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Permit
?I/7 9 / �� 4 s�ia& °� CITY OF TIG D MA TER PERMIT � ° 'a C OMMUNITY DEVELOPMENT Permit #: MST2009 -00158 . Date Issued: 07/21/2009 . I ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103BC07000 Jurisdiction: Tigard Site address: 12244 SW LANSDOWNE LN Subdivision: Lot: 0 Project: Millcallef Project Description: Add second story over garage, extend rear wall of garage out 5'. 9/18/09, adding service panel. BUILDING Floor Areas Required Setbacks Required Stones: 2 Bedrooms: First: sf Basement: sf Left: 5 Parking Spaces: Height: Bathrooms Second: 685 sf Garage: 103 sf Front: 20 Smoke Dwelling Units. 1 Third: sf Right: 5 Detectors: Total: sf Value: $87,212 00 Rear: 15 PLUMBING Sinks: 1 Water Closets: Washing Mach. 1 Laundry Trays: Rain Drain: Catch Basins: Lavatories Dishwashers: Floor Drains. Sewer Lines: SF Rain Other Fixtures: Tubs /Showers: Garbage Disp: Water Heaters: Water Lines. Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: Clothes Dryers: 1 Natural Gas Heat Pump N Hoods: Other Units: 1 Furn <100K: 1 Vents Woodstoves: Gas Outlets: F u rn> =100 K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 1 0 -200 amp: W/ Svc or Fdr: 5 Ea add] 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add'I Br Cir: 601 -1000 amp: 601 +amp- 1000v: 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY - SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All Other. N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) MICALLEF, VINCENT A & MARK DAWSON CONSTRUCTION LLC DEBORAH D 41290 SW SANDSTROM RD 12244 SW LANSDOWNE LN Gaston, OR 97119 TIGARD, OR 97223 PHONE: PHONE 503 -805 -0814 FAX: 503- 357 -9590 Total Fees: $2,302.75 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules —are set forth in OAR 95 01 -0010 through O • R • - I k 1 -010' You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.81. 2.2344. etf 0 i ,i I sued By: Permittee Signature: /`—! „ CITY OF TIGARD MASTER PERMIT ' - 2 - COMMUNITY DEVELOPMENT Permit #: MST2009-00158 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009 Parcel: 2S103BC07000 Jurisdiction: Tigard Site address: 12244 SW LANSDOWNE LN Subdivision: Lot: 0 Project: Millcallef Project Description: Add second story over garage, extend rear wall of garage out 5'. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: First: sf Basement: sf Left: 5 Parking Spaces: Height: Bathrooms: Second: 685 sf Garage: 103 sf Front: 20 Smoke Dwelling Units: 1 Third: sf Right: 5 Detectors: Total: sf Value: $87,212.00 Rear: 15 PLUMBING Sinks 1 Water Closets: Washing Mach: 1 Laundry Trays: Rain Drain: Catch Basins: Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures Tubs /Showers: Garbage Disp. Water Heaters: Water Lines: Drains: Bckflw Prevntr: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: Other Units: 1 Furn <100K: 1 Vents: Woodstoves: Gas Outlets: Furn > =100K: ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr: Ea add'I 500 sf: 20 1 -400 amp: 201 -400 amp: 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 401 -600 amp: Ea add' Br Cir. 601 -1000 amp. 601 +amp -1000v 1000 +amp /volt: ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: N Other: N Other Description: p g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) MICALLEF, VINCENT A & MARK DAWSON CONSTRUCTION LLC DEBORAH D 41290 SW SANDSTROM RD 12244 SW LANSDOWNE LN Gaston, OR 97119 TIGARD, OR 97223 PHONE: PHONE: 503- 805 -0814 FAX: 503 - 357 -9590 Total Fees: $2,212.81 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules - - •rth in OAR 952 - 001 -0010 throu• h OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.33 - 344. - — — — — -- — ` i- - Issued By. ■ t . _ ( J \� �l �_� ♦ Permittee Signature: /L'✓ / Building Permit Application Residential RE(,BATED • FOR OFFICE USE ONLY City of Tigard 1 1 Permit No.: ° 131 Received SW Hall Blvd., Tigard, 612.) V009 P lan R ie �j �f1 �/ 0 ` Phone: 503.639.4171 Fax: 503.598.19 pRD D : P: JIVE ® o Other Permit: T 1 GA R D Inspection Line: 503.639.4 ' QF N Date Read y: 1uris: ® See Page 2 for Internet: www.tigard- or.gov DING DN lSi0 Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: 1- 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 2- family dwelling ❑ Commercial/industrial Valuation: $87,212.35 ❑ Accessory building ❑ Multi - family Number of bedrooms: 0 ❑ Master builder ❑ Other: Number of bathrooms: 0 JOB: SITE INFORMATION AND LOCATION • Total number of floors: 2 Job site address: 12244 SW Lansdowne Ln New dwelling area: 685 s are feet City/State /ZIP: Tigard, Oregon Garage /carport area: _wi Js quare feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: 121" Tippitt Lansdowne - Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the • DESCRIPTION OF. WORK work indicated on this application. Additioin over garage Valuation: $ Existing building area: square feet New building area: square feet PROPERTY _OWNER ❑ TENANT Number of stories: Name: Vince and Deb Micallef Type of construction: Address: 12244 SW Landsdowne Ln Occupancy groups: City /State /ZIP: Tigard, Oregon Existing: Phone: (503)887 -3456 Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON NOTICE Business name: Mark Dawson Construction LLC All contractors and subcontractors are required to be Contact name: Mark licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: sbdawson @att.net CONTRACTOR Business name: Mark Dawson Construction LLC BUILDING PERMIT FEES* Address: 41290 SW Sandstrom Rd (Please refer*, fee schedule) City/State/ZIP: Gaston, Or 97119 Structural plan review fee (or deposit): FLS plan review fee (if applicable): Phone: (503) 8-5 -0814 Fax: (503) 357 -9590 CCB lie.: 187209 Total fees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Mark Dawson Date: 7 -16-09 * Fee methodology set by Tri-County Building Industry Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) a 0 • 8 e , Wuii Permit Application Residential i . FOR OF I ICE 1 S ONt 1` . City of Tigard :ncx Received n / Q t ;t F. , , , u, , Date/By 7 At e 9 Permit No.: �T�l6 / _ &)0151 114 ® 13125 SW Hall Blvd., Tigard, OR- 97223" " Plan Review B Phone: 503.639.4171 Fax: 503.598.1960 , :ss`, Date/By: Other Permit: • Inspection Line: 503.639.4175": s "'' 13. ! ` " t a Ready /By: ® See Page 2 for TI :a '`-'' ,., . , ,"; Date ateRead B luri ' : Internet: www.tl and -or. o � yi . ' ` " = - N /M : /'1 Supplemental laformation ._. .. ' g g ,.t "r „. _ ' ,c4 TYPE OF WORK REQUIRED DATA: 1- 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. Z 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $87,212.35 ❑ Accessory building ❑ Multi- family Number of bedrooms: 0 ❑ Master builder ❑ Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 12244 SW Lansdowne Ln New dwelling area: 685 s are feet City/State /ZIP: Tigard, Oregon Garage /carport area: 10, Aquare feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: 121 Tippitt Lansdowne Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Additioin over garage I r 11 � J es� , J o r,. J e a a Valuation: $ Ac e-4.. Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT" Number of stories: Name: Vince and Deb Micallef Type of construction: Address: 12244 SW Landsdowne Ln Occupancy groups: City /State /ZIP: Tigard, Oregon Existing: Phone: (503)887 -3456 Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON NOTICE Business name: Mark Dawson Construction LLC All contractors and subcontractors are required to be Contact name: Mark licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State/ZIP: . apply: Phone: ( ) Fax:: ( ) E -mail: sbdawson@att.net CONTRACTOR Business name: Mark Dawson Construction LLC BUILDING PERMIT FEES* Address: 41290 SW Sandstrom Rd (Please refer to fee schedule) Structural plan review fee (or deposit): City/State /ZIP: Gaston, Or 97119 FLS plan review fee (if applicable): Phone: (503) 8-5-0814 Fax: (503) 357 -9590 CCB lie.: 187209 Total fees due upon application: --- - ---� Amount received: Authorized signature: v _ ° _ - ..„ r ' � This permit application expires if a permit is not obtained � within 180 days after it has been accepted as complete. Print name: Mark Dawson Date: 7 -16-09 * Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Petmits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02 /COM/WEB) .: Plumbing Permit Application Building Fixtures FOR OFFICE USE CiNI City of Tigard Received PermltN 1 n 13125 SW Hall Blvd., Tigard, OR 97223 Date /By. ti T lJ / 9 g Pl Phone: 503.639.4171 Fax: 503.598.1960 D an Review r. ateBy. Other Permit No.: Inspection Line: 503.639.4175 • TI GARD Date Ready By: funs El See Page 2 for Internet' www.tigard - gov Notified/Method Supplemental Information -, £ *.,,5•r. •al ..;`i ' ^%'. rT r: r ":o' -. -_ x.t.'.:. �, <...;.. w° N.. - ^':. - _ _ _ �_:f . K' .....�, " `n,�S '.s' ". u ' x b.Sa� , ; <' i rc,6'n.Yi: ...., + r h:Aa r �` "' a ", *.`,.:s- : *.1. -; ^,-s fir..: "�' '. v :, a:` s +4 ;v,;r.` =r z - :?v e:..z _',' .,,s'''''r.«.;r�was "'=:_s 'n* bs�',;. . �: , 2 :. p r }� F `1' Ry�,c'h.,e'- ' 7 ' P' i t ., "rr.*,�, <'� '4=»4 ''Y� 4 k' ``! ,a -:' ^. °� P :S. a l' C E OPf�z' ±.+ <`ti 2� '" { �} ? , d ^ '1 ,,:,, s ' S,.� L - 1 T . _ �; , - � .,� �p r`+ �, � , ._ :��'.,���� > ra � ''t� , � � _'r�ra�r N � ' ���r FETE S �,, , � . ,:- � ' '�: 3.,H,..:- ,- .....,.�� :�.r� .,max, ;.... b .. "��;: �: >.m.,._ . �...:+�, ,...........H ,. � �� < •��....: - � s� ; ?,.,� �= < ❑ New construction ❑Demolition For special information use checklist Description Qty. Ea. 1 Total p -- Addition/alteration/replacement ❑ Other: Ps. M, yWn __ s _ v jai }v New 1 - 2- family dwellings (includes 100 ft. for each utility connection) V t �..( :, °sf ` C GORY OF CQNSTBUCTI©N : f " , _,^ " 05 7 SFR (1) bath 249.20 172'1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: ,, °;'; >.,..:,;: ":. -.; ,' ,..:x - =F- , ,s,. ;Y= - ,.,_•= ...,.:n,:r Fire sprinkler ( sq. ft.) Page 2 V 4m ..- JOB S1 r6ii suo1S �D LOGAT1ON `' . ,� ' Site u tili t i es Job site address: /a 4/ „5 zif_Al5 Le„ &9Nfi Catch basin or area drain 16.60 City /State /ZIP: 6 4 2: � Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 1 10.00 Cross street/directions to job site: / al 2 �7712 Lfh34 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.• ) Page 2 Subdivision: l Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item ovvy ::''' ."a:.., ;:as , : ri:«. "#,.»3,,`.' 'a`i ;.'-rw ,^;,ka E.t!:v�m::,*::' -».,.,, :�?,. M �:> -- "- e;,a,:=:., y Absorption valve 16.60 ,, 4- :, �x, 4 * D SCRIPTIO,jOF.,W " RK r1` R` Backflow preven ter Page 2 /)B't /eft sH/Z. _2>le. mr / i - "7 / Backwater valve 16.60 Clothes washer / 16.60 /10,6O Dishwasher 16.60 "` PR OWNER,� �� � I .A t'a ®TENANT 'x # Drinking fountain 16.60 ���� Ejectors /sump 16.60 Name: /i` Z c--..„2_ 9�- D � /i(r' eff CL t= /- Expansion tank 16 60 Address: /02,a 9 q . AA) 5 D64_6/40... L.4 ti - Fixture /sewer cap 16.60 City /State /ZIP: 77 6111Z; Floor drain /floor sink/hub 16.60 Phone: (� T)3) $g 7 - 3 y (, Fax: ( ) Garbage disposal 16.60 5 r >;: rri, a '. :,: j ,';:? ' .;: ,: ,,..g . ,... ,.. ' : A� Hose bib V �I'LLGAl�1�T � ,CONTAC'�T 16.60 �^ Ice maker 16.60 Business name: A� ,�_ . (K �J 50.6 ( -7 , ,, -t ( /�!� I11 C Interceptor /grease trap 16.60 Contact name: M c . Medical gas (value $ ) Page 2 Address: 1 / / z` 0 ./ 5a-vl j .5 r /2_d_ l C Primer 16.60 City /State /ZIP: 4 ` t� _ 572) /9 Roof drain (commercial) 16.60 Sink/basin /lavatory j 16.60 � / Phone: (.. 933 ) ac A I II Fax:: (5 ()5 3 7' � �Co' Tub /shower /shower pan 16.60 E - mail: S / a 5erv>, &t A Urinal 16.60 7T ; 1 'V *C rr -.r -� TAP Si , NT1i CTO ` ` A MS °` ` i Water closet 16.60 Business name: ray ,g.,. pl t c ,U ! Water heater 16.60 Address: �/ 7 J C / 7 E 3J pie ce ,Di i.J / Other: City /State /ZIP: Subtotal 33, ZO ���� ����' �Z f // ( Minimum permit fee: $72.50 Phone: (5Dy ) 35 36 co f--.:6-V/ 61)13 - 70'- yy 33 Residential backflow minimum permit fee: $36 25 72: CCB Lic. :4-0 a - / _ Plumbing Lic. no.: 3 y -q e Plan review (25% of permit fee) Y° - -- State of permit fee) . g,10 Authorized signature: TOTAL PERMIT FEE . )q� i 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: \ BuildingWermits\PLMF- PermitApp. doc 12/27/06 440- 46 16T(1 0 /02 /COM/WEB) 5 I 2- Plumbing Permit Application - City of Tigard �► Page 2 - Supplemental Information Fee Schedule• : Residential Fire Suppression Systems: , 7.Y K x S'1te Ut111'tIQS Qty fee (ea) r ,Total r r 1 SgiiareiFootage Nr ° Pe ±ee tntt _ , Footing drain - 1' 100' 55.00 0 to 2,000 $11 5.00 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 Water Service - each additional 100' 46.40 Medical Gas Systems: Storm & Rain Drain - 1st 100' 55.00 aYluationit ,_;� „� Permit ee s „ ;z Pg .�... c,: $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 ' Qty0 Fee(ea) 1 Total: , additional $100.00 or fraction thereof, to and :F1X 112' Or Iteill . - it:12 x. *,gw.: - ,. ,ems :.._: 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. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1 20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: ><al Fix <_`; „Pia _.xReviewfor tPlumbIng I sPIIA:tions Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed ,��g�ni ,„��. QuantttYbyr (Ftxture)�VorkPerformed: Fixture,T�pe �� �;7� ��� PRepl9cerr engineer. t Capped dried zt`shng " ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic, ,,,,.. -„ Drinking Fountain 1.AIILVA4043t4 SQIIlC T1C QC TSe la. r, „ ,, s Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i \Buddmg\Permrts\PLM- PermitApp doe 12/27/06 . , . .. -07/22/2009 15:04 5033579590 MARK SHARON DAWSON PAGE 01 . . Plumbing Permit Application RECEIVE . . Building Fixtures r • v L.....1 V L i poi:, oFFIct: FsE • . City of Tigard • 3125 SW Ha 17a , . . Permit No.: ng " 2(7:)1, I • Phone: . COI al 1il Slvd., Tigard, OR 9'7223 JUL 2 2 2009 ..„,... „.._ ...... \ _.) IN 503.639.4171 Fax: 503.598.1960 Plan Review -.1" aaraPcmnNo.: . .1.1,...;;ii.to IntInspection rnet Line: 503.639.4175 ' CI I Y OF TIGARD D !'.'''': _„..._., „„- Date Ruady/By• milA: 1Z1 Sc c Pagc 2 for - e: wwl.v.tigard-or.gov Mil 10.: D s I.. Notif ed/Nkthed: Supplemental Information -:k":::::, • : ' :::"1... ..:! : 0 1 gg i in ; i -: :#00 . ?' , '::......... : :! : ',": , : , ':';. ' Ji:...: ; ':;: : : . . - fl New construction 7 0 Demohtion For special information use checklist . .-_ ..._ . 1 ,,ix ddi [ion/ _. Description alteration/replacement 0 Other: New 1.. 2-family dwellings (i I qty 1 Ea Total ncludes 100 ft lot each utility connection) 1§§:O.?**l.$i SFR ( bath 24920 ... _ ----- ,..- lki- and 2-family dwelIin I Li Commercial/industrial SFR (2) bath 350 00 --- -,„. 0 Accessory building C] Multi-family SFR (3) bath 395t.00 --- 0 Master, builder El Other Each additional bath/kitchen 45.00 : Page 2 Fire sprinkler ( sq. ft.) V=WiY,..N.l.nigig4.41010i -- ,7---. ' :• ..,.. :),.i.121,7M7_21; 4' ',,' .:'.."' ', , .■. ,. . 2 :•;..',. .;:. '';:; 2: Site Oil iej es __...-----,--. Jub site address: /..Z g «4/ -- , CL' L 4,,,to s7 , 4 _,- 4 -_,,,,,.. 4 ),2, c .,..c: .a 1,1) basin or area drain 16.60 ----- city/Slate/ZIP: - 7, g-D 1 7 - - . 2'.. IDiywell, each line, or trench drain 16.60 ----------------- toting drain (no. linear ft ) Page 2 Suite/bIdgiapt. no.: Project name. • ------ - • - '''' ' Manufactured home utilities 110 00 Cross street/directions to job site: . (4 4 ) 5 A, z2) , ‘ , , , r , manhoit; ..._,_ 16.60 1 . Rain drain connector 16.60 ,-- . Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no lineal ft.: ) Page 2 Subdivision Lot no.: Water service (no. linear fl. • ) Page 2 : - _ Fixture or Item - r ax map/parcelno: • ,,,„,,, .. ..„ .„.,, ..,,.. ,,,,, Absorption valve II 16.60 :I : ,..,‘,?, , ....,:..„, ,,,..,.. .,,,...,. ,..,.. „.„,..,...4..:,..,,„,,,,,A.:;,,,,,,,,,.,,.,...,,,,,,,,.. ,.,,,,,.. Backflow preveliter Page 2 41/0511 f ;. /t. -)(-.. '414724/34_,_ a aCkwatcr valve 16 60 Clothes washer 16 60 /6-. __ .......... Dishwasher 16.60 - - . - 16.60 .' 2 ' ..77 ' 7.77 ' '' ' ' 411 f'': 2 1, Drinking fountain --- 16,60 ._ .. Name: I/ t . 4 k c.„._ , 1) 4:: / .:4 : 7;. ‹ . ( -i. ( 4, t,-._: /L.- E:xparis ion tank 16.60 ._ .- Address: / /-/ Z../ ja -,...) - ,, 4././zi& Fixture/sewer cap „..,- 16.60 --..2 Floor drain/floor sink/hub 16,60 City/State/ZIP: 77 6/bz:;) Z)X --_,... ..,_ ..._ , ' ----- drain/ Garbage disposal 16.60 Phone: (6c:13) S'e• 7 - 3>. if . Fax: (' ) - „. I-lose bib 16.60 '....3 Y. ' ': ;;','.' ..t■I''' 630.. itovr: a : ■.' "Sii - ,..,',2: , 'I'::2 - ..,.,0W .7.k ;' '' 4 ' ' . 2 :'''''''''' ''' " ' ' ' '''''''' '''' . '''' Ice maker . 16,60 business name: / 419,4_ . Diii. LL' 5. ( • , / ei, 1660 _ Interceptor/grease trap Contact name,. ) 44 ) .1. i.z_4 Medical gas (value: S ) NMI . Address: q 1 .:zio --Q.) r).-.1 J -,--/- ic--16-rc 27) .......___ Primer , ..,.,...... 16.60 -., Roof drain (commercial) 16,60 City/State/ZIP: ‘,/:" ,,., x i t , ., 5: .,... ...,„ ........._ _,--- .--- -- Sink/basin/lavatory l 16.60 /6,, e fl p hcmc: (.5 ) g e-,..g i 1 i Fox: ; (5 '" ' - --- Tub/shower/shower pan 16.60 ___..._., E S' Ld_ 4e25_ (;) 0.17 -. Urinal 16.60 77 : 7 .7:ll'',:•. ,,, ... 1 : 7 ^.': : .% . , - ;. , ;;: l . , ..i.,; . ;;;::: : '; .. , , l'edg.Wi6i,e0C4..l.T.'. ,7 •''..'' , ' , WW.::! .., •.:',',..',.....: . ::'l, , ;■g r !:l,k1 , ..' wate„),,,et 16.60 Business name: - 3" --- --7 /?< d -r- 4 ....,,./ ;(7- , :..(j_.<, watel heater 16.60 . w. --s / Other: Address: ' g .3- „,, 5:- en/ t ''/.7 . ,i LA? C..1. - - -- Subtotal . 3S, 2.6 City/State/ZIP: /1: C 2 - , /z.,577/,* _ __... _ Minimum permit fee: $72.50 Phone: (i ) 367- AI CC- 4; ‘ -47 c4V/6V3 -• 74.) - ' y' 3.3) _ backflow minimum permit fee: $36.25 74 -" Plan review (25% of permit foe) , CD Lic.•. - ) 4 9' 57 __......... lurnbing Lie. 1, 0.: 3 Li'-'06'Pe ."" - -, state surcharge (12% of permit fcc) g, /0 a..,: s. Print !la ....., Authorized si I e• • ' __ TOTA PERMIT FEE . r - O a t e TOTAL 'This permit application expires if a permit is not obtained within . ' Xit .,,,,, I f _, ,.. _ „......__ 180 clays after it has been accepted as complete. 'Fcc methodology set by 'Tri-County Building Industry Service Board 175..1616TO 0/92/CONVWFB) 8' 0 ..,..„„„..rmits)PLMF.Pr.■m■tApp doc ' .., 7/06 i .z~. . 'Mechanical Permit Application FOR OFFICE USE ONLY El City of Tigard Received Permit No `7 Date /By: 44 , oz., - UZl f 5 c 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit. Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information p TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction Addition /alteration/replacement Mechanical permit fees" are based on the value of the work 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* I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling / Air conditioning or heat pump Job site address: / o2a ye/ b'. CANS ,tee t(AAle__ . (requires site plan showing placement) I 14.00 / V City /State /ZIP: r Furnace 100,000 BTU (ducts /vents) 14.00 /'f Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 0 /.2 /1... ! L4�52 '4t) - R 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue /vent for any of above 6.80 G ib'D Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 /✓)GiJ ri112. A(4 L. .E /0,5.!!J X it&j7 Sa 21,c &4) Flue vent for water heater or gas fireplace 10.00 DCt 67afrevz. k., Log lighter (gas) 10.00 Wood/pellet stove 10.00 • Wood fireplace /insert 10.00 ❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00 Other: 10.00 Name: Vli1l LE- cy-- 27 3 �Z C L E / Environmental exhaust and ventilation Range hood/other kitchen Address: / 2 Z efi/ 5 LR /) p z4 A) L equipment 10.00 City /State /ZIP: y G, >z - � ) Clothes dryer exhaust 10.00 AO / J Single -duct exhaust (bathrooms, Phone: (60) 6 3 y5 Fax: ( ) toilet compartments, utility rooms) 6.80 ® APPLICANT ❑ CONTACT PERSON' Attic /crawlspace fans 10.00 Other: 10.00 Business name: M K-_ D 4d5c9 A .. 7 . / C_ Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: je� JA 13it d �,�tg2z ' ,aif) LLC Clothes dryer (gas) Other: Address: L// t 2 -5l..t, 5/4.11 D h�2iy--t( AD MECHANICAL PERMIT FEES* City /State /ZIP: X/4 S j ,,„ f /2/ / , Subtotal _444-61. p � Minimum permit fee ($72.50) 72, so Phone: (5D $ 05 _ D 4, Fax: (60 357 - 7,6--D � _ . _ _Plan.review-(25 %.of.permit fee). /ff. /3 CCB lic.: /Y 9 R a 7 l State surcharge (12% of permit fee) g. yap i � ! i / TOTAL PERMIT FEE -wj; Authorized signature: /,24e. This permit application expires if a permit is not obtained within n 180 180 days after it has been accepted as complete. Print name: /y� D , z J Date: t- /G w * Fee methodology set by Tri- County Building Industry Service Board 1 zd L\Building�Permits�MEC- PermitApp.doc 01/19/07 440- 4617T(11/02/COM/WEB) � f , 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. • $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • • 1:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2 • 4';. ' . S..11 5 I 5 09 10:55a Leann Gre,ason. 503-359-1981 p.1 - ,p`p,otiy,10, , a, , ,:s ., E,001 , :.):,4; , ,,.-,,,-:::.; , :. ,, :.. ,- •; , . , ..: , ,, , ;•.?,,,,,..,,::',•:,, ; • ::,,,.:, ,.;:::,),-,,, - Renal Ved ' ''''''-',.; •"''• .,., Caty of Tigard DucfRy Perini! f42.20 7 f 55( :- ,' 13125 SW Hall Blvd., Tivlio, OR 97223 Plan Review --1 I ether Permit: '4*_•: Phone: 503.639.4171 Fax: 51)3.598.1960 Das . teepee/ion Lane: 503.639.4175 NE; Reedy/Br 1 turiv 1 RS See. rage2 for ..:: Internet www.tigiad NotifisiAletbea.: I I Supplemental ixtformumiart ,- '-1'''. , - - 1 ;*:t.';-:-7-' , 1: - .:- -- -:: '... •,•:'•:'.::;;:z:: : • ' • • - - • ' 7 . - 7 9- ' 7- 7 ...:"77..': - .!•• "!"/ r.".77,..r-17,-.7 ,.. ,, .. „..,„ ..,--7-esp....777.7-. ”. , 7-77,.,..,.. : ' , .1:.!,: : ' 1 .. ... ' ,: • i' '.', r...', •'.. , - .T , letr OF. WORK' ; ; '; . : - ; - : . .. : : ; . • - -.; : : PLAN Rtylatlii::;: .•;,: .: . ., - . ' ;: : : - - , 3 New construction 0 Addidonialteratiordreplacresnent Pica= cheek all dm apply tsabmit a set; if plans w(iteim avd betow7: 0 SONIC ecinlidef 401) min or more EZIPAuRficn ovultm sucks. 3 Demolition 0 Other %vitae the available; tea cumin 0 Ma l= and WM/ .K .: '',.'-,,,' .'''..:.'''''.'-' /;Eb -'. t 6 i - .- .;•:":1 - 7 oreseds 16,096 asps at 15D vo4ts or El floating buildings, icis te FANISII„ crr exceeds 14,000 0 Cal-use agricultural 1 31- and 2-family dwelling [3 Conmercialfindustrial 0 Ace-esti:pry, building mice *Tall oast insadlattons. buildings. 3 Ivluiti-farnily 0 tvlaster builder 0 Other: 0 Fire peso. 0 Insiallatinn if KVA or huger separately derived sysicro. -;-'-'*'.. h ' - ` ' ' ' ibiti - .drg 7 iktottNiki - thi4 •;, i:;cickt • " . Di E'e-i?SlY 5./14tRL ouomencY. 3ii no.: 7 site addr=s: \-*"..-' ... \--\\:\ C.: \z, .,,e- v...\,..,_ "/°1 cg a°°re • -_---._ \i .'. " 0 5i/C OT Marl: imidonial units, ri Reacational vehiaz parks 0 F i a t t e r r a r e facilities. 0 Y o or more tan ity/Staite/ZIP: '''' N.., , `,.--,‘%, .•-••••="■--*`'.'":::\ '-)- \ ‘- ., ' 13FlaZardbuS lamina. 600 wits ix schnil. uitcfbldglapt. no.: 1 huject name: °Service or *Wel WO eines or must. — — ; . • ::... ' i.. ; - -• - le'E SellEfIVIW ::',...,'.".:" :rims save/directions to job site: ceirser, __, t771. Fre. I rout 7 New resIdesi sinAVe- or meiti-famOy dinning unit. fineleules attached garage. . ohdivn: Thot no.: 1,000 r.q. it. or less 145.1T-- U --- I s2: 00 sq. 11. or por tion 33.40 ap -- , ox map/panel no.: Li I mited energy, retitteritizi 75.00 1 2 .._,,, . _ ...._ .. • --- 1 1 Litotes/ ;mug); niniti-faatily 71 00 2 ..Si _ 1 itsiihintie1 (wit ft h above sq. .) ' • — • ..Seritts or feeders installatisti alteration, aiiiter relocation 200 snips or lets 80.30 ; 2 .. 0-PROPERTY...OWNER; • • - 7 . • • • 0 TENAN 1 - 201 amps to 400 artlin 106.85 2 • f 401 amps to 60 amps III it4.60 2 ;air.e:_:\„„...•)7.1;;;;c-y \ '`` , .:;;\.„>„::"..._c;-.1 . -_,■"‘ , „,"=:;,' (- lc. • - 601 amps to 1,000 L arrips 1 ' 240.60 1 2 -----L-- —.—... tddrts•t• \ ---- ---..,,,■■•■,,, S \ s..— \-...)." S N -• '-',..., Over L000 sows or wits I : 454.65 2 • "-------- Temporary services or feeders insaillados„ alteration, and/or itylStaleJZIP: -- ` - :;: - Nr; , ;-i, - t \ C& ` \ 7%.'.,.;_. . Indication hoe= ( ) — Fox: ( ) / 2 arms or leng _ i I 66.85 1 1 1 I 2 iwnex in.11ation: This hmitation is being made on property th at I own whici 201 ams to 400 rans 10030 vis not — . !tended for sale, lee, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 590 Trips i 133.75 1 2 new. alteration., or extension. . r Oef iwner Signature: pat= -------- A. Fee tb 1 7.7".7.7. 0 .1 i.Pliiirit19T - -77":7- - r -7 .." 1:3 .. ' - aloave service or feeder fee 1 6.65 2 each branch circuit 11! " `. ' ‘""c••‘ \ s-i- \, ..S.Z....., • FoiirrWianch s..s...„ — • -- 1 -- witraera sesvice at feedes fee, li\ 4CM ,, 2 •• 4 01 name: Oli...9. \,,.....,s•-•.,c.:.•*..„ (---",..r--->r--z<-7---- . fiat brands circuit Ea& add't branch circuit 1,- 6 - 43- 1):,`•c:•'-ti• - : 2 Otiress: ' 1: cZ',.,.. "..;;...1-.„, 7),.--,‘..-). 1 fritsceits sisr vice oi .......... 4 ... reede riot inctudixt ity/Staie$7jP: , , ,..; 1 .,_ , , 's; .- — Each aturouracturcd or triodukir ewe inz anclior feedes 9°"" 2 ,- hme' 1 . -- :'§z•) - 74 `---?-:.....- .7.'...,-- C'.'s _I ra*: : ( ) . Reconnect cody 6 1.111 615 111111111 2 -4 -- -mai : , Pump or irrigation the MI 53.40 2 .i:;. . .:';2`".• : ::••:;!;"::::•;:.:;,,::: : :- • :'-'?;;::" --" •-'' '• : -. - , .. - . - --- ' - . - i siP or CPalbn lighling 53A0 f 2 --- 5ignal circuitts) or Inotteei- • ; usiriss =MC: A8cj Electric 1 entrgy pima aiteration, or _.._ &is tt.s,..: PO Box 330 , extension. Describe: Page 2 -1; .... -------- --;- 1 ivy/State/ZIP: Forest Grove, OR 97116 Each additiona hispeetion over allowable i®' atapsf theTahove 1 62.50 T --- ;iTeTiiiY;;;;:/ii".W --------------------- F;;;()iii:T;717 ----------------- ] zrzm • 62.50 ----- --- Cli Lie.: 959 Eiectrics Lc: 34 --- FS'ivrv. Lie.: 50558 I Indus:AS Am per hoer - 73.75 j • — ;.„ :; - .. 114..telnitIGAV ta.10/Veptrglgt • --.•:!:.:.'::;-•:•,::: uprv. Electriciar signature. required: '''''' ------- ( - 1 ..3 ,,..-1_4 „. %_ . Stibnite: ...............-. .,_ .... 1117111111 lint name: Tony Wilson -..--L— -- Plan review (25% o n f perrit fin): Stele sun:huge (12°Ai of penult fee): A. ; ,uthorized signature: i 1 TOTAL PERMIT FEE: -.-, r---- e.;.;_'■ , ,Lz, TM": patina application amplres if a pert:alit Co net cbtaimsl t;ithia ISO tint narnc: Date: drys after it has been icaepted ats coalipletc. ------ • %actor inaectiera Alowc per permit. ------ 3AdVrenoilltELC-PaitilApp OUZO% — -- - - - — • — - 440;4615T(Il/05/CDOWifir - c 1 --- -,............. ,4) , , 2300 E. C - , ,-.., ,-, , , 1 -. 9 t . . & ___,______________________----- . \-------- ----- , 12244 SW LANSDOWN _As\,=. . u . . -, 0 __________----------- - \oc.Po: ,,. ., UJA51-1INGTON COUNTY . . , PROPERT'r ID LIJ202L 4 . , STATE ID 2510360 0000 • = I 4 V ; ALT ACCT. R20102'S4 , • / gi I it . , PROPERT'i AREA = ?.„0:3 SO g id ' i ........................................ ------- -w t y lai • - -. .,‘ \ ExIST. I-i01 AREA = .,.--- _. S -ii- ., 4 7 ... ' . VAIt. S" 4 , _ • , ii.• ., .7" ADDITION AREA = 100 SO . ; NEW FOOTPRINT = 1,a SO, v..- 1 ., .. : , • ................ . „ RATIO BUILDING/pRoF. C■ 0) ..1- ....................... _ ... , / 1 1 . ."/// .. 1; /// , - / , i, .• , / ....-: „....,uT , c 'r c " --- i . . . . 11 t .:, \ : NM AREA OF ADDI7ON '71 I a k . . • u ; ._, . ' A ________H I / AREA OF NEW ROO= . „.-= •: '. ,__.. 1100 ,_ 6 e.. . \ 10 , 6 a . . ‘ i , - II WililiiMlil . . DIRIVEUJA.I' - .l, _ 1 PL \ '/IEw , . . i SC-LE : I” I: 20' -0' „ . 1 II, _., . _ _ _. b 1 ...._ . 04' ' ,,--- s-,,— () (i o o 1,,r . f .r. SIDEWALK , < 0 , Zeio ,..9 3 u. ot z :.J u-i i u 6- 0 2 LU ,::' ■ li ji f 0 1 s,J L4\57)0\= L A \ = z .., ..., _,....... .... • •■•-•161•14 SHEET HO. 4. = • II • ____ . ____.. .__ . ... l'i . • a , CITY OF TIGARD - SITE PLAN REVIEW l l � BUILDING PERMIT NO.: H hr -4l I 5 PLANNING DIVISION: Required Setb ks: [at Approved ❑ Not Approved Side: P Street Side: /' Front. rage: Rear: , l Visual Clearance: �Ap .roved ❑ Not Approved Maximum Building Height feet CWS Service Provider Letter Required: ❑ Yes ❑ No y ❑ Received ft. • ,✓� 'r Date: 1(9-1 / ENGINEERING DEPARTMENT: Actual Slope: ❑ Approved ❑ Not Approved Site Plan: ❑ Approved ❑ Not Approved By: Date: Notes: CITY OF TIGARD - SITE PLAN REVIEW • BUILDING PERMIT NO: 1`f h rg,9 -67 t' /5 ' Street Trees: 0 Approved ❑ Not Approved Protected Trees: ❑ Approved ❑ Not Approved By: Date: Notes: