Permit f CITY OF TIGARD MASTER PERMIT
4 4 4 1 PERMIT #: MST2002 -00475
- _ . f �r DEVELOPMENT SERVICES DATE ISSUED: 1/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
SITE ADDRESS: 14252 SW 128TH PL PARCEL: 2S109AA -05200
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -
BLOCK: LOT: 018 JURISDICTION: TIG
REMARKS: Construction of new SF Detached residence. Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 29 FIRST: 1,765 sf BASEMENT: 735 sf LEFT: 9 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: 514 sf FRONT: 21 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 7
VALUE: 252,238.40
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,765 sf REAR: 56
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 • 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: 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: $ 7,710.65
Y INC This permit is subject to the regulations contained in the
PAUL CARNEY PAUL R CARNEY C N ND AVE. PAUL R AR E AVENUE Tigard Municipal Code, State of OR. Specialty Codes and
1480 PORTLAND, OR 97229 PORTLAND, OR 97229 all other applicable laws. All work will be done i
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: 503 297 - 9406 Phone: 503 297 - 9406 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 56852 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp B' Wtr Proofing Bsm't Wa Footing /Foundation Dr Electrical Rough In Gas Line Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final
Sewer Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Footing Insp Underfloor insulation Plumb Top Out Exterior Sheathing Ins Rain drain Insp Plumb Final
Foundation Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Issued By : Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
DFi 7 U � ' = e d 3,
t • B Permit Application
1
.dw.Ay,�l'�I rr, City of Tigard RECEI _ oe Datereceived: Permit no.:l') / of _2O` 75
......... _- Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 —
Phone: (503) 639 -4171 DEC 1 02 Date issued: By: Receiptno.:
503
Fax:
(503) 598-1960 Case file no.: Payment type:
CITY • 6 - iGA - •
Land use approval: _ • ,ti • N 1&2 family: Simple Complex: W
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi - family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: 4 Z 57 S' t'2, e ' L Bldg. no.: Suite no.:
Lot: ( S I Block: (Subdivision: 1c_ •1- top.) \ 14 ESTpla4Tax map /tax lot/account no.: 2, 10 A-A -05)00
Project name: `' / � g -a y0, '// . 4 _., •
Description and location of work on premises /special conditions: l- W Da '"r12.. 4 el ark I r -- j
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST ; , '
Name: t_ 'e CAI-44A ey (Flood plain, septic capacity, solar, etc.)
Mailing address: / y g . NJ t.� OZ -- 1 & 2 family dwelling: -
y �•e� ►�
City: IStateO1 _ I ZIP: 9-22 .9 Valuation of work $ 25 2 t
Phone: A 7 - 9 <-1 IFax: -t IE -mail: No. of bedrooms/baths 3- 3 • 1
Owner's representative: �, S Ere Total number of floors Z.
Phone: r - - 7 Z.6 Fax: E -mail: New dwelling area (sq. ft.) 2-5
APPLICANT Garage /carport area (sq. ft.) -S / L i 6 1119-
Name: _S a -AtiC 09 gg? Covered porch area (sq. ft.) / 7
Mailing address: Deck area (sq. ft.) 5 cl 1--
City: I State: ZIP:
Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $
Business name: Sarin 4-5 .�� " Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.) ....
Address:
Number of stories
City: I State: IZIP: Type of construction
Phone: I Fax: I E -mail:
Occupancy group(s): Existing:
CCB no.: New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: /1� „„SreMedir--- provisions of ORS 701 and may be required to be licensed in the
Address: 'St 3 > 1J1 SeNECA- jurisdiction where work is being performed. If the applicant is
City: -7 04 4,4T/d✓ State: IZIP: "77)0 Z exempt from licensing, the following reason applies:
Contact person: / V i mi t , j/iQOZ I Plan no.: A/ • -Z
Phone: Fax: E -mail:
ENGINEER
Name: JA-,n gs 4 Contact person: Fees due upon application . $
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I E -mail: I . Please refer to fee schedule.
I hereby certify I have read and examined this application and the ' Not all jurisdictions , cards, please call jurisdiction for more information
attached checklist. All provisions of laws and ordinances governing this Visa ❑ Mas
work will be complied wi w er specified herein or not. Credit card n mber: _` '003 Z-Ce - 1 3)36 Ex
bb /b`r
_
Authorized signature: /� .ri— . Date: / �� /JO-
D � N iii / .�� �' der . . • • non credit card $
Print name: -� No— " 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)
i
r
I
•
Commercial Plan Submittal
�., Requirement Matrix
City of Tigard
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans. After
plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire pro n systems require that plans bear the original seal of an
Oregon licens re suppression engineer, or NICET level "3" technicians.
is \dsts\forms \COM- matrix.doc 9/24/01
i i
Mechanical Permit Application
Date received: Permit no.: 5
" ,' l ye City of Tigard �••- .,b f -+
ty b Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 - 4171
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 U Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ) ti 2.52 ■n1 r . fs ?I 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: f c IBlock: I Subdivision: Rac 0t1l5e" *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 1 I ZIP: '? 2t.3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes ❑ No
Air conditioning (site plan required)
Is existing space insulated? 0 Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
L �, State boiler permit no.:
Business name: I�4n HP Tons BTU /H
Address: Z 3c' 1 12. h/ coael - Fire /smoke dampers/duct smoke detectors
City: 4 DsOUp I State:6 L I ZIP: 9 7 1 2 - 3 Heat pump (site plan required)
Install/replace furnace/burner BTU /H
Phone: 6Z e - StoZp I Fax: I E - mail: Including ductwork/vent liner 0 Yes 0 No
CCB no.: Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): 6E401 Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
?ere Absorption units BTU/H
�,
Name: l,$ ?er Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
—
Phone: q' 3 5 - 7Z S Fax: E -mail:
Dryer exhaust
OWNER Hoods, Type 1/11/res. kitchen /hazmat
hood fire suppression system
Name: Ao..- y Exhaust fan with single duct (bath fans)
Mailing address: I fib jv ,W i oirznd Exhaust system apart from heating or AC
City: State t (L I ZIP: 9 7 ZZg Fuel piping and distribution (up to 4 outlets)
y'y-'� Type: LPG NG Oil
Phone: 2. `) - 4 Old. Fax: 2 ,L -96Q I E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: ill (L STE1 } 9 ,SD Other l of outlets
Other listed appliance or equipment:
Address: Sj L 3"1 €' 1..) s' E'C*4- - Decorative fireplace
City: 4 1 I State: OIL- I ZIP: Gj'7 J L Z Insert - type
Phone: 0 133 771 Fax: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature: I Date: Other: _
Name (print):
'Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $
Visa 0 Mast rC d y Notice: This permit application Minimum fee $
Credit c :number. 5-1.... 2 " Q i..3�� � i t* D 1 expires if a permit is not obtained Plan review (at _ %) $
. Expires within 180 days after it has been State surcharge (8 %) .... $
Name o s■ .wn on credit card accepted as complete. TOTAL $
'• • h signature Amount , 440-4617 (bW/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 6.80
$1.45 for each additional $100.00 or
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 Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond ,
fraction thereof. footnotes below. Comp **
•
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
-
8% State Surcharge $ 8) 3 -15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb
unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30-50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: _ 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
•
Furnace 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 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.
21) 00
15-30 hp; absorb. unit, 501k to 1 2,310 Gas piping one to four outlets
mil. BTU 5.40
30-50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
•
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
•
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator $62.50 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 $62.50 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) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
-
TOTAL COMMERCIAL $ "'Residential NC requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
i:Wsts\forms\mech- fees.doc 02/11/02
Building Fixtures
•
Plumbing Permit Application OFFICE USE ONLY
Date received: Permit no.As i �00,?_0,,) #'75
City of Tigard
A - ' , 1 City 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: 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 ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 2- s 12_ - ' ill PL 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 f5 IBlock: I Subdivision: EoOla UPLe Tt SFR (2) bath
Project name: SFR (3) bath
City /county: Tu A{ ArI" I ZIP: en -2.:1_2., Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: CAA -etc hA.L.ri t_flA 0 Linn e in4 Manholes
Address: Rain drain connector
City: I State: [ZIP: Sanitary sewer (no. lin. ft.)
Phone: `3 1 a..g s I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: t O Z Ss 5 I Plumb. bus. reg. no: 34 -2 7!c _ f'15 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Absorption valve
Contractor's representative signature:
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins /lavatory
Name: (,45 ?erg- Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: q q -7zer Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Floor drains /floor sinks /hub
Name (print): PAL . 1 2.21...
address: I d Garbage disposal
Mailing �� �D Hose bibb
City: o Q,T�Q -....4. State: P R- I ZIP: 1 221 Ice maker
Phone: q 7 I Fax:'Z 1C. -' I 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)
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
, �� ? AZ S5 v Water closet
Urinal
Name: t-111-1.4_ ,t-111-1.4_ �,i _ a
Address: 513-7 .--__S St71l�c Water heater
City: ,,,4 State: O Q. ZIP: 17 b G — L Other:
Phone: ge _33- I Fax: S71431E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
Visa ❑ MasterCard expires if a permit is not obtained °
Credit car Q wyr mber: S 1 a-6071'3°6 /.04/D1 State surcharge (8%) .... $
C [�1 r Expires within 180 days after it has been
accepted as complete. TOTAL $
Name of cardholde ass . ires
p card
/ $
Cardholde —gnature Amount 440 -4616 (6/00 /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
16.60 for each utility connection)
Lavatory 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 PLEASE COMPLETE:
3" 16.60
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
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 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
Other Fixtures
Water Service - each additional 200' 46.40 (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 62.50
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.
** AII New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i : \dsts \forms\plm- fees.doc 12/26/01
• s Electrical Permit Application
Date received: Permitno.:nrjf�� -oe) 7•,
� '.f � I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: 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 ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1 '-1 LS L .> 1 . ,.7 l Pi Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I rb I Block: !Subdivision: L Azad PA p(e eSTi4T )
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: p z IL Li a+ � Sri? - Description Qty. (ea.) Total no. Map
New residential - single or multi - family per
Address: 1031 „s& 2, Cr — dweilingunit Includes attached garage.
City: g I Stater E_ I ZIP: el 7062) ' Service hicluded:
Phone: 3 1-2,-1 I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: I ti 0 1 I Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
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): ?A ., i. - . cibrevey 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: l Ll taa 4.3Q /to-et-4 601 amps to 1000 amps 2
City: Pe fer244. 0 I State:6a_ I ZIP: Q ?22-q Over 1000 amps or volts 2
Phone:2M 7 - 1 I Fax: Zq 6 -4401 I E -mail: Reconnect only l
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, or relocation:
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,
or extension per panel:
Name: 111 i t_ .S t 1 ' A A. Fee for branch circuits with purchase of
Address: S 11 7 .S W So c,a • service or feeder fee, each branch circuit 2
City: --i w.t I State :6 (L I ZIP: 9 706 I— B. Fee for branch circuits without purchase
Phone:. 6S 8..S 1 Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REV (Please check all that apply) Misc .(Serviceorfeedernotincluded):
❑ 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 signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* � 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other: Per inspection I I
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 $
e Visa O MasterC expires if a permit is not obtained Plan review (at _ %) $
Credit c 1 po3z-6 p 73 134 I 06/ within 180 days after it has been State surcharge (8 %) .... $
Expires
Name o r i`n -' accepted as complete. TOTAL $
shown •n credit card
$
` * n.0 r signature Amount ., 440 -4615 (6100/COM)
1
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT - FEES:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: 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 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 I I Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders r7 Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 Systems*
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n 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. Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 _ 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ri Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00 I--I
Each additional inspection over l i Medical
the allowable in any of the above
Per inspection _ $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 _ ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ _ F Other
8% State Surcharge $ 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 $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MALMEDAL ENTERPRISES INC
42405 NW OVERLOOK DRIVE
BANKS, OR 97106
Plumbing Signature Form
Permit #: MST2002 -00475
Date Issued: 1/21/03
Parcel: 2S109AA -05200
Site Address: 14252 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot: 018
Jurisdiction: TIG
Zoning: R -7
Remarks: Construction of new SF Detached residence. Path 1
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:
PAUL CARNEY MALMEDAL ENTERPRISES INC
1480 NW 102ND AVE. 42405 NW OVERLOOK DRIVE
PORTLAND, OR 97229 BANKS, OR 97106
Phone #: 503 - 297 -9406 Phone #: 503 - 310 -9795
Reg #: MET 4232
LIC 102535
PLM 34 -276PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X {
Signature of Authorized Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
FRANKLIN ELECTRIC INC
1031 SE 23RD COURT
GRESHAM, OR 97080
Electrical Signature Form
Permit #: MST2002 -00475
Date Issued: 1/21/03
Parcel: 2S109AA - 05200
Site Address: 14252 SW 128TH PL
Subdivision: ELK HORN RIDGE ESTATES
Block: Lot: 018
Jurisdiction: TIG
Zoning: R -7
Remarks: Construction of new SF Detached residence. Path 1
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:
PAUL CARNEY FRANKLIN ELECTRIC INC
1480 NW 102ND AVE. 1031 SE 23RD COURT
PORTLAND, OR 97229 GRESHAM, OR 97080
Phone #: 503- 297 -9406 Phone #: 492 -4651
Reg #: LIC 140170
ELE 26 -1041C
SUP 2260S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Afrdex
Signatur- of Su•ervising Electrician
If you have any questions, please call (503) 639 -4171, ext. # 310
Jul 29 03 10:36p Rntix International 503 - 848 -0163 p.1
August 5, 2003
City of Tigard, Building Dept.
@ Fax 503- 624 -3681
Re: MST2002- 00475; aka: 14252 SW 128 Place, Tigard, OR; aka lot 18 Elk Horn
Ridge Estates
Sirs:
Please remove the laundry tray from the above permit. I am also requesting that you
acknowledge this plumbing item removal through fax to: ATTN. Jamie @ fax # 503 -639-
1471. If you have any further questions or comments, please call myself at 503- 297 -9406
(my fax # 503- 296 - 9681).
Very truly yours,
Paul R. Carney, President — Paul R. Carney, Inc.
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/ I. IVVVVVVVVVVVV VVV VVVVVVVVVVVY V VVVVVVVVVVVVVVVVVVVVVVVVV7VVVV1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 Op 2 _604/7S
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location /' o . 5 Z /2_8° Suite MEC
Contact Person Ph (50 93 9 - 7 2F5 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
Fire Sprinkler
•
Fire Alarm
Susp'd Ceiling
Roof
Other:
1/ - 70
Final
PASS • : - T FAIL i
r.st &Be-
U •erSI..
Ro ' h -I
Wate - ervice
Sanit- Sewer
Rain a r m s
Cat* B- -in / Manhole
• m Dr -'n
•wer Pan
* her
Fin
PASS PART FAIL
CHANIC
Post & eam
Rough -In
Gas Line
Smoke Dampers
(Final)
PA T FAIL
RI AL
e
Rough -In
UG /Slab
Low Voltage
- Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
4 PART FAIL
Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date ? (4 / 0.3 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 2 _ ° 6 75
INSPECTION DIVISION Business Line: (503) 639 -4171
f BUP
Received (/ Date Requested — / AM PM ✓ BUP
Location 7° S 2- 1 Z g ?L —Suite MEC
Contact Person ('.41/1(%1 Ph ( ) 1 3 7 - 7a RS 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 0 •
Framing L�_ sl� ' tAL3�i�
Insulation N b et, O .
Drywall Nailing 4
Fi reveal I C/•ttly '� •
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
SS PART FAIL
•L BING
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date . ILA \ <53 - Inspector C rt l Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 a 2 -00 C, 7
INSPECTION DIVISION Business Line: (503) 639 -4171
RecYed /,, ` Vv Date Requested - BUP / AM PM BUP
Location // � Suite MEC
Contact Person
CL S Ph ( ) 97C- 72 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 r GIN sh �� 7
Drywall Nailing /!
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PART FAIL
4:1:40
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
HANICAL
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 Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk
16// 3 I nspector Ext
PP
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL