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Case File a Y 04.03 •o �' o' - --•u --b-— 71d ttA l i. o p 74 A4 TO ~T4-0 T4,•'a 1 IF 111.4! — 1 6000 5900 5817/0 5700 5600 5500 * 3400 5300 �Y100 ,� " P 30 28 3 3 V�2 3 I - Q yu- + �' 2s 0 2 4 �l+� auALrrY CONTROL T4-w ar 10.77 ti >0 74 o TO 00 ( i ARC TECTURAL BURLH E IG HTS ' •`' �� �— M .;•„ PLANNING. CAST S W �' J200 ' \ 7Hds.. n . ,. 13 - Ts 77 44.17 �Jj ` • COORDINATION 61�`� �J 2 5 04 600 6200 6 6400 6500 g • e . ~. . ,. J N \` PROPOSED.ND►'NTION� k 16 b _ 00 ' ra►s7,7i11 1144 �14i1 2 wl G .. • � G�` 6417109 � / �• ry E 900 �� _ o E� I9�0 4 21�a • `��.111, r �yj' L0 800 0 3S-1lY _ 23'4r+/. a 4. loo •• — i eco �+ . 12 �: 0% 14 .•► !1�6700 �, `'• E 0 // a 00 708 -- a'°° --- I 1 r• � 1100 �;D 6 L15'-6"+/-44 � S 404 M iK C� o 'J '� • ` � .�. � ` ,- • \Y� W N '� t_„ '0 2 • 1200 1'x'00 1435. � 2� � ei 71+0* � � � o �+ Z► I O ' a it500 45 C'_ ,oca lal . ` ., It Y ; �J Qz �f r 7 I 1300 1 ear 71� � a 6��•.• �� .J 6 Y `-1 41 :2700 47 0��4L 0 DRIVEWAY r K r*� 714 +0, ch KCjp__ M •1'St'7 R MID1 w.fp \ �► \ � I 04 © N / 1 1400 4- ♦ rr1 .. w At wA` _� 1 J 2 1vv 11 r 4,` � iii Z 100.00 l oo.00 so 1M w s la c- lipt D SE MAP \ O U IS 1 34Ca Q d elfN VICINITY 11/IAP 2 SITE PLAN cn 1 _ Q r~ rn A.1 A.1 1/32" = 1'-0" N.T.S. I REC'" WE' D APP � ;,^., LEGAL DESCRIPTION : DRAWING INDEX. _ up SITE all -- - — $ G� �+C?� P L.AN - LOT 12, BLOCK 2, BURLWOOD A•1 LEGAL DESCRIPTION / SITE PLAN - IN THE CITY OF TIGARD, WASHINGTON COUNTY, OREGON REVISIONS A.2 FLOOR PLAN A.3 ROOF PLAN A.4 ELEVATIONS ST M. P N I DATE 04.09 02 A.5 FILE SECT IONS ,OB NO - 20970 A.6 FOUNDATION PLAN �� PORTL. NG, OR OF o �> A, . 1 ice.-'W'FaSi ' y Y i, -..... .r .. '-4;. ••q.6tC RH:..y, - Y•.1' .:... ..-. �i•kw4+xr•iwwriw.i •.wWr<arw ,... A }' .... __. .... • . i NOTICE: IF THE PRINT OR TYPE ON ANY , II_ I � r T � I I � I I � I 1 � � � rr � I ! Tr , TTr� �_ r.rrl;7 � � ! ! � ! r� ! r ! ! I ! ! ! ! ! 1rt ! ! � ! ! � ! Ir ! ! ! ! ! ! ! I ! ! ! I ! � rtti � � � � ! .I I Jill I I I S I 1 I I I f � (' I ► i � �� IMA I I I f GE IS AS CLEAR AS THIS NOTICE, 1 2 3 4 5 0 7 _ a� IT IS DUE TO THE QUALITY OF THE _ _ _ _ _ _ _ — � � No 3� �� ) _ _ _ mow. ORIGINAL DOCUMENT TE 6Z 8Z - _L�- 9Z � Z � Z EZ ZZ iZ OZ 61 SI LT Si 5 [ � � EI Z iT OT g 8 -_ 9 g £ — Z T �Idl�w ,..u.r�wr .wi.r...»,._�.......�....,.....:.«d.�.».r.w.�.uW�,,......._.«W...,........�,��........rM wavwMIWIM i i 1 i t i 11927 3W Buricrest brive CITYOF TIGARD MASTER PERMIT PERMIT#: MST2002-00215 DEVELOPMENT SERVICES DATE ISSUED: 5/6/02 13125 SW Hall Blvd.,Tigard, OR 97223 ,503) 639-4171 SITE ADDRESS: 11927 SW BURLCRE3T DR PARCEL: 1S134CA-01900 SUBDIVISION: BURLWOOD ZONING: R-4.5 BLOCK: LOT: 012 JURISDICTION: TIG REMARKS: 576 sf, addition to back of house. Path 1 BUILDING REISSUE.: STORIES: I FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 10 FIRST: 575 of BASEMENT: ^at LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE: of FRONT: PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: a1 RIGHT VALUE: 5 52165 50 OCCUPANCY GRP: R3 BDRM: RATH: I TOTAL: 57600 of REAR: 24 PLUMBING SINKS: WATER CLOSETS: I WASHING MACH: 1 LAUNDRY TRAYS: RAW DRAIN: TRAPS. LAVATORIES: 1 DISHWASHERS: rLOOR DRAINS: SEWER LINES. SF RAIN DRAINS: I CATCH BASINS: TUB/SHOWERS: I GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES' _ MECHANICAL FUEL TYPES FURN<100K: DOIL/CMP c OHP: VENT FANS CLOTHES DRYER. GAS FURN—100K: UNIT HEATERS: HOOPS: OTHER UNITS: MAX INP. btu FLOOR FURNANCES. VENTS. 4 WOODSTOVES: GAS OUTLETS: ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS _ MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: t PUMP/IRRIGATION: PER INSPECTION. EA ADD'L 500SF: 201 400 amp: 201 400 amp. tat WIO SVC/FDR: SIGN/0117 LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp. EA ADDL BR CIR: 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 AkEAISPC OCC. ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: T VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING 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 0 SYSTEMS Owner: Contractor: TOTAL FEES: $ 1,326.12 GRASSMAPJ, JASON M+ JENNIFER A TERRY TAI.HERT CONSTRUCTION Tigard permit is subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and 29735 SW ROSE LN#156 8920 SW MIDEA LN all other applicable laws. All work will be done in WILSONVILLE,OR 97070 PORTLAND,OR F 7225 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 R"a# HC '42=1 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 Erosion Control Insp 8, Underfloor insulation ^lumb Top Out Exterior Sheathing Inst Mechanical Final Footing Insp Crawl Draln/Backwater Electrical Service Low Voltage Plumb Final Foundation Insp Fooling/Foundation Dr; Electrical Rough In InSulation Insp Final inspection Post/Beam Structural PLM/Underfloor Framing Insp Rain drain Insp Post/B aarihiBCharlle Mechanical Ins Shear Wall Insp Electrical Final _ l _ i Is suled By : 1i{ _ Permittee Signature Call 1503) 6 -4175 by 7:00 p.m. for an inspection needed the next buss ss dal Building Permit Application City of Tigard Date received:'T 'Y Permit no.: 7__ CiryofTigard Address: 13125 SW Hall Blvd,Tigard, 97223Project/appl.no.: Expire date:Phone: (503) 639-4171 Date issued: By: Rece Fax: (503) 598-1960 Case file no.: Payment type: C Land use approval: —_ — 1&2 family:Simple Complex: ❑ 1 &2 fainfly dwelling or accessory J Comnurcial/industrial 'J Multifamily J Nrw t tmstrucntm U Demolition Addition/alteration/replacement U Tenant improvement J I ire sprinklrr/alaim J(ghrr: Job address: tJ 15 cJQ �" Bldg. na.: rSuitoen! t Lot: 2 Block: Subdivision: _ - Tax map/tax lot/account no.: Project name: Description and location of work on premises/special conditions: Y/O/✓ Name: jtyf//��l� i1t .(Floodpla in,%ept is:capacity,solar,e1c.) Mailing address: 1 dr 2 family dwelling: L Clly: /V� State: ZIP: sz � � z Valuation of work...................a...........:........ Phone: ciU. Fax: E-mail: No.of bedroo aths�............................... Owner's representative: �/� ( >C 9rotal number of oors................................. _-- Phone: Fax: E-mail: New dwelling area(sq.ft.) .......................... ��� Garage/carport area(sq.ft.)......................... Name: C /� 'A Covered porch area(sq. ft.) ......................... Mailing address: 1 / Deck area(sq. ft.) ................. ...................... City: 7Y State: ZIP: -� Other structure area(sq.ft.)......................... Phone _3,; Fax: E-mail. Commercial/industrial/multi-family: JUL Valuation of work................................. ..... $ Business name: �,P I /�'� ,{� i Existing bldg.area(sq.ft.) .............. .......... -- Address: / New bldg.area(sq.ft.) City: �,�,.� State: ZIP: V72---17- Number of stories................ ................... --- I Phone: Z 92- Pax: E-mail: Type of construction...... ................ ..... CCB no.: - - -_-- t�,Z/ Occupancygroup(s): Existing: Z-�� New:City/metro lie.no.: Notice:All contractors and subcontractor-,are acquired to he licensed with the Oregon Construction Contractors Board under Name: /yl //�/, , 4"/'• ! provisions of ORS 701 and may he required to he licensed in the Address: Ti - (pi .�� 5urisdictian where work is being performed. If the applicant is Citexempt from licensing,the following reason applies: c�''�A�L S te: ZIP: Contact person: <; i ��'% an no.: -- — ---- Phon 3 �(o t Fax: I E-mail: — Name: Contact person: Fees due upon application ........................... $—�— Address: -� Date received: City: State: ZIP: Amount received ......................................... $ Phone: Fax: -_ E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all furisdktions accept credit cards,pteaxe caul jurisdiction for more iar«matioe attached checklist. All provisions of law and ordinances governing this owes 11 MasterCard work will he complied w�heth d herein or not. t'Rd+t recd nurntM L / rxplres Authorized siEtmnurr: 110 r711 t_— Date.: _ Z — Naim nr cardholder u shown on credit card Ogg liint name] 7_w �A Cardholder signature s Amount 1 Y Neale c phis permit application expires if a permit is not obtained within 190 days ager it has been accepted as complete. 440 13(fifflOMM) One-and Two-Family Dwelling Building Permit Application Checklist Refcrenceno.: Associated permits: ctry „r Tigard Ci Of Ti Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Ilall Blvd,Tigard,OR 97221 UOther: Phone: (50.3) 639.4171 Fax: (503) 598-1960 11111, 11,011,11,01 VING ITEMS ARE, RFQI IRED FOR PLAN REVIEW Ves No N/A I -Land use actions completed.See jurisdiction criteria for concurrent reviews. _2 Zonings. blood plain,sola balance points,seismic soils designation,historic district,etc. 3 verification of approved platnot. _ 4 Fire district approval required. - - ---- — 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. 7 Water distrlct approval. _ 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U 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 he 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 he completed if copyright violations exist. _ I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations rif there is more than a 441.elevation differential,plan must show contour lines at 24 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. 1; 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 he 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 Well 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 menther 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,iee 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 fioorh sof 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 Englueer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. 23 Five(5)site plans are required for Item I I above. Site plans must be 8-1/2"x I i or I I"x 17". 24 Two(2)sets each arc 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 approves:project street tree plan(if applicable),and COT Street Tree List. Checklist must he 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. 4404614(sMCOM) Mechanical Permit Application Datereceived: Permit no.:L61,�2p 6 •• ,f City of Tigard Project/appl.no.: —' Expire date: City gfTigard 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: — Building permit no.: U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacenu,nt U Other: Job address:- Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment.labor,overhead. Tax map/t•t■ lot/account no.: ---- - profit. Value.$ lex: —_ Block: I Subdivision: *See checklist for important application information and Project name: jurisdiction's fee sciedule for residential permit fie. Citv/county: ZIP: Description and location of work on premises:____ — _-- -- Fee(ea.) 'Total Est.date of completion/inspection: Desr:ri ion Qty. Res.only Res,only Tenant improvement or change of use: Is existing space heated or conJitioned?U Yes U No Air handling unit CFM Air conditioning(site plan required) Is existing space insulated'?U Yes U No Alteration of existing AC system [KOJILV-1 IM of er compressors Business name:name: State boiler permit no.: —_-- ----_-- _. HP Tons BTU/H Address: Fir smo a dampers/duct smoke detectors — City: _ State: ZIP: eat pump(sire plan require ) - - Phone: ax: E-mail: Insta rep acefurnace/burner_� - Includingductwork/ventfiner UYesUNo CCB no.: nstal rep ace/re ocate eaters-suspen e , City/metro lic.no.: wall,or floor mounted Name(please print): Vent fora lance-Iter than furnace Refrigeration: Absorptionunits__­___ BTII/11 Name: Chillers----- Address: hillers_--_Address: — --- Compressors-- State: Z,IP: - Aliv ronmenta exhaust andvent n: at o City � Appliamevent Phone: Fax: E-mail: )�x aust - - -I odds,Type 11 res, nc a tazmat hood fire suppression system — — Name: 50 1 �/ S'A-�--- c?,�1i9n_ (�,��,1�- Exhaust fan with single duct(hash fans) Mailing address: / ,S tri aw _— :xhaust system a Cart from eating or AC Fuelpiping anf st t er un(up W4 outlets) city: _ Stale: 7,IP � Tyle: ___Lf(; W ___ Oil Phone: ,� Fax: E-mail: •u�-each addiliona over d outlets rocess p p ng(schematic required) Name: Numner of outlets ----- - Other listed app ante or equ pmenli-- Address: _ _ Decorative fireplace City: Stale: Insert -type - -- - - oo stov_pellet stove --- - Phone: -_----' Fax: F.-mail: - Applicant's signature: Date: Name (print): - —` - --- Nm all jurisdictions accept credit cods,pluue call iv,imlictimt for more infcamnhon. Permit fee.....................$ - Notice:This permit application U Visa L3 MnsrrrC'nrd Minimum fee................$ - expires if a permit is not obtained Credit cord rwmher:-- �— _-- .._L_—L Plan review(at %) $ within IRO days atter it has been State surcharge(8%)....$ Name of cardholder as shown on credit curd $ accepted as complete. TOTAL . $ J __—_Cardholder signature ----Amount- 410-4617(6111000M) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION_: PERMIT FEE:_i Description:_ $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Price Total $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and f6) Repair ace to 100,000 BTU Qty (Ea) Amt $1..52 for each additional$100.00 or ding ducts&vents 1400 fraction thereof,to and including ace 100,000 BTU_+ $10,000.00. _ ding ducts&vents$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and Furnace-'------ 17.40 $1.54 for each additional$ X0.00 or ing vent t4 00 fraction thereof,to and including ended heater,wall heater ____ $25,000.00. __ or mounted heater _ $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and t not included in appliance permit 14.00 $1.45 for each additional$100.00 or (radion thereof,to and including -- 6.80 __ _$50,000.00. r units - $50,001.00 and up $742.00 for the first$50,000.00 and 12 15 $1.20 for each additional$100.00 or Check all that apply: Boiler Heat Air ____--_L (ractiun thereof. For Items 7-11,see or Pump Cond _ _ footnotes below. Comp •• Minimum Permit Fee$72.50 SUBTOTAL 7)`3HP;absorb unit -- --- _-�-------_ ___ to 100K BTU 14.Oo 8%State Surcharge $ -- I 8)3-15 HP;absorb - --- - ----- _ _unit 100k to 500k BTU 25.60 25%Plan Review Fee(of subtotal) $ I 9)15-30 HP;absorb - - _ P.equlred for AL_L co_mm_erclal permits ons _ unit.5-1 mil BTU TOTAL COMMERCIAL PERMIT FEE: $ 10)30-50 HP;absorb 35.00 unit 1-1.75 mil BTU 52.20 --- - -- - --_---- - -- 11)>50HP;absorb --- unit>1.75 mil BTU 8720 ASSUMED VALUATION S_PER_A_PPL_IANCE: 12)Air handling unit to 10,000 CFM - - Value Total .1000 Descri�Gon: _ Qt (Ea Amount 13)Air handling unit 10,000 CFM+ Furnace to 100,000 BTU,Including 955 _ 17.20 _ducts&vents _ 14)Nonevaporate-cooler -portable Furnace> 100,000 BTU including 1,170 10.00 ducts&vents 15)Vent fan connected to a single duct Floor furnace includin ve ent 955 --- 6.80 Suspended heater,wall heater or 955 16)Ventilation system not included in - floor mounted heater a liance permit _ _ 1000 Vent not included in appliance 445 17)Hood served by mechanical exhaust - - rmit R- air units _- 805 18)Domestic Incinerators 10.00 <3 hp;absorb.unit, 955 _ to 100k BTU _ 19)Commercial or industrial type incinerator_ 17.40 3-15 hp;absorb.unit, 1,700 _ __ 6995 101k to 500k BTU 20)Other units,including wood stoves - 15-30 hp;absorb.unit,501k to 1 2,310 -- - _ mil.BTU _ � __ 2')Gas piping one to four_outlets - 10.00 30-50 hp;absorb.unit, - 3,400 - 5.40 1-1.75 mil.BTU 22)More than 4-per outlet(earh) >50 hp;absorb.unit, 5,725 _ >1.75 mil.BTU1.00 Air handlin unit to 10 000 cfm _ 656 Minimum Permit Fee$72.50 SUBTOTAL: $ Air handling unit>10,000 cfm j 170 _ 8%State Surcharge - Non-portable evaporate cooler _ 656 _ _ $ Vent fan connected to a sin le duct t---�- Venf system not Included ink--- - 446 _ TOTAL RESIDENTIAL PERMIT FEE: a i 856 a Ilancepermit I loud servedh e b mechanical xaust - Y-- - 656 Other Insuectlons and Fees: Domestic incinerator _ 1 170 1 inspections outside of normal business hours(minimum charge-two hours) Commercial or Industrlal indnerator 4 590 -- $62 50 per hour Other unit,Including Wood stoves, 656 -- 2 Inspections for which no fee is specifically indicated (minimum charge-half hour) inserts,etc. $62 50 per hour ---- - _ 3 Additional plan review required by changes,additions or revisions to plans(minimwn _Gas piping 1-4 outlets 360 charge-one-half hour)$62 50 per hour Each ac;ditlonal outlet _ _ - 63 *State Contractor Boller Certification required for units>200k BTU. TOTAL COMMERCIAL. $ --- "Residential A/C requires site plan showing placement of unit. VALUATION: _ All New Commercial Buildings require 2 sets of pians. i ldsts\tonnslmech-fens doc 02/11/02 Plumbing Permit Application Daiereceivecf: Permit no,: City Of Tigard Sewerunit Building g penun no,: City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 - Phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: By Receipt no.: Land use approval: Y_ Case file no.: Payment type. ❑ 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U't'cnant=improvelnent ❑New construction ❑Addition/alteration/replacement U Food service U Other: lob address: //C7��l /'(C�l���[� Description Fee(ea.) Total Bldg.no.: - Suite no.: - New I-and 2-family dwellings only: (includes 100 ft.for each utility connection) Tax map/tax lot/account no.: SFR (1)bath Lot: IBlock. �tttdivision_V SFIt(2)bath - - — Project name: _ SFR(l)bads City/rounty: 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 MWEEMEMod Fatting drain(no. lin. ft.) Manufactured home utilities 7city: name: (fit t)N) Manholes -� Manholes - -- Rain drain connector - State:_ "Z.IP: - Sanitary sewer(no. lin.ft.)- --- Phone: -— �x: v1 E-mail: Storni sewer(no.lin. ft.) CCB no.: _ Plumb.bus.reg. no: Water service(no.lin. ft.) City/metro lie.no.: Fixture or item: --- Absorption valve _ Contractor's representative signature: Back flow pnrventer _ Print name: Date: Backwater valve Basic s/lavalory Name: Clothes washer - - Address: A ---- Dishwasher Drinking fountain(s) -- City: -- State: ZIP: Ejectors/sump -�—� Phone: Fax: IExpansion tank Fix(ure/sewcr cap Nance(print): ) z`)� Floor drains/floor sinks/hub �--��5 t a c dis sal Mailing address: I J� -Garbage City: �� state:('1 ZIP: _- A Ice maker Phone: ? lax: E-mail: lnterceptor,'grease trap _ Owner instal lation/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 promy I own as per ORS Chapter 447. Sink(s),basin(s),la-v8(s) Owner's signature: -t. Ite: -'A Sump Tubs/shower/sho%Acr pan Name: Urinal _-- Address: ^- -�-- Water closet Water heater City_--— _ - State: ZIP: _ _ Other: -- Phone: _Fax_ - E-mail_ Total Not all ktrisdicticm trxept credit cards,pleax call fudsdicilon fa ruse Inrornmuon. Notice:This p,'rmit application Minimum fee................$ ❑visa ❑MasterCard expires if a permit is not obtained Plan review(at —, %) $ Credit card number: r<p�_ within 1110 days after it has been State surcharge(8%)....$ _ accepted as complete. TOTAL .......................$ ,. Name d cardholder u shown on credit card P ---- S - -- Cardholder slRrtuwe�—--- -- Amami —_ — 441-4616(NTOCOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: 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 U 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 Closr t 16.60 - - SUBTOTAL _ Urinal 16.60 Y 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" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater O conversion, O like kind 16.60 uanti by Work Performed Gas piping requires a separate mechanical Fixture Type,.: New Moved Replaced Removed/ errmit. Capped MFG Home Now Water Service 46.40 Sink MFG Home Now San/Storm Sewer 46.40 Lavatory -- Tub or Tub/Shower Hose Bibs 16.60 _ Combination Roof Drains 16.60 Shower Only _ Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) 16.60 �- Urinal Dishwasher Garbage Disposal Laundry Room Ira - - Washing Machine Floor Drain/Sink: 2" Sewer-1st 100' 55.00 3,-, - - Sewer-each additional 100' 46.40 4" Water:service-1 sf 100' - 55.00 Water Heater Water Service-each additional 200' 46.40 - Other Fixtures - Storm&Rain Drain-1st 100' 55.00 (Specify) - Storm&Rain Drain-each additional 100' 46 en Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 - Catch'Basin 16.60 -- Inspection cf Existing Plumbing or Specially 62.50 Requested Inspections - erAir _ COMMENTS REGARDING ABOVE: Rain Dr,'n,single family dwelling 65.25 Grease Traps 16.60 - QUANTITY TOTAL -�- --- - - Isornelric or riser diagram Is required If --- --- Over dty Total is >9 -- *SUBTOTAL r ------ -- - - 11%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL ---Required oNy If fix'ure qty.total is>9 _ TOTAL $ "Minimum permit fee Is$72 S0 4 8%stale surcharge,except Residential Backflow Prevenhan Device,which Is S38.25+8%slate surcharge "Ail New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. IAdstslforrms\plm-fees.doc 12/26/01 Electrical Permit Application Dale received. Permit 7typc: ��City of Tigard Project/appl.no.: ExpireCityofTigarl Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639 4171 Date issued: H ) `+ ipt no.:Fax: (503) 598-1960 Ca -7 se file no,: Payment Land use approval: U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacement U Other: -__ _ U partial Job address: i Bldg. no.: Suite no.: Tux map/tax IoVaccollnt no.: Lot: Block: Subdivision: Project name: Description and location of work on premises: Estimated date of completion/inspection: KIWEN?film V63 Job no: ��_� I'M Max Business name: Description qty. (cm) total no.ins r Address: New residential-single or mudli-family per dwelling unit.Includes aflached garage. City: Stale: ZIP: Servicrincluded: Phone: Fax: E-mail: l(XX)sq,it.orless 4 CCB no.: Elec.bus.lie.no: Foch additional 5(x1 sq.R.or portion thereof `- City/metro lic.no.: LimitedenenRy,residential Li mi ted energy,non-residential _ finch manufactured home or modular dwelling Signature of supervising electrician(required) Date Service and/or feeder 2 Sup elect.name License no: Services or feeders-Installation, alteration or relocation: 200 amps or less 2 Name(print): 0 A- CSG s S 201 amps to 400 amps 2 Mailing address: / 401 amps to 600 amps 2 601 amps to 1000 amps 2 City: State* ZIP: 7Over 1000 amps or volts Phone: _ 2 Fax: E-mail: Rcconnectonl --- 1 Owner Installation:The installation is being made on property I own Temporaryservices orfet: ers- which is not intended for sale,lease,rent,or exchange according to Installation,alteration.orreloeation: ORS 447,455.479,670,701. 200 amps or less , i201 t, to 600 amps amps -- — -- -- ; 401 — Owner's si nature: Dole: -- _ - Branch a rcults-new,alteration, Name: or extension per panel: Address: A. Fee for branch circuits with purchase of service or feeder fee,each branch circuit 2 City: Stale: ZIP: B. Fee for branch circuits without purchase Phone: Fax: E-mail of service or feeder fee,first branch circuit: 2 Fach additional branch circuit- Mite.(Service or feeder not Included): U Service aver 225 amps-commercial U Health-care facility Each pump or irrigation circle 2 U Service over 120 amps-rating of 1&2 U Hazardous location Bach sign or outline lighting family dwellings U Building over ROW square feet four or Signal circuits)or s limited energy panel. -'— U System over 600 volts nominal more residential units in one structure alteration,or extension* , U Building over three stories U Feeders,400 amps or more . — — -- U Occupant load over 99 persons U Manufactured structures or RV pork Descri tion:_! U ress/li htin rinn 1�ac11 additional Inspection over the allowable In an of the above: Fg R gi U Other Y -- Per inspection �-1----- Submll____ sets of plans with any of the above. Investigation fee — The above are not applicable to temporary construction serAce. Other ----------- Na is jmisAic MasterCardaccept ere;fit cants,plr•ace call lwinhcti.m roe megc in6xtnation. Notice:Ti1is permit application Permit fee.................. ❑Visa U Mnexpires If A Plan review $ Credit card number. P permit is not obtained (at — `1b) $ --L _ within ISO days after it has been State surcharge(8^F) ....$ Exp6e� -- ---- Nam a��-c# -- accepted as complete. TOTA1. .......................$ Amount 440.4615(hAXY('o1N) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: -- -- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00 Number of Ins ctior.s r :mit allowed (FOR ALL SYSTEMS) Service Included: Items Cost Total Check Type of Work Involved. Residential-per unit 1000 sq.fl,or less _ $145,15 —`—_ 4 L_l 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 Garage Door Opener' Dwelling Service or Feeder _ $9090 2 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.'0 — 2 L� Vacuum Systems' 20'I amus to 400 amps — $10685 _ 2 401 amps to 600 amps _ $160.60 2 -1 601 amps to 1000 amps $24060 _ 2 J Otherover 1000 amps or volts $454.65 2 Reconnect only _ $66.85 z Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY TemFee for each system.......................................................... $75.00 Installation, or relocation 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, ❑ Audio and Stereo Systems see"b"above. Brarich Circuits ❑ Boiler Controls Now,alteration or extension per panel a)The fee for branch rirruits ❑ Clock Systems with purchase of service or feeder fee. Each branch circuit $6.65 ❑ Data Telecommunication Installation b)Ton fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 HVAC Each additional branch circuit $6.65 — E] Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or;rrigation circle _ $53.40 Intercom and Paging Systems Each sign or outline lighting $53,40 Signal circuit(s)or a limited energy Landscape Irrigation Control' panel,alteration or extension _ $7500 Minor Labels(10) $125.00 r Medical Each additional Inspection over L � the allowable In any of the above ❑ Nurse Calls Per Inspection $62 50 _—� Per hour _ $62.50 _ In Plant $73.75 El Outdoor Landscape Lighting' Fees. ❑ Prolective Signaling Enter total of above fees $ E-] Other 8%State Surcharge $ _Number of Systems 25%Plan Review Fee ' rto h,.enses are required Licenses are required for all other Installations See"Plan Review"section on $ front of application ____—_ -- Fees: Total Balance Due $ _A_ Enter total of above fens $ ❑ Trust Account q _. _—_ 8%State Surcharge = Total Balance Due $ All New Commercial Buildings require 2 sots of plans. i:\dsts\farms\etc-fees doc 08130K)I Permit #: OILT 0 UCS d t `_, Addrdby: S W_ Lc— `, ;• � Issu -- �4 _ — 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 3'B: 211 1. I own, reside in, or will reside in the completed structure. �� 2. 1 understand thirt 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 _ � , Cxv 5 7 r z i (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 3B. 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 about Construction Responsibilities on the reverse side of this form. eV 0 ao ev (Signature of permit applicant) (Date) V (White copy to issuing agency permit file, pink copy to applicant) T a Y 0 CITY t .® 24-Hour B,.aIL u Inspection Line: (503)639-4175 INSFECTiCe DIVISION Business Line: (503)639-4171 MST r f _ BLIP Received - -_Date req ested- , AM__.._____- PM __- BLIP _ -�---- Location _ �/) J137� Suite----------------- MEC ---- Contact Person ---- PLAA Contractor - ----- Ph 1---) -c� - {- ---- ------ SWR BUILDING _- - Tenant/Owner ELC --- -- - _ --- Fo-oting _--- ---- .------. Foundation Access: ELC ----- - >-- ----- Fig gain Crawl Drain ELR _ Slab Inspection Note sG w SIT Post&Beam - - - - Shear Anchors -J-d .. t') 1`J(�V� �U (i Ext Sheath/Shear - 16 Int Sheath/Shear .- - Flaming - ------ -- — --_ -- Insulation Drywall Nailing Firewall ------ --- ----- -- —- -- Fire Sprinkler Fire Alarm Susp'd Ceiling - Roof --_-- --- Other:--- ---- Final PASS PART_FAIL -- PLUMBING - ~- Post&Beam - - -- Onder Slab ----_.- -__ - - -- . oug -n -- Water Service ----- .--___._---- SanitarySewer --------- Rain Drains ------ ...-___ Catch Basin/Manhole --- - — - Storm Drai i --_-.---- Shower Pan Other: --- - - - -- --- --- Final PASS PART FAIL —- -- - --- - -- - --- - - - -- - -- MECHANICAL oat& Beam - - -- Rough-In - --------- - --- aaS Line -- - - Smoke DampersFinal -- PASS PASS PART FAIL ------ ELECTRICAL ernce - - - -- Rough-In ------------- --- UG/Slab -- - -- --- Low Voltage Fire Aiarm - -- ---- rn PAS -PART FAIL �_� Reinspection fee of$.-___._--_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S -_ _ Please call for reinspection RE:_- _ ❑ Unable to inspect-no access Fim Supply Line ADA --, Appruach,'Sidewalk Date -L= �— a Inspector _ Ext OthsrA"4— Final DO NOT REMOVE this Inspection record frons the job site. PASS PART FAIL