Permit ,... _ i. .
A
CI TY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00107
4.111. DE VELOPMENT SERVICES - DATE ISSUED: 3/18/03
�`�' R ��' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10276 SW PICK'S WAY PARCEL: 2S114BB -18100
SUBDIVISION: RIVERVIEW ESTATES ZONING: R -
BLOCK: LOT: 027 JURISDICTION: TIG
REMARKS: Construct small bump -out to house new gas fireplace.
BUILDING
REISSUE: STORIES: • FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: 6 sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: Troll: sf RIGHT:
VALUE: 5,200.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 8 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: ,
OTHER FIXTURES:
MECHANICAL -
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: .
LPG FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 •
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 FOR: PUMP/IRRIGATION: - PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: 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: $ 252.86
MILLION, ROBERT C + SUSAN M ARTISAN RENOVATIONS INC This permit is subject to the regulations contained in the
10276 SW PICK'S WAY 16205 NW BETHANY CT #112 Tigard Municipal Code, State of OR. Specialty Codes and .
TIGARD, OR 97224 BEAVERTON, OR 97006 all other applicable l v. A work will by done i
accordance with approved plans. 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. ATTENTION:.
Oregon law requires you to follow rules adopted by the
Phone: Phone: Oregon Utility Notification Center. Those rules are set •
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg 6: LIC 102568 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Framing lnsp Final inspection
Gas Line lnsp '
Gas Fireplace - .
Insulation Insp
/
Mechani I-Fi.-
Air
Issue By : � I % 4.2_s Permittee Signature : Alkailialif a...t_
-- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day - -
•
Building Permit Application FOR OFFICE USE ONLY
Received Building Lt n_
Date/By: r / ��
Cl of Ti and P lanning Ap Other
l.
g Date/By: Permit PermitNo.: No.: /1 ova S ' ooio 7
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 - i %�
/ �� ,,�� ���� ` Post - Review Land Use
www.ci.tigard.or.us ww.Ci.tigard.or.us s ^ ^^ 6:f I ' Date/By: Case No. ' Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:
R N A ew construction ❑ Demolition • 1 & 2 FAMILY DWELLING
ddition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
I 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
❑ Master Builder ❑ Other: Valuation $ 5,2oD. ).
.JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 107_7 (p S 1/.3 Picts L(.2 New number area floors
y New dwelling area (sq. ft.) % S Q PT.
Suite #: / I Bldg. /Apt. #: / Garage/carport area (sq. ft.)
Project Name: MI nu.t0ti l..tv ■ Nc.,.R Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
Sw 103d2D ist.E Sw �P,e_x_s v ll
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: R we-1211) tE.w ESTp S I Lot #: 027
Tax map /parcel #: 2-S it N B ft- ► $ MC) Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
I NS (9/ -:bt o..ed-T %kr-4 . e_Q- e.._ .
LeNSre.vc:r C r►- u ) . 3' v - p- Os., 1 Valuation $
Existing building area (sq. ft.)
1'N STh6(_ M O -' c>oKC' A—se New building area (sq. ft.)
Number of stories
VI PROPERTY OWNER I ❑ TENANT Type of construction
Name: Rogogr , Sus,...) fAttAAorJ Occupancy group(s): Existing:
New:
Address: 10 2'71, Sta P, e -S W Ar Y
City /State /Zip: - I I ( m217 / 0 R 912.Z-J
Phone:503- (039 -59 NOTICE: All contractors and subcontractors are required to be
9 Fes: licensed with the Oregon Construction Contractors Board under
10 APPLICANT [J CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: AR•rsgwl cl∎Jc akTtotJS 1N jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 4..1.6 ea WertnsJ from licensing, the following reason applies:
Address: Ito 2O i.r w (Se- Ctna- *1 ) . 2--
City/State /Zip: sAinst..3a,J t 0 R. 9 /00C.
Phone: So3 -&10 -ol o t Fax: s
' l BUILDING PERMIT FEES*
E -mail: }-�pt,.Jtrrtx> t� .t4tmSAbAge.w oht Please refer to fee schedule.
CONTRACTOR
Business Name:ctsAtJ R1v,J S. t. N Fees due upon application $
Address: I o - LDS MJ [ n ri Cov -T **t t Z--
Ci /State /Zi p
I ,! q - e) 6, Amount received $
tY P BQ
■ Phone: . - - 0 3 - ( o +‘I•- ®`jtat. I Fax: 'VG -( t y - a 9 TO Date received:
CCB Lic. #: 02 _ - : _
Authorized ", . , Notice: This permit application expires if a permit is not obtained within
Signature: ,� ���' � 180 days after it has been accepted as complete.
2 _i I t • *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\DstsTermit Forms\BldgPermitApp.doc 01/03
One- and Two - Family Dwelling
4 1 11 Building Reference u ilding Permit Application Checklist
- Associated permits:
City of Tigard City of Tigard b O Electrical O Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TIIE 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 -, , ion control O plan 0 permit required. Include drainage -way protection, silt fence design and location of
catch- .• asin protection, etc.
10 3 r s mplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
a .' a ing 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 alms are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
. 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. l .
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. 440 -4614 (6/00 /COM)
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
Date/By: y: / d 0 3 Permit No.: �� � ---0 - 0Io -7
Planning Appr val Building
City of Tigard 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 U r vK� I' Post - Review Land Use
Internet: www.ci.tigard.or.us , 6 . ' I ( f� Date/By: Case No.:
Contact Juris.: ID See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ^ '" Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
al-Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
cs 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION _ Furnace - add -on air conditioning ** 14.00
Job site address: 107-1 (p ¶ L P% C%(S Ui Gas heat pump 14.00
Suite #: / Bldg. /Apt. #: / I Duct work 14.00
Project Name: mI -,.1 LAVtt.styi�,c�GyV Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: `` (for radiator or hydronic system) 14.00
S' J lO a a n Fl-v1 E. i S W ' at- S Vi) A.' Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) • 14.00
Flue /vent (for any of above) 10.00
Subdivision:(ZwE2vae ESATE. Lot #: O27 Repair units 12.15
_ - Other Fuel Appliances
Tax map /parcel #: .S 11 %.4 6 B - I B Water heater 10.00
f DESCRIPTION OF WORK Gas fireplace l 10.00 /Q. eV ' G L NF_ Pit- b 1 Q1G� Aitr T Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
_
C-'2.- q.4%-e--e.. Wood/Pellet stove 10.00
' "tt1 IZA-,e.T AI PuJT C' -P Wood fireplace/insert 10.00
• Chimney/liner /flue /vent 10.00
- [PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: R� -r k 5 1N\ te.1.A.OP r ki equipment 10.00
Environmental Exhaust & Ventilation
L Range hood/other kitchen
Address: 10 2 1( S b ) P ,,,,,s 1�R-y I Clothes dryer exhaust 10.00
City /State /Zip: T1(. 1 D 12 q"7 Single duct exhaust •
Phone: So 3 - (p31- 5 11. Fax: (bathrooms, toilet compartments,
,.APPLI CONTACT PERSON utility rooms) 6.80
H
Name: O1w)Pt4_C -f2. fs-i) tr.3 Attic /crawl space fans 10.00
Address: N E27..c' - NW BtGT y cz Other: 10.00
(3110-06, � 1 - Fuel Piping
City/State /Zip: 13Ertki 2wcJ O� * *($5.40 for first 4, $1.00 each additional)
Phone:S03 --( i.-1 -010 1 Fax :63- t l4 -VI up F urnace, etc. **
Gas heat pump **
E- mail:} y 1,a (2 AA-Nis el. Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: ART%5Ar1 es.NOt/rA-'nOW 14JC. Fireplace - I ** 5
Address: lb 20 NI 44 BST ikkav Range •*
BBQ **
City /State /Zip: A, 2 , C CI I W (O Clothes dryer (gas) **
Phone: S ' o - & 4 - p 1 Fax: -S - ( Q l4 gq 2-0 Other: **
CCB Lic. #: 02 - , / Total:
/ /
Authorized Mechanical Permit Fees* .I
Signature: / %''�' Date: Ild Subtotal: $ i 5• `( 0
Minimum Permit Fee $72.50 $
1 -\-0-01A-Q-A -. Plan Review Fee (25% of Permit Fee) $
(Please print name) • State Surcharge (8% of Permit Fee) $
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 $5,000.00 Minimum fee $72.50
$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 including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$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 and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Es) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to I mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
•
i:\Dsts\Permit Forrns\MecPermitAppPg2.doc 01/03
CITY OF TIGARD s 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 -4 5 - 0 /6
INSPECTION DIVISION . Business Line: (503) 639 - 4171
--7 BUP
Received Date Requested (— ° Z� / AM PM BUP
Location l b -7 Co. � � • y i Suite MEC
Contact Person /4-19-4-0 Ph ( ) (o l c{ - O I en PLM
Contractor Ph ( ) 4 10 7 - (04 6 0 SWR
ILD IN Tenant/Owner ELC
o.� 9
Foundation ELC
Ftg Drain Access: v r l 0 3 ELR
Crawl Drain
Slab Inspection Notes: Arly_...2..zei SI T
Post &Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
PART FAIL
PL I ' BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
FAIL
C , ANIC
Posi eam
Rough -In
Gas Line
Smoke Dampers
a= PART FAIL
RICAL
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: 0 Unable to inspect — no access
Fire Supply Line Inspector c7��
ADA 7/? L_3 1 " �n Ext
Approach/Sidewalk Date
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL