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Permit -: - CITY OF TIGARD MASTER PERMIT i pil is a COMMUNITY DEVELOPMENT Permit #: MST2010 00087 .T t G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/10/2010 Parcel: 2S109AA00800 Jurisdiction: Tigard Site address: 14335 SW 125TH AVE Subdivision: Lot: 0 Project: Oelke Project Description: New SF. New house to remain on septic service. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 2906 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 23 Bathrooms: 5 Second: 2453 sf Garage: 956 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $574,771.63 Rear: 15 PLUMBING Sinks: 2 Water Closets: 5 Washing Mach: 3 Laundry Trays: 2 Rain Drain: 1 Catch Basins: Lavatories: 6 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Other Fixtures: Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 11 Clothes Dryers: 3 Natural Gas Heat Pump: N Hoods: 1 Other Units: 1 Fum <100K: Vents: Woodstoves: 2 Gas Outlets: 6 Fum > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: Ea add 500 sf: 11 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add'I Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: 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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) OELKE, CHRISTIAN & APRIL RIDGECREST CONSTRUCTION CO INC 1 Prcl Gen Planning Division inspection 14335 SW 125TH AVE 6600 SW 92ND AVE SUITE 100 2 MST Ersn Cntrl 503 - 681 - 4444 TIGARD, OR 97224 PORTLAND, OR 97223 3 MST Geo Tech Report PHONE: PHONE: 503- 246 -8808 FAX: Total Fees: $11,253.06 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special C des • d all other pp cable law. All work wit be d in a rdance with approved plans. This permit will expire if work is not started within 180 days o issu nce, or if work is -u ..ended for more the 180 day . ATTENTION: •regon law requires you to follow the rules adopted by the Oregon Utility Not cation C •-r. Those ul: :.e set .forth in OAR 95 - 001 -0010 through 0 • R 9 -001 1100. You may obtain a copy of the rules or direct questions to OUNC by call' g 503.r ..66.9 .r .800.33 ..2.44 Is ed By: ■ 1 �� it - iA I _ _ , Permittee Signature: kill • ! Building Permit Application C EI V Residential 11411 �� Foli orrlcul tisl.: o�N�i.N City of Tigard Y 1 4 ?dl0 Date/By: I N l D Permit No.: � /D -ax g 7 ° 13125 SW Hall Blvd., Tigard, OR 97,22�11'y Plan Review 1.�1 II G Phone: 503.639.4171 Fax: 503.59Stgt �F T IC ARD Date/By: ( � \rJ v (0 Other Perini p : " T I G A It D Inspection Line: 503.639.4175 NGD fV Date Ready/By: 1ari3 ® See Page 2 for Internet: www.tigard- or.gov I SION Notified/Method: / ). 10 Supplemental Information A,:} C - r -a, le.sit M 'VA 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. - and 2- family dwelling ❑ Commercial /industrial Valuatiork,7ak 1( S ei . O , a . 9C 0 I ❑ Accessory building ❑ Multi - family Number of bedrooms: t ❑ Master builder 1:1 Other: Number of bathrooms: ? 1 JOB SITE INFORMATION AND LOCATION Total number of floors: a Job site address: tK 33c S k 'ZS (W rte, New dwellinn a: square feet City /State /ZIP: -` ((.Sp Y t:- Garage /carport area: 956 ivare feet Suite/bldg. /apt. no.: Project name: 6e(_14,.4 Covered porch area: 7A1 square feet Z � Cross street/directions to job site: Deck area: square feet 2 ) Other structure area: t0 square feet `3 REQUIRED DATA: CO M ERCIAL -USE CHECKLIST Subdivision: 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. NS 'F12-. Valuation: $ Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: p f iZ-1 L / 2�4-4 Pi( 5 T 1 k1....) be- l--K{, Type of construction: Address: `ZA.33 S S,-2 1.? S Occupancy groups: City /State /ZIP: -1-(C io C>(Z Existing: Phone: ( ) Fax: ( ) New: APPLICANT ❑ CONTACT PERSON NOTICE Business name: pfNST� p -1,2 .. t'TS All contractors and subcontractors are required to be Contact name: V- .- - \W(- Co - { Ltd- licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: eC (3.A-- j5 A- jurisdiction in which work is being performed. If the City /State /ZIP: ,p Z`( applicant is exempt from licensing, the following reasons 1 D — c.R apply Phone: (g (0:3 0,- Te-}ci - Fax:: 15 7f (o- 7i4°3 -c. � E -mail: AA y.--e_ & A F-SV e.-AZ— e _4... vl-e-,, Co, C ) ONTRACTOR Business name: FA r-)C- C ( 7T kov` r S BUILDING PERMIT FEES* Address: Coco S `,,, S Z - j (Please refer to fee schedule) City /State /ZIP: PO a'tr -J J SI 7 . Z;5 Structural plan review fee (or deposit): FLS plan review fee (if applicable): Phone: ( o3) Zs,.IE(o - ege Fax: ( ) CCB lic.: -] z� 1,1c61 t( Total fees due upon application: Amount received: f 75th 40 Authorized signature: n < - This permit application expires if a permit is not obtained 'v ✓ ,� within 180 days after it has been accepted as complete. Print name: (- I Date: VI // * Fee methodology set by Tri- County Building Industry r l'-'" Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(11 /02 /COM/WEB) • Building Permit Application Checklist One- and Two - Family Dwelling FOR r OFF WE USE ONLY City of Tigard Received Date/By: Permit No.: V 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: a: Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical TWA RD Internet: www.tigard - or.gov ❑ Other: 111 rFOLLO\VIN( 11'FIVIS< ARE.- REQUIRF1) "FOR '.I'LANIZE\'11 W 'Yes , No I Land use actions completed. See jurisdiction criteria for concurrent reviews. . ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. , 0 ❑ ❑ 3 Verification of approved plat/lot. ,0 ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control f plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch - .0 ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state 21 ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 1 1 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if , ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size J21 ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, , ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub - ,B ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ,0 ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- /�' ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing .2 ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ,0' systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ) ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ - 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required j' ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or la ❑ ❑ architect licensed in Ore•on and shall be shown to be as rlicable to the •ro'ect under review. IUIZISI�IC I LONE, \I - SI CII 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\ Building \Permits\BtJP- RES- PermitApp.doc 03/21/06 440- 4613T(Il /02 /COM/WEB) . Electrical Permit Application r( ( it`►< 1, t ? � 1 Ct J .........:..... }�, Receiveds O Tigard Received Permit Nn.: 2., — il COpeR ^• 13125 SW Hall Blvd.. Tigard. OR 97223 Mtn Review a • Phone: 501639.4171 Fax: 503398.1950 Dstelriy: OtherPcriait; r 1 , N i Inspection Lino: 503.639.4175 Date Ready/By: , /unc H See Page 2 ibr • Intern et: www.tigerd- or.gov Notified/Method: Supplemental Information TYPE OF WORK • AN I IEW ,�'fdew construction 1:1 Addition/alteration/replacement Please cheek alt than amity (submie? set *loins *loins w/itemt checked below) D Sen'ieo or feeder 400 maps or more li BuIdin over three stories, Demolition © ❑ Otter: where die available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Flawing buildings. 2 "fartlil dwelling less to Remand, Or exceeds 14,000 ❑ Commercbl -use egrigdtural 1- and Molly g ❑ Commercial/industrial ❑ A ccessory building amps for all other installations., buildings. O Multi•15tmily ❑ Master builder . 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB S INFORMATION ANT! LOCATION ION . L7 Ems genoy system, larger aepatatcly derived system, • ❑ Addition of new motor load of CI "A ", "E", "1 -2" "1-3 ", Job no.: Job site address. L 333 t�� 1 13:. f er or mom. occupation. M'1' f�5 � ❑ Six mr more residential emits, ❑ Recreational vehicle parlc9. City /State/ZIP: — C - 14&1 1 4 74 7 O V-- 0 Health-core firoilitiea, El Slip h vdlttee for morn dm 0 FTnzerdoua looadana. ' 600 volts eomiml, Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more. cross street/directions t job site: Dercripdoa FEE SCt Qt . j 8 o 6'e4 ► raw I • New residendal single- or multifamily dwelling unit. Includes attached p,,arage. 1 .000 sq, ft. or less 145.15 t fig, S+r' .4 Subdivision: Lot no.: j Tax map/parcel no.:. Ea WI 560 sp. ft or portio _ U tcd energy, residential I 75.00 (,,;..7,e1.4 2 DESCRIPTION OF WOB! (with above sq. ft.) Limited energy, mniti•£amily 75.00 2 residential (with above se, R,) _ Services or feeders instaliatian and/or relocation 200 amps or less ( 80.30 t co. %T' 2 0 PROPERTY OWNER ( ❑ TENANT 201 amps to 400 amps 106,85 2 Name: pe t - t I— i C44 Cal 51 p4,—.) ORE-- 1 — 401 an to 600 amps 160.60 2 Address: 601 amps to 1,000 amps 240.60 2 • Over 1,000 amps or volts 454,65 2 • City/State/ZIP: Temporary services or feeder!' installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or Iris 66,85 1 1 Owner installation: This installation is bein g made on r' 201 am 401 s to 400 amps 100.30 2 property tha I ow which not � intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701, amps to 599 m^P s 133,75 2 Owner signature: Dots:. Branch circuits -new, alteration, or extens per pant! _ _ A. Fee ibt branch circuiks with ❑ APPLICANT . I ❑ CONTACT PERSON above service or fader fee, • each branch circuit 6.65 2 Business name: - B. Fee lbr branch circuits ' • Contact memo: withou service or feeder fee, 46.85 2 first oircttit Address: Each add'i branch circuit 6.65 2 Miacetlanecus (service or feeder not included) City/State/Z1P: Each manufactured or modular 9090 22 Phone: ( ) [ F es; : ( ) dwelling, service and/or feeder L Reconnect only 66,85 2 • E-mail: Pump or Irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 ss name: �/ 1 Signal circuit(s) or limited - Busine 1 ' / " .� E to 05) f . energy panel, alteration} or Address: ay. -,/,.... A so . 9 k II (t extension. Acsortlrc: Page 2 2 ' City /State/ZIP; 1 �/ y ■ , / ur I") 1 "Each additional inspection over allowable in any of the above Per inspection 62.30 Phone: (t3) SVL" g66o Fax: (x) )s gz.1'C n Investigation perhhonr (t hr min) 62.50 CCB Lic.: t 5 1 Electrical Lf . ,5 Suprv. Lie.: Os" Industrial plant per hour 73.75 • ELECTRICAL PERM:a FEES Suprv, E]oetrician signature, r. d: ao . -4 -<'-1 - . . Subtotal: t0, JJ '' -- 3 f Plan review (25% o omit fce - .._ ��, 1 'T7 I ( Date: P } : Q5', a �' Print name: I '`�'� State surcharge (12% of permit fez): Authorized signature: • 7 OT P b "RMIT FEE: �(}� Print name' Date' pia permit application expires if * permit is not obtained within 180 dnya after it bee been accepted es =mom, • Number of inspections snowed per permit. t:+euumneu iltsIE.t•.Pem,tupv.dee 03mro6 4 /O /COM/WM Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY Cit of Tigard Received Permit No.' a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: 2 • Phone: 503.639.4171 Fax: 503.598.1960 an Review DateBy: Other Permit No.: T I G A R f> Inspection Lipe: 503.639.4175 Date Ready/By: 1uris: B) See Page 2 for Internet: www.tigard or.gov Notified/Method: Su. .Iemental Information � ,,, I a -.. yar, or"` .. r x L " ' fC .J + z. • Y . . , t n!117 !� I�7,wb.�.. k `�� "7riliiI:i " .� !'" -71' c u .: r �" ' 1 03 ''k:, 3 61 It e r st :�i'�.3� ...:� ., ... ,:.. __. . z�_,. w -r��. ,,.., � 2ra�isy�a- ��, ® New construction ❑Demolition For special hiformation use checklist. Description 1 Qty. 1 Ea. 1 Total [] Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ' ` d i 'vS TEGOR`Y Q CO}K #0* : ;,.41_ : ., , SFR (1) bath I 312.70 1 ® 1- and 2- family dwelling ❑Commercial /industrial SFR (2) bath 437.78 ID Accessory building T SFR (3) bath ( 500.32 y g ^ 0 Multi - family Each additional bath /kitchen '� 25.02 0 Master builder : 0 Other .z'��+'r`" s� '«tx�.M v t R F , �� Fire sprinkler ( sq. ft.) I Page 2 I 0; t r3 v<� 4 1; : 1 '�' I v, �,�� �t 5 , ! r tjbiT 'dti��'• .' Y ;4: }:-y ,F. ,,, 2. r , . . , ,. 4: r a s -a, ,.:.a) a, ; >. Site utilities: Job site address: 1 333 . SU/ Ave Catch basin or area drain 18.76 City /State/Z1P: Tigard, OR ` Drywell, leach line, or trench drain 18.76 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.: I O ) 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 . .�f , ; y « c4»r > • N �<y Backwater valve 12.51 '- .4:��5+ ia:�% n ii � F " -k 4'lv'.•: i«' 2 i !� Atirit '$,�.fl fdia.. ;VI �... New SFR Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 I ' 8 t r h' : n %. QWNER ® :,:.. s. , --5 Expansion tank 12.51 Name: A.>Pe -t L >1 C A-A Wt ST 1 At--.) O EIr Fixture/sewer cap 25.02 Address: Floor drain /floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) ice maker 12.51 y ,� v. ^g„ :mod y ,.,v,}r r s x Vwv , i , �j '4 t (a} , t .. r � i M NATF1 ?fix interceptor /grease trap I I 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 City /State/ZiP: • Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51 E -mail: Urinal 25.02 « x c . , Water closet 25.02 I , , ; : f A< t4I a r , :_. 01�1 - , - CTOIt _ s W« ` .,. , 3 4-, , ; Water heater 37.52 Business name: Craftwork Plumbing Inc Water piping/DWV 56.29 Address: 7737 SW Cirrus Dr. Other: 25.02 City /State/ZIP: Beaverton, OR 97008 Subtotal 55 6 Phone: (503) 644 -8698 Fax: (503) 644 -5989 Minimum permit fee: $72.50 I Plan review (25% of permit fee) CCB Lic.: 79666 Phan ing Lic. no.: 20 -148PB State surcharge (12% of permit fee) �ofo� � fid Authorized signature: i € TOTAL PERMIT FEE (o ( (9. 40 44-- Print name: Peter Pollard Date: u JJ Q' ? r /O This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by 1'ri- County Building industry Service Board. I:\ BuildinglPcrmits \PLMU- PermitApp.doc 10/01/09 44046167(le/02/COM/WEB) Mechanical Permit Application � FOR / 01 : 1 : 1(' i 1 2 CII S l � N1 i ti' City of Tigard (rEI� V 7�� Date/By: • / 7 A I Permit No.: /7/- ... 4rop a 13125 SW Hall Blvd., Tigard, OR Plan Review m Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit: . t , A It i , Inspection Line: 503.639.4175 MAY 14 2010 Date Ready/By: luris: Internet: www.ti ardor. ov S See Page 2 for g g Notified/Method: Supplemental Information CITY OF TIGARD • TYPM1i DIVISION 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* - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. Ea. I Total JOB SITE INFORMATION AND .LOCATION .. Heating/cooling // Job site address: t 4 3 35 ) I ZS" - Air conditioning 1 4 75 i CIG 7 `' (requires site plan showing placement) � City /State /ZIP: Furnace 100,000 BTU (ducts/vents) 46.75 Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts /vents) 1 54.91 .11 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 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: ! 23.32 - 2.3. #. 5 - 2-- Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater I 23.32 2,332 Gas fireplace 33.39 A--9S F1Z Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 7. 23.32 4, EA- Wood/pellet stove 33.39 Wood fireplace /insert Z 23.32 4G,GA- ❑ PROPERTY OWNER • I • ❑ TENANT Other: Chimney/liner/flue/vent 23.32 Other: 23.32 Name: PI'f ■i I— g C. -t-t?1 ST PA.-1 O C -V-{G- Environmental exhaust and ventilation ,, L3 3 hood/other kitchen 3-�' Address: "` said CZ 5 equipment ` 33.39 r City /State /ZIP: 1 C/r) i-e_ Clothes dryer exhaust 3 33.39 1 Q''t ( 7 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) I 1 t 23.32 2,q,,62 •.. PPLICANT • : ❑ "CONTACT, PERSON JA Attic /crawlspace fans 23.32 Other: 23.32 Business name: ' �� 5 y e 1 c IS Fuel piping Contact name: iJ.-. lV -V--- CC - (1%-e.. $14.15 for first four; 54.03 for each additional _ Address: C a i--0.,,_ 1 Furnace, etc. 14, !J 1 Gas heat pump City /State /ZIP: ' b 1 2,4-tAm...)D bk. i ! ZJ Z Wall/suspended/unit heater • Water heater f Phone: (<i)3) ( �v.- 1-(�'j Fax: : ( ) Fireplace -- 2/ E -mail: Range 1 4, 03 .CONTRACTOR, ' Barbecue 1 Business name: , (A,p Ler1 t 0 ce i d R-(` Clothes dryer (gas) ( Other: Address: 7 lr At A e ,(,f itet„ C i 2 e.I, a(t /, MECHANICAL PERMIT FEES* City/State /ZIP: (i) t L 5 O A) vt LLL 0 2 �f'7c2 70 Subtotal t.. , J 7 r Minimum permit fee ($90.00) Phone: 603 ) ee K A .. [ (q FS Fax: ( ) 6g2,,-. /01 g Plan review (25% of permit fee) l CCB lie.: x 91 2_ State surcharge (12% of permit fee) --- 8,14,-,, TOTAL PERMIT FEE 7 3 z.:3 3 This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: 4..t. • Co /(- Date: 5 ✓ / V (6...S ' Fee methodology set by Tri- County Building Industry Service Board I:\ BuildingWermitsVMEC- PermitApp.doc 10/01/09 440-461 (11 /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. 1:\Building\Pennits \NEC- PennitApp.doc 10/01/09 2 116 7- a?0/ 0-0008 7 RECEIVED LAND USE COMPATIBILITY STATEMENT (LUCS) MAY 2 0 20 .0 `aGT o I • For Onsite Sewage: Disposal System Permits 1 CITY OF TIGARD BUILDING DI.VISION .n , ,.ICI WO i I , � { I 1 1 . ; i � ` . I I' V�i can at�u�;nt�i b�parltt l n I� 'Ir r�ltli H�IW�1 m r�rices ! 1 �i; I l' ;1 1 ' ..I . I'. 1 1 i 1. d 1 1 1 r :,1 i I I ' I I 1 r 1 1 h W I h II,_' i ; I I I n: f Env Heal h QRECO? .i 155 North First Avenue, MS 5, S uite . 16 0 i':Hillsboro; Oregon 97124 -3072 Telephone: (503) 846 -8722 SECTION 1' TO.BE COMPLETED BY APPLICANT ; 1. 1 Printed Name plican roperty Owner: M� ` �`f 1/t 1 �.►AS`r�/i(z- re4z -'1^ cc5 ,, Mailing Address: , .a Jk•SS City; State, Zip Code:: i . f O C . ) 1 1 . / X 7 1 C . ) ' 9 . - 7 7 2 - - 4 - 4 - 1 Day Phone #: C . , ' e u - , -iI1. - Fax #: S e 3 7.-- ' 76 , '2. r ] E -mail Address: *tos c ° - - s z- 2. ;Property,lnformation:.. :• 1 . I ` v. County: v.1 PSN kO(rTo 't -- Tax Lot #: J 4 e5 /4-- - 4"" 1 Township: i ' . Range: _ Section: Physical Address: l_ 4 '3 S 5 t 74 • \.( { Block: Lot: Subdivision: 3. his pro sa t i 1, i'f I�' f. l ? ' An lndi 'd ual /�aingle I ; ram�ly Dwelling ❑ Other - [ escribe•type of ,development, business or, facility, and the provided services: ' � III ; I I � � .. 4. Permit or apprdval you are requesting ' l: . , 1 .. 1 1 ❑ Construction /lnstalIation permitl for: 1 , °' r 1 1 : , : 1 ;;; ;l:, 1 I I I Yyl 19 Mi doh'p { �1P I,lIII�:'�'� ?F i 9 J l !1 1i� let ! ! a 1q 11 I1 II I; � I rk I I !;1 r I I ; I I II I I I I Y ytilvIrf9hilS1(1111011 r� I It, t' ~ ambgro �) 1 1 I ; 1'' ., II b ; r I I l 1 Ilf ' .1�1 1��11 f r'Ci II to l I I 1 '1 L. i �, . � i I 1 1' 1� u. onz io or: 1 ' I' f , 1 cement of Dwelling Replacement ❑ Bedroom Addition' ntial sewer fl w t g O her, p change in land use,involving,ppte q increases , 1Ir SECTION 2 - TO BE COMPLETED BY CITY OR COUNTY PLANNING 'O 1.. Il;ii _ ,!I;..I ,1:1li;lll..i ,I D 5. ?roperty Zo : Lo n i ng Mini mum Pa rcel Si ze : 5 f G9 6.. The facility ptbposal is 'located: 1 itIhside City Limits 1 ❑ 'Insider. UGB CI- Outside UGB ; - 'If inside the UGB; the faeifity is tObject to: i ' . 1 ' ' with a' loca I I'' ❑ City'' Jurisdiction' fl Cbun 'Jurisdiction' ❑ le Shared 'City /County Jurisdiction •" ' 7. The' busine`ss ' com 'lies p ll pp licab 1`lari' d us'e `requirements: X' Yes ❑ No ,If you answered "Yes" above, was this compliance based on: Compliance with local comprehensive plans and land use requirements (provide a citation to the applicable provisions) Conditionaapprovai, (Provide findings and citation or attach a copy of the applicable land use decision) ❑ Measure 49 waiver (provide Department of Land Conservation and Development approval number) • Either provide reasons for affirmative compliance decision or attach finding of fact: / l r 8. Planning Official S'gnaturei 'T:&' `�/ / MP 1d J Print Name: ✓' S Date: 572 / /iO Title: � 475t f/44 v Telephone: 57)3 7// • '/L) WCDHHS EH LUCS Revised 01/09 M ro -000 7 WAS H I N G TC rl COUNTY OREGON Standard or Alternative Onsite System Except for Commercial Sand Filter, RGF and ATT Systems CERTIFICATE OF SATISFACTORY COMPLETION NAME OF PERMITEE: ,421 (1 E i, !tom, PERMIT #: fU - °C)6 Property Address: 14-33S S' )Zit /9<lgmu Map/Tax Lot #: - 70 - Soc) Final Inspection Request and Notice Acceptance Date: 7 / i /o, /u Inspection Date(s): 1 7 h, ' 0 2 nd 3rd 4 5 th Correction Notices Issued: ❑ Yes El No /� System Inspected By: L.4.( I' tr�i� . STF 2 . >2E I Name of Installer: Liz- Sri A✓K� 6 4:2U/ Periodic inspections may be required for all Alternative System installations OAR 340 - 071 -0260. All systems must be operated and maintained in compliance with OAR 340 -071 and must not create a public health hazard or pollute public waters. An authorization is required to change the use of or increase the projected daily flow. The area of the initial system and the identified replacement area must not be subjected to activity that is likely to adversely affect the soil or the functioning of the system. Such activities may include, but are not limited to, vehicular traffic, covering the area with asphalt or concrete, filling, cutting, or other soil modification activities. In accordance with Oregon Revised Statute 454.665, this Certificate is issued as evidence of satisfactory completion of an onsite sewage disposal system at the location identified above. Issuance of this Certificate does not constitute a warranty or guarantee that this onsite sewage disposal system will function indefinitely without failure. Conditions imposed as permit requirements continue for the life of the system. This Certificate of Satisfactory Completion (CSC) is valid for a period of 5 years. It is valid exclusively for the septic system installed and connected to the facility as referenced herein. Upon expiration of this certificate, rules for Authorization Notices or Alteration Permit as outlined in OAR 340 - 071 -0205 and 340 - 071 -0210 apply, including payment of an additional fee. Certificate Issuance Criteria: IS CSC - System Inspection ❑ CSC - Operation of Law - 7 Days Notice ❑ CSC - Pre -Cover Inspection Waived Per 340 -071 Authorized Agent (Signature) Title Date To be valid, this document must be signed by an "Agent" as defined in OAR 340 - 071 -0100. Department of Health & Human Services - Environmental Health Division 155 N First Avenue, MS -5, Hillsboro, OR 97124 -3072 rev 10/11/06 Phone: (503) 846 -8722 o Fax: (503) 846 -4490 o www.co.washington.or.us Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: / / ° 4� ` ~' Jurisdiction: y Site Address: Subdivision/Lot #: and /or Map and Tax Lot #: By my signature below, I certify that a minimum of fifty 50 installed lighting fixtures in the above mentioned building have been t install d with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: Owner /General Contra tor/Authorized Agent Date: // Print Name: tip _e, .©Ff ' ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. je7 i L Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM am the general contractor or the owner - builder at the following address: Site Address: ,�A City: Permit #: Subdivision /Lot #: and/or Map and Tax Lot #: _ / _ 0 yhA r 300 To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the general contractor that all moisture - sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weigrt of dry framing members. 7 2 - Signature: 4 t Date: .S" -// –// General Contractor o d ner- Builder • I:\F3uilding\ Form \RES- MoistureSensitiveWood.doc 09/25/08