C.N�Jy REfY14rJEL FEV SCHEDULE 7 .. Dery Mis 1 "'''L Feel- taxi Cross street/directions to job site: 'PA 0-r- New residential single-or mull!-fiamily dwelling unit. - Includes attached garage. _ 1.000gq.0.or less 143.13 – 4 Subdivision: p� S j�� I.ol no.: Z2_ Ea.add'I 500 sq.11.or portion _33.40 1 Tax map/parcel no.: ptJR.R,y tJ6L.L Q LAT- 2- limited energy,residential 73.00 2 Limiter'energy,non-residential 73.00 2 DFAC RI[PT1ON_ OF WORK _ Each manufactured or modular - dwelling,service and/or feeder 1 1 90.90 2 Services or feeders installation,allerallon,and/or relocation 200 amps or less 80.30 2 - PROPERTY OWNER -�- ❑ 't ENANT 201 amps to 400 amps _ 106.85 2 401 amps to 600 amps 160.60 2 Name: SC M-rr CE.0 A C . k,0 OL -Y 601 amps to 1,000 amp, 240.60 2 Over 1,000 amps or volts 454.65 _ 2 Address 14685 _SW nstZlt� D�LL C7 Reconnect only _ 66.85 2 City/Stale/ZIP: 11 c Aco Oa- 9 7zZ3 amporary services or feeders installation,akeration,and/or Phone:(50 3) 67a l S 53 Fax:( ) relocation _ — _ 200 amps or leas 66.85 _ 1 Owner Installation:This installation is being made on property that I own which is not 201 amps to 400 amps _ 100.30 2 intended I'or sale,lease,rent,or exchange, ording to ORS 447,449,670,and 701. 401 amps to 600 amps 133.73 2 (honer signa(urc:_►��L. Dale: 0!j Branch circuits_-new,akendlon,or ettell_s_Mn,per panel ❑ APPLICANT _tGl CONTACT PERSON A.he for branch circuits w1►h service or feeder fee,each 6.65 2 Business name: branch circuit _ ContHct dame: - - - B.Fee for branch circuits KO OL -- - - -- ----- m1hour service or feeder fee, / each branch circuit46,85 z 2 Address: 7 SSS DAB Each add'I branch cim ."�� _ 6.63 C 2 City/State/7.U': -r C,^A.D (>Z- E)72_-Z_3 Miscellaneous(service or feede r not Included) --- Pump or irrigation circle 53.40 2 Phone:(Sal 3)6"70 1853 Sign or outline lightinr: 33.40 2 E-mail: tin–OaL(? S9kfL1'rOQE, Co/►1 Signal circuit(%)orliailed- CONTRACTOR energy panel,alteration,or -'-� —' --- extension.Describe: Page 2 2 Business name: C) l.(_ l u - - Address: Each odd_Mbnal ins-pection over allowable In any of the above -_ -- --------- Per inspection 62.50 City/State/7lP: Invesiigation per hour(I hr min) 62.50 -- Phone:( ) Fax ( ) Industrial plant per hour I %1.75 -- - ---- ELECTRICAL PERMIT FFr!; _ CCB Lic.: 7_171ectrical Lic.: Suprv.Lic.: Suprv.Electrician signature,required: Plan review(250»of permit fie) State surcharge(806 of permit fee) J5 Print name; _ Date: — TOTAL PERMIT FF.F. ` ./ Authorized Signature: This permapplication espres if•permb not obtained within in -_ tg0 days after It has beets accepted as complete Print name: 1 fete: 0-Fee methodology set by Tri-County Building Industry Service Bond Retroactive: Install new appliances-—dishwasher, cooktop, refrigerator, microhood and oven (dishwasher and refrigerator remove and replace, conktop replaces stove-oven unit, microhood is new, oven to new location). Remove and replace existing kitchen ceiling light fixtures with fan-light, fluorescent light and Halo H7 flushlight (replaces existing square flushlight). Install new Halo 117 flushlight in kitchen. Replace garage entry light with Halo 147 flushlight. Install new hall light in basement stairwell. Install duplexes and GFCI receptacles per code, wire 120v for cooktop, disposal and under cabinet lighting and 240 v circuit for oven. Install bathroom heater/light/exhaust Can. R&R bedroom ceiling light fixtures with remote-controlled fan light fixtures. Plumbinp- Permit implication Cil of Tigard Removed City �.anDate/By: I'ermrt No 13125 SW Hall Ilhd.,Tigard,OR 97223 Plan Review - - Phone: 503.639.4171 Fax: 503.598.1960 Date/By other Penmi f4 24-Hour Inspection Line: 503.639.4175 Date Ready/By h""" fd ke Page 2 for Internet: www.ci.tigard.or.us Notified/Method Supplementallnrormalton TYPE OF I ORK FEE" SCHEDULE ❑New construction ❑Demolition -A _ for special information use checklist -- Description 1sa ['Dont Addition/alteration/replacement IlVi1U11C Other: - New I-3-famUy dwe111ngs(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)batlt 249.20 I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 399.00 ❑Master builder - Bach additional bath/kitchen 45.00 ❑Other: - - fire sprinkler(_s9,ft.) Page' JOB SITE INFORMATION AND LOCATION See utilities Job site address: 5 5W `:E U-7 &LL&L[ C1 Catch basin or area drain 16.60 City/State/ZIP: TGr-r%20 GO-g2_7_3 Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Projcsd name: kK r_ Footing drain(no.linear It.:_� Page 2 �o L_IC..tT�N EN �I�� Manufactured home utilities 110.00 Cross strect/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer(no.linear ft.: _� Page 2 Storm sewer(no.linear ft.:____) Page 2 Subdivision: Lot no.: 2Z Water service(no.linear ft.:_) Page 2 'Tax map/parcel no.: DERRY' ,TAIL PLA-r Z Fixture or Item e - -- Absorption valve 16.60 DESCRIPTION OF WORK ---- - ___ Backflow prcventer Page 2 INS?AU- GAR-66ct& P25P95Akt ICt EL__,q_ic-Ea.__ Backwater valve 16.60 Clothes washer 16.60 - - Dishwasher 16.60 Drinking fountain 16.60 I°f PROPERTY OWNER -� ❑ TENANT -- Ejectors/sump_ 16.60 Name: C�a q a l_-- -_ Expansion tank 16.60 Address: J> _„ Del l C.r Fixture/sewer cap 16.60 - City/State/ZIP: TUA(Ld OR_ 9W-Z-3 Floor drain/floor sink/hub 16.60 Phone:(50-3) 670 1 4t�_ Garbage disposal 16.60Hose bib 16.60 APPLICANT CONTACT PARSONBusiness neme: -- __ _- Ice maker 16.60 -. --- _-- _-.._-- Interceptor/grease trap 16.60 Contact name: (�FL_jA 1�-D Qr✓ _ Medical gas(value:S ) Page 2 Address: jobF)S 5W USLL_ CT Primer -_ 16.60 City/Stale/zIP: Roof drain(commercial) 16.60 ��223 Sink/basitt/lavatory _--- -16.60 Phone:(,5C,3) 6'70 �_.- Fax :( ) - - ---- I:-mail - k 0 CL-<P S P 1 ILt i'O N E. CO/''l Tub/shower/shower pan 16.60Urinal 16.60 CU1rTNAC1'OIR Water closet 16.60 :''Isinesa name: t7Lt�L LL Water heater - 16.60 Address: Esher: _ City/State/ZIP: _ - Subtotal 3j. Minimum permit fee: $72.50 Phone:( ) Fax:( ) _ Residential backflow minimum permit fee: $36.I3 TZ•15• CCB Lic.: Plumbing Lic.no.: Plan review (250f,of permit fee) Authorized signature: CI �Z �J� - State surcharge AL90/a Epermit fee) /I -iLr� -�\ TOTAL PERMIT FEF. Print name: Ft t AS p�L nate: ) I , n e This permit application expires If a permit h not obtained within -' 18n da.sN after it has been accepted as complete. ,'Aechanical.Permit Application City of Tigard Rec,',n°y'' Perml No 13123 SW Hell Rlvd.,'I'igard,OR 97223 Daic�Plan Review - - Phone: 503.639.171 Fax: 563.598.1960 Date By nhrr Prm,d Inspection Line 503.639.4175 [late Ready/13y Juin 0 ser page?.for Internet.' www.ci.tigard.or.ua NotifiedlMolhod Supplemental Information TYPE OF WORK _ COMMERCIAL. FEE* SCHEDULE- USE CHE.CKLISTT r' New amsiruction Addition/td(ent(iot>/replucemenl-MT"-4C Si U Mechanical permit fees*are haled om the value of ffic work perfixmrd.Indiccle the value(rounded to the nearest dollar)of all ❑ I ktnolilion ❑Other_- _ mechanical mawrials,eyuipmau,labor,overhead,and1xolit. _ CATEGORY OF CONSTRUCTION Value:8 --- I•turd 2 y d -lumilwcllin — -- RESIDENTIAL EQUIPMEN /SYSTEMS"IES* - - g ❑Commercial/industrial ❑Acccssory building -_-- - I br special to/ormation use checklist. ElMulti-lumily ❑ Mnslc7 halide? r.t)ther: - - - Ik'Sl7lplllm Fa. '10181 JOB SITE, INFORMATION AND LOCATION HeaNn contlng i- _ Job site address: t 88 5 5 Air conditioning or heat pump (L (_Z - (r tyres sue plan showing plocemenq 14.00 City/State/ZIP: T{ Anz R ^ /L7-3 Furnace 100,000 RTU ducts venU 14.00 Furnace 100,000+BTU(ducal/vents 17.90 Suite/bldg,/apt.no.: Project name: Oar_k t1 CN M Gas heat pump 14.00 Cross street/directions to job site: FA(U Ihux work - 14,00 - - - Hydre•uc hot water system 14.00 Residential holler(radiator or - -- ,•dro.nic) _ 14.00 -- -- - - Unit heaters(fuel-type.not electric), - _- m- 11,in-duct,suspended,etc. 10.00 _ Subdivision: Qa4J�y int no.: Z - -- Flue/vent for an•of above 10.(0 Z - - �---- --- Other: _ 10.00 _ Tax map/parcel no.: >fit Ry. pEa-4- PLA,T Z Other fuel as Itances _ DESCRIPTION OF WORK Water heater 10.00Uas --- Lo/MUGS NooD 7� g -3 p Flue or _ 10(0 - 1 N�.Q�-—_ Flue vent for water heater or gas S�.�UCrN�CJ[.FI USUSIfA(V fireplace 10.00 I.o !ightrr(gases 10.00 -`_ Wood/pellet stove 10.00 _ Wood tiro la a/insert10.00 - Chimney'liner/fluewent 10,00 PROPERTY OWNER TENANT ❑ — __ Olticr: _ IO.Or1 Nerve: SCD T`T -E ( U A C� , O L Environmental exhaust and vent laden - Addross: '1 Range hood/other kitchen - ----- O 5• sal iJF�ys D�LLCT --_--- equipment I 10.00 City/State/7•I': 1 CwAlb 0- 9 7ZZ3 Clothes dryer exhaust_ - 10.00 Fax.( - ------- Single•ducl exhaust(bathrooms. Phone:(SC) 6�_ 5 3 ) toilet compartments,utility rooms 6.80 _ ❑ APPLICANT - --- CONTACT PERSON Anll'lTBw'IapaeC lana --_ 1000 (hher: Business name: 10.00 - - Contact name: CE-Li A _ L C)p�__-- - ---�-- � aS.40 for oral roam 51.00 ror each addlWrnal - Address: lOR06 5 Furnace.etc. --- Gas heat pump City/State/7,IP: -r,r A(I tj✓ Walt/suspended/unit heater Phone:.1503) C--70 _ 5 3 Fax: :( ) Water heater _- 1"_mail /�. --- -- -� Fir lace k 0 tL_` S l'121 TO uE . Cs'r) R e --_-� -__ CONTRACTOR Barbecue - -- Business name: — �} Clothes Address: -- Other: -- --- MECHANICAL PERMIT FEES* City/StateZill: - Phone:( ) Fax:( -- Minimum permit fee(572.50) j2 - - -- plait review(250b of permit fee) CCb tic.: - - _ State surcharge(86b of permit fee) 1.OTAL PERMIT F•EE Authorized signature: q This permit application expires if a permit Is not obtained within 190 AZ � _ MA7_ 11 2 0 V_qI days Mer it has been accepted as complete. F GC-1--,A C K o o l_ T r- . ?1J