Permit A CITY OF T IGARD MASTER PERMIT
PERMIT #: MST2004 -00081
91 DEVELOPMENT SERVICES DATE ISSUED: 4/26/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09025 SW WHITEOAKS LN PARCEL: 2S111AB -GP382
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 082 JURISDICTION: TIG
REMARKS: New SF detached
BUILDING
REISSUE: PH1024A STORIES: 2 FLOOR AREAS - - -- - REQUIRED SETBACKS -- - REQUIRED- -
CLASS OF WORK: NEW HEIGHT: 20 FIRST: 2,197 sf BASEMENT: sf LEFT: 4 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE' 480 sf FRONT: 20 PARKING SPACES : 2
- TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 4
VALUE: 217 522 00
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 2,197 sf REAR: 15
PLUMBING
SINKS: 2 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
■
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 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 W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp' EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HWSVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM: OTH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
b GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,501.44
FOUR D CONSTRUCTION CO FOUR D CONSTRUCTION This permit is Municipal C subject Code, the regulations contained C o i the
Ti
PO BOX 1577 PO BOX 1577 Tigard Municipal Code, State of OR. Specialty Codes and
BEAVERTON, OR 97075 BEAVERTON, OR 97075 all other applicable laws. All work will be done i
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:
Oregon law requires you to follow rules adopted by the
Phone: 503 - 590 - 0805 Phone: 720 - 7445 MOBL Oregon Utility Notification Center. Those rules are set
5qqpp forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
LIC
Reg #: 0805 1037 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Structural Mechanical Insp Shear Wall lnsp , Insulation Insp Water Service lnsp
Sewer Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Gyp Board lnsp Appr /Sdwlk lnsp
Footing Insp Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Foundation lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Post/Beam Structural PLM /Underfloor Framing lnsp Gas Fireplace Water Line lnsp / Plumb Final
Issued B ' ���� Permittee Signature , -'tfa=
Y
/ '
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b ' iness day
•
Building Permit App N FOR OFFICE USE ONLY
OF TIG '
City of Tigard Received PermitNo.• t . ii
13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 h
2 I Plan Review
Phone: 503.639.4171 Fax: 503.598 1960 ^ .. p,1 ' i'� Date/B : hl.:,N1 - 2. 3 Pun - 0 Other Pun 4 „ � . , 4
Inspection Line: 503.639.4175 ,,. � Notified/Method: '�i ^'III Date Ready/By: El See Attached Checklist for
Internet: www.ci.tigard.or.us
C ITY t Supplemental Information II
\)i BUILDING DIVISION 0
. TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING 1.
Permit fees* are based on the value of the work performed.
(rNew construction 1=1 Demolition
Indicate the value (rounded to the nearest dollar) of all r
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation:
D7 s F�z 00
14 1- and 2- family dwelling ❑ Commercial /industrial
(%
Number of bedrooms: 3
❑ Accessory building ❑ Multi- family
El Master builder El Other:
Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors: / .. I,
Job site address: ?Q2, s' ,.,(0, /,Jy�7.. CAI & 1,#i)42.--• New dwelling area: / �sga feet
City/State/ZIP: 7 9A / i1 „rte dn f 972.24e Garage/carport area: r y square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: , p' 7 Rsquare feet
Cross street/directions to job site: Deck area: — square feet
CJ 9 �. - 2 fi t.. Other structure area: -- square feet
v REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Cz L.,Ahd,/, 992 0 3 Lot no.: d?2 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.
2 Mew / J Valuation: $
C�4�' ' 1i y Existing building area: square feet
New building area: square feet
gl PROPERTY OWNER ;r / ❑ TENANT Number of stories:
Name: 4 r1 a �,'� a -I DOW (. Type of construction:
Address: (-p 0 AS e2 7 Occupancy groups:
City/State/ZIP: 2 Auk C) ,e 97 C)7€ Existing:
Phoneme ) Sc) - O 0 j Fax: 4.5 ) ,S 767 New:
L APPLICANT ❑ CONTACT PERSON NOTICE
Business name: . '9.yul„, AIS b bUc-. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: i "
gU'P !/!9�°p°j 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/ZIP: apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: SAS ,bJ' ,OA 0 o4— BUILDING PERMIT FEES*
Address: Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.: 7j0 3 7
/ Date received:
Authorized signature: A / This permit application expires if a permit is not obtained
/ within 180 days after it has been accepted as complete.
Print name: � a p e ,e% Date: 3 —,5-p, * Fee methodology set by Tn- County Building Industry
Service Board.
i.\ Building \Pemuts\BUP- PernutApp doe 12/03 440- 4613T(I I /02/COM /WEB)
One- and Two - Family Dwelling „
Building Permit Application Checklist FOR OFFICE USE ONLY
Citt 'of Tigard ° 1 Received Permit No.:
y g Date/By: „ - .
" •13125 SW,Hall Blvd., Tigard, OR 97223 ; ;'Associated permits
'
Phone: 503.639.4171 Fax: 503.598.1960 A' 2ji ' ❑ Electrical ❑ Plumbing ❑ Mechanical
24- Hour inspection Line: 503.639.4175 E•I 1
Internet: www.ci.tigard.or:us , ❑ Other:
THE 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. ❑ ❑ I
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: ❑ ❑ ❑
5 Septie system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water districtapproval. ❑ ❑ ❑
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 orrsite;, and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size . ❑ ❑ ❑
and location. • ' - . _°, f:, , .. ..
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, roofmg, 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. ❑ ❑ El
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 C ❑'. . ❑ ❑
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 s • II ❑ ❑
locations. Show attic ventilation. • . . " . , ,
18 Basement and retaining walls. Provide cross sections and'details showing placement-of rebar. For engineered • ❑ ,,❑ El
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 0 ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform load. -
20 Manufactured floor /roof truss design details. , - ' '` ' 0 ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. •A.gas- piping, schematic is required t, 2, ❑ ❑ ❑
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 applicable to the .ro 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 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.
i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03 . ,
Eleetrical'Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Received
13125 SW Hall Blvd., Tigard, OR 9722., Plan Re iew
i♦ �I d
Phone: 503.639 4171 Fax 503.598.1960 '�" "w 1 +I Dat mi
Other Permit:
Inspection Line: 503.639.4175 MAR 1 b 20 0 ,L r 1 Date ReadyBy: Jura Vi See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. Supplemental Information
TYPetlaSY rr MAR PLAN REVIEW
NI New construction ❑ Adt { anon/re acement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, com'I ❑Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq ft.,
CATEGORY OF CONSTRUCTION of 1 and 2 family dwellings 4 or more new residential
1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑Master builder ❑Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address:9�5 2 w ar Lis, ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: --77tJ ,9 €. Q ? 722// The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: ✓ (Project name: `f FEE* SCHEDULE
Description I Qty. I Fee I Total
Cross street/directions to job site: 6)9 Liz /, ebi-• New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145 15 4
Subdivision: CE t... TARi 3 Lot no.: J2 Ea. add'I 500 sq ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential / 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
•/J 9 dwelling, service and /or feeder 90.90 2
( Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
pa PROPERTY -OWNER I ` ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: g- an-Ye S7-tGLC.77 A) 601 amps to 1,000 amps 240.60 2
Address: 0 gex /._77 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: `2*.wv„..e j , ,,, / 4)2. 97676 Temporary services or feeders installation, alteration, and/or
Fax:
relocation
�„O) "j 175 � 20
Phone: ` �a ,57C)..- ,57C)..- ,57C)..- ��d s' /�—! 200 amps or less 66 85 I
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
g- APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6 65 2
Business name: .S'NA1.e A pL cK,.., branch circuit
Contact name: 4� "1 Xp7d A2 � B. Fee o ur service circuits
� 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
Business name: ?�l> .S I G extension. Descnbe: Page 2 2
Address: 7 59 3,.(a). // Each additional inspection over allowable in any of the above
Y iQ u'e Per inspection 62 50
City/State /ZIP: rpa 0..7 vg. 97.2.2 / Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
Phone: ) z 77S Fax: ( ) S ELECTRICAL PERMIT FEES* '
CCB Lic.: 93 S Electrical Lic.:342,3C. SSuprvv.Lic. Subtotal
Suprv. Electrician signature, required: /i � d d Plan review (25% of permit fee)
Print name: 7 hQ ` in? (z 1 I Date: g __S".:. O(tz State surcharge (8% of permit fee)
/� TOTAL PERMIT FEE
Authorized signature: / A�j This permit application expires if a permit is not obtained within 180
r� �`� days after it has been accepted as complete
Print name: I ..J�// , 9.4 r 7 . 4W m je J Date: 3 -5_0 (( • Fee methodology set by Tri- County Building industry Service Board
�✓ •• Number of inspections per permit allowed
i \Building Warms \ELC- PernutApp doc 12/03 440- 4615T(10/02/COM /WEB
Electrical Permit Application.- City of Tigard
Page 2, ; Supplemental Information ,
LIMITED ENERGY PERMIT FEES: :, q
PRESIDENTIAL 'WOW K ONLY: I
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:
7C0MIVIER0AL ,WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved: '
❑ Audio and Stereo Systems
❑ Boiler Controls • '
S ,
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
•
•
❑ Instrumentation
❑ Intercom and Paging Systems
•
❑ .Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting *
❑ Protective Signaling ' -
' 1 h
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i. Building \Pemtits\ELGPmrotApp doc 04/03 '
Mechanical Permit Ap licat' FOR OFFICE USE ONLY
City of Tigard I EU Y ED Received �� _/ /
Date/By: Permit No. C I C OQ g'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /� Iy Da teB .
Inspection Line: 503.639.4 b 2004 .14 '� y
Other Permit:
Ins MAR 1
P � , Date Ready/By. ®
y. lira. See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method• Supplemental Information
CITY OF TIGARD
TB L� 1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
V 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
K( 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address:
5 SiG � ,/./ /.e. 2give (requires site plan showing placement) 14.00
City/State/ZIP: ^T ) 9.722 Furnace 100,000 BTU (ducts/vents) 14.00
-r m , 2 4
Furnace 100,000+ BTU (ducts/vents) 17.90
Suitelbldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
tT ,t0 i' 1t2 �- R eside n i hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision SGvIfirPCj�'
mm •3 Lot no.: 2 Flue /vent for any of above 10 00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Z " 421 A. ,ryiLe, 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
�V PROPERTY OWNER ❑ TENANT Other:
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: `) aeS1y. RT�u. L Tl 6,Z) a Environmental exhaust and ventilation
Range hood /other kitchen
Address:
O.2 152.45. 7 7 equipment 10.00
zypiti_LA).41*yt D ,7o 7 5-- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (9 3) 5,0- CkpD s Fax: (SO) 5'O -/ 75-7 toilet compartments, utility rooms) _ 6.80
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
L � 1 Other: 10.00
J
Business name: ihstQ. #42, e a tJ" Fuel tin
P�P l;
Contact name: "-Z:o e. 2) /� i $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
Business name: ��� �,�� Clothes dryer (gas)
�� / 46101r ,,, 1 Other:
Address: /4 0/ S i tJtr R
MECHANICAL PERMIT FEES*
City/State/ZIP: 14‘../..,s,6 4e c ? 7L2 3 Subtotal
Phone:493 ) St Fax: ( ) 3 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: Gb s 7e State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: /" This This permit application expires if a permit is not obtained within 180
/ /ti�►j'yn ��/f( ,vp days after it has been accepted as complete.
Print name: Iti pR,►IQr,A,t( )Ikowe4..d Date: 3- 5-4,9 • Fee methodology set by Tri- County Building Industry Service Board
i \Building\Pennils \MEC- PermitApp doc 12/03 440.4617T (I I /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: ' Permit Fee:
$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 \Permits\MEC- Pemvt.App.doc 12/03 2
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard p �CE�� E Deceived
Date/By: or�J
Permit No.:��/�� 4 X06 eg/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960
rl Gµea ` \ Date/By:
24- Hour Inspection Line: 503.639.4175 MAR 1 b �- e! I 1 Date Ready /By. Jun' El See Page 2 for
Internet: www.ci.tigard.or.us n Notified/Method: Supplemental Information
TYPE OTG TIGARD FEE* SCHEDULE
[ New construction BUI eag110l °N _ For special information use checklist.
Descnption 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
ja 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder 0 Other: Fire sprinkler ( sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 7b�S . .lam / es z Catch basin or area drain 16.60
City/State/ZIP: < 7'/9 0 pR. ?7,22171 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name:
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
,c5 y- hvi Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
� � � wee 3 I Water service (no. linear ft.: ) Page 2
Subdivision: `�J� Lot no.: 62
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
� 1.1 Me. fi Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I ❑TENANT Ejectors /sump 16.60
Name: )14/ a / l 5 y l , S7 . 4 47 /6,l( Expansion tank 16.60
Address: ? DL Z wy, J 97 Fixture /sewer cap 16.60
City/ State/ZIP: �/ C.�/� . 9 7e376- Floor drain/floor sink/hub 16.60
Phone: (j03) 59 - e> s
/ ���
Fax: S7" s 0 / 7 Garbage disposal 16.60 Hose bib 16.60
pc APPLICANT ❑ CONTACT PERSON 16 60
Ice maker
Business name: ' S fryrw AS Ai - , Interceptor /grease trap 16.60
Contact name: r Ig(fip, C 4,4409,1po Medical gas (value: $ ) Page 2
Address: Primer 16.60
Roof drain (commercial) 16.60
City/State/ZIP:
Sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR • Water closet 16 60
Business name: /' 13 (( 4-yyrkiA(C/ _ Water heater 16.60
Address: /5-92 S �' .St �
j � Other:
ty ,2�b O 97!
Subtotal
Ci / State/ZIP: p 7/2 3 Minimum p ermit fee: $72.50
Phone: £3) 6 6 -23uu Fax: ( ) Residential backflow minimum permit fee. $36.25
CCB Lic.: 9 907 Plumbing Lic. no.: - l 1j Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: "/ /l_, ,Qi - eg ,LI- TOTAL PERMIT FEE
Print name: / Lige, - (1 ( ^ JL . Date: 3 -S O4 Thls permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i \ Building\Permits\PLMF- PernutApp doc 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 - l' 100' 55.00 0 to 2,000 $115.00
2,001 to 3,600 $160.00
Footing drain - each additional 100' 46.40 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 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $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
Q ty. Fee (ea) Total additional $100 00 or fraction thereof, to and
Fixture or Item 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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"
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 MachJRefrig. Drains fees assessed for the sewer increase must be paid before the
Oil Separator (Gas Station)
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service
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:\ Building \Pemtits\PLM- PennitAPP.doc 3/03
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I, U 1.) . , ��Owner /``-,gent for Z ' D 4�3`1c?�,t.C17p�
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Do hereby ce y th tthe folJd'w r g location
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44 _� g /Washington County
® land use and development standards for street tree installation.
ADDRESS: Q / C � S S c C3 , WI-4 1 SOP. .S j_ J, 0.
® LOT: - B - _ SUBDIVISION: F- SW -� � k ox/ 0.
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4131 VVVVVVVYVVYVVVVVFVVVVVVVVVVVVVVVVVVVVVVVVVVFVVVVTVVVVVVFVVVN
CITY OFTIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175 :01 c7, 006
INSPECTION DIVISION Business Line: (503) 639 -4171 L
V/
BUP
Received Date Requeste 3 AM PM BUP
Location I >-mit. / �'C�� Suite MEC
Contact Person ��.'� Ph ( ) 7,1-6 - 7 Y fS PLM
Contractor Ph (- ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain f � ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
•
Insulation
Drywall Nailing
Firewall •
Ili _�/ /i � L� / �/` s
Fire Sprinkler —
Fire Alarm
Susp'd Ceiling
Roof AV'?
Other: - - - - - — -
Final
PASS PART FAIL
Post & Beam -
Under Slab
icarali
• ervice
'Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
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
ADA r/�—e?
Approach/Sidewalk Date q 2,/ v� Inspector y Ext
Other:
Final DO NOT REMOVE this inspection record from the job site. -
PASS PART FAIL
•
CITY OFTIGARD 24-Hour . G
BUILDING Inspection Line: (503) 639- 4175 �� 7 . by r/
INSPECTION DIVISION Business Line: (503) 639 -4171
'7 Received Date qu�;•t•J AM PM BUP
Location ��� I`�i ! %y Suite MEC
Contact Person - Ph ( ) ?? • e, )6 v t— 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 C4A 11Aiqte
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
PAS •ART FAIL
+'' AL
y
U/
Low Voltage
rm
� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
`�' 4 PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line '
ADA /
Approach/Sidewalk Date . .- Inspector ' / Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site. -
PASS PART FAIL
CITY. OF,TIOARD 24 -Hour
BUILDING , Inspection Line: (503) 639 -4175 MST °�� Y_ ' d
INSPECTION.3JVISION Business Line: (503) 63914171
y BUP
Received Date Requested � AM = PM - BUP
Location .9 Op, S t� � Suite MEC
Contact Person hQ-r --c Ph ( 6 -71 PLM
Contractor . Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: L O =- S
Ftg Drain .� ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing — c r Alm 577; IC CT
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
-
n
ASS ART FAIL
UMBING
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
ASr$ — RT 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 reinspectiori RE: El Unable to inspect – no access
Fire Supply Line
ADA Q " -/S = a �-
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL