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12830 SW BLUE HERON PLACE co C4 0 N W r c m m O z -v r r � f i i t 12830 SW BLUE HERON PL CITY OF TIGA RD 24-Hour BUILDING Inspection Lines. x,03)639-4175 MST a?_(2,112 � INSPECTION DIVISION Business Line: (503)639-4171 BUP -- Received D Date Requeisted-3 71d p_�— AM __PM � BUP Location _ o L� Suite MEC —- — Contact Person .— _��- -� Ph(--.) 7cfJ - q3-7_T_' PLM — Contractor__ _ Ph(—.—_) _ SWR _— BUILDING Tenant/Owner — _ ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain SIT Slab Inspection Notes: - -- Post&Bear,r, Shear Anchors Ext Sheath/Shear 16 -- Int Sheath/Shear Framing — Insulation Drywall Nailing Firewall _ Fire Sprinkler — -- Fire Alarm Susp'd Ceiling Roof _ Other: - Final _ PASS PART FAIL PLUMBING Post&Beam — I Inder Slab -- - Rough-In Water Service — - Sanitary Sewer Rain Drains Catch Basin/Manhol6 Storm Drain --- ---- — Shower Pan Other:.. r F;nal — -- -- --- — PASS PART_FAIL _MECHANICAL ----- Po;t& Paam Rough-In -- - ------ Gas Line Smoke Dampers — -- --- --- Final _ PASS PART FAIL --- --- — — ___ ELECTRICAL Service Rough-In -- UG/SkAb '-- Fire Ala�P�A�RT �] Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd. AS4 FAIL _ SIT Please call foi reinspection RE: Unable to inspect-no access 7 Fire Supply Line ADADato /Gs_—G --- ins or l't Ext Araroach/Sidewalk Other: _ __ Final DO hGT EM. this InspoWon roeolyd om the j site. PASS PART FAIL CITY OF TIGA,RD 24-Hour BUILDINGinspection Line: (503)639-4175 AST INSPECTION DIVISION Business Line: (503)639-4171 "IZA BLIP Received`IA �-L Date Requezit d PM BLIPLocation __.— � ,1, ite MEC Contact Person --. �d _ off— Ph(. � "�_` 7� — PLM Contractor Ph(____._) SWR BUILDING Tenant/Owner _- ELC --�_ - Footing _ ELC Foundation Access:Access: Ftg Drain ELF! Crawl Drain SIT Slab Inspection Notes: Post&Beam ------ —---- _ Shear Anchors Ext SheathiShear L - - - -- Int Sheath/Shear Framing Insulation ,�r;�j �L G LTi�t L�4L �,,.ems L ( U�e�,� 3 IGrL14� /`7• �� Drywall Nailing Firewall Fire Sprinkler -- -- Find Alarm — — Susp'd Ceiling Roof rAhmr Final -r' , FAIL ------ ----- -- _ 8 Post&Beam Under Slab -- Rough-In — Water Service —— Sanitary Sewer —_ Rain Drains Catch Basin/Manhole _ Storm Drain — Shower aan Other: — Final —. PASS PART FAIL__ MECHANICAL — Post& Beam Rough-In - -- — Gas Line Dampers — Fi _ PART FAIL -9UTIRICAL _ --- Service .------ Rough-In — UG/Slab Low Voltage — Fire Alarm Final Reinspection feo of$-- —roquired before next Inspection. Pay at City Hall, 13125 SW Hell idlvd. PASS PA'IT FAIL SITE [� Please call for reinspection RE:_ Unable to inspect-no access Fire Supply Line ADA DOW Inspector _ Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record fitom the Job site. PASS PART FAIL �LAAA AAAAAAAALAA A6,&OA�AAA-AAAAAAAA,& ►&ALA,ALAA '"AAA �I r o r � � 1 w ► O i o I ► 11 N ► izd ✓_ I < < I► 11• plo- /1 ► �I ► G7= lop- I� �I I► v '► tl = lop. �� _ = Opp. CITY OF TIGARD 24-Hour BUILDING Inspection E.Ine: (503) 639-4175 MST INSPECTION DIVISION Business Lino: (503) 639-4171 BUP,�� _ Received Date RequestE J _ 3- �� AM _ PM -__ BUP Location Suite___ _ MEC Coattact Person - - - --— -= - - -- -- Ph(-- ) -7 F6 PLM ------ -- ---- Contractor- _-- Ph(- ) — _ SWR ------ -------. _ BUILDING Tenant/Owner ELC - --- Footing Foundation Access: ELC --- - --.---_- --. -_--- Ftg Drain ELR -- -- — --- Crawl Drain _ Slab Inspection Notes: SIT Pcst& Beam -- ---- ------ -.- Shear Anchors Ext Sheath/Shear _ -- -. Int Sheath/Shear ---- Framing _ Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp d Ceiling _ Roof Other: — Final i------ — v PASS PART FAIL PLUMBING Post&Beam — -- Under Slab — Rough-In —� Water Service _- Sanitary Sewer Rain Drains Catch Basin/Manhole — Storm Dre'i - - Shower Pan r: - - nsS PAR r' FAIL .-- _ ANICAL Post& Beam ---- - - Rough-In Gas Line - -- - - Smoke Dampers -- - - Final -- PASS PART FAIL _101-eTRICAL - Set vice ---- - Rough-In UG/Slab -- - - -- - ---- — Low Voltage -_---- Fire Alarm Final LJ Reinspection fee of$- _required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS_ PART FAIL SITE __ � Please tali for rein oection RE: _ Ej Unable to iiisr no access Fire Supply Lin-� ADIA 11 Approach/Sidewalk Date -_ Inspector- �- E�} -- Other: _ Final DO OT REMOVE this Inspecl Ion record from the Job site. PASS PART FAIL A A >, 3 0 joi F3 V � - O o o0 0 n` � W � C V x W O 1 `+ W fel z U w C1 332 'A of CITY OF TIGARD MASTER PERMIT PERMIT#: MST2003-00352 DEVELOPMENT SERVICES DATE ISSUED: 9/18/03 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12830 SW BLUE HERON PL PARCEL: 2S103BC-08e00 SUBDIVISION: BLUE HERON PARK ZONING: I2-4.5 BLOCK: LOT: 005 JURISDICTION: TIG REMARKS: Const. of new SFA residence. BUILDING REISSUE: MAS4112F STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CI.ASS OF WORK: NEW HEIGH': 24 FIRST: 1.250 at BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 40 SECOND: 554 at GORAGE: 319 at FRONT: 20 PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: 1 THEW al RIGHT: 5 100.50 OCCUPANCY ORP: R3 BDRM: 3 BATH: 3 TOTAL: 1.004 at VALUE: 175, REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDR I TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS OTHER FIXTURES: M'CHANICAL FUEL TYPES FURN<100K: BOILICMP<3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN>-1UOK: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: I MAX INP: btu FLOOR FURNANCES: VENTS: 1 WU DSTOVES: GAS OUTLETS: 4 EI.ECTRICAL RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS AISCELLANr:OU3 ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 •200 amp, 0 •200 ampWISVC OR FOR: PUMPnnn1UATION: PER INSPECTION: FA ADD'L 500SF: 3 201 400 amp, 201 400 amp 1st WIO SVCIFOR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 000 amp: 401 - 000 amp, EAADDL BR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVC/FDR: 001 1000 amu: 601*anpa•t000v. MINOR LABEL: 1000+amplvoll: PLAN REVIEW SECTION Reconnect only: >-4 RES UNITS: SVCIFDR>-225 A.: >000 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL S.COMMERCIAL AUDIO&STEREO: x VACUUM SYSTEM: x AUDIO B STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X OTH: ALL ENCONIP BOILER: MVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATAITELE COMM: NURSE CALLS: TUTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,440.32 WINDWOOD CONSTRUCTION,INC WINDWOOD CONSTRUCTION, INC. This permit is subject to the regulations S contained in the 12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA Tigard Municipal Code,Stat,of k w Specialty Codes and TIGARD,OR 97223 TIGARD,OR 97223 all other applicable laws. All work will be dune it accprdancP with approved plans. T`1is permit will expire H work is not started within 180 days of issuance,or if the work is sL 5pended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Phone: 503-625-6526 Phone: S03-025-6526 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0080. You Rep k: I I�• Sll 14)(1 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Grading Inspection Post/Beam Mechanica Plumb Top Out Exterior Sheathing Insf Firewall Insp Appr1Sdwlk Insp Sewer Inspection Underfloor insulation Electrical Service Low Voltap^ Rain drain Insp Electrical Final Footing losp Crawl Drain/Backwater Electrical Rough In Gas Line ^r Storm drain Insp Mechanical Final Foundation insa- PLM/Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final Iss ed By :I� �l l """`� Permittee Signature Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day CITE( OF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-00282 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/18/03 SITE ADDRESS; 12830 SW BLUE HERON PL PARCEL: 2S10313C-08800 SUBDIVISION: BLlJlJ HERON I'ARK ZONING: R-4.5 BLOCK: LOT: 005 JURISDICTION: TIO TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEV DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SFA dwelling. Owner: — - -� FEES WINDWOOD CONSTRUCTION, INC. 12655 SW NORTH DAKOTA Description Rate Amount TIGARD, OR 97223 I SWI JSA Swr Connect 9/18/03� I �� $2,400.00 (SWI ISA ISN%rninnect 9/18/03 $0.00 Phone: 503-625-6526 ,-,WlNSI' 9/18/03 I I ��S��r Inspect I " $35.00 Contractor: 1SWINSI11 Swr Inspect 9/18/03 $0.00 Total $2,435.00 Phone: Reg#: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires '180 days from the date issued. The total amount 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 to^ated, the installer shall pure ase a "Tap and Side Sewer' Perm Issue by: `- ' z /J - -- -- Y (� �-C�-I �� Permittee Signature: Call (503) 6394175 by 7:00 P.M.for an inspection needed the next business day "CSU Building Permit Application r Datereceived:7_e)-6j ZP) Permit no.: r City of Tigard �3 Address: 13125 SW Ball Blvd,Tigard,OR 97223 Project/appl.no.: Expire date: r ,n,,l7;burd phone: (503) 639-4171 Date issued: Bya I Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: m Land use approval: — I&2 family:simple L:a Complex: -nit IE T~ OF PERMIT. 2 family dwelling or accessory U Commercial/industriol U Multi-family 0 New construction U Demolition U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: JOB SITE-INFORMATION ��•, Job address: k •a,1 /'r fp Bldg.no.: Suite no.: Lot: Block: SubdiNision: plue /loin I Tax map/tax lot/account no.. 5/40Y& 71 3S' Project name: Description and location of work on premises/special conditions: ' SPECIAL INFORMATION, Name: r� tam► ( rtlS Mailing address: 11 &2 family dwelling: City: ZZ,to Stat ZIP: Valuation of work........................................ $j7.`/��7, !' Phone: _�$ G Fa f. I E mail: No.of bedrooms/baths............ ................... Owner's representative: OP,/ ,!1/ '1 Total number of floors...........4................... 2- Phone: Phone:Zi/rrl Fax: E-mail: New dwelling area(sq. ft.) .. / Garage/carport area(sq. ft.)...... '....... Name Covered porch area(sq. ft.) ......r. t4......... Mailing address: Deck area(sq.ft.) ........................................ City: ate: ZIP: StOther structure area(sq.ft.)......................... Phone: Fax: E-mail: Comrnercial/industrial/multi-fandl}: 1 1 Valuation of work.... ......................... $_ Business name: Existing bldg.area(sq. .) ................. ....... New bldg.aren(sq.ft.) Address: City: _ State: I ZIV Number of stories.............. Phone: I;tx: Email: — Type of construction... ............ ................. Occupancy group Existing: CCB no.: New: City/metro lic.no. Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: Ala^ provisions of ORS 701 and may be required to be licensed in the Address: iN w tLjurisdiction where work is being performed. If the applicant is A 0qCity: /t JState&Y ZIP: Q p exempt from licensing,the following reason applies: Contact person: ef A Plan no.: Phone:;0 S- Fax� I E-mail: --- Nano: kt Contact person: ,6 Fees due upon application ........................... $ Address: rl _ Date received: City: / __ State .e ZIP: yL Amount received .........................•............... $ Phone: ,1 ,2 Fax: Gj E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Na ri iaUdkdom wcW credit crda,please call IudidRuon r«mac,arfoentr►eo attached checklist. All provisions of laws and ordinances governing this U Visa O MasterCard work will be complied with,whether specified herein or not. lCredit cord mother: — — —L—L- - Eapirea Authorized signature Y Date: Nuns of cardholder r shown on credit cad Print name: :4c� _ -- -- s J Crdholder aigratwe Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been acr:pied as complete. +e0-4r3(ttiwr.:oM) One-and Two-Family Dwelling - Building Permit Application Checklist Reference no.: Associated permits: ClryojTigard City of Tigard O Electrical 0 Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 CI Other: Phone: (503) 639-4171 Fax: (503) 598-1960 Pr THE �OLLOWING ITEMS ARE 9EQUIRED ' PLALUVIEW No NIAYcs I Land use actions completed.See jurisdiction criteria for concurrent reviews. _ 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,.!tcj_ _ 4 Verification of approved platllot. 4 Fire district approval required. 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 0 plan O permit required. Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 3 Complete Sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes.Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details.Pian review cannot be completed if copyright violations exist. _ I I Sitelplot plan drawn to scale.The plan must show lot and building setback dimens ons;property comer elevations(if there is more than a 441.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:utility locations;direction indicator lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,morn identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixturts,balconies and decks 30 inches above grade,etc. _ 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roc f construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace constnrcuun, thr.rrnal insulation,etc. 15 Elevation views.Provide elevations for n-w cunst ucti=minimum of two elevations for additions and remodels. Exterior elevations must reflect the actua' grade if the change in grade is greater than four foot at building envelope, Full-size sheet addendums showing foundation elevations with cross references are acceptable. _ 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non rescriptive paff.analysis provide specifications and calculations to engineering standards. _ 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spatting,and hearing locrtions.Show attic ventilatic:r. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,see item 22,"Engineer's calculations." — 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/Joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance.Identify the prescriptive path or provide calculations, A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or architect licensed in Oregon and shall be shown to he applicable to the projert under review 23 Five(5)site plans are required for Item I 1 above. Site plans must he 8-1/2" x I I"or 1 I"x 17". _ 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to:cafe`indicates standard architect or engineer scale. 28 Site plan t�)include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 4404614(WCOM) Plumbing Permit Application rSewer ceived: _!.",Lv �� Perndtno.: City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 permitno..: Building permit no.: City ofTigard Phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 / Date issued: By: Receipt no.: Land use approval: ! ' �� Case file no.: Payment type: TYPE 0 ❑ 1 &2 family dwelling or accessory ElCommercial/industrial ❑Multi-family LIru Tant improvement ❑New construction U Addition/alteration/replacement ❑Food Scrvir-c lJ(Alter rl,�bdress: 3� j -/ K�TJ fJlee(ea.) 'total Bldg.no.: Suite no.: New 1-and 2-family dwelionly: - - --- tincludes 100 ft.for each utility connection) Tax map/lax lot/account no.: _ SFR(1)bath Lot: Block: Subdivision: SFR(2)bath Project name: [i&A SFR(3)bath City/county: I ZIP: Each additional badAitchen Description and I ation of work on premises: Siteutilides: Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain Footing drain(no.lin. ft.) Manufactured home utilities Bufiness name:&,-,-, Manholes Address: A,.;% Rain drain connector City: 1V4I' A Y Stnte/v-� Z,1P: �� Z San sewer(no.lin.It.) Phone: 'j .,Z-. 361 Fax: E-mail: Storm sewer(no.lin.ft.) CCB no.: 41 . Plumb.bus.reg.no:�? Water service(no. lin.ft.) City/metro tic.no.: Fixture or Item: Contractor's representative st atu_re: Absorption valve Print name �, - -- -- Back flow reventer Date: Backwater valve —Basi ns/lavato Name: � _ Clothes washer Address: �S`�,,,1 Dishwasher Cyt Drinkin fountain(s) Y State: ZIP: I?jectors/sum Phone:'Phane: 73 qj -.V rFax: E-mail: Expansion tank Fixture/sewer ca Name(print): f�r�k, Drax s Floor drains/floor sinks/hub Mailing address: r-t- Garbage disposal City: 3ta � Hose bibb ice maker Phone: E-mail: Interceptor/grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will he made by me or the mainten rice and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s), lays(s) Owner's signature: Date: Sum Tubs/shower/shower pan Name: Urinal Address: Water closet Water heater City: State: ZIP: Other: -- Phone: Fax: E-mail: Total Na as Jtrrdlctlor accept rraat &di.Oere c,rt Jariedicuan fQ mac taramwt.) Minimum fee................S an O Visa O MerCard I Notice:This permit application Plan expires if a permit is not obtained Pian review(at — 96) $ aaut e.a cumber. — ) vtithin 1$0 days after it has been State surcharge(8%)....$ TOTAL None of r on credit accepted as complete. .......................$ S . CmWdw d — Amemm 1164616(6001('OM) PLUMBING PERMIT PEES: PRICE TOTAL New 1 Bind 2-family:lwellings only: FIXTURES (Individual) QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink _ 16 60 the swelling and the first100 ft. QTY lea) AMOUNT 16 60 for each utility connection) Lavatory _ _ One(1)bath $249.20 _ Tub or Tub/Shower Comb. 16.60 Two 2 bath _ $350.00 Shower Only 16.60 Three 3 bath _ $399.00 Water Closet 16 60 SUBTOTAL _ Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN_REVIEW 25°/.OF SUBTOTAL TOTAL Garbage Disposal 16.60 — -l-aundry Tray 16.60 Washing Machine 16.60 FloorUrain/Floor Sink I- lsso PLEASE COMPLETE: 3- 16.60 T-- - 16.60 ----- Water Heater O conversion O like kind 16.60 _Quantity b Work Performed Cas piping requires a separate mechanical Fixture Type: New Moved Replaced T 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 1660 _ Combination Roof Drains v 16.60 - Shower Only Drinking Fountain 16.60 Water Closet — 16.60 _Urinal Other Fixtures(Specify) _ Dishwasher Garbage Disposal - - J - LaundryRoom Tray Washing Machine _ _ Floor Drain/Sink: 2" _ Sewer-1st 100' 55 00 3• Sewer-each additional 100' 46.40 4" Water Service-1st 100' ,z).00 Water Heater Other Fixtures Water Service-each additional 200' 46.40 Storm&Rain Drain-1st 100' 55 Storm&Rain Di ain-each additional 100' — Commercial Back Flow Prevention Device 4640 - -- Residenbal Backflow Prevention Device' 2755 Catch Basin 16,60 --- Inspection of Exishnq Plumbing or Specially 62.50 Requested Inspecf ons erAir COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 - Grease Traps - 1660 --- —----- -- - - QUANTITY TOTAL - Isometric nr riser diagram is requifed if Quantity Total is -.9 _ 'SUBTOTAL --- 8%STATE SURCHARGE -- -- - "PLAN REVIEW 25°/.OF SUBTOTAL -_,-.—_ Requaed only if fixture qty total is>9 $ — TOTAL S .Minimum pormit fes is$72 50•8%stale surcharge,exr Rasidenlial Back1low Prrventhtti r)evice,.vh1ch is SM 25+8%state surcharge ..All Now Commerclsl Buildings require 2 sets of plans with isorrrtric or riser diagram for plan revlew. 1:\dsts\forms\plln-fees doc 12/26/01 Mechanical?ermit Application 7,, ved: Permit no.:t _l Ci sof Tigard�' gpl.no.: Expire date: CityofT:,ard A•'idress: .1125 SW Hall Blvd,Tigard.OR 97223d: By: °c:-int ro.: Phone: (50") 639-4171 --- .m (503) 598-1960 Case file no.: Payment type: Land use appy-✓al: _._ Building permit no.: JVPE OF PERMIT family dv 'i'rt or accessory U ConuncrciaUindustrial ❑ Multi-family U Tenant improvement ❑h'es ,uc,truction U Add ition/alteration/replacement U Other: +7M• JOIfSfT9 INI ORMATION COMMERCIAL VALUATION1 1oh address: �� h� lj��, /q/C• Indicate equipment quantities in boxes below.Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: 5/ �j�, J'L 3 y('v profit. Value$ _ Lot: Qlack: Subdivision: p •See checklist for important application information and Ptnject naive: 161tr k-,-& ct jurisdiction's fee schedule for residential permit fee. City/county: C[ SCHEDULE Description and location,6f work on premise, l t t t :ee(ea.) 'Total Est.date of completion/inspection: Description Res.otdv Rm.only rnant improvement or change of use: nA Is existing space heated or conditioned`'U Ye,. U No Air handling unit _CFM Air conditioning(site plan required) Is existing space insnlared?U Yes Cl No Alteration of existiaLHI AC system CONTRACTOR of er/compressors // State boiler permit no.: Business name: 1��Ll1Ln'� /� _ _ HP Tons BTU/H Address: fd C, _ Fir smoke ampers/ tier smo a erectors City: /I GM I State: IP' Q ,L,3 ear pump(site plan required) Phone: 3 Fax: E-mail: nstal rep ace fumace/burner 9 - ��— Including duetwork/vent liner C1 Yes O No CCB no.: //off Y1T/ Instal replace/rcocate heaters-suspended, Citv/metro lic.no.: So wall,or floor mounted Name(please print): �, Acnt for appliance other than furnace 0Refrigeration: Absorption upas_ BTU/H _ Name: -5Gt/'t <- Chillers lip Address: Com ressors Hp Enyiromentall eximust and ventilation: City: Slate: ZIP: Appliance vent _ Phone: Fax: E-mail: Dryerexhaust ocx s,Type U I Ures.kite en/ azmat hood fire suppression system Name: 4j,+-A,,,&, -c3n,:o $ Exhaust fan with single duct(bath fans) Mailing address: ( Exhaust system aartpromoeat n or A p , Fuel piping w—Tdistribution to 4 outlets) City: > / 2/0 .-Y State:6F/-1ZIP7k-4-3 'Iype: LPG NO Oil Phone: 64;i w I Fax: E-mail: Fuel piping each additional over 4 outlets Process piping(sc ematic require ) a Name: Number or outlets Other appliance or eq pment Address: _ _ C-corative fireplace City: ___ State: ZIP: v nsert-type Phone: Fax: E-mail; oo dov pe et stove Ot er. Applicant's signature: _ Date: t Name (print): Na all)urtwicurm accept Irwin cards,Please cart JuriWiction for more Information. Permit fee ................ O viae ❑MasterCard Notice:This permit application Minimum feeee $ . ..............S _ Cmdli cast cumber � / expires if a permit is not obtained Plan review(at _ %) $ ----- within ISO days after it has been State surcharge(8%)....$ Name ot cardbolderu shown on c t ci@ accepted as complete. s TOTAL .......................S cardhower Apatin 1141617(15MCOM) MECHANICAL PERMIT FEES 30MMERCIAL FEE SCHEDULE: 1 & 2 F4MIL) DWELLING FEE SCHEDULE: rTOT/,L VALUATION: PERMIT FEE: Desr7iption: Price Total $1.00 to$5,000.00 Minimum fee.$72.50 Table IA Mechanical Code ob (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 1130,000 BTU $1.52 for each additional$100.00.r including ducts 8 vents 1400 fraction thereof,to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts 8 vents 1-40 0 to$25,000.00 $148.50 for the first$10,000.00 and I - 3) Floor Furnace .. 7,001.0 $1.54 for each additional$100.00 or Including vent 14 00 fraction thereof,to and including 4) Suspendeu heater, wall he-!;, " `,J00.00. or floor mounted heater 1 00 11'25,6C1.6011'25,6C1.6025,O .OU to_$50,000.00 $S,'9.50 for the first$25,000.00 and 5) Vent not included in apoliance permit i $1.45 for each additional$100.00 r 6 80 . fraction thereof,to and Including 6) Repair units $50,000.00. 12,15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For items 7-11,see or Pump Cond fraction thereof. footnolas below. Comp Minimum Permit Fee$72.50 SUBTOTAL: $ 7)100K absorb unit to 100K BTU 14.00 B•/.State Surcharge $ 8)3-15 HP;absorb ?5 ,f unit 100k to 500k BTU 25%Plan Review Fee(of subtotal) $ 9) 15-30 HP;absorb unit.5-1 mil BTU 35.0 Required for ALL commercial perrnits onl TOTAL COMMERCIAL PERMIT FEE: $ unit 30-50t 1-1.75 mil BTU absorb 52.0 uni _ 11)>50HP;absorb unit>1.7.5 mil BTU _ 87 20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00 Valuu Total 13)Air handling unit 10,000 CFM+ Description: Qty En Amount 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evapurate cooler ducts 6 vents 10.00 Furnace> 100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents _ _ 6.80 Floor furnace including vent _ 955 16)Ventilation systum not included in Suspended heater,wall heater or 955 ap Ilp ance�ermit 10.00 flour mounted heater 17)Hood served by mechanical exhaust Vent not Included in applicance 445 10011 permit 18)Domestic incinerators Repair units 805 17.40 <J hp;absorb.unit, 955 19)Commercial or industrial type incinerator to 100k BTU 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,iI Icluding wood stoves 101k to 500k BTI _ _ 10.00 15-30 hp;absorb.unit,5011,to 1 2,310 21)Gas piping one to four outlets mil.BTU _ __ 5.40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU 1.00 _ >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mil.BTU _ Air handling unit to 10,000 cfm 656 _ 8%State Surcharge $ Air handling unit>10,000 cfm _ 11170 I Nan-portable evaporate cooler 656 _.- TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected'o a single duct 446 Vent system not Included in 656 appliance permit Hood servt, y mechanical exhaust:by ht 651 Inspections_6 _ other po and Fees: _ ectionoutside of Hormel brslnesa hours tminimum of,age-two hours) Domestic Incinerator 1,170 _ _ $62 50 per hour Commercial or industrial Incinerator 4,590 v 2 Inzipections for which no fee Is specifically indicated (minimum charge-half tour) Other unit,including wood stoves, 656 $62 50 per hour Inserts,etc. 3 Additional plan review required by changes,additions or revisio..s:o plans(minimum Gas iPIrl1-4 outlets 360 _ charge ono-half hour)S6.".50 per hour Each additional outlet _ 63 'State Contraclor Boiler Certiflr•.ation required for units>200k BTU. $ "Residential AIC requires site plan showing placement of unit. TOTAL COMMERCIAL VALUATION: All New Commerci•,I Buildings require 2 sets of plans. I ristsVonnsWect,fees.doc 12/26/01 Electrical Permit Application Date received: Permit no.; - City Of Tigard Projecdappl.no.: Expire date: Cii.volI7gurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.; Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT U I &2 family dwellinr or accessory 0 Commercial/industrial U Multi-family U Tenant improventeot 0 New construction U Addition/alteration/replacement U Other: U Partial Job address: aC 4 Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: Project name: �yN Description and location of work on premises: Estimated date of completion;+n-;vection: APPLICATIONIN 114111ACII-OR Job no: Fee Max B1151ne55 naRT:: Descripll n (NY. (en.) Total no.insp �- ��',� - New rnidential-tingle or multi-famiiv per Address: C t+� dwelling unit.Includes attached garage. City: ee. •,0 State ,^ ZIPC{` 7 Service included: �- Phone: Fax: — 1000 sq.rt.or less 4 th� E-mail: —_ Each additional 500 sq.ft.or onion thereof CCB no.: 3 1 Elec.bus.IIT.no: t -(fir-7 Limited energy,residential 2 City/metro lie.no.: _ 70 _ Limited energy,non-residential _ 2 Each manufactured home or modular dwc17,ate Signal rf supervising electrician(required) Date Service and/or feeder Sup.clect.name(pnmi �. - Lict.,,sr,o„ o _ Servlcaorfeeders-Installation, alteration or relocation: 200 amps or less 2 Name:(print): U. tI' _�•,�,� 0,::-/ 201 amps to 400 amps 2 t� �, /�A �� 401 amps to 6(N)amps 2 Mailing address: aJ _ 601 amps to IOW amps 2 City: State:g!�'% ZIP: .0 Over 1000 amps or volts 2 Phone: I E-mail: Reconnect only I Owner installation:The installation is being made on property 1 own Temporary services or feeders- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation: ORS 447,4.55,479,670,701. 2(x)amps or less -- 2 201 amps to 400 r aps 2 Owner's Sita 'lUi'J: _ Date: 401 to 600 am s Branch circuits-new,alteration, or"'least".der panel: Nip' _ A Fee for brunch circuits with purchase of Address: servic:or feeder Fee,each branch circus 2 City: State: 71 B. Fee far branch circuits without purchase Phtuu I ,t� 1'-mail: ofserviceorfeeder fee,firstbranch circuit: 2 Erich additional branch circuit: PLAN REVIEly(Please check all that appis Misc.iserviee or feeder not Included): J Service over 22°amps-comm:rctal J I lealth-care facility Each pump or irrigation circle '- O Service over 320 amps-rating of 1 rtr2 U Hazardous location Each sign or outline lighting _ _ — familydwellinlls U Building over 10.000 square feet four or ?ignal circuit(s)or a limited energy panel. U System over 6(0 volts nominal more residential units in one structure alteration,or extension• '- O Building over.hree stones U Feeders.400 amps or more 'Description. U occupant tuad over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In any of the above: U Egress/lightingplan U Other: Perinspecuun Submit___sets of pian with snv Ni the above. Investigation fee _ Ile above are not applicable to temporary construction service. Other Not all junsdicuons accept credit cards,please call tunsdiction fur more mformauon Notice:This permit application Permit fee.....................$ _ U Visa 0 MasterCard expires if a permit is not obtained Plan review(at _ %) S _ Credit card numher _ __ within ISO days after it has been State surcharge(8%)....$ "ire` accepted as complete, TOTAL ............ ..........$ Name cardholder as drown on credit carte—_ Cardholder sipsture s Amount 4411461516MCOM) fir• ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE(IF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: ResLicted Energy Fee...-.......... — $75.00 .... ................ Number of Inspections per permit allowed) (FOR ALL SYSTEMS) Service included: Items Cost Total t Check Type of Work Involved: Residential-per unit 1000 sq ft.or less $145.15 4 Audio and Stereo Systems' Each additional 500 sq it.r r portion thereof $33.40 1 Burglar Alarm Limited Energy $75.00 _ Each Manufd Home or Modular L� Garage Door Opener' Dwelling Service or Feeder $9090 2 Services or Feeders F�j Heating /entilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 Vacuum Systems' 201 amps to 400 amps _ $106.85 _ 2 401 amps to 600 amps 4160.60 2 601 amps to 1000 amps $240.60 2 ❑ Other__._ Over 1000 amps or volts $454.65 _ 2 Reconnect only $66.85 _ 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL CNLY Installation,alteration,or relocation Fee for each system.......................................................... $75.00 200 amps or less $66.85 2 (SEE OAR 919-260-260) 201 amps to 400 amps _ $100.30 2 401 amps to 600 amps $13375 2 Check Type of Work Involved: Over 600 amps to 1000 volts, nee"b"above. Audio and Stereo Systems Branch Circuits Boiler Controls New,alteration or extension per panel a)The fee for branch circuits 1 with purchase of service or �J Clock Systems feeder fee. Each branch circuit _ _ $665 2 C' Data Telecommunication Installation b)The fee for branch circuits without purchase of service Fire Alarm Installation or feeder fee. First branch circuit _ $46.85 Each additional branch circuit $6 65 HVAC Mlscollaneous Instrumentation (Service or feeder not included) Each pump or irrigation circle $5340 F—] intercom and Paging Systems Each sign or outline lighting — $53.40 Signal circuits)or a limited energy panel,alteration or extension $75,00 _ Landscape Irrigation Control' Minor Labels(10) $125.00 _ Each additional Inspection over E] Medical the allowable in any of the above Per inspection _ $6250 Nurse Calls Per hour _ _ $6250 In Plant $73 75 v Outdoor Landscape Lighting' Fees: L.-1 Protective Signaling Enter total of above fees $ _ Other 8%State Surcharge $ __ _ —_----_Number of Systems 25%Pian Review Fee See"Plan Review"section on $ No licenses are required Licenses are required ler all other installations front of applicalion _ — ---- Fees: Total Balance Due $ -- Ente•total of above fees $ Trust Account p_ 8%State Surcharge = Total Balance Due $All New Commercial Buildings require 2 sets of plans. i:\dsts4orms\elc-fees,doc OR/30101 lu,�G wt�,o ms`s ��hx� -i1b 5d 5�,� ,y/� ��,► Ate 73 s!�Fr !tet G y3�7.s�Fr 14� turn U �2 Y p7 � CITY OF TIGARD - SITE PLAN I?F:VIFW BUILDING PERMIT NO.: $T 2oo3 •-DD 35 PLANNINDIVISION: Requir'd , etbacks: Approv,.d ❑ Not Appro%ed Sid+:: Street Side: _1:°__ Front. X3.2._ Garage: ay Rear,. Is visual Clearance: 'kpproved Q Not .Approwd 1; ximui Fttiilding. Height' .3-0 feet 1 , �'. ; service provider Letter Required: 0 YeS : L 11 ` (n(iINE � '(.i DLPA R'l \II.N'1 . - Acioul Slope:—% M Apprt, hj iJ, ' .t of site pinn: (.�--SAhpro�vd ❑ t 1 :1 prtt��'ti �il Fig nate Nut�s� I I