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Permit ::, ,.. CITY OF TIGARD MASTER PERMIT A PERMIT #: MST2002 -00370 -. A T DEVELOPMENT SERVICES DATE ISSUED: 9/3/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10570 SW 71ST AVE PARCEL: 1 S136AD -02501 SUBDIVISION: VILLA RIDGE ZONING: R -4.5 BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: 112 sf kitchen addition. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 14 FIRST: 112 sf BASEMENT: sf LEFT: 50 SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 42 VALUE: $ 23,000.00 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 112.00 sf REAR: 50 PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 1 201 - 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: SIGNAUPANEL: 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 & STEREO: VACUUM SYSTEM: AUDIO & 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: Owner: Contractor: TOTAL FEES: $ 794.60 This permit is subject to the regulations contained in the MARTIN, WALLACE D AND BETTY J INSIDE JOBS CONSTRUCTION Tigard Municipal Code, State of OR. Specialty Codes and 10570 SW 71ST AVE 2845 SW 87TH AVE all other applicable laws. All work will be done in TIGARD, OR 97223 PORTLAND, OR 97225 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: LIC 141092 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Electrical Rough In Electrical Final Foundation Insp PLM /Underfloor Framing Insp Mechanical Final Post/Beam Structural Mechanical Insp Gas Line Insp Plumb Final Post/Beam Mechanical Plumb Top Out Insulation Insp Final inspection Underfloor in - Electrical Service Rain drain Insp • • Is- ued By : l� s � � , . / /I : - 9_ Permittee Signature :xK4a4 Call (503 .39 -4175 by 7:00 p.m. for an inspection needed the next business day %v Ds1r --(y-oz Ff Building Permit Application Date received: I 5 Permit no.:OVIST? - 003 70 s-:°,,:) 1 City of Tigard - '_ Project/appl. no.: ty Expire date: Ci ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 Date issued: B2 I Receipt no.: Fax: (503) 598 -1960 , Y. ./ , ''! Case file no.: Payment type: ' Land use approval: 1 &2 family: Simple Complex: • TYPE OF PERMIT O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 New construction 0 Demolition 0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other: • ` JOB SITE INFORMATION Job address: # 70 / i 1 / ,2J Off' Bldg. no.: Suite no.: Lot: Block: Subdivision: Tax map /tax lot/account no.: Project name: ' Description and location of work on premises/special conditions: AgfarriffSWI 0 0 • , • 011TR .FOR SPECIAL INFORMATION, USE CHECKLIST Name: Act m OF ,9/LT) /, (Floodplain, septic capacity, solar, etc.) Mailing address: #s--7e) Sf l) / ST j 1 & 2 family dwelling: L3 _ Jo Ezz, ZIP: Z3 Valuation of work $ 2-3 o a 0 Phone: )-y (- '' Fax:a24/1 f/j E- mail:Alp „p/ `v No. of bedrooms/baths Owner's representative: / )2I .Ll Total number of floors `/L Phone: Fax: E -mail: New dwelling area (sq. ft.) St 3 44 - 74- APPLICANT - Garage /carport area (sq. ft.) Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) City: State: ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: Cotpmerclallindustria1Imulti- family: CONTRACTOR Valuati on_ofwork $ sT J 4 7 ,,yl Existing bldg. area (s >ft,) Business name: , 5/,,,e ,_7O.8.5 t New bldg. area (sq. ft.) Address: 9 s _ ,' — f4v6 y P , 7Z4 Nz OEM Number of stories City: ZIP: ' Type of construction • , , ',` one: 93 ' 9gs /a Larli i E -mail: Occupancy group(s): Existing: ' CCB no.: 2Q 0 0 ' _ �' New: City /metro lic. no.: ��- Q a Notice: All contractors and subcontractors are required to be •• ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Name: 9'" 6 f itr ` --7 d LC_..i - • provisions of ORS 701 and may be required to be licensed in the Address: - 71 _ . N _la_ cam- p� jurisdiction where work is being performed. If the applicant is exempt from licensing, the following reason applies: ani2123EMI ZIP: q7 ___. Contact person: Plan no.: - Phone:03_6 q. % Fax: E -mail: ENGINEER Name: Contact person: Fees due upon application $ Address: Date received: City: State: ZIP: Amount received $ Phone: Fax: E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this 0 Visa O MasterCard work will be complied with, w4gther spectfi herein or not. Credit card number: / / Expires Authorized signature: W �< Date: c/' VZ Name of cardholder as shown on credit card $ Print name: Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (Mn)OICOM) I1I.V1 One- and Two - Family Dwelling .. :,,,,, , ;,,y ;, Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard ty g O Electrical O Plumbing O Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 ' THE FOLLOWING; ITEMS ARE REQUIRED FOR. PLAN.REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control O plan Cl permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state 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. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; propostyrafignet - :' _ - • ' •• • • •• - - - •, A4• -r- , location of easements and driveway; footprint of structure (including decks); 1 ton o we ; utility locations; direction indicator; 1 existing structures on site; an e. 12 'Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size 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 -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. 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 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets 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 for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. • JURISDICTIONAL SPECIFICS 23 Five (5) 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 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/00/COM) r. Mechanical Permit Application Date received: Permit no.: .,.; ". ili I City of Tigard Project/appl. no.: Expire date: CifyofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Phone: (503) 639 -4171 Date issued: By: I Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement 0 New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION CO %lMERCIAL VALUATION SCHEDULE Job address: / 0 5 70 / / 77 M O, a Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: 1 Suite no.f value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ . Lot: (Block: 1 Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT EEG SCIIEDULE • Description and location of work on premises: AND COMMERICAL/INDUSTRLAL EQUIPMENTSCIIEDULE Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res.only Res.only Tenant improvement or change quo,: _ • HVAC: Is existing space heated or conditioned? ❑ Yes- -U No• •• Air conditioning unit CFM g P Air conditioning (site plan required) Is existing space insulated? ❑Yes ❑ No Alteration of existing HVAC system 11ECIIANICAL CONTRACTOR Boiler /compressors • • - - ' • Business name: �, State boiler permit no.: -re - HP Tons BTU /H Address: Fire/smoke dampers/duct smoke detectors City: 1 State: 'ZIP: Heat pump (site plan required) Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner ❑ Yes O No CCB no.: InstaWreplace/relocate heaters — suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace CONTACT PERSON Refrigeration: Absorption units BTU/H Name: Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: _ Appliance vent Phone: Fax: E -mail: Dryer exhaust OWNER . Hoods, Type U II/res. kitchen/hazmat hood fire suppression system Name: Exhaust fan with single duct (bath fans) Mailing address: Exhaust system apart from heating or AC City: 'State: I ZIP: Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: Fax: E -mail: Fuel piping each additional over 4 outlets Process piping (schematic required) Number of outlets — Name: Other listed appliance or equipment: Address: Decorative fireplace City: , State: 1 ZIP: _ Insert —type Phone: 1 Fax: 1 E -mail: Woodstove/pelletstove Other: Applicant's signature: I Date: - Other: Name (print): Not alf jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ❑ Visa 0 MasterCard Not Th permit application Minimum fee $ / expires if a permit is not obtained Plan review (at %) $ Credit card number: Expires w ithin 180 days after it has been p State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ Cardholder signature Amount 440-4617 (6100/COM) MECHANICAL PERMIT FEES • COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: • PERMIT FEE: Description: . - ' , ' - ' Price . Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code ' QV (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Fumace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Fumace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14.00 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Check'ail that apply: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see . or . Pump Cond fraction thereof. footnotes below.. ' Comp Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit $ to 100K BTU 14.00 8% State Surcharge $ 8) 3-15 HP; absorb 25.60 unit 100k to 500k BTU 25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00 Required for ALL commercial permits only unit .5 1 mil BTU TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20 unit 1 -1.75 mil BTU 11) >50HP; absorb unit >1.75 mil BTU 87.20 ASSUMED. VALUATIONS PER APPLIANCE:` 12) Air handling unit to 10,000 CFM 10.00 Value Total 13) Air handling unit 10,000 CFM+ Description: Qty (Ea) Amount 17.20 Fumace to 100,000 BTU, including 955 14) Non - portable evaporate cooler ducts & vents 10.00 • Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct ducts & vents 6.80 Floor furnace including vent 955 16) Ventilation system not included in Suspended heater, wall heater or 955 appliance permit 10.00 floor mounted heater _ 17) Hood served by mechanical exhaust Vent not included in appliance 445 10.00 permit 18) Domestic incinerators Repair units • 805 17.40 < 3 hp; absorb. unit, 955 to 100k BTU 19) Commercial or industrial type incinerator 69.95 3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves 101 k to 500k BTU 10.00 15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets mil. BTU 5.40 30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) 1 -1.75 mil. BTU 1.00 >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Minimum Permit Fee $72.50 SUBTOTAL: $ Air handling unit to 10,000 cfm 656 8 % State Surcharge Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent system not included in 656 appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: Domestic incinerator 1,170 1 Inspections outside of normal business hours (minimum charge -two hours) $62.50 per hour. Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) Other unit, including wood stoves, 656 $62.50 per hour inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour Each additional outlet 63 *State Contractor Boiler Certification required for units >200k BTU. TOTAL COMMERCIAL - $ "`Residential NC requires site plan showing placement of unit. VALUATION: All New Commercial Buildings require 2 sets of plans. i:\dsts \forms\mech- fees.doc 02/11/02 ,. Electrical Permit Application Date received: Permit no.: a.rr 6• � �,j, •.J� , City of Tigard Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: • TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family 0 Tenant improvement O New construction 0 Addition/alteration /replacement 0 Other: 0 Partial • • 3011 SITE INFORMATION Job address: /0570 j(l 7/ , '77/01 Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: Subdivi : Project name: kt4/l7 /�/ Award Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCIIEDU,E. • • Job no: 1 ---- / jD Fee Max Business name: �C L�' v 6 C(�e7�/ L' , /N 'L Description Qty. (ea.) Total no. insp New residential - single or multi - family per Address: ._5 S'E g'� dwelling unit. Includes attached garage. City: // /Lt,S/2,p/Lp I State: 8g_I ZIP: 9 "24,2 3 • Service included: Phone: (, y 36 0 I Fax: I E -mail: 1000 sq. ft. or less 4 CCB no.: / /( Z $y I Elec. bus. lic. no: 3y -L433 Cr Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: • PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation: 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 - ENGINEER . . Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REVIEIV (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2 O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2 O Building over three stories 0 Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress/lightingplan 0 Other. Per inspection 1 1 Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ • Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: 00111 Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total `t' Check Type of Work Involved: Residential - per unit 1000 sq. fL or less $145.15 4 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 ❑ Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 • 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. ❑ Audio and Stereo Systems Branch Circuits New, alteration or extension per panel ❑ Boiler Controls a) The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control* Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable in any of the above Per inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ ❑ Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ All New Commercial Buildings require 2 sets of plans. Total Balance Due $ i:\dsts \forms \elc- fees.doc 08/30/01 08/28/2002 1 0: 32 5032038408 SHELBY BODEN PAGE 01 4 Plumbing Permit Application I 1 ti f O. City of Tigard Date received: Permit no.: ,u ,� �' Address: 13125 SW Hall Blvd, Ti Sewer permit no.: Building permit no.: City ojTigard Tigard, OR 97223 Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: 1 1 1'I: 01 1'1.I011 1 ❑ 1 & 2 family dwelling or accessory • Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction a ' • ddition/alteration/replacement ❑ Food service 0 Other: _ .IOIt 11 14. INl t)It:11 11 1(1N 1.1 .1 1( 111 1)1 1 (lo••l)rt•i;tl infor,n:16011 u.r n het l.li.l► Job address: j D 5 70 S,,) '1 I vs" Desniption Qty. Fee (ea.) Tonal Bldg. no.: 1 Suite no.: New 1- 2-family dwellings only: Tax map /tax lot/account no.: • (includes 100 ft, for each utlty connection) SFR(I)bath .. Lot: 181ock: [ Subdivision: SFR (2) bath Project name: r1 77A �� EL_ r SFR (3) bath City/county: ZIP: Each additional bath/kitcben Description and location of work on premises: — Site utilities: Catch basin/area drain Est. date of completion /inspection: Drywells/leacb line /trench drain 1r1 l :1 MINI. ('t►\ IR %t 1014 Footing drain (no. lin. ft.) r Manufactured home utilities Business name: 7 r- S TA.t 19440/9 Manholes Address: p •7 . — ,6e - T un Op= Rain drain connector City: , tA State:a, ZIP: q.-701 Sanitary sewer (no. lin. ft.) Phone: 663 67 ZZ Fax: t? 4-, £.� -mail: Storm sewer (no. lin. ft.) " CCB no.: /3 9 3 7 / /3/ y Plumb. bus. reg. no: 3 — q; 7 pQ Water service (no. lin. ft.) City /metro tic. no.: ‘ ,2 9 L / - Fixture or item: Contractor's representative signature: ,/y y—. Absorption valve g� Print name: Back flow preventer G fc ► Date: Backwater valve Basins/lavatory Name: Clothes washer Address: Disbwasher Drinking fountain(s) City: I State: I ZIP: Ejectors /sump Phone: Fax: E -mail: Expansion tank r Fixture/sewer cap Name (print): Floor drains /floor sinks/hub Mailing address: Garbage disposal Hose bibb City: 1 State. 1 ZIP: Ice maker Phone: Fax: 1 E -mail: Interceptor /grease trap Owner installation /residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's si Date: Sump 7 Tubs/shower /shower pan - Name: _ Urinal __, — Address: Water closet Water heater City: Tstate: !ZIP: Other: Phone: I Fax: 1 E -mail: Total r . Na all jurisdictions accept credit =MS, please call j,yjgOe m more leforation. Minimum fee $ / C7 Notice: This permit application p rev (at %) $ 1 visa u MasterCard a Tres if a Credit cord number. , / / xP permit is not obtained State surcharge (8 %) $ Bxplrea within 180 days after it has been TOTAL $ NM. of cardholder as shown on credit cars accepted as complete. $ Cardholder signature Amount 440.4616 (6 /00/COM) CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE KELSO ELECTRIC INC 545 SE 3RD HILLSBORO, OR 97123 Electrical Signature Form Permit #: MST2002 -00370 Date Issued: 913102 Parcel: 1 S136AD -02501 Site Address: 10570 SW 71ST AVE Subdivision: VILLA RIDGE Block: Lot: 004 Jurisdiction: TIG Zoning: R-4.5 Remarks: 112 sf kitchen addition. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and retum this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MARTIN, WALLACE D AND BETTY J KELSO ELECTRIC INC 10570 SW 71ST AVE 545 SE 3RD TS CARD, OR 37223 9 OR 97123 Phone #: Phone #: 503 - 648 -6360 Reg #: s P 14gL54 � ,0 ELE 34 -433c AN INK SIGNATURE IS REQUIRED ON THIS FORM • X �ure of Supervising Electrician If you have any questions, please call (503) 639 -4171, ext. # 310 Sep 05 02 08:45a Four Star Plumbing Inc. 503- 663 -6332 p.l CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ° _ FOUR STAR PLUMBING INC SEP 0 5 2002 10745 SE EASTMONT DR Cdg ? Y EA' i r�.I {; GRESHAM, OR 97080 :i T `�t�` Plumbing Signature Form Permit #: MST2002 -00370 Date Issued: 9/3/02 Parcel: 1 S136AD -02501 Site Address: 10570 SW 71ST AVE Subdivision: VILLA RIDGE Block: Lot: 004 Jurisdiction: TIG Zoning: R-4.5 Remarks: 112 sf kitchen addition. Your company has been indicated as the plumbing contractor for the perrnit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and retum this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: MARTIN, WALLACE D AND BETTY J FOUR STAR PLUMBING INC 10570 SW 71ST AVE 10745 SE! EASTMONT DR TIGARD, OR 97223 GRESHA,M, OR 97080 Phone #: Phone #: 503- 663 -6722 Reg #: LAC 139370 PALM 3 -437PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Au rize Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 24 -Hour BUILDING . Inspection Line: (503) 639 -4175 MST o� - Ov_2i Z� INSPECTION DIVISION Business Line: (503) 639 -4171 . _ [ L � jsup- Received Date Requested — (3 AM PM BUP • Location 1 'b 7 S t Suite MEC • Contact Person Ph ( ) 4 11g -- 51a5 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: rn S c 5 - SIT Post & Beam J Shear Anchors /7t �• Ext Sheath/Shear t� V Int Sheath/Shear ©(.k ,C-+4 Framing Slots-L. Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Ot er: PASS1RT FAIL 'PL Post & Beam Under Slab Rough-In -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan .- Einal 7— SS 'ART FAIL { ' ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage ;alarm El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL ❑ Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line 21i ADA .3 /0 Approach/Sidewalk C Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL 1 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST eD :3 7 O INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested • ?/t AM PM BUP Location / U S 7/ ta-? /4 L ( Suite MEC Contact Person Ph ( ) 9 f ; C/' -'PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain' Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear • Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final FAIL S un8 UG/Slab Low Voltage Fire!Alarm Final D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 'ART FAIL 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire ADASupply Line / 1 WO Z� Approach/Sidewalk Date / Inspector ( Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour I i 0 0 3 a Inspection Line: 639-4175 nspecton ne: (503) 639 -41 r `� BUILDING -60 Z, INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested !/ ° AM PM BUP Location /0 S 70 7/ ldu-'t- Suite MEC Contact Person Cir Ph ( ) 6 q O's/ - PLM Contractor Ph ( ) SWR BUI • G Tenant/Owner ELC ooti , ELC Foundation Access: MB° Ftg Drain ELR Crawl Drain -Slab Inspection Notes: s j — SIT Post & Beam ( Shear Anchors Ext Sheath/Shear Int Sheath/Shear _ Inso . Drywall Nailing Firewall Fire Sprinkler Fire Alarm Gov e 6 / 1�Cr 7 6iz_ i (7 - /' 1'� � ec/ c Susp'd Ceiling '-'Roofs" / 1 7 1, p -e c c 6, c f � PART FAIL roe rn , Oe c k- sa '+- '''� I G\ "ost &B -:m v U •er -b 6 0 U 0 - Z Rou . -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: \-- (C-Illj final PART FAIL i ? { % ANICAL _- Post & Beam Rough -In Gas Line /T �/ ' /C / l71-0-11 1p ( / S u • • - Dampers [ �' "i ce inal , PART FAI - �., RICAL `ough- •• up r ab Low Voltage Fire Alarm Fina • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. gral PART FAI ■ ❑ Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line 1 l� ADA / Q- Approach/Sidewalk Date / I In Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST .3 7d INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested a- AM PM BUP / Location / 0 5 70 71 Suites e MEC Contact Person �- Ph ( ) __L_0 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear _ Int Sheath/Shear ra n nsulation Drywa Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: F' PASS ART FAIL BING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspectio .*E: Unable to inspect — no access Fire Supply Line ADA � G -� Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 G � BUP Received Date Requested • / �� AM PM BUP Location Suite MEC Contact Person Ph ( ) q PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear 5 eflo � .5 Ta A. 0J ma c.= -�c— Insulation Drywall Nailing n Firewall 4 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof O ,", S — a Other: Final / Ot � 7 ( .) 47 SS / PASS PART FAIL PLUM Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In *WV"' mo a Dampers Final SS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Date �// �� Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 Of MST a d Z7 310 INSPECTION DIVISION Business Line: - (503) 639 -4171 BUP Received Date Requested /r 7-6 AM PM BUP Location O5-70 7 /- ae . Suite MEC Contact Person Z J ay Ph ( ) 9 7 ? F -S lobs PLM Contractor �/ Ph ( ) SWR = UILDIN 11 Tenant/Owner ELC ooting Foundation ELC Access: � ,-- Ftg Drain Q -- 7 / ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors - eat h/S r n ea Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Fi 1 — ,1 ✓FART FAIL ' ' 'os :eam Under Slab Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fin PA PART FAIL CHANICAL Post & Beam Rough -In - Gas Line Smoke Dampers Final PASS PART FAIL n AL Rough - In UG/Slab Low Voltage Fire Alarm Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ASS PART FAIL $ ❑ Please call for reinspec ion RE: El Unable to inspect - no access Fire Supply Line , / Z u ) ADA ef/ CJ Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST — e lr, 370 INSPECTION DIVISION Business Line: (503) 639 -4171 P BUP Received Date Requested / / 6 AM BUP Location G� 1) 5 7 / / t . l' Suite MEC Contact Person 0,41.! o Ph ( ) l ” 1 - PLM Contractor / ✓ Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection No °(----1 SIT Post & Beam Shear Anchors 6_.e.€4_44.t..) Ext Sheath/Shear ]] � � ` InSh � eat � h/She �ST0.J�Jl 7_,,,e ) `s iC.•S �(�' S rams Insulation Drywall Nailing CR-er..---^- S Firewall Fire Sprinkler Fire Alarm A, J1� el L L S Ceiling A so. ' � Roof _S2_ck_ • Other: Final PASS PAR FAIL , _ _ / b S ; 1 _ ., ' ! PLUMBING � 15 �Cx S - e C \. Post & Slab C� �P �"�g�/ Rough -In 2— G f Water Service l ci. 1 ° Sanitary Sewer 10,) ` 46 � ' S r A—% ( S-- Rain Drains // 1,---- Catch Basin / Manhole � v� C S T l ` v! ■ (Q L- -) 2.‘f—"6. Storm Drain _ `� Shower Pan C -C� ��.e (- Other: Final Vim; \ � 0,--c.__. PASS PART FAIL � / < a_ ck - �, (� ' MECHANICAL �F Post & Beam I _ Rough -In _ 1��.1 eta Gas Line -1\--1 ( _ _ �� �` Smoke Dampers U �uC ' U Final ,n C PASS PART FAIL e ELECTRICAL I J Service 6 Rough -In S UG/Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date /(e./c) Inspector ` - ^ E xt Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 d()----MST A'2a0Z-66 3 70 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 9' AM PM UP Location /12c 70 St() 7154- ' )'e Suite MEC --- Contact Person • ) ? C t si 2 - 3 PLM Contractor Ph ( SWR • i ►- Te •nt/Owner bs '<-0-\ ELC ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Ina Sheath/Shear �� Framing C [�- Insulation � C / a . - C__ Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Fin PART FAIL MBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final AA )97 PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PAR FAIL i Please call for reinspection RE: El Unable to inspect - no access ire Supply Line ADA Approach/Sidewalk I ate Inspector " Ext Other: VS 1'X'05 Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL