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Permit i i ` MASTER PERMIT CITY TIGARD PERMIT #: MST2003 -00445 '�4 E�0 DEVELOPMENT SERVICES DATE ISSUED: 9/4/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10226 SW KENT CT PARCEL: 2S114BB -21200 SUBDIVISION: RIVERVIEW ESTATES NO. 2 ZONING: R -7 BLOCK: LOT: 056 JURISDICTION: TIG REMARKS: Addition of 880 sq. ft. to existing residence. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 440 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 386 sf GARAGE: sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5 VALUE: 57,890.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 826 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 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: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 1 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 FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: oo SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 2.00 SIGNAL /PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: - MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,073.44 DOLAN, MATTHEW J + KEHLI K BRUCE ABRAHAMSON CONSTRUCT r d d Municipal is subject to the regulations ec C o i the icipal Code, State of OR. Specialty Codes and 10226 SW KENT PL 12735 SW MARIE CT all other applicable laws. All work will be done in TIGARD, OR 97223 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: Phone: 539 - 6790 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 102637 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Exterior Sheathing Insf Electrical Final Foundation Insp Mechanical Insp Gas Line Insp Mechanical Final Post/Beam Structural Electrical Rough In Gas Fireplace Final inspection Post/Beam Mechanical Framing Insp Insulation Insp Underfloor i la ion Shear Wall Insp Rain drain Insp Issued y : \ , : , :.. 1,:. n I ' ,d./ /tom P ermittee Signature : . -:l /. 11' AI — CaII.(503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application FOR OFFICE USE ONLY RD � ? Pe Build i ng Date/By: : � t / / U Permit rnvt No.: No.: YLIS j 2 d ( 14 ( 14 ' 5 pU.3 — �� Cit Of Tl ar pCE'vE® P Approval Other y g �66ssoo 13125 SW Hall B1v — Plan Review Other , . Tigard, Oregon 97223 Date/By: IAA/ 9 3 • G) Permit No.: y� Phone: 503- 639 -4171 ■ I :, : 2013-52003960 „,,A„, ". ills l l h \ Date/By: Case No. C on tact .Tuns.: Post - Review Land Use 7 _ Internet: www.ci.tigard.or.us � -. � pa, ® See Page 2 for 24 -hour Inspection Recce C�C"11075 Name/Method: Supplemental Information BUILDING DIVISION Wo/ ii _ 5 a " *i ` <F , R'r a'�"= ti }.' ,. p�. " <. 'aa. t r , �S"o e ?o f '°z: ' s">,i ,0- 7'- i -P. ",- ',. ''t, b " > .. .. ' ` 1: . �" ` �TYPF , ®FIWORI{ € s ❑ New construction ❑ Demolition- emolition `� ` � ,& 2 0 zY � It I X44 ,, 1 - M Addition/alteration /replacement ❑ Other: n ," ., ra C 1 VOAY OEC(O S1LR1 C ION„ ;�°`` = A Note: Permit fees* are based on the total value of the work performed. Indicate ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this applicatio 6 3 ,z '>b . 1 .1 - 0 ❑ Accessory Building ❑ Multi-Family GI I � 9 o -....* 111 Master Builder El Other: Valuation ' ' ) $ - e Ue . ' " t00001V ().R1 Tro d .$oC IO m -43§ No of bedrooms: n No of baths: 0 Job site address: ID22‘ 3W (*tit Cr rj aval O' Total number of floors .2— I( 9 New dwelling area (sq. ft.) , G Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) Project Name: Po Ian Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) 4,- ;1,e , §, s „C1 n � 'fir °:sf�. tFt �. *• � � i »r n ' '�C- OMNJER , S E ` , 0 . Subdivision: Lot #: �� a k ' " Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate pf. `' <DE CRIPT T r ocwo ,x ,`li '-' _ ,--, 7mtinz the value (rounded to the nearest dollar) of all equipment, materials, labor, I c i4-►'OY\ ,t '14 S ! i vti c- f vu.c,(-,u.l -e overhead and profit for the work indicated on this application. Valuation $ _ P4 *I Existing building area (sq. ft.) y New building area (sq. ft.) q' Number of stories PRO0I3R Y OWNER '; -<`> VNN , R ` f l ' Inn Type of construction Name: Mod+ q Mehl(' Do /c.r Occupancy group(s): Existing: New: Address: (0 221, St.) kenT e'r City /State /Zip: 1'14Ard o R- g722y Phone: 691y -L1YU Fax: NOTICE: All with the Oregon r subcontractors to be Consstruction Contractors Board under provisions of ORS 701 and maybe required to be licensed in the Business Name: 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: *.,- ,-xt.z E �-1 _ dim_ B I_D IlyG ' RM . E 1 �, E ki 1 s s ced �, r�.t °�� � P eare to f ee�shule � ,�� �i ����� `; amKF 3's ..., 0' T D O - D �' '",° ,f S ' J P A G1 0 € i E 'v .. _ :.; .. . ' � r-..a..e "., +. „•...�� xv�,.z i :":.�� .,. �ed�` ` c''. �... ��.. 1.` +JF:7ri�?.�1.��- ',,`..�w�.x��.'d . - � . ..� _ ....eF �''.:;�,:.HL�:•.. ._.,'*�..n �za :«. . , .�...... .. zx. �.h�, .. ,�.�'v�. l- t Business Name: Brkce AbY0.11Ciwl5ori ConsI. Fees due upon application $ Address: I. - 735 S W IYIay; e. C,l City /State /Zip: i ' 0 6 ({ q 1 ZZ 3 Amount received $ Phone: 5q 6 -qt./ 00 Fax: t51 " y 10 (p Date received: CCB Lic. #: I b 2 (a 31 Authorized �' . �_ /� �?,. Notice:._ This:permit_application expires_if-a.pecmit is_not_obtained within _ _ . Signature: i 1 Date: o"' 180 days after it has been accepted as complete. ' " , < u e_l Ian V *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 One- and Two - Family Dwelling , ' . . , , .. . . A , s Vi a , �i Building Permit Application Checklist Reference no.: II of Associated permits: City of Tigard City Ti and Y 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, i 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) Electrical Permi : pp 'cation . jii �3 il g S l� �� �.P 0 2 no3 Date received: Permitno. 3''�t (/V.,(7 ; CI of Tigard ProjecUappl.no.: Expire date: � •1 City ojTigard Address: 13125 SW Hall Blvd. TigartIIR. UP2I IGARD Date issued: By: Receipt no.: Phone: (503) 639 -4171 BUILDING DIVISION Fax: (503) 598 - 1960 Case file no.: Payment type: Land use approval: TYPE 01: PERMIT . ❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family ❑ Tenant improvement ❑ New construction 0 Addition/alteration /replacement O Other: 0 Partial JOB SITE INFOItl1 Job address: '/Z9€2 t5(,O T //7 c=r . Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: IBlock: ISu ivision: Project name: I Description and location of work on premises: Estimated date of completion/inspection: • _ ('ON'flt ACID It A P It l.l(ATION 'FEE SCHEDULE Job no: Fee Max Business name: (n Pk fp G (2 cJ —/ c Description Qty. (en) Total no. Imp f New residential - tingle or malts- tamlly per ^ Address: , ) O (c& (S G dwelling unit. tnetudes attached garage. City: /7 r fro I State: p'-P I ZIP: C 7 2-) J Servialndadeul • Phone: ? C 1-'1 Z�(G I Fax:? 6 Z.`C! IrY1 E -mail: tow sq. n. or less 4 Each additional 500 sq. ft. nr portion thereof CCB no.: (� I Elec- bus. lie. no: 3 ?$ C Limited energy, BY• msidential 2 City /metro lie. no.: i ll( 3 V Limited energy, non- residential 2 . ( l6 Each manufactured home or modular dwelling Signature of s rvising a )ecltician (required) Date Service and/or feeder 2 — �/ [ Services or feeders- Installation, Sop- elect. name (Print): e4 E�` 6 License., f 5 S alteration or relocation: 200 amps or less 2 Name (print): 20I amps to 400 amps 2 401 amps to 600 amps Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only 1 Owner installation: The installation is being made on property 1 own Temporary writers or leaden - which is not intended for sale, lease, rent, or exchange according to lost'natton,alteratloa , orretocmlon: 200 amps or less 2 ORS 447, 455, 479, 670, 101. 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am 2 Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of A'Jdress: service or feeder fee. each branch circuit 2 , City: IState: IZIP: 0. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E -mail: Each additional branch circuit: I' Jtl:YlLW (Please check nil that apply) Misc. (Serviceor feeder not lncluded): O Service over 225 amps•eommercial 0 Health -care facility Each pump or irrigation circle 2 0 Service over 320 amps-rating of 1&2 0 Hazardous location Each signor outline lighting 2 family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential units in one structure alteration, orextension" 2 O Building over three stories O Feeders, 400 antpa or room • *Description: 0 Occupant load over99 persons 0 Manufactured structures or RV park Each adiftlonal Inspectlon over the allowable In any of the above: 0 Egress/lightingplan 0 Other. Perinspection I I I. I Submit sets of plans with any of the above. - Investigation fee The above are not applicable to temporary construction service. Other Nd all Jurisdictions accept nadir cant, please call Jurisdiction for mare information Notice: This permit application Permit fee $ El Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ credit card number. / / within 180 days after it has been State surcharge (8%) .... $ - - - -- - - - -- ----- -- -- - - . - - - - - - Expires - - -- - - accepted as complete. -- TOTAL - - - - - - Name of cardholder as shown an credit card S ■ cardholder signature Amount 440-4615 (6AOVCnbft I'd 8816 29L -EOS 3I?J133-3 3I1.139 e90:LO ED 8z 2n8 • Electrical Permit • • FOR OFFICE USE ONLY Received Electrical Date/By: PermitNo.: /}61,,,O3 - 0a Clt of Tiand Planning Approval Sign Y g 1 200 Date/By: Permit No.: 13125 SW Hall Blvd. AUG L Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503- $gl�119®$ TIG' 11 Post- Review Land Use Internet: www.ci.tigard.or.us BUILDING DI ' �Cw 'y' ��� Date/By: Case No.: ` Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. M rl .,&S� ., - '�,.�... :� �� .m �` � � �� � am "=, z�Z . "„ �"°`�, . , .4# • -..,#, ..,_ _,.s >,:� �`„;` ' _ .* �w� v.� =:_ . , `1'; ..MO _ ,_ _. _ kr �- .�� ° tint _ .. � ra :t a c` 4kaj that..P.. i New construction El Demolition p ❑ ��� ❑ Service over 225 amps- Health -care facility Addition/alteration/re lacement Other: Service over 320 amps- rating of ❑ Building over 10,000 square feet, commercial over ❑ Hazardous location ,� ❑ ❑ fig , u.10 ' 4RO®Nf' QM` (Q =:" o' °.. E 1 & 2 family dwellings four or more residential units in ❑ 1 & 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, : ,� �" Mfr Submit et f ` ;J,� SZ�E�O�� � N�'a�id. LOIL�� � ON''� '`�_` � t s o plans with any o f the above. `�� �r '" �� The above are not applicable to temporary construction service. Job site address: / O Z2.1 ,/,) ke,0 1-- ., _ I ...,. ` tttS4 fil t " Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed Project Name: t D' l � V) Description Qty Fee (ea.) Total l Cross street/Directions to job site: New residential- single or multi - family per 1 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 Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling 'E1 ` " "' _ ' p' -fir' ; j service and/or feeder 90.90 2 " � � , �� "�� �� � � y �� ` l' � Services or feeders - installation, CA-4 i v II ' - f 5 1', u j f " alteration or relocation: _ J 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 '' " ®p R 3 sj az , TM £ µ t• 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: p 200 amps or less 66.85 • 1 Phone: I Fax: 201 amps to 400 amps 100.30 2 . 401 to 600 amps 133.75 2 Branch circuits - new, alteration, or Name: extension per panel: . A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 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: I Fax: Each additional branch circuit cg- 6.65 2 E -mail: • Misc.(Service or feeder not included): ,N _tG» p: ,� t , Ate s Each pump or irrigation circle 53.40 2 _ Each sign or outline lighting 53.40 2 Job No: 1 j 9 - Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: Description: Address: City/State/Zip: Each additional inspection over the allowable in any of the above: `J p Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: Lic. #: Other: Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: Lic. #: 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 Ti Burglar Alarm Garage Door Opener n Heating, Ventilation and Air Conditioning System n Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 - 260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls Clock Systems Ti Data Telecommunication Installation El Fire Alarm Installation n HVAC Ti Instrumentation Ti Intercom and Paging Systems n Landscape Irrigation Control n Medical Nurse Calls Outdoor Landscape Lighting Ti Protective Signaling Ti Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 Sep 03 03 07:19p Sherr & Bruce Abrahamson 5035794706 p. 1 Mechanical Permit A cE"J • 1 lication Received Mechanical ONLY • - it FOR OFFICE USE s Date/By: city o f T FIE Planning Approval Date/By: Building igard Permit No.: 13125 SW Hall Blvd. , n 4 1On Plan Review Other Tigard, Oregon 97223 SE u Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-UV Post-Review Land Use //4 , 40 ,,, .:,,„„ 6 \ Date/By: Case No.: Internet: www.ci.tigard.o trt 6 Of TIG„tr N arlii Contact Juris.: Igi See Page 2 for 24-hour Inspection ReqlsOL tittE060.141 •/r Name/Method: Supplemental Information. ; •,iti!.-.•. r. X4 1-1 AgAQI - k.V.R.4;74i. ..'. .110.,:titUMOUVAMPAUgeft000 4 . 1 ;:k.'P. : . i7 .!q0tift . atttgat : MttS c gt011 .6 "::a",-,.:MOMOrCaS.r...n$ ,: :,4' D New construction [11 Demolition Mechanical permit fees* are based on the total value of the work performed. Indicate the value (rounded to the nearest dollar) of all Li Addition/alteration/replacement 0 Other: afgaMear,04:40iikOW,WirOYMMAlijii=1;Xt57,":-; mechanical materials, equipment, labor, overhead and profit. E I & 2-Family dwelling E Commercial/Industrial Value: $ See Page 2 for Fee Schedule ' -"' ' - . -4- igiiIiterlafria*MikOratVarettig0 '";'• -'''' 0 Accessory Building III Multi-Family Description I Qty j Fee(ea.) 1 Total El Master Builder 0 Other: !.;,;.1',.:..;', :'' ;':''. .. .-.:;.'.- IleAtiiiWCT:tiaiii,... 9V.A6:P■14,00 el, 11 :40V4 - .00Ni t` .... : 1 , ge-4 Furnace - add-on air conditioning" 14.00 _ Job site address: /00R,4, /e) t Gas heat pump 14.00 Suite #: I Bldg./Apt.#: Duct work . 1 14.00 Project Name: - to- , A.- Hydronic hot water system 14.00 - 1:)o Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in-duct, suspended, etc.) 14.00 Flue/vent (for any of above) 10.00 Subdivision: Lot #: Repair units 12.15 .' :, ,',,:..,;.-..-: - •• :,- Tax map/parcel #: Water heater 10.00 144MEWWWWWIWOOKURAMMWTMTRWW Gas fireplace / 10.00 4cCekrto--.--- 1 /•eAc V7.40-6-) . - Flue vent (water heater/gas fireplace) / 10.00 Log lighter (gas) / 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner/flue/vent 10.00 • :0 PPOPtigigeViiit;rtttiM Other: 10.00 Name: , 1 st-- ti- L., c- be-t 4.--4.A._ Range hood/other kitchen equipment 10.00 Address: /O2-4j .,..,) 1 6•......4;- C_.i- . Clothes dryer exhaust 10.00 City/State/Zip:-r Q10-.. ? - 7 2-2-4 Single duct exhaust Phone: (t-1 - 1, 1 Fax: (bathrooms, toilet compartments, lt, gi 1. utility rooms) 6.80 Name: Attic/crawl space fans 10.00 , Other: 10.00 Address: ..*.. •.•:..'::, - City/State/Zip: **($5.40 for first 4, $1.00 each additional) Phone: i Fax: Furnace, etc. / ** Gas heat pump ** E -mail: Wall/suspended/unit heater " ** 10.107;41. , Water heater ** Business Name: • iz _ (_- i 1 . . , h Fireplace / ** *4. Address: ', Alinga _ . Range ** . -"" BBQ City/State/Zip: /Th tuku i 6 r e_ q7, ,__ i Clothes dryer (gas) ** Phone,663 -73,-,..1?5 Fax: Other: ** CCB Lic. #: i 9 '(1,.!/,_: !,,:,•: Total: .4 • .,--, •::-.:.• '-:•::• Authorized Signature: _., . L C(-\S Date: -02> Subtotal: $ Minimum Permit Fee $72.50 $ 1 E- , 1._ ; -- C Ats Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE S - 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. i:\Dsts\Permit Forms WeePermitApp .doc 01/03 • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 3 ___00e-l4S INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received 1 Z /I I 31 0 Date Requested I Z / 2 © M PM BUP Location , Suite MEC Contact Person f511,{A,C Ph ( & 796 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation F ELC Access: � (r3 l� Ftg Drain ELR Crawl Drain /ARP/ /70i f i/Ya L" 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 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 P S__.P T FAIL TR Service Rough -In UG /Slab Low Voltage Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. -,:r - W PART FAIL Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Date /02/ Inspector (7-y Ext Approach/Sidewalk P 1 Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CIT " : TIGARD - 24 -Hour fib ILDING Inspection Line: (503 , • • 175 Mb MST � s � / " ) INSPECTION DIVISION Business Line: (5 1 / (� V ..- BUP Received Date Requested �'/ — C ® AM PM BUP Location /0 Z--T--( k#,, f f C T Suite MEC Contact Person 327 - (e, Xhak f) 5 D PLM Contractor Ph ( ) SWR ILDI G. Tenant/Owner ELC 0o ing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear hit Sheath /Shear PkeFraming /'r.Q'r C "vi �r'C''t -'" Insulation r/� 5 � �' Firewall j / t Drywall Nailing �J 6 1✓j / l d, »i�l1d%G� � / (( Fire Sprinkler Fire Alarm Susp'd Ceiling Roof 0 , \ , FART FAIL t d r Post & Beam I ' ' % Under Slab r 1 , / . Rough -In Water Service / Sal' . Sewer - Deiti " Catch Basin / anhole . Storm Drain ' Shower Pan Other: Fi I P ASS PART FAIL V/......" MECHANIC-At CI� ( / Post & Beam NICAL ' . : � -'r / / / Rough -In Gas Line ts L- o ' A_.� Smoke Dampers Final PASS PART FAIL tilte ELECTRICAL u_, Service Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE , ❑ Please call for reinspection RE: / Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date_ t I nspector ��'� / Zar _ . Ext Other: Final DO NOT REMOVE this inspection cord from the job site. PASS PART FAIL