Case File 1. PROVIDE A 1`-1INIMUM 8" DEEP GRAVEL FOR ALL
DRI VE-LUA Y 4RE45,
2. I"IAXIr1U!`1 DRIVEWAY 5LOFE SHOULD BE VERIFIED WITH
THE BUILDING DEPARTI"IET.T PR10)R TO CCNSTRUC:TION.
3- PRO VCE A MINIMUM 4" DEEP GRAVEL BASE FCR ALL
SIDEWALK AND PATIC AREAS, e
4. PIPE ALL 5TORr'1 pR,4IN,4GE FROM Tr,E )BUILDING TO A Z
D15P05AL POINT APPROVED BY THE BUILDING �-
DE'PAR7 ;ENT Cn
5. PROv'1DE AND MAINTAIN POSITIVE GRAlN.4CzE AWAY C)
FROM BUILL)(NG ON ALL SIDES, Ln
X
— _�_• _ r r.w�.— .� r .. Q
6. E BOUNDAi:Y AND TOPOGRAPHY IN=ORMATION - - - - - " _ ~ - - - - ----- - -
HAS BEEN PR^VIDED TO POLLARD •. HOSMAR (n
t F--
DESIGNERS, INC. BY THE CONTRACTOR, Ou.INER OR I �-------- -- ----- __- .�----, I '
ENGINEERING CONSULTANT. FOLLARDLn
DESIGNERS, INC. WILL NOT BE HELD LIABLE FOR THE N .
I I I I +�
ACC
CURAY OF THIS INFORMATION. IT IS THE SALE I I I ! �, W �
RESPONSIB;LITY O* THE CONTRACTOR TO VERIFY I I I !
ALL SITE CONDITIO, 15 INCLUDINa ANY FILLPLACEC i EXISTING i�'E IDENCE
ON THE SiTE. THE CONTRACTOR r'fUS7 INFORI`'l THIS RE N I _ rq
OFFICE OF ANY POTENTIAL FIELD 1'IODIFICATION5 I I ! �► o
I I I
NOT SPECIFIED ON THE PLANS.
'7. NON-57ASILIZED FILL Mus? NOT EXCEED 2:1 SLOPE
I I I
U)
I I I
S. EXCAVATION MATERIAL K7!"1AINING ON Si TE (S TO
BE CONTAINED BY AN APPROVED 5EDI"IENTBARRIER- I ---
t W
(FILTER F•4BR!C TENSILE, STRAW BALE SEpIME�N r BARRIER C
► I 'i G
OR EROSION BLANKET WITH ANCHORS; THE CONT,
RACTOR I C/1) Q
!"?UST VERIFY LOCATION WITH APPROPRIATE BL�11_DING EXISTING i mc�
Off=FICIAL. t I I GARAG
I - I F--
g. PROTEC=T STOCK PILES FRC.�M OCTOBER 19t THRU ``- -
A PER _.� � I
PRIL 30th R THE EROSION CONTROL HANDBOOK. I \
I i ` \` I W
I I O
10. NO CUTTING OR FILLING SHALL T
AKE PLACE WITHIN
THE DRIP LINE OF AN EXISTING TREE UNLESS THE I I w
EXCEPTION 15 APPROVED 51' THE BUILDING DEPT. I-
I I � 0 �
I I �
!I. AFTER COMPLETION OF CONSTRUCTION, THE CONTRACTOR
MUST ElTNER LANDSCAPE THE SOILS, MULCH THE SOIL ORL ---- �
SEED THE EXPOSED SOILS. ---�--- --
0
tit
HATCH INDICATES
NEW AREA TO f3E ADDED 3:
v�
a
r-
I T E F L
LOT 60 RIVERVIEW ESTATES NO. 2
CITY OF TIGARD OREGON
PREPARED FOR:
FETE 4 ERIffN
10468 SW BONANZA WAY
TIGARD, OR PH2O-160
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NOTICE: IF T4E PRINT OR TYPE ON ANY _rrl_ + I + I I I I I ► I I { I III ► { I I ► I i�r. .rj�_ r -r �r r r r I > > I I i i i -
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IT IS DUE TO THE QUALITY OF THE -- - 8L 91 lo[- ----- 11 12
ORIGINAL DOCUMENT /
Z L Z Z 5 Z No.36
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10468 SW BONANZA WY
CMASTER PERMIT
CITY �� �I����
PERMIT#: MST2001-00226
DEVELOPMENT SERVICES DATE ISSUED- 4/17/01
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171
SITE ADDRESS: 10468 SW BONANZA WY PARCEL: 2S114BC-04300
SUBDIVISION: RIVERVIEW ESTATES NO. 2 ZONING: R-7
BLOCK: LOT:080 JURISDICTION: TIG
REMARKS: Addition of 442 sq.ft. bonus & bedroom over garage
BUILDING
REISSUE: STORIES: 2 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: at BASEMENT: of LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: 442 at GARAGE: of FRONT: PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: of VALUE: $38,144.00 RIGHT:
OCCUPANCY GRP: R3 BORM: BATH: TOTAL: 44200 of 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: 1301UCMP<3HP: VENT FANS: CLOTHES DPVER:
FURN>•100K: UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOnR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: I 0 -200 amp: 0 200 amp: WISVC OR FDR: PUMPIIRRIGAnON: PER INSPECTION:
EA ADD'L 50CSF 201 400 amp: 201 400 amp: tat W/O SVC/FDR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 •600 amp: 401 •600 amp: EA ADDL BR CIR: SIGNAUPAPIEL: IN PLANT:
MANU HMISVCIFDR: 601 1000 amp: 601+amps•1000V: MINOR LABEL:
10004 ampIVolt
PLAN REVIEW SECTION
Reconnect oniv: >•1 RES UNITS: 9VCIFDR>•226 A.: >600 V NOMINAL: CLS ANEAISPC OCC
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL S.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAfTELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
TOTAL FEES: $ 872.48 1
Owner: Contractor: This permit is subject to the regulations contained in the
RUSSELL,PETER A+ERIN M DJL CONSTRUC nON Tigard Municipal Code,State of OR. Specialty Codes and
10468 SW BONANZA WAY 14345 SW SPANIEL CT all other applicable laws. All work will be done in
TIGARD,OR 97224 BEAVERTON.OR 97008 accordance with approved plans. This permit will expire H
work is not started within 180 days of Issuance,or if the
work is suspended for more then 180 days. ATTENTION
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Rego: LIC 110875 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
Footing Insp Framing Insp Electrical Final
Foundation Insp Shear Wall Insp Mechanical Final
Underfloor Insulation Exterior Sheathing Ins[ Final inspection
Merhanical Insp Insulation Insp
Electrical Rough In Rain drain Insp
r,
Issued By : i( r�zc�- Permittee Signature : f�
Chit (503)639.4175 by 7:00 p.m.for an inspection needed the next business d y
Building Permit Application
City of Tigard ° " �to
City n/Ti,gnrd
Address: 13125 SW[fall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (.iO3) 598-1960 Case file no.: Payment type:
Land use approval: I&2 family:Simple Complex:
7�Add
ly dwelling or accessory UCommerciaUindustrial U Multi-farnily La New construction U Demolition
teration/replacement U Tenant impnrvemont J Fire sprinkler/alarm U Other:
Job address: AAU WA T 4 Ar 17.2.2`/ Bldg.no.: Suite no.:
Lot: Block: Suhdivision: RisjffjAj t5krArr i'ax map/tax lot/account no.:
Project name: LuSu 11 AAA l7riad
Description and location of work on premises/special conditions: Add M614--b
Name: r j 66N
Mailing address: u flfike.02A -'-JAY- — - I&2 family dwel
City: Statc: Q ZIP: Q t/t Valuation of work. $ 0; a
Phone Fax: E-mail: No.of bedrooms/baths.. /.�, .......
Owner's representative: _�- 4415 Total number of floors _
bol I ax A I; mail: New dwelling area(sq,ft.) �f a
.......................
Garage/carport area(sq.ft.).........................
Name: DIL tkftcr - DAstO Covered porch area(sq.ft.) .........................
Mailing address: 3110C 'SU S Deck area(sq. ft.) ........................................
City: _ State: ZIP: eo Other structure area(sq.ft.).........................
Phone: I';tx: E-mail: Commercial/Industrial/multi-family:
Valuation of work........................................ $
Business name: L �a eN Existing bldg.area(sq. ft.) ..........................
Address: New bldg.area(sq.ft.)................................ _
City: mut Q Number of stories........................................
State: ZIP: Type of construction
Phone: 7 Fax: E-mail:
CCB no.: jib 017 Occupancy group(s): Existing:
New:
City/metro lie.no.: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: Palwd provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing,the following reason applies:
Contact person: &40 Plan no..
Phone: I Fax: 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 this application and the Na all iraMWkdom wmp creatt a,&,plena call ludWictim for more inrornmalm
attached checklist.All provisions of laws and ordinances governing this U visa U MuterCard
work will be complied with,whether specified herein or not. Credo card nandw:
Authorized signature:---__. Date: — Name of cw&older u oa t o
xj
Print name:_ — s
Cadhokler i4pettreAtaaaat
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440461.3(rnaaroM)
0 (o
One-and Two-family Dwelling
IBuilding Permit Application Checklist Reference no.:
City of TigardC>Ity of Tigard Assocfatedpermits:
YaElcctrical Plumbing id Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U other.
Phone: (503) 639-4171 — -
Fax: (503) 598-1960
I Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. --
3 Verification of approved plat/lot. — - - —
4 Fire district approval requircvl. — —
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 U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 _L Complete eels 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 be completed
if copyright violations exist.
I I Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if
there is rnore than a 44 elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway:footprint of structure(including decks);location of wells/septic systems;udlity 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. V
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 detnNs.Show all framing-member sizes and spacing such as floor beams,headers,joi�is,sub-flour,
wall construction,roof constntction.More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sh cathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. /
Full-size sheet addendums showing foundation elevations with cross,references are acceptable. V
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for /
non-prescriptive path analysis provide specifications and calculations to engineering standards. v/
17 Floor/roof framing.Provide plans for all fioors/roof assemblies,indicating member sizing,spacing,and hearing /
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered /
systems,sec item 22,"Engineer's calculations." V
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. J
20 Manufactured floor/roof truss design details.
21 Energy Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required
for four or more appliances.
22 Englunr's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ^/
architect licensed in Oregon and shall be shown to he applicahle to the project under review.
23 Five(5)site plans are required for Item I 1 above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are required fee Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ors,
26 No rolled,reversed or mirrored building plans will be accepted.
27
7
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Red ink is reserved for department use only. 4404614(;AacoM)
I --
Electrical Permit Application
Date received: Permit no.:
City of Tigard Project/appl.no.: — Expire date:
Cifygf igard Address: 13125 SW Hall Blvd,Tigal-d,OR 97223 Date issued: By: f eceiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
;New
&2 family dwelling or accessory commercial/industrial U Multi-family U Tenant improvement
construction A(irlition/alteration/replau,ment U Other: U Partial
aJJress: (� (,� Bldg. no. Suite no.�_ Tax map/ax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises: &Aw Abe.*, 1 f3o4(b G M 4
siated(late ol'completion/inspection: ..q7 - 15- 61 m
,lob no: Fee Max
Business name:
Description (AY. (ea.) Total no.fns c
New residential-single or multi-family per
Address: dwelling unit.Includes attacked garage.
city: m6lqua State: X ZIPA-7019 Serviceincluded:
Phone: t, Fax: E-mail. l(wo sy a or less t
Bach additional 500 sq.ft.or portion thereof
CCB no.:Iaq ITAWElec.bus.lic.no:Jq1A1 C34fVS Limited energy,residential 2
City/metro lic.no.:adW Li mi ted energy,non-residential 2
Each manufactured home or modular dwelling
Si nature of sit rvising electrician(requited) Date Seryice and/or feeder 2
Sup elect nnme(printt4 I.icerise no: Servleaorfee&n—Installation,
alteration or relocation:
200 amps or less 2
�� + F n U 201 amps to 400 amps 2
Nartc(print): —y� - �_ 401 amps to 600 amps 2
Mailing address &O S4 0 601 amps to ION amps 2
City: r Slate:d d: ZIP: _ Over 1000 amps or volts 2
Phone: Fax: I E-mail: Reconnect onlyi
Owner installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447.455,479,670,701. 201 ramp%i,r 4M am 2
2111 amps o,JINI ramps _ 2
Owner's si nature: Date: 4011(,W)nm % 2
Branch circuits-new,alteration,
or extension per panel:
Name: _ A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
Mise.(Service or feeder not Included):
U service over 225 amps commocnial U Health-care facility Foch 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 Lircuit(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 snips or more •Descri tion:_
U Occepnu load over 99 persons U Manufactured structures or RV park Fieh additional Inspection over the allowable In any of the alcove:
U Egress/lightingplan U(thee __..- —.-- Per inspection
Submit sets of plans with any of the above. Invests ation fee
The above are not applicable to temporary construction servFe. other
Not all Jurisdictions accept ctmW ends,please all Jurisdiction for mote information. Notice:This permit application Permit fee.....................S
U visa O MasterCard expires if a permit is not obtained Plan review(at _ %) $
coedit cud number: _ within ISO days after it has been State surcharge(9%)....$
Expires accrpted as complete. TOTAL $
.......................
Name 1 w.dnovvn on credit cid -
S
-- Cardholder siputnt Amount t40461(6001t'OM)
j
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00
--
Number of Ins ctions Per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit q Audio and Stereo Systems
1000 sq ft.or less $145.15 _—
Each additional 500 sq ft or 1
portion thereof $33.40 _ Burglar Alarm
Limited Energy — $75.00
EManuPd Horne or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 2
I
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation / $80 30 2
200 amps or leas V Vacuum Systems'
201 amps to 400 amps - _ $106.85 2
4U1 amps to 600 amps _ $16060 2 ❑
.60 2 Other_-- _-- - ---- -- --
601 amps to 1000 amps $240 _ 2 - -
Over 1000 amps or volts _ $454.65 _ 2
Reconnect only $66,85
TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system.......................................................... $75.00
Installation,alteration,or relocation $66 85 2 (SEE OAR 918-260-260)
200 amps or less — 2
201 amps to 400 amps $100.30 _
401 arnps to 600 amps -�_ $133.75 Check'type of Work Involved:
Over 600 amps to 1000 volts. Audio and Stereo SystemF
see"b"above.
Branch Circuits Boiler Controls
New,alteration or extension Pei panel
a)The fee for branch circuits Clock Systems
with purchase of service or
feeder fee.
Each branch circuit $665 _Y_ CJ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 _ ❑ HVAC
Each additional branch circuit $6.65
Miscellaneous instrumentation
(Sere ce or feeder not included)
Fach pump or irrigation circle $53,40 Intercom and Paging Systems
Each sign cr outline lighting $53.40 —_
Signal circuit(s)or a limited energy Landscape Irrigation Control'
panel,alteration or extension $75.00
Minor Labels(10) $125 00 ❑
Medical
Each additional Inspection over
the allowable In any of the above "' U Nurse Calls
Per inspection $6250
Per hour $62.50 ❑
$73.75� Outdoor Landscape Lighting'
In Plant --- ---
Fees: Protective Signaling
Enter total of above fees $ _ Other
a%State Surcharge $ ------Number of Systems
25%Flan Review Fee No licenses are required Licenses are required for all other installations
See"Plan Review"section on $ ------
front of application — — - Fees:
Total Balance Due $
r—� Enter total of above tees
LJ Trust Account 8 - _ - 8%State Surcharge $
Total Balance Dne $
I 41st-utirnsWc-fees.dots 10/09100
Mechanical Permit.Appl cation
Date received: Pe •t no.:
City of Tigard Projecdappl.no.: piredate:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 9722 i
( Date issued: By: Receipt no.:
Phone: 3) 639-4171
Fax: (5t 598-1960 Case file no.: Payment type:
Land use ap val: _ - Building pe ' ..
IV
U 18c 2 family dwelling or acct sory U"�C-ommercial/industrial Multi-family ❑Tenant improvement
U New constnlctiun �e Adetition/alteration/replacement Other
Job address: dicate equipment quantities:n boxes below.Indicate the dollar
Bldg.no.: Sui o.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: prof t.Value$ d
Lot: Block: I Subdivision: / 'Se:checklist for important application information and
Project name: gtjfAfLL 4,J4 1 junsdiction's Ice schedule for residential permit fee.
City/county: ZIP:
D.eschiption and location of wog k on premises:
• / 1 nUFee(ea.) Total
Est.date of completion/inspection: 1Dewiri ion Qty- Nes.only Res.only
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or co Itioned? es 0Ill Air conditioning(site plan require )
Is existing space insulated?0 Yes ❑ Alteration of existing HV AC system
oiler/compressors
State boiler permit no.:
Business name: i HP Tons BTU/14
Address: QLoC WFire/smoke amper uctsmo a detectors
City: tate: Zip: 06 Heat pump(site plan required)
Phone Fax:7 E-mail: event'
ace umac• urner BT
ductwork/vent liner ❑Yes❑No _
CCB no.: -'/r in r n replace/relocate eaters-suspende ,
City/metro lic.no.: (J'Q / or mounted
Name(please print): pane o er an furnace
ton:
Aits BTU/H
Name: C �_ HPCors HP
Address: en x list
rent on:
City: State: ZIP: Appliance vent
Phone: 'ax: E-mail Dryerexhaust
o s, ype res. t e azmat
Mw a
hood fire suppression, ste
Name: Exhaust fan with single c (bath fans)
Mailing address: x aust s stem n art rom satin or C
State: ZIP: ue p P n t i�ct (up to 4 outlets)
City: ----L Type: LIK; _ _ Oil _ —
Phone: Fax: E-mail: Fuel piping each additional RFR outlets 11
roce"piping(sc ernancrequir -'.
Number of I _
Name: Other listed appliance or equ pme t:
Address: _ Decorative fireplace
('icy: Scute: ZIF': _ -Insert type
stov pe et stove � �_._
Phone: Fax: E-mail: Other: — -
Applicant's signature: Date: I Other-
Name(print): I —_--
Not dl juriedictim.weep credit cwb.plew call juristtiction fa more information. Permit fee.....................$
Notice:This permit application Minimum fee................$
O Visa O MasterCenl _.
expires if a permit is not obtained plan review(at `96) $ —
Credit card rmirnW. .___—___ ---- ____L_-/_ within 180 days eller it hes been
Expires State surcharge(8%)....$
No=rIder v thews on credit card
accepted as complete.
s TOTAL .......................
Codholder sipatttre --— ---Amount 49t,*17(60000M)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: ,^ Description: Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnare 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+
$10,000.0_0. including ducts R--ts 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnac(
$1.54 for each additional$100.00 or including vet _ 14.00
fraction thereof,to and Including 4) Suspended heater,wall heater
$25,000.00. or floor mounted heater _ 1400
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vert 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. 1215
$50,001.00 and up $742.00 for the first$50,000.00 and Check a!I that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
_ fraction thereof. _ footnotes below. Comp*
7)<3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: _ to 100K BTIJ 1400
Value Total 8)3-15 HP;absorb
Descrt tion: Ot al Amount unit 100k to 500k BTU 25.60
�?_ -- 9)15-30 HP;absorb
Furnace to 100,000 BTU,including 955 unit.5-1 mU BTU 3500 _
ducts&
ents
Furnace v>100,000 BTU including 1,170 --- unit
301.7 mi absorb
unit 1-1.75 mil ETU 52.20
ducts_&vents 11)>50HP:absorb
Floor furnace Includin- vent 955 unit>1.75 mil BTU _ 87.20
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater 1 10.00
Vent not Included in applicance 445 13)Air handling unit 10,000 CFM+
permit --_ _ __ 17 20
Re air units 805 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 10,00
to 100k BTU -- 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 680
101k to 500k BTU _
15-30 hp;absorb.unit,501k to 1 2,310 16)Ventilation system not included in
mil.BTU appliance permit 1000
30 50 hp;absorb.unit, 3,400 - 17)Hood served by mechanical exhaust 10.00
1-1.75 mil.BTU -
>50 hp;absorb.unit, 5,725 18)Domestic incinerators
17.40
>1.75 mil.BTU 19)Commercial or industrial type incinerator
Air handling unit to 10,000 cfm _656 6995
Air handling unit>10,000 cfm 1,170
Non-portable evaporate cooler 656 20)Other units,including wood stoves _ 10.00 _
Vent fan connected to a single duct 446 21)Gas piping one to four outlets
Vent system not included in 656 5.40 _
appliance permit __ 22)More than 4-per outlet(each)
Hood served mechanical exhaust 656 - _ 100 _
Domestic incinerator 1 170 Minimum Permit Fee$72.50 SUBTOTAL: $
Commercial or Industrial Incinerator 4,590
Other unit,Including wood stoves, 656 - 8"/"State Surcharge Y $
Inserts,etc.
Gas piping 1-4 outlets _ _ 360 25%Plan Review Fee(of subtotal) S
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL s [::TOTAL RESIDENTIAL PERMIT FEE: L $
VALUATION:
0 ectlonq and Fees:
1 Inspections outside of normal business hours(minimum charge-two hours)
$72 50 per hour
2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
$72 50 per hour
3 Additional plan review required by changes.additions or revisions to plans(minimum
chergeone-half hour)$72 50 pot hour
"State Contractor Boller Certification required for units 3-200k BTU.
"Residential A1C requires site plan showing placement of unit.
i:\dstsVorms\mech-fees da; 10/11/00
SEE 35MM
ROLL# 22
FOR
LARGE
DOCUMENT
G,sz p --
GITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-hour inspection Line: 639-4175 Business Liiie. 639-4171 — — -
BUP
Date Requested__ _AM_ PMBLD
! f,cation S G' 45a'r1'cf J1 2'Q t,-. Suite MEC _
Contact Person r)4 n � — Ph ��Z CSS~
PLM
Contractor Ph _ SWR
BUILDING Tenant owner ELC
Retaining Wall ELR —
Footing Access:
Foundation FPS -- _
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab --------_ ------ - — --— SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing -_..______-__-_._ — — -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Ronf
Misc: --
Final
PASS PART FAIL
PLUMBING
Post& Beam ----------__ ----- — ---
Undei Slab
Top Out ----------- -
Water Service —_-
Sanitary Sewer
Rain Drains _
Final
PASS PART FAIL
MECHANICAL
(lost& Beam - -----
Rough In
Gas Line ------ -
Smoke Dampers
Final -- -- -- -
PASS PART FAIL
Service _-
Rough In
UG/Slab
Low Voltage
PASS PART FAIL
SIT
ackfill/Grading �-
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before n t inspection. Pay at City Hall, 13125 SW Hell Blvd
Catch Basin [ ]Please call for reinspection RE: -__ [ 1 Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk - /��
Other — Date L Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection rersord from the joh site.
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