12717 SW 121ST AVENUE .w
v
12717 SW ,121st Avenue
_ MASTER HERMIT
CITY
OF T'GA�^`�rr� PERMIT#: MST2002-002.55
DEVELOPMENT SERVICES DATE I,SUED: 7/19/02
13125 S V Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITi_ ADDRESS: 12717 SVV 121ST AVE PARCEL. 2S103EC-01101
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: Construction of new SF detached residence, Path 1.
BUILDING
REISSUE: STORIES: 2 _ FLOOR AREAS REQUIRED SEYBAChS REQUIRED _
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1.7::0 of BASEMENTsf LEFT: 5 SMOKE DETECTORS Y
TYPE OF USE: SF FLOOR LOAD 40 SECOND. sf GARAGE: 437 of FROVT: 24 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS FINDSMENT. sf RIGAT: 5
OCCUPANCY GRP: R3 BDRM: 7 BATH: FOrAL y,1200 sf VALUE: $102,121 80
REAR•. 33
-- PLUMBING_
SINKS: I WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN CRAIN IOU TRAPS:
LAVATORIES'. 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: IO0 SF RAIN DRAINS. I CATCH BASINS:
TUB/SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: I WATER LINES: 100 PCKFLW PREVNTR. + GREASE TRAPS:
MECHANICAL OTHER FIXTURES:
FUEL TYPES FURN<10OK: BOIL/CMP c 3HP: VENT FANS 4 CLOTHES DRYER: I
FURN-10OK: 1 UNIT HEATERS: HOODS: I OTHER UNITS. 1
MAX INP. btu FLOOR FURNANCES: VENTS: + WOODSTOVES: GAS OUTLETS. I
ELEC TRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPEC110NS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATIOW PER INSPECTION
EA ADD'-501ISF: 3 201 400 amp. 201 400 amp: tat W/O SVC/FDR: 00 SIGN/OUT LIN LT. PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL OR CIW SIGNALIPANEL: IN PLANT:
MANU HMISVC/FDR: 601 • 1000 amp: 601.amps-1000v: MINOR LABEL.
1000+amp/volt:
Reconnect only: PLAN REVIEW.ECTION
>=4 RES UNITS: SVC/FDR)--225 A. a 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL _ B.COMMERCIAL
AUDIO 6 STEREO: X VAC+IUM SYSTEM• X AUDIO 6 STEREO: FIRE ALARM. INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: X OTH: BOILER: HVAC: LANDSCAPonRRIG: PROTECTIVE SIGNL
GARAGE OPENER: X CLOCK INSTRUMENTATION: MEDICAL: OTHR
HVAC: X DATAITELr COMM: NURSE CALLS: TOTAL a SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,302.88
DOUGLAS S. BREDALL DOUGLAS BREDALL CONSTRUCTIO This permit Is subject to the regulations contained in the
'2655 SW 121ST AVE 12695 SW 1^1ST AVENUE Tigard Municipal Code,State of OR Specialty Codes and
1 IGARD,OR 97223 TIGARD,OR 97223 all other applicable laws. All work v:N:be done In
accord,-c 3 with approved plans, This permit will expire 9
work is riot started within 181 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
Reg 0: LIC 132076 forth in OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling•103)246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor insulation F lumb Tup Out Exterior Sheathing Inst Rain drain Insp Plumb Final
Fooling Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final Inspection
Foundation Insp Footing/Foundation Dr Electrical Rough In Gas Line Insp Appr/Sdwlk Insp
Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Elec cal Final
Issued Byktl(L t Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
L � �.��
Building Permit Application
Date received: �-/�D� Permit no.:,ij`5 f
City of Tigard Project/appl.no.: Ex 're date:
C'ityof'Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: Y Receipt tno.:
Phone: (503) 639-4171
Fax: (503} 598-1960 Case file no.: Payment type:
Land use approval: 1&2 family:Simple Complex: (�
t
0 1 &2 family dwelling or accessory U Commercial/industrial U Multi family Ncw construction U Demolition
U Addition/alteration/replacement U Tenant iniprovement J Fire sprinkler/alarm l]Other. —
tSITEANFORMATION
Joh address: lC1 / G _ Bldg.no.: Suite no.:
4A 7/ � � /,: �✓� i£ Tax map/tax lot/account no.: Q3 a IN
LAt; Block• ISuhdivision: JPJOAJ�(1'a C�Vt k1�x;g 17C
Project name:
Dcsc 'prion and locati n of work on prcniiseyspeci�aonditions-AL&O
Name:
Mailing addre s: .0�" I Z\_. J " 1 &2 family dHclling: _ -
State; ZIP: C 2 Valuation of work.,........L .. $
7.?)
Phon k y- Fax SZ'/ E-mail: No.of hednwms/baths.................................
Owner's representative: ural number of floors................................. Z
Phon aJ Stj'- Fax:; c. mail: New dwelling area(sq.ft.) ..........................
Garage/carport area(sq.ft.).........................
Covered porch area(sy1tft)..... ..........'.... _
Name: t a )kms. a Deck area(sq.ft.) , ......................
Mailing address: _
Other structure arca(sq. ft.).........................
City: f State:73ZIP: Z
G nrtil:
Commercial/Indust ria l/molt i-family:
Phone: Fax:
Valuation of work............................ $
Existing bldg.area(sq.ft.) ...C........./... ...... _
Business name: a � ),tftra t -P New bldg.area(sq, ft.) ............r,.................. _
Address:I ? - Jr 7 Z — Number of stories............ ...... — _
City: T State: 7.1 P: Type of construction......................... ........ __-_—,—
Phon r y 7 Fax: E-mail: mcupancy group(s): Existing: —_--
CCB no.: 1 "sK ----- N� --
City/metro lic.no. ) Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may he required to be licensed in the
Name: ( c L� I S jurisdiction where work is being performed.If the applicant is
Address:lK (�)�k �( exempt fmm licensing.the following reason applies:
(71—1y 7L C iStun 7.IP: Z __
Contact person: I'Inn no.: 21
Phone 125 I Fax Z25 E-mail:
Nante ' %i i'' ntact person: Fees due upon application ...........................
Address: Date received:
City: r State: ZIP: Amount received ......................................... $`--_-----
Phony --21;75 _. I 1 Falease refer to fee schedule.
�,, x i E-mail:E mall: _
I hereby certify 1 have read and examined this application and the Not sit jurisdiction&accept credo cods.pleat cm jurisdiction rot more inronnnucw
attached checklist.All provisions of laws and ordinances governing this U Msa U Mastercard
work will he complied rith,wh t r s cifie� Wem or not.
Credit cud number, aplres
Authorized si natu ' Date: Name or cudhotder w shown on cmdtt char f
—
Print name: u Crdltolder slEttattas Amount
Notice:This permit application expires if 8 permit is not obtained within 190 days after it hos been accepted as complete. 440-4611 tt➢Oat'0Mt
r
. t
One-and'Uwo-Family Dwelling
Building Permit Application Checklist Reference no.:
Cit a Tigard Associated permits:
City l 8 City of Tigard U Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OP. 97223 U other:
Phone: (503) 639-4171
Fax: (503) 598-1960
t is
1 Land use actions completed.tics jurisdi Won ci iocna III I ollcurrrnt rcvirWS.
2 Zoning.Flood plain,solar balance point;:.seismic soils designation,historic disu 1,1,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.
S Solis report.M:,st c: original applicable stamp and signature on file or with application. _
9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basun 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 be incorporated into the plans or on a separate full-sire
sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed
if copyright violations exist.
I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;r•or'�y comer elevations(if
there is more than a 4-11.elt.vauion differential,plan must show contour lines at 241.inter ti•ation of easernent%and
driveway;footprint of structure(including decks);location of wells/septic systems;utilit. . - direction indicator; .r
n; a;rrziWffg'strgCfWM,... +girl«Gil ideulsitt a�— --
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and/reinforcing pads;connection details,vent
size and location.
13 Floor pians.Show all dimension%,room identification,window size,location of smoke detectors,water heater,
furnace,ventilation I'ans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(,)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists.sub-Iloor,
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,nxal'slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
1.5 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 addendurns showing foundation elevations with cross references are acceptable.
I tI Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive.path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,anti hearing
locations.Show attic ventilation. _
19 Basement and retaining walls.Provide cross sections and details showing placement of mbar, 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
over 10 feet long and/or any beam joist carrying a non-uniform load.
20 Manufactured Boor/roof truss design details.
21 Energy Code compliance. Identify[lie prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances._
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roo4 truss)shall he stamped by an engineer or
architect licensed in Oregon and shall be shown to he applicable to the project under review.
23 Five(.5 site plans are enquired for Item I I shove. Site plans must he N-1/2" x I I"or 11"x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 abovt,.
'S Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted.
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. _
27 "Drawn to scale"indicates standard architect or engineer scale.
28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List.
Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Red ink is reserved for department use only, 4404+14nnmWoMn
Mechanical Permit'Application
Date received: Pennit no,
City of Tigard Project/appl.nu.: Expire date:
City of Tigard Addrefs: 13125 SW Hall Blvd,Tigard,OR 97223 pate issued: _ By: Receiptno.:
Phone: (503) 6394171 --
Pax: (503) 598-1960 Case file no.: Payment type:
Land use approval: , Building permit no.:
�1 I &2 family dwelling or accessory U Commercial/indusitial U Multi-family U Tenant improvement
New constmction U Ad(lition/alteration/rcplacement U Other:.1011 SAF _
' QSCII,EDULL
Job addrr!,s: 7/ /Al 11'1-�e)` iiith a(c cquipmcn, quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax man/tax lot/account no.:,Z,S 103 OC 01101 profit. Value$
Lot: 1 p Block: Subdivision:/V►ti,e 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county_fj�4rrj7153 In 7.IP: M — 1
Description and locat'on of work on premises:_ 1
Tolal
Est.date of cumpletion/inspection: — I)MApdon Y (My. Rmi.only Res.i •
A han
Tenant improvement or change of use:
Is existing!space heated or conditioned?U Yes U No Air andling unit CFM
Aircon it (site plan require )
Is cxistin} .pace iw t la,••"U Yc,; U No Ulteration of existing!IV%C system
Sot er compressors
Business name: ' 1 ,, r State hailer permit no.:
u-t— _ HP Tons BTU/H
Address: fj ' '� E. f 4 d' 1- smo a ampers/ uct—smoke detectors _
City: S Istal4e 'LIP: —Rest pump— (site ppmrequired) _ -
Phon .5 (, �� Pax 1 E-mail: nsta rep ace urnac urner
Including ductwork/vent liner U Yes U No
CCB no.: L/SI % uses rep ac re ocateteaters-suspende ,
City/metro lic.no.: wall,or floor mounted
Name(please print): e-4e i__)_*)r .S en(forappliance other(Fan-furnace
e geral on:
Absorption units BTU/H
Name: Chillers HP
Address: ('one ressors HP
-- - - �nv ronmi ental exlmust a. vent a1 on:
City: State: Im Appliance vent
Phone: Pax: E-mail: I Dryer exhaust
o s, ype res. itc a azmat
hood fire suppression system
Narnc:.ak( J fa 5 13cf-4, Exhaust fan with single duct(both fans) _
Mailing address: xhaust s stem a art nom cat n or v
City: State:of' ?.IP: n are piping as distribution(up to out ets
Type: _ t.l'G NO Oil
Phon !zTU arc piping each additional over outlets
n :
roeesspiping(schematic requre )
Name: Number of outlets
Other ItAid app anceor equipment:
Address: Decoralive fireplace
City: _ State: ZIP: nsert-type
Phone: ux: A I E-mail: stove/pe I let stove
Other:
Applicant's signature: 4 Date: 07
Name (print):
Nog all juddic.l.ccep credo cards,please call judrfictlon for mere Infonntdon. Permit fee.....................$ ,_-
UYisa UMasterCard Notice:ifa permit application
Minimum fee................$
Credo card number: _--_—_--_�__ __ expires if a permit is not as been PIM review(at ^ %) $
,,� within I80 days after it has been Slate surcharge(896)....$ —
rne c n_W_t w ahtmn on chit cry— accepted as complete.
S TO'i U .......................$ -
Cardholder signature Amooni. 4104617(60YMM)
MECHANICAL PERMIT FEES
I 8 'l FAMILY "WELLING FEE SCHEDULE:
COMMERCIAL FEE SCHEDULE: Frice Total
"P city (Ea) Amt
TOTAL.VAL_____UATION: PERMIT FEES-- Table 1A Mechanical Code -
$1.OU to_$5,000.00 Minimum fee$72.50 1) Furnace to 100,000 BTU •14.00
$5,000.00 and includin ducts&vents
$5,001.00 to$10,000.00 $�55 f2ra aee fladditonnal $100.0001 2) Furnace 100,000 BTU+ 17.40
fraction thereof,to and including includin ducts&vents
510,000_00. _ 3) Floor Furnace 14.00
$10,001,00 to$25,000.00 $148.50 fol the fret$10,000.00 and includin vent
$1.54 for each additional$100.00 or 4) Suspended heater,wall heater 14.00
fraction thereof,to and including or floor mounted heater
$25000-00. 5) Vent riot included in appliance permit 6.80
$25,001.00 to$50,000.(T $ e fir $25,000,00 and
17 5 for ea9.50 for ch additional$1 o0 00 or 6) Repair units 12.15
fraction thereof,to and Including
$5000000. Check all that apply: Boiler Heat Cond
$742.00 for the first$50,00000 and or Pump
$50,001.00 and up For Items 7-11,see Comp
$1.20 for each additional$100.00 or footnotes below.
traction thereof.
7)<3HP;absorb unit 14.00
SUBTO to 100K BTU
Minimum Permit Fee$72.50 8)3.15 HP;absorb 2560 _
-- 8%State Surcharge $ unit 100k to 500k BTU
9)15-30 HP;absorb 35.00
/52 %Pal n Review Fee(of subtotal) $ unit.5-1 mil BTU -
RA wired for ALV commercial permits on) 1C)30-50 HP;absorb 52.20 -
TOTAL COMMERCIAL PERMIT FEE: $ Upi
)>50HP absorb 87.20
C --- - unit>1.75 mil BTU
12)Air handling unit to 10,000 CFM 10,00
-Ag_ gUMED VALUATIONS ONS PER APPLIANCE: Total 13)Air- handling unit 10- 00�M* 17.20
Qtv Ea Amount
Desai tion: 955 14)Non-portable evaporate cooler 10.00
Furnace to 100,000 BTU,Including
ducts&vents 1,170 15)Vent fan connected to a single duct 6.80
Furnace>100,000 BTU Including
ducts&venom 955 - - 16)Ventilation system not included In 10.00
Floor furnace includin vent - 955 appliance permit
Suspended healer,wall heater or _ _ 17)Hood served by mechanical exhaust 10.00
floor mounted heater licence 445 __
Vent not Included in app 18)D,)mestic incinerators 17.40
_permit 805
Re air units 955 19)Co,rmercia.0r industrial type incinerator 69.95
<3 hp;absorb•unit,
to 100k BTU_--- 1,700 20)Other units,Including wood staves 10.00
3.15 hp;absorb.unit,
101k to 500k BTU ___ 2,310 21)Gas piping one t0 four outlet 540
15-30 hp;o bsorb.unit,501 k to 1
mil.BTU U_--- 3,400 - 22)More than 4-per outlet(each) 1.00 ,
30-50 hp;absorb.unit,
1.1.75 mil.BTU _ 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>50 hp;absorb.unit, _
301,75 mil.BTU8%State SuSurcharge a
858 _
Air handlin unit to 10 000 cfm 1 170 $
Air handlin unit>10,000 ctm - 656 TOTAL_ RESIDENTIAL PERMIT FEE:
Non�ortable eve orate cooler 448
Vent fan connected to a sin Is duct 656 - -
Vent system not Included in Qthar n s tions anSl�s!!
a plfence�e"_emit - 656 __ t Inspections outside of normal business hours(minimum charge-two hours)
H- served by mechanical exhaust 1 170 $ee 50 per hour
Domestic Incinerator 4 590 _____ 2 Inspections for which no fee le specfflcallY indicated (minimum.harge-half hour)
Commercial or_industrial incinerator 656 �� $62.50 per hour
review required by changes,additions or recisions to plans(minimum
Other unit,including 3 Additional play wood stoves, ohargea l pier ho 't St.2.50 per hour
Inserts etc. 380 �_
Gas loin 1-4 outlets 63 'Stale Contractor Boller Certification required for units>200k BTU.
Each additional outlet "Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL
$ All New Commerclal Buildings require 2 sets of plans.
VALUATION:
I Wsts\forms\mech-fees.doc 12/26101
Plumbing Permit Application
/ Date received: Permit no.
City of Tigard Sewer per no.: Building permit no
Address: 13125 SW I lall Blvd,Tigard. OR 97223 1'rojecUappl.no: Expire date:
City:�JTiganl Phone: (503) 639-4171 - -
Fax: (503) 598-1960 late issued: By: - Ilrtcil,t no
Case file no.: Payment type:
Land use approval: _ -
t
I &2 fancily dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
Ncw construction U Addition/alteration/replaeement U Food service U Other:
11 U 111 X
IescrpQty. Fee ea.) Total
Job address: /,�j/ 'J Ncw 1 and 2-family dhellinj;s only:
Bldg.no.: Suite no.: (includes 100ft.forcacti utiiifyconnectfon)
Tax map/tax lot/account no.: 7 1nI� SFR(1)bathLot: �O Block: Sua SFR(2)bath _ -
-Project name: SFR(3)bath -
ZIP: 2 Z Each additional bath/kitchen
City/county:'(' ,r ti Siteutilities:
Description and locatio of work on premises: Catch basiit/area drain _
_-__-__-- -- Drywells/leach line/trench drain
Est.date of completion/inspection: Faxing drain(n 11 o.lin.ft.) —
! OR — -
Manufactured home utilities
Business name: _ Manholes
Address: I O_ U r' c Rain drain connector -
City: State: ZI�� A �_ Sanitary sewer(noo.lin.
lin.) —
Fax: E-mail: Storm sewer(no.lin. 1't.) _—
Phone 91 Water service(no.lin.ft.)
CCB no.: Q Plumb.bus.rcg.no: -z5 Fixture or item:
City/metro lic.no.: 'z Absorption valve ---
Contractor's representative signature: t r Back flow rcventer
Print name: e Date: r7 z Dackwatcr valve — --
Basins/lavatory ----
Clotheswasher
Name: I qS t f E t, L S- Dishwasher
Address:IZ(p j W 21Drinking fountain(s) _
_City: State ZIP:r-/72Z E'ectors/sum _ --
Phonc �,• c.�,I 7 Fax: `P�;;_ F.-mail: 7 /113 Expansion tank
Fixture/sewer cap — ---
Floor drajns/floor sink. ub
Name(print): Cu r4 / fN �- - Garbage disposal ^-
Mailing address: lJ ove bibb —
City: r State ZIP: Z Z Icc maker
Phon -f y7 Fax: i"_ E-mail• leen lhSN Intcrce for/greavc trap
Owner instiillation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Ront'drain(commercial)
employee on Ute prop I own as�Pcr RS Ch t, 447. gk(s)l,basin(s),lays(s) -'-
(hvner's vignaturc: _ �' Datc:, / a� (ubs/shower/shower pan
Urinal
Name: Water closet
Address: Water eater
-- --------
City: State: ZIP: Other:
Tota
Phone: Fax: Email:
---
................ __-
Not all jwi,JicUum wcert credit cud", Aew call jurisdiction for n;X hdarmaMinimum fee
flon Notice:This permit application Plan review e.. ,_ 96) $ ---
U Visa U MasterCard expires if a permit is not obtained State i ew(atrge(89h) -...$ -
C"t rued numb":_ within 180 days after it has been TOTAL .......................$
accepted as complete. �-
-' None of air ul u shown oo ciedit cud $
-- C.2d rl`notoive --Amow�l� 4/0JGI61( xV('OMI
PLUMBING PERMIT FEES:
— PRICE TOTAL New 1 and 2-family dwellings only: pRICE TOTAL
QTY, ea AMOUNT (includes all plumbing fixtures In
FIXTURES (individual) 1r — the dwelling and the first100 ft. QTY (ea) AMOUNT
Sink `v 16.6U —
_ for each utility connection)
16.60 $249.2v
Lavatory —_ One(1)bath -
---` 16.60 Two 2�bath _ $350.00
Tub or Tub/Shower Comb -- -- $399.00
Shower Only 1666Threebath
Water Closet 16.60 __ SUBTOTAL --
Urinal — 16.60 _ 8%STATE SURCHARGE _
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL —
_ —" I - TOTAL
Garbage Disposal 16.60 -- - ----_-TOTAL.—
Laundry Tray 1660
Washing Machine —_ - 16.60 1
Floor Drain/Floor Sink 2" 1660 PLEASE COMPLETE:
_ 16.60 ----
14 16.60
Quandt b Work Performed
Water Heater O conversion O like kind 16.60 New Moved Replaced Removedl
Fixture Type: Ca ed
Gas piping requires a separate mechanical _—
_ermit Sink - -
MFG Home Naw Water Service 46.40 -- — -- —Lavatory
—
46.40 —_ -- -----
MFG Dome New Sar lStorm Sewer Tub or Tub/Show!r
Hose Bibs 16.60 Combination --
Hoot Drains 16.6U --- Shower Only
-- 16.60 Water Closet — _ --- --
Drinking Fountain Urinal — —
Other Fixtures(Specify) 16.60 Dishwasher --
Garha a Dis osal --
Laund Room Tray —_-
- -- --
Washinq Machine
Floor Drain/Sink: 2"
Sewer-list_10(V _ 55.00 — — 3 —
Sewer-each additional 100' 46.40 4
55 00 Water Heater— _-- ----
hater Service-1st 100' Other Fixtures
Water Service each additional 200' 46.4D S ecif — --
Storm 8 Rain Drain-1 st 100' 55.00 — —
Storm 8 Rain Drain-each additional 100' 46.40 —
Commercial Back Flow Prevention Device 46.40 _ —
Residenlial Backflow Prevendor,Device' 27.S.i
Catch Basin 16.60 --
Inspection of Existing Plumbing or Specially 62,50 COMMENTS REGARDING ABOVE:
Requosted Inspections per/hr
Rain Drain,single family dwelling 65 25 --
Grease Traps —
QUANTITY TOTAL
Isometric or riser diagram Is required If —
Quantity total is >9
°SUBTOTAL
8%STATE SURCHARGE
°•PLAN REVIEW 25%OF SUBTOTAL
Required only it fixture t total la>9 _.
TOTAL _—
*Minimum permit Iso is$72 50•P%state surcharge,accept Residential Backflow
Prevention Device,which Is$36 25-a%stale surchArgn
"All Now Gommerclal Buildings require 2 sats of Plans with Isometric,or riser
diagram for pion review.
I:\dsts\fcrms\plm-fees.doc 12/26/01
Electrical Permit Application
Datereceived: Permit no.:
City of Tigard Project/appl.no.: Expire date:
Cityr(f7igard Addre.gs: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: itcceiptno.:
Phone: (503) 639-4171
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval:
OF P0,11WIT
J]<1 1 roe 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
�tl New construction U Addition/altcritionireplacement U Other: U Partial
JOIRVITF 1
Job address: /,9;7/7 fad ���- ' '
Bldg. m Suite nn.: Tax map/rig lot/account no251030ac a Cl
Lot: Block: [Subdivision:
Project name: Description and location of work on premises:
ESlinlated date of conlpleti n/inspection: _
1
.lob no: Max
Business name: _ `o tMseri flan Qi). (r.:.) Total no.Insp
New ry idrrdiat angle ar mufti-family per
Address:SOOr dwellingunit.Includes attachedgarage.
City: +- W C. State: Q,I ZIP. Serviceltrcluded:
Phon - Fnx: E-mail: Ilex)sq.ft.or less 4
CCB no.: 3S 4 Elec.bus, lic.no: -�(d� Each additional S00 s .ft,or portion thereof
Limited energy,residential 2
City/metrolic.no.: I.imltedenergy,non-residential _ 2
Each manufactured home or modular dwelling
Signature of bupervising supervisingelectrician(required) [)a _ Service and/or feeder - 2
Sup.elect.name(print): License no: Services or feeders-Installation,
alteration or relocation:
1 21111 amps or less 2
Name(print): j, 201 amps to 400 amp, 2
DS4Mailing address: t 401 amps to 61x)amps 2
601 amps to 1000 amps 2
City: Stale:0<I ZIP:M ZZ Over 1000 amps or volts 2
Phon Reconnect Ily y
Owner installation:The installation is being trade on property I own Iemporary services orfeeders-
which is not intended for sale,lease,rent,or exch rage according to Installation,alteration,or relocation:
ORS 447,455,479,67 701. 21x1 sngns nr less 2
201 ntups to 400 amps 2
Owner's signature: e: s ' 401 to 60o snips 2
Branch circuits-new,alteration,
or extension per panel:
Name: _—_ A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: Slate: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: 151 r F.-mail: Each additional branch circuit:
M lac.(Service or feeder not Included):
U Service over 225 a nn. n u u i .d U l ienhh-care facility Each pump or irrigation circle 2
U Service over 320 snips-rating of 1 hr2 U Hazardous location tach sign or outline lighting 2
family dwellings U Building over 10,000 square feel four or Signal circuit(s)or a limited energy panel.
U System over 6(x)volts nominal more residential units in one structure alteration,or extension' 2
U Building over three stories U Feeders,40(1 amps or mart •lkscri pfion:.
U Occupant load over 99 persons U Manufactured structures or RV park Fach additlonal hupedlon over the allowable In any of the above:
U Egreas/Iightingplan U Other ___ Per Perinspection
Submit sets of plane with any of the aixrve. Invest) ation fee
the above are.,ot applicable to temporary con traction sere lce. Other
Not all puisdtcdrns accept credit cards,piasr call jurisdiction fa more Irdonnarran Notice:This permit application Permit fee.....................$ --
U Visa U MasterCard expires if a permit is not obtained Plan review(at _. %) S _
Credit card number. _- _ __�� within 190 days after it has been State surcharge(8%)....$
accepted as complete. TOTAII. ....$
Narrne—fe car�iad r a shown on credit card
_ S
Cardholdet sipaturt Amount 4404615(60WOMI
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
---` TYPE OF WORK INVOLVED -RESIDENTIAL ONLY-------- �.. $75.00
Complete Fee Schedule Below: Restricted Energy Fee................................
Number of Inspections per eerm_ it allowed (FOR ALL SYSTEMS)
Service inclucfr!d: Items Cost Total Check Type of Work Involved:
—�
Residential-per unit $145 15 J 4 Audio and Stereo Systems'
1000 sq it or less
Each additional 500 sq h or $33.40 1 burglar Al,-m
portion thereof $75,00 _
Limited Energy -
Each Manuf d I foot.or Modular Garage Uoor opener'
$90,90
Dwelling Service or Feeder
Ej Heating Ventilation and Air Conditioning System'
Services or Feeders
Installs!ion,alteration,or relocation $80.30 2 Vacuum Systerns'
2o0 amps or less $106.85 2
201 amps to 400 amps $160.60 2
401 amps to 600 amps 2 Other - - -
601 emps to 1000 amps $240.60-_�_ 2
Over 1000 amps or yr $454.65 _—
$66.85 ___ 2
Reconnect only -- TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system.....................................
Installation,alteration,or relocation $66.85 ? (SEE OAR 918-260-260)
200 amps or less $100.30 _ 2
201 amps to 400 amps $133.75 ? Check Type of Work Involved:
401 amps to 600 amps -
Over 600 aotp�to 1000 volts, ❑ Audio and Stereo.,ystems
see"b"above.
Branch Circuits Boiler Controls
New,alteration or extension per panel C�
a)The fee for branch circuits L Clock Systems
with purchase of service or
feeder fee. $6.65 — �] Data Telecommunication Installation
Each branch circuit
b)The fee for branch circuits Fire Alarm Installation
without purchase of service
or feeder fee. $46.85 f 'I
First branch circuit - L J HVAC
Each additional branch circuit $6.85
n Instrumentation
Miscellanejus
(Service or feeder not included) $53.40 Intercom and Paging Systems
Each pump a irrigation circle
Each sign or outline lighting $53.40
Signal circuit(s)or a limited energy $75.00 El Landscape Irrigation Control*
panel,alteration or extension $125.00
Minor Labels(10) Medical
Each additional Inspection over Nurse Cells
the allowable in any of the above $62 50
Per inspection - - " $6250 _.
Per hour -- -" - $73 75 _! outdoor Landscape Lighting*
In Plant - _
El
Ej Protective Signaling
Fees:
Enter total of above fees
$ [1 Other_� -----— -
$ _ ----Number of Systems
8•/Stale Surcharge �-'
25%Plan Review Fee $
No licenses are required Licenses are required for all other Installations
See'Plan Review"section on ____--------
front of application _ Fees:
Total Balance Due $ Enter total of above fees $—
❑ Trust Account p
0%State Surcharge s----"---
___—_----------- Total Balance Oue
All New Commercial Buildings require 2.sets of plans.
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CITY
OF
TI GARlVSEWER CONNECTION PERMIT
D PERMIT#: SWR2002-00170
DEVELOPMENT SERVICES DATE ISSUED: 7/19/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S10313C-01 101
SITE ADDRESS; 12717 SW 121S7 AVE
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT:__ _ JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEVA! DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF.
Owner: _ – FEES
DOI'GLAS S. BREDALL Type _ By Date Amount Receipt
12655 SW 121ST AVE --- — ---!
TIGARD, OR 97223 PRMT CTR 7/19/02 $2,300.00 27200200000
INSP CTR 7/19/02 $35.00 27200200000
Phone: 503-524-4947 _ _ Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
chis 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 doeE 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,the installer shall purchase a"Tap and Side Sewer" Perm
Issued by: <<___ ZfL1tL Permittee Signature:
r
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
CITY OF TIGARD
13125 S.W. HALL BLVD. � C\
TIGARD, OR 97223 U� il� �`Z
IMPORTANT PERMIT NOTICE
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
Plumbing Signature Form
Permit #: MST2002-00255
Date Issued: 7119/02
Parcel: 2S103BC-01101
Site Address: 12717 SW 121 ST AVE
Subdivision.
Block: Lot-.
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Construction of new SF detached residence, Path 1.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept.
No plumbing inspections will be authorized until this cornpleted form is received
OWNFF PLUMBING CONTRACTOR:
DOUGLAS S. BREDALL MODERN PLUMBING
12655 SW 121ST AVE_ 11 120 SW INDUSTRIAL WAY
TIGARD, OR 97223 TUALATIN, OR 97062
Phone #: 503-524-4947 Phone #: 691-6166
Reg #: i ir. 87906
PI M 34-250PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Sigi4atj& of Authorized Plumber
If you have any questions, ,,ease call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ARLO ELECTRIC INC
50705 NW CLAPSHAW HILL RD
FOREST GROVE, OR 97116
Electrical Signature Form
Permi: #: MST2002.00255
Date Issued: 7119102
Parcel: 2S103BC-01101
Site Address: 12717 SW 121 ST AVE
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Construction of new SF detached residence, �ath 1.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical peri-nit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
DOUGLAS S. BREDALL ARLO ELECTRIC INC
12655 SW 121ST AVE 50705 NW CLAPSHAW HILL RD
TIGARD, OR 9 223 FOREST GROVE, OR 9711 G
Phone #: 503-524-4947 Phone #: 357-2350
Req #: LIC 35763
SUP 33?1S
ELF 34-118c
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD 24-Hour _
BUILDING Inspection Line: (503)639-4175 MST _-
INSPECTION DIVISION Business Line: (503)639-4171
BLIP — -
Received __ __Date Requested_____ �____- AM. ____ PM BUP —
Location -- Suite---- MEC _ --
_ _
Contact Person _ __—_—_—_�--- Ph PLM
(— ) - ---�— 7— ---
'C L -l-�-
Contractor PhSWR���_ "' _ ( � _
BUILDING TenanYOwner _ �._ _ ___ _ __ ELC _--
Footing ELC _-_.--
Foundation Access:
Ftg Drain (� ` ELR _ -
Crawl Drain i � -' SIT
slab Inspection N tes: —�—
Post& Beam -- - ---- -U --- ,
Shear Anchors --
Ext Sheath/Shear ------� ------
Int Sheath/Shear
Framing - - - -- -.- - --
Insulation
Drywall Mailing __—__M__— --- ----- —
Firewall
Fire Sprinkler - --- -------
Fire Alarm
Susp'd Ceiling - --- --
Roof ---
Other:
Final ---
PASS_ PANT _FAIL - - -- ---------
_PLUMBING _ — -- - — _ --- - --�
Post& Beam
Under Slab --
Rough-In
Water Service - --- - -- -- -- -
Sanitary Sewer
Rain Drains - - --- -- — - —
Catch Basin/Manhole
Storm Drain - - -_,_-__.- -------- -----
Shower Pan
Other. ------ -- ------
Final
PASS PART FAIL
MECHANICAL _ ------------ - ---
Post& Beam
Rough-In --- - --- -- - -
Gas Line
Smoke Dampers -
Final
PASS PART FAIL - - - - - ----
ELECTRICAL
Service
Rough-In - - - -- -- - -
UG/Slab
Low Voltage - --
Fir larm
-r"ia Reinsportion fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI Please call for reinspection RE:,------ Unabla to inspect-no access
I lie Supply Line yy
AUA 1.�Q� d _�� Ext
Approach/Sidewalk --- + �� Inspector
Final UO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 � .5
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received _.__—__ __-- Date Requested_____�-,� AM____ PM_—_ BUP
Location .... _�_ v�- Suite_—. -, MEC
Contact Person _ ______11 Ph ( ) —�_5� PLM
Contractor — 12 Ph _ SWR _
BUILDING _ Tenant/Owner ELC
Footing ELC
I oundation Access:
Ftg Drain
Crawl Drain �1 o%,�- ELR
`� T __�_
Slab Inspection Notes: M SIT
Post&Beam
;hear Anchors ------- --
Ext Sheath/Shear
Int Sheath/Shear e_
Framing
Insulation
Drywall Nailing _ __.___-_ ---__
Firewall
Fire Sprinkler - - --
Fire Alarm
Susp'dCeiling _ _. -- ---- -- - - ----- ----. ___.r_------- ---
Roof
- ----- -----
Final
_ F RT FAIL
LUMBING
Pos T—
Under Slab
Rough-In
Water Service - -
Sanitary Sewer ---------------------- --
Rain Drains - - -- - -
Catch Basin/Manhole
Storm Drain - --
Shower Pan
Other: --
P _ PART FAIL —
MECHANICAL_
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL — ------- -_ ----_
ELECTRICAL
Service _ - - - ----
Rough-In
UG/Slab - - - ------ -- ___-- --- --
Low Voltage ----
Fire Alarm
Final ❑ Reinspection foe of$ required before next inspection. Pal,at City Hall, 13125 SW Hall Blvd,
PASS PART FAIL
SITE Please call for reinspection RE _-_ ___- - -----__- CA Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Y Inspectorr�' / --_ Ext __- -
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
i
p. 2
EASEMENT FOR SANITARY SEWER AND STORM SEWER
For a valuable consideration,receipt of which is hereby acknowledged,the Gramors
Douglas S. Bredall, Renee M. Henricksen Bredall
Hereby grants and conveys to the Grantees
Douglas S. Bredall, Renee M. Henricksen Bredall
And to their successors and assigns,the rights,privileges and authority to constrict,improve,repair and maintain
Sanitary Sewer and Storm Sewer,in Washington County, State of Oiegou,to-wit,
A legal description for a sanitary sewer and storm sewer casement being ten feet in width across a portion of
l,ot m—rrppitt Place"in the northwest one-quarter of Section 3,T. 25.,R. 1 E., W.M.,City of Tigard,
County of Washington,Stale of Oregon. 12695 SW 121"Ave'Tigard, OR 97223 more particularly
described as follows:
The west ten feet of parcel one of that particular tract conveyed to Douglas S. BredaU and Renee M.
Henricksen Bredall on July 6,2001 by Document No.2001006460
Grantor shall retain the right to use the surface of said easement for walkways, planting,parking and related uses
without unnmsonably interfering in the Grantees rights to construct,improve, repair and maintain the Sanitary Sewer
and Storm Sewer and so long as no building or struchures are erected on said casement- Grantee rights to easement is
only for the above mentioned reasons. The Grantor cannot deny access to property to Grantee for the above
mentioned rights and privilege.
EASF,MENI IS FOR THE BENEFIT OF TAX LAT No. 2S103BCO1101 , ACCOUNT No.82008770
12717 SW 121In AVE.TIGARD,OR 97223
The covenants herein contained shall run with dic land and are binding upon all subsequent owncre thereof.
Dated this\\_day of
Sign
n
Signature
Address
City, State,Zip__`
State of Oregon
County of Washington
On this \A day of
Before ore
Known to be the iutdividltal/s described in and who executed the within and foregoing instrument, and acknowledged
that they signed the some as their lice and voluntary act and deed,for the uses and purposes therein mentioned.
o RUssi=u Given under my hand and official seal the day and year la-t
:YCOM:MISSION
UBLIC•OREGON above"tlen
COMMISSION NO.342003 `n C �1
EXPIRES JAN 15,20Uai Ll
Notary Publi&ln and for the State of Oregon
My Commission expires:
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP _
Received —_ —Date Requested /� 3��� AM PM_ _ BUP
Location - lam.-7 / 7 �`r`' -_Suite _ MEC .�
Contact Person -
Contractor ----- Ph ( ) -- — SWR —
BUILDING Tenant/Owner ._.__ —_ _ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR --__--
Crawl Drain -- -- SIT
Slab Inspection Notes: -- ------�
Post& Beam
Shear Anchors —J
Fxt Sheath/Shear
Int Sheath/Shear
Framing #� 'LEcT1Zi CAL __i- �.t n<. �►►►i�P� 12- 3 -o -� ... ._z• --
Insulation
Drywall Nailing - - -- --- -------—Firewall _
Fire Sprinkler — —
Fire Alarm
Susp'd Ceiling ----
Roof _
Other.
PART FAIL -- - -
PLUMBING -
Post&Beam
Under Slab - - - - ---- — ---
Rough-In
Water Service
Sanitary Sewer
Rain DrainsCatch Basin Basin/Manhole
Storm Drain
Showr,r Pan _..-- -- _--- —
Oth,jr: - - --- -- - --
Final
P_ASS PART FAIL
MECHANICAL - - - --- - ------- -------
Post&Beam
Rough-In - --
Gas Line
Smoke Dampers -- ---- - - - - - -- - - --
Final
PASS PART--- FAIL ------ - --------------_-- ----- ----.____
ELECTRICAL
Service
Rough-In ------- ----
UG/Slab - ---
Low Voltage - _--- -- ---—----- -
Fire Alaim
Final I 1 Reinspection fee of$ - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE i-� Please call for reinspection RE:.__ Unable to inspect-no acres
Fire Supply Line
ADA Z - 7/ -e Z..•
Approach/Sidewalk Date I Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00069
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/20/03
PARCEL: 2S 103BC-01101
SITE ADDRESS: 12717 SW 121 ST AVE
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 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 cfm:
Remarks:
Owner: n kc � �, _ FEES _
DOUGLAS S. BREDALL Description Date Amount
12655 SW 121 ST AVE -- —
TIGARD, OR 97223 INIECtIJ Pcrnut I-L-i' 2/20/03 $72.50
ITAX18%,Stats,"I a, 2/20/03 $5.80
30
Phone: 503-524-4947 Total $78. _���
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone: 51► -G56-1 184 Final Inspection
Reg #: LIC 447
This permit is issued subject to the regulations contained in the Tigard Murucipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans This permit will expire if work is not started within 180 days of issuance, or ii work is suspended
for more than 180 days ATTENTION Oregon law requires you to follow rules aaopted in the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0100. You may obtain copies of these rules or direct questions to OILING by calling
(503)246-6699./ p
Issued By: }' � � Permittee Signature: ! lj ✓)�/i (��y,C(��'y 1
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next busslness day
lechanical-Permit Application
Date received; - ,-Q Permit no.:Cityof Tigard RECEIVED Project/appl.no.: Expire date777
Address: 13125 SW Hall Blvd.Tigard,OR 97223 22 Receiptno•:
CitygfTigard Dateissued: By r/
Phone: (503) 639-4171 [B 14 2003
Fax: (503) 598-1960 Case file no.: Payment type:
Land use app 1. GI TY OF TIGARD Building permit no.:
rV.I &�2ily dwelling or accessory J Commercial/industrial U Nlulti4,3111 ly U Tenant irnrovement
truction U A(Idition/alteration/replacement
1 1"17m,1 sai1 1
Job address: ST V - Indicate equipment quantities in boxes below. Indicate the dollar
2117_ 2 k?-I _
Bldg no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax a tax lot/account no.: Apt
profit. Value$
tart: Block: Subdivision: *See checklist for important application information mid
Project name: W41 jurisdiction's fec schedule for residential permit fer
City/county: 7.1P: - 1
Description and location( work on premises: r
1 1 1
C- ob _ IM(ra.) Iolal
Est.date of completion/inspection: 1Deaeri iuu ^� OI y. Re�.anly RrY.only,
Tenant improvement or change of use:
Air handling unit _ CFM.-.,-
is
FM.-._Is existing space heated or conditioned'' J Yes U No Air conditioning(site plan required)
Is existing space insulated?U Yes U N,, Alteration of existing HVACsystem I •
Boiler/compressors
State boiler permit no.:
Business name: ���_-. IIP 'tons BTIJ/H
Address: rs�y it smo edamper uctsmoke electors —
Cily: Stat ZIP: eat pump(site plan required)
pltoltc a��d hux E-mail: nrep ace urnacc Mine f /
_ Including ductwurk/vcnt liner O Yes CU No
CCB no.: U1611 nsta /rep ac re ocate heaters-suspen e ,
City/metro lic.no.: �1�9 wall,or floor mounted
Name(please print): Q.
Vent for r n—fiance of er thin furnace
Refrigeration:
Absorption units_ BTU/Il
Name: - �,i _ ( - Chillers III'
-- Com ressors III'
Address: S r _ v runmenta ex (rst an ventilation:
City: _ State: ZIP: Appl,•-nccvent
F'Ironr: 1:ix E-mail: Dryer exhaust _
Hoods,Type res. itc ten/haamat
hood fire suppression system —
Name: Exhaust lan with single duce(hath fans) _
J l �
Mailing address: ix must s slcm_a�ra�il from hcaun or C
—--
City: --__1 __. Stat LIP: � , Ty�eP p ng anddistribution(up to outlets)
T _ — LPG N(; Oil --
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Name: 1 er sleTppilance or�equ pment:
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call Jurisdiction f all)addictions accerr credit curl,pleax• r more inhKmsaem Permit fee.....................
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Notice:llris permit application Minimum fee................$ _ .-
U Visa v MasterCard expires if a permit is not obtained
('relit cud numlwi -- Plan review(at -- %) - --
---- - — f Apt - within 180 days alter it has been
. Stair surcharge(89F) ....
accepted as complete
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST ---
INSPECTION DIVISION Business Line: (503)639-4171 BUP —
Received _. —__Date Requested_ J AM�-PM --- BUP
Location _."_— a —__-_� — Suite--- --- MEC
PLM
Ph _ - -
Contact Person _ - - -- ---) -
SWR
Contractor -__ — - -------- _- Ph( -) -- -- _---
BUILDING Tenant/Owner _----_ ---- --------- ---— — ELC
Footing -- ELC --_----
Foundation AC c�L , -
Fig Drain N►�lC�.eQ%��'J ��- ( 'T (il/ ELR —
Crawl Drain SIT --
Slab Inspection Notes: —
Post& Beam —
Shear Anchors
Ext Sheath/Shear --
Int Sheath/Shear
Framing - ---- _-- -------- ---_-_-..--_
Insulation
Drywall Nailing - - —
Firewall - -
Fire Sprinkler --
Fire Alarm -_ -T - ------
Susp'd Ceiling --- -- -- _ _
Roof
Final _ --- ------
PASS PART FAIL - J —
PLUMBING --__--� — ---
Post&Beam __--
Under Slab --- -- -
Rough-In -
Water Service -- - ---- ---- --
Sanitary Sewer __--
Rain Drains --' -
Catch Basin/Manhole --_-
Storm Drain
Shower Pan -- -
Other:_ --_--- - --_
Final -
PASS PART FAIL -
MECHANICAL ------ -- --
Post& Beam /
Rough-In •`'' --_ ----- —
Ras Line 1
ZCSmke DampersPART FAIL
TRICAL - -- -
Service - ----
Rough-In - -- -- --- - _
UG/Slab - -�
Low Voltage ----- - - -- -- --- ---- --- -----
Fire Alarm
Final Reinspectlon fee of$__ required before next insF ction. Pay at City Hell, 13125 SW Hell Blvd.
PASS PART FAIL
SITE L� Please call for reinspection RE:__ L� Unable to inspect-no access
Fire Supply Line
ADA DOW � 7 _(�__�'' Inspector
Approach/Sidewalk
Other ___
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL