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Permit II a CITY OF TIV ^® • MASTER PERMIT COMMUNITY DEVELOPMENT PERMIT #: MST2008 - 00086 DATE ISSUED: 6/12/2008 TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 103DA - 04100 SITE ADDRESS: 13365 SW 107TH AVE ZONING: R -3.5 SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: LASATER Project Description: 526 sq. ft. detached garage and (2) branch circuits. Transferred from MST2007- 00112. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: HEIGHT: FIRST: at BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: DWELLING UNITS: THIRD: 51 RIGHT: VALUE: OCCUPANCY GRP: BDRM: BATH: TOTAL: 0 sf 19,641.00 REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 2 TRAPS' LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 0 CATCH BASINS: TUB /SHOWERS:. GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ' ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD•L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: 2 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/0 SVC /FDR: 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 /FOR: 601 - 1000 amp: 601•amps- 1000v: MINOR LABEL: 0 1000. amp/volt : O PLAN REVIEW SECTION \ww�C Reconnect only: I) > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY O A. SF RESIDENTIAL • B. COMMERCIAL CO AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO E. STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: ai BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: SN GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL a 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 KARL LASATER OWNER laws. All work will be done in accordance with approved plans. This 136 NW 107TH AVE permit will expire if work is not started within 180 days of issuance, or PORTLAND, OR 97229 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- 314 -0652 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Reg #: TOTAL FEES: $ 715.75 REQUIRED ITEMS AND REPORTS I / Issued B �/-�, / /_ /`_ / ��; ► Pe m t ee S ignature : o r� r � Call 503. • • . • 1- 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 �i Residential n CEO YD FOR OFFICE USE ONLY City Tigard of Ti and I� Received DateB • AY0 1,111 Permit No.:, ' ° —( �+ , , ,i • q 13125 SW Hall Blvd., Tigard, OR 97223 ,\ \� 1 ! � �oo$ Plan Review . Phone: 503.639.4171 Fax: 503.598.1960 ' RD Date/By: Other Permit: T I G A R D Inspection Line: 503.639 all O wt Date Ready/By: 0 See Page Z for Internet: www.tigard - or.gov CITY N � � 1)IV % S% 1`� Notified/Method: Supplemental Information 1 Dk Sf TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING P�Vew 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. ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ / �(J Pr Number of bedrooms: E Accessory building ❑ Multi - family / ❑ Master builder ❑ Other: Number of bathrooms: A//� JOB SITE INFORMATION AND LOCATION Total number of floors: // Job site address: I 3 3 ( 5 3 W / U 7 Tti A4/6 New dwelling area: 5- 6 square feet City/State /ZIP: r j 6e9'0 012_ q•71)-3 Garage /carport area: 5-a to square feet Suite/bldg. /apt. no.: Project name: LA sarne G Covered porch area: N /4, square feet Cross street/directions to job site: Deck area: f //q' square feet vl Ct W To 1 vreS T -1'v l.33 1: - Other structure area: 4//4 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. 5 sQ PT - CGl2 &a'Z46 &� Valuation: S Existing building area: square feet New building area: square feet C 1 OWNER ❑ TENANT Number of stories: Name: /69,e6 LAjq - T6s72 Type of construction: Address: / 33 63- 3 w /d 7 Occupancy groups: City /State /ZIP: 77 G,*'i1%' Q IC 17) Existing: Phone: (533 ) 3/y 04495 Fax: ( ) New: [APPLICANT ❑ CONTACT PERSON NOTICE Business name: 04/it/e92 All contractors and subcontractors are required to be Contact name: //�� L �f � licensed with the Oregon Construction Contractors Board (� rT -`7 under ORS 701 and may be required to be licensed in the Address: / 3 3 c f se,/ /CS 7 Z 4 - jurisdiction in which work is being performed. If the City /State /ZIP: 77 6 l re ale ' 2 )-)- 3 applicant is exempt from licensing, the following reasons apply: Phone: (5 3) 3 /c( Q(o r) - Fax:: ( ) E -mail: k 6, 4A C. (& 4/L-s CONTRACTOR Business name: ) w BUILDING PERMIT FEES* Address: ' 33 (pS S w /G7 ve (Please refer to fee schedule) ty r O O y y Structural plan review fee (or deposit): C ,� 6 3 q City/State/ZIP: Phone: v3 ) /9 G ( S')- Fax: ( ) FLS plan review fee (if applicable): __--- CCB lic.: Total fees due upon application: fe 7 t 3 (� Amount received: ( 6 / r 3 / Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Ica et, LA Sq J7. Date: _ ()- - D �0 * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(1 l /02 /COM/WEB) Building Permit Application Checklist ,. a One- and Two-Family Dwelling FOR OFFICE USE ONLY ITI City of Tigard Received Permit No.; Date/By: • 13125 SW Hall Blvd., Tigard, OR 9 7223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 TIGARD 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 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 applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 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 required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ 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- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. AR-121 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 . s , licable to the . ro'ect under review. JURISDICTIONAL SPECIFICS 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) Electrical Permit Application FOR OFFICE USE ONLY City of Tigard � P Elate/By: /� /vr `7 Permit No.: / 15eti 7 — i1 WE —/'c !� I L` , i 11 OP 13125 SW Hall Blvd., Tigard, OR 97223 %% Plan Review ( , ! �wlJo I Q Phone: 503.639.4171 Fax: 503.598.1960 � D eBy: Other Permit: T l K D Inspection Line: 503.639.4175 ,\ 1 Rudy /By: Juris. B See Page 2 for Internet: www.tigard- or.gov \ \�\` ,_.,(' . "ot d/Method: Supplemental Information TYPE OF WORK �, \'- PLAN REVIEW lew construction ❑ Addition /alteration /replace \c>.) Please check all that apply (submit 2 sets of plans w /items checked below): S!)\ ❑ Service or feeder 400 amps or more ID Building over three stones. ❑ 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 ccessory 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 ", "I -2 ", "l -3 ", Job no.: Job site address: ( 3 3 G S S w / a 7 Ti 100HP or more. occupancy. ❑ ( / 0 Six or more residential units. Recreational vehicle parks. City/State /ZIP: 17 6 072,a q j y ❑ Health -care facilities. ❑ Supply voltage for more than `�r ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: L4f o17s!L G 4 65" ❑ Service or feeder 600 amps or more. FEE SCHEDULE ^, Cross street/directions to job site: "l 1(„/ 7 bl -/Ll/ tA veyrro /4t7l Description I Qty. I Fee. I Total 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 DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family „ 2 13 /VC I G / i e & c am / / T 70 6/ Abe residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation �� 200 amps or less 80.30 2 l� r4OPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: /Z,e, O L fq,7 L 401 amps to 600 amps 160.60 2 -. 601 amps to 1,000 amps 240.60 2 Address: /3 S^ 4,/ / 7 /y -G.tr"" Over 1,000 amps or volts 454.65 2 City /State /ZIP: 976 ,a c;2 9 2 )--)- 3 Temporary services or feeders installation, alteration, and/or relocation Phone: ( $7)) 3/Y ,M .$—).--- 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 r t, or xch nge, according to ORS 447, 449, 670, and 01. 401 amps to 599 amps 133.75 2 Owner signature: Date: / OP (� Branch circuits - new, alteration, or extension, per panel Gi / A. Fee for branch circuits with E APPLICANT ( ❑ CONTACT PE ON above service or feeder fee, ) 6.65 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, Contact name: /L f � ie first branch circuit 46.85 2 Address: to � J . � � J ) / AT . 2 r� ~-- Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: 7/G ~ a /2 9 2 yy 3 Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: (, 7 ) 3/ YG ,f>- Fax: : ( ) Reconnect only 66.85 2 E -mail: /L C/,/iW,C (/&s3Z2vy . 4,--&—r- Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: Q'(� /rt/L� Signal panel, e r t limited- o or energy panel, alteration, or Address: / 3 60 , - j -- 4 ,, / /p extension. Describe: Page 2 2 City/State /ZIP: 776A/ea O 1 2 y3-- 3 Each additional inspection over allowable in any of the above � n Per inspection 62.50 Phone: ( °i ) 3/ Y Covr)— 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: Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: " �f y� D a t e: /_ This permit application expires if a permit is not obtained within 180 f /l y CD /�� /Q 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(11/05 /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 ❑ Garage Door Opener* ❑ Healing, 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 n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ 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 Plumbing Permit Application Building Fixtures 0 FOR OFFICE USE ONLY City of Tigard Received n �^� 11377 ,�� /� oo� DateBy: /� l�fd PermitN /��K� /�/r��a BYO • 13125 SW Hall Blvd., Tigard, OR 9 .= ry� Plan Review %/ ■ Phone: 503.639.4171 Fax: 503.59: ?t• .0 ` \ww\\ N. ��0 C�ateBy: Other Permit No.: Inspection Line: 503.639.4175 v\v G Date Ready/By: orris Ill Page 2 for Internet: www.tigard-or.gov See Pa T I G A R D ard -or. ov J t�� y y g g g � C C} � y 0 ' Notified/Method: Supplemental Information l TYPE OF WORK � � � , 1 .. ) . ‘, FEE* SCHEDULE Er ew construction ❑ Demok -4: ' 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 (I) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 IDAccessory 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: l 3 3 („, v , S w / p 7 An/e Catch basin or area drain 16.60 City/State /ZIP: 77 & Qie T 7 Z y .3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: 6,g404,� Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: �/J Manholes 16.60 T g U� 77> / /Pf1 lr 7a l c 2 � 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 tZ 4 (/_/ 0 12-4-/A/ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 [a- PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: (G4 - /Z4 L / i J-g.77y` Expansion tank 16.60 ca--- ,(" Address: /3 3 G t� (O' , - Fixture /sewer cap 16.60 City /State /ZIP: 77 ,(9.--/Z/f' ave 1'7 _.1.1 3 Floor drain/floor sink/hub 16.60 Phone: (5(,) ) 3 / t.( 6,5 Fax: ( ) Garbage disposal 16.60 APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: s,? C Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: 0 („../rfje7Z,. Water heater 16.60 Address: Other: City/State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) 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 ` G ��? �� ` 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\Building\Permits\PLMF- PermitApp.doc 12 /27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum 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 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial 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 OAR918- 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" -4 „ 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: i:\ Building \Permits\PLM- PermitAPP.doc 12/27/06 • Information Notice to Property Owners About Construction Responsibilities Statement Oregon Law 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. [ORS 701.055 (4)] 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. Please check the appropriate box and complete the following statement: I own, reside in, or will reside in the completed structure and my general contractor is: pW /2-.4-?Z 6.4 Name CCB# Expiration Date I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I I will be performing work on property I own, a residence that I reside in or a residence that I will reside in. 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 have read and understand the Information Notice to Property Owners about Construction Responsibilities contained on these two pages and I hereby certify that the information checked and completed above is correct and accurate. Print name of ermit applicant Si nature of e it applicant 0 /0 P g P PP Date Permit #: /� a�cX This form is supplied to building � permit offices by the Oregon Address: � � � Sw �U ' Construction Contractors Board �F :�a�'�� —� as required by ORS 701.055 (6) �� c �� Issued by: Date: AZIOCh— This copy to issuing permit office , . , r , , 6\)5))..).6. . ... - ' : ,•:� y 0 IA* r` c � S - \.,. S\...j , 4-\ g '? t -, x, < 0 I..: _ ' A� ` PROVED T I 1 � i • A 4 ,p 1 � i �� U ' N CV k ,I ,,,,:\\ S-,_:N 1 . • I oz, 1 I i , ,.. .. i . i I \ \ \N:. \ \, \ NI-,., 1 z ,..t.' 4 i,,,:\ - \ N" -\:-,,,,s1 i 1 C w 4 Y \ mot `? ar 4 `- S 3 , J n • '� \i \\ - •i y rn I - '- a. \\ �, z • CI 1 1� s• `f 1 ! __ tV = • ,.• \ \ \\ 1r - ` T #GARD -SI :SD:: P R WIt W , c o l CITY O F Q ., \ \ \ • \ R BUILDI PERMIT NO: �� r �� - 6 z/ 6z: w \ ` \ .. . �.: -r i G''AtPP� OD� ^ A pprov ed �� N \ \ \ 3-` Not \ \ `'� ‘• .� � A• � , :" = ' \Jr- '•' Street Trees: od ❑Not A pproved • • \ �� ' ., � i Protected Trees: APPr ate: ` \ - -- ._.__ Notes: I I — ., ✓� _ 1'Y OF TIGARD • ITG PLAti REVIEW 1 Ci 1 i BUILDING PERMIT NO.: r ^q . 'M aOCSt - 00 1 l . ■ ' PLANNING DIVISION: Required .Seth ,cks: g Approved - ❑ Not Approved Sid ' Str et Side: L� . , -` _. '� $ 1: . t ' �i ` . w.. �� F .. ��. �-� I y ;� �a0rc � Garage: Rehr: 1_...C.._ i \ r — -- ... � _� - �~ r Visual' tearance: ❑ Approved ❑ Not Approved " r 1 I �� SW 101 TH lk\ �ax r. B;. Height feet s .,� L...,/ mot . :. . .: ..., t 77C' `' Frarvider Letter Required: ❑ Yes % tio, 9 , C .1 l eceived 1 1 i I : - 'l- 7,7, .... ti t L.- r '4� ; f...J )r,"?f=~"R. ) L1 ..,y..I'.;i 1 77V Date: I l �� l 7 7 . j j ' i ; b!NGITNNEERIN9 DEPARTMENT: ` V3 s Accui:: -lope: % Approved ❑ Not Approved , i .. ' Site Pi L k__ ,J Approved ❑ of pproved `& *4 By: Date: i( Q G 7 _ Notes: . OFFICE COPY CITY OF TIGARD BUILDING DIVISION PERMIT # : STcyr -o0086 _ Ato 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/12P008 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' 1 INSPECTION WORKSHEET FOR DATE: 10/31/2008 TIME: 7:00AM PAGE: 14 SITE ADDRESS: 13365 SW 107TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: I ASATEIR DESCRIPTION: 626 s< . R. detached garage and (2) branch circuits ;. Transferred from MST2007•00112. OWNER: LA SAT ER, KARL. PHONE #: 503 -314 -0652 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10131/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 236 Shear walls/ anchors 077480-01 503.314 -0652 N Corrections /Comments/ Instructions: Age f S h/ 6 / 4-6 /4 - SS ❑ PARTIAL APPROVAL El CANCEL El NO ACCESS I I FAIL , CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 0 1/ a r . Inspector: Date: / � Phone #: (503) 718- 74 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST 2008-00086 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6112/2008 Phone: (503) 639 -4171 . A Inspection Requests (24 Hrs.): (503) 639 -4175 . � ' -_ INSPECTION WORKSHEET FOR DATE: 10/31/2008 TIME: 7:OOAM PAGE: 13 SITE ADDRESS: 13365 SW 107TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: LASATER DESCRIPTION: 526 sq. ft, detached garage and (2) branch circuit. Transferred from MST2007- 00112. OWNER: LASATER, KARL PHONE #: 503-3140652 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/31/2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 07748(102 503-314 -0652 N Corrections /Comments /Instructions: • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED hh L ` Inspector: Dater U V Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION - PERMIT #: MST2000.000B6 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 611212008 Phone: (503) 639 -4171.. ,,11� �'�1 Inspection Requests (24 Hrs.): (503) 639 -4175 ..'._!i F.- INSPECTION WORKSHEET FOR DATE: 9/8/2008 TIME: 7:OOAM PAGE: 13 SITE ADDRESS: 13365 SW 107TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: LASATER DESCRIPTION: 526 sq. ft. detached garage and (2) branch circuits. Transferred from MST2007- 00112. OWNER: LASATER, KARL PHONE #: 503-314 -0652 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/8/2008 Pour Time: 2:00 Code # Inspection Description Confirm # Contact # Message 210 Foundation walls 07520402 5033140652 N Corrections/Comments/Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL 7 NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I A .--- Inspector: , Date: 9 j - x --.02 Phone #: (503) 718 - x, -'' 4 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2008 -000B6 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/12/2008 Phone: (503) 639 - 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 �': "'' — INSPECTION WORKSHEET FOR DATE: 9/8/200l TIME: 7:00AM PAGE: 14 SITE ADDRESS: 133& SW 107TH AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: LASATER DESCRIPTION: 626 sq. ft. detached garage and (2) branch circuits_ Transferred from MST2007 00112. OWNER: LASATER, KARL PHONE #: 503 314 - 0662 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/8/2008 Pour Time: 2:00 Code # Inspection Description Confirm # Contact # Message :?05 Footing 075204-01 603- 314 -0662 N C orrections /Comments/ Instructions: O► = - ASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS ❑ FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ..1 IME Date: 9---- -o & Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #: MST ZOO/ . 00% 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 .p'I INSPECTION WORKSHEET FOR DATE: Lit I 2 TIME: PAGE: SITE ADDRESS: CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 41 24 161 Pour Time: Code # Inspection Description Confirm # Contact # Message iqq COA sL 2 , q q FINN A L B 1 t_� , ` t( Corrections /Comments /Instructions: A PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 6 • N Uv Date: 24 0 Q Phone #: (503) 718- 1It4