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Permit AN: CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00343 147 1 i DEVELOPMENT SERVICES DATE ISSUED: 12/9/2004 `' ,.� ■ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14196 SW 97TH AVE PARCEL: 25111 BA - 00100 SUBDIVISION: ZONING: R - 4.5 BLOCK: LOT: JURISDICTION: TIG REMARKS: New SF. BUILDING REISSUE: SSN2746 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 19 FIRST: 2,147 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 599 sf GARAGE: 712 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 272 990.60 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,746 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVCOFDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HMISVCIFDR: 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: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,650.23 MASTERPIECE permit is subject , the regulations contained in the ASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUCTION IN L figard Municipal Code, State of OR. Specialty Codes 14225 SW 128TH PL 14225 SW 128TH PLACE and all other applicable laws. All work will be done in TIGARD, OR 97224 TIGARD, OR 97224 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 750 - 5549 Phone: 524 - 4371 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #` LIC 69010 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insj Gyp Board Insp Appr /Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final Issued : Permittee Signature : L,R,ga,._ —efffil Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day . 4oT L ee -AJVs M--- -r • , Buildin - ' P e rmit A lication � FOR OFFICE USE ONLY City of Tigard RE t + �'V � , Date/B y / -' / ` Z Penult No.: e., - 4 3 3 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 r(''� Q I'''' ''' Iii � ` Date/B / 'Z : /h ' t — S'C' Other Permit: l '', l i Inspection Line: 503.639.4175 W.+ I v 44. '� I Date Ready/13y: El See Attached Checklist for Internet: www ct tt and or us Notified/Method: Supplemental Information g FTIGAR� CITY 0 • ry . + r, , � a , s .. Is7 1 `3 „ > s ,,-,-`, , , 4 G 63 ... WEI:,I.ING — 1:35 - � 1.74014p._:. 4:25 vas .,. - .€ h R ,.. &,. x . � ,,, z"1 _ . ter_ b as 'vide a : . k , New construction ❑ Demolition Permit fees* are based on the value of the work performed. ---..... Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the y *mil 1 ;; +~ .. work indicated on this application. i 4 / 0 a 0 d r- h - and 2- family dwelling ❑ Commercial/industrial Valuation: $ I=1 Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 3 1110 �" , Total number of floors: �, * t + k, , a t a l- DLO Job site address: //I 1 ' , S k.J Q f ,.-V g r , New dwelling area: "7 d V square feet City/State /ZIP: 'T t.9 1Q 1 0 1 / 7 2'� Y Garage /carport area: tic 1 4 square feet Suite/bldg. /apt. no.: �"' I Project name: 1 Covered porch area: / Q V square feet Cross street/directions to job site: q -- ) - 1 (d" ` 4 i w 1 f Deck area: '$ square feet i Other structure area: square feet ` , QUIREI? DA,'FA. '-COMIVI 4.CIA,Ia-USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: ( - I �p . 0 I 1 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the "- ':- 1 i ' � a- :as a - ,? 'z ' ' a ,p � ! u 1 ,,, ., - p , , wor • in dic a ted on this application. ik € t-tJ 43 1\•.„,4:r Valuation: $ Existing building area: square feet New building area: square feet Name: yy sec tc e _ ✓ t - ,,, C- c I k______ k______ Type of construction: Address: / 27 es -- 7 - (� f 1 ,F � 1 P I Occupancy groups: City/State/ZIP: \ Lk ___ et '11--'%--`1 Existing: Phone: ) ' ~ 6 Fax: K.__ ) 2 - New: is a b � ] a $* 4 "t a ' a x "a' .n d 3: �..' _s . " ;.. ' ' at. g Business name: All contractors and subcontractors are required to be Contact name: 7\A ( licensed with the Oregon Construction Contractors Board I ' ` under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) I Fax:: ( ) E -mail: Business name: 1 4 Address: Please refer to fee schedule City/State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: Date received: Authorized signatur : This permit application expires if a permit is not obtained aa ( within 180 days after it has been accepted as complete. Print name: A.. A.. k k d, t� A Ki '' ati U 1'S v 7 � * Fee methodology set by Tri-County Building Industry Service Board. i:\ Building \Permits \BIJP- PermitApp.doc 12/03 440- 4613T(II/02 /COM/WEB) One- and Two - Family Dwelling . - ,. Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Date B Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Y Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 // enirN U pu NU�u 'I +� CI Electrical ❑Plumbing ❑Mechanical 24- Hour Inspection Line: 503.639.4175 ■ �,�, Internet: www.ci.tigard.or.us — '. ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I 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 1=1 0 ❑ 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 Development Fees document. ❑ ❑ ❑ . 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One - Two - FamilyChecklist.doc 12/03 Mechanical Permit D FOR OFFICE USE ONLY City of )cigars C Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 v ., f ,. i `, n 2004 Plan Review Phone: 503.639.4171 Fax: 503.598.196 I � . e7 G HQ , pi,, \ Date/By: Other Permit: Inspection Line: 503.639.4175 ■ {�. Date Ready/By: Juris: See Page 2 for Internet: www.ci.tigard.or.us CITY OF TI GAR r "' Notified/Method: Supplemental Information BUILDING D IVISI ON TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ew construction El Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating /cooling Job site address: / Li I I L, S W 1 i If9 U e Air conditioning or heat pump (requires site plan showing placement) 14.00 City/State /ZIP: T l l 14_,.,_A a __._ Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 i`' ,, Hydronic hot water system 14.00 " ` .A-- �- �. Y" � 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.: t2 0 S 1 1 I Q A. 1 0 Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 �,rJ J Gas fireplace 10.00 /V `, 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 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00 Other: 10.00 Name: A` Y t CLr /� v ,..„ m s Environmental exhaust and ventilation Address: (1.-( V (f ^, -� ' --- ( � J 1 / v. Range hood /other kitchen S ` 9 l equipment 10.00 City/State /ZIP: ` � 1._'L � t Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: 60 ) 7 6' .,954 el Fax: (101) / -( 31 1 toilet compartments, utility rooms) 6.80 EAPPLICANT 1 ❑ CONTACT PERSON Attic /crawlspace fans 10.00 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 -mail: Range CONTRACTOR Barbecue �+J - ( 2,-. ` v .._ \ 1 v` Clothes dryer (gas) a Business name: V C Other: Address: .P b tis 1 3 L MECHANICAL PERMIT FEES* City/State /ZIP: es d 1L. 11 %3 ) Subtotal V Phone: ( r-. V b s� I` 1 b Fax ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: 3O 4 9 State surcharge (8% of permit fee) { TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 j d ays after it has been accepted as complete. Print name: 6 1l < 1 6_, w 1) A Date: 14. . 6 -6 I * Fee methodology set by Tri -County Building Industry Service Board Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information • Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof; to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\Building\Permits\MEC- PermitApp.doc 12/03 2 Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard f I Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 : Plan Review Phone: 503.639.4171 Fax: 503.598.1960 //,�,e�/NI � €> Plan Re \ DateB Other Permit No.: 24- Hour Inspection Line: 503.639.4175 lJ t+ I .4 9 2004 . I .' i y J„ Internet: www.ci.tigard.or.us Date Ready/By: See Page 2 for S Notified/Method: Supplemental Information :T S i;i: ; , z . $Vi;Zz- - V-1: 1 .1, 1 ,3 3 ,Fie. : , . ..- s g 7 r � � < ' 1::4it'ais a fall r t t " 1 .. - .< �,..,.L... � , ..... . dl Ili ew construction ❑ Demolition For special information use checklist. Description Qty. I Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection) . _" i ,•% SFR (1) bath 249.20 r 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 35D.00 El Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other Fire sprinkler (_ sq. ft.) Page 2 € '-'''''"j'''' E g :,-.."-t1'... t i . lx c a q , -. (' . ,. '-.,.:. -. ... -- ---' � .' '' s Site utilities Job site address: / S.( l L S ' � T k (r'L' Catch basin or area drain 16.60 City /State/ZIP: l � Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 1 T L " '-C u j Manholes 16.60 1 ► "\ 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 Tax map /parcel no.: I y ♦ pJ V Fixture or item ' r ,,,� Absorption valve 16.60 ;1 x t • =1:t Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 fi x r 6 i F :' � R ` A Y. a _ Drinking fountain 16.60 � � 5 � 1 @ -' k .a. m, ,.�. _ _ _.. � ^ _ ' ? ,... . it Ejectors /sump 16.60 Name: IA 16-. °(-p. /4^ l CC t CO31 Cl" / / k ( Expansion tank 16.60 Address: / kt (5 ' 5 ( -4-/ j J / 1 ! Fixture /sewer cap 16.60 City/State/ZIP: i Q er a `.. L 11 Floor drain/floor sink/hub 16.60 Phone: W ) 7 V`-• Lt Fax: 4 ) Z. ( iv ' Garbage disposal 16.60 t Hose bib 16.60 e .. .. - ± '''' , Ice maker 16.60 Business name: Interceptor /grease trap 16.60 cry Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax :: ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 E-mail: Urinal 16.60 t ' ' 'it: f,_ .i . 1 �1 . i k . .. ~. Water closet 16.60 r Business name: F J Of e r J '" • ( Water heater 16.60 ) Address: 3 ( . / , Other: City/State /ZIP: ��„, , f / I _ Subtotal Minimum permit fee. $72.50 Phone: ( 21 ���11'OIM� Fax: ( ) Residential backflow minimum permit fee. $36.25 io� 0 Plumbing Lic. no.: v - Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized s i hire: �jo . TOTAL PERMIT FEE Print nand \' ' 2 � ,�-) Date f b "• j' , tti This permit application expires if a permit is not obtained within 1 180 days after it has been accepted as complete. Fee methodology set by Tri-County Building Industry Service Board. is\ Building \Pertmts\PLM- PermitApp.doc 12/03 0 - 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard 4 Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: t ee ea" Total m i t Fee: q 44 tape Per Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer- 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 i>1a011,,w, 'rm><t „Fee. $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 additional $100.00 or fraction thereof, to and 3- a� Feee `I'6talt 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 * . • m 4 . m Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" - 3" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach./Refrig. Drains 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 Isometric or riser diagram is required if fixture quantity - Commercial 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\Pernits\PLM- PennitApp. doc 3/03 Electrical Permit Ap igti FOR OFFICE USE ONLY ( s City o£.Tigard CEIVEDA DateBReceived y: PetmitNo.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 c ) / ", "`"' 111 � ` OC [ �� Date/By: Other Permit: Inspection Line: 503.639.4175 (�' 200 . ,.. ' Date Ready /By: JAS: Ed See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information �-,,� R 'PE19A ■I1 ISION PLAN REVIEW ,IQ N e u construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential Er 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more ['Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: Job site address: /O t `1Ls t�J � '1 11.,�crc^ ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City/State /ZIP: T \q ! (\ f C —7-1_-- y The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total I ** Cross street/directions to job site: New residential single- or multi - family dwelling unit. n \ �C I Includes attached garage. /V µj ! I 1,000 sq. ft. or less ! 145.15 4 Subdivision: o , + Lot no.: Ea. add'1500 sq. ft. or portion 2„...--- 33.40 1 Tax map /parcel nor / / f 6 'V• © i Q V Limited energy, residential ./ 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION WORK Each manufactured or modular �/ dwelling, service and/or feeder 90.90 2 / r� Services or feeders installation, alters ' n, and/or relocation 200 amps or less 80.30 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: f Q I Q � C p ' 601 amps to 1,000 amps 240.60 2 Address: / n `LK' (� 1 a ' - / �f / C Over 1,000 amps or volts 454.65 2 l v ' n Reconnect only 66.85 2 City/State /ZIP: el ll �S e___ / ZZ� ( _ Temporary services or feeders installation, alteration, and /or Phone: ) -7 s---(1......s---5-4 j Fax: S 1 c 2�I ( 57 1 relocation 200 amps or less 66.85 1 Owner installation: This installation is eing 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 ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: et..- 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) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or /� extension. Describe: Page 2 2 Business name: q Ti C 2 T �-(�„ 1 PA S 1 Q ,S ('V� Address: l r P /{ � 1 j j (4 2 Q Each additional inspection over allowable in any of the.above U J ` �/ Per inspection 62.50 City/State /ZIP: (( j . pw t, a- a - N 11-- 9 '^ / V 7 b 1 Jl Investigation per hour (1 hr min) 62.50 Phone: ,3) LS 1-- O 1 ci ' __ t Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic)y 5y L Electrical Lic.:3 1 a g Suprv. Lic.: / g 5 Subtotal Suprv. Electrician signature, required: I { Plan review (25% of permit fee) Print name: C u� e,i0. Date/ tJ`('S/ II t State surcharge (8% of permit fee) ,, TOTAL PERMIT FEE C.C Authorized signature: i �,, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name) VLV 4 01 - t _ D ate K --� " * Fee methodology set by Tri- County Building Industry Service Board `Y U ** Number of inspections per permit allowed. i:\ BuildingTermits \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: RESIDENTIAL WORK ONLY: Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: 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 is \ Bui tding\Permits\ELC- PetmitApp.doc 04/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE t.v X— 11 cam W-44 c 32 - SW BARNET ST FOREST GROVE, OR 97116 -8651 Plumbing Signature Form Permit #: MST2004 -00343 Date Issued: 12/9/2004 Parcel: 2S111 BA -00100 Site Address: 14196 SW 97TH AVE Subdivision: Block: Lot: Jurisdiction: TIG Zoning: R -4.5 Remarks: New SF. 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 j=am,, i1-ee-t i (, (27- 2 OWNER: PLUMBING CON MASTERPIECE CONSTRUCTION INC 14225 SW 128TH PL 3254 SW BARNET ST TIGARD, OR 97224 FOREST GROVE, OR 97116 -8651 Phone #: 503 - 750 -5549 Phone #: 503 - 359 -0560 /6, i 5-5 Reg #: LIC ..4 PLM 34PB c( AN INK SIGNATURE IS REQUIRED ON THIS FORM )1utzmber If you have any questions, please call 503.718.2433. CITY OF TIGARD • 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GAGE ENTERPRISES INC PO BOX 1429 CLACKAMAS, OR 97015 -1429 Electrical Signature Form Permit #: MST2004 -00343 Date Issued: 12/9/2004 Parcel: 2S111 BA -00100 Site Address: 14196 SW 97TH AVE Subdivision: Block: Lot: Jurisdiction: TIG Zoning: R -4.5 Remarks: New SF. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MASTERPIECE CONSTRUCTION INC GAGE ENTERPRISES INC 14225 SW 128TH PL PO BOX 1429 TIGARD, OR 97224 CLACKAMAS, OR 97015 -1429 Phone #: 503 - 750 -5549 Phone #: 503 - 657 -0142 Reg #: SUP 618s LIC 34544 ELE 3 -128C AN INK SIGNATURE IS REQUIRED ON THIS FORM X J020 -�r �CI Signature of Superv • Electr If you have any questions, please call 503.718.2433. CITY OF TIGARD 1, 1 BUILDING DIVISION / PERMIT #: aT °�OOA -00343 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/9/2004 lP At MOBPhone: (503) 639 -4171 4 Inspection Requests (24 Hrs.): (503) 639- 4175 I.. INSPECTION WORKSHEET FOR DATE: 917/2005 TIME: 7:08AM PAGE: 118 SITE A DDRESS: 14196 SW 97TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MASTERPIECE DESCRIPTION: New SF. OWNER: MASTERPIECE CONSTRUCTION INC, PHONE #: 503 - 760.5549 CONTRACTOR: MASTERPIECE CONSTRUCTION INC PHONE #: 5244371 Inspection Request Scheduled For: Date: 9/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 015028 -02 503 - 750-5.9 4100 C Corrections /Comments /Instructions: t ANC -0 s= i��� ii-x,,,A s--Q . (7-4-: La) \,),-. 003Clatck- cl , it u-isAJJ-C__ A- r \/Le 0. \ 9 . 4.....1- 1 e.ia ii ,) C--L-e--e,t - \, -.Q.J ■ - Th Rp_Va s ---- (- q /- ) / c ---- s ,, _ Lj - IAA 0 Li-1,_____ --Q--z..ic Le Vs 1 (..D,) • n PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS p;? I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED ■ Inspector: �,/s - Date: //d Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00343 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/9/2004 Phone: (503) 639 -4171 / u�� � i , � �\, Inspection Requests (24 Hrs.): (503) 639 -4175 .�' ' I.. INSPECTION WORKSHEET FOR DATE: 91712005 TIME: 7:08AM PAGE: 119 SITE ADDRESS: 14196 SW 97TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MASTERPIECE DESCRIPTION: New SF. OWNER: MASTERPIECE CONSTRUCTION INC, PHONE #: 503 - 750 -6549 CONTRACTOR: MASTERPIECE CONSTRUCTION INC PHONE #: 5244371 Inspection Request Scheduled For: Date: 9/72005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 015028 -01 503.750 -5549 N Corrections /Comments /Instructions: 71 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL [ I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED (� Inspector: �A - - Date: -1 `, Phone #: (503) 718- CiTi''OF TIGARD t BUILDING DIVISION PERMIT #: MST2004 -00343 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: - IM2004 Phone: (503) 639 -4171 Ark pu�ii�l' Inspection Requests (24 Hrs.): (503) 639 -4175 `:_.. INSPECTION WORKSHEET FOR DATE: 9/6/2005 TIME: 7 :06AM PAGE: 25 SITE ADDRESS: -14196 SW 97TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MASTERPIECE DESCRIPTION: New SF. OWNER: MASTERPIECE CONSTRUCTION INC, PHONE #: 503 750.5549 CONTRACTOR: MASTERPIECE CONSTRUCTION INC PHONE #: 5244371 Inspection Request Scheduled For: Date: 9/62005 Pour Time: Code # I • - ' • . P escription Confirm # Contact # Message 199 Electrical final 014970 -01 503.7511.5549 N Corrections /Comments ns ructions: • • ------ PASS ❑ PARTIAL APPROVAL n CANCEL Li NO ACCESS FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: (� � Date: et 1 qa-5-- Phone #: (503) 718- 2LNO • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004- 00343 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/9/200-4 Phone: (503) 639 -4171 Jowl �l Inspection Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: 3/2/2005 TIME: 7:87AM PAGE: 22 SITE ADDRESS: •4196 SW 97TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: MASTERPIECE DESCRIPTION: New SF. OWNER: MASTERPIECE CONSTRUCTION INC, PHONE #: 503- 750 -5549 CONTRACTOR: MASTERPIECE CONSTRUCTION INC PHONE #: 524 -4371 Inspection Request Scheduled For: Date: 9/2/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 014893 -01 503 - 750.5549 Y Corrections /Comments /Instructions: S PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (h,t ► �` U h-�_- • Date:4f IO..,Io Phone #: (503) 718- `Ta N A I ATIO TIF C TREE CER S r:, 1 I, O wner /Agent for (Not) 1 CL----r 1 CC--c a "`-'57-- P4- (PLEASE PRINT) (PERMIT HOLDER) w � Pt '-`, =M - ; w fi : ���. ;.._ Do hereby c°erti f y hat tilae fo ll wi location meets . ,Ctyof :Tigard /Washingto .l ounty �ro , -�,� . =, �, �.� . �� o�:. ,�:�.e land use and development standards for street tree installation. Do- A ! 0- • ADDRESS. ( C ( I t S L 1 Tlivl-LAL77 o. • LOT: ` t. l lir SUBDIVISION: i • BY: �� , DATE: --- RECEIVED BY: DATE: 10/7/0