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14336 SW 128TH PLACE A ` i 14336 5W 128"' Place CITYO F T I GA R D _PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2002-00167 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/20/02 SITE ADDRESS: 14336 SW 128T,-I PL PARCEL: 2S109AA-05400 S!IBVIVISION: ELK HORN RIGGE ESTATES ZONING: R-7 BLOCK: LOT: 020 JUPISDICTION: TIG GLASS OF WORK: ALT GARBACE DISPOSALS MOBILE ;IOME SPACES: Tl' 'E OF USE: SF WASHING MACP: BACKFLOW PREVNTRS: 1 OCCUPANCY CRP: FLOOR DRA:NS: Tp APS: STOF;ES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: J URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: it WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Back flow prevenler Owner: FEES �— `-- Type 5y Date Amount Receipt 22830 SW NOBLE ST KOZAK ENTERPRISES INC �PRMT CTR ' 5/20/02 $36 25 27201200000 BEAVERTON, OR 97LJ7 5PCT CTR 5/20/02 $2.90 27200200000 Total $39.15 Phone 1: 503-848-7014 Contractor: PROFESSIONAL GROUNDS MGT INC PO BOX 661 CO.'RNEL!LJS, OR 97113 REQUIRED INSPECTI(,NS Phone 1: 503-740-6333 RP/Backflow Preventer Reg #: LIC 6832 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 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 244)-1987. Issued By: ---�–=-1' �w_ _ Permittee Signature: Call 03'I 639-4175 b 7:00 P.M. for an Inspection needed the next bualr�ss da ( Y p Y i 7t- Phimbing Perms(4-0 a Date,_ceived: Per 4r oxo--w t City of Tigard Sewer permit no.: Building pennit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 P-oject/appl.no.: Expiredale: City of Tigard Phone: (503) 639-4171 — Fax: (503) 598-196(1 Lll Y ul" 111�� Date issued: By: k�ccipt no.: BUILDING DMI-ON Land use approval: Payment type: Case file no.: Y _ �. U 1 &2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant improvenlem U New construction U Addition/alteralionheplaccm,nt U Fool service U Other: t 7 G Descrytion Qlv. Fee(".) TWO Job address: �`G (tib lr �� New t-and 2•family dwellings only: Bidg.no.: Suite no.: _ (includes 100IV.foreachuliliryconnection) Tax map/tax Int/account no.: _ SFR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: SFR (3)hath Zip: Each additional hath/kitchen Citylcounty: Descriptio d I atioof ytork n��ptisCs* L� Siteutillties: l� C! / Catch basin/arca drain Drywclls/leach line/trench drain Est.date ofcompletion/inspection: Footing drain(no.lin.ft.) _ PLUMBING t Manufactured home utilities Business name: ' 7jMinholesAddress: o ,(Qin drain connector City; ar ��y _ State: p ZIP: –1 t l Sanitary sewer(no.lin.ft.)hone:C�Cq Z-L,'!Z Fax: 0 E-mail: c W Storm sewer(no.lin.ft.) _. CCB no.: ( �Z Plumb.bus.reg.no: Water seryice m: lin.ft.) �� — Fixture or item: City/metro lie.no.: Absorption valve Contractor's representative signatu Back flow preventcr Print namr: i ;t Dale: S o 0" Backwater valve _ $asins/lavatory _ Clothes washer — Name: ___ _ — Dishwasher Address: f _ — Drinking fountain(s) City: —Fs—tate: LIP: E•cctors/sum Phone: lax: E-mail: Expansion lank Fixture/sewer Floor drains/floor sinks/hub Nan.r(print): �' Y Garbage disposal _ Mailing address: ` t Hose.Bibb City: tker Phone:'( ' ,%6,74 1 Fax• –7 E-mail: lnterce tor/ rease tra — Owner installation/residenlial maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair r.iade by my regular Roof drain(commercial) — employee on the property 1 own as per ORS Chnpter 447. Sink(s),basin(s),lays(s) Owner's si mature: Date: Surnp Tubs/shower/shower pan _ Urinal Name: _ _ Water closet Address: — V✓rater heater State: ZIP: Other: —--- Phone: Fax: E-mail: Tots Minimum fee................S Not all Jurisdictions accept credit cards,please call Jurisdiction rot mne inr rnWlpn, Notice:'rhis permit application Plan review(at — %) $ _ U Visa U MasterCard expires if a permit is not obtained State surcharge(8%) .....$ a G Cmdu card number _ ._LL__ within 180 days atter has been Espl•:a TOTAL .......................$accepted as complete. Name or c older as s wn on credit c = _ CT. use Amount 4404616(&WCt/M) r PLUMBING PERMIT FEE; : -- PRICE TOTAL New 1 and 2-family dwellings only: - FIXTURES individuate - QTY e� AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT '!- for each utllit connection) _ Lavatory 16.60-- _ One(1)b --- - _- -- $249.20_ _ Tub or Tub/Shower Comb 16.60 Two(2)ba'h _ $350.00 16.60 Three(3)bath $399.00 Shower Only --- --- -� Water Closer 16.60 SUBTOTAL _ Urinal 16.60 8%STATE SURCHARGE Dishwasher 15.60 PLAN REVIEW 25%OF SUBTOTAL - Garbage Disposal _ ---- 1s 6a _ Laundry Tray 1660 _- Washing Machine16.60 Floor Drain/Floor Sink 2" - 16.60 _ PLEASE COMPLETE: 3" 16.60 4" Water Heater O conversion like kind 16.60 Work Performed _ Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ Caped permit. MFG Home New Water Service 46.40 Sink- Lav MFG Home New San/Storm Sewer 46.40 - Tub or _ - _ -_-- Tub or Tub/Shower Hose Bibs 16.60 Corlbination Roof Drains 16.60 Shcwer Only Drinking Fountain 16.60 Water Closet -- __ Urinal Other Fixtures(Specify) 16.60 Dishwashe Garbage Dia- �- Laundry Room_Tray Washina Machine _ - _ Floor Drain/Sink: 2" _ - Sewer-1at 100' 55.00 3„ Sewer-each additional 100' 46.40 _4- Water Service-1 st 100' 55.00 Water Heater - Other Fixtures Water Service-each additional 200' 46.40 (Specify) -- Storm 8 Rain Drain- i 3 100' 55.00 - Storm&Rain Drain..each additional 100' 46.40 -- Commerclal Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 - Inspectlon of Existing Plumbing or Specially 62.50 Re ueated Ina ectlons er11r COMMENTS REGARDING ABOVE Raln Drain,single family dwelling 65.25 -- - Grease Traps 1F.60 - - QUANTITY TOTAL - omelric or riser diagram Is required If _ 01 pritity rota)is >9 - _- *SUBTOTAL 8%STATE SURCHARGE ' "PLAN REVIEW 25%OF SUBTOTAL Ilectulied only It fixture qty total Is>9 TOTAL �C / *Minimum permit lee Is$72 50+a%state surcharge,except Residential Backflow Prevention Device,which Is$36.25•6%state surcharge "All New commercial Buildings require 2 sets of plans with Isometric or riser diagram lar plan review. I:klstslforms\plm-fees.doc 12/26/01 July 26, 2001 CORIGON F TI Kozak Enterprises Inc. \ / 22830 SW Noble Street / Beaverton, Oregon 97007 RE: MS'1' 2001-00 5 — 14336 SW 128`h Place Dear Applicant: A question was raised at the time of issuance on the increased permit fees for alterations to the original permit authorization. The fee increase was based on the following premises. The original permit was issued based on the construction of single family dwelling with a crawl space. A subsequent request to amend the plans converting crawl space to habitable was approved, requiring additional fees. The additional fees are based on the difference between the original valuation calculations and the new valuation. Additional plumt'.,g fees stem the addition of a hot water tank, mechanical stem from the addition of a furnace, electrical for the additional branch circuits. If you require further clarification, please feel free to call me at 503-639-4171 X392. Sincerely, W1 4u�- Ito �rt D. Poskin, CET CBO Senior Plans Examiner 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 TDD(503)684-2772 — -- —1 r CITY O F T I G A R D ELECTRICAL PERMIT \\ — RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT d: ELR2001-00191 13125 SW Hall Blvd.,l ivard, OR 97223 (503) 639-4171 DATE ISSUED: 7/17/01 PARCEL: 2S 109 AA-05 400 SITE ADDRESS: 14336 SW 128TH PL SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 02(, JURISDICTION: fl Proiect Description: Al! encompassing restricted energy permit A.RESIDENTIAL B.COMMERCIAL P --- AUDIO & STEREO: AUDIO & S fEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATAITELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: ALL ENCOMP X HVAC: PROTECTIVE SIGNAL: — _INSTRUMENTATION: OTHER _TOTAL# OF SYSTEMS-____—� Owner: Contractor: KOZAK ENTERPRISES INC GARY'S VACUFLO INC 22830 SW NOBLE ST 9015 SE FLAVEL BEAVERfON, OR 97007 PORTLAND, OR 97266 Phone: 503-848-7014 Phone: 775-2042 Reg #: LIC 69047 ELE 26-72801.E _ FEES Required Inspections — Type `By Date Amount Receipt Low Voltage Inspection PRMT CTR 7/17/01 $75.00 2720010000 Elec:l'I Final 5PCT CTR 7/17/01 $6.00 2720010000 Total — $81.00 This Permit is issued subje•,t to the regulations contained in the Tigard Munici,al Code, Oe of R. Specialty Codes and al;other applicable laws. All work will be done in accordance with approved plans. This permit will expire if wort: is not started within 180 days of issuance, or if work is suspended f-)r more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules a,e set forth in OAR 952-001-0010 through OAR 9 00 -0080 You may obtain copies of these rules or direct questi s to OUNC at (503) 246//<1987 \ i Issued by ,,�_ _ Perrnittee Signature . OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. lease, or rent. OWNER'S SIGNATURE: --- _-- _ —-- — ___—_ DATE:__. _ CONTRACTOR INSTALLATION ONLY —_-_—___,___ SIGNATURE OF SUPR. EL.EC'N __�_ DA'fF:_ -- —__— L I C E N S E N O: —�------- --------- — ----- --— _——. _ _ Call 639-4175 by 7:00 P.M. for an inspection needed the next business day t 1 i Electrical Permit A,ppNeation Aatereceived: // Permil no..�G[� w-Gb/F/ City of Tigard Projezt/arpl,no.. Expire date: -- City ofTigard Address: 1312.+SW liall Blvd,Tigar,l,OR 97223 pare issued: ..__-_ By: Rcceiptno.; Phone: (503) 639-4171 Payment ty c F.u: (50i) 548-1960 Cose file no.: P Land use appruval: 7,. &2 y dwelling or accessory U Corttmercinl/industriafO Multi family U Tenant ilnp�ovemanl ictionO Addi:iorJaltemtion/replueement U 011ier: ___ U Purtial ortre � 5 r'/L1 1 BIr1f_no., Suite no,: — Tux mug/tax lar/r.ccounl no.: -Lot: Block: Subdivision: -�-�aud --Projectname:nisei: - Dc9cnpaHon of Work on prtrnises:` _ - --- Estimated date of completion/insm cowl. Job no: - IRncctipliva Qfy• ra) fulnl nu.ilia ChNTHAL VAC 1NSTALLA'1IONNeva,7hlsYlhnl•sinC4+nrMWd-fatnilyprr GARY ' S VACUFLO, 1NC 775-20112 _ dw.uiltgutd►.indadrsannchcdgaraaa+. ��U 1 g SE F'LAVEL, 87268 CCB: 69017 Servicrbrclud"I: a p &ch CLE: 28720 —_ -1000 a,l 6 r,rle>c J L E: �$� 8och w dhinnd Soo ag,h,or slice thereof mlted cnergy,residend012 VO-Wy metro lie.no.: Lltnitcd'ens nvn-raiJentlol --- er mdnu6Oil ttsu or modulus dwelling Dale service an Mor f-1c, CII ensure of supervising a eeirkl4n Ociyired) Servkaaorfeedees In.ndladal, al•at,nnmo(print): _ Li rear rlo: siteratlan or reloculiuu: Z00 all PS or ler% _ 2 Z01 n�;pc io A00 arnpe 2 2 Name(print): 401 Mr h to 600 ain Mailin address; 'U — 601 amps to 1000 nrt� 2 Ci 5tnta: Zip: O+,er IyW amps or volts Y Phone; Fax: _ ,'•mail: - Reconneotonly -- _ Toroporary novices or fvedens- - Owner Inst-Antfon;The inatailatinn is being,made on ptopaty I own iasWllutlotbaltrlvUao,orrelomtbn: wch is not intended for We, Icase,tent or e•cchange according to _� 2 hi 200 Mips or Irsa _-- 2 ORS W.455,479,670,701. lel amp,to 400 Camps Owner's signature: _-- - Date: __ __ 401 to Goa err Bench ciriults-new,alturntiuu, or et4risiun per pant Name: _ —_ A Fee for brwwh cirenUs with oulchrute of 2 Address: y - eery ce or feeder fee,each branch circuit - ST,Ite Fee for brunch circuits wi aut purwhuu 4 City __ ..�- --— - of sFlv+cc or feeder fee,fit bon inch clrcuit, Phone: Feld: I -Ivuil. finchedrllUUna)blench circuit, ILUMMIMMIgUIVIUM; Mite.(Semite u4 imtlrer not htclyded): 2 U II„IUs careliu his Fuoh up mporittitWoncirctr r7 gervlceover 225ampsu3rrunetcld Bach sign or outline lighting O Service over 320 ampn-muni;of I&) IJ Hvnrdous locallon slgnd t rcult(sl or u Ilmiterl onerEY Pnneh fandlydweliings O Bulldingovcr 10,000sgtrntefeetkurnt 2 ❑syslemoverbWvoliarwminul more ravdentislunitahioneswcture aherallon,oneutmr.run• U Fcudr.rs,400 amµs or neon: �t)rseri dive. ✓1J U Buildfnguverthreenwrlw cC - !7 otv0pnni load uvrt VU venom U Mnnutae tucd atructules at R V pnrk pjdt addiflostal incpectinn use rhe wl,wail.in skmny u f t elwse a EptessAightingpivi, O Other, _ pertlts than —� Brffloil sets of plan+with any o:dw abom InvesdiptillorittvU. --- -~- Ills above tine not appucable to tempo"W7 eotutruclion ux+ice. er - -�-$- " $ Pomitfee..................... I di tudsdtw><+ru nrcrpt clank Cards.ptr,nr runt 111AAC Mitt for tnratnsUun Notice:'ibis permit application I Ian review(Cat Vtan U M within I(e ptnit is not obtained ';tate surcharge(8%).••.$ crr>i ewe um uwithin tgU days after fl has been � euweptcd UP complctc. TOTAT. .......................$ ser, cor3aui a au'd )<aresal 140snis(eIODrC:oMt CBea'�_ __ -- ]]]tt]tYYYYreeeelaaaraaallll T/T'd L6z ON WdbS:E 1oop-'8T,-inr CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERNMII' I"OTICF MALMEDAL PLUMBING INC 19931 SW CELEBRITY ST ALOHA, OR 97007 Plumbing Signature Form Permit #: MST2001-00075 Date Is,,jed: 03/05/2001 Parcel: 2S1 u9AA-0540u Site Address: 14336 SW 1.28TIl PL Subdivision: ELK HORN MIDGE ESTATES Block. Lot: 020 Jurisdiction: TIG Zoning: R-7 Remarks: c!F 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 completed form is received OIPVNFR: PI_IJMBING CONTRACTOR: KOZAK ENTERPRISES INC MALMEDAL PLUMBING INC 22830 SW NOBLE ST 19931 SW CELEBRITY ST BEAVERTON, OR 97007 ALOHA, OR 97007 Phone #: 503-848-7014 Phone #: 5'03-- 3la- q 7q5`_ Reg #: I Ir 102535 FSI M 34-276PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Authorized Plumber 'I you have any questions, please call (503) 639-4171, ext. # 310 o� Pe A (Vtq7� ?X-V1s1 b/9s - BE C1 Y Q F T 1 ® MASTER PERMIT PERMIT#: MST2001-00075 DEVELOPMENT SERVICES DATE ISSUED: 3/5/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 14336 SW 128TH PL PARCEL: 2S109AA-05400 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 020 JURISDICTION: TIG REMARKS: S/F Path 1 BUILDING REISSUE: STORIES: 2 FLJOR AREAS REQUIRED SETBACKS REQUIRED _ CLASS OF WORK: NL W HEIGHT: 24 FIRST: 1,786 of BASEMENT: of LEFT: 6 SMOKE DETECTORS: Y TYPE OF USE: SI FLOOR LOAD: 40 SECOND: 2,209 of GARAGE: GWI al FRONT: 27 PARKING SPACES 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 5 VALUE: $393993;10 OC.;UPANCYGRP: R3 BDRM: 4 BATH: 4 TOTAL: 3,99500 of REAR, 51 _ PLUMBING SINKS. I WATER CLOSETS. 4 WASHING MACH 1 LAUNDRY TRAYS I RAIN DRAIN: 100 TRAPS: LAVATORIES: h DISHWASHERS: 1 FLOOR DRAINS. SEWER LINES. 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 2 WATER LINES: in,,) BCKFLW PREVNTR: I GREASE TRAPS: MECHANICAL OTHER FIXTURES: FUEL TYFES FURN<100W BOIL/CMP<AHP: VENT FANS: 6 CLOTHES DRYER: I GAS FURN»100K, 2 UNIT HEATERS: HOODS: 1 OTHER UNITS: I MAX INP: LOU FI-OUR FURNANCES: VENTS: 2 WOODSTOVES: GA„OUTLETS I ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200.-nip 0 200 amp: WISVC OR FDR: 1 PUMPARRIGAIION: PER INSPECTION: EA ADD'L 500SF: 8 101 - 400 an o 201 400 amp: tat W/O SVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp. 401 600 amp: EA ADDL OR CIR: SiONNUPANEL: IN PLANT: MANU HM/SVC/FDR: 601 - 1000 amp. 601 ampa•1000v: MIND;)LABEL: 10070•ampl',oll PLAN REVIEW SECTION Reconnect only: �— >-4 RES UNITS. SVC/FDR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL 8,COMMERCIAL _ AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO. FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM. OTH: BOILER: MVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL• GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,460.07 KOZAThis permit is subject to the regulations contained in the 22830 ENTERPRISES INC 711 N ENTERPRISES INC Tigard Municipal Code,State of OR Specialty Codes and 22830 SW NOBLE ST 71? N MOLALLA AVENUE all other applicable laws. All work will be done in BEAVERTON,OR 97007 MOLALLA,OR 97038 acmrdence with approved plans. This permit will expire If work is not started within 180 days of issuance,nr if the work is suspended for more than 180 days ATTENTION: Phalle Phone: Oregon law requires you to follow rules adopted by the Oreqon Utility Notification Center. Those rules are set Rep N: LIC 077219 forth.In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by,:alling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Footing Insp Wtr Proofing Bsm't We Footing/Foundation Drl Electrical Service Exterior Sheathing trial Grading Inspection Footing Insp Post/Beam Structural PLM/Underfloor Electrical Rough In Low Voltage Sewer Inspection Foundatlon Insp Post/Beam Mechanical Mechanical Insp Framing Insp Gas Line Insp Sewer Inspection Foundation Insp Crawl Draln/Backwater Mechanical Insp Shear Wall Insp Insulation Insp Fooling Insp Wtr Proofing Bsm'1 We Footing/Foundation Dn Plumb Top Out Exterior Sheathing Inst Gyp Board Insp Issued By Permittee Signature Call (503) 639-4175 by -00 p.m, for an inspection needed thMQ " s day r CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2001-00041 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/05/2001 SITE ADDRESS; 14336 SW 128TH PL PARCEL: 2S109AA-05400 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 020 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 7 YPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF detached dwelling. Owner ---__ FEES KOZAK ENTERPRISES INC 22830 SW NOBLE ST Type By Date Amount Receipt T _ --- - BEAVERTON, OR 97007 PRMT CTR 03/05/2001 $2,300.00 27200100000 INSP CTR 03/05/2001 $35 00 27200100000 Phone: 503-848-7014 Total` $2.,335.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Ag. ncy 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'ocated, the installer shall purchase a"Tap and Side Sewer' Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to tallow 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 copiP,? of these rules or direct questions to OUNC by calling (503) 246-1987. / j Issued by: t�— _ _ Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the ext business day le OO - Blli rmitno.tDate received:,2/.P,1/0 Pe /City4ca1^D d / O. _ Address: 13125 SW Hall Blvd,TiLard,OR 97223 Project/appl.no.: Expire date: City of Tigard Phone: (503) 639-4171 Date issued: Icy;,' � Receipt no., Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: __ 1&2 family:Simple Complex: !. 61 W 1 U I &2 family dwelling or accessory U Commercial/industrial U Multi-landly U New construction U Demolition U Addition/alteratiott/replacement U Tenant improvement U Fire sprinkler/aiami U Other: ._—_ Job address: , Bldg. no.: Suite no.: Lot: Block: Su hvision: zc t4 4 . J Tax map/tax lot/account Project name: &C, ZA/< Description and location of work on premises/special conditions: 011%NI It FOR SIILCIAL.INFOR�IATIONj USE,411ILCKILIST Name: �, c Z,�/< ��.. . - ( s S c_ Mailing address: .��, ,� ^!,/-4 - 1 &2 fandly dwelling: / '/ City: '? e, State• p- ZIP: c;-i Valuation of work......-3t!l�t.3116......... $ � _ Phone: - p/ Fax: o/ E-mail: No.of bedrooms/baths................................. Owner's representative: ( c` 2,9/< Total number of floors................................. Phone: 1176:""" 1-, c E-mail: New dr.elling area(sq.ft.) .......................... LZ.. Garage/carport area(sq.ft.)......................... Name: / l Covered porch area(sq.ft.) ......................... )60 Mailing address: Deck area(sq.ft.) ....................................... `��`� City: —=talc: TZ—IP, Other structure arca(sq.ft.)......................... Phone: ',� �F-mail: Commerciatlindustrialimulti-family': CONTRAff1 Valuation of work............................. ..... $-- Business name: �, i - Existing bldg.area(sq.ft.) ......... ... .......... Address: New bldg.area(sq.ft.)..........I...... ........... City: State: ZIP: Number of stories.................... .... Phone: Fax: E-mail: TYIx of construction......................:....... ... CCB no.: - Occupancy group(s): Existing: w New: City/metro lit.no.: Notice:All contractors and subcontractors arc requi •�be licensed with die Oregon Construction Contractors b d under Name: provisions of ORS 701 and may be required to txs licensed in the Address: _ jurisdiction where work is being performed. If the applicant is Cit j• Stater l i ZIP: exempt from licensing,the following reason applies: Contact person: I- yi Plan no.: — Phori I I'.-mail: ---- Nor -- ---- -- -— INme: ('ontact person: Fee%due upon application $ r,ddress: -- -- Date received: City: _ State: ZIP: Amount received ......................................... $ Phone: Fax: Email: Please refer to fee schedule. _ 1 hereby certify I have read and examined this application and the Not vl jurisdictions accept credit cants,please ar`jurisdiction tta rmxr infannmion. attached checklist. All provisions of laws and ordinaries governing this U visa U Mastercard work will he complied with,whether spent hotehi or not. Creddt cmd nunther - ----- -- — —�--- Xplres Authorized signature: _ ?- , _ Date: Name of cardholder u shown on credit cud Print name:_ �- _��,�/! /�/( Csrdholdet rianmum S Amount Notice:'this permit,app$dtlon expires If s permit is not obtained within ISO days after It has been accepted as complete. 4404613(r:dWICOM) One-and Two-Family Dwelling _Building Permit Application Checklist Reference no.: Y Associated permits: r,,cn,Yi�r,n� Cit of Tigard Y � O Electrical O PIurnihing U Mcchaniril Address: 13125 SW WIN Blvd,Tigard,OR 97223 UOther: Phone: (503) 639-4171 Fax: (503) 598-1960 TI I IE FOU 1 ' 1 I 1 I Land use actions completed.Sce jurisd,cho n crUcua for run,urrri.l IC iews. ----- -- 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. _ 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report.Must carry 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-basin protection, 10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot he completed _ if copyright violations exist. 11 .Sitelplot plan drawn to scale.The plan must show lot and building;setback dimensions;property corner elevations(if there is more than a 4-I1.elevation differential,plan must show contour lines at 2-ft.intervals);location of casements and driveway;footprint of structure(including deck);location of wells/septic systems;utility locations;direction indicator,lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction. More than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. _ 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four fan at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)andlor lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 [boor/root framing. Provide plans for all floors/roof assemblies,indicating member siring,spacing,and hearing locations.Show attic ventilation. IN Basement and retaining walls.Provide moss sections and details showing placement of rebar. For c .,,neered systems,sec.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 floor/roof truss design details. _ 21 Energy Code compliance.Identify the prescriptive path or provide.calculations.A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or architect licensed in Oregon and shall be:shown to he applicable to the project under review. 21 Five(5)site plans are required for Item I I above. Site plans must be 8-1/2"x I I"or I I"x 17". 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contr.in red lines or tape-ons. 26 No rolled.reverse,l or mirrored building plans will he accepted. 27 28 _ 1-H_ Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black Ink. Red ink is reserved for department use only. 44o.M14 te+oanvMl Plumbing Permit Applio7ta_tion Date received: Permit no.: City of Tigard Sewer permit no.: Building permit no.: Address: 11125 SW Hall Blvd,Tigard,OR 97223 ^-- - -— City ofTigard Phone: (503) 639.4171 Projecdappi.no.: Expire date: — Fax: (503) 598-1960 Date issued_ By: Receipt no.: Land use approval: _ I Case file no.: Payment type: :LUI &2 family dwelling or accessory U Commercialhii(imnial ❑Multi-family U Tenant improvement New ronstruction J Add iti,m/tdteiationhehlaccrnent U Food service U father: Job address: / J 5�...9 Z Description _ (Qk . Fee(ea.) Total Suite no.: _ New I-and 2-family dwellings only: Bldg.no.: - (includes 100 R.f'ur each rnility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Z,c> Block: Subdivision: / SFR(2)bath Project name: JC-Z/}/ _ SFR(3)bath City/county: ZIP: Each additional bath/kitchcn Description and location of work on premises: Site utilities: Catch basin/area drain _ _ I Drywulls/leach line/trench drain Est.date of completion inspection: Footing drain(no.lin.ft.) —— Manufartured home utilities Business mune: �pyf.-Nra-� c f C S J = Manholes [Address: / �..� C� /cRain drain connector v L, StateL�� P: ?O� ) Sanitary sewer(no.lin.ft.) _ Phone: ' b Fax: Email: Storm sewer(no.lin. ft.) CCB no.: ! s 3 Plumb.bus,reg.no: -ry - Z7E TjJ water service(no.lin.ft.) _ --�7-- Fixture or Item: City/metro lic.no.: rBack so tion valve Contractor's representative signature:_ _ flow preventer �' ' Date: z z 4/c Print name: ;-• lv�. . v ckwatcr valve Basins/lavatory _ Clothes washer _ Nance: (+ �%�� o Dishwasher Address: Drinking fountain(s) City: State: ZIP'_ E'ectors/suntp Phone: Fax: E-mail: Expansion tank Fixtum(sewer cap _ Name(print): v S r 5 Floor drains/floor sinks/hub �.t _ Garbage dis�Osal Mailing address: 7 Hose bibb - -- City_ � State: ZIP: c'� _ Ice maker Phone: 27 t7 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. Sink(%), as n(s), ays(s) Owner's signature. Date: _ Sum _• Tubs/shower/shower pan Urinal _ Name: _� Water closet Address: _ -W—M-11-Rater _ City: Stnte: _ LIP: Other: Phone: Fax: i E-mail: Total _ Not all wish,ion. cmat crndh.Mee call MO&Cdon fm mae Irtrrxmulm. Minimum fee................$ i .c«pt Notice:This;tcrmit application plan review(at — 96) $ u visa U MuterCtud expires if a permit is not obWned cteait card number -__ 1-• within 190 days after it has been State edreharge(8%)....$ _ TOT,AL —- Name of etudholdn n none It rwd — s accepted as complete. TO AL ....................... -cardholder dynature - —— --Ar�ounl 40016 MWOM) , PLUMBING PERMIT FEES: - RICE TOTAL New 1 and 2damil-y�dn flings only: FIXTURES (Individual_ QTY _ ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL \ Sink 16.60 the dwelling and the fimt100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection -_ _ _ _ Tub or Tub/Shower Comb. 16.60 One 1 bath $249.20Two(2 bath- _ -- $350.00 Shower Only 16.60 Three 3 bath $339.00 Water Closet 16.60 -- - _ _ __ SUBTOTAL Urinal 16.60 8%STATE SURCHARGE _ Dishwasher 16.60 PLAN REVIEW_25%OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine - 16.50 Floor Drain/Flcjr Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" - 16.60 Water Healer O conversion O like kind 16.60 Quantity by 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 New San/Storm Sewer 46.40 Lavatory Hose Bibs - 16.60 Tuh or Tub/Shower Combination Roof Drains 16.60 Shower Only _- Drinking Fountain 16.60 Water Closet O,her Fixtures(Specify) 16.60 -�--- Urinal - - Dishwasher _---,- - - - Varbagr_Disposal - _ --- Laundry Roorn Tray - Washing Machine Sewer-1 st 100' - 55,00 Floor Drain/Sink: 2" ---- 3" Sewer-each additional 100' 46.40 --� 4" Water Service-tsl 100' 55.00 Water Heater _ Water Service-each additional 200' 46.40 Other Fixtures - _ _- S!onn 8 Rain Drain-1st 100' 55.00 -(Specify) Storm&Rain Drain-each additional 100' 46.40 Commercial Bark Flow Prevention Device 46.40 - - Resldenliai Backflow Prevention Device' 27.55 --- -- - -- Catch Basin 16.60 - Inspection of 1xisting Plumbing or Specially 72.50 Requecred lospectionaper/hr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 -_ QUANTITY TOTAL -- Isometric or riser diagram is required If - _ Quentil Total Is >9 - - - 'SUBTOTAL - --- -- 8%STATE SURCHARGE - --- "PLAN REVIEW 25°/.OF SUBTOTAL - _ R iqulrod_o 11 r j rept Iota'Is�9 TOTAL- 5 'Minimum permit fee is$72 50•8%state surcharge,except Residential Backilow Prevention Device,which Is$113 25•8%state surchnrge ' All New Commercial buildings requirn plans vith iscmehic or riser dingrarn and plan review I:\dsts\forms\plm-fees.doc 10110100 Mechamcal Permit Application 7Date;meived: Permit no.: City of Tigard .: Expire date: CiryofTigard Address: 13125 S1W Hall Blvd,Tigard.OR 97223 Phone: (503) 639-4171 aes -i By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _______ Building permit no.: U'l &=familying or accessory U Commercial/industrial U Multifamily U Tenant improvement U NeU Addition/alterati,-it/replacement U Other: 1 Job address-...L/ Indicate equipment quantities in boxes below.Indicate die dollar Bldg.no.: Suite no.: _ value of all mechanical materials.equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: '- 'r ><s a 'See checklist for important application information and Project name: .-7 jurisclicti- i—s fee schedule for residential permit fee. City/county: ZIP: Description and location of work on premises: Fee(ev.) Total Est.date of completion/inspection: C� zc Description Qi • Res.only Res.only Tenant improvement or change of use: Air handling unit --_CFM-__ _ Is existing space heated or conditioned?U Yes U Nor Air conditioning(site plan require ) _ Is existing space insulated?U Yes U No teration of exlating A system a LILY" Boiler/compressors Business name: �e State boiler permit no.: HP __Ton:. BTU/H AddiAddicts: /� G� ' >c�1_ L' l/'C ' it smo a ampers/ductsmo a electors_ )4 C l �. ' Stale:6ZIP: 7 v/ deal pump(site plan require ) Phone: <- J/ Fax: E snail: n"talurep ace urnac umer Including ductwork/vent liner U Yes U No CCB no.: 76'7? ala /rep cc re ocatcheaters-suspended, City/metro lic.no.: wall,or floor mounted _ Name(pleme print): lK ; - vent tn—r u Tnce other than furnace Refrigeration: Absorption units _ B i U/H Name: Chillers lip — - Comressors Address: ___ �- --ent- .. v ronmenta ex uvt ml vat on: City: _— Slate: ZIP: Appliancevent - -- - Phone: - ---- - fax: f.-mail )rycrcx gust o s, ypc res. itcTienThazmat hood fire suppression system _. Name' �`fi 1� _ Exhaust fan with single duct(bath fans) IVt:ultng address: x,aust s titan mart from heatingor AC Stat%> ZIP: e a � ) P P ng a.nJ11s: to on(up to outlets) City: r r A./ tV %> Type; 1-M __ NG Oil _ Phone: - cv r. Fax: '� -mail: uc 1 m enc i at itions over outlets 'rucessppng(sc cmaticrcquuc ) — _— Number of outlets _ Name: — -O-ITier list appliance or equipment: Address: Ihcotative fireplace City: -- Mate:- 7.1 P: _ Insert- tv�pe - t slovGpellelslovr Plinne: Fax: 1:-Illall: — -- (h eT r: Ap,)licant's signature:^�- -- Date--- - — ter: ,-- ,- Name i Not all Juriedicnorte accept credit cetde,please cell Jurisdiction fix rune infrxmaiion Pelslit fee ................ U Vise U MasterCardNotice:'Phis permit application Mninnun feeee................ expires it a permit is not obtainer Plan review(at Credit cod mtmba _.-.-L— -_- within 180 days after it has been f:spitee y• Stale surcharge(8%) .... Now d urN-w1Je u eMrwn on credo cud accepted as pomp e1C. $ TOTAL .......................$ _ - CWdholJ,cr eltnotrrc T --- - -Amoun•__ 411IJ617(&M COM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: Price Total-- $1.00 to$5,000.00_ Minimum fee$72.5_0 Table 1A Mechani ml Code _ Qty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 10(1,,000 BTU $1.52 for each additional$100.00 or including duds&vents 14.00 fraction thereof,to arid including 2) Furnace 100,000 BTU+ $10,000.00. including ducts&vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnac^ $1.54 for each additional$100.00 or including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall healer $25,000.00._____ or floor mounted heater 14.00 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent riot included in appliance eermit $1.45 for each additional$100.00 or _ _ 6.80 fraction thereof,to and including 6) Repair units - ___ _ 3501000.00. _ _ 12.15 $.50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond fraction thereof. _--� footnotes below. Com _ 7)<3HP;absorb unit ASSUMED_VAL_UATIONS PER APPLIANCE: to 100K BTU _ 14.00 Value Total 8)3-15 HP;absorb - Description: __ Q Ea Amount unit 100k to 500k BTU __ 25.60 -=Y- --L - 9)15-30 HP;absorb Furnace to 100,000 BTU,Including 1 it un .5- mil BT35.00U _ ducts&vents 955_ _ - Furnace> 100,000 BTU including 1,170 - 10)30-50 HP;a'-sorb ducts&vents unit 1-1.75 mil B J 52.20 Floor furnace including vent 955 11)>50HP.absorb Suspended heater,wall heater or g55 unit>1.75 mil BTU 87.20 floor mounted heater 12)Air handling unit to 10,000 CFM Vent not Included in applicance 445 _ __- 10.00 permit 13)Air handling unit 10,000 CFM+ Repair units -- 805 _ _-_- 17.20 <3 hp;absorb.unit, 955 --� 14)Non-portable evaporate cooler -- to 100k BTU _ _ _ 10.00 3-15 hp;absorb.unit, 1,700 �- 15)Vent fan connected to a single duct _ 101k to 500k BTU _ 6.80 15.30 hp;absorb.unit,501k to 1 2,310 - 16)Ventilation system not Included in - mil.BTU appliance permit 10,00 30-50 hp;absorb unit, 3,400 17)Hood served by mechanical exhaust 1.1.75 mil.BTU_ _ 10.00 >50 hp;absorb.unit, �- 5,725 18)Domestic Incinerators --- - -` =1.75 mil.BT_U17.40 Air handling unit to 10,000 dm_ _ 858 �- 19)Commercial or industrial type Incinerator Air handlingunit>10,000 cfm 1,170 _69.95 Non portable evaRorate cooler - 656 20)Other units,Including wood stoves - - Vent fan connected to a single duct 446 - - --. 10.00 Vent system not Included In 656 21)Gas piping o',e to four outlets a (lance errnit 5.40 .Pp-_2g b ------ 22)More than 4-par outlet(each),----- - - Hood served by mechanical exhaust 656 DomesticIndnerator__ 1 TO 1.00 Commercial or Industrial Incinerator ---.4,590 �- Minimum Permit Fee$72.50 SUBTOTAL: $ __ Other unit,including wood stoves,- 656 _ 8y.State Sur-charge e Inserts,etc. g Gaspiping 1-4 outlets _ 366 - -2Sy.plan Review Fee(of subtotal) E Each additional outlot _ - __ Required fur ALL a�mmerdal permits only ______ Y TOTAL COMMERCIAL a- TOTAI RESIDENTIAL PERMIT FEE: $ VALUATION: Other Inspection* nd Fees 1 Inspections oulside of normal business tours(minimum charge-two hours) $72 50 per hour 2 Inspections for which no fee Is spocilically Indicated (minimum chargo-hell hour) $72 50 per hour 3 Additional plan review required by&.anges,addiflons or revisions to plans(minimum charge-one-half hour)$72 50 per hour 'State Contractor Boller Certification required for units 1-200k BTU. "Residential A/C requires alts plan showing placement of unit. I,\dsts\forms\nmch•few.doc 10/11/00 Electrical Permit Application Tigard Date received: Permit no.: city Of Tigard Project/appl.no.: -- Expire date: City of Tigard Address: 13125 SW Hall Blvd,Tigard,OP- 97223 Date issued. By: Receipt no.: Phone: (503) 639-4171 YP' Payment type: Case.file no.: Y : Fax: (503) 598-1960 Land use approval: ---- 7UNe, 2 lamily dwelling or accessory U Commercial/industrial U Multi:family U'Partial improvement construction U Addition/alteration/replacement U Other. U Partial Job address: 3 i Bldg.no.: I.Suite no.: ITax map/tax lot/account no.: l.ot: �' lock: Subdivision: _ _, — ------ ---- - Project name' es'7/1-V— Description and location of work on pre:nuses: Estimated date of completion/inspection: << y ree Max Job no: Description _Qty. (ea.) Total no.hasp f Rusinessname: p' +�R New residential-single orinuhi-family per Address: Gi dwellinguniLlnclueksattachrdprraRe• City: j C State:,,4t ZIP: �/�3 Service included Phone:Sl 70l rax: `ht.� E-mail: 1000 sq.ft.or less 1 Hach additional 500 sq.ft.or portion thereof CCR no.: �' Elec.bus.lic.no: Limited energy,residential 2 — � Limited energy,non-residential —2 City/metro lie.no.: - - Each manufactured home or modular dwelling Service and/or feeder _ 2 — Stgr c of supetvl fig electrician triad) Dale — LJ J�✓ Serrlcesorfceders-Inslallallon, Sup.elect.name(print): �y _ License no: U alteration or relocation: 200 amps or less 2 201 amps to 400 amps 2 Name(prinq: 401 amps to 600 amps _ 2 Mailing address: Z Z 3 C_' ` c l 5 601 amps to 1000 amps 2 City: f 1 J / Slaleta t ZIP:�y 7 U a�3 Over 1000 amps or volts ——__ 2 y: I c rgx; /a/ F.n1siL Recoanectonly _ Phone: �'� Trmparary wrvlces or feeders- Owner installation:The installation is being made on property I own Install atlon.aheralIon,orrelocallon: which is not intended for sale,lease,rent,or exchange according to 200 amps or less __ 2 ORS 447,455,479,670, )1. 201 amps to 400amps __ _ __... _ 2 Owner's si riatfirt �— QaIC: � e r ft/ 401 to 6(10 smps --- 2 Branch circuits-new,alteration, or extension per panel: Name: A Fac for branch circuits with purchase of scrcicc or feeder fee,each branch circuit ne1mve: ?Address: --- — State: ZIP: Feefur hranch cineole without purchase City: of service or feeder fee,first branch circuit:Phone: Fax: E-mail: Each additional branchcircuil. Misc.(Ser rice or feeder not Included):tach um or irrigation circle❑Servlxover223unp connrcrcaal U Il nith n Inubt _ rnutlinclighUngU Service Iver 320 amps-rating of 1 R2 U liazardous location Si nal circuits)or a limited energy panel,family dwellings U Buildingover Iojwsquare feet four or gU System over 600 volts nominal more residential units in one structurealteration,or extension•U Budding over three stories U Feeders,4110 amps or more •Iiescrition:U Occupant load river 99 persons U Manufactured swctures or RV park E aeh additional InspMion over the allowableU Egre+s/lightingplanU Other.Submit sets of plans with any of the above.'ILe above are not applicable to temporaryconstruction service. Other Permit fee ........I....... _—_ -- Not all)uriedicUem arcelA credit earth,please call jurisdiction I'm rraxe Inforou ion Notice: this permit application Plan review(at _ Iso 1i . U VIRa U MasterCard expires if a permit is not obtained —�� within 180 days alter it has been State surcharge(8%) .... credo card numM --- --- --- Psplreh accepted as complete. TOTAL. ...............I.......$ ---Nime a�car�wTir ee as own one t card �-- s -- —'i'enlholter s{Enarure ---— A.nount — 4404611 IMxYr'tiMi Electrical Permit Fees: Limited Energy Fees: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Foe... ............ $75.00 ..................................... . Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service Included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq,ft.or less _ _ $145.15 4 Audio and Stereo Systems Each additional 500 sq.ft.or portion thereof _ $33.40 1 ❑ Burglar Alarm Limitad Energy $75 OC Each Manufd Home or Modular L J Garage Door Opener" Dwelling Service or Feeder $90 90— 2 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less _ $8030_ 2 201 amps to 400 amps _ $106.85 2 F1 Vac mirn Systems 401 amps to 600 amps _ $16060 _ _ 2 601 amps to 1000 amps _ $240 60 2 ❑ Other Over 1000 amps or volts $454.65 _ 2 Reconnect only _ $6685 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL.ONLY Installation,alteration,or relocalion Fee for each systern.......................................................... $75.00 200 amps or less _ $6685_ 2 (SEE OAR 918-260-260) 201 amps to 400 amps _ $100.30 2 401 amps to 600 amps _ $133.75 – 2 Check Type of Work Involved Over 600 amps to 10C„volts, see"b"above. A,,h->and Stereo Systems Branch Circuits New,alteration or extension per panel C J E�oiln,r Control, a)The fee for branch circuits wifh purchase of service or Clock Systems feeder fee. Each branch circuit _ _ $665 2 Data Telecommunication Installation b)The lee for branch circuits wlfhouf purchase of service r Fire Alann Installation or feeder fee. First branch circuit _ $46 85 Each additional branch circuit $6,65 HVAC Miscellanp.,us Instrumentation (Service or feeder not included) Each pump or irrigation circle _ $53 40 Each sign or outline lighting — _ _ $5340 Intercom and paging Systems Signal circuit(s)or a limited energy panel, alteration or extension _ $7500 _ ❑ Landscape Irrigation Control' Minor I aheir(10) $12500 _ Medical Each additional Inspection over i ❑ the allowable In any of the above ❑ Per inspection _ $6250 Nurse Calls Per hour ____ $62 50 f � In Plant u `__ $73 75 Outdoor Landscape Lighting' Fees: ❑ Prolective Signaling Enter total of above fees $ n Other 8%State St.rcharge $ Number of Systems 25%Plan Review Fee See"Plan Review"section on $ No licenses are required Licenses are required for all other Iislalletions front of application — — – — Fees: Total Balance Due $ _------ Enter total of above fees s ❑ Trust Account M_ _ 81,1.State Surcharge s_— Total Balance Me t _ 0dsts\fornuklc-fees doc 10/09/00 01 Feb 15 08:34:36 R;\If\LT20EHRE.dwg RDS —7 7�7 ,' r,,,,)le- _2 0,-2 '13f, N ............ ....... .............. ............. 7 d-O XXX X 4,10 ............... rn .................. cn .......... lcm wit: A, w 9 m 9 0 LOWER ► JOISTED CK LOWER FLOOR EL -.458 0' ........... ..................................... ............ FLOOR LL :468 0' FL C FLOOR JOISTED GARAGE Jl L :461 5' E 161 9. ............ 4" CONC DRIVEWAY 13500 P S I I N 0'15'30 1 8 7 0 c;- SW GREENP ARK PLACE .91.r r[Ncr O CoNc RUNNING WAU U211" S C A L i 2 0 . 0 MAN VASCO'.''IESION ASSOCIPIS VIC it 40 c IT 41, ''' C Ll,B �Op Tl ACCUPACT OF 1�01 IOPOMAPH' ITT OF TIGARD D WOOVA11004 It I INE SOLE olopoksokil,OF �P_. ELK HORN RIDuE ESTATES WADE"10 VERWY AU SITE CMT001% 10CL r LOT 121 OANY ti WALED 000 IMI VIE AND NOtfY 1*6 LOT 20 (,*41 DS Of ANA POINTIPA MD MODIFICA11043 5 ALAN Mkl!C ORO MIM ASSOCAffl.le BY KYLE KOJZAK 10,J87 so Fr) CITY OF TIGARD OREGON INTENT TO HAUL EXCAVATION (LOTS STEEPER THAN 20%) (print name), hereby certify that ALL excavation --j-�" --.��- material on the subject property will be removed from the site and not be the foundation ONLY. Il ui derstanld except for th;t amount necessary to back-fill that failure to remove the excavation material will result in require entpreto r byva the material or obtain a grading permit by submitting grading p lanslicensed engineer accompanied by a geo-technical report -egarding the placement of the excavation material as fill. on I further understand that my footing inspection haube led,ed�anddif thathwork wellat tibe reveals that excavated material has not been stopped and no further inspections conducted until the City has received and approved a plan and report from a goo-technical engineer regarding placement of the fill material. Scnatur Date Permit - zg Job Address: o it,S Lot:-2-1b Subdivision:�.�� [houl.doc(DST)7/96 13125 SW Hall Blvd., Tigard, OR 97223(503)639-4171 TDD (503)684-2772 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE LITE-RITE ELECTRICAL 28820 SW BURKHALTER RD HILLSBORO, OR 97123 Electrical Signature Form Permit #: MST2001-00075 Date Issued: 03/05/2001 Paruel. 20-109AA-05400 Site Address: 14336 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Bl()ck: Lot: 020 Jurisdiction: TIG Zoning: R-7 Remarks: S/F Path 1 Your company has been indicated as the electrical contractor for the permit in6icated above. In order for the electrical permit 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 tj the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received OWNER-. ELECTRICAL CONTRACTOR: KOZAK ENTERPRISES INC LITE-RITE ELECTRICAL 22830 SW NOBLE ST 28820 SW BURKHALTER RD BEAVERT'ON. OR 97007 HILLSBORO. OR 97123 Phone #: 503-848-7014 Phone #: 503-693-9775 Req #: LIC 00089854 SUP 4041S ElE 34-359C AN INK SIGNATURE IS REQUIRED ON THIS FORM X - , ' _- Si a re of Supervising Electrician It you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TICARD it spection Line: (503)639-4175 X1 BUILDING �= — INSPECTION DIVISION Business.Line: (503)639-4171 ' BLIP — Received . __--Date Requested_ ZL_�vAM_ — PM — BUP - -'_ c _ MEC - - Location - �3 / ------- _SUlte p OOI�o) Contact Person _--`— --- ---- Ph l--) ----� ---- Contractor ._ - -- Ph SWR ----------- LDIN Tenant/Owner �_--_._—_--- ____._ _._�--- ELC - ---� ELC Foundation Access: ELR Ftg Drain 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 Susp'd Ceiling - - Hoof Oth (rin;SS 5 ----. PART FAIL eam Under Slat, Hough-In �t!I Water Service I1""j - -- ------- Sanitary Sewer Rain Drains - - - - Catch Basin/Manhole Storm Drain Shower Pan Other:_�.--- PART FAIL 0*6WA_N_ICAL - _- Post&Beam Rough-In - ------ ----- Gas Line Smoke Dampers -- — -- Final -- PASS PART FAIL - - ELECTRICAL — Service Rough-In - UG/Slab Low Voltage _-- ---- Fire Alarm Final El Reinspection fee of$. required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL E]917E Please call for reinspection RE: Unable to inspect-no access Fire Supply L Ins - , /1 ADA Date Z� U Y Inspector �/ '� c��. Ext. Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PARI FAIL Burgstahler Engineering Systems Consulting Structural Engineers 320 S.W. Stark • Portland, OR 97204 • (503) 228-6841 August 1, 2001 RECEIVED Mr. Kyle Kozak COMMUNITY DEVEWPMENT KOZAK EN FRPRISES 22930 SW Noble St. Beaverton, OR 97007 Re: Mascord Plan 1215 Detail 1 Sht. 4 Job 0 01-035 Mr. Kozak, I understand that Detail 1 of Sheet 4 was detailed for 2X stick fralTle floor joists at hath sides ofthe hearing wall. Since 'I'JI joists were installed on the right side of that detail, the twist strap shown in this detail cannot be satistaetorily attached to the 1/2" OSB TJI web since it will not hold the nails. Therefore, this detail applies only to full stick frame construction and not to construction that contains TJI joists. The Floor framing on both sides ofthe bearing wall are lully braced with plywood shear walls. The lack ofthis strap does not aflcct the vertical or lateral load bearing systems. If you have any further questions, please do not hesitate to call. Sincerely, Neal Burgstahler P.I1.. CITY OF TIGARD BU11 DING INSPECTION DIVISION MST rn� 244'.....f Inspection Line: 63• 175 Business Line: 639-4, BUP 0 L r Date Requested AM —PM - BI_U Location_ 3 2 ��✓✓ Suite q MEC Contact Person Ph PLM Ph SWR Contractor _ E'er . ELC BUILDING Tenant/Owner ELR _ Retaining Wall Footing Access: �y 1 FPS Foundation Ftg Drain SGN T� Crawl Drain Inspection Notes: SIT Slab Post 8 Beam Ext Sheath/Shear Int Sheath/Shear Framing --- Insulation _ -- Drywall Nailing - ---- ------- Firewall Fire Sprinkler — ------ Fire Alarm — Susp'd Ceiling ------ - Roof -- - Misc: Final pAS'§—p-A-A'W FAIL PLPNMI Q-- Fost 8 Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains rn FAIL _ HAN eam Rough In - Gaa Line Smoke Dampers pA FAIL CTRI Sery ce -- Rough In UG/Slab — Low Voltage Fire term -- - nal ----- SS' PART FAIL — - — - Backfill/Grading Sanitary Sewer re wired before next inspection Pay at City Hall, 13125 SW Hell Blvd Storm Drain I ]Relnspectlon fee of$ n Catch Basin I ]Please call for reinspection RE' ] Unable to inspect no access Fire Supply Lina () � -- ADA Approach/Sidewalk pate _ Inspector Ext __ Other Final 0A98 PART FAIL DO NOT REMOVE this insr-ctiort record from the job site, r WSC-81 WbVA:TT TOOZI-8T-370 0.4 0 lob.s 40 w IL 44 oil. l� ► P. Id �- H F1poll - • i ooil yy �iamp.w o ► 44 ► ► P. .4 Poo i ► � R S{ R t ► 14 ON, 4 No, t ► 4L No.. t0'd r10LLVw-wi a' N.lJdSNi cr a �_ _V .kis- Odl w t?CITT TNt-W-ET loc ,,- 113% tzQ E05 of POOR-80-NOf l^ p O V.N .y a' N a � < t1 o. ° ti a� gr o �� O o r0 v � 0 � I 70 O 1 a A s IZ 5 7 5 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BLIP r� - Received ------Date Requested--" � — AM_.__ (�RSA��_.� BLIP ►_ovation Suite MEC Contact Person Ph(_ 1} ._ PLM _& -A.-I Contractor -- ------- -- --- _ Ph (T__-} ----_-.--- SWR _UI renant/Owner __ - _-.��-- - _ ELC Footing _ ---^ ELC Foundalior Accps6. i t 9425 Fig Drain , �� ' L'Y f G•�`� ELR Crawl Drain Slab InspetVan-Ne#@S'--- --- SIT _-- Post& Beam Sher Anchorsr- Ext .)heath/Shear Int Sheath/Shear Framinc Insulation Q Drywall NailingFirewall ? Fire Sprink!ar ---r Fire Alarm Susp'd Ceiling Roof `t VL►r .- C?�-j A , FAIL -6 � Post�Bearn - Under Slab r in -- ?7�----- Rough-In Water Service Sanitary Sewer Rain Drains - ---- - - - - - Catch Basin/Manhole corm Drain - :ihower Pan .- ► �� Other. Final PASS PART FAIL EL MECHANICAL - rost&Beam " --- ! �w4 Rough-In Gas Line Smol Dampers ,- /� f•- (.�Y1 .� � �G1_ t` '�-` Final PASS PART FAIL ----- — --- - -- --- ---- - ELECTRICAL _ Service Rough-In - UG/Slab Low Voltage Fire Alarm Final I PART FAIL Reinspection fee of$ __ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PA 8 _ - Please call for reinspection RE: _ _ __--_-_ r Unable to inspect- access e Supply Line l ADA Dab 1 Z�� Inspector _ ------ Ext - - ach/Sidewalk Other. Final- � DO NOT REMOVE this laspection record from the job site. !3 T AIL /