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7107 SW LOLA LANE-1 80.0 — . — — — — — — — — — a s — — —— - - - — — — — — —— — — — — — — — — r — — .r — — — — — — — — — — — — — — — — — — — — —+. 1 98.9d2100 E 1 ; I I 1 � 1 � I I 1 � 1 � 1 1 r • I ' o I r � r � I ' 1 I 1 � � 1 , 1 I ' 1 � I � 1 I r o I ' r I 1 � I � 1 � I � I 6 Z I r-- r r EXISTG. F-,OME 1 12.5' • NEW;� �,� :., i ADDITION,/ I r• son 1 � 1 I 1 1 o I r EXISTG. DRIVEWAY I i of Awe rf C� Sf0r� ' ' I o � I 1 1 I 58-9,d19'22"E "'m _ _ �W �� w rGomm no � 80.27 SIDEWALK IN �.....�i�r"i Ti l^r7 ._\7L r, ECIF LOLAL ''C`��(�-�'G� i_..�Lt G��._-Y, ✓�:.:,;�l�.i��,�'__'�C:' �iM DOR�iNG �1 7107 SW LOLA LANE S [TE PLAN] TGARD, OREGON 07223 ------ THE RAZBERRY PATCH LOT 000 525,T1S,R1W ROBERT LIBERTY DESIGNEnS BUILDING DESIGN/CONSULTING 1751 N. JAINITZEN, SLIP M-9 • PORTLAND, OR 97217 ►kw�wn�+rnt�tw,cunorr 503/289-0976 ,...�e��, . :-., �-- ♦�„�r ,yam "NdOT;CE. IFTHE PRINT OFZTYPE ONANY lf IIS � I � Illllli i_� ili__ li ill � � llr rI-rlT� l �-1 �ilil.i-...i .11i Ilt ililil � � Iili � Ijillllji � ililili iIIIIIi i � � lr� l .� lilr � il � � t �� ill � i � i Ililili Il � lili ilil � li illi i 1 IMAGE IS NOT AS CLEAR AS THIS NOTICE 1 4 I la $ IT IS DUE 'TO THE QUALITY OF THE IIIIIIillllllllllllllllllll. IIIlII11T�1111l�I'IZ E 7 1 Z TN'o—36 ORIGINAL DOCUMENT 93 IZI51 � £�j ��IZ• . I TII�I la�if�31w1111 Y Ifil►Ifilllllll_II11111► Illlilillllll illllhl �l �l,l Illl�l ll1_ Ul IU O y r O r z 7107 SW LOLA LN CITY O F T I G A R D MECHANI CAI DEVELOPMENT SERVICES FIE_RM I T FSE RMIT #. . .. . . . . . . . MFC98-0057 13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DOTE ISSUED- 02/l9/98 P,ARCEL: IS125DB-08900 `:3I TE ADDRESS. . . : 07107 SW I. LN SUBDIVISION. . . . : THE RAZBERRY PATCH ZONING- R-4. 5 BLOCK. . . . . : LOT. . . . . . . . . . . . . :009 JURISDICTION: TIG CLASS OF WORK. . :ALT Fl.-OnR FURN. . . . : 0 EVAP, COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . - 0 VENT FANS. . . : 0 OCCUPANCY GRP,. . - Rl--" VENTS W/O APPL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUEL TYPES------------- 0-3 HP,. . . . : 0 DOMES. TNCIN: 0 .GAS 315 HPI. . . . : 0 COMML. INCIN: 0 NIAX INPUT- 0 STIA 1.5-30 i-ir.. . . . . o RFP,ATR UNITS: 0 WOODSTOVES. . : 0 rIRE DnmrFRc3`. 30--r .'0 Hr'. 0 GAS P,RESSURE. 50+ Hr-,. . . . 0 CLO DRYERS 0 NO. OF AIR HANDLING UNITS OTHER UNITS. : 0 FIJRN ( 100F, STU: 0 10000 rfm : 0 GAS OUTLETS. : I TURN ) =100F BTU: 0 1,001210 r7fM - 0 Remarks : Moving gas meter Owner-: FEES Kim DnRSING tynp amol-Int by date rer-nt 7107 9W LOLA I-N FDRMT $ 25. 00 B 02/19/98 98-303428 BEAVERTON OR 97005 5PICJ $ 1. 25 B 02/19/9B 98-303428 [-"hone #: rontt-actor-: OWNER ffi 26. 25 TOTAL Pt-rl #. 999999 REQUI RED I NSPIECT IONS This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection applicable laws. All work 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 by the Oreqon 'Aility Notification Center, Those rules are set forth in OAR through OAR 952-9814080. You may . ...... obtain copies of these rules or direct questions to OW by calling f to ++ +++4 -1 + By : jtj Per,mi.ttee SignF.(ti..tre: .......... ....... f f.4+4...4.....................f-4-++++-1-4-+++4......................... Call 639-4175 by 7:00 p. m. for inspections; needed the next bitsiness clay .,.++•+++++.+++++++++++++++++++F++.++++++++++++++++++++++++•+++- +•.............4......4+ Plan Check CITY OF TIGARD Mechanical Permit Application Recd By 13125 SW HALL BLVD. Commercial and Residential Date Recd Z I� TIC-tQRD,OR 97223 Date to P.E. (503) 639-4171, x304 Date to DST Print or Type Permit# 1 -7707, Incomplete or illegible applications will not be accepted Called _ Name�iDovelopt/Prolect, Description / /J2 m�0P'S/N 2Table 1,%,Mechanical Code oTY PRICE AMT Job Street Address burials A) Permit Fee -0- -0- 10.00 Address /l0 7 w,td'i (`/J, Bldg# COY/State - Zl'r 1.) Furnace to 100,000 BTU 6.00 including ducts&vents Name(or name of to Iness1 2.) Furnace 100,000 BTU+ 7.50 Owner r�J M �C't�$ //ll including ducts&vents Mailing Addre)s S w 3.) Floor Fumaco 6.00 7/0 ' �"% including vent city/stall! Zip rPh n p7�v 4.) Suspended heater,wall heater 6.00 7-1 qpfor floor mounted heater Name(or name of business) 5.) Vent not included in appliance permit 3.00 Occupant Mailing Address 6.) Boiler or comp,heat pump,air Gond. 6.00 to 3 HP;absorb unit to 100K BUT- City/state Zip Phone 7.) Boiler or comp,heat pump,air Gond. 11.00 3-15 HP;absorb unit to 500K BTU** Contractor NafT1e 6.) Boiler or comp,heat pump,air Gond. 15.00 f.V Q v 15-30 HP;absorb unit 5-1 mil BTU" Prior to permit Mailing Address 9.) Boiler or comp,heat pump,air Gond. 22.50 issuance,a copy 30-50 HP;absorb unit 1-1.75mil BTU" of all licenses city/state Zip Phone 10.) Boiler or comp,heat pump,air Gond. 37.50 are required if >50 HP;absorb unit 1.75 mil BTU" expired in COT Orego..Const.Cont Board Lic ls Exp Date 11 ) Air handling unit to 10,000 CFM 450 _database Architect Name 13.) Non-portable evaporate cooler 4.50 or Melling Address 14) Vent fan connected to a single dud 3.00 Engineer Cityistate Zip I Phone 15.) Ventilation system not included in 450 appliance peand Describe work New O Addition O Alteration 40 Repair O 16) Hood served by mechanical exhaust 4.50 to be done Residential Non-residential O Additional Description of w 17) Domestic incinerators 7 50 16) Commercial or industrial type 30.00 _ Incinerator Existing use of 19.) Repair units 4.50 building or property _ 20.) Wood stove 4.50 Proposed use of 21 ) Clothes dryer,etc. 4.50 building or property 22) Other units 4.50 Type of fuel-oil O natur,.I gas LPG O electric O 2'.) Gas pining one to four outlets 2.00 II hereby acknowledge that I nave read this application,that the 24) More than 4-per outlets(each) 50 information given is coned,that I am the owner or authorized agent of the owner,that plans submitted are in compliance with Oregon State QTY SUBTOTAL laws SignAture of Owner/Agent Date 'SUBTOTAL 4- 0 L' /AJ 0 7 Sj O 5%SURCHARGE Contact Pemon Name Phone U PLAN REVIEW 25%OF SUBTOTAL -� TOTAL rVTiechpmt.doc (rev 9 'Minimum permit fee is$25+5%surcharge -Residential A/C requires site plan showing placement of unit. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE OWNER Electrical Signature Form Permit # • . • . : MST98-0030 Date Issued. : 02/20/98 Parcel . . . . . . : 1S125DB-08900 Site Address : 07107 SW LOLA LN Subdivision. : THE RAZBERRY PATCH Block. . . . . . . . '[ot : 009 Jurisdiction: TIG Zoning. . . . . . . R-4 .5 Remarks : Construction of garage addition 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 eler:trician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received. AN INK SIGNATURE IS REQUIRED ON THIS FORM ')WNER: ELECTRICAL CONTRACTOR: KIM DORSINC OWNER 7107 SW LOLA LN BEAVERTON OR 97005 [hone # : Phone # : R.eg it • . : 999999 X Sig ature of upervising ectrician If you have any questions, please call 639-4171 , ext. #310 11 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 639-4175 Business Phone: 6394171 �►p Date Requested: _ - eZ . 647M. P.M. MST: c Location: _ � �_ L BIJP:_ Tenant: Suite: _Bldg: MF.C:_ Contractor:4 / Phone: &,O c- ' PLM: Chvncr: �honc: ------ EL,C:_ �.. .. - — •' _ SIT: BUILDING BLDG(con't) PLUMBING MECHANICAL _�,LECTRI--CAa SITE Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Stonn footing Roof Undfl/Slab Rougb-In Ceiling Water I,ine Slab Framing Top Out (IRS Linc Roug)-o-In 110 Sprinkler Foundation Insulation Sewer II(xxi/I)uct Rec:ontimt Vault Bsmt Damp Drywall Stonn Furnace 'I ernp Service MISC. Masonry Ceiling Rain Drain A/C OG Slab Shear/Sheath Fire Spklr/Alm Dr h Crawl/bound eat Pump Low Volt Approved Approved Approved Arov Approved Appr/Sdwlk Not Approved Not Approved Not Approved roved Not Approved FINAL FINAL FINAL IN FINAL f � I 0 Call for reinspection J I ispection fec of Srequired before nexi inspection 711inable to inspect Inspector -- � - DAC 3 r Z- / Page— ---of -- CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 639-4175 Business Phone: 6394171 Date Requested- 3- -.-,) 1 ,A.M. 1___ 1'.M MST: W Location: 1 7 +: --� `--' TBUP: -Tenant: _1 _,� ^ Suite: Rldg: MEC: � U W. Phone: ��.�� r � PLM: Contractor: --- Owner. U Phone: _ &I _ _ srr: BUILDING BLDG(con't) PLUMBING MECHANICAL ` SITE Site Post/13eam Post/Beam PoAffleatn Cover/Sery=_. Sewer/Stone Footing Roof 1 indFl/Slab Rough-In Ceiling Water line Slab Framing lop Out Gas Linc Rough-In t 1G Sprinkler Foundation Insulation SeAer Ilooditict Reconnect Vault Bsmt Damp Drywall Stonn Furnace 'Temp Service MISC. Masonry Ceiling Rain Drain 1/C IJG Slab Shear/Sheath Fire Spklr/Alm Crawl/Fbund Dr I teat 1'canp Low Volt Approved Approved ApprovedApproved Approved Appr/Sdwlk Not Approved Not Approved Not Approved �pi�„ we`d Not Approved FINAL FINAL FINAL ' FINAL FINAL C7 Call for reinspection einspection fee of S required before next inspection O I lnnhic to inspect Inspector: Date: T , 31 Page _of CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP _Date Requested AM PM BLD I-ocation r, �'�.C� LVI Suite MEC Contact Person _ Ph PLM Contractor �Gr`!�y' �n S`�. Ph Y SWR �ILDr TenanUOwner ELC Reta.nmg Wall ELR ,1-uolin, Access: Foundation ,,// FPS Ftg Diain Il-41 �t Crawl Drain Inspection Notes: SGN Slab — — — SIT Dost& Beam Ext Sheath/Shear IM Sheath/Shear Framing --- --- -- Insulation Drywall Nailing --- - -----_-_._� _.—____..--.---------_--T-- Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc. -- - — -- _----. - ----- — -- SS PART FAIL -- ---- -- - --- -- - . _- PLUMBING Post& Beam - -- -- - - - - - Under Slab Top Out - - -- - - - - Water Service Sanitary Sewer - Rain Drains Final -- ---- ------- ------- PASS PART FAIL MECHANICAL - -- Post& Beam Rough In Gas Line - - - Smoke Dampers Final - -- - - - PASS PART FAIL ELECTRICAL - - - Service Rough In _ _ - - - -------- UG/Slab Low Voltage ----- —--------- --- ---— Fire Alarm Final PASS PART FAIL SITE Backfill/Grading - - — Sanitaiy Sewer Storm Drain [ ]Reinspection fee of$ required before.next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line I ]Please call for reinspection RE: [ ]Unable to inspect-no access ADA Approach/Sidewalk Other Date Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD MASTER PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : MST98-0030 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 02/20/98 PARCEL: 1S125DB-08900 SITE ADDRESS. . . :0-7107 SW I OL ra I SUBDIVISION. . . . :THF RAZDERRY PATCH ZONING: R-4. 5 ALOCK. . . . . . . . . . 1. 07. . . . . . . . . . . . .. :009 JURISDICTION: TIG Remarks: Construction of garage addition --------------- --------------------------- --------- BUILDING --------------------------------------------------------------- REISSUE: STORIES.......: 1 rLOOR ARFAS----------- BASEMENT...; 0 sf REQUIRED SETSACKS---- RE(?UIRED-- --- --- -- CLASS OF WORK.:ADD HEIGHT........ : lP FIRST.... ; 0 sf GARAGE.....: 240 sf LEFT..........: 5 SMOKE DETECTRS: TYPE OF USE....-SF FLOOR LOAD.... : 50 SECOND...: 0 sf FRONT.........: 20 PARKING SPACES: 0 TYPE OF CONST..-5N DWELLING UNITS: P C1NDSMFNT: 0 sf RIGHT......,,,; P OCCUPANCY GRP.:R3 BPRM: 0 BATH: 0 TnTAI ------; 0 Sf VAI_I1F..1: 4P4; PEAR.......... : 0 ------------------------...-------------------------------------- PLUMBING --------------------------------------------------------------- SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAPS. : 0 RAIN DRAIN ft: 0 TRAPS.........: 0 LAVATORIES....: 0 DISHWASHERS... : 0 GLOOR DRAINS..: 0 SERER !_INF ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 TUB/SHOWERS...: 0 GARBAGE DISP.. ; 0 WATER HEATERS.: 0 WATER l-INE ft: 0 BCKFLW PPFVNTP: 0 GREASE TRAPS..; c� OTHER FIXTURES: 0 ----------------------------------I---------------------------- MECHANICk --------------------------------------------------------------- FUEL ------------------------------------------------ FUEL TYPES---------- FURN f 1001! .. : 0 BOIL/CMP l 3HP: 0 VENT FANS...... 0 CI-OTHES DRYERS: 0 FURN >=100K ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 0 -----------------------------------------•--------------------- FIFCTRICAL ------------------------------------------------------------ —RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-- 1000 SF OR LESS: 0 0 -• 200 asp..: I 0 - 200 asp..: 0 W/SVC OR FDR..: I PUMP/IRRIGATION: 0 PER INSPECTION: 0 FA ADD'I 500SF. : 0 ?01 - 400 aso.. : 0 ?01 - 400 aso., : 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER W,?UP......: 0 LIMITED ENERGY.: 0 401 - 600 asp..: 0 401 - 600 asp,. : 0 EA ADDU. BR CUR: 0 SiGNAIlPANEI...: 0 IN PLANT.....,: 0 MANE HM/SVC/FDR: 0 60: - 1000 asp.: 0 601+asps-1000 v: 0 MINOR LABEL -10: 0 1000+ asp/volt.: 0 ----------------------------------- PLAN REVIEW SECTION -----------------------------•---- Reconnect only.: 0 1=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC: -------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ------------------------------------------------- A. SF RESIDENTIAL-------------------------- B. CGWRCIAL------------------------------------------------------------------------------ AUDIO I STEREO.: VACUUM SYSTEM..: AUDIO ! STEREO.: FIRE ALARM__ INTFRCOMIDAGING: OUTDOOR LNDSC LT: RIIRGLAR ALARM..: OTH: N BOILER.........; HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE S1GNL: GAPAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: ,VAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMS: 0 Owner: ------------------------------------Contractor: ----------------------------- TOTAL FEES:f 159.36 KIM DORSING DORSING CONSTRUCTION This permit is subject to the regulations contained in the 7107 SW LOLA LN 71.?5 SW SHADY CT Tigard Municipal Code, State of Ore. Specialty Codes and all BEAVERTON OR 97005 TIGARD OR 97223 other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is Rhone #: Phone #: 805-1954 not started with:n 180 days of issuance, or if the work :s Reg C.- 057349 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 952-001-9010 through OAR 952-001-0080. You may obtain copies of these rules or firert questions to OIUNC by callinq (503)246-1987. ----—-------------------------- ---------- REQUIRED INSPECTIONS -- --------- --------------------------------- ,'uslon Control Low Voltage tooting Insp Rain drain Insp Electrical Servi Electrical Final Electrical Rough Building Final Praline Insp Tss�-ied SV: Permittee Siclnati_ire : 4-+++++++ i-+ a- 4- t-4�+a-�1-�1-� ...4-�1--1.+-.....+++ +4..++t�l-....�4•+ F++-��1-d--F�1-� .4- ++. 4-4 C�11 E�39-417�� by :i p, m. for an inspection needed the next b�.is;iness y Plan Check# CITY or TIGARD Residential Building Permit Application Recd By,,--1L 13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd -� TIGARD,OR 97223 Single Family Detached or Attached (Duplex) Data to P.E. V 503-639-4171 Date to DST.2-/ 7J_� F 503-6847297 Permit# Print or Type Called Incomplete or illegible applications will not be accepted c /,—J Name of Project ame Job t�IZS//o Qb4W1 -` -�`� ��'S�'�►�ri2 .� Architect Mailing Addtess Address Site Address q 4 j j 1 C Ll� `v Ir l_ t.. t t City/ tats Z)g -7 71p� 2'one—&q 1 Name 11 ,� Name Owner Mpiling Address tl L`10 L l Engineer Mailing Address CityState Zip Phong ,1,414 17 City/State Zip Phone General Name Contractor `5/A) 0 �'` Describe work New O Addition Alteration O Repan o rW 51 Mailing Address to be donen of Work: __ _- Prior to permit 3 c - h t1(�. (t t Additionsd Dei riptic� , issuance,a copy C /Stat Zi Phone �1 __ 6 A� of all licenses ( ` are required if Or gon Const.Cont.Board Exp.Date PROJECT �{ expired in COT Lic# VALUATtvN database 7 'Jleclhanical Name NEW CONSTRUCT;( ONLY: Sub- Sq. Ft. House: Sq. Ft. Garage Contractor Mailing Aadress _ _ _jU 6� r b Prior to permit Corner Lot YES NO Flag Lot YES NO issuance,a copy City/State Zip Phone (checK one) (c'Teck one) of all licenses _ Restricted Audio/Stereo Burglar are required if Oregon Const.Cont.Board Exp. Date Ener(y System Alarm expired in COT Lic# database Installs tion Garage Door HVAC Plumbing Name Opener Systems Sub- (check all that Other: Contractor Mailing Address apply) NII the electrical subcontractor wire for all YES NO estr�cted energy installations? Prior to permit Cry/State zip Phone Has the Subdivision Plat recorded? N/A YES NO issuance, a copy of all licenses are Oregon Const,Cont. Board Exp.Date required if Lic# Solar Compliance expired in COT (Calculation Attached) database Plumbing Lic.# Exp Date I hearby acknowledge that I have read this application,that the information given is correct, that I ani the owner or authorized Name agent of the owner, and that plans submitted are in compliance with Oregon State s. Electrical _ _ Signat��.pf ow er/ ent Dat Sub- Mailing Address cl�._. '—% 2- Contractor — Contact -Person Name ` ^1Y�l C ne# City/State Zip Phone - Prior to permit FOR OFFICE USE ONLY: issuance,a cc,p,, Plat % Mapf%*_ Q of all licenses are Oregon Const.Cont.Board Exp.Date x 6�li ( rA I J I AJ L)f) _r)g, required if Lic,# Setbacks e•� ,— Solar: expired in COT database Electrical Lic.# Exp.Date Engineering Approval: Planning Approval: TIF: I SFREM DOC (UST) 4/97 CITY OF TIGARD Electrical Permit Application Plan Check N 13125 SW HALL BLVD. Recd By_- TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503)639-4171, x304 Print or Type Date to DST Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit# Fax (503) 684-7297 Called _ 1. Job Address: 4. Complete Fee Schedule Below: t Name of Development .j)c,y- r h C 1 Number of Inspections per permit allowed Name(or name of business) _ Service included: Items Cost Sum Address_ - _ 4a. Residential-per unit 10(x)sq.It.or less $110.004 City/State/Zip - Each additional 500 sq.ft.or v Commercial ❑ Residential ❑ portion thereof $25.00 1 Limited Energy $25.00 Each Manul'd Home or Modular Dwelling Service or F9eder - $68.00 2 2a. Contractor installation only: (Attach copy of all current licenses) 4b.Services or Feeders F lectrical Contractor Installation,alteration,or relocation Address -- 200 amps or less . $60.00 2 City___ State_ _Zip 201 amps to 400 amps 401 amps to 600 amps $8120 00.00 2 Phone No. 601 amps to 1000 amps $180.00 2 Job No. Over 1000 amps or volts $340.00 _ 2 Elec. Cont. Lice. No. _ Exp.Date Reconnect only $50.00 2__ ---OR State State CCB Reg. No.� _Exp.Date __ 4c.Temporary Services or Feeders COT Business Tax or Metro No. Exp.Date" __ Installation,alteration,or relocation 200 amps or less - $50.00 Signature of Supr. Elec'n_ _ 201 amps to 400 amps $75.00 - --- --- 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. _ Exp.Date _ see"b"above. Phone No. ----"--------- 4d.Branch Circuits l New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase of service or Print Owner's Name el 61 Y1 feeder fee. Address L o l..Rtne Each branch circuit $5.00 __ 2 b)The fen for branch circuits City_ �_ _____ State C�-_ Zip�� _ without purchase of Phone -�� - service or feeder fee. First branch circuit $35.00 2 The installation is being made on property I own which is not Each additional branch circuit- $5.00 2 intended for sale, lease or rent.(\ 4e.Miscellaneous nature Ki- (Service or feeder not Included) Owner's SI9 ? Each pump or irrigation circle $40.00 2 Each sign or outline lighting _ $40.00 _ 2 3. Plan Review se tion (if require * Signal cir-.Lit(s)or a limited energy panel,alteration or extension $40.00 _ 2 Please check appropriate item and enter fee in section S8Mlnor'_abels(10) $100.00. `-- 4 or inure residential units in one structure 4f.Each additional Inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special orcupancy Per hour - $55.00 as described in N.E.C.Chapter 5 In Plant - $55.00 "Submit 2 sets of plans with application where any of the above apply. 5. Fees: Not required for temporary construction services. Se.Enter total of above fees $ _ 50/10 Surcharge(.05 X total fees) $ -- NolICE Subtotal $ - 5b.Enter 2G%of line.so for PERMITS BECOME VOID IF WORK OR CONST'"XTION AUTHORIZED IS Plan Review if required(Sec.3) $ -NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ ---- IS SUSPENDED OR ABANDONED FOR A PEF.IOD OF 180 DAYS AT ANY 1--1 TIME AFTER WORK IS COMMENCED 0 Trust Account Total balance Due s I.\DSTS\ELC96 APF' new A'!* ASTER PERMIT C I Y O F T I G A R D PERMIT#: MST2004-00074 DEVELOPMENT SERVICES DATE ISSUED: 3/12i2004 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 SITE ADDRESS: 0710 7 SW LOLA LN PARCEL: 1 S125DB-08900 SUBDIVISION: THE RAZBERRY PATCH ZONING: R-4.5 BLOCK: LOT: Licit) JURISDICTION: I•ICi REMARKS: Kitchen/dining room remodel and 68 sq.ft. addition Other plumbing fixture is ice maker. 6/30/04, adding a/c & gas piping for cooktop. BUILDING REISSUE. STORIES: I FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST 68 of BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: •IO SECOND: sf GARAGE: st FRONT: a PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: I THPO sf RIGHT: 00799. OCCUPANCY GRP: R3 BDRM: BATH: T07AL ,I' sf VALUE. 10, REAR: _ PLUMBING SINKS: WATER CLOSETS. WASHING MACH: LAUNDRY TRAYS: RAIN ORMN: TRAPS: LAVATORIES: DISHWASHERS: I FLOOR DRAINS. SEWER LINES. SF RAIN DRAINS: CATCH BASINS: TIIBISHOWERS, GARBAGE DISP I WATER HEATERS. WATER LINES'. BCKFLyY PREVNTR. GREASE TRAPS: OTHER FIXTURES: I MECHANICAL FUEL.TYPES FURN<100K: BOIL/CMP<3HP I VENT FANS: CLOTHES DRYER: FURN—100K. UNIT HEATERS HOODS: 01 HER UNITS. MAX INF': btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I ELECTRICAL _ RESIDENTIAL UNIT SERVICE.FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCLLLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS. 0 200ampp. 0 - 200arnp: WISVC OR FUR-. PUMPIIRRIGATION: PER INSPECI'ION: EA AOD'L 500SF. 201 - 400 amp. 201 400 amp. 1st W1O SVC/FORSIGWOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp- FA ADnL BR CIR. SIGNAL/PANEL: IN PLANT: MANU HM/SVCIFDR. 601 1000 amp: 601"amon-1000v MINOR LABEL: 1000-amplvolt PLAN REVIEW SECTION Reconnect only: —4 RES UNITS: SVC/FDR-225 A. >600 V NOMINAL CLS AREA/SPC OCC: _ ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL _ B,COMMERCIAL AUDIT)&STEREO- VACUUM SYSTEM. AUDIO IL STEREO: FIRE ALARM INTERCOMIPAGING. OUTDOOR LNDSC LT: BURGLAR ALARM: OTH. BOILER: HVAC I_ANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK. INSTRUMENTATION: MEDICAL. OTHR, HVAC DATAlTELE COMM: NURSE CALLS. TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 569.69 This permit is subject to the regulations contained in the 1 n_)RSING KIM LAND OWNER 1 igard Municipal Code, State of OR Specialty Codes MATFiERN, JANICE L and all other applicable laws All work will be done in 107 SW LOLA LANE accordance with approved plans This permit will expire PORTLAND, OR 97223 if work is not started within 180 days of issuance,or if the work is suFNanded for more than 180 days Phone: S03-244-0780 Phone: ATTENTION Oregon law requires you to fol!nw rales adopted by the Oregon Utility Notification Center Those Reg N: rules are set forth in OAR 952-001-0010 through 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987 REQUIRED INSPECTIONS Footing Insp PLM/Undeliloor Exterior Sheathing Insf Plumb Final Foundation Insp Mechanical Insp Gas Line Insp Final inspection Post/Beam Structural Plumb Top Out Insulation Insp Underfloor insulation Electrical Rough In Electrical Final FootipgfFo`undat 61'ri� Framing Insp Mechanical Final ISSd By : �� {� �� , Permittee Signature Call (503) 639-4175 by 7:00 p.m. for an inspection needed he next busin ss day vN J _ Building Permit Application Reccncd1 Building Date,By d� I'ermit N. X _00 0 7 City of Tigard Planning Approval U' other Y g Date/ByI ermit_No _ 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 pLL Date/By:: 3 1:1 a Permit No Phone: 503-639-4171 Fax: 503-598-I9 E LDPost-Review Land Use Date/B : Case No Internet: www.ci,tigard,or.us contact Juns ®tics Page 2 for 24-hour inspection Request: 503-639-4175y� I me/Method: Su Llerncntal Information CfTY OF TIGARD TYPE OF WORMS IL ING DIVISION REQUIRED DATA: New construction Demolition I &2 FAMILY DWELLING Addition/alteration/replacement Other: CATEGORY OF CONSTRUCTION Note. Permit tees'are based on the total value of the work performed. Indicate I & 2-Family dwelling Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application./, Accessory Buildin Multi-Family 10 74$,4jh Master Builder ❑Other: Valuation......................................................... $ JOB SITE INFORMATION and LOCATION No.of bedrooms: No.)f baths: Job site address: ''I D SGJ GC/ Gwe 71 aky) Total number of floors..................................... -g— New dwelling area(sq. ft.).............................. Suit-#; Bld ./A 1.#: Gara a/ca ort area(sq. ft. Project Name: til/ NON CW61 IV C' Covered porch area(sq.ft.)............................. Cross street/Directions to b sit ; Deck area(sq. t.).............. .............................. 7y�P �`Fkky y 'Hazy Other structure arca(sq. t.)............................ To Cola REQUIRED DATA. COMMERCIAL-USE CHECKLIST Subdivision: `Ne et'l � Lot#: — i TeX map/parcel#: o S1 a5.1,15,k/u! W,Mt' f bite: Permit fees'are based on the total value of the work performed Indicate DESCRIPTION OF WORKvalueflMvalue(rounded to the nearest dollar)ofall equipment,materials,labor, inoverhead and profit for the work indicated on this application � RFMOl�F/ Valuation......................................................... S _ ff Existing building area(sq. ft.)......................... — —_- New building area(sq. ft.)............................... _ Number of stories............. ... .......................... PROPERTY OWNER TENANT_ Type of construction........ Name: �� /�(J M�f�tA/ — Occupancy group(s): Existing: Address: �/D J 40? /ti,- �T New: Cit /State/Zi :_jtin Phone:S_0 ayS� 078CJ H) 580 -S_7A NOTICE: All contractors and subcontractors are required to be APPLICANT — CUNTAr'i'PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: J.urisdictior,where work is being performed. If the applicant is exempt Contact Name: K i Al 60 k5 iNfrom licensing,the following reason applies: Address: 7/0 7 510 4 0/ - Cit /State% 7i71 IM — - — Phone: o .��,� Fax: _ ----- ---- —i E-mail: BUILDING PERMIT FEES* Please refer to fee schedule. CONTRACTOR - --- ---- Business Name: Fees due upon application.....F.L.N..... . _ y/ S Address: _ City/state/Zip: Amount received........ ............................... 3 Phone: Fax: Date received: CCB Lic. -- ------- Authorized Notice: This permit application expires If a permit is not obtained within Signature: �_ Date: Z�P ISO days after it has.)ern accepted as complete. (�_ 1 s k� _ •Fcc methndolok� sal h. "frl-(boob Building Indusrr.� ticrsici Board. (Please printn e) i:iDsts\Permit Forms'�BldgPermitApp.doc 0103 One-and Two-Family Dwelling Building Permit Application Checklist Relcienceno.. CiryofTigard City of Tigard Associated permits. Address: 13125 SW Hall Blvd,Tigard. (W �)7 t 0 Electrical J Plumbing J Mechanical Phone: (503) 639-4171 O Other: Fax: (503) 598-1960 1 Land use actions completed.Sce jurisdiction criteria for concurrent reN)cws. 2 Zoning. Flocxl plain,solar balance points,seismic soils designation,histone 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 J plan J permit required. Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size sheet attached to the plans with cross references hetween plan location and details. Plan review cannot he completed if copyright violations exist. I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions:property corner elevations(if there is more than a 4-11.elevation differential,plan must show contour lines at 2-ft.intervals):location of easements and driveway;footprint of structure(including decks);location of wells/septic systems:utility locations;direction indicator;lot area;building 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 flo)r 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,nx)f 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 and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bra Ing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non-press riptrve path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing, and hearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,sec item 22."Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple.joists over 10 fect long and/or any heam/joist carving 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 be applicable to the project under review. 23 Five(5)site plans are required for Item I I above. Site plans must he 8-1/1"x I I"or I I"x 17". 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall nei 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 plat to include tree size,type&location per approved project street tree plan(if applicahle).and COT Street Tree List. Checklist must be completed before plan review start (late. Minor changes or notes on submitted plans may be in blue car !,lack ink. Red ink is reserved for department use only. 440.4614 rn)OWMI) Electrical Permit Application Received Electrical Date/By: Permit No.: City of Tigard Planning Approval Sign Date/By: Permit No. 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598 )60 Post-Review Land Use Date/ByInternet: www,ci.tl ard,or.u9 Contact Case No.: g Contact Juris: See Page 2 for 24-hour Inspection Request: 503-639-4175 NameiMethod. Supplemental Information. mAddition/altecation/replac ruction _ T ] Demolition Service over 225 amps- Health-care facility ement ❑Other: commereiv ❑Hazardous location El Service over 320 amps-rating of ❑Building over 10,000 square feet, K ,y;� - �` ,�::R?`r' - I&2 family dwellings four or more residential units in 1 & 2-Family dwelling L1 Commercial/Industrial _ ❑System over 600 volts nominal one structure ACCCSSO Building Multi-Family' ❑Building over three stories ❑Feeders,400 amps or more ry g �__ ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder SOther: ❑Egress/lighting plan I ❑Other: 'IN1+gR tfj ) Submit—sets of plans with any of the above. --- The above are nota Ilcable to temporarl construction service Job site address 7,t' / S_ W LO/a L!i 7`%r_•d K.. SL Suite#: �131�/Apt.#: — _Number of inspections per permit allowed Project Name: otscri tion Qty Fee(Co.) Total -- - Ne w residential-single or multi-famlly per Cross street/Directions t0 Job site: d•,nelling unit.Includes attached garage. toy/nR A 1`�i •7V�k 5�1 / �n N "erviceIncluded; L 1000 sq.ft.or less 145.15 4 T 41) 4 <7j/i 7 1 Each additional 500 sq,A.or portion thereof 33.40 _ 1 -7� - Limited energy,residential 75.00 2 Subdi Limited energy,non residential 75.00 2. Tax mag/ arca) #. SFr Each r ianufactured home or modular dwelling I service and/or feeder 90.90 2 Services or feeders-installation, alteration or relocation: - -� - 200 amps or less -__ 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps _ 160.60 2 601 amps to 1000 ams 240.60 2 Over 1000 amps or volts 454.65 2 Nam e: pt) e,'/A)y//I.)Atli Q/V Reconnect only 66.85 2 Address:'7/0 j ,�(� �0�G N _ Temporary services or feeder-installation, alteratCity/State/Zip: /C Q/1Cl — 200 amps o le relocation: - 0 2(10 amps less 66.85 I 1'hcmc:,90,E o7y Fax:—_ -- ---- 201 amps to 400 amp. _ 100.30 2 401 to 600 amps _ 133.75 2 7� p � iL1CT p - ' Bra;.^h circul.s-new,alteration,or Name: Ornslk 11414 /i CAIextension per panel: -- -- A.Fee for branch circuits with purchase of Address: 7/07 �56(J 40ACL CCN service or feeder fee,each branch circuit 6.65 – -- - —— City/State/Zip: r/ Q/L'f O/Z B.Fee for branch circuits without purchase of f -- -- service or feeder fee,first branch circuit_ 46.85 1 1 2 Phone: "_Iy QEach additional branch circuit / 6.65 2 E-mail: Misc.(Service or feeder not included): +, Each pump or nTigatron rrcle 53.40 2 Each signng or outline ligWi _ __ 53.40 _ 2 Job No: Signal circuit(s)or a hin ted em rgv panel, --�" -"--_" --- - ,o ion alterattor extension Pae 2 2 Address: Business Name: --_ Description - -- -- -— - Each additional Inspection over the allowable In an ofthe above: City/State/zip: Per inspection-per hour(ruin I hour) _ _ 62.50 Phone: FaX: Other: - CCB Lic. #: Lic. #: • Supervising electrician _ Subtotal S signature required: _ Plan Review(25%of Permit Fee) Print Nam' : Lic. #: State Surcharge 8%of Permit Fee _ TOTAL PERMIT FEE S _ Authorized -- I I Notice: This permit application expires If a permit is not obtaedinwithin Signature: UBte:_ Z G 180 days after It has been accepted as complete. `Fee methodology set by Tri-County Building Industry Service Board. 1 --- - lease print name) i:\Dsts\Permit Forms\ElcPemtitApp.doc 01 3 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: Audio and Stereo Systems* Burglar Alarm Garage Door Opener* Heating,Ventilation and Air Conditioning System* 1-1 Vacuum Systems* ❑ Other__- — ---.----..._ COMMERCIAL WORK ONLY: _ Fee for each system.......................................................... $75.00 (SEE OAR 919-260-260) Check Type of Work Involved: Audio and Stereo Systems C� Boiler Controls E Clock Systems El Data Telecommunication Installation I� Fire Alarm Installation IIVAC Instrumentation Intercom and Paging Systen s Landscape Irrigation Control* Medical Nurse Calls Outdoor landscape Lighting* Protective Signaling L�� Other –- Number of Systems * No licenses are required. Licenses are required for all tither installations i'Dsts\Permit ForrnSTICPe iitAppPS2.doc 01/03 Building Fixtures Piumbinp. Permit Application Received Plumbing Date'B _ N-rmit No.: _ Citof fi and Planning Approval Svwer Y g Date By P.rrmit No.: 13125 SW [fall Blvd, Plan Review other Tigard,Oregon 97223 Date'BY: _ _ P:mut No. – Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use Internes: www.ci.dgard.or.us Date,By: ^_ _ Case No Contact Jeri, See Page 2 for �4-how Inspection Request: 503-639-4175 Name Method: Su elemental Information. _ TYPE OF WORK FEE*SCHEDULE forspecial Information use checklist New construction Demolition Description I Q". I Fee(ea.) Total Addition/alteration/replacement Other: New 1-&2-family dwellings CATEGORY OF CONSTRUCTION includes 100 R.for each utility connection SFR (1)bath 249,20 1 & 2-Family dwelling _C'ommercial Industrial SFR(2)hath 350.00 Accessory Buildin Multi-Family SFR(3)bath — _ 399.00 Master Builder [] Other: Each adduionai bath,knchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler-sq. A.: Job site address: '�/CI a Yl ,ctl Site Utilities Suite #: Bldg./Ap A Catch basin/area drain _ 16.60 Dr� Vle elach Irne/trench drain 16.60 Project Name: Footing drain(no linear ft ( Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 7'a�/a�s �c" y ILL" 7y �� Manholes 16.60 �SHfi.Ol1 11444' AO Z O/Q til/ �/d/ Rain drain connector i 6.60 Santtary sewer(no linear ft 1 _ Page 2 Subdivision: �g aryl /11c i4 - Lot t#:T Storm sewer(no. linear ft ) Page 2 -_ Tax ilia / arccl #:tSE .5t-, ��/S ,Q/(y1 r11��/�� Water service(no linear fl ( Pae 2 �—DESC .iPTION OF WORK Fixture or It em _ Absorption valve 16.60 Backflow preventer Page — _ Backwater valve 16.60 Clothes washer 16.60 —— --- Dishwasher _ / 16.60 Drinkingfountain 16.60 'OWNER�TENANT ectors,summa 16.60 Name: iVr Ex ans;on tank 1660 Address: x/07 sw Lo1Q /1FI i.rture,sewer cap 16.60 _– City/State/Zip: 70"gaed 60c _ - Floor drain floor sink/hub 16.60 Garbage disposal ! 16.60 Phone:6r,1 Al/V 6 980 Fax: _ hose bib 16.60 10 APPLICANT J FLI CONTACT PERSON Ice maker _ / I6.60 Name: /)etS/A-' /1 1/a 1 F{E �' �_/_ Interceplorgrcasc trap— --- -- I6.60 Address: 7/6 7 S i Medical as-value. S Pae 2 -- Prii,ier — -- _ 16.60 Cit /State/Zi ----- -------- Roof drain(commercial) 16.60 Phone: j,- 0 Fax _ Sinkrbasinla%atory 16.60 E-mail: _ rub'shower shower pan _-_ 16.60 _CONTRACTOR Urinal 16.60 _Business Name: ?-Yl Z/1 Nater closet —_-_ 1660 -- -- -- Water neater 16.60 Address: _-__. -. other --- Cit/State/Zp: other Phone: _ Fax: Plumbing Permit Fees* CCB Lic. : Plumb. LicA _ subtotal S Minimum Prrmit Fee 572.50 S Authorized _ , Residential Backflow'�trnimum Fee Safi_5 Signature: � — Date: L Zt� Plan Review (25%ofPcrmlt Feel S Y` — State Surcharge(845,of Permit Fee) S `I ,e pr t name) TOTAL PERMIT FEE_ S _ Nonce: This permit application er r s Ifs permit Is not obtained within 111 new commercial buildings require 2 acts of plans wish(sorts ric or 181)da.vs after it hus been accepted complete. riser diagram for plan resiew. 'Fee oielhodoiog� set h.� Tri-('ounh Building Indoor.N Sersice Ii,rard. t�Dsts\Pcmiit Fomu�PimPermitApp.doc 01/03 Plu_mbkqgPermit Application - Ciq of Tigard Page 2 - Supplemental Information Fee Schedule: _ Residential Fire Suppression Svstems: Site Utilities Qty. Fee(en) Total S uare_Footage:_ Permit Fee: _ Fooling drain-1"100' ss 00 0 to 2.000 $11500 1 iKiOng drain-each additional 100' 20)1 to 3,600 $160.00 3,601 to 7,200 _ S220.00 _ Sewer- Ist 100' 55 1l 1,201 and greater i 5309.00 Sewer-each additional 100' 40 411 Water Service- Ist 100' S")0 Medical Gas Svstems: Water Service-each additional 100' 46 aft Valuation: Permit Fee: Storm&Rain Drain-Ist 100' 55 1N) $I 00 to$50)0.00 Minimum lige$72.50 Storm&Rain Drain-each additional I OO' 26 40 $5,00100 to$10,000.00 $72,50 for the first$5,000.00 and 5152 for each Fixture or Item Qty. F:e(ea) Total additional S 100.00 or fraction thereof,to and _ including$10,000.00. Commercial Flack Flow Prevenw)n Device 46..10 _ $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 51.54 for Residential Backllow Prevention Devic each additional$100.00 or fraction thereof,to Iminimum permit fee$36.25 27.55 and including$25,000.00. Rain Drain,single family dwellirg 65 25 $25,001.00 to 550,000 00 $379.50 for the litst$25,000 00 and 51.45 lilt each additional$100,00 or fraction thereof,to Inspection of existing plumbing or and including$50,000.00. specially requested inspections-;rcr hour 72.50 $50,001 W and up $742,00 for the first$50,000.00 and S 1.20 for Subto(al: each additional$100.00 or fraction thereof. Fixture Work: %re You capping, moping or replacing existing fixtures:' If "ses",please indIC.11e work performed b� fixture. Failure to accurately report_fixtures could result in increased sewer fees". Quantity h Fixture Work Performed Comments regarding fixture work: Fixture Type: Replace New _Moved Fxb11n Capped 11a ust -/Font Itath -Tub/Shower - -Jacutxi/Whirl ool -- Car Wash -Each Stall -C)risc Thru _ Cuspidor Water Aspirator Dishwasher -commercial -Domestic Dnnkingi'ountainEye Wash _ _ — Floor Drain sink .2" .4" -- Car Wash Drain — -- F s -)te: If the fixture work under this permit results in an Garbage -Domestic — increase of sewer EDI's,a sewer permit will be issued and Disposal -Commercial -Industrial fees assessed for the sewer increase must be paid before the Ice Mach..Refri .Drains — plumbing permit can be issued. Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Dar Lavatory, -Bradley _ -Commercial -Service _ Swimmm Pool Filter Washer-Clothes Water Extractor Water Closet-l oiler Urinal Other Fixtures: I Dsts'Permit Forms Plnd'erm itAppl g2 doc 0103 Mechanical Perdflt.A.0 ik,6- 6-on Received Mcchamcal Date/B 1'crtmt No. _ City of Tigard MAR 1 ] 2004 Planning Approval liuddutg - - — Date/By Permit No.: 13125 SW Hall Blvd. CITY OF TIGAH Plan Review other Tigard,Oregon 97223 ��t1�Itt CCS�INr �,,\f,� nN Date/B : Permit No.: se Phone. 503-639-4171 Fax: 5Q3=5�8-i9bWDate[ Post- evievv Cane o.: �` Date/B Case No.: _ Internet: www.ci.tigard,or.us Contact Juris.: See Pagt 2 for 24-hour Inspection Request: 503-639-4175 Name Method Su elemental Information. TYPE OF WORK _ COMMERCIAL FEE*SCHEDULE-USE CHECKLIST I New construction I I I Demolition :vlechanical permit fees'are based on the total value of the work Addition/alteratiun/re cement 17 Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment, labor,overhead and profit -- i l Value: S See Page 2 for Fee Schedule 1 & 2-Familydwelling C'ommert;ial/lnc.ustri�. _ Schedule- RESIDENTIAL Buildin _Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDULE - Description t Fee ea. Total Master Builder Other: "eatinattcoolin JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning" 14.00 _ Job site address: �>(Ll IV 0/0 'U' 7iGg k Gas heat pump 14.00 Suite #: Bld ./A t.#: Duct work 14.00 Project Name: H dronic hot waters stem 14.00 Residential boiler Cross street/Directions to job site: for radiator or h dronic system) 14.00 FeAl 7c' 9V.Ste S/IfC % Unit heaters(fuel,not electric) 4191le f0 1%Vt Q 44 (67) in wall,in-duct,suspended,etc.) 14.00 _ Flue/vent(for any of above) 10.00 Subdivision:RA 13CA)k Q Lot #: Repair units — 12.15 _ Other Fuel A� Ilanca Tax map/parcel #:s� ',s/ e J>�lb Water heater 10.00 DES CRI TON OF WORK Gas fireplace 10.00 k✓1chte-n Ad/"i 7,0e/ Flue vent(water heatengus fireplace) 10.00 Log li htcr( as _ !(IAO Wood/Pellet stove 111.00 Wood fireplace/insert 10.00 Chimney/liner/flue/vent _ _10.00 _ PROPERTY OWNER TENANT Other: _ l o.Oo — Envl onmental Exhaust&Vt.ntllation Name' IN6, ^ �N_ _-- Range hood/other kitchen equipment It)Otl Address: WO ) S to LOLL& 4 Clothes dryer exhaust W 00 Cit /State/Zi _ � -/ �.— Single duct exhaust Phon�3- o? dl 078 eA Fax: (bathrooms,toilet compartments, APPLICANT CONTACT PERSON utility rooms) _ 6.80 Name: R y i 0.7,11 C;An Attic%crawlspace fans _ 10.00 Address: Z/Q See) Cola 4� Other: Fuel Piping 10.00 Cit /State/Zi c1 •"(55.40 for nrst 4,$1.00 each additional) — Furnace,etc. Phone:` Gas heat pump •• E-mail: Wall/suspended/unit heater 00 CONTRACTOR_ Water heater Business Name: a— _ Fire lace Address: --- — -- ---- Range .. City/State/Zip: _ _ Clothesdryer(gas) Phone: Other: •• -- -- — Total: CCB Llc. j Mechanical Permit Fm* Authorized O� Subtotal: S Signature: _ Date:_ Minimum Permit Fee$72.50 S Plan Review Fee(25%of Permit Fee) S (Please print nam State Surcharge(8%of Permit Fee) S TOTAL PERMIT FEE S Vutice: This permit application expires if a permit iv not obtained within "Fee methodology set by Tri-County Building Industry Service Hoard. I R0 day c after it ha%been accepted ac complete. "Site plan required for exterior A/C units. tws Pcrtnt I nnu Mrrl'cinnt:\rr I-,r '11 tl Mechanical Permit Application - Cite of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION: tadditio RMIT FEE: S1.t10 to_$2,0110,00 imum fee$72.50 _ $2,001.00 to$5,000.00 .50 for the first$2,000.00 and$2.30 for each _ al$100.00 or fraction thereof,to and udirz$5,000.00.$5,001 00to$10,000.00 $141.50 for the first$5,000.00 and$1.80 for each additional$100.00 or fraction thereof,to _ and including$10,000.00. $10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and$1.35 for each additional $100.00 or fraction thereof,to and including$50,0000.00. $50,001.00 to$100,000.00 $771.50 for the first$50,000.00 and$1.25 for each additional$100.00 or fraction thereof,to and includi,$100,000.00. _ S 1011,001.011 and up $1,39650 for the first$100,000.000 and $1.10 for each additional S 100 00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. i TuddingTermit Forms\MecPe•rMtAppPg2 09-01-03 doc FFEB 2 4 2004 Itile Number r, /l q j Glc��,II Witer Cervices ()w ,n,,,,,,;1,,, .,,, <iv,,r. Sensitive Area Pre-Screening Site Assessment 7i c�vd Jurisdiction nate Map & Tax Lot /��, :L`j�Q C�99�^ lwner Site Address7LC�/ 0!_/j,[ te--,41 C/ /Ori q,��c1►s r1G. .� •�cl. /� 7 i( Contact .-- - �,-T- d� . �CI.J Proposed Activity �, F,t�—� - Address Phone ..20 Official use only below 1/11.9 hoe Y N NA Y N NA r, ❑ Sensitive Area Composite Map U Stormwater Infrastructure maps LJ Map#�i-ZICaJ� I OS 9 I l Locally adopted studies or maps Cj Other I ISpecify -- - - � Specify Based on a review of the above information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04-9: I Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properti^s, a Natural Resources Assessment Report may also be required. Sensitive areas do not a ppear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. The proposed activity does not meet the definition ok'development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: i rf"oirolrA „ Je-1,2 1e urea e Q�pec/• Reviewed By: Date: Returned to Applica►ri Mair lith_- Corurfer ,55 N F ir%t Avenue, ,ultP 270•H111%horo.Oregon 97124 "7 Phone (503)B4F-3553•Fax. 15031 848-3525. <,,,,clrun„nian,rn io rn•, E 'd 8426 '66E 'EOS �W t lt,dly R 1.1! e tl � S 11 ) -H11 bll +,,� ud 1 Qjp•�'�' �c�0 21 'DO'', N2 �4 Rel�J DRR/N�, TO 7-1 C /N 7') ' I (r/l�!�1Gf D!•��}I n!� � 2 8 '2 STDk*( ice 12`-Cd' 0` s (R: +146 ADT a ,TI U- KPS Mpnz-f ;fUT jn,rr 60007--f', ?Ofd CITY OF TIGA RD - SITE PLAN REV I F%k' F BUILDING PERMI-I NO.: 3 I'LANNIN(i DIVISION: Required SclKicksApproved [3 Not Appic-.-d (,.@.irj--w: Rear; ri-wit. —.0 Visual CleArwice: Af)p!C,%Cd ?Jett A p, fect CW's ye.; ❑ Lj I,.IN()IN 1 1.) 1',11; 1 \J k".,Y: At;lcal Approved ❑ Not Approved site III ApprovtA ol;Approvcd Date: 2 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP _ -- Received Date Requested _ AM __ PM __—__ BUP —_ Location Suite —_ MEC ----_--- � �- = i G Contact Perscn — _ __.__ Ph ( ) �_ PLM _- Contrartor Ph SWR _— -- BUILDING Tenant/Owrer __-_--_—_ ELC Footing ELC Foundation Access: Fig Drain ELR Crawl Drain Slab Inspection Notes: �`� Y SIT Post& Beam - -- -- Shear Anchors ^ -- _ Ext Sheath/Shear ---- Int Sheath/Shear Framing --- ----- pp - ----- Insulation Drywall Nailing Firewall Fire Sprinkler - --- Fire Alarm Susp'd Ceiling ---- - -- Roof 1A, - -- Other: �- - ` _phiSS PART FAIL PLUMBING --- — � -- - - —^- ----- PL_UMBING — ��-- �Q --- -- --- Post& Beam Under Slab - - r-- -- Rough-In Water Service - -------- \ ` pp \ ` Sanitary Sewer C� "�'� \` J l�� V41 0 '-s Ruin Drains -ly\ J Catch Basin/Manhole V�kv' Q \`I� �L7 }� -t IM I N��--__--- Storm Drain -- ---- -- Shower Pan Other: --- ------. in _ _PART FAIL ---- ---- -- --- --- ---- — MECHANICAL — Post&Beam Rough !- --_-- Gas Line Smoke Dampers --- -- - �- — - _t PART FAIL Service Rough-In - UG/Slab I Low Voltages `\ ------- - --- -- - - ----------- Fir At urn N ' inal Reinspection fee of$ __.--_—__ required b,fore next inspection. Pay at City Hall, 13125 SW Hall Blvd. `-11y PART FAIL p Unable to inspect-no access SITE _ Please call for reinspection RE: __.___-_- P Fire Supply Line / ADA Data 'Z �� Inspector'" �,� ��.�-- Ext PP A roach/Si ewalk Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL