Loading...
Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00037 �.��� DEVELOPMENT SERVICES DATE ISSUED: 2/20/04 --" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09510 SW 74TH AVE PARCEL: 1S125DB-03703 SUBDIVISION: BOULEVARD HEIGHTS ZONING: R -4.5 BLOCK: LOT: 023 JURISDICTION: TIG REMARKS: 833 sf adding to upper level. • BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: 19 FIRST: sf BASEMENT: sf LEFT: 20 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 833 sf GARAGE: sf FRONT: 5 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 15 VALUE: 76,969.20 OCCUPANCY GRP: R3 BDRM: 3 BATH: 1 TOTAL: 833 sf REAR: 5 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL /CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 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: W /SVC OR FD R: - PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400' amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 4.00 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: LANDSCAPEJIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,305.92 This permit is subject to the regulations contained in the MINETTO, STEVEN L + JAN V DALTON CONSTRUCTION INC Tigard Municipal Code, State of OR. Specialty Codes and 9510 SW 74TH AVE 5331 SW MACADAM AVE #376 all other applicable laws. All work will be done in TIGARD, OR 97223 PORTLAND, OR 97239 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: Oregon law requires you to follow rules adopted by the Phone: 503- 245 -1555 Phone: MBL. 209 -8869 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 -001 -0080. You Reg #: LIC 67798 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Underfloor insulation Framing Insp Rain drain Insp PLM /Underfloor Shear Wall Insp Electrical Final Mechanical Insp Exterior Sheathing Insr Mechanical Final Plumb Top Out Gas Line Insp Plumb Final Electrical Rough -In\ Insulation Insp Final inspection Iss ed By : _! ,�– I 1 :. / �.f ,/1 viii Permittee Signature :?c — Call (503) .39 -4175 by 7:00 p.m. for an inspection needed the next business day - ,,, Q EIVED • Building Permit Ap on . FOR OFFI'C,E`USE *ONLY.. _ City of Tigard JAN 2 9 1004 ` • Received L i Permit No.: 91 (�'7G�3 DateBy: 1 -" ,7 /�� 7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1eg'( OF TIGARD t'f' X11, Ot Other Permit: D ate /B A t/ o� ' � � Inspection Line: 503.639.4175 ' 03.639.4175 t , BUILDIN DIVISI •fu =N Date Ready/By: Juris: ® See Attached Checklist for Internet: www.ci.tigard.or.us Notified/method: �f Supplemental information : -401: ''� ' r x'' 4 ` s " ttr U ORK' t ` r,; I I ' t" , a r S 4 a .i ��' sx F+s { �' °`� ° REQUIRETADATA 1 AND 2 FAIVIILY'DWEELINC m« r 44 ``� �� :. � � r. ti. 7+ TY . , PE r �' ? , , i �:IIR ,.4,e:: -: i .,::,a5 �.,.� 4 _.d . <52a': r ... „ ta: • -... .. <, , l , ., ,. , , ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all C Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the q P : g �z� x5k CONSTRUCT r IO r f k i work indicated on this application. i, '41:thiitlaaa `at CA i rid3 OF N V .. o,� t,:0,, , ,:.: k ... . Valuation: $ 15 000 ►;j 1- and 2- fartuly dwelling ❑ Commercial /industrial ■ Number of bedrooms: 3 ❑ Accessory building ❑ Multi - family ❑ Master builder ❑ Other: Number of bathrooms: s° U i �, *r Total number of floors: ,s t to a �a JOB,)S�ITE, INFORMATI,QN� AND tLOCATION a �.�. ,;; Job site address: CA 5-1D Sw '"l 4 "x' Akie New dwelling area: g 3 3 square feet City/State /ZIP: •-k-l( -eD ppa ck' - j7.2 j Garage /carport area: 2( square feet ? Suite/bldg. /apt. no.: --- Project name: IAA Oe r tax - 0 j Covered porch area: fa square feet Cross street/directions to job site: 1 L.I " F \I Lim VOpoD Deck area: �' square feet SW S .l <9.-P4 94) 4,1 Other structure area: C square feet 'l REQUII2EDDATA : COMMERCIA I:'USE `CHE Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the 0 k+ l Y� F k 9 T 'y, *-.Y , r by 9 of . sf ' ` parA , p R } DE O WORK m k_ r t , work indicated on this application. Valuation: $ 33 SQ Fes. Se SitRNf 41/4-DDi`n0 Existing building area: square feet New building area: square feet qi,,,L ®PROPERTY lOWNERt* i I N 'TM3 Al TEIYT; ' Number of stories: Name: 5 - —� 4 .2-k1,1 tJtiOTTO Type of construction: . Address: Occupancy groups: City/State /ZIP: G 9 c cl 223 Existing: t Phone: (5c5 ) 2 — (SS S Fax ( ) New 7 ei 1 ' '�3"i x.$ 1 f: _ � 4- ' ke K' J ' Y t ,d '} , k - ,1 I .. : V 4 NN ID APP ICAN .,, ` i', o f s;:i , , ..` ' CONTA C T g _.. t t , H_ ;4..M NOTICE " Business name: -3 tT - p i C 5 -It,f.3� i K e_ All contractors and subcontractors are required to be � i � licensed with the Oregon Construction Contractors Board Contact name: 1v under ORS 701 and may be required to be licensed in the Address: 52)3 k 5Q- NE IV-ND A-N 1 31 E, jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: y :11- A►..Z. ©a. ci1239 apply: Phone: ( 5 3 ) 207/ " b'g bet Fax:: ( 603) 113- 013 E-mail: l.- F -l-�� 1 - kEs)Fvun) J(L1 Lcoh'` b ra» r,, 'W t ;,&' s. M- Alt' 3y Mil : 3 p/0 t .. # '� '<, I V i t k NTRAET6R�� a, f' p v ,g� r � ,, Business name: ') k.eTONi C'O t.j GTI, U C;(10 0 3 1 I lAC_ ' , ' t ° BUILDING PERMIT .FEES Address: t 73..31 5 M-AC_ PO) A "* L Please refer to fee schedule. City /State/ZIP: (1) N , O.Q. �� 2 3 9 Fees due upon application Phone: c5()3) F cl - 7g(001 Fax: (5c ) 2_9 q 3 -- 4,1-0 Amount received CCB lic.: ( $ Date received: Authorized signature: I This permit application expires if a permit is not obtained _�` i " within 180 days after it has been accepted as complete. Print name: L,,et ' 7.1.11-t---1-01•1 Date: L kfi 1 o4 * Fee methodology set by Tri- County Building Industry 1 Service Board. i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(1 I /02 /COM/WEB) I • One- and Two - Family Dwelling BuildinE Permit Application Checklist • Fo Permit R OFFICE USE ONLY City of Tigard Date/By: Permit No.: Y 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: , Phone: 503.639.4171 Fax: 503.598.1960 14 rw Iii $ + \ •., ❑ Electrical. CI Plumbing 1:1 Mechanical - 24- Hour Inspection Line: 503.639.4175 ,..1 �� Internet: www,ci.tigard.or.us ❑ Other: 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. 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 ❑ plan ❑ 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; property comer 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 ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ fumace, 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 ❑ 0 ❑ prescriptive path analysis provide specifications and calculations to engineering 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 Ore:on and shall be shown to be ap ilicable to the ero'ect 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 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 tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area .Pre 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. ■ i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 Mechani al Pe:01:01 431 i t • 0 a , ;FOR OFFICE USEONLY" .. • . City of Tigard Date /B Penult No.: Y 13125 SW Hall Blvd., Tigard, OR 3 n 4 Plan Review Phone: 503.639.4171 Fax: 503 9 9 20U4 isarar A o J t l � Date/By: Other Permit Inspection Line: 503,639.4175 ! Date Ready /By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD mmall Notified/Method: Supplemental Information BUILDING DIVISION . " " ' , O � } ,k h COIVIMERCI FE SC US E G 13 E C K L IS T r x 4 �� e TYPE OF WORK t . r a B x ` : ,kl ,_ . „ . .. .. _ . ❑ 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. 1m11 r� � iti t '� °+ CATEGORYI11OF CONSTRUCT[ON u f a r "' 1 '• Value $ , r :^ a ._ xs� „x, -. . R T IAJL EQUI PrM ESIDEN ENT / SYSTEIVIS'FEES* /r 1- and 2 family dwelling III Commercial /industrial ID Accessory building / For p information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total t , „, .� + 4 Y. � a .i.. , -.. r t* �.e« y,„t ,h»v, �., r, ,n, o i a. ;f N t „ A. I,d < Heating/cooling . ` '� ��'��� ��s���JOB'S1TEINFORIVIATION�AND LOCATI:ON ��� y � `, (.` /�'' Air conditioning or heat pump Job site address: cm -ID e7 5 W y`H" s� i t (requires site plan showing placement) 14.00 City/State /ZIP: G b .0 e e97 'Z �3 Fumace 100,000 BTU (ducts /vents) it 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 ' Suite/bldg. /apt. no.: Project name: I"l I l Tts I' tDD iTio . Gas heat pump 14.00 Cross street/directions to job site: l 4 - ft . , E bC � Duct work 14.00 l' 1 Hydronic hot water system 14.00 6 f j` ,?n4 0 T}k`{ Lbw Kt, Q FE-RW-1 AAck Residential boiler (radiator or CE-t.�f6 C 12-e- S'- Unit h ic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 • Other: 10.00 Tax map /parcel no.: Other fuel appliances `� i DESCRIPTION OF'�' WORK' �" rs Water heater 10.00 s , ` 160614... i1. . z. , .amaze....h,.4.,- .,,,,1 , . s33+;. ,. r ,1 .. m Am __a'I Gas fireplace 10.00 " ' 4e T (S L� 5"-( STE 1 (aiJ 1 11 G t.1 ik Flue vent for water heater or gas 1'4 �` C I A-NiG � OJT E♦EL FU2 A-c.E L l igh 10.00 Log lighter (gas) 10.00 • 4c) G Wood /pellet stove 10.00 Wood fireplace /insert 10.00 ,� 2,„ ` , t , �E 1 ^* f Chimney /liner /flue /vent 10.00 ` ..., ' :,! PR OWN4W41$ " 'SW1 � , ,� 10 ., NT ,�..�,_. � _.. ..�L ...r - ..1-.,,_. faa '- Other: 10.00 Name: 5 Vl: 4 s•rJ M I Ns t= Environmental exhaust and ventilation Range hood /other kitchen Address: CA 5 - 1 D. 5 U 1 `1 1 if== AVe equipment 10.00 City/State /ZIP: - n (,e 69 C • 1 z3`( Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (503 ) 20 2- ( 555 Fad) toilet compartments, utility rooms) / 6.80 a r3 AI, rls `APPLICANT a i [ CONTACTlPERSON F . N Attic /crawlspace fans 10.00 Other: 10.00 Business name: � - , ( 1 0 , 1 4 � - cpaic rt0 0 k h G_ Fuel t io p'P' g Contact name: 1_ t.3 `�.A_ j $5.40 for first four; $1.00 for each additional Address: 331 SW • MA"C '� 4 ,PrbArI 31 (G Fumace, etc. 1 5 Gas heat pump City/State /ZIP: , I 4:2 _ c.. 97-2_39 Wall /suspended /unit heater r Phone: ( 503) 2Cfi - $g69 Fax: : (503 ) 2_9 3 --1,113 Water heater p Fireplace E -mail: L-ET R LTO t i (- ' - rt-te t) FH TCIJ Cf) • e-t1 -1 Range ONOPPlaztion- rx ,r ; ,. 1 m w t o ` ; ` i Barbecue l CON TRACTOR.' i ,a Business name: Y"" i Clothes dryer (gas) !� Other: Address: r -a ,g 11ECHANIc,AL IT PERM FEES* City/State /ZIP: Subtotal Minimum permit fee ($72.50) Phone: ( ) Fax: ( ) / Plan review (25% of permit fee) CCB lic.: / ? g/ State surcharge (8% of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board i:\Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I/02 /COM/WEB) Mechanical Permit Application - City of Tigard `..- Page 2 - Supplemental Information • Commercial Fee Schedule: 'Io>lal' . Permat`'ee • $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\Building\Permits\MEC- PermitApp.doc 12/03 2 G ED Electrical Permit Appliat. EI FOR OFFICE "USE ONLY ; ,; :, • City of Tigard r 201 Received Permit No.: JAN 9 DateB : i1 ?S j�T„0y , ri1�: -7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 CI TY Of TI °-` �� DateB : Other Permit: Inspection Line: 503.639.4175 D �, ig�'. - , .i`!. >I ! Date Ready /By: 1 $: El See Page 2 for w Internet: ww.Ci.tigard.or.us BUILDING Notified/Method: 1 1 `i Supplemental Information s s r iw r n *rt h i i TYPE� W ORK a r s " ' " , S _ 1 �' i �� -1 ,, ;l1 '( A . „ I r + PLAN REVIEW • .,,, ed- �f"�.r�st, �,�. ._ .. .,,� ' m v..txa „?. .u_. t..,�, �, . .,. y � x :, e , .,.. .' � T!'',, , ❑ New construction ■ Addition /alteration /replacement Please check all that apply: ❑ Demolition ❑Other EService over 225 amps, comm'l EHazardous location at ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., v ,112, 1CATE,GORY :OF COIYSTRUCTI KIII a � n of 1- and 2- family dwellings 4 or more new residential E 1- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Mult1 fam11 't•; y s JOB SITi ❑ Master builder ❑ Other: } f ❑Occupant load over 99 persons Manufactured structures or i , abig SINF'ORl1'IATIONlANArLOCA TMI 4 ❑ Egress /lighting plan RV park it '% Job no.: Job site address: ''j - ❑Health - care facility ❑Other: �� 0 1 Submit 2 sets of plans with any of the above. City /State /ZIP: — 1- - Q4 ts ,,� - 2 9 2 ? The above are not applicable to temporary construction service. I Suite/bldg. /apt. no.: ,._ Project name: i�11P1' ►� f�DD1Te NI M -..:'z N: ,FEE* * Description Qty. Fee Total Cross street/directions to job site: I L A * C EI_m >I) New residential single - or multi - family dwelling unit. Includes attached garage. j cv-T-4 0'- `Th'f>-c)e.5 Q�'y 4 cD C e 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 . ` tt , '`DSCRIPTION %OF„ WORK r ��d.,r.���, +- a��k >� �'.��� ,� . s E s. .. . , . .; vr, � ... ,nl� � ,, � idr. ,. =h _ Each manufactured or modular - I dwelling, service and /or feeder 90.90 2 W` ' ( 6 E�'t� 571312-4 i D i 11 a Services or feeders installation, alteration, and/or relocation O eo 3' Pr , 200 amps or less 80.30 2 '' I TENANT 201 amps to 400 amps 106.85 2 P4401'Elif OWNER r r 4 - w ,� „,. .... .. 160.60 2 Name: 5 J 4 zyM A i o c 'rT o 601 amps to 1,000 amps 240.60 2 Address: 1510 �LAi _7 A Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 Ci /State /ZIP: ` ( C --t �-Z3 Temporary services or feeders installation, alteration, and /or 1 relocation Phone: () ) 245-_ (5 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 _ intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel r' T rr§ I F 1 g "" CONTACT PERSON V A. Fee for branch circuits with service „ �� b,�� A ���.�rtsl., �;.a �,.�,� ._. -��. � .� .� n �. �,� �:_ -�., Business name: u I V� b ranc h �rceeder fee, each isL_�'CI.4 cotSsTaUC:no(� 6.65 2 Contact n , � ) B Fee for branch circuits ontact name: iL E Ni Iv 2> 4 -i rt� 1J without service or feeder fee, 46.85 2 each branch circuit Address: 1, 3 I s w 1 , A � ,r4 (v1 3' l Each add'1 branch circuit if 6.65 2 City/State /ZIP: 1:)0 .- - P rt ,9 1) 02_ (1-7-z_30, Miscellaneous (service or feeder not included) � I Phone: (50 5 ) 1_69 , 03G Fax: : (503 ) ' Pump or irrigation circle 53.40 2 l 3 73 Sign or outline lighting 53.40 2 E Ler) Pt1oDNI e 114 E1)lke tO CO • '- M Signal circuit(s) or limited - G 1 , ISFAM t NTE O CTOR `,1 f �� ' ; I" � � g'',-' ; energy panel, alteration, or �� �� ��� / extension. Describe: Page 2 2 Business name: �-�l t�� Y-0 , Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ,,, „ , r , ELEC,TR7C,AL,'PERMIT FEES* " ,, , CCB Lic.:1 5341 1 „ Electrical Lic.: [1_�1 / (1 Suprv. Lic.: I/4455 Subtotal Suprv. Electrician signature, required: i Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB Electrical Permit Application - City of Tigard - Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: u§ ONLY Ott`..... ,. A 1, Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i: \ Building \Permits\ELC- PermitApp.doc 04/03 Building Fixture i � R gib Plumbing Permflt 1 Y ED .FOR- OFFICE USE ONLY "'„' City g of Tigard N 9 2004 Received Permit No.:0-61"�oDy-12vo37 13125 SW Hall Blvd., Tigard, OR 97J A Review Other Permit No.: Phone: 503.639.4171 Fax: 503. 1Q ,6fbF TIGARD 1 4 " 1414146 1 111 -. Date/By: 24- Hour Inspection Line: 503. 4175 D iu e` . Date Ready /By: iu Ill See Page 2 for Internet: www.ci.tigard.or.us 1LDING DIVISION Notified/Method: Supplemental Information Y.., a ��� K ' lt�,�r t K t ,.��a� V �TRYPE OF WORK H .�. uk- ,.,,.: n.. � r ' '`� t t t ��; � l !;�' FEE SCHEDULE , ❑ Demolition For special information use checklist. ❑ New construction Description 1 Qty. 1 Ea. 1 Total Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) ";'F l i t fCATEG,O itT ,�4 COP ] STRUCTIO N f 'EM ' �, SFR (1) bath 249.20 S. 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 SFR (3) bath 399.00 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: _ Fire sprinkler ( sq. ft.) Page 2 n •as �+ YS s. u s ra�t. i � .�- � w ary $�at Ord^', r � - �' �, -�`� } =',� , 4 , J OB9S 1 E1N ORiVI TI ON AN ' i tch IONr 4z .'o` f Site utilities Job site address: 9 J`l p 6u 3 `74'k -`' AckiE Catch basin or area drain 16.60 City/State /ZIP: - --n 4 p , Of? C17.2--Z-3 Drywell, leach line, or trench drain 16.60 - t Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: - I Project name: m i r\ .X.DDc t 0 Manufactured home utilities 110.00 Cross street/directionsto job site: `t'= AVE &) -ELM WOOD '- Manholes 16.60 50∎;-rk-k C- " - T'iN• L 0P-5 F- R¢`4 RD eL kC'- Rain drain connector 16.60 C f\ Gt s'r- Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Lot no.: Water service (no. linear ft.: ) Page 2 Subdivision: Fixture or item Tax map /parcel no.: Absorption valve 16.60 fti ' DES_CRiPaTI'ON OF'WORKi d t n ; S, Page 2 _ � .0 1.,,.. f t• g„,,. �„„4„„i. , mot, x � .. ,,,, , .•& a ,e, „y W.4= _., , Backflow preventer • 1 1 NiG, t' r ©1\e-. 1,- -714 .MNI dtz Backwater valve 16.60 J NeV.� S� ST ��i 'c Dt . 17 ,,,, N I Clothes washer 16.60 ��� Dishwasher 16.60 ` la ' ' : �` . Erd ti NAN g Drinking fountain 16.60 f4.: , r { r i ( PROPEReTX OWNER i rg .I. - ' , ., : , .. . Ah i ....IS : Ejectors /sump 16.60 Name: 5- A. _ k+, i,'T`70 Expansion tank 16.60 Address: cts l c 5L3 ---r.1-1--1.-.. -/{'✓ Fixture /sewer cap 16.60 City/State /ZIP: -' -- ,p-_ 1 of q "7 22 3 Floor drain /floor sink/hub 16.60 Phone: (5 b3) 7- 15-5 Fax ( ) Garbage disposal 16.60 N5 m t 5 p �a Hose bib 16.60 t� srll r APPLICANT .'� i ,` �' r (�. +*GONTACT PERSON A * i 16.60 � fin, ��;' � � ���r� �� ,m � ��., Ice maker Business name:. 7\ (]1-u.Tt,t (DNI j - r _izo L'rt O 1J , t r Interceptor /grease trap 16.60 Contact name: \---- - P1 - LT ) C) Medical gas (value: $ ) - Page 2 Address: .5 Sod \\A-4-( -1\/\ 3 t, Primer 16.60 � 2 q,� Z3c Roof drain (commercial) 16.60 City /State /ZIP: - �Q D i ! Sink basin /lavatory 16.60 Phone: ()03) z 9 _ 51( G 9 Fax:: ( 563 21 - b tI 7 3 Tub /shower /shower pan ( 16.60 E-mail: LeD A',v "( b N cp -n4 E i-L ico o 6 c^- CO M Urinal 16.60 . 16.60 f 14 x. 1k 1 i r ' 4CONTRACTOR t t 6 '� �� 1 w,` Water closet t rH. ��E��, ',�i''t,. �a `'�xi"rs,a..,���.�� �P. �rTMS, r.:an�.r�y- ,.. .. ,��+r�.�, r,.�ae�i. �. ,..�C _ 3B Business name: `l- 6 o ptit is �LN`� . Water heater 16.60 Other: Address: Subtotal City/State /ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 f g cg 99 Plumbing Lic. no.: Lir•�Z/�� CCB Lic.: l Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building ',Permits\PLMF- PermitApp.doc 12/03 440- 4616T(10/02/COM /WEB) Plumbing Permit Application - City of Tigard ; Page 2 - Supplemental Information l F ee Schedule lte Residential Fire Suppression Systems: Re St111t1eS ,. Qty :Tee Total, SquareFoO •4 , I 'Perrri><t Fee • Footing drain -1 s` 100' 55.00 0 to 2,000 5115.00 2,001 to 3,600 $160.00 Footing drain - each additional 100' 46.40 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater 5309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 J ',' Fee,„ :.,. . • Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 55,001.00 to $10,000.00 572,50 for the first $5,000.00 and $1.52 for each l "¢ +£' t Qt Fee(ea)* Total additional $100.00 or fraction thereof, to and 3.. including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first 550,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees egt",te*Tuall Quauttty by (Ftxture)Work Performed F� ►r yp � • N New m a bE staog c p pe a Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" 3 -4 „ Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains fees assessed for the sewer increase must be paid before the Oil Separator (Gas Station) Rec. Vehicle Dump Station plumbing permit can be issued. Shower , -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE G & B PLUMBING PO BOX 1269 HILLSBORO, OR 97123 -1269 Plumbing Signature Form Permit #: MST2004 -00037 Date Issued: 2/20/04 — - - Parcel: 15125DB - 703 -- - - -- - -- -- - -- -- - -- - — -- -- 03 Site Address: 09510 SW 74TH AVE Subdivision: BOULEVARD HEIGHTS Block: Lot: 023 Jurisdiction: TIG Zoning: R - 4.5 Remarks: 833 sf adding to upper level. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, -ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: MINETTO, STEVEN L + JAN V G & B PLUMBING 9510 SW 74TH AVE PO BOX 1269 TIGARD, OR 97223 HILLSBORO, OR 97123 -1269 Phone #: 503 - 245 -1555 Phone #: 503 - 640 -2311 Reg #: MET 00002017 LIC 19907 PLM 34 -44PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X 1.1e f vi 3 JP Signature of Authorized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE WESTERN CASCADE ELECTRIC INC PO BOX 23124 TIGARD, OR 97218 Electrical Signature Form Permit #: MST2004 -00037 Date Issued: 2/20/04 -- — — — - —_ -- Parcel: 1 S125DB -03703 Site Address: 09510 SW 74TH AVE Subdivision: BOULEVARD HEIGHTS Block: Lot: 023 Jurisdiction: TIG Zoning: R - 4.5 Remarks: 833 sf adding to upper level. 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 return this Electric_ al Signature Form to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is,received OWNER: ELECTRICAL CONTRACTOR: MINETTO, STEVEN L + JAN V WESTERN CASCADE ELECTRIC INC 9510 SW 74TH AVE PO BOX 23124 TIGARD, OR 97223 TIGARD, OR 97218 Phone #: 503 - 245 -1555 Phone #: 503 - 521 -0000 R #: ELE 34 -616C SUP 4625S LIC 153416 AN INK SIGNATURE IS REQUIRED ON THIS FORM 'Signatu of pervising Electrician • If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 — o 7 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received //. 0 Date Requested n "--- AM PM BUP Location e 7 5 -/0 "7 Suite MEC Contact Person Ph ( ) 0 — Y/6 7 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 v Framing ��{ /� Insulation 6u ?l-YJ1 yc, L — d�� g-Ti- G.r Awita r /s Drywall Nailing vL (� V �1/ Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains ; �"' y Catch Basin / Manhole Storm Drain Shower Pan _ a Other: Final PASS PART FAIL • MECHANICAL Post & Beam Rough -In Gas Line Sm•ke Dampers Fin P - 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 • inspect – no access Fire Supply Line ADA Approach/Sidewalk Date , 16y- Inspector Ori 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 0 3 2 INSPECTION DIVISION — Business Line: (503) 639 -4171 BUP Received /� Date Requested / A M PM BUP Location f s /l� / 74v Suite MEC Contact Person Ph (3) -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 Framing Insulation Drywall Nailing Fi rewal I 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 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 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 Approach/Sidewalk Date v 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 MST60V'(-)VDS INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested -5 AM PM BUP Location Suite /`�G1 MEC Contact Person ��it .� ��, ( � 7 )3) e; �2v / 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 Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm F L Susp'd Ceiling 1 1 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 PASS PART FAIL (€LECTR Service • Rough -In UG /Slab Low Voltage m F ai Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. AS PART FAIL SITE. ❑ Please call for reinspection RE: Unable to inspe — no access Fire Supply Line ADA / Approach/Sidewalk Date Inspector % Ext Other: Final DO NOT REMOVE this inspection r ord from the Job site. PASS PART FAIL