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Permit A �TY OF TIGARD MASTER PERMIT PERMIT #: MST2004-00273 I l .� i� DEVELOPMENT SERVICES DATE ISSUED: 9/29/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14807 SW KENTON DR PARCEL: 2S112CB -13800 SUBDIVISION: ASHFORD OAKS NO. 3 ZONING: R -7 BLOCK: LOT: 147 JURISDICTION: TIG REMARKS: Addition to master bedroom & family room. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 22 FIRST: 200 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 200 sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THR0: sf RIGHT: 5 VALUE: 60 OCCUPANCY GRP: R3 BDRM: 1 BATH: 1 TOTAL: 400 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 3 00 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: Owner: Contractor: TOTAL FEES: $ 1,101.56 MY ER S, TERRY & NANCY SLS CUSTOM HOMES INC This permit is subject to the regulations contained in the SW KENTON ST PO BOX 1093 Tigard Municipal Code, State of OR. Specialty Codes 14807 14807 SW OR 97223 TUALATIN, OR 97062 and all other applicable laws. All work will be done in 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: 503 691 - 9878 Phone: 691 - 9878 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 91577 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Plumb Top Out Insulation Insp Foundation lnsp Electrical Rough In Electrical Final Post/Beam Structural Framing Insp Plumb Final Underfloor insulation Shear Wall lnsp Final inspection rain lekater Exterior Sheathing Insr A A sued By : k. ._ 1d / ILl11 !.� _ : •_ Permittee Signature : . � Call (503 .39-4175 by 7:00 p.m. for an inspection needed the next busi ess d F Building Permit Ap, tEJED FOR OFFICE USE ONLY r City of Tigard DateB Permit No.: , „ �' —790 ard, OR 97223 13125 SW Hall Blvd., Ti y Tigard, 3 200 Pl R eview Phone: 503.639.4171 Fax: 503.598.1960 SEP 1 O�Yalydl� '`✓;� 13`l,\ DateB : Other Permit: Inspection Line: 503.639.4175 -{i3 .. Ail Date Ready/By: 7wis: 10 See Attached Checklist for Internet: www.ci.tigard.or.us GITY ��61V1�� ®� Notified/Method: 7) ( Supplemental Information -'` t:Tir ;,,:?Yp a , , '.: <,':z:#. L. " ' :Vii ; 7 3: �m.a;;w`.�: ; V :Irl =q ,T. , ` ID k # E I "` YPE: , F a ` -MKIA : . ; ' 7 +;� ` l i t 0 TJ D AT A 7 : -ND ;:a:,,... 2 FAMILY DWELLING , . .. 'ss °a _ '��,'' ar AAA ,% . , , 3'r't -le "0. ,'n }, , � : sv ' ?. °t k . . ..-. ?`?�. � z,�.f Aa: *'.v �,.�'..�sa. rQ„ .�. ">.s;c .,. .._._ .... �... ..... E .. . _ , �� ^° —:� .- �auar . .� d<�,' -:.� T . � . ice:_ .�°,�`* �',� .�E ,.x � � w �� -.,-_ ....�s. t ,i ... � +o .A ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of ''V- ❑ Other: equipment, materials, labor, overhead, and the profit for the trI ` , '' ' '- " £" .;a ''_� " a` `. " work indicated on this application. • 2 # �• t r Z CA`TEG OItY OF GOSIII2U P 9,: • ❑ 1- and 2- family dwelling El Commercial /industrial Valuation: $ ( W J 3 ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: a- `iL t z. • h OJOB STT I1V 0 'TIO AN] LOCATIQ �, '' - Total number of floors: Job site address: l Lgp'-) a W 1, _ ,,-k30,1 , ' New dwelling area: L square feet LIJ City/State /ZIP: - --r1 0a- Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: el\ y A_ RP ow J--k Covered porch area: square feet - Cross street/directions to job site: Deck area: square feet Other structure area: 73 c.f square feet • Wi kEOPII2ED'.DAT iCOMMERCIALiUSE'CHECKLIST. 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 > ,.:: .';.; ^ ;:".. 3t ,.; . , a , and the profit for the equipment, materials, labor, overhead a e o r '411410 � s DES CRIPTION O WORk , a , work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet , 4. " ,❑ PI OPERTY O WNER T EN A NT - 44 '04 '4 ' Number of stories: Name: R /i--.. Type of construction: Address: C1p.ri--& Occupancy groups: City/State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ,,:',y �. ° , "u �'`� ? ^u � <a "�°4;� � � r ..-`�'� �. .,�!s..ys „"^; •':�: (. ;,.: , + qtr';` ;:.�z� , " '. ^, �' °COL'TAC'TPERSON ;: . j- �4`: � .; " ,.., . u, .:.w Y? -r a- �5�' 5'a . r��,.,,, a °r 's, ° : -.s. .-. .,- >�: s ....ter.:, A.''"'? , w . 1a:�n, �' . ...4 . a s.d, y S i a* s T,i = . N O T ICE , 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: d '�' a° z .�� "„ =� . , x , rya "b °`�`., •',,.«. , 21' r� t . �.., . ( AVAI s `�a . a t � '�`> 7 ifi .i nom' $ a.. ..3, a }4 .... ,ry #. m. ogWe4?4i$.. . ,i,:i ._ " $.4,a _ PL s " , _ . 3 C ,, ag., Business name: ( r rt �s:::..`•'Lt4 ":'�;4':'�xiv , . a :,. , Si S C.U. ��1 / f . Q a Ag' >�� rasl tri , =>lLL BLIILDIN, : ' 'MPE'RMFT ^fiEES:•-. la: . Address: O \ o 5 `i . :'t2.- te.:4: - ": w,;> s ,:::;,_. ;: Please refer to fee schedule. City/State /ZIP: .- � OIL Q�Cb L Fees due upon application • Phone: ( ) lo t t 8 'j e Fax: ( ) i 5 , Amount received CCB lic.: 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: S *ewC S Date:,] 19 ) O 9 * Fee methodology set by Tri - County Building Industry Service Board. i:\ Building \Permits \BUP- PermitApp. doe 12/03 440- 4613T(1 1/02 /COM/WEB) One- and Two - Family Dwelling 1•6 Building Permit Application Checklist FOR OFFICE USE ONLY Received City of Tigard Permit No 13125 SW Hall Blvd., Tigard, OR 97223 Associate Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 /19,isil l,N �A �h)�IN��G'1l •Electrical ❑ Plumbing ❑ Mechanical 24- Hour Inspection Line: 503.639.4175 • Internet: www.ci.tigard.or.us . 0 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. ❑ ❑ E 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 ❑ 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 elevation s 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 as slicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. . ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. •,❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot. of record approved prior to September 9, 1995. i:\Building\Permits \One - Two - FamilyChecklist.doc 12/03 ■ " 2. 2j Building Permit Application ,� Date received: Permit no.:/W7-- 2� v - _,,, x 3 +L .,),„, City of Tigard ^__.. Projecdappl. no.: Expire date: CirynfTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 - 4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: 1 &2 family: Simple Complex: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB. SITE INFORMATION ' Job address: / k/ gO 7 S (,J (,J t. 'f ,S— Bldg. no.: Suite no.: Lot: Block: Subdivision: Tax map /tax lot/account no.: Project name: X1'1 -e LS a - 7-1. Description and location of work on premises/special conditions: 194 t o rrc>" - TO MA 6 OvP41 I- 64,1 , u f2 OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: L( -e-g.---c (Floodplain, septic capacity, solar, etc.) Mailing address: • 1 & 2 family dwelling: City: State: ZIP: Valuation of work $ Phone: Fax: E -mail: No. of bedrooms/baths ?)_ V-` Owner's representative: LS c t Tom \-i.om J I /0 L Total number of floors "-- Phone: ( \ ' `18 EMISKIMI E -mail: New dwelling area (sq. ft.) .._5 s .A- - APPLICANT - .. Garage /carport area (sq. ft.) Name: S ( , , Sc_) Covered porch area (sq. ft.) ' �-� Mailing address: t D k s 3 Deck area (sq. ft.) State y ZIP: e -104 Other structure area (sq. ft.) Phone: C G L - - 4 1 1 ? Fax: (o i l' - 19 I'3 E -mail: Commerciallindustriallmulti- family: CONTRACTOR Valuation of work $ Business name: ' LS . 1 "Mm f brre J i+ d L Existing bldg. area (sq. ft.) Address: New bldg. area (sq. ft.) City: _. AN A ".'"- State: ZIP: Number of stories Phone: Fax: E-mail: Type of construction CCB no.: �} [ S Z Occupancy group(s): Existing: New: Ur i etro lic. no.: (. O Notice: All contractors and subcontractors are required to be h. ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under 112 i provisions of ORS 701 and may be required to be licensed in the Address: _.-1. , . jurisdiction where work is being performed. If the applicant is City: L � %-x,,,. State: ZIP: ct 7 11-3 exempt from licensing, the following reason applies: Contact person: 1 A-1 Plan no.: C ;vim Phone: (, LB -0 7._,3 c, Fax: (012 2_3 i 3 E - mail: ENGINEER t, EINEIMPAMIM person: Fees due upon application $ Address: Date received: City: State: ZIP: Amount received $ Phone: Fax: E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard work will be complied w' , whether specified herein or not. Credit card number: / / Expires Authorized signature: Date: t =f """f Name of cardholder as shown on credit card Print name: S4-&P( ..S4.0 I .1 Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00 /COM) One- and Two - Family Dwelling ► A y Building Permit Application Checklist Reference no.: Associated permits: . City gfTigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 - THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No . N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 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 ❑ 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 applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. 26 No rolled, reversed or mirrored building plans will be accepted. 27 28 • Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6 /00 /COM) Sep 13 04 01:27p GfIW Electric Inc. 5032176236 p.2 E ec ca Per ' It Al - ..- . I (fl � i 1 1 F 1 l \ 1 t) :. i � i- ( :' ... .'. 9' i 11 t a , ,* .:. Pamir Na. �'J� -UL a 3 City of Tigard 0 _ 13125 tie trait pivd.. Tigard, OR 97223 Ptah device Other monk Phone: 503.639.4171 Fax: 503 592.1960 .`".5;' mar te Inspection line: 503 - 639.4175 `. lkrii Re dolt' pp ,. 121 See Yutak for 2 2 taSunutio� Internet www.t t.tigtuti TYPE, ❑ j WCRIC J PLAN REVIEW - Noose t cheek all than apply: O construction ► Addition Ll tCttiti%udreplaa:nn'tlt `i ihx over 225 arttp3, uxtutt'i Ql tazatrivus location (� Donation Other: ! °service over 320 amps- rating Djltpldng over 10.900 sq. It, of 1- and 2 - family dwpihn j 4 or loopy new residential CATEGORY Q'� r ."IRIKTtb1v 0Systorn over 600 volts nominal units in one stratum ®1- and 2- family dwelling El 1 � Con ,. industrial 0 Accessory building n its in n stmt i °Building over three stories ®ilan lu lured Sips ore or or mo c 0 Multi-family 0 Master • 1 Ida' ❑ • Other: Q( tgmatt hand over 99 persons ❑ ,101f SIM INFO IL � t AND LOCATION ❑F. plan Q KV KV Ir [� �/ 4 []Health -care facility Job star.: Job site addfl bs: I / 7 �°7 (,) ,4 -4r 6t Submit 2 sets *farms with any of the above ` — The above are tot applicably to temporary construction soviet. t ityrStatc�711': �f � 10(c_ FEE* SCHEDULE Suitctbidg. /apt no.: I Project i , c: /)l. "./i j oa.rrtp�. 1 V4. 1 101 raw_ 21 - " Ntw residential seftgle or multi - family dwelling unit. t r ass ,tic t:t//d;rna lions to job site: I ror� C . luehstks enacted Cams - �'J I i t1r() s A . or less 145.15 4 y 1 l Let no 1 � 500 sq ft. or portion 33.40 - I Subdivision: Limited rnen y. residential 75.00 2 no.: _ I Limited army, ran- residcnriai 75.00 2 - Tax map/parcel F ach natwl'attured or modular t2l5CRllrl' i� OF WORK �� _ �- dwellinF ry armor realer - - 90.90 . 2 ` �1�^^ ` L tam II T Nervier' or feeders ieatatls. alteration. and/or reluctant' [ less 80.30 2 -"re•- — Q-r . 3 ' - ` - C . - 201 amps to 409 mans 106.85 2 C 'ROPEKTY OWNER I [) .TF. l' • — 401 amps to 600 amps 160.60 2 Name: vp(\ �.rS w�, 601 amps to 1.000 amps 240 -60 2 �p L pp � ' Over I ,0(K1 ramps or voles 454.65 2 � p . Address: S cs I ps e , _ Ittivunnera only +56.45 U City /St te/ %NI': Temporary servkes or feeders instnllatina alteration. aaJ/or ocatio Phone: ( ) I I Fax: ( ) rrel amps 00 amps �� � - or less inattelletion: This installation is , og made on properly that 1 own which is or 701 amps to 400 amps 100.30 intended for sale, lease, rent. or each • • I . lading to ORS 447.449, 670, and 701 401 maps wpm ;uttps a Ma Ell C7tvtrcr sigltalUrv' ! • _ Date :. Brooch circuits -arty, alteration. or extension. per panel ® APPLiC.ANT 0 CONTACT PERSON A. Per for branch circuits with or Bodes (cc. each 6,1.33 2 !� tatmch circuit Business nay: 7 ;i • _ IS Fee Fee fix branch circuits C:ptttact paint: I wihms service or feeder fee, 4G .A5 Y.- ---.� each branch errant ■ Address: I each M(1'1 branch circuit 6. 2 City/State/ZIP: /tiktte! /.1N: - Nfreennoe°us (service or feeder not included) ti _ I I,,ntp or irri(Cation circle 53.4t! Phony: ( ) I pax' : ( ) Sign or outiint Nigh ring 53.40 Q 8- trail: It Signal circuit(s) Oe hnnmt- energy panel. alteration or 2 CO j cunt — cstensioo. Ile -ribc: Page Z Rucincss name: GAW Eletrie Inc. I - '— E*th eddition>tl innpettion over Allowable in any of the s A d d r e s s : P.O.1RON 3414 P a inspection CityJStatc/L1P: Tualatin, OR 97062 Investigation per loot (t hr win) El e2.50 62 Min Industrial plant per hour 118111111111111111115 Phony (503) 692-3540 II■ Esuc (!(Q3) 217. 61.36+ _ ELECTRICAL PUtJ4M1T EELS* CCR 1.ic.: 150495 Electrical I e..: 34-586C Sum, l.ie.: 39395 Subtotal ,,. Plan review {25 %Of perfnii fcc) Supry Electrician ician si)gauturc, required: • �4 f%s�1" ."-.�. R° /. Of permit feel Stan Nadine Print name: 4I, Dade: 04/25A14 d TOTAL PERMIT 6 IF 'flea,. permit eppheano" moires s it a permit i. amt utese rd within ISO putltori d signature: ' ,; , days after it has tared aectptid a. eomptm r 114-- Data: 0812. m - Fee tlnstalogy in by TO-County Boras radar" Novice Board Print name: <- / �'-. � c it � i 1• Number of i oaar per hermit altomed. 1 Building Fixtures Plumbing Permit Application F OR OFFICE USE ONLY - City Tigard Ti and Received Permit No.: 14 7 ( _/ �7 ""- 9_7 �/ Date/By: 13125 SW Flail Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 � _ 1NP I , ' 11' Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 e! f' Date Ready/By: Suns' 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information <e ?:u , � � ' - .: .;�_�: � �. .�•. -, - a,.;ai =r`� = mac ' -.-: - :�- z- :.ms::;� -r � ra' °�� va :�`,:�:�-= ;,�,',°�;� g ..: -r•a: r .. _- ; - ,.4. x p '?°,. i�fi; �' z >�:X ? Cia', l MSb �,k��," ..,s�:. a>.: .re �,, _'"• a .:t x,r :T.; . .. ,, � � HY OT WOltl � - : r .,EIM E, SCHEDIJL> << ❑ 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) 3 TEGO�OFCONSTRUGT 01, SFR 1 bath 249.20 :�.�_. a�ar�z < ��, -. � tee, _- Ws,�.:,�.a. «�_.� ❑ 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: a Fire sprinkler ( sq. ft.) Page 2 i i': 0 . i dO'SIB TE TNFORMr1TtION AND'L© ATT6N i w :5V . .,,v;i --..w ., ft, . ....-;. .w . _ .g ',-1 .t 3 Site utilities Job site address: I F0-7 Sc,3 4, o Catch basin or area drain 16.60 City/State /ZIP: -'n 1 eDit- Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 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 1 6.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no r Absorption valve 16.60 - ' . , ..i SCRIPTIQN OF 'WORK , ' ' T r N;i. ...`�. � : Vig.% �- , am- J,- - x .i :.. < - &. v, , itAal• Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 1 x 2 f•< -• OPLRTY_ (44 x , '' E T l Drinking fountain 16.60 �. � `� _ .� �: - ��� � �.> . ;�-� � ... ��; )�. x , .. K....� Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: ° Fixture /sewer cap 16.60 City/State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 :p `I , 'jt , 7 ;�AYPLI7ANT , CONTAC;'I`z'`pER ON a Hose bib / 16.60 ,..t t t. �.,...:. �€ - „i� Ice 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 i 16.60 E -mail: Urinal 16.60 _ .v. =it"5"2.pa 3:1,-,t6 'ry «� -,w � = �'��''*:r :.. c,;. _ = :�: t�f^ r,. F:.a �..:. "s �=' ��." `�N;::�4� , � .. `, * i CONTRACTOR - . a rt . y4 , . Water closet ' 16.60 Business name: 'RA. ` „� r r) `y) ` �f / Water heater 16.60 Address: ' ` Other: Subtotal City/State /ZIP: ' , AR.a/v r c 1 06.- Minimum permit fee: $72.50 Phone: (SO ) ( c [ 3 7 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: 7 Plumbing Lie. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) . Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Pemuts\PLMF- PernitApp.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: vaa ESrt1 °;ri ;= tsvi ' i '=,, " , aQty (ea)'v w e > til>Lt es ,._ �� a e �. � :.... 'iSquare oot _ _,a33 er t Fee..h Footing drain - 1s 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 V�a' uation r _ Pernut $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 Fee ear¢To "tat additional $100.00 or fraction thereof, to and 1XtIIYe „Qr It4i11 .• . , ;, ' �' 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 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: 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 * . lxture Type r " _ ` 4Replac q' 'T ;f o vea �soc� f..� .,;�..:..., �.� ..� t Comments regarding fixture work: - � .R :..�rW� e ,'�; .it t`S_ Fn�X"i.i4��£ 2 P �L1 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 increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink -Bar/Lavatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantity - Commercial - 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: is \ Building \Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RAYBORN'S PLUMBING INC PO BOX 69 • TUALATIN, OR 97062 Plumbing Signature Form Permit #: MST2004 -00273 Date Issued: 9/29/2004 Parcel: 2S112CB -13800 Site Address: 14807 SW KENTON DR Subdivision: ASHFORD OAKS NO. 3 Block: Lot: 147 Jurisdiction: TIG Zoning: R -7 Remarks: Addition to master bedroom & family room. 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: MYERS, TERRY & NANCY RAYBORN'S PLUMBING INC 14807 SW KENTON ST PO BOX 69 TIGARD, OR 97223 TUALATIN, OR 97062 Phone #: 503 - 691 -9878 Phone #: 503 - 692 -4139 Reg #: LIC 87852 PLM 34 -166PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Si u Authorized Plumber If you have any questions, please call 503.718.2433. i Sep_28 2004 2 F CLEAN_WATER SERVICES 503 68144399,7983 No 3382 P. 1 P. 1 i))f_ i .. L • r 1 • SEP 2 0 /F104 File Number� E EtVED L. :1 CIeanWat Servic ._ - -_ SIP 2 9 2004 Our cointnititxht ; . : cka _ ,. Sensitive Area Pre - Screening Site Assessment CITY OF TIGARD Jurisdiction ---- ic t iv. 4 0 Date Ct .- -o -o c.( 13111! ®Ii11G ®1111St ®Pl Map & Tax Lot ;;Z51 rAd e /38,V _ Owner - RAF , / Ol y r r Site Address L yeaO o - - Contact s ues..� 5LS eurtDn J 113(- Proposed Activity a 4 j.._ ko giet*a. at Address Qc, 1oct3 - l4,34 r A ' 1. 'c1 , 4 ( 0 004' - Phone So.s b41- ( IV F A y ( 1 2 3 Officio/ use oMy below this lam Y N NA Y N NA Sensitive Area Composite Map ra Stormwater Infrastructure maps F• ❑ [] Map# ),,5141/9 ❑ Q t4 OS# 4etr.zi ❑ ❑ .. Locally adopted studies or maps n J ❑ ❑ Other Specify �. Specify acp,„/ ,,,„ Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04 -9: U Sensitive areas potentially exist on site or Within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. r`A Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. ❑ The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: L rrN7i4 SePseei; ve 4( 4 71 60 1012,, OW Reviewed By: L e ' Date: _ pe a Y Post - its Fax Note 7571 Date ' Foci Z I Returned to Applicant f Mail Fax Counter .:... % / Date . '' ?f• A y By ' Cow. . griSMINIIIM • Phone M Phone # { 3 .. . . Q 5 . - Fax0_ 0 ... r FaxA ✓ J A. i _ • . CITY OF TIGARD 24 -Hour [ / BUILDING Inspection Line: (503) - 75 MST o (7_' 73 INSPECTION DIVISION Business Line: (50 • , /,� 1 - 1/ ( 0-71 -- BUP /g3o Received te Re• e ted AM PM BUP Location I £4 O ��/ ' Suite MEC Contact Person i O. / Ph ( -7 1 ) <5793 67e PLM Contractor ¶V--S C LA S iaf .J Ph ( ) SWR iwILDiNa Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes_ AK ) L.„ SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear � �� J _. � V\ p ,L. -7 / � ' Z. / �'"D Framing �--rj Insulation Drywall Nailing Firewall 2) Fire Sprinkler `� Ord Fire Alarm Susp'd Ceiling Roof • • . �;F- T FAIL ( /........." . BIN , Post : : eam Under Slab Rough -In �. —.) ‘ Water Service . e v Sanitary Sewer , , Rain Drains Catch Basin / Manhole Storm Drain , • Shower Pan 4 Q 444# ART FAIL NICAL.; - 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 El Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ----- / � /l - ADAoach/Sid D a t e ` /6 Inspector .' �` Ext pp ewa / , Other: Final DO NOT REMOVE this inspection record fronts -the job site. PASS PART FAIL CITY OF TIGARD _ 24 -Hour BUILDING Inspection Line: (503) 639 -4175 ( 1 X73 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received A te 1 c : C ) Date R e q u e s t e d ! ( PM BUP fir Location • .. Suite MEC Contact Person Ph ( 7S PLM Contractor / . A Ph ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain i C L 6d ° - c J ' ELR Crawl Drain BOSS 8`/ Slab Inspection Notes: f - SIT GZ Post & Beam ( / ! . A0 J 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: Final PASS PART FAIL . :MECHANICAL. Post& Beam Rough -In Gas Line Smoke Dampers Final PA PART FAIL ECTRI Service ` ;� Rough -In S UG /Slab V� Low Voltage. 6:1( � v � ,. Z D o 7 `d0 Z7 Fire Alarm J _ -,, in �/` Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS PART FAIL S Please call for reinspection RE: Unable to inspect — no access. Fire Supply Line ADA - Approach /Sidewalk Date � � � 6 Inspector L IL. Ext Other: i , - Final DO NOT REMOVE this inspection recor (o the Job site. PASS PART FAIL