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8070 SW BONITA ROAD 8070 SW Bonita Road IT�`1V A(�.+7�F TIGAR D MASTER PERMIT PERMIT 4: MST2000.00545 DEVELOPMENT SERVICES DATE ISSUED: 12/8/00 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 08070 SW BONITA RD EXPIRFrI PARCEL:: 2 11)2BC-00200 SUBDIVISION: DURHAM ACRES /�� BLOCK: LOT:069 C JURISDICTION: TIG REMARKS: Correction by homeowner of work by prior owner done without permit. Work expanded in process, no penalties per Hap due to prompt compliance. Mechanical: changing hard duct to flex, extending BAIL DING _ REISSUE: STORIES: _ FLOOR AREAS -_ REQUIRED SETBACKS - REQUIRED ::LASS OF WORK: RFP HEIGHT: FIRST: if BASEMENT. If LEFT: SMOKE DETECTORS: TYPE Or USE: SF FLOOR LOAD: SECOND: of ^'+RA GE of FRONT: PARKING SPACES T IPE OF CONST: SN DWELLING UNI1S: FINBSMENT: if RIGHT: Vl+I"UE'. £,4n,u00 00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 00 of REAR: _ PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACES LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVA'S DRIES' DISHWASHERS: FLOOR DRAINS: SEWER LINES- SF RAIN DRAINS: CATCH BASINS: TLIBISHONERS: GARPAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL.TYPES EARN�100K: BOIL1CMP,AHP: VENT FANS: CLOTHES DRYER: TURN>=1001(: UNIT HEATERS HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR I'ORNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL _ RESIDENTIAL UNIT _SERVICE I''EEDER m TEMP SRVCIFEEDrRS _ BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 200 ump: 0 2L0 amp: WISVC OR FOR PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 400 amp: '31 Aar amu: tat W/O SVC/FDR: SIGN/OUT LIN LT: PER HOUR: LIMITED EVER G' 401 600 amp: 0- - 600 amp: EA ADDL SR CIR: SIGNAL/PANEL: IN PLANT: MANU HMISIV,1FD 3: 601 1000 ump: a0•"amps-1000v: MINOR LABEL: 1000-ampIvelt _ PLAN REVIEW SECTION Reconnect onty , >600 V NOMINAL: CLS ARENSPC OCC: •_�RES UNITS: SVCIFt R>•220 A.: _ ELECTRICAL•RESTRICTED ENERGY RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO A STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LPIDSC LT: BURGLAR AL ARM: OTH: BOILER: HVAC: L.ANDSCAPEARRIG: PROTECTIVE SIGNL: GARA3E OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR HV,-c: DAl A/TELE COMM: NURSE CALLS: TOTAL a SYSTEMS: TOTAI FEES: $ 641.83 Owner: Contractor: This permit is subject tc the reguiationa contained in the LIT-l",E,MARK OWNER Tigard Municipal Code,Slate of OR. Specialty Codes and 8070 SW DONITA QD all other applicstble laws All work will be done in TIGA.RD OR 97224 acoordance wits approved plans This permit will expire tf work is not started within 180 days of Issuance,or if the work is suspended for more than 180 days ATTENTION' Phone: Phone: Oregon law req sires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Res a forth in OAR 95:'.-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questio.ls to OUNC by calling 1503)246-1987, REQUIRED INSPECTIU"JS Pt M/Underfloor Machan'uil Final Mechanical Insp Rumb Flnal Electrical Rough In Building Final Framing Insp EleaMcal Fir al 41 Issued B j/, k-�,W / Permittoe Signature Call (503) 639.4175 by 7:00 p.m. for an inspection needed the next business day i Building Permit.Application -- Date received:/A-,9-Oce Permit na:M"- City of Tigard Wojcct/appi.no.: Expire date: City of7'igard [Address: 13124 SW Hall Blvd,Tigard,OR 97223 __ Rccei too.:Date issued: BY — Phonf: (503) 639-4171 _ p — Fax: (503) 598-1960 Case file no.: Payment type: _— Land use approval: 1&2 family:Simple Complex: LU I &2 family dwelling nr accessory U Cornmcrcial/industrial LJ Multi-tanuly J New construction U Demolition LI Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: Job address: �. o t� �, c Bldg.no.: �4uit�� Lot: k: vision: map/tax lot/account no.: Projact name.: Description and location of work on premises/special conditions:_.4 a7 + ►' ' t L . tt/ t Name: Ii,a r- k * ---- Mailing address: p, V etc S" 1 do 2 family dwelling: State: c 'LIP: �v Valuation of work........................................ $ e, — %1\ Phone: r0 ' 3 Fax: E-mail: _ No.of bedrooms/baths................................. _ Owners representative: — Total number of floors................................. Phone: Fax: E-mail. New dwelling area(sq.ft.) .......................... Garage/carpott area(sq.ft.)......................... Covered porch area(sq.ft.) ......................... -- Name: Deck area(sq, ft.) Mailing address: -- Other structure area(sq.ft.)......................... City: _ State: ZIP: ma Fax. E-mail: ('ornme.rcial/industriallmultl-family: Phone: n of work............. ............... ........... $ Valuatio . Existing bldg.area(sq.ft.) .......................... —_ Business name: (e New bldg.area(sq.ft)................................ _ Address: Number of storir s........................................ City: State: ZIP.: Type of construction _ _.. _ Phone: Fax: - — E-mail: Occupancy group(s): Existing: CCB no.: New: _ --— City/metro lic.no._ Notice:All contractors and subcontractors arc required to be licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Name: — — __. jurisdiction where work is being performed.If the applicant is Address:_L1 _ — exempt from licensing,the following reason applies: y: v Statc: ZIP: _Contact Berson; — — Plan no., --- Ftix: E-mail: — Name: Contact person: Fees due upon application ........................... $ — Address: Date received: --- $-- C'ity: State: ZIP: Amount received ............................ .......... . Phone: Fax: E-mail: Please refer to fee schedule. — 1 hereby certify 1 have read and examined this application at:d the Not all jurisdictions rccept credit cards.ri call jurisdiction for vuxe inrcxnwtion attached checklist.All provisions of laws and ordinances goveimng this U Visa U MasterCard Credit work will be complied w ,whether specified herein or not. redit crd na^toner'_--— -- Expire /. Authorized signaturr:` 2 � Date' `f —Namt d cerdlrolder es+hown on credit card $ Print name:—2-211 1—1k _a— _— Cmirdlwlskr iignatnre Amoual Notice:This permit application expires if a pennit is not obtained within IRO days afler it has been accepted as coni;fete. 440.4613 t6l WOMi One-and Two-Family Dwelling Btdlding Permit Application Checklist Reference no.: — Associated permits: City gfTigard City of Tigard U Electrical U Plumbing U Mechanical Addre;;s: 13125 SW Hall Blvd,Tigard,OR 97223 U Other: -- Phone: (503) 639-4171 Fax: (501) 598-1960 ITS"10 ME- JSE=- I hand use actions completed.See jurisdiction criteria for concurrent reviews. _ 2 Zoning.Flood plain,solar balance points,_seismic soils designation,historic district,etc_ _ 3 Verification of approved plat/lot. __ — — 4 Fire district____-_-approval required. Septic system permit or authorization for temodel.Existing system capacity 6 Sewer permit. - _7 Water district approval --- 8 Soils report.Mvst carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required.Include drainage-way protectio.•t,silt fence design and location of catch-basin protection,etc. lU _ Complete sets of legible plans.Must be drawn to stale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into ttme p:ans or on a separate full size sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed copyri ht violations exist. _ I I Slie/plot pian drawn to sale.The plan must show lot and building setback dimensions;property comer elevatic,ns(it' there is more Uman a 4-ft.elevation differential,plan must show contour lines at 24 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 Cron:sectlon(s)and detalls.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wa!t construction,roof construction.More than one cross section may he required to clearly portray construction.Show derails of all wait and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. -- -- - 15 Elevadon views,Provide elevations for new construction;minimum of two elevations for additions and remodels, Exterior elevations must •eflect 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 braclnq(prescriptive path)andlor lateral auslysis plans.Must indicate details and locations;for non-prescriptive p tiat analysis rovide s cifications and calculations to engineering standards. 17 Floorlroot framing.Provide plans for all floorslr•oof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. - t 8 Basement and retaining walls.Provide cross sections and details showing placement of rebar.Far 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 m,,tiple joists over 10 feet Iang and/or any beanm/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.WI•ren required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall fw shown to tx applicable to the project under review. 23 Five(5)site plans ar-required for Item i I above. ---- 24 25 --- 26 -- -— - 27 — 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. 440-4614(&MCOMi Mechanical Perunit Application --- -�- Date received:A-f Permit no.:rbntoo S Y City of Tigard Project/appl. Expire date: City of Tigard Address: 13125 SW liall Blvd,'1'igat 1,OR 117221 Date issued: By: Receiptno.: Phone: (503) 639-4171 Fax: (503) -98-1960 Calc rile no.: — Payment type: Land use approval: _ Banding permit m, .: U I &2 family dwelling or accessory U Commercial/industrial U Multi-Guuily U Tenant improvement U New construction U Addition/ulteration/replacerncnr U t Wirl 111C i1 1 • f •z R d Indicate cyuipmcnt yua Job address: $ 0 7 0 ntitie- in boxes below. Indicate the d('11w `'t. 0ob g.address: Suite no.: a of all mechanical materials,equipment,labor,overhead, Bldno. Tax map/tax lot/account no.: Value$ Lot: Block: Sutxlivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: ZIP: 1 Description and location of work on premises: _—_ 1 t � 1 �-.-► ��r- , �„ r .�-� a �/_. � _ — Fec(ea.) 'Tulal DeKtiptI01111 Res.only" Res.only. Est.date of completion/inspection: Tenant improvement or change of use: Air handling unit CFM Is existing space heated or conditioned?U Yes U No Air conditioning(site plan required) Is existing space insulated?U Yes U No Iteration of existing 14VAC system _ of er compressors State boiler permit no.: j Business name: u w vt HP Tons BTU/H — '( Address. _ Firc/smo a amper, uct smoke UCICCtOrS City_ State: ZIP: eat pump(site plan require ) rax: E-mail: ns(a rep ace f itnac urner.� Phone: ---- Including ductwork/vent liner U Yes O No CCB no.: nsta I/rep ac re ocate heaters-suspen-suspended, City/metro lie.no. �_ wall,or floor mounted Narnc (plcam, print) ent For—appliance other tanfurnace Refrigeration: Ab::orption units BTU/H Chillers HP Nzme: _ -.- Com ressors� _ lip Address: _ nv ronmenta ex ud and ventilation: City: — State: ZIP: �� Appliance vent Phone: Fax: E-mail: )rycrex aunt tico s,Type I I/res. itc en azmat hood lire suppression system -- Name: /1 p k _ L I -Y Exhaust fan with single duct,bath fans) X aus:system a att from heatingor AC Mailing address: . c ue p ping andistribution up to outlets) State: i) ZIP:q 7 o -3 S City: 4:,E �f w � Type: _LPG —_ NO Oil Phone: Email: t'Fuel i in each a ditiona over Woutlets Process piping(sc ematicrequire ) Number of outlets _— Name: --_�___—_ Other listed appliance or equpment: Address: _ Decorative fireplace City: State: Z1I': --t _ -- - Wood oo�oO alov pe let stove Phone: fax: E-mail: E0t er: Applicant's signature: Date: �*L -o f v -D-1111141411. Name (prim): rNa A- I-, 7, '/ r _ Permit fee.....................$ — rNrs all jurisdiction,acreirt credit crank,plew rail jurisdiction for mire informsoit, Notice:This permit application Minimum fee................$ I U vis t U MasterCard expires if a permit is not obtained plan review(at ___ 3'r,) $ Cry V:care number_ _- ---- -- within 180 days after it has been State surcharge(8ri6)....$ -- - -- ecce ted as complete. Name of cardholder ss shown on credit card $ p TOTAL .......................$ ,(Gg0/COMI — 1, -- Cardholder elp ature _` Amount 440.46 MECHANICAL PERFAIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TO2T-k.VALUATION: FEDescription: Price 0 to t;5,000.00 M nirnum fee$72.50 Table 1A Mechanical Code - Qty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first S5,t'00.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or includin 14.00 ducts&vents _ faction!hereof,to and including 2) Fumace 100,000 BTU+ $10000.00. Includina ducts&vents 17.40 $ 6001.00 to 525,000.00 $14u.50 for the first 510,000.00 ar.d 3) Floor Furnace $1.54 for each additional$100.00 or Including vent _ _ 14.00 fraction thereof,to and inrrluding 4) Suspended heater,wall heater _ __ $25,000.00. or floor mounted heater 1400---- j- $?5,001.00 to$50.000.00 $379,50 for the first$25,000.00 and 5) Vent not included in appliance permit 6.80 $1.45 for each additional$100.00 or - fraction thereof,to and Including 6) Repair units 12.15 $501000.00. - - $50,001,00 and up $142.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air 51.20 for each additional$100.00 or For Items 7.11,see or Pump gond fraction thereof. _ _ footnotes below. Comp" ---" �J 7)<3HP;absorb unit to 100K BTU 14.00 ASSUMED VALUAT►ON_SPER APPLIANCE: 8)3-15 HP;absorb - - Value Total unit 100k to 500k BTU _ 25.60 Descripfinn__ Oty AEp _A_m_ou_nt g)15-30 HP;absorb Furnace to 100,000 BTU,including 955 unit.5-1 mil BTU 35.00 ducts&vents -- - 10)30-50 HP,absorb Furnace>100,000 BTU including 1,170 unit 1-1.75 mil BTU 52.20 ducts&vents _ _._-______ 11)>50HP:absorb Floor furnace Including vent 955 unit>1.75 mil BTU I 1 1 87.70 Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM floor mounted heater 10.00 Vent not Included in applicance 445 13)Air handling unit 10,000 CFM+ n_ermit 17.20 Rspair units 805 14)Non-portable evaporate cooler <3 hp;absorb.unit, 955 10.00 to 100k BTU 15)Vent fan connected to a single duct 3-15 hp;absorb.unit, 1,700 6.80 101k to 500k BTU 16)Ventilation system not Included In 15-30 hp;absorb.unit,501k to 1 2,310 appliance permit 10.00 mil.BTU17)Hood served by mechanical exhaust 30-50 hp;absorb.unit, _ 3,400 10.00 1-1.75 mil.BTU 18)Domestic Incinerators >50 hp;absorb.unit, 5,725 17.40 >1.75 nill.BTU --- 19)Commercial or Industrial type Incinerator Air handling l nil to 10,000 cfm 656 69.95 _ Air handling unit>10,000 cfm 1,170 20)Other units,Including wood stoves Non-poeva orate cooler _ 656 10.00 Vent fan connected to a single duct 446 _. 21)Gas piping one to four outlets Vent syste,.,not included in 656 5.40 a Ilanceep rmit _ _ 22)More than 4-per outlet(each) Hood served by mechanical exhaust 656 _1.00 Domestic indnerator __ 1,170 Minimum Permit Fee$72.50 SUBTOTAL: 5 Commercial or industrial Incinerator 4,590 _ Other unit,Including wood stoves, 656 8%State Surcharge $ Inserts,etc. Gas pi Ip ng 1-4 outlets 360 - 25%Plan Review Fee(of subtotal) $ Each additional outlet 63 Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION:_„_ Other lnspecllons_tndFees: 1 Inspections outside of normal business hours(minimum charge-1-c hours) $72 50 per hour 2 Inspections for which no tep is specifically Indicated (minimum charge-half hour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-one hall hour'$72 50 per hour "State Contractor Boller Certification required for units>200k BTU. "Residential A/C requires rite plan showing placemer t of unit. I\dstsUorms\mech-fees.doc 10/11/00 Electrical FerinitApplication ---'-- Dale received: /i- Permitno.:f•,j�� _fps City of Tigard Project/,appl.no.: Expire date: City of Tigard Address: 13125 SW liall Blvd,'Figard,(W 97221 Date issued: By: Receipt no.: Phone: (503) 639-4171 — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: U 1 Bc 2 family dwelling or accessory U Corrtmerrial/indust ial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacenu rat U Other: U Partial 'b address:_r`lu 7� w /?•p . 'r., 2 r7 Bldg.act.: Suite no.: Tax map/tax lot/account no.: Lot_ Block: Subdivision: � i_ Project name: Description and location of work on premises: Estimated date of completion/inspection: r Err OW ( nfa. Business name. Descriptlen ea) rotnl no.fus _ _ - Newreslrkrttial-singkormultlL•nnilVlKr Address: _ dwellinganh.Includes attached garage. City: State: I ZIP: Ser-deeincluded: -� 1�- 4 Phone: Fax: E-mail. 1000 sq.ft.or less Each additional 500 sq,ft.or portion thereof CCB no.: EIeC.hila, he.no: Limited energy,residential 2 City/metro lic.no.: Limited energy,non-residential 2 Each manufactured home or modular dwelling Signature of supervisino electrician(required) - Date c:mice anti/or feeder 2 Servlcesorfeeders-lastalldlan, Sup alteration or relocation: t 200 gimps or less 2 A r �[ t� / .` 201 amps to 400 amps -2 Name(print): — 401 amps to 600 amps 2 Mailing address: P. 601 amps to 1000 amps '- City: L o U 5 rti n State: v R ZIP: �?f Uver 1000 amps or volts 2 Phone: t • &4 f.? Fax: E-mail: Reconnect ant ! rs owner installation:The installation is heing made on properly I own Tentponry.ervkllon.oes or ereoci which is not intended for sale,lease,rent,or exchange according to Installationrultrratlnn.nrrrinratinn: 200 amps or lees -' ORS 447,455,479,670,701. / 201 amps to 400 amps '- Owner's si mature s _,moi ' Dale: 11- s IF h 401 to W)ams --- 2 - Branch circuits-new,alteration, or extension per panel: A. Fee for branch circuits with purchase of Address: — service or feeder fee,each branch circuit 2 ZIP: B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: I a I mai I Each additional branch circuit: Misc.(Service or feeder not Included): OServin:over225amps-commercial Uiicalth-care!acility Each pump or irrigation circle EF2320amps-rating of 1&2 U Hazardous location Each sign or outline lighting fantilydwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited enrrgy panel. ❑System over 600 volts nominal more residential units in one structure alteration,or extension* U Building over thrix stories U Feeders,400 amps or more •Descrition. - U Ckc upant load over 99 persons U Manufactured structures or RV park Each additiomi Inspection over the allowable In any of the above: U Egrem/fighting plan U other -- I'erinspection Submit__sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other _- -- —, —•-- Hermit fee.....................$ Not ail juriklictiom accept credit ca,dq.pteaw can judsit:tinn far more Inftxntation Notice:This permit application U'ViSa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ Credit card number _LL_ within 180 days after it has been State surcharge(8%) ....$ --------- - eapim. accepted as complete. TOTAL . Name of cardlw!dtr a shown rHt credit card�- S Cardholder signature --- - Amount 440-4615 i60WOM) Electrical Permit Fees: Limited Energy Fees: — - --- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee.... .�... $75.00 Number of inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit $14` .5 4 ❑ Audio and Stereo Systems 1000 sq ft.or less -------- Each additional 500 sq,f! or 1 r•-, portion thereof _ $33 40 LJ Burglar Alarm Limited Energy --_ $75 00 - Each Manufd Home or Modular n Garage Door Opener' Dwelling Service or Feeder _ $`It1 90 [� Heating,Ventilation and Air Conditioning System' Services or Feeders Installation,alleration,or relocation $80 30 ❑ 200 amps or less — 2 Vacuum Systems' 201 amps to 400 amps $106.85 - 401 amps to 600 amps __ $160 60 2 ❑ Other 601 amps to 1000 amps $240.60 2 _ Over . 00 amps or volts $454.65 2 Reconnect only $66.85 - TYPE OF WORK INVOLVED -COMMERCIAL.ONLY Temporary Services or Feeders Fee for each system.......................................................... $75.00 Installation,alteration,or relocation 2 (SEE OAR 918-7.60-260) 200 amps or less $66.85 201 amps to 400 amps $10030 2 Check Type of Work Involved: 401 amps to 600 amps $133.75 2 Over 600 amps to 1000 volts, ❑ Audio and Stereo Systems see"b"above. Branch Circuits ❑ Boiler Controls New,alteration or extension per panel a)The fee for branch circuits ❑ Clock Systems with purchase of service or feeder foe. Each branch circuit _ $6 65 -_ 2 I ❑ Data Telecommunication Installation b)The fee for branch circuits ❑ without purchase of service Fire Alarm Installation or feeder fee. First branch circuit $46.85 - - ❑ HVAC Each additional branch circuit $6.60 Miscellaneous ❑ Instrumentatior. (Service or feeder not included) Each pump or Irrigation circle $53.40 ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 _ Signal circuits)or a limited enerc.y ❑ Landscape Irrigation Control' panel,alterMlon or extension $75.00 Minor Labels(10) $125.00 ❑ Medical Each additional Inspection over the allowable In any of the above $62.50 ❑ Nurse Calls Per inspection Per hour $62.50` _ $73.75 El Landscape Lighting' In Plant _ � - Fees: ❑ Protective Signaling Enter total of above fees $ - ❑ Other 8%State Surcharge $ - Number of Systems 25%Plan Review ree $ No licenses are required Licenses are regdired for all other installations See"Plan Review"section on front of application - _Fees: Total Balance Due $ ---- Fnter total of above fees $ — I LJ Trust Account#— —_-- �— - 8%State Surcharge $ IL- Total Balance Due $-- i:\d3ts\form3Nelc-fees,doc 10709f0(1 Plumbing Permit Application Date received/2--!d r<J Permitno.; /-lii City of Tigard Sewer omit no. Building Address: 13125 SW Hall Blvd,Tigard,OR 97223 - p _ g permit no.: City nf7i;gord Phone: (503) 0;19-4171 Projecl/appl.no.: Expire date: Fax: (503)595-1960 Date issued: — By: _ Receipt no.: Land use approval: _ Casc file no.: Payment type: ❑ I &.2 family dwelling or accessory ❑Commercial/industrial ❑Multi-faintly Ll Tenant improvement U New construction ❑Add ition/alteration/replaccnx•[It I]Food service U()cher: INORNIATION FEF SCIIEDt _j Job address: 2 l ..-, { M1.e i? Description Qly. Fee(ea.) "Total J --_---- New 1-rind 2-family dwellings only: Bldg,no.: - Suite no.: (includes 100 f.for each utHilly connect ion) Tax map/tax lot/account no.: __ SFR(1)bath SFR(2)bath Lot: Block: Subdivision: ------- --- -- — — _ Project name: �_- SFR(3)bath -- City/county: 7..IP: � "- Each additional hativki(chen Description and location of work on premises:— - —__ Site utilities: r ..e -•a v d / _—� Catch basin/area drain h.st.(.late of completion/inspxtinn: �— --- D wells/leach line/trench drain - — --- Footing drain(no. lin, ft.)111 Manufactured home utilities Business name: p ���- ----�- -- _ Manholes -- — -- Address: Rain drain connector — _ -- City: State:— ZIP_ Sanitary sewer(no. lin. ft.) Phone: Fax: L mail; Storm sewer(no. lin. ft) CCB no.: _ Plumb.bus.reg.no: Water service(no.lin. ['t.) City/metro lic.no.: Fixture or item: C mtractor'c representative signature: Absorption valve - ----- Back flow preventer Print frame: [)air --- _---__ _ Backwater valve t Basins/lavatory Name:_ Clothes wa.her — Address: -- - Dishwasher - Drinking fountain(s) City: ------ - — State: ZIP: Ejectors/sumr Phone: Fax: - E-mail: Expansion tank —"- Fixture/sewer cap_ Name(print): /z Floor drain-h/floor sinks%hub k L. �}-/-� _--_-- -- Garbage disposal— Mailing Osal— - -- Mailing add ens_r. G . �,c i/ Nose Bibb -- - - City. J_ 61 o5 -State: t'T I ZIP: q 7 S- Ice makes -------- - ---II Phone: e?6 yy9 j p-3 Fax: G,l N ?4;i F E-mail: Interce rtor/grease trap / Owner instal lation/residential maintenance only: The actual installation Primers) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property 1 own as per ORS Chapter 447. Sipk(s),basin(s),lays(s) — Owner's si nature: Date: Jo�- Sump Tubs/shower/shower pan -- Nance: Urinal --- - ---- ----- ------ --- Water closet Address: Water heater City: _State: ZIP: _ Other. ------------ ---- -- Phone: — Fax: - Email• _ Total Not all Jurisdictions accept credit carr%,rt,-lac call iurisdi-ion for more information. Minimum fcc ...............$ L1 Visa U MasterCard Notice:Ibis pennit application Plan review(at %) $ expires if a permit is not ohtained -- — credit cord number: -- ----- 1--�-- within 180 days after it has been State surcharge(8%)....$ _ Esaccepted pires ns Iete. TOTAL $ -- — - cons Name of cardholder as shown on credit cvd p p t Cardholdett signawte -— --Amount J 440-4616(6WrOM) PLUMBING PERMIT FEES: PRICE TOTAL Now 1 slid 2-family dwellings only: FIXTURES (individual) -_-- QTY ea _AMOUNT (Includes all plumbing Hxtures In PRICE TOTAL Sink 16.60 the dwelling and the Tfrst100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) __ One 1 bath -- Tub or Tub/Shower Comb. 16.60 -( Z--- ---- _ $249.20 - _Two 2 bath Shower Only 16.60 Three 3 bath $399.00 Waist Closet -� 16.60 -- - - - - - ___ SUBTOTAL Urinal _ - 16.60 _ - -_8%STATE SURCHARGE ---- Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL `- Garbage Disposal 16 60 _ -----_-- TOTA_L --- Laundry Tray - 16.60 _ --- ----- Washing Machine - 16.60 Floor Drain/Floor Sink. 2" -- 16.60 3" - _ -- 16.60 -- PLEASE COMPLETE: 4" 16.60 Water heater O conversion O like kind 16.60 Quanti bWork Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. _ Capped MFG Home Now Water Service - 4640 Sink - A1FG Home New San.'Storm Sewer 46.40 Lavatory oTub/Shower - - Hose Bibs -----V 16.60 1I r Combination Roof D-ains 16.60 Shower Only - Drinking Fountain 16.60 Water Closet _ Other Fixtures(Specify) - 16.60 Urinal _ _ - - - Dishwasher - ------ ---•- --- _-_ -- Garbage Dis --- Laund Room Tri - ----- - _- WashinaMachine -- --- Floor Drain/Sink: 2" Sewer-1st 100' 55.00 - - - --- 3„ -Sewer-each additional 100' 46.40 -- Water Service-1st 100' Y 55.00 -- Water Heater _ Water Service-each additional 200' 48.40 -- -_"-- Other Fixtures Stonn 8,Rain Drain-1st 100' 55.00 - -- - Storm Rain rain-each additional 100' 46.40 - Commercial Batik Flow Prevention Device 46.40 -- Residential Backflow Prevention Device' 27,55 - ---- Catch Basin 16.60 -�--� - Inspection of Existing Plumbing or Specially 7.50 - ' Requested Inspections _ _- -per/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling_ 65.25 Grease Traps - -- 16.60 - QUANTITY TOTAL -_ -� - ------------ ----- Isometric or riser diagram is required If --- ---- -- -- OuantMy Total Is >8 - -- ----_----- - *SUBTOTAL 8%STATE SUPCHARGE "PLAN REVIEW 25%OF'iUBTOTAL --- Required only If fixture qty total Is>g TOTAL $ "Minimum permit fee Is$72.50+8%state surcharge,except Residential Backflow Prevention DevlLe,which Is$36 25+8%state surcharge #"All New Commercial Buildings mqulre plans with Isnmetrlc or riser diagram and plan review I:\dsts\forts\plm-fees doc 10/10/00 GL+r�(X�G�Gvr c� AO � V-r2 ---� {1: , To 5e ` a -1P ' / / -I'rrmit t#. l lTGtD —c :J7 6_ -7/ y Acl Issue by: � )�IAJIa Date: /c!'; "r Statement: Information Notice to property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licenced architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2,and eithcr box 3A or 3B: C, 1. I own, reside in, or will reside in the completed structure. �0 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. (� 3A. My general contractor is — 1 (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with,the Construction Contractors Board. OR \� IB. 1 will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information Iscorrect and that I haN a read and do understand the Information Notice to Property Owners about C'orstruction Responsibilities on the reverse side of this form. (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant)