Permit A 't CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00394
,,, le DEVELOPMENT SERVICES DATE ISSUED: 10/7/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13000 SW WILMINGTON LN PARCEL: 2S109AB -08200
SUBDIVISION: ZONING: R -
BLOCK: LOT: 011 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.Need fire spriklers installed
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 21 FIRST: 2,443 sf BASEMENT: 930.00 sf LEFT: 17 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 808 sf GARAGE: 567 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 15
VALUE: 501,034.90
OCCUPANCY GRP: R3 BORM: 4 BATH: 5 TOTAL: 3,251 sf REAR: 5
PLUMBING
SINKS: 3 WATER CLOSETS: 5 WASHING MACH: 2 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 6 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 8 CLOTHES DRYER: 2
GAS FURN > =100K: 1 UNIT HEATERS: HOODS. 1 OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: 1 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 10 201 - 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: 00 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 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 9,714.70
This permit is subject to the regulations contained in the
LARRY BARNUM VINTAGE HOMES NW
LARRY B D U S #1201 VINTAGE G LOOM LANE Tigard Municipal Code, State of OR. Specialty Codes and
11407 BEAVERTON, OR 97007 TIGARD, OR 97223 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 -0850 Phone: 503- 312 -0759 Oregon Utility Notification Center Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 16766 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Lin Insp
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Sprinkl oug
Foundation Insp Footing /Foundation Dn Framing Insp Gas Fireplace Spri r Fin
....
_.. .
Issued By : -62 Permittee'Signature • c ,71.--,_.----___
Call (5 -4175 by 7:00 p.m. for an inspection neede e next usiness day
'
Ali Building Permit Application
Date 9 �.','� City Q� Permit no.: t�`JT.2oaa ^e057/
," , (2 Cit of Tigard
�–
- _° g Project/appl. no.: Expire date: O
CiryojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By: I Receipt no.: N
Fax: (503) 598 - 1960 Case file no.: Payment type:
1 &2 family: Simple Complex: . /
Land use approval: � !/
TYPE OF PERMIT
•
A 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi - family - New construction 0 Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement 0 Fire sprinkler /alarm U Other:
• - JOB SITE INFORMATION
Job address: /Am° ( 9, 0 tO/ L /. 1Z Bldg. no.: Suite no.:
Lot: / Block: Subdivision: v . _ Tax map /tax lot/account no.: ' —
Project name: 34 a ► , u. 2&5 :< A..,,
Description and location of work on premises/special conditions: N & w ND M• f
l 1 OWNER: FOR SPECIAL INFORMATION, USE CHECKLIST
(Floodplain, septic capacity, solar, etc.)
Mailing address: a _ 1 • . p� . 1 • 1 & 2 family dwelling: b — —
ZIP: ' '7 60 7 Valuation of work ...60./ t $ - - lg
Phone: .• • a , ; Fax: E -mail: No. of bedrooms/baths 4I — s .' '
Owner's representative: GA z.. Total number of floors 13 -- av
Phone: / zo c Fax: E -mail: New dwelling area (sq. ft.) ....„5./.B
,';;, • APPLICANT Garage/carport area (sq. ft.) `5.4. 7
Name: Z.A R¢ R. mu Covered porch area (sq. ft.) / 2
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: CommerciallindustriaUmulti- family:
f, r': _ - CONTRACTOR ' Valuation of work $
Business name: y� Existing bldg. area (sq. ft.)
Address: New bldg. area (sq. ft.)
L •' Number of stories
. State° ZIP LL Type of construction
Phone: 3 Z D7 , Fax: E -mail: Occupancy group( Existing:
CCB no.: - - _ New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
', :. :''- ? , ` ARCHITECT /DESIGNER : licensed with the Oregon Construction Contractors Board under
Name: S -; ¢ , ■ /I 6, ,,'S provisions of ORS 701 and may be required to be licensed in the
Address: — 77_,,,/-9 • • d rte_ jurisdiction where work is being performed. If the applicant is
ZIP: exempt from licensing, the following reason applies:
Contact person: Do v ,v M/,I Plan no.: VA p,,,,,,..,,, .
Phone:4 2 o g Fax: E -mail:
ENGINEER
4, . 6 Contact person: Fees due upon application $
Address:c/ a e/ s ,c,r //s D Date received:
®A MMr =M ZIP: Amount received $
Phone: 27 g Fax: t7 .., A E -mail: Please refer to fee schedule.
I hereby certify I have read an , amined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provi • • s of I • . s and ordinances governin this o Visa 0 MasterCard
work will be complied wi whe; r specified herein or not. Credit card number: / /
Expires
Authorized signature• Date: 2 3 'OZ. Name of cardholder as shown on credit card
Print name: L.d o o)/ A Q ' •-3-) Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00/COM)
1
4 One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City Of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED 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 ❑ 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 exisk:
11 . Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there ismore than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of stricture (including decks); location of wells/septic systems; utility locations; direction indicator, lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted.
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document.
27 "Drawn to scale" indicates standard architect or engineer scale.
28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (6I00/COM)
'Electrical Permit Application
. A Date received: 9 (p 6 .., Permit no.: N o -er.)3py
a.m iii, •
r ,) j.., 1 City of Tigard Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERIiIIT
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
New construction ❑ Addition/alteration/replacement U Other: ❑ Partial
• JOB SITE INFORMATION
Job address: Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: /( I Block: (Subdivision: rR AU6 AJ
Project name: T . _ I Description and location of work on premises:
Estimated date of completion/inspection: - / a.. o 3
CONTRACTOR APPLICATION FEE SCHEDULE •
Job no: Fee Max
Business name: Ott) t tj e 2 Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: dwelling imit. Includes attached garage.
City: s„( I Stated I ZIP: ' Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no:
Limited energy, residential 2
. City /metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
. Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): L ?,,, f t , .yl 201 amps to 400 amps 2
'� R y 401 amps to 600 amps 2
Mailing address: ��jj� 601 amps to 1000 amps 2
City: - E--Q A t� e. rye w/ I Staten I ZIP: 4'-7 n o Over 1000 amps or volts 2
, Phone:3 / 7- 07 s I Fax: I E -mail: Reconnect only 1
Owner installation: The instal 'on is being made on property I own Temporary services or feeders -
which is not intended for s , lease t, or exchange according to installation, alteration,orrelocation:
200 amps to or 40 less 2
ORS 447, 455, 479, 67 01.
201 amps to 400 amps 2
Owner's signature ,/ Date:9 -S%-e57— 401 to 600 amps 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps-commercial ❑ Health -care facility Each pump or irrigation circle 2
Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
0 Egress/lighting plan ❑ Other. Per inspection I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
rm
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT. FEES: .
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total sl, Check Type of Work Involved:
Residential - per unit
1
1000 sq. ft. or less $145.15 4 Audio and Stereo Systems'
Each additional 500 sq. ft. or
portion thereof "7 $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf d Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2 in
Services or Feeders ❑ 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 ofservfce 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 ❑ 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
Each additional inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50 El Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting`
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ 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 $
All New Commercial Buildings require 2 sets of plans.
i :\dsts\forms\elc- fees.doc 08/30/01
Ali. "MechanicalPermit Application cy
Date received: / (P pg Permit no.: S(
,. .,�;III City of Tigard Project/appl.no.: Expire date:
City ofTigard Address 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: • Building permit no.:
TYPE OF PERMIT
1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
New construction 0 Addition /alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCIEDULE
Job address: L I I iov-eA) r . Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ /5,/),0 D O •
Lot: // IBlock: I Subdivision: 4i, 'See checklist for important application information and
Project name: ' A 0.ti,t,,.,,.k 'ge.,s • jurisdiction's fee schedule for residential permit fee.
City /county: LAM a 4 . I ZIP: Q z2.-y 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and location of work on premises: A,iF w /A r» 1 AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: z/210 3 Description Qty. Res. only Res.only
Tenant improvement or change of use: NVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing NVAC system
MECIIANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: 4.IF EA 47 HP Tons BTU /H
Address: &0 Fire /smoke dampers/duct smoke detectors
City: e,p „ I Stated ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Insta i ef urnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: Install/replace/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: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: g q9 co S'4,,S" Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ I I/res. kitchen/hazmat
• hood fire suppression system
Name: L" eje 7 �A R N n ,,, Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: 3 p Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature: I Date: Other: •
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Not Th permit application Minimum fee $
O Visa 0 MasterCard expires if a permit is not obtained
Credit card number: E Expires wit hin 180 days after it has been Plan review (at %) $
x
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (6i00/COM)
MECHANICAL PERMIT FEES - -
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: -Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) , Amt
O °
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) including ducts & vents Furnace to 100,000 BTU 14.00 a
$1.52 for each additional $100.00 or Furnace 100,000 BTU+
fraction thereof, to and including 2) 17.40
$10,000.00. including ducts & vents
$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 6.80
$1.45 for each additional $100.00 or
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 Comp Pump Cond
o
fraction thereof. footnotes below. p
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 - 50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1.170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust / 10.00 /d
Vent not included in appliance 445
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. i
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1 170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator $62.50 per hour.
Commercial or industrial incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 pef hour
inserts, etc. 3 Additional plan review required by changes. additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge-one-half hour) $62.50 per hour
Each additional outlet 63 + State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ 'Residential NC requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
is \dsts\forms\mech- fees.doc 02/11/02
Building Fixtures 4 1
Z.11 City of Tind OFFICE USE ONLY
Date received: / Q 2' Permit no.: -g44 , .-391 f
r -
,� .J f I City g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Projectfappl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
New construction ❑ Addition/alteration/replacement ❑Food service ❑Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: /b000 Sw 42 /L/16 o Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 1 SFR (1) bath
Lot: // I Block: I Subdivision: ,p tJ c A. 2./ 4e_ SFR (2) bath
Project name: 1, A a ka,,. ,,. - e...S „ SFR (3) bath . J 3 9 y 2Y
City /county: I ZIP: Each additional bath/kitchen •.. U f G
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywalls /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ` j i,,,, 'S u.ri 6) N 7 Manholes
Address: Rain drain connector
City: 4 r t, , State; 5' ZIP: Sanitary sewer (no. lin. ft.)
Phone: (, c.iq yo3 q I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Absorption valve
Contractor's representative signature:
Back flow preventer
Print name: Date: Backwater valve
. . • - CONTACT PERSON } Basins/lavatory
Name: E .-. 0 , UG Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
. OWNER Fixture /sewer cap
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Name (print): Floor drains /floor sinks/hub
address: Garbage disposal
Mailing Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other: •
Phone: Fax: E -mail: Total
Minimum fee $
Not all junsdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application o
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
State surcharge (8 %) .... $
Credit card number: / / within 180 days after it has been
Expires $
Name of cardholder as shown on credit card accepted as complete. TOTAL
Cardholder signature Amount 440-4616 (6/00 /COM)
PLUMBING PERMIT FEES:
PRICE TOTAL . New 1 and 2- family dwellings only:
FIXTURES, (individual) - . QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 3 16.60 the dwelling and the first100 ft. QTY ; (ea) AMOUNT
for each Lavatory b 16.60 One (1) bath connection)
h $249.20
Tub or Tub /Shower Comb. A__ 16.60 Two (2) bath $350.00
Shower Only 3 16.60 Three (3) bath X $399.00
Water Closet q 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE .
Dishwasher 1 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal Z 16.60 TOTAL
Laundry Tray / 16.60
Washing Machine j_ 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed .
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory
Tub or Tub /Shower
Hose Bibs 3 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' /7' 55.00 3^
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 2 y ' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' i'C, I 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 1 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram Is required If
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
"PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
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* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36 25•+ 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts \forms\plm- fees.doc 12/26/01
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
JIM'S PLUMBING
18962 SW SHAW
ALOHA, OR 97007
Plumbing Signature Form
Permit #: MST2002 -00394
Date Issued: 10/7/02
Parcel: 2S109AB -08200
Site Address: 13000 SW WILMINGTON LN
Subdivision:
Block: Lot:
Jurisdiction:
Zoning:
Remarks: New SF detached, Path 1.Need fire spriklers installed
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
LARRY BARNUM JIM'S PLUMBING
11407 SW DAVIES #1201 18962 SW SHAW
BEAVERTON, OR 97007 ALOHA, OR 97007
Phone #: 503 - 590 -0850 Phone #: 649 -1034
Reg #: LIC 71860
PLM 34 -186ob
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
. Signature,of Authorized Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310
Permit #: (x) 3 94/
Address: 00n LO t C. 1► rJ (oTO ti)
Issued by: Date:
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.
Fi 1 ' he appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
1 before or upon completion.
r% )
3A. My general contractor is V4Vote.... d mzs N w
(I (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
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" above information is correct and that I have read and do understand the Information
Notice to Prope / wners a» 't Construction Responsibilities on the reverse side of this i rm.
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ignature of permit applicant) Date)
(White copy to issuing agency permit file,
pink copy to applicant)
linfovmatkon MoUoe to PPopery O me e
About CConstruccUon RespornsHANtnes
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction 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.
ElIPLO ER RESPOMSOBOLOTO[ 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 wifthollding tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for 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 945 -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 Department 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. Ifyou fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable forall claim costs ifoneofyouremployees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888.
U.S. internal Revennaae 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 RESPONSOE3lLOTIES ARID ',REAS •F CONCERN:
Code compliance: As the perm it holder for this project, you are responsible for resolving any fai lure 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
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E TIFICATION
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I, ,Owner /A for (/ J �,�,� / �/4) ►
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• (PLEASE PRINT) (PERMIT HOLDER) ►
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• Do hereby certify that the following location ■
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• meets ,City:of-Tigard /Washington County ■ ■
• • land use and development standards for street tree installation.
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ADDRESS: ? 3 0 6 .s � ✓ W >.�S' /1/1/ L ►
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• LOT: I/ SUBDIVISION: l ?,p Le^, / /1":4/5 E t• ■
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� DATE: , /,��_ •
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A RECEIVED BY: , eP i . 40 DATE: ¢ - 7 - 0 3 • ►
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST — d 0 . 3 7
INSPECTION DIVISION Business Line: (503) 639 -4171
11 P (m BUP
Received d ' a Date Requested 7 AM PM BUP
Location 3 0870 id Suite MEC
Contact Person l j , Ph ( ) 3.2q - 9 4 3 3 PLM
Contractor V Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: jeef SIT
Post & Beam de ,
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Oth :r:
�_R� 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: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ¢^ 7 Inspector ` Est
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business ine: (503) 639 -4171 MST - �� `1
BUP
Received Date Requested ■ � AMM PM BUP
Location / 3odr, � � /L- f/4 A Suite MEC
Contact Person ��/ -144/779SG Rh ( ) 32-47-63 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole c
Storm Drain a L n '' ,
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
R
LECTi T FAIL R
Service
Rough -In
UG/Slab
Low Voltage
F = Alarm
Celkh PP 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PARAR T
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date — In ector C� C I c Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -41/5 MST 2 - o03 4 ,1
INSPECTION DIVISION • Business L e: (503) 639 -4171
BUP
//
Received Date Requested '`�` AM PM BUP
Location / 30 (9 d Mal/A4 7V/% / ' ite k MEC
Contact Person RR/1i`� X 'S � � Ph ( ) 32-4, 9 [0 �3 PLM
Contractor 1 NT F, ''� 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 C ��
Susp'd Ceiling — – �/= _ �� �, ce _
Roof
Other:
Final >'
T FAIL
LUMBING
�PesLi�
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan e,(144/
iiri PART FAIL
Rough -In
Gas Line
S Dampers
PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final
Reinspeclion 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
Approach/Sidewalk Date �� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL