Permit CITY . OF TIGARD MASTER PERMIT
PERMIT #: MST2006 -10068
.' , r , m i DEVELOPMENT SERVICES DATE ISSUED: 5/1/2006
f 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104CA -02500
SITE ADDRESS: 13599 SW LAUREN LN ZONING: R -
SUBDIVISION: HILLSHIRE LOT: 025 JURISDICTION: TIG
Project Description: creating bathroom in crawlspace.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: 128 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: .
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 128 sf 10,000.00 REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP a 3HP: VENT FANS: 1 CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
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: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2 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: •
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
JIM & BEV ST JOHN RICHARD C. SIMANTEL applicable laws. All work will be done in accordance with approved
13599 SW LAUREN LN PO BOX 383 plans. This permit will expire if work is not started within 180 days
TIGARD, OR 97223 WEST LINN, OR 97068 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules 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
Phone: 503 - 524 - 6757 Contact #: FAX 503 723 - 4267 of these rules or direct questions to OUNC by calling 503 - 246 -6699
PRI 503 657 - 1950 or 1- 800 - 332 -2344.
Reg #: LIC 33524
TOTAL FEES: $ 462.55
REQUIRED ITEMS AND REPORTS
A A i
��s
Issued By : L/ Permittee Signature : Aire ���'
b /-
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.
Building Permit ApplicatioiC ; 'FOR OH I' ICE USE ONLY
� A �M Y q
City of Tigard D Re � ceiv ee , By ed
l .Y J'/ 0 �- Per mit No`131-I96 [ / ' '
13125 SW Hall Blvd., Tigarr, OR 97223 P lan R eview 0
Phone: 503.639.4171 Fax: 503.5,9p8:1i960� 0 2000 "' * t't'M�,�'y ; 's W DateBy:1i A 1- t -(e Other Permit:
Inspection Line: 503.639.4175 1°►� e . Date Ready/By: Juri ' H See Attached Checklist for
Internet: www.ci.tigard.or.us TY OF -r1GP`R Q ® w ' Notified/Method: l /, t f lE - Supplemental Information
TYPE OF WORK 65 PAC[.- REQUIRED : AND,:2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
' ' CATEGORY OF CONSTRUCTION ' ' work indicated on this application.
1- and dwellin Valuation: $
y g ❑ Commercial /industrial !e:
•
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
' . • ' ' S ITE .INFORMATION
1 AND LOCATION . : ' Total number of floors:
Job site address: 43 5'99 .Su, ! A ed rt"if-) 2 New dwelling area: square feet
City /State /ZIP: j �� 2 d e�‘. c 7.-Z. Garage /carport area: square feet
• Suite/bldg. /apt. no.: Project name: s7 T� it ,J Covered porch area: square feet
Cross street /directions to job site: r Deck area: square feet
Other structure area: / square feet
' REQUIRED DATA: COMMERCI'AL - USE CHECKLIST . .
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
,D ESCRIPTION - OF � WORK ' ° work indicated on this application.
�J� Valuation: $
�e
cl' A Inc
,/o, or ,,,j/ ,j, 7) a� Existing building area: square feet
1 � New building area: square feet
. _ KROPERii " OWNER . • ' : ❑ TENANT Number of stories:
Name: cj iv[ >K g`i c< 76A/L) Type of construction:
Address: /.36-79' 5 a) a,r --e 2,J Occupancy groups:
City /State /ZIP: • G- 7 7 74-44 eae Existing:
Phone:0 5) �j 2y' �7..c 7 Fax: ( ) New:
APPLICANT 0 CONTACT PERSON NOTICE
Business name: S/'TY7 / L / g' et �/ All contractors and subcontractors are required to be +
ie' Contact name: -a:>/d1 S �Jn - 9wL licensed with the Oregon Construction Contractors Board
c under ORS 701 and may be required to be licensed in the
Address: zofie, Agd■C . 2--- jurisdiction in which work is being performed. If the
City /State /ZIP: Ge....7e.,s71 applicant is exempt from licensing, the following reasons
r iV� apply:
Phone: ( 79 Gy
) 7 D Fax: ( )
E -mail: " °am� / T- .
,- CONTRACTOR - . _ e '
Business name: 2 c 52 27 7 . 4„,.0 7 ‘..-Z i , / - .
BUILDING PERMIT FEES *
Address: _pt Ag _ _�
T '�' � Please refer to fee schedule.
City /State /ZIP: 4, T L , vita !9/2 97 d G /�
� F ees due upon application � (,9t S5
Phone: 4.57 /Is%) I F ax: ( �z l 72, - *:.4.
CCB lie.: 001 Amount received q� S�
° s j .7 I ��llll Date received: 3-- 31 V6
Authorized signature: This permit application expires if a permit is not obtained
/' within 180 days after it has been accepted as complete.
Print name: �j .i�aAS 7m���/ Date: 37�/ 6 * Fee methodology set by Tri- County Building Industry
77 Service Board.
i:\ Building \Permits\BUP - PermitApp.doc 12/03 440 -4613T(11 /02/COM/WEB)
•
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received
Dece
Associated permits: Permit No
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 - / — � - oi ft ?` iv
24- Hour Inspection Line: 503.639.4175 � I I ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us ❑ Other.
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑ . ,
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
b asin 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- seliarate 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 Ore :on and shall be shown to be . • • licable to the •ro'ect 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 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. _ ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I: \B ui l di ng \Perm its \BUP -RES -fermi tApp.doc 2
1
4 Electrical Permit A°>p liea; } E. FOR OFFICE USE ONLY
1
City of Tigard Received
Date /By: Permit N. S' ;06 _ / g
( 13125 SW Hall Blvd., Tigard, OR 97223A n 0 2 006 Plan Review
Phone: 503.639.4171 Fax: 503.598.1460 4 . , ! `', Date /B : Other Permit:
__
Inspection Line: 503.639.4175 GtTY OF TIGARD - '_f I Date Ready/By: _furls: ® See Page 2 for
Internet: www.tigard- or.gov r t I IC , D , v' S'O Notified/Method: Supplemental Information
TY PE OF WORK PLA_ N REVIEW. . •
❑ New construction dition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I El Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
l and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family I=1 Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more
DOccupant load over 99 persons 0 Manufactured structures or
- , 'JOB" SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: ❑Health -care facility ❑Other:
/3s7 Sa) /p,wre v I o Submit 2 sets of plans with any of the above.
City / State/ZIP: -- rf - 7,417g I / S �/ ) , ' 7 2 7, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: / Project name: / FEE* SCHEDULE` " .
�� � AD Description I Qty. I Fee. I Total I `*
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non- residential 75.00 2
' DESCRIPTION OF WORK . . Each manufactured or modular
*O�� „ie. ' dwelling, service and/or feeder 90.90 2
�f76Y� Services or feeders installation, alteration, and /or relocation
- 200 amps or less 80.30 2
E FRO OWNER, • El TENANT 201 amps to 400 amps 106.85 2
' 401 amps to 600 amps 160.60 2
Name: _.j, rn s . g a d c c c/ N.77, h .'c) 601 amps to 1,000 amps 240.60 2
Address: l 99 Gt.) LAW /-etc, 4,t) Over 1,000 amps or volts 454.65 2
ICJ Reconnect only 66.85 2
City /State /ZIP: T
✓/'y/sg-.yay 9 7 '7j Temporary services or feeders installation, alteration, and /or
Phone: ( j ) // Fax: ( ) relocation 00
✓�Zr JJ �i7-5 7 200 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
w , ❑ APPLICANT . ❑ CONTACT. PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: ,7 (1 ��J�-4KI� L z5 ,4, /1 branch circuit
j / B . Fee for branch circuits
Contact name: ` ��� � -�
66 �". without service or feeder fee, 46.85 2
first branch circuit I
Address: PC) etg el1 W 3,3 Each add'l branch circuit a 6.65 2
City /State/ZIP: '6.S / i` ,� / D2 7 7 &G � Miscellaneous (service or feeder not included)
Phone: 503) Fax: ( mil�l / 512.47 Pump or irrigation circle 53.40 2
Cam✓ 77 � , 66�C.F ' 7Z3 - 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: Ad icrre6Y5t '
Address: Each additional inspection over allowable in any of th abov
Per inspection 62.50
City /State/ZIP: (" ,�- eie! •iz':s Investigation per hour (1 hr min) 62.50
Phone: ( ) lax: ( ) Industrial plant per hour _ 73.75
ELECTRICAL .PERMIT FEES *'
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
1:\ Building \Pennits\ELC- PermitApp.doc 12/30/05 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
'COMMERCIAL WORK ONLY.::
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1. \Building\Permits\ELC- PermitApp doc 12/30/05
Mechanical Permit Application FOR OFFICE USE .ONLY
' City of Tigard r te. gcE
V �, D Received
Date/By. , Permit Np� S , ,e,6 / _ /�� S / ` 13125 SW Hall Blvd., Tigard, 0' 3 Plan Review
l Phone: 503.639.4171 Fax: 503.598.1960 c / /a y ; lll t � ;_ �; Date/By:
Other Permit:
Inspection Line: 503.639.4175 MAR 3 0 2006 J �� 11
Internet: www.ci.tigard.or.us ' - Date Ready/By: Juris: ® See Page 2 for
g CITY OF TIGARD Notified/Method: Supplemental Information
- BO IL t� i AK l ,
I lSIVVtORrK COMMERCIAL FEE *` SCHEDULE – USE CHECKLIST
Mechanical permit fees* are based on the value of the work
El New construction Ition/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: $
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
ifr�and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ For special information use checklist.
❑ Multi - family
❑ Master builder Other: Description Qty. I Ea. I Total
. ,JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: /A 5 79 5 4 , / - Air heat pump em
syy -I�I.F B. �/(� e (requires site plan showing placement) 14.00
City /State /ZIP: T g. -�� t 9 7 7 2 3 Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: `T Project name: �1 l Furnace 100,000+ BTU (ducts/vents) 17.90
�T �Jh AD Gas heat pump 14.00
Cross street /directions to job site: Duct work I 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: . 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/� Gas fireplace 10.00
�1t /� g /f/i6 CO b77L. 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
8 PROPERTY;OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
/ Other: 10.00
Name: .....7-/- /n b'` ‘,0,) ......<0/ r C6K , Environmental exhaust and ventilation
Range hood/other kitchen
Address: 13599 cw .1 ex s.) Z4
sec.) equipment 10.00
City/State/ZIP:
77- d .64 9727 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 74 — 54 6 757 Fax: ( ) toilet compartments, utility rooms) ) 6.80
0 APPLICANT ❑ CONTACT PERSON ' Attic/crawlspace fans 10.00
• Business name: �e S ✓y „_Ki �/ / /f_ _ Other: 10.00
J J 6Le tG� Fuel piping
Contact name: ,die /G (5 ,274,,s'.trJ G $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
i 4 aiP 0 3 - Gas heat pump
City /State /ZIP: /.,.'e4 / j i,,,e) / d 2 4 7 p 6 /i” Wall /suspended/unit heater
Phone: (5th) 67 v -g 45 g c Fax: : (5 7Z?, [-/ 2,47 Water heater
Fireplace
E -mail:
Range
- CONTRACTOR • Barbecue
/ c - � , Q � / / / /1 Clothes dryer (gas)
Business name: t e L 4a-
J �' Other:
Address: 0 0 01 6 4 C )c. c_3 MECHANICAL PERMIT FEES* _
City /State /ZIP: 4'P5 f J r 0 1) 4 / , 2 976 Ztr Subtotal
) 7 � r- L 6 7 Fax: c 3)
Minimum 25 permit fee r mit fee
Phone:
723 -��.67 P lan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
/ , TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /7, j 07 J 4L Date: 8 __ 6 - z) 4 * Fee methodology set by Tri- County Building Industry Service Board
\ B \ P
i:uildingennits \ NEC- Perm itApp.doc 12/03 440 -4617T (1 l /02/COM/WEB)
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information
it
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.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
Plumbing Permit Appli�catTO � , #� , ; t
CE I ' s ` rr( ( � , * , FOILOI -p'S. O,N.1
•
Y 7Y" • and.. '' .. '4 v 4 . ' ' '' : s ' '{� �,. ''.�,
±' City SW Received � nyr _ /t 9
Date
MAR Date/By Permit No. /v /C7
6
13125 SW Hall Blvd., Tigard, OR 97223 3
Phone: 503.639.4171 Fax: 503.598.1960 J ® u '
/ Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175
�� y
T � � � Plan Review
`-• Date Ready/By: �uris, B
CITY OF ^:, o_:. ®See Page 2 for
Internet. www.tigard or.gov R' 1if nIntn nt" 1^I ^' Notified/Method: Supplemental Information
+. ?`;;,. ;�" �",., 'wS,�. >z:. _ _ ".� .r�:'r ±,.,; ,T�Vi•4Jf:;d�';- ' i,} � � - ` v" - +r _•'r; �s� .� --r, i
a TYPE i' 'OF a WORK 4: ut'p •« E w' = t r,; Pw
;,�: � r r,3 - �_ _ � .. * z + .., : �`� .�:a,: = : 3 .';�. "�� ,1 .tta. SCHEDULE �� ,. ' � �=�,�� ' •r•s
�� r
meµ truction ❑ Demolition For special information use checklist.
Description I Qty. I Ea.
Ad / In e
ditin ateratio/replacen 0 Other: Total
r. t o t ` t i o T /replacement New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
t *, :,- °a„ CATEGORY .OF : CONSTRUCTION,-, ' ',.'''2', 14 ;.;, / ,T . : 1 ;:,.. : I SFR (1) bath 24920
El 1 -and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
w . s y y v Fire sprinkler ( ft.) Page 2
: < ='i" : ' " `JOB'. SITIIVFU N 'x u:,F ., 1 s ,.. r ' : sq. ) g
= „w ., . „ E k O _ ' AND ` LOC ATION.,;' a ', i
. _. __ � - . -- . ''=" ' ^ - " ,.. ; 1 ""'; :7 ;; Site utilities
Job site address: /3 sa) f eA) ,Z.4 de, e„ Catch basin or area drain 16.60
City / State/ZIP: / / ,Zej ePiZ 972-7.3 Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: Project name: , s / V; h 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
Storm sewer (no. linear ft.: ) 1 Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
. ,. ,D Absorption valve 16.60
„'
,' T ,' ; r ESCRIPTION', OF WORK . ; ..yz. > t . - 4 ,-;,, . 2 : ,
i? 4, Backflow preventer Page 2
.4 A is ,, iA ti9e ,- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
;, ;.4, t}PriOPERTY�;:OWNER, -•. - •; ',.;' 0 : TE N A NT fi ` ".x Drinking fountain 16.60
z. , • . ' -� '�`: Ejectors/sump 16.60
Name: .T M 9, J S/ f4 Ao
Expansion tank 16.60
Address: /3.59F S L 4e..A.tL ) L o Fixture /sewer cap 16.60
City /State/ZIP: / /,'•`.?��J 972-7-3 Floor drain/floor sink/hub 16.60
Phone: (.§j3 �Z _ (757 Fax: ( ) Garbage disposal 16.60
. - B- FPLICANT', Ia _CONTACT PERSON Hose bib 16.60
, _ Ice maker 16.60
Business name: r< , A �/ L / `� r
l Interceptor /grease trap 16.60
Contact name: .I.: (5 1 L Medical gas (value: $ ) Page 2
Address: Q D 6.,„ e 3 i Primer 16.60
City /State/ZIP: ��7L .4 /4) J / t� /T '57e) 6 Roof drain (commercial) 16.60
�,, 7/ Sink/basin/lavato ry 16.60
Phone: (�'ba) 7 p ' ee0�� Fax:: ( -72 J r' ► 74 Z o
7 Tub /shower /shower pan ' 16.60
E -mail:
Urinal 16.60
` . , •. % : ,'. - - "' . .-` _ : =CONTRACTOR <,
Water closet 16.60
Business name: t . �i L €�"D J � -.0d
� T w Water heater / 16.60
Address: TD 1 , „,,v i _ s _ 5 � Other:
City /State /ZIP : sp., f-- woe'D , D IL 970/i D4D , Subt
Minimum permit fee: $72.50
Phone: ax:
( 3 ) 37 4� ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: 324 16 1 j U i (o I Plumbing Lic. no.: ,3.-1,53 f t Plan review (25% of permit fee)
U State surcharge (8% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1'\ Building \Perm its \PLM - PermitApp.doc 17/30/05 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard -
Page 2 - Supplemental Information "' "
Fee Schedule: Residential Fire Suppression Systems:
-- w� - ; 'x;�m�!w,. ; . .� - ?.: .ca _'M:�>.,� "r�t °; �xa�x. °�,t,�s i�� ��,.�: ^g wa , >, - .,�. :,y•r - y ts7,�- >s•; , r F' °.v
:Site. UtilitleS i
„ ;' ` w s- -t:+ , ,:�; Qty., , T ° " Total s 6 t, p z $ � . a ”. ,
k.� . _ t � Square'�F,00tage �. �, li �Pea�nit� - Fee �����- ,.� -�� �.
Footing drain - I 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 e,. r•• -. - , ,
Valuation•- a= _ ,fr: 4 ;. ,,
Storm & Rain Drain - 1st 100' 55.00 " ; „ F.,,• ` s.r
$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.Iteiaii'C- '';x i •- N"� PQty .f '-" , ( ” " , {T otal., 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
$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: F �'"
°-4 ��PladiReview;`f Structures. °
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
= Quanti by (Fixtarc) Work Performed ❑ Any new commercial building.
11 = ?:,;,94,--,;,:°,;:. 0 _ ❑ Any new exterior plumbingsite utilities.
s
Fa turefType `f� � r' ==>' -�� �- ;���"` = � "` =`,. r Replace =g
- r Previous:. { Capped" ' Added ' ,u'.Eihtiug ° • ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions'to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" . Submit 2 sets of plans with any of the above.
Car Wash Drain i _. ` - , ,, ,,, .- sometnc or Riser D a ram' ,:,, ° ' -� x�
:f
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refig. Drains .. •
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory ` '
- Bradley . ,
- Commercial . .
- Service '
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this ermit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is \Building\Permits \PLM- PermitApp doc 07/06/05
CITY OF,TIGARD
,. s ,
BUILDING DIVISION PERMIT #: WT2006-10068
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/112006
Phone: (503) 639-4171 A i
Inspection Requests (24 Hrs.): (503) 639-4175 2
INSPECTION WORKSHEET FOR DATE: 6/19/2006 TIME: 7:05A1v1 PAGE: 29
SITE ADDRESS: 13599 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 026 TYPE OF USE:
PROJECT NAME: Si JOHN
DESCRIPTION: creating bathroom in crawispace.
OWNER: ST JOHN, JIM & BEV PHONE #: 503-6246Th?
CONTRACTOR: SUN/JANIE., RICHARD • PHONE #: 503-
Inspection Request Scheduled For: Date: 6119/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Me —le 104
299 Final inspection 031922-01 503-657-4556
Corrections/Comments/Instructions:
to i.iaim :I- ' ' teloil./C—S ° K..
•
elO ' II
PASS I I PARTIAL-APPROVAL 0 CANCEL n NO ACCESS
0 FAIL EI CALL FOR INSPECTION Ti ADDITIONAL FEES ASSESSED
Inspector: C.-HIT Date: 6 -/,. 0 6 Phone #: (503) 7182‘177
CITY OF_TIGARD
BUILDING DIVISION PERMIT #: MST200
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5//1/2006
Phone: (503) 639- 4171m���uyp��j�il�
Inspection Requests (24 Hrs.): (503) 639 -4175 =�
INSPECTION WORKSHEET FOR DATE: 6/19/2006 TIME: 7 :05AM PAGE: 26
,3�■ . IBC 1 3599 SW LAUREN LN
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 025 TYPE OF USE:
PROJECT NAME: Si JOHN
DESCRIPTION: creating bathroom in crawispace. .
OWNER: ST JOHN, JIM & I3EV PHONE #: 503 - 524 - -6757
CONTRACTOR: SIiANTEL, RICHARD PHONE #: 503'657 - 1960
Inspection Request Scheduled For: Date: 6/1 Pour Time:
Code # Inspection Description Confirm # Contact # Mes e
399 Plumbing final 031922 -04 503- 657 -4555 Y 184
Corrections /Comments /Instructions:
5 1 ii
•
ai -ASS ❑ PARTIAL - APPROVAL —I I CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: -1(-71- Date: / 'M O Phone #: (503) 718- Z-6 3z.
CITY OF.T.IGARD
BUILDING DIVISION - PERMIT #: tv1ST2006-10068
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 511/2006
Phone: (503) 639-4171 /41t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/19/2006 TIME: 705A1Y1 PAGE: 20
•
SITE ADDRESS: 13599 SW LAUREN LW CLASS OF WORK:
SUBDIVISION: HILL LOT #: 025 TYPE OF USE:
PROJECT NAME: ST JOHN
DESCRIPTION: creating bathroom in crawispace.
OWNER: ST JOHN, JIM & BEV PHONE #: 503-524-6757
CONTRACTOR: SlIvIANTEL, RICHARD PHONE #: Ma 6 . 57-1950
Inspection Request Scheduled For: Date: 609/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 031922-02 503-657-4555
Corrections/Comments/Instructions:
•
•
tg_EASS I- I PARTIAL APPROVAL CANCEL Li NO ACCESS
FAIL I I CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: Date: 19 0 Phone #: (503) 718-
CITY OF_TIGARD
BUILDING DIVISION PERMIT #: i ST2006-10068
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2006
Phone: (503) 639 -4171 /
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/19/2006 TIME: 7 :01AM PAGE: 0
A
%3ST`'
SITE ADDRESS: 13599 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 025 TYPE OF USE:
PROJECT NAME: ST JOHN
DESCRIPTION: creating bathroom in crawispace.
OWNER: ST JOHN, JIM & BEV PHONE #: 603.524-6757
CONTRACTOR: SIMANTEL, RICHARD PHONE #: 503667 - 1950
Inspection Request Scheduled For: Date: 5/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # M =�. _ • 120 Electrical rough -in 030165 -01 503-7N-60E14 ,011
p orrections /Comments /Instructions:
/
Zeal r i' C
/ /.JSpL� A -J
75 PASS . PARTIAL.AP_P_ROVAL_ . n CANCEL n NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 3r:/ • ° Phone #: (503) 718- 2.--
•
CITY OF TIGARD aU
BUILDING DIVISION PERMIT #: 2c —100
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ann 4lni i i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: S /5/06 TIME: PAGE:
SITE ADDRESS: (-35 S&.) £vRJ CLASS OF WORK:
SUBDIVISION: H e t > LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: Q . ( 0 Cp
OWNER: l � ` PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
4 1 A ,
61OF ./
(/)
•
‘PASS Ii PARTIAL APPROVAL - ❑ CANCEL ❑ NO ACCESS
FAIL ■ CAL FOR I SPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 7 / Date: / / 0 Phone #: (503) 718 - 04-z-3
CITY OF-TIGARD
BUILDING DIVISION PERMIT #: t'AST2006-10068
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: &1/2006
Phone: (503) 639-4171
„. .114 l
Inspection Requests (24 Hrs.): (503) 639-4175 '
r
INSPECTION WORKSHEET FOR DATE: 531912006 TIME: 7:01AM PAGE: 49
SITE ADDRESS: 13599 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 025 TYPE OF USE:
PROJECT NAME: ST JOHN
DESCRIPTION: Creating bathroom in cravvispace.
OWNER: ST JOHN, JIM & BEV PHONE #: 503-524-6757
CONTRACTOR: SIMANTEL, RICHARD PHONE.#: 503
Inspection Request Scheduled For: Date: 5/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # M- -
276 Framing 030166-01 503-7846084
Corrections/Comments/Instructions:
1-4( i•A el
Alatill Um 'AA.
p<1 1<■S$ PARTIALAPRROVAL CANCEL El NO ACCESS
FAIL fl CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: C- -4411: Date: S r:1 °7- --°6 Phone #: (503) 718-
•
CITY OFTIGARD
BUILDING DIVISION
/AL; PERMIT #: MST2006-10068
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/19/2006 TIME: 7:05AM PAGE:
SITE ADDRESS: 13599 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 025 TYPE OF USE:
PROJECT NAME: ST JOHN
DESCRIPTION: creating bathroom in crairolspace.
OWNER: ST JOHN, JIM & BEV 503-5246757
PHONE #:
CONTRACTOR: SIMANTEL, RICHARD PHONE #: 503
Inspection Request Scheduled For: Date: 6/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 031922-03 503-657-4555
Corrections /Comments/ Instructions:
•
,F5k)ASS I I PARTIAL-APPROVAL - fl CANCEL fl NO ACCESS
7 FAIL I I CALL FOR INSPECTION pi ADDITIONAL FEES ASSESSED
Inspector: Ciiir Date: 6 , M .e:76 Phone #: (503) 718-