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Permit
t: C 19 Y F TIGARD MASTER PERMIT PERMIT #: MST2001 -00515 . 4 iii -, , DEVELOPMENT Tigard, ) 639 -4171 DATE ISSUED: 10/31/01 SITE ADDRESS: 09870 SW VENTURA CT PARCEL: 1S125DD-05600 SUBDIVISION: WASHINGTON SQUARE ESTATES NO. ZONING: R -4.5 BLOCK: LOT: 064 JURISDICTION: TIG REMARKS: Convert space over garage to habitable space BUILDING REISSUE. STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND. sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT. sf RIGHT: VALUE: S 26,981 00 OCCUPANCY GRP R3 BDRM 1 BATH. 1 - TOTAL. 0 00 sf REAR. PLUMBING SINKS: WATER CLOSETS 1 WASHING MACH. 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS' WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 0 MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 2 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS. 4 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS' ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR. PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 • 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp 401 - 600 amp: EA ADDL BR CIR: 0 SIGNAUPANEL: 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: $ 756.14 SODERQUIST, DAVID R + PAMELA E KELMAN CONSTRUCTION & REMODTi9a d Municipal is subject , the regulations contained C o i the Tigard Mun Icipal Code, State of OR. Specialty Codes s and 9870 SW VENTURA CT 7540 N CHAUTAUQUA BLVD all other applicable laws All work will be done in TIGARD, OR 97223 PORTLAND, OR 97217 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 142712 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 Underfloor Insulation Electrical Rough In Plumb Final PLM /Underfloor Framing Insp Final inspection Mechanical Insp Low Voltage _ Plumb Top Out Insulation Insp Electrical Service Electrical Final / c •- I Issued By : 40,. _ 4`.. i ■ Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day /�'/ l , yl 0 ,_sz, Bull. Date received: Permit no.:MjpaZ)/-nd,575 `" , - i ?i'jP City a 5 - Projectiappl. no.: Expire date: City gjTigard 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: I &2 family: Simple Complex: , , TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ New construction 0 Demolition Addition/alteration/replacement 0 Tenant improvement ❑ Fire sprinkler /alarm 0 Other: JOB SITE INFORMATION Job address: 9 5 7D Stu VE/L1TLLRAA C.T, - rie 9 7,2-) - 3 Bldg. no.: — Suite no.: — Lot: ( y Block: ~- (Subdivision: W & ,& t;, cauftEEEJTR,e 1:1-zI Tax map /tax lot/account no.: 3 Project name: jyL cSDI) t/ /S ,'671ObEL fveoJELT -o Description and location of work on premises/special conditions: Rs TA 1 1S A D 17 1 Ti 0/3 P's 13 OV EGh(AC E , ) D /Ai& _ 7 EZR0O cr / Orr /0 /110 v;//6 L 4alUDR - , A/o &xTC2 /o,C /POD . — OWNER FOR SPECIAL INFORMATION, USE CHECKLIST ' (�j, Name: DqV I f /}A) b ,P flt. A S o p E 1.( lST (Flood plain, septic capacity, solar, etc.) 0 Mailing address: o g 7t Su) VEAJTURrI C T, I & 2 family dwelling: "r _ o t City: T/ &A (State:OR, ( ZIP: 9 7 L -3 Valuation of work $ .j) (/S _ 0 Phone: a --S - 94, 3(-, ' (Fax: a//y S/y3D(E -mail: SDD►FA/1 HD..r No. of bedrooms/baths Goner's representative: — Total number of floors Phone: Fax: — E -mail: — New dwelling area (sq. ft.) `r/00 APPLICANT Garage /carport area (sq. ft.) _ p Name: c//E2 4(,Z 2 _ al _ Amir , Covered porch area (sq. ft.) _ -.1 Mailing address: Deck area (sq. ft.) City: ( State: ( ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: Commercial/industrial/multi- family: CONTRACTOR Valuation of work /// $ o p Business name: I< EL/Yl/�1S) p/1J.5 T 2bit TtAti cr °E711DDEL. //llfr Existing bldg. area (sq. ft W Address: 7.S - t-/U N. CyRZ7rAtzaiA 73L Y1). New bldg. area (sq. ft.) Y P r ZT Ant I ( 7 Number of stories city: C State:0 ZIP: / Phone: 0 2 Et - / s'g ( Fax: p284,- /1/ 5 ( E -mail: — Type of construction CCB no.: 07 7/ a Occupancy group(s): . Existing: 7 New: City /metro lie. no.: (PS 7 3 $D PUP I LA-11)0; Notice: All contractors and subcontractors are required to be - ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Name: GA fl) /LEER . /)ROJ /TELT/ieE, Arfl PC provisions of ORS 701 and may be required to be licensed in the Address: a I a S S 41 Fauf'T/-1 AvE, S .$761 jurisdiction where work is being performed. If the applicant is City: f-' TL PYN n State: 6� (ZIP: 97ap / exempt from licensing, the following reason applies: Contact person: (;L.EIJ A? /LLk ' Plan no.: UIF e, Phone: ga - ei 71 Fax:8a7_ g E mai1:‘A rn aa!AlZLNt . C7Z0 , On/A ENGINEER Name: flt 'lQy-/ (cDLI/kko OtG v Qontact person: JO H rJ o(' - 1)L/ Fees due upon application $ Address: 3 60 . 9 S'yl N tT Aveivt[E Date received: City: (dp 'LL\ f State: Q j (ZIP: Ci 7 J Amount received $ Phone: o2a17 - 7713 ( Fax: ? 7_7789( E -mail: 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 ordinances governing this ❑ visa ❑ MasterCard work will be complied wih,ether spec' led herein or not. Credit card number: / / ��//// Expires `` ((JJ Authorized signature: /� Date: 10 . 3 -0) Name of cardholder as shown on credit card Print name: 7 V / T) R, of 9D au /ST Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-0613 (6/00 /COM) 1, 9 — Clt t ■ One- and Two- Family Dwelling � � a ,�.. • ° • ° ' ' Reference no.: A M1 e 1 , i Building Permit Application Checklist Associated permits: City ofTigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 r . - .''' THE. FOLLOWING. ITEMS ARE R FOR41LAN REVIEW ';` , ; . 31., l'' * _. , :Yes6 - N o''N /A'_ 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V 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 V • 6 Sewer permit. ✓ 7 Water district approval. ✓ 8 Soils report. Must carry original applicable stamp and signature on file or with application. t/ 9 Erosion control 0 plan ❑ permit required. Include drainage -way protection, silt fence design and location of ✓ catch -basin protection, etc. 0 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. 1 1 Site/ of plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and / rivewa , 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. r 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 e . 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. p o ✓ 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. • 26 No rolled, reversed or mirrored building plans will be accepted. 27 28 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. 440-46i4 (6/00 /COM) A Electrical Permit Application Date received: /Q S/ p/ Permit no. f , , / � A I l City of Tigard Project/appl.no.: Expire date: A. City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory Cl Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction Addition /alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION GI Job address: g g7a 6 j,) VE/ Ti1/) CT, T/64 Bldg. no.: — Suite no.: — Tax map /tax lot/account no.: — Lot: ( Block: (Subdivision: W I'bi ,3& -rotJ Sou/`2E ES A f$ 2. u'l Project name: TH r .kioI Description and location of work on premises: u Psm,,l5 AD P -i3 3OVE 46 kJ Estimated date of completion/inspection: if — 3C) — t CONTRACTOR APPLICATION FEE SCHEDULE « Job no: Fee Max 6` Business name: EPr&LE rz j=LT IC L Description Qty. (ea.) Total no. insp c) Address: �$'�G SIU 1nO ST. New residential -single or mull - family per dwelling unit. Includes attached garage. City: POCTLf)-OJT I State: 0f IZIP: 9 7 aig' Service included: D Phone: `,.10 - $D2( ? I Fax: / - 0 / I E -mail: 1000 sq ft or less 4 n Each additional 500 sq ft. or portion thereof , CCB no.: /€ I/ � 3 y I Elec. bus. lic. no: Limited energy, residential 2 X City /metro lie. no.: Limited energy, non- residential 2 9,y Each manufactured home or modular dwelling W Signature of supervising electrician (required) Date Service and/or feeder 2 Y1 Sup. elect. name (print): License no: Services or feeders — installation, °O alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): DAV 70 414b FA \ELA SDJER. i I ST 201 amps to 400 amps 2 g 9 g 7d rf 4 ) >��A CT, 1 401 amps to 600 amps 2 Mailing address: // 601 amps to 1000 amps 2 City: T /G-f » I State:Og I ZIP: 0 -7?--3 j Over 1000 amps or volts 2 Phone: ,296 -s3( IFax: 02W -9'361 E -mail: SOD trilM `HO d,„ . _Reconnectonly I Owner installation: The installation is being made on property I own Temporary servicesorfeeders - 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 � /Q 3 —b 201 amps to 400 amps 2 Owner's signature: a:14 �d Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: 3eR,Jt 1{ — N01? DL11 ENL-• 1 =N C , A Fee for branch circuits with purchase of Address: 36 Si.iJ ChRBET7 A VEAM'E service or feeder fee, each branch circuit 2 City: ppRTLAAJ tD I State: OK I ZIP: g 7 pc)/ B. Fee for branch circuits without purchase a a� 778 90 8� of service or feeder fee, first branch circuit. 2 Phone: Fax: 77 E -mail Each additional branch circuit: PLAN REVIEW (Please check all that apply) 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/lightingplan ❑ Other. Per inspection 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/oo /COM) 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 y 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 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular n Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation and Air Conditioning System` Installation, alteration, or relocation 200 amps or less $80.30 2 r —� 201 amps to 400 amps $106.85 2 I I Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 ❑ 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. n Audio and Stereo Systems Branch Circuits El New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit / $46.85 //G • 5' I � I I Each additional branch circuit $6.65 / 7 5 7' I HVAC Miscellaneous , ,, -, 1-' ❑ 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 ❑ Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over ❑ Medical the allowable in any of the above Per inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: / / ❑ Protective Signaling Enter total of above fees $ 474, Fi n Other 8% State Surcharge - $ ) e / 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 $ is \dsts\forrns \elc- fees.doc 06/07/01 • Plumbing Permit Application Date received: / b l/ p Pe t no.: sr / ,, - . City of Tigard i � , I Sewer permit no.: Building pe 4.4 Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: I 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 121 Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: 9ff79 Jll) VE✓NTW C : 1 77640),a I7, 3 Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: — New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: NAP: Islas Acr:Ra3Q5'03 SFR (1) bath Lot: �4 'Block: 'Subdivision: s S t ReE SFR (2) bath Project name: 7i/E SoDE72462U /ST k'S/NDDEL p2D JEC7 SFR (3) bath City /county: T(( )/ w / 4 . I ZIP: o) 7 x 2 3 Each additional bath/kitchen Description and location of work on premises: UPSTR1 i2 AID rrion) Site utilities: k 94-1 6ii.F �I Di 9 y / n T 7 , 'E /l /u o .� 2 Q o )p 't , l d OVVl E o /cE Catch basin/area drain nVia G %2 c R Fx Est. date of completion/inspection: /I - 3 b - 01 Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: MI l'( pA:il - Ek S) ' LL(Pl a /isJ6- Manholes Address: /5 J. m ITCH EcL cPINE Rain drain connector City: OREGOn: C / I State: o2 I ZIP: 9704' Sanitary sewer (no. lin. ft.) Phone: 9L/.0 - 2.99J, I Fax: (03,? -54,0 E -mail: Storm sewer (no. lin. ft.) CCB no.: 8 j 74' ' I Plumb. bus. reg. no: 3 --3 p6 Water service (no. lin. ft.) City/metro lic. no.: Sa t r2. C m€72e) Fixture or item: Contractor's representative signature: Absorption valve Back flow preventer / i j / Print name: 171 1 kE P A T E A .; Date: J Backwater valve • CONTACT PERSON nn as'ins/lavatory Name: G'lUrY€2 - 130/1/V a.6 0/1/V � leX __ w Clothes washer Address: Dishwasher Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): DA V / D Aa D PmmEL_R SODUUZ.01.(/ ST Floor drains floor sinks/hub Mailing address: ei g 7v S u) VENTLI R.! Cr: Garbage disposal Hose bi bb City: 7 /l•llLD I State: OR I ZIP: °/ 7 ?a' 3 Ice maker Phone: ?.91e - 53(0(0 I Fax: W'/ -7&Sb 1E-mail: So t i!;11 ©,y, 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 prop gtty wn a p r O S Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: �VII�J Date: /� - �/ Sump Tubs/shower /shower pan Name: 13EER - NORDL /A/G EA1 er, JAI 0 Urinal Water closet Address: 3(r,0 SW C)Rl3ETT AVE7✓uE Water heater City: pog-mlijoD I State: Cg I ZIP: 9 7020 / - Other: Phone: aa7 -7"7 83 I Fax: ?27- 7785I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application Plan review (at %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00 /COM) . PLUMBING PERMIT FEES: ` - PRICE_, TOTAL r Newt and 2- family dwellings only: v - - - FIXTURES (individual) - ' QTY (ea) - AMOUNT (includes all plumbing fixtures in PRICE > TOTAL • Sink 16.60 the dwelling and -the first100 ft. QTY (ea) . AMOUNT Lavatory 16.60 for each utility connection) - 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 Urinal 16 60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 1660 PLEASE COMPLETE: • 3" 1660 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 -Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: ; New ; Moved Replaced_` Removed/ permit . - . . - Capped - . MFG Home New Water Service 46.40 Sink ' I MFG Home New San/Storm Sewer 46.40 Lavatory I Tub or Tub /Shower Hose Bibs 16 Combination g i T Roof Drains 16.60 Shower Only Drinking Fountain 16 60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray / Washing Machine I 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 A 5 3U/Y!E "/ 4W^/d/uj Room 776.1 y " r /1 A s A-Un1 /` S /AKK . Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if - , Quantity Total is > 9 - *SUBTOTAL • . - •, 8% STATE SURCHARGE • **PLAN REVIEW 25% OF SUBTOTAL , Required only if fixture qty total is > 9 TOTAL $ • A * Minimum permit fee is $72 -50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36 25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review is \dsts \forms \plm- fees.doc 10/10/00 Mechanical Permit Application .- A' Date received: Per no.: / 4 / D/ //y /,o/ ev5 :.� I1 City of Tigard Project/appl. no.: Expire date: of Tigard Address: 13125 SW Hall Blvd, Ti OR 97223 City f 8 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building pemut no.: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement ❑ New construction XAddition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: 9S'7 S&votin! C7 , - 7 - 7 b92 fO / D$..'' 7 3 Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: r I Suite no.: — value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: tAA IS IAgbD - CSbOD A"R232$03 profit. Value $ . Lot: (p /-1- IBlock: - I Subdivision: Ia)Aytis r Rge *See checklist for important application information and Project name: 7/E 3oQ /( /5T RE71WPEL f OJ jurisdiction's fcc schedule for residential permit fee. City /county: T(o'Q //ijA..91 I ZIP: 9 7 - 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: UPJTA /EJ A, i)D /� /Dili AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE AODvFOrg.ALE, Pr DDH'J 0! Ofl( eHOIPE p// ' /CE, 7YdV /n/6fill/1461, Fee(ea.) Total Est. date of completion/inspection: 11/ 3D - 0 / Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Air handling unit CFM Is existing space heated or conditioned? ❑ Yes J No Air conditioning (site plan required) Is existing space insulated? ❑ Yes No Alteration of existing HVAC system MECIIANICAL CONTRACTOR Boiler /compressors State boiler permit no.: Business name: 51v) 'TA j4Eicti AA, S fn R. CO JD I TO4bac , / 41 0 . HP Tons BTU /H Address: PO Box (, Fire/smoke dampers/duct smoke detectors City: pa I State: O(.. I ZIP: C) 7 920 Heat pump (site plan required) Phone: . 0,a 7- ITS I Fax: 0,2 - 7d,g7I E -mail: InstalUreplacefurnace/burner BTU /H Including ductwork/vent liner ❑ Yes ❑ No CCB no.: So27s3 Install/replace/relocate heaters - suspended, City /metro lie. no.: 3 (j(, 7 (IY► ET/ZU i) wall, or floor mounted Name (please print): in i cH A EL SPA )1-1A Vent for appliance other than furnace CONTACT PERSON Refrigeration: Absorption units BTU/H Name: Chillers HP Address: Compressors HP Env romnental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone: Fax: E -mail: Dryer exhaust OWNER Hoods, Type 1/11/res. kitchen/hazmat hood fire suppression system Name: PA Ji f .e a DA V r S D i7EP.ZAU iSr Exhaust fan with single duct (bath fans) Mailing address: q g 7D S u) ven- ThrPJ1 C-T, Exhaust system apart from heating or AC City: T/ ( f2l) I State: 0k I ZIP: Gj 7 ?a-3 Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: 9- - Fax: aw -V 31 E -mail: S D D iP41r®Ho(I� € � Fuel piping each additional over 4 outlets Process piping (schematic required) Name: . �12 N 02DUAXT EA) U . , /D N . Other l of d appliance - Other listed appliauce or equipment: Address: 3 (o0 SUJ CD 2,4E77" Ay EN a Decorative fireplace City: pop I State ;OR I ZIP: G}' 7 aij ) Insert -type Phone: 0-9-7 - 7 7 g 3 Fax: ,�a7 -778 E -mail: — Woodstove/pelletstove Other: Applicant's signature: I Date: /Q -3 —0/ oth Name (print): DA V (! 60 D - 72& G(/TT Not all jurisdictions accept credit cards, please call junsdiction for more information. Permit fee $ ❑ Visa ❑ MasterCard Notice: This permit application 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: TOTAL VALUATION: FEE: Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt $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 Check all that apply: . Boiler Heat , Air . $1.20 for each additional $100.00 or For items 7 -11, see or . Pump Cond. fraction thereof. footnotes below., Comp ' " 7) <3HP;absorb unit to 100K BTU 14 00 ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb Value Total unit 100k to 500k BTU 25 60 Description: Qty (Ea) - Amount 9) 15-30 HP; absorb Fumace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00 ducts & vents 10) 30 -50 HP; absorb Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20 ducts & vents 11) >50HP: absorb Floor furnace including vent 955 unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM floor mounted heater 10.00 Vent not included in applicance 445 13) Air handling unit 10,000 CFM+ permit 17 20 Repair units 805 14) Non - portable evaporate cooler < 3 hp; absorb. unit, 955 10.00 to 100k BTU 15) Vent fan connected to a single duct 3 -15 hp; absorb. unit, 1,700 6 80 101k to 500k BTU 16) Ventilation system not included in 15 -30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10 00 mil. BTU 17) Hood served by mechanical exhaust 30 -50 hp; absorb. unit, 3,400 10.00 1 -1.75 mil. BTU 18) Domestic incinerators >50 hp; absorb. unit, 5,725 17.40 >1.75 mil. BTU 19) Commercial or industrial type incinerator Air handling unit to 10,000 cfm 656 69.95 Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves Non - portable evaporate cooler 656 10.00 Vent fan connected to a single duct 446 21) Gas piping one to four outlets Vent system not included in 656 5.40 appliance permit 22) More than 4 -per outlet (each) Hood served by mechanical exhaust 656 1.00 Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge • - $ inserts, etc. .. Gas piping 1-4 outlets - 360 25% Plan Review Fee (of subtotal) - $ Each additional outlet 63 Required for ALL commercial permits only ' , . - TOTAL COMMERCIAL - $ TOTAL RESIDENTIAL PERMIT FEE: ' , I $ VALUATION: Other Inspections and Fees: 1 Inspections outside of normal business hours (minimum charge -two hours) $72 50 per hour 2 Inspections for which no fee is specifically indicated (minimum charge -half hour) $72 50 per hour 3 Additional plan review required by changes, additions or revisions to plans (minimum charge-one-half hour) $72 50 per hour * State Contractor Boller Certification required for units >200k BTU. "Residential A/C requires site plan showing placement of unit. is \dsts \forms\mech- fees.doc 10/11/00 CITY OF TIGARD '13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MIKE PATTERSON PLUMBING 15028 S MITCHELL LANE OREGON CITY, OR 97045 Plumbing Signature Form Permit #: MST2001 -00515 Date Issued: 10/31/01 Parcel: 1 S125DD -05600 Site Address: 09870 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NC Block: Lot: 064 Jurisdiction: TIG Zoning: R-4.5 Remarks: Convert space over garage to habitable space. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: SODERQUIST, DAVID R + PAMELA E MIKE PATTERSON PLUMBING 9870 SW VENTURA CT 15028 S MITCHELL LANE TIGARD, OR 97223 OREGON CITY, OR 97045 Phone #: Phone #: 632 -7374 Reg #: LIC 81746 PLM 3 -359PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X 4' Signature of Authorized Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE EAGLE ELECTRIC LLC 4840 MOSS ST PORTLAND, OR 97219 Electrical Signature Form Permit #: MST2001 -00515 Date Issued: 10/31/01 Parcel: 1 S125DD -05600 Site Address: 09870 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. Block: Lot: 064 Jurisdiction: TIG Zoning: R-4.5 Remarks: Convert space over garage to habitable space Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: SODERQUIST, DAVID R + PAMELA E EAGLE ELECTRIC LLC 9870 SW VENTURA CT 4840 MOSS ST TIGARD, OR 97223 PORTLAND, OR 97219 Phone #: Phone #: 452 -8026 Reg #: SU 3565S ELE 26 -968C AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of SuOgrvising Electrician If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 24 -Hour " BUILDING Inspection Line: (503) 639 -4175 MST dO0( — DO 575 INSPECTION DIVISION • Business Line: (503) 639 - 4171 / d BUP Received Date Requested AM PM BUP Location 77) EE Suite MEC Contact Person � Ph ( ) e2 cf —6 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing 19 Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: I �( SIT ` Post & Beam �. N his' , 1 J p ps w o 'it � �p)1 2 Ext Sr Sh ea Anchrs th / ear \ h 1 � } ��) �� U`f Ext eah/h `'fl I 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 Storm Drain Shower Pan Other: • Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab . Low Voltage G LA? �)^ F' rm �a1 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S PART FAIL Please call for reinspection RE: Unable to inspect – no access Fire Supply Line / ADA G Approach/Sidewalk Date "� Onspector �� Other: Final DO NOT REMOVE this inspection record from t ois site. PASS PART FAIL CITY OF TIGARD • 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 0200 — a O SL INSPECTION DIVISION s. Business Line: (503) 639 -4171 - 7 BUP - Received Date Requested l I AM PM BUP Location ? R 70 V(-12-1/1 C2 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR Yn BUILDING Tenant/gar /24'� G'V �o - £3'' ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewall Fire Sprinkler Fire Alarm Susp'd Ceiling /" Roof Other: Othe Final PASS PART FAIL PLUMBING • Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: n ASS PART FAIL • MECHANICAL Post & Beam Rough -In Gas Line S_• __Dampers S PART FAIL CTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Anal 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: 0 Unable to inspect — no access Fire Supply Line ADA f Approach /Sidewalk Date 1 Inspector Ext Other: Final DO OT REMOVE this inspection record from the job site. PASS PART FAIL s CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested f / — 2 4 ) AM PM BLD Location C 7 & 7 0 )JC. Suite MEC Contact Person Ph 4.1( , PLM Zoo se, D mi Contractor Ph SWR BUILDING Tenan ner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation e Drywall Nailing . Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: _ Final PASS PART FAIL PLUMBING • Post & Beam . Under Slab 6 r _ Top Out Water Service Sanitary Sewer Rain Brains 40.—* PART FAIL - • NICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk ij/1 Appr Date o f Inspector ' e' // t� 1��- Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.