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Permit .. Al CITY OF TIGARD MASTER PERMIT . PERMIT #: MST2002 -00359 " DEVELOPMENT SERVICES DATE ISSUED: 9 /20/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10173 SW LADY MARION DR PARCEL: 25111 CB - 03300 SUBDIVISION: MARION ESTATES ZONING: R - 3.5 BLOCK: LOT: 006 JURISDICTION: TIG REMARKS: New S/F detached Path 1 NEED TO GET A STREET OPENING PERMIT FOR NEW DRIVE WAY BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,464 sf BASEMENT: 0.00 sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,562 sf GARAGE: 830 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 9 VALUE: $ 306,411.40 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,026.00 sf REAR: 30 ' PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 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: X VACUUM SYSTEM: X AUDIO & STEREO: X FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X OTH: ALL ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,459.34 MASTERPIECE CONSTRUCTION INC MASTERPIECE CONSTRUCTION INCThis permit is subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and 15435 SW ASHLEY DR 15435 SW ASHLEY DR all other applicable laws. All work will be done in TIGARD, OR 97224 TIGARD, OR 97224 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 69010 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 Erosion Control Insp 84 Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ins F Rain drain Insp Plumb Final Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection Foundation Insp Footing /Foundation Dr; Electrical Rough In Gas Line Insp Appr /Sdwlk Insp Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final ?\ i Issued By : � 2iY1 1 Permittee Signature : , , _ _ Call (503) 39-4175 by 7:00 p.m. for an inspection needed the next business day • Building Permit Application FDA OFFICE USE ONLY " Received l Building u„ Date /By: g/ /( - ., • . . ) Permit No.: UT 42— 4® 357 Planning Approval Other a ��' �_ ��..� A City of Tigard Test Form Planning y: Permit No.: '��� 4j 13125 SW Hail Blvd. Plan Review g 0� ' Other 6 oz38' Tigard, Oregon 97223 Date /By: 0 � f �" Permit No.: Phone: 503 -639 -4171 Fax: 503 -598 -1960 W i 111 Post- Revie Land Use I� Date /By: /3 / r!J!L �7 Case No. Internet: www.ci.tigard.or.us san a° Contact Ju s ID See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: /1U.e/j Ae�-a -- IILI Supplemental Information -' a n .M�ye xi. . :; *3 .., ...,Y..m��.. sa,,,,,'. '-..?1,7W a .,,. :E a "',� "`1t" :a.. - ,fl{"xuy,,a't ; 3 Z . TYP'E= +OF{WORK a ? .�.... "� W ' 1 ' V , >p�T;`a%�a :;A��' ��« � ` .� � - REQ iIIREDDA T . � a �_ [ j New construction ❑ Demolition ; a � 5i 0 . 1t & y 2 FA,M LY DWELLING 4 ❑ Addition/alteration/replacement ❑ Other: °` ,. 'p " CATEGORYaOF CONSTRUCTION ` r ` ,,, , Note: Permit fees* are based on the total value of the work performed. Indicate II & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family / [1] Master Builder � ❑ Other: Valuation 3a vii, S ^' 4,,,,,,o.,`$ITE INFORMATION and I; OCATION = ,' ft2' ` v No. of bedrooms: ( No. of baths: 3 Job site address: /a s L44-41 /hAa Q Total number of floors New dwelling area (sq. ft.) JO ,Z Co fj. Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)......., Project Name: Covered porch area (sq. ft.) L t 0 0 Cross street/Directions to job site: j 4_ [ Deck area (sq. ft.) �-- l Other structure area (sq. ft.) (.r to_ 1.,3,. -R-t if° �'S "" D T __ G � . r CO USE ChE€1 S T Subdivision /ti���b1..) ` SC p-Tt,1 Lot # : < . e _ �,.. .. .,_., . �.. �. _ _ Tax map /parcel #: ,. . ;�a .:� :` i 1 I co 33 6' Note: Permit fees* are based on the total value of the work performed. Indicate `� � . � ' �WORK��� :� � � r a�t�,��`:: " "_� the value ( rounded to the nearest dollar ) of all equipment, materials, labor, x ;;�'�;,DESCRIP'rION�,OF overhead and profit for the work indicated on this application. Valuation $ -- Existing building area (sq. ft.) 1 .. New building area (sq. ft.) I Number of stories rPROPERTYVOWNER.r; " = . , ...❑ T N T ENA ,:. ,,,: ` ,.' . Type of construction &" Occupancy group(s): Existing: ` Name: va3-S1- � k p (0 c.t c . r r . I N C- -- New: Address: I S' ( -(2 S _S iA 3 l 1 tel Q 2 _ -- City /State /Zip: i■ ket p-i t 6 2 PC/ `Z Y. NOTICE: All contractors and subcontractors are required to be Phone: 7 5' A -5S ( 1, q Fax • S l 724 -y 3.1 I licensed with the Oregon Construction Contractors Board under i ❑ 1 A PPLICANT '`` ; c ` ® CONTACT P L provisions of ORS 701 and may be required to be licensed in the ' Business Name: x .,„„.._. jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: r r , � E- mail: " 14 BUILDING,PERM ITtEg * l n „ ' 0 : Pleas referto fee sahe u v . • :� ���.� ,. ���e�, T'RACT�OR . dt .r. o4yr:s,gm Business Name: , rAN_ Fees due upon application $ Address: City /State /Zip: Amount received $ Phone: Fax: Date received: CCB Lic. #: - — Authorized , ` • Notice: This permit application expires if a permit is not obtained within rr • 180 days after it has been accepted as complete. Signature: \ n,_, ` Date: ' t �, �\ *Fee methodology set by Tri- County Building Industry Service Board. 1 1- (Pease print name) \ 1.r.\ One- and Two - Family Dwelling • • • ' ' e e `6•! ►!. Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City f Tig y b ❑ 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 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 Wafer district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection,,silt fence design and location of catch -basin protection, etc. ` - 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with 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; footp�iat of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot ;ilea; building coverage area; percentage of coverage; impervious area; existing omsite; 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 oni submitted plans may be in blue dr black ink. Red ink is reserved for department use only. 440 -4614 (6/00 /COM) Electrical Permit Application i FOR OFFICE USE ONLY Received pp Q Electrical J Date /By: 0 0 8 9 e �� Permit No.: rl a'AV 351 Clt Of Tl and Planning Approval Sign Y g Test Form Date /By: PermitNo.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use /O wdl i 1� Date /By: Case No.: Internet: www.ci.tigard.or.us ■ (�„� en I Contact Juris.: Li Sec Page 2 for 24 -hour Inspection Request: 503- 639 -4175 " ° -W Name/Method: Supplemental Information. ., .... at e ..'.. Tl(PE',OF.WORKte a P9 , iW -Aa ;. ;PLC'AN:: (EleaseleheekmalliitiatlappiY) W . y :' >:; ew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, 1 ; p= ;,<CATEGORY. ',OFICONSTRUCTIONi' I . 1 1 & 2 family dwellings four or more residential units in RI I 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ['Building over three stories LI Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress /lighting plan ❑ Other: ' - .` e • -.1 JOB." SITE ;;INF.ORMATIONand t �� Submit sets of plans with any of the above. � The above are not applicable to temporary construction service. Job site address: c, 13 Lin-4.,-.1- 1e t(� , ° M� ., FEE *SCHEDULE; ' %, - ,; ;, Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total 1 New residential - single or multi - family per Cross street/Directions to job site: (-k, "3 P- dwelling unit. Includes attached garage. (9' k- \ lel& W / r ( Service included: 1000 sq. ft. or less 145.15 4 y�r� rr�� i j Each additional 500 sq. ft. or portion thereof Z,. 33.40 1 Subdivision: / ' ` P „ V gv U \ T Ot #: L Limited energy, residential e / 75.00 2 p Limited energy, non residential 75.00 2 Tax map /parcel # 7S i 1 OS - 633 b Each manufactured home or modular dwelling - = service and/or feeder 90.90 2 _ it.,,.,DESCl2IPTION.aOF WORK, 1, b� Services or feeders - installation, 1. 1A. J U-/ ' —© A-f alteration or relocation: • 200 amps or less 80.30 2 rs 201 amps to 400 amps 106.85 2 401 amps to 600 amps ,+''-• 160.60 2 •» rPROPERT `; 3 , s ., ' -I ENANT . m., . :la, . 601 amps to 1000 amps 240.60 2 r> Name: IN\ A-' S �? IL (^ 1 / Over 1000 amps or volts 454.65 2 4' l L ! � 1 .. (� C Reconnect only 66.85 2 <. Address: (C 3 6 & - 1-4- , ya.,$ h 1 C 4 —I tL Temporary services or feeders - installation, City /State /Zip:' ' \ C -1/k Q R ') 2Z'4 alteration, 00 or relocation: 200 amps or less 66.85 1 Phone:3'i 1 ,— 7 S't%-5l y S Faxc'M 5'ZV —43 1 201 amps to 400 amps 100.30 2 ®;AE LICANTI,, `,; ',' , ,M- . ,. ,CONTACT PERSosa 401 to 600 amps 133.75 2 Branch circuits - new, alteration, or Name: 2 extension per panel: Address: S \vv"., A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: max: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): ';a +° , ' CONT_1t4 CTOR k bu.rx,>'x'= ,,,,,,, ,, ,_ .„Xel,!:,tli Each pump or irrigation circle 53.40 2 Job No: Each sign or outline lighting 53.40 2 Signal circuit(s) ora limited energy panel, Business Name Qg 0 t c—' wTe 12- f 2 f c..r r 1 n.� a*lterationD or extension* 75.00 2 Address: pi , b�� 1 mix__ ption: City /State /Zip: r✓.14 -C L .-wa -s , 6 e— 5"i DI Each additional inspection over the allowable in any of the above: Per inspection (per hour - min. 1 hour) 62.50 Phone:-L' - ®I Mt-Fax: • Investigation fee: CCB Lic. #:electrician y - 4 Lie. #: 3-1 c v Other la ` c `3 IDS w E,I, efrical Perm►t ' EtM-20 �; ` . Supervising °rf9 /o3 1010 "'� Subtotal $ signature required: l Plan Review (25% of Permit Fee) $ Print Name CORD- > °, 6 Lic. #: (0 1. S . 10I u State Surcharge (8% of Permit Fee) $ TOTAL PERMIT-FEE -$— - -- Authorized (� �■..(jZJ Notice: This permit application expires if a permit is not obtained within Signature: Date: 0 180 days after it has been accepted as complete. • __IL \ g ho '' II *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) Plumbing Permit Application FOR OFFICE USE ONLY Received Plumbing Date/By: r y: v g a Permit No.: Y& City f Tigard Planning Approval Sewer Y g T est F orm Date/By: PermitNo.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 494410 Post- Review Land Use � � �� • . Date /By: Case No,: Internet: www.ci.tigard.or.us �^*+' Contact Juris.: Egf See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. l'ai" :'_; TYPE QF WO1W;;; 31I 5 s =- X: : „ ." . !f f : , ,";;" FEE* SCHEDULE (foi i,Ii ial,information nse:ehecklis.t r :- �• � t Fee ea Total New construction El Demolition D escription I Qty. I Fee( ea.) ❑ Addition/alteration/replacement ❑ Other:" g z� Zv v New1 e& 2 awpefltngs, ,b; s , CA,TEGORY OF CONSTRU,C 1 ION <<:P '.. s ' .;:?;=.',' ' ' ` , ' Z " 4 # „ft ; for utihtylconnection)r,W„�t ,° „: a, . ,. dwelling Commercial/Industrial SFR ( bath 249.20 1 & 2-Family g . ❑ SFR (2) bath 350.00 ['Accessory Building El Multi-Family SFR (3) bath .� 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen . 45.00 , iJOB SITE 'INFORMATION�andiL r , *f'' -`a " °t Fire sprinkler - sq. ft Page 2 ' 3 V b e;, ,; „-i, rra;a' "� , :siol ti11t1e , l .:... r' ,a...� `i Job site address: t l L 4 6� Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell /leach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: f ( 3 a-_ 6 Manufactured home utilities 110.00 L Vi-a M 0, k0,--) Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: yymt%12. (t- b ft prpzil L X.:"„ ot #: I Storm sewer (no linear ft.) Page 2 4. Water service (no linear ft.) Page 2 Tax map /parcel #: a S [ I 1 -6`x'3 a,e ,,,, u ; a, Fixture gr ltem . _ k...,,...:.' - IO " i '°' JESGRIPTION`,OE.WORIC .,, g :.." . Absorption valve 16.60 2 kJ 1 .-Jw.. -..� Backflow preventer - Commercial 46.40 Backflow preventer - Residential 27.55 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 : ® ;PROPER 4itiOWNERf .. ,, l '` iEl TENANT. 3. WA Drinking fountain 16.60 Name: ivy V4 R 1L. f ( c C, % . j wC . Ejectors /sump 16.60 Address: j ` Lk `2 '' 5k-,J A--.3 k I 4, Expansion tank 16.60 City/State/Zip: f- Fixture /sewer cap 16.60 y p' ; x �� "� F drain /floor sink/hub 16.60 .[� " Phope:L5 d'7 15 - S tis Fax:S -S �31 1 Garbage disposal 16.60 APPLIC "AN. "¢ =-z' ` , `CON TACT'PERSON: = :'58 :: Hose b ib 16.60 Name: c - , Ice maker 16.60 Address: Interceptor /grease trap 16.60 Medical gas - value: $ Page 2 City/State/Zip: - Primer 16.60 Phone: Fax: Roof drain (commercial) 16.60 E -mail: Sink/basin/lavatory 16.60 7. * n j d ' : CONTRACTOR ;- "'' ,. >,,. w a g : `° x Tub /shower /shower pan 16.60 Business Name: P. c E"r pi U 6. i v-1 Urinal 16.60 Water closet 16.60 Address: 3 a 6 8 eouctrq sr Water heater 16.60 City /State /Zip: 1 i yv 1:12-61( c C0 rc.„, Other: Phone:5 - k s / _cm 3\0 Fax: E : � a ,° .., ..: Oumbmg P'erm►tFeesfg;e _: ` : z w'F Subtotal $ CCB Lic. #: 1 . 2--6 ei 1 Plumb. Lic. #: 3 LI -,34141 Minimum Permit Fee $72.50 $ Authorized k Residential Backflow Minimum Fee $36.25 - Signature: (( a� Date: �'J 'dam Plan Review (25% of Permit Fee) $ State Surcharge (8 %-of Permit Fee) -$ y ■`Q.Uv '4 -_ D j3- s« '� TOTAL PERMIT FEE $ 1 J (Please print name) Notice: This permit application expires if it permit is not obtained within All new Commercial building require 2 sets of plans with isometric or 180 days after it, has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. riser diagram for plan review. Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ° St Utilities � Qty : u F e ( T Square Footage`C . ,, f, e. , . . Permif Fe Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 i fi : ." , ,. � ,y , .,. e: -- �Valuatton: _ _. . -Permit �Fee:..- , ' Storm & Rain Drain • 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and ''``' F110 or. Item ;I : v 7Qty Fee (ea) ;FTotal„ 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 *. - Comments regarding fixture work: ?�° V $ ,', Quantdy�by ( Ftxture) Work Performed g g ,ti Vat:.:` 1 eR ii14.' ' _" e Ftztur- e�T�ype � � _ � � � .. ? ; , A' A... ., n e w „ � 4 444 i E sis tin 'g , ;._Capped 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 If the fixture work under this permit results in an Garbage - Domestic Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) . Rec. Vehicle Dump Station Shower -Gang . -Stall ` Sink - Bar /Lavatory - Bradley - Commercial - Service • Swimming Pool Filter ' Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: Mechanical Permit Application FOR- R.0._ USE ONLY Received I Mechanical Li Date /By: 8 9 0 ' Permit No.: i i /i v9 60351 Clt of Ti and Planning Approval Building Y T Form Date/By: Permit No.: • 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 4n10 Post- Review Land Use ( Internet: www.ci.tigard.or.us1.� I - Date /By: Case No.: Contact Juris.: I:4 See Page 2 for — 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. .;:Yki a7 a 0 i 1 . ., _:0:? _:}' '!it' EOIVIIVIERCIM FEE';;SCHEDULE` ISEiCI ECKItiST ,. New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all rT _` , fi ` C =TE.G,ORY; OF CONSTRU ,A' '- ` ` ; _ . mechanical materials, equipment, labor, overhead and profit. 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family h RESIDENTIALEQUIPMENT /SYSTEMS FEE 3SCHEllULE, Description Qty Fee(ea.) I Total ❑ Master Builder ❑ Other: - -- : , a: , 't 1 " .' ` " Heating/Coorng 0 • '. W_s:r, JOB;SITEaINFORIVIATION andLOCA =TIONi, „;, : Furnace - add -on air conditioning 14.00 Job site address: f Q ``13 S l.,....1 L 10-3.d n Ltc11I J Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work / 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: 1 3 e.t_ (r t4 (for radiator or hydronic system) 14.00 C � �1 1-y IN^ 0 fL& f\'-' Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Z Repair units 12.15 Subdivision: 1 -� 1. CST t" hL Water heater 10. of #: ' ;: . -1.:, ,Otiter'Fdel'Apance pli , ,. , ", :•', ,,< . ,. . , . Tax map /parcel #: 2 S ti 1 C - t 3'3 { u 10.00 :> T W:.'DESCRIPZT'IONIOF WORK ,;,, . ', ;, r ...,:51 Gas fireplace . f 10.00 :3 1\ __' Flue vent (water heater /gas fireplace) 10.00 5 Log lighter (gas) 10.00 . Wood/Pellet stove 10.00 1 ° , , Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 PROPERTY OWNER, „ : TENANT .:: :,K , , :.4.4 . Other: 10 00 . �` `::. EnyironincritalExhaust &ye"=tiiation,: Name. 6 L Ie -Pte. t C T ; Range hood /other kitchen equipment // 10.00 Address: (S `k C S -t.-.4 s i — Q ' Clothes dryer exhaust r 10.00 City /State /Zip: `— t ' '� . ) ___±,t: -� Single duct exhaust Phone: S mi" S� y Fax: J (bathrooms, toilet compartments, APP ;,', :e.7._; : ; . ® 'CONTACT PERSON " ; =, utility rooms) J 6.80 Name: J (7 b--1 Attic /crawl space fans 10.00 Other: 10.00 Address: ! -: t: , ,,f;::,-;, , ,,' . ' - ',.4. Y FiielTi ti w:° ; , ... , ; :,,' • . ° 0 , City /State /Zip: ($5.40 for first 4, $1.00 each additional) ** Furnace, etc. ee ** Phone: Fax: Gas heat pump ** E-mail: Wall /suspended/unit heater ** a tki:I.:>. ' IE ; - 1 _.k, i t':. CON'IRA7CTO l ';'.. 1..' :, . ig Water heater V ** Z w Fireplace /�, ** Business Name: v L� ft-Tt `� p / Address: l), . v O --)(....t., Range ** II �� q BsQ ** City /State /Zip: V Q I �� Clothes dryer (gas) ** Phone: / –k n 1/41 -lo'�(_ t 2k, Fax: Other: ** CCB Lic. #: 61 y Total: ' MechanicaUPerinit =Fees* • Subtotal: $ Authorized (, Minimum Permit Fee $72.50 $ Signature: — 001231.--- ' — - Date: - ( --'P� Plan Review Fee (25% of Permit Fee) $ q� State Surcharge (8% of Permit Fee) _ $ ! vi V TOTAL PERMIT FEE $ (Please print name) Notice: This permit application expires if a permit is not obtained within • 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total:Valuat rn `- Perm t` Fee , $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and • $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • • • LAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Nq r / M I5 T Rya — a - 035 q 0. E TIFICATION ot 44 T 0.. EET TREE C R S R .. , .. I, A \ 1 c tt-/ D ret 14.fr e-ri CO K- -/ u C . :: (PLEASE PRINT) (PERMIT HOLDER) 1 _ ,, t Do herebycertfy that the folio location meets �Ct, < of - Ti � ard /Washgton County Ot land use and development standards for street tree installation. ADDRESS: / t S L L- 1 A - `� N i m hoe ( (( K ro. LOT: lv SUBDIVISION: i ll- K 0 K/ OS rAa rr J BY: DATE: 7-2- 1-- dam , ::: RECEIVED BY: , d to DATE: / 2 -/ 9 -- ®3 . ' Ot A- t • CITY OF TIGARD 24 -Hour • BUILDING Inspection Line: (503) 639 -4175 MST 01 '" Ov 3 j ° f • INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 7 �1 AM PM BUP Location 6 =�� /11J_ Suite MEC Contact Person / /' Ph ( ) 7 5:0 - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: _ Ftg Drain ELR Crawl Drain �� . , � Slab Inspection Notes: SIT Post & Beam Shear Anchors • . Ext Sheath/Shear. . Int Sheath /Shear Framing Insulation - 2 C (00 l I% • 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 ELECTRIC AL Service Rough -In L- V I /eJv /- UG /Slab ff �1 • Low Voltage AJE- iY ( Fire Alarm ` 1 ; PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. . SITE 111 Please call for reinspection RE: ❑ Unable to inspect — no access Fite j , ADA Date 7 l 4 Inspector Ext Approach/Sidewalk / Other: Final DO NOT REMOVE this inspection record fro the job site PASS PART FAIL CITY OFTIG14RD 24 -Hour _ BUILDING Inspection Line: (503) 639 -4175 • T INSPECTION DIVISION i - Business Line: (503) 639 -4171 A MST • ,�- ��� �- BUP 2 - 0J 3,57" Received Date Requested AM PM. BUP Location D > ii , _� _ "If / . Suite MEC Contact Person gLge-b-,__ Ph ( ) - 7 S - . ,5 Y? PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: , ' 5 ELR Crawl Drain 7 0 Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation 5 671 g l // _ / /g rywall Nailing /�/ G ( V Firewall �6� C ��j 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: V A PART FAIL CHANICAL , - Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL • Service Rough -In UG /Slab Low Voltage - Fire Alarm Final ❑ Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE n Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date yA _ Inspector Ext Other: • Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 - 6035 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested AM PM BUP Location / O / 75 I. 0.o)) Mai G-+1 b• r. Suite MEC Contact Person ' A (°`^-. Ph ( ) 750 - 5-545 PLM Contractor l40. ()Cer1L ColAgfri4cArl ijC_Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear 4# Framing -' Insulation / , W61 �y 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 IO S PART FAIL CTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspe tion RE: ❑ Unable to inspect – no access — Fire Supply Line -- � - Date r — ADA Approach /Sidewalk Date � � Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 _ D 0.351 INSPECTION DIVISION Business Line: (503) 639 -4171 /'q BUP Received Date Requested 1%Z -- I / AM PM BUP Location d O� 7 � k / 4 ( 9 - ? - - ) by. Suite MEC Contact Person Ph ( ) 7ED PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC f ooting Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam ✓ /(� pl Z �^� Shear Anchors VU Ext Sheath/Shear rFr S 'e vvvv.) / /�-i �� Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof P A S S 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 ELECTRICAL Service • Rough -In UG /Slab • Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA Approach /Sidewalk Date /2_ — D '. Inspector Eat Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL