Permit CI TY OF TIGARD MASTER PERMIT
PERMIT #: MST2006 -00042
__,i,Ll DEVELOPMENT SERVICES DATE ISSUED: 3/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102CD - 02604
SITE ADDRESS: 09610 SW HILLVIEW CT ZONING: R
SUBDIVISION: TWALITY HILL LOT: 004 JURISDICTION: TIG
Project Description: 864 square foot pole building w /attached breezeway. 6/2/06, adding 50' of storm service to
connect to public line in easement.08 /2/06: Added 50' of rain drains.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: FIRST: sf BASEMENT: of LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: of GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: at RIGHT:
VALUE: 6,610.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 of REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 200 TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER UNES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER UNES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > -100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 . 200 amp: 0 - 200 amp: WISVC OR FOR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 . 400 amp: 1st W/O SVC/FOR: SIGN/OUT UN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC/FDR: 601 - 1000 amp: 601aampa- 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: LANDSCAPEJIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
MINDY SHELDON MCMINNVILLE LUMBER applicable laws. All work will be done in accordance with approved
9610 SW HILLVIEW CT 2779 BUNN RD plans. This permit will expire if work is not started within 180 days
TIGARD, OR 97223 MCMINNVILLE, OR 97128 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -001 -0010 through 952 -001 -0080. You may obtain copies
Phone: 503- 813 -5358 Contact #: PRI 503 - 472 -1631 of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Reg #: LIC 113388
TOTAL FEES: $ 300.68
REQUIRED ITEMS AND REPORTS
Issued By : /�, 1_2r Permittee Signature : "'. 00
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r
CITY OF TIGARD MASTER PERMIT
PERMIT #: RMIT 6 - 00042
�,L� DEVELOPMENT SERVICES DATE ISSUED: 3/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102CD - 02604
SITE ADDRESS: 09610 SW HILLVIEW CT ZONING: R - 4.5
SUBDIVISION: TWALITY HILL LOT: 004 JURISDICTION: TIG
Project Description: 864 square foot pole building w /attached breezeway.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: at FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT:
VALUE: 6 ,610.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 to REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 96 TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER UNES: 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 < SHP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN/OUT UN LT: PER HOUR:
LIMITED ENERGY: 401 - 800 amp: 401 - 600 amp: EA ADDL 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
MINDY SHELDON MCMINNVILLE LUMBER applicable laws. All work will be done in accordance with approved
9610 SW HILLVIEW CT 2779 BUNN RD plans. This permit will expire if work is not started within 180 days
TIGARD, OR 97223 MCMINNVILLE, OR 97128 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through 952 -001 -0080. You may obtain copies
Phone: 503 -813 -5358 Contact #: PRI 503 - 472 -1631 of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Reg #: LIC 113388
TOTAL FEES: $ 269.47
REQUIRED ITEMS AND REPORTS
Issued By : 70 Slav" 13" Permittee Signature : $gyp, cI �(� �p
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. '( i
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD 3/31/2006
a 13125 SW Hall Blvd. 4:26:49PM
C Tigard, Oregon 97223
TIGARD (503) 639 -4171
Receipt #: 27200600000000001051
Date: 03/31/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MST2006 -00042 [BUILD] Bldg Permit 245- 0000 - 432000 110.50
MST2006 -00042 [TAX] Build 8% State Surchrg 100 - 0000 - 207020 8.84
MST2006 -00042 [BUPPLN] Pln Rv Deposit 245- 0000 - 433000 71.83
MST2006 -00042 [PLUMB] PLM Permit 245- 0000 - 431000 72.50
MST2006 -00042 [TAX] PLM 8% State Surcharge 100 - 0000 - 207020 5.80
Line Item Total: $269.47
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard MELINDA SHELDON BB/DLH 268528 In Person 269.47
Payment Total: $269.47
cReceipt.rpt Page 1 of 1
•
CITY OF TIGARD RECEIPT
4 DEVELOPMENT SERVICES RECEIPT DATE:
' 9jao
I l i� 13125 Sall Blvd., Tigard, OR 97223 JURISDICTION.:
� '�' - 503- 639 -4171 www.tigard - or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS:
Case No. I Fee Description I Revenue Acct. No. Amount Due
li4r o 000 V 2 -6LA Pi-k) AO. CLe, I 7 / • 'J
D
ti 1oo - ono �c? - Pt,d,, -t6 P .H �T �� .__ - -- _ � 7
•
r
Total Due: $ Alo
❑ SEE ATTACHED FEE SCHEDULE.
PAYMENTS: Payer: jilnn .f. a Method Initials I Check No. I Confirm No. I Amount Paid
' Ci 131 5 Lo 5 a_t 4 i I
Total Paid: $ ale) , y7
IA Bu ildingWorms\ ManualPermitFormsUvIanualReceipt .doc 03/01/063/1/2006
•
Building Permit Appli • :5 t v . FOR OFFICE USE ONLY
City of Tigard E L E B Ff • r � � R1Ved - f ' Permit No. pd ► -
Date/B .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 m.-/c.• �� / P
o d Other Permit:
I ` ` Date/B . 1
Inspection Line: 503.639.4175 FEB 14 ' 4 I Date ReadyB . ®See Attached Ch ecklist for
Internet: www.ci.tigard.or.us • • • Notified/Method: I Q /� Supplemental Infor
CITY OF TIGARD
BIM P Rlb ISJON REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction Y El Demolition P ermit 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
CATEGORY OF CONSTRUCTION work indicated on this application.
l a I- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 66 Q coo
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
• Job site address: 9 b 16 s w ‘.\:,-...\..,,---1/4c,„..., C New dwelling area: square feet
City /State /ZIP: ---- `� �—� Q Q1 7 223 Garage /carport area: square feet
i
Suite/bldg. /apt. no.: I Project name: Covered porch area: square feet
Cross street /directions to job site: 0r Deck area: • square feet
. Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: ` c,` .,' \ ` 7 Y'1 S I Lot no.: 26 ,q Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
(� 2 ,4 3/ p e _ g ' 1 � J I l Valuation: $
`
w f to- ee ze \,..1 t[ �n Existing building area: square feet
New building area: square feet
lEDPROPERTY OWNER I ❑ TENANT Number of stories:
Name: \' x S Type of construction:
Address: q b I 0 ` 5 ` , J ` ` C-k---, Occupancy groups:
City / State/ZIP: --- "K_' - . cc ,, r -&,, CS 77 2_2_? Existing:
Phone: ( ) 81.3-5-3 SS Fax: (563 ) G20 - O I (J New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax:: ( )
E -mail:
CONTRACTOR
r 1 :: la
Business name:. 1r -e �� .T BUILDING PERMIT FEES*
Address: 277 re.
y �� M � ` O Please refer to fee schedule.
• `\
City /State/ZIP: 1 C 1 e � .t,.._J��2 ' 0 C� q 7 ! Fees due upon application
Phone: (�3) 4-12__ (b 3 ` Fax: ( )
CCB lic.: /I 55 SS 3 �9 01 Amount received
Date received:
1
Authorized signature: This permit application expires if a permit is not obtained
•, within 180 days after it has been accepted as complete.
j/ Print name: [,^. . — d'N- Date: 2_ 1 l{ -O., • Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Permits\BUP- PermiiApp.doc 12/03 440 .4613T(11 /02/COM/WEB)
•
One- and Two - Family Dwelling
Building Permit Application Checklist FoR OFFICE 11SL ()NIA
City of Tigard
Received
ty Date/By. Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated parrots:
Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 {' _ I O Electrical O Plumbing O Mechanical
Internet: www.ci.tigard.or.us - O Other:
I 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. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ 0 ❑
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 -fl. elevation differential, plan must show contour lines at 2 -fl. 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, ❑ ❑ 0
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. 3
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 Ore on and shall be shown to be licable to the ro'ect under review.
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x I I" or 11" x 17".
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ' ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building'plans will not be accepted. 0 ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. . .. . . ❑ ❑
30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ • ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\ Building \Permits\BUP- RES- PermitApp.doc 2
' . Building Fixtures
Plumbing Permit AD r1 Eig Ely .. >' I oil of ric:l: (SE ON,.,.
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Ti gird, OR 97223 Date/By.
Phone: 503.639.4171 Fax: 503.598.1960 FEB 14 2014.:,,..,., } � �
Plan Review
Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 _ Date Ready/By: Jun la See Page 2 for
Internet: www.ci.tigard.or.us
CITY g �/ OF T _ Y I / Nodfied/Method Supplemental Information
fE l N( 1 1, V 1 TTSION FEE* SCHEDULE
❑ New construction ❑ Demolition For speciel information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alterationheplacement 0 Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
`a 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
O ` \\ a htiies
Job site address: IO (- ��4 C� C Cat tch basasin or area drain 16.60
City / State/ZIP: V Q � U 4-7223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ` I Project name: • Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: ^ Manufactured home utilities 110.00
0,..0.1 Manholes 16.60
• Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: Q 6 ) Page 2 . 5"Itt) i(..0
Subdivision: v,,,.3-,,,,A 4 la ., Lot no.:
J Water service (no. linear ft.: ) Page 2
i Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
D
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: \ i1/4..._ ,, -
Expansion tank 16.60
Address: +1 (() S\ w y L1\4,.5 Fixture /sewer cap 16.60
City /State/ZIP: `' 0 L. T-7 2..2,3 Floor drain/floor sink/hub 16.60
Phone: (93 ) $t3 - S3 S X Fax: ( ) 620 - O D q g Garbage disposal 16.60
I Hose bib 16.60
❑ APPLICANT l I ❑ CONTACT PERSON
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail: � J Urinal 16.60
t.
CONTRACTOR L ,L)� f Water closet 16.60
Business name: Water heater 16.60
� Address: �/ ,) ) / Other:
City/State/ZIP:
Subtotal
Minimum permit fee: $72.50 g,
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 a
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) f
State surcharge (8% of permit fee) .7 Yd
Authorized signature: TOTAL PERMIT FEE 7 , " 2 !0
I Print name: ; r'_- 4 Ve. I Date: a _N _06 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. •
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permila\PLMF- PennitApp.doc 06/05 4404616T(I0/02/COM/WEB)
r
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total 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: 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
Fixture or Item Qty. 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
and including $50,000.00.
specially requested inspections - per hour 72.50
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: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A `complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or, relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher -Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units. .
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose file sprinkler system.
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
-4 "
Car Wash Drain Isometric or Riser Diagram
•
Garbage - Domestic ❑ Isometric or riser diagram is required.for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service •,
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal • - fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
•
i:\ Building \Permib\PLM- PermitApp.doc 07/06/05
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CITY OF TIGARD - SITE PLAN REVIEW
BUILDING PERMIT NO.:
PLANNING DIVISION: /0 ' OY_
Required Setbac •s:
Side: Approved ❑ Not Approved
Street Side: A>
From. ie e: Garage: {�
�`isu:�l Clearance: � Rear: //5— '`'`1axuntrn, Building Height. feet
❑Nut Approved
r�.� �� ;� .ti r��� r,� K feet
e Provider Letter Required: ❑ Yes r
-t .A ❑ Recei :e
I ENGINEERIN; Date: 7 06 Actual lope: ' DEPARTMENT:
Site PI Approved 0 Not Ap roved
B Approved ❑ of A,proved
Not Dat-: Z ZE 0
Nov.15. 2005 :033PM CLEAN WATER SERVICES 503 6811439 No.0026 P. I
• • NOV- lY ..0 >JJ 1-1 . -+6 rrt3_ni. TO: 503 846 .J_ r. 2/3
R ECEI V
E®
• FE 14 2006 •
• CITY OF M umb
CleanWater Serv�,DING� � 05- °C)9710
Our commitment Is Cleat. � S ''"� s1�ffS5 Pr0•SCrCenin Site Assessment
Jurisdiction V 1, . o Date if- 14-05
Map & Tax Lot - S • _ C • Owner u
' • e Applicant IA ' _ 1 %4At
Site Address , _ ;', (MRCS Company
Address 9 h Jj
LO_SW u :�e,.,_ , L -,
Proposed Activity 4.fes�
�o __ City State Zip Q C
‘ri �
2Y'%' Phone �y - 4324 — St87X
Fax 01- 620 —gri •
By submitting this form the Owner, or Owner's authorized agent or representative, acknowledges
and agrees that employees of Clean Water borvicee have authority to enter the project site stall
reasonable times for the purpose of inspecting project site conditions and gathering information
related to the project site.
Om ei use only below tee Itna
• Offiotel use only below ties line Official use only a low a is one
Y N NA Y N NA
El r'' � Sensitive Area � S1t � ostto Map ❑ a StormwateP maps
I • A gQS tt y
❑ I Locally adopted studies or maps Other
Li Specify ❑ Specify
•
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. If
Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural
Resources Assessment Report may also be required.
51 Sensitive areas do not appear to exist on site or within 200' of the site. This pre -screening
she assessment dons NOT eliminate the need to evaluate and protect water quality
sensitive areas if they are subsequently discovered. This document will serve as your
Service Provider letter as required by Resolution and Order 04.9, Section 3.02.1. All
• required permits and approvals must be obtained and completed under applicable local,
state, and federal law.
The proposed activity does not meet the definition of development. NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER IS REQUIRED.
.Reviewer Cowmen
•
Reviewed By: • Date: N/1f /q5 . .
Postit" Fax Note 7671 adie / /fl4 / I me
Official use only
• TO 1 7r1,�d. -S ' �r eSalees" Pan ,, ` &m ,ks.`lie�r Ma
il ned to
x Applicant
Co./Dept. Co. �f ,5 Date �! f j f�OS By
Phone a Phone A [ wo .1,700
-
FaxU 50.5• Lw. 88fir Fax _
•
CITY OF TIGARD MASTER PERMIT
, �.� , BUILDING SERVICES DIVISION
q�� I ' 13125 SW Hall Blvd., Tigard, OR 97223
-- 503 - 639 -4171 www.ci.tigard.or.us PERMIT #: 0
00 4V...
DATE ISSUED: 3 131 06 . - - -_
SITE ADDRESS: 9WO� H i y _l d Lk) Cr __ PARCEL #: __
BLDG /STE #: _ _ _ ZONING:
SUBDIVISION: LOT: JURISDICTION: _
6.
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
•
The actual permit will be issued and mailed to the applicant
within one week of the date issued above.
PROJECT DESCRIPTION: _s_ kg_ % f �j F} ILO_ Cikf_ W I'rl+ 123 eLfe A.t.
OWNER . . FEES
Name: _!ko_!A.L�.. - -
Address: 9tl_LQ_iL.0 14 ELL' uk) Cr _ _ Total Fees: $ le 517
City /State /Zip: --(Taft 2yzo Orts _�1S1. —
Phone: 5 c , 3 — '3t3- 5358 - - ......_..... —
3
CONTRACTOR
Name: _Ht.tti_k14 . L €&__
Address: 1,3 74
City /State /Zip: b , t a b ) tJ.t t C3 {`_. q ?1 8_ _. (}
Phone: 503 - (4.12, 1l L
Fax:
CCB Lic #: I j_33$54- - -- -- 1
O
O
REQUIRED ITEMS REPORTS Q `
Erosion Control 681 -4444 ❑ Bolts in concrete . ❑ Licensed fabricated steel ❑ Special inspection (see plans) J �
Piles /caissons ❑ High - strength bolts ❑ Structural masonry ❑ Structural observation
❑ Reinforced concrete ❑ Structural welding ❑ Engineered soils ❑ Other report:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes 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 work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies
of these r direct questions to OUNC by calling 503 - 246 -1987 or 1- 800 - 332 -2344.
Issue By: Permittee Signature: •
Call 503 - 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1 :\ Building\ Forms\ ManualPermitForms \ManualMSTpermit. 12/05/05
Inspections Required for: MST b - 000 H a
' I i I Code I Inspection Description I PASS Date I By I .
MST - Master Permit
405 Excavation
410 Fill
415 Grading fi V
X 205 Footing b 8 911-N �'
805 MFG - Structure grading/footing
210 Foundation walls
215 Footing drain
305 Plumbing underslab J
105 Underground/slab cover
O 0. ,..-\ '
220 Slab y . .
310 Crawl drain
315 Post/beam plumbing
605 Post/beam mechanical
225 Post/beam structural
230 Underfloor insulation
235 Shear walls/anchors •
240 Exterior sheathing E S, a
242 Interior shear walls 'A U (,Q/ /
245 Firewall `‘ /b 7
250 Roof nailing
255 Wtr proofing basement walls 14"Ai
265 Masonry
270 Reinforcing steel (rebar)
320 Plumbing rough -in .
322 Shower pan
610 Gas line
615 Mechanical rough -in ;.S
110 Temporary electrical service .-
•
115 Electrical service
120 Electrical rough -in
135 Low voltage
910 Sprinkler rough -in
A:
275 Framing
810 MFG - Structure set -up "} 1
X
280 Insulation
`/ 330 Water service
>C 335 Rain drain �� 340 Storm drain
505 Sanitary sewer
350 Septic tank A ^� (fr-)
285 Drywall nailing x,00 �� 0 / '
289 Approach/sidewalk
295 Misc. inspection: �� 1 �0 �� ��
899 MFG- Structure final 1 6(:. 498 Grading final
699 Mechanical final
X 399 Plumbing final ti 4 4 0
199 Electrical final
X 299 Final inspection
c t tA ksG .e-a 5e -eukr S `796 .T '-
1:\BuildingUnspection Cards\Forms\MST- InspCard- Blank.doc 12/09/2005
CITY OF TIGARD },
BUILDING DIVISION - PERMIT #: MST2006 -00042
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/3/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ,'.'!� L
INSPECTION WORKSHEET FOR DATE: 8/4/2006 TIME: 7:04AM PAGE: 67
SITE ADDRESS: 09610 SW HILL VIEW CT CLASS OF WORK:
SUBDIVISION: TWALITY HILL LOT #: 004 TYPE OF USE:
PROJECT NAME: SHELDON
DESCRIPTION: 664 square foot pole building w /attached breezeway. 6/2/06, adding 50' of storm service to connect
to public line in easement.08/2/06: Added 50' of rain drains.
OWNER: SHELDON, MINDY PHONE #: 503- 813 -5356
CONTRACTOR: MCMINNVILLE LUMBER PHONE #: 503- 472 -1631
Inspection Request Scheduled For: Date: 8/4/2006 Pour Time:
Code # Inspection Description Confirm # C ntact # Message
335 Rain drain 034384 -01 503 - 887 -7566 Y
• Corrections /Comments /Instructions:
) r");\/ /- 6/ 1/1/'
A,
0 3 i
c.;
/ ,i, # _______
• / ice' i .
1 8
p - 2 1
I
I .
ASS ❑ PARTIAL APPROVAL_. ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ii f Date: ki 6 / P hone #: (503) 718 - D-
V
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2006•00042
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/317006
Phone: (503) 639 -4171 M
Inspection Requests (24 Hrs.): (503) 639 -4175 s_'- °_
INSPECTION WORKSHEET FOR DATE: 5/6/2006 TIME: 7:07AM PAGE: 76
SITE ADDRESS: 09610 SW HILL_VIL CT CLASS OF WORK:
SUBDIVISION: 1WAI..ITY HILL LOT #: 004 TYPE OF USE:
PROJECT NAME: SHELDON
DESCRIPTION: 864 square foot pole building W /attached breezeway.
OWNER: SHELDON, MINDY PHONE #: 503- 813 -5368
CONTRACTOR: MCMINNVILLE LUMBER PHONE #: 503.472 -1631
Inspection Request Scheduled For: Date: 5/8 /2006 Pour Time 9.00
Code # Inspection Description Confirm # Contact # Message
20( Footing 02.8452 -01 503-620-8878 N
Or Corrections /Comments /Instructions:
5144 6 }L2 h- Mc N prt_-p
.� M u 1l':......r i
•
‹.-- I.
Are
1
d OFt .......,
r ' . rS w ' ,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 4 II CALL FOR INSPECTION ❑ ADDITIONAL , EES ASSESSED •
Inspector: I � I �� Date: /P � 440 , Phone #: (503) 718-
\/