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Permit A CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00127 411I DEVELOPMENT SERVICES DATE ISSUED: 6/3/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09235 SW 74TH AVE PARCEL: 1S125CA-08800 SUBDIVISION: ALL TOWN PROPERTIES PARTITION ZONING: R - 4.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: SF detached. BUILDING . REISSUE: MAS1228C STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 17 FIRST: 2,473 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 650 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THR p: sf RIGHT: 5 VALUE: 244 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,473 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOILICMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL /PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : 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 AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: fLL EGO m P BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,197.93 This permit is subject to the regulations contained in the LIFESTYLE HOMES ARNETT CONSTRUCTION COMPAN Tigard Municipal Code, State of OR. Specialty Codes 15450 SW MIDDLETON 15450 SW MIDDLETON COURT and all other applicable laws. All work will be done in BEAVERTON, OR 97007 BEAVERTON, OR 97007 -5181 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 more than 180 days. Phone: 503 644 - 6644 Phone: 503 644 - 6644 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 105058 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 IN Ersn Cntrl 681 -4444 Post/Beam Structural PLM /Underfloor Shear Wall Insp Insulation Insp Appr /Sdwlk Insp Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Rain drain Insp Electrical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final Foundation Insp Footing /Foundation Dri Framing Insp Gas Fireplace Water Service Insp Building Final M i li tA , ( :, - Issue By : ! c �LL- �' Permittee Signature : I �4'�- Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day vao le yvl vl� a (-2 0 a" I Building Per,Lm 1&atlQ C O .. FOR OFFICE USE ONLY ', ' City of Tigard Received �� f Permit DateB (.� Peit No.:�� — ��� 13125 SW Hall Blvd., Tigard,\OR-)97 i� Plan Revie � Phone: 503.639.4171 Fax: `50377.598.1960 p d h' 'i DateB : Other Pern t5Zdie Ara Od l� / Inspection Line: 503.639.41,I5� Y OF IGAR � TIG�t t® „ el 1 Date Ready /By: ® See Attached Checklist for Internet: www.ci.tigard.or.i Notified/Method: , / /� Supplemental Information \ BUILDIN �� f 5 1 s 0� ' t ' iktir OF - z : ' :" t ; ' :k ; G 1 , REQUIRED DATA 1 Ai N' w FAMILY DWELLING . 0 New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the Y. 't ;; � } _ g iNiWaTEGORYkOF.'C*ONARueTION i ,r f' ,, f `' work indicated on this application. Valuation: NO- and 2- family dwelling ❑ Commercial /industrial $ /Gj jp r. / r (��? Number of bedrooms: 5 ❑ Accessory building ❑ Multi - family Master builder r. A i ❑ Other Number of bathrooms: 7� , '' �r ; —, x, , JO B SI LNFO A ND +LOCATIO ; fi t ' ti , Total number of floors: Job site address: gZ35 51,,,✓ 7g fit Ave,... New dwelling area: square feet City /State /ZIP: rlAcl. Garage /carport area: Z square feet Suite/bldg. /apt. no.: / 7 Project name: /L-rf/ if/ /( l Covered porch area: square feet Cross street/directions to job site: Deck area: - square feet Other structure area: square feet l . .2- 0, II2ED ra?A COMMERCIAL USE CHECKLIS. r Subdivision: gezi.ii2 (ZL-ot 4 r A is moo.: / y - / Permit fees* are based on the value of the work performed. ; / Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: 7.i19E9 ,pc, G r ' ice /5/a J 6 O equipment, materials, labor, overhead, and the profit for the R 4 ` g "v ,,,,,,,,,, work indicated on this application. a4 � I a ; DESCRI fT r OF WORK , I , i sS,�aza�', a ' V _:»F...ry .,L; .',„ �rekuae? E ,s�� r. .°.. > g- . ., w m:e _, ;.., ..., �'., r.� �• ..,w a , /� y f /s _ � I » Valuation: $ �/y CL3�y �j Existing building area: square feet New building area: square feet r ` i Tektb TYL,OWNER .',f 4.7: r.. , TENAN ,.4x W i + f! Number of stories: Name: . 4 ,~ S 1 L ! e3 Type of construction: Address: l �r -7 7 - 0 J / e,,� 10 f °A .4 C. Occupancy groups: � City /State /Z1P: R i.t'e el., C �•7 Existing: Phone (l i / ',-10 Fax ( ) New: � i .� v � $;. b �1 s 3 x� x � a� .: � ,, roM -�,. v '.rat � �. KI � APP1t.ICAN 4 , � `, a:�.t.., a 4 CONTACT PERSON � 3 ' + i : } ' .;„ a ' NO ' `` ' Business name: �^ /' ' All contractors and subcontractors are required to be P' licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: apply: Phone: ( 9>S ) (,t./4 • (p(O 4V Fax:: ( ) E -mail: zo-a Ya m 2 �, 3 5 » , rcd 1 w `�$ a t�' 7 z r r t+ * s i- ,, ...:;, t .,, A x " w € x CON RACT® i cR . ,; t a"aa, 0 ; � #3 �' ,i,,'e ; Business name: ,513-11/ L �11 1 i B UIL D ING P ' ' - Address: Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) - � � �� 5-31 Amount received CCB lic.: f�J Date received: Authorized signature: �� �s jiU^ .1", '� G d nei This permit application expires if a permit is not obtained IT / within 180 days after it has been accepted as complete. Print name: mkt ,N 4y/ /hi 1[...� F Date: q 2 1,pi * Fee methodology set by Tri -County Building Industry l l Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T( I I /02 /COM /WEB) One- and Two - Family Dwelling , Building Permit Application Checklist " FOR OFFICE USE ONLY 5 City of Tigard Date/Bed Permit No.: Y 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 Lti 0 01 i '' 24- Hour Inspection Line: 503.639.4175 I ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us " "' ❑ Other: '' N THE FOLLOWING I.TEI ARE'° RE FO RE VIEW - r Yes ' 'No" , N /A:. 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat /lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: • . ❑ ❑ ❑ 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 ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 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 -ft. 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 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, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions 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 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 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ • ❑ systems, see 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 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 be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore:on and shall ll be shown to be applicable to the iro'ect under review. JURI SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. • ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ _ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03 .. Y n Plumbin ECE @�l E Permit Application , -„ FOR oFFJCE USE. ONLY ;.- s =- w City of Tigard Nf 6 �'*t^ 200 Received ,Date/B Pennit No.k,ST \\ - t� d ' # � ^ 7 13125 SW Hall Blvd., Tigard, OR 97223 y g 1G� �tP1an Review Phone: 503.639.4171 Fax: 503.598.1960 C► A I , ' . y Other Pennit No.: 24- Hour Inspection Line: 503.639.4175 1.�2 E • 1 I � , , Date Ready/By: Jig's: See Page 2 far Internet: www.ct.tigard.or.us Notified/Method: Supplemental Information , it 11r4 P, . #, .. '1 C ri c F (' „ h .f a t -�r<: s ?:wn. r .,9rt y � i ``' `w dA"�..t s i., wV r 'stn ,�"` il `' ... .� * +:+ '. t g ��tl Sine :At gTYPE OF4tWORK� i' v t " ' - ,i r ; f .std a r + F w SC71EDULE . . ., i„S��^l ti es �. +` e`;L$..d�� `�,.n. , 1, �''' sus .,< ..1n �-., .,ti . ,x.. �° . Af�s _ , . � .e .: .,, �,.'� ,, _.. .� x..'w . .. � .._.,. - _ _ .- g New construction ❑ Demolition _ For special information use checklist. Description 1 Qty, 1 Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) p fd 0 , s , k is 1 ° a a sn-+. =s..r,� c v � a ' �'�{ 'fi "_'� .,A.i ' t , :r ' :` d�. t CA EGOR <Y O *Iva S RUCT O N ht'Nfeak:V,f S.�. ,.... tr, - SFR (1) bath 249.20 A l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 XMaster builder ❑ Other: t � u 7 ,taa , ,., Fire sprinkler ( sq. ft.) Page 2 eo ai4 , JOB�SITEf INFO =IONI ®CATION O ? , , h: Site utilities Job site address: / Zw- 3 ,,, i °'? ! 4ve„,„ Catch basin or area drain 16.60 City/State /ZIP: / Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities' 110.00 Cross street/directions to job site: Manholes 16.60 , Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: :e. y - 4 ,4 -, J je4 4 j Lot no.: f jre, /2 Water service (no. linear ft.: ) Page 2 /* / ( Fixture or item Tax map /parcel no.: r ��'j /0�� IN �((PC „, Absorption valve 16.60 i �� ; i r DESCRI WORK ' � 6 '_. Backflow preventer Page 2 /4J 1 i ,_ ✓A 7 5 1 eA Backwater valve 16.60 �*fTT ✓� 4 '7 Clothes washer 16.60 Dishwasher 16.60 ,A PEtzw g i 0,r , i ` , TEN7N }� : w Drinking :ta ems 16.60 Name: /- / AS' 4 74 � Expansion tank 16.60 / Address: ) � ' / 99,c) Jetd//g ci- Fixture /sewer cap 16.60 City/State /ZIP: Floor drain /floor sink/hub 16.60 rf� i Garbage disposal 16.60 Phone: ( r l /, koLit/ Fax ( ) • T ,,,,,---.isv , Hose bib 16.60 ' PI f ' LCANT �. F I S T C Z ONA PERS a ,� ��t � .r- Ice maker 16.60 Business name: , ,, 4 f /r- / ig i; • Interceptor /grease trap 16.60 Contact name: �'�/ �"��' ` Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) 16.60 Sink/basin /lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E-mail: �3 Urinal 16.60 ^ v� . . h. t - '.5.s .,i tw k t } CONTRACT .4t „ `. '.� 11, :, , : , , .. , ' rs , _ ;, Water closet 16.60 Business name: A, //.4. / tt, vi j f p / Water heater 16.60 Address: 24/ r � L, t - Oth City/State /ZIP: J y- 7/ 5 ,314.1 ` , f �, Subtotal / / Minimum permit fee: $72.50 Phone: ( .�) i /bay Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: 9 VG/ Plumbing Lic. no.: y12,40 Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: 41Aitt //� TOTAL PERMIT FEE Print name: rd 114L4/44 �6 Date: // `T z1, This permit application expires if a permit is not obtained within / 180 days after it has been acceptedlas complete. *Fee methodology set by Tri -County Building Industry Service Board. is\ Building \Permits\PLM- PemiltApp.doc 12/03 440- 46t6T(l0/02 /COM/WEB) . Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S><te LTtil><>[es 3 Qt Fee(ea > otal Sq uare F ootage a ; fi Perrmit Fee ... -.,m„ , M� L A, 764 t gli �. 1r �.,.w!;�u finer axe... a < , t ,t ° . . d Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each 1 %tll3re or "Itelll y „` Qty, � ` Total j additional clluding $100.00 or fraction thereof, to and Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 " $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including 550,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742,00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . lax> f' "t Quantity "by (Fixture) Work Performed'1 FixureType ° 'o y t*�" L : ,r ,Replace � N li '� `, . , ..aped Comments i ; ommens re ardn � � �Moved� v E:ashn Cap >, 1 regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Permits\PLM- PertnitApp.doc 3/03 . Mechanical Permit Application FOR,oFFICE,USE ONLY' City of tigard Received Pernut No.: ln5r.xo'/- 0049 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review . Phone: 503.639.4171 Fax: 503.598.1960 ‘11 �D „,„,,,l„ 6 "t Date/By: Other Permit: Inspection Line: 503.639.4175 ��� AL: .I�_ Date Ready /By: Juris: 0 See Page 2 for Internet: www.Ci.tlgard.or.US Notified/Method: Supplemental Information ` * § 'T S w )'i4� 'r r0`ta �a s YP E ° OF* W ORK r 4 i' v ' ,. t ` O ' y�r :x Y �e sp E * 5 giX tit;. s ., .. e . ,..:[� s , „ °Ac. _-�� k _,,, ��.i+:�.r,-u .�.",11 ., ,. _: ua.,-_ :in . „Q. s ,k ate. U� _, , . � /. ,; ,,� irv ._ H _ — . , , CST COM FEE SCHEDULE FU SE •C ' New construct ❑. Add 'if /alt Mechanical pei nit fees* are based on the value of the work K. 1 r • pw t` performed. Indicate the value (rounded to the nearest dollar) of all ill Demolition [r i" ' - -. mechanical materials, equipment, labor, overhead, and profit. �� r r Value $ i iir: 'i /51,1 , .., e CAM—Wi OF, CONSTRUC„T10> L " . 0.. . , e, ,. ,, , _: ,,. :. ,.,.. , ,, ), „ i RESIDENTIA L EQUIPMENT / SYSTEMSf FEES* tt.% and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building - For special information use checklist. ❑ Multi- family jMaster builder ❑ Other: Description Qty. Ea. Total is a 1 Zi ' , tz JOB gii- I AND"LOC'ATIOr ° 1 . t i a R Heating/cooling ! y / "7 /J'9' Air conditioning or heat pump Job site address: / � " " / ( (� (requires site plan showing placement) 14.00 City/State /ZIP: 1 1,4, 624 Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 r j/ / Lot no.: Flue /vent for any of above 10.00 Subdivision: �(/,✓1x /V�! y�f �1��'B� Other: 10.00 Tax map /parcel no.: 260g r-e /' Flue vent for water heater or gas Q fiP Other fuel appliances i f ' fili iA l s 1 , e� e ' , i A Water heater 10.00 a . 2 .1.. t . trR .4ta. t � i � .DE CRIPT O OF R'ORIC ��, ,1 : 3. . '.4: .:,, ! �F.:,A . , :z l e d j li4^ Gas fireplace 10.00 . P n ( J {/ / 4 � '� �YL, fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 )4 *ri PROPER Y OW 4`�l yu 4 41 I ' Chimney /liner /flue /vent 10.00 r .._ .R _ ,...., T j . � 21 m.. Other: 10.00 Z4. 5 Name: 4j le- / i, 7 ie Environmental exhaust and ventilation j � � �� CA Range hood /other kitchen Address: r ( e ui p meat 10.00 City/State/ZEE): ;/4415e 977 Clothes dryer exhaust 10.00 / Single -duct exhaust (bathrooms, Phone: (� 2 ) k 1 , , 46 vv .! Fax ( ) toilet compartments, utility rooms) 6.80 F v t� AT ' *" '` � ' ®`CONTACT PERSON "' s i . Attic /crawlspace fans 10.00 - 7:7 �� Business name: 2, 4f �i � / �1 J2 Fuel F 10.00 2,4 4 piping Contact name: + ,@n,— ^ � $5.40 for first four; $1.00 for each additional Address: , /, 1 Furnace, etc. �` c �Z 7�fl��dj� Gas heat pump City/State /ZIP: ei , / 7j" ( Wall /suspended /unit heater Phone: ( ) L /9f ..2 _ Fax: : ( ) % _ Water heater �Z l — t f Fireplace E -mail: Range p 1 5'� �'qr s. i '.1.47.470M 0 std Barbecue re. i t ieW04 ; 1 .l r CONTR rx :'r. . Business name ' 1 � Clothes dryer (gas) ,�Y ' �l� -+'1 r � � C-� Other Address: / C A S , ,6 �. MECHANICAL E *F•; ; City/State /ZIP: C am / "` / ,A a r �e, _ q7 (554 Subtotal 1 Minimum permit fee ($72.50) Phone: ( ) Fax: ( ) d j (� Plan review (25% of permit fee) CCB lic.: € 7Z4Z„..3 State surcharge (8% of permit fee) !! TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: 4� ( "� days after it has been accepted as complete. Print name: / f /en ‹libxJ fi y � Date: 420(.7 * Fee methodology set by Tri- County Building Industry Service Board B \ P \ ME i:\uilding ermits C- PermitApp.doc 12/03 / 440- 4617T (11 //02 /CCOM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: sTotaly aluat<on ' ... 4 r?!: Z' $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $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 $50,000.00. $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 including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\Building\Permits\MEC- PermitApp.doc 12/03 2 Electrical Permit Application_ , FOR: OFFICE:USE ONLY , -• . C i Il lI Tigard Of Ti and t Received Permit No.: �r t J��U -- CO/ex/1 CO/ex/1 Date /By: . 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 A p n 2 3 200 °NIPS pig� `� Date : Other Permit: Inspection Line: 503.639.4175 '' ' ` a�..: "11 I B Date Ready /By: turfs: RI See Page 2 for Internet: www.ci.tigard.or.us CITY Or TIGARI) Notified/Method: Supplemental Information rr auk" a �' rk r, s ' # " r. -.rr. , an rr t ^r. s 3 t i :. r �: f tiro i i iii OF W M(rS' 1V #+l a a �, , > it P REVIEW ',.,,,wz, n, s."nt. ,,,A,: mkd aim ,t :4,,,,.v_� ,Y ,, ,..}� a"agi,,,,;1, � a ,.f. „ 4 . � �"P ..r r. -r �,r �,-r . EbS . e New construction ❑ Addition /alteration /replacement Please check all that apply: El Demolition El Other Service over 225 amps, comm'l ❑ Hazardous location r - r iy rf„„aORY O ' CONSTRU EService over 320 amps - rating ❑ Buildn over 10,000 sq. ft., � 1 Cttr r s`la c. # ` ` F � � t = m of 1 and 2- family dwellings 4 or ore new residential � ri - and 2- family dwelling ❑ Commercial /industrial 111 Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi family aster builder ❑Other ❑Building over three stories ['Feeders, 400 amps or more - Occupant load over 99 persons ❑Manufactured structures or h , Y ei JOBI,SITE r WFORMAT ON AND iLOCATION L u n , ['Occupant " ❑E /li plan RV park Z 5 7 9 x, � . ' ❑Health -care facility ['Other: Job no.: Job site address: � t�'ly Submit 2 sets of plans with any of the above. ble to temporary construction service. City /State /ZIP: � not app 1 The are not SGI3EDULE � �' ” Suite/bldg./apt. no.: � � � Project me: t �1 �� , 4 —g f_ ° , Description Qty. 1 Fee. l Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: (�, Lot no.: ©�, Ea add'1 500 sq. fl. or portion 33.40 1 ✓�� 110 �( I/ f C a Limited energy, residential 75.00 2 Tax map /parcel no.: c7 op, g'e6.,� (✓d °z p �� Limited energy, non - residential 75.00 2 ,> , , el , „ 1; t DESCRIPTION . „ WORK , b c,t ,, N i, Each manufactured or modular �N , /� L NG �+ 1 dwelling, service rs installation, feeder 90.90 2 1 � �Tj Services or feeders instaallation, alteration, and/or relocation 200 amps or less 80.30 2 ' i 1 ' ®TENANT'. m. 201 amps to 400 amps 106.85 2 `� r `` " "'`" ""' . 401 amps to 600 amps 160.60 2 ` Name: /_�, S 7 /, J t, 601 amps to 1,000 amps 240.60 2 Address: / / A�'/ ( - = Over 1,000 amps or volts 454.65 2 / Reconnect only 66.85 2 City /State /ZIP: 6 ex? ), 9-2 7 Temporary services or feeders installation, alteration, and /or / relocation Phone: ( >� ) / /) / G �y Fax: ( ) 200 amps or less 66.85 1 Owner in s This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel § ,r ; fi „ ` ei APPLICANT s� -, T , 7 T ,� µ oiedi TACT 'PERSON t ' ,' A. Fee for branch circuits with . • �' service or feeder fee, each Business name: i - 44 d9/4"V� branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, Address: each branch circuit 46.85 2 Each add'1 branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53,40 ' 2 Phone: ( ) - Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - ?p „ r j £i g "� CONTR`ACTOI2' t ,..rte1 "' s energy panel, alteration, or ,. Wi=t �, _ ; Att. . , . a t, ,,.,,, � . extension. Describe: Page 2 2 C j Business name: c4ft / - L 7., y......- n ` / � L,� 7 � + _ 1 elf J , Jy 9 7y1 ,�- Each additional inspection over allowable in any of the above Address: j! 75 � Per inspection 62.50 FIB �� /�-_ City /State /ZIP: ( e,_ 8 . 9 "7�b' Investigation per hour (1 hr min) 62.50 Phone: & `1 te -y7e2 Fax: ( ) Industrial plant per hour 73.75 5 `' x . k `,, IELECTRICA PE FEES* ` -; �t.S rr .. �x CCB Lic.: U c Electrical Lic.:� S� 2 Suprv. Lic.: � e 7 s Subtotal Suprv, Electrician signature, required: ( 1,,,„____,....„ (/ Plan review (25% of permit fee) Print name: e 1 Gt e k 6 file Dater u ` State surcharge (8% of permit fee) "' r �°� TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. I:\ Building \Pemvts \ELC- PermitApp.doc 12/03 440- 4615T(10/02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDEgit W UWAV: ` 4 y_ „ ^, .'. k „$ Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* 2 Alarm [Garage Door Opener* Heating, Ventilation and Air Conditioning System* '4acuum Systems* ❑ Other: c 1 :.' . ! 7.0-W WORK:ONLY „l'.. .. ' ME . Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i: \ Building \Permits\BLC- PermitApp.doc 04/03 CITY OF TIGARD ' 24 -Hour . P • BUILDING ( L Ins Line: 503 175 MST °� 7 -00 /c)' `T INSPECTION DIISION Business Line: (50 a• : 1' t.c� (n , BUP Received el% D ate Requested / — Z Z AM PM BUP Location 9 7 Suite d MEC Contact Person - 7)1././�..1e Ph ( )S S0 OD- - 3 / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain` Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear. Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling 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: ina PART FAIL HANICAL , Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE . ❑ Please call for reins ection RE: ❑ Unable to inspect — no access Fire Supply Line ,. J''' / ADA ,, g b Approach /Sidewalk Date v6( vV 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 MST a�w`�� a INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested /� 7 AM PM BUP Location 9 ' 3s 7 - Suite MEC Contact Person ` )" h a��- Ph ( ) ° — 3/sI / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Ft FoundDraiation Access: '0 Ca 2S 1= v°?C.S Y o Crawl LA OX Drain d X J 7 ELR Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling 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: 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 t;L C/1 fG a Mr L o k,/ \fie L - 74ca , 6 -- Fire Alarm Reinspection fee of $ required before ne inspection. Pay at City Hall, 13125 SW Hall Blvd. *ART FAIL Please call for reinspection RE Unable to inspect - no access Fire Supply Line ADA Date / Inspector Ext Approach/Sidewalk Other: Final DO NOT R OVE this inspection record 4 m the Job site PASS PART FAIL • CITY OF TIGI�lRD . Inspection Line: (503) 639-4175 _ a BUILDING MST T b d l 7 INSPECTION DIVISION Business Line: (503) 639 -4171 B Lk Received • Date Requested ` o AM�PM BUP Location D- ✓ Suite MEC Contact Person Ph ( ) STa —3 /Se PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation g ELC Access: r Ftg Drain ` b ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear C 4 1 / Framing j Insulation _ i , -/ / / n/ n „ y ' � © � Drywall Nailing / v Firewall w/ , 2O0 - / - Fire Sprinkler " '" Fire Alarm Susp'd Ceiling Roof Other: Df/ _PART FAIL 1 MBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line r `t]lgke Dampers (1 A PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE f Please call for reinspection RE: i / ❑ Unable to inspect — no access Fire Supply Line ADA Date /4 ---2 Inspector ZA Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL