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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00257 A- a, DEVELOPMENT SERVICES DATE ISSUED: 8/25/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11400 SW 90TH AVE PARCEL: 1S135DA -02900 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG REMARKS: First story addition and remodel. 11/7/03 added WH, furnace, a /c, waterline, vent and gas line to permit BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 21 FIRST: 836 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,403 sf GARAGE: 552 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 90,660.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 2,239 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 3 DISHWASHERS: 0 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 3 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: 0 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: 1 VENT FANS: 3 CLOTHES DRYER: 1 FURN > =100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: 00 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL 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: $ 1,747.58 VASILE REPTA WILD WEST CONSTRUCTION This permit is subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and 11400 SW 90TH AVE 18956 S. LELAND RD. all other applicable laws. All work will be done in TIGARD, OR 97223 OREGON CITY, OR 97045 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: 503 730 - 9969 Phone: 503 - 319 - 9122 Oregon Utility Notification Center. Those Hales are set forth in OAR 952 - 001 -0010 through 952 -001 -0080. You Rey #: LIC 65425 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control lnsp & Post/Beam Structural Mechanical lnsp Shear Wall lnsp Mechanical Final Footing Insp Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insi Plumb Final Footing Insp Underfloor insulation Electrical Service Insulation Insp Final inspection Foundation Insp Crawl Drain /Backwater Electrical Rough In Rain drain lnsp Foundation Insp PLM /Underfloor Framing Insp Electrical Final Issued By : - ' _____ • Permittee Signature : Li t / '/ef I Call (50 ) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application FOR OFFICE USE ONLY Received ll�� 2 �e Date/By: �E A I 1 Building Permit No. : �'0"�2�✓'G�p� 7 City f Tigard Planning Ap•rova Other y Date/By: Other No.: —� CA 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 � Date /By: IN A) 6 - i 3 - 0 3 Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 A,A1 / 4 11 Post- Review Land Use C . Date/By: Case No. w Internet: ww.ci.tigard.or.us Contact Juris.: CO See Page 2 for 24 -hour Inspectio Request: 503- 639 -4175 Name /Method: Supplemental Information (e/ o 14u F RoJ af.`Decu►- t €41 •THAT - eimEr-t r CS §owl dtbE 6F P2oPs.2T'4 I+ls �eciJ 1tM • �p t. .. s >.` .1rtr EA'ti l� �. �:�. `'�,.G .' yx�.�n:s'. %r. v = c �_ =ta ,arr�:�Ys: `'��• *��; „. ` .. ,`�'j .., : 4',i TYPEOFWWORK .:t - `. .. �� ..... x._ REQ DATA , 'i _ r�'` 11] New construction ID Demolition - F � A 1 al '& 1?AMILY DWELLING X�` E1 Addition/alteration /replacement ❑ Other: ( , '''' , = y pC`ATgEGQRY::OF�CONSTRUCTION �� �i' "'" 1 Note: Permit fees* are based on the total value of the work performed. Indicate `�-L ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, L overhead and profit for the work indicated on this application., ❑ Accessory Building ❑ Multi- Family �� f� wo ❑ Master Builder ❑ Other: Valuation $ R ;c: 1-ir OBIS INFO dItae.ATIION f i n',1 No of bedrooms: ,e No of baths: 3 Job site address: a c iQ' , , j / a Total number of floors A' New dwelling area (sq. ft.) 1 y Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) 5 5 Project Name: Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) C i ^Qel 6 -i' fc CI w 1 90 ) 4 ij. h` „, ,y . p ; . , �, _ 1 REQUIRED DATA ?' t ' 1,COMMERCIAL USEICHECKLIST' ' Subdivision: Lot #: S _ _�.; -° l . vz,i .`° i P ;� dE_ ...'- .a iA A.a .s,4.� * x �6 :af• Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate li„. (rounded to the nearest dollar) of all equipment, materials, labor, c.,s__,:sa arc ..,, gY ,,, ,:�, ,:, A t , SCRIE,TIOIV OF WORK .� g ' the value e ; �/./JJ II / overhead and profit for the work indicated on this application. 7'Y6'�U r �,G ta�.� Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories - ''1 EROPERT0.OWNER `. ;'; F ,TENANT M'" `� ... Type of construction Name: �I / d ' f / '' J, Occupancy group(s): Existing: fJ F / /T New: Address: //'yO s -' 70/4 /Of City /State /Zip: 7 • Die 9 7 22 3 Phone: 6 C� 99 3 Fax: NOTICE: All contractors and subcontractors are required to be licensed with the°Oregon Construction Contractors Board under APL;I PCANi ,' , ` etiNTACT i'ERS` 1 _ : -t _ , p of ORS 701 and may be required to be licensed in the Business Name: \W I 1 } . "7Z/&5I coA 5TgvCT/� I A iti where work is being performed. If the applicant is exempt Contact Name: MO1e0 ti from licensing, the following reason applies: Address: I8 ci �,C . LE-e-4-.41,6 2 . City /State /Zip: OiZECOI / Cam { o e 9'7 c 5 Phone:(-03) 31S gl2z Fax:(50 L 57 45 7/ , 3. : ' , 4 - P , '* "k a tnitti LDING PERMIT FEES* ° r � ` E -mail: , , - - o - , 4 4 w `k ' 4 �. - :�. ,.... .€�,w .�. F , �a � � ��� �" 4 x�� � t � CfC d � � g � . � 47 ..�:F� s¢�. ��,t:� t �-t.; ��, _ , sCONT �.. � �.��;. ..W fee u e�,'�� , � Business Name: W42_6 W E5T OOA) ftt, Cli� t/ti ees due upon application $. Address: 13 S e L E Z. 6- Pd • City /State /Zip: 0eea N uly 02 ?7045 Amount received $ Phone: Fax: Date received: CCB Lic. #: (p 9 .Z. y - -2- - Cl/ Authorized / i D Notice: This permit application expires if a permit is not obtained within Signature: Q = � j �� -,(, 180 days after it has been accepted as complete.. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 One- and Two - Family Dwelling J Building Permit Application Checklist Reference no.: Associated permits: City ofTigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 - THE FOLLOWING ITEMS ARE REQUIRED 'FOR 'PLAN REVIEW Yes = No . 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ 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 Oregon and shall be shown to be applicable to the project under revive. JURISDICTIONAL SPECIFICS = = 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. • 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6 /00 /COM) Electrical Permit Application - FOR OFFICE USE ONLY Received Electrical �- � ' / I /, 7 � Date/By: Permiti3o.: ( / City f Tigard Planning Approval Sign y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use Gsarg sNl� �� 4 6 \ Date/By: Case No.: Internet: www.ci.tigard.or.us ;' L� W Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information. OK � s�. - 4.+� 7 �-.,wr�:.:::s .. -. ,,s .. �•_ :4':�'tn:'{�`:,�, �,� �s :• � N ;*�'.. ;Y.".#c�` .. #`34�:�M �` �:rc�t• -�: -e 'r �,,, ..<,g-:.�:.<<_�..:•� An a% , tgirM OFT1 �,1� C.?_ ..,. .a,. � . , ale 12 E1N R�?IEWAtrefase, checl all ITAI P A-0 w'. ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location 1 . f Addition/alteration /replacement ❑ Other: 1=1 Service over 320 amps- rating of ❑ Building over 10,000 square feet, `¢1rXWVW:A:; ,® t VSTRU TI,O - 1 - . ; `k _ 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: ;_ ''z"`" = ""s "ST° § "� , '-'R ° { ;ti Submit sets of plans with any of the above. �;�,����:�.J��B�. _ �TIN��OY�IQ�t�an�d'IOC;��aION�;; s��� == �»,�::., The above are not a plicable to temporary construction service. Job site address: / /'9DD c('llJ 9& I2 7;, . !' .. ��° �� ;i. � �r�� .� � £ -E1-' S�HEDIJ ati;, ,Z;`-' M Suite #: _ Bjg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total 1 Cross street/Directions to VV job site: New residential - single or multi - family per � dwelling unit. Includes attached garage. ( PY l� JI r 1. e4 1.i. » ' 1 4 © A /4dak. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel # Each manufactured home or modular dwelling s y., ., s i nt service and/or feeder 90.90 2 .. ���:�� D�sciur���oQF �wo.�cE, ,�: � � � .. ,21 Services or feeders - installation, alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 P#0 1 NE t ' - cT - P amps � gt �x t � EN� �€~ ':- '�� =° .�,.�' 601 amps to 1 00 am s 24.0 2 , (Q n 44 Over amps or volts 466.85" 2 �a. gt Name: Reconnect only 66.85 2 ' Address: j7y�d ,f .U' 01-ii n live Temporary services or feeders - installation, t6ci Fvi 172 7 5 alteration, or relocation: City/State/Zip: T ` l� 200 00 amps or less 66.85 1 Phone: 5 D3 -7'30 Fax: 201 amps to 400 amps 100.30 2 ig 1 PFL C ._ .z �. ,,_ 401 to 600 amps 133.75 2 _ ? :; ` :, 'ANA uC ?N4I',�, CT R R O ', 1 Branch circuits -new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of 6.65 2 service or feeder fee, each branch circuit City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): N u t: z ,, : . 2 ., ; , :,_ .E - a ; M CC1NTRCT;Q7? r ..N r_ r„� Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: b 1 T . ELG lei C, alteration, or extension Paget 2 Description: Address: 28 70 oV E f e64-A1 STS 1I3C City/State/Zip: G '�P�S 1-1-4 Q 9 7 03 ?� Each additional inspection over the allowable in any of the above: Y p Per inspection per hour (min. 1 hour) 62.50 Phone:Sp3 O 9/ 04 i Fax: Investigation fee: CCB Lic. #: �l( q7 S � Lic. #: 26 — / //� G oth M � _ ., ', Supervising electr id/ t7 Subtotal $ signature required: /i 4i w — eiz,_ Plan Review (25% of Permit Fee) $ Print Name: Ff16lo yeLeA Lic. #: 31q5 S State Surcharge (8% of Permit Fee) $ (d i i tot( TOTAL PERMIT FEE $ Authorized I ArsItt Notic e: This permit application expires if a permit is not obtained within Signature: lj lX{ Date: 2?-24,0 180 days after it has been accepted as complete. V *Fee methodology set.by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \E1cPermitApp.doc 01/03 Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: Audio and Stereo Systems n Burglar Alarm ri Garage Door Opener n Heating, Ventilation and Air Conditioning System n Vacuum Systems Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation Intercom and Paging Systems Landscape Irrigation Control n Medical n Nurse Calls I I Outdoor Landscape Lighting n Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 Mechanical Permit Application Received FOROFFIMEUSE Date/By: Permit No.: Planning Approval Building City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 � p Post - Review Land Use - lli l Date /By: Case No.: Lk Internet: www.ci.tigard.or.us , 44 e Contact Juris.: ® See Page 2 for (p w_w_o 24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information. ;?` ' ; VA T TE OE:t'WORk -k '' eg i :.} , 'i: . : %: ,: °' ",: �'`COM11'IERCFAL FEE' SGHEDDDMUSE GHECKE1ST Mit,, � New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all t '`i=:ti OVII:6QRYsOF CO70411CT,I 1 5112,' e'f xr mechanical materials, equipment, labor, overhead and profit. a gyp. ❑ 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi Family a RESFDENTI Ati> EQUFPMENT /SYSTEMS;FEE *SCFIEDUtiEd F , Description I Qty I Fee(ea.) Total ❑ Master Builder ❑ Other: : . - - AeatingiCooling r. _ ., X,, ,. 'JOBr8TIO NE®RNfATIQN,anddL9CATION ,„ ' ',_ ,., Furnace - add -on air conditioning ** 14.00 Job site address: / (1., 00CIA) c f , A 0-V4 , f v + N v'' ) 2Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 (P4rePn-% „e- f� .'� 0 / ( t vg Flue /vent (for any of above) 10.00 Subd isi n: LOt #: Repair units 12.15 -, .. Other Fuel, Applianc . , F. , e ., . Tax map /parcel #: Water heater 10.00 a W ` S AM ES 1114:10 .10F =rWORK ' '=w= ,? IN Gas fireplace 10.00 M 7-t `b`', Flue vent (water heater /gas fireplace) k 10.00 430 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney/liner /flue /vent 10.00 . ;PROPS T 'A,OWNER'R` AM I) TENANT :. , yE - k s Other 10.00 Name. ' F "� � � . .. � , <� Environmental Exhaust; &aventila ,, �. �� ` �� �.,-, °`'' , � �' �/ Range hood /other kitchen equipment 10.00 Address: .4( k tv t o S jelA Clothes dryer exhaust 10.00 City /State /Zip: e r 1 t t 1 14-1/..e g Sin le duct exhaust Phone: 3 -1-90,..7/ Fax (ba throoms, toilet compartments, E= AiRPL CANT * ik ' ' CO ITACsT,PEILSOT' Mt utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Other: 10.00 Address: A ..., _,. '#'".. = ` " -;`: Fuel Pipin -. ,:04 . ; , i . u°` , " r =` -: City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: Gas heat pump ** E -mail: Wall /suspended/unit heater ** mdr r , -xiim a:t, * . GON.T ' VIMSAVItiNK Water heater ** Business Name: (x) I Li- ) )6..s-7- --- { �- Fireplace ** Address: / g 9 5!� S ��� Range ** sBQ ** City /State /Zip: (9, C— , G - 2 DV 5 Clothes dryer (gas) ** Phone: 319 _c / 0 1 2-- Fax: Other: ** CCB Lic. #: 6 6Y -S Total: c-: `Y=; 'Mecliaiiical'.PerrnifFees *;., ,,f'-:,', Authorized Subtotal: $ Signature: Date: Minimum Permit Fee $72.50 $ (1O^ l� Plan Review Fee (25% of Permit Fee) $ (Please nt name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. I : \Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total'Valuaton :`, , ,Permit $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. • $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 and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or • fraction thereof. Assumed Valuat><onaf er •401141 Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 • Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU • >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 _ Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL 2• ~ y' VALUATION: • • is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 Building r fixtures Plumbin Permit A licatio n - FOR OFFICE USE ONLY • • pp Received / Plumbing k i ,.....t,G/ . Date/By: ' % / 3 Permit No.:l t /Q'J' J 7 City of Ti and Planning Appro al Sewer �,7 g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use i�riµ'Miy�i� 1 4 1 1 l + Date/By: Case No.: Internet: www.ci.tigard.or.us L c. , . ' I C on t ac t Juris.: 0 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 � Name /Method: Supplemental Information. - .�:t,� .,.a. :''�P "*:';i 'i+, "; "`�_ � :.V .. � _ ,: &ird :� : -,,.�; : a ",�' =�:._ ..* ' _ a.._ ._,3- s:. =x+-: err.... ».;.. �„-'" �;: a �� �s �: .,,x � _ g`s4tVR2 ,f ft = tintelPN ORK a a , ttttit > a„4 x^ , FEE - ..SCHEDULE (for spa al nformatton pse checklis ❑ New construction � ❑ Demolition Description I Qty. I Fee(ea) I Total IN Addition/alteration /replacement ❑ Other: � � ci`�a s 1 o &�o e n �iuW � �° 4. .�._ .>�. ; f. dig to( t _ _ )� M'MM_M:blit 11200 G®RY .00CONSTRMOVONIRO {, r I SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling _ ❑ Commercial/Industrial SFR (2) bath 350.00 • ❑Accessory Building ❑ Multi- Family .4SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 ''.1.4i ° c U,O$ SITS"1INFFORMTI®N'ai LOPOION ;x Fire sprinkler - sq. ft.: Page 2 Job site address: / / ti/ ` -- /A de ��6 4 J) a ei ;o . :, � i 4 i 4 ;���� � ��: ;. � Stte�Util►ties ;�.< �. ..,��,�. Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell/leach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 C ilee41, ' )� � ,,, A v / t i / , Manholes 16.60 9. /�` / Y 7 �1 Rain drain connector 3 16.60 Sanitary sewer (no. linear ft.) • Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no linear ft.) map /parcel #: Page 2 ._ . g 3 3Mal a, ur�kiai n v .��.: a ,. -�,. ���;�;M . %� -;�, �� ,�.�����,.,:���;�'��;�, , � �Ftxture�or�Rem �` '�����F� : g. :: IZIN tSCRIPirtON OF. W®RK .... ...ai,.v >,a�r �t::�:. ._.. � .. n..„ a ��� ((,, Absorption valve 16.60 _ tf c GV. i,+n-i Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 IZYPROPER�TY=IUWNE li .v MENANT ,N, f OIN Ejectors /sump 16.60 Name: V y, V /ge v Expansion tank 16.60 Address: / /.,ice e (' t ,(/ 0-fh L. li e Fixture /sewer cap 16.60 City /State /Zip: 77 6 g. ✓ f) pe cy 7 2 Z 3 Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone:03 '730 '7Qo Fax Hose bib / 16.60 r 41sAI OT I`= , ,.: e 2 I Ed Z.CONTOTWW)NTAA Ice maker 16.60 . Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City /State /Zip: P 16.60 Roof drain - (commercial) 16.60 Phone: Fax: sip. Je. : .davatog X02 16.60 E-mail: ell ower •an 16.60 ,r . S r t'i; -. - f a l 16.60 * r � i��' �;��.�.�>�F�in�._ �a`� 3 ;�s:_ t � .x.:,,����� rtnal Business Name: ,� , /h /`� L//`f/e // , V Water closet 16.60 Water heater 16.60 Address: //// YA tda y Other: City /State /Zip: U4 co u v- 1Z u 1/44, a $ 6 - 1 Other: Phone:(5o3) 313 -- 4 3 3-4 Fax: 3 . , �'T € s .,:,.,.: t �{ ., =Pluimbin ``P�erm�=Fees * , . ;.' . � �' �� fj Subtotal $ i 9 , ao �� 4- CCB Lic. #: / /$z / Pl umb. Lic. #: 37-35? t /3 Minimum Permit Fee $72.50 $ Authorized W Residential Backflow Minimum Fee $36.25 Signature: - Date: 6,,2 0 Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ / 5 • `/ y (Please print name) TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i: \Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: NOW lat.0341i S Footage> IPe riiitF J Footing drain - 1' 100' 55.00 0 to 2,4300 $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 YligFin't' 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 AU IF (ea) additional $100.00 or fraction thereof, to and WalAtatiefgeWriiiii9KVX maim z avoil 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 $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*. tr, • t 4 VEQTalitiVIROifili 4NYciiiiiiPittiad Comments regarding fixture work: „„ ;Ifizctiii*Type*::,411 fT4)%p:4 g. OMoved a aijedif 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 *Note: If the fixture work under this permit results in an Garbage -Domestic Disposal -Commercial increase of sewer EDUs, a sewer permit will be issued and -Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory -Bradley -Commercial -Service Swimming Pool Filter Washer - Clothes Water Extractor • Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Forms TImPermitAppPg2.doc 01/03 • F ORM'No. 4 - - DEED- CIIITCLAIIS. -' _ •r:= .4 -. ,r -- . ., .,C'f'..rF.cNn Ftee;: no4,rn agr ,:.•,? • ' *2 + , ' EARL OFJENS , a lv, dowel and .u - 5, KNOW ALL MEN BY THESE PRESENTS, That _____. • <, „� sE EN AND NO /100 - - - -" - Dollars,, } citk •' - in consideration ot _.._.._._ Z — ^ --- --- ° - ^ --° i1 : _ — —: AVON W. BARBER and BERNICE M. BARBER, Husband and Flife, � hi to par b y......____ __ - 4 .....__. #, . ''' .-ma ' a s do /hereby remise, release and forever QUITCLAIM unto the said AMOK _W__ _BARBF.[L_ a nd__ — . _ 3 G • BERNICE M. BARBER, Husband and Wife, •atr d'uurto their .heirs 6 t : aed O r •` � � � : . all - w - w - ,/ right, title and interest in and to the following described parcel of teat estate, together with 3 the tenement hereditaments and �, situate in City o T ,g nit_ ,,, b xX, $,tr a $ • C ounty oat ... W ashington , State of Ore gwr, ro wit: r• , .„;.0- „,„ 1 :., Ys r Now A : . That certain strip of easement conveyed in Deed recorded at page 655, Book 387 of Deed recorded in County of Washington, State of Oregon, the same therein. being described as follows: - 6 e t r 4 ” Right -of -way or'easement for ingress and egress to and from said ,.,_ ' : °; p such right -of -way being fifteen (15) feet on each side Wit i. of the Southerly line o said premises extending Westerly to Lincoln Avenue." .. _ , .. ✓ '',A�:s^�^-,' "am, I � iF h ks ci : 7� :t.',4 f 1`' jyk ii • :� ' - evuin w_ P.ARBER BFaNICE.i....$ a.. I: ` " T o Have a n d Hold the seam it, ue «u� - their .heirs and ass forever. - . .i iusbarid and Wife; _ ____ _ .___. -_. ..an to Bet " • 1.,..-, q ` `� R I + , : IN WITNESS WHEREOF, I .have hereunto set_ fil._._..hand.... and see/__.. this __ 7 " day ot...Septeiber , /4b ' ' #' t Executed in the presence of = ifI- 1 _ ` �.., .•.! . � ._ (S EAL) ' ' V ifi _. ,. _....._._._ _ __ _ _ / (Svuj. - w ", ij ... . (S � ) . .�, __- qq� CSC.), BOOK 4 vbrF i1 `' net; •K; � • sr-' r..i „ . . . ... �. .... , ._. <....._ _,.... ,.._ - N ., __. , r u . .ug._. � - 7.i"4,:: 5' • r CITY OF TIGARD 13125 S.W. HALL BLVD. RECEI VED TIGARD, OR 97223 , \ - SEP 19 2003 IMPORTANT PERMIT NOTICE CITY OF TIGARD BUILDING DIVISION I M PLUMBING 411 HARNEY WAY VANCOUVER, WA 98661 Plumbing Signature Form Permit #: MST2003 -00257 Date Issued: 8/25/03 Parcel: 1 S135DA -02900 Site Address: 11400 SW 90TH AVE Subdivision: Block: Lot: Jurisdiction: TIG Zoning: R - 4.5 Remarks: First story addition and remodel. 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. I No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: VASILE REPTA I M PLUMBING 11400 SW 90TH AVE 411 HARNEY WAY TIGARD, OR 97223 VANCOUVER, WA 98661 Phone #: 503 - 730 -9969 Phone #: 312 -8612 310 -2083 Reg #: LIC 115262 PLM 37 -3570b AN INK SIGNATURE IS REQUIRED ON THIS FOR • = X Signature o Authorized Plumber If you have any questions, please call 503.718.2433. CITY ,CAF TIGARD 24 -Hour BUILDING • Inspection Line: (503) 639- 75 M S .,c),0 3- 06)-C 7 INSPECTION DIVISION Business Line: (50 , • 3 1 BUP• Received Date Reques d `� A ■ PM BUP Location 1 4 ©Q 0 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR :4 ILDI 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 k).2,1113/ C - (0 ) Framing ( �'�' �=/' C Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Oth - r: 4il PART FAIL BING. Post & Beam Under Slab Rough -In A 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 ELECTRIC AL 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 El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA i kect Approach/Sidewalk Date �� Inspector ( 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 INSPECTION DIVISION Business Line: (503) 639 -4171 MST" t t BUP Received Date Requested g) — ' AM PM BUP Location / / /O() 7Q A 7 °u Suite MEC Contact Person Ph ( ) PLM Contractor A Ph ( ) SWR B -. : Tenant/Owner ELC Footing IL F oundation ►, ti �rfc,: ��� c +4 �r ..„�,,�;: ELC Ft Drain y''. - . i1� '.�A� +Z ^� ;71�';,� , �• , ,, ,, �;; Crawl Drain -... In v (k-1 r "A P :N A - i ..w?�ir ._...1ili Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear "Idak— Int Sheath /Shear --1- Framing Insulation Drywall Nailing i Firewall Fire Sprinkler Fire Alarm ( Susp'd Ceiling / ' 1 Roof Other: / Final ')r' PASS PART FAIL '' 9 1A- --- u\ti. j jP,LUMBINC Post & Beam C --- * Under Slab L Rough -In t r Water Service // 1 'M Sanitary Sewer (, faillEMM I 117 Rain Drains ;-- -, Catch Basin / Manhole rr I k. 6 r v Storm Drain j 06 Shower Pan i l N " Other: Final PASS PART FAIL .1- � � ° IIIIEdHANI:CAL w 1 ii 1 1 Post &Beam MI �1 111/ \i� Rough In Gas Line r < ` V A ' vry ' /r Smoke Dampers _ Final It ■ PASS PART FAIL . ..•` ' - :ELECTRICAL :.= • . ' i 11% AMA 1 Service 1 ' •'- `IT/ Rough -In I '' j UG /Slab V Low Voltage ,n Fire Alarm larm , V 1 ` 1 ' " ,-` Final -' ❑ Reinspection fee of $ r u e e 4 e 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 - . ti ' � ' 'z Approach /Sidewalk Date Inspector Ext Other: .� Final DO NOT REMOVE this inspection record from the job site PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 3 DO S 7 INSPECTION DIVISION Business Line: (503) 639 -4171 -� / BUP Received Date Requested 3 �° AM PM BUP Location / I L 100 (70 0 ' — Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC 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 Other: Final PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab , Voltage Fire Alarm 011 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PA PART FAIL SITE 111 Please call for reinspection RE: 111 Unable to inspect — no access Fire Supply Line 1 ADA Date 3 ' ' o Ins actor 9 �1 " O B X Ext Approach/Sidewalk P Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD a 24 -Hour . BUILDING Inspection Line: (503) 639 -4175 MST " Zo`2-5 INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested 3 - 2-8 AM PM BUP Location \ v I A 3© ° C Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing • Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Dry at wall N F.'I N'a ‘'\--..) i I 10 �` r Drywall Nailing �d V G � Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final RT FAIL 'UMBING Post • beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan PART FAIL M HANICAL . Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service • Rough -In UG /Slab Low Voltage Fire Alarm Anal El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA ^ �{- l Approach /Sidewalk Date 3 1 v Inspector ?? N `-- Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD . 24 -Hour BUILDING Inspection Line: 39 -4175 i MST 3 " I) 6 ` 7 INSPECTION DIVISION Business Line: -4171 BUP Received ! J Date Re sted `� � AM PM BUP Location / �� Suite MEC Contact Person 96 ' w G Ph ( ) PLM Contractor Ph ( ) SWR — BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors i Ext Sheath/Shear / Int Sheath/Shear V ✓�, _ _ 3 / -J / � Framing �� C! Z Insulation \S I, 1 s�� k. Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm 1 Susp'd Ceiling -..--- A/ Roof 1 1 ° -27 ( # L.N Oth - Oft 1 AL. a d A , _ a . . dAir - AS PART Arm: ��I � ` r�i��� - / --P wr: ING , ,r I Post & Beam 1 7 - Under Slab Rough -In Water Service k Sanitary Sewer C Rain Drains Catch Basin / Manhole Storm Drain Shower Pan \ Other: \ Final PASS PART FAIL - MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers PART FAIL - RICAL 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 0 Please call for reinspection RE ❑ Unable to inspect — no access Fire Supply Line Approach/Sidewalk Date '3 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL