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Permit 1 ,,, A ' CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00488 L �i �;� DEVELOPMENT SERVICES DATE ISSUED: 10/15/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11110 SW TONY CT PARCEL: 1S134CB - 05701 SUBDIVISION: ANTON PARK ZONING: R -7 BLOCK: LOT: 019 JURISDICTION: TIG REMARKS: 384sq. ft. addition. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 192 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 192 sf GARAGE: sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 37,872.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 384 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: . UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 2 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 SVC/F DR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 1.00 SIGNAL/PANEL: IN PLANT: MANU HWSVC/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 0CC: 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: DATAITELE COMM: NURSE CALLS: TOTAL 1$ SYSTEMS: Owner: Contractor: TOTAL FEES: $ 834.86 S, BASIM AMIN /NIHAYA BASIM OWNER This permit is subject to the regulations contained in the IBSIES, Municipal Code, State of OR. Specialty Codes and 11110 S S W TONY NY C C3 T 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. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: Phone: Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Rea A: may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Exterior Sheathing Insf Foundation Insp Mechanical Insp Rain drain Insp Post/Beam Structural Electrical Rough In Electrical Final Post/Beam Mechanical Framing lnsp Mechanical Final Underfloor insulation Shear Wall lnsp Final inspection Issued By : Permittee Signature : _---- _ c---- r Call (5 3) 639 -4175 by 7:00 p.m. for an inspection nee. ed the next business d T -To ?- / 6 - - 3 - 0 7 MA ✓ Building Permit Application FOR OFFICE USE ONLY Received /2 3 Building �f Other �® DaDate/By: a / D3 i(/ Permit No.: TaP.73 -00 O City of Tigard EI� Planning A va y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 SEP 2, 4 2VVA Date/By: Permit No.: Phone: 503 - 639 -4171 Fax: 503-598-1960 ��' }lhl�i Post ew Land d Noe Internet: www.ci.tigard.or.us Ty of TIGA R. . - Contact Juris.: ®See Page 2 for 24-hour [ 9 o ur Inspection Request: 1 1 �} • Name/Method: Supplemental Information C/ R J 1 • GW�dL �++ ' - 41 , .. w•7 QR- t 1�7 , �J..°N;m4; i � = , ' .1 r 'v_ - fiti '`ii.• i ." t,, G:• ; ''.3 ,J...= -- S•.L t.u�IQS_. iTrllRx -JI.: �.zT�' PE:��Ea '. :� .:i•U ��, ' Y ..� ;;:-�,.*,?I .7 - 4 r 2 '' T Zi "L Y Q 3 '!' - S � RE UIR D D ; DA'Ii`A ' g , i:... New construction ❑ Demolition�� ; e j r ;1 & 1H�1.Y DVVLiIIV� 4 ` ` � " Addition/alteration/replacement _ I:1 Other: , , ti - _ -_ '� �,x_ TM i'. t ``. AS=; MATEaOR 'p'OM.:M T ClfOST ��. " Note: Permit fees* are based on the total value of the work performed. Indicat 6 i. 2- Family dwelling ['Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, mate . Is, labor, )c.. overhead and profit for the work indicated on this application Accessory Building ❑ Multi-Family 9 d a rY g Y ❑ Master Builder ❑ Other: Valuation $ 3 7✓ - „.;�-, ; -:",;, _ -„ "arid )C ,,t,fsfi SI EjNII QR itaro -�N ;OCATIObl, 15-,” r::. r No of bedrooms: No of baths: . Job site address: 11 ` Sw i ( Total number of floors �,, y New dwelling area (sq. ft.) Suite #: I Bldg. /Apt. #: J Garage/carport area (sq. ft.) ,1_ Project Name: d 611 1 6 St ti Covered porch area (sq. ft.) Poi Cross street/Directions to job site: Deck area (sq. ft.) �-{ — 7 g Other structure area (sq. ft.) 7 / a :" i „ �° ; r , .° 4.1 7 • - $. cuL ie _ •- ' - w NiVA z 'i , ; ?' t$1EQ D ATfA ' t4 (k :0 i6.t' , " : ,:, - ; 4" :9 CO 1t wIM t I E CAI - USE ' t 14b51::-.:.'1: • z , . . Subdivision: / 5/3'40 C2'5 70/ Lot #: / of >. _.. ?-.. ;,�.; : ,.. _ , �;t . .. ; Tax map/parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate ( i ^;',; i l `.A. ;: D CR IONt )F wORTC ii - `v :... -,. `: , the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this appl on. �Q Ke e ft a,... , Valuation $ Existing building area (sq. ft.). New building area (sq. ft. _ Number of stories v. 00PtRT3 ONTNI R ixW,'. , :Eli 'TE IXISITi R 'r, ':4` :s` � " Type of constru • n M Name: 1701, OS Occupancy up(s): Existing: Address: New: C (((0 S (T City/State /Zip: "" twel are required to be Phone: S'03 -sip.- � '3 l.{KY 7� -, Fax: NOTICE: All contractors and subcontractors q 3 licensed with the Oregon Construction Contractors Board under Y ?�,PITICANI ?' 'r . ,; •y,( ®VONTA T MS. ON-=':: ; provisions of ORS 701 and maybe required to be licensed in the Business Name: YC jurisdiction where work is being performed. If the applicant is exempt Contact Name: di),�, ( ' from licensing, the following reason applies: Address: ft c S Si 0 t� �'tfi u Tef Otr. City /State /Zip: L( “.. , ( 4 % 70 ,- Phone: g03— l4Rf� — tS i /J �. Fax: - 6'i't ( _. .' z _ :.. K`.:�,iif .,y n '�, 4 w }# . ° ly -':.`±e.t:r .H . s .: : ,,: AN CUL( aL y s' #l: i - :k =t._B lk NG WM AT„ FE E S" a t - : '3: ;: � e ,.i , . E -mail: • :��� V SL h. � S' r? ch F.. 1•�n'M1� .45' � � y � , i.. .� S'a� S�SV Y.: -� �. .T :: jy� S4 ' J��� t; • , � _ Y � rf- i ..� Please refer to�fee75che$iil(.: ,.. .._ ,4":: : , -1 : . ::: : , , , . , .;1 . ..: - ,4:'" `V-ii -}CON -` G�+OR°' ' "3 :. ,yH •- 1 �;.,.; . �; � �� ' ' :, ,. �. .. o ... Fc Yy�,�SL S R � `S �! u : 9 1! t�� � �h-� � � �k� .'nli. .. k : �Ci:.` � ;•1�: V y . y �. {.4 "- _ .. � [. r . _ ..� _ . , - �-'•a.u".,. ,.�kt- _ _ ». n' ... • �. ua�� . �`� ;lc' 3 ¢'. cy� ': r.'., y . �s?�.e ;�q � :f,:- iv ".'E"•� Business Name: )L te . Fees due upon application $ Address: City/State /Zip: Amount received $ Phone: Fax: Date received: CCB Lic. #: Authorized Signature: Date: E �f L �v�• Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. � L k `` v r � u • *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) f i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 � \ 1 One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard `J ❑ Electrical O Plumbing O Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I 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. Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan ❑ 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 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, 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 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 & 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) FOR OFFICE USE ONLY Mechanical Per I:. I on Received Mechanical ' Date/By: Permit No.:/ 5jr 605 -0U f City of Tigard SEP 4 4 2003 Planning Approval Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Ore on 97223 Date/By: Permit No.: Phone: 503-639 - 4171 Fax: 509 g�IGAR r Post-Review Land Use B VI I IVI %a^z �,)r� I Date/By: Case No.: Internet: www.ci.tigard.or.us crl Contact Juris.: la See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. . ' . TYPE OF - WORK - • ..COMMERCIAL FEE *SCHEDULE'= USE CHECKLIST. • p New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work [( 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. 1 & 2- Family dwelling ['Commercial/Industrial ' Accessory Building ❑ Multi- Family Value: $ See Page 2 for Fee Schedule ' 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 - on air conditioning ** 14.00 Job site address: it( (Q 5 � ot Gas heat pump 14.00 Suite #: I Bldg. / #: t Duct work Z 14.00 (4 ` Project Name: 1:36( o S e•S, 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 e f - Red' `pd' ) 12u c{ Flue vent (water heater /gas fireplace) 10.00 c CC Log lighter (gas) 10.00 ' - ' "« � `t'`` - Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner /flue /vent 10.00 X PROPERTY OWNER , - •- . I ❑ TENANT Other: 10.00 Name: y�� ` Environmental Exhaust &•Ventilation 11 t1P s ' Range hood/other kitchen equipment 10.00 Address: 1 it I o Sw •6 4 A Le. Clothes dryer exhaust 10.00 City /State /Zip: —64 axe( r Single duct exhaust Phone: VS - S/0 7f , Fax: (bathrooms, toilet compartments, ,�] APPLICANT . ' . I ❑ CONTACT PERSON utility rooms) 6.80 Name: t Attic /crawl space fans 10.00 1 �� " ' t Address: ► ( /,� t) St . et t,�i I, *s .1)i- Other: Fuel Piping 10.00 City /State /Zip: 6f a•cica u.t ,4 1,1 �/{ 17D( Ss * *($5.40 for first 4, $1.00 each additional) Phone: cos- j -, g Fax: 5 of • ., Furnace, etc. ** 7! I Gas heat pump E- mail: J l[ kC ` a au.A.z'� I jet •'l. r WalUsuspended/unitheater ** r: CONTRACT. Water heater ** Business Name: 64 f 1A Fireplace *' Address: Range a t ** City /State /Zip: Clothes dryer (gas) at Phone: Fax: Other: ** CCB Lic. #: . Total: Authorized / / Mechanical Permit Fees* g Subtotal: $ Signature: L ��I�� / � ' ` / Minimum Permit Fee $72.50 $ %-. a k (Lit - 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\MecPerrnitApp.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 cach 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 101k 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: • • is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 • FOR OFFICE USE ONLY lectrlcal Permit Application Received Electrical RECEIVED Date/By: PermitNo.:nlSl"gLU3 DOSS Sign Cl of Tigard Planning Approval Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 SEP 2 4 200 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review land Use � y1, } ( Date/By: Case No.: Internet: www.ci.tigard.or.us CITY OF TIG' ' e . ' I I Contact Juris.: El See Page 2 for 24 -hour Inspection Request: 50t6i@f41ts6 DI - - ' Name/Method: Supplemental Information. ' ` • : TYPE OF WORK . - , .PLAN REVIEW (Please check all that apply) ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location [ Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, .. CATEGORY OF CONSTRUCTION • 1 & 2 family dwellings • four or more residential units in 61 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: - 'JOB SITE INFORMATION a d LOCATION - Submit _ sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: /(((Q cJ te c� t . FEE* SCHEDULE , Suite #: I Bldg. /Apt*: Number of inspections per permit allowed � S, Project Name: D escription Qty Fee (ea Total Q�a b ((� ,te 1 New residential - single or multi - family per Cross street/Directions to job site: dwelling unit. Includes attached garage. �firr Service Included: f (“ 1000 sq. ft. less 4 Each additional 500 sq. ft. or portion thereof 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 WO service and/or feeder 90.90 2 Q� / Services or feeders - installation, AV Z Gk.(taj 4.4 _ L f 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 lif,1 PROPERTY OWNER I ❑ TENANT , - . 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: tg IL I Ig Si {o S, Reconnect only 66.85 2 Address: j(( ( p 'W irrI4 6.1 Cr Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: -- a Qk , 200 amps or less 66.85 1 Fax: 201 amps to 400 amps 100.30 2 Phone: $��" 74 , ax: 401 to 600 amps 133.75 2 OLAPPLICANT El CONTACT PERSON Branch circuits - new, alteration, or Name: a C ( t, LA. r extension per panel: r rQ t A. Fee for branch circuits with purchase of Address: l J ul A I /i4 1,c l S r . service or feeder fee, each branch circuit 6.65 2 City /State /Zip: 0 et ck a,w. -M DR, q 7 ('S B. Fee for branch circuits without purchase of as service or feeder fee, first branch circuit 46.85 2 Phone 6QQ -as I Fax: S '- Pe -�6Q - - Each additional branch circuit 6.65 2 E -mail• t(1 ( c:th K Oai n Jter r E Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: l al on or ex t or limited energy panel, a Business Name: d alteration, or extension si on Page 2 2 Description: Address: City/State/Zip: Each additional inspection over; he allowable in any of the above: Per inspection per hour min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: Lic. #: Other: Electrical Permit - Fees* - ", Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized 9 7 f f ij Notice: This permit application expires if a permit is not obtained within Signature: ' Date: 6 ( C 180 days after it.has been accepted as complete. J 4(11. 64E4- *Fee methodology set.by Tri -County Building Industry Service Board. (Please print name) r 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: Audio and Stereo Systems* O Burglar Alarm • Garage Door Opener D Heating, Ventilation and Air Conditioning System ❑ Vacuum Systems ▪ Other COMMERCIAL WORK ONLY: Fee for each system ... $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: 0 Audio and Stereo Systems ❑ Boiler Controls O Clock Systems n Data Telecommunication Installation n Fire Alarm Installation El HVAC El Instrumentation O Intercom and Paging Systems • Landscape Irrigation Control 0 Medical ❑ Nurse Calls • Outdoor Landscape Lighting O Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Fotms\ElcPermitAppPg2.doc 01/03 Oct 10 03 l2:llp jc 503 - 698 -6668 p. 1 1!/10/03 10:52 FAIL 5038463525 CLEAN WATER SERVICES ®001 RECEIVED R p �� x i1� Numb er � OCT 10 °� 1.5 r� �3 OCT o s 2003 Luj C1eanWater Services Our commitment ;: cteIX OF TIGARD S • itive Area Pre -Sere ning Site Assessment BUILDING DIVISION By __-- ----- ((� f Jurisdiction • ` ' i,.6, % Date '4.A 61 Map & Tax Lot _ G �i/II Owner x, &T;�W r Site Address J i ,SvJ .914 - . y .• ��! s (Dr. - .acv i Contact _, i -° . ' OL Proposed Activity — , Address .rte -r b Phone — — OA7ciel we oMy Ddow Mhz fins Y N NA Y N NA ❑ ❑ Sensitive Area S1 Lei 1 .- 1 Map ❑ ❑ © QSrt �r �r�Vucture map; • ❑ n L mt Specify adopted studies or maps ❑ ❑ Specify a..002. oox a er. .s./ Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 03 -11: ❑ Sensitive areas potentially exist on site or within 20D' 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. El 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 LEVIER 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: "./apes czok - A.ce• Q...reed �jrh0 • • Reviewed By: Date: / Post -ir Fax Note 7871 DIne /iliydj l o► / Returned to Applicant Mail Par X Counter r �O�iti (i°w `'°"� /�a�.4,1... Datelo /a3 RY. movies Pt 7Sse - 34X3 ��° 553 698. Fa" • Permit #: I 7 c3 O - 9O Vga Address: /1 /10 SW Issued by: 929d— Date: /6 4s-l43 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: I I 1. I own, reside in, or will reside in the completed structure. I 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 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 3 B. I will be my own general contractor. 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 Owners a I out Construction Responsibilities on the reverse side of this form. ■ /vl /s/a3 . re o \ : it applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) [ : km1 M© c® too Prropeng Ordne m Qip®l� 0 ©ns T ©on G°3c oponalioMen :Vote: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5 ,). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. C��SPLOYER FZEOP O SM0=,0t] If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ofa residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply w ith the following: Oregon's wnholc1tiang lag law: As an employer. you must withhold income taxes from employee wages at the time employees are paid. You will be 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. Usnempioyment Han §ana•aance tan: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378 -3524. Wor2s:rs' co n, ersatIca Ens rarce: As an employer, you are subject to the Oregon Workers' Compensation Law. and must obtain workers' compensation insurance for your employees. Ifyou fail to obtain workers' compensation insurance. you may be subject to penalties and w ill be liable for all claim costs ifone ofyour employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. J.S.:in /eramail Revenue S -v ce: As an employer. you must withhold federal income tax from employees' wages. You will be liable for the tax payment even ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1- 800 - 829 -1040. 011=MR ESPOS o OUT S ABM AREAS OF COM RM: Cede coacnp aanse: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Un.bEay cand Lor©perty damp flaasuan•anDee: 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. tire. or work that must be re -done. Tiiaane to saapea employees: Make sure you have sufficient time to supervise your employees. (Expertise: Make sure you have 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 Oct 10 03 12:11p jc 503 - 698 -6868 p.2 '4 REECEVE D 11540 SE SOUTHERN LITES OR. CLACKAMAS, OREGON 97015 OO�j 10 NO3 Ph: 503-6 JTC INC. Fax 503-698-6668 E - mall: itcinc.johnthul@verizon.net CITY OF TIGARD BUILDING DIVISION Fax To: CITY OF TIGARD From JOHN CHU fax Pages: 2 include cover Pte, Date: 10/10/2003 Re: BOB ISBIES PLAN CC: Urgent 0 For Review O Please Comment ❑ Please Reply ❑ Please Recycle PLEASE ROUTE THIS FORM (CLEAN WATER SERVICES) TO THE BUILDING PERMIT FILE. 11110 SW TONY CT. THANK YOU. JOHN CITY OF TIGARD 24 -Hour a®tr3 -. 0 0 4 BUILDING Inspection Line: 3) 639 -4175 MST f 7-- INSPECTION DIVISION Business LI (503) 639 -4171 BUP Received Date Requested AM PM BUP Location ° = = _ � Suite MEC Contact Person 1/ 1 1 1 Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/ 00 n ELC Footing 3 - L 3/ ELC Foundation Access: Crawl ELR Drain 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: .Eina_ PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final C . PASSPART FAIL V - MECHANICAL Post & Beam Rough -In Gas Line S� Dampers __PASS —PART FAIL ELECTRICAL __ Service Rough -In Low olt Low Voltage Fire Alarm r PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: D Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 7/.17/09 Inspector a Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour - BUILDING Inspection Line: 639 -4175 MST 3 -17)11 INSPECTION DIVISION Business Li = (503) 639 -4171 BUP Received ` �lr�—o Date Requested Bo PM BUP Location 1/ /1° S W Suite MEC Contact Person - Ph ( 5Z'3 ) 13 PO-''/ F / PLM Contractor Ph ( ) SWR UILDIN� Tenant/Owner ELC ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear 1 a �,_p� � Ro Framing l `� t- Insulation Drywall Nailing Firewall Fire Sprinkler • Fire Alarm Susp'd Ceiling Roof • SS PART PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL Z: Rough -In Gas Line S i • e Dampers ii PART FAIL RICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Z / O Inspector Ext Other: Final DO NOT REMOVE this inspection re rd from the job site. PASS PART FAIL