Permit . f
< MASTER PERMIT
CITY O F TIGARD PERMIT #: MST2000 -00522
1I1I DEVELOPMENT SERVICES DATE ISSUED: 12/27/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10582 SW KENT ST PARCEL: 2S115AA -02400
SUBDIVISION: DOVER LANDING NO.2 ZONING: R -4.5
BLOCK: LOT: 063 JURISDICTION: TIG
REMARKS: 224 SQ FT ADDITION PATH 1
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 10 FIRST: 224 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 11
VALUE: $ 19,331.00
OCCUPANCY GRP: R3 BDRM: 1 BATH: TOTAL: , 224.00 sf REAR: 29
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
• MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 0 CLOTHES DRYER:
GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 3 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: 1 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: SIGNAUPANEL: 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: $ 708.48
COOK, GARY R /SUSAN E AMBIANCE PAINTING permit is subject to the regulations contained in the
COO ING & REMODELIN GARY
KENT R/ ST 2 4 A AMBIANCE E PAIN NGNE Tigard Municipal Code, State of OR. Specialty Codes and
TIGARD, OR 97224 HILLSBORO, OR 97124 all other applicable laws. All work will be done in
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 128044 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 Crawl Drain /Backwater Electrical Service Low Voltage Mechanical Final
Foundation Insp Footing /Foundation Dr Electrical Rough In Insulation Insp Plumb Final
. Post/Beam Structural PLM /Underfloor Framing Insp Rain drain Insp Final inspection
Post/Beam Mechanical Mechanical Insp Shear Wall Insp Water Service Insp
Underfloor insulation Plumb Top Out Exterior Sheathing Insl Electrical Final
,
/
'''' bp,. Issued By : I �� / 11- Q-____ Permittee Signature . ►- , 1111
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Buildin Permit Application
A. Date received: // et) Permit no.: / --00 J r�
l� 1 1 City of Tigard
- Address: 13125 SW Hall Blvd, Tigard, OR 97223 Projecdappl.no:¢ Expire date:
City of Tigard
Phone: (503) 639 -4171 ' Date issued: By: Receipt no.:
Fax: (503) 598 -1960 I V Case file no.: Payment type: r-
Land use approval: 1 &2 family: Simple Complex:
N
• TYPE OF PERMIT
1 21y dwelling or accessory C:1 Commercial /industrial ❑ Multi- family CI New construction ❑ Demolition
c Addition/ teration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
' JOB SITE INFORMATION
Job address: I b S $.. 5 iN.) /( 4A)1 ST' Tti gtt,D G2 . 14/224 Bldg. no.: Suite no.:
Lot: . 'Block: Subdivision: t 1.16w (1„ iz �,,,,,� I Tax map /tax lot/account no.: 4' s,,S6-47 z' /r)
I Project name: 1'..60 1(.... At 17 1 to 62 9/, S
Description and location of work on premises /special conditions: .ben/ - G./9-A/A /A/t9 eve) . 2)
OWNER T . • FOR SPECIAL INFORMATION, USE CHECKLIST
Name: �. C �/ , ' `(Floodplain, septic capacity, solar, etc.)
Mailing address: ( 10 sg2 ,SW KfrJ1' ST. 1 & 2 family dwelling: • J - _
City: 1 AQ1 State: OA ZIP: 9 7224 Valuation of work $ C .13 3 d
V3 Phone: of.. /fig q (Fax: 1E-mail: No. of bedrooms/baths /25
Owner's representative: Total number of floors I _
Phone: Fax: E -mail: New dwelling area (sq. ft.) c, Z//..1`
APPLICANT Garage /carport area (sq. ft.) !V
Name: Covered porch area (sq. ft.) AJ0
Mailing address: Deck area (sq. ft.) - -
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustriallmulti- family:
CONTRACTOR -_ • Valuation of work $
Business name: Existing bldg. area (sq. ft.)
M (j Pf/'1 Arf7nIG F � o DEr- /W New •
bldg. area (sq. ft.)
71 B Address: ij ?1 `/ S 2 -FIA. . QLtESTh ��
S I State: B� , I ZIP: 9 ? 12 Number of stories
City: n . "LL 13 bre.o l Type of construction
Phone: 693 -- 9 /SI I Fax: 8y8 - ?923 1E-mail: •
CCB no.: 1 gip g-/y i1�t02 2... 6 o s 1.3 Occupancy group(s): Existing:
New:
City/metro lic. no.: q.7 DO • i.o • 4 OIL V I EJ/J b4- 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 - .
Name: Contact person: Fees due upon application $ /5 . 9',5"
Address: Date received:
City: State: (ZIP: / Amount received $
Phone: I Fax: 1E-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 with, ter specified - - -- Credit card number:" -- / /
Expires
ev
Authorized si nature Date: ?.1 N °' Name of cardholder as shown on credit card
Print name: 1 /----x. ��LC 612/ic Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00 /COM)
. j
One- and Two - Family Dwelling
_ h,,,, Building Permit Application Checklist Reference no.:
Associated permits: - -
City ofTigard City f Ti and
Y g ❑ 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 N/A
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 Cl plan ❑ permit required. Include drainage -way protection, silt fence design and location of
I ' catch -basin protection, etc.
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. .
r — 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 stmcture (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.
24
25 .
26
27
28
. 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)
Mechanical Permit Application
. ,
Date received: /02 Permit no.:, rzp-zyn dOs
,L I1 I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
LI 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family • ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: f PS' g'... S L i K -1--s - 775A r u)or 9") L - 1 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:.._.) A k fu,),„ *See checklist for important application information and
Project name: C. / et-bp t -t-.w, jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCI-IEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: t
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
space insulated? 0 Yes ❑ No Air conditioning rati of x ta ng plan required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors .
State boiler permit no.:
Business name:
AMC{r M I w7GLr HP Tons BTU /H
' A. Address: 2.? 1 S( T k M LIF a S TU4)1 Fire /smoke dampers /duct smoke detectors
,A City: /4 L( s d I State: 0 K., I ZIP: c7712. Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 1200 I &( 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
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
•
Name: Exhaust fan with single duct (bath fans)
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: Woodstove /pellet stove
Other:
Applicant's signature: Date: Other:
Name (print): •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa U MasterCard Notice: This permit application Minimum fee $
Credit card number: / / "expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (6/00 /COM)
•
•
MECHANICAL PERMIT FEES ,,
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts &vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$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 :Checkrall that , , ; Boiler He •.• ;,:Air - e t ,
$1.20 for each additional $100.00 or "For 7 11, see or ; ° ,.Pump .Cond ` -
fractionthereof. footn9tes'belowr4••• Comp * - , r • . r. =u** -
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: '
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents . 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent riot included in applicance 445 13) Air handling unit 10,000 CFM+
permit ,. . 17.20
Repair units • 805 14) Non - portable evaporate cooler '
< 3 hp; absorb. unit, 955 10.00
to 100k BTU - Vent fan connected to a single duct •
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15 -30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40 -
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 6 69.95 •
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: _ ;,., °;r $
Commercial or industrial incinerator 4,590 ' a : _.
Other unit, including wood stoves, 656 8% State Surcharge = T; , , T _: $
inserts, etc. #: n }' ;-'
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) z - - ter' -: • ,: $
a
Each additional outlet 63 Required for ALL commercial permits only�p
.
TOTAL COMMERCIAL p ° '1,` ; $ TOTAL RESIDENTIAL PERMIT FEE: 5'a - ° " �` $
VALUATION: ` " ,t_ ... ^7F
Other Inspections and Fees:
• 1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee,is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
•
Plumbing Permit Application
�A Date received: //�Z ? /Qt) Permit no.://,5 _695'7 4
"11 )III I City 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
-- '4f1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service Cl Other:
JOB SITE INFORMATION FEE SCHEDULE'(for special inforn ation use checklist)
7 Job address:(0 S 2_ Sr.a gatc47 _ g ( Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
Tax ma /tax lot/account no.: (includes 100 ft. for each utility connection)
p SFR (1) bath
Lot: 2_ I Block: I Subdivision: t-J t ( (,w 6,". k r•-e4 SFR (2) bath
Project name: c cx "a t = r -,,,,, SFR (3) bath •
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
�-� -- batch basin/area drain
Est. date of completion/inspection: ,77./' DryWells/leach line /trench drain
PLUMBING CONTRACTOR Footin , drain (no. lin. ft.)
Manufa4tured home utilities
Business name: A vhg 64 r1/4J (,/ 14 r' P,Qq i ►.1 Oat l Manholes
Address: "02 7 / y St mbt, S L o f Rain drain connector
,Address:
).4-, ( IS L, o — /I StateO'Y I ZIP:c/7n14 Sanitary sewer (no. lin. ft.)
Phone:Co 9 —91 c ( I Fax: r I E mail :, _ > Storm sewer (no. lin. ft.)
, CCB no.: / O' -1'1 I Plumb. bus. reg. no: Water service (no. tin. ft.)
'
Fixture or item:
City /metro tic. no.:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: T / S - , . Date: a`t 'II. v O a Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer .
•
Address: Dishwasher
Drinking fountain(s)
City: I State: . I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank .
OWNER Fixture /sewer cap
Name (print): Floor drains/floor sinks/hub
Garbage disposal
Mailing address:
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: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total ,
Not all jurisdictions.accept credit cards, please call jurisdiction for mote information. Pl Minimum fee $
Notice: This permit application
❑ Visa 0 MasterCard _ -. expires if a- permit is notobtained 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:
_,;PRICE. , ;TOTAL; °.. " .
°New�1 and<2 family dwelh ngsonly ° v ° f.
IX • .` • r - = ax lud
FIXTURES (individual W QTY : ' ,�(ea) AMOUNTS (inces all4phimping�fizfurein s �..� _v�= � RICE P 4 TOTAL= - -
Sink 16.60 the dwell�ng' the first1f _ . e - .. , QTY1 (ea) /AMOUNT;•
Lavatory 16.60 'for_ each `°sutility.•,conhection) ft . , - - ", ,, :' "
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 1 6.60 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 '• `, . . -.- Quantity by formed'E--
Gas piping requires a separate mechanical ` Fixture Type: ,fi" • ,. ; New =, ..?).'..r001.00, * , r Replaced - Removed/'
permit. Gapped. _.
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
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray -
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60 '
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25 -
Grease Traps 16.60
QUANTITY TOTAL ': .. .,:'
Isometric or riser diagram is required if r . _, - ``} _'= '; -k,,,
Quantity Total is > 9 -; : -
SUBTOTAL -
�, V'
8% STATE SURCHARGE `' `,' - 1st
REVIEW 25% OF SUBTOTAL' ` •
Required only if fixture qty. total is > 9 ;
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** AII New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00
ElectricalPermit Application
Al
Date received: ///2 v Permit no.:i57-2,670 Di 52 ,
...I I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type: _
Land use approval:
TYPE OF PERMIT -
1 & 2 family dwelling or accessory 0 CommerciaLindustrial 0 Multi- family 0 Tenant improvement .
0 New construction 0 Addition/alteration /replacement 0 Other: U Partial
• JOB SITE INFORMATION .
Job address: I O ?2 5 w (Ca.,. -T ST Bldg. no.: Suite no.: Tax map /tax lot/account no.:
,( Lot: I Block: I Subdivision: \,,, , V \ (,.roe L s
•
Project name: c k P�0, r I Description and location of work on premises:
Estimated date of completion/inspection: .
. CONTRACTOR APPLICATION, FEE SCHEDULE
Job no: �^ 1 e� Fee Max
� AAA) kg C.. Lat c 'r a. t c__ Description Qty. (ea.) Total no. ins
Business name: P
New residential - single or multi - family per
Address: 21 7 g S' 5 0 7:t I. I4 • dwelling tmit . Includes attached garage.
City: A I.O N ft- I State: v et I ZIP: Service included:
Phone: S'11. )32 a I Fax: I E -mail: moo sq. ft. or less . 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no:
Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
• Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
PRO PERTY OWNER • alteration or relocation:
. 200 amps or less 2
Name (print): G A- 1 201 amps to 400 amps 2
Mailing address: /0 Z s ✓ /iZ— S— T
401 amps to 600 amps 2
�- 601 amps to 1000 amps 2
City: -- (7 /4,1_1" I Stater *— I ZIP: Over 1000 amps or volts ' 2 .
Phone: (.3 ` l , t Zg j I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or- exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
a'. _ ° ENGINEER ' ' ' .. Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): .
❑ Service over 225 amps- commercial O Health - carefacility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ 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: / / 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 (6 /00 /COM)
r
•
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or •
portion thereof $33.40. 1 �-1
Limited Energy $75.00 I I Burglar Alarm
Each Manufd Home or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener*
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 n Vacuum Systems
401 amps to 600 amps $160.60 2
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 ❑ ' •
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 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service r - 7
or feeder fee. l I Fire Alarm Installation
First branch circuit $46.85 ❑
Each additional branch circuit $6.65 HVAC -
Miscellaneous n
Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy - -
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical •
the allowable in any of the above ❑ •
Per inspection $62.50 Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting '
Fees: n Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
. See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
• • Fees:
Total Balance Due $
Enter total of above fees $
El Trust Account # 8% State Surcharge $
Total Ba lance Due $
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD
13125 S. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TUALATIN VALLEY HWY S
ALOHA, OR 9 700 6 -1 248
Electrical Signature Form
Permit #: MST2000 -00522
Date Issued: 12/27/2000
Parcel: 251 5AA -02400
Site Address: 10582 SW KENT ST
Subdivision: DOVER LANDING NO.2
Block: Lot: 063
Jurisdiction: TIG
Zoning: R -4.5
Remarks: 224 SQ FT ADDITION 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 Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
COOK, GARY R/SUSAN E GARNER ELECTRIC
10582 SW KENT ST 21785 SW TUALATIN VALLEY HWY S
TIGARD, OR 97224 ALOHA, OR 97006-1248
Phone #: Phone #: 591 - 1320
Req #: LIC 121159
SUP 3707S
ELE 34 -305C
AN INK SIGNATURE IS REQUIRED O T IS ORM
X
• Signature of Supervising Electrician
If you have any questions, please -call- (503) -639- 41- 7- 1 -ext -# -310- - --
CITY OF TIGARD BUILDING INSPECTION DIVISION MST exi-eo
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
, Date Requested o 3 AM PM BLD
Location / 0 5 — Q a 0 9 -0'4 Suite / MEC
Contact Person , ;77P1/1 Ph " 7 PLM
Contractor (//1/4/01--44-41 SWR
:_ `� Tenant/Owner ELC
Retaining Wall ELR
Footing Access: (� � � � Foundation FPS
Ftg Drain 1!�'� SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing - •
Insulation
Drywall Nailing
Firewall
Fire Sprinkler �n
Fire Alarm 56 q " J
Susp'd Ceiling
Roof
Misc:
MIA PART FAIL
PLi TNG •
Post & Beam -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
I
Post & Beam
Rough In
Gas Line
Smoke Dampers
4:4 PART FAIL
E RIC ;..
Service
Rough In
UG /Slab
Low Voltage
?Wil arm
PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA -7
Approach /Sidewalk Date L7z /0 / Inspector �� Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.