Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00052
11i, DEVELOPMENT SERVICES DATE ISSUED: 3/28/2005
` =NW 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S134CA -FS004
SITE ADDRESS: 11168 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 004 JURISDICTION: TIG
Project Description: New SF.
BUILDING
REISSUE: MAS22138A STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,109 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 970 sf GARAGE: 647 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 208,518.90
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,079 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: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: J VENT FANS: 4 CLOTHES DRYER:
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 FE/ R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 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:
This permit is subject to the regulations contained in the
Owner: _ Contractor: Tigard Municipal Code, State of OR. Specialty Codes
PAYS CUSTOM HOMES INC PAYS CUSTOM HOMES INC and all other applicable laws. All work will be done in
17481 SW HOODOO CT 17481 SW HOODOO CT accordance with approved plans. This permit will expire
BEAVERTON, OR 97007 BEAVERTON, OR 97007 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 rules
Phone: 503 Phone: 503 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
Reg #: LIC 155849 direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 9,577.31 1 - 800 - 332 - 2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Issued By : - T? , .e. Permittee Signature : r 7.x0
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.
a
0
Building Permit Ara, illaatio�n� p i r ' . • • FOR'OFFICE USE ONL
u u 6„„, 6„„, R eceived
City Tigard
Permit No.:
131 Hall Blvd., Tigard, OR 97 DateBy - �� QS 31 P i �S ��?GC,9.rOlJeo
g Plan Review .
Other Pemilr.
Phone: 503.639.4171 Fax: 503.59. top Date/By: S �d�
2 2 2005 IF' 1 I i e � A� 3S� I odS ,5�
Inspection Line: 503.639.4175 as Date Ready/By: n hurls: See Attached Checklist for
Internet: www.ci.tigard.or.us c Y _ �� �� N fied/Met�: of D � ) r l(r Supplemental Information
T7 T rr _ i Iq `'
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:z ., ` p „„ Vii.. » -s °,r' v;;,. t `` r.. m „ .,. 5' . 4:
sN--- 6 _ - .t 1( - ,O t � r., , ,,.t, � , .,... . •,;, ` t 1144:i1IRED;iDA ANp 2 =hAIVIIL0-"W: - LLN
'_�.<,,'�k`"z.'r��'.��r =... �Y�..,, �.. �.: z_^»,,..,: Aw :,'„ffi.'.;�;rs•.�.a�'.^��3. -.., �$ ".a���z -.:? �.�,'€��..r.�,: S„ �t�,'+- �. z��a. ?. P:; ��; >- �: „��: :....... •....... .:�.�.q: ^. -a, �. I.t. .G
1gl 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
1 - t " fydi "'z — i" R ice-' _- ^ -- !. r ` work indicated on this application.
`' �$��$� il l "14 .A TFG OIt Y4C)F tCOP tS T R U CTI01 , 1 'a ` ` , r ` t i : `- ` °, PP
'N'tei Y �� .3.�c3 att >�= 4M<v'§'.cr :., dk.e' "�:u"`t+°"°�?s�'i� � ,�9' d.mwe. „K�. rx i3,Y � ? �^`s..:.`h;i
1- and 2-family dwellin Valuation: $
y g ❑ CommerciaUindustrial
Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
X JOB STTE I : " Q TRIO AND5LOCA ' Total number of floors
Job site address: 1 1 lf;•S (,J I 1'74.11 New dwelling area: square feet
City/State /ZIP: Let 0� .� 2 Cr1 d O -1 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: cehr o [. ` . Sliber Vthan. Covered porch area: square feet
Cross street/directions to job site: S I/J i f�Y 6 A IA S ,- f Deck area: square feet
I ) tq,,\fj-+ C. Q7/ l Other structure area: square feet
vv EQUII2ED D 1A :G01VIiVIERG ; }SE CHECKLIST;
Subdivision: - y ' I Lot no.: 1 Permit fees* are based on the value of the work performed.
I Si 3 G1 Indicate the value (rounded to the nearest dollar) of all
5
Tax map /parcel no.: r 4 0 0 3 ao equipment, materials, labor, overhead, and the profit for the
> -+ - :' ; - - , % °'x;:^ ,,.,=. �.�*o-.. `..s`:;;',,s�:8 ur.. :;r €�; .r"'�- :s. ,t..; a�° ^ ; V "` : ' : - §; , �` '31
filar W ; �� ` ” . DESCRIPT� ORS. - � t ° t o -! work indicated on this application.
N e-A ,1 � P) � l to e / , _ _ Valuation: $
�"/v Yom/ DCY1 Existing building area: square feet
New building area: square feet
°N ' t PROPEItT OWNS$ - , P. _ 1 .a 4 1,..;.i:',44,04, IEI\'ANT z Number of stories:
Name: Q S S M i -k / Inc, of construction:
Address: _ 1 7 4 et 4 li o ploo c Ob a Gk Occupancy groups:
City/State /ZIP: 'se.e4f.&V ton) J 2 – 1 '7 00'7 Existing:
Phone: (52)3) 415.- 5 0 4 I Fax: (S(3) zi 4, $s 0D New:
`°,. .'a -��, r� .�a*rou�s -`�5` �rrz "'z:� ":xv� ^x.�� e: °;5 h�",ce�- ar ff.:.,.: . �r'.>z;�` >�t ,��.'&. ^. ::t;:�'�!?cg�. tj _
:'. . 74 i ifi I{: I 4 WA . - VE071NT'AC '' E`RSON.a - .., „4,0 ,N,, I „cr ,z .-s .:,. . • a� ,if' ..._.ems` - a'-v :r � .. m`� °`: � >. - ? /a°r,r...t ' - "' ,: , W .:, , thil S :s�+NOT' &; e=
. .�,€ „. "� x< s." �a.« �A �as' �z+ 3.Sc;:�-,::. r.,mi#:a *d� 3 i. °m`; -� ',. , '.
Business name: — 54),/y1,(_ -- All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax: - : ' ( •
,,
Email Ar(lkgir S Goy► -1 ails /°CJA l
n ' €s F '. ' -x :. ' r vs: 43's>;. . r r `€°asz Mt .es 'j ur. ; ,c
B usiness name: taint; , i..:,.,,, r �.. , ... ,, �. �. ,
S A .4 °:.jz � 4,,,_ BrJ 1LDI 30 ; P ERIVIT T BES* '$
Address:
Please refer to fee schedule.
City/State /ZIP: Fees due upon application
Phone: ( ) Fax: ( )
CCB lie.: 1g- 5 (../5 Amount received
Date received:
Authorized signature: 4 , `Y� % / / R This permit application expires if a permit is not obtained
l�' within 180 days after it has been accepted as complete.
Print name: — rO Aok.- I . PG S Date: 0) /.5 / if * Fee methodology set by Tri -County Building Industry
_ J r Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T( I 1 /02 /C0M/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFI USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Date/By:
Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 4i,� ,
24- Hour Inspection Line: 503.639.4175,' ❑ Electrical ❑ Plumbing ❑ Mechanical
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. ❑ ❑ ❑
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 ,., * 1 ' U. ❑ ❑
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 setbackedimenions;'property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at•2- ftAntervals); 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 ofrebar. 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 Oregon and shall be shown to be applicable to the .roject 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 ". • , . — ❑ ❑ ❑
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
" [.- --, , i �
Electrical Permit iApplication ,
� � FOR OFFICE USE O
City of Tigard Received
Permit No.:
Date/By:
13125 SW Hall Blvd., Tigard, OR 97F20 2 2 2005 Plan Review
i (h t\ B
Phone: 503.639.4171 Fax: 503.598.1 1 " Date : Other Permit:
P ki i''
Inspection Line: 503.639.4175 •� Date Ready/By: fu s: 8 See Page 2 for
Internet: www.ci.tigard.or.us ( 1 'OF fIGARD Notified/Method: Supplemental Information
t i ,� ;z ,l
' "r. .F- r oE '4i.� ww. s k :A :, nl'' - .,• o-1 '1:;I n',1" tf - 4 , - :-. v = •,,-� „r '. ;° • " •
� �- �� .v , O ��VQ i' , `,. /.:: r ; . - . s M < ,PTiA h ItE,3?
:�. ��.e . �� . _ . . : a. :"" '��§�. -_u -'c $ „ �?o- ' v - >��3'+:a'�.n� <= e,- .x�,:. °'�.'� ��Y2`+�a�.e � � s.0 _ �_ --.... ,,. .. _
ip New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'i ['Hazardous location
z ,, „.,, .. a ,eksa* :max ties . ., ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
ii :A `ECarpRS�O , �� RTS TON X .„„ ;, � of 1 -and 2- family dwellings 4 or more new residential
1 - and 2- family dwelling ❑ CommerciaUindustrial ❑ 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
ritentrePaRtMIMMAIWWWW s ' i ❑Egress/lighting plan RV. park
EHealth-care facility ['Other:
no.: Job site address: t ` ` 6 50 17 Submit 2 sets of plans with any of the above.
City/State /ZIP: ""r co i,..4 0 (1.______ (1.______ 9j -' 2.Z The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: (/V+ !A A Project name: - _ k 1 � J� / k #� �SGID- r :. ...
Fin (� I Description Qty. Fee. Total
Cross street/directions to job site: i g f o q -. --�.� RIZA4A. New residential single- or multi - family dwelling unit.
I Includes attached garage.
ck_ I/4 .l�
- VI izt .E. 1,000 sq. ft. or less 145.15 4
Subdivision: l r Pjr\ 5 U � n l � I Lot no.: Li Ea. add'l 500 sq. ft. or portion 33.40 1
J ! Limited energy, residential 75.00 2
Tax map /parcel no.: G /' O b
11 G Ps A -,_, f ,, . t Limited energy, non - residential 75.00 2
..-, .i.l. �f .x ,. -, W. D S, KT 'P rd ,, : 1, QF $ t „ `
° ?tr. ; Each manufactured or. modular
�res�a�n,.iasa�c� a �i� H. +kC
•
y � I \ �n C /�p ,, p dwelling, service and /or feeder 90.90 2
si ?.'((' n 1 4'o', h �` Ji t�(,(I + t c(. Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
� � � • :: «_.� �:�,,����,��,�,,:u .,��..� �,{ .�, "�.:p< �,� �:�:, . ;��•�u��: 201 amps to 400 amps 106.85 2
.,1 ;'W RQ,3 TY 6,1 �0: f °F: x, tr .1LN:41: '_, . .
' "" "° 401 amps to 600 amps 160.60 2
Name: Av C i s & t 1 S L, 601 amps to 1,000 amps 240.60 2
! /
Address: j ') (/ D l ,...5,...5G,3 t, G c,0-6 �_, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: /P/►' - .) U i q - )9 '--7 Temporary services or feeders installation, alteration, and /or
Phone: ( ) 4 C1 -2, 5 / Fax: (S63) Z) Y- gS b� relocation
� 3 .
200 amps 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 signature: Date: Branch circuits - new, alteration, or extension, per panel
;� �;: " E ' ' �' ';,;� , • " � C w1 §� --'
'. ...� - . ' °� _ ". " �'' �. a A. Fee for branch circuits with service or feeder fee, each
Business name: _ 5 branch circuit 6.65 2
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 J k i{/5 . ,( j p r'1 C dB-4. 1 Signal circuit(s) or limited -
`;�� `'° +f'a rf ` Oi RAC C}�2R ' % c. ; o l energy ..:, �`��;:�'��ir =��.. .. � �,.�., � �:,;' ; � fs,a� '- ,.�,,�4'�'��. , P anel, alteration, or
_�- extension. Describe: Page 2 2
Business name: ei Je 1.1 4 r�-
Address: U 7'J7 5 1 r s^ , i >�� Each additional inspection over allowable in any of the above
) J a 5---)--- I Per inspection 62.50
City /State /ZIP: Y Q C'77 Investigation per hour (1 hr min) 62.50
Phone: ( ) S 6/ 0666 Fax: (5 S - l 7� �Industrial plant per hour 73.75
a:}ir_.W
t '" _ { Zg:707S: ) II FE, S : *z Ott .. ° c
CCB Lic.: ectrcac.: l_ Suprv. Lic.: G
/�� /�a Electrical Li 3 / /�OG P f� L 5--- S Subtotal
Suprv. Electrician signature, required /(��� 1t -
Plan review (25% of permit fee)
(mot
Print name: J ��� Da' O Date: > ,l O State surcharge (8% of permit fee)
t/ TOTAL PERMIT FEE
Authorized si �
m atur 6 4ttC�_ / _ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: ,v 4 -� ( Date: // j * Fee methodology set by Tri- County Building Industry Service Board
1 T / •* Number of inspections per permit allowed.
m
i:\ Bui lding\Peuts\ELC- PermitApp.doc 12/03 4 40 -46 5T(10 /02JCOM/WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ Burglar Alarm
.
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
n O ther:
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*
❑ P rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is \ Building \Permits \ELC- PemutApp.doc 04/03
Mechanical Permit Application FOR.OFFICE U SE:ON Y.
City of Tigard Received y � � cEy, Da te/B PermitNo.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Ar,, Ni ��1G ( Date/By: Other Permit:
Inspection Line: 503.639.4175
Internet: www.ci.tigard.or.us -- FEB �tJ1 � r:,' I'� Date Read y y
B Juris: a See Page 2 for
g Notified/Method: Supplemental Information
• - rc�+r� mrci °+rte a
1 2 7: 40°- < : ON4: :- e :=� COMMERCI FiE *`;
S'CHED.ULE= tJS E:CHEC'IQ;IST ' '
r�;na ,�s i ' ,� �� _ - -� ' - S.a cep ,:, k . :� ,5 =.�f.: a�,.' � , - .. ' - � . � . , ,�:. , -
❑ T on/ ' � 1Q B l Ig Ari j `t Mechanical permit fees* are based on the value of the work
New construction AddLi alter 1on1�e la ement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,_v,a r,> y w .wulm a -4.1p,.---,-�. . .,y,_„ rilt; ,-.74 : :_..s=rz,t,: Value: $
r° " i s C ..k 1 . C®NSTRUGTION - " G d
.a.. ra,v t l ,. . ",_, v. <= te r ti . ..:...,. � .. . .. ;' lrSIDfisiti I EQUII SYSTEMS`FEES*
ig,1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building' ""
For special information use checklist.
❑ Multi - family ❑ Master builder ['Other: Description Qty. Ea Total
Heating/cooling
Job site address:
` ;;xsn., - ';cfi' ";a..as ° "tt5 -rxxa'wsse zH .;.�3r ' a$.:..- "r,�;" -= `.rte ^r. ^..0 " :s. �.,; °: ,x .
tjirA, ;t : ; SI r I 1 ON AND 1 A �c r , '. § u s Air conditioning or heat pump
t p S� �' �e (requires site plan showing placement) 14.00
City/State/ZIP: - 11 o1n `� O 2 q2 S 2./2, Fumace 100,000 BTU (ducts /vents) 14.00
f "" `� _
( 1 J > Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: T r, � y.fr-N ,b( Gas heat pump 14.00
Cross street/directions to job site: (..,1.) 111 ( ) 4 J -(-'0-- Duct work 14.00
4 1) Ajcb - i — (+- Hydronic hot water system 14.00
l Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: 0 Cg- Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: \ 5 -5- CA- (pc, '0-p Other fuel appliances
*Vt) � t 7 4 S �'` Se IPTIO Or - yij' K 3 ' Water heater 10.00
:?' : r x D 1 _ 11iT ; Gas fireplace 10.00
1v Q1u&� . n 9 k em-n- 1,1 / � f _ Flue vent for water heater or gas
J fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
TOK1 R i- VaiAitl ` r� "
.
Y . 2 TENA` 1 7 Chimney /liner /flue /vent 10.00
� .s,=, � w _,,A, i i A. , w� „. " m. : l.: , 1:l. , c Other: 10.00
Name: o yN S W 5 t_ 5 ,L GLC , Environmental exhaust and ventilation
a �. t — Range hood /other kitchen
Address: ` ((i E� ` /�� equipment 10.00
City/ State/ZIP: - �('�, 0 Q / Clothes dryer exhaust 10.00
F Single -duct exhaust (bathrooms,
Phone: 663 q ) v (4 / Fax: (563 2 ( Li - i- toilet compartments, utility rooms) 6.80
ia' Attic/crawlspace fans 10.00
A tool x' v `, „,,,, - CONT AG' PFsRS'o p
Other: 10.00
Business name: -- 51yjyL��
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: 4 (- 'C/r- S' C''T cJ f , (. /� e Range
Cr, M T , CO>vTRAG "_3s Barbecue
- e'e`�'" �, Yzs -_' 1�z���I�. xa _ ?; ti ..� � / rez,� . �. . -eP.m. .. � 5`•' � Clothes dryer (gas)
. -� �. _. ,�,.���.d_�:, .-a. iearoa'�",
Business name: W i I ( 10 e5/ i n a c A" (
(� ! �" ���vvv ` Other:
Address: 7 3O �3h s e .'"t -- ' - E :'
IYIECH- AN3GAC:P,•EE1VITIFLES *< "
City/State /ZIP: NI / 5bQ ,6(2_, ' 7/ 217 ' h+` m Subtotal
Phone: � r ✓ / �/ �`' Fax: Minimum permit fee ($72.50)
( � 3 ) ( !0 7 (� (, ( ) Plan review (25% of permit fee)
CCB lie.: 1 3 v V S 0 n State surcharge (8% of permit fee)
0 ` TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 130
days after it has been accepted as complete.
Print namc( a2,.....Q. "3 Date: * Fee methodology set by Tri- County Building Industry Service Board
1 .\Building\Permits \MEC- PerrnitApp doc 12/03 440 -4617T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard • •
Page 2 - Supplemental Information
Commercial Fee Schedule:
ota1 Valu o Perm Fe n 4 ., .` w °-
$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
Building Fixtures RECE:VED»
Plumbing Permit Application . . - • FOR OFFICE USE ONLY ". , ::r -< Received
City of Tigard FEB 2 2 20 Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 y
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Oiia I g r 11 Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 C 1T 'Y OF T1 "�g I •� � i s J uris:
� v �� Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us TIT TIT TlTN(' TlJ V V ( I Notified/Method: Supplemental Information
r '- 3 S e. ,3 = 7' <, ",. .i;.~ -' - '., -+"� :t'� =..' y a"k:, P "` :�3,^i.: '�;. C# 4 3 s- :"3,",' t %s'r` k„ ,w. �M , , ,: X'.x x :e z� -s , .'i -"i° -
• # ",�, ...:� -'� . a �n= u;"-, � �c� . �: ��� €t+2?. .�"�,P?w��:.,> ..r'_ _ �.i � ac s �C ^._.. r..a,.�.rrt.m. - acv t�c .., y;. ao>+sw ^'�xa°L.f. _ ,
g New 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)
;�6'.�,„ =vas.: <�r�xss: m„ rc ��r�,� ° �: c?w�'+,.: �>..:: r�k' i}:" ��.p+ a�G:sa--- ?'ae.,a'.e§;38� ",�:1�Y �°��i��.;�r.-��:ep :,....,.cw�
is�-�
s 11 ... . CA E 144 ce01 8TRU � _ ~`kEtell. . SFR (1) bath • 249.20
,f1- 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
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
4=1,1 A' � - '�� � s � (�ti'�a#i"�a4 � i,T:"�5: sa � ':h x� r ar`"� �.
,, i „ . OB . ; ' "IlVF RIV ATIO 1\,;D CATSON . . „,?` i �. Site utilities
Job site address: 1 1 1 6 $ so 1I 74i-, - Teerr,,,a__ Catch basin or area drain 16.60
City/State /ZIP: --- Vi D 2- G - ) 223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: �� � �
r'lR/✓ Footing drain (no. linear ft.: ) Page 2
j � Manufactured home utilities 110.00
A �
Cross street/directions to job site: •Stn) 0 ci C / J (A-' �
n �1( I/ Manholes 16.60
'/ j1/ ( Q � i�z� Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
1
Subdivision: --.j 4, ���� ✓ Lot no.: Water service (no. linear ft.: ) Page 2
��I "`�� I ��` ` C OD -3,,:)_. .
_ Fixture or item
Tax map/parcel no.: 1
r .,x =, r.K ~ « e; r s as >.. ,;, .,_ .,. ,. c Absorption valve 16.60
' s D ESCOri i. CIN O F. "W ORK W ' "' , N '"'
:sa . ��. � „, 74, „ < .,. t . �, o, f �� : ,,� Backflow preventer Page 2
N .eli, C I / k f tk(ri) f id C Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
=e ' t`r.e`Yrta a .>,, n ak : <..w yam ,,a !»a t A,a, Drinking fountain 16.60
RROPERx O WNI R <. `1 ki r ,r4- ' e tt; A �N rva, .
,, ' �,��.,. ,•4
a 3 m.. - iru,,,,. r .s*rit ,.. -.. .a •
~...: c ,,A *x ,.._i, r 4,„ 141,,., ' Ejectors /sump 16.60
COS �� ,�.� �,^ r.-^, Name:
J s v s W f 1 L .S / Expansion tank 16.60
Address: (1 (Wt G .1 1 pp� i� Fixture /sewer cap 16.60
City/State/ZIP: ` ry , Q,__ C j ' 7 Floor drain/floor sink/hub 16.60
Phone: (5o ) cis': SC:$ Fax: ( 3) 2 / 11 - ES-OD Garbage disposal 16.60
r i t fli C .T ' ``' PAI g _ _l GO1 T R ER Hose bib 16.60
.w�° m "'"" Ice maker 16 60
Business name. S Aty
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: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: A c ,�•,Q /r s � /ll 16.60
Urinal
:3i"':�.; _� -+"�$� a =",�+'9> �.- *",'+x° �,+�.;.r. e"F�:+'.`,'.a, a:.�; �„3.' 4,8: Nit y :;�e.G`i-� >�};1v^i.= :5?�:�
�.� -"�< , � , s . "4 `_.. CONTRACTOR` 8: i i n om' 16.60
s ' ' . s 14 ,�� " � i _ w� W ater closet
Business name: �1 //b �/� � / L „ Water heater 16.60
Address: po , . b y 19 (-8
I l Other:
City/State /ZIP�: 1J t )Jy Ai 9 t / ' _ Subtotal
f 9 J Minimum permit fee: $72.50
Phone: ( 1)) )01 1- Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: ) Sit) )o Plumbing Lic. no.: 341 ad. 6 _ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 0 TOTAL PERMIT FEE
Print name: il 't. 0 , pi/ j � jr Date:/ / • AD 7 This permit application expires if a permit is not obtained within
J 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Building\Permits\PLMF- PermitApp.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:
Slte.Utll-1t ,, a *Qty° ee (ea} a T a
: u ' "Pe1GI11
w� .;�...._....: _
Footing drain - l' 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
i aluation R' Per =m t Fee
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
NOV* additional $100.00 or fraction thereof, to and
�?'lxtul'e O) it 1T1 Fee ota1..'
� �r � • •�� (ea). .� 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
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 * .
rt b m. -,
� Quant►t� by (Flxtur- e)�Work�Performecl�r4
Frs � _ y � $ ` .z Replace •
: - r ,; ,
e g � Mo a_ tilOP l A 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"
-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:
i :\Budding\Permits\PLM- PenuitApp doc 3/03
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® RECEIVED BY - DATE: 6 /■ —
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 -00052
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28/2005
Phone: (503) 639 -4171 4v<��j��ib��ll
Inspection Requests (24 Hrs.): (503) 639 -4175 :�� `:_..
INSPECTION WORKSHEET FOR DATE: 10/17/2005 TIME: 7:04AM PAGE: 22
SITE ADDRESS: 11168 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 004 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: New SF. 10/12105, ADDING A/C UNIT.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503- 475 -6041
CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503-475-5041
Inspection Request Scheduled For: Date: 10/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 018507 -01 503. 475.6041 Y
Corrections /Comments /Instructions:
1 ; . 7 ,,
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
(l FAIL CALL FOR INSPECTION ❑ ADDITIAL FE S ASSESSED
f 1
Inspector: PA Date: ( /7hone 4 #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005.0Q062
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 33
SITE ADDRESS: 11168 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 004 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: New SF.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503-476 -5041
CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503°475-5041
Inspection Request Scheduled For: Date: 10/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 017877 -01 6 603 -475 -6041 Y
Corrections/Comments/Instructions:
PASS ❑ PARTIAL. APPROVAL n CANCEL n NO ACCESS
n FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /0 "`/ O Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2006 -00052
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28/2005
Phone: (503) 639 -4171 A 41u��*il t\
I Requests (24 Hrs.): (503) 639-4175 ':_...
INSPECTION WORKSHEET FOR DATE: 10/14/2005 TIME: 7:02AM PAGE: 127
SITE ADDRESS: 11168 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 004 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: New SF. 10/12/05, ADDING NC UNIT.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503- 476.5041
CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503 -475 -5041
Inspection Request Scheduled For: Date: 10/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Me pe
699 IY Mechanical final 018259 -03 503- 475 -6041
Corrections/Comments/Instructions:
PASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V ` Dat e: - Phone #: (503) 718-
p � � )
CITY OF TIGARD
BUILDING DIVISION t.
j PERMIT #: MST2005- 000521
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2012005
Phone: (503) 639-4171 uy�u
niiviii
Inspection Requests (24 Hrs.): (503) 639 -4175 �.'!� %I..
INSPECTION WORKSHEET FOR DATE: 10/14/2005 TIME: 7:02AM PAGE: 128
SITE ADDRESS: 11168 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: .FEHRENBACHER LOT #: 004 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: New SF. 10/12/05, ADDING NC UNIT.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 -475 -5041
CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503 - 475 -5041
Inspection Request Scheduled For: Date: 10/14/2005 Pour Time: ,
Code # Inspection Description Confirm # Contact # Mes.. - -.e 1, 1 7 0
399 VV Plumbing final 018259-02 503. 475 -5041
Corrections /Comments /Instructions: .
/ i
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f2.1-
t-- ..) .___ L__‘, L.,c q .
Tar, - - 43 z-(9 -61 r-
.
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
i
11 ' IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: OA ` 0 / Date: l 8 j / V SPhone #: (503) 718 -