Loading...
Permit t N CITY O F T I GA R D MASTER PERMIT PERMIT #: MST2005 -00048 DEVELOPMENT SERVICES DATE ISSUED: 4/12/2005 AA ' � , 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S134CA -FS001 SITE ADDRESS: 11222 SW 117TH TERR ZONING: R -4.5 SUBDIVISION: FEHRENBACHER LOT: 001 JURISDICTION: TIG Project Description: New SF. BUILDING REISSUE: MAS2106CD STORIES: 2 FLOOR AREAS - REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,540 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 768 sf GARAGE: 424 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 TURD sf RIGHT: 5 VALUE: 225,189.20 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,308 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 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: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 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: 3 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL /PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: ALL - ENCOMP 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 PAYS CUSTOM HOMES INC PAYS CUSTOM HOMES INC and all other applicable laws. All work will be done in 17481 SW HOODOO CT 17481 SW HOODOO CT accordance with approved plans. This permit will expire BEAVERTON, OR 97007 BEAVERTON, OR 97007 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: 503 475 - 5041 Phone: 503 475 - 5041 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 155849 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 9,684.68 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 -1 / . l am / Issued By : ft 1, CLC� /i ,e. --( '2 Permittee Signatu J./ `G' 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. • Bui 'Lling Permit ABlett FOR OFFICE USE ONLY - City of Tigard Received 4 Date/By: J �(-.1 Permit No. .S l.0 0 UJ q [/ � d d 4 j 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revievi „ Phone: 503.639.4171 Fax: 503.5g$ 2oo5 A fpi�p'��I Date/By: 1 'I A 4f L� - /i S Other Permt:Sl /S— �� © � c,�/ Inspection Line: 503.639.4175 �� tL N , ,.,, LI Date Ready/By: '/ ■ Juris Iv7 See Attached Checklist for Internet: www.ci.tigard.or.us 1 '1.16 � • � Notified/M - thod: 7 p ' Supplemental Information IV EZEALWee V: EEEE EE.. . - t,y . ,t p Q = _ ;f4 REQU A N D s3`FA M IL DWELLING �' �M ",T„ -�",. ...�;�i m � . t _r t,.::::a�: ".�.,.".�rX -'s^ '�°: ..a:'iL�.. s� �a�e.^��e5i:.. .�'w�a .. .., ,' z- i n..��:a?;s:,r:«::: - „ r.� ' ;... Permit fees* are based on the value of the work performed. New construction El Demolition P Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the r.t,: «.c.:;� ;r.., ;bt : k+t= < =':'- 'sue ='.: °:•.ice- ""...,c..ws. x a �:�; ...�.-�.'=- 4,,.:_� "', °' "- `{'�`'� �" °`�"`" °- ?�4�:� C2tTEG,ORY O � , g �;�:��4�� °�� ``�`° "" "�"- � =•_ °�`_�`�"'��'�`�w work indicated on this application. Fes. QNSTI2UGTION -���' ;� ;�'�n,- �+�,��s �°r,�; .. - "�w^: ri.��,�;« i�a..,;, b�. �.ax r�: =�:*_s�t;, ,;; '..i;. « .t , ' �� � t ,_, r ter., «.., to _,. >. a,e.. K 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ ❑ Accessory building El Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: - 1': H�>; .4. ''°„•' ,�4 S ' ' ,,;,_a5 Ya:: a `..saS.M >."i.'.:,'un a... a�3? B . e '-:5;;.- Y- `;"' " ., r _ ` 1 JOB .SITE INFORM TION AIVD COCA TON 7:.: , • , Total number of floors: : �.�,. �. �� �,x -'- «tam':-;« '� _ :a7� �� .:;..> �,. .'� Job site address: I 2,7 S W l I TH.% 1 f4 ._ New dwelling area: square feet City/State /ZIP: ' t a , CI 2 °C1 •ZZ 3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: e. hrei bo,,6,el,,,. Covered porch area: square feet Cross street/directionss to job site: 5t3 j th 00x,04-6 ` s _6 44.7 4, Deck area: square feet k . • •,: k - v , 4 --- c, •,: k - v , 4 --- c,.. P L rn•(/,E.. Other structure area: square feet "`r'f° }EQUEIR ing TA CQMIVIERCT.0 SE.GJE,CKLIST- •.dx” w5 s°^.4::;;LS « ",..t•.ti� -;� I: SN, ,.ii�T£,.....c��:.�..�..,.... «, .. - Subdivision: Fc1/4„, n \.... a,,ker. Lot no.: ( Permit fees* are based on the value of the work performed. Tax map /parcel no.: t 5 I 3 �� D 3 00 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the tigtalgiA; -" ,s1,,I .; � �, D 4i — m— G v WO �P 0 / 1M .. work indicated on this application. Valuation: $ N et/3 S t no k e 1, l 1 rub t clIkA G_ f Existing building area: square feet New building area: square feet ,,. - � � � � � , 1 ��, �9 • � � � TENA s � � � � ' �- Number of stories: e • ,� .,� � �,�; ..�s� �J =4 � < ..,b�� .. ate.. �'l' Name: 4c\vs Cu / v Type of construction: Address: 1-14 R ( S W 14» d t) t-b Occupancy groups: City/State /ZIP: o e.,AuP/1r..6), / 0(L ' '•� Ot�'1 Existing: Phone: (5b 3) ( 4' - � - S O �) Fax: (Sp-3) [1 ' ,t55-a.0 ' New: . p ...s .t.e: , -,- . %;*. ,.r.. « „t,„kv. >,,-b.� s °.,t.. zs tat 'av"F4 ' ' ' :'', ' �. :d.: RP � a - 4 - .4.,,: -, �P �. <x�4 su' 2 m , :'3R; k „' n y i,' ';' : ;' ® P I CANT- , .. i < 4, , M . .Q& "1- f , ,.s ?t , ,' z. , ; ;P.,. , , '�r,.a =a r ,� CO N�'ACT P TRSOIV;. ,� .. ; �;�-i ,„ ,�.,� ; r” . ,4 :ba w. -.0 �:( >: ,xi� e.«.w: ,= Fe�a:§' a r ".. ,. -, : . .. u3:j : „E '":,.•ra:« , :.a. ..«:. ,.a ;,a .:x '' '':: -� ;¢ . r, . rt s ,.,.?�.r;�.^...*«`, x:»^ d9s '� _ ;sr . .., . , Business name: — S,,Ame., -- 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 City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: A c h e✓ S• l� 4 •n 0,,,,s-P . /li Qiit .., t � a i i i - `. 'a ^s s ° < ie are,E % - ra ail i a , . i :•; �) CONTRACTOR 9 Business name: — SAM --- ` � , E= 3. :u ; a , ,:, ,;;; BtJI DING PE RiV IIT „.FE t i - « •71` , - ,, * ° + Address: 111.4 r , :. v. ,., ..-� ;,�; s . '�- a - , , _. - .. , Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: (s 5 49 Date received: Authorized signature: 2rdec /� LL 8, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: --1" ,/ (� �� ! s Date: II/ 0 3l 01 * Fee methodology set by Tri -County Building Industry G� 1 Service Board. i Permits UP- PermitApp doe 12/03 ' t \ \ B 440- 4613T(1 l /02 /COM/WEB) 1. One- and Two - Family Dwelling Building Permit Application Checklist FOR OFFICE USE ON City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Asso permits: Phone: 503.639.4171 Fax: 503.598.1960 es i c 24- Hour Inspection Line: 503.639.4175 , i. .. " ❑ Electrical ❑Plumbing ❑Mechanical l Internet: www.ci.tigard.or.us "" °❑ Other . . . THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes N o N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat /lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ . ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ . El 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. . 1I Site /plot plan drawn to scale. The plan must show lot andbuildirig 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 for non on ❑ ❑ ❑ 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 , • ❑ El systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. . 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more'appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be as slicable to the project under review. • JURISDICTIONAL SPECIFICS • 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x•1.1" 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 : • - Electrical Permit i pplicatC \ii E ') FOR OFFICE USE ONLY ` Received City of Tigard C� P g Permit No.: 13125 SW Hall Blvd., Tigard, OR 9722 2 `2 2005. an/B �$ Plan Review Phone: 503.639.4171 Fax: 503.598.19.0 bn a,Hr r t Other Permit: t� � I DateB Inspection Line: 503.639.4175 • r A t' 'L�; -1. I Date Read B A ® See Page 2 for P V r�r_ � �.� Ready /By: g Internet: www.ci.tigard.or.us i 1 o Notified/Method: Supplemental Information `ter ts- a ��.,:# aam.+ z u�,. w , , : :, � � x * W , ;07,M�; ;:a? a fir ,,. :_ , >: ; . PFI 4*...7*, ii( -.. • � ., z 3�._� -; _.�� _.�?* _�'?��a;_ �. �a�es�� " �- ,.t. - -.. Uos.,.�"Ce., <x;.x ;�.a, �';cs..;. �,�..., � .: :•: -; '._ ,. ,New construction Li-Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location : � ® CV'01 ° RIJOT f1Ai ,11:6- � a 4 � , _ EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft., l r i = =9-`rr st of 1- and 2-family dwellings 4 or more new residential Tini 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 � .. _ .. Q .. . . ... 0 ,., _ ` „ ® 3 A�D ,v Ol " i �! ° ❑E gress/lighting plan RV. park Job no.: Job site address: I ( 222, St.") I 17 4,.Qiir ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City/State /ZIP: l(_ V ©2 Qt'') ' 7 ' The above are not applicable to temporary construction service. Suite/bldg. /apt. n j L � � „c k . ro y � >ti . s " v } r E ',.;,. o. Pro ect name: � r � , _ • .. - 1 y escnption Qty. Fee. Total Cross street/directions to job site: 5W N VQ*'r4 ' Ag-dT0. S _-f' New residential single -or multi - family dwelling unit. ,�,/ ,, Includes attached garage. A DI°4\4 - 1 - A- f2 I e 1,000 sq. ft. or less 145.15 4 Subdivision: 'F* Irk b aG k Lot no.: 1 Ea. add'1500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: 1 5 3 Lt CA 001w> *,-i.• x ' �,� �� � ^ � � �,� ,^ r ,� � 0 Limited energy, non - residential 75.00 2 t ` 4` arc j ' ONA 6F1, +(mil 4.'::,:.:40.14- : , '� lv- 4, . :,� >-..;,4.1, -,.k , . .r ,., . - . , ..a .h . ; •' k �2Atel Each manufactured or modular W . I , ,Q �� ,, dwelling, service and /or feeder 90.90 2 e L& ` 5 ■ r� L_ ( W\ 1 I d .t�K.. Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 t. ",. -trA ( . `,, - ; .g .:e. eau. r t r•:. , t m . a a�.�:.a�.,,., v'sr r; 201 amps to 400 amps 106.85 2 Q ag . RKT O.sWN., ..h - 2'1 lif e r. µ f E ,- ° .F P mP �. > -.. tea. �� „' <a.�: A..x- a Arlf 401 amps to 600 amps 160.60 2 Name: c:I s Gu.5 �� , 601 amps to 1,000 amps 240.60 2 Address: 1 s ( � FTOOc� 0.o C. " Over 1,000 amps or volts 454.65 2 t� J Reconnect only • 66.85 2 City/State /ZIP: Ll CA i , 62 en 00--) Temporary services or feeders installation, alteration, and /or Phone: (56 4S _5.09 I Fax: a 200 amps 3 ) -Z �3 ) - S -o 200 a s or less 66.85 1 Owner installation: This installation is being 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 v .fir, �°` >" A. Fee for branch circuits with .w ,s, .. a:, - . > s : ,. :al ,-'4,1w � `: , ,, , , t . v., ,,,. service or feeder fee, each 6.65 2 Business name: - Z, branch circuit tevytt B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: Pump or irrigation circle 53.40 2 ( ) Fax : ( ) Sign or outline lighting 53.40 2 E -mail A r CA-19/Y 5' 8,, Co „- 1 f • Nef Signal circuit(s) or limited- energy panel, alteration, or extension. Describe: Page 2 2 Business name: t) G(A CaSejo 0/ a - Address: 07X SW Evr,' 1 / S Each additional inspection over allowable in any of the above v` � Per inspection 62.50 City /State /ZIP: q 7 l 0 g'7 2,z_i Investigation per hour (1 hr min) 62.50 - 1 ' , ! Industrial plant per hour 73.75 Phone: (C )j) 5--Z� 00(5 . Fax (✓� )3) 5-2_/ f30 ? ,f 7 CCB Lic.: / 5 -3 9 /G , . Electrical Lic.: mo /G C_ Suprv. Lic.:L/ Z J. Subtotal Suprv. Electrician signature, required: 6-P-- Plan review (25% of permit fee) Print name: Date:�l ` /� State surcharge (8% of permit fee) l C/ �' / TOTAL PERMIT FEE Authorized signature: l , I This permit application expires if a permit is not obtained within 180 V - days after it has been accepted as complete Print name: \ (l_Q_ , Date: /,f /r /" " / / * Fee methodology set by Tri- County Building Industry Service Board J l�T ! //1 ** Number of inspections per permit allowed. i:\ Building \PermitsEELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 2: r.; ^ztt+�.:.a�.a 7 .._ ,r� r,o:;�. si�sx%w+�3x� >. :.•;: stn^ Y �,�., ba � .,.. 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: r O;MkVI °LAT ; I`'?Sr ",;RM- C)NL. _ .z,Y4. a �����. ,,.. -� ?�,.�. "..'' ".�fifi,.,`, -.tk� �.`i�.:x�*. `6+ Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* • ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i.\ Building \Petmits\ELC•PemtitApp 04/03 Mechanical Permit Applicati FOR OFFICE U SE ONLY - . City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, X22� q y � k, o' Plan Review Phone: 503.639.4171 Fax: 3 Other Permit: Date ReadReady/By: J uris: 0 See Page 2 for x598: 1960 �oo� Ggp� ,� DateBy: Inspection Line: 503.639.4175 �� „ . I I Q ,, _ „ -W Internet: www.ci.tigard.or.us [0. •, w Notified/Method: Supplemental Information ■ �. �,,, _ ,..,,..,;. ` ^�,.: fir` ";ti'",`.t �'m�:�:v� � � � � ,,... ;,�;. .�;,.�;t *:ate c :; -� � a� - - - ' € a .� T. mE `Ol O y4,.$�I ;.3 ' 4 ' �� " ` C;OM F F�E *�SCHIJD.UI/E - 'iTJSE`,CHF•.CKL-IST L..= i?v'��.. .. �". �s. .mt.,..,,�.+- 3x ..Y�.� �.. ^_� "'v'+a�xh _ _e..�3 ... _-... . 3_,N - i �: :._ .. - >� .. � ,._ . r '�1New construction } v �� ❑ Ad f'lteratton/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition [Other: mechanical materials, equipment, labor, overhead, and profit. 24, ; f.: ra�,,r „ x =`3. ,°'ki:.r':;ag.:'+ :; �v:ra,s.�:. >':c. �,�, ",„x�s� -„ t: k �'� "` .,�` . �,:� V alue: $ x y v ' CATEGOk -OF COI�I rgAlTIOAIr : .` ,: 7=s.s 'r=' :.;?") t.5 .st ' � � �, ` �=:: r „rx*dn�am.�,c- ...tr�:�.�.,:w - ors �, - a : +.:, �sb .�e�ss;..�:.ua.�'s�:.i..... .', ...:.� �.t.,.�.,. >:;.� ure-`s ^"- ���ii�:'a; :ne, - =�rta:. _ .. .. ... . . ..... �, .. -. - - v - RESIDENTIATJ EQ.UIP Oit 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total - '� 4, ';" JOB #SIZE T I OC .. � � w s 0 , :a, Heating/cooling 2ZZ V Job site address: 1\ 7 v i 1 4' 1 r_L r .„ Air conditioning or heat pump (requires site plan showing placement) 14.00 City/State /ZIP: '� ol-r 0 (1_9-1. Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: A ,, p b' � '' p � ` � f Gas heat pump 14.00 Cross street/directions to job site: 5e/3 f Or Q j Duct work 14.00 Hydronic hot water system 14.00 460 -eft- 1 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 r Flue /vent for any of above 10.00 Subdivision:_t_c_k Lot no.: Other: 10.00 Tax map /parcel no.: lS l T. 4 CA-- c > Other fuel appliances c(; x + iii s A 0 y * a ESCRIPTION a ` 6W , Water heater 10.00 3 V.i:4 A' 5.. ' , ,: S .:'*t.i.... .. .w <.1,,,, is ,e&Iri`7,,, #'?a. 'S •.. �T.g. $E» °„ 6.b'�n•iat.'Ed' r .L, w`2 °ssT.. =4» R.4 ... �.Sffi .tea .. E n"�n.. "'sect' I Q Gas fireplace 10.00 Q � t lil �- N (�-C/l G 6-- Flue vent for water heater or gas J fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 ., 14 ,„, , , � u r T - ,__, ; Chimney /liner /flue /vent 10.00 ' � PROPE Y O TEINAMIOSO" a :m w ` ..��?���, � .- ��» ��, �� .�.,� ���,�.�- .;se.�,.er..�".3 � ��.� �b_�sr���,�s . �.�;� -.. Other: 10.00 Name: (1 M At<• N tom' 1• Environmental exhaust and ventilation Address: /' Range hood /other kitchen ` --2 c i f ,/ _\\ � equipment 10.00 City/State /ZIP: -9 2k � (7 , a , J G D � q - 2C�O -7 Clothes dryer exhaust 10.00 � \ _ - , r Single -duct exhaust (bathrooms, Phone: 60 $ 4 / Fax: (� 2 144 _ 0 toilet compartments, utility rooms) 6.80 . mr M t ' » i ' « t°' , - S; I v : Attic /crawlspace fans 10.00 ' Y ., te a ; .:, AAP I - - T . � , ,, . 11,M. CON,T G P P I2 ..4 u�. ,u v, Other: 10.00 Business name: - 5 Fuel piping Contact name: $5.40 for first four; $1.00 for each a dditional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater file Fireplace E -mail: f r s 0 C6 n C S4', fil ej 1 Range t '11G GONT relfaii ; ` „ a, - P. r.,� Barbecue Business name: (Ai ‘..t. Q _ C t. Clothes dryer (gas) c � y� 12-1.-t.,? Other: Address: C 5 i 3 --- ) G r ,...., �..� .7 _; � ...... ::r:..; : . I G 1 `/ .nt 1VIE, Cis$ :AP„IICALJYERl!'I•I>Te`FEES,,. - ty C . \�'� RGS% >. *§ sY e.. '� -' 4 r h e x "` ^.'>3:^ ... .."1 City/State/ZIP: - Subtotal Phone: 55 G (s r Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: `' k 565 State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signat 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 i:\ Building \Permits \MEC- PermitApp doc 12/03 440 -4617T (I I /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Permit Fee ,,. _y; o , ; ... r .. ,.... $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 Building Fixtures x I cis:) i. Phimbing Permit A c .. c ° FOR 'OFFICE USE ONLY ' - City of T Received igardr� 0 PermitNo.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Plan Review Phone: 503.639.4171 Fax: 503.598.19( p ;, `� //a; 11111 Date/By: Other Permit No.: � � I 24- Hour Inspection Line: 503.639.4175 ^ 11 Date Ready/13y: lu ® See Page 2 for ► ^ Internet: www.ci.tigard.or.us (l l t �T . . - '� Notified/Method: Supplemental Information �' °f � *�.�. 't' -:u,�^ ,a's, �`w�rn'a' �. � st, , ��'�wt. "+ � '�i =i; ?^. �'� �nSM»z` - . ; > „� «,�,e "»�..�as a .` ; e. # � ;° ::a =;�'" '.° - �., _ :: - , t`'E;S,e .vT rB ,® 's; , 9 i,'V e �F ts; r r ' rs ; ,,'^sr. '':;a ,�a. '...:-. c uh :. ,tc?- FE`E* S.C'HEDULE- .. ; ?_�:. , �`< '°r ; �z . _'e ' ' r1r ..N.. z, s- .,,, a : ,+. , tt � 5'1. k.4. 1,? y 4:VW r , _ ; a' . i ;,a .. _ _,, ,.�. _. I V1 New construction p - o ❑ Demolition For special information use checklist. Description Qty. Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) mss, ,6 ..° I'2•'1 g%st',=..at '; - ti7.' ' '''' em �; x tcATEGOl2Y OF;,C OAIS?TRUGT OLs F�;�a q =�= , vg :. SFR (1) bath 249.20 e'i;:;5., x ._1: 1 : >.. .,. ��'� �:.�.;,e �..�. -�. � _,..s.s ^a:e�»? pia `;,':.' �a 'a'� =kw'�`�..`a��a:;'��'uiss. � a F - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder ❑ Other: Each additional bath/kitchen 45.00 _ Fire sprinkler ( sq. ft.) Page 2 OB SITE� ,,.° Il�IFORMALTOA1� U r . 4x, - ��4.� a >_ : t. . _ t, . _ . ._. Site utilities Job site address: I Z _ f Catch basin or area drain 16.60 City/State /ZIP: "AiclAir c'7 ci-7 2_2,3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: 1„p ‹� Footing drain (no. linear ft.: ) Page 2 I `� �✓ � Manufactured home utilities 110.00 Cross street/directions to job site: S( N 0 (2.... i>4Z(j _ '/ k_4 '_ 9/1-42- , Manholes 16.60 t ( Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: c-C� r _�� \. pr I Lot no.: 1 Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: � ,( C� D 7 t Fixture or item Op D Absorption valve 16.60 tari „ . Y &s ` gt :; % DESCRIPTION OF WORK ,, . - : s °1 Backflow preventer Page 2 0 'A c j,'i le- ((hM. j ) ( 5 AL `_ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 . < 5 ;r t e in �^=�x , °� e , ,$ . PRO OWN'E i�" F ' P.s l ` , l� " S.'1 iY. 0 : Drinking fountain 16.60 ���.,. �,� � L �.� : tn•� . � .:,,t� Ejectors /sump 16.60 Name: ��/l r U S L D'Yl /4 �✓L , C. Expansion tank 16.60 Address: I (l 9 ' 14 J Lt____ cap 16.60 City/State/ZIP: ll jj/ m 69n O 2 q'200"/ Floor drain /floor sink/hub 16.60 Phone: (5 3 q7515 64,1 Fax: (j 63) 24 (/ 85-63 Garbage disposal 16.60 s r; , t i i "; Hose bib 16.60 .;: g _ : -.... , ICs P iT r = G®N PERSON � , � . , r , ,r... _ , Ice maker 16.60 Business name: "in_ C. Interceptor /grease trap 16.60 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: S W (� R � _ Urinal 16.60 ; �' 1.3z } •s e Cs 'r }. r� j �.y " a.,- .uk'�^ : � :ae`»s �x > ., ..1: i . ,-,:4:- t � .. a Water closet 16.60 Business name: _ r/ L 01 n .., �� I, /,_.' .-4 Water heater 16.60 • Other: Address: �� �f > 1i1 � - �� - Subtotal 1M, ti Al /1,1 ,2 77/33 Minimum permit fee: $72.50 Phone: ( ,' ) 0 ,_ _ / 1: Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: - _ /' ' Plan review (25% of permit fee) Authorized signatur= _ J State surcharge (8% of permit fee) • / _ ! /y� TOTAL PERMIT FEE Print name: 7 - n i 6 , /�- Date: / / --Q �J This permit application expires if a permit is not obtained within I pC /�1 7/' 'V 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i.\ Building \PennitstPLMF- PermitApp.doc 12/03 440- 4616T(I0 /02/COM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: 14S1 .. It TWA ; Q y7 ,sa 0141:1 f15461019,14.„0::::* ZPermit Fee:,.; Footing drain - 1s 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 iii, Storm & Rain Drain- 1st 100' 55.00 Valuation Peanut $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 _ w; i r - r additional $100.00 or fraction thereof, to and �tl@tUrel'=I>�eltl� ` q ty Fe E ��otali} ; 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quanrit by,(Fi ttdre),Work Perfprmed 05;0444i: %,V% #a gs , Rej)1$a ;� 0 *, A g f, ' Exit„ C Com ments regarding fixture work: - ...nr... g g 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" -4" 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 Commercial Isometric or riser diagram is required if fixture quantity 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: i:\Building\Permits \PLM- PermitApp.doc 3/03 CITY OF TIGARD BUILDING DIVISION _ PERMIT #: IVMST2005.00048 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/12/2005 Phone: (503) 639 -4171 ��luliit Inspection Requests (24 Hrs.): (503) 639 -4175 . ' W INSPECTION WORKSHEET FOR DATE: 10/17/2005 TIME: 7:04AM PAGE: 18 SITE ADDRESS: 11222 SW 117TH TERR CLASS OF WORK: SUBDIVISION: FEHRENBACHER LOT #: 001 TYPE OF USE: PROJECT NAME: FEHRENBACHER DESCRIPTION: New SF. OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503-476 -5041 CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503-475-5041 Inspection Request Scheduled For: Date: 10/17/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 018509-02 503-475-5041 Y Corrections /Comments /Instructions: NOT (p / • ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL (---- n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED iii Inspector: fy Date: Phone #: (503) 718- _ j_:tr_f____ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -0004 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1212005 Phone: (503) 639- 4171 l Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/17/2005 TIME: 7:04AM PAGE: 'l9 SITE ADDRESS: 11222 SW 117TH TERR CLASS OF WORK: SUBDIVISION: FEHRENI3ACHER LOT #: 001 TYPE OF USE: PROJECT NAME: FEHRENOACHER DESCRIPTION: New SF. OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503. 475 -5041 CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503-475-5041 Inspection Request Scheduled For: Date: 10/17/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 018509-01 503 - 475.5041 Y Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 01 0 Date: l (7 ` S Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005- 00048 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/12/2005 Phone: (503) 639 -4171 i�p�flj Inspection Requests (24 Hrs.): (503) 639 -4175 1.I.: INSPECTION WORKSHEET FOR DATE: 10/12/2005 TIME: 7:04AM PAGE: 113 SITE ADDRESS: 11222 SW 117TH TERR CLASS OF WORK: SUBDIVISION: FEHRENBACHER LOT #: 001 TYPE OF USE: PROJECT NAME: FEHRENBACHER DESCRIPTION: New SF. . OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 - 475.5041 CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503 - 475.5041 Inspection Request Scheduled For: Date: 10/12/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 018012-01 503-475 -5041 Y Corrections /Comments/ Instructions: \ J U& I® \ 3 59 --(006g fi rrh 0 oo . _ SASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /0 ^/ 2- Phone #: (503) 718- , f . ; CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005-00048 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/12/2005 Phone: (503) 639 -4171 Piml���i�d ; Inspection Requests (24 Hrs.): (503) 639 -4175 AA :_,. INSPECTION WORKSHEET FOR DATE: 10/13/2005 TIME: 7 :04AM PAGE: 10 SITE ADDRESS: 11222 SW 117TH TERR CLASS OF WORK: SUBDIVISION: FEHRENBACHER LOT #: 001 TYPE OF USE: PROJECT NAME: FEHRENBACHER DESCRIPTION: New SF. OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 - 475-5041 CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503- 475 -5041 Inspection Request Scheduled For: Date: 10/13/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 018273 -01 503 - 475.5041 Y Corrections /Comments/ Instructions: fi? . 0 / ), 14% . (11(.114- & 0 el )' C ° ' 3 75 t / - - • i ; � f ,. - — / �. • --.4 PASS ` PARTIAL APPROVAL ❑ CANCEL n NO ACCESS • n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ) Date: /(/ (6% Phone #: (503) 718- CITY OF TIGARL , . r BUILDING DIVISION PERMIT #: MST2005 -00048 13125 SW Hall Blvd., Tigard, OR 97223 D A TE ISSUED: 4/12/2005 Phone: (503) 639 -4171 /s otpv v � i� Inspection Requests (24 Hrs.): (503) 639 -4175 ° `:_.. INSPECTION WORKSHEET FOR DATE: 6/20/2005 TIME: 7:11AM PAGE: 7 p 1 SITE ADDRESS: 11222 SW 117TH TERR CLASS OF WORK: SUBDIVISION: FEHRENBACHER LOT #: 001 TYPE OF USE: PROJECT NAME: FEHRENBACHER DESCRIPTION: New SF. OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 -475 -5041 CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503 - 4755041 Inspection Request Scheduled For: Date: 6/20/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 009690 -01 503-309-5750 N Corrections /Comments /Instructions: , I I PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 17 1 Date: A / 1 Phone #: (503) 718-