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13045 SW 107TH COURT PX �+ 'D r Q 170 J .I +•� 3D NOTICE: IF THE PRINT OR TYPE ON ANY �) rf ' Ir ' ilil � li il � lil � ililili 1111111 11111Ir [ [rT � alr i i i � � i i i i t t t t t tai i t i iii i 1 I I I I I I 1 1 1 lii i t ii � i 11 � IMAGE IS NOT AS CLEAR AS THIS NOTICE, 1 2 3 4 ( I I I J e, a to ___ _ _ g 9 ( -may IT IS DUE TO THE QUALITY OF THE -- -- ---- -- --.. 1- _ - - 12 ORIGINAL DOCUMENT �- - ---- - -J91, -- - ��--' --•'� ' i •��I E 6Z 8Z LZ 8Z i 5Z fiZ EZ ZZ IZ UZ 6 8I LT Oi 6 8 LIIIlllllIIII �(�(I . . IIIIIIIIIiIllllll IIII IIII IIII IIII IIII 11 T� 11 Il llllllllllllllllllllllllll ll II�I��i � Lt w I%, ZAIA { 7�Rp&A F1 -w \ 1 \ � f _ 0 :Id L4 4- job 1 i , r Q ,, h C %.v jrj I/ Ile If "X Px . r . S i 1 t 2 a .5 doe CA• 190s. 4A,e4, t LIABILITYtic -- The City of Tigard and its mployees shall not be Nk ibl e for discrepa - .._._________ ._. .�._•__ re spo ns h i ch a pear herein. _.. �. .: wy appear t 400 kj-e L4 ( j7j CITY OF TIGARD ` Approved ................................. It, Conditionally Approved ......................... )� For only the work a described in: ` PERMIT NO. ; ` See Letter to- Follow.._. .------------------- 11 0I 11 ' Ata h- _ _ . �( � ` � •- � `� a E3y r� R Of X00 fr - ,o TI I APPROVED BY : SCALE : DRAWN BY iC= REVISED I 1.51 ' DATE (77- I . i! ��^ �..•? DRAWING NUMBER � o w ' I NOTICE: IF THE PRINT OR TYPE ON ANY � I1 11 � 11 ► III 111 III ► 11 ilt ! 1111 ! ! 111111 ( ( ( Ijlll 11�Cf111 1 ( 1 � lllllllll f 1111 ! 11 111111 ! 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REVISED _. _ 130 DRAW;NG NUMBER , . '�"n'.;17"'..:,.:Myw.urw•a.r.wr•- .._. v..,:, .. '�•:1���"...r,71e-...r-.^...�.... - 'w..c..., NOTICE: IF THE PRINT OR TYPE ON ANY 1 1 ► ! I ! I I t I I I I I I I I I 1 1 1 I l I l l f l l l l ( l ' f I I l l I ( ( I � I I S I i l i i � l I S I l i l i ( ( I ( l I I III ill ! � l � I � { � il � i ! i i ! i � { i ili Thi il � iii ili il � i ! i { ili � I � i ! � � lilil � Ali i { � i i i a --► , I I ( I I l + { + IMAGE IS NOT AS CLEAR AS THIS NOTICE, 21 3 4 8 9 10L7 ITIS DUE TO THE QUALITY OF THE - No.36 •'�'' , ORIGINAL DOCUMENT E 6Z gZ LZ 99 z vZ vZ Z TZ oZ � i 8 � LT 8T ! 4T i►I ET SIT ti oI 8 -_ . till {{ll I{{{ {l{I LI{{ ilii IIII IIII Illi I{1{ {{{L 1i11 !11{ 1J{ Ill{ {!� IIII I{111!l111�1 Illi {ll! IIII IIII Illi IIII Illi i!!I 1111 .1lIIlllll till Lill ILII IIII IIII �IIII►ili I I ) � J � II L IelII ! q t, IIII I<<I— Illl IIII .IIII. II!l�LIII IIII .L�1 � IIII LJ11 L Llllllll'IIII a I , c� Q A Ul CN G O ti s n O C 13045 SW 107"' Court CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 -ASPECTION DIVISION Business Line: (503) 635-4171 MST -3 _ Z BUP _ Received Date Requested— ��/ �° AM PM BLIP Location D J p7 — Suite MEC Contact Person __ Ph(—) � PLM - - Contractor Ph � ) i1 - - - ( -,�-�- �� J SWR BUILDING Tenant/Owner --- --- ELC— - - - Footing -- � - - -- Foundation ELC Ftg Drain Access: Crawl Drain ELF Slab Inspection Notes: SIT Post&Beam - - - - -- Shear Anchors - - - - - Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall -- Fire Sprinkler - -. Fire Alarm - Susp'd C( 1. ig - --- ---- Roof Other: ----- -._ - -- ---- _...�--_ Final - - - PASS PART FAIL I.LUMBING - Post& Beam Under Slab Rough-In —- Water Service Sanitary Sewer -- -----. Rain Drains Catch Basin/Manhole Storm Drain ower Pan - - --- - Other:_ Final - - PASS PARTFAIL MECHANICAL Post&Beam - - _- Rough-In Gas Line Smoke Dampers Final ---------PASS_PART_PART FAIL TRIAL - ---- ------- Service - --- --- UG/Slab Low Voltage Fire Alarm -- - ---- ___- Fin ------ Ej A_ PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd. Please call for reinspection Rt - Unable to inspect--no access Fire Supply Line -- ---� --- ADA _ Approach/Sidewalk Date -p Inspect or �� Other:------ ".�.4'._-��.�J..�&4�a Eut ..---- Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL ';% CITY OF TI GA R D � MASTER PERMIT DEVELOPMENT SERVICES PERMIT 9: MST2002-00332 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/29/02 SITE ADDRESS: 13045 SW 107TH CT SUBDIVISION: PATHFINDER PARCEL: 2S103AD-03500 BLOCK: 25 ZONING: R-4.5 REMARKS: Convert existing space into (5) bedrooms & (4) bathrooms. JURISDICTION: TIG BUILDING REISSUE: STORIES: FLOOR AREAS CLASS OF WORK: ALT HEIGHT. ,t BASEMENREQUIRED SETBACKS REQr11RE—p FIg5T: T. ---� TYPE OF USE: SF FLOOR LOAD: st LEFT: SMOKE DETECTORS: Y SECOND sI GARAGE st FRONT: TYPE OF CONST: 5N DWELLING UNITS: PARKING SPACES FINBSMC-�NT: at .t VALUE S 14,000.GU RIGHT OCCUPANCY GRP: R3 BDRM. 5 BATH : TOTAL: U ao sl REAR: PLUMBING SINKS: WATER CLOSETSt WASHING MACH: LAVATORIES: 4 LAUNDRY TRAYS: RAIN DRAIN: DISHWASHERS FLOOR DRAINS: TRAPS: TUB/SHOWERS: t SEWER LINED: 100 SF RAIN DRAINS: GARBAGE DISP: WATER HEATERS: CATCH BASINS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: MECHANICAL OTHER FIXTURES: GAS FUEL TYPES FURN�100K: –'� BOIL/CMP c 3HP: VENT FANS: 5 FURN>= CLOTHES DRYER: 100K: UNIT HEATERS: MAXINP HOODS: OTHER UNITS: blU FLOOR FURNANCES: VENTS: tU WOODS7'OVES: OAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER _ TEMP SRVC/FEEDERS _ — BRANCH C,_ IR_ CUITS 1000 SF OR LESS: MISCELLANEOUS ADD'L INSPECTIONS 0 200annr 0 200anp EA ADp'I.5009F: WISVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: 201 400 amp: 201 400 amutet W/O SVC/FDR: LIMITED ENERGY: SIGN/OUT LIN LT: PER HOUR: 401 800 amp: 401 BOU amp- EA,>ODL OR CIR: MANU HM19VC/FDR: 001 • 1000 amp: 001.ampn1000vSIGNAL/PANEL: IN PLANT: : 1000+amp/volt: MINOR LABEL: Reconnect only: -- PLAN REVIEW SECTION 1•4 RES UNITS: SVC/FDR>•220 A.: >000 V NOMINAL: ELECTRICAL•RESTRICTED ENERGY CLS AREA/SPC OCC: A.9F RESIDEN PIAL AUD o s srEREO vgcuuM SYSTEM V B•COMMERCIAL AUDIO 8 STEREO FIRE ALARM: INTERCOMIPAOINO: BURGLAR ALARM OT H OUTDOOR LNDSC LT: BOILER GARAGE OPENER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE 91GNL: CLOCK. INSTRUMENTATION: HVAC: MEDICAL: OTHR: DATA/TELE COMM. VURSE CALLS TOTAL N SYSTEMS: Owner: Contractor: TOTAL. FEES: $ 743.05 STROIE,VIORICA&CONSTANTIN OWNER This permit Is subject to the regulations contained in the 13045 SW 107TH Tigard Municipal Code,Slate of OR. Specialty Codes and TIGARD,OR 97223 all other applicable laws. All work will be done In accordance with approved plans. This permit will expire N work is not started within 180 days of Issuance,or If the Phone: Prone work Is suspended for more than 180 days. ATTENTION Oregon law requires Ra a Oregon Utility Notification Center.. rThosedn les are ted yset forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these I ales or direct questions to REQUIRED INSPECTIONS OUNC by calling(503)246-1987. FMechanlcal Inspection Electrical Service Electrical Final "— loor insulation Electrical Rough In Mechanical Final nderfloor Framing Insp Plumb Final Insp Low Voltage Final Inspection Top Out Insulation Insp Issued By : -s' l/ ll. �r i_ %�.;1� _ i . � P � � .� ,� �- ermittee Signature : �_ Call (503) 639-4175 by 7:00 p.m, for ar inspection needed the next business day Building Permit Application -� City of Tigard Datereceived: 7 1A oz Perini 0.1 S Cily(If Tigard Address: 13125 SW hall ltic<I, 'I'rV;irrl, OIl 97,-21 Project/appl.no.: Phone: (503) 639-4171 re date: Fax: (503) 598-1960 Date issued: By Receipt no.: Case file no.: Land use approval: Payment type: -- 1&2 family:Simple Complex: r ❑ 1 &2 f,•tmily dwelling or accessory ❑Commercial/indust);al U Multi-family Ll Addition/alteration replacement ❑Tenant ire inn dusk. y U New construction U Demolition 1 LI sprinkler/alarm ❑Other: Job address: �r� / Lot: Block: Suhdivisiorr 1 Bldg,no.: Suite no.: Project name: IT.x map/tax IoUaccount no.: (- Dvscription and localion ol'work on premises/special conditions: �1 -------_- — —._ — -- �h-\ Name: ft �, t t - Mailing address: , City: 1 &2 family dnclling: State: ZIP: 1 Phone:,' Fax: - Valuation of work............... $ UL)(-, Owner's representative: No.of bedrorms/baths..... .. ..........,y...... Phone: Fax: E-mail: Total number of floors............. . ................... ., New dwelling area(s ft. Name: Garage/carport area(q. ft.).......................................... ----- - - d Covereporch area(sq, Il..) Mailing address: .....••...•..,...,.. Cit Deck area(sq. ft. Phone; State; ZIP: Other structure area(S!L ft.)......... .............. ►;lx: F.-mail; Commercial/industrialtondo-fantlly: Valuation of work $ Business name* Existingbid ...•...�................. ..••.• g.area(sq. It.) %.i. Address: _ — New bid ...•I.... City: f g.area(sq. ft.) .................. ........... afe: ZIP: Number of stories.......................} Phone: - ................ ax: E-mail: Tyle of construction CCB no.: — ..............I.............,.. _ Occupancy group(s): i Existing; City/ntelm lic.no.: New: _ t Notie:All contractors and subcontractors are required t—ohe Name: licensed with the Oregon Construction Contractors Board under Address: - provisions ol'ORS 701 and may he required to be licensed in the Cit -- _ _ jurisdiction where work is being performed, If the applicant is State: ZIP: exempt from licensing,the following reason applies: Contact person: Plan no.: Phone: I:r, — E-mail: N,tnu' Contact Address: person: Fres due upon application City: Date received: a'-'—"'----- State: -- Phone: ZIP' Amount received ......•...Amount _ I hereby certify I have read and examined this application and theEceln Please relcr to Ice schedule. --- attached checklist.All provisions of laws and ordinances ,)vermin r crcdir cords,plense colt ludsdlctlon for nxe infurmaaorr. Villa work will 1x core lied withwhether s cilied herein or n,t. b flus rCardP I,,,Authorized signature: , /_ Date: ! I / ' f' L tAPIMI Print name; •fJ �(A , older v shown on credit--— Notice: 71115 permit application expires if permit is not obtained within 180 days all it has been accepted as u complete. S — moar 440461.1(&r•oM) One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Cit f Ti and Associated permits: City q('1'igurd y og U Electrical ❑Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97221 U Other: Phone: (503) 639-4171 Fax: (503) 598-1960 '1141F 11.01TOWING ITENIS A-Kjl-, RFIQUIRIA) FOR PLAN REVIEW Yes No N/A 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,..eismic soils designation,historic district,etc. 3 Verification of approved plat/lot. 4 Fire district approval required. _ 5 Septic system permit or authorization for remodel.Existing system capacity _ 6 Sewer permit. _ 7 Water district 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 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. I I Site/plot plan drawn to scale.-'he plan must show lot and building setback dimensions;property comer elevations(if there is more than a 4-f1.clevatinn 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 arca;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such ns floor beams,headers,joists,sub floor, wall construction,roof construction.More than one cross section may be required to clearly portray construction.f how details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stJrs, fireplace construction, thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations]'or 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 shoe(addendums showing foundation elevations with cross references are acceptable. _ 16 Wall bracing(prescriptive pa(h)and/or lateral analysis plans.Must indicate details and Incau„nti: 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 hearing 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 it non-uniform load. 2i) 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 he ShOW11 In hr applicable In the proirel under review. 21 Misr Itil site plans are required flu Item I I above. Site plans must hr M 112" \ I I"„i 11" i 1 24 'T'wo(2)sets each are required for Items 16, 19,20&22 above. — 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans swill be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit& System De�clopment Fees(,u•ument, 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan Of applicable).+and COT Street Tree List. Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink. Red ink is reserved fir department use only. W-4614(MltWONI) Building Fixtures Plumbing Permit ApplicationOFFICE USE ' Date received: 7��%Z 09� Permit no.7 70001"OQ T 33� City of Tigard Sewer permit no.: Building permit no,: Address: 13125 SW Hall Blvd,Tiga d,OR 97221 iry of Tigard Phone: (503) 639-4171 Project/appl. no.: Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: U I R 2 family dwelling or accessory J Couuncrcial industrial Ll Multi-family U Tenant improvement J Nev, construction U Addition/alteration/replacement U Food service 0 Other:_- _ 1 i Job address: /3Uy�j_SU� 409 CJ .11CrA-RO°�P Uescripliei (py. Fec(ca-) 'total \cr+ 1-and 2-family d+scllings only: Bldg.no.: _ Suite no.: (iucludcti 100 ft.fnr each utility connection) Tax map/tax lot/account no.: SIR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: SFR(3)bath City/county: ZIP: Each additional bath/kitchen Uescription and location of work on premises: Site utilities: Catch basin/area drain _ Est.date of con letion/inspection: Drywalls/leach line/treift.) ain Footin drain(no.lin.Manufactured home utA9-lt singes name: Manholesress'. Rain drain connectorCity: e: ZtP- Sanitary sewer(no. lin _ P e: Fax: E-mt►t : Storm sewer(no. lin. it.) CB o.: .7 Plumb.$tis.ii- Water service no.lin. it.) City afro lie. o.: �= _ Fixture or Item: Absorption valve Contractar's representative signature: — Lack flow preventer Print name: Date Itackwater valve CONTACT PERSON Ilasins/lavatory _ ('lathes washer Name: -------- Dishwasher Address. - Drinking fountain(s) State: ZIPaEjectors/sump _ Phone: 1", I -mail Expansion tank Fixture/sewer cap Name(print): CO/JSI 1 -1 hIy I o kl (� u5 Floor drains/floor sinks/hub --i �-- Garba aalis osa Mailing address:_ 1304,5 40 I lose bibb City: 7'jCttW State:OJE ZIP: 1017223 Ice maker Phone: Fnx: E-mail: 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 rain(commercial) employee on the properly( own aas�tier QRS Chapter 447. Sink(s), asin(s),lays(s) Owner's si mature: Date: d 42 42._ Sump Tu s/shower/shower pat, Urinal Name: _ Water closet _ Address: Water heater City: State: ZIP: Other: Phone: Fax: E-mail: ata Minimum fee................ $ Not all jurisdictions accept credit cards,please call jurisdiction fnr more Information. Notice: This permit application U via LJ MasterCard expires if a permit is not obtained Plan review(at _ %) S _ Credit card number -- — --1- within IRO days after it has been State surcharge(8%).... $ x fan p TOTAL. accepted as complete. """""""""""' Name or cardhol er a shown on creditt cs`rV_ (TrAoTd,, ritinature s mouni_ 4401616(MCOM t PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (individual) CITY oa AMO_UNT (includes all plumbing fixtures In PRICE TOTAL Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory i J 16.60 / ,-L4 for each utility connection One(1)bath $249.20 _ Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00 Shower Only 7 16.60 0 Three 3 bath $399.00 Water Closet -- - 1660 G r'n 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- 16.60 3• 16.60 PLEASE COMPLETE: 4- 16.60 Water Floater O conversion O like kind 16.60 uantity b i Work Performed Gas piping requires a separate mechanical Fixture Typo: New Moved Replaced Removed/ permit, Ca Ped MFG Home New Water Service 46.40 Sink _ MFG Home I Inw 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 Tray Washing Machine Sewer•1st 100' 55.00 Floor Drain/Sink: 2"3„ Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater _ Water Service-each additional 200' 46,40 Other Fixture:; Storm&Rain Drain-1 st 100' 55.00 (Specify) 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 62.50 Requested Inspections per1hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL --- --- -- - --- Isometric or riser diagram Is required If ---------- - -- ----- Quantity Total Is i 9 ----- 'SUBTOTAL -- - ----- - - ---- - 8%STATE SURCHARGE "PLAN REVIEW 2F8,:OF SUBTOTAL Required only It fixture qty total Is>9 _ TOTAL a *Minimum permit fee Is$72 50 4 a%state surcharge,except Residential Backflow Pmvention Devine,which Is$39 25•B%state surcharge **All New Commercial Buildings require 2 sets of plans with Isometric or rber diagram for plan review. F\dsts\forms\olnI-fees(to(: 12/26101 Mechanical-Permit Application Date received-. iA lir permit no.:HS/AoeA�Siaeoa _0633 City of Tigard Project/appl.no.: ire date: City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: B Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 1 Case file no.: r Payment type: Land use approval: _ Building permit no.- TYPE OF PERMIT U 1 &2 family dwelling or accessory U Commercial/industrial J Multi-family U Tenant improvement U New construction U Addition/alteration/replacement J Other: JOB SITE INFORMA1110N COMMERCIAL VALUATION SCHEDULE Job address: 107 CT. T CAW 9 Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, profit.Value$ Tax n ap/tax lot/account no.: Lot: Bluck: Subdivision: *See checklist for important application information and schedule fist residential permit fee. Project name. jurisdiction's fie City/county: ZIP: r 1 11101 Description and location of work onremises: t r r r r P --- — [ee(e.o Total Est.date of completion/inspection: Uc.criptio„ c1t�. Itu,.onh Its�.onl) Tenant improvement or change of use: Air handling unit CFNt Is existing space healed or conditioned'?U Yes LINO Air conditioning(siteplan reqaired) - Is existing space mmil,ded7 U Yes U No Ieratiun ol'existing A .system 1L.—offer/compressors MECHANICAL CONTRAC70111 State boiler permit no.: Business name: 14P Tuns 13TU/H _ Address: Fire/smoke dampers/duct smoke electors cat pump(site plan require ) City: State: ZIP: _., Phone: Fax: Email: nsta rep ace urnac urner _— —_ Including ductwork/vent liner U Yes U No CCB no.: nsta rep ac re orate eaters-suspen r City/metro tic.no.; _ wall,or floor mounted N(lme(please tint): Vent for appliance other than furnace Refrigeration: CONTACIMMON Absorption units BTU/14 Name: Chillers lip -- -- Corn lessorsY lip Address: -,nv ronmenla exhaust and vent al on: City: -- State: 'LIP: Appliance vent _ Phone: (-ax: 1?-111:ul: Uryerex aunt 0o s,Type Tres. itc a sazmat hood fire suppression system ----- Name: CDA&TMr/A v/D (� �NE�� 57��� Exhaust fan with single duct(bath fans) Mailing address: / p*!!S, to Cr ixhap s strm a all from heating or C •ue p p ng andistribution(up to outlets) City: T/ '4QQ Slate:D� 7.iP 1j22 1•ype LPG NO Oil Phone:'?�3.690,0 6 l'+'x I "'tilt i.in ear s u itfona over outlets rocesspiping(scsematicrequired) _ Number of outlets Nano: Other listed app ante or eq—Tent• -- A(Aress: — Decorative fireplace City: State: ZIP: nsert-ty e _ I: mail oo stov pe et stove - — ---- Phone: Ot er: Applicant's signature: ° Other- Name )ate:0►J / D 1 er:Name (print): Oo N ST)¢N h N cNTPX/e Permit fee.....................$ Nm all)uu.—kii ns rccept credit cmde.plena roll furimliction hu morn intominfion Notice:This permit a lication p application Minimum fee................$ U Visa U MasterCard expires if a permit is not obtained Credit card number' / / Plan review(at _ %) $ Cxplres within 180 days alter it has been State surcharge(896) ....$ accepted ted as complete.Now of car m e r m&own on ire a c f p p TOTAL .......................$ — Cardholder signature 440-4617(61W/COM1 MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description; Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code dtY (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. Includin ducts 8 vents 1 4O $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 Incl udin vent 14.00 fraction thereof,to and Including 4) Suspended heater,wall heater $25,000.00. _ or floor mounted healer 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 G t)0 fraction thereof,to and Including 6) Repair units $5000000 550,001.00 and up 12 1 $742,00 For the first$50,000.00 and Check all that apply: Boiler Host Air $1.20 for each additional$100.00 or For Items 7.11,see or Pump Cond fraction thereof. footnotes below, Comp •• Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit to 100K BTU 14.00 8'/e State Surcharge $ 8)3-15 HP;absorb _ _ unit 100k to 500k BTU 25.60 25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb Required for ALL commercial permits only unit.5-1 mil BTU 35.00 TOTAL COMMERCIAL PERMIT FEE: $ 10)30-50 HP;absorb - __ unit 1-1.75 mil BTU 52.20 - - -- 11)>501-113;absorb unit>1.75 mil BTU 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM jEa lue Total 10.00 Descri lior: at Amount 13)Air handling unit 10,000 CFM+ Furnace to 100,000 BTU,including 955 17.20 ducts&vr,nts 14)Non-portable evaporate cooler Furnace>100,000 BTU Including 1,170 10.00 ducts&vents 15)Vent fan connected to a single duct Floor furnace Including vent 955 �; 6.80 c Suspended heater,wall heater or 955 16)Ventilation system not Included In floor mounted heater applIance permit /1) 10.00 i o U Vent not Included in appllance 445 17)Hood served by mechanical exhaust pe It _ 10.00 Repair units 805 18)70mestic Incinerators - <3 hp;absorb,unit, 959 17.40 to 100k BTU19)C ommercial or Industrial type incinerator 3.15 hp;absorb.unit,---- 1,700 89,9E 101k to 500k BTU 20)Other units,Including wood staves 15.30 hp;absorb,unit,501k to 1 2,310 10.00 mil.BTU 21)Gas piping one to four outlets 30-50 hp;absorb.unit, 3,400 5.40 1-1.75 mil.BTU 22)More than 4-per outlet(each) >50 hp;absorb.unit, 5,725 1.00 >1.75 mil,BTU Minimum Permit Fee$72.50 SUBTOTAL: Air handHn unit to 10 000 cfm 656 _ $ �, r Air handlin unit>10,000 cfm 1 170 8%State Surcharge _ Non-portable evaporate cooler 658 _ _ _ $lo,7 t. an fan connected to a single duct 440 TOTAL RESIDENTIAL PERMIT FEE: $ Vent system not Included In 856 appliance ermit Hood served by mechanical exhaust 658 Other Insoeellons and Fees: Domestic incinerator 1,170 1 Inspections outside of normal business hours(minimum charge-two hours) Commercial or Industrial Incinerator _ 4 590 $62 50 per hour Other vnit,Including wood stoves, 656 2 Inspections for which no fee Is specifically Indicated (minimum charge-half hour) Inserts dc. $82 60 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum Each ach additional outlet d it 1 4 outlets 360 charge-one-half hour)$62`O per hour E63 'State Contractor Boller Certification renuired 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 plans. I:ldsts\formslmech-fees.doc 02/11/02 Electrical Permit Application Date received. /Z GA Permit no.::::: 00,37. City of Tigard Project/appl.no.: fiaKre date: Ciryu(Fig ard Address: 13125 SW Hall Blvd,'Figard,OR 97223 Date issued: B : Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment tvpe: Land use approval: OF 7New ly dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant improvement ruction U P ddition/alteration/replacement U Other: — U Partial JOB SITE INFORMATION Job address: ) Y 7 J C Jc:h f: _ . no. JJ2Suite no.: Tax map/tax lot/account no.: _ Lot: Block: Subdivision: Project name: Description and location of work on premises: Estimated date of completion/inspection: - CONTRACTOR APPLICATION Job no: fee arae BUSllletiti 11:1111 - - Ilrscription 01y. (ea.) Iolat no.imp - - New residential-sin{Ir or nuild-famih lWr Address: __ dwellingunh.Inrludcs ntlaclrrd garages. City: State: ZIP: Service Included: Phone: Fax: Email: 1000 sq,ft.or Icss Each additional 500 sq I t lir portion thereof CCB no.: Elec,bus.lie.no: Linvied energy,residential 2 City/metro lie.no.: Lintiled energy,non-residential 2 Each manufactured home or modular dwelling -Signature of supervising electrician(re oired) Date Service and/or feeder 2 Sup.elect.name(prino License no: services orfeeders-Installation, alteration or relocation: PROPI-114V OWNER 200 amps or less 2 Nanlc(print): A)Om,e, (.:��41 A/V/Ile; �/�!'' 201 snips to 40o amps 2 401 amps to 600 amps 2 Mailing address: 1 � ID711 601 amps to IO(10 amps 2 City: 1cm State:r1! ZIP: '712 Over I(Mampsorvolts 2 Phone: 1 (• f) 'ax:r , /f -mail: Reconnect only I Owner insta cation:The installatiod is being thade on property I own Temporary services or feeders- which is not intended for sale,lease,rent,or exchange according to I"dallation,alteration,orrelocation: ORS 447,455,479,670,701 j 201 amps to Ices 2 ` l` 201 amps to 400 amps 2 t Owner's signature: Date: Gf�� c 1_ --»i I"I,6(x)11111p% Branch circuits-new,alteration, Or a%tension lm,r panel: Name: A. [-cc for branch circuits with purchase of Address' _ service or feeder fee,each branch circuit r it� I H. Fee rot branch circuits without purchase -- _ " —--- of service or feeder fee,first branch circuit: I'hutte: I ,t . li-m,u�: Hach additional branch circuit Nlivc.(Service or feeder not Included): U Service over 225 Milli,,cnnauetci d U l lralth care facility Each put»t or irtigaiion circle ❑Serviceover320amps-rating af I&2 U Ilazurdouslncation Fachsignoroutlinelighting _ -- familydwellings U Building liver 10.00n square feet four or Signal circuit(s)or a limited energy panel, U Systemovrr6(lOvohenontinnl nuneresidential unh=+none structure alteration,oretttension' _ 2 U Building over three stories U Feeders.4(x1 amps or more •Rscti ton U Occupant load over 99 persons U Manufactured structures or Rv park Each additlonal Inspection over the allowable In any of the alcove: U Egress/lightbtgplan U Other _ -- - Per inspcLoon Submit_sets of plans with am of the shove. Investigation fee The above are not applicable to temporary construction service. other Not all jurisdictions accept credit rands,please call lutisdiction for nave Infonnation Notice:This permit application Permit fee..................... U visa U MasterCard expires if o permit is not obtained Plan review(at —_ 9F) $ Credit cud natnher _ within ISO days aller it has been State surcharge(8%)....$ TOTAL .......................$ risme of cardholder o shown one If c accepted as complete. _ S _ Cardhol3er signature Amount 4411-4615(~'OM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Number of Inspections perermit allowed . Restricted Energy Fee................................................. ... $75.00 (FOR ALL SYSTEMS) Service included: Items Cost Total Residential-per unit Check Type of Work Involved: 1000 sq ft or less $145 15 4 ❑ Audio and Stereo Systems' Each additional 500 sq.It or portion thereof $33-n0 1 Limited Energy $75.00 ❑ Burglar Alarm Each Manufd Home or Modular Dwelling Service or Feeler — $9090 2 Garage Door )pener' Services or Feeders Installation,alteration,or relocation ❑ Heating,Ventilation and Air Conditioning System' 200 amps or less __ $80.30 2 201 amps to 400 amps $10685 _ 2 ❑ Va,:uum Systems' 401 amps to 600 amps $16060 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. ❑ Audio and Stereo Systems Branch Circuits New,alteration or extension per panel ❑ Boller Controls a)Thi fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6 65 - ❑ Data Teleco nmunication Installation b)The fee for branch circuits without purchase of service ❑ or feeder fee. Fire Alarm I lstallation First branch circuit $46.85 Each additional branch circuit �_ $6.65 7-37�11 ❑ HVAC Miscellaneous (Service or feeder not Included) ❑ Instrumentation Each pump or Irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circult(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 anv 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 $ S. _ ❑ — Other 8%State Surcharge $ �i 'i ' _ -- __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 = F-1 'Rust Account u 8"e Slate Surcharge $ All New Commercial Bulldings require 2 sets of plans. Total Balance Due $ i:klsls\romukic-fees.doc 08/30/01 Permit ;address: S 6,3 10 issued by: Date: Statement: Information Notice to Property owners About Corstruction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who care not registered with the Construction Contractors Board to sign the folloti,ing.statement he ore a building permit c•an be issued This statement is regt,ired fiw 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. 1:111 in the appropriate blanks and initial boxes i and 2,and either box 3A or 313: Fol 1 . 1 o%Nn, reside in, or will reside in the completed structure. V5 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # i will instruct my general contractor that all subcontractors who work on the structure must be registered \\ith the Construction Contractors Board. OR © 313. 1 will be my own general contractor. If hire subcontractors. I will hire only subcontractors registered \\ith the Construction Contractors Board. I I'I change me mind and hire a general contractor. I will contract with a contractor who is registered \\ith the CCB and\%ill inunediatek notify the office issuing this building permit ofthe name of the contractor. her-chN cer-tiA that the ahoy a information is correct and that 111.1%e read and Flo underst;urd the Information Notice to Propel-IN (h%ners about Construction Itesimnsihilitics on the reierre side of this form. 07111 (Signature ofpermit applicant) (Date) (f l'hIle c•opv to issuing agenc'v permit fila, pink co11v to applicant) GOLDEN GATE ADULT FOSTER CARE r` Viorica Stroie — Owner 13045 SW -107" CT' Tigard, OR 97223 October 10, 2002 Gary Lampella, Buiding Official City Of Tigard 13125 SW Hall Blvd Tigard, OR 97223 Dear Mr. Lampella: I am requesting a prorata refund of the permit fees that I paid for the approved remodeling of my home. The original fee for these permits was $ 743.05. The permits included 4 lavoratories. I built only three. The Permit# is MST2002-00332, issued 7-29-02 for Parcel 2S103AD-03500. The prorata rate is 80%. Thank you for your consideration in this matter. Regards, Vvf'�_ c - -J Viorica Stroie, Owner CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Lime: (503) 639-4171 BLIP _ .3 — -- ----- Received ___---_ Date Requested M BLIP � AMP _- Location __�,��� -Sw /!yam - Suite//__ _ — MEC - -- Contact Person -- Ph ( —) ;Z6 PLM - -- - --- Contractor _ - -- Ph( ) _ --- SV4 - --- Tenant/Owner _ .- ELC ------ ----- ----- Footing - EL ---- - Foundation Access: ELR Ftg Drain ✓+�I�n�. (� Crawl Drain — SIl Slab Inspection Notes: Post&Beam - - Shear Anchors Ext Sheath/Shear Int Sheath/Shear - Framing Insulation Sys ` Drywall Nailing - Firewall Fire Sprinkler Fire Alarm - Susp'd Ceiling -- 71 Roof G1 U iC �S �� Other: UMBING am Jnde lab - -- --- Hough-In — Water Servicr Sanitary Ss>wer -- Flarn Drains ---------.".— - .-----.---_— Catch Basin/Manhole — - Storm Drain Shower Pan ---- -- --^- Other: Final --- —`__� ----- _ PART FAII_ CHANICAL - --- —. Post&Beam ------- ---"-- —�—..- ---- Rough-In Gas Line __-- ------- -- Smoke Dampers — Final ----- FAIL `_----- -- ELECT7ALRough-In - ------ UG/Slab Low Voltage - - - - Fire Alarm Fin Reinspection fee of$__- required before next inspection. Pay at CityesHell, 13125 SW Hell Blvd. AS PART FAIL Unable to inspect-no accs E _--. ❑ Please call for reinspec ion RE: - ❑ Fire Supply Line 7 / ADA ire r ` Inspector t! Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection rocord from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 1 CUUZ- INSPECTION DIVISION Business Line: (503)639-4171 MST __ 00 33 2 Blip Received Date Requested PM - Blip Location 3 P r �-�- y -yo - 7.-- Suite - MEC Contact Person _._-- Ph( ) - -_-_ --- -- PLM Contractor -- - - Ph(-- - -- SWR o y ILDI - Tenant/Owner ELC Fo -- - - -..--- -- Foundation ELC [Access: eiL c r L Ftg Drain e�Crawl Drain , - ELRSlab spection Not:�s SIT Post R Beam Shear Anchors - Ext Sheath/Shear Int Sheath/Shear - Framing Insulation - Drywall Nailing Firewall - Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other:_ ina rlS RT FAIL MEN I eamV Under Slab _ Reugh-In Water Service ��` C '� t�S / s-v -S lr C' Sanitary Sewer - - Rain Drains — - Catch Basin/Manhole Storm Drain - - Shower Pan Other ---- PART FAIL _-_- MECHANICAL Post&Beam - - - - --- Rough-In _ Gas Line ----- - - Smoke Dampers Final PAS RT FAIL ----- __ Service - ---- Rough-In UG/Slab --- - — -------- -- ---— LOW VOltane ----- Filx4arm - -- - — --__ - ---- --- --- Vaa p Reins ection fee of$ PART FAIL required before next inspection. Pay et City Hail, 13125 SW Hall Blvd. Please call for reinspection RE: F] Unable to inspect -no access Fire Supply Line --- ADA �� — Approach/Sidewalk Dolle-&,Z6�d Inspector Ext Other: -- Final DO NOT REMOVE this; inspection record from the Job site. PASS PART FAIL SE- . E 35MM ROLL #21 FOR OVERSIZED DOCUMENT