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Permit r V ?-.4 - /%7 ASTER PERMIT C D PERMIT #: MST2004 -00074 A. ��4 DEVELOPMENT SERVICES DATE ISSUED: 3/12/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 07107 SW LOLA LN PARCEL: 1S125DB-08900 SUBDIVISION: THE RAZBERRY PATCH ZONING: R -4.5 BLOCK: LOT: 009 JURISDICTION: TIG REMARKS: Kitchen /dining room remodel and 68 sq.ft. addition Other plumbing fixture is ice maker. 6/30/04, adding a/c & gas piping for cooktop. BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 68 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 10,798.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 68 sf REAR: 15 PLUMBING SINKS: 2 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: 1 SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: 1 VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCFDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1.00 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: 0TH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner Contractor TOTAL FEES: $ 569.69 LAND OWNER This permit is subject to the regulations contained in the DORSING, KIM DORSING, KIM L A L Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in 7107 SW LOLA LANE accordance with approved plans. This permit will expire PORTLAND, OR 97223 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 244 - 0780 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: 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 lnsp PLM /Underfloor Exterior Sheathing Insr Plumb Final Foundation Insp Mechanical Insp Gas Line lnsp Final inspection Post/Beam Structural Plumb Top Out Insulation Insp Underfloor insulation Electrical Rough In Electrical Final Footi oundatio = • Framing Insp Mechanical Final • Iss ` y : _ .611 /,: .� -_! -/ Permittee Signature :.� _./1,411 J IlLAdo; Call (50' 639 -4175 by 7:00 p.m. for an inspection needed he next busin•ss day ii " • FIC . FOR OFFICE USE ONLY Building P ermit Ap Received , Building Date /By:, /I I PI P ermit NoNadtV y.-Ob 0 71 Cit of Ti and Planning Approval Other Y g Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 _ - l` Date /By: Pi 4\) 3'n - o Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 - - *.. ~; il'iri\ ® Post - Review Land Use --+� a7 A I I Date/By: Case No. Internet: www.ci.tigard.or.us Juris.: 2004 Z1 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 MAR 11 Name /Method: Supplemental Information CITY OF TIGARD % f ',., :: � ' ;', :: _ -. - ":,;TYPE 'OF iDI1(ISI,(7N � i ik } r REQUIRED` a , . El New construction ❑Demolition '� F i - ; : - Pf ,c1 & "2 FA ' ; Addition/alteration /replacement El Other: . ::* „:,: ,- 1:'9... C ATEGORY'OF :CONSTRU,CTION, '., ;'_R°.”: ° :.. .; Note: Permit fees* are based on the total value of the work performed. Indicate 12 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application./, ❑ Accessory Building ❑ Multi- Family 6v 79$ /16 ❑ Master Builder ❑ Other: Valuation ''`Z,O; "ic - ° = ITE INFO RIVIATION`andvL" n' :'b'''" "` `` `" No. of bedrooms: No. of baths: Job site address: ''T /o • ,SW <4/44it/e 7 ,2,4) Total number of floors New dwelling area (sq. ft.) 6Q g 1 I " Suite #: / Bldg. /Apt. #: Garage /carport area (sq. ft.) Q � Project Name: M/47/46eAI Q6/cs/ AI 9 Covered porch area (sq. ft.) Cross street/Directions to • ob site: Deck area (sq. ft.) • r , _ /, ° y d /j 4(T1, 7 8 ,q C7 `, Other structure area (sq. ft.) Tv Loll LA, # */07 . _ , r .� _ u • ,z r • y ... , •n ; ' 1 : ' , a ' REQUIRED;;DAI'A » ;tiv, 4s >' 9 ""`4 z ,,N ' .t -: 'CO IUSE�'CHECKLIST x Subdivision: - 4'` -1 /e 1 ,,kc,/'1 /elu+ Lot . .d,. , Tax map /parcel #: ' E. /q 0 0 S'ec .25 7 is Rik/. Gt/, /tt1ek,,4 te: Permit fees* are based on the total value of the work performed. Indicate :.:�� rf;;r`a�z':'� ;,;;, . '' "ziDESCRIPTION OF `WO z s , '2 Fa- '; a i:.. 'r .. = value (rounded to the nearest dollar) of all equipment, materials, labor, s -� � =• � a overhead and profit for the work indicated on this application. / ,f ,-.lfeA) Af/t/ /n / R1�MoI / r Valuation S la building area (sq. ft.) New building area (sq. ft.) Number of stories _ '" .; ; "� Type a.; �a �; �TENANT'�r.-�.y� =� r�.>r::� "'_ °;� >� „x.��, ?Ia. YP e of construction Name: j) &R psj4) 4 A- N&A�tJ Occupancy group(s): Existing: New: Address: ''/07 � 0 /2 /tie City /State /Zip: Tr9gq d a le Phone :3 01A/ 0,90 (H) Fes: Sgd — s - 7a 0 (am) NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under wAPPLICANT'-?'- - � • • :;CONTACT PERSON:” _' t. provisions of ORS 701 and may be required to be licensed in the s;- Business Name: /n� jurisdiction where work is being performed. If the applicant is exempt Contact Name: K / /?4 ,V0 RS lNCi from licensing, the following reason applies: Address: 7/07 Sc,> L c/& 4-4/ vc) • City /State /Zip: 7 9qni j 1 Phone: %g aIyh/ -0?So Fax: ,,, q x.µ .. a E -mail: 4 t - BUI PERMIT FE * l; ` a � ' ..' : - , . ��Ple.a5e refer to feers '` f m�:.- CONTRACTOR ', : • _ ': A• Business Name: p Fees due upon application [� t . !.J $ 3y r . 3 Address: City /State /Zip: Amount received $ Phone: Fax: Date received: CCB Lic. : . Authorized -- - i I l� Notice: This permit application expires if a permit not obtained within Signature: Date: t v� 180 days after it has been accepted as complete. V I W bt/rS t Yk *Fee methodology set by Tri- County Building Industry Service Board. (Please print n e is \Dsts \Permit Forms \B1dgPermitApp.doc 01 03 One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City f Tigard `J b O Electrical ❑ Plumbing O Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O 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. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. 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. 44o -46 (6 /oo /cOM) • FOR OFFICE USE'ONLY - ,- . - - - . Electrical Permit Application Received Electrical ' c.} Date/By: Permit No.: n5 I2t V /�,, LF'X1 t 7 City Cat of Tigard Planning Approval Sign g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use Internet: www.ci.ti ard.or.us g / /�mu iNl�iry��� �� li l Date/By: Case No.: r =� Contact Juris.: ®See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. atanozim.atwromovogorafoemvmwm naraticaoiawvowgraavaotaysmnmo ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility M. Addition/alteration/replacement Ill Other: commercial ❑ Building over er 10,000 ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, ' >- ::111 .A - HOC TR UCTMle ,; A;� a ,• 1 & 2 family dwellings four or more residential units in 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure 111 Accessory Building ❑ Multi Family ['Building over three stories El Feeders, 400 amps or more ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: : I`° " . sets of plans with any of the above. Submit x::z ; � �ro1��s>t uv��oR �oe�?r�o��� �. - The above are not applicable to temporary construction service. Job site address: '7/0 SW 4(0 czZ4 7`i 0 d f e A *, Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total New residential - single or multi - family per j Cross street/Directions to job site: dwelling S // _ dwelling unit. Includes attached garage. ��y /oR - '!c to 7`^ y Service included: / r© 0 � �� 1000 sq. ft. or less 145.15 4 C7/07) Each additional 500 sq. ft. or portion thereof 33.40 1 Subdivision: 2a 6e/ *c]t Lot #: 7' Limited energy, non residential se 75.00 2 / / /3� L' Each manufactured home or modular dwelling `c ,2 Limited energy, non residential 75.00 2 Tax map /parcel # SF, Se j '� ©', ,� �.� service and/or feeder 90.90 2 / � � :.. , . 4 D,ESCRIP a . .�(f IW0121�. !� f fC.1T �'i 2 , , Services or feeders - installation, alteration o N '/� /ii) f / Aerhed.ei rrelocation: • J 200 amps or less 80.30 2 • 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 _ 2 P PRMP 0` TNT. - W-Pl9 I, TEN •}„ AM 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: DO /,57A)9 /1427 f A/V Reconnect only 66.85 2 Address: 7/o7 ,5 04a. /./1/ Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: 7'7 9Q J 0 A- 200 amps or less 66.85 1 Phone: SOS 074/g Fax: _ amps to 400 amps 100.30 2 C y . Y4 ` . C . p „ 0 :: 401 to 600 amps 133.75 2 rs PPLI " -'� �� °" ` T � - - Branch circuits - new alteration, or Name: 0 C,i /©45/k / 4/q / Q extension per panel: Address: 7/D7 ! JO �D� R /V A Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 • 2 City /State /Zip: 7/'Ql irl, 02 B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit j 46.85 2 Phone:,40,3 ay ' 0780 Fax: Each additional branch circuit / 6.65 2 E -mail: Misc.(Service or feeder not included): - - u s 1 ' t a R % Each pump or irrigation circle 53.40 2 " - ° ° ' ° ' - ''' Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: Description. Address: City /State/Zip: Each additional inspection over the allowable in any of the above: y p Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: Lic. #: Other: Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Nam • Lic. #: State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized -- . / Notice: This permit application expires if a permit is.not obtained within Signature: 4. 0* -_ Date: I I iC 0.) 180 days after it has been accepted as complete. _ *Fee methodology set. by Tri -County Building Industry Service Board. t POD `�C lease print name) i:\Dsts\Permit Forms \ElcPermitApp.doc 01 3 • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems - $75.00 Check Type of Work Involved: • Audio and Stereo Systems ❑ • Burglar Alarm El Garage Door Opener n Heating, Ventilation and Air Conditioning System n Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls PI Clock Systems n Data Telecommunication Installation PI Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control El Medical n Nurse Calls n Outdoor Landscape Lighting n Protective Signaling Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 Building Fixtures FOR OFFICE [JSE OONLY - Plumbing' - Permit Application Received Plumbing 1 Date/By: Permit No.::M ` f - U � 1. / Cit of Ti and Planning Approval Sewer Y g Date/By: Permit No.: 13125 SW Hall Blvd. . Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use nr � i Date /By: Case No.: Internet: www.ci.tigard.or.us -3 1j . i 11 Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 d - W ' Name /Method: Supplemental Information. iit'• d -• ,..._ : ff TYP,EOF8V,ORI MM _ TA .... � °(for special ;tnfoi'mation;use,checklist) ; *,,: ❑ Desc Description Fee ea. New construction ❑Demolition p I Qty. � Fee( ea.) I Total w s .�; � �, � v , ��;, tea ��; , lacement Other: , R New 1 � & 2` fai I- y4WT. ellingsf O 3 : r , Addition/alteration/replacement p F ❑ � ,h €,t (mcludei)100 fc f � eadill tli itiinectwn) ; 4 t ,Ar k ' CATEGORY;OF CONSTRUGTION? ,. .. , [2 & 2- Family dwelling ❑ Commercial /Industrial FM SFR (1) bath 249.20 SFR (2) bath 350.00 Accessory Building ❑ Multi - Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 , ' ' JOB`SITE INFORMATION; and LOCATIO _' �� 'j. ;� Fire sprinkler - sq. ft.: Page 2 3 °Fg=' - °°IM�"i'r ' z'"- ° V,G s 4;o sa.t „` ^a,ta$rT�,=a:>�=. �.�et n .s Job site address: ? /0'� �A /a 4t) 7'79' q� .Yl ; ' ` ,,. ....,- ;Situ.Utiiities .. ,..,. ° =p, ,�,, u % °; . Suite #: Bldg. /Apf. #: Catch basin/area drain 16.60 Project Name: Drywell/leach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 reel /0 25 / 'i y to 25 e Manholes 16.60 v 5- , y A p y Z4 4 e / 7 t 0 L ° O / et / N ?/O / Rain drain connector 16.60 • Sanitary sewer (no. linear ft.) P ge 2 Subdivision: Re ,o18, PAlc H-- Lot #: 9 Storm sewer (no. linear ft.) Page 2 Tax map/parcel # :SF Water service (no. linear ft.) Page 2 5 2S IS ,Q id iii me/c GO , A � a , M _ _ ; . ',�' " , F,u°'A�ff;: " }_.�::: r . . _ . .,, Tt' ",t�v,%k. i.- "', _d .: af f a ;A :*L- _ _ :DESCRIPTIONIOEVOItt : -, . .h <� ° <�a Fiz- [ "Item,, / Absorption valve 16.60 �C(f J/ 6/f`)fr)9 ,t /no DP/ B ackfl ow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher / 16.60 • � PROPERTY4OWNtiC: `;;;JV s �s; rTENANti,' Fs Nr> ` ` °' <' ., ` ; `; Drinking fountain 16.60 �"�� �' •� ` °���� Ejectors /sump 16.60 Name: ik/ si/v ei/ AA q_r iv Expansion tank 16.60 Address: 2/67 s w Lola L A Fixture /sewer cap 16.60 City /State /Zip: 7( 9and OQ Floor drain/floor sink/hub 16.60 / Garbage disposal / 16.60 Phone:6 Aw 69 ?8d Fax: Hose bib 16.60 E APPLICANT , ~'', \,''•`,,3 -'4' i ]'C,ONTAGT <PERSON ' :w Ice maker / 16.60 Name: pa/zs!A1.. /1/) /9 --f#ge 4/ Interceptor /grease trap 16.60 Address: VD 7 S Go /Ci 4") Medical gas - value: $ Page 2 City /State /Zip: ti 4/ 0 �/ Primer 16.60 Roof Roof drain (commercial) 16.60 Phone: ,5 a /S/y 6 - 7,5) d Fax: Sink/basin/lavatory 16.60 ■ E -mail: Tub /shower /shower pan 16.60 .r.. .. uz ,; °'',. • . �CON:TRACTORN s:,. ,,,' ._ Urinal 16.60 Business Name: " ryt piles Water closet 16.60 Water heater 16.60 Address: Other: City /State /Zip: Other: Phone: Fax: `' "'.. ; ?P,lti "inb'i*tlruiii,�Ee"'e"s* » _ °' "�' <�,�r..s;:`.. K�`3�.�.,�.+�t ?r ".�..: ?:.a � `�`; �k., -�'� i�"h "`5'`ti:�t:3a,a ;c CCB Lic. ,: Plumb. Lic.#: , Subtotal $ Minimum Permit Fee $72.50 $ Authorized i+ Z;) Residential Backflow Minimum Fee $36.25 Signature: `".� - Date: l 2 ' 7 Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) S ' lease, pr 7 t name) TOTAL PERMIT FEE $ Notice: This permit application ex,- s if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted + complete. riser diagram for plan review. *Fee methodology set by Tri- County Building Industry Service Board. is \Dsts \Permit Forms \P1mPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities e zQty: # ,, `; =Fee_(ea) , Square Footage: Permit Fee: Footing drain - l 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 Valuation:. Peri iit_Fee: �. 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 additional $100.00 or fraction thereof, to and ' Ftxtu a or Item ? . Qty r Fee (ea); ° . Total - including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional 5100.00 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 fixture s could result in increased sewer fees *. ' '`` : x n:? . : {Quaiifity tiy'(Fixtu�e):,Wo�k:Perfoimed : Comments regarding fixture work: Future Type � s Replace . Vin ' 4,4. .'4"0.4:."i .' 3x ., ti%ib . g ,.,New od ve Earsting' k.. Capped.;? Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic • Dnnking Fountain Eye Wash Floor Drain/sink - 2" - 3" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic P Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service • Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal - Other Fixtures: is \Dsts \Permit Forms \PlmPermitAppPg2.doc 01/03 • 7 '� 4` FOR OFFICE USE ONLY Peron . hI ' " • ri Received Mechanical ----� Date/By: Permit No./14 v-ovii-067y CIt Of Tl and MAR 11 2004 Planning Approval Budding Y g Date/By: Budding No.: 13125 SW Hall Blvd. CITY OF TIGARP Plan Review Other Tigard, Oregon 97223 Permit No.: Phone: 503-639-4171 Fax: 51 ��NN DIVI Off. I 9� Post - Review Land Use ` I , Date/By: Case No.: Internet: www.ci.tigard.or.us 7 . Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. . ,,,.,t;t`. =, TYP,EOF =WORKw > ;; t ; a5'E:,", }' -� _• `, `: P ' »COMMERCIAL•`' FEE- .rSCHEDUI,V= .USECIiECKLIST ;,;;:; .„�,�' El New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ® Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all ,, G. , ,t u' "I* mechanical materials, equipment, labor, overhead and profit. �`r'z �-�� ��;�� k, - ��CAT.EGORY�OF;CONSTI2UCTION ���"±� a � ��,�,,�. i��. El & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi - Family - RE SID EINTIAL E Q URMENT/ SY,STE MS fEEE ti SCIIED_UL'-E: ;-:w Description Qty I Fee(ea.) Total ❑ Master Builder ❑ Other: Heating/Cooling ' ' • i ' ; ° : ` =r: `JOB0SI:TVINFORMATION'`and' L OCATION ' : fr-�' , ° g: = ' * * Furnace - add -on air conditioning** 14.00 Job site address: 'x(07 S sULOfQ 40 7 I d Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work / 14.00 Project Name: Hydronic hot water system 14.00 Residential Cross street/Directions to j ( job site: (for radiator boiler r or hydronic system) 14.00 7 /gq /O/QS R72/2y j o '?9'.5 70 317/64 Unit heaters (fuel, not electric) 4 4e to , Z/ (I /07) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: rQflsf 8ek /ay Pa /c. // Lot #: 9 Repair units • 12.15 Tax map/parcel #: ' . /� �' s'6' ,76 Other Fuel Appliances `T( ® l Water heater 10.00 ,1'j; , tK : nN ...:`1x'DESCRI TION; OF WORK ;` . F'3 '.; =, ii Gas fireplace 10.00 t ffen /Q/ 4/ 40/2)40.0e-/ Flue vent (water heater /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 L :PROPER'lW OWNER 1 °,1 ;: ` ®:pTENAN. 4 A . ` C V : Other: 10.00 Name' tV no N / RS J y N 1 ^ Environmental Exhaust"& V oblation _'=', C� /`t eA Range hood/other kitchen equipment tom Address: 7/D 2 C19 LoLA 4i) Cit City/State/Zip: Clothes dryer exhaust 10.00 y p' ri / �� Single duct exhaust Phone:�J�3 o?Vf —o78 el Fax: (bathrooms, toilet compartments, ' ;7[0;APPLICANT °: :::., .,A.' :.: _ s�2 ; = MI gCONTACT`"PERSONa: t :1 utility rooms) 6.80 Name:/kR./ri /(i((�.` 'I eitim Attic /crawl space fans 10.00 Other: 10.00 Address: 7/0 5' L.eLtt, 7) _ r Fuel Piping . r. City /State /Zip: - ,C/Q /Id 04 * *($5.40 for first 4, $1.00 each additional) Phone:, ? 3 ao 0 - Fax: Furnace, etc. ** Gas heat pump E-mail: Wall /suspended/unit heater ** N. { 'i:;''' " ` "T.-. `s`CONTRACTOR'2s k, : . ' :_; 5 :,f , ,it,', :4;;7, :: Water heater ** Business Name: _ ,�,� ,�� Fireplace ** Address: Range ** BBQ ** City/State/Zip: • Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lic. #: Total: Mechanical Permit Fees* Authorized ` : I iSta' O (r i ��j Subtotal: $ Signature: l/ Date Minimum Permit Fee $72.50 $ .,= l\''''1/4- V -`fi - lVf Plan Review Fee (25% of Permit Fee) $ (Please print nami State Surcharge (8% of Permit Fee) $ vv TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. i:\Building\Permit Forms\MecPermitAppPg2 09- 01- 03.doc . t. • IIR \I MI FEB 2 4 2004 Ile Number q6 -' ' C1eanWate ___ / __ — lJ Services a ,/ Y Our cutniuilmciki is c i c; , r . Sensitive Area Pre - Screening Site Assessment af Jurisdiction Ird d�'d 2 � � d - - Date ..-V,24- 5l Map & Tax Lot 79 finer kt M ,�+')C' 1c2e) f'� GglG7 /, 770 7 Site Address 40 44 4 A/. �� 4�ek.60 4 v / ' '-G� Contact y Fj. l), 9 4 5. /J(.7, . -/" Proposed Activity ,. tc �-,t,r AC/di f i.W Address , ii/ /' -i e) � 'Q 1- / S ( - X(C- ;4 y e. �F7h 7`i Cii) ,,, 2 9 / r (;\/ l? Phone ,sag - ,,g'y9- ? eiS </ ec -. . 5' O - k - 5 -- a) - (ill Official use only below this line 4li —> S7 — 9a /' >} .ill Y N NA Y N NA `R n n Map # 1Ve Area Co_m posite Map Li i I INA Stormwater Infrastructure maps QS # yo,Z2 n n i►yi Locally adopted studies or maps I I ( Oth Specify Specify 2 c, e.;4 / /iaTa 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: 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. rii 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. n The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: ,..7 t orraT;aJ a / .fet :v ad Ca. ct. pret -5 TO q'C. ,9 .Oec4 Reviewed By: 72. Date: 3/2/ 0c./ Returned to Applicant Mail f( Fax Counter Date , -`..V®y By—j- 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Phone: (503) 846 -3553 • Fax: (503) 846 -3525 • www.cleanw 3tyrscrviccs ur1; E 8tr28'66E'EOS 2uts..lou Rpues eBI :RO 4n &2 cla-1 S �� e I k& 1 �QQ� CITY OF TIGARD 24 -Hour BUILDING Inspection Line: 1503) 639 -4175 BAST 460 4 1 - 66674. 6 7 INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date R uested /( ,2 -- AM PM BUP Location l /6 Suite MEC Contact Person r- Ph ( ) SFO . 5 7a PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: - ELC Ftg Drain ELR Crawl Drain ' Slab Inspection Notes: I -2j SIT St Beam alL-1(-) / lJ^ � Shehear r Anchors Ext Sheath/Shear Int Sheath/Shear Framing T `� \ Insulation "!*o G� 0A1 ]� \U C © �e 1 M w ) Drywall Nailing , `J Firewall Fire Sprinkler - Fire Alarm Susp'd Ceiling Roof Other: PART FAIL /"." PLUMBING - ,' , w Post & Beam (J 1 �L Gr� Db � Pe LI\V S0 Under Slab Rough -In Water Service ` , c '� 1 1� Sanitary Sewer \ `A D (1�\ , i► , `V 1� � �C ) - o " `ek Rain Drains Catch Basin/Manhole t \ t \ t 4 \A, Storm Drain Shower Pan Other: PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers • PART - FAIL CTR . Service Rough -In C 2R, C.A \"[),)J-" (1) UG /Slab - Low Voltage Fire Alarm PART FAIL [I] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA / Approach/Sidewalk Date L �' U Inspecto d ��.��� ��� Ext • Other: Final DO NOT REMOVE this inspection record from th ob site. . PASS PART FAIL li