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14783 SW 91ST AVENUE-1 35'-0' OvERALL 14'-0' 21'-0' ADDITION - -- � _-- —� t"C `'i-""'' I. / I\i,j•c a-- i.— r— , --- NORTr f PROPERTY ' t -- """...-.--• L NES 100.00' — ----------- -- ---- ------ i 1) SITE ADDRE55: 14'183 5W 91ST AVENUE, TIGARD, OREGON 91224 -�. _ _.. 2 JR-4.5 f { l y �'' ., ZONING: R-4 5 (LOW DENSITY RESIDENTIAL DISTRICT; - ----_-_ ---,_ * MINIMUM SETBACKS: TH15 PROJECT: ' . FRONT YARD: 20' N/A SIDE YARD: 5' 18'-6' r`- m + REAR YARD: 15' 15'-0' RECEIVED MAXIMUM raEIGI�T: 30'-0' � ____ �` -=-4c - - __- -___ �1�'I'✓) I �.►`'� �('✓� 3) NEW FOOTPRINT AREA: -- 4) NEW OF AREA. 104 5QUA FEET- Th•K NIEF" C ,c'�t3�NvVr .ION 3 �� ��` � M �'. - t rr� ► ''' M � , � 2003 g; ,*v# � eva I i oo,,p* No's.: 1 r4e:w Puo eoo 4 is1 TY 0 F T-I T11- jDILDING DlVlsjo�.j �C A R ! mn4� N 10,11 1) THESE NOTES ARE (jENERAL IN NATURE AND ARE INT"ENDED TO SET MINII`1UM \ �d ► I STANDARDS FOR CONSTRUCTION. THE DRAWINGS SHALL (GOVERN OVER THE D 5 VE A LM 1 GENERAL NOTES TO THE EXTENT SHOWN. 2) THE CONTRACTOR SHALL VERIFY ALL DIMENSION5 AND CONDITIONS ON DIFF- ` ( ERENT DRAWINGS AND IN THE FIELD AND NOTIFY GUY ALTMAN, ARCHITECT OF ANY DISCREPANCIES BEFORE PROCEEDING. I � \ia3) JOB SITE OBSERVATION !S NOT PROVIDED BY THE ARCHITECT, UNLE45 OTHEc= O WISE AGREED UPON WITH THE OWNER. iz 4) CONTRACTOR TO PROVIDE ALL NECESSARY TEMPORARY SUPPORT' FOR WALLS AND FLOORS PRIOR TO CG)MPLETION OF VERTICAL AND LATERAL LOAD SYS- \ W TEMS (TO BE BRACED FOR WIND AND EAP,THQUAKE FORCES). FIRST FLOOR SHALL BE PERM<,NENTLY ATT,4CI4EO TO WALLS PRIOR TO BACKFILLING AGAINST THE STRUCTURE.v I CODES AND STANDARDS 1) ALL WORK SHALT_ BE IN STRICT COMPLIANCE WITH THE FOLLOWING CODES t9 w (LATEST EDITION)- IN7ERNAT!ONAL BUILDING CODE, CABO ONE i TWO FAMILY DWELLING CODE, AGI, RISC AND ND5 I I \ I / FOUNDATIONS �4 1) DESIGN 501L PRESSJRE ASSUMED TO BE 1,500 P5F 2) ALL FOOTINGS TO DEAR ON FIRM, UNDISTURBED SOIL THAT ISA MINIMUM OF 1'-0' / BELOW ORIGINAL AND i'-6' BELOW FINAL GRADE, NOTIFY ARCHITECT BEFORE \ PROCEEDING ii' ANY UNUSUAL CONDITIONS ARE ENCOUNTERED IN THE FOOTING I EXCAVATIONS. \ r 3) DO NOT EXCAVATE CLOSER THAN 2: 1 SLOPE BELOW FOOTINGS. 4) CLEAN ALL FOOTING EXCAVATIONS OF LOOSE MATERIAL BY HAND. ---- --- -� _ 5) BOTTOM OF FOOTINGS MAY BE STEPPED ELEVATION TO ELEVATION 2'-0' HORIZONTAL _ TO 1'-0' VERTICAL, IF NECESSARY, BUT ONLY WHEN APPROVED BY A REGISTERED \ f� r r ENGINEER \ CONCRETE -- 1) MINIMUM CONCRETE COMPRE551VE STRENGTH TO BE 2,500 PS! (AVERAGE 3000 P51) AT 28 DAYS. MINIMUM CEMENT CONTENT TO BE 5 SACK5 PER YARD, SLABS ON GRADE K.;.j_r t-yj' TO BE 5-1/2 SACKS. I v 15'VIJA)" 2) SLUMP: 2 TO 4 INCHES, • 1/2' TO - I' DEVIATION. \ 3) PLACE AND CURE AL!_ CONRETE PER AGI CODES AND STANDARDS. 4) SLEEVES, PIPES, OR CONDUITS OF ALUMINUM SHALL NOT BE EMBEDDED IN STRUCTURAL CONCRETE UNLESS EFFECTIVELY COATED. 5) PROVIDE KEYED CONTROL JOINTS IN ALL SLABS ON GRADE AT BUILDING CORNERS AND ,- 25' O/C EACH WAY MAXIMUM. PROVIDE HEAVY (3/4' ) TOOLED JOINTS AT 5' O/C. REINFORCING STEEL — ` pPERT, VINE 1) ALL REINFORCING STEEL TO BE AST* 4615 GRADE 60. WELDED WIRE MESH, STIRRUPS, AND DOWELS TO BE AI85, GRADE 40 2) PLACE ALL REINFORCING PER AGI CODES AND STANDARDS. ' 3) PROVIDE DOWELS FROM FOO"PINGS TO MATCH ALL VERTICAL WALLS, PILA5TER5, ANG ;,J- COLUMN REINFORCING. PLAN NORTH 4) LAP ALL CONTINUOUS BARS 30 D'A+METERS OR 2'-0', WHICHEVER IS GREATER f' WOOD Al 1/8"_V-0~ XRFF(S): -- - 1) ALL LUMBER SPECIES AND GRADES TO BE AS FOLLOW5: A. JOISTS, BEAMS AND STRINGERS. DOUGLAS FIR " 2 66' NOM. BEAMS AND STRINGERS- DOUGLAS FIR ' I :.;:..,-;x.,.rM,1�NtFx.'B/�'mx,m,MYM'^MA•,,••': :•-:i-:.,t'.wR...rYW,fn.^,+unxrwina.i..+.vu-,an+.yy,lU... NOTICE: IF THE PRINT OR TYPE ON ANY -T I-I- I I P III III III I I 1 1 1 1 11 1 1 1 III III I I I.1�f TT 11 I 1 I I 1 1 1 1111 III I I P 111 I I I A III I ( 1 111 I I I I I IIT 7_I 11 I I 1 1 1 1 1 --111 I I Tp1 T_ -r I- 1 111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I (' I I I 1 f > 1 � � �rr � iiiiil � a IMAGE IS NOT A I I I I _ 1 3 4 5 9 S CLEAR AS THIS NOTICE, _ _ _ _ IT IS DUE TO THE QUALITY OF THE - - -- - No.36 01-nn, .. -- ORIGINAL DOCUMENT - ► E 6Z $ Z LZ 8Z � Z fiZ EZ ZZ TZ OZ J61 8T Li 8T si � i ET Zi TT i � 8 L 9111IlII1111I1ii11111111 :IIIItill1111IIi11111I11i�li111111i11�. 1111 1.111 �l.l.�lillLlllllli �11.1 ll lll1 � Ill IIIIC�11 A 4 co W ca D m z G 14783 SW 9151 AVENUE CITY OF TIOARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST -0�a 73 INSPECTION DIVISION Business Line: (503) 639-4171 f BUP Received �7 Date Req e_sted J 771 `� .-_ AM_-__ — PM -___ BUP Location _ / S T _. Suite —_ MEC Contact Person LOA, _ Ph (__— _) 7�1 �/�3 PLM Contractor -_- _ -_ -. - _ Ph (_. ) — — SWR -- ll G' Tenant/Owner -- - ELC Footing T Foundation ELC Access: Ftg DrainELR Crawl Drain /10-11 Slab Inspection Notes: / l SIT - Post&Beam --- - - - � � +( Ora' U &'d /-4y Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing -- - Firewall Fire Sprinkler ----------- Fire Alarm Susp'd Ceiling --- -- Roof Other: ---- RT FAIL MBIN Post& eam Under Slab - --- - Rough-In Water Service --- Sanitary Sewer Rain Drains ------- Catch Basin/Manhole Storm Drain — Shower Pan r ---- — Fir PART FAIL -- M ANICAL Post& Beam --i-_ — — Rough-In —_ Gas Line Smoke Dampers --- -------------------- Final P FAIL - --- ---- --- LEC RICAL Rough-In UG/Slab — Low Voltage E m in ❑ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S PART FAIL Please call for reinspection RE:— Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Ants -'U- Inspector Ext Other: Final - ._- DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF T I GA R D MASTER PERMIT PERMIT#: MST2003-00273 DEVELOPMENT SERVICES DATE ISSUED: 7/30/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417'1 SITE ADDRESS: 14783 SW 91ST AV PARCEL: 2S111AD-14800 SUBDIVISION: MALLARD LAKES ZONING: BLOCK: LOT: 1114 JURISDICTION: 110 REMARKS: Addition of lower and upper = 354-1/2sf. BUILDING REISSUE: CUSTOM STORIES. FLOOR'AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT. (I)FIRST: -t9-i4S,It BASEMENT- sl LEFT. 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD. .1 ',SECOND- %AZ&-%f GARAGE. 0 FRONT. 20 PARYING SPACES TYPE OF CONST: SN DWELLING UNITS. rf,iuu n of RIGHT: 5 VALUE. OCCUPANCY GRP: R3 BDRM: BATH. TOTAL ,-' of REAR: 15 PLUMBING SINKS1 WATER CLOSETS: WASHING MACH- LAUNDRY TRAYS. RAIN DRAIN TRAPS: LAVATORIES: DISHWASHERS: FLOUR DRAINS SEWER LINES. SF RAIN DRAINS: 2 CATCH BASINS: TUBISHOWERS: GARBAGE DISP. WATER HEATERS WATER LINES: BCKFLW PREVNTR• GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FURN�10OK: BOILICMP<3HP: VENT FANS: CLOTHES DRYER: FURN>-100K: UNIT HEATERS: HOODS OTHER UNITS: MAX INP blu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVGFLFDERS BRANCH CIRCUITS MISCELLANEOUS AOD'L INSPECTIONS 1000 SF OR LESS: 0 200 amp: 0 - 200 amp WISVC OR FDR. PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 5005F: 201 400 amp: 201 400 amp tIl W/O SVC IF DR: W SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY. 401 600 amp: 401 - 1X111 am 1, EAADDL BR CIR: 300 SIGNAL/PANEL: IN PLANT: MANU HMISVC1FDR. 601 1000 amp: 601-vnps-1fKI0v MINOR LABEL: 10004 amolvoit: PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS 9VGFDR>=225 A.: >900 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR. HVAC: DATAlTELE COMM: NURSE CALLS: TOTAL N SYSTEMS. Owner: Contractor: TOTAL FEES: $ 984.92 FUSICK, MARK E +JONI W HORIZON RESTORATION SYSTEMS This panne c al Cod to the regulations contained In the 14783 SW 91ST AVE 7301 SW KABLE LANE Tigard Municipal Code,State o OR. Specialty Codes and TIGARD,OR 97224 SUITE 100 all other applicable laws. All work will be done PORTLAND,OR 97224 accordance with approved plans. This permit will expire K work is not started within 180 days of Issuanoe,or if the work Is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone. Phone. 503-620-2215 Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through 952-001-0080. You Rep N: 11� 4Ei0R 1 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIUNS Footing Insp PLM/Underfloor Exterior Sheathing Inst Plumb Final Foundatlon Insp Plumb Top Out Insulation Insp Building Final POst/Bearn Structural Electrical Rough In Rain drain Insp Underfloor Insulation Framing Insp Roof Nailing Crawl Drain/Backwater Shear Wall Insp Electrical Final Issued By : _�!_ /i _ ' Permittee Signature �►--- Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day FOR OFFICE USE ONLY Buillidinp, Permit Application ,received Balding C E' `]p n Datc/E3 : : ',U•o Permit No 1� a3 -00: ? L1 of Tigard 1 1 Planning Approval Other City g 9„r Date/By:: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-59$-�9CGU Post-Review Land Use Cid l Date/By: Case No. r Internet: www.ci.tigard.or.us 'N( contact Juris.' See Page 2 for 24-hour Inspection Request: 503-0" Namc/Method: / Su lemental Information TYPE OF WORK REQUIRED DATA: New construction 1 0 Demolition 1 &2 FAMILY DWELLING Addition/alteration/replacement Other: CATEGORY OF CONSTRUCTION Note: Permit fees•arc based on the total value of the work performed. Indicate �C" 1 &2-Family dwelling ❑Commercial/industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, Accessory Building Multi-Family overhead and profit for the work indicated on this application. ❑ _ ❑ Master Builder Other: Valuation........................................................ Sv b JOB SITE INFORMATION and LOCATION No.of bedrooms:_ No.of baths:_—_ _ Job site address: 1 �3 5W 41 N 77 Total number of floors..................................... New dwelling area(sq.ft.).............................. Suite#: Bldg./Apt.#: _ Garage/carport area(sq,ft.)............................ Project Name: VS A , Covered porch area(sq.ft.)............................. Cross street/Directions to luh site: Deck area(sq.ft.)............................................ S.W. e,-A 5T#%C r/54%' " e" Other structure arca(sq.ft.)............................ SW "All-c- 13 L-11/0 t a 4A''mLy—i REQUIRED DATA: -J'tea-- ev — r gli°JT✓ E r COMMERCIAL-USE CHECKLIST Subdivision: ly�/1, J Lot#: Tax ma / areel #: A L'- i'f Y' -, Note: Permit fees•arc based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value(rounded to the nearest dollar)orall equipment,materials,lahor, 1 .CJD S �'rra4 mo mjr/ overhead and profit for the work indicated on this application. mr) � Valuation......................................................... 5 --- A'V I 99-*T* For, 't"� T[W47 Existing building area(sq.R.)......................... AaMON New building area(sq.fl.)............................... �; 1D kwm_ S Number of stories............ — — U PR—O-, R�PEERTTY OWNER TENANT — Type of construction....................................... lYl Name:Jln/ ow Jd FUQe-f— Occupancy group(s): Existing: a-- Nl —_ New: Address: 103 " 9JsrAkG- Cit /State/Zi aoi n1 Photle: _1 t66 -536 Fax: NOTICE: All contractors and subcontractors are required to be APPLICA T I El CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name:i5'Vy&_*rr" Mruor jurisdiction where work is being performed. If the applicant is exempt Contact Name: 6-%ey !g from licensing,the following reason applies: Address: — U City/State/'Zip: J"'Yl. W10 6r72�_--- -- - --- -- -- Phone: ax: S30®� b � - E-mail: BUILDING PERMIT FEES* AM �! r h• Please refer to fee schedule. — CON►I RACTOR_ Business Name: H 12eN RWt � Fees due upon upplication........... ............. 5 Address:"1301 _ 'I• r l,,�IV gUfi'E I 2 _ _ Amount rc:eived..... ................................ ......Cit /State/Zi : Phone: GPZ&•7127R`"1J_ Irate received: ----- CCB Lic. #: fib(-)q' _ Authorized /LAJ��— Datc: � *soIIrc: This permit applicallon expires If a permit is not ohtained•%ithinSignature: �1�J�. I80 dos after It has been accepted as complete. Ai"� � J i t✓'- r 'Fee mcthodolop-set by tri-Couni% Ifulldine,ImItiot� "er%i•( uuurd (Please print name) ) ODstsTermn FormolildgPermitApp doc 01103 � cr One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: Ciryn(Tignrd City of Tigard J Electrical J Plumbing O Mechanlcal Address: 13125 SW Hall Blvd,Tigard,Oil 97223 J()they: Phone: (503) 639-4171 Fax: (503) 598-1960 FOLLOWING 1 I FOR PLAN REVIEW Yes No N/A 1 Land use actions completed.Sec jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Veriflcatlon 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 J plan O permit required. Include drainage-way protection,silt fence design.end location of- catch-tysin protection,etc. 10 3 Cbmplete sets of legible plans.Must be drawn to scale,showing conformance to applicable loc,.•i and state building codes. Lateral design details and connections must be incotpoYated into thb plans(it on,trsellrAte�rll-size; e sheet attached to the plans with cross references between plan location and details. Plan review cannot he completed if copyright violations exist, I I Sitelplot plan drawn to scale.The plan must show lot and building setback dimension;propt:ny corner elevations(Jifv' there is more than a 4-11.elevation differential,plan must show contour lines-at 2-ft.intervals);location uPc.txment,;and driveway;footprint of structure(including decks);location of wells/septic systems;utility IcKatfon+;dltectibn indivatar;lot area;building coverage area;percentage of coverage;impervious area cxis111tg 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 tiItto��adetectgrs,water neuter, furnace,ventilation fans,plumbing fixtures,balconies and decks 30.ihch6 abdve gradc;•etc. • -•• _ 14 Cross section(s)and details.Show all framing-member sizes and spaciig Such 0floor btams,hcaddrsjoip,t Fah-floor. ' wall construction,roof construction.More than one cross section may be required to clearly,portray conynuction.Show details 4tf all wall and roof sheathing,roofing,moll slope,ceiling height,siding material,rootin&s nrid(od/tdatidn,stairs, ' fireplace construction, thermal insulation,etc. I • 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot af.buflcaing envplupa. Full-size sheet addendums showing foundation elevations with cross references ute acceptable. • 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must ipdicate det.yl,,and 10c;tlitn8;for non-prescriptive path analysis provide specifications anti calculations to engineering st;uulards. ' 17 Floor/roof framing.Provide plans for all floors/rcrof assemblies,indicating member suing,spacing-affil brarioF locations.Show attic ventilation. 18 Basement and retailing walls.Provide cross sections and details showing pladqmenA Af rehat.For en lntered systems,see item 22,"Engineer's calculations." 19 Beam calculations.Provide two sets of calculations using current code design values for all herons find Multiple joists over 10 feet long and/or any heam/joist carrying a non-uniform load. 20 Manufactured floor/root 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'sWriped by an engineeroi ' architect licensed in Oregon and shall he shown to he;ipplirahlr to the project tmdrr revi JURISDIII-111ONAL SPECIFICS 23 Five(5)site plans lire required for Item I I above. Situ plaw,mu.t lie 8-1/2"x 11" 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"huildinp plan~will he not accepted 26 "Reversed"building plans must meet criteria outlined in the Permit& System Development Fees document. 27 "brawn to scale" indicates standard architect or engincer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and�COT Street Tree Iijt. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be iii blue of black ink. Ited ink is reserved for department use only. 4.u)0,14 irnruroM) Bunaing r ixtures Plumbine Permit Application ' ' OFFICE- ' Received Plumbing T Date/13 : Permit No.: Ill`- l aC)( City of Tigard �++^ Planning Approval Sewer g i�1 _ u D Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review other Tigard,Oregon 97223DatcfB : Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 I�i�� I') 3 Post-Review land Use Date/By: Case No.: Internet: www.ci.tigard.or.us Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 _ I^I�'I P Name/Method: Supplemental Infor nation. TYPE OF WORK _ FEE"SCHEDULE forspecial Information use checklist Description (Jt>• re(ea.) T total New construction _ � I)emolih_on F_v Addition/alteration/re lacement Other: New 1-&2-family dwellings CATEGORY OF CONSTRUCTION includes 100 ft.for each utility connection 1 & 2-Family dwelling SFR(I bath 249.20 Commercial/Industrial SFR 2 bath 350.00 ccessory Building E] Multi-Family _ SFR 3 bath 399.00 Master Builder ❑Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Firesprinkler-sq. 11 Pae 2 Job site address:14703 SHI°I to _ Of Site Utilities Suite#: Bld ./A t. Catch basin/arca drain 16.60 ell/leach a drain Project Name:FJ/t p GF Footing drain no.linear ft. Page 2 Cross street/Directions to job s•te: Manufactured home utilities 110.00 Wf4_ ra Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no. linear 111. Pae 2 Subdivision: __ Lot#: Storm sewer 'no. linear ft. Page 2 Tax map/parcel #: 'ZS'll I f( rI4 Water service(no. linear fl.) _ Page 2 DESCRIPTION OF WORK Fixture or Item 0 SIN � Absorption valve 16.60 Backflow preventer Pae 2 W H KOW AW 04 Backwater valve _ 16.60 E Clothes washer _ 16.60 Dishwasher 16.60 Drinkingfountain 16.60 PROPERTY OWNER TENANT Ejectors/sump 16.60 sine: M4-"e VoA�l _ __ Expansion tank 16.60 Address: Fixture/sewer cap 16.60 Cit /State/Zl : OA40pelk Floor drain/floor sink/hub 16.60 ------ Garbage disposal 16.60 P onesaj 6 Fax: _ Hose bib 16,60 PPLICANT �CONTACT PERSON [cc maker 16.60 Nam _ A1 � Interco tor/ reasetra) 16.60 Address: 19— Medical as-value: S Page 2 Cit /State/Zi : JOP'h7�M'O�f7272 Primer 16.60 Roofdrain commercial _ 16.60 Phone:Ps t�- b� aX:'�3 h Sink/basin/lavatory 16.60 E-mail: Tub/shower/shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: tVh� �' /��, �j, Water closet 16.60 -- ------- rm Water heater 16.60 Address: _ _ other: City/State/Zip: _ other: Phone: FaX: Plumbing Permit Fees" -- Subtotal S CCB Lic. #_Y _ Plumb. LiC.# / , Minimum Permit Fee$72 50 S Authorized Residential Backflow Minimum Fee$36.25 Signature /f — Datc:t� ��Zj Plan Review 25%of Permit Fee S _d!)VY 4tTMAti^1'/ " r 'I / State Surcharge 84o of Permit Fee) S (P J%t,111111t name)) " / TOTAL PERMIT FEE S Notice: This permit application expires ire permit Is not obtained sslthln All new commercial buildings require 2 sets of plans with Isometric or IAO days after It has been accepted as complete. riser diagram for pian review. *Fee mcihodolog� art h.vTrI-('ounty Building Industry Service Hoard. i.V)sts\Perniii 1'omis\i'Inni'ermitApp dt 01101 Plumbing Permit Application - City of Tigard Page 2- Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total S ware Foots e: Permit Fee: Footing drain- I" 109' 55.00 0 to a.100 _ $115.00 - Footing drain-each additional 100' 46.40 __FOO 1 to 3 600 $160.00 -_ - 3,601 to 7,200 _ $220.00 _ Sewer- I st 109' 55.00 7,201 and greater $309.00 Sewer-each additional 100' AAAA Water Service-Ist 100' 55.00 Medical Cas S 'stents' Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain-I st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each Fixture or Item Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and including$10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Devicc each additional$100.00 or fraction thereof,to minimum permit fee$36.25 17.55 and including$25,000.00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for Inspection of existing plumbing or �19h additional$100.00 or fraction thereof,to (� g P g s • -had including$50,000.00. specially requested inspections-per hour 72.50 Subtotal: $50,001 U0 and up $742.00 for the first$50,0110.00 and$1.10 for eaph additional$10@.OQ onfraction thereof. Fixture Work: Are you capping,moving or rcpiucing existing fixtures? If • "Yes",please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. t uantit,b Fixture Work Performed I CoMments regarding fixtbre work:' •' Fixture Types Replace t ; New Moved POO Ca d *-�- Ba lisb /Font Bath -Tub/Showrr •' _ -Jacuzzi/Whirl pool _ Car Wash -Each Stall - Y -Drive Thru • Cuspidor/Water Aspirator Dishwasher -Commercial _ -Domestic Drinking Fountain -Eye Wash - - Floor Drain/sink .2" .3'. .4" Car Wash Drain *Note: If file fixture worlo under this permit results in an Garbage -Domestic _ -increase of sewer EpUs,a sewer pet-mit will be fs3ued and Disposal -Commercial,•, -Industrial _ fees assessed for the sewer increase must be paid before the Ice Mach./Rcl'ri .Drains plumbing permit can he issued. Gil Separator Gas Station Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory -Bradley -Commercial _ -Service Swimming Potil Filter _ Washer-Clothes Water Extractor Water Closet-"toilet Urinal Other Fixtures. ODsts\permit Fomu\Plml1cnmtAppPg2 doc 01/03 fail no ILIJ t Mechanical Permit Application Received Mechanical Date/By: Permit No Planning Approval Building City of TigardE !. "VE Date/By: Permit No - -,_ 13125 SW Hall Blvd. Plan Review Other DaWB : Permit No. —— Tigard,Oregon 97223 Post-Review Land Use Phone: 503-639-4171 Fax: 503-598-1960 03 Date/By: Case No.: _ Internet: www.ci.tigard.or.us �U Name/Method: so lemental Information. Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 --- -'JILL.-1;4.- ` 101 TYPE OF WORK COMMERCIAL FEE"SCHEDULE-USE CHECKLIST Demolition Mechanical p,rmit fees'arc based on the total value of the work New construction Additiot�/alteration/re lacement ❑ Other: performed. In licate the value(rounded to the nearest dollar)of all _ mechanical ma erials,equipment,labor,overhead and profit. CATEGORY OF CONSTRUCTION Value: S See Page 2 for Fee Schedule 1 &2- amily dwetlin Commercial/Industrial 1111 JRESIDENTIAL E iJiPMENT/SYSTEMS FEE*SCHEDULE ❑ Accessory Building Multi-Femil _.. Descri tion h Fee(ea.) Total [] Master Builder Other: Hearin CooOn _ 14.00 JOA SITE INFORMATION and LOCATION ace-add-on air conditionin " 14.00 Job site address: ®3 Sw s / fit- heat um/----- 14.00 Bld /A workSuite#: � onic hot waters tem 14.00 Pro•ect Name: S/C /'QResidential boiler Cross street/Directions to job site: for radiator or h dronic s stem 14.00 s,`vy, S,�� �,y, r�,, f ._ Unit heaters(fuel,not electric) 71I"` in wall in-duct,sus ended,etc. 14.00 pw yw / — Flue/vent for any of above 10.00 Repair units 12.15 Subdivision: /�/,�IL �J Lot#: ORtUeIA _ 'Tax ma / arced?-r "i'fWater heater10.00 DESCRIPTION OF WORK _ Gas fireplace 10.00 Fluc vent(water heater/ as 10.00 Lo li htt r as10.00 P " rd /✓�'�� Wood/Pellet stove10.00_� j�_ Wood firs: lace/insert —10.00 Chimney/line flue/vent 10.00 .10V--rtew~ Abvi, Other: 10.00 PROPERTY OWNERTENANh. -- Environmental Exhaust 6c Ventilation Name: f'I _ J �mN/ i'_/�,�,L. - Range hood/other kitchen equipment 10.00 Address: 7�3-r�r_Z_"=— -- Clothes dryer exhaust 10.00 City/State/Zip:J%G��iD d��_ __ Singlc duct exhaust Phone:,t4fl9 Fax: _ (bathrooms,toilet compartments, CONTACT 6.00 PERSON utility rooms) PPLICANT - Attic/crawl s ace fans 10.00 at c: _— Other: 10.00 Address: d �- w Fuel Pt to Cit /$tate/Zi : D /►77 •"(55.40 for flret 4 $1.00 etch additional L-- FUfI1aCf etc, rr Phone: 2'gb'-slts x� �2 '�— Gas heat pump 'r — Wall/sus ended/unit heater rr E-mail: _ - .. CONTRACTOR Water heater rr Business Name: OV ra 1���ti Fireplace rr Range Address: Ba Cit /State/Zi _ _ Clothes dryer as rr rr Phone FOther:ax: —__— Total: CCB L.iC. Mechanical Permit Fees• Authorized ,(�,, 0! Subtotal. S Signature: �1! """ Date�7�� -+ Minimum Permit Fee$72.50_ S /�� �y Plan Review Fee 25%or Permit Fee S �'i - ---- State Surchar a g%of Permit Fee S (Please print name) TOTAL PERMIT FEE S *Fee methodology set by Tri-County Building Industry Service Board. Notice: 'i'hls prnn'1 application expires If a permlt h not obtained wlthln ..Site plan required for exterior A/e'nnits. IAO days after It has been accepted as complete. +\ilsts\Permit i urrns\Mccl'crmilApp doe 01103 Mechanical Permit Application - Citi' 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 V 0,(X)O.(X) $72.50 for the first 55,000.00 and 51.52 for each additional$100.00 or fraction thereof,to and including$10,000.00. $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$I WAX)or fraction thereof,to and including S25,000.00. 525,001.00 to$50,000.00 5379.50 for the first$25,000.00 and 51.45 for each additional$100.00 or fraction thereof,to and including S50,000-00. $50,001.00 and up $742.00 for the first 550,000.00 and $1.20 for each additional$100.00 or fraction thereof. Assumed Valuations Per Applienee: ' Value Total Description: _ Ea Amount Furnace to 100,000 IITU,including 955 ducts&vents Furnace>100,000 BTU including ducts 1,170 $vents loor 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 BTU tr 3-15 hp;absorb.unit, 1,7(X) 101k to 500k BTU 15.30 hp;absorb.unit,501k to i mil. 2,310 ' BTI 1 30-50 hp;absorb.unit, 3,400 1.1.75 mil.BTU >50 hp;absorb.unit, 5,715 • >1.75 mil.BTU _ Air handling unit to 10,000 cfm 656 Air handling unit>10 000 cfm 1,170 Non-portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 rmil Hood served by mechanical exhaust 656 Domestic incinerator 11170- Commercial 170Commercial or industrial incinerator 4,590 __ _ • Other unit,including wood stoves, 656 inserts,etc. _ Gas piping 14 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ "' VALUATION: i, i:\l9ts\permi1 Forms\Mecl'em1itAppt'g2.doc 01103 Electrical Permit Application Received ° OFFICE USE ONLY Date/B : _ _ PermitNo.: City of Tigard (', t, ` Planning Approval Sign RECEIVE Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-9,PA19411I 7 Post-Revicw Land Use Internet: www.ci.tigard.or.us Date/By: Case No..- Contact o.:Contact luris.: See Page 2 for 61 24-hour Inspection Request: 503- 1�4't-� I i� Name/Method: Su Icmen .al Information TYPE OF WORK PLAN REVIEW Please check all that a I ❑New construction I Demolition 0 Service over 225 amps- Health care facility Addition/alteration/re lacement commercial El Hazardous location Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feel, CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in 1 &2-Family dwelling El Commercial/Industrial ❑System over 600 volts nominal one structure -EAccessory Building Multi-Family ❑Building over three stories ❑Feeders,400 amps or more El Occupant load over 99 persons ❑Manufactured structures or RV park _ Mas_ter Builder Other: i ❑Egresslighting plan ❑Other: _ JOB SITE INFORMATION and LOCATION Submit__sets of plans with any of the above. The above are notapplicable to temporary construction service. Job site address q/ �r/Gi1if�/� FEE*SCHEDULE Suite#: _ �$ldg./Apt.#:' Number of inspections per pertnit allowed Project Name: Description Qly Pee(ea.) I Total Ncw residential-single or multi-family per CrO55 street/1)II CCI It)t15 tojob SI e: dwelling unit.Includes attached garage. CSU s/''f fL- ( JW��/J��( �'b ,f/�47 _ Service Included: r r,0 ,/ 1000 sq.fl.or less I 145.15 4 _ r/ti Each additional 500 sq.ft.or portion thereof 33.40 1 Lot#: j Limited energy,residential 75,00 2 SUl)dIV1SlOn: Limited energy,non residential 75.00 2 Tax ma / reel#: /// / h Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 z ormirS V kqW47; Aw—*V j , Services or feeders-Installation, 1/ alteration or relocation: Z ��► �-�� � f � 200 amps or less 80.30 _ 2 ^�r201 am to 400 ams _ 106.85 2 [�G /,* 401 am s to 600 ams _- 160.6(1 2 Over IOG01 amps to 1000 ams _ ROPERTY OWNER�,I- , TENANT . 240.60 2 Name ^'�I �eV r a' lel -_ --- W amps or volts 454.65 2 Reconnect only 66.85 2 Address: '�n}��Sw �1 Temporary services or feeders• Instailalion. City/State/Zi alteration,or relocation: _ e ��L ,� ___ 2W amps or Icss 66.85 I — -- PhonetwS - Fax: 201 amto AW am ps ps 100.30 2 PPLICANT CONTACT PERSON 401 Iii 61 N)ams 13.175 Branch circuits-new,allerallon,or Name: extension per panel: Address: © P~411111 S w� 4�d S A.Fee ifarce branch circuits with purchase of �y service or feeder fee each branch circuit 6.65 2 City/State/Zip �/� � B.Fee for branch circuits without purchase of service or feeder fee first branch circuit 46.85 2 Phone: Z�b– ax: 0.7 Cbz ___ Each additional branch circuit 6.65 2 E-mail: _ Mlsc.(Service or feeder not included)! CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 .l Ol) NO: ©Vr r�� Signal circuits)or a limited energy panel, Business Name: mP'-((+CJI— alteration,or extension — Pa e2 2 `5,��'Y 1�-- LkscripNnn: Address: City/State/Zip: F:ach additional Inspection over the allowable In any of the above: -- Per inspection per hour Lmin_I hour) 62.50 Phone: _ Fax: _ Investigation fee: -- CCB Lic. #: Lie. #: =T Othm —-- Supervising electrician -- Electrical Permit Fees* _ Subtotal S signature required: Plan Review 25%of Permit FeeL S Print Name: _ Lic. # ;_ l State Surcharge(8%of Permit Fee) S TOTAL PERMIT FEE $ Authorized Notice: This permit application expires If a permit Is not obtained within Signature: t ------ I)ate: � 180 days after It has been accepted as complete. *Fee methodology set by I ri-( aunty Building Industry Service Board. (Please itnt nanx 1 - ---- -- i NDsts\Permit Forms\ElcPermitApp.doc 01/03 Electrical Permit Application -City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ $75.00 Check Type of Work Involved: 0 Audio and Stereo Systems* Burglar Alarm 0 Garage Door Opener* ElHcating,Ventilation and Air Conditioning System* ElVacuum Systems* 17 Other - COMMERCIAL WORK ONLY: ...... system......:_ ........ $75.00 Feefor each ................................... (SFI;GAR 918-26o-260)' Clieck'1, pe of Work Involved: y' ' Audio and Stereo Systems U Boiler controls, Clock Systems Data Telecommunication Installation • nI ire Alarm Installation IIVAC A Instrumentation Intercom and Paging Systems Landscape Irrigation t'nntrol* ❑ • Medical Nurse Calls ROutdoor Inndscapc Lighting* M Protective Signaling ElOther -----— Number of Systems * No licenses are required. Licenses are required for all other Installations i\Ustsn!'ermit Fomts\F.IcPermitAppPg2.doc 01103 07/21/03 09:53 FAX 5098463525 CLEAA' WA SERVICES Zool ��' JUL 1 0 2003 File Number C1eanWatcr Services Our comtnitinent is clear. ks$ _I - rreen'ng Site Assessment Jurisdiction Crrr u� Date Map R Tax Lut 2. K I 11 .4)-� TL 14 b 0 O Owner mgr r 4 t.c, Site Address l Lt_1Z2 5 -7 z2-yContact Wit-, I'1a Su h Praposed Activity Address 133 1 S V-.%. to 1, -a... .,-c. Phone Officlal use only below ihis line Y N NA Y N NA 1 t:;Prisitivo Area Composite MapSto�nwater Infrastructure maps Map��_1.. acv ------- — - CI [� L2� os #-- 1 �° � � �.. I Specify kx;ally adopted stud it ur malls ther Specify .if)F'.(:Ify 2t70y7, �r�/s�f�ioro Based on a review of the above Information and the requirements ( f Clean Water Servires Design and Construction Standards Resolution and Order No, 03-11: J Sensitive: areas potentially exist on site or wi.hin 200' of the site.THE APPLICANT MUST Pt-RfORM A SITE CERTIFICATION PRIOR TO ISSUAh CE OF A SERVICE PROVIDER LETTFR OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a datural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' A the site. This pro- screening site assessment does NOT eliminate the need to itvaivate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMI-NT OR SERVICF PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION "O ISSOF A STORMWATER CONNLCTION PERMIT. The proposed activity does not nice(the definition of deveir.llmerlt. NO SITE ASSESSMENT OR SERVICE PROVIL)ER LETTER IS REQUIRE ). Comments: n•, "!6*PMl s S;7't A(202 q of T(r �yjed �D/T�Or Ni// wj r �'adr: sem..♦ler :w.'or 'nwr MwttLlltl Reviewed By: - ''�- _.�,�- - Date: ) Ai o Returned toApplicant 11ai1 - Far P Gaunter__ Date�� --- By" 158 N First Avenue,Suite 270•Hillsboro,Oregon 87124 Phone- (809)648-6821•Fu: (5031046-3525•jvAt .cicantvatcnr,LVJW� SEE 35MM ROLL #21 FOR OVERSIZED DOCUMENT FROM :MCCOY ELECTRIC FAX NO. :5032349473 Aug. 05 2003 09:31AM F1 CITY OF TIGARD 13125 S W. HALL BLVD, TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MCCOY ELECTRIC CO 2014 SE 09 H AVE PO BOX 42428 PORTLAND, OR 97214 Electrical Signature Form Permit #: MST^003-00273 Date Issued: 7/30/03 Parcel: 2S 111 AD-14800 Site Address: 14783 SW 91 ST AVE Subdivision: MALLARD LAKES Block: Lot: 014 Jurisdiction: TIG Zoning: R-4.5 Remarks: Addition of lower and upper = 354-1/2sf. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above. ATTN Building Division No electrical inspections will be authorized until this completed form Is received OWNLR: LLLC I RICAL CON I RAG I OR: FUSICK, MARK E t JONI W MCCOY ELECTRIC CO 14783 SW 91ST AVE 2014 SE 9TH AVE TIGARD, OR 97224 PO BOX 42428 PORTLAND, OR 97214 Phone tt Phone #: 503-234-7521 Req #: MFT 00011.1629 LIC 8277 SVP 2 175 F1 F 26-82(_ AN INK SIGNATURE IS REQUIRED ON THIS FORM X Sign re of Supervising Electrician ar-^ s I-►tet�_� Z 1�S 5 It you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. a VV\ TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MP (MILWAUKIE) PLUMBING CO P.O. BOX 393 I` CLACKAMAS, OR 97015 Plumbing Signature Form Permit #: MST2n03-0027:3 Date Issued: 7130103 Parcel: 2S111 AD-14800 Site Address: 14783 SW 91 ST AVE Subdivision: MALLARD LAKES Block: Lot: 01-; ,Jurisdir;tion: TIG Zoning: R-4.5 Remarks: Addition of lower and upper = 354-112sf. der Your company has been indicated as the plumbing contractor ndiv dual fromrmit yourn indicated above, belowrandf for the plumbing permit to be valid, please have the appropriate 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: FUSICK, MARK E + JONI W MP (MILWAUKIE) PLUMBING CO 14783 SW 91 ST AVE P.O. BOX 393 TIGARD, OR 97224 CLACKAMAS, OR 97015 Phone #: Phwle 0 503-655-9161 Req # LIC 5002 PLM 3-17PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X � Signature of Authon7ed Plumber It you have any questions, please call 503.718.2433.