12350 SW NORTH DAKOTA STREET 1S viowa HlbON .NS 09C 6
a
a
a
0
a
0
z
3
0
u�
M
tV
r
12350 SW NORTH DAKOTA ST
,A 'CITY O F T I G A R D MASTER PERMIT
PERMIT 0: MST2002-00203
DEVELOPMENT SERVICES DATE ISSUED: 6120/02
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171
SITE ADDRESS: 12350 SW NORTH DAKOTA ST PARCEL: 1 S134CB-04900
SUBDIVISION: ANTON PARK ZONING: R-7
BLOCK: LOT:011 JURISDICTION: TIG
REMARKS: Adding440 square feet to second story.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS _ _REQUIRED SETBACKS!_ REQUIRED
CLASS OF WORK: ADD HEIGHT: 20 FIRST: of BASEMENT: N LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 440 of GARAGE: of FRC`rr: PARKING SPACES!
TYPE OF CONST: SN DWELLINA UNITS: FIMBSMENT: of RIGHT:
VALUE: t 30,000.E
OCCUPANCY ORP: R3 BDRM: 1 BATH: TOTAL: 440.00 of REM:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DIS:fWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
1 US/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GnWE 1 RAPS:
OTHER FDITUREB:
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER:
GAS FURN 3-100K: UNIT HEATERS: HOODS: OTHER!RATS:
MAX INP: hlu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS _ADD-L INSPECTIONS
1000 SF OR LESS: 0 200 amp: 0 200 amp: W/SVC OR FDR: 1 PUMPARRIOAlOMN: PER INSPECTION:
EA ADD%SOOSF: 201 400 amp: 201 400 amp: let W10 SVCIFDR: SIONIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 400 amu: EA ADDL BR CIR: SIONALIPANEL: IN PLANT:
MANU HM/SVCIFDR: 401 1000 Imp: 401g(npt-1000V: MINOR LIBEL:
1000+ampNON
PLAN REVIEW SECTION
Reconnect only:
—4 RES UNITS: SVCIFDR>e228 A.: >400 V NOMINAL: CLS ARE"PC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO S STEREO: FIRE ALARM: INTERCOMVPAGINO: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL A SYSTEMS:
Owner: Contractot. TOTAL FEES: $ 816.54
SEICIANU,VALENTIN C+DONNA G OWNER This perrnh Is subject to the regulPtir)llm contained In the
12350 SW NORTH DAKOTA SIGNED RESPONSIBILITY Tigard Municipal Code,State of OR. Specialty Codes and
TIGARD,OR 97223 FORM IN FILE accordance
other applicable laws. AN work WE be done In
accordance with approved plans. Tib permit will expire 1
work Is not started within 180 days of issuance,or If the
L work Is suspended for more than 180 days. ATTENTION:
C Pho„e: Phone: Oregon law requires yral to follow rules adopted by the
I>t Oregon Utility Notification Center. Those rules are set
,. Reg A: forth In OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by catling(503)246-1987.
Q REQUIRED INSPECTIONS
Footing Insp Framing Insp Mechanical Final
Underfloor insulation Shear Wall Insp Plumb Final
Mechanical Insp Insulation Insp Final inspection
Electrical Service Rain drain Insp
Eleefrical Rough In Electrical Final
Isl ed By : Permittee Signature
Call(503)639-4175 by 7:00 p.m.for an Inspection needed the next business day
TV
-Building Permit Application
. . "rAteeived: � IS �� Permitna.:N•�i�,,-oipa�
City of Tigard A�Q��D ---
Address: 1.1125 SW Ball B Project/appl.no.: itedate:
City of Tigard Date issued: BEY ecei t no.:
Phone: (503) 639-4171 P
Fax: (503) 598-1960 Case rile no.: Payment type:
Land use approval: Ch Y OF iWAKU 1&2 family:Simple complex:
U 1 &2 family dwelling or accessory U Commerciat/industrial U Multi-family U New construction U Demolition
U Addition/alteration/replacement U Tenant imprvvcment U Fire sprinkler/alarm U Other:
Job address: ( °1,3 SO 3 y/ O f-'T*AQt o 1"i- Bldg.no.: Suite no.: _
Lot: I Block: Subdivision: Tax map/tax lot/account no.: _
Project name: — _
Descri ion and location of work on premises/special conditions: �� fl u i `'�`"�
' o < 'F
Name: V f t I i N T I N S t 1 C I i t-1 y
Mailing address: 1 3 S 0#TtA D/fiJK_s� — I &211allih dwellltag:
City: T 1 f; R CZ State:0 ZIP�z 3 Valuation of work........................................ $380 ,00—
Phone: E-mail: No.of bedrooms/baths.................................
Owner's representative: i' Total number of floors................................. 2/ _
Phone: Fax: E-mail: New dwelling area(sq.R.) ..........................
Garage/carport area(sq.ft.).........................
Name:
Covered porch area(sq.ft.) .........................
Mailing address: Deck area(sq.ft.)........................................
City: _—� State: ZIP: Other swcture area(sq.ft.).........................
Phone: Fax: E-mail: C.,otowerclaUludustrlall/mItl-faedly:
Valuation of work.............. ..... $
Existing bldg.area(sq.� ....' '
............ .....
Business name: Q l f i I F New bldg.area(sq.ft.).......
....... ............
Address:
City: _ State: ZIP: Number of stories.................. ..... ......... _
�ax: Email:
Type of construction...... ...........................
Phone:
Occupancy grovp(s • Existing: _
CCB no.: New: _
City/metro lic.no.: rNtion
All contractors and subcontractors are required to be
with the Oregon Construction Contractors Board under
Name: CU N(--7'L I L E ns of ORS 701 and may be required to be licensed in the
Address: where work is being rfotmed. If the applicant is
4 -- from licensing,the following reason applies:
City: State: ZIP:Contact person: — Plan no.: — --
Phone: - Fax: E-mail: _
J
m Name: —kontact person: Fees due.upon applicadf a ........................... $
(7 Address: _ Date received:
W City: StIt ZIP: Amount received ......................................... $
Phone: Fax: -mM1: — Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Not ri iariad ctk m weeps cmdrt cards,plane call larhdk4m for mme iaMmutloa.
attached checklist.All provisions of laws and ordinances governing this visa U MasterCard
work will he complied wi whether speci 'fed herein or notr Credit card comber --
Authorized signature: &1__r*e-, Uz_rlate: `� �- ---Name of cardholder u dw"on cre&card
Print name: VA1_ Ery Tl N S E/ C / NN c.. _ CN&Wider Assams
Aaortt
Notice:This permit application expires if a permit is not obtained within 190 days after ft has been accepted as complete. 4404613 OMCM
OVAL -,-07 - X32-1090 (Ss'�,9b
One-and Two-Family Dwelling
Building Permit Application Checklist 77777
CityoJTigar�1 City of Tigard U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 __
Phone: (503) 639-4171
Fax: (503) 548-1960
I Land use actions completed.S--c jurisdiction criteria for concurrent reviews. —
2 Toning.Flo od 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 hewer permit.
7 Water district approval. —
8 Soils report.Must arry original applicable stamp and signature on file or with application. _
9 Erosion control U pIRn U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection, c. _
10 3 Complete sets oli I able plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral des n details and connc.tions must be incorporated into the plans r nn a separate full-size V
sheet attached to the plans w cross references between plan location and details.Plan plans
cannot be completed
if copyright violations exist. --
l lteiplot plan drawn to scale. Ian must show lot and building setback dimensions;property comer elevations(if
Ihem is more Ulan a 4-fl.elevation di rential,plan must show contour lines at 24 intervals);iocation of easements and
driveway;footprint of structure(includi decks);location of wells/septic systems;utility locations;direction indicator;lot
arra;building coverage area;percentage o overage;impervious area;existing ctures on site;and surface drainage.
12 Foundation plan.Show dimensions,anch bolts,any hold-downs and tri forcing pads,connection detail,vent
size and location.
13 Floor plans.Show all dimensions,room identit tion,window size, atior of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balco s and decks 30' cher above grade,etc.
14 Cross section(s)and details.Show all framing-mem sizes and acing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross tionJl6ay he required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,cei height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc. _
15 Elevation views.Provide elevations for new constnrctio ,minim of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the , ange in gra is greater than four foot at building envelope.
Full-size sheet addendums showing foundation ele_va ons with cross re rences are acceptable.
I6 Wall bncing(prescriptive path)and/or lateral aiysis plans.Must in ' ate details and locations;for
non-prescriptive path analysis provide specifica' ns and calculations to engt ering standards. _
17 Floor/roof framing.Provide plans for all n s/roof assemblies,indicating me r sizing,spacing,and bearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provid ross sections and details showing placement o bar.For engineered
systems,see item 22,"Engineer's c . lations."
19 Beam calculations.Provide two is of calculations using current code design values for all beam, d multiple joists
G. over 10 feet long and/or any n/joist carrying a non-uniform load. _
20 Manufactured floor/rood ss design details.
U) 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 he stamped by an engineer or
=1 archite•t licensed in Oregon and shall be shown to be applicable to the project under review.
100
C7
W 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17".
r
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 he in blue or t lack ink.
Red ink is reserved for department use only. 440-4614(M)DICOM)
'VIeZr did Permit Application
IDater!eeived: 91 permit
City of Tigard Projecr/appl.no.: Expire date:
City n(Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171 ---- —
Fax: (503) 598-1960 Case file no.: Psymewtype:
Land use approval:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
*New construction U Addition/alteration/replacement U Other. _____,_ U Partial
Job address: 12-36-0 -fit/ 141O it-T M -h A KO Idg.no.: Suite no.: ITax map/tax lot/account no.:
Lot: LBlock_ Subdivision: _
Project name: I Description and location of work on premises: r n n u& t6vtA
Estimated date of corn lesion/ins coon: p 'tIF
fl o 9 .�
Job no: Floe Max
Insp
Business name: ea Total tta.
---- New resiaeolW-afr�ie ar nwM4411tat�y per
Address:. dwelYrr�IsaM.lttxlaarastteaclreae.
City: _ State:— ZIP: Se00 sq.ft.or le
Phone: Fax: E-mail: loon w.n_or leas a
CCB n0.: EICC.His.tic-no: Each additional 500 .fl.orinortion thereof
Limited en:rgy,residential 2
City/metro lic.no.: _—_ Limited energy,non-residential 2
Each manufactured home or nodular dwelling
Signature of supervising electrician(required) Date Y Service and/or feeder 2
Sup.elect.norm(print): License no. Servia morfeesers–Installation,
alteration or relocation:
200 amps or leas 2
Name(print): �/A L C t�T (M t-t C 11'r N. g40
1 amps to 400 amps 2
o Jl T 11 D 1 amps to 600 amps 2
Mailing address: k Z3 S O �W 4N K—o'C1i1 stn 1000 amps 2
City: 1 G D State:rJ ZIP: L? er 1000 amps or volts 2
Phone:Co'S S 79--34`I Fax: _ I E-mail: Reconnect only I
Owner installation:The installation is being made on property I own Te"I"r-Ts"VIC Orfeeaen-
which is not intended for sale,lease,rent,or exchange according to brslallatlom,allerade s,orrelocath m:
ORS 447,455,479,670 701. 200 amps or less 2
D- 201 amps to 400 ams _ 2
0lvnef S Si nature: c1ate: 401 to 6(10 amps
2
Branch elrealb-new,alteration,
or exteaalon per Anel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
4. of armee or feeder fee,first branch circuit: 2
Phone: Fax: E-mail: Bch additional branch circuit:
HMMc.(Service or reeaer no Win"):
CO) U Service over 225 amps-commercial U Health-are facility Lach pump or irrigation circle _ 2
U Service over 320 amps-rating of 1 Ret U Hazardous Incation Each sign or outline lighting 2
familydwellings U Building over 10,(1(1()rquare feet four or Signal circuit(s)or a limited energy panel,
SJS U System over 600 volts nominal more residential units in one structure alteration,or extension* 1 2
al U Building over three stories L-1 Feeders,400 amps or mote *Description:
(� U(kcupant load over 99 persons U Manufactured structure+or RV part: Fj sad 11116 W hosp elka over the allowable its say of ilk above.
JU F.gress/lightingplan U Other: Perina ion
Submit__sets of plant wkb may of the above. Investigation fee
The above rove not applicable to temporarycoaatlrlactoa aer
lvlce. Outer
Th
Nor all jurisdictiom accept creme cards,please call Jurisdiction for more Information. Notice:This permit application Permit fee.....................$ _
U Vise U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card munher: / / within 190 days after it has been State surcharge(8%)....$ _
Expires accepted as complete. TOTAL.......................S
Named u s on t c
s
cardholder signature Aasmmt 4411.4615 Offlorm)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00
Number of Ins ons p9r permit allowed (FOR ALL SYSTEMS)
Service Included: Itemst Total
2-2
Check Type of Work Involved:
Residential-per unit
1000 sq.fl.or less $14&1,5_w_ 4 ❑ Audio and Stsroo Systems"
Each additional 500 sq.fl.or
portion thereof $33.40 1 ❑ Burglar Alar
United Energy _ $75.00_
Each Mani d Home or Modular ❑ Qat
Dwelling Service or Feeder 590.90 _ 2
Door Opww*
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
201 amps or loss $80.30 2
201 amps to 400 amps \panel
6.85_ 2 ❑ VAcuum Systems401 amps to a00 amps0 60_ _ 2601 amps to 1000 amps0.60 2UtherOver 1000 amps or volts4.65 2Reconnect only6.85 2Temporary Services or FeeTYPE OF WORK INVOLVED-COMMERCIAL ONLY
Installation,alteration,or relocaFee for each system.......................................................... $75.00
200 amps or lose6.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps0.30_ 2401 amps to 800 amps .75 2 Check Type of Work Involved:
C ver 600 amps to 1000 voitesee"b"above. Audio and Stereo Systems
Branch Circults
New,alteration or extension po ❑ Boller Controls
a)The fee for branch circuits
with purchase of servicClock Systerfeeder fw.
Each branch circuit 6 65 Data Tei munication Installation
h)The fee for bran .circuits
without purchase of service
Fire N Installation
or INeder he.
First branch circuli ( $46.85 ❑
Each additional branch circuit -,a $6.65 C
Miscellaneous
(Service or feeder not Included)
Instrumentation
Each pump or Irrigation circle _ _ $53.40
Each sign or outline lighting $53.40 ❑ ntercom and Paging Systema
Signal circuits)or a limited energy
panel,alteration or extension $75.00 ❑ Lands Irrigation Control'
Minor Labels(10)
Each additional Inspection over ❑ Medical �k
the allowable In any of the above 11��
Per Iriltpectlon _ 50 LJ Nu ffM 00
Per hour — --~ $62.50 _
In Plant $73.75 ❑ OuMbOfuItlbWeLvIrllr'
a Fees: / ❑ Prollalw.Signaling
Enter total of above fees 5�,0, ❑ ��Y�
� Other�__--
8%State surcharge $_ Number of Systems
25%Plan Revlow Fee
See"Plan RevIW section on $ No licenses aro required. Lloenese are roqulred for all other Installations
front M application.
3 --
Fees:
J Total Balance Due 5
Enter total of above Nes
❑ Trust Account N_ 8%State Surcharpe
All New Commercial Buildings require 2 sets of plans. Total Below: :us,
0dsts\fmms\eic-fees.doc 08/30/01
"11%Me8hariical-Permit Application
Date received: V,, /j Ptxmit no.: _eV
City of Tigard Project/eppl.no.: Bxpire date:
CifyofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Paymcnttype:
Land use approval:
Building permitno.:
U I &2 family dwelling or accessory U Cominercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Other:
9113141111111MIN Kalil Ll In
Joh address: 11'3S-0 S W N o trr" K OTh Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$ _
Lot: Block: Subdivision: i •See checklist for important application information and
Project name: — jurisdiction's fee schedule for residential permit fee.
City/county: 16J Zb ZIP: Li-3
am
scnption and location of w rk on premise
ui �0O o U0 — Fee(ee.) TOW
ovilly
Est.date of completion/inspection: _ Res. Rea.
Tenant improvement or change of use: 7Arhandlingunit CFMIs existing space heated or conditioned?U Yes U No n3iu`o to ng(sine an requ )
Is existing space insulated?U Yes U No 1 Alteration ofcxtating HVAC system
o er compressors
�� State bailer permit no.:
Business name: HP Tons BTU/H
Address: _ __ Fire/smoke dampers/duct smoke aetectors
City: State: ZIP: eat ump(site plan u
Phone: Fax: E-mail: Insinillreplace ac umer-___
Including ductwork/vent liner U Yee U No
CCB no.: nsta rep ec re ocate heaters-suspen
dul—
Ctty/metro lit.no.: wall,or floor mounted
Name.(Please Print): ens fora tante other than furnace
Absorption units_—_ BTU/H
Name: Chillers _ HP
Coasors HP
Address: ex Bed sent .
City: State: ZIP: A liancevent
Phone: Fax: E-mail: erex aunt
s, ype res. tc a azmat
' / hood fire Ruppression system
Name: V L E("IN E I C 1 N Exhaust fan with single duct(bath fine)
Mailing address: L 3'� t O Vt_T t1 �f t� euet a stem—art I�rorn heating or
AC
State ZIP: -�LL up to outlets)
City: r✓• O �_!3_ T ---LPt3 NO Oil
Phone:, ;• X H- 5 ax: E-mail: uc n each a ons ova 4 outlets
IJProem pliltbig(schematic requi _
Number of outlets _
Name: air
Address: Decorative fi Ir�ace _
State: ZIP: nsert-type
City: tov pe estove
U Phone: 0 E-mail: Other:--
Applicant's signatur �, J1, Date: /S o
Name(print):
Minimum
credit cards,ptease call)t
Nd all Jurisdictima accept rriadiction fnr more iw;; inn. It
N ..................... _
Notice:This permit application MMinimumm fee $fee................S ,
U vsn U MasterCard expires if a permit is not obtained Plan review(at — %) $ _
Credit card mimber: �_ _._. - -- --/ / __
within l80 days after it has been
Expires y State surcharge(896) $
ac rd as complete.
— NaW d carAtol ax s n nn c •t card f � TtDTAL
Cmdholder elpmw Amoal J 4441617(WIMC aq
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Osscxiptlort: Prim Total
$1.00 to$5,000.00 _ Minimum fee$72.50 Table 1A Meftnitatl goo _ City (Fa) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Fumace to 100,000 BTU
$1.52 for each additional$100.00 or Including ducts 6 vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000,00. Including ducts 3 vents 17.40 _
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or Including vent 14.00
fraction thereof,to and Including 4) Suspended heater,wall heater
_ $25,000.00, or floor mounted heater _ 14.00
$25,001.00 to$50, 0.00 $379.50 for the first$25,000.00 and J6) R
nt not Included in appliance permit
$1.45 for each additional$100.00 or 6.80
fraction thereof,to and including pair units
$50,00000. 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and it that apply: Boller Heat Air'NI1.20 for each additional$100.00 or s T•11,see or Pump Cond
fr on thereof. ea below. Cornp
--
Minimum Permit Fee$72.50 BTOTAL T) H ;absorb unit
s BTU 14.00
8X 8tate 8urc gs $ HP;absorb
k to 500k BTU 25.60
~� 25'/.Plan Review Fee(oi subtotal) )15-30 HP;absorb 35.00
,__Required for ALL commercial permits only unit.5-1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10)30-50-1.7 mi absorb
unit 1-1.75 _l BTU 52.20
-------. -- --_`_�--- --��- _. 11)>50HP;absorb - -
>1.75 mil BTU 87.20 _
ASSUMED VALUATIONS PER APPLIANCE' 12) ndling unit to 10,000 CFM
10.00 _
Value Total 13)Alr handlingT> ,ODO CFM+
Description__ _Qty_ Ea Amou 17.?0
Furnace to 100,000 BTU,Induding 955 14)Non-portable evaporate cooter-
ducts 8 vents 10.00
Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single dud
ducts&vents _ _ 6.8_0
Floor fumace Induding vent 955 16)Ventilation system n tinc4ld_ed in
Suspended heater,wall hector or 955 appliance permit 10.00
floor mounted heater 17)Hood served by mechanical exhaust
Vent trot Included In appliance 445 10.00
permit 18)Domestic Incinerators
Repair units 80 17.40
<3 hp;absorb.unit, 9 19)Commercial or Industrial type Incinerator
to 100k BTU _ 69,95
3-15 hp;absorb.unit, 00 20)Other units,Including wood stoves
101k to 500k BTU 10,00
I5-30 hp;absorb.unit.501k to 1 2,310 21)Gas piping one to four outlets
mil.BTU 5.40
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) -
1-_1.75 mil.BTU - 1,00
p, >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL:
>1.75 mil.BTU
H Air handling unit to 10,00b cfm656
U) Air handling unit>10,000 cfm 1,170 SX State Surcharge
-Non rtable evaporate ooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
J Vent fan connected to a single du 446
m Vent system not Included in 656 _
_�ppliance permlt
Hood served by mechanical exhaust 656 4�1e►InewcUom and Feea:
1. Inspections outside of normal business hours(minimum charge-two hours)
LU J Domestic incinerator _ 1,170 $02.50 per hour.
Commercial or industrial Incinerator 4,590 2 Inspectinns for which no fee Is spedffcslly Indicated (minirm:m charge-half hour)
Other unit,Including wood stoves, 656 $62.50 per hour
Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plena(minimum
Gas piping 14 outlets 380 charge-one-heli hour)$62.50 per hour
Each additional outlet �_ 63 *State Contractor Boiler CerlMeatkm required for units>200k BTU.
TOTAL COMMERCIAL. : "R"td'°'d't A/C requires oft plan showing plecsmant of unit
VALUATION: All New Commercial Buildings"Ire 2 seta of plans.
I:%dsteVorms\mech-fees.doc 02/11/02
Permit
Addres &0 MD����^v7�►
OP
Issu by: Date: kL
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2,and"either box 3A or 3B:
XED 1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor If the Amettlt+e is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
L If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
C Board. If I change my mind and hire a general contractor, I will contract with a contract .who is
registered with the CCB and will immediately notify the office issuing this building permit of the
] name of the contractor.
Ji hereby certify that the above information is correct and that I have read and do understand the Information
i Notice to Property Owners abo Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
information Notice to Property Owners
About Construction Responsibilities
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construetion'Contrarfors Board in acrordance with DRS 701.0$5(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing Structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered wit the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residen i,I stntcture,you will, in most instances,he ruled to be m employer and the people
you hire will be employees. As the employ you must comply with the following:
Oregon's withholding tax law: As an employe ou must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments en if you don't actually withhold the tax from your employees. For more
information,call the Oregon Dept.of Revenue at 9 -9091. 1 `
Unemployment insurance tax: As an employer,you required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information,call the O n Employment Division at the partment of Human Resources
at 378-3524.
V1 kers'compensation insurance: As an employer,you are su ' t to the Oregon Wor rs'Compensation Law,and must
obtai orkers'compensation insurance for your employees. If you it to obtain wor .'compensation insurance,you may
he so.tbjec •nalties and will be liable for all claim costs if'orie of your utployees' jured cin the jbb. For more information,
call the Work 'Compensation Division at the Department of Consurnc usiness Services at 945-7888.
U.S.Internal Revenue Service: . , t must withhold federa 'ncome tax froth emplover�'wages. You will bF
liable for the tax payment even if you didn't actually withhold the tax. For mo information,call the Internal Revenue Service.
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS O CONCERN:
Code compliance: As the permit holder for this project,you are responsible for resolving y failure to meet code requirements
that may be brought to your attention through inspections.
= Liability and property damage insurance:.Contact your insurance agent to see if you have adequate insurance coverage for
accident., and omissions such as falling tools,paint overspray, water damage from pipe punctures, fire,or work that must he
re-done.
j Time to supervise employees: Make sure you have sufficient time to supervise your employees.
jExpertise: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish
t trades, and to notify building officials at the appropriate times go they can perform the required inspections.
If you have additional.questions,write or call the Construction Contractors Board(PO)Box 14140,Salem,OR W 309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300,in Salem.
pmp-own.pm4
1/94
CITY OF TIGARD 24-Hour
BUILDING Inspedlon Lim (503)$39-4175 MST a �
INSPECTi6N DIVISION Business Line: (503)630-4171
SUP
Received Date Requested_ v 2 —AM PM_ SUP
Location D Suite MEC
Contact Person _ Ph( _) PLM
Contra r _ Ph( —) _ SWR
Tenant/Owner u� .n�J .S� 9— ELC
ting ELC
Foundation Accesallill
Fig Drain �eA ELR
Crawl Drain
Slab Inspection Notes: SIT —
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 —
UMS
eam
Un r Slab -�.
Rough-in
Water Service — —
Sanitamagwer
am DfaWs-) --
.a ch Basin/Manhole
Storm Drain
Shower Pan
Other:
RT FAIL
MECHA AL
m
Ro h-in — —
Gas Line
M Smoke Dampers —
U) ART FAIL
R AL�
LQ Rough-In
C9 UG/Slab
Low Voltage —_--- -- -- —
Fire Alarm
na PART FAIL Reinspection fee of E. _required before next Vispection. Pay at City Hall, 13125 SW Hail Blvd.
A _
SITE Please call fort In °n RE: Unable to Inspect-no access
Fire Supply Line
ADA Daft
O ' flikt
Approach/Sidewalk
Other: _
Final DO NOT REMOVE this INspeaftm mewd ftoiiiii tm loll aft&
PASS PART FAIL
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT: MEC1999-00222
13125 SW Hall Blvd.,Tigard,OR 97223 (503)839.4171 DATE ISSUED: 5124/99
PAP CCL: 1 S134CB-04900
SITE ADDRESS: 12350 SW NORTH DAKOTA ST
SUBDIVISION: ANTON PARK ZONING: R-7
BLOCK: LOT:011 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: 3 VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP: WOOD8TOVE8: 1
GAS PRESSURE: 50+ HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Woodstove and vents
Owner: FEES
VALENTINE SEICIANU Type By Data Amount Receipt
12350 SW NORTH DAKOTA PRMT BON 5124/99 $25.00 99-315620
TIGARD, OR 97223 5PCT BON 5/24199 $1.25 99-315620
Phone:579-3492 Total $26.25
Contractor:
HOMESTEAD STOVE CO INC
THE ENERGY SAVERS
2729 NE BROADWAY REQUIRED INSPECTIONS
PORTLAND,OR 97232 Misc. Inspection
Phone:282-3615 Final Inspection
Reg M LIC 85707
ORIGINAL
W This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
J Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire N work is not started within 180 days of issuance, or if work is suspenued
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may o in opi f these rules or direct questions to OUNC by callin (50 )246-9189. r
Issue By: �- �--- Permittee Signature: (C IVA-
Call(503)639.4175 by 7:00 P.M.for Inspections needed the xt business day
Plan
eck
CITY OF TIGARD REC hanical Permit Application PWd By
13'f25 SW HALL BLVD. mmercial and Residential data Reed z
TIGARD, OR 97223 MAY 2 4 19T4 c)ata to P.11
(503) 639-4171, x304Date to DST
COMMUNItr QFVEtQPMEN� Print or Type permit s-ff �
Incomplete or ills iblo a plications w'll not be accepted called _
Nems of Devebpm•rNrPrq•a Description
Table to Mechanical Code Prix Amt
Job Afton A Permit Fee 10.00
Address 1) Furnace to 100,000 BTU
csw• .� Induct ducts 8 vena e.00
2) Furnace 100,000 BTW
Including ducts b vena 7.50
r {"a(T name of busihs") 3) Floor Furnace
Owner U vt, i►�►t" Se b G a h including vent 6.00
k"IM4 Address �) Suspended heater,wall heater
Vg or floor munNd heater
8.00
r_Ml �',Lo
5) Vent Iwt hwkxbd In appliance permit +�
Ph" 3.00 T
Tk �JLZ,� CHECK ALL 'Boiler Hest Air
Nam(or d bustle..? THAT THAT APPLY: or Pump Cond Qty Price Amt
Comp
"- --
om
8)<3HP;absorb unit to
Occupant MoIWV Aden 100K BTU _ _ 800
',13-15 HP;absorb unit
CRY/awe ;Lip Ph" I 00 to 500k BTU 11.00
8)15-30 HP;absorb
unit.5-1 mil BTU 15.00
9)30-50 HP;absorb
unit 1••1.75 mil BTU 22.50
Homestead Stove Curnpar,y 10)>50HP;absorb unit _
>1.75 mll BTU 37.50
2729 NE Broadway 11)Air handling unit to 10,000 CFM Portland, OR 97232 4.50
503-282-3615 12)Air handling unit 10,000 CFM*
OR CCB # 85707 13)Non-portable evaporate cooler 7.50
Metro License # 2367 4.5_0
or Mal"Address 14)Vent fan connected to a single dud
3.00
15)Ventilation system not included in
Engineer cayrstate zip 17, a----d
liance rmit 4.50
1R)H :cns3 by mecnank.:I exhaust
Describe work to be done: 4•50
17)Domestic Incinerators
New O Repair O Replace with like kind: Yes O No O 7.50
Residential'O� commercial O 18)Commercial or Industrial type Incinerator
_ 30.00
Additional Information or description of work: 19)Repair units
4.50
20)Wood stove
_ 4.50
21)C.othes dryer,etc.
_ 4.50
Type of fuel: oil O natural gas O LPG O electric O 22)Other units
4.50
I hereby acknowledge that I have read this application,that the Information 23)Gas piping one to four outlets
given Is c9ped,that I am the owner or authorized agent of 2.00
j theat s submitted are in compliance with Oregon State laws. 24)More than 4-per outlet(each)
W _ .50
—i Signa �rfAgent as
Minimum Permit Fee$18.00 SUBTOTAL 2
5%SURCHARGE
cortta arson Name Ph PLAN REVIEW 25%OF SUBTOTAL
-
RogiAred for ALL commercial permits on
TOTAL
"State Contractor Boller C 41 icatlon requked
"Resktelydiai AIC requires site plan showitg pbosrtsnt of unk
l:lmechperm doc rev 07/20/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
() c y SUP
Date Requested �7iE ( 1 AM PM BLD
Location�1; Suite MEC 9�fJrrrz 2
Contact Person _ Ph _ PLM
Contractor Ph S 8W _
BUILDING Tenant/Owner ELC
Retaining Wall ELR —
Footing Access:
Foundation FPS
Fig Drain SON
Crawl Drain inspection Notes: —
Slab — SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Firewall P A x l C
Fire Sprinkler
Fire Alarm / C Z-'A-
Susp'd Ceiling �' "
Roof
Misc: _ 1111���
_ --- --
Final
PASS PART FAIL
PLUMBING
Post&Beam -
Under Slab
Top
Water
Service
Sanitary Sewer
Rain Drains
Final �^- -
PASS PART FAIL<49U
HAN
Post&Boam
Rough In
Gas Line — —
Smoke Dampers
S PART FAIL
ETEMICAL
Service _
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
AIM
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ ed before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RE: [ ]Unable to Inspect-..a ao0M
ADA
Approach/Sidewalk Date Inspector
Other - -
Final
PASS PART FAIL DO NOT REMOVE this Inspection record f'r+on the fob site.
i