11075 SW ERROL STREET Q
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1107 SW ERROL ST. --
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)630-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received Date Requested----,---/ AM--- PM_ _ __ BUP
Location __ 1 D :7 Suite _ MEG
Contact Pe,son 17 � — Ph(--) _3 L/ g �_-� �PLM
Contractor rl�'
' E;[" ,(£L .. Ph(_Z3) � --L� SWR
BUILDING Tenam'Owner ELC _
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain - -
Slab Inspection Notes: 74'���� d. SIT _
Post&Beam T,
Shear A,ichurs --
Ext Sheath/Shear
Int Sheath/Shoar -
Framing
Insulation
Drywall Nailing ---- - -- --
Firewall
Fire Sprinkler - - - --
Fire Alarm
Susp'd Ceiling n-�- -- - --
Roof
Other:
Final -
PASS PART FAIL - -- -- --�
PLUMBING
Post 8.Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains --- - ---
Catch Basin/Manhole
Storm Drain - -- -
Shower Pan
Other: - ----- ------
Final -..----_------------
PASS PART__FAIL --- ^ - -- --
MECHANICAL _
Post&Ream
Rough-In --- -- ------____-- ---.-- -
Gas Line
Smoke Dampers -- ------ --
Final
PASS PART FAIL. -- --- - - -
ELECTWCAL
Service
� __ --- ---- ----- ---- ----- ---
Rough-In
UG/Slab
Low Voltage -
Fire Alarm
final >
PART FAIL Reinspection fee of$ required before next InspPcction. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: Unable to it_ -no access
Fire Supply Line _
ADA \ +
Approach/Sidewalk Daft inspoetor l -Ext----
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-"171
BUP
Received Date Requested U _ AN1 PM BUP
Location A t;Z Suite— MEC —
Contact Person -�A'Yl� Ph( ) _LQ_�O�5 PLM
Contractor — Ph( ) SWR
BUILDING _ Tenant/Owner ELC —
Footirg ELC _
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT _
Post&Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ---
Fire Alarm
Susp'd Ceiling - -- - -
Roof
Other: --
Final � �-
PASS PART_ FAIL -"- - --`-
PLUMDING —
Post&Beam - — --_-—� -� - - —
Under Slab
Rough-In
Water Service ----- - _
Sanitary Sewer
Rain Drains - - ---- - -
Catch Basin/Manhold
Storm Drain -- - -- ---
Shower Pan
Other: __- --_-- --
PART FAIL ---- -"- _—`- —
_MECHANICAL
Post&Beam �-
Rough-In
Gas Line
Smoke Dampers - ---- ---- —�-.
Final
PASS PART FAIL
ELECTRICAL
Service - --- -- — -
Rough-In
Low Voltage -
Fire Alarm
Final El Reins on fee of$ required before next Inspection. Pay at City Hell, 13125 SW Hall Blvd.
PASS PART FAIL
Sh-E -- [] Please call for reinspection RE:_ I Inable to Inspect no access
Fire Supply Line A
ADA
Approach/Sidewalk Dab- _ lntita�ctor - Ext
Other:
Final DO NOT REMOVE this Inspoal record holm this fob oto.
PASS PART FAIL
CITY OF TIGAIRD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received Requested �� U AM PM P
BU
7 —
Loczwon _ r 5– C Suite MEC
p
Contact Person — � _ Ph(__._} b 5 PLM
Contractor—� _ Ph( _) SWR
BUILCIN_G Tenant/Owner _ _ ELC
Footing - ELC
Foundation Access: -
Ftg Drain I_LR
Crawl Drain
Slab Inspection Notes: IT _
Post&Beam _
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - -
Firewall
Fire Sprinkler - -- --
Fire Alarm
Susp'd Ceiling - - ---
Roof
Other:
Final
PASS PART FAIL -�-
PLIIMBING
Pust& Beam - -- -- - -- --_ -__.-
Under Slab
Rough-In
Water Service -
Sanitary Sewer
Rain Drains - -- ------- --
Catch Basin/Manhole
Storm Drain -- -- --- - -
Shower Pan
Other: _ --- - - -
499 PART FAIL -
MEC%IANICAL
Past&Beam T. - - ----Rough-In
Gas Line
Smoke Dampers -- - -
Finnl
PASS PART FAIL - - - --------
ELECTRICAL _
Service -" -
Rough-In
UG/Slab - ---`
Low Voltage
Fire Alarm
Final L] Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hail Blvd.
PASS PART FAIL
SITZ: ❑ Pl,ase call for reinspection RE: E1 Unable to inspect-no access
Fire Supply Line
ADA n
Approach/Sidewalk
Other:
Final v -- I NOT REMOVE this inspo i lon r000rd freer tho JO aft,
PASS PART -AIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST "
INSPECTION DIVISION Business Line: (503)639-4M-7 BUP
Received [)ate Requested. l f _AM PM BUP
Location Suite_ F _— MEC
Contact Person Ph(—) PLM
Contractor__ _ Ph( ) SWR _
BUILDING Tenant/Owner ELC _
Footing ELC _
Foundation Access:
Drain ft'6j--" c� �;; !� ELR
C;awl Drain
Slab Inspection Notes: JkLa �. SIT
Oost&Beam —
Shear Anchors Lt 'S 4--
Ext
.
Ext Sheath/Shear
Int Sheath/Shear �)
Framing l.7
InsulationZ- f_e ! '
Drywall Nailing
Firewall �� r /�/e� &l
Fire Sprinkler
Fire Alarm �d� T��✓ r
Susp'd Ceiling
Roof
Ot er:PASS
>c a
PART AI
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service - -- —
Sanitary Sewer
Rain Drains --- --
Catch Basio/Manhole
Storm Drain --- - -- -- -
Shower Pan
Final ---�---�----
PASS PART FAIL — --
MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers - -----
S PART_ FAIL -- --- --- --
EL CTRICA_i
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$. required before next inspection. Pay at City Hall, 13125 SN!Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: _ Q Unable to Inspect-no access
Fire Supply Line
ADA
1
m
Approach/Sidewalk Date— Inspector Ext
Other:
Final --— DO NOT RKMOVE this Inspection record from the job alto.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST 0 a 3 ! r
INSPECT;CN DIVISION-TIytA; Business Line: (503)630-4171 —
m / BUP
Received — 3 ( P� Date Requested AM _ PM_ BUP
Location ._ _ 7 S Suite — MEC
Contact Person — Ph(_ ) _ PLM
Contractor _ — Ph(--_) _ SWR
BUILDING Tenant/Owner ELC _
FootingIQ
- O ".LC
Foundation Access: --
Fog Drl.In ELR __—
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing _LrSLV ^o l ✓Zi1.�p s✓�5, <'en�S< <:'1�r Insulation
Drywall
r-
DrywallNailing
Firewall
Fire Sprinkler -- --
Fire Alarm
Susp'd Ceiling �—
Root
Other: -
i _
ASS) PART FAIL_
FIMBING _ D,L - .- fir' lid'7'--
Post
Post&Beam
Under Slab -- -------------- --
Rough-In
Water Service -------
Sanitary Sewer
Rain Drains -------- — — - --- —
Catch Basin/Manhole
Storm Drain -- ------ —
Shower Pan
Other-
Final
therFinal —
PASS PART FAIL -- - -�---- - -- - -
MECHANICAL —
Post& Beam
Rough-In ------ -------- -
Gas Line
Smoke Dampers --- --
Final
PASS PART FAIL — - —
ELECTRtC,ZL
Service - _— ----------- -- - - -
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspectbn fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ ❑ Please call for reinspection RE: _ ❑ Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dab ' G 4-� ____ Inapaetor — Ext_
Other:
Final _ 00 NOT REMOVE this Inspoction mord Froin tho fob eke.
PASS PART FAIL
CITY OF TIGARD TEMPORARY CERTIFICATE OF
OCCUPANCY
DEVELOPMENT SERVICES PERMIT#:
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PERMIT ISSUED: ?!!,�-eZ
PARCEL: ag/0:3/K-0 21602)
ZONING: R. ' 5
JURISDICTION: -n61/41L/)
SITE ADDRESS: �Q����`114 16;r,-D I`�-T
SUBDIVISION:
BLOCK: LOT:
CLASS OF WORK:`! � '
TYPE OF USE:
OCCUPANCY GRP. tQ '7j
OCCUPANCY LOAD:
TENANT NAME:
REMARKS: TEMPORARY OCCUPANCY FOR DAYS FROM /" 3
Owner:
5af.yz-
Phone: .07 - 310 - 7 7lj
Contractor: lntyIlli'kl `Any 600
Phone:
Reg #: lj7g 7j
i
It is understood by the owner/tenant that the issuance of this Temporary Occupancy Permit by the City of Tigard for the use and/or
occupancy of the structure located at the site address listed above(hereinafter"structure"),does not grant orconvey to the owner or
tenant any property right or other protectible property Interest in the use and/or occupancy of the structure forany purpose. It is further
understood that this Temporary Occupancy Permit shall only be valid for the number of days frem date of issuance listed above and
that the owner/tenant will no longer be authorized to occupy the structure after the period sperified,unless and until all the conditions
of approval Imposed under the City's or County's Notice of Decision for the project's land use case(s)Issued by the City's Development
Services Department or the County's Department of Land Use and Transportation and/or the Clean Water Services and all
building and related code requirements and any other applicable requirements h e been com letely fulflllea and complied with to the
Citv's or C�'s satisfactlo 1 7
BUILDING INSPEC OR BUILDIRd OFFICIAL
a
POST IN CONSPICUOUS PLACE
DEC-19-2072 04 : 14 PM JAMESGRIFFITHSEXC 503 263 174"
James Griffiths Excavating, Inc. Invoice
dAa. Griff'a Sepur S> Mce ----
PU Box 1136 OATS —� INVOICE 0
Canby, OR 97013 I2118n002 — lgoe`^
503-263-9038 503-263-1743 Fax
BILL TO JOB NAME I ADORE 88
R J. STEVENSON CONSTRUCTION 11073 SW ERROL ST
1297)SW 22ND 713ARD,OR
LAKE OSWEGO,OR 971 034
I
P,O,NUMBER TERMS TOLEPHONE A CCM DECK
Dere Upon CompletionISOUEDIATE
02 2434694 104320 37164
---- - --— - - - DESCRIPTION AMOUNT —�
i PUMPEA SEPTIC TANK FOR ABANDONMENT 200.00
PAID IN FULL BY CHECK 02266
i
I
t,�cl
t ,
I
�ii,i Ni YOC FOR YOUR BUSINESS.
Total :wo
"A service charp of 1 1%will be laviad on all put dun+invoices
•Reumned chock tee to Stn 00
"to case suit,Action or arbitnition is inatintted by either part fcrr breach or to enfbrce any provision
heroin,the ooun shell award reasonable attorney fees and actual costs to the r vailrng party at trial or
arbibrabon,or upon any appeal takan chert fbm.
CITY OF TIGA,RD 24-Hour
BUiLDING Inspection Line: (503)639-4175 MST
INSPECTION UIVISION Business Jne: (503)639-4171
BLIP —
Received --Date Requested AM—_. ----- 3UP
Location / 7_ r'Zt::7 Suite MEC
Contact Person �- r -- Ph( --) ? PLM .,22 d� o
Contractor _ — __-- Ph(_--) — SWR ---- _
BUILDING TPnanVOwner .___ — ELC
Footing ELC --
Foundation Access:
Ftg Drain ELR
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -- -- --
Insulation ,
Drywall Nailing -
Firewall
Fire Sprinkler -- -- -
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL — —
_PLUMBING —_--_ —
Post&Beam
Under Slab — --
Rough-In
Water Service -- —
Sanitary Sewer
Rain Drains — ----�—
Catch Basin/Manhole
Storm Drain
Shower Pan
(ow_hF ii
- — - -- --
PAS PART FAIL _
_ANI
CAL
Post&Beam --__
Rough-In
Gas Line
Sm(ke Dampers ------
Final
PASS PART FAIL
ELECTRICAI.–
Service
Rough-In
UG/Slab
Low Voltage — —
Fire Alarm
Final LJ Reinspection fee of$ requirad before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS_ PART FAIL
SITE _ r] Please call for reinspec'on RE: Unable to inspect-no access
Fire Supply—Lin-13--
ADA
ino n /` � )
ADA Deft j I �!J /i-- Inspector � �t—
Approach/Sidewalk --
Other:----.--_--_
Final ID NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY of T IGARDDL:JMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00483
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1216/02
PARCEL.: 2 S 103AC-02800
SITEADDRESS: 11075 SW ERROL :iT
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: PT .JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY"TRAYS: SF RAIN DRAINS-
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 80 ft
WATER CLOSE i S: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of approximanely 80 feet of sewer line tc connect to sewer lateral Septic tank is to be pumped,
filled and inspected. Reimbursement district fee previously paid.
FEES �
Owner: -`---'
Description Date Amount
PIERCE, DARE<FN F +AMY J
11075 SW ERROL ST II'LUMBI I'ernit Fee 12/16/02 $72.50
TIGARD, OR 97223 (TAXI8%State Tax_ 12/16/02 _ $5.80
Total $78.30
Phone
Contractor:
R.J. STEVENSON CONST.
12820 SW 22
LAKE OSWEGO, OR 97034 REQUIRED INSPECTIONS
Phone : 503-245-8694 Sewer Inspection
Misc. Inspection
Reg#: LIQ' 56228 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Wnicipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is Suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: LA -�c�7r Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next businAss day
Plumhini! Permit Aim>lication '
-�� Received Plumbing
Date/By: Permit No.?!-en,iJOa
Planning Approval Sewer
City of Figatrd Test Form Date/By: Permit No.:SL0�a 00
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date!D : Permit No.:
Phone: 503-639AI71 Fax: 503-598-1960 Post-Revicw Land Use
Date,D . Case No.:
Internet: Llk Contact Juris.: ID See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: I Supplemental Information.
TYPE OF WORK _ FEE*SCHEDULE(forspecial Information use checklist)
New constructionDemolition Description Qty. Fee(ea.) Total
Addition/alteration/re lacement Other New 1-&2-family dwellings
CATEGORY OF CONS-- N (Includes 11111 ft.for each unlit connection)
SFR I bath 249.20
1 &2-Family dwelling- Commercial/Industrial SFR 2 bath 350.00
Accessory BuildingMulti-Family SFR 3 bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
JOD SITE.I FORMATION and LOCATION Firesprinkler-sq. fl.: Pape 2
Job site address: J o'SVS L Site Utilities
Suite#: Bldg./Apt.#: Catch basin/area drain 16.60
D wrell/lench line/trench drain 16.60
Project Name: 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 R. r7 Page 2
Subdivisic n: _ Lot#: Storm sewer no.linear ft. Page 2
Tax map/] .reel#: Water service no.linear ft. Page 2
Fixture or Item _
DESCRIPTION OF J ORK Absorption valve 16.60 _
&&o ate �C (9+ti Backflow prevcntcr Page 2
Backwater valve _ 16.60 -
Clothes washer 16.60
-- Dishwasher _ 16.60 _
Drinking fountain 16.60
PROPERTY O NER ENANT Ejectors/sump I6.60
Name: t Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/Zip: Floor drain/floor sinkihub 16.60
Garbage disposal 16.60
Phone: Fax: Flose bib 16.60
APPLICANT Y CONTACT PERSON Ice maker 16.60
Name- _ Interco tor/ rcase trap 16.60
Addn;ss: Medical gas-value: $ _ P .2 _
Cit /State/Zi Primer 16.60
�_ --------- Roof drain commercia; 16.60
Phone: FaX: _ Sink/basin/lavato _ 16.60
E-mail: Tub/shower/shower an _ 16.60 _
CONTRACTOR Urinal 16..,J
Business Name: -(k)-4%1L V-VA t Water closet 16.60
v- Water heater 16.60
Address: tW_ 3 Other:
Cit /State/Zi .L Other:
Phone: S= Fax: 3 U -y0 4.3 Plumbing Permit Fees*
CCB Lic. #: ST1'd Plumb. Lic.#: subtotal 5
Minimum Permit Fee$72.50 5
D
Authorized �-I Residential Backflow Minimum Fee 536.25 2 �;V
Signature: / ' �� Plan Review 25"6 of Permit Fee) 5
B ate: State Surcharge 8%of Permit Fec 5 47-
TOTAL
TOTAL PERMIT FEE 5 _
(Please print name) Notice: This permit application expires If a permit Is not obtained within
All new Commercial building require 2 sets of plans with Isometric or 180 days after It has been accepted as complete.•Fee methodology set by Tri-County Building Industry Service aoard.
riser diagram for plan review.
Plumbine Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule. Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing dram-1"100' 55.00 0 to 2,000___ $115.00
2.001 to 3,600 $1%00
Footing drain-each additional 100' 46.40 3,601 to 7,200 $220.00
Sewer-1 st 100' 55.00 7,_201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service-Ist 100' 55.00 Medical Gas S stems:
Water Service-each additional 100' 46.40 Valuation: Permit Fee:
Stnmi&Rain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Ram Drain-each additional 100' 46.40 $5,001.00 to$10.p00.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) Total including$10,(M.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148,50 for the first$10,000.00 and$1.54 for
each additional$100.00 or fraction thereof,to
Residential Backflow Prevention Dev'^c
and including000.00.
minimum permit fee$36.25 27.55 _ $25
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or —� and including$50,000.00.
specially requested inspections-per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,mav'^n or replacing existing fixtures? If
"yes",please indicate • k performed by fixture. iiallure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Work Performed Comments regarding fixture work:
Fixture Type: Replace -
Ncw Moved Exbtin C cd
Baptistry/Font _ --
Bath -1 uh/Shower
-Jacuzzi/Whirl ool
,at Wash -Each Stall --
-Drive Thru _
Cuspidor/Water Aspirator
Dishwasher -Commercial -
-Domestic
Drinking Fountain _Eye Wash
Floor Drain/sink -2"
3..
.4"
Car Wash Drain *Note: If lite fixture work under this permit results in an
Garbage -Romestic increase of sewer EUUs,a sewer permit will be issued and
Disposal -Commercial
-Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refri .Drains plumbing permit can be issued.
Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -Gi'ng
-Stall
Sink -Bar/lavatory
-Bradley
-Commercial
-Service
Swimming Pool Filter _
Washer-Clothes
Water Extractor
Water Closet_Toilet
Urinal
Other Fixtures:
/ CITY OF TI GAR D SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002..00266
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/18/02
SITE ADDRESS; 11075 SW ERROL ST PARCEL: 2S 103AC-02800
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: PT JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF Bf.,ILDINGS:
INSTALL TYPE: LTPSWR IMPERV bURFACE:
Remarks: Connect existing house to newly installed sewer lateral. Septic tank is to be pumped,filled and
inspected.
Owner: � FEES
PIERCE, DARREN F +AMY J Type By Date Amount Receipt
11075 SW ERROL ST — -. -- ---
TIGARD, OR 97223 r 'I.MT CTR C-,18/02 $2,300.00 272.00200000
INSP CTR 9/18;;;2 $35.00 27200200000
Phone: Total $2,335.00
Contractor:
Phone:
Y #.
Required Inspections
Sewer Inspection
Septic Tank Filled
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 froin the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm
i
J
Jssued b �-' Permittee Signature: C
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
I�
1
CITY OF TIGARD MASTER PERMIT
PERMIT#: MS'T2002-00311
DEVELOPMENT SERVICES DATE ISSUED: 7/19/02
13125 SW Hail Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11 X75 SW ERROL ST PARCEL: 2S103AC-02800
SU
'DDI V IOION CCI IO I IF-IG! ITC ZONING: R-4.,;
BLOCK: LOT: PT JURISDICTION: TIG
REMARKS: Add itioWremodel 350s.f. plus garage arid covered porch.
`_W !UILDINc
REISSUE: •� ,••� STORIES: I FLOOR AHEA5 - — —REQUIRED SETBACKS _ RFOUIRED __
CLASS OF WORK: Or HEIGHT: FIRST: 350 of BASEMENT: of LEFT: SMOKE DETECTORS
TYPE OF USE: Sr FLOOP LOAD: 40 SECOND: e. GARAGE: 154 of FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS FINSSMENT: of RIGHT
OCCUPANCY GRP: n3 BDNM: BATH P i TOTAL: 350 DO of VALUE: $70 oaa ro HEAR
PLUMBING —
SINKS: I WATEF:CLOSETS: 1 WASHING MACH: I LAUNL .4AYS RAIN DRAIN' TRAPS:
LAVATORIES: DISHWASHERS: FLOOR L'RAINS: SEWER LINES: SF RAIN DRAINS: I CATCH BASINF.:
TUB1SHOWERS. I GARBAGE DISP: 1 WATER HEATERS: I WATER LINES: BCKFLW PREVNTR. GREASE TRAPS
MECHANICAL OTHER FIXTUCES.
FI IEL TYPES FURN�100K BOIUCMP<3HP: VENT FANS: i CLO HEf.DRYER. I
FURN -10001: UNIT HEATERS: HOODS: I OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: I WL'OOSTOVES: GAS OUTLETS: •1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TE19P SRVC/FECnERS BRANCH CfRCU1TS
MISCELLANEOUS _ ADO'L INSPECTIONS_
1000 SF OR LESS. 0 200 amp: 1 U 200 amp: WISVC OR FDR: 1 PUMPIIRRU-01ON: PER INSPECTION,
EA ADD'L 500SF: 201 - 400 amp: 201 40h amp 1st WIO SVCIFDR: SIGN/OUT LIN LT: PER HOUR,
1 RdITcD LNERGY. 401 - 600 amp: 401 600 amp: EA ADDL 7R CIR: SIGNAI_IPANEL: IN PLANT
MANII HMISVCIFDR: 601 • 1000 amp: 601+8n105•1000V MINOR LABEL.
101)0+amp/volt
PLAN REVIEW SECTION
Reconnucl only: �• — — -- --
-4 RES UNITS: SVCIFDR-=225 A.: -600 V NOMINAL CLS AREAISPC OCC,
_.,• ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL__
AUDIO a STEREO. VACUUM SYSTEM AUDIO 6 STEREO: FIRE ALARM: INTEKCOMIPAGINGOUTDOOR LNDSC LT.
BURGLAR ALARM: OTH. BOILER HVAC: LAND.SCAPE9RRIG: PROTECTIVE SIGNLI
GAVAGE OPENER: CLOCK INSTRUMFNTATIOW MEDICAL, OTHR:
HVAC: DATA7TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL_ FEES: $ 1,520.02
PIERCE, DARREN F +AMY J MORNING STAR CONSTRt1CTION INThis permit is subbed to the regulations contained in the
11075 SW ERROL ST' 11180 SW ERROL ST igard Municipal Code, State of OR. Specialty Codes and
TIGARD.OR 97223 TIGARD,OR 97223 all other applicable laws All work will be done in
accordance with approved plans This perm it will expire if
work is not started within 180 days of issuance,or if the
work is suspen led for more than 180 days ATTENTION
Phone: Fhone: Oregon law requires you to follow rules adopted by the
Oregon Utility Noti:ication Center Those rul_r are set
Rep M: I Ic oort forth in OAR 952.001-00101hrough 952-001-0080 You
may obt::in copses of these -files or direct questions to
CUNC by calling(503)246-1987.
RFQUIRED 114SPECTIONS
Erosion Control Insp 8, Underfloor insulation Electrical Servicc Low Voltage Appr/Sdwlk Insp
Fooling Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Electrical Final
FOUndation Insp PLM/Underfloor Framing Insp Cas Fireplace Mechanical Final
POSUBean,Structural Mechanical Insp Shear Wall Insp Insulation Insp Plumb Final
Post/Hearn Mechanics plumb Top Out Exterior Sheathing Inst Rain drain Insp Final inspection
Issued By :r -!�_- may Permittee Signature :
Call ('503) 639-4175 by 7:00 p m. for an inspection needed the next business day
Building Piermit Application ,
FDreceived: p y Permit no.:M jo. o
City of 'Tigard . --
Address: 13125 SW Hall Bl h VED Project/appl.no.: Expire date:
City nfTigard Phune. (503) 639-41 71 nntriexned By: fteceiptno.:
. r
Fax: (503) 598-1960 -ase fiileno.: Payment type:
J fr
Simple Complex:
r
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-tamily U New construction U Demolition
Addition/:Iteration/replacement U Tcnant improvement 0 Fire sprinklvdalarm U Other:IoR SUIT INFORMATION
t
Joh address: ( s7 7 S.IJ. Fv r�� �� 131t1�. n Suite no.:
�— l — Tax ma /tax lot/account no.: '2 5103CO
Lot: Bhxrk: Subdivision: p 2 SL�6 _
Project name:
Description and location of work on premises/special conditions:_ on - e14 G
rK
(Floodplain.septic capacity, lar.eft.)
Name: !:h rC� _ r
Mailing address: 11075 SQ. E rwO 1 3� 1 &2 family diAePing:
oW
City: —�, 5tdle: dr "LIP: T77-Z3Valuationof work........................................ ��,
Phone: 'jn Fax: E-mail: No.of bedrooms/baths.................................
Owner's representative: l i u,v eex er Total number of floors............. ^_Z
__—
Phone: ,CD3 37 Y(0yS f:ax: 96 ?_V E-mail: New dwelling area(sq.ft.) .......................... U
Garage/carport area(sq.ft.) ........................
Name: -� C.overed,porch area(s(t.ft.) ......................... L7__
—"
Mailing address: I l g0 S.w. Erqd 5f-, Deck area(sq. ft.) ....................................... ----
City: Slate:o ZIP: Q77Z3 Other structure area(sq.ft.)........... .............
Phone: 3 yf(�ySS" Fix; Email: ('ommerciallindustrisllmulti-family:
Valuation of work........................................ $ --
Exishng bldg.arca(sq. ft.) ..........................
Business name: rWl41 5 ►� ►'�+� ""� New bldg,area(sq. ft.)
Address: C) 5-L.J.. E trvfl _ S Number of stories
City: `Tt � Stale: Qr- ZIP: 2L ........................................ --------
i yle of construction....................................
Phone: 1 '63 (D Occupancy group(s): Existing:
CCB no.: S6 (v$3 New:
City/metro lie.no. I"''>/' Notice:All contractor-,and subcontractors arc required to be
t licensed with the Oregon Construction Contractors Board under
Name: `pry�'It1� 1�cty �av1S� ('iw� �1�}2r provisions of ORS 701 and may be required to be licensed in the
Address: ��� � ,;� ,�. �y,.,�. e� jurisdiction where work is being performed. If the applicant is
ZIP: exempt from licensing,the following reason applies:
City: Slate;
Contact person: 7-jt� _ked Plan no.
34 — —�
phone: 8 l�y5 ' Fax:4 gZz7 E-mail: T rh ar ewit9
Name: lConlact person: - — I-ces due upon application ........................... ___--
Address- Date received: —
City: — State: ZIP: _ Amount received ................ ........................ _
Phone: Fax: E-mail: Please refer to fee schedule_
1 hereby certify I have read and examined this application and the Nut all juriKlictions accept credit cods,please call jurisdiction lot mote intonnati,xt
attached checkh '_:' nrovisions of laws and ordinances governing this U Visa U MasterCard
work will be complied% ith,whether speclfi d herein or nM, credit carni number.
Authorized signature: �.,._�1� Dale: _ Name of cardholder as dm-Nn on credit card
Print:tame: -Tj►"'k l eje)eGr -- Cardholder sipapur
Notice:This permit application expires if a pcmil is not obtained within 180 days after it has I�cn accepted as complete. +w461.1(6MCOM)
�tv _ , i3
t'
One- and"Two-Family Dwelling
Building Permit Application Checklist 7Relerencen-
MRno-Wedpermits
Citygfhgurd City of Tigard
O Electrical J Plumping U Mechanical
Addw,, 11125 SW Hall lilvd,'Tigard,OR 9722 U t ichor
Phone: (503) 639-4171 _ - ----
f-ax: (501) 598-1960
THE t w t
I band use actions completed.See jurisdiction criteria for concurrent reviews.
2 ; ning.Mood plain,solar balance points,seismic soils designation,historic di•u rct,etc.
3 Verincation of approved plat/lot.
4 hire district__approval required.
5 Septic system permit or authorization for remodel. Existing system capacity _-
6 Server permit. — _ --
7 Water district approval.
8 Soils report.Must carry original applicable stamp and signature or.file or with application.
9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 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 he incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
it copyright violations exist.
I I Silt/plot plan drawn to scale.The plan must show lot and building setback dimensions:property corner elevations(it'
rheic is purr.:than a 4-11.elevation differential,plan must show contour lines at 241.intervals);location of easements and
th n c%k;iv:10 K)tprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot
arra;budding coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
I' Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
we and location. _
I t Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater. --
lurnace, ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. _
1.1 Cross section(s)and detaiM.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor
wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show
details of all wall and rool sheathing,rooAling,roof slope,ceiling height,siding material,f(x)tings and foundation,stain,
fireplace construction, thermal insulation,etc.
Is 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 tour foot at building envelope.
Dull-size sheet addendums showing foundan,m elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)andlor lateral nnalis;s plans.Must indicate details and locations;for
non-prescriptive path analysis provide sl_, rtrcatrons and calculations to engineering standards. _
17 )Floor/roof framing. Provide plans torr all noors/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 rehar. 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/ioist 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,O.e.,shear wall,roof truss)shall he slanrped by an engineer or
architect licensed in Oregon and shall he Shown to br;y,plicahle ro rhe project under wN ic%%.
JURISDII01ONAL SPECIFICS
23 Five(5)site plans are required for Item 1 I abcwe. Site plans must be 8-U2" x I I''or 11" 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 phun will he not accepted.
36 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document.
27 "Drawn to scale"indicates standard architect or engineer scale. _
23 Site plan must include street tree size,type&location per City of Tigard Street Tree List box+klet.
Checklist must he 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(r,VICOW
El lectrical Permit Application
• Daterecciyed: Permit no.! rT.IXXV _0631
City of Tigard Project/appl.no.: Expire date: —_
City of Tigard Address: 13125 SW H:di Blvd,Tigard,OR 9722.3 Date issued: HV:—_ Receiptno.:_
Phone: (503) 639-4171 -- I
Fax: (503) 598-1960 Case file no.: Payment type
Land use approval:
U I &2 family dwelling or accessory Cummerc:iavrndustrial U Multi-family U Tenant improvement
U New construction Addition/aheration/replaccrnenl U(ether: U Pattial
Joh address I ID
_I
Elrro I 5-t Itldg. nc. _ tiuilr no. — Tax map/tax lot/account no.:2S103[p
Lot: Block: Subdivision:
Project name: Description and location of work on premises: li�
Estimated(late of completion/impection:
Job no: Fee Max
Business name: - Description cry (ryr> 7brsl n0.insp
P L - 9 Y'1 L —___ New residential-single or multi-family per
Address: 4AgQ 5.W• dwellingunit.Inchafesattached&rdrage.
City: ' State: ZIP: Serviceincluded
Phone: �YY 7 Fax: ;Z n
E-mail: 1000 sq. .or less00 __^— - - 4
Each additional 5s .ft,or rtion thereof _
CCB no.: Elec.bus.lie.no:...'211. 10 7 G Limited energy,residential _ _2
City/metro lic.no.: p 3 Al Limited energy,non-residential 2
Fach manufactured home or modular dwelling
signature ms'jri electrician(required) »_ pate Service andfor feeder — 2
License a no: Services or feeden-Installation,
Sup.elect.name(print): ,T , alteration or relocation:
III Itelill 200 amps or less _ 2 _
:1.-p.-�'to 400 amps 2
Name(print): C f �I ey C.� -- -- — to W)amps z
Mailing address: 07S S•GJ r/t�T S to 1000 amps 2
Pity; State: ZIP: 0 amps or volts _ _ 2
Phone: Fa I E-mail: Re-nnne t only I
Owner installation:The installation is being made on property I own Temporary services U.feeders-
which is not intended for sale,lease,rent,or exchange according to Instanation,aiteratlop d relocation:
'is-:amps nr less _ __ 2 e
ORS 447,455,479,670,701. 201 amps to 4M amps 2
Owner's si nature: Date: 1401 to 600 ams 2
Branch circalts-new,al::ntke.
or extension per panel:
Name: A l�ce for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State: ZIP:. f B. Fee for branch circuits without purchase
of service or feeder fee,first branch circsit: 2
Phone: Fax: F.-mall: Fach additional branch circuit
P::: 'r"Iceorfeedernot included):
U Service over 225 amps-commercial U 11calth carc:aciliry l a,. ump or irrigation circle 2
U Service over 320 amps rating of 1&2 U Hazaidous locationEach signor outline lighting J_� 2
family dwellings U Building over 10,0(x)square feet four or Signal circuits)or a limited energy panel,
U System over 600 volts nominal none residential units in one structure alteration,or extension' _ _ 2 —
O Building over three stories U Feeders.4(x)amm or mom *Description:
U Occupant load over 99 persons U Manufactured structures or RV park Fich addNtottal inspection over the allowahle M any of the above: _
U Egteas/lightingplan U tllher -- Perinspection _ --�
Sabwit sets of plan+with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other --
Nd all jurisdiction Lm
fit dr cards,pleae call jurisdiction tar.ower Wornueioa Notice:this permit applicatic i Per
nit fee................ ) $ --
UVisa U MasterCard expires if a permit is not obtained Plan�e view(at — 96) $
Credit cad rumbm - __—_ ____ _ — within 190 days ager it has been Stare surcharge(8%)....$
accepted as complete. TOTAL.......................$
- - Near did u drovro on credit rand -
S
Aman 4"15(&"'Mi
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED -RESIDENTIgI_PNLY
Complete l=ee Schedule Below: ------ - -
p Reatriclod Energy Feo..................................................... $75.00
'Number of Inspections per permit allowed) (FOR ALL.SYSTEMS)
Service included: Items Cost Total + Check Tvne of Work Involved
Residential-par unit
1000 sq.ft or less — $145 15 4 Audio and Stereo Systems'
Lach additional 500 sq ft.or
portion thereof _ $33.40_--_� 1 �� Burglar Alarm
I Imited Energy $75.00
I:ach Manufd Home or Modular
Dwelling Service or Feeder $90.90 —_—�— 2 Garage Door Opener'
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 toms�S �
201 amps to 400 amps $106.85 2 ❑ Vacuum y
401 amps to 600 amps $160.60 2
601 amps to 1000 amps �— $240.60 ��— 2 ❑ Other
Over 1000 amps of volts _ $454 65_ 2
Reconnect only $66,85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL.ONLY
Installation,alteration,or relocation Fee for each system.................................. ...................... $75.00
200 snips or less $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps _ $133.75 _ 2 Cheek T ype of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel Moiler Controls
a)The fee for branch circuits
with purchase of service or I j clock:;y tems
feeder fee.
Each branch rircuil _ $5 65 2 1).ita 1 etprommunication Installation
b)The fee for branch dicuits
without purchase of service
or leader fee. Fire Alarm Installation
First branch circuit _ $46.85
Fach additional branch circuit Y� $6.65 HVAC
Miscellaneousr
(Service or feeder not included) Lam) Instrumentation
I ach pump or irrigation circle $53.40
I ach sigr x outline lighting v _ $53,40 ❑ intercom and Paging g g Systems
agnal circult(s)or a limited energy
panel,alteration or extension $75.GJ_ ❑ Landscape Irrigation Control'
Minor Labels(10) $125.00
Each additional inspection over Medical
the allowable In any of the above
:'er inspection $6250 _ Q Nurse Calls
Per hour $62.50_
In Plant _— $73.75 — ❑ Outdoor Landscape Lighting'
Fees: (� Protective Signaling
Fntertotal ofabove fees $ JJ• �� Other---- __.--_—_-------____ ---
R%State Surcharge $ /Z•3 U _Number of Systems
25%Plan Review Fee
See-Plan Review"section on s No licenses are rewired Licenses are required for all other installations
frond of application
Fees:
Total Balance Dote $
-- Enter total of above feesFJ
Trust Account>K
- ------ --- 8•/.State Surcharge : —
__.-- -----------.--------- — =_A
All New Commercial Buildings require 2 sets of plans. Total Balance Due —
i dxtsV'orms4lc-fees.doc 08/30/01
Mechanical Permit Application 0
7ID),tjc
recehvei: Permit no.art;1
City of Tigard ct/appl.no.: Expire date:
Cityoffigard Addref(8: 13125 SW Hall Blvd,Tigard,OR 97223 ---
Phone: (503) 639-4171 issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
U I & 2 Ianily dwell ,c.or accessory U('nnuncn ial/industrial U Multi-family U Tenant improvement
U New construction Addition/alteration/:eplaccntent U Other: _
i
Job address: C)Z j $,(,t). ,w - - T" qy Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Sujtc no_: _J _ value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: 2 51 C)3 C 'ZWD Q profit. Value.$ --
Trot: Block: — Subdivision: *See checklist for important application information and
Project name: jutisdiclion's fee schedule for residential l.crinit fee.
City/county: 1 g i.,rcl Z.IP:
Descriptionand�n of work on premises: M_ i
Fee(ea.) Total
Est.date of completion/inspection: �j -- lk�scri ion Qly. Res.orrly Res.only
Tenant improvement or change of use:
Is existing space heated or conditioned?U Yes U Nu Air handling unit .—CFM
is existingspace insulated?U Yes U No Alt conditioningrxi ting pan C sysi 1 _
�P _Alteration of existing AC system:
of er compressors
Business name: State hoilcr permit no.:
7- 1"0 �C_ HP _,tons_ HTUM
Address: e 33 Fir smo a amper, act smo a defectors _
City: 1 State: ZIP: eat pump(s--- ite pian required
Phone:rI'M I-ax:1-� E-mail: Instal replacefurnace/burner B U/Il
CCB no: Including ductwork/vent liner U Yes U No -
n_to rep aTL/re ocatTiers-suspen ec.
City/metro lic.no.: ro : qz VS _ wall,or floor mounted _
tName:
ase print): Ch Le ent fora iance other than furnace
e emit on:
Absorption units _ BTU/Fi I VA Keele Chillers H!'s: S.LtJ -rep S Compressors
Cil -Titate: :nv rorrmenta exhaust an vent at on:
City. r Qtr ZIP: 4722.3 Appliance vent
Phone: ,SS I Fax: ZL E-mail: Dryerexhaust
foods,TypeT111/res�n/hhazmat — —
hood fire suppression system
Name: r e rC e— Exhaust fu..with single duct(bath fans) —_
Mailing address: I I D 7S 9.w. E rro, — Exhaust- s stem a an from heatingor A C
ue p p ng an sl ut o o 0vt ets)
City: -- 1_ State: Qac ZIP: e172LU Type: —LPG G Oil
Phone: Q (p Fax: E-mail' I-uei hi rim�e�ac hTd id t�Ona outlets — --
rocP etspiping(scheematicrc(Iuired)
Name: Number of outlets
-_ _ terTlsle�i appliance or pmenl:
equ
Address: Decorative fireplace --- —
City: --- - state: zIP: _ inst•rt-type
Phone I ax: - E-mail: 1VrooTtove/pe let stove
Other:
Applicant's signature: Dat::
Name (print):
Not an jurisdictions accept credit cards.plena call juriulirtirn fen mrw infarmatirn Permit fee.....................$
U Visa U MasterCard Notice:This permit application Minimum fee................$
trait sand nnnrner -_ 1 expires if a permit is not obtained Plan review(at _
96) $ _
- -- within 180 days after it has been State surcharge(8%) ....$
------ ------
Name or cardholder u s-gown an credit cm1 accepted as complete.
S TOTAL .......................$
_—
Cardholder sipature _ __ _ Amount 441-4617(6Mi NO
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Des,,�intlon: Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mdehanical Code Oly (Ea) Amt
$5,001.00 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 including ducts A vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+ -`
$10,000.00. including ducts 3 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 including 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 ~--
$1.45 for each additional$100.00 or
fraction thereof,to and including 6) Repair units - - --
$r'0O013.00. 12.15
$50,001.00 and up 2,0 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. footnotes below. Comp
Minimum Permit Fee$72.60 SUBTOTAL: a 7)<3HP;absorb unit
- ---
to 100K BTU 14.00
8`/.State Surchargea 8)3-15 HP;absorb
unit 100k to 500k BTU _ 25.60
25%Plart Review Fee(of subtotal) S 9)15-30 HP;absorb
Required for ALL commercial�ermits onl unit.5-1 mil BTU _ 35.00
TOTAL COMMERCIAL. PERMIT FEE: $ 10)30
unit 1-11.7.7 5 mil BTU 52.20
_.._. 11)>50HP;absorb
__ unit>1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM --
- --- __
Value Total 10,0013)Air handling unit 10,000 CFM+
Description: _ _ _ C]t Ea Amount _ 17,20
Furnace to 100,000 BTU,Including 955
ducts&vents 14)Non-portable evaporate cooler
_ _
--
.1000
Furnace>100,000 BTU including 1,170
ducts&vents 15)Vent tan connected to a single duct
Floor furnace Including vent 955 6.80
Suspended heater,wall heater cr 955 16)Ventilation system not Included in
floor mounted heater appliance permit 10.00
Vent not included In applicant e 445 17)Hood served by mechanical exhaust
permit 1000
Repair units 805 - 1 B)Domestic incinerators
<3 hp;absorb.unit, 955 - _` 1740
to 100k BTU 19)Commercial or industrial type Incinerator
3-15 hp;absorb.unit, 1,700 6E 95 _-
101'(to 500k BTU 20)Other units,Including wood stoves
15-30 hp;absorb.unit,501k to 1 2,310 1000
mil.BTU 21)Gas piping one to four outlets
30-50 _
1-1.75 mil.BTU s 40
hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.7 I P
>50 hp;absorb.unit, 5,725 1 1 00
>1.75 mil.BTU Minimum Permit Fee:72.60 SUBTOTAL: $
Air handling unit to 10,000 cffn 656 -----
Alr handlingunit>10,000 cfm 1,170 8%State Surcharge $
Non-portable evaporate cooler _ 656
Vent fan connected to a single duct 446 - TOTAL RESIDENTIAL PERMIT FEE: S
Vent system not Included in 658
a Iiancepermil -
Hood seryed by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1.170 1 Inspections outside of normal business hours(minimum chargeJwo hours)
Commercial or industrial Incinerator 4,590 $62 50 per hour
2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
Other unit,Including wood stoves, 656 $62.50 per hour
Inserts,Rtc. 3 Additional plan review required by changes,additions or revisions to plans(minimum
GaspIping 1-4 outlets S60 charge-one-half hour);62.50 per hour
Each addlUonal outlet 83
- *State Contractor Boiler Certification required for unite>200k BTU.
TOTAL COMMERCIAL $ *"Residential A/C requires site plan showing placement of unit.
VALUATION: -__ All New Commercial Buildings require 2 sets of plans
I\dsts\forms\mech-fees.doc 12/26/01
Plumbing Permit Application
City of Tigard
Datereceived: Permit no.:r
Sewer permit no.: Building perinit no
Addre.%:13125 SW Hall Blvd,Tigard,OP. 97221 ---
CiryofTigard phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: �Reccipt no.:
Land use approval: Case rile no.: Payment type.
TYPE 1
U 1 & 2 family dwelling or accessory U('unnncrcial/industrial U Multi-family U Tenant inipitnendent
U New construction nddititm/;dterntiun/rclrlacenlcnt U Food service U Other: 7
�--
.1011 SITE 1
Job address: )S.W. Errol $ I/escri tion Qt Y.f Fee(ea.) Total
Bldg.no.: Suite no.: 4SFR
New1-and 2-family dwellings only:
Tax map/laxlot/accountno.: Includes 1000.for each utility connection)
c> O SFR(I)bathLot: Block: SFR(2)bathProject name: (3)bath
City/county: ZIP: Q u'3 Each additional bath/kitchen
Description and location of work on premises: _ Siteutilitles:
Catch basin/arca drain
Est.date of completion/inspection: Drywells/leach line/trench drain
Footing drain(no. lin.ft.) v —v
Manufactured home utilities
_Business
name: Q 1 hyl ty s / �� jtL, Manholes
Address: U(c2 _ q g Rain drain connector —
City: _C)yeciovN State: orl ZIP: � Sanitary sewer(no.lin.ft.) - --
Phone:(iL yp a Fax: (off 0 Email: Storm sewer(no.lin.ft.) _ ----
CCB no.:(OS 3L S Plumb.bus.reg.no •«3� Water service(nu. lin. ft.)
City/metro lic.no.: A Fixture or Item:
Contractor's representative signal ,� Absorption valve —
Print name: �- ,tT., �,r,, pate: Back flow preventer
-Backwater valve
Basins/lavatory
IN me: lu+r. �E'E'�Ce+• Clothes washer
Address: - Dishwasher - —
_ s j��$G S.w. t rro Drinking fountains) �— -- --
City: �; at . State: ZIP: 2Z3 Ejectors/sum
Phone: 3 Fax:94( E-mail: Expansion tank _
Fixture-sewer cap
Name(print): r Fla)r drainstfloor sinks/huh --
.�t.rret� �— Garbage disposal ---
Mailing address�1 67 3.L j fs►-ro l GarbHose aged _ --
bibb
City: -j 9 Q; _ State: Or ZIP: e172Z-3 Ice maker —
Phone: (�2Q- �� (� Fax: E-mail: Interceptor/grease trap —
Owner ir.stalletion/residential maintenance oily: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)—
employee on the property I own as per OR;N Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature:_ Date: Sump -
Tubs/shower/shower pan - —
Urinal
-- —�
Name: -_---- -- Water closet —v
Address: Water heater
City: —�--- State: _ 7,(P: Other.
Phone: _ - Fax F-mail: Total
Na all jurisdictiotn accert credit earls,please cell jurisdiction for mom informatimMinimum fee................$
Notice:•fhia permit application —
U Visa U Mastr;C•ard expires if a permit is not obtained Plan review(at — %) $
Credit card number _____ -_- surcharge
— _
_ _�^,L State surchar a(8%
within 180 days after it hes been g ) •�••$
Expires TOTAL . .$
---Nnnx td cardholder u shown on credit cart---- aCCCpled as complete. •.•••••••••••••••••.. �---
S
Cardholder siguave — Anaum 40416(b00R OM)
.'a
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individualr QTY ez AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink �, 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato 16 60 for each utility connection____—
ry _ 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
Garbage Disposal 16.60 — —__TOTAL —
Laundry Tray 16.60
Washing Machine 16 c0
FloorDrain/Floor Sir:, - 2— 16.60 _ PLEASE COMPLETE:
3" 16.60
4" 16.60 _ ---�
Water Heater O conversion O like kind 16.60 — Quantic b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
Capped
MF(3 dome Now Water Service _ 4640 Sink
MFG Home New San/Storni Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains - 16.60 Shower Only _
Drinking Fountain 16 60 Water Closet —
16.60 Urinal _
Other Fixtures(Specify) _ Dishwasher
Garbage Disposal _ v -
---- — — Laundry Room Tra _
-- Wash±Machine
Floor Drain/Sink: 2"
Sewer-1s1100' ---- 55.00 —
Sewer-each additional 100' 46.40 4" —_
Water Service-1st 100' 5'5 0 Watnr Heater — —
Other Fixtures
Water Service-each additional 200' 46.40
S eu�f�-- — -- - —
Storm 8 Rain Drain- 1st 100' 55.00
Storm 8 Rain Drain-each additional 100' 46.40 --
Commercial Back Flow Prevention Device 46.40 -- —
Residential Backflow Prevention Device' r65.
—
Catch Basin —inspection of of Existing Plumbing or Specialty
requested Inspections _ __ COMMENTS II.EGARDING ABOVE:
Rain Drain,single family dwelling
Grease Traps 16.c0 -"---
QUANTI'TY TOTAL
Isometric or riser diagram is required if
quant LTolal is g
"SUBTOTAL —
8%STATE SURCHARGE -- -- -- — --
"PLAN REVIEW 25%OF SUBTOTAL
_ Required o If rxture qty total is>
— TOI AL. S
"Minimum permit fee Is$72 50+8%state surcharge,except Residential Backflow
Prevention Device,which Is$36.25+8%state surcharge.
"All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:\dsts\forms\pim-fees.doc 12/26/01
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SITE PLAN
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CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC1999-00490
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/16/1999
PARCEL: 2S103AC-02800
SITE ADDRESS: 11075 SW ERROL ST
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: PT JURISDICTION: URB
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS _ OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 2
> 10000 cfm:
Remarks: Furnace, gas ir3t.rt and gas piping to both units.
Owner: _ FEES
PIERCE, DARREN F + AMY J Type By Date Amount Receipt
11075 SW ERROL ST PRM4 BON 11/16/19 $50.00 99-319798
TIGARD, OR 97223 5PC2 BON 11/16/19f $4.00 99-319798
Total $54.00
Phone: --
77
Contractor:
SCOTT A SHAMBURG HEATING LLC
17913 SW PACIFiC HWY
TUALATIN, OR 97062 _ REQUIRED INSPECTIONS
Gas Line Insp
Phone:503-692-5563 Misc. Inspection
Reg #:LIC 126881 Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain co)pies,of these rules or direct questions to OUNC by calling (503)246--9189.
Issue By: � r lel- ! l"i�?(,� c --- Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day 1_
CITY OF TIGARD Mechanical Permit Application Plan Check
p� Rec'd By
1312.5 SW HALL BLVD. Commercial and Residential Date Recd t-
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type Permit# r--:c_I
Incomplete or illegible applications will not be accepted_ Called
Name of Development/Project Description
Table 1A Mechanical Code _ Qt P►ICe Amt
Job Street Address (� 1 TSuneN A) Perini!Fee 16.00
Address /C/5� �j�C//D� -S C 1) Fumn;e to 100,000 BTU
Bldg# CRY/State zip inr uding ducts&vents _ 9.65 1 V)
Furnace 100,000 BTU+
1 Cl/Ole� �_a3 including ducts&vents _ _ 1200
Name(or name of bt inose! 10(� 3) Floor Furnace
Owner Z�I /Cil 'f ,+I9 �e including vent_ _ —_ 9.65
Melling Address 4) Suspended heater,wall heater
1 or floor mounted heater _ 9.65
5) Vent not included in appliance permit _ 4.75
City/State Zip Phone Check all that apply 'Boiler Heat Air
�3_ y.3�5/� For Items 6-10,see or Pump Cond Qty Price Amt
e(or name of business) footnotes 1,2 Comte
11� 6)Repair units
8.40
J C( �, �L�U✓(�
Occupant Mailing Address 7)<3HP;absorb unit to
100K BTU _ 9 65
CRyrSta!e zip Pnone 8)3.15 HP;absorb unit
t 00k to 500k BTU _ _ 17.65
Contractor Name 9) 15-30 HP;absorb
'` / unit.5-1 mil BTU _ _ 24.15 _
�.. 41/Y)"((�� /7 u( – 10)30-50 HP;absorb
Prior to permit Mailing Address unit 1-1.75 mil BTU I 1 _36.00
issuance,a copy 1 ri I � 11)>50HP,absorb unit>1.75 mil BTU
of all licenses CHy/State ,,/� Zip Phone _ _ 60.15
are required if �G (a�/L(/�— (��7i''SS-&3 12)Air handling unit to 10,000 CFM
expired in COT Oregon Const Cont.Board LIc.0 Exp,Date 7.00
_ database /" G> 13)Aii handling unit 10,000 CFM+
Architect Name 11.85
14)Non-portable evaporate cooler
or Meiling Address _ _ �'p� --
15)Vent fan connected to a single duct
_ _ 4.75
CRY/State Zip Phone
Engineer 16)Ventilation system not included in
_appliance permit— 700
Describe work to he done 17)Hood served by mechanical exhaust
_ 7.00_
New O Repair O Replace with like kind Yes O No O 18)Domestic incinerators
Residential la— Commercial O Modification O __ 12 00
19)Commercial or industri_ ,,e incinerator
Additional information or description of work. _ _ 48.25
nos-ea LC F0 lo f,&,Ili rwe �r9a S' InSP/� -P .5 444 20) Other units, including wood stoves` r e
bov-A Griltie-y 700
NOTE: For Commercial projects only;Units over 400 lbs.located on the 21)Gas,piping one to four outlets
roof,require structural talcs.prepared by licensed engineer �1375
Type of fuel oil O natural gas(DLPG O electric O 22)More than Tper outlet(each) 75
I hereby acknowledge that I have read this application,that the information
MI um Permit Fee$60.00 U SUBTOTAL .
Nen is correct,that I am the owner or authorized agent of 8%SURCHARGE
g g PLAN REVIEW 25%OF SUBTOTAL
the owner,that plans submitted are in compliance with Oregon State laws Required for ALL commercial permits only
SlgnaJ�tr�of OwrterlA inth/ Date/ — TOTAL CA/1l Other Inspections and Fees
Contact Person Name Phone
I Inspections outside of normal business hours(minimum charge-two hours) $50 00 per hour
/'� 2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
s50 00pertintir
Foonotes for commercial projects or:?: i
3 Additional plan review required by changes,additions or revisions to plans(minimum
1. Provide full schematic of existing and proposed gas line and pressure charge-one-half hour)$50 00 per hour
2. Provide drawings to scale showing existing and proposed mechanical *State Contractor Boiler Certification required
units. "Residential A/C requires site plan showing placement of unit
1:lmechperrill rev 1111/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
_ BUP
Date Requested ;;_!�M PM _ BLD
Location_ / 6,7 { %� Suite MEC /!%" - GpG�t!G
Contact Person Ph PLM
Contractor Ph SWR
BUILvING Tenant/Owner ELC
Retaining Wall ELR
Footing Access.-
Y~
Foundation FPS
Fig Drain SIGN
Crawl Drain Inspection Nates:
Slab _ _ ---____—. --- SIT
Post& Beam --`
Ext Sheath/Shear
Int Sheath/Shear �—
Framing -- — --- --- — --- ----- — -- -----..--_.-.
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ---
Roof
Misc: --- i 4r -� - - - - ---- - -- --
Final - -
PASS PART FAIL — — — --- --- - - -----
PLUMBING _
Post& Beam --- - -- -- --- - -
Under Stab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post$BeamRough In
=IN-
Smoke Dampers
- - -- -
S PART FAIL
rRICAI_ -
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS_ PART FAIL
SITE
backfih/Grading -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I ]Please call for reinspection RE: [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewplk
Other Date Inspector Exv,
Final
PASS PART FAIL DC I NOT REMOVE this inspection record from the job site.