Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2004 -00237
4441? DEVELOPMENT SERVICES DATE ISSUED: 8/17/2004
' �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 13241 SW WOODSHIRE LN PARCEL: 2S104DC -08500
SUBDIVISION: MORNINGSTAR ZONING: R - 4.5
BLOCK: LOT: 022 JURISDICTION: TIG
REMARKS: Finish off lower level. All rough -in work was done and inspected under MST96- 00404. This permit
is for the purpose of final inspection.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE. SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THRD sf RIGHT:
VALUE.
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 0 00 REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN. TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR. GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS• HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 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 AREAISPC 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: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
•
Owner Contractor TOTAL FEES: $ 250.00 •
OWNER This permit is subject to the regulations contained In the
JOHN WHEELER
JOHN WHEELER ELER Tigard Munidpal Code, State of OR. Specialty Codes
TIGARD, OR WOOD LN 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 - 524 - 8562 Phone: ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: 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
Electrical Final
Mechanical Final
Plumb Final
Final inspection
Bu' ' g Final
I sued By : ..._ _�'_ +� !_ Permittee Signature :X iM/.4 ( 7,441C40._—
Call (503) 6 • -4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application FOR OFFICE USE ONLY
Received DateB . �� /i'
Permit No )6r . oi ?3
City of Tigard
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598 1960 & t Date/B Other Pe
Inspection Line: 503.639.4175 44, ' 12. Date Ready/By r 0 See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method' � �� Supplemental Information
' :,," :' r S ' `a- TYPE OF ,WORK ' . R EQUIRED DATA 1.= AND'2 DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
- - = �■•' • - work indicated on this a
CATEG -T - ' , - ', = •a ,u ._ - application.
. .. � ..: ,._ .. - OR CONSTRUCON
... -, ' �- Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial/industnal
❑ Accessory building ❑ Multi- family Number of bedrooms
❑ Master builder ❑ Other: Number of bathrooms •
• :OB` SITE, INFORIVIATION '. .,,', Total number of floors
Job site address: /3,2 c/ / 6 A 1 zA j os i,/, . New dwelling area: square feet
City/ State/ZIP: ,K44w f Q4 97223 Garage/carport area• square feet
/
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area square feet
Other structure area: square feet
- REQUIRED DATAi'COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, matenals, labor, overhead, and the profit for the
// .,DESCRIPTION WORK - r , work indicated on this application.
k -t)).5 2 ✓E.aL C�C'iir,' -- AL 6L_0(J s // ,oL T� 10 Valuation: $
074 ,ems /T /115 r9(. — OD7 0 y — ,,e( A to X Existing building area: square feet
6= L cai.1. - 0 - J /"../ 02(.710, New building area: square feet
,. gi n, _
< -
[0 PROPERTY! OWNER -.`❑ TENANT Number of stories:
Name: -<:06,0 u1/43 EFL Type of construction:
Address: /3 z*( S ,� e„, f/ t 44. Occupancy groups:
City/State/Z1P:-- � Cji-iL 97 2-23 Existing:
Phone: ( 05) s- _ s4 3 Fax: ( ) New:
2APP
' LI ANT `
� ' "0: . CONTACT PERSON -'
_ ,
� :: :..NOTICE z .
- -. • - ....
Business name: vF t 2 A - A/ (,�)tI` t-R— All contractors and required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: »/i.— 75 ,UL_ junsdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
` , CONTRACTOR ,
Business name: ,/ vJc(er� c /L • - B U3LDING'PERMIT ,FEES *:'-
Address:P , y ' �
� �a v Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.•
Date received:
Authorized signature: 53,4_ e„ ,34 i e This permit application expires if a permit is not obtained
��� / within 180 days after it has been accepted as complete.
Print name. p�/� , , J� �G6� Date: �/ / (e /p�i * Fee methodology set by Tn -County Building Industry
W /// / Service Board
I \Bwlding\Pemuts \BUP- PermitApp doc 12/03 440- 4613T(I 1 /02/COM/WEB)
One- and Two - Family Dwelling .
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard ' Received Permit No
13125 SW Hall Blvd , Tigard, OR 97223 AssBy:
Phone. 503 639.4171 Fax: 503 598 1960 Aa * I ,I 0 o Electrical CI Plumbing 0 Mechanical
d permits 24- Hour Inspection Line: 503.639 4175 61 I ''
lec
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, histonc district, etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of distract: . ❑ ❑ ❑
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; footpnnt of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area, existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding matenal, 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 ❑ ❑ ❑
prescnptive 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 MI ❑ ❑
for four or more appliances. 1\
22 Engineer's calculations. when required or provided, (i.e , shear wall, roof truss) shall be stamped by an engineer or ❑ f ' ❑ ❑
architect licensed in Ore•_ on and shall be shown to be ap plicable to the .ro'ect under review. 1'
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
Mechanical Permit Application FOR OFFICE USE ONLY
City Of Tigatil Received
Date/By* Received
f / 7 CI Permit No ir
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503 639.4171 Fax 503 598 1960 , ft q+ \ Date/By
Inspection Line: 503.639.4175 !L Date Ready/By. Lunt ® See Page 2 for
Internet: www.ci.tigard.or.us Nottfied/Method Supplemental Information
rt, TYPE WORK 5 t COMMERCIAL FEE SCHEDULE = USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement
performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
,.. - .CATEGORY „OF- CONS ; . F ; Y • j °- ` Value $
; , -RESIDENTLAL "EQUIPMENT /;SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi-family Master builder For special information use checklist.
y ❑ 0 Description Qty I Ea Total
_,; ,a .. 'JOB SITE, AND'LOCATION, '` -,'.•_ _ y % Heating/cooling
Job site address: / 32 /J / s � I A' � S l 2 ! L / Air res site plan or heat pump
'�/ G -I`, (requires site plan showing placement) 14.00
City/State /ZIP: ..-- i.7 i 694 f (? 7 3 Furnace 100,000 BTU (ducts /vents) 14 00
Furnace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14 00
Cross street/directions to job site Duct work 14 00
Hydronic 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: Lot no.: Flue /vent for any of above 10 00
Other: 10 00
Tax map /parcel no.: Other fuel appliances
" - _ _ DESCRIPTION OF.WORK ' "= '''=:Q ="r. Water heater 10 00
r �' Gas fireplace 10.00
�N(StttO Grs .i E_A_ / 4..t]ZJ1,_ A .4 £- 6UCzif - (►•5 ( Flue vent for water heater or gas
cTn 6� i4 rr rL( i 9YP — 60Y0 V -,4-o prca-x )�zx 26 Log
fireplace 10.00
Log lighter (gas) 10 00
Pf�/c.._ — Y[ - GCS -r 2tJ j 7 --J p C) Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue/vent 10.00
"PROPERTY OWNER ` ❑ - TENANT -
. Other 10 00
Name: ' - c e0Q l J O et e �� Environmental exhaust and ventilation
Address: �� / ` 3 2- 5u) C io ) -L hL_ LS Range hood /other kitchen
equipment 10 00
City/State/ZIP I7 A.,,. L 7— 9 7z-2-3 Clothes dryer exhaust 10 00
( Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
...x i' „ )2APPLI , ,..,, , Y
„ : U ; ° ❑' CO 4CT'PERSON Attic /crawlspace fans 10 00
Business name: Other: 10 00 ti4d C�� Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: -",-V7411..- fri E� Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) . Fax: : ( ) Water heater
Fireplace
E -mail: Range
_ . = =,' -, 7 CONTRACTOR , , ° - , Barbecue
Business name: C �
_ Oa) /O Q� Clothes dryer (gas)
Other:
Address:
�,;;' MECHANiCAI; , PE RMIT.,FEES"
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72 50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: —L.A.) This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: �f-EN cAi Nt,Ec,� /L Date: 8 / /(Q /tr7 p • Fee methodology set by Tri- County Building Industry Service Board
i \ Building \Permiis \MEC- PemutApp doc 12/03 440 -4617T (I 1 /02 /COM/WEB)
Mechanical Permit Application - City Tigard
Page 2 - Supplemental Information . •
Commercial Fee Schedule:
��I'gtal wV�aluatoi:����:�d�w =,�.� Permit:F_ ee��:§ =;; r�... _ �. 1��3 •:- � <�:.rfi�;:�:•;:�w�::; °���:
$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:\Buiiding\Pemrits\MEC- PermitApp.doc 12/03 2
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received d�Q
Plan R eview Permit No. w '+� l5
13125 SW Hall Blvd., Tigard, Plan R ard, OR 97223
Phone: 503 639.4171 Fax: 503 598 1960 A. i,i Date/B Other Permit.
Inspection Line: 503 639 4175 E!1 I � Date Ready/By funs El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Ivlethod Supplemental Information
. - TYPE OF WORK - PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply
El Demolition 12 Other: ❑Service over 225 amps, comm'l Hazardous location
EService 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
❑ Multi family ❑Master builder ❑Buildin over three stones ['Feeders, 400 amps or more
❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION . ❑Egress/lighting RV park
Job no.: Job site address: /3 a,(// avIr * f.. ' ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above
City/State /ZIP: ..dE / 6 A - / (N2 97Z23 The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty I Fee. Total I "
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq ft or less 145.15 4
Subdivision: Lot no.: Ea add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75 00 2
DESCRIPTION OF WORK - - Each manufactured or modular
AA // dwelling, service and /or feeder 90.90 2
kerSi. t 0 2t W`[,/� ( - 11 614 CoAtp[.E en Pea our Services or feeders installation, alteration, and/or relocatio
41167,6 -- DO fe;91 — QOpC0 AYPILO /D A e 9.0 Gzie lfp /t/ 200 amps or less 80.30 2
201 amps to 400 amps 106 85 2
PROPERTY OWNER I ❑TENANT 401 amps to 600 amps 160 60 2
Name: 1.0 i t/G1L ` 601 amps to 1,000 amps 240 60 2
Address: /3 .4 ( 5 j L J rn hE ;_ 6_-,( J Over 1,000 amps or volts 454 65 2
Reconnect only 66.85 2
City/State /ZIP f 4) 02 9 7z2-'s Temporary services or feeders installation, alteration, and/or
Phone: (513 — 85 2_ I Fax: ( ) 200 relocation
2 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
y APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: \j i-yJ t&—f--Cie— — without service or feeder fee,
each branch circuit 46.85 2
A dd r ess : J.yyt-f-- , 14
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53 40 2
E -mail: J »1,pp,( ex- ( vex-/lie4,- Signalctrcuit(s)orlimited-
CONTRACTOR energy panel, alteration, or
Business name: (,��J
r, , \ extension Descnbe: Page 2 2
Address: Each additional inspection over allowable in any of the above
Per inspection 62 50
City/State /ZIP: Investigation per hour (1 hr nun) 62 50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lie . Subtotal
Suprv. Electrician � signature, required: Plan review (25% of permit fee)
Print name:< Date: State surcharge (8% of permit fee) —
/� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
` . 1 days after it has been accepted as complete
j Print name: o 4,,..j li-J tl e.-771----.. Date: 5//6 / • Fee methodology set by Tn- County Building Industry Service Board
/ •• Number of inspections per permit allowed
I \Budding\Pemuu\ELC- PermitApp doc 12103 440- 4615T(l0 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ri✓ �� ry' ^"'^RRi157'^X"�'-� �'. 5<�u.�
:45- OP[I Y :T ` `. Zg x
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:
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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation.
❑ 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
t \Bmldmg\Pemuts\ELC- PerctutApp doc 04/03
Building Fixtures ,
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No )1 2 -'O' 37
13125 SW Hall Blvd., Tigard, OR 97223 Date/By. �i07K/
Plan Review Other Permit No
Phone: 503 639.4171 Fax: 503.598.1960 //m ', A Other
24- Hour Inspection Line. 503.639.4175 ■ c� W Date Ready/By tuns ® See Page 2 for
Internet: www.ct.tigard.or.us Notified/Method. Supplemental Information
- `!: ` :` �' _- TYPE�OF- :WORK , - . - a'. :-r. FEE *. SCHEDULE S : " ' .
. - .. - _ - - ' ';". r;`H , _ r ; ': Pik;--' - .'. . . ... .,
❑ 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` CONSTRUCTXON,` , ,+;ii " ;i °d, ' ^ SFR (1) bath 249.20
❑ 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 •INF�ORMATION;AND LOCATION , ° _ -' 4, ,. '
- ..., =�" -. , v - Site utilities
Job site address: /3,2!9/ Kt) tI)CO rfi2£_ 4/ Catch basin or area drain 16 60
City/State/ZIP. �t4 D ! O2 C17� :3 Drywell, leach line, or trench dram 16 60
Suite/bldg. /apt. no.: I Project name: Footing drain (no linear ft • ) Page 2
Cross street/directions to job site: Manufactured home utilities 110 00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft ) Page 2
Subdivision: I Lot no Water service (no linear ft. ) Page 2
Fixture or item
Tax map /parcel no.:
- _ DESCRIPTION,OFWORK",-- r �_ ;;a.
Absorption valve 16.60
��_ ��'`� Backflow preventer Page 2
Ft v (pint 2v / I ail roil 11 / $75 /'.®•it'P,/i �� i9,1 44.1,4 Backwater valve 16 60
� /„- O VO o/ Q v , /IM E`' o em - . 1 i. or / Clothes washer 16 60
(lam e T �l'1 Dishwasher 16 60
tlP ?il aoo.qi _ ,
::',-1,.::, , , _, , ._ - Dunking fountain 16.60
PR R O ;NX , ❑,xTENAT T, , -, .
O . • Ejectors /sump 16.60
Name: � Expansion tank 16.60
Address: 13 Z y / �Oli DWI 2t- Fixture /sewer cap 16.60
City/State/ZIP: _ f (9A Floor drain/floor sink/hub 16.60
Phone: ( sh3) (2 ' - gCZ `Z Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
. , 1 APPLICANT _ _ `. - ❑- CONTACT . PERSON -
Ice maker 16 60
Business name: Lja66zerz... Interceptor /grease trap 16.60
Contact name: Medical gas (value $ ) Page 2
Address: . 040 /4601/E. 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
.. .0 ONTRACTOR a •.---�. ; ,
ck �� ,�� - �'t � k � � - � � ' "^ t :, , =,�.; =. , r Water closet 16.60
Business name: ff ea.-6 Water heater 16 60
Address: ' fit 4-5 AlterVF Other
City/State/ZIP: Subtotal
Minimum permit fee $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee• $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: ��,,,^ �(.4_,,,e_6„..,_ TOTAL PERMIT FEE -
Print name(n,) (A) t-(c.e_L- _ Date: 9//6/01 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
1 \Building\Pemuts\PLMF- PermnApp 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 - 1 ° 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
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
Subtotal: $50 00 and up $742.00 for the first $50,000.00 and $1 20 for
each additional $100.00 or fraction thereof
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Dnnking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refng. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
\Budding\Permns\PLM- PemutApp doc 3/03
CITY OF TIG/A - 24-Hour ,
BUILDING Inspection Lines (50a)- 639 -4175 MST �Gr� - �v a37
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested a - 3 pp AM PM BUP
Location i.3a I _ 'i 1 Suite MEC
Contact Person - 7:4 � - Ph ( ) 3 ' — gS 6'o PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain S X 96 °-od 4 f 0 I ELR
Crawl Drain I
Slab Inspection Notes: SIT
Post & Beam r-- - ---- -. _____ - - --
Shear Anchors - - -
Ext Sheath/Shear �� �� °� . �- - Q Iy- ----
Int Sheath /Shear • _ _ _--? - -- _,-`- _ „ __ _ _F
Framing
Insulation
Drywall Nailing �-,
Firewall /VV CA
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
, -$� P . - T FAIL
:
Post z : �: m
Und: :b
Row!
Wat: '•ervice
Sani . Sewer
Rain II rains
Cat Basin / Manhole
St. Drain
Snow: Pan
other:
- ASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
1 1 0 'n - Amin
. 1 MEV - ART FAIL
inlEff ICAL
n
'.lab
tage
Alarm
O I
° PART FAIL D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: / El Unable to inspect — no access
Fire Supply Line
ADA c?
Approach/Sidewalk Date O .2 3— G) • Inspector 1 Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIG 24 -Hour _
BUILDING Inspection Line" (56P 639 -4175 a ( / ' �0���
INSPECTION DIVISION Business Line: (503) 639 -4171
n BUP
Received Date Requested b � � AM PM BUP
Location / 2 7' / v1J71 - tr S Suite _ MEC
l
Contact Person Y rc- Ph ( ) a 'f E 6 Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 7 ELC
Footing
Foundation _ ELC
Access:
Ftg S / d , / ELR
Drain cQ 7 "
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam _
Shear Anchors �� r s, r
Ext Sheath/Shear ti + - l':. 6716
�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling I �}
Roof 1 14 � 1
Other:
Final•
PAS ART FAIL
P BI
eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth -
SS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ECTAICAL
ervice
Rough -In
UG /Slab
Low Voltage
Fir larm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date ■ Inspecto 3 �"` J Ext
Other:
Final DO NOT REMOVE this inspection record from the j site.
PASS PART FAIL