Permit , I •
.CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00157
�s DEVELOPMENT SERVICES DATE ISSUED: 3/12/02
_.f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14111 SW 120TH PL PARCEL: 2S110BB -06100
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
REMARKS: 540 s.f. garage addition and upper level storage.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: 540 sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT:
VALUE: $ 12,852.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0.00 sf REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: 1 VENT FANS: 1 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 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: 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: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 605.38
GARY/JEANNE HENRY OWNER This permit is subject to the regulations contained in the
GARY / Tigard Municipal Code, State of OR. Specialty Codes and
14111 JE NN
TIGARD, 120TH TH TH FORM IN FILE ED RESPONSIBILITY all other applicable laws. All work will be done in
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:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rea #: forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Electrical Service Gas Line lnsp Plumb Final
Footing Insp Electrical Rough In Gas Fireplace Final inspection
Foundation Insp Framing Insp Rain drain lnsp
Slab Insp Shear Wall Insp Electrical Final \ \
Mechanical Insp Exterior Sheathing Insi Mechanical Final `r
Issued By z : (4j jr " <7.F�G� Permittee Signature : � �L=
f ` ¢' f.� c. Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day i
,
./s 3-1/ 02 - /1
• Building Permit Application
. Datereceived: Permit no.: 5r a J`
-00 / ,
, ,���, 1 1 City of Tigar E� .
. : _.. Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97 2 r
Phone: (503) 639 -4171
FEB 7111 / j Date issued: By.`, Receipt no.:
Fax: (503) 598 -1960 f D /(�/ Case file no.: Payment type:
CITY UF Illi
Land use approval 1 &2 family: Simple Complex:
. . .
•. . s . s' , ,
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
z. Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: /42 /// 5A) /20 7 2' 1 / 9 L„4. 64 - Bldg. no.: Suite no.:
Lot: I Block: I t1bdivision: I Tax map /tax lot/account no.:
Project name: 113 - . LI
Description and location of work on premises/special conditions: 6 4 - r 6.6 S14 , D /7>rm1 f 57D2.4-L£
, oa'Y+n /> 7 /77 7D Lx' 5 77^J G O') £GU.J 6
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: m /44/15 . ii,NLV /74•-&7v/1.47 (Floodplain, septic capacity, solar, etc.)
Mailing address: /cf7 / / 5 w / p 77! / Ltd 1 & 2 family dwelling: o
City: 77 6,4 -yj, State: o , . ' ZIP: 7 22 3 Valuation of work o X ZJ $ /2 j'5
Phone: 68-V — 903 / IFax: I E -mail: No. of bedrooms/baths NM
Owner's representative: L7f1-t// D /1'}/3 L $ Total number of floors Z
Phone: 2 o — op / Z Fax: o -000,0 E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.) SW
Name: 4714,6£,ewooD /472 f leerttvp ct',GS Covered porch area (sq. ft.) _
Mailing address: /thy 4/ .5,,,) 6-n, y lc G7:
Deck area (sq. ft.)
City: ,B1 .54, J State: o. - ZIP: 17D0 - Other structure area (sq. ft.)
Phone: > >p _ / 2. Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name:
5 l >f3 ' ' c New bldg. area (sq. ft.)
Address:
Number of stories
City: I State: I ZIP:
Type of construction
Phone: I Fax: I E -mail:
CCB no.: /3 4 Occupancy group(s): Exp Ne g •
City/. etro c. no.: 6 Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: /y/ 7 ,i /,, L/}1,., QF3/ / EyL provisions of ORS 701 and may be required to be licensed in the
Address: / o, o , ,3 6 / 3 jurisdiction where work is being performed. If the applicant is
City: p,47! 6,2,Y I State: p/2 I ZIP: 97 - /o�- exempt from licensing, the following reason applies:
Contact person: ,41 /ice.// Plan no.:
Phone: (, - j 4 Z Fax: E -mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: I Fax: (E -mail: Please refer to fee schedule.
I hereby certify I . ve read an' • xamined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A 'row • . ns . laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied w . , wh er ::-cified herein or not. Credit card number: sx i /
P
Authorized signature: — .c' - ii Date: .2l2 C/ Name of cardholder as shown on credit card
Print name: ./)A /o livAR5 Alit WoeD /1/2" Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00/COM)
et '• 4,..--7
One- and Two - Family Dwelling
' • • ' ' '
';tk Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard LI Electrical ❑ Plumbing LI Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 LI 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.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review. -
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 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)
•
. Plumbing Permit Application
Date received: Permit no.: y) T, - 00 1 7
.-1 City of Citf Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction )KAddition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: /y /// S Al / 20 72/ /'''' 4.14-C £ Description Qty. Fee (ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: 4/0-4.441 .g4*c4 Site utilities:
/47901Tw- /Irv, SIb 204 -4t R oir. R-AO / n, Catch basin/area drain
Est. date of completion/inspection: 3 /2 . 0 0 Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: G, A r ai-4e. ,0.ves- i4/AJ6 Manholes
Address: 77 36 SW N'4i 4145 /¢'✓E • Rain drain connector .fr- ev fl 4it 5
City: AffW14,.71 I State:04 -1 ZIP: 9 ?oar- 4ye9 Sanitary sewer (no. lin. ft.) /
Phone: $2 Sv Zo I Fax: £Zs'_ , sv/ y I E -mail: Storm sewer (no. lin. ft.)
CCB no.: / 7 ie te4/ I Plumb. bus. reg. no: ;, , O - /Li Water service (no. lin. ft.)
Fixture or item:
City /metro lic. no.: S 0(
441 Back valve
Contractor's rep r sentative signs ure:
Back flow preventer
Print name: er p J ' Date: Z--ar�rL Backwater valve
CONTACT PERSON Basins/lavatory
l3umirc Clothes washer
N a e : 4, r2won n A n t . e l , ' ' D h4/.r31d S
Dishwasher
Address:
/i_ S 5/ o S /,J ONY}t e7 Drinking fountain(s)
City: Rr, t e<29 1 State:pa I ZIP: 1 2007 Ejectors/sump ______'
Phone: STo - /QS Fax: 3 • -1)08E E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): a //025 GA--,2 y .v
Floor drains/floor sinks/hub
address: ill Hose bibb
disposal
Mailing /� /� / S� X20 ��= Hose bibb
City: -- 7 - 24, 4 _,L0 I State: pa. I ZIP: g 2 yZ
3 Ice maker
Phone: 4 t 5/ _ 4 o 3/ I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) ,j
/ loA444'LL /
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Name: Urinal
Address: Water closet
Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application
❑ Visa ❑MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount
440-4616 (6100 /COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100'ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub /Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3 ..
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
* *PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
* * All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts\forms\plm-fees.doc 08/29/01
Mechanical Permit Application
. A: -
Date received: Permit no.: c/1/5-7- - 0 0 i ,
.44,1-' :� �� City of Tigard Project/appl. no.: Expire date: 7
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction - Addition /alteration /replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /4/ /// Sw / 2 -# / 0p,4t Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'Block: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: 6/A71-,a6 SP4•oa: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
19,00 /T2I t Syr; 44 S1,¢e.4 A:l2%i77or/ Fee(ea) Total
Est. date of completion/inspection: 3/g0 /o - z — Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? CI Yes ❑ No Alteration of existing HVAC syste
MECHANICAL CONTRACTOR Boiler /compressors RernwF raspy
State boiler permit no.:
Business name: ..57-1 C HP Tons BTU /H
Address: F r 2 1' Sr../ 77M7-49 9 5% • Fire /smoke dampers /duct smoke detectors
City: ?76,/h✓ti, I State: ea..... I ZIP: /7 2z 3 Heat pump (site plan required)
Phone: (o 2e — S 4/31 Fax: Sge - DWI-E-mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 6 G C 7r Install /replace/relocateheaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): ^/p2M /t+ L / 5 Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Maine " ,4 - »4 /3f/tin/VD 0 /- fo+'t^Er3 � 6f7/E" 7fi��2BS t
Chillers HP
Address: /SL q 4' C s/,,/ es/pc dr Compressors HP n virressors
J Environmental exhaust and ventilation:
City: , tfiV 1L l I State:D/t_ I ZIP: 1 7Op 7 Appliance vent
Phone: 5T0 - /pSL Fax: E -mail: Dryer exhaust
OWNER Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: /h,Q //k,g5 6/427 / Exhaust fan with single duct (bath fans)
Mailing address: /4/ m S� / 20 7Di £ Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: - I State: 0/L I ZIP: 9727 3 Type: LPG NG Oil
Phone: 4,f-ti - o 3 Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorativefireplace ,(Ey►, /4- /LErt.-4GL
City: I State: I ZIP: Insert - type
Phone: Fa E -mail: Woodstove/pellet
Applicant's signatur I Date: Z /z_r /o Z O
Name (print): /'/qt/ /4 /f143/35 / /17 4 /A l2140PG' /c 'hr 5
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit ap Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount
440 -4617 (6/00 /COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description; `:Price , '! Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code. Qty, (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and 'Chec1(atl tat appC , ®lerN J ) a
$1.20 for each additional $100.00 or For rteins:7 11, see , !4 �d
fraction thereof foot otes jbw z COViv A „
' 1/' .,'" :,.. : ; 'w E 7) <3HP; absorb unit
Minimum Permit Fee $72.50 S U BT OTAL : ^$ to 100K BTU 14.00
8% State Surcharge 8) 3 -15 HP; absorb
g $ unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal) 9) 15 30 HP; absorb
$
Required for ALL commercial permits only unit .5 -1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 52.20
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASS .010 IVUATIQN `SEA APP CE r , . 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Fumace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 10.00
floor mounted heater appliance permit
Vent not included in applicance 445 17) Hood served by mechanical exhaust 10.00
permit
Repair units 805 18) Domestic incinerators 17.40
< 3 hp; absorb. unit, 955
to 100k BTU 19) Commercial or industrial type incinerator
69.95
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU 20) Other units, including wood stoves
10.00
15-30 hp; absorb. unit, 501k to 1 2,310
mil. BTU 21) Gas piping one to four outlets
5.40
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU 22) More than 4 -per outlet (each)
1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.1. 75 mil. BTU
af4t
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170 8% State Surcharge $
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
TOTAL RESIDENTIAL PERMIT FEE: - $
Vent system not included in 656 . .
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1,170 1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Other unit, including wood stoves, 656 $72.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge-one-half hour) $72.50 per hour
Each additional outlet 63
* State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL x $ ** Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech - fees.doc 08/29/01
A . • Permit Application
Date received: Permit no.:5 7 X03 - (90 / 1
1 City of Tigard
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi - family ❑ Tenant improvement
❑ New construction Addition /alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: /ii/// 5 /2.p rAL / Pm-cc. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: ISubdivision:
Project name: 'Description and location of work on premises:
Estimated date of completion/inspection: ay a 2—
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: ,EeyfrL ! t: t CGGTrG /e- /4/ •
(Description Qty. (ea) Total no. insp
/ residential - single or multi - family per
Address: 2 6 9 UTFd LL£ #4,0 N dwelling unit. Includ sattachedgarage.
City: pp,,iA -z. I State: pg. I ZIP: 11702v Serviceincluded:
Phone: (0 7f -- /3 s - I Fax: Or_ No r E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no:
Limited energy, residential 2
City /metro lic. no.: Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): ism/r114-.5 4 ,Lt_ i 401 amps to 400 amps 2
�j '/ ''_ , 401 amps to 600 amps 2
Mailing address: / /// ..5 / ,l.1C
601 amps to 1000 amps 2
City: —724.4. I State:O _ I ZIP: q 72- 2- 3 Over 1000 amps or volts 2
Phone: 4,e, / - v0 I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2 .
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
rm
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ A udio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manuld Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 n V acuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n
or feeder fee. Fire Alarm Installation
First branch circuit I $46.85
Each additional branch circuit t,.. $6.65 n HVAC
Miscellaneous n
Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: ❑ P rotective Signaling
Enter total of above fees $ / ) n Other
8% State Surcharge $ Gi b'/
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
All New Commercial Buildings require 2 sets of plans. Total Balance Due $
i:\dsts \forms \elc- fees.doc 08/30/01
MAR 14 ' 08:56AM P.1
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
BEAR ELECTRIC RECEIVED
20985 BUTTEVILLE RD NE
DONALD, OR 97020 MAR 1 5 2002
CITY OF /RAW
BUILDING DIVISION
Electrical Signature Form
Permit #: MST2002 -00157
Date Issued: 3/12/02 - _....
Parcel: 2S110BB -06100
Site Address: 14111 SW 120TH PL
Subdivision: REDWOOD VISTA
Block: Lot: 003
Jurisdiction: TIG
Zoning: R-4.5
Remarks: 540 s.f. garage addition and upper level storage.
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 Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
GARY /JEANNE HENRY BEAR ELECTRIC
14111 SW 120TH 20985 BUTTEVILLE RD NE
,_.. TiGARD -OR - -9 223 DUMALL� �.�R. 20
Phone #: 503-684-4031 Phone #: 503- 678 -1355
Reg #: EL5 249 c
SUP 3162 -S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X ? : � �2 ..
Signature of Supervising Electrician
If you have any questions, please call (503) 639 - 4171, ext. # 310
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST °`� 0 d d 157
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location / I /I 4-- Pt Suite MEC
Contact Person Da.c r-e__ Ph ( ) 1,;- 6 / PLM
Contractor Ph ( ) SWR
BUILDIN Tenant/Owner ELC
.,o g LC
Foundation Access: '\
Ftg Drain CO—Y)"/ f ) f / ELR
Crawl Drain a
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
O. •
inal
'• 'T FAIL
c
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains +�
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
RT FAIL
-.I. -n
Gas Line
S ke Dampers
final
FAIL
IC
•
oug -
UG /Slab
Low Voltage
Fire Alarm
✓i' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'b PART FAIL
SIT Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date (/ f ---Inspector _ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL