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Permit I ', CITY OF TIGARD MASTER PERMIT rif PERMIT #: MST2005 -00309 , 1641ll DEVELOPMENT SERVICES DATE ISSUED: 11/14/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 BA -04000 SITE ADDRESS: 14100 SW 98TH AVE ZONING: R -4.5 SUBDIVISION: MCDONALD ACRES LOT: 015 JURISDICTION: TIG Project Description: Bay in dining room. Mechanical fees included in building permit- MAV BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 30 sf BASEMENT: sf LEFT: 15 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5 VALUE: 6,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 30 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FOR: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: 1 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 AREAISPC 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: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes DICK BRACK TIMES CONSTRUCTION and all other applicable laws. All work will be done in 14100 SW 98TH ST 746 SW 4TH ST accordance with approved plans. This permit will expire TIGARD, OR 97224 GRESHAM, OR 97080 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 Phone: 503 Phone: 503 adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: LIC 38110 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 273.16 1 -800- 332 -2344. REQUIRED ITEMS AND REPORTS Issued By : �1tiL %it-lfs ! „ , ,/2 Permittee Signature : Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application ®®Q ' :FOR OFFICE'U ONLY �,. ,., ; City of Tigard B ECEI �D E Receive J � ,) , yam 1312 Hall Blvd., Tigard, OR 97223 Date/By: - ,f�C'�,.) YL/�,, PemutNo - 1— p0347 g Plan Review Phone: 503.639.4171 Fax: 503. 598.1960 AUG 2 2 2005 _ Other Permit: �/mi���l� Date/ By: � y a� lA,l 4� "31 �uS Inspection Line: 503.639.4175 ["''rte �W Date Ready /By: ;( � lens: L_ �rt" / El See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: �'/ 'a�1) Supplemental Information CITY OF TIGARD sO O e ( - I V 6\ \4._\ n="'>� "'�'i "x'`c .M,�..- , ;sue . � L i.�# � ;> AWA . s, �. pi's, :,s .,�.. „a,� "� vzm�,;.�,i. " I ` " 6-a 5 .1 `1 'xa p� ,•, a � ' t. 4,'.x-- ^>, .. s 6 � ' A . 1 " = . _ : Y ID� W LLING ' ', 0 F'" , ' v rk; '; '. r i RFQUIRED DATA 1 Al D= 2� FAIVII) : , - �"�.��.+: . - � n;_ ����` h�o-t� ���',.:. �, �Z,.N*.."° s> �.•' �e. Y. �' � ��' ,°, �; ':�:a,'.��'`��?_`� �r^., � � °�:`::>�s��u�,�:a�r ��bovid�3:z �; �.:�� .._" .�. ❑ 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: f{_ J 3 t 64,0,/, O t4--t equipment, materials, labor, overhead, and the profit for the : z :,K ,'A NE _- tzt f =« 56 .7 .:=s= >t >4, i =t.� w`. r> • ; work indicated on this application. ; ` ' ,, a `" " CATEGOR . OE 'CONS.., iT ..1 N•" q : ;' r k106 4i �v.�' a„ -� �:x'���`•":c- ... f:��.�:."E`€� .'w.���.': :�t;^�45zxt e#"m�..scr ��. n .�. �w's�a1.�;�- a a�? > >`:= .,. F...e. Valuation: $ ❑ 1- and 2- family dwelling ❑ Commercial /industrial , oaD El Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder IrOther: f2E ak l Number of bathrooms: s.''' ;:sy 'W"3`{m"<, 1:!. 'g Y »' %'. ,, , `.zp,rr:; ,4014— ;.3.? VI . . ,.., ;. y .,..,.,,, '. ',',,, ; ,. , I ,P,..<00;2', O - FORMAT ON ANN`D EOCA I,ON - , n. „ , ` ry • Total number of floors: Job site address: /tf f e,O 5 f '. 9 g- r S t New dwelling area: square feet City /State /ZIP: 7'/� _d e9.-- 97aaY Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: , CA Covered porch area: square feet . Cross street/directions to job site: �' . 43 . ' � „ Q8 ' Deck area: square feet ` Other structure area: square feet tria'IRED;,= D °?.TA il1311 EI2CIAli' iSE;C LIST,. Subdivision: /f') e _ il„ e} _g 4 6 „, is Lot no.: /S Permit fees* are based on the value of the work performed. Tax map/parcel no.: ` • Indicate the value (rounded to the nearest dollar) of all a„ 5- %A v „ equipment, materials, labor, overhead, and the profit for the I I ' " t a it 4DESC N'OF WORK .0 ,r � E work indicated on this application. LL / Valuation: $ € /,I` /G / i a. ? J I) At O1 di n0 ell frtSDiv' Existing building area: square feet New building area: square feet '>.�iT�'�' x°�'^ "��> �'��P�+ ;2�#=`a�`�&:� "�. , ..ac,Q� r ;.:y�..:�::;i��ihr,r;&;;.�.�,'s C'', 7;14'4, ,� -+'�., �.i`t•C� ,:;�5: ":at ; :�� ,�..- ,�'K.�,�. q-� *' tPROPERTY O `4NER „� - I E�. 1V TA i i i Number of stories: Name: D p 44- 6 r ¢ Type of construction: Address: /L4 loo 5l� £ ' & ! 51"; Occupancy groups: City/State/ZIP: ! J g 4 e d 0 r t?/ '?'P,g f Existing: Phone: ( ) Fax: ( ) New: ZA - �,;;: �.>a.�, r'�rf �t;�, �w,m -� s;.,: °t.'- ��t �:,• �.,>:- a., � : >�r?. ac��a-��:=�.,�'.s�„ -;.. .,. _ , ¢ : ' a , . � .. V' ". ..'':' . +,;, .-y '.� �.. >;, 1'LI „ ANT: -�� ;�� ° � - C OO .T CtI'�+PE'RSO »i� �:�,3;, r�;� - 'r,' ��:' , �' , �:. :;e m �s ; � � , �;,1° �,<,;: .,. , „ ' G n ., ". I, ,, s , , �1. + ^.�.w 17 i ", u ,. : 1E .. x .nib s R , .t � .^.s „._: ����a, ra �.x, ^..','a>�.':�;:tk�R..'ticse, ':.�`: �'�.,.. �;.rt: . "�:. �;3:,?" �- '„v:�J'� �x4�:.p*.�......,'�`r�H ',.di...=: -.z� ,,'' 't'd�. ND"I`,IClti 4a.�"�.�, -, :r >'i _ - Business name: / mi.5 � S All contractors and subcontractors are required to be Contact name: A� ©� licensed with the Oregon Construction Contractors Board under ORS 701 and maybe required to be licensed in the Address: --22 fe S ti i-e-ai 5r jurisdiction in which work is being performed. If the City/State/ZIP: /� /� applicant is exempt from licensing, the following reasons Cit Y ! .. i.- e s .+^ % C t C 76 a0 apply: Phone: ( ) '?ir Loge Fax:: ( ) E- mail: . A>�i '�”` £' "°,�`"" - 3- `C, A .. h$ �; X � - e- fix• ,&w ", +e " . _ I{ W S In ` ; W ' O CON ?1RA G TOR g EINI e t r ',f: , O ff Business �:. ,,>,,,;,tx;.:' ness name: *,,,,3,,,, � `�>�- � �����:, � �. -: ! h 1 L 5 ILbIIVGP,ERIIIT I Address: 1 ta � ' - 7j/ S A) "- r A- 7 :.6,,..,. • ' : •a.- ;;:w$0°,M . �°•, i :.' - ` V• ' =- Please refer to fee schedule. City/State /ZIP: - Es A 4 - , r , 6 j 9 , Olf, Fees due upon application K Phone: (Y3) 760' Qaq Fax: ( ) 138^ 1 1 Amount received CCB lic.: Date received: Authorized signature: �� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 'l,.. f 5 g__ re) O Date: 8-- ad — Qg * Fee methodology set by Tri- County Building Industry Service Boar i:\ Building \Permits \BUP- PemtitApp.doc 12/03 440- 4613T(11 /02 /COM/WEB t 1 .,51 7— '$.-5. O0 T' - One- and Two- Family Dwelling t . Building Permit Application Checklist FOR OFFICE • US E ONLY- q City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 9 223 Date/By: Phone: 503.639.4171 Fax: 503.59:o 1960 � /aaN I'�p k� Associated permits. 24- Hour Inspection Line: 503.639.41 5 I ❑ Electrical ❑Plumbing ❑Mechanical Internet: www.ci.tigard.or.us ❑ Other: ` . ' :: THE F.OLLOWING,ITEMS'ARE R E Q U I R E D ,, FOR,PLAN"REVIEW , : , :' , '''yes . . No -- N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar ba .nce points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat ot. ❑ ❑ ❑ 4 Fire district approval require . Name of district: ❑ ❑ ❑ 5 Septic system permit or authori..tion for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original a.'.licable stamp and signature on file or with application. / ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit -quired. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. . - 10 3 Complete sets of legible plans. st be drawn to scale, showing conformance to applicable local and .tate ❑ ❑ ❑ building codes. Lateral design details ano connections must be incorporated into the plans or on a separ. - full -size sheet attached to the plans with cross refe -nces between plan location and details. Plan review canno .e completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan mu t show lot and building setback dimensions; prope corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differentia , plan must show contour lines at 2 -ft. intervals • ocation of easements and driveway; footprint of structure (including . ecks); location of wells /septic systems; ut y locations; direction indicator; lot area; building coverage area; perce age of coverage; impervious area; ex': mg structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, :n), hold -downs and reinforci t pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, locati. of smoke detectors, water heater, ❑ ❑ ❑ . furnace, ventilation fans, plumbing fixtures, balconies an.' decks 30 inche .hove grade, etc. 14 Cross section(s) and details. Show all framing - members t es and spac' g such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one c oss sectit may be required to clearly portray construction. Show details of all wall and roof sheathing, roo', g, .of slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulatio ,-tc. 15 Elevation views. Provide elevations for new construction; ime of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the ch. ge in grao e is greater than four foot at building envelope. Full -size sheet addendums showing foundation eleva 'ens with cross -ferences are acceptable. 16 Wall bracing (prescriptive path) and/or latera . nalysis plans. Mus indicate details and locations; for non- ❑ ❑ ❑ prescriptive lath anal sis . rovide s.ecificati..- and calculations to en•in- ering standards. 17 Floor /roof framing. Provide plans for oors /roof assemblies, indicatin: member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls rovide cross sections and details showing pla -ment of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Eng' - er's calculations." 19 Beam calculations. Py ide two sets of calculations using current code design valu: 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 pipin g 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 a..licable to the project under review. ' SPECIFICS •. ,, ' 1rr.* , 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 M echa n ical Permit App m FOR OFFICE U S E ON L Y t ^ 1\1E4 Receive City of Tigard Date/By: Permit No.. 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 AUG y�� Plan Review G 2 10 I II Date/By: Other Permit: Inspection Line: 503.639.4175 als I t _1,,, � Date Ready/By: s' 8 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information CITY OF TIGARD �`°P ts'r = , �n;.�'"Kx .. �ia�i+3V .��" 6 �k�.�t. g v: - - :::; •l, ^w° +r - r: .asg- r�.. ",e .�,�ss;; 1t 4 ,,.. 'l 1. 4, " _TT'P• io iW o V1, F -''�:, -arW , t _ ..lCOMiV EI2CI i f SGNEDUT7E" = TJS 0. k it 'ICLvIST" l _a�1x �-`��° - "..�,uws.�..�.u.��r.'�a�w,aa��- tip,_ -_�tt ors. .. :'nom._,.. a�f ._C ,.�e. -t ��:� ?!s �n,.�+.rn,��,._ _ . -.a _ -, .. ❑ New construction El ddition/alteration/replacement Mechanical permit fees* are based on the value of the work l / performed. Indicate the value (rounded to the nearest dollar) of all El Demolition Other: ��r' /O 1 .. IA-Ai /3 1 w I mechanical materials, equipment, labor, overhead, and profit. ' � r t �•ax S ; ' ,,' : "Y rs� -- } '.vua.,a:: .. . " " � r J Z�` ;, Value • S t .W .,,,� kA*TEGO O ON STRUC'TI ON x ^n � :t :. --. -: :: - . ,s as x.r...=. ,..�a:k 1-i,, a ,.. :.> ,.. 7.-...,;.w 2.. - �w^T,&'a way: ^,^.,, k;aaa+,'"c'<- :.t:>:°:aa.3i: , - o . 'c � ., a y..a i S - ` RESIDEN;TI EQUIPME = /SY" ' S TElYI >F - * 171 1- and 2-family dwelling Commercial /industrial � . . 'd' ',` ": " "° "` ^` - y g ❑ ❑Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder Other: af Description Qty. Ea. Total • "�','.�`"fx t ❑ µ,'.,' .Yj"C'.' -" ,e��f§ «''t (} = �v`.`.'' '.'N;4.i�i' 'FX3 Ea`f'a i�Ik,w.': h. ,; °°"' .# r, ,,+„ ,, A JOB,,, �INFORMA I,,,, 4 y D LOC TI ON� 1 . Heating/cooling Job site address: J l ) , Air conditioning or heat pump �(/(/ W , ....le---0 t � � $� (requires site plan showing placement) 14.00 City/State /ZIP: 15 a-rd arm q �� ^� 1J Furnace 100,000 BTU (ducts /vents) 14.00 P ( Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: "....a6/: Gas heat pump 14.00 Cross street/directions to job site: ji'05 5t @h q S r Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: Al e De ", ay d s r te Lot no.: / Flue /vent for any of above 10.00 /' Other: 10.00 Tax map /parcel no.: Other fuel appliances '' ti . st a : 1i Water heater 10.00 x.' .- , . ..:, tii:: ,-_: 1DES 2 ,, IQ N R OF •WOR t1:. `� 4 „ ; • , 3 i• > t ,y . 1 Gas fireplace foe gas 10.00 61- Q- l Z � 1 S t `� L 5 r t /'f Flue vent for water heater or as fireplace 10.00 �� Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 '' ;; g , o �; = s :.cue y a, . '.,, $4: 'WONT" ,h> t, z �-: - Chimney /liner /flue /vent 10.00 6 xJ' # r, PRO « ' i sa ' y r , ; ❑ TE ANI'.2, � . �. � .. .. _...� o. �� �� _x »aaa:'� i ,„a,�- � + a ... 5.5.E ,, ��aa '>r:, � ° � ?1'*�`' Other: 10.00 Name: 13 i e_4 6 , Environmental exhaust and ventilation Address: /i l - t Range hood /other kitchen 5. - S equipment 10.00 City/State /ZIP: 7 4,,,1 (3r_t 1- 2,2.,:v4 Clothes dryer exhaust 10.00 39 _ S / comp Single-duct exhaust (bathrooms, Phone: (,�(dm [o Fax: ( ) toilet compartments, utility rooms) 6.80 "; .y " °'.'.� a, " ,*','- 't��'::t.�.a*: <<r.�, r „r L:?,i a._ a' .'P , , ,, ..g- a�__. a. "'ra: ^:a; >.nr c raw ce fans - {..:: . T .: ,.- t ,, ONT O Attic/crawlspace , , AP�P,LIC�,N : � -�� _ C CST °��P�RS � t �� Atric/ 1 10 00 .q x$'.x�,E;. a m„, !. ix+.� ' dsL: "':''^5«�r. `� yiA?'.� � �....a /� Other: 10.00 Business name: 1 - / ' <'1'►f 5 l___O /) s /- Fuel piping Contact name: / /" h / 6061 / $5.40 for first four; $1.00 for each additional Address: '-- let? S 4.-) L.(�. S fi Furnace, etc. Gas heat pump City/State/ZIP: g 10 Cr 9 go Wall /suspended /unit heater Phone: (3) Igo_ L * Fax: : ( ) Water heater Fireplace E -mail: Range a; �a+ -.mow y:raaa;»,'4z:? r '&r` C ,� ;t• "^'° .c� ., ,t ,4 - ' „ .:.v4 GQ:TRACTOR i `'. a . e 1.7.1 Barbecue ?n':�: "� � �-. - �. .' �.�w*=,,. �.sz , > �'4 f�_".�t .;�� '�.....� -�_ '�1 5,� Ba e Business name: i v►�, L .6„-,57- Clothes dryer (gas) -}- Other: Address: t 1� s I , c am. ,., ; .f��,, a y ff"� , , , * . s . :,a , ��: �Y� IR! : �"L .1 M'ECH`r1'NTCALfI�ER I P) F< .: `, S `tC'?��Tiiit� s, nc.at:'.�.,.�:.a.;:'s.:,z:n:n= r.� ..�. .._ ,... City/State /ZIP: ( ha_ 14, O rL Subtotal Phone: (3) 7ep- L./ a G r Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: 3 S- ` 10 State surcharge (8% of permit fee) TOTAL PERMIT FEE 7 ie 30 Authorized signature: Thi p er m it a expires if a permit is not obtained within 130 „ ... t , days after it has been accepted as complete. Print name: !,� T ii t sr 0 d k Date: as - ®° * Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Permiis\MEC- PermiiApp.doe 12/03 440 -4617T (I1 /02 /COM/WEB) • Mecha ical Permit Application - City of Tigard Page 2 - upplemental Information Commerc „1 Fee Schedule: &Total f iu t> on „ Per riif Fee 1° 5 : , $1.00 to $2,00c.00 Minimum fee $72.50 $2,001.00 to $5,100.00 $72.50 for the first $2,011.00 and $2.30 for each additional $111.00 or fraction thereof, to and inclu : ng $5,000.00. $5,001.00 to $10,000.00 $141.50 for the fir: $5,000.00 and $1.80 for each a. ditional $100.00 or fraction thereo', to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 fo the first $10,000.00 and $1.35 for -ach additional $100.00 or actio hereof, to and including $ 00.00. $50,001.00 to $100,000.00 $77 ' . 0 for the first $50,000.00 and $ .25 '. each additional $100.00 or action t -reof, to and including $100,000.00 $100,000.01 and up $1,396.50 for . e first $100,000.00 and $1.10 for each a... itional $100.00 or fraction thereof. Note: All ne commercial buildings require 2 •ts of plans. i:\ Building \Permits\MEC- PermitApp.doc 12/03 2 Electrical Permit A i ki FOR OFFICE USE.ONLY a� ® L. City of Tigard W r Received Date /By. Permit No.: • 13125 SW Hall Blvd., Tigard, OR 972211,G Plan Review Phone: 503.639.4171 Fax: 503.598.1 l,7 2005 ��," I • Date/g. Other Permit: Inspection Line: 503.639.4175 ,- • Date Ready/By: luris: El See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information 8 Lificiainil DYMON PLAN REVIEW ❑ New construction Pl ease check all that apply: ❑ Addition /a lte� �on/r placement PP Y: `I7 b •Jti Si) Al / n g OService over 225 amps, comm'l ❑Hazardous location • ❑ Demolition [l�Other: © L ��P d .....71 - 0 Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION oft and 2- family dwellings 4 or more new residential ❑ I - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder [Other: 1 ..ir[p j / ❑Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION RV park ❑Egress light plan P Job no.: h / f Job site address: / / 0Q S U q8 5 fi- Submit ❑He 2 - care o fp ay ❑ above. e 2 sets of pl with any of the above. City /State/ZIP: r , 5 4„4 4 ,.. j 0 r 7�aiJ The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: J I Project name: 6 r l FEE* SCHEDULE /� Description I Qty. I Fee. I Total I ** Cross street/directions to job site: ' / �DJ t exit e 9k...3. 57. New residential single- or multi - family dwelling unit. Includes attached garage. • 1,000 sq. ft. or less 145.15 4 Subdivision: M Lt ,', a il s er£S Lot no.: /b Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION' OF WORK Each manufactured or modular l� t�UL 1/94.--)_?" al/ p / j �) on 2 1 dwelling, service and/or feeder 90.90 2 J Services or feeders installation, alteration, and /or relocation 4 �.,.P 0 wt 200 amps or less 80.30 2 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 J 401 amps to 600 amps 160.60 2 Name: /7 of /( 601 amps to 1,000 amps 240.60 2 Address: /Li/ 00 .5 i-J. Over 1,000 amps or volts 454.65 2 l Reconnect only 66.85 . 2 City /State /ZIP: ri JQr ® 7aa:2/ Temporary services or feeders installation, alteration, and /or relocation Phone: (5i3 ) a 3 cy._ ?, I Fax: ( ) 200 amps or less 66.85 I Owner installation: sin tallatio ' g made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, re , or excharge, cording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner Signature: Date: e 't r a`� Branch circuits - new, alteration, or extension, per panel P LICANT �9 I ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: 'f 1 m /��� 5 branch circuit // lr B. Fee for branch circuits Contact name: i ' P,.h / g eon without service or feeder fee, / 46.85 2 each branch circuit / Address: "7'16 s ./.). ' 1(.1 .5 r. Each add'I branch circuit 6.65 2 City /State /ZIP: /;, S � N Of-2... raj 20 11-0 Miscellaneous (service or feeder not included) (j ` Pump or irrigation circle 53.40 2 Phone: ( 603) ' -O— leo I Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or ,,pp extension. Describe: Page 2 2 Business name: it /'''► £ 5 l .on 57- Address: — [ 6 ,..s (,J 1 - 1 � Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: 0.....,--E5 h4_ Dr -' 7t fro , Investigation per hour (1 hr min) 62.50 Phone: (503) �ko - t 10 �Gr Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lie.: 38-up Electrical Lie.: Suprv. Lie.: Subtotal �/ .3 Suprv. Electrician signature, required: Plan review (25% of permit fee) !! �� Print name: Date: State surcharge (8% of permit fee) 3 7 TOTAL PERMIT FEE ...570, t Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board •* Number of inspections per permit allowed. i:\ Building \Permits\ELC- PerrnitApp.doc 12/03 440- 461ST(1 0/02/COM/WEB Electrical Permit Application - City of Tigard ' Page 2 Supplemental Information LIMITED ENERGY PERMIT FEES: I - RESIDENTIAL WORK -ONLY: ' . �_. ___ --- I Pee for all residential systems combined ... $75.00 Check Type of Work Involved: • • udio and Stereo Systems* i ❑ Bu „Oar Alarm ❑ Garage 0 oor Opener* ❑ Heating, V- 'tilation and Air Conditioning . System* ❑� ,/ Vacuum Systems ' [J Other: /v i L 4 .. 4J/ r I1 COMMERCIAL WORK ONLY: Fee for each commercial system $75.01 . (SEE OAR 918- 260 -260) Check Type of Work Involved: • ❑ Audio and Stereo Systems . ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installatio ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Sy- ems ❑ Landscape Irrigation • ontrol* ❑ Medical • ❑ Nurse Calls ❑ Outdoor andscape Lighting* . ❑ Protec ive Signaling ❑ Othe 1 Total, number of commercial systems: • • *No licenses are required. Licenses are required for all other installations . i:\ Building \Pennits\ELC- PennitApp.doc 04/03 r CITY OF TIGARD , BUILDING DIVISION PERMIT #: MS-M(640309 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11114/2005 Phone: (503) 639 -4171 � 'N4 �u"`� Inspection Requests (24 Hrs.): (503) 639 -4175 „ ' '! L . INSPECTION WORKSHEET FOR DATE: 8/9/2006 TIME: 7:04AM PAGE: 71 SITE ADDRESS: 14100 SW 98TH AVE CLASS OF WORK: SUBDIVISION: MC {DONALD ACRES LOT #: {?15 TYPE OF USE: PROJECT NAME: BRACK DESCRIPTION: By in dining room. 8/4/06: THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS FOR A PERIOD OF 30 DAYS. OWNER: BRACK, DICK PHONE #: 503 - 639.5863 CONTRACTOR: TIMES CONSTRUCTION PHONE #: 503..760 4429 Inspection Request Scheduled For: Date: 8/ci/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 034613-03 503 -639 -5863 N Corrections /Comments /Instructions: d i, PASS I I PARTIAL APPROVAL I I CANCEL n NO ACCESS FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED JJff o Lf Inspector: Ci/ll Date: O'. 06. Phone #: (503) 718 -Z 4' ' CITY OF TIGARD 1 k• A BUILDING DIVISION PERMIT #: MST2005-00309 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005 Phone: (503) 639-4171 „.... Inspection Requests (24 Hrs.): (503) 639-4175 19.6■ --.. INSPECTION WORKSHEET FOR DATE: 819/2006 TIME: 7 PAGE: 72 1 SITE ADDRESS: 14100 SW 98TH AVE CLASS OF WORK: SUBDIVISION: MCDONALD ACRES LOT #: 015 TYPE OF USE: PROJECT NAME: BRACK DESCRIPTION: Bay in dining room. 814/06: THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS FOR A PERIOD OF 30 DAYS. OWNER: BRACK, DICK PHONE #: 503-639.5863 CONTRACTOR: TIMES CONSTRUCTION PHONE #: 603.780-4029 Inspection Request Scheduled For: Date: 8/9/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 034513-02 503-639-5863 N Corrections/Comments/Instructions: )r.4 PASS El PARTIAL APPROVAL 0 CANCEL n NO ACCESS FAIL 0 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: --i-i/ i --- Date: 5 ' 7- 0 Phone #: (503) 718- ZSW , , • c CITY OF TIGARD , BUILDING DIVISION PERMIT #: MST0l1rt10309 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: /10/402005 Phone: (503) 639 -4171 i ii ii Inspection Requests (24 Hrs.): (503) 639 -4175 . ' ' INSPECTION WORKSHEET FOR DATE: 8/9/2006 TIME: 7:04AM PAGE: 73 SITE ADDRESS: 14100 SW 98TH AVE CLASS OF WORK: SUBDIVISION: MCDONALD ACRES LOT #: 015 TYPE OF USE: PROJECT NAME: BRACK DESCRIPTION: Bay in dining room. 8/4/06: THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTIONS FOR A PERIOD OF 30 DAYS. OWNER: BRACK, DICK PHONE #: 603.639.6863 CONTRACTOR: TIMES CONSTRUCTION PHONE #: 503- 780 -4029 Inspection Request Scheduled For: Date: 8/9/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message . 299 Final inspection 03.4513-01 503 639 -5863 N Corrections /Comments /Instructions: /( PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C--/hi Date: B . 7. Phone #: (503) 718- 2‘'/y , _ _ . _ . . . CITY OF TIGARD , f. 1 BUILDING DIVISION PERMIT #: MST2005-00309 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005 Phone: (503) 639 -4171 •9 rpi °� Inspection Requests (24 Hrs.): (503) 639 -4175 ,�. '!I... INSPECTION WORKSHEET FOR DATE: 11/18/2005 TIME: 7:17AM PAGE: 96 SITE ADDRESS: 14100 SW 98TH AVE CLASS OF WORK: SUBDIVISION: MCDONALD ACRES LOT #: 015 TYPE OF USE: PROJECT NAME: BRACK DESCRIPTION: Bay in dining room. Mechanical fees included in building permit- MAV OWNER: BRACK, DICK PHONE #: 503 - 639 -5863 CONTRACTOR: TIMES CONSTRUCTION PHONE #: 503- 780 -4029 Inspection Request Scheduled For: Date: 11/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 021789-02 503-780-4029 N Corrections/Comments/Instructions: ..___. e 1 -- 7 ,---- /11111" 4I ' ' 9 EA7C--iceouiv ____ ("7_0 �c� •✓ fil I►r f e ,44----- ' l 101--(__, • 4 PASS ' PARTIAL AP' :OVAL ❑ CANCEL n NO ACCESS "' 14 CA ,' " INSPECTION ADDITIONAL FEES ASSESSED Ayr I nspector: 4.- Date:� �� Phone #: (503) 711 ■.,,,, C IT Y O F TI 1 ' g � • BUILDING DIVISION PERMIT #: MST2005 -00309 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005 Phone: (503) 639 -4171 � � � �4�1411,,)1i Inspection Requests (24 Hrs.): (503) 639 -4175 ;; - I_,, INSPECTION WORKSHEET FOR DATE: 11/18/2005 TIME: 7 :17AM PAGE: 97 SITE ADDRESS: 14100 SW 98TH AVE CLASS OF WORK: SUBDIVISION: MCDONALD ACRES L'OT #: 015 TYPE OF USE: PROJECT NAME: BRACK DESCRIPTION: By in dining room. Mechanical fees inc ded in building permit- MAV OWNER: BRACK, DICK PHONE #: 503 -633 -5863 CONTRACTOR: TIMES CONSTRUCTION PHONE #: 503-780-4029 Inspection Request Scheduled For: Date: 11/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 021789-01 503-760.4029 N Corrections /Comments /Instructions: f rn o e/(c�Q /DA �,e i Jo..�.�J i- h .e4 aA-e l DP /d��/ K- � ./i7.07 ahle vi PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: /�l Date: 7 i Phone #: (503) 718- CITY OF TIGARD ., BUILDING DIVISION PERMIT #: MST2005.00309 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005 Phone: (503) 639 -4171 Dit Iiil, Inspection Requests (24 Hrs.): (503) 639 -4175 .. INSPECTION WORKSHEET FOR DATE: 11/18/2005 TIME: 7:17AM PAGE: 96 SITE ADDRESS: 14100 SW 98TH AVE CLASS OF WORK: SUBDIVISION: MCDONALD ACRES LOT #: 015 TYPE OF USE: PROJECT NAME: BRACK DESCRIPTION: Bay in dining room. Mechanical fees included in building permit- MAV OWNER: BRACK, DICK PHONE #: 503- 639 -5863 CONTRACTOR: TIMES CONSTRUCTION PHONE #: 503 - 780 -4029 Inspection Request Scheduled For: Date: 11/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 615 Mechanical rough -in 021789-03 503 - 780.4029 N Corrections /Comments /Instructions: PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS ❑ FAIL I I CALL FOR INSPECTION I I ADDITIO AL FEES ASSESSED Inspector: Date: fir! . / ? l& ---- ;✓ Phone #: (503) 718- ,