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9640 SW NORTH DAKOTA STREET 133HIS V10NV4 H LHON MS n:A w w a Q F- O Y <f � O CIG = z m 3 cro W 9640 SW NORTH DAKOTA ST 01 CITY OF TIGARD MECHANICAL.PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2004-00110 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 3/10/04 PARCEL: 1 S135CA-01901 SITE ADDRESS: 09640 SW NORTH DAKOTA ST SUBDIVISION: BOETCHERS ADDU-ION ZONING: R-12 BLOCK: LOT:001 JURISDICTION: TIG CLASS OF WORK: ALT _ FLOOR TURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: 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: WOODSTOVES: GAS PRESSURE: 50+ HP: CLO DRYERS: FURN < 100K BTU: _ AIR HANDLING UNITS OTHER UNITS: 3 FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Replace all< i, I work and furnace/H20 vents Owner: _ FEES_ HERNANDEZ Description v Date Amount 9640 SW NORTH DAKOTA [MECHJ Permit Fee 3/10/04 $72.50 TIGARD, OR 97223 [TAX] 8%State SurcharE 3/10/04 $5.80 Phone: 503-332-8084 Total $78.30 Contractor: BELL HEATING 15550 SE PIAZZA AVE CLACKAMAS, OR 97015 REQUIRED INSPECTIONS Phone: 503-656-1184 Final Inspection Reg#: LIC 447 a. OL rN C J_ m_ This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will b -ordance with approved plans This permit will expire if work is not started within 1 days is uan , or if work is suspended for more than 160 days. ATTENTION: Oregon law req res you to f o rule adopted in the Oregon Utility Notification Center. Those rules are set forth inAR 952-001-0 0 throu h OAR 952-001-0100. You may obtain copies of these rules o direct ques ' to OU N by callit (503)246-6699. Issued By: _ Pefmittee Signatur . Call (503) 639-4175 by 7:00 P.M.for Inspections needed the next business day 5 v�r✓ES Mechanical Permit Application 4 • Received Mechanical Datesy: 3= -�� Pcrmit No#J4,,�d)y-W t Cl Of Tia1'd Planning Approval ©uilding `J g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review- other -- - Tigard,Oregon 97223 D&!*TL_ Permit No.. Phone: 503-639AI71 Fax: 503-598-1960 Post-Review Land Usc !1� Date/By: Case No.: Internet: www.ci.tigard.or.us AA Conuct luris: seep 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: —_ _ Supplemental Information. �', f ' '•i• 1"L OF WORK, WCd l�'RCIAIrFE DULE USP.0 ClKGIS"I';aV :3 New construction Demolition Mechanical permit fees'are based un the total value of the work Addition/alieratio a laceirten Other: performed. Indicate the value(rounded to the nearest dollar)of all of A71TG0 i FGO R %;7 mechanical materials,equipment,labor,overhead and profit. r 1 &2-Family dwelling commercial/Industrial Value: S__ _ See Page 2 for Fee Schedule Accessory Building Multi-Family Description t Fee�ea. Tot■I ►easter Builder Other: - Ileaun/�cootln - __ i A 011taiti CAT10N' ++ Fumace add-on air conditio_nin '" 14.00 _ Job site address: — (Q (J Gas heat pump 14.00 Suite#: Bld ./A t.#: Duct work 14.00 Project Name: _swmcJ -� Hydronic hot water"em 14.00 Cross street/Directions to jab site: Residential boiler for radiator or hydronr'c system)_ 14.00 Unit heaters(fuel,not electric) �eP���""�J� in wall,in-duct,suspended,etc. 14.00 sem_ (p r7 :lue/vent for any of above) 10.00 _ Subdivision: Lot#: -�- Rc air units 12.15 --- _ lhaea _ Tax ma /parcel#: _ - - .� Water heater oth Fuel A10.00 -A/--- ESCIt1(PrION.OF WORK Gas fire lace. _ 10.00 Flue vent water heatcr/ as fireplace) 10.00 ,J y7Lq Log lighter as 10.00 _ -- Wood/Pellet stove 10.00 Wood fireplace/inse — 10.00 Chimne /liner/flu ent 10.00 PROPS OWNER TENANT -- Other: _ 10.00 Name: V Environmental Exhaust&_Ventilation _ - — - Range hood/other kitchen equipment 10.00 Address: — ----- -- Clothes dryer exhaust 10.00 City/State/Zip: _ Single duct exhaust Phone: Fax: (bathrooms toilet compartments, : _;z a•+ i O ti!oA'CTPF1It.ON: �': utility rooms) _ 6.80 Name: ��_ Attic/crawl space fans 10.00 Address: - t ocher: lo.00 City/State/Zip: �`fAC r-(k .1 0.40 for first 4 $1.00 each odditional 1L Phone: —1�Q,� Fax: (D J6-? ( Furnaceetc. _ •• S— Gas heat pump •- E-mail: Wall/suspended/unit heater •• N x,. CONTRACTOR';;: a Water heater •• Business Name: C�-t e.�� � Fireplace - •• — _ .J _Address: Range " m City/State/Zip: _ BBQ •- (� — Clothes dryer as •• us Phone: CT Fax: _ _ other_-- - •• CCB Lic : --- _ Total: Authorize __ Mechanical Permit Fees" � _ Subtotal:�S Signature _ Date: _ Minimum Permit Fee$72.501 Plan Review Fee 25%of Permit Fee S �— ease print name) _ State Surcharge(8%of Permit Fee) S t.J TOTAL PERMIT FEE S— Notice: This permit application expires If a permit Is not obtained within 'Fee methodology tet by Tri-County Building Industry Service Board. 180 days■Rer It has been accepted as complete. "Site plan required for exterior A/C units. is\Dsts\Permit Forms\MecPemnitApp.doc 01103 Mechanical Permit Application - City of Tigard Page 2 -Supplemental Information Commercial Fee Schedule: Total Valuation: Petmlt gs�; " $1.00 to$5,000.00 Minirrnim fee 572.50 $5,001.00 to 510,000.00 572.50 for the first SS,(W.M and SI-52 for ear.h additional S 100.00 or fraction _ thereof,to and including5-1-01000.00 SI(1,001.00 to 525,000.(N) S 148.50 for the first 510,000.00 and 51.54 for each additional 5100.00 or fraction thereof,to and including S25t000.00. $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and Sl 45 for each additional S100 00 or fraction thereof,to and including _ S50 000.00. 550,001.00 and up $742.00 for the first$50,000.00 and -- S 1.20 for each additional 5100.00 or fraction thereof. Assumed"Voluktions Per t Value Total Description: QtY (Ea) Amount Furnace to 100,000 BTU,including 955 ducts&vents Furnace>100,000 BTU including ducts —1,176--- &vents Floor furnace including vent 955 Suspended heater,wall heater or floor 955 mounted heater Vint not included in appliance permit 445 - Repair units 805 <3 hp;absorb.unit, 955 --- to I00 BTU * _ 3-15 hp;absorb.unit, 1,700 —� 101k to 500k BTU 15-30 hp;absorb.unit,501k to 1 mil. ',310 BTU 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU _ >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handlin unit to 10,000 cfm _ 656 _ Air handling unit 110`000 cfm _ 1,170 Non-portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 rmit __ Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator490 —— Other unit,including wood atot _ y 656 inserts,etc. Gas piping I A outlets 360 -- IL _Each additional outlet 62 i-- F' TOTAL COMMERCIAL, N VALUATION: W i,\NIMPermir Forms\MecPermitA-pPg2.doc 01/03 CITY OF i IGARD 24-Hour BUILDING � Inspection Line: 3)639-4175 � MST0&�_ 'UO�� INSPECTION DIVISION Business LI (503)639-4171 BUP Received D--attee�Requested _`�AM PM—___ BUP Location -- ! 'i��- 1. ite____ MEC)2,00 i7 a t-- //U Contact Person — �u>` —_ Ph y7 ` -7.3G� Contractor_ —_.-_-_— _.----_.-_.__-- Fh( ) SWR �FBUILDING Tenant/Owner _ ELC F�ooting Foundation Access: ELC _ F'g Drain ELR _ Crawl Drain _ Slab Inspection Notes: SIT _ Post&Beam ---- C ,r_-HT1 _ _ Shear Anchors - Ext Sheath/Shear Int Sheath/Shear -� Framing Insulation 6 ,2Z -o Drywall Nailing Firewall Fire Sprinkler _- Fire Alarm Susp'd Ceiling - -- _.- Roof Other: --- - PAS PART FAIL 4�041311NG Post&Beam Under Slab _ Rough-In Water Service M _ Ak a/- Sanitary Sewer Rain Drains - - Catch Basin/Manhole Storm Drain Shower Pan Other: - Final � ----� PASS PART FAIL MECHANICAL Post&Beam - - -- Rough-In Gas Line a Smoke ampere ' W Fin AS ART FAIL -- - -- -� ELECTRICAL .� Service W Rough-In 5 UG/Slab W Low Voltage Fire Alarm - - Final Rainspertion fee of$�^ PASS PART FAIL -_required before next inspection. Pay at City Halt, 13925 SW flail Blvd. SITE _ ❑ Please call for reinspection RE: E] Unable to Inspect-no access Fire Supply Line ''� ,,�y , ADA DSU 4�'Z��r CJ Approach/Sidewalk --- ' e'r Other: _ Final DO NOT REMOVE this inspection re rd from title job sfb. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)63 7S IB INSPECTION DIVISION Business Line: (503)6 71 BUP Received Data ReQuested AM PM SUP Location C� ]` y ` , GAY" / `T_ �c�`�C MEC Contact Person _�-- Ph(�_—) Z�- - �i PLN Contractor__ — _ Ph SWR _ BUILDING Tenant/Owner — _ ELC Footing Foundation SLC ---- ----- Ftg Drain Access: ELR Crawl Drain Slab inspection Notes: j� , ,p p SIT Post&Beam Shear Anchors Ext Shbath/Shear Int Sheath/Shear - Framing Insulation Drywall Nailing - ----.-----.�- Firewall Fire Sprinkler __- Fire Alarm Susp'd Ceiling Roof 7ther: Final zuRT FAILP !n i _ Post&Beam Under Slab _ Rough-In Water Service Sanitary Sewer Rain Drains — -- Catch Basin/Manhole Storm Drain -- - Shower Pap t Ot -- --- _ ina S PART FAtt__8909 -- _-- ANICAL Post&Beam Rough-In Q, Gas Line a Smoke Dampers ---------- Final PASS PART S=AIL --- -- -- ELECTRICAL J Service _ m Rough-In � W UG/Slab _j Low Voltage Fire Alarm Final r-1 Reinspection fee of$__ required before next PASS_ PART FAIL - Inspection. Pay at City Hell, 13125 SW Hall Blvd. SITE _ - Please call for reinspection RE:._.____- _—� --____ �� Unable to irisport-- no access Fire Supply Line 2 Ana Approach/Sidewalk T__ Other: Final DO NOT REMOVE this Inspection rocord from the job sib. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)621141175 M3T INSPECTION DIVISION Business Line: (503)639-4171 SUP Received ._ __ Date Requested - _AM ___._._._ PM 8UP -_ Location Suite— _ MEC Contact Person Ph( L-) .`77a3 ?3G PLM Contractor_ - -_____.__._____._- Ph(_ ) _- SWR BUILDING TenanflOwner -- -- _-_ ELC Footing _ ELC _ Foundation Access: ` Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT -- -— Post&Beam Shear Anchors - Ext Sheath/Shenr Int Sheath/Shear Framing - --- --------- Lnsulation �- Lrywall Nailing - - --_ F rewall ? O y Fire Sprinkler -- ----- --�-- - Fire Alarm Susp'd Ceiling ---- ---- - --- _ Roof Other:Final PASS RT FAILCLU _------------- -- MBI - P38t&Beam Under Slab -- Fough-In Water Seivice ------ --- -_. _ — ;;anitary Sewer Rain Drains -- - - - - - �--_ - _- Gatch Basin/Manhole ;storm Drain -- ---- ----- - "" Shower Pan =ice --- ___-_- -------- - -- .--_- -- flWP RT IL ECHA AL Pos earn Rough-In ----- --__ _--_-- - ------ -- a Gas Line WA( ke Dampers ------ -- - - --------_ _..----- ----- - H N s PART FAIL -- ---- - - --- - - -_- __-- RICAL Service CO Rough-In 0 UG,Slab -_- ----------•--- - Low Voltage ---- ---_-�-__ -- ___ -._- --__--._----- -------- Fire Alarm Final H . mectlon fee of$ __ -egljired before maxi inspection. Pay at City Nell 13125 SW Hall Blvd. PASS PART FAIL SITE — E] Please call for reinsnection RE:__- —_- -.- C . Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dab -- OMp�OIr Other:_ Final OO NOT REMOVE this Inspe0lion ti5lCOId ham 1ths,job*No. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection rine: (503)639-4175 INSPECTION DIVISION Business Linc (503)639-4171 SUP Received --_ Date Requested �`' `� _ AM_ PM _ SUP Location __ 16 '-/G k F --.Suite _ MEC — Contact Person . Ph(.____) 8:17 — 2 0 PLM Contractor_ Ph(INL) aF 3—,E gaI SWR BUILDING Tenant/Owner ELC Footing --- ELC — Foundation Access: Fig Drain �� ��' kELR Crawl Drain Slab Inspection Notes: SIT — — Post& Beam Shear Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation ��Q. �1 `� � Drywall Naili-ig - W — A — — Firewall VC � "� Fire Sprinkler -- Fire Alarm Susp'd Ceiling — -`- '— Roof Other:----------- - — - Final PASS PART FAIL — — — PLUMBING _. _— __ 7� __ — Posf&Basin ` Under Slab —.— -- -- ---- --- Rough-In Water Service — — ---- f--- -- --- — Fanifary Sewer Ran Drains —--- - Catch Basin/Manhole Storm Drain — Shower Peri rJther: Final PASS PART FAIL MECHANICAL —_ Post&Beam Rough-In -------- Gas Line Smoke Dampers --- p-. Final PASS PART FAIL - — — ELS'CTRICAL Service CO Rough-in W UG/Slab _j Low Voltage Fire_ Alarm F -n Reinspection fee of$ —required before next Inspection. Pay at City Hall, 1312.§SW hall Blvd. AS PART FAIL SITE lJ Please call for reinspection RE:—� __�-�� __.- �� Unable 4o inspect -no access Fire Suppl;-LineADA 1ity� Approach/Sidewalk Dam-�V 14% � InsPecter _ �_— —M 1 `n6 W Other: Final -- --- _-- DO NOT REMOVE this: Ilnsp ecto I rd from t1w job sib. PASS PART FAIL r _ MASTER PERMIT CITY OF TIGARD PERMIT#: MST2064-00003 DEVELOPMENT SERVICES DATE ISSUED: 1!12104 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4.171 SITE ADDRESS: 09640 SW NORTH DAKOTA ST PARCEL: 1S135CA-01901 ' SUBDIVISION: BOETCHERS ADDITION ZONING: R-12 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: Fire repair. BUILDING REI5SUF. CUSTOM � STORIES: � 1 FLOOR AREAS REQUIRED SETBACKS_ _REQUIRED CLASS OF WORK: AL I HEIGHT: 12 FIRST: of BASEMENT: of LEFT: _ SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR 1-OAD: 40 SECOND: of GARAGE: of FRONT: PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 1.04110: o/ RIGHT: VALUE: 50 000 00 OCCUPANCY GRP: R3 BDRM. 3 BATH: 7 TOTAL: 0 of REAR PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: LAUNDRY TRAYS. RAIN nRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS. 111816HOWERS: 2 GARBAGE DISP: 1 WATER HEATERS. I WATER LINES: RCKFLW PREVNTR. GREASE TRAPS- OTHER FIXTURES- MECHANICAL IXTURESMECHANICAL FUEL TYPE3 FURN<100K: v B(NUCMP<3HP: VENT FANS: 2 C1-0'rHES DRYER: FURN>0001(: UNIT HE\TERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: J WOOOSTOVES: GAS OUTLETS: '.LEC rRICAL RESIDENnAL_U41T SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 100■1.1p: 0 700 omp: WISVc OR PDR: PUMP/IRRIGATION: PER INSPECTION. EA ADD'L SOOSF: 701 - 400 amp 701 400 amp: tot WIo SVCN DR: oo .SIGWOUT LIN LT: PER HOUR: IJMITED ENERGY: 401 - 600 amp: 401 - 400 amp: NAADDL OR CtR: 4 Ql SIGNAUPANEL: IN PLANT: MANU HMISVCIFD..: 601 - 1000 amp: 601*amps-1000w MINOR LABEL! 10004 omplvolt PLAN REVIEW SECTION _- Reconnect only: >a4 RES UNITS: SVCIFDR>s225 A.: >600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL _ B.COMMERCIAL ___� �• AUDIO S STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTFRCOMMAGING: OUrDOOR L NDSC I.T: BURGLAR ALARM: OTW BOILER: HVAC: 4ANDSCAPERRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK. INSTRUMENTATION: MEDICAL* OTHR: HVAC. DATATTELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,317.85 This permit is subject to the regulations contained in the HERNANDEZ SIMMCO GENERAI CONTRACTING 9640 SW NORTH DAKOTA 5430 N.COLUMBIA CT Tigard Municipal Code,State o OR. Specialty Codes and TIGARD,OR 97223 PORTLAND,OR 97203 all other ce wiRble laws. All work will be done it acardance Wkh approved plans. Th is prrmit will expire if work is not started within 180 days of k-nuance,or it the work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Phone: Phony. 503-735-0500 Oregon Utility Notification Center. Thuse rules are s ' 4 forth in OAR 952-001-0010 through 952-001-0080 '.oU Reg 0: LTC 154107 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. 3 REQUIRED INSPECTIONS Footing Insp Framing Insp Plumb F!nal Y� PLM/Underfloor Insulation Insp Final Inspection Mechanical Insp Rain drain Insp Plumb Top Out Electrical Final Electrical Rough In Mechanical Final Ise,ued By : �>!��s ��1�.�A�!� Pe,mittee Signature Call (E03) 6394175 by 7:00 p.m. for an inspection needed the Rex business day RECEIVED Building Permit AP-01eaNion 2004 keceived Permit No../VJ5 aGtD y—0,0,90a City of Tigard G.tere __ 13125 SW 1-lall Blvd.,Tigard,OR9 �y OF TIGARD Plan Review Other Permit. Phone: 503.6+9.4171 Fax: 503.j�'�f><], Date/nom Inspection Line: 503.b39.4175 ING DIVISION Date Readyfily: turd SSee Attached Checkllit for Notilied/Metlrod: /�L� Supplemental information Internet: www.ci.ligard.or.us TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING ❑Demolition Permit based on the value of the work performed. [:1 New construction WWare Indicate the value(rounded to the nearest dollar)of all �Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the r work indicated on this application. CATEGORY OF CONSTRUCTION —�- -_ -- — Valuation: XI-and 2-family dwelling ❑Commercial/industrial Number of bedrooms: ❑Accessory building ❑Multi-family _— —• --- Other: — Number of bathrooms: ❑Master builder ❑ - JOR 91ft )INFORMATION AND LOCATION Total number of floors: Job site address: — New dwelling area: —__ square feet Garage/carport area: square feet Citi/Su►ttJZIP. ) Suite/bldg./apt_no._ Project name:+ Covered porch area: square feet Cross street/directions to job site: = _ Deck area: _ square feet Other structure area: square feet 411JI"b ii irk COMMERCIAL•USE CHECKLIST i Lot no.: Permit fees" teased on the value of the work performed. Subdivision: —T;r lJf� arc indicate the ,slue(rounded to the nearest dollar)of all Tax map/parcel no.: �.,���-�•A _Q/9Q/ equipment,materials,labor,overhead,end the profit for the DESCRIPTION OF WORK work indicated on this application._ Valuation: S Existing;building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: �I6 ► �`- Type of construction: Address: 1r — �� uC _ Occupancy groups: City/State/ZIP: — Existing: Phone:0 V3) Fax:( ) New: PLICANT [] CONTACT PERSON NOTICE Business name KP fi _��r t 2l i.lf _ All contractors and subcontractors are required to he licensed with the Oregon Construction Contractors B-)ard Contact name: tt under ORS 701 and may be required to be licemecd in the Address: -403-1 h� r I r rl �� Sty 1 i£ �- jurisdiction in which work is being performed.If the applicant is exempt from licensing,the foliuwing reasons City/State/ZIP: apply: Phone:( ) L �s , �`�1� Fax: •' — '"— _ —.^ __ E-mail: G�rvc r CO]NTRACTOR <Y ----- — Business name: ' At-AontCto 61L LIA1111A1� BUILDING PERMIT FEES" Address: t,��Q ��T . please refer to fee schedule. — CityrState/ZIP: 1.0 Fees due upon application Phone:(Sdyj) '.� 3 S F"x --- _ Amount received CCB lic.: 15 ( / -x 7 J' _ -- Date received: Authorized signature: This permit appllatien expires If a permit Is not obtained witUn 190 days after It has been accepted as complete. Print narn Data 1 � —p • Fee methodology set by Td-County Building Industry Service Board. i\Buildinji\Permi&BUP•Pern*A{rdoc iws 4404613r(ire02coMiwea) One- and Two-Family Dwelling Buildin Permit Application Checklist City of Tigard !Reccived Pernrii No.: 13125 SW Hall Blvd.,Tigard,OR 97223 LAper":Phone: 503.639.4171 Fax: 503.598.196024-Hour Inspection Line: 503.639.4175l O Plumbing O Mechnlcal Internet: www.ci.tigard.or.ua 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 sstem permit or authorization for remodel. Existin system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report.. Must carry ori trial applicable skmp and signature on file or with application. 9 Erosion control C1 plan [I permit required. nclude drainage-way protection,silt fence design and location of cetch- besin rotcction,etc. _ 10 J Complete sets of legible plans. Must be dr wn toscale,showing confotmanco to opplicable local and state 13 building codes. Lateral design details and tonne ions must be incorporated ing,the plan: or on a separate full-size sheet attached to the plans with cross references b een plan location and det iils. PIP:,review cannot be completed if cop),right violations exist. 1 I Site/plot plan drawn to scale. The plan must rho of and building setback dimensions;property omer elevations(if there is more than a 441.eie,,ation differential,plan ust show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks); ocation of wells/septic systems;utility locations;direction indicator,lot area;building coverage area;percentage o coverage;impervious area;existing structures on site.;and _ surface drainage. 12 Foundation plan. Show dimensions,anchor bolts,any hdowns and reinforcing pads,connection details,vent size and location. 13 Floor plans. Show all dimensions,room identification,win w size,location of smoke detectors,water heater, furnace,vents atiun fans, lumbin fixtures,balconies and dec 30 inches above grade,etc. 14 Cross section action, Show all framing-member sires a d spacing such as floor beams,headers,joists,sub- 17 floor,wall cons roof construction. More than one cross AWion may be required to clearly portray construction. ShoAAdetails of all wall and roof sheathing,roofing, of slope,rei.ing height,siding material,footings and foundation,stair , ire lace construction,thermal insulcinn,etc. 15 Elevation views. Provi elevations for new construction;minimum two elev or additions and remodbls. Exterior elevations must re t the actual grade if the change in grade i r than four foot at building envelope. Full-size sheet addendums show oundation elevations with e e nces arc acceptable. 16 Wall bracing(prescriptive path)and or s plans. Must in 'tate details and locations;for non1:1 El - prescriptive path analysis provide specifications and calculations to en inee standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating her sizing,spacing,and bearing locations. Show attic ventilation. _ _ 18 Basement and retaining walls. Provide cross sections and details showing place ant of rebar. For engineered systems,see item 22,"Engineer's calculations." _ 19 Beam calculations. Provide two sets of calculations using current code design value 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-plping schematic is required for four or mo,_appliances. _ 22 Engineer's calculations. When required or provided,(i.e.,sht;ar wall,roof truss)shali he statVed by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. 23 Five(5)site plans arc required fcr Item I I above. Site plans must be 8-1/2"x I I"or 1 I"x 17". 10 s 24 Two(2)sets ea:h are required for Items 16, 19,20 and 22 above. 25 Building plans shall not curtain red lines or tape-ons. "Mirrored"building plans will not be accepted. LY 26 "Reversed"building lens must meet criteria outlined in the Permit&System Development Fees document. Jl 7 - 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to inch de tree size,type and location per approved project street tree plan(if applicable),and City of Tigard _ Street Tree List. 29 Site Man to include tree protection measures as required by conditions ofproval. _ 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions including decks,patio covets(over non-impervious surface)and accessory structures to existing residential dwellings on a lct of record approved rior to September 9, 1995. i:\Building\Pci-tnits\one-Two-FamilyChecklist.dor 12/03 Monday,January 12.2004 9,32 AM Joe Squires 503-253-5831 P-02 ,]an 1� 0� 09s23• KP.a &wring 5032210423 P.2 X47. ism! F lertria]PgTnIt Ap ' 9 ��=�t.M,�Lt 2 Citi ofdw 11123 LM HMI Mrd..Tird.f1e 17221 JA t'Y„ r + — Oen hoes: 309131,1171 Rs IS-1 ICAO !'� -- 1M,r,plOW Mwoe.w uro 303 639.4173 I T Y 0 F T wte w.rw:. i.�•...tr_w�+ INN 1-rift 00*0" 1 .r on t G'-": NLS • 21er•commuelon Au3dltkad lay.w2L3maseeseros1 [ HR—dositsc.tw f,R e 10/e 1(�+ plfw„ho ora 7?0 ertre rr1.0 �Yih>ra!o+s WISDOM.A. ---- -�. .r►-1,td>�u>,tI1rl.rww d or mmt wtv rsctU Abi 1 cAllo f1T Oy G_(XN OL ,Nor iR0+eLt— 1 mm a+w WACWC I.rttl 2 W y d..K M (�rrrmetudl9rt�111h1>tl�Ame""-�1R ���y ow Nor,s wlw amore )r(ullj fyeil ❑P1mm hi ddo 0 00m: Q0�11..0 oar„pcw"" drew M w Ll I,pOAfl01f. t•..- z+ O PdryA"Pla^ KY pow ure 016f10sta0lt a 0060,r pflsMht,r.OlcilfQ, 2e6110. �raM ddww: ' (I`1� M -1?h K tJ7 '�isu�+�, w r/Tt"'dry«n -Cir,MSlltdf.IP: 1 p�. 9�xr�-�_ 111 Morns„e not NplkMk to o-Me.ory e011+"+eMoo i 2rli• 0l2>f4MR� _ _ — — Nd f'sModlr■'�"'P''w�' s!onM Gyo�1Uet1/dfi0ealeel a job tlhs: �_r.. bsle,/os aMlstrw��>� — 1 A0o tg•r,et leo 145.11 s MPINK 33. _ 1 9rbt1ivi011e: 101 oe.: � � w1lMaeill 7340 f -" DIM 1lowewyWpM 7300 1 TOx "0.: ,A � .8686.1 wa0ntr '� ' ��w Ot1llrt! o111r taoMlr rsl000dl� _� -- - Ho w w10 701 000 IMf� ] Sol~0 S+�Of'Lit<:ir bMaf1L! <'• ;r' � •'r'i�-r'��n• 101 IOdM 11Q.6! 2 21010 2 maw. �_.a I�z.� _�- Qvor 1� f M r011ti Is1d3 A1101e01' l�,wrM N n CIfllffsld�+ _ Tow�Mosy slnit0o w OeoMeOdes.a.11«tlt/oe.summ Pfleec i ) Ftrs ( 1 20o snp a�lsse - I'll Y 1 sr 1 ewe wlitb t mo! !pl n 100 Ittn. Owmw 1t1tgmw..TMil llldUtfon Ic Dtrilts 2 as prapelly ieMeldOd lbs 0186 bUt,nN Cr WbWV' CO on Of►8 417,4►0,f70,ttrd 101. Ni lr b!0 111-m bow- 111.86*eirso111-eta..,oMerttYsO.es ss111adrr, 186 aM Omer cieltwre rs � — w. oaa "s"th 111CAKT , C �— tarme cr hole.M,each 6 til 2 _La8111.80 Asr!1C UsLt— TTAm br kma e 'ol CelMa1el00ree ..wk d..Mao«!rd«ko. N p a 0k Adkkelc ?ot IvdheKllwft*C 0ofr yob�r trolls ool l oebb4 C-IModz — tr Ads IMAD 2 '- _ or h ts� WOW" Dswdbs: ►str� s dttcinaol nanw. y a ► GTR 1 G Rook odklo01"am over rMwtw is ►6 N M!obtr --- !1186. CitylS11t0/Lit: vA. A 0 i Itnarl Mr ItOot r�+ .So �als01tls1 .,1 k0s nal cce m 1556#6 Ravi*,l*—Vp-Mol wv � _ °•'"•' � lulrv.El/elfiCltO d9r mre, OWN& —lrl.s.edp(�of 1 1 M Frb1>t01e1: s� V, I t 4 TOTAL FULWT ISR 1 TtM 7--_0—7 rwr b _' too A1l!110!4 td.6.4"mr er ___ d,0.A%w M base"rerep•s w ommou Sy.asrlael�dsrl+tTr►CMNyIuNNgl,Arvra � rllol nwr: yA t ��r1 - »wrlm of w rc+low pw •` s,.v11 .w.annwxa0rlw Buildipg Fixtures Plumbing Permit Application City of Tigard %V , Received Permit No ��t _ � Dale/By: ST 13125 SW Hall Blvd.,Tig•trd,OR >��O Plan Review Phone: 503.639.4171 Fax: 50�2��/R IC r/G Date/Ely: _- 011ier Permit No.: 24-Hour Inspection Line: 503.6_4'4/IVG 01 ARQ Date Ready/Ay �Q° 1 See Page 2 for Internet: www.ci.tigard.or.us �V/Q 10 A Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULZ ❑New construction _ ❑Demolition For speclalIn oration use checklist. Description For Fa. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 n.for each utility connect;-n) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 ❑ 1-and 2-family dwelling ❑Commerc i al/induE trial SFR(2)bath 350.00 ----- ❑Accessory building [I SFR(3)bath 399.00 Multi-family -- - - e i Each additional bath/kitclien 45.00 El Master builder ❑Other. Firr,sprinkler(__sq.ft.) Page 2 JOB aITE INFORMATION AND LOCATION _ Site utllitlei - - Job site address: t/. 1. Catch basin or area drain 16.60 tw SW IIALIK-ft( LL d S7 _ - City/Stale/ZIP: Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Projo't name: Footing drain(no.linear ft.: Page 2 ) Manufactured home utilities 110.00 Cross street/directionS to job site: Manholes 16.60 _ Rain drain connector MAO Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: Water service(no.linear ft.:_) -- Page 2 -- -- - - - Fixture or Item Tax map/parcel no.: _ Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 - Clothes washer 16.60 Dishwasher 16.60 E] PROPERTY OWNER L .NANT Drinking fountain 16.60 -- -_ Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City/Slate/ZIP: Floor drain/floor sink/hub 16.60 - Phone: Fax:( ) - Garbage disp3sal 16.60 ( ) _ - APPLICANT (] CONTACT PERSON- Hose bib 16.60 ---- ----- ------ Ice maker 16.60 7 Business name: t 1� l� �,_1( Interceptor/crease ti,) -- 16.60 Contact name: -A(-A(7,4 A A rL tP v�� ___ Medical gas(value:S - ) Page 2 Address: �2-� tit r�) I Y�1 �>✓ <. 1 l-TE 2 cV Primer 16.60 C2L -- Roof drain(commercial) _ 16.60 City/State/ZIP: �- Sink/basin/lavatory 16.60 Phone:(G7p3 ) ' 2 Fax::(�jU3 )Z2'� . tS` t 3 Tub/shower/shower pan 16.60 E-mail: , c n �� e r (final 16.60 CQN'CliA R -_ Water closet 16.60 Business name: I Water heater I6.W � Other: Address: (D 7;1 SE ---- Subtotal City/State/ZIP: --,?;!2w- �1�, �-- -W Minimum permit fee: $72.50 Phone: Fax:(rA ) 65� � `a Residential backflowmmimumpermit fee: S36.25 CCH Lic.:_ Ply bing Lic.no.: _ Plan review (2546 of permit fee) _ State surcharge(g%of permit fee) Authorized signature: .,.�. '�- TOTALPERMIT FEE Print name: K Date���.Z This permit application expires If a permit It not obtained within Igo days after It has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i\!)tail(fing\Permiu\PLMF•PemdtApp.doe 12107 440.46IM10/02/COWWHa) I Plumbine Permit Application •• City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire SuppressioD Systems: Site Utilities)`. Qtr• Fee(ea) total uare��= Permit Fee_ Footing drain-I"100' 55 w— 0 to 2 OCA $115.00 46.40 2,001 to 31600 _ $160.00 — Footing drain-each additional 100' 3,601 to 7,200 $220.00 Sewer-1 st 100' 55.00 7,201 anteater $309.00 Sewer-each additional ICO' 46.40 Water Service-I"100' 55.00 di+cal Gas S stems: _ . n-- –water Srnice-each-additional!00' 46.40 � " Storrtsingle &RiDrain-1st100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50StorDrain-each additional 100' 46.40 $5,001 DO to$10,000.00 $72.50 for the first 55.000.00 and$1.52 for each ack Flow Prevention Device 46 additional 3100.00 or fraction thereof,to and _ includin�SIO,00!1.00. Com $10,001.00 to 525,000.0^ 3148.50 for the first$10.000.00 and 31.54 for Resickflow Prevention Device each additional 5100.00 or fraction thereof,to(minmit fee$36.25 27.55 and including$25,000.00. _ Rainngle family dwelling 65.25 525,001.00 to S50,000.(N) $379.50 for the first 525,000.00 and 51.45 for each additional 5100.00 or fraction if r.to inspxisting plumbing or and including$50,000.00.s ecested in .ctions-per hour 12.50 550,001.00 and up $742.00 for the first 550,000.00 ana 51.71)ibr Subtotal: each additionai$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing exis ng fix tute.�If t'yes",please indicate work performed by ture. Faccurate) re ort fixtures moult) result in inc aceds*. lzture 3 k Pe Fixti re type: Rept^ New Moved . Eaistln Capped Comments regarding fixture work: Baptistry/Font -- Bath -Tub/Shower _ -]acuviiWhirlpool _ — Car Wash -Each Stall —�— -- _ -Dri,c Thru Cuspidor/Water A-•*iratot _ — Dishwasher -Commercial - -Domestic Drinkinit Fountain Eye Wash — -- Floor Drain/sink 2" _ 3" _ 4„ Car Wash Drain Garbage -D otnestic Disposal -Commercial *Note: If thetii�ttre work under this permit results in an -industrial _ increase of sewer EDUs,a sewer permit will be issued and ke Mach./Refri .Drains — fees assessed for the sewer Increase must be paid before the Oil S arstor Gas nation _ Rec.Vehicle Du Station _ plumbing permit can be issued. Shower -Gang - -Stall Sink -Bar/Lavatory __ Quantity Total -Bradley – Isometric or riser diagram Is required if fixture quantity -Comrnrrcial — total is_>9. -$mice _— Swimming Pool Filter �• Washer-Clothes Water Extractot _ Plan ReN_ Water Closet-Toilet Plan review Is required if fixture quantity total is>9. Urinal — Other Fixtures: i.\Nuildina\Pam \PLM-PtmAApp.dot 7N3 g� Mechamicai Permit Application 7DatcReadyfBy: Pernut No. City of Tigard () v Ot�OQ 3 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit Inspection Line: 503.639.4175 Jura ® see Pelt 2 for Internet www.ei.tigard.or.us Notifted/!vlethod: Supplemental Information COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTION Value $ - aIDENTIAL EQUIPMENT I SYSTEMS FEES« ❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building - — For special information use checklist. Multi-family ❑Master builder []Other: Description Qty. Fes. Total JOB SITE INFORMATION AND LOCATION Hestln coolln -- Air conditioning or heat pump lo!)site address: -U w �Ot`i f� R��7 S A �7�• (requims Bite plan showing placement) _ 14.00 Furnace 100,000 BTU(ducts/vents) 14.00 city/State/ZIP:_ -At C.4 Furnace 100,000+BTU(ducts/vents) 17.90 Suite/bldg./apt.no.: Project name: Gas hest pump 14.00 Cross street/directions to job site: Duct work - 14.00 -_-- II dronic hot water system 14.00 Residential boiler(radiator or h dronic) 14.00 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 10.00 — - Flue/vent for any of above10.00 Subdivision: Lot no.: -- Other: 10.00 Tax map/parcel no.: Other fuel r Ilanca 10.00 DESCRIPTION OP PORK Water heater -- - Gas fireplace 10.00 _ Flue vent for water heater or gas -- -- - fireplace __ 10.00 Lo h lhter(gas) - 10.00 Wood/pellet stove _ 10.00 -- Wood ftreplacchnsert 10.00 ❑ TENANT Chimney/liner/flue/vent 10.00 PROPERTY OWNER );; Other: _ 10.00 --- Name: Environmental exhaust and ventilation — Range hood/other kitchen Address: J � a ui ment 10.00 city/state/ZIP: Clothes dryer exhaust 10.00 Single-duct exhaust(bathrooms, Phone:( ) Fax:( ) toilet co artrnents,utilq rooms 6.80 ►APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: �� f (A� �� 14 Fuel piping a Contact name: A $5.40 for Ilrst four,$1.00 for each additional Furnace,etc. Address: w -14 ktg- _cU t D Gas heat pump CitylStatdZiP: Wall/sus !tided/unit heater _ Il��A 0 209 �__ --- - ( Fax: ) : Water heater J Phones Lam. b�I Z ( 3) Fireplace -- _m E-mail: , 14 - Ranitc _ BarbecueLU — J c / Clothes dryer(gas) Business name: _ CJ I rA (..> �pEY\F1/� fIL A( T?b(�T Other: Address: �>✓E DuIL„O1'Jut `'l�JLM 1T AeP - MIC"MCAL PEWAM FEES* City/Statc/ZIP: �A1 ()�� �L I F I O n"�� Subtotal i --�-- r Minimum permit fee($72.50) _ Phone:( ) Fax-( ) Plan review(25%of permit fee) CCB lie.: (S y I State surcharge(8%of permit fee) TOTAL PERMIT FEE This permit application esplrn If a permit Is not obtained within Ia0 Authorized signs -, days after It has been accepted as complete. Print name: _ — Date: , 12 Z � Fee methodology Bet by Tri-Count'Building Industry Service Board i\Buildina\Peritt\MEC-Pe.•hAppdoc 12/07 440461rT(I1102/MWWEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental information Commercial Fee Schedule: $1.00 to$2,000.00 Mininamt tee$72.50 $2,001. to 55,000.00 $72.50 for the first$2,000.00 td$2.30 for each additional$I 00.00,ofr fraction thereof,to and includin $f,000.00. $5,001.00 to$10, .00 5141.50 for the fust S5, .00 and $1.80 for each additio S 100.00 or fraction thereof,to a including _ _ 0 000.00. $10,001.00 to$50,000.00 $20 for the 1 $10,000.00 and $1.35 ach a itional$100.00 or fraction th f o and including $50,000.00- $50,001.00 to$100,000.00 $771.50 for t fi 50,000.00 and $1.25 for ea additio S 100.00 or fraction the ot;to and inc ing _ $100,000. $100,000.01 and up $1,396.5.1t, r the first$I 00,000. nd $1.10 foch additional$100.00 or fractionreof. Note: All new commercial b ildings require 2 sets of plans. CL a m c� w J i:\Building\Pffmits\MEC-PermitApp.doc 12/03 2 " CITY OF TIOARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2004-00313 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 5/25/2004 PARCEL: 1 S 135CA-01901 SITE ADDRESS: 09640 SW NORTH DAKOTA ST SUBDIVISION: BOETCHERS ADDITION ZONING: R-12 BLOCK: LOT:001 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: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15-30 HP: REPAIR UNITS: FIRE DAMPERS?: 30-50 HP: WOODSi'OVES: GAS PRESSURE: 50+ HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS _ OTHER UNITS: 1 FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Gas piping,outlet and vent for gas stove. Owner: FEES HERNANDEZ Description Date Amount 9640 SW NORTH DAKOTA [MECH]Permit Fee 5/25/2001 $72.50 TIGARD, OR 97223 [TAX] 8%State Surcharl 5/25/2001 $5.80 Phone: 503-332-8084 Total $78.30— Contractor: T& K MECHANICAL 11525 SW CANYON! ROAD BEAVERTON, OR ::7005 REQUIRED INSPECTIONS Phone: 503-626-4652 Gas Line Insp Mechanical Insp Reg,'1: LIC 121165 Final Inspection IL ot: t- rn m W This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes –r and all other applicable laws. All worts will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules arse set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to 01INC by r.allinq (503)246-6699. Issued B Permittee Signature: 0"9`7 Call(503)639.4175 by 7:00 P.M.for Inspections needed the next business day f-'OM HOTSPOT FIREPLACE PHONE NO. : 15036259138 May. 24 2004 04:33PM P1 Mechanical Permit A i tion J 1"ect/appl. rcceivMU Fbnnttno.:, �,LOQr/-a20�13 City of Tigardr SW no.: Expire date: City ofDgard Address: 13125 Sts, Hall Biv 113a Qjt 3 - Phone; 503 639-4171 F`' Date issued: ( ) _ Receipt.no.: � Fax: (503) 598-1960 Y U Payment o I JUAJ-io 1 Case file no.: Pa ClT F F,IME=FB r y �. Land use approval: ,,�Ntt1NCa1Ft�1 Bundlagpermit no.: " ;Job &2 family dwelling or accessory ❑Commercial/industrial 0 Muld-family (3 Tenant impmvcment ew coutruction Addition/alteradon/replaicament Q Otbet; 111211 go ILI dchtas: !�� 0v' . ` (�, Indicate equipmr:nt quantities in boxes below.Indicate the dollar Bldg.no.: Suite no.: value of all mechanical rnateriols,equipment,labor,overhead, Tax map/tnx lot/noeount no.: — profit. Value$ lac ---TBlock: SuhcliviFion: *See checklist for Important application Information and Project name. urisdiction's fee schedule for residential permit fee. City/county: ZIP 1111111KAMMEM 1111111011111-- Des: "Prion a d lolation f work on premise Ila 1111211 `- Fee(eL) Taasl Est.date of t ompletion/inapection: _— les ark ROL Tenant improvement or change of use: r Is existing spare heated or conditioned?U Yes ❑No Air ban lin unit CPM Is existing space insulated?13 Yes 0 No r con ition n ate Elan Altastj!ijoFeXisting HVAC system u CO1nprCllOra Business M1srrte:� shite boiler permit no.: Iv r C HP Toru BTU/H Address: �$ „L • e/amo ampersr uct invoke etecton etity: ✓ +U tat veil pum s IIE plan r uire��"T Phone: Faxes_ / E-mail. nota rep ace ac urner - ��na: -� Including ductwotit/vent liner ❑Yes O No s1a cp���cc +eocstehcaters--sus(en odd, City/rnetrolic.no !,(, (e7 wall,or floor mounted Name(please nt): jAr eat fora Tfancc o a?i'n`)WR e ", / -1 MINE Absorption units _ BTU/H arrte N : e n Pr �Z ca,illrnl_ -- - HP Address: Com essors HP - a es MW GW-__ :� " Q 0Q Sate: r ZIP: Applianccvent Phone' Fax• E-mail: lWyerexhautrt — -Moods,Type V iiTre`a, itche amtat Nameha+4 fire suppression system _ ^y3�K(A PY►1lff? Q Exhaust fan with single duct(both fans) Mailing address: Q�rL— haust system art rom City: 67.0'-C_1 Sta ✓ 7.1P: Q — TyE : LPCI Nopipliag MM "tion Oil Phone: _ Pax: email: c -piping-'CWh tidditional over 4 outlets recess p (u emat c requ ) .I Natoe: Number of ontlett m Address: °e Add � _ _ Decnrative"lace IN State: zip: -type -..t Phone: mall to ve Applicant's si re : Name(print : 1- eiy -- — _ Na an htdsAkl{ms accept cmtit carPermit fee.. s . Cl Via OMasterCard Notice This permit application Minimum fee................$ SO T credo cad aomber:. _ expires if a permit is sot obtained Plan rcvlcw(at %) $ — xp -- within 180 days aRu It has been State surchaw(8%)....$ ardtwlC rr m a~an err h owd aow%cd as complete. TOTAL _ crmotder ditutm 4"17(tialtlOOM CITY OF TIGARD ELECTRICAL PERMIT PERMIT 0: ELC2003-00526 DEVELOPMENT SERVICES DATE ISSUED: 8/27/03 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 6394171 PARCEL: 1S135CA-01901 SITE ADDRESS: 09640 SW NORTH DAKOTA ST ZONING: R-12 SUBDIVISION: DOETCHERS ADDITION BLOCK: LOT: 001 JURISDICTION: TIG Project Description: Service reconnect RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: 31GNAL/PANEL.: MANF HM/SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION 201 - 400 amp: 1 at WIO SRVC OR FDR: PER HOUR: 401 - 600 amp: EA AWL BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+amp/volt: »-4 RES UNITS >e00 VOLT NOMINAL: — Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC. Owner: Contractor: SUNNY HERNANDEZ SQUIRES ELECTRIC 9640 SW NORTH DAKOTA 16416 SE SALMON ST, TIGARD,OR 97223 PORTLAND,OR 97233 Phone: 503-332-8084 Phone: 503-877-2860 Reg 0: LIC 135085 -- -- ELE 26-11010 _ FEES SUP 4882s Description Date Amount Required Insper;tlons [FLPRMT) ELC Permit 9i27/03 $80.30 (TAXI 9%State Tax 8/27103 $B.42 Elect'!Service Total $86.72 This Psrmit is issued subject to the regulations contained in the Tigard Municipal 'ode,State of OR.Specialty Codes and all other applicable laws. AN work will be done in accordance with approved plans. ThK permit will expire if work is not started within 180 days of Issuince,ur 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 952-001-0100. You may nbtain copies of the 3e rules of direct questions to OUNC at(503)246-6699 or 1-800-332-2344 Issued By: -��/m (l� Permit Signature:. _ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or ront. 3 n OWNER'S SIGNATURE: __ DATE: -J CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE:— LICENSE NO: ._-- Gall 639-4175 by 7:OOpm for an inspection Khs next business day Wednesday, August 20. 2003 3 5 PM Joe Squires 503-253-5831 p.02 e - Electrical Permit Application Date received 03 Pmmit no City of Tigard Preiect/appl.00.1 Expire due: Ciry Ti rnl/ Address: 13125 SW flail Blvd,'Tigard,Ok 97223 xr Dpte inued: — BY: Receipt no.: -- Phone. (503)639-4171 --- ----- Fax: (503) 598-1960 Care Ne no.: Payment type: Land use approval: U 1 A 2 family dwelling or accessory U Comrncitial/industriai ❑Multi-family ❑Tenant improvement U New construction U Addition/alteration/replacement U Other. _ U Partial Job address: V17 -- !W!—no,.- Suite no.: _ Tax map/lax lot/accoW no.: Hlack: Subdivision: Project name: cription and location of work on premises _CE_C1 G Estimated date of con Iction/i tion: Job tao: w. Han Business name ,f l S. '"� ...'C W7. ( Tow hasp �. �- -Address: City: � State• ZI_P: Z s..,r■n,.ta.a: Phone: -11�D'1 Fax: - I E-mail: 1000,�.fl.or k.. 4 CCB no.;��C�p Elec.bus lis.no* lY 11I�1 L- Each rMtuc�ri 700.�11 or Portion wcyaor — - City/metro lic.no.: k&'aiVLtlJmNed en��—,Imd�1i.1 _ z Fwh m■mrfitdured h wr or modrlw dwAft mervirina electrician uired) Oat Service aid/or 0amt(met): , - Lierese no: r Senlaesorlardaav—lerlalindes, altrrwrl iererrrelocdone IOD amp■or less 2 Name(print): `av to rJ_ Rf R a kz_ 201 aroln to 400 amps W z Mailingaddresa: 964ouJ �h R 601■min to 1000 amps - — 2 City: ot Qb State;Q ZIP: 1 _ over low.mr,"„em z Phone:' - p Fax: E-mail: R WISFAI l o* Owner installation- The installation is being made on property 1 own Trarpos'r7snvk which is not intended ror sale,lease,rent,or exchange according to lwandh ales,aMerullov6orr�reaYae" ORS 447,455,479,670,701. 200 amp$or less — _ 2 201 amp to 4m amts r 2 Owner's si lure: Date: 40f to 600 amps --- 2 'base"cirtaltr-sew.ataeratlss, Name: ar exhsdea par Assad: �.--.-- ---�- — A. Fee for bmmb cirruite wiar ptriase of Address: service or header ft-,ewb bramb circuit 2 City: — -- State: ZJP: H. Fee for hr,eeh cirt:rrlh widwr ptoechar Phone: Fax: P-mail of service or feeder he,fast}mach ckvA: 2 Ere*adANbaa brsa■b c*eeslC I Wee.(Servke R►edar sat lal#edd r Q U Service over 27.5 atnM—"vr a rW U Heawcare ddlhy Each pulp a briffaka circle 2 U Service over 320 amps-rating of 147 ❑Har■edoers location Each dp or ottlbe lgk4 1 2 Emily dwellings U Hulldinot over 1(},000 quare he flxa or 3itmrl cncuMs)or a Willem em ily panel, - - U Sywrn over 6W,oIts nrxnirrl nave residential rnlh in nor sltwwm aheratin or eximmAm*' 2 U Huilding over dre aeries U FerdM 400 ergs or mere •De km: -- -- U OocuMn bad over 99 prions U Manufloumd wuchm or RV perkRadnaiAN ikadiw9rsileaaw"dwall aalanvedrMaMrar U EVvW4dnting plan U other: — Per r m 1 W. l3aittak Wh 01 vials WINS say of Ike move. }eve tie Theimp ars tact appllcaNt to feattierwy cowkwillse aervke. }Ther -Y- --- -- ---- — — W1 Non all in iadicdota accept eradit cedes,pleers call iwriadictinn fn maw infatettion. Notice: Thit permit application Permit fee......................S io U Maexpirrs if a pemi t Is haat c btahed Plan re-riew(at— %) c emlmnaber 1 7i� Igs2lR�i�1 U/30 gL witbin Igo days after it has been State surcharge(3%).....S eapine �d complete. TOTAL.........................-q-� acs es ete. 5 e of tdh IsaMwn cWHend SZl 1J,I S UV e lUldff■gnturr Amount 440.46IS(6AMl NW) CITY 4F TIGARD 24-Hour BUILDING Inspectlon Lino: (503)631"176 MST INSPECTION DIVISION Business Lino: (503)6311`4171 SUP Received /Z112 ' ­14 'Date Requeglad �_ . ---- — aUP Location �q6 _ .- ---.�_.._•.� kid`f�t A Suite _—_._ _ MEC .-- - Contact Person w7 �U,. Contractor - I'h( ) _ Wn BUILDING Tenant/Owner _ - ELC -:� -, chJ Footing F_I.0 Foundation DrAcce88: Ft DrainELR Crawl Drain �' Slab Inspection (Votes: SIT _ Post 8 Beam __I�z r, ��.eLC�s �•l%/[Lc�C'.�L.. Shear Anchors C.�, p �0 ----- - - - Ext Sheath/Shear �1���(,c Int SheatNShear Q Framing Sfir ((��Ge GO Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm ��i�C f-, • 7 ,Od uJ/✓ /r �., (� Susp'd Ceiling — - Root Other: — Final PASS PART FAIL r � f 2 f ✓� PLUMBING C_ e I �y� /' float 8 Beam bill -t06 A 1 l FJ t Inder Slab Rough-In �•f� P" er /S C U Al^o'LC@ !Nater Service Sanitary Sewer Rein Drains Catch Basin I Manhole Storm Drain --?- — - Shower Pan Other: Other: — -------Final PASS PASS PART FAIL -``-- - - - MECHANICAL 17 Post 8 Beam �J-- a Rough-In a Gas Line �-. Smoke Dampers - -_ � Final inPA4Q FAIL — -- ----- _ CT C__ m Service 1. uvugh In - _j UC/Slab Low Voltage �_- Fiis Alarm Fi Reins $__ _ ASS PART FAIL � �ion fee of ---required before next Inspection. Pay at City Hell, 13125 SW Hall Blvd.U Please cell for reinspection RE: __ _.. ��Unable to inspect• no access Fire Supply Lina /d ADA Osft /'1)h//d h// Approach/Sidewalk —�.1 �A9P� Other: _ Final _ DO NOT REMOVE this Im peetWo good}I my Un job Nb. PASS PART FAIL CITY OF TIGARD 13126 S.W. HALL BLVD. TIGARD, OR 97223 WPORTANT PERMIT NOTICE KEITH CARTER PLUMBING 6722 SE MAPLEHURST RD MILWAUKIE, OR 97222 Plumbing Signature Form Permit#: MST2004-00003 Date Issued: Parcel: 1 S135CA-01901 Site Address: 09640 SW NORTH DAKOTA ST Subdivision: BOETCHERS ADDITION Block: Lot: 001 Jurisdiction: TIG Zoning: R-12 Remarks: Fire repair. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing Inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: HERNA.NDEZ KEITH CARTER PLUMBING 9640 SW NORTH DAKOTA 6722 SE MAPLEHURST RD TIGARD, OR 97223 MILWAUKIE, OR 97222 Phone #: Phone #. 503-654-9766 a. Reg #: LIC 149965 ac C AN INK SIGNATURE IS REQUIRED ON THIS FORM m 1 W X 0 Signature of Adfhorized Plumber If you have any questions, please call 503.718.2433.