Permit .... ..— . , : • ' (t)i r-4 b(2e eta ced 91-462! v/ i ci... 9 _, / )56
A - 0 MASTER PERMIT
CI ¥ OF TIGARD PERMIT #: MST2003 00490
DEVELOPMENT SERVICES DATE ISSUED: 10/17/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11355 SW TIGARD ST PARCEL: 1 S134DC -00600
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: Replace existing roof and add onto existing garage. Also adding 162Sq. ft. of living space per
revisions.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 10 FIRST: 162 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: 550 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD. sf RIGHT: 5
VALUE: 50,944.80
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 162 sf REAR: 15
PLUMBING
SINKS: 0 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER: 1
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: 1 W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: _`1i' 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL 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: X VACUUM SYSTEM: X AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
l BURGLAR ALARM: X OTH: ALL ENCOM BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
‘ t G ARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
lr HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 1,600.48
ANDERSON, LARRY R AND SPACEMASTER REMODELING This permit d Mu is Municipal subject to the regulations contained Co i ode s and
the
Ti
CYNTHIA M 12505 NW 20TH AVE. all other applicable cable , State laws_ All wor k rk will OR. Specialty done Codes
11355 SW TIGARD ST VANCOUVER, WA 98685 l otr applice ved plans. This o p eron i
accordance with approved t
TIGARD, OR 97223 v pm it 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: 360 -573 -5751 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952- 001 -0080. You
Re g # LIC 122803 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Crawl Drain /Backwater Electrical Rough In Shear Wall lnsp Electrical Final
Footing lnsp PLM /Underfloor Framing Insp Exterior Sheathing Insi Mechanical Final
Foundation lnsp Mechanical Insp Shear Wall lnsp Exterior Sheathing Ins Plumb Final
Foundation lnsp Plumb Top Out Shear Wall Insp Insulation Insp Final inspection
Slab Insp Electrical Service , Shear Wall In Rain drain Insp
trio
Issued By : ,e. �j, ?/G>�_ p..- c-f :. - � Permittee Sig natur4:- -- '�� `
-�`7/
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the nextbusiness day
Mechanical Permit Application FOROFFICE USE ONLY,
Rece Mechanical
• Date/By /)/ Permit No. Mr q —dO9 ?
City Tigard 1 igand Planning Approval Building
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
4°1411411i ; \ Date/By Case No .
Internet: www.ci.tigard.or.us _j_14, y I
Contact Juns • ` See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method Supplemental Information.
-:I, . -'ri.TYPE :OF'WORK; ''_,= , -- 4 :: -1F5COMMERCIAi:• FEE *= SCHEDULE,?:USE:CHECKL•IST ;2 .:.
❑ 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
.'''° '= ':.`';:' CONSTRUCTION ,' ;, r.. ; .'; <. mechanical materials, equipment, labor, overhead and profit.
❑ I & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family =. ^•- RESIDENTIAL•. EQUIPMENT /SYSTEMS'FE *, SCHEDULE.: �:
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
- :.. <2.10B SITE INFORMATION Ind tOCATION - :` Furnace - add - on air conditioning ** 14.00
Job site address: /7 3 c s>,w , : Gas heat pump 14.00
Suite #: Bldg. /Apt. Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Tax map/ parcel #: Other Fuel Appliances
ax ma
P p Water heater 10.00
. ::`,.- ' :. _ .. _ :':" .DESCRIPTION!OF WORK.': ", :, , '''. _'• - � '.'. ' Gas fireplace 10 00
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
' -',;
❑PROPERTY ° _OWNER;_':.�• ="': _= ' � TENANT.w '` � rw; . - - - : - _. _ -: ; '": Other: 10.00
// Environmental Exhaust & Ventilation
Name: .Cge�, C_'4.v nn �d'ozc-an_
/T Range hood/other kitchen equipment 10.00
Address: i ,' 3 5 _ 5 S ' " " t 2 2 Clothes dryer exhaust 10 00
City /State /Zip: -77' (> ,9� pv t7'7
� Single duct exhaust
Phone: Fax: _ (bathrooms, toilet compartments,
: :❑•APPLICANT` , ® CONTACTPERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: _ 10.00
Fuel Piping .
City /State /Zip: ••($5.40 for first 4. $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E - mail: WalUsuspended/unit heater **
• ;CONTR ACTOR'.- .. , '::'
. � - -� - - -- - - _ Water heater **
Business Name: G,Q r'e_ CourcTati S paw « Fireplace **
Address: Range *1 **
City /State /Zip: Clothes es dryer (gas) **
Phone: 77 —czZ3 Fax: Other: **
CCB Lic. #: Total:
Mechanical Permit Fees*
Authoriz Subtotal: $
Signature. Date • /Z _/03 Minimum Permit Fee $72.50 $
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 $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.
$1 00,001.00 and up $1 ,396.50 for the first $1 00,000.000 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
Building Permits li 1•
r On ' FOR OFFICE USE ONLY
Received Building //
cs
DateBy q d 4 3 Permit No . 110Toveo 0 '' 0 7 ?d -.►
City of Tigard iZ 4 ' 5 Planning Approval other
Date/By: Permit No.:
13125 SW Hall Blvd. S G f D ` Plan Review Other
Tigard, Oregon 97223GARp Date /ay Permit No.: (j
Phone: 503- 639 -4171 Fax: PO f� \O " ��r iw di i ?f,l l ;i � Post- Review Land Use
UU ■ , _11 Date/By Case No.
Internet: www.ci.rigard.or.usaU1Lp - °^ Contact
.h___./t El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: - Supplemental Information
� ' _: ' ` _ , . ,.� , ilVgW {" ` :P'YP.E.4,V; URIC " -'4y eM g at r r . �a n : � p ,° 4 ,,; it k1` ,,, � , '=c '.
. •.��,.:�:,_e ��" ,.rr� ��.s� _�_ a_ .- . �'�. - - , ''d'c?,����, �,,i' ; ex�s,,am�.�iz:;.. ,'�'�`'��'"�'� E '��`'":,, ,� `�'�12E , D� � � 8-k..,. �
III m 'x �x • g Q; ; -eerr o <. y ��. � = ,gyp, ° - � � LL : � "�'Fik
New construction III Demolition k , -�. ° $ 1� & � �` ` , - Vi i ;` ;1„te C� If` ,qtr to , 3�'
ritta . Y#S:.n'• a, f i.'z., - g Lj,' - o .74 7 40 :4..d,.
do - alteration/replacement ❑ Other:
tt : ;,, ; ',' ,CAirtORI OF gONS~T OTtON ' ` ' om Note: Permit fees* are based on the total value of the work performed. Indicate
®'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. W
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
.413 I1 Ra TIONiiird1400 v nti !N ' No. of bedrooms: No. of baths:
Job site address: / �- Total number of floors 16
3.5 S /,(� 77 ter 5 New dwelling area (sq. ft) a 1P. Sso1__,
Suite #: I Bldg. /Apt. #: Garage /carport area (sq. ft.) lam) •'cj Q .)
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
,i `s 's.•S ^ -. _ - 3'. , 5`
S%2r'+' -J« - a - 5 ✓'I '� i ;'
sa. � 2EQ 17,4�TaA., � � �,d'
i CO E C I A L � C ele ,i?,. ' ' ` ' ° a
Subdivision: I Lot #: r «% - ek ,r " *:. „ ' f , ,P ng:;_<1-1,3 :$.:: - ;, ' .4'. 4, 1 , , , a,,, ,, ,', - :.1-.
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
� '° �._ `.,tt 3 °',� 'y °” "spa r- ., 4 tf the value (rounded to the nearest dollar) of all equipment, matena s, labor,
Ki 1 tz§v aDESCR P,,00 - Nr F Oi;M: , 'r foimis:
overhead and profit for the work indicated on this application.
4_01 . AP 7.s1 ,A 4,_4 c e z Valuation $
/ Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
la. ROP u i 'Y ® tioisrt1 ll > 't r+ jiga Type of construction
X49 ci r Occupancy group(s): Existing:
Name: Z. Q t/ - �� 3� 1 _se) New:
Address: //3 & .� w. � iF C�;� c7
City/State /Zip: , A✓ e f2_ £ 97773
NOTICE: All contractors and subcontractors are required to be
Phone: Fax
x PPL licensed with the Oregon Construction Contractors Board under
P N 001st ;s A'z; ;'=; G tOti 1- C ` ` 1 , , O z i= .
,, O � provisions of ORS 701 and maybe required to be licensed in the
p Business Name: _ _ -. . H. './PC _ _ s V G C.. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: ,) C kin c from licensing, the following reason applies:
Address: '2 5 S cc) '. � �1 D t ,A --
City/State /Zip: / //9,0 L GOA 5j '6
Phone:_ 3/,0 ,c2.3 - -S W/ I Fax: 3 -S 73 - -,1 / ," " • $ t 4 ;: r i rAv,s -- „ i ;fp.vv j
E -mail: B IG P E PgE«ES �_ _ Nirt , ; ,
►7 ✓ s-7 , • i ! - c + c4 .* , lint . s. Y - 1 „ 5--1 4q
5 d ,4s C t .. S . N . z �°, ;1 ~ { ,,.. ; ,.� , ;
�/ , .��, _ � �t� . `�� , l ea se refer� fee s c ti e c7i ile e „, �a , -.. � „�,<
k ;%e , 0 3w W 1 6,AX: ®NT A a..
lz_ y : •s ? .
' s, s xz, <M.. -4 4.4 u A , ' n e F ,. t' . , N � _ » ;t
Business Name: 5� C le k_ —' Fees d ue upon app $ •
Address:
City/State /Zip: &P-01 04/ Amount received $
Phone: I - : Date received:
CCB Lic. #: A� 4 0
AuthoR__�� Notice: This permit application expires if a permit is not obtained within
Signature: _��-� Date: 7 "� 3 180 days after it has been accepted as complete.
-- A' -t21 ) me a-u._.) *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i• \Dsts\Permit Forms\BldgPermitApp doc 01/03
ri
4 1•
4 11‘ One- and Two - Family Dwelling Building Permit Application Checklist Reference no.:
Associated permits
City of Tigard City of Tigard
❑ Electrical ❑ Plumbing 0 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 Oft. 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. 440 -4614 (6/00/COM)
•
Electrical Permit Application. . ..FOR OFFICE -USE ONLY ,. -;
' Received • Electrical
Date/B • 9 Ay o 5 QQ
Permit No : i // , o; Oa 70
City of Tigard RECEIVE* Planning Approval Sign
Date/B Permit No
13125 SW Hall Blvd. �y Plan Review Other
' - Tigard, Oregon 97223 SEP 2 LO Date/B - Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
� Date/B Case No
Internet: www.ci.tigard.or.us QTY OF Ti 7 �� . Contact El See Page 2 for
24 -hour Inspection Request: 503 - gaL4l 3 Di r . i Name/Method: If s - Su i ,lemental Information.
..- ; TYPE OF - _ . _ , : +, i•PLA'N REVIEW, lea`se`ctieck=ill_thit:a _ :'',,',-",',,
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
E] Other:
commercial over ❑ Bilding Hazardous over 10,000 ❑ Addition/alteration/replacement
❑ Service over 320 amps - rating of ❑Building over 10,000 square feet,
' +i '. `, .Y-,' •CATEGORYOF < -' `,":,-.., - -; I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other
_"' JOB`SITE INFORMATION'and;LOCATION v - - ,. ' Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: : ,r .
.. ti. �., ., , :. .= FEE * - SGHEDULEA � „�.` . ,�:F . , ',";.:-:;
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145 15 4
Each additional 500 sq. ft. or portion thereof ‘ ' 33.40 1
Subdivision: Lot #: Limited energy, residential 75 00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
<. ` ='DESCRIPTION . •
4 - :.: :.�. - �•� • .� _ service and/or feeder 90 90 2
�
n /1.1t4- Services or feeders - installation,
is 6_ 4 4r ha P 1 Q,(t F - - alteration or relocation:
200 amps or less V 80 30 2
201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
�q 601 amps to 1000 amps 240.60 2
° ❑PROPERTY'UWNER:..�� .;; <::: ;_�:TENANT.,'_,i ;.�, _. ',;.:' - „,;. •:. `' •- .
n Over 1000 amps or volts 454.65 2
Name: 1., w P' (7 2v �y 4 � £&L- Reconnect only 66.85 2
Address: (43 SS .5",0 . - 7 - 79A / ST Temporary services or feeders - installation,
/State /Zi � cy ` 3 200 amps or less 66.85 I
alteration, or relocation:
Cit
}r p• //'� �'�/6 � �7u
Phone: / F___ ____ax: / 201 amps to 400 amps 100 30 2
401 to 600 amps 133 75 2
❑'APPL•ICANT , • :'' .' CONTACT, PERSON° _” •, - Branch circuits - new, alteration, or
Name: i /,� • �0 , c k dll'1 L , extension per panel:
Address: A Fee for branch circuits with purchase of
2 o-s /I .GC/ . a — service or feeder fee, each branch circuit 6.65 2
City /State /Zip: !/Abc- W4 q .S B Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: 260 S ; S`7S1/Fax• (, 0 s -di/ d Each additional branch circuit 6.65 2
E -mail: /.de (2 M/4-Siek 060( 5 , r C tx � Misc (Service or feeder not included).
Each pump imgation circle 53 40 2
;,
':`CONTRA = OR;/::-'''''.:.:;'::;-' Each sign or or outline lighting 53.40 2
Job No: —7-6 S ignal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
Description.
Address:
City/State/Zip: Each additional inspection over the allowable in any of the above:
y p� Per inspection per hour (min I hour) 62.50
Phone: Fax: Investigation fee -
Other
CCB Lie. #: Lie. #:
Eleetiieil ieFees* ' ,. �. ,yd;..;,_ -i i
Supervising electrician Subtotal $ rt
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date. 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp doc 01/03
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:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
n Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
El Clock Systems
D Data Telecommunication Installation
O Fire Alarm Installation
n HVAC
n Instrumentation
El Intercom and Paging Systems •
Landscape Imgation Control
0 Medical •
El Nurse Calls
Outdoor Landscape Lighting
O Protective Signaling
n 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
Plumbing Permit Application FOR-OFFICE-USE ONLY
■ Received / Plumbing
DaDate/By: / /o.3 Permit No ff 5j a9 3-- 0 e q0
City of Tigard Planning Approval Sewer
DateBy Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Ailli. Post - Review Land Use
1D I A Date/By S Case No
Internet: www.ci.tigard.or.us
j Contact Juris ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method. _ Supplemental Information.
- ` = ig•- ' "- 'TYPE_OF:WORK:: " • ; -° -, - ..',. Y .. 'FEE *`SCHEDUL•E.(foespeeial inforinatioo`use'checklist)`
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: , , , ) ' , &2 family "dwellings , ` -'
ORY OF,CONSTR - 00 ft. for.each
'_CATEG UCTION..,�'�� "'� ;.,,' : �;'-.' �'' :' utility 'conneetioo) :-.;'- ,`'•
1 & 2-Family dwelling SFR (I) bath 249.20
El y g ❑ Commercial/Industrial 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 LOCATION - 2 Fire spnnkler - sq. ft.: Page 2
Job site address: / /3S c� •a_.1_77 . r 9 •a t .�/ _ _.: , ...::Site Utilities - ,. - 4r = •
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: LAE,e. C, 4,04,- 4 ti�l eK J Drywell / leach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Direction to job site: I Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
crr . -, ;g - •Fixture or Item ;�j a ;; ° {ii,
'MESCRIPTION.OF. WORK , ' , - :'
-
Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
:•E1 OWNER , -lc,- ;:I TENANT ;.:'„ ' _ Ejectors/sump 16.60
Name: 14 ' P, , yerlr A 2
S a) Expansion tank 16.60
Address: // �c' �'` Gtr - ; - , 4 .d (,.? Fixture /sewer cap 16.60
City /State /Zip: - g * f t��' t"%,�✓ T-7LL. Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax:
Hose bib 16.60
'•❑'APPLICANT'. • .; ® 'CONTACT.PERSON- s. : _. '
Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: S Page 2
City /State /Zip: Pnmer 16.60
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
_ . ' . : ;CONTRACTOR' . - Urinal 16.60 •
Business Name: , A/36-- i• a Water closet 16 60
Address: 511- 17 �''j `Vo ti ‘14 3e -' ' Water heater 16 60
Cit City/State/Zip: Other
Y p' �i�/uG. !/� /- '� l�la�5' Other:
Phone: $76.- X77 Fax: "`�; ` :'. ''Plurnbitig•Peitiiit Fees.. „
CCB Lic. #: /2 F960 r Plumb. Lic. #: subtotal $
Authorized r 1 Minimum Permit Fee $72.50 S
Si ature• ),- J ac - --O -- Date: /Z- /--r,Z Residential Backflow Minimum Fee $36 25
' Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) S
(Please pnnt name) TOTAL PERMIT FEE $
Notice: This permit application expires 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 as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i. \Dsts\Permit Forms \PlmPermitApp doc 01/03
Plumbing Permit Application - City of Tigard,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
r Site Utilities Qt r. Fee,(ea) Total. ; Square Footage: ' q Permit Fee:
Footing drain - I 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: - • . • Permit 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
`Fee(ea)�',Total�' additional $100 00 or fraction thereof, to and
;, ' 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
Inspection of existing plumbing or each additional $100 00 or fraction thereof, to
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 *.
Quantityby (Fixture):Work'Per`formed Comments regarding fixture work:
Moved? 'E 't1 ,`; ,ECapped
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 Dram *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. /Refng. 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:
i \Dsts \Permit Fors \PlmPermitAppPg2 doc 01/03
- CITY OF TIGARD
13125 S.W. HALL BLVD. �
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PATTERSON ELECTRIC
1834 NE ESTATE DR
HILLSBORO, OR 97124
Electrical Signature Form
Permit #: MST2003 -00490
Date Issued: 10/17/2003
Parcel: 1 S134DC -00600
Site Address: 11355 SW TIGARD ST
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R
Remarks: Replace existing roof and add onto existing garage. Also adding 162Sq. ft. of
living space per revisions.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
ANDERSON, LARRY R AND PATTERSON ELECTRIC
CYNTHIA M 1834 NE ESTATE DR
11355 SW TIGARD ST HILLSBORO, OR 97124
TIGARD, OR 97223
Phone #: Phone #: 614 - 8000
Reg #: 40 §&05021
LIC 38538
SUP 3195S
ELE 34 -112C
SUP 3116S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
ELE 34 -211C
X C D - c, ; -,v.
_ Signature of Supervising- Electrician
If you have any questions, please call 503.718.2433. • .
CITY OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175 MST d 03 V96
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested 9 3 AM PM BUP
Location ,� ` - 7 --- + . «i/ • , Suite MEC
Contact Person 1 P C -_Q_J Ph () /C 2/.--8D-D-3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation % i c to
Ftg Drain )A cce r � �t ELR
Crawl Drain ' " .1�e • ; ,F "' " t ci _
Slab Inspection Notes: SIT
Post & Beam 1
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation r, ,'r 1/;‘, Yea
Drywall Nailing
Firewall v �/� Wr Fire Sprinkler �"� 1� G" W S��U''`�
Fire Alarm
Susp'd Ceiling -
Roof & 6-44--- 1't-e GQ f L° 041-40t [.+.il
Other: /�
Final /3/1 ,
PASS A PART FAIL
( PtGMBINQ G l 3l
eam /1/1;;7-5) / 3 � o
Under Slab
Rough -In 2 2, K ( 130 0
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole Ii e-L , I C 19- —VRecil-$ S
Storm Drain _
Shower Pan 7RJ- Ufa. "re, — /1.4
final r�/ / e f•-( ,
PASS PART CP
MECHANICAL
Post & Beam
R
dir
ough -In __ , _• . e.Ae■ 'r- - - . # 1 _, rtA_ .
Gas Line
7 4 / '
Smoke Dampers ,
/' - 7 - 4-; -44 `� D
!� Final
PASS PART FAIL
Vice
g In
UG /Slab
Low Voltage
Fire Alarm
��y, PART FAIL fl Reinspection fee of $ required before next pection. P- ,Fli= -' • -II, 13125 SW Hall Blvd.
Please call fo einsp tion RE: / /% `' to inspect - no ccess
Fire Supply Line 111 ADA Approach/Sidewalk Date InBpeCt _ / d A V 1e
Other:
V 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
0/P_...-f2WW
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM �PM BUP
Ety
Location .• i Suitt ' 7 MEC
Contact Person Ph ( ) PLM
Con Ph ( ) SWR
UILDING 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 / /�O� /
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm (71,7
Susp'd Ceiling
Roof
• ' er:
FAIL
i'i :7r
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole / .1
ef
Storm Drain '
Shower Pan
Other
f inal _
''' 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 0 Reinspection fee of $ required before next spection. Pa = • all, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 111 Please call for inspecti- RE: Unable to inspect — n cress
Fire Supply Line �J O i '
Approach/Sidewalk Date / Inspector i /�
Other: gir
. Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL