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12790 SW BLUE HERON PLACE y cD Q UC C CO G CD CD Q a 6a n m I I I 12790 SW Biue Heron Place CITY OF TIGARD IGARD MASTER PERMIT PERMIT#: MST2003-00032 DEVELOPMENT SERVICES DATE iSSUED: 2/20/03 1 125 SW Hall Glvd.,Tigard,OR 97223 '503)639-4171 SITE AUr.RESS: 12790 SW BLUE HERON PL PARCEL: 2S103BC-08600 5UBDIVISiON: BLUE HERON PARK ZONING: R-4.5 BLOCK: LOT: 003 JURISDICTKjN: TIG REMARKS: C BUILDING I.EISSUE: STORIES: 2 FI-OOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,157 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 40 SECOND. 944 al GARAGE: 400 of FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: SN DWELLING UNITS: 1 THIO of RIGHT: 852 40 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2.101 of VALUE: 203. REAR: 30 PLUMBING SII IKS: 1 WATER Cl OBETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIZS: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS, 1 WATER LINES: 100 B CKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOILICMP<3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN>•t00K: 1 UNIT HEAT RS: HOODS: i OTHER UNITS: I MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I ELECTRICAL _ RE11DENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSI ECTIONS 1000 SF OR LESS: 1 0 -200 amp: .1 •200 amp: WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION: EA Y='L 500SF: 3 201 - 400 amp. 201 400 amptat WIO SVC/FDR: SIGN/OUT LIN LT: PER HCUR: LIMITED ENERGY: 401 - 000 imp: 401 - e00 amp: EAADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFDR: flat • 1000 amp: Rai+amps Io00v: MINOR LABEL: 1000*amp/Vol,: PLAN REVIEW SECTION Reconnect only: >600 V NOMINAL: CLS AREA/SPC OCC: -4 RES UNITS: SVCIFUP.�•22S A.: ELECTRICAL•RESTRICTED ENERGY r_ A.SF RESIDENTIAL IS.COMMERCIAL AUUIO 6 S rEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH:ALL e NI-Um BOILER: HVAC LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARA3F.OPENER: CLOCK: INSTRUMENTATION- MEDICAL: OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL.. FEES: $ 6,443.83 This permit is subject to the regulations contained in the WINDWOOD CONSTRUCTION WINDWOOD HOMES INC Tigard Muliicipal Code,State of OR. Specialty Codes and 12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA all other applicable laws. A:I work will be done in TIGARD,OR 97223 TIGARD,OR 97223 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 than 180 days. ATTENTION' Oregon law requires you to follow rules adopted by the Phone: 50-1-625-6526 Phone: 525-G526 Oregon Utility Nctification Center. Those ruler,,ire set fortn in OAR 952.001-0010 through 952-001-0080. Yo I Ray N: LIC 50196 fnay obta_-opiec of these rules or direct questions to OUNC by c filling(503)246-1987 REQUIRED INSPECTIONS Erosion Control Insp& Post/Be,3m Mechanica Mechanical Insp Shear Wail Insp :nsulation Insp ApprlSdwik Insp Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Ins, Gyp BoFrd Insp Electrical Fi:al Footing Insp Crawl DralnlBackwater EI-: ilival Service Low Voltage Firewall Insp Mechanical Final Foundation Insp Footing/Foundation Dr; electrical Rough In Gas Line Insp Rain drain Insp Plumb Final Post/Beam Structural PLM/Und,^rfinor Framing Insp Gas Fireplace Water Line Insp Final inspection Issued B Permittee Signature Issu y —�a�1.�(�s �,..� Call(503)6514175 by 7:00 p.m.for an inspection needed the next business day CITY OF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-00031 13125 SW Hall Slvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/20/03 PARCEL: 2S 103BC-08600 SITE ADDRESS; 12790 SW BLUE HERON PL. SUBDIVISION: BLUE HERON PARK ZONING: R-4.5 BLOCK: LOT: t,tt JURISDICTION: TIG TENANT NAME: USA NO: FIXT!IRE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: S Owner: FEES VJINDWOOD CONSTRUCTION Description Da'a Amount 12655 SW NORTH DAKOTA TIGARD, OR 97223 [SWIJSA] Swr Connect 2/20/03 $2,300.00 1SWUSA] Swr Connect 2/20/03 $0.00 Phone: tiO3-625-6526 (SWINSP] Swr Inspect 2/20/03 $35.00 tSWINSP] Swr Inspect 2/20/03 $0.00 Contractor: — ^- _—__— Total $2,335.00 Phone: Reg#: Required Inspections This Applicant agrees to comply*th all the rules and regulations of the. Clean Water Services. The permit expires 180 days from the date issued. The total arnount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm Issued by. - Permittee Signai.ure: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next btsiness day i 110 Building Pernut Application „� Datereceived•. i ter,-03 Permitno.:/) City of Tigard Rg f ,EV 'Project/eppl.no.: Expire date: Address: 13125 SW Hall Blvd,Tigard, 223 _ City njgand Phone: (503) 639-4171 Date issues: _ By: Receipt no.: Fax: (503) 598-1960 1 7 �U�� Casefrleno.: Payment type: Land use approval: ,;lTY QF TIGARC 1&2 family:Simple Complex:— d ,QIM 2 family dwelling or accessory U Commercial/industrial O Multi-family U New construction U Demolition U Addition/alteration/mplacement U Tenant improvement U Firs;sprinkler/alarm U Other._ _ _- 01 Job address: !VI-710- _LhL�_ rGA elf l Bldg.no.: Suite no.: Lot: ^j Block: Subdivision: uC r Tax map/tax lot/account no Project name: m•+ a,- Description and location of work on premises/special conditions:_ ---- Name: 6d0JS7-4kV1—" I a Mailing address: S w /!/Dwc� ifY- _ 1 &2 family dia-Aling: City: rdt Stat ZIP: P7_ — Valuation of worK........... ....... .................. Phone: ��$ G F F•rmail: No.of bedrooms/bat ...........3.................... Owner's representative: - Total numbLr of(loots....,.....c�,...... ....... d Phone: Wax:Fax: E-mail: New dwelling area(sq.ft.) .. k G-� Garagelcarport arra(-q.ft.)......qp.......... --— Name: Covered porch area(sq.ft.) .....rip............ -- Mailing address: Deck area(sq. tt.)........................................ _ City: _ State: ZIP: Other structure arra(sq.ft.)......................... Phone Fax: E-mail: CommercinUlnduatrial/multi-family: Valuation of work........................................ 5 Existing bldg,.area(sq.ft.) ................. ... _ Business name: ,M�- New bldg.area(sq.ft) ... ......... Address: �� City: State: ZIP: --- Number o"stories................... ..`` Email: T�P" ctmstrucd. n. _ Phone: Fax: ........ .................... / - V -- Occupancy group(s): Exiaing: CCB no.: New: City/metro lie.no.: Notice:All contractors and subcontractors are required to be licensed With the Oregon Construction Contractors Board under Name: �, provisions of ORS 701 and may be required to*)e licensed in the Address: m w ! jurisdiction where work is being performed.If the applicant is City: 1 State�^r ZIP: exempt from licensing,the following reason applies: Contact person: a A Plan no.: _ Phone: $'^Q/(r Fax'��' E-mail. 1`Iarrre;, aUkc// )U Contact person: ,Q�j Fees due upon application ........................... $ Address: 1 — Date received: _ City: Stat ,e ZIP: ,1_/(. Amount received ......................................... $ Phone "t(�j Fax: G,7 E-mail: Please refer to fee schedule. I hereby certify I have reed and examined this application and the Na all jur+adkdom WMF oval cads.rdeaw CWi Juriadiaion r«marc idormu,00. attached checklist All provisions of laws and ordinances governing this El Visa UMast"Cud work will be complied�Oth.whether s ifed herein or not. �'card comer — FAPima l Authorized aignattr _ �-7— Date: r Name of cw&*W a rows an man card _ Print name:_ s l-- Cadholder s Arra Aunt Notice:•This permit application expires if a permit is not obtained within 190 days after it has been accepted as complete. 4404613(GOWCOM) Ocie-and Two-Family Dwelling Building Permit Application Checklist rAssociated rencno.: s: CiryojTigard permit tyoan ❑Electrical O Plumbing O Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 OOther: Phone: (503) 639-4171 Fax: (503) 598-1960 FOLLOWINGTllF 1 1 FOR PLAN REVIEW Yes No' 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/iot. 4 ;Fire di. ict--approval required. 5 Septic system permit or authorizz tion for remodel.Existing system capacity 6 Sewer permit. 7 Water dish lct approval. 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion contr,ui t.l plan O permit required.Include dr,unage-way protection,silt fence design and location of patch-basin probx•:ion,etc. ]0 _- Complc:e sets of legible plans.Must be drawn to scale,showing conformance to applicable local and scute building codfss.Lateral design details and connections must be incorporated into the plans or on a s-paste full-size sheet atta.hed to the plans with cross references between plan location and details.Plan review cannot be completed if copyright violations exist. 11 Skelplot plan drawn to reale.The plan must show lot and building setback dimensions;property corner elevations(if there is more than a 4-R,elevation differential,plan must show contour lines at 2-ft intervals);location of easements and driveway;footprint of structure(including decks);invation of wells/septic systems;utility locations;direction indicator,lot arra;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. _ 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, V furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. _ 14 Cross section(s)and details.Show all ft'aming-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may be rer,uired to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling heigf;t,siding material,footings and foundation,siairs, fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. _ 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and Imatiom.,-for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/rouf assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sectiuns and details showing placement of rebar.For engineered systems,see item 22,"Engineer's calculations." 19 Beam calculatioar,.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non-uniform load. _ 20 Manufactured Aoorlroof truss design details. 21 Energy Code,.omplianee.Identify the prescriptive path or provide calculations.A gas-piping schematic is required for four or more appliances. 22 Fatgineet''s calculations.When required or provided,(i.e.,shear wail,roof truss)shall be stamped by an engineer or arddtgct licensed in Oregon and shall be shown to be applicable to the project under review. --• 23 Five(5)site plans are required for Item 11 above. Sire plans mus:be, 8-1t2"x 11"or 11"x 17". _ 24 1 wo(2)sets each are required for Items 105, 19,20&22 above. 25 Building plans(:hall not contain ted lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit dt System Development Fees docurr 27 "Drawn to scale"indica,n standard architect or engineer scale. 28 Site plan to include tri.size,type dt location per approved project street tree plan(if applicable),and COT Street Tree List. E. Checklist must be completed before plan review start dab:. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is re!.erved for department use only. 440-4614(MOCOM) Plumbing Permit Application 7peffnit Permit no.: City of Tigard Building permit no.. Address: 13125 SW Hall Blvd,Tigard,OR 97223Cityof'rigard phone: (503) 639-4171 pp. . Expiredate: Fax: (503) 598-1960 Date is sued: By: Receipt no. Land use approval: _ Case file no.: Payment type: " ' &2 family dwelling or accessory O Commercial/industrial 0 Multi-family ❑Tenant improvement ❑New construction 0 Additiun/altemtion/mplacement 0 Food service ❑Other. lu 110 NJ 0 Job address: A lif-e ,- NQ, Descrl doo Qty. Fee M. Total Bldg.no.: Suite no.: — New 1-and 4otally dwellings only: Tax map/tax lot/account no.: mac/ L 3 O (Includes1001t.foreachu tycotmection) SFR(1)bath Lot: Block: Subdivision: kro^ SFR(2)bath Project name: u� SFR(3)bath City/county: I ZIP: Each additional baduldtchen Description and 1 ciao o work on premises: SiteutWties: Catch basin/area drain Est.date of completiordinspection: Drywells/leach line/trench drainKU _ Footing drain(no.lin.ft.) Manufactured home utilities _Business name: 1>h __ Manholes Address: P Rain drain connector City: _ State• 2 ZIP: 76f'y 7 Sanitary sewer(no.lin.ft.) Phone: Y 01(f Fax ()j 1 E-mail: Storm sewer(no.lin.ft.) _. CCBno.: -71b(00 I Plumb.bus.reg.no: 4 - b(f Water service(no.lin.ft.) City/metro lic.no.: Fixture or hem: Contractor's representative signature: _ �— Absorption valve Back flow preventcr Print name: Date: Backwater valve Basins/lavatory Name: SCt ffl r Clothes washer Dishwasher Address: _Drinkingfountain(s) City: State: ZIP: Ejectors/sump Phone: Fax: E-mail: Expansion tank Fixture/sewer cap Name(print): &j;'it- t,, J04 &WS/' 422L Floor drainstfloor sinks/hub Mailing address: v N Ai--� --% Garbage disposal Hose bibb City: 1 StateZIP: Ice maker Phone:1$;krff�elFax.(,, E-mail: Interceptor/grease tri Owner insW!ation residential maintenance only: The actual installation Primer(s) will be made by mi:or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Ch„pter 447. Sin (s),basir.(s), ays(s) Owner's ,;; natu —Date: Sum Tubs/shower/shower pem NUrinal Name: A � — iter closet Address: iter heater City: tact': ZIP: _ Other. Phone: Fit: Na ea mbic*m wogm crs&t cads,Pere all jwirdicdw for mm lofarmrlaa NotMinimum fee................$ U via O 1MasterCard expires This permit application Plan review(at ._ %) $ _ expires if a permit is not obtained C-d1r cad mmber_ _ — - within 180 days after it hes been State surcharge X896)....$ -- Nam if cardboider r dum as cmd t eccepte l as complete. TOTAL ......................$ CwtilmiderS die —_ A010e01 410.1616(600000M) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: 1--- FIXTURES Individuel _QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY .(ea) AMOUNT Lavatory 16.60 for each utili connection)_ _ One(1)bath _ $249.20 Tub or TublShower Comb. 16.60 Two 2 bath _ $350.00 Shower Only v 16.60 Three 3 bath _ $399.00 Water Closet 15.60 _ SUBTOTAL Urinal 16.60 81%STATE SURCHARGE r Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.66 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 -- PLEASE COMPLETE: 4" 16.60 _ rWater Heater O conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. _ Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 ;ombinatlon Roof Drains 1 16.60 Shu.:9r_On�- Drinking Fountain 16.60 Water Lioset_ Other Fixtures(Specihj) 16.60 Uririal Di!hwasher Garbage Dis osal Laundry Room Tray _ Washing Machine Floor Drain/Sink: 2" Sewer-Iat 100' 55.00 3* Sewer-each additional 100' 46.40 4" Water Service-1st 100' 55.00 Water Heater Water Service-each adoilional 200' 4640 Other Fixtures _ Sed Storm d Rain Drain-1st 100' i 55.00 Storrs 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 4640 Residential^-4r*gow Prevention Device' 27.55 Cai;h Bas,,1 16.60 Inspection of Existing Plumbing or Specially 62.50 Requested Inspections PEW COMMENTS REGARDING ABOVE: Rrin Drain,single family dwelling 65.25 __- Grease Traps 16.60 _ QUANTITY TOTAL Isometric or riser diagram Is required H Ouantfly Total N n s S 'SUBTOTAL - 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL ;•i Fri. +�I►9'�'ns' Required oNy it ilxtu-e qty total le�6 TOTAL `, Z *Mlnimurn pennit fes Is$72.50+8%state surcharge,except Residential Backfow Prwmr t;rA Device.which Is$36.25•sit stale surcharge "Jul New Commercial Buildings require 2 soft of plans with Isometric or riser diagram for plan review. I:%dstsVorms\pIm-few.doc 12/26/01 Mechanical•Permit Application - Date received: Permit no.: City cif Tigard Project/appl no.: Expire date: Cavof 7igerd AddreQtt: 13125 SW Ha!1 Blvd,Tigard,OR 97223 -- Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment Type La"1 use approval: _-� -- Building permit no.: U 1 &2 farnily dwelling or accessory U Commercial/industrial U MuIU-family LI Tenant improvement U New construction U Add ilion/alteration/replacement U Other: Job address: n !tc � Q/` —__ Indicate equipment ouantities in boxes below.Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/lax lot/account no.: j 3yoo profit. Value S �Y4� rc_ Lot: Block: Subdivision: Ark n •Scc chcckli:a fog important vpplication information and Project name: 5/ar kip u.4 jurisdiction's fee scheduk for residential permit fee. City/county: I ZIP:v�7?.2ILI Description and location,6f work on premises:- I Fee(ea.) ToW Est.date of completion/inspection: _- Du ai oa (Xy. Res.only Res.only Tenant improverneut or change of use: Is existing space heated or conditioned?U Yes U No Air handling unit - CFM - Is existing space insulated?U Yes U No Air t me itiofexin[z(silt piorequired) to ,- — K�P" A tcration of existing F A system of erer/�compress6 s — - Business name: State boiler permit no.: _ FIP .—Tons---9TU/11 Address: 3 7(, -inh`mok-e dampers/ uct smoke detectors City: �Zn$ h aM State: IP: e?-,1rj,30 Heat pump(sne p an rcqutrc ) Phone: QS-3, 3 Fax: Email: rsta umac mourner_- 1 I/b yl — Including Ia ctwork/to h liner U usp U No CCB no.: nstT�ac�e ocT ateheaters-suspen e , City/metro he.no.: $-a,S"�� _ _ wall,or floor mounted Name(please print): Y l 5a n WU ent fora lianccother than furnace e era e: Absorption units BTU/ll Name: Chillers Chillers_ Hi' _ - - Com resscrs- Address: _ Favironmentall exhaust and vent ton: City: - - ----- --tale: LIP: Appliance vent Phone: Fax: E mall: —rycrexhaust --------- o'i s,Type res. kitc en/liazmat �� hood fire suppression system Name: _ .)4 ©w&b4 c&,s r ��.. Exhaust fan with single duct(bath fans) Mailing address: �a(p�' _ W �r�i f�j7QExhaust system a tartm eat-min of AC — - City: /3 State:Q'/� 7.1P: 7�7�3 Oe piping Nt r �r utioo(up to outlets) Phone. a-ks�0 Fax: b" - 75 E-mail: Type: __—LPC; vei _ oil - - uel lir eat ad itiona over 4 out.es piping(schematic require- Name: Number of outlets - -- ----- t K 1WR opplinwe or equipment: T Address:-- _-- - Decorative fireplace City: State: "LIP: nscrt-type Phone: Fax: E-mail: at(1vstove -- Applican!'s signature: Date: _ Name (print): -- —� --1 -- - -- --- �_ Na dr addictiap aaepr credit cards•please call Jwi&&,icv ra more infonruNm Permit fee.....................$ _ UViisr, U MasterCard Notice:This permit application minimum fee................$ _ expires if o permi!is not obtained , credit:rd number -_._--_-- / / Flan review(at _ %) $ .-- - l r pile, within IRO days after it has been State surcharge(8%)....S _ ----Name or wdlrolder w dx w•n on credit card s accepted as compete. TOTAL ....................... -_ Cardholder sipmum ---� Amaml ) _. 1101617((vtxYCY)M) 1 MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: YOTAL VAL'UATIONs PERMITEEE: -. » Description: Price Total $1.00 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 100,300 BTIJ $1.52 for each additional$10C.00 or including ducts&vents _ 14.00 fraction thereof,to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts&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 includingvent 14.00 fraction thereof,to and including 4) SuspenJed heater, Nall healer $25,000.00. ___ or floor mounted heater 1400 $25,001.00 to$50,000.00 $379.50 for thr•irst$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 6.BU fraction thereof,to and including 6) Repair units _ $50, 0.0 0 _ 12.15 00 _ $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply, Boller Heat Air $1.26 for each additional$100.00 or For Items 7-11,see or Pump Cond fraction thereof. footnotes below.'' Comp . •• Minimum Permit Fee$72.50 SUBTOTAL: to 100K 7)100K absorb unit 5 BTU 14.00 State Surcharge F1"/. a 8)3-15 HP;absorb 25.b0 unit 100k to 500k BTU _ 25%Plan Review Fee(of subtotal) 5 y) 15-30 HP; TU 35.00 Required for ALL commercial permits onl _ _ unit.5-1 mil ;a _ TOTAL COMMERCIAL PERMIT FEE: $- unit 301.7 mi absorb unit 1-1.75 mil BTU 52.20 11)>50HP;absorb unit>1.75 mil BTU L81.20 ASSUMED VALUATIONS PER APPLIANCE:" 12)Air handling unit to 10,000 CFM _ _ _ _ 10.00 Value -Total 13)Air handling unit 10,000 CFM+ Description: City-__fes Amount 17.20 _ Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts&vents _ 1000 Furnace> 100,000 BTU including 1,170 15)Vent fan connected to a single duct ducts&vents 6.60 Flo,r furnace Including vent 955 Suspended heater,wall heater or 955 16)Ventiance permit not included:n 1000 floor mounted heater appliance pemlit Vent not Included In 3pplicance 445 17)Hood served by mechanical exhaust 10.00 _permit18)Dor,estic incinerators Re air units __ - 805 _ 17 4n e 3 hp;absorb.unit, 955 - - to 100k BTU19)Commercial or industrial type incinerator - -- 6995 3.15 hp;absorb.unit, 1,700 101k to 500k BTU 20)Other units,in�li ding wood stoves 1000 15-30 hp;absorb.unit,501k to 1 2,310 _mil.BTU 21)Gas piping one to four outlets _ ___. 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: �' i� t.e. >1.75 mil.BTU }'•� Air handlingunit to 1C,000 cfm 656 - -- - - _ - -- 8%Mate Surcharge "�• a Air handling unit>10,W0 cfm 1,170 z' Non-portable evaporate cooler _ _ 656 - Vent Fan connected to_a singly,duct e46 TOTAL RESIDENTIAL PERMIT FEE: Vent syslern not Included In 656 a Ilance_kertnit Hood served by mechanical exh_aust 656 Other Inspectionsand Fget�.: Dmm1GJtic incinerator 1.170 t. Inspections outside of normal business hours(minimum charge-two hours) $82 50 per tour Commercial cf Irdustrial Incinerator 4,590 _ 2 Inspections for which no fee is specifically indicated (minimum charge hill tour) Other unit,Including wood stoves, 656 $62 50 per hour Inserts et,:. 3 Additional plan,eview required by changes,additions or revisions to plans(minimum Gas piping 14 outlets 360 charge-one-haft hour)$e2 5o per hour Each additional outlet 63 --- -- -- - State Contraclo,Boller Certification required for units>200k BTU. TOTAL COMMERCIAL ^_ : ~Residential A/C requlres site plan showing ptacemant or unit �__] VALUATION: _ Al'New Commercial Buildings require 2 sets of plans. I:ldstsVorrn! :h-fees.doc 12/26/01 I Electrical Perrait Application Received Electrical �1 c. DaleB . Permit No.:11 o Planning Approval Sign City of Tigard Date/B : _ Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 DateB : Permit No.: Phone: 503-6394171 Fax: 503-598-1960 Post-Review land Use Date/By: _ Case No.: Internet: www.ci.tigard.or.us Contact Juris.: N See Page 2 for 24-hour Inspection Request: 503-6394175 Name/Method: —_ Supplemental Information, TYPE OF WORK PLAN REVIEW Please check all that apply) _ ew construction Demolition Service over 225 amps- Health-care facility commercial ❑Hazardous location Addition/alteration/replacem►:nt Other: [j Service over 320 amps-rating of ❑Building over 10,000 square feet, _CATEGORY OF COI ISTRUCTION 1&2 family dwellings four or more residential units in 1 &2-Family dwelling CommcrciaVIndustrial ❑System over 600 volts nominal one structure 171 Building over three stc ies ❑Feeders,400 amps or more Accessory Building_ Multi-Family ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder Other: ❑Egress/lighting plan ❑Other: '1'ION'and OCATION Submit sets of plans whh any of the above. JOB SiTE INFORMA The above are not applicable to ternporary construciloi_service. .lob site address: / ' I r i __— FEE*SCHEDULE Suite#: I Bld ./A t.#: Number of ins ections per Permit allowed I'ro'eet Name: Description Qty Fee(ea.) TOM New reslulenlial-single or multi-family per Cross street/Directions to job site: dwelling unit.Includes attached garage. Service included: 1001 sq.ft.or leas 145.15 4 Escl additional 500 sq.ft.or portion thereof 33.40 1 Limited energy,residential 75.00 2 Subdivision: /! I-Ot#: Limited ener ,non residential 75.00 2 Tax ma /parcel #: Each manufactured home or modular dwelling Q1' DESCRIPTION OF WORK service and/or feeder 90.90 2 --- — Services or feeders-Installation, alteration or relocation: - ---- 200 amps or leas 80.30 2 ____ ------ 201 amps to 400 amps — 106.85 2 401 amps to 600 ams 160.60 2 JVROPER,7tiYOBER7ENAN ;_ 001 am to IOOOams 240.60 2 ►her 1000 am or volts 4S4.6S 2 e: Reconnect only 66.85 2 Address: 2_6 S-S- S cv /lam, /-A�'� � Temporary services or feeders-Installation, _ alteration,or relocation: Cit /State/Zl : 1 w�+ �� 7�'�3 200 amps or less _— 00.85 I s — is ?Phone: Fax: 2 � 0am o4E� 401 to 600 am i APPLICANT , CONTACT PERSON__ Branch circuits-new,alteration,or Name: �L� _ A.Fee extensionper panel: A.Fee for bunch circuits with purchase of 6,65 2 ' Address: _ service or feeder fee each branch circuit City/State/Zip: D.Fee for hunch circuits without purchase of service or feeder fa tint bunch circuit 46.85 2 Phone: Fax: Each additional branch circuit (FS 2 -mall: Misc.(Service or feeder not included): CONTRACTOR Each um or irriation circie 53.40 2 ----- Fach sign or outline lialiting 53.40 2 Job No: Signal circuit(,)or a limited energy panel, Business Name: _ !�` e �«' a Descralteraiption:or extension — — Page 1 2 T. Description: Address: -- Each additional Ina ectlor:over the allowable in any of the above: City/State/Zi Per inspection per four(min. Aur 62.50 Phone: —- FSX: lnvesti ation fee __—__.— _ CCB Lic. #: Lic.#: Other: Electrical Permit Fees* Super ising electrician _ Subtotal $ ff store Icr uired: ' _ __ Plan Review(.'',5%of Permit Fee St Name: Lic.#: _ Elate Surchar a 8%of Permit Fee S TOTAL PERMIT FEE S Authorized Notice This permit application expires If a permit Is not obtained within Signature: Date:_ — 180 dais after It has hern accepted■s complete. *Fre methodoloXv set by Tri-County Building Industry Service Board. (Please print name) i 1Dsts\f'erm:t Formski1cPermitApp.doc 01/03 Iu is/a r 4r 2of 3- 3 75'i .S_Qf_. v �e. roL 1 z3� ; 41 � a: I A ry AA am 9 s�13�.4e 1-14lew f���L 06,,09/2003 11; 17 FAX 5005798056 Z001 CITY OF TIGAPn 13125 S.W. HALE. BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GREENWAY ELECTRIC COMPANY 15145 SPIV GULL OR BEAVERTON, OR 97007 Electrical Signature Form Permit* MST2003-00032 Date Issued: 2120/03 Parcel: 2S10313C-x;'600 Site Address- 12790 SW BLUE HERON PL Subdivision: BLUE HERON PARK Block Lot: 003 .Junsdiction: i1G 7oninq. R-4.5 RPrnarks: Contrucbon of new SFA. Your company has been indicated as the electrical contractor for Ihu permit indicated above. In order for the electrical permit to be valid,the :signature of the supervising electncian is required_ Please have the appropr iate individual from your company sign below and return this Electncal Signature form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized un this completed form is received OWNER: ELE_C I RICAL CONTRACTOR: WINDWOOD CONSTRUCTION, INC. GREENWAY ELECTRIC COMPANY 12655 SW NORTH DAKOTA 15145 SW GULL DR TIGARD, OR 97223 BEAVERTON, OR 97007 Phone N' 503-625-6526 hone 503-579-WJ64 Reg ; LIC 153421 ELL 3"1''C 11 5025s AN INK SIGNATURE IS REQUIRED ON THIS FORM X L) Si ature aT�upervv i _e rician If yo:; have any questions, ►+lease call 503.718.2433, e, / 3 -6 ,-), Y- 36 9 To0®j Irma 94TH aNV911 .30 U13 T99C1,79cnv a'V3 CT:tt NOK COi60.90 CIT ( OF T'G,^,RD 24.-Hour B!)1LDIhu Inspection Line: (503)639-4175 3_ 0002 -__ c,JSP C PION DIVISION Business Line: (503)639-4171 (!s ---- BLIP Received . ----, ___-. Date Requested __ 10 11 AM — PM _ PUP ocation � � /'1S u-- suite—___ MEC _T Contact Pe;Son __—_ �� '�.G��,.o� — Ph(- ) - 7 80 — '-�3 Vis` PLM - - -- - Contra-tor- ,� - _ Ph( ) SWR Btl 71NG Tenant/Owner . -__.- -_ - ELC i Fjutinp -- -- -- — ELC _ Founriction r"Iccess: n Ftg C' in I ELR — Crawl ljrp.i Slab Inspection Notes: SIT - Post&Bea ------ - `dear Anchors Lxt Sheath/Shear Int Sheath'Shear Framing - - _- - -- - Insulation Drywall Nailing ------- -- -- - - - Firewali Fire Sprinkler - - — - -- -- Fire Alarm Susp'd Ceiling Root Other: Final _PASS_ PART_ FAIL _ PLUMBING Post 8 Beam --- - � ----- -- -- Under Slab -------- —� Rough-In Water Service --- ---- ----- -- -- -- Sanitary Sewer Rain Drain -- — --- — Catch Basin i Manhole Storm Drain -- - -- -- — — Shower Pan Other: - Nnal S1H#1C FAILA arn C Rougk-Jn � 6 i -- -------- — - - -- --- Gad Linb She Delmpers -- nal RT FAIL --- -------- -- "ELECTRICAL Rough-In UG/Slab Low VoltageLl� SS ART FAIL U Reinspection fee of$--_. _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _ Please call for reinspection RE:_ Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk Date_11,L_=.__?-11._�� 3 Inspector- Ext -- Other: Final — DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Li (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 �-- Received _ 1 OCA*wDateRequeotedIoIAM _—_ PM __ BUP -- —__ Location -,e � L Suite-- — MECContact Person _ Ph(_ ) PLM —_— Contractor ---_--___ ____-- -- ---__-_--._-__-- Ph(- ) —.___ SWR ___.--- BUILDING Tenant/Owner --_--_---_—_-- —_-- — ELC Footing - _ -- ELC Foundation Access: Ftg Drain ELR _�--_ - Crawl Drain - Slab Inspection Notes: SIT Post&Beam -----�..-- -----___--_--- --- - Shear Anchors Ext Sheath/Shear -- Int Sheath/Shear Framing -E t�--� / It ✓ c'��✓G�� � '� t�iK --- -- Insulation Drywa;l Nailino -- ----- - -- - Firewall Fire Sprinkler ------ ---Fire Alarm Susp'd Ceiling - --- - Roof r ..FS11h ._ __ --- - t NPART FAIL - - - ----- - --- Post&Bea ' Under Slab 7 - Water Service - Sanitary Sewer Rain Drains - ---- - ----� Catch Basin/Manhole Storm Drain -- ---- -----�--�- ---- - -- - Shower Pan Fi PAS PART FAIL ------ - ------ --------- ----- MECHANICAL __-------_- Pont Seam - - 1 S�i'Jh t 1�['l ��--W►� "- ems - s Rough-In - Gas Line e Dampers --- r {KKK \' /y►'�Jn \ny, �l --- Final a V)Ll - s PARTAIL --- ELECTRICAL Service Rough-In ----- -- 1.� �\ ��2J� ' ARD _ • .ow Volta � --• -- _ I'ir rm R6inspection fee of$_ --required before next inspection. Pay fit City Hall, 13125 SW Hall Blvd. _PASS PART Q FAIL SI i E _ Please call for7inspecti RE: ' Unable to Inspect -no access Fire Supply Line ADA Approach/Sidewalk Date ` Inspa. r t Other: _ Final DO NOT REMOVE this Inspectior record from th,•job>alte, PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)6?9-4175 INSPECTION DIVISION Business Line: (503) 639-4171 �v / t BUP Received aal, Requested r -- Ah1_ PM.---_--.. BUPLocation I L �L�L _ Suite— — MEC Contact Person — —�. L1`\ W_0�\Ph( ) —L.QL1 PLM _ ---_ Contractor _ _—-_- --__-_ Ph ( ) _ __ SWR BUILDING _ Tenant/Owner __ _ _ ELC _ _—_-- Footing ELC Foundation Access: Ftg Drain ELR -- Crawl Drain Slab Inspection Notes: ;,IT Post&Beam -- - ----------- _ __ Shear Anchors - Ext Sheath/Shear Int Sheath/Shear ) r Ct (�: Framing ✓ T��c.��! -r2+9�vs f /C/�t"'� ?7c�n� /�C , = Insulation Drywall Nailing p`7� �, r✓� � TlBp.4y t G Firewall Fire Sprinkler Fire Alarin Susp'd Ceiling Roof Gather: --- Final _ PASS --PART FA -- ----------- — PLUMING Post& Beam Under Slab - ---------------- Rough-In Water Service —..___.___._- ---.----------.-_ -- Sanitary Sewer Rain Drains -------- Catch Basin/Manhole Storm Drain Shower Pan Other: - ----- ----— --- Final PA _ T' FAIL Pos eam� Rough-In — - -- --- --- - - — Gas tine e ar pers _—_.---- ------. —� ---- - inal _ S PART FAIL -- --- - ----- — — ELECTRICAL Service - ---- -- -- - - Rough-In — UG/Slab Low Voltage _ Fire Alarm Final Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE [] Please ca!I for reinspection RE:__ _— ______- [� Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date _-__ '-�' Inspector -_� _-- - -�-- _--Ext--- Other:__ Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL o, � ` O CL. >. C d 0 � O Or Lei.■ � O cm <1 'J o. O ` Q o a iJ 0 •ti' � U .0 h rryy � N � Uy c .c h � 7 cy � CL O O LE � V 0 fl• L� ,n