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Permit ; r _41... �. CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00120 "PilI DEVELOPMENT SERVICES DATE ISSUED: 4/28/04 13125 SW Hall Blvd.,,Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11084 SW 81ST AVE PARCEL: 1S136CB -08800 SUBDIVISION: HERB + PEGGY'S PLACE ZONING: R -4.5 BLOCK: LOT: 026 JURISDICTION: TIG REMARKS: addition of 600sf. Other mechanical is duct work. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 600 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 55,440.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 600 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 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: 2.00 SIGNALJPANEL: 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: $ 1,140.00 This permit DEES, DANIEL L SHIRLEY M EXECUTIVE CONSTRUCTION & Mui c to the regulations contained Co i ode s and the 11084 SW 81ST REMODELING Tigard Municipal Code, State of OR. Specialty Codes TIGARD, OR 97223 10928 NE KILLINGSWORTH all other applicable laws. All work will be done i PORTLAND, OR 97220 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: Phone: 503 762 - 1675 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 119919 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Underfloor insulation Shear Wall Insp Mechanical Final Footing Insp Crawl Drain /Backwater Exterior Sheathing Insi Plumb Final Foundation Insp Mechanical Insp Insulation Insp Final inspection Post/Beam Structural Electrical Rough In Rain drain Insp Post/: - o - • • ical Framing Insp Electrical Final ■ "000 11111 4 VIPIP PIPP— ssued By : L 0 .d/ , r /./ z..� . ; ' Permittee Signature : i � VI Call (503) :- 9 -4175 by 7:00 p.m. for an inspection needed e P • t busi -ss day Building Permi p ' 21.ieatiW1- ® FOR OFFICE USE ONLY „ 1 I1�'� 0 r t la Received ' (j City of Tigard DateB : f i•3 O`/ ,6/ PermitNo.: T" e 004 13125 SW Hall Blvd., Tigard, O12 Plan Review , Phone: 503.639.4171 Fax: 503 598k1960 4 2004 40,4 a li Date/B : Other Permit: Inspection Line: 503.639.4175 r:: Date Ready/By: Juris: lZI See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION „ 5a 10, : 4P i 4 gi",.�:'..f ,�t'o a iit:i. P I$ ::.. = =.Zf"fi ,,, p A .,. t yi H, r tl _w'iG RY.v F F A: d Y ' ii p , _ _ ^..h i x :�:0*m x.,,`.:::tu`i. . -. i` =ik� .;`_..rr.,TYPE, OF WORK" .t. }ai.: . . . . € ` t- - sa :td �,,. ;,,.. -, i.1 QIIIRED DATA: L.;AND,, FAMILYDV1!EtiI.TNG H !� its e � �. _ . .1 m ^s � P + r Permit fees* are based on the value of the work performed. ❑ construction ❑ Demolition Indicate the value (rounded to the nearest dollar) of all Addition/alteration/replacement ❑Other: equipment, materials, labor, overhead, and the profit for the ". , ,.; h ... ` ,CATEGORY, OF CONSTRUCTION O ,!, �y � ' ° -, t ' ,, work indicated on this application. Valuation: $.,` - Z'3' 1- and 2- family dwelling i ❑ Commercial /industrial Number of bedrooms: 5 ,'i N U ❑ Accessory building ❑ Multi - family ❑ Master builder ❑ Other: Number of bathrooms: , , ,� x c ,w r A ALIT; , , t . f t t Total number of floors: ,. . ` �,, JOB SITEa INFORMATION AND�LOCATION i Y, t 1, a , L OS A , l •1 O j 5 `� 9 i st A New dwelling area: / 0C) square feet Job site address: TJ` \ z City/State /ZIP: � , _ C.._4 -- V -� 97 �p. J Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: ��� Covered porch area: square feet Cross street/directions to job site: 9 C1 f4 t .`/ Deck area: square feet Other structure area: aa) square feet oro, fi r'. Y'S t g^ s "4 *," * a a e REQUIREIXDATA COMMERCIAL USE CHECKLIST' }> 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.: ESQ 478,53 equipment,. materials, labor, overhead, and the profit for the t a*tu ., t it .,:� s a work indicated on this application. �,I a � , r o 4,DESC QF R'ORB ;��A..� �_.,, �.. �.. `r . .ar e . __,. a �, a.: �,�xza x.i.:4,5 � ;g ,.=E , x'r - _ \c 1 S ` (� , `� t \r Valuation: $ �• F Existing building area: square feet New building area: square feet 4 ' ® PROPERTY OWNERi r '= 3 is : ` A r TENANT p , r R% .� Number of stories: C ` Type of construction: Name: J h. `f' e , S Address: VI p W B 1 Sk Ave__, Occupancy groups: City/State /ZIP: , \ C -> ! �� 5•7_" Existing: Phone: ( o ) (,D._ Q' 65 Fax ( ) New: T e °APPLICANT r 0 fark t . „ c *1 ! ,70 r NOTICE l CONTACT PERSON r ` A0 , �. 33.h...,xs,.�§` ..., €. , svas�� -s ! §" _..��t � i 6 . k .,, e z.:� nl.. � � i, .� ( x � � gimi . ., _ _ n �* � s °, .. '._ t. 2 ?! Business name: �� e_c ,..�_ ,.,..., c � " ,, ,Y�� F � . ky All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: v * 6* under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the a c o U t' ` �^ `1v '�' applicant is exempt from licensing, the following reasons City/State /ZIP: C ''(yr -\---N G r- l (� � 97P2-0 apply: Phone: (503) 7 c,.- 16 S ^ Fax:: ( ) E-mail: h e f , LV.-, `e' VYN5y1 c ' - - -- Business name: ' A`, �° a � � `� � BUIL PERMIT :FEES * � - S k Address: Please refer to fee schedule. • City/State /ZIP: Fees due upon application Phone: ( ) Fax: ) Amount received CCB lic.: `' 9 \ -) y /7 oe( (jjj Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: • M+V-_= � Date: on: * Fee methodology set by Tri- County Buildin Industry S Boa a ^ I ,� � �-rgti �— is\ Building \Permits \BtJP 'ermitApp.doc 12/03 . 440- 4613T(I I /02JCOM/WEB) ,Ev • V (f' �( (J • One- and Two - Family Dwelling ' Building Permit Application Checklist , FOR OFFICE USE ONLY City of Tigard oar /Bed Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Y g Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 �% h ■ tv , '�di��N� ) q x ❑ Electrical ❑ Plumbing ❑ Mechanical 24- Hour Inspection Line: 503.639.4175 �-a±i 67.1 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 corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft, elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ 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 Ore:on and shall be shown to be applicable to the .ro'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 Devel2pment 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 - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures td existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 Electrical Permit Application FOR OFFICE USE ONLY . City of Ti and Recezew g Permt / _ 00Igo OR 97223 ECEI Phone: 503.639.4171 Fax: 503.598.1960 �� NIA Date : Other Permit: i t "AO B Inspection Line: 503.639.4175 M. Date Ready/By: Juris: El See Page 2 for Internet: www.ci.tigard.or.us j ADO 1 41U 4 Notified/Method: Supplemental Information r q tr , " iii ' YR ° r w fr at >a V <: �c. M r si r A 'W re A . z . t iii ., t .. 4. , � . ,.,.; T PE�®,, R , O 4nR� Yts ... - fain : - 44.igi .... ,: �'': _A - T PLAN R EA, I , W . , :,, ❑ New construction ddition/aliera "tion la pp ent I t Ul V I ° Please check all that apply: Service over 225 amps, comm'l ❑ Demolition ❑ Other: BIIILDIN ❑ p , ❑Hazardous location s ❑Service over 320 amps rating EBuildng over 10,000 sq. ft., ,,, M r W ,a x 1 N r CATE, 012 OL CO? ST UCTTON S � 4 r ` , of 1- and 2- family dwellings 4 or more new residential - 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 E builder ❑ Other: Q t O N "�' ❑Occupant load over 99 persons ❑Manufactured structures or k ` a , JJOlB SITE INEORI IA '1(ON Iolow ❑E /li plan RV park Job no.: Job site address: 11 t/ St„..) 8 1 S� .� ❑Health -care facility ❑Other: � Submit 2 sets of plans with any of the above i City /State /ZIP: \ GK 57 �, 3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: roject name: p l I. _ �. kt - DUPE - . �/ Description Qty. Fee. Total Cross street/directions to job site: New residential single - or multi - family dwelling unit. Includes attached garage. 0 \A / 1,000 sq. ft. or less j i g 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 ot` =.a' x DESCRIPT XO I I � O F , O Tti w ° "'` i , i t ;_ Each manufactured or modular dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 1 ' Ir ` 0PR Ig g T OWNERS I TE pto 201 amps to 400 amps 106.85 2 N 14NrT � , ,. a _. ,.� .��� . 'v , �.. w .eti. 401 amps to 600 amps 160.60 2 Name: S i S 601 amps to 1,000 amps 240.60 2 � , 1 J �e Address: // r ? • / / $ (A) 3 j S4 AL ,t) p Over 1,000 amps or volts 454.65 2 --v-, / ) - L� Reconnect only 66.85 2 City /State /ZIP: 1 1 c /'1 F., 5 7e-) 3 Temporary services or feeders installation, alteration, and /or Phone: (, ) Ca _ �7 0 Fax: ( ) relocation 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 t m " e, ' r i A. Fee for branch circuits with L I ... 1 ` .0 t mAM I ' A . , —: G ®1v Talc r. r IiS® ,, service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'l branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: • Signal circuit(s) or limited - i i g y : i -� . *...' ITRA.CTOR ` H " , ' "�' r energy panel, alteration, or . .z �.�t,. ',. r '. "..," 1 � extension. Describe: Page 2 2 Business name 0 p� / � C�LC�a( e.: Address: 1P-`6? g/� • i. e- N c . qS4 Each additional inspection over allowable in any of the above `�� Per inspection 62.50 City /State /ZIP: 4.4. 4 / G Oe.._ 9 7/ 9-7 Investigation per hour (1 hr nun) 62.50 \P$f / lone: Industrial plant per hour 73.75 Pt (1}3) "7 D4 1 ( Fax ( ) '. A ELEGTRICALL�PEI2MIT FEES* _' I , 'J CCB Lic.: / 7g Electrical Lic.: / : Suprv. Lic.: Subtotal .,.. �,.......,,...____ ;gnature, required: / ° r y ( °� Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) 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* ❑ Other: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls • ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls Outdoor Landscape Lighting* • ❑ Protective Signaling . ❑ 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 Fixtures Plumbing Permit Application ® FOR OFFICE USE ONLY City of Tigard E CE% !J DateBed y' Permit NoJ S x.00 a0 / a0 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 P /f/#2744006 � Other Permit No.: APR `I „,.A4140, R DaDate/By: 24- Flour Ins ection Line: 503.639.4175 jpR 1 ' p 11,.. Date Ready/By: Surfs: El See Page 2 for, Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information "'t 7- xg, .r.r t' ° L f 1 x ,a t � s .ro. o '^'�.. ve v ` t" z °_ -, _ r ;; -;�; F.% i s 5 s, V a x „ FEE* 'SCITEDIJLE . : : � �' ��:.. » u T'YPE�4F R. I `F �a'.. -:" � ��o'.k ., »;�, ❑ New construction 13U .:' rtte.f �' nth' Demolition For special information use checklist. Description I Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: . New 1- 2- family dwellings (includes 100 ft. for each utility connection) g` 0Z 3 l CATEGON O STCRiJCTIOIY �' r SFR (1) bath . 249.20 $...,F.iMitt.34&, %Illtd ..r,.z 4es.. 441. aEu ,m,.. » a' � ` e. ,.: IC m„a . r_ ., ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building El Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder D Other Fire sprinkler ( sq. ft.) Page 2 r. sF -'.� tea 5 "a x et ,y xt °'a i � » y - OB TT�EfIN�OR T a A : �I ' "Y Site utilities Job site address: 1 / O94 J( n �i f G • Catch basin or area drain 16.60 City/State /ZIP: / ei-a.X Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: - S Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no 4 �" a r k Absorption valve. 16.60 f k D E S CIt PTI0 0 W x r i Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 TA r .� c Drinking fountain 16.60 y� I f, PROPERW O ER�rx o " "1 T , . .�. �..� . _. Ej eC102S /SUrilp 16.60 Name: . ,,,'9 t Expansion tank 16.60 Address: " Fixture /sewer cap 16.60 City/State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 a s Hose bib / 16.60 Fta k ? ,.€ _ . »..,. A f CCO � � , ` u ` _ GONT . ...E ERSON.,. , . 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 Phone: ( ) Fax:: ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 C eta Fh "? ".; " 'fir CgNTRAC ®R Water closet 16.60 • > x 1 a ... . �, . ate , .: � 3 1 , ,1 r. Business name: / ` L 1.4 J J._f, , 0 Water heater 16.60 D (� . / ¢ t p Other: Address: � !-� � 0 7� ,/�� City/State /ZIP , 1' W f7 _ Subtotal � ��./ Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: /p15 75, Plumbing Lic. no.: 3 7 -, 7/J5 Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: )S - 7 ' 7to q 39 -t3 ► Pe TOTAL PERMIT FEE Print name: . DS(Q 5 s 0 / Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 7 D ( . *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Permits\PLMF- PerrnitApp.doc 12/03 440- 4616T(10 /02/COM/WEB) 3 a - 7 - L(C175- Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: 'Salt � tfire � Rolm wee op z Tofa u; > t .. ,i=, -r .� .. ), „.`agcy .. . d �l nlit 'ee ,� Footing drain - li 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 v aluation / .Perm><t °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 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each rt �QtyFee (ea `1•.'otal ` ^ additional $100.00 or fraction thereof, to and 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 Backftow 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 $50,000.00 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 ',5V 047 _ zxmiit't5ovvii-vorfimRot.Rtiiiiiiw5 F are "TYPQ a r y , t t Repiace Po 40; l Mu xtsnn Capp Comments regarding fixture work: .. ,: New 1. _ n ��a� re.... ,. ,�, 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 Ice Mach. /Refrig. increase of sewer EDUs, a sewer permit will be issued and g. Drains � A 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: is\ Building \Permits\PLM- PemutApp.doc 3/03 RECEIVE!* Mechanical. Permit Application FOR OFFICE USE ONLY City of Tigard AN A ' LUO ReceivY ed 1 Permit jT Cd ) ea.4 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.59A.96Y OF rIGNND /�/ 4/ Date/By: Re Date Plan Review Other Permit Inspection Line: 503.639.4175 BUILDING DIVISION . j f 1 Date ��i w Ready/By: 0 y: luris: See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ° k s. - w Y , o YP O WQR Y .� s ; 4 - , a , 0 00MNIERCT�AI IEEE SCHEDCJ ,- - • . HECKLiST =` ❑ New construction 'd dition/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. _ '�l atit,, >�CA EGOR`�Y OF C . RUCTT ©N u . ,, 2,.Ir . . 4:i Value $ RESIDENTIAL EQUIPMFN / SYSTEMS FES. 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building " ' ..0 .. For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total i s ®B SITE I FORMATION AND LO,CATIO'� ttt + 4 , Heating/cooling Job site address: I I D y S L 1 -g i � Air conditioning o heat pump (requires site plan showing placement) 14.00 City/State /ZIP: ,D 3 Furnace 100,000 BTU (ducts /vents) 14.00 1 P C J �� t Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: �-/ Project name: Oec 5 Gas heat pump 14.00 Cross street/directions to job site: 4 i j y 99 Duct work 14.00 1 Hydronic hot water system 14.00 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 "" ""' t Water heater 10.00 ° , 4 DESC.RIPTIO t�'OF�W0 :'` . l ` M 17 Gas fireplace 10.00 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 F is Y i Ot T �4,, .¢, ;. GS NA o t` � F} Chimney /liner /flue /vent 10.00 ROI?RT ONER +�.y. t � ®, ✓ , . ( Environmental exhaust and ventilation Other: 10.00 Name: __Si-7 1 y - /' Address: GU UUU d st Range hood /other kitchen 1 �� / w (l equipment 10.00 City/State/ZIP: -�; l 5' 73-) 3 Clothes dryer exhaust 10.00 �/ ' I G - �J Single -duct exhaust (bathrooms, Phone: ( 5 ') “ 7 Fax ( ) toilet compartments, utility rooms) 6.80 , V i y �!x - T t nG" oi . Attic/crawls ace fans r 10.00 �� APPLICANT w � � CONT AC °Ta° I? ERSON ' xis+ P Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended /unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E _ „, Range f � ,�,. •a' ,� a r ; �„ '�'° .�^� �r� r- �� a csc. r � t ``,,fit ' "� p �- ' � + � T CO sTR CTOR" .� z�x -..d ma v,> '�, . _ � ���^� ��. �4a.:. s�,., �.`)'.�w.� ,. ,,���r; Barbecue Business name: -/ r ✓y aosi Clothes dryer (gas) Other: Address: t, r r x , N �M ECHANTGAL PERMIT FE- 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 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 (11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Tb b aluratton PM .v P erm to Fee Pte 1 $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. g q P i:\ Building \Permits\MEC- PermitApp.doc 12/03 2 CITY OF TIGARD 4 61V 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE NELSON PLUMBING SERVICES LLC 20565 SW 104TH TUALATIN, OR 97062 Plumbing Signature Form Permit #: MST2004 -00120 — - — —_ -- _ _ Date Issued: 4/28/2004 Parcel: 1 S136CB -08800 Site Address: 11084 SW 81ST AVE Subdivision: HERB + PEGGY'S PLACE Block: Lot: 026 Jurisdiction: TIG Zoning: R - 4.5 Remarks: addition of 600sf. Other mechanical is duct work. 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: DEES, DANIEL L SHIRLEY M NELSON PLUMBING SERVICES LLC 11084 SW 81ST 20565 SW 104TH TIGARD, OR 97223 TUALATIN, OR 97062 Phone #: Phone #: 503 - 957 - 1883 Reg #: LIC 157769 PLM 34 -431 PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of A ° =rized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST ° QC - 0-6 INSPECTION DIVISION - Business Line: (503) 639 -4171 BUP Received Date Requested AM _ PM BUP Location /10 3 `' L Suite MEC Contact Person Ph ( ) 76 ,- J / PLM Contractor Ph ( ) SWR UILDI 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 r ie Insulation Drywall Nailing o6' Firewall �- 1l Fire Sprinkler Fire Alarm Susp'd Ceiling Roof "giber: in -, < AS PART FAIL Post & Beam Under Slab Rough -In Water Service Sanitary Sewer" Rain Drains Catch Basin / Manhole Storm Drain Shower Pan i t )1 Y7o 01\i L ,. ' 311 \t ..1-, (O. 1l l.11 V§ § Other: - • PASS PART FAIL /CHA AL Est Beam Rough -In Gas Line Smoke Dampers in Sa -ART FAIL CTRI L Service Rough -In UG /Slab Low Voltage Fir- . larm PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA 9 Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from theldbite. PASS PART FAIL ,