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Permit MASTER PERMIT ' + q CITY OF TI;ARD — COMMUNITY DEVtLOPMENT PERMIT #: MST2008 -00137 DATE ISSUED: 9/4!2008 I 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104AD -03101 SITE ADDRESS: 12976 SW WALNUT ST ZONING: R - 4.5 SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: LAYTON Project Description: Utility room addition, 66 sq ft, within existing garage. Mechanical other: ductwork. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: 8 FIRST: 66 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: sr GARAGE: si FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5 VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 66 sr 6,390.78 REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: • SEWER LINES: SF RAIN DRAINS: 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: 1 FURN >=100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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: W/SVC OR FOR: PUMP /IRRIGATION: PER INSPECTION: wpb EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: V , 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: 5 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: ,0 > =4 RES UNITS: SVC /FOR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY 6 A. SF RESIDENTIAL B. COMMERCIAL AUDIO B STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: CA GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAJTELE 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 ELIZABETH LAYTON GIGS CONSTRUCTION laws. All work will be done in accordance with approved plans. This 12976 SW WALNUT 17 NW HARTLEY AVE permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 GRESHAM, OR 97030 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 -590 -0236 Contact #: PRI 503 -888 -4409 questions to OUNC by calling 503.246.6699 or 1.800.332.2344. FAX 503 -328 -9886 Reg #: LIC 178076 TOTAL FEES: $ 428.79 REQUIRED ITEMS AND REPORTS I i I sued By : /� ./ Permittee Signature s4 flor vI Call 503.639.4175 by 7:00 a.m. for an inspection that business da , This permit card shall be kept in a conspicuous place on the job site until co m�►eiien TI project. Approved plans are required on the job site at the time of each inspection. Buildingjermit Application Residential :; r �;, � .: ,� oio ` t � FOR OFFICE: USE O NL A ' d�% ` " ^ r " Received f /fr ilk\ i Ci of Tigard (� Permit No.: y f j , I 13125 SW Hall Blvd., Tigard, OR 97223 � , .. Plan Review ^7 ' '' ; 11 Phone: 503.639.4171 Fax: 503.5 . t. \ Date/By: L` ` i',Se g Other Permit: / 'llE / cI �, '' Inspection Line: 503.639.417 i t [„. y Date Ready /By: Ju■ns 61 See P 2 for 1GnRl� N'.-::4-1- Internet: www.tigard- or.gov C \l Notified/Method: Supplemental Information t' P TYPE O W 41; 1 0 , . REQUIRED DATA: 1- AND 2- FAMILY DWELLING.' ❑ New construction r 4 � ' 'lam- Permit fees* are based on the value of the work performed. I T i �� Indicate the value (rounded to the nearest dollar) of all PI Addition/alteration/replacement �t equipment, materials, labor, overhead. and the profit for the . CATEGORY. OF CONSTRUCTION work indicated on this application. f ❑ 1 -and 2- family dwelling ❑ Commercial /industrial Valuation: $ �j 3 f d] 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: / 2, J 7 6 svu oLfol h (A 4- 5 r New dwelling area: ‘ (7 square feet City /State /ZIP: 77 644 iiz b O k 7- 2 3 3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL- USE -. 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 ` work indicated on this application. ' � DESCRIPTION OF WORK. _ PP Valuation: $ Existing building area: square feet New building area: square feet PROPERTY. :OWN NT ER /d ; . - • ❑ • TENANT ' Number of stories: C Name: L f 2 A ,S 5 T V ' 7,1 / TON • Type of construction: Address: (2, 91_6 S W OU el L NUT S T Occupancy groups: City /State /ZIP: 77 6 P3 k. 6 0 e 7 7 2 3 3 Existing: 9 2 g� Phone: (503 v / 00 3 � Fax: ( ) New: ❑ APPLICANT. ❑, CONTACT PERSON_ II NOTICE . Business name: 4_1 G . 5 Co n, {'t/ 1.1 C j1 O 0 All contractors and subcontractors are required to be Contact name: ' O N N e U L ft licensed with the Oregon Construction Contractors Board _ under ORS 701 and may be required to be licensed in the Address: / Ai V/ 44 A g l 4.. C Y A v-e _ jurisdiction in which work is being performed. If the City /State /ZIP: L j Q 6 S a i1 p..( o A ct .1' 0 3 0 applicant is exempt from licensing, the following reasons �p PP Y: Phone:( eV '8 i ( Fax::( .3g 9 9O o g6 E -mail: CONTRACTOR Business name: 6T , s , . C 9/ lJ S T /\ OCT( O ✓ BUILDING PERMIT FEES* Address: / / 0 \x „, 1 :4 i t r L L y V C ^ . review fee (or d schedule) .. y 6 i E S I`'l 04. 9'70.3C Structural plan review fee (or deposit): City/State/ZIP: Phone: () Q g 4 e 0 g ax: 5- 3 t! 8 ( 8 tp 6 FLS plan review fee (if applicable): CCB lic.: / ,) © 16 ?//3 g Total fees due upon application: r ! Amount received: Authorized signature: _ This permit application expires if a permit is not obtained � within 180 days after it has been accepted as complete. Print name: 7 Y p y �/ /� j►t. -.� � ` ",�{ Date: `7 0 � *Fee methodology set by Tri- County Building Industry J L/ - , AJ e c, L A Servicear . 1: \Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02 /COM/WEB) Building Permit Application Checklist ' One- and Two - Family Dwelling ?i r.� . dy FOR yOFFICE�USEON City of Tigard Received Permit No.: 11 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: C Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 0 Electrical ❑Plumbing 0 Mechanical ;'1' 16A ` RIB Internet: www.tigard - or.gov ❑ Other: %4.1 ;THE EOELOWING, IT EMS <A'R U,IRED„FOR ,REVIEW AY E >; y • ^,Yes No,v N /� 1 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. ❑ 0 ❑ 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. ❑ ❑ ❑ 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 Ore•on and shall be shown to be a..licable to the •roject under review. t �; I U RISDIC ' l IONAL S PECIFIE S' . _ _ .. ' `_: , „ _ .. .. �t � lc 23 Three (3) 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 must include 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. 1:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11 /02 /COM/WE13) Plumbing Permit Application Building Fixtures f s „ � . : af,- r'• *' { t t 1 ;_ ,' a '` � FOR OFFICE USE ONLY 3 u + f City of Tigard 5 Permit No.: z OO / 1. 13125 SW Hall Bd., Tigard, OR 97223 `c 7 Date/By: ! / G Phone: 503.639.4171 Fax: 503.598.1961 1 Other Permit No.: Inspection Line: 503.639.4175 a Re T 1 C A D A � Date Ready/Hy: luris: ® See Page 2 for Internet: www.tigard - or.gov r . C p - . r Notif d/Method: Supplemental information .. TYPE' OF WORK - ..4iG , CHE FEE* SDULE • ❑ New construction ❑ Demolititlii►\1 0 ��v 1` For special information use checklist `"t�� Ty `4 � Description Qty. 1 Ea. 1 Total ��, Addition/alteration/replacement 0 Other: 1 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: DL ( 7 6 S w a) _ e„ u iL S r Catch basin or area drain 16.60 City /State /ZIP: -1,-' Q Y Q1 1 . tf ? 2 3 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: J Project name: 1 Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: _) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK - Backflow preventer Page 2 Backwater valve 16.60 Clothes washer I 16.60 Dishwasher 16.60 Drinking fountain 16.60 _ PROPERTY .OWNER l ' ❑ TENANT ' Ejectors /sump 16.60 Name: ( j? A 6 T Fj L I ^oN Expansion tank 16.60 Address: / 2 9 7 t N Woe t (ALA 4- 3 1 Fixture /sewer cap 16.60 City /State /ZIP: p. r01 ©e y 2 33 Floor drain/floor sink/hub 16.60 Phone: ( ) r V 1 Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 . ❑ APPLICA . ❑ ' CONTACT . PERSON ` . f Ice maker 16.60 Business name: �' 6 . S ( v. Wri--te Interceptor /grease trap 16.60 Contact name: T O&I iiv (:^i c _ C 6k Medical gas (value: $ ) Page 2 Address: / Z N ti /-p&)( 11--U 2= Primer 16.60 City /State /ZIP: /, k 5 , 4 -- i 4 e9 R. ci. - 0 3 0 Roof drain (commercial) 16.60 � ` Sink/basin/lavatory 16.60 Phone: (5O eo v 7 t r. e r ) Fax:: b3 1 8 g �� Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Water heater 16.60 • Address: ((( "` "' 1 / E. Other: City /State /ZIP: 060 Subtotal Minimum permit fee: $72.50 ,- Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7Z.tC CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) + State surcharge (12% of permit fee) R 7:5 Authorized signature: TOTAL PERMIT FEE e , ,.' Print name: 1 be('k LQ yi Date: ci (,t U I... 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. 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 - 1s 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 Storm &Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to 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: is\ Building \Permits\PLM- PermitApp.doc 12/27/06 Electrical Permit Application , . �' FOR OFFICE U SE ONLY)g , K :14�� t r � t ' �.. a '#*,St� 4 n 1 ..ter ' IN City of Tigard ; - a r . .. it` v i,: , .. ;.--, + v, lai Date/By: Y Received Permit No. 1 1K 8 ,...00 ! 3 q 13125 SW Hall Bl vd., Tigard, O''' .'"! � Re :ceiv n Review - C Phone: 503.639.4171 Fax: 503. ti '4! % s 1 C-Q � • By Other Permit: .[f I . GA R D Inspect Line: 503.639.4175 Cj ® � �\\?� c afe Ready /By: Juris ® See Page 2 for "'!"•" Internet: www.tigard- or.gov �\ � ` Notified/Method: Supplemental Information - TYPE OF WORK ����� • PLAN REVIEW ❑ New construction ❑ Addition /alterationcy 'IA ent 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. . 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 ", "I- 2 ", "I -3 ", Job no.: Job site address: ! , CC 76 $ W aJOf (c4 �, -C r 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: r 0 A 9 1 , 3 3 0 Health-care facilities. 0 Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty I 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 Ea. add'I 500 sq. ft or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK . " (with above sq. 0.) Limited energy, multi - family 75.00 2 residential (with above sq. 0.) Services or feeders installation, alteration, and/or relocation 11 200 amps or less 80.30 2 di PROPERTY. OWNER 'n ❑. TENANT 201 amps to 400 amps 106.85 2 Name: ez. 1 2 Ai H (. !4- y TOA) 401 amps to 600 amps 160.60 2 _ 601 amps to 1,000 amps 240.60 2 Address: i 2 ` ' ' 9 7- 6 S 0/ of eA _ i- S ( Over 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or ry �[�Citl1` �� 3 relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that 1 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 4 caner signature: Date: 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 ��j 2 Q eo IJ FC LA P ee, first branch circuit -- Address: i 7J W 1 -1. PTG r- V if ve Each add'I branch circuit 6.65 (p7 2 Miscellaneous (service or feeder not included) City /State /ZIP: a Q G s p o Q Q 7- 0 3 Q Each manufactured or modular 90.90 2 j 6 9 4 0 9 (5 2 `� g r s7 p 6, Reconnect onl and/or feeder Phone: (�� ) 7 Fax: J 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: I •J r 1 �, 1 (./ energy panel, alteration, or Address: 060 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 Sup - an signature, retitr reds Subtotal: 6-3 .5-0 c i ,tint name: �� Date: l U ; Plan review (25% of permit fee): I v l! State surcharge (12 /o of permit fee): �j , 'y 1� r `thorized signature: 4 rr �iE "- ` ' TOTAL PERMIT FEE: .C -1, C t This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. Building \Permits\ELC- PermitApp. 05/23/06 440- 4615T(I I /05 /COWWEB Electrical Permit Application - City of Tigard Page - - 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORKONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: 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 ❑ Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls n Outdoor Landscape Lighting* n 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 Mechanical Permit Application :' s , FORioFIaCIALSEZo v * .: City of Received Date/By: o Permit No.: � 2 (z r70 ( `J f Ti b and i� ° 13125 SW Hall Blvd., Tigard, OR tom' 1— � — cElvED Plan Review O C Phone: 503.639.4171 Fax: 503. "8. ' .:. Date/By: Other Permit: "P l" "=- Ins ection Line: 503.639.4175 ®See Pa e 2 for "I�ICARL� P D a t e R ea d y /B y: Jails: B - i r .loan Internet: www.tigard or.gov ��(( S E P — 4.(;:::i (ce Notified/Method: Supplemental Information TYPE oF( �tl i) F 1 (WARD COMMERCIAL FEE* 'SCHEDULE -. USE CHECKLIST ❑ New construction ❑ Addition I�N� MMNIUN Mechanical permit fees* are based on the value of the work 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 For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION • Heating/cooling Job site address: Air conditioning or heat pump � S W W aC� j� (/t Si — (requires site plan showing placement) 14.00 City /State /ZIP: -,--, Q f OR or I. 2 3 3 Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: 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 Gas fireplace 10.00 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 L ,^ ^ Other: 10.00 Name: _cc ( . . I A � T 1 I L i`1 )' t O / v Environmental exhaust and ventilation Range hood/other kitchen Address: / Z 1 p 7_ 6 S CV Up q AI 114 St equipment 10.00 City /State /ZIP: T7 ally 0 i Of OR Q -7 2, 3 `3 Clothes dryer exhaust 10.00 / Single -duct exhaust (bathrooms, Phone: (ST)3) s9 Us0 Q 2 36 Fax: ( ) toilet compartments, utility rooms) 6.80 . ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: ) 6 . _J._ - 6 . �O 0 s ru C' ©A Fuel piping Contact name: c 4 1--1‘24- $5.40 for first four; 51.00 for each additional Address: N 44 sz IC_ > y r9- j c Furnace, etc. Gas heat pump City /State /ZIP: 6 � (� s /4 /4 l i t 0£ . 0(9- 03 Q Wall/suspended/unit heater Phone: ($03) 8g8 `� 6, 0 Fa x::( 5-03 328 9 (, g Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: G , j- 6 (QH 5 lyi u C � r m ^ Clothes dryer (gas) `, t n / / r Other: Address: r N w /A e TL Y /9 V MECHANICAL PERMIT FEES* City /State /ZIP: a , �s4y /4f'-( 0 R 9- � 0 340 Subtotal Phone: ) ( 6E5 etc( 0 Fax: ) ( 5' 2 0 /' g / Minimum permit fee ($72.50) — (2,C.) (O Plan review (25% of permit fee) CCB lic.: Q C.. O 6 - State surcharge (12% of permit fee) ` , 7(0 TOTAL PERMIT FEE 1 et .20 This permit application expires if a permit is not obtained within 180 Authorized signature: ' = days after it has been accepted as complete. Print name: OA] , � . �� D ate: 7 / - Q , ' Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp.doc 01 /19/07 440 -4617T (1I /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 $1 0,000.00 $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 'u a CITY O ���� ® _ MASTER PERMIT COMMUNITY DEVeLOPMENT PERMIT #: MST2008 DATE ISSUED: 9/4/2008 ',IGA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2 S 104A D - 03101 SITE ADDRESS: 12976 SW WALNUT ST ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: LAYTON • Project Description: Utility room addition, 66 sq ft, within existing garage. Mechanical other: ductwork. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT - HEIGHT: 8 FIRST: 6 S r BASEMENT: sf LEFT: _., 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: . THIRD: sl RIGHT: 5 VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 66 sf 6,390,78 REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: - SEWER LINES: SF RAIN DRAINS: 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: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 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: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: 3 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 O Reconnect only: w > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: • ELECTRICAL • RESTRICTED ENERGY t A, SF RESIDENTIAL B. COMMERCIAL 0 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: DATA/TELE COMM: NURSE CALLS: TOTAL fl 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 ELIZABETH LAYTON GIGS CONSTRUCTION laws. AS work will be done in accordance with approved plans. This 12976 SW WALNUT 17 NW HARTLEY AVE permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97223 GRESHAM, OR 97030 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 -590 -0236 Contact #: PRI 503- 888 -4409 questions to OUNC by calling 503.246.6699 or 1.800.332.2344. FAX 503 -328 -9886 Reg #: LIC 178076 TOTAL FEES: $ 428.79 • REQUIRED ITEMS AND REPORTS (/---------(___--- ■ • I sued By :1 .. P ermittee Signature � , _ i ` r Call 503.639.4175 by 7:00 a.m. for an inspection that business da W This permit card shall be kept in a conspicuous place on the job site until convjetierroffneproject. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD l r BUILDING DIVISION if' PERMIT #:Y151206 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 .. 11' Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: ', — 9 TIME: PAGE: SITE ADDRESS: I LS D $ U7 kiJik 14 U , CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: L 9 - Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments/ Instructions: • k PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Crti 1 \6G vQ Date: ()` \ — Phone #: (503) 718- z"1 L-to CITY OF TIGAR® e :. 4° BUILDING DIVISION PERMIT #:n51 J --7 13125 SW Hall Blvd., Tigard, OR 97223 :. °' ` DATE ISSUED: Phone: (503) 639 -4171 4 :' Inspection Requests (24 Hrs.): (503) 639 -4175 ,�, . 1 INSPECTION WORKSHEET FOR DATE: 6 9 TIME: PAGE: SITE ADDRESS:, J i D , co WTk 144 v 57. CLASS OF WORK: SUBDIVISION: �r_ S" LOT #: TYPE OF USE: PROJECT NAME: r / DESCRIPTION: OWNER: - - PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: (;) Pour Time: Code # Inspection Description Confirm # • Contact # Message Corrections/Comments/Instructions: PASS n PARTIAL APPROVAL ❑ CANCEL 1 ( NO ACCESS FAIL . ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED NOG L - - 1� L Inspector: Cr Date: D Phone #: (503) 718 - J , i) CITY OF TIGARD l BUILDING DIVISION PERMIT #: t{IST;l,44$-(01�'1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5 2,C1 - Q 9 TIME: PAGE: SITE ADDRESS: 1 2.911, S t) W 61.N 4T, CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: S1 25 Pour Time: Code # Inspection Description Confirm # Contact # Message 1 Corrections /Comments/ Instructions: S r f 'PVT s/1 • Rf.: pa6 L5,- 0,6 (� PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS &.4 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: � �" +� Date: V 21 01 Phone #: (503) 718- 244L . . . . . . . . [,, .2: =LP ''' ti'.1i 1 ' aYillit'i,i::111i:Sht. Eirlf LILA- D7. ! l : ■ + X p i n httos:fiax.eiccela.comijetspeed/portal ,. ,.! 5 1 . ,, : : : L,.. , , File Edit Vie?: Favorites Tools Help 4 , i . - . , i,- 6? I AtiAccela Automation a I I - E c .. i ti - L- Page .! !'c_j Tools - 30. Acceia Automation!, https://ay.accela.comJetspeed,,'portal -1. , , Utility room addition,- Inspections 09/0.4,12008 0 a, --..,-; --.--.--------!...--- :.---:!, = . ..........=,. ..r... = : ..,. ,====--%---.,-- ', = -:.•=- = CAP ID: IVIST2008-00137 ! :2- , . =, ,„ i , r ._„, , . 1 :--=-• --, — .-1.1-J !: Menu ij New al Cancel ei Reschedule ," I Help l i ...,_ ....., ii 1! +, Go To J) Documents (0) Fee (9) GIS (0) Hearings Inspections (10) MST Organization Owner (1) Parcel (1) Paymi 0 Inspection To Scheduled Scheduled Inspector Inspection Result Result Comment R 31 11 . Date: Time Date - E7-1 il 03/16/2009 12:00 Gary Noble Scheduled 0 E I i El 27:. 7- a -- ,. - f. 03/16/2009 12:00 Chip Barnett Scheduled 0 , I Al 03/16/2009 12:00 Chip Barrett Scheduled 0 ! = -7 ! , 1 0 32 !_,,.•:::::1 03/16/2009 12:00 Rick Bolen Scheduled 0 ,=-.......) 11 i , —_.........._.---.-..1 ,, 03/12/2009 12:00 Chip Barnett Rescheduled 0 -----_- --, li - ..-_,......, 11 , E 2: =, - a,• 02/13/2009 09:00 Rick Bolen 02/13/2009 PASS 080539-01 ,--, 503... • =1.1, .1 El , ,..-..,.,.„..„ n,i27/ Rick Bolen 03/02/2009 FAIL 03/12/2009 Dan Nelson 03/12/2009 PASS minor CASE -7 IL.. 0 =I i ll ,—, u 32• : :l..-- - ,7_-_,,,:,! - H!, - 03/12/2009 12:00 Rick Bolen 03/12/2009 FAIL Washer waste to... 0 03/12/2009 12:00 Gary Noble 03/12/2009 FAIL ART. 210.70.2 R... 0 ; =.------ _ --1:3 ___ - —_ , ......)._1 .Reports I- CC. LAQPNLV) :-.-------",..- ., • 61■7-5(--\A ILL 1* 2 -1 R.eports ==== -_--....... )'Case Specific Permits ==== --------- )0-Cashier • -....-_-___--- , . lIt■'Export - IAFS Payment ).-Export - Permit Activity 'at-Inspections Internet C.4.'" 100% ■ , . - : 1 ,24. i : i:.: Inbox -Microsoft Out../ 0 , .:,.;-, n Edit CAP ' . CITY OF TIGARD e - BUILDING DIVISION PERMIT #: MST20013-00137 4 6, 0 D 13125 SW Hall Blvd., Tigard, OR 97223 e DATE ISSUED: 9/4/2008 Phone: (503) 639-4171 ,..t i b Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 2/27/2009 TIME: 7:01AIVI PAGE: 5 SITE ADDRESS: 12976 SW WALNUT ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: LAYTON DESCRIPTION: Utility room addition, 66 sq It, within existing garage. Mechanical other ductwork. OWNER: LAYTON, ELIZABETH PHONE #: 503-590.0236 CONTRACTOR: GIGS CONSTRUCTION PHONE #: 503-138134109 Inspection Request Scheduled For: Date: 2n7/20m Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 000900 503 N Corrections/Comments/In tructions: „ 0 r , • f ' LA / A A _ ■ 1 _ .: k ' ' 4 P i _ ......_ ...............„. je (4 d , 91/1-1 c. c,jt &( 1/4Apft. 64 X) 4 4.... CN‘ok _ A g 4- Z s ,- • PASS 0 PARTIAL APPROVAL 0 CANCEL [ NO ACCESS !VA; AL D CALL FOR INSPECTION D ADDITIONAL FEES ASSESSED Inspector: t Date:?Y) / q Phone #: (503) 718- c7-)174 CITY OF TIGARD , / BUILDING DIVISION ►/ PERMIT #: MST2 icft 00 3� 13125 SW Hall Blvd., Tigard, OR 97223 G DATE ISSU P; 914/ 000 Phone: (503) 639 - 4171 ' ' Inspection Requests (24 Hrs.): (503) 639 -4175 `'' 4 010 INSPECTION WORKSHEET FOR DATE: 2/13/2009 TIME: 7 :00At I PAGE: 3 SW ST LP_ " G 0' SITE ADDRESS: 12976 SWWALNUT S T CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: LAYTON * d 1 SS-6 DESCRIPTION: Utility room addition, 66 $q h., within exiAing garage. MP hanica other: ductwork. OWNER: LAYTON, ELIZABETH 61n PHONE #: 6o: 590 -02.36 CONTRACTOR: GIGS CONSTRUCTION • I PHONE #: 503- 8884109 40 Inspection Request Scheduled For: Date: 2/13/2009 Pour Time: 9:00 Code # Inspection Description Confirm # Contact # Message :no Foundation walls 080539 -01 503- 1300.4409 N Corrections /Comments /Instructions: 4--s- (29-‹- c/i 7 Aci_.• -- f ( 0 { PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL (l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED \./i2 Inspector: Date: W/ , i 3 / Phone #: (503) 718- 2N f