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Permit f. • 4T '\ ■ , MASTER PERMIT CITY OF TIGARD PERMIT #: MST2002 -00389 6 - 41,1.1141I DEVE SW i LO BMEN I ) 639 -4171 DATE ISSUED: 9/20/02 SITE ADDRESS: 11095 SW 93RD AVE PARCEL: 1S135DB-09800 SUBDIVISION: REEL ACRES ZONING: R -4.5 BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: Addition Path 1 BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 399 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 17 VALUE: $ 13,745.00 OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 399.00 sf REAR: 27 PLUMBING . SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP <3HP: VENT FANS: 1 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 3 WOODSTOVES: GAS OUTLETS: 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: 1 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: 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: TOTAL FEES: $ 856.64 Owner: Contractor: This permit is subject to the regulations contained in the TODD PATOKOSKI OWNER Tigard Municipal Code, State of OR. Specialty Codes and 11095 SW 93RD AVE SIGNED RESPONSIBILITY all other applicable laws. All work will be done in TIGARD, OR 97223 FORM IN FILE accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Plumb Final Foundation Insp Footing /Foundation Dry Electrical Rough In Insulation Insp Final inspection Post/Beam Structural PLM /Underfloor Framing Insp Rain drain Insp Post/Beam Mechanical Mechanical Insp Shear Wall Insp Electrical Final Underfloor insulation Plumb Top Out Exterior Sheathing Ins l Mechanical Final / 1 Issued By : i614,�G't'Vl _ 1---)-i/t Permittee Signature :-1- /2 /` Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day or { Permit #: ACT BOG a- - O 0 3 Address: /l ? s dam) Y,5 W • Issued by: Date: 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 boxes 1 and 2, and either box 3A or 3B: 1 ) 1. I own, reside in, or will reside in the completed structure. • 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 ( - \ \ i 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 aba. Construction Responsibilities on the reverse side of this form. • . /,.:. P �i ../.7e/707-- (Signature ofpermi applicant)) (Date)- (White copy to issuing agency permit file, pink copy to applicant) I ^ Inf^r0 Notice to Property Owners AL.)out Constructi0A Responsibilities Note: This Information Notice to Property Owners cibout Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, 'you can prevent many problems by being aware of the following responsibilities and areas ofconcern. E *!ESPONS8BYL0TUES: If you 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 employer and the people you hire will be employees. As th employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employeewages at the time employees are paid. You will be liable for the tax payments even if you don't actirally withhold the tax from your employees. For more information. call the Oregon Dept. of Revenue ut945'D09L Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department atJ78-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers Compensation Law, and must obtain workers' compensation inurance fot your employees. lfyou failto obtain workers compensation insurance, you may' be subject tn penalties and will bc liable for all claim costs Joxnofyoor employees is injured ootbe job. For more information, call the Workers' Compensation Division at the DepartMent of Consnmer and Business Services ut945-788M. • U.S. InternalRevenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even i f you didn't actually withhold the tax. For more information; call the Internal ReVenue Service at 1-800-829'1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code «omm plim nee: &s the perm it holder for this project, youurnmupounih|c§orroso|vinguoy[ui|uncnVmmrtcodcrequio:ment that flay be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent tosee if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire. or work that must be re-done. . . Timmmt000pervoe - enmo|oyouo: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-i n and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box l4\40, Salem, ORV730g'5052. 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-o°npm+ L' eS C t` A , Building Permit Application Date received: g ,* ' O Per mit no.: row —038'F qt y' { 'jyi City of Tigard Project/appl. no.: Ay date: City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 �� Phone: (503) 639 -4171 Date issued: MA Receipt no.: • Fax: (503) 598 -1960 Case file no.: Payment type: _ 1 Land use approval: l &2 family: Simple Complex: :' TYPE OF PERMIT - . , , . . ., • , ....- ❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ New construction ❑ Demolition A Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: • • ` JOB SITE INFORMATION `_ .. . . Job address: j, 0 95 SW 93 ' ?lire__ n l4 -d t7 y? , . 3 Bldg. no.: Suite no.: Lot: 4 I Block: !Subdivision: [Zee.( Az. Ye,s I Tax map /tax lot/account no.: j5' /33-,93 -6q vp Project name: 1 ask ; Ad WDY► .1 R 1ZL/3 ?64' ip Description, and location of work on premises /special conditions: Aia ,& 1+ X Zp ' /he,S,er /jib /v'0"r / i747,PrYt'it a k �o 1he we.s� e✓l l e- f '4,P e°ki..fil 1 f'r- 1 . s, :` , • OWNER - FOR SPECIAL INFORMATION, USE CHECKLIST Name: 74 P00-0 kaSk; ( Floodplain, septic capacity, solar, etc.) Mailing address: I 1 bc1,3 5.A., 13' Ave, I & 2 f ami l y dwelling: _ r�� Y� City: -�`� Gr� State:() ZIP: 9�Z Va of work /,ml� ✓�-S $ + ' 1 I Phone:svj 6?0-903jIFax: IE -mail: / kit0_ No. of bedrooms/baths _/_ ( Owner's representative: U -,. i.ii . r74 Total number of floors p / Phone: Fax: E -mail: New dwelling area (sq. ft.) ,3f / APPLICANT' Garage /carport area (sq. ft.) , Name: 56trvt as �eJoa1,� Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) City: I State: I ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: Commercial /industrial /multi- family: •` CONTRACTOR Valuation of work $ Business name: Ele---- Existing bldg. area (sq. ft.) New bldg. area (sq. ft.) Address: S City: I State: I ZIP: Number of stories Type of construction Phone: I Fax: I E -mail: CCB no.: Occupancy group(s): Existing: New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under Name: 1 provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed. If the applicant is City: State: !ZIP: exempt from licensing the following reason applies: Contact person: Plan no.: Ott)" e r n i /0 r Of -e ri )/' Phone: Fax: E -mail: ENGINEER Name: k Contact person: Fees due upon application $ t f d 7. 6-7 Address: Date received: City: 'State: IZIP: Amount received $ Phone: I Fax: I E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept - credit cards, please call jurisdiction for more information. attached checklist. All provisions o laws and ordinances governing this ❑ Visa O MasterCard work will be complied wi eth' ; `c's - d herein or not. Credit card number: Expires Authorized signature: /<i/�„it/ Dater 3 � Z _ Name of cardholder as shown on credit card $ Print name: 1 oo / d O / Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6ro0ICOM) e bb wO/Zk c0 3 — A6 Y - 73 • 7oZ^ 06,olp One- and Two- Family Dwelling ��� 4. ; Building Permit Application Checklist Reference no.: Associated permits: City of Tigard 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 N /A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity V 6 Sewer permit. 7 Water district approval. V 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 patch -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 l� 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 B/ • details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, d( 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. 6( Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for . non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ')( architect licensed in Oregon and shall be shown to be applicable to the project under review. - -- JURISDICTIONAL SPECIFICS • 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. _ 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6 /00/COM) . i }; Plumbing • Permit Application' Date received: g Sts 09-' Permit no. 6j jA-c033, � , , g City of Tigard `J Sewer permit no.: Building permit no.: - " Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: • TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction XAddition/alteration/replacement ❑ Food service ❑ Other: • - JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist) Job address: /)OTS .3'k) 93Y' Ave, Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings•only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: 15133 -0(1 fj 507 e p y,3 .V SFR (1) bath e " Lot: 4 (Block: ',Subdivision: •R e,/ f4r..V SFR (2) bath Project name: P p ps (( j� /10 y! SFR (3) bath • City /county: - ` ,,, v LJ ;a ZIP: ei i Z �.3 Each additional bath/kitchen Descn ton anoc li and lon of work on premises: of PD Site utilities: 41,ext. Ft'p IA ¢.d We j. e Catch basin/area drain Est. date of completion/inspection: . ) 3 Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name:/ 1/0 Manholes Address: Rain drain connector City: `State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: (Fax: 1E-mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: - Back k flow valve Absorption - flow preventer • Print name: Date: Backwater valve • CONTACT PERSON Basins/lavatory ' Name: C, O w r J Clothes washer Dishwasher • Address: Drinking fountain(s) City: I State: . I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): — 5 - )1.4) P i ,.4 o k Floor drains/floor sinks/hub address: O ' 5 3 I Qt Hose bibb disposal Mailing � � J e Hose bibb City: gar (State: OK I ZIP: q7.z,z,3 Ice maker Phone: 4 e '5CO39 1 Fax: E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump Tubs/shower /shower pan Name: Urinal Water closet Address: Water heater City: I State: ZIP: Other: r ti-) 1Z4- Phone: I Fax: 1E-mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ 7A '5Z ju ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card numtier: / / State surcharge (8 %) .... $ .S 'O Expires within 180 days after it has been TOTAL $ `Z k 6() Name of cardholder as shown on credit card accepted as complete. . $ Cardholder. signature Amount 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: u. rt, =, ,u L rANeitinl and2- fartiil`; :dwelli ib4gni` x,; =° � . : 5B' ° � ,Vog ,. ;<` .. PRIC,E ,;� :�;� }TOT, ,�, Y 9 Y �: -.,c' s .�., z: i ..r- z x +;i' �. l .�z ;� -.. .r'. �r a :. ^:�5 w. ` " '� � ':�> " - :� °. �. � E. _g L 'FIXTURES °r (individuaal)s : ', , . QTY" ;: (ea) , ..i AMOUNT'' •(in clude s II�plum fixture fns t , , R I C '40141:',K14 „ Sink ' * 16.60 rKthe,dweilingiand he trst 1 00 ft QTY ° ,(ea AMOU NT Lavatory 16.60 `for' each utility connection). : „ =r : � ® �- :��u One (1) bath i $249.20 jgq, Tub or Tub /Shower Comb. 16.60 Two (2) bath • $350.00 Shower Only 16.60 Three (3) bath $399.00 " Water Closet 16.60 SUBTOTAL , g ' '••=';::' ".. `!< Urinal 16.60 8% STATE SURCHARGE ''''%:_,-- "..': ' ' '-' Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL , ••' Garbage Disposal 16.60 TOTAL , Laundry Tray 16.60 Washing Machine 16,60 Floor Drain /Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 '.`; s'` '" . _ ''`;" „" 'N ri.: -iQuantity,tiy Work`Performed Gas piping requires a separate mechanical ' Fixture Fy'pe:. ,- ,' New, , , Moved' ; ,=~ _ Replaced "-;:Removed/ P 9 q P -- _ , ,.., ° - , a. ;' "; ~ '. .Capped permit . .� .. . - .. - MFG Home New Water Service 46.40 Sink _ MFG Home New San /Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only _ Drinking Fountain 16.60 Water Closet . Urinal Other Fixtures (Specify) • 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine _ Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3" Sewer - each additional 100' • 46.40 . 4" _ Water Service - 1st 100' 55.00 Water Heater Other Fixtures Water Service - each additional 200' 46.40 (Specify) • Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 'Catch Basin 16.60 Inspection of Existing Plumbing or Specially _ 62.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL '<:;' "` ` " : :., -: Isometric or riser diagram is required if ',.-.V,k ,, , >',n,; =. T ,, Quantity Total is > 9 ' i rk,« E. . ', . .. *SUBTOTAL ', , ° h F a , , 8% STATE SURCHARGE '��. " " "' `''� �,,; , , �;`e o f;% **PLAN REVIEW 25% OF SUBTOTAL ,a.` .. i '" ;`.,` i4C. - ' ^,. Required only if fixture qty, total is > 9 s , � =t,c,�ts ;, s.�` : �. ; TOTAL :',q,` ;: $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25•+ 8% state surcharge. **Ali New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. ' is \dsts \forms\plm - fees.doc 12/26/01 • . • `' Electrical PermitApplication . A Datereceived: ! 30 O 9- Permit no.: 115rgop; _q?3 Z City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF'PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement . ❑ New construction [, Addition /alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION . . ' Job address: 0 ' LA) C V A Bldg. no.: Suite no.: Tax map /tax lot/account no.: .2t/37„ di Lot: . Block: Subdivision: f ; 4, -S ;yy, 0-;; 5 3 ' . E. . - C ' k 9 Project name: I, e as k, 4 > Description and location of work on premises: i , g vo „ '� . r • Al 't/,, Estimated date of completion/inspection: yWy.. 1063 ' CONTRACTOR APPLICATION ' - FEE SCHEDULE • . Job no: Fee ' Max Business name: ,. /r ���,✓ Description Qty. (ea) Total no. insp New residential - single or multi- family per Address: dwelling unit. Includes attached garage. City: State: ZIP: . Service included: Phone: Fax: E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof __ CCB no.: Elec. bus. tic. no: Limited energy, residential __ 2 City /metro lic. no.: Limited energy, non- residential ___ 2 . Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder ■■ 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: - . _ - - - PROPERTY OWNER - -- -- `: . 200 amps or less 2 Name (print): , 4. ( • A ( t b d , • 201 amps to 400 amps ___ 2 401 amps to 600 amps ___ 2 Mailing address: i ( e 6 . lj'J 33” 601 amps to 1000 amps ___ 2 City: '- a x .-t3 State:QE. ZIP: F .23 Over 1000 amps or volts —__ 2 Phone: 6 0— 03 ' Fax: E -mail: Reconnect only ii.Mi t Owner installation: The installation is being made on property I on Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps ___ 2 Owner's signature: Date: 401 to 600 amps ___ 2 • . ENGINEER Branch circuits - new, alteration, or extension per panel: Name: . w C A. Fee for branch circuits with purchase of 1'p Address: service or feeder fee, each branch circuit 2 City: State: , ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: MIN Phone: Fax: E-mail: __ _— Each additional branch circuit: PLAN REVIEW (Please check all that apply) ' Misc. (Service or feeder not included): O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle Ilill 2 O Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting M__ 2 family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* - ■■ 2 ❑ Building over three stories O Feeders, 400 amps or more *De i , ., , : O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ Other: Per inspection __ Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 0 Visa ❑ MasterCard expires, if a permit is not obtained Plan review (at — %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card . $ Cardholder signature Amount 440 - 4615 (6/00 /COM) • ELECTRICAL PERMIT FEES: 4. LIM'iTED ENERGY PERMIT FEES: ., • TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: „ Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total `I Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less I $145.15 /145 1 4 n Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 • Each Manufd Home or Modular Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less _ $80.30 2 ❑ 201 amps to 400 amps $106.85 2 Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps • $240.60 2 Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 • 2 Check Type of Work Involved: Over 600 amps to 1000 volts, • see "b" above. ❑ Audio and Stereo Systems Branch Circuits New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 0 Data Telecommunication Installation b) The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 n HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 n Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension - $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over n Medical the allowable in any of the above n Per inspection $62.50 Nurse Calls Per hour $62.50 In Plant $73.75 0 Outdoor Landscape Lighting Fees: ,t El Protective Signaling Enter total of above fees $ /145' Ii, n Other 8% State Surcharge $ II , 10 I Number of Systems 25% Plan Review Fee . See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ 16 Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ All New Commercial Buildings require 2 sets of plans. i:\dsts \forms \elc- fees.doc 08/30/01 Mechanical Permit Application' Date received: g dl/ D 9-- Permit no.: l ilWeio.,2 .493g y 41■0•4s , � i i, • , vi 1( City of Tigard Project/appl. no.: Expire date: of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 City f 8 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ' ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement 0 New construction Addition /alteration/replacement O Other: JOB SITE INFORMATION COMMERCIAL VALUATI SCHEDULE Job address: j/095" St,) 13 s- R U.Q Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: /5 J 3 co r - 09 gee) profit. Value $ . Lot: Lf (Block: I Subdivision: K ( A .5 *See checklist for important application information and Project name: eiv*a kosi t P.415 - ,y, (') V', jurisdiction's fee schedule for residential permit fee. City /county: f i C A , ,rd W A I ZIP: Q .7 2z. 3. 1& 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and occat of work on premises: ens- Redv,„e - t AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE l� Ci / t L 17 r T 1 d +^ ± r7 � ✓7 Fee (ea.) Total Est. date of completion/inspection: z c 3 Description Qty. Res. only Res. only Tenant improvement or change of use: 7 HVAC: Is existing space heated or conditioned? 0 Yes ❑ No Air handling unit CFM space insulated? ❑ Yes ❑ No Air conditioning existing plan C system Is existing P Alteration of existing HVAC system 1 MECHANICAL CONTRACTOR Boiler /compressors Business name: 4,1 J - 626)A..) 9 State boiler permit no.: HP Tons BTU /H Address: Fire/smoke dampers/duct smoke detectors City: I State: I ZIP: Heat pump (site plan required) Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H CCB no.: Including ductwork/vent liner ❑ Yes O No Install/replace /relocate heaters- suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace CONTACT PERSON Refrigeration: n/� p (( t Absorption units BTU/H Name: 1 f.") €C0 t' ((�� C.l'1�t1I4eSVt0 Chillers HP Address: 1( �S- �S� C/3 r Compressors HP Environmental exhaust and ventilation: City: 7. 4 e Y•6,9 I State:Qe. I ZIP: i 2Z3 Appliance vent Phone: ' 16 e 3 ' Fax: E - mail: 114, 'ate k 9 IteE/yef alma ` 'n + OWNER Hoods, Type 1/ II/res. kitchen/hazmat hood fire suppression system Name: 7 eit G 1 P cJ ' o \& p .S `{ t Exhaust fan with single duct (bath fans) Mailing address: l(O ` a ' C -S c 140-e Exhaust system apart from heating or AC Fuel piping and distribution (up to 4 outlets) City: j t 611 a-Y & I State t .I ZIP: Q 2 Z Type: LPG NG Oil Phone: "7Q Fax: E - mail: Fuel piping each additional over 4 outlets Process piping (schematic required) Number of outlets Name: Other listed appliance or equipment: Address r Decorative fireplace City: I State: I ZIP: - Insert - type Phone: ax: / E -mail: Woodstove/pelletstove ���; ��� Other: Applicant's signature:'l�L%�Yi//.4i/r�..- Date: g-47,,__ Other: Name (print): -r J e P i" a-i:n o.Sk i Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ❑ Visa ❑MasterCard Notice: This permit application Minimum fee $ expires if a permit is not obtained Plan (at % Credit card number: an review ( %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. TOTAL $ Cardholder signature Amount 4404617 (6/00 /COM) • r MECHANICAL PERMIT FEES ... COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION , P f FEE ,, ,, -, Descnption:,,� Y,i �' ..3 `P nceZ of 5 _. ,;. Qty (Es) s .. A, $1.00 to $5,000.00 Minimum fee $72.50 .1 blerlQ °,Code - , . � $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater o �, $25,000.00. or floor mounted heater 14.00 <2- 7' $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and ' Check all that app,lyz 6 ,';, Boiler .,.Heat ° Air,, ' . Y;:, ,, $1.20 for each additional $100.00 or For, items 7 11, see: o r ; : P um p C - fraction thereof. footnotes below Co ,, . .. 7) <3HP; absorb unit Minimum Permit Fee $72.50 SUBTOTAL: $ to 100K BTU 14.00 8% State Surcharge $ 8) 3-15 HP; absorb 25.60 unit 100k to 500k BTU 25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00 Required for ALL commercial permits only unit .5 -1 mil BTU TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20 unit 1 -1.75 mil BTU 11) >50HP; absorb unit >1.75 mil BTU 87.20 ASSUMED VA'L APRtIAN`CE ,:,;- 't ` - 12) Air handling unit to 10,000 CFM 10.00 Value Total 13) Air handling unit 10,000 CFM+ Description: Qty (Ea) Amount 17.20 Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler ducts & vents 10.00 Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct ducts & vents 6.80 Floor furnace including vent 955 16) Ventilation system not included in. Suspended heater, wall heater or 955 appliance permit 10.00 floor mounted heater 17) Hood served by mechanical exhaust Vent not included in applicance 445 10.00 permit 18) Domestic incinerators Repair units 805 17.40 < 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator to 100k BTU 69.95 3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves 101kto500kBTU 10.00 _ 15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets mil. BTU 5.40 30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) 1 -1.75 mil. BTU 1.00 >50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: ( $a >1.75 mil. BTU a Air handling unit to 10,000 cfm 656 0 :.^ $� Z 4 Air handling unit >10,000 cfm 1,170 8% State Surcharge , r . ka3 Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: ' � ` ` , �'° $ Vent fan connected to a single duct 446 , -� - ,� >;�,� i � g� Vent system not included in 656 ...• . , 3e e appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: 1,170 1. Inspections outside of normal business hours (minimum charge - two hours) Domestic incinerator 1 $62.50 per hour. Commercial or industrial incinerator 4,590 • 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) Other unit, including wood stoves, 656 $62.50 per hour inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour Each additional outlet • 63 * State Contractor Boiler Certification required for units >200k BTU. TOTAL COMMERCIAL 'II fiPtotiko,4p '*Residential A/C requires site plan showing placement of unit. VALUATION:. " -:, wa. . �� Alt New Commercial Butldings require 2 sets of plans. is \dsts \forms\mech - fees.doc 12/26/01 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST —0d38 INSPECTION DIVISION Business line: (503) 639 -4171 BUP Received Date Requested I — AM PM BUP Location 110 q, " 73 � ✓ V' - Suite MEC Contact Person ! ewe[ Ph ( ) d a "' 6 0 PLM Contractor. Ph ( ) SWR 111 Tenant/Owner ELC rooT ELC Foundation Access: Al tg Drain OF F + Q K01 ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: - PL' i�1- PART FAIL BING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service • Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ 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 7 1 � ��� ADA 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 3- • 87 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received Date Requested 2 — 2 p' AM PM BUP q Location l 5 1 73 /1.,k Suite MEC Contact Person Ph ( ) 76 2 – G 06 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall • Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam I 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 ' I Final —T© ��) D V PASS PART FAIL '' ELECTRICAL Service Rough -In UG /Slab Low Voltage Fi - Alarm ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI Q Please call for reinspection RE: El Unable to inspect – no access Fire Supply Line ADA Date , 0 Inspector /JL. - •i. i ir/ Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record fr r / the j s site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 a — �3 s9 INSPECTION DIVISION Businees Line: ( 503) (503) MST / BUP Received Date Requested Z —15" AM PM 1 BUP - Location it d ?s '. 'mot' Suite MEC Contact Person Ph ( ) 7d Z — 66. Dt6, PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC ©V• Footing ELC 0 Foundation Access: ip Ftg Drai . ELR Crawl Dra /1�/ Z +� '�'sla Inspection Notes: �`-1r SIT a; LPost & Beam t1/9/4,7- (es) T ` Shear Anchors Ext Sheath/Shear Int Sheath /Shear r Framing �`.imi: . „,- . 4f `t. - _ of Insulation Drywall Nailing -2 ; ∎ Veil— Q Firewall Fire Sprinkler L a Fire Alarm v v \,`f - N \ Al 3 .°"y._ \A- -7( t/G Susp'd Ceiling `� q o 4 Roof 6 ) k I. k NA -- 1 8 Other: Final PASS PART FAIL i UMBI (lam' �' �— V Poste& eam 2 _ A Under Slab i 11AV Rough -In 1 2�c4/d3'2 P S) /� Water Service `k' ^' `'� �P- ' — G`" "9 e-,---e-----0 Sanitary Sewer lZ(, �/ �lr1 k/ �„ - 6 y0/ Rain Drains Catch Basin / Manhole ' 0 Storm Drain 1`'.l'„`' f t� e �1�1's� ■ Shower Pan ` Ot 4 40 PART FAIL , . = '.rr AL Post & Beam AL, M - og Rough -In 1 7.H6y(Tt.0 Gas Line Smoke Dampers ma , PART FAIL TR ICAL Service o s. , Rough -In UG /Slab - Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA �/ °� ; Approach /Sidewalk Date — / Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site.. PASS PART FAIL •