Permit n CITY OF TIGARD MASTER PERMIT
• ° • COMMUNITY DEVELOPMENT Permit #: MST2009 -00200
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009
Parcel: 2S114AC00400
Jurisdiction: Tigard
Site address: 16545 SW 93RD AVE
Subdivision: CAFFALLS CORNER Lot: 4
Project: Lethbridge
Project Description: Kitchen remodel: remove wall & install new beam.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 0 sf Basement 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 0 Smoke
Dwelling Units: 0 Third: 0 sf Right 0 Detectors: Yes
Total: sf Value: $35,000.00 Rear. 0
PLUMBING
Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckfw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0
Ea add'I 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'l Br Cir:
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet
Owner: Contractor: Required Items and Reports (Conditions)
LETHBRIDGE, ADRIAN & HOLLY INTERIOR REVISIONS CUSTOM
16545 SW 93RD AVE REMODELING INC
TIGARD, OR 97224 17270 SW 131 AVE
TIGARD, OR 97224
PHONE: PHONE: 503-473 -5231
FAX: 503- 684-5856
Total Fees: $1,268.40
This permit is issued subject to the regulations contained In the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: & -0 lX. At. tilAyb Permittee Signature: `
Brandin Permit A licatio PeD � r � . Residential ECEIUED - - , 1:OR OFFICE USE ONLY
114 City of Tigard OCT 1 4 2009 Received : G /ii e imA Permit No.: 1/ 9.lNOno
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review [I.
C Phone: 503.639.4171 Fax: 503.598.1@e OF TIGARD Date/B : ''' %`���� Other Permit:
TI G n Ii D
Inspection Line: 503.639 Date Read t .Q iuris: El See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified /Meth od: r ; Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
I 'ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
and 2- family dwelling ❑ Commercial /industrial Valuation: $ 35 /OCC.1 , dQ
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I ( 5 s vJ cc-3 r d A/ .G New dwelling area: square feet
City.'State/ZIP: ° 176,4ep r (:)(z_ ¶122 Li Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: ‘4i (1✓14t?J QC Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
IKr - N3EAM 1 ¢.LwaVE. iKITE - to 2. WALL f
Q . V Existing building area: square feet
,_ / New building area: square feet
la PROPERTY OWNER ❑ TENANT Number of stories:
Name: A 4 �pk_L.( Liz' zet Type of construction:
Address: I( 614 S SW 93 it$ MG - Occupancy groups:
City /State/ZIP: "T GA¢ r (:)e, 972Zy Existing:
Phone: ( ) 35Z - 451 Fax: ( ) New:
APPLICANT [B'ONTACCT PERSON NOTICE
Business name: 14-1�2 12611 e1o.- 6 Cas-P r 4 l ,cn t L-+t" > Irk_. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
. 1 c) -p., I FCX f- Q ' under ORS 701 and may be required to be licensed in the
Address: iiz SW 13( 14v6., jurisdiction in which work is being performed. If the
City /State /ZIP: pplicant is exempt from licensing, the following reasons
T6A I dQ ' 97 Z 4 apply:
Phone: ( 0 ) 413-5231 I Fax: : (503 484-586
E- mail i--- 50 • 17 1a I ATE2102 Visiot -lS_Com
CONTRACTOR
Business name: S.4fs.r.41` QEzd�� I BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State/ZIP:
Structural plan review fee (or deposit):
Phone: ( ) Fax:
( ) FLS plan review fee (if applicable):
CCB lic.: 7 5 f gEs Total fees due upon application:
Amount received: ' c( 70
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: .Jp
,„ F � �9.^ Date: 16/14/4q
• Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building \Permits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(I1 /02 /COM/WEB)
Electrical Permit ApplicatiRECEIVED FOR OFFICE USE ONLY
114 City of Tigard Received • 9 'I��TA i�l
° 13125 SW Hall Blvd., Tigard, OR 9722 C T 1 � 2009 DateB ' �� l y w7! /� 1�
Plan Review
10 Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: kris: Ei See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 secs of plans w/items checked below):
El New construction [ lddition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1(0545 Sy( 2 ctI A� or more. occupancy.
1 ❑ Six Six o or r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TGAcm, 1 tZ 4 Li ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
J Description I Qty. I Fee. l Total I •
Ncw residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
' ` Limited energy, multi - family
67.84 2
1LITWEp • V-E-MODC.L_ I Nap G3LPvN.) Q 1 hC1�1C A residential (with above sq. ft.) _ _
Services or feeders installation, alteration, and/or relocation
VA/>tLL 200 amps or less 100.70 2
Ef"�ROPERTY OWNER I ❑ TENANT • 201 amps to 400 amps 133.56 2
n r 401 amps to 600 amps 200.34 2
A
Name: -DI-4 *- Wnt...Ly Lc- r1-412,1zavecrL. Lc- 601 amps to 1,000 amps 301.04 2
Address: (G S 4 5 S te/ 9 1 .4 AN( E Over 1,000 amps or volts 552.26 2
City/State /ZIP: 1 G, 4 �D 1 9-77.2.4 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 5tr3 ) 3 SZ - 4 59-7 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 168.54 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
A. Fee for branch circuits with
(CANT [?FONTACT PERSON above service or feeder fee,
a-� n each branch circuit 7.42 2
Business name: 1 S.�10� VaC=V t lOaS "►Ord K. om ' ►pvCi.r'ry,,, B. Fcc for branch circuits
without service or feeder fee,
Contact name: I 56.18 2
Ct� first branch circuit 1
Address: 1°1Z10 S AN %' A g t _ Each add'I branch circuit 3 7.42 22 -2b 2
Miscellaneous (service or feeder not included)
City/State /ZIP: TZ.A D l (Q q Each manufactured or modular
Phone: (5� , 44-13 _ Sz31 F ax : : ( pp,L, Reconnect service and/or feeder 67.84 2
� �o V-7 - s 8 S�o Reconnnect only 67.84 2
E - mail :_ip 0-- I aTS32...►pji =QfV 1Si0PAS - CA Ind Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: IA•••-A ` 1 Signal circuit(s) or limited -
�4 Av_goi t.1to t � r1 L energy panel, alteration, or
Address: 2.3833 ,....N. g.. tD1.._15Aa extension. Describe: Page 2 2
City/State /ZIP: \Ak \/1 L-LA6G. O Q cr-/ocC, Each additional inspection over allowable in any of the above
i Per inspection 66.25
Phone: (56.3) 492.-3(,A1 Fax: ( ) 4412 - -317 8
Investigation per hour (1 hr min) 66.25
CCB Lic.: Fri 4 8 Electrical Lic.: Suprv. Lic.: 3Z10,6" s Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 7 4
Print name: � . - Date: K.,114/61
Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6 .4,
Authorized signature! 0 / TOTAL PERMIT FEE: 9? 7 , 8 / j
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ BuildingTermit s \ELC- PermitApp.doc- 10101/tl2_ ---- 440- 4615TO I /05 /COM/WEB
Mechanical Permit Application F012 OFFICE USE ONLY
City of Tigard RECEVEI eceived i OD
. II ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
t In Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 OCT 1i4 2009 Date/By:
T I G A D Date ReadyBy: Suns: R3 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF WORT U LDIN(3 DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Q A dition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ CommerciaUindustrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: (( 45 SW q'3 cr-I MG_ Air conditioning
(requires site plan showing placement) • 46.75
City /State/ZIP: Ttc,,q¢'D I Q ,z..z. 1 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.:
Flue/vent for any of above 23.32
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
11 '' -- p ��� Gas fireplace 33.39
�--�1 �H F-c r"nO _l... VEfJ"1' S14. ‘41.4.D 1 Flue vent for water heater or gas
fireplace 23.32
NACS•6.. GAS 1-4 14‘_ Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
[ROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32
1 , Other: 23.32
Name: p1/417,9_112,04 4. �1eLi '( �-CI�v�t�1�fo� Environmental exhaust and ventilation
Address: 1(0545 SW C I 3 t' l AVG. Range hood /other kitchen
equipment I 33.39 433,3i
City/State/ZIP: -rLeozc, 1 ("s 9-72z 4 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( 5 6. 3 ) '? 52 - 45q, Fax: ( ) toilet compartments, utility rooms) 23.32
[ PPLICANT ❑WNTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: I A-1-02 T2‘4 1510x- C S 1 % ar46 Ir4C. - Fuel piping
Contact name::__13:,..4 $+cr.J4 o_ $14.15 for first four; $4.03 for each additional
Address: 1--1 2 E 1J 1 AqE Furnace, etc.
Gas heat pump
City /State/ZIP: -- 1 (i r ez)Q [17Z2L( Wall /suspended/unit heater
Phone: (9G) 473 57...31 Fax: : (543) (;a4 _sSt'o Water heater
Fireplace
E- mail: ___Jooy € In1TE.244 7-17-E4lS1ai4S S-6 IAA Range I 14.Irj
CONTRACTOR • . Barbecue
Business name: Clothes dryer (gas)
N Y SZ-t0 �EAll r C. A ►1Z C o NVDt- 'w41n1G, Other:
Address: 0, x 3 Z 9 MECHANICAL PERMIT FEES'
City /State/ZIP: Czar' L I OIZ 11113 Subtotal Ak 7, 6As
Phone: (5 351_ 5443 Fax: ( ) Minimum permit fee ($90.00)
42..44_
Plan review (25% of permit fee)
CCB lic.: I , 421 C)3 State surcharge (12% of permit fee) IO.So
TOTAL PERMIT FEE ( CC),ff,
Authorized signature f:?_- This permit application expires if a permit is not obtained within 180
A days after it has been accepted as complete.
Print name:Jor y 1? $s --x� I Date: id/14/47 7 • Fee methodology set by Tri- County Building Industry Service Board
\
1:Building\PermitAMEC- PermitApp.doc 10/01/09 4404617T(I1 /02/COM/WEB)
.Plumbing Permit Application
w Building Fixtures RE CB'JED
Received , A
City of Tigard Date/By: /D 0' Permit No. 09 -Q04(/
� a 13125 SW Hall Blvd., Tigard, OR 97223 T 1 4 2009 Plan Review
; y
G Phone: 503.639.4171 Fax: 503.598.19600 C Date/By: Other Permit No.:
Inspection Line: 503.639.4175 TIGp►R Date Read B kris: ® See Pa e 2 for
CI�
TIGARD Y y g
Internet: www.tigard - or.gov l QF Notified/Method: Supplemental Information
TYPE OF WORKBUIIDI G UIVISIOt
FEE* SCHEDULE
El New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
d 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: f (os LIS Sw 93 t 1 AYE Catch basin or area drain 18.76
City / State/ZIP: - 174„A (2, d� Drywell, leach line, or trench drain 18.76
i �� Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
V-41Ti{ED---1 .1 -- 7( -4C-I FIM4¢E5 Dishwasher I 25.02 75;02.
Drinking fountain 25.02 ,
Ejectors/sump 25.02
ahlkOPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: A1 ,q, 4. 1-iot_L-e LC7_114 8R1 pc. rG
Floor drain/floor sink/hub 25.02
Address: I4,S Li 5 Gv.4 93 cd AV E
Garbage disposal 25.02
City /State/ZIP: TI 4,AwD t U 2_ 9 -rzZL4 Hose bib 25.02
Phone: ( 53) 3 G2 - 4 597 Fax: ( ) Ice maker ' 12.51 (2. 5 1
BPPLICANT [ 1 NTACT PERSON Interceptor /grease trap 25.02
� Medical gas (value: $ ) Page 2
Business name: 1 tJTe_CLIOZ Ir- �V 1514 ,4S C 55 QEMcsp,g t Ac., Irot: Primer 12.51
Contact name;_i $f-t t _c9_,
Roof drain (commercial) 12.51
Address: -I271 0 SVJ t3I A•JE Sink/basin/lavatory I 25.02 21 Q7--
City /State/ZIP: -- r(..AAep 1 Ci2.. 91224 Solar units (potable water) 62.54
Phone: ( 53) 413- SZ3I I Fax: : (5z3 ) Gay-S5(o Tub /shower /shower pan 12.51
Urinal 25.02
E -mail: ii. 1a -R-1a e- P ,Siata5 -CAM
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: C_LASSI�. -17.A. j JtnA'elk t4 Water piping/DWV 56.29
Address: szt 5. -5 L.P.NE. Sr. Other: 25.02
City /State/ZIP: a6114 p oCo t (W., q 7 1z Subtotal bZ,
Phone: ( ) - 20 - 4S1c Fax: (913 ) 53£3- 8570 10 Minimum permit fee: $•240 cf , -5
Plan review (25% of permit fee)
CCB Lic.: 1Z3Z3 Plumbing Lic. no.: 34 -81 PEI
Authorized signature: • • State surcharge (12% of permit fee)
______ • TOTAL PERMIT FEE e( , �O
Print name: ��, Date: 101 l9 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
Fee methodology set by Tri- County Building Industry Service Board.
I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(l0 /02/COM/WEB)