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11040 SW HALL BLVD a A a 11040 SW Hall Blvd CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 6394175 MST � INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received __ Date Requested AM -� '� BLIP Location _ 1 (�' ' t --- - ----- suite... MEC Contact Person Ph (__-�__) �� v-_`��off- PLM Contractor _ ___ _ - Ph qWR 13UILDING Tenant/Owner - - _______--_-_ ___—__ ELC Footing ELC Foundation Access: Ftg Drain Ela - - -- -- - Crawl Drain _ __ Slab Inspection Notes: SIT Post&Beam - ---- --- - - ---- - Shear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing ---- - - Insulation ' v Drywall Nailing -- --- - -- - FireH all Fire Sprinkler - -- Fire Alarm Susp'd Ceiling Roof Other. -- Final PASS PART FAIL - -- PLUMBING -- Post&Beam Under Slab Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other: Final - v _PASS PART FAIL MECHANICA__L ---. Post&Eeam Rough-In - Gas Line Smoke Dampers - - - Final PASS PAFiT FAIL __-- -_ELECTRICAL__ Service Rough-In wVolta -- --- --_--__--------_---- -�__.---- ----__--- Fir farm Reinspection fee of$ required before nsxt inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL r1 Please call for reinspection RE:�__—___—____-_. ___ LJ Unable to inspect- no access Fire Supply Line -� ADA Date Approach/Sidewalk Other:-_----__ - Final DO NIOT REMOVE this lnnpectlon record from the ob site. PASS PAnT FAIL CITY OF TIGARD �. BUILDING Inspection Line: (503) 639-4175 _ INSPECTION DIVISION Business Line: (503) 639-4171 MST Received . Date Requested `'Z AM _ - PM _ - BLIP L.:cation e i Suite_- -__- MEC Contact Person -_- -_ __— Ph(—) —— - - PLM -- - Contractor_ Ph{ _) SWR — BUILDING Tenant/9wnet' ELC Footing Foundation Access: ELC _ Ftg Drain EL.R --_- Crawl Drain ___ Slab Inspection Notes: -- SIT Post&Beam _ _ - Shear Anchors _ Ext heath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing _ Firewall Fire Sprinkler --- - - _ Fire Ai,u— Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post&Beam Under Slab Rough-In Water Service --- Sanitary Sewer —- - -- Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Oth M-SSART FAILCAL _ Pcc!& Beam Rough-In G_uJ.ine ---- -.- ampers V4i.� -- ART FAIL ---- --- _ 'ELEC-TMCAL Service -- — s — -- - --- Rough-In UG/Slab — - -- - Low Voltage Fire Alarm Final Reinspection fee of$__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE _ _ LJ Please call for reinspection RE: _ E] Unable to inspect-no access Fire Supply Line ADA 1 (,,4 t� Approach/Sidewalk Date- _c-� Inspector _ _ Ex}-- Other: Final �— DO NOT REMOVE this InisPection record from the Jolt site. PASS PART FAIL A A A A kA4L A AAAAA AAA AAk AA AAA A. 14 WO 0 -C� < .4 14-4 7:5 CITY OF TIOARD 24-Hour 01 BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 e BUP Received ___.._-. Date Requested AM PM_ __ BUP Location !) ---suite— _ MEC Contact Person _ _ - 1/ _ Ph( ) _ PLM Contractor Ph ( _) __ SWR BUILDING Tenant/Owner ELC Footing ELC - Foundation Access: Ftg Drain ELR —_-_- Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors Ext Sheath/Shear -_ ---- ---- Int Sheath/Shear Framing Insulation Drywall Nailing - -Firewall Fire Sprinkler -- - r- - --� Fire Alarm Susp d Ceiling - - -_------ ----- - -- -- -- Roof Other: PASS PARI' FAIL PLUMBING -__ ___ ---- -- ___ --- ----- - - --- Post&Beam - Under Slab -- -- --- ---- - ----- - - - -�_ _ - - Rough-In Water Service ----- - --- - - - ------ -- __- - ------ ---- Sanitary Sewer Rain Drains -- - --- ----- -_ - __. --___-_--_- ------_-- Catch Basin/Manhole Storm Drain ------- --_".. _. _---�----- -- -- ---.. Shower Pan Other: Final -� PASS _PART FAIL MECHANICAL - Post&Beam Rough-In Ges Line Smoke Dampers Final PASS PART_ FAIL - --- ---�_..ELECTRICAL Service _-- - ---_ Rough-In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of$_ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd. PASS_ PART FAIL SITE [] Please call for reinspection RE: Unable to inspect-no arcess Fire Supply Line ADA Date A roach/Sidewalk -� ` Inspector PP Other: Final _ DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL. CITY `(`.10 F TIGARD - - ELECTRICAL ENERGY- RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2002-00263 13125 SW Hall Blvd., Tiqard. OR 97223 (503) 639-4171 DATE ISSUED: 11/25/02 PARCEL: 1 S135AD-03200 SITE ADDRESS: 11040 SW BALL BLVD SUBDIVISION: METZGER ACRE TRACTS ZONING: R-12 BLOCK: LOT: 008 JURISDICTION: TIG Proiect Description: Phone and TV A.RESIDENTIAL_ B.COMMERCIAL___v -- AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL.: HVAC: DATA/TELE COMM: NURSE. CALLS: VACUUM SYS TEM: FIRE ALARM: OUTDOOR t_ANUSC LITE: OTHER: X HVAC: PRO"i ECI IVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL# OF SYSTEMS___________ Owner: Contractor: LIVIU STEFAN WELL DONE ELECTRIC 9730 SW DENNY RD. 17045 SE ROYER RD. BEAVERTON, OR 97005 CLACKAMAS. OR 97015 Phone: 503-644-7189 Phone: 503-201.401)(1 503-201-4006 Reg #: 1.1( I Ila l` 111 -; ,(. �I I' t1�,zti FEES Required Inspections — Description date Amount _ Elect'I Final �I;1,1,k(�I I 1 L.LIZ Permit 11/25/02 $75.00 ITA X I H state Tax 11/25/02 $6.00 Total $81.00 This Permit is issued subject to the regulabons contained in the Tiaard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if work is suspended for more than 180 days ATTENTIO Oregon law requires You to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in R 952-001-0010 throuc I Issued by Permittee Signature = -� / Wit. �� - OWNER INSTALLATION ONLY The installation is being made on property I own which Is riot intended for sale, lease, or rent. OWNER'S SIGNATURE: —_� _ — DATE:_ CONTRACTOR INSTALLATIr)N ONLY — SIGNATURE OF SUPR. ELEC'N _ DATE:—.— LICENSE ATE: .-___LICENSE NO: _ ---- --- ----- -- ---_ —-- Call 639-4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application "Dateeceived: Permit n City Of Tigard Project/a.ppl.no.: Expire date: City gTigard Address: 13125 SW Ball Blvd,Tigard,OR 97223 Date issued: By: Receiptno.: Phone: (503) 639-4171 Fax: (50.3) 598-1960 Case file no.: Payment type: Land use approval: TITF OF PERNIFY W.,1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replaa•tn, w U Other: U Partial 11 SITE INFORMATION A. !ob address; p Bldg.no.: Suite no.: Tax map/tax lot/account no.: _ Lot: Block: Subdivision: Prqjcct name: Description and location of work on premises: _ Estimated date of completion/inspection: kPPLICATION FEE SCHEDULE Job no: I'ce Mttx Description Qly. (ea.) 'Iota) no.Sas 'Business na rte: & s_ New rrsitkntlal-single or multi-fxmily per Address: r ' v U doellingunit.Includes attnclrerlgarage. City: ZIP: lieniccincluded: Phone: �� C'C Fax: 2 E-mail: ux)o sq.n.or les -. ---— —''-- Each additional 500 sq.ft.or portion thereof CCB no.: Elec.bus.lie.no: -�LZ C.r Limited energy,residential - _ 2 City/metro lic,no.: --- Limited energy,non-residential 2 Each manufactured home or modular dwelling Signature of supervising electrician(required) Unle -- Service andfor feeder _ 2 So .elect.namcServiresorfeeders-Installation, alteration or relocation: IIROPER14Y OWNER 200 amps or less - 2 Name(petal): 201 amps to 400 amps i 2 401 amps to 600 amps 2 Mailing address: _ 601 amps to Io00amps 2 City; Stale: LIP: Over 10(10 amps or volts 2 Phone: Fax: E-mail: Recrnlnectrnily l Owner installation:The installation is being made on property I own Tempurary wriIcei or feeders- which is not intended for sale,lease,rent,or exchange according to Installation.aheratIon,orrelocation: 2111 amps or less 2 ORS 447,455,479,670.701. 2U I aI11p5 10 4tH)a111p5 2 _ Owner's signature: I I.Ir 401 to 600 amps 2 Branch circuits-nevv,alteration, or extenslon per panel: Name: I A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: State I-.IP: B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: Fax: F-mail: Each additional branch circuit: — M Isc.(Service or feeder not Included): U Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle _ 2--- (3 service over 320 amps-rating of IAt2 U Ilazardouslocation Fach sign or outline fighting 2 fancily dwellings U Building over 10,0111 square feet four or Signal circuit(s)or a limited energy panel. U System over 600 volts nominal more residential units in one structure alteration,or extension• _ 2 O Building over three stories U Feeders,411)amps or more *Description: _ U occupant load over 99 persons U Manufactured structures or RV park Fath additional Inspection over the allowable In any of the above: U F•gress/lightingplan U Other __ I'et inspeclron Submit_rets of plans with any of the above. Investigation fee The above are not applicable to temporary constru..;,n service. Other Permit fee....................I$ Not all jtuisdictions iccepr credit cards.piesa till jurisdiction for more information Notice: This permit application Plan rCV1eW(at 9l,) $ U visa U MasterCard expires if a permit is not obtained — --- Credit card number within 180 days after it has been State surcharge(8%)....$ :eplres accepted as complete. TOTAL $ Now of cardholtkr is shown nn credit carr _ $ Cardholder signature _ — Amount 440-4615(60VCOMI ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY _ /a Restricted Energy Fee............................................ ........ $75.00 _ Number o`Inspections per permit allowed (FOR ALL SYSTEMS) Service Included: Items Cost Total Chock.Type of Wurk Involved: Residential-per unit 1000 sq ft or less $145 15 4 -1Audio and Stereo Systems' Each additional 500 sq.ft.or portion thereof _ $3340 1 F] Burglar Alam Limited Energy _ $75.00 Each Manufd Home or Modular Garage Door Opener' Dwelling Service or Feeder $90.90 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less _ $80.30 2 201 amps to 400 amps $106.85 2 Vacuum Systems 401 amps to 600 amps $160.80 2 601 amps to 1000 amps $240.60_ ? Other Over 1000 amps or volts $4:4.65 2 Reconnect only _ $66.85 2 Temporary Services or Feeders TYPE. OF WORK INVOLVED -COMMERCIAL_ ONLY Installation,alteration,or relocation Fee for each systenl......................................................... $75.00 200 amps or leas $6685 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 1 401 amps to 600 amps $13'3.75 __ 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. E] Audio and Stereo Systems Branch Circuits Now,alteration or extension per panel ❑ Boller Controls a)The fee for branch circuits ❑ H Ith purchase of service or Clock Systems feeder fee. Each branch circuit _ $6.66 .__. ❑ Data 1 elecommun[cation Installation h)The fee for branch circuits wlfhout purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 _ ❑ Each additional branch circuit $6.65 HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or Irrigation circle $5340 _ ❑ Intercorn and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s)or a limited energy panel,alteration or extension $75.00 ❑ Landscape Irrigation Control' Minor Labels(10) $125.00 —_ _ Each additional Inspection over F-1 Medical the allowable In any of the above ❑ Per inspection $62 50 Nurse Calls Per hour _ $G2 1,0 In Plant _ $13 Vs ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ ❑ Other _ 8%State Surcharge $ - ___ __ _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 $ �J }�-,- Enter total of above fees ❑ Trust Account MS8/•• y (l State Surcharge _—___-,_-----.-_-- Total Balance Due 1 Al: New Commercial Buildings reciuiro 2 sets of plans. I 41stsVir ms,elc-fats due 08 10111 J MASTER PERMIT CITY OF T I G A R a PERMIT#: MST2002-00427 DEVELOPMENT SERVICES DATE ISSUED: 10/18/02 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1 S135AD-03200 SITE ADDRESS: 11040 SW HALL BLVD ZONING: R-12 SUBDIVISIOW METZGER ACRE TRACTS JURISDICTION: TIG BLOCK: LOT: 008 REMARKS: Const, new SF detached residence. Sewer credit applies. No sewer permit. SDC credits: Effective upon final .nspection for house demo. Parks $1679.00,Tif res. $2,210.00,Tif BUILDING REISSUE: STORIES: 7 FLOOR AREAS RCOUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 025 sf BASEMENT: of LEFT: 35 SMOKE DETECTORS: Y TYPE OF USE: 9F FLOOR LOAD: 40 SECOND: 947 of GARAGE: 421 of FRONT: 25 PARKING SPACES: RIGHT: 15 TYPE OF CONST: 5N DWELLING UNITS: PINBSMENT: el VALUc: 173,870 70 REAR: 99 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,771 of PLUMBING — SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRYTRAYS: RAIN DRAIN, 100 TRAPS: LAVATORIES: 5 DISHWASHERS: i FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS. 1 CATCH BASINS: TUB/SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: 100 BCKFLW PREVNTR: I GREASE HER FIXTURES: OT MECHANICAL FUEL TYPES TURN<100K: I BOIL/CMP<3HP: VENT FANS: ` CLOTHES DRYER: 1 FURN>=1100K• UNIT HEATERS: HOODS: I OTHER UNITS: 1 GAS GAS OUTLETS: I MAX INP: flu FLOOR F'IRNAfICES: VENTS: t W000970VE9: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER _ TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS I ER IN 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: W/SVC OR FDR: I PUMPIIRRIGATION: INSPECTION: EA ADD'L 5009F: 3 201 400 emp: 201 400amp: tit WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 •600 amp• EA ADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HM19VCIFDR: 601 1000■mp: 80140mpe•11000w MINOR LABEL: 1000.amplvolt: PLAN REVIEW SECTION Reconnect only: >.4 RES UNITS: SVCIFDR>=225 A.: >600 V NOMINAL: CLS ARENSPC OCC: ELECTRICAL•RESTRICTED ENERGY e.COMMERCIAL A.9F RESIDENTIAL AUDIO&STEPEO: VACUUM SYSTEM: AUDIO&STEREO! FIRE ALARM: INTERCOM/PAGING: OUTDOOR LN09C L7: BOILER: HVAr,: LANDSCAPE/IRRIG: PROTECTIVE 91GNL: BURGLAR ALARM: 0TH: MEDICAL: OTHR: GARAGE OPENER: CLOCK: INSTRUMENTATION: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: HVAC: TOTAL FEES: $ 2,750.04 Owner: Contractor: This permit is subject to the regulations contained in the LIVI U STEFAN TEODOR MAGDA Tigard Municipal Code,State of OR. Specialty Codes and SW RD. 1208 NE MAGDA L4NE all other applicable laws. All work will be done In 9780 9780 SW DENNYD N,OR 97005 PORTLAND,OR 97230 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: Oregon law requires you to follow rules adopted by the Phone- 503-235-6058 Oregon Utility Notification Center. Those rules are set Phone: 503•644-7189 forth in OAR 952-001-0010 through 952-001-0080 You may Obtain copies of these rules or direct questions to Reg 0: I W 83065 OUNC by call ng 1,r-0,3)246-1987. REQUIRED INSPECTIONS Shear Wall Ins Rain drain Insp Mechanical Final I Erosion Control Insp 8, Post/Beam Mechanica Mechanical Insp P Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ins{ Water Line Insp Plumb Final Footing Insp Crawl Dra','Backwater Electrical Service Low Voltage Appr/Sdwlk Insp Final Inspection g Electrical Rough In Gas Line Insp Misc, Inspection Foundation Insp Footing/Foundation/Foundation Dn Insulation Insp Electrical Final Post/Beam Structural PLM/Undertloor Framing Insp r Permittee Signature : < — Issued y Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day M Building Permit Application • f)atereceived: 2. Permit no City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 ProJccdappl.no.: Expire date: iry of Tigard phone: (503) 6394171 Date issued: By: Receipt no.: Fax: (503) 598-1960 r, Case file no.: Payment type: O Land use approval I`C 1&2 family:Simple Complex: C U I &2 family dwelling or accessory U Commercial/industrial U Multi-family 0 New construction U Demolition I�� U Addition/alteration/replacemcnt U Tenant improvement U Fire sprinkler/alarm U Oflier: . Job address: L' t, �j yL-y Bldg.no.: Suite no Lot: Block: Subdivision: _ IfTax map/tax lotlaccount no.: + Project name: _ Description and location of work on premises/special conditions: Name: 7.a"1 11f /-1 VII _. Mailing address: 61 IZZIC :S t.(,+ 4 Out ot e v 1 &2 famlly duelling: l City: ec t. State: ZIP: OC'JV Valuation of work......... � .y1?,l.Z..�. Phone: ax: E-mail: No.of hedrooms/baths................................. _ _Owner's representative: 4CTotal number of floors................................. Phone: Fax: li-mail: New dwelling area(sq.ft.) ...../.V,.7..1...... M11 U U 19 MOM Garage/carport area(sq. ft.).......y., ./........ M Name: imF-emt Covered porch area(sq. ft.) ......................... Mailing address: —� Deck area(sq.ft.) ........................................ _ City: State: ZIP: �» Other structure area(sq.ft.)......................... Phooe4v — ax: E-mail: Commerclal/industrial/multi-family: Valuation of work.................................... .. $ — -- Business name: GL.�T rrv&- Existing bldg.arca(sq.ft.) ................ ........ _ `�---- New bldg.area(sq. ft.) Address- ------- City: _ Statco.. ZIP: I Number of stones.............I...I ....... ...... ... Phone: r�3 Fax �--b 4 i?-mail: Tj pe of construction........ ................... ... CCB no.: �1�_ Occupancy group(s): Existing: _ New: City/metro tic.no,: Notice:All contractors and subcontractors are required to he licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may he required to he licensed in t Address: jurisdiction where work is icing performed. If the applicant is City: State: ZIP; exempt from licensing,the following reason applies: Contact person: I Plan no.: ---- —-- -- .------ Phone Fax: morn 10, Nanrc: Contact Pelson: I cc;;due upon application ........................... $ Addrrss: Date received: — — ----- -- -- it City: ZIP: � Amount received ......................................... $_ Phone: _ax -mail: Please refer to fee schedule. hereby certify I have read and examined this application and the Nix all iunsdictions accept credit cards,please call Jurisdiction for mat inimmation. attached checklist. All provisions of laws and ordinances governing this U visa U Mastercard work will be complied with, Cher specified herein or not. , Credit card number. yf7�/ r.xpirrs Authorized signature: L Date: O d — Nanre of cardholder hhown on credll card Print name: - fir _.rY& __ t (�ardhOldtr tiRflalUR Amount i — Notice:This permit application expires if a pennil is not obtained within 190 da)s after it has been accepted as complete. 440-4613(ISMADM) 0s< e- :andrfwo-Fa111ily l welling Building Permit Application Checklist Associated permits: Ciw ofTigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tig:ud,OR 91223 UOther: Phone: (503) 639-4171 Fax: (503) 598-1960 REOVIRED FOR 1 Land use actions completed.See pilt k, i, riteria for concurrent reviews. 2 Zoning.Flood plain,solar balsa .e points, nuc , ! designation,historic district,etc. - — 3 Verification of approved plat/lot. 4 Fire district--approval required. 5 Septic system permit or authorization fog remodel. Existing system capacity_ 6 Sewer permit. 7 Water district approval. _ IIs report. Must carry original!lppftcable stanipand signature on file.,1 with application. 9 roslon control U plan U permit required. hn U'le drainage-wq protection,silt fence desi),n and location of catch-basin.protection,etc. 10 3 Complete sets of legible plans. Must he drawn to Scale,showing conformance to applicable lo-al and state building codes. Lateral design details and connections must hr incorporated into the plans or on it separate full-size sheet attached to the plans with cross rcfercnccs h.•twrcn plan location and details. Phan review cannot be completed if*copyright violations exist. _ 11 Sate/plot plan drawn to scale.The plan muss shl m I,11 and building setback dimensions;property corner elevations(if thcic I,,IIIory than it 4-fl,clevali0t1 thl lcr('IIItill,111I11 MMI slww contour lines at 2-ft.intervals);location of easements lnd driveway;footprint ol'strtucture(including decks);lilt alion of actor;/septic systems;utility locations;direction indicator;lot area;building coverage area,perceryage ol'coverape;imperilous via;cxlsting structures on site;and surface dminape.-- _ 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent ,J/v and location, - I I Flour plans,Show all dimensions,room identification,window size,location of smoke detectors,water heater, Irinlace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 1-1 Cross sectlon(s)and details.Show all framing-nlenlher sizes and spacing such as floor beams,headers,.lo . s,Sub-floor, a,lll Comiruction,rool'construction.More than one cross section may be required to clearly portray construction.Show demi,tot all w;lfl and rool'shcathing,roofini,roof slope,ceiling height,siding material,footings and foundation,stairs, tilCplal, cin,.lruction, thennal insulation,etc. I 1 lesatiun siesss. Provide elevations for new Construction;minimum of two elevations for additions and renx,dels. I �I i inn cls �,lulu.. nur;1 IC11L. t the M111,11 1'radr it 1111CChange in grade is greater than four foot at buildit envelope. 1 1111 •. (• '11CCI addrndunns Showing toundatiOn rlrvations with cross references are acceptable. 2 .0 PI t, yl all bracing(prescriptive pa(ls)and/or lateral aualysi!c plans, Must indicate details and locations:for 111111 pu••. 1 i111lvr path 111M 1dC '•p(•L Iliraul)u�mol calculations to engineering standards. 17 Floorhoul framing. I'ruvide plans for,lli floors/roof assettlhlics,indicating member Oing,spacing,and hearing locations.Show attic ventilation. _ 18 13asement and retaining scalls. Provide cross sections and details showing placement of rebar. For engineered systems,see item_22,'laneineer's calculations.' _ r-.---'-------- _ __ 19 lle-mm calculations. Provide two sets of , A,illations using current Code design values I'ur till heanls and multiple.joists m !,c 1(IIII,and/or any hetim/joist k.111 111);It 1101' Lnnfirrnl load. 20 Manufatturrd fluor/roof truss design delalls. 21 Energy Code compliance. Identity the prescriptive path or pig d ,.I,ulaiiom.. A t'as-piping schematic is required for four or more appliances. _ 22 1,:11gbteer's calculations.When required or provided.(EV., '1v-11I. , i miss)shill he stamped h� ;1n engineer or :urhitcCl IiCCll9rll ill(heron;urol shall hr !.Ill 1x11 1 1 11" ,111111k;11110 Iu Ib. I'll'; I 1 undrl n•\u•w. JURISDICTIONALSPECIFICS 23 Five(5)site plans err required for Item I I ah( nr. Site plans trust hr 8-112" x I I"or I I'• x 17". 24 Two(2)sets each are required for Items 10, Ir),20&22 above. 25 Building plans shall not contain red linrS or tape-ons. "Mirrored"building plans will he not accepted _ 26 "Reversed"building plans must meet criteria outlined in the Permit Rt System Development Dees document. 27 "Drawn to scale"indicates standard architect or engineer scale. _ 28 Site plan to include tree size,type X location per approved project street tree plan(it applicable),and car Sheet Tree List. Checklist must he completed hefhre 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. •wa.u114(rdt11tCOM) Ulu ,a WOO, nCY:I�1�A� pLc�atfrnn t %;t►as esai Patwlt nv y t p tLtVif!Mom'. city of Tigardr P i ane (501) ;1'30.41'1 PEY>keattvpl� FW (SOI)SOK 140() L..---•-•------- — ' "•.:r-_-:�r a 1�•LSir'. "'1 Mu11:f urw', (,t 7�aa.tt In,pfrvun'nl ,(b,��wnuolr.,cln, a Add 40" AI rw. 9..,'t,r Tut me:>ltalt bt azwun:no.: mid `11 i ►►u f� .InY: _ "_ra••_•�(,�,..�:a; .fin�E�r^plcrw►I�.,�---___ -. .._._._.._._. ... _._-� E,;imit�etlaeoirotnPteU^rn�/^ m: V Job D[7lY (011 Is".0v 1 name _ _ vwMiii., >c n•rrtaW-run ,tw I I f ^ -oomWwA 4rJ%4w�rbttrodPtaee• R•nw i ISlaw rM Of I P1Wna ( _ Ith i lic 6, •2+rear tlwt�wt_� r• \ C.t6 iK st.h1li. tc.n0' m tMllletltbl i t ` ' no _ _— --- -- Lam r,o.• r,.a"lttlaeRlfl ._._r. ......r Mmt rvt«Ma err a. 11011 "^ h� u oht 1rr u.Yd' V _ ) 'i aka en.M M i 1�iP NlsnRioc;x"106 WM ., nJ 700 a uw __--- AQQl MMUrl Adam" �iur '� State:��_ ,� iftv��•.�—.._T� Y MUM [tail; a on _ �� I UWne�eWIGilun:'the i�neteR made ew pMccQ y 1 e" w,tMwr�rMw+M�r.n st,ortdealMM+ ' 1 ktl.InetIn'eneerfPurEde•leofe"41h"fleeecaus,'art• dk ttr. o � 004 441,aye. - Wf,C!`I ii MEt,Ya' L12a1. w1;'fJOo f� ......-.--• rttR+Ih1^ae�•— v �M k y1gE11rw/^'pEaIL i \31 I•( w's�•�•_"^_� f��•-'•,)111:-' � D f'iq—�iaMfun Arlldl»»n.».MY��IIIi� IetoKtnrkakrqu.rap"MIS lWW,��,,,• ..�;..... `�` 1 "� ~6..iw..•..—. 'T_Fai $II�i: �tbmlhntiohtAFVAA lwlm�MILAN— .�� „}� ` FiNhpem�otMfl�eonMMN__�_—. --�`•F-• �..s. H.W111ww Wrm y yw.itt,vtr320env tNmwdt'Nt"e1"'"` e4MRa • E.1oht rllMle ��N�!1� "0 (►vWYd•+din� 7S1Mp�a1llt1dC10'2 e .l lN�mtv:tKKl,nht tttwM tal Oe1re1M'11w�relOURSit Wil!lttMtrt R�a—�NMIM—�' _ 1 l r.�.w•.1-+ 1 `' �ti � .G�:i.a. -'�.tW .�.r,'�It�f.•'M.i,:;GP^Ihtp: 1+ dl: Y.�.. M 60AMUM"N I"a RV PASSI�ikTww a.0 1 a 1n1 e e . _ J I F c ^t nd nm a Vert 1"low E ete Not Inwidt t0 tuar-owy 01%wbO:41f_AL!_ »------_ t�WZ kr man wmskm) NWw,Tn.permit 1ppUWIQP plan tL'v'R.N(At - a1 d w�di;;Sir Mill eE:1'.t rif thnM !(a av e1t OOt ^�!eietd �••»-� 1 lWla 7MIIIIt:tVd ( »I hjr tin 1e•.•wr htY11 M.- waa luscaulf n•Iit "IN niYl7__. �.�w.w_-...._._ rn Md E.'MlM1�GIk Tv7rR AL S �w.�.w.—..... r'!�!!� _ _ � � 1f'-N'1 1{4Iv{.•111 ce •d wd te: zt el�z->ra- lao Bt ilding Fixtures Plumbing reirrnit Application " Date received: Permit no,: Cit Of Tigard City g Sewt:r permit no.: Building permit no.: Address: 13125 SW Ilull Blvd,Tigard,OR 97223 City of Tigard Phone: (503) 639-4171 Project/appl. no.: Expire date: -� Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: CCase file no.:M Payment type: 1 Ll 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacement U Food service J f Ithcr: It SITE INFORMATION ' Job address: C ni, f i� /e� %^ �_C/ I Description Qty. Fee(ea.) 1 Twist Bldg. no.: F Suite na:_ 'New!-and 2-family ditellings only: (includes 100 R.fo-,elicit utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: Block: Subdivision: - SFR(2)bath Project name: _ SFR (3)bath City/county: zip: Each additional bath/kitchen Description and location of work on premises: Site utilities: _ Catch basin/area drain Est,date of completion%insprcti,)tn Drywellsdeach line/trench drainPLUMBING e 1 Footing drain(no,lin. R.) Manul'uc(uled home utilities Business name: 17Cry L Manholes Address: 2 _61V_ _ % Rain drain connector City State' ZIP: 2 Z�� Sanitary sewer(no.lin. Il.) Phone• p nx;'� ,J nail: Storm sewer(no.lin, It.) ce no.lin. ft. CCB no.: Plumb.bus.reg.no _ •f�• Water servi e.no.: p/y _ ' _,_ �' Fixture or item: City/metro Ii -�, Absorption valve Contractor's representative signature_ ,I, Inte V Back flow reventer Print name: : C 0 C Backwater valve PERSONCONTACIf asins/lavatory Name. Clothes washer -- ---- - Dishwasher Address: Illbraking fountain(s) _ City �- State: A/II' I?Iectors/sump Phone: Fax I -m;ii1 Expansion tank Fixture/sewer cap Floor drains/floor sinks/hub Name(print): Garbage disposal -- -- '-Willing address: (lose bibb City: -� State: 'LIP: —� Ice maker Phone.: Fax: I E-mail: Interceptor/grease trap Owner instal Iation/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 property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's signature:_-___-----Date: Sump Tubs/shower/shower pan t Final - Name: — —---- Water closet --- _ Address: _ _ Water heater City. J_--- �— State: ZIP: Other: - ----F - Phone: Fax: E-mail: _^ ota Minimum fee....... .. ..... Not ii Jurisdictions accept credit cards,please cell Jurisdiction for more informstfun Notice: This permit application Plan review rat _._ %) fa r - U Visa U MasterCard expires if a permit is not obtained State surcharge(8%)lip res .... $ Credit card number _ within 190 days aftet it has been —� -- accepted as complete. TOTAL........................ S —. Name of carrL older as o a wn nn credit�- S -- — Card et signature 4404616(fu00H;OM) PLUMBING PERMIT FEES: -— -- PRICE-T—TOTAL New 1 and 2-family dwellings only: _FIXTURES (individuals CITY (ea)_ AMOUNT (intheludes all dwellingand the fi st100 ft.in CITY PRICE AMOUNT TOTAL Sink 16.60 for each utility connoctlon 16.60 Lavatory One�lLbath $249.20 Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 --- 1B 6Q Three 3 bath $399.00 _ ffDishwa—sher y — 1 16.60 SUBTOTAL 16.60 8%STATE SURCHARGE 16.60 PLAN REVIEW 25%OF S-UBTO_TAL _ -� TOTAL sposal 16.60 — — - Laundty Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3.. 16 60 q• 16.60 __CIuandt b Work Performed Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed/ Gas piping requires a separate mechanical _Geed ormit. MFG Home New Water Service 46.40 Sink APG Homo New SanlSlorm Sewer 46.40 Lavatory Tub or TublShower ose Bibs 16.60 Combination _ Roof Drains 16.60 Shower Onl 16.60 Water Closet Drinking Fountain Urinal Other Fixtures(Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tra Washing Machine _ Floor Drain/Sink: 2" ewer-1st 100' v 55.00 3" Sewer-each additional 100' 46 40 4„ -- Water Service ' 55.00 Water Heater 1st 100 Other Fixture] Water Service each additlor, 70' 76 A 0 (Specify) Storm&Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46V25 40 — Residential Backflow Prevention Device'Catch Basin Inspection of Existing Plumbingor Specially Re npectiors COMMENTS REGARDING ABOVE: Rain brain,single family&.elling . Grease Traps 16.60 QUANTITY TOTAL -- Isometric or riser diagram Is required If Quantity Total Is >a 'SUBTOTAL - 8%STATE SURCHARGE - - "PLAN REVIEW 25%OF SUBTOTAL Required only It fixture qty total Is>B TOTAL $ "Minimum permit fee Is$72 5o•B%state surcharge,except R,:-idential Backflow Prevention Device,which is$36 25+B%elate surcharge ""All Now Commerclat Rulidings require 2 sets of plans with Isometric or riser diagram for plan review I:\dsts\forms\plm-fees.dnc 12/26/01 i Mechanical Permit Application Datereceived: Permit no.: City of Tigard Project/apl,l ao,: Expire date: (:irpt?fTigard Address: 13123 SW Hall Blvd,Tigard,OR 9722:a Phone: (50 i) 639-4171 Date issued: By: Receipt no.: Fax: (50?) 598-1960 Case file no.: Payment type: Land use approval: 13aifding permit no.: TTPE OF PERMIT U I &2 family dwellin,:or accessory U Commercial/industrial U Multi-family U Tenant improvement U New ronshoction U Adclition/afleration/replacement U Ocher: 1 ; SITE INFOINATIONCOMMERCIAL e�litihmctu quantities in boxes below, Indicate the dollar Bldg.no.-. Suite no,: V value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit. Value$ Lot: Block: Subdivision: *See checklist fir important application information and Project name: jurisdiction's Ice schedule for residential permit fee. city/county: ZIP: 13111-1y, 0 f Description and location of work on premises: Ft�yra.) iiNal Est.date of completion/inspection: thuripliru, Ql). Res.nnly Res.orlh Tenant improvement or change of use: Ah-handling unit CFM__Is existing splice heated or conditioned?U Yes UNo it conditioning (site plan require ) Is existing space insulated?U Yes U Nt' teratfon of'e:x sting HVAC system 1 f301 er compressors Stntc boiler permit no,: Business name: tC �_El,.'�+ rt i �< ti��1 !fir, .`i Ifll7�llti HP _ Tons BTU/IA Address: 1 S \ S,l( 'ir'smoke ampels/ ucl smo a electors _ City: 1[ It t State;` 7_ 7.1 P: l Z C F�cat pump(sin,plan required) Phone: Zt.�'i � i� Fax: �2. E-mail: nsia /repacefurnace urner /1 Including ductworf/vent liner U Yes U No - CCB no.: k' nsta rep ac relocate heaters-suspen e , City/metro lic.no.: wall,or floor mounted _ Name(please ring: -,r C r-j �A i I Vent for app lance other than furnace CONTACT PERSON e geral on: Absorptionunits _-- BTU/I1 _ Name: Chillers _ _ fill - Compressors-— 111' Address: nilronmenta exhaus(and ventilation! City: Statc: ZIP: Appliancevcnt Phone: j I'am M E-mail: ryerexhaust _ -- 0o s,1 ypc res. lichen/hazmat hood fire suppression system Name: Exhaust fan with single duct(bath tans) Mailing address: _ _ :x aunts stem a rot from kaon or AC' State: LIP: Fuelpiping andistribution(up to out ets) City: _ Type: I-M _,_ NO __ Oil Phone: Fax: li-mail: `t tial piping eacha ditionarirvcr�outicts rocesspiping(scematicrequired) Number of outlets Name: -Number IIMM ar p (nee or equipment: Address: Decorative fireplace _Stale: ZIP: nsert- type -- I'hone: Pi E-mail oor slovC pe lel stove O,her: Applicant's signWU'Jr `- Date: IGC ` a ter: Name(print): i a l i t k-E R, Not all lutirdictions accept credit cords,pleae tall itouliction for more information Permit fee.....................$ Notice:T1tis permit application Minimum fee................$ _ U Visa U MasterCard expires if a permit is not obtained Credit ced nurnber: _ �__ __�_L— Within 180 days after it hes been Plan review(at ! t�) $ splree Y State surcharge(8%)....$ Narm of car bol r as e own on ii c card s accepted as complete. TOTAL .......................$ Codholder sijnalttre v Arnount 440-017(MXWOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description: - Price Totai $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Oty (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 Inch ding ducts&vents 14 00 fraction thereof,to and Including 2) Furnace 100,000 8 rU+ $10,000.00, Including ducts&vents 17 40 510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace ^� $1.54 for each additional$100.00 or including vent 14.00 fraction thereof,to and Including 4) Suspended heater,wall heater $25 000.00. or floor mounted heater 14 00 $2!i,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 ,, or 6.80 fraction thereof,to and Including 6) Repair un is ___ $50,000.00. _ 1215 $50,001.00 and up $742.00 for the first$50,000.00 and_ Check all that apply: Boiler Haat Air $1.20 for eacn 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 BTL! 14.00 6%State Surcharge $ 8)3-15 HP;absorb iinit 100k to 500k BTU 25.60 25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb Reyuir_ed for ALL commercial permits only unit.5-1 mil BTU 35.00 TOTAL COMMERCIAL PERMIT FEE: $ unit 10)30-50-1.75 mil mil absorb '-1.7BTU 52.20 11)>50HP;absorb unit>1.75 mil BTU 1 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM --- Value Total 13)Air handling unit 10,000 CFM+ 10.00 Description: Qt Ea Amount 17.20 Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts&vents 10.00 Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents 6.80 Floor furnace Including vent _ 955 Suspended heater,wall heater or 955 16)Ventilation system not Included in floor mounted heater appliance ermlt '10.00 Vent not Included in appliance 445 17)Hood served by mechanical exhaust 10. permit __ Repair units 805 18)Domestic Incineratorsi - 17.40 < hp; absorb.unit, _ 955 19)Commercial or industrial type Incinerator I TU 3-15 hp;absorb.unit, 1,700 69.95 101k to 500k BTU 20)Other units,including wood stoves 15.30 hp;absorb.unit,501k to 1 2,310 10.00 mil.BTU 21)Gas piping one to four outlets 5.40 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU 22)More than 4-per outlet(each) 1.00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: >1.75 mil.BTU $ Air handling unit to 10,000 cfm 656 Air handling unit>10,000 cfm 1,170 8%State Surcharge $ Non-portable evaporate cooler 658 TOTAL RESIDENTIAL PERMIT FEES $ Vent fan connected to a sin le duct 448 Vent system not Included in 656 appliance permit _ Hood served b mechanical exhaust 656 Other Inspections and Fees: _Domestic Incinerator 1,170 1 Inspections outside of normal business hours(minimum charge-PNo hours) $62 50 per hour Commercial or Industrial incinerator 4,590 2 Inspections for which no fee is specifically Indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 $62 50 pet hour Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum Gas piping 1-4 Outlets 360 charge-one-half hour)$62 50 per hour Each additional Outlet 63 'State Contractor Boiler 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 plans. I:\dstslforms\mech-fees.doc 02/11/02 � I 1 i rnC z cc <I ca i � j > d W J U- 7 w Q m tJ ;n JC = Lr u F- I r C7 • oS N I � I 1 I r Zi Zj II .r--T- W pjDAgjn08 IION 'M•S c v a a3M3s J-HVIINvs rt rrC. CITYOF TI GAR D BUILDING PERMIT PERMIT#: BUP2002-00433 DEVELOPMENT SERVICES DATE ISSUED: 10/3/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S135AD-03200 SITE ADDRESS: 11040 SW HALL BLVD SUBDIVISION: METZGFR ACRE TRACTS ZONING: R-12 BLOCK: LOT: 008 JURISDICTION: TIG REISSUE: _FLOOR AREAS EXTERIOR WALT_ CONSTRUCTION _ CLASS OF WORK: DEM FIRST: sf N: S: E: W: TYPE OF USE: SF SECOND: sf _ _PROJECT OPENINGS? _ TYPE OF CONST: 5N sf N: S: E: W. OCCUPANCY GRP: R3 TOTAL AREA: 000 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP RATED: BSMT?: MEZZ?: RE_QD SETBACKS _ REQUIRED_ _ FLOOR I.OAD: psf LEFT: ft RGHT: ft iFIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR- ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 1,500.00 Remarks: DoIno 1 stricture Approximately 480 sf. Sewer line to be capped and inspected. All debris, to be reiuow cl. Owner: Contractor: LIVIU STEFAN OWNER 9780 SW DENNY RD, BEAVERTON, OR 97005 Phone: 503-644-710 Phone: Reg#: FEES REQUIRFD INSPECTIONS Description Date Amount Cap Sewer Line Insp [BUILT)] Permit Fee 10/3/02 $62,50_____ Final Inspection [BUILD]Permit Fee 10/3/02 $0.00 [TAX] 8%StateTax 10/3/02 $5 00 [TAX] 81%,State Tax 10/3/02 $0.00 (additional fees not listed here) Total $110.40 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of these rules or dirLd questions to OUNC by calling (503)246-6699 or 1-800-332-2344. Issued By: ;-..� t �. GC Zc c c; Pemfittee �.- Signature: _ �,(, Call 639-4175 by 7 p.m. for an inspection the next business day DE O Building Permit Application Date received. Permit no.: `? City of Tigard - City qfTigard ---- Address: 13125 SW Hall Bivd,Tigard,OR 97223 Project/appl.no.: Expire date: - --- Phone: (503) 639.4171 Date issued: By: a 1 Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 1&2 family:Simple Complex: U I &2 family dwelling or accessory U Commercial/industrial U Multi-Gamily U New construction U Demolition U Addition/alteration/replacemcnt U'fenant improvement U fire sprinkler/alarm U Other: Job address: e C '541 -e'm' - 2-L3 1Bldg.no.: Suite no.: Ltt:1L_ Block: Subdivision: Tax map/tax lot/account no.: Project name: Description and location of work on premises/special conditions: Name: Mailing address: 4L' ( 6,101 CY I I do 2 fancily d"elling: City ew le State:0 : 7tY-4 Valuation of work............ ........................... $ Phone: ax: E-mail: No.of bedrooms/baths................................. Owner's representativr: Total number of floors................................. -e. I'htulr: I,a,: I nrnl New dwelling area(sq.ft.) .......................... APPLICANT Garage/carport area(sq. ft.) — Name: 6 j B F,*N oZ-/ Y10 Covered porch area(sq.ft.) ........................ Mailing address: W _-5 W At Deck area(sq. ft.) ........................................ City: State: .. IP: V[t tis' Other structure area(sq. ft.)......................... _ Pho '' --ax: E-mail: Commercial/industrial/multi-family: Valuation of work........................................ $ ,, Existing bldg.area(sq.ft.) .......................... Business name: Address:- New bldg.area(sq.ft.) — Number of stories........................................ --- City: State: ZIP: 7 Type of construction _. .._ Phone: Fax: E-mail: - -- - ---- - Occupancy group(s): tixissing: CCB no.: ---- ----- C ilyhnctrcttic,ntt.; Notice:All contractors and subcontractors are required to he It( -rased with the Oregon Construction Contractors Board under Name: pito isions of ORS 701 and may he required to he licensed in the Address: jurisdiction where work is being performed. If the applicant is -- -- exempt from licensing,the following reason applies: Cit State; 7.IP: Contact person: w_ Plan no.: Phone: I E-mail: --- ---- - Name: l Contact person: _ Fees due upon application ........................... Address: _ _ [late received: -- -" City: State: 7.IP: Amount received ......................................... $ Phone: - Fax: E-mail: --- Please refer to fee schrrlule. I hereby certify I have react and examined this application and the Not all Juniclictinns accept credit cardi,please call Jurisdiction for nuxe inrcmt oh. attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard work will he complied with, hether specified herein or not. Credit card number: Authorized signature: �IJ� Date: Expires g T-- .�_ Name or c Ider u shown on credit card Print name: -- s Cardholder 11i1rralure Amount Notice:This permit application expires if a permit is not ohtained xvi thin 180 days alter it has been accepted as co tete. W-.tela(hrtloCP)j'L Commercial Plan Submittal Requirement Matrix City of Tigard - --- TYPE OF SUBMITTAL # of Plans (Includes New, Additions or Alterations) Re bud d at tall Site Work (must include location of all accessible parking) Plumbina - Site Utilities 2 Building 1* Fire Protection System 3** Mechanical 2 Plumbing - Building Fixtures L Electrical Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over-the-counter commercial tenant improvements, submit 2 sets of plans. **"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i\dsts\forms\coM-matrix.doc 9/24/01 Permit Address: . Issued bya Dater Statement: Information Notice to Property owners About Construction Responsibilities Note: Oregon Law, ORS V.055(4), requires residential construction permit appli- cants who are not registered Kith the ('onstruction Contractors Board to sign the .Ji)lloti+,ing statenuer7t before a huilcling permit run he issued This siatelnent is required for residential building, electrical, mechanical, and plumhing permit, Licensed architect and engineer applicants, exempt.from registration under ORS -01.01(1(7), need not submit this sfaternent. This siatement will be filed ivith the permit. Dill in the appropriate blanks and initial boxes 1 and 2. and either box 3A or 36: 0 1. 1 own, reside in. or will reside in the completed structure. 2. 1 understand that 1 must resister as a construction contractor if the structure is sold or offered for sale before or upon completion. FU 3A. My general contractor is J (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 r1j 36. 1 will he my own general contractor. If I hire subcontractors. i will hire only subcontractors registered ssith the Construction Contractors Board. If'l change m\ mind and hire a general contractor. 1 will contract %sith it contractor sshu is registered smith the CCB and will immediately notify the oflice issuing this building permit of the name of the contractor. hereh� certifN that the ahoy c information is correct and that I ha%a read and do understand the Information Notice to Propert (hNners about Construction Responsibilities on the reverse side of this form. (Si_ �,natt � pp i� rcrinit applicant) (Date) � (11'hite (.-op),to issuing agenct•perm it.file. pink copj-to applicant) information Notice to Property Owners About Construction Responsibilities Aid. I ht' to Prolwi't1' I)1,N("I rli!t'tlf + WIS11,11olon kc• pon.slh11 lw1 JI,I thr' ('rm,t•tructit)ri , 'ol Itr'ctcv;try h't+(jr,l nl�c ordtmcv 1cilA ORS 70 1.05 it i) 11 ',oil arr 8,.IMIC..i`• \I! If ,,\\I1+.'(1IlU-a\tM Ii OfIV II'IILI ;I r!':\\ 110111 Lill rllakc a tlh,;tfinilaI iinprovCnlent Io all t'\I IIitv,,Strut:Ikire, v rnt can prev+.nt mai,,O pwblelw,b)'being avv arc+a thc:1,01low iu)g EMPLOYER RC SPONSIBILl TIES: II 1Uu IIIrC hl.'r`,UII:+ II' 114:�,Url�.'tl.'+.1 VA1111 Ills' I."w'L't11;twit (. ulili,li. lof', It,,;li,l tloh� i I'1 �vll,tlll�tlll,kt +,f ar;til'+1111 ill the ,:,+IlYlt'tl�llall of Impt+'1 Cn1C!1' +�l.I!'l'�1+1!'tlll(ll wtI"Illtll!'1,`"A+'.11 tb 111. !Il Ill�_'wt Ili•I.tll.:c'��.h'fUlCii It>ivU 1111 CIIlt71(')Cr Illltl 111 t:'17Ci1t1IC V a!1 hire Vv III he enlplm rc"; ;I 11C Lill 'N Cl ;oit Ill II rt,tltl~I�. Av ith the folloAA ink•: (11regon's ,otlihntdingtaxLoksftI)c"utpIf)%. o .',rnllnn,;tvc'itlitwi,ling.,mirinixil frtltitenlpI(IvecN-,I m:rlheliIll ccmIIIo.\ccs arc Paid You vv ill he linhhv 10t. t,tv 111Iynlew-;c•v cl) if.k,+Ill dorl't,u.lurllh'vyilhh+ld the tqv: rront vr�!�r, nitll%,ver" . l:or Irtnlc' ifll61,111iltioil.call the( hrltnn i)e:pt,(it R rvennu at 9.1� f0(lill t`nernpluvinvilt insal•11nee tav A,;ali cmpl+)Ncr. N r'u alrc required to pa\ a lax intitlranLe PurpiScs on the c\ages(if all enlpit ccs I ,+r more ir•ItoilltmiMit.ra'll the ,)0?i ��tlrl(l'1'y�CI►ItipCn9at1OII 1)t9llrrUll"f!: :�',1111�'llll'll ,1 C0., 5+1J arc srlLljcLt to laic l►rc:V..un Li I kcPf t,ui!lpclisillloll Law, 1181St ! i h(x111114'll'kt'I';�1'i1171t1CII'+(111a11111':IIr111!+,:+: ttN'\tlllt;:'I'lllil+,1 a,'�. I( \,'�t1l�llltuol',111111A��1'{ t"1'��!'+�Inhl'll'ktill,lllll',tlrtlhCe,AtillIlia}' { , I, t. I I j c� n('ormatiiln. Int",11(7 Cttt+i llilitltll'� tlJdyv11111.'Ililhll'I+'r�lllu tlttll+}', 11x111'(! va1lYeln 11++v.'r," i�111CrIQIlltll 1}h, I ilYlllil'C t I!!111C �0 111,. i t'lltltllilt l! '+I UM!`1111 l 11111 i oI lnt. 1(v, lliternal Rv%cnlie Nery ice: k"an c wllhl�)ti cf.you 11111-•t vv itllhold 14cicral income tav I I i I+!,n,�, : �°„lk2cr,- lun�'•ill kxr Ilahte fur the lax 11u�111..nt c\+.n d i,uu didn't ac.tu<IIIN \\itlrhuld the til:\. Fur more illfurintttloll•cell the I Irr, rnA lJvtlUtL Seri ice OTHER RESPONSIBILITIES AND AREAS OF upNCERN' CodecompliHnee: vcthe permit holder Cor till,Ill 0icc1,\,Oki;lrt , ,p,ln,ihlcturtr, ,(\Inl nn� lailurettllllretr,ldcicclulremt'nt� ihat Iliav ht hiouvIlt to l'001'11IMIIIall thR11"01 Ilr'lccliolls. .illhilih alai property ellu)1ap-C in'lllrallce. l on!a�t\+1r,r in'urartce al!cnrt tr, . tl i1 1 h.r\c cld<yuatr ur:ur,u1,:� c c'r,lcic tc\r r.+.iclt'nt alld otilissloll",Buell a\; falling loin:,.paint u\cr:.luu\,\\11tt r dlunapr frc in pipe punc.imcs, tire.nr\\irk that must he 1�..�-tl�,nc• Mme to super)kv en)plol ccs: \L11,., ,arc' \ ,it ha\r '1111(1+ is Ill time to super.I.c\'OUI rntplocres I' xpertisc: i%hkk'.`RI!l•v,NIhJvI.till, a".v m.ovin5!l'I1Cr811'r111t1'ai'tat,1:'Cat�fdll)�11C1111'vCnrh+llr�1!IL'h lllrllllll111151t tr;tdc�s. tid t l nc+tii� hniltlink nf7irial'; t the l prclt,ri�tciitttcs` �+ttir�, t rtr tic fiirm ti u rt.tlit ired iw;l1r:•oiorie. If\oil hair;additwImI yuCAir,nti, \\i it or call the i'on,,irncti(III Cot ract„r'; It,+ard(N) Ilo\ I I I III, S,,IIcIII,tilt 97104-505'_. 501'37R #(1?t). Fill: K,flyd i,, locat+ ,l :11 '00 `-It. NL Suitt 1011. In tialcm. 1 ,1.1 i I I I , cc U, Q I I I Z W C] -' Z C w cn � v" wmU- �J Of IY I I � l laCl Li Q .-j x a ti 3 d N > t0 I � I i Q, t0 �[ h � I _ � I I I I I I r Z In " =IT Z - , - zI Lr)I ZW rrt ,5i +- -- - -- - W w W; M m z -- 631vM w p.1ona/n0g IIInN M 'S $ ZI ° o" ; svo o LLJ 83M3S A6V11NVS y, LL _ J � CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST 10� �-�— INSPECTION DIVISION Business Line: (503) 639-4171 �- BLIP Received ___ [)ate Requested__- ! AM__ PM SUP — I_ocation __ � _ Suite __ M( Contact Person �_� �1 Ph PLM Contractor—_ -- Ph( ) _ _-_ . ---- SWR __.---- -_-_-_- — BUILDING FLC Footing Foundation Access: ELC - - - Ftg Drain ELR Crawl Drain ____ - - - - Slab inspection Noies SIT Post& Beam Shear Anchors Ext Sheath/Shear IntSheath/Shear Framing -- Insulation - _--- -- Drywall Nailing Firewall r - Fire Sprinkler --- Fire Alarm Susp'd Ceiling - - - - - Roof Other: � �� {�►� - Final PASS PART FAIL - - PLUMBING �I Post&Beam Under Slab Rough-In - Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain -- Shower rdn Other. - Final PASS PART FAIL ---- - -�' MECHANICAL _ Post&Beam ---- ------- -- ----- -A Rough-In _.---- ------ ------ - - Gas Line Smoke Dampers _ -• ---- -��—_- -_--__ Final PASS PART FAIL -- -- --------- - ----- - -- - ELECTRICAL Service -- -- - -` `�----` — Rough-In - UG/Slab —"-" Low Voltage -_--- __- _- ,-- ----_--_ Fire Alarm Fin Reinspection fee of$ re-__- uired before next A3 _ A_Rt FAIL q Inspection. Pay at City Hell, 13125 SW Hall Blvd. $ - �- u Please call for reinspection RE: _ El Unable to inspect -no access Fire Supply Line ADA Approach/Sidewalk Dats�C` InspktOr��_/,� � __ Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL l v c� so n. N � a. J a F � n � T 4 O o Q o c� o � o � � 4 5 V s k