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Permit ,. i . ,,..: t A 4 CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 00118 . DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004 - -• 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13769 SW LEAH TERR PARCEL: 2S109BA - 08900 SUBDIVISION: DAFFODIL HILL ZONING: R -7 BLOCK: LOT: 015 JURISDICTION: TIG REMARKS: New SF detached. 4/27/04, adding a/c unit. BUILDING REISSUE: PSCUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,557 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,666 sf GARAGE: 513 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 310,271.10 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,223 sf REAR: 15 PLUMBING SINKS: 2 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: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: 1 VENT FANS: 5 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION . Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: 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: $ 8,318.09 This permit is subject to the regulations contained in the GOODLET/MARSHALL GOOD LET /MARSHALL BLDG & DEV.Tigard BOX 91551 PO BOX 91551 Tigard Municipal Code, State of OR. Specialty Codes PORTLAND, OR 97291 PORTLAND, OR 97291 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: 503 297 - 1881 Phone: 503 297 - 1650 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 100882 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 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Storm drain lnsp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Gas Line Insp Water Line Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service Insp Building Final Foundation lnsp PLM /Underfloor Framing Insp Insulation Insp Appr /Sdwlk In-. Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain lnsp Electrical Fi / Iss ed B : , . . .1 ._ 11 — /�_ ,�; _ Permittee Signature : ✓ . ,i- i k Call (50 639 -4175 by 7:00 p.m. for an inspection needed the next .usiness day uIvISION BulldinE'`Permit Application p FOR OFFICE USE ONLY of Tigard ! E C 0 `1� ® Dat # �� () Pennit No.: j 7 L/ CO/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.196 . 'R ,`' � ' ` { Q[�Q{� t7 " � � Da te/B / '�/� ✓ S' S - `� bier Perrm ' LtII� DO l�l Inspection Line: 503.639.4175 APR 14 2004 A � �� Date Ready/By: 5751 Reis: ® See Attached Checklist for Interne: www.ci.tigard.or.us Notified/Method: Supplemental Information CITY OF TIGARD c 51y/ . , . x�, ^ . , yw •: � 2.ar'? 'S6 }.'Y•;. `1f ., - .a�,�fii �,, ua'�.'". .. ?a ,.• � WE LLING; . ®,.._,.. �� .._ ._.•.- ..� . _... ,� .: ^a' _fl.,.r °���� »,,:.,,;�_ b <.�. •v- ter._.. :;� . ® New construction 0 Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the work indicated on this application. :�:� ` � ", °��':�;?� � ,,u.CATEGORI' OF ~ COivSTRCTIO� K �� g- .mo & " - E ' �`.r' �; ® 1- and 2- family dwelling ❑ Commercial/ industrial Valuation: $275,000.00 ❑ Accessory building ❑ Multi- family Number of bedrooms: 4 ❑ Master builder ❑ Other: Number of bathrooms: 2 iR .. .. _a }.n . ._. _ ,... < f �'r. Fb ark naY:; w, e .. 2 :..�",. th�iy• , '^�^' : °r t'JOB`SITE INFORI4IATION4AND- LOCATION ` . 1. ,` ' r : Total number of floors: 2 m AT,* ^'�,5 b >r. _. - ° , s "�'' a ` ` n` . Tali_ site :address:_13769_SV:aililTerraccam �_: _ t New dwelling area: 3,223 square feet City /State/ZIP: Portland, Oregon 97224 Garage /carport area: 513 square feet Suite/bldg. /apt. no.: Project name: Daffodil Hill Covered porch area: 0 square feet Cross street/directions to job site: Deck area: 0 square feet Other structure area: 0 square feet ° >S..m,.. t . . , LISTI >:v Subdivision: V jai t�i �}- Lot no.: 15 Permit fees* are based on the value of the work performed. v,5 /� Indicate the value (rounded to the nearest dollar) of all Tax map/parcel no.: equipment, materials, labor, overhead, and the profit for the .a =-;w a, - a .:t t,;1, "�' '- . „ DESCRIPTION ",OE WORK q :, work indicated on this application fi x _. srs_ r�.. �_ ���`�r.xm�e��'�as•.ac ^4zrasr. a °*'^ _ m�s.,s m�T. �s az.�., ks. .`sa w��i�,� � b...a'.4_a•� _ .. _ New SFR Valuation: $ Existing building area: square feet New building area: square feet y -v., f t, a �.. : b'r•. - y ....p ...,n ,.. ..� ,. ,. , .� .,, i u... �' - , :"•, r, ll n. . n. " - . r ❑� TEIYANT " 1 , Y, ` `e Number of stories: ,. ".e �. • �.°�n• •�'z �*tw _ .n .w; °�w�"5,��7x£ ' -' ==-• �°i�x�,+n �, a.n> �: a�,YK,.���'�: SS�c3� �... .,u„. .. l..• U��,�`W s'._ <e Name: Goodlet/Marshall Building & Dev. Co, Type of construction: Address: PO Box 91551 Occupancy groups: City /State/ZIP: Portland, Oregon 97291 -0551 Existing: Phone: (503)297 -1881 Fax: (503)297 -1650 New: , > z ^ t , .,, s:, ,, ":� s . ": ,.wv,a.., x�.a i ..;i �.a" ®•APPI;ICAI�tIa' SCONTACTfPER.SOIV Vi e'. , ; °�,'_.. :ee,r.'a',w „uk u,sz. „r.:_ w t '” a � m�` »rex� -s.,r- '�;�"`• ,r:,..:�??�` >he � ���`g .�. «� %x,, ,- t•�yr°F�,t'°;,�g'� Business name: Patrick Schmitt, Designer Inc. All contractors and subcontractors are required to be Contact name: Patrick Schmitt licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 2414 NW Stimpson Lane jurisdiction in which work is being performed. If the City / State/ZIP: Portland, Oregon 97229' applicant is exempt from licensing, the following reasons apply: Phone: (503) 768 -4573 Fax : (503) 246 -3559 E -mail: schmittdesign@comcast.net f ':?a:` .. ., ". - s: - ;'a - `� rt:^ ?c •zasaris;:.. �,•��,,. "�e(�, a .;t 'w- -a,"�'z� N ,;.,< CONT RACTORS" %� , :O ff o , ry ,� �� ,,R ,to x # tf , 3. ��' °' �' "T R7A ' r �r ."� •. , , Business name: Goodlet/Marshal Building & Dev. Co. _ . „ BLTIIDING PERMII'';:EEES,,t :x Address: PO Box 91551 Please refer to fee schedule City/State/ZIP: Portland, Oregon 97291 -0551 Fees due upon application Phone: (503) 297 -1881 Fax (503) 297 -1650 Amount received CCB lie.: 10882 Date received: Authorized signature: This permit application expires if a permit is not obtained Date: 4/14/04 * Print name: Patrick Schmitt within 180 days after it has been accepted as complete. Fee methodology set by Tri- County Building Industry Servine Board II . 94,re Ot„ Applications a : ' : r u.m # t ° Datereceived: Petmitno.. , opy"Ua a 4... 'ill' of Tigard ,1 �n Project/appl.no.: Expire date: City o�gard Address: 13125 S I4a111Bivd, Turd, OR 97223 pate issued: By: Receipt no.: Phone: (503) 639 -4th T IGARD Fax: (503) 598-496`0 ' Case file no.: Payment type: BUILDING DIVISI Land use approval: 1.1 PL QI PI 1iMI 1 ti I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 91 construction 0 Addition/alteration /replacement 0 Other: 0 Partial O 1 1 a 4 1 _ � 1 011 5111 1 \I OR�lI• i \ , Job address: 1 Gott 1.1� -ic,41, Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: - C Block: Subdivision: 2r C'OrL.- i,u– 1 Project name: Description and location of work on premises: ■7 (L, Estimated date of completion/ins. ion: .. : ;:4 , CON f R1ClO12. Al'I'LICA1ION 7, f ,%•,, „ ,j ,.. L - I FEU DLLL, 1 'e. , 4 ; Job no: r Business name : , +%+ 11111111EIF;1 Total Fa Address: / s ,rt,J New residential- single ormufti-Wally per Stste: ZIP: r dwd mdt.Includesattachedgarage. EZFZ 7 7 n Serrieelacluded; Phone: , Q.. - Fax:6,26, - A / E - mail: 1000 sq. ft. or less 4 ` : no.: / Elec. bus. lic. n0: V 7 a Each. additiona15M sq. f - or portion thereat -- Lmtedeaergy,residential --_ 2 City/metro 'c. no.: Limited energy, non-residential ___ 2 f° 49/ 3/ O g s.. Each manufactured home or modular dwelling ignature of supervising electrician ( -. vied) Date Service and/or feeder ■■ 2 Sup dectname (rint) / ea, 47 License no ' . y S SenIces tpstallsUon, z• - z � aitara fPROPLRI 'yi R w ,. ' 'y” h 200ampsorless 2 Name (print): NUN 0.. miesr -. • L i ihp 201 amps to 400 amps ___ 2 Flailing address: i, e 0 0 1551 " 7 ! 401 amps to 600 amps IS= � 2 601 amps to 1000 amps —_— 2 Ci : ;, / yahp State: oIt.. ZIP J Over 1000 - or volts --_ 2 Phone: 29a- :.151 Fax:217.11e G. email: - - 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to dOB'al orreloca tiO° . 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to400coups — !_ 2 Owner's signature: Date 4 01 to 600 amps ___ 2 , L \GI\LLR , Branch circuits -new, alteration, Name: or extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: State: ZIP: B. ut purchase Phone Fax E -mail. Fee for branch circuits witho IIIIIII of service or feede.r fee, first b circuit: 2 4- -r Vt.'N RL\xI till' ;(Pleas e cli e'l: 'a II i hat sipp1 ), _,, Misc. (Servieeorfeeder not included): ■■ Cl Service over 225 amps commercial O Eleaith- care facility . Each pump or irrigation circle 2 0 Service over 320 maps-rating ofl&2 0Hazardouslocailon Each sign oroutline lighting . —__ 2 fly cgs O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential mritsin one structure alteration, or extension* ■■ 2 CI Building over three stories 0 Feeders, 400 amps or more *Dual , .;oo: O Occupant load over 99 persons Cl Manufactured structures or RV part: Each additional inspecting over the allowable in atryaftba above O Egress(lightingplan O Other: Per inspection __ __ sniknitt_sets of plans with any of tbe above. Investigation fee The above are not applicable to temporary construction service. Other . Not all Jurisdictions accept credit cards, please call Jurisdiction for more inf rmsdra. Notice: his permit application Permit fee $ O Vasa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ credit card number: = / / —within _ 180 days after it bas been State Surcharge (8 %)- $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on cruet card $ Cardholder clgnatarr Amount 440 -4615 (6/03rcOM) Building Fixtures Plumbing Permit Application .,-.,,,, ,,, -...._. .. .:.., .. Fri E -u,s , Date received: Permit no,: th6ratV 2 4 0 ' 4.i, s:-,l City of Tigfri d:CEOVErt Sewer permit no,: Building permit no.: Address: 13125 SW Heil Blvd. Tard, OR 9,223 --- Cil o f n Phonc: (503) 6394171 Projectlept. p no.: _ Expire date: Pim (503) 598-1960 APR 1 4 2004 bate issued: Hy I Receipt r19,.. --".—'..-- Land use approval: CITY OF TIGARD Casc fib: no.: t Paymcct type: tiLrit_utiNu uvii11 eI 'llrk 0: relt.mtir .:--....::::,':.: :-*. ;''':' '.:- .,...' - -- T. --- :.: - ',- , -. ‘'• - ••••;:i ' i'':: •.''':' n ' - .+.. . .. .._ .. .. . . _ I & 2 family dwelling or accessory U Conunerciallindustrial 0 Multi-fainily 0 Tenant improvement /fIsiew cOnstruition 0 Addition/alteration/replacement J Food service ID Other - . , • .. :•';'-;'''''..,:•'..:-. 1041:telsORMOVN:'.i..:: ." - ;; 1 ': f.': .-:''.:'': : ii$etheatui4.V.$ Job address: \51(./\ S'No k..-fley1Ir "tV414"---%<--c-- New Description 1Qty. r Pee (e.a.) ' Total Bldg. ,: I Suite no.: ----- -"•*-- 1- aLlti 2-family dwellgis only: i no — --- (includes 100 ft. for each utility connection) • ! ; Tex map/mx lotiaccount no.: te, ‘ S _ . SFR (1) bath • - - 1" . ....1 ' Lot: \e, 17310 _ 1 , Subdivision: SFR (2) bath ___________ ( - Project name: ?Dr-for:AL: NALL. SFR (3) bath 1 i • Citylcounty: ZIP: ITZZA,- tach additiontiMit, _ ---- Description and :ocation of work on premises: I1/47W-?. . Site utilities: ' i -. i - I Catch basin/arta (train - -----. -- — I ... Dry wellsilcac iineltrench drain 1 ' ; ■.............1 A6t. data of completion/inspection: I - ---: ; 1 :.-.'' ' . 7 '''i"' ,: h` - '41.1114131ING CN OTIrtrAtiOk '('' ' F ' Ilia (no lin il 4 -,.i-,.-• .,: ...,.:,..-..,...:, _ noun , . .) i. . , - • - - • • • • • • . - - ,- ' Many Clay: ed home utilities - 1------1 , Business name: /, , a 0,, V liveythp . :Martholes Address:_ . ei ; .. — Rain ---: lrt connector ---- State: I aiL__=11_214 aAJ.1 ZIP: gl)i.S_ Sanitary sower (no. lin...11.1 - ___...._ I ?hone; r aC g iL .. . () Fax: g( 7 E-rnail: .._ — Stonn sewer (no. lin. ft-) ___ _ Cell no 71 1 ........... ....._ . - -----°- 3_ -7 pp .--- Water_service (no. hn. ft.) . , ......aa2a I Plumb. bus. re g. not - T ., . "' Fixture or Items . ' I ; Cityimen lie. ritLLOD 0 _ / COrillltit3T rtpresentative signature: 4 . . ;,-q- - Absorption vve tv"/-------- Back flow preventer r--.-- - Print name: ;,'"e. • I met, Date: Backwater vaTve -----1— :-..,:_..,,,:-...,,:,:.•, : :7,.--' - :,•I'-.. ,,, ". ,T.' AftnVIIMICSONi.. '. : '' '... • .' ''': ';'-'-''' •••'::, :-• ' r3asi Clothes Name: washer 1 '-i------1 la5r SciAvwrrr • --- •• - Disbweiher -i i___ i .. _i Address: ZA \ k Is.D to %le-ter-APO tA- . fountain(s) I 7Cii) Stattost i ZIP: 97271 - A . Ejectors/sump I I 1 , ! Phone: in'a-761. 4573 Fax: 744-55 E Exoan.sion tank - 4-----,-- i 1 .._ . - ,,.",:;:,...:: - • , , ..:!:(MNE11... -',-, ,': . - - . -:•.,- ..„, • ,.. :•'',..:-..,'. -•,..i.-: FixtIll'e cap Floor drains/floor sinks/hub Name (print): )0 A , ,,,..., e ,, ,,:.. Eux, t. cw..#, 6t, . . ' --..- Garbage disposa! I . 1 Mailing address: Po tr 1 15/ . Hose bibb i City: &Vri..4=te4 1 Statc)L- e I ZIP 0/772.9 m 1 . --\_ Ice aker — --_-,,... I L_Phoneff,-12 2 5_1_11 1 , ex.: :Oa- V., Ted E-mail: . • - Interceptorq tease trap 1 4 -- Owner installationhvsidetrial maintenance only: The actual installation Primer( 1 ...... . — 4— . will be made by me or the maintenance and repair made by my regular Roo rattLcsommercial) empleyee on the property I own ea per ORS Chapter 447. Sinfastn(s), lays(s). — 1 Owner's signature: Date: Sump _ • ENGINAR '. ; - ' .;' :• "!..% :.' :: -'• •-•;::,. :. Tub e s/showr/shower pan E _ Unual I Na --- Wafer closet 1 ! Addrcas: ____... Watcr heater - i i: Cii):: State ZIP Other . ... ... I I Phone: 1! I Total —1-7', .......... ...... .... .._..... — Minimum fee S . 1,..TZIT;;;;;;i:Zons scoop ertatet agree. please WI Jerisdittio kt Infannati ;Aldo: This permit application -, pi • v • . Is re tew (at _ A) $ I CS Visa 0 Marten:4rd expims if a permit is not obtaieed !Creek cwd number. _______ -----. -- within 180 dos eller it has been State surcharge (8%) S ________ TOTAL S 1 ted s Namt of cloc6older oS (bowls on of Mt clam I accep a complete. . Cereholdet siEnature .. i __ 4.40-4415 (ditiOiCOm) • Mechanical Permit Application FOR OFFICE USE ONLY Cit of Tigard n Received Date/By: rmit NoM () // 13125 y SW Hall Blvd., Tigard, OR y7/ 23IC C -VED Pe A Plan Review Phone: 503.639.4171 Fax: 503.598.1960 — herok, • It■ Date/By: Other Permit: Inspection Line: 503.639.4175 , APR 1 4 2004 --- Date Ready/By: Juris: !RI See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information Ot* t6MMElklAt , IZ New construction 0 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 El Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit CATEGORYOF Value: $ 7,500 P - „,' • „- - . • AV' • 'RES1DEpRI4J. *QPitMiNT115711n1WFrgESp El 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. El Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total 1 Heating/cooling Air conditioning or heat pump Job site address: 13769 SW Leah Terrace (requires site plan showing placement) 14.00 City/State/ZIP: Portland, Oregon 97224 Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg./apt. no.: Project name: Daffodil Hill Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel-type, not electric), in-wall, in-duct, suspended, etc. 10.00 Flue/vent for any of above 10.00 Subdivision: Lot no.: 15 Other: 10.00 Tax map/parcel no.: Other fuel appliances op Water heater 10.00 — 4.• 4 ....4.„„„„..:„• Gas fireplace 10.00 New SFR 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 Chimney/liner/flue/vent 10.00 10.00 Name: Goodlet/Marshall Building & Dev. Co. Environmental exhaust and ventilation Range hood/other kitchen Address: PO Box 91551 equipment 10.00 City/State/ZIP: Portland, Oregon 97291 Clothes dryer exhaust 10.00 Single-duct exhaust (bathrooms, • Phone: (503)297 Fax: (503)297 toilet compartments, utility rooms) 6.80 Attic/crawlspace fans 10.00 Business name: Patrick Schmitt, Designer Inc Other: 10.00 Fuel piping Contact name: Patrick Schmitt $5.40 for first four; $1.00 for each additional Address: 2414 NW Stimpson Lane Furnace, etc. Gas heat pump City/State/ZIP: Portland, OR 97229 Wall/suspended/unit heater Phone: (503) 768-4573 Fax: : (503) 246-3559 Water heater Fireplace E-mail: scluniftdesign@comcastnet Range Barbecue Business name: Michael's mechanical Clothes dryer (gas) Other: Address: 1241 NE 194th City/State/ZIP: Portland, OR 97230 Subtotal Mini Phone: (503) 661-6183 Fax: (503) 661-4341 mum permit fee ($72.50) Plan review (25% of pemit fee) CCB lie.: 35795 State surcharge (8% of permit fee) ° 46.4-6 4— This permit application expires Ira 13 F permit isnotobta Authorized signature: obtained within 180 days after it has been accepteas complete. _ e. -1- —.1 I 1,-a— A III le * Vi.o. mptlInrInlnem aPt Isu T,-;-rnimtv Tvu-hIctry ix • Mechanical Permit Application FOR OFFICE U SE ONLY - City of Tigard Received Date/By: Permit No.: 12 ,4 D - 66// t/6// ., 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 7 Phone: 503.639.4171 Fax: 503. 598.1960 / R Other Permit: Inspection Line: 503.639.4175 y r.LIr-. . ; 'Al l Date Ready/By: Juris E I See Page 2 for Internet: www.ci.tigard.or.us Notified/Ivlethod: Supplemental information f . 4 '4 . 0,, , . < # TYPED . W ORK 4I PTI , COMMERCIAL FE .., .S C HED - - -, , 1CHECKIiIS, Mechanical permit fees* are based on the value of the work ❑ New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. t , .. �. t ,, . ty Pu Value: $ `"':�. s, , . , R ,CATEGORX OF A CONSTRUCTION �- ' - - x su . BE SIDE,N AL EQUIPMENT+ / / SY El 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building I ° ' � 131 For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total '` VI; I _ f JOBlSITI INFO AI LOCkitiON" i3` Heari Heating/cooling i{ iggAN. x cy �w . *, -., ..,,: za a.,, a ,- P.; a :iai S te' E' a P, mob site address: f. 576 Leh k_ 'P oG�- Air conditioning or heat C 7 q (requires p uires site plan showin g placement) / 14.00 City/State /ZIR: 9ek i 0e9 6, Furnace 100,000 BTU (ducts /vents) 14.00 f r 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 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electnc), in -wall, in -duct, suspended, etc. . 10.00 Subdivision: Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: _ Other fuel appliances W© Water heater 10.00 Gas fireplace 10.00 e . .414--- 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 i,,,,,e:;,.;z ; .:; - v "N: ,;,;.,y�. •jir -,, 0 :z: ' , ,:-. * ,,2 Chimney /liner /flue /vent 10.00 ' "s' ..r. -;=PRO T Rt ' WNER a4. -,. ; ?s'.: > l• , - , ,,,it . „..ww „� ; ' .3 r n ', a ., . z. .,, ®s ;TEN -ANT K 10.00 Name: Environmental exhaust and ventilation Address: Range hood /other kitchen equipment 10.00 City/State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 c;= it ig r,.® Aqt 'T ; 4 ` 24 i $ ON ,, CTP�GT PERQ e S�1 . � try Attic /crawlsace fans 10.00 p Other: 10.00 Business name: 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 '" � a x s 'g 1 ,' mss» . vi ,, ; .--, , 7 ' t a :,' z" �,._ ,. ; ". itet ag *(. '..�(� C"TO' , ` g ` - „� Barbecue Business name: boy ern ` , S Clothes dryer (gas) /SC ? Other: Address:R < °:.w {,,,� .> t t I ' vMEGHA:NIC'AIs,PRMTTEES " City/State/ZIP: e Subtotal - Phone: ''��" /). 7 ,_{ 1 Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: c State surcharge (8% of permit fee) ' TOTAL PERMIT FEE � - - - `C ii , ,. I � " `Y � l This permit application expires if a permit is not obtained within 180 uthonzed signature 4 - - 4 , - \ days after it has been accepted as complete. Print- name: - - _- -Dates I * Fee methodology set by Tri- County Building Industry Service Board Iti i:\ Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I l /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: =,T'otalYa'luatioz: Permit Fee:.. 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 /M r - o// g" ■AAAAAAAAAAAAAAA AAAA AAAAA AA AA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Pr ■ 0. ■ ■ S TREET TREEERTIFICATION Y\ ► , . i I, / i _/.: _ 0 , awner/ for • 4 ail") (P EASE PRINT) (PERMIT HOLDER) { $ ' f r` ► Do hereb t 4e° Olithvi location ,I At i �_ rc Via .,.. ■ Cix, 4 � :ofard i ■ �;:- � � ' ., ton C meets o unty ■ land use and development standards for street tree installation. j ■ ► ■ 1 ,, \1 ADDRESS: U� /� J Leek_ ralkiek, r LOT: SUBDIVISIO 1 'K L 1) 1 1----/- . i I, \ ► l i �� I t � � ► BY: \ h. . 1, .�'� ► D ATE: L M ZOO ► 1 ► '1�' ► RECEIVED BY: �_ DATE: b ��— e ° d • FVVVVVVVVVVVYVY VVVVVVVVVV pro VVVVVVVVVYYYYYVVYYYYYYVYYYYYY1 ■ CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST .='700 (7-CEO /I INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested c;- AM PM BUP Location l 3 7 ? 7 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain 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 D rain Shower Pan ' Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL 'ELECTRICAL Service Rough -In UG /Slab Low Volta•e Fire Alarm ins Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS PART FAIL SITE Please call for reinspection RE_ 111 Unable to inspect — no access Fire. Supply Line ADA Approach/Sidewalk Date Inspector �r � Ext Other: Final D • NOT REMOVE this inspection record from the job site. PASS PART FAIL 1 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 - 4175 MSTM q" INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested /a — AM PM BUP Location l - 37 &• 6 _.� - -�/'✓V Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain 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: PART FAIL CHANICAL 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 0 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line r� ADA !/ Approach /Sidewalk Date /2c f/, Inspector / r I 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 INSPECTION DIVISION Business Line: - 03) 639 -4171 BUP Received Date Requested AM PM BUP Location 6 Suite MEC Contact Person � Ph ) > — 7_012— PLM Contractor Pt ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear 67 /Z- 6 Ks) iss v CJ Framing Insulation Drywall Nailing Firewall ' - " Fire Sprinkler _ '. Fire Alarm . • Susp'd Ceiling Roof ---- Other: S ASS 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 P -ART FAIL LECTL. Service Rough -In p sSED UG /Slab Z _ 2. 0 Low Voltage Firearm ! f !trig El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ` _Q Please call for reinspection RE: _ Unable to inspect — no access Fire Supply Line ADA Date 17' (� Inspector t ®r Ext Approach/Sidewalk P Other: Final DO NOT REMOVE this inspection record a the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (51 • 39 -4175 ` MST °? / © /� INSPECTION DIVISION Business Line: ) 639 -4171 f BUP Received Date Res uested / AM PM BUP • Location Suite MEC Contact Person P ( ) 7? — 7 � /c�- PLM Contractor ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access:. Ftg Drain ELR Crawl Drain - - - - Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear C Framing � ® � L Insulation S0) L 6 Drywall Nailing Firewall CO V\ Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: 401‘0 1.°P411111 PART FAIL :ING;, " _... Post & Beam Under Slab Rough -In I Water Service felibb Sanitary Sewer Rain Drains Catch Basin / Manho Drain Shower Pan Other: Final PASS PART FAIL — MECHANICAL 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 Y. Approach/Sidewalk Date Inspector — Sat Other: Final DO NOT REMOVE this Inspection record tEl the Job site. PASS PART FAIL