Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00224
�1�l DEVELOPMENT SERVICES DATE ISSUED: 8/3/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10753 SW 115TH AVE PARCEL: 1S134BD-09700
SUBDIVISION: PENN LAWN ESTATES NO.2 ZONING: R - 4.5
BLOCK: LOT: 025 JURISDICTION: TIG
REMARKS: Fence and retaining wall. Other plumbing fixture is dry well.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: OTR HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: TAO: sf RIGHT:
VALUE: 800 .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: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES: 1
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: 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:
EA ADD'L 500SF: 201 • 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 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: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner Contractor TOTAL FEES: $ 228.43
This permit is subject to the regulations contained in the
SMITH, STEVE W OWNER Tigard Municipal Code, State of OR. Specialty Codes
10753 SW 115T1 AVE and 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.
Phone: 503 - 579 - 7870 Phone: ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: 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
Storm drain Insp
Plumb Final
Final inspection
/......, , Issued By : , `. _ \ ' .. Permittee Signature :� r .
J
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Apj '��
�Il!!!ll<Ll FOR OFFICE USE ONLY
City of Tigard V 0 3 2004 Date/Bea w / LYMIN Permit No.: 3 , g i _490 22
13125 SW Hall Blvd., Tigard, OR 97223 ' Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 TIGARD , irr,o) „�i, I DaBy Other Permit:
Inspection Line: 503.639.4175 Gt OF � Da te Ready/By. Ririe: la See Attached Checklist for
Internet: www.ci.tigard.or.us BUILDING D NI SI • ' _ �, Notified/Method: � /(k Supplemental Information
, i s " ,0 a ' € ll�t- WEL
a , w ` ' ,, a g , ! a r J ' y e , t ,. +-4 , t .. 1 / - -
❑ , ': : , LING
New 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
�., „, s ' , _ � ` -,- , '"' : work indicated on this application.
G 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ Q 0 C7
❑ Accessory building ❑ Multi - family Number of bedrooms: v
❑ Master builder ❑ Other: Number of bathrooms:
tea, Q
, , 4.. . -�iv,� e , -7, ��_.,,,$ ,,.. 2> ... .. , , Total number of floors:
Job site address: fa '53 , t ,,,, ) ∎r -% A(.... New dwelling area: square feet
City/ State/ZIP: '`' � �,...,., r c) R 9 72-2 Garage/carport area: square feet
Suite/bldg. /apt. no.: — I Project name: y ►.. 0,-„,.. '; \ • Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
p _Sy ,� q L.+ odd ' br , Other structure area: square feet
J , 4i : t ! t ' 1 { � C$ E.CKLIST
Subdivision: V .. 51.. c... 3, I Lot no.: r 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
4. ,:
equipment, materials, labor, overhead, and the profit for the
r
a t , ® - i "i work indicated on this application.
Valuation: $
(0 t t- tf" C . ,-...•c. 1i 0 p o k w t;,. ( � Existing building area: square feet
New building area: square feet
:4 t t � r. „ ''" v , Number of stories:
Name: s' } ,,) ,. S , tt 4 L Type of construction:
Address: ) p'7 i $ c. ) I c \ i'+.- � Occupancy groups:
City/ State/ZIP: -- c .,.,, / d t . 7 C 2 2 ? 3 Existing:
Phone: (1 ..) —24 - J 8 ') o Fax: ( ) New:
mss. t 1 ,t
3 , , r � S t$„ c 's � s �' S � s �'�3�' '� ,,_ � � •,tom ,, �"' � ���"'"`�' i ,�. w'. „.E . .i `�':3� .. 4 _. '1,4 .
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax:: ( )
E -mail:
Business name: '_ j t ; t 7 1 i
Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lie.:
Date received:
Authorized signature: G , This permit application expires if a permit is not obtained
C within 180 days after it has been accepted as complete.
Print name: _54_,,, J � t t � 1 1 Date: Tg • • C� y * Fee methodology set by Tri -County Building Industry
Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date
/By: Assoociated permits:
Phone: 503.639.4171 Fax: 503.598.1960 b i* , NiO4114r B
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us ❑ 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 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. El El ❑
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. ❑ El El
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 a..licable 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 1 I" 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. ❑ ❑ El
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 structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
i:\Building\Permits \One- Two - FamilyChecklist.doc 12/03
Building Fixtures RECEIVED
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard AUG Received�/ 2��4 Date/By: 6 yei 3/ PermitNo.h, Li �ppAR c f
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie y
Phone: 503.639.4171 Fax: 503.598.1%'Y OF TIGARD ■ Ay . I ' 'u � liii '� Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.41 DIVISIO l ^ .' I Date ReadyBy: Juns El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
w . �,:.'-. ' ak. • .3 t t � 4 i :' =' r .. " 'I ''''' * SC IiEDU-
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. l Ea. Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
s� a x �` -•,, �{ SFR(1)bath 249.20
C 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
El Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
; , a „ - ms r p
„n t . i ' 1 s '" _ 5 . . - . Site utilities
Job site address: /0 C, AJ I ` /4,,` 4 Catch basin or area drain 16.60
City/State /ZIP: , 7i S 2ra\ c l 722_3 Drywell, leach line, or trench drain ( 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
1M0 ^.e t
Manufactured home utilities 110.00
Cross street/directions to job site:
q Manholes 16.60
S 7<,'n5 LA./ L. ..)a i)r. Raimdrain connector ' 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
t I Lot no.: Water service (no. linear ft.: ) Page 2
Subdivision: .--pc.,,,,.--pc.,,,,,,‘ �-� S4- ^t 2
Fixture or item
Tax map /parcel no
Absorption valve 16.60
4 .4 15 10 . t.,,' . At -..� 1. -7 q ZZ .WiV ii Backflow preventer Paget
(t rat..- -c f5c. i •. ,-;4.,..c, Fra ^•« 5 a ,-,-.5 -(. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
; T ,, -: . i, g i P .._ ill t - , Drinking fountain 16.60
Ejectors /sump 16.60
Name: j • t ,,, S t .1 t, ,� Expansion tank 16.60
Address: 1 v'7 . c, w I )1 4 Fixture /sewer cap 16.60
City/State /ZIP: 7 ....5 1 . C ' 012 Cf J 2 z j Floor drain/floor sink/hub 16.60
Phone: Cris, ) s e - > ) ` Fax: ( ) Garbage disposal 16.60
_'° s ` 4 ,.tom` , ` :4 t t� Hose bib 16.60
' �,r _ �.�,. _-fie
�'° �� ` Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
s
l , "�... 1 � :`� -• t __� � ! , m ��. n. nib :,'': - _ Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature:
i / y,,,«/ State surcharge (8% of permit fee)
/v` [ TOTAL PERMIT FEE
Print name: S 1 f ✓ l _ ti 14. Date: f j ?�� 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.
is\ Building \Permits\PLMF- PemvtApp.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:
p S;qu.arFoota Permit :Fee•
Footing drain - 1" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 i ,,�°
Storm & Rain Drain - 1st 100' 55.00�� i?e
$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�s s,r t� zi °_ " � ,,. is including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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 * .
a zR c t r
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
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./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump 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
Service total is >9.
Swimming 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:\ Budding \Permits.PLM•PemutApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 /,��` _
INSPECTION DIVISION Busin ss Line: (503;4 639 -4171 MST /'Y " ��1�
BUP
Received Date Requested AM PM BUP
Location /9 7 // Suite MEC
Contact Person Ph ( ) PLM
— UM
C ( ) uz 6
BUILDING Tenant/Owner ELC
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
•
FAIL
Ice .1AOGU.c
Post & Beam _ ►tom _'
A � w /
1 _ f _
Under Slab r t. Rough-In
Water Service
Sanita ewer
'ain Drains
. :asin / Manhole
Storm Drain
Shower Pan
Ot er:
i
O p 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 Reinspection fee of $ required before e. • - '• t City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE I I Please call for einspect•n RE: �� I I Unable to inspect — access
Fire Supply Line
ADA /3, � _ / •�
Approach /Sidewalk Date In s p e r _;. 1� E
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL