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'10173 SW Lady Marion Drive
MASTE
CITY OF TIGARD EPMIT : MST2 -
PENMIT#: MST2002-00359
DEVELOPME14T SERVICES DATE ISSUED: 9/20/02
13125 SW Hall Blvd.,Tigard, UR 97223 (50;)) 639-4171
SITE ADDRESS: 10173 SW LAD ' MARInN D^ PARCEL: 2S111CB-03300
SUBDIVISION: MARION ESTATES ZONING: R-3.5
BLOCK: LOT: 006 JURISDICTION: TIG
REOARKS: New S/F detached path 1 NEED TO GET A STREET OPENING PERMIT FOR NEW DRIVE WAY
BUILDING
FtE1SSU1 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLAZ i OF WORK: NEW HEIGHT. 27 FIRST: 1.464 of DASEMENT: 0.00 of LEFT: r, SMOKE DETECTORS: Y
T)PE OF USE: SF FI OOR LOAD: 40 SECOND. 1,562 of GARAGE: 830 of FRONT 20 PARKING SPACES:
TY°E OF CONST: 5N DIAELI.ING UNITS: 1 FINBSMENT: of RIGHT: 5
VALUE: S 308,411.40
OCCUPANCY GRP: R3 BDRW 4 BATH: 3 TOTAL: 3,0260 :r REAR: 30
—�� PLUMBING —
SINKS I WATER CLOSETS: 3 WASHING MAC'{; I LAUNDRY TRAYS: RAIN DRAIN: tnn TRAPS:
LAVATOR F5. DISHWASHrRS: 1 FI DOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: i CA „H BASINS:
TUPISHOWERS: 4 GAP3AGE `P: i WATER HEATLAS: I WATER LINES: '00 BCKFLW PREVNTR: I GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<1100K: BOILICMP<3HP: VENT FMIS: 5 CLOTHES URYER: I
GAS FURN>•100K: I UNIT HEATERS. HOODS: I OTHER.UNITS: I
MAX INP. btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADDT INSPECT')NS
1000 SF OR LESS: 1 0 20C amp: 0 - 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION: PER INSPrUTION:
FA ADD'L 5oosr 6 201 400 amp: 201 - 400 amp: lot W/O SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - Boo amp: 401 600 amp: EA ADDL BR CIA: SIGNALIPANEL: IN PLANT:
MANII HMISVCIFr'R, 601 1000 amp: 601+empa•1000V: MINOR LABEL:
10004 antplvplt
PLAN REVIEW SECTION
Roronnect oad•;
—4 RES UNITS: SVCIFDR>=225 A.: >600 V NOMINAL: CLS AREAISPC UCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDEW IAL B.COMMERCIAL
AUDIO 8 STEREO: X VACUUM SYSTEM. X AUDIO 6 STEREO. x FIRE ALARM: INTERCOMIPAGIN G. OhTOOOR LNDSC LT:
BURGLAR ALARM: X OTH: ALL ENCOMP BOILER: HVAC: LANDSCAPEIIRRIG: 1'POTECTiVE RIGNL:
GARAGE OP'dNER: X BLOCK, INSTRUMENTATION: MEDICAL.: OTL,R:
HVAC: X nATA/TELE COMM, NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor. TOTAL FEES: $ 8,459.34
MASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUCT ION INCThis'Bruit is subject to the regulations contained in the
15435 SW ASHLEY DR 15435 SW ASHLEY DR T geld Municipal Code,State OR. Specialty Codes and
TIGARD,OR 97224 TIGARD,OR 97224 all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire if
wor k is not started within 180 days of issuance.,or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted 1,y the
Orepon Ulillty Notification Center. Those rules are set
Reg 0: 1-1' fr'rin in('AR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling 150°)246-1987.
REQUIRED INSPECTION:
Erosion Control Insp 8' Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation h.Rp Mechanical Final
Sewer Insoection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Rain draln Insp Plumb Final
Footing 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 Electrical Final
Issued ley : Perrnittee Signature
Call (503) 39-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGAR D _ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES P`-OMIT#: SWR2002-00238
13',25 SW Hall Blvd.,"Tigard, OR 9,223 (503) 639-4171 DATE_ ISSUED: 9/20/02
SITE ADDRESS; 10173 SW LADY MARION DR PARCEL: 2S111CB-03300
SUBDIVISION: MARION ESTATES ZONING: R-3.5
BLOCK: LOT: 006 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNrT.^,. 1
TYPE OF USE: SF 010. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new S/F
Owner: _ FEES
MASI ERPIECE COivS I'RUCTION INC
Type B Date- Amount Recei `�
15435 SW ASHLEY DR yp y_. p'
TIGARD, OR 97224 PRMT CTR 9/20/07. $2,°00.00 272002(,0000 i
INSP CTR 9/20/02 $35.00 27200200000
Phone: 503-524-4371 Total $2,335.00
Contr.
Phone:
Rcg #:
Required Inspections
This Applicant agrees to comp;y with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals If the sewer is not located at the 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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 It h OAR 952-001-0080.
You may obtain copies these rules or c -ect questions to OUNC by calling (503) 246-1987.
Issued by: Permittee Signature:
-�.. 1- �-- — ----
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
_Building Permit Application Received Building
Datc/B : g 11/�� - Permit o•:17 5t,�{Aoit- �`7 7
City of Tigard ,-,k Planning Arrproval Other G
Test Form Datc/D : P-^--tNo.: S+� "i9_0& %`O
13125 SW Hall 131A. Plan Review 0 Other bOZ3
Tigard,Oregon 97223 Date/B : i,' Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 A Post-Reviey� Land Use
/ 3 G.�- nT/
[nternInternet: www.ci.tigard.ot.us Date/D Case No.—Y—y —_
Contact �9 Ju •s See Page 2 for
24-hoar Inspection Request: 503-539-4175 Name/Method: �7 rJ �� _fly I Supplemental Information
TYPE OF WORK — REQUIRED DATA:
ew construction I El Demolition I &2 FAMILY DWELLING
[]A.ddition/alteration/replacement Other: _
CATEGORY OF CONSTRUCTION Note: Permit fees*are has.d on the total value of the work performed. Indicate
I &t: 2-1-amily dwelling Commercial/Industrial I the value(rounded to the uc.-est dollar)of all equipment,materials,labor,
LJ Accessory Building Multi-Gamily
overhead and profit for the„ork indicated on this application.
Master Builder ❑Other: Valuation.....,,304..W/,.t.................... .... $ .•�c ►
JOB SITE INFORMATION and LOCATION No.of bedrooms:_ No.of baths:-. _
Job site address: r$ 4J Z-4 -1 m to it t 6 %-- Total number of floors............. •.,,
— New dwelling area(sq. R.)........ ...... .. ,3-o 2 6r--
Suite#: Bldg./Apt.#: Garage/carport area(sq.fl.)•....F,S'.'•.,3...
Pro'ect Name: Covered porch area(sq.fl.).......
`(..Q..10
....... —
Cross street/Directions to job site: �- Deck area(sq, ft.)............... �......•...........
Other structure arca(sq.ft.). .......................... —
REQUIRED DATA:
COMMERCIAL-USE CIIECI.LIST
S.,',division: f�R�.OU . l✓ Sta T-t ' Lot#: _ -------- — ---
7 ,. map/parcel#: 5 I I 1 LA, 1 Note: Permit fees*are based on the total value of the work performed. Indicate
DESCRIPTION OF WORD' the value(rounded to the nearest dollar)of all equipment,materials,labor,
e — overhead and profit for the work indicated on this application.
Valuation......................................................
. S
-----------
- Existing building area(sq. fl)..... ........ ......
-- --- ---- New building area(sq.fl.).................. ........•
Number of stories..........................
PROPERTY OWNER TENANT Type of construction...................................... _
'Janie: VR S Occupy group(s): Existing:
''� _ �'� r. P t. t,ti �,� N C rt'. I ancrou
N �_ New: --- --
Address: 15 �(S S S w .� ---- _._
Cite/State/Zi �-.1 p 2 q zt �- —
hf TICE: All contractors and subcontractors are
Phone.•7�-rjS�{ required to be Fax: ' 'U --S2tE--4� 1
APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under
_LJprovisions of OILS 701 and may be required to be licensed in the
Business Name: CA A,,-q — _ — _ jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing,the following reason applies:
Address:
—City/State/Zip: —��----�- -- —_ –
Phone: -
- -- - BUILDING PERMIT FEES*
E-mail:
CONTRACTOR Please refer to fee schedule.
�^
Business Name: M C Fees due upon application.............................. 5
.Address:
City/State/Zig Amount received............................................. $
Phone: _ Fqx: Date rcc.ived:
CCB Lic. #:
Notice: This perrnit application expires If a permit i%aur oirwinrd%sithin
Authorized \ t,p .
Signature: Com.._ _ Date: 'd Z. tilt)Itatx ager it lists been Accepted AS Complete.
*I've mcthodoinw set by Trl•Cnuntc Building Industry Service Board.
(P ase print name) '�
One- and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permus:
(ih (I'i)rird City of Tigard ❑Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 ❑Other:
Phone: (503) 639-4171
Fax: (503)598-1960
1 ,
1 Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood pain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of wpproved platllot.
4 Fire dlstrict_ 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 (1, rmit required.Include drainage-way protection,silt fence design and location of
aitch-basin protection,etc.
10 3 Complete sets of le rs,Must be drawn to scale,showing conformance to applicable'oc, and state
building codes. Lateral design uet...ls and connections must be 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 c,nnot be computed
_ if copyright violations exist.
I I Site/plo t plan drawn to reale,The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);locatiot,of casements and
drivcv.: ;!1(mq)tiia of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot
,tea;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
eine and location.
13 Floor plans.Show all dimensions,room identification,wirdow 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_t-1-
wall construction,roof construction.More than one cross section may be 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 foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Aust indicate details and locations;for
non preferiptive path analysis provide specifrcati,tns and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floor. 00f assemblies,indicating member sizing,spacing,an
/td bearing
locations. Shaw attic ventilati:n.
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets or calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any bemn/joist carrying a non-uniform load,
20 Manufactureddfloor/roof truss design details.
21 Energy Code compliapee.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 be stamped by an engineer or
architect licensed in Oregon and shall he shown to he applicahle to the project under review.
JURISDICHQNAL SPECIFICS
21 Five(5)site plans are required for Item I I above. Site plain intM he R 112" � I I' or 11" 07".
24 '1,,%o(2)sets tach are required for Items 16, 19,20&22 above.
25 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 1 rec List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614(6N0rc•0M)
OFFICE USI,' ONLY
Electrical Permit AppliVa><ion 1 '
Receivedr� Flcctrica] _
Date/B C/g _ PctmitNo.:
City Of Tigard Planning Approval Sign
Test Form -Date/By: Permit No.: _
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Datc/B : Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 .,. Post-Review Land Use
Date/BInternet: www.ci.tigard.or.us : Case
Contac _
g Contact Juris.: 0 Sec Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: I Supplemental Information.
TYPE OF WORK PLAN REVIEW 1'ie tse check all that apply)
CW construction y _ I LJ Demolition r0 Service over 225 amps- EJ I IcaUh-care facility
commercial E]1 fozardous location
Addition/alteration/re lacCn3etll I El Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in
_& 2-Family wellinng ❑ Commercial/Industrial ❑System over 600 volts nominal one structure
Building Minti-Family ❑Building over three stories El Feeders,400 amps or more
F-1ACCCSSO I3u_ry_ � ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder El Other: [l Fgress/lighting plan ❑Other:
JOB SI i E INFORMATION and LOCATIONSubmit_sets of plans ss9th any of the above.
'rhe above are tint applicable to temporary construction service.
Job site address: `l h K_t K_ _
/D1 i � ITE*SCIIEDULE
Suite#: Bldg./A,st.#�_ _ - Number of ins ectlons per )erntlt allowed
Project Name: Description Qty Fee(ca.) Total
New residential-single or multi-family per
Cross street/Directions to job site: P 4 T dsselling unit.Includes r it .hed garage.
.y �1p Kc Q Service Included:
1000 sq.R.or less 145.15 4
AEach additional 500 s .n.or portion thereof 33.40 1
Subdivision "-(fes�t V�U Ot#; limited energy,residential 7`00 2
_ _ Limited encrity,non residential 75_00 2
Tax map/parcel #: f - Each manufactured home or,nodular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2_
Services or feeders-Installallon,
uL/ M K alteration or relocation:
200 am s or Icss 80.30 2
-.- ---- 101 amps to 400 ams _ 106.85 2
---- 401 a ii,3 is 600 amps 160.60 2
PROPF.RTX OWNER 601 amps 10—1000 amps 240.60 2
Over IWO amps or volts 454.65 2
Name: M O- J T C K. A ^ c7�� t�C - Rect.nnectonly - 66.85 2-
Address: 1 S S S w IQ S I C ~ _ Tem,iorary services or feeders-Installation,
alter atlon,or relocation:
City/State/Zip: et f Ilk -7.1-A 200;,nips or less66.85 1
__
Phone:516'l-7 % (1 Fax, QJ -S 14 f 43 201..ops to 400 amps 100.30 2
APPLICANT CONTACT PERSON 4aI Gal)amps 133.75 2
— Branch circuits-new,alteration,or
Name: _ extension per panel:
Address:! A.Pee for branch circuits with purchase of
service or feeder fee each branch circuit 6.65 2
Cit /State/Zl : B.Fee for branch circuits without purchase of
-- service or feeder fee first branch circuit 46.85 2
Phone: Fax_ Each additional branch circuit 6.65 _ 2
F-mail: Misc.(Service or feeder not included):
_ CONTRACTOR Each pump or irrigation circle 53.40 2
-- Each sign or outline lighting 53,40 2
Job No: Signal circuit(s)or a limited energy panel,
Business Nanleq A L V`' F R-{�R r Com[ t l� C alteration,or extension* 75.00 2
*Description:'1-
Clt /rJtate t 10 b Each additional Inspection over the allowable in any of the above:
Per inspection r hour-min. I hour_ 62.50
Phone: h - I V
-Fax: _ Investi ation fee: _
CCB Lic. #: S r Lic.#: —1 other: _
Electrical Permit Fees*
Supervising a ectrician W1/02, It, 01
.. _
Subtotal S
si ago tune re utred: Plan Review 25%of Permit Fee $
Print Name uak- - Lic,#: V State Surcharge S8%of Permit Fee 5
TOTAL PEP.;sitr FEE $
Authorized _�-�1-' Notice: Tlils permit application exuires If a permit Is not obtained within
Signature: Date: 180 dais after it has been accepted as complete.
"Pre methodolot;� set bY Tri-County Building Industry Sersice Board.
(Please print name)
FI
Plumbing Permit Application Received " Plumbing Kyr y�
Datc/13y: is ? PcrmitNo.: Off` i4✓U /
City of Tigard Planning Approval Sewer
Tess: Form Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/Ejy: _ Permit No.:frost- -
se
Phone: 503-639-4171 Fax: 503-598-1960 Date/ y: se o.:
Date/By: �.ose No.:
Internet: www.ci.tigard.or.us Contact Juris.: Sce Page 2 for
24-hour inspection Request: 503-639-4175 Namc/Method: I Supplemental Information.
TYPE OF WORK FEE*SCHEDULE(for special Information use checklist)
]ZrJ'4cw construction _ Demolition Description Uh• Fec(ea.) -total
Addition/alteration/replacement Other: New I-&2-family dwellings
Includes 100 ft.for each u ility connection
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
1 & 2-Family dwelling Commercial/Industrial SFR 2 bath 350,00
EAccessoty Buildill _Multi-Family >rR(3)bath 399.00
Master Builder Otlier: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Firesprinkler-sq.ft.: Pae 2
Job site address: �_ `,t 11 C G b Site utilities
#: Bld ,/Apt,#; Catch basin/arca drain IG.60
Suite
Dr well/Ica' .line/trench drain 16.60
Project Name: Footing drain no.linear ft.) Pae 2
Cross street/Dimctions to job site: I 3 it --- l0i Manufactured home utilities 110.00 _
L V� ..� n Q t ► Manholes 16.60 ---
Rain drain connector 16.60
Sanitary sewer no. linear R. Page 2
Subdivision:MA 44 f4W t 5T - 81 of#:L Storm sewer no.linear f). Page 2 -_
Water service no.linear R. Page 2
Tax map/parcel #: C 3 Fixture or Item
-__ DESCRIPTION OF WORK
Absorption valve _ I6•f��
�' kJ �• tJV�. C _.____ _ Backflow preventcr-Commercial_ 46.40
Backflow prcvcntcr-Residential 27.55
Backwater valve 16.60
-- Clothes washer 16.60
___ Dishwasher 16.60
PROPERTY OWNER TENANT Drinkingfountain _ 16.60
Name: , P- y'L_' K.. Pt e r t K_J ►. Ejectors/sunip 16.60
Address:
Expansion tank 16.60
�-� t�S ( It ---
Cit /State/Zl - L G (� Fixturciscwcr cap 16.60
Floor drain/floor sink/hub_ 16.60
Phone:.5G - i1b- Fax 11 ��Zy' X31 Garbage disposal 16.60
_M:XPPLICANT CONTACT PERSON Hose bib _ 16.60 _
_Name: QA rv.,a Ice maker 16.60
Address: Interceptor/grease trap 16.60 _
-- - _ Medical gas-value: $ Page 2
City/State/Zip: _ _ Primer 16.60
Phone: ---=ax.* Roof drain commercial 16.60
E-mail: � Sink/basin/lavatory 16.60
CONTRACTOR Tub/shower/shower an 16.60
Urinal 16.60
Business � .
Name: 'Cmcsr
U h" ' � - Water closet IG.60
Address: - -.1 4 Ae&L7" ra TO Water heater 16.60
City/State/Zip: ryQcs1 e7 pau Q C� '�- Other:
Phone:,� - . 1c-L Fax: Plumbing Permit Fees*
Subtotal $
CCB Lie. M i 'b'2-614 y Plumb. Lic.#: Minimum Permit Fee$72.30 $
Authorized
Residential Backflow Minimum Fee$36.25
,Q1. Plan Review(25%of Permit Fee $
_b
Signature: (1 WQ�C -- Date: State Surcharge " -
8.o of Permit Fee) 5
TOTAL PERMIT FEE 5
(Please print name) 'lotice: This permit application expires If a permit Is not ob!alned within
I No days after it lists been accepted as complete.
All new Commercial building require 2 sets of pians with Isometric or •Fcc methodoloogy set by Trl-County Building Industry Service Hoard.
riser diagram for plan review.
Plumbint` Ncrmit AVIlication - City of Tigard
Page 2 - Supplemental Information
Fee Schcdu:e: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ca) Total Square Footage: Permit Fee:
Footing dram- 1"100' 55.0 0 to 2,000 3115.00
Footing drain-each additional 100' 46.40 2 01 to 3 600 $160.00
3,601 to 7,200 $220.00
Server-I st 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 46.40 -
Water Service-Ist 100' 55.00 Medical Gas S steMS: _
Water Service-each additional 100' 46.40 Valuation: Permit Fee:
Storm&Rai,Drain-1st 100' 55A0 $1.00,o$5,000-00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 55,001.00 to It 1(,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ca` Total includ:ng$10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001,00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
(minimum permit fee 336.25) 27.55 and including$25,000.00.
Rain Drain,single family dwelling 65,25 $25,001.00 to$50,000.00 $37250 for the first$25,000.00 and$1.45 f'or
each additional$100,00 or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00.
specially requested inspections-per hour 72.50 $50,001.00 and!.p $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additionai$100.00 or fraction thereof.
Fixture Work:
Are)flu capping;,nerving;or replacing;existing; fixtures? If
"yes",please indicate work performed b'v fixture. Failure to
accurately a)ort fixtures could result in increased sewer fees*.
Quantity by(Fixti re)Work Performed Continents reg;ardhrg;fixture work:
Fixture Type: Replace —
_ New Moved Existing __K&Ted
ed Baptistry/Font
Bath -Tub/Shower
-Jacuzzi/Whirlpool — -- — — --
Car Wash -Each Stall
-Drive Thin -
Cus pidor/Water Aspirator --- �— —'— '-�— —
Dishwasher -Commercial
-Domestic
Drinking Fountain — —Eye Wash
Floor Drain/sink .2' _
.3' -
-4"
Car Wash train *Note: If the fixture work under this permit results in im
Garbage -Domestic _
Disposal -Commercial increase of sewer MIN,a sewer permit will he issued and
-Industrial _ fees assessed for the sewer increase must be paid before file
Ice Mach./Refri .Drains plumbing;permit can be is tied.
Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -Gang _
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial
_ -Service _
Swimming Pool Filler _^
Washer-Clothes
Water Extractor
Water Closet-'roilet
Urinal
Other Fixtures: —
s
Mec'haniral Permit Application
Received01IMechanical
r,'ttc/B 87j,
- Permit No.: ✓/�
r Planning Approval Building
City Of Tigard Test Form Datc/B _ Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.: _
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact Juris.: Sec Page 2 for
24-hour Inspection Request: 503-639-4175 LNamc/Mcthod: S�Icmcntal Information.
TYPE OF WORK COMMERCIAL F EE*SCHEDULE••USE CHECKLIST_
New construction I I . Demolition —_ Mechanical permit fees*arc based on the total value of the work
Add i tion/alteration/re.p I acement I ❑Other: performed. Indicate the value(rounded to the nearest dol:ar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and pratt.
1-& 2-Famtl dwellin ConunercialMdustrial value: S� _ See Page 2 for Fee Scltedul�
—�---- — RESIDENTIAI,E U1P_MEN'T/BYSTF:MS FEF.*SCHEDULE.
_Accessory Building F1 Multi-Fa
mk Description h' Fee(ea.) Total
Master Builder [_]_Other: _ Heatin WCoolin _
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning 14.00
Joh site address: L a n,A Li J V_/ Gas heat um 14.00
Suite#: Idg./Apt.#: Duct work / 1400
Project Name: t lydronic hot water system 14.00 _
Residential boiler
Crass street/Directions to job site: 1 3 eiL tA (for radiator or h dronic system) 14.00
y � Unit heaters(fuel,not electric)
in wall in-duct suspended,etc. 14.00
Flue/vent for any of aboi a 10.00
Subd'visionR��►-J 3 T f I C" Lot#:�. Repair units 12`15
Other Fuel Appliance _
Tax map/parcel#: __- S I I C,b 63�3 X Q Water heater 10.00
DESCRIPTION OF WORK Gus fireplace 10.00 _
l ci Flue vent(water heater/ as fire lace) 10.00
Log lighter as 10.00
--- Wood/Pellet stove _ 10.00
Wood fireplace/insert _ 10.00
Chimne /liner/flue/vent — 10.00 —_
PROPERTY OWNER TENANT _ Other: 10.00
Name: �� .(r t? r_0► ��—
Environmental Exhaust&V lllatlon
�- Range hood/other kitchhenen equipment 17.00
Address: ( rM Clothes dryer exhaust 10.00
City/State/Zip:_''� exhaust
►— Single duct exhaust
Phone: Qj— Fax: V (bathrooms,toilet compartments, -j
APPLICANT CONTACT PERSON utility roomJ 6.80
Name: tC Attic/crawls ace fans J0.00
--- Other: 10.00
Address: Fuel PI ing___ _
Clt /State/Zl $5.40 for first 4,.$1.00 each additional)**
--��-- Furnace,etc.
Phone: _ Fax: Gas heat pump _ `*
E-mail: %Ya 11/suspended/unit heater * '
CONTRACTOR Water heater
_ _**
Business Name: l`' �{{ T t -1 Fireplace
Range
Address: p°` -��-L. BB .«
City/State/Zi �^- Clothes dryci gas)
Phone:/—k o V_,,c,A-Ob Fax: � -- Other:
CCB Lig. #: 3 y�� MechanTotal: _
tcd Permit Fcca•
_ Subtotal: S
Authorized Minimum Permit Fee$72.50 S —
Signature: _�, rCJ� Date: 't�� Plan Review Fee(250%of Permit Fee) $
� �+ ���� l State Surcharge(8%of Permit Fee) $
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TOTAI.PERMIT FEE $
a (P case print name) Netice: This permit application expires tf a permit Is not obtained within
180 days after It hos been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
Mechanical Permit Application - City of Tigard
PLge 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$5,000.00 Ntmimum fcc$72.50
$5,001.00 to$10,000.00 $72.50 for the first$5.000.00 and$1.52
for each additional$100.00 or fraction
thereof,to and includin $10,000.00.
$10,001.00 to$25,000.00 $148.50 for the first$10,000.06 and
$1.54 for each additional$100.00 or
f}action thereof,to and including
$25,000.00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and
$1.20 for each additional$100.00 or
fraction thereof.
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST _OU 3,5
INSPECTION DIVISION Business Line: (503)639-4171
BUP - -_
Received __ _ Date Requested_____._ �--. AM _-. PM BUP
Location bj -1 —SuiteMEC
Contact Person ------ . _ - -- Ph S Sq 1- PLM __--
Contractor ---------- --- - - �_ Ph(-----) - -- - SWR -- -----
BUILDING Tenant/Owner _-_ ..._._--- __--. p-- ---�_-- ELC -__--
Footing -- - -- ELC --- ----- ----
Foundation Access:
Ftg Drain L' / ELR
Crawl Drain
Drain
Slab Inspection Notes: SIT
Post& Beam -_-.__--
Shear Anchors -- __-_
Ext Sheath!Shear
Int Sheath/Sf ear
Framing - -
Insulation �12 Q V-CA
Drywall Nailing -
Drywall
—
Firewall l
Fire Sprinkler ---
Fire Alarm
Susp'd Ceding --- -- — —�— --
Root
Other:
Final
PASS PART FAIL _— - --------- __.—__._
PLUMBING
Post&Eeam
Under Slab -- - - - ---- --- -— ----
. ' ;h-In
V,ater Service - -- - ----- __ ------ ---- -- ---_
Sanitary Sewer
Rain Drains --- - - - -- - --
Satch Basin/Manhole
Storm Drain - -
Shower Fan
Other: -
Finai
PASS PART FAIL -- - ----- - - - - --
MECHANICAL - --- - --- -- - _-_ -
Post& Beam
Rough-In - --- --
Gas Line
Smoke Dampers - ---- - - - -- ---_ - - -
- --
Final
PASS PART FAIL --- ------ -----_ _ _
ELECTRICAL
Service
Rough-In �� f`N_c�
UG/Slab
Low Voltage — ---- — --- ---- -- -- -- -—
FireAlarm
ff
SSS-' PART FAIL. Reinspection fee of$ _-._required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
`
SITE Please call for reinspection RE:_-_ __—._ Unable to inspect-no access
Fire Supply Line ^
ADA L,lit-,r / -
Approach/Sidewalk Date ,,1.__J_- __-__.� Inspector _ Ext
Other:
Final DO NOT REMOVE this inspection record frorh the,job site,
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspecf ion Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171 Bu
Received -- Date Requested.. �� AM _.__ - PM BUP
Location ____.._ l 7�?--�1?�(.., -2Suite k L _ MEC _—
Contact Person Ph( ) '0 - `�`� PLM
— Ti•—G�vrb-
Contractor .__ _..._ -_ Ph(_ 1 _—_ SWR _ —.—
BUILDING lenant/Owner _ ___ ELC ----- ---
Footing----- ELC __—._----
Foundation Access:
Fig Drain C^ -� ' -Id ELR
Crawl Drain ___ 4--
Slab Inspection Notes: I SIT
Post& Beam --- -- - - ------ --- ---
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing - - -- --{�--- -- ------ --
Insulation �j s
Drywall Nailing --- - - - ---- -- - - —
Firewall -
Fire Sprinkler [ a ----- ---- -- -
Fire Alarm
Susp'd Ceiling --- ---- -_ -- -- --- --- -
Roof
Final
PANS PART FAIL
Post 3 Beam —
Undur Slab --- - — —-------
Rough-In
Water Service -
Sanitary Sewer
Rain Drains - - - - - ---------- --
Catch Basin/Manhole
Storm Drain -
Shower Pan
Other --------- -- - -- _. --- - __
.:'OA PART FAIL
CHANI C_AL ----
Post& Beam
Rough-In --- —— - -- -- _----
Gas Line
Smoke Dampers - ___ - __ ------ ------ --
Final
PASS PART FAIL --- - - - ---- -- -------
ELECTRICAL —
Service
Rough-In
UG/Slab
Low Voltage ---
Fire Alarm
Final C- Reinspection fee of$_- required before next i,ispection. Pay at City Hall, 13125 SW Hall Blvd.
PASS_ PART FAIL
SITE - Please call for reinspection RE:._ . _ -___ -- --___ L] Unable to inspect-no access
Fire Supply Line - i
ADA
Approach/Sidewalk
/ Inspector �: `�-_ _--- - Ext-----_--
Other
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 D 035 G}
INSPECTION DIVISION Business Line: (503)639-4171 MST 2
BIOP
Received — _ Date Requested AM PM__ BLIP
1_ocation OI 3 —4a,4� Mck-yoo-ri ___— Suite--- ---_—_-- MEC
Contact Person �"<<�"`` /��� _ Ph(— 75U- �5 --- PLM —
Contractor SWR .. ----�
BUILDING Tenant/Or - -,- -__ ELC
Footing - Tenant/Owner ELC _-_-_.-
Foundation Access: -
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam _--__—.- --- _-_-- -__—. -. -_--
Shear Anchors -- ---_ _-_-_
Ext Sheath/Shear
Int Sheath/Shear i
Framing — - -
Insulation
Drywall Nailing - -
Firewall -�
Fire Sprinkler
Fire Alarm
i
Susp'd Ceiling —�-- '-
Roof
Other: -
I'i7al
PASS PART FAIL -
PLUMBING
Post&Beom
Under Slab ---- -- --- _.
Rough-In
Water Service - - -- - - -
Sanitary Sewer
Rain Drains ---.. --
Catch Basin/Manhole
Stoim Drain - - - ------- ------- ----- -- - -
Shower Pan
Other: ----- - ----..-------- -------
Final V
PASS PART FAIL
MECHANICAL _ _ _- __ -_--------.-----.- --.-- _ - -
Post& Beam
Rough-In --- ------ - - _ - - - -- -
Gas Line
SaQke Dampers -- - -- -- --- ------------ - ---- -
17,09T
S _PART FAIL -- -- ------- - --------------- - - - - -
CTRICAL -
Service
Rough-In
UG/Slab - -
Low Voltage
Fire Alarm
Final Reinspection fee o($ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ Please call for reinsp tion RE:_-__- ___. . _____ Unable to inspect no access
Fire Supply Line
ADA �/ (/ Y
Approach/Sidewalk Date - - -- Inspector.-- -------_1-- `- - -_- _ - - EKt_._----
Other:
Pin:,i DSO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received Date Reques ed — AM__ PM— BUP —
Location 1-7 _ _/� _L�� Suite MEC --_�
Contact Person —, ___—_ Ph(—_--) __ `7, —SS -YrT PLM
Contractor _-- -------_--- Ph(—____-) -- -- _ SWR -- -_--
BUILDING Tenant/Owner __ ____-____— —_—___—_ __—_ ELC
Doting -
Foundation ELC
Access:
Fig Drain ELR -
Crawl Drain
Slab Inspection Notes: �� SIT ------
Post&Beam
Shear Anchors - --�_--- -
Ext Sheath/Shear S �G trr V
Int Sheath/Shear _ --
Framing ----------- -- --- ---- ----.. -- - -- ----_ - ----
Insulation
Drywall Nailing —._ - -- -- ---- ----- --- - -
Firewall
Fire Sprinkler --- ---- - -___-_-_--------_--------. __ __-- -
Fire Alarm
Susp'd Ceiling - - - ---- - -------------- -- ------- -----
Roof
PASS PART FAIL
PLUMBING
Post& Beam -- -
Under Slab ---------- ---------------
Rough-In
Water Service - ------ - -- --- ------------- --------- ---- --- -
Sanitary Sewer
Rain Drains - ---- -- ---- ---- _-.._..-- ----- --- -
Catch Basin/Manhole
Storm Drain
Showe-Pan
Other:
-- - --- --
Final -------
PASS PART FAIL
----------------------
ME_CHANICAL _.__�------------.-__-- __-_—
Post& Beam �---- -- -- -- --
Rough-In _-_--
Gas Line
SmokeDampers ---- -- - - -- - ---------------_.�..---------------- --
Final
PASS PART FAIL _-
ELECTRICAL
--- ----------
Seivice
Hough-In _._ ---- - --
------
lJG/Slab
- -----.-____- -_..__.-----__-- ----_-__.--
Low Voltage - -- - - - -- - _-------- --- --- -
Fire Alarm ---------._. ----- --- -
F,nal F Reinspection fee of$ _ _.-__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: _ _. -_-_ C,I Unable to inspect -no access
Fire Supply Line
ADA
Approach/Sidewalk Date �Z�-! -�3 Inspe�for__ -_ -_ - Ext --
Other: _
Final - DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171
SUP
Received —_— —_ Date Req ues ed`____J� 1!Ah1 PM SUP
Location __ 101 -72) -Suite _ MEC ^--_
Contact Person ._���+�. ___ Ph (_ 1 _ 752 -�5�� PLM
Contractor _ __� _._—._.___ Ph(— ) __ — SWR .—
BUILDING Tenant/Owner _ .—�—._� _ —. ELC
ooting - ELC
Foundation Access:
Ftq Drain ELR __-
Crawl Drain _.
Slab Inspection Notes: p SIT _-_ ---__--
Post& Beam
Shear Anchors - --`--_"-
Fxt Sheath/Shear V,s bt Cv✓Yi V �1
Int Sheath/Shear
Framing --- ------------ ------
Insulation
Drywall Nailing —_.___-- ----._.------ -- - _---- ----
Firewall
Fire Sprinkler -.____--- - _- ---------_._-_ --_-- - _--
Fire Alarm
Susp'd Ceiling -------- --- - __. ----------- ---- -
Roof
rPASS'
PART FAIL - --- -- -- ---- - - ------ -----._..__
PL.U_MBI_NG
--- ----------- —
Post 8
Under Slab - --- --�..- --- .....-----.._.----_- --
Roitgh-In
Water Service ---- --- - -- - - - ------ --- -. — - - - -- ---------
Sanitary Sewer
Rain Drains ---- -- - -- -- ---- --- - — __.�- ----------
Catch Basin/Manhole
Storm Drain
Shower Pan
Other ---_._.-_----- -__
f anal
PASSPART FAIL ------_.._--- -- ---- - -- -- ------- - - ---------------------------------
MECHANICAL
Pu,t& Beam
Rough-In -- - -- - -- ---
Gas Line
Smoke Dampers ---- -- -- - - ----- ------ ------ -- --- -------------
Final
PASS PART FAIL
ELECTRICAL
------- --------------
Rough-In —_-- --- ---- ---- - - ----- -
UG/Slab
Low Voltage
Fire Alarm
Final Ll Reinspection fee of$ required before next inspection. Pay at City Nall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ l Please call for reinspection RE:-__.._-__ _. __ __ Unable to inspect-no access
F=ire Supply Line
ADA -
Approach/Sidewalk
Oats _lZ-�l_ri��.3 -__ Inspector _ _ _ __ Fact
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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C ,- ENGINEERING PERMIT _
�-TY O F TIGARD PERMIT#: ENG2002-00102
DEVELOPMENT SERVICES PRIM. PERMIT#: MST2002-00359
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/20/2002
SITE ADDRESS: 10173 SW LADY MARION DR PARCEL: 2S1 11 CB-03300
SUBDIVISION: MARION ESTATES ZONING: R-3.5
BLOCK: LOT: 006 JURISDICTION: TIG
PERMIT TYPE: SOP PUBLIC IMPRV QUANTITY LIN FT VALUE
AGREEMENT DATE: GRA/EROS:
ASSURANCE EXPIRATION STREET: "
— SAN SEW:
PERFORMANCE: STM SEW: "
MAINTENANCE: PATHWAYS: "
ALL OTHER: ""'" $800.00
TOTAL: $800.00
Remarks: STREET OPENING; TO REMOVE A PORTION OF AN EXISTING CONCRETE SIDEWALK AND, THEREAT,
INSTALL A CONCRETE DRIVEWAY APPROACH,
FEES
Owner: --
MASTERPIECE CONSTRUCTION INC Type By Date _ Amount Receipt
15435 SW ASHLEY DR OPEN CTK 9/4/2002 $150.00 2720020000
TIGARD, OR 97224 BOND C'Trl 9/20/2002 $800.00 2720020000
Total $950.00
Phone: 503-524-4371
Engineer:
Phone: REQUIRED INSPECTIONS _
_ STMISAN SEWER STREET
Permittee I Applicant: MHICB/CO CRB LINE & GRADE
PIPE LN & GRD SUBGRADE
BCKrLL & CMPCT BASE ROCK
AIR &TV TEST LEVEL COURSE
WEARING COURSE
Phone: GRADING TRAFF & PED CONT
MONUMENTATION
CONTOURS STREETLIGHTING
DRAINAGE WALK/APRON/RAMP
Permittee! EROSION CNTL.
Applicant ��� �
Signature:
REPR'S1ADJ'S PATHWAYS
Issued By (� " -P-tM��-�
FOR INSPECTIONS, CONTACT THE CITY OF TIGARD,
SPECIAL CONDITIONS: (SEE ATTACHED) ENGINEERING DEPARTMENT, AT: (503) 639-4171
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