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Permit i.` CITY O F TIGARD MASTER PERMIT PERMIT #: MST2004 -00132 o 1 DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004 11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13092 SW ASCENSION DR PARCEL: 2S104CB -02900 SUBDIVISION: HILLSHIRE WOODS ZONING: R - BLOCK: LOT: 075 JURISDICTION: TIG REMARKS: 208sf. adddition and 208sf.upper deck. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 16 FIRST: 208 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 22 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 208 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: 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: EA ADDL BR CIR: 100 SIGNAUPANEL: 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: $ 640.16 This permit is subject to the regulations contained in the LUSK, KIMETHY D OWNER Tigard Municipal Code, State of OR. Specialty Codes 13092 SW ASCENSION and all other applicable laws. All work will be done in TIGARD, OR 97224 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 - 880 - 0781 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 Footing lnsp Crawl Drain /Backwater Exterior Sheathing Insl Foundation lnsp Mechanical lnsp Insulation Insp \ Post/Beam Structural Electrical Rough In Electrical Final Post/Beam Mechanical Framing lnsp Mechanical Final I Underfloor insulation Shear Wall Insp Final inspection ►, Issued By : . Permittee Signaturei! Allit i Call (503) 639 -4175 by 7:00 p.m. for an inspection needed th> t ess day RECEIVED • Buildin Permit • t i 8li ?AigU FOR OFFICE USE ONLY F f4 • tit`: City of Tiga CITY OF TIGARD Date/13y: Pi 1iv 4 r Permit No. T2.[00 �`,��� 13125 SW Hall Blvd., Tigar.;, EYN DIVISION Plan Review vP �� Phone: 503.639.4171 Fax: 503.598.1960 ado +� Date/By: ��/ — 7',,,, ' /� t� Other Permit: � � Inspection Line: 503.639.4175 ,,,�.1. II DateB Date Ready/By: 5..../0 C h 1 11., i s: � 0 See Attached Checklist for Internet: www.ci.tigard.or.us — i 1 �/ t y � �� Notified/Method e y `d /�F� / Supplemental Information $ .3 lam'"sa"` i . , - "'t '� r ,a. .„ . k ;a � `::' ' &. ,k � : R :; l &,� i s ;a:.uX° . ." T,, ,„ wWORI{ mi .t,,, ,�u e m ;- IZE =,iJI&ED DATA. , AND 64 :�� � ^�e,,�- ts"f��;,;�'�� � .. ��:r� �''•s>.�°= '�E� =�': ». e�.�,.:c ...�:;: �"3 e�,...,.� '?;.,'�„"izr��• =�,�::ti� :: �: �. a:, i,; �Q' -•.*. _ E;. TS' �":=:` �." d�` a; �:. c�:,:.,^' d ° »z.!�';r:�'?kr.�:�,k�rr ...;. .,.,k,..- ..:,•:;�:.: , ❑ 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 � i °� ` " ''' ' s* V'' AFGOR 'im' t Y O it F COI�ST ilt t g r' , " ' i work indicated on this application. a . 'C . � . 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ � p� / ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms. z "'�i" : �? "« ` ,A : a , rH'.w._fi '> �;::. ? s' r '; ,--' °.E y ,: ;: _i?; _,Ki,' °= x' _';„;f rAM:.a°v" '�-;5£.?; €' gli Total number of floors: t � t � h r= , *m .- j- k I ® AAI-9 �t '°'; 9 Job site address: 13 0 9 .. 5 /1 'C 5/ 6A/ New dwelling area: ? square feet 77 City/State /ZIP: 6 �4 © A. Garage /carport area: ` square feet Suite/bldg. /apt. no.: r 6 e� Proj name: U s Covered porch area: square feet Cross street/directions to job site: 7X,/ 1 S' /I �./. Deck area: 2 square feet �—! / � "'"- � 7`-`- Other structure area: square feet ` EQU1R D DATA'`% COrVI•N ERC.IAI/»USE= CHE;CKL °IST Subdivision: Lot no.: 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 equipment, materials, labor, overhead, and the profit for the 41-1:1C:•, eglgi � '„ ESC'DR :'rtor. ' r° v '^``"" ° "` N ' - - lication y work indicated on this a . . t i. $ O R �n �VO1tI� — P/9797 !L & � / . y 7 ®. ) Valuation: $ j /' N Existing building area: square feet New building area: square feet tagif •cis a _ .. .. is a Z e k- r '�• "`- & : PR 9 PF1RTY O�i'N r TENANT ! t �" Number of stories: Name: A A4 1-EIS1 Type of construction: Address: /30 2 j w /mac te Occupancy groups: City/State /ZIP: `/6D 0 � Existing: Phone: (5 3) go • 67 r 1 Fax: ( ) New: a' l ; RC ' );, .t"•.:•3 w s ", 4;.. � Vi a.- 4mii . , C,. ®r . . AP PLICA NT 6 CO NTAC ,- .I`PER j,- :,k= le :1,`s„,.' ,, .,. 3 ' :�#:: t.�:�:i1.�3' .. - >_ .i s � .,.,sr : , �..;" �;bF`tx>i: zs z:�iz<; �>,r . ^.? .�. :o ..' "'''''F''' ti �` ° =:1 -i :e..So- k4, - , : -. z, ; .;i . , S,1 1, yaikli : Business name: BL,,�#{•, Cit 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: 1470 ^ / ( ,J /l G Zh— 4-1/ jurisdiction in which work is being performed. If the City/State /ZIP: , applicant is exempt from licensing, the following reasons !`-- pply: II Phone: (5 ) 6 4 I , s - 7 2 3 Fax: : ( � / 3) ,� 5-066 l �� (. 0 7 E -mail: 4 � . � � � : e4 , NTR A CTOR t * 4 ` . ... , . � � . � !� �7� n ., � vr r� , ,.3� � . � � > � �� . _ � a• ._ say �-&5 .�w Business name: A/ . - �_ i ; , w ..P� RMIT F -EES ;' '' ' x , ,,;''A:';'.",, ` . . , Qf/t/ .,. . i• t 7, B7JIL ,, s„ .F, *. ,,:. t`" Address: sue- �w < Please refer to fee schedule. City/State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lie.: 4 Date received: Authorized signatu - • This permit application expires if a permit is not obtained ti within 180 days after it has been accepted as complete. Print name: ,.41. ¢� O " �e� Date: * Fee methodology set by Tri- County Building Industry [ t Service Board. r\ Building \Permits \BUP- PernitApp doe 12/03 440- 4613T(11 /02 /COM/WEB) One- and Two - Family Dwelling . , , Building Permit Application Checklist .FOR OFFICE USE ONL City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Associat Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 &slp i i 7 '"' 24- Hour Inspection Line: 503.639.4175 ,�a� _•' I , ❑ 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. LI ❑ ❑ 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 -fl. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details.' Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. , 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. ' 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." • 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS - 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 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 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 MechanicaE>iPion FOR OFFICE USE ONLY :=. ks City of Tigard (RR 27113 Date/By: : Permit No. .0''� � / /1 / 13125 SW Hall Blvd., Tigi}73 20U4 / (� Plan Review Phone: 503.639.4171 Fax: 503.598.1960 /6nrNI �� Date By: Other Permit: Inspection Line: 503.63�I1T� OF TIGARD I �l Date Ready/13y: Juris: 0 See Page 2 for Internet: www.ci.tigagl t . t ING DIVISION Notified/Method: Supplemental Information ^€°+. � � .t' • :;�., �g . ".,;." T=: t�. �. sy� , : - � � .• ����� r ^ ya,:; , 'a�'�.�:.�;r mac .. "' °' vNU^'. ,�'lY'4'r T 5 T T d-"'t � ',: •F301�i1 d. '.' '5 � .: Y , 4S t '�4.^?.Sn <Yxie'�: .#',a:v}}�„w,t 4`Jtx�.k. Lro' 4:..F G 1T � _+ :;zrr�;�.f ,.; 4r�, ,r ?V,ftt - - _� :"'« h,«w0 ri- 9 s„ .. t ` ab.,�,,.., , ,z4 , - c.! :, t;C :NM RCIALI,FE *< _ - tiSDCHEC'IC AST ❑ New construction Add ition/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. ,i7 >��.''�,,." s '' - . 4t. a;.c_.4,u ,:. -,4s'«�3y» sti.:,:s�- ,; -;-; nate eN::. r !.sa'?,s;:: a^°...u;: S', „.e: Value: $ �” � � � � �ATEGOR�Y ®F C0IYSTRI3CTION �� ' �= _e .x _. , .- wasxracza.�:,�u_: ��.7asFtta" `_ :� a "f= = :. . mss : _ ., ,� ' 1 ' RESIDENTIALaEQUIPIVIENT ; /SYSTEMS riii 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building M builder For special information use checklist. Multi - family ❑ y ❑ ❑ Other: Description Qty. Ea. Total ht i a ,4 "4;"is• +,; T�.` is g f i ` .' : 'az; +, _ :,5 , :. a.� .F;'� r x. a, ° a. ^- r5z #'� «:.; +;w ,,; _ ":s`: ' al: :•3 M as E t. r kr a JOB, S1 INFOI TATf AANi LOCATION 'C ' v`i Heating/cooling u _._ . � ��s�,E,- �:� �� �.� Job site address: / 3 Q q Z 64) /���/ ) s/ d/V Air conditioning or heat pump tip v (requires site plan showing placement) 14.00 City/State /ZIP: 7 77 6 i 9,2 ea 6/e___, Furnace 100,000 BTU (ducts /vents) , 14.00 > ,, Fumace 100,000+ BTU (ducts/vents) 17.90 I Suite/bldg. /apt. no.: Project name: 5 B� Gas heat pump 14.00 Cross street/directions to job site: ©K/1S 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 Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances Mr. � „� • l' :;" ": � 4,,a�•., �. ��`' "r;; -,,� , -� �: r'�.v?��, Water heater 10.00 ;. i i s 3 ra `li, x <'P - DESG OR A .. ; .l". .;t,,. ; Gas fireplace 10.00 � ^ _ __ or - , -. - % " v Flue vent for water heater or gas / ` j ' / "" 0” ' / _ -C p / fireplace 1 0.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 i t , . ;';wY ,; • ,;r. ; �'.,, ,,4::<,. > <f_ _ '0 '' ROP O W N ER W k '` . ®TENANT , 2, "t; " „: Chimney /liner /flue /vent 10.00 Other: 10.00 Name: K/ / 7 6v5/C Environmental exhaust and ventilation Address: /70 72 1 s w / 6 , / Range hood /other kitchen • equipment 10.00 City/State /ZIP: 7 --, 6 , 9 .„A 0 Clothes dryer exhaust 10.00 7 j S 7 3 Fax: 6,13 6 Single-duct compartments, exhaust t s (bathrooms, Phone: rooms) ( ) � � � ) tu-i� toilet compartments, utility rooms) 6.80 i' : r.kih'LI UV: 5 ;rVI T G, NTACT . PERSO ` tea i” Attic /crawlspace fans 10.00 >ix "r a ,.-v, - �ar_ . ate a tftr -an ice, . ..U. ,,,.' ^. � n � 1 Other: 10.00 Business name: PY.i l / Fuel piping CC> Contact name: 1, $5.40 for first four; $1.00 for each additional Address: f 4 70 � /161- AV Furnace, etc. / I Gas heat pump City/State /ZIP: / ," �� di Wall /suspended /unit heater Phone: (93 ) 6 / S ' 7 Z / 3 Fax: ( so') 4g s6 :6 Water heater l Fireplace E -mail: Range ,.�, qua , Y+ r .� � �,- ri�"� s g my s } r � ;.> ys 1 fli ,2� Mfg at: �z? a. . COPITRACTOR r A- Barbecue ��a�., ��`�.. .3�s.. xz_,l�i.. �.��s,. r:.3 aa,��:4 ? _.�_� .. .......�.i� S 4 H. a / I v ' Clothes dryer (gas) Business name: � y l( ��� ��/ z/ Other: s 3 L it14 --Yn t . Address: ,�Qy j `�1V1`EC'HZ'BERl1fITFEES *''•, City/State /ZIP: 'P--( Subtotal p Minimum permit fee ($72.50) Phone: (SO 3) D Q • s ZZ -7 Fax: ( ) 7 3 g 8 S C 7 Plan review (25% of permit fee) CCB lic.: 3 0 1 7‘ � ' State surcharge (8% of permit fee) 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 i.\ Building \Perndts \MEC- PermitApp.doc 12/03 440 -4617T (I1 /02 /COM/WEB) Mechanical Permit Application - City of Tigard ' ' • . Page 2 - Supplemental Information Commercial Fee Schedule: Total Valua iniv .i e , Perm><t Fee . .. .i -..z .. . $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 • Electrical Pe t F OR • OFFICE US ONLY "v . � , • • City o f Received Tigard Date /By: Permit N° Tr_)49.0/ 00 )3 1 13125 SW Flail Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 82 9 I p 7�' 9 200 � I ti R Date7>.. Other Permit. Inspection Line: 503.639 4l r.! Date eadylgs• Jn:is � 0 See Page _fur Internet: .., OF TIGARD Notihcd /Ntethod: Supplemental Inlorniation BIJILDINcvilIVl8IObRK PLAN REVIEW ❑ New construction II Addition /alteration /replacement Please check all that apply' ❑ Demolition ❑Other: ❑ Service over 225 amps. comm'l ❑Hazardous location E Service over 320 amps - rating ❑Buildng over 10.000 sq it , CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more nett residential I - and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Buildin over three stories ❑Feeders, 400 amps of stoic ❑ Multi family ❑ Master builder El Other: ['Occupant load over 99 persons ❑:y'lanufactured structures or JOB SITE INFORNIATM^u AN:" r ^CATION ❑Egress /lighting plan RV park Job no.: Job site address: j 3 o el Z. Sol /4-.sc�st© 01-care facility ❑Other � L�,�(����� Submit 2 sets of plans with any of the above l / C:>7I/2I/ City /State /ZIP: Q4_ The above are not applicable to temporary construction service. Suite /bldg. /apt. no.: Project name: 4,05/4,05/4_. 5/ FEE* SCHEDULE Description Qt). Fee. 1 rural Cross street/directions to job site: 0 New residential single - or multi - family dwelling unit. Includes attached garage. 1,000 sq ft or less 145.15 4 Subdivision: /11 LcSRG Ill ©vi-) Lot no.: Ea. add'1 500 sq. it or portion 33.40 I Limited energy, residential 75.00 Tax map /parcel no.: Limited energy, non - residential • 73.00 DESCRIPTION OF WORK Each manufactured or modular i dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER 201 amps to 400 amps 106.55 2 ❑ TENANT -101 amps to 600 amps 160.60 I 2 Name: Kt AI Lys K. A , 601 amps to 1,000 amps 240.60 Address: 1 '7h 2. a) ���^�•-A,) ES'�0/�./ Over 1,000 amps or volts 45.1 65 3 Reconnect only 66.35 I 2 City /State /ZIP: G ( .J / ' — Temporary services or feeders installation, alteration, and /or relocation Phone: (5 3) D 078 1 Fax: ( ) 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 ' intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 600 amps I 133.75 ' Owner signature: Date: Branch circuits - new, alteration. or extension. per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder tee, each 6 65 ? Business name: 4 i, • branch circuit B. Fee for branch circuits Contact name: 6/ E6 i /L � without service or feeder tee, 46.35 each branch circuit Address: fib o A4i j //4- Each add'I branch circuit 6.65 City /State /ZIP: p og. ? Miscellaneous (service or feeder not included) Phone: ( � , y ) 641 ' 723 Fax: : ( ,3)3 ) 643 ,9,-)66 {'wimp or irrigation circle 53.40 2 Sign or outline lighting 53 40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel. alteration, or extension Describe: Page 2 ' Business name: c- Pr- eit "- E(ELT. p allowable zi w d0 SE (t �e iiiYYYLLL /// U wf--G Each additional inspection over alloable in any of the above Per inspection 62 50 City /State /ZIP: a(iK Yc Investigation per hour (I hr nun) 62.50 Phone: 6I) ' ! �1 • '7 O Fax: ( ) Industrial plant per hour 73.75 I 2 / - -y ELECTRICAL PERMIT FEES* CCB Lic.: 473 36, Electrical Lic. • 3-22-5 ^ G S Lic.: ( r Subtotal Suprv. Electrician signature, required: Plan review (23 of permit fee) State surcharge (S`F of permit fee) Print name: Date: TOTAL PERMIT FEE Authorized signature' This permit application estnres if a permit is not obtained within ISO 1 dass after it has been accepted as complete Print name: Date: ` Fee methodology set by Tri -County Building Industry ten ice Hoard " Number of inspections per permit allowed. i \ELC- Peimit.pp don 12. 03 140- 4515TI ioeD'cOvC NEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... S75.00 Check Type of Work Involved: Fl Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* Fl Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system 575.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls Clock Systems n Data Telecommunication Installation n Fire Alarm Installation I I HVAC • n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* • P1 Medical n Nurse Calls Outdoor Landscape Lighting* P1 Protective Signaling Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations ' giuilding ∎Pernuts1ELC- PermitApp.doc 04(03 • .Permit #: l`t. pd 4/,DD /3 a� Address: 1 &nig g, Az Ae-e...i.,3 41p 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: A 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure .must be registered with the Construction Contractors Board. OR 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 ay ut Construction Responsibilities on the reverse side of this form. , �� ��. (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) • Information Notice to Property Owners About Construction Responsibilities Note: This Information Notice to Property Ovi'ners about Construction Responsibilities was de by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your 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. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an employer you must withhold income taxs from employee wages atthetiine employees are paid. Youni||hcUob|cforthc1ozpuymcntmevruifyoudoo'tamluaJ]ywidhhoNthotuxfromyuu/emp|o9ceo. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 378-3524. \Vorkers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. Efyou foil to btain workers' compensation insurance, you may be subject to penalties and will be 1 iable for all claim costs if one of your employees is injured on|hcjob.Furmoroinfbrmo1ion call the 'Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for thetax payment even it'you didn't actually withhold the tax, For more inf�rination. call the Internal Revenue Service at 1'800-829'1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder forth is project, ject, you ar responsible for resolving any failurto 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 ufflcient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work ofrough- in and finish txades, 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 |4l40, Salem, 0RV73U9'50j2, 503/378'4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 l/94 CITY OF TIGARD 13125 S.W. HALL BLVD. - TIGARD, OR 97223 IMPORTANT PERMIT NOTICE TEAM ELECTRIC CO 9400 SE CLACKAMAS RD CLACKAMAS, OR 97015 Electrical Signature Form Permit #: MST2004 -00132 Date issued: 5/11/2004 Parcel: 2S1 04C B -02900 Site Address: 13092 SW ASCENSION DR Subdivision: HILLSHIRE WOODS Block: Lot: 075 Jurisdiction: TIG Zoning: R -7 Remarks: 208sf. adddition and 208sf.upper deck. 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: LUSK, KIMETHY D TEAM ELECTRIC CO 13092 SW ASCENSION 9400 SE CLACKAMAS RD TIGARD, OR 97224 CLACKAMAS, OR 97015 Phone #: 503 - 880 -0781 Phone #: 557 -7180 Reg #: LiC 47336 SUP 4416S ELE 3 -225C AN INK SIGNATURE IS REQUIRED ON THIS FORM . fl l Signature of Supervising Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 S�- INSPECTION DIVISION Busin - s Lin (513) 639 -4171 MSf 6 BUP, . 47 A Received Date Requested AM PM BUP Location / 3 CD 5 2_ ' CP-/ Suite M9--0-411 MEC Contact Person / / Ph ( ) PLM Co .,� / / � Ph ( ) SWR UILDING Tenant/Owner Lu b< ELC Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation -` / _ ' d.e)L. A's " Drywall Nailing Firewall /2-14 '.s- ��`V217 E Fire Sprinkler Fire Alarm Susp'd Ceiling /f� - / a 47 Roof e°' /�N`/��/Y 1&e Ot er: ((( /• :T FAIL Pos :earn , Under Slab ` " -_ / Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O.- • (i- apir‘i FAIL Post "& Beam pill/I-- Rough-In Gas Line Smoke Dampers Final T FAIL CTRICAL ervice Rough -In UG /Slab Low Voltage Fire Alarm 4i1JZO Reinspection fee of $ required before nex 'nspection. Pay Hall, 13125 SW Hall Blvd. PART FAIL ,+ SITE El Please cal or reinspe« on RE:� able to inspect - n ccess Fire Supply Line / 4 Approach /Sidewalk Date Inspect° i Ext Other: Final D e NOT REMOVE this Inspection record from the Job site. PASS PART FAIL 77-%