Permit %.
,
CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2001 -00201
..II DEVELOPMENT SERVICES DATE ISSUED: 4/12/01
f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12875 SW WATKINS AVE PARCEL: 2S102BC -02600
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 026 JURISDICTION: TIG
REMARKS: 1561 square foot remodel of existing residence.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: 561 00 sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT:
VALUE: $ 67.357 00
OCCUPANCY GRP: R3 BDRM: 2 BATH: 1 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: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 6 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 0 201 - 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 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: - INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 2,040.18
K+ JULIE A OWNER This permit is subject to the regulations contained In the
JAMES, ALAN
JAMES, WATKINS Tigard Municipal Code, State of OR. Specialty Codes and
12875 S SW ALAN
, OR TKIN S AVE SIGNED
IN FILE ED RESPONSIBILITY 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
Reg #: 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 Insulation lnsp
Electrical Service Electrical Final •
Electrical Rough In Mechanical Final
Framing lnsp Final inspection
Low Voltage Building Final
Issued B / Permittee Si natu : 4 / u
y / g I
Call ( 03) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. tr j -u -it 01 y SLR z 1
Building Pe '
Permitn -; :1.1' City of Tigard nof 2 r aj Nye � aoi
!A1' ''---- - Projec /appl. 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 N.
a .90 1 0/ - Coo -1 C ase file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
1 & 2 family dwelling or accessory U CommerciaUindustrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration /replacement U Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: ! s 5 S', c(). ; T C 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: 2 Wt.c
O WNER , . FOR SPECIAL INFORMATION, USE CHECKLIST
IMS ,I (Floodplain, septic capacity, solar, etc.)
Mailing address: /fig s AA./, L jgrAFE 1 & 2 family dwelling:
City: , ¢ State: d 4 ZIP: q , _ 3 Valuation of work I�P.I $
Phone: ■ , -, , .. A Fax: E -mail: No. of bedrooms/baths
Owner's=representative - To numbe� of -floors t - - - - _ " -
Phone: Fax: New dwelling area (sq. ft.) APPLICANT Garage/carport area (sq. ft.) ... 43' h
Name: a ✓I Covered porch area (sq. ft.)
Mailing address: , ; 75 , K / . ' - i.rs Deck area (sq. ft.)
City: j ' r}it_ 0 EMMI ZIP: - _ Other structure area (sq. ft.)
Phone: , , - z, Fax: E -mail: CommercialindustriaUmulti- family:
CONTRACTOR Valuation of work $
Business name: dip L Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address:
City: State: ZIP: Number of stories
Phone: Fax: E -mail:
Type of construction
CCB no.: Occupancy group(s): Existing:
New:
City/metro lie, no.: Notice: All contractors and subcontractors are required to be
ARCII ITECT /DESICNER licensed with the Oregon Construction Contractors Board under
Efflilez 4 /11:4... lifff provisions of ORS 701 and may be required to be licensed in the
Address: i �) 2-4) S. jurisdiction where work is, being performed. If the applicant is
® . 0 EEMBI ZIP: 7i 3 exempt from licensing, the following reason applies:
Contact person: , �� D Plan no.:
Phone: Ais , 10 E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: 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 0 Visa Cl MasterCard
work will be complied whethei&specifred herein or not. Credit card number: / /
/ Expires
Authorized si : ( J 'IY n7C I j t Ze4 Date: J - 6 7 / .-0 / !Name of cardholder as shown on credit card
$
Print name: a h• V t° S 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 (61V0/COM)
One- and Two- Family Dwelling
• • • • • • Reference no.:
Building Permit Application Checklist
'' II Associated permits:
City of Tigard City of Tigard ❑ Electrical 0 Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TILE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/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 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations dxis(
I I Site/plot plan drawn to scale. Z'he '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
: vewa ; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot
71, ,;, ring coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation,plafl Sliow tibhlensions, 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.
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.
26 No rolled, reversed or mirrored building plans will be accepted.
27
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. 44o -4614 (6J00/COM)
t Mechanical Permit Application
Date received: Permit no.: ft .5-7-0,0/... DOao
' .i1. City of Tigard Project/appl.no.: Expire date:
of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223
City f 8 Phone: (503) 639-4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF P ]U%iIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE I NFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / a f 75 SGT) , J - - T! < /,LS 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: I Subdivision: '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 FIE SCHEDULE
Description and location of work on premises: AND CONIIIERICAL /INDUSTRIAL EQUIPMENT SCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
g p Air conditioning (site plan required)
_ - _ - - -Is Alteration of existing HVAC system - - - MECHANICAL CONTRACTOR Boiler /compressors
` Business name: j' wn/Ej� State boiler permit no.:
HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I F ax: I E - mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
- �'• CCB no.: InstalUreplace/relocate heaters -suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address: ComFressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ IUres. kitchen/hazmat
hood fire suppression system
Name: /9— -/./ ( J// E ....1791‘i 6-S Exhaust fan with single duct (bath fans)
Mailing address: /'AeP75 �� GJ,j/ -7. Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel i ing each additional over 4 outlets
p ping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other.
_ Applicant's signature: I Date: O th er
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa CI 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.
. $ T ®TATOTAL $
Cardholder signature Amount 440-4617 (6/00/COM)
•
MECHANICAL PERMIT FEES
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
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
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) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
"Residential NC requires site plan showing placement of unit
iAdsts\forms\mech- fees.doc 10/11/00
• frtSTaoo / -
Electrical Permit Application
Date received: Permit no.:
AO
_oi t '�� �
,. City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT ' f
jii 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: l] Partial
JOB SITE INFORMATION •
Job address: \ ci.\, 5 .\.„.) \.,,) . ', , Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: `" 3o ,, -a, '''Claa, >
Project name: ' c , I Description and location of work on premises: e,..� ,,rv, c. r-, S c� c_,,e_
Estimated date of completion/inspection: 10,,., l. , . , ' L Ln > a, ��l �j-C t
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: f L ■-\ q Fee Max
Business name: �v.ra\c.V \t, L. Description Qty. (ea.) Total no. map
New residential - single or multi - family per
Address: c)c tb.QX (c,s5 dwellingunit. Includes attached garage.
City: \N) . \Sorw∎\\.t. I State: I ZIP: g1C lO Service lncluded:
Phone: &$a. t \ ssI Fax: 6 -. \ctd4I E -mail: 1000 sq. ft. or less 4
CCB no.: (,, 65 lac. bus. lic. no: ' Each ed energy, residential sq. ft or portion thereof
Limited energy, residential 2
City /metro lic. no.: 411, { Limited energy, non - residential 2
-1---- 1 Lk "S —o1 Each manufactured home or modular dwelling
"Signatur—e or'supervising — Elan required) Date Service and/or feeder 2
Sup. elect. name (print): l'\� \L ii, ,..4, t License no: . �3S Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER - 200 amps or less V] ks." &x:30 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 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:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am,s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of . e
Address: service or feeder fee, each branch circuit IL L ik7 1'1. %0 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail' of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle . 2
❑ Service over 320 amps- rating of I &2 O 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories O Feeders, 400 amps or more *Description: _
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan 0 Other. Per inspection 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 information. sdiction for more infoation. Notice: This permit application Permit fee $
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ \D. a 1
Expires accepted as complete. TOTAL $ \1 a • c \ 1
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
.,
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 El 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 ❑ 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 ❑ 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. Audio and Stereo Systems
Branch Circuits ❑ Boiler 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 ❑ 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 n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom 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
Per hour $62.50
In Plant ' $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ ri 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 $
Total Balance Due $
•
i:\dsts \forms\elc - fees.doc 10/09/00
Permit #: H04 " C
pF
/ 7 -1
'`'' N Address: /, 675&J taq - 1 , ■)S
a: 3 a:°o
'' Issued by: 9yy! i Date: _" /?.. d /
-,--:59
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes -1 and 2, and either box 3A or 3B: - - -
1. I own, reside in, or will reside in the completed structure. -
Oa 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
4 before or upon completion.
n 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
•
IT 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Prope4 1 ers abo Co uction Responsibilities on the reverse side of this form.
I... _ 33 J-9 -.Di`
(Signature of ie 't applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
•
Information Notice to Prrie p rr y Owners
About Construction Rc sponsibiiities
Note. This Information Notice to Property Owners about Construction Responsibilities
was' developed by the Constructibri Contractors Board in accordance with ORS 701.055(5).
if you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER f ESPONSD OLOTI(S:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable fe: the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at -8091. • .
• Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division, at the Department of Human Resources
at 378 -3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, .
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. t
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040.
OTHER ( ESPONSO[3OLOm ES AND AREAS OF CO OCERM:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re -done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish
trades, and to notify building officials at the appropriate times so They can perform the required inspections. -
If you have additional questions, write or call the Construction Contractors Board ,(PO Box 14140, Salem, OR 97309 -5052,
503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own. pm4
1194
• ..CITY OF TIGARD P' IILDING INSPECTION DIVIS'"N
24 =Hour Inspection Line: ,9- 4175 ;, Business Line: 63,. 4171
MST abo( -- O 0 0_0
a BUP
Date Requested AM PM BLD
Location 44,--quite MEC
Contact Person _ • et.-__12¢k% . , T , Ph (r4 '44--e g o 7 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 - X4:5. // =- c 4td c ./)/ /C/ s.<
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling .
Roof
Misc: • •
, A RT FAIL PO/
PLUMBING
Post & Beam •
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final i
PASS PART FAIL C 74 S _ /J..t4.Lcp
MECHANICAL
• 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
Other Date — 2 S -D( Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CIT'h: OFTIGARD P' IILDING INSPECTION 'DIVISIV'N " -
24 -Hour Inspection Line: ,J -4175 :business Line: 63. ,171 MST Tel a0 c ) - 0/
BUP
Date Requested g AM PM BLD
Location / -2 -8 7.c Lev _ ,. Suite MEC
Contact Person Ph PI -FA 7 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
Susp'd Ceiling
Roof
Misc: • -
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
ampers
PAS 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 ( Inspector , Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from job site. .
- CITY OF-TIGARD P° IILDING INSPECTION DIVISION , M ST 24-Hour Inspection Line: J-4175 .. 3usiness Line: 63 171
BUP
Date Requested D AM PM BLD •
Location / Z g 7 5 c (.) Suite MEC
Contact Person 0,0 O Ph (o g `r - 8 E‘7 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 t
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler / ✓! ��/ r� C�Ct �/ �/f /� / — n)1
Fire Alarm
Susp'd Ceiling
Roof
Misc: _ _
Final
PASS PART FAIL
PLUMBING
- Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final l
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab,
Low Voltage
Fir- `rm
"615.0.1 PART FAIL
BackfilUGrading
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 r 2 – / Inspector Other Date p Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
;.CItY OF TIGARD B' m
"LDING INSPECTION' DIVISIO
M ST �OO I oo 61
24 -Hour Inspection Line: !. 4175 _ Business Line: 639 11 A
BUP
Date Requested AM PM BLD
Location / R 7 ,' LA..) Suite MEC
Contact Person Ph (a Fli—gs/(7 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
Susp'd Ceiling
Roof
Misc: - -
Final •
PASS - PART FAIL
PLUMBING
Post& Beam -
Under Slab
Top Out
Water Service
Sanitary Sewer •
Rain Drains
PART FAIL
M' 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 Dat� /Zf /C InS ector Til " � � E x t
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site..