Permit r . ,
MASTER PERMIT
CITY OF TIGARD
fil� DEVELOPMENT SERVICES DATE ISSUED: g 03003 -00251
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14580 SW 120TH PL PARCEL: 2S110BC -02600
SUBDIVISION: WALL PARTITION /MLP2001 -00006 ZONING: R -
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Construction of new SF detached residence.
BUILDING
REISSUE: MAS22137 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,204 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,477 sf GARAGE: 535 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 TFt sf RIGHT: 5
VALUE: 263
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,681 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: 5 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:
EAADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: 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: X VACUUM SYSTEM: X AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: X OTH: ALL ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 8,169.26
MASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUCTION INCThis M n is subject to the regulations contained C o i the
Tl o d u
other r applicable cal Code, State work k w Specialty Codes and
14225 SW 128TH PL. 14225 SW 128TH PLACE all other applicable law All work will be done i
TIGARD, OR 97224 TIGARD, OR 97224 t
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 rules adopted by the
Phone: 503 267 - 6730 Phone: MBL 860 - 3298 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: Bt 431 9010 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation Insp Water Service Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insf Rain drain Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Foundation Insp PLM /Underfloor Framing lnsp Gas Fireplace Water Line Insp Plumb Final
\ ,
Issued By : �� i „_L P ermittee Signature : ,
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
T ? ?7 «o
Building Permit Application Received FOR OFFICE USE ONLY
Building �y
Date/By: 6 - 11 -o t PermitNo.:R4J7cX — OOoc5f
Planning Approval '^� 'J
City of Tigard
Date/By: y: Permit No. 003 -- 7w I'
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.S()l 6,00 do /' a
Phone: 503-639-4171 Fax: 503-598-1960 "
/ � Ut, ���.
�l ;\ Post - Review Land Use 0) • Date/By: Case No.
Internet: www.ci.tigard.or.us Contact Juris.: ® See Page 2 for N
24 -hour Inspection Request: 503- 639 -4175 Name /Method: -j- C- Supplemental Information -
? - . S I I O ec - 0,2_1,CrJ
TYPE OF WORK REQUIRED DATA:
Fr New construction ❑ Demolition I & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
___/: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
al I & 2- Family dwelling 0 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family 0
111 Master Builder ❑ Other: Valuation , t $
JOB SITE INFORMATION and LOCATION No of bedrooms: 3 No of baths: ij -----..
Job site address: j y 5'8' 0 S LAJ i a () to I Total number of floors ge
New dwelling area (sq. ft.).2r..4 ��
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) L-( Q..0
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.) - J'
6 U l t 'V - 1' 6 1 l 2 0 -- L ! Other structure area (sq. ft.) "1:3
\ REQUIRED DATA:
( COM MERCIAL - USE CHECKLIST
Subdivision: Lt- ►Q-' \ Plg�T ` 1 e '`" Lo #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
J j overhead and profit for the work indicated on this application.
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNER - I ❑ TENANT Type of construction
Name: & sT e g_ P l e « Occupancy group(s): Existing:
Ne
Address: j 9 2'L -'S g W l )- irT L P I
City /State /Zip: 'T ■ i 0-12 D 2 ct - 72tt1
Phone: 03 _i b -55'46 Fax cO) -IN 2ti^ y 3'1 I NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
0 CO NTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: A l'( € Iti D A )✓ rks le-r from licensing, the following reason applies:
Address: � � /V\. City /State /Zip:
Phone: Fax:
BUILDI PERMIT FEES*
E -mail: Please refer to fee schedule.
CONTRACTOR
Business Name: `
/\J� Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB Lic. #: to 0 ( 0
Authorized J ` Notice: This permit application expires if a permit is not obtained within
Signature: Datej 1 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
One- and Two - Family Dwelling
��, %,:i Building ' Reference no.:
_,, Permit Application Checklist
Associated permits:
City of Tigard
City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
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.
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. 1
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent 1
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 Oregon and shall be shown to be applicable to the project under revi• .
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 1 1" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6/00 /COM)
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
Date/By: Permit No.:
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Post- Review Land Use
Phone: 503- 639 -4171 Fax: 503 -598 -1960
nii II \
' Date/By: Case No.:
Contact Juris.:
Internet: www.ci.tigard.or.us . ' I Inspection Request: 503- 639 -4175
24 -hour Ins ® See Page 2 for
g
P Q Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE ;= USE CHECKLIST==
[Q1 ew construction 0 Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATIIGORY mechanical l materials, equipment, labor, overhead and profit.
❑ 1 & 2 Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi Family RESIDENTIAL. EQUIPMENT /SYSTEMS FEE! SCHEDULE
Description I Qty I Fee(ea.) 1 Total
❑ Master Builder ❑Other:
Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: 1 4 j & 0 Slid 12— UT L 1 l Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Cross street/Directions to job site: (for orid radiator boiler
V l � Y`^� P � �'l. ( radiator or hydronic system) 14.00
l T 2 0 (J I Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: 4,N9.1∎. 9 13Aff‘ 45 Lot #: I Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
Gas fireplace / 10.00
f�-�L.IJ k 11\ l? Flue vent (water heater /gas fireplace)
l 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
: ii." t) ' -: - 0.- 4 - a > : Other: 10.00
Name: � t rL� C S Environmental Exhaust & Ventilation
Range hood/other kitchen equipment / 10.00
Address: / (-(q_51-'S S t. (' T1.-n i
Clothes dryer exhaust / 10.00
City /State /Zip: L A S / o 2- °l --.1 �2 Single duct exhaust .
Phone. • -. \- c Fax:' u -S'L _ - 1 (bathrooms, toilet compartments,
' ; CO , TAC UPERSO .. utility rooms) 5 6.80
Name: Attic /crawl space fans 10.00
Address:
c A , L - Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTOR t Water heater **
Business Name: S k t 2 a- `(` ( ivy Fireplace **
Address: d�, , , , - 1 `� / 1 Range **
CsQ **
City /State /Zip:5g? 3 /2-- 3 3
( Clothes dryer (gas) **
Phone - 0, /-- eilz)-ge( Fax: Other: **
CCB Lic. • : Z I �� L Total:
l
Authorized ✓ Mechanical Permit Fees*
Signature: /''� DateC, ^ �� Subtotal: _ $
Minimum Permit Fee $72.50 $
1 1 I &_J / 0 A k' 'C'-ci ie—T t., Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
$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 including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$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 and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including / 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
Building r fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received Plumbing
Date/By: Permit No.:
Cit of TI and Planning Approval Sewer
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DateBBy: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�H /�r diy j.! '\ Date/By: Case No.:
Internet: www.ei.tigard.or.us Date/By:
Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 "' Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
few construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (Includes 100 ft. for each utility connection)
dwelling Commercial/Industrial SFR (1) bath 249.20
& 2-Family g ❑ SFR (2) bath 350.00
Accessory Building ❑ Multi - Family SFR (3) bath .--- 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sc ft.: Page 2
Job site address: 1 `( S e" O Sw k ZpT L p 1 Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: j Manufactured home utilities 11 0 . 00
6 U I\ A" : (4--- ` 0 p 0 / Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: L4., - i \ sok r_'j'; d ..'- - Lot #: / Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fixture or Item
Absorption valve 16.60
/v w 1 0 M C Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Er ROPERTY OWNER I ;❑ TENANT Drinking fountain 16.60
�_���� Ejectors/sump 16.60
Name: ANA_ t 4 Pt C << C1/4) " T i „ C. Expansion tank 16.60
Address: I y 2` s t-4-/ I a eirte l Fixture /sewer cap 16.60
City /State /Zip: Th- k etat-l. 64_ 7-7 '721.--/ Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: U ^7) 6 ` Fax: -5'2_4-- ∎-i3'7 Hose bib 16.60
.' LI.. `T ,fit z, tea, e _1 1 : e "', Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: cf,l-A/V, ( Medical gas - value: $ Page 2
Primer 16.60
City/State/Zip:
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR ., , Urinal 16.60
P � f' e f u b c, Water closet 16.60
Business Name: q
� n � ^' t l Water heater 16.60
Address: `? 9 (0.(Z.ttI 1T S T' Other:
City /State /Zip: c�� 1 �(J 01Q-- Other:
Phone:.? b 3 - 1? I - a2`3Fax: Plumbing Per_uiit Fees*
'x,�, p Li Plumb. Lic. #:;3 -. 31 y Subtotal $
CCB Lic. #:
3 L Minimum Permit Fee $72.50 $
Authorized / Resid ential Backflow Minimum Fee $36.25
Signature: Date: [s, -- ' v 3 Plan Review (25% of Permit Fee) $
1 `5 I() A y ./ (Z:[' State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Ste9It l Square Footage: Permit Fee:
Footing drain - 1 100' 55.00 0 to 200 $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 Valuation: Permit 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. , Fee 014 ' Total 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 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 *.
Quantity by (Fixture) WorkPerformed Comments regarding fixture work:
I1xture Type: I[teptare
New Moved Existing Capped
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 *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
Date/By: Permit No.:
CIt Of Tl and Planning Approval Sign
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
Internet: www.ci.tigard.or.us ■ ��
/ /xnni� -,d�1, I i ��' l �� Date/By: Case No.:
Contact Juris.:
I I I ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ." "'" W Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
�ew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
E 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ Syste over 600 volts nominal one structure
❑ Buildi over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building III Multi-Family 1:1 Occupan t load over 99 persons ❑ Manufactured structures or RV park
['Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 0-f 5 S t i'1- <11-1- P i FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: LA., t ,e-1 k Z iQ ,A l21" ■ T id s`' / Description Qty Fee (ea.) Total 1
Cross street/Directions to ob site: New sidential- single or multi - family per
1 dwel unit. Includes attached garage.
U 1 ` ry 12.4 I Q 12 t T l4 ) Service included: /
1000 sq. ft. or less F 145.15 4
Each additional 500 sq. ft. or portion thereof ` 33.40 1
Subdivision: I Lot #: Limited energy, residential A- 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service an 90.90 2
Services or d/or feeders feeder - installation,
(u ` w l7 Y� ` alteration or relocation:
200 amps or less - 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
~ , itil - ' ROPER O : __ ER s .1 ' 601 amps to 1000 amps 240.60 2
O ver 1000 amps or volts 454.65 2
Name: ( A S A t3 le- Pt 0,R C (N-S r , w-c • Reconnect only 66.85 2
Address: 1 ``( 't' c - K. w' i.1 Ffi,, , Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zips vq Jg t-4 U it_ c l �`t2 200 amps or less 66.85 1
Phone:'c 111- )ig —cc41 Fax: 2 4— ti '3'1 1 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
8-A'FPLICANT ` ' 13-CONTACT PERSON Branch circuits - new alteration, or
Name: n• w/ extension per panel:
A. Fee for branch circuits with purchase of
Address: ,ci / & ' service or feeder fee, each branch circuit 6.65 2
City /State /Zip : B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
-1 , CONTRACTOR Each pump or irrigation circle 53.4 2
Each sign or outline lighting 53.40 2
Job No: C1 vl {z (..,} L fRt 5c1 Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: 4 iel-q,c Description:
Address: I. (. . a a* 1 (4 21
City/State/Zip: k ( IC i9 N O Each additional inspection over the allowable in any of the above:
y ) Per inspection per hour (mm. 1 hour) 62.50
Phone:5'(. . i, - 01 (Z Fax: Investigation fee:
CCB Lic. #3q vi i1 Lic. #: 3.-12.4' c__- Other: Electrlcai: Pe`7mitI±ees* .,,
Supervising electrician Subtotal $
signature re wired: c Plan Review (25% of Permit Fee) $
Print Name :C�(, �r_ Gj ( / . Lic. #: L. (O S State Surcharge (8% of Permit Fee) $
[ TOTAL PERMIT FEE $
Authorized Il / J"1 43 Notice: This permit application expires if a permit is not obtained within
Signature: I ■ _ ill /" 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElePermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
n Heating, Ventilation and Air Conditioning System
O Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
F - 7 Clock Systems
D Data Telecommunication Installation
Fire Alarm Installation
n HVAC
D Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control
jj Medical
El Nurse Calls
0 Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PREFERRED PLUMBING
3254 SW BARNET ST
FOREST GROVE, OR 97116 -8651
Plumbing Signature Form
Permit #: MST2003 -00251
Date Issued: 8/7/03
Parcel: 2S1 10 BC -02600
Site Address: 14580 SW 120TH PL
Subdivision: WALL PARTITION /MLP2001 -00006
Block: Lot: 001
Jurisdiction: TIG
Zoning: R -
Remarks: Construction of new SF detached residence.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
MASTERPIECE CONSTRUCTION INC PREFERRED PLUMBING
14225 SW 128TH PL. 3254 SW BARNET ST
TIGARD, OR 97224 FOREST GROVE, OR 97116 -8651
Phone #: 503 - 267 -6730 Phone #: 503 - 359 -0560
Reg #: LIC 132604
PLM 34 -340PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X � i/
Si • a e • • - orized P mber
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS, OR 97015 -1429
Electrical Signature Form
Permit #: MST2003 -00251
Date Issued: 8/7/03
Parcel: 2S110BC -02600
Site Address: 14580 SW 120TH PL
Subdivision: WALL PARTITION /MLP2001 -00006
Block: Lot: 001
Jurisdiction: TIG
Zoning: R -
Remarks: Construction of new SF detached residence.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
MASTERPIECE CONSTRUCTION INC GAGE ENTERPRISES INC
14225 SW 128TH PL. PO BOX 1429
TIGARD, OR 97224 CLACKAMAS, OR 97015 -1429
Phone #: 503 - 267 -6730 Phone #: 503 - 657 - 0142
Reg #: SUP 618s
LIC 34544
ELE 3 -128C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X C A. ,
Signature of Supervising lectrician
If you have any questions, please call 503.718.2433.
• •
• •
• •
• •
E TIFICATION TREE C EET R T S R ►
• . . ►
• . ►
Al II DIU-Jr-Y-71N P -14-57 r -
� s � . I, � l (kJ , Owner /Agent for � Gbh C � \ ►
• (PLEASE PRINT) (PERMIT HOLDER)
• ►
• ►
• ►
• ►
• • Do hereb r ti the following location - ►
• meets City of Tigard / County 1
•
• land use and development standards for street tree installation. ■
• ■
• ■
i u -- r� ir2-o ►
• ADDRESS: C l v •
• •
• ( ,---- (--
1,(46 ( 0, i 7/6 4- '
i • LOT: 3 S UBDIVISION: ■
• • • BY: D ATE: 3 -- V ■
• ■ ■
• RECEIVED BY: DATE: ■
A ITVVVVVVVVVVVVYVVeyyyvyVYVVVVVV VVVVV77VVVVVVVVVVVVVVVyVVVVV1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST °d D a. .57
INSPECTION DIVISION Business Line: (503) 639 -4171
• BUP
Received Date Requested 3 - 30 6 `{ AM PM BUP
Location t q 4 80 io- O k PL Suite MEC
Contact Person (itii. Ph ( ) 1S7) —6 :6 W PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
n S _ p v ELR
Crawl Drain -- W '\ I�
Slab Inspection Notes• -- SIT
Post & Beam C.)/ / l U(/ it, r tcl,
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
r:
Fin
PART FAIL
- NG
Post & Beam
Under Slab ,
Rough In
/\ , '
Water Service `n
Sanitary Sewer / ' V f
Rain Drains cOL
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot r %
final
i'
S PART FAIL % I —
MCHANICAL L � j
Post & Beam 7
Rough -In
/ 1„) ..6t , \.) 1 '
Gas Line
Smoke Dampers
Final
PASS PART FAIL — ..,._ _
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire /
re A
‹` gr) 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE fl Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line / '
ADA 7 r, U 1 c v/ I ns ector Ext
Approach/Sidewalk Date p
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Li a03) 639 -4175 MST
INSPECTION DIVISION Business Li : (563) 639 -4171
BUP
Received Date Requested AM PM BUP
c1
Location / 7 —8 ° � if)/ Suite MEC
�� -��
Contact Person C rit Ph ( ) 750 - 5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: p ) ELR
Crawl Drain L a1 �i� K YY�C3��✓t �-�-�/
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smo. - Dampers
stidt4
•ART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 S :
PASS PART FAIL
SITE El Please call for reinspection RE: f Un to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL