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16200 SW GRIMSON COURT r i N O O ?.a O Z n . O C r' 1 r 16200 SW CRIMSON COURT i lkiechanical Permit Application �� Datereccived: -_ Permit no: �� )-00.7 (t / Cit of Tigard and - City g PrgjecUappl.no.: Expire date: Cit of Iir;,Ir,! Address: 13125 SW Hall Blvd,Tigard.. OR 97223 �— Phone: (503) 639-4171 Date issued: By: — Receipt no.: Fax: (503) 598-1960 Case file no.: Pai ienttype: Land use approval: Building permit no.: 1 U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U"Tenant improvement U New c;unstruction LI Addition/alteration/replacement U Other: Joh address: [/ ,� '\. LS4 _LA , Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: ,Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax m_ ap/tax lotlaccount no.. profit. Value$ Lot: Block: Subdivision: *See checklist for important upplication information and Proiect na:uc: L L.�44L jurisdiction's fee schedule for residential permit fee. City/county: _c., iN,a,') JIP: sill Description and location of work on premises: wt: — bI r LA" j4% "'4 `f 3�I�;,s�S�c'b3+�.r--kms Fee(ea.) Total Est.date of complelion/inspr-: qt :,n: M-scription _- y. Res.nnly Res.only Tenant improvement or change of use: r AC- Is existing space heated or conditioned'?U Yes U No Air handling unn ---CFM--- _ Air conditioning(site,:t qn required) Is existing space insulated?U Yes U No ANei anon of extsiing RVI sysle?�m ---- otterer co�ors — — - State boiler permit no.: Business rarrte: a�k ��,,•�� A_� 4 �c �1Ar F IIP Tons BTU/II Address: _ Fr smokeoamper�o aettectors City: State: ZM ---- cat pump(sue plan req- uiredt Phone: Fax: E',-mail: Install/replace urnac urner__ BTU/ Including ductwork/vent liner U Yes U No CCB no.: nsta /rep ac re oca►eTieatcrs--suspen FF- City/metro lic.n_o.: -- -— ^_— wall,or floor mounted _ ,;3 Name(please print): Vent fora i Lance other an furnil _ c Rest un: Absorption units_ BTU/Ii Name: ('hillcrs__�__�__�__� IIP --- ---- - Com res' _ III' Address: - -- ---- - --- my ronmenta exroust an vent al on: City: _ - Stale: 71-1-P Appliance vent Phone: I a<---- 1{ nwil Dryer exTiaust-- -- --- OWNERooes,Type . ,l/res. ttc eMrnzmni hood fire suppression system Exhaust fan with single duct(hath fans) Mailing address: Exhaust systema apart ht!atm or AC _ - -- — ale prp ng.nadlstt'Ibutlou(riTp to ont ets) City: tate: ZIP: -__ Tv LPG _— N(i __ Oil Phone: I E-mail: ue i in each additional over 4 oui ets -- Process piping(sc emat c r�eq—Wre- Number of outlets Name —T _ - --- MYt R —appliance or equipment: -- - Address: Decorative fireplace State:__ Z.IP:_ -- nsert-ty - stov,pe••t stove Phone: Fax: E-mail: _ Applicant's signature: Date: O er. -- ter: Name (print): — Nd it furiedkNme accept credit cords,plena call iunsdictim fix mexe infcxin t-n i Permit fee............. .......$ U Visa ❑MasterCard I Notice:this ermitii application Minimum fee....... ........$ expires sofa permit is not obtained credit card nart.tw -._----_---___--_ .__1—L— Plan review(at —._ 9F) $ _ Expire, within Igo days after it has been State surcharge(8%) ....$ - -- Nun of cartl1wider as shown on ctedit crri accepted as complete. TOTAL . Crdholdet alparvre --- Artwont -- — 4161617(6001'OM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILi VL- Description: L-t lN� rtE SCHEDULE: -------------- -- - -- - - ---- Description: Price Tuta! TOTAL VALUATION: FEE: --- Table 1A Mechanical Code oh . (Ea) Amt $1.00 to$5 000.00Minimum fee$72.50 1) Furnace to 100,000 BTI $5,001.00 to 10,000.00 $72.50 for thr f rst$5,000.00 and- Inciudin ducts 8 vents .00 $1.52 for each additional$100.00 or 2; Furnace 100,000 BTU+- __ fraction thereof,to and including including ducts 0 vents _ 17_40 _ $10,000_00.$13) Floor Furoate 0,001.00 to�25,000.�10 $148.50 for the first$10,000.00 and Including vent 1�,00 $1.54 for each additional$100.00 or u--Q--- -- - 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$2.5,000.00 and 5) Vent not Included In appliance permit 6.80 $1.45 for each addiG-Nnal$100.00 or 6) Repair units fraction thereof,to and cluding 12 15 $_50,000.00. -up-- ___ $50,001.00 and up_ $742.00 for the first$50,000.Uu 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 belo+v._ Corn ` - 7)<3HP;absorb unit to 100K BTU _ 14 00 - FASSUMED VALUATIONS_ PER, PPLIANCE: 8)3-15 HP;absorb Value Total unit 100k to 500k BTU - 25.60 -_- Description: Ot Ea Amount 9)15-30 HP;absorb Fumace 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 8 vents 11)>50HP:absorb Floor furnace Including vent_ _ 955 unit>1.75 frill BTU I 1----_ 87.20 _- Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM floor mounted heater i _ 10.00 Vent not Included In applicence 445 i 3)',,r handling unit 10,000 CFM+ permit _- 17.20 Re air units _ - 805 14)Non-portable evor��ate cooler <3 hp;absorb.unit, 955 - 1000 to 100k BTU15)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 30 mil.BTU17)Hood served by mechanical exhaust 30.50 hp;absorb,unit, 3,400 10.0 1-1.75 frill.BTU 18)Domestic Incinerators >50 hp;absorb.unit, 5,725 17.40 - >1.75 mil.BTU --- 19)Commercial or industrial type Incinerator Alr handling unit to 10,000 cfm 658 Air handling unit>10,009 cfm - 6c'95 1,170 20)Other units,Including wood stoves Non-portable evaWlale cooler 656 _ _ _- 1.0.00 Vent fan connected to a single duct 446 21)Gas r iping one to four outRits Vent system not inHuded In 658 - -ti 40 a (lance en fit - 22)More than 4-per outlet(each) Hood served by mechanical exhaust _ 658 I 1.00 _ Domestip.Incinerator 1.170 Minimum Penult F:a$72.50 SUBTOTAL: 9 Commercial or Industrlo. incinerator 4 590 Other unit,Including wood stoves, 656 8%State Surcharge $ S Inserts,etc. -- Gas piping 1-4 outlets -_ 380 _ 25%Plan Review Fee(of subtotal) $ Each additional outlet - _ 63 Required for ALL commercial permits only TOTAL COMMERCIAL s TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION:-- _ _1 --- ---- -- ---- Otherinspectlons and Fees: 1 Inspections outside of normal business hours(minimum charge-two hours) $72 50 per hour 2 Inspections for which no fee is specifically Indicated (minimum charge•hatf hour; $72 50 per hour 3 Add florist pian review required by Oianges,additions or revisions to plans(-nlnimum chwgeone half hour)$72 50 per Maur "State Contractor Boller Certificiticm required lot units>200k BTU. "Residential A/C requires site clan showing pincement of unit. i:\dsts\formsVmek;l dees.doc 10/11/00 CITY C F TI G I R D MECHANICAL DEVELOPMENT SERVICES PERMIT 13125 SW Hall Blvd.,Tigard,OR 97223(503)639.4171 PERMIT #. . . . . . . : MEC98--0488 DATE Icj'—)UED: 10/30/98 PARCEL: 2SI14BA-01500 SITE ADDRESS. 16c..100 SW GRIMSON CT SUBDIVISION. . . . : PICKS LANDING N0. 2 ZONING: R-4. 5 BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . : two JURISDICTION: TIG CLASS OF WORK. . :ALT FLOOR FURN. 0 EVAP COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :R3 VENTS W/O APDL : 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRFS50R5 HOODS. . . . . . . : 0 FUEL TYPES---------------- 0-3 HP. . . . 0 DOMES. INC IN- 0 .GPS 3-15 HP. . . . : 0 COMML. INCIN: 0 MAY INPUT: 0 IATU 15-30 HP. . . . : 0 REPAIR UNITS: 0 FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . .- 50+ HP. . . . : 0 CLO DRYERS. . - 0 NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : 1 FURN ( 100K STU: 0 10000 Cfm: 0 GAS OUTLETS. : I rURN ) =100K BTU: 0 > 1.0000 cfm : 0 Remarks - gas fireplace and piping Owner--.- --------- -------- FEES —--------- JOAN CLINE type amrLint by date rer-pt 16200 SW CRIMSON CT PRMT $ 25. 00 B 10/30/98 98-310433 25 B 10/30/98 98-310433 TIGARD OR 97224 5PCT V'hone #: Contractor: ADVANCED HEATING & OIR COND. 6918 SE 48TH $ 26. 25 TOTAL PORTLAND OR 97206 Phone #: 235--0060 Reg #. . : 000985 REQUIRFr) TNqpFrT1,11N5) This pereit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical I n s p applicable laws. All work will be lore in accordance with Final Inspection apprcyed plops. This pervit will expire if work is not started within IN days of issuance, or if work is suspended for vore than IN dabs. AITENTION: Oregon law requires you to follow rules adopted by the Negon Utility Notification Center. Those rules are spt forth in OAR 952-MI-NIO through OAR 952-081-M. You say obtain copies of these rules or direct questions to OLK by calling (583)246-9187. ....... Iss,-1 e Permittee Signati-tre : D 4-+-4-+'!'+++ +++++..++++++++++aV............4-++.4...............+++ ....... Call �394175 by 7:00 p. m. for inspections needed the next b%tsiness day ............ I ..............4...+++4..............4,++++4......... +++++++++,+,++ Plan Check# CIT"r OF TIGARD Mechanical Permit ApplicaY IVED Recd By R�_ _ 13125 SW HALL BLVD. RECEIVED Coma ercial and Residential Date Recd . TIGARD, OR 97223 OCT 2 6 1998 Date to P.E. Date to DST (505) 639-417'x, X304 l `� ��5 liC Print or Type COMMUNITY 11FVF1.0Pr'FNl Permit#PAC L Iricomplete or illegible applications will not be -iccepted Galled -- N�mu of Development/Project Descnptiun Table 1A Mechanical Code CITY PRICE AM r Job 9troet Address Sudety A) Permit Fee -0- -0- 10.00 Address AU � <% r . Badge Clr -'cats �` Zip ,.) Furnace to 100,000 BTU 600 including ducts 8 vents _ Nome(or name of business) 2.) Furnace 100,000 BTU+ 7.50 Owner • Y � /` including duds a vents Moiling Aduress _ 3) Floor Furnace +— 6.00 including vent _ atytstate Zip Phone 4.) Suspended heater,well heater i 6.00 or floor mounted heater __ Name( m business) 5) Vent not included in appliance permit 3.00 OCciipant Mailing Ada 6) Boder or comp,heat pump,air c,ona. 6.00 _ to 3 HP;absorb uni.to 100K BUT" _ cdyts a 21p Phone 7) Boder nr comp,heat pump,air cond 11.00 3-15 HP;abso,'j unit to 500K BTU" Contractor Name 8) Boder or comp,heat pump,air Gond. 15.00 15-30 HP absorb urit.5-1 mil BTU" Prior to permit Mailing Address 9) Boiler or comp,heat pump,air Gond. 22.50 issuance,a cop., C N �. 30-50 HP',absorb unit 1-1.75mil BTU" of all licenses ttytstale Zip Phone 10) Boder or crimp,heat pump,air crud 37 SC are required if 1 � I >50 HP;absorb unit 1.75 mil BTU'" _ expired in COT 0 on ones.Cont.Board ic.N (Exp.Date 11.) Air handling unit to 10,L00 CFM 4 50 database Architect Nome 12) Air handling unit 750 _ 10,000 CTIA+ _ or Mailing Adcress 13) Non-portable evaporate cooler 4 50 Engineer t;itYtsfate Zip Phone 14) Vent fan connected to a single dud 300 Describe work Newt Addition O Alteration O Repair 15) Ventilation system not included 450 to be done _Residen tal O Non-residential Oin appliance permit Additional Description of work — 16.) Hood served by mechanical exhaust 4 50 - 7) Domestic incinerators — 7.50 Existing use of16 1 Commercial or industrial 3000 budding or property _incinerator tr ) nepair units 4,50 --� Proposed usa of / / ,0.) Wood stove \ �� 1 4.50 l l building or property ___ Ce \ I 21 ) Clothes dryer,etc. 4 50 Type of fuel-oil O natural gas LPG O electric O .22) Other units 450 I hereby acknoedge that I have read this application,that the information 23) Gas piping one to four cutlets ( 2 90 wl given is correct,that I am the owner or authorized agent of � 0 (10 tha caner,that plans submitted,a Ti pliance with Oregon State I 24) More than 4-per outlet(each) li STgnature of Owner/Agent Date 'SUBTOTAL *1 LD l < 5°16 SURCHARGE � 1 Contact Person Name Phone PLAN REVIEW 25016 OF SUBTOTAL Required for all commercial permits only. .• -- --- TOTAL --' �*Minimum permit fee is 425+59,6 surcharge "Residentiai A/C requires site plan show-r;placement of un,t 1 lmechpnnt doc rev 4/15/98 r CITY CSF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM98-040P, 13125 SW Hall Blvd., Tigard,OR 91223(503)639-4171 DATE ISSUED: 10/30/98 PARCEL.- 2SI14BA--.01500 SITE ADDRESS. . . : 16200 SW GRIMSON CT SUBDIVISION. . . . : PICKS LANDING NO. 2 ZONING: R-4. 5 BLOCV. . . . . . . . . . : LOT. . . . . . . . . . . . . : 124 JURISDICTION: TIG CLASS OF' WORK. . :AL.T GARBAGE DISPOSALS. : 0 MOBILE -COME SPACES. : 0 TYPE OF LJSE. , . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 1lt STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0 FIXTURES--------.----_-. LALJ14DRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . e 0 URINALS. . 0 GREASE TRAP'S. . . . . . . . 0 1 AVATORIES. . . . 0 OTHER FIXTURES. . . . :' * " — — 0 TUB/SHOWERS...: 0 SEWER LINE (ft ) . . . : 0 WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : water heater conversion Owner: ------ -------------------------------------------------- FEES JOAN CLINE type amount by date recpt 16200 SW GRIMSON CT PRMT $ 25. 00 B 10/30/98 98-310433 TTPrARD OR 97224 `SPC-1 $ 1. 25 B 10/30/98 98-310433 Phone #: JIM' S PLUMBING PO BOX 7160 ALOHA OR 97007 ------------- Phone #-. 649-40311 1 26. 25 TOTAL Reg #. . : 71.860 REQUIRED INSPECTIONS ...... This pewit is issued subject to the regulations contained in the Mi 5'r.-. Inspection Tigard Municipal Code, State of Ore, Specialty Codes and all other Final Inspection applicable laws. All work will be done in accordance with approved plans. This pervit will eupire if work is not started within 180 days of issuance, or if work i� suspended for wore ....... than 180 days. ATTENTION: Oregon law requires you to follow rules ........ adopted by the Cregon Utility Notification Center. Those rules art, set forth in OAR 952-000I-0010 through rAR 952-000I-0080. You P, obtain copies of these rules or direct questions to OUNC by calling (563)246-1987. 1 s s u e d B y : �lti��► _''-_. C e r m i t t e e f i i n gat�.�r e : u G ( !y1__� _�.._ ......... L-4-++4.......4-4++4-++4......................................++A++ +++ Call 639-4175 by 7:00 p. m. for an inspection needed the next business day, ........4•........4................................4-++++4..........4................4 CITY OF TIGARD Plumbing Permit Application rlan Cb,!ck f -131SW HALL BLVD. Commercial and Residentia! RECEIVED Rec'd 8, Y,0,j TIGARD, OR 97223 Date Recd (503) 1,339-4171 OCT 2 C 19,)>, Date to h.E. Print or Type Date to DS _ Incomplete or illegible applications will nt1•'l b'ftd*pted Permitsill, Related SWR Coiled - blame o1 Deve7opment/Pro(ed dl _ MA IM Job Sink 9.00 Address street Address sulfa v Lavatory 9.00 66 1 Tib Tub or Tub/Shower Comb. -ti•� Bldg!g ZR ` Shr er Only ./.00 - c V.Aar goset 9.00 Name Disfnrasher Owner Mailing Address sults Garbage Disposal ,---_-�_-_ 9.00- P310 /State Zip Phots Fbor�D�ralNFloor Sink 2' -- -- -- - — 0.00 -- 3' ---- 9.00 - 4' e.CO Occupant MaDing yL SuIN water►lector 74,t rsk n O like kind i +� 9.00 - t Gas piping requlrbe ase art:, mocharrcal It. _ __�_.—_—_.—__fin CHy/ to Pion Laundry Room Tray -- —Y4_Y 9.00 Urthal 9.00 NimeOMer Fbdures(Specify) ---- - 9.00 9.0n ContractorManing Address _ s �-------�.—__ — -- I LD Prior to permit City/Sta Zip Phww Geyer-1st 100' 30W issuance,a copyj l l Sewer-each addHional 100' y 25.00 of ali licenses aro Oraq m Coro Exp.ate t/yater Service-1st 100' - 3(1.00 reqs d ' I` c - expked in COT Plumbing S Data Water Service-each additional 2�0' _ 25.00 database ► .� Stone 6 Rain Rain-1st 100' 30.00 Name Stone 6 Rain Drain-each additional 100' 25.00 Ar(:hltect Mobtie Home Space -- 25.00 or Msnhhp Address &une Commercial Back FMw Prevention Device or Anti- 2500 PWJc,n Device Engineer CHymate 71P Phone Residential BaCdiryw Orevrntlon Device' — 15.00 onigation tlmftV devices require a separate r[ratrtded eueryy nnH.) _ work to - Naar` Repair O Replace with Ike kkA Yrs O No O Any Trap tx Waste Not Gorunocted to a Flxlure - 9.0 NMI '' Cornmerdsl O Gatdr Basin 9.00 Additional 06scription of work: Irisp of F_xtatlng Plumbing 40.00 parMr Specialty Requested Inspections -- �- 40.00 - _ Rats Draln,;kV a family dwe h g 30.00 M1 Are you capping,mooting or replartg any fixtures Grease Traps ~�- 9.00 —7 Yes OI No � _ If yes,see back of form to Indic to work performed by -- QUANTITY TOTAL fixture. FAJLURE TO ACCURATELY REPORT FIXTURE Ls.xrwW.or riser d m b required II ou_s_n,ly Total Is >a WORK COULD RESULT IN INCREASED SEWER FEES. 'S JOTOTAL I hereby scknowledge Chat I have rear)this application,that the Inform Mlon -- ghron Is coned.that I am the owner or authorized agent of the owner,and 5%SURCHARGE that laru sublydtted ere In compliance with tJregan Siete taws. signature of OwnerfAgont Data "PLAN REVIEW 20: OF SUSTOTAL A 0V_1 ed only f axon+9iy tow Is>9 -TOTAL ��4 � Contact Person Name Phone _i- — -_. 'Minimum permit fee Is$25+596 surcharge,exce1,4esidential aackflow t19-y Prevention device,wtach Is$15+ �%sur Charge — **All Now Commercial Buildings re4.�re plans w'rh isometric or riser diagram and pian review r hesrs�ou<ttsvn.dss f?11! -nn Ah mttr� t in t t t nnr. t cr.r t•rrr �t t t t r•t t rt oc n- at CITYOF TIGARD PLUMBING PERMIT — DEVEL0PMENT SER EJ PERMIT#: PI_M2003-007.56 13125 SW Hall BIN,,i., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/13/03 SITE ADDRESS: 16200 SW GRIMSON CT PARCEL: 2S114BA-01500 SUBDIVISION: PICKS LANDING N0.2 ZONING: R-4.5 BLOCK: LOT: 124 JURISDICTION: TIG CLASS OF WOW': OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPF OF USE: SF WASHING MACH: BACKFLOW PREVN 7RS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TI'B/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of irrigation backflow preventer. _ --� — �— Owner: ---FEES—_-_—e_ -- Description Date Amount CLINE, JOAN U -- - --� — -- 16200 SW GRIMSON CT i i l'L I AIII I Permit I ec 6/13/03 $3o,25 TIGARD. OR 97223 IA 811.,Sfaf' l ay 6/13/03 $2.90 Total $39.15 _ Phone Contractor: M J'S PLUMBING 1045 NE 79TH PORTLAND, OR 97213 REQUIRED INSPECTIONS Phone : 503-261-9155 RP/Backflow Preventer Final Inspection Reg #: LIC 36338 PL.M 26-592PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spec�alty 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 i" Is Led By: 0 �: Permittee Signature- ��. Call (503) 639-4175 by 7:00 P.M. for an inspection needed t e next bus ess day la C1B :If�a Mike LeFeuer 5032523475 p. I .JO8/03r)i•-JJuFdA722J892 SCO77S LANDSC E X01. (Jing.gmbi�nQ Permit A li.c R on ` occirad urrtbin DauIJBY Permlt lYo.:;<•//:v City of TigardPlwlinaA,— 1 --- s. __.___------ Dtor/Bi Pcamh No.: 13125 SW FEW B1vtL 1------ pim Pzvict, ot>tor Tigard,Oregon 97223 -Phone- S03-639.4171 lase: 503-598 1960 N�•t- aW f I�,d Us* Imetner. www.cl.d ardor.us — n' _y i,:`w'. 8 Contact 29 Sm Pap 7 fir 24-how Inspection Request: 501.63'-417' NarnoMed,ud. savnlc11•fermatio.. I I New commliction_ _ T�. h tion FMS) Twl Addition/alwatiolol—Iaccrlleflt l A2-iamil dwellin Commerci 1/Induetrial SFRt1 both __ 1A4I0 y -_ — .�._� SFR 2 bath ctsso�r BuildingMultrF I _ sFR 3 bath I " 399.110 Master'Builder OP}ltr: Eacb`addilliori4 bmWtchen 45.00 - i F;re avrinklict 4 sa.1L Plie Jab site address Suitt#: _—_ Bldg/A4Rt.#: CaWA btuLd a tiriia __ _ _16.60 Pro`xt Name: eWloach inehntteh l6sio 16.60 Fooee dFain o.linear RZ-- 1 2 Cross Brmt(Diwmembaon io job site: -__- - Manuhcntre_d onto uulitlw 110.00 Manholes -- _ 1660 Rain dn co Cesar 16.60 Smitsty sl w �oTlinear R. Page 1 Subdivision: _ !— __- — at#: Storm se-wa Wo.Near fL1__-- I put 2 -- Telt tna fel#: Wats tletvice no. inear It. Page:2 16.60 _ —"_ t 1jaClr}10W CVi:t]tef P 2 8ackwatar�iral re -� 16.60 --- - Clothes washer -- — 16.60 _- -. ___._ — -- ----- 1 Dishwasher 1 16.60 bri founWr - _ 16.60 16.60 Name: �(1dleBS_�Iast,O �1 Ff_xlurtlro,ver cap-- - 16.60 - -- Floordraitt/tloor sink/hub 16.60 - -- --- --_ G Rol 16.60 Photie: VAX: Hose bib _ 16.60 V_ k ioC Wsker 1660Inme�orttwe� 6�� ^. Medical -valur._3- N 2L.11\'/�eO 0/zi -l`r __ �rr1� It� ' ��i-�-- It n0�ti1E111 COQM>lT6Ral 1 fi.60 P3cate: avar r��_ sinwea�Ntavetn�r r 16:60 H�ttli;r Tub1showei/showery _ 16.60 - ..7 Urinal _ 16.60 rBuisitwis Name: �•j_fes .. Water Closet - 16.60 - rl �,>>�� Address: L�`/ S ,�' t._? -'� oth fbtaler - - 16A0 Other -- i Phone: Fax' '? 'i. .1 1 IF' CCD L.ie.1IVV: %s'� lumbJ Lia. „�'c�Si�f'E1 —_- Mininimperndtree s 2.6 S___ Authorised 1RaWeritAl eacldlow Kn Fee S361S I Siarlaram: I"-�,r / L `�; t _ �,��`G j' _ _ _Plot Revievr125St trl'PetrrUl�ae f l•'r�:�� :/'�'a i°O ___— Stele Surcharge(9Yi erPertnit l a S r�r�t� (Ilene printnsnrN j TOTAL PERMIT ME M Natke- TMs partnit eppllgtiett etPtnH p a a rtrtit is sal blaisew tritbis All new carotn�-cid beAdirt�e"Ire 2 wo*I p la►•-c#►;w w4ris or Iso days filer It bet born sccepad as 4vaspleta I Meer dlagram h, Id■e Icier. i\n.i&vttml,i'antnV'It7I'rrtNtApq da al/03 I 1� �t,ci'ee wethodobg set by TrWoonty nnlldiat IndustryStrla Board. CITY OF TIGARD 24-Hour BUILDING Inspection Line: (603)639-41;5 INSPECTION DIVISION Business Line: (503) 639-4171 MST SUP Received ----Date Requested—_ _� -_ — AM PM __�__ ___ BUP _ Location -- U n ]_ Suite MEC 7 Contact Person 3 Ph PLM Contractor—_� - _ Ph(_ ) SWR ._ BUILDING Tenant/Owner —__--- _ ELC -_ FootingELC Foundation Access' �� Drain ELR Cr Crawl Drain Slab Inspection"Notes: r SIT Post& Beam Shear Anchors Ext Sheath/Shear Int Shet,th'Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler _._-- Fire Alarm Susp'd Cyiling -- - -- -- -- - ---.�- Roof % Other: - - Final PASS PART FAIT - PLUMBING Post 8 Beam --A- _ -- ---- Under Slab Rough-In Water Service Sanitary Sewer Rain Drains — — Catch Basin/Manhole Storm Drain - - Shower Par. Other: - A S_PART FAIL HANICAL Post& Beam - Rough-In Cas Line Smoke Dampers Final PASS PART FAIL - - - - - - - ELECTRICAL Se Ace --._ Rough-In UG/Slab ---- Low Voltage — Fire Alarm -- — — Final LJ Reinspection fee of o— required before next Inspection. Fay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE __ [� Please call for reinspection RE: - Unable to inspect-no access -Fire Supply Line C,DA Date/,nnroach/Sidewalk Di --- Inspedor 2 Ext Other: Fina DO NOT REMOVE this Inspection record from the job site. PA`;S PART FAIL ori CITY OF TIGARD BUILDING INSPEr•TION DIVISION MST �OC� �C 3�� 24-Hour Inspection Line: 639-4175 Btusiness Line: 639-4171 BLIP Date Requested_' '_ _._AM —_PM 13L.D Location_ ZU . 1-�-'� Suite _ MEC Contact Person Ph 3— J �-f `_�� PLM _ r Contractor n` [ �_�_ r�, `�-d. �= c Ph _ SWR BUILDING Tenant/Owner ELC Retaining Wall v- ELR _ Footing Access: Foundation .I i FPS Ftg Drain _ Crawl Drain Inspection Notes: SGN Slab - --- ----�- ---- --- SIT Post& Beam - Ext Sheath/Shear Int Sheath/Shear - --- Framing - --- Insulation Drywall Nailing _ --. ------------_ __ Firewall Fire Sprinkler ,_-- Fire Alarm j Susp'd Ceiling —� - -- -- -- -- - Roof I \ -- Final PART FAIL ------ PLUMBING Post& NPS n -__--- ------- — Under Slab Top Out Water Service Sanitary Sewer - Drains Fi S PART FAIL M IANICAL. _ Post & Ream -- — Rough In Gas Line --- ------ - �CF. Dampers FinhRICAL -- -..- _-- -- --- - > PART FAIL Service Rough In UG/Slab - Low Voltage Fire . arm ---------------- --------- C. PARTFAIL -- --- - --- - - -- ----__—_.�._+___--�- - SI �. Backfill/Gr ading -- -- ---- - -- -- -- Sanitary Sewer Storrn Drain [ 'Reinspection fee of$ _ �-required berore next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ]Blease call for reinspection RE [ [ Unabie to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date Inspector J�_--��-- ---Ext Other - --- 17-inal PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RECEIVED OREGON CITY PLUMBING 611 7TH ST CC4"AIlN11Y pFVFLIIr'NiFNi OREGON CITY, OR 97045 Plumbing Signature Form Permit #: MST2001-00341 Date I.3sued: 6/27/01 Parcel: 2S114BA-01500 Site Address: 16200 SW CRIMSON CT Subdivision: PICKS LA14DING NO.2 Block: Lot: 124 Jurisdiction: TIG Zoning: R-4.5 Remarks: 414 sq.ft. living room addition and kitchen remodel. Your company has Doan indicated as the plumbing contractor for the permit indicated above. In order for the plumbing perm't to be valid, please have the appropriate individual fron, your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, AT1N: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER. PLUMBING CONTRACTOR: CLINE, JOAN D OREGON CITY PLUMBING 16200 SW GRIMSON CT 611 7TH ST TIGARD, OR 97223 OREGON CITY, OR 97045 Phone #: Phone #: 656-8556 Reg #: I If: 0002132 PI M 3-20PB AN INK SIGNATURE IS REQUIRED ON THIS FORM W, A � - Signature of Authorized plumber If you have any questions, please call (503) 639-4171, ext. # ?10 CITY OF TIGARD 13125 S,W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE TUALATIN ELECTRIC PO BOX 655 WILSONVILLE, OR 97070 Electrical Signature f=orm Permit #: MST2001-00341 Date Issued: 6/27/01 Parcel. 2S114BA-01500 Site Address: 16200 SW GRIMSON CT Subdivision: PICKS LANDING NO.2 Block: Lot: 124 Jurisdiction: TIG Zoning: R-4.5 Remarks: 414 sq.ft. living rccm addition and kitchen remodel. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the super✓isinq electrician is required Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, A1TN: Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICA.I_ CONTRACTOP: CLINE, JOAN D 'TUALATIN ELECTRIC 16200 SW GRIMSON CT PO BOX 655 TIGARD, OR 97223 WILSONVIL LE, OR 97070 Phone #: Phone #: 6d2-2955 Req It. LIC 00065650 SUN 3483S ELE 3-2680 AN INK SIGNATURE IS REQUIRcd ON THIS FORM ,l f- 1 Signature of S ervising Electrician If you have any questions, please call (503) 635-4171, ext. # 310 CITY OF TIGARD BUILD;N!', INSPECTION DIVISION MST I-Hour Inspection Line: 639-41,75 Business Line: 639-4171BUP Date Requr�sted - AM PM _ BLD LocationSuite EC Contact Person _ Ph PLM ContractorTj ,L� SWR [BUILDING Te,tant/Ov:mer ELC Retaining Wall ELR __ Footing Access: ^ FPS Foundation Ftg Drain I�C! /) ; /1jrN Q �(cJ �' - M111 -- �C w��`- SGN _ Crawl Drain Inspection Notes: Slab SIT _ Post& Beam �� C, Fxt Sheath/Shear - Int Sheath/Shear Framing -- - - ------ - Insulatio., Drywall Naain9 --- ------- ---- - - - Firewall F=ire;Sprit ikler --_- --.--.--------------- -- --- -- — Fire Alarrn S,usp'd C-iiling ----- ---- - - - -� Roof Misc: _ ---- ------ --- - --------- Final PASS PART FAIL -- -_ — _--- - PLUMBING Post&[learn i Under Slab 'fop Out - --- -----------._...------------ ---____ Water SevicP - ---- ---- ---- --- _- -- - - Sanitary Sewer Rain Drains ---- ----------- - ---- --- ----- Flmnl PASST FAIL __ --- CHAN CAL Past8 Beam ------- ------- .-------------------------------- -_-._.-___ _-- Rough In (was Line --- ----- -- ---- ---------- -- Smoke Dampers PA PART FAIL EL TRICAL Service - ----.._ ---- -- - - - ----- ----- Rough In — - - UG/Slab - --- ---._- ---- ---- ----- -- -- I r-.. Voltage Fre Alarm - - -------- - --------- Final PASS PART FAIL ---._�__.-_---- - --- ------ ------ - - --- SITE ----- -- --- — --- - Backfill/Grading -- Sanitary Sewer Storm Drain ( ]Reinspection fee of$----_-_required before ne)•1 inspection. Pay at City Hall, 13125 SW Hall Blod Catch Basin ( ] Please call for reinspection RF.-_--__ -_---- __--_ ( ]Unable to inspect- no access Fire Supply line ADA / Approach!Sidewalk �- Date Inspector �` _Ext Other - Final PASS PART FAIL. DO NOT RE�WOVE this Inspect!on record from the job site. MASTE ERMIT CITY OF TIGARD PERMIT : MST2 PERMIT#: MST2001-00341 DEVELOPMENT SERVICES DATE ISSUED: 6/27/01 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 16200 SW GRIMSON CT PARCEL: 2S114BA-01500 SUBDIVISION: PICKS LANDING NO.2 ZONING: R-4.5 BLOCK: LOT: 124 JURISDICTION: TIG REMARKS: 414 sq.ft. living room additicn and kitchen remodel. BUILDING — REISSUE: STORIES: I FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 CIRST. 414 of BASEMENT. at LEFT. SMOKE DETECTORS. TYPE OF USE: SF FLOOR LOAD: 40 SECOND: if GARAGE if FRONT: PARKING SPACES TYPL OF CONST: 5N DWELLING UNITS: FINBSMENT: if RIGHT: VALUE: S 35J:D Zu OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 414.00 if REAR: _ PWMBING _N - _.._ TRAPS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS RAIN DRAIN: LAVATORIES: DISHWASHERS: 1 FI.00R DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH DA:;INS• TUBISHOWERS: GARBAGE DISP: I WATER HEATERS: WATER LINES: DC,KFLW PREVNTR: GREASErRAPS: OTHER FIXTURES, MECHANICAL FUEL TYPES r'IRN<100K: BOIL/CMP<3HP: VENT FANS: 3 CLOTHES DRYER: FURN> 100K: I UNIT HEATERS: HOODS, OTHER UNITS. MAX INP. hw FLOORFURNANCES: VENTS: WOODSTOVES. GAS nLITLETS: ELECTRICAL -- MISCELLANEOUS ADD'L INSPECTIONS RESIDENTIAL UNIT SERVICE FEEDER _TEMP 1,RVC/FEEDERS BRANCH CIRCUITS 1000 SF OR LESS: 0 200 amp: I 0 200 amp: W/SVC OH FOR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L SOOSF: 20' 400 amp'. 201 409 amp: 1st WIO SVCIFDR: SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 800 amp: 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT. MANU HMISVCIFDR: 601 1000 amp: 801+amp+•1000v: MINOR LABEL. 1000+amp/Voll: PLAN REVIEW SECTION Reconnect only -4 RES UNITS: SVCIFDR>425 A: >600 V NOMINAL: CLS AREA/SPC OCC,: ELECTRICAL•RESTRICI ELI ENERGY _ B.COMMERCIAL A.SF RESIDENTIAL __ �� AUDIO&STEREO VACUUM SYSTEM. AUDIO&STEREO. FIRE ALARM: INTERCOMIPAGING•. OUTDOOR SC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE VE SIGNL. CARAGE OPENER CLOCK. INSTRUMENTATION: MEDICAL: OTHR: HVAC DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: TOTAL FEES: $ 930.36 Owner: Contractor: This permit is subject to the regulations contained in In, CLINE, JOAN D NEIL KELLY CO Tigard Municipal Code State of OR Specialty Codes and 16200 SW GRIMSON CT 804 N ALBERTA ST all other applicable laws. All work will be done in TIGARD,OR 97223 PORTLAND,OR 97217 accordance with approved plans This permit v,,;:_-(sire If work is not started within 180 days of issuance,cr if the work is suspended for more than 180 days ATTENTION Pho„e: Phone: Oregon law re�luires you to follow rules adopted by the Oregon Utility tjotification Center Those rules are set Rep C HC 001663 forth in OAR 952-001-0010 through 952-001-0080 You may btain copies of these rules or direct questions to OUNC by calling(503)246-1987 REQUIRED INSPECTIONS F g Insp Crawl DiaiNtTackwater Electrical Service Insulation Insp Final inspectlon ation Insp Footing/Foundation Dr; Electrical Rough In Rain drain Insp Post/Beam Structural PLM/Underfloor Framing Insp Electrical Final Post/Beam Mechanica Mechanical Insp Exterior Shualhiny Insl Mechanical Final Underfloor insulation Plumb Top Out Low Voltage Plumb Final j Issued By e`_ Permittee Signature '�' ��' — Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day Building Pernnit Application - � Dale received ;/"',/(S Permit no.:N,I 1 City of Tigard I'rojecVappl.no.: 8xptrc date: Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960VU Case file no.: Payment type: Land use approval: 6�lscq' 9i 9 1&2 family:Simple Complex: _ x`] I &2 family dwelling or accessory U Commercial/industrial U Mulu 1;11110v U Now constniction U Demolition Additi:rn/alleration/repiacrment U'I'euam improvement U 1.11t, tiltrinkl r/,Hann U 011ier: _ _-- Job address: 6f A.!�1�1.. , i� 14t,y j 131dg. no_ Suite no.: Lot: Blor:k: Sulxlivisioil: Tax ma /tax lot/account no.: 0 F/ ---- L� /14 G i f' - map/tax I I — (_C Project name: ' / Description and location of work on premr;es/special conditions: bUtuo, _ i f�� c�` 1- �ASe Name: Mailing address: its 2L["_ ytaa- c-`i , 7Valual family dwellinCity: ' Slatc:ct, ZIP: 1Lion of w(rrk........, ..77.Z.. .......... $Phone:.. 24 Fax: E-mail: o.of bednxims/baths................................. Owner's representative: _ S 'Total number of floors................................. _ Phone: Fax f?- tail: New dwelling;area(sq.ft.) ........................e? __ c Garage/carport area(sq.ft.)......................... N;une: l a Covered porch area(sq.ft.) ......................... Mailing C � -i� Deck arca(sq. ft.) ........................................ g address: -- r City: g <tale:e 7.IP: c, Oilier structure area(sq.ft.)......................... Phone: l Z - ('ommerciaUindustrial/multi-family: Fax: Valuation of work........................................ $_ Existing bldg.area(sq.ft.) .......................... _—_------ 7�Ii_,L : �Ll_ �t.1. _ --- New bldg.area(sq.ft.) ................................ rT f.1- A tail��_ — Number of stories ............................ ........... M State:Cf� Z1P:f -'--- 'Type of construction.................................... ---_ - Phone: Z ¢' ]�{4. Fax: L .L E-mail: _ Occupancy group(s): Existing: -- -_. CCB no.: S.S_r{Ji -'v -- �r New: City/metro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in the Address: < ;�� jurisdiction where work is being performed.If the applicant is -- - exempt from licensing,the following reason applies: City' ►�Atr,t j Stale: &ik I ZIP: Il Contact person: tr�p, l �`,�c, Plan no.: -- Phone: Fax: I E-mail: — Name: JC.onlact person: Fees due upon application $- L_L6 1 Address: Date received: _— City: - State zlI': Amount received ......................................... E - mail --- Please refer to fee schedule. Phone: lf`ax� 1 hereby certify 1 have read and exp mined this application and the Noi all jurisdictions wcepl nedii cards,preys call juwdi--:im for rr(xe infortnatim. attached checklist. All provisions of jaws an otdinances governing this U visa U MasterCard work will be complied with,whe'A f d herein or not. Credit cord numtKn--- --------- Expires Authorized signature: i•• _ Date: �� Nine�r cardtnulder .Hewn nn smart card S Print name: ''ii M _ I_ sec ,tom CzdWder siywure ---- Anmnt Notice:1llis permit application expires if a permit is not obtained within 180 days after it has been accepted as complete 440461.4(M)WOM) i n One- and'Two-Family Dwelling _� Building Permit Application Checklist 12eferenceno.: Associated perry its: Cityn/l,t;u»d City of Tigard J Electrical U Plumbing U Mechanical Addn•�,, 13125 SW Hall Blvd,Tigard,OR 97223 ❑Othee _ �_ __ Phone: 1503) 639-4171 Fax: (503) 598-1960 THE.FOLLOWING 1,11 IIS ARE REQUIRED FOR PLAN Rl:%I 1 11 MM I Land_use actions completed.See jurisdiction criteria for concurrent review,_. No 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plot/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 Agnature on file or with application. 9 Erosion control U plan U peuuit tequired. Include drainage-way protection,silt fence design and location of catch-basin protection,etc_ ___ t J_ 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-sire sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed il'copyrighl violations exist. I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions; atio ro?%X corner elevns(il' i there is more than a 4-I1,elevation differential,plan must shcaw contour lu,rti;a 211.interva s);location o -vatic _ f easemenLs and driveway;to ogrrint ol'structure(including decks);location of we115/septic systems;utililyTiations;direction indicator;lot area;building coverage tura;percentage of coverage;imperviousarca;rca;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,veal size and location. _ 13 Floor plans.Show all d...iensions,room identification,window sire,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 sires and spacing such as floor h ams,headers,joists,sub-floor, wall construction,roof cow4ruction. More than one cross section may be required to clearly portray construction.Show details of all wall and rOOI sheadiing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc, 1.5 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and cnuodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. 1-ull-sire sheet addendums showing foundation elevations with cross references are acceptable. I6 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;l'or nun-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/root framing. Provide plans for all floors/roof assemblies,indicating member siring,spacing,and hearing locations.Show attic venti,alion. 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:urrent code design values for all beasts and multiple joists Ove, 1i)feet lung amUor any loam/joist carrying a nun-uniform loud. - 2( 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,1 shear wall,roof truss)shall bar stamped by an engineer or mchuect licen�cd in Orepon and shall toe shown tO he:y,l,lac,ihlc to the 11WILTI under revit'% . 21 live(5)site plans are required for Item 1 I above. Site plans must lx M 1/2" s I I'm I I" v 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. 26 No rolled,reversed or mirrored building plans will be accepted. 27 --- - - - - - --- 28 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. 4424614 aMUCOM, Plumbing Permit Application City of Tigard�+ Date received: Pcnnitno.: � Sewer permit no.: Building permit no.: Address: 13125 SW Hpll Blvd.'I'igard,OR 97223 -- Ciry of Tigard Phone: (503) 639-4171 Project/appl.no.:v � Expire date: Fnx: (503) 598-1960 Date issued: By: Receipt no - Land use approval: _ — Case file no.: -- Payment type: U I &2 family dwelling or accessory U Commercial/industrial U Multi-family O Tenant improvement U New construction U Additicnl/alteration/replacement U Food service U Other: - _- Job address: r r Descrl on . Fee(ea.) Total ��=� -5- `- '' '�-1 -�- New 1-and 2-family dwellings only: Bldg.no.: _ I Suite no.: _ /lax lot/account no.: - (Includes IOOtt.for each utility contredlon) Tax map/tax P — SFR(1)bath_ Lot: -_ Block: Subdivision:--�_- SFR(2)hath - -- Project name:�- �I� SFR(3)bath - City/co-inty: •r LL,.,[k.N ZIP: �� ;�,- Each additional hath/kitchen Description and location of work on prew ki es: w� N_"!O� Sheutillties: _Catch basin/area drain Est.date of con Ietion/inspection: — Drywells/leach line/trench drain _ Footing drain(no. lin. ft.) _ Manufactured home utilities Business name: c� ��-t,.(/� C �--t, l-L, ^'a��r M:r_iholcs - - Address_ L_ Rain drai-i connector - City:�,,i, f-,(_dk State:ck; ZIP: C1-1 Sanitary sewer(no. lin.ft.) Phone:�,5i,; -iG,r, Fax: E-mail: Stomi sewer(no. lin. It.) CCB no.:J �_, Plumb.bus.reg.no:S-;).o '� Water service(no.lin. ft.) City/metro lic.no.: Fixture or item: Absorption valve Contractor's representative signature: _ - Back flow reventer Print name. al(V: Backwater valve _ Basins/lavatory - �� — _ Clothes wnshcr Name: _ Address: _nitihwatiher -_ _.L �--1--=� I)sinking fountain(s) City:C< ',kG` State: ,G 71P: C ` Ejector%/sump-- -- _ Phone:I, Fax: E-mail: Expansion tank - Fixture/sewer cap Name(print): � Floor drains/floor sinks/hub �- Garbage disposal Mailing address: L c - - r - - _ I:_� _Hose Bibb State: Vis, 7_IP: tL `� Ice maker Ph( E-mail: Inlerceptor/grease trap Owner installationAesidential maintenance only: The actual installation Printer(s) will he made by me or the maintenance and repair made by my regular Roof drain(commercial) _ employee on the properly I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ Owner's signature: Date: _ Sump 'puhs/shower/shower pan Urinal _ Name: ----- -- _-- - Water closet -- Addrrss: Water heater _ City: -v_---- State: zip: Other: Phone: _- Fax: E-mail: I Total NM all lurisdictiotu weep credit cants,please call jurisdiction kr more ink rnuu:o r Minimum fee................ — Notice:This permit application Plan review(al 31�) $ CU Visa U MasterCard // expires if a permit if,not obtained - credit card number:_-�--- ---- �/zpirca L__ Stale surcharge(8%) ....$ _ within 180 days aller it has been ETOTAL ....., '" - --- accepted a•,complete. ................."' Name nr cudholdcr as shown on credit card — Cardholder silmalute Amount 4404616(&%M Yl) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 24amlly dwellings only: FIXTURES Individual QTY ea AMOUNT (Includes all plumbing%lures in PRICE TOTAL Sink 16.60 the dwelling and the flrst100 ft. QTY (ea) AMOUNT 16.60 for each utili connection Lavatory _ -One',1)bath _ _ $249.20 Tub or Tub/Shower Comb. 16.60 Two(2)bath _ $350.00 Shower Only 16.60v Three�j bath __ $399.00 _ Water Closet 16.60 -"-- _-- SUBTOTAL Urinal 16.60 8%STATE SURCHARGE_ Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL I Garbage Disposal 16.60 TOTAL _ Laundry Tra/ 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 -�-- PLEASE COMPLETE: 3" 16.60 4"- 1660 _ Water Heater O conversion O like kind 16.60 Quentit b Work Performed Gas piping roquires a separate mechanical Fixture Type: New Moved Replaced Removed/ ermit. - CApped MFG Home New Water Service 46.40 Sink _ MFG Home New San/Storm 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 - Other Fixtures(Specify) 16.60 - Urinal _ Dishwasher _ Garbage Disposal - _j,!jundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer-1 st 100' 55.00 3" Sewer-each additional 130' 46.40 4" Water Service-1st 100' _ 55.00 Water Heater Water Service-each additional 200' 40.40 Other Fixtures S ecifyL Storm 8 Rain Drain-1st 100' 55.00 Storm 8 Rain Drain-each additinnaF 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 - - Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspectionsper/hr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL _ Isometric or riser diagram Is required If Quantity Total is >9 --- 'SUBTOTAL --- - --� 8%STATE SURCHARGE - "`PLAN REVIEW 25%OF ZUB-i OTAL Re�c ulred only i(li,tures teal I_�>9 ------ TOT.Al" *Minlmm. ,_:.:::,r•c Is s'2 8%state surcharge,except Residential Backflow Prevention Device,wn,-h Is S36 2b•8%state surcharge "All New Commercial 6alldings require pians with Isometric or riser diagram and pian review 1:\,dsts\forms\plm.-fees doc 10/10/00 Electrical Permit Application - Date received: Permit no. I - !"j City of Tigard Pro)ect/appl.no.: _ Expire date: < itrn/liJ;,ud Address: 13125 SW Hall Illvd,Tip,aid.OI( 97221 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 1 Case file no.: Payment type: Land use approval: U I &2 family dwelling or accessory U Commercialiindustrial J Ix1ulu-family J•1'enant improvement J New constructior U Addition/alteration/replaL�entenl J Othct: _ __- 'J Partial INFORMATIONJOB Sl I F Job address r llldg.. nu.: tiurtn nn. I;tx nay,/lax Int/arcnwri no.: _.._ L.ol: Block: Subdivision: - _ Project name: Description and location of work on premises: ' Estimated date of com iletioll/ins ection: Job no: Fee Max 4 Description (r . lea.) Total no.Ins Business name: 7_L__)a t �.t�P i L l TUL 1 ' — New reddentlal-single or"will-family Pet Address: duelling unll.Includes attacher)garage. Ci(y: — StHtC: ZIP: %ervicelncluded: --- Fax: IWO sq.It or less 4 : Phonr: E-mail - -- Each additional 5(AI sq.ft.or portion thereof _ CCB no.: ,' -�- - Elec.bus.Ile.no: �, �.�r(. ._ Limited energy.residential _ 2 City/metro lic.no.: Limited energy,non-residential 2 Each manufactured home or modulm dwelling Service and/or feeder SiEnatme of supervising electrician(required) Dale - License Serolcesorfeeders-Installcllon, Sup elect.name aheratlonorrelocation: III[to 200 amps ur less 2 201 amps to 400 amps — 2 Name(print): 401 amps to 000 amps 2 Mailing address: (101 amps to I Wo amps _ 2— City: SlatC: over IWK)amnsorvolts _2 Phone: - Fax: E-mail: Reconnect only Owner installation:The installation is being made on property I own 1'emponry services or feeders- stillipallnlon.attItenUon,orrelueation: which is not intended for sale,lease,rent,or exchange according to insl haat t t less 2 ORS 447,455,479,670,701. 5( I cops a-4il(l mops -� _ -2 (tuner's signature: Date: _ awl ao0o:uu s 2 Branch circuits-new,alteration, or ettenslon per panel: Name: A Fee for hranch circuits with purchase of Address: _ service or feeder fee,each branch circuit 2 Stale: ZIP: — H Fee for branch circuits without purchase City: — of service or feeder fee,first branch circuit: 2 Phone: Fax 1i-Bail: 1•.achadditional branch circuit : - Mise.(Service or feeder not Include-1), Each pump or irrigation circle 2 U Serviceover225amps-counne:nal U lienal catefacility --- I U Service over 12C amps-rating of 1&2 U HaaardouSlocalion Each sign nr oulline lighting -- familydwellings U Building over 100x)square feet four or Signal circuit(s)or it limited energy panel. - U System over 6(x)volts nominal more residential units in one structure alteration,of extension* u Nuilding river three stories U Feeders,400 amps or more 'Ikscrition: — U Occupant lond over 99 persons U Manufactured structures or RV park F.rh additional Inspection over the allowable In any of the above: _ U F•.gress/lighungplan U Other Per Inspection - —Submit sets- sets of plans vvlth any of the above. Investigation fee Me above are not applicable to temporary construction service. (ether --- __ ---- -- - Permit fee ..........$ NM ell turitdicnnru a'ceis rtedit 1anh,1111W 11111 ianwhrtion fa near intommtion Notice:Mitis permit application Plan review(at U Visa U MasterCard expires if a permit is not obtained Slate surcharge(9%,) .. $ Credit,wd number -- L _-1 within 180 days alter it has been arg' --- _ accepted as complete Name of cardholAn se ihowr on c t card- b Cardbotder tiptaturc -- Amount 4404615(~OM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENT ONLY p Restricted Energy Fee...................................................... $75,00 Number of InsjpectIons per permit allowed (FOR ALL SYSTEMS) Servico Included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq ft or less _ _ _ $145.15 _ _ 4 ❑ Audio and Stereo Systems' Each additional 500 sq it or portion thereof _ $33,40 _ —_ 1 Burglar Alarm Limited Energy $7500 _ Each Manufd Home or Modular Dwelling Service or Feeder $9090 _ 2 El Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 2.00 amps or less _ $80 30 2 201 amps to 400 amps $106.85 _ 2 Vacuum Systems' 401 amps to 600 amps $160.60 2 601 amps to 1000 amps -- $240.60 _ 2 Other Over 1000 amps or volts _ $45465 2 Reconnect only $66,85 _ 2 Tem'Jorary Services or Feeders TYPE. OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system......................................................... $75.00 200 amps or less � $66.85 (iG. 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100:10 2 401 amps to 600 amTri2_ $133 _ 2 ChecK Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. Audio and Stereo Systems. Branch Circuits New,alteration or extension per panel Boller Controls F,,)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit ( $6'6_5 „Z6. G 2 ❑� Data Telecommunication Installation b)The fee for branch circuits without purchase of service ❑ Fire Alarm nstallation or feeder fee. First branch circuit $4685 Each additional branch circuit $6.65 HVAC Miscellarcous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle _ __ $'/3.40 r� Each sign or outline lighting $53.40 Intercom and Paging Systems Signal circuits)or a limited energy nanal,alteration or extension _ $'5.00 _ El Landscape Irrigation Control' Minor Labels(10) $125.00 _ Each additional inspecilon over ❑ Medical the allowable In any of the above ❑ Per Inspection _ _ $62.50 Nurse Calls Per hour $62.50 In Plant _ $7375 _ ❑� Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fee, $ r ❑ y� Other- 8%State Surcharge $ __—��v _____Number of Systems 25%Plan Review Fee See"Plan Review"section on $ No licenses are required Licenses are required for all other installations front of application — Fees: Toto!Balance Due $ Enter total of above tees $ - ❑ Tnist Account#____ _ _ 8%State Surcharge $ Total Balance Due $ i.Wsts\fomis\elc-fees doc 06/07/01