Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00243
A lII DEVELOPMENT SERVICES DATE ISSUED: 7/1/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11125 SW 125TH PL PARCEL: 1S134CB-07500
SUBDIVISION: ANTON PARK ZONING: R -7
BLOCK: LOT: 037 JURISDICTION: TIG
REMARKS: Addition of 200 square feet to second floor.
BUILDING
REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 20 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 200 sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT:
VALUE: 23
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 200 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 2 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: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL 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: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 671.28
This permit is subject to the regulations contained in the
HARRINGTON, DAMIAN L + JENNIFER C B CONTRACTING Tigard Municipal Code, State of OR. Specialty Codes and
11125 SW 125TH PL 18565 S SCHUEBEL LANE all other applicable laws. All work will be done in
TIGARD, OR 97223 BEAVERCREEK, OR 97004 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: Phone: 503 632 - 3346 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg #: LIC 112881 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Mechanical lnsp Exterior Sheathing Ins( Mechanical Final
Plumb Top Out Insulation Insp Plumb Final
Electrical Rough In Rain drain Insp Final inspection
Framing lnsp Roof Nailing
Shear Wall Insp Electrical Final
Issued By : _! �. , _ Ili._ Permittee Signature : -
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the n • xt bu -'ness d \%
7b `P.7 6 -.s 03
4 Y Building Permit Application OFFK I USE
received: , i� ' i��i //.
e t1 ' City of Tigard
Address: 13125 SW Hall Blvd, Tigard O K ` 97223
C o/ Tigard
Phone: (503) 639-4 Date issued: ;� Receipt no.: e
Fax: (503) 598 -1' .1 JUN ,- U LI) Case tile no.: Payment type: ! 4
Land use ap troval: 6 ;TY
(`r Tlr ^ RD I &2 family: Simple Complex: W
r t1 1
T1 PE OF PERMIT <,
J 1 & 2 family dwelling or accessory J Commercial /industrial J Multi- family J New construction J Demolition
'Addition /alteration /replacement J Tenant improvement J Fire sprinkler %alarm J Other:
JOB SITE INFORMATION ��
Job address: ti 1 n ` 12 , rj - • R utka Bldg. no.: Suite no.:
Lot: I Block: (Subdivision: I Tax map /tax lot /account no.:
Project name: -- \aRe:rN Ciro f\J (gyp, r
Description and location of work on premises /special conditions: Atsai^iie f\ 4F 1).fi-a,rS G P 1�
in,n-.0r !°R,.�wY• - t
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: . e1 ■ A,_ , illiq --cow ( Floodplain , septic capacity, solar,0tc.)
Mailing address: \a.5 Sv v, go t,AG I & 2 family dwelling: - 3 / I 0
City: (j\f„& State: opjZIP: R-7 2 Valuation of work St�
Phone: !a\ - (A2,\� I Fax: - 12,1-I (E- mail:,,A, , , No. of bedrooms /baths
Owner's representative: c‘11 -A2sf') % �T Total number of floors
Phone: —°1 Fax: te, E -mail: New dwelling area (sq. ft.) • II
Garage /carport area (sq. ft.) t•- A
Covered porch area (sq. ft.) N
Name: �flMF. A5 4'�V�. P q' •
Mailing address: -----.> Deck area (sq. ft.)
City: —� I State: — ( ZIP: Other structure area (sq. ft.) pi
Phone: Fax: — E -mail: ---- Commercial /industrial /multi - family:
CONTRACTOR Valuation of work S
(... Existing � Existing bldg. area (sq. ft.)
Business name: I) l�F►�s['� C. Mb
�M � L tJ New bldg. area (sq. ft.) 1
l9 Number of stories
City: t* State:OK ZIP: RiCol Type of construction
Phone: 72.7 -1 \3`7 I Fax: ( ? mail: --�'
Occupancy group(s): Existing:
CCB no.: i` ZW$ k New:
City /metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 8' . 1J provisions s of ORS 701 and may be required to be licensed in the
Address: k vtc 11\ S Ltr»e..9,V L. jurisdiction where work is being performed. If the applicant is
City: 111 State: (�Q�( ZIP: 017�J exempt from licensing, the following reason applies:
Contact person: mr I R Plan no.: u �t-y -
Phone: 1qk _ o Fax: �- E -mail: — - -
1
ENGINEER OFFICE USE ONLY \
Name::_ NORDRZN( Contact person : %.N N(.t ees due upon application S / "1/ • -, 7 44
Address: d ) S\13 ClsF,�c� yF . Date received: v
City: g uyNl) State: Of,. IZIP: Ri2.SO\ Amount received 4 (C s o.23n? - 90
Phone: Za') -11 I Fax: 22,117$111 E -mail: br, � e_- 2 , a p7 J(o Please refer to fee schedule. — G /, 3 „3
I hereby certify I have read and examined this application an he C Not all jun. diction accept credit cards. please all jurisdiction for more information:
attached checklist. All provisions of laws and ordinances governing this U Visa U MasterCard
work will be complied with, wheth- s f - 10 ified herein or not. Credit card number: / /
E spire,
Authorized star . ture: r , �� i ., . Date: t 1 3� Name of cardholder as shown on credit card
Print name: a •r; tt. �� e " , ` \L 1� s
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 /COW1
/1/OT ✓L /7'e '9A/6 ,1 C_T 69u '9776A/ , 07/e 5� 07 /�C."S� �/ /ezt) �£ S
e!`4L L.Ee.7�d 44),G ex.& - 7 / / . eOLL ZZ 7 / ?"7'fr/V/A/&-
/ P7 gr /SS u e -. 4�iO'3 .
Jiutluing r fixtures
Plumbing Application Permit A lication FOR OFFICE USE ONLY
Received 2 Plumbing
Date/By: C /0 63 Permit No.: /'1 5 OQa
City of Tigard Planning Approval Sewer
y g Q EC C Date/By: No.:
13125 SW Hall Blvd. 11 11 Lv C Plan Review Other
Tigard, Oregon 97223 DateBy,: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
/�a,d lh'��Yl ( I � Date/By: Case No.:
o
Internet: www.ci.tigard.or.us . I Contact Juris.:
• I ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175' C "'" Name/Method: Supplemental Information.
OuiLDINC4 �.iv
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description Qty. Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
2-Family dwelling Commercial /Industrial SFR (1) bath 249.20
1 & 2
❑ y 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 - sq. ft.: Page 2
Job site address 12 1 2,5 � P(.. 77(i,y9 4 t 3 .,. =: 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: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ❑ TENANT Ejectors/sump 16.60
Name j f1l l -V t Diti rl I ail t t 1 11(3 Y1 Expansion tank 16.60
Address: )112.S cl 1251/ p( - J Fixture /sewer cap 16.60
City /State /Zip:119 C ,(,to al 0/7i2 3 Floor drain floor sink/hub 16.60
Garbage disposal 16.60
Phone(j03 3.9 1-q/21 q Fax: Hose bib 16.60
El APPLICA ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60
�' p Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan I 16.60
CONTRACTOR Urinal 16.60
Business Name: - r -1-- 4 or co I
c water closet 16.60
Water heater
Address: Po &6x 2`7 Other: 16.60
City /State /Zip: ..,' L, / OR 1 1 - g Other:
\D" phone: SJ3_ c [) -- gam Fax: Plumbing Permit Fees*
4)
4
Authorized CCB Lic. #: 10 �7 12. Plumb. Lic. #: -Z `iP R subtotal $
Minimum Permit Fee $72.50 $
f� Residential Backflow Minimum Fee $36.25
i O � Signature: i • �'u [ wm Date:__ Plan Review (25% of Permit Fee) $
1AAA ' ' • I l ( I n Ella l 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:
`° Square Foot Permit Fee:
Footing drain - I' 100' 55.00 0 to,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 ValuatioA� 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 F4 $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
Pixture;gr" QtY• 46.40 lea) _ including $10 ,000.00.
i on Device
Commercial Back Flow Prevention $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 w to
accurately report fixtures could result in increased seer fees *.
fi-antity 'or1 Feria " meal Comments regarding fixture work:
use e. �1 -<
°,Moved
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\Pemiit Forms\P1mPermitAppPg2.doc 01/03
FOR OFFICE USE ONLY
Electrical Permit Application Received / Electrical
Date/By: CP to e 3 Permit No.: S j :, o -o00
Cit of Ti and Planning Appro al 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 -19 i 60 ,• Post- Review Land Use
�, mr�'iU �, Date/By: Case No.:
Internet: www.ci.tigard.or.us L •� I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 --J Name/Method: Supplemental Information.
TYPE OF WORK ' PLAN REVIEW (Please check all that apply)
❑ New 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 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant 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.
lob address: I I I 1 L(j I '?.6 ` 0 11 4112. FEE* SCHEDULE I
Suite site #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total i
Cross street/Directions to job site: New residential-single attached ac ed fg a r a per
.l dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
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
601 amps to 1000 amps 244.60 2
p ' a ,g `I`OWNEIL. MAIM ?` TENANT O ver 1000 amps or volts 454.65 2
Name: 1)4M 1 ti,n , Lit or-icy Y ! ir(lr Reconnect only 66.85 2
Address: I I I 26 S1,6 I P L Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: TIC) (Ldl C-- ci 3 200 amps or less 66.85 1
Phone: 52.1 -q Z l y Fax 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
fl" PLICANT ' "' ,- Branch circuits - new alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: 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: I Fax: Each additional branch circuit _ / 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
�-�-� 0. n alteration, or extension Page 2 2
Business Name: IL',' Flee ic1 ( , Description:
Address: (M CA.,acMa.
City /State /Zip: ( ( % 1 O . n 045 Each additional inspection over he all in any of the above:
Per inspection r hour min. 1 hour 62.50
Phone: - 33 9 \-. 1�� ' T Fax': Investigation fee:
CCB Lic. #: 15\ Lisa5 Lic. #: 3- 5'iO C— Other:
EIectrical Permit.Fees . , `- ' A
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: CHAL 1 Ao5E,0 I Lic. #: 1-1 S State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized 4 Notice: This permit application expires if a permit is not obtained within
Signature . ',r V)1 V Date: 14 i (6/0.3 180 days after it has been accepted as complete.
. *Fee methodology set by Tri- County Building Industry Service Board.
I ,, e .nn /It)' fria,r Y 1 +&Y1
(Please print name)
i:\Dsts\Permit Fotms\ElcPermitApp.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:
• Audio and Stereo Systems
❑ Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
❑ 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
0 Boiler Controls
n Clock Systems
0 Data Telecommunication Installation
n Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
D Medical
❑ Nurse Calls
n Outdoor Landscape Lighting
T7 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
Mechanical .Permit Application FOR OFFICE USE ONLY
Received // // Mechanical
Date/By: CO /0/p 5 Permit No.: N 5 — 100 .- 3
Cl of Tigard Planning Approvals Building
`J g Date/By: Permit No:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 0 2003 DateBy. Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 / /#/ f//... Post- Review Land Use
i , A Date/By: Case No.:
Internet: www.ci.tigard.or.us 1 y '
•I I Contact Juris.: El See Page 2 for
24 -hour Inspection Request :. 503. -639 -4175 Name/Method: Supplemental Information.
TYPE OF WOK ;COMMERCIAL FEE* SCHEDULE -s USE CHECKLIST
['New construction ❑ 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
CATEGORY OF CONSTRUCTION mechanical 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) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORIVIATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: /1 I ZS S'l _ / 2_5 IYI RL Ti jtvvi y i223 Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct ork 14.00
Project Name: Hydr is hot water system 14.00
Cross street/Directions to job site: (for ra sal boiler
(for di. or or hydronic system) 14.00
Unit heate . (fuel, not electric)
(in wall, in ct, suspended, etc.) 14.00
Flue /vent (for . y of above) 10.00
Subdivision: Lot #: Repair units 12.15
Tax map/ parcel #: Other Fuel Appliances
ax ma
p p Water heater 10.00
DESCRIPTION= O WORK ` Gas fireplace 10.00
e4 rE ll. 'D L t OrIS Flue vent (water heater /g. fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue/vent 10.00
0 PROPERTY I 0 TENANT . Other: 10.00
N , r n t c { 1- ha ni ,, f ) r � , 'ri f j t ? ( /1 Environmental Exh . st & Ventilation
Address: 1 I I Z6 Si3O 126- p L 1 Range hood/ot kitchen equipment 10.00
Cit City/State/Zip: Clothes dryer exhaust 10.00
Y P it l� �aa3 Single duct exhaust
Phone 111Z 691- G/ I Fax: (bathrooms, toilet compartments,
.. ,"° e " 'V - '. utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additiona
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR _: Water heater **
Business Name: r„,„pt‘, Fireplace **
Address: y -)?� Mv
on4ti , \v'►e,, „) 5, Range ** .
City /State /Zip: as C.. PR S'-]0g Clothes dryer (gas) **
Phone: SW3- 19 - 1 Fax: Other: **
CCB Lie. #: Il-1 (' -d-c) -O 41 Total:
Mechanical Permit Fees*
Authorized ,. �� Subtotal: $
Signature: / jL,L a 7 i Date: (Q l.0 Minimum Permit Fee $72.50 S
j r de (. r Ha ri i I -1-6 1 7-) 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:
Tom >l - -
$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.
t ons=I'Or 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:
i s \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour /
BUILDING Inspection Line: (503) 639 -4175 MST 3 - g , 7'3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location / / °Pt-- PL Suite MEC
Contact Person Ph ( ) 1 -o - 7 ( 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain , 4-6 ELR
Crawl Drain
Slab Inspection Notes:
Post & Beam , i
Shear Anchors rierAmmowiiiiffijor Sheath/Shear ����
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ,-
Roof U
Other: irr
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
S PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: E Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date /52 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour C /
BUILDING Inspection Line: (503) 639 -4175 MST 3 — aQ a T3
INSPECTION DIVISION Business Line: (503) 639 -4171
a BUP
Received Date Requested D AM PM BUP
Location r r I as l a.s AC— Suite MEC
Contact Person ( AA,1-6 Ph ( ) 7 a 70 — 7137 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
.■
atidn
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
PART FAIL
MBING
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
•:o •h-r7
Gas Line
Smoke Dampers
PART FAIL
RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please - or rei spection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date v Inspector AV A Ext
Other:
Final DO NOT REMOVE this inspection I F cord from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Li ne: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ` AM PM BUP
Location < I ID-5 /a S ' PL- Suite MEC
Contact Person Cdt Ph ( ) a. D — 71 37 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing �^
Firewall H\J Cr �1 ~ i S w.I `, A ) (! _ Fire Sprinkler
( � �
Fire Alarm
Susp'd Ceiling tom( / (` \ ` n M
Other: 1 ` N ` 11 � �l H kk l� ' 1' 0'0\
Final
PASS
PLUMBINGRT FAIL cUM )4 "44k
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer 4P
Rain Drains
Catch Basin / Manhole
Storm Drain -
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage /Z/ c L- 7
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE ❑ Unable to inspect — no access
Fire Supply Line
ADA f
Approach/Sidewalk Date d Inspector L Ext
Other:
Final DO NOT REMOVE this Inspection record fro the Jo site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 o C 2-V3 INSPECTION DIVISION Business Line: (503) 639 -4171 MST 3
BUP
Received Date Requested R t t AM PM BUP
Location t t t�� /2-c P1 Suite MEC
Contact Person C Ph ( ) 7 > O 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
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 /C/ (i 0/0
er:
,SS) 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
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA 9 —//--(1 3
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL