Permit CITY O F TIGARD MASTER PERMIT
PERMIT #: MST2001 -00101
:VI DEVELOPMENT SERVICES DATE ISSUED: 3/27/01
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15277 SW REGENT TERR PARCEL: 2S111 DA -10700
SUBDIVISION: • APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT: 100 JURISDICTION: TIG
REMARKS: S/F Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 18 FIRST: 1,198 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 668 sf GARAGE: 440 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 5 '
VALUE: $ 171,024.00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 1,866.00 at REAR: 17
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: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
• OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 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 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: 3 201 - 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: 00 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 • 800 amp: EA ADDL 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 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 3,790.80 •
This permit is subject to the regulations contained in the
LEGEND HOMES LEGEND HOMES CORP Tigard Municipal Code, State of OR. Specialty Codes and
12755 SW 69TH AVE #100 12755 SW 69TH AVE #100 all other applicable laws. All work will be done in
TIGARD, OR 97224 TIGARD, OR 97223 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 60563 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 & Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insr Rain drain Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line lnsp Final inspection
Foundation Insp Footing /Foundation Dn Electrical Rough In Gas Line Insp Appr /Sdwlk lnsp Building Final
Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final
T . #00e7 /
Issued By : 1 Permittee Signatu • _�iri -
Call (50 ) 639 -4175 by 7:00 p•m• for an inspection needed the next b ' siness day
_,
i
' 671 LLZ5I o -ea o d
Building (70 i ce- eceived: Per►
�:�.. ^,� �.1' City of Tip
3h /n( l -ao(ol
c • l�.' ' ct/appl. no.: Expire date:
Address: 13125 SW Hall Blvd Tigard, utc yILL.)
CiryojTigard
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 59 8-1960 Case file no.: Payment type: /
Land use approval: l&2 family: Simple Complex: l
TYPE OF PERMIT
VI & 2 family dwelling or accessory 0 Commercial/mdustrial 0 Multi -family 17New construction . 0 Demolition
0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkledalarm 0 Other.
JOB SITE INFORMATION
Job address: (S' 11 ,0•-3 - p-'-.sr `T Bldg. no.: Suite no.:
Lot 00 Block: Subdivision: 4 - iDO P •-, Tax map/tax lot/account no.:
Project name: .
Description and location of work on premises/special conditions: / _ —� d t Z 9 ,� 3 1, 3
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST '
�"
(Floodplain, septic capacity, solar, etc.)
Mailing ad. : _ d --- ,•5 --- _ 1 & 2 family dwelling: �
State:0 / ZIP: f7„,_ G Valuation of work /1/ O 2 C { $ -,
Phone: •l�,ZW -.'off a j Q3 E -mail: No. of bedtooms/baths 3
Owner's representative: Pee, colOt.E3P.1 Total number of floors
Phone: 02C 50 "ax: S` t o E -mail . New dwelling area (sq. ft.) taco
APPLICANT Garagelcarport area (sq. ft.)
Covered porch area (sq. ft.)
Name: . �. 0 v . Deck area (sq. ft.) .
ESNIMVAIIMINIINI statep ' L I' �j- NI Other structure area (sq. ft.)
Phone: , CJ o� °� j r E - mail: Commercial/Industrial/multi
CONTRACTOR Valuation of work $
Business name: Z O. - ��tj e25' Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: ),Z, 7 '
•
City: o' air Stated ' ZIP: 9 7a.2. The of construction
Phone- . D i Pill 7 ,77,2 E-mail: .
CCB no.: r to O —6, Occupancy group(s): • Wig:
New:
City/metro lic. no.: 7 _ Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
•
Name: ...At, ' O 1 Jr provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City. d & o , StateCo Zlp• 97_ exempt from licensing, the following reason applies:
Contact person: & . : )1 Plan no.:
Phone:4,20 'i a • M= E-mail:
ENGLNEER
MWZEIMMMIIIMINII Contact person: Fees due upon application $. '
• , , . r _ Date received:
• City: ai ZIP: % 7 ,73 Amount received $
Phone: — p,• Fax: E-mail: • Please refer to fee schedule.
I hereby certify I have read and examined this application and the • Not all jmisdrcdom eooept audit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this O visa t] MasterCard
work will be complied. with, whether s • 'fled he • . or not. , Cm& Card number Expires
Authorized t • - ,gi /- i ,_., %..Ii li . : 0 I Name of cardholder as shown on credit card
Print name P a Cardholder Cardholder S
/ Cardholder signature Amount
Notice: This permit applicati6n expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00!COM)
Plumbing Permit Application
Cit of Tigard Datereceived: Permit np9ijy'7 �
vt ,e f
:y 1 .' � is
!,� I � Address: 13125 SW Hall Blvd, Tigard, OR 97223 Sewer permit no.. Building permit no.:
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
1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
01Gew construction 0 Addition/alteration/replacement : 0 Food service 0 Other:
• JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: I S7-1"7 SuJ IZC 't Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. foreadt utility connection)
• • Tax map/tax lot/account no.: SFR (1) bath
• Lot: (o t2 IBlocic I Subdivision: SFR (2) bath • Project name: i....e ij W > f /Le- . 1 SFR (3) bath
eitYienuntYrir grand I ZIP: $7 Each Each additional bath/ldtchen
Description and lobationof work on premises: SiteutWties:.
Catch basin/area drain
Est. date of completion/inspection: DrywelLs/leach line/trench drain •
PLUMBING CONTRACTOR Footing drain (n °' lin. ft.)
Manufactured home utilities
Business name: %t)ol Coo Plum.: zx Manholes
Address: pa B k Q DO 7 Rain drain connector
Ci a /QSA I State:OA I ZIP: 9 70 Sanitary sewer (no. lin. ft.)
. Phone: 06 7-/7,/ I Fax: GE. 7 -9fl/ I E-mail: Storm sewer (no. lin. ft.) .
CCB no.: n 1,, 3?97 I Plumb. bus. reg. no: 0?626pie Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
. Contractor's representative signature: p ✓�lt -- a Absorption valve
y � Back flow preventer
/ /
Print name: a - d o/I Date: V( 01 Backwater valve
CONTACT PERSON Basins/lavatory
Name: 6 /or t- Clothes washer
Address: po B d i- 7 ► r
• Z IP: Drinking fountain(s)
City: . ,.1 S tateO. '
/1 •7D.3ZJ Ejectors/sump
Phone: , - ; - Fax: E-mail: Ex . • on tank -
OWNER Fix . sewer cap
Name (print): Z . p a #0,46,5 Floor drains /floor sinks/hub
Mailing address: / 7 d? li
3.d P� ' Garbage disposal
Hose bibb
City: �or f- d d7 State: a & I ZIP: 97� Ice maker
Phone: G„0 o je I Fax: d J - 'r?9# I E-mail: Interceptor/grease trap
Owner installation/residential maintenance only The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) .
employee on the property I own per ORS 447. Sink(s), basin(s), lays(s) /,/ •
Owner's signature: F D '0 Sum
Tubs/shower/shower pan
Urinal
Name: ,.. ,A ' Water
Address: G 9Gje) if07� 44 Water c heater
City: "9/"9/ ' A1./,/ . I State; I �:9 Other:.
Phone: 4 4 -[Fax: I E-mail: Total
•
' Nat an Ju iodctioo, credit cards, please Cell Jmiad rot Mill' lofor Minimum fee $
leapt Notice: This permit application
O Visa O MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card camber: -- within 180 days after it has been State surcharge (8%) .... $
Expires
accepted as com lete. TOTAL $
Name of cardholder as shown on credit card P P
$
Cardholder dgaatme Amount 440-4616 (6IOOICOM)
PLEASE COMPLETE:
FIXTURES • (Individual) , $Qtly r,�w Iced' ; Total
Fixture Type Quantity by Work Performed
Sink 16.60 New Moved Replaced Removed/Cappa
• lavatory 16.60 Sink
Lavatory
Tub or Tub/Shower Comb. 16.60 Tub or Tub/Shower Combination
Shower Only • 16.60 Shower Only
Water Closet . .16.60 Water Closet
Urinal
Urinal 16.60 Dishwasher
Dishwasher 16.60 Garbage Disposal
Laundry Room Tray
Garbage D 16.60 _Washing Machine
Laundry Tray 16.60 Floor Drain/Floor Sink 2"
3
Washing Machine 16.60 _ 4 .
Floor Drain/Floor Sink 2" • - 16.60 Water Heater
3' 16.60 Other Fixtures (Specify)
•
4' 16.60 •
Water Heater 0 conversion 0 like kind • 16.60
Gas piping requires a separate mechanical permit.
MFG Home New Water Service , 46.40
•
MFG Home New San/Storm Sewer • 46.40 .
• COMMENTS REGARDING ABOVE
Hose Bliss 16.60
Roof Drains 16.60 •
Drinking Fountain • 16.60 •
•
Other Fixtures (Specify) • 21.75 •
Sewer - 1st 100' • 55.00
Sewer -each additional 100' • 46.40 a■"`..""i.`° -
Water Service -1st 100' • 55.00 •
Water Service - each additional 200' • 46.40
•
Storm & Rain Drain -1st 100' 55.00 •
Storm & Rain Drain - each additional 100' 46.40
•
Commercial Back Flow Prevention Device • 46.40 •
Residential Baddlow Prevention Device' 27.55
Catch Basin 16.60
Insp. of Existing Plumbing or Specially Requested 72.50 •
Inspections per/hr •
Rain Drain, single family dwelling • • 65.25
Grease Traps • 16.60
QUANTITY TOTAL •
Isometric or dser diagram b required 8 Ouarddy Total b > 9 `:;'` ;7< f:• "!
'SUBTOTAL : : <:i .... •
r
8% SURCHARGE ' t'tg`
"PLAN REVIEW 25% OF SUBTOTAL -;:.
Required only ff fodure qty. total is > 8 ;,• ..
TOTAL
•
*Minimum permit fee it $72.50.8% surcharge, except Residential Beddow Prevention
Device. rMidh b $38.25 • 8% surcharge. •
"A8 New Commercial Buildings require plans wdh Isometric or riser diagram and plan review.
•
•
•
Electrical Permit Application
Date received: Permit n'o /1 73.0 - d
5. 7.11! City of Tigard Project/appi.no.: Expire date:
City ogard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMII'
1 & 2 family dwelling or accessory 0 Commercial/industrial CI Multi - family . 0 Tenant improvement
New construction O Addition/alteration /replacement . CI Other. 0 Partial
JOB SITE INFORMATION
Job address: IS "j 56 jZr(, fL Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot I CV I Block Subdivision: .44PPL" JX> P Z 14 '
Project name: I Description and location of work on premises: -
Estimated date of completion/inspection:
—
CONTRACTOR APPLICATION FEE SCHEDULE '
Job no: Fee Max
Business name: (� oi/loi t/ eeh. F r:
Description Qty. (ea) Total no. limp
p Newresidentlal-
Address: ,2! 7 6 jit,e q ri dwelling unit. Includes per
City:A /, ha- I Stated4' 1 2JP: 91106 Service
Phone• ? / j ) j Fax: o Z —7 f lj'h -mail: 1000 sq. ft. or less • 4
C :.1 o.: / i L.1 I Elec. bus. lic. no: ..T �� 500 ft. or portion thereof
2
• ty is;" AI • .1:r 3 7 i Limited energy, non- residential 2
. � ' I rifMI / /S' _ • 1 Each manufactured home or modular dwelling
1. - .' supervis ,7 el - -. 'clan (required) D :. Service and/or feeder 2
Sa Sup. name Services or feeders— hmtallation,
P (print): i �C S I , A t .,c License no :370 S
alteration or relocatiem
PROPERTY OWNER 200 amps or less 2
Name (print): 4 6 , 9 �x Be rl s S 201 amps to 400 amps 2
Mailing address: 7 743 S" J1 w L9 i¢ 401 amps to 00 amps 2
ti0l amps to 1 1000 amps 2
City: "P�,� G n I States,./ I 9"12.2
UP: Ova 1000 amps or volts 2
Phone: 602P jai I Fax:s P9.01. I E-mail: Reconnect only 1
Owner installation: T h e installation is being made on property I own Te rry services or feeders - .
which is not intended f o r sale, lease, rent, or exchange according t o Installation, alteration, errelocation:
ORS 447, 455, 479, / 670, 701. 200 amps or less 2
Owner's signature: V a A 0 2 201 am to 400 am 2
401 to 600 2
Branch drenits - new, alteration,
or extension per panel:
Name: r /CA 6/17, - A. Fee for branch circuits with purchase of
Address: G74 9e) # . I0 �/, p service or feeder fee, each branch circuit 2
C11y;�' /qf
' mo ' IS�P,t IX0/7) B. Fee for branch circuits without purchase fa
• Phone: • � ' . m Fax: E - mail: of service or feeder fee, first branch circuit 2 .
Pack additional branch circuit
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service ova 225 amps - commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 18E2 0 Hazardous location Each signor outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuits) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension 2
O Building over three stories O Feeders, 400 amps or mom oDesaiption:
O Occupant load over 99 persons 0 Manufactured structures or RV park
Faeh additional hrspedlon over the allowable In any of the ahoy:
O Egress/lighting plan 0 Other. Painapecdon i I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Nat an Jurisdictions accept credit cards, please call Jurisdiction for mote information. Notice: This permit application Permit fee $
O Visa O 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%) .... $
Fsphes accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$ •
Cardholder signature Amount 440 -4615 (6/00/COM)
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
4. Complete Fee Schedule Below: .
Number of Inspections per permit allowed Restricted Energy Fee». »....... ».... » ............. » »». '$75.00
Service included: Items Cost Total 4' (FOR ALL SYSTEMS)
4a. Residential - per unit Check Type of Work Involved:
1000 sq. ft. or Less $147.15 4
Each additional 500 sq. ft. or ❑ Audio and Stereo Systems
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular .
Dwelling Service or Feeder $90.90 2
❑ Garage Door Opener'
4b. Services or Feeders
Installation, alteration, or relocation ❑ Heating, Ventilation and Air Conditioning System'
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 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
•
4c. Temporary Services or Feeders '
Installation, alteration, or relocation Fee for each system»...... »... »........ ».......».». ». » ,,, $75.00
200 amps or less 566.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 . Check Type of Work Involved:
Over 600 amps to 1000 volts, •
see "b" above. ❑ Audio and Stereo Systems
4d. 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 ❑
b) The fee for branch circuits Data Telecommunication Installation •
without purchase of service ❑
or feeder fee. - • Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
•
4e. Miscellaneous
(Service or feeder not included) ❑ Instrumentation •
•
Each pump or Irrigation circle $53.40
Each sign or outline lighting • $53.40 ❑ Intercom and Paging Systems
Signal circuits) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels (10) $125.00 .
•
4f. Each additional inspection over • ❑ Medical
the allowable In any of the above
Per inspection $62.50 0 Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting* .
5. Fees: • _ ❑ Protective Signaling
•
5a. Enter total of above fees $
8% Surcharge (.08 X total fees) $ ❑ other •
Subtotal $
5b. Enter 25% of One 5a for Number of Systems
Plan Review If required (Sec. 3) $
Subtotal $ • • No licenses are required. Licenses are required for all other 8utallations
I Trust Account t FEES: .
•
! Total balance Due $ , - ENTER FEES $
8% SURCHARGE (.08 X TOTAL ABOVE) $
TOTAL $
•
- • A Mechanical Permit Application
Date received: Permit n 5l!- ( 01
;4..1'1_ City of Tigard Project/appl. no.: Expire date:
City Address: 13125 SW Hall Blvd Tigard, OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no Payment type:
Land use approval: Buildingpenvitno .
TYPE OF PERMIT
f 8c 2 family dwelling or accessory O Commercial/mdustrial 0 Multi - family 0 Tenant improvement
ew construction 0 Addition/alteration/replacement . •O Other.
.10B SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
. Job address: 'l 0 ' If is G " ' Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit Value $ •
Lot WI_ 'Block: I Subdivision ;,A�� Q ,/A . *See checklist for important application information and
Project tee: / / I ° jurisdiction's fee schedule for residential permit fee.
City /county: �-- ,, ,aiiii ZIP - t & 2 FAI1ILY DWELLING PERMIT FEE SCHEDULE
Description and 1. on of work on premises: - ND COMM ERICALIINDUSTRIALEQUIPMENTSCHEDULE
Fee(ea.) Total
Est date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvem Air
e • r change of use: Air handling A handling unit CFM •
Is exis' . _ space heated or conditioned? Cl Yes 0 No Air conditioning (site plan required)
Is e • . g space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler/compressors
.�d „ State boiler permit no.:
Business name:
tett) HP Tons BTU/H
Address: ,.,?y.2A Q /04.1 �lrelsmoke dampers/duct smoke detectors
City: O Stat V - ZIP: 97,72 , Heat pump (site plan required)
rep ace i"�' -7 • urner : S +
Phone: , - 7 Fax :, -703 E Including ductwork /vent liner Cl Yes Cl No
CCB no.: tkr / 3 Install/replace/relocate heaters -suspended,
City/metro lic. no.: d. 74v. - wall, or floor mounted
Name (please print): i p /) Cr-, Vent fora fiance other than furnace
on:
CONTACT PERSON ChiAbsorption llers units BTU/H
Name: �p n r{, HP
C �, ressors HP
Address: �/d� J $ QTf r' ' S ■ amental exhaust and ventilation:
City: Poi L`�� o / l State:0k I ZIP. f 71,kl Appliance vent
Phone - 7 Faxo4,7 i3-' 7t 3 E - mail: Dryer exhaust
res. a azmat
hood fire suppression system
Name: f ,, pq ,p d D,q) 0 C Exhaust fan with single duct (bath fans)
• Mailing address: / J' _ - ' ft - -4 r/'' -- Exhaust system apart heating or AC
S t ated ZIP' 9 0 3 Fuel piping and distribution (up to 4 outlets)
City: Type: LPG NG Oil
Phone• , _ ,, - a o r� i e :: E-mail: Fuel • i . ing each additional over 4 outlets
Phone:
ENGINEER • , - piping (schematic required)
Number of outlets
•
. Name: r- /, G A Other listed appliance or equipment:
Address: ....4 1 Decorativefueplace
- City: . t - y G N ° State: ZIP - Insert - type
Phone: foa% 7.00,3 Fax: E -mail: Woodstove/pelletstove
'Miter:
Applicant's signature: , l/J. - -_ . a : : L 4 O ' —0—then
Name (print): ' ?eq "A„),,,, .1 - .
i Not as jurisdicdom / audit cards. . call Jluisdtadou far make torommdm Permit fee $
� Notice: This permit application M i n imum fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _. 96) $
cruder and number: ) within 180 days after it has been
Expires within surcharge (8%) .... $ •
Name of cardholder as shown on «edit and accepted as complete. TOTAL $
$
Cardholder signature Amount • 440-4617 (6100/CONE
•
Commercial Schedule
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPUANCE
Furnace to 100,000 BTU Table A
including ducts & vents • 955 1) Furnace to 100.000 BTU Price Total
hhdudmg duds & vents 14.00
Furnace > 100,000 BTU 2) Furnace 100.030 BTU. •
including ducts & vents - 1,170 ' 3) Floor Furnace
& vents 17.40
floor furnace vent 14.00
4) Suspended heater, wall heater
Including vent 955 or floor mounted heater 14.00
suspended heater, wall heater. 5) Vent not Included In appliance pertNt 6.80
or floor mounted heater 955 6) Repair ands 12.15
Vent not included in appliance permit 445 � � Heat err see Punta Coed Qly Price Total
Repair units 805 footnotes 1.2 Comp -
7) CHP; absorb unt to
• < 3 hp; absorb.unit • 100K BTU 14.00
8) 3-15 HP; absorb unit
' to 100k BTU . 955 10ok to 5008 BTU 25.fi0
3-15 hp; absorb.unit • 9) 15-33 HP; absorb •
101k to 500k BTU 1700 0) 30 550HP; absorb
unit 1 -1.75 mil BTU 5220
15-30 hp; absorb.unit 11) >501P; absorb unit >1.75 n l BTU
• 501k to 1 mil. BTU 2310 87.20
12) Alr handling unit to 10.000 CFM
•
30-50 hp; absorb.unit 10.00
1 -1.75 mil. BTU 3400 13) Atr handling unit 10.000 CFM.
17.20
> 50 hp; absorb.unit 14) Non - portable evaporate cooler .
10.00
> 1.75 mil. BTU 5725 15) Vent fan connected to a single dud
6.80
Air handling unit to 10,000 dm 656 • 16) Ventaation system not Included In •
appliance permit .
Air handling unit > 10,000 d n
m ' 1170 • 1 edranlcal exhaust 10'00
Non - portable evaporate caller 656 18) Domestic Indneralors 10.00 • vent fan connected to a single dud 446 - 17.40
Vent syst not included In appliance permit 656 19) Carrarherctal or Industrial two tndnerator
69.95
Hood served by mechanical exhaust 656 20) Other units. Including wood stoves
10.00
Domestic Indnerator 1170 21 ) Gas piping one to four outlets
Commercial or Industral Indnerator 4590 22) Mae t han 4�er ohNd (eadh) 5.40
wood stoves, Inserts, etc. 656 1
Other unit, including M Permit Fee $72.50 SUBTOTAL li Setgat
Gas piping 1-4 outlets 360 • 8% SURCHARGE Um NM
Each additional outlet • 63 • U
PLAN REVIEW 25% OF SUBTOTAL . - .-._
Repu for ALL eommerclal penults only ' :. ` : NNW
. TOTAL
•
'
Other tespadlons and Fees:
1. Inspections wise at normal business hours (minimum durge.two hours)
57250 per hour
• 2. Inspections for dddn no lee b spmmaNr Indicated (minimum charge-hall hall)
57250 per her
Total Valuation Fee - 3. Adrenal plan mime required W d ed snores. addalons or revisions b plans p iiam _
dnrpeonandhaa) 572.50 per Aar
•
"Slate CaWac or Baiter Cedfilo8on required
$1.00 to $5,000.00 Minimum $72.50 NC 1eardr s u s plan shouting p 1ac p of 1st •
•
• $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 $14850 for the first $10,000.00 and $1.54 ,
for each additional $100.00 or fraidion
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
$50,000.00 and up • , $742.00 for the first $50,000.00 and $1.20
. for each additional $100.00 or fraction
• thereof
•
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TUALATIN VLY HWY #C
ALOHA, OR 97006 -1249
•
•
Electrical Signature Form
Permit #: MST2001- 00101
Date Issued: 3/27/01
Parcel: 2S111 DA -10700
Site Address: 15277 SW REGENT TERR
Subdivision: APPLEWOOD PARK NO. '
Block: Lot: 100
Jurisdiction: TIG
Zoning:. R -7
Remarks: S/F 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:
LEGEND HOMES GARNER ELECTRIC
12755 SW 69TH AVE #100 21785 SW TUALATIN VLY HWY #C
TIGARD, OR 97224 ALOHA, OR 97006 -1249
Phone #: Phone #: 503 - 648 -4552
Reg #: LAC 121159
SUP 3707S
ELE 34 -305C •
AN INK SIGNATURE IS REQUIRED WHI
FO
X
Signature of S pervising Electrician
•
If you have any questions, please call (503) 639 -4171, ext. # 310
' C1TY.OF TIGARD RVILDING INSPECTION DIVISInN MST - DO/ O(
24 -Hour Inspection Line:. J9 -4175 " Business Line: 6:. 4171
BUP
Date Requested ? AM PM BLD
Location / Cc:)--7 7 Suite MEC
Contact Person 17-6-4".12- Ph - 7 - 3 370 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 -O � i \r/ /9.,--T - r —iT ?EE C e
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: Mt)
�r
PASS FAIL
PAR
PLU I NG r
Post & Beam
Under Slab `
Top Out
Water Service
Sanitary Sewer
Rain Drains C4 SG �,,.,1 Zcit
Final
PASS PART FAIL
MECHANICAL
Post & Beam , __________
Rough In
Gas Line - -
Si.•.eDa ers
4a
SS ART FAIL
tErCTRICAL
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 1 o / Inspector Ext
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.
CITY Of TIGARD P' IILDING INSPECTION DIVISION MST -(:).:f)(- pOra(
24 -Hour Inspection Line: . A-4175 Business Line: 63. J71
BUP
Date Requested F- /4 AM PM BLD
Location / <D f ,L' �..,QJI/�J Suite MEC
Contact Person Pha-G 7- 3370 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain (f;N7n 0/
SGN
d Crawl Drain Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Ina min gth /Shear /' S /Q /( e / D F Col/ 42,-- e•M e
Framin ) ! -P� H �.
Insulation
Drywall Nailing D i o r w Pra.
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
14 ,71-70_, •ART FAIL
_ ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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 D - / v r Q Inspector �, // � � �
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
• CITY , OF TIGARD BUILDING INSPECTION DIVISION MST ( /O(
24 -Hour Inspection Line: )-4175 Business Line: 63. 471
BUP
Date Requested R - 1 L t AM PM BLD
Location / S C7 7 iieQ.-P�,p,, y1- 7OE44 Suite MEC
Contact Person Ph 7- 33 70 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /ec_,/ rl Cq /
Susp'd Ceiling
Roof
Misc: c � Q rD
/ /
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains -
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
FAIL
Rough In
UG /Slab
Low Voltage
Fire Alarm
ASS P RT 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 aant_pA___ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.