Permit TV ? 7 -a3 -o3 ,
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A • Building Permit Applicat .1
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Date received Q3 Pennitno.:�{r -op?
aoo ?
t'�_I! City of Tl `dr � �I " Project/appl.no.: Ex. ire date: -
Cityogard Address: 13125 SW H lvf, Tigard, OR 97223 - wu
fT
Phone: (503) 639 -4171 JUN 3 u 2003 Date issued: ' Receipt no.: •
Fax: (503) 598 -1960 C Case file no.: Payment type:
CITY OF TIGARD
Land use approval: _ 4 , i _, _, 1 &2 family: Simple Complex: - tit.
... . i r F of , - illl rr ,
❑ 1 & 2 family dwelling or accessory 0 Commercial/industri • O Multi- family ,'New construction 0 Demolition
O Addition/alteration /replacement 0 Tenant improvement O Fire sprinkler /alarm 0 Other
-, � fi ,,
a : -, SNFORM ON I, ' . ^� • k ,*- O B_'ITE I .. 's I -e -t Sl � ? s - i 0- F ^ ., NYI. M 4. , as , 0.*� ,.:,„.;,-`.-•.:':1..,,,,,,',-.;
. Yii3
Job address: gj j, ,/ % 4J� i I /, L ', _ . r Bldg. no.: Su no.:
n s
Lot: Block: Subdivision: Mit , i“ Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: 0
OWNER FOR SPECIAL INI.Ol iAl'lON;- USI._ClLECliLIST
Name: �f� li �' � 14 dir ' (I �loodplain ; septiccapacit), solar, etc.)
Mailing address: -e z R�!'3m art I & 2 family dwelling:
City: IMO ZIP: i inirs61. Valuation of work $
Phone:. r" �l �� , -mail: No. of bedrooms/baths / r/
Owner's representative: '',lf j I cut (ft � Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) Wr#0
APPLICANT E- _ _' '1 Garage/carport area (sq. ft.) r '
Name: VM , �.a` % Covered porch area (sq. ft.)
Mailing address: e. tty1p - s a , Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: _a k „� d � i iiriidasL! New bldg. area (sq. ft.)
Address: _ • v �r Number of stories
City: State: ZIP:
Type of construction
Phone: I Fax: I E -mail:
CCB no.: 7, 5 Occupancy group(s): Existing:
New:
City/metro he no.: Notice: All contractors and subcontractors are required to be
, ` " -"ARCIfi_ITECI%DE.SIGNER
,, P..- licensed with the Oregon Construction Contractors Board under
Name: (IC/AA la 6111111 : - provisions of ORS 701 and may be required to be licensed in the
Address: C Ai jurisdiction where work is being performed. If the applicant is
'` ` exempt from licensing, the following reason applies:
City: State: ZIP:
Contact person: Plan no.:
Phone: Fax: E -mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions ,rapt credit cards, please call jurisdiction for more information.
attached checklist. • . rovisions of 1 ws and oi-dinances governing this 0 Visa O MasterCard
work will be complt . wi whether cifred ilereA t (� Credit card number: / /
1 a y . t k ' � ` y� '11 n2 7 Expires
Authorized SI a am r-• .. ..� � Name of cardholder as shown on credit card
Print name: _L air 4 1 (. K_ Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44e -4613 (6/00/COM)
One - and Two - Family Dwelling
,y; . Building Permit Application Checklist Reference no.:
City of Tigard Cl of Tigard Associated permits:
J g ❑ Electrical 0 Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING'ITEIIS•ARE;REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. i
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved platlot.
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 CI plan Cl 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 r/
if copyright violations exist. J�
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 x
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, t ,.
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, roofmg, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation. etc. J�
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. J�
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. x
20 Manufactured floor /roof truss design details. • y
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required 1'
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 ". X
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
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 -4614 (sroWWCOM)
4 , ,, ,.. -.- Mechanical Permit Application
Date received:6 14 Permit no.:Vvaicog5.-06,24/
Y 6 ''1 ' � City of Tigard t ill, ^;_� l ty g Project/appl. no.: Expire date:
City ofT Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: l Receipt no.: _
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement •
XNew construction 0 Addition/alteration/replacement 0 Other.
`;:JOB'SITE INFORMATION, ; '' "- r ,; , j r VALUATION. SCHEDULE ,
VIIIerpli Job address: do %� er l ; t I ndicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot ,..,��'7 Block: Subdivision: j ' 'See checklist for important application information and
Project name: An " jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: 1 & 2 FAiMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? Cl Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
, Boiler /compressors , ■
. 1-- ECFIAWICA1L CnN RACTO q t
��}� ` State boiler permit no.:
Business name:
�.l�SZa . fi I. J - HP Tons BTU/H
Address: tllrairp_ Fire /smoke dampers/duct smoke detectors MI
City: � �� 21IN M ZIP: -N ij a Heat pump (site plan required) IM
Phone: _�j Fax: E -mail: ■ ■-
Install/replacefurnace/burner BTU /H
, jGj
Including ductwork/vent liner ❑ Yes !] No
CCB no.: • • InstalVreplace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted ■ --
Name (please print): 4 rdilp G �lV Vent for appliance other than furnace i
CONTACT PERSON Abs ■ --
Absorption units BTU/H
Name: # is , ° % • Chillers HP MI ME
Address: Compressors HP
♦ + Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWN y R', ;` Hoods, Type I/ II/res. kitchen/hazmat
•' hood fire suppression system - __
Name: 1 ..iii �l Exhaust fan with single duct (bath fans)
Mailing address: wirj _/ A�_aed Faust system apart from heating or AC NM
City: . ,, Ip , State 1 '4 ZIPR-20 Fuel piping and distribut (up to 4 outlets) ■ --
Type: LPG NG Oil
Phone: ■
7 - �l Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schemauc required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: [ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove ■ --
. s Applicant's si :��,�, yl ro' J Date: F Oth MI
Name (print): .(r • , '
T
Nor all jurisdictions accept credit cards. please call junsdicuon for more information. Permit fee $
Notice: This permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number E
Expires w i t hi n 180 d after it has been Plan review (at %) $
x
p State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (600ICOM)
•
r
Plumbing Permit Application
4 111 .11t' Date received: , , � b Permit no.: t ,_�, �. • •
141 City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd., Tigard. OR 97223 Expire date:
City ofTigard Phone: (503) 639 171 Project/appl.no.:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case tile no.: Payment type:
-. PER
:TYPE OF i1T
O & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
. New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
' ' r r :.``: JOB SITE INFORMATIOI� , "`' , Y , I y FEE SC EDULE (for special informatt ru checklist)
Job address: 1 7 I glu! W Description Qty. Fee(ea.) Total
New 1- and 2- (amity dwellings only:
Bldg. no.: Suite no.: (includes 1009. for each utility connection)
Tax map /tax lot/account no.: SFR (I) bath
Lot: d Block: Subdivision: LVIM^ I VAral SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities: .
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
— Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: P.c. ` 7 L . Manholes
Address:
�� ,
Rain dram connector
�� S tate - AO /1 i ZIP: Sanitary sewer (no. lin. ft.)
City: G v� � Storm sewer (no. tin. ft.)
Phone:(' —L-5L../ Fae: E -mail: Water - service (no. lin. ft.)
CCB no.: , (9 7 L( -] I Plumb. bus. reg. no: - - ' Fixture ry i tem:
City/metro tic. no.: N/A / �/ / — Absorption valve
Contractor's representative signature � /t,/ , -..,,_ 1 Back tlow preventer
Print name: , iAIS, Backwater valve
CON PERSON - Basins/lavatory
1 I . (� t)' E Clothes washer
Name: �`� Dishwasher
( Address: Gx�.rr•P (,1,,, CtIcy t° _ • Drinking fountain(s)
City I State: [ ZIP: ' Ejectors/sump _
Phone: I Fax: E -mail: ' Expansion tank
Fixture/sewer cap
, y � Floor drains/ floor sinks/hub
Name (print): - : �t� Garbage disposal
Mailing address: _ - "• • �a► 11 . r Hose bibb
City L _C) . State ZIP:q - 70. �j Ice maker •
Phone: 2 7 - 1 1 i Fax: > - : Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Pnmer(s) ■
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENG IN EL R. Tubs/shower /shower pan MI
Urinal
Name: ' Water closet
Address: Water heater
City I State_ J ZIP: Other.
Phone: — I Fax: E -mail. Total
.
.
Minimum fee .............. $
Not all lunsdscuons accept credo cards please call luns:Lcuon for more tnformuuon Notice: This permit application Plan review e .. %)
0 visa 0 tilaslerCarti expires if a permit is not obtained
C.edit card number / / within 180 days after it has been State surcharge (3%
) .... $ ---
Expires TOTAL $ —"
accepted as complete.
None of cardholder as shown oa credit card
$
Cardholder signature Amount 4404616 (&WCOM)
. .
. , .....
Electrical Permit Application
Date received: PIO Permit no.: ,,,63-•,_s`
gi i! City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial Cl Multi- family 0 Tenant improvement
' New construction 0 Addition/alteration/replacement 0 Other. 0 Partial
.I011 SITE INFORMATION' - • - •
Job address: �.1�7'A/�ti /I ;� '� t ldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: aMEM Block: Subdivision: illinai(, 7
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CON I RACI OR ,\lfl'l.IC.\"I ION FEE SCHEDULE -..
Job no: _ Fee Max
D Qty (ea.) Total no. Imp
New residential -single or multi- family per
Address: 4P. 4. I/ • �� at` dwelling unit. Includes attached garage.
En ='� ' :, Sere ceincluded:
Phone: 7j 1 hj Fax: E -mail: iiii 1000 sq. ft. or less 4
�' Each additional 500 sq. f . or portion thereof = = =—
CCB no.: y Elec. bus. lic. no: • 0 Limited energy, residential 2
('c am Limited energy, non- residential ___ 2
)/ �) , Each manufactured home or modular dwelling ■■.
nature of supervising electrician (required) Date er /i� Service and/or feeder 2
• .i Seeraofeeders— installation, IIII
Sup elect name (print) . _ A rJ' 1 , ' k License no A • J
alteration or or rellocatcat ion:
PROPERTY O\VNI:R 200 amps or less 2
• 201 amps to 400 amps ___ 2
Name (print): tNt1.`L.yail• 401 amps to 600 amps ___ 2
Mailing 4. ing address: ��� ����' /> r�• . 601 amps to 1000 amps MOM 2
City: • , CiLii1 m ZIP: a I Over 1000 amps or volts
Phone: ,1261-2MES,WEParial Reconnect onl __ 1
Owner installation: The installation is being made on pro I S wn T services or feeders - 111.111111 2
irtstallation,altention, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps ___ 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: • service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit: •__—
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): IIIII
Cl Service over amps-commercial 225 amps-commercial Cl Health-care Each pump or irrigation circle 2
are facility
O Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting __ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ■■■ 2
O System over 600 volts nominal more residential units in one structure alteration, or extension
O Building over three stones Cl Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other Per inspection __
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdtcuons accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (at To) $
0 Visa 0 MasterCard expires if a permit is not obtained
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 (600/COM)
•