Loading...
Permit CITY OF TIGARD MASTER PERMIT ? � ' Permit#: MS72010 -00110 COMMUNITY DEVELOPMENT f • T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/14/2010 Parcel: 2S104ACO5400 • Jurisdiction: Tigard Site address: 12730 SW 133RD AVE Subdivision: MORNING HILL NO. 8 'Lot: 198 Project: Khalil Project Description: 117 sf. kitchen addition. 7/31/2012: Revisions submitted for 160 sq ft upper story bedroom, addition above kitchen adaitlon. Total project valuation increased from $12,342.00 to $28,969.20, BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 126 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 160 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 286 sf Value: $28,969.20 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =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! 500 sf: 0 201 -400 amp: 0 201 amp: 0 W/O Svc/Fdr: 1 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -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: ADD SF VB R -3 286 Owner: Contractor: KHALIL,.MASOOD OWNER Required Items and Reports (Conditions) YOUMTOOBIAN, LIDA 12730 SW 133RD AVE , TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $1,859.98 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 0; R % 52 -001-. r 90. You m y obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.332.2344. Issued By: ■ a ∎ Permittee Signature: • Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. 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. y CITY OF TIGARD MASTER PERMIT h 0 : > COMMUNITY DEVELOPMENT Permit #: MST201000110 x Date Issued: 07/14/2010 T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 ,n , N- o.,`. Parcel: 2S104ACO5400 Jurisdiction: Tigard Site address: 12730 SW 133RD AVE Subdivision: MORNING HILL NO. 8 Lot: 198 Project: Khalil Project Description: 117 sf. kitchen addition BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 126 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $12,342.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 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 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 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! 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'I 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) KHALIL, MASOOD OWNER YOUMTOOBIAN, LIDA, 12730 SW 133RD AVE TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $914.55 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 •ermit .will_ -exp' e if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law require • •u 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. • " • -_ • . - - • • - • es or direct questions to OUNC by calling 503.246.6699 r 1.800.332.2344. -.- ��— •,- Issued c . Permittee Signature: sy`= r • Building Permit Application SO) '!� ' • Residentia ��� F o ff r I US ()NEV.. - City of Tigard �� � ' L��� Date/By: 6 ! 9 10 1.7i PermitNo.: r r?flio_00I 10 13125 SW Hall Blvd., Tigard, OR 97223 \ A Plan Revie ;~ . _ \ V i� . ,` I/ ` —7/1,_ I Other Permit: Phone: 503.639.4171 Fax: 5 �lGP l0 \` Date/By: �, / 1 T I R D Inspection Line: 503.639 OC ON Notified/Method: Ready : ® See Page 2 for Internet: www.tigard- or.gov C 1 ;. ()% a rU V fied/Method: Supplemental Information TYPE OF WURK 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. Valuation: .� $ I- and 2- family dwelling ❑ Commercial /industrial 12 ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder 0 Other: Number of bathrooms: — JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 273 0 5 (,A) / 33 re/ Ave. New dwelling area 7.— square feet City /State /ZIP: i1 qa/�(,� O/ 9 7 113 Garage /carport area: square feet Suite/bldg. /apt. no.: J Project name: K HfLi1 ADD / Ti on! Covered porch area: square feet Cross street/directions to job sae: c„,jg r TO /32-n d 4 (6/ r To Deck area: -- square feet J 33 rd /9V5. Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: riprh 01 A( (( mo. g Lot no.: 1 9 g Permit fees* are based on the value of the work performed. p 2 s �y Rc — S O Indicate the value (rounded to the nearest dollar) of all Tax ma / p a rcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Add�nq to A/0 4 KiTcA arCel. Valuation: $ J • Existing building area: square feet New building area: . square feet 0 PROPERTY OWNER ❑ TENANT Number of stories: Name: ft/95 kHA 01- Type of construction: Address: / Z.73 0 S (.,,) / '3 3 rot »V. Occupancy groups: City /State /ZIP: ard, or 3 712_3 Existing: Phone: ( S03) 7 q — 6 O 3'-/ Fax: ( 5o3) 6 4/ -23 "2_Z- New: • J APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: /' - S(9 0D Kii A L/ L licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: /2730 S (.) /33rd !4 i76 jurisdiction in which work is being performed. If the Tpa,--d 2_2 applicant is exempt from licensing, the following reasons City /State /ZIP: j or 9 7 1 apply: Phone: ( 503) 6 -- 7/ Sea/ Fax: : ( S03) 6 yo -z.3 ZZ E-mail: '41 NfL(L @ R6'O 8 v /LT. ea/`1 CONTRACTOR ' F \ Business name: Ry QC,' �� ner 'e BUILDING PERMIT FEES* Address: (Please refer to fee schedule City /State /ZIP: VII I e \_(.:7' Structu plan review fee (or deposit) I I FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB lic.: Total fees due upon application: `f if?, 1/ Z Amount received: Authorized signature: / /J� This permit application expires if a permit is not obtained /// within 180 days after it has been accepted as complete. Print name: r1/95 OO D X NA- L1 L. Date: 6 j Z # / (, Fee methodology set by Tri- County Building Industry Service Board. l: \Building\Permits \BUP -RES PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB) Electrical Permit Application C N N I)I+ t)l I lLlUsl t)N'1 0 o City of Tigard r, .: Date /B : 0 d T Permit No.: OA /J • 13125 SW Hall Blvd., Tigard, OR 97223 �� C Phone: 503.639.4171 Fax: 503.598.1960 aL�.. iik.vi a . ; Other Permit: I I C n It 1) Inspection Line: 503.639.4175 eilG gill '17: te Ready/By: H1 See Page 2 for Internet: www.tigard- or.gov � M1i Q� � ,Vla Notified/Method: Supplemental Information T OF WORK v PLAN REVIEW • ❑ New construction dditio /alteration/repla ement 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. 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 ❑ Commercial /industrial ❑ 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. El A Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", Job no.: Job site address: a-73 /33 RCQ Six or or more re s. occupancy. ` ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ^7' ❑ Health -care facilities. ❑ Supply voltage for more than / r /cif ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: ( Project name: ❑ Service or feeder 600 amps or more. . FEE SCHEDULE• Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 * New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add' 1 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential . DESCRIPTION• OF WORK • (with above sq. ft.) 67.84 2 Limited energy, multi - family 67.84 2 (I ) /�� �-t1 f Qe4d , 9 J residential (with above sq. ft.) Ll /i-/-6(.411- Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER / I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: A op Ohl L r t v- L/ d 4., A (/mifipd Ian 601 amps to 600 000 amps 301.04 2 Address: 1 ,27 3 G 5(..,_). 13.3.4 / Ve Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: " — ct A OR c' ,2 j 3 relocation ( 5'4 , 3 Phone: � `I 200 amps or less 59.36 1 ) 7 - �'f Sa 3 > l� - 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, re xch " — ording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel Owner signature:( ���� / , Date: A. Fee for branch circuits with ❑ APP 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: C q & ��� B. Fee for branch circuits without 7 service or feeder fee, first Contact name: branch circuit 56.18 ICS 2 Each add'l branch circuit 1 7.42 1 C 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: / , ( panel, alteration, or extension. Page 2 2 �l/ 4 V Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%] hr min) _ CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES • . Subtotal: s(O, 1r Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): t, , 74 a TOTAL PERMIT FEE: / IA 2 t 1 a Z Author signature: This permit application expires if a permit is not obtained within 180 � _ a _ — .- - — _ f / days after it has been accepted as complete. ;., mtn me-• Da 1 , d y;, U,,, too haft { . r t- e: / -7 � 7/ /0 * Number of inspections allowed per permit. Pr_ I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: . Fee for all residential systems combined ... $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm H Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling H Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations C\ Building \Permits\ELC- PermitApp.doc 10/01/09 Plumbing Permit Application . R ECEIVED rt , -k r , i - - , m . Building Fixtures "� r I OR "'�OI I I(I d (hV'I 1 ; t� °r '� ' w g ,.„ s , i 4„ils„t„: ,„,. �r ., „ t t , ..,,, `,.. , ,?Jn k � City of Tigard R eceived Permit No.:).-brae (Q.-00 //2 V 13125 SW Hall Blvd., Tigard, OR 9722311l JJ Plan R y: . 0 Phone: 503.639.4171 Fax: 503.598.1v • 0 Plan Review Other Permit No.: DateBy Inspection Line: 503.639.4175 I I c:. A Il I) OF TIGARD CITY Date Ready/By: g Juris: El See Page 2 for Internet: www.ti ard -or. ov g g Notified/Method: Supplemental Information . TYPE OF Vif(C'DING DIVISION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. 1 Ea. 1 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 ❑ 1- and 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: 12 73 0 Sco 1 334 /Eve Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: ,-,' qv k ° • A'lag / /, ` Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: J I Project name: Smu.G ead, 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 ii'�11 Clothes washer 25.02 MoV 1 /No WWi l" it.... Si ntoa j 5 A2,4: Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑_ PROPERTY_ OWNER 1 ❑ TENANT • Expansion tank 12.51 Name: - da- (/ LL 6 /�Q Sda� 1�/1q' 1 Fixture /sewer cap 25.02 1 / oVY�94t� ictvt F Floor drain/floor sink/hub 25.02 Address: ja7 s 1-),-- f A(Ao Garbage disposal 25.02 City /State /ZIP: 1 ot n (. c 7aa 3 Hose bib 25.02 Phone: (50 3 ) 7 _ g g 6 8 Fax: ( ) Ice maker 12.51 ❑ APPLICANT . ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: - Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 25.0 Z City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 • CONTRACTOR Water heater 37.52 Business name: 1 (� Water piping/DWV 56.29 Address: i\sj / �� Other: 25.02 City /State /Z1P: Subtotal 25, QZ Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 k7,.46 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12 %ofpermit fee) .7 C) Authorized signature TOTAL PERMIT FEE Z8 % , 2 __ r7(/� f�D Date This permit application expires if a permit is not obtained within 180 days Print name: (jai y l�i�JJJ //12) after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1: \ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(10/02 /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 - r 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm &Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for ec Other Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to p and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) . and including $25,000.00. Inspections outside of normal business 90.00/hr • $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr - $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. Quantity_ by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace. greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure Tub /S i/Whirlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Thru ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash . Isometric or Riser Diagram • Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. -4" Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: 1:\ Building \Permits\PLMF - PermitApp.doc 2 • This form is recognized by most Building Departments in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. III a BUILDING DIVISION TIGARD TRANSMITTAL LETTER a TO: OAII DATE RECF ED• DEPT: BUILDING DIVISION RECEIVED JUL 09 2010 J/ CITY OF TIGARD FROM: L; de.. / c vraoo b I c .- BUILDING DIVISION COMPANY: p ,,,.,,,i_ ' 19,7 30 SW 1 33r a Alice By: PHONE: 'So 3 _7oa - 6& RE: 7 O10 — On II0 (Site Address) (erm tl ase Number) (Probe name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: . Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. _ Engineer's calculations. Other (explain): REMARKS: - FOR 9FFICX USE.ONLY ' • . Routed to Permit Technici . Date: 7 113 1 j) Initials• Fees Due: 11] Yes [ 'No Fee Description: Amount ue: $ • . $ $ $ Special • Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07 ,' Information Notice to Owners About tonstructimon i es onsi ilities (ORS 701.055 (5)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503- 378 -4988. • Unemployment Insurance Tax: Employers 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 503 - 947 -1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to http : / /www.oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503 - 947 -7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs.gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough -in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052 Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007 Website Address: www.oregon.gov /ccb f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. 1 have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. /f ,950 mH /L Print Name of Permit Applicant Signature of Permit Applicant Date Permit #: / 75790/ O — Oc)/10 ,T � 1 73 C �. r ? Address: f �� ` � .� � 74'A ����� \111 •r y �. t , 1111 , 7 )44C) 7 3 ��, Issued by: Date: 7/V0 This Copy for Permit Offices Mechanical Permit A licatio hog orFICE USE ONLY Received City of Tigard Permit No.: Date/By: ° 13125 SW Hall Blvd., Tigard,OR 97223 I (j Plan Review III Phone: 503.718.2439 Fax: 503.598.1960 2 8 7012 Date/By: Other Permit: T I G A R D Inspection Line: 503.639 C ITY Date Ready/By: 3uris: ® See Page 2 for Internet: www.tigard- or.gov OFTIGARD Notified/Method: 770, Supplemental Information g f ULDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction WA- Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: (requires site plan showing placement) 46.75 City/State /ZIP: Furnace 100,000 BTU (ducts/vents) 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 1 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 Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ROPERTY OWNER ❑ TENANT Chimneyfliner /flue /vent 23.32 / Other: 23.32 Name: / 1 20D K ///J L( L Environmental exhaust and ventilation: Address: / 2_73 () 5 co 7 33 rd 41/'6 Range hood/other kitchen J equipment I 33.39 City/State /ZIP: - q o•.+ �Gf y 97 Z' j Clothes dryer exhaust 33.39 // Single -duct exhaust (bathrooms, Phone: ( 5 3) 5 79_ to 0 3 L( Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater E -mail: Fireplace Range CONTRACTOR Barbecue Business name: abliA/E/L Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: �'���j� (� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. y ) Print name: / in so o v )< 1.1416 1.1416 Dat 29/ / 2 • Fee methodology set by Tri - County Building Industry Service Board 1: \ Building \Permits\MEC- PermitApp.doc 03/07 /12 440- 4617T(II /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi - Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. • $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\BuildingRermits'MEC- PermitApp.doc 03/07/12 2 1 , 1 q Building Division Development Code Provision Review TIGARD Residential Projects . Building Permit No: / 6)0 //c CWS Service Provider Letter Received: Yes ❑ No ❑ N /A, Routed Plans: Original Plan Submittal Date: (0 V///s 1st Revision Submittal Date: 7/3///x- ❑ Site Plan Only 2 Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked ( items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. C Planning Review (contact lf.rtt I CAA v CJ at 503- 718,d43 7 or Ote 't / a - @ tigar d-or.gov) Land Use Case No. Name Zoning R -a pi Setbacks: N/ A Front Rear Side Street Side Garage Maximum Building Height (IS 4)-• Actual Building Height g,a 1 • Visual Clearance NJ P lJ Easements IN/(q Sensitive Lands Type: NI A Notes: s4-0r rn j4; .4.; ov, ea? a �- Y'e vi zr -a' 11 rs *Dr) C.Zo►07 . $'ee- ct- 4 l-0. c.l -e.d a pi a,n dA kd to M.c m 't a u) 0.) Original Plan: Approved pa Not Approved ❑ Date: 7/31/ /? Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @ti d -or. ov ❑ Actual Slope: cyo Notes: Original Plan: Approve. al Not Approved ❑ Date: Revision 1: A.. .ved ❑ Not Approved ❑ Date: Revision 2: ' pproved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 Ci Arborist Review contact Todd Prater at 503 - 718 -2700 or todd @ti:. d -or. toy ❑ Street Trees ❑ Protected Trees Notes: Original Plan: Approved ❑ of Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applic Revision 2: Date Sent to cant Okay to Issue Permit: es ❑ No ❑ Date Routed to Building: • . Page 2 of 2 i k,� t i S . if MO gg 0 510A ( CoA Mt-1/7. RECEIVED e `ate ' „ . a. JUN 2 4 ", H ) • ZS3 . _�.. • i 0 a , , GITY Or TIGARD N . ..'" ,.„_ BUILDING DIVISION • / 9 9 6 P.�' C � Z�G \ .- r E95 E ft 7Z ? G / I %� _ A RP : I 1 _ i _ I ,4- :1 / j o L /r ✓_ �I i / , m -\ •0 I . . dt. t 7 , /,, o•-, PGA ?5,z- ,� r �.. 7- s / 8 s _ _ c,..--- 0 6� s _ . \., ���✓ _� zg3 2 3.E a.• ! ' - F • \ r / z:Je4 , l/ _ Pa c 1 ; o mma ! - ..L \ / scaLE j y ✓9J' - _J S ✓ c c,=.r� r SR ' I ��� L F,y nt%:' L EN S _ PAZ—.. 74 TAX LoT 2514. AG -05400 • -- /1/o 12 3O S.W. 133 rD• TI D OR. 37C z LoT *-►98 NIoR /A 6KILL A/0. B :ZONE° RaS(f 0MT 20' 5/DE 5 } EAR 1s NPr4c : 48saoD KHRL►L' ., ,- Y 730 5 /3 3 R te! A ` ' . . IIIIIIIPr; • • TIGARfl -SITE P 7 REVIEW i • NO : S - . I —SS0 (0 jl I • VISION: Not Approved WOW Set : ErApproved y ❑ Stre Side: // Side: Rear: is _ Front. 1_— G' ge: Visual Clearance: ppr d ❑ Not Aprr�••.e(i ' ' t2: Maximum Building He,-.�,t CWS Service Provider Ler,cr Requires:: ❑ Yes ' No IV tea, ' • J' . t t Plte: Le a-`F (� BN: ENGINEERING II PARTMENT: Not Approved Site Plan: ❑ Approved 0 Not Approved B : Date: Notes: 0,004.13 /0-1-4-' O . T IGARD • SUE PLAN t r. i IG • RM1T NO: ThS ❑ Approved ❑ Not Approved %Pest Trees: L Arn; wed ❑ Not Approved prgeeted Trees: Date: Notes: FOR OFFICE USE ONLY - SITE ADDRESS: /,:, 73 O Sa) /3.3 ' /il/� This form is recognized by most building departments in the Tri - County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 7ii Transmittal Letter - r I G A It i 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: --7a�/ /k/E DATE RECEIVED: DEPT: BUILDING DIVISION, FROM: ®7/99 ooh ,<!//} / t___ JUL 31 i COMPANY: ,-' i�© 1-5Y f CITY numb 3 — PHONE: X03 —_5 9 r 6 D� BUILDING `S;bi' : )� RE: ���D �� /J 3 /1-6 /y�S7 /0 - t9 4 O (tte Ad ress) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: / Additional set(s) of plans. 1/ Revisions: .a€�,eaor1 ff� .6 i77 V\. Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: E 7j fc)n/S 77) A65 // O aC62DOC7 /7 0A/ GVfE72 shy, FOR OFFICE USE ONLY Routed to Permit Technician: Date: Initials: Fees Due: ❑ Yes ❑ No Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit (per PE): Yes I ❑ No I ❑ Done Applicant Notified: iygs acs 5 [)ate: -/ d / __ I Initials:/> 1:\ Building \Forms \TransmittalLetter - Revisions.doc 05/25/2012 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 12730 SW 133RD AVE, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final PASS MST2010-00110 Jeff Grove Violation Summary: Inspector Contractor