Permit t
1
Ai
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00170
I,r; DEVELOPMENT SERVICES DATE ISSUED: 8/23/2004
'�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14180 SW 89TH AVE PARCEL: 2S111AA -08300
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 067 JURISDICTION: TIG
REMARKS: New SF detached
BUILDING
REISSUE: PH2226D STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,345 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,414 sf GARAGE: 568 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 TI4tD: sf RIGHT: 5
VALUE: 271 290.40
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,759 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 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 WO SVQFDR: 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: ALL - ENCOMP BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
TOTAL FEES: $ 7,759.16
Owner: Contractor This permit is subject to the regulations contained in the
FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION Tigard Municipal Code, State of OR. Specialty Codes
PO BOX 1577 PO BOX 1577 and all other applicable laws. All work will be done in
BEAVERTON, OR 97075 BEAVERTON, OR 97075 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 - 590 - 0805 Phone: 720 - 7445 MOBL ATTENTION: Oregon law requires you to follow rules
5qqpp adopted by the Oregon Utility Notification Center. Those
Reg #' LIC 080 1037 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Mechanical Insp Low Voltage Storm drain Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Gas Line Insp Water Line Insp Plumb Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Fireplace Water Service lnsp Building Final
Foundation Insp Footing /Foundation Dr Framing Insp Insulation Insp Appr /Sdwlk lnsp
Post/Beam Structural PLM /Underfloor Exterior Sheathing Insr Rain drain Insp Electrical Final
1
Issued By : f Permittee Signature : _ s
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next .ess day
M \1GQ
Building Permit Application,. ' FOR OFFICE USE ONLY
City of Tigard ? N DateB / ed l(JRf ,i� Permit No.: ,t �,
13125 SW Hall Blvd., Tigard, OR 97223 c5 • w , Plan Review / I
Phone: 503.639.4171 Fax: 503.598.1960 �\ ��� ,, Date/B : / `/ o Other P i 1!/ � , /_I�
Inspection Line: 503.639.4175 -\Nt t,..... 1J J ' . � _ .. , Date Ready/By: M� ® See Attached Checklist for
Internet: www.ci.tigard.or.us
G� (--IT il • r_ • Notified/Method: tai • • Supplemental Information
N
' ' ' x s g 0, ` REQUIRED DATA 1- AND 2- FAMILY DWELLING
g p� New construction ❑ Demolition Permit fees* are based on the value of the work performed. c\
!`d Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the `
`" 44 X'' " ., CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
® 1- and 2- family dwelling ❑ Commercial /industrial
/" Number of bedrooms: e3
❑ Accessory building ❑ Multi - family
❑ Master builder ❑ Other: Number of bathrooms: N
JOB SITE INFORMATION AND LOCATION _ Total number of floors: O
Job site address: /4//43 S' ! J d 2 `' - New dwelling area: p_-2 square feet
--..........
City/State/ZIP: "�la // ye,( O,C. 9 7 .7,2 t' Garage/carport area: .3-6(> square feet
Suite/bldg. /apt. no.: .✓l Project name: Covered porch area: Ja s square feet
Cross street/directions to job site: Deck area: —' square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision:C�, e�S-S' L.-1 jJ 9,9? , Lot no.: '6_-, •, 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.: equipment, materials, labor, overhead, and the profit for the
,1`s1 . 14 o- � r �` � R work indicated on this application.
d.... , ..
} / �� /4%4412- Valuation: $
!� Existing building area: square feet
New building area: square feet
_ .e `,.s` v e 1 ,� � °- a, S t F0 :' r ; s a.r4 Number of stories:
i-gwmfrlte,„ 7 : Name: (-Zoe ` ..- STR co r 7� ,. do , Type of construction:
Address: Z a %?c 2 , ;; � ? Occupancy groups:
City/State/ZIP: AU,.. ..- ,e.._ 7 Existing:
Phone: All. 4 S - '� Fax 5 7 4 7/ 7 New:
w ,�r � � l � r � 1 � . �, ,.� � �E� , �- - . �f .., .. � _•,,. , ` , ��'"` �_ � � NOTICE I
Business name: � .- ,4, .i2 d o ., Q ,. All contractors and subcontractors are required to be
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: ( ) I Fax: : ( )
E -mail:
# ;'° "-7" da .i 3 ' t 1 :, ,, a K """�' +s '' y 3 s ;"" '; a - -
a € xis 1 1 'tl 3
r ? 7 m .v', wt�a+�f�t�a�����`l �:a � x .., tP� , ; :�, .°.e�?a���f�h.a�. �-�', k ._. ., ..�.m. i✓..R
Business name: S) /J f s� o , 44 a— —' B UILDING PERMIT FEES*
Address: Please refer to fee schedule.
City/State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.: —7/ v3 7
Date received:
Authorized signature: / / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name : 4 / Date: s � ,U[L * Fee methodology set by Tri- County Building Industry
" T Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 46I3T(1 l /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Da Received
Permit No.:
Y
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
`
Phone: 503.639.4171 Fax: 503.598.1960 ^ /1 ;iitiNj�'I�i iil'i� ❑ Electrical ❑ Plumbing ❑ Mechanical
24- Hour Inspection Line: 503.639.4175 .aJ;.
Internet: www.ci.tigard.or.us ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ El
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 be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL 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
��\1 5D
Building Fixtures Rj
Plumbing Permit Application /0 FOR OFFICE USE ONLY
y of Ti g Received
Date/By Permit No.: ��, .-e0.-e0(762 e0(
Cit and AR
13125 SW Hall Blvd., Tigard, OR 97't F �� �+1
C
t'1,v1.7 Plan Review
Phone: 503.639.4171 Fax: 503.598 6(1 ♦� C7t V /�H N;t. \ Date/By: Other Permit No.:
Q�N i r. `I
24- Hour Inspection Line: 503.639.4 •f I Date Ready/By: Jun': H See Page 2 for
Notified/Method: Su
Internet: www.ci.tigard.or.us �' g
Supplemental Information
'° y 4 $ r 4 a FEE * -'' SCHEDULE
( New construction 1 ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
` ' 1 . $ $, F4o 1 x SFR (1) bath 249.20
1 - and 2- family dwelling El Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
�. t „ Fire sprinkler � sq. ft) Page 2
.it - t 7 , A k o, . ' m p ' ,. .... 4 Site utilities
Job site address: 7'Q jd'n S ,,,.1 6 , V . Catch basin or area drain 16.60
City/State /ZIP: 779 /1/1/ b� 92 72322 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: a a?i' cG.J,9 cpi4.4,,e I Lot no.:b Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
u : s . , „ ;' , , i Backflow preventer Page 2
• J���, i � ep s Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
z ;_ Drinking fountain 16.60
6 1 b K s3' a P1 �° M' i� (11s
2 > .e, n:, , n, Ejectors /sump 16.60
Name: Aga �.. C - / , _ Expansion tank 16.60
Address: ' s,?--. / 77 Fixture /sewer cap 16.60
City/State /ZIP: / .-J , ` 9? 2) 7 ‘ c-- --- Floor drain /floor sink/hub 16.60
Phone :6 L s O , ; 0 Fax:
(` ) SS O -/ 7.5-/ Garbage disposal 16.60
Hose bib 16.60
Ice maker 16.60
Business name: _9yyte__ jP. n Cl--e--' Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
' - a�a „* ,. v , 234 , s W ater closet 16.60
Business name: 0 `L��-� 1;, L„ Water heater 16.60
Address: AS 72 g,. s/SG A v , Other:
City/State/ZIP: �ezS d � 6 c , - 27/2`3 Subtotal
/ Minimum permit fee: $72.50
Phone: ) p ,_ 9_3// Fax: ( ) _ Residential backflow minimum permit fee: $36.25 _
CCB Lic.: / 7o Plumbing Lic. no. j- ,i'<,/ pi, Plan review (25% of permit fee)
!�i� �ed State surcharge (8% of permit fee)
Authorized signature:
f - TOTAL PERMIT FEE
Print name: „a f-- w i_ e x__ Date: �6 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLMF- PermitApp.doe 12/03 440- 46t6T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard . •
Page 2 - Supplemental Information '
Fee Schedule: Residential Fire Suppression Systems:
ilti
t� _ °., q Dot age P ermit.Fee:
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 o eP ... Fern Feel
$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
additional $100.00 or fraction thereof, to and
Iota including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention 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 $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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 * .
a `� uagfa >rk �� fbrin fl
T y V l Comments 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
Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
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:
\ Building \Pemrits\PLM- PcrmitApp.doc 3/03
Mechanical Permit Application JUN 3 200 FOR OFFICE USE ONLY
City, Tigard Q ' QF it AP► ON Date/By:
Permit No.: \ g / /Apo /70
13125 SW Hall Blvd., Tigard, OR 97223 DI S Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 BUILD' / /m,, hi . p . I ,•\ Date/BY: Other Permit:
Inspection Line: 503.639.4175 _ • �,' , I 11
Internet www.ci.figard.or.us �., Date Notifiedd /Meth : od: R Juris: S See Page 2 for
g /Meth Supplemental Information
` t , M M # - VO '` CO6iME+I2.C'IAL FEE SCHEDULE - USE-CHECKLIST
New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
`' "` .,.: , ? ; t Cx . afll C � NSI1� `C T' . ' : Value: $
1- and 2- family dwelling ❑ Commercial /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES
M,
❑ Accessory building
Multi family ❑ Master builder ❑Other: For special information use checklist.
Description Qty. Ea. Total
*AW 'l €a e P ^'`3 ) 41 ,' 9 r 14 ? tyN_D L4O .x. 6. Heating/cooling
n Air conditioning or heat pump
Job site address: J
�zi /d . /� e ( P / 9 0 e, (requires site plan showing placement) 14.00
City/State/ZIP: - Q ,, J 0 i 9 726 7224/ Furnace 100,000 BTU (ducts/vents) 14.00
/' / Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: I 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
Subdivision: C, nu Lot no.: 6 Flue /vent for any of above 10.00
l� Other: 10.00
Tax map /parcel no.: Other fuel appliances
, ; ,> ; t . rs a t i ' . „ ...:# , Water heater 10.00
z 1 Gas fireplace 10.00
9 Alai...) i.-- 44.(_e.- Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
c.,:#0,16, ar„ +; ,K. @ : °1: s ° i, ` s, ` `:' �g ¢ Chimney/liner /flue /vent 10.00
"tip - ,p Other: 10.00
Name: � �
/ 2 --- '0 .
v G-L �- (i-571. S7 e-L C.7! r) ,J &-.-/- Environmental exhaust and ventilation
Range hood /other kitchen
Address: ? 2 t / s --,- 7 25 7 equipment 10.00
City/ State/ZIP: Pw4 IL y G "-7 6'75- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5S) , _ II■4 ,3 Fax:33) e3 ,../ toilet compartments, utility rooms) 6.80
. k. :, ;F 1 ,,SS `` Attic /crawlspace fans 10.00
e s ea. # $ 7 0 S., 6 .
may, ,, / Other: 10.00
Business name:
c s // A& ,41Z LP-Ri Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range
s r . t , � , i Barbecue
Business name: or : /� �
Clothes dryer (gas)
Other
��`x���»� `� °� �r � "
Address:
14 0 / 2 T! u 6 a eP "III F:P'ES*
City/State /ZIP: 4 /czS4 Diaz �� 9 ? /2 _ ,..3 Subtotal
Phone: (� 6 ___s---4,r3 Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 4hu_s7a State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: �iy� This permit application expires if a permit is not obtained within 180
l /�( days after it has been accepted as complete.
Print name:4� A,f /1 hint /�` u Date: S- .2� d fC ` Fee methodology set by Tri- County Building Industry Service Board
i:\Building \Perm \ ME
its C- P er i `p.
erm 12/03 440- 4617T(11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
$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 ittetteN ED FOR OFFICE USE ONLY
City of Tigard Da
Tigard, OR 97223 PerrnitNo. 1T' �` f
y� �/?
13125 SW Hall Blvd., Ti I•
8 3 2 004 Plan Review
Phone: 503.639.4171 Fax: 503.598.1910 i� `,-,,r,'41 Date/B : Other Permit:
Inspection Line: 503.639.4175 ARD vii..„ Date Ready/By: Avis: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TI G O N Notified/Method: Supplemental Information
1
' ti' a y . '�,. l � + �'�i � ��,... t ' _
I NJ New construction ❑ Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ❑Hazardous location
❑ Other
❑ Demolition ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
3 `` i t ' < , " '' '' ,' � ® ; L
'a , t p � " ' `` r3 " - of 1- and 2-family dwellings 4 or more new residential
'1 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi ❑Master builder ❑Other ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
"1 -� ii : r , $ ., 6 ' ' G t' ' . € ?t 8 RV ark
��z�.� i�� _ e .a�� # ..�� a a� b 1" _ _ �. �_ _�... ❑Egress /lightingplan P
Job no.: Job site address: a • f' s 0 ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: f , , / ) C D - — The above are not applicable to temporary construction service.
xr e,
Suite/bldg. /apt. no.: Project name: - - u -QT:.--'-'-- I ` --
Description Qty. Fee. 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: • , i , W , - x Lot n • ,7 Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential / 75.00 2
Limited etler ,tron residential 75.00 2
s :- e9 . -- . , c < Each manufactured or modular
C-/ /440 ` , "� ' , dwelling, service and/or feeder 90.90 _ 2
• /(-K -. Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
?� i . �� �q . , N Z� 4' 201 amps to 400 amps 106.85 2
_.�'.,,ti . w�� 401 amps to 600 amps 160.60 2
Name: b . t om , l . c z J 4 601 amps to 1,000 amps 240.60 2
Address: ` 7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: _ b ' — Temporary services or feeders Installation, alteration, and/or
Phone: a . ) _ _ .. d Fax: (51,3) relocation
O 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 atrips 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: . y '� n . j r , ' . 4"»a"s , - � a ',- A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: a - ar , aa a branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
,1 j _�. � energy panel, alteration, or
„:.=` ..;. a�� : -.. es„ . ��aa.� ° ", ,.�, e��zW - :
..rw� ° ��� _ ,
� .
Business name: `_ , -,.c.: extension. Describe: Page 2 2
Address: Each additional inspection over allowable in any of the above
`�� Per inspection 62.50
City/ State/ZIP: ! TL a., 4 LS • Investigation per hour (1 hr min) 62.50
Phone: (5019 4 Fax: ( ) Industrial plant per hour 73.75
EMIIIMM Electrical Lic.: 3 C, Su Lic.'.` • S Subtotal
Suprv. Electrician signature, required: e _ , C N _ / Plan review (25% of permit fee)
Print name: • A 6 , Qe A, ! k/ Date: State surcharge (8% of permit fee)
6 d TOTAL PERMIT FEE
Authorized signature: a ol/, ,AI This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: / . `� 1 , . . Date: u�ce * Fee methodology set by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
e\ Building \Pemtits\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:
RESIDENTIAL
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
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\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00170
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/23/2004
Phone: (503) 639 -4171 �� " �NN��y Im'tiNM� i����
Inspection Requests (24 Hrs.): (503) 639 -4175 ........ ' __..
INSPECTION WORKSHEET FOR DATE: 3/15/2005 TIME: 7:11A PAGE: 18
SITE ADDRESS: 14180 SW B9TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 067 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 5900805
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720.7445 MOBL
Inspection Request Scheduled For: Date: 3/16/2005 Pour Time: 1-u.:k 0(
SKI
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 001928 -01 503. 720 -7445 Y
Corrections/Comments/Instructions:
C jN SE_ F 1-, E_ D
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 14411 Date: 1 6 - O -3— "' Phone #: (503) 718-
CITY OF TIGARD V
BUILDING DIVISION PERMIT #: MST2004 -00170
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/23/2004
Phone: (503) 639 -4171
71
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3!1612005 TIME: 7:11AM PAGE: 17
SITE ADDRESS: 14180 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 067 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503. 590 -0605
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720-7445 MOBL
Inspection Request Scheduled For: Date: 3/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 00192 -01 503 - 720 -7445 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: //RV Date: 3 -16 -0 S Phone #: (503) 718-
CITY OF TIGARD ' A
BUILDING DIVISION PERMIT #: MST2004 -00170
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/23/2004
Phone: (503) 639-4171 11zi' NrNP�Ip�� l `N
Inspection Requests (24 Hrs.): (503) 639 -4175 A
INSPECTION WORKSHEET FOR DATE: 3/15/2005 TIME: 7: 13AM PAGE: 72
SITE ADDRESS: 14180 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 067 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590'0805
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 720-7445 MOBL
Inspection Request Scheduled For: Date: 3/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 001680 -01 603- 720 -7445 V
Corrections/Comments/Instructions: K 1
, ......)
d
.....,,,, // 4
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: f 1 `- 4 Date: —341/ Phone #: (503) 718 -
�r0
CITY OF TIGARD
BUILDING DIVISION PERMIT #: % ;}a? . 001
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ' °2 -" 2."
Phone: (503) 639 -4171 4 7 . 109 0l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: )I15'`'. * TIME: PAGE: 71
SITE ADDRESS: tel 3t! t 'F 89 i i`I AV 1 : CLASS OF WORK:
SUBDIVISION: i.;RI~EN:-'i ARD !'A0 NO. 3 LOT #: ` TYPE OF USE:
PROJECT NAME: #;I <EEI :}.WARD PARK Wi).
DESCRIPTION: tti "n"' `•..;i' : t;°. ac::{lga{2
OWNER: t 01,1P } ,.>Pf; l c T lON co, PHONE #:
CONTRACTOR: t v ( I , i.' ='::UN ;�f�t., ?4.,544 ' PHONE #: 720 144b MOBS_
Inspection Request Scheduled For: Date: •'k th'24)i)fa Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 680- f4 ;'20-74 ,
Corrections /Comments /Instructions:
� r ' T ' '; mi •4/
/ .)-, / 14 &
Vie
c- 11,11/ A7, / //
IA PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-