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Permit - MASTER PERMIT CITY 1 I G A R® PERMIT #: MST2005 -00011 , DEVELOPMENT Ha ME d , SERVICES 5039 -4171 DATE ISSUED: 2/24/2005 SITE ADDRESS: 11460 SW FONNER ST PARCEL: 2S103AC -09400 SUBDIVISION: GERTZ PARTITION ZONING: R -4.5 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: New SF BUILDING REISSUE: NJA2486 STORIES' 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,238 sf BASEMENT: sf LEFT. 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD. 40 SECOND: 1,248 sf GARAGE: 420 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS 1 THRD sf RIGHT: 5 VALUE: 241,373 20 OCCUPANCYGRP: R3 BDRM' 3 BATH: 3 TOTAL: 2,486 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS. 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 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' 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: 4 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: 4 201 - 400 amp' 201 - 400 amp: 1st W/O SVCIFDR• ' 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 REVIEWSECTION 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. ALL - ENCOMP BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL: GARAGE OPENER' CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC' DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 10,299.97 This permit is subject to the regulations contained In the GERTZ CONSTRUCTION GERTZ CONSTRUCTION Tigard Municipal Code, State of OR Specialty Codes 19200 SW 46TH 19200 SW 46TH and all other applicable laws All work will be done in TUALATIN, OR 97062 TUALATIN, OR 97062 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 Phone: 503 638 - 3390 Phone: 503 692 - 3390 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through Reg #: LIC 34350 952- 001 -0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699 REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 _ / / / Is . ued By : ,a :_„/ �/ Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b (iness day . RECEIVED Building Permit Application k.l oiR of H IcEuSE ONL\' JAN 1 2005 i I City of Tigard Received % —1 I - o 5 0 Permit No aoe, — OU C�i�• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503 ART O % A + ) l ? ' Date/By.. pi, , k/ - /U - 0 S Other Permit• S (j J5 .- e v ee t 0 Inspection Line: 503.69 417 _„ Date Ready/By: Juris RI See Attached Chet __ ' Internet: www.ci.ti ar g S BUILDINC ' t DI VJ g S. . ??1 d' "I Noufied/Method � � Q��(✓ TI et Supplemental Information d.or.us 3 ti • TYPE OF WORK REQUIRED DATA: 1 -.AND 2- FAMILY DWELLING New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the • CATEGORY OF CONSTRUCTION work indicated on this application. 4 1- and 2- family dwelling ❑ Commercial /industrial Valuation: 1b0 ©O . ca '3 ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other Number of bathrooms: 'lift JOB SITE INFORMATION AND LOCATION Total number of floors' ',L Job site address: 1 1 LQ ' 'CO t N 1✓ - New dwelling area: 2,4(13(0 square feet City /State/ZIP: — 1.9 c c) Rw. Gj -7^7,-2,5 Garage /carport area: 42,0 square feet Suite/bldg. /apt no.: Project name: Covered porch area ,— square feet Cross street /directions to job site: Deck area: square feet I i 5 41- -1- * FrN t.Ie - . Other structure area: .-- square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: 5 Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the • ' DESCRIPTION OF WORK ' work indicated on this application. Valuation: $ Existing building area: square feet New building area: square feet IQ - PROPERTY OWNER ' , ❑ TENANT' Number of stories: Name: � ,e, Type of construction: Address: " '/N{ Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax ( ) New titr APPLICANT , ' ❑ CONTACT PERSON NOTICE" ' , Business name: ( C o.) 5 a,f...) LAI eiJ All contractors and subcontractors are required to be Contact name: 6 ere T licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 1 q ZU 0 11 - jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City /State/ZIP. 'TV A Acel 1 t Of...I✓� C1■.1 '7 Off -� 2 - apply: Phone: ( g)'7) 6,g 2,- 5 590 Fax: : (9 3) bin - 5 433 E -mail: • CONTRACTOR ` , , ` • ' • , Business name: . , . BUILDING PERMIT FEES*-. Address. 54-11/1g _. Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone•( ) Fax:( ) Amount received CCB lie.: '3e4-'35O 4x1 // Date received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: F/7-- /7 C 5 * Fee methodology set by Tri- County Building Industry Service Board. 1 \Building\Permits UP- TI- PermitApp doc 12/03 440- 4613T(1 I /02/COM/WEB) Building Division Plan Submittal Requirement Matrix Commercial & Multi- Family - New, Additions or Alterations City of Tigard Type of Submittal # of Plans (Includes new, additions and alterations.) Required at Submittal Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (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 protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i \ Building \Permits\BUP- TI- PermiApp doe 12/03 440- 4613T(11/02/COM /WEB) Plumbin ° Jg ,1i L! '!aj.ziuj ) A AiR ICE USE ONLY City of Tigard R eceived : Permit No.y�,, 13125 SW Hall Blvd., Tigar R 97223 g Date /By. I r \�J T2_00 �j ' 000 It Phone: 503.639.4171 FaA *At Plan ByeW Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ; ..__, ' Date Ready/By h ® See Page 2 for Internet: www ci.tigard. T ^ / orr..u$ D Notified/Metho Supplemental Information F UILDIEN 1'ID tWO FEE* SCHEDULE New construction l � 9 El Demolition For special informadon use checklist. T Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: Newt- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 1- and 2 -family dwelling El Commercial /industrial SFR (2) bath P 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 El Master builder El Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 1 4110 c I ,,r f Catch basin or area drain 16.60 City /State /ZIP: 6 01,-2.J t oft_ 9-7 2-2- Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name. Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: Manholes 16.60 ) IS t FoN "f - Rain drain connector 1 16.60 Sanitary sewer (no. linear ft.: ) i Page 2 Storm sewer (no. linear ft. ) 1 Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) 1 Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 ' . ' DESCRIPTION OF WORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 1 16.60 Dishwasher 1 16 60 - q PROPERTY OWNER I 0 TENANT Drinking fountain 16.60 y Ejectors/sump 16.60 Name: ' 'r "`E- Expansion tank 16.60 Address: Fixture /sewer cap 16.60 V City /State /ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal I 16.60 til Hose bib 2- 16.60 APPLICANT ❑ CONTACT PERSON Ice maker 1 16.60 Business name: ( '(2. -r2.. U.)/ e.,0 cal () N Interceptor /grease trap 16.60 Contact name: jr\eN1 61 r7-- Medical gas (value: $ ) Page 2 Address: j cjj 4 4 OP Primer 16.60 City /State /ZIP: -w jfl,Q 0 f,_ a /0(aZ Roof drain (commercial) 16.60 Phone: ( ) 6 ai 2 1.0 I Fax: : ( ) �Q 2 -514'53 Sink/basin/lavatory t� 16.60 Tub /shower /shower pan "Z 16.60 E -mail: Urinal 16.60 5c■ CONTRACTOR Water closet Z 16.60 Business name: LX71 ?ilue1/1.At.,A.J Water heater ( 16.60 Other 7 �•�, 2:7 1 City /State /ZIP: tA.) - L.. ©-&. ct vLp� Subtotal Minimum permit fee: $72.50 Phone Fax: f bz, z, Residential backflow minimum permit fee: $36.25 C;, CCB Lic.: 1 01;7 Ora Plumbing Lic. no.: ` -- q•- `�-(Ij Plan review (25% of permit fee) Authorized signature: /jf/f j State surcharge (8% of permit fee) ( 7 - P' TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn -County Building Industry Service Board. i rtudding\Permits\PLM- PermitApp doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - I 100' i 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' f 55 00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation • Permit Fee: Storm & Rain Drain - 1st 100' i 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 Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and 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 accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3 -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: if the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures - \Building\Permits\PLM- PermitApp doc 3/03 Electrical Permit ' s . 'c e - FOR OFFICE USE 0 Y - City of Tigard ' Da < ` �e/Br Permit No I X005 - 0 DO I I 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639 4171 Fax: 503.598.19 p� 4,7' rii Date /B . Other Permit: Inspection Line: 503.639.4175 I 11 2005 : ,Y__J ; DateReadyBy Juns: 0 See Page 2for Internet: www.ci.tigard.or.us Notified/Method Supplemental Information . • C.I 'Yl['EU ' dit ARD PLAN REVIEW , New construction Big .. d+ti l eNtio1%t1SI t nt Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I - and 2 family dwellings 4 or more new residential d 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE. INFORMATION AND LOCATION ❑Egress/lighting RV park Job no.: Job site address: 1 a j 'col -A ❑Health -care facility ❑Other: Submit 2 sets of plans with any of the above. City /State/ZIP: 11 b prg43 OR. '22,3 The above are not applicable to temporary construction service. ' Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1 l S OCR.. 1,000 sq. ft. or less 1 145.15 4 Subdivision: Lot no.: `-j Ea. add'I 500 sq. ft or portion 'I 33.40 1 Tax map/parcel no.: Limited energy, residential 4 75.00 2 Limited ma , t DESCRIPTION OF WORK Each nufactured energy or modular non - residen ial 75 00 2 dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 PROPERTY OWNER ❑'TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: s Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City /State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel . 0 APPLICANT' ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each Business name: ki ee c N 5 - r 9.,,, 0 ,., branch circuit 6.65 2 Contact name: ?M � B. without for service circuits es . without service or feeder fee, ��_fit, each branch circuit 46.85 2 Address: I q 2 . ()0 $4.,) �� `CV' Each add'1 branch circuit 6.65 2 City/State /ZIP: U/4iK1 011(-- C1161.02-- 1 0, Miscellaneous (service or feeder not included) ) . -5 C Fax: : ‘51-ES. Pump or irrigation circle 53.40 2 Phone: ( ) ( ) 2- Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- , . CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: EA uz - £L_e avt L Address: 48 4 � t,J Each additional inspection over allowable in any of the above Per inspection 62.50 \,.. City /State /ZIP: e. 70 exLm'..' D ® a_ ci 1 z..11 Investigation per hour (1 hr min) 62.50 ' Industrial plant per hour 73.75 Phone: ( ) List Bo2ii Fax: ( ) 1 462.-- 0 t 21 ELECTRICAL PERMIT FEES* a CCB Lie.: 124 c330( Electrical Lie.: 7j,.. q(pgc,Suprv. Lie.: Subtotal � Suprv. Electrician signature, required: ? - I - A Plan review (25% of permit fee) Print name: �l� TrNn f Date: State surcharge (8 %ofpermit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tn- County Building Industry Service Board •• Number of inspections per permit allowed. I \Buddrng\Permits\ELC- PermitApp doe 12/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: rRESIDENTIAL WORK ONLY: — 1 Fee for all residential systems combined ... $75.00 Check Type of Work Involved: X ] Audio and Stereo Systems* �] Burglar Alarm Garage Door Opener* El Heating, Ventilation and Air Conditioning System * ❑ Vacuum Systems* ❑ Other: j COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i \Building\Permits\ELC- PernutApp doc 04/03 Cp l/ E D Mechanical al Permit pp Icahn - FOR OFl ICE USEOINLl , City Of Ta and R� 5 � 2 Received Permit No.: (V 13125 SW Hall Blvd., Tigard, O — - 0f 5 Date/ ' V (���� ��� i Plan Review Other Permit Phone: 503.639.4171 Fax: 503.598.1960 A yv , iAN, Date/By. Inspection Line: 503.639.4 C ITY OF TI( �i� lr° A p _ Date Ready/By. Jung. El See Page 2 for Internet: www.ei.tigard of l is R �� .,_ .. Notified/Method: Supplemental Information El C IN DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST 0 New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi - family ❑ Master builder El Other: For special information use checklist. Description I Qty. I Ea. I Total JOB SITE 'INFORMATION AND LOCATION Heating /cooling Job site address: 1 1 Q Q `61 J C _ i - Ai ((requires q conditioning or heat pump t res site plan showing placement) 14.00 City /State /ZIP: (& Ale t <7 2,2„-& Furnace 100,000 BTU ( ducts/vents) 14 00 Furnace 100,000+ BTU (ducts/vents) ( 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14 00 Cross street /directions to job site: Duct work 14.00 Hydronic hot water system 14 00 I I ,j tD N IJ 1 j Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above I 10.00 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.. Other fuel appliances ' DESCRIPTION OF WORK Water heater I 10.00 Gas fireplace 1 10.00 Flue vent for water heater or gas fireplace I 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 RRRrrr,,, Wood fireplace /insert 10.00 PROPERTY ,OWNER ❑ TENANT Chimney/liner/flue/vent 10 00 (, Other: 10.00 Name: 4 Environmental exhaust and ventilation Address. '�/l Range hood/other kitchen equipment I 10.00 City /State /ZIP: i/ Clothes dryer exhaust 1 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 4 6.80 ' . 14 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: &t 2 TZ CA) N S r {Z,jC9,v4,) Fuel piping Contact name: 'CoN CI $5.40 for first four; $1.00 for each additional Address. l L{ �p — (j/_ i'- Gas hea etc. 1 �l `"'' Gas heat pump mp City /State /ZIP: ) N I 0 & 'i'7 0 Co Z Wall /suspended/unit heater Phone: ( ) GM_ 3j U Fax: . ( ) Z– z.I-S3 Water heater i Fireplace i E -mail: Range I ' CONTRACTOR Barbecue • Clothes dryer (gas) Business name: 0 r 67 0tj c ,.---.. e t--e- N q Other Address: 1 0 355 MECHANICAL PERMIT FEES* City /State /ZIP: EOM Ce". C x--e v-t , 0 In, 2l --1 •ZZ, Subtotal Minimum permit fee ($72 50) Phone: ( ) (0'5-5 - 02Z ( Fax: ( ) (v$b - IAA 3 Plan review (25% of permit fee) CCB lic. • 4 6 1 State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: /UU Date: • Fee methodology set by Tri- County Building Industry Service Board i.U3w1ding\Pemuts �C- PermitApp doe 12/03 440.4617T(1I /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. . $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i: \ Building \Permits\MEC- PermitApp.doc 12/03 2 CITYDETIGARD r t BUILDING DIVISION PERMIT #: MST200&00011 A. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/24/2006 Phone: (503) 639-4171 easoilliT\ Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7:08AM PAGE: 17 SITE ADDRESS: 11460 SW FONNER ST CLASS OF WORK: SUBDIVISION: GERTZ PARTITION LOT #: 003 TYPE OF USE: PROJECT NAME: GERTZ PARTITION DESCRIPTION: New SF OWNER: GERTZ CONSTRUCTION, PHONE #: 503-638.3390 CONTRACTOR: GERTZ CONSTRUCTION PHONE #: 503.692..3390 Inspection Request Scheduled For: Date: 7/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 012329-02 503-780-7793 N Corrections/Comments/Instructions: it/0 Si- .. :..-=--, ' 52 v. : / 4:5 - ....-----0 ..._ PARTIAL APPROVAL 0 CANCEL NO ACCESS F FAIL E CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED ,14 Inspector: .' ' a1. , Date: 7- - Zi8"-t ---- Phone #: (503) 718- „ . CITY-OFTIGARD 9 .. . . BUILDING DIVISION A tiA --: PERMIT #: MST2006-00011 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/24/7005 Phone: (503) 639-4171 _ ./ it' Inspection Requests (24 Hrs.): (503) 639-4175 ,Raii- '' INSPECTION WORKSHEET FOR DATE: 7/22/2005 TIME: 7:09AM PAGE: 29 SITE ADDRESS: 11460 SW FONNER ST CLASS OF WORK: SUBDIVISION: GERTZ PARTITION LOT #: 003 TYPE OF USE: PROJECT NAME: GERTZ PARTITION DESCRIPTION: New SF OWNER: GERTZ CONSTRUCTION, PHONE #: 503-638..3390 CONTRACTOR: GERTZ CONSTRUCTION PHONE #: 503..692.3390 Inspection Request Scheduled For: Date: 7/22/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 9 - 50:3-780-7793 Y Corrections /Comments / Instructions: • ZRNO - \I-1:_--,\! KZ fl _ .i•t u 5 Ay .) ■■■■■■ -f - 2 Os PASS 0 PARTIAL APPROVAL El CANCEL 0 NO ACCESS 0 AIL 0 k LL FOR INSPEC ON El ADDITIONAL FEES ASSESSED 0=i 1 l Inspector: J. / '% / Date: - 7` 6 Phone #: (503) 718- _ _ CITYQ TIGARD r BUILDING DIVISION PERMIT #: MST2005«00011 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/24/2005 Phone: (503) 639 -4171 Ablid 1 BI � Inspection Requests (24 Hrs.): (503) 639- 4175' INSPECTION WORKSHEET FOR DATE: 7/28/2005 TIME: 7 :08AM PAGE: 1e SITE ADDRESS: 11460 SW FONNER ST CLASS OF WORK: SUBDIVISION: GERTZ PARTITION LOT #: 003 TYPE OF USE: PROJECT NAME: GERTZ PARTITION DESCRIPTION: New SF OWNER: GFRTZ CONSTRUCTION, PHONE #: 503.63300 CONTRACTOR: GERTZ CONSTRUCTION PHONE #: 503 b 3t3- - 90 Inspection Request Scheduled For: Date: ' 7/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 012329-01 603-780-7793 Y Corrections /Comments / Instructions: ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 7 —d Phone #: (503) 718- CITY OF TIGARD 24 -Hour BUILDING Inspectio (503) 639 -4175 O5' cti j / INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Recuested — 7 A PM BUP Location ` l 1 Q o Suite MEC Contact Person D « ,I! - e-- Ph ( ) - 7( 5 T/ " a7 /S PLM Contractor Ph ( ) - ''R BUILDING nt/Owner ELC • Footing E - Foundation Ft Drain Access: 9 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 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 Smoke Dampers Final PASS PART FAIL =TRICAL - Rough-In , UG /Slab Low Voltage Fir - al Reinspection fee of $ required before next ins•ection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line Approach/Sidewalk Z Inspector Ext Other: Final DO NOT REMOVE this inspection record fro Job site. PASS PART FAIL