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Permit „» MASTER PERMIT C ITY OF T I G A R® PERMIT #: MST2004 -00222 � I�, DEVELOPMENT SERVICES DATE ISSUED: 8/23/2004 - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 08930 SW GREENSPARK LN PARCEL: 2S111AA -08700 SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R -4.5 BLOCK: LOT: 071 JURISDICTION: TIG REMARKS: New SF detached. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,402 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,430 sf GARAGE: 590 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 TARO. sf RIGHT: 5 VALUE: 277 408.20 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,832 sf REAR: 15 PLUMBING SINKS: 3 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 6 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 , OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 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 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: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,180.86 FOUR D CONSTRUCTION FOUR D CONSTRUCTION This permit is subject to the regulations contained in the F F O R BOX CON FO BOX CON Tigard Municipal Code, State of OR. Specialty Codes BEAVERTON, OR 97075 BEAVERTON, OR 97075 and all cer applicable p. Al. l done in accordance anrace with approved ed This pe rmit plans. This permimi t will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: Phone: 720 - 7445 MOBL ATTENTION: Oregon law requires you to follow rules 5qqpp� 55 adopted by the Oregon Utility Notification Center. Those Reg #` LIC 080 71037 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation lnsp PLM /Underfloor Framing lnsp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain Insp Electrical Final Issued By : /! f' P ermittee Signature : �.� - Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next usiness day a Build C E VED i ng Permit Applicatio J . FOR OFFICE USE ONLY - ,, City of Tigard JUL 3 " 2U04 0 Date/By: r, 30 0ql , PermitNoMS�V3/100�2 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 1, ii At. Date/B : A n/ —/ 3 - GC/ OtherPernuts ! 00 440 2 Rev Inspection Line: 503.639.417 p CITY OF TIGAF�4W 071E, Da te Ready/By: / Y y: fps /? I21 See Attached Checklist for Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: 1 Supplemental Information tl r ; x V. x _, ,,t, ` S- �' r r ,._ .. = Do-, t , A, �x,eigi 16_ ` < f a.: &;V: '.. YPE O . ' I._ 1 . - t.. S f 4 - 13 � � � RE IJIRE '�DA�T A 2 �At �Y DWELL,'ING tXt 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 - 4 v '" P .:r „s >,�, -:e "�,;„ " •. :° ' a *r 21 ` °.s: i• work indicated on this application. 1 _ �, ar ' : %u s. ®F;wCmr u , , is e ; ,: PP r t� , Valuation: $ 1- and 2- family dwelling ❑ Commercial/industrial v tl ❑ Accessory building El Multi-family Number of bedrooms: `3 i ga Master builder ❑ Other: Number of bathrooms: J/2 s }t �.,,s';* ` ., :z sari > .., y : _,,: ,,,.:; ;q,.,:, of floors: �. t : ' � Total number Job site address: I!' 0 .' to ,_ 6-'42_40,4 S i)144, 4/ , 74 , v4/ , 74 , v ...,, 3 .. New dwelling area: 2c . square feet City/State /ZIP: `" —*'!, f1/�L C) 9 7. ;' Garage /carport area: L square feet Suite/bldg. /apt. no.: Project name: Covered porch area: .. p[, square feet Cross street/directions-to job site: Deck area: square feet Other structure area: square feet REQUII EDtDATA•fetisl ERCIAL El cLIST Subdivision:�i 3�4 N� Lot no.: 7 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 3 ..n�:'�*;�.�r1 <w�",, °;�-",,'a"*, &�€ �x,.. °.�� �`.�.��.. .. ,, -. ;�;�. "'�;,,��y�, »..:� "fir"''^`°`,, v 1 ,` 4 : DESCRIPT O .W,MC . Z A,_ I CI'V ` work indicated on this application. as •.n . -.r - •.s, r•. , . ,�'°'. Amt.h, i .s� 4,,. ^..� M,3y,: .,.ter' ?., . , ..0 - ,.0 ,,2:, :" ':'; : 't / t ,41.1-2.-12-1 Valuation: $ /�/��,� /� Existing building area: square feet New building area: square feet f . l k 49MI I Y O �V Vi ER � � ,e��5' . , 1, Ts �. , Number of stories: E� n .. - �7 .�. , r�,�C,.�'., ��• - ;.*Y: �� z�,t �?sa?E a - � �' Name. r ! X c ) ss7-2. GC C7-7e)4/ Type of construction: ` Address: P ©, as-4.- 5 ` 5 - '7 7 Occupancy groups: City/State /ZIP: LL.x., ,\-` zI- 9'2 - 67;S— Existing: Phone: ( — t5 o O(p0 S- Fax: (..2 6Y — t-S! v- / 7 ts� New: a.� ".�r'� "'so-,; _ ::�=�r. ,�;�;� �" t � �`_` 'tea *,"�< :'s'.,; ,: q. �zs��`. .�"'T�:.";s.�''? - ,,� ' `F liMi ANT A -COIYTitfiPERS e . y': i-a' R t Cli: , w ,xr:,, -a s: ' -, »ei; •. ;�K" 1N., n< , . z.,.,�:. - i.:; .�. .,' i,,L 1: c " . B" N oT10E ' , -..,„ i, :: :. ,' _., :i . a2.'9. " '�- , �*,.' - : : ,: z v.44 .74 , . > .F F2 .h,A'S; ;.HaMi #, ..DVS : + ..3i. ".. a,. . % Business name: < j ,/ I „as S /IM r) 1....4"..; . 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: ,'VF .. _''117. l t *, s; , - +,:,, raz,"s".'st" st ateig9 7 x := ;.:tse , >= gy4 °, '� r � ; •'t' W Business name: Sp , l't.r2. , ' IJ-ei .: :��. =:z .>,,. ,� " t., <:: • -a ,,- ,zBULLDII!tG ° °xP„E F..E' ;` : :; �� *� � e���, �*,�. ��..� �*- ..,....... � : .... Address: Please refer to fee schedule. City/State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) CCB lic.: 7/ 0-3 Amount received 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: :2Ze._ 7 " ,d�tLe7 Date: . 2-- ... .95-1.4 v * Fee methodology set by Tri- County Building Industry r f Service Board. i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11 /02 /COM/WEB) ■ One- and Two - Family Dwelling I , Building Permit Application Checklist FOR OFFICE USE ONLY . City of Tigard Receive Permit No.: Date/By: 13125 SW Hall B1vd., OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 Oaau�,dl 1 & 24- Hour Inspection Line: 503.639.4175 Vh f I I) ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A ' I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ , ❑ 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. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original a applicable stamp and signature on file or with application. ❑ ❑ ❑ P Y PP P im PP 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements . and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. _ 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show:all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and.details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑' ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required td 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 Ore:on and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 1.1 above. Site plans must be 8 -1/2" x 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 Applica't'ionIV c ' ® FOR OFFICE, USE ONLY City of Tigard Date/By: Permit No.: UL 3 ` t 2004 y: V�ST2 l * OD a.a. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 //ei 'die ''�t,.rii' Date/B : Other Permit: Inspection Line: 503.639.4175 [''� a� I Date Ready /By: ions: 0 See Page 2 for • Internet: www.ci.tigard.or.us CITY OF TIGAFID Notified/Method: Supplemental Information wri+ .-as fe,fo td se'.t °�"�> iS.z "s'. 't i «�,,`. ^ 3: - a�4.� a�?x.�d�,aw - , ��,; ,„,:F Ar��3y�;?i:.,x„? . -;<i:: ''�' - ° „,r�* ce;- 2:�s_. - .n= �amaw�a,. �.,,- ��; "'.�: : xmi , ant" a � €' T .PE � O WORK' :.. ;° ° , �. ` i . . , = " 1�0ti., � ' .iPLANKREVPI?W> _ .�a� � '_� r.,� _, ,b. ;,E� . ,?�.; i:,* @t�z2.�.s ��� .a. & ^��, -- -. A run ,5. -. =c„� �. �_�,��_ �. - . [5(New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: Service over 225 amps, comm'l ❑ Hazardous location ,WON tt,,s; - .x�,. =1 a c lr * ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., l'4' , y,, b ,' ;,r ffi OF CO sj T eR m , N u'v ti b.- tt 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: Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JO BoSITE IFORMATIO : ,LO C')IOiv` ( =: RV. �� � ,_�� .m��sar.; �:� _s� "ate > ,�r�z =�.�,�t� >.t`�..a�° .,�' ❑Egress /lighting plan park P o ( / ' it/ ❑Health -care facility ❑Other: Job no.: Job site addressrn W `gyp s - OOP* griz r" L Submit 2 sets of plans with any of the above. City /State /ZIP: 1 0 // The above are n _, _...� not applicable to temporary construction service. Suite/bldg. /apt. no.: 1 Project name: /��� ' .. ', ':a;7. ...,'. 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:6j4 0 e �2 Lot no.: `7 / Ea. add'I 500 sq. ft. or portion 33.40 1 ' [' �f��`rp� ^ Limited energy, residential 75.00 2 Tax map /parcel no.: .,.r w ;mh 4. mow rvy y A „ £ _ Limited energy, non - residential 75.00 2 x rr - SCRIPTION 6VtnRIi f 1 a. ' I ; Each manufactured or modular dwelling, service and /or feeder 90.90 2 / itig'`_ , •_ / • 'k--) Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 s iiOPERTY ''l O.VP ii t t'ic T � ii TIENANT !� n V 201 amps to 400 amps 106.85 2 ' ) . ., .; ,,a,. .4- ` ' /am}} , aa�ititsi di `:,'.` - � ° ' ` `�°ff 401 amps to 600 amps 160.60 2 Name: k ' / 1- , Cc � ,.%T i ∎�z- d ^) 601 amps to 1,000 amps 240.60 2 Address: v' Over 1,000 amps or volts 454.65 2 ` -`" <" 7 Reconnect only 66.85 2 City /State /ZIP: ..,..44,1/...A.,:4,0,1_,, O L 7 � � t5 Temporary services or feeders installation, alteration, and /or Phone: ( ) O Fax: (S ) Cf v - / ? S relocation t O - S ° 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 $ , m g. m,: � , � R V A gi ' ,' N ; Valat, ,, �.,. i= = ° i A. Fee for branch circuits with AP EL CANT 1 l t i s ;` ` service or feeder fee, each 6.65 2 Business name: ) A/,t:.i.. i „ 4b p J ,,,,, branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 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 energy panel, alteration, or limited- 3"w' " "' , : ' i � ,,, F ,�>�... , . } -a"' , ' , . , "•t .�. � �� '. ° �,. `�, ��-' CONTTZ "FOR .' r�, .. .�:� .� t" .. ��'�t,� ;�, extension. Describe: Page 2 2 Business name: ,14...e e1 7,A t Address: �7 5 - 7 .S� a ,-e_, Each additional inspection over allowable in any of the above < Per inspection 62.50 City /State /ZIP: ( ? z) `. -G. f D4 9 7.2.../ Investigation per hour (1 hr nun) 62.50 Phone:` )./. ,..5 l � Fax: ( ) Industrial plant per hour 73.75 M117 ISM;EIIE'G I;It_CUS��.i2Mi- TWE$7C 21� �' "1 CCB Lic.: er ? Electrical Lic.3 t ,' C Suprv. Lie.:3 5 j P S Subtotal Suprv. Electrician signature, required: Xa „ i '1 Plan review (25% of permit fee) Print name: J � Date: State surcharge (8% of permit fee) �� �� /�l �`, �V TOTAL PERMIT FEE Authorized signature: ,/ ,, , L This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: /,'Zeo.„.`` 9M/C.7 Date: a.__ 6' * Fee methodology set by Tri County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building 'PermitslELC- PermitApp doe 12/03 440- 4615T(l0/02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm (� Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: r � OM V O UNi;Y, , M . MEN. � ., �.ev� -,,, �_.� .�:� �,� �..Ur=' Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i \ Building \Permits'ELC- PemtitApp.doc 04/03 Mechanical Permit Ap,plica n FOR OFFICE USE ONLY ^ ,� / City of Tigard c UU Received b 9f 20 - r DateB Y: Permit No.: - a v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 I 3 0 2004 /��itt �" i 11i\ Date/By: Other Permit: Inspection Line: 503.639.4175 J 6 .' I I Date Ready /By: Juris Iii See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information CITY TIGARD °- ^sa=3 ;a- .r,c-• ;$1:4V- t t :tr. �'d` t. . ^,.`':: ';! ,na =x,z- a .ier •,,., , :: -., ;. ;c�+:s. Y " "'- w ' 7 ` ' E OF x i i,_ A G®M F E E* S, U S IST " r. m..- �-.: � «. "..r:`n z, .,«� ".:...�. ��:. «d�A.�u.�s -na4 a��.� a,�._ .n... _ .... �a.'�». _. , ._....._... ��e!� _,:�;.ac��.rna,;...rb.: <. �..:z -<.�, - KNew construction ❑ Addition/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. �--t ��,� ;, y �u �.::� .�,.- ,t.. >, F, r.: r' x; c . �., w �, r�c-•ti�a a�.,�:ru�..;::^a,�� ` . i", '' _ -�.� st =' -.:� , ^.����r:,,: Value: $ . �- . .4,1%,,.. ` ,.. r CATEGO R,, O E' ,l CO S ` `,* kr - ` "1 r ,„^ A0. , , - • 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building Ri k RESI PNTT L EQUIPMENTt/ SYSTEMS -` `FEES For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB ST FORMa1TION A a � '' A",l Heating/cooling Job site address: -j ? ` Air conditioning or heat pump vv 9 3 O w �j j ip ,f L Ai /1f-z, (requires site plan showing placement) 14.00 City/State /ZIP: --77 O A 9 2 c � c —4 Furnace 100,000 BTU (ducts /vents) 14.00 �� 7 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 t 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: (74 5 6 � � Lot no 7 Flue /vent for any of above 10.00 o Other: 10.00 Tax map /parcel no.: Other fuel appliances tr ' ¢ n SGR P TIOim t �W `:' , ,* t t Water heater 10,00 a.:,a 4 s_ ^ , ' 4 4 ,•...t^ :^ _. , 1 E ,1 r,,t» .w s . ;;,,NL'' 'c.�:a:u:��� 4C12: Mk«:.�. °'∎':.,� : sg' ::'4.:a. '.s:.� : A Gas fireplace 10.00 R 1l fk. Flue vent for water heater or gas fireplace 10.00 • Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 p , • :�.. ` : a . ss» uuu a s r . ,,. :; ' a; x ti' ~a ' * -N ,44 _'. .,' 4, -, Chimney /liner /flue /vent 10.00 l a UP T� iti wi ksf e „ . -, , * „%d , .�, . z , , ;" " 9 4, , -, 4 - . ` "° "x._.41. ., -e4, Other: 10.00 Name: ,<. ! I_. L 6- -f_ 6e c / c , � �� Environmental exhaust and ventilation Address: O. 2,(R,.- t /6--2 •7 Range p hood/other kitchen equipment 10.00 City/State /ZIP: 0�li Clothes dryer exhaust 10.00 - �''{ Single -duct exhaust (bathrooms, Phone: 6 -2 0 _ © e O c Fax: (,93) s"5 o _ / - ( toilet compartments, utility rooms) 6.80 S . -„ " -_ « ;. >; 1 ' .:,� '' ` s, :...,: ..• V t .f 'P 10.00 1 r e �A! P*G NT _ ' C ONT IG RSQNj w A Attic /crawlspace fans . l Other: 10.00 Business name: S,A1.7444, /-4 1 9 h 0 ( I - - Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended /unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range '' t wv' r . ,, " � CONTR t g , ,r A Barbecue Business name: /� / t Clothes dryer (gas) / �/ r_s. S/ 1 � N� Other: ,. Address: /C / s C / (I-er M ECH�A :ICALT PER E ES 1 City/State /ZIP: �l LL S 6 4 e/ �/' 2 /23 Subtotal ) c� �, F ( ) Minimum permit fee ($72.50) Phone: � D"s Plan review (25% of permit fee) CCB lic.: (O 5-7d' State surcharge (8% of permit fee) ff, TOTAL PERMIT FEE Authorized signature: 'et rVfr ' Y(, ii0 "Me_, This per application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: /It (s ?,cJ i ,„ 4 , � Date: -- O v * Fee methodology set by Tri- County Building Industry Service Board i Building \Permits \MEC- PemritApp doc 12/03 440 -4617T (1 I /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: • Cotal. aii to , ._ .._�^ : ` :=;Perm t Fe� i , E .. . t : , r ,: $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 Building; Fixtures 8V , Plumbing Permit Applicatio ' - ,FOR'. OFFICE USE ONLY �, City of Tigard JUL V 3 1 [ 20O R E ew D PePermit t No.: � D ....0 J v 13125 SW Hall Bd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 l 'l Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 CITY OF TIGP ss . I Date Ready/By. Suris: p See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIVtoistn Notified/Method: Supplemental Information ., :'..- a -�. .,7 -x.. . -. :o- �s•n�.»t' F .: "`, � .;s >'t.;. >w. "�... .,; ; :.55'; +cam- ,' "� ?i, x.'= rt e- 9 ';' ,:.t-:?� E• :�a� �'.x;;. Mz':�.? °:- 'Fn4 „I a�.';„ =_:',` a t `F" � , ;r "a V r ` i : F'.a t ; . ",t'e3' =r'' x.: , � ct s ° F.1✓ * ail iLYi.: %-�,..,..� K - i ..., - -�o,: ■- ',WV a O QRIC " . , oc . ', .....*+_t gf, s4A m-Aida .T. , ,...x ., ;:; x,s ';, =_ ....�, u_ �, �.�a��= s�.,r.:.�.�e��� As a';. t`:_'��. v"�'v':7a..� ..,_ - i;, New construction ❑ Demolition For special information use checklist. Description Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) as x , ,»<,a "�, 1' �,'i :as�.w s *m;it m V- hr „� k dx „�.. R , 1K ,x, , * * CATEGORY O g C ©�STRUC IO i y 04 �. SFR (1) bath 249.20 pl 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: ' ' '' JO S1 Er INFO IC A�1s SIttefir T _ ii Fire sprinkle ( sq. ft.) g 2 r s ft. a e lki < ,„0 :. r i,s,4 . �... <... ;, � �� x... Site utilities Job site address: i ''3 t e- , , ,, Z-; Catch basin or area drain 16.60 City/State /ZIP: / Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: f I Project name: 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 L no.: Water service (no. linear ft.: ) Page 2 Subdivision: .0 �✓ jta 2 � 7 / Fixture or item Tax map /parcel no - _ y , Absorption valve 16.60 an w i f ' .. D ZI3S C RIP � O � . . ,, z�` 41 :we ir , t Backflow preventer Page 2 i _ ` ..., C,�� Backwater valve 16,60 Clothes washer 16.60 Dishwasher 16.60 f a Mkra ' r ,- a ,_ I Drinking fountain 16.60 Q, $ PERT .OWNER {1'" �I 6 r vly ' , itWT� ; . ,,. "s.0 ,� ��'' �s. . �•a: �sl�r�� °,.. � ��v. ��.�-... p.e .. Ejectors /sump 16.60 Name: �/L a 2 A 7 -c-72 6 0 1) R ` Expansion tank 16.60 Address: r * _) Fixture /sewer cap 16.60 City/State/ZIP: 23 " t „ ...4 ,....4 z Q X- Floor drain/floor sink/hub 16.60 ,.,-7,,�! Phone: L.�w) 70 QeOS Fax .66 .3) _S ,o /76--/ Garbage disposal 16.60 t� �' . -" ,,�.�.,�z �" � � .;_� � � � - T � s _ �� Q � ;,�,�:�. Hose bib 16.60 a" �, I AP 'VT ? `i � ATA - PERS®N, �,h;t _: . � ' �: r a ca .uw ., 'l,k:d4: 1 gs: , r'r ; ., :, . . ,..x.,..4,:40. u,, ° Ice maker 16.60 Business name: -S n . c 4b0 ir'v 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 16.60 E -mail: Urinal 16.60 : CONT '� ° ,0��M ` : 16.60 �'�. JAW _ �' #t. �a.��,�z �� +:i .1��.„� , Water closet Business name: , Z 24,L Water heater 16 60 Address: / 4 �i2 S S7 At 0,--4-- _ Other: Subtotal City/State /ZIP: ms ti Minimum permit fee: $72.50 Phone: (- 6 V c'� / _3 / / Fax: ( ) Residential backflow minimum permit fee: $36 25 _ CCB Lic.: / ? 2, 0 7 Plumbing Lic. no.:3f- Plan review (25% of permit fee) ` ? a , State surcharge (8% of permit fee) Authorized signature: / ti' _ ... ,..,..,..g../ TOTAL PERMIT FEE - Print name:17 1.1 w1,2, /.- Date: 7- 2 3 -d This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i :\Building\Pemuu\PLMF- PermitApp doc 12/03 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: SateLlt$i Q ( e a q „u areFoota gli : Pexmr<t ,Fe • Footing drain - 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 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 Qt y” F e ( �T tal n a $100.00 or fraction thereof, to and including 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 $50,000.00. specially requested inspections - per hour 72.50 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: 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 *. • 1 Quaat b (Fixt i e) Work rforme _ Fzxtltie e s , 0 4,7 kivxvIV ec p e 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 \Pemuts\PLM- PermiiApp.doc 3/03 ,t4 s i a2 U - 6 4 - ao 2 2'2__ 1 STREET T C A 0. I, ] u ) , = 444-Woe-I , ,Owner / 1 i„, gent for (.t i& D 6N s c.l c:1Z (PLEASE PRINT) 4 4/ v (PERMIT HOLDER) F '1, .S) to* q f ..r y kb . 9 �� ,r t° , �� 0 Do hereb� c fr % fi g �atrhe' f o1l=owing location • �,�� meets C ` Y of��' i�ard /Was� °i�i gton �C ounty � C* �� .- ,rm«�',�s.± < ='is+xsrkma,rar �; '_- .«f.�t "c=".� ,._k _ '�_-';. �-� l an d use and development standards for street tree installation. 'jS9 'es • ADDRESS: 0 S t -C J. G - s AtL� • LOT: 71 SUBDIVISION: Jet✓ ro►�:► �'A 0 . • BY: _ /� DATE: / 2 /- -4 0 RECEIVED Y: l'\11)- � :% ' .d 1 " DATE: / / S VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVFVVVN 1 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST O() ��� INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Re•uested / -( AM t/ PM BUP Location : • 0 _ 1 _ i Suite MEC Contact Person / Ph ( ) - 72 D — 7 4S PLM Contractor Ph ( ) SWR BUILDING _ Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: 1 d )( _ s ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing • Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING ` Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: F � PART FAIL = ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage, Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date I • Inspector f Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD - _ 24 -Hour • BUILDING - • Inspection Line: (503) 639 -4175 MST o OG41 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received � Date Requested AM PM BUP t Location c` 4' . al Suite MEC Contact Person Ph ( ) � _ ?` PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain � X , „ ELR Crawl Drain l ' i Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Ina Sheath /Shear Q1Q Framing (..‘eij � ^� S e'� - r�_ . 1 �G� -�-�T — r — t) (/A ,k ye-.. Insulation Drywall Nailing 6 05 6 ra4c = S Firewall Fire Sprinkler L.44 J et - ". ✓ C/4 c_ " 'c-i — Fire Alarm //,7/7 Susp'd Ceiling • Roof F D c_syLI Other: --PASS PL PART FAIL Post & Beam • Under Slab Rough -In Water Service Sanitary Sewer • - Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers � a ASS RT FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date / 2 r�S Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL • CITY OF TIGARD 24 -Hour r BUILDING Inspection Line: (503) 639 -4175 MST ?v° ( t ` X 62- 2-2 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 1 - 4 4 AM PM BUP II Location ` ' i�e..� i .t .. ••uite _ MEC / Contact Person � .+�- -- Ph ( ) -1 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation �,��, ELC Ft Drain Access: S ti-- Crawl Drain �� INN ELR Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL • PLUMBING Post & Beam Under Slab Rough -In 01 Water Water Service t Sanitary Sewer - Rain Drains Catch Basin / Manhole ' Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL • ELECTRICA Service Rough -In UG /Slab :ow Voltag' Fi A Alarm � PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 0 Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line \ ADA 1 _ — 0 S Inspector a ��A' ` 0 �h Ext Approach/Sidewalk Date p Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL