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Permit
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' ' C ITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00147 i DEVELOPMENT SERVICES DATE ISSUED: 6/18/2004 "" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15762 SW 79TH AVE PARCEL: 2S112CD -07000 SUBDIVISION: PP1991 -063 ZONING: R -12 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: CUSTOMB STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 20 FIRST: 2,024 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 620 sf GARAGE: 720 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 10 VALUE: 266,648.80 OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 2,644 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 0 MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: / VENT FANS: 2 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W10 SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & 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: $ 8,278.29 This permit is subject to the regulations contained in the DANIEL SLIMICK DANIEL R. SLIMICK Tigard Municipal Code, State of OR. Specialty Codes 11345 SW 97TH CT 11344 SW 97TH CT and all other applicable laws. All work will be done in TIGARD, OR 97223 TIGARD, OR 97223 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. Phone: Phone: 503 - 684 - 6496 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 107487 rules are set 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 Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insc Gyp Board Insp Appr /Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final / / Issued By : / . � � _ `I � / Permittee Signature/ \- = - ' A . --Ad CaII (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day M ' 1 Building, Permit Application a (� ko FOR OFFICE USE ONLY . City of Tibard tid IF' DateB J (l y Permit No.: i � I -col 13125 SW Hall Blvd., Ti ard, OR 97223 ttt��� VV!! F� y g Plan Review n a'bc Phone: 503.639.4171 Fax: 503.598.1960 hos" I \ Date/By: �/ Inspection Line: 503.639.4175 � .� Q� p y Other Pe rmir � C MAY Date Ready /By: - J El See Attached Checklist for Internet: www.ci.tigard.or.us I °1P1 Y 2 0 20011 � Notified/Method: to /7 / L .,2:61.-• / 1� Supplemental Information _ /...s- i nt T P. A Il L, a-vt. ( Q^) . .,ss.t 'q ` r 5 igt, , ,T y'a a: s S„a ''''' ti , ; ' . % ;i/ : ': g i D rfr,' ` ✓ 4: Yf . II Y^ .i&A.;� 1',WEA. .:m . silo : . � '' * s. :N ,. A :.: 1 ... � x - aii ,. i" U .w ,,., D`p e..z a .t ,17 rw!=: 3 DW LLING E 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 1",,, i . ; Y f a` V CA EGORYt�JE GONSTR CTIO ` � , � i s work indicated on this application. -r, ..: : ' A d.11 zi..,.A...�oac.,.. �, . r ,..t. N 1e, Z,, r.aer ,, 9: . ,,ga, ` -'a 4-._e �_ 1 - and 2-family dwelling Valuation: $ ,` g o ) y g ❑ Commercial /industrial III Accessory building ❑ Multi - family Number of bedrooms: p j F=1 Master builder ❑Other: Number of bathrooms: -. SI " M O 'N _:` Total number of floors: L- " x " : ' . ( - 4 *'•' J Bu E,INFORMFAT&ION D LOCATION L'r .,. rtZ A.,,..d Job site address: (' 5 Z 5c4) 7q 'lr"r^ L ; , ; e _. New dwelling area: g c -,'D square feet City/State /ZIP: —,--. a ,r.U( (9 to_ er, ;).. ., - Garage /carport area: 66-0 square feet Suite/bldg. /apt. no.: Project name: Covered porch area: /0-0 square feet Cross street/directions to job site: Deck area: d square feet ( - B.(0-e. .k.5 .6 vr- L 0. CR S tg,Q Other structure area: square feet ` REQUIREDtDA TACOM MERCIA U SE C Su 1 ' j1 9 _.. C (( Lot no.: 4P 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 a equipment, materials, labor, overhead, and the profit for the 1 ; ' a -� "�DESC, IP�TION O WORK IV{ L .. ; 11,! r �` ; work indicated on this application. /V (/ -ug ,/s x/C. ..`v -- Valuation: $ o{. -L,,, Existing building area: square feet New building area: square feet pa :..c. i" e l . .t' OPERTY g OW1 rRR r A x i r i Cr � ate` + � . o v x ,.,y Number of stories: rp iuPR � TENANT .- Name: (( f T �� �.. i" I. C. t LA" t CAC Type of construction: Address: / i ' q \ w 4 > f (' , G-f-__. Occupancy groups: City/State /ZIP: i 0 1� Q S � � j Existing: Phone: ( 3) 6. v, - c Y4 ( Fax: (` )3 (o gY w I q co New: fl y AP PLI + ANY ,, t ' 4 ` CONT PE , : 4 - t t 4 0 �" ` u a . � � ro _. L . - n. �� k d „ d X , � g c NOTIC ,, ;,P..,11,:...'::5:,,,' '" Business name: All contractors and subcontractors are required to be Contact name: ,-----.7 licensed with the Oregon Construction Contractors Board > under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: L r�' `' , a"tCONTaRACTOR r `., _ �?a' Business S name: - ,^ - S ( Ct , .,. r a mot, ,'1 � ��BiIII,DING,PERMIT FEE*" Address: /( y 5 � G•I- e p Please refer to fee schedule City/State /ZIP: .Tc` Qt O . � a . a -3 ( ) 6b r - �i 1 GIN / Fees due upon application ( �� 'I C�_ C(� Phone: � t� Fax: (' c Amount received CCB lic.: `0 ? y ? 7 (A , 61k/I Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as c omplete. Print name Date: -j 1 /0 c * Fee methodology set by Tri- County Building Industry Service Board. 1:\ Building \ Permits \BUP- PermitApp. doe 12/03 440- 4613T(11 /02 /COM/WEB) I • . Building Division / Plan Submittal Requirement Matrix Commercial & Multi - Family - New, Additions or Alterations City of Tigard ��� yp o Submittal i woar a i% Required qi Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) • Plumbing (site utilities) 2 Building 1* Fire Protection System 3 ** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i:\Building \Forms \COM- PlanSubReq.doc 12/24/03 ., Electrical Permit Applica.tion� r . ' , , FOR OFFIC U S E O NLY , ? , t .K 4 r Received ' �� ry � City of � Date /By Permit No.: M� 5,1"--6O /c/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review `-"i--- 4' Phone: 503.639.4171 Fax: 503.598.1960® p� 2, O 10 �' Date/By: Other Permit: Inspection Line: 503.639.4175 1 ° � ► 1 e l l I Date ReadylBv: Jails El See Page 2 for Internet: www.ci.tigard.or.us - rveg" Notitiedi\lethod: Supplemental Information _.r! O -...tic AII I TYPEAFAW,OORK PLAN REVIEW V New construction ❑ A °i' n /alteration /replacement Please check all that apply: ❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'1 ❑Hazardous location Service over 320 amps — rating ❑ Buildng over 10,000 sq. ti.. CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential "E4°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 ❑ Multi - family ❑Master builder ❑Other: ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park Job no.: Job site address: / x M ,J ' ❑ Health - care facility ❑Other: — L.. Submit 2 sets of plans with any of the above. City /State /ZIP: s... � < Q � 1 ®k �' ��,� The above are not applicable 10 temporary construction service. Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE Description Qty. Fee. 1 Total Cross street/directions to job site: New residential single -or multi- family dwelling u nit. �a Includes attached garage. / - I6-� s a ! + b 0 rt rx_.+. ca . 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 I 2 Tax map /parcel no.: Limited energy, non - residential 75.00 . DESCRIPTION OF WORK Each manufactured or modular / / 1 `I / dwelling, service and /or feeder 90.90 2 "�)✓ / '�' C61/l Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 PROPERTY OWNER El TENANT 201 amps to 400 amps 106.85 401 amps to 600 amps 160.60 2 Name: CLAA i Q S 1 ( r LA" 'CC: 601 amps to 1,000 amps 240.60 ' Address: /l y 3 - 5 Sc () q - O c1*� -- Over 1,000 amps or volts 454.65 2 ! Reconnect only 66.85 2 City /State /ZIP: I c_ , r •/ (�V- « �. Temporary services or feeders installation, alteration, and /or r relocation Phone: (533 c ((q I , Fax: ( 3 Gr �(._6(f � 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 I ' intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 1 133.75 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 2 Business name: branch circuit 6.65 Contact name: B. Fee for branch circuits without service or feeder fee, 46.85 each branch circuit Address: Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or in'igation circle 53.40 2 Phone: ( ) Fax::( ) Sign or outline lighting 53.40 2 E - mail_ Signal circuit(s) or limited - CONTRACTOR i energy panel. alteration, or extension. Describe: Page 2 ' Business nam C,.0L E(`e - -tf A. Address: r Each additional inspection over allowable in any of the above Per inspection 62.5(1 I City /State /ZIP: Investigation per hour (1 hr min) 62.50 • Phone: ( _ _ K, O _ _ �, . - Fax Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: I Electrical Lic.: Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (23.i' of permit fee) State surcharge (87'o of permit fee) Print name: Date: i TOTAL PERMIT FEE 1 Authorized signature: I . This permit application expires if a permit is not obtained ssithin 150 _ - days after it has been accepted as complete Print name: • Date: • . /0 f/ . Fee methodology set by Tri- County Building Industry Service Board I / 7 " Number of inspections per permit allowed. i `,Building \Permits \ELC- Perrnit.App doe 12103 aa0 - 40 15T( io ■o: CONI :w1 :B Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... 575.00 Check Type of Work Involved: 1 Audio and Stereo Systems* Burglar Alarm • n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems 1 Boiler Controls - n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC 1 Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls 1 Outdoor Landscape Lighting* n Protective Signaling n Other _ Total number of commercial systems: *No licenses are required. Licenses are required for all other installations , Bui Iding''_P<rmicslE LC- Permit A pp. doc OW03 Building Fixtures Plumbing Permit Applic`ati'o e FOR OFFICE USE ONLY • City of Tigard Received \ *j,0o a ,/ 7 Date/By: Permit No.: 1�( (DY/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.196 2 O 10 UHVna 1 I ° + +, Date/13y: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 Rc �� 7 1 i Iuris: .1 v - W D a t e R ea d yBy: El See Page 2 for Internet: www.ci.tigard.or.us �, O� G+ Notified/Method: Supplemental Information T { , s " �� T � O ORI . * . r - %t " ' , x F E SC LEA "st . _ ' s? ..�, . '�' _ k .. ,, +fir < - ' w.i`i„ .,..., 'e.,� k4 ��.1!: � 3i.� .J!. :r ..:'ea _ .x . ;. =. . ,a a ,x :_ r.. - . f New construction ❑ Demolition For special information use checklist. Description Qty. 1 Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) M T '` t *:'71 k a:diii OF C01 STRUCTTOFt ' M i t ar t t " "P l [a . r :6,2e ,,» e01111 T,�� 6 , . .z€ a.. ,. . a4. r,.� a SFR(1)bath 249.20 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 ,�r ear ,r JP, . OB SIT WFORMATI(5N a IfOCATION ,. ,64m .. ,.. , g , . X1,, W , � ,,:w Site utilities Job site address: /5- 7G;).... Sc4) `f4•-■ pt _ Catch basin or area drain 16.60 City/State /ZIP: --- /-0 p Vim' ar q .) 2-? Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: (� o, Manholes 16.60 -� W or, t� � S m l � �J-t .,.,,� Ps. (Q -- 5A-) Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no NOW' ru , Absorption valve 16.60 _. + ESCRIPTION OF 6Z , ai ''' & xired t v, . �.� s ,, ,,� ;4 - bra, - _ .. ' x.t - Am . . >.t. . Backflow preventer Page t y /J�.�_ i ( t ' Backw valve 16.60 /l Clo washer 16.60 Dishwasher 16.60 hw -, d p ��� a Dri ater foun 16.60 _ � ;�, * ittrriWNER� �t.gM. r ,.'. "Vr 1N . t Ejectors /sump 1 6.60 Name: , - sf 'S (( C:--‘"c:-- Expansion tank 16.60 Address: //'(-( S S c,t) q> V-^ c f--- Fixture /sewer cap 16.60 City/State /ZIP: "/`'t•'cp ✓c i ek q") D -D- 3 Floor drain/floor sink/hub 16.60 Phone: 5a) 6 (( 6 t(q p Fax ( 553 6g`( 6 71 Garbage disposal 16.60 P - 1 r, r 1 ,l , t � .�. L C ;AN„ T S a, : , 3 :, ®CON A C CT , PERSON ;( Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: ✓ ` , Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Sink/basin /lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 g i i n�'t` m OI T TOR ...Q, Water closet 16.60 Business name: '' Z (i { {-f- P.I() (-a-Al Water heater 16.60 Address: Other: City/ State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: 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 Fee Schedule: Residential Fire Suppression Systems: 4 ,r r FCe 0aI roam f e r SiteTThl><ties : Q rz ,.0 t ) ,.Sgiare ,Footage `...• ,, _ Pexm tt Fee... Footing drain - l 100' 55.00 • 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 �a'luat>loi ° �perilllt Fee $1.00 to $5,000.00 Minimum fee 572.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each QtyRee (eat Tofal additional $100.00 or fraction thereof, to and Fxtuleor )tern .....> including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to 525,000.00 $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 525,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to 550,000.00 5379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: 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 * . 1 t Quantit by (F►xtu rk werform �_. ; � � w W ;4f MaPea x�stin cappea 3 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 ewer p Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. 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 Mechanical Permit Application ' -, - FOR OFFICE U SE ONLY . `' . City of Tigard Received permit No.: 13125 SW Hal] Blvd., Tigard, OR 97223 G ' t "' Date/By: 5 _,-, A ,,„ .... �� Plan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.19 Or %aNMvI Date/By: Inspection Line: 503.639.4175 O _ i I I Date Ready/13y: Juris: 0 See Page 2 for Internet: www.ci.tigard.or.us kik0 R° Notified/Method: Supplemental Information nc Ite...cea1NG' Vair 4 ..n ' 4Xiii, P O ASZOV 7 ' . ' 1 Y 4 0 31 w �. � x EE CIA "--r--,,,--"''', i S COMMERL D E UL - ' -': ; CIIECI{LIST` - • on/alteration/replacement Mechanical permit fees* are based on the value of the work mod, ew construction ❑ Additt performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. {� t rf ' a mirow 4 , F ;c• 1 m Value $ 4 ii N «.r�, i40Ati. �a1r _a . �.'Al.. ,r0..M -,: 9.c.. x4i1111a s. ;u n. s.. .;.,.._ P4E,1 .�`s�x .a "- 4m - 1 - and 2 family dwelling ❑ Commercial /industrial El Accessory building < r WIDEN, IAL EQUIPME'YT YSTEMS FEES* M builder For special information use checklist. M ulti - famil ❑ y ❑ ❑ Other: Description Qty. Ea. Total 1 e` Air' :r - suz r r ' a a a ',s a o° a '"S%a r i° c. �; - x ,14,- ; J O „ INFOItM 1„44. 4 , da " a s Ei ,,, Heating/cooling Job site address: J` S 7 ` S (, 2 7q T .L ,t� _, Air conditioning or heat pump l ( l (requires site plan showing placement) 14.00 Ci Furnace 100,000 BTU (ducts /vents) 14 4 4 ty /State / ZIP: �� ® � �� Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 �, Z- Hydronic hot water system 14.00 ,./S- ��f9 e CTS �� - rjj C Residential boiler (radiator or hydronic) 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 p7 O r V s, r it , ° fir:: , Water heater 10.00 -41:.•:• x ` pe r : DESGRIP I O i O F ,W .'n t . :, :< - tf ': / Q( Gas fireplace 10.00 /f / �(... ,`vf -,- a CSI c- it " e - ai Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 ) a t itai fiFro kii7 5 ',E _ n � `' TENANT w„ . , a` 1 Chimney /liner /flue /vent 10.00 .- . - . ..... .,...1. - - gir::: 1 *� . �w."& -. _ . P ., :..� Other: 10.00 Name: C.2 r l C.24." e C G r ,, tA. 1 c _k_., Environmental exhaust and ventilation // 5 ��� � c' l •` pi-t-, C Range hood /other kitchen Address: equipment 10.00 City/State /ZIP: N----- 4, ©� 4' D4'-. Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( 3) 6i/'- 6 Yu ,,j Fax: (1)3) c ( 6 Y 4� c toilet compartments, utility rooms) 6.80 f � � A N' : x M a RCONTA T'.'PE12SON z N Attic /crawlspace fans 10.00 Business name: Other: 10.00 Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Q Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended /unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range ,'r , , "gt " ' ` i a g ., - ` s xs ' , Barbecue �� SW/ W / ` / Clothes dryer (gas) Business name l� „ Other Address: ,, rg r " + I.� u T aFE n * y . , �MEGHAISICAL PERMTT FEES City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 • d ays after it has been accepted as complete. Print name N "ta, 1 S I 1 G,.∎, I G . Date: Ls / 3 _ 0 41 y * Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I 1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total'�'a nation, . Permrt Fee _ . . $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 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 • Permit #: 1`'( o - CO N7 Address: l ,A A4..) 79 C Issued by f \ - a Date: /' 0 • Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: . 1. I own, reside in, or will reside in the completed structure. k 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ......);‘,4.,— t J ((tr...A.t.7---- (Signature of permit applicant) (D te) (White copy to issuing agency permit file, pink copy to applicant) ` . . � ^. • Notice to Property Owners About 'Construct'on Responsibilities • Note: This Information Notice to Property Owners about Construction Responsibilities was developed by t/ie (Jonsti'uct/on C Board in accordance with ORS 701.055(5). • lfyou are acting as your own contractor to constructa new horne or make a substautiai irnprovement to an existing structure, you can prevent many problerns by being aware oy the following responsibilities and areas ofconcern. EMPLOYER RESPONSIBILITIES: lfyoo hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an ern ployer and the people you hire will be employees. As the emPloyer, you must comply with the following: Oregon's withholding tax law: Asun employer, you must withhold income taxes from employee wages olthotime employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. o[ Revenue u1g45'8O9l. Unemployment insurance tax: As. an employer, you are required to pay a tax for unemployment insurance purposes on the wages of alt ernployees. For more informatioii, caH the Oregon Ernployrnerit Departmentat 378-3524. Workerx`onmupenmwtiwmimaurmmce:/\suuemp\oyer,youureyobjcotontkcOrcgonYVorkcrs'ComVennutionLuvv,00dmust obtain workers' compensation insurance for your ernployces. If Ifyou fail to obtain workers cornpensation insurance, you mav be subject to penalties and will be liable for all claim costs ifone of your employees is injured ou|he job. For more iufonnation, call the Workers' Compensation Division u\ the DuP rtmento[Conyumeroud8uoinesoServioes U.S. Internal Revenue Service: As an employer, you mustwithho Id federal income tax from employees' - wages. You will be liable-for dhetuspayment evenifvoudidn'tuctua{\ywhbho\dihctam.Formnnciufbouotinn at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: Asthe perm it holder for thi you are res ih}nfbrreooh/inganyfai|un:tomeet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: C your insurance agent to see ifyou have adequate insurance covma&e6nr accidents and oniissions such as failing tools, paint overspray, water damage . from pipe punctures, fire, or work that must be • re-done. Time to supervise employees: Make sure you have siifficient time to supervise your emp)ovees. Expertise: Make sure you have the expertise to act as your own genera I contractor, to coordinate the work ofrough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections, If lfyou have additiont qucstions, write or call the Construction Contractors Board (PO BOX |4l4O, Salem, OD97309'5052. 503/278-462}). The Board is located ot70O Summer St. NE Suite 300, in Salem. . pmp'm,n.pm* |/94 • STREET TREE C .. .. E r I, or..`c fc ��- r /A Ownegent for ( a K( _S `� �^ t (PLEASE PRINT) r (PERMIT HOL 4°C) �Q Do hereby certify that the following location C1 � .G �ti meets City o YTi W ashington County 85 04' land use and development standards for street tree installation. ri t° fe. 112,L IT — a y l ADDRESS: (5 7 �� t74 0 � ` )-(-- (i q v �(' 7 � 3 LOT: SUBDIVISION: f BY: , — DATE: (� q RECEIVED BY: _ DATE: Elk VVVVVVVVVW4W CITY OF TIGARD 24 -Hour BUILDING 410 Inspection Line: (50 639 -4175 S MST INSQEQ.TION DIVISION Business Line: (51 639 - 4171 BUP Received Date Requested /)- — 10 • PM BUP Location AN Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: ( ELR Crawl Drain 01- " Slab Inspection Notes: SIT Post & Beam Shear Anchors - Ext Sheath/Shear 1 Int Sheath/Shear is�G E j�_Z `- - Framing Insulations Drywall Nailing Firewall /'`/'1 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof OA OA PA PART FAIL P MBING m Under Slab ijIi1. 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 AI-rm / Reinspection'fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. P S -• PART FAIL SIT' ❑ Please call for r nsp :. ion RE: Unable to inspect — no access e Supply Line �q ADA g i v Ext Approach/Sidewalk Date Ll Inspector Other: Final DO NOT REMOVE this inspection rec rd from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour • BUILDING Inspection Line: 03) 639 -4175 LI _d a 147 INSPECTION DIVISION Business Line:, •03) 639 -4171 MST BUP Received Date Requested / AM PM BUP Location Cf-t- 4 �..:� Suite MEC Contact Person mot.. _ ( ) E 7 7 PLM Contractor - ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain. Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear U� r �. �D i Framing.` Insulation �,�. � -7 _ sir. Drywall Nailing Fire Sprinkler -- '��� Fire Sprinkler _ Fire Alarm f' t> V Dc� �� 'l� % C�L% /3/I //i■/ Susp'd Ceiling Roof 1\1- l �- ! �7! ) /N Other: o Kiev i / / ivb S / -i4e /' - SS PART PLUMBING ir 3 P2 o u/ rte (� 7) J4 12A-i Post & Beam F 2 U P I �2- 7i e-2 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 S PART FAIL CTRIC AL Service Rough -In UG /Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. - PASS PART FAIL 1 SITE El Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line `- ADA Approach/Sidewalk Date Z` 9 ` o Inspector ...411!, Ext Other: Final DO NOT REMOVE this inspection rec from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 ' INSPECTION DIVISION Business Line: (503) 639 -4171 MST •/4/7 BUP Received Date Requested 1 AM PM BUP Location / s 76a a— / L Suite MEC it Contact Person f �}'j� Ph ( ) t� ' 7 a 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 Framing Insulation Drywall Nailing . /_ 4 Fire Sprinkler " Fire Alarm / V Susp'd Ceiling - ' _ / /_ /' -%' Roof Other: Final �e 4 PASS PART FAIL PLUMBING Post & Beam - �f � Under Slab %�� "' '~ Rough -In f Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole fa Storm Drain Shower Pan PART FAIL CHANICAL 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 t I Date Inspector • • � Ext Approach/Sidewalk �� ��� Other: Final D • NOT REMOVE this inspection record from the job site. PASS PART FAIL • C • ES13USINE55 FORM5: INC. %(503) 242 -0884 �ITY OF TICGARD 2 Ho , - - BUILDING Inspec 0_ Li � rie x(503) 639 -4175 .91 C .f ( ON DIVISION .. f..'Busin ' -s ='ne .:(503) 639=4171 - IN CTI/�,^,.. BUP /, a Requested b - ` �� AM PM ` `BUP '� eived = Date Req ` .ocation / S C2. r)— `'l T .— I - - Suite. MEC. - ,ontact Person - Ph ( _ ) : . . ` PLM,. ,ontractor Ph ( SWR - ';t' Tenant/Owner • ELC . fBIJILDING ` 'x�,x _r ,x Footing ELC Foundation ' ...- . ' 5"4.,, -i f fn ; Access �e, '�t� ��� �� ELR Ftg Drain' '3V-'k=:.'-': ; . , s •: 4- . , � Crawl Drain -" " ' ' SIT Slab . Inspection Notes: - Post & Beam • Shear Anchors Ext Int Sheath/Shear - Framing I Insulation Drywall Nailing . ■ Firewall . Fire Sprinkler .. - . Fire Alarm Susp'd Ceiling Roof . Other: Final PASS PART FAIL PLUMBING``„ -°' VA Post & Beam Under Slab Rough -1n Water Service Sanitary Sewer Rain Drains • Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL S-- 1 ~, } ::MECHANICAL ' ° ., e _ ? ' - 1 _ 1 . A), " Post & Beam Rough -In `�^ h � r /,, /t Gas Line p� Y �� \ ' i ) P i t7V/ ' ic✓ ? L2/ Smoke Dampers Final PASS PART FAIL CT• .AL= `: tF"x`rE ery - 4o UG/Slab /V (L .. t ow Vc�� 1-ire Alarm rm Sal n Reinspection fee of $ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. RT FAIL :SITE' - =.::4" ., &:�' ; . - ❑ Unable to inspect — no access Please call for reinspection RE: n Fire Supply Line ADA Date /6/7V7/ Inspecto Ext Approach/Sidewalk • Other: Final DO NOT REMOVE this Inspec record from the b site.