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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2002 -00200 �yI DEVELOPMENT SERVICES DATE ISSUED: 4/17/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09570 SW LEWIS LN PARCEL: 1S135CD -02900 SUBDIVISION: RUTH ZONING: R -4.5 BLOCK: LOT: 005 JURISDICTION: TIG REMARKS: Adding approximately 1322 square foot second story. BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 17 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,164 sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: VALUE: $ 63,000.00 OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 1,164.00 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 W00DSTOVES: 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: 1 201 • 400 amp: ' 201 • 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ ampNolt : 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 E. STEREO: VACUUM SYSTEM: AUDIO 8 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 /f SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,548.35 SON, JASON B /SUE D OWNER This permit is subject to the regulations contained in the DOT DOT O gard Municipal Code, State of OR. Specialty Codes and 9570 SW LEWIS LE E W D IS LANE 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 Res a: 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 `84 Plumb Top Out Exterior Sheathing Insr Electrical Final Footing Insp Electrical Service Low Voltage Mechanical Final Foundation Insp Electrical Rough In Gas Line Insp Plumb Final PLM /Underfloor Framing Insp Insulation Insp Final inspection Mechanical Insp Shear Wall Insp Rain drain Insp / ` Issued By : �.. , .a._ .41111r a_ Permittee Signatu : �" - ll Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application t " i City of Tigard i� E atereceived: 'f /9 O9 Permit no.: O _ _ Project/appl.no.: E date: - � is Ci n T i and Address: 13125 SW Hall Blvd, T i , VVVttxcc 97223 ry 1 8 Phone: (503) 639 -4171 . : ; -, : Date issued: ( Receipt no.: V Q � Fax: (503) 598 -1960 ����k i. ', tl- Case fileno.: Payment type: I Land use approval: C" ^ TC'1kar2 family: Simple Complex: ( ^ TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction Demolition y rAddition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION Job address: 4 " _ _ 'wi Bldg. no.: Suite no.: Lot: .5 Block: Subdivision: Off Tax map /tax lot/account no.: 16 -„, Project name: S, �T�ri� tf►0 Description . • location of wo k on premises/special conditions: '1�� A • �� ' 1 � — _ .- ... A ' OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: a qt i_ •• �_ ( Iloodplain ,septiccapacity,solar,etc.) 1 Mailing address: ' A� _ _ V rati I I CM �a I= 1 & 2 family dwelling: , �i �E�/I ZIP. Valuation of work $ `„ 00 Phone: , ,E w A Fax: -- its twl-r No. of bedrooms/baths .3 Z Owners representative: A arm_ ' �Jrn Total number of floors '‘..--- Phone: Fax: E -mail: New dwelling area (sq. ft.) /fit: Y APPLICANT Garage/carport area (sq. ft.) _ Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) City: State: ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: Commercial/industrial /multi- family: CONTRACTOR Valuation of work $ S . _ Existing bldg. area (sq. ft New bldg. area (sq. ft.) Address: Number of stories .. City: State: ZIP: Type of construction .. Phone: Fax: E -mail: CCB no.: Occupancy group(s): Existing: 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: provisions of ORS 701 and may be required to be licensed in the Address: Ah _rte 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 < / ,,;,�v Contact person: .4 . a 2, Fees due upon application $ Address: 7 6 ,fflre;MMTZMINIM Date received: i _ /1323Kai ZIP: 026 _ Amount received $ Phone:. — Af A f• 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 comp(' : • with, wheAi ed herein or not. Credit card number: Expires Authorized signs _ - % . bate:" — �' Name of cardholder as shown on credit card Print name: ( '9L/ ?'O ? 0 Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 180 da s after it has b n accepted complete. 440-4613 (rioo�oM) A 50 One - and Two - Family Dwelling .. q ..) Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O 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. K 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 ❑ plan Cl 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. design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if • there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. .7<, 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. X 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, vent 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. r � Full -size sheet addendums showing foundation elevations with cross references are acceptable. �L 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. - • tC JURISDICTIONAL SPECIFICS . , 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ./ 24 _Two (2) sets each are required for Items 16, 19, 20 & 22 above. • 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6/00//COM) .c MechanicalPermit Application IIIIMIIIIMIMIMIMIIM Date received: / p } , Permit no.: f -OOa C0 1r,A. City of igard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Phone: (503) 639 -4171 Date issued: By: I Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family r- Tenant improvement ❑ New construction %Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: '5',57b r `! Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: 1 Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: I I ?jt,'s(':b - , profit. Value $ . Lot: 3 'Block: Subdivision: 0 *See checklist for important application information and Project name: T) D (10,77C)1,e/ jurisdiction's fee schedule for residential permit fee. City /county: / 2c' `." ' IP: 9�o�o`Z 1 & 2 FAMILY DWELLING PERM!' FIT, SCHEDULE Descri do and 1 cation of work on premises: 7� �t c,,.� AND COMMIERICAL /INDUSTRIAL EQUIPMENT SCHEDULE 9 fr./ r /Y:r.!° SC 8") i-z ,/ e Fee(ea.) Total Est. date of completion/inspection: . I.,-31- Zj �Z Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? Yes ❑ No Air condi Air conditioning unit CFM ioning (site plan required) Is existing space insulated? OE es ❑ No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: ©1/U N e State boiler permit no.: HP Tons BTU /H Address: Fire/smoke dampers/duct smoke detectors City: I State: I ZIP: 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.: 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 Con ressors HP Address: Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone: Fax: E -mail: Dryer exhaust OWNER Hoods, Type I/ IUres. kitchen/hazmat hood fire suppression system Name: u e ' r ,'y) 1-3 , -) Exhaust fan with single duct (bath fans) Mailing . ddress: 47 7,.. ( .6 -, , , Exhaust system a , art from heating or AC ZIP: e pp i g an . .ltd , 1 on up to 4 out ets City: I s rn�� �i _ Type: LPG NG Oil Phone: , , illrm. Fax: . *!' Fuel piping each additional over 4 outlets ENGINEER Process piping (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: 601 Decorative fireplace City: 111 ' / I State: I ZIP: Insert-type Phone: Fax: E - mail: Woodstove/pellet stove Other: Applicant's signal I Date:4s(/ \ Oth Name (print): j,e.,�n Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $ expires if a permit is not obtained Plan review (at % Credit card number: / f ( %) $ 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 (6I00/COM) • MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT 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 induding 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see r Pump Cond fraction thereof. footnotes below. m Comp Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit to 100K BTU 14.00 8% State Surcharge $ 8) 3 -15 HP; absorb 25.60 unit 100k to 500k BTU 25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00 Required for ALL commercial permits only unit .5 1 mil BTU TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20 unit 1 -1.75 mil BTU 11) >50HP; absorb unit >1.75 mil BTU 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00 Value Total 13) Air handling unit 10,000 CFM+ Description: Qty (Ea) Amount 17.20 Furnace to 100,000 BTU, induding 955 14) Non - portable evaporate cooler ducts & vents 10.00 Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct ducts & vents 6.80 Floor furnace induding vent 955 16) Ventilation system not included in Suspended heater, wall heater or 955 appliance permit 10.00 floor mounted heater 17) Hood served by mechanical exhaust Vent not included in applicance 445 10.00 permit 18) Domestic incinerators Repair units 805 17.40 < 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator to 100k BTU 69.95 3-15 hp; absorb. unit, 1,700 20) Other units, including wood stoves 101 k to 500k BTU 10.00 15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets mil. BTU 5.40 30-50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) 1 -1.75 mil. BTU 1.00 >50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $ >1.75 mil. BTU Air handling unit to 10,000 cfm 656 8% State Surcharge $ Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ _ Vent fan connected to a single duct 446 Vent system not included in 656 appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: 1,170 1. Inspections outside of normal business hours (minimum charge - two hours) Domestic incinerator 1 $62.50 per hour. Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) Other unit, including wood stoves, 656 • $62.50 per hour inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum Gas piping 1 outlets 360 charge - one - half hour) $62.50 per hour Each additional outlet 63 *State Contractor Boller Certification required for units >200k BTU. TOTAL COMMERCIAL $ * "Residential A/C requires site plan showing placement of unit. VALUATION: All New Commercial Buildings require 2 sets of plans. I:\dsts\forms\mech- fees.doc 12/26/01 _ .� 4._ Electrical Permit Application il k Date received: q /A 09- Permit no.: }(w -(o ff -;.; l I! City of Tigard Project/appl. no.: • Expire date: City of Tigard Addre s: 13125 SW Hall Blvd, Tigard, OR 97223 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 f ►+ I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family enant improvement 0 New construction 1tddition/alteration/replacement • 0 Other: 0 Partial JOB SITE INFORMATION Job address:95 d L �,) ,, , Bldg. no.: Suite no.: Tax map /tax lot/account no.: r,6 j ' • 0 .- ' l Lot: Lj Ilock: Subdiv ion: (,j Project name: J & , •�i.s - Description and location of work on premises: i • L - : it _ m Ar • --; Estimated date of completion/inspection: ill. — — o 41■1j _ _ . • / • CONTRACTOR APPLICATION FEE SCHEDULE G Job no: d W AI t��Q Fee .Max Business name: Description Qty. (en.) Total no. insp New residential - single or multi- family per Address: dwelling unit Includes attached garage. City: I State: I ZIP: • Service included: Phone: I Fax: I E -mail: 1000 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, alteration or relocation: PROPERTY OIVNER 200 amps or less 2 201 amps to 400 amps 2 Name (print) _/ - �- �' 401 amps to 600 amps 2 Mailing ad ss: (,Jr' 7 II , .. • 601 amps to 1000 amps 2 City: ` State:e I ZIP: 97 ?3 Over 1000 amps or volts 2 • Phone: (p L j 79 4 1 Fax: I E -mail 1'1Sb iS onnect only Owner installation: The installation is being made on property I own Temporary services or feeders - which is not int nded for sale, le. - • it, or exchange according to Installation, alteration, orrelocation: ORS 447, 455, ' 79, 6 0, 71 200 amps or less 2 201 amps to 400 amps 2 Owner's signs .,.::� ; / f _ 1 m Date: A.A.. 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: [ State: I ZIP: B. Fee for branch circuits without purchase Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2 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 sign or 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/lighting plan ❑ Other Per inspection Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: I / 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 PERMIT FEES? -- TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: „ Restricted Energy Fee $75.00 `Number of Inspections per permit allowed (FOR ALL SYSTEMS) • Service included: • Items Cost Total `i' Check Type of Work Involved: Residential - per unit 1000 sq. ft or less $145.15 4 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or • portion thereof $33.40 1 . ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular . Garage Door Opener • Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation.and Air Conditioning System* Installation, alteration, or relocation 200 amps or less , $80.30 2 ❑ 201 amps.to 400 amps $106.85. 2 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. El 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 - ❑ Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits • _ without- purchase of service •❑ Fire Alarm Installation • or feeder fee. First branch circuit $46.85 . Each additional branch circuit $6.65 ❑ HVAC , • Miscellaneous - ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ 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 - . ,. p Medical • • the allowable in any of the above .. Per inspection $62.50 . - .. ❑ Nurse Calls Per hour • $62.50 - In Plant $73.75 ❑ Outdoor Landscape Lighting" . . Fees: . -❑ Protective Signaling Enter total of above fees . $ I I Other • - 8% State Surcharge $ Number of Systems 25% Plan Review Fee - See °Plan Review" section on $ * No licenses are required. Licenses are required for all other installations - front of application. • . , , Fees: Total Balance Due $ .. Enter total of above fees $ ❑ Trust Account # 8% State Surcharge '$ • T otal Balance Due $ All New Commercial Buildings•require 2 sets of plans. • i:'dsts'.forms\elc- fees.doc 08/30/01 • . - ' • Plumbing Permit Application 1` Date received: 4 / /.it 09- Permit no.: ��il -'j� a ( ,t City of Tigard ° "�� g 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: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction LAddition/alteration/replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCI IEDULE (for special information use checklist) Job address: 457 L6.D ,�/ 3 r Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: j 3 135 D- b. '6(..... SFR (1) bath , Lot: Block: Subdivision: r ��j9 SFR (2) bath ' Project name: e' ; f AO 41/ SFR (3) bath City/county: -4;4 ri ZIP: • _ Each additional bath/kitchen Description and I+ � lion f work on remt �! . �/ ��� G i Site utilities: iut bU 2° , ,l' ( / Av,,'j!i`/ Catch basin area drain Est. date of completion/inspection: b — — �� Drywells/leach line trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: C3,t/ -12— Manholes Address: Rain drain connector City: I State: I ZIP: Sanitary sewer (no. lin. ft.) Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Absorption Contractor's representative signature: Back flow flow valve Back preventer Print name: Date: Backwater valve • Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: . I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Floor drains/floor sinks/hub Name (print): (IF Garbage disposal Mailing add - ss: ! 5 7 LD / r Hose bibb City: / ` • (, — " I State:1 7a? Ice maker Phone: - , ' - jjL� Fax: E- mail:jaD1g ` ice•. nterceptor /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 th rope I ow r 0 S Chapter 447. � Sink(s), basin(s), lays(s) Owner's sign Date: Sump 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 aept credit cards, please call jurisdiction for mode information. Notice: This permit application Minimum fee $ oo 0 Visa 0 MasterCard expires if a %) $ p permit is not obtained Plan review (at 8% rchar te surcharge Credit card windier: / / within 180 days after it has been Sta g (8%) .... $ Ex TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6M00/COM) PLUMBING PERMIT FEES: F PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) , - .QTY ,, (ea) AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink '. • 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath • $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 ' PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixtur - Type: New Moved Replaced Remov permit. _ Ca ed MFG Home New Water Service 46.40 Sink a 1 MFG Home New San /Storm Sewer 46.40 Lavatory Tub or Tub /Sho er Hose Bibs 16.60 Combination 1 / Roof Drains 16.60 Shower Only .. Drinking Fountain 16.60 Water Closet _ Other Fixtures (Specify) 16.60 Urinal d Dishwasher f ` Garbage Disposal Laundry Room Tray / Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3" 4 Sewer - each additional 100' 46.40 4" / Water Service - 1st 100' 55.00 Water Heater 1 Water Service - each additional 200' 46.40 Other Fixtures (Specify) / Storm & Rain Drain - 1st 100' 55.00 /' Storm & Rain Drain - each additional 100' 46.40 !` Commercial Back Flow Prevention Device 46.40 �/ Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 / Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram Is required if Quantity Total is > 9 . *SUBTOTAL 8% STATE SURCHARGE "PLAN REVIEW 25% OF SUBTOTAL Required only If fixture qty. total is > 9 TOTAL $ * Minimum permit fee Is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25+ 8% state surcharge. ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. • iAdsts\fomts\plm- fees.doc 12/26/01 Permit #: ��) - OF O � , ct5�( 600 k €U I€ A 4; ) Address: Lt Issued by: dl �3/4 Date: 4 — r - o r , I g Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1 9, 1. I own, reside in, or will reside in the completed structure. ,E1) I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. LII 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR P i. 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Co tion Responsibilities on the reverse side of this form. (Signature of permit applicant) _ (Date) _ _ _ _ (White copy to issuing agency permit file, pink copy to applicant) Information Notice to Property Owners About Construction Responsibilities Note: This Information Notice to Property Owners about Construction Responsibilities was developer! by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your Own contraf :tor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registe_ed with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ol a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance ta3•: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For :no:e information, call the Oregon Employment Division at the Department of Human Resources at 378 -3524. Workers' compensation insurance! As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will he liable for all claim costs if one of your employees is injured on the job. For More information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1 -800 -829 -1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own.pm4 1 /94 CITY OF TIGARD 24 -Hour • • BUILDING Inspection Line: (503) 639 - 4175' MSTQpa O INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested /d J Z (° AM PM BUP Location 9c 7 U bee-L.-41—c Suite // MEC Contact Person ... 1, Ph ( ) 6 a `� `` — 7 '/9 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain v ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing i 1` 0 t - 1 -7 k\ X1 1 N t - b i3 b I Ni el 1- Ltslj q 1-, Insulation �� ' • • t t , IV �l. e0 3' •Lt►�o∎ hl G [ ln" \\c 06- c\ 14 / Drywall Nailing • Firewall 6. Fire Sprinkler Fire Alarm Susp'd Ceiling Roof` Other: Iiii.M. \ V 41\ W CRASS RT FAIL JCUMBINGJ Post & Beam Under Slab Rough -In _ _�� Water Service �....' Sanitary Sewer , Rain Drains Catch Basin / Manhole Storm Drain Shower. Pan Other: Final FAIL Pos & Beam Rough -In Gas Line Smoke Dampers Final l_t VI WQ Orn � 1 - 4)\I \ J scrZ FA N RT FAIL li CT -1 . L Service .......... Rough -In _—_ 7 11(( �!!���! - _ ) ) 1 ,` Low Volt I i , t b y N1( L R) ■ ) li 1_1)1 , A Low Vo s ��.� �� \- Fire Alarm lY 1 SS PART F IL E] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SIT ❑ Please call for reinlpect on RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date / v m Inspector / . Ext Other: Final DO NOT REMOVE this inspection record rom th job site. PASS PART FAIL