Permit A: CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2001 -00308
,t:hi DEVELOPMENT SERVICES DATE ISSUED: 5/29/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10360 SW WALNUT ST PARCEL: 2S102BC -01807
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R-4.5
BLOCK: LOT: 026 JURISDICTION: TIG
REMARKS: Fire Repair
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT:
VALUE: $ 29,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0.00 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: W00DSTOVES: GAS OUTLETS:
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 ADDL 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: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS ARENSPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 9 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 868.38
THOMAS, MARC C + CAROL A LAY'S CONSTRUCTION CO This permit is subject to the regulations contained in the
10360 SW WALNUT ST 7400 SE MILWAUKIE AVE Tigard Municipal Code, State of OR. Specialty Codes and
TIGARD, OR 97223 PORTLAND, OR 97266 all other applicable laws. All work will be done in
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rea a: LIC 4017 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
Mechanical Insp Low Voltage Mechanical Final
Plumb Top Out Gas Line Insp Plumb Final
Electrical Service Insulation Insp Final inspection
Electrical Rough In Rain drain Insp
Framing Insp Electrical Final
Issued B Per mittee Si nature
Y� 9
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
7i Jo- S -Z3 -c)/ g r' -r
Building Permit Application
o
h Datereceived. /D / Permitno.:rl
: - °.�"�= �y City of Tigard /
- Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
1 &2 f amily: Simple Complex:
Land use approval: �
0
TYPE OF PERMIT
9.1 & 2 family dwelling or accessory 0 Commercial/industrial O Multi- family O New con ,tn.irt' i O Demolition
0 Addition/alteration /replacement O Tenant improvement 0 Fire sprinkler /alarm 0 Other. - / /2E REPS/,
-,
JOB SITE INFORMATION h `" '._
Job address: i, 0 S r✓ W - L N { 1 - Arca O'C g 7 Lz j Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: v A gC - C A R o L T 0 r P.Z. (Floodplain, septic capacity, solar, etc.)
Mailing address: ( 03 . S w t•- P State:p I & 2 family dweWng:
• Valuation of work $ �9• ego
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
/ IMEMPIMENINIMMEIBIMMII Covered porch area (sq. ft.)
Mailing address: , 7 4, oa S M 1_ ,� E Deck area (sq. ft.)
Staters n. ZIP: 0 Z Other structure area (sq. ft.)
Phone: ,Z 3 3 - 9 tiv •. Fax: E- mail: Commerciallindustrial/multi- family:
CONTRACTOR Valuation of work $
Business name: L A s . ,, Existing bldg. area (sq. ft.)
Address: co 5 � •
to-% A , e ' '! New bldg. area (sq. ft.)
Number of stories
• - State: es ZIP: 9 z o Z Type of construction
Phone 3 - - COMM E -mail:
CCB no.: 0 1 jZA p y Occupancy group(s): Existing:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
A 91ITECT /DESIG licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If thea pplicant4i: • • .
exempt from licensing, the followin •reason iiem
City: State: ZIP: ••••••
s PP..
•
Contact person: Plan no.: .. .. • • . • •
Phone: Fax: E -mail: . - - • - • .. - . .
ENGINEER
Name: Contact person: Fees due upon application • • • X • •. • •
•. ••
Address: Date received: • • • •
• • • •
City: State: ZIP: Amount received 1111111U•111 $• • • •
• • • •
Phone: Fax: E -mail: Please refer. tie foes schedule. * •
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards:piease call jurisdictIolansr. a information. •
attached checklist. All provisions of laws and ordinances governing this ❑ Visa o MasterCard ••••
. • •
work will be complied with, wh er ifi erein or not.
Credit card number: / I I. •
p l� / Expires •. • •
�( Authorized signature " Date: 2 I • 0 I Name or cardholder as shown on credit card
/\ C�t>V 02 A O c. 1` $
Print name:
S � 4 1-, re � 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 (6r00rcOM)
One- and Two - Family Dwelling
r °, , ,,, Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard
City of Tigard O Electrical 0 Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I 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 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 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."
•� • Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
• • over 1Qfeet4ong and/or any beam/joist carrying a non - uniform load.
...2Q .Manuflctffed floonlwofdruss design details.
• . '21 EnergrCode compIjance. identify the prescriptive path or provide calculations. A gas- piping schematic is required
for fodr or•rflore apptimsees,
• • 22 Engineers calculatiW When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architget ljF2Osed inQreg2rt and shall be shown to be applicable to the project under review.
• > "" JURISDICTIONAL SPECIFICS
•• ▪ 23 Five sit. plans are fe2181tfted for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
• • n. Two (2)'sets each atlr gyired for Items 16, 19, 20 & 22 above.
• 25 Buildlgg putts shalt tret►sontain red lines or tape -ons.
• �, •?,¢. No roljed reversed or mirrored building plans will be accepted.
•
•
28 •
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 (6100/COM)
. A . Mechanical Permit Application
Date received: Permit no.:pk fT,ZOd -!/o Y)
.' ii City of Tigard �1,{- ' � __., ty b ProjecUappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction O Addition/alteration /replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 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: (Block: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUI PMENTSCIIEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use:
HVAC:
handling existing space heated or conditioned? ❑ Yes ❑ No Air cnditng unit CFM
g p Air conditioning (site plan required)
• Is existing space insulated? O Yes 0 No Alteration of existing HVAC system
MECIIANICAL CONTRACTOR Boiler /compressors
7 L /� o F-N .4_ So ,4_3. State boiler permit no.:
Business name:
6 6 HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner O Yes 0 No
CCB no.: Install/replace/relocateheaters- suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Core ressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
_
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets) • . • . • • • • • • •
II
Type: LPG NG,..._.Oil •••••
Phone: Fax: E -mail: Fuel piping each additional over 4 outlet% • r. • • ' • •
Process piping (schematic requite • . • • • • • •
•- •
Name: Number of outlets • • • •
• Other listed appliance or equipment. • •
Address: Decorative fireplace •• • • • • •
• •
City: I State: I ZIP: Insert - type ..... . • • •
Phone: I Fax: I E
Woodstove/pellet stove • •
• • • •
Other: - • • • • •
Applicant's signature: Date: Other • • •
• • - •
Name (print): _ ••••
Permit Tom..• •
•
Not all jurisdictions accept credit cards, please call jurisdiction for more information. •
Notice: This permit application Mi fee .. $.•
.
C1 Visa 0 MasterCard • •••• •
Credit card number: / / expires if a permit is not obtained Plan review (at 1,o) $
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 (6l00/COM)
•
MECHANICAL PERMIT FEES 7 . -
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$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 apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* "
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15-30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30-50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30-50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
• brinStic indn ,rt nor 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
tbrntnerciai or industral incinerator 4,590
D Otheranit, inc ltidlrig wood sta7* ? • • 656 8 % State Surcharge $
inserts, etc. : • • • •
▪ Ajping 14 outlets 360
• 25% Plan Review Fee (of subtotal) $
' Ach additional outlet
•••• 63 Required for ALL commercial permits only ■
• ,TOI\L COMi EkCIAL •• $ TOTAL RESIDENTIAL PERMIT FEE: $
• VALUAT IQN� am
• • • • • Other Inspections and Fees:
• • • •
• 1. Inspections outside of normal business hours (minimum charge -two hours)
•• ••
•••• $72.50 per hour.
• • 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
•• •••• • •••• • $72.50 per hour
• • 3. Additional plan review required by changes, additions or revisions to plans (minimum
• • • charge-one-half hour) $72.50 per hour
• • • • * State Contractor Boiler Certification required for units >200k BTU.
"Residential A/C requires site plan showing placement of unit.
i :ldsts\formsniech- fees.doc 10/11/00
• Electrical Permit Application
MO
Date received: Permit no.: /'l5T2 00 I — 003(/
it ..I I 1 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
I'
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 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:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: Fee Max
Business name: , &J E Ct
Description Qty. (ea.) Total no. insp
New residential - o o m
r multi-family per
Address: dwelling wilt. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: moo sq. ft. or less 4
CCB no.: I Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
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
401 amps to 600 amps 2
Mailing address: 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
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:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 40l to 600 am s 2
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: • ....
- 7. •
Phone: Fax: E -mail: Each additional branch circuit: • ••••
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not lncluded): • ••• • •
• • •
•
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle • • . . _ 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each signor outline lighting • • • '-
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy pint: • • • • • •
O System over 600 volts nominal more residential units in one structure alteration, or extension' • • • • • • 00:00:
• & A
Cl Building over three stories Cl Feeders, 400 amps or more *Description: • • • •
Cl Occupant load over 99 persons 0 Manufactured structures or RV pans Each additional inspection over the dIRABIlle in any dr jlip ve: • •
O Egress/lightingplan 0 Other. Per inspection 1
Submit sets of plans with any of the above. Investigation fee • • • • .. •
The above are not applicable to temporary construction service. Other _ • •
■... • •
Permit fet " .. $ •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ,,,� • • • •
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ ��l $ • ....
•
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 (MXYCOM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2
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. Audio and Stereo Systems
Branch Circuits Controls
New, alteration or extension per panel
a) The fee for branch circuits ❑
with purchase of service or Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy ❑
panel, alteration or extension $75.00 Landscape Irrigation Control
Minor Labels (10) $125.00 ❑
Medical
Each additional Inspection over
the allowable in any of the above Nurse Calls
Per inspection $62.50 El
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
•, Rees: • • •. • • ❑ Protective Signaling
•
• ▪ Enter total of ahovo fees • $ n Other
• • • • •
• :' . / Surch. r
$ • • $ Number of Systems
• ••••
• • ?61(o,Plan Rapte%P. • • • • * No licenses are required. Licenses are required for all other installations
• • • • � ge "Plan Revie section on $
• f ront of applicatign. • • Fees:
• •• ••
• • •Fatal Balance Due . , $
• • • • • Enter total of above fees $
•••• •
• ❑ Trust V.court # • 8% State Surcharge $
• ••••
• •
... -
• Total Balance Due $
i Adsts\forms\elc- fees.doc 10/09/00 •
. •' • Plumbing Permit Application
Date received: Permit no.:/v14newl — c o3
- . .., Tigard City of Ti and
' i City Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial O Multi- family O Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCIIEDULE (for special inforn ation use checklist)
Job address: Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Manufactured drain (no. lin. ft.)
Manufactured home utilities
Business name: /1/4 / u.16 /' Manholes
Address: Rain drain connector
City: I State: {ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Absorption
Contractor's representative signature: Back flow flow valve
Back preventer
Print name: Date: Backwater valve •
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: 1 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) _ •
-
Ownet's signature: ' Date: Sump • • •
Tubs/shower /shower pan • • •
Urinal • •• -� •..•
Name: Water closet - • • • • • • • .
Address: Water heater • • • • •
City: I State: I ZIP: Other: • •
.. • •
Phone: I Fax: I E -mail: Total „•••• • • Mini fee • . $• - •
Not all jurisdictions accept credit cards, please tali jurisdiction for mote infom�atian. Notice: This permit application ti • • .
❑ visa O MasterCard expires if a permit is not obtained Plan review (at _ pr $ . •
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6/00/COM)
PLUMBING PERMIT FEES: . ,
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (Individual) QTY (ea) AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato 16.60 for each utility connection)
ry One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3^ 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
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
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isomelpt 8r 'hlei diagranlis required if
Quantit•T.t.lis > 9
• • epee • *SUBTOTAL
• • • - • •
• • 8 % S J!'ETAAGE
• •...
• PltI1 REVIEW 257o OF SUBTOTAL
• • • • Required only if fixture ggi.(1014 ii .1
• • • • • .•7ATAL $
• • -
• •. •.
• • ViRimum pe R %VIPs $72.50 + 8% state surcharge, except Residential Backflow
• Prevention D ever wlaic'h is $36.25 surcharge.
•
"All New Comrperclal �ulldings ff;�i}tre plans with isometric or riser diagram and
•• IA: revi . •
i:kdstsVormskplm- fees.doc 10/10/00
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MP PLUMBING CO
MILWAUKIE PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015
Plumbing Signature Form
Permit #: MST2001 -00308
Date Issued: 5/29/01
Parcel: 2S102BC -01807
Site Address: 10360 SW WALNUT ST
Subdivision: NO. TIGARDVILLE ADDITION
Block: Lot: 026
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Fire Repair
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 Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
THOMAS, MARC C + CAROL A MP PLUMBING CO
10360 SW WALNUT ST MILWAUKIE PLUMBING CO
TIGARD, OR 97223 PO BOX 393
CLACKAMAS, OR 97015
Phone #: Phone #: 655 -9161
Reg #: LIC 5002
PLM 3 -17PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD. RECEIVED
TIGARD, OR 97223
200 .
IMPORTANT PERMIT NOTICE CoMMLINIlY UEVELUI'MEN1
ROSE CITY ELECTRIC CO INC
4012 NE CULLY BLVD
PORTLAND, OR 97213
Electrical Signature Form
Permit #: MST2001 -00308
Date Issued: 5/29/01
Parcel: 2S102BC -01801
Site Address: 10360 SW WALNUT ST
Subdivision: NO. TIGARDVILLE ADDITION
Block: Lot: 026
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Fire Repair
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:
THOMAS, MARC C + CAROL A ROSE CITY ELECTRIC CO INC
10360 SW WALNUT ST 4012 NE CULLY BLVD
TIGARD, OR 97223 PORTLAND, OR 97213
Phone #: Phone #: 287 -6164
Reg #: suP 21276
LIC 3567
ELE 26 -113C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X.
Signature of Supervising Electrician
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD BUILDING INSPECTION DIVISION MST La/ c 3 08
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• BUP
•
Date Requested J / � '- 3 AM PM BLD
Location / Q 3 (0 L( Suite MEC
Contact Person Ph 9-3 3 q PLM
Cont - • Ph SWR
= UILDING Tenant/Owner ELC
Retai ing +all ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post h Beam j C Ca�� N6 %Off/
Ext Sheath /Shear �� �CG S�Z�'�r Q�
Int Sheath /Shear
Framing -Z0 6
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: \\
(II
IJ_�' PART FAIL
PLUMBING / ge4Preri287.1.---- \--- ` Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
FAIL
(4 HA
Post & Beam
Rough In
Gas Line
Smoke,Dampers
.J ' • - FAIL
ELECTRICAL
Rough In
UG /Slab
Low Voltage
Fire Alarm
=QA. PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
• Fire Supply Line [ ] Please call for reinspection RE: [ I Unable to inspect - no access
ADA
Other oach /Sidewalk Date / (13/0/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.