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Permit . Building Permit w1 111 " FOR OFFICE USE ONLY Received City of Tigard Date/By: t th S $5 Permit No,: yyC�T�06� a p v ki f 13125 SW Hall Blvd,, Tigard, OR 11/X. Parr1 Aliktk p t: Phone: 503.639.4171 Fax: 503. 590960 - M- i��' Date/By: �� ^V ti-)j- � Other Permi/12�05 —�O6Q� Inspection Line: 503.639.4175 Date Ready/By: J�is: El See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Ti / ( Supplemental Information BUILDING DIVISION � �._irY$E. OF, —:,.,. r <: - !!�� ;,�, s .� s , ,.. R14 RED DA3I'A.If,.'��.(D:2- EAlVIIL•�,D ,.EIILDYG -_ - C ' •,n- vv... .r ��; n, .l : �:: � y ryS ,. `fj . �r'V.. . QUI - ,., _ .r.! V,..,. � • . - �• . �'d��L•' = � ' m,. . _. ,...,':... New construction Permit fees* are based on the value of the work performed. ❑Demolition Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the v, rp , C , 1 :: , 5 : c ;.0 .r av , s , r , u ' 4 4 7: . ,} ,,, q work indicated on this application. r' . �:n;'43C ►fIIEGQ it© GUl � SiTRU I } ;.. ,. . , ,li :. i,,: , , A: ,. �: ��, � :'.. � ,,y: r'� , ::, r�% ,,. �.•. 'r " - , h �' � ^•.. ,. °'' + ^:£4'F,; :.0 :J), ..j'V� h„i}�'A:f::7, •� v �,.;: ', � le(i i.. 'Tw •_.. .nln. :;. !.:1 :.IR... J:'f<. :V, _. ,. Sr: Y'. "a` _ .�t .. Valuation: ID 1- 1- and 2- family dwelling ❑ Commercial /industrial ( I $3e0. \ O ❑ Accessory building ❑ Multi- family Number of bedrooms: LA ❑ Master builder ❑ Other: Number of bathrooms: 2 . 5 i. c .. / ? ;:. fiii ,. • ;t , ;: ; ., , i .,, .,• ,;a�,� ,:.,,:-;,•,,.,, -., :,.- 64,1,..:-° � r iii.�«: '' Total number of floors: � , = '-s: iA Z c ',. , ; L ∎V,4 ; iU B< SYfII S II!( F Q I I ZMATIO .V( l ly D'iL QC A O ' S `�'/' : �•.i+sa1 .� s.Yi ��:;i� e.,, •,._ ..ter ; ,... _t .,:• ,r y...,y,. c.c,•,�, * *. -a„ �.X... v...,,�. Job site address: a c 3 J , e, A `reArr. New dwelling area: -In O square feet City/State/ZIP:11 i Ole_ Garage/carport area: (f c >� square feet Suite/bldg. /apt. no.: Project name: Covered porch area: ` square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet 1 ;^ M' p -' v?rir 'a,�•; V , :, Yi •,fi i *oiL'ni'.7 U ,. S ..�,, -et - r,, - _ e w•' " +'{ !t IR A ;> / •t ° R �: i t!i .,. ice .. `l:Ca /,. -t'A^? vi, A /. 0'7'.:",•'•,:2,,,,, ::1'u!„�,LS ;a:: .t: •''• Subdivision: 4.- Indicate the value (rounded to the nearest dollar) of all �� \— 2t Qi Q , I Lot no.: �� Permit fees* are based on the value of the work performed. Tax map /parcel no.: �/_ equipment, materials, labor, overhead, and the profit for the , :; ∎? i .t=ai'' ; % g4ia '° :,.. .: ,c "• ^ } :- s tt.S`ctiwr : ,a,� lr i S'i.i t; � ?; ",w � :gli. C1 0,;'i `', ,-2 ;'; ' w e.. H ' , 's; ; " .. } , T .7 i ; r t w work indicated on this application. ;�� -' ' >,� ?:� � � t ; , �,D' �F w,ORK� , ' , �� .dF:- .' „- �i' - .. S��if , ::.Sk,;�Yl:'- VkiSi- �;.4?.i: .r. .�:�.rti�. l'1 ,��'h .7:rr�: r �;:?;.�;? l K�,, �+' °;n' Valuation: $ Existing building area: square feet • New building area: square feet it?t °s I ej:', _ ,A ,o,._ :evs7 _ s e4'':w:. F _ ^ 4 7 ^ 3) : ab i,'V S 0"..'"%4 !., ' ggf o.,,,, " � ; 1 "" P : • +a l e:., ; ': PROrIERMY OVVNEIV''` r ' ''' ` , s ' . „• " ?; " : V ` i , t IA'�1 1. ,: „..., 4,'? Number of stories: ;:. , V;,. ,At .^: ar•:t1 A.,.11.,- ,sa,.....ti - . F; .I ;.r A Z,t r e.i.:.: `5'• N rr 'i _ ';; g i::. ' ., :.� Name: %_'-5 , � Ga MMU Ni 'Lr� t �(-.� Type of construction: Address: 41 ,92 ( G) - £ (�i •00 Occupancy groups: City/State/ZIIPP.: L,V ,G CY - -� C) (K 3 J" Existing: Phone: CO) ✓ W - 7S ,,CC . 0 Fax: ( /5) 3 U 7 -7 ( /� [ S New: , , -. 4 ,. ; y.` 41 , •. ..TS U : .',` °LhvVS ;;;wi 7,S; ,Iii a:'T. .n1.;91r._ -R .64, 'd'i '1,:7:,,. v } - ;: fir ! ,, .. : - ., r 1 •� ; cld,p. , ,.. . �,.�,. ,.Q "� i �' r 1 . �v,i:a,. i , I,'n - • A c FS.. +l : . �9 {r�P G'. rh': . 1,. r • a- r�..,.OUN ;' L I 4 � ► TE�RS tir,:; , lt.. ; .r _ ,� } �'o ....5,-,:'•,- =, 1 „ y r, '1 " ,',. .. � ;'Y ^•� ;y .N ; .y, ,,. . ,rya. r 'a. ` ' , � , 1+ � •� ':: •+.� fi+, .�; ,'F tif., +: M A T , � . .., .r „ • i -'nb`.;a , t .. �1., �. , 1•F -, t', � Y ?1 .{. l y r a= - :3':IA, ,+i' :a?f . -. , l� Sf,1�u ..i /, �[.��...,1 \O�I�� .: , J 1 e P< l� , :b = .. ' Business name: All contractors and subcontractors are required to be Contact name: 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 I apply: Phone: ( ) Fax: : ( ) E -mail: ,',',' ' ;',y:It i �; . '-; 2 ";; 1�iY - ,r- ��„ ,:1',6•,4"1;.. �if`- i_� ,! 1j: :c(" ';'v.�,, ,,g 41 a . r ' l r ` i }., . - ` , , M ) , ; t,.lr: ` • . y . , q i'': ,,. ?i: =_l' i ,,::i::• ;,? �;,: .. ..�:,.� ,, ni ...;�` \' 'e.'4., °r�: + }��.,;1t�c:,;'�:::' Business name: . P , ; I' `f ., . L' � �;i'��,�s�y.i;a�'':rj:';BU> DING '�;PERl1;I>,T ;FEAS *•.'ri' Address: Please refer to fee schedule. City / State/ZIP: - Phone: ( ) Fax: Fees due upon application ( ) - Amount received CCB tic.: r � 5► Date received: Authorized signature: This permit application expires if a permit is not obtained 1 , ) C j 0 ( Q within 180 days after It has been accepted as complete. Print name: i 1 1 z Date: 3 * Fee methodology set by Tri - County Building Industry Service Board. is \Building \ Permits \BUP- PermitApp.doe 12/03 440- 4613T(II/02/COM /WBB) • Plumbing Per ' - < � •e s� . s lu •r 1, FOR OFFICE USE ONLY ,_ • . -- City of Tlgard Received Date/By Permit No,ii4c•��05 ". 000ef 13125 SW Hall Blvd., Tigar \ A1 97F2} ��35 plan Review Phone: 503.639.4171 Fax: ection Line: 1 98:19'60 /lb*, {�� 1 ','� Date/By: Other Permit No.: 24- Hour Inspection 503.639.4175 p � ": I Date Ready/By: Iris' See Page 2 for Internet: www.ci.tigard.or.0 _ y OF TIGARD Notified/Method: Supplemental Information - '.:. --, ,, ,,, • ,,, ;,,, �.� „ ,ti:,:, ".'. .. - d:,Sqr��r ��.`�•;S�Y.i -�:� v_��,_ . ri; :r(i7'i• _ '. �x,- -,.- - �•� -. y.,r • - . ,, yy }} .6r:; ��: °��R7{;,;.;r�. ; . n.,,,,1, I j - •1' . . ':FEE, }SCHEDULE: %�<�' • ., • . - - i5! . .: ;. ... .:�,....: •.`.._,. o.1rAr rr•.•,1. ]:..i. . n 1 Ir New construction ■ • - For special information use checklist. Description Qty. Ea. Total ■ Addition/alteration/replacement ■ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) e e o o SFR (1) bath 249.20 ■ dwelling ■ SFR (2) bath 350.00 ■ ■ SFR (3) bath 399.00 Each additional bath/kitchen 45.00 El Master builder El Other: Fire sprinkler ( sq. ft.) Page 2 e t a o t o e Site utilities Job site - . - J ! . Catch basin or area drain 16.60 City / State/ZIP: 140 l Oz Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: `` �� I Project name: 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.: ) Page 2 Subdivision: kali t k a4 Q_ Lot no.: ,n Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 r". ,. _ . LC, y - ''s.. 6 l i '. °i, Nt'6.x`. . ; -? ' `.:),�•of•p s ,44 - ... �,tW.F' D;E CRIRITIQ1Yt'•O '' , -ri-!3 , �,,: 1 A r �'i�,: ��, ,,.. :r,C,�.,;.,�.,:l.-�l ; .,, „�.,, . ':,• . ..,� 'it: J 1 ,:a<4n - ,a � •.1',�. „4,� Backflow „ . ..,<. ;� < � . ,3�'-'.. r Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 a , G •'- � ,, �.. <,,,.Y,, , ,.- ;,,.,,� c „ l - Drinking fountain 16.60 5! l PRO+ PERT 'WI� y -''2' :r ,.:, 7" E n i, ' .. t''•' .. N'• < v_-a:., ..:-�.. ._ °y''ll :,� '1 ,u "T .,, .Y.1'i Ejectors /sump 16.60 Name: 4044 >10L . / .. ' ' ' c m (1h � I C A-... Expansion tank 16.60 Address: •'2/I . . , / ' f 1 51‘.,, t Fixture/sewer cap 16.60 City/State/ZIP: r) a a / _ q � Floor drain /floor sink /hub 16.60 Phone: F ) 323 .. 7 � _ ! Fax: ( � ...N)--2--7 Garbage disposal 16.60 E,,n- <;;',':- ), �'u: ;v,,.,;� !` 5 °;;';:i5' I, ^ •IF:::•;._ " Hose bib 16.60 j; ' r... k,.,.. 7, : r - r•: ,...., Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 -mall. Urinal 16.60 °`'.,' PCONTR� P ; t. _,::",:' ::kr1 - X .:. l ! , b,; , : . . ; . • ..,�.. �..�,,.,,... :,_. s .•..4,. , .r,._.. -_. ,,;�..: a:�,: -.. � closet 16.60 Business name: / t(,,,--,„e_ � i v • di Water heater 16.60 Address: 1 O T. 6 1,1 / Other: City / State/ZIP: ,rj / # j Subtotal 2 ( Minimum permit fee: $72.50 CO _ i -' ✓ / Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: 1,0 I - 744 ,- 7 ltltnbing Lic. no.: - 4)P Plan review (25% of permit fee) Authorized signature. ` il? State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: J , \ • t (v g Date: 31 q'ob This permit application expires if a permit Is not obtained within �J 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Permits\PLM- PermitApp.doc 12/03 440 .4616T(10 /02/COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received Permit No.: t ► S 7-__3.120 . -- o GOugi 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 5= 7t ' > .60 //, ep:' tr' e Date/By: Other Permit: I t3 3 ,, .P.. r j InspeCtio L 1 __ Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information MAR , ZOOS . +1: ti'' :,r- : ?f' j iaiu'] n:;i i• wG` *V . a.. . . OF +: 1 0, - * :," ! �. ,L Cd ` �RCIAL' 'DE.,. S CHEDULE : ' :.�YJSEt0100 LIST _ r: z_, .. ,r +- .:;,.,,..2a:1r,n•i -rh r $'a':._� °i'.•�, }:".• "Ii4'.'a... s::k / ^i.`., ' a: ' a.,_I ,u•,r.V',:, !� _, .._ •,:: o gNe itt IN G D 0 Addition/alteration/replacement Mechanical permit fees* are based on the value of the work � 'LDII� G DIViSPOf�r performed. Indicate the value (rounded to the nearest dollar) of all ❑ Dem Other: mechanical materials, equipment, labor, overhead, and profit. ;i .:C F=i , s. , , h ;. ..;;:.: , .; ��; - , .,, .:. ' CON$sDRUGTi©. <� '. , `... ,�t�;(•(� ,.,.' .ai Value: : +;;, . -i. , :';RESIDENIPIAL-'EQ.UIPMENT. I 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;; INFORIYIATION� XND'..JJOC'ATION` : ' :;>, I "` ;.; w - . ,,, ,. • J , ,:� . «., ., h: ; , : .J, if;;KA;i Heating/cooling Job site address: ^ M- Air conditioning or heat pump I g ) ' v��(,e [ C/4 1 (requires site plan showing placement) 14.00 City/State%ZIP: 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 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 l wy `� r r of no. R• Other: 10.00 Flue/vent for any of above 10.00 Subdivision: S �l : Tax map /parcel no.: Other fuel appliances • .,. �_ _ ,Y`,r ":y � c n , 1 _, . -' - _ r.;h•- '+ '''' '' .. ..,.� '. 4•y0314 :.h... h• X14 - .,p.,t Water heater 10.00 ; L�d: 'k v a ,, : 4 y , ^ ! ±��'F,GSS 4 „ - \'4 ".`i'.; s, °'1. .::T ; ;t,; .. . •:r ,; -• ` ; . J , , - D193'f, W a IOTl IMciR K; �� ..J , , t " x. .. r ? r . , R�� ;� , • .. .. -r - . �i '� ,., ;�; ^,F:.'y „ y .7 ...9YL',c3: �11��. "F .. Gas fireplace 10.00 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 iii ? ".(. ..•. 4 „r• r;,�; t'%It ,Z:,,'. Chimney/liner /flue/vent 10.00 m ::PR`OPERr tJJ.. - J w -.1>t . ""' `' s:,'; .:,117;;;;;',,' , NAN :r :� a• :. F __ TY`'OWNER,.� .,�c -.::+ C ' r i� ; '' S,.. _T ,' I '- `�.. ".�`„'� '' ? .. J:,. . .- :li•;iti-T'.... .• .,- ' '- ; ,,,,, , , . ;:x;;�' - , > : Other: 10.00 Name: • ,r � �`�i1 Z I. ' I ��)�� Environmental exhaust and ventilation Address: e , l5 Range hood /other kitchen "'� i U'U'JJ equipment 10.00 City/State/ZIP: D" '(I q ')Q7 , Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: - Fax: ( 7 •- - 2(01 toilet compartments, utility rooms) 6.80 ;: li :Ac{ N � r . ., . iiiiiy ' Atli tti, +i ,'.' 9ia 1' 6�ri T� ;`a ' • wav rF :e..,l' ._ ._ ' `1,,n : +.',. ;:. i a *3 : ®; hI,-YG ta ! - - r..: •, : + ' i t'd, •i'' n" 4Q N AG dri U. l 7 r ,kA -I Attic/crawlspace fans 10.00 .. a i .., ., �f.... •. ,, .: ,,. a . • :, -?� :•.:& .. ,f'i' =4 . � d : . aliJ(�: !r, c.';'ir'Q, ,. �••:. •F,';... . ✓.., ,, - L'. �" :[r�'::f :.�,,. �!:: `^iYb�' � Business name: Other: 10.00 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 E -mail: Fireplace Range ' .iCONiI1RACTOR, , 9';'"-- r . `. ;�:, Barbecue Business name: /. ( Q Clothes dryer (gas) l JIa ' ea , u '" Other: Address: /� /' L ' I � .' it ":: l *: ,:' . � D ` t z l l z'1 ; `i F :vt M iiiiim : FEES°, , :, � - l � v \• el -7C�5 s , .._. tota l: City/State/ZIP: Subtotal Phone: r �, � 1 Fax: ( ) Minimum permit fee ($72.5 d I Plan review (25% of permit fee) CCB tic.: State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: ,+,/ ', ffrie This permit application expires If a permit Is not obtained within 180 days after It has been accepted as complete. Print name: 1 0 g 1 f rla T Date :Date: `3: * Fee methodology set by Tri County Building Industry Service Board i:\ Building \Permits \MEC- PermiIApp.doc 12/03 440- 4617T(1i /02/COM/WEB)