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Permit r , CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00357 A, DEVELOPMENT SERVICES DATE ISSUED: 8/8/03 .,i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11095 SW SUMMER LAKE DR PARCEL: 1S133DA-01400 SUBDIVISION: AMART SUMMERLAKE ZONING: R - . BLOCK: LOT: 036 JURISDICTION: TIG REMARKS: 100 s . ft. in (2 additions. 3125104-added replace gas furnace, to this permit 7 f - "- BUILDING` J • REISSUE: CUSTOM i ST_ORIES 1 OOR=AREAS - ' i REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 100 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 40,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 100 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 2 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 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 /FOR: 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 AREAJSPC 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: $ 931.93 MC CORMICK, CAROLYN JLM SERVICES INC This permit is subject to the regulations contained in the 11095 SW SUMMERLAKE DR 12220 SW WALNUT ST Tigard other Muni Code, State laws. All work k e will l be done Specialty Codes and TIGARD, OR 97223 TIGARD, OR 97223 all oer applica This b 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: Oregon law requires you to follow rules adopted by the Phone: 503 - 579 - 5662 Phone: 590 - 2451 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Rea #: LIC 70082 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Mechanical Insp Exterior Sheathing Insr Electrical Final Foundation Insp Plumb Top Out Gas Line Insp Mechanical Final Post/Beam Structural Electrical Rough In Insulation Insp Plumb Final Crawl Drain /Backwater Framing Insp Insulation Insp Final inspection PLM /Underfloor Shear Wall Insp Rain drain Insp Issued By : Az..4& (' A�lr Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day -Mechanical Permit Application FOR OFFICE USE ONLY Received ; 4 . Mechanical Date/B : ' L 0 .' Permit No.: S ^ c7 3 -OD 5 City of Tigard Planning Approval Building 13125 SW Hall Blvd. Date/B : Permit No.: Plan Review Other Tigard, Oregon 97223 Date/B : Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -1960 A Post - Review Land Use DateB Internet: www.ci.tigard.or.us �'l(' �� Case No.: 24 -hour Inspection Request: 503- 639 -4175 ` ' �+ Na Juris.: Su See Page for Name/ Su . � lemental Information. • TYPE OF W ORK . '," a�'.%COItiII1'IERCIAL•ifFEE+`' SCHEDULE:= ;USE'CRECKLIST • • _ ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work r z Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY'OF CONSTRUCTION; .'•ti:, .', .'i '•: •:'. mechanical materials, equipment, labor, overhead and profit. [ �,j & 2 Family dwelling E] Commercial/Industrial Value: S See Page 2 for Fee Schedule ❑ Accessory Building C Multi Family - ' :±:iRESIDiEItEI EQ.UIEN►EI i : : :SCHEDUL•E. Description Qty Fee(ea.) Total ❑ Master Builder E] Other: • JOB SITE U FORMATION and LOCATION `. - g/Cooling Furnace • - add-on air conditioningioning•• / 14.00 Job site address: // 9 �� iiVArmi , Gas heat pump 14.00 Suite #: 1 Bldg. /Apt. #: /t.. Duct work 14.00 Project Name: Hydronic hot water system 14.00 Cross street/Directions to job site Residential boiler (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue/vent (for any of above) 10.00 Subdivision: j Lot #: Repair units. • 12.15 Tax map /parcel #: .. • Other Fuel Appliances DESCRIPTION.OF WORK Water heater 10.00 • Gas fireplace 10.00 /Ler/ « 9'4 S I "A. -tome_• Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner /flue/vent 10.00 e ROPERTY.OWNER . :I'•[]:TENANT : :':r :, :; Other: 10.00 ame: C .4 ��/ _ _ _ _ ,t /` : •::.:Env(iootnetital Exhaust & Ventilation Address: /gyp 9s SW . ��/ Range hood/other kitchen equipment v 10.00 Si∎ARAra tlal.e__ !lw City /State /Zip: Gad Clothes dryer exhaust 10.00 Phone: 5-795' Single duct exhaust 4,4 ?� Fax: (bathrooms, toilet compartments, ❑•A • :` CONTAC'rPERSON::_.` :.:. :.• utility rooms) 6.80 Name: Attic/crawl space fans 10.00 Address: Other: 10.00 City /State /Zip: Fret Piping "(65.40 for first 4, S1.00 each additional) Phone: I Fax: Furnace, etc. •• E-mail : Gas heat pump •• WalVsuspended/unit heater •• CONTRACTOR .. 1 : Water heater •• Business Name: lb / „nhra ">rr, .L (0p / /AI 6 Fireplace •• Address: ,O D Range •• �e>c X3 0. VI City /State /Zip: G Q � 0 BBQ •• '4 9 74 3 Clothes dryer (gas) • • Phone:503 G ay A q I Fax: ,5'o3 5-9, 0.776 Other: •• CCB Lic. #: Total: Authorized Mechanical Permit Fees* Signature: �� Date: 07-20: Subtotal: S Minimum Permit Fee $72.50 S PA Ai e /A A !JA / b Plan Review Fee (25% of Permit Fee) S (Please print nam State Surcharge (8% of Permit Fee) S TOTAL Notice: This permit application expires if a permit is not obtained within •Fee methodology set by Tri - County Building d ng Industry Service Board. 180 days after it has been accepted as complete. **Site plan required for exterior A/C u nits. i:\Dsts'Permit Forrns\MecPermitApp.doc 01/03 • R , CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00357 ; �� DEVELOPMENT SERVICES DATE ISSUED: 8/8/03 ''�" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 11095 SW SUMMER LAKE DR PARCEL: 1S133DA-01400 SUBDIVISION: AMART SUMMERLAKE ZONING: R - BLOCK: LOT: 036 JURISDICTION: TIG REMARKS: 100 sq. ft. in (2) additions. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 100 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 Tim: sf RIGHT: 5 VALUE: 40 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 100 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 2 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: CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: W0ODSTOVES: GAS OUTLETS: 2 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 FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: 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: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 931.93 MC CORMICK, CAROLYN JLM SERVICES INC This permit is subject to the regulations contained in the 11095 SW SUMMERLAKE DR 12220 SW WALNUT ST all other r applicable Municipal Code, State work k w Specialty Codes and all other applicable laws. All work will be done in TIGARD, OR 97223 TIGARD, OR 97223 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: Oregon law requires you to follow rules adopted by the Phone: 503 - 579 - 5662 Phone: 590 - 2451 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #` LIC 70082 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp PLM /Underfloor Shear Wall Insp Roof Nailing Foundation lnsp Mechanical Insp Exterior Sheathing Ins( Electrical Final Post/Beam Structural Plumb Top Out Gas Line Insp Mechanical Final Underfloor insulation Electrical Rough In Insulation lnsp Plumb Final Crawl Dr - ' - : - -ter Framing Insp Rain drain lnsp Final inspection Issu d By : , , ! l! / - _'/LL �L / Permittee Signature : _o/07- Call (503) 639 -4175 by 7:00 p.m. for an inspection need: 9 - ext busines day 7 a1 - t B Building PHEGE f tion 4 FOR OFFICE USE ONLY uilding �B Received Building h�t��3 f�v 357 Date/By: 7 1 Permit No.: City of Tigard JUL 14 2003 Planning Approval Other Date/By: Permit No.: 13125 SW Hall Blvd. CITY OF TIGARD Plan Review Other Tigard, Oregon 9722.3, Date/By: Permit No.: W w VII JU JY ! / A lir �' +� Post - Review land Use Phone: 503 - 639 -41 ax: : I Date/By: Case No. I ww.Ci.tigaid.or.us '' Contact . Juris.: ® See Page 2 for r 24 - hour Inspection Request: 503 639 - 4175 A Name /Method: Supplemental Information 94 V/a , 6 1 ‘ ‘ 4') t()al - I/ 6 .i.91.07,,,,eg.t..c.).429/_„L,A ci..-Ate.rco TYPE OF WORK REQUIRED DATA: ❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING gi Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate 0 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Accessory Building ❑ Multi - Family ❑Master Builder 111 Other: Valuation $ l� �� JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: Job site address: //Q 96 SO 5 /de , ':. Total number of floors New dwelling area (sq. ft.) /B0 0 Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) Project Name: Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) -4- v1A -k-r 5ofigWrct REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: Lot #: Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, � overhead and prof t for the work indicated on this application. i ,/ �Scal , e', aiddi ho 0+ /,e'n Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories XI PROPERTY OWNER . I ❑ TENANT Type of construction Name: t p t /!� , C Y �N DGIG Occupancy group(s): New: Existing: Address: // 09/54 ,Suhiner /eAe...Dr. City /State /Zip: X4avi, DR 9'1 z2-3 NOTICE: All contractors and subcontractors are required to be Phone: .5 -5 z Fax: licensed with the Oregon Construction Contractors Board under N U APPLICANT At CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the siness Name: ' n jurisdiction where work is being performed. If the applicant is exempt /p a? /Yl Contact Name: C /1175O6,7 from licensing, the following reason applies: Address: City /State /Zip:. Phone: ,57)44- $'77g I Fax: — BUILDING PERMIT FEES* E -mail: Please refer to fee schedule. CONTRACTOR r Business Name: l..,e ,$'eY!/lLes , Zir Fees due upon application $ Address: /22.—,zo Sw ze_Ja4 City /State /Zip: %i e .'/e 9' 7z2-3 Amount received $ 5 Phone: 9d -S/ I Fax: a — 2.f Date received: CCB Lic. #: 7 7p'J 9 7...._ Authorized Notice: This permit application expires if a permit is not obtained within Signature: . te Ai / Date: / 'S 180 days after it has been accepted as complete. flii? / +• . 1 4: 4 ; 7 0h *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) 6/1) Q 9,G7 9-1 is \Dsts\Permit Forms\BldgPermitApp.doc 01 /03 ' One- and Two - Family Dwellin ..„.0.4- , Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard U Electrical ❑ Plumbing ❑ 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. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan 0 permit required. Include drainage -way protection, silt fence design and location of 000 -basin protection, etc. 10 3 omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state • I ing 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 copyright violations exist. 11 ite/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." , 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. , 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required for four or more appliances. . 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under revi• .. JURISDICTIONAL SPECIFICS 23 Five (5) .ite plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". wo (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 (6/00 /COM) • Building Fixtures 1-4 57 - ar, 3- 0-0 35 7 Plumbing Permit Application . Received FOR OFFICE USE ONLY Plumbing Date/By: Permit No.: City of Tigard Planning Approval Sewer r �1 C I \ / C ® Date/By: Permit No.: 13125 SW Hall Blvd. V G Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 51111 "1 9 4.1 60 2003 � 9 Post Review Land Use ��rrdi ( Date/By: Case No.: Internet: www.ci.tigard.or.us - ^ 64 I f� Contact Juris.: ® See Page 2 for 24 - hour Inspection Request: QIT1S 1i1 3 ' Name/Method: Supplemental Information. BUILDING DIVISION TYPE OF WORK FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total IN Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (1) bath 249.20 IN 1 & 2- Family dwelling LI Commercial/Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: _ Page 2 Job site address: //Q Q S� . - .10/imerkAe- Site Utilities Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell/leach line/trench drain 16.60 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 Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) _ Page 2 Tax map /parcel #: Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 167Qe ad447 re.1.0. Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher / " 16.60 /G. Drinking fountain 16.60 'g PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: __,.4Tro/ „ ,I1 e6),./),) Expansion tank 16.60 Address: //D i SA.) SScuerAneYlci e Zr-. Fixture /sewer cap 16.60 City /State /Zip: 4i r, d"( 97z.Z3 Floor drain/floor sink/hub 16.60 Garbage disposal Phone: 5 CZ 1 Fax: Hose bib / 16.60 / G. G o ❑ APPLICANT rEj CONTACT PERSON Ice maker / 16.60 /e0 , 6o Name: ticT. Aiisod, , 1TG1 Serw es„TC Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 • Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 �p 16.60 /6 ,60 Phone:�,3 $7�y - UZ'78 Fax: Sink/basin/lavatory / E -mail: Tub /shower /shower, pan 16.60 CONTRACTOR Urinal 16.60 � ,j0esteat -f >la.�rtbin. �o..4ftc� Water closet 16.60 • Business Name: c r Water heater 16.60 Address: 0Z170 S& e2 S Other: City /State /Zip: AY/ D £ 97/z3 Other: Phone:5 - 03 -6 rta -2,067 Fax: 5O3 _ t -S?SS Plumbing Permit Fees* . . Subtotal $ d , '/ 3 CCB Lic. #: 7 . s b. Lic. #: 3(-/97 P e Minimum Permit Fee $72.50 $ 9.I l' Authorized / Residential B Minimum Fee $36.25 Signature: 71-- Date: go Plan Review (25% of Permit Fee) $ J. ,n / O 7 - 7 - wait State Surcharge (8% of Permit Fee) $ 5, 7 (Please print name) TOTAL PERMIT FEE $ 7e, '3 0 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03 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 - l 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 additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: 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 Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped - 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 - *Note: If the fixture work under this permit results in an Garbage - Domestic ✓ increase of sewer EDUs, a sewer permit will be issued and Disposal - Commercial _ - Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains " plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - - Bradley - -Commercial - Service _ - Swimming Pool Filter , Washer - Clothes _ Water Extractor Water Closet - Toilet - Urinal Other Fixtures: _ • i:\Dsts\Permit Forrns\PlmPermitAppPg2.doc 01/03 0 . -aa357 • Mechanical Permit Application FOR OFFICE USE ONLY Received Mechanical Date/By: Permit No.: Planning Approval Building City of Tigard RECE I V D Date/By: Permit No.: • 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 '''' tt Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -lM. 1 1 O Post Review Land Use Pa iud il g l ;`� Date/By: Case No.: I Internet: www.ci.tigard.or.us � OF ,n, I Contact Juris.: ®See Page 2 for 24 -hour Inspection Request: 503 -6 ING DIVISION Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work to Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. ig 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add - air conditioning ** 14.00 Job site address: //995&) ,[/ante✓ /4 ke .Dr Gas heat pump 14.00 Suite #: I Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: I Lot #: Repair units 12.15 Other Fuel Appliances Tax map /parcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 kd cd;i a i /re model Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue/vent 10.00 1 21 PROPERTY OWNER I ❑ TENANT Other: 10.00 Name: er►, rod n j 1 c , r.n.tek Environmental Exhaust & Ventilation mm Range hood/other kitchen equipment / 10.00 Address: //0f5',514..) m ja ,hev 1.) e. K- Clothes dryer exhaust • 10.00 City /State /Zip: 7 -6yQ'� / 0 97Z,Z 3 . Single duct exhaust Phone: 5 - Fax: (bathrooms, toilet compartments, )0 APPLICANT �,/ ❑ CONTACT PERSON utility rooms) 6.80 Name: 7i i¢Sorr .5 Services ZirL Attic/crawl space fans 10.00 Other: 10.00 Address: / 2.22-z, S&) /n ed Fuel Piping City/State /Zip: - ' vt00 Q/` 9 * *($5.40 for first 4, $1.00 each additional) Phone: 5fd- Z 41r Furnace, etc. ** I Fax: Gas heat pump ** E -mail: Wall/suspended/unit heater •* CONTRACTOR Water heater ** Fire lace ** Business Name: Co /,�iy/, iG /'- .A.- Con /, .✓ y Range / ** • Address: g0 /�e� ,0303 97 BBQ ** City /State /Zip: y a47 04_ 9 a a3 Clothes dryer (gas) ** Phone: �,? ‘ ,2--,0 ( Fax: ,59r' p .7a Other: • *5 CCB Lic. #: /76 35 9 Total: Mechanical Permit Fees* Authorized Subtotal: $ �/J Signature: Y/ �B—O� Date: ° 7 y�D� Minimum Permit Fee $72.50 $ , � ' r . /en Plan Review Fee (25% of Permit Fee) $ � / (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 • $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace> 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101 k to 500k BTU 15 -30 hp; absorb. unit, 501k to I mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU _ Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets . 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: i:lDsts\Permit Forms\MecPermitAppPg2.doc 01/03 /VIS'T o' oo —ov 3,57 Electrical Peirle64tOgon .. FOR OFFICE USE ONLY R ece i ve d Electrical Date/By: Permit No.: Cl Of Tl and Planning Approval Sign `,3 g Date/By: Permit No.: 13125 SW Hall Blvd. JUL 1 4 2003 Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 C 1 ktg ., :: Post- Review Land Use /den. f' +' (t� Date/By: Case No.: Internet: www.ci.tigard.or.us IS* ^ , Ilk ' ,,.� I I Contact Juris.: ® See Page 2 for — 24 -hour Inspection Request: 503- 639 -4175 -- Name/Method: - Supplemental Information. ': f. •, ' "*' •' - • .` : TYPEOF WORK -`' ', • "a':"., , ' • ' , : `. PLAN REVIEW (Please check all that apply)': • •,::' :`.';,. ': ❑ New construction 0 Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location lig Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, ::;i rh'° '''' ° "i :t1 ':,CATEGORYOF CONSTRUCTION'c'.'. '; f.'''• 1 & 2 family dwellings four or more residential units in 1 & 2- Family dwelling El Commercial/Industrial 0 System over 600 volts nominal one structure ICIli ❑ Building over three stories 0 Feeders, 400 amps or more Accessory Building I=1 Multi- Family ❑ Occupant load over 99 persons 0 Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: i F ;'' '''- .JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above. . �S /SG.� The above are not applicable to temporary construction service. �� Job site address: d —Cum" .e-. . FEE* SCHEDULE" . • , °� :: . Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description • Qty Fee (ea.) Total 1 Cross street/Directions to job site: New residential- single or multi - family per dwelling unit. Includes attached garage. Service Included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: I Lot #: . Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling :+-'' ' `'. � DESCRIPTION OF WORK "`; r' o'e, iel ,:` service and/or feeder 90.90 , 2 Services or feeders - Installation, lei "tell &d-, aseai*GVre alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ) RROPERTY'OWNER• - • ' . • ] • ❑ TENANT N' '•'' ; °. "` `! ,,, . 601 amps to 1000 amps 240.60 _ 2 Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, ' alteration, or relocation: City /State/Zip: 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 ®1APPI,TCANT' ' :5: " •_.. , ' . ❑ CONTA0I ,PERSON ; ".` :. , < Branch circuits - new, alteration, or Name: extension per panel: - A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of /, service or feeder fee, first branch circuit / 46.85 2 Phone: I Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): `jr 5 t � `,:l , i" !'' . ' , COIyTRACTOR. ^l t• 4 • ' • '+' ' Each pump or irrigation circle 53.40 2 }' i -' ' 1 ' �' , .u. , -"--' '' " • ' ` Each sign or outline lighting 53.40 2 , Job No: Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: ( I I q , it t E(r,• r t c, (, ..z._ Description: Address: pd A o g_ 2. 3o s kr 7 City/ State/Zip: �` Z / E ch additional inspection over he allowable in an of the above: y p: T 5 n - n rt ins p ec tion hour (min. I hour 62.50 • Phone:C563) 42.4 - 76 3 / Fax: G 2Lt — 29 r g Investigation fee: Other: CCB Lic. #: ? szs Lic. #: 3 y • 28.3 6- ` b:�`.' . ; ? '. �` � <• :�::.. .:- Electrical 'PermifFees* 1�.7 t': :ir=`' ' "�`1i�ht Supervising electrician Subtotal $ signature required: i /2,.....--- Plan Review (25% of Permit Fee) $ Print Name: /)R -,,, Lic. #: / S S State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ _ Authorized Notice: This permit application expires if a permit is not obtained within Signature: r .i� - 4 ///, ,/ 4. Date: / 4 1 /53 180 days after it has been accepted as complete. *Fee methodology set.by Trl- County Building Industry Service Board. Ii) 41 4, - . (Please print name) • i :\Dsts\Permit Forms ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: El Audio and Stereo Systems Burglar Alarm Garage Door Opener ❑ Heating, Ventilation and Air Conditioning System ❑ Vacuum Systems Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 91 8- 260 -260) Check Type of Work Involved: • El Audio and Stereo Systems El Boiler Controls El Clock Systems El Data Telecommunication Installation Fire Alarm Installation El HVAC Instrumentation El Intercom and Paging Systems • Landscape Irrigation Control Medical El Nurse Calls Outdoor Landscape Lighting Protective Signaling El Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Pe Forms\ElcPermitAppPg2.doc 01/03 �` File Number .6140 o CleanWater Services Our commitment is dear. Sensitive Area Pre - Screening Site Assessment • Jurisdiction ./ 5 , , Date X /3/ /62. Map & Tax Lot 1ST 33t24 oploo Dwner ` Site Address / % pie s: Sojymleee L4ee 7J ,e, / ‘. .4:0 Contact 54 i Proposed Activity ,mod /1 , y Address ,54 Q6e4 ex, Phone 6-idt 4f *fft /r/ i 1 fr/ 503 - a 2 • Official use only below this line Y N NA Y N NA IN Sensitive Area Composite Map Stormwater Infrastructure maps ❑ Map# 151WN. ❑ ® QS# yg16 Locally adopted studies or maps Other le ❑ ❑ I wi Specify I El Specify Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 00 -7: • I Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT • MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. 1►N Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: Po Pwr: wily Sete f r; V P cuyee, Cs. �Jeq TO Reviewed By: �,,� Date: /x73//o ff Returned to Applicant Mail X Fax Counter Date z /.3/&- By 4' 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Phone: (503) 846 -8621 • Fax: (503) 846 -3525 • www.cicanwaterseiviccs.org CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST odd 3 8d 35-7 INSPECTION DIVISION Business'Line: (503) 639 -4171 BUP Received Date Requested g — ' AM PM BUP Location _ r / ° Suite MEC Contact Person 9,4-/A42J Ph ( ) �0 S - 1 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain 01 / ��11 ELR / / /�I Crawl Drain �/ V ' 0 1 Slab Inspection Notes: SIT �� Post & Beam Ext Shear Sheath/Shear th / Ext eah/hear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall T `N VK 4 2 ( Fire Sprinkler Fire Alarm 5`tka_ EL� Susp'd Ceiling Roof Other: C7IR PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service S itary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Off: S PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ECTRICAL Se e Rough - UG /Slab Low Voltage - Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 'ASS PART FA SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date <L `' O Inspector 1 " V g 1 Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL