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9430 SW CORAL STREET STE 100-1 00 #Paa3S 1ea07 MS m76 5 u A <JJ (Crl C' n O 1 N i M ♦L CD i f,. 9430 SW Coral Street #1n0 BUILDING PERMIT CITY OF TIGARD PERMIT#: BUP2002-00227 DEVELOPMENT SERVICES DATE ISSUED: 6/19/02 13125 SW Halt Blvd.,Ticiard. OR 97223 (503) 639-4171 PARCEL: 1S126DC-04400 SITE ADDRESS: 09430 SW CORAL ST 100 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 007 JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: FPS FIRST: sf N: S: E: W: Y— TYPE OF USE: COM SECOND: sf _ _ PROJECT OPENINGS? TYPE OF CONST: 5N sf N: �S: !E W OCCUPANCY GRP: S TOTAL AREA: 0.00 sf ROCF CONST: FIRE RET? OCCUPANCY LOAD: 85 BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: _ READ SETBACKS _ REQUIRED _ FLOOR LOAD: psf LEFT: ft RGHT: ft ~� FIR SPKL_ SMOK DET: DWELLING UNI rS: FRNT: ft REAR: ft FSR ALRM HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 5,200.00 Remarks: Add Sprinkler below new suspended ceiling for TI. Owner: Contractor: MARTIN, ROBERT CLARE FIRESTOP CO THELMA M 9384 SW TIGARD ST BY JO RENE M MOODHE TIGARD, OR 97223 SVyFPFiRWOOD, OR 97140 one: Phone: 620-6140 Reg#: LIC 63846 FEES _REQUIRED INSPECTIONS _ Type By Date Amount Receipt Fire Alarm Permit Requirec PRMT CTR 6 12/02 $100.90 27200200000 Sprinkler inspection S 5PCT CTR 6/12/02 $8.07 27200200000 prinkler Final PLCK CTR 6/12/02 $40.36 27200200000 Total $149.33 This permit is issued subject to the regulations contained in the Tigard Municipal Gode State of OR Specialty Codes and all other applicable law 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 wort; is suspended for more th-in '180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAP, 952-001-0010 through OAR 952-901-1987 You may obtain a ::opy of these riles or direct questions to OUNC by calling (503) 246-6699 or 1-800-332-23,14. Pe mt ittee Signature: Issued By: Call 6394175 by 7 p m. for an Inspection the next business day a Building Permit Application CIt O� Tigard d Uatereceived: -OZ.. Permit no.:(�U�' �0.) -0 2- 7 ity j`'l �rILUGr Project/appl.no.: Expire date: e;ityn(Tigard Address: 13125 SW Ball Blvd� Phone: (503) 639-4171 TTS! Date issued: B Receipt no,: Fax: (503)598-1960 lQQI C, l Nn r Case file no.: _ Payment type: Land use approval: __ 1&2 family:Simple Complex: rMA 1=1 ❑ 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New constntcl ion U Demolition 16 Addition/alteration/replacement M'cnant impimenu:ntpre sp—n'n a alarm ❑Other. Job address: Bldg.no.: Suite no.: Lot: I Block: Subdivision: _ Tax map/tax lot/account na.: Project name: aJ%+[ L --1�0 L Z6MN __.,C.e . Description and location of work on premises/special conditions., AP-P 'ki'(I.R1` hilt.1 5a4ae� Name: Mailing address: I & 2 family dwelling: City: I State: ZIP: Valuation of work........................................ $ Phone: I ax: _ Email: No.of bedrooms/baths................................. _ — Owner's representative: Total number of floors................................. Phone: Fax: E-mail: New dwelling area(sq. ft.) .......................... Garage/carport area(sq.ft.)..............I.......... Name: Covered porch area(sq.ft.) ......................... Mailing address: Deck area(sq.ft.) ........................................ City: Slate: ZIP: Other structure area(sq. ft.)......................... Phone: Fax: E-mail: Comrnerciallindustriallundti-family: Valuation of work........................................ $ Existing bldg.area(sq.ft.) . _ Business name: figee, Co Address: q 3 84 S� T[� 4 New bldg.area(sy. fl.). City: ?-�� IJ _ State: ZIP:_��LL Number of stories..... _ Phonck:IA 4p ax:,G.4-f2e41 E-mail: ` Type of construction. �`--" FOccupancy group(s): Existing: New: City/metro lic.no.: Notice:All contractors and subcontractors are required to he licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to he licensed in the A --- - jurisdiction where work is being performed. If the applicant is Address: State: 'LIP: exempt from licensing,the following reason applies: City:Contact person: Plan no.: -- I'hwte: — - I-ax: I E-mail: Name: Icontact person: _ Fees due upon application ........................... $ Address: Date received: City: State: _ ZIP: Amount received $ Phone: Fax: E-mail: i Please refer to fee schedule. hereby certify I have read and examined this application and the Net all jurisdictions except credit cards.Menu cull jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this ovist ❑MasterCard work will be complied wA,whe Sryefedhereinor not. Cmdit card number: Fx in Authorized Sigure: - - Date: � D c or n on credit era Print name:` L�_LA V ` _. c r sipwture s Amount Notice:This permit application expires if a permit is not obtained within 190 days ase;4 has been accepted as complete. 440461;(tWCOM) Fire Protection Permit Check List IBA� ❑ New _❑ Addition U Alteration ❑ Rer .) Modification to sprinkler heads only: Describe work to I 1. 1-10 heads: No plan review required. be done: 2. 11+ heads: Plan review required. Number of sprinkler heads:_ Additional description of work: Type of System Corn A, B or C as applicable D ❑ A. Sprinkler Wet 6� _ --Standpipes ---- Addit'.onal Hazard Group Information Densit --- ,�--- Desi n AreaK. Factor __ ----- - �� Sprinkler Project Valuation: $ B� p I - Hood_Fire Suppression System — Hood Pro qct Valuation I $_= C.)_Flr,i Alarm -- — Submittal shall _Battery Calculations Yes ❑ Include: Individual Component Yes ❑ _ Cut Sheets _-- - -- _ Fire Alarm Pro ect Valuation: $ _ _ Project Valuation Subtotal �A, B 8 C : $ — Permit fee based on valuation see chart):-_ $ 8% State Surcharge: $ $. elf FLS Plan Review 40% of Permit_ $ TOTAL: $ - Plan review requires a completed application and 3 sets of plans at submittal. Plan review fees are required at submittal. "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. IAdsts\forms\FPScheckhst.doc 11/21/01 • ;� r y e AgEMFire systemsSprinklers "Automatic" Sta • • Glass Bulb Sprinklers Model • Pendent N UL Listed- FM Approved* a� 2-7132' 2-7rj2" t 10 Upright Sprinkler !Y Pendent sprinkler "Temperature Ratings: Discharge Curve: 155-F •: 111 1750 F(790 C) / 11 11 • 45 (310) iH ii:=::::::::::a::�i:: /El 35 ■urur rrau• r■rr u• ■ ■uu Open • rating) ■■u•■■■o•r.■cruor■ or■rrr■■■■r uro ■muu■■■u■u ■■■r.rr■r■■ ru■ :■rr••■ rwr ■ •uuu■: "Finishes: 30 ::::E:::::::�Elsar a EEd t•:::: ■ •�:E, •o�nnE ■_ ■ . ■■■■ r■■■ r•rr • ■u r■■■r o■ •oro■ ••. orrruu :::?::•:r :::::s:::: ► Plain Brass 25 : ::ea:E:EEi as:::::R 0 White (138) :::e ::::: ::::::•:: 14 #t# El : . ■ :-0 Coro Coated (Vlax) B�E:� EEEEa: E. E::ae;sa::T. .a..:..:r::.:::::aa�$s �i..... ■ Coro • • • • ■■■■■■•R••rrrrrrrrrr rrr■ • 5El1 1 25 35 40 • • :• &scft**I go,Iw+.I ly White finished sprinklers are=FM Approved. See backof page for • •' rating,ture andfloish combirdtions. killir r t 1 01987, 1989 Figglo Intemational1 { t ' Fire systems Sprinklers • utomatic" Standard Glass • Modelulb Sprinklers ListedN UL FM Approved* co Upright . Pendent "Temperature Ratings: Y 1550 F •: ■ 2000 • 45 ••es esaa�a{ssEE •sas•••••• •s•••e• .. . .... ... ... . ::::E:E:: �E:E :s:EEEEE ---E1E 35 ------EEEI� E =E g EEE4**Finishes: 30 �lE E :::::::::::::::::::E::;•: :r •;:::: E:eEeeE 'EEEcEEEEiaE:sEF '� � � ase.. ■ 25 : ■ :.:. .� : ...... .. . ....:e . ..... 1 Chrome ' • (Bright) CL 20 E:::�r.':.::EEEE:Er 0 White ee'seE:EEEEieeEei�si'sEEias EEEEEEEEE D Bright EaEEEli : EEE� . •. . EEEE5 10 15 20 25 30 35 40 E �EEE =� E =E $EEE � ElEE ! ■ Dischafq%In g*V�L White finished sprinklers are=FM Approved. ON See back of page for available style, teTpera- ture rating, ki I . d � O O Q G U C M M h i 0 0> M © A V V tf d m m U m r; o 0 o rJ O p O O N S N Z N ti CO .. M 0 c? 0 ' ry a 9 0 o N a N � N ,a c m a it ) O U AlF- .C: m �.+ a F- tL >� d o 2 _L rL N p m m a a a� rn p C! N N LL 0 C 0 NNp N N Z O O O � n a M m m uo U) uo �+ C IliO a a a ^ 5. N ao U h m m m O C) Q ~ F- Y r lA T a n. Lou CITYOF TIOARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT-#: CWR2CO2-00191 13125 SW Hail Blvd., Tigard, OR 97-.23 (503) 639-4171 DATE ISSUED: 6/11/02 SITE ADDRESS; 09430 SW CORAL ST 100 PARCEL: I S126DC-04400 SUBDIVISION: LEHMANN ACRE TRACT "ZONING: C-P —_BLOCK: _ LOT: 007 _ JURISDICTION: TIG TENANT NAME: BOGUMIL, HOLZGANG & CO. USA NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: .1 EDU increse. Previous fixture count was 81.6, this permit adds 2 fixture values for a new total of 83.6 fixture values or 5.2 EDU's for an increase of .1 EDlYs. Owner: MARTIN, ROBERT CLARE FEES THELMA M Type Ey Cate Amount Receipt BY JO BENE M MOODHE PRMT CTR - 6/11/02 $2.30.00 2720020000o SHERWOOD, OR 97140 — —_---— _ Phone: Total V $230.00 Contractor: Phone: Reg #: Required Inspections I This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued The total amount paid will be forfeited if the permit expires. The Agc ncy does not Guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement gives the installer shall prospect 3 feet in all directions from the distance given If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utilitv Notification Center. Those rules are set forth in CZAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987 Issued by: !t r r _ Permittee Signature: L f Call (503) 639-4175 by 7::00 P.M. for an inspection needed the next business dda Y YOF T I G A R D _— PLUMBING PERMIT QEVELOPMrK7 SERVICES P'PMIT#: PLM2002-00207 13125 SW Hail Blvd. .. .ard, OR 97223 (503) 639.4171 DATE ISSUED. 511102 PARCEL: 1 S 126DC-04400 SITE ADDRESS: 09430 SW CORAL ST 100 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 007 _ _ JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES_ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN GRAIN: ft Remarks: Add 1 bar sink FEES Owner: __ -- - Type By Date An.ount Receipt MARTIN, ROBE=RT CLARE_ FRMT CTR 6/10/02 _ $72.50 2-000200000 THELMA M 5PCT CTR 6/10/02 $5.80 27200200000 BY jO RENE M MOODHE �__--- SHERWOOD, OR 97140 Total $78.30 - Phone 1: Contractor: CRAFT\NORK PLUMBING INC 7736 SN.'NIMBUS AVE BEAVERTON, OR 97008 REQUIRED INSPECTIONS Top-out Insp Phone 1: 644-8698 Final Inspection Reg #: LIC 79666 PLM 20-148PB This permit is issued Subject to the regulations contained in the Tigard Municipal Code, State cf OR. Specialty Codes and all other applicable laws. All work will be done in accordance with apps oved plans. This permit will expil e 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 by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued E3yl 1. �,� Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day 1,11T (IM' '1'1GAND X002 Phmbing ' .� .t . i ��I•4w.�OYi - 'S/ yi f'/111Yt t�.:1� 1 O.y of Tigard yetva per mi[ao.: 13 uildlni pormlt ao Addmaw. 131259W NA Blvd),n ud,ORM* pro)�appl.no. Expire dnt r rks Phone: (303)439.4171 Peat: (503)598-1960 '. l i Y Uk Dataiwjed 8y. Rsamv no.: .and use approval _r Cue fl"ao.: Paymem : 01 d:2 family dwulung of Cgmme><dWrtdustrial 0 Maid-fug ':y Tonimt impmvament 0 New eooatr 1c" AddidcuWttlrododreplacmneat Q Food acts v t.7 Ofty Jab aMmu, S.✓ czraf Do 0. Freea. Tow >3 no.: oU_-1L? Joe e.rare,� dm ttr ) Tax mapAn lof&mmt na SPR(l)b _. Lot alocic - Su4dfvlaim: ft*q -- ��� tc en DwAptim and o of WO&on momism: __ lldteotllkleat -- `,([ Catch bttsidmea linin Fst.dace of on; q-- act_ing (na anufacoxed bome Will etTat ltDttainAae tuna: m to es ----- Address: 1 _ n caonaotor - !h Statt: Z>F�� �'am borer no��� p{► P'aa: 1-toad' storm smr no.Ed fit) OCB no.: ' 6 Plumb.bus_ no: p uer c•(a� Ci /rtheho Nc-na: Ph two or kap: Caft>tcsas't ,anauivA Ab.'r>Ki ---- aCIC now pm"_enter tltOr Kim rlliota: Date: ::,f Nr 6 a�hwaahGr — _Atk mu; -- n�ountain _- cl 1:: �- 1 Stam, 123P. txroralwm _ Phos: RX on ixtu newer ItMai w willAaeffir rMW Fax: H.tnai- n tor/ ate- --- -- - Owtkr hhata4�tlonhtsaldentiti maintenance on y: ; e acarol instillation Prime a will be rnaete by rrte or the maintenance oral repair made by my terAm convnencia1) thmployee Ce the pMpaty I own a$prx ORS Chap'wr 44-,,. s), 2, al r9 s) Ownses Dare um __—_ ---Tit-6M—O- TWJiowor_pan - - - Name: VA-w—a-0sa— ��F Addrow.. _ —t—�_ waterTieetar PMtthx -T—Sx.- s �1S rrr.Q: n„ wan.,am. Minimum fat_..............S slot eti 1slrAs a�eA1 aedlt oaeK t l Notice;This permit appllcadan ...r D wu 0 MrsAi-xd expitns i t a poRrmit is not obtained Ptah ro mh (al ____ 9.. S civet cut Mwaw - - whhln IR6 Aays afl�it las boon Stats surcharge(896) -..s aeoepied as ooropleu. TOTAL .......................3 IL-- —'��-t�r�__..�_-- -��wa.p +ca•Me taoacaw4 CITY OFT IGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BLIP - Received -.�.. __-- Date Requested___ d- AM PM _ _ BLIP -- Location Suite-----,/ �i _ MEC -- - - Contact Parson ------ ------c=�— - Ph ( _--) �� � C� Cc PLM Contractor— ------- ---- Ph(---- ? -- SWR BUILDING Tenant/Owfier -_. -- _--__—— __ - ELC Footing -- -- --- - Foundation ELC Fig Drain Access: - —- Crawl Drain A',3 ELR — 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 --- - — inal PASS_ PART FAIL - PL�JMBING --- --V Post& Beam ---- Under Slab _- Rough-In _ — -- ---_- -- Water Service Sar't:iry Sewer - -� Rain Drains - Catrh Basin/Mar hole --- 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 JoitngP ire Alarm SS -- ------- �n L] Reinspection fee of$_— required before next inspection. Pay at City Hail, 13125 SW Hall Blvd PART FAIL SITE _ _ _ PleaLc/allffreinsp ction RE: Unable to inspect-no access Fire Supply Line ADA -- '4""�Approach/Sidewalk Dat6 _ —. lnsRscta -Ext Other; _- --- �-_ ----- Final DO NOT REMOVE this Inspection record from the Job $Ite. PASS PART =AIL RMIT- CITY OF TIGARD -- ELECTRICALRESTRICTED ENERGY RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: EL.R2002-00146 13125 SW Hall Blvd..Ticiard, OR 97223 (503) 639-4171 DATE ISSUED: 7/31/02 PARCEL: 1 S126DC-04400 SITE ADDRESS:09430 SW CORAL ST 100 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C P BLOCK: LOT: 007 JURISDICTION- TIG Proiect Description: Thermostats (11)for HVAC. _RESIDENTIAL B.COMMERCIAL _ AUDIO &STEREO: AUDIO&&STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: MVAC: X PROTECTIVE SIGNAL..: INSTRUMENTATION: OTHER: TOTAL#OF SYSTEMS: 1 Owner: Contractor: MARTIN, ROBERT CLARE ROTH HEATING &COOLiNG THELMA M 6990 S ANDERSON RD BY JO RENE M MOODHE CANBY, OR 97013 SHERWOOD, OR 97140 Phone: PI-,-►ne- 503-266-1249 Reg#: L.ic 14008 ELE 3.314CRE FEES Required Inspections Type By Date Amuunt Receipt _ _ Low Voltage Inspection PRMT CTR 7/31/02 $75.00 272002.0000 Elect'I Final 5PCT CTR 7/31/02 $6.00 272002.0000 Total $91.00 This Permit is issued subject to the regulations contained in the Tigard Muniapi I Code, State of OR. 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 by the nregon Utility Notification Center. Those rules are set forth in OAR 952-0,11-0010 through OAR 952-701-0080 You may obtain copies of these rules or direct questions to OUNC at (503) 246-1987. � Issued by 111�'� ���i.>.r 1G�,:LL�, t Pei rnittee Signature _ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. lead ,or rent. OWNER'S SIGNATURE: _ _ _ DATE: CONTRACTOR INSTALLATION_ 'NLY SIGNATURE OF SUPR. ELEC'N: _ _ DATE: LICENSE NO: _ 'yti - I�l L !�L Call 6384175 by 7:00 P.M. for a,i inspectio needed the next business day Electrical Permit Application Datereceived: '7 3, Permit no.: LL/� ) w City of Tigard Project/appl.no.: Expire date: City rfTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 Date issued: By:,98 I Receipt no.. Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: UI &2 family dwelling or accessor; U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteiatiun/replacement U Other:_ U Partial Job address: / <' Bldg.no.: Suite no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: — Project name: / scription and to x4on of work on premises: - ---- Estimated date of completion/inspection: Job no: Fee Max BUsineSs name: Description QMy. (ea) Total no.insp Address: New residential-single or multi-family per dwelling unit.Includes attached garage. City: AUState ZIP: / Service Included: Phone Fa E-mail: I000 sq.ft.or less 4 CCB no.: Elecbus.tic.no: _ Each additional 500 sq.A.or portion thereof — Limited energy,residential — 2 City/metro tic.no.l 1-imitedenergy,non-residential _ 2 Each manufactured home ormodulardwelling Si nature of supervis n electrician(re uired) Date Service and/or feeder 2 Sup.elect.name(print): License no: servicesorfeeden-Insfallallon, allenlion or relocation: 200 amps or less 2 Name(print): 201 amps to 400 amps - 2 Mailing address: 401 amps to 600 ams 2 Ci : 601 amps to 1000 ams 2 �_ StatC: ZIP: Over 1000 amps or volts 2 IAIAPhone: _ Fax: E-mail: Reconnect onlyI Owner instailatlon:The installation is being made on property 1 own Temporary services or teeden- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation: ORS 447,455,479,670,701. 200 amps or less 2 Owner's signature: Dat 201 amps to 400 amps 2: 401 to 600 amps 2 Bench circuits-new,alteration, Name: orextenalonper panel: l 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 Phone: Fax: E-mail: of service or feeder fee,first branch circuit: 2 21 Each additional branch circuit: Misc.(Service or feeder not Included): U Service over 225 grips-commercial U Health-care facility tach 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 fouror Signal circuit(O or a limited energy panel. U System over 600 volts nominal more residential units in one structure alteration,orextension• 2 O Building over three stories U Feeders,400 amps or more *Description: U Occupant load over 99 persons U Manufactured structures or RV park U Egress/lighting plan U Other. Fecin x tal Inspect Ion ower the allombk In any of the above: Pet inspacectionion --�--�--1-- Submlf T,acts of plans With any of the above. Investigation fee The above are not applicable to lellI otrary conalrudion seMce. Other — --- Not all Jurisdirtions weep"credit cants,please earl jurisdiction for more inromMlon. Notice:This permit application Permit fee.....................$ U visa U MasieWard expires if a pernit is not obtained Plan review(at %) $ (-dcvli"card number. within ISO days alter it has been State surcharge(8%)....$ Expires accepted as complete. TOTAL . $ Name of r, older ass "Ti wn on c it r — S �Cartlh.dder siarrMure — p 441-4615(64)(t" o( j) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEE Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Number a t�s f�low:s r Restricted Energy Fee...................................................... $75.00 spa permit allowed (FOIL ALL SYSTEMS) Service Included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq.ft.or l3ss $145.15 4 ❑ Audio and Stereo Systems` Each additional 500 sq.ft,or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy _ — $75.00 Each Manufd Home or f Arv:;Aar Dwelling Service or roader $90.90 ❑ Garage Door Opener' Services or FeAders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocalior 200 amps or less _ $80.30 2 201 amps to 400 amps $106.85 2 ❑ Vacuum Systema* 401 amps to 600 amps $160.60 2 601 amps!o 1000 amps —_ $240.60 2 Other Over 1000 amps or volts $45465 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $7.5.00 200 amps or less $6685 2 (SEE OAR 918-200-260) 201 amc- 400 amps _ _ $100.30_ 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, T see"b"above. ❑ Audio and Stereo Systems Branch Circuits New,alteration or extension per panel ❑ Boller Controls a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee, Each branch circuif $6.65 2 C] Data T31ecommunication Installation b)The fee for branch circuits without purchase of service or feeder fee. ❑ Fire Alarm Installation First branch-;Ircult _ $46.85 Each additional branch circuit $6.65 d HVAC Miscellaneous ❑ (Service or r .der not Included) Instrumentation Each pump or irrigation drele $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems 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 Nurse Calls Per hour $62.50 In Plant _Y _ $73.75 ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total ofabove fees $ Other 8%State Surcharge $ .____Number of Systems 25%Plan Review Fee See"Plan?3view'section on $ No lic.ensns are requireu Licenses are required for all other installations front of application Fees: Total Balance Due $ Enter total of above fees $ 5,0 _ ❑ Trust Account# ----- 8'/.State Surcharge : _ ` Total Balance Due : All New Commercial Buildings require 2 sets of pla I y,1sis`finnis`.elc-ices tloc OW If,01 CITY OF TIGARD CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2002-00216 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 6/18/2002 PARCEL: 1 S126DC-04400 ZONING: C-P JURISDICTION: TIG SITE ADDRESS: 04430 SVS/CORAL ST 100 SUBDIVISION: LEHMANN ACRE TRACT BLOCK: LOT:007 CLASS OF WORK: ALT TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: 85 TENANT NAME: BOGUMIL, HOLZANG & COMPANY REMARKS: Tenent Improverrzmt Owner: MARTIN, ROBERT CLARE THELMA M BY JO RENE M MOODHE S 5JOC�5q�ob�140 Contractor: 656-4111 RENAISSANCE CUSTOM HOMES 1672 WILLAI IE'TTE FALLS DR WEST LINN, OR 97068 Phone: 557-8000 656-4111 Reg#: LIC 130449 This CF-tificate issued 9'26/2002 grants occupancy of the above referenced buiidir-if or portion thereof and confirms that the building has been inspected for compliance with the State of Oregon Specialty Codes for the group, occupancy, and use under which the referenced permit was issued. BUILDING INS ..C7OR BUILDINS OFFI __ POST IN CONSPICUOUS PLACE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST _-- c7 BUP Received _ ___Date Re�uested— AM— -PM BUP Location MEC —_ Contact Person --_ U — Ph(_—_—) S �� _ 5� PLM Con ---- Ph SWRFoa ring ----- — _ BUILD G Tenant/Owner —_ ELC Foundation ACC@SS: ELC ---_-------�- - Ftg Drain ELR Crawl Drain ------ -- Slab Inspection dotes: SIT Post&Beam — --- Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing ---- - �.-_-- ----- Insulation - Drywall Nailing ✓�C C i��% r J C .t✓ - ----- --- -- Firewall T �- Fire Sprinkler - - _-. ---- -- —- -- - - —_- - -- Fire Alarm Susp'd Ceiling ----- — - -- _—_-- Roof Other: -- -- --- ------- ne,> ----- ASS_PART FAI-L — — -- -------- - - -- PLUMBINGi 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 Rainspection fee of PASS PART FAIL $-- ----- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE _ _--- '�] Please call for reinspection RE _--_ _ — Unable to inspect-no access Fire Supply Line ADA Da4� � ® Z tor6 -_ � l�- � �Approach/Sidewalk Inspef. ��-- Ext Othr Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL a CITY OF'� IGARD 24-Hour BULDING Inspection Line'- (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 �j MST Received __--Date Requested. BUP _ '_�c'=D— AM -- PM — Location . BUP—�� 3 ��L✓� -- --SuiteZC�� MEC Contact Person . Pf, S�� , �— - Contractor__--_— —_ --- Ph ( ) — ------- —__ SWR Tenant/Owner —� --- Fonting _ --- ------- -- --- - ELC _- ---- - Found!:tion ELC Ftg Drain Access: Crawl Drain ELR Slab Inspection Notes: SIT Post&Beam - Shear Anchors - -- — ---- -_- Ext Sheath/Shoa ---- --- - -- Int Sheath/Shear' �- Framing - Firewall Fire Sprinkler Fire Alarm - i - Susp'd Ceiling Root - ---- -- ------- Other. -�..----- ---- Final CAR PASSFAILPLUMB _— --�- --- Post&Beam Under Slab - Rough-In - Water Service Sanitary Sewer ---- --. _._- - _- ---- --- ------ - Rain Drains Catch Basin/Manhole Storm Drain Shower Pan "'-------- - - ----- - Other: - Pinel --- PASS PART FAIL MECHAPIICALr"�� �-0 Z�;1--- (� �� Z 62, --- -.�_ Post& Beam - -.---__-- _ Rough-In - ras Line - ----- / Smoke Damper: - --- Find PASS PART r AIL _- ELECTRICAL -- - - --- Rough-In ----------- ------- UG/Slab - _-- ---- ---- _ - _- Low Voltage -- - Fire Alarm - __-_------ ------- - -.��_- -- - --- Final - -- PASS -PART FAIL Reinspection fee of$___ required before next inspection. Pay at City Hall. 1312.5 SW Hall Blvd. SITE - F] Please call for reinspection RE:___-_ Fire Supply Line c, -- ---- - -- --- Unable to inspect-no access ADA Date O L— Approach/Sidewalk sato- L 2 l�z Other. _. Inspector - ^ Ext _ - t nal DO NOT REMOVE this InsPoction record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUIXING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BLIP Received / Date Requested AM_-___ pM BUP — Locationj�� Suite__��cMEC ` Contact Person Ph(--) _ _ Contractor Ph(--) PLM— SWR BUILDING _ Teriant/Owner ELC Footing _ — --— -- Founuauon ELC Ftg Dain Access: - Crawl Dra;n ELR Slab Inspection Notes: SIT – Post& Beam -- --- -- ----- Shear Anchors y----- - Ext sheath/Shear ,---- Int Sheath/Shear am r — nsulation - -- Drywall rJailing _.��. , S ! 1�_ v u c" Firewall � — Fire Sprinkler Fire Alarm Susp'd Ceiling � �..-_(�� A/ Root l Other: oTtZl N rc f! t L c� l ti �/vt / //_v ci'`1 Final r PASS PAII FAIL _ `�-- PLUMBING —� I Post&Beam _ Under Slab Rough-In ------ Water Service _ Sanitary Sewer - - -- ['7 ( � vim ✓ C��/�'✓� c c r Rain Drains Catch Basin/Manhole U Q / -- Storm Drain --- 1 Shower Pan Other:— ------- �•�'��''��— - - Final-PASS PART FAIL T- F MECHANICAL Post 8 Beam - -- Rough-In --- Gas Line Smoke Dampers - Final — PASS PART FAIL_ ------ -- EL_ECTRICAL_ Rough-In UG/Slab Low Volta I Fire Alarm --- __-- ---- ------- Fin;al PASS PART FAIL Reinspection fee of$._— pnili—H before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE - Please call for reinspection RE:_ _ Unable to inspect-no access Tiro Supply Line ADA Approach/Sidewalk Data Other: L � Inspector �� 4t — Ext--—- Final - PASS PART FAIL OO NOT (REMOVE this Inspoetieln record from the job site. CITYOF TIGARD BUILDING PERMIT PERMIT#: BUP200- 00216 DEVELOPMENT SERVICES DATE ISSUED: 6/18/02 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-04400 SITE ADDRESS: 09430 SW CORAL ST 100 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 007 JURISDICTION: TIG REISSUE: FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? _ TYPE OF CONST: 5N sf N: S: E: W_ OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 85 BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: REQD SETBACKS REQUIRED _ FLOOK LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP AGC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 70,000.00 Remarks: Tenent Improvement Owner: Contractor: MARTIN, ROBERT CLARE RENAISSANCE CUSTOM HOMES -fHELMA M 1672 WILLAMETTE FALLS DR 13Y JO RENE M MOODHE WEST LINN, OR 97068 S�koonee: OR 97140 Phone: 557-8000 Reg #: i-iC 130449 FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Mechanical Permit Require PLCK CTR 5131/02 $377.13 272002.00000 Electrical Permit Required Sprinkler Permit Required FIRE CTR 5/31/02 $232.08 27200200000 Fire Alarm Permit Requirec PRMT CTR 6/18/02 $580.20 27200200000 Plumbing Permit Required 5PCT CTR 6/18/02 $46.42 27200200000 Framing Insp Firewall Insp Total $1,235.83 Gyp Board Insp Susp Ceiing insp Final Inspection This permit is issued subject to th4 regulations contained in the Tigard Municipal Code, Slate of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approveo 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 r^quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503)246-6699 or 1-800-332-2344. Permittee -- , Signature: Issued By: .. zze�_ u � Call 639-4175 by 7 p.m.for an Inspection the next business day Building Permit Application_ City of Tigard Datereceived: - 1-()Z_ Permit no.: City ofTigard Address: 13125 SIN Hall Blvd,Tigard,OR 97223 Projecl/appl.no.: Expiredate: Phone: (503) 639-4171 pate issued: Fax: (503)598-1960 1iY - llcceipt no.: Case file ut,.: Payment type: Land use approval: I&2 family:Simple Complex: ~� -------------- XU a 111911111M ❑ 1 &2 family dwelling or accessory ❑Commercial industrial U Multi-family U New construction U Demolition O Addition/alteration/replacement XTenant improvement U!'ire sprinkler/alarm U Other: Job address: 9' Q JU _COXA I t I Bldg.no.: Suite no.: 100 ��►' Block: Subdivision_: Tax ma �AL_AC '2 p/tax lot/account n Project name: o.: S / DC-py 03 � �Y �'i co 13 Description and location ol'work on premises/special conditions.- 6 1 A I S onditions:A/,,q/S 1 SAN Mailing address: I L7 �yW Lv 1 &2 tamlly dwelling: \ Gty: (V State ZIP:9706 Valuation of work.... Phone: -br ha_-Z -/Lol E-mail: _ No.of bedrooms/baths................................. -- Owner's representative: 8 �L �� Total number of floors. _ jr;j S7-�ftQ [:mail: New dwelling area(sq, ft.) - Name: - Garage/carport area(sq.ft.)............... - — — � Covered porch area(sq.ft.) ................. Mailing address: Deck area(sq. ft.) ................................ . City: _ Zip: Other structure area(sy•R•).........._ _ _ Phone: F;tx:� m E-mail: Comereial/induatrial/multi-famliy_: Valuation of work -2 oc Business name: A/Y� Existing bldg.area(sq. ft.) .................... —/ / Address: -- New bldg.area(sq. ft.)................................ City: State: z-1P Number of stories..............................I......... Phone: Fax: E-mail: Type of construction.................................... V-N CCB no.: ---- — Occupancy group(s): 1 Existing: City/metro lic.no.: — `— New: JILITHM Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: �, E-, ,(�AUS AiZ provisions of ORS 701 and may be required to be licensed in the _Address: !Sc. jurisdiction where work is being performed. If the applicant is City: CAA_LA IYAS State Z(p; 70/� exempt from licensing,the following reason npplies: Contact person:`DCr ItA4S 6 Plan no.: c3 2 Phone:&y(._4 Fax: _ LZ Email: Name. _ Contact person: Fees due upon application ........................... s_ Address: Date received: _ _ City: -- State: 7.l1': Amount received ........................ f'honc: f a.x: -- _ — E-mail: — _ Please refer to fee schedule. I hereby certify I have read and examined this application and the Na all jurisructiom accept credit cards,please call jurisdiction for more inronnation. attached checklist.All provisions of laws Wd ordinances governing this U Visa ❑MsstetCard work will be compliedcher ed herein or not. Credit card numrrer: Authori?.ed signator:: __ L Dale: �—O Name M cardholder as shown on credit card Print name:.—Y7 --- — ('ardholdcr ri�rrattue Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4441613 rfro(11roM) Commercial Plan Submittal Requirement Matrix City of Tigard TYPE OF SUBMITTAL # of Plans (Includes New, Additions or Alterations) Required at Submittal Site Work 4 (rnust include location of all accessible parking) Plumbing - Site Utilities 2 Building �* Fire Protection System 3** Mechanical 2 Plumbing - Building Fixtures 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over-the-counter commercial tenant improvements, submit 2 sets of plans. New fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level -'3" technicians. hdstsVorms\COM-matrix doc 9/24/01 r • •-Y . Wr , e1.i0 • ewr -• „iY, I �ry I i S 4,46 E 2 30 a nuln nmr b Lj I I 7 I ' SS gI-Vulp. Rlry i' S4A S-0 e Ig � V 1 • - I II 6c I V/ S 4 --�� z oo i __,;, I I � I S4 �-�E /30 -I men nm! -L14�(( w I I II�, MrvIIBUI! . 54 Ae JS o F:gWp. lila 1 + 541+E /0,0 i I_A " I I .. I :Lobby,' CITYOF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2002-00242 13125 SW Hall Blvd.,Tigard, OR 97223 (.503) 639-4171 DATE ISSUED: 6/6/02 SITE ADDRESS: 09430 SW CORAL ST 100 PARCEL: 1 S 126DC-04400 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: FIRE DAMPERS?: 30 -50 HP: REPAIR UNITS: GAS PRESSURE: 50+ HP: WOODSTOVES: FURN < 100K BTU: _ AIR HANDLING UNITS CLO DRYERS: FURN >=•100K BTU: <= 10000 cfm: OTTER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Alteration to existing HVAC. Addition of ducts and grills. Owner: _ FEES MARTIN, ROBERT CLARE Type By Date Amount Receipt THELMA M PRMT CTR 6/6/02 $305.80 272002000(_ BY JO RENE M MOODHE ' SHERWOOD, OR 97140 5PCT CTR 6/6/02 $24.46 2720(_2000(_ Total $330.26 Phone: Contractor: ROTH HEATING &COOLING 6990 ANDERSON ROAD CANBY, OR 97013 REQUIRED INSPECTIONS Final Inspection Phone:503-266-1249 Mechanical Insp Reg#:LIC 14008 Duct Inspection Misc, Inspection This permit is issued subject to the regulations contained in the Tigard Municipal 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. Al TENTION: 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 obtai opies of these rules or direct questions to OUNG by c ing (503)x"46-91 39. Issue By: Permittee S;gnature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day w Mechanical Permit Application Dale received -tZQ�/ Permit no.:1'} City of Tigard Project/appl.no.: Expire date: CityajTtgard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: :Bi Z i� Receipt no.: Phone: (503) 639-4171 Fax: (503)598-1960 Case file no.: Payment type: Land use approval: Building permit no.: U I &2 family dwelling or accessory U Ceniniercial/indusuial U fvlulti- :� rally U Tenant improvement J New construction U AddiIiou/alteealtonlreplacenle'it j Utlicr. --- 1 luh udder s: r (: Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite nu- Tax e value of all mechanical� materials,equipment,labor,overhead, profit. Value ` N K� Tax mit tax lot account no.: _ Lot: Block: Subdivision: 'See check�lst for imf.ortant app,icntion inforn .tion and _ jurisdiction's fee schedule For residential permit fce. Project name: City/county: _ ZIP: Description and location of pork on premises F�(�) Total - - Deacrf on Ql . Res.only Res.only Isl.date of co pletion/inspectidn: L Tenant improvement or change of use: Air handling unit _CPM Is existing space heated or conditioned?3'�cs U No Air:on icon ng(sue p an required) Is existing space insulated?U Yes U No ATeration of existing C system _ R er compressors State boiler permit no.: Business name: ✓ - HP Tons BTU/H Address: f it smo a ampere/ uct smo a erectors ___ City: State- �=' ZIP: cat pump(site p an requlre ) E mail: nstal replace urnace urner Phone:'(j� Fa Including ductwork/vent liner U Yes U No CCB no.: nsta rep ac re ocate eaters-suspended. City/metro lic.lto.: wall,or floor mounted _ Vent for app lance of er t an urnace Name(please rint): T e gerst on: Absorption units Bum Chillers lip Name: I1P Com ressors Address: Frivironinental exhaust and vent at on: Clty: State: ZIP: Applituu•cvent — Phone; Fax E-mail: jlryel cx aust — Ifoods,•type res. .tc ell azmat hood I ire suppression system — Name: r t?xh_tust fan with single duct(bath fans) F, Txiiallst. stem a art from heaun or Mailing address: /C y Ue p p ng an dr ut on up to 4 outlets) Citv: r�,� State• ZIP:r �� .I.Yp: L P(i _- NG _— Oil Phone: Fax: E-mail: Pur. i in each ad itional over outlets rocessp�ping(schemalicrequired) Number of outlets No ='� ter IisteA app!lance or eq�q pment: < ;A-coralivefireplace _Address: _ State:Q ZIP: / nsen- type CitY: oo slov pe et stove Phone % ` F E I: cr: Applicant's signature-1 l- Date: t Name (print): -J Permit fee.....................$ Not all jue.sdictions accept c it cods,0lease cell f,nisdidion for nwrt inrcrtnatiat. Notice'.'r srmit application PP lication Minimum fee................$ U Visa U MasteWnril expires if a permit is not obtained plan review(at _ `yn) $ credo card number -- aplms - within f g0 days after it has been — State surcharge(8�)....$ - --— -- accepted as complete. Name of cudholder u shnwn on cmdit card TOTAL .......................$ 'f' ••�{a Cidhrder altnalure $ Amomt 4401617(NOaK'OM) ,4w MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMI r FEE: Description: v Price Total $1.00 to$5,000.00 _ Minimum fEe$72.50 Table 1A Mechanical_Co_de 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 includin ducts&v mts 14.00 fraction thereof,to and Including 2) Furrace i0^,000 TU+ $10,000.00. _ incluiing ducts& ents 17_40 $10,001.00 to$25,000.00 w $148.50 for the first$10,000.00 and 3) Floor`urnace $1.54 for each additional$100.00 or includiL.q vent _ 1400 fraction thereof,to and including 4) SusponCed heater ­all heater -05,001 $2___ $25,000.00. __ _ I or floor mounted heate _ _ 1400 5,1)01.00 to$50,000.00 $379.50 for the first$25,000.00 and 1 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 $50,000.0_0. __ _ __ 1215 an $50,001.00 d up $742.00 for the first$50,000._00 and Check all that apply: Boile', Heat Air $1.20 for each additional$100.00 or For items 7.11,see or PumTond fraction thereof. footnotes below. Comp Minimum Permit Fee$72.50 - SUBTOTAL: $ 7)<3fiP;absorb unit -� to 10K BTU _ 140-) 8'/.State Surcharge a 8)3-15 HP;absorb unit 100k to 500k BTU 25.6u 25%Plan Review Fee(of subtotal) E' 9)15-30 HP;absorb Requirc4d for ALL commercial permits only unit.5-1 mil BTU 35.00 TOTAL IA COMMERCL PERMIT FEE: a to)30-50 HP;absorb uni! 1-1.75 mil BTU 52.20 --- ..-- -- ------- 11)>501­111,absorb unit>1.75 mil BTU 8120 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 1000 Value Total 13)Air handling unit 10,000 CFM+ Description: _ _ lit Ea Amount _ _ 17.20 Furnace to 100,000 BTU,including 955 ducts&vents 14)Noit-portable evaporate cooler _ _ _.-.- 10.00 Furnace> 100,000 BTU Including 1,170 ducts&vents 15)Vent fan connected to a single duct 680 _ _ Floor furnace Including vent 955 _ Suspended heater,wall heater or 955 16)Ventilation system not included in appliance permit 10.00_ floor mounted heater _ _ Vent not included in appii.ence 445 17)Hood served by mechanical exhaust eimlt ___ _- - 10.00 Repair units ^ ._�- _-_ - --_80F __-_-- 18)Domestic incinerators ___ _ 17.40 _ 3 hp;absorb.unit, 955 to 100k BTU 19)Commercial or industrial type incinerator t 3-15 hp;absorb.unit, --- - 1,700 - ___ - 69.95 - 101k to 500k BTU 20)Other units iding wood stoves 15-30 hp;absorb.unit,501k to 1 2,310 - _ 10.00 mil.BTU 21)Gas piping one to four outlets 30-50 hp;abs,trb unit, 3,400 1-1.75 mil.BTU 22)More than 4-per outlet(each) _- 1. >50 hp;absorb.unit, - 5,725 00Minimum 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 cooler656 TOTAL. RESIDENTIAL PERMIT FEE: a Vent fan connected to a simile duct �446 Vent system not Inrluded in R56 - _�e^-�---- Hood served by mechanical exhaust 85: Other Inspection _and Fees. Domestic Incinerator _ 1,170 1 Inspections outside of nounal business hours fmirumum charge-two hours) $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 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-hnlf hour',$62 50 per hour Each additional outlet - 83 -- - -'- -'- 'State Contractor Boller Certification required for units>200k BTU. TOTAL COMMERCIAL s "Resldentlal NC requires site plan showing placement of unit. -VALUATION ---- All New Jommerclal Buildings require 2 sets of plans. ildsts\forms\rnech-fees.doc 12/26/01