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Permit " CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00001 A 4 ' DEVELOPMENT SERVICES DATE ISSUED: 3/1/04 �` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 . SITE ADDRESS: 09670 SW PIHAS ST PARCEL: 1 S135CD -13300 SUBDIVISION: GREENBURG PINES ZONING: R - 4.5 BLOCK: LOT: 004 JURISDICTION: TIG REMARKS: New SF detached. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 21 FIRST: 803 sf BASEMENT: sf LEFT: 15 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,131 sf GARAGE: 450 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 191 29660 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,934 st REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 0 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 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: PUMP /IRRIGATION: PER INSPECTION: ' EA ADD'L 500SF: 3 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000v MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL . AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,225.40 This permit is subject to the regulations contained in the VISTA NORTHWEST INC VISTA NORTHWEST INC Tigard Municipal Code, State of OR. Specialty Codes and PO BOX 91459 PO BOX 91459 all other applicable laws. All work will be done in - PORTLAND, OR 97291 PORTLAND„ OR 97291 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: - - - Oregon law requires you to follow rules adopted by the - Phone: 503 - 531 - 0505 Phone: 503 - 531 - 0505 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 75507 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Gyp Board Insp Appr /Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final Issue By : _ _ ! _ ` •. Its P ermittee Signature : /, ; Call (50 639 -4175 by 7:00 p.m. for an inspection needed the next business day l � �f D FOR OFFICE USE ONLY Building Permit A� 11'' Received 1 / Building . Permit No.: ( • • '/ -LLvo/ ' JAN D 200 Date/B : I O /W `/' \ City of Tigard Pla nning Approva Other Date/B : Permit No.: a,.. ,■ // - "L /° 13125 SW Hall Blvd. WY QFTI c • " Plan Review Other Tigard, Oregon 97223 G DI Date/B : , ? -�/• Permit No.: p�� p / �+sa� dl N ,' Post - Review Land Use NCN Phone: 503 - 639 -4171 Fax: 503 -W-17 . � �1 it Date/B : C ase No. Internet: www.ci.tigard.or.us -a+ Contact Page 2 for 24 - hour Inspection Request: 503 639 - 4175 Name /Method: — Su lemental Information (� ^ TYPE OF WORK f REQUIRED DATA: ra • ew construction ❑ Demolition 1 & 2 FAMILY DWELLING • Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate ►' & 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 ❑ Master Builder ❑ Other: Valuation $ JOB SITE INFORMATION and LOCATION No. of bedrooms:_ j No. of baths ,S Job site address: 96 7,:. ,524./ P1 //4-,s' J Total number of floors `> New dwelling area (sq. ft.) f z Suite #: I Bldg. /Apt. #: Garage/carport area (sq. ft.) i Project Name: �T 4/ G .,Q, a , ,AP/ Covered porch area (sq. ft.) /.::::=k- Cross street/Directions to job site: Deck area (sq. ft.) 7 1 .• 12 Other structure area (sq. ft.) REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: � . ,i./ , ,, „, Lot #: 9 Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories PROPERTY OWNER . I ❑ TENANT Type of construction ame: fj- /y Tipii�_ ..01. r Occupancy group(s): New: Address: �3 � 9 City /State /Zip: ��i�,g -, f/z �J` 29/ Phone:,S3 O.S4.S Fax: y NOTICE: All contractors and subcontractors are required to be f' licensed with the Oregon Construction Contractors Board under ❑ rAPPLICANT 0 CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: 54 P #'7,g_. jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City /State /Zip: Phone: I Fax: BUILDING PERMIT FEES* E -mail: Please refer to fee schedule. CONTRACTOR ` Business Name: S��r Fees du e 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 Signature: / /t. "ate:.�s 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms\B1dgPermitApp.doc 01/03 ■ On - and Two-Family Dwellin °�� e a Y g in � Building Permit Application Chec"khst$AL Reference no.: Associated permits: City of Tigard City of Tigard", Ra -� �i t11�11811/1�1 �� ma 0 Electrical 0 Plumbing Cl Mechanical Address: 13125 SW Hall Blvd, Tigard, 97223 `O Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 TILE 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/ot. 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 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under revi . 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) Mechanical Permit Application FOR OFFICE USE ONLY Received Mechanical � Date/By: f a G Permit No.: � ' f \ Planning Approval Building City of Tigard _ � '' Date/By: Permit No.: 13125 SW Hall Blvd. ni Plan Review Other Tigard, Oregon 97223 JAN 0 v Llil Date/By;. Permit No.: Phone: 503 -639 -4171 Fax: 503 -59 - 6AB r !l Post Yieview Land Use $aip � Internet: www.ci.tigard.or.us CM e1' i I Date/By: Case No.: ® See Page 2 for 24 - hour Inspection Request: a P/P : '° "" " Name/Method: ' `� Supplemental Information. TYPE OF WORK . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST . S New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work U Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule DI Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 Job site address: 744 f y ,7 //ti/ , 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: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: ,Q,C5,t ffj,3 eJ,P �/Ai, of #: Repair units 12.15 Other Fuel Appliances Tax map /parcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 .• • Wood fireplace/insert 10.00 Chimney/liner /flue /vent 10.00 PROPERTY OWNER I 0 TENANT Other: 10.00 a me: �� Q � Environmental Exhaust & Ventilation 1V d Alit Range hood/other kitchen equipment 10.00 Address: /„ ,/ Clothes dryer exhaust 10.00 City /State /Zip: ,)-4,-,,,(2.724-_/,b 99.2w Single duct exhaust Phone: ,5 , j,i 2 - Fax: (bathrooms, toilet compartments, _ 0 APPLICANT ' ❑ CONTACT PERSON utility rooms) 6.80 Name: Attic/crawl space fans 10.00 Other: 10.00 Address: Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: Gas heat pump ** E -mail: Wall/suspended/unit heater ** CONTRACTOR Water heater ** Business Name: , 5'(4,/(3,/1 ,-/ - Fireplace ** Address: Z92 8 S- /4,:a5- Ran /State /Zi �' /y / Q 4.* * Ci ty p: TL�� / �+�(� Clothes dryer (gas) ** Phone: I Fax: Other: ** CCB Lic. #: Total: Authorized ' Mechan Permit Fees* uthorized / "� Date: Subtotal: $ Signature: i� - Minimum Permit Fee $72.50 $ Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit Is not obtained within *Fee methodology set by Tri- County Building Industry Service Board. 180 days after It has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit 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. Assumed Valuations Per Appliance: _ Value Total Description: Qty _ (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU • 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 'Sniffling "filxtures FOR OFFICE USE ONLY Plumbing Permit. Application Received Plumbing • Date/13 : / S 0 �.�/ Permit No.: I -) / - City of Ti and Planning Approv.1 Sewer g rn, 0 Date/By: Permit No.: 13125 SW Hall Blvd. SIN ©= Li Plan Review Other Tigard, Oregon 97223 �N® Date/By: Permit No.: Phone: 503- 639 -4171 0T c i � $y5v5 -5 � ;q n tm /�a�a 6 Post - Review iand Use . M,r� il ,, \ I + Internet: www.ci.tigaz ��R1 ` ,, I a_ Date/By: Contact • Case No.: Judi.. ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: -/ /a Supplemental Information. TYPE OF WORK. FEE* SCHEDULE (for special information use checklist) . ew construction ❑Demolition Description Qty Fee(ea.) I Total Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF C (includes 100 ft. for each utility connection) k 6z, 2- Family dwelling . ❑ Commercial/Industrial SFR (1) bath 249.20 SFR (2) bath 350.00 ❑Accessory Building ❑ Multi - Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE I. FORMATION and LOCATION Fire sprinkler - sq. ft.: - Page 2 - Job site address: 7? 4 4 1 f7jA ,517' Site Utilities Suite #: I 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: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision ja )61 / 49)6Xj9 Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) Page 2 DESCRIPTION OF WORK Fixture or Item Absorption valve 16.60 4 f fe n.. `r Backflow preventer Page 2 Backwater valve 16.60 . Clothes washer 16.60 Dishwasher 16.60 • OPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: / / / �� Expansion tank 16.60 Address: `" r 9>C5 Fixture/sewer cap 16.60 City /State /Zip: gJ Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: (5 Fax: Hose bib 16.60 0 APPLICANT [] CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Cit City/State/Zip: Primer 16.60 y P Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 CONTRACTOR Urinal 16.60 Water closet 16.60 Business Name: ✓ "/ t .�/ti Water heater 16.60 Address: - • - _ �5-� ` Other: City /State /Zip: - "" -=x Other: Phone: ._ -- , - Fax: Plumbing Permit Fees* CCB Lic. #/ . " Plumb. Lic. #: �SSf >. Subtotal $ Mi n i mum Permit Fee $72.50 $ Authorized - ! / / / Residential Backflow Minimum Fee $36.25 Signature: / /�i�:- Date: ,3 Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ (Please print name) _ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within AB new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri- County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 55.00 0 to 2)00- $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 Valuation: 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 Fixture or Item Qty. Fee (ea) Total 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for 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 *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing 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 *Note: 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: i:\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03 I FOR OFFICE USE ONLY Electrical Permit Application FOR • Date/By: r, / D r \ Permit No.: I i . • s D000 City of Tigard - J Planning Approval Sign 1, �� Date/By: Permit No.: 13125 SW Hall Blvd. �'L`.� Plan Review Other Tigard, Oregon 97223 0 rt0 Date/By: Permit No.: - Ajta Phone: 503 -639 -4171 Fax: 50 , t -�6© //,„ul���o> Post- Review Land Use I \ Date/By: Case No.: Internet: www.ci.tigard.or.us L w�/ TiG 1 1 r l Z Contact Ju s. ® See Page 2 for 24 -hour Inspection Request: 5001M0 D � v, - . Name/Method: '/ /CQ Supplemental Information. TYPE OF WORK PLAN REVIEW (Please check all that apply) New construction 0 Demolition 0 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, CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in t 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure Building Multi-Family ❑ Building over three stories ❑ Feeders, 400 amps or more Accessory g ❑ y ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: 9a6 7,9 P1 s, .S T FEE* SCHEDULE Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total 1 Cross street/Directions to job site: New residential-single giI attached multi-family c ed gar per dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision :SA " ® 4 6 , ,e Lot #: 9 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 Services or feeders - installation, alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 "- , 401 amps to 600 amps 160.60 2 .. .. _ RQ`P. OWNER 'P ❑TENANT 601 amps to 1000 amps 240.60 2 c � J fib N' Over 1000 amps or volts 454.65 2 aI lle: U Reconnect only 66.85 2 Address: (� ®ems Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: /?I O, . '' p 7 '' 200 amps or less 66.85 -•s �L , ` , � Fax: F 201 amps to 400 amps 100.30 2 Phone: „s ; 1m; �f i x 401 to 600 amps 133.75 2 ❑ +APPLTCANT . ❑ CONTACT PERSON Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: 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: I Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): "'' CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: (,Z7 _.- Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name s ,. lr° Description: Address: 20gi tS[- / pii7i9-il .l / I Each additional inspection over the allowable in any of the above: City /State /Zip: /LLS 3 e ems � / �_3 Per inspection per hour (min. 1 hour) 62.50 Phone: 4Z Fax: Investigation fee: CCB Lic. #: i /0,3. i Lic. #: 3� Other: . Electrical Permit Fees *- ,-; _ - Supervising electrician/ Subtotal $ signature required: i / --lit.: I Plan Review (25% of Permit Fee) $ Print NameS7 / , m$5' Lic. #: /7., 7 State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set.by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\ElcPetmitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Burglar Alarm ❑ Garage Door Opener ❑ Heating, Ventilation and Air Conditioning System 9 Vacuum Systems O Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls 0 Clock Systems 0 Data Telecommunication Installation Ei Fire Alarm Installation ▪ HVAC Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control 0 Medical O Nurse Calls 9 Outdoor Landscape Lighting ▪ Protective Signaling F7 Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 LAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Nil V ® STREET TREE C ... A Is ® 7, A ® I, , l) �,. /' �5� / , ,o w ner /P gent for /%, 4 /c�PT 1S� (PLEASE PRINT) t„ (PERMIT HOLDER) J t. ® '� �' QED ► ® RECEIVE 1 7._ �' " 1 ��', 200 � , y'�-r / \ :, K 0 i 4 ® Do hereby - certify that = �e ' folloing location D w , TY I v j dot 1 ® meets tr ofj / Wa s h n co ® land use and development standards for street tree installation. A ADDRESS: x(70 ,S �� / ) / ,445 ® ® LOT: SUBDIVISION: �,�_ ..0 `141S i ® �^ ® BY: /LI DATE: /�� /� 1 • RECEIVE BY: _ i DATE: ,/ 0 CITY OF TIGARD 24 -Hour • BUILDING Inspection Line: (503) 639 -4175 MST °?°63 D • INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received . Date Requested /° --/ S AM PM BUP Location ! 6, - U / Suite MEC Contact Person Ph ( ) . PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain / 2 � [,��C� 6 ELR Crawl Drain (� / Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation / /7 Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PA FAIL UMBIN) Pos am Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Air ,- PART FAIL •IfiMATY.. AL Post & Beam Rough -In Gas Line Smoke Dampers in 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 reinspection RE: Unable to inspect — no access Fire Supply Line ADA 19-1 A roach/Sidewalk Date (J Inspector Ext PP Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: ( 3) 639 -4175 MST 'PO y 66 INSPECTION DIVISION Business Line: 03) 639 -4171 BUP Received Date Requested / — AM PM BUP Location ( 7v f.-r Suite MEC Contact Person 0,4 1 Ph ( ) a7 0 —' - 3 � PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear /O � )11m/ .0 It D v ff Framing — Insulation -Z:SS U CE, \ P 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 ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. /kW PART FAIL SITE Please call for reinspection RE: Unable to inspect – no access Fire Supply Line j ADA Fire Supply Date f� g Inspector Ext Other: Final DO NOT REMOVE this inspection record fro the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDINd Inspection Line: (503) 639 -4175 MST o y - DOO INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Re AM PM BUP Location Suite MEC Contact Person Ph ( ) ' 7 0 - (aa3 / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: C/� /1 `! - Ftg Drain (J 1( ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear ,, /�r� • L Framing (ate �-L �r�`?4vc J�/d/LiG H9�- ci�krcA -c. Insulation .� r a .0 r � r X (#,JA . Drywall Nailing C �' d•A(� Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: 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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 1/— tj — d Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL