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Permit
4 w V 'i I. ,.. 1 A . CITY OF TI GAD MASTER PERMIT PERMIT #: MST2005 -00014 1 DEVELOPMENT SERVICES DATE ISSUED: 1/13/2005 '�I P. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 13655 SW MOUNTAIN RIDGE CT PARCEL: 2S109BA -00900 SUBDIVISION: THREE MOUNTAINS ESTATES ZONING: R - BLOCK: LOT: 017 JURISDICTION: TIG REMARKS: Complete unfinished lower level. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: 1,225 sf ' LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THRO: sf RIGHT: VALUE: 8 OCCUPANCY GRP: R3 BDRM: 3 BATH: 1 TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 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 < 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 SVOFDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 4.00 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: $ 510.69 BRUNKE, JOHN H /ANGELA M OWNER This permit is subject to the regulations contained in the SW MOUNTAIN RIDGE CT Tigard Municipal Code, State of OR. Specialty Codes 13655 13655 S , OR 97224 and all other applicable laws. 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 the work is suspended for more than 180 days. Phone: 503 - 590 - 7581 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Electrical Final Mechanical Final Plumb Final Final inspection . i � Issue By : h / I,_ O_JL.;_) _ / Permittee Signature : r , L _ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed , 'next business day . .-. Building Permit Application , FOR OFFICE USE ONLY City of Tigard Date/B : I �dS Permit No.: j11I 'D so/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 G i Date/B Other Permit: Inspection Line: 503.639.4175 ! y► " I I 1 Date Ready/By: Fir/1 ® See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: ((Q 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 53 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY, OF CONSTRUCTION work indicated on this application. Valuation: $ G ( q ® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: • ' ,. • ' JOB SITE INFORMATION AND LOCATION �,: �.;:,, ;;.,_... ,^ . , ; . ,- ,: Total number of floors: Job site address: (3 A S S N .4.) S dot ou•lv.4eLt•.., p. td y . LT New dwelling area: I sl . IS square feet City/State/ZIP: \ r` Q. 0 q- 2.2_11 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet °✓ it Ali- gd -4u (3 3k `6 ■.4 . Q :4 G ( Other structure area: square feet 004. Pr II vq +t D t we REQUIRED DATA: COMMERCIAL -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 DESCRIPTION OF WORK work indicated on this application. � ° r Valuation: $ C, c_ r. pie t..1 to t y . h t.stLe ! t ca W &f-- t eue / Existing building area: square feet New building area: square feet . NI PROPERTY OWNER ❑ TENANT Number of stories: Name: ! /IL N z v.ut". Type of construction: Address: ( b 6 S Sw Nilo�v` "r - Occupancy groups: City/State/ZIP: u. o e- 4- 2_22f Existing: J Phone: (5b) 5 7 Sa t Fax: ($)3) E'] q 5 New: APPLICANT 4 - ❑ CONTACT PERSON • • NOTICE Business name: All contractors and subcontractors are required to be Contact name: 1 t licensed with the Oregon Construction Contractors Board V � l • e',IVt k•v.. ke under ORS 701 and may be required to be licensed in the Address: 136 SS 6(.4.> IM- a..,�. 'h� : lZ d G r jurisdiction in which work is being performed. If the r .. � t � City/State/ZIP: -7: t V applicant is exempt from licensing, the following reasons ....i4 o k 47 "2:2_ apply: Phone: (563) 7 - .r! I Fax: : ($2A S.7 C l Ss 7 E -mail: j aka • tov114.‘.K..e r+ uev 12uv�. Yl CONTRACTOR Business name: 0444 e--( BUILDING PERMIT FEES * Address: Please refer to fee schedule. City /State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lie.: Date received: Authorized sip a re: This permit application expires if a permit is not obtained �� within 180 days after it has been accepted as complete. Print name: ! Ye'� -- I' Date: a t G * Fee methodology set by Tti-County Building Industry Service Board. i:\Buildin: • errnits \BUP- PermitApp.doc 12/03 440- 4613T(I1 /02/COM/WEB) One- and Two - Family Dwelling `• Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Date/By: Associated permits: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 O,tvat t, ,.. ' k � Ri ❑ Electrical O Plumbing ❑Mechanical 24- Hour Inspection Line: 503.639.4175 �„ � ■ I+ g Internet: www.c 0 Other: THE FOLLOWING ITE1<'IS 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 sion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin rotection, etc. 10 3 mplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ ,......tadi. ng 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, roofmg, 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 applicable to the .ro 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:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 Plumbing Permit Application F FOIR OFFICE IJSI: O'`l.l' City of Tigard Receives A MINE Date/g C Permit No.: )%ii - -- 1/ SO / 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit No.: Phone: 503.639.4171 Fax: 503.598.1960 /'"tji�,.; -f' � I\ Date/By. Hour Inspection Line: 503.639.4175 1 Date ReadyBy.. Id See Page 2 for Internet: www.ci.tigard.or.us Notified/method: C Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total 0-Add it i on/al t era t i on/r ep I a cem en t ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 249.20 12 1- and 2- famtiy 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: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: ( G SS 6 (J N�a v �.-.4 4.,.....„ p .4 cop Cr Catch basin or area drain 16.60 City /State/ZIP: t I. %...A O 4.- ZZ`i Drywall, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear 11.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 I) u ( ( Wt'( Q.L. '4v () 3 Rain drain connector 16.60 i '2 3 T, it4. - pZ L e( c_ C.. Sanitary sewer (no. linear ft.: ) Page 2 D O , Fes,v4L j,/(il Storm sewer (no. linear ft : ) Page 2 Subdivision: z pot U V k. �......‘ I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 CI ,,, t 7 I +e �,/ c . _ 12 w� �ij t J (r -4 ,, y r� Backwater valve 16.60 M �� l Clothes washer 16.60 Z LA.-0 Rte- 1r w-. Stw�. J Dishwasher 16.60 ® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: V d• t4 • a kr Expansion tank 16.60 Address: 13 6 SS S i c, ry1a►.t_ `i-4 f w �r � e_ LT Fixture /sewer cap 16.60 City / State/ZIP: \ �/ Ce v--� d g Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 10 APPLICANT I ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: JO‘‘.... “ - b V, ■,..ls. ,` - Medical gas (value: $ ) Page 2 Address: 13 GCs f c L.) Wta.., t,>,}c,,.... re.d,,c CT Primer 16.60 City / State/ZIP: T` C.... bit 4') 2.Z44 Roof drain (commercial) 16.60 Sink/basin/lavatory 2 16.60 Phone: (I2.73) s-q & _ -)g-8 ( Fax: : ( ) s`7 4 ps-4_7 Tub /shower/shower pan 1 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 1 16.60 Business name: ©ril-*)C„ Water heater 16.60 Address: Other: Subtotal City / State/ZIP: Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential back flow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: ,...- TOTAL PERMIT FEE Print name: I 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. is BuildingTennita \PLM- PennitApp.doc 12/03 440- 4616T(l0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backfow 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. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" - 4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach /Refrig Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley - Commercial Isometric or riser diagram is required if fixture quantity -Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ BuildingTermits \PLM- PermitApp.doc 3/03 . .... Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Receive i ' Date/13 : 'M i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev d iew Phone: 503.639.4171 Fax: 503.598.1960 - 4 , 10 7N,Olie, - Date/13 : Other Permit: Inspection Line: 503.639.4175 ,..c, 44,. el 1 Date Ready/By: 65 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: BM Supplemental Information 41.'kg OF WOK '''; MIENVAITAPPACOTEOCT .•;-; ,, ,' - . • : 0 New construction iski Addition/alteration/replacement Please check all that apply: 0 ['Service over 225 amps, comm'l 0 Hazardous location Demolition D Other: ['Service over 320 amps - rating 0Buildng over 10,000 sq. ft., CATidiilidi? easrsiiil 1W - leiice"- of 1- and 2-family dwellings 4 or more new residential .•.-',',.---.. '- - , .., ..- - , .• .- •. -, : • . . . - ,.. - r: ,....' l'' '?'4 St 1.. RI 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure ['Building over three stories ['Feeders, 400 amps or more 0 Multi-family 0 Master builder 0 Other: - 00ccupant load over 99 persons 0Manufactured structures or JOB SITE AND •LOCATION `' '.' '_ -,;: .-' ,--, ['Egress/lighting plan RV. park 0Health-care facility ['Other: Job no.: Job site address: Submit I sets of plans with any of the above. City/State/ZIP: The above are not applicable to temporary construction service. Suite/bldg./apt. no.: Project name: 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 Limited energy, residential 75.00 2 Tax map/parcel no.: . Limited energy, non-residential 75.00 • 2 agtitiFil0.Viik Each manufactured or modular - _ dwelling, service and/or feeder , 90.90 _ , 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ' ' . ', . • . . - ..'''.' - ' -- ' - "" - .- ! - 7 ' : - • .- ' '"' • --,, , ,,, .. ' : : 201 amps to 400 amps 106.85 2 .i ",, . .-•. :,:.._ 14 SIVREItil ,,: ', ,: f :,. : . . , ':': - .'i : . ':' 1:7 TENA 401 amps to 600 amps 160.60 2 Name: irltet v. t-4- . ilse'• LA. tn. CC le. 601 amps to 1,000 amps 240.60 2 Address: (. 6 SS 6(4- 7 c..- 0 Over 1,000 nnect s or volts Reco only 454.65 66.85 2 2 City/State/ZIP: --- f. 4. ‘......._ 0 9, c 222-f Temporary services or feeders installation, alteration, and/or Q relocation Phone: (50) ) swe 0 ..,..) c Fax: cr ) s- ...) q c 200 amps or less 66.85 1 - Owner installatio I • This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, le. -ntio c, . : : ace. ding to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signa . . Date: //i 2/5 Ir Branch circuits - new, alteration, or extension, per panel .- , '*1' ' ICkNT - ' -'' • '. '' ' - 1 :: ''' ' • Ef tizii ititgoo an ..-:,- , . ': _. A. Fee for branch circuits with 0 service or feeder fee, each 6.65 2 Business name: • branch circuit B. Fee for branch circuits Contact name: , J- ) V vk - ? Nr t.4,-,ke._ without service or feeder fee, I 46.85 2 each branch circuit Address: I 7 ,:, 61.4., Wto to 1A-44:■ U..- R %.4 c. C-T 0 Each add'l branch circuit q 6.65 2 City/State/ZIP: A OP- cc) 2.-( Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) s--q V••-)K--A3 I Fax: : (5o3 ) 5'') i 6 Sign or outline lighting 53.40 2 E-mail: Signal circuit(s) or limited- . ,:`-,.-:4- .:: .-- '.'-:, ,=•.i :,,- , . ' .:,'.., -.'",' - c .‘.-- .‘ .•:.:- ,--:: A ;c1 .:1 „,.., :,Nr, energy panel, alteration, or extension. Describe: Page 2 2 Business name: 401.e.),L)Eit_ Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/Z1P: - Investigation per hour (1 hr min) 62.50 , Phone: ( ) Fax ( ) Industrial plant per hour 73.75 OPS CCB Lic.: Electrical Lie.: Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: 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. i:NBuilding1PermitAELC-PerrnitApp.doc 12/03 440 5T(10/02/COM/WE3 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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: 1. >` :001930 :000.O O 1,77 . 7Y t-; :� • 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 i:\ Building \Permits\ELC- PertnitApp.doc 04/03 . ._. Mechanical Permit Application r(JI( ()Ill( . 1.1I'Sl /N1 ■■ Received City of Tigard DaI�y. 1 ffa Permit No.: KG,raz5. -pay 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ,r, 1 , _ i Date/By. Other Permit: Inspection Line: 503.639.4175 _ j L . • I i 1 Date Ready/By: 13 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information 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' ® 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist. Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: 13 6 5 C 5 IL) WVOLn.tn" -te.■ .. G Cr (requires site plan showing placement) 14.00 City / State/ZIP: ` 1 0.wd 0 R c..-/ ZZ Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work / 14.00 /It ^ (2- L Hydronic hot water system 14.00 g u k A- J._ 41, t 3 ' Residential boiler (radiator or ( 4- ' I ,, _ hydronic) 14.00 3 w L+ � �� Unit heaters (fuel -type, not electric), Q Ow"� PV- vcCi-f PI r•tiQ in -wall, in -duct, suspended, etc. 10.00 Flue/vent for any of above 10.00 Subdivision: I Lot no.: Other: 10.00 _ Tax map/parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 A IN eezt p,..'{ ( e�I 1 '4. to .L-4.. v.v, 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 ® PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 10.00 Other: 10.00 Name: J AA v. 14- a L „,..k ._ Environmental exhaust and ventilation S'S 6 W U/1 r,,, „,-{ - �'s _ Range hood/other kitchen Address: 1 ?) 6 Z � CC equipment 10.00 City / State/ZIP: % ,.. 0 Z. q' - 2 Clothes dryer exhaust 10.00 �y Single -duct exhaust (bathrooms, Phone: ( 6 0 9 ) 0" • $ - 3 ( Fax: ( - U 3 ) I e 5 7 toilet compartments, utility rooms) I 6.80 ( y I APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: p Fuel piping name: e Ly, ?) r� kr $5.40 for first four; $1.00 for each a additional v Furnace, etc. Gas heat pump Address: 1.. G ,._c, S(-c) veto v ,4,....._,...„, qe (�T City / State/ZIP: l t.. `( 0 571 )...2_4 J Wall/suspended/unit heater Phone: (jb) S 40 i I Fax: : (5b3 ) S'-) 4 S X17 Water heater Fireplace E V , b vs ta.ti.{k -t " ULV 1 • "G"t Range CONTRACTOR Barbecue Business name: 060 N)V(2—. Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State/ZIP: Subtotal Minimum permit fee ($72.50) Phone: ( ) I Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. I Print name: I Date: I • Fee methodology set by Tri -County Building Industry Service Board i:\ Building \Pennits�C- PermitApp.doc 12/03 440.4617T(I1/02/COM/WEB) 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. • i:\Building\Permits\MEC- PermitApp.doc 12/03 2 • Permit #: H 1 7) I a 0 / 4 1 1 1 4.4,,,,,?„,,,__,,,.:„ : 4, Address: I Ze.OJ NOGC7i 1■) PNb6 ._ CT •°t`'`"' ., .•' ' Issued by: Date: T / 59 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: a 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. El 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR B. I will be my own general contractor. VIA If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property wners about Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) V ( 'ate) (White copy to issuing agency permit file, pink copy to applicant) Information Notice to Property Owners . About Construction Responsibilities i;:''rinotion Notice t'r Pioperty O1:7 ?eis ob oitt Construction Responsibilities tle ,% e, � ;t ' by the Cwis Contractors Board in accordance with OR.S' 701.055(5). 1 ' ,'oc are actH, as y our ov. e . `.nira(. for lc Cons ;'react :a 1!t:W home or make a substantial improvement to an existing structure, can prevent many prohicni•, by being aware of it-,e :allowing responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: it you hick' person- irk the CunStrLCtt "n Contractors Board to do labor in Constructing or assisting in the ennstructirm or improv: mcnr e! a re'ideniial structure, son will, in most instances, he ruled to be an employer and the people you hire will be employ Les. As the employer, you must comply with the following: Oregon's withholding tax 'tins: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You v. ill he liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. Unemployment insurance tax: As an cntplr}ye.r, you are required w pay a tax for unemployment insurance purposes on the wages of all r pluy_es. For ':,; in omiation, call the Oregon Employment Division at the Department of Human Resources at 378 -3524. Workers' compensation irrnr •once As an employ,•,, nil are subject to the Oregon Workers' Compensation Law, and must obtain wotl, -ers' comocn:,att; :.! ;.urtnee for your cntnin' Cry. IF you fail to obtain workers' compensation insurance, you may be subject n:: penalties and v., 1' liable for all claim c;r.tr if one of your employees is injured on the job. For more information, call the Wurkei Co!npen .. , Dis , siun at the Department of Consumer and Business Services at 945 -7888. U.S. Internal Revenue Set k employer, you must withhold federal income tax from employees' wages. You will be liable for the tax ,pin. tent c, ri it you didn't atually a ithhold the tax. For more information, call the Internal Revenue Service at 1 -800 -829- i 040 OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the p, •rm: t holder for this project, y ou are responsible For resolving any failure to meet code requirements that may be brought to you, attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees Make sure you have sufficient time to supervise your employees. Expertise: Make sure you ha the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own.pm4 1 /94 'CITY OF TIGARD 24 -Hour BUILDING Inspection Line: 4503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received VQ./ ° Date Requested � AM PM BUP Location 13 655 M° ' MA n R L Suite MEC Contact Person J Ph ( ) 39.9 - $',54'¢ PLM Contract Ph ( ) SWR G Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: � A SIT Post & Beam ✓\R.Er�S Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation S )C0vP o-1 Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof J V PART FAIL U 7''' Post & Beam Under Slab Rough -In / Water Service Sanitary Sewer Rain Drains C� Catch Basin / Manhole ` Storm Drain Shower Pan Older P4 FAIL ECHANIC Post & Beam Rough -In Gas Line Si, eke Dampers 'MA PART FAIL LECTRICAL e c: Rough -In UG/Slab Low Voltage F e Alarm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date `� - Inspector \3 \%\ - ) \)\) CI Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL