9595 SW LEWIS LANE-1 I ;
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LEGAL DESCRIPTION
EXISTING DOUSE I LOT 1, SUBPLAT OF RUTH ADDN.
I CITY OF TIGARD, WASHNGTON CO. OR.
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I TTIGQASRD, OR.97223
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NOTICE: IF THE PRINT OR TYPE ON ANY � I I I I I ( � ( I I � I I J j I I 11 1�1 III I ( I I ( i III V I I I .r.(-L > L� I� �� rlrl -� I r r r r .-1 7 i� I ' 1 I f I r. r � I I I
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E S NOT AS CLEAR A� HIS NOTICE, 2 4 �� 6 $ - 1� I 1 Iz
IT IS DUE TO THE QUALITY OF TFiE No.ss
ORIGINAL DOCUMENT -
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9595 SW LEWIS LN -
G A R D P MASTER PERMIT
CITY OFT �/ PERMIT#: MST 1999 00159
DEVELOPMENT SERVICESc� DATE ISSUED: 5/6/99
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-417
SITE ADDRESS: 09595 SW LEWIS LN al PARCEL: 1S135CD-03600
SUBDIVISION: PI-171 ZONING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Single-family addition
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS_ REQUIRED
CLASS OF WORK: ADD HEIGHT: 18 FIRST: 875 of BASEMENT: If LEFT: SMOKE DETECTORS: Y
TYPE OF USE. Sf rLOJR LOAD: 40 4cCONTJ 575 of GARAGE. of FRONT: PARKING SPACES:
TYPE OF CONST 5N DWELLING UP;IS: 1 FINBSMENT: of RIGHT: 5
VALUE: $100.978 00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: of REAR: 45
PLUMBING
` SINKS: WATER 1:LOSETS: 2 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
L AVATORIES: 3 DISN✓JASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: I CATCH BASINS:
TUSISHOWERS. ! G'.ABAGE DISP: WATER HEATERS: WATER I-INES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL S"YPEI; FURN<100K: BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER.
FURN—100K: UNIT HEA)ERS. HOODS OTHER UNITS:
MAX INP. btu F-OOR FURNANCES: VENTS. 5 WOODSTOVES: GAS OUTLETS:
_ ELECTRICAL _
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS 0 200 amp: 1 0 200 atop: WISVC OR FDR: 1 UMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 400 amp. 201 400 pmp: 1y1 WIO SVC/FDR. SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 - 600 amp. EA ADUL BR LIR SIGNALIPANEL IN PLANT:
MANU HM/SVCIFrH: 601 - 1000 amp 601-amps-1000v: MINOR LABEL.
1000+amplvoll
PLAN REVIEW SECTION
Reconnect only: —4 RES UNITS: SVCIFDR-225 A.. ,600 V NOMINAL. CLS AREA/SPC UCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL _ B.COMMERCIAL_
AUDIO R STEREO. VACUUM SYSTEM. AUDIO B STEREO. FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM. OTH: 8011-ER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK INSTRUMENTATION: MEDICAL: OTHW
HVAC. DATAITELE COMM NURSE.CALLS: TOTAL N SYSTEMS:
Contractor: TOTAL FEES: $ 1,018.48
Owner: This permit is subject to the regulations contained in the
LEWIS.SEAN M+JANEL K OWNER Tigard Municipal Code,State of OR Specialty Codes and
9595 SW LEWIS LN SIGNED RESPONSIBILITY FORM all other applicable laws All work will be done in
TIGARD,OR 97223 IN FILE accordance with approved plans This permit will expire if
work is not started within 180 days of issuance,or if the
work is suspended for mole than 180 days ATTENTION
Phone: Phone Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Reg 0: forth in OAR 952-001-0010 through 952-001-0080 You
may obtain copies of these rules or direct questio,I;to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion 844-8444 Undelf:,)or insulation Electrical Service Electrical Final
Footing Insp Crawl Dr•1in/Backwater Electrical Rough In Mechanical Final
Foundation Insp PLM/Under"oor Framing Insp Plumb Final
Post/Beam Structural Mechanical Insp Insulation Insp Final inspection
L—Post/ m Mech'a' Plumb Top Out Rain drain Insp Building Final `
Issu B __ Permittee Signature : 1
y �3
�— Call (503) 639-4175 by 7:00 p.m. for an inspection needed the(nex business day
CITY'OF.TIGARD Residential Building Permit Application Plan('I`Jck#
13125 SW HALL BLVD. Additions or Alterations Recd By� -
— fir j
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date Recd
Date to P.E.
V 503-639-4171t7��1
F 503-684-7297 Permit# N! `�'�� /►'� ,''I
Print or Type Called_v-7
Incomplete or illegible applications will not be accepted p ��
y S .oma
Name of Project Name
Job1_n►t �r-iaDEL r>`l, SuEA- _ --St r`
Architect Mailing Address
Address Site Address -� e V.,
1!)'P_1 .1s.L.a. Elwtt.5
--- --
Name -City/State Zip Phone
ii L1 '-t'72Z i in,
Owner Mailing Address Name
City/State ZIP
Phone
Engineer Mailing Addniss
ZL3 l��`� yt-,7 , Cit�dState
General Name Zip Phone
Contractor Desc ')e work New O Addition Alteration O Repair O
Mailing Address to be me: _
Prior to permit Additic,nal Description of Work:
issuance,a copy City/State Zip Phone
of all licenses
are required if Oregon Const.Cont.Board Exp.Date PROJECT
expired in COT Lic.#
database VALUATION t
_ _
Mechanical Name NEW CONSTRUCTION ONLY:
Sub- �_'I��- << Sq. FL Houser Sq. Ft. Garags
Contractor Mailing Address 1410
Prior to permit Indicate the restricted energy installation by the electrical
issuance,a copy City/State Zip Phone subcontractor in the following areas
of all licenses Restricted Audio/Stereo
are required if Oregon Const Cont. Board Exp.Data; Energy System Aft3rms
expired in COT Lic# Installations Vacuum Irrigation
database S stem System
Plumbing Name - (check all that other:
Sub- r)1i-11,Lr--_ ' a I
Contractor Meiling Address —� Corner Lot Ig Lot YES NO
(check one check one
Has the SubdivItinn Plat recorded? N/A YES NO
Prior to permit City/State Zip Phone
issuance,a copy
of all licenses are Oregon Const.Cont Bosrd Exp.Date
required if Lic* -
expired in COT I hearby acknowledge that I have read this application,that the
database Plumbing Lic # Exp. Date information given is correct,that I am the owner or authorized agent
of the owner,and that plans submitted are in compliance with
-Oregon State laws.
Name Si lure of O ner entVWD t
Electrical 'i�S f �- _
Sub- Mailing Address C nt c F' _ yamp
l . L_eu)I j �O t'Il
Contractor
oz
City/State Zip Phone
Prior to permit
issuance,a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const.Cont Board Exp Date plat#: MaplTL#:
required if Lic#
expired In COT
database Electrical Lic # Exp Date Setbacks: Zone 1 Solar
Electrical Supervisor Lic p Exr; Date Engineering Approval: Planning Approval TIF:
i'\dsts\formslsfaddalt doc 11/20/98
Perini, #: 1=
9s GN
Isst cd by:
-T —
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Lmv, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
.follovt-ing statement before a building permit can be issteec�. This statement is t equired
for residential building, electrical, rrtec•hanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not sub►nit this statement. This statement will be filed with the perinit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 313:
I own, reside in, or will reside in the completed S11-1.10111'e'.t2. I
understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
E 3A. My general contractor is —
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
13. 1 will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
1 hereby certify that the above inforrn.ition is correct and that I have re.ui.incl clo understand the Information
Notice to Property Owners abou Construction Responsibilities on the reverse side of thi for �.
5
- — — ---
ISicnature o ermit a licant) ate)
p pp
(White copy to issuin-agency permit,ile,
pink copy to applicant)
Information Notice to Property Owners
About Constructiran Responsibilities
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EMPLOYER RESPONSIBILITIES:
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f!titrl ('111'tl 11Y
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t lregoll's WithholtlltIg fila Ill I%; .l';'ill CIll11li11'Nf,\'tnr !nt l,'t 1'l'0111111 1111111:!1.1co/1l(' In`f frnnl 1''11)111rn-'e ivri«t'•;'1t till f;n
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itil'or"miion, +- i1i t "' ();egotl l) (fit 1 R Citu1' :11
t�Ilenlplllymunt lntiltl'llnce tax: 1)11>. . 1!tlr't.(1 1� ( . r , l i!, r iirir r.,r,.� Ill u, 111 Il!.
t(•',• 11t all c`rnlllrlvcr,. Ful-nifAt.-information,call the 4)Pt:1 Oil E?rr1p10YIPAIt 1 o1,,lun x ilic I k?pivinictit(,l 110ill,ul}2( •1111"'
;It 37fS-X524,
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I
U.S.Internal Re%'enue Service: As an unplo• c1.',(Al rlfust viiIthlwld Ied(:r.11 irlculua t,lx Fit ltl<>1t111Ir,f'(:e+s (il. �rtYl ��%111 11(
li;iliile for thvt'ak PaVthtnt I acbi lllj v,ithhclid the twt For riwi-e irlOirmiuon,C;ilf ilf(, lrlt('r-rial he'.cnnt ''1rrvi.-,
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OTHER RESPONSIBILITIES AND 141'tEAS OF CONCERN:
s
>dectlrnpliance: A, Ih1`pr:i-v ul ltnl(Ict I�ortllia 111'r1rC1• (r1r , . I ,ricn1•,
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f )shill(;- !and property damage itwuralnc.e: C:unulo .11:011 tu�4'12 11k.
Itl(:nl, :Intl t.`niissiutl> ,uch as falling took,(111111 (11e1G11111l . 1101('1 li.11'lilp( Ir'llill P111' It11111.1U11'7, lUT Uf F"✓;.lr. (1181 111'1'-I
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V-4prrtke: NIA e111:ll'e'fir—i,rrrriiQ(-ti-it 1-t'.1(41rr111't1RCtit,rilcr'ntrioor toco(,,elitl:!t!lth •tcr4,tifn'11-11 itl;in-liitli:l,
I r;tde�, ;1!111 1n 1111111Y('11111(1111€t h ricil4k :It the :11ir11rnlitialf tim";111 tht \'cml rt>rfomi tliP 1"('nnit-•`tI 1tt�rPr't I11t1C.
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50/3lti -to.,) 1. I'he Bo;'tlf 1� lc„ sited it 700 Sumnict '�1 'VI- finite ;t.Mi, in Salem.
(1rr,p.,o1 if ring,
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit #: MST1999-00159
Date Issued: 516/99
Parcel: 1 S135CD-03600
Site Address: 09595 SW LEWIS LN
Subdivision: RUTH
Block: Lot: nn1
Jurisdiction: TiG
Zoning: R.4.5
Remarks: Single-family addition
Your company has been indicated as the electrical contractor for the permii 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
Firm prior to the start of the 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
OWNER: ELECTRICAL CONTRACTOR:
LEWIS, SEAN M + JANEL K OWNER
9595 SW LEWIS LN
TIGARD, OR 97223
Phone #: Phone #:
Req #:
. 1
1
X /
SigdtJ re of Supervising efibeTrician
1' J
If you have anv questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Plumbing Signature Form
Permit #: MST1999-00159
Date Issued: 5/6/99
Parcel: 1 S135CD-03600
Site Address: 09595 SW LEWIS LN
Subdivision: RUTH
Block: Lot: 001
Jurisdiction: TIG
Zoninq: R-4.5
Remarks: Single-family addition
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work .
No plumbing inspections will be authorized until this completed form is received
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER: PLUMBING CONTRACTOR:
LEWIS, SEAN M + JANEL K OWNER
9595 SW LEWIS LN
TIGARD, OR 97223
Phone #: Phone #:
Reg #:
Sigf is ure of Authorized t ber
i /_,ase return this completed form to the address above.
Sig(
ATTN: Building Dept.
If you have anv questions, Dlease call (503) 639-1171, ext. # 310
CITY OF TIGARD 24-Hcur
BUILDING Inspection Line: (503)639-4175 MST ' O2,C �
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received .___- _ Date Reque ted.-__ _ a AM____ PM BUP
Location Suite— --- MEC --
Contact Person _ _____ _— ___- Ph(--) -5-2-2- 5 PLM
Gontctor_ __ __-..__.._----...___-_-_----_----__-_._-- Ph (---) - SWR
UILDIN Tenant/Owner - ELC
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
Vire Sprinkler --- - - - -- -- --- ---
f=ire Alarm ;
Susp'd Ceiling —
Roof
Other:
A PART_ FAIL_
ING —- ��- ----- -- -
Pos -m
Under Slab ------------ -- ---
Rough-In
Water Service
Sanitary Sewer L�
Rain Drains — --
Catch Basin/Manhole r //1V "J
Storm Drain -- ---
ShowerPan
al
AS _.PART FAIL - — -
- — -- --
ANIC
os -beam
Rough-In -- _
Gas Line -
SmQke Dampers -
Silial.
MSS MART FAIL ---- -- - - --- - - ---ELECTRICAL)
Rough-In
UG/Slab ___ ------ —_ _-_---- ----..�__-----------
Low Voltage
AlarmZ=MI -- -- --- ---
.fiWL
S_')PART FAIL `� RFinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S TELJ Plea,e call for reinspection RE:—_--_—_-__.______.__ —_ L] Unable to inspect--no access
_-- -----
Fire Supply Line
ADA IfAte
Approach/Sidewalk . _. Z Inspector- _--� 1L --- _-- Ext
Other:
Final 00 NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY
OF a�IGARO -� MASTER PERMIT
PERMIT#: MST2002-00260
DEVELOPMENT SERVICES DATjD ISSUED: 7/30/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171
SITE ADDRESS: 09595 SW LEWIS LN PARCEL: 1S135CD-03600
SUBDIVISION: RUTH ZONING: R-4.5
BLOCK: LOT:001 JURISDICTION: TIG
REMARKS: Structure modification. changing roof line and adding 1 door and 2 windows
BUILDING _
REISSUE: STORIES: FLOOR AREAS - REQUIRED SETBACKS REQUIRED
CLASS OF WORK: AI T HEIGHT: FIRST: at BASEMENT: at LEFT: SMOKE DETECTORS:
TYPE OF USE: Sr FLOOR LOAD: SECOND: at GARAGE: of FRONT: PARKING SPACES
TYPE OF CONST: SN DWELLING UNITS: FINBSMENT: at RIGHT:
VALUE: $15 00n CO
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 000 at REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR- GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN c 100K: BOIL/CMP s 3HP: VENT FANS: CLOTHES DRYER:
FURN—100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: blu FLOOR FURNANCES: VENTS: WOODSTOVES: GAB OUl'LETS:
ELECTRICAL. -
__ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS _Ar.D'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 200 amp: WISVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF- 201 400 amp: 201 400 amp: tat W/O SVCIFDR, SIGNIOUT LIN LT: PEF.HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 600 amp: EA ADf1L BR CIR: SIGNAL/PANEL: 1 IN PLANT:
NIANU HMISVCIFDR. 601 • 1000 amp: 601*ampa•1000v: MINOR LABEL:
1000+amolvolt
PLAN REVIEW SECTION _
Reconnect only:
>=4 RES UNITS: SVCIF DR>=225 A. 800 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED LNERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING+ OUTDOOR LNUSC LT:
nURGLAR ALARM 0TH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER. CLOCK: INSTRUMENTATION: MEDICAL OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 499.94
This permit is subject to the regulations contained in the
LEWIS.SEAN M+.IANEL K OWNER Tigard Municipal Code,Slate of OR. Specialty Codes and
0595 SW LEWIS LN
all other applicable laws. All work will be done In
TIGARD,OR 97223 accordance with approved plans. This permit well expire if
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION'
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Red a forth in OAT;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 Rain drain Insp
Electrical Service Electrical Final
Electrical Rough In Plumb Final
Framing Insp Final inspection
Insulation Insp.,
Issue By : Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspec+ion needF,d the�t business day
All
Building Permit Application
City of Tigard ' Date received:`'1d b7 1 Permit no.: .T .CJC_rJ 4
Address: 13125 SW Nall BI
Project/appl.no.: Expire date:
City rfTigard phone: (503) 639-4171 ' C Date issued: BY: U Receipt no.:
Fax: (503) 598-1960 r C_ Case file no.: Payment type: -
Land use approval: .- 1&2 family:Simple I olnplex: .
war
;Jobaddress:
&2 family dwelling or accessory U Commercial/industrial U Multi-family U New conriniction U Demolition
dditiol alteralion/ryrlaccment U Tenant improvement U Ui,t•,prinklcrhdarm U(flier:Sg S ;�.I v, Lt;y�y 3 L 1,- - 131dg• Suite no.:
7. l.cri: Block: Subdivision: _ Tax fnap/tw, lot/accouni
Project name: --
1
Description and location of work on premises/special tial conditions: �i3Th-ut"64 CA--Ftt? I� L+►J.E
A(1 - P p I�" - -- --- - -
VjfJ M � l t r a L•t-'f
1 "
Namc:
Mailing address: A595 S.l s. LQ ,j% L4. 1 ilk 2 family dwelling:
City: TuA&.tz►, State: 0ZIP: 9,-121.3 Valuation of work........................................ h S, uoa
Phone: 431-'JaV7 fax:`16A 56 Email:
No of hedrooms/halhs.
Owner's representative: Total number of floors.................................
.,i
Phone I;!x: I marl New dwelling area(sq.ft.) ..........................
U Garage/carport area(sq.ft.).........................
r1 rN, e: tee.►l� 5 k'6t a Covered porch area(sq.ft.) .................•.......
ing address Deck area(sq.ft.)........................................
State: ZII . q•Other structure arca is ft.).........................
Phone: it ,te I?-mail: - — Commercial/industrial/multi-family:
t Valuation of work........................................ $
D lJ►�f3Q Existing bldg.area(sq.ft.
Business name: -- - --
--- New bldfr area(sq ftJ
Address: - ---
City: Stale: ZIP: Number of stories........ ...
Phone: fax: Email: Type of construction --
- - - -- Occupancy group(s): Existing''-
CCB no.. -- New:
('itvhnetru tic. n... -
Notice: All co"tractors and subcontractors are required to he
licensed will- the Oregon Construction Contractors Board under
N:unr: provisions o ORS 701 and may be required to be licensed in the
Address: jurisdiction%tiere work is being performed. if the applicant is
City: State: ZIP: exempt from lictzising,the following reason applies:
Contact person: Plan no.: ---
Phone: I Fax: I E-mail: - - --- --
Name: 5Ulr Mt-W, Contact person: k+14 Lffes due upon application ........................... $_ _
Address: 34e>7 et TAum. Dale received: _
--
City: Ftp State: . ZIP: 7101 Amount received _ _
Phone: 2211-17403 Fax: 72.1.178 E-mail: _Please refer to fee schedule
hereby certify 1 have read and examined this application and the Not all jurisOictions accept crcdi!cards,plena call Jurisdiction for mnrr infonnntion
attached checklist. All provisions of laws and ordinances governing this UVsa U Mastercard
work will he complied with hether speqrico herein or not. Credit card nuonber
Explres
Authorized siggature: _ Date: _*1 Z-L&-Z Nante of cardholder as shown on credit card
Print name:
Lai J13 $
Cardholder dRneture Amount
Notice:This permit application expires if a permit is not obtained within 190 days after it has been accepted as complete. aao�u(&WICoM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.: _
Associated permits:
City n/Tigard Cit ' g of Tigard and
� I U Electrical U Plumbing. U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97, "{ UOther:
Phone: (503) 639-4171
Fax: (503) 508-1960
'I IIE FOLLOWING UIEMS ARE REQUIRED FOR PLAN REVIEW
I Land use actions completed.Sec jurisdiction criteria lirr concurrent-r-cviews.
2 'honing.flood plain,solar balance points seismic soils designation,hstoric district,etc.
3 Verification of approved plat/lot.
4 Fire district _---approval required.
5 Septic system permit or authoriz ition 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 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 be incorporated into the plans or on a separate full-sine
sheet attached to the plans with cross references between plan location and details. Plan review cannot ho completed
if copyright violations exist. __—
I 1 Site/plot plan drawn to scale.'rhe plan must show lot and building setback dimensions;property comer elevations(if'
there is more than a 4-0.elevation differential,plan must show contour lines at 241.intervals);location of casements and
driveway;fcxrtprint of structure(including decks);location of welIs/septic systems;utility locations:direction indicator;lot
area;building coverage area,percentage ofcovcmge;imperviuu,area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs a,td reinforcing pads,connection details,vent
size and bunion. _
I ; Floor plans.Show all dimensions,room identification.window size,location of smoke detectors,water heater,
fumace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show all framing-member sires and spacing such as floor 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,roo"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 cle,,ations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is great„r than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross reference, 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 standards.
17 Floorlroot 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,we 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 feet long and/or any beam/joist carrying a non-uniform load. _
20 Manufactured floor/roof truss design details. _
21 Fuergy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more arrliances.
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
architect licensed in()regon and shall be shown to be applicable to the project under review.
23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x I I"or I1"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 be not accepted.
26 "Reversed"building plana 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 car Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 4404614(~'OM)
Electrical Permit Application
Dateieceived; — Permit no. %'a � ' D✓��t(p
City of Tigard Project/appl.no.: _ Expire date: __-
f Address: 13125 SW Hall Blvd,Tigard,OR 97223 Dale issued: Ily: Receipt nu.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-farniiy U'renant improvement
U New construction U Addition/alteration/replacement U Other: U Partial
JOB SITE INFORMATION
Joh address: Ci$q5 S.w. �.6tv.S (.�.1, l 0�. ltldl•nu.: Suite no.: Tax map/tax lot/nccount no.:
Lot; I Block: Subdivision: __- —
Project nam Description and location of work on premises: Rov� to Ve,s_�GCsNZs
Estimated date td•rnmpletionhns eclion:
Job no: Fee Max
- -- lles_criplion Qly. (ea.) Total no.blip
Business(tame: .)IJ _- New residential-singleormulli-family per
Address: _ _ dwellingunh.lncludesattachcdgnrage.
City: State:- ZIP --- Seri let Included:
1000sq f L or less
Phone: Fax: E-mail: -- -- -
- Each additional Six)sq.ftor portion thereof
CCB no.: Elec.bus.lic.no: Limited energy,residential _ '-
City/metro lic,no.: _ Limitcdenergy,nnn-residential 2
Each manufactured home or modular dwelling
Service and/or feed cr 2
Signature of supervising electrician(required)
i)mr —
I,icensenu. Services or feeders-Installation,
Sup.sleet.name(print). alteration or relocation:
2(x)nntps or less _ _ 2
201 amps to 400 amps -'
Name(print): SFIAal t.sl5 - 2
401 amps to 60(1 amps
Mailing address: $9S S jP. lawj,3 LAI, 601 amps to l(NK)amps '-
City: ¢a Slate:. ZIP: '12-L3 Over I(xx)amps or volts 2
Phone: -546'"1 Fax: E-mail: — — Reconnect only I
Temporary services or feeders-
Owner installation:The installation is being made on property I own Instalist ion.alteration,orrelocation:
which is not intended for sale,lease,rent,or exchange according to L1x)stops or less
ORS 447,455,479,670V101. 201 amps to 4( -Ps
Owner's s' nature: �e 4 Date: S 22 O L 401 to 600 ams>D 4(F
--
Branch circuits-new,alteration,
or extension per panel:
Name: A. Fee for hranct circuits with purclmse of
Address: service or feeder fee,each branch circuit — 2
Cil A — T State:— ZIP: B. Fee for branch circuits without purchase
y ----1-' of service or feeder fee,first branch circuit: 2
Phone: --- hax: I Mail: Each additional branch circuit:
Misc.(Service or feeder not Included):
Each pump or irrigation circle 2
Fltrvice over 225 amps-conunercial U Health-care facility --- — 2
ervicemer 320 amps-rating of 1&2 U Hatardouslocation Bach sign or outline lightingmilydwellings U Building aver 10,(xx)square feet four or Signal circuit(s)or a limited energy panel.
U System over 600 volts nominal more residential units in one structmc allot tion,orexrenxion• 2
U Bu;lding over three stories U Feeders,400 amps or more •Ihscnption: — — —
U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over flit allowa'.te In any of the above:
U F.gress/lightingplan U Other Per inspection
Submit--sets of plans wtth any of the above. Investigation fee
The above are not applicable to temporary construction service. Other _
Permit fee.....................� ----
Not all jurisdictions accept credit etude•pleax cull jurisdiction for mote informudion. Notice:This permit application plan it.'fee..(al .__ °/...
U visa U MasterCard expires if a permit is not obtained
___L[_ within IRO days atter it has been State surcharge(8°k-) ....
Credit cord number —�_---- -- Expirca accepted as complete. TT Ah ......................
N .
__
— ame of c--srr Ider sr s own on credH card
- - —
Mo li(60WOM)
Cardholder signature
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVE[, -RESIDENTIAL ONLY
p Restricted Energy Fee..................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total
Check Type of Work Involved:
Residential-per unit
1000 sq it or less $145 15 4 ❑ Audio and Stereo Systems*
.Each additional 500 sq fl or
portion thereof _ $33.40 1 ❑� Burglar Alarm
Limited Energy $75.00 _
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener'
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less _ $8030 2
201 amps to 400 amps $10685 2 Vacuum Systems'
401 amps to 600 imps $160 60 2
601 amps to 1000 amps �^ $24060 2 ❑ Other
Oyer 1000 amps or volts _ $45465 _ 2
Reconnect only $6685 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps or less $6685 _ 2 (SEE OAR 918-260-260)
201 amps to 400 amps $10030 2
401 amps to 600 amps _ $133 75 2 Check Type of Work Involved.
Over 600 amps to 1000 volts, --__ _ .
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel ❑ Boiler Controls
a)The fee for branch circuits
wlflh purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $665 2 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Instalia+on
First branch circuit _ $4685
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous
(Service or feeder not included) instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting _ $53.40 Intercom and Paging Systems
Signal dreuit(s)or a limited energy
panel,alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels(10) _ $125.00
Each additional Inspection over ❑ Medical
the allowable In any of the above ❑
Per inspection _ $6250 Nurse Calls
Per hour $6250
In Plant _ $73.75 _ �❑ Outdoor Landscape Lighting"
Fees: Protective Signaling
Enter total of above fees $ Other
8%State Surcharge $ _Number of Systems
25%Plan Review Fee
See"Plan Review"section on $ No licenses aro required Licenses ire required for all other installations
front of application, -
- Fees:
Total Balance Due $
------ Enter total of above tees $
❑ Trust Account#
---- 8%State Surcharge $
All New Commercial Buildings require 2 sets of plans. Total Balance Due
i:\dsts\forms\elc-fees doc 09/30/01
Plumbing Permit Application
Date receive, Permit no:1j f 2C) � -0O 2 4
City of 'Tigard Sewer permit:u.: Building permit no.:
Address: 13125 SW Hail Blvd,'1'ig:ud,OR 9722:1 pruject/appl.nu.: Expircdate
City of Tigard Phone: (503) 639-4171
Fax: (503) 599-1960 Date issued: —_ lty: Receipt nu.: —
Land use approval Case file no.: Payment type:
7UNcw
2 family dwelling or accessory U Commercial/industrial U Multi-family LI Tenant improvement
construction U Additionlalteration/replacement U Food service U Otter: —.
pde� oo Fee ea. Total
lob address: �S�5 S.t.�- l.taw,s �►�- "�'ial►T� �C
- ------ New 1-and 2- y dwellings only:
Bldg.no.: -_—� Suite no.: (includes loon.for each utility connection)
Tux mapltax lot/account no.: SFR(I)bath
---_— Blcxk: Sulxlivtston: SFR(2)bath
--�---- —
Project name: - SFR(3)hath
--- kSN• Zi �Zti3 F,ach additional bath/kitchen
City/county:
Site utlllties:
Description and location of work on premises: Catch basin/area drain
Ur_-H0 6-4,•.e or 1 ruaf stwt-�tR��sa Ya—isT _.
Drywells/leach line/trench drain _
Est.date of completion/inspection: Footing drain(no.fin. ft.)
Manufactured home utilities
Business name: Dl,���eR- __- �_ Manholes
Address: Rain drain connector _
City: State: ZIP_ Sanitary sewer(no.lin. ft.) _
Fax: Email: Storin sewer(no.lin. ft.)
Phone: Water service(no.lin.ft.)
CCB no.: Plumb.hus.reg.no: -__ _ _ _ Fixture or Item:
City/metro lic.no.: Absorption valve
Contractor's representative signature: _ -- Back(low preventer — -
Print name: Date: Backwater valve
Basins/lavatory
Clothes washer
Name: Dishwasher __ _ _
Address: _ Drinking fountain(s)
City: LIN: 1;jectors/sump _
Phone: — F:tx: E-ntatl: Expansion lank _
Fixturelsewer cap
Floor irains/0oor sinks/hub
L�Phone:
_�_,-- - - Garbage disposal
s_ _ ___-.._. Hose bibb _
State 7.- � e trap
Owner intaation/residential -mintenance only; The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the pmprrl wn a�rpRS Chapter 447. Sink(s),basin(s),lays(s)_
r Date: s 2L a2 Sump _ --
Owner's signature Tubslshower/shower pan
Urinal
Name: _ _ Water closet—
Address_ —� Water heater - _ --
State: ZIP: Other:
Phone: Fax: Eail: total
- - -mMinimum fee................$
Na all iuriedlctions rxepse t credit cents,pleacall i"'i'dicti m rM mae Infrnmetlo^. Nn�; c; this permit application Plan review(at __ %) $
0 visa u MeatetCard expires if a permit is not obtain.:d Slate surcharge(896)....$ _
Credit cord number: --1 -1-- within 180 days after it has h-,en
Expires accepted as complete. TOTAL .......................$ .— --
Name of cardltoldrr as Chown wo credit card s
---— Cardholder eipWure Amount — 44046I6(4ala/,'nM)
L_—
PLUMBING PERMIT FEES:
PRICErAM
TAL New 1 and 2-family dwellings only:
:FIXTURES individual) QTY ea OUNT (Includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY jea) AMOUNT
Lavatory - 16.60 for each utility connectioA___
- One(1)bath _ $249.20
Tub or Tub/Shower Comb. 16.60 Two 2 bath _ $350.00 _
Shower Only 16.60 Three(3)bath $399.00 l �
Water Closet 16.60 TO
_ _SUBTAL
Urinal 16.60 _ 8%STATE SURCHARGE _
Dishwasher 1660 - PLAN REVIEW 25%OF SUBTOTAL_
Garbage Disposal 1660 ___- _ _� TOTAL
Laundry Tray 16.60
Vashing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater O conversion O like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
ermit -` Capped
MFG Home New Water Service 46.40 Sink _
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only_
Drinking Fountain 16.60 Water Closet
Urinal _
Other Fixtures(Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray _
Washing Machine
Floor Drain/Sink: 2"
Sewer-1st 100' ss o0 3" _
Sewer-each additional 100' 46.40 4"
Water Service-1st 100' 55.00 Water Heiter _
Water Servi each additional 200' 46. - Other Fixtures
rq-
40
_ _ _ _ (Specify)
Slotm&Rain Drain-1st 100' 55.00 _
Storm&Rain Drain-each additional 100' -
Commercial Back Flow Prevention Device 46.40 -
Residential Backflow Prevention bnwice• 27.55
Catch Basin 18.60
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections pr/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 _ -
Grease Traps 16.60 - -- -
QUANTITY TOTAL
Isometric or riser diagram Is reouired If
_ Quantity Total Is >9
"SUBTOTAL --- -
8%STATE SURCHARGE --- -
"PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture t .total Is>9
CTOTAL - S
"Minimum permit fee Is$72.50+8%state surcharge,except Residential Backhnw
Prevention Device,which is$36 25•8%state surcharge.
""All New Commercial Buildings requl-e 2 sets of plans with Isometric or riser
diagram for plan rsvlew.
1\dsts\forms\plm-fees.doc 12J26/01
Mechanical Permit Application
Date received: Permitno.:y� c��l a ��at� r✓d
City of Tigard Project/appl.no.: Expire data':''
Ciryof7igord Address: 13125 SW Hall Blvd,Tigard,OR 77223 - -
Phone: (503) 639-4171 Dote issued: __ By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment;ype:
Land use approval: Building permit no.
;6 1 & 2 family dwelling or accessory U Commercial/industrial U Multi-family U T,.,nant improvement
U New construction U Addition/alteration/replacemcnt U()tier: _
Job address: 1'515 Lo, TVPRt)"�_ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value ol'all mechanical materials,equipment,labor,overhead.
Tax map/tax lot/account no.: - --- profit. Value
Lot: I Block_ Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ASH . 7_IP: di (2'L3 ok-Alls Ism
Description and h,c:aion of work on premises:__
GuD�-AVE u C m 4PA-0 Gycc oSSd(Su Fee ea.
�_�..�'� l ) Total
Est.date of conthletiott/insl;eriion: Description (11 . Res.only Res.onl
Tenant improvc,ncnt crt ch•mge of use: C'
Is eximin ace heated or conditioned'. U Yes U No An conditioning
unit CSM
g�'p• ) Air con itioning(site plan require ) _
Is existi;ig space insulated?U Yes U No Alteration of existing HVAC system
oiler compressors --T
State boiler permit no.:
Business name: �,V�(� _ , __ HP Tuns. BTU/11
Address: -ire/smoke dampers/duct smoa etectot:s
City: --^ Stale: ZIP: _ _ Ileal pump(site 0Tan rrequirecT)-
Phone: rax: I:mail: _ Install/rep ace furqace burner_, fT 1
IFT
Including ductwor'c/vent liner 'J Yes U No
CCB no.: -_ _ _ Install/replace/relu alelic:itero--sup;en e ,
Cily/mcfro tic. no.: - __ wall,or floor mounted
Name(please print): Fent for appliance of er than furnace
e goat on:
Ahsorptionunits BTIJ/H
Name: Chillers—�_, __-__ _ IIP
-- - �_ - (bm ressors HP
Address:
;nv ronmenta exhaust and ventilation:
City_ State: ZIP: Appliance vent
Phone: I ;tx: t;:-mail: Dryer exhaust
all [foods,Type I res.kitchen az.mat
hood fire suppresFion system
Name: 1515P rJ i_Ea. S Exhaust fan with single duct(hath fans)
Mailing address:
-t xhaust system a art from healing of AC
jam,1's oxj) .
City: - Stale: ZIP: -- Fuelpiping an distribution •(up to outlets)
fypc: LP(; NG —_ Oil _
Phone: Fax: I G mail: I Incl piping each additional over 4 outlets
Process piping(schematic required)
Number of outlets _
Name: Zl; er sl app glace or equ perms nt:-
Address: Decorative fireplace
City: State: ZIP: Insert-type ._
r Phone:^ Fax: E-mail: O r Woo
stove pe et stove
Applicant's signature: ,�, Uate: S Z 0'� Other:
y
Name (print): -5
Not till jurisdiction accept credit cards,ple-.w call jurisdiction for mme mf;Wnetton. Permit ice................. ...$
U visa U MasterCard Notice:'Iles permit application Minimum fee................$ _
e redo caro number'
expires if a permit is not obtained Plan review(at _ %) $
- - -._ ---�—L—
Expires within 180 Mays offer it has been
Name of ctirdtis holdet shown:c7 credit card accepted as complete. State surcharge(896) ....$ —
� TOTAL .......................$
—
Cardholder signature— _^_ Amount — 440-4617((d WOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
_TOTAL VALUATION: PERMIT FEE Description: Price Total
51.00 to$5,000.00 _ Minimum fee$72.50 Table 1A Mechanical Code Qty (Ea) Amt
1) Furnace to 100,000 BTU
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 1 ducts 0 BTU+
fraction thereof,to and including including ducts vents 1740
_ $10,000.OU. 3) Floor Furnace
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and including vent 14.00
$1.54 for each additional$100.00 or 4) Suspended heater,wall heater
fraction thereof,to and including 14 OU
$25,000.00. or floor mounted heater __-
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit 6.80
$1.45 for each additional$100.00 or --
fraction thereof,to and including 6) Repair units
12.15
$50,000.00. __
$50,001.00 and up $742.00 for the fiat$50,000.00 and Check at that apply: Boner Heat r
$1.20 for each additional$100.00 or For Items 7.11,see or Pump Cond
fraction thereof. _ footnotes below. Camp
^� _ 7)<3HP;absorb unit
Minimum Permit Fee$72.50 SUBTOTAL: $ to 100K BTU 14.00
_�.- ---- 8)3-15 HP;absorb 25 60
- - 8°/.State Surcharge $ unit 100k to 500k BTU
- 25%Plan Review Fee(of subtotal) $' 9)15-30 HP;absorb 35.00
unit.5-1 mil BTU � -
_ Required for ALL commercial Permits on10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU - 52.20
11di sorb
-- -_- - 87.20
unit>1.75 mil B'11 1.1 _
--- 12)Air handling u fit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: 10.00
Value Total13)Air handling unit 10,000 CFM+
Description_ (]t �� Amount_ 1720
Furnace
720Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts_&_vents
10.00
Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct
ducts&vents 6 80
Floor furnace including vent 955 - 6)Ventilation system not included in
Suspended heater,wall heater or 955 appliance permit 10.00
floor mounted heater -- 17)Hood served by mechanical exhaust
Vent not Included In applicance 445 10.00
hermit 18)Domestic incinerators 1740
Repair units --
<3 hp;absorb.unit, - 955 19)Commercial or industrial type incinerator
to 100k BTU
_ 69.95
3-15 hp;absorb.unit, 1,700 20)Other units,including wood stoves
101 k.to 500k BTU _ _ 10 00
15-30 hp;absorb.unit,501 k to 1 2,310 21)Gas piping one to tour outlets
5,40mil.BTU
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU _ 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit tee$72.50 SUBTOTAL: $
>1.75 mil.BTU _ --
_Air handlin 656 unit to 10,000 rim 8%State Surcharge $
Air handling unit>10,000 cfrn _ 1,170 -
Non-portable evaporate cooler_ _ _ 658 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connecter,to a single duct _ _446
Vent system not included in 656 -
a liance permit
-Hood
Other Inspections and Fees:
Hood served bymechanical exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours)
Domestic Inc_ nerator _ 1,170 $62 50 per hour
Commercial or Industrial indneretor 4,590 2 Inspections for which no fee is specifically Indicated (minimum charge-hall hour)
Other unit,including wood stoves, 658 $62.50 per hour
Inserts,etc. _ 3 Additional plan review required by changes,additions or revisions to plans(minimum
_ -380 charge-one-half hour)$62 50 per hour
Gas piping 1-4 outlets_ _Each additional outlet` 83 'State Contractor Boiler Certification required for units>200k BTU.
'"Residential AIC requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION: All New Commercial Building, require 2 sets of plans.
i"\dsts\forms\mech-fees.dor 12/26/01
Permit #:
or O
Address:
Issue by: Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential c•on.struction permit appli-
cants who are not registered with the Construc•tirm Contractors Board to sign the
following statement before a building permit c•an he issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exenipt,from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
1. 1 own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is _—
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must he
registered with the Construction Contractors Boarr'.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand they Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
ET
(Signature of permit applicant) (bate)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
Ahcut IConstruclion Responsibilities
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EMPLOYEP RESPONSIBILMEC: !
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liahlt•for Or tm iltlytltrnl ` ,`'n II , ,,1 ,I(1 fill I:.
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OTHER RE"WONSIBiLffIES AND AREAS OF ;ONCERN:
(7mle c(impliancu: r't'e the pr'rnlil h(d'.1cl1'!l i111"rrt l� ;lnc fnihlw t"mcct codf,r('•.Iuirl�_ul'.
that nt,l1 l,c hroughl i!! t(1m,(Itlt'llll(,ll IIII(IIIirh 1141?t`CP1VI11'<
Liabilil', :and proputy dam ige insurance: (.untar.t)1l in,"'ur 110,altcnt to r,cc (f)(,u haVC a161! t(a insw anor
IICCid,.a1., mid omis�,io 1:• such as t:liitllC tu''k, 1,atllt ( \Lt i1!'il}, WittC( (.Ii1111[(g( 6.010 I)II)l' 011la(l1i"t'>. hIC, 01 `Norm thill Ilm'; 1„'
rC-d(11w.
Timm. to sulll vinpluyees: Make curt+yoti have s(t[hit.Icni now I(, kr •,tnlr VIIIJ Iw t`,•',
1?x�terlitic: Mak(•sur,'�(�n tt'1cr thr r�<rrrt+�r r., a•t n��yrur(,wn�rncr�il crrtlrrtrinr,to(vmrrlin;ltc`h('1t�1'rk of r(llrf?h ill;ifld t'ini`:I,
ir;u.lct, atilt to riMI v hr(ilrhnrr At I110 J11r1l'C ii1tP timr,; ll they(-,,III perform the trttnirrd imcprl
It you hm%w addilit,nal yuemions, write or cal! the(:'ontitructna, ('onlracturs i ow-d W( R('x 14140, salcm,(}1t "
503/37 8-Ml I 1 "i he Board i', located at 7W Summer St. NF Suite 3M, in Salem.
1,t'lip-1 ,.t it tem-i
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u
CITY OF TIGARD
August 25, 2004
OREGON
Sean Lewis
9595 SW Lewis Lane
Tigard OR 97223
FIE: Permit MST2002-00260
This letter is notification that the referenced permit for the work at the above address
has not received a final inspection. Since more than six months has elapsed with no
inspection activity, it is assumed that the work has either been suspended or
abandoned and this permit will be expired by limitation as provided in Section R105.5
of the Oregon One & Two Family Dwelling Specialty Code.
Please be odvised that, in the event of a subsequent sale of your home, the lack of
inspection approval for this permit could delay closing. The lending institution and/or the
title company may require proof of a completed permit for such work prior to the sale of
the property.
We will allow thirty (30) days from the date r+f this letter for an opportunity to apply for
reinstatement of this permit for the purpose of final inspection(s). Certain fees will be
applicable at the time of reinstatement.
If you have any questions about the permit or its status, please call Jeanne, Temple in
our office at 503-718-2 433.
S' cerely,
Darrel "Hap" Watkins
Inspection Supervisor
cc: Property File.
13125 SVS/ Hall Blvd., Tigard, OR 97223 (503) 639-4171 TDD (503) 684-2772 —
our
CITY OF
BUILDING ARD 2r sp inspection Line: (503)639-4175 , s -OC) .2 O
INSPECTION DIVISION Business Line: (503)639-4171 �BU?�P' —
/ b
Received __—_ Date Requested____—_ —d, AM —PM — BUP --
Location _�S�_ - 'P,u1 t'� —Suite
`S- / _
Contact Person —_.�_-- __ Ph(__-) 5�'2- PLM -- ---
_. Ph ( ) SWR
Contractor .---_._--.-------- --- - —� -
BUILDING _ Tenant/Owner ELC — ---
Footing ELC -
Foundation Acress:
Ftg Drain ELR —
Crawl Drain SIT _--
Slab Inspection Notes:
Post&Beam _ ---------------- -- _ --
Shear Anchors
Ext Sheath/Shear --—------
Int Sheath/Shear
Framing -- - _--- -----
Insulation
Drywall Nailing ------- - — ^--"- -- - -Firewall
--
Fire Sprinkler ----- --- --- ._---_-_--
---- -------
Fire Alarm --- -
Susp'd Ceiling _-- �---- -- --- J-----
Roof -- -
Other: - ---
Final
PASS PART FAIL - ---- ----- ----^--_..----
. _
_PLUMBING - --- - --__---..--------------.__ _----- - --- - --
Post&Beam
Under Slab --_--- --- - - - - ------- ..
Rough-In —----
Water Service - ---- -- --
Sanitary Sewer
Rain Drains ----
Catch Basin/Manhole ---._ ----
Storm Drain -- -- --- ----------�--- ----
Shower Pan _------- -- —
Other:
__ PART FAIL
M_C_WANICAL �- --- - --- ----- -- -- ---- -- -
Post&Beam
Rough In
Gas Line -_---.--
Smoke Dampers ---- ---- - ____ ---_---------
Final -
PASS PART FAIL ---- _ ------ - - -�
ELECTfI1CAL - --- ---------------_-
Service
Rough-In - ---- - ----------- _ ------ ---_
UG/Slab � -
Low Voltage _
Fire Alarm
Final Reinspection fee of$ required before noxt inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART . -FAIL. _
--- Please call for reinspection RE:_ Unable to inspect-no access
SITE - - -__. __- __ -_
Fire Supply Line '
ADA
Approach/Sidewalk
Date—v r� -- Inspector---`/-- --- _ Ext
--
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171
MST �C��.,�
BUP
Received _ .. Date Requested- UM PM_-_- BLIP -_ -
Location __ � � Suite.- - MEC
Contact Person 'uu-y"v► Ph — PLM
Contractor—_ Ph__ - Ph( ) - SWR _
BUILDING _ Tenant/Owner _ _ ELC
Footing ELC
Foundation Access: )
Fty Drain C U ELR --
Crawl Drain
Slab Inspection Notes: SIT _ -
Post& Boam
Shear Anchu s -
Ext Sheath'Shear
Int aheath/Shear
Framing
Insulation
Drywall Nailing -- -- - ---
Firewall •
Fire Sprinkler - - - - -- -
Fire Alarm
waft—
Susp'd Ceiling -
Roof
r:
�15ASS' DART FAIL -
__ 81NG -- — ---- -
Post& Beam
Under Slab
Rough-In
Water Service -
Sanitary Sewer
Rain Drains — ----- - ---
Catch Basin/Manhole
Storm Drain - --- -- --
Shower Pari
Other: --- -- ---------- - - -----
Final
---PASS-- PART FAIL ---- - -_____--- ---- -- — �--
--
ME_C_HANICAL _ _-- -----.-----___---
Post 8 Beam ----- - ----
Rough-In -----
Gas Line
Smoke Dampers - --- --- ----_-- -- __._.
'inal
PASS PART FAIL
ELECTRICAL
Service
Rough-In -- ---- _ - - - - - --- —--- -- -
UG/Slab
Low Vol ag® - ------- --- ---- _ .-_- --
Fire At r J�
PAS PART Reinspection tee of$ _._ _ ..___--_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
RT FAIL
S E Ll Please call for reinspection RE:-----,—�,� .T Fj Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date w- L' ` _ C' G _ inspect ----- -- Ext ----
Other.
Final DO NOT REMOVE this Inspeeklon reco d f om the job site.
PASS PART FAIL