Permit • CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00018
, il l DEVELOPMENT SERVICES DATE ISSUED: 2/25/2005
'=--' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S1 11 AA -08900
SITE ADDRESS: 14225 SW 89TH AVE ZONING: R -4.5
SUBDIVISION: GREENSWARD PARK NO. 3 LOT: 073 JURISDICTION: TIG
Project Description: New SF. 8/15/05: Added A/C unit.
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: 566 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 2 71,290.40
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: BOIUCMP < 3HP: 1 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 W/O SVC /FDR: 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: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION applicable laws. All work will be done in accordance with approved
PO BOX 1577 PO BOX 1577 plans. This permit will expire if work is not started within 180 days
BEAVERTON, OR 97075 BEAVERTON, OR 97075 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies
of these rules or direct questions to OUNC by calling 503 - 246 -6699
Phone: 503 -590 -0809 Phone: 503 -590 -0805 or 1- 800 - 332 -2344.
Reg #: LIC 71037
TOTAL FEES: $ 9,613.50
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Issued By : J //O (- Permittee Signature : _ ;--e:_ Q- o
\ V
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2005 -00018
4 4, , _41,1- '�I DEVELOPMENT SERVICES DATE ISSUED: 2/25/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 14225 SW 89TH AVE PARCEL: 2S111AA -08900
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 073 JURISDICTION: TIG
REMARKS: New SF
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 THRDD sf RIGHT: 5
VALUE: 271 29040
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 W/O SVCJFDR: 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: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
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.
ATTENTION: Oregon law requires you to follow ru les
Phone: 503 - 590 - 0809 Phone: 503 - 590 - 0805 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
Reg #: LIC 71037 952- 001 -0080. You may obtain copies of these rules or
f OTAL FEES: $ 9,598.38 direct questions to OUNC by calling (503) 246 -6699.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Issued By : . �r . - i c. GL. ____-) Permittee Signature : t.? s
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED , • - 8 oeo..2.L7
,Buildin2 Permit Application IORUIII( I 1 'l ONIl
City of Tigard N `) ! ! 200 Received -;zO -05 , - Penult No.: Ms - raoa5 -4WD /g
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: Qrl ) l OF TIGARD Plan Review r"to , - -cr - Other Pemtit:#15 / ; - 06) 28
Inspection Line: 503.639 ; . I Date Ready/By: RI See Attached Checklist for
Internet: www.ei.tigard.o t LDING DIVISIO t ,, Notified/Method,( -/ , O Supplemental Information
/SS I �f'�1.3T - .1 7C le1 r V-k7 , e ` /�t�
TYPE OF WORK REQUIRED DATA: I- AND 2-FAMILV DWELLING
ew 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
,_ CATEGORY OF CONSTRUCTION work indicated on this application.
I(d't and 2- famtiy dwelling ❑ Commercial /industrial Valuation: $
❑ Acc sory building El Multi-family Number of bedrooms: 3
Master builder 0 Other:
Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11/12,5- '/) (P7Z New dwelling area: .2 ,75 9 square feet
City /State/ZIP: "7T7y1/12,4 Ox_ ( 9 7 7 2.-.2-CZ Garage /carport area: 3 square feet
Suite/bldg. /apt. no.: ( Project name: Covered porch area: / 6 square feet
Cross street /directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL-USE CHECKLIST
Subdivision: a geg 4. 7 ie 3 Lot no.: 73 Permit fees' are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
g1 �� / /(L€ -s..J /�u-,�� Valuation: $
Existing building area: square feet
New building area: square feet
RTY OWNER I ❑ TENANT Number of stories:
Name:�� `� �� Type of construction:
Address: 7 0 l�Jx' tS 77 Occupancy groups:
City /State/ZIP: -'s. ` ()7 7 C)5 Existing:
Phone L5153) 5 — C) c,P O S Fax: (..S713 S7c - 17.s New:
CANT ❑ CONTACT PERSON -
Business name: A� O 0-4— All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
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: ( ) Fax:: ( )
E-mail:
' CONTRACTOR
Business name: J A'"r-e_ /,.S ,452d d 0"e- t
BUILDING PERMIT FEES
Address:
Please refer to fee schedule.
City / State/ZlP: Fees due upon application
Phone: ( ) Fax: ( )
7/ 0 9 Amount received
CCB lic.: J
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: ��� � � `� / I Date:/ _ d S ' ' Fee methodology set by Tri- County Building Industry
Service Board.
is\ Building \Penmits\BUP- PennitApp.doc 12/03 440 -4613T(I1/02/COM/WEB)
One- and Two - Family Dwelling
■
Building Permit Application Checklist F OR OIII( II I sl: O\1.1
City of Ti a nd Received
iga Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Associated permits:
24- Hour Inspection Line: 503.639.4175 . I I ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us ❑ Other:
III'. FOLLO\\ I \(. ITEMS .%RI: REQI IIZEI) FOR PI, \ RFNIFW c.
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 El ❑ ❑
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, ❑ El El
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- ❑ ❑ El
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. 0 ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required ❑ ❑ 0
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 Orel on and shall be shown to be . s .livable to the • o'ect under review.
.11'R1S1)I(' I1O\:AI. SPI ('III('S
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 Mans shall not contain red lines or tab -ons. "Mirrored" buildin_ Mans will not be acce•ted. ❑ ❑ 0
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. • El El
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\BUP- RES- PermitApp.doc 2
Electrical Permit AD i E I V E, FOR OFFI( 11 .I I ∎\ I N
City of Tigard D BB. Permit No.: WS 70005 .
13125 SW Hall Blvd., Tigard, OR 97223 ;JAN 0 2005
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/ .
Inspection Line: 503.639.4175 . .,4, 11, 'i I_ Date ReadyBy: runs: ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIG • No Notified/Method Supplemental Information
Ill O Y-ll?i't4.7N PLAN REVIEW
New construction ❑ Addition/alteration/replacement Please check all that apply:
12 Demolition 12 Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
�� CATEGORY OF CONSTRUCTION of 1 and 2 - family dwellings 4 or more new residential
r] 1 and 2 family dwelling ❑ C merciatIindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress/lighting plan park
Job no.: Job site address: N 5 S' GJ < f xl U-t- ❑Health -care facility ❑mar:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: - 775/ha / O k 2 2 9 4/ The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
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: ' 5 pe hI/QK Lot no.: 7 3 Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
' ;) . A/ /-4 �5.�
dwelling, service and/or feeder 90.90 2
Q�C Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: F C-GX `2 � - L CP/ ,J ar 601 amps to 1,000 amps 240.60 2
Address: � C Z ca" /3 7 7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 2p% U_,..., (5,L 7 6 7 S' Temporary services or feeders installation, alteration, and/or relocation
Phone: ( 3) S — (:),P0 Fax: (6-7 7 200 amps v - l l �� 200 amps s
or less 66.85 1
Owner installation: 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 signaturre: , Date: Branch circuits - new, alteration, or extension, per panel
LET APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
/ service or feeder fee, each 6.65 2
Business name: Ste ,4 O V . Q branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
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 -
CONTRACTOR energy panel, alteration, or
X D n7 LQ..,_ e e C extension. Describe: Page 2 2
Business name: ,�'
Address: - ,S-- 7 ! 1 (i,
* ., ��� ,Vii-t..., Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: d ��G�ti 4 , < � ' 7 22 ( Investigation per hour (1 hr min) 62.50
Phone: �3) 2 4'V 77g t' F ax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:''CPa Electrical Lic.igl - C Suprv. Lic.aPeg S Subtotal
Suprv. Electrician signature, required: A... 4..„1 � a-,- Plan review (25% of permit fee)
Print name: /) Date: l State surcharge (8% of permit fee)
T C �T / )7 " � Ci eI 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 _ D,Q.�4,,,e_ , L Date: f-.-- C) S • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed
is\ Building \Permits\ELC- PermitApp.doc 12/03 440-4615T(10/01/COM/WEB
A
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
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
is \ Building \Permits\ELC- PennitApp.doc 04/03
•
M Permit Application FOR OFFICE USE ONLY
CIt of Tigard Received
y g Date/By: Permit Norn C. 00G _060/ y
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review O
Phone: 503.639.4171 Fax: 503.598.1960 Alk '\ D ateBy:
Other Permit:
O , , � ` y y . Sufis: Ea See Page 2 for
Inspection Line: 503.639.4175 J A Ar a j1,1 • Date Read B
Internet: www.ci.tigard.or.us AN 4, V� 2005 Notified/Method: Supplemental Information
i T et kw COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
B V11. glalali ement Mechanical permit fees* are based on the value of the work
ew construction u ueaaF+� performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION LOCATION LOCATION Heating /cooling
5 S' G.�
Air conditioning ho or heat pump
Job site address:
��� c P9 6 � �' (requires site plan showing placement) 14.00
City/State /ZIP: - 77 9 Q 0 4_ j� 7 . Furnace 100,000 BTU (ducts/vents) 14.00
J `, l 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
: Q . h�� 4e 3 Lot no.: 7 Flue /vent for any of above 10.00
Subdivision
�itsa "'� Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
y Gas fireplace 10.00
12? /lJ p J &J 4. 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
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: f l 4 s 71 C � z . 6 , (_ Environmental exhaust and ventilation
Address: /( f`" O / 5 7 Range hood /other kitchen
equipment 10.00
City/State /ZIP: 0� p ie �1' 7 Q 7 S Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 613) 5. o— Q cPO S Fax: (5 - 1%.1 . c) -/ 7s( toilet compartments, utility rooms) 6.80
— PLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: _29m,52 A nJ a et-e-- 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: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: ,\ �'* , Clothes dryer (gas)
6 O / SL Other:
Address: Fi (J t - 1-- MECHANICAL PERMIT FEES*
City/State /ZIP: ,1'/j', L)/e- q 7/2 3 Subtotal
Phone: ', ,,��``��) / �j 6 !� `� Fax: ( ) Minimum permit fee ($72.50)
�W (� Plan review (25% of permit fee)
CCB lic.: 6 6 .5 State surcharge (8% of permit fee)
/�, TOTAL PERMIT FEE
//16._.f....7.4„,„_ 'l /( This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
Print name: MN / i1 /9.74/ ,e_ a F Date: / — /e j * Fee methodology set by Tri -County Building Industry Service Board
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information •
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$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
. Plumbing Pe>r etaE i6E D FOR OFFICE USE ONLY
Cit of Ti and Received
13125 SW Hall Blvd., Tigard, O 722 Date/B Permit No.: 7.
Phone: 503.639.4171 Fax: SQ A .i (() 2005 / /yin; ry; D teB eview
kr Other Permit No.:
24- Hour Inspection Line: 503.639.4175 �� .•f II\� e orris:
., Date ReadyBy: 0 See Page 2 for
Internet: www.ci.tigard.or * a . Notified/Method: Supplemental Information
r ... > ` . e s J _ t i a itaf - • 111h.. i,: O k . FEE* SCI3EDULE
I� ew construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
F
- t,;3.,j :!4 T e.t.a E .? ..' yg�.�. _ SFR(1)bath 249.20
% 1 - and 2 - family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
[Master builder ❑Other: Each additional bath/kitchen 45.00
r , ,, ire sprinkler ( sq. ft.) Page 2
�_� “� . _ .4.,... Site utilities
Job site address: 2 S'� W of /_ ,q. Catch basin or area drain 16.60
City /State/ZIP: ! l g b/- 7 7 225 Drywell, leach line, or trench drain ■ 16.60
Suite/bldg. /apt. no.: P ject 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: �' k4 �� ' / 3 I Lot no.: 7 3 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no :
Absorption valve 16.60
o .. - ...5. Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
r
Drinking fountain 16.60 _
Ejectors /sump 16.60
Name: �4%�- `2) (L - T2_CC c7Z' A� Expansion tank 16.60
Address: (' . / Fixture /sewer cap 16.60 -
City /State/ZIP: ./5�% 6,C.- Floor drain/floor sink/hub 16.60
Phone x J � p Q�D S Fax. (�� S� p 1 ��
Garbage disposal ■ 16.60
�; � r ,- Hose bib 16.60
�_,�3� - .;- ._. Ice maker � 16.60
Business name: �i yy` �d' 6 6 v� 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
j` -1= 0 � �� € _. C, _. Water closet 16.60
Business name: �7' - ' t�L ��xii, Water heater 16.60
Address: /5 7 _ 2 Sl .. Z ,9, Other:
Subtotal
City /State/ZIP: a /Zej" . d.� oi< 7 7/ 23 Minimum permit fee: $72.50
Phone: `62o - p_3 / / Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: / 9 9 , 7 Plumbing Lic. no.3� </ Plan review (25% of permit fee)
Authorized signature: �'�Z�� .fX , State surcharge A L ERM T fee)
TOTAL PERMIT FEE
Print name: --/\ / /�,� F LAI- Date: / -/d Q 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 \Pemuts'PLM- PemdtApp.doc 12/03 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
opt,
e k Dotal. quare Footage: Permit 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 $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
fee (eat additional $100.00 or fraction thereof, to and
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 $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 * .
a� b �c nr��ne •
p x c i^ Ea fi 5 ,, -_
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
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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:
is \ Building \Pemuts\PLM- PermitApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005. 00018
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2c;/20O6
Phone: (503) 639 -4171 �»� °�m�lpu�(I�''h
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8116/2005 TIME: 7,06AM PAGE: 311
SITE ADDRESS: 14225 SW AVE
9TH CLASS OF WORK:
6
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 013 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF, 8115/05: Added NC unit.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 603
CONTRACTOR: FOUR 0 CONSTRUCTION PHONE #: 503-590 -0805
Inspection Request Scheduled For: Date: 8/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013826.05 503.720.7445 N
Corrections /Comments/ Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/ ,1 r
Inspector: Date: /[ g-v Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 00018
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2542005
Phone: (503) 639 - 4171 " ��aaar"gaaap i � ��.'
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7:06AM PAGE: 36
SITE ADDRESS: 14225 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 073 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF. 8/15/05: Added NC unit.
OWNER: FOUR 0 CONSTRUCTION CO, PHONE #: 503- 590 -0809
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590-0805
Inspection Request Scheduled For: Date: 8/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message ',n
699 Mechanical final 013826-07 50:3 -720 -7445 Y O% Pis
Corrections /Comments /Instructions:
1g4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
U
Inspector: f� Date: � ` " �� Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST200 00018
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/26/2006
Phone: (503) 639 -4171 „/„4,# i lli' I �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/18/2006 TIME: 7:06AM PAGE: 35
SITE ADDRESS: 14225 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 073 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF. 8/15/05: Added NC unit.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503- 590.0809
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503- 590-0805
Inspection Request Scheduled For: Date: 8/180005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 013826-08 503-720.7445 Y
Corrections /Comments /Instructions:
a —ei a-v r
ailk _
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
LI FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: K Date: Phone #: (503) 718-
CITLOF TIGARD
BUILDING DIVISION PERMIT #: M T2005 -00018
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2/2005
Phone: (503) 639 -4171 , " r �V'11il l "'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7:06AM PAGE: 37
SITE ADDRESS: 14225 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 073 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF. 8/15/05: Added A/C unit.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0809
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503590 -0805
Inspection Request Scheduled For: Date: 8/10/2005 Pour Time:
Code # Inspection Description Co ' # Contact # Message
399 Plumbing final ' 0138 06 503720 -7445 N
Corrections/Comments/Instructions:
E PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: •• �+ Date: t' 05 Phone #: (503) 718- Z`J'N
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00358
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 8/8/2005
Phone: (503) 639 -4171 �N,�,
Inspection Requests (24 Hrs.): (503) 639 -4175 X11.,`
INSPECTION WORKSHEET FOR DATE: 8/10/2005 TIME: 7 : 05AM PAGE: 4
SITE ADDRESS: 16622 SW 88TH PL CLASS OF WORK:
SUBDIVISION: WAVERLY ESTATES LOT #: 0 l TYPE OF USE:
PROJECT NAME: HAWKING
DESCRIPTION: Irrigation backflow.
OWNER: HAWKING, CONNIE PHONE #: 503 -28 8-1524
CONTRACTOR: DENNY, JAMES PHONE #: 59)11945
Inspection Request Scheduled For: Date: 8/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/backflow preventer 013275 -01 503590.1945 N
Corrections/Comments/Instructions:
ere Ift'v usi d, ;
C re_ Few
M PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (1 k 1r 04, Date: '91/0 o3' Phone #: (503) 718 -
5
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