Permit r 1
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00021
W _illj.. DEVELOPMENT SERVICES DATE ISSUED: 1/30/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10235 SW HOODVIEW DR PARCEL: 2S111CB - 01703
SUBDIVISION: HOOD VIEW ZONING: R - 3.5
BLOCK: LOT: 2 - 3 JURISDICTION: TIG
REMARKS: Laundry & kitchen remodel.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: 80 sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT:
VALUE: $ 20,000.00
OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 80.00 sf REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 2 CLOTHES DRYER: 1
GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS . MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 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: 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: 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: $ 679.45
This permit is subject to the regulations contained in the
DEREK ROTHERY ROLOFF CONSTRUCTION, INC. Tigard Municipal Code, State of OR. Specialty Codes and
10235 SW HOODVIEW DR 11004 SW 37TH AVE. all other applicable laws. All work will be done in
TIGARD, OR 97224 PORTLAND, OR 97219 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:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: LIC 140721 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Electrical Service Mechanical Final
Underfloor insulation Electrical Rough In Plumb Final
PLM /Underfloor Framing lnsp Final inspection
Mechanical Insp Insulation Insp
Plumb Top Out Electrical Final c 7 Issued B �/� Permittee Signature : G U �" �� /�
Y /��
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day ;
. . 7z) d 51" /-,25 z--- 7,7" .
r
Building Application •
Date received: / 'J S' el— Permit no.: /yyf . .2 saO
A ; City of Tigard
Project/appl. no.: Expire date:
Ciryo}Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 • Case file no.: Payment type:
•
Land use approval: l &2 family: Simple Complex:
TYPE ,OF PERMIT
❑ 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ New construction ❑ Demolition
] / Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
- JOB SITEINFORMATION
Job address: 0 3 S Ok) co, OE Piz_ 776,--4/2•0 Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: "0,2. a i ' .. -- ,r—i. ,
Description and location of work on premises /special conditions:
OWNER FOR INFORMATION, USE CHECKLIST
Name: ' ' e S - ?ei-MMMIIIM (Floodplain, septic capacity, solar, etc.)
Mailing address: /441/10 • A 0 u-e__ 1 & 2 family dwelling: , 0 -,
City: State: ZIP: Valuation of work $ 0 �U�
Phone: 503 6Zd / ' Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors �C •
Phone: Fax: E -mail: New dwelling area (sq. ft.)
• , APPLICANT Garage /carport area (sq. ft.) .-->l
Name: Covered porch area (sq. ft.) X
Mailing address: Deck area (sq. ft.) 39Z
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.)
` 0,71 S G New bldg. area (sq. ft.)
Address: /co d _s 3 r &--" Number of stories
State:OX ZIP: ' 7z,1" Type of construction
Phone: Z"1 S'OCn S� r 't ►7 C� 4 cpancy group(s): Existin .
• CCB no.: ° • 0 New:
City /metro tic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 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: Plan no.:
Phone: Fax: E -mail:
- ENGINEER
EZIMMINM Contact person: Fees due upon application $
Address: Date received:
City: • Zl? - State: ZIP: Amount received $
Phone: �I� �� 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 w er - d/D or not. Authorized signatu credit card numt er: / LLr k. " � � Z Exires
9�f - Name of cardholder as shown on credit cazd Print name. f �a J& / Cardholder signature . $ Amount
/
otice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00/COM)
One- and Two- Family Dwelling
' ' ' Checklist
Building Permit Application Chkli Reference no.:
City of Tigard Associated permits:
Ci
City of Tigard ❑ Electrical ❑ Plumbing O 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 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.
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 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
driveway; footprint-of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
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 review. -
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)
A
Electrical Permit Applica VV
Date received: / i�� eb - Permit no.: H T y.2 -oee A./
_ ? ,,L r, , City of Tigard Project/appl. no.: Expire date:
City ofTigard 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:
, - .r, a TYPE OF PERMIT'
❑ 1 & 2 family dwelling or accessory 0/commercial /industrial ❑ Multi - family 0 Tenant improvement
❑ New construction UAddition /alteration/replacement ❑ Other: ❑ Partial
.' • - JOB SITE INFORMATION •
Job address: /p2 -? � i�� Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: , Subdivision:
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
••.CONTRACTOR APPLICATION , FEE SCHEDULE = ,
Job no: b S J 0 1522111.111 Fee Max
Business name: Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Addres -.,2_2' 7 _ l S `f dwelling unit. Includes attached garage.
EMPT ��..� MI State:0 a ZIP: 97/;21 Service included:
Phone: (s 30 2 I . Fax: E - mail: 1000 sq. ft. or less 4
CCB no.: j.3 ,' ZZ Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof —_ _—
Limited energy, residential ___ 2
City/metro lic. no.: /0 - 5- -O �0 - D / - c y Limited non - residential
Y '' /� energy, __ 2
4 lp 2 6 /%/i9 //t7 ,[ 0 - — -' Each manufactured home or modular dwelling
Signature of supervising electrician (required) / 7 Date Service and/or feeder ■■■ 2
Sup elect name (print): License no: Services orfeeders - installation,
alteration or relocation:
z; - , PROPERTY OWNER 20 amps or less 2
• Name (print): it l v t(z. 1 tWWt, 201 amps to 400 amps ___ 2
Mailing address: p .3$ c..--) - i 0 • I Ute�
601 amps to 600 amps —__ 2
61 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: 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
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
EN GINEER 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: State: 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:
PLAN REVIEW (Please check all that apply) Misc. (Service orfeedernot included):
CI Service over 225 amps- commercial CI Health-care facility Each pump or irrigation circle 11111 2
0 Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting MEM 2
family dwellings CI Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ME
O 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:
❑ Egress/lighting plan ❑ Other: Per inspection __
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: I I 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 (6100 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
(� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `I' Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 I I Audio and Stereo Systems
Each additional 500 sq. ft. or .
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 I Vacuum Systems"
401 amps to 600 amps $160.60 2 n
601 amps to 1000 amps $240.60 2 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 n
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 .
Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 I �
Each additional branch circuit $6.65 l i HVAC
Miscellaneous I I Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n
Each sign or outline lighting $53.40 Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125:00 I �
Each additional inspection over I I Medical
the allowable in any of the above �
Per inspection $62.50 l l Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: In 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.
is \fists \forms \elc- fees.doc 08/30/01
•
Mechanical Permit Application -
Date received: / Permit t no.:X , ,,2,/
. � I+L :. .. City of Tigard Project/appl. no.: Expire date: •
CiryofTigard Address 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no..
• TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction WAddition/alteration/replacement 0 Other:
----- -- - JOB SITE INFORMATION ` - - - -- COMMERCIAL VALUATION °SCHEDULE -
Job address: / 0 2- No c 5„0 V /�kJ f Y2_ 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: (Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: �( 2 0 I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on emises: . w e , AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
gecl.�0
6Y+ -/ ~ Z on
t Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
• Tenant improvement or change of use: HVAC:
Is existing space .heated or conditioned? 0 Yes 0 No Air handling unit CFM
g Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system ('r
MECIIANICAL CONTRACTOR Boiler /compressors
� State boiler permit no.:
Business name: t Gt%g%2? •.,le( 4 -�T C A HP Tons BTU /H
Address: / 7 c9 3 ( r-„/; Dl t/t S i 0 Fire /smoke dampers/duct smoke detectors
City: ?b,/ I State: X. I ZIP: 4/ 2 a Heat pump (site plan required)
• Phone:rs 03)76/_ ,45-00 I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 7953 c7 kc Install/replace /relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent Ill-
Phone: Fax: - E -mail: Dryer exhaust
OWNER Hoods, Type 1/ II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans) 2.
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets .
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: • I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstovelpellet stove
Other:
Applicant's signature: I Date: Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
O Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan (at %
Credit card number: an review ( %) $
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:
- "; Description`';;£ ; ' k'4" r ,, , Price, ',,Total
• TOTAL V _. . , N: P.: ER • . FEE: r, • $ 1.00 to $5,000.00 Minimum fee $72.50 rnicaL
Table 1) Fu `9 rna A,Mech to naalYCode ' Qty ° (Ea) 'Amt
Furnace $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including o 10 vents 14.00 000 0 TU
BTU
$1.52 for each additional $100.00 or
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 . Checkeall``that apply: s,:, ;, Boiler,' ::.Heat '' -p. Air•, , -s _ :' ,;E•
$1.20 for each additional $100.00 or Forttemsq.01 ° see •; % or„ Pu 'Coed . - ;,,,,
fraction thereof. footnotes°below Comp . -
Vr..,' >.���; ... .. _ . � :> u _ 7) <3HP; absorb unit .,
Minimum Permit Fee $72.50 SUBTOTAL: $ to 100K BTU 14.00
8 %State Surcharge $ 8) 3 -15 HP; absorb 25.60 .
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10).30-50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
' ASSUMED .'UALVATIQNSPER'APPLIAN,CE f' :'': - a. - `,, 12) Air handling unit to 10,000 CFM
10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents - 10.00
- Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents , • , , 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40 •
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, , 1,700 20) Other units, including wood stoves
101kto500kBTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: ='n`i - , , TV ,I '; - `"> $
>1.75 mil. BTU t �';°
Air handling unit to 10,000 cfm 656 0 � ,- - , °' -.
9 8 /o State Surcharge �r ' $
Air handling unit >10,000 cfm 1,170 • . ;': ' °' " "
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: " � 1 ' '"' , $
Vent system not included in 656 - ° ° •" ., i.
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $62.50 per hour.
Commercial or industrial incinerator 4,590 • 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. • 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL ''';'':?:,'
P $ **Residential A/C requires, site plan showing placement of unit.
,
VALUATION:. . litV �` "ft,.,, _. -a All New Commercial Buildings require 2 sets of plans..
is \dsts \forms\mech - fees.doc 12/26/01
PlumbingPermit Application J
Datereceived: / �� e Permit no.: / kr�e2, — GCb;,I
)y ,u i
�.AI., ; ; ; � � 'i" Cl ` � of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory CI Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction C- t' Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION _ _ . . _ FEE SCHEDULE (for special infori ation use checklist)
Job address: /c ? ? G c-✓ /o Description Qty. Fee(ea.) Total
l /� �J New 1- and 2- family dwellings only:
Bldg. no.: Suite no.:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: �G/a -d2/ I ZIP: Each additional bath/kitchen
Des ription and location of work on premises: .■.c( Site utilities:
p -5 "Ti; 8c-/ec,,r `A1)&014 Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: e_y : U et." i AV ' /9/4/4.-1.4 > ,` Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone:563 - ?Z.5 /3-f Z.I_Fax: I E -mail: 34 _ :3k, g pB Storm sewer (no. lin. ft.)
CCB no.: /4 /I 7 I Plumb. bus. reg. no: -ti;:, Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: - _ ._�,i, Absorption valve
Back flow preventer
Print name: Date: Backwater valve •
CONTACT PERSON Basins/lavatory Z
Name: I V' ,, " PL - s.k, l.C5-4 Clothes washer 1
- Address:
Dishwasher 1
Drinking fountain(s)
City: p k- l_,-... o..Q._ I State: I ZIP: Ejectors/sump
Phone: -• .5 e ( Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): IV . e' Me , � Floor drains/floor sinks/hub
Mailing address: 62_3s Garbage disposal 1
S �� `P� .02 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
ENGINEER Tubs/shower /shower pan - ._
Urinal
Name: Water closet /
Address: Water heater
City: State: I ZIP: Other: •
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application
Li 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 TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount • 440 -4616 (6/00 /COM)
•
PLUMBING PERMIT FEES: .
71P0cE9
FixtuREsAroi;.Tddair.: cm, PRIC
Sink 16.60 the dwelling and the firstlOO ft QTY 7 ,(ea) ;',AMOUNT5
teir;6ch
Lavatory 16.60
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
Water Heater 0 conversion 0 like kind 16.60 S 1;lUititity. by Work Performed
Gas piping requires a separate mechanical Fixture Type N ew - Moved Replaced Removed! permit.
MFG Home New Water Service 46.40 Sink
•
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' - 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
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 4W .
-
Isometric or riser diagram is required if -
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE ,!,%12
-. **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.
•
hdsts\forms\plm-fees.doc 12/26/01
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
•
IMPORTANT PERMIT NOTICE
CUSTOMIZED ELECTRIC
1282 3RD. UNIT 84
LAFAYETTE, OR 97127
Electrical Signature Form
Permit #: MST2002 -00021
Date issued: 1130102
Parcel: 25111 CB -01703
Site Address: 10235 SW HOODVIEW DR
Subdivision: HOOD VIEW
Block: Lot: 2 -
Jurisdiction: TIG
Zoning: R - 3.5
Remarks: Laundry & kitchen remodel.
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 Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
DEREK ROTHERY CUSTOMIZED ELECTRIC
10235 SW HOODVIEW DR 1282 3RD. UNIT 84
TIGARD, 0R 972.L.' LI I? Y Err E., GI? .2,712.7
Phone #: 503 - 620 -5509 Phone #: 503 - 307 -2416
Reg #: SU 46285
LIC 136922
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervi ng Electrician
b P � e Ssi / ��"�t (I
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140
Plumbing Signature Form
Permit #: MST2002 -00021
Date Issued: 1/30/02
Parcel: 2S111 CB -01703
Site Address: 10235 SW HOODVIEW DR
Subdivision: HOOD VIEW
Block: Lot: 2 -
Jurisdiction: TIG
Zoning: R - 3.5
Remarks: Laundry & kitchen remodel.
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 Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
DEREK ROTHERY 3 MOUNTAINS PLUMBING
10235 SW HOODVIEW DR PO BOX 386
TIGARD, OR 'x+7224 SHERWOOD, OR 97140
Phone #: 503 - 620 -5509 Phone #: 503 - 925 -1342
Reg #: LIC 141187
PI_M 34 -368PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authoriz "
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 g-000_1
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested s I - 7 AM PM BUP
Location • 2 3 �' ! � :' - MEC
Contact Person d Ph ( ) 76 S 73? 5 P
Contractor Ph ( ) SWR
,QUILDING Tenant/Owner ELC
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain ��
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /�
Susp'd Ceiling
Roof
Other:
ina �
L ��, •ART FAIL
�hdL
: - -m
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
- AS _ • RT FAIL
•
Rough- n
Gas Line
Smoke Dampers
T FAIL
Roug - n
UG /Slab
Low Voltage
Fire Alarm
final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
4 g3 PART FAIL
Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA _i
Approach /Sidewalk Date 1 7 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART ' FAIL