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Permit
CITY OF TIGARD MASTER PERMIT PERMIT #: MST2002 -00458 01A, DEVELOPMENT SERVICES DATE ISSUED: 12/3/02 '�'�" _. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14220 SW 128TH PL PARCEL: 2S109AA - 05100 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 017 JURISDICTION: TIG REMARKS: Const. new SF detached residence.Path 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 35 FIRST: 1,734 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,394 sf GARAGE: 680 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 TRRD: sf RIGHT: 5 VALUE: 308,008.00 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 3,128 sf REAR: 27 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: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 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: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 • 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: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: X VACUUM SYSTEM: X AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,247.66 This permit is subject to the regulations contained in the KEITH W.BAKER QUALITY CARPENTRY ETC. Tigard Municipal Code, State of OR. Specialty Codes and 13037 SW ROCKINGHAM DR. 13037 SW ROCKINGHAM DR. all other applicable laws. All work will be done in TIGARD, OR 97223 TIGARD, OR 97223 accordance with approved plans. This perm it 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: 503 740 - 3488 Phone: 503 740 - 3488 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 92071 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Scft7 -.S011/ REQUIRED INSPECTIONS Erosion Control Insp 8 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 lnsp Shear Wall lnsp Insulation Insp Mechanical Final Footing lnsp Underfloor insulation Plumb Top Out Exterior Sheathing Ins[ Rain drain lnsp Plumb Final Foundation Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection Issued By : .. -ft_� /r all Pe rmittee Signature : ` I ,t �] 1.fJ" — " — _<4 Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day ii— Z1 —o 2 B i . Building Permit Application Date received: / 1� r �iJ)— Permit no. S 9 ' i i City of Tigard AFC E IV ED Projecdappl. no.: Expire date: CiryofTigard Address: 13125 SW Hall El; , Tigard, OR 97223 Phone: (503) 639 - 4171 15 2UO2 Date issued: By: p ' Receipt no.: Fax: (503) 598 -1960 Nov U Case file no.: Payment type: Land use approval: CITY OF TIGA CJ DIVIS 1 &2 family:Simple Complex: I.u o TYPE OF PERMIT (J 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi family New construction ❑ Demolition ❑ Addition/alteration/replacement ❑ Tenant improvement Cl Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION -g Job address: 142.2 0 S� , 1 •Z$'I'� N I . Bldg. no.: Suite no.: Lot: 1 Block: (Subdivision: ri �{ ‘4-0i'h zo c ESfidh Tax map /tax lot/account no.: 2s/ 0944 OS/ o Project name: I - 1 `() 41 t y. E Description and location of work on premises/special conditions: _..._ Y' 1 OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: 14e r yA J , , L..tr -- (Floodplain, septic capacity, solar, etc.) Mailing address: t a p 1 i/ J . R. `, .: th r, 1& 2 family dwelling: City: -- T-1 3a re ,t State: o ' P: a Z Z2.3 Valuation of work ...,3.Q 4 w t $ 2-1 0 p049 o Phone: 7tiD —3N $A (Fax: (E -mail: No. of bedrooms/baths E 3 2.5 Owner's representative: Total number of floors 2. Phone: Fax: E -mail: New dwelling area (sq. ft.) sY/ 1 APPLICANT Garage /carport area (sq. ft.) 4 Sa i66' rii Name: K, --L v\1 , R Covered porch area (sq. ft.) Mailing address: 5„, vv , e a , S a too Deck area (sq. ft.) I �$ City: 'State: ( ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: Commercial/industrial /multi- family: CONTRACTOR Valuation of work $ Business name: Existing bldg. area (sq. ft.) IMINIM New bldg. area (sq. ft.) Address: ' , .4 - . , i� Number of stories City: State: ZIP: Type of construction Phone: (Fax: (E-mail: c� Occupancy group(s): Existing: -24 CCB no.: 4 to 7 1 ' -. — 0 New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be ARCIIITECI' /DESIGNER licensed with the Oregon Construction Contractors Board under Name: Ai y, Ma, S C19 r 4 425 TA N S provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed. If the applicant is City: State: (ZIP: exempt from licensing, the following reason applies: Contact person: I Plan no.: Phone: Fax: E -mail: ENGINEER A II Name: Ma Ow^. Contact person: V. A Fees due upon application $ Address: Date received: City: (State: (ZIP: Amount received $ Phone: 2_3g ©b 33 (Fax: (E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard work will be complied w'th he t, s 4 ified herein or not. Credit card number: / / Expires Authorized sl atu • : i _, , . ,',..,',......A ,.. Date: k k (Z Z Name of cardholder as shown on credit card Print name: At" '111A Lac ' Y` $ Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44o -4613 (broo/COM) T ' a One- and Two - Family Dwelling 4.7;11 Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City f Tigard y b ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fait: (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. V 3 Verification of approved plat/lot. ✓ 4 Fire district approval required. V 5 Septic system permit or authorization for remodel. Existing system capacity / 6 Sewer permit. V 7 Water district approval. ‘7i 8 Soils report. Must carry original applicable stamp and signature on file or with application. V 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of earth-basin protection, etc. 7 3 omplete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ,,..__� ' ing 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 v if copyright violations exist. 11 Site/plot plan drawn to scale: The 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 V ., 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, V 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 w / locations. Show attic ventilation. V 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. V 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. V _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. V 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 )WCOM) , • , . Plumbing Permit Application , , .A Date received: Permit no. y. —CV ` g �A City of Tigard ..1,1- . 411 S ewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Proj ect/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: I 1 PE OF PERMIT X 1 & 2 family dwelling or accessory ❑ Commercial/industrial LI Multi - family ❑ Tenant improvement S it New construction LI Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEI)ULE (for special information use checklist) Job address: /L4,3,0 aW J()__ 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: IBlock: 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: Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain Footing drain (no. lin. ft.) PI I'M CONTRACTOR Manufactured home utilities Business name: C �' i ; C..) /V `' Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve Print Back flow preventer rint name: Date: Backwater valve ('ONTACI' PERSON Basins/lavatory Name: Clothes washer Address: Dishwasher Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): Floor drains/floor sinks/hub Mailing address: Garbage disposal Hose bibb City: I State: I ZIP: Ice maker Phone: 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) Owner's signature: Date: Sump 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. Notice: This permit application Minimum fee $ O Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / State surcharge (8%) .... $ Expires within 180 days after it has been Name of cardholder as shown on credit card accepted as complete. TOTAL $ $ Cardholder signature Amount 440 -4616 (6i00/COM) PLUMBING PERMIT FEES: • PRICE '� TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY AMOUNT dude 1$pumbing XtUresln PRICE TOTAL Sink 16.60 th w ,� r ° d the fir$000 fi;" QTY P . (ea) AMOUNT Lavatory 16.60 l a 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 Quantity by Work Performed Water Heater 0 conversion 0 like kind 16.60 y Y Gas piping requires a separate mechanical New Moved Replaced %.Rerfloved/ permit. e 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 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 *SUBT OTAL kol 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. is \dsts \forms \plm- fees.doc 12/26/01 Electrical Permit Application Date received: ( (- t f) Permit no. P67-66 _ 4 d 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 ►_ & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ew construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: Iy -2_,2,0 w i i. ES L1 P V , Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: 1 "7 I Block: I Subdivision: El k kl»rn ? q e E3t6,1N, S Project name: I Description and locatidn of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: - yL .I --,-C Fee Max Business name: Description Qty. (ea.) Total no. insp Address: New residential - single or multi- family per dwelling unit Includes attached garage. City: I State: I ZIP: Serviceinduded: Phone: I Fax: I E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: I Elec. bus. lic. n�: 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): 201 amps to 400 amps 2 Mailing address: 401 amps to 600 amps 2 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -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, 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: 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 of service or feeder fee, first branch circuit: 2 Phone: Fax: E -mail: Each additional branch circuit: 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: ❑ Egtess/lightingplan ❑ Other: Per inspection 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 $ ❑ 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 (6i00/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 Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems* Each additional 500 sq. ft. or portion thereof $33.40 1 Limited Energy $75.00 ❑ Burglar Alarm Each Manuf'd Home or Modular Dwelling Service or Feeder $90.90 2 L�CJ Garage Door Opener Services or Feeders eating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 Vacuum Systems 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. 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 $46.85 Each additional branch circuit $6.65 ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ 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: n Protective Signaling Enter total of above fees $ n 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 A Mechanical Permit Application Date received: Permit no.: rns 7�0,9 -cell 6 .� 1' City of Ti • :_.. � and g Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 Date issued: By: 0 rrj Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ;l 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family 0 Tenant improvement n New construction 0 Addition/alteration /replacement 0 Other: JOB SITE INFORMATION ('OMMER('IAL VALUATION SCHEDULE Job address: 11-12:24) Sw , I Zrc1 t^ (31 . 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: l-7 (Block: ISubdivision: m 6rN Ri4.e t . ee checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: - j s �, I ZIP: q ` 7 7.--L3 1 & 2 FAMILY DWELLING PERMIT FEE SCIIEDULE Description and T6ca ' n 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 ctS ODD CFM Od Is existing space heated or conditioned? 0 Yes No Air conditioning (site plan required) Is existing space insulated? ❑ Yes ►'t No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors ^ State boiler permit no.: Business name: 5 y S ' w, t .S C • HP Tons BTU /H Address: I'1 141 1 J , FL `r yk. S + Fire/smoke dampers/duct smoke detectors City: "1- j &` I State:01- I ZIP: ' 1 3 Heat pump (site plan required) Phone: j 2y —5 2_7 I Fax: I E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner 0 Yes 0 No CCB no.: 3 goh7_ Install /replace/relocateheaters- suspended, City /metro lic. no.: wall, or floor mounted Name (please print): i , ` "P i L• Vent for appliance other than furnace Z. CONTACT PERSON Refrigeration: Absorption units BTU/H Name: V.,P l , r Chillers HP Address: Compressors HP En exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone: Fax: E -mail: Dryer exhaust I OWNER Hoods, Type U IUres. kitchen/hazmat hood fire suppression system Name: k 21 j � Exhaust fan with single duct (bath fans) 1 Mailing address: ( 7 (.pl) , R., i bi k k Z r , Exhaust system apart from heating or AC Fuel piping and d istrib n (up to 4 outlets) City: Q t I State r . ItP: cl 71 2,_3 Type: LPG i NG Oil Phone: • r - ; i Fax: E -mail: Fuel pi ip ng each additional over 4 outlets , ENG I N FIR Process piping (schematic required) .. ^^ Number of outlets Name: Ivy, klow Other listed appliance or equipment: Address: Decorative fireplace City: I State: I ZIP: Insert -type Phone: Z r - r , F : — E -mail: Woodstove/pelletstove Applicant's signature: j, Imo., Date: \ ( t 02 Oute iri j r: Name (print): 1 4. 4 7 ; 3C■ .(-- Not all jurisdictions Permit fee $ accept credit cards, please call jurisdiction for more information. Notice: This permit application 0 Visa 0 MasterCard 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) Fumace 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 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. fo otnotes below. C •• Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit $ to 100K BTU 14.00 8% State Surcharge $ 8) 3 -15 HP; absorb unit 100k to 500k BTU 25.60 25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00 Required for ALL commercial permits only unit .5 1 mil BTU 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 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 ducts & vents 14) Non - portable evaporate cooler 10.00 Furnace > 100,000 BTU including 1,170 ducts & vents 15) Vent fan connected to a single duct 6.80 Floor furnace including vent 955 Suspended heater, wall heater or 955 16) Ventilation system not included in 10.00 floor mounted heater appliance permit Vent not included in appliance 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 3 -15 hp; absorb. unit, 1,700 69.95 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 >11 .75 mil. BTU Minimum Permit Fee $72.50 SUBTOTAL: $ Air handling unit to 10,000 cfm 656 0 Air handling unit >10,000 cfm 1,170 8 /o State Surcharge $ 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: Domestic incinerator 1,170 1 Inspections outside of normal business hours (minimum charge - two hours) $62.50 per hour. Commercial or industrial incinerator 4,590 c 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 A/C requires site plan showing placement of unit. VALUATION: . All New Commercial Buildings require 2 sets of plans. i:ldsts\formsirnech- fees.doc 02/11/02 CITY OF TIGARD 13125 S.W. HALL BLVD_ • TIGARD, OR 97223 IMPORTANT PERMIT NOTICE • KUZBASS ELECTRIC 16604 NE 80TH VANCOUVER, WA 98682 RECEIVED 2 Electrical Signature Form pR 2 2003 OF TIGARD Permit #: MST2002-00458 Date Issued: 12/3/02 BUItL LDING DIVISION Parcel: 2S 109AA -05100 • Site Address: 14220 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES • Block: Lot: 017 Jurisdiction: TIG Zoning: R - 7 Remarks: Const. new SF detached residence.Path I 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: KEITH W.BAKER KUZBASS ELECTRIC 13037 SW ROCKINGHAM DR. 16604 NE 80TH TIGARD, OR 97223 VANCOUVER, WA 98682 Phone #: 503 - 7403488 Phone #: 360 -882 -4768 Reg #: LIC 153252 ELF 37 -978C SUP 4619S AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of 9tipervising Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE PRECISION PLUMBING CO GARY DEAN HARPER 10569 NW LOST PARK DR PORTLAND, OR 97229 Plumbing Signature Form Permit #: MST2002 -00458 Date Issued: 12/3/02 Parcel: 2S109AA -05100 Site Address: 14220 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 017 Jurisdiction: TIG Zoning: R -7 Remarks: Const. 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: KEITH W.BAKER PRECISION PLUMBING CO 13037 SW ROCKINGHAM DR. GARY DEAN HARPER TIGARD, OR 97223 10569 NW LOST PARK DR PORTLAND, OR 97229 Phone #: 503 - 740 -3488 Phone #: 503 - 641 -7105 Reg #: MET 00003616 LIC 53982 PLM 34 -193PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X .3 Signature o- thorized Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 • • ■ • ► • ■ ■ T EE CE STREET R R TIFICATION : • I, 14eA Owner /Agent for qwx\ i C • (PLEASE PRINT) (PERMIT HOLDER) • • ► • ► RECEIVE ► • • Do hereby certif that the following location FEB 2 5 2004 ► • Y Y • • meets City of Tigard/Washing Count CITY OF TIGARD • ► Y County BUILDING DIVISION • land use and development standards for street tree installation. ; • ■ A ■ • t ` ■ • ADDRESS: 1''�Z�� 5 \U ,, in c \r-r 0 (- . �1 ZZ3 ► • LOT: � , - 7 SUBDIVISION: E I k 6r-v. R .. 5` • • • • • • p� � i ■ 1 BY: CA o e-)1 Gc r'A (\ C rto X 4 0 v� 5 DATE 1 1 5 ( ■ • ■ • ■ D ATE: a - a 5 -04 • • RECEIVED BY: SALIA_ec_ ► CITY OF TIGARD 24 -Hour BUILDING 411 Inspection Line: (503) 639 -4175 fig 2.= Do INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / ° — � AM PM BUP Location 1 if _20 122 Pf Suite MEC Contact Person /<e i ke Ph ( ) 74 — S-`t' 8'g PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain r g ± ji:;!!2 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: Final P RT FAIL UMBING o sr beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: ��i PART FAIL 4P, ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final -._ _ - T FAIL Service Rough -In UG /Slab Low Voltage Fire Alarm ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. (40' PART FAIL ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA ° /Z /i ( �N Approach/Sidewalk Date y 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 , -�p[� INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received 5-3` -pi ` Date Requested '' // AM PM BUP L Location 77 ' . v 1 23 ,/ Suite MEC Contact Person (C411" " Ph ( 51)3) 7t/O '3 ya k PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: /42k ( � j p� 1 q1/0 ELR Crawl Drain Slab Inspection Notes: j 7 / � C , / � J /� Ay v e SIT Post & Beam ` c v/ 7 Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing 4i) �' �� ��, ���L�Lv� 3 4 ST_ _ Insulation Drywall Nailing — L — �GL� Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Sm Dampers in T 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 Approach /Sidewalk Date 1 5- D �� Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour = 6s...2 PS - 8 BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 Received ? / ?Date Requested j /04 AM PM BUP Location /q2-20 / Z e e Suite '/ 7 MEC Contact Person �. 6 Ph ( 70/— 3 c.z PLM Contractor Ph ( ) SWR BUILDING 0 Tenant/Owner ELC Footing Foundation ELC Access: ( I c::? Ftg Drain (/ ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam r,ta,"' Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof •T 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: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 3 ^ Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL