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Permit II p CITY OF TIGARD .0 MASTER PERMIT COMMUNITY DEVELOPMENT ' _ Permit #: MST2011 -00014 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 /p Date Issued: 01/14/2011 T f G AR L) Parcel: 1S134CD07200 Jurisdiction: Tigard Site address: 11730 SW TIGARD DR Subdivision: Lot: 0 Project: Steven Project Description: 400 sq ft. garage conversion to (2) bedrooms, (1) bath and family room. 3/10/11, reprint to add (3) branch circuits. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 2 First: 400 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 400 sf Value: $20,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 6 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecom asing: N Other: N Other Description: p BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 400 Owner: Contractor: STEVENS, DONNA MARIE HOME RESOURCES UNLIMITED INC Required Items and Reports (Conditions) 11760 SW TIGARD DR 294 NW 2ND AVE #412 TIGARD, OR 97223 CANBY, OR 97013 PHONE: PHONE: 503 - 263 -1976 FAX: 503- 263 -0067 Total Fees: $1,379.36 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes ) ar i d all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,' ssuance or if w # k is suspended for more the 180 ' days. ATT • e Oregon aw requires you to follow the rules adopted by the Oregon Utility Notification Center. / ose rules are set forth in OAR 952 -001 .110 through 0AR 2 -0 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or, .800.332.2344. Issued c : _ , , ' / �, t . Permittee Signature: "r(1 Lj — Call 503.639.4175 by 7:00 a.m. for the next available inspecti n pate. This permit card shall be kept in a conspicuous place on the job site until com of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application RECEIVED FOR OFFICE USE ONLY City of Tigard Received fir to lt � i 3; P er m it No.: ` ( 13125 SW Hall Blvd., Ti ar OR 97223 MAR 1 0 n' 1 DateBBy: i / Tigard, Plan Review ` I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T 1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juri s: ® See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit / sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", `B ", "1 -2 ", "1 -3 ", Job no.: Job site address: tooHPormore. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family _ , `, residential (with above sq. ft.) 75.00 2 �/ Al ` " Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit - 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City /State/ZIP: 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 _ 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (V2 hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application aspires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I:' Building \Permits\ELC- PennitApp.doc 07/01/10 440- 4615T(11/05 /COM/WPB 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* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) 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 1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 CITY OF TIGARD MASTER PERMIT 1111 q >S COMMUNITY DEVELOPMENT Permit #: MST2011 -00014 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2011 Parcel: 1 S134CD07200 Jurisdiction: Tigard Site address: 11730 SW TIGARD DR Subdivision: Lot: 0 Project: Steven Project Description: 400 sq ft. garage conversion to (2) bedrooms, (1) bath and family room. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 2 First: 400 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 400 sf Value: $20,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add! 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 3 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 400 Owner: Contractor: STEVENS, DONNA MARIE HOME RESOURCES UNLIMITED INC Required Items and Reports (Conditions) 11760 SW TIGARD DR 294 NW 2ND AVE #412 TIGARD, OR 97223 CANBY, OR 97013 PHONE: PHONE: 503 - 263 -1976 FAX: 503 - 263 -0067 Total Fees: $1,354.43 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty „d. and /Il other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of is , • ' work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the les adopted by the Oregon Utility Notificati• en/ Those rules are set forth in OAR 952- 001 -0010 through OA' 952 - 001 -0090, You may obtain a co•yMtlakes or direct questions to OUNC by calling' J, ' ::: or 1.800.332.2344. Issued By: / _.� / _.....— =/ r Permittee Signature: / , , Co . 175 by 7:00 a.m. for the next available inspectio rate. This permit card shall • e 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. uilcing Permit Application -\\___,..41(4-- ."" s- � � ' � ' 1 /Z ET /bew7ir9L roil OFFICE USE ON1.1' !' C IS d ��� City of Tigard C � 1 -, EIVED DateB Receive / ��Pr Permit N9 757 //_ /y 13125 SW Hall Blvd., Tigard, OR 97223 4 ' C Plan Revi Phone: 503.718.2439 Fax: 503.598.1960 Plan Re : ��, ' , l I I Other Permit: Inspection Line: 503.639.4175 JAN 1 11 2011 Date Rea. iuris: ® See Page 2 for f I G A R D Internet: www.tigard- or.gov p Notifie a od: / /y I/ - ' �� Supplemental Information • CITY OF TIG�� � it tv / - r J TYPE OF wdlitILDING DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all X Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. j5 1- and 2- family dwelling ❑ Commercial/industrial Valuation: S Zd 6 ©V El Accessory building ❑ Multi - family Number of bedrooms: 2 ❑ Master builder ❑ Other: Number of bathrooms: l JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: li ‘ / .� 0 Lil / , t . ; j ,ZC) a , New dwelling area: 4.6, square feet City/State /ZIP: -I-4 Alp © 2 / Garage /carport area: square feet Suite/bidg. /apt. no.: I Project name: S _ . Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK 1 work indicated on this application. n M � �t Valuation: - l yAP, +2 Sf D ___ J Existing building area: quare feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: N N A 5'. u_ v•4S' Type of construction: Address: 11 i) 6 r S ( S 7l / � itzcj, 'D (Z , Occupancy groups: City/State /ZIP: 7 5, r 92 D Q� Existing: Phone: ( ) / Fax: ( ) New: 10 APPLICANT AZI CONTACT PERSON NOTICE Business name: c v- '.- -5 /A2 t �� L 1 , A a i C • All contractors and subcontractors are required to be Contact name: G ��.( licensed with the Oregon Construction Contractors Board v F. '�-A ,, � under ORS 701 and may be required to be licensed in the Address: � y N� 2 ma poi_ 1‘1'2._ jurisdiction in which work is being performed. If the City/State /ZIP: CAN �y d� 7w3 applicant is exempt from licensing, the following reasons / apply: Phone: ( 5 3/ o ) 9 t L I Fax: : o) 2 C.3 - C$ c4 E-mail: dennikelmajlik d I\ k) e., ®ir•F 0\1434 my k NL e • C iVtA CONTRACTOR Business name: 1� ow , f __ � I, - C � L , 1/4.R L a. S (A ; 1-t A ax) c....._ BUILDING PERMIT FEES* Address: 2_5 L( ryk Z Av ( c -k y I Z (Please refer to fee schedule) City/State /ZIP: CAj•, N■ Structural plan review fee (or deposit): ys 4, 9 Fax (S Z �3 4 6 FLS plan review fee (if applicable): Phone: (SO) 310 Pi S I r Total fees due upon application: CCB lic.: 1 S 3 /�//// Vi i`• +unt received: o, y.S, (p X Authorized signature ifs4 This pe rmit a , plicatioo expires if a pe rmit is not obtained J t W �� I I O Date: within 180 days after it has been accepted as complete. Print name: Ci �, a t e : Ii — � ( —' ( * Fee methodology set by Tri-County Building Industry Service Board. I: \Building\Permits\BUP -COM PermitApp.doc 09 /09/10 440-4613T(1 I /02/COM/WEB) 11111 e , ° Building Division Accessibility: Barrier Removal Improvement Plan TIGARD REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation, alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per -cent (25 %). VALUATION: Total of all renovation, alteration or modification being done, excluding painting and wallpapering: [1] $ MULTIPLIER (25% barrier removal requirement): x .25 TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking $ (b) An accessible entrance: $ (c) An accessible route to the altered area: $ (d) At least one accessible restroom for each sex or a single unisex restroom: $ (e) Accessible telephones: $ (f) Accessible drinking fountains: and, $ (g) When possible, additional accessible elements such as storage and alarms: $ TOTAL (shall equal line [2] of Valuation Computation): $ I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08 Mechanical Permit Application FOR OFFICE USE ONLY II City of Tigard Permit No S77 0 00 RECEIVED Dat eB y. Rece ived a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit: ' I G n It 1> Inspection Line: 503.639 JAN 1 1 Mil il Date Ready/By: luris: H See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information CITY OF TIGGARD TYPE OF W WII DING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction , Addition/alteration/replacement Mechanical permit fees" are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* l- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. Multi- family ❑ Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling 2 s' .----A Air conditioning Job site address: 1 \�J c3 1 /y fj2. 1 \ 2 (requires site plan showing placement) 46.75 City/State /ZIP: �`/ , t9<-4 Ca_ �! Furnace 100,000 BTU (ducts/vents) 46.75 � l Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: ' ri V s Heat pump 61.06 Cross street/directions to job site: Duct work I 23.32 2.. .3'2 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 G RK � � ,� n'1 0 / Gas fireplace 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 Ji PROPERTY OWNER ❑ TENANT Other: 23.32 Name: 7) :31\11 „, lc\ E VI S Environmental exhaust and ventilation -7r-- P Range hood/other kitchen Address: (. 7 6 ('3 , s -- At 1 / i 9a I d equipment 33.39 City/State /ZIP: " / CJ pt(L Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (j ) Fax: ( ) toilet compartments, utility rooms) 1 23.32 2,32 APPLICANT p' CONTACT PERSON Attic /crawlspace fans 23.32 4_s-. t / Other: 23.32 Business name: f - kwv -. 4. '7 C OM , / rn I f £ CI Fuel piping Contact name: V 1(....1 5i TN ( , $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: (S'e 3 f f '7' SS Z Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR ` Barbecue Business name: aM _E )4_ S 0 u krir --S W N I I Al ' T �Cd Clothes dryer (gas) ( Other: Address: ZS/ /0, 2 " 2 AUK- ST L((1 t fiiC MECHANICAL PERMIT FEES* City/State /ZIP: / C—lT N p \' 0 (c Subtotal . � } T Minimum permit fee ($90.00) -7 t j 1,3 Phone: ( S 3 ) 340 .-. t7 5 S°Z Fax: ( ) Plan review (25% of permit fee) CCB lic.: ( 1/ `?) ` State surcharge (12% of permit fee) 10, So �"� V /� TOTAL PERMIT FEE SC. This permit application expires if a permit is not obtained within 180 Authorized signature. � , t II V Jr\ days after it has been accepted as complete. Print name: i1* SA4TAIL Date: l- I —) 1 * Fee methodology set by Fri-County Building Industry Service Board I:\ Building \Permits'MEC- PermitApp.doc 10/01/09 4404617T (11 /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. ' Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC- PermitApp.doc 10/01/09 2 1 , •. RECEIVED _ __ ____ Plumbing Permit Applieat -- -- ____. ._-- -- - ____._..__..._--- -_..._ 1 3 2011 FOR OFFICE USE ONLY City of Tigard Received � rJte/tl / � � �r�.TA' . r PeniiuNo.: O7 O /�K/l a 13125 SW Mall Blvd., Tigard, 9114g22,1.- TIG;'1D )' 0 Phone: 503.639.4171 Fax: .6'Jx Al I • flan Review A{ 1), Other I'cnnil Ni - TIGARD Inspection Line: 503,639.41 BUILDING DIVISIO Date Ready /13y; - Internet: �t'whf,tigard- (rc.gov lutist 0 Ser Page :for 14066ed/Methodt supplemental TYPE OF WORK FEE* SCIIEImLE use checklist 0 New construction I Qty. ❑ Demolition Description l or s ecr nl rn urnrnll t. I ttion Qt I a. Total Addition( alteration /rc laccmcnt _,- !? ' ❑ Other: New )- 2 -famay dwain s (inchwcs 100 0. lot c,uh W ilily connection) CATEGORY OF CONSTRUCTION SFR (I) bath 24c) �0 I- and 2- family dwelling ❑ Commercial/industrial SFR (2) halls 3 ❑ Accessor building ❑ Multi- family SFR (3) bath 3'1'1.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: -- ......,..._. Fire sprinkler ( sq. Ii.) Page 2 JOB SITE INFORMA'T'ION AND LOCATION -• _ Site utilities Job site address: / / 7 / e , ' tpr. Catch basin or area drain 16.00 I City /Slate /ZIP: ‘, i 0 e ' i 7 '2., 3 Drywcll, leach line, or trench drain 16.60 n I 1 Project Footing drain _ Pave 2 Suite/bldc .la t. no.: 1 `t name: Footing (no. linear ft.: ) I r • -- -.._.. - Manulhetured home utilities 1 10.00 Cross street/directions to job site: _,_ - Manholes I 6.60 -. _._.. Rain drain connector 16.60 Sanitary sewer (no. linear N.: _) Page 2 Storm sewer (no, linear ft.: ,_) Page 2 subdivision: Lot no.: W service (no, linear 0.' _ p ;i; , c 2 _.._._..__ ... __..._..- _.._._..._....__ -_ Fixture or item Fax map /parcel no.: __........ ______ Absorption valve 16.60 1 SCRIP'T'ION OF WORK ... 1) Back now prevcnter P age 2 • 4: 11.?". '? 0 0 1$'°1 J. .. a i ('p ""* Backus :tier valve 16,60 Clothes washer 16.60 Dishwasher J 16.60 ❑ PROPERTY OWNER Drinking fountain 16.60 Ejectors/sump 16.60 Name. .__._,__..__..._._........._.__ _..... -_.._ .__.._. _. Expansion tank 16.60 Address: Fixture /sewer cap 16.60 I City /State /71I': Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 [lose bib • ❑ APPLICANT ❑ CONTACT' PERSON 16.60 Ice maker 16.60 i Business name: I Interceptor /crease trap 16.60 Contact name: Medical gas (value: $ ) Pave 2 Address: Primer 16.60 City /Stater /,11 : Ratl'dmin (commercial) 16.60 „,., Phone: ( ) Sink/basin /lavator / y�542 (. ) Fax: ___ - - - -. _ Tub /shower /shower pan 12.47 f mail: / _.._...... Urinal 16.61) CON'I RAC Water closet _ / Z'J. _ Business name: Canby Plumbing Inc Water heater 16.60 ` Address: 805 NE 4"' Avenue Other: City/State/ZIP: Canby, OR 97013 -2399 Subtotal - Minimum permit lee: $72.50 Phone: (503) 266 -2091 % Fax: (503) 266 -1424 Residential backflow minimum permit lie: $36.25 -1 r4 • C Lic.: 33572 1 1 I A Plumbing he no.: 3 -7PB _ e surcharge (12% of Plan review (25 %orpermit ice) State fee) I ` Authorized signature: + '�� w , aCs„2. , .. /"1.--C4-, TOTAL PERMIT FEE ! W Print name: Ben S:tndsness Date: t i : This permit application expires if rt permit is not obtained within - -- 180 days after it has been accepted as complete. *Fee methodology set by 'Fri- County Building Industry Service Hoard. Fm:MyFax - Karen Darnell To:City of Tigard (15035981960) 17:18 01114111GMT -05 Pg 01-01 01/13/2011 08:19 5035 Jf4 CITY OF TIGARD raft mini Fm:MyFax -Karen Darnell To:Clty of D 10:49Oili2111GMT-08 Pg 01 -01 Electrical Permit ADP141fb i 14 2 11 . - City Tigard ,x iknolo �y o1dl/ ©0 6 .. . l so;.nta430 F. , _.., Q - ' TIGARD rxto-/mer, rapea'm tine 503.630 ' ' nenenny �ra+ a w• .1. I tor lamer, want) , . ILD s 4.. .. si ur4 ` f r �. I New communion I Addition/ • •„� p . :ay .. `nal gen . � tea um, demo ... ..._.vl: \ knee ❑DGndition ❑Omer 1114 1* V CItomb:4erfeeAn/00ompe QHnihronwe non omit. 1 Aet.the Arnie* Ps* =of a *tits tad tonnes �. »x:N .g. IM ; ''tt, r .� + >'�r. y llaced* lnpglamse HO whreo 0 rinm: ItirdP a - We a rend. r .4.4114.OM El " - .miuuhmt 1 . 4 I- end 2 -femly dwelling 8 (.tnnneereisltintheB r is l , r, MO. WW1 taxi am4ommmm. awldirrm. ❑ Mu1ti iJiily 0 Asa oer Wilda . 1 x ° . Orin � rin p O w,cmwt,. 75 eVA M c ❑ y system lans pready salt' :190m l .r :r„ �' "` :S. tiWra , 7 ` t'17:?R° ,, irl . sti kil in Admen arm,..,e.towbr 0 ^A`, - , F✓•. ^t. • -:: . job no.: Jot site adihras' 11'x59 SW Tito rd by. 1 ' 1017141 or 1 en. °"'"paecy .. ..., ' O Sim ht Whet AN wane Q Rftmasmad %Qrirb mix. I City /Sado/UP: Tigard, OR InsastRmmtari0'N. n swots vomit lu OW Sum I ORScadaekciliera.. 806 vat. Suite/614V. no.: Project no CISto.4 SarmnctOono Cara, tri l /dlreodnne to,jtdi file: -.` -. .. -_�— ', •'''. .,- •: n .. 1 s rl' ' __ i Pfk, — ntyl tenpJa or nutW horny 6ev . ■ up mat mcLpn t Mtn .. - _..... 1.000 se. a or ku tot .7a 4 , Ea. 1160'1300 xn 0. dr peAlm 31 1 Linen/ energy, residonad ) ' , I''' 'ik ^y ;' a. , 'y ✓' � -71 t ' � 41',: ` `. ... '. <=,�'"' _ .�. ,., R. Remodel of iota S - `• :" . •3111 ' 9500 2 &per' Going spa takraoaltlwldtmamam4lt) $addrrtirtpvmkY1H87Y0[i.06914 _ or keens isg*tton,aita r afptler retnnolinn Mann �-- i � i ll.P4 ' ... ra c ; �i;.Z r' Mar] r :, ' g . 1.4_ ' 201 t6 MO0 - 13 :1 2i Nume: Donna Stevan' 401 wags to 60oanwc .. _ 2°0. w _� 1 601 1150" IMOur 301 2 1 AddtneA: O O empt N ll $52.2.6 ._ 3 . __ _____ __ - -...- --- _.._ __ •- Terrnblrysentens ar totitewboodiatleao deisrtFen smear Cftyismt /ZlP: reloattiaa Phone: ( ) 1 r'x;1 ) 2oo awro alias 39.36 p Owoor Es'i' Manna: Siis ionsflofian it' Neaegmaate on progeny ■ doll own wh h s nis 4°1 MP" 400anr , I zs Ot p intended for salt les=E rCa. or melange. awarding to OftS 447.441. ff70. And 101. 4w eaqueasv9ea� )61.53 � © Beaeelldewld.•waa.. ar - _.. Owner eft A, tb tlrmds 1 ma r dim 7 &m r . I 2 , ' • s , yp'= "'a: " 1. ,_. � °mo Pt'n� . da .,.,. 1 a . mot • � d>ri+it mwits or0aidar Ike, run Contact name: • - - ekuuY ' -,•_- Eittaldo'1branch dsdlii 1.11 742 2 Address: i'. - ',... . ar(aeder noti.....: _.i r aoiodltr d1 . � ^ CityJ$CmralP: ICI Ptoeio: ( ) I Fax::1 ) .. Roam ctanlp 61.01 2 P:mail: gun erlmealmnd+de 01.60 2 B meg Vhbn POaer and l ikht ddress: 3809 W St ' 'mil espeolon n or olio) 5s2N of C!(YtS11atarllP Wast11wggl, WA 0 Or _ i 4425 6,,r p A Monied . (1 Wolin) it lax kr _- Plume (5413'y 9041 h. Far.: -. • lmrenite'tor 9.tielt soOnn Ill „milt, 1L,,. 1141ermia B Lie,: 16236.9 F.leerrictl IA 90 Suprv. Lie :. 46Btt; . MB :'•. goon. Eleenneim sltnOtmp tte u red: � I .•. - Salt - 1 ..: mew OS%etgunk Rey [_Print name Ovid Darnell Dare! Vn11/11 State essrailiegaft (12% of ono* toes: - - - - -_. — _..—. rorA4rfiulrr Fey I 1 I Authorized rierimslrc; O. arAnneit.d nM d t 6, 0 0 - das.MF U 6.r teea stewed rtaaekte- 1 Prim I name Nam ) ' Premner ./Inyestn.44ido.edpapouir