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10226 SW KENT COURT t f� G N N Ol G. + ro tr � G n' I 'I � 1 i M 10226 Sw. Kent r:. CITY OF T:GARD 24-Flour BUILDING Inspection Line: (503) 639-4175 INSPECTION DIVISION Business Line: (503)639-4171 SUP _ Received Z Date Requosted ZAM PM BUP _ Location �r1 Z�( �� Suite _ MEC _ Contact Person �{% _ Ph PLM Contra.tor _ Ph(-) _ SWR BUILrJING � Toranvowner _ ELC _ Foot,ig Foundation /`' ELC Access: /� _ --------- -_--- - Ftg Dram , / / I7 Crawl Drain moi,�.Oi 1?o/-V r1ye?L �, ELR - ----- Slab Inspection Notes: Si i Post&Beam — ear Anchors _- Ext Sheath/Shear Int Sheath/Shear ---- - -- Framing Insulation Drywall Nailing -- - --- Firewall Fire Sprinkler - - - - Fire Alarm Susp'd Ceiling - - - -— —— ----- — loof --- Other:_ -- ---- - -- -- - - -- Final PASS PART _FAIL - - --- --- PLUMBING Post&Beam Under Slab _- _- --- -- _--__- ---- Rough-In Water Service _ _ -- ---- �•, - Sanitary Sewer Rain Drains Catch Basin/Mannole Storm Drain ---- Shower Pan .x Other. - Fira' PASS PART FAIL - - ---- — MECHANICAL Post&Beam Rough-In Gas Line 1,moke Dampers -__-- F nal P P-AJ-1 FAIL - - TRI -'-� - -- - - Service - —- -- -� Rough-In UG/Slab -- --- - Low Voltage Fire Alpm ---- - -- Fi0% Reinspection}ee of$ PART FAIL ragvired before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S I J Please call for reinspection RE: _ _ C7 Unable to inspect-no access Fire Supply Line ADAff}}� J ApproachiSidewalk Date- , /�/� Inspector —/ _- Ext _ nthnr 1 anal DO NOT REMOVE this Inspection record from the job site. PASS Mir FAIL CITY TIGARD 24-Hour BUILDING Inspection Line: (503 �#_-4175 INSF�ECT;UN DIVISION Business Line: (5 ), - 1 f QST �3- �- �_ Q BUP Received -- _._--Date Requested��� AM_--_—PM__. _ .__. BUP Location -__ _�1��2 � �-.-__-Suite _-__ MEC Contact Person --------- �. �c-' z- f <'4' L�hj(1- Wit,) 7,�C --,/�a�jr C) PLM _-- Contractor _ ._.__. _—.._ _ Ph (— ) SWR LDI G Tenant/Owner _----- _ - _-�_-- -.--_ ELC -.-_---- FooTng F.LC Foundation Acc9ss: Ftg Drain PI_R e _ -- Crawl Drain _ Slab Inspection Notes- SIT Post& Beam Shear Anchors """--- Ext Sheath/Shear Int Sheath/Shear Framing Insulation f, �L14 Drywall Nailing --=L r Firewall Fire Sprinkler --- Fire Alarm Su3p'd Ceiling — — ---. --- -- Roof Other. — \ ----- - ---- �!, i'a A�SsART FAIL Po,t&Bearn Under Slab - --- - - _ Water Service S _-Sewer Catch Basin/ anhole / Stone Drain I — --- -- -- - -- --------- Shower Pan Other: - -- ------- --- -- -----� - / ePART FAIL MECHANICAL — Post& Beam - - ----_-_�- Ruugh-In -- - ---- - Gas Line Smoke Dampers ---�`�1 C. � - ------------ Final PASa PART FAIL --'— — --- -- - --- ELECTRICAL Service — Rough-In ---- - - - - --- -- UG/Slab Lew Voltage - -- ------ ---- -- - -- -- Fire Alarm Final neirspection fee of$ requireo hefore next inspection. Pay at City Hap 13125 SW Hall Blvd. PASS PANT FAIL __ SITE u Please call for reinspection RE:_-____-____--___ __._�_ I -� Unable to inspect -no access Fire Supply Line ADA E t Date_ Inspector_ Ext Approach/Sidewalk - -- +� —�^�'f -- Other: , Final DO NOT REMOVE this inspection tr`cord from the job site. PASS PART FAIL CITY OF TIGARD MASTER PERMIT PERMIT#: MST2003-00445 DEVELOPMENT SERVICES DATE ISSUED: 9/4/03 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 63911171 SITE ADDRESS: 10226 SW KENT C;T PARCEL: 2S114BB-21200 SUBDIVISION: RIVERVIEW ESTATES NO 2 ZONING: R BLOCK: LOT: 056 JURISDICTION: I I(I REMARKS: Addition of 880 scl ft to existing residence. EUII-DING REISSUE: CUSTOM STORIES Y FLOUT APEA6 REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT. FIRST-�111 %f BASEMENT sf LEFT SMOKE DETECTORS: Y T YPE OF USE: SF FLOOR LOAD JO SLCOND. ni 0 (;ARAGE- at FRGNT: 1 S PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: 1 1111N1) cf RIGHT. , OCCUPANCY GRP: R3 BERM. BATH: TOTALVALUE 57,89000 REAR: 1'. PI.UMBING SINKS WATER CLOSETS. WASHING MACH. LAUNDRY TRAYS: RAIN DRAIN: IRAPS: LAVATORIES. DISHWASV.HS: FLOOR DRAINS- SEWER LINES. SF RAP/DRAINS: CATCH BASINS: TUB!SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PRFVNTR: GREASE TRAPS: OTHER FIXTURES: _ MEC!IAN CAL FUEL TYPES FURN<100K: B 3HP: VENT FANS: CLOTHES DRYER: FURN»100K: UN,'. '.EATERS: HOODS: OTHER UNITS 1 MAX INP btu FLOOR FURNANCES: VENTS. 2 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP ERVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 -200 amp: 0 -200 amp Wt9VC OR FDR: PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 5005F 201 - 400 amp: 201 - 400 amp: tat WAD SVCIF DR. IBI SIGN,3UT LIN LT: PER HOUR: LIMITED ENERGY- 401 600 amp: 401 600 amp: EAADDL BR CIR: 2 M SIGh�AL/PANEL: IN PLANT: MANU HMISVCIFDR 801 1000 amp: 601+amps-10flov: MINLR LABEL: 1000•amplvolt: PLAN REVIEW SECTION Reconnect only: »4 RES UNITS: SVCIFDR>=225 A.: >600 V NOMINALCLS AREA/SPC OCC: ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTEPCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: L ANDSCAPE/IRRIG. PROTECTIVE SIGNL: GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL OTHR: HVAC: DPTAITELE COMM: NURSE CALLS TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,073.44 DOLAN,MATTHEW J+ KEHLI K BRUCE ABRAHAMSON CONSTRUCTThis permit is subject to 1t:3 regulations contained In the SW KENT PL 12735 SW MARIE S Tigard Municipal Code,State of OR. Specialty Codes and 10226 10226 S,OR 97223 1 273RD,OR 97223 all other applicable laws. All work will be done In TIGAaccordance with approved plans. This permit will expire If work is not started within 180 days of Issuance,or if the work Is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: Phone, 539-6190 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0080. You Rea 0 LIC 102637 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain/Backwater Exterior Shevthing Insf Electrical Final Foundation Insp Niechanlczl Insp Gas Line Insp Mechanical Final Post/Beam Structural Electrical Rough In Gas Fireplace Final Inspection Post/Beam Mechanica Fram.ng Insp Insulation Insp Underfloor insulation Shear Wuil Insp Rain drain Insp Issued By Permittee Signature : Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application Receive - �, Building Date/By: t Permit No.:tiL1�•T.�oU 3—�h City of Tigar Planning Approval Other g IRECEIVED Plan R Other No.: _ 13125 SW Hall Blv L•• Plan Review Other �\ Tigard,Oregon 97223 Date/By: CAOW '-3 ' O Permit No.: Phone: 503-639-4171 : '301-1(960 Post-Review Land Use Date/By: Case No. Internet: www.ci.tigard.or.us Contact Jura. See Page 2 for 24-hour Inspection Ret" 6049MW Name/Method: Supltlentental Information_ i3U1LDING DIVISIOt'i _ I = ----lK a :t * ify "I AZ'A� New construe tlo_n _ _��—Demolition hj� ,� �, ,t Addition alteration/re placement ❑00 er: - --- ;("ArGQR mote Permit fees"are based on the total value of the work performed. Indican the value(rounded to the nearest dollar)of all equipment,materials,labor, 1 &2-Family dwelling Colnme uia,strial ovrhead and profit for the work indicated on this applicatioil, Accessory Building Multi-Family r t o.of bedrooms. ` baths:_ $Master Builder Other • .. "•' ' •"' JOI3t ITE7 1ORIVY,A'CIO tti#LOC lttYQ)Y�' No.of baths Job site address: IDLs SIJ C 1— CT_ ri avr,l 04- Total number of floors.....).................... ........ _ New dwelling area(sq.ft.).............................. Suite #: I Bldg./Apt#: Garage/carport area(sq.ft. Project Name: Dv In in Covered porch area(sq.ft.)............................. Cross street/Directions to job site: Deck area(sq.ft.).............................•........•..... Other struc ure area(sq.ft.)... .... Subdivision: Lot#: Tax ma / arcel#: Note: Permit fees'are based on the total value of the work performed. Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor, nverread and profit for the work indicated on this application. Valuation.......................... $ Existing building area(sq.ft.)......................... t — ----- -- New building area(sq.ft.)............................... Number of stories............................................ —. Type of construction..... ... ............................ Occupancy - — Name: AUK q h(1J)Jt pUlkr Oup(s): Existing: Na — New: Address: 10 L2 L., 50 ken r Cr — City/State/Zip: r•rd 0 2 9 7 t V1 Phone (s'Ly GI;1YU Fax: NOTICE: All contractors and subcontractors are required t "PPLIC ' ``` - " NTACl PEIt30N ; r licensed with the Oregon Construction Contractors Board unc' _ ----- —= -•-- provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: Address:_ _ __-------- _ _� City/State/Zip: — ------ - _ Phone: I3 _ Fax: I I.-------�---- —_ -- -- __--- — UIL,DI'V( P ERM IT FEES', Please refer to fee schedule. r Business Name: 6t wce 4 t c+ o t)5 f • Fees due upon application.. Address: 11135 3 W M airy 6 C-T --- City/State/Zip: 'roat-a 6 (e Ci"1 ZL'y Amount received........... ... . _ ...... .... ._ g Phoney 11 yyej Fax: r q ' y 1 U Date received:_____—_ CCB Lic. #: b (o 3 1 __-- Authorized Notice: This permit application expire%if a permit Is nn1 obtained within Signature _�, W a — Date: t��-e 3 180 days after it has been accepted a%complete. I� ! — a t1 ��. _ *Fee methodology set by Tri-1 aunty Building Industry Service Board. (Please print name) i:!Dsts\Permit Fomis\BldgPetmiLkpp.doc 01103 One- and Two-Family Dwelling Building Permit Application Checklist Reference no.: Tigard — — -- —' Associated permits: 01voITi,q(ir`l Cit 1 il City Op Tg O Electrical ❑Plumbing O Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 OOther: Phone: (503) E39-4171 Fax: (503) 598-10o0 MFAOWING ITEMS ARE REQUIRFD No NIA 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. _ 2 Zoning.Fluod plain,solar balance points,seismic soils designation,historic district,etc. _ 3 Verification of approved plaG9ot. 4 Fire district _.approvak' required. 5 Septic system permit or authorization for remodel. Existing system capacity_ 6 Sewer permit. 7 Water district approval. 8 Solis report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control LI plan ❑permit required. Include drainage-way protection,silt fence design and location of catch-basin protection,etc, _ 10 3 Complete sere of legible plans.Must he 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 due 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 comer elevations(if there is more than i 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 t area;building coverag,,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 constnlction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofin_ ,­)f slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,et. 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 foundaticti elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)arld/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis providespecifications and calculations to engineering standards. 17 Floortroof 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 aod/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance.Identify the prescnptive path or provide calculations.A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When. wired 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. .11 RISDIU11IONALSPECIFUS 23 Five(5)site plans are required for Item I I above. Site plans must be 8-1/2"x I I"or I1"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 Pennit&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 da'e. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department u4 only. 441-4614(6=/c0M) Electrical Permit' ppilcation I M Dotereceived: Permitnor City of Tigard Noiccuappl.nu. Expiredtic: CaytIligard Address! 13125 5W hall Dlvd,Tigart A F902NUARD Dateissued U Recei - nn.: Phone: (503)639-4171 )UC' I`nING DIVISh.)�I atc file no Fax:(503)598.1960 _ Payrnentlype_ Land use approval _-- _-- M hill Ill U 16r.2 frmily dwelling or accessory U Con memial/indliglI'l 11 Multi-family U Tenant improvrurem U New cot struction U Additiun/nllernlion/replacement O Other U I'attial e Joh address: »j�):� '1t u�L� et r . Dldg.no. Suit,no.: ITax reap/tax lotlaccount no: Block: Subdivision: - Project name: _ _ Descriplion and location of work on premises: Estimated date of con letion/inspeclion: As=UU Job no: FK bra. business name: nett,ipnoa (A . e) kilts no.Imp /Kr.�.�,,... – Newresidnaid-dMitorrroftl-lamllyper Address: 7 0 � City:— --f-•► stab:o a �lr: z��. 5arltebtel.tivr �~~" taltl t n ar less I'hone: -7 op z2 Z- fax: G Lye/ E-mail 4' -- --- -- - - -- -. --- Each atbliliond Slxl sq 0 w pumt rhNrol CCB no.: G Elec.bus.lic.no: F Unfiledc_ne6y,rnidcnual -- z City/Inelro lie.no.: ^` Limnedencray.non rcridenuol 2 Each tnaauloctured hnnr nr nwitul■r dwelling � (required) Service and/or nd/or feeder 2 5ignaiure or rvlsinsectrkirn U.to SeI _ — _ Sp dc(t "M alleratlon or rrIatallow Uttep NIO amps or lets _ 2 iJamr(print): 201 amps to 400 amps 2 - .. 101 amps ro fi(x)mm 7. Motilin address: --__ �"-_M - - -----� --..—..-_–----- 601 amps ro 1(Nxt amps 2 ('fly Isinfe. ZII�: Over 10110 a ops ur volts _ 2 Phone: Fax: E-mail: aunnectonl I Owner installation:The inttallat'nn is being made ton property I own ry «fie"- 1"`"IM'M.w'Mer'Ma" which is nal intended for sale,lease,rent,or exchange according to ''rrahttafl°"' ORS 447,455,479,670,701. 2q)orsln or less 201 emps to 41)V taprf� – 2 Owncr's signature: bite: 401 rohUoamps _� 2 1101111111010 1 Sranehth,calts-wvr,aiterNlnn, oreahrrohm per panel: Narne: --_---.._ K Fee for brarnh cin-sus moth put,hue of A ldless: __ sctvKe or_feMer fee,each branch circuit 2 City: State: 2,I A P A. Fee for hooch circuits without purchase _ - -- - of service or feeder fee,first branch crrcod. 2 shone: Fax: l mail W Each dditionidbranch cifcoic Hr.Mer vice W fetter aet Incl I" UScrviorover 225ompi-commerdal UNenhh-carefacility Fach ontporirri8alionelrrlr 1 U Service over 120 amps rating of lag U I11ratt4on4lacation FAChalgnoroutlinelsf,hnng 2 family dwellings U Ruildnix over IflMlIsgnmr fret(0111", Signal cncuit(s)m s li,mird enrtxy panel, U System over 6110 vola nominal Irons tewnknhat unils in ane tnuaure alteration,or extension, 2 0Ruildingover three stories UFerxiers,4110amptanarrr •De U(krupust load over 99 persom U Man"Wwred structures or RV pat Fich additional 1n1pMlsn ores t1Fa odlowabk In sty of to.abve:' I I f.1t,4 1igMingplan U nflwr Sabm11»sett nt plans milk any of The above. love stigalion fee '11U,above are tool appitcabk to lemporary condrisdil m mvke. Wer_ Nd NI inrlat,,.,.► -m reedit card,rkose call psrlodkuat Im nae hlenwioa Notice:this pernnl apphwaltnn Permit foe.....................S _-- U Visa O Mamercaed expires if a permit is nM nhtaincd Man review(al _ %) s credit clod aamher —_._._._ _ --L- , _ within 100 days a ier i1 has b"n Statr surcharge r accepted atraxnplete TOTAL ..................... S _. a•—mate–a'un�ia7a r�i.t�n an ere-mit cad--.-.. -- f _ ----- CAMMOMW�IMN __��_._- Am ons 4an 4615 tAtM1'CrMll I -d 881E ZJG-EnS 31813313 31M39 e811 :L11 EO Be 2ny Electrical Permit Aar-ie 1��1� Received Electrical , T Date/By: _ Permit No.:firw — 0 City Of Tigard Planning Approval Sign qqu��G 21 200° Date/By: Permit No.: 13125 SW Hall Blvd. iliVPlan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-99'` W TIG Post-Review Land use Internet: ww.ci.tigard.or.us r3UILDING DI Date/By: : Case No.: w Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 1 Name/Method: Supplemental Information. e; at amp Yb r. New construction Demolition LJService over 225 amps- Health care facility commercial ❑Hazardous location Addition/alteration/re 13CC111Cnt other: C3Service over 320 amps-rating of C3Building over 10,000 square feet, _- – w'ei I &2 family dwellings four or more residential units in 1 & 2-Fr.mily dwelling COrnmercial/Industrial [I System over 600 volts nominal one structure AccP;So Building _ Multi-Family ❑Building over three stories ❑Feeders,400 amps or more ❑Occupant load over 99 persons []Manufactured structures or RV park Master Builder Other: ❑agressnighting plan ❑Other:— Submit__ %etc of plans with any of the above. The above are nono� ti mble to tem mnrar construction service Job site address: e kp-kl GT Suite#: Bld ./A t,#: _ Num_ber of 1 SLmections per permit allowed Project Name.. a A Description Qty Fee(ea.) Total Cross street/Directions to job site: New residential-single un .to udor tachemultigaga per dwelling unit.h,cludec attached garage. Service Included: 1000 sq.ft.or less 145.15 4 Each additional 500 sq..'t.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 11-7 d; service and/or feeder 90.90 2 Services or feeders-Installation, ,� alteration or relocation: 200 ams or less 80.30 2 201 am a to 400 amps _ 106.85 2 401 amps to 600 amps _ 160.60 2 ;.,,. 601 ams to 1000 ams _ 240.60 2 Over 1000 amps or volts 4.54.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders-Installation, alteration,or relocation: City/State/Zip: _ 200 amps or less 66.85 1 Phone: Fax: 201 ams to 400 ams _ 100.30 2 401 to 600 ams 133.15 2 Branch circuits-new,alteration,or Name: extension per panel: A.Fee for branch circuits with purchase of Address: _ service or feeder fee each branch circuit 6.65 2 Cit /State/Zl B.Fee for branch circuits without purchase of City/State/Zip:p service or feeder fee first branch circuit 46.85 2 Phone: _ _Fax: _ Each additional branch circuit 6.65 2 E-mail: Misc.(Service or feeder not included): Each pump or irrigation circle 53.40 2 — Each sign outline lighting 53.40 2 Job No: Signal circuit(s)or a limited energy panel, Business Name: alteration,or extcrosion — _ Page 2 _ 2 Description: Address: — Each additional inspection over the allowable In any of the above: tt City/State/Zip: Per inspection per hour(min. 1 hour) Phone: FOX: Investigation fee: CCB Lic.#: Lic._#: Other: Supervising electrician _ Subtotal $ _ si ature required: Plan Review L5%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) i:\Dsts\PertnitForrm\ElcPem-dtApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ $75.00 Check Type of Work Involved: ElAudio and Stereo Systema* Burglar Alarm Garage Door Opener* El Heating,Ventilation and Air Conditioning System* 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 Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation HVAC Instrumentation Intercom and Paging Systems ElLandscape Irrigation Control* Medical Nurse Calls El Outdoor Landscape Lighting* Protective Signaling n Other_ _ Number of Systems * No licenses are required. Licenses are required for all other Installations i:\Dsts\Permit Fortes\ElcPermitAppPg2.doc 01/03 Sep 03 03 07: 19p Sherr 8Bruce Abrahamson nn 5035794706 F- 1 Mechanical Permit A lication ONLY Re«,ve, ' ' Me.,haniFICE USE Date/B _.._-_ - cal PcrrnitNo.: j�_�111' 5- City -City of Tigard Planning Approval— Building D;uc,E+Y Permit No.: 13125 SW[fall Blvd. SEP Q NO Plan Review Other Tigard,Oregon 97223 nate/ll Permit No.: Phone: 503-639-4171 Fax: 503-598- 0 Post-Review i.and Use _—_ Internet: www.ci.tigard.o V O'r TIGA � haters Case No.: �� C N - C„n�,ct Juris.: See Page 2 ton 24-hour Inspection Req " JP1X Supplemental Information. �U`L NamrlMcthnd: :lWig c' iii tra_� _3 +Y. anw ALM,Fj l New construction _ Demolition Mechanical permit fees"are based on the total value of the work Addition/alteratu-m/rc lacernclit Other performed. Indicate the value(rounded to the nearest dollar)of all ON mechanical materials,equipment,labor,overhead and profit. I 1 &2-;am,Jy dwelling rn Commercial/industrial Value: S_ _ See Page 2 for Fee Schedule Accessory Buildin Mult►-Family h-409"- t iaS ` MaSter Builder F-1Othcr: description �t Fe ea Total Fieatln Conlin urn , 1:9� Face-add-on air conditioninG'" � 14.00 _ — Job site address: - � � Uas heat pump 14.00 _ Suite#: Bldg./Apt.#: Duct work - 14.00 H dronic hot waters stem Project Name:_ __ o-„`,_ W 14.00 Cross streetUreclions to job site: Residential boiler for radiator or h dronic 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#: Re air units 12.15 - a Uther;,?io61= Ilaticel u Tax map/parcel#: Water beater 1000 'z ' i' I .E C ?plbY�'Cj ' •_ " " Gas fue�luce __ -11,(ek, f i Flue vent water heater/gas fireplace) / 106-0- _ Log lighter as 10.00 — `� �-—�— - Wood/Pellct stove 10.00 --- ------. Wood fireplace/insert — 10.00 T--- Chimne /liner/flue/vent 10.00 Other: 10.00 Name: �t�l l ti V dw� ltldrrl2A1ue11 f'tftt&VYtitll Hd t : ,`,;t r Range hood/other ititchen equipment 10.00 Address: �0 P-�-t:P 'S.., �1,� (',*� Clothes d - - ryer exhaust 10.00 CIt_Y�State�Z-1p�T 1 09. `�7 � -- Single duct exhaust Phone: L( Fax: (bathrooms,toilet compartments, utility rooms 6.80 Name: Attic/crawl space fans 10.00 --•-_--' -- _ - Address. Other:, l0 00 City/State/Zip: •'L5 40 ror first 4 $1.00 eaqr ---- Furnace,etc.Phone: Fax: Gas heatpump E-mail Wall/sus cnded/unitheaterFIMM -Yt. rr�� :_t�„err i , ll �' :.,�,�; �, Water heater _ _ •• — B11slness Name. �i ti7 y Fire :ace - •+ f ddter-c / ``C.. Ran c --- "• BBQ /zi : twla-u a.) Clothes dryer as +• -- PhoriS�o 2gteF` Fax: — _— other: - •• --- CCB Lic. �i: q/ �7- Authorized Mechanical Perfutt Ntia• _ Subtotal- S --- Signature: t�. — Date:r 3`��i Minimum Permit Fee$72.50 a L�ti:}s rz J K A` _ Plan Review Fee(25'/0 of PgiLW Fee $ - (Please print name State Surcharge(8%of Permit Fee' S TOTAL PER_M1T FEE S Notice: This permit at,9 -stloo expires If a permit is not obtained within *Fee methodology set by Trl-Cennty Bulldl.g Industry Service Board. 190 days after It has been teeepted as complete. **Site plan required for exterior A/C units. i Tsu\Petmit Forms\MccPertnitApp.doc 01/03 : aka ,r S i 5 . : lli�lt a R 11i i V I I SITE PLAN Matt & Kehli Dolan 10226 SW Kent Ct. •/ 1 M Note: Downspouts leads to be disconnected and relocated to accomodate addition. Tie—in new downspouts to existing line. ' I�. W1 ,PA' S). 100,85 Existing J74 F House �6' 1 " ' =20 ~-- FFE 101 .d0 i' Proposed 5.5723' 1<r FFE-92.44 Addition �� � ( 22' x2o') �_V Trees to be 4 U removed c) *Contour interval — 1' S83'39'41 N89'46'41 "E 9u.6UQ0.90 20.91 ' 70.00' CITV OF TIGARD• SITE PLAN RFVI'EW�7 BUILDING IPLRMIT NO.: PLANNING DIVISION: R- 7 Pn Required Sethacks: (3 Approved ) Not Approved Side: �._.. ytreet Side: 10 � �*����� From. � Garage: ..22.. Rear: �s 9 Visual l leurancc:VIAApproved ❑ Not ! r. roved Maximum Building tlright J-5 feet AUG 2 1 2003 CWS Service Provider Letter Required: ,a'Yes Q No � rites0 Received CITY OF TIGARD H 3� Date: BUILDING DIVISION CNc;INL KIN6 0EPARTM N L Actual Slope: % Q'Approvcd ❑ NeN Approved Site Flan: Approved ❑ Not Approved Notes: ea sf 'a-4,v� /lam.