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Permit „` MASTER PERMIT CITY TIGARD PERMIT #: MST2005 -00144 `, i DEVELOPMENT SERVICES DATE ISSUED: 4/25/2005 �-” 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S13500-08300 SITE ADDRESS: 11730 SW GREENBURG RD ZONING: R -4.5 SUBDIVISION: PP1994 - 086 LOT: 001 JURISDICTION: TIG Project Description: Converting garage to home business. Mechanical fees in BUP per MAV. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 427 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: VALUE: 3,800.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 427 sf REAR: PLUMBING _ SINKS: 2 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: 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: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: ta (0 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: LANDSCAPEJIRRIG: 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 RUDY MARTINEZ OWNER and all other applicable laws. All work will be done in 11730 SW GREENBURG RD. accordance with approved plans. This permit will expire TIGARD, OR 97223 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 Phone: 503 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 284.61 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS 1 / Issued By : C� Permittee Signature . 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. i 1 r , , Building Permit Appli ( *S. ) EN ED h _ r FOR OFFICE USE ONLY , _` " h City of Tigard Received g Date/By: . .7 0 ,. ; Permit No. ti -r „ 41 13125 SW Hall Blvd., Tigard, OR 97223 AYR 2 t 20 ■ Phone: 503.639.4171 Fax: 503.598.1960 H k i o k I , : �°' Date/B eB Review IA .. L _ -�• s " � Other Permit: Inspection Line: 503.639.4175 Ca OF T IA -.. _ Date Rea•y, /By: 4 is 0 See Attached Checklist for Internet: www.ci.tigard.or.us G DIVI • • Notified/Ivlethod: r Supplemental Information BUILDI ;c �''+- '.r ��4�.r ;_" .. r: � �. t":' s., s` . "<.t;°; "A.:.k- r�u3; `at5':'. - �,a�*�s�*�'»- - ..'in.' , Mme,. ... �. E. '� ^� :�¢. -, 5.,.�,.r �'. °f�F r. a-. S' �fi�. a� `� '�>;.�=ar�S.�;� , ;..::::. ° , - : t ,.. ri �.. -e ,.,1+' g a ;'i.xi. :sW I " :ire' ' tw. YP'E O , .,,��, : -ii1 °• ,�� : � �.E >:;- "� �w°� ��', s :.'��� RE UIREDDAT .A:�l' �AND' FAIVIII; � WELL - :�q, a -s; ' .r>:~��s�," _.-�^�r� ;.� , , ,«< <.r.,,;t?= w�:•'v :ks..ec` ._.,s5: li' °:.Y, .... ,. _ .. ..., - , , , . _. ;, .. ,.. a .. ❑ New construction El Demolition Permit fees* are based on the value of the work performed. Addition/alteration/replacement El Other: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the 't �.',y:, .,,.,v,. <,.p' - , d?:' ' s= F, kix 'rr� °as;�,",= rb`, °.*. ",..: ^""'s _w- ;,".d,a - ; : ; ? a :kr :, Q €r ,,,i,, tekii : ert - ��. rep 4.':45'':`) : -,;. —j ;1 �.,: ; _:,<; work indicated on this application. fr ' :r' a f °„W.:�;" � n CATEGORY OT+ CONS tI.2LTCTION 1„P r. .1..5X,. Z : ; . ;� PP 111 1- and 2- family dwelling . ❑ Commercial /industrial Valuation: $ t O 6 a ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: ' ; -sq" ,;� ;,r�, ..�..;�?„:: ad,�6.�'t:e: � *�'. �t?'" SU '.'..,.�. ::x� 4? x .� : q r: '�::...' a, ' JOB S INE®i21VIATIO AND L ` .... - Total number of floors: Job site address: i t S 4, C,+L.a.e.w 1,k2_ S itt New dwelling area: square feet City/State /ZIP: et; J 5 p ,� A , L 97 a.) 3 Garage /carport area: Z1;1 square feet Suite/bldg. /apt. no.: Project name: S /�� " 4 � s- y Covered porch area: square feet Cross street/directions to job site: < ✓ Deck area: square feet Other structure area: square feet REaii ii' FDgDAT :A'°''COIVIIVI,ERCIAI;.'USE- CHi,'61dIS'I Subdivision: Lot no.: co ( Permit fees* are based on the value of the work performed. Tax map /parctl nlo`.. S C"3 O G Indicate the value (rounded to the nearest dollar) of all ,,.„ � „ , A , , ; equipment, materials, labor, overhead, and the profit for the "- �" �� ` ��3E CRLPTT01T 'OF W,IC it ' N rt ii � work indicated on this application. 11 Valuation: $ . 1 w � fu s I l ea R l l- A- f -I /ZG a rM 14 DA- !co ( NO koS i 0 "Fkiwf of S A E.5��� Existing building area: square feet New building area: square feet 4 ,1:. - �� >, 1, °m:.” -,� ; ";`�z4F`%3*' u-'54; :=Ma r.'.'��Es�r'. �., r ;:.te " "� :. ` ,�,.te ^s.; �r.e 4 "' i PROPERT3RWAl t ' ', . + 3 TENANTT i £ k Number of stories: i Name: U t. n '�LIY � 1? i.4 ok � �Q.tivE Z Type of construction: Address: 1 172 6 a� r � r1 �D Occupancy groups: City/State /ZIP: f n a3 Existing: 1_/1 / � t � �C Phone: 0r�� (/� c ' -I Fax: ( ) New: J U 3) llJ - 0 'T V , ;� " <£t.x, .t< 'e " t ` a�;,�.�v � , - ' ;;.-� : '��� -. - i: :." , �C.'!?�s�eh'�.`. "t, .r. " - t m . 'A`P.PLI, i�TaI.' r ,,,�,„ , CO TA.':'�«T` P °I2'S - € a ,, ":: z:h :� =: st �,�., =Z" .. „.,� � # ate. 5 c� -a b .� : . NOTICE , - Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: .:f_ N , � ,� P; CONTRA X CT i. a � , g�,v , ` ' ,. .,, e Business name: CYL9 I/i) e e___ 9 ` •OBU DING : , ' .[IT FEES* Address: Please refer to fee schedule. City/State /ZIP: Phone: ( ) Fax: Fees due upon application ( ) CCB lie.: /I 7 Amount received /...... ` Date received: Authorized signature: 0/� This permit application expires if a permit is not obtained ”' J within 180 days after it has been accepted as complete. Print name: �`� Date:4?_2, i 05 * Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB) ;t Y qa 4-•\ r*J Building Division A NA �� Plan Submittal Requirement Matrix s ` Commercial & Multi- Family - New, Additions or Alterations City of Tigard n � ; ...� ;,, -,�.x , ti�rws :�;: ;:max ,t ; z_,, : , id Typ'e�ofSubm><ttal� #�of ans iV (Includes new additions an alterat><ons) Requi>rred atNt . �, • . ` a� W#L;,, r ; t � ' Subxnittal : t -gym ��f.. �m."� ,.a,- _rs. -...n 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 1* 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:\Bui lding\Forms \COM- PlanSubReq.doc 12/24/03 E lectrical Permit A RGEAV ED ,,, . `" t+ FOR OFFICE•USE ONLY Cif' of Tigard 1 Received 13125 SW Hall Blvd., Tigard, OR 97223 P e) 2005 ' n,, � � , J � A l ttj R t± 2005 Date /By: Plan Review Permit No.: y / , ,.. , , Phone: 503.639.4171 Fax: 503.598.1960 ' ' Date /By: Other Permit: TIGAR� Inspection Line: 503.639.4175 CITY OF R ° __.. Date Ready/By: Juris 66 See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIVISI ` '1 Notified/Method: Supplemental Information TYPE OF WORK . ' PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: Service over 225 amps, comm'I ['Hazardous location ❑ Demolition ❑ Other: ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑Buildin over three stories ['Feeders, 400 amps or more ❑ Multi family ❑ Master builder ❑ Other ❑Occupant load over 99 persons DManufactured structures or JOB SITE 'INFORMATION AND LOCATION ['Egress/lighting plan RV park / / /� EHealth-care facility ['Other: Job no.: Job site address: �/'7 3 0 3,,�� G Q .eew 19 0 ^ 3 J Kb Submit 2 sets of plans with any of the above. City /State /ZIP: ' r t s 01 The above are not app licable to tem porary construction service. FEE* SCHEDULE - Suite /bldg. /apt. no.: Project name:sw /� _ // /. `� ** c7A�Q{'(/ /'F!{7jEt� 0'T �1 ( e J Q 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'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: C c-C f S / J6 c / - 7 x (� .$-500 Limited energy, non - residential 75.00 2 DES CRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 0 146 e7 f;le41e4:5 sS 0 Z- Cflz Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 F/ PROPERTY OWNER I El TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 • Name:• t t 1I1I JuViCtL _ ? 1„ M r t � ) , z ) d� 601 amps to 1,000 amps 240.60 2 J q '7 9 Over 1,000 amps or volts 454.65 2 Address: `� �] ��� �Y 1�-{ Reconnect only 66.85 2 City /State /ZIP: - 110j L. (Jr G( 6�cr-�3 Temporary services or feeders installation, alteration, and /or J relocation Phone: (,5 `3) (Dl 1 05 ---- +. s- 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 to 400 amps 100.30 2 intended for sale, leas hange, accordin q to ORS 447, 449, 670, and 01. 401 amps to 600 amps 133.75 2 Owner signature: — i L ' Date: Branch circuits - new, alteration, or extension, per panel 0 APPLICANT C ❑ CONTACT PERSON A. Fee for branch circuits with ' service or feeder fee, each 6.65 2 Business name:A N A t' eiR oc , l 0 branch circuit + �( B. Fee for branch circuits Contact name: -� -k 0 4 g 1. I ly R ile,� without service or feeder fee, each branch circuit ! 46.85 �(/6, (�� 2 C _ I Address: Set, v Each add'l branch circuit 6.65 � 2 1 3 C City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: (5v y ?� -5-5 0 X10. ci Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration. or extension. Describe: Page 2 2 Business name: �i, Ow t u • Each additional inspection over allowable in any of the above Address: Per inspection 62.50 City /State /ZIP: Investigation per hour (I hr mn) 62.50 Phone: ( ) Fax. ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal (!o �5 � Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Al i 1 ' Date: Y_�s -dS State surcharge (8% of permit fee) 4.1 j _ TOTAL PERMIT FEE 64 9 6 / Authorized signature: pliV This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: D ate: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:A Building VPermits \FLC.PennsApp.doc 122105 110- 1515T( 1 0,02 /CON1 /WEB Electrical Permit Application - City of Tigard 4 Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* TI Heating, Ventilation and Air Conditioning • System* Vacuum Systems* n Other: COMMERCIAL WORK ONLY: 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 Data Telecommunication Installation • TI Fire Alarm Installation n HVAC Instrumentation • n Intercom and Paging Systems n Landscape Irrigation Control* n Medical I I 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 r Building \Pcmtits\ELC- PennitApp.doc 04 /03 RECEIV ED Plumbing Permit ApplifrItin 2005 . - ,. ' FOR -OFFICE`USE 'ONLY.' City of Tigard Received r�7� /f pF TIGAFtD Date/By: Permit No 6Ta-v ✓- - 4 "1 13125 SW Hall Blvd., Tigard, OR 9722CITY �� , Plan Review Phone: 503.639.4171 Fax: 503.598 ING DIVISI �ydWw "N�) \ Other Permit No.: ygt_D I' Date/By: Hour Inspection Line: 503.639.41 I '- Date Ready/By: Juris: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. 1 Total 5 3 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 ❑ 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: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 730 SGv ce.eerie 6 ,A,R At Catch basin or area drain 16.60 City/State /ZIP: SAl O � Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: J Project name: S^ Footing drain (no. linear ft.: ) Page 2 3 /�i / n/1//07,9,g,, y 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.: w(_ I- in. 15 I .6 S 30 tl Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 . /`�' '-1 ° ✓ ■ k�tlt9n s tN {{ l Ca 081 co.-51 Backwater valve 16.60 / 7 i ( - q ( ow ( Q( pi.. 04 / r Clothes washer 16.60 ' ) 2.o.cc CX E x 51St u Dishwasher 16.60 7 PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 - Ejectors /sump 16.60 Name: T + t . & _1, Tai �� °b`1 Expansion tank 16.60 � Address: l 7 :5.A_, C 2�eij tt.fJ k N Fixture /sewer cap . 16.60 City/State /ZIP: , 1Z") O' Q 77, w)) Floor drain/floor sink/hub 16.60 Phone: (sj ) 6 y o S-- li Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT 111 CONTACT PERSON Hose bib 16.60 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/basi .. vatory a' . 16.60 _ Tub /shower ower pan 16.60 E -mail: Urinal 16.60 • CONTRACTOR Water closet / 16.60 Business name: © o iv-eft Water heater 16.60 Address: Other: Subtotal City/State /ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7? - CCB Lie.: /7 Plumb Lic. no.: Plan review (25% of permit fee) `� � State surcharge (8% of permit fee) .S xef Authorized signature: (�`--_' TOTAL PERMIT FEE -7 0 v 3) Print name: Date: Y 2, _Qs 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. tiBuilding \Permits\PLM- PermitApp.doc 12/03 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - ls` 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 Valuation: Permit Fee: 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 Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 * . Quantity by (Fixture) Work Performed Fixture Type: Replace New 'Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thni 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 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: i:\ Building \Permits\PLM- PennitApp.doc 3/03 Mechanical P,' f . ` F U S E O N L Y " Received CitN. of Tig ard Date/By: Permit No.: V , , 1 -dO "i 13125 SW Hall Blvd., Tigard. O 22 Plan Review Phone: 503.639.4171 Fax: 5. 1Z 206 •1 0 Date /By: Other Permit: Inspection Line: 503.639.4175 D ,_,�. , Ii Da te Ready /By' Juns: El See Page 2 for Internet: www.ci.tigard.or.usCITY OF TIGAR "'"" �� Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work El New construction ❑ Addition/ alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: S RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating /cooling • Job site address: / (U / Air conditioning or heat pump /1 7') S �Qjyt, Jam{+ (requires site plan showing placement) 14.00 City/State /ZIP: , / 7 a Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: 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: I Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION. OF WORK Water heater 10.00 Gas fireplace 10.00 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 C76 PROPERTY OWNER ❑ TENANT Chimney/liner /Flue /vent 10.00 I Other: 10.00 Name: / ' r - Environmental exhaust and ventilation Range hood/other kitchen Address: // 7 7 Q C G, t 7 /7 • €.44_, 4 `/ u rr q /7 a equipment 10.00 City/State /ZIP: ^� - /1 (j Clothes dryer exhaust 10.00 / I t14K u Single -duct exhaust (bathrooms, Phone: (937 3 - 50 _ 9 Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 • Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump City/State /ZIP: Wall /suspended /unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) OWN e Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Minimum permit fee ($72.50) Phone: ) Fax: ( ) ( Plan review (25% of permit fee) CCB lic.: State surcharge (8% of fee) TOTAL PERMIT FEE , This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: Date: _ OS ` Fee methodology set by Tn- County Building Industry Service Board Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to S50,000.00 $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. S100,000.01 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:ABuildin \Permits \NIEC - PermitApp.doc 12/03 2 RECEIVED .5 Permit tm-r j 001`-/ ffll c LT, Address: l 11 -D JW @ /r1 A PK 2 5 1005 ) i CITY OF I Issued by: Z „e � t Date: '' )�.6 Jp 5 BUILDING DI VISION / Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: • 0 -- 1. I own, reside in, or will reside in the completed structure. !MI 2. I understand that I must register as a.construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR • >( 3B. I will be my own general contractor. 01A- If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above infortio • is orrect an • ; t at I have read and do understand the Information Notice to Property Owne , e about ons • uction Resp , nsibilities on the reverse side of this form. . / t 4 / — .2 S QS Signature of •'rmit ap d licant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . � K�������`�� Notice to ��� Owners .."= ~" "v~,= Property � ~,°° ` � �Jb��U�t��w����t���t'���R Responsibilities ` Note.- This Information Notice to Property Owners about Construction Responsibil.hje.s � • `. was developed by the Constr Contractors Board in accordance with ORS . : If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES; If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvemeniofa residential structure, you will, in most instances, be ruled to he an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As imemployer,you ust withhold income taxes frOm employee wages at the time employees are paid. You will be liable for the tax payments even if you don't attually withhold the tax from your employees, For more information, call the Oregon Dept. o[RcVenocutP45'089|. . Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more i nfonnation, call the Oregon Employment Department at 378-3524. Workeru'oomupmmmu¢imminuurumoe:&ouncmp|oycr.youxn:ou6ccttotho[}o:gon\Vprkeo'CompcnnudonLuyv`ondmuut obtain workers' compensation insurance for your employees. lfyou fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one ofyour employees is injured ootbcjob. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. internaiRevenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable forthe tax payment even ifyou didn't actually withhold the tax. For more information. callthe Internal Revenue Service at 1'800'829-1040. ' OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: /\u the perm it holder for this project, ynoarn/rxponuib|c[hrr000|viogaoy[ui|urc0nmoctcudcrcquhrmcrUs that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agentto see if you have adequate insurance coverage for accidents and omissions such as fall ing tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervse your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of i'ough-in and finish trades, and to notif' building officials at the appropriate tiriies so they can perlbrm the required inspections. If you have additional questions, write or call the Construction Contractors Board (P0 Box 14140, Salem, Dkg73O9'5052, 503/378-462l), The 'Board is located at 700 Summer St. NE Suite 300, in Salem. ' prop-own.wm4 !/9w AUG /10 /2005 /WED 11:36 AM DETEMPLE PLUMBING CO FAX No, 503 274 7686 P. 001/001 08/10/2005 1018 FAX 5035981960 CITY OF TIGARD tJ001 CITY OF TIGARD • 13125 S.W. HALL BLVD. . TIGARD, OR 97223 IMPORTANT PERMIT NOTICE DETEMPLE CO INC 1951 NW OVERTON ST PORTLAND, OR 97209 Plumbing Signature Form Permit I#; MST2005 -00144 Date Issued: 4/25/2005 Parcel: 1S135DC -08300 Site Address: 11730 SW GREENBURG RD. Subdivision: PP1994 -086 Block: Lot: 001 Jurisdiction: TIG Zoning: R - 4.5 • Remarks: Converting garage to home business. Mechanical fees in BUP per MAV. 8/4/05: Added (1) 200 amp service & (6) branch circuits. 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, ATM; Sullding Division. No plumbing inspections will be authorized until this completed form is received • OWNER: PLUMBING CONTRACTOR: • RUDY MARTINEZ DETEMPLE CO INC ' 11730 SW GREENBURG RD. 1951 NW OVERTON ST TIGARD, OR 97223 PORTLAND, OR 97209 Phone #: 503 - 684 -0575. Phone #: 503 -227 -2641 • Reg #: LIC 2510 PLM 26 -25PB AN INK SIGNATURE IS REQUIRED ON THIS FORM / .�► X • Signature ofAuthi•rized Plumber If you have any questions, please call 503.71 S2433. • CITY OF TIGARD , . t 1110111Puse BUILDING DIVISION , PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 Phone: (503) 639-4171 DATE ISSUED: d 1 I 1 \ i I t------ M ST2006-00144 4/25/2005 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: W28/2005 . 7:08AM 30 SITE ADDRESS: CLASS OF WORK: 11730 SW GREENBURG RD SUBDIVISION: LOT #: TYPE OF USE: PP1994-086 001 PROJECT NAME: MARTINE/ DESCRIPTION: Converting garage to home business. Mechanical fees in BUP per MAV. 8/4/05: Added (1) 200 amp service & (6) branch circuits. OWNER: PHONE #: MARTINEZ, RUDY 503-684-0575 CONTRACTOR: PHONE #: OWNER Inspection Request Scheduled For: Date: W2812005 Pour Time: Code # e lnspection Description Confirm # Contact # Message 299 ' 1VY Final inspection 01686201 503-330-9069 N Corrections/Comments/Instructions: \ . '■I (:// -' _, )--- t PASS fl PARTIAL APPROVAL pi CANCEL 0 NO ACCESS I I FAIL CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED - d Inspector: Date: ( :5 Phone #: (503) 718- CITY OF TIGARD . ..„....-_-" BUILDING DIVISION -1 . . . PERMIT #: MST2006-00144 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/26/2006 Phone: (503) 639-4171 Ase Inspection Requests (24 Hrs.): (503) 639-4175 44.- li. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 9/26/7005 7:12AM 54 SITE ADDRESS: CLASS OF WORK: 11730 SW GREENBURG RD SUBDIVISION: LOT #: TYPE OF USE: PP1994 001 PROJECT NAME: MARTINEZ DESCRIPTION: • Converting garage to home business. Mechanical fees in BUP per IvIAV. 8/4105: Added (1) 200 amp service & (6) branch circuits. OWNER: PHONE #: MARTINEZ, RUDY 503 CONTRACTOR: PHONE #: OWNER 503-475-3180 Inspection Request Scheduled For: Date: 926/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 016610-03 503-330-9059 N Corrections/Ce al is - slIzra...:-- : IA PASS 0 PARTIAL APPROVAL 0 CANCEL , [1] NO ACCESS 1 FAIL 0 CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED Inspector: Gq■CO\ V '644 Date: V i 2-4 Phone #: (503) 718- . . CITY OF TIGARD 41Pesr--•=a BUILDING DIVISION , PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 Inspection Requests (24 Hrs.): (503) 639-4175 DATE ISSUED: MST2005-00144 4/25/2005 Phone: (503) 639-4171 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 9/26/2005 7:12AM 55 SITE ADDRESS: CLASS OF WORK: 11730 SW GREENBURG RD SUBDIVISION: LOT #: TYPE OF USE: PP1994-086 001 PROJECT NAME: MARTINEZ DESCRIPTION: Converting garage to home business. Mechanical fees in BUP per MAV. 814006: Added (1) 200 amp service & (6) branch circuits. OWNER: PHONE #: MARTINEZ, RUDY 503-684-0575 CONTRACTOR: PHONE #: OWNER 503-475-3180 Inspection Request Scheduled For: Date: 91260006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 016610-02 603-330-9069 N Corrections/Comments/Instructions: ) , , ■•=1.- .., 11111117=1.41■2,ZT ' eA PASS I I PARTIAL APPROVAL 0 CANCEL El NO ACCESS fl F IL - I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED , i Inspector: rini° Date: Phone #: (503) 718- . m' ; , 0', ■ CITY OF TIGARD BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DE ISSUED: MST2005 Phone: (503) 639 -4171 /6,,,0 �1iiti I I AT 4/2512005 Inspection Requests (24 Hrs.): (503) 639 -4175 „ 11. INSPECTION WORKSHEET FOR DATE: 9/2612005 TIME: 7 PAGE: SITE ADDRESS: CLASS OF WORK: 11730 SW CREENBURU RD SUBDIVISION: PP1994 - 086 LOT #: 001 TYPE OF USE: PROJECT NAME: M+ARTINEZ DESCRIPTION: Converting garage to home business. Mechanical fees in BUP per MAV. 8/4/05: Added (1) 200 amp service & (6) branch circuits. OWNER: MARTINEZ, RUDY PHONE # : 503- 684 -0575 CONTRACTOR: PHONE #: OWNER 503-475-3180 • Inspection Request Scheduled For: Date: 9/26/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 016610 -01 503.330 -9059 N Co�rr Comments /Instructs ( k k rA - ^ SS n P ARTIAL APPROVAL n CA NCEL n NO ACCESS n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Da / Z4 7° Phone #: (503) 718- CITY OF TIGARD 1 U LDING DIVISION PERMIT #: MST2005 -00144 ' � � 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/2,/200, � Phone: (503) 639 -4171 is/44 el\ Inspection Requests (24 Hrs.): (503) 639 -4175 '__.. INSPECTION WORKSHEET FOR DATE: 8/1/2005 TIME: 7 :05AM PAGE: 55 SITE ADDRESS: 1 SW GREENBURG RD CLASS OF WORK: SUBDIVISION: PP1994 -085 ' LOT #: 001 TYPE OF USE: PROJECT NAME: MARTINEZ DESCRIPTION: Converting garage to home business. Mechanical fees in BUP per MAV. OWNER: MARTINEZ, RUDY PHONE #: 503 - 6840575 CONTRACTOR: OWNER PHONE #: 503. 475.3180 Inspection Request Scheduled For: Date: 8/1/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 616 Mechanical rough -in 012535 -01 503 -330 -9069 N Corrections /Comments /Instructions: /• le 6"/(1,` • PASS ❑ PARTIAL APPROVAL ❑ CANCEL - ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: � Date: 8 #: (503) 718- „CITY OF TIGARD BUTEDING DIVISION PERMIT #: Rr1ST2005 -00144 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/25/2005 Phone: (503) 639 -4171 :,!ri��d�I09iNifl iii l' Inspection Requests (24 Hrs.): (503) 639 -4175 ...' INSPECTION WORKSHEET FOR DATE: 8/1/2006 TIME: 7 :05AM PAGE: 56 SITE ADDRESS: 11730 SW GREENBURG RD CLASS OF WORK: SUBDIVISION: pp1994-086 LOT #: 001 TYPE OF USE: PROJECT NAME: MARTINEZ DESCRIPTION: Converting garage to home business. Mechanical fees in Blip per MAV. OWNER: MARTINEZ., RUDY PHONE #: 503-6840575 CONTRACTOR: OWNER PHONE #: 503 - 4755.3180 Inspection Request Scheduled For: Date: 6/1/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 276 Framing 012534 -03 503 - 330 -9059 N Co /Comments /Instructions: / N . A .d if - Ig - i'- - C., 14-- 5 ,,.c / r J L5 /lJ0� 6 t.• ,/ 1 I PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL ❑ o ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: / -C/N Phone #: (503) 718-