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Permit CITY Or TI MASTER PERMIT PERMIT #: MST2004 -00113 I 11l DEVELOPMENT SERVICES DATE ISSUED: 4/16/04 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10345 SW CENTURY OAK DR PARCEL: 2S111CC -02100 SUBDIVISION: SUMMERFIELD ZONING: R -7 BLOCK: LOT: 018 JURISDICTION: TIG REMARKS: Addition of 300 square feet. Other mechanical units include extending duct work. Other plumbing fixture is ice maker. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 15 FIRST: 300 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD' sf RIGHT: 5 VALUE: 40,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 300 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 0 MAX INP: btu FLOOR FURNANCES: VENTS: 0 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: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 3.00 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: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 977.79 LARRY COMSTOCK GCL CONSTRUCTION This permit is subject to the regulations contained in the 10345 SW CENTURY OAK DR 1163 NE 3RD AVE Ti Municipal Code, State Specialty one Codes and TIGARD, OR 97224 HILLSBORO, OR 97124 all l other er applicable laws. All work will be done i accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 348 - 4526 Phone: 504 706 - 8873 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 113563 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Framing Insp Rain drain Insp Foundation lnsp PLM /Underfloor Shear Wall lnsp Electrical Final Post/Beam Structural Mechanical Insp Exterior Sheathing Insj Mechanical Final Post/Beam Mechanical Plumb Top Out Low Voltage Plumb Final Underfloor insulation Electrical Rough In Insulation Insp Final inspection Issued By : z 411Vieweg......1da..._ Permittee Signatu Call (503) 639 -4175 by 7:00 p.m. for an inspection needed th next business day • Building Permit Ap 1icatiUn, a FOR OFFICE USE ONLY ll am) t- I , f Received Agng Pe City of Tigard 1 1 • Date /B : / 0 . mi itNo. � l0 0 13125 SW Hall Blvd., Tigard, OR 97223 I y Plan Review Phone: 503.639.4171 Fax: 503.598:11260 0 5 2004 / �N� Q ll Date/B : .M ) y 9 -0 V , f R � jJJ � Date Ready/By: 1 ' " Other Permit. Inspection Line: 503.639.4175 NN —. •i RI See Attached Checklist for " HAIL W Supplemental Information Internet: www.ci.tigard.or.us CITY O F TIGARD Notified/Method: r�' !II��NC� OMSO : =r•t 5,d;: , 1' :i'1 ti': ":"M":'14 .n " :.:za ' "'r�§'4;; ' {r s! W.v l 59= ,d'l+¢." «i .F�Lki:Ai4t�'s' l ° •ass a - eYf1�1t " 3S'.�'Sµ .. , ,,� � . „ � � � ?' {� ' a �: /.i a vs ,:��`; •:� "z I��.r', � 2= FAIVIILI' r �r �°,,, S ,. 1 ° : zRE UIRED':DATA: r • = d: � . �?_ ;'' ;. � �" ,.A' t � s:r TYP EreO . c W §, . a,ir 'ils' =u: r .�3 -'r�;. a "y � - .,�ir, , r � „:P'J'„ s 5��:�� %:�.'G ,. `.: .. , .�. ..- �;r` ,. �, :.s° z �.t , :ait�`��xs�,.>�'i.l�a�c�.�� ms�. l ', �sli:: �A :*: � .�Irh.,� r q: �. � , �r'�, e ,_.�,,, .A. •i'd:, ;. - ,�.. - -a - ❑ Ne 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 ,. „ ow -,, ,yyy , ,,, ..; ,.,:, t b o ji , ; . , s :,:,- :.�r =,«r: ij : _,,f,.,": t 1, , -,10. .:4 work indicated on this application. �� "- ��'" :r;°°�,'` . ,� " ,� ,. RY OF� i i =CON STRUCTION° et �.. `"` L�" " ",- � 's`�E''' t t k 1 „ =vf' < lr' cCATE ,;.:.ri " „. ,r;f ua:, r , w.,r, r t >, ; ; Valuation: $ � 1 and 2- family dwelling ❑ Commercial /industrial Number of bedrooms: �9, OI . `_sr- ❑ Accessory building ❑ Multi- family ❑ Master builder ['Other: Number of bathrooms: �, ., : h.,: :: < ,:,,,a..; Wi t... t ., ,: r. . r rellg ', f iSifT T i'E`INFORMATION ANDi LOCA : i s� Total number of floors: � ..��...P� � : � � ; ��, � �.. , r��.� �s : �, e� ".ur a : ,� � ,� its � ,; ��,a Job site address: 1 9314S-- $sJ ( ✓'vJ d�,/Z /��ti New dwelling area: 3e, 67 square feet City/State /ZIP: °T7t' -at_ �� Garage /carport area: square feet r / t� I f Suite/bldg. /apt. no.: Project name: W yySa-d - Covered porch area: square feet Cross street/directions to job site: C 1,-'A -vr- Deck area: square feet Other structure area: square feet =R DATA " 'zC O M M ERC U SE ° I +' : 4' , ,:-a'o , '0 [.1 ' "V! , ..v ra k• ,:`e.'. ' iaM"Zc 1 -'" .. , ' :, ;, <: ,,, Subdivision: 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.: Z5 d ( 1 `( c L. 021 0 0 equipment, materials, labor, overhead, and the profit for the t R a W '., ei ia,%t `itDES`CRI .PTION. >oF; WO a k 1 r ; - :'mot work indicated on this application. x Z,,.^.;r#va6illAV.:° i`�illiM».'.lti N e, wa.. _ .. .,, »„... , , „A' RK if ° ; . ieat,' Asa ti T.dr ,g ,..,,.., .. _ _ _ Pr V 4 01^-S tDt 3 I rj - S 0 4/::: �dJS L. Valuation: $ E,, A r it-46I -)(13 )c �- Existing building area: square feet 1 �` New building area: square feet .. - "v er,,w :c:t�',;:,.-' e: ,. n ; ^'” x r,!ren ' -:,:sF .' w :i ir�s 5i:.N ti:.i:ni �. a'i'-'`�' i ' ` ` P RO PERTY OWNER �' s . o l ' Number of stories: �� sI €�,�y <„ :. �:,V.. -. ea :�.,.», a,ua; R ».... �r��';x. "s�� : �;? ®��E �� ' ; wa: �s=LWet t:�.fi Name: j.�, t�r,/ 4 �l., /pv 6zevx. S40 e->_ Type of construction: Address: 103,LA5 5 ,, ; -j 0_, 0 ,v/` Occupancy groups: City/State /ZIP: . r a 0 L... Existing: Phone: (5/8) 3 i..f LISZ.t.o Fax ( ) New: . ..0 n .ERSON "a' i. - g t �.. s , ,.� '.;.. r? :� 't � � �. �a �, ,�'C *ON TAGT�k? , P §a• � I �..� �s, a " � � � ,, � ,. :t^ R, -•tn . - A PPLICANT ;ft ' µ;:„ <' _ -mot ' g: t:. l , .,e : , ;, ,° .,. "° tw. ; n .,.,�,~ , !. s :h�.�F3_, �a t J- ',., a 3a °�u s= . �e§ .'c', �r'ai-�ks'ai Ib' rok.. �. 2 n : `c „a,5udt a.:� a*a�, ^'� -� E. r a vint" >� ; _`� �,'J- t 4r..i ars m, „ ..: ' ....c. _ , Business name: C-3 �L— 84$41C-1 i'"� All contractors and subcontractors are required to be Contact name: -t- J�Ly licensed with the Oregon Construction Contractors Board tg)v..v� 1- �J under ORS 701 and may be required to be licensed in the Address: 1 I AI E S' -AV t jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: vA \\ '1. (0 1 U` 0— X71-41 apply: Phone: ($ ) - 7 0 1 . 2 04373 Fax:: (- ) a y tY 7S E -mail: , '" <�� S 3 a.4. *6 e, =x� C ` kONTR ACTOR , > ,r 0:; ,��. :� .�, �.� �' �� 'tknl. x :5" r3 fink -,fi a ,ra- asx�. rVu"� � "'2 . , _ ��-. ._ � �. Business name: (IC— L djr\ -/- - : ``:t';,`,44 - BUIL*DING0PERMIT EEES* Address: Please refer to fee schedule. City/State/ZIP: v Fees due upon application Phone: ( ) Fax: ( ) � Amount received CCB lie.: i (3 j L3 '/ / D S Date received: Authorized signature: I � This permit application expires if a permit is not obtained �� within 180 days after it has been accepted as complete. Print name: �� Ucy o ; " e: L /S 4 e. * Fee methodology set by Tri- County Building Industry . Service Board. i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(1 I /02 /COM/WEB) One- and Two - Family Dwelling f Building Permit Application Checklist F foil OFFICE USE O NLY City of ard.. Received } Ti g Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 % i�i NI ' r � ❑ Electrical ❑ Plumbing ❑ Mechanical 24- Hour Inspection Line: 503.639.4175 � Internet: www,ci.tigard.or.us ❑ Other: THE FOLLOWING, ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 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. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin -pr ection, etc. C 1 0 3 Co m to 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 . sf t- attached to the plans with cross references between plan location and details. Plan review cannot be completed if — copyrt violations exist. 11 Site/pi ,t an drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there i • m re than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and 'v ay; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indi ator; 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 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." . 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. • 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore: on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS - _ ■e 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, ❑ ❑ ❑ 1" 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. '503 — 6 96' 53 ('t jA".. L k- • i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03 rr- la i Electrical Permit a irlig oation D . . ,:- FOR OFFICE USE ONLY . . 1 6 2004 A Recei A ved , , City of Tigard Permit Noltly „, 13125 SW Hall Blvd., Tigard, OR 9722-3R : ) Date/By: 7 Plan Rev Phone: 503.639.4171 Fax: 503.598.1960 &OW*. Date/B : Other Permit: Inspection Line: 503.639.4175 CITY OF TIGARD g:14.4P .11. Date Ready/By Juris. IZI See Page 2 for Internet: www.ci.tigard.or.us ,B911,,n1NG DIVISION Notified/Method: Supplemental Information Mliagrer"4:VgiaMisici'VrET6M151k::::40,14MiljtatArt,A4.1 ',REEIgritrtrfe,A3441-■VAki0V,- ,,,.wi,ouui...ort ':d ':a:. - A.- , - ---,---------,- ----,, - - --- ,- . . ew construction 111 Addition/alteration/replacement Please check all that apply: p 0 Service over 225 amps, comm'l OHazardous location Demolition ['Other: ,,, . EService over 320 amps - rating EBuildng over 10,000 sq. ft., g of 1- and 2-family dwellings 4 or more new residential a1c* 13.,!S 6.t. 'rcElit i,ticisits=c cna^c,snitic4s :1 D'i[and 2-family dwelling D Commercial/industrial 0 Accessory building 0 System over 600 volts nominal units in one structure EBuilding over three stories 0Feeders, 400 amps or more 0 Multi 0 Master builder El Other: ElOccupant load over 99 persons CI Manufactured structures or IrtgatiV,Wii 6ligATCRA/TfrOVAhroWirek" 0 RV park . -:, :''vlt.,m l -ill& 4 lZ'-i. ''7 E p lan A _ 0Health-care facility 1:10ther: Job no.: Job site address: 1 i' S)"1 61 814 1J1'. Submit 2 sets of plans with any of the above. City/State/ZIP: ,--A---._ ■_ The above are not applicable to temporary construction service. i ESSIMM744#43R ; 7 Suite/bldg./apt. no.: Project name: Description Qty. Fee. Total ** Cross street/directions to job site: New residential single- or multi-family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 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 Elifaregtrattteli***gtagqhtb:WRS'tMfaaafCM Each manufactured or modular dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ,,,ttlalytittVlfilbiliffigaWgniallltWlrlall i 401 201 a s 400 ammp to ps 106.85 2 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps 10 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel - • - raPopkimiivoffireAelorTJ,4 ii,:iii IN. -07413 A. Fee for branch circuits with service or feeder fee, each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, 1 each branch circuit 46.85 2 Address: Each add'l branch circuit 3 6.65 2 City/State/ZIP: , Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E Signal circuit(s) or limited- it; aTVORMAMMEreri*WouiiiyA.m4rir ir;70.1matom energy panel, alteration, or extension. Describe: Page 2 2 Business name: S --)004 0.1 T.7..lcar (...... Address: ,.,,J 1-1-0N h additional inspection over allowable in any of the above z(-1 I -TV -i Per Eac insp 62.50 City/State/ZIP: - 1..k;; 1 .., C 0 k•,_ Q 7 1.?-- Investigation per hour (I hr min) 62.50 ) Phone: ( S'o. e. zs -rz Fax: ( ) Industrial plant per hour 73.75 lINNIZintntrttOWMIWIIVEMifIT CCB Lie.: Electrical Lie.: Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: TOTAL PERMIT FEE 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-PerinitApp.doc 12/03 440-4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: .��.v +:�.t:„s�-uxc �..: ,� _ :.:�.�- ::.�� ^:�z�*.,• u: •i�B` fi.an_fi.';.., � , rTa�..:: RESxDkI AL VE'CW— kINL -'. ;'f, ` . P Fee for all residential systems combined ... $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical • ❑ Nurse Calls ❑ Outdoor Landscape Lighting* Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\Building\Perm ts\ELC- PermitApp.doc 04/03 Mechanical Permit Application FOR O U SE ONLY City g � 9 � ® of Tigard Received Date /By: Permit No.: , ......,./.0 ......,./.0 �✓ 13125 SW Hall Blvd., Tigari, 0 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / sii iyi� ( , Date/By: Other Permit: Inspection Line: 503.639.4175 APR 0 i 2004 � ,.,1J,1 Al . • Date Ready /By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information CITY OF TIGARD u '* a : t 'n z s f :r. � w . r '; x. , a € h> rLE RCI avovi `_ . I (i «`3[: E I/RoMS t ��a < n n . i� V:4 COMMEAc itikE* I SED CH,ULE .EL (� � �.�. , .�' ,..,, :. ;ay ' �s, - r USOHCKI ST „ z Mechanical permit fees* are based on the value of the work 12ew construction ❑ Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. ' n: I3"Y; °kt"+. =�`,4' "F»4i447�kk?�t en.>,s �iriej ._� =i = "T =,c;;;. Value: $ 1 'sk' ' 4?, ; �e' , � CATEGORY., OF CONSTRECTI ,, ..' :,,, , t. a r a ° RESIDENTIAL EQUIPMENT`% SYSTEMS FEES* l a nd 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total r ' � 'a�c�a,,__ ps,' „c,,��. - ;:sws:�e�; -::s .c'� =r ..- ��:,.,a�' ^: a�e..a�,. aa,.:>��' _ t,:g ` ��,^�:'"4'�`� BSITE INFORMATI�ON),ANDLOGATIONq�, r ., _ k ' : Y H ,�/•� Air conditioning or heat pump Job site address: 10344 S .5),,./ 6 A, e9/4l1- 64"1/./k (requires site plan showing placement) 14.00 City/State /ZIP: ' 7 [,,. v c� Furnace 100,000 BTU (ducts /vents) 14.00 J � m Furnace 100,000+ BTU (ducts /vents) 17.90 ' Suite/bldg. /apt. no.: Project name: -GJt 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.: ZS o 1 I) L. erboD Other fuel appliances J "a�^. �'� :,at. ms's: `n F "jk„ »�J k'i` �'.i,.t5i., T' .: S#tr ,u uk'Y :.. "�, ::_"Law'. .,C:KK.[': <, . PA''44 .' Kr' i;= »u ;`uk k 'F'" a 'w, Water heater xa� �� ' -"� DESCRIPTION OF WORK o• .. ,, r ' � r i 10.00 a'.. t'sa't�,.':# -... k.,3 »;' "e ^3'a *°sm. - ;.,�r. e:.2,:. -�:s, z.0 „z,..se,. ,xs.+.l,.., `-.:,: ' u € .a . . s= / , r` - 1 Gas fireplace 10.00 e I(t -t-"'' - L >�*e "1- ' -t�j Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 • Wood /pellet stove 10.00 Wood fireplace /insert 10.00 tx : ,,., f .r s.:. emu=. ., :x - t 4.- �w s ,a., Chimney /liner /flue /vent 10.00 i- : 9 PROPERT Y OW NER Fo�Q , f '``; 'TEN °ANT : ,a' `2`v k,�.,. ._..,..,s ,,,,, ' - 3�a, ,,c. +� -.u. _.. ' x.e aiw ._. .- .,.. _, _an' ",4 ;E .;ado4„ ' e_h,;:.V2 Other: 10.00 Name: , 4 S)", cv v-. (....:p vv` S� tJ L Environmental exhaust and ventilation Address: 1 o3&4 5 J &AID Range hood /other kitchen / equipment 10.00 City/State/ZIP: •�� - D r< Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( &a) 3y_ zi i Fax: ( ) • toilet compartments, utility rooms) 6.80 'Tr SN, ,, .Y, .:,', : ., r ,; <.. :mar ,, ,. ,,. v ,,. ;. :R:, v' trs t ' Att /crawls ace fans 10.00 : $ : 'APPLICANT �' t� . - 3.. i CONTACT ,, , r te, f , P Business name: (a t-�Jv\ Other: 10.00 Fuel piping Contact name: .- , -e $5.40 for first four; $1.00 for each additional Address: ) t (D3 AE 3v _ a _ )0,v,<- Furnace, etc. Gas heat pump City/State/ZIP: -?AS 0 (24 712i -) Wall /suspended /unit heater Phone: ( ) -7 3 - 7 7 j Fax: : ( ) Water heater Fireplace E -mail: Range - 'ri a '".', '.- . ew, : "�'�"- ,,',,, ; :s„:.W'*. a:�,u:;*� :':x"i:. ',- €. kr *._�tH��. s$: R'':.�6,es� 'ar;:, rte` ni er ? �� . " CONeT-=RACTOrge f - r Barbecue Business name: Clothes dryer (gas) Other: Address: fl;( 5 '° 41VIECHANICAL'.PERMITEEES * • City/ State/ZIP: " Subtotal Phone: Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: "-[ ' State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: _ k Date: 9 /s 1A * Fee methodology set by Tr - County Building Industry Service Board i:\Buitding \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I1 /02 /COM /WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: :`natal Valuation ° _� Permit Fee �,, a , °., . $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 RECE \ `I ED Plumbing Permit Application 2001} FOR OFFICE USE ONLY rR City of Tigard N RD Received Permit No.: ln� �� iY3 //� 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGA / _eCJ Phone: 503.639.4171 Fax: 503.598.1 Q L tx� Date/ By: Review g¢ � IVISI , Other Permit No.: 24 - Hour Inspection Line: 503.639.417 "IL DI�G D e 1 C�6� 1 Date R Re ady /By: Saris: RI See Page 2 for . Date Internet: www.ci.tigard.or.us e g Notified/Method: Supplemental Information ., ., ;.. - z�-. ;- x::=^a,T .'�•� ^" '• "'�,,,:.;- �r'�:�at • '-�' z � �,, '. � q k '�„i" °�` �.i.. :t ;�`- �r.�- �,s7^ - :a ., " :? '):: r0- ,. t ^- '' '_- '' •;at . ,,a s.::sa<'� e. T ... I - �:t�: c �_ i rte '� , ;, %,1" T1't - OF FYO ' v r 2 •,., ,' F ;i , v , 1? E • - , 1 ;S.CH EDIFLE . �.„ . -�,_ - ,�.' �, s ��rtats�.�. .. � - ea �- .--" :.�� ,. :,�- . ��, vv�:�.,»�?.. %.m a ;_ :.wF�:<:�::e_� :..., ».�,�;an- ',ten. -. .. • ❑ ew construction ❑ Demolition For special information use checklist Description Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) �';"?� - ,�i , ;Z��iz , . ., .� -:M� &, u��.:.:<� `d i ".sr;,vi:?'- - :-�,-:,:�'�.�%��.r>F s��.,: ,��.: A�+r:. -;p. "" � CATS OR OF , CONS'I'RIJCTION " ;V -W=�_ - - SFR (1) bath 249.20 and 2 family dwelling ❑ CommerciaUindustrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: ,> .. '; ._ g.E : r�r:,s = »,:,sar ;., ;:...:„ . Fire sprinkler ( sq. ft.) Page 2 ' ,t4V6 SITE "tINFOR VIATION AN r-Wk R "; 4 ' ' r � . .- t,0 .ei, .. ,rk � :1 it ,t Site utilities Job site address: } 034 S 6 - vt J OAK_ or , Catch basin or area drain 16.60 City /State /ZIP: � - � 4 �� Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: _ £'.:T,...m.• Absorption valve 16.60 ,. _ t . ' ; D SGRIPTION OF QVORT -. , s . :. - E >, � t � :��. . r »��g.�.,��.�: »�.�� _: _.. , �'n.°� . �, ,��,�� o �.�,ro -� ' a .:y Backflow preventer Page t • Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 "_ tr OP RTXL= m ir "` I , m- `� 1 Drinking fountain 16.60 » n #� .tv 1 »�. � 3,_; .11'3 _...._- 4w'..a." ,.. I, =r > Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 1 16.60 kn � ) , ,4 Hose bib 16.60 i N ��1PP * "» ':c LL r - `CONTAGT PE » �� '. , e .�e. .. . .�..R ,. Ice maker 16.60 Business name: . 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 1 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 . ; „' : $ $ * i, �µ ,'. Water closet 16.60 '"'� ..�.�,"�°' � ,"'�tr xe.,:.. -'� �,.�� ».a:.rJ, . .:�.�a�.., <?�'- ea:�r: rte, '..-:v Business name: ' 1 ' , ,r t7 !slA.AIy,\ 1.0 Water heater 16.60 Address: �� p �� Other: ��LGLr • / City/State/'11Y � ■ts,�� - - , ._.4 Q' Minimum permit fee: $72.50 Phone: ( ) /4i 1-4/6b4' Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: Sj 5 4 5 1 Plumbing Lic. no.: 61i- 97/ Plan review (25% of permit fee) vv State surcharge (8% of permit fee) Authorized signature: Bh.� dt l - 7/3//6 � c y TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i\ Building 'Permits\PLMF- 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: .`';* r.A � , �`.":a"':§.� : "`@e . „�� ;.:;fir. " s "'� .�.� �;< � „�;,s •,'� * �.� x. " a lie. 1jh s . ,- Qt .,..� (eat „ o lf ali . fiA ,age. ermiLFe . � ,�_ � �� __ Sqar „ ot �e Footing drain - l st 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 a Uat pn _,r_ „ permltFe,e, a $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 . t"' t .M Qf `7i eeea) ''' otar additional $100.00 or fraction thereof, to and F1Xt I ` _ . EtAkay ., ;r z ° >» 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 $25,00'1.00 to $50,000.00 $379:50 for the first $25,000.00 and $1.45 for each additional $100.00 or.fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 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 * . 1 CQuant< by (Eixtyxe }Work Performed Ftxturey �� aRep ace ?.> v lived�sttng� capped Comments regarding fixture work: ,`",•„ c �wadcw«�kr.,�..;� __ .Aa. ,��, a �W - ate° a _.3 ��'.. sir- .�.9` 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 Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and 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 • Bradley . Quantity Total 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.\ Budding \ Permits \PLM- PermitApp.doc 3/03 E CE ., \'\'\\ .J File Number �,�� 0 5 M AR 2 5 2004 I .� RD 1-043 Clean ' �. teDI i 'rvices B Our commitment is clear. 1 ve Area Pre- Screening Site Assessment Jurisdiction j C_� \ Date 3 - Zip <-\ Map & Tax Lot \I 0 Owner f./ C tjvI , Site Address I a 6r; k_ Contact Proposed Activity p,,-1; .1.; u 1 \ Address ) (U?, .J- 3 i' }e . i 15 LIZ l/ / Phone � -7 Z\ . � Official use only below this line W Y N NA • Y N NA Sensitive Area Composite Map Stormwater Infrastructure maps Map # 2,5/4.) A QS # 4 /6 /9 Locally adopted studies or maps I� n Other • M Specify I I I L Specify Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. I The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: Reviewed By: �� Date: 7, ®U y • Returned to Applicant Mail Fax CounterX • Date t o/S /a y B 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Phone: (503) 846 -3553 • Fax: (503) 846 -3525 • www.cleanwaterservices.org CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE HILLSBORO PLUMBING PO BOX 1823 HILLSBORO, OR 97123 Plumbing Signature Form Permit #: MST2004 -00113 Date Issued: 4/16/04 Parcel: 2S111 CC -02100 Site Address: 10345 SW CENTURY OAK DR Subdivision: SUMMERFIELD Block: Lot: 018 Jurisdiction: TIG Zoning: R - Remarks: Addition of 300 square feet. Other mechanical units include extending duct work. Other plumbing fixture is ice maker. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: LARRY COMSTOCK HILLSBORO PLUMBING 10345 SW CENTURY OAK DR PO BOX 1823 TIGARD, OR 97224 HILLSBORO, OR 97123 Phone #: 503 - 348 -4526 Phone #: 503 - 640 -2525 Reg #: MET 00001589 LIC 35851 PLM 34 -207PB AN INK SIGNATURE IS REQUIRED ON THIS FORM S n e of Authorizes ' / you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING ' Inspection Line: (503) 6 -4175 MST °?oe 41 - vd t'3 INSPECTION DIVISION '''Business Line: (50 639 - 4171 BLIP Received Date Re•uested AM PM BLIP Location 3 [r% - Suite MEC Contact Person Ph ( ) 1a ° R &7 3 PLM Contractor T ' Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: _ ELC Ftg Drain Sa C� t/ — / � S � ELR Crawl Drain Slab Inspect: Notes: SIT Post & Beam Shear Anchors d4__62 -- 77 , 1-- Ext Sheath/Shear Ina Sheath/Shear pn e .� � yz S . S � Framing r Insulation Drywall Nailing '3� Firewall Fire Sprinkler �`�"�� w :a Fire Alarm Susp'd Ceiling Roof Other: PART FAIL BING Post & Beam Under Slab Rough -In Water Service �—.. Sanitary Sewer Rain Drains — - - Catch Basin / Manhole A illf Storm Drain Shower Pan Other: Final PASS PART FAIL wippipp- MECHANICAL Post & Beam Rough -In Gas Line • pampers PART FAIL RI CAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA , . Approach /Sidewalk Date / V Inspector Ext Other: Final DO NOT REMOVE this inspection reco from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION ''Business Line: (503) 639 - 4171 MST DO -00 l 1 3 BUP Received Date Requested F_c: 7 AM PM BUP Location /0 3 S Y-GtJ1 f��2. Suite MEC Contact Person Y-Mt-1 Ph ( ) ER 23 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner • ELC Footing Foundation ELC Access: Ftg Drain Crawl Drain 2 -60 x = / 9 5–(o ELR Slab Inspection Notes: SIT , � Post & Beam E:a Sr Anchors Mir Int Ext Sheath/Shear ear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Fi ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PAS. PART FAIL ❑ Please call for reinspection RE: ❑ Unable to inspect – no access Fire ADASupply Line pp � / Apte56/2n,y Approach /Sidewalk Date D` 2 7 Inspector f Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL