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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00194 'I DEVELOPMENT SERVICES DATE ISSUED: 6/30/2004 I ': ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10965 SW GENEVA ST PARCEL: 1S134AC-05200 SUBDIVISION: HARTS LANDING ZONING: R -4.5 BLOCK: LOT: 023 \ JURISDICTION: TIG REMARKS: Add 30 square feet for laundry room. `� BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT. FIRST. 30 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y , TYPE OF USE: SF FLOOR LOAD. 40 SECOND' sf GARAGE: sf FRONT: 20 PARKING SPACES • TYPE OF CONST. 5N DWELLING UNITS: 1 THRD' sf RIGHT: 5 VALUE: 2,772 00 OCCUPANCY GRP: R3 BDRM: BATH. TOTAL: 30 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: 1 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' 0 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS. HOODS: OTHER UNITS: 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. EAADD'L 500SF: 201 - 400 amp' 201 - 400 amp' 1st W /OSVC/FDR: 00 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: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS. TOTAL FEES: $ 387.30 Owner: Contractor: This permit is subject to the regulations contained in the ROSETTE, DAVID T +JILL R ARTEKA INC Tigard Muniapal Code, State of OR. Specialty Codes 10965 SW GENEVA ST 9350 SW ROYAL WOODLANDS and all other applicable laws. All work will be done in TIGARD, OR 97223 BEAVERTON, OR 97005 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. Phone: Phone: 503 - 203 - 6774 ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those Reg #. LIC 150419 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987 REQUIRED INSPECTIONS Footing Insp Mechanical Insp Electrical Final Foundation Insp Plumb Top Out Mechanical Final Post/Beam Mechanical Electrical Rough In Plumb Final Underfloor insulation Framing Insp Final inspection PLM /Underfloor Insulation Insp -�' Iss d B : ∎ �.! ,y i[.__�.L P ermittee Signature : ,( �LI Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b •c- III Building Permit „ - <, Bu eGS T4t :, \ V : il L FOR OFFICE :USE ONLY s f ` , t City of Tigard O Received Penult No . 1312 SW Hall Blvd , Tigard, OR 97223 CF i \G \ C Plan Review � Sr ” �Bl Phone 503 639.4171 Fax. 503.598.1960 G \ G O \ � '4 1t�i " ■ t ' Date/B Other Permit Inspection Line: 503.639.4175 Date e Ready/By 0 See Attached Checklist for Internet www.ci tigard.or us Notified/Method Supplemental Information . i :�,,. <:�qs.� -:.r`�b44-4:-;f431, r,;:E ��'; �•'4,{w�. �`..."-� ^�.,'r� ?� ;r'•`r -� >r ;; z :af =�:.�>'. , hN Y �;.9;.`•' ;� �.r�. z- :'s7,.�x.�: ' ,,'.. - fir f ° n: , sa=a*� �, .. ,El , •s; - S ' ` °.a°' A*4 ,' .y j a y , A ' . T „OT+,, _ `e ;.�` � >:: 1 : .= •'REQCJ =D ATA . 1 AND 2'- AM ILY °D . : ; G �.>' -'� �� »:. = x; ;.as sr.z- . ".. '. E.,^' t_-'- �� : '^a��'�.,s;.F ..` `S'�'°.a..�w� :'a�'� °:� tom,. r�. �'�� �. , >x �.>:�,ae c ';.:Z.6.:4%*,', Z =,.,. ,. _. <, ., • , ❑ New construction ❑Demolition Permit fees* are based on the value of the work performed Indicate the value (rounded to the nearest dollar) of all dition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the i -. , - .7: ° 61 ..3 ' ;, ry;. %; ,:-- ,: n71 ; V :.' work indicated on this application. .t °a,;; " ,h� , >3, ,: t,, GATE -1:.,Aw G YvOk' � � t = r n . '.gin < ''��.�' ° H , PP lication . , ' t , -- e ''; nx : xe CM7VST J gION a , -4 ,' 1>. Y1- and 2-family dwelling Valuation • $ — y g ❑C ommercial /industnal —` ��7� l ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other. Number of bathrooms • r;» " ' ° . q z .3 . .,,, ; °;• , . aV , ... k` ,&b s '; "' , „,, „,; E:•,, To number � ,'�:, , :J p .r AN�D'•LO � �'" �" -' >� of floors s >:' �' i� .r - Y:-"c µ �':::C.B+; �' .,�. � ' �"`` a�`,' " _�� Job site address: i p R . ,5(_ �. r -. �° New dwelling area: square feet ' o City /State/ZIP: �� C � er2 Garage /carport area: square feet Suite/bldg. /apt. no.: ��� Project name: lg t Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area. square feet te D L ISE:CHE C KLIS T ' 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.: equipment, materials, labor, overhead, and the profit for the 5xi .'tKt". • „23:z'e• " R.- ,r w,' �,`" ' L, F Z,� r t,�1 `�g �- 41'.` DES I- XON 1 OF ' �WORK'i; 4 ; ° ": : - work indicated on this application. .�:� �a'���� a �;�� :�, .'�;: try ° � k �•� 'ts`=a ' A_�<x�:, ° . '� ,t''�;� - _,N' =`:��» -': Valuation: $ Existing building area: square feet New building area square feet r P O W , 1E R; Pe �, - ` E NA 15 T `' - " ' `' . Number of stones. Name: © J44 ,(Qtr -s-et" Type of construction. Address: _ ®C' 695 51As (fit L Occupancy groups: City/State /ZIP: Ti —y a �` Existing: Phone: WJ to 3 q - 3 ` Fax: ( ) New: q','; � <K, "e�"� .�w, ar o•�� :�' 4 ,�,°;;�p'.'�"`s � " »t.:;i R' 3 n` .';�av "' -- ;,.. '. � 1 :: v rLIC -AIY r ` _ ; '' E e 6t im f ifi SON. „ 4:. .;,,, ., P2= , =3gg -1 3r .... ,, fir , �, ` :.w, , C ' , ; .. >t= ::, , . .E_ . Business name 65-4.0k r All contractors and subcontractors are required to be Contact name. p h tip , licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the ddress: cr'3S" D (t � I r at t xIl&lY�C� , jurisdiction in which work is being performed If the ity/State /ZIP: D / q 76e, 6 applicant is exempt from licensing, the following reasons / apply: Phone: ( (6` - . 2.0 . .. c ??4 Fax:: ( `t - 2C3_67 E -mail. v .. ' i 4 ` = "" `'' , -, ,' CONT CTOR °«, _ '., ' ;�';; _ x' t :` , - ''"U;'=':;'"=, r ; - > : '� 6 .F, .,t':q,�6'rt � , �:':. . "�. � xs.��::,�,.. sue,. . - w ' ,£ < ': „ � .� , :say ;s , .i Busin- ame: "` " ' - '" " 'BUI T DI ' PERZV i , T P Address �C� Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) Fax ( ) CCB lie.: f.�0 .4.,i� Amount received Date received. Authonzed signature. • This permit application expires if a permit is not obtained i ' — within 180 days after it has been accepted as complete. Pnnt name: %��` Date. b a , 63 * Fee methodology set by Tn- County Building Industry / - MOW Service Board I \Bmldmg\Permits \BUP- PerntApp doc /03 440- 4613T(11 /02 /COM/WEB) Building Division /4.„001,01A Plan Submittal Requirement Matrix Commercial & Multi- Family - New, Additions or Alterations City of Tigard y ie of= =Siibm><ttal :' °,`:, °; f ...; t# o, t.Pl'g'ns ' s - ` n (Includes new =aadd tions,anaAlferattomq:w.. 41 � - �k,zz. Sii mina• ��. Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building I* Fire Protection System 3** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over -the- counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i \Building\Forms \COM- PlanSubReq doc 12/24/03 • Building Fixtures ® I Plumbing Permit Applie ' , ,'FOR OFFICE USE ONLY ,,,- ' ;R,. °=;; City Of Tigard � \� DateB ) ,.1 ....250 /9 5/ v Peanut No 13125 SW Hall Blvd , Tigard, OR 97223 y Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ��� /h. ��� Date/By Other Permit No 24- Hour Inspection Line 503 639 4175 \,ey O ' . !. lts �W Date Ready/By o � Q See Page 2 for www ci.hgard.or.us �i , C1\\* Notified/Method. Supplemental Information a . „?. -s 3 s"` . 7; „ "[#N.:.' ri�� "; '.�` s "P.:7 '.'u` �i � ,. k.'`;;a. ,;.' t`L°Yi' :• t` �. �F .��s' ^.�,'.' °� �' �' , ', - ..`i,::'a z � ,�:w -,,e ., � rv - ;,.L .- l #;,•;c..;', 2F x'� " °,g s -� �ic3� ' �y ' k ` ^ ".k" " N x ?�,�,`_ _ 'ws !.... _ ,�,'a„ ` a Ai .e a,2/ 1 %- r �,a , '«E` ,, •,-'.'`� « +•`•- ^wa'•= "e A .;y, ^ y ' s .: tl' r s .. ,' y., t,- `t, 2/. °O F,:: Y i 12Tf , ,z .` ``. ,,g, 0 ' `' _ 6, , -� "- k,.- ; FE E= i , SC HEDU E .,. %,�'e�".' €�"��4,-,1-,,..., ''t,':�`fi'�':Z='.r_`sY , ..re"^z*�a,a ' .�a' - ? -, - "�'& , °.= s"�tA'�`e ' c��;r°, _ . � .. '. �_.::_�_ ".,`' t ;."�£:rM.:�:.a ,..,r,.—,,,-_, _ _ For special information use checklist ❑ New construction ❑ Demolition Description I Qty. I Ea I Total ❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (Includes 100 ft for each utility connection) z,^� �. ' F? #' �d °S a� �i"' .. ...;' km 'z?�,&a:�'. °�:? „`.,t.°; €�;,= a,�^5`= ' � %;a " ° '� �' ' .1: 4 :',, �:'a "' G ATEGQRY : �O F C©N'S7RLJCTT "sa' `, `' ' i ,; � SFR (1) bath 249.20 okra oo- ::.. , r '.?�- :, ... ,x ^ -fix tvt.�. . u, ar s�: a .as.,,;.,,...� rd ,`n' : - o, -, 40 '''' i pe ;r- . `,,.. ` � � /-'' °`<' Y,`, ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350 00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: 3' :`eir...° =?x 6 *T,, , o - , -3 :' , = 7 ,, �; . „.,` , s ° °: xr. _,. :N Fire sprinkler ( so ft) Page 2 ,''`' t4 .' '” a4.a OB' '.4.TI4E =di m -a�;s; 3' xy4: . °. I2NJt� T�QN':` E,,, x; till} ; °;��'_,� ,, ' .- , .£�"i', li x :� ;�`�= �.�. .f�.� ",`��'� ,.�,. °�«• ,..�� . � � -'-° .,�. ,,,� Site utilities Job site address. / O q6s 6 c c r* -, Catch basin or area drain 16 60 City/State /ZIP: '// ++ � .II9 691R Drywell, leach line, or trench drain 16 60 Suite/bldg. /apt. no.: Project name: - 5 — 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: Lot no.: Water service (no linear ft ) Page 2 Fixture or item Tax map /parcel no.: ',': =c' :' 1•,; `` ' = - „ ::..hn - „;,-,,„.,�,., Absorption valve 16 60 , ”' °r •:: , i '``�'' �3” ° ' :V ItA.,, , ,I,,- ..a * ' a...... - ' : e „ .:;.& *: ,;,n ": Backflow preventer Page 2 Backwater valve 16.60 Clothes washer f 16 60 Dishwasher 16 60 -> a . , ;,; n . •.rte` •a, Dnnkm fountain 16 60 . , '� `�PRDI'EF;T1' CIWEI2 �`r .„,t ' ° � 1,i x . . �,' = ' ,U , . ` � :��_s: - �r'r�. •.: �A€. • .01h47,: ..,�ar ' . a:�.�, ::� = ` ;r? *_ .r�«.�'a,<,. � EjeCtOiS /SUmp 1660 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 16 60 wry 7''w ',I :»;:z a" a< ., ,,:.. 1 W 11t i f Hose bib 16 60 k- ® T6i , ,, IC: ,?,,e 44 1 : `� %, , ; `; x., '` ` ® ''l!t7" G T �P EItSf)N _, : �"�`"` , f�•;''i� =.'.`' �. z ..e�r�s.�u r��- � ����'=` . •'g: •1,• . �� .. -;�: mss:, . ,., . 1 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: ( ) Fax:: ( ) Sink/basin/lavatory 16 60 Tub /shower /shower pan 16 60 E -mail: Unnal 16 60 iNtoii,o1 i, ,V , o ; —%R '- :'s : a, - : i - . v.:.p-°°,;,,t ,.,ms ; 7;O L`: F «CONY CI OR - Water closet 16 60 Business name: k �� � Water heater (16 60 Address. f Z6 3 ' S e,f , Other- YY Subtotal City/State /ZIP: g Ater jir, t /1 6 , -7 Minimum permit fee $72.50 Phone , —&46 — 3ga, 4 Fax: ( Residential backflow minimum permit fee $36 25 CCB Lie.: / 0 1 274- , Plumbing Lic no . Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: 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 Tn -County Building Industry Service Board t \Buildtng\ Permits \PLMF- PermitApp doe 12/03 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S ,,- , ` £ := ': . ,Ttee: <IOW r e iltil><t><es a ' r °: '`' s <' • , ; �•€ -v _q`ua�re„Footag . ,., Footing drain - l' 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' 46.401 •�� it a�tian' ,. - Pe, Tp: x ::• ' = Storm & Rain Drain - 1st 100' 55.00 -- - . $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 e "' :k ='i.'y „ `, "_ t =,3Fee ( �•. ea " Iotal` additional $100 00 or fraction thereof, to and I ' t igli OPIRItc _ k ,¢ 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 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 e 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 * . -verwmc uantl , by:( I�' �atiure ) =_;Gt?ork;Pei'formed °.`a,,Y; „..0 e s' l ;,Rep acl e t f Comments regarding fixture work: a,,� ,. �, � � oved•�•=�;.a�`rExishn �,Ca ed �s Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Dnve Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" - 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 Isometric or riser diagram is required if fixture quantity - Commercial 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: \Budding\Perm¢s\PLM- Perm¢App doc 3/03 qo tGEN Mechanical Permit Applicatio - ' , . , - - - : ,, . ,-. ,,:.- , :lFoR ofFicF vst.„:0Nty.:: ,. .. :,•.,,. , '.:: .---: -,, City of Tigard 0 ;') l Ill, Received Date/By Permit No H4 &Et. .. - .0 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503 639.4171 Fax 503 598 1960 f i. ‘f „taioatt Date/By Other Permit Inspection Line: 503.639 4175 Cl ( I ` J r .:1 I, A I Date Ready/By Jut is El See Page 2 for Internet www ci.tigard or.us 12 i LD kl' - --7--- . Notified/Method Supplemental Information igi; 7 4, i'i,` ilI 'Ii':' ',,C Q CrAPT1EV:iiS OFIEPIILE `=':I.ISE CFIECKLIST New construction ..As ition/alteration/replacement Mechanical permit fees* are based on the value of the work [' • jr„ performed. Indicate the value (rounded to the nearest dollar) of all El Demolition • Other: mechanical materials, equipment, labor, overhead, and profit 4 4 1 al-eleATEGORYVEie , . - - , s , %;.0. , ', ,, ,l- e, Value $ :RESIDENTIAIL:EQUIPMENT / SYSTEMS FEES* 1Crid 2-family dwelling El Commercial/industrial El Accessory building For special information use checklist El Multi 1=1 Master builder El Other Description Qty Ea Total K 6filkfililrditiaiiii5r Heating/cooling ,' ,. -, .A:".i.,-.41."., ',, ;,...; ,', i ■ a Job site address: / 0 Z w (c/...,, Air conditioning or heat pump (requires site plan showing placement) 14 00 City/State/ZIP: 77,<7. 42---' Furnace 100,000 BTU (ducts/vents) 14 00 Furnace 100,000+ BTU (ducts/vents) 17 90 Suite/bldg./apt. no.: Project name. pc 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 Flue/vent for any of above 10 00 Subdivision: Lot no.: Other 10 00 Tax map/parcel no.: Other fuel appliances ,yor,1*71 ,i *,04v : taivoriiiv4A Water heater 10 00 ",.1'4,-°% -V "l4t-' . :e: , ...iii..- -... ....4.10-& :,- 'A - tTa- ,' Gas fireplace 10 00 rO ` ' 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 5-.- -'ib-i. Ir , , i - iRwa.,,,- , s9n,, 4 *,,,ri ; Chirnney/liner/flue/vent 10 00 Other 10 00 Name: ‘ 1:)&4i.r : - ,) 4( fi Environmental exhaust and ventilation Address: /(RS' S'_.- Or-noire J - Range hood/other kitchen equipment „(..-, 10 00 City/State/ZIP: Ty ?-e& CZ , Clothes dryer exhaust 10 00 Single-duct exhaust (bathrooms, Phone: (t" CO 4,29 ....... 3 443 Fax: ( ) toilet compartments, utility rooms) 6 80 ttic/crawlspace fans 10 00 ' ,illtA 7 4: ' 1 .4 77 : - '14- A 6 ili f• i: M ',rti42,'"- - .., V ' t2' '"::';;amt '664 l10::;,1,4, , --,C4. A Business nun': r4eik_a_ g-Ac , Other Fuel piping 10 00 Contact name: SpA i 1 Dc )S loy $5.40 for first four; $1.00 for each additional Address: 1 7 j cAi -ske 65‘c..6 , Fumace, etc Gas heat pump Ci tate/ZEP: 73.e op__ Wall/suspended/unit heater one: („,vog 2-03 77 ct, Fax: . ( s, _ 2 6-793 Water heater Fireplace E-mail: Range l " - -i ., " W ,' ..,,, Barbecue 44,1'•:1, ki,nrsll` ; --A0-`,1? :-,' '--a. usiness name: Clothes dryer (gas) Other Address: . rotie= mtw!i.m City/State/ZIP: Subtotal Minimum permit fee ($72 50) Phone. ( ) Fax ( ) Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signa e. / / Jr This permit application expires it a permit is not obtained within 180 —de days after it has been accepted as complete Print name: AlWr / AO ° --- Date 2' 20 04_ . Fee methodology set by Tn-County Building Industry Service Board ■/ IMO" %NW I \Building \Pemuts \ MEC-PermitApp do 1 03 440 (11/02/COM/WEB) Mechanical Permit Application - City of Tigard ' Page 2 - Supplemental Information Commercial Fee Schedule: ��� ,,d _.��;�� �,...«; �.,, a »�.�.. : „,�, 1487: aluat o i t Pertief ee a,., ing f . ,: ;.1'_ .. ;:t $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. 1 \Building\Permits\MEC- PermitApp doc 12/03 2 0 , . Electrical Permit ApplicatioiCEN ' ''' • . ''' . tFottoFFIcE USE ONLY - ..: City of Tigard 0 0 VAipto Received Date/By Permit No 14, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review T.A:.ai Phone: 503.639.4171 Fax 503.598.1960 400010 DatetB . Other Permit: Inspection Line: 503.639 4175 See Page 2 for 21 0 .: .71.1,, Date Ready/By Jur Internet: www.ct.tigard or.us GO 1 0, oil‘-‘ - Notified/Method Supplemental Information - ptiiOl[tAt,,, - , 0 New construction 0 Addition/alteration/replacement Please check all that apply EService over 225 amps, comm'l OHazardous location 0 Demolition 0 Other: S, 0 ervice over 320 amps - rating OBuildng over 10,000 sq ft W OlVit i.'ktflo'1e,'6'6A''PilileifoI■It '- '5,i:ii of 1- and 2-family dwellings 4 or more new residential f , a, a .4,, .,:tF -,,...-„,,o,,'.wrr;=, -: , ,pAwtg44,, 0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure OBuilding over three stories OFeeders, 400 amps or more 0 Multi 0 Master builder 0 Other: 00ccupant load over 99 persons EManufactured structures or .4; -,-„A A , ['Egress/lighting plan RV park OHealth-care facility nOther. Job no.: Job site address: /bc„, 5u oe- at- \-)s) - Submit 2 sets of plans with any of the above City/State/ZIP: T7; f2-r 4Z The above are not applicable to temporary construction service ::'''fA:i'a. Suite/bldg./apt. no.: . Project name: 4 , 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 ''l:2.7-.?i l'l '''-- )11 qY"I'';'`Teig l etiof•P OV4r3rlill f a . YvvI:''''',,P . 1 , -- - ' -=---`, ,,,t,, „ ." ,,,,, - ^4:', ^±,n;: .t.t ;"- ' 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 f" -1 Ili iikei,iffivvArkAg.. NR:4*, 0„,0:T ,g, 201 amps to 400 amps 106 85 2 401 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: ( ) 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 to 600 amps 133 75 , 2 Owner signature: Date Branch circuits - new, alteration, or extension, per panel gt'amvrtm,- nnertx `-;:itIT A Fee for branch circuits with each 6 65 2 Business name: branch circuit B Fee for branch circuits Contact name: without service or feeder fee, 1' 5 each branch circuit 46 8 2 Address: Each add'l branch circuit ° 65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or imgation circle 53 40 2 Phone ( ) Fax: : ( ) Sign or outline lighting 53 40 2 E Signal circuit(s) or limited- Neckli energy panel, alteration, or extension Describe Page 2 2 Business name: Ardt•akit- yie(AiNe: Address: i 07 1 0 SttS Vh96t 4*---- Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: 06 &R.. q7C6 Investigation per hour (1 hr nun) 62 50 Phone: ( Z.439 - 254g Fax. ( ) Industnal plant per hour 73 75 :Itlf:c:-MM;40:AFtiKafi F.: :' ' '-':: CCB Lic.: I S 9353 Electrical Lic.: Supry 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 Tn-County Building Industry Service Board ** Number of inspections per permit allowed i \Building \Perrnas \ELC-PermitApp doc 12/03 440-4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard , Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: n Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: CO, ,! �_, -R,C7 L O .: OIYL i ,.= ` _ •_ t r. :ur" :�.:�; si Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation Ti Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations \Buddtng\Pernuts\ELC- ParmtApp doc 04/03 ecovE/, / ISTAGc-/ BO 94 , vo File Number CITY OF TIGARD, OREGON or( o� �I F0 vA Setis-i Pre - Screening Site Assessment Community Development Shaping A Better Community Jurisdiction Date Map & Tax Lot Owner Site Address / 9, - s ' Cenet. �P/ -- - 771 t Contact Proposed Activity Address Phone Official use only below this line Y N NA Y N NA n 7 , Sensitive Area Composite Map Stormwater Infrastructure maps Map # n QS # Locally adopted studies or maps n ❑ Other Specify I 1 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: I I 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. n The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: Reviewed By: MAi Date: 6- 3o - ot,� Returned to Applicant Mail Fax Counter Date By 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 Phone: (503) 681 -3605 • Fax: (503) 681 -4439 • www cleanwaterservices org CITY OF TIGARD 13125 S.W. HALL BLVD. , TIGARD, OR 97223 • • IMPORTANT PERMIT NOTICE ROYAL PLUMBING 14035 SW 6TH ST BEAVERTON, OR 97005 Plumbing Signature Form Permit #: NIST2004 -00194 -Date Issued: 6/30/2004 Parcel: 1 S134AC - 05200 Site Address: 10965 SW GENEVA ST Subdivision: HART'S LANDING Block: Lot: 023 Jurisdiction: TIG Zoning: R-4.5 Remarks Add 30 square feet for laundry room. 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: ROSETTE, DAVID T + JILL R ROYAL PLUMBING 10965 SW GENEVA ST . 14035 SW 6TH ST . TLQARQ, �R 97223 _ BEAVERTON, OR 97005 Phone #: Phone #: 646 -8824 Reg ##: LIC 121274 PLM 34 -311 ob AN INK SIGNATURE IS REQUIRED ON THIS FORM natur uthorized lumber If you have any questions, please call 503.718.2433. T3 3.9 d DNI5Wr11d ivAOZI tZ889t9E95 SZ :Za VOK /8Z /?e CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ADVENT ELECTRIC LLC 18710 SW VINCENT ST ALOHA, OR 97007 Electrical Signature Form Permit #:, MST2004 -00194 Date !slued: 6/30/2004 Parcel: '1 S134AC -05200 Site Address: ,10965 SW GENEVA ST Subdivision: HART'S LANDING Block:' Lot: 023 Jurisdiction: TIG Zoning: R -4.5 Remarks: Add 30 square feet for laundry room. Your company has been indicated as the electrical contractor for the permit indicated above. I n order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: ROSETTE, DAVID T + JILL R ADVENT ELECTRIC LLC 10965 SW GENEVA ST 18710 SW VINCENT ST TIGARD, OR 97223 ALOHA, OR 97007 Phone #: Phone #: 503 - 259 -2548 Reg #: ELE 34 -647C LIC 153338 SUP 2335S AN INK SIGNATURE IS REQUIRED ON THIS FORM x 0-61h(- O. G bLe Signature of Supervising Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING' Inspection Line: (503) 639 -4175 INSPECTION DIVISION Busines 'Line:' (503) 639 -4171 •i MS /✓ BUP Received Date Requested 9 t 3 AM PM BUP Location ® 4 7 ;` uite MEC Contact Person Ph ( ) PLM Co Ph ( ) _ SWR BUILDING Tenant/Owner ELC ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation y, . 160 C1-/J4 Drywall Nailing Firewall Fire Sprinkler �� /� /f` Fire Alarm � Susp'd Ceiling Roof f r-y SS PART FAIL P I BING 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 RT FAIL CTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm ASS PART FAIL Reinspection fee of $ required before n--g'inspectio - ay .t City Hall, 13125 SW Hall Blvd. SITE El Please call for einspecti. RE: r Unable to inspect — no access Fire Supply Line , ADA °I j / D Inspect, /� /...._� Approach /Sidewalk / , r Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART • FAIL