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11695 SW GALLO AVENUE c, v. a� 'r 0 c 11695 SW Gallo Avenue CITY O F T I G A R D MASTER PERMIT PERMIT#: MST2002-00336 DEVELOPMENT SERVICES DATE ISSUED: 8/1/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 11695 SW GALLO AVE PARCEL: 1S134DC-07200 SUBDIVISION: GALLOS VINEYARD ZONING: R-4.5 BLOCK: LOT: 003 JURISDICTION: TIG REMARKS: Add 480 square feet of living space to family room and (2)bedrooms. BUILDING REISSUE: {�^^ STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLAZS OF WORK: 1 / t`Y Y HEIGHT: 12 FIRST: 480 at BASEMENT: of LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: If GARAGE: of FRONT: PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: of RIGHT: VALUE: S 12.180 00 OCCUPANCY GRP: R3 SDRM: BATH: TOTAL: 49000 of REAR: 35 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS! GARBAGE DISP: WATER HEATERS: WATER LINES: BCIfFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN c 100K: BOIUCMP c BHN: VENT FANS: CLOTHI'5 DRYER: FURN>•100K: UNIT HEATERS: HOODS: OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS, ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS `BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTIONS 1000 SF OR LESS: 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATION PER INSPECTION: EA AOU'L 800SF: 201 400 amp. 201 400 amp: IatW/O SVCIFDR: 31GNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 800 amp: 401 600 amp: EA ADDL OR CIR: SIGNAUPANEL: IN PLANT: MANU HMISVCIFDR: 601 • 1000 amp: 6014amps•1000v: MINOR LABEL: 1000+amplvolt PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: 9VCIFDR>•225 A.: >800 V NOMINAL: CLS AREA/SPC OCC: ELEC i RICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM. AUDIO S STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAOF OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATArTELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 601.36 This permit is subiecl to the regulations contained In the CARRIER,TIMOTHY S OWNER Tigard Municipal Code,State of OR. Specialty Codes and 11695 SW GALLO AVE all other applicable laws. All work will be done in TIGARD,OR 97223 accordance with approved plans. This permit will expire If work Is not started within 180 day,.,f Issuance,or If the work is suspended for more thar t80 days. ATTENTION: Phone: Pr Oregon law requires you to fr ; les adopted:y the Oregon Utility Notification Centel. Those rules are set Raga forth In OAR 952-001 0010 through 952-001.0080. You may obtain copies of these rules or direct questions to OUNC by c..aing(503)246-1987. REQUIRED INSPECTIONS Footing Insp Mechanical Insp Exterior Sheathing Inst Mechanical Final Foundation Insp Electrical Service Low Voltage Final inspection Post/Beam Structural Electrical Rough In Insulation Insp Post/Beam Mechanica Framing Insp Rain drain Insp Undl,rfloor Insulation Shear Wall Insp Electrical Final Issued By : 1) l_—r 17 i c_F_ .f-1 t c _ Pel mittee Signature Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day -eo33r - Address: Lex ) !!to w c. Issued by: --L-�� Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, URS 701.055(4), requires resideruial construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can he issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt,from registration under URS 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 either box 3A or 313: 1. i own, reside in,or will reside in the completed structure. LOLJ 2. i understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. F1 3A. My general contractor is (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 , _Ln 3B. + will be my own general contractor. If hire subcontractors, I x\ill hire only subcontractors ^gistered with the Construction Contractors Board. IFI change my mind and hire a general contractor. i will contract with acontractor who is registered with the CC'B and will immediately notify the office issuing this building permit ofthe name of the contractor. hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners out C/;nstruction Responsibilities on the reverse side of this form. C C (Signature of permit applte�tit) (pate) (While ropv to issuing agency permit.ile, pink copv to applicant) Information Notice to Property Owners About Construction Responsibilities �l" "I a/rlfl"Ij Vdh (' 'II h'I7)00,11I) 11i, I t rlllow( r,ll+il Its 111•Il b,1:I! (`I'ri,IC -., I), �R'llly.',lr,A dre�Il ll;. l '�1�11VI 0.1.it .I,, EMPLOYER RESPONSIBILITIES: 1 ►tt';;'III '• ,�iflllll,Illlll!.'tl\ It11" �. I11� !III+I„, ,". "t1:1,1 .Illillif i,l•.,, „111'. I., I, +ti ''il'�,1I` I, I II11'1:1`, jl;,1 Incllt• I',t"l di.111 1, 1wilk tAIlldlolrl till' In•, II`+111 AI'111 .I '.1. i ' iI, 1 i1.'llt i,1 Il'.'`:itrll•1111).l- .�{(t+i1 t.,I'lclol liu.:la\pa%11� ;VI ! ;11111.jQ'?U.f(1•x(1. OTHER RESPONSIBILITIES AND AREAS OF CONCERW I)IICI'lllllllllalll'(': ;�', I�:� � �. '[till h,dilt'I t l IIII-j)II jC` I •,,ill•U '�'�, - lel' II .'ll'I - - fllal II,�I', I`r I+11'11},III II" ''-'II -llh'lll l:+ll tI111�t1;'II II1' I'�'+'l!�`It, I.lallllll+ Hlll) I)1'111►CI'1, II:111t:IRl'Itl�tllaltit- IIICIII>JIt41 omi-,sl1,11'. NllCh;I,,Bill Ing It)ok.I)illlll C I)I'r11Lll yl.: 111+tt'' Id III• ',•` Ir, I Time to wupivr',isc emphoN eec: N I;I,t' 111 L cnII I1:1\c:11141k il,Ill I nil,. I I I V I iu�++ur e'nlrlt+l c txpertiNc: Makusim.,.kill ll1\I. I1h'c',,IWI.h'.Clli;lCla^, lk01111111Jill t+`iia+rllilla(CIT'\b,t1{. `) 1. il_'I1 In,Ui•III 1' i'. lrtt&C .and to no ift•6ildine rfiicial`,'11 the;Irl)rr)i)t illctinlcs':r thrl ccln rerti11•I11 the tcgoirt d ina)rrti+�n IIVl,llllil4citlllillll1lli1111111'ti(I1�115. NrllC11(iilll (hC( l)I1�1r11ClINIll i+Illr;Icll'11', I;tglyd(I'(1I11�\ 111 ttt. ',;ti,.'I'. ill� 'I 'lllli 11 ,' iO? ? 18-16211. 'I ht: Poore i', Il)cnlcll :11 '7iltt Summer 5t, NI Salem. {il't'I'-1"'11 I"111 1 lJ•1 T-,;') Js T- 7--•2- 3- (5) z -. L3 Building Permit Application — -- Date received: �t lY p y- Permit no.: hl �->ap3� City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Lk ProjeeUappl.no.: E ire dart: City of Tigard phone: (503) 639-4171 Date issued: Byj Ij Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 1&2 family:simple Complex: 1 U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition Addition/aheration/replacentent U Tenant impntv;-nicnt U Fire sprinkler/alarm U Other:MW Cl 1 1 Job address: 6 51W. tin Av,._ Bldg.no.: Suite no.: v Lot: I Block: Subdivision: Tax map/tax lot/account no.: — r Project name: _ Description d location of work o premises/special conditions: r/VD � � _-i✓� �__�� J Name: �` �ejr Mailing address: o — I &2 family dr1clling: /L J �✓ Cil State: QZ ZIP: 1 Valuation of work.......... City: — ......... $-- Phone: - Fax: E-mail No.of bedrooms/baths......... ...................... Owner's representative: _ Total number of floors................................. _ 13 1' narrl New dwelling areas ft. H tf 0 Phone: —�--- f= ( q. ) .......................... AW W M 1110 Garage/carport area(sq. ft.).... Name: fo rt oaf 0"j V'U j Covered porch area(sq.ft.) ......................... Mailing address: - Deck area(sq. ft.) ........................................ _ - City: Other structure area(sc. ft.)..............I...... Statci J'-11�.L .... -- �- — Commercial/industriallmulti-family: Phone: I ,n E-mail: 1 Valuation of work.......................... ............ Existing bldg.area(sq. ft.) ................ .... Business name: Uwv1u - - ----- _ __ New bldg.area(sq.ft.)........................... .. Address: - - --- City: State: ZIP: Number of stories............................... ....... _ _ Fax: I I: mnil: Type of construction....................... ........... Phone: -- — - -- Occupancy gmup(s): Existing: ._- - CCB no.: _ _ _ _ New: - C'ityhnetrolie. mr. Notice:All contractors and subcontractors are required to be ARUIIIIITECTIDlicensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and cony he required to he licensed in the Address. jurisdiction where work is being performed. If the applicant is -- - Cit Stale: exempt from licensing,the following reason applies: i I I Contact person: Plan no.: _ - Phone: Name: Cunlak t i".1 Son: Fees due upon application ........................... $ Address: Date received: City: State: ZIP: Amount received ...................................... . $ __ Phone: Fax: E-mail: Please refer to fee schedule. I hereby certify 1 have read and examined this application and the Not all}urisdictinns accept credit cards.please call}urisdictinn rM mose inrMmation attached checklist.All provisions of laws and ordinances governing tills U Visa U MasterCard week will he compiled yvl�pwhtcift�herein or not. Credit card number:_— __ CaircrAuthorized signaturesignature; pate; _ 6 _rJ2. Nems of cardholder as flown on credit cud $ Print name: r Cardholder signature Amount Notice:This permit application expires if a permit is not obtained within ISO da',- -ifter it has been accepted as complete. 491-413 WMIC'oM) S-03 - 685` 1962- 'ICY One-and Two-Family Dwelling Building Permit Application Chet klist Reference no,: Ciry of Tigord City Of Tigard Associated permits: Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Electrical O Plumbing U MechanicalU Other: Phone: (503) 639-4171 — Fax: (503) 598-1960 FOLLOWINGTME r Volt PLAN REVIEWYes No N/A I Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,cic 3 Verification of approved plat/lot. - 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 U permit required, Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 _L 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 if copyright violations exist. 1 I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if there is more Utan a 4-R.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 hams,headers,joists,sub-Iloor, wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views.Provide elevations for new construction:minimum of two elevations for additions and remodels. Exterior cleva(k1w,must reflect the actual grade if the change in grade is greater than four foot at building envelope, Full-size slice(addcndums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis rlans.Must indicate details and locations;for nun-rrescriplive path analysis provide specirications and calculations to engineering standards. 17 Floor/roof framing,Provide plans fur all floors/root'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 bean/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 gats-piping schematic is reqs fired for four or more appliances. 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 and shall be shown to he 011111icahle to 111e project un Ira review. JURISDIU110NAL 2.4 Five(5)site plans are required for Item I I ah-c Siie plans must he 8-112' x I I"or I I" x 17". 24 Two(2)sets ench 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 Street Tree List. Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink. Red ink is reserved for department use only. 440 4014(MUCotit) _Electrical Permit Application IDatcreceived: � 7._ Permit no.: Ai� A City of Tigard Project/appl.no.: Expire date: CifygTigard Address: 13125 SW Hall Blvd, Fgard,OR 97273 Date issued: Receipt no.: Phone: (503) 639-4171 — Fax: (503) 598-1960 case file no.: Payment type: Land use approval: U 7Newconstiruction ly dwelling or accessory 0 Commercial/industrial U Multi-family U Tcnant improvement ❑ U Add it ion/alteration/rcpl aceme nt U Other: U Partial INFORMATIONJOB SITE Job address: f Bldg,no.: Suite no.: Tax map/tax lot/account no.: Lot: IFuck: Subdivision; Project name: Dcscriptinn and location of work on premises: Estimated date of completion/inspection: — __-- 1 1 1 DULE Job no: Fee Mat Bitsiness(tame: U ) f` f Dv%cription Qly. (ca.) 'Total no.insp Address: — - New residential-single ormnki hamils per dwellingunh.Includes attached garage. City: I State: ZIP: Serviceincluded: Phone: Fax: E-mail: I(x)O sq.ft.or less 4- Bach additional 5(10 sq.ft.or portion thereof CCB no.: Elec,bus.lie.no: I.imitedenergy,residential 2 City/metm lie.no.: Limitedenerg ,non-residential _ 2 Each manufactured home or modular dwelling Signature of supervising ch-,trician(required) Date Service and/or feeder 2 Sup.elect.name(print): License no: Services or feeders-installation, alteration or relocation: PROPERTY OWN11,11 200 amps or less 2 201 amps to 400 amps 2 Name(print): � ',r,�, L,p, ( �t C401 amps to 6110 amps z Mailing address: f' -- 601 amps to 1000 amps _ 2 City: Stale: Q 6L I ZIP; Over I(Wstrips orvolts 2 Phone: 6 J Fax: I F-nail: Reconnectont Owner installation:The installation is being made on property I own Temporary services orfeeders- which is not inlended for sale lease,rent,or exchange according to Installation,elleratlon,orrelocation: ORS 447.455,479,6 701. 2(x)amps or less 2 t 201 amps to 4W arnpc 2 Owner's signature: - -� Date: - 6 O1 401 to 600mn„ 2 ENGINEER Branch circuits-new,■llerallon, or extension per panel: Name: or Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: Stale: ZIP: B. Fee for branch circuits without purchase - _ — — of service or feeder fee,first branch circuit: Plume: I + E-ttutil: F.ach additional branch circuit: pillavEju Misc.(Service or feeder not Included): O Service ocer 221 anq+s wnunercurl U Health-care facility Each pump or irrigation circle 2 U Service over 320 amps-rating of 1&2 U Hazardous location F-ach sign or outline lighting 2 familydwell Ings U Building over 10AX)square feet four or Signal circuit(s)or a limited energy panel. U System over 600 volts nominal more residential units in one structure alteration,or extension* 1 1 2 U Building over three stories U Feeders,4W nmps or more 'Icscri tion:_ U Occupant load over 99 persons U Manufacturer)structures or RV park path additional Inspection over the allowable In any of lire above: U Fgress/lightingplan U Other: _ Perins ection Submit—sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other - Not all jiuMicnons accept credit can&,please call jurisohction for mole information Notice:'I"his permit application Permit fee..................... U visa U MasterCard expires il'a permit is not obtained Plan review(at __ %) $ Credit card numhec ....__ _ _ within 190 days atter it has been State surcharge(8%)....$ _ Expire% accepted as complete. TOTAL . $ Narruc of cardholder v shown on credit cud __ S Cardholder signature Amount J 4444615(601DCOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: -- -- --- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: - -- Restricted En orgy Fee..................................................... $75.00 Number of Inspections Per permit allowed (FOR/ALL SYSTEMS) Servi,a included: Items Cost Total I Check Type of Work Involved: Reslr.entlal-per unit ❑ 1000 sq ft or les., $145 15_ 4 Audio and Stereo Systems' Each additional 500 sq ft or portion thereof J. $33 40 1 ❑ Burglar Alarm L imited Energy $75.00 _ Each Manurd Horne or Modular ❑ Garage Door Opener* Dwelling Service or Feeder $9090 2 Services or Feeders Heating,Ventilation and Ail Conditioning System' Installation,alteration,or relocation 200 amps or less _ $80.30 2 ❑ Vacuum Systems' 201 amps to 400 amps $106.95 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 ❑ Other over 1000 amps or volts $454.65 _ 2 Reconnect only $88.85 2 Temporary Services or Feeder TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $75.00 200 amps or less $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 2 401 amps to 600 ani $133.75 2 Check Type of Work Involved. Over 600 amps to 1000 volts, ❑ see"b"above. Audio and Stereo Systems Branch Circuits ❑ Boller Controls New,alleralinn or extension per panel a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder foe. Each branch circuit $665 1 ❑ Data Telecommunication Installation b)1he fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit _� $46.85 rf��11 HVAC Each additional branch circuit _�_ $6.65 LJ Miscellaneous ❑ Instrumentation (Servs a or feeder not Included) Each lump or Irrigation circle _ $53.40 _ F] intercom and Paging Systems Each :ign or outline lighting $53.40 _ Signal circult(sl or a limited energy panel,alteration or extens,on _-_ $75.00 ❑ Landscape Irrigation Control" Minor Labels(10) $125.00 Each additional Inspection over — ❑ Medical the allowable in any of the above C� Nurse Calls Per inspection _ $62.50 Per hour $6250 ___ In Plant _—_ $73.75 ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ . — ❑ Other - 8°i State Surcharge $ — Number of Systems 25%Plan Review Fee ' No licenses are required. Licenses are required for all other installations See"Plan Review"sectinn on $ fr?nt of appfcation --- Fees: Total Balance Due $ ---- Enter total of above tees $ ❑ Trust Account p _ 8%State Surcharge $ Total Balance Due $All New Commercial Buildings require 2 sets of plans. 0dsts\fonns\elc fees.doc 08/30/01 Mechanical-Permit Application Date received:17 / a Permit no.: ` rXj33 Cite of Tigard Projec:/appl.no.: rc date: City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 pate issued: By Qjj:Receipt no.: Fax: (503) 598-1960 Case file no.: Payment tyr;: Land use approval• Building permit ne OF U I &2 family dwelling or accessory U Commercial/industrial U Multi-family LJ Tenant improvement U New construction U Addition/alteration/replacement U Other: JWIAL .1011 SITE INFORNIA]ION COMME1 1 Job address: S",U)7!;2Q AITT Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: •tire checklist for important application information and Project name: jurisdiction's 1ec schedule for residential r,•rmil fee. City/county: ZIP: 1 Description and location of work on premises: t 1 1 Est.date of completion/inspection: Ikwcription OL. Itis.onl� Ites.onh Tenant improvement or change of use: Airr handling Is existing space heated or conditioned'1 LJ Yes U No Air unit _CFM__ Is existingspace insulated?U Yes U No it r,ti conditioning g VACan systui em) •P teratiun of existing system _ MECHANICAL CONTRA( o cr compressors Business name State boiler permit no,: Hl' Tons BTU/N Address: _ •irr mo a dampers/duct smoke detectors City: _ State: 7.I P: Heat pump(site plan require ) - Phone: I I',tti _ E-mail: nsta rep ace urnac urner - Including ductwork/vent liner U Yes U No CCB no.: _ _ Ua rcp aC rC ocatC eaters–suspen e City/metro lic.no.: _ floor mounted Name(pleaseprint): rnp lanceot!u.rthan furnace CONTACT PER4;ON Refrigeration: Absorption units BTUAI Name. Chillers__ _ HP Acltlre.ss: Com ressorsHP -_ Environmental exhaust and vent at on: City: State:_ ZIP: Appliancevent Phone: Fax: E-mail Uryetexhaust _ 0o s,Type res. kite en/hazmat hood fire suppression system -- Name: Exhaust fan with single duct(bath fans) Mailing address: p Exhaust systema art from heatingorWC City: " Qr State:W. ZIP: r ue p ng andistribution(up to outlets) -- -- ��. -r it r7.� Tyle: HIG NG Oil Phone: hnx: I l uel qlgnjaieach additional over 4 outlets ENICANEFR rocexq p p ng(sc ema►ic require ) _ Number of outlets Name: Other limed appliance or equipment: Address: Decorative fireplace City: I State: ZIP: nsert-type _^ Phone.: E-mail oo str VC/PCIICt stove Applicant's signature. ` Ot Date: r. 7- 6• o z eter: _ _ Name (print): Minimum -- No all judedictinns accept ctedil cont+,plena call judediction fin more information it fee.....................$ (]vian UMasterCnrd Noticc:'I'hispermit application MMinimum fcc................$ Ordit card numlkr ,_– �_ expires if o permit is not obtained Plan review(at _ %) $ -- Expires within 180 days after it has been _ State surcharge(896)....$ accepted as complete.Nnnte of cnrdhohkr ns-pawn on crcdll cud —.— d Tete.p p $ TOTAL .......................$ — 'VCudholder dgnaWre — — Amoum 440-4617(MxU'ONI) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL_VALUATION: PERMIT FEE: Description: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code _ Qty (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&vents 14.00 fractlon thereof,to and including 2) Fur:iace 100,000 BTU+ $10,000.00. including ducts&vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or Including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater $25,000.00, or floor mounted heater $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 6.80 fraction thereof,to and including 6) Repair units $50 000.00. 12.15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond _Ty _ fraction thereof. _ footnotes below. Comp •• Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit to 100K BTU 14.00 8%State Surchargo $ 8)3-15 HP;absorb unit 100k to 500k BTI.' 25.60 Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb Required for ALL commercial permits only unit.5-1 mil BTU _ 35.00 ----�--" ----.A_ - _Y_ 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 ---------------_- --- ---__-- 11)>50HP;absorb - - unit>1.75 mll BTU 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM ----- - - - 10.00 Value Total 13)Air handling unit 10,000 CFM+ Descrl Gan: Qt Ea_ Amount 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler ducts&vents Furnace>100,000 BTU including 1,170 10.00 ducts&vents 15)Vent fan connected to a single duct Floor furnace Including vent 955 6.80 Suspended heater,wall heater or 955 16)Ventilation system not Included in floor mounted heater appliance permit 10.00 _ Vent not Included In appliance 445 17)Hood served by mechanical exhaust 10.00 jermiRepair 18)Domestic Incinerators fZe air units 805 17 40 t 3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator to 100k BTU 3-15 hp;absorb,unit, 1,700 69.9520 Other snits,including wood stoves 101 k l0 500k BTU ) g 15-30 hp;absorb.unit,501k to 1 2,310 10.00 mil.BTU 21)Gas piping one to four outlets 30-50 hp;absorb.unit, 3,400 5.40 1-1.75 mil.BTU 22)More than 4-per outlet(each) ^ _ >50 hp;absorb.unit, 5,725 1.00 >1.75 mil.BTU Minimum Permit Fee$72.50 SUBTOTAL: $ Air handling unit to 10,000 cfm _ _ 656 - -- 8°/.State Surcharge Air handling unit>10,000 cfm 1,110 g $ Vent fan connected ectad t to cooler d _ 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct_ 446 Vent system not Included In 656 appliance permit - - - Hood served by mechanical exhaust _ _ 656 Other Inspections and Fees: Domestic Incinerator 1,170 1 Inspectiuns outside of normal business hours(minimum charge-two hours) $62.50 per hour. Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-half hour) 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 Gas piping 1-4 outlets 360 charge-one-half hour)$62.50 per hour Each additional outlet 63 --- 'State Contractor Boller Certification required for units>200k BTU. TOTAL COMMERCIAL $ **Residential A/C requires site pian showing placement of unit. VALUATION: _ All New Commercial Buildings require 2 sets of plans. is\dsts\forms\mech-fees.doc 02/11/02 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639.4175 MSTINSPECTION DIVISION Business Line: (503) 639-4171 _ BLIP Received --_ _-_- -Date Requested _____ AM, PM BUP _ Location - � S S _- Suiite �� - ME6 '� 4)C) $3 Contact Person _ - el Ph(— - -) /(1=-�- PLM -- Contractor- - --- - -- - _ Ph( - - ) - -_ SWR - ---- BUILDING Tenant/Owner _ _ _ -_-- ELC Footing ELC Foundation Access: Ftg Drain ELF! _ Crawl Drain _ Slab Inspection Notes: SIT Post&Beam Shear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing -- -- ---- - - --- -- Insulation Drywall Nailing - - Firewall Fire Sprinkler - -- Fire Alarm Susp'd Ceiling -- - -- - — -- - - - - Roof Other: V - -- Final -- PASS PART FAIL PLUMBING_ Post& Beam Under Slab Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other: Final PASS_ PART FAIL MECHANICAL__ Post&Beam Rough-In Gas Line Smoke Damper; -- ----- Final vCC, PART FAiIRICAL�- Service Rough-In _— UG/Slab Low Voltage Fire Alarm Final F1 Reinspection tee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd, PASS PART FAIL SITE - n Please call for reinspection RE: __ — Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date . _ Inspector " ' __ Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF T'IGARD 24-!Hour BUILDING Inspection Line: (503)639-4175 PAST o1 — ed 33INSPECTION DIVISION Business Line: (503) 639-4171 BUP AM PM — � -- --- BUP -- - Received __—._Date Requested_ Location _ _.� t��.�._----© - Suite MEC s -.� � tP a- PLM _ Contact Person _. � Ph( ) SWR - - - -- Contractor^ _ Ph(- ) — -- ELG - ILDIM Tenant/Owner - ELC 00 Foundation Access: FLR - Ftg Drain Crawl Drain -- — SIT _ - - Slab Inspection Notes: Post&Beam ------ Shear Anchors - - Ext Sheath/Shear Int Sheath/Shear - -- - ---- — _ - Fram�ng In , )n Drywall Nailing Firewall - Fire Sprinkler Fire Alarm — Susp'd Ceiling Roof a PART FAIL -- PLU BIND Post&Beam — Under Slab Rough-In — Watet Service Sanitary Sewer - Rain Drains -' Catch Basin/Manhole -- Storm Drain Shower Pan Other: Final PASS PART FAIL MECNA CNICNI AL Post&Beam Rough-in Gas Line — Smoke Dampers -- - AS PART FAIL - Service -- Rough-In - UG/Slab - - Low Voltage -------- -- - Fir Alarm Reinspection fee of$ ____—required.�efore next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL — Unable to Inspect--no access _SITE Please call for reinspection RE: --- Fire Supply Line7'. Y Ext— ADA Dili / _ _-o T Inspector -- Approach/Sidewalk Othe•: -- DO NOT REMOVE this Inspection record from the job site. Final PASS PART FAIL