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Permit `CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00233 rlit DEVELOPMENT SERVICES DATE ISSUED: 8/13/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12045 SW BURLHEIGHTS ST PARCEL: 1S134CA -05900 SUBDIVISION: BURLWOOD NO.2 ZONING: R -4.5 BLOCK: LOT: 032 JURISDICTION: TIG REMARKS: Addional of bathroom, furnace installation & duct work. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 35 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: VALUE: 2,000.00 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 35 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 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 FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: . OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 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: EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: co SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2.00 SIGNAL/PANEL: 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: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor TOTAL FEES: $ 335.23 This permit is subject to the regulations contained in the JOHNSTON, PERRY & CYNTHIA Tigard Municipal Code, State of OR. Specialty Codes 12045 SW BURLHEIGHTS and all other applicable laws. All work will be done in TIGARD, OR 97223 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 880 - 6019 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg it: 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 Underfloor insulation Framing Insp Final inspection PLM /Underfloor Gas Line Insp Mechanical Insp Electrical Final Plumb Top Out Mechanical Final Electrical Rough In Plumb Final Issued By : I ? 2: Permittee Signature : , .ddRy. _ .._ ! .. k A-isi Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ext busine - day Building Permit Application F O FFIICE USE ONLY City of Tigard V EIVED DateBy 13 ore ' 0 Pernut No.: j / /." - 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Au L -( ` 3 °� 00 4�ba+l�p °I I Date : Other Permit: Inspection Line: 503.639.4175 - o j B Date Ready/By: El See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information CITY OF TIGAD ' , � � "ii„ °t34:x ;.3a- �' " r: "c:'� an�;� ':��,:: :"�..? „;i?a� ° �z�':« - >��':, a.a.a. >t_c °t: , r. ; � : ;w �Y 0 a l 'I -� � , ;I . - : � - . : _QU '—.' TA 1= A11tD 2 FAMII YDWE'LILING • �;� ±,a ..�d.e.� -0�:vs�.X�.,. �. w..'> ��- �. �:, cu :a:�,;.:,r3�''-.�,�s:°: ��,:,�.°�,��.�w�a:i r.. a. :y�d „i:� «..�C.�sa� ,�^z'i :x �:v.. �'e �.> =..� , ❑ 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 '?���;. ��, �'$ '`� ” °” r�,�, , ��J work indicated on this application. a g V,; : " NON ' : _ :. 4ATE .OR 7 CONS.I RITGTIQN. , 4144 'a , <k kat : �:' �€ �seia� :s.< >r„�...s,�.�..�'�..w�, -e :.:a�'.<.,. _ w- °:' ,. ... ;b'd'ai<rtz . `,F riJ"aF�,.:r�',.�,x,...w..�e; .c,:- 2.�;:::; ii at"' t tcl 1- and 2- family dwelling El Commercial /industrial Valuation: $ Z 6 6 0 e [1] Accessory building El Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: / ?¢:., i Total number of floors: i;' �::.. � J iEp INFO I AT,ION AND LO TII ` ". }. : i . . - , . Job site address: ' 2.6 `4' 5 s L.& 0 vie L 1 l = l a, i TS 5 , 1 -,- New dwelling area: square feet City/State /ZIP: 7 ! G> 1.R 0 r b ► c -7 Z . 3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: 13t1Trt R n0 % 1 (G N Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet , RUQUIR •DtDATA ° C 6 OlYIMER Cl i4 SEICHECKLIST- 1.. tJ_i. 5g . et.i u�x ...,.. _.., - . . 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 4�, � - ._ �* �€r "ar .- < ',,rte a$ ,yf DE �L` x , r £A equipment, materials, labor, overhead, and the profit for the ` '`z`t' ;',.,SER�a ��`�.,�.�a�� > IPTI®i ` irOF � WOR '. �,. a �,d�M�. �.wa ..;� h , a ,, � tt work indicated on this application. � :�� - - � , A- 1) 19 F ULL e 1 Valuation: $ FI5 IRN A C- t= /1,5J l 1 0/0 � C0 0 g Existing building area: square feet DL) C� �t o R I. ' New building area: square feet r;��w k \kti' g a,.a+ e•: �+' �,: `rgr"rt ". -'z': i.� '�, I *,'.� s<F ''� .,N`��' F .; " ° �;,5� '`iYi- <��•'��.' " =r� , s t , -ERT,�Y OWNE V �� . :. F ; .: ik aH∎T C Number of stories: �, t. : �� ;, a0 r. om,,, : te a 1,,,.., Name: 6��1? �/ 9- C y /Lm/ 14 J C Ht.) S ( O Type of construction: Address: 1 10 Li C., 5 l J j3 L R L Fj (c E{ Is Occupancy groups: City/State /ZIP: T, (,rat Ni) ( 5 k, 9 � 2_2— p Existing: Phone: ( 5-63) D pe - ( I c ( Fax: ( 5 5 2. t:,-- 3t-(20 New: LI *ANT '� °, � : CO�TT . C'T'E PE�R"' 'a � „ ,. >,;: F ,. °t .. ; .; ''_ APP C I .< A S �F ?'� ' ”- i' �:,. ,x : � a : "��^,~zc.....�t� 3 ., ,Aa , , � tt , ek c; .., , 4 4' ' ,Y ,: . ?' ,'t : ,,, ,,.,'_' t „ ,. u:A,, •Miff <�F Q' C < . „ _. _ � , - � „ ,�..,a� t om . ���� _ � a � ' : - �����: � m.. _, � � "�' <� N TI T �,:„�� Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax: : ( ) E -mail: r > S V ` CON x .. , { t _ ,, .a te ,, a.!4,v -: � '.1 _,w � , ... , «. , mot e .,t , m Business name . z� r ?:..., ; - a , �. ;I.� . Bit =ItiDI " _ '' Add ress: .. � b .,., �:. ow; �' `; a,, e:�t ^�1.�rtr.,iz:.«, - • i ' :_ , Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) Fax:( ) Amount received CCB lie.: Date received: 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 \Permits \BUP- PermitApp doc 12/03 440- 4613T(11 /02/COM/WEB) One- and Two - Family Dwelling • Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard Received Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Asss oociated permits: Phone: 503.639.4171 Fax: 503.598.1960 Ashiljelll 24- Hour Inspection Line: 503.639.4175 ` . ❑ Electrical - U. 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. El ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan El permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall. and roof sheathing, roofing, roof slope, ceiling height,. siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be a• ilicable to the project under review. — _ - _ -- - - -_� _--- _ — __ _ _ . _ — ^_ JURISDICTIONAL — - — -- - -- 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 Electrical Permit App °11:Cat1mr 1'V t . . , , . , , . ; FOR OFFICE USE ONLY' City of Tigard (� Received permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Au3 a. 200 ar DateB : g Plan Review Phone: 503.639.4171 Fax: 503.598.1960 "ip1 1 B Date : Other Permit: Inspection Line: 503.639.4175 - "'. !' I. Date Ready/By: Suns: See Page 2 for G Internet: www.ci.tigard.or.us I `� �F p Notified/Method. Supplemental Information { aa¢fi::":. - "'S ,Ii: ,i:: , :.i,.e'�Y,.' i :lv ;pia:' .'; Xp ' �.X=.,'l{ ham' " >` :ti+. , >.. ;:, : :.,•. -;;;h ; . t .. °,,, i'i*' ".:"c 4ya �' G t �. 4 A'S� �,,v'.. ^_ i C.`5'h :.i{. ? - 4 I , I TI E OT WORK is �` ' ; __4 '.'= _ :> - PI3 R�YEF�W • t�.�4.. c"�. 2 ,�. ,t _ - - ,.�'e...t,..., �s .:a�'s�°,� rs.e.rr»`^�',��°`�+�>�'�z�rs �.._•"�...�-`"-.:„�.:.'{ °• � ^t�;�.... %x�'Y..:� .. _ � , ._ .. - ❑ New construction El Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑ Hazardous location lit -Ex; °, „ tat 3 .., -_ -,,, _ w _,µ„ V = - , , fl e_ ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., ,. „ ." F : ,Y'IFGAEGORk -`'OF tCONSTRUCT ONi, ` p;:cv; s, ; i c,.: i �„ � IIII .., ,� : _ r l W ,,_ z ,, i _ ff l of 1 -and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi family ❑ Master builder ❑ Other: ElBuilding over three stories ❑Feeders, 400 amps or more _ ❑Occupant load over 99 persons ElManufactured structures or 1;104.1 ,„ ; j 2 -.- NFOMATLO A O1V "` ; lt n ❑ Egress /lighting plan RV park .t :��.�,. ta kr ... ..21 gs vz,_ '. nN �. � ;,. :' t'a , - .s�L'� _ ❑Health -care facility ❑Other: Job no.: Job site address: 12 O- g 5'1 &U e?LFi e I C HT5 Submit 2 sets of plans with any of the above. City /State /ZIP: The above are not applicable to temporary construction service Suite/bldg. /apt. no.: Project name: " "YT .FE° R$Ofi ii,M;� , .. .. :. ` Description Qty. Fee. Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 att.,w... '''',,,,VIA, : p.« r. ;.n,: - -r s r `; s Limited energy, non - residential 75.00 2 ; r "" aDE4, 41 Ti®N' QF WOE t `° tg, Each manufactured or modular =. , ..:�: ,:� "=iii � w` 1 r �-,., s.�.: <�` �„� dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 .,,me„ " ± ., " v. =i 201 amps to 400 amps 106.85 2 -,l 5 RUPE _ RTY` O=r- t2 " "`, , ❑,, T NNT� 'n- . v' . w, i . �1�«r z '.� ,:, '.e.L._ . - �.e:r,.zaas''.:.'^: ':i ,i � .;IXYkrv.�, x..,,....s. >: ;" ��,. x .P .z.i e . -sa 401 amps to 600 amps 160.60 2 Name: PE f J ) q-- Cu (UTI -(/ a 'TF H i tqS C 601 amps to 1,000 amps 240.60 2 Address: I a ® s T 4 e 0 l e_ j..., t4 EA cr 14.-i- S Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: T I G. A (2.--3 0e- 9 ') a� Temporary services or feeders installation, alteration, and /or e ) D O - (o i 4 Fa x: ( relocation 00 am Phone: ( .J� 8 � s a � - 3 L(30 200 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 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 �L ig A ITS P ` l � °ON .ACT PERSONI '� »tj A. Fee for branch circuits with :�:i ;.8r <`3�- +...hw•;g:4.^Lnu.A YttuStt �,. ,- ,.xAol'&a,�.n 43� w. St4Y^A ', service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 t S 2 Address: Each add'I branch circuit q 6.65 / 3, 3 d 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- ;;;; -21ir : , , , ,,,,-m- 70;: _,.,� �. » �..... �-„ ��„��: ��- ,. a. ohitiRAwo , " ' ;' #"„ 1 ' �3; ° energy panel, alteration, or extension. Describe: Page 2 2 Business name: Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 1 " EI E'CT?RIC"A°I a P,E`R1VI '* T ?N "`' ' 'm CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal ll f.. Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) Y , V / TOTAL PERMIT FEE ,(y , 9 i 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. is\ Building 'Perrnits\ELC- PermitApp.doc 12/03 440- 4615T( I 0 /02 /COM/WEB Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESI'DE'a,r.,HWORiONLY .:x: Fee for all residential systems combined $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm Fl Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: U O FRCq, . >.. M ®N ;t n 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 n Data Telecommunication Installation n Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Pemits\ELC- PermitApp.doc 04/03 \ Building Fixtures P1uffi i( bing Permit Appli ENE iF •OFFICE USE ONLY / `. City of Tigard Received Permit No.: [� � 1 3 20t 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ° ' 1%litiit l � Date/By: Other Permit No 24- Hour Inspection Line: 503.639.4175 i (04., !I I f l\ Date Juris: H See Pa e 2 for Internet: www.ci.ti ard.or.us VI . �w Ready/By: y y g g CITY O F � \S1 .�. Notified/Method: Supplemental Information MAW'''. . «�, ���!i ^.� `K. v'z"S:Ftfi „��a D a. "...- . ":;�. :., ��y> :� ,,:.. ^, `e ri?tw`: . "' _ v, }f •4�,- s ,xS <,Y 's Sa i. v ,� Z „;�^< ,. - ' `' - ,a`� fi �hi "�•:.. ":p � . rvE�i.�FS.. , w'f• ± > " " K1 • , �i:�R .- . ...m _ . .�... `s.... .. t' aw -. • ... j DT PE�QF � � � ° . =ates.F. ' �:;, .i,I?E � a � S ,.�,.i ate, _ ;m; - .. i� cd��'�^.� _ ,a;ro;= _te ' e� z. .�€°ac, � ��;� ���`,�a,:�r�.ac�" �� 'a.,�»��. »..5, _ r���- . m ° <� .,,�.,. ❑ New construction ❑Demolition For special information use checklist. Description Qty. I Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (Includes 100 ft. for each utility connection) . l v .• �. C4 FGORY OI GON Fg'4, I . ': i - x S FR (1) bath 249.20 El 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 • Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 ' 1, : 8i STTE�IlvF TION ANA LOCATIOlO j� � �a ?,st ��i, ,, _ .. - oii, ,... i , .r .. , .i ..t- ,� Site utilities Job site address: 1 2b 5 Su) i3 vy LH i ( C, N 51- Catch basin or area drain 16.60 City/State /ZIP: ' r C Vt- f O r o e 7-2 2-2-2:3 Z' Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt- no.: l Project name: I Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 x , 4, ;'' I)ESCl2IP,TI - : ()F WORK ! =e4- r ' .x�, .�,w,. ;� .� _�- � ���_ ��.� «- ,. "��s »''��� ''''-aar,i:11a.U.. it,,.e, , Backflow prev enter Page 2 Backwater valve 16.60 Clothes washer j 16.60 • Dishwasher 1 16.60 r • � Drinking fountain 16.60 Imo- T t PROPk3R r 0h� 11f rtE1�ANT& � x;,A s ... ir „.., .` x, R ^,.. A. � N __. 4.,, .�. � , Ejectors sump 16.60 Name: VCR RY 9- C• ; I t eV 7c15 14 N SJ. - 1 - p/ Expansion tank 16.60 Address: I ao L{ 5 ��� 6 U .,� L 14 i ¥ l� iS Fixture /sewer cap 16.60 City/State/Z1P : r' t � 1 ek n( _. 9 ��a 3 Floor drain /floor sink /hub 16.60 Phone: ( 3) ggo_ 6 1 Q Fax: (5)3 S 3 L.( 3,0 Garbage disposal 16.60 'f�'' ,. x su tr �, r .� Hose bib 16.60 : %` ' 'Kiat C t0 A.: •• 1 ,;: t. 1VQ A .3. ` , PERSC ,1 �IN & ` l - ', �,_�_ .ate -. ,,. ', I maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax: : ( ) Sink/basin /lavatory • ! 16.60 Tub /shower /shower pan j 16.60 E -mail: Urinal 16.60 ; . -�. d ip 4 a .xr r&: .ac , R . `"M' �+"..r".:�C; "`4..<'ij' I C ONTRAC,'()R ; ; e ` r •„ < . ^���. ;: �s,��;•:,�'^°�� � ��. . �,- ..�R. i, sc� ..�:�. <,:.t�r; ".. ,, s � u �..i�4 'a:� �'��n Water closet 1 1 Business name: Water heater ( 16.60 Address: Other: City/State /ZIP: Subtotal 3- Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) 6.6 ti 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. *Fee methodology set by Tri -County Building Industry Service Board. i:\Building\Permits\PLMF- PermitApp.doc 12/03 440- 46t6T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: '3 ''' '"" a u. � s z „�: . ; sr 3 SiteTilities .Q ,, ` ' ¢v ., , S quare Fo :otage Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 '3,601 to 7,200 • $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 a �" - mt s - ` ° "'° V alu a t><on 1' ermrt Flee, Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 • Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each .- ;: "_ • =f d, "t , ,a:,4a ,p s ° °_, a dditional $100.00 or fraction thereof, to and . FixtureorkIem : u Q..Y Fee(ea) Pota - including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. , Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379:50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including 0.00. specially requested inspections - per hour 72.50 first Subtotal: $50,001.00 and up $742.00 for the e first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . 'Mt' Quantayby (Fixture)4orkPerforineii Fixture t e �" a' - pa � "'! ReplaceA� e iS g t p F ; Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall • -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3" -4" Car Wash Drain • Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial • Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review • Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i: \Building\Permits \PLM- PermitApp.doc 3/03 FROM :ALL -METRO HEATING, INC. FAX NO :5009499220 Aug. 10 2004 10:46FM Fl EGE°ED Ak132 Mechanical Permit Apphicat rb TIGAR) H'� u alit i( F: I ti� t :yh City of TI$ U ( 'VI Y � ' 1904 Peewit No.' OR 9;2 Bo, D t�aedar' 13129 Six' R41 t1va„ 11Bard plea A,,,,„w — Ynarta ;0 }.4p.41 rt pen: S01.598.IMO <• Dxtt/h Other "otnic trapectton Line: 601.6.19.417S s.r_,1.�;: %�..��I�. Dxu Yt tiy, . d<..ts Si tl rxyte xtbr Internet 1YWW.d.GQard.e1r•us NetLt Ssyylemesuettet0rmett;a t7! ! ' ' E ' 1'Wa a'W Wn + liR1- ; 0&:; 171.. l t§; P4 V ! lgro,'i.itlil , : �< � YSi'clttem ft'r New 4 pty4ertetiaxt At3ditionlalteratxattut� lecnrnartr ! to rice en hihees dart based em the valve of !he Work ❑ Q F pert effreL_ Indicate the ytue (roundel; to :he men: est douse) of all ❑ Demolition ❑ Other: rued-mini re:merits. equipment. iab�n,averhexd and welt , .- - e .1 . rr e ' ix cy 9i,r a�,4 Tb /�sw. i',+ t.h. $ I �T srtcr. 3 c _ r. x .Iti . �s .,e, .i h; e ;1 F ? 1∎4 � '� FAY PEES. C1 I. and Z•family dwoiIing {❑ Ceeraztexcialhmfitctiat Accessory building ! For yya crai lafCrmett:oR use ehtlnk'u1 .--j ❑ Nlt:lti•£arnity Ci Master b•.rlder © Other', p ,a y sa. r :ta: g p p Acv, .2�f,F; „ h ��i.f Mtli i N � 7 Ei M �1°ah' ��'N�" 1r.�.��:•'�. -m.� ,vtntQ.c, "lo,r�^r�a �i:J ° .:.G:`:WO I licatiAS+lsaOlinA Job lice t1a1�2CS: g y Par osmt itioailla OT beg per 1 z d ; . S .._ S e �..} p 4, Ha .`d . ! !' j_,.... .ri.�+ aa. p!r�w abou.m . . .n»,..) 1440 1 C+eSenteriTh * 1 - G F' O 6 � � 2, rumba 100,0+ ° ani M enter 111= 1 , 14,00 ... 1 Fewer: 100,000+ ETU w c$roeots) 17.90 �� SuitebtdgJ9pi tad.: Project nuue: aas heat pump 14 00 Croce arxvr/dlrxdons ad job site: • Cticr_Acrk 1440 IterrmtIn bet water tyrum _ ;4,C19 ReedenaaJ6oiter (r=dtator a' 1 h A'L•, g 14.00 ...._. --...H tJnii hearty et - type. iibt den*, 1 in- wall. in-duot, au - - - - , em. 70 60 iqut/voat fir an of above 10:00 Subdivision: Cat rte.: Other 10:00 Teat mag/pareal ao ,, Otbsr feel a • ' - am* t r "h r�tl y vN 7 ii SS " ,... : Sfi A -S ' k ! �..,� .," 'kihilii 1M }lr l-4 t . 'a� 1r ° k" t �. s w i Y FERIIIIIIIIIM MOO MOO ____ ue vent fb wttt71texteT QT gas - E .1r.ds 10.00 ...I, 10.00 MEM 'W....• let nave 10.00 -__ Weed Preplan/hoed : 10.00 err ? pr r — - }w 1,`, f..f.. Ctuttiitsw"dRilutlfut/vent I 1O.o0 l i. T > : ,W.. l ..- 7 �r . x c Y p °3 . RItititiM ` r�� ',1s R. 1 i t. 4.:. .' . 16.00 ! E Name: • a• • • 1 Ynarfran rsl tit Must sad vertdtatllra Rsenge baodlothet Ir( he Asa c r Zi n g .s 0 l] I (Z, l.. ,�?-E T S Nui rust t 1 0.00 City/S --1-- i & A---e_ ^ (� a3 Clothes dryer (Wanes( f 10,00 -- � sinFL. ductech e=Charbtooms. nne: Pb (4 O ©p `fir- -- '7 a g S . Q er ` Fu: (a+ Sa 6, ' 3 q .) Q t mt7st 40rtt4ttfiYinti. on moans) 6.80 . y� � emu. 7 �t.'fir 1� }'11' titl ai lI w T ' war i I � fe n �in;n L_ .�.. :car; �..a l�, .,.a ` ,: } u ti Al"rawl - a 5111 :COO Other; :0Ii0 I j Ekstrom name: — — � _ 1 Coninenemict r $6..40 farStAttber; seek eclaliuital Address, sum • etc. I 1 — — Oes ksai • ,. I aty.StatdZPP: — PI Wa11/4te eedadtimit heeler I i 1 new: C ) Fax:: ( ) waxer heater __ -- E-mail; M r , : a+l j_. 'I —11 i 1 . 1e"g t .., ,.� r.,,q .Y' r (1 lyMl ,A1' TW. Las v' F 'r I VY y� f �.,IIj� �� J i � � =' �'e ti� �� : �, ?� I�S.s�_� 9, art eCUC EMMIE Jv L r ..7 .._ .... IL .rJ.. __ .� t.IDt11W 461 6116°2'4Itmse: A LLL.METfR) 14et4T,NC. y f A)4, — 101111111111111111111r11111111111Wra l Addrec:tt � r` :r1 iu ' s,tini e ti •<., ._. . / / .. �-r i • .0 8ua7a ... _,. . City/6iatoiZIP; .+ . • i ± M► So Mlaimum vernet fee 172,50) fir. . Ilskaez ( ) S` 1 :. 1 FAx: ( S034 'a`i 1 -. _ I ?ISta Tevttvu (294 of Permit feel CO3 4ic. Q _ _ j Star surc ( 6%a 4i oar i i' i _1 Q' � � L , To'C . Ai , . PERMIT FEE 1 "7$'. 30 I This psrmta eppltatioe (apiece ire permit la :rot udtalmd ' rii chi. iao ITWrIZe451ItI1dtar0 d ays afar it ha born ew.tea.0 aw usauylleN. ' T at �_ .� --. - - l P rxtf..raofaxy s cl try'"r - c tY Bulldint tnar r+ Ssrvicr II�.r,; priatura a G at;: g -- to ,e) a sc r — 6teilt7nx1''A'44i.O •0.,^0^tr, me 12k! aaowt 171 f 11 A31C4NV'At.Wl F...1 Wd•E :90 VOW Oil 'exit! 0zI 5ZS 20S : 'ON hold ?77 OD NO I NOlaiHef -4:610 - Addd : WOdd • • RECEIVED Permit #: 1" \.3�aoy 001.33 rieD F ° � . F AUG 13 2004 ti Address: I. :,.i t,- - , O CITY OF TIGARD " . `' 2 DIVISION ' / BUILDING Issued by : ��°Q D at e: 23 � 9 ��85� 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: 10 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. 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 n 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 abo Construction Responsibilities on the reverse side of this form. dektivik .ai. Iritr ) /) 3 20 V / (Signati fe of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) --- --__-- • . . INIt'ovmaUon Noate to PV©peny Owneve AbcoA ConstrucUon maspons^billuem . Note: This fnformation Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). if you are acting as your own contraetor to construct a new home or make a substantial mproveInent to an existing structure, you can prevent marry problems hybebmg, aware ofthe following responsibilities and areas of concern. EUPLOVER RESPOKISIElLMES: • if you hire persons not rrgiste^ed 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 mast comply with the following: Oregon'avvia_%m8�Ing ta 11E As an employer, you must withhold income taxes from employee wages at the time employees are paid You wil be liable fcr the em payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue o1945-8U9|. 0nmmmplloyment insurakxa11ma; As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. Fo: more information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Wodirers' compensation inscrance: As an employer, you are subject to the Oregon Workers' Compensation Luvv, and must obtain workers coinpensatioi' insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject topenubiexondwDlhe]iol`lofbru1\cluimuocutxifooeofyouccmp}oynnoioi |urodontbe'oh. For more information, call the Workers' Compensaton Division at the Department of Consumer and Business Services at 945-7888. 0.S,ffnternmt RevenumEerv:, As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even f you didn't actually withhold the tax. For more information, call the Internal Revenue Service at)-8O0-829-<04O OTHiER nESPONSBUTEES AND AREAS OF CONCERN: Code compliance: /\o the permit holder for this project, youurornspooniblcforrcu:Jvinguoyfai)uu:k/muctcndeccquine000ntm that may be brought to youi attention through inspections. Liability and proi:rerty 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 employes: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials al the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Con(ruoto Board (PO Box l4l4O Salem, OBL97309-5O5%, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1/94