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Permit Y # : 04 ► ® MASTER PERMIT Qi. ,3 901114„" CITY OF LARD PERMIT it: MST2007 -00135 N COMMUNITY DEVELOPMENT 8/28/2007 , ;, D ATE ISSUED: T tGA 'D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 • "'"" '" `` PARCEL: 1S125DC-03500 SITE ADDRESS: 07071 SW BARBARA LN ZONING: R -4.5 SUBDIVISION: THE RAZBERRY PATCH LOT: 028 JURISDICTION: TIG PROJECT: JACKSON Project Description: Addition and interior redo. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD • HEIGHT: FIRST: • 48 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: s/ RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: 0 TOTAL: 48 sf 10.000.00 REAR. PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: NAT • FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 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: : SIGNAUPANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 .amps-1000y: MINOR LABEL: A o 1000 amp/volt : _ V 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: LANDSCAPEJIRRIG: PROTECTIVE SIGNL: 0 GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: ', HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS: tl . This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable SCOTT JACKSON OWNER laws. All work will be done in accordance with approved plans. This 7071 SW BARBARA LN. 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- 977 -9022 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. • Reg #: TOTAL FEES: $ 600.26 REQUIRED ITEMS AND REPORTS - , /�� Is ued By :' ` � � / /�L�� Perm ittee Signature Call 503.639.4175 by 7:00 a.m. for an inspection t - t busi • ss day. . This permit card shall be kept in a conspicuous place on the job sit- ntil ompletion o e oject. Approved plans are required on the job site at the time of ea • - ' • • - • • n. CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007- 00135 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6128!2007 Phone: (503) 639 -4171 �� :A Inspection Requests (24 Hrs.): (503) 639 -4175 .�'. `_.. INSPECTION WORKSHEET FOR DATE: •1 TIME: 7 :01AM PAGE: 50 SITE ADDRESS: 07071 SW BARBARA IN CLASS OF WORK: SUBDIVISION: THE RAZE3ERRY PATCH LOT #: OM TYPE OF USE: PROJECT NAME: • JACKSON DESCRIPTION: Addition and interior redo. OWNER: JACKSON, SCOTT PHONE #: 503 -977 -9022 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/1612007 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 059798-01 , 503-977-9028 N Corrections /Comments /Instructions: r P4f, PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL [❑ CA R INSPECTION ❑ ADDITIONAL FEES ASSESSED r Inspector: Date: W D7 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: try 51 2007 00 1 ;i5 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28/2007 Phone: (503) 639 -4171 1( Inspection Requests (24 Hrs.): (503) 639 -4175 !: ' -... INSPECTION WORKSHEET FOR DATE: 11/16/2007 TIME: 7 :01AM PAGE: 48 SITE ADDRESS: 07071 SW DARI3ARA LN CLASS OF WORK: SUBDIVISION: THE RAZ_t3FRRY PATCH LOT #: 026 TYPE OF USE: PROJECT NAME: JACKSON DESCRIPTION: Addition arid interior redo. OWNER: JACKSON, SCO•1T PHONE #: 503-977-9022 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/1F42007 Pour Time: Code # Inspection Description Confirm # ontact # Message 120 Electrical rough -in 059790 -03 503-977-9028 N Corrections /Comments / Instructions: • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CA FOR.INSPECTION ❑ ADDITIONAL FEES ASSESSED Date: 1 P '�" 07 Phone #: 503 Inspector: ( ) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007- 00135 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28/2007 Phone: (503) 639 - 4171 iC Inspection Requests (24 Hrs.): (503) 639 -4175 "'' � : INSPECTION WORKSHEET FOR DATE: 12/20/2007 TIME: 7;01AM PAGE: 61 SITE ADDRESS: 07071 SW BARBARA LN CLASS OF WORK: SUBDIVISION: THE RAZBERRY PATCH LOT #: 028 TYPE OF USE: PROJECT NAME: JACKSON DESCRIPTION: Addition and interior redo. OWNER: JACKSON, SCOTT PHONE #: 50'S 977 -9022 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 12/2012007 Pour Time: Code # Inspection Description Confirm # Contact # Message 280 Insulation 061879.01 503 - 7802362 N Corrections /Comments/ Instructions: �D � �� PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /2.----�1 -0 — c #: (503) 718- -IA CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007-00135 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28/2007 Phone: (503) 639 -4171 - ''n 1,lyi Inspection Requests (24 Hrs.): (503) 639-4175 "_.. INSPECTION WORKSHEET FOR DATE: 11/16/2007 TIME: 7:01AM PAGE: Q7 SITE ADDRESS: 07071 SW BARBARA IN CLASS OF WORK: SUBDIVISION: THE RAZ PATCH LOT #: 028 TYPE OF USE: PROJECT NAME: JACKSON DESCRIPTION: Addition and interior redo. . OWNER: JACKSON, SCOTT PHONE #: 503977 - 9022 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/16/ 7 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 059798- 603- 977 -9028 N Corrections /Comments / Instructions: 1 ,V1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: I II 1 4 ° Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007-00135 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28,/2(i0'/ Phone: (503) 639 -4171 AnA I C I Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/16/2007 TIME: 7 :01AM PAGE: 49 SITE ADDRESS: 07071 SW BARBARA LW CLASS OF WORK: SUBDIVISION: THE RAZE3ERRY PATCH LOT #: 028 TYPE OF USE: PROJECT NAME: JACKSON DESCRIPTION: Addition and interior redo. OWNER: JACKSON, SCOTT PHONE #: 503 -977 -9022 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/16/20 Pour Time: Code # Inspection Description Confirm # Contact # Message 615 Mechanical rough -in 059798 503. 877 -9028 N Corrections /Comments/ Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1.1P1 Inspector: 1� Da te: f' Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007- 00135 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/ ?8/2007 Phone: (503) 639 -4171 • ' f1l Inspection Requests (24 Hrs.): (503) 639 -4175 „4 INSPECTION WORKSHEET FOR DATE: W28/2007 TIME: 7 :00AM PAGE: 73 SITE ADDRESS: 07071 SW BARBARA LN CLASS OF WORK: SUBDIVISION: THE RAZBERRY PATCH LOT #: 028 TYPE OF USE: PROJECT NAME: JACKSON DESCRIPTION: Addition and interior redo. OWNER: JACKSON, scorr PHONE #: 503- 977 -9022 CONTRACTOR: owNER PHONE #: Inspection Request Scheduled For: Date: 9/780007 Pour Time: . Code # Inspection Description Confirm # Contact # Message 276 Framing 056521 -01 503 - 780 -2362 N Corrections /Comments/ Instructions: / 44/ ----- 1 "s.g ! ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL A CALL FOR INSPECTION El FEES ASSESSED Inspector: Date: 9 28 -- 0 7 Phone #: (503) 718 - ?) ci TY O F TIGARD MASTER PERMIT PERMIT #: MST2007 -00135 COMMUNITY DEVELOPMENT DATE ISSUED: 8/28/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S125DC SITE ADDRESS: 07071 SW BARBARA LN ZONING: R -4.5 SUBDIVISION: THE RAZBERRY PATCH LOT: 028 JURISDICTION: TIG PROJECT: JACKSON Project Description: Addition and interior redo. . BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD • HEIGHT: FIRST: 48 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: 0 TOTAL: 48 sf 10,000.00 REAR: PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: NAT FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 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: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: 0=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA /SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 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: 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 SCOTT JACKSON OWNER laws. All work will be done in accordance with approved plans. This 7071 SW BARBARA LN. 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: 503 977 - 9022 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 600.26 . REQUIRED ITEMS AND REPORTS IS ued By : _ _; I' ... - �jj Permittee Signature • ,/ Call 503.639.4175 by 7:00 a.m. for an inspection t • t busin -ss day. This permit card shall be kept in a conspicuous place on the job sit- ntil ompletion o e oject. Approved plans are required on the job site at the time of ea • - • • - '•n. I Building Permit Appl><c .TALQ j ' FO OFFICE USE ONLY 2 . Received - City of Tigard Date/B : a 3 a 7 i Permit No re. f i7— oQl3J ® 13125 SW Hall Blvd., Tigard, OR 97 ^007 Plan Revie 1 Phone: 503.639.4171 Fax: 503.598. l J — 2 2 L DateB : 1 ti . gJ Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready /By: kris: ® See Attached Checklist for Internet: www.tigard- or.gov CITY O TWA �1 N otified /Method: Supplemental Information CITY OF , O T i\.' 3FORK eJ ' REQUIRED DATA: 1- AND 2- FAMILY,D,WELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all I El ❑ Other: equipment, materials, labor, overhead k and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. wi 000 , e6 2 and 2- family dwelling ❑ Commercial /industrial Valuation: --4— j- ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 777) SDP +1aI24,„l► Li e. New dwelling area: 425 square feet City/State /ZIP: — feaA¢.r s Q 7 =3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: 30.4 �� .x,1701.4 > E Covered porch area: square feet Cross street/directions to job site: IN UL- 11 SAG- Ln4..3 3 Deck area: square feet 2}r �,sar Lab.44Z „'j',.. E ) 4 .•14,-./ Sk)t4y Other structure area: square feet ,S VE TV.P -.7�. C.C;U a� REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: '„ F xc_bi Lot no.: Zej 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 S( %'G 17 c.c., ? l ' QO equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK, work indicated on this application. Valuation: $ 1a., S5/FIS■315)-i Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: , 3T J 5 Type of construction: Address: 7 °7) ss ,, i E t A , 3: ,„, s Occupancy groups: City/State /ZIP: fi ' z:362. 972,23 Existing: Phone: ()77 •9� Fax: (%3 )1-7e - 4 New: APPLICANT ❑ CONTACT PERSON "NOTICE . Business name: • All contractors and subcontractors are required to be Contact name: e.o7-3r t licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 70 7) � jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: 1 "' O � q 7 223 � . J apply: Phone: (►53)9-j Fax: :(„ ) ) 47u'9 - la d /9.,/ E -mail: 5Mj 6.4 "API a pro.Y'GLH }RCVS . cowl CONTRACTOR �` Business name: BUILDING PERMIT FEES* Address: (Please njer to fee schedule) Structural plan review fee (or deposit): City/State /ZIP: - Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): - CCB lic.: Total fees due upon application: A Amount received: 4 /&%.99 j ?I-7 Authorized signatu This permi appl cation expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: � � Date: 7. �C • O� Fee methodology set by Tri-County Building industry Service Board. (:\Building \ Permits \BUP- PermitApp.doc 03 /21/06 440- 4613T(II /02 /COMJWEB) T i T i.e.0ts1 Plumbing Permit Appl . l Received FOR O us oivt v City of Tigard Permit No / �/ /1�7- Be 935 I - n Date /By: 13125 SW Hall Blvd., Tigard, OR 97223 nil/ 0 lu` Plan Review Phone: 503.639.4171 Fax: 503.598.1 (i t' Date /By: Other Permit No.: TIGARD Inspection Line: 503.639 �� D e Ready /By: Juris: 0 See Page 2 for Internet: www.tigard - or.gov n, r Date Supplemental Information ff TYPE 014RICi i e Ignar• FEE'` SCHEDULE ❑ New construction `'a ❑Demolition For special information use checklist. Description I Qty. I Ea. I 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 [i(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: 7c 5w LizakIrklr. Catch basin or area drain 16.60 City/State /ZIP: 1 , 6}: 9 7z .3 Dr leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name tom✓ e ► . c�1 Footing drain (no. linear ft.: _) Page 2 }`�� Manufactured home utilities 110.00 Cross street/directions to job site: o pv 621G ot oblograzax. Manholes 16.60 14:44-4E. '1 ' }- SW 5rii4,1 mac,. /2-0-43 ' Rain drain connector 16.60 Gar '4 -4 _) Sanitary sewer (no. linear ft.: ) Page 2 c•/ Storm sewer (no. linear ft.: _) Page 2 Subdivision: �A�,�.¢,.y L3 „ 4 I Lot no.: -2,5 Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: 1.5 1 24p 1244; S Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 04 fin .1A Backwater valve 16.60 . . YrG J Clothes washer 16.60 - 2 PROPERTY I 16.60 vtJ PROPERTY OWNER I ❑. TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: `�c�� Expansion tank 16.60 Address: 7c 1 9 Fixture/sewer cap 16.60 City/State /ZIP: -r-, t:4 +,A , `�7z2Z3 Floor drain/floor sink/hub 16.60 )417 7.9a (50 ) `{ 7 . Garbage disposal I 16.60 Q • Phone: / Fax: "0' 7 APPLICANT Hose bib 16.60 ❑ CONTACT PERSON Ice maker ( 16.60 Business name: Interceptor /grease trap 16.60 Contact name: `LAS Medical gas (value: $ ) Page 2 Address: 7671 5 W I44ap....v...12-;, L P rimer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 ' CI G 7 Zz Phone: ( 7 • 9oZ 5 (tom- 3)477.39 z Sink/basin/lavatory f Z 16.60 'lj',Zp f Fax: Tub /shower /shower pan 16.60 ') E -mail: Urinal 16.60 CONTRACTOR Water closet 1 16.60 fop. (per Business name: .vI^),E.A Water heater 16.60 Address: Other: City/State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 �3 D D CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) j . 75 State surcharge (8% of permit fee) 4,44 Authorized si e TOTAL PERMIT FEE / /p -39 Print name .0 G .5 Date: 7. .67 This permit application expires if a permit is not obtained within f ii 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I: \Building \Permits \PLM- PermitApp.doc 06/26/06 440- 4616T(10 /02 /COM/WEB) Mechanical Permit Application FOR OFFICE USE ONLY Cl of Tigard DateiBy: Permit No/115 ai) l ° 131 Hall ar dr p$,,t� Date /By: , '' ✓✓ 7 "Z7� 1 r� ! �;5� riB Plan Review Phone: 503.63 Blkic .a '5038 9 Date /By: Other Permit: TIGARD Inspection Line: 503.6 39. 1, -75 . ng o 11-1) A T ,� 3 Date Ready /By: J ® See Page 2 for Internet: www.tigard v Notified /Method: Supplemental Information 100 07. 1nr . TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction g alte t A diti Mechanical permit fees* are based on the value of the work ratio ' re , la ce . 0. rtt� � � rarr,, performed. Indicate the value (rounded to the nearest dollar) of all ID Demolition EROther:4 % .1 r mechanical materials, equipment, labor, overhead, and profit. CAT EGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* P i - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: 77771 s • i (requires site plan showing placement) 14.00 City/State /ZIP: -- 6 ,, Cam, 97223 Furnace 100,000 BTU (ducts /vents) 14.00 • Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: jpb,c104. Gas heat pump 14.00 Cross street/directions to job site: Duct work ( 14.00 14.00 Hydronic hot water system 14.00 114 COL: 'OE '5 4- Q1.1 IZ.$1:4323:1% 1-12.4g 1•-d r'vf3, Residential boiler (radiator or , P l S17( Rte. / SW Ygx Unit heaters ic) 14.00 Unit h (fuel -type, not electric), e..e".1524 - in -wall, in -duct, suspended, etc. 10.00 Flue/vent for any of above 10.00 Subdivision:,z .r Lot no.: 25 Other: 10.00 Tax map /parcel no.: 1S1 2* pc '"017 Other fuel appliances DESCRIPTION OF WORK. Water heater 10.00 yy• Gas fireplace 10.00 V'f`1(. 6 N , y4:413-'t .,P.1y57 fief -t Flue vent for water heater or gas r�G N fireplace 10.00 ' Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 PROPERTY OWNER Chimney/liner /flue/vent 10.00 ❑ TENANT Other: 10.00 Name: Environmental exhaust and ventilation Range hood/other kitchen Address -701 � Sw p -„1�. .� equipment a 10.00 City/State /ZIP: 7 L 7223 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (%"3 )) 7.96L� Fax: (0?) 4-7& . 9 9277 toilet compartments, utility rooms) ( 6.80 (p ./40 tE . APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: , jam cA -1 $5.40 for first four; $1.00 for each additional Address: 7b7) 6v -.E � Z .46 Furnace, etc. Gas heat pump City/State /ZIP: .....r 16Aplti, >OQ 9 ZZ,3 Wall/suspended/unit heater c � 2 /` Water heater Phone: (.6� 1 77 . 9028 F ax:: 7 T7 &'� 2c„ Fireplace E -mail: Range ( V2i4 CONTRACTOR Barbecue . Clothes dryer (gas) Business name: - 1.4 102- Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal , Minimum permit fee ($72.50) 12• • ' Phone: ( ) Fax: ( ) Plan review (25% of permit fee) ' . /3 • CCB lie.: State surcharge (8% of permit fee) 5. "So TOTAL PERMIT FEE .f /3 Authorized si • 'r r - This permit application expires if a permit is not obtained within 180 ��A days after it has been accepted as complete. PrintAggi :I _� _ Date: , I , a Fee methodology set by Tri- County Building Industry Service Board I:\ But \MEC- Permit• pp.do 04/06/06 440 -4617T (I I /02 /COM/WEB) Electrical Permit Ap i c 1'rl(X1.i p �� I� � • FOR OFFICE USE ONLY . • City of Tigard �V l r� 13 Re Date/B ed .7� 111 Permit No , 5 Ov� -7, i , 0 / , - ° 13125 SW Hall Blvd., Tigard, OR 97M7 O y -Inc Plan Review Phone: 503.639.4171 Fax: 503.59$ k0 C, !� Date/13 : Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard- or.gov , c a -�1 tl I Notified/Method: Supplemental Information T OY PLAN: REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction E 'Addition /alteration /replacement ❑ 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 Er 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 -2 ", "I -3 ", Job no.: Job site address: 7077 5%,4 2A� l -aza � 100 or or more residential occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 110.1=42".37 v¢ 197223 ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name:, 3`14 g. ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: RN � uL• • c �^ Description Qty. Fee. Total I • c7�G�. - E]J OA New residential single- or multi - family dwelling unit. , j,, 1 e. Se .p 64 9,, si"Va pift cT Includes attached garage. Subdivision: ►z . -.4 3asrca4 I Lot no.: eg 1,000 sq. ft. or less 145.15 4 Ea. add'1500 sq. ft. or portion 33.40 1 Tax map /parcel no.: 1 A 2.s sok. bG 3tsay, Limited energy, residential . DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 75.00 2 14-141421113416 - 431414i M-4p S .3-404,Aw k iS residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2 Name:- (,� Gy 401 amps to 600 amps 160.60 2 V 601 amps to 1,000 amps 240.60 2 Address: 74 S IE � 2434 t. Over 1,000 amps or volts 454.65 2 City/State /ZIP: "' 4 , . 7 � c,i 1 7ZZ3 Temporary services or feeders installation, alteration, and/or relocation Phone: ('77 .9., . I Fax: (3) 418 .0 ? - p 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, .r exit ange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 - "* B ranch circuits - new, alteration, or extension, per panel Owner sign... - _ Date: 7• •p' A - A. Fee for branch circuits with � 1 AP.' I 0 CONTACT PERSON above service or feeder fee, each branch circuit • 6.65 2 Business name: B. Fee for branch circuits Contact name: S without service or feeder fee / 46.85 2 . . � first branch circuit Each add'l branch circuit 6.65 2 Address: 7a 7( 1 z.,..7:14. Miscellaneous (service or feeder not included) City/State /ZIP: �; Each manufactured or modular / /G..d I 90.90 2 dwelling, service and/or feeder Phone: / ( � 6 y J 7 � 77. G v2,3 Fax: : ( 3) 167e s - „, 2..o Reconnect only 66.85 2 E -mail: / Pump or irrigation circle 53.40 2 . - CONTRACTOR. Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: ff v.,, 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: Li ( o, c s5 Print name: Date: Plan review (25% of permit fee): State surcharge (8% of permit fee): '2 7 S Authorized signs - " sr ''` TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name .....c Date: 724. by days after it has been accepted as complete. s * Number of inspections allowed per permit. I:\Building\Permits\ELC -P - • .. .oc 0 t. 440.4615T(II /05 /COM/WEB Construction Contractors Board Permit #: MSr'a l —001 700 Summer St NE Suite 300 Address: f -,() EA - ',.7.• PO Box 14140 r. =-',',;,';'‘ Salem OR 97309 -5052 ' ' Issued y: Date: U7 y Phone• 503- 378-4621 F t Web Address: www.ccb.state.or.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: RI 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 Fr 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 hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. �► - 7 Alp • f permit applicant) (Date) i, - copy to issuing agency permit file, pink copy to applicant.) J Property_owner.doc 06 -01 -04 Actin as Y. liir' Own General Co tractor? ..... . • INFORMATION NOTICE TO PROPERTY OWNERS • . ABOUT CONSTRUCTION RESPONSIBILITIES . . . . ... 1 s . NOTE: This Information Notice to Property Owners about Construction Responsibilities 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 to an existing structure, you can prevent many problems by being aware of the following responSibilities and concerns. E Ii pli lyer ''' espo I i sibilities 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 taxes from employee wages at 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 purposets-; 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.dor.state.or.us/formsp_ay.htmll 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 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 EIN number, call the IRS at 1-800-829-4933 or visit their web site at.www.irs.gov. 'Cher . esponsibilities an i Areas of Co f , cerns 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 have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Ti. , \ - ,.. ty ,,..;' ,.,,,, ,-,, - - .. .. - - . Time: Make sure you have sufficient time to supervise your employees. . ' f ' 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. I If you have additional questions call the Construction ntractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 06-01-04 ,.,._Aug. 9. 2007-- 11:52AM No. 2549 P. 1 , AUG l REC 1 � • l ']ll 32 • . . • C > . :8 - ..:•p s AUG 2 o 2007 BY— S oir;rrar o fib" foil&. cwsru TfG,�RD Sentsltive Area Pre-Screening Slte Assessment I I 1�(s I Jurisdiction: Property Information: (example 1$234AB01400) Owner information: p Tsxdot ID(s): I S1 2 ^r? V�eJ .... _ . Name: r � _!F }� 2".1 _ Company: Address' 7 2 71 _ ~ 1r Site Address: 7x71 Stn/ �. r_14 .. a ev_izr. 9 - rre , � - '17223 PhonWFax :,n3 /7<f0 / , �h7�3 9°r�o Nearest Cross Street: V -ITV t� C-T— E -mail: / ' vt to pY L G i1 - ��.. covet Develo Activity: Check all that apply Applicant Informatlo Addition to Single Family Residence (rooms, deck, garage) I Name: ' Tr S 1 Lot Line Adjustment ❑ Minor Land Partition ❑ Company: Residential Condominium ❑ Commercial Condominium ❑ Address: 7o71 ►5 f +41‹ Residential Subdivision ❑ Commercial Subdivision ❑ - •,.. F Single Lot Commercial ❑ Multi Lot Commercial ❑ Phone /Fax: " -` e4.$ -, l ', • 47B •1..72 • Other -. -- . . - Email: ,Srit jchc}r ), cp pr +avr 11 I. - e Will the project Involve any off-site work: YES ❑ NO M Unknown ❑ Location and description of off site Work Additional comments or information that may be needed to understand your project: ' This application does NOT replace the need for Grading and Erosion Control Parmtie, Connection Permits, Building Permits, Site Development Permits. DEQ 1200 -C Permit or other permits as Issued by the Department of Environmental Ouellty, Department of State Land* and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable )oca1, state, and federal law_ fly slpning this form, the Owner OrOvmer'o authorized agent or representative, acknowledges and agrees (hat employees of Clean Water services have authority to enter the project silo at all reasonable times for the purpose of inspecting project she Condluont and gathering information related to the project slle. I certify that lam familiar with the information contained in MIS document, and to the best of my knowledge and belief, this infomrattan is true, complete, and eoarrate- PrinUType Name: . 4irniliaA .. Print/iype Title: Signature:! _ Date: 12.7 FOR DISTRICT USE ONLY 1 Se salve areas po - (tally exist on site or within 200' of the site. TH APPLICANT UST PERFORM A SI ASSES M ENT • a : ID - e - VICE P - .! a .: LETTER if Sensitive Areas exist on the site or within 200 feel on adja *"s, a attire! Resources Assessment Repoli may also be required. ❑ Based on review of lh submitted materials and best available information Sensitive areas do riot appear to exist On site or within 200' of e site Thle Sensitive Area Pre - Screening Site Assessment does NOT. eliminate the need to evaluate and protect water q sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained end _ completed under applicable local, State, and federal law. , _ RI Based on review of the submitted materials and best avallable Information the above referenced projectwlll not significantly impact the existing or potentially sensitive area(s) found near the site. This Sensitive Area Pre-Screening Site Assessment . does ISM eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and Federal law. ❑ This Service Provider Letter Is not valid unless . CWS approved site plan(s) are attached. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/0/95 ORS 92.040(2). NO SITE ASSESSMENT 0R EERViCE PI�,OVIDER LETTER IS REQUIRED. - Reviewed By: . 1.�f. ,--( ` : — --- -- Date: 2560 SW H019bora Highway • Hillsboro, rragan 97123 • Phone: (803) 081$100 • Fax: (503)661-443e • }w,9y,Steanwalerscrvicer.ora • Fq. Revkad. May a 2007 • • _iii Z00 /LOO'd OILS 60:56 LOOZ /£0/80 0266 8Lib E09 gnna + zq><Mo )Iaad :woJA 5.