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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00139 DEVELOPMENT SERVICES DATE ISSUED: 6/4/2004 " " - - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11114 SW 108TH AVE PARCEL: 1S134DA-01901 SUBDIVISION: ZONING: R - 4.5 BLOCK: LOT: JURISDICTION: TIG REMARKS: New SF detached BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 17 FIRST: 3,137 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 747 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 309,336.90 OCCUPANCY GRP: R3 BDRM: 3 BATH: 5 TOTAL: 3,137 sf REAR: 15 PLUMBING SINKS: 2 WATER CLOSETS: 5 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 150 TRAPS: LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 150 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 150 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVQFCR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: >=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: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,537.59 This permit is subject to the regulations contained in the GRANT, JIM WELLINGTON HOMES INC Tigard Municipal Code, State of OR. Specialty Codes 11865 SW SCHOLLWOOD CT. 18151 S. UPPER HIGHLAND RD. and all other applicable laws. All work will be done in TIGARD, OR 97223 BEAVERCREEK, OR 97004 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. Phone: 503 - 579 - 1088 Phone: 503 632 - 1144 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 109110 rules are set forth in OAR 952 - 001 -0010 through 952 -001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace = er Se- ice Insp Building Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /'iwlk Insp , / / Issued By : .4,11./1,14. a *A, .1 Permittee Sig . _ mt./ florin! . Call (503) 639 -4175 by 7:00 p.m. for an inspection n -ded the next business day Building Permit Airu}ieipn, FOR OFFICE USE ONLY City of Tigard CC 1��, CC �I VED A Received �� yy�� q,, , �7 Date /B : i/Lr �� Permit No f' `"'�A90 / - V613 13125 SW Hall Blvd., Tigard, OR 97223 Plan v h 2004 I' 41111'‘ 1i Plan Revie ' I' M4 l N �� , l Date/B : A V _ , Other Pe ti Phone: 503.639.4171 Fax: 503.598. 1 a ` �Of Inspection Line: 503.639.4175 W Date Ready/By: el See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information BUIIDIN �� 5 ., r° 4 7 $ ff . IA , • a f �,- � D A '� AI '' D2 F A M ILYD L LING ►.i ew 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 � � 4 - g t work indicated on this application. x 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ Z / `O F . 0O ❑ Accessory building ❑ Multi - family Number of bedrooms: 3 ❑ Master builder ❑ Other: Number of bathrooms: 4 4 ', 1 r B 'Si _ t ®. 6: .. � __ 1 ° : s ,. ,. Total number of floors: Job site address: ( ((( I-1 ¶,o 1 v O T ( • New dwelling area: 3 to' 7 square feet City/State /ZIP: -776 A p9 / 0 (. 9 7 Z Z s. Garage /carport area: 7 L('7 square feet Suite/bldg. /apt.no.: 1 Project name: , RRn7 -- Covered porch area: S square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED Dj TA COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: / ��-�1 CJ� Indicate the value (rounded to the nearest dollar) of all r" equipment, materials, labor, overhead, and the profit for the a o a � � t work • indicated on this application. ,( � s g Valuation: $ It Existing building area: square feet New building area: square feet " -) Number of stories: Name: t r 4 G t 1 ,,f 7 -- Type of construction: Address: / / g 6 5 5 W • ,s H o LL (mac) OC) 0 G-r Occupancy groups: City/State /ZIP: 776,4 It. t2 ,, 0 le 9 7 2 - 2 -r Existing: Phone: ($ % 3 579- (0 g$ Fax: ( ) New: �. ,,. . s.. .- .W Ir & t3ti $ �$ ` .. 0� � , - 4t . r!ig4 3 -+, m Z Business name: EL L (N GTO N go !`? E S, (/YG • All contractors and subcontractors are required to be Contact qame: t } (M SG g. u,_,--t--rot licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: /R,i $ / s', G1/ f f /2_ �( 6ft' GA (N/,' dt jurisdiction in which work is being performed. If the City/State /ZIP: A-4 U c2 GQ s . -1 0 9700c/ applicant is exempt from licensing, the following reasons apply: Phone: (5 -03) 63L— (t'z/6/ 1 Fax:: (.S ‘,32 — (( E -mail: Business name: Address: �U () � Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) AI r . Fax: ( ) CCB lic.: (09l/0 Amount received Date received: Authorized sign. IIIP! This permit application expires if a permit is not obtained Kil /` within 180 days after it has been accepted as complete. Print name J SG,e rO !'( Date: L 2_5-- Cox * Fee methodology set T ' Coun Bull in dus Service Board. 4 7/0 y c � r I" i:\Building \Permits \ntJP- PermitApp.doc 12/03 440- 4613T(i 1 /02 /COM/WEB) - €5 / _ _ y ,../� /J � /� 0-4 fLLR��ifff99@ 010.1.411;i4 G� One- and Two - Family Dwelling Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Phone: . 503.639.4171' Fax: 503.598.1960 iii Associated permits: 24- Hour Inspection Line: 503.639.4175 , ( 1� h� CI Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us F "'� — ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ 2 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ la 3 Verification of approved plat/lot. . ❑ ❑ 4 Fire district approval required. Name of district: . Ii ❑ ❑" 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ e' 6 Sewer permit. ❑ ❑ i 7 Water district approval. IT' ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. L ❑ ®' 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 [r ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water (seater, [r ❑ ❑ 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- /r ❑ ❑ 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. Er ❑ ❑ 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 - [r ❑ ❑ 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 E 1' ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 21" 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 Er ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ 12' 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 [r ❑ ❑ architect licensed in Ore l on and shall be shown to be applicable 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 tree protection measures as required by conditions 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 stru ures to existing residential dwellings on a lot of record a roved rior to Se tember 9, 1995. 5 6-7 J — (Q8/ — 36005 i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 Electrical Permit A 1' • ED FOR OFFICE USE ONLY City of Tigard Received q '/ 7 -'/ Date/By: Permit No.:M 51 �D7 ' op/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1 5 2 °� �i "n»iilli�, lipt�� D ateBy: Other Permit: Inspection Line: 503.639.4175 ! y. Date Ready/By: Jur 0 See Page 2 for Internet: www.ci.tigard.or.us F TIGA Notified/Method: Supplemental Information '' s 41 v > r i 0,-,•:::-1%.--!:,-„„.„ r° n : '`` PLAN REVIEW ew construction ❑ Addition /alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location a,�,� ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., af 4 40 ; Fi � ,, TJ� T , w. of 1- and 2-family dwellings 4 or more new residential ► i 1- and 2- family dwelling . ID Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure ❑ Multi-family ❑ Master builder ❑Other ['Building over three stories OFeeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or :. 4 i�d $ 'SI s.. Q -i ; r TI ...:.., „- ' . E e g g plan T * ) � ❑ gr ss/li htin lan RV park Job no.: I Job site address: 7(/ 7 S mg T'f Av £ ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City/State /ZIP: 77 4 1 4. a le_ 9 7 2.2 3 The above are not applicable to temporary construction service. / Suite/bldg. /apt. no.: Project name: 7- ,' Z 4 :- !' S rD g Description I Qty. Fee. Total 1 ` Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less L 145.15 4 Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 "i , z .i S ' q F 3 , ' ( „ ` ;�,i .,"` r Each manufactured or modular x / 5 K dwelling, service and /or feeder 90.90 2 �Y Services or feeders installation, alteration, and/or relocation 200 amps or less 1 80.30 2 N r� PRD t' , _ ,_ 201 amps to 400 amps 106.85 2 .; ,:. .,. .. ,,._ ...4, .:�,. lei: ;' r ` ,' AN, ., ` lt 401 amps to 600 amps 160.60 2 Name: ` S ( i - fl G (1-14 t / 7- 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 Address: ( (.5 s 0). c L /-7 (- C,J O 0 67 P - Reconnect only 66.85 2 City/State /ZIP: 7 - 7 ---, rt j 0 2 9 7222,3 Temporary services or feeders installation, alteration, and/or Phone: (570 S`7�/_ (' Q I Fax: ( ) relocation v 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel a d � y , s ' * >_ r ` A. Fee for branch circuits with serv or feeder fee, each 6.65 2 Business name: E CC, ( /YG � /( Ai ol es ( mac . branch circuit B. Fee for branch circuits Contact name: .... Sc / C TT n-( wit hout serv ice or feeder fee, 46.85 2 (.�I _s 0 eI°G,t (7(6- <1 7 �d ,i12 each branch circuit Address: l - Each add'l branch circuit 6.65 2 City /State /ZIP:✓' 4 U t2 Gta S E k 0,e_ q 7 QO $ Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( 23) (32 - /l c/� Fax:: (S43) ,c 3'. - //'6 - Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - { ; r a.:'r{ i . ., i t'l'I? �c ,. .:r vrt n, ` energy panel, alteration, or �� � ' extension. Describe: Page 2 2 Business name: Op_ st f F.__Ec.? i / c . Address: p. Q /go X F6 3 6 ( Each additional inspection over allowable in any of the above Per inspection 62.50 City/State /ZIP: Pa err - cfritivf t / OrZ c' ?a.9- G Investigation per hour (1 hr min) 62.50 ( / 7 !/ Industrial plant per hour 73 75 Phone: (S 7 h 5-6 � 7 Fax: (I`D3) 7 7 ` �� r , '',, { t tt40: , IIT CCB Lic.:7� Y6 b Electrical Lic. / fq c Suprv. Lic.:2 ? 7 6 ' Subtotal Suprv. Electrician signature, required: / / !j Plan review (25% of permit fee) /n� / Date: 1� State surcharge (8% of permit fee) Print name: ZE E F� C 7 6 S O r - 2 3- TOTAL PERMIT FEE Authorized sie: This permit application expires if a permit is not obtained within 180 4 days after it has been accepted as complete Print name: !`n S C./ tti�ro� Date:._ z - d (� * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: :z s PEA *x ye s 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: } ���� D ffi ®�`3 9. Y .• P �#°Yk.` `. °.ra a __ O a I Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ 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- PemutApp.doc 04/03 Mechanical Permit Received Appli E'V 1 F OR OFFICE (S O Cl of Ti drfl 11 '11 G Permit No. // �j `J b Date/By: ,. "i /i rl / i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 MAY 5 ! , y , r� D ate/B y: Other Permit: Inspection Line: 503.639.4175 _di. M 4 1 1 Date Ready /By: Iuris: See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental information CITY OF TIGARD i � f lid rr�� Wp�„',„ , � ,„ %, ' ' COMMERCIAL FEE* SCHEDULE USE CHECKLIST New construction ❑ Addition /alteration/replacement 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. #, sm. xi m * , z� �:, d7 Value: $ g � � ������ Q ��� �� RESIDENTIAL EQUIPMENT / SYSTEMS FEES* For special information use checklist. 1- and 2- family dwelling ❑ Commercial /industrial 11 Accessory building Multi family 0 Master builder 0 Other: Description Qty. Ea. Total _ a Y u;. tt ',� Ik 'F i -� ' e a ,.a a �a ' s 1 ., m, s ' ,,. ,,..,., T Q* CA, I' , Heating/cooling Job site address: r / C.( ,5 (Q G7 TN A (J Air conditioning heat pump V 6. , (requires site plan shh owing placement) ' 14.00 City/State/ZIP: 776 A Ap 02 9 7 7.--a 3 Furnace 100,000 BTU (ducts /vents) 14.00 f Furnace 100,000+ BTU (ducts/vents) I 17.90 Suite/bldg. /apt. no.: Project name: - Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 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. 10.00 Flue /vent for any of above 10.00 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances ., .Nv.a • 1 k s , s . ' , d ° f V ; i ' a ., „..,a-r, Water heater I 10.00 04.Notohigissekato.i, ii Gas fireplace 1 10.00 N F. / Flue vent for water heater or gas fireplace 1 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 r1 t0 e 1 Chimney /liner /flue /vent 10.00 .„ � s, x '*. �.. _ ��, �. �; 0:,4,4 ' 160 gN54, a- �:m < Other: 10.00 Name: -j I N•( 6 7 R , N 7--- Environmental exhaust and ventilation Range hood /other kitchen Address: / / �6 s (, SG 0 L (, wo (),io G r' equipment 1 10.00 City/State /ZIP: (/ , A p Q (Z_ �� 7 Z Z 3 Clothes dryer exhaust I 10.00 r Single -duct exhaust (bathrooms, Phone: (3 ) 5-7 7 _ /Q g8 Fax: ( ) toilet compartments, utility rooms) 7 6.80 � ' Attic /crawlspace fans 10.00 , '` , li t .INTACT PERS �.� .�... » a.. � n , '` - „ Other: 10.00 Business name: g6.-6 ( /VG Toni / /dM q- S" f 11 C • Fuel tin P�P i; Contact name: \ ' t /,,1 SG tr �-t- 7-O N $5.40 for first four; $1.00 for each additional I Address: ( 2 ( `•/ . - S'. u lee E a2 //6 G,1 iv,� Gas heat etc. Ka Gas heat pump City/State/ZIP: 74 U C4, („g g_ t'"/ Oj Q 7 00 r‘ . Wall/suspended /unit heater Phone: ( $3) 671. _ ( /y{(/ I Fax: : (sW) 4-' 3z - /( 4,6- Water heater Fireplace E -mail: Range I ,- i^ a ' Barbecue �� m a Clothes dryer (gas) Business name: 6 ,p £Inn( C />ry g47 — /At E Other: Address: / 5-9 5 L 2 2 ��' h, Y.>_a C C .L..„,, :;FE City/State /Z1P: ( 4c< v7 #i S $ R _ Subtotal Minimum permit fee ($72.50) Phone: (5-D?) 6 L Q 2 2 ( Fax: ( ) Plan review (25% of permit fee) c CCB lic.: ' L,rr 2 S-'t ci State surcharge (8% of permit fee) / TOTAL PERMIT FEE Authorized si This permit application expires if a permit is not obtained within 180 gn days after it has been accepted as complete. Print na - Date: y Z 3 - O 4 * Fee methodology set by Tri- County Building Industry Service Board /n- i:\Building\Pe - is \MEC- PermitApp.doc 12/03 4404617T(II/02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\ Bui lding\Pemvts\MEC- PermitAPP.doc 12/03 2 e Building Fixtures Ni Plumbing Per , ]. 1 , ibh FOR OFFICE USE ONLY City of Tigard 10 4 Received Date/By: Permit No.:fr sr� 0/./� 00 13125 SW Hall Blvd., Tigard, O' • ! ! t 3 5 Plan Review rte/v7 / Phone: 503.639.4171 Fax: 503. :. 960 D ' '' ,1 I ' , Date/By: Other Permit No.: r iii 24- Hour Inspection Line: 503.639.4175 O� `1GP`R ! y. ' j . Date Ready /By: Juris: gl See Page 2 for Internet: www.ci.tigard.or.us Gfa'(Y >t �V�s1 ON Notified/Method: Supplemental Information t , _ i r t:Ya sw a ;iii -" 0 $ x e�s' r '} FEE* SCHEDULE New construction 1"0 Demolit ion ❑ For special information use checklist. Description i Qty. i Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) `' � � i ,I. .. t � ;o e1 ..- 1 ° .. ti .'A' SFR (1) bath 24920 K1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath l 399.00 Each additional bath/kitchen ` 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 : 0 . ' a ' ..N ,h ',,.. . e] " ,. S u Job site address: /7// 4/ ( _ , ( o ' 4/f Catch basin or area drain 16.60 City/State/ZIP:-77 f �J I 2 9 7 zz_ 3 Drywell, leach line, or trench drain 16.60 // V 0t / - Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: C ern/ 7 - , Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 1 6.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: /5 ) Page 2 Storm sewer (no. linear ft.: /SO) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.:/ SD ) Page 2 Fixture or item Tax map /parcel no Absorption valve 16.60 , � 1 « ,:...-°, . t o . + � , � ,. Backflow preventer Page 2 /V-5 . , A Backwater valve 1, 16.60 Clothes washer ( 16.60 Dishwasher 1 16.60 �t� �� . J ,, , 4, a gr.;', ' ,_ Drinking fountain i , 16.60 ... .,., A , -1w �., , r E j ec t ors / sump 16.60 Name: \, (M 6 lc Af r- Expansion tank 16.60 Address: // QC) cS. W c G,-i U t. C..- L1') 0 0Z/ Cdr Fixture/sewer cap 16.60 City/State/ZIP: - j, g.,,9 0/2.- 9 7Z L. Floor drain /floor sink/hub 16.60 Phone: (5 3) '� - __ ® ( Fax: ( ) Garbage disposal I 16.60 a . i �- t ),i - ll y v i `i � :C d .Rte) ''` � Hose bib 2. ] 6.60 Y . #�: a ° . -- . , P. x .a4W-: .;._ Ice maker 1 16.60 Business name: E' 1% A(C TU A / 0 M J , � C Interceptor /grease trap 16.60 Contact name: (. pl SC, A. I to /Si Medical gas (value: $ ) Page 2 Address: (2(S ---� cr. Gc/P6 R f- ((G't- ' 6, #9,�1/,' f. /. Primer 16.60 City/State /ZIP: ff f'4 v£a CP E D fc 9 7 Q d Roof drain (commercial) 16.60 F �^ Fax: / Sink/basin/lavatory 16.60 Phone: SdJ (� i2_ /( � c/ : ( 03) ‘3 a - /'I ti Tub /shower /shower pan 3 16.60 E -mail: Urinal 16.60 . '. ® � ° g 4 § Water closet S 16.60 Business name:: A s c' 0 l.. Lk. N1 L Q (14G co , Water heater I 16.60 Address: 2 Co 3 0 ( y . /-/, y 0 c iv /S 64 . Ate y 3 Other: Subtotal City/State /ZIP: ,F0 le- 2-- t0 Z 7 Z 1 .,( Minimum permit fee: $72.50 Phone: (5 ) 5- �l c - y ‘ v Fax: (S' Z 6 C F Residential backflow minimum permit fee: $36.25 CCB Lic.: (2 O g' 3 Plumbing Lic. no.: 34 .., (( (2 Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Es _4 i! . ... 41111Lar Print name: 1 dlt1..F. / 0 Date: ty LL 6 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. i:\ Building \Permits\PLMF- PermitApp.doc 12/03 440- 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' J 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' l 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 • ° or Ite> Q. (ea) ' Fee ea Total. additional $100.00 or fraction thereof, to and Fixture , ; 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 accurately report fixtures could result in increased sewer fees * . 'xture ' I di, I �it�rd Reace' �� l ar g ■ Capped Comments regarding fixture work: Ba.tis. /Font Bath - Tub /Shower - - -- - 7acuzzi/Whirl • ool - - -- Car Wash -Each Stall _ - -- -Drive Thru -_ -- Cu • idor/Water As .irator - - -- Dishwasher - Commercial - - -- - Domestic - - -- Drinkin: Fountain - - -- E e Wash - - -- Floor Drain/sink - 2" - - -- -3" - - -- - 4„ - - -- Car Wash Drain - - -- Garbage - Domestic - - -- Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refri:. Drains - - -- Oil Se.arator (Gas Station) - - -- fees assessed for the sewer increase must be paid before the Rec. Vehicle Dum. Station - - -- plumbing permit can be issued. Shower -Gang - - -_ -Stall - - -- Sink - Bar/Lavatory -_ -- Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial - - -- total is >9. - Service - - -- Swimmin: Pool Filter - - -- Washer - Clothes - - -- Water Extractor - - -- Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal - - -- " Other Fixtures: - - -- , i:\ Building \Pennits\PLM- PermitApp.doc 3/03 Nay. 4. 2004 1:24PM CLEAN WATER SERVICES 503 6814439 No.1322 P. 1, .,,� JAN loco �:�� •elf �,�� TU:5036813u_.�. .2. , `''� RECEIVED � f 5 200t' F iloNumber � 'rJ S ' L94.155' � ea n T Y A Sensitive Area Pre- Screening Site Assessment ktur coto maifiytrti,I ' nbIVISION Jurisdiction C. ettic C)F Date Map & Tax Lot J41 Owner t J , .glajagii►.t, 2 Site Address J /// y 54) rem` _ - - -_ —, Contact 5 r3.49( Proposed Activity A4 u) St rt 6 t-F. ,., Address f L.,5 Izoi>r . f,� RANT(L4r fife Sd fi x' r�G`C.- Phone__ "At +r r'a- tt oh7, sl use onl below this line Y N NA Y N NA Sensitive Area Composite Map Stortrwati?r Infrastructure. maps ® ❑ M J 5/1-00 ❑ WI QS# yai ❑ ❑ rui Locally adopted studies or maps ❑ 1 - 1 Other Spedty Specify Based on a review of the above Information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No.fiii kleflq r 7 ❑ Sensitive areas potentially exist on site or within 200' of the site, THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE~. PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Arras exist on the site or within 200 feet on adjacent properties, a Natural Rasourcea Assessment Report may also be required. IQ Sensitive areas do not appear to exist on site or within 200' of the site. This Re- screening site assessment does NOT eliminate the need to evaluate and pratect water quality sensitive areas if they are subsequently discovered on your property_ NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER is REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. MO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: WP Te�rial�� eit 'r: v - ,;,,` s o : ._ __— Reviewed By: ,,._ Date: �V0 Y Returned to Appt scant Mail Fax Gorrrtter Post -it' Fax Note 7671 Date / I r► / — / f� t �� / Date S/ y >�Y _ To /11,41 YON From AL _ j eM j /�C+./ Co. Oe Go. CA Phone a PYIOne #5C,3*- 6/ „ 3E0..5 Fax 3 6 ` / /tom F JAN -14 -1999 THU 12:36PM ID: PAGE:1 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (50 639 -4175 lady" /Th, INSPECTION DIVISION Business Line: ) 639 -4171 ' BUP Received Date Requested AM PM BUP Location / % r AV Suite MEC Contact Person Ph ) PLM Contractor P ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Fin - 'AS P - T FAIL ELECTRICAL Rough -In UG/Slab Low Voltage ( ,art/ CtVVl F arm rr } PART FAIL Ei Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 4w El Please call for reinspection : 0 Unable to inspect - no access Fire Supply Line / ADA '- Approach/Sidewalk Date Inspector Ext Other: Final . _,( 10 MOT REMOVE thls inspection record fro he Job site. PASS PART FAIL CITY OF TIGARD. 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST OU 4 / 3 INSPECTION DIVISION Business Line: (503) 639 -4171 / _ BUP Received Date Requested_ / AM PM BUP Location < / / / � g Suite MEC Contact Person c Ph ( ) 4 —77 6 ©7 PLM Contractor / p,( SWR BUILDING Tenant/Owner Afr SIM/1 �� ` ELC Footing - Foundation ELC Ftg Drain Access: 'I ELR Crawl Drain "� 7.e> Qom Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: IWO PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Q1V Approach/Sidewalk Date / Inspector Ext Other: L Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour © �� __ BUILDING Inspection Line: (503) 639 -4175 / "6 yeji 3y' INSPECTION DIVISION Business Line: (503) 639 -4171 � A I ��� O ��/ AM PM B JP Received Date Requested, Location 1 ( L I 1 ir�` �^ Suite MSC Contact Person Ph ( ) e "U ) "9 62 2 , ©3 PLM Contractor Ph ( ) `f (' 62 07 SWR Ba LDI Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: �G 1 ELR Crawl Drain v Slab Ins tion es: (4,r ti SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing / /C._ ..—.-- e--=c ) c c S Insulation Drywall Nailing !`�1� Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof i / Othe g f A tis ) PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final M ART FAIL CAL Post Ti Beam Rough -In Gas Line • e Dampers �• - PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA r— Approach/Sidewalk Date / /6 — Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL