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Permit Y /)-)fir S' 1-.7,,--7 a CITY F 1R® • MASTER PERMIT PERMIT #: MST2006 -00246 .. °- - COMMUNITY DEVELOPMENT DATE ISSUED: SS 11/9/2006 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S136CB SITE ADDRESS: 11130 SW 82ND AVE ZONING: R -4.5 SUBDIVISION: RANCH VALLEY LOT: 006 JURISDICTION: TIG PROJECT: HEATH Project Description: 114sf addition to house 444 sf added to garage. New trusses. 4/22/08, adding (10) branch circuits and 100' of interior water service. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 114 sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 444 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 114 sf 45,000.00 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: 1 NAT FURN > =100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: 12 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : 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 B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable ROGER & DIANNE HEATH OWNER laws. All work will be done in accordance with approved plans. This 9373 SW FAST PL. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 - 701 - 3357 Contact #: questions to OUNC by calling 503:246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,388.62 REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 . s— Issued By . r/ Permittee Signature : i/ . Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 0 • ., C CITY 1'IG�4® R r MASTER PERMIT rl X . PERMIT #: MST2006 -00246 COMMUNITY DEVELOPMENT Ix DATE ISSUED: 11/9/2006 i-.1 f IGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S136CB-02500 SITE ADDRESS: 11130 SW 82ND AVE ZONING: R - 4.5 SUBDIVISION: RANCH VALLEY LOT: 006 JURISDICTION: TIG Project Description: 114sf addition to house 444 sf added to garage. New trusses. BUILDING • REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADO HEIGHT: 12 FIRST: 114 st BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE 444 st FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: 4 5,000.00 OCCUPANCY'GRP: R3 BEAM: BATH: TOTAL: 114 5 REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 1001: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: 1 NAT FURN >x100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD_ INSPECTIONS 1000 SF OR LESS: 0 • 200 amp: 1 0 • 200 amp: W /SVC. OR FDR: 2 PUMP/IRRIGATION: PER INSPECTION: 3 EA ADD_ 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC/FDR: SIGN/OUT UN LT: PER HOUR: [ A LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL W PLANT: MANU HM/SVC/FDR: 601 - 1000 amp: 601 *amps- 1000v: MINOR LABEL: • 1000. ampNolt : PLAN REVIEW SECTION Reconnect only: w4 RES UNITS: SVC/FDR»225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY ' A. SF RESIDENTIAL B. COMMERCIAL 0 AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: ' BURGLAR ALARM: OTH: BOILER HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER CLOCK .INSTRUMENTATION: MEDICAL: OTHR: 41 t HVAC: DATMELE COMM: NURSE CALLS: TOTAL. # SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor., Municipal Code. State of OR. Specialty Codes and all other applicable ROGER & DIANNE HEATH OWNER laws. All work will be done in accordance with approved plans. This 9373 SW FAST PL. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility ' Notification Center. Those rules are set forth in OAR 952 -001 -0010 through 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 701 - 3357 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,112.54 REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 i Issued By : 4_„,,. ✓_ .,,, Permittee Signature : . - Call 503.639.4175 by 7:00 a.m. for an inspection that business d y. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Ap.plicatt Building Fixtures Bu ' V,.: ; t^ kt .n im . 0 1 :JR OFFICE USE ONLY � u 4J��," t '1�, . P ,� st o .2,,-;2,..',,,,',:.,, L. J •91' w P 7'ia i, ' rld Received � l'' � C1ty of Tigard w ', a 13125 SW Hall Blvd., Tigard, OR 97223 Date /By A /��/ / tl� .. r r Phone 5 F 503.598.1960 Plan Review Other,Perrnit No.: � ` Date/By: '.0' 503.639.4175 Date Read /B lu ris: ®See Pa a 2for TIG - Ready /By: B ARD .. Internet: www.ttgard= or.g . Notified/Method: Supplemental Information ' P "" , M o:R ,n j 4 '+_. d a y •nq yv : _C - m ,�" � ITYPE OF WORK � � . � � FEE : SCHEDULE �. - I �� ` ❑ New construction ❑ Demolition For special information use checklist Descri.tion ' Qty. Ea. . Total Addition /alteratioti/r ❑ Other:. New 1- 2- family dwellings (includes 100 ft. for each utility connection) �::;_ .CATEG O F ' CONSTRUCTION " . I? t , `� ; h ''.) SFR (1) bath. 249.20. %l'- and 2 faniily-dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory' bin lding ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other ... ' Site utilities (' sq. ft.) Page 2 t s , � JOB SI ; T E INFORMATION , ND LOGATION'' 2°. Fire-sprinkler ties Job site address: 7 dU - 40 ® 2 40 Catch basin or area drain 16.60 City /State /ZIP: Drywell, leach line, or trench-drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing "drain (no. linear ft.: ) Page 2 Manufactured home utilities 1.10.00 Crossstreetldirecttons to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft : / /a/) Page 2 T5 Fixture or item Tax map /parcel no Absorption valve 16.60 ✓ 5 s , :.' ... y 2'g °ffiU DESCRIPTION' OFD WORK t I :;,e,,', C' "1'...A'7: h Backflowpreventer Page 2 Backwater valve 16.60 Clothes washer V/ 16.60 Dishwasher J/ 16.60 , ii PROPERTY `OWNER Z `NANT , " , „ Drinkingfoirntar r" 16.60 (; ' . w , v . . - _ .. a ; � s ❑ TE < - : -21 , ' ''''' " Ejectors /sump I� 16.60 Name: Expansion tan- I� 16.60 Address: Fixture /sewer ap _ ,I 16.60 City /State /ZIP: Floor drain /figor sink/hu ss� ll ii I I 16.60 Phone: ( ), Fax ( ) Garbage dispe r aii / 16.60 . r " M 7,t `' ' � ❑.'CONTAGT'•CrP ERSOPI ` Hose bib' r n, 16.60 .ry, r "; - ..p r , ® APPLICAN T , ' ; .�. i1 - Ice:maker. 16:60 Business name: . Interceptor /? ease trap , I ■ 16.60 Contact name: , y 0 / Medical gas Page 2 Address: 'i.1l, __ 1_ 16.60 of ran (c City /StatelZlP; r - Ro di ='= 16.60 Phone: ( ) ( ) Sink/basin/lav%tory ! 1�11� 16.60 Fax: : Tub /shower /shi-wer pan ita'It' 16.60 E mail: EMMIMIIIRIMILM 16.60 v w } c `"s _+.. n e ;.,c.r . i . $ CONTRACTOR . t ' L ". '- . 2! : Water closet mr' 'ini 16.60 Business name: Water heater r r/ 16!60 Address: Other: 'Subtotal City /State /ZIP: Minimum permit fee: $72.50 CC 9t Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 J -� CCB .Lio : Plumbing-;Lie., no.: Plan review (25% of permit fee) >- State.surcharge (12% of permit fee) Co .0 Authorized signature: // , TOTAL PERMIT FEE /, (fib Print; name: Date: This permit application expires if a permit is not obtained within 180•days after it has been accepted as complete. *Fee methodology set byTri- County Building Industry Service; Board. d:\ Building \Permits\PCMF - PermitApp.doc 12/27/06 440- 4616T(10/02 /COM/WEB) Plumbing Permit Applicatiois City of Tigard • Page 2 - Supplemental Informati Fee. Schedule: Residential Fire Suppression Systems: Site Util><tes aQ F Total Footage Pea mat�'ee ;+a a Footing drain - 1 ' 100' 55.00 0 to-2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems Water Service -each additional 100' 46.40 ' Valuation !Permit; Fee Storm & "Rain Drain 1st 100' 55.00 $1.00'to $5,000.00 Minimum fee $72.50 Storm& RainrDrain -each additional' 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first$5,000.00 and $1.52 for each 'igtur te'¢ �* ` Qty' Fee (ea) > irTotal ' ;! additional $100.00 or fraction thereof to and ," , r ti� .. ad:� .: Ana ! ,: >.,sa including $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 $36.25) 27.55 - and: including $25 ;000.00. Rain Drain, single familydwelling, 65.25 $25,001.00 to "$50,000.00 $379750 for the first $25,000.00 and_$1.45 for Inspection of existing - ,plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal • $50 and up $742:00 for the first $50,000 and$1.20 for each additional $100.00.or fraction thereof. Fixture Work: Plan Review for, Plgmbing:Installahons� a ' ATV. Are you capping,.adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed.by.fixture. Failure to Please check all that apply. ❑ Any new commercial building with water service 2 and accurately report fixtures could result in increased sewer fee s * . a _ greater, except systems designed and stamped by licensed �� ^• A " a '� .Quanhty by (Frxture) Work Performed Frx � _ '�' Replaced engineer. . 1 a . "Previous.. Capped „Added a ,Exist i ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918 -780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash` -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru• Cuspidor /Water :Aspirator , Submit 2 sets of plans with any of the above. Dishwasher - Commercial' - Domestic . Drinking Fountain h ISOl11etl iC Ol' R1er, lag1'aill Eye Wash ❑ Isometric or riser. diagram is required for new buildings FloorDrain/sink - 2" that meet the qualifications above. - 4 " Car Wash. Drain • Garbage Domestic Comments regarding fixture work: Disposal - Commercial • - Industrial Ice; Mach. /Refrig. Drains • • Oil Separator: (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar /Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the. sewer increase must be paid before the : Swimming P.00l',Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet- Toilet Urinal Other Fixtures: is\ Building \Permits\PLM- PermitApp. doc 12/27/06 N� � +., '''''°:r'';,. ' � - u'S ., :1 ld ' � L O FFICE S � � , � E „ �F yip 'L� r t ,, � a7�� ; ; .�1n w � k � i _ . T 1 i ., S , K ,, Electrical Permit A licati. ] v t. �� ',;.4,,,,:, + i / O us o N 1 + „ i , �� Received /'� 1.',:, i , a City of Tigard, Date/By: P ►' , � �V 0 L i" . r+ 11 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 0 N F..;.,„ Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: T ' ",'' ' . RD 1; ' Inspection Line: 503.639.4175 Date Ready/By: Jurist' See Page 2 for , Lilt +; . Internet: www.tigard- or.gov Notified/Method: Supplemental Information - w TYPE OF WORK' ' PLAN REVIEW' ❑ New construction , Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. 1 - and 2 CATEGORY Y' OF CONSTRUCTION ' " --- ', exceeds 10,000 amps at 150 volts or Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural il dwellm Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder .0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or _ 0 Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION 0 Addition o new motor l oa d o f ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: /) site address: `/'/ gw 6 "' 100HP or more. occupancy. ❑ ❑ Six or more residential units. Recreational vehicle parks. City /State /ZIP: ❑ 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. ' FEE SCHEDULE; . t Cross street/directions to job site: Description I Qty. I Fee. 1 Total 1 * New residential single - or ti-f. unit. , V L i ' odes attachedgarage. ' Alk l , 4 " a Subdivision: Lot no.: i )1,000 sq. ft. or less Am 14 � „ � Tax map /parcel no : �` Limited eno gy re denttal 0 MEN 1 sq. 3 1: 2 Ea. or . si ' ° '' };`• -� .DESCRIPTION''OF'WORK•, y(.' (with above sq. fr. _ ■ Limited - .0 3 , multi - family �- 2 • j s or ins (with above a t.) , \... Seri s r feeders installation, alteration, and/or relocation r � 0 or less 80.30 2 ❑ PROPERTY 'OWNER: ❑ .TENANT ` ,I )o 2 1 amps to 400 amps 106.85 2 Name: 401 amps to amps 160.60 2 4j 5 601 amps to 1,000 amps 240.60 2 Address: nVVV��""""' Over 1,000 amps or volts 454.65 2 City/State /ZIP: ► \ `� ..{'1 � Temporary services or feeders installation, alteration, and /or ir? �j I/ relocation Phone: ( ) Fax: ( ) "l 200 amps or less 66.85 1 Owner installation: This installation is' being made on, property that I own which is not 201 amps to 400. amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with • '. . ' T APPL I ❑''; PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each,add'I branch circuit in 6.65 64.4) 2 Miscellaneous (service.or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) Fax:: ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 ,a ..;•• • CONTRACTOR_ -_`. ,. a. Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited- energy panel, alteration, or Address: extension. Describe: Page 2 2 City /State /ZIP: Each additional inspection over allowable in anyof the above Per inspection 62.50 Phone: ( ) l Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: I Electrical Lic:: I Suprv. Lic.: Industrial plant per hour 73.75 ,• ^ELECTRICAL; PERMIT FEES ` -- '. Suprv. Electrician signature, required: Subtotal: /O Print naine: Date: Plan review (25% of permit fee): � - Statesurcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: � This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I :\Building\ Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/NEB Electrical Permit Applicati- City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WOR.KONLY '" "71 Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERG °IAL`WORKx,ONL_ Y: y= ` k } 1 Fee forreach commercial $75.00 • system (SEE OAR 918 -309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ • Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp:doc 03/23/06 City of Tigard, Oregon 13125 SW Hall Blvd. m Tiga R 97223 ; FR3, ,k, ;A � '4 tom .�. ' ' }u iy rF as imi f " J 3 vi kits P; i 4 ]I E qry y # IIa , RgV March 10, 2008 Roger & Dianne Heath 9373 SW Fast P1 Tigard OR 97223 RE: Perniit MST2006 -00246 This letter is notification that the referenced permit for the work at the above address has not received a final inspection. Since more than six months has elapsed with no inspection activity, it is assumed that the work has either been suspended or abandoned and this permit will be expired by limitation as provided in Section R105.5 of the Oregon One & Two Family Dwelling Specialty Code. Please be advised that, in the event of a subsequent sale of your home, the lack of inspection . approval for this permit could delay closing. The lending institution and /or the title company may require proof of a completed permit for such work prior to the sale of the property. We will allow thirty (30) days from the date of this letter to apply for reinstatement of this permit for the purpose of final inspection(s). Certain fees will be applicable at the time of reinstatement. A reinstated permit will be valid for 30 days. If the required inspection(s) fails, you will have an additional 30 days to make the necessary corrections. A minimum fee of $70.00 will be assessed for additional inspection(s). If you fail to request these additional inspection(s), this permit will be expired without the opportunity for reinstatement. If you have any questions about this permit or its status, please call me Monday — Friday 7:30 a.m. to 4:00 p.m. Sincerely, 01" Lv4J Darrel "Hap" Watkins Inspection Supervisor cc: Property File Phone: 503.639.4171 0 Fax: 503.684.7297 0 www.tigard- or.gov 0 TTY Relay: 503.684.2772 CITY OF BUILDING DIVISION PERMIT # MST7006-00246 •, 13125 SW Hall. Blvd:; Tigard, OR 97223 DATE, ISSUED: 11/9/2006 'Phone: (503) 639 -4171 /0/4114 • Inspection Requests (24 Hrs.): (503) 639- 4175 It �, INSPECTION WORKSHEET' FOR : DATE: 4/5/2007 TIME: 7:03AM . • PAGE: 6 SITE ADDRESS: 11130, SW;82ND AVE . CLASS OF WORK: SUBDIVISION: RANCH VALLEY LOT #: 006. TYPE OF USE: PROJECT NAME: HEATH DESCRIPTION: ' •i l4sf ;addition to house 444 sf added to garage.. New trusses. OWNER: HEATH.'ROGER & DIANNE,, • PHONE #: 503-701-3357 CONTRACTOR: OWNER? PHONE #: • Inspection Request Scheduled For: Date: 4/5/2007 Pour Time: Code # Inspection Description Confirm,# Contact # Message 240'. Exterior sheathing 046055-01 •503 -701- 3367 N Corrections /Comments /Instructions: . • • • 1 •; , ❑ PARTIAL APPROVAL ❑ NO ACCESS o ®` PASS � PROVAL ❑ CANCEL ® ` FAIL • n CA .L, FOR INSPECTION ADDI I NAL IFEES.ASSESSED ' .9 6 A Inspector: Date: / Phone #: (503)'718- . • _ ° • . • . , CITY OF TIGARD BUILDING DIVISION - . e PERMIT IP MST A<0,....... 11/912006 006-00246 . . • .... , DATE ISSUED: . - 13125 SII1t Hall Blvd.-, Tigard, OR 97223 ,Phone: (503) 639-4171 • 40 404 qw,, ' . . Inspection Requests (24 Hr.): (503) 639-4.175 A4 -11:i . INSPECTION WORKSHEET'FOR DATE: It/20/2006 TIME: 7:01AK4 PAGE: ' 29 . . , SITE ADDRESS: 11130 SW 82ND AVE CLASS OF WORK: SUBDIVISION: RANCH VALLEY LOT #: 006 TYPE OF USE: RRO4EPT,NAME: HEATH, , - . , • DESORPTION: 1.14sf addition to house 444 si added to garage. New try6ses. • OWNE9: 'HEATH, ROGER &DIANNE .PHONE #: 503-701-3357 CONTRACTOR: OWNER 0 .. PHONE#: - . Inspection Request Scheduled For: Date: .11/20/2006 0 • Pour Time: . Code # InspedtiOn DesdiOian ' , 'Confirm '# Contact # : Message. 335 ' Rain drain .. 040033-01 503-701 • CortectiOns/CornmentstInstructions: ." . • / '' --- L „ • ' ' -'. a k '-' . . . . .. . 1 _ , o/ ol,k sA .,./‘. ' ciAr-0L- - (Qs (f ' 4 '' C 9 r:o ir?-47\ (-- c-k' (-41--‹. \J_.) V ■(.6g V Q JL:(--c ,0, . -D '‘..--v•-k ' .0 e c . - ' :' 4&*‘'-' • , . . „ . , . . • . _ VLI- . „ , +ILQ: 6jAhSS n PARTIAL APPROVAL . I] CANCEL - NO ACCESS I FAIL. E CALL FOR 'INSPECTION ' 'I 1 ADDITIONAL FEES ASSESSED. , . \ tjY Inspebtor: Date:1 /Ze /.. C) Phone #: (503) 718- IV2 . , . . , , • . CITY OF TIGARD. 0 , - - I" /nsT BUILDING DIVISION, - ,PERMIT #a60C2 - 0o a 16 13125 SW Hall Blvd: Tigard, OR 97223 'DATE ISSUED: ' - g '9POili'i • • ' nspection.Requests (24 Hrs.): (503) "639 -,4175 ' • INSPECTION, WORKSHEET FOR DATE: • • TIME: - PAGE: SITE ADDRESS "1/.30 4 2'? / CLASS OF WORK: • SUBDIVISION: ,• LOT #: TYPE OF USE: PROJECT NAME:: 4 DESCRIPTION: OWNER:. PHONE #: CONTRACTOR: PHONE #: . , • / , ' Inspection Request Scheduled For: r Date:, / q' /ob Pour Time: . I/ , Q U Code # Inspection' Description' Confirrn # C tact # M sage - Corrections /Comments /instructions : <. / /". " in - " 0 ' '�� • di ,4 Cf • :' fl W,a r CL A f4 to D. OFF P.6-6' 4.1 Faoc,l".14; ,- 0425 r ?Ro ✓-7 b( /4-Z -- N ;, 3 C'. L 26 : , A . i r __ �ig Z/' :eo Te t -i',a s tf 'D 5 w 2 FA c f o - v c? /Fn u kJ DA`smay+ /, . _ D y 1/s D L ® _ • a : . 1 .mat-s' ' A R-4.41 I,. PASS. n PARTIAL APPROVAL , . 1 I CANCEL 0 NO ACCESS 1 {'FAIL , . 0 CALL FOR INSPECTION n ADDITIONAL,FEES ASSESSED • Inspector: A / Date:, _ILL_ Phone - #: (503) 718- 2 ' q " -5 I ii \ 3> a i I 7T -,,,,,s,,,, `S - IIVH //, CO c9 ___________-\--- IIVH ® ®® i ® I� a-= _HALL- ® b �- 1 1 aA18 I !, =Ni . ;;;_ m e _,.,,,,, i 1 aft MD 4 ilk Il k P 10•01 A , r _,-,, a .. ,..., II 1 1 - \ lim\ IN J ...... i s _ _ •� 85TH A _a 84TH AVE T I : f0 m m —� m m m 83RD = � m ®® h D / AVE m; ' m T \ 8 2ND _ 82ND AVE AVE r - 0 ' ---) 11 I II II 1 i (FP' 0 _ I 81ST - AVE' / _ ,� iiii 80TH - 17 1 9T AVE- ,■ I 1 / \ , 1 ®1 1 78TH II E 1 / j AVE . all 4 I �� n I 011W' 00000000 77TH 0011111100 0000000 S \ .■ r0 � 011000 ' I j 00110 ! 13 I o 0 1100110 7 6TH P m 1 1100110 00011 !^ r m 000000 m c CITY OF TIGARD • BUILDING DIVISION - PERMIT #: MST2006- 00246 1'3125 SW Hall Blvd:, Tigard, OR .97223 - DATE ISSUED: 1102006 Phone: (503) 639 "MI Inspection R=equests (24 Hrs.): (503) 639 - 4175 ' s ,_L. INSPECTION WORKSHEET FOR DATE: 4/28/2008 TIME: . 7O2AMi PAGE: 1 SITE ADDRESS: 11130 SW 82ND AVE . CLASS OF WORK: • SUBDIVISION: RANCH VALLEY LOT #: 006 TYPE OF USE: PROJECT NAME: HEAT1 DESCRIPTION: 114sf addition to houae 444 sf added to garage: NGw'trrat;5eE. 4/22/08, adding (10) branch circuits and 100' of interior water : ervioe. OWNER: HEATH, ROG & DI,ANNE: PHONE #: 503-701-3357 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled for: Date: 4/28/2098 Pour Time: Code # Inspection. Description, Confirm # Contact # Message ' 115 Electrical service 068977 -01 503- 701.3357 Y Corrections/Comments/Instructions: C.) ;NFrKinn G s PT OD 6 " 0 FAN( iox i► 13* Dwt 1d'o \I • R : VIN iacv . . ❑ PASS , 4 PARTIAL_APP' e ' L ❑ CANCEL ❑ NO ACCESS ❑ FAIL i OR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i V6v L Date: 2iitn Phone #: (503) 718- ViLfL Building Permit A • ' mr7,51 1..0N OFFICE ('SE O City of and Ti ' "� .p.- Tigard / i Pewit N ` .S / �, 13125 SW Hall Blvd., Tigard, OR 97223 C E P 2 'E 2006 Plan ' e Phone: 503.639.4171 Fax: 503.598.1 '!: „1(; �'' + � Date/B 1 Date/13 : • 0 Other Permit: Inspection Line: 503.639.4175 Odd OF T GARD ' Q Date Ready/By: See Attached (7�ecldist for Internet: www.ci.tigard.or.us I3UBL�BIl,S DIVBSION Notified/Method: 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 ® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ ► 0 04 ❑ Accessory building ❑ Multi- family Number of bedrooms: 3 ❑ Master builder ❑ Other: Number of bathrooms: j2 JOB SITE INFORMATION AND LOCATION Total number of floors: / Job site address: /// 30 S c i s ni A [/, New dwelling area: ict D square feet //4/ City/State/ZIP: �, i q 7V-9-3 Garage/carport area: G An., square feet 3 d/z Suite/bldg. /apt. no.: Project name: 1/� ti, 4 S - + Dr7n/c.E Covered porch area: square feet / ?-2_ Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: RA NC. /-1 0 a a-k: 6-1 Lot no.: 6, Permit fees* are based on the value of the work performed. 1 Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: /5 /3 40C/3 - C5%130 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Ik b t) E C_ /✓fired 7 € fS /C�V'� Valuation: $ RE Existing building area: square feet A OP //V rig' 1-0 fiaat. 34 SP F ••1-12— New building area: square feet i tstrie ® PROPERTY OWNER I ❑ TENANT Number of stories: Name: y( .e A' ' DI" ■ IV IVE a ilk Type of construction: Address: 9 3 7 3 S co Fi4 s 7 PLR cite. Occupancy groups: City/State/ZIP: 12 9 42 rJ i nlL � 7 - z, Existing: Phone: (.50 70 1 - 33 5 7 Fax: (.3'a3) 3 x7 _ X05/ I New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business namqI /�� BUILDING PERMIT FEES' Address: ' Please refer to fee schedule City/State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: Date received: Authorized signature: _ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: K by, iv E k Date • Fee methodology set by Tri-County Building Industry Electrical Permit Application OFFICE USE O � r � r , l2 ONLY Cit of Ti �� lO Received Permit No.: ° 13125 SW Hall Blvd., Tigard, OR 97,2A.. . C • Phone: 503.639.4171 Fax: 503.59) 60 ® b. L u u u Date/B Review Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: 3u b: 65 See Page 2 for Internet: www.tigard- or.gov CITY OF TIGAR Notified/Method Supplemental Information curl Pili\l(3, nIUISION TYPE OF WORK PLAN REVIEW ❑ New construction RI Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. • ❑ Demolition 0 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 ® I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ^, "E ^, "l -2 ", ` 1 -3 ^, • Job no.: Job site address: N n tools or more. occupancy. 3 O 54J Q ¢ 4 tJ E. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ` 41c il 1 0 rz 9 7 !. 3 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 4/ R isit R S 1 D i ae ❑ Service or feeder 600 amps or more. Description FEE SCHEDULE Qty I Cross street/directions to job site: Fee f rr� pp <,. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. . • S ubdivision: 41 N t:,// J4 LLB cf. Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family . 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation • 200 amps or less g. 80.30 2 [. PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 L , 401 amps to 600 amps 160.60 2 Name: A q€t °l' 11 I A iv iv E 1 V Al' }� 601 amps to 1,000 amps 240.60 2 Address: 9 3 7 S' w /- /3 St ,O (— Over 1,000 amps or volts 454.65 2 City/State/ZIP: �- 1 P. /L 0 Temporary services or feeders installation, alteration, and/or � I � l 9 7 ?-`L t? relocation Phone: (� 7 0 ) ) - - 3357 Fax: (SD) ) 3 2 ,l - , 4 04/ 7 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee 46.85 2 first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only " 66.85 2 E - mail: Pump or irrigation circle . 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited- energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: q' 3,( Print name: Date: Plan review (25% of permit fee): State surcharge (8% of permit fee): '7. 49 Authorized signature: TOTAL PERMIT FEE: . This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • - • Number of inspections allowed per pemrit. ' I: \Building\PnmitaLC- PermitApp.doc 0523/06 440- 4615T(I I /05 /COM/WEB Electrical Permit Application - City. of Tigard - . , Page 2 Supplemental Information . " ;LIMITED ENERGY PERMIT 'FEES: • PRESIDENTIAL WORK ONLY Fee for all residential systems combined :. _ $75.00 Check Type of Work Involved: a Audio snd Stereo Systems *' ❑ Burgl Alarm " t `';Garage DoorOpener*. _ , ❑ ❑ Heating, Ventilation and'Air Conditioning System* , , Vacuum System* Other: , ' , . COMMERCIAL WORK ONLY: Fee for each commercial , - ` $75.00 - . ' system. (SEE OAR 918=260 =260) ' . - Check Type of Work Involved • • ❑ -Audio and Stereo Systems' • ; ❑ Boiler .Controls ': q , _ ❑ Crock .Systems , e . Data Telecommunication Installation ❑ Fire Alarm:Installation, • , • ❑ - HVAC In ' '. ❑ Intercomand,Paging Systems ❑ Iandscape:Irrigation Control* , • _ ❑ Medical • ❑ Nurse Call - . - .. ti ❑ Outdoor Landscape Lighting* ❑ Protective: Signaling .. ❑ O ther - - , ' Total number of co mmercial systems: `*No_licenses are 'required. Licenses are required • for all''other installations- AF I:\ Building\PamibNELC- PamitApp.doc 0323/06 . Mechanical Permit Application l:olt 01 I lCi 1;S °NI City of Tigard ,- -� v v , `� Received Permit No.: � , ' ° 13125 SW Hall Blvd, Tigard, OR 97223 11 -- r -� ' Dale/BY Plan Review B Phone: 503.639.4171 Fax: 503.598.1960 10QU p� Other Permit: T I G A it D Inspection Line: 503.639 , \„., , e Date Ready/By: Jung: El See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information -- 1,22!'f ) . TYPE OF WORK 1 1— L . • COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction [ ] Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. • CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Un 1 - and 2 family dwelling ❑ Commercial /industrial ❑ 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 n Air conditioning or heat pump Job site address: 1,1 3 a S r.J b' N v t V k (requires site plan showing placement) 14.00 City /State /ZIP: 7 g Akir e 2 T72.7-3 Furnace 100,000 BTU (ducts/vents) 14.00 Suite/bldg /apt. no.: Project name: ,, // Furnace 100,000+ BTU (ducts/vents) ' 17.90 NE1j � 1 O.AJG£ Gas heat pump 14.00 Cross street/directions to job site: l/R I 1 -GL Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: K p Ix/ r �� f� Lot no.: Flue /vent for any of above 10.00 { y Other: 10.00 Tax map /parcel no.: I Other fuel appliances DESCRIPTION OF WORK Water heater I 10.00 Gas fireplace 10.00 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 al PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00 • _,c Other: 10.00 Name: ,4' 4 ti A nu lu £ N 7 /A Environmental exhaust and Ilentilation Address: Q q 7 < 4....) rifts* Pt- Range hood/other kitchen equipment 10.00 City / State/ZIP: fA c h . 9 7 2 � , Clothes dryer exhaust 1 10.00 / / J Single -duct exhaust (bathrooms, Phone: ( ) 70 1- 3 3 5 -7 Fax: (s2) 317 - fe, 3' toilet compartments, utility rooms) 1 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/erawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. X Gas heat pump • City /State /ZIP: Wall/suspended/unitheater Phone: ( ) Fax: : ( ) Water heater ft_ Fireplace E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 �, days after it has been accepted as complete. Print name: X4 9e. ,, /r• L , A / Date: • Fee methodology set by Tri- County Building Industry Service Board \ B I:uilding\Pennits \ NEC- Penn itApp.doc 04/06/06 440-4617T(II /02/COM/WEB) • `Mechanical Permit Application City of Tigard - ` ti t Pa 2 - Supplemental Information , • `Commercial;Fee'Schedule - ' Total Valuation: Permit Fee: , '$1:00;to• $2,000.00 Minimum fee $72.50'. , `$2,001: 00.to•$5,000.00' ' ;;$72:50 °for the :first;$2,000.00' and :$2.30 . - �forea additional�'$10000 or'firaction - °thereof, to and including $5 ' , `$5,001.00 to'$10,000.00 :.$141 -.50 for first $5;000:00 and;' .. z $1.80 for each additional $100.00.or , ' '' ;fraction thereof, to and including, , , . ' 1 •-• . - , , , $10,001 .00 to $50,000:00' , $23 for the first $10,000.00 and $1 35. for each additional $100 00 of ';' -fraction thereof to and including - . ' _. _ $50,000.00. _. - t - $50,001:00 to $100;000.00".' $77 for the first $50,000:00 and ' - $125 for each additional $100 00'or- r fractionttiereof, to. and - _ $100;000:06. ; ' .;$100,000.01` and up :'$1,396:50 for the first $100,000.00 and f $1.10 for each additional'$100:00;or : .. r fraction: thereof. ;, Note r new commercial buildings require 2 sets; of plans. I I I: \ Building \Permits PermiiApp doc. /30/05 2 ' Plumbing Permit Application `Building Fixtures FOR OFFICE ('SE ONE) City of Tigard r ' �� R 74 i . „i Permit No.: Plan Rev v 13125 SW HaII Blvd., Tigard, OR • 97223 Date/By. 503.639.4171 Fax: 5031598:1960 s �jv�j Date/By:eW Other Permit No.: T I G A It t7 Inspection Line: 503.639.4175 Date Ready/By: Juris: I ® See Page 2 for Internet: www.tigard- or.gov ,.•• o, r -- Notified/Method Supplemental Information TYPE OFEWOR.K FEE* SCHEDULE • - ❑ New construction ❑ Demolition For special information use checklist. Description , Qty. I Ea. I Total (I Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 IN 1- and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: //2 3 B S,,, fr d. 4 Catch basin or area drain 16.60 City /State/ZIP: '7`2 i D 2 4 , 2-Z3 Drywell, leach line, or trench drain 16.60 /a t. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. y t+L . nE w Manufactured home utilities 110.00 Cross street /directions to job site: /0A--4 )F/..: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: Page 2 Storm sewer (no. linear ft.: ) Page 2 Lot no.: 4 Water service (no. linear ft.: ) Page 2 Subdivision: �'p rt/C� t 9 � � " E I Fixture or item Tax map /parcel no.: - Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 P ,terA14 f l £7Y Backwater valve 16.60 • • I` Clothes washer , 16.60 ' Dishwasher 16.60 ® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: R0 ? a t 17 A .0N ijEA Expansion tank 16.60 Address: 9 s 7 j 5 csj �A % 7 1. pc_ Fixture /sewer cap 16.60 • City /State /ZIP: 71 A9 r /5X._ 97 y7- 3 Floor drain/floor sink/hub 16.60 Phone: ( Z p i - ?J 2 ,s 7 Fax: OD7) /A 7 - f O Lai; Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 . Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Sink/basi vatory I 16.60 Phone: ( ) Fax: : ( ) T show ower pan ' 16.60 E-mail: Urin 16.60 • CONTRACTOR Water closet / 16.60 Business name: 'TS D Water heater 1 16.60 Address: Other: Subtotal City / State/ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backtlow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) _,... .....474.--(2/ State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: 04, tX 6 ° �� I Date: This permit application expires if a permit is not obtained within 666��"' 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. t:\Building\Pe nits\PLMF- PmnitApp.doc 04/06/06 410-4616T(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty Fee (ea) Total Square Footage: Permit Fee: Footing drain - I 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty Fee (ea) Total additional $100.00 or fraction thereof, to and including $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 $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof • • Fixture Work: Plan Review for Plumbing Installations . • Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ Any new exterior plumbing site utilities. Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities. • - Bath - Tub /Shower - X ❑ Any multipurpose fire sprinkler system. - Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040. Car Wash - Each Stall - Drive Thru Submit 2 sets of plans with any of the above. Cuspidor/Water Aspirator Dishwasher -Commercial Isometric or Riser Diagram - Domestic g • • Drinking Fountain ❑ Isometric or riser diagram is required for new buildings Eye Wash that meet the qualifications above. Floor Drain/sink -2" -3" -4" Car Wash Drain Comments regarding fixture work: Garbage - Domestic • • Disposal -Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stan • Sink - Bar/Lavatory X *Note: If the fixture work under this permit results in an - Bradley increase of sewer EDUs, a sewer permit will be issued and -Commercial fees assessed for the sewer increase must be paid before the - Service plumbing permit can be issued. Swimming Pool Filter Washer - Clothes }[. Water Extractor • Water Closet - Toilet X Urinal Other Fixtures: is \ailldmg\Penmrts\PLM- Permiwpp.doc 09/22/06 Permit #: 1"\S \ 004(0 — 00cq ' Address: ) I 1 Q S k) 1 32- MO Issued by: `i No& Bette: ;6 iled«' Statement: Information Notice to Property , Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. K 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR K 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with. the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Ale Notice to Pro 1 • Owners abo . t Construction Responsibilities on the reverse side of this form. / tie (Signature of permit applicant) ( D ) (White copy to issuing agency permit file, pink copy to applicant) • ~ • • - .Information / .. Ce to Property Owners About Construction Responsibilities . . _ Note: .This Information Notice to Property Owners about' Construction Responsibilities was developed by the-Construction Contractors Board m accordance with ORS �.055(5). . . _ - If you are acting as your own contractor to construct a new home or make a substantial improvement loan existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: • If you hire persons not registered with the Construction Contractors Boacdk/ labor in constructing or assisting in the construction or improvement of a residential' strUcture, you will, in Most instances, be ruled to be an employer uudthcpoop|c you hire will be employees. As the eiploy ivu must comply vvhhthcfnUuwing: ^ ' Oregon's withholding tax law: As an employer, you Must withhold income taxes from employee wages at the time employees are paid. 9 ouwi\\bo|iub|ethrtbc\uxpaymcnis.ovcnifyoudou'tuctuuUywidhho|dthctax6nnnyourenp|oyces. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378-3524. Workers' compensation n insurance: As an employer, you are subject to the obtain workers compensation insurance for your employees. /f you fail n/oLtaio workers' compensutibbinsurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured onUhcjob For more information, cu||\hcWorkcrs'CompcnoudonDivisionmtheDcpurtmen1ofC000unucr' and BusineoS Services otg5'7Q88. U.S. Internal Revenue Service: As an employer you must withhold federal income tax from employees wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal ReYenue Service at 1-800'829^1040. ' .. OTHER RESPONSIBILITIES AND AREAS OF CONCERN; Code compliance: As the perm it holder for this project, you are responsible for resolving any failure tu meet code requirements that may be brought to your attention through ins inns. • Liability and property damage insurance: Contact your insurance agent to see ifyon have adequate insurance ce cocoverage 6ur accidents and omissions such as falling tools, nt overspray, water damage from pipe punctures, fire or work that must be re-done. ' , Ti �o Make bhuv�sufficient to mm* supervise o you time supervise our employees. Expertise: Make sure you have the expertise to act as yourown general contractor, tu000rdinute the work of rough-in and finish trades, and to notify building officials at the appropriatefimeS so they can perform the required inspcc1ions. ` • If you have additional questions, write or call the Construction Contractors Board (PO Box l4l4O, Salem, OK97J09'5U52, 503/378'4621). The Board is located at 700 Summer St. NE Suite 300, in Su|�ro�' • . prop-o°m.pm4 i/94 ' � n -,i n nn R . r t. --rna, n r n� ne rr-f rrn wrrt F rnt a art rr n „l i ''{.. {.. 1 . 4114. id.�;AN ATF-R E11 r E .1 6'3144 1 1, .5 P _.: • , 1: ;rzai20. �a.z�* ]332te, rc tvt F run ..cW1TR." ... IFM+V r -,� F t J 4. - � - ,� �� ;� � ,;r II r .` t �� s . s RECEIVED r IJC L `c i CET NOV 6 2006 =-__ �y =°° CITY OF TIGARD CWS File cumber 06- 320? i le-An %$Cater i Services - - 0117 C4tttt(tihneitt iy cleat. . :moles Area Pre-re .emir," S to Aas e ne t • Jurisdiction _ f P _ Date ' # Tax Map & Tax Lot 21.0 A c C rr, 13 tt 0 OWnar _ _ -- - - Applicant . Site Address 02_3.0 F1 "1°' A 1 ,j g Company - 7", ,44.2 nee j. .. Address 73 73 5r J /C7 Proposed Activity _ Ai _ oil c ... City State ZIP _7 ,eD, ex 972.2-3 - , Phone Se2I 7a!- 17 . Fox • ,57, 4o 32.,..&....g.1_______,___ By submitting this form the owner, or Owner's authori.ed :agent or representative, acknowledges and afire that emplvyeeb of Clean Water Services have authority to enter the project Belie at all reasonable times for the purpose of Inspecting profit site conditions and Beth Thee information . related to the project ate. . (Ai uae only Official we e ' below tears lihC � Official ussonly Wow tills Wo lf N NA Y Ni to Szrlskl9'o Area Crsrripuaite Map { Stormweter Infrastructure reaps I l , flap # riisi) ® as #_____92011_ - - - V - L ' 1 Locally adopted studies or maps Other L� r i Speedy -- { l—.� specify a i y ,ri • rue.ied On A review of•the above Information and the requirements of Clean Water Services Design and Construelloie Standards Resolution and Order No 04-9: L_. i Sensitive areas potentially exist on *Be or within 200' of the Alta. THE APPlICANrT MUST PERFOI_ R A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER. it' Sensitive Areas exist on the site or within 200 feat on adjacent properties, a Natural Resources Assessment Report may also be required. Serra srva arena do not appear to exist on site or within ZOO' of the site. This pre - screening Bite ratsecsnient dose NOT eliminate the need to evaluate and pretest water quality sensitive areas if they are subsequently rliAtx:rve•ed_ This document win eerie se your Service Provider letters required by Resolution and Order 04.9, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, end federal law. . [ i The proceed activity aloes not meet the deRinitit n of development. No SITE c ASSESS NT OR SERVICE PROVIDER LETTER IS REQUIRED. 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