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14355 SW MCFARLAND BLVD-1 aArIII aNVrIHVaON MS S S£i r I a a a x IL w � u m Ln to Ln � i M 14355 SW MCFARLPND BLVD CITYOF T I GA R D _ELECTRICAL RESTRICTED ENERGY PERMIT DEVELOPMENT SERVICES PERMIT#: ELR2005.00144 ARM 13125 SW Hall Bwd.,Tigard,OR 97223 503-639-4171 DATE ISSUED: 6/3/2005 PARCEL: 2S 110BA-04600 SITE ADDRESS: 14355 SW MCFARLAND BLVD ZONING: R-2 SUBDIVISION: SHADOW WILLS LOT: 019 JURISDICTION: TIG Project Description: Low voltage-audio. A. RESIDENTIAL B COMMERCIAL _ AUDIO&STEREO: X AUDIO&STEREO: INTERCOM&PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACrtUM SYSTEM: TIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTELTIVE SIGNAL: INSTRUMENTATION: OTHER: _ TOTAL#CF SYSTEMS: Owner: Contractor: M NIELSEN, KENT&TINA OWNER 14355 SW MCFARLAND BLVD TIGARD,OR 97224 Phone: 503-639-7897 Phone: Reg i FEES Description i Date Amount REQUIRED ITEMS AND REPORTS IELI'RMT] LLR Permit 6/3/2005 $75.00 [TAX)8%State Surcha E/3/2005 $6.00 Total E81.00— — This Permit is issued subject to the regulations contained in the Tigard 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. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503-246-6699. IL Issued By: ; Permittee Signature: H OWNER INSTALLATION ONLY N The Installation is being made on property I own which is not Intended for sale, lease,or rent. J OWNER'S SIGNATURE: DATE: C? W CONTRACTOR INSTALLATION ONLY a SIGNATURE OF SUPR. ELEC'N: DATE:_ LICENSE NO: — Call 503-639-4175 by 7:00 a.m.for an Inspection that business day. This permit card shall be kept In a conspicuous place on the job site unt!I completion of the project. Approved plans are required on the job mic at the thne of each Inspection. CITY OF TIGARD � MAS'tERF!ERMiT PERMIT#: MST2005-00017 DEVELOPMENT SERVICES DATE ISSUED: 2/10!2005 13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171 PARCEL: 2S110BA-04600 SITE ADDRESS: 14355 SW MCFARLAND BLVD ZONING: R-2 SUBDIVISION: SHADOW HILLS LOT: 01 JURISDICTION: TIG Project Description: Convert garage into bedroorn add new 2 car garage w/2nd story, breezeway on rear walkway BUILDING REISSUE STORIES 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 1,567 of BASEMENT: al LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: if GARAGE: 575 of rRONT: 30 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: TMD of RIGHT: 5 0001X1 OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 1,51;7 of VALUE: 250 REAR: 25 PI UMBING SINKS: 0 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS LAVArORIE£ 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUBISHOWERS: 1 GARBAGE DISI' WATER HEATERS: 1 WATER LINES BCKFLW PREVNTR: GREASE TRAPS- OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 1 CLOTHES MYER: GAS FURN>-100K: 1 UNIT HEATERS: MOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVFS: OAS OUTLETS: 2 ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP 9RVC/FEEDERS BRANCH CIRCUITS _ MISCELLANEOUS ADD'L INSPECTIONS 1000 9F OR LESS: 0 - 200 amp: 1 0 200 amp: WISVC OR RJR: 20 PUMPfIRRIGATION: PER INSPECTION: EA ADD'L 6009F: 201 400 amp: 201 400 amp: 18t wo SVdFOR: SIGNIOUT LIN LT': PER HOUR: '-IMITED ENERGY: 401 600 amp: 401 400 amp: EA ADDL OR CIR: SIGNALIPANEL: IN PLANT: MANII IIMISVCIFDR: 601 - 1000 amp: 60Oempa•1000r MINOR LABEL: 1000+amplvoll PLAN REVIEW SECTMN Reconnect onh. — -- —"�'• "--' —4 RES UNITS: SVCIFDR>-226 A.: >640 V NOMINAL: CLS AREA/SPC OCC: ELECTPICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 9 STEREO: VACUUM SYSTEM: AUDIO S STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANOSCAPEIIRRIG: PROTECTIVE.SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS. This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code,State of OR.Specialty Codes NIELSEN, KENT&TINA ROYAL REMODELING RESOURCES I and all other applicable laws. All work will be done In 14355 SW MCFARLAND BLVD PO BOX 230805 accordance With approved plans. This pp p permit will expire TIGARD,OR 97224 TIGARD.OR 97281-0805 if work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. rules d Phone: 503-639-7897 Phone: 684-7873 Those E ' rules or N Reg#: LIC 90746 99 or TOTAL FEES: $ 2,928.75 J REQUIRED ITEMS AN Ersn Cntrl681-4444 W ,J Issued BY —.— Perms Call 503-639-4175 by 7:00 a.m.for an This permit card shall be kept in a conspicuous place Approved plans are required on the job s CITY OF TIGARD _ MASTER PERMIT PERMIT 0: MST2005-00017 DEVELOPMENT SERVICES DATE ISSIIED: 2/16/2005 13125 SW Hall Blvd.,Tigard, OR 9722.3 503-639-4171 PARCEL: 2S110BA-04600 SITE ADDRESS: 14355 SW MCFARLAND BLVD ZONIRG: R-2 SUBDIVISION: SHADOW HILLS LOT: 019 JURISDICTION: TIG Project Description: Convert garage into bedroom, add new 2 car garage w/2nd story, breezeway on rear walkway. BUILDING REISSUE: STORIES: FLOOR AREAS _REQUIRED SETBACKS PEOtARED CLASS OF WORK: ADC HEIGHT: 21 FIRST: ;,567 r! BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y �- TYPE OF USE: SF FLOOR LOAD: 40 4ECOND: a! GARP.3E: 575 a/ RONT: :>n P',AKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: THIRD a1 RIG4T: 5 OCCUPANCY GRP: n3 BDRM: 1 BATH: 1 TOTAL: 1,5VALUE: 2W67 s! 000 00 REAR: 25 PLUMBING _�, _�. -•T_ SINKS: 0 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRACIS: CATCH BASINS: TUBISHOWERS: 1 GARBAGE DISP: WATER HEATERS. 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: SOIIJCMP<3HP: VENT FANS: 1 CLOTHES DRYER: GAS FURN>000K: 1 UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNAPICES: VENTS: WOODSTOVES: GAS OiTLFTS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVI:IFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LES:,: 0 - 200 aryr: 1 0 - 200 anv: WISVC C R IOP: 20 PUMP/IRRIGATION: PER INSPFCTION FA ACD'L 500SF: 201 -400 amp: 201 -400 amp: 1H WO SVC/FDR' SKLNIOUT LIN LT: PEP HOU'i: LIMITED ENERGY: 401 - 600 amp. 401 600 cnp: EA ADDL BR CIR: SIGNPLIPANEL: IN PLANT: MAAU HM/sVCIFDR: 801 - 1000 amp: 1101++rips-1000V: MINOR LABEL: 1000+amplvnR: PLAN REVIEW 8 EC'ION Racannncl anlV: _4 RES UNITS: sVCIFDR>.22S A. >600 V NOMINAL: CLS AREMSPC OCC: ELECTRICAL-RESTRICTED ENERGY _ A.SF RESIDENTIAL S.COMMERCIAL AUDIO A STEREO: VACUUM SYSTEM: AUDIO L STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC LANDSCAPEARRK3: PROTECTSIE SIGNI: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHIR: HVAC: DATArFELE COMM: NURSE CALLS: TOTAL N SYSTEMS: This permit Is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code,State of OR.Specialty Codes NIELSEN, KENT&TINA ROYAL REMODELING RESOURCES I and all other applicable laws. All work will be done In 14355 SW MCFARLAND BLVD PO BOX 230805 accordance with approved plans. This permit will eXplrn TIGARD,OR 97224 TIGARD,OR 97281-0805 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 0- adoptel by the Oregon Utility Notification Center. Those a Phone: 803-639-7897 Phone: 684 7873 rules-ire set forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or Reg 0: LIC 90746 direct questions to OUNC by calling 503-246-6699 or TOTAL FEES: $ 2,928.75 1-600-332-2344. _.! REQUIRED ITEMS AND REPORTS 001 a Ersn Cntrl 681-4444 W Issued By : T__---T Permittee Signature Call 503-639 4175 by 7:00 a.m.for an Inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the projer;. Approved plans are required on the Job site at the time of each inspection. CITY OF TIGAIRD BUILDING DIVISION PERMIT#: MST200&00017 13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 211f3/2005 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: TOSAM PAGE: 0 SITE ADDRESS 143565 SW MCFARLAND BLVD CLASS OF WORK: SUBDIVISION. Si1ADOW HILLS LOT#: 019 TYPE OF USE: PROJECT NAME: Nit'1BON DESCRIPTION: Convert garage into bedroom, add new 2 car garage w/2nd story, breezeway on row waikmW. OWNER: NIELSEN, KENT&TINA, PHONE#: 503.639.7097 CONTRACTOR: ROYAL REMODELING RESOURCES INC PHONE#: F04-7673 Inspection Request Scneduled For: Date: 10121/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inerection 0195.14,01 603.209-2292 N Corrections/Comments/Instructions: y I � g o5 X1/1 Ooev — V a� J_ x1 a Aj ,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: __ _ Date: hone #: (503) 718- ____ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005.00017 13125 SW Hall Blvd., Tigard, OR 9722.3 DATE ISSUED: 2/1E1/200f- Phone: (503) 639-4171 Inspection Requests (24 Hrs), (503) 639-4175 INSPECTION WORKSHEET FOR DATE: I(V 1912005 TIME: 7 O3AM PAGE. 69 SITE ADDRESS: 14365 ESW MCFARI AND E3l. D CLASS OF WORK: SUBDIVISION: SHADOW HILLS LOT #: 019 TYPE OF USE: PROJECT NAME: NIF SON DESC-RIPTIO14: Convr►rl garage into bo(koi", add new 2 cat garage w/2nd stray, breezeway nn fear walkway. OWNER: NIELSEN, KENT &TINA, PHONE #: 503-6397897 CONTRACTOR: ROYAL RE_MODUING 14ESOURCES INC. PHONE #: 684-7873 Inspection Request Scheduled For: Date: 101/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 01867901 50332W2292 Y Corrections/Comments/Instruriions: a r`- rn J w --- -- x PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS [_] FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: fb)! i��l f�-�+-�- Date: Q4AJ.6 1__ Phone #: (503) 718- �TY OF TIGARD BUILDING DIVISION - PERMIT#: MST2001�-0001 l 13125 SW Hall Blvd., Tigard, OR 97223 ,/ DATE ISSUED: XIII/MY) Phone: (503) 639-4171 Inspection Requests (24 Hrs): (50 9175 INSPECTION WORKSHEET FO \ •�\'wVDATE: 10/13/2005 TIME: 1:04AM PAGE: 44 ,.V SITE ADDRESS: 14355 SW MCFARLAND BLVD CLASS OF WORK: SUBDIVISION: SHADOW HI11_S LOT #: 019 TYPE OF USE: PROJECT NAME: 141r.-.1-SON DESCRIPTION: Coovert gavage into bedtoom, add now 2 cat garage w/2nd ori, breezeway on rear walkway. OWNER: NIF:I CCN, KENT &TINA, n PHONE C 5036337897 CONTRACTOR: ROYAL REMODELING RESOURCES INC .^' PHONE #: 6847873 Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact /! Message f✓r 199 Fleruu al 11111,11 0182.41.03 50'0,0E12292 Y Corrections/Comments/Instructions: IL oc - J_ m w .J PASS ❑ PA TIAL APPRL� CANCEL ❑ NO ACCESS ❑ FAIL ❑ ALL F TION E] ADDITIONAL FEES ASSESSED Inspector: _ Date: _� Phone #: (503) 718- _ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200 -00017 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/18/2(M Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: '10/13/2005 TIME: 7 04AM 1 PAGE: 49 SITE ADDRESS: '14355'M MCFARLAND BLVD CLASS OF WORK: SUBDIVISION: SHADOW HILLS LOT #: 019 TYPE OF USE: PROJECT NAME: NIIpLSON DESCRIPTION: Convert gsxage into bc+ciroom, add new ?r;ar gsrcage w0nd r~Icxy, t,reezewav on rem walkway. OWNER: NIELSEN, KENT &TINA, PHONE #: 503638.7897 CONTRACTOR: ROYAL REMODELING RESOURCES INC PHONE #: 694-71373 Inspection Request Scheduled For: Date: 10/131200; Pour Time: g_ Code # Inspection Description Confirm # Contact # Messa e 699 Mor:hanir-al final 016241.01 503-2032292. Y Ccrrectipns/Com merits/Instructions: 6z le–) oc cn — ED w _j P/SS ❑ PARTIAL APPROVAL ❑ CANCEL I—J NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1 � Inspector: ` cC �_ Date: )/61(_Phone #: (503) 718- CITY OF TIGARD 1wf*1 1-1, BUILDING DIVISION PERMIT#: FLR200a;-00144 13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: E13/1A();� Phone: (503) 639-4171 �L Inspection Requests (24 Hrs.): (503) 639-4175 AW INSPECTION WORKSHEET FOR DATE: 6/6/7(1A5 TIME: 7:13AM PAGE: K,!, SITE ADDRESS: 14355 SW MCFARLAND BLVD CLASS OF WORK: SUBDIVISION: SHADOW HILLS LOT #: 019 TYPE OF USE: PROJECT NAME: NIELSON DESCRIPTION: Low voltage- audio. OWNER: NIELSEN, KE14T &TINA, PHONE #: 503-639-7897 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: GAV)005 Pour Time: Code # Inspection Description Confirm # Contact # Message 13+ I_.rm voltage 008519.01 60'~-A Q292 N Corrections/Camments/Instructions: VPASS ❑ PARTIAL APPROVAL '❑CANCEL ❑ NO ACCESS FAIL ❑ CALL OR INSPECTION [ ADDITIONAL FEES ASSESSED r Inspector: Date: 6 �- 05— Phone #: (503) 718- VTY OF TIGARD* • BUILDING DIVISION - PERMIT #: PLM2005.00114 13125 SW Hall Blvd., Tigard, OR 97223 DATE. ISSUED: 3/21/2005 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 3/30/2006 TIME: T 11AM PAGE: 14 SITE ADDRESS: 14355 SW MCFARLAND BLVD CLASS OF WORK: SUBDIVISION: SHADOW HILLS LOT#: 019 TYPE OF USE: PROJECT NAME: NIF LISON DESCRIPTION: Installation of residr+nlial bacildlow prevention device for irrigation. OWNER: NIEL.SEN. KENT&TINA, PHONE #: 5036337897 CONTRACTOR: TERRA-SOL LANDS('APING PHONE #: 603691-6105 Inspection Request Scheduled For: Date: 3/30/2005 Pour Time: Cofb # Inspection Description Confirm # Contact # Message 325 RP/bar.Idlow preventer 003728-01 603-691-6105 Y Corrections/Comments/Instructions: l --- ------- a _ F0 W PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS [] FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ✓T Date: �____ Phone #: (503) 718- _ CITY OF TIGARD 13125 S.W. HALL BLVD. R E V E��//CC D TIGARD, OR 97223 v IMPORTANT PERMIT NOTICE FEB 2 4 2005 CITY OF TIGARD WEBBER ELECTRIC INC. BUILDING DIVISION PO BOX 231154 TIGARD, OR 97223 Electrical Signature Form Permit #: MST2005-00017 Date Issued: 2/18/2005 Parcel: 2S 110 BA-04600 Site Address: 14355 SW MCFARLAND BLVD Subdivision: SHADOW HILLS Block: Lot: 019 Jurisdiction: TIG Zoning: R-2 Remarks: Convert garage Into bedroom, add new 2 car garage w/2nd story, breezeway on rear walkway. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising Pledrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the addr,3ss above, ATTN: Building Division. No electrical inspections wi!: be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: NIELSEN, KENT& TINA R LECTRIC INC. 14355 SW MCFARLAND BLVD PO 231154 TIGARD, OR 97224 TIGARD, OR 97223 Phone #: 503-639-7897 Phone #: 503-620-1906 Req #: ELE 34-4420 LIC 44087 C- SUP 40285 AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of Supervising Electri ban If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RAYBORN'S PLUMBING INC PO BOX 69 TUALATIN, OR 97062 Plumbing Signature Form Permit #: MST2005-00017 Date Issued: 2/18/2005 Parcel: 2 S 110 BA-04600 Site Address: 14355 SW MCFARLAND BLVD Subdivision: SHADOW HILLS Block: Lot. 019 Jurisdiction: TIG Zoning: R-2 Remarks: Convert garage into bedroom, acid new 2 car garage w/2nd story, breezeway on rear walkway. Your company has been indicated as the plumbing contractor,for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: NIELSEN, KENT & TINA RAYBORN'S PLUMBING INC 14355 SW MCFARLAND BLVD PO BOX 69 TIGARD, OR 97224 TUALATIN, OR 97062 Phone #: 503-639-7897 Phone #: 503-692-4139 Reg #: LIC 87852 PI-M 34-166PB i AN INK SIGNATURE IS REQUIRED ON T S FORM X _ Signature orAuthoriz4 Plumber If you have any questions, please call 503.718.2433. CITY O F T'G A R D _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2005-00114 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 DATE ISSUED:PARCEL: 2S 11 2511 005 0BA-04600 SITE ADDRESS: 14355 SW MCFARLAND BLVD ZONING: R-2 SUBDIVISION: SHADOW HILLS LOT: 019 JURISDI(:f10N: TIG Project Description: Installation of residential backflow prevention device for irrigation. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TU13/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: r FEES NIELSEN, KENT&TINA Description Date Amount 14355 SW MCFARLAND BLVD TIGARD, OR 97224 {PLUMBI Perini( I ce 3/21/2005 $36.25 [TAX]S%State Surchari 3121/2005 $2.90 Phone: 503-639-7997 Total $39.15 Contractor: TERRA-SOL LANDSCAPING 21685 SW HEDGES DR REQUIRED ITEMS AND REPORTS TUALATIN, OR 97062 Phone: 503-691-6105 Reg#: LIC 5019 CL W This permit is issued subject to the regulations contained in the Tigard MuqdaN Sta R. Specialty Codes �1 and all other applicable laws. All work will be done in accordance with appThis pe it will expire if work is not started within 180 days of issuance, or if work is suspended for more tays. TION: Oregon law _J requires you to follow rules adopted by the Oregon Utility Notification Cente rules a set forth in OAR 952-000 - .1W_through OAR C52-0001-0100. You may obtain copies of ts or dire questionstoOUNCby calli 503-246 9 0 332-2344. Issu d By: Permittee SignatCall 503-639-4175 by 7:00 a.m.for an inspectionnes day.This permit card shall be kept in a conspicuous place on the job com let' n of the project. Approved plans are required on the job site at the time of each inspection. Building Fixtures III umbinL,Permit Application �� City of Tigard Receive Pemut No.: L N'wVS-6V lot 13125 SW Hall Blvd,,Tigard,OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 NatelBy OtIKr Permit No.: 24-Hour Inspection Line: 503.639.4175 Note ed'NieIty t ® See Pale 2 for Intcmet www ri IiRard onus Date /oe, Supplemc+»al Information _T.A TYPE of w --- sr - T li>v1iLe New construction ---- -- - --- ❑ ❑Demolition Forspecial Information use chec tf __ -- - -- Description Ea. F Toul Addition/alteratiott/replace.:ncnt ❑Other: _ New I-2-famlly dwellings(includes 100 R.for each utility connection) 249.20 I TGORY O C(f SFR(1)bath and 2-family dwelling - ❑CommetclaVind« trial SFR(2)bath 350.00 SFR(3)beth 399.00 [jMulti-famil Accessory building Y ----- Each additional bath/kitchen 45.00 ❑Master builder ❑Other: Fire sprinkler L-_sq.ft.) Page 2 Site utilities Job site address: Iq C ,"ate,(,,a"to Catch basin or area drain 16.60 Drywall,leach line,on trench dein 16.60 City/State/ZIP: Suite/bldg./apt.no.: Project name: Footing drain(no.linear ft.:_, Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 3an+tary sewer(no.linear ft.:�� Page 2 Storm sewer(no.linear ft.:---) Page 2 Subdivision: Lot no.: Water service(no.linear ft.: ) Page 2 Fixture or Item Tax map/parcel no.: ton valve 16.60 Page 2 y `r, "'.-- Backflow prcventer A 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 Ejectors/sump 16.60 Nam- it L So Expansion tank 16.60 Address: 'jtas(vwr�-^ Fixture/sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 / Garbage disposal 16.60 Phone:(SO) (0' -? Fax:( ) -- 16.60 •,t i ,� , ltosebib ---- - Ice ma SON ker 16.60 Business name: 1VZQ^ -C-7'0 . u2'eS Lwa I Interceptor/grease trap 16.60 ` Pae 2 Contact name: rpJ �.� Z , tfy\tfut(1.r11`rtr4�,.( Medical gas(value:S ) 8 Address: 2(Wf, t'(,)tt•I,s v�' Primer 16.60 City/State/ZIP:'� "l'� 1p Roof drain(commercial) 16.60 - �Q - � O Sink/basin/lavatory 16.60 Phone: t ( Fax::( ) Tub/shower/shower pen 16.60 F-mail Urinal 16.60 Water closet 16.60 Business name: L� �.�VV�IZ-� -- Water heater 16.60 Other: _ Address: ---- Subtotal City/State/ZIP: Minimumper : $72.50 Phone:( Fax:( ) Residential backflow minimum et -%,ee $36.25 S(c CCB Lic.: 5(�(q Plumbing Lic.no.: Plan review (25%of permit fee) r State surcharge(8%of permit fee) . it) Authorized st stun: TOTAL PERMIT FEE li Print name t� s MY4-tW1% Date:3-0 -J) This permit application expires If a permit Is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Servic&Board. 11Buildint\Pemdu\PLMF•PennaAppdoe I2/07 M0.4a16T(ION2/C0W. W8B) Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities,K- �_ Qty. e e Fea) Tdta ,'4 S' ua : ;Nota' 8 : pialrmit Fee: Footing drain-v1"100' 5500 0 to 2,000 _ $115.00 _ Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer-1 st 100' 55.00 7,201 and greater u- i $309.0.0 Sewer-each add itior,l 100' 46.40 Water Service- Ist 100' 55.00 — Medical Gas S stems' Water Service-each additional 100' 46.40 Storm&Main Drain- 1 st I00' 55.00 — $1.00 to 55,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 4640 $5,001.0010$10,000,00 $72.50 for the first 55,000.00 and S L52 for each FRtuie or e r t Qfy. Fee(ea) T ll t"' additional$10000 or fraction thereof,to and TI Iincluding$ ,000.00. Commercial Rack Flow Prevention Device 46.40 _ $10,001.00 to$25,000.00 5148.50-for the first 510,000 00 and$1.54 for Residential Backflow Prevention Device each adtional 5100.00 or fraction thereof,to rninimum erm' fee 536 27.55 and Of ludinm 525,000.00. _ (fain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 S .50 for the first$25,000.00 and$1.45 for ach addit mal S 100.00 or fraction thereof,to Inspection existing plumbing or _ and including$50,000.00. S specially requested inspections- hour 72.50 _. $50,001.00 and up $742 00:or the first$50,000.00 and$1.20 for Subtotal: each additional$100.00 or fraction thereof Fixture Work: Are,you capping,moving or replacing existing fixtures? f "yes",please indicate work performed by fixture. Failure accurately report fixtures could result in increased sewer fee.*. t r1Y k 40 �, . ,,:•Rr Comments regarding fixture work: Baptistry/Font _ Bath Jub/Shower - -Jacuzzi/Whirl ool Car Wash -Each Stall _ �J -[rive Thru Cus idor/Water Aspirator _ Dishwasher -Commercial -Domestic —` Drinking Fountain _ Eye Wash Floor Drain/sink 2" 3" ---4" — Cir Wash Drain d Garbage -Domestic Disposal -Commercial — *Note: If the fixtt a work under this permit results in an U) ►ndustrial increase of sewer E its,a sewer ermit will he issued and lee Mach./Refrig.Drains p Oil Separator Gas Station fees assessed for the s wer increase must be paid before the Rec.vehicle DumpStation _ plumbing permit can issued. $hewer -(Jiang _ -Stall W Sink -Bar/Lavatory _ uantity jota1 –� Bradley Isometric or riser dia ram s re aired if fixture quantity -Commercial g q q y _ -Service total is>9. SwimmingPool Filter _ Washer-Clothes _ Water Extractor _ Plan Review Water Closet-Tnilet Plan review is required if fixtu quantity total is>9. Urinal _ Other Fixtures: i\Building\Permits\PLM-PetmitApt doe V03 CITY OF TIGARD MASTER PERMIT PERMIT 0: MST2005-00017 DEVELOPMENT SERVICES DATE ISSUED: 2/18/2005 - 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 SITE ADDRESS: 14355 SW MCFARLAND BLVD PARCEL: 2S110BA-04600 SUBDIVISION: SHADOW HILLS ZONING: R-2 BLOCK: LOT: 019 JURISDICTION: "TIG REMARKS: Convert garage into bedroom, add new 2 car garage w/2nd story, breezeway on rear walkway. GUILnItw REISSUE: STORIES- 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 1.567 of BASEMENT of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF rLUOR LOAD: 40 SECOND of GARAGE: 575 of FRONT: 30 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: TMPD of RIGHT: 5 0011 00 OCCUPANCY GRP: R3 ODRM: 1 BATH: 1 TOTAL: 1.567 If VALUE: 250, REAR: 25 PLUMBING SINKS: n WATER CL OSETS: 1 WASHING MACH. LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUBISHOWERS: I GAkP.'GF DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FURN<WOK: BOIUCMP<3HP: VENT FANS: 1 CLOTIIES DRYER: GAS FURN>-100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VFNTS: WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS •)60 SF OR LESS: 0 - 100amp: 1 0 - 200emp. WISVC OR FDR: (X, PUMPIIRRIGATION: PER INSPECTION: EA ADD'L S00SF: 201 -400 amp: 201 - 400 amp: ht WO SVaFDR: SIGNIOUt I.IN LT: PER HOUR: L1%ATFD Ia'ERGY: 401 600 omo: 401 -600 amp: EA ADDL RR CIR: SIGNALIPANEL: IN PLANT: MANU IIMISVC0 DR; 601 - 1000 amo: 601•amps-100ov. MINOR LABEL: 10004 angtivolt: PLAN REVIEW SECTION Rocnmtect only: >-4 RES UNITS: SVCIFDR-22S A.: >600 V NOMINAL: CLS ARFAISPC OCC: _ ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO d STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEnRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 2,928.75 This permit is subject to the regulations contained in the NIELSEtJ, KENT 8 TINA ROYAL REMODELING RESOURCES Tigard Municipal Code,Stale of OR Specialty Codes 14355 SW MCFARLAND BLVD PO BOX 230805 and all other applicable laws. All work will be done in TIGARD,OR 97224 TIGARD,OR 97281-0805 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 mom than 180 days Phone: 503-639-7897 Phone. 684-7873 ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those y rules are set forth in OAR 952-001-0010 through Reg#: LIC 90746 952-001-0080 You may obtain copies of these rules or J direct questions to OUNC by calling (503)246-6699. XQ REQUIRED ITEMS AND REPORTS W Ersn Cntrl 681-4444 J 9 Issued By: Permittee Signature : 7/ilii Call (503)(503) 639-4175 by 7:00 p.m. for an inspection needed the next business day 1WNy irrQ hermit Applic CEI V E Cit of Tigard Dale/B : 0-OS S o.Uf3 0001 Received City � Permit No.: "� 13125 SW Hall Blvd„Tigard,OR 9722.3 �f 'f Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ralV �i Date/By MAS Other Permit, Inspection Line: 503.639.4175 Date Ready/By turn ® See Attached Check lit for Inteniel www ci tigard.or us 'Method: / Supplemental lnformatlon .. CITY OF TIhAkI) -Notified/' — � - -- : �� `TYPE Ok' WORK - MSEQUIRED DATA:1-AND 2-FAM11,Y DWELLING ❑New construction ❑Demulition Permit fees*are based on the value of the work performed. ---- Indicate the value(rounded to the nearest dollar)of all Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the r CATEGORY OF CONSTRUCTION work indicated on this application. _- —`-`�-- Valuation: S I-and 2-family dwelling ❑Commercial/industrial — ❑Accessory building ❑Multi-family Number of bedrooms: -El Master Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors lob site address: /y3�s S(1 rhw 1V W _ New dwelling area /S�� square feet City/State/ZIP: ' _ �-� _ Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Covered perch area: square feet Cross street/directions to job site: sh f �� Deck area: square feet 9 _" _ Other structure area {q ( 3-7 square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: ,I -- Lot no.: , Permit fees*are based on the value of the work performed. Tax map/parcel no.: SRS��C��i �C��J �_ Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the ,t DESCRIPTION OF WORkM. work indicated on this application. t _Mt - — (1/ Valuation: S 10) i� ►rl,e_ � p ro[2m � A tY Q �orou r_ /.�t4r- / ;J -��=a — !� 1 ` Existing building area: square feet 011C001fr On &IC New building area: square feet ..PROPERTY OWNER � � ��-�"TEN'ANT Number of stories: Name: f r / t" 7 �'�r '_ i f' SI''1 Type of construction: Address: k) /0/1 � _- Occupancy groups: City/State/ZIP: • 1 - Existing: Phone:(56-11) 7 _ W Fax:( �?� CU �> `7 I��13 New: j4APPLICANT ❑ GONT,►g PERSON -� - - - - KQTICE Business name: All contractors and subcontractors are required to be Contact name: —��r f, licensed with the Oregon Construction Contractors Board 1111-A-d e under ORS 701 and may be required to be licensed in the Address: /Y3,5 ,5 jurisdiction in which work is being performed.If the City/State/ZIP: � r 7 A applicant is exempt from licensing,the following reasons pe --7 t 7c;Rd�-- r� apply Phone:(�}3) �03�'/�=7 ( )�,8 .�J - J E-mail: L.� r ` ---- -- — (� CONTRACTOR ` Business name: W J11bli,DING IPERMIT FEES" v Address: please refer to fee schedule. City/State/ZIP: OxnS — Phone:(��' ) -1 Fax:(,S(��) � Fees due upon application Amount received CCB lic.: (2 < c r _ — Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. Print name: Date: matD • Fee methodology set by Tri-County Building Industry Service Board. i\Building\Per ta�B(IP-Pe itAppdoc 12/03 440.4613T(1 I/02/COWWEB) One- and Two-Family Dwelling , BuildinLy Permit Application Checklist City of Tigard P':-'Id •, Date/B Penna No 13125 SW Hallll Blvd.,Tigard,OR 97223 — -- - ---- -- -- Phone: 303.639.4171 Fax: 503.598.1960 Associated permits 24-Hour Inspection Line: 503.639.4173 O Electrical O Plumbing o Mechanical Internet: wv xi.tigard.or.us O other 'I'll F, FOLLOWINC FIT NIS AitF RFQl IR ED FOR PLAN RE% I V\N Y es No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. _ ❑ 13 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 3 Verification of approvedplat/lot. 0 4 Fire district approval re aired. Name of district: [� 5 Septic sstem permit or authorization for remodel. Existing system ca acit 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable staff and signature on file or with application. 9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- -❑ basin protection,etc. 10 y3 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. The plan must show lot and building setback dimensions;property corner elevations(if there is more than a 4-ft.elevation differential,plan must show contour lines at 24 intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage, 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ furnace,ventilation fans,plumbing fixtures,balconieF and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. S',ew details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. _ 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendum 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- ❑ 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 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 beatti/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. IL 21 Energy Code compliance. Identify 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 ❑ to architect licensed in Oregon and shall be shown to be a licable to the ro ect under review. J23 Five 5 site plans arc required fnr Item I I above. Site plans must be 8-1%2"x 11"m 11"x 17". Li [] [] ED 24 Two 2 sets each are required for Items 16, 19,20 and 22 above. ❑ _ 0 25 Bu Iding plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. W26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard El— Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment fomr is required for all building additions, �] including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9 1995. i:\HuildingU'ermitslpne-Two-FamilyChecklist.doc 12/03 Electrical Permit App}�;�C V�� VIW INNER nmwl city o1 Tigard r j I pec:d Permit No 9 13125 SW Hall Blvd,Tigard,OR 97223 Plan Review Utlxt Permit. Phone: 503.639 4171 Fax: 503 598.1960 I tP� Date/By: Inspection Line. 503 639.4175 1.1 A N 0 � Date Ready/By � luru ® See Page 2 for Intemet: www Ci ngatd.or.us to Notified/Method — Supplemental Information PLAN REVIEW ew construction �lldlllkdn r I Id�it/I" Please check all that apply ❑ ❑ Demolition F1 Other: Service over 225 amps,r_omm ❑ '1 Hazardous location — ❑Service over 320 amps-rating ❑Buildng over 10,000 sq,R, of 1 and 2-family dwellings 4 or more new residential -$a_L-and 2-family dwelling ❑Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure ❑ ❑ Building over three stories Feeders,400 amps or mote El Multi-family E]Master builder E]Other ❑Occupant load over 99 persons []Manufactured structures or ass/li titin F. Ian RV park i. >• i a _t� ❑ gr B g P Job no.: Job site address:/Cl/3F� f� /'.9 ❑Health care facility ❑Other: _ C C ,1 Submit_.sets of plans with any of the above. Cit /State/ZIP: / 7 The above are notapplicable to temporary serviceconstruction sece City/State/ZIP: IJIL % 7i7t c��—_�` jW SOODUB11: Suite/bldg/apt.no.: T Project name: �. ,�/ Description Qty. I Fee. Tool Cross street/directions to job site: New residential single-or multi-fimlly dwelling unit. Includes altpched garage. AllY ell /4 /h,41 o! 1,000 sq.R.or less 145.15 4 Lot no.: - Ea add'I 500 sq.R.or portion 33.40 - 1 Subdivision: VILLimited energy,residential 75.00 2 Tax map/parcel no.: �1&4 '16 1Limited energy,non-residential 15.00 2 -, t4M+i +,, � Q y. `1i: �•. . A, ,�.T 1 . Each manufactured or modular 3= LL / dwelling,service and/or feeder 90.90 2 � >`, �f1r rn C r. �h a m ,�-jd/.�eg 6Y e,,,j �C,cy_gz Services or feeders instatlation,alteration,and/or relocation 200 amps or less 8030 2" mP 201 amps to 400 amps 106.85 2 401 amps to 600 amps 16060 2 Name: �rI ,syr J'nini 14/ /SrP, 601 amps to 1,000 amps 240.60 2 Address: ��35 /"Q�„/tG� Over 1,000 amps or volts 454.65 2 — Reconnect only 1 _ 66.85 1 2 City/State/ZIP: �/' 7 Temporary services or feeders Installation,alteration,and/or S�� relocation _ Phone.( ) 3g_7�� Fax:( 1 S�n,C - (G�� ' 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 ex hange,a to ORS 447,449,670,and 701 401 amps to 500 amps 133.75 2 Owner signature: Date: % cr�L� 1 Branch circuits-new,alteration,or extension,per panel ft I, S A Fee for branch circuits with y service or feeder fee,each 6.65 2 Business name: branch circuit _ d r �fi L B Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuitI It-2 _ Each add']branch circuit 6.65 2 City/State/ZIP: Miscellaneous(service or feeder not Included)_ Pump or irrigation circle 53.40 2 IL Phone:( ) Fax: :(��/�) - �� Sign or outline lighting 53.40 2 lZ E-mail: j /51 PT' Signal circmt(s)or limited- U) `9 y - e • energy Panel,alteration,or extension.Describe Page 2 2 t Business name J Address: f' ' Each additional Inspection over allowable In any of the above m I / y � ! Per inspection _ _ 62.50 (_9I City/State/ZIP: l . C Investigation per hour(I hr min) 62.50 -I Phone:( tial) ��}�� Fax:O �� Industrial plant per hour 1--73.75 IYA CCB Lic.: /y Electrical Lic.: Suprv.Lic.: �U-1 _��7 Subtotal Suprv. Electrician signature,required: ?t y U Plan review(25%of permit fee) State surcharge(8%of permit fee) 0 Print name: bate: -- - - TOTAL.PERMIT FEE -j-214—i Authorized signature: This permit application expires If a permit Is not obtained within Igo days after It has been accepted as complete Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board ••Number of inspections per pemut allowed. i\Huilding\PermdtlFLC.PermitAppdoc 12/03 "0_"IsTi10/0VCOMAM Electrical Permit ADDlication - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: w Fee for each commercial system....................... $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Moiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical J m ❑ Nurse Calls C7 .jj ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i.\Building\Perrrulf\PLC-PernmApp dm O4103 Building Fixtures e� V �r�Plumbing Permit Applica QC C I._ City of Tigard ,JQI� 11IReceiveMd U 2 Date/By, Permit No S WO I 13125 SW Hall Blvd.,Tigard,OR 97223 -- --- ----- ----- Phone: 503 639.4171 Fax: 503.598.1960 .Ian Review Other Permit No GatdBy, _ 24-Hour Inspection Line: 503.639.4175 C IT Y OF T Date Ready/Ily June 0 See Page 2 for IntemeL www ci Tigard or its f'r t Nolified/Method. Supplemental Information TYPPEi bi IiSrt{� „ s « 5CEdDI)LE ew construction ❑Demolition __ For special in ormallorr use checklist ------- Description t Ea. Total ❑Addition/alteration/replacement ,~ ❑Other: _ New 1-2-family dwellings(includes 100 R.for each utility connection) CATEGORY OF CONSTRUE P?N SFR(1)bath 24910 �[1-and 2-family dwelling ❑Commercial/indusinal SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 399.00 El Master builder _ El Other. Each additional bath/kitchen 4500 y_ Fitt sprinkler(_%ft.) Page 1 r Qt 4 +r 300 S1'TE INFORMATION Af D, L6CA710N. _ _ _ _ _y-" Site utilities Job site address: �C�? S^^ ` 'Y Ll Catch basin or area drain 16.60 City/State/ZIP: 7'1 7 Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Project name: c. Footing drain(no linear It ,j Page 2 .,( Manufactured home utilities 1 1000 Cross streeUdirec/tions to job site: �J / _ - / /r Manholes 1660 / e _ Rain drain connector 16.60 _ Sanitary sewer(no linear ft.: _) Page 2 ((� Storm sewer(no.linear R:__) Page 2 —!ep Subdivision: _ l Lot no.: Water service(no linear R: _) Page2 `_ Tax map/parcel no r�J UL-)64 Fixture or item Absorption valve 16.60 D{ESCRt1sT[/6NS O7r Backflow preventer Page 2 1l ! r' l/11 't7I /C cl Backwater valve 16.60 Clothes washer 1660 &T(k c l/t UJA Dishwasher 16.60 {r :yy y �, Drinking fountain 16.60 Names —}- rt —!0r'!(1 Ejectors/sump 16.60 ir�, ''�� Expansion tank 16.60 Address: �S J( � �ai - XYL-- d r Fixture/sewer cap 16.60 City/State/ZIP: gCj7 el, , -7 y Floor drain/floor sink/hub 1660 Phone:QfCL3) 39- Fax:( ) ! J Garbage disposal 16.60 it�qt+ t ; sa Hose bib 16.60 a Ice maker 16.60 Business name: Interceptor/grease trap 16.60 Contact name: j�e3 c)r �f (' Medical gas(value:5 ) Page 2 a Address: <' Primer 16.60 City/State/ZIP: Roof drain(commercial) 16.60 p`�73 Sink/basin/lavatory 16,60 Phone:( ) Fax::( �"r(l �,} 0 s�7 � Tub/shower/shower pen 16.60 E-mail: n I Urinal 1660 CONTRACTOR - Water closet16 60 W Business names v�.,� I f� , h� /P�P�'J �t� Water heater 16.60 Address: 5`' Other: City/State/ZIP✓� !��7 Subtotal Minimum permit fee: $72.50 Phone:(Si,_j) Fax:(S(1)?) �j��, a��/ Residential backflow minimum permit fee: 536.25 CCB Lic.: Plumbing Lic.no.: Plan review (25%ofpermit fee) Authori2cd signature: State surcharge(8%of permit fee) C TOTAL PERMIT FEE Print name: /,J Date: /a d This permit application expires if a permit Is not obtained within 180 days after It has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board i�RaildingTerrnitt%PLMP-PermirAppdoc 12/07 N0-/616T(10102/C0M/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities. Qty. °:its' u eot,ta earmit 'ee: �--- opi Footing drain-1"100' 5500 0 to 2,000 $115,00 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer- I St 100' 5500 3,601 to 7,200 $22000 and eater $309.00 Sewer-each additional 100' 46.40 Water Service eIst 100' 55.00 Medical Gas S stems' _ ee: Water Service-each additional 100' 46.40 it ,. �� . t F _ Storm&Rain Drain-1st 100' X5.00 $1,00 to$5,000.00 Minimum fee 572.50 Storm&Rain Drain-each additional 100' 4640 $5,001.00 to$10,000.00 572.50 for the first 55,000.00 and$1.52 for each _Fixture or item icy Fee(ea) Tota additional$100 00 or fraction thereof,to and — — including$10,000,00. t'ommercial Hack Flow Prevention Device 46.40 510,001.00 to$25,000,00 5148 50 for the first 510,000.00 and SI 54 for Residential Backflow Prevention Device each additional SI00,00 or fraction thereof,to minimum permit fee$36.25 27.55 and including$25,000.00 Rain Chain,single family dwelling 65 25 $25,001.00 to$50,000.00 $379,50 for the first$25,000.00 and$1 45 for Inspection of existing plumbing or each additional$100.00 or fraction thereof,to � specially requested inspections-per hoand including$50,000 00. 72.50 550,001.00 and up $742 00 for the first S50,000.00 and$1.20 for Subtotal: al: 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"'. 4antt by(VIxtare).Wo' Fixtm a type: aPP New rtitnvEd E:itflr)' rN Comments regarding fixture work: Baptistry/Font Bath -Tub/Shower - -Jacuzzi/Whirl ool Car Wash -Each Stag _ -Drive 71ttu C'u idor/Water Aspirator Dishwasher -Commercial -Domestic Drinking Fountain Eye Wash Floor Drain/sink 7." 1' 4" _ IL Car Wash Drain ---- — _�_ lX Garbage -Domestic Disposal -Commercial *Note: If the fixture work under this permit results in an Industrial increase of sewer IDUs a sewer permit will be issued and Ice Mach./Refri .Drains _ + Oil Separator Gas Station fees assessed for the sewer Increase must be paid before the .J Rec.Vehicle Dump Station _ plumbing permit can be Issued. (n Shower -Gang 0 -Stall ,j Sink -Bar/Lavatory — Quantity Total -Bradley -Commercial Isometric or riser diagram is required if fixture quantity -Service — total is>9. Swimming Pool Filter _ Washer-Clothes Water Extractor Plan Review Water Closet-Toilet Plan review is required if fixture quantity total is>9. Clrmal _ — Other Fixtures: i BaddinalPe ,WPLKPerrnitApr doc 3101 Mechanical Permit AD11ficatiRol on Received City of Tigard pate/By Pe- No. 13 M�� G ' 13125 SW hall Blvd.,Tigard,OR 97HECEIVE Plan Review 7 ) G� Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit Inspection Line: 503.639.4175 IAA 2,t �DO Date Ready/BedlMeth lura ® See ant l for Internet: www.ci.tigard.or.us--�J�r-t 1�1 V Notified/Method: Supplemental Information �'FYPIl KdAAKD COMMERCIAL FEE" SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work New construction d t fa I ka�l' performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other. mechanical materials,equipment,labor,overhead,end profit. CATEGORY OF CONSTRUCTION Value:S -k,,-and 2-family dwelling ❑Commercial/industrial ❑Accessory building RESIDENTIAL EQUIPMENT/SYSTEMS FEES" For special information use cheeklir;. Multi-family ❑Master builder E]Other: - Description _ Qty. Ea. _ T'otal JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address Air conditioning or heat pump NO S_ " ;'W_e- ,0 �' —[�1_ re uires site plan showing placement 14.00 City/State/ZIP_ry� �^ 9 zt ' 5/ Furnace 100,000 BTIJSducwvmta 14.00 Suite/bldg./apt.no.: Project name: t1�Q Furnace 100,000+BTU duce vents 1790 Gas heat pump 14.00 Cross street/directions to job site: ' Duct work 14.00 _ dronic hot water system 14.00 _ /�C_! _ _ Residential boiler(radiator or h dronic) 14.00 -- Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 10.00 (� 11 Flue/vent for any of above 10.00 Subdivision: l Other — 10.00 - Tax map/parcel no.: 2Z /D 6 A eZ&00 Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 _ / l Gas fire lace 10.00 j-(�qY � /O / Flue vent for water heater or gas TT 11r1 ` 1 fireplace 10.00 c7�+F _S/Zt_-✓ 1LJ 1 CQLtPI^ a� C Log lighter(gas)�^ 10.00 _ Wood/pellet stove 10.00 Wood fireplace/insert _ 10. PROPERTY OWNER � Other: 00 _^ ❑ TENANT _ th /liner/clue/vent 10.00 Outer. f0.00 Name: ^ f- K/�� Environmental exhaust and ventilation _ Z ///!rt �—moi I GIS r1 Address: 315- S(� 4/k.i M N 1od Range hood/other kitchen 7 - [s/ UN equipment ment _ 10.00 City/State/ZIP: '� '7aa Clothes dryer exhaust 10.00 -----� Single-duct exhaust(bathrooms, Phone:('� -) , 7 ?7 Fax:( ) �J: toilet compartments,utilityrooms 6.80 _ Qih' -- ,ZAPPLICANT ❑ CONTACT PERSON Attic/crawls ace fans 10.00 Business name: Other: 10.00 Fuel piping Contact name: PN $5.40 for first four;$1.001 r each additional ` Address: Furnace,etc. _ i'Y� — Gas heat pump City/State/ZIP: Wall/suspended/unit heater Phone:( ) _ _-_ Fax: :( _ 3 Water heater Fireplace E-mail: =` axevca Range CONTRACTOR Barbecue ,�,/�� Clothes dryer(gas) : _ j:::_ Business name .. - Other: Address: /0' MECHANICAL PERMIT FEES" Ci /State/ZIP: Subtotal Phone: Fa Minimum permit fee($72.50) ( ) �- � x:(� ------- ___ S�5 - � V v Plan review(25%of permit fee) CCB lic.: State surcharge(8%of permit fee) _ TOTAL PERMIT FEE Authorized signatureze� _ _ This permit appllcatinn expires if a permit Is not oblalned within 18a days after It has been accepted as complete. Print name: / AAI Date: Fee methodology set by Tri•C runty Building Industry Service Board Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation:` Permit Fee: $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 includin $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 and $1.10 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. CL it CO a m C7 LU r\Buildii g\Pennit9\MEC-Perm itApp.doc 12/03 2 11 I File Numbor C�leanWa er Service I�{ 'JAN 0 3 2005 I F5*-,XyXc-51 011r commitment Is Clem 13y Sensitive Aroa1 Pre-Screening Site Assessment Jurisdiction 1' Date t Map & Tax Lot j Owner �. ,, 161,;W �.� Site Address ^sFij lglj,�M /1.�^_lf1ti 4,)L `i 7.i g S' Contact Proposed Activity j��t, ��,..� e ��; ...,7,1,,,.f1 Address /]�1s��_�_�_h�� qds"& vt�w�1l�c[,J,1w4�G��1� .f�(2��.AL l-Jt ( r �j^.� j ?s,� "24 Phone Ly al Official use only below fbis line Y N NA Y N NA [3, f��-11_I Sensitive Area Composite Map z�p� Stormwater Infrastructure maps i� ❑ Map#_---e-ti/W��__._____ ❑ ❑ lint QS# N5'/ r Locally adopted studies or maps Other ❑ C_� - Specify ❑ ❑ Specify.aC ��1�.__ Rased on a review of the above Information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04-9: Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required, �r Sensitive areas do not appear to exist on site or within 200' of the site. This pro- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AU7HORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: f C/l f•:�I/Cs' itrf'effi �<..,4l1 I V tic" ��1.�V�t�_� �• 7— Date: , _'AN 2,0 205 Returned to Applicant Mail_X I'ar Counter_ CITY OF lui/u ) Date 1 , 05' By 6),4 BUILDING DRII 1?�. 2550 SW Hillsboro g ay•Hillsboro,Oregon 97123 Phone: (503)881-3005•Fax: (503)881.4439•!Lv..MM&jMy t yioLnra