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Permit ; / _ MASTER PERMIT c r rY T PERMIT #: M5T2007 -00224 I COMMUNITY DEVELOPMENT DATE ISSUED: 1/25/2008 T_IGAR 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 135AA -00905 SITE ADDRESS: 10200 SW 90TH AVE ZONING: R - 4.5 SUBDIVISION: TOWN OF METZGER LOT: 004 JURISDICTION: TIG PROJECT: DENT Project Description: Interior remodel (Phase 2) Add bathroom at existing habitable area of basement 2/19/08. 10/15/08, adding feeder and (5) additional branch circuits. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: 8 0,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: 7 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 0 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 0 SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREAJSPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable MICHAEL DENT OWNER laws. All work will be done in accordance with approved plans. This 10200 SW 90TH AVE. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the 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 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 - 813 - 6366 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,287.74 REQUIRED ITEMS AND REPORTS Issued ty : I G Permittee Signatur- . - 1 _ �(C 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 project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application '- FOR OFFICE USE ONLY City Of Tigard " EVED Received h gi � �l ft/1 Permit No.: �r �f .97.....a12 a, • a 13125 SW Hall Blvd., Fax: 0 . 8.1960 Ti ar& ` i ` � ' Date : O �1C/ �°' Ill..' Phone: 503.639.4171 g ' ./ i 1 , . Date /By: Other Permit: ^ Ins ection Line: 503.639.4175 OC � 1 t ` Date Read /B lurk: TIGARD p 1 Ready /By: ® SeePage2 for Internet: www.tigard or.gov � Notified/Method: Supplemental Information TYPE CON ►i. , ` , ` , HH � , `V PLAN REVIEW ❑ New construction ❑ Additiop 11041 ement Please check all that apply (submit 2 sets of plans w /items checked below): r�77�� �� ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ", Job no.: Job site address: WOO 'o 9' - /41)E.` 10011P or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than .� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: / / F ( ❑ Service or feeder 600 amps or more. �� FEE SCHEDULE Cross street/directions to job site: Description 1 tom. 1 Fee. 1 Total 1 • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) _ Limited energy multi - family 114"75-D t, f x (s _ (/► P2-k0 1 1 residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/o , • on 200 amps or less / 80.30 '' 1, ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 . 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 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 599 amps 133.75 2 Branch circuits – new, alteration, or extension, per panel Owner signature Date: A. Fee for branch circuits with ❑ APPLICANT —1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'l branch circuit 5 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: a ' , \ ` 1 2 Signal p a ne l, a) er or t o n , or (�, / � J energy panel, alteration, or Address: extension. Describe: Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. " Number of inspections allowed per permit. 1 .\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1 I/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ;:'-RESIDENT WORK ONLY:T Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \ Building \Permits\ELC- PermitApp.doc 03/23/06 1.',V.r i V ;.::::`:,' ; :: W i C A i '' ./ ' - ‘ - '‘;' 1 16 1 AS/ER . Atg ‘ i il !Ty OF TI GA ° PERMIT #: MST2007 -00224 ° COMMUNITY DEVELOPMENT DATE ISSUED: 1/25/2008 TIGARIY 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S135AA-00905 SITE ADDRESS: 10200 SW 90TH AVE ZONING: R -4.5 SUBDIVISION: TOWN OF METZGER LOT: 004 JURISDICTION: TIG PROJECT: DENT Project Description: Interior remodel (Phase 2) Add bathroom at existing habitable area of basement 2/19/08 ��..• BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 40,000.00 REAR: PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS AMYL INSPECTIONS 1000 SF OR LESS: 0 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAL /PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA /SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA /TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable MICHAEL DENT OWNER laws. All work will be done in accordance with approved plans. This 10200 SW 90TH AVE. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the 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 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 -813 -6366 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,140.05 REQUIRED ITEMS AND REPORTS Issued By : fP 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 project. Approved plans are required on the job site at the time of each inspection. 11 ,Co ® o ® ■■ (z)/ L--- ` A R C I tIIP .. PERMIT #: MST2007 -00224 r , i , „ :; COMMUNITY DEVELOPMENT DATE ISSUED: 1/25/2008 i TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 135AA -00905 SITE ADDRESS: 10200 SW 90TH AVE ZONING: R -4.5 SUBDIVISION: TOWN OF METZGER LOT: 004 JURISDICTION: TIG PROJECT: DENT Project Description: Interior remodel (Phase 2) Add bathroom at existing habitable area of basement 2/19/08 BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 51 BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sr RIGHT: VALUE: OCCUPANCY GRP: R3 BORM: BATH: TOTAL: 0 sf 40,000.00 REAR: PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 4 DISHWASHERS: i FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 2D1 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAUPANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps•1000v: MINOR LABEL: 1000* amp /volt : PLAN REVIEW SECTION Reconnect only > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA /SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO A. STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA /TELE COMM: NURSE CALLS: TOTAL $1 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR Specialty Codes and all other applicable MICHAEL DENT OWNER laws. All work will be done in accordance with approved plans. This 10200 SW 90TH AVE. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the 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 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 -813 -6366 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,140.05 REQUIRED ITEMS AND REPORTS Issued By : ,ea_ 44. 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 project. Approved plans are required on the job site at the time of each inspection. • , 1 1 1 4� q , i Ty O F T I A ® MASTER PERMIT " COMMUNITY DEVELOPMENT DATE SSUIED: MST2007 -00224 '�'. 1 /25/2008 ,T IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S135AA-00905 SITE ADDRESS: 10200 SW 90TH AVE ZONING: R -4.5 SUBDIVISION: TOWN OF METZGER LOT: 004 JURISDICTION: TIG PROJECT: DENT Project Description: Interior remodel (Phase 2). BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 40,000.00 REAR: PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOILICMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amplvolt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVCIFDR > =225 A.: > 600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: • OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable MICHAEL DENT OWNER laws. All work will be done in accordance with approved plans. This 10200 SW 90TH AVE. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the 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 952 - 001 -0080. You may obtain copies of these rules or direct Phone: 503 -813 -6366 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,140.05 REQUIRED ITEMS AND REPORTS �'� , / � Issued By : < � Permittee Signature : �olt1� 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 project. Approved plans are required on the job site at the time of each inspection. ' , Building Permit Application o- iii i ��at � y ; r< ' isr,� n 436 ia 0. 4 '4 I P g.l F . i;: a r,� k J^ r o Residential �� �, � �� ,� �t ,� � ��� ���" !•E� � t tifgr�hx � r v F US ONLY a„ o� i �'�' ,r te _ ��` �r.'_ =as?1 a ..�tl�l::�. � � a >�1 P�'�.l�l:� o-t �k a -u 4�' t� 11 tj( ►) Received i l i „ City of Ti gar d GY f/ Date/By: l PI O7 Permit No.: 1/0.-100 ?� pQ a a )f i ° 13125 SW Hall Blvd., Tigard, OR 97 ((�� 1 4 200? Date Plan Review Ate P I k • Phone: 503.639.4171 Fax: 503.598060 / ,� 6/D / O. Other Permit: w Inspection Line: 5036394175 l! 4A p.. (( j((j������ ppT�/ r / Date Ready /B� t ®See Page 2 for , 4tu G R D ® t " • �� I J� Notif e od: �/ a ( 0 a. Supplemental Information 1 k��d Internet: www.tigard- or.gov ®® ®B'� tg rIN V � TYPE OF ,WORK ° REQUIRED 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 nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION' work indicated on this application. • ❑ l- and 2- family dwelling ❑ Commercial /industrial Valuation: $ LiV1 ❑ Accessory building ❑ Multi- family Number of bedrooms: /00 e /74q ❑ Master builder 0 Other: Number of bathrooms: /VO IWP /9bbi 770,4P JOB SITE INFORMATION : AND LOCATION Total number of floors: Job site address: 102KSO SW 40 — `I'� 1;tre New dwelling area: square feet — City /State /ZIP: - 1 ' 1' RAC 0t2..._ SI 22 3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: ENT. Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 1 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 •rs t for the DESCRIPTION OF WORK work indicated on is application. n BUY' ��.4 Valuation: $ v l/l Existing building are.. square feet New building area: square feet ❑- PROPERTY OWNER ❑ TENANT Number of stone Name: kii CiA0. tLA 0 - D o-r■th Type of cons ction: Address: 1 2 90 Occupanc ' groups: City /State /ZIP: , i c ix ' Oe C 22,3 Exist g: Phone: (�3 2•`1 3(D 5� Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON" NOT ICE 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 Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax::( ) .... E- mail: CONTRACTOR Business name: 2 CI BUILDING PERMIT FEES* ' Address: • ` (Please refer to fee schedule) ' Structural plan review fee (or deposit): City /State /ZIP:. Phone: ( ) ( ) FLS plan review fee (if applicable): CCB lic.: / Total fees due upon application: Amount received: Authorized signature. Fax: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 11 _ 1 _, i � t � Date: 12 (C( /2496 ? * Fee methodology set by Tri- County Building Industry Service Board. l: \Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two- Family Dwelling y ; w FOR OFFICE'USE "SONLY I , � "r a� a. City of Tigard Received Permit No.: a Associated y 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits 0 Phone: 503.639.4171 Fax: 503 598.1960 0 Electrical ❑ Plumbing ❑ Mechanical T 1 C A R L7, 24- Hour Inspection Line: 503.639.4175 Internet: www.tigard- or.gov I -❑ Other THE FgOLLOWINGITEM REQUIREDFORPLANrREVIEWj�i , ,, a Ye sf� N ox N' 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. Q ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system 'permit or authorization for remodel. Existing system capacity _ ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. • 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicableaocal 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 t completed if copyright violations exist. 11 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 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 size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- .. ❑ , ❑ ❑ floor, wall construction, roof construction. More than one cross section may be requiredto clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑' ❑. 0 prescriptive path analysis provide specifications and calculations to engineering standards.'- 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member s izing; spacing, an_ d 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 beam/joist carrying a non - uniform Toad. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be a, •licable to the iro - ect under review. C� ti i . �� / IIJR ISDICTION A `L.SPCCIInICS�G r.••_. wr. ,..,,. �� t,�,,, „�:��....��r. ��.��,,�•..�� �.n,a. � ,.,,�::,,.�r�n.�r� N�.�� �.,.I,,�f 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2” x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City_of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and accompanied by the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre- 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 of record approved prior to September 9. 1995. I:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 . 440-4613T(11/02/COM/WEB) Jwl '! i!r OF a +. 3 +' 'i k at y 7htu1 ' E p y I �I �, Electrical Permit Application :� w �� , FORpoFF uS>EONL ,,; l ! i n 'I' City of Tigard Received Permit o.: �p6 2 7 tvci Pit ate iv /iZ �/4- �4-7 �/ P i N /7/� ' ° 13125 SW Hall Blvd., Tigard, OR 9722 P�1 I lan R ev iew ® r1 Phone: 503.639.4171 Fax: 503.598.1' .0 t ' s a ate/By: Other Permit: T I C� A R D' Inspection Line: 503.639 DEC 1 " 4 1007 Date Ready /By: l uris . ® See Page 2 for i .. x . ' Internet: www.tigard Notified/M Supplemental Information TYPE OF W0RI01 LW OI � y - ' PLA REVIEW . ❑ New construction ❑ Addition /alterat i 1 • F , li PUl 10N Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. C OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION A ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I- 2 ", "I -3 ", I G , \ 100HP or more. occupancy. Job no.: Job site address: `6 J6V q c — t 1u • ❑ Six or more residential units. ❑ Recreational vehicle parks. 7 City/State /ZIP: -- I 23 ❑ Health -care facilities. ❑ Supply voltage for more than 1 l�A�► 012___ t l ❑ Hazardous locations. 600 volts nominal. ` J 1 "t - �� ❑ Service or feeder 600 amps or more. Suite/bldg. /apt. no.: Project name: 1,J FEE SCHEDULE . Cross street/directions to job site: Description 1 Qty. 1 Fee. I Total 1 • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 • DESCRIPTION. OF WORK (with above sq. ft.) T.nA _QJ\toI- 11� r Limited energy, (with above sq . ft 75.00 2 1 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ' . ❑- PROPERTY OWNER' ` ❑ TENANT _ 201 amps to 400 amps 106.85 2 Name: MI l wi. O • C-Q.rt.k-- 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 102.06 SW � U . Over 1,000 amps or volts 454.65 2 City /State /ZIP: �' ^ _' y 91'2 23 Temporary services or feeders installation, alteration, and/or W, �'t . relocation Phone: (5p3) -24:1 , b5 "")- Fax: ( ) 200 amps or less 66.85 I Owner installatio • his installat is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, ease, rent, or ex ge, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits— new, alteration, or extension, per panel wrie %signatu : _,�IL Date: 4 __ L S - D. -An f A. Fee for branch circuits with APPLICANT ( ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'I branch circuit .4, 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2 E - mail: Pump or irrigation circle 53.40 2 C � � � Sign or outline lighting 53.40 2 Ott) name: O Signal circuit(s) or limited - energy panel, alteration, or Address: extension. Describe: Page 2 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) I Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: I Electrical Lic.: 1 Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICA L PERMIT FEES Suprv. Electrician signatur• equire.. Subtotal: Print name: 1 Date: Plan review (25% of permit fee): State surcharge (8% of permit fee): Authorized signature .40 11.e. TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: f b% I` 1 / zero l -in—+ Date: 1 'Z/ tq 7 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1t/05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* H Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems H Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 03/23/06 Mechanical Permit A t 1ll± 1 "` IV ° � r ' ..n r 4K FOR, S O N, YY i ° � � w 'r r l ,, ii ^ ' City of Tigard 1 4 1007 Date/By: i iv o ' � , Permit i,`/T-09 7—oo ge q 13125 SW Hall Blvd., Tigard, OR C Plan Review �.,.,. Phone: 503.639.4171 Fax: 5036•1001.• Cl Other Permit: ®Atl a Date/By: T I G A I. p', Inspection Line: 503.639 pppp �+ltaft��� Date Ready /By: luris. ® See Page 2 for ,$�-s: ,'0 Internet: www.tigard- or.gov BLIND � Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE *. SCHEDULE = USE CHECKLIST Mechanical permit fees* are based on the value of the work N ew construction ❑ ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION , . Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* . ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building El ❑ Master builder ❑ Other: For special information use checklist. Description Qty. I Ea. Total JOB SITE INFORMATION Ruth- LOCATION Heating/cooling Job site address: 102.0C) ) c 5 -k i 6.Q_ A ir conditioning or heat pump ` (requires site plan showing placement) 14.00 City /State /ZIP: 1 I o� 9-1223 Furnace 100,000 BTU (ducts /vents) 14.00 f Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: DENT Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 • Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF • WORK Water heater 10.00 '�n^ oN� Gas fireplace 10.00 +rJ ` Flue vent for water heater or gas fireplace 10.00 • Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ' ❑ PROPERTY OWNER • • ❑ TENANT Chimney /liner /flue /vent 10.00 Other: 10.00 Name: CLL O • (� �' o -� Environmental exhaust and ventilation Address: \ ` -!Wj1 Range hood/other kitchen X0203 SLz �b - Ave.. • equipment ( 10.00 City /State /ZIP: -Tr OIL 9'1223 Clothes dryer exhaust 1 10.00 ? ^� Single -duct exhaust (bathrooms, Phone: (Q 2g _ �(OS - Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON " Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: a° (`-' /` Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* _ City /State /ZIP: Subtotal (,.ks.0 , Minimum permit fee ($72.50) - 7 t ) s Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lie.: State surcharge (8% of permit fee) 5. 0 ' TOTAL PERMIT FEE 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: 1 Il ( t * Fee methodology set by Tri- County Building Industry Service Board I :\ Building \PermitskMEC- PermitApp.doc 01/19/07 440 -4617T (11 /02 /COM/WEB) 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 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 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1: \Building \Permits \MEC- PermitApp.doc 01/19/07 2 f . ` ' , Plumbing Permit Applic CL It IV i 5 i f a F Gig . w. :11, ' t .' r "' t Building 'Fixtures . 1 h , � FOR OFFICE uSE ONLY . Date /By l D Permit No.: MS 7 City of Tigard DEC 1 4 ZOO/ Received / 7 ^ 11 14 0 1 3125 SW Hall Blvd., Tigard, OR p t , I ' Plan Review Q �/ 1 'r Phone: 503.639.4171 Fax: 503.8.9.:' Date/By: 1 . 3 ' Q l� Other Permit No.: - Ti G A R D! Inspection Line: 503.639.4175 �' 1 Date Ready /By: Lwrs! ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: R,0 Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description . 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) . CATEGORY OF CONSTRUCTION . . ' _ . SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 'u2rib SI,,, 9•6 P Catch basin or area drain 16.60 City/State/ZIP: --1-: C�� Z , 2 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: ,P roject name: Ch-kT Footing drain (no. linear ft.: _) Page 2 .lJ� Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 )t\} Q 111.6Y 7Q7-.pd4J Backwater valve 16.60 Clothes washer I 16.60 - Dishwasher e 1 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: 0 • 'fi' Expansion tank 16.60 Address: 10 2.00 Std3 C� CT'' � • Fixture /sewer cap 16.60 City /State /ZIP: --1 O � ` 9-122_3 Floor drain/floor sink/hub 16.60 Phone: (SS) . g(0. Fax: ( ) Garbage disposal i 16.60 ❑ APPLICANT ,. Hose bib 16.60 .. 0 PERSON, Ice maker I 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 1 /0 / -1 16.60 Phone: ( ) I Fax: ( ) Tub /shower /shower pan 3 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet a., 16.60 Business name: Ot ) �� 2 Water heater 1 16.60 • Address: t� Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: j Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: '� TOTAL PERMIT FEE Print name: 11 �� Date: 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. K� 1:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 • 440- 4616T(10/02 /COM/WEB) . r i 4 • CC!! ` 1 5 • 4 0 •SAX: l %•5q Plumbing Permit Application - City of Tigard ; • ,',' �i� t ' ' • • - Page 2 - Supplemental Information • Fee Schedule: Residentia1,Fire Suppression Systems: 'Site - Utilities • Qtr. Fee (ea) . * Total Sgnare Footage , ; __, 'Permit Fee: Footing drain - 1" 100' 55.00 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 - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 ermit Fee: . Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum P inimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each "Fixture or Item ' Qty. Fee (ea), Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 .• and including $25,000.00. . Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50Tor the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00.or fraction thereof, to and including specially requested inspections - per hour 72.50 efir , 0 Subtotal: $50 and up:: E : $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: • Replace engineer. Previous Capped Added . Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR9.18 -780 -0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic • Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" Car Wash Drain Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial • Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar /Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and • - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor - Water Closet - Toilet Urinal ' Other Fixtures: t is�Building \ Permits \P LM- PermitApp.doc 12/27/06 • -�',,� :k,1\4! Permit #: o'(OD 7 G2� Construction Contra 700 Summer St � ��'� . � i 1 Address: /'i ao a 76)— , PO Bog 14140 , d t Salem OR 97309- 5052�� ���t�� Issued by: `F° Date: ! �b r / - J = Phone 503- 378 -4621 0 et / 1,4 Web Address: www.ct.us Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing 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. I own, reside in, or will reside in the completed structure. —� 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. ❑ 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereb certify that t 1 . above information is correct and that I have read and do understand the Information Not i to Property Owne about Construction Responsibilities on the reverse side of this form. / 4 1 / oc) • i ature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06 -01 -04 Acting As Your Own GenerA - ��ontractot? • INFORMATION NOTICE TO PROPERT'TYvOVNERS . ABOUT CONSTRUCTION RES '6ASIBIL TIES: NOTE: This Information Notice i© Property Owners about Construction Responsibiliti was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement t� an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities • You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you.use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or. improvement. of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you Must withhold income tares from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information; call :the Department of Revenue at 503- 378 -4988. Unemployment Insurance Tax: As an employer; you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503- 947 -1488. • The Oregon Business Identification Number (BIN) is a combined number, for both Oregon .Withholding and Unemployment Insurance Tax. To file for a BIN, call 503- 945 -8091 or www.dorstate.or.us/forrnspay.htmll l for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable 'for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division. at the Department of Consumer and Business Services at 503- 947 -7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax' from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal FIN number, call the IRS at -1- 800 - 829 -4933 or visit their web' site at.w.ww irs.gov. • .. Other Responsibilities and Areas of Concerns - Code Compliance: As the permit holder for this project, you are responsible for resolving any failure 'to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance - agent `to see if you liave - adequate insiirarice coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you•have sufficient time to supervise your employees.., - - • -_ . - Expertise: Make sure you have the skills to act as your own general 'contractor; to coordinate the work of rough -in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503 - 378 -4621) or write the agency at PO Box 14140, Salem, OR 97309 - 5052. Property_owner.doc 06 -01 -04 r �; : s, ' MASTER PERMIT , '. CITY OF 1 ' ,AR® _ PERMIT #: M 25/200 00224 COMMUNITY DEVELOPMENT DATE ISSUED: 1/25/2008 ..I'GARD 13125 SW Hall.Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 135AA -00905 SITE ADDRESS: 10200 SW 90TH AVE ZONING: R - SUBDIVISION: TOWN OF METZGER LOT: 004 JURISDICTION: TIG PROJECT: DENT Project Description: Interior remodel (Phase 2). BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sr LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 40,000.00 REAR: PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 • CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: - WOODSTOVES: GAS OUTLETS: 2 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: izna tsn LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000. amp /volt : PLAN REVIEW SECTION 6 Reconnect only: > =4 RES UNITS: SVCIFDR> =225 A.: > 600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: • OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 4 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR Specialty Codes and all other applicable MICHAEL DENT OWNER laws. All work will be done in accordance with approved plans. This 10200 SW 90TH AVE. permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 if the 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 952- 001 -0080. You may obtain copies of these rules or direct Phone: 503 -813 -6366 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 1,140.05 REQUIRED ITEMS AND REPORTS • Issued By . •" , , .M ,_ Permittee Signature : , IJ ' . I 'J• 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 project. Approved plans are required on the job site at the time of each inspection. i\ . CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST2007 002?�� 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1125112008 Phone: (503) 639 -4171 AA Inspection Requests (24 Hrs.): (503) 639 -4175 6 7 I _. INSPECTION WORKSHEET FOR DATE: 9/19/2000 TIME: 7:00AM PAGE: 9 SITE ADDRESS: 10200 SW 90TI1 AVE CLASS OF WORK: SUBDIVISION: TOWN OF METZGER LOT #: 004 TYPE OF USE: PROJECT NAME: DENT DESCRIPTION: Int.oriur remodel (Phase 2) Add bathroom at existing habitable area of basement 2/19/00 OWNER: DENT, MICHAEL PHONE #: (:;03-813 -E;366 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/19/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 075695 -02 503- 293 -3657 N Corrections /Comments /Instructions: C ,a k..c.e I Le—,A ( 0 44 ��Gt. ' e ❑ PASS ❑ PARTIAL APPROVAL igl CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED J Inspector: 144-- - Vim,.._ Date: r t G k p t Phone #: (503) 718- CITY OF TIGARD • BUILDING DIVISION PERMIT #:rAer27 ,00221 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 � Inspection Requests (24 Hrs.): (503) 639 -4175 �' °_.. INSPECTION WORKSHEET FOR DATE: 3 • % () TIME: PAGE: SITE ADDRESS: louse 6w r , o ��f CLASS OF WORK: SUBDIVISION: "I V • LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: a 1,A) KMit -s • PHONE #: Inspection Request Scheduled For: Date: 3 . . Qc\ • Pour Time: Code # Inspection Description Confirm # Contact # Message pp 123 u ..0.)• c k- � lv Corrections /Comments /Instructions: n- konnov< AILL t STI t A r 0 P t ift ( otr AU, er 13 AM lit - C4,0,IAD 4 '&(>1 • 1461 P • - o/\) 0.1:4 t• w 4 b %AL a!_ a i1 t_. ► L X0.52 -- . . Pct (4)G1i tLES 11\ 1 4/1 E ' .1, L NO 1A 0.b ?mN +Os. I( c ' c 1. E o,) ALL w a c Li 2 F1. ( i‘) L rA.-"Ew) L ()F coo 01"of),4 p'1 o• G' o )Q`S ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 15q FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 3 • n • O Phone #: (503) 718 - 2•1-(46' / L L//) , --'‘ '.7 _ - . mirk) (I w 91ST all II i9 --__________/ \\___H'I BORDERS i ____ / ____fd! 2 it / ,/- I /.._ LANDAU .! 0 ED ." • 4 / D Opc=1 } -1 ] ( II IF. ■••■ 1.1 Rii-- H == ST LOCUST I . , —, ilp LOCI ' \L 1 *I . a... ,:,. , , , i - F ' MI ' CA; - , 1" E. .r • ia . \ <> /7--- _ r... OAK OAK IL 111 2 y 2 i ] j . fa ow I 1 1 j ,/ __ i i / PINE ST PINE , / \ .4b, / 7777 . . , I 1 11/ _L j II i _ N , ------ ----~~� / 1 -- / J co 1 � � `` 7' _ ----� CITY OF TIGARD 0 BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1125/2008 0OOZ�Q Phone: (503) 639- 4171gb Inspection Requests (24 Hrs.): (503) 639 -4175 . -'.- ". INSPECTION WORKSHEET FOR DATE: 10/17/2006 TIME: 7:O2AM PAGE: 5 SITE ADDRESS: 10200 SW 90TH AVE CLASS OF WORK: • SUBDIVISION: TO1�11�1 OF t1�F T7GE.la LOT #: tip TYPE OF USE: PROJECT NAME: DENT DESCRIPTION: Interior rernodel (Phase 2) Add bathroom at existing habitable area of basement 2119/08. 10115108, adding feeder and () additional branch circuity. OWNER: DENT, MICHAEL PHONE #: 503 636G CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/17/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 115 Electrical service 076064 -01 503 - 705-4857 N Corrections /Comments /Instructions: CD s vtioir Nrw 112 evil, .'"A 1 VN CI -toff - SiPt LT, C UrQ 4 4 00 G�� , g ia- 33 •3J_ ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 7 NFAIL 0 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: -----) 66 LE Date: 1 01 1 . - 1 n Phone #: (503) 718 - ',y q / I 4 III Tidemark Advantage [Gary Noble - GN] a ( File Edit Options Window Help Exit New Open Task List QBE GIS 1 E2 1 Close Edit Project Group Add Clone Parcel Activity People Fees Valuation Conditions Case Notes Tags Documents GIS Case • Master Permit -- MST2007 -00224 Status I fLi Name:MICHAEL DENT Updated: 10/15/2008 BLD General Address:10200 SW 90TH AVE Jur: IG __ __ Description: Master # -00247 Project: IDENT Building Interior remodel (Phase 2) Add bathroom at existing habitable area of basement _ __ _ 2/19108. 10/15/08, adding feeder and (5) additional branch circuits. Mechanical Plumbing Sinks: 1 Floor Drains: Backflow Drains: 1 Lavatories: r 4 Water Heaters: FT Traps: i Electrical Tub /Showers: 1 4 Laundry Trays: f Catch Basins: E __ ___ Electrical Water Closets: Sewer Line: Grease Traps: Dishwashers: FT Water Line: Other Fixtures: r1 - - -- Restricted - Garbage Disposals: J 1 Rain Drain: Elecrical � ° Residential Washing Machines: i 1 SF Rain Drains: l Restricted Elecrical Commercial 4 LI View /Add Activities r it. [� Inbax Microsoft Out,., �Ti demarkAdvdotaQe .,, i�■ d r - ) 1" 7:58 AM F. N CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST2007- 00224 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/25/2008 Phone: (503) 639 -4171 ,,, Inspection Requests (24 Hrs.): (503) 639 -4175 .J.W ... INSPECTION WORKSHEET FOR DATE: 9/19/2008 TIME: 7:OOAM PAGE: 11 SITE ADDRESS: 10200 SW 90TH AVE CLASS OF WORK: SUBDIVISION: TOWN OF METZGER LOT #: 004 TYPE OF USE: PROJECT NAME: DENT DESCRIPTION: Interior remodel (Phase 2) Add bathroom at existing habitable area of basement 2/19/08 OWNER: DENT, MICHAEL PHONE #: 503- 813 -6366 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/19/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 075695 -01 503-293 -3657 N Corrections /Comments /Instructions: ❑ PASS ❑ PARTIAL APPROVAL TACANCEL ❑ NO ACCESS ❑ FAIL — CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: G' 0 Q L Date: 91 {q 1 Phone #: (503) 718- 11-11-46