11375 SW 95TH AVENUE f
11375 SW 95r"
CITU OF TIGAaRD BUILDING INSPECTION DIVISION IVIST
24-hour Inspection Line: 039-4175 Business Lin 6,,19-4171
0 �Y. E1ur --
__ Date Requested i� —AM _PM BLD _
Location / 3 i}/ -sc_v ��* Suite MEC
Contact Person Ph �G� 31/ Z ��-� -GG y�
Contractor Ph SWR� ✓_ Ou /
i._.
c �✓-� '
BUILDING Tenan'rOwner ELC
�"�3 v �'�'' -7--
Retaining Wall ELR _
Footing Access: FPS
Foundation
Ftg Drain - -- SGN
Crawl Drain Inspection Notes:
Slab — - - SIT
Post&Beam
Ext Sheath/Shear
--`--
Int Sheath/Shear
Framing -- - _-
Insulation
Drywall Nailing CJ 7 --
Firewall •�- �.t� _ 4� / jr� —
Fire Sprinkler
Fire Alarm ,2
Susp'd Ceiling �--
Roof
Misc:_
Final
PASS PART FAIL — - - - — -
Post&Beam
Under Slab ---
Top Out
I
e&ns n
Fin
?eAS19 PARTMEC-
HANICAL
Post&Beam - -- -e- - --
Rough In ----
Gas Line _�---
Smoke Dampers _ --
Final
PASS PART FAIL_j --
ELECTRICAL
Service - --- '—
Rough In
UG/Slab -._--
Low Voltage
Fire Alarm --------
Final
PASS PART FAIL
SITE —
Backfill/Grading --�
Sanitary Sewer
Storm Drain f 1 Reinspediz)n fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I Please call for reinspection RE __ ( j Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 6 Inspector \t� E X t1c5l
Other _
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITYOF TIGARD _SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2000-00317
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/5/00
SITE ADDRESS; 11375 SW 95TH AVE
PARCEL: 1 S 135CA-02100
SUBDIVISION: BOETCHERS ADDITION ZONING: R-1.5
BLOCK: LOT: 003 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Cunnect existing residence to sewer line. Septic tank must be pumped, filled and inspected or
removed.
Owner: — —
FEES
TOM CARMICHAEL Tyne By Date Amount Receipt
11375 SW 95TH AVE
TIGARD. OR 97223 PRMT CTR 10/5/00 $2,300.00 27200000000
INSP CTR 10/5/00 $35.00 27200000000
Phone: 503-966-9703 Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measuremei., given,the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer' Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling(503),246-1987.
Issued by: Permittee Signature:
Cali (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITYOF T i GA R D ELECTRICAL PERMIT
PERMIT#: E 9-00635
DEVELOPMENT SERVICES DATE ISSUED: 1U/25/1/25/1 999
13125 SW Hall Blvd., Ticard. OR 97223 (503) 639-417"1 PAR'–'EL: 1 S135CA-02100
SITE ADDRESS: 11375 SW C5TH AVE
SUBPiVISION: BOETCHERS ADDITION ZONING: R-4.5
BLOCK: LOT : 003 JURISDICTION: 'FIG
Proiect Description: Install (1) 200 amps or less Service/Feeder.
_
RESIDENTIAL UNIT TEMP SRVCIFEEDERSMISCELLANEOUS
1000 SF OR LESS: 0 200 amp: 1 PUMP/IRRIGATION:
EACH ADD'L 500SF: 20'; - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNAL/PANE!.:
MANF HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (101.
SERVICE/FEEDER BRANCH CIRCUITS _ A_D_D'L INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL ��
Reconnect only:_ SVC/FDR >= 225 AMPS: _ CLASS AREA/SPEC OCC:
Owner: Contractor:
TOM CARMICHAEL FARNHAM ELECTRICAL CO.
11375 SW 95TH AVE 1050 LAFAYETTE AVE
TIGARD, OR 97223 MCMINNVILLE, OR 97223
Phone: Phone: 503-472-2186
Reg #: ELE 36-3C ORIGINAL
LIC 000012
SUP 350S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT KJP 10/25/199E $64.25 99-319319 Elect'I Final
5PCT KJP 10/25/199E $5.14 99-319319
Total $69.39
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. 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 952-001-0080. You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987
PERM'TTEE'S SIGNATURE j�-� � i '�— ISSUED BY:/'� J
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: C1 L+���•�� DATE: S _
LICENSF NO: 3 S O S
Call 639-417' by 7,00pm for an inspection the next business day
:-lit 16:22 FAA 503 59h 1960 Cin' OF 'FIGARD
.. try OF T!G n RD �ECEIVEC) Plan Cheat r _
Electrical Permit Application r,ec,dBy
13126 SW NAL!_ BLVD. ti Date Reed
TIGARD OR 97223 OCT 1 r ��g..
Date to P.F.
Phone(503)639-4171,x304 COMMUNITY UEVEL10mi Iv Data to DST_
Inspection (503)6394175 Print of Type pormb
Fax(503) 598-1960 Incomplete or Illegible will not be accepted Celled_
1. Jab Address: 4. Complete Fee Schedule Below:
Number of Insnecborrs per ps mit allowisd _
Name of Development
Name(or name of business).j3_) l L 1�(y. \C_lf�CtC'� Service included: Items Cost Sum
Address._,11�1�� E�' `: I'1 (Lt 2 411 Realdenuat-Per ur,�
:—,.i -- 1000 sq.t1 0+lass f t 17.75 4
city/stacerzlp �__a_� �► 1 Z� Each additional 500 sq n.or
portion thereof _ S 20.75 1
Commerrial Residentilkro)l Ltrnned Energy f 60 00
Each Maruf l Home or hlodWar
2a. Contractor installation only: Dwelift Service or Feeder — f 72.75 _ 2
(Prior to permit Issuance,applicants must provide contractor license 4b.Services or Feeders
kfformation for COT data base). (- InnlAllatlOn,alteration,of mMx thtlon
G I t 2f)0 amps ar Was
� f Cri 25 �__� 2
la
Electrical Contractor_�><r nhGr»__ C1C_ --- — 2
Address_ � 201 amps to 400 amps _ S 85 50
401 amps to 600 amps f 128.50 2
City 1jj\�Sta Zip ��_�- 601 amps to low amps s
Ptlone N l 1_l a - t 4.X)( t, Over 1000 snips or Volo f :183.75 2
Jab No _�\(�`(r� Reconnect only � f 53.50 �_--_— 2
FJec-Coni Lice.No. Ain -'� Exp.Da'm J 1 4c.Temporary SeMces or Feeders
lneta
OR State CCB Reg No. Q 2 1j 200 amps or leExp.Date r ye„ smi,altora" a relorelocationssi 53.50 2
m
COT Business Tax or Metro No. Exp.Date 201 am"lu 400 aps � f 8125 2
401 amps In 600 amps f 10000
Signature Of SUpf.Etelc'n Over 800 amps to 1000 voMa,
see"h"above.
LIcentie No._ � � > Exp.Date Ip r L` r 4d.Branch ClrwAts
Phone No.--Q,-1L.—--1"7 , New,sherMlon or extension per pane,
14 e)Tim lee for branch dreults
2b. For owner installadinns: .s�yutC'"h IM K e of service or
foodsir Print Owner's Name ►r 1^++ Each branch 01`001 s 5.35 ___ 2
b)The fee Ice branch circuits
Address _ without purchase of service
City �_State__.._-.Zip_. _--.- or heeler iiia.
Phone NO. - rtrst branch atuA S 37.:50
-- Eacth additional branch urcuit w S 5.35
Tile installation is being made on property I awn which In not 4•-Mtscedaneous
Intended for sale,lease or rent. (servioo or dasde1`not axludnd)
Each pump of Inlgation circle f 4271 ---,
Each sign or outline fighting - $ 42 75
bNmer .r Signature -- - Signal tlrrult(a)or•limited energy
panel,¬ation at extension $ 6000
3. Plan Review section (/f required):' Minor Lat)els(10) f too DO
Please check appropriate itom and anter fee in rection 5H 41.Each additional InspecAlon over
1 or mora real. the sllorrable In any of the above
',antal units 00101 structure the
lnepac,rcan _`- S 5000
Service and fender 225 emr 01`more Per hart _ S 5000
System trier 600 volts nominal In Plant u f 5900
CtassKrrsd area o(structuv a)r*slr kV speciat rnzlrpancY as 5. Fees: 2 r
F..
described In N C.Chapter 5 4 J
w ba.Enter Intel of abavP lees s ---�-�-f-
s Submit 2 sats of plans with apPlication where arty of ffw above apply. 0%Surcharge(oil X 101111 Ives)
Not required for temporary construction eaMcet. Subtotal =
tib.Enter 7)%of fine 6a for
NOTICE Pian Rev'mv M rgunr4(bec 31 f __
Subtotal f ---
pFRMITS BECOME VOID IF WORK OR GONS1RU"ON AUTHORIZED �Q
IS NOT COMMENCED WITHIN 160 i)AYS OR IF CONSTRUCTION OR 1 nest Arr:ount#
WORK IS SIISPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS -- (�
AT ANY TiME AFTER WORK IS COMMENCED Total balance Duo
I 1danlformhlelearlc Aoc
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST ------_--
_Date Requestied ( LC� �Q`( AM---IDM CUP -- _
_
Location I1 � iS� � �S +�.� _ Suite BLD
MEC
Contact Person /�-t`rCn�. �( ,�k�Z>~� Ph 9��_��G�. --
I'LM
Contractor _ �C�� ph y7o1-���� SWR
ff
NG Tenant/OwnerELCg Wall ELRon Access:n FPS
Crawl Drain Inspection N
Slab ota sGN
Post&Beam — SIT
Ext Sheath/Shear
Int Sheath/Shear
Framing ---
Insulation _
Drywall Nailing _
Firewall _
Fire Sprinkler -- - -'-�
Fire Alarm
Susp'd Ceiling -_
Roof
Final ` ----------- -----
PASS PART FAIL _
PLUMBING _--- ------
Post& Beam - - -- ---- --___- _
Under Slab
Top Out
Water Service -_-
Sanitary Sewer --
Rain Drains - -._------ ------- -_-._ - ----
Final
PASS PART FAIL_ -_
MECHANICAL __--
Post& Beam --�
Rough In
Gas Line
Smoke Dampers -Final
FAIL
LECTRICAL --- -- - `
Rough In - _ ----- - -
UG/Slab
Low Voltage
F' larm
S ART FAIL
Backfill/Grading
Sanitary Sewer
Storm Drain J Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin -
Fire Supply Line I )Please call to, reinspection RF
ADA - -- ___ J Unable to inspect no access
Approach/Sidewalk
Other - Date Inspector Ext
Final -`�
-PASS PART FAIL 00 NOT REMOVE this it'spection record from the job site.
CITYOF TIGARD _ PLUMBING PERMIT'
DEVELOPMENT SERVICES PERMIT#: PL.M2000-00399
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED:
SITE ADDRESS: 11375 SW 95TH AVE PARCEL: 1 S135CA-02100
SUBDIVISION: BOETCHERS ADDITION ZONING: R-4.5
BLOCK: LOT: 003 .JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: M%'-)BILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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. 100 ft
WATER CLOSETS: WATERLINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 00'of sewer line
Owner. ^�--�-_- FEES
Type By Dote Amount Receipt
TOM CAPMICHAEL Y p
11375 SW 95TH AVE PRMT CTR '10/2t„00 $72.50 27200000000
TIGARD. OR 97223 5PCT CTR 10/26/00 $5.80 272000'00000
Total $78.30
Phone 1: 503-96891'0,3
Contractor:
REQUIRED INSPECTIONS
Phone 1: Final Inspection
Reg #:
Thi3 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. ATTENTION: Oregon law requi,as you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issi,ed By: i Permittee Signature:
Call (503)(439-4175 by 7:00 P.M. for an inspection needed the next tu�ingsa dl�y
~,L t'fi
Plumbing Permit Application
�4
,Dceived: Permltn� , �- _37r
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of Tigard Phone: (593) 639-4171 ProjecUappl.no.. Expire date:
Fax: (503) 599-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
OF PERM IT
1 &2 family dwelling or accessory U CommerciaUindustrial O Multi-family U Tenant improvement
U New construction U Add ition/alteration/replaceincnt U Food service U 011ier. _
li SITE INFORMATION1ULF(for special Information
Job address: s �� G V Description (?ty. I !_a.) 'D'olal
Ne" 1-and 2-family dnellings only:
Bldg no.: Suiteno.: (includes 100 A.foreach utility connection)
Tax map/tax lot/account no.: SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath
Project name: _ SFR(3)bath
City/county: IP: Each additional badAitchen
Description and location of work on premises: 5v- SlteuNlities:
Catch basin/area drain _
Est.date of completion inspection: Drywells/Icach line/trench drain
Fastin drain(no.
1 lin. ft.)
PLUM BING 1
Manufactured home utilities
Business name: vti- Manufactured
Address: c> ` L Rain drain connector
CitY:(cy✓l. �'—t v Statea2_ ZlP: / 13 Sanitary sewer(no.lin.ft.)
Phone:<;03 y¢j x: E-mail: Storm sewer(no.lin.ft.)
CCB no.: l Plumb.bus.mg. Water service(no.lin.ft.)
City/meth lic.no.: Fixture or Item:
Absorption valve
Contractors representative sig tura: flow revenuer
Print name: " �: �t Datc: G* �. -j7B_ack
Backwater valve Basins/lavatory
Clothes washer
Name: Dishwasher
Address: Donkin fountain(s)
City; State: ZIP: Ejector sum
Phone: Fax: I mail: Expansion tank
ixture/sewer cap _
Name(print): �� ��s•�y Floor drains/floor sinks/hub
Garbage disposal —
Mailing address: 11-77 ��� 'S Hose Bibb
City: Ice maker _
Phone: ' Fax: E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sin (s),basin(s), ays(s)
Owner's signature: __ _ Date: Sum
Tubs/shower/shower pan _
Urinal
Narne: - - — —,-- WaterC oset
!�ddrCSS: _. ater eater
City: Slate: ZIP: Ut ct:
Phone: Fax: E-mail: ottl
Nor all)utiuucuau accept credit card+.ple0t call)urirdlcaori for more information Notice:This permit application Minimum fee................$ r _
U visa U MasterCardPlan review(at —. 76) $ _ [>
expires if a permit is not obtained Stat:surcharge(976)....$
Credit card number: _�—_ �L�L within IRO days atter it has been
t:xpites accepted as complete. TOTAL $
Name of e-irrnioi�rr u shown on credit cant
"""""""""""'
S _
C r d cure Amount 410-1616(&V"M)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dweiiings onlyw- --
FIXTURES ylndividual _QTYea AMOUNT (includes all plumping fixtures in Pfir%E TOTAL
Sink 16 60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection
One(1)bath u_ $249.20
Tub or Tub/Shower Comb. 16.60 _ Two(2)bath _ _ $350.00
Shower Only 16.60 Three 3 bath _ $399.0_0
Water Closet 16.60 ---
6.60 --
SUBTOTAL
Urinal - 16.60 8%STATE SURCHARGE -
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage bisposal 16.60 -- TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sint; 2 16.60
3" - 16.60 PLEASE COMPLETE:
4" 16.60 _
Water Heater O conversion O like kind 16.60 _ Qua-r6tity b 1 Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit, Capped
MFG Home New Water Service 46.40 Sink _
MFG Home N6w San/Storm Sewer •46.40 - Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination _
Root Drains 16.60 Shower Only
Grinking Fountain 16,60 _Water Closet
Other Fixtures(Specify) 16.60 Urinal -
Dishwasher
_
Garbage Disposal
Laundry Boom Tray
Washing Machine
Sewer•1st 100' 55.00 Floor Drain/Sink: 2"r 3" - -
Sewer-each additional 100' 46.40 4"
Water Service- 1st 1 C 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures -
Storm 8 Rain Drain-1st 100' 55.00 -(specify)
-- --
Stc 8 Rain Drain-each additional 100' 46,40-
Commercial Back Flow F,evenlion Dovice 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60 ---
Inspection or Existing Plumbing or Specially 72.50
Requested Inspections _per/hr __ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 6525
Grease Traps 19.60
QUANTITY TOTAL - - --
Isometric or riser diagram Is required If --
Ouantity 1 otal Is >9
'SUBTOTAL P7
8%STATE SURCHARGE S� -
"PLAN REVIEW 25%OF SUBTOTAL 7
Required only if fixture gly total is>9
TOTAL
i
Minimum permit Na Is$72 50 4 8%slate surcharge,except Residential Backflow
Prevention Device,which is$38 25+8%state surcnarge
**All Now Commorclal Buildings require plans with Isaneh':or riser diagram acrd
plan review
1:\dsts\forms\plrn-fees.doc 10/10/00