Permit Mechanical Permit Application ttV FOIL UFI-l( l I sr n�l �
City of Tigard Y_ mt ,�� f1 (�btb2.
1111 q 13125 SW Hall Blvd.,Tigard,OR 97223 AR 4 �e21 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit:
T 1 t.,ti D Inspection Line: 503.639.4175 11`� ..... I I UARU Date Ready/By: Juris: gi See Page 2 for
Internet: wvw.tigard-or.gov 1.III fl!N�( (DIVISION Notified/Method: Supplemental Information
TYPE OF WORE .. .._, ... . - . -, ,, ,.., ,
``r" Mechanical permit fees'are based on the value of the work
❑X New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSI WCFi m .< x 3nxf.r1 ".
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building Forapedai information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea Total
"4 t .,r t ?s t "., r --P, 1•r r �,' - ; Hatin diti o ing:
H ti ' wvt' `° � - `. - Air conditioning 46.75
Job site address: /0 L/ 7 q 'w L.v ( . Furnace 100,000 BTU(ducts/vents) I 46.75
City/State/ZIP: ! ! got re:;(/ 0# Z Z 3 Furnace 100,000+BTU(ducts/vents) 54.91
l� / �y ///��� Heat pump 61.06
L_,.
Suite/bldg./apt.no.: Project name: 1 yr S n ab.2.9 Duct work 23.32
Cross street/directions to job site: J Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other. 23.32
Subdivision Lot no.: r
Other fuel appliances:
Tax map/parcel no.: Water heater I 23.32
.1 s k r, Gas fireplace/insert i 33.39
Flue vent for water heater or gas
HVAC for new construction home fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
._ _i.E...� __ - _ __ -_ /+ _ . .... . Environmental exhaust and ventilation:
Name:: Wg4�7-FWOD/.[ norms p //c T.
Range hood/other kitchen
f d 6 W� Co / J l( M_ equipment dryer
33.39
Address: !i /� Clothes dryer exhaust 33.39
City/State/ZIP: P°C4/;{i4 d 0/2 q/Z2 T. Single-duct exhaust(bathrooms,
-7/-3 '�2q ! ( ) toilet compartments,
an utility rooms) 23.32
Phone: /`�'fl Fax: Aitic%rawlspace fans 23.32
r a Other: 23.32
Business name: QS 00 d 1`1C/ S//v
�6�/,�I ,Ina(/
$14.15 for first four;S4.00i for each additlonal
Contact name: Furnace,etc.
Address: `700 riiW / t/C-// Gas heat pump
tY �/111 Q g7 47 Water i Wall/suspended/unit heater
City/State/ZIP:/State/LIP: Y � Water heaterrFireplace I
Phone: � Gv2qy I Fax::( ) _
E-rnail:.� - / . WOS' et'/ /C(�r�►v ` Barbecue I
Business name: Lakeside Heating& Cooling17.
MECHANICAL PERMIT PEPS*
Address: 7021 SW McEwan Subtotal
City/StateJZIl: Lake Oswego, OR 97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503 ) 635-5253 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 227694 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 160
days after it has been accepted as complete.
Authorized signatures • Fee methodology set by In-County Building Industry Service Board
Print name: Jason Charlton I Date: -3//(/2(1246
I- 13dos 4404617r(11/02/CCWWEB)
Electrical Permit Application FOR OFFICE.USE ONLY
RECEIVE
City of Tigard Receivedt Permit#: K{ST 1t eh sr
• 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 4 2021 Plan Review Related Permit#:
• Phone: 503.718.2439 Fax: 503.598.1960 Date :
Inspection Line: 503.639.4175 .JITY OF TIGARD Ready Date/By: iuris: 0 See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
I II1,fl!NNO Dlti/hlnN
TYPE OF WORK PLAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION - exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
-Ai
of new motor load of system.
Job#: Job site address: 100HP or more. ❑"A",`7;","1-2",`i-3",
City/State/ZIP: ,�q`(,J1 .0 Q— �G ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: r+S (.,na1 ❑Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: /7 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.It.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.8.) 75.00 2
New SFR Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Westwood Homes LLC 200 amps or less 100.70 2
Address: 12700 NW Cornell Rd 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97229 601 amps to 1,000 amps 301.04 2
Phone:(971)678-5018 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
la APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Same as Owner above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service Address: branch orci feeder fee,first 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ross Electric Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ID See Page 2 2
Address:2870 SE 75th Ave#203 panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
�' Additional inspection(1 hr min) 66.25/hr
Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:RossElectric@comcast.net Industrial plant(Ihrmin) 78.18/hr
�1 Inspections for which no fee is 90.00/hr
CCB Lic.: 157891 Electrical Lie.: 34-436C Suprv.Lic.: 42325'�y specifically listed(%hrmin)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Stephen Ross Date: 0 Plan Review Required(25%of permit fee): _
.r State surcharge(12%of permit fee): _
Authorized signature % TOTAL PERMIT FEE:
4;,Print name: This permit application expires If a permit is not obtained within 180
Date:*/ (((( — I J days after it has been accepted as complete.
• Number of inspections allowed per permit
I:\Building\Permits\ELC_PermitApp_EIR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Plumbing_Permit ApplicationEC r /
ED
' Building Fixtures �l l(llz OFF I( E. I sl: ONI m City of Tigard MAR 4 2021 Reeei.ed
Dare/By: 1
Permit No.:r „ 7��`-'J r �-lNisyz
114 a 13125 SW Flail Blvd.,Tigard,OR 97223
_ Review
Phone; 503.718.2439 Fax: sD3.s9a:tsea Y Or TIGARU Pla nuBY: Other Permit No.:
11�;,;1;0 Inspection Line: 503.639.4175 >i ,!I
I IN.- DIVISION Date Ready/BY: hula IS See Page 2 nor
Internet: www.tigard-or.gov Notified/Method
Supplemental Iefo*madoa
TYPE OP WORK . jrEE•.SCHF.DUIE
•
13 New construction 0 Demolition For special information use checklist
Description i Oty. i Ea. I Total
❑Addition/alteration/replacement 0 Other New 1-2-family dwellin
gs(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® I-and 2-family dwelling D Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 1 50032
0 Multi-family
Each additional bath/kiteben 25,02
1 Q Master builder 0 Other: Fire sprinkler( sq.ft)
Page 2
JOB SITE INFORMATION AND LOCATION Site unlides:
Job site address: li'C2(� //4 c 1,t4 L.VC-9 Catch basin or area drain 18.76
6
City/State/ZIP:Tigard OR 7�3 J Footing
Drywall,leach lion or trench drain 18. 2
Footing dram(no.linear ft.:_) Page 2
Suite/bldgJapt.no.: Project name: e(// -S /4na9/2C, Manufactured home utilities 50.03
Cross street/directions to job site: allManholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear It: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: l7 Fixture or item:
Tax map/parcel no.: • Bae*flow pre venter j 31.27
DRWRIPTION OP WORK I Backwater valve 12.51
., . . t ` Clothes washer ( 25.02
i
Dishwasher 25.02
Chinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER . .. .0 TENANT Expansion tank 12.51
Name:Westwood Homes LLC drFixture/sewer tip 25.02
Address:12700 NW Cornell Road Floor
Garbaggee disPal dispo ra sinklftub 25-02
sal ( 25.02
City/State/ZIP:Portland OR 97229 Hose bib
2 25.02
Phone: Fax:(503)342-2403 Ice maker I 12.51
® APPLICA_N!•,.. O icoNVTAcr PERSON • InIercePtor/Vease traP 25.02
Medical gas(value:$ ) P 2
Business name:
Contact name: ^ Primer 12.51
Roof drain(commercial) 12.51
Address: _ Sink/basin/lavatory (1 25.02
City/State/ZIP: Solar units(potable water) 62.54
-Phone: Fax::( ) Tub/shower/shower Pam 3 12.51
"
E-mail
" Urinal 25.02
corrrliAe-r. Water closet 3 25.02
Water heater 37.52
Business name:HMI Mechanical Water WV
PiPuaf� 56,29
Address:5757 SE Willow Lane Other
25.02
City/State/ZIP:Milwaulcie OR 97267 Subtotal
Phone:(503)975-9787 Fax:(503)659-2979 Minimum permit fee: $72.50
CCB Lie.: 178122 Plumbing Lie.no.:(2bL/'il Plan review (25%of permit fee)
State surcharge(12%of permit he)
Authorized signature: ,�i JrA/ ; TOTAL PERMIT FEE
Date Print name:Dus ' a ague
. Mk permit appleo.aoa eTP'� • �i<is sot d wilhlo 280 days
g , / ' sitar it ban berm a4ceptedPr as comph6eobtaine
//// "Fee methodology set by Tri-County Building Industry Service Board
I1BuildinalPerrnicAPt.MU-PermiIApp.doc 10/01/09 440-46i6T(10/02/COWWE8)