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Permit t F l . y. V. CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00505 � i DEVELOPMENT SERVICES DATE ISSUED: 11/7/03 , �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12625 SW KATHERINE ST PARCEL: 2S104AA -08200 SUBDIVISION: BELLWOOD NO. 2 ZONING: R - 4.5 BLOCK: LOT: 103 JURISDICTION: TIG REMARKS: 538 s.f. addition over garage. (mother -in -law) BUILDING • REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 20 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 538 sf GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT. 5 VALUE: 50 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 538 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 2 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: - MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: 00 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL 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: 0TH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,107.57 This permit is subject to the regulations contained in the RANDY WITTEN Tigard Municipal Code, State of OR. Specialty Codes and 12625 SW KATHERINE ST all other applicable laws. All work will be done in TIGARD, OR 97223 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 - 524 -9500 Phone: Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Underfloor insulation Electrical Rough In Rain drain lnsp PLM /Underfloor Framing Insp Electrical Final Mechanical lnsp Shear Wall Insp Mechanical Final Plumb Top Out Exterior Sheathing Insc Plumb Final Electrical Service Insulation Insp Final inspection Issued By : '11f_' .` `AO 1t • Permittee Signature : = —_� ■ �— - Call (503) 639 -4175 by 7:00 p.m. for an inspection needed e next II d ay • • :- • BuildIng Permit Application Received FOR OFFIC Building E USE ONLY . / --....p Date/By: M Ii. 74fr Permit No.01,5104/03 — 00,57)5 Other City of Tigard ,,, Planning Approval Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By:PAd /0 - ,Dol , c.)1 Permit No.: 0 Phone: 503-639-4171 Fax 503-598-1960 --.171w10 Post-Review Land Use • Date/By: Case No. Internet: www.ci.tigard.or.us .4.iiik. 11. Contact lurisi _ 0 see Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: "1 1 a Supplemental Information .1 ,. TIT rOFWORIC 4. ; ::;,V 4:: '..,* .';:.;:i::= ,, , III New construction 0 Demolition - ' , ----•g-i ri. , , - ,7 -''':41-8e1 , FtWmILYDWELIAINi•G:: , ,''..,••---,•-••.'-' --• :: '',: , :=:-: -.:,,,,: a:7' 5'' -',:.,-- „.4,,: .; : ,' ': . :`';'''',:ir.".. ' .-.-''-' ''' II Addition/alteration/replacement 0 Other: -, ,:a•i.'_1'.'?,'f-,;'.14-.'''.1:,C,klEGORY:01F,':,CONSTRUCTION:ct,:,,..., ,, Note: Permit fees* are based on the total value of the work performed. Indicate & 2-Family dwelling 0 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. K Building D Multi-Family [11 Master Builder E Other: / Valuation $ 4013''SITELINFORMTIONiiii ',----. '''.'1:1!, No of bedrooms: No of baths: Total number of floors I 7 .5 0 ( T Job site address: / )_ 6 15 56.3 101-1-/ke-r S3a- i '- - New dwelling area (sq. ft.) . , Suite #: 1 Bld g ./Apt.#: Garage/carport area (sq. ft.) ' / r: Project Name: . Covered porch area (sq. ft.) /- Cross street/Directions to job site: Deck area (sq. ft.) / Other structure area (sq. ft.) U -' -;r'? il 1 6:jiiik"itak Ili iv e.'.I i.iz- A4"c rj. Subdivision: Lot #: /0".,' ,:!`.,-.;• ,;,':;',, . -'4 - '7,,,:: , ,,,,, ., .—..,,„:.: ,- ! - ,!.47;..Y.k?,:%, -, ',1,,"11,'' 1 ,'.f.1 Tax map/parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate f 4 `I'VZ' , , ,,, :'4 :1 • : A)EseitiP,TION orwoktC4_34:a.'"-;---,V,',1Aa*,';', the value (rounded to the nearest dollar) of all equipment, materials, labor, it -. overhead and profit for the work indicated on this application. k it. A /4-11-81 i Valuation $ 3 0 - e_ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories fROPERWOWNERc:2, .1 TENANT.41s 47eP,'":Kgir Type of construction Name: X f b ii- i i., Occupancy group(s): Existing: New: Address: City/State/Zip: 7 PhoneS0 3 5 7 v icVo Fax y-erf NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under APPLICANT":' . .,, ',': provisions of ORS 701 and may be required to be licensed in the Business Name: fL 1 ......„,( 7 , b-s /-1-.te,,, jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City/State/Zip: Phone: Fax: ,,,,;teet., .:: t . ''' '' -1 E-mail: 4 'st'l ,,,':' :;' .;- ,',...-''':','N - 5`-': -.1- '7 . . - ' , '::, ';'' Business Name: — 0-60N6/2_ Fees due upon application S 3o 5 , s Address: City/State/Zip: Amount received $ Phone: Fax: Date received: to CCB Lic. #: . Authorized Notice: This permit application expires if-a permit is notobtained within Signature: , ..:, '... 1_,,a, --,_,---- Date: P --- -3 180 days after it has been accepted as complete. L 4 - /AO i - ' i te As * F ee methodology set by Tri-County Building Industry Service Board. Ae■ ease print name) i:\Dsts\Permit Forms\ BldgPermitApp.doc 01/03 i • One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City of Tigard Ci}y of Tigard `� O Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 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. 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 protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors. water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/00/COM) . Mechanical Permit Application Received FOR OFFICE USE ONLY Mechanical LY Date /By: Permit No.: rif / — ®UJ (, 1 City of Tigard Date/By: Approval Building y: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use Internet: www.ci.tigard.or.us"'�f'� Date /By: Case No.: W Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. . ''x;'4- Af- ,:c `.f- 1 - 1i:°.'-v:4' -�n'F '' +.;e : ; '& ,1 _ t5 ,„ P ,.. .. � n> ._°' � .t..,.... ;� TYPE,OF�;WORK'k; ', Vi . =��;4s ,.... >� ..< °�COMMERGIAI�; FEE.., SCHED[ JI ;E.= tJSE.�CHECKIIST:, te » N' : ��` ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work '7' Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all '- r ,CATEGORY QE CUNSTRUCTION,. k' mechanical materials, equipment, labor, overhead and profit. 1 & 2-Family dwelling Value: $ See Pa y g ❑ Commercial/Industrial Page 2 for Fee Schedule Up Accessory Building ❑ Multi- Family ': RESIDENTIAL" EQUIP. MENT /SYSTEMS ;FEE* SCHEDULE° ce ffi, Description 1 Qty 1 Fee(ea.) Total El Master Builder El Other: - Heating/Cooling _ ' ,' ;;4= ,?JOB`„ SITE ;INFORMATION /a iiflOCATION i : :' .; s ,- i ` Furnace - add -on air conditioning ** 14.00 Job site address: /„24, $w ) -'Le. r- tN _. Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) 1 (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: Lot #: Repair units 12.15 Other Fuel Appliances Tax map /parcel #: Water heater 10.00 i > -" , •Z =` '.:. 1,;, °"'DESCRIP,TION:OF WORK u "W k'' Gas fireplace 10.00 fretylki-20 >v b v (`sy Flue vent (water heater /gas fireplace) 10.00 d Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 i IROPERTYrOWNER: :3 ", e ` - i 1 a . <., n r ,, Chimney/liner /flue /vent 10.00 4,��,(,, ;. �. ;. TENAI!IT.�.n= ii>ar „ ��:�i`,�,�;: � -:,;.� Other: 10.00 Name: I , / ( J t4- M.... . .. Environmental Exhaust & Ventilation' . ' • Range hood/other kitchen equipment 10.00 Address: ` 3.c, a-S Ste) 1-g9- wt. City /State /Zip: j f d, Clothes dryer exhaust 10.00 Single duct exhaust Phone: )c - 3 h? D Fax: (bathrooms, toilet compartments, E I PPLICANT !i 'r =; ' ”` .i le rCONTACT;PERSON' `% ``` t. utility rooms) 6.80 Name: f C Pk 7�- Attic /crawl space fans 10.00 Address: Other: 10.00 Fuel Piping . City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Phone: Fax: Furnace, etc. ** E -mail: Gas heat pump ** Wall/suspended/unit heater ** CAIYTRAG Tnit, +,j ^', ` , t`:_,..:g'n.n Water heater ** Business Name: Fireplace ** Address: Range ** City /State /Zip: BBQ ** Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lic. #: Total: Authorize. Mechanical Permit Fees* Signature: Date: /0 -/ 5 - Et 3 Subtotal: $ AMIN Minimum Permit Fee $72.50 $ Arun rail A- ■ Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. is \Dsts \Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY ' Received Plumbing Date/By: Permit No.: fl4.G&r e) -(950.5- Cit of Tigard Planning Approval Date/By: Se Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: . Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use G7 1 Date/By: Case No.: Internet: www.ci.tigard.or.us , � , n. Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 - 4175 ` " "" " ' Name /Method: Supplemental Information. -?::.:' , P �. r " K *•S LE (for,spec al mforiri44 nse,c>001 t) �',�.� ���;�_�:., - �`T�Y E�OF�WORK��`.... _ - �.,.�._,.,�~_. t;� EE CI3EDU.....,. g %k ❑ New construction ❑ Demolition Description Qty I Fee(ea) I Total jid2Addition/alteration/replacement ❑Other: ,. New l & P, e W ' well ngs „ ,. ' y, 7, ( incl 109ft ,fore �,. " a t ... . ^ - Evi2:Z� ;OVZCON TSTRITOHON ±::., t , ...._ SFR (1) bath 249.20 ►_/ & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00 Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 .._. P Fir sprinkler s ft Page 2 „ _JOB SITEFINF®RMAT:IQN and.L OCATIO ^ p 9 g Job site address: , D_6, - SW )io'f .r-1 1 ;: gi. ..., ..R M S -i th►ttes ... =_ A_ _ nva mm Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell /leach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 t k 3, p ! :u . . Water service (n linear ft.) e Page Tax map /parcel #: 2 (no. i t. ag �txtur r *I }em � � , �r WA , %: , ,? L- , ADESCRTPTIONACVVIORKs.MI , Absorption valve 16.60 Xt p( t F u)' d ✓ 64-rl1 -e Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ROP,ERM OWNER 7 . T` ., �s;_ TENANT;,' .� -� Ejectors /sump 16.60 Name: U�-'a e... 1 �-e , Expansion tank 16.60 Address: 1, ,�� s e,) o 4.. v...L. Fixture /sewer cap 16.60 City /State /Zip: ! Lye Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: 57 q 3, g - 6 Fax: Hose bib 16.60 `1EPLIC z . `.. ,.:� .. t; ,.. CONTACT`PERSONk 1 Ice maker 16.60 Name: 1)...) L .1 -ems. Interceptor /grease trap 16.60 Address: I Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 PIS C g x., a CONTRACzT,O$ ., .> ' ,. .>3, Urinal 16.60_ Water closet 16.60 Business Name: Cd_J Water heater 16.60 Address: Other: City /State /Zip: Other: Phone: Fax: M., .. il!C Plumb►ii:Ori ttftili so, IRM 4 , m ; Subtotal $ CCB Lie. #: Plumb. L1C.#: Minimum Permit Fee $72.50 $ Authorized / Residential Backflow Minimum Fee $36.25 Signature: _ w , -0•1=b, Date: JO -/5-c 3 Plan Review (25% of Permit Fee) $ A / " , A � ;- State Surcharge (8% of Permit Fee) $ �` (Please print name) TOTAL PERMIT FEE - $ - Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or • 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms\P1mPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Footing drain - 1" 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 $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 additional $100.00 or fraction thereof to and 0 g4i3. ttell IF.KOR tj 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*. ,„ Comments regarding fixture work: 151!:1 tz:N'evai Moved 4E *rrElatikk 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" • Car Wash Drain *Note: If the fixture work under this permit results in an Garbage -Domestic Disposal -Commercial increase of sewer EDUs, a sewer permit will be issued and -Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall . Sink -Bar/Lavatory -Bradley -Commercial • -Service Swimming Pool Filter Washer - Clothes Water-Extractor Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 A cation •� PIE FOR"OFFICE -USE ONLY Electrical Permit Received Electrical r `� 4 200 3• Date /By: Permit No.: , 0r _/ �� � U� City of Tigard Planning Approval Sign Y Tigard Date /By: Permit No.: 13125 SW Hall Blvd. OFTIGA� . Plan Review Other Tigard, Oregon 97223 G LNG Off' '1� Date/By: P d Permit it No Phone: 503-639-4171 Fax: 503 5�� IT�60 ,L Post -R y: Lan No hottxt Internet: www.ci.tigard.or.us All Contact Juris.: ® Sec Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. ;:--: ��e� _ '".: ,.. r -,. COE,:...ORK°v T =;.' u.� .� _ . � . .•- 1 �� ;;� ^. PLAN: REVIEW '(Pleasetieck4all�itiat�apply). _ �F" rt .. ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location VZAddition /alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, =le ;''t - le: '' `•, - CATEGORY: OFICONSTRUCTION` ° -"3:-;e "' "'' _ , t . 1 & 2 family dwellings four or more residential units in ✓T I & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress /lighting plan ❑ Other: " 1'' N JOBFSITE. INFORMATION and`LO.CATION `1, - " "'. Er: K Submit sets of plans with any of the above. Job site address: 12 625 S. ti/ /�/�TN //� S7 The above are not applicable to temporary construction service. ; x ,..�FEE.SCIIEI) LE ::g:::;;,A.'`xc•� ._..�:.��N:�. � "�;� � Suite #: Bldg. /Apt. #: Number of inspections per permit allowe Project Name: Description Qty Fee (ea.) Total 1 Cross street/Directions to job site: New residential - single or multi - family per dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 , Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling ^ ;';DESCRIPTION,CIF WORK : ''` i service and/or feeder 90.90 2 A�D1 T /tN O VER 64,AGE Services r r - installation, 3p alteration on relocation: or relocation: •. • 200 amps or less / 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 :x:' :PROPERTY :OWNER . ` ; ° RI TENANT . i 0;:'a' > -, : _ $" ,;,, 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 . Address: Temporary services or feeders - installation, City/ State/Zip: alteration, or relocation: y p 200 amps or less . 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 ❑ APPLICAN.T: ; : i-`` i' i CO(YTACT_ PRSON: - - , r: : . Branch circuits - new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 _ E -mail: Misc.(Service or feeder not included): Y ''' "1CONrTRACTOR'_ Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: 4zi -/ ) -� p c. , Description: Address: IQO' goX /640 Clt City/State/Zip: n Each additional inspection over the allowable in any of the above: y p /IUO(7f Pl2-c` o Od x'97/33 Per inspection per hour (min. I hour) 62.50 Phone: /© /•/ —02v Fax: b /Lf - //f Investi fee: Other: CCB Lic. #: , 63 Lic. #: 1 1/2e� i ,�� � �-`1 �'__ �� , ��wEleet`ricallPerinit Fees *= �k�;���'�,�; ° °;` =�k � - �,._�. Supervising electrici, r ") Subtotal $ signature required: UAi,t.+r. Plan Review (25% of Permit Fee) $ Print Name: ( 1t,;' c; i )) • Lic. #: 3 iR 5 J State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts \Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems In Burglar Alarm n Garage Door Opener n Heating, Ventilation and Air Conditioning System I Vacuum Systems Ti Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems T7 Data Telecommunication Installation n Fire Alarm Installation n HVAC I I Instrumentation 0 Intercom and Paging Systems • Landscape Irrigation Control n Medical ❑ Nurse Calls Outdoor Landscape Lighting n Protective Signaling n Other Number,of Systems * No licenses are required. Licenses are required for all other installations \Dsts \Permit Fortis \ElcPermitAppPg2.doc 01/03 E • - Electrical Permit Application Received FOR OFFICE US ONLY ::- -. Date/By: Permit No.: City of Planning Approval Date/By: Sign Tigard Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit N .: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land U:e .■ Date/By: Case 'o.: Internet: wvvw.*; tigard.or.us j, All Contact Jun..: [2] See Page 2 for 24-hour Inspection ' equest: 503-639-4175 - " " ' ---* Name/Method: Supplemental Information. — 1 . : i,•: - !1-:. : ::7 1 `'E;g'ia.;fiqW:?TY '! 1,0F,:W,O1lKVM4W64VQ%gr,•• 0,t4ViiitNtPLAMRENIEW Ele4e.fe1fe0(7i11J1iitAiiiiMP-;;::;'!..- 0 New construction 0 Demolition 0 Service over 225 amps- 0 Health-care facility commercial I 0 Hazardous location 10Addition/alteration/replace c t 0 Other: 0 Service over 320 amps-rag of 0 Building over 10,000 square feet, . ' 4 I & 2 family dwellings four or more residential units in IIR & 2-Family dwelling 111 Corn , ercial/Industrial 3111 Building 0 Multi-Fa -R ily 0 System over 600 volts 0 Occupant load ove 9 persons ominal one structure 0 Building over three ones 0 Feeders, 400 amps or more Accessory Buldng 0 Manufactured structures or RV park 0 Master Builder 0 Other: 0 Egress/lighting p n El Other: JOB SITE tt•:.:.,:i''',",l'F'"t-T':i-N: Su mit sets of plans with any of the above. The abov are not applicable to temporary construction service. Job site address: /a G .,1 5 )( '1, r -i. - , ',1C .44, Suite #: 1 Bldg./Apt.#: Number of inspections per permit allowed Project Name: Descriptio Qty Fee (ea.) Total 1 New resid ntial-single or multi-family per Cross street/Directions to job site: elfin nit. Includes attached garage. Ser • ncluded: 1000 . . or less 145.15 4 Eac addit al 500 sq. ft. or portion thereof 33.40 1 Li i i t t e ed e e n n e e r rg . residential 75.00 2 L d energy, Subdivision: 1 Lot #: . residential 75.00 2 Tax map/parcel #: ach man ed ' , e or modular dwelling DEStRIPTIOMDF'NVORk- '.if.•72' service d/or fe der 90.90 2 Servi s r fee er: • • ta , tion, Apittt i-lb t-- , t''-'f /k " alterat t reloc• 21i a !lo ess , \ 80.30 2 201 :les to 400 .rMWIIIIIIIIMMMMjIIM 106.85 2 40. . .s 10 600 altaWilirkillUI 160.60 2 la*,11 Ei ItSaIN ., , 601 a ,'p - to 1000 a IIIIMMINIEW...WIM 240.60 2 - - rer 000 am k,or zoitwmurAmmil 454.65 2 Name: g,,,...„. .4,i 0-1_, , - no ect onl ymimLvm;■ 66.85 2 , Address: i D..C. 15 sc,-) X.0.-4--ise ye.--c ;., ''''‘ orary ser ''c • - or • • i : s n - • • . , lai1eration, or reli ation: City/State/Zip: T-1 (3 1 el 7 ,,12-3 •Iry I o amps or less L 66.85 1 j° M. Phone:57/ 3 6, rA Fax 201 amts t. 401 am.s 00.30 2 .wr.,. MEW= 2 ; ::'p'•.:•::1; ..,'-, Branc cir tilts - new, alteration, or • Name: tti4 lia ut--k-%. extensi er panel: A. Fe . o branch circuits with purchase of Address: s . c or feeder fee, each branch circuit 6.65 2 City/State/Zip: B. ee branch circuits without purchase of s ice or feeder fee, first branch circuit 46.85 N 2 Phone: Fax: wi?,dditional branch circuit 6.65 E-mail: Mise!(Service or feeder not included): 53.40 N ch pump or irrigation circle i a sign or outline lighting 53.40 2 Job No: 'Ap_2) j : circuit(s) or a limited energy panel, teration, or extension Pa Business Name: IIIMISW I II Description: Page 2 2 g Address: 4//ararla AorArzimmi Each ichnsapdecdtiiotin per h additional inspection (m ect:roln I hour) 620 the allowable in any of the above: Cit /State/Zi• : Per Phone: FilwAprairiwmi Investigation fee: CCB Lic. #: ..o-7;:two.;wAVATAWAtleaiie'aiWiiiiit;WMPaiZtf7Z-45f;',-ite'MfM Supervising electrician Subtotal 1 $ signature required: / Plan Review (25% of Permit Fee) S Print Name: Lic. #: State Surcharge (8% of Permit Fee) S TOTAL PERMIT FEE 5, , Authorized Notice: This permit application expires if a permit is not obtained within Signature: -- - ate: / 0 "15 - 3 180 days after it has been accepted as complete. itilff 14741'-°'17 *Fee methodology set by Tri-County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: n Audio and Stereo Systems ❑ Burglar Alarm n Garage Door Opener ri Heating, Ventilation and Air Conditioning System Li Vacuum Systems n Other COMMERCIAL WORK ONLY: • Fee for each 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 n Fire Alarm Installation n 1-IVAC n Instrumentation ❑ Intercom and Paging Systems ri Landscape Irrigation Control • 0 Medical n Nurse Calls ri Outdoor Landscape Lighting n Protective Signaling Other • Number of Systems * No licenses are required. Licenses are required for all other installations is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 A , . Permit #: ;17 , — e7 ... -QJ505 OF O I 'e `� Address: I atop, s i,.c) c.Ct+ kil41 Z 1 .;.....i.i*-V Issued by:� : 8, Date: I I — -0 85 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: E 1 1. I own, reside in, or will reside in the completed structure. Ir 2.. understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. n 3A. My general contractor is I (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 id 3B. I will be my own general contractor. 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 inform ion is correct and that I have read and do understand the Information Notice to Pr s : - 1 wners abou ' ons 1 ction esponsibilities on the reverse side of this form. --d (Sign.tu - of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) 1I i.ition Noidce to Protpat Owneva About ConetrucUon Respone'b Note: This Information Notice to Property Owners about Construction. Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.0550. 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 RESPONSESOLDTIIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comp y with the following: Oregon's withholding tax law: As an emploYer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers compensation insurance for your employees. If you fail to obtain workers' compensation insrance, you may be subject to penalties and will be liable for all claim costs if one of your employees Es injured on the job. Fornnnreiufurcuadno, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7883. U.S. Internal 1 Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER RESPONS0911UTOES AND AREAS OF COMCERM: Code compliance: As the permit holder for this p ject, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contuctyoo/ionu?uncoagent to see if you have adequate insurance coverage for uccideot> and omissions such as falling tools, paint overspray, water damage from pipe pooctu»oa, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate tbnvvorkofcnugh-inundfloiab trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box ]4l4O. Salem, {)]l97309-5O52. 503/378-4021). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1 /94 CITY OF TIGARD 24- Hour // ,,, �, � BUILDING Inspection Line: (503) 639 -4175 Mss >0 - _56 c_5 INSPECTION DIVISION Business Line /(503) 639 - 4171 BUP Received ; / 4>9 Date Requested 5 , 72. ( --0 / c/ / AM PM BUP Location /Z7 2-5 X `f"lA -P Suite MEC Contact Person Ph ( ) 969--</7 F ? PLM Contractor Ph ( ) SWR r BUILDING Tena can ELC Footing ELC Foundation 1,✓✓q V Ftg Drain Access: i ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear l r Framing —'�• KT _/ ! S' • C- MA -l- U MB Insulation Drywall Nailing caci �---,. .- / Firewall \ \/j / -- Fire Sprinkler __ 7 V \ \ Fire Alarm \1 Susp'd Ceiling Roof / n () a 11 w" "� // (1 - /-), PAS PART FAIL / Jr-1\\ " n (�f , \ \ PLUMBING (I n r) / 1 , CO v I) Post & Beam \\ /I j» / // Under Slab ! Rough -In I / ) (1) U ^ // Water Service �! V 1 , / .1 �� Sanitary Sewer Rain Drains \\ Y \\ /7- Y/ Catch Basin / Manhole \\ Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Su • e Dampers • PASS PART FAIL ELECTRICAL _ Service Rough -In UG /Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. P. at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: / % r Unable to inspect - no access Fire Supply Line li, ADA C` Approach /Sidewalk Date v I nspector Ext - Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL F TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 v INSPECTION DIVISION Business Line: (503) 639 -4171 MST a BUP Received LO Date Requested g-22"�(7/AM PM V BUP Location l Z rr ,, ll Suite MEC Contact Person .Q) ( 6 — 2 > (O PYPLM Contractor Ph ( ) SWR BUILDING Tenant/Owner Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I 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 , ;WIT FAIL CE'CECTRIC)e Service Rough -In UG /Slab Low Voltage PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspe lion RE: Unable to inspect — no access Fire Supply Line / / ADA rte- _ Approach /Sidewalk Date • Inspector a Ext � � � � Other: Final DO NOT REMOVE this inspection record from the Jo - site. PASS PART FAIL • CITY OF TIGARD - 24 -Hour BUILDING Inspection Line: (503) 639 -4175 3 v o 5 ' 5V INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP Received e' 09 Date Requested 4 2 Z-O� AM PM BUP Location / 210 J Suite MEC Contact Person :`. i . ' . •h (_Z�) 5 — 3696 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PA FAIL LUMB Post &Beam Under Slab - Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O ier: ids' F PART FAIL ECHA I :AL Post & Beam Rou g - • as Line Smoke Dampers PART FAIL - CTRICAL 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 El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ) L ADA / a ` Approach /Sidewalk Date ( // `� Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL