Permit 4,1 01ot R r r ,>7 fea - t) i ea�vc4.®t� of As- y iix �f
1
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00082
,,,,; DEVELOPMENT SERVICES DATE ISSUED: 5/12/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 08985 SW WHITEOAKS LN" PARCEL: 2S111M -09600
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 080 JURISDICTION: TIG
REMARKS: New SF detached
BUILDING
REISSUE: MAS22143 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,464 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 832 sf GARAGE: 620 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THROE sf RIGHT: 20
VALUE: 230 00
OCCUPANCYGRP: R3 BDRM: 3 BATH: 3 TOTAL: 2.296 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 W00DSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVOFDR: 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+ ampNolt :
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: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 8 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,719.25
FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION This permit is subject to the regulations contained in the
F
F O R BOX ON FO FOUR
BOX CON Tigard Muniapal Code, State of OR. Specialty Codes
BEAVERTON, OR 97075 BEAVERTON, OR 97075 and 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.
Phone: 503 - 590 - 0805 Phone: 720 - 7445 MOBL ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg 8: M0805 1037 rules are set 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
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Se • •- Building Final ":„..
Issued B Y Permittee Signature - - 1�i/ i%
Call (50 ) 639 -4175 by 7:00 p.m. for an inspection needed the n • t b -.
business d -
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00082
"6
. DEVELOPMENT SERVICES DATE ISSUED: 5/12/2004
" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 08985 SW WHITEOAKS LN PARCEL: 2S111AB -GP380
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 080 JURISDICTION: TIG
REMARKS: New SF detached
BUILDING
REISSUE: MAS22143 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,464 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 832 sf GARAGE: 620 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 NMI sf RIGHT: 20
VALUE: 230 00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2.296 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 • 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 • 400 amp: 201 • 400 amp: 1st IMO SVOFOR: 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 +amp6-1000r 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: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner Contractor TOTAL FEES: $ 7,719.25
FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION This permit is subject to the regulations contained in the
F
F O BOX CON PO BOX CON Tigard Municipal Code, State of OR. Specialty Codes
BEAVERTON, OR 97075 BEAVERTON, OR 97075 and other applicable laws. Al. will done in
accordance anrace with approved ed This
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.
Phone: 503 - 590 - 0805 Phone: 720 - 7445 MOBL ATTENTION: Oregon law requires you to follow rules
p � adopted by the Oregon Utility Notification Center. Those
5q
Reg #: LTC 0805 1037 rules are set forth in OAR 952 - 001 -0010 through
1 952- 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electncal Service Low Voltage Storm drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Foundation lnsp PLM /Underfloor Framing Insp Gas Fireplace Water Line lnsp Plumb Final
Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation Insp Water Service Insp Building Final
Issued By : - \n iyZQJA. Permittee Signature : /� _i
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next bu mess day
,
Building Permit Application FOR OFFICE USE ONLY
` � 2�j0't Received
City of Tigard 72re A11!_j Permit No.: :&o 4- o
DateB
13125 SW Hall Blvd., Tigard, OR 97223 c > Plan Revie 2 d Other Permit o
,
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIG amo ;, ,, i\ Da �• rI 8
Inspection Line: 503.639.4175 BUILDING DI', _ Date ReadyBy. la See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: MI Supplemental Information
TYPE OF WORK
REQUIRED DATA: 1- AND 2- FAMILY DWELLING
New construction ❑ Demolition Permit fees* are based on the value of the work performed. O
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. r
Valuation: $
1;0 I- and 2- family dwelling ❑ Commercial /industrial J
❑ Accessory building El Multi-family Number of bedrooms: 3
CI Master builder ❑ Other:
Number of bathrooms: . 2 / /'L ,_
JOB SITE INFORMATION AND LOCATION Total number of floors: T
Job site address: 6)9Rs �, w, i,,,y,r ,rs L Ai/ - e - New dwelling area: 2 x square feet
City/State/ZIP: ✓✓ /p/) 4 64 9722 Garage/carport area: 6 6 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 2 /6 square feet
Cross street/directions to job site: Deck area: square feet
9' i~ a.eshAzz Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: � S 40,1 ?AQK `3 Lot no.: Q Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
- Re., /La /z / Valuation: $
,z -
Existing building area: square feet
New building area: square feet
Tir PROPERTY OWNER ❑ TENANT Number of stories:
'...
Name: • " - ",) e.e /t'- ,2) ` r� ' /� rry/ 4 ST2 e..././6 .t) Gr Type of construction:
Address: ce O. 2 Q /s 9 7 Occupancy groups:
City/State/ZIP: "E9-461.4,--4,,,,. OR. ' 7 D7S Existing:
Phone: (51..\2) 5 530_ G 4-- Fax: (,S13) S'qo- /7S/ New:
cif APPLICANT ❑ CONTACT PERSON NOTICE
Business name: �' na,. Ais b t3 p ti All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board 3:
Contact name: under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/Z1P: apply: I
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: S , / ,/ D U•e._ BUILDING PERMIT FEES*
Address: Please refer to fee schedule.
City/State/Z1P:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.: `7/ d S 7
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: M 4,�s ..Qf./- Date: fs Q ( / • Fee methodology set by Tri- County Building Industry
Service Board.
r\ Building \Pennrts\BUP•PcmtitAppdee 12/03 440-4613T(II /02/COM/WEB)
One- and Two - Family Dwelling
•
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard 4 Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 A �� " � j � l l
24- Hour Inspection Line: 503.639.4175 �),�. ❑ Electrical 0 Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us
' 0 Other:
TH 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. Name of district: • ❑ ❑ ❑
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- ❑ ❑ ❑
I 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 Ore_on and shall be shown to be a. •licable to the •ro'ect 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 1 1" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building, plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be 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 and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
t:\Building\Permits \One - Two- FamilyChecklist.doc 12/03
r FD
Mechanical Permit A � � FOR OFFICE USE ONLY
City of Tig Received
�� Date/By Permit No.: t i /,7Q M4/ __p00 gf $ —
13125 SW Hall Blvd , Tigard, OR 97223 �� ,,i, t.- • Plan Review 7 /Tw
Phone: 503.639.4171 Fax: 503.598.1960 ., 4,..,
D a WB y: Other Permit-
Inspection Line: 503.639.4175 T 1, ' ' p
C‘�Y � fyS - 0 1 i' Date Ready/By: Jurls El See Page 2 for
Internet: www.ci.tigard.or.us 1 �`� �w Notified/Method Supplemental Information
• - -. TYPE OF WORK . , _ ' COMMERCIAL FEE *. SCHEDULE-- USE.CHECKLIST
cgi New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• CATEGORY OF CONSTRUCTION , . . _ Value: $
yi 1- and 2 -famil dwellin y - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ Accessory building
❑ Multi - family 0 Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION - Heatinp/cooling
Job site address: p �s r Air conditioning or heat pump
/ rf J i.'t , q LA)/1 / /"2 6 � L A f.. (requires site plan showing placement) 14.00
City/State/ZIP: '7-7 p Ail/ Oi - G 72 2 7 /( Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: ✓ Project name: Furnace 100,000+ BTU ( ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
e 4.. « Reside Hydronic hot water sys 14 00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc 10 00
Subdivisiong as-, 4,Loz t�, , 3 Lot no.: 6 Flue/vent for any of above 10 00
Other: 10
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK _ . Water heater 10.00
Gas fireplace 10.00
L4--ji /•le,t•) �d 0 -S-e -, Flue vent for water heater or gas
fireplace 10 00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
PROPERTY 'OWNER . ❑ TENANT Chimney/liner /flue/vent 10 00
Other: 10 00
Name: 44 . j - . , a / 6h S T R •e t e "+ .) ar ---- Environmental exhaust and ventilation
Address: Range hood/other kitchen
J . 7 7 equipment 10 00
City/ State/ZIP: L a -7 Clothes dryer exhaust 10 00
n Single -duct exhaust (bathrooms,
Phone: (SUS) „5 -- CVO S Fax: L.5a 3 7Si toilet compartments, utility rooms) 6.80
FE APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
//
Other: 10.00
Business name:
c ih -ku- ,44 /4-d6CJ Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
-' CONTRACTOR Barbecue
O / , � j ) _r - ',_/Vy Clothes dryer (gas)
Business name:
J ` ( Other:
Address: / 6 of s E 2 / U g_,,e- . ... MECHANICAL.PERMTT FEES*
City/State/ZIP: / /LLSZ 6Ito 6A- Subtotal
S(r 4e3 Minimum permit fee ($72 50)
Phone:
tu` ) 2 _ Fax: ( ) Plan review (25% of permit fee)
CCB lic.: (o Cs State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: f y � This permit application expires if a permit is not obtained within 180
// C i/ days after it has been accepted as complete.
Print name: ilpvg„„iz f! MR7`�lcLs. Date: 4-45 fL • Fee methodology set by Tn- County Building Industry Service Board
i \Building\Permits MEC- PemutApp doc 12/03 440.4617T (I 1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\l'emiits\MEC-PermitApp.doc 12/03 2 .
Building Fixtures
Plumbing Permit Applicationt,_ r) FOR OFFICE USE ONLY
City of Tigard f D� , , " I Received
Date By Pemut No. i / _/— 4 ,9 49 ,2 u u �/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � <� t� /,`,,9,p � �.;,\ Da /By: Other Pernut No.
24- Hour Inspection Line 503.639 4175 r ■ c•I � Date Ready/By: /uru RI See Page 2 for
Internet: www.ci tigard.or us nF T , ,� - Notified/Method. Supplemental Information
C!-fY "' - ,i .
TYPE Oi��'NOI , 'NG D1\ . _ .' - FEE* SCHEDULE' -
c2t New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION , ' .
:...,- ', - SFR (1) bath 249 20
rg 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399 00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq ft.) Page 2
• JOB SITE INFORMATION AND
I / LOCATION Site utilities
Job site address: �9t7s f. ( /Ajl jr Lq.LI � Catch basin or area drain 16.60
City/State/ZIP: ""T - 7p • iJ 0 72. 29' Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: c/ I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16.60
tf 9 OL�'ne- ayta1. Ram drain connector 16.60
Sanitary sewer (no. linear ft. • Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: g S t ,„//,‘.. �.92K 3 I Lot no.: PC, Water service (no linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
• DEIPTI OF WOR / Backflow preventer Page 2
e SCCR
3 d /�u✓ Ff O (.f S-e.- Backwater valve 16.60
Clothes washer 16 60
Dishwasher 16 60
Drinking fountain 16.60
.. ' � PROPERTY OWNER - ,I' , ' ❑ TENANT ,
/� Ejectors /sump 16.60
Name: Cpu.L a) (idh c S'7T C7/ 04) Cllr- Expansion tank 16.60
Address: 0. v 9 7 Fixture/sewer cap 16.60
City/ State/ZIP: Se/Ni/...t., .,‘ 6ic 9 7 a 7-' Floor drain/floor sink/hub 16.60
Phone: (StS3) S9d— Oa D 5 Fax: („r S 0-/ 7s/ Garbage disposal 16.60
- , cgt APPLICANT ' ' 0 CONTACT PERSON Hose bib 16.60
l ice maker 16.60 —
Business name: 14 - Ih- )9i, 6 £ - Interceptor /grease trap 16 60
Contact name: Medical gas (value $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16 60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16 60
CONTRACTOR ' _ i. Water closet 16.60
Business name: .. "-- s L‘2? CP244-1.e.4 / ) Q Water heater 16.60
Address: / -\ e 644 + , ..S u.4- Other:
City/State/ZIP: /OZZ_T jV� CQ 12.5 Subtotal
6, � 7 Minimum permit fee. $72.50
Phone: ( 6 440.2`2 /( Fax: ( ) Residential backflow minimum permit fee $36 25
CCB Lie.: / 9 9 PPlumbing Lic. no.:3 & W'Z Plan review (25% of permit fee)
Authorized signature: / _ _ er b
State surcharge (8% of permit fee)
�.0 4
TOTAL PERMIT FEE
Print name: Fp W Le Date: if- /S:- D 5,1 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
i ‘BuiidingiPcrmits\PLMF- PermitApp doe 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: " Permit Fee:..
Footing drain - I 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater $309 00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 _ ..
Storm & Rain Drain - 1st 100' 55.00 Valuation: _ Permit Fee:
$1.00 to $5,000 00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001 00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
• Fixture or Item Qty. Fee (ea) . 'Total additional $100.00 or fraction thereof, to and
Including $10,000 00
Commercial Back Flow Prevention Device 46 40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1 54 for
Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001 00 to $50,000 00 $379.50 for the first $25,000 00 and $1 45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72 50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1 20 for
each additional $100 00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
- Quantity by (Fixture) Work Performed
Fixture Type: . . Replace
New • Moved Existing Capped Comments regarding fixture work:
•
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
- Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\Buddmg\Pern,ite\PLM- PemutApp doc 3/03
Electric . Permit A lic tion FOR OFFICE USE ONLY
City 5f Tigard � � � `- Da`t�y Permit No NSregae9 — aro $�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ff t , //'.. • +� Date/13 Other Pet
Inspection Line: 503.639.4175 Fl - `� f _ _l 6 `'
v - Date Ready/By J�t% ® See Page 2 for
Internet: www ci ttgard.or us Notified/Method: Supplemental Information
TYPZ
CITy OF T. ` ' ' j' PLAN
C9� 'Y D i V. S i •
VI New construction ❑ Addition/alteration/replacem Please check all that apply
❑ Demolition ❑Other' ['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq ft.,
CATEGORY OF CONSTRUCTION ' - - of 1- and 2- family dwellings 4 or more new residential
(N 1- and 2- family dwelling ❑ Commercial/mdustrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lrghting plan RV park
Job no.: Job site address: ?CPsS w LJ //��4/cd. ❑Health - care facility ❑O�az
Submit 2 sets of plans with any of the above.
City /State /ZIP: '7 — /tt/ ,g J, O x.... The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Totol ••
Cross street/directions to job site: C) 9 12-nc 4. tt-2,,,a New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145 15 4
Subdivision: p.
�0,, Lot no.: d Ea. add'l 500 sq. ft. or portion 33 40 1
�` �� �� Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
4 2 N Ord lis Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
(g, PROPERTY OWNER , I ❑ TENANT 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
Name: FO CI- L- C — c79 Q. G7 - ON a- 601 amps to 1,000 amps 240 60 2
Address: d c � /S 7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: T,,,,9 ire..., ),c Temporary services or feeders installation, alteration, and/or
Phone: (r,� `3) $ B ._ O8 S Fax: (SM`S) p. relocation 00 ms
v° 1 `�� 1 7s� 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
. 1.APPLICANT _ " . ❑ CONTACT PERSON A. Fee for branch circuits with
„) service or feeder fee, each 6 65 2
Business name: s_ Ff,, OlJ - e..., branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
Address: each branch circuit
Each add'l branch circuit 6 65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53 40 2
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
- extension Describe: Page 2 2
Business name: (46 i.eQ.TS tG1¢c7 ec
Address: , / � Each additional inspection over allowable in any of the above
,S7 9 -. P �� Per inspection 62 50
City/State/ZIP: C p n otr2__,44v� i�-- CY 722/ Investigation per hour (1 hr nun) 62.50
Phone: (s 77 Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* .
q �
CCB Lic.: ! J > Electrical Lic. :'-2.3c Suprv. Lic.: 3 Gpc 6 S Subtotal
Suprv. Electrician signature, required: ( / h 0 ,.s Plan review (25% of permit fee)
Print name: R04 `yyk l J C�/k� I Date: �� G State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature:, This permit application expires if a permit is not obtained within 180
Print name: T�,// days after it has been accepted as complete
2)4 S> K d� Date: /S —dr • Fee methodology set by Tn- County Building Industry Service Board
• Number of inspections per permit allowed.
t.\ Building \Pennits\ELC- PermutAppdoc 12/03 440 - 4615x(10 /02/COM/WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
I-
COMMERCIAL WORK'ONLY: - 7 1
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i- BuildingTrnnits\ELC- PamnApp.doc 04/03
CaTY OF TIGARD Credit No.: 2004 - 000•4
Date Issued:
Engineering
-- Authorization
Date: 3 -23 -04
TRAFFIC IMPACT FEE
CREDIT VOUCHER Land Use
Casefile No.: SUB2003 -00002
In accordance with Ordinance 379 (Washington County Traffic Impact Fee Ordinance) Four D
Construction
developer) (name of
is entitled to $ 44,194 in Traffic Impact Fee Credits that can be applied to TIF charges for
development on lot(s) 1 -27 of the Greensward Park 3 Development. The use of TIF credits are
subject to the rules and limitations of the TIF Ordinance which are listed on the back of this voucher.
WARNING: This voucher must be presented at the time of issuance of the building permit, or if
deferral was granted, issuance of an Occupancy Permit.
Q P.
Director
Date Permit Numbers Lot Numbers Credit Used Balance
Beginning Balance $ 44,194
Balance carried forward to TIF Credit No.
• Ordinance 379 provides for an expiration 10 years from authorization.
login \viola \tif09.1
® AAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
®
STREET T EE CERTIFICATION R ..
434 I>
/I\ 03-
® I, J »v 1 fl D 'r1 4' , p® wner/ .gent for F u lb �N s 7- ac - o, J
® (PLEASE PRINT) I (PERMIT HOLDER)
1 rift'
x k i
® Do hereby ce�rf _ th em e` 940wing location
® X . "� L . ' =. \
® meets , <_tyy Qf Ti gardf Wa shngton oun et
® land use and development standards for street tree installation.
44 Bt-
® ADDRESS: e / e S S, (Ai , W ITEOAr S 4) ,
44 10-
® LOT: S UBDIVISION: 61 C��� n R 1 H 1
® BY / / �_ _
® •
DATE: 3
® / /
® RECEIVED BY: - / DATE: � 1 3 - p V
A VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV®
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST os° 4-/- v �$ Z
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested , o _ — 3 , ( \ AM PM BUP
(7 "V
Location tC 1_ g� _ -.cZ aft-k-) Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In •
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers •
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
-ADA .— �j
proach/Sidewalk Date l` O Inspector Ext
Other:
DO NOT REMOVE this Inspection record from the Job site.
A S PART FAIL
CITY OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175 MST :2,1367 g#Z
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /6 2 - 2 AM PM BUP
Location 9 �' S Suite MEC
Contact Person Ph ( ) 7 a O - 7 '/ '/_ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain / ELR
Crawl Drain (� 13•--)( .i s
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing —
Insulation gr,
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
'.' CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART. FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /fv��
ADA Date L v
Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
•
CITY OF TIGARD s „ 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST v 1616 y'ddDg v .
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested l'' AM PM BUP
Location gq ?.5 (.i / Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation AcceSSL
Ftg Drain LEO y S ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear -
r Z O GE) " /)
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fir= Alarm
�r Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
1 J: PART FAIL
SITE 0 Please call for reinspection RE. ❑ Unable to inspect — no access
Fire Supply Line `
ADA Date IIZ ' O 4/
Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record the job site.
PASS PART FAIL
CITY OF TICARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST a0
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested Z ,a AM PM BUP
Location c j g' /1 , 11 Suite MEC
Contact Person Q4)-9 Ph ( )7°9 8 - 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: 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:
S PART FAIL
BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
ASS ART FAIL
EL CTRICAL
Service
Rough -In
UG/Slab
- Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2-- �'g — U S Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL