Permit •
• ,,...
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2000 -00485
,�.�I�; DEVELOPMENT SERVICES DATE ISSUED: 11/21/00
'�" ' ---' 13125 SW Hall Blvd., Tigard, OR 97223 (503).639-4171
SITE ADDRESS: 10677 SW LADY MARION DR PARCEL: 2S110DA -08100
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 042 JURISDICTION: TIG
REMARKS: Construction of new single family detached residence, Path 1. .
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: . 20 FIRST: 1,646 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,528 sf GARAGE: 711 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 5
VALUE: $ 293,335.00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,174.00 sf REAR: 45
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 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: 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:
Contractor: TOTAL FEES: $ 7,356.49
Owner: This permit issubject to the regulations contained in the
RENAISSANCE CUSTOM HOMES INC RENAISSANCE CUSTOM HOMES Tigard Municipal Code, State of OR. Specialty Codes and
1672 SW WILLAMETTE FALLS DRIVE 1672 WILLAMETTE FALLS DR all other applicable laws. All work will be done in .
WEST LINN, OR 97068 WEST LINN, OR 97068 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 049955 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 Structural PLM /Underfloor Electrical Rough In Gas Line Insp Appr /Sdwlk lnsp
Grading Inspection Post/Beam Mechanical Mechanical Insp Framing lnsp Gas Fireplace Backflow Preventor
Sewer Inspection Underfloor insulation Mechanical Insp Shear Wall lnsp Insulation Insp Electrical Final
Footing lnsp Crawl Drain /Backwater Plumb Top Out Exterior Sheathing Insl Rain drain lnsp Mechanical Final
Foundation Insp Footing /Foundation Dr; Electrical Service Low Voltage Water Line Insp Plumb Final Ir
Issued By : . • •.7 Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
/27 / €- Z /' ) - d ✓M aa` ' /O -31-00
A . Building Permit Application
Date received: Permit no.:A/S R, .zit05p
0U- 111l1?' City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt -no.:
Fax: (503) 598 -1960 Go2c.20 _ 60 _ 317 Case file no.: Payment type: ___
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
"Al & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family $New construction , ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: 10 g 'StA) J /14 h ON PlU VE Bldg. no.: Suite no.:
Lot: 4 Z Block: Subdivision:, 4' _ Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
GO1 y[1Z'LT $104 L . FA1MIt.Y Roma
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: 1 , ,; I f ,09.,1C •. 0. (Floodplain, septic capacity, solar, etc.)
Mailing address: I (o L WI ♦f L4 ii , LL. 1 & 2 family dwelling: = �-
. • J ZIP: - Valuat of work $ J
33
�. ''
Phone: S .- , CP &/ Fax: E -mail: No. of bedrooms/baths 2,5
Owner's representative: U Total number of floors
� � Phone:4 - 2... Fax: E -mail: New dwelling area (sq. ft.) ,
- APP LICANT Gar age/carport area (sq. ft.) 7 . S .
n Covered porch area (sq. ft.) j
Mailing address: nailpr �`
Deck area (sq. ft.) F-
State: ZIP: Other structure area (sq. ft.)
—
City:
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft
Business name: New bldg. area (sq. ft.)
Address: Number of stories
— State: ZIP:
Type of construction
Phone: Fax: E -mail: Existing:
Occupancy group(s): g
CCB no.: New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: PO j p ♦ i( provisions of ORS 701 and may be required to be licensed in the
y jurisdiction where work is being performed. If the applicant is
Address: • Law exempt from licensing, the following reason applies:
1 ..i J! ZIP: - 22. in
Contact person: A 'Ian no.: /]Ti
Phone: ' Zi Fax: E -mail:
ENGINEER
EMIMMIIIMMEIMI person: AL I• Fees due upon application $ —
Address: kip Date received:
Mi i L A 0 lama ZIP: Amount received $
Phone: 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 hether herein or not. Credit card number:
n
-- k — — — 'n it -- — Expires
Authorized sl e: Date: 1 0 w Name of cardholder as shown on credit card
Print name: 504 I 1 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 (6ro0!COM)
/`I
One- and Two - Family Dwelling
• ° • Application Checklist
Building Permit A lication Chkli Reference no.:
rygfTigard Associated permits:
Ci
Cit O f Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No 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:sys[eni capacity 9'r 4 ° " ; ' ;',
6 Sewer permit. . - t :" ' `' ti -
7, Water district approval.
. 'Soils '
re ort: +Mu' tc on nal`a P licable stam =arid'si. nature.on fileor with application.
QTY" gi PP P g PP lication.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 _ 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 plahs a sepa"rate;full : . 1 ,1
sheet, attached to the plans with cross references between plan location. apd detait;ss•'P,lan be,completed
.ificopynght violations exist. a '' •
1'• .Site/plot.rlan drawn to scale. The plan must show lot and, building setback dimensions; property corner elevations (if t ' `• '
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and ` .1 4 �.
'driveway; footprint of structure (including decks); location of wells/septic systems; titilitytlocafidns; direct on'ind{cator; lot
; area;'building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage;. `••• < . '., ra
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
'4C ?
- 'size and location.
13 Floor plans. Show all dimensions, room identification window size, location of smoke detectors, wafer 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 arid 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." 9 I '.1 • �,�, <• <•
19 Beam calculations. Provide two sets of calculations using current code design values for all ;beams" and,multip le; joists`
over 10 feet long and/or any beam/joist carrying a non - uniform load < ,,, °, •ri r t •' i
20 Manufactured floor /roof truss design details. . ' s • r q r LL
21 Energy Code compliance. Identify the prescriptive path or provide cal culations. piping schematic i'regiiired
for four or more appliances. P. t'
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 projpct under review. r3 . -
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. A
24
25
26
•
27
28 d w ..'.;' <
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans i n ' May or black ink.
Red ink is reserved for department use only. 440-4614 (6/00 /COM)
•
Mechanical Permit Application
Date received: Permit 9445 T — ii 55$j
irk I
s ,l,�, .� ( � City of Tigard Project/appl. no.: Expire date:
City nfTigard 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
6
1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi family ❑Tenant improvement
New construction ❑ Addition/alteration/replacement
CI Other:
JOB SITE INFORMATION ' • - COMMERCIAL VALUATION SCHEDULE
Job address: 1,0611 4t) 'Airy ofAt pp.. 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: 4s- 'Block: I Subdivision: e vcri t io pj ins *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /count : - W L► ZIP: j LL5 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
61719 'P 't T 51 Ott T #1M n_y 7M/1 f 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? ❑ Yes ❑ No Air handling unit CFM
• Is existing space insulated? ❑Yes ❑ No Air conditioning (site plan required)
g P Alteration of existing HVAC system
• MECHANICAL CONTRACTOR Boiler /compressors
Business name: C10M /y1 i 61 HP boiler permit no.:
HP Tons BTU /H
Address: 2 'n
1 �o ;7� �• Fire/smoke dampers/duct smoke detectors
City: 141 L.L..go t.o I State:Pt- I ZIP: 471 Z 3 Heat pump (site plan required)
• `x' Install/replacefurnace /burner BTU /H
Phone: � .�4. ( 1 I Fax: I E Including ductwork/vent liner ❑ Yes 0 No _
I ; CCB no.: 122,17 S OZ Install /replace /relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): epep ,i. Li !rte% 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 U 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 Fuel piping each additional over 4 outlets .
4 't ENGINEER 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 fcc $
_ _O Visa_ — ❑_ MasterCard _ __ __ _ Notice: This permit application Minimum fee $
Credit card number: _ / / expires if a permiris 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
including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including 17.40
$10,000.00. including ducts & vents
$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 `•'t '6) Repair units' . ;T' • r •
• $50,000.00. a �` " i i 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and « Check all`thaf apply ..0 'Boiler Heat P,Ir ;• .
$1.20 for each additional $100.00 or For -items 711, see ' or g t Pump Cond
fraction thereof. -;a' foott,otes+belowt : Comp* , '' :' a
7) <3HP;ab'sorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3- 15 :HP; aljsrb
Value Total unit 100k to 500k BTU - ' ` ' ' 25.60
Description: Qty (Ea) Amount ,..,. 9),r1,5 -30 HP;,absoib;.� • - -.a ^ , • .,: j r; ,n c' \ ^,
Furnace to 100,000 BTU, including 955 unit'.5 -1 mil'BTU' • ' a • ' ' . • ' 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 not included in applicance 445 13) Air handling unit 10,000 C M. +.4� ; _ , t
permit ' "1 _ c , t .. j 17.20
Repair units 805 14) Non - portable evapo 'rate cooler .. ;z " - ,t
< 3 hp; absorb. unit, 955 .r , • ", '' ,
4 . - `6 . : ; ‘ , `,.73, 1 5, 0.00
x :{1
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 ' 1t. 4 ^'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,byme hanical exhaust .
30 -50 hp; absorb. unit, 3,400 ' . - .. L ; 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 656 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: J:;, ....: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge . ", $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) ::.' '-= - $
Each additional outlet 63 Required for ALL commercial permits only r ° , . "'
TOTAL COMMERCIAL ' $ TOTAL RESIDENTIAL PERMIT FEE: ,. $
VALUATION: _ _
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 NC requires site plan showing placement of unit.
is \dsts \forms\rnech- fees.doc 10/11/00 •
Plumbing Permit Application
..
. . .
Date received: Permit no f —al/VS .i.g —al/VS }� A-I City of Tigard and
`J Sewer permit no:: Building permit no.:
rt" 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
14.1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction. ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
• Job address: LOL-11 ) LAIN Mirkwo pit- Description Qty. Fee (ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: 4 2.- IBlock: I Subdivision: SFR (2) bath
Project name: ta*M.! /41 SFR (3) bath
City /county: 4 j,r) Z IP: 11 2.2-5 _ Each additional bath/kitchen
Description and location of work on premises: Site utilities:
CO .VLT 4( W4 LSE- pt4 la. t'fll►N1 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: colifT moilLw Manholes
Address: 11Sto ) 141149v5 Rain drain connector • '
City: . I State: ..I ZIP: On Sanitary sewer (no. lin. ft.)
Phone: ZAI Fax: I E -mail: Storm sewer (no. lin. ft.)
. CCB no.: 1•O[ t#4't, I Plumb. bus. reg. no: '2 t4€ -mtp pg, Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: _.L . 1 Date: 1 ' 29 es, 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): Q,Pk1����7A�1V(,t. Floor drains /floor sinks/hub
Mailing address: G1 Z ' j� f W((..L, T( Garbage disposal -
t l rise bibb
City: W jr L,, O I State: ZIP: Air, Ice maker
Phone: 45 I 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 prop I own as per ORS Chapter 447. _ Sink(s), basin(s), lays(s)
Owner's signature: Date: 'O _ ..,r DV Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: " Water heater
City: I State: 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 Plan review at _ %)
0 Visa ❑ MasterCard - _ _ _ _ expires if a permit - is not obtained review ( M
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:
v. ; _ . , ,Ne w' 1
":a
rond 2a- f'niiIy dcvelIiri g s'onI` ", :'' , r:`.`. :it :` ` � ° 'F
.. ���, ,.;,.. =��- r • sPRICEar:• T OTAL -'., •_ #� •• "y �.�,.9 Y� : i:' �.
FIXTURES (individual) ? QTY"_ . Z:7 . ___ . AMOUNT °r =(incl%des all plumbing fixtures�in , -' , PRICE TOTAL w
Sink 16.60 . the dwelling an d the frst100 ft * QTY (ea) '• ;AMO UNT •
16.60 ,for.eachiutility;connection) :.. . ,.> ". :, `
Lavatory One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath • $350.00
- Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL -- a ':. : _ ` , -,.
Urinal 16.60 8% STATE SURCHARGE f' , , ,... :. ,
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL >
Laundry Tray 16.60
Washing Machine 16.60
� t
Floor Drain /Floor Sink 2" 16.60 f •1 , '; ,' ••• t • `.t^ A ..
3" 16.60 PLEASE COMPL
4" 16.60
' ; Quantity` by <Wo "r1i Ferfortne8;= .
Water Heater 0 conversion 0 like kind 16.60 rFix4ure T pe R- Nevin :1-M. ed{ '°Replac ed ; _ Removed%'
Gas piping requires a separate mechanical ; u y , - - t e,r _ - _ a 4 4 ; . d
p ermit. tr..-1- . _....,. :. .s _ . ' . = --',..t.-..t : :
MFG Home New Water Service 46.40 Sink •
MFG Home New San/Storm Sewer 46.40 . . Lavato
. . Tub or-11: /Shower' • t ' . ..r .1 ,i,..1
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 _ Water Closet
Urinal . " - .,:ti .
Other Fixtures (Specify) 16.60 ;
Dishwasher •., . , , .
. •„ , Garbage Disposal '' " • ' _ , ' `
' - Laundry Room Tray
• Washing Machine
'FloBt , Drain /Sink: 2"
Sewer- 1st 100' 55.00 . ` 3" -
Sewer - each additional 100' 46.40 4" •
Water Service - 1st 100' 55.00 -Water Heater '
• ,' Other Fixtures •
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device" 27.55 .
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections , per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25 ..'1'---- ,$ ,' •° ' - , •r
Grease Traps 16.60 - :5', Y • • ;, t .. '' •
QUANTITY TOTAL n`::"w` -: :, ,`;' ,. _ • •^. - 1' .. ', , ''N •
Isome or riser diagram is required if ; �,_ . ' :. : _ „- , I
Quantity Total is 9' E"
*SUBTOTAL , " b� : ,. °': "A''r{ "
8% STATE SURCHARGE ,• "'' t'°s.1 - :: '
**PLAN REVIEW 25% OF SUBTOTAL 'C``. =..;�"
Required only if fixture qty. total is.> 9 - ,: - " �
TOTAL ; , r ,_ -0,: $
* 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 plans with isometric or riser diagram and
plan review.
•
is \dsts \forms \plm- fees.doc 10/10/00 .
•
Electrical Permit Application .
Date received: Permit no.:/ ,WIT/61 -ord 14.
/4 %
� �) • '
, j, �.I 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:
TYPE OF PERMIT .
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement .
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: IVfr? 1 .54,0 L t hy/ s Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 4'L Block: Subdivision: E0-IG114 I
•
Project name: I Description and location of work on premises: •
Estimated date of completion/inspection: 4 0
CONTRACTOR APPLICATION , FEE SCHEDULE . •
Job no: ,
• Fee Max
Business name: ato r. � �j,�/f1�1 Description Qty. (ea.) Total no. insp
��."rr "' 1 • New residential - single or multi-family per •
Address: pc £pX )42in dwelling mit. Includes attached garage.
City : K, �j State ZIP: len4 Service included:
' , 1-IIl 1000 sq. ft. or less 4
Phone: 441 —� 1 4 1.-I Fax
E Each additional 500 sq. ft. or portion thereof
. CCB no.: d .044 I Elec. bus. lie. no: 401 tt>
Limited energy, residential ' 2
City /metro lie. 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,
alteration or relocation:
• - - - -. , -. -- ., PROPERT OWNER - -- -• - 200 amps or less 2
Name (print): R ��j1"�fcj� 201 amps to 400 amps • 2
g t 4 L WILL/0.1 � . D r 401 amps to 1000 amps 2
Mailing address '� Da 601 amps to 1000 amps 2
City: l / ' , f L10, I State: ZIP: 41 MA Over 1000 amps or volts 2
Phone: 1 5, i . 6 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:
200 amps or less 2
ORS 447, 455, 479 01.
1'
201 amps to 400 amps 2
Owner's signature: Date: P 401 to 600 amps. 2
. • 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 ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 . ❑ Hazardous location Each signor outline lighting • 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ 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/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: 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 (6/00 /COM)
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 1, 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 n , Burglar Alarm
Limited Energy $75.00
Each Manuf'd 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 am am s to 400 s $106.85 2 .,: •� V * • , • F.;•� r•>
P P + w I* d rvf+ (' <1''2,1,,
401 amps to 600 amps $160.60 ,;•2rt .�, i ., • •' + , L . R
601 amps to 1000 amps $240.60 2 K '" '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
200 amps or less $66.85 . 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 - 260).1 *''' .. °r 'i. ,'••
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, ,. „ Qt Type of Work Involved: "• •' ' ' ' s
see "b" above. • . - ' .. ,; ,
I Audio and Stereo Systems s ;, t, , a•,: „
Branch Circuits +�
New, alteration or extension'per panel `n fi
a) The fee for branch circuits ° Boiler Controls
with purchase of service or
feeder fee. n Clock Systems
• Each branch circuit $6.65 2
b) The fee for branch circuits n Data Telecommunication Installation
without purchase of service ,•
•
or feeder fee. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ,„ -•, , .,) ., -..) Al ` „
', , ' • t.4 n r -.•HUAC , , • • a), t *”
Miscellaneous '' + ., ' ' : °� . :1_ :' °r• ` t. . � ., "•_ " • V
r�
(Service or feeder not included) } • -, Instrumentation .4 ' ""'‘.....,' :. •
Each pump or irrigation circle $53.40 . • : t , ; , ;•
•: ,:
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
Minor Labels (10) $125.00 n Landscape Irrigation Control * .
Each additional inspection over r,.•y '`` ❑ '
the allowable in any of the above Medical
Per inspection $62.50 n •
Per hour $62.50 Nurse Calls
In Plant $73.75
pi Outdoor Landscape Lighting
Fees:
Ti Protective Signaling
Enter total of above fees $
Other
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
Total Balance Due $
is \dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS, OR 97015 -1429
- Electrica! Signature Form •
Permit #: MST2000 -00485
Date Issued: 11/21/00
Parcel: 2S110DA -08100
Site Address: 10677 SW LADY MARION DR
Subdivision: ERICKSON HEIGHTS
Block: Lot: 042
Jurisdiction:•-TIG
Zoning: R - 3.5
Remarks: Construction of new single family detached residence, 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:
•
RENAISSANCE CUSTOM HOMES INC GAGE ENTERPRISES INC
1672 SW WILLAMETTE FALLS DRIVE PO BOX 1429
WEST I INN, OR. _9 CI_ACKANIAS, OR 97015 -1429
Phone #: 503 - 557 -8000 Phone #: 503 - 657 -0142
Reg #: sUP 618s
LIC 34544
ELE 3 -128C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising Electrician
If -you- have -any questions, please call (503)- 639 - 4171,- ext. -# -31-0
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CRAFTWORK PLUMBING INC
7736 SW NIMBUS AVE
BEAVERTON, OR 97008
Plumbing Signature Form
Permit #: MST2000 -00485
Date Issued: 11/21/00
Parcel: 2S110DA- 08100
Site Address: 10677 SW LADY MARION DR
Subdivision: ERICKSON HEIGHTS
Block: Lot: 042
Jurisdiction: TIG
Zoning: R - 3.5
Remarks: Construction of new single family detached residence, Path 1.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your._company sig'n 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:
RENAISSANCE CUSTOM HOMES INC CRAFTWORK PLUMBING INC
1672 SW WILLAMETTE FALLS DRIVE 7736 SW NIMBUS AVE
WEST LINN, OR 97068 BEAVERTON, OR 97008
Phone #: 503-557-8000 Phone #: 644 -8698
Reg #: LIC 79666
PLM 20 -148PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
•
•
Signature of Authorized Plumber' • '
If you have any - questions, - please -call- (503) -639- 41-7- 1 —ext# -310
CITY OF TIGARD BUILDING INSPECTION DIVISION .
MST " , 2 • 1 ' v ' c7 6 R
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
t 1 BUP
Qate- Requested `/' "/ 3 AM PM BLD
Location / 0 6 ' 7 ? 51-✓ L d 7 rn s y, w 1✓ Suite MEC
,Contact Person Ph 9 1 76 Z / PLM
Contractor Ph SWR
BUILDING, , Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall on
/ / D6L ' ��
Dwal Nailing �- !� � 6//c C� (�'
. . Fire l �
Sprinkler C/ 6- AT Q✓Z �� S I G� & s "gc-f �,
Fire S rinkler C
Fire Alarm rf
,1/0 7�
Susp'd Ceiling . O eg-� d 141 / 6 < t' T f 2 ,Vi
Roof /5&--206/4,7
Misc: v O O c/7 7
Final
PASS PART FAIL
Post & Beam —_
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS FAIL
Post
Rough In
Gas Line
lampe
Fina ��
PASS _ :_____ AIL
- ice
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
A i* PART FAIL
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
Approach /Sidewalk
Other Date Inspector 0 Ai Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. - •
CITY OF TIGARD BUILDING INSPECTION DIVISION -�
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /9 AM PM BLD
Location / o6 71 5• 6-4 Suite MEC
Contact Person Ph ,‘ ,9 3 - 2 PLM
Contractor Ph SWR
BUILDING. �: _. �`.. Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
F / -
b'� PART FAIL
PLUMBING a`
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post & Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service •
Rough In
UG /Slab
Low Voltage
. Fire Alarm
Final
PASS 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
Approach /Sidewalk
Other Date 9 / — / Q — e:,/ Inspector Ext
Final
PASS PART FAIL - DO NOT REMOVE this inspection record from the job site.
„CITY OF TIGARD BUILDING INSPECTION DIVISION ,:- � �5
24 -Hour inspection Line: 639 -4175 Business Line: 639 -4171
(7/-13-0 BUP
Date Requested 1 AM PM BLD
Location 1(9 �a 7 7 SZ(/ Zei ,a/ / As✓ Suite /� MEC
Contact Person / Ph 6g— 3 C) 2,i PLM
•
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Q ��
Foundation Access: /-64-s
[ 1� •� ' C FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam '
Ext Sheath /Shear
Int Sheath /Shear
Framing #;) C- i4 Pi o vea ) P — TLS R % v /1.>. Az c
Insulation - -
Drywall Nailing ' D C Q 4/ /O 2/
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING'
Post'& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PAS •A FAIL
= -am
Rough In
Gas Line -
Smoke Dampers
Fi
A PART FAIL
ELECTRICAL ";° ; ';
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
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
Approach /Sidewalk
Other Date / / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.