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Permit E. CITY OF TIGARD MASTER PERMIT Alk PERMIT #: MST2002 -00220 14l DEVELOPMENT SERVICES DATE ISSUED: 8/30/02 r "" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14050 SW RIDGEFIELD LN PARCEL: 2S109AA -05900 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 037 JURISDICTION: TIG REMARKS: New SF detached, Path 1. BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,682 sf BASEMENT: 741.00 sf LEFT: 15 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,587 sf GARAGE: 895 sf FRONT: 50 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 15 VALUE: $ 397,012.00 OCCUPANCY GRP: R3 BDRM: 3 BATH: 4 TOTAL: 3,269.00 sf REAR: 35 PLUMBING SINKS: 1 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 2 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP <3HP: VENT FANS: 6 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 9 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EAADDL BR CIR: 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: PROTECTIVESIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,987.15 This permit is subject to the regulations contained in the RICHARD DOEL KOZAK ENTERPRISES INC Tigard Municipal Code, State of OR. Specialty Codes and 12981 SW TEAROSE WAY 711 N MOLALLA AVENUE all other applicable laws. All work will be done in TIGARD, OR 97223 MOLALLA, OR 97038 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: LIC 077219 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 Erosion Control Insp 8 Post/Beam Mechanical Ftng Drain Bsm't Walls Framing Insp Gas Fireplace Appr /Sdwlk Insp Grading Inspection Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final Footing Insp Crawl Drain /Backwater Plumb Top Out Exterior Sheathing Insl Gyp Board Insp Mechanical Final Foundation Insp Footing /Foundation Dri Electrical Service Low Voltage Rain drain Insp Plumb Final Post/Be tructural \PLM /UnderFlor Electrical Rough In Gas Line Insp Water Line Insp Final inspection Issu d By : h\ J tti I~ - Permittee Signature : \ /' =' Call (503) 639 -4175 by 7:00 p.m. for an inspection needed . one.. . u€t , ess day • r? t 3 r .7- 0.7 .- 0 Z, /3 r A Buildi ngPermit Ap pli cation "' . - _. , , � Date received: ��d 02 Permit n o. J Tam", -00 ,- 0 • ,,� ...., C ity of Tigard C� - °_y Project/appl. no.: Expire date: J Address: 13125 SW Hall Blvd Tigard OR -97223 City of Tigard u� v �}L�J -QO w , Date issued: B Receipt no.: Phone: (503) 639 -4171 nJ 37 yT, P J\ Fax: (503) 598 -1960 4244t, H 15 A -ate Case file no 'Payment type: -5! Land use approval: A-0001 co 1 &2 family: Simple Complex: X ;,TYPE OF-'PERMIT • ❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi- family ,New construction ❑ Demolition ❑ Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: x .. t JOB SITE INFORMATION', �• , .. , Job address: 1 t � O 5 tz . T irte, t6. Lm Fi€ 4 Bldg. no.: Suite no.: Lot: 37 Block: 'S ubdivision: Cog 4 M 1Z Ob4E AiAlti map /tax lot/account no.: - 5' Project name: 7® 6 L - rxesq> Fi,1/41C- as A-A - 0690 Description and location of work on premises /special conditions: 1.1 .e:1Z Cl * 5 4 `G-t_lc-TIo Oc A OWNER i FOR SPECIAL INFORMATION, USE CHECKLIST Name: L, "qt., © ' (Floodplain, septic capacity, solar, etc) , Mailing address: 1e2q / SW 5_ UI/,4 t1 1 & 2 family dwelling: --js r� City: State: CYLIZIP: 97Z23 Valuation of work 7 r — $ -= = = Y ` - cf Phone :( )„ZQ6,- J�lo702 Fax: E -mail: SCG)b4 &men . No. of bedrooms/baths ,3 .3_ Owner's representative: )/\, p Z (_ E)e Total number of floors 3 Phon vM0. 1. Erie 7 1 ! -mail:, .r • ew dwelling area (sq. ft.) - 3 .6) - q,', `, ,. APPLICANT •' k Garage /carport area (sq. ft) r” - Name: d r4 em Covered porch area (sq. ft.) ) _Mailing address: Deck area (sq. ft.) 75" City: State: ZIP: Other structure area (sq. ft.) JSZ.) Phone: , . Fax: E -mail: Commercial /industrial/multi - family: CONTRACTOR Valuation of work .... $ Business name: Q 13,E vs-Tejo-J.1 � Existing bldg. area (sq. ft.)� Address: New bldg. area (sq. ft.) .... City: I State: I ZIP: Number of stories Type of constructs. Phone: I Fax: I E -mail: CCB no Occupancy group(s): Existing: New: J City /metro lic. no.: Notice: All contractors and subcontractors are required to be ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Name: , Ave.., t tV L provisions of ORS 701 and may be required to be licensed in the Address: r3k07 51 1,-.-- jurisdiction where work is being performed. If the applicant is City: GA 1 - ►1j.J1 S State: GA -ZIP: ga 24, exempt from licensing, the following reason applies: Contact person: . A Plan no.: 21 p 1 Phon ' 3006 ., Fax: 7 1 . E -mail: ENGINEER = ,,, Namee ASCAD6' 176544 Contact person: eAT16-5 Fees due upon application $ Address: `( sia, ge' ZUb A416 'StO %TE I 8Lj Date received: , City: Cc .'/ALIAS IStaat ''' ZIP: 9 7'3 O Amount received $ Phon ,[11 �Lt417 Fax: 'J , E- maiiil: _— Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and r ces governing this ❑ Visa ❑ MasterCard i -: n or not. Credit card number: / Authorized si I p work will be complied with, er spe ' Expires tur gs e: 'T'{/! / < 1 �d� .r' Date: -Z O c• Name of cardholder as shown on credit card ' \ Print name: h - Pr r! Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 180 days Mier it has been accepted as complete. 440 -4613 (6/O0 /Corm) One- and Two - Family Dwelling a� �' fi • I,• Building Permit Application Checklist Reference no.: ryofTigard Associated permits: . City City of Tigard 0 Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other: Phone: (503) 639 -4171 • Fax: (503) 598 -1960 . THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW • • Yes "NO N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. K 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. _� 3 Verification of approved plat/lot. _ X 4 Fire district approval required. X 5 Septic system permit or authorization for remodel. Existing system capacity k- 6 Sewer permit/ `,- — 7 Water district approval. K 8 Soils report. Must carry original applicable stamp and signature on file or with application. ' 9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and location ,of catch -basin protection, etc. . _ 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ,_ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed. X 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 onrsite; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details,,vent • ty size and location. - " 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, L furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. X 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 X 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 Y locations. Show attic ventilation. /� 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered v 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 anon- 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 vv architect licensed in Oregon and shall be shown to be applicable to the project under review. - JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2' x 11" or 11" x l7 ". X ■ 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. • . )< 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. • • '{ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. �� 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6ro0icoM) I Electrical Permit Application Date received: q 9469, Permit no.: /7 CO • , • _4 , I City of Tigard Project/appl. no.:. Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.: Phone: (503) 639 - 4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT 91: 2 family dwelling or accessory ❑ Commercial/industrial - ❑ Multi- family ❑ Tenant improvement rI New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: / it ei S.J ' 0:icE ,Ft,,p L Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: 37 I Block: ISubdivision: El L/ ZIlloc b Project name: jZi 'S$L VsSfrea3C4Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: Fee Max Business name: v — r - 16, • � Description Qty. (ea.) Total no. insp Address: New residential - single or multi - family per dwelling unit. Includes attached garage. City: I State: I ZIP: Service included: Phone: I Fax: I E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: I Elec. bus. lic. no: Limited energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders - installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 Mailing address: 401 amps to 600 amps 2 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps • 2 ENGINEER r Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E -mail: Each additional branch circuit: PLAN REVIEW (Please check all that ap Misc. (Service or feeder not included): ❑ Service over 225 amps- commercial ❑ Health-care facility • Each pump or irrigation circle 2 ❑ Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighting plan ❑ Other: Per inspection I I. I Submit sets of plans with any of the above. Investigation fee . The above are not applicable to temporary construction service. Other . Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card . $ Cardholder signature Amount 440 -4615 (6 /00 /COM) 4 , ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 Limited Energy $75.00 Li Burglar Alarm Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 - n Garage Door Opener I Services or Feeders n Heating, Ventilation and Air Conditioning System" Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 • ❑ -Vacuum•Systems 401 amps to 600 amps • $160.60 _ .2 . • . • 601 amps to 1000 amps $240.60 2 n Other . Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation • Fee for each system ' $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. ❑ Audio and Stereo Systems Branch Circuits New, alteration or extension per panel n Boiler Controls • a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 . 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n or feeder fee. Fire Alarm Installation First branch circuit $46.85 . Each additional branch circuit $6.65 n HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 n Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account.# 8% State Surcharge $ Total Balance Due $ All New Commercial Buildings require 2 sets of plans. • i:\dsts \forms \elc- fees.doc 08/30/01 e.. 4 Mechanical Permit Application ,� Date received: e/ of 02.- Permit no.: , f, ii,.. ) X1 :,,1 I City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT _. - _ _.. ---. _ _ _ ___ ti & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement A , New construction 0 Addition/alteration /replacement 0 Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: /Z/p Sw £LjF -rtako y72z Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, i • Tax map /tax lot/account no.: profit. Value $ . Lot: 37 IBlock: I Subdivision: *See checklist for important application information and Project name: Dtit . l pf jurisdiction's fee schedule for residential permit fee. City /county: •T-1, f{D /y X ZIP: '72 1 & 2 FAMILY DWELLING PERMIT' FEE SCHEDULE Description and location of work on on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE N gel/✓ > c'//146 /*' Y Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res. only Res.only Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM Is existing space insulated? 0 Yes CI No Air conditioning (site plan required) Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: --7- P State boiler permit no.: Address: HP Tons BTU /H ddress: Fire /smoke dampers /duct smoke detectors . City: I State: I ZIP: Heat pump (site plan required) Phone: I Fax: I E -mail: Install/replacefurnace/burner BTU /H Including ductwork/vent liner O Yes 0 No • CCB no.: Install/replace/relocate heaters-suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace CONTACT PERSON Refrigeration: Absorption units BTU /H Name: .A-( eell')t/7— Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone 10, 3* Fax: E -mail: Dryer exhaust OWNER Hoods, Type I/ lures. kitchen/hazmat o,. / hood fire suppression system • Name: -lr.40 k Exhaust fan with single duct (bath fans) Mailing address: aq, j 5.&,/ 'TAM, j441- Exhaust system apart from heating or AC City: / 4 ; j I State{S ILI ZIP: 972,2Y Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil • Phone: C92 ; ' - 70V,xu Fax: E -mail: Scr*P_aracy24- -Cdr Fuel piping each additional over 4 outlets ENGINEER Process piping (schematic required) Name: C,f J,OWL , iz(6 5 Number of outlets Other listed appliance or equipment: Address: j I Z'b NE 2,. FvE_ $t .- /Oy Decorative fireplace City: cat// US c% I State: (,'1z... I ZIP: % 733rt Insert - type Phone:(94/) 7 53- W/7 I Fax: 7 y yZZI E- mail:Sitq /c Woodstove/ Applicant's signature: Date: 'Other: Other: Name (print): Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 0 Visa 0 MasterCard Notice: This permit ap Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ • Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ Cardholder signature Amount 440-4617 (6 /00 /COM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTVAL at- A :T.10[V 4 PERMIT FEE;i, :. �. _r t Des on hani-ca , ¢ 4 -' ?tike ,Total $1.00 to $5,000.00 Minimum fee $72.50 Table lA Meel COde', , ,,;: .. -..,•. �::, * 4� aty, = '. (Ea)4:� AmtA $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14.00 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Checkrall ft at apply F Botler4 pleaf Alr % $1.20 for each additional $100.00 or For tems3 i see , E of g . and �, fraction thereof. of bel� C0l" k fo es d . f • '.. �,Sx „�,. .' SIMii, , .? ,: . a.,.�s3 SOME' . i c''r� "' x' � '''9 .241 " r, ;',.� 4 a4a _-?', e a '= . ,,.,..It's '7,s '' , _wi.,. , .''. % ; Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit $ _ to 100K BTU 14.00 8% State Surcharge 8) 3 -15 HP; absorb $ unit 100k to 500k BTU 25.60 25% Plan Review Fee (of subtotal) 9) 15 -30 HP; absorb $ Required for ALL commercial permits only unit .5 -1 mil BTU 35.00 . - TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20 unit 1 -1.75 mil BTU 11) >50HP; absorb • unit >1.75 mil BTU 87.20 WASS A . yr 1 2) Air handling unit to 10,000 CFM WPNLUATIQ S PER API?L ANCE r ,➢ ; - 10.00 Value Total 13) Air handling unit 10,000 CFM+ Description: Qty (Ea) Amount 17.20 Furnace to 100,000 BTU, including 955 ducts & vents 14) Non - portable evaporate cooler 10.00 Furnace > 100,000 BTU including 1,170 ducts & vents 15) Ventfan connected to a single duct 6.80 Floor furnace including vent 955 Suspended heater, wall heater or 955 16) Ventilation system not included in 10.00 floor mounted heater appliance permit Vent not included in applicance 445 17) Hood served by mechanical exhaust 10.00 permit Repair units 805 18) Domestic incinerators 17.40 < 3 hp; absorb. unit, 955 to 100k BTU 19) Commercial or industrial type incinerator 69.95 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 20) Other units, including wood stoves 10.00 15 -30 hp; absorb. unit, 501k to 1 2,310 mil. BTU 21) Gas piping one to four outlets 5.40 30-50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) 1 -1.75 mil. BTU 1 >50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: __ $ >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 8% State Surcharge $ Non - portable evaporate cooler 656 = - Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: , " ` , $ � � _ _µ ti, Vent system not included in 656 s:�;.3 :: appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: Domestic incinerator 1,170 1 . Inspections outside of normal business hours (minimum charge -two hours) $72.50 per hour. Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) Other unit, including wood stoves, 656 $72.50 per hour inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum Gas piping 1 - 4 outlets 360 charge -one -half hour) $72.50 per hour . Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU. TOTAL COMMERCIAL '°f * * Residential A/C requires site plan showing placement of unit. k VALUATION: V eel : > _ - All New Commercial Buildings require 2 sets of plans. i : \dsts \forms\mech - fees.doc 08/29/01 • Plumbing Permit Application A Datc received: !f ' /fI per. Permit no.: j j .. 4„'+0,,,,. C of Tigard 1 t. •� � � Se permitno.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City ofTigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receipt no.: . Land use approval: Case file no.: Payment type: .__ TYPE -OF PERMIT _. .. ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition /alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: iii 6 5 1 "Z go', L }t Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: Tax map /tax lot/account no.: ( includes 100 ft. for each utility connection), 2o4� i � SFR (1) bath Lot: 37 IBlock: I SubdivisioneGK6W glT4 F SFR (2) bath Project name: � ^ "7`t� c SFR (3) bath City /county: " qt_3> I ZIP: 'j ZZy Each additional bath/kitchen Description and location of work on premises: 1 Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: ; /j3) Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Absorption valve Contractor's representative signature: Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory Name: ? e'e-fk1 Clothes washer Address: Dishwasher Drinking fountain(s) City: I State: I ZIP: Ejectors /sump • Pho i e /,._ a7 1 Fax: E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): Floor drains /floor sinks/hub Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump • ENGINEER Tubs /shower /shower pan Name: Urinal • Address: Water closet Water heater City: I State: I ZIP: Other: . Phone: Fax: I E -mail: Total . Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application ❑ Visa ❑ MasterCard Plan rev (at _ %) $ . expires if a permit is not obtained • Credit card number: / / State surcharge (8 %) .... $ Expires within 180 days after it has been accepted complete. TOTAL $ ce as Name of cardholder as shown on credit card p P $ Cardholder signature Amount 440-4616 (6/00 /COM) PLUMBING PERMIT FEES: rlf:TATAP 41*ttiagSA(kcllkiPqP41Izl4 M QTY 0:4fea) - N PAMOORTA g (uges all tteRiC:i, . Iff64411111604iiii**00100 p ? 7.fw7v 1 ta TqL Sink 1660 (ea) folc*Nt4 116oa616 Lavatory 16.60 One (1) bath $249.20 Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Titril nagiMi Urinal 16.60 8% STATE SURCHARGE tr:IL$ ragfaii Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL 'f1W4:1!; - Garbage Disposal 16.60 TOTAL flen• Laundry Tray 16.60 Washing Machine 16.60 • Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 4 WiiiikOtiklititif7071WOWPOOFFried Gas piping requires a separate mechanical 51#01.f7, 0:001:0Wintrei,(We permit. k MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures (Specify) 16.60 Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer - 1st 100 55.00 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is >9 'LAEigh* *SUBTOTAL 7 RAPP* 8% STATE SURCHARGE P305..:: W **PLAN REVIEW 25% OF SUBTOTAL Matm Required only if fixture qty. total is > 9 Aiatin tfr4r. TOTAL IF;42 W7-1; $ F.:1A1P: 'PA:17A • * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. i:\dsts\forrns\plm-fees.doc 08/29/01 n .s CITY OF TIGARD WASHINGTON COUNTY OREGON VOLUNTARY COMPLIANCE AGREEMENT AND TEMPORARY CONDITIONAL CERTIFICATE OF OCCUPANCY RE: Tax Map 2S109AA Tax Lot 05900 Kyle Kozak MST2002 -00220 Kozak Enterprises 14050 SW Ridgefield Ln. 22830 SW Noble St. Tigard, OR 97224 Aloha, OR 97007 I, Kyle Kozak, responsible person for permit MST2002 -00220 regarding the above property, agree to the conditions set forth below and promise to fully comply with them. This is a Temporary and Conditional Certificate of Occupancy issued June 26, 2003 and expiring at 5:00 p.m. July 26, 2003 by which time the following conditions must have been met and approved by the City of Tigard: Permit MST2002 -00220 must be completed and approved, including all outstanding conditions, corrections, ancillary permits, and fees. I understand that with this agreement the City will withhold further legal or enforcement action regarding these conditions until 5:00 pm on Saturday, July 26, 2003. Upon compliance with all the above conditions, this case will be closed and a permanent Certificate of Occupancy will be issued. I further understand that if these conditions are not complied with fully this Temporary and Conditional Certificate of Occupancy will become void at 5:00 pm on Saturday, July 26, 2003, after which time I and any occupants of the premises may be served with a Summons and Complaint without further notice for violation of requirements set forth in the Oregon One and Two Family Dwelling Specialty Code (Final Inspection Approval required prior to occupancy). Signed: Date: Thur day, July 10, 2003 9 �, Signed: A /i// i d7 '" 4427:- ftee CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 —® INSPECTION DIVISION Business Line: (503) 639 -4171 4155- BUP Received Date Re • ested � — � r� AM PM BUP • Location / 4 _ Suite . MEC Contact Person ii ! ,� Ph (4 ') V9-- d 6 Z - PLM Contractor / Ph ( ) SWR Q i71) - 14 Tenant/Owner ELC Footing ELC Foundation Access:, Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear ` Int Sheath/Shear n . .� ► - Framing ` Insulation i ' or ak �avir P} — / -� ° s � ( - ) Q Drywall Nailing , r - _ '— ".� � ` � ` . 4 61 `4V, Firewall Ca SS V ` f `f (� �` V, Fire Sprinkler Fire Alarm A- I_ �\ e..' .c� J 4011/./ i 3 or II � , Susp'd Ceiling �i C Roof ' .S C ye-j 6/ O S (I N C in _ r: - PASS PART FAIL // PLUMBING g SS-ee v t 7/0 7-6 Post & Beam W! OA( Under Slab // \ x Rough In t a • it • `- Water Service Sanitary Sewer 4 0 - S e, A .. . '..` 1. , Gl- Rain Drains ' Catch Basin / Manhole Storm Drain Shower Pan S Z.lr■) "-' 4---j• — Other: Final PASS PART FAIL 1 L /� ° / 7/ `� MECHANICAL - dj 4 _� _ - r ) .— ' -. Post& Beam I . �" 4. Rough -In , .� . - ` __ ■ Gas Line Smoke Dampers Final PASS PART FAIL . ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE - ' , - 0 Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line t.� � ADA Approach /Sidewalk Date v7? / Inspector " Ext GG Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OFT 'RD 24 -Hour BUILDING nspection Line: (503) 639 -4175 ©COc),�v INSPECTION DIVISION Business Line: (503) 639-4171 BUP Received //,, Date Requeste / Z'1° AM PM BUP Location I_ `�'� ct J2_1 Suite MEC Contact Person • \� Ph ( ) —6( °' 2-1 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: CJ d Z Ftg Drain EL Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling �/ Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole /1°2-05 s F6- Storm Drain Shower Pan Other: Final PASS , PART FAIL MECHANICAL Post & Beam Rough -In Gas Line 0 V �� , Smoke Dampers G O Final PA w. •T FAIL - CTRICA /y a Rough -In /1.4 UG /Slab Low Voltage Fir- . larm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SIT ❑ Please call fo einspe on RE: Unable to inspect — no access Fire Supply Line ADA l Approach /Sidewalk Dat — Inspectors Ext Other: Final DO NOT REMOVE this inspection record f . PASS PART FAIL CITY TIGARD 24 -Hour . BUILDING Inspection Line: (503) 639-4175 d O 2-2- INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 6s — 0- , n , /n� AM PM L- BUP . Location "1 S0 / e fa Suite MEC Contact Person 1< ct[ , Ph ( ) ,S -,- d(ootci PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC A ccess: //ll Ftg Drain .o e 6 - __ i.� �_ , Crawl Drain � ' - � Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear &Ar-?) Int Sheath/Shear / � - CS .7 % !0 t.- -vLsLs 3 Framing `� Insulation 1 ) , t 0 i ' vv\ W\ w`5 a 4.) . Drywall Nailing ) Firewall F , ,9 d . ` / 0,�,, . ,v/) s or � . ,, / " �" � 1 Roof C _ �{ , r. / - V �r .l' V O� �' ! 7f ` SL�t/ d PASS PART , PLUMBING 11 "'"' A4 1 Af 6='t/L-.ck Post &Beam �� � . � � 1 , - _ T Under Slab _ / `�`'�'�""� �^^ � --- Rough -In Water Service Sanitary Sewer Rain Drains G Catch Basin / Manhole , f ,, ' ` c- Storm Drain Shower Pan 1 1 I Other: A !v G � " CO - -) (9 — ® r f � PART F AIY - < � Y1 � CHANICAL Post & Beam i /( _ ' v r � f `��,- Rough -In `'I" Gas Line n Smoke Dampers \((/ ° Final 'ASS PART IL EL CTRICAL c. ,_ Rough -, � , A �� UG /Sla• Low V• a• : L 6 (J. C�1/L'�- Fire , arm � . (--) T T L v..� `-- U d i* FA ❑ Reinspec on fee of $ required before next inspection. Pay at City Hall, 13125 SW H f lvd. "ASS PART FAIL ITE - - ❑ Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA / (� 6 Approach /Sidewalk Dat 1 ` I nspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL JUL -16 -003 10:30 FROM: TO:5036847297 P.001 FILE Copy G /?r 7J ✓ Enginee' lug, Inc. 73'12 S �� A t > � � ; Durham Road .j Fenian Oregon 97224 Tel (503) 598.5445 • F: 1, (503) 598 .8705 i June 26, 2003 r Project No. 02 -7979 RECEIVED w Kyle Cozak Enterprises RECEIVED e 22830 SW Noble Street JUL 16 3003 Beaverton, OR 97007 Fax No. 503 - 848 -70.14 ITV ®F TIGtp1R® k — BUILDING DIVISION - SUMMARY OF GEOTECHNICAL SERVICES 1 Elkhorn Estates. Driveway for Lots 37 and 38 City of Tigard p This brief letter summarizes our services on the above - referenced driveway and lots. GeoPacifi. observed and tested the Lock -n -Load retaining wall construction and compaction, the foundation subgrade, - ; d the rockery retaining walls post - construction. The Lock -n -Load wall fill consisted of reject rock and not clean rock as specified. We requesi'Id clarification from the wall designer from Key West, but have not received it. Otherwise, the wall constructitr, appeared to meet the design. Density tests and our field inspection reports are attached, fi Rockery walls in the rear yard were complete on Lot 38 at the time of our foundation excavation view and on Lot 37 at the time of our final site visit. The boulders appear acceptable, though slightly small, a , the wall well I stacked, but the batter of the wall is steeper than typical for a wall of this type. The height of the I; alls is limited such that we conclude that they do not represent a hazard to the structures or adjoining prope „ but that the Factor -of- Safety against sliding is 1.3 to 1.4. The area above the walls should remain natural an.i of be heavily irrigated. Heavy irrigation and concentrated water flows above the walls could adversely affect 1; e walls. We also are not certain whether till or native soils are behind the rockery wall at the entryway on Lot 3 11 Our work scope pertains to a geotechnical engineer's foundation excavation review only an ',the conditions existing and exposed at the time of our site visit. No warranty is herein expressed or impli: No detailed subsurface,.geotechnical studies of the_site have been performed, nor are they considered neo sary given the generally favorable conditions exposed. If you have any questions, please. call. Again, we ass ',� e that the top of the driveway wall will be protected to keep cars and people from tumbling over the top of wal e.g., by a curb and planter and pedestrian rail or a guard fail..- __.., Sincerely, j3 OG s /© GeoPacific Engineering, Inc. fi t., 14 743 , • ,. ,7:-.- .. L I James D. Imbrie, P.E. OR EGON Geotechnical Engineer d v 4 * �3, i f a � cs, Attachments Field Inspection and Density`'Tesf- ma h CC: Hap Watkins City of Tigard 503 - 684 -7297 p F k 0 F r t C •' r ,...r ... • : . • _ , .. . -11 ;0 Knv-i DusL--- . . . P\crifi; As-roc-m . Om -r., pt, - T 0 Arb3 . . • \f 7tIVO / 0 e z# P,,,, A d-- - - , ,6ed_e_e4-0=x/ , (A0P-ei ytA•e.. .,. , . .-q / • 07/te-e_ 2i . / - • " 'd Li ) b _ 7 6* "(AZ_ -, ' • • - / • 9 ., ' . , i l . . .,, .:. Nog) .. ;tr ' • 76i11/19 ( N_ 7z,z 3 : . • . . , • . : .. . . ... , . ir .II l!i . 111 „. I ., Ili 11 i'l