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Permit • A. CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00268 _AVM DEVELOPMENT SERVICES DATE ISSUED: 10/12/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 06770 SW ALFRED ST PARCEL: 1S125DA -12000 SUBDIVISION: LAWRENCE PARTITION ZONING: R - 4.5 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,848 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 823 sf GARAGE: 894 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 269 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,671 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 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: 4 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: let W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEWSECTION 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: $ 8,644.95 This permit is subject to the regulations contained in the ROBERT H. LAWRENCE OWNER Tigard Municipal Code, State of OR. Specialty Codes 15840 SW BOBWHITE CIRC and all other applicable laws. All work will be done in BEAVERTON, OR 97007 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: 503 975 - 6560 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 Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Low Voltage Rain drain lnsp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Gas Line lnsp Storm drain Insp Mechanical Final Footing lnsp Crawl Drain /Backwater Framing lnsp Gas Fireplace Water Line lnsp Plumb Final Foundation lnsp PLM /Underfloor Shear Wall Insp Insulation lnsp Water Service lnsp Building Final Post/B =- - . —I Mechanical lnsp Exterior Sheathing Insl Gyp Board Insp Appr /Sdwlk lnsp Issu - d By : ii, 0,, . I i Permittee Signature : y ,......' - Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne siness day Building Permit Application c[ � FOR OFFICE USE ONLY City of Tigard SEP 0 ' DateB �dI d 1`—� j� Permit No y = �� PIII I 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review p O ,, O CITY OF %M ^ ' t. Other Permit: �. / r /'I. G s Phone: 503.639.4171 Fax: 503.598.1960 �I ,, t D a teB ! i t• � a Inspection Line: 503.639.4175 BUILD, - st i.. ., ? ,. Date Ready/By: 9 , O lS ® See Attached Checklist for Internet: w .ci.tigard.or.us Notified/Method: Supplemental Information """Del-to y Q.N tr — a P,.. —.. q 2111%5• -I_ibl • • 1:. ,.. ., . TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING MNew 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 CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 1 Sp 000 , o c, ,� 1- and 2- family dwelling ❑ Commercial /industrial E3 Accessory building ❑ Multi- family Number of bedrooms: 4 - ❑ Master builder El Other: Number of bathrooms: Z 1 / - 2-- JOB SITE INFORMATION AND LOCATION Total number of floors: dor Job site address: G 7 7 U , 51A/ A L F 2 17 5 T re E New dwelling area: square feet 7/ City /State /ZIP: 'rt Z - A - 2 17 I Q r2. q -7 2 2 3 Garage /carport area: 'd, y--91 ,., - square feet Suite/bldg. /apt. no.: - Project name: -- Covered porch area: " " " -. square feet Cross street/directions to ob site: N --� 1 S, tom/ — L O ‘A/EST Deck area: square feet e , rt A V P rte. 1 7 A P P v rt. G x g L oc- C S To Other structure area: square feet 5 , -r;_ REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 16 ht L -5 1/ t a vv I Lot no.: 46 Permit fees* are based on the value of the work performed. l Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: �A4fZLEv •,'4 /' C PuT. i '. - 0 0 ° 1 0 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK • work indicated on this application. �` F— Valuation: $ N M \A/ S r 1-k C- c- e. >= A t`n t t....-.-r" )--+ O Existing building area: square feet New building area: square feet • X PROPERTY OWNER ❑ TENANT - Number of stories: Name: iFo b e e- -- r -.. 4 t L Q , 'e ^ Cr v Type of construction: Address: 1 5 F 40 S, N/, Bo b w h ire.... G! rG1 e Occupancy groups: City/State/ZIP: 8 ` . Q a c e- To n f Q r. Cx 1OO 1 Existing: Phone: ( 5o3) q79- a 56 0 Fax: ( *3) .2 G 5 - 8 Z . K'3 New: XAPPLICANT ❑ CONTACT PERSON NOTICE Business name: — All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: re b e.T )- I , (_a,.,.. • e . et. under ORS 701 and may be required to be licensed in the Address: i 4 41 s, I , S /, go}jf.✓ h ;r ..-,,..e.„ C - °_ jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: Sect ✓ ei - Toh Qr . g7tao apply: Phone: (50,) 975, .. ( Fax::( �j -;„26 S.iZ E -mail: — CONTRACTOR Business name: A p i L f L■A f - t T" £ 0 vc/ h4 t. rz_. BUILDING PERMIT FEES* t Address: ( 3 Please refer to fee schedule. City/State/ZIP: / Fees due upon application Phone: ( ) ✓ Fax: ( ) Amount received CCB lie.: Date received: Authorized signature: � g /�J 01,/ This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name: ra,bt rT 1-I . L. a'.✓ re ^ e. 4E, Date: 9_ 7-0 4/ * Fee methodology set by Tri -County Building industry Service Board. ppz a 5. d D ( $E i. \ BuildingiPermiu \BUP- PermiIApp.doc 12/03 440- 4613T( II /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 Associated Phone: 503.639.4171 Fax: 503.598.1960 4h yiNi i ,,, (;a Dated att ed permits: 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 I Land use actions completed. See jurisdiction criteria for concurrent reviews. Pt_i' }' ® ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. R y t 5 - ❑ ❑ 3 Verification of approved plat /lot. ® ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ . l 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. -t v ❑ ❑ 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 he plans with cross references between plan location and details. Plan review cannot be completed if copyright vio(.zticas exist. 11 Site /plot plan Jrawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if 21 ❑ ❑ there is more than a 4 -8. 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 t ❑ ❑ 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 YEa ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ -. architect licensed in Ore:on and shall be shown to be as slicable 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. El ❑ ❑ 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 • Electrical Permit i FOR OFFICE USE ONLY Received City of Tigard Da[eB Plan Review Permit No.: g 13125 SW Hall Blvd., Tigard, OR 97223 y Phone: 503.639.4171 Fax: 503.598.16Ep 0 9 200 4 ""L' 1 1 'i ' :� l\ Date/By: Other Permit: Inspection Line: 503.639.4175 -a I Date Ready /By: tuns FO See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information a910N PLAN REVIEW ` New construction ❑ Addition /alteration /replacement Please check all that apply: ❑ Demolition ❑ Other: 0 Service over 225 amps, comm'I 0 Hazardous location ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. II., CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential %I - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi family ❑ Master builder ❑ Other: ['Occupant load over 99 persons 0 Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: - Job site address: 770 ❑Health - care facility ❑Other: G ' / " S T Submit 2 sets of plans with any of the above. City /State /ZIP: Te -,4 1r p Ovj; 972 Z A The above are not applicable to temporary construction service. / FEE* SCHEDULE Suite/bldg. /apt. no.: — Project name: Description Qty. Fee. Total Cross street/directions to job site: . 5 . W, ti Z •' - z__, GlIe,ST New residential single -or multi - family dwelling unit. Includes attached garage. ay ,94r�� AQ/J A' , 2 gLI $ 7 $ , 1,000 sq. ft. or less / 145.15 4 Subdivision: /lip✓! S <<✓ �4� Lot no //,,- Ea. add'I 500 sq. ft. or portion 33.40 I Limited energy, residential / 75.00 2 Tax map /parcel no.: fiy,rC 0 ' / e e ne4 ?) /f!L P2 I'5 Q� /!/ Limited energy, non - residential 75.00 2 DESCRIPTI N OF WORK Each manufactured or modular / dwelling, service and /or feeder 90.90 2 N L� /ri'cL. / "/9/W /'�Goi.e.- Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: /-g ,‘i� /^" ,I/, 4A 4,,,,re0.4. G. 601 amps to 1,000 amps 240.60 2 Address: /S�4- .5,-. G./ , �,...„ ,7 cj�f/G� Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: .e /t,,,e/z2� ‘2," 9'700 7 Temporary services or feeders installation, alteration, and /or ( /r 3) 97 O ( 'Jr 0 ) X65- 51 relocation Phone: L l �� LJG Fax: 3 / 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I o 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 APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: ,y/ / 4 branch circuit B. Fee for branch circuits Contact name: /7 A " L,,,,,,re vG €... without service or feeder fee, 46.85 2 each branch circuit Address: /If OP v6: Each add'l branch circuit 6.65 2 City/State/ZIP: ✓ Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) • Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: ` j i- /7 .. ` - G ........ Each additional inspection over allowable in any of the above Address: pc., GY 7 5 / Per inspection 62.50 City/State /ZIP: / L fB , 9 7/.2 3 Investigation per hour (I hr nun) 62.50 Phone: (S03) a 4 ;7 ,./ y Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: 3 O S/ Electrical Lic.: / - Suprv. Lic.:, y 77 Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: 0,4 v/ /, J fee, ¢� Date: TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • 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: RESIDENTIAL WORK ONLY: 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: - ►"t -c.E i -.-c I., _ Lim r'Ge v COMMERCIAL WORK ONLY: 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 is t Building \Permits\ELC- PermitApp.doc 04/03 City Mechanical Per CRIED FOR OFFICE USE ONLY Received Date/By: '[ Permit No.:�/ � t1 � Q City o 13125 SW Hall Blvd., Tigard, OR 97223 O 9 A 1 00 � Plan Review Phone: 503.639.4171 Fax: 503.5 0 e7 /„„,,,ry' i\ Date /By: Other Permit: Inspection Line: 503.639.4175 � 1 i r• �� Date Ready/By: funs. See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work New construction ❑ Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) al all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION I RESIDENTIAL EQUIPMENT / SYSTEMS FEES* - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For specie! information use checklist. Multi- family E Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: h 7 70 S, 1,A,/ . A . G/?ED 5,7 T (requires site plan showing placement) / 14.00 City/State /ZIP: 7 /-/I 2 U / © Z /p, ct 7 Z ; Furnace 100,000 BTU (ducts /vents) / 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: a N O ` L o - r Duct work / 14.00 S' Hydronic hot water system 14.00 ,, A ,.. A- pl"'? , Z 8 LOC k S Residential boiler (radiator or hydronic) 14.00 Tb 5 .7 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above / 10.00 Subdivision: /4,,a_ $ 00 vs/ Lot no.: jP0/4 /EGG IvT /• Other: 10.00 Tax map /parcel no.: P, '4- / /91LP ZUG3- C'e'p i0 Other fuel appliances DESCRIPTION OF WORK Water heater / 10.00 Gas fireplace / 10.00 N�� / , y /GI e - do7l / ‘ 1* / 4 j /G006'�.� Flue vent for water heater or gas fireplace / 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 PROPERTY OWNER ❑ TENANT Other: pA oar «r I 10.00 Name: 2Z et�7--* Ai, L,« ./re. C 4l- Environmental exhaust and ventilation Range hood /other kitchen Address: / j t [/p S4./ 3 4s.7' -- Ci- /` equipment 1 10.00 City/State/ZIP: Clothes dryer exhaust I 10.00 tY �,c d am• TG �i� , 970D7 g / Single -duct exhaust (bathrooms, Phone: (5p 7! - � rj`Q Fax: (5e3) Z 6 5 - g 7'4'3 toilet compartments, utility rooms) L l 6.80 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: N A Fuel piping Contact name: �o 4, /7/ • LA w--OArG C-- $5.40 for first four; $1.00 for each additional Furnace, etc. f Address: C/-, ,9a vim/ Gas heat pump City/State/ZIP: \ ✓ , Wall /suspended /unit heater Water heater I Phone: ( ) ✓ Fax:: ( ) ! Fireplace E -mail: -- Range /G.odKroi' / CONTRACTOR Barbecue / Clothes dryer (gas) Business name: /7 B,,Lp / r../ Ei/ 7' >, Other: Address: .,./ 5 e ✓ F."e / rt' ,r •l" XP MECHANICAL PERMIT FEES* Subtotal City/State/ZIP: �.G�/ O/5/ c' T y` P. y7D /I / 61A Minimum permit fee ($72.50) Phone: (5) - ) v 7 ' Fax: ( ) Plan review (25% of permit fee) CCB lie.: " 7 , 1 £7iC4 - ' 12. - /O l /O State surcharge (8% of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: ,// ,�,,- ,,,r�uk days after it has been accepted as complete. Print name: b D ate: y /,� 5 /" * Fee methodology set by Tri County Building Industry Service Board i.\Buildin ¢\Permits \MEC•PermitAOD.doe 12/03 440- 4617T(11 / / 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:\ Building 'Permits\MEC- PermitApp.doc 12/03 2 Plumbing PermaD FOR OFFICE USE ONLY Received I q� City of Tigard Date /B Permit No.: i.M -9,09 .024 g 13125 SW Hall Blvd., Tigard, OR Q 9 200 y • ww ` Plan Review Phone: 503.639.4171 Fax: 503.5 ection Line: 48 60 /4>ha all■ . ry t' D ate /By: Other Permit No.: �wp f'`I+ Date Re ady /By: Juris. 24- Hour Ins Li 503.6 ��i 1 � /S OF.T I�Rp `' P � � See Page 2 for Internet: www.ci.tigard.or.us . Notified/wtethod: Supplemental Information r • ■ • ■ • , TYPE OF WORK FEE* SCHEDULE W New construction ❑ Demolition For special information use checklist. j Description I Qty. I Ea I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 5(1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building El Multi-family SFR (3) bath (2 i/7_) l 399.00 Each additional bath /kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: to 7 7 ‘ ) 5, l ,e/ , /4 L GlZrs l7 gr T Catch basin or area drain 1 16.60 City/State/ZIP: - T j 4 Ar /Z p a 2 , Cf 7 Z'Z 3 Drywell, leach line, or trench drain 1 6.60 Suite/bldg. /apt. no.: - I Project name: - Footing drain (no. linear ft.: ) 1 _' Page 2 Manufactured home utilities } 110.00 Cross street/directions to job site: s . vt/, w a rl 7 - L ee �/ `� ST Manholes 1 6.60 O - A- e_ 12 E r] / r rz u x , rs - 4,4.. /c" 5 '7 e, Rain drain connector ) 1 6.60 5 t TE Sanitary sewer (no. linear ft.: • ) 1 Page 2 Storm sewer (no. linear ft.: • - ) j Page 2 Subdivision: Lot no.: u Water service (no. linear ft.: ; 1 Page 2 1(t i._i « t / law dr Fixture or item a Tax map /parcel no.: � rt,«l_ / Re_ PC.4T n,t Plop, -00 Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer6.20.wi. (7 ¢ivts) I Page 2 N.� W 5 t Iti �- - E Fft■ KA t 4. F M E - Backwater valve 1 16.60 Clothes washer 1 16.60 Dishwasher 1 16.60 Drinking fountain 1 6.60 PROPERTY OWNER I ❑TENANT Ejectors /sump 16.60 Name: g G b e ,.T ►-t , Law / < <„,• Expansion tank 16.60 Address: 1 S i- L1 U 5 , t,J . go w In t-t' c t rG 1 Fixture /sewer cap 16.60 City/State/ZIP: g a ,,-t - ,., C9 r, q -7 v u 7 Floor drain /floor sink/hub " 16.60 Phone: (0 5) 4 7 L - 6 ,54 c .„) Fax: ( , 5 . e 2 ¢3 Garbage disposal / 1 6.60 �{ Hose bib Z. 16.60 �l APPLICANT ❑ CONTACT PERSON Ice maker / 16.60 Business name: 1 A Interceptor /grease trap 16.60 Contact name: 1 p 1 e ,.T 14, L a w / e M C.�....0 Medical gas (value: $ ) Page 2 Address: p. 3a ,., __ Primer 16.60 City/ State/ZIP: , - Roof drain (commercial) 16.60 Sink/basin /lavatory 6 16.60 Phone: ( ) r I Fax: : ( ) Tub /shower /shower pan Z 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet Z 16.60 Business name: L 13 PL /.,/frf /P /41 -... " .. Water heater 1 - 16.60 Address: �,l /p .5.6. 3 9 �� e /� Other: Subtotal City/State/ZIP: /1 / L4S ,gvltl4 / C ,e, 974' 3 - Minimum permit fee: $72.50 Phone: (5v 3) % /Q -..,. 3. / / Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: / 9 9Q 7 Plumbing Lic. no.: 3y e // /PB Plan review (25% of permit fee) /4r ,irE Fowc oft= 30 // .7 State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. o ./ 7 *Fee methodology set by Tri- County Building Industry Service Board i - .\ Building \Permits\PLM.PermitApp.doc 12/03 /J-1 •veG 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 S 5 , 0 to 2,000 $115.00 Footing drain - each additional 100' / 46.40 i/G 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' / 55.00 5S. oe, 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' / 55.00 S 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 y4 ,5 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Qty. Feel(ea) Tota additional $100.00 or fraction thereof, to and Fixture or Item 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 f and and including $25,000.00. Rain Drain, single family dwelling / 65.25 G 5 1! $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 $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by;(Fixture) Work Performed' Fixture Type Replace New Moved Exlittng Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator - Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial n increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service > Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: \ Building \PermitaLM- PermitApp. doc 3/03 Permit #: M Aar gOO4 - DO A Co g .F n �� '"` Address: 1 0 770 0 A i� --1--- 1•a► s r l '*:!$�°'�` Issued by: Date: 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 1. I own, reside in, or will reside in the completed structure. F r* 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale r ' A . before or upon completion. ri 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 / A d 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 out Construction Responsibilities on the reverse side of this form. ignatiire a'rmit applicant)? (Date) (White copy to issuing agency permit file, pink copy to applicant) xrt 340 1(11'} i(t aif'3 1. /t34 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE DAVID JEROME ELECTRIC OFD PO BOX 751 o c T 1 HILLSBORO, OR 97123 2004 G p � S Electrical Signature Form � Permit #: MST2004 -00268 Date Issued: 10/12/2004 Parcel: 1 S125DA -12000 Site Address: 06770 SW ALFRED ST Subdivision: LAWRENCE PARTITION Block: Lot: 001 Jurisdiction: TIG Zoning: R -4.5 Remarks: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. Your company has been indicated as the electrical contractor for the permit indicated above. I n order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: ROBERT H. LAWRENCE DAVID JEROME ELECTRIC 15840 SW BOBWHITE CIRC PO BOX 751 BEAVERTON, OR 97007 HILLSBORO, OR 97123 Phone #: 503 - 975 -6560 Phone #: 648 -5144 Reg #: LiC 36051 SUP 2877S ELE 34 -119C AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of Supervising Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE G & B PLUMBING PO BOX 1269 HILLSBORO, OR 97123 -1269 Plumbing Signature Form Permit #: MST2004 -00268 Date Issued: 10/12/2004 Parcel: 1 S125DA -12000 Site Address: 06770 SW ALFRED ST Subdivision: LAWRENCE PARTITION Block: Lot: 001 Jurisdiction: TIG Zoning: R -4.5 Remarks: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: ROBERT H. LAWRENCE G & B PLUMBING 15840 SW BOBWHITE CIRC PO BOX 1269 BEAVERTON, OR 97007 HILLSBORO, OR 97123 -1269 Phone #: 503 - 975 -6560 Phone #: 503 - 640 -2311 Reg #: LIC 19907 PLM 34 -44PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X `' 1 e w' 3011 T P Signature of Authorized Plumber If you have any questions, please call 503.718.2433. 1 ; ; Li: - • 1 . - . 1, t; ■ i .., . , , , , 7 �2a ? 15A c.a. s 7 ? T: ` I X s� $ r T x- r l T x V x AL .. ... { , j. 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S6 w Ktl.+4'-i_ y,wtf ~' 1 $t T � et. tap R - r., 4!Y tas '(Xo∎0 EROS,oN SCA 4 77q S,5.10V. �t4Pica7 � $NC� -r • <-A P, O4.. 4• f�3Z��s $'-'0" .4 • CITY OF TIGARD 7 SITE P�' � �� , BUILDING PERMIT NO.: v����r ��M PLANNING DIVISION: Approved ❑Not Approved Required Setbacks: ❑ Side: S Street Side: .46- Garage: 422— Rear: /5 Front. A.2- Visual Clearance: , �{ Approved pP Not Approved ❑ Maximum Building Height' feet No CWS Service Provider Letter Required: a Received �,�_ . . Date: 9 -/s 0 ENGINEER ' G DEPARTMENT: Approved Actual Slope:_% Approved ❑ Not App /► .proved ❑ Not Approved Site ' an: t ! . - Date: Notes: if 7LQ ..vh U nacherytz 70 dry f' oAq '�' 1444 eO 1 CITY OF TI RD C O GA BUILDING DIVISION G / v PERMIT #: MST20I 4 -QQ269 13125 SW Hall Blvd., Tigard, OR 97223 ISSUED: 10/12/2004 Phone: (503) 639 - 4171 � o��q��f;aopi�fli t i l A Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE: 26 SITE ADDRESS: 06770 SW ALFRED ST CLASS OF WORK: SUBDIVISION: LAWRENCE PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: LAWRENCE DESCRIPTION: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. OWNER: LAWRENCE, ROBERT PHONE #: 603- 975.6560 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/13/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 1/00 299 Final inspection 009087 -02 503 - 975.6560 V Corrections /Comments /Instructions: . A I ) III 2 4"*" PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED l Inspector: VO/ Date: Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00268 • 13125 SW Hall Blvd., Tigard, OR 97223 .7 DATE ISSUED: 10/12/2004 Phone: (503) 639 -4171 � Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/13/2005 TIME: 7:08AM PAGE: 27 SITE ADDRESS: 06770 SW ALFRED ST CLASS OF WORK: SUBDIVISION: LAWRENCE PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: LAWRENCE DESCRIPTION: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. OWNER: LAWRENCE, ROBERT PHONE #: 503- 975 -6560 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/13/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 009087-01 503- 975-6560 N Corrections /Comments / Instructions: • • • ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v 1 Date: ("4 Phone #: (503) 718- r g‘zil r , CITY OF TIGARD .BUILDING DIVISION PERMIT #: MST2004 X10265 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/12/2004 Phone: (503) 639 -4171 Ai, �� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/10/2005 TIME: 7:05AM PAGE: 40 SITE ADDRESS: 06770 SW ALFRED ST CLASS OF WORK: SUBDIVISION: LAWRENCE PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: LAWRENCE DESCRIPTION: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. OWNER: LAWRENCE, ROBERT PHONE #: 503- 975 -6560 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 006902 -01 503. 975.6560 Y Corrections /Comments /Instructions: r /'4 .M //�D I�l�r� ^PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS [I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: rjL jA/ Date: / f Phone #: (503) 718- CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST2004 -00268 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/12/2004 Phone: (503) 639 -4171 ii„ �ril4jm u � 1^ f� Inspection Requests (24 Hrs.): (503) 639 -4175 '� I. — INSPECTION WORKSHEET FOR DATE: 6/6/2005 TIME: 7 :13AM PAGE: 84 SITE ADDRESS: 06770 SW ALFRED ST CLASS OF WORK: • SUBDIVISION: LAWRENCE PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: LAWRENCE DESCRIPTION: New SF detached. DEMO CREDITS FROM BUP2004 -00193 APPLIED TO THIS PERMIT. OWNER: LAWRENCE, ROBERT PHONE #: 503 - 975 -6560 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/6/2005 Pour Time: 11 Code # Inspection Description Confirm # Contact # Message e - p p 9 w 399 Plumbing final : 008459-01 50975- 6±=,60 Y "'/�`�, a ji-lf Corrections/Comments/Instructions: • /J 3 . / / 1A )�.e - � �° - 0 ( occic- /v — ' i 1 t LA/U ( e L,t,,` k-0 , rL r ct c.-4 -Ai 7 I II , G/s k — / - ► If h . • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED V6 tAr(------ Inspector: Date: / 6 / °.S— Phone #: (503) 718-