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Permit 4 Alii k CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00515 DEVELOPMENT SERVICES DATE ISSUED: 11/10/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 . SITE ADDRESS: 13712 SW 130TH PL PARCEL: 2S104DD -07500 SUBDIVISION: MOUNTAIN HIGHLANDS NO.3 ZONING: R -4.5 BLOCK: LOT: 033 JURISDICTION: TIG REMARKS: Convert existing crawl space to bedroom & bathroom. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 1,333 sf BASEMENT: 1,076 sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 843 sf GARAGE: 663 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 16,000 00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 4 TOTAL: 2,176 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 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 SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 1 00 SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 6 01+amps 00 0 v: 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 JADRANKA MRKELA OWNER Tigard Municipal Code, State of OR. Specialty Codes and 13712 SW 130TH PL 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 - 579 - 5491 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 Slab Insp PLM /Underfloor Insulation Insp Post/Beam Structural Mechanical Insp Electrical Final Post/Beam Mechanical Plumb Top Out Mechanical Final Underfloor insulation Electrical Rough In Plumb Final Crawl Drain /Backwater Framing Insp Final inspection I ■ k j Issued By / :C1 2 444/lC� ,d��/f.- Permittee Signature j/ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed th next business day • f Permit #: i/hST'2.0(' -- ,(:- 5/-n OF O * �v ���'� �,� � Address: 1 ?, l a- S� 1 v?,._ . '.'' ' j I ssue d b y: 422 l�c� c� � D ate: j / / /6/0 3 5 8 � 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: „�) ,C 1. I own, reside in, or will reside in the completed structure. r 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. n 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 7 I 3B. 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 abou Construction Responsibilities on the reverse side of this form. .?( --____ --- ._... „2._)- ' a-, e .---' , 7\ , 1 D _1 QD (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) *m01 MOUCS to Property 01 liMSTS About Construct Ion Clespinabii0Mes Note: This lnibrmation Notice to Proper Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as you own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. ERii;PLOVER RESPONVEDLMIES7 f you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement c F a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. AF the employer, you must comply with the following: Oregor's w khofling tax flaw: 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 en employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For nuoze information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. • Workers' compensation ir.Fa:•ance! As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insumnce foryoul employees. If you 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 on the job. For more information, call the Workers Compensation Divisiwi at the Department of Consumer and Business Services at 945-7888. U.S. Enter:mai] Revenue ServScs:- As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if yo ti didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTi ESPOMSBOLMES - AREAS OF COMCEIRM: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements 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 employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify 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 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1 /94 • -r r 7 I - G- 0 -✓ ' FOR OFFICE USE ONLY Building Peirmit Received Building H II 1 LR IC u V 1 U /-1 Date /B Permit No.: . f 6 ao / City g of Ti and Planning Approval Date /B : Other �-- ��� r V + „� Permit No.: 13125 SW Hall Blvd. 3 i j,73 Plan Review Other `y Tigard, Oregon 97223 Date /B : M AV I -t -a Permit No.: 1 e, Phone: 503- 639- 4 1tTI1TY xi 15;0j3,?5 1960 - Post - Review Land Use � R' 11 f r n r , al I 1 Date/13 : Case No. Internet: www.ci'tigard!or:us')IVISIOPd Contact Juris.: 0 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Su, elemental Information N TYPE`OF'WORK- . • > - -' , ° -,' -• r �. ., . . _, 4 -� � • �„ .� �-� ;..�� :�. ,.�, . , � REQULRED�DATA- :1 :.' '- . ,; ❑ New construction ❑ Demolition � . - I & 2 FAMILYDWELL'ING 0 Addition/alteration /replacement ❑ Other: ■.__ `- : , ..r.'CATEGORY `OF - CONSTRUCTION,=:•;; '` "_ Q . Note: Permit fees* are based on the total value of the work performed. Indicate t ❑ 1 & 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 ❑ Master Builder ❑ Other: Valuation $ A b I COO c s :..-1; = °`JOB:SITE INFORMATION and`I:OCATION, / No. of bedrooms: No. of baths: Job site address: t - 7 - 1 2 to i 5Q 7 ' f) ) , Total number of floors New dwelling area (sq. ft.) ICC) Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) t0 Project Name: Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) —` Other structure are sq. ft.)...E.tCt S rl N.12 Z7 ,, , COMM I `USE" C H E CKLIST `' Subdivision: Lot #: x =.�•k -r Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate D ESCRIPT ION' Or 'WORK, ° :w.?-"`' " °`' the value (rounded to the nearest dollar) of all equipment, materials, labor, CO k1 k_114-1 C13 5 - F.AcE TQ overhead and profit for the work indicated on this application. 4- (AF)1T jE? _. Valuation $ P€xxM 4— BATt+ N^ Existing building area (sq. ft.) . New building area (sq. ft.) Number of stories - : PROPERTY OWNER.•?; '-'.•t; :; 1 ® , - ;TENANTT `? °' ;:" ; �;,, Type of construction Name: i7 'lN,DRIaI•‘K,4 INARiL.EL\ Occupancy group(s): Existing: New: Address: 3 5l,, 1 -`-" p1 , City /State /Zip:II C, Ar'D 62 . C( 7 2 2- Phone: F ax 5 5 19 59 NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under ❑': AP.PC [CANT ; " ❑= CONTACT PERSON" 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: Fax: ., ;: .spy ,. = - t BUILDING FEES* ', E -mail: :; - ` 4. 5:'-''''i '_ , ?` , 2.! s�: , '''1 , ' . .edulr, t . . l :1 • ,. ':.' ' e ' ` toee.sc ' ,fhe, ', . . > .. `CONTRACTOR`< ` ;.;. :' :,r. Plase, refer ,r_. Business Name: CYLL 2— Fees due upon application S Address: _ City /State /Zip j 7 Amount received $ Phone: Date received: CCB Lic. #: Authorized / V „A V� Signature: I 1 W� _ ate: !/ 1 - J 3 Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. -b Nsc1N GCDLWkN *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts \Permit Forms \BldgPermitApp.doc 01/03 One- and Two- Family Dwelling a e • • • s AA 41� Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City Ti and `J b Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 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 Wail 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 1 1 above. Site plans must be 8 -1/2" x 1 1 " or I 1 " 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. 4404614 (6/00/COM) Building Fixtures 'Plumbing Permit Application FOR OFFICE USE ONLY Received Plumbing / R C� I L. r'.` Date/By: Permit No.: ►Tj 00 c /` C I of TI and Planning Approval Sewer `J g Date /By: Permit No.: 13125 SW Hall Blvd. "i '� 30 Plan Review Other Tigard, Oregon 97223 �' / • Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use CITY OF' Date/By: No.: Internet: www.ci.tigard.or.us Q ��' ^. I Contact Juris.: See Page 2 for 24 -hour Inspection Request: 503- 639 - 4 -DIN -" -- Name/Method: Su pplemental Information. .. ■, TYPE'.OE WORkl: . _ t:: . 4"FEE*!SCREDULE'(ftir s ieeial;infoimation ase'ctieklisi)' W ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) l_ Total Addition/alteration/re lacement Other: £ " •- �, , a NeWYIx „ &r2 family, dwellings k,k ;- P ❑ ' �' r ��;�� ' . `�'�� " . ,r: � . &_,. � � . � �;.:. ,, ? ' ; ` 'CATEGORY ".OF'CONSTRUCTION .: ,, !, `` "� "' i � kW.`: ,.;,�? >fi for,eacl intiity connecttdn) 4 s, "` SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00 ❑Acces'sory Building ,t Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 -P JOB..` SITE; INFORMATION'andzLO N ,4. Fire sprinkler - sq. ft.: Page 2 Job site address: /3 %a2 a€ , / A, . ' _. ;,:...; - .4,„ . ;. 1 „ ,,.., , 1 .., ,: r � " � r�;�,,;�Site;i7tilities" �, �,,; . „-,,., Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: DrywelUleach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) - Page 2 Tax map/parcel #: _ `< -'.: ,!_ `=Fiztnreror.Item : . .. „ .,. _ , ;, :; OF:WORK',:.' :'q-.:: .:. =a �,'n'r. =^ <t• : Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ,.® PROPERTY.OWNER.r/ // ' 1 ®;TENANT; ' , ,. �r Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /Zip: Floor drain /floor sink/hub 16.60 Garbage disposal . 16.60 Phone: Fax: Hose bib 16.60 ®lAPPLICANT;�• .. ,t,n,,, : ', �h; ®t; CON.TACT.P.ERSON- Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City /State /Zip: Primer 16.60 Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 1 16.60 E -mail: Tub /shower /shower pan t 16.60 .,. '4 7• ;: CONTRA" C - T,OR,. :r ° *'::`' --' °• , .rs -, " Urinal 16.60 Water closet i 16.60 Business Name: &-4.-'5 pll?1MSCtJG Water heater 16.60 . Address: Other: City /State /Zip: i_k D1 Other: Phone: Fax: . ` =K`' '�`'''' `ski»', *P1aRltiingFPermit.Feest` ;, i` ?rs., ` a F „`l -4..;- ,. Subtotal $ CCB Lic. #: Plumb. Lic. #: 3ii.L/i/Pf3 Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 Signature: Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ (Please print name) 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. is \Dsts \Permit Forms \PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: v StteUtilities a s ;Qty s gee (eaj, Total° Square' Footage: 'Permit.Fee: Footing drain - l 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer 3,601 to 7,200 $220.00 ewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation:. ., Permit,Fee: • Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each 00 r additional 100. or fraction I,V. Fixture or Itent ;.< , °4 ' . ,!;; 3� 490'4, .12.Fee_(ea) # ; ,Total ' '= o coon 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 $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 *. Per " Comments regarding fixture work: rs„a .,�;- • 1^ 'tw,m; yr „±�.:. Fixfii'ce =Type: +._ ?,` F,tv M n , . Replace 4 P k . 9'M6v "ed _ 3Existing `Gapped?; 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 er p Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - 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: is \Dsts \Permit Forms \P1mPermitAppPg2.doc 01/03 Mechanical Permit Application FOR OFFICE USE ONLY Received Mechanical EC R Date/By: Permit No.: Jfa2D3 'BOO /" City of Tigard \u/ D 11 Planning Approval Building Date/By: Permit No.: 13125 SW Hall Blvd. OCT Plan Review Other Tigard, Oregon 97223 3 ( it.., Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 • Post - Review Land Use Internet: www.ci.tigard.or.us -- �aoo� . .' J� CITY O' I Date /By: Case No.: Contact luris.: 24 -hour Inspection Request: 503- 639- 417i5LDIt� ;,� ,7,t Su See Page for p q Name /Method: Supplemental Information. . . T YPO° E;F WORK' °; _ t ;: <' :: :COMMERCIAL'-FEEt SCHED + `.�. ` �. "' UI.E;�USECHECKL:IST,` £,i ❑ New construction ❑ J' Demolition Mechanical permit fees* are based on the total value of the work dditton/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all .;`r # r,CATECORY,OF. CONSTRUCTION ? h':= "' *,, mechanical materials, equipment, labor, overhead and profit. ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule . ❑ Accessory Building ulti- Family -' ; RESIDENTIAL 'EQUIPMENT /SYSTEMS.FEE SCFIEDULE ; :' Description I Qty Fee(ea.) Total 111 Master Builder Other: Heating/Cooling a; °s's,,:' : JOB 'SITEINFORMATION a nd LOC TION :_'2 ?''.' ''1.', Furnace - add - air conditioning ** 14.00 Job site address: (37 2. jI...x.3 U 5 p . Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work ( 14.00 Project Name: 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 Tax map /parcel #: Other Fuel Appliances Water heater 10.00 .. i ': : 'T......, - ' ".F'DES,CRIPTION OF,:W. ,ORK '..;; ;' :: ", `': ' ;. ;. Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 ;=XFPROPERTXQSYNtk ; ^ '-iO TENANT >' ;' *: ".: ,-; `i,,t: Other: 10.00 Name: J'f D rIi fit- Environmental Exhaust & Ventilation ' Range hood/other kitchen equipment 10.00 Address: 1 - 7 l W" 1 r N 1p l • Clothes dryer exhaust 10.00 City /State /Zip: Ttc(2-\7 oZ Single duct exhaust Phone: 5C3 - - -11,1 Fax: (bathrooms, toilet compartments, ❑:A ' PPLICANT.: .. .. ' ® "'CONTACTPERSONt� _G `P`'' , utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Address: Other 1 0.00 City/State/Zip: Fuel Piping }� p * *($5.40 for first 4, $1.00 each additional) Phone: Fax: Furnace, etc. ** Gas heat pump ** E-mail: Wall /suspended/unit heater ** _'. : • e._ ._ . _ . . .- .: e'.k Water heater ** Business Name: 14.0 me it .1.yN>GZ, Fireplace . ** Address: Range ** City /State /Zip: �..:. BBQ ** Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lic. #: Total: ` Authorized Mechanical Permit Fees* ignature: Date: Subtotal: $ Minimum Permit Fee 572.50 S Plan Review Fee (25% of Permit Fee) S (Please print name) State Surcharge (8% of Permit Fee) S TOTAL PERMIT FEE S 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. . is \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 $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. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. i:\Building\Permit Forms\MecPermitAppPg2 09- 01- 03.doc " Electrical Permit Application FOR OFFICE USE ONLY ._ Received Electrical l Date/By: Permit No.: l ine- 7 7 - 0-00 _b05/ City of Tigard R EC E _ V E © Planning Approval Pe Y g � Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 o (' A `J` �� Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 �, ��. "N i \ Date/By: Post - Review Land Use Internet: www.ci.tigard.or.us _ s e � ! .1 Case No.: • (:ir{ C..- - Contact Juris.: ® See Page 2 for 24 hour Inspection Request: 503-639-41:75 , bLDING DIVISION Name/Method: Supplemental Information. � - YaEhti k.: ;;e � ° fi.,z c ; 7 .�. _ «L' U .' . °� a , ; li ,- ` MOW P .,,w '"- a. x`, xr.,�.' ME . , .., y„„- v. .: , }sue � a�j,�x< »��� . . .. '. � � _�. �N�O�;_„�,�,,�:�:� 'At ' �, -5'�a , �' �AN�? :(Please,c�eck,alla�ha�aP.PIY�) .:{,� Y,��� ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility • ddition/alteration/replacement El Other: commercial over 320 amps-rating of ❑ Building over 10 10,000 square feet, ❑ Service q =3 l C.,4 FE„GQWOF GOV$Tg> GTI,®F ,; ,' , ' n I & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial El System over 600 volts nominal one structure 111 Accessory Building Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: MI _ ; ; "rio-: % , e i <t t Submit sets of plans with any of the above. ; f�� , � 7O, BxSI�E�INI�O- R1V,I(1`L'(a_ndOC�:�ION;� °�,�.. � � �� The above are not applicable to temporary construction service. Job site address: %?�� 1- 0 1t. • �y a . Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential - single or multi - family per 1 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 Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: ' Each manufactured home or modular dwelling me „' i m' m DES RI'I'`)C O ?logy s Wit;„ ` e ` iltM service and/or feeder 90.90 2 Services 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 T ' „ 1 x ` la.. IS :fat`=°=, . ; ; 601 am Ps to 1000 amps 240.60 2 am �:QW�T;ER _ :,:,<� � t? :nTEN�T � �� „� �;: °,..°. P P /� Over 1000 amps or volts 454.65 2 Name: . 3 A pT N`9 %- V��, L1 Z' Reconnect only 66.85 2 Address: 1 '6” 7 l'2, e, JJ 1 TN pt.. • Temporary services or feeders - installation, alteration, 00 amps o less relocation: City /State /Zip ' T i 6� 1 f Z 200 amps or less 66.85 1 Phone: 533 Sic/ —Siltax 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 PI ”" P C' l?E . . 3 O uCOI\'T ' P.T!. SOI , ' Branch circuits - new alteration, or Name: extension per panel: - Address: A Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: 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): r r o n m m_ : iw Each pump or irrigation circle 53.40 2 '`� s _ � Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: } -}oyN'e Cui t\-1€\ alteration, or extension Page 2 2 Description: Address: j Ml Pc City/State/Zip: Each additional inspection over the allowable in any of the above: y l� • Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: Lie. #: Other: te ' � ���__�����- �� >��,�; -� ���- -.,� SASIMI ca>� er-: it, ee * It ; . to t Supervising electrician Subtotal $ signature required: 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 MI a. 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 n Burglar Alarm El Garage Door Opener n Heating, Ventilation and Air Conditioning System n Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls E Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation • HVAC • n Instrumentation E Intercom and Paging Systems ri Landscape Irrigation Control O Medical n Nurse Calls • n Outdoor Landscape Lighting El 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 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 3 — 003-/ - INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Ro 00- 60 36 L Received Date Requested 3 -31 AM PM BUP Location / 3 71 2,. /3 U t- Suite MEC Contact Person Ph ( ) ' PLM Contractor Ph ( ) SWR CILDINCW Tenant/Owner ELC 9-000 Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: L PART FAIL Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: anal PART FAIL • CHANT L _ PoSTeam Rough -In Gas Line Smoke Dampers a PART FAIL Service Rough -In UG /Slab Low Voltage Alarm dtr 111 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ig El Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line 2 ADA Approach/Sidewalk Date 3/3/10 G l Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL