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Permit w ■ - MASTER PERMIT CITY TIGARD PERMIT #: MST2003 -00105 l DEVELOPMENT SERVICES DATE ISSUED: 3/25/03 T 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14660 SW 89TH AVE PARCEL: 2S111AD - 02600 SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5 BLOCK: LOT: 023 JURISDICTION: TIG REMARKS: Convert 470 sq ft of garage space to habitable space. Installation of area drain in driveway, work is approximately 6' from house. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THRD. sf RIGHT: VALUE: 16,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: 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: 1 MECHANICAL FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 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: EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR:'A.00 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 555.02 This permit is subject to the regulations contained in the BRIAN SCHMIDT OWNER Tigard Municipal Code, State of OR. Specialty Codes and 14660 SW 89TH AVE all other applicable laws. All work will be done in TIGARD, OR 97223 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: 503 968 - 7875 Phone: Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Mechanical lnsp Mechanical Final Electrical Rough In Final inspection Framing lnsp Insulation Insp Electrical Final Issued By: l .(Y /Jt1 Permittee Signature • Allb, , _ - - _ __ - OW Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application FOR OFFICE USE ONLY Received 9 Building Mh re a3 - se s o Date/By: d I $ / 3 Permit No.: City of Ti and Planning Appr.val Other g RE Date/By: Permit No.: 13125 SW Hall Blvd. CE O V ` �� Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 F R gfl3 -598 - 1960 ---"31` ' "q� n 1 Post Review Land Use g � 1 2003 .' Date/By: J Case No. r'1 See Page 2 for Internet: www.ci.ri and us 24 - hour Inspection R f V5GP613�yq 75 Name/Method: Supplemental Information rCi� DING D !V! S p I ., TYPE � . . a . .... E , , .1 : � III New construction • Demolition t! t h � 1 Addition/alteration /re • lacement • Other: -' i ! , om 0 _ Note: Permit fees* are based on the total value of the work performed. Indicate 1 '8.L 2 - Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. • Accessory Building ❑ Multi- Family ov ❑ Master Builder • Other: � Valuation $ / L, o o O JOB SITE INFO • F ' + a .C 1 . , No of bedrooms: No of baths: Job site address: / ((Coo 5i./ 81 r1t 'qt.- Total number of floors New dwelling area (sq. ft.) 4 1 70 Suite #: I Bldg. /Apt. #: Garage/carport area (sq. ft.) Project Name: SC K M i PT fe2S 4 r i n. Lt Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) '' @ E ° e t R ' ° ' , ••. 5 k -5' Subdivision: 1 Lot #: - Tax ma • / • arcel #: Note: Permit fees* are based on the total value of the work performed. Indicate - ,; 44 DESCRIPTION OF WORK ` N ; : ,per r the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. 4 tw e.44A pizA , paR ,'ri .- fv41. • , ysJ Lr hQrtt{t bcot_.> Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ❑ PROPERTY OWNS • _ E t '? , , Type of construction Occupancy group(s): Existing: Name: j.t Si-41046r New: Address: /'I /4 5 J 81 rN AA. City /State /Zip: 11444-L D 01Z- ° 17 - 223 Phone: Sea 9 'd'1- Fax NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under ID APPLI x ,w s , y'- '" . 1 3. Ai provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City /State /Zip: Phone F ax: : c .� e 7i.- y t ' ,. 4, ;lip z � c E-mail: v �� . __ ,. CONTRACTOR - t Y �, Business Name: S t e..p•,1 r N a i i✓v...,t.,.s -2 i-1.-e.. Fees due upon application $ Address: /333 /0 Lo Zo9 -r04 L+,NZ City /State /Zip: J , kv/.a ras OF q 7d©b Amount received $ Phone: So3 -135 - LI Fax: Date received: CCB Lic. #: /77 !7'( Authorized . Notice: This permit application expires if a permit is not obtained within Signature: 1 Date: 3 ! / 4 ' 12 3 03 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts 410 /� \Permit Forms\B1dgPermitApp.doc 01/03 X y �i 3 0 /` s, , O °^ / , \ 1 �� � ADD � n'�- � !� One- and Two - Family Dwelling • • • • • ' Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard LI Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 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. 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. 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 applicable to the project 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 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/00/COM) Electrical Permit Application FOR OFFICE USE ONLY Received Electrical �J y Date/By: , 3 / e 3 Permit No.: i /fir eD5 —GV/Q.r C of Ti and Planning Ap.roval Sign y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598-1960 H� Post- Review ' Land Use � � R Date/By: Case No.: Internet: www.ci.tigard.or.us e ��li(I,I� l Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: _ Supplemental Information. c 4 .7-A WE '' '�', REVIEW Please check all that a � . .. TYPE OF WO � � =�_ _ ., �� ;. � .., -� ` < E• ew construction ❑ Demolition • Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ❑ Addition/alteration/re • lacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 1 0,000 square feet, f r R ; ?war - .; ; I & 2 family dwellings four or more residential units in MI 1 & 2 -Famil dwellin: ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more Accesso Buildin: ❑ Multi -Famil ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: JOB SITE INFORMATIO v p `k Submit sets of plans with any of the above. The above are not a . licable to tem s ora construction service. Job site address: / /Apo ;,ii SYr•4 ' l • .iEt r ti ` ,A;Atickmizma Suite #: Bid: ./A • t. #: Number of inspections per permit allowed Pro ect Name: 5'1.44 ■4 t AT rl r A ?"41-t Description Qty Fee (ea.) Total 1 Cross street/Directions to job site: New residential- single or multi - family per dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax ma • / • arcel #: Each manufactured home or modular dwelling t s c sy t service and/ feeder 90.90 2 Services or or feeders - installation, alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 =PR a t ; i v a ` , ( a ai , .,., 4 , ow.11 601 amps to 1000 amps 240.60 2 " Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: Ci /State /Zi • : 200 amps or less 66.85 1 P • ne: Fax: 201 amps to 400 amps 100.30 2 ,� LN _ 401 to 600 amps 133.75 2 ,-.. i. ` `a Branch circuits -new, alteration, or P I , tt - �M extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 IMES i • : B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit / 46.85 2 Phone: Fax: Each additional branch circuit / 6.65 2 E-mail: Misc.(Service or feeder not included): N 53.40 kf r , ; Each pu or irrigation circle 53.40 2 Each s ign or outline lighting 53.40 2 Job No: _ Signal circuit(s) or a limited energy panel, BUST • , • alteration, or extension Pa•e 2 2 Description: At •ress: 33 low 20 4rrt L ( Each additional inspection over the allowable in any of the above: r it /State /Zi • : • t A .,;< it ►.n (Z /-/© b Per inspection per hour (min. 1 hour) 62.50 r Phone: So3 . qSi . tib Fax: ' Investigation fee: CCB Lic. #: I k to? Lic. #: Other: `upervisin electrician Subtotal $ {3 B• ,,:.! a re • uired: Plan Review (25% of Permit Fee) $ Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. ., *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: Audio and Stereo Systems ❑ Burglar Alarm Garage Door Opener I I Heating, Ventilation and Air Conditioning System Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems I T Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation HVAC F - 7 Instrumentation Intercom and Paging Systems n Landscape Irrigation Control 0 Medical n Nurse Calls LI Outdoor Landscape Lightirig D Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i: \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 Mechanical Permit Application FOR OFFICE USE ONLY �� Received Mechanical /le-j- Date/By: Permit No.: f ` " 0 ' 2 O 3 — vy p City f TI and Planning Approval Building y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use iNdl�yi��ll ' " Contact Case No.: Internet: www.ci.tigard.or.us a ." Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 -" Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. ❑ 1 & 2 Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFOR ATION and LOCATION Furnace - add - on air conditioning ** / 14.00 X Job site address: / k(Q �vj/ Fr7 — ,4I Gas heat pump 14.00 Suite #: Bldg. /A t. #: Duct work 14.00 Project Name: c �C.HN /— ie /DENCE.....-- Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: Lot #: Repair units 12.15 Other Fuel Appliances Tax map /parcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 e X re G X/ 5 77^/& /1,4117/I/e-- Flue vent (water heater /gas fireplace) 10.00 �UG o e1< %V FL4� /WA( ,r9w,) Log lighter (gas) 10.00 Wood/Pellet stove 10.00 /20O/ SPACE . Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 r itiL d, l a€a�e a: ,A Other: Name: , ?j /C�fref D �- Environmental Exhaust & Ventilation Range hood/other kitchen equipment 10.00 Address: /4' 66,0 s �-: , ). Clothes dryer exhaust 10.00 City /State /Zip: 2 Oka 9-7Z )---_ / Single duct exhaust Phone : 3 9 t -5Z f 5Pax: (bathrooms, toilet compartments, 0 APPLICANT .0 CONTACT PERSON utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Other: 10.00 Address: Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) F etc. ** Phone: Fax: Gas heat pump ** E -mail: Wall/suspended/unit heater ** :'' 6 a4 f L.., c ,,,z ° .` Aid '? Water heater ** Business Name: oe,c,kie/7 Fireplace ** Address: Range BBQ e ** City /State /Zip: Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lie. #: Total: Mechanical Permit Fees* Authorized - Subtotal: $ Signature: �..a Date: 3 1 -03 Minimum Permit Fee $72.50 $ iF>1 Ia Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $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 and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: i: \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 Building Fixtures Plumbinz Permit Application Received FOR OFFICE USE ONLY Plumbing i1, _ Date/By: .3 Id O - Permit No.: / " / �u�J -00/0 Planning Approval Sewer City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503-598-1960 ,, Post Land Use Internet: www.ci.tigard.or.us �' l � n "la � i l , Date/By: Case No.: k •J I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 - 4175 "° " ". Name/Method: Supplemental Information. New construction Demolition Descri • tion Qty. Fee(ea) Total Addition/alteration/re slacement UI Other: �, s o a t - - ° ,A 4 - Asa, -' 4'' .- it' .�, I 1 ' i it r- i ,I uu 4, s. __ 12"-k` v. ' .. ;u E, SFR 1 bath 249.20 IG 1 & 2- Family dwelling ❑ Commercial/Industrial SFR 2 bath 350.00 DAccessory Building ❑ Multi - Family SFR 3 bath 399.00 ■ Master Builder ❑ Other: Each additional bath/kitchen 45.00 4 • ® - °P sN an 'MO (3 :,,A Pa :e 2 Job site address: plitho 5vo elTel 'vIr " ` .a ;> r ta C atch basi r i W 16.60 - Suite #: I Bldg. /Apt. #: - Project Name: Sj lA Ai cbT IQt ti>tw� D ell/leac in trench drain 16.60 Footin: drain no. linear ft. Pa:e 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanita sewer no. linear ft. Pa:e 2 Subdivision: I Lot #: 117 Water service no linear ft. Pa :e 2 Taxma•lsarcel #: oa 4 : # , ; ,, fix' ,, :'� �. ` . la . *x ; , ,:, .. e f s, ` ,:,. < :? a 1 1, 1 6 .. 60 e Abso • tion valve i k e_Lt,.,e ,Viii t 9- / Backflow .reventer Pale I - 11/I am ) e - e / A�� - °:41'°5 riik Backwater valve 16.60 ,Q a Clothes washer 16.60 {` � Dishwasher 16.60 % 0/ U� _ Drinkin fun 16.60 fountain 1 � t ` <' r' E'ectors/s • 16.60 Name: Ex • anion tank 16.60 Address: Fixture/sewer ca. 16.60 City/State/Zip: Floor drain/floor sink/hub 16.60 Garba:e dis • osal 16.60 P • ne: Fax: Hose bib 16.60 <:. : EiriliffnollattN Ice maker 16.60 i e: Inter •tor /y ease tra 16.60 Address. Medical :as - value: $ Pare 2 City/State/ imer 16.60 i y P Roof drain commercial 16.60 Phone: I Fax: Sink/basin/lavato 16.60 E-mail: - Tub /shower /shower •an 16.60 P :.Y CONTRACTOR . .., 4 !" Urinal 16.60 Busiliess l an 5 tlirAtLA /tt 0. ■[) Z,Le_ Water closet 16.60 Water heater 16.60 Address: / 311 /N L•.O Z t 1 r L -& other: City /State /Zip: 6 f h vk R. Yc7ti o e. 1700 Other` � hone: So3 -931- 404 Fax: ' r s Subtotal $ CCB Lic. #: /214 con- Plumb. Lic. #: Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 • ignature: Date: • 1 8. 0 3 Plan Review 25% of Permit Fee $ State Surchar • e 8% of Permit Fee $ (p TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri- County Building Industry Service Board. i:\Dsts\Permit Forms \PlmPern itApp.doc 01/03 Plumbing Permit Application - City of Tigard e w Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ' e.:1; "F , Square Footaie: 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 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55 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 additional $100.00 or fraction thereof, to and a 1 .,i t rif: s , 1 ar ., 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accuratel re sort fixtures could result in increased sewer fees *. iti Comments regarding fixture work: Baptistry/Font Bath - Tub/Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash - Floor Drain/sink - 2" -3" -4 „ Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic increase of sewer EDUs, a sewer permit will be issued and Disposal - Commercial - Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: 1: \Dsts \Permit Forms\PlmPermitAppPg2.doc 01/03 Permit #: i � i X00 — 00 5� Address: /41P(C Ito $`1 Issued by: /./_ z _ ate: 3 -0..5 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered 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 registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. ✓? .0 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale �'I—I before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR (3 7 ri 313. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered 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. AIW !nature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) - * � = information Notice to Property Owners About Construction Responsibilities Note: This nio// No/ice to Property Owners about Construction Responsibilities was developed 6y rho Construction Contractors Board /xur/'o/i6m/e with ORS 70/.o5j(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an ex isting structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not rcgb(cru1 with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ofa residential structure, you will, in most instances, he ruled to he an employer and the people you hire will hemnp|o!re:S. /\s the employer, you must com ply with the following: Oregon's withholding tax law: As an employer.you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer. you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lfyou fail to obtain workers' compensation insurance. you may be subject to penalties and will be liable for all claim costs if one of your employees is injured nodhcjob.Fornuorcin{6nnu\ion, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. tJ.S. Internal Revenue Service: As an employer. you must withhold federal income tax from employees' wages. You will be liable forthe tax paymenteven ifyou didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829'1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this p jcct 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 overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise em layoew: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expert ise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notif' building officials at the appropriate times so they can perform the required inspections. If you have additional questions. write or call the Construction Contractors Board (PO Box \4|4U, Salem, 0Ry73Ou-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. pmy+xu.pm4 1/94 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 �� _ ©��OS INSPECTION DIVISION . Busin ss Line: (503) 639 -4171 MST BUP Received / / Date Requested Z 2 - M PM/ BUP / Location ` " CQ °: iv ge , Suite _MEC Contact Person 1 _ Ph (/, ` rlp,? — 7cA \ PLM Co _ Ph ( ) SWR = UILDING Tenant/Owner ELC ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear // //✓4 Pi .---- a / N .¢� Drywall Nailing c " Firewall Fire Sprinkler Fire Alarm LL dRie_e_4f57-70/14- D e s Susp'd Ceiling Roof CO__&P,4 Other: gar PART FAIL T :"_ NGD j 71---=- L /4 O S =2:44 _ rd/ poet, Beam Under Slab &•-• f' ArSifferira Rough -In r Water Service _ Sanitary Sewer 3 / Rain Drains - y� „A..., ., r� , 4.1 i 1\ • Catch Basin / Manhole r Storm Drain �� / r P .1.-. ' Shower Pan Other: . FAIL " ' ANIM Post beam Rough -In za Gas Line Sm' . - Dampers 0 , �` FAIL r — CTRICA Y berme Rough -In UG/Slab Low Voltage Fire Alarm 0 Reinspection fee of $ required before ne ■ inspection. P .rl� ity Hall, 13125 SW Hall Blvd. PART FAIL �— SITE 0 Please call fo reinspec ' n RE: � ADA � able to inspect - n access Fire Supply Line �, , / L 42 » // )'‘":" . ��i _ II' Approach/Sidewalk D a t e. Inspec Other: Final DO NOT REMOVE this inspection record from the job site. L___ PASS PART FAIL _ I / - -- frt/et a ic ,'„/‘ 7),..„1?"- jeeee_Vz_e 17,/ g 1 _ z eP--4!)‘ jZt err rte - jG 7e76 6 Q U ; L Lt c am-, V if"-V L Ic 'or y 96 . 7' l - 44■'a V 7.) a_ -°' ■ • _e _4; '.--- c yt." 6 .9 / 71— ice0--Z Ae_ /dam A • /4_11 te• _ /4 gz4:1 7- / ise7 %Oaf o•Are ‘ 4.:e �%LC� - E� ua. (6eP k v rn! i'� ABC ELECTRIC JOB INVOICE A Better Choice ' • .1440 135 NE 9th Ave. Ph: 503-233-7551 PORTLAND, Fax: OR 503 233 -7552 ORD PIO. DATE p ` R A KEN BY DATE `1'f� D % O CCB #161501 A.M. ORDER TA IS ❑ .M. BILL TO ❑ P.M. &et An � 7't2 t p7-- 948- Q ADDRESS /` 7 �P >e}� 1�l /1 r+� MECHANIC � � CITY C�// J •Qsic: Gera Y ily Il / ^J HELPER JOB NA E20W - ❑ DAY WORK DESCRIPTION WORK ❑ CONTRACT ShSThLL ex 11noct"C Qtir-s - ,- Lt in ❑ "TR" ?AriLC_ • LAr t "AnLL. QUART. DESCRIPTION OF MATERIAL USED PRICE AMOUNT CD t4I i RED Rcr c4 t F „i/J, 'in Pc:c COP • ton Dr -D G4 P, Pr' 2 - h 74LL FjcPos' -e® Loewe Put i s in re L i� S vue. G.iet'D AxT er 4ti FrAion/y em Pt,t cote- I2 1"nsr•4L.Et= D • t,3t}T; _ c l cda 6 „:4 - 01./fr t /Ij ova / S 4,,,,,0 fikt4 tre.4 S IounibL th ,f iAert 'e lr1 ae'' ?cif Coo . r - • HOURS LABOR AMOUNT TOTAL MECHANICS o MATERIALS / a G 0 HELPERS 0 ABOR 5 o a s JRac,A CAffigcr /4 0a • ereby acknowledge the satisfactory TOrAAL LABOR TAX • . •letIon of • - ,..% - described work. NA1 RE DATE COMPLETED T OTAL �►.,.. �1��1� 3d