10880 SW 79TH AVENUE ,- i
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CITY OF T i GAIL'S
Approved ------------------------------------
-1 � ,nditionally Approved --_--------
I- jr only the work as described in:
jjr:qMlT NO.
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See - - i I E~C 1 V E
See I .ettor to: Follow.... - - --- -- - - - - - -
Attach ...... I
Job 'Address:
JUL 2 8 2003
CITY OFTIGARD.
WILDING DIVISION
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10880 SW 79T" AVENUE
MEN
/ CITY OF TIGARD ____ MASTER PERMIT
DEVELOPMENT SERVICESPERMIT#: MSI-2003-0039413125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 7/28/03
SITE ADDRESS: 10880 SW 79TH AVE PARCEL: 1S136CA-02203
SUBDIVISION: MARG TERRACE ZONING: R-4.5
BLOCK: LOT: 003 JURISDICTION: 'I lc;
REMARKS: Garage conversion and remodel of kitchen.
BUILDING
REISSUE: CUSTOM STORIES' FLOOR AREAS _ REQUIRED SETBACKS REQUIRED
CLASS OFWORK: ALT HEIGHT: FIRST: sl BASEMENT: el LEFT: —.
SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: rf GARAGE: sf FRONT:
PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: THRD sf
RIGHT:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL a al VALUE: 17 cur 00
REAR:
PLUMBING
SINKS WATER CLOSETS: WASHING MACH. t LAUNDRY TRAYS: RAIN DRAIN
TRAPS:
LAVATORIES, DISHWASHERSI FLOOR DRAINS SEWER LINES SF RAIN DRAINS:
CATCH BASINS;
TUBISHOWERS. I GARBAGE DISP: I WATER HEATERS WATER LINES. BCKFLW PREVNTR
GREASE TRAPS:
--- MECHANICAL OTHER FIXTURES:
FUEL TYPES FURN c 100K BOILICMP c 3HP VENT FANS: I _ CLOTHES DRYER.
FURN—100K: UNIT HEATERS. HOODS: t
OTHER UNITS:
MAXINP. btu FLOORFURNANCES- VENTS 0 WOODSTOVES
GAS OUTLETS: I
--- - ELECTRICAL
_ RESIUEE'TIAL UNIT SERVICE FEEDER _TEMP SRVC/FEEDERS BRANCH CIRCUITS _ MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OE'-CSS. 0 - 200 amp 0 -100 amp- W/SVC OR FDR. PUMPIIRRIGATION. _ PER INSPECTION
EA ADD'L 500SF: 201 - 400 atnp. 201 400 amp 181 W/O 5 V IF DR: 011
SIGNIUCi LIN LT PER HOUR-
LIMITED ENERGY: 401 6.0 amp' 4U1 600 amp FAADr11 RR CIR: I SIGNALIPANEL:
IN PLANT.
MANU HM/SVC/FDR: 601 - 1000 am0- 601♦amps-1000v
MINOR LABEL.
1000*amp/Voll
Recomlect only P1ANREVIEW SECTION
—4 RES UNITS: SVCrr DR>-225 A.. >600 V NOMINAL CLS ARENSPC OCC
--- _ rLECTRICAL•RESTRICTED ENERGY_
A.Sr RESIDENTIAL _ — '---
___ B.COMMERCIAL
AUDIO 6 STEREO VACUUM SYSTEM <`IDIO&STEREO: FIRE ALARM IP!iERCOM/PAGING OUTDOOR LNOSC LT:
BURGLAR ALARM OTH- BOILER: HVAC. LA'vDSCAPEfIRRIG PROTECTIVE SIGNL:
GARAGE OPENER CLOCK: INSTRUMENTATION
MEDICAL: UTHR:
HVAC: DATArTELE COMM: NURSE CALLS TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 578.88
TERRY HALSTEAD TK PRODUCTIONS INC This permit is subject to the regulations contained In the
15845 SW BRECCIA DR PO BOX 661 Tigard Municipal Code,State of OR. Specialty Codes and
all other applicable laws. All work will be done In
F3EAVERTON,OR 97005 BEA\'ERTON,OR 97005
accordance with approved plans. This permit will expire if
work Is net started within 180 days of issuance,or if the
work is Suspended for more than 180 days. ATTENTION:
Phone: Oregon law requires you to follow rules adopted by the
516-6975 Phone: 503-524-5595 Oregon Utility Notification Center Those rules are set
forth In OAR 952-001-0010 through 952-001-0080. You
R'°" I I(' 141 1 12 may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1.987.
REQUIRED INSPECTIONS
Underfloor Insulation Gas Line Insp
PLM/Underfloor Electrical Final
Plumb Top Out Mechanical Final
Electrical Rough In Plumb Final
Frain ifisp Final Ins ectlon
Issued Bytw
: k '
_ LPermittee Signature
Call(503639-4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application Received Iiu Iding r7��
Date/B aSlC:' Permit No.:H� r&gv3-6c39
City of Tigard Planning Approval Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Datc/B Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 t' Post-Review Land Use
Date/B ('ase No.
Internet: www.ci.tigard.or.us Contact Jurts.. 0 See Page z fol-
24-hour
or24-hour Inspection Request: 503-639-4175 r Name/Method: _ Supplemental Information
TYPE OF WORK ^REQUIRED DATA:
E New construction ❑ Demolition I &2 FAMILY DWELLING
_ !(I�tion/alteration/replacement LJ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees'are based on the total value of the work performed. Indicate
l &2-Family dwellin Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,tnatcrials,labor,
overhead and profit for the work indicated on this application.
Accessory Buildin _Multi-Family
Master Builder ❑ Other: Valuation.........................................................
---- -'- No.of bedrooms:_ No.of baths:b;-
303
303 SITE INFORMATION and LOCATION —
Job site address: 0 Qom') Scu Iota)number of floors..........1........................ _
j 7 9 New dwelling area(sq.R.)..............................
Suite#: �sldg./Apt.#: Garagc/carport area(sq.ft.)............................
Project Name: Covered porch area(sq.R.).............................
k area s
Cross street/Directions to job site: Dec 't q fl.)............................................
Other structure area(sq.R.)............................
REQUIRED DATA:
COMMERCIAL-USE CHECKLIST
Subdivision: Mjrw,— WAt G 4-- Lot� -
Tax ma / al'Cel #: (p Z I — — Note: Permit fees*am hayed on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor,
v rr�
overhead and profit for the work indicated on this application.
Valuation......................................................... S_-----
-- - Existing building area(sq.R.).........................
- ----— - New tuilding area(sq.ft.).............................. — --
_ Number of stories.............. .............................
ROPERTY OWNER _rTENANT Type of construction.......................................
'— Occupancy group(s): Existing:
Name: .7e ___— New:
Address: y, - Ste_
are CG aI. `—
City/State/Zip: D ga_tie- Toh, O 9_7&__C11_2_____
P110nC. �j/ Fax: NOTICE: All contractors and subcontractors are required to be
��3 licensed with the Oregon Construction Contractors Board under
APPLICANT _ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: -f"/�- I^a����e merot jurisdiction where work is being performed. If the applicant is exempt
lg
Contact Name: re of — from licensing,the following reason applies:
Address:
Cit /StateiZiil: �1� to v o,., _ q
Phone"57J3-�� �= , Fax: -.- BUILDING PERMIT FLES"
E-mail: _ Please refer to fee schedule.
CONTRACTOR — ------- -
Business Name: T& /�� +� Fees due upon application...... . . . . g _
Address: Joe
- 'Cne- e17f!— Amount received....................................... .....
A-0-City/State/Zip: A- w L_�r v —S
PhomtoI--,S_rV-J- Q' Fax: Date received:
CCB Lic. #• /y/t/ —
Authorized -2; / Notice: flet%permit application expire%if a permit 1%mol obtained Ntlihi'.
Signature: t Date: MEAV 4} IHo days after It ha%been accepted as complete.
7—.j rr _ (�0,1 C/ _ Fee MCI hodolo�} cet by'IrM ou mY Building,Indu%In 'Net%ice Heard.
(Please print name)
i:\bats\Permit Forma\EIIdgPetmitApp.doc 01103
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
ryajTigard " Associatedpermits:
Ci
City of Tigard U Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
FOLLOWING1 FOR PLAN REVIEW Yes No N/A
I Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar t,alance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report.Must carry original applicable stamp and signature on file or with application.
9 Erosion control U plan U pr,-mit required.Include drainage-way protection,silt fence design and location of
catch-basin protection.etc. _
10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or or a,icparate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if co yright violations exist.
11 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is mon than a 441.elevation differential,plan must show contour lines at 2-ft.intervals);location of eascments and
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator:lot
area;budding coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. _
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location.
13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. _
14 Cross section(s)and details.Show all framing-member sizes and spacing such as Moor beams,headers,joists. sub-floor,
wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc. _
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions anJ remodcts.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building em elope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering stand:rds.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating tnember sizing,%pacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rchar.For engineered
systems,see iieni 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 feel long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details.
21 Energy Code compliance.Identify the prescriptive path or provide calculations, A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or
architect licensed in Oregon and shall he shown to he applicable to the project under revi
A LI r
23 Five(5)site plans are required for Item I I above. Site plans must he 8-1/2"x I I"or 1 I"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 he 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 he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Red ink is reserved for department use only. 440.4614((AWOM)
FOR 107FICE USE ONLY
Electrical Permit Application Received Electrical
Dale/B PC G 3_ Permit No.:
Planning Approval i Sign
City of Tigard �- � � Date/By: Permit No.: _
13125 SW Hall Blvd. REG - Plan Review OtherB
Tigard,Oregon 97223 Datc : Permit No.:Use
_
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land
DatdB : Case No.:
_-
internet: www.,:i.tigard.or.us Contact TU"7 See Page 2 for
24-hour Inspection Request: 503-639-4175 LName/Method: Su iemental Information.
TYPE OF WORK PLAN REVIEW Please check all that al►p�__
Service over 225 steps- I lealth-care facility
kAdEdi:it:iion/alteration/i-eplac,cnleiit
ew construction _ Demolitioncommercial ❑Hazardous location
Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 &2 family dwellings four or more residential units in
1 ❑System over 600 volts nominal one structure
1 & 2-Family Commercial/Industria.-.
_ [-I Building over three stories ❑Fecdcrs,400 amps or more
Accessory BUlldt Multi-Family -- — [i Occupant load over 99 persons ❑Manufactured structures or RV park
❑1'.gress/lighting plan ❑Othcr. _ _
Master Lhtilder ether: --.-- Submit_sets of plans with any of the above.
JOB SITE INFORMATION and LOCATION The above arc not applicable to temporary construction service.
Job site address: /0880_ 5,w• - -- _ FEE*SCHEDULE
_ A T
Number of insLctlons�ryerntlt allowed
Suite#: Bldg./Apt.#: —
_�--- Description -- Otp Fee(ea.) l'dnat
Pro'ect Name: hew resldentlrl-single nr nndtt-fanrlh per
Cross street/Directions to Job Site: dwelling unit.Includes atinched garage.
Service Included:
�( 1000 .ft.or less 145.15 4
Each additional 500 s .n.or rtion thereof 33.40 1
_ — Limited encr residential 75.00 2
SllbdlVlSlOn: mQ� !r//-a r: I.Ot#' -; Limited ever non residential 75.00 2
Tax map parcel #: 0 2 2 ,S Each manufactured home or modular dwelling
service and/or feeder 90 90 2
DESCRIPTION OF WORK Services or feeders-Inst.illation,
alteration or relocation:
200 amps or less _ _ 80.30 2
l'c U I N �/TL�gea 201 amps to 400 amps^� - —_ 106.85 2
401 am s to 600 amps _ 160.60 2
601 amps to 1000 amps 240.60 2
PROPIN:RTV OWNER TENANT____ OVer io00l000 em s or volts __454.65 2
Name: l�rs �o _ Reconnect only66.85 2
-� t Temporary services or feeders-Installation,
Address: / ' Sct� b fit.CC /� q
alteratlon,or relocation:City/State/Zi : q 70C/ 200 ams to Irss66.85 � I
201 am to 4(N)ams 10(130tPhone: -j -f Irl-01/2 Fax: sol,n 60o am s 133.75 2APPLICANT CONTACT PEit50Branch circuits-new,alteratlon.or
Name: extrusion per panel:
- A.Fee for branch circuits with purchase of 6.65 2
Address: v�_--__ ser,ice or feeder fee each branch circuit_ _
Clt /State/ZI _, 9.Fee for branch circuits without purchose of P
�_�_ service or feeder lee,first branch circuit 46.85 /V t 2
Phone: FeX:_ _, Each additional branch citcuit 6.65 2
-- -- Misc.(Service or feeder not included):
E-mail: __ Each um or itrf ation circle 53.40 2
CONTRACTOR Each si or outline liahtrn� 53.40 2
Job NO: _ Signal circuit(s)or a limited energy panel. 2
alteration,or extension Pa 2
Business Name:,E tc.�n�/p -�K�e�' �ows�L c Desrrirrnn
Address: d X o 7�e' � F:sch additlonsl Inspection over the allowable In any of the above: —_
City/State/Zip .�d ��Q 9 71 3 Z Per ins coon per hour(min. I hour) J 62.50
Ji 3�-bb FaX:.�b3'S38`807.� Investigation. _
Phone: S Other: - - J -
CCB Lie. M / 91 i Llc. #: ) 1'd C I t I. _ Electrical Permit Pees*
Supervising electrician i _ _ i Subtotal T S—
si nature re wired: 11 W !�" 'd Platt,Review(25%of Permit Ft c a v
State Surchar c(8%of Permit Fee) S _
Print Name: ,,
—Saunders Lic•#: +(7/.S".S _ TOTAL PERMIT FEE $
Authorized Notice: This permit application expires If a permit Is not obtained within
bate: IRO days after It has barn accepted as complete.
Signature' -- *Fee methodeingy set by Tri-County Building Industry service Board.
—�—(Please print name) --- _—
i:\Data\Permtl pomtemcpermitApp.doc 01103
Electrical Permit Aaulication-City of Tigard '
Page 2 -Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
F1Garage Door Opener*
El Ideating,Ventilation and Air Conditioning System*
RVacuum Systems*
Other —
COMMERCIAL WORK ONLY:
Fee for each system.......................................................... $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
nAudio and Stereo Systems
C� Boiler controls
Clock Systems
Data Telecommunication Installation
n Firc Alarm Installation
HVAC
Intercom and Paging Systems
Ul andscapc hrigatmn(bntrol*
Medical
C-1 Nurse Calls
F1 Outdoor Landscape Lighting*
Protective Signaling
Other —
Number of Systeme
* No licenses are required. Licensee are required for all
other installations
i:\DsteV'etmit Formv\F.IcPrnnitAppPg2.doc 01103
Mechanical Permit Application
Received Jrl �J Mechanical ieri, �/
Permit No.: 1`
Planning Approval Building
City of Tigard Date/By: T Permit No.: _
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: _ Permit No.:
Post-Phone: 503-639-4171 Fax: 503-598-1960 Datc/ y: land o.:
Dat_e/By: Case No.: _
Internet: www.ci.tigard.or.us Contact tuns.: (� See Page 2 for
24-hour Inspection Request: 503-G39-4175 Name/Method. _ Su Icmentel Information.
TYPE OF WORK COMMERCIAL FEE'SCHEDULE-USE CHECKLIST
�]New construction I I I Demolition Mechanical permit fees"are based on the total value of the work
L] Addition/alteration/re lacernenl Other: performed. Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead and profi
CATEGORY OF CONSTRUCTION t.
�l &2-Family dwelll_N Commercial/Industrial value: $ _ See Page 2 for Fee Schedule
Accesso Buildin Multi-Famtl RESIDENTIAL_EQUIPMENT/SYSTEMS FEE"SCHEDULE
�__�_ ❑ �-- Description tv Fee ca. Total
[] Master Builder ❑Other: _— -- Hcatln CooUn _
JOB SITE IN_FORNIATION and LOCATION Furnace-add-on air conditioning'" 14.00 --
Job_site address: Gas heatsu� -- 14.00
Suite#: Bld ./A t.#: — Duct work _ _ 14.00
fi
Project Name: dronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: for radia_for or hydronic system) 14.00
Unit h. ers(fuel,not electric)
in wall,in-duct suspended,etc. 14.00
Flue/vent for any,of above _ + 10.00 _
Repair units 12.15
Subdivision: _ Lot#: Other Fucl A Ilancee
Tax ma / arcel #. Water heater 10.00
DESCRIPTION OF WORK _Gas fireplace -_ 10.00
Flue vent water heatcr_/gas fireplace) 10.00
Log lighter(gas) 10.00
—� -- Wood/Pellet stove10.00
Wood fircplace/rnsert_ 10.00 _
Chimney/liner/flue/vent 10.00 _
PROPERTY OWNER =[TENANT Other: _ 10.00
---- Environmental Exhaust&Ventilation
Name: _ _ _—_---_.--- Range hood/other kiit.Lcn equipment 10.00
Address: _ _. Clothes dryer exhaust 10.00
City/State/Zip: _ Single duct exhaust
Phone:
Fax: (bathrooms,toilet compartments,
APPLICANTCONTACT PERSON_ unlit rooms b.80 _
Name: Attic/crawl space fans 10.00 _
-- -- 10.00
AOther:ddress: _Fuel Piping
!•S( 5.40 for first 4,$IAO cache
Furnace,etc. _
Phone: —�FaX: — _— _- Gasheat tum
E-mail: Wall/suspended/unit heater
CONT-RAZTOR Water heater __ '• __ _
Business Name: n/l T - Vh1 x Per(_ Fireplace
Address:1 S' l-,/ANn/ _ — -- ••
City/State/Zip: �11(a./,�7?n 9 7 ZClothes drycr�gas _
Phone: S 3 s Fax: other:
Total:
CCB Lic. #: l�9�l� _ �� n _
Mechanical Permit Fees"
Authorised 7ZSA 3 Subtotal: S
Signature _ .' �ate:1 _ Minimum Permit Fee$72.50 S "1
_Plan Review Fec(25%of Permit Fce $
— (Please print Warne) _ Statc Surchar c B%of Pcrrnit Fee S
TOTAL PERMIT FEE $ _
Notice: rhlx penult appllcatlon expires If a permit R not obtained within `'Fee methodology set by Tri-County Building Industry Service Board.
180 days after it has been accepted as complete. ""Stir plan regalred for exterior A/Cunits.
i\Usts\Pemiit f'rmvVNecPennitApp,doe 01103
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$5.000.00 Minimum fee$72.50
$5,001.00 to$10,000.00 $72.50 for the first$5,100.00 and$1.52
for each additional$100.00 or fraction
theicof,to and including$10,000.00.
$10,001.(x)to$25,000.00 $148.50 for the first$10,000.00 and
$1.54 for each additional$11x).00 or
fraction thereof,to and including
$25,000.00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1,45 for each additional$100.00 or
fraction thereof,to and including
$50,000.00 _
7-0-01
.00 and up $742.00 for the first$50,000.00 and
$1.20 for each additional Sl 00.(X)or
fraction thereof.
Assumed Valuations Per Appliance:_ _ —
Value Total
Description: t Ea Amount
Furnace to 100,000 BTU,including 955
ducts&vents _
Furnace>100,000 BTU including ducts 1,170
&vents _
Floor furnace including vent _ 955
Suspended heater,wall heater or floor 955
mounted heater
Vent not included in appliance permit 445 _
Repair units 805 _
<3 hp,absorb.unit, 955
to 100k B'ru
3-15 hp;absorb.unit, 1,700
101 k to 500k BTU
15-30 hp;absorb.unit,501 k to I mil. 2,310
BTU ----..-
30.50 hp;absorb.unit, 3,400
1-1.75 mil.BTU
>50 hp:absorb.unit, 5.725
>1.75 mil.BTU _
Air handling unit to 10,000 cfm 656 _
Air handling unit>10 000 cfm 1,170
Nun-,portal Ic e%aporatL cooler_ 656
Vent fen 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 incinerator _ 4,590
Other unit,including wood stoves, 656
inserts,etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
'CUTAL COMMERCIAL I -- �
VALUATION:
I:\DetsWertnit Fom \MecPerrnitAppPg2.doc 01/03
Building Fixtures
Plumbing Permit Application 7Date/By
) Plumbing /
i] C _ Permit Nn. I,
Cit of Tigard y NEI V EC1 oval - - Scwcr
7
City g °� C r Permit No
13125 SW Hall Blvd. Plan Review other
Tigard,Oregon 97223 Date/By _ - Permit No.
Phone: 503-639-4171 Far: 503-508-1960 Post-Review Land Use
Datc/BInternet: www.ci.tigard.or.us Contac Case No.:
_Contact luris.: See Page 2 for
24-hour inspection Request: 503-639.4175 Name/Method: _ _ Supplemental Information.
TYPE OF WORK __ __FEE*SCHEDULE(for special information use checklist
�❑ New construction ❑ Demolition ucscri oion QV'. F'cc(ca.) folal�
Addition/alteration/replacement ❑Other: New t-&2-tamily dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft.for each utility connection
i &2-Family dwelling Commercial/Industrial Si-'R I bath _ 249.20
� ' SFR 2 bath 350.00
=Accessory Building Multi-Famil _ SFR 3 bath _ 399.00
Master Builder Other: Each additional bath/kitchen 45.00
JOB SiTE iNF_O_RMATION and LOCATION Firesprinkler-sq. ft.: Page 2
Job site address: Site Utilities
Suite#: q� Bld lb/.1pL#: _ _ Catch basin/area drain 16.60
Project Name: Dr cll/leach lineltrench drain 16.60
--- -- -
Footing drain no,linear ft. Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no. linear ft.) Page 2
Subdivision: Lot#: Storm sewer(no. linear fl.)
Tax map/parcel #: Water service no.linear ft.)
_ DESCRIPTION OF WORK r Fixture or Item
- Absorption valve 16.60
Backflow prcvcnter Page 2
Backwater valve 10.60
Clothes washer 16.60 4
--- -- - -- -- Dishwasher 16.60
C LPROPERTY OWNER o TENANT Drinking fountain � 16.60
t1_ 1_LlEjectors/sum _ 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/Zip' Floor drain/floor sink/hub 16.60
--- -_--- - - - --- - - Garbage disposal 16.60 _
Phone: lax: _ Hose bib 16.60
CFA LICANT I L_CONTACT PERSON Ice maker 16.60
Name: Intercc tor/ rease trap _ 16.60
Address: _ Medical gas-value $ Pae 2
_Cit /State/Z,t _- Primer 16.60
-_.._�__ ------ Roof drain commercial 16.60
Phone: Fax: _ Sink/basin/lavatory - 1 _ 16.60 3
E-mail: Tub/shower/show_er�tan i 16.60
CONTRACTOR Urinal 16.60
Water closet M60
Business Name: W. Water heater 16.60
Address: /Z 1105' 91,4 rtOther: -_--
City/State/Zi :'j76ly►'L,D -7�7 3 _ Other -- - -� - _-- -
Plumbing Permit Hees*
Phone: s-01 S',7T-6i 3. Fax: Subtotal s
CCB Lic.
Minimum Permit Fee$72.50 $
Authorized '/15 Residential Backflow Minimum Fre$36.25
Signature: bate: /'�� Plan Review(25%of Permit Fee) 5
State Surcharge 8%of Permit Fee) $
(Please print name) TOTAL_PERMIT FEE 5
Notice: 'fhli permit application expires If a permlt Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
190 days after It has been accepted as complete. riser dlagrarn for plan re%lew.
'I-ee rite,hotlolokv set by-I ri-('ounh Nullding Industry Set%Ice hoard
ODst0ermit FormsOmPermitAppAtic 01/03
SEE
ROL35MM
L # 21
FOR-
0,, VE..,, RSIZED
DOCUMENT
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (S03)639-4175 MST
—��� -
INSPECTION DIVISION Business Line: (503)639-4171 �>
BLIP _-
Received —_—.— —_ Date Requested____.iD _. r1M_-_-.____ PM-__.-- BUP
Location ______Z -_-7 e? _---_Suite_. _ MEC -
Contact Person _ __-- Ph (.--._-) �LCQ _ to `� 7� PLM - __---
Contractor __ _—___-_— Ph SWR
BUILDING_ Tenant/Owner -_...__T _ _ -_ —- ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR __-------____--
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
.Shear
-- __-_ -- _-- _--
Shear Anchors VT
Ext Sheath/Shear _
Int Sheath/Shear -
Framing ------------ - -- - --- — -- ----
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ---- -- --- ---__ _ _ _ C�Cae�t'r•� -P�
Fire Alarm _ ` •_ - �� — -- -- -
Susp'd Ceiling1---
Roof
VSS
ART FAIL _--
PLDMING
Post,:Beam --- ---
Under Slab
Rough-in
Water Service _. - --- --------------- - _------ ----
Sanitary Sewer
Rain Drains ---.__--
Catch Basin/Manhole
Storm Drain - - - ----
Shower Pan
OthNt -- - -
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough In -- - - - - ........ -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
-_ - --
CI ECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspectinn fee of$ required befo a next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE lj Please call for reinspection RE:— Unable to ii,spect-no access
Fire Supply Line
ADA I
Approach/Sidewalk Oats Inspector Ext
Ext
Other
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
OCT-06-03 MON 01 :34 PM K PRODUCTIONS 5249178 P. 01
4-
TK Productions, Inc CCB1# 14111.2
P.O.Box 661 W avedoN Oregon 97007
Office:303-524-5595
Cell: 503-516-6975 Date:Oct,6,2003
TO: Hugh
At City of Tigard -Building permits
As per our phone conversation regarding permit#MST 2003 00394 located at 10890 SW
Wh in Tigard, the planned kitchen gas range was not installed. Instead an electric range
was installed No mechanical systems were installed or modified in this remodel.
Terry Halstead
FILE COPY
CITY OF TIGARC 24-Hour
BUILDING Inspection Line; (503)639-4175 Mii 3_
INSPECTION DIVISION Business Line: (503)639-417 .
C 130 BLIP - --
Received Q Date Requested ---- PM---- SUP --.. --
Location v d Suite--__ - MEC _ ---
Contact Person _— r-e-'' 4 Ph(_ _-----) / —:�2 PLM —_----_
Contractor _-- _-- —.-------__--- Ph( ) _-- _ SWR —
BUILDING Tenant/Owner _ _ - __-__- ELC -
Footing ELC _--
Foundation Access: /'
Ftg Drain /� V ELR
Crawl D,am _- - ---
11 lab 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
Final
P FiT FAIL
- LUM I -
pos eam
Under Slab -- -- --- -- - --
Hough-In
Water Service ----
Sanitary Sewer
Rain Drains - - -�
Catch Basin/Manhole _
Storm Drain -
Shower Pan —_--_-
Otho[: '— -- .-
SS) PART FAIL -_ _ - _�-----
-- -- -
_M _ ANICAL -
Post& Beam
Rough-In --------_. - - ---- - - ----- - ----- - -- -
Gas Line
Smoke Dampers -----_---- --------- ----- ----- _- _ -
Final
PASS PART FAIL - - - ------------- --------------- ___-----__
ELECTRICAL
Service _ __. - ----------- --
Rough-In ---- ----- - ------------ - —- ----- -- -- --- ---
UG/Slab
Low Voltage ----- ------- --------- - -- -
Fire Alarm
Final ❑ Reinspection fee of$ required before next inspection. Pay at City Hall 13125 SW Hall Blvd.
PASS PART FAIL
-- - - - linable to inspect no access
SITE � Please .all for reinspection RE:
Fire Supply LineADA -
Approach/Sidewalk Date Ext
-- Inspector f ` ( �''
Other:_-
Final DO NOT REMOVE this Inspection record fi om the Join site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 ---
/a Prt�� G •� BUP _
Received .. 0 v�pate Requested ��L AM PM ___ BUP _ --- --
Location _—- I U G MEC _
Contact Person Ph l_ —__; %1�a�— �.i �S PLM -- ---__-----
Contractor__..`_ ---- -- Ph(-- -- -- - - -—�_ SWR ---- -----
!!UILDING _ Tenant/Ownei _ ._ __— ELC
Footing
ELC
Foundation -------_---___._
Access:
Fig Drain ELR
Crawl Drain --
Slab Inspection Notes: SIT
Post$Beam
Shear Anchors - - — -- - -----
Ext Sheath/Shear
Int Sheath/Shear
Framing ---- - ---
Insulation
Drywall Nailing --- --- - - - - _.- ---.__
Firewall
Fire Sprinkler --- - - - --
Fire Alarm
Susp'd Ceiling — - — -
Rout
- -- - - _
Other: -
Final
PASS PART FAIL -- - -
PLUMBING
Post 8 Beam
Under Slab
Rough-In --
Water Service -- -
Sanitary Sewer
Rain Drains - - -- - - _
Catch Basin/Manhole
Stoim Drain - - - - -
Shower Pan
Other:
Final
PASS_ PART _FAIL -
MECHANICAL
Post& Beam
Bough-In -_ -
Gas Line
:smoke Dampers -
Final
PA T FAIL -
E ECTRIC - -------
se -
Rough-In
UG/Slab
Low Voltage
F' rm ---
PASS PART FAIL Roinspoction fee of$___ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for einspection RE:__.—..._ -_._ (�Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dam ',� �-���' Inspector ( - t
Other: /
Final DO NOT REMOVE this Inspection record from the site.
PASS PART FAIL
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