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12850 SW BLUE HERON PLACE f r � N 00 (T O CCn f C I� m 0 W 0 f i i i I 12850 SW Blue Heron Place CITY OF TIGARD MASTER PERMIT PERMIT#: MST2003-00029 DEVELOPMENT SERVICES DATE ISSUED: 2/20/03 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 SITE ADDRESS: 12850 SW BLUE HERON PL PARCEL: 2S10313C-09000 SUBDIVISION: BLUE HERON PARK ZONING: R-4.5 BLOCK- LOT: 007 JURISDICTION: TIG REMARKS: Const, new SFA residence BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 27 FIRST: 9 it of BASEMENT: of LEFT: 5 SMOKE DETECTORS: 'v TYPE OF USE: SFA FLOOR LOAD: 40 SECOND: 739 of GARAGE: 400 of FRONT: :4 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: t THRD or RIGHT: OCCUPANCY GRP: RS BVALUE: 165,876,00 DRM: 3 BATH: 3 TOTAL: 1,890 of REAR: 16 PLUMBING SINKS: I WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISI/WASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS•. 3 GARBAGE UISP: 1 WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: I GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: 1 BOILICMP<3HP. VENT FANS: 5 CLOTHES DRYER: I GAS FURN>•100K: UNIT HEATERS: HOODS: I OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 -200 amp 0 200 amp: W/SVC OR FOR: PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 3 201 400 amp: 201 - 400 amp: 1 at W/O SVCIFDR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY 401 000 amu: 401 6DO amp: EAADDL BR CIR, SIGNALIPANEL: IN PLANT: MANU HMISVCIFDR: 601 1000 amo: 601+amps-1000v. MINOR LABEL: 1000+amolvolt PIJW REVIEW SECTION Reconnect onlV: >•4 RES UNITS: SVCIFDR>•225 A.: >800 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO f1 STEREO: x VACUUM SYSTEM: X AUDIO k STEREO: FIRE ALARM INTFRr:OMIPAOING OUTDOOR LNDSC LT: BURGLAR ALARM: X 0TH: ALL ENCOM BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: x DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,239.87 WINDWOOD CONSTRUCTION,INC. WINDWOOD(SEE OTHER) This pennil is Subject to She regulations contained in the Tgard Municipal Code,State of OR. Specialty Codes and 12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA all other applicable laws. All work will be done in TIGARD,OR 97223 TIGARD,OR 97223 accordance with approved plans. This permit will expire if 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: S03-625-6526 Phone: 625-6516 Oregon Utility i Iotificatlon Center. Those rules are set forth in OAR 952_C)04-U010 through 952-001-0080. You Rap N 11C 5f11 L)6 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Foundation Insp Footing/Foundation Dr; Electrical Rough In Low Voltage Firewall Insp Sewer Inspection Post/Beam Structural PLM/Underfloor Framing Insp Gas Line Insp Rain drain Insp Footing Insp Post/Beam Mechanica Mechanical Insp Shear Wall Insp Gas Fireplace Water Line Insp Footing Insp Underfloor insulation Plumb Top Out Shear Wall Insp Insulation Insp Appr/SdWk Insp Foundation Insp Crawl Drain/Backwater Electrical Service Exterior Sheathing Insl Gyp Board Insp Electrical Final jr �.� Issued By :�,L� CC Permittee Signature Cail (503) 639-4175 by 7:00 p.m.for an Inspection needed the next business day CITYOF TIGARD SEWER CONNECTION PERMIT_ DEVELOPMENT SERVICES PERMIT#: S -00026 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 2/220/030/03 PARCEL: 2S 103BC-09000 SITE ADDRESS; 12850 SW BLUE HERON PL_ SUBDIVISION: 1 IJ+ IIFRt)N PARK ZONING: R-4.5 BLOCK: LOT: 007 JURISDICTION: TIG "TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Stu-AL Ce,J►Ju-nom Owner: Got. �� FEES _ WINDWOOD CONSTRUCTION Description _ hate Amount 12655 SW NORTH DAKOTA — TIGARD, OR 97223 ISWUSAI Swr Connect 2/�NO3 $2,300.00 1SWUSA] Swr Connect 2/20/03 $0.00 Phone: 503-625-6526 ISWINSPI Swr Inspect 2/20/03 $35.00 ISWINSPJ Swr Inspect 2/20/03 $0.00 Contractor: Total $2,335.00 Phone: Reg#: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Seniices. The permit expires 1,110 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 located,the installer shall purchase a"Tap and Side Sewce' Perm Issued y' � �__ Permittee Signature:)AA AQ2<1 - Call (503) 639-4175 by 7.00 P.M. for an inspection needed the next business day Building Permit Ap ' ationxmmmloifiiil� City of Tig Cj Date received: i - / -G� Permit no. x)51Co-,' - ; Project/appl.no.: Expire date: CityojTigard Address: 13125 SW Vd,Tigard 223 - Phone. (503) 639-4171 + Date issued: pt no.. Fax: (503) 598-1960 ,A VACR,jC Case file nuc,: Payment type: G,Jy JF I&2Camil Si —v Land use approval: y:Simple Complex: fd'r&2 family dwelling or accessory U Commerciallindustrial U Multi-family U New constructiop U Demolition O Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other. Job address: /a p .7/t r t (p I Bldg.no.: Suite no.: Lot: I Block: Subdivision: uC �dn r Tax map/tax lotlaccount no. $/ 3fi Project name: elk 4 Description and location of work on premises/special conditions: Namc: r� W D ( ICUs Mailing address: P,1101/r_ 1 &2 family dwelling: City: f ct Stat ZIP: P7Valuation of work........................................ $1� Phone: 117a113-mail: No.of bedrooms/baths..........:3.................... _ 3 Owner's representative: /c 12(r_AorA Total number of floors *I................... Z- Phone: Fax: E-mail: New dwelling area(sq.ft.) .....46#0......... &f Garage/carport area(sq. ft.)......qG.......... �l _ Name: /rt=' Covered porch area(sq.ft.) ......t�4............ Mailing address: Deck area(sq.R.) ........................................ -- Other structure arca(sq.ft.) '- City: C-- State: ZIP: ......................... Phone: Fax: E-mail: Commercial/industrial/multi-family: Valuation of work................. $ — Business name: Existing bldg.area(sq.ft.) . ............... ..... Address: New bldg.arca(sq.ft.)................. .......... City: State: ZIP: Number of stories....................... ............. Phone: Fax: E-mail: Type of construction.............. .................... -- CCB no.: Occupancy group(s): Existing: New: City/metro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: Q provisions of ORS 701 and may be required to be licensed in the Address: w f jurisdiction where work is being performed.If the applicant is Ci; : /c Statet?''r ZIP: Q 1D exempt from licensing,the following reason applies: Contactperson: &cy n I Plan no.: — — Phone:?-)T-Q Fax E-mail: Name: v 4 Contact person: Fees due upon application ........................... $ Address: Date received: City: StateCe ZIP: oL l:. Amount received ......................................... $ Phone: , Fax: ;,,j E-mail: Please refer to fee schedule. hereby certify I have read and examined this application and the Na all jurisdictions accept credit cards.please call juriadicrion rot mm inllxmatloo. attached checklist.All provisions of laws and ordinances governing this U Milk ❑MasterCard work will be complied with,whether specified herein or not. credit card number: Fzh L- AuthoriZed signature: OT�E � Date• Name of crdholdrr u shown on credit cardPrintname:_ J Ge J __._ Cardholder siFnuwe $ Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. aaia.0(&%ICOM) One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Associated permits: City ojTigard City of Tigard O Electrical ❑Plumbing 0 Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 9723 UOther: Phone: (503) 639-4171 Fax: (503) 598-1960 THE FOLLOWING rumS ARE REOUIRED FOR PLAN REVILIVYes No IN/A 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 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 U plan ❑permit required.Include drainage-way nrotection,silt fence design and location of catch-basin protection,etc. _ 10 3 Complete sets of legible plans.Must be drawn to scale;,showing c mformance 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 o^tails. Plan review cannot be completed if copyright violations exist. — I 1 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if there is more than a Oft.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,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 details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof constriction.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 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 locations;for non- rescri Live path analysis provide specifications and calculations to engineerin standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered systems,see item 22,"Engineer's calculations." — 19 Beam calculations.Provide two sets of 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. _7 - 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon anu shall be shown to be applicaole to the project under review. 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x I I"or I I" x 17". 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type location per approved project street tree plan(if applicable),and COT Strut 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) Building Fixtures Plumbing Permit Application Re��ived Plumbing Date/B : b -Permit No.: 'a�oo2 City of Tigard Planning Approval Sewer - Date/[3 : Permit No.: _ 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 �, Post-Review Land Use ard.or.us Date/By: Case No.: Internet: www.ci.tigard.or.us Contact Juris.: 0 See Palle 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information. TYPE OF WORK FEE*SCHEDULE forspecial Information use checklist New construction I Demolition Description Qq. Fee(ca.) otal Addition/alteration/replacement ❑Other: New I-&2-family dwellings Includes 100 R.for each u Ility connecgmt CATEGORY OF CONSTRUCTION 1 . 2-Familydwellin Commercial/Industrial SFR 1 .20 bath _ 350 x SFR 2 beth 350.00 -Accessory Building Multi-Family _ SFR 3 beth 399.00 Master Builder Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION k Firesprinkler-sq.ft.: Page 2 Job site address: TQ t s:` Site Utilld Suite#: I Bld ./A t.#: Catch basin/area drain 16.60 Project Name: D ell/leach line/trench drain 16.60 Footing drain no.linear ft. Pae 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no.linear tt. Pae 2 _ Subdivision: Lot#: Storm sewer(no.linear ft.) Pee 2 Tax ma / areal#: Water service no.linear ft. Pae 2 Fixture or Item DESCRIPTION OF WORK Absorption valve 10,60 _ Backflow preventer Pae 2 ------- � - -- Backwater valve - -_ 16.60 ----- -- Clothes washer 16.60 - -- - --- - Dishwasher 16.60 -JJDrinking fountain 16.60 PROPERTY OWNER T NANT _ Ejectors/sump 16.60 Name: _ /�� _/ Expansion tank 16.60 r Address: Fixture/sewer ca 16.60 I Cit /State/Zl Floor drain/floor sink/hub 16.60 Y --- - - --- - Garbage disposal 16.60 Phone: _ Fax: 1-lose bib 16.60 El A L CAN'T CONTACT PERSON Ice maker 16.60 Name: Interceptor/grcase trap 16.60 Address: _ Medical gas-value: $ Page_2 City/State/Zip: Primer 16.60 Roof drain commercial 16.60 _ Phone: Fax: Sink/basin/lavatc 16.60 E-mail: Tub/shower/shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: 'l- OZ' 71 Water closet 16.60 Water heater 16.60 Address: �y�`) O -n I ) _ Other: City/State/Zi : Other: Plumbing Permit Fees* Phone: ?,j 4 P) Fax: -- CC§-. 1 73` Plumb. Lic.# -SS 8 subtotal S Minimum Permit Fee$72.50 S Authori Residential Backflow Minimum Fee$36.25 Signature: Date:-7 11/03 Plan Review 25%of Permit Fee $ < � C, State Surcharge 8%of Permit Fee S (Please print ame) TOTAL PERMIT FEE S __ Notice: This permit application expires If a penult Is not obulned within All new commercial buildings require 2 sets of plans wuh Isometric or 180 days after it has been accepted as complete. riser dlaltram for plan re.-lew. 'Fee methodology set by TrI-County Building Induon,Service Board. i:\INts\PermitFornis\PlmPemiitApp.doc 01103 Plumbing Permit Application - Cit;✓ of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppr•ession Systems:_ Site Utilities Qty. Fee(ca) Total Square Footage: Permit Fee: Footing drain-I"100' 55.00 0 to 2 000 — Sl 15.00 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer-Ist 100' 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-Ist 100' 55.00 Medical Gas Systems: Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain-Ist 100' 55.00 SI.OU to$5 000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to 510,000.00 $72.50 for the first 5:,,000.00 and$1.52 for each Additional Sinn nn or fraction thereof,to and Fixture or Item Qty. Fee(es) 'Total including$10,000.00. Commercial Back Flow Prevention Device 46.40 S10,001.00 to$25,000.00 5148.50 for the first$10,000.00 and 51.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27.55 and including$25,000.00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 51.45 for Inspection of existing plumbing or each additional$100.00 or fraction thereof,to _ and including$50,000.00. Specially requested ins ctions- r a72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Subtotal: $50,001 additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures? If "Yes",please indicate work performed by fixture. Failure to accurately report ort fixtures could result in increased sewer fees*. Quantityb Fixture Work Performed Comments regarding fixture work: Fixture Types Replace New Moved Existing Capped — — Ba Mist /Font Bath -Tub/Shower -Jacuzzi/Whirlpool _ Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator —--.—.--.—_-- --_._--.---.-------"—�_--- Dishwasher -Commercial -Domestic Drinkinit Fountain — -- C e Wash ---- Floor Drain/sink -2" .3„ — —-4" Car Wash Drain *Note: If the fixture work under this permit results lit an Garbage -Domestic Disposal -Commercial Increase of sewer EbUs,a sewer permit will he issued and -industrial _ _ fees assessed for the sewer Increase must be paid before the Ice Mach./Ref i .Drains plumbing permit can he issued. Oil Se arator Gas Station Rec.Vehicle Dump Station Shower -Clang -Stall Sink -Bar/Lavatory -Bradley _ -Commercial -Service _ Swimr"'tl,,I ool Filter _ Washes ('ithes _ Water Extractor Water Closet-Toilet Urinal Other Fixtures: i mhsts\Permit 14mns\PlmPermitAppPg2.dor 01/03 I Electrical Permit ApWicationIeE1Ved ' g Electrical Date/By: Permit NoA i `-'; ,{L7 —e, Planning Approval Sign City of Tigard Date/By: - Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 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: 503-639-4175 1 Supplemental information. TYPE OF WORK PLAN REVIEW Piease,clieck all thlit ti" 1 TiKew construction Demolition Service over 225 amps- 0 Health-care facility commercial ❑Hazardous location Addition/alteration/replaCementH.Other: []Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in 1 &2-Farnily dwelling_ Commercial/Industrial ❑System over 600 volts nominal one structure ❑Building over three stories [3 Feeders,400 amps or more :H Accessory Building Multi-Family ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder Other: A ❑iEgress lighting plan C1 Other: Submit seta of plans with any of the above. JOB SITE'INFORMATION;and LO x1` The above are not applicable to temporary construction service. Job site address: TQ FEE"SCHEDULE Suite#: I Bid ./A t.#: Number of ies ections per permit allowed Project Name: Description Qty Fee(to.) Total New residential-single or multi-family per Cross street/Directions to job site: dwelling unit.includes attached garvge. Service Included: 1000 scl.ft.or less 145.15 4 Each additional 500 sq.ft.or portion thereof 33.40 1 Limited energy,residential 75.00 2 Subdivision: // Lot#: Limited energy,non residential 75.00 2 Tax map/parcel#: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 Services or feeders-installation, alteration or relocation: 200 amps or less 80.30 --_ - ----- 201 amps to 400 amps 106.85 2 401 amps to 600 ams 160.60 2 F OPER' .�'OWNER _T1rNANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: W4 a(*J_61 011p t PVC Reconnect only 66.85 2 Address: e,) A9e4 Temporary services or feeders-Installation, alteration,or relocation: City/State/Zip: 200 amps or less 66.85 I Phone: 65'�r Fax: S-=�2 5-6 201 am s to 400 am 100.30 2 +� 401 to 600 amps 133.75 2 XPLICANT _ CONTA.CJ PERSON Branch circuits-new,alteration,or Name: - - extension per panel: — --- - A.Fee tot branch circuits with purchase of Address: _ ____ service or feeder fee each branch circuit 6.65 2 City/State;/Zip: B.Fee for branch circuits without purchase of --- ---- -- -- service or feeder fce first branch circuit 46.65 2 Phone: Fax: Each additional branch circuit 6.65 2 E-mail: Misc.(Service or feeder not included): CONTRACTOR Each umg or irrigation circle 53.40 2 _. ---- Each sian or outline lighting _ 53.40 2 Job No: Signal circuit(s)or a limited energy panel, alteration or extension _ _Pae 2 2 Business Name:_1,Ae t sp c,- oe—Ir–Ca4 Description: Address: Each additional Inspection over rhe allowable in ally of the above: City/State/Zip: Per ins tion r hour min.I hour 62.50 _ Phone: Fax: Investigation fee: CCB Lie.#: LiC.#: other. tctrlcAl Pertlllt Fe Supervising electrician subtotal S _ si ature required: Plan Review 25%of Permit Fee $ Print Name: Lic.#: State Surcharge 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 days after It has been accepted as complete. *Fee methodology set by TN-County Building ledustry doard. (Please print name) i:\Dsts\Perrrtit Forms\ElcPemvtApp.doc 01/03 Mechanical Permit Application Date received: Permit no4W --& <i City of Tigard Project/appl.no.: Expire date: City 4Tigard Addre.ft: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: ___�s Building permit no.: TTPE 6F PERMIT U 1 A 2 family dwelling or accessory ❑Commercial/industrial ❑Multi-family ❑Tenant improvement ❑New construction ❑Addition/altemlion/replacement ❑Other:_ VALUATION Job address: In(hCate equipment quantities to boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot account no.: 5/ (�L J-L 3 5 (oo profit. Value$ Wt: Bhxk: Subdivision: a Mian 'See checklist for important application information and Project name: 11 e jurisdiction's fee schedule for residential permit fee. City/county: t[' / t. ZIP: �7 -4rAC 1 t Description and location4f wor on premises: 1 Fee(m) Total Est.date of completion/inspection: Desert oo Res.only Res.onl Tenant improvement or change of use: handling Air handling unit CFM Is existing space heated or conditioned?0 Yes ❑No Air conditioning(site plan required) Is existing space insulated?❑Yes U No Alteration o existingsystem of er compressors // State boiler permit no.. Business name: /tt �� in r�Tr' _ Hp Tons BTU/H Address: d 2 4 Fire/smoke a�uct smo a etectors City: ft UM State: 1P: ep X3 eat pump(sue plan required) Phone: l--ax: E-mail: nsra rep ace furnac urner Including ductwork/vent liner U Yes U No CCB no.: Install/replace/relocateheaters-suspen e City/metro lic.no.: SO wall,or floor mounted Name(please print): p `j 5d,1 Vent for a lance other than furnace Refrigeration: Absorption units BTU/H Name: SGc Chillers HP -- Com ressors HP Address: Finviroussentall exhaust MW vent ton: City; Stale: ZIP: Appliance vent Phone: Fax' E-mail: ryerexhaust OWNER Hoods,Type res.kite a aamat hood fire suppression system Name: 4 wd!t he S >1 _ Exhaust fan with single duct(bath fans) Mailing address: /9 r J G," A 4-A50 74 Exhaust system apart from hFuel eatin or City: - ,44/O n State:Q/` ZIP: ')IN13 Type:piping art on to outlets) LPG NG Oil Phone:rias=bS�G Fax: 6 Email: Fuel pi in each additional over 4 OWES rocesspiping(schematic requi ) Number of outlets Name: _ _ — ter appliance or equipmenti Address: Decorative fireplace City: State: ZIP: Insert-type Phone: Fax: I E-mail; Woodstov pe et stove _ Other: Applicant's signature: Date: Other. Name(print): Na ail joridkuom accept credit cards,please call jorisaction fat moa lararrnatlon. Permit fee.....................$ Notice:This permit application Minimum fee................$ 0 Vlsa O MasterCard expires if a permit is not obtained arrant ora ottmber: / Pian review(at 96) $ Expiml within 190 days after it has been State surcharge(8%)....$ ,me _cm_&WGW AS on cra—m card-- accepted as complete. $ TOTAL .......................$ Autc 110-4617(ISMIC.'OM) CAL PERMIT FEES CIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: VALUATION: PERMIT FEE: Description; Price Total $5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Oty (Ea) Amt .00 to$10,000.00 $72.50 for the first$5.000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or includingducts&vents 14.00 fraction thereof,to and including 2) Furnace 100,000 BTU+ $10,000.00. includingducts 8 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 includin vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater $25,000.00. or floor mounted heater 14 00 $25,001.00 to$50,000 00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit 6.60 $1.45 for each additional$100.00 or 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 C $1.20 for each additional$100.00 or For Items 7-11,see or Pumpond _ fraction thereof. footnotes below. Comp 7)<3HP;absorb unit $Minimum Permit Fee$72.50 SUBTOTAL: to 100K BTU 1400 8%State Surcharge $ 8)3-15 HP;absorb 25.60 unit 100k to 500k BTU 25%Plan Review Fee(of subtotal) 9)15-30 HP;absorb Required for ALL commercial permits onlyS unit.5-1 mil BTU 35.00 TOTAL COMMERCIAL PERMIT FEE: $ 30absorb unit 1-11.7.75 mil BTU 52.20 unit _ 11)>50HP;absorb unit>1.75 mil BTU 8720 ASSUMED VALUATIONS PER APPLIANCE:_� 12)Air handling unit to 1 .,J00 CFM 10.00 Value Total 13)Air handling unit 10,000 CFM+ Description: Ot E� Amount 17.20 Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts 8 vents 10.00 Furnace>100,000 BTU including 1.170 15)Vent fan connected to a single duct ducts 8 vents 6.80 Floor furnace including vent 955 1 16)Ventilation system not Included in Suspended heater,wall heater or 955 appliancepermit 10.00 floor mounted heater 17)Hood served by mechanical exhaust Vent not included in appliance 445 10.00 ermit _ ---- 18)Domestic Incinerators Repair units 805 17.40 <3 hp;absorb.unit, 955 19)Commercial or Industrial type incinerator to 100k B t U 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU _ 10.00 15-30 hp;absorb.unit,501 k 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 ' Alr handling unit to 10,000 cfrn 656 8%State Surcharge : Ali handlin unit>10,000 cfm 1,170 Non- ortableemirate cooler 658 TOTAL RESIDENTIAL PERMIT FEE: s Vent fan connected to a single duct 448 Vent system not Included In 656 appliance permit. meter Inspections and Fees: Hood served by mechanical exhaust _ 856 t Inspections outside of normal business hours(minimum charge-two tours) Domestic incinerator_ 1,170 1 $62 50 per hour Commercial or Industrial incinerator 4.590 1 2. Inspections 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 revisions to plans(minimum Gag I e 1-4 outlets 360 charge-one4wif hour)$62.50 per hour Each additional outlet 63 'Stale Contractor'roller Cortlflcation required for units>200k BTU. "Residential AIC requires site plan showing placement of unit TOTAL COMMERCIAL : VALUATION: All New Commercial Buildings require 2 sets of plans. I:\dstsVonns\mech-fees.doc 12/26101 1 .� Al Aa 3 G,oo 14, ryry LITIW v�f i i I CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE METZGER ELECTRIC INC 8780 SW LEHMAN ST TIGARD, OR 97223 Electric-21. Siy!''.ature Form Permit #: MST2003-00029 Date Issued: 2/20/03 Parcel: 2S10313C-09000 Site Address: 12850 SW BLUE HERON PL Subdivision: BLUE HERON PARK Block: l-ot: 007 Jurisdiction: TIG Zoning: R-4.5 Remarks: C Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: WINDWOOD CONSTRUCTION METZGER ELECTRIC INC 12655 SW NORTH DAKOTA 8780 SW LEHMAN ST TIGARD, OR 97223 TIGARD, OR 97223 Phone #: 503-625-6526 Phone #: 244-9025 Req #: MET 1034 LIC 96805 Sul' 31 10S ELI: 34-167(' AN INK SIGNATURE IS REQUIRED ON THIS FORM X_ :/Z.2/ -- Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 06/09/2003 11: 18 FAX 5035798056 00.1 CITY OF TIGARD 13125 S.W. HALL. BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GREENWAY ELECTRIC COMPANY 15145 SW GULL DR BEAVERTON, OR 97007 Electrical Signature Form Permit*: MST2003-00029 Date Issued; 2120103 Parcel 2S103BC-09000 Site Address: 12850 SW BLUE, HERON PL Subdivision: BLUE HERON PARK Block Lot. 007 Jurisdiction. TIG Zoning.- R4.5 Remarks: Const new SFA residence Your company has been indicated as the electrical Lontracdor for the permit indicated above In order Sor the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Flectrical Signature Folin prior to the start ofthTe work to the address above, A1TN• Budding Division. No electrical inspections will be authorized until this completed form is received O\ANFR: ELECTRICAL CONTRACTOR. WINDWOOD CONSTRUCTION, INC. GREENWAY ELECTRIC COMPANY 12655 5W NORTH DAKOTA 15145 SW GULL DR TIGARD, OR 97223 BEAVERTON, OR 97007 Phone A. 503.625-6526 hone* S03-S79-8054. Reg 0: t.ic 1.53421 T:LP 3"17c SUP 50255 AN INK SIGNATURE IS REQUIRED ON THIS FORM X 51x1 lure of Supervising 6mc an IF you have any questions, please call 503.719.2433. coo fP1 jA3Q Kalil "F9I1 10 AID i89M00O2 SVA C1. '1 r NOR CCl/60,'90 06/09%2001 11:18 VAX 5015798058 003 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GREENWAY ELECTRIC COMPANY 15145 SW GULL DR BEAVERTON, OR 97007 Electrical Signature f=orm Permit#: MST2003-00029 pate Issued: 2/20103 Parcel 2S103BC-09000 Site Address: 12850 SW BLUE HERON PL Sut:diviaion: BLUE HERON PARI Block- Lot: 007 Jurisdiction_ TIG Zoning: R-4.5 Remarks: Const new SFA residence Your company has been indicated as the electrical wrtractor for the permit indicated above In a'der for the electrical permit to be valid, the signature of the supervizing electrician is required. Please have the appropriate individual from your company sign below and return this Flectdcal Signature Form prior to the start of the work to the address above, ATNV Building Division. No electrical inspections will be authorized until this completed form is received OWN FR: ELECTRICAL CONTRACTOR: WINOWOOD CONSTRUCTION, INC. GREENWAY ELECTRIC COMPANY 12655 SW NORTH DAKOTA 15145 SW GULL DR TIGARD, OR 97223 BEAVERTON, OR 97007 Phone 4: 503-625-6525 hone: S03-S79-8054 Reg #: 'Yw' J153421 ELF 3"17G SUP 5025S AN INK SIGNATURE IS REQUIRED ON THIS FORM X 0"-�� ') P,-,. — S1 rmm of Supervising ctrician If you have any questions, please call 503.718.2433. cu0 P JAN 9C'19 04V911 ria 1LLio i R9ctz!9co2 Xvi ei 'i i Now ro.,6o,9n CITY OF TIGARD 24-Hour _ BUILDING Inspection Line: (503)639-4175 MS7 3 7! 2 INSPECTION DIVISION Business Line: (503)639-4171 -� BUP Received %Z Date Requestedl;_�'-' � AM PM_ .— BUP Location / 2 ,Q Suite MEC — � -1 a 4 C c-L��Z 2G7!Z (---) Contact Person � Ph ^' PLM Contractor __..�. s_ Ph SWR ILDIN Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain C ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam _----- Shear ---Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - --- - --- - - ------ InsUlation Drywall Nailing -- --- -- - - — --- - ---- Firewall Fire Sprinkler - - - -----_-__-------------------. Fire Alarm Susp'd Ceiling Roof Fina ----- ------ ASS PART FAIL Post& Beam — Under Slab - Rough-In Water Service — Sanitary Sewer Rain Drains - - ---- -- -- Catch Basin/Manhole Storm Drain -- - -- Shower Pan Other:_ ---- ------ - - - in T FAIL MECHANI L eam Rough-In - -- Gas Line `✓mo a Dampers - ------- i ----i SS PART FAIL - - - - - ---- - - -- - -- - --- . Ic Rough-In UG/Slab_,__ Low voltage Etre jRMrm Fin n Reinspection fee of$-- ___required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SIT Please call for reinspection RE:__ _ Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk Date / Inspector Em Other: _ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL x o, 3 �, o v �' � � `� v � o 0 OM O � w o H 'moi r \ .' r � � � ^, V V n` y � W � � `r C C � F. r7 �/ �v �a . '� ¢ ° � 'H � � � � � � � � � �` � '� �? 'Z`3 °' � I •� > � � � .� 0� 'J ° � � a � •� � � r1 � � � � C p '� �° o �„ � � o � .� �� y � a � A � �