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Permit 'I Y CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00370 1 . , 4 , 1 111 DEVELOPMENT O PMEN dSERV SERVICES DATE ISSUED: 10/22/03 SW SITE ADDRESS: 14145 SW 128TH PL PARCEL: 2S109AA -04900 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 BLOCK: LOT: 015 JURISDICTION: TIG REMARKS: New SF Detached, Path 1 BUILDING REISSUE: MSAP2636 -A STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 29 FIRST: 1,911 sf BASEMENT: 1,329 sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,851 sf GARAGE: 440 sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 494,131 40 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,762 sf REAR: 15 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: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: . BOIUCMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 4. UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: -.'4 S' ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF: 8 201 - 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: $ 9,795.05 This permit is subject to the regulations contained in the PAUL R CARNEY PAUL R CARNEY INC PAUL R CARNEY PAUL R CARNEY AVENUE Tigard Municipal Code, State of OR. Specialty Codes and 1480 PORTLAND, OR 97223 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 - 848 - 5635 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 & Post/Beam Structural PLM /Underfloor Electrical Rough In Gas Line Insp Storm drain Insp Sewer Inspection Post/Beam Mechanical Ftng Drain Bsm't Walls Framing Insp Gas Fireplace Water Line Insp Footing Insp Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Foundation Insp Crawl Drain /Backwater Plumb Top Out Exterior Sheathing Insf Gyp Board Insp Appr /Sdwlk Insp Slab Ins Footing /Foundation Dn Electrical Service Low Voltage Rain drain Insp Electrical Final Iss c y : ■ . _ 0 , f. _44..._..2: � Permittee Signature : JO OIZ. Q � � t_adt.-4. _ Call (50 639 -4175 by 7:00 p.m. for an inspection needed the next business day f Debbie Adomoki - Lot 15 Elk Horn Ridge Pa•e From: Matt Scheidegger To: Adamski, Debbie; Butler, Barbara; Temple, Jeanne Date: 10/21/03 4:55PM Subject: Lot 15 Elk Horn Ridge OK to release building permit. To `1 to -g -03 MA,/ Su.) ,e ..3-Ozai-vd,)_gd Building Permit Application „.. FOR OFFICE USE ONLY R ece i ve d . Building Date /B 0 3/yy�?-- Permit No! YI 2 3 ' 31 Planning Approval `�'�� Other City of Tigard Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review p Other Tigard, Oregon 97223 Date /B .87._ U• (I-03 Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 " ` Po st - Review Land Use (, _ q . ( - Date/By: Case No. Internet: www.ci.tigard.or.us ; ' 7 Contact Juris.: ® See Page 2 for 24 -hcur Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information r r TYPE OF WORK REQUIRED DATA: New construction ❑ Demolition 1 & 2 FAMILY DWELLING ' ❑ Addition /alteration/replacement I El Other: ' CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate El 1 & 2- Family dwelling I ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, Z overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation $ i/9(1 131. 1-"”' F. JOB SITE INFORMATION and LOCATION No of bedrooms: S No of baths: — Job site address: )9 i t-� w Z� i 11--4--1_ New a � l number floors New dwelling area (sq. ft.) .SU 9/ Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) .9 4/ 0 Project Name: Covered porch area (sq. ft.) / / 3 Cross street/Directions to job site: Deck area (sq. ft.) G 72-- go) rt riv _ 2 ttola r 6 )., g eN,/ a_ Other structure area (sq. ft.) IZip. r 6 N cHl OP ,i — Lam •n1 i LS REQUIRED DATA: COMMERCIAL -FUSE CHECKLIST Subdivision: 624:_ Aber) 1i4 e Lot #: l Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this appli ion. We W $1 r t6Le ns-riac --1 Valuation ••• $ Existing building area (sq. ft.... New building area (sq. ft.) .... Number of stories 0 PROPERTY OWNER - ) ❑ TENANT Type of construction Name: Tq,, -k `,_ 6 0-` 1 Occupancy group(s): Existing: New: Address: ) go � 0 taz �-- Po b City /State /Zip: NPbei 61t 9'1 F ax: '1'8 - d 13 NOTICE: All contractors and subcontractors are required to be Phone: so? 93R - licensed with the Oregon Construction Contractors Board under ❑ APPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: Sa- is As lWo v jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: BUILDING PERMIT FEES* E-mail: Please refer to fee schedule. CONTRACTOR r Business Name: - ,A -r-ie ,a,_ A -cZo•" Fees due upon application $ Address: City /State /Zip: Amount received $ Phone: , e J v Fax: `, p Date received: CCB Lic. #: S -1 - a Authorized 01/47 Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. C �,l iE *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 One- and Two - Family Dwelling . . �, • • • Application � ' Reference no.: ,,1 Building Permit Checklist Associated permits: City of Tigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No /A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity ' 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and 2 driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot ei— it'"j' area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under revi.. . JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 - 1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape - ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/00/COM) Electrical Permit Application FOR OFFICE USE ONLY P P Received Electrical Date /By: Permit No.: Cit of Tigard Planning Approval Sign Y Tigard Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 ` Post- Review Land Use Internet: www.ci.tigard.or.us _ , """ , � ' ,4d 1 � Date/By: Case No.: Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 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 I & 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. Job site address: FEE* SCHEDULE Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential - single or multi - family per Jr 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 I Subdivision: Lot #: Limited energy, residential 75.00 2 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 0 PROPERTY OWNER f ❑ TENANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, City/ State/Zip: alteration, or relocation: ty p 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 ❑ APPLICANT ❑ CONTACT PERSON Branch n 600 ch amps 133.75 2 circuits circuits -new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): 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, Business Name: A LiDoe El.> Cl?1 C4 L. Descri ti or extension Page 2 2 Description: Address: 2 1 150 S6 sr*, NIE- City /State /Zip: 6g, - CS - I-4 An 9 7 08 d Each additional inspection over the allowable in any of the above: Per inspection per hour (min. 1 hour) 62.50 Phone: 111 — Z3 - -$eyoc Fax: Investigation fee: CCB Lic. #: 31 3 L1 y Lic. #: 3- S 7 L- C Other: Su Supervising electrician Electrical Permit Fees* p g Subtotal $ signature re uired: Plan Review (25% of Permit Fee) $ Print NameC`A;tL 14.18 CELL -1 I Lie. #: 22t, ,5 State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts \Permit Forms \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: n Audio and Stereo Systems n Burglar Alarm H Garage Door Opener Heating, Ventilation and Air Conditioning System I I Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems 0 Boiler Controls 0 Clock Systems 0 Data Telecommunication Installation 0 Fire Alarm Installation n HVAC 0 Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control n Medical Nurse Calls n Outdoor Landscape Lighting 0 Protective Signaling Other Number of Systems * No licenses are required. Licenses are required for all other installations is \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03 Building Fixtures 5 ive -1- ... Plumbing Permit Application FOR OFFICE USE ONLY Plumbing Date/B : .2 6 3 ; „ra 'ermit r i i -4, 6 City of Tigard Planning App oval ' Sewer Date/B : Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/B : Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use g yimrNl� Fj'I Date/B Case No.: Internet: www.ci.tigard.or.us . Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503-639-4175 - " -- "' ''''' Name/Method: Su 1 .lemental Information. TYPE OF WORK FEE *'SCHEDUJ...F (for special ' . formation use checklist) Fee ea L ew construction ❑ Demolition Descri , tion Qty. ( ) I Total ❑ Addition/alteration/re • lacement ❑ Other � a �. , _ '°, ■ CATEGORY OF CONSTRUCTIQ t 3 ,k` , r - SFR (1) bath 249.20 L/ & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 LAccesso Buildin_ ❑ Multi -Famil SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB'SITE INFORMATION and LOCATION Fire s•rtnkler si. ft Pa :e 2 Job site address: "< ' -_ i Suite #: Bld:. /A • t. #: Catch basin/area drain 16.60 Pro•ect Name: n 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 /2w _3.7 q t . iii qv Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Fr Storm sewer (no. linear ft.) Page 2 Subdivision: l� 1-� Zh1 l'QC - mot. Lot #: � 5� Water service (no. linear ft.) Page 2 Tax ma• /•arcel #: - F t ure o r Item . t E g R,, ': _ - DESC' I' e 1 'z,a«: `i' -7, Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 L: ; c ` : t Q, . ,:: z, 16.60 �,�.� . , � .. �.,�. Ej ec t ors / sum p Expansion tank 16.60 Address: 'rte (.S ;IQ /c n Fixture /sewer cap 16.60 'MEOW r 97 2-2, Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: 0/16 c. 3 S Fax: g i „Ott., Hose bib 16.60 i ' a e k -- n , i‘': ari Ice maker 16.60 Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 Cit /State /Zi • : Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory 16.60 E -mail: • Tub /shower /shower pan 16.60 .s Urinal 16.60 • ti st 3�. ,. Water closet 16.60 Business Name: f14 i_i �[,O - Water heater 16.60 Address: ` . 0, 2 4 (.., Other: Cit /State /Zi • : 3 Ai-J kS °V.- 9 OG Other Phone: j 0 - -' 7' r Fax: `` e -�l ii) -. ii c 1� :9 ° ;. S$7 $ CCB Lic. #: �'02. 3S Plumb. Lic. #:3 (-74.?, Minimum Permit Fee $722.50 .50 $ Authorized Residential Backflow Minimum Fee $36.25 Signature: Date: Plan Review (25% of Permit Fee) $ 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: Fee (ea) Total Square ` quare Footage; Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and Fixture or Item Qty. '` Fee (ea), Total including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accuratel re I ort fixtures could result in increased sewer fees *. Comments regarding fixture work: - A c rf a..4111 Ba.tis. /Font Bath -Tub/Shower - Tub /Shower - - -- - Jacuzzi/Whirl.00l - - -- Car Wash -Each Stall - - -- -Drive Thru - - -- Cus.idor/Water As.irator _ - -- Dishwasher - Commercial - - -- - Domestic - - -- Drinkin: Fountain - - -- E e Wash - -_- Floor Drain/sink - 2" - - -- - 3" - - -- Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic increase of sewer EDUs, a sewer permit will be issued and Disposal - Commercial - - -- - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refri:. Drains plumbing permit can be issued. Oil Se.arator Gas Station - - -- Rec. Vehicle Dum. Station - - -- Shower -Gang - - -- -Stall - - -- Sink - Bar /Lavatory - - -- - Bradley - - -- - Commercial - - -- - Service - - -- Swimmin: Pool Filter - - -- Washer - Clothes _ - -- Water Extractor - - -- Water Closet - Toilet - - -- Urinal -_ -- Other Fixtures: - - -- i: \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 ' Mechanical Permit Application FOR OFFICE USE ONLY Received Mechanical Date/By: Permit No.: Cl of Tigard Planning Approval Building City g Date/By: No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503-598-1960 „, ifi .. ,,, ., Date Post - Review Land Use ar� j` /By: Case No.: Internet: www.ci.tigard.or.us . J4,. �) � Contact Juris.: E1 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 ' Name/Method: Supplemental Information. TYPE OF WORK N ti COMMERCIAL FEE* SCHEDULE _: USE CHECKLIST New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/re . lacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all , ;w. mechanical materials, equipment, labor, overhead and profit. i Value: $ See Page 2 for Fee Schedule 1 & 2-Family dwelling ❑ Commercial/Industrial ❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 Job site address: 1 sky /L. L 1124 Gas heat pump 14.00 Suite #: I Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) ,10.00 Subdivision: &L/t /)v12// 2./P4 .e I Lot #: is— Repair units 12.15 Other Fuel Appliances Tax map /parcel #: _ Water heater 10.00 DESCttII'T)( Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 . Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 : t; : P a ` i ' . k. ; r 1: W : At 2t.:., , , Other: 10.00 Name: kv f K C_q-4,E r a Environmental Exhaust & Ventilation Range hood/other kitchen equipment 10.00 Address: ) f , c N vv i ©2 Clothes dryer exhaust 10.00 City /State /Zi s : fer, if-4,4÷.4:1, CZ- q 7z z. 3 Single duct exhaust Phone: 6 /3 -72-0 S Fax &I S - -5 (bathrooms, toilet compartments, ❑ . 1PLI :. :t.. 1 ' 4 . ( := 1 ” TA , .. , e < i.., utility rooms) 6.80 Name: j 41-1F p -S �e $ v s Attic /crawl space fans 10.00 Other: 10.00 Address: Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Phone: I Fax: Furnace, etc. ** Gas heat pump ** E -mail: Wall /suspended/unit heater ** x ik°I t.fii F Water heater ** Business Name: e c L. /-1-1i,/, Fireplace ** Address: Z ?ai Z S W CSR- i26,4U Range ** BBQ ** City /State /Zip: 41 c-IL._ S i 3.2b a g- 9' 71 2.3 Clothes dryer (gas) ** Phone: (o a,e. _J.7 Z.a Fax: Other: ** CCB Lic. #: %by S7 / Total: Mechanical Permit Fees* Authorized 1 Subtotal: $ Signature: ! Date: Minimum Permit Fee $72.50 $ Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total;Yatutat ola; emit Fec $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. AssunMM Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1 ,70 0 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to I 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 A $ VALUATION: • is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ALPINE HEATING & A/C & ELECTRICAL 27150 SE STONE GRESHAM, OR 97080 Electrical Signature Form Permit #: MST2003 -00370 Date Issued: 10/22/03 Parcel: 2S109AA -04900 Site Address: 14145 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 015 Jurisdiction: TIG Zoning: R - Remarks: New SF Detached, 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 R CARNEY ALPINE HEATING & A/C & ELECTRICAL 1480 NW 102ND 27150 SE STONE PORTLAND, OR 97223 GRESHAM, OR 97080 Phone #: 503 - 848 -5635 Phone #: 971- 235 -5900 R #: ELE 3 -572C LIC 37344 SUP 2260S AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Su•ervising 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 MALMEDAL ENTERPRISES INC 42405 NW OVERLOOK DRIVE BANKS, OR 97106 Plumbing Signature Form Permit #: MST2003 -00370 Date Issued: 10/22/03 Parcel: 2S109AA -04900 Site Address: 14145 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 015 Jurisdiction: TIG Zoning: R -7 Remarks: New SF Detached, 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 R CARNEY MALMEDAL ENTERPRISES INC 1480 NW 102ND 42405 NW OVERLOOK DRIVE PORTLAND, OR 97223 BANKS, OR 97106 Phone #: 503 - 848 -5635 Phone #: 503 -310 -9795 Reg #: MET 4232 LIC 102535 PLM 34 -276PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X / 9ea 4" - Signature of Authorized Plumber If you have any questions, please call 503.718.2433. ....„. \ -.%‘'.:".. '%"4"ft.lb W:v ...... \... , '' '...4........... ... • ... UM. ..._.... www w_.- w.w.v+.+rr_v.w w �.•n•,.. ^•~'y. ti �V"'w'...�„ _ a . M a `__ .,,,..„..7 ter -`" �'`- ? � �7 o We ,.... �... ,..w. ..■i. w,.. r.... .... Newel►. �... ...., / -� ~ . �`' MIN FF= 453.88 ""`r "Oft. � ' \ � ..� SFF= 444.84 r Mtn., '' � LOT 14 '„„,..- ., -- I - -... / . .."*. .„ +.+ ... ♦ eR N 'tT ........ '` ti -� ��• .N. if MIN FF= 453.37 � ~ N. N '` • SFF= 424.80 '° 4 .. )1 1. , ' N LOT 15 N. N. Z . - mamm ‘ii - --. .......\ ut \ III Oar "s"*. I ._ \ - %N.. • ' r -..., mow. • iii ■ - _ _ _ J ! �, s , -.1 • •.,, —. "fin. I � .•. — _ L 1.`` • ',` ' • � • /- (Pe LOT 1 MIN FF= 453.60 I ti SFF= 423.20 I % CITY OF TIGARD 24 -Hour BUILDING 0 Inspection Line: (503) 9 -4175 MST gQ 3 e3 INgPECTHON DIVISION Business Line: (503) 9 -4171 BUP Received Date Requested /6 — 2 Z AM PM BUP Location i Lt I /r g ' uite MEC Contact Person -/ Ph ( 93 9 — 7c7 PLM Contractor Ph ( ) SWR UIL 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 ` / ' ?/ LL�� Framing �' Insulation I/ Drywall Nailing z • . Ys1 4.' ./ , ... Firewall Fire Sprinkler Fire Alarm �� � S C� • lo Susp'd Ceiling Roof Other: C PART FAIL PLUMBING Post & Beam Under Slab Water S Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final P T FAIL CHA AL Post & Beam Rough -In Gas Line Smoke Dampers • SS PART FAIL IeAL Service Rough -In UG/Slab Low Voltage Fir: Alarm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date D •-Z_ CV Inspecto + Other: Final DO NOT REMOVE this Inspection record fr O the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST i e3 7e) INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested /b — Z a AM PM ✓ BUP Location / 4') Y f .-$ ` Suite MEC Contact Person ` Ph ( ) q 3 ? 7 Z 'S 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 A f Firewall Fire Sprinkler - �� �'� - Fire Alarm Susp'd Ceiling Roof Other: Final /� I �/1� PASS PART FAIL it PLUMBING L ■ i Post & Beam -/ Under Slab Rough -In Water Service 6 Sanitary Sewer ` . Rain Drains V — Catch Basin / Manhole Storm Drain Shower Pan Other: 4 e, ` 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 El 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 l� Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL