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Permit . . . . A C Ill( O F TIGARD MASTER PERMIT PERMIT #: MST2002 -00409 -x.141 DEVE LO P MENT SERVICES DATE ISSUED: 10/4/02 `--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10225 SW RIVERWOOD LN PARCEL: 2S114BC -02500 SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: REMARKS: 185 square foot addition. BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 21 FIRST: 76 sf BASEMENT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 109 sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: VALUE: 23,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 185 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADDL INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 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+ 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: ' , " _�. : ,�" INSTRUMENTATION: MEDICAL: OTHR: y HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: 'TOTAL FEES: $ 757.23 . This permit is subject to the regulations contained in the THORNTON, JOHN A + DIANE L ROYAL REMODELING RESOURCESTigard Municipal Code, State of OR. Specialty Codes 10225 SW RIVERWOOD LN INC and all other applicable laws. All work will be done in TIGARD, OR 97224 PO BOX 230805 accordance with approved plans. This permit will expire TIGARD, OR 97281 -0805 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 Phone: Phone: 684 - 7873 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through Reg #: I,IC 90746 952- 001 -0080. You may obtain copies of these rules or d REQUIRED INSPECTIONS Erosion Control Insp 8z Underfloor insulation Plumb Top Out Low Voltage Mechanical Final Footing Insp Crawl Drain /Backwater Electrical Service Gas Line Insp Plumb Final Foundation Insp Footing /Foundation Drt Electrical Rough In Insulation lnsp Final inspection Post/Beam Structural PLM /Underfloor Framing Insp Rain drain lnsp Post/Beratn Mechanical Mechanical lnsp Shear Wall lnsp Electrical Final I Issu By : t ��� 440 ,82L �� `�! ,I Permittee Signature : J l ' ...._ _/ _ _ Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day \ 7 ,. -- d t s -r -- 9,__/ "-a z__ ,,,,,, . . Buildin Permit Application . - Datereceived: f /7 A Permit no.:$10 - 6() Ci : 'r City of Tigard l • Project/appl. no.: �e date: Q...) Ci n Ti and Address: 13125 SW Hall Blvd, Tigard, OR 97223 ��^ rY .f 8 Phone: (503) 639 -4171 Date issued: �I%' Receiptno.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: 1 &2 family: Simple Complex: TYPE OF ,PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition VI Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: ' JOB SITE INFORMATION Job address: I O ZZ5 .5%......) 2%•/t.e2 s_a LA-) . Bldg no.: s Suite no.: ~ Lot: I Block: I Subdivision: I Tax map /tax lot/account no.: Project name: -- •'pp12,J—rot..._) Description and location of work on premises /special conditions: ,LS°�L7►' '. OWNER - FOR SPECIAL INFORMATION, USE CHECKLI� Name: �U N>-4 — j ;--\4540...5-1-01...) (Floodplain, septic capacity, solar, etc.) F Mailing address: 1o2-7_ 5 SL.. e.•vC2v.'nor, Lt.) 1 & 2 family dwelling: City:'F ►C.At2t IState: a • IZIP: Valuation of work $ 23 ©d Phone: 4.2.A 913S 'Fax: IE mail: No. of bedrooms/baths 1 Owner's representative: .fl S t.,c, Total number of floors Z V" Phone: 440 Fax: E -mail: New dwelling area (sq. ft.) 185 ° APPLICANT h Garage /carport area (sq. ft.) Name: (2.-O`r1�t_, 7 -1 t..) G.l Covered porch area (sq. ft.) Mailing address: pp Z,3 © g05 Deck area (sq. ft.) - City: 'T6,, " I State02 I ZIP: `112, $ i Other structure area (sq. ft.) Phone: 68. 1613 Fax L84 4,24-0 E -mail: Commerciallindustriallmulti- family: CONTRACTOR Valuation of work $ Existing bldg. area (sq. ft.) �' Business name: (Z4r-T 2rcM pt_ CI /'° , N ew b ldg. area (sq. ft.) Address: ‘*...X._ ph i_ t C State: . Number of stories City: I State: I ZIP: �,✓ -- -- Type of construction Phone: I Fax: I E -mail: /- Occupancy group(s): ,./' Existing: CCB no.: ,,,J New: City /metro lit. no.: • Notice: All contractors and subcontractors are required to be ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Name: .) fl 1 C.1 ‘,1 S Gp /`J provisions of ORS 701 and may be required to be licensed in the Address: Zl , f• �� tom 13� - • Zc 3 jurisdiction where work is . being performed. If the applicant is ✓� State:O'. ZIP: exempt from licensing, the following reason applies: City: "f I c r, Z 1 z Contact person: �p 07'e°JLE'I Plan no.: Phone: .140 Fax: E -mail: ENGINEER , Name: Contact person: Fees due upon application $ Address: Date received: City: 'State: IZIP: Amount received $ Phone: Fax: E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this O Visa ❑ MasterCard work will be complied with hethe - = -cified herein or not. Credit card number: / / (a Expires Authorized signatur• . .0"" Date: I " 1'8 - CZ Name of cardholder as shown on credit card Print name: Sf a Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00 /COM) p / / °1P • One- and Two - Family Dwelling "it . q . Building Permit Application Checklist Reference no.: Guy of Tigard City f Tigard Associated permits: Y g ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED'FOR PLAN REVIEW.. ' ° r .. Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature'on file or with application. 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with 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. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. • 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. - - . i 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) Plumbing. Permit Application • Date received: 9f/g ®.- Permitno.: //yryeD2 --CX) 9 4 *"' > � _;� City i' a Tigard . - -... City g Sewer perm 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: Receipt no.: Land use approval: Case Fite no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction . Addition/alteration /replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: IOZZ.S .5,1/4, rat vrceewoOO Lev Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: 'r'E- {c,I2,...)'TOk_) SFR (3) bath • City /county: `riG I ZIP: Each additional bath/kitchen Description and location of work on premises: Site utilities: 1 icy...) Catch basin/area drain Est. date of completion/inspection: Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: -. '1. €c,, . Manholes Address: �N s Po NO Ce 4 Rain drain connector City:fi,,A.uq -- to I State:0A, I ZIP: 9216 A Sanitary sewer (no. lin. ft.) Phone: [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 valve Contractor's representative signature: Back flow preventer Print name: Date: Backwater valve CONTACT PERSON Basins/lavatory Name: g..% („ 4 2 F3 2 Clothes washer Dishwasher • Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank • OWNER . ' Fixture /sewer cap Floor drains/floor sinks/hub Name (print): Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: 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 as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER 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 accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application Plan review (at _ %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Creditcard number. / 1 within 180 days after it has been State surcharge (8 %) .... $ Expires TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6/00 /COM) . , , ... PLUMBING PERMIT FEES: . _ .,,,,:, : 1.7.07#4, , ,, , :i a lie , •-,,:, wg ,ivi,.•;:',,„ prRic,.,s ft-frovii: oNeviaiicc,pamilatogivoloriry3t w,f--1.ti ,n,vtit6,1 q,ox-17,ORE.Aiildrvidualjn:::::-_, ;;;;; Icitkg ::,,,,,A4-0, N aixmouNT fon'61ad8irilitolurtibin ; .i"1,4TA13. Sink 16 f; - • 1 .60 'FaRckallatin f ''t i A '``:,d 'rk A lit ''!riAduT' --_-:-..-A,..-AS.o-4- 4L [5,4i4ei 'f,I•k, Ailk ?.., - ,„:,,„ , todeach,uti lityldonn‘dtionYti ::!:*ii...3: t:.:4,,,a':: , ,' , si44N.t:ri= , ' Lavatory 16.60 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 1 16.60 PLAN REVIEW 25% OF SUBTOTAL : .,',?..:- 7. Garbage Disposal 1 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 '1'it' -4 4- bywoek:,Petformed • - , - Gas piping requires a separate mechanical 00:01;9jjr.li.i5e':i1,1,14-141 T ,'Mayeli.,- ;]Reitilal:661:1',0 ZRelf(oi(pd/ '4V..= C appe d - permit. ,MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures (Specify) 16.60 Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor 2" Sewer - 1st 100' 55.00 • 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Other Fixtures Water Service - each additional 200' 46.40 (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling I 65.25 Grease Traps 16.60 QUANTITY TOTAL Tiogi;oi,r4 .*zzfar,p Isometric or riser diagram is required if Quantity Total is >9 ai4;j'A42 SOnlAiii8 *SUBTOTAL M ricir:44;1' 21 '1, 8% STATE SURCHARGE NON 06 'f..g AMIikAtgi i, ' **PLAN REVIEW 25% OF SUBTOTAL ,.'4'il,A W:Viaik: . • Required only if fixture qty. total is > 9 WiNiltr TOTAL NORNEft• V•'z:::474 $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25+ 8% state surcharge. ** Ali New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. i:\dsts\forms\plm-fees.doc 12/26/01 'Mechanical Permit Application Date received: 9 /g D^ Permit no.: r �_ e a,, i o �3 1 , • �-�1:.1 I r City of Tigard Project/appl. no.: Expire date: CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE' OF PERMIT • ❑ I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction Addition/alteration/replacement ❑ Other: . , JOB SITE INFORMATION • . • ' COMMERCIAL VALUATION SCHEDULE . • Job address: l ZZ.S 'St., te s�2wcCb 1 . Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ • Lot: IBlock: I Subdivision: *See checklist for important application information and Project name: 7-1.1o12r--1-TeN jurisdiction's fee schedule for residential permit fee. City /county: 'ale &.K:P I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE Ac:APt t0►J Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Air handling unit CFM Is existing space heated or conditioned? ❑ Yes ❑ No Air conditioning (site plan required) Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system '' .' 'MECHANICAL CONTRACTOR Boiler /compressors Business name: QrJ� sAr t IJ State boiler permit no.: HP Tons BTU /H . Address: Pa gX I Ze.+ Fire /smoke dampers /duct smoke detectors City: C. Q.) S.' I State:O ( I ZIP: 9),13 Heat pump (site plan required) Phone: 2(_( -( 1 I Fax: I E -mail: Install /replacefurnace /burner BTU /H 29 Including ductwork/vent liner ❑ Yes ❑ No CCB no.: Install /replace/relocateheaters- suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace Refrigeration: CONTACT PERSON Absorption units BTU/H Name: c 4 442pt°F E l j _) Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: State: I ZIP: Appliance vent Phone: Fax: E -mail: Dryer exhaust OWNER Hoods, Type U II/res. kitchen/hazmat hood fire suppression system Name: .o(-..N T \- \or2► -rior-4 Exhaust fan with single duct (bath fans) Exhaust system apart from heating or AC Mailing address: `jog S t l7E> Fuel piping and distribution (up to 4 outlets) City: I State: I ZIP: Type: LPG NG Oil Phone: 41°Z;! 13s Fax: E -mail: Fuel piping each additional over 4 outlets . Process piping (schematic required) Number of outlets Name: . Other listed appliance or equipment: Address: Decorative fireplace City: I State: I ZIP: Insert - type Phone: Fax: E -mail: Woodstove/pellet stove Other: Applicant's signature: Date: Other: Name (print): Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ El Visa ❑ MasterCard Notice: This permit application Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ . Cardholder signature Amount 440 -4617 (6/00 /COM) MECHANICAL PERMIT FEES i, COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: .. Descp'ption o:A .0 > . r ` -, 'AP A nce - ' Total .TOTAL VALUATION. , �PERMIT FEE; F- r, , $1.00 to $5,000.00 Minimum fee $72.50 Table^�1'AiMechanical "Code„ - - •''Qt1 «(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 including 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:applyi�>.- ';`.:. Boiler : Heat Air " - S ° 1' « of $1.20 for each additional $100.00 or Fo�,items°,7= 1;1,isee;:'„' � ` :CO TO , , Pump Cond' fraction thereof. 'footnotes below. •Comp , Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP.; absorb unit to 100K BTU 14.00 8% State Surcharge 8) 3 15 HP; absorb $ unit 100k to 500k BTU 25.60 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 VALUATION.$kP u : ;, i .- .`: 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, including 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 including 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 appliance 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: ,e , , . ; " 4z $ >1.75 mil. BTU Air handling unit >10,000 cfm 1,670 8% State Surcharge i ° y' $ s i ,. Non - portable evaporate cooler 656 � � °� Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: ',- � - ' $ Vent system not included in 656 , ;,' , �a appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: Domestic incinerator 1,170 1: Inspections outside of normal business hours (minimum charge -two hours) $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 - 4 outlets 360 charge-one-half $62.50 per hour Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU. °fi r. ..,Tt-,�..; $ ** Residential A/C requires site plan showing placement of unit. TOTAL COMMERCIAL . ° VALUATION: _ -4 All New Commercial Buildings require 2 sets of plans. is \dsts \forms\mech- fees.doc 02/11/02 . . . , • _Electrical Permit Application Date received: 9 /S 49- ' Permit no.: Weev -- 21' 07 A ``. fil City of Tigard �: .� y g Projecdappl. no.: • Expire date: CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: /-5 bk.) f / 6 4.(j Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision: Project name: . I Description and location of work on premises: io9Lih 7 6 A. ) op-0 ) /J c Estimated date of completion/inspection: d/ t /— • - CONTRACTOR APPLICATION - • FEE SCHEDULE - - r> Job no: Fee Max Business name: Zej e bE,2_ � z._Ge 7 z / Description Qty. (ea.) 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. lie. 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 OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 Mailing address: 401 amps to 600 amps 2 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only 1 . Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation: ORS 447, 455, 479, 670, 701. 200 am or less 2 • 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of • • Address: service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): ❑ Service over 225 amps - commercial O 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 I I 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 O MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / 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) i . • • ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMITIFEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 Limited Energy $75.00 Burglar Alarm Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 n Garage Door Opener 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 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n 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. , n Audio and Stereo Systems Branch Circuits New, alteration or extension per panel n Boiler Controls a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 I b) The fee for branch circuits I Data Telecommunication Installation without purchase of service ❑ or feeder fee. Fire Alarm Installation First branch circuit . $46.85 Each additional branch circuit I $6.65 ❑ HVAC a . Miscellaneous ) r 0 (Service or feeder not included) Instrumentation Each pump or irrigation circle $53.40 I � I Each sign or outline lighting $53.40 l l 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 n Medical the allowable in any of the above . Per inspection $62.50 0 Nurse Calls Per hour $62.50 In Plant $73.75 n Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ n 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 $ All New Commercial Buildings require 2 sets of plans. Total Balance Due $ i:\dsts \forms \elc- fees.doc 08/30/01 • CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RAYBORN'S PLUMBING INC PO BOX 69 TUALATIN, OR 97062 Plumbing Signature Form Permit #: MST2002 -00409 Date Issued: 10/4/02 Parcel: 2S114BC -02500 Site Address: 10225 SW RIVERWOOD LN -Subdivision: - - - Block: Lot: Jurisdiction: Zoning: Remarks: 185 square foot addition. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: THORNTON, JOHN A + DIANE L RAYBORN'S PLUMBING INC 10225 SW RIVERWOOD LN PO BOX 69 TIGARD, OR 97224 TUALATIN, OR 97062 Phone #: Phone 5 0 6A') A139 1 IIV11V VVV- V.7L -iVV Reg #: MET 00001806 LIC 87852 PLM 34 -166PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X (•v,0) Sr - e 6 Signatur( of Authorized Plumber • If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL 'BLVD. TIGARD, OR 97223 . IMPORTANT PERMIT NOTICE THORNTON, JOHN A + DIANE L �QQ 10225 SW RIVERWOOD LN ,� 9 `: TIGARD, OR 97224 Qc► Electrical Signature Form Permit #: MST2002 -00409 Date Issued: 10/4/02 Parcel: 2S114BC -02500 Site Address: 10225 SW RIVERWOOD LN - -Subdivision. - RIVERVIEW ESTATES N0. -2 - - Block: Lot: 062 Jurisdiction: TIG Zoning: R - Remarks: 185 square foot addition. 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 Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: THORNTON, JOHN A + DIANE L WEBER ELECTRIC INC 10225 SW RIVERWOOD LN PO BOX 231154 TIGARD, OR 97224 TIGARD, OR 97281 Phone #: Phone #: 620 - 1906 Reg #: LIC 44087 SUP 40285 ELE 34 -442c AN INK SIGNATURE IS REQUIRED ON THIS FORM X Ailege Signatu e of Supervising Electricia If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: , -(503) 639 -4175 MST act 6)- - 0'() , -) by INSPECTION DIVISION - Business Line: (503) 639 -4171 �q BUP Received Date Requested ` `' 0( AM PM 7� BUP Location ' 2 \ V b' ' \) 1 Suite MEC Contact Person 75‘ Li9+r Ph (S — P - ) - PLM Contractor Ph ( ) SWR Tenant/ 6 T' 4 T 0 N/ ELC Footing yi —'J 9 ELC Foundation Access : , Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear _ Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: PART FAIL Post & :eam Under Slab Rough -In Water Service Sanitary Sewer �' Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: SMART FAIL - GHANiCA Post & eam m , , - Rough -In ` , w Gas Line \ Smoke Dampers \ c 1 4 1 S9 PART FAIL Service Rough -In UG /Slab Low Voltage ` Fire Alarm mina ❑ Reinspection fee of $ required before next inspection: Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE - " _7 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA 1 1 Approach/Sidewalk Date ``� Inspector Ext • Other: Final DO NOT REMOVE this inspection record from -the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING - Inspection Lin (503) 639 -4175 MST6U�— L/67 INSPECTION DIVISION • Business ' e: (503) 639 -4171 " : � — / 12--' `� BUP Received Date Requested a AM PM BUP Location (Q 2 , l � Suite � C EC Contact Person „�4i,4, Ph ( ) D ZZ , -1 PLM 1 S4)\ ' Contractor ) L , Ph ( ) SWR BUILDING Tenant/Ow r LC Footing (p a c f — q7 3.5 g6Xa `/ 75 Q lLC _ Foundation Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: gaze CO �„�'L./LJ - SIT Post & Beam a Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation �\AiNNI\-VD `G; 4 Drywall Nailing �+ 4 Firewall ' \ 'NfA % `V.S. ?AND o r Fire Sprinkler ` � Fire Alarm `(^ 1 N ) Susp'd Ceiling Roof , l 4\— / Fi PASS PART FAIL PLUMBING' .. _ ; I� nn Post & Beam V R Pi (( �k 2 1"0 G� } Go �, G i, Under Slab ` � 1 � � �' _ 5 Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Oth : ' PAS PART FAIL MECHANICAL Post& Beam Rough -In Gas Line Smoke Dampers Final . PASS PART FAIL ELECTRICAL`_ _ ; Service Rough -In UG /Slab Low Voltage P1, b F' Alarm in ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. .ASS PART ` FAI SITE , _ , , 0 Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line C2 ADA � ` Approach /Sidewalk Date 7 I nspector Ext Other: Final DO NOT EMl OVE.this inspection record from the job site. PASS PART FAIL I 1 3 0 CC ■/ _ / _