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Permit l ti • CITY OF TIGARD MASTER PERMIT PERMIT #: MST2005 -00282 m - i DEVELOPMENT SERVICES DATE ISSUED: 8/11/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114BB -18800 SITE ADDRESS: 16183 SW 103RD AVE ZONING: R - SUBDIVISION: RIVERVIEW ESTATES LOT: 034 JURISDICTION: TIG Project Description: Finish room above garage.Other mechanical is duct work -fee in BUP -MAV BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: 180 sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: VALUE: 3,500.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 180 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 FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADOL BR CIR: SIGNAL /PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amp6•1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEWSECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes MELISSA PIELE OWNER and all other applicable laws. All work will be done in 16183 SW 103RD AVE. accordance with approved plans. This permit will expire TIGARD, OR 97224 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: 503 467 - 6654 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 #: direct questions to OUNC by calling 503- 246 -6699 or TOTAL FEES: $ 124.74 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Issued By : Permittee Signature : ? ; R, all 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. r A Permit #: MST S _ Address: 1101 73 SW 103i2A Issued by: Date:'/1 0/05 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in t appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale 2. e before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 19 3B. I will be my own general contractor. If I hire subcontractors, 1 will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above infor ation i correct and that I have read and do understand the Information Notice to Property Owners abo ' onst . .. • Re 7 si , I on the reverse side of this form. ■ � / �� _Aar ll 7 , ' re (Sign of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) • • . � w � information Notice to Property Owners - - _ - About Construction Responsibilities Nom: This :Votice to Property Owners about Construction Responsibilities was developed 6y the Construction Contractors Board /n accordance with ORS 70/.05J(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas ot concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ofa residential structure, you will, in most instances, he ruled to he an employer and the people you lure will he employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an emplOyer, you must withhold income taxes . from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378-3524. .=— Workers' compensation insurance: As an employer, you are subject to the Oregon Workers Compensation Law, and must obtain workers compensation insurance for your employees. lfyou fail to obtain workers' compensation insurance, you may hoou|jcottupcnubieoundp/iUbcUuh|c5uruUdoimuogyiFoocofyovremp|oynoyioi jurcdmn/bcjob.Forrnorcin6ormudoo, calI Workers' Compensation DiVision at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable forthe tax payment even ifyou didn't actually withhold the tax. For more information, call the internal Revenue Service at 1'800-829'1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project. ynuurcn:xponoih\e(brn000|viogonytuiiure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to su employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perforrn the required inspections. If you have additional divestions, p/6tcorcu|| the Construction Contractors Board (PO Box i4(4U, Salem, 0B97309'5O52. 503/370-4621). The Bbardis located at 700 Summer St. NE Suite.300, in Salem. prop-orpm4 1/94 Buikling Application V C V 1 O12 OFFI( 1. I sl O\l.l City of Tigard , 2005 Received as Date/13 . 0 I I / i i Permit No , , ' _D,2, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/13 . Other Pemut: Inspection Line: 503.639.4175 v i t Y OF TIGAR 11 x4 'iJ.. Date Ready/By: El See Attached Checklist for Internet: www.ci.tigard.or.us BUILDING DIVISI• I Notified/Method: UM Supplemental Information TYPE OF WORK REQUIRED DATA: I- 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 ❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2 -family dwelling ❑ Commercial /industrial Valuation: S .- • ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / (, / 575 SW / O 3 L ,4t/e, New dwelling area: ; 63 square feet City /State /ZIP: 9ety Ole. q ¥ Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: cia4e 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: Lot no.: 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 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. '' Valuation: $ 441410/,�sd like --/ Sit+PR t/Y! C.k e()0 w1 a e g le- Existing building area: square feet New building area: square feet i,d'PROPERTY OWNER I ❑ TENANT Number of stories: Name: ide---(is eJ Pi Type of construction: Address: / 6 1 Q 3 ` Sid i2312r A/c-_ z Occupancy groups: City /State /ZIP: l f _CVO( ©R ci 7th ( 7 1 Existing: Phone: 3) y6 / y - 6'6 Lr Fax: ( ) New: 0 APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt fropok licensing, the following reasons City /State /ZIP: apply: 72. • / , Phone: ( ) Fax:: ( ) 5 E -mail: `1/` �� CONTRACTOR S Business name: D BUILDING PERMIT FEES* Address: Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: r Date received: Authorized signature: A This permit application expires if a permit is not obtained 4/1rey(C—P:red within 180 days after it has been accepted as complete. Print name: /GJelt 5°1 T e-(+✓. Date: «/i0 /05 * Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Pennits\BUP- Pe+mitApp.doc 12/03 440 -4613T(I I /07JCOM/WEB) One- and Two - Family Dwelling Building Permit Application Checklist r()R (1Frl( t: 1 st: Om.) City of Tigard Received Permit No.: Date/By. 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 ❑ Electri cal ❑Plumbing ❑Mechanical Internet: www.ci.tigard.or.us ' .— ❑ Other. 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 Se ' tic s stem • rmit or authorization for remodel. Existin: s stem caraci ❑ ❑ ❑ 6 Sewer permit. • ❑ • 7 Water district approval. 0 ❑ ❑ 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. 1 I 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 licable to the ro'ect under review. 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 ❑ 0 0 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:\Bui lding \ Permits \BUP- RES- PermitApp.doc 2 - Mechanical Permit Application FOI(()IFFFI( I.: I SI'. 0y1.1 City of Tigard g Received Permit No 1 I V E r Date/By: • ex 13125 SW Hall Blvd., Tigard, OR 97223 1 i,J L. Plan Review Phone: 503.639.4171 Fax: 503.598.1960 D ate/By Other Permit: Inspection Line: 503.639.4175 J.i '1_L. Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information t,jHE1U COMMERCIAL FEE* SCHEDULE USE CHECKLIST t l^. n!`l ❑ 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* ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist. Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/coolin Job site address: ((/ /T �6/ (5 i _ _n fog / Air conditioning or heat pump (requires site plan showing placement) 14.00 City/State/ZIP: 3 �i C ) Li Furnace 100,000 BTU (ducts/vents) 14.00 t Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: 1 Gas heat pump 14.00 Cross street /directions to job site: 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: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WOI{ Water heater 10.00 / f � Gas fireplace 10.00 �j(/�CIC�. —• �/l� ��O Flue vent for water heater or gas 4 t!A (yp - (3 a vay e- • fireplace 10.00 %r O 2 t Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 ROPERTY OWNER I ❑TENANT Chimney /liner /flue/vent 10.00 Other: _ 10.00 Name: / /( ss�. &(e--- Environmental exhaust and ventilation Address: /6l53 /63/(`°//-1/. e Range hood/other kitchen equipment 10.00 City /State /ZIP: ( l 0 4, q 7a ,. 2 Clothes dryer exhaust 10.00 �6 S� Single-duct compartments, exhaust (bathrooms, Phone: (503) � 6 Fax: ( ) toilet t compartmtm roo ents, utility rooms) 6.80 APPLICANT ❑ 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 t j� �, , f } &2 Clothes dryer (gas) Business name: J LCJ��/ Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) F es: ( ) Minimum permit fee ($72.50) _ Plan review (25% of permit fee) CCB lic.: C � State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: 44 , c� days after it This permit application expires if a permit is not obtained within 180 � bas been accepted as complete. ` Print name: a i Date: IP toe v 5n • Fee methodology set by Tri- County Building Industry Service Board i:\ Building \Pennits \MEC -PamitApp.doc 12/03 44 6171' (11 /02/COM/WEB) _ • 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 << CITY OF TIGARD BUILDING DIVISION PERMIT #: A ?- c3C,5 % Z Z- 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: $ l/— ZOOS Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 A INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /6 /83 Jb 3 -17-A7 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: P7-- 14 • Pour Time: Code # Inspection Description Confirm # Contact # Message 2 F 114./L4 Pe-c ., Corrections /Comments/ Instructions: ' _ ^ yew ) PASS -'• =i IAL APPROVAL El CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , Date: !L — 1-- - 0 G Phone #: (503) 718- 2.4 . N CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200S -00282 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/11/2005 Phone: (503) 639 -4171 „ riVvi lI , Inspection Requests (24 Hrs.): (503) 639 -4175 J� INSPECTION WORKSHEET FOR DATE: 902005 TIME: 7 :09AM PAGE: 82 SITE ADDRESS: 16183 SW 103RD AVE CLASS OF WORK: SUBDIVISION: RIVERVIEW ESTATES LOT #: 034 TYPE OF USE: PROJECT NAME: PIELE DESCRIPTION: Finish room above garage.Other mechanical is ckict worlgee in BUR -MAY OWNER: PIELE, MELISSA PHONE #: 503-467-6654 CONTRACTOR: OWNER PHONE #: 503- 475 -3180 Inspection Request Scheduled For: Date: 9/8/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message • 276 Framing 015092 503 467 - 6654 Y Corrections/Comments/Instructions: i / , i S �-, ',Ll v v..i /vim -72- 0 ,,v 1, , ,- y ; 1 n PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . Date: 8 .. Phone #: (503) 718 - ■