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Case File I I w N Qf (A I D � N 3 D c i i1 � i 13265 SW Ash Avenue CITY OF TIGARD 24-Hour BUILDING Inspection Line: 503 639-4175 / INSPECTION DIVISION Business Line. (503)639-4171 BLIP Received -� / _Date Re nest __ `�' Z(C __ AM_—____ PM _ - BLIP Location — 1-5.) 1� _ - ----- 67be --_Suite------. -(-/ �C MEC _--_ Contact Person __-__ ! Ph(— )� �� PLM Contractor — _ _ Ph SWR ELC Foo mg --._ ____-------- Foundation 9" -- ELC Ftg Drain K Access: ELR Crawl Drain _ Slab Inspection Notes. _. SIT P^st& Beam - - -- - -- -- -- - iear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing ---- -------- Insulation Drywall Nailing Firewall — Fire Sprinkler -- — Fire Alarm � � Susp'd CFAinq ( —_ ----- --- - Hoof Other. -- - -- - -- -.--. fin ASS PART FAIL — - - -- ---- -- Post& Beam - Under Slab Rough-In Water Service -- -- ---------- -- _ — Sanitary Sewer Rain Drains - --- -- _ Catch Basin/Manhole Storm Drain - — --- -- Shower Pan Other -- ----- - -- Fir* rc iT FAIL - ----- — ------- - HA^ _—�— —_— ----- — - Post& Beam Rough-In Gas Line �'-- S Se Dampers --- ----- - _ _ _- .iraa4-- PASS PA FAIL _ __ — --- -- --- -ft TRI A Rough-In -- - -- ---—-- ---- -- - - UG/Slab Low Voltage _.�------- --- --- -- - __ —__-_�—� Fir m <19;.1z' ❑ Reinspection fee of$— ^_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd ASS PART FAIL Please call for reinspection Ri=: Unable to inspect -no access Fire Supply line i ADA �� Approach/Sidewalk Dft� L_.. I► spectotr ��='`G!C ti__LL�1 Ext Other: Final DO NIOT REMOVE this lnspectior: record from the job site. PASS PART FAIL - MECHANICAL. PERMIT CITY O F TIGARD DEVELOPMENT SERVICES PERMIT#: MEC2001-00435 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/3/01 PARCEL: 2S 102CA-00244 SITE ADDRESS: 13265 SW ASH AVE SUBDIVISION: VIEWCREST TERRACE ZONING: R-4.5 BLOCK: 02 LOT: 001 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMPRESSORS HOODS: _ FUEL TYPES 0 - 3 HP: DOMES. INCIN: LI'G 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: OD GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS C FURN >=100K BTU: <= 10000 Cf m: — OTHER UNITS: > GAS OUTLETS: 10000 cfm: Remarks: Furnace replacement. Owner: FEES —_ LARRY STONE Type By Date Amount Receipt 13265 SW ASH PRMT CTR 12/3/01 $72.50 272001000C TIGARD, OR 97224 5PCT CTR 12/3/01 $5.80 272001000C Phone:503-684-9014 Total $78.30 Contractor: MR FURNACE HEATING INC 16285 SW 85TH AVE TIGARD, OR 97223 REQUIRED INSPECTIONS __ Mechanical Insp Phone:684-9014 Final Inspection Reg #: L IC 87907 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable lows. Ali work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. YOU may obtain copies of these rules or direct questions to OUNC by calling Issue By: .mak.;, _ `Z /, Permittee Signature: r= Call (503) 639-4175 by 7:00 P M. for inspections ne ded the next business day Mechanical Pernit!Application Date received: �� ) I Permit no.:A)�f- City of Tigaru ProjecUappl.no.: Expire date: ('to,ofTigard Address: 13125 SW Hall Blvd,-q4fard,OR 97223 Date issued: LB Phone: (503) 639-4171 Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: suuding permit no. U I &2 family dwelling or accessory 0 Commerciat/industrial U Mulli-family U Tenant improvement U New construction U Addition/alteration/replacement U t Wicr:.JOB SITE INFORMATION tOMMILACIAL VAI I 1 Job address: ' ' ;, (,y L)f Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit. Value$ -_ Lot: IBIock: I Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit liar. City/county: ZIP: 7 Z Z Description and 166ation of work on premises: t i c eZr2f l Fee(ea.) Tolal Est.date of completion/inspection: Dewririplion Qly. Res.only Res.only Tenant improvement or change of use: Is existing space heated or conditioned?U Yes ❑No Air handling unit CFM Is existing space insulated?U Yes ❑Noit conditioning(site plan require-3i) 8 P Alteration of cxfsting A,system Boiler/compressors — ------ Business name: State Moiler permit no.: HP Tons BTU/H Address: - 71 -J 5 /,<" o,a Firc/smoke dampers/duct smoke detectors City: Slate ZIP: C? eat pump(site plan require ) Phone: Ci/ Fax: c - '7 Email: nsta rep ace urnac u r n e r _ / Including ductwork/vcnt liner Yes U No _ CCB no.: 7 nsta I rep ac rbc eaters-suspe City/metro tic.no.: /, �' _ wall,or floor mounted Name(please print): 1 1 S Vent fora lianre other than furnace Refrigeration: Absorption units_. BTU/H Name: Chillers HP Address: t Com ressors___ HP nvirommental exhaust and ventillstrow City: - r, V State: ZIP: Appliance vent 14 Phone: l,lr E-mail Dryerexhaust ----1— -^ loods,Type res.kitcherdhazinal hood fire suppression system Name: 1-A r Exhaust fan with single duct(bath fans) Mailing address: j }� �� Exhaust s stem apart from heatingor AC City: ; Stalr ZIP: c�7_» ue p p ng an n ut on(up to outlets) -t -- = Type: LPG NO Oil _ Phone: ! ' 1 Fax: E-mail: I Uuel pipingeach additional over 4 outlets rocess piping(sc emat c required) _ Name: Number of outlets Other listed applGince or equipment- Address: qu pment-Address: _ Decorative fireplace City: State: ZIP: nsert-type Phone: I Fax: E-mail: oo stov pe et stove Applicant's signature: pate: / O er. _ ter: Name (print): oU (dw e — _ Na all jutisdictionn arcera credit cards,please call jurisdiction for more information Permit fee.................�$ on U Visa U MaSICK'ald Notice:This permit not obtain _ Minimum fee................$ --- Credit card number _ expires if a permit isnot obtained Plan review(at _ 10 $ ---- Etpires within ISO days after it has been State surcharge(8%) ....$ ti W-' -- ------------ Name of cardholder as shown on credit card accepted as compete. TOTAL . $ 7'1..30 cardholder signature — Atnmttnl 4004617(GIOaICI)MI MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FERMIT FEE: Description: — - Price Total _$1.0_0 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Oty (Ea) _Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents -� 14.00 fraction thereof,to and Including 2) Furnace 100,000 BTU+ _ $10,000.00. includingducts&_vents 17.40 $10,001.00 to$25,000_.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or Including vent 14.00 fraction thereof,to and Including 4) Suspended heater,wall heater $25,000.00_ _ or floor mounted heater 14 00 — $26,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or �— _ 6.80 fraction thereof,to and including 6) Repair units __ $50,000.00. 12.15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cund _ fraction thereof. _ footnotes below. Comp Minimum Permit Fee$72.50 SUBTOTAL: 7)<3HP;absorb unit $ to 100K BTU 14 00 8%State Surcharge $ 8)3-15 HP;absorb unit 100k to 500k BTU 2560 -— - 9)15-30 HP:absorb 25%Plan Review Fee(of subtotal) $ unit.5-1 mil BTU 3500 Required for ALL commercial permits only- - -- -- ---- - 10)30-50 HP;absorb TOTAL. COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52 20 11)>50HP;absorb unit>1.75 mil BTU 87 20 — - --- _ 12)Air handling unit to 10,000 CFM ASSUMED VALUATIONS PER APPLIANCE: _ 1000 Value Total 13)Air handling unit 10,000 CFM+ Description (]tom Ea Amount 17 20 _ Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler l ducts&vents _ 10.70 Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct T ducts&vents` 680 _ Floor furnace In Juding vent 955 16)Ventilation system not Included In — Suspended heater,wall heater or 955 10.00 floor mounted heater a 17)Hood served bby liancey mechanical exhaust _ _ -_ Vent not Included in applicance 445 - 1000 ennit 18)Domestic Incinerators - - Repa r units 805 _ 17 4n <3 hp;absorb.unit, 955 to 100k BTU 19)commercial or industrial type incinerator -- 6995 3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU _ 1000 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets 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 frill.BTU Air handling unit to 10,000 cfm 656 — --- Air handling unit>10,000 cfm 1,170 8%State Surcharge $ Non-portable eve orate cooler 656 _ Vent fan connected to a sin leduct 446TOTAL RESIDENTIAL PERMIT FEE: $ Vent system not included in 656 _ appliance permit Hood served by mechanical exhaust 656 Other Inseectlons and Fees: Domestic Incinerator 1,170 1 Inspections outside of normal business hours(minimum charge-two hours) Commercial or Industrial incinerator 4.590 eper hour Inspections 2 Ins Inspections for which no lee is specifically indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 $72 50 per 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)$72 50 per hour Each additional outlet 63 ------- *State Contractor Jolter Certification required for units>200k BTU. TOTAL COMMERCIAL ! "Residential A/C requires site plan showing placement of unit. VALUATION: i _ All New Commercia!Buildings require 2 sets of plans. i\fists\forms\mech-fees doc 08/29/01 CITY O� �I��® MECHANICAL PERMIT _ DEVELOPMENT SERVICESPERMIT#: MEC2002••00043 DATE ISSUED: 1/2.5/02 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S102CA-00244 SITE ADDRESS: 13265 SW ASH AVE ZONING: R-4.5 SUBDIVISION: VIEWCREST TERRACE JURISDICTION: TIG BLOCK: 02 LOT: 001 - CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS — HOODS: FUEL TYPES '0 3 HP: DOMES. INCIN: 3 15 HP: COMMI_. INCIN: %FIG MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: !nstall gas furnace (Water Heater being done under Minor Label), gas piping 1 outlet and 1 vent. FEES Owner: -- LARRY STONE Type By Date Amount Receipt 13265 SW ASH PRMT CTR 1/25/02 $72.50 272002000C 71GARD, OR 97224 5PCT CTR 1/25/02 $5.80 272002000C Total _ $78.30 Phone:503-684-9014 -- Contractor: - MIDWAY HEATING CO 12625 SE SHERMAN PORTLAND, OR 97233 REQUIRED INSPECTIONS _ Gas Line Insp Phone:252-4003 Mechanical Insp Reg#:LIC 00024044 Heating Unt Insp Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipai Code, State of Ore. Specialty Codes 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 work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952.-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189. Issue By: ' i 1„ll�l Permittee Signature: _(' i, 1 1C _ — Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day 1 MIDWAY HEPTItK; 5032525e8l. P.01 ;5 0.35 AA 19 0 1.1 CIT' OF T1 6 46C. City of Tigard Projectlappl.W.: Rxpimdatc; AdElfew 1317.53W Hall Blvd. NR"97k4002I 11"Nirm.. (503) 639-4 t i I bl�Olz 11 71Uo=9.4.u.'el,I'd, P1 rot, (5 ,9tqDJN6 Far., 01) 599.19()0 lie no., I------.-- rKli Payt", u WON -------- I Land Ilse approvill: Building Petnut ni., 1011ft I.; .j i &,i ramoy rtw,vi,)A or acw'.toly Cl conlilietclaViridtisuial 0 hifild-family MfR, a I MUM mran I i 1 t t 4,3 90mv: "7z lndicme equipment quantities in two)xm below. ludichte tIve&Alo -.;,r 2, 1-1 1, 4z L 4:4A.- __ fl,jr.no! ( Suite no., vahe of all mechanical materials,equipment, labor,overtitcid. . , 'lap.ril� -suntn%i*t profit. V3)uo S "See checklist for important application information and hIv;t nal ne fee schedule for residentialpoxinit LN)PrOROSPW .rt 03"t fiLprownrip-lit of change of use: Ali handling unit CFM ONo Is existifir -Ali�0-5071-hTa i 41 te,Plan rmuimd]I' APACC Ul Yea Q No 06M pmwrs ao.; HP ,'%d4tvvj1 1262') Sji,' to.,:to ri lo I -r-'et,i5ii�(site P an tv.qu I- js��t�� .-6R ZIP: 1xf,:-M 13 -7WF--.r ins n cefurns ami 0 0 Includin ductwoikNitnt liner MYesUnANo I -su CU3 lie: 2 4 0 4 4 1910- 7nudgfip Z relor- I"fWvlOrU1jv-IIO-: 1 *102 wall�or floor rijoun" aw e4w ioi illi!): ancentherthariftim.a.cc Absorption waits131UH HP 5Aroe KP Applian ON"! I tc ctvent R- - Susi—_.r hood fits suppression srystr.m Now; DIblust fah with tingle dw(both fans) Nome; - -J. _�!dj#Zby�n_4A W'Ai� --, Fuel p1ping Owd dUtribullou(tip t4 4 OutIC713 — Tvpc-: —LPG NO Oil I e f P I&0�rij 6 G-aoveri 0 N umber of o i Lieu app7lioce Oppq lottlis Deconifive"Is" -_qT4 Woo 5-t_O—vej�W etstavo ture- OVIII A IS Ano -I- -Ntrttw AL T Z, 111.�S_.__...... q __ PP1mtl fee... .. .............. r�Cmfcv*.ww,w0jummixi for aw_g;�c�oz NoticeTh permit aicWioll rj ym a MsdT X, d irpirns ifa ptrnilt is not obtaineA Nflnift.lurin fee...•.•....• S Aw Plan mi,,w(at 1X-1 S 13—irws within I go days after It ba beta 14-r-m-L-4 ViAk" 4 sicciepted m compMe. TOTAT. .................... 1 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 AOT INSPECTION DIVISION Business Line: (503) 639-4171 BLIP Received _ Date Requested_ � � AM_____—_ PM __— BUP —— --- Location __ 5 Suite MEC n 6 Q- 00 0 3 Contact Person Ph( ) b D 3— PLM Contractor-- ._..— — Ph ( ) .— SWR -- — BUILDING Tenant/Owner �_ _ __ ____ ELC --- ---- Footing — -- -- ELC Foundation Access: G �--`^^ ELF! Drain r/ j' / ---__- — ------- Crawl Drain — — Slab Inspection Notes: SIT --- Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing -- Insulation Drywall Nailing -- _---- Firewall Fire Sprinkler — Fire Alarm Susp'd Ceiling Roof Other: - Final PASS PART FAIL PLUMBING_— -- Post& Beam Under Slab ----- - - - Rough-In Water Service -- --- Sanitary Sewer Rain Drains -- - - Catch Basin/Manhole _ Storm Drain -- - — Shower Pan Other: Final FAIL4=& Beama- Rough-In ost ----- _- —_ Gas Line Smoke Dampers -- --- - - - FAIL — --- _ .. _. -- Service_ ------------ Rough-In Low Voltage Fire Alarm ak)PART FALL Reinspection tee of$ required before next inspection. Pay at City Hall, 13125 SW Hall F)Ivd. Please call for reinspection RE: _ u Unable to inspect-no access Fire Supply Lire / ADA <-7? Approach/Sidewalk Dab / Inspector Ext _ _...... Other Final DO NOT REMOVE this Inspection record from the job s1te. PASS PART FAIL CITYOF T I G A R D _ MASTER PERMIT PERMIT#: MST20--00118 DEVELOPMENT SERVICES DATE ISSUED: 2/19/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 13265 SW ASH AVE PARCEL: 2S102CA-00244 SUBDIVISION: VIEWCREST TERRACE ZONING: R-4.5 BLOCK: 02 LOT: 001 JURISDICTION: TIG REMARKS: Kitchen, bath and laundry remodel. BUILDING REISSUE: STORIES. _ FLOOR AREAS REQUIRED SETBACKS_ REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMFNT: sf LEFT: SMOKE DETECTORS: TYPE OF USE: S!" FLOOR LOAD: SECOND: 51 GARAGE. sf FRONT: PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: rINBSMENT: sf RIGHT: VALUE. S '.Duo uo OCCUPANCY GRP: R3 BORM BATH: TOTAL: nun sf REAR: PLUMBING SINKS: WATER CLOSETS: 0 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 0 DISHWASHERS FLOOR DP.AINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: 1"UBISHOWE.RS'. I GARBAGE DISP. WAI ER HEATERS: WATER LINES: BCKFLVI PREVNTR: GREASE TRAPS: MECHANICAL OTHER FIXTURES: _ FUEL TYPES FURN:100K: BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER: FURN> 100K: UNIT HEATERS: HOODS: OTHER UNITS: IAAX INP: ulu FLOOR FURNANCES: VENTS: WOODSTOVES GAS OUTLETS: ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS _BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 10011 SF OR LESS: 0 200 amp: 0 200 amp: W'3VC OR FDR: PUMP11RRIGATION: PER INSPECTION: EA ADD'L 500SF 201 7 10 amp: 201 - 400 amp: isl W/O SVCIFDR SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 000 amp: 401 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HM13VC/FDR. 001 1000 amp: 801-amps-1000x, MINOR LABEL: I 1000.amplvoll PLAN REVIEW SEC TION Reconnect only: —" 1=4 RES UNITS: SVC/FOR> 225 A. 1 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY_ A.SF RESIDENTIAL S.COMMERCIAL _ AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO. FIRE ALARM: INTERCGMI:IAGING: OUTDOOR LIIDSC LT. BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR HVAC: DATA/TELE COMM. NURSE-;ALLS: TOTAL M SYSTEMS: Owner: Contractor: TOTAL FEES: $ 253.26 W ASH AVE This permit is subject to the regulations contained in the LESLIE DEMERS OWNER Tigard Municipal Code,State of OR. Specialty Codes and TIGARD, ASH OR 97223 13265 all other applicable laws. All work will be done in accordance with approved plans This permit will expire if work is not started within lou cdy c of issuance,or if the work is suspended for more tnan 180 days. ATTENTION Phone: Phone. Oregon law rsquires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg" forth in OAR 952-001-0010 through 952-001-0080 YOU may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS PLM/Underfloor Electrical Final Plumb Top Out Plumb Final Electrical Service Final inspection Electrical Rough In Framing Insp Issued By ; a Permittee Signature : zt - L '`^ _ Call (503) 639.4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application 11)aterccei�,ed:lo t 0 tar Petmitno.: ST City of Tigard R RUV E D ojecUappl,no.: Expire date: Address: 13125 SW Hall Blv _ CltyojTigurd fate issued: B Receipt no.: Ut Phone: (503) 639-4171 Y�� f -� Fax: (503) 598-1960c Case file no.: Payment type: J Land use approval: 1&2 family:Simple Complex: U I & 2 family dwelling or accessory U Corn mercial/industrial U Multi-family U New construction U Demolition Pil Add ition/al teration/replaccment U Tenant improvement U Fire sprinkler/alarm U Other: musm r `v Job address: l Bldg.no.: Suite no.: Lot: Block: 2 I.Igubdivision: C Cl S 7- T v Tax map/tax IoUaccount no.:2510 2 CA -OQZ y, Project --- Description and location of work on premises/special conditions: rNF.0RMAJ1'.ION' USEJ111ECKLIST ;K� �G �• ( �� . r.�.aT�r.r�� __ iin Name: 1&1- v—I r S Mailingaddress: ' _ ) v 1 k 2 family dwelling: w � � City: C _ State:Q ..I ZIP: -5 Valuation of work $ 6 ( Phone:. � y Fax: E-mail: No.of bedrooms/baths................................. Owner's representative: rotal number of floors... ................... ......... Phone: Fax: E-mail: New dwelling area(sq.ft.) .......................... G arage/carport area(sq.fl.)......................... Name: orch area(sq.ft.) ......................... Mailing address: (sq, ft.)City: State: 'LIP: cture area(sq.ft.)......................... Phone: Fax: E-mail: Commerclal/indwstriaUmultl-family: Valuation of work........................................ $ Existing bldg area(sq. ft.) .......................... Business name: fv)Vv _ N C� New bldg.area(sq.rt.)................................ Address: — ---- ` Number of stories Stale: ..................................... City: _ - Phone: I'ax: E-mail: Occupancy of construction.................................... CCB no.: Occupancy group(s): Existing: New: __ City/mctro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 101 and may be required to he licensed in the Address: —`- jurisdiction where work is being performed If the applicant is City: State: ZIP: exempt from licensing,the following reason applies: Contac:person: Plan no.: — Phone: Fax: I E-mail: Name: Contact person: Fees due upon application ........................... $ Address: Date received: _ City: State ZIP: Amount received ......................................... $ Phone: Fax: - I E-mail: — Please refer to fee schedule. 1 hereby certify I have read and examined thi application and the Not art jurisdictions Kvw credit cards,please call jurisdiction for nun infnmrntion. attached checklist.All provisions of laws and ordinances governing this U Visa U MasterCard work will be complied with,whether specified herein or not. credit card number:- — _ / Authorized signature:________, Date: _ —Nen r of earamldet as shown on credit card — Expires S Print name: Cardholder slitnalme �- Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. aur-013(&MCOM) t`yylt-` 7 One-and Two-Family Dwelling Building Permit Application Checklist Referenceno.: -- Associated permits: (ire(if Tigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW Ball Blvd,Tigard,OR 97223 U Other Phone: (503) 639-4171 - - Fax: (503) 598-1960 r r FOR PLAN REVIEW Yes No N/A f band use actkona completed.Scc.lurixdtcuon cru' oa lur curetment rC%l(''A' — 2 Zoning. Mood plain,solar balance points,seisnuL mils designation,histort 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. J - 7-Water district approval. 8 Sails report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required.Include drainage-way protection,silt fence desi;,n and location of catch-basin protection,etc. 10 3 Complete nets of legible plans. Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he 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 he completed if copyright violations exist. I I Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if there is more dian it 4-11.elevation differential•plan must show contour lines at 2-I1.Intervals):location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. I 3 Floor pinns.Show all dimensions,room identification,window size, location of smoke detectors,water heater, 1 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. _ 14 Cross section(s)and details.Show all framing-memher sizes and spacing such as flexor beams,headers,joists,soh-flour, wall construction,roof construction.More than one cross section may he mquired to clearly portray cunaruction.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 constru^.tion;minimum of two elevations for additions and remodels. 1 Exterior elevations mu.it reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size shret addendums showing foundation clevations with cross references are acceptable. _ I 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescrip!1ve-2th analysis provide specifications and lalculations to cngincerini,standards. _ 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing fixations.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 calculation:,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 comp.'anee. 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 he stamped by an engineer or architect licensed in Oregon and shall he shown to he anplicah1v to IN,project under review. 23 Five(5)site plans are required for Item 1 I above. Sitc plans must he 8-i/2"x 1 I' I I"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 he not accepted. 26 "Reversed"building plans mu,;t 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. Check;;st must he completed bcfnt,. plan review st a1 date. Mini r changes or notes on submitted plans may be in blue or biack ink. Red ink is reserved for department use only. 4614 tt KIWOM) Permit#: f' (�r Address: 3 a.ld5 S.W w-------- �_. z y: G? DG� Gate / O Issued b Statement: Information Notice to Property Owners Abo,.jt Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313: Fill1. 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 -- �� before or upon completion. ;A. My general contractor is l_ (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 a3B. 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. 1 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 herehy certify that the above information is correct anti that I have read and do understand the Int'ormation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) J (Date) (White copy to issuing agency permit file, pink copy to applicant) Information Notice to Property Owners About Construction Responsibilities !�n(r'. /h ��c•'� 1.1-l.11� l .;�;r, �� I "i��, (,111�/lA'IS U�%iN1 �' ..,i'l(i ,i�,u: li, ,�t,�r.,l:'d(I�[Cfi 0553).. _ , i;_ ., .. . , !i i, f' .. fa ��;�.� 11 ;i- :I ,f ,,li'� '1� ,� •r� .'I[1 it'�ai14'\i`�dllir.` '.ii iq� , i,l+'•I ''. :tl, 1;�us;., dt4 �� _, I; i l�lj' 1 ' L .;;i . .. ,e 1 tli .at ,Il �.Ut.iill EMPLOYER RESPONSIBILITIES: :TT ' •! %- 1 't' '!lY�.ti 15 i' I�IrINrlrr ta4'' lila: Q5 ill .,11!�`1n1's�r }'1111i�ll`;t t1'iill�n!•,i ilu' i'!1- t;i.i fl-,",fll�,�� ,�1. .,,. r ilh. 1 if t! 1till hi11iM, tatrlhe tax pa'Vvrl ntst'Vty Kyou 4 rival auti04 A& ilir.d int:�rn:ati,ln. ; <,11 lig- i 1,:ur,Wrl Papt. of iteyenue at t)4",-8091: 1, l["riPfill l.�ll`.I fit t[1'Ii1Sf'iY111'1,' tax: A�- 11;1 t,itliil `"i.� . 1:1 :1fi Ii'TllrC(I :I t:'!x li' lJlir'ilq 111Ciit 11"ilww i i'l (111 Uoi tiwit all l'x'C)r1 igni l.'fil1pllI il"til 1AW'kin WE Aparl,ynent(41-1 Ptl'an Remnine 1 178-15111 ��(11'ki.`I'�� IYH71 1f'rl!*altl(111 Y{15111'1tIlC(`: titi ,ill "ni 1,c s, ywl ;lig; i.ii Illc i)i�opi'll W14 -r.'f t'lli t'1'lsatioll I al'v ;i'Id il:t, �+f:;;:;ti1 '.ti,�Il,i'ryI�CllltllCu;,;tttl'li tll�ilia,lc'." l ,t .r ii y!'•i1 +, iI I'_,rlht:1111 worl.�'v , tldtipci'lSalllltl trt,"maitlC, tr)ll lqh�Ji, 11! X111'';"C i 1"1�r'll;iltlrti�lilrl lU 1'-l" l(;Il+h' ii l oil 1 1;Jiln .0, 1(lint'of�i'11i i+iflltliCo"n lbe, job. ror.t111Nk" 1r1t1'rlililll! . A IN GKitltr i`4 4'tti1i11:`tl'-i11U,11 16 "m to :1, 1 i ISi wt'll „l I)it,,mvi .=1 Ilavirlts; 9lrt We iit "IV 7q 8 I. A Ilderi al lZCiC11lic Svil v ivC: A,All lltl'll101XI. illiLtil w�,i111110:d i('L,ILA,d lll(.tiitli"l;Ix flt'::li V1�ylrr1 im bb hir tl'w wx payif+,m ,:i ii i! ,ru;Iwh ( a'. vtal� ilhltt'ld the t.1�. t "! '110r" ,li'i file Il'iti-mol i"Crti 1�'t it Y)U•�i29—1t)dO, OTHER RESPONSIBILITIES AND AREAS OF GONCERN: f�(A('IC!'1d1111Y14S1ii1'.l': "�.�')!'.'('k'rlillltl;tiitlt't ��tfu'1111'-l�„'Slt'.,.1, 'vn-.IfLC1l"�,i7lttlwilll�"lf,; SP`,fllblii3�',;Gl'. l;!61i: (iliTtt'Ct:(u.lt"li'lllllf�l!.1'ta', hlolly'1{i Iti Vlllu NilCliill•n thlol,lph 1n`lu't ti11i1� t i:rbilig., mid prope.dtydamilge irrstlr live: Cllllt.':t 'our fnsurarLc agcnt to SVC if Ku 11011c adcWuuti: iilsl.trall(r 0", 11"1' fi r ttit iit. tlld tsmi �1t,n� mach ;Is falling itil, pava 1 ocispivy, v ater danwr - Ircin pipe launitures. fire, or rvtwk that mwl W 1 i1na. lit "Iiircrcisv vill iltlll't".: t.l.lbIt II 11!1'. .10 lmk' iiw" .tlilr l'll id )%V(Y"' 'w►"ke. t';',corlydir+it!t+flit.•%vi ifl Ilf I'tlllc',11 1G iiilt�t1111�II Illi 111 llofifv lnlilrline I Inchk at Q al-orty '1 s st,tht•v titin lvi-fot-n the rrrquired inspectiilil., li iu lltvk the Board (IN) INV 14140, S;dvm,(,k �-1 tt) tiller � SW74421 1 l'he N(iard i', Imat.-d at 7N)Sunitywr St. NF, Suite 3iN), in saslern. �rnt± ,+ert�.n:n4 Electrical Permit application -� Datereceived: Permit no.: City of Tigard Project/appl.no.: Expire date: CityofTigard Addreft 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 — -- Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: U I &2 family dwelling or accessory U Commercial/m&i,,trial U Multi-G mily U'renant improvement U New construction U Addition/alt(•ctlnmhrl)I,t�cnu•ni U Other: U Partial JOB S11F 1 1 Joh address: tits it n .: I';tx rasp/tax Ir,t/account no.:�—m- - Lot: Block: ,Z Subdivision: _ Project name: rr,N,k — I Descriplion and location of work on premises: t PU,e c � yt AC( ^__ Estimated date t)I'completion/inspectit+0: Job no: I ec star Business name: G _ __ c 'Iota pt on Ory. (ca.) i l no.hs, New resirkntial-singk or narlti-t:.mlly per Address: dwelling unit.Includes attach"i r sMm. City: State: 11 P: Service included: Phone: Fax: I E-mail: 10(10 sq.It or less 4 Each additional 5W _ft.or portion thereof CCB no.: Elec.bus.lie.no: Limited energy,residential 2^ Cily/meln,lic.no.: Limited energy,non-residential Each manufactured home or modular dwelling Signature of supervising electrician(required) Date —� Service and/or feeder 2 Sup.elect.name(prim) License no: Services or feeders-Installation, alteration or relocation: 200 snips or less - 2 Name(print): e .t,,,.l 20!amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: t I u,� �� ,� fl---- 601 amps laslamps — - — _ 2 City: State: 'tic ZIP: _ Over IOW amps or volts 2i Phone: Fax: E-mail: Recormccl only I Owner installation:The installation is being made on property I own Iemporaryservices orfeeders- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation: 200 amps or less 2 ORS 447,455,479,670,701. / 201 amps to 4W amps 2 Owner's si nature: �� --.— Date: 1 401 to 600 amps — — z Branch circuits-new,alteration, or ettenslon per panel: Name: A. fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: _ State: ZIP: _- B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Photic Fax F-mail: Each additional branch circuit: Mist.(Service or feeder not Included): U Service over 225 amps-cominercial J Health-care facility Each pump or irrigation circle 2 U Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2 family dwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel, U System over 600 volts nominal more residential units in one structure alteration,or extension* _-_ -- 2 U Building over three stories U Feeders,400 amps or more •Descri tion: U Occupant load over 99 persons U Manufactured structures or RV park FAch addhioul Inspection over the allowable in any of the above: U F.gressnightingplan U Other: — Perinspection L--F--_ Submit_.sets of plans with anv of the above. Investigation fee The abovp are not applicable to temporary construction scryice. otter Not all jurisdictions accept credit cards,pkat.call call jurisdiction fix mae information Notice:This permit application Permit fee.....................$ U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ Credit card number: _LL_ within 180 days after it hes been State surcharge(8%)....$ �— Expires accepted as complete. - ----- TOTAL ....................... NNW NaEder u ow shn on credit card S Cardholder signature ---- -- Amomt 44n4615(6WCOM) I ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: ----------------- Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY p Restricted Energy Fee....... .. _ Number of inspections per permit allowed $7�00 (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq ft or less $145.15 4 CJ Audio and Stereo Systema' Each additional 500 sq.ft or portion thereof _ $33.40 t Burglar Alarm Limited Energy — $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $9090 2 ❑ Garage Door Opener' Services or Feeders Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 Vacuum Systems' 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 reit.ddon Fee for each system........................................... .............. $75.00 200 amps or less $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 amps $10030_ 2 401 amps to 600 amps _ $1�23 75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. Audio and Stereo Systems Brar,ch Circuits New,alteration or extension per panel ❑ Boiler Controls a)The fee for branch circuits f�1 with purchase of service or L 1 Clock Systems feeder fee. Each branch circuit _ $6 65_ 2 Data Telecommunication Installation b)The fee for branch circuits without purchase of service L� or feeder foe. L Fire Alarm Installatir- First branch circuit $46.85 Each additional branch circuit $6.65 LJ HVAC Miscellaneous Instrumentation (Service or feeder not included) Each pump or Irrigation circle $53.40 _ Each sign or outline lighting $53.40 — ❑ Intercom and Paging Systems Signal circuk(s)or a limited energy panel,alteration of extension $7500 Landscape Irrigation Control' Minor Labels(10) $12500 _—_ _ Each additional inspection over ❑ Medical the allowable In any of the above Per Inspection $62.50F-1Nurse Calls Per hour $62.50 In Plant ___ $7275 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 N 0%State Surcharge All New Commercial Buildings require 2 sets of plans. Total Balance Due iAdsts\fomss\eic-foesdoc 08/30,101 Plumbing-Permit Application Datereceived: Permit no.: City 9f Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 Pro ect/a I no.: Expire date: ('itvuJTigard phone: (503) 639-4171 J PP I _ Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: —_ Case file no.: Payment type: I &2 family dwelling or accessory 0 Commercial/industrial UMulti-family U'I enant improvement U ew contiu U Nucii:mm U Addition/alteration/replacement U Food service U Other: Description Qty.- Fee(ea.) Total Job address: 1 (p 5 St_' <lsh _ — New 1-and 2-family dwellings only: Bldg.no.: Suite no.: (includes 1000.for each utility connection) Tax map/tay lot/accou,.'.no.: _ SFR(I)bath_ Lot J Block: Subdivision: SFR(2)bath _ -- Project name: aJjl- SFR(3)bath _ City/county: j q�t ZIP: Each additional bath/kitchen Description and location of work on premises: Siteutilities: Ne f Cr ld Catch basin/area drain Est.date of completion/insprt tion: Drywells/Ieac 1 line/trench drain Footing drain(no.lin.ft.) Manufactured home utilities Business name: (�j I l: r., ! _ Manholes _—_ _ Address: Rain drain connector _ City: 5. ZIP; Sanitary sewer(no.lin.ft.) Phone: Fax: E-mail: Storm sewer(no.lin.ft.) Water service(no.lin.ft.) CCB no.: _ Plumb.bus.reg.no: Fixture or item: City/metro tic.no.: Absorption valve Contractor's representative signature: Back flow reventer Print name: Date: Backwater valve _ Basins/lavatory Clothes washer _ Name: -- Dishwasher Address: ---- Drinking fountain(s) City; _— State: InP: Ejectors/sump Phone: I E-mail: Expansion tank _ Fixture/sewer cap Name(print): Lo.3(c { i ja�1 n Floor drains/floor sinks/hub ' Garbage disposal Mailing address: t 6 7,u 5 .S,' Hose bibb City: u r b State: ZIP: f I Lz3 Ice maker Phone: ' ,, a ' s /b" Fax: E-mail: I 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, r ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's signature: Date:" " ? Sum Tubs/shower/shower Urinal _ Name: —� _ Water closet _ Address: _ Water healer City: State: ZIP: Other: Phone: I Fax: E-mail: Total Minimum fee................$ Nrtt all jurisdictiom accept oast cards,please call Jurisdiction for more Infomtadon. Notice:This permit application Stan review(at J 96) $ ❑Visa ❑MasterCard expires if a permit is not obtained credit card number:— --W— within 180 days after it has been State surcharge(896) ....$ Name of cardholder as Mown on crallt card accepted as Complete. Crdholder ripWure --� s Amount 4964616(6MCOMI PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 24amlly dwellings only: -- FIXTURES (individual) r QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink • 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT for each utility connection _ Lavatory 16.60 One(1)bath -- - _–_ $2.49.20_Tub or or Tub/Shower Comb. 16.60Two 2 t bath $35 0.00 Shower Only 16.60Three 3 bath . _— $399.00 Water Closet �— 16.60 --- --��--_ SUBTOTAL — Urinal 16.60 8°/.STATE SURCHARGE _. Dishwasher 16.60 PLAN REVIEW 25%O_F'SUBTOTAL -- 1s so TOTAL _ Garbage Disposal ------ — Laundry Tray v 1660 Washing Machine 1660 Floor Drain/Floor Sink 2° 16;60 PLEASE COMPLETE: 3'r-- 16.60 4" 1660 _ Water—Heater O conversion O like kind 16.00 Y ___Quantity b Work Performed _ Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory___ Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16,60 Water Closet 16.60 Urinal Other Fixtures(Specify) _ Dishwasher Garbage Disposal Laund Room Tray Washing Machine _ Floor Drain/Sink: 2" _ Sewer-1 st 100' 55.00 — 3" Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater _ --- Other Fixtures Water Service-earth additional 200' 46.40 (Specify) _ _— Storm&Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 ---- Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin Inspection of Existing Plumbing or Specially 6250 Requested Inspections —per/hr COMMENTS REGARDING ABOVE, Rain Drain,single family dwelling 6525 — 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 _ _Requlrad only it fixtura qtty_!otal Is>9 TOTAL S "Minimum permit fee is S72 50•8%state surcharge,excopt Residential Backilow Prevention Device,which Is$36 25+8%state surcharge "All New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. 1:\dsts\forms\plm-fees.doc 12/26/01 r" CITY OF TIGARD BUILDING INSPECTION DIVISION U'__11M' ST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ---- -- Date Requested, �T AM PM300 BLD Location ` �� Z ,SL, ` `- Suite MEC 9 r'l D U Contact Person —__ T.,�"1,'1-� Ph d �1 U/ PLM Contractor -- Ph SWR _ BUILDING — Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS _ Ftg Drain SGN — Crawl Drain Inspection Notes: - Slab -- - SIT Post& Beam // -- Ext Sheath/Shear ��-� Cel �--e_ Int Sheath/Shear ^------- - Framing Insulation ---- Drywall Nailing Firewall - —— Fire Sprinkler Fire Alarm Susp'd Ceiling --- --- ------- _ Roof - Misc _- Final PASS PART FAIL -.— PLUMBING Post& Beam _.___---- ---T --- Under Slab d Top Out Water Service �- Sanitary Sewer - --- '---— —J Rain Drains Final ; PASS PART PAIL � T Post& Beam - -- --- -_-- Rough In Gas Line -------- Smoke Dampers Yt_s__�> PART FAIL ELECTRICAL —- --- - — — Service Rough In -------- --- ----- ------ -- -- - UG/Slap Low Voltage Fire Alarm Final ---- PASS PART FAIL SITE Backfill/Grading ---� --- - - - — Sanitary Sewer Storm Drain [ J Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( )Please call for reinspection RE:_ [ )Unable to inspect- no access ADA Approach/Sidewalk ✓�' I Other Date -V,-\ � �! �/ Inspector - (_.t �� —Ext)- Final PASS PART FAIL DO NOT REMOVE this inspection record from the joh site.