10475 SW MCDONALD STREET-1 '- J22ILLS CI'IVNW0W M5 SL607
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10475 SW MCDONALD ST
CITY OF T`I GA R D MASTER PERMIT
PERMIT
DEVELOPMENT SERVICES DATE IS UED: 8 s7/20000227
4
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171
SITE ADDRESS: 10.375 SW MCDONALD ST PARCEL: 2S102CC-08700
SUBDIVISION: PPI996.073 ZONING: R-12
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Remodel existing house, adding front porch and rear deck.
BUILDING
REISSJE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS_ REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: at BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD. 40 SECOND: of GARAGE: of FPONT: 15 PARKING SPACES: 2
TYPE OF CONST: 51`1 DWELLING UNITS: I THBR at RIGHT: 5
OCCUPANCY GRP: R:I DORM: 9ATN: TOTAL: 0 at VALUE: 10000 00 REAR: 15
PLUMBING
SINKS: I WATER CLOSETS: 3 WASHING MACH: I I AUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: 2 GARW,IE DISP: WATER HEATERS: I WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES: 3
MECHANICAL
FUEL TYPES FURN<100X: BOfUCMP<SHP: I VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN>,1GCK: I UNIT HEATERS: HOODS: 1 OTHEP UNITS. 1
MAY.INP: btu FLOOR FURNANCES: VENTS. I WOODSTOVES: GAS OUTLETS: 6
_ ELECTRICAL
RESIDENTIAL UNITY SERVICE FEEDER TEMr SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS _ ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: PUMP/IRRIGATION: r PER INSPECTION:
EA AOD'L 300SF: 201 - 400 amp: 201 400 amp: let WO SVO'FDR: m SIGNIOUT LIN LT. PE,R HOUR:
LIMITED ENERGY: 401 600 amp: 401 - 600 amp: EA.ADDL aR cin 2 oV SIGNALIPANEL: IN PLANT:
MANU HM/SVCIFDR: 601 - 1000 amp: 601#ami&-1000x. MINOR LABEL:
1000-amolvolt:
PLAN REVIEW SECTION
Reconnect only:
>-4 RES UNITS: svctrDR>•223 A.: >600 V NOMINAL CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AULIO It STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPFARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAfTELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 903.29
MARTIN OWNER This permit is subject to the regulations contained in the
KEVINTigard Municipal Code,State of OR Specialty Codes
PO ART 0 7 97132 and all other applicable laws All work wi11 be done in
NEWBER
accordance with approved plans This permit will expire
if work is not started within 180 days of issuance,or If the
d work is suspended for more than 180 days.
Phone: 503.550-6276 Phone: ATTENTION: Oregon law requires you to follow rules
N adopted by the Oregon Utility Notification Center Those
Rag 0: rules are set forth in OAR 952-001-0010 through
952-001-0080. You may obtain copies of these rules or
direct questions to OUNC by callina (503)246-1987.
REQUIRED INSPECTIONS
WPlumb'rop Out Electrical Final r
—� Electrical Rough In Mechanical Final
Framing Insp Plumb Final
Gas Line Insp Final inspection
Gas Fireplace
Issued By : Permittee Signature :
Call (503) 6394175 by 7:00 p.m. for an inspection needed the usiness d4
Buildinp- Permit ApplicationRECOVED
City of Tigard AUG (} r) �� p:«Be Permit N•,
13125 SW Hall Blvd,Tigard,OR 97223 Plan Review —�
Phone: 503.639.4171 Fax: 503.598.1960 Date/By (, a Other Permit
Inspection Line: 503.639.4175 GITY 0 Date ReadylBy ru ® See Attached Checklist for
Intertlet w.ci tiger usD) Notificd/Me od �� Supplemental Information
_MN
r ---__
''' TYPE OF _A"W'iX:z ,$.901"D DATA.:.I-AND 2-FAMILY DWELLING (\\�
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
-- --- -- -- Indicate the value(rounded to the neare.t dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSrRUiCTION work indicated on this application.
❑ 1 and 2-family dwelling�- -_ - ❑Commercial/industrial Valuation. S �T
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
Ji7B S117fit,*FORMATION pleb LOCATION Total number of floors
Job site address: /Q e vvyt je - New dwelling area: square feet
City/state/7_[P: � A 4 Q C ' — Garage/carport area. , square feet
Suite/bldg./apt.no,: Project name: ��It T��/ Covered porch area: square feet 16
Cross street/directions to job site. -� Dec).area: - square feet
Other structure area: square feet
QUI AD DATA:COMMERCIAL-USE CHECKLIST
Subdivision: _—_ Lot no.` Permit fees'are based on the value of the work performed.
Tax map/parcel no Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead.and the profit for the
�SSCl�tIkfON OF , „ RIS work indicated on this application.
Valuation: S
-----
Existing building area: square feet
CAIj y�ro��s Q �Qu�f I/ New building area: square feet
tA�11 Q1it of
, Number of stories:
Name: Q v f h �N Q f�',4. i - Type of construction:
Address: P 3;,X 3.pq- Occupancy groups:
City/State/ZIP: IV et.,6erl o ti 13,-- Existing: —
Phone:(SD3) So ._h2,1b Fix:( ) New: 1---
❑ APP• CANT w' CONTACT PERSON
Business name: _ All contractors and subcontractors are required to be
Contact name: — licensed with the Oregon Construction Contractors Board
- --------- ----- -- under ORS 701 and may be required to be licensed in the
IL Address: iurisdiction in which work is being performed.If the
City/State/ZIF: applicant is exempt from licensing,the following reasons
W ---- ---- - .—�--- apply --
Phone:( ) Fax: :
J E-mail:
00
W Prin ss n e: ., . . :
I1FE1C3"
dr -- - --- ------
-- - Please refer tv fee schedule.
ty/S at
– Fees due upon application Q
on ( �_....r_ -_
Amount received
Blc . -
-- - -� Date received:
Yt orized signature: This permit application expires if a permit is not obtained
within 180 days after It has been accepted as complete.
Print name: (eyr,� d rt,,7 rDate: 9/s" O ' Fee methodology set by Tri-County Building Industry
" Service Board
i\8uildine�PermiWRL1P Pert Mpp doc 12103 440-0 111T(11,02TOM/WF.B)
One- and Two-Family Dwelling
Rnildinp_ Nt.�mit Application Checklist
City of TI garll Hereived
Penna.'Jo
13125 SW flail Blvd.,1lgard.OR 97223 Date by _
Phone 503 639 4171 Fax 503.599.1960 MsociZed permits
24-flour Inspection Cine: 503.639.4175 ❑ Electneal Li Phrmbmg L) Mechanical
Internet. www.ci.tigard.orus ❑ 01h t
I HE 1,011,ILONVINC UITNIS ARE RIKQUIRED'FOR PLAN REVIE* N C% N41 N/Ii
I Land use actions completed. See jurisdiction criteria fur concurrent reviews. ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. _
3 Verification of approvedplat/lot. _
4 Fire district a1rprovaI required. Name of district:
5 Septic system permit or authorization for remodel. Existing system capacity _
6 Sewer erertnit. �]
7 Water district approval. _
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ El 0
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- a
basin protection,etc.
10 _J.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 tf
cqpyright violations exist. _
I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft intervals); location of easements
and driveway; footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage, _
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
_ and location.
13_ Floor plans. Show all dimensions,room identification,window sire,location of smoke detectors,water heater, 0 D ❑
_ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross sections)and details. Show all tiaming-member sizes and spacing such as floor beams,headers,joists,sub-
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,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, 4
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 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-
_ rescriptive path analysis provide specifications and cal-ulations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing �]
locations. Show attic ventilation. _
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑
__ systems,see item 22,"Engineer's calculations." _
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑
over 10 feet long and/or any'i k i .oist carrying a non-uniform load —
20 Manufactured floor/roof truss G^slgn details. _
4. 21 Energy Code compliance. identity the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances.
f, 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
N architect licensed in Oregon and shall be shown to be a licable to the ro ect under review
IN
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". ❑ [] ❑
to 24 Two 2 sets each are required for Items 16, 19,20 and 22 above. ❑ []
U 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will notbecce ted. ❑ []
W _26 "Reversed"building plans must meet criteria outlined in the Permit&System Develo ment Fees document. U -�
27 "Drawn to scale"indicates standard architect or engineer scale. T] _ 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard
Street Tree List. _
29 Site plan to include tree protection measures as required by conditions of approval.
30 A Clean Water Services'Sensitive Area Fre-Screening Site Assessment form is required for all building additions,
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot ofrecord approved prior to September 9, 1995.
i\Building\Permits\C le•Two-FamilyChecklist doc 12/03
Mechani�a! Permit Application vE
ived
City of Tigard DatefBy
y Permit No.: y M
13125 SW Hall Blvd,Tigard,OR 97223 Plan Review r==•
Phone: 503,639.4171 Fax: 503.598.1960 nn Date/Ry Other Permit
Inspection Line: 503.639.4175 U� Date Ready/By 73�r,a ® See Page 2 for
Internet. www ci.tigard.or us Notified/Method Supplemental information
ITY OF TIGAR1 --- -- —-- _�
COMMjRCTAL'1REF- SCHEDULE – USE CHECKLIST
❑Net✓construction �❑Addition/alteration/replacement — Mechanical permit fees•are based on the value ofthe work
performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
cA`i� + » pri bN value s
RESIDENTIAL EQUIPMENT/SYSTEMS FEES•
❑ I-and 2-family dN ell ng ❑Commercial/industrial ❑ Accessory building
For special information use checklist
❑ Multi-family ❑Master builder ❑Other: Descnption Qty. Ea Total
fop i * �,1(3N Heating/cooling _
Job site address 5 f�/ _ �(w p S f– — Air conditioning or heat pump
U 7 N _ rc uires site Ian showinplacement) 14.00
City/State/ZIP- C2 q 122V Furnace loo,000 BTu(d t,,venla> 14.00
Furnace 100,000+BTU ducts/vems) 1790
Suite/bldg./apt.no.: _ — � Project name: Gas heat pump 14.00
Cross street/directions to job site: LtV� Duct work 14.00
– -- H dronic hot water system 14.00
— Residential boiler(radiator or
h dronic) 14.Ul-
l/ Unit heaters(fuel-type,not electric),
in-wall,in-duct,su ended,etc 10.00
-- Flue/vent for an of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
rte_ t4 ; °IlE$ PTIOP' dWater heater 10.00 v
Gas fireplace._ 10.00 47
A/d A4 ,Cp,"5 e_e . Flue vent for water he:ter or gas
T 1 '1 600, — fireplace I0.Go _
f/14 10' / P/ Log li hter as 10.00
Wood/pellet stove 10.00
r/ Wood fireplace/insert 10.00
e I r Chimney/liner/flue/vent 10.00
r� 1 ! T tl✓�i 'w
Other: 10.00
Name. .s ✓C�k�l�i� Environmental exhaust and ventilation
Address: Range hood/ether kitchen
tt� vQ 7 _-- equipment 10.00
City/State/ZIP: 6 ��32� _ Clothes dryer exhaust 10.00 Oi
Single-duct exhaust(bathrooms,
Phone: Fax:( ) toilet compartments,utility rooms) 6.80 loU
•h 6r:i '� t"` i t Attic/crawls ace fans 10.00 -
a � i..r. 4 Other: _ 10.00
Business name: Fuel piping
Contact name:—� $5.40 for first four;$1.00 for each additional
IL Furnace,etc. _ L
Address: Gas heat pump
NCity/State/ZIP: Wall/suspended/unit heater
Phone:( ) — Fax: :( ) Vater heater
Fireplace
�_
"1 E-mail: Range
- � -* Barbecue
liJ R siness ,me: Clothes dryer as
J _ � ---- Other:
ty/ at 7 Subtotal
— Minimum permit fee($72 50)
ce _ Fax:( ) Plan review(25%of permit fee) _
tic:VV State surcharge;.,o of p,-nit fee)
_TOTAL PERMIT.EE _
Thls permit application expires If a permit Is not o,•aleed within 180
Authorized signature: L - -.1Z C, _ days after It hin been accepted as complete.
Print name 4f�7j—h Date: /C'pt,—� Fee methodology set by Tri-County Building industry Service Board
!tBuildinS\Permitu\MFC Permit App doc 12103 440-46177(11/02/coww B)
Mechanica► Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
$1.00 to$2,000,00 Minimum fee$72.50
$2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30
for each additional$100.00 or fraction
thereof,to and including$5,000.00.
$5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and
$1.80 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and
$1.35 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 to$100.000.00 $771.50 for the first$50,000.00 and
$1,25 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first$100,000.00 andel
$1.10 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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is�Building\PffmitS\MF..C-PermiL%pp.doc 12103 2
Building Fixtures `l��
Plumbin Permit A �1
I sow
City of Tigard nn r r, 4 Received PNo
13125 SW Hale Blvd.,Tigard,OR 97223 UG \I LOO Demut ate/BY
T
Phone 503 639.4171 Fax: 503.598.19)'
03.598.19 Plan Review Datr,Tly Permit Other No
24-Hour Inspection Line: 503.639.4175 A tutu ---
Internet: www.ci.tigard.or.us ,��OF TiGA Date ed/Me9y: S See Pane 2 for
Ci �cJ� Notifett/MelMd: Supplemental Information
y ,{
y,t,•�!�( ..���y" �-.. �,�: :�o .: bn� Mir}•- t. )t �� C.'li)�(�f:E
❑New construction ❑Demolition For special information use checklist.
-- Description C't Ea Total
❑Addition/alteratiorVrtritacemenl ❑Other: New I-2-family dwellings(includes 100 R for each utility connection)
SFR(I)bath 249.20
❑ I and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00
❑Accessory building ❑Multi-family SFR(3)bath 399.00
❑Master builder - Each additional bath/kitchen 4500
❑Other:
5 u, Fire sprinkler(_ sq fl.) Page 2
ak-• ti t t ( ~- Site utilities
Job site address: 0�7 e,a- S>f Catch basin or area drain 16.60
City/State/Z[P: j j-}G� �r� C/7��L Drywell,leach line,or trench drain 16.60
Suite/bldg./apt.no.:-tom/} Project name: Footing drain(no linear ft.: ) Page 2
Manufactured home utilities 11000
Cross street/directions to job site:
Manholes 16.60
_ Rain drain connector 16.60
Xve-f r Sanitary sewer(no.linear R.:... Page 2
Storm sewer(no.linear R.. ) Page 2
Subdivision: Lot no.: Water service(no.linear fl.: Page 2
-- Fixture or Item
Tax map/parcel no
Absorption valve 16.60
`i l., Hacl:flow preventer Page 2
1W ey Backwater valve 16.60
Clothes washer 1660
Dishwasher 16.60
Drinking fountain 16.60
4IN Ejectors/sump 16.60
Name: i l�r Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP. wC G .L Floor drain/floor sink/hub 16.60
Phone:( 3 ) S y o b�� Fax:( ) - -- - - Garbage disposal 16.60
r JV I„t.tr i' t ;. i CONTAt T- ISO
%, Iry;. Hose bib 2 16.60
-- ----- - --- - Ice maker 16.60
Business name: -
__--_ interceptor/grease trap 16.60
Contact reme. Medical gas(value:S ) Page 2
p, Addresa:^ �- i -- -- - Primer 16.60
City/State/ZIP: Roof drain(commercial) 16.60
N Phone:( ) Fax: 1 ) Sink/basin/levatory _ t 16.60
— --- -- Tub/shower/shower pan Z 16.60
E-mail: Urinal 1660
mCONTRACTOR
Water closet 16.60
Business name: Water heater 1660
W - —
J Address: Other:
Ciry/State/Z[P: Subtotal
Minimum permit fee: 572.50
Phone:( ) Fax:( ) Residential backflow minimum permit fee: 536.25
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(8%of permit fee) a.S;p
Authorized signature: ` ,� -
--C TOTAL PEP,MIT FEE
rPrint name: �{ /way,fjh Date: 8� 1 This permit application expires if a permit Is not obtained within
ISO days of'-!r it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
i\Building\Permits\PLMF.PennitAppdoc 11103 440.4616T(10A1VC0WWFH)
Plumbine Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site_Utilities_ Tu{ 1 ' u6ijbi.. :,Permit Vee,
lee._�_
Footing drain-I"100' 55.00 0 to 2,000 $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 S160.00 _
3,601 to 7,200 5220.00
Sewer- Ist 100' 55.00 7,201 and greater 5309.00 ��-
Sewer-each additional 100' 46.40
Water Service-1 st 100' 55.00 Medical Gas S stems'•
Water Serv,ce-each additirmal 100' 46.40
Storm&Rain Drain- I st.00' 55.00
51.00 to SS 000.00 _ Minimum fee 572.50
Storm&Rain Dram-each additional 100' 46.40 $5,001.00 to S10,000.00 $72.50 for the first$5,000.00 and 51.52 for each
Fixturegr Ytettlty. Fee(ea) Total additional 5100.00 or fraction thereof,to and
including$10,000.00_.
Commercial Back Flow Prevention Devise 46.40 $10,001.00 to S25,000.00 $148 50 for the first 510,000.00 and Sl 547o r
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25) 27.55 and including 525,000.00
Rain Drain,single family dwelling 65.25 $25,001.00 to 550,000.00 $379.50 for the first 525,000.00 and S1 45 for
each additional SI 00.00 or fraction thereof,to
Inspection of existing plumbing or and including f50,000.00.
specially requested inspections-eer hour 72.50 550,001.00 and up 5742.00 for the first S50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please Indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
itBut[ty b Fi re .WorkPertotmed
>rliture Type: «, T �epy
;1(titlstin$ Capped Comments regarding fixture work:
Baptistry/Font
Both -Tub/Shower
-Jacuzzi/Whirlpool - --
Car Wash -Each Stall _
-Drive rhni
Cuspidor/Water Aspirator _
Dishwasher -Commercial
-Domestic
Drinking Fountain _
Eye Wash
Floor Thain/sink 2-
_111 -
4,. - -
Car Wash Drain _
Garbage -Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
-Industrial Increase of sewer EDUs,a sewer permit will be issued and
Ice Mach./Refri .Drains
Oil Separator Gas Station - fees assessed for the sewer inr:rease must be paid before the
Rec.Vehicle Dump Station plumbing permit c:n be issued.
Shower -(_fang
-Stall _
Sink -Bar/lavatory Quantity Total
-Bradley Isometric or riser diagram is required if fixture quantity
-Commercial total is>9.
-Service -
Swimming Pool Filter
Washer-Clothes
Water Extractor Plan Review
Water Closet-Toilet Plan review is required if fixture quantity total is>9.
Urinal
Other Fixtures:
i�,_'t,finiTermitsTLM-Perndt App doc l/07
Electrical Permit Application nitiuimmlm
City of Tigard Ir r u,weed Permit No. 5
13125 SW Hall Blvd,Tigard,OR 9727.3 Plan Review
Phone: 503.639 4171 Fax: 503 598 1960 Date/By:. Other Permit
Inspection Line: 503 639.4175 AU Date Ready/By _ Inns ® See Page 2 for
lntemet www,ci tigard.or.us Notilled/Method v Supplemental Information
TYPE OF WOIi (Q rnFLAN REVIEW
E)New construction ❑Addition/alter "�i
atMhY "'—" Please check all that apply:
❑Demolition ❑Other: ❑Service over 225 amps,comm'I []Hazardous location
.. I I - ❑Service over 320 amps-rating ❑Buildng over 10,000 sq.ft
"CA'CXPOF� ""O� ,0"ItwjPIok of I-and 2-family dwellings 4 or more new residential
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building^ ❑System over 600 volts nominal units in one stricture
❑Multi-family ❑ Master builder ❑Other: ❑B'lilding over three sto-ics ❑Feeders,400 amps or more
[]Occupant load over 99 persons ❑Manufactured stnlctuies or
xs i 1, eA'�r � .b o iIAW" ❑Egress/lighting plan RV park
,lob no.: Job site address: y1 f/ �� /`/ S,f 01 -care facility ❑Other_
Submit 2 sets of plans with say of the above.
City/State/ZIP: The above ate not applicable to temporary construction service
46
Suite/bldg./apt.no.: Project name: A��� �u1"tC 1rE• Scli$AIJICE
Description Qty. Pee. Tetsl
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
/- Includes attached garage.
h�(K`4k�.� �� �i'f�'�f/ 1,000 sq ft.or less 145.15 4
Subdivision: ot no.: Ea.add'1500 su,ft.or portion 33.40 1
L
Tax map/parcel no.: — Limited energy,residential 75.00 2
t — Limited energy,non-residential 75.00 2
DESCRIPTION WO � " ;t � '' Each manufactured or modular
dwelling,service and/or feeder 1 90.9c 2
Services or feeders Installation,alteration,an(d/or relocation
200 amps or less 80.30 2
W' -ROPF,RT1' OWNS R wt, ti ' 201 amps to 400 amps 10685 2
401 amps to 600 amps 160.60 2
Name ke✓s ^ ' r`AAc-�r+h 601 amps to 1,000 amps 24060 2
Address: A 0. 30 9-, Over 1,000 amps or volts 454.65 2
Reconnect only _ 66.85 2
City/State/ZIP: , M 4.4;,e re oYz Y7132-- 'f emporary services or feeders Installation,alteration,and/or
Phone:6_*D3 )S S o -6 7-1 CJ TFax:( ) relocation _
200 amps or less _ 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133 75 2
Owner signature e✓'1�— Date: � LBranch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Ott service or feeder fee,each
Business name:
branch circuit 6.65 2
3,Fee for branch circuits
Contact name: wi our serv' or fee r e, 46
Address: a brant ci uit 7
tab a rand d uit as 6.65 2
City/State/ZIP: Miscellaneous(service or feeder not Included)
Pump or irrigation circle 53.40 2
CL Phone:( ) Fax: :( ) Sign or outline lighting 53 40 2
E-mail: Signal circuit(s)or limited-
tn s ` ' .a t ., • energy panel,alteration,or
Business name: extension.Describe Page 2 2
J d re Each additional Inspection over allowable In any of the above
W ---- Pet inspection 62.50
UJ it / te/ P Investigation per hour(I hr rein) fit 5p
w – —
J h :( I
Fax: ( ) Industrial plant per hour 73.75
1 ;
Li le trical Lie.: Suprv.Lie.: Subtotal
E c ci si atu ,required: Plan review(25%of permit fee)
rim name Date: State surcharge(8%of permit fee) S
-- TOTAL PERMIT FEE
A ho Pd si ill This permit application expires if a permit to not ohWri.d within 180
-- days after It has been accepted as complete
ri te: Date: Fee methodology ret by Tri-County Building Industry Service P.oard
••Number of inspections per permit allowed.
i Building\Permits\ELC.Petn ltApp doc 12/03 440-4615T(l=2/C0WWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ELVER Y PERMIT FEES:
RESIDENTIAL WORK LY:
Fee f/►r all residential syste\AirCon
...... $75.00
Check Type of Work Invol
❑ Audio and Stereo Sy
❑ Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation inning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system....................... $ .00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Syst s
❑ Landscape Irrigatio ontrol*
❑ Medical
❑ Nuraf tails
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. I..icenses are required
for all other installations
�HuildinglPermrtt\FLC Pe.wApp dm 0411))
Permit #: �
�r
5 ?d44 Addres �7�rt�o-�7�
OV stc,Aso is. tied b D� T
/ ^ CITY tNG p1V1`+to Y _ ate: G
Butt 0 �-�_--
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 70.1.0.55(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement b(, re a building permit can he 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 3B:
1. 1 own, reside in, or will reside in the completed structure.
® 2. 1 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. #
1 101.1 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.
a If I hire subcontractors, i will hire only subcontractors registered with the Construction Contractors
oC Board. If I change my mind and hire a general contractor, i will contract with a contractor who is
U) registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
J_
m f hereby certify that the above information is correct and that I have read and do understand the Information
wNotice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signaturl of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
' s
I nforination Notice to Propert�d*grs
About Construction Responsibilities
A,,r, Ilu ri►tutr� r .Nolire 111 1'trr1lP►-h, Ort1lte►..►edwl►r(.onS1ri4clion Respon.%ibilities
>7,,1 by iJl,- (•ons4ni tion Contractors Board Idaccorduna•e,*irlt ORS 70?055(5).
111:I!,
11 .;t.Mfr_ ,+', c u II ,:t,I_ nl1;I! II,, I,I t'I,I14I,UcI a nr\ti' home or make a substantial improvement to an existing structure,
•nl Ina:l•, II"1 ;I111, ,; ' in!_ io,;ireofthelofIi,,+Ing responsibilities and areas ofconcern.
EMPLOYER RESPONSIBILITIES:
If '11 hin pt-1"' n, 11o1 rt','! t.'?c'cl tt llh the Conshlit li,Itt Contractors Board to do labor in constructing or assisting in the
,;.;1 Mi-11 1,1 +Iul,n l�cmcni , I I rc-,ldcnlial ,Iri ture, you will, in most instances,be ruled to be an employer and the people
0,11 tum ,s lli hl ilio rn11110P•r, %tin must comply with the following:
c�,, utt's ,t illrl►oldinf;tay IaI,+ As.In elliployor,you n}nst withhold income taxes from employee wages at the time employees
1,, I,:Ii:l t :ll .�III hr h,th11• frl the tax paym(Ints even ii-you don't actually withhold the tax from your employees. For more
iul+�Imatnn, +.;.III Ih�� (?n?hon I�,�pt of Revenue at 945-6t)Ui.
t. nernplg)yntetit insllrancc I;t•:: As In rniploycr, you are required to pay a tax for unemployment insurance purposes on the
r•, I.III rn!i,lo�rrs t „1 I? n• it,VIII-ntation,call the Oreton Employment Division at the Department of Human Resources
W,01-1kers' alntperlsaUicm ill;I;P;lnecr A an+•rrlt,lo%C'I. vnu are ';uhject to the Or^gon Workers'Compensation Law,and rhusl
u„I.i" <<.,,II•,.r� �uullu'n ..Itl 1 :li Ur;tnIhr�utlr+f11171Uyel'�. If you I',-tiIto obtaiit woikers'compensation iinsurance,you may
i, pk 11 dt R 'and „ : hall,•tui all(.-him ci"+,if olle of yourernployees Is inured out the joh. For mire intor rintlon,
i k i,i1,n at the Department of C'onsunter and Busint`ss Services at 94.5-7888.
! .`c. Itticrttal Itc*enuc tic r,is : ,�! ,til, Iollll ycr,%till intro withhold federal income tax from employees'wages. You will be
I,.II lc foi ih+ t;I�. pnvnu nt c� ' 11 oll,h,ln't actually v,ithhold the tat. For more information,call the Internal Revenue Service
at I M0 829-11W)
OTHER iIESPONSIBILITIES AND AREAS OF CONCERN:
Code conliplian e: As the pee mit hol I ct fl,r lhi,,prnlrl 1.�ant Me rt-ponsible for resolving any failure to trteetcctde requirements
I11;11 w,n be t,roughl to your;I'tc•ntiorl through inspections.
a I,iahilit) and property damage insurance: Contact y our insurance agent to see if you have adequate insurance coverage for
;I+a illcuts and omkl ions Stich as falling tools,paint overspiav, water damage from pipe punctures,fire,or work that must be
re-+la,nc.
m
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
t7
tw 11,xpertise: Make-sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish
a
trach•., aunt to notil y Ill iiMing I11'ticials at the appropriate times so they can perfoll-m the required inspections.
II you have additional questions, write or call the Construction Contractors Board(PO Box 14140,Salem,OR 97309-5052,
5(1.1/:378-4621). The Board is located at M)Summer St. NF Suite 300,in Salem.
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JAN RECEIVED
AUG
T CITY OF TIG RD
BUILDING DIV ION
i
CITY OF TIGARD - SITE III-AVIV REVIE.NN'
d�•t "'t,--)oI�l!ILDIN�i !'[.RMI T NO R -tom
PLANNING DIVISION: rno�d
❑ N',� �`t�r""
Kctluircd SethApproved
neks: ,
Sidi: 5 Street tiidr: IS
IS Garage- a° Rear:
Front. -- N()t Approved
Visual Clcar,utce: N�� (] Approved ❑ pp
Maximum linildillp Heiuht teet ,�(
(.,WS Service Provides Later Required: ❑n
Received
-] No �
11N: Q• Do e:
LNGIN[:E 1,R; DLPARTMENo�u ❑ Not Approved
Actual Slope:2--% 0 App
Site III Approved [3 Not Approved
ti
F3
kk Date:
pa a( n dvl -rtrndvl J cmc cLg Ite n t�.r`t .
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Adilk
CITY OF TIGMD
Tuesday, December 14, 2004 ORlQON
Kevin Martin
10475 SW McDonald Ave.
Tigard, OR 97223
RE Final Inspection Approval, MST2004-00';27, 10475 SW McDonald.
Dear Kevin:
Congratulations on completing your remodel of 10475 SW McDonald!
This confirms that you have received from our office final inspection approval of the work
done under permit MST2004-00227. That permit is now complete and case finalled.
Prior to your purchase of the property we had issued a "do not reoccupy" order based on then-
existing violations of the Housing and Building Codes. Your remodel corrected all of those
violations and this advises you that all requirement% for reoccupancy have been met and the
"do not reoccupy" order has been lifted.
/Shiel
ur nem ho lease call me if you have any questions.
i
L Housing Inspector, Building Codes Enforcement Officer
r
cc: Property File
3
0
U
J
13125 SW Hall Blvd., Tigard, OR 97223(503)639-4171 TDD(503)684-2772
CITY OF TIGARD 24-4our
BUILDING Inspection Line: (503) 1"175 • ST `�_ Gp Z2 7
INSPECTION DIVISION .Busitless Line: (503) 39-4171
BUP
Received _ Date Requested A PM BUP
�
Location ZQ y�� MC oNA L7C'-, Suite_ MEC
Contact Person �<E:v//.4 _ Ph( ) sa 6 7 6 PLM
Contractor — Ph( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SR'
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear C C.
„_
Framing - "inT = yV D �j. VC=e L]o0/c
Insulation
Drywall Nailing I-UK G_c
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof
Other: —
Final
PASS PART FAIL
PLUMBING
Post&Beam
Linder Slab --
Rough-In
Water Service ----
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain —
Shower Pan
Other:
Final
PAS FAIL
RANI w�-----
eam A
Rough n
Gas Li
IL SM a Da
p� in
&S I PART FAIL
rtn ELECTRICAL
�L Service
J Rough-In
m UG/Slab
WLow Voltage
J Fir-!alarm
Final U Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd.
PASS PART FAIL
SITE F-1 Please call for reinspection RE: _ u Unable to inspect-no access
Fire Supply Line
ADA -�
Approach/Sidewalk Drib/ O 1111111181111166W E7tt
Other: _
Final DO NOT REMOVE this Inspection m the fob slb.
PASS PART FAIL
CITY OF TIGARQ 24-Hour
BUILDING Inspection Line: (503)611"ll75 0 ' MST
INSPECTION DIVISION •Business Line: (503)636-4171
"Up
Received ' u Date Requested Id J— AM_ —PM _ BUP
Location ClSuite MEC
Contact Person Ph( _) _S. Co a 7(v PLM
Contractor —__ Ph( ) SWR
BUILDING Tenant/Owner , _ ELC
Footing ELC
Foundation Access:
Ftg Drain EIR
Crawl Drain
Slab Inspection Notes SR
Post 8 Beam
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation r^
Drywall Nailing
Firewall �t✓ 2_ � � D 1�.�"'��EC�1�/1��,
Fiie Sprinkler — — -- -
Fire Alarm
Susp'd Ceiling --
Roof
Other:
__ SCJ rL 2� C. t� -- 2-
PASS PART FAIL
BINQ
Post 8.Beam
Ner Slab
Rou -In
Water ervic An Ink
Sanitary or
J
Rain Drai
Catch B in anhole
Storm ain I
Show Pan i
i �
ASS PART FAIL
CHANICAL
Pos Beam /
Rough- _
Gas Line
IL S k ampe ---
a
y ASS PART FAI --
ELECTRICAL _
Service
m Rough-In
UG/Slab
WLow Voltage
Fi larm
in ❑S RT FAIT. ext Reinspection fee of$__ required befo Inspect ay at City Hell, 1312'5 SW Hall Blvd.
A
S _ ❑ Please call for rei pection �__ _ ❑ Unable to inspect-�+o access
Fire Supply Line J
ADA Daft ! Z/ l [� !n _ Ext—_
Other:Approch/Sidewalk �---/ Q r2-eQ
Other. CY
Final DO NOT REMOVE this Inspt liftlen mord ho tho fob alter.
PASS PART FAIL