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Permit CITY OF TIGARD MASTER PERMIT ii „......, COMMUNITY DEVELOPMENT COMMUNITY MST2013 00074 T LGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/22/2013 Parcel: 1 S 135CA01902 Jurisdiction: Tigard Site address: 9600 SW NORTH DAKOTA ST Subdivision: BOETCHERS ADDITION TO GREENBURG I Lot: 1 Project: Purkey Project Description: Remodel fire damage & return 4 -plex into SF residence by relocating interior non - beraring walls and removing exterior door and window and replace with overhead door (re- convert garage) BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $10,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 10 Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Ecompasing: N Other: N Other Description: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 0 Owner: Contractor: PURKEY, DIANE CORNERSTONE DISASTER REPAIR Required Items and Reports (Conditions) PO BOX 42 5331 SW MACADAM AVE SUITE 377 BEAVERCREEK, OR 97004 PORTLAND, OR 97239 PHONE: PHONE: 503 - 295 -0108 FAX: 503 - 295 -1896 Total Fees: $932.32 Thi ermit is issued sub - t to the regulations contained in the Tigard Municipal Code, State of OR. Speci- ty C. .es and all other - 'plicable law. All work will done in accordance with - .proved plans. This permit will expire if work is not started within 180 days of iss =' ce, or if work '- spend" for more the 180 days. ATTENTION: Oregon s you to follow the rules adopted by the Oregon Utility Notific- io Center. Thos es ar- set iotth in OAR 952 - 001 -0010 through OAR • 2 -001 / r r ' ou may obtain a copy of the rules or direct questions to OUNC by calling 50 3 .19 :7 or .800 • 44. lit I t iL Issued By: // Permittee Signature: V _ Call 503.639.4175 by 7:00 a.m. for the next available inspection d ,. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Bui Permit Application RECEIVED 'rl • • * lOR0111( I ( .1. t)\I.1 City of Tigard MAR 2 5 2013 Received ats a --5/(9-3/ /3 S, Permit No.v a 1 3 -Jvo III • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1 (% I ( ` 3 Other Permit: Phone: 503.718.2439 Fax: 503 . 598 . 1 �dTY OFTIGARD Date/By: / �rj Inspection Line 503 D a t e Ready y Jar s: See Page 2 for rIGARn BUILDING DIVISION / u Internet: www.tigard or.gov No tifi ethod: x t t P Supplemental upplemental Information 1---/U TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. X I ndi Additiorteratior� replacement cate the value (rotnded to the nearest dollar) of all ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1.11ip and 2 -famil dwelling Valuation: $ %*� � 2-family g ❑C ommercial /industrial tr v / 12 Accessory building El Multi-family Number of bedrooms: El Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: C-4.420 5-/ i -7 . -k i A �" New dwelling area: square feet City /State /ZIP:. 7&1 Z) / f�g A, GI �s 5 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST , • ' 'sion: Lot no.: it fees* are based on the value of the work performed. /; is map /parcel no.: In ' to the value (rotnded to the nearest dollar) of all o _ e / _ Al /., . — / ..4/ equipm materials, labor, overhead, and the profit for the 0 t //v . M't ;Moil; OF WO ' S ,, ,vc��- q ork indic on this application. IITTLL �L aluation: S 1,1 L!. , f � i k . AX _ 1 P Existing building area square feet t , • � 1� ovr g ..Iw � , New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Ca'C ) Number of stories: Name: ttikjE p e Type of construction: Address: ci t% so' A4.: £A„ --,r* 5:77. Occupancy groups: City/State /ZIP:. - me �.� I , , t o r c Existing: Phone: ( ) Fax: ( ) New: APPLICANT J°'t CONTACT PERSON NOTICE Business name: T. „ 7ti.t 0 ' ...c devil) L1_ All contractors and subcontractors are required to be Contact name: cow licensed with the Oregon Construction Contractors Board L,0 under ORS 701 and may be required to be lensed in the Address: P,0 LDX, . f 2., jurisdiction in which work is being performed. If the City/State /ZIP: e f .� �U� applicant is exempt from licensing, the following reasons �� Ca t apply: Phone: ( 0 b 3 Z_2 k'b 2,- Fax:: ( ) E-mail: 5 c- V b ttl) / Co C(TRACTOR BUILDING PERMIT FEES* (Please refer to fee schedule Q„ Business name: ; 'n � I t ..4� �� �.. i ��, ?t, e_., e_., lw ,y Permit fee: Address: 53-3/ c i i T -v i � State surcharge (12% of permit fee): City/State/LIP: Z� ✓ , 0 4 ► V ( 7 z-.3 7 FLS plan review (40% ofpermit fee): Phone: Q7.3 Ze7 _ O k ) Fax: ( ) (Due upon application.) CCB lic.: / 5" LI I l Total permit fees: - Authorized signature: Amount received: `„l This permit application expires if a permit is not obtained Print name: � � k Date: 5 - -2,01) within 180 days after it has been accepted as complete. / * Fee methodology set by Tri -County Building Industry Service Board. 1 \BuildinguPermits\FPS- PemtitApp .doe Rev 01/05/2012 440-4613T(1 1/02/COMAVEB) ? tf,( 7 7 City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition ❑ 1 -10 heads: No plan review required. ❑ Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ❑ Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ C.) Fire Alarm Submittal shall Battery Calculations ❑ Yes include: Individual Component ❑ Yes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $198.75 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal (see A, B & C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ FLS Plan Review (40% of permit fee): $ TOTAL: $ Plan review requires a completed application and three (3) sets of plans at submittal. Plan review fees are required at submittal. I: \Building \Pemvts \FPS- PermitApp.doc Rev 01/05/2012 2 APR, -03 -2013 10:09 AM L &K ELECTRIC 5036630343 P. t ttil u�11 Electric 1 P r it A tic ti '�EIVED s, --Cl) �07 Received f, 4, , 5 sf Per mit No. City of Tigard oato'B I A • • 13125 SW Hall Blvd., Tigard, OR 91 2,11, Plan Review Other Permit a Phone. 503.718.2439 Fax 503.59 Hll 0 3 3'3 Date B n See Page (o ao 3 r Date Ready /By Ju Supplemental fa 1 I i. A I (.1) Inspection Line' 503.639.3175 '�otifiedwlcthod Internet; www.tigard -orgov CITY OFTIGARD .. --' G DIVISION PLAN REVIEW T1�� Please Check ell that apply (submit i sets of plans w /items Checked below). ❑ D ew cow co nstruction ® Addition /alteration /replacemen ❑ Service or feeder 400 amps or more ❑ Building over three stories ❑ Oth where the available fault current ❑ Marinas and boatyards ❑ emolition exceeds 1D,000 amps at 150 volts or ❑ Floating buildings. CATEGORY OF CONSTRUCTION leas to ground, or exceeds 14,000 ❑ Commercial -use agricultural El l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps fbr all other installations. ❑ b ui ld ings. of 15 KVA or ❑ Other: ❑ Fire pump. (21 Multi family ❑ Master builder ❑ Emergency system. larger separately derived system, JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of CI "A", "E ". "1.2 ", "I.3 ", IOOFIP or more occupancy, ❑ Si x or more residential nu ❑ Recreational vehicle parks Job no.: 13 - 4250 Job site address: 9600 SW North Dakota S ❑ Health -care facilities. ❑ Supply voltage for more than City /State /ZIP: Tigard ❑H a zardous locations 600 volts nominal. ❑ Service or feeder 600 amps or more, Suite/bldg. /apt. no.: Project name: - FEE SCHEDULE - Uetc, • • t.a , r. .hl * Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1.000 sq. ft or less 168 54 4 Subdivision: Lot no.: - 3392 t Ea add'I 500 sq fl or portion i Tax map/parcel no.: Limited energy, residential 75 DESCRIPTION OF WORK (with above sq It) Limited energy, multi- famil) Attach to permit MST2013 - 00074 residential (with above K. ft ) ,_ 75'00 2 1 Services or feeders installation alteration, and/or relocation _ 200A overhead service with 10 branch circuits 200 amps or less I 100.70 100.70 2 0 PROPERTY OWNER 0 TENANT , 201 amps to 400 amps 133.56 . 2 401 amps to 600 amps 200.34 2 1 Name: Purkey 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552 26 , i 2_ Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation 200 amps or less 59.36 H Phone: ( ) Fax: ( ) 201 amps to 400 amps 125 08 2 Owner Installation: This installation is being made on properly that 1 own w is not 401 amps to 599 amps 168.54 - 2� intended for salt. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension per panel Owner signature: - Date: A. Fee for branch circuits with above service or feeder fee. 10 7,42 74 20 2 Cl APPI,ICANT ©CONTACT PERSON each branch circuit . B Fee for branch circuits x irhout Business name: service or feeder fce, first T 56 18 2 branch circuit .. Contact name: _ Each add'/ bra nch circuit 7 42 2 Address: Miscellaneous (service or feeder not included) - Each manufbctured or modular 67.84 2 City/State/ZIP: dwelling, service and/or feeder _ Reconnect only 67,84 2 Phone: ( ) Fax ( ) Pump or irrigation circle 67.84 2 E Sign or outline lighting 67.84 2 CONTRACTOR - circuit(s) or limited- energy panel, alteration, or extension Page 2 2 Business name: L & K Electric, Inc. Each additional inspection over allowable in any of the above Address: 10122 SE Shady Lane Additional inspection (I hr mm) 66 25/ hr Investigation (l hr min) 66.25/ hr City /Stale /ZIP: Damascus, OR _ Industrial plant (I hr min) 78.18/ hr Phone: (971) 506 - 8351 Fax: (503) 663 - 0343 inspections fbr which no fee is 90.00/ hr — specifically listed ('1i hr min) .• cell Lic.: 157326 l Electrical Lic.: 26-I 180C uprv. Lie.: 4975S ELECTRICAL. PERMIT FEES _ . _ ,, Subtotal 174.90 Su rv. Electrician signature, re uired; ' p g q 4 , - Plan review (25% of permit fee); Print name: Larry Peterson , / Date: 4/03/2013 State surcharge (12% of permit fce): 20.99 7 .r. TOTAL PERMIT FEE; ) 195.89 Authorized signature: L ' /44,A. �,/ � _ This penal, application explrea If a permi is not obtained within ISO days afar It has boon accepted as complete. Print name: Larry Peterson •'' Date: 4103/2013 • Number of inspections allowed per permit I '• 6wldmp',Pcrnt, :ELC- Penni '01 :C 440- 461Mt'11I/05/COM/WEa Mechanical Permit Application RECEIV: i = .: , ,. r : -.i ., City of Tigard - Dre 13 Perris No.:0 13 - 0 4- I 13125 SW Hall Blvd., Tigard, OR 972231 - 0 2 2011 Plria Review Phone: 503.718.2439 Fax: 503.598.1960 Da,eity. OlbOE Permit Inspection Line: 503 L; ; \RI) l u a' .... Ql se, Pare lfor - 1'I Inter www.tigord -or goy CITY OF TIGAR[ �;� d - Suppl emental laftr„atios BUILDING DIVISION -- — — -.___ .._ _�w... — TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST Mechanical permit fees' arc bused on the value of the work ❑ New construction Add it' terati replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit Value: S CATEGORY OF CONSTRUCTION i RESIDENTIAL EQUIPMENT /SYSTEMS FEES' at and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building Forspedal htforatallon use checklist ■ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total JOB SITE INFORMATION AND LOCATION fleeting/cooling: / �i Air conditioning Job site address: gh(XJ _S-iii /V 04Th Dj _T , (rogwra site p showing placement) 46.75 ! Fumaee 100,000 ST11(duets/vents) 46.75 City/State/ZIP: T(44) , n g_e D , f GI '1Z Furnace 100,000t- 13TU (duets/vents) nts) j 54.91 Suitc/bldgJapt. no.: I Project name: •V ilea pump (requires site plan showing placornent) 61.06 Cross street/directions to job site: Duct work , 1 23.32 llydronic hot water system 2332 Residential boiler (radiator or hydronic) 2,332 , Unit healers (fuel-type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: I Lot no.: Flue/vent for any of above 23.32 Other: 23.32 _ Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK 41iggiA%t., Water heater j 23.32 Gas fucplacelinscrt 33.39 Flue vent for water healer or gas fireplace , 23.32 Log 1ip,hter j)(as) 23.32 Wood/pellet stove 33.39 . Wood fireplace/insert 23.32 X PROPERTY OWNER I 0 TENANT Ctdmneyllirner!(ltx / vent 23.32 Other: 2332 Name: .. > , Pvc2.4-.,:e`. Environmental exhaust and ventilation: Address: `I bno ` S / , / MO A-11-1-1 1 za Th— s- �� Range other kitchen 33.39 rV r` e1 r City/State,./ZIP: ` j t o RE G,TA.4 9 -1 •Z25 Clothes dryer exhaust t 33.39 l Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet cotnparun ants, utility rooms) 2332 APPLICANT 1,4, CONTACT PERSON Attidcrawlspace fans 23.32 Business name: - i 1�1! IY j 1 ?Q M (� ir. F u oK: 23.32 J s r rl s { 1 P I P Contact name: Cc 'T'i $14.15 for first four, $4.03 for each additional Address: ,p() Z �l ? a Furnace, etc. t Geis heat pump i City/State/ZIP: r y— J� � ) 1 /�Q -v �,. r I f (47001_, Wall/suspended/unit beater Phone: ( ba3 ) 3 h2 Fa (1 Water heater Fireplace E-mail: So- 0D „ CV Range ` COWTRACTOR Barbecue Business name: I�tJ H - 4 CooL^i,) ClO dr y' ') Address: 20 ())( b 5 j 2 other MECHANICAL PERMIT FEES' City /State/LI Gf� a' c,i C7 of3 Subtotal r � /- 1 Minimum permit fee ($90.00) Phone: ( } 1� �v - 17. 1 Fax: ( ) Plan review (25% of permit fee) CCB lic.: ..4 1 . State surcharge (12% of permit fee) �// TOTAL PERMIT FEE Thin permit applIcatloa expires If a permit is riot obtained within 180 U[hOrtZed signal �� days after it has beta accepted as complete. Print name: i ? , ' I Date: • Fee methodology se. by Tri- County Building Industry Service Road 1:\BuildimalPermitair -PermAp.., 03007/12 +4o -+e17r (11 m2/COM!WEa) RECEIVED Plumbing Permit Application ROI 2 2013 Building Fixtu City of Tigard CITYOFTIGARD Received I • � , ' Pr rtnit N o.: a S{ , 3 0ov -24- 11 • 13125 SW Hall Blvd_, Tigard. OR 9722 8UILDING DNISIO telly a P hone: 503.7181439 Fax: 50 f�Ian Review Other Permit Nn.: Inspection Line: 503.639.4175 Date/ke T I C: A R n and -0r. uv late k d/MeiI od: y: Q S See P am 2 for g g Notified/Method: , l� I Supplemental Informati TYPE OF WORK FEE* SCHEDULE ❑ New construction _ Q Demolition For special information use checklist. Description - I Qty. I Ea. I Total IC I Additi ter ati n/replacement 0 Other: - New I- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION • SFR (I) bath 1 312.70 Sand 2- family dwelling ❑ Commercial/industrial SFR (2) bath { 437.78 - Q Accessory building ❑ Multi-family SFR (3) bath I 500.32 --- _._. ..._.......__ Each additional bath/kitchen 25.02 ❑ Master builder Q Other: __.._._...__ _.___.___....__._ . _ _ -.- ----. Fire sprinkler ( sq. ti.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: C hooey? 51A; r'; .7 "4' ' Catch basin or area drain 18.76 / �.�[ H t ! ]C,G7; t Drywell, leach line, or trench drain 18.76 City /StatelZIP: L9 7-1 -1 `may r r-- Footing drain (no. linear R.: _) Page 2 Suiterbldgi n apt. o.: 1 Project name: Manufactured home utilities 50.03 Cross streetidircctions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: _ _ I Lot no.: __ Fixture or item: Tax map /parcel no.: Badtflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 CX� D ( Q ,! iJq Clothes washer r 25.02 fr 0e,i4ef e 1 aA 0 Q_ AJO,V 'W t)4(.Gcs Dishwasher 25.02 tePoolrez ()Q [ 'i iduitiVc Aq/) gegile-Le Drinking fountain + 25.02 L'>�� - (t) Ejectors/sump 25.02 ff PROPERTY OWNER ❑ TENANT Expansion tank 12.51 j 4 Name:`/ j1-� j - py1�� Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 1 �/' �'/ k a r - - - t , ^ � -' -- Garbage disposal 25.02 T City/State/71.P: 7 ) r..,,,.. A; 2„> Hose bib 25.02 , Phone: (• ) Fax: ( ) Ice maker 12.51 I r APPLICANT X] CONTACT PERSON Interceptor /grey a trap 25.02 Business ttarne: y " � � ` j � / " Medical gas (value: $ ) Page 2 i'a.. -4 , •' iY' s� ,,= � 3 6-'' L1 'y - --t:.- Primer 12.51 Contact name: COTr -- j'"t - - -- �' • • - Roof drain (commercial) 12.51 Address: '40 i X Sink /bash avn 25.02 ' (`it): /State/7IP: /= ) . i ,~ J4 f) y C1 ?CZ Solar units( le water) 62.54 Phone: 0203 t/: - 2 ( 2 _ l Fax:: ( ) _- Tub/shower/shower pan � 12.51 E-mail: C ��i a Urinal - 25.02 ( . be . C(; Water closet � 25.02 CONTRACTOR --- - -. Business name: ilii n ? Water heater 37.52 !' ! t I i �/ L ' Water pipingJDW V 56.29 Address: V ',- '7 Other: 25.02 - City /State/ZIP: /A'5 GU1+3 l i* t - , 9 6 (''7 I Subtotal Phone: (57) tot - C, ; �'7 Fax: ( ) � J Minimum permit fee: $72.50 CCB Lic.: 1 " •J . ) Plumbing Lic. no.: j ,6R Plan review (25% of permit fie) / � - St ate surcharge (12% of permit fee) ' Authorized signature: a --- ..__....__ -- TOTAL PERMIT FEE Print name: (�0 Ci Date: CU t Thu permit application expires ire permit is not obtained within 180 days Orr it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Hoard Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9600 SW NORTH DAKOTA ST, TIGARD, OR, 97223 Residential - Master Permit 120 Electrical rough-in 06/13/2013 13:09 MST2013-00074 PASS Violation Summary: Inspector Contractor