Permit Er! CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2007 -00031
COMMUNITY DEVELOPMENT DATE ISSUED: 2/5/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104CC -06600
SITE ADDRESS: 13679 SW ASCENSION DR ZONING: R -
SUBDIVISION: HILLSHIRE WOODS LOT: 010 JURISDICTION: TIG
Project Description:
al 7/9 4 G
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: 320 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE: (oQbI • oc>
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 320 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: 0 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL I
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
NAT FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 2
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: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
DAVID SPOONER AL ZILKA ASSOC. LLC laws. All work will be done in accordance with approved plans. This
13679 SW ASCENSION DR 12775 SW 6TH permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 a utLea•ti.11.4. 0 Q - if the work is suspended for more than 180 days. ATTENTION:
- CC' 5 Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: Contact #: PRI 503 - 209 - 7767 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 331.16
REQUIRED ITEMS AND REPORTS
L
Issued By : Permittee Signature •
II
Call 503.639.4175 by 7:00 a.m. for an inspection that burin: day.
This permit card shall be kept in a conspicuous place on the job site until c ' mpletio ' o' the project.
• Approved plans are required on the job site at the time of each inspection.
. .
1 • .;!.a ..
Building Permit Application c --.---, .= ' - ., To R.OFFIcEi ISE ON 1 l' '-' • ',• 'A :.t :-. ••••
, • , • :.:. City of Tigard IrtEut\lx„-.1.) Received — ... 41. Permit N: 6 7- v0,93
• . • '• . 13125 SW Hall Blvd, Tigard, OR 97223, Ki
m ::::.• Phone: 503.639.4171 Fax: 503.598.4
71 2 9 2007 Date/B .
Flan Fteview,; ..
'L-- l : Other Permit: ... e•
•TIGARD • Inspection Line: 503.639.4175 Y OF FG Dale Ready/By: Jwis: el See Attached Checklist for
CIT IAIRD
• - ., Internet: www.tigard-orgov BUILDIN Notified/Method: Supplemental Information
G DWISION
T •zi#_ 8iv'olik
L=I New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
ZI 0 Other: equipment, materials, labor, overhead, and the profit for the
: -. :;.".■' " ...;4.
l '' -
,".."`C.::'''.1
‘ c
:
ii :- '...; ..,.,- work indicated on this application.
!n ,- f ', ..'.. -:': .1t,- ', : - _ 6,ift6 , t .3.-., ''. - .-,'..., - , . ' ---.:...*:.t.'
Valuation: $ 00 d20 .
)F1- and 2-family dwelling El Commercial/industrial —
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
, r - , - - t'. ,•:•'' •'• *JOB SITE :INFORMATION AND LOCATION , : . - • t.' -`• . . . . . , Total number of floors:
Job site address: i 2 c --1 1 (Ai *--,c,...., t 0 rZ New dwelling area: , 34 Li square feet
City/State/ZIP: . • L.9 OrmArD o rz_ Garage/carport area: square feet
Suite/bldg./apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: - . Deck area: square feet
Other structure area: square feet
,,: COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map/parcel no.:
equipment, materials, labor, overhead, and the profit for the
,-. ' P: t'" - ; 1 ".3 ',,, '1'1 •-•:' • ::••••;.,ki.-fjEkitiiiijoiNi OF WORK , : , : ,, -::; , r4 ,, ,: ,, i work indicated on this application.
- J. . :. _. ,,•'• - ' „.. f..a„.= ..,- -.,. -,-......,. f■ ; - --,=• A !. ,
L- 1/4- — \-- 1 Cs— I.) 7 c - - •/■..T c, 13o-IL i et.s--&-S ■-.) ,---1" Valuation: $
-
Existing building area: square feet
6,4 •c_. a ,„„ .__ s-tA- t , o
,„_ ,. 7 ,_. / , ,-.) -,...) ■ ,a--1/4 c_ 6 (. AA•r s ifiew building area: square feet
•P'•; • A :=•PROPERtY'OWNER ,tr!.' '7.., ."'•':q1'..' '`':'' : . 0 TENANT.. i •,.' ,, ,, •,.■ : ,. •
7Zr Number of stories:
Name: D .p, ,) ' V) 5 p 0 0 1..i E 14._ Type of construction:
Address: \ ... Co - 1 I St".. A S G..... t■-) C.-. ■ 0 - ."--.1 Occupancy groups:
City/State/ZIP: i_
- 1 - X CD An/LAD Cr'- Existing:
Phone: ( ) Fax: ( ) New:
A PPLICANT ,i: ';'::'-: c ; ' '..';i - 1: , ..0 0 :;PNI PP*0.N*: :: !).:4:•`•,;;;.::": •:,,,.."..1
• Business name: ta _ L., - 2- k 1/4.- 1-e--A. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: .- k - c. , - - x•-) 1-• - Z.- . ■ L_- 1 t..." / ..)v is- -- z..- ‘•
..._. 11-,,
under ORS 701 and may be required to be licensed in the
Address: % '7 - 1 ) G -e" S k jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: T2, _c___ R_ v
apply:
Phone: (503) - 2.... 0 oi - 7 - I (.,..--/ I Fax: : ( )
Business name: .i , C... -- a_ i L._ 1 o .,,,. 2, 1 Ls. A 0_ A
- :' ,t , 1: 4_': PERMIT
Address: I - 7 - 7 - 7 C z.."- ( „.......s (.., ____( S7"--- ,,,.,,,-,,,„...: (Pledie .iefer io fee kb .!.. : - - . , • . i • - : . . ,
Structural plan review fee (or deposit): X5
City/State/ZIP: `i 4 'CC 14_. - ti - C\. &-(L. - .
FLS plan review fee (if applicable):
Phone: ( ( 03) . 2 c e l - --) - 7 (., -) Fax: ( )
CCB lie.: Cr, Total fees due upon application:
t el Ll 1 I
Amount received: l < 1
Authorized sigrture: _ ,
This permit application expires if a permit Ts not obtained
within 180 days after it has been accepted as complete.
Print name: 1 I Date: I / 2. ei / ,-1 • Fee methodology set by Tri-County Building Industry
Service Board.
1: l Hui Id ingkPerrn its \ BUIRES-Perm itApp doc 3/2/06 440-46 13 T(11/02/C OWW EB)
•
One- and Two - Family Dwelling
Building Permit Application Checklist , 3 1 oli of H let LISI o,N i> a
City of Tigard moved Permit No.
Ihi `.r g �� :
q 13125 SW Hall Blvd., Tigard, OR 97223 Y
Associated permits:
: 0 Phone: 503.639.4171 Fax: 503.598.1960
TIGARD
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical
Internet: www.tigard- or.gov ❑ Other
. .
. _ I HE FOLLOWING ITEMS ARE�REQUIRED FOR`PL REVIEW. ., ., Ye. • No /:C
I 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. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ ❑
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 ❑ 0 0
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- • 0 0 ❑
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. 0 0 ❑
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 0 ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
2l 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 .' , licable to the • o'ect under review.
I U'RIS
� DICI'ION4 SPECK •
ICS
i .
�: �� 1 ,
._. r , .; . x '
23 Five • (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or I I" x 17". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ 0
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ 0 ❑
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. 0 _ ❑ ❑
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 \BUP- RES- PamitApp.doc 03/11/06
• Mechanical 'Permit. Application . FOR -OFFICE USE O NLY
7,11 City of Tigard Received Permit No.: 1 - 0003
Plan Review il
v 13125 SW Hall Blvd., Tigard, OR 97223 4
C ' . Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit:
TI G R D Inspectio Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
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) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
dwelling RESIDENTIAL SYSTEMS FEES* - .
❑ 1- and 2-family g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: V (p - •) S � 6.--4 0 Ai conditioning ho or heat l a em
`� (requires site plan showing placement) 14.00
City /State /ZIP: '4 t (Q Q.„-el�D Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU ( ducts/vents) 17.90
Gas heat pump 14.00
Cross street /directions to job site: Duct work 1 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
. DESCRIPTION OF WORK . Water heater I 10.00
Gas fireplace 10.00
1 ) 0 1. v _ V 5 7 AS S 0 C- \ 4A t 9 Flue vent for water heater or gas
�`'�� 4- i r r tom' ` ,1� Z-- fireplace 10.00
l`t K Log lighter (gas) 10.00
t cc (4 CL — S -(..9 T /v\ Wood/pellet stove 10.00
(y G` — Wood fireplace /insert 10.00
ROPER Y OWNER TENANT Chimney /liner /flue/vent _ 10.00
Other: 10.00
Name: .,4Af I {'� l j Pc79-r--.5 'V,e_— Environmental exhaust and ventilation
` r Range hood/other kitchen
Address: (`� 6 Z 5 t�J 6 \ fz L t t9 �� equipment 10.00
City /State /ZIP: 'TA CA-ILA) ') Clothes dryer exhaust 10.00
• Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
,_APPLICANT ' CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: i Z c C-- (,A Fuel piping
Contact name: - -k-c,5-4 - .Q --,/ Z t (G,■ $5.40 for first four; $1.00 for each additional
Address: \Z -- 1 r."-- . �� Furnace, etc.
Gas heat pump
City /State/ZIP: `3 r J � j c,- _ S Wall /suspended/unit heater
Phone: (15 2 p 1, , ,1 C Fax: : ( ) Water heater 1
Fireplace
E -mail: Range
• CONTRACTOR Barbecue
Business name: A. L ` c_. «-✓< Clothes dryer (gas)
Other:
Address: 1 Z -71 t ;? G • MECHANICAL PERMIT FEES*
City /State /ZIP: K v Subtotal
Phone: () 'Z� Z ( Fax ( ) Minimum permit fee ($72.50)
y 1 Plan review (25% of permit fee)
CCB lic.: , (.0 6 4 4 ( State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized t azure: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name Date: 2((7 r i * Fee methodology set by Tri- County Building Industry Service Board
L:\Building\Penni C- PermitA .doc 04/0 06 440-461 (II /022/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - S upplemental 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.
•
1: \Building \Permits \MEC- PermitApp.doc 12/30/05 2
. . . ..
Plumbing Permit Application : ,... '.. -,). .•'..'NFOli:.014:10.;USF::-,ONL.1'
City of Tigard Received . r e"
Permit N. too 7,- f
: 'I Tigard, it 13125 SW Hall Blvd. Tigard OR 97223
Plan Review
lig Date/By.
vi
.: ' • .• Phone: 503.639.4171 Fax: 503.598.1960 Dat/By. Other Permit No.:
e
Inspection Line: 503.639.4175
TI GA RD Date Ready/By: ;axis: la See Page 2 for
- • - • Internet: www.tigard Notified/IvIethod: Supplemental Information
' ■ , %,. ':' • '. - .....:.:` 'T ,,,, i'mq 7 1.', ,, kr cr : kOr:;.;: r i;:' . .: , ...:4 , 'i-kitr'tiiiiii:ii,f : ;,•: .. `\ - T . 1`„ , :t.:* - 3,4
-'.V..t77 9.f... -'''.: ."'I`„ ". ;In -.:'..;,-'- ', - 41''.....'i.: .,.....`." Y. . ..;,::`:7 ...„. , ... . .. ... .-!..r., ?
".>-!...--.,.. , ....
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
- - .! ''''''''' '', I'' . " .". ■• • ' t •CAT,EGORY . OF CONSTRUCTION: ..--'- - .-=, ,. .. - =';'-' , SFR (1) bath 24920
0 1- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE ' 11 , 1 KIRNIAT-I9N,JAN.Pk , 4 ..‘. .: ,,1 i Site utilities
Job site address: 1 .... C9 " 1 _) uk..., C . t O f•-) Catch basin or area drain 16.60
City/State/ZIP: -V- ‘ ( p 0-4- Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: S pp° e (
Manufactured home utilities 110.00
Cross street/directions tojob site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.:
_ .,,, , , Absorption valve 16.60
, ''.... j . - i',, , : ' ..' .iliieliik:,; ..,;:,
, - ,•-•-• - „ . .„ , ,, , , , - .i. F. , ., 0■4'":: , Backflow preventer Page 2
IA,t_tz f t....s '-k t k4 ctp.>(,.'/t_ A-- )4S4ir..4 P41 Backwater valve 16.60
Clothes washer • 16.60
_
Dishwasher 16.60
. . ,
0 TEINA INI'T 1
Y e r,, Drinking fountain 16.60
' -•-• ';"; --;:- 0 i'lloPiliT1/ -:';''' '' ''-'''''' : '''' • 1 . -'' v '..," '. ' .
16.60
Name: p "3„,). 7 ,00.z. ril KAR-- Expansion tank 16.60
..
Address: k & 7 1 •e- vs-3 1,4 fZ.$\-)C-- k 0 .,e- Fixture,/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
:;'.;';',..",'.'2%. `,.Li:".'4PPLICANTI;::. : ;‘' 1-.. .'i ' U - ^e(ji■riA&. ', j;ili, 61.1
16.60
Business name: AL__ -z_ I (- (4,, Interceptor/grease trap 16.60 .
Contact name: A------------7 +0- - 7- t (-- te-.A Medical gas (value: $ ) Page 2
Address: i - 2_- - 7 --- 5 (.„_.) 6 -- reA •---v Primer 16.60
City/State/ZIP: k -.. "kJ C "( 0 e ? -700-5- Roof drain (commercial) 16.60
•
Sink/basin/lavatory 16.60
Phone: (3) - 2-0 9 -7 i 6, 7 Fax: : ( )
Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
Water closet 16.60
\ CI Business name: 90 ,t.....\ %.( 'P.P.-3( it- uwo '-"c P L u v1.\'' A zi Water heater 1 16.60
Address: --kottV\ fa fe-N) Q 1
CiA.: 74' I/ /0q
Other:
-
- g...7 tr.....2-, -, 7-1 -
CityCity/State/ZIP: teiZIP: lc? ,1, s t--3-7q 7:
.4.• Mini Subtotal
mum permit fee: $72.50
Phor ' 3 •gt 7oN ') I Fax: (V) ) Aii4 Residential backflow minimum permit fee: $36.25
, ..... 1
1 -- - ... CCB Lic.: I t.-1.1„ \ (, 0 Plumbing Lic. no.: 4/11.1SIA49 Plan review (25% of permit fee)
_
State surcharge (8% of permit fee)
Authorized s a re: 4.70 TOTAL PERMIT FEE
Print name: Date: .2 0 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I: \ Bui IdingTenn its UN -Penn itApp .doe 0676/ 440-4616T( I 0/02/COWWEB)
•
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
_ ...% wmF _ �,�.,�,..». �ng'3. xc ASTON= �' Fft f8 � irTOtal�:�� `�. a4.+,r&:,` r•,- ad' °1,�"i.�.3 "?°,�, �oac*.�' °," �. '� r b< x
S�te�Uhhries ..:; �- �.�:M.u� �:����C��� ���
Footing drain - I 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 •
S 3,601 to 7,200 $220.00-
Sewer - I st 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 .A I . n ,
Storm & Rain Drain - 1st 100' 55.00 "°Valuat09n . a Ptk y PCI'II1 1 t' C. 4'6 z ° . ,: .
$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
�; ° ^e •: t ,•- � : v additional $100.00 or fraction thereof; to and
°Fixtures r' =� .£ : 1 , > �tef t$ �Total:u,
ItClll,��rt~;: �;. =�� °a ^r: .: , ;0 � r�. % >� s.�te�� ��.e 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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
lanNRev><ew�for�
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply. •
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
.µs. .QuaantY�by(Fiztdre greater, except systems designed and stamped by licensed
,� ) Work- Perfordied�'�
Fatnre,Type ,� " �� 1, Replace engineer.
i s , r' , PP►e io s Capped, a „Added 3 r. Eiishn
s. �"'�a' � � �.• �' ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
- Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher -Commercial
- Domestic x', r . a
,. Isometric , r:Riser. >ta ra m 4 `P* 14;1
Drinking Fountain '�''D^
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink -2" that meet the qualifications above.
-3°
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an ' '
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Peranits\PLM- PennitApp.doc 09/22/06
CITY.OF TIGARD
owe COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
IMPORTANT PERMIT NOTICE
w*t. .
q& v4,
Plumbing Signature Form
Permit #: MST 2O07 • 00011
Date Issued: -115/01 •
Parcel:
Site Address: 1310 '7 St-c)
Subdivision:
Block: L
Jurisdiction: - T 1 c o :
Zoning:
Remarks:
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:
Phone #: Phone #: Sb
3. 8- Ts-$" 3t
Reg #: La°
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X \ .
Signat e of Au prized lumber
If you have any questions, please call 503.718.2433. •
Please return this form by mail, or you may fax it to 503.624.3681.
H
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007-00031
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 215/2007
Phone: (503) 639-4171
L
Inspection Requests (24 Hrs.): (503) 639-4175 4 tt .
INSPECTION WORKSHEET FOR DATE: 2/9/2007 TIME: 7:041A1Vi PAGE: 73
SITE ADDRESS: 13679 SW ASCENSION DR CLASS OF WORK: '
SUBDIVISION: HILLSHIRE WOODS LOT #: 010 TYPE OF USE:
PROJECT NAME: SPOONER
DESCRIPTION: Alteration to existing crmilspace.
OWNER: SPOONER, DAVID PHONE #:
CONTRACTOR: AL ZILKA ASSOC. LLC PHONE #: 503
Inspection Request Scheduled For: Date: 2/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 0431443-01 503-875-5629 N
Corrections /Comments/ Instructions:
/ ....--
...., A ,...4.‘
-.NOP IMP'
•
11
...ki<s
fl PARTIAL APPROVAL fl CANCEL NO ACCESS
I I FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: e-4 Date: / d Phone #: (503) 718-
. .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST7007 -00031 ;
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/5/2007
Phone: (503) 639 -4171 d
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/9/2007 TIME: 7 :04AM PAGE: 70
t i M -- Leo S
SITE ADDRESS: 13679 SW ASCENSION DR CLASS OF WORK:
SUBDIVISION: FIILLSHIRE WOODS LOT #: 010 TYPE OF USE:
PROJECT NAME: SPOONER
DESCRIPTION: Alteration to existing crawispace,
OWNER: SPOONER, DAVID PHONE #:
CONTRACTOR: AL ZILKA ASSOC. LLC PHONE #: 503.209 -7767
Inspection Request Scheduled For: Date: 2/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
225 Post/beam structural 043143 -04 503. 875-5629 N
Corrections /Comments/ Instructions:
•
c4 PASS ❑ PARTIAL APPROVAL n CANCEL I NO ACCESS
F CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L -IN (P Date: Z / d 7 Phone #: (503) 718- ��
CITY OF ��m m n ��m �n�m�mun��
BUILDING DIVISION PERMIT #: IVIST2007-00031
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/512007
Phone: (503) 639-4171
Inspection Requests (24Hmj:(583)S3Q'417S „_,y4 1
INSPECTION WORKSHEET FOR DATE: 2y9/2007 TIME: 7:04Ak4 PAGE: 71
SITE ADDRESS: 13679 CLASS � �
SUBDIVISION: HILLSHIREVV0(}QS LOT #: 010 TYPE OF USE:
PROJECT NAME: SPOONER
DESCRIPTION: Alteration to existing craewspmce.
OWNER: SPOONER, DAVID PHONE #:
CONTRACTOR: &LZ3LNA ASSOC. LLC PHONE #: 503-209+7757
Inspection Request Scheduled For: Date: 219/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 F1umnb/ngroumh'ie 043143-03 503-075-5829 N
Corrections/Comments/Instructions:
�� � ~ °l �- �
• , � '����^^ �_ y�^/����____- �
•
ASS fl PART APPROVAL CANCEL I NO ACCESS
�| |
FAIL 7 CALL FOR INSPECTION I | ADDITIONAL FEES ASSESSED
�
, ��
Inspector: ate Oa1e� `- /� Phone#� (5O3\718'
_ -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007-00031
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 21512007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/9/2007 TIME: • 7:04AM PAGE: 72
SITE ADDRESS: 13679 SW ASCENSION DR CLASS OF WORK: •
SUBDIVISION: HILLSHIRE WOODS LOT #: 010 TYPE OF USE:
PROJECT NAME: SPOONER
DESCRIPTION: Alteration to existing crawispace.
OWNER: SPOONER, DAVID PHONE #:
CONTRACTOR: AL ZILKA ASSOC. LLC PHONE #: 503-209-7767 •
Inspection Request Scheduled For: Date: 21912007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 043143-02 603-875-6629
Corrections/Comments/Instructions:
• NZ* L 7 4 1 - 10 (/ir/C—
g
H etemAlz F
fl PARTIAL APPROVAL r - 7 CANCEL NO ACCESS
I FAIL I CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: COP Date: I Phone #: (503) 718-