11335 SW IRONWOOD LOOP THESE NOTES 3
THE DRAWINGS
STATEL. VEPIF
OR ENCYINEER C
RESPONSIBLE 'r
SUPPORT OF TL
�O OF THE INTERN
'UNIFORM BUILC
SITE DATA FOUNDA
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ADDRESS: 11335 SW IRONWOOD LOOP
� TIGARD, OREGON DESIGN LOA
/ B.4s�c ROOF Lir
TAX LOT: (8134.4801500 p SNOW L
WIND LOAD . 84
ZONINrs: R-4.5 LOW SEISMIC PER UB
EXIST. HOUSE: 1,918 e.f. FOOTING DE51Ci
� PRE83lIRE (AS'
ADDITION: 164 e.f. FOUNDATION:
TOTAL: 2,141 of.
SITE AREA: 8,204 s.f. (APPROX .19 Ac.) FOOTINGS SHALENCsINEERED FIL
CONCRETE:
THE AGI STAND,
Wc
ACI-301 SHAD
EXIST. THE DRAWINGS
HOUSE J\PROPOSED MINIMUM COMPF
'
ADDITION 3000 Pal POF
3500 Pvl FOR
MAXIMUM SLUMF
OTHER CONCH
Ad EXTERIOR CONI:
DECK CONCRETE N.4P1
' HOT �ST. ACI-301 IF NOT ,
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I
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1 LUMBER GRADE
55:6' JOIST, RAFTER
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11335 SW Ironwood Loop
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CITY OF T I G A R D MASTER PERMIT
PERMIT#: MST2001-00040
DEVELOPMENT SERVICES DATE ISSUED: 02/09/2001
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11335 SW IRONWOOD LP PARCEL: 1S134AB-01500
SUBDIVISION: ENGLEWOOD ZONING: R-4.5
BLOCK: LOT: 072 JURISDICTION: TIG
REMARKS: 14'by 12' kitchen addition onto SE corner of house. Patti 1
BUILDING
REISSUE: STORIES 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 168 ef BASEMENT: if LEFT: 9 SMOKE DETECTORS:
TYPE OF USE: Sr FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sl RIGHT
VALUE. E 1',H,fl1�11
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL 169 00 of REAR 47
PLUMBING
SINKS: 1 WATER Cl OSETS. WASHING MACH LAUNDRY TRAYS. RAIN DRAW TRAPS:
LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS. SEWER LINES SF RAIN DRAINS. CATCH BASINS:
TUBISHOWERS: GARBAGE DISP. 1 WATER HEATERS: WATER LINES. DCKFLW PRLVNTR. GREASE TRAP:,.
OTHER FIXTURES. 2
MECHANICAL
FUEL rY'PES FURN<100K. BOILICMP<3HP VFNT FANS: CLOTHES DRYER
FURN>=100K: UNIT HEATERS. HOOD° 1 OTHER UNITS:
MAX INP: btu FLOOR FURNANCES- VENTS: WUGUSTOVES. GAS OUTLETS. 1
ELECTRICAL _
_RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS. 0 200 anin 1 0 200 arm) W/SVC OR FDR. PUMP/IRRIGATION: PER INSPECTION
EA ADD'L 500SF: 201 400 arnp 201 400 ai.ip I.it WIO SVCIFDP. SIGN/OUT LIN LT: PER HOUR.
LIMITED ENERGY. 401 600 aml) 401 600 amp EA ADDL BR CIR SIGNALIPANEL: IN PLANT
MANU HMISVCIFDR* 601 1000 amp 601-amps-1000r. MINOR LABEL.
10004 amplvolt
PLAN REVIEW SEC PION _
Reconnect only. >=4 RES UNITS. SVC/FDF.-225 A: >600 V HOMINAL: CLS ARFA/SPC OCC.
.
ELECTRICAL•REQ',RICTED ENERGY
A.SF RESIDENTIAL B.CU1V',1ERCIAL
AUDIO&STEREOVACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM* INTERCOM/PAGING. OUTDOOR LNDSC LT.
BURGLAR ALARM OTB. BOILER: HVAC. LANDSCAPEIIRRIG PROTECTIVE SIGNL.
GARAGE OPENER: CLOCK: INSTRUMENTATION. MEDICAL: OTHR:
HVAC: DATAITELE COMM NURSE CALLS TOTAL 0 SYSTEMS.
Owner: Contractor:
TOTAL FEES: $ 712.68
HENLEY,GEORGE A+SHARON L DONOGH CONSTRUCTION SERVICETgThis permit is subject to She reCF;Municipal Code,State off ons contained in the
CF Spe ialty Codes and
11335 SW 113ONWOOD LOOP 601 SUNSET CT all other applicable laws All work will be done In
TIGARD,OR 97223 NEWBERG,OP 97132 accordance with approved plans This permit will expired
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Phono Phone: 503.544.1280(cell) Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center chose rules are set
Rap 0 LIC 140469 forth In OAR 952-001-0010 through 952-001-0050 You
may obtain copies of these rules or dhrct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Mechanical Final
Foundation Insp Footing/Foundation Dn Electrical Rough In Gas Line Insp Plumb Final
Post/Beam Structural PLM/Underfloor Framing Insp Insulation Insp Final inspection
PosUBeam Mechanica Mechanical Insp Shear Will:nsp Rain drain Insp Building Final
Underfloor insulation Plumb Top nut Exterior Sheathing Insi Electrical Final
Issued By : _' l Permittee Signature
Call (503) 639-4175 by 7:00 p.m for an inspection needed the n b Vie" daly
SEE 35MM
ROLL # 20
FOR
OVERSIZED
DOCUMENT
Building Permit Application
Daterec:eivt:d: Permit no.:
City of Tigard Project/appl.no.: r Expire date
Cityu("/'ixard Address: 13125 SW liall Blvd, I igard,OR 97223
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1 Q60 Case file no.: Payment type:
Land use approval: - 1&2 family:Simple Complex:
I &2 family dwelling or accessory U Commercial/industnal U Multi-family U New construction U Demolition
"' •Addition/al lerat iott/replace ment U Tenant improvement U Fire sprinkler/alarm U Other: _-
Ml�Job address: Bldg.no.: Suite no.:
Lot: Block: Subdivision: Tax map/tax lot/account no.:j SO
Project name: _
Description and location of w(,rk on premises/s tial conditions:__ �L_ 7 ►� ��%� -�..— —
Name: G 1 �2l
< < 1 & 2 family dwelling:
Mailing address: fdeb
City: State ZIP: Valuation of work................ .......................
Phone" ` Fax: Email: hof trcdrowms/baths.................................
Owner's representati+e: Total number of(luxus.................................
Phone: Fax: Email: New dwelling area(sq, ft.) .........................
Garage/carport area(sq.ft.) ........................
C Covered porch area(sq.ft.) ...................
` ......
Name: —I r
Bailing uddress: --- ( Deck arca(sy, It.) ............................. .......... _
Cit State r ZIP: r �_ Other structure area(sq. ti.) ...... - --
y' -- Co merciaUindustrial/multi-fnmi!v:
Phone�.t,'5- - ' Fax: E-mail:
auauoilA(41work........................................ $ -
r, Existing bldg.area(sq.ft.) .......................... --
Business name: New bldg.area(sq,ft.)
Address: r C_"t Number of stories........................................ —
O'ity: , Stat ZIP: 3 .Z Type of construction....................................
Phone: �; �%/� Fax: —r mail: _ Occupancy group(s): Existing: _---
CCB no.: New:
(� ---
City/metro lic.no.: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: nt^ provisions of ORS 701 and may he required to be licensed in the
jurisdiction where work is Freing performed.If the applicant is
Address: c — ''' exempt from licensing,Ore following reason applies:
Cit _ Stat ZIP: `
Contact person: _ _ Plan no.:
Phone: - '- ,ax: E-mail:
mg 1j
Name: Contact person: Fees due upon application ........................... $
Address: -- -- Date received:
_City: State: ZIP: Amount received ......................................... $
Phone: Fax: Email: Please refer to fee schedule.
hereby certify 1 have mad and examined this application and the Not all jurisdictions accept credit cards,peen"call iuri%diction f(w more infornution.
attached checklist. Al"provis' s of[a%"nd(rdinances governing this Uvisa UMasterCard
work will be complied wit �r c' d erein or not. credit card nt mtKr:
Authorized signature: _ _ Date: Name of cudholdn ns shown on credit cenl — s
Print name: c.rdltolder dsnattrre Amount
Notice:This Permit applicatim expires if a permit is not obi ined within IRO days after it has been accepted es complete. W-41J(iraacoM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference
City of Tigard – Associatedperuuus.
City of Tigard U Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171
Pax. (503) 598.1960
1111111" FOLLOWING ITUNIS AIRE' REQUIRED FOR PLAN REVII-1V Ves No N/A
1 Land use actions eomN_ieted.tier junscrictiom criteria lair concurrent reviews.
2 Zoning.flood plain,solar balance poin,s,seismic soils designation,historic district,etc
3 Verification of approved plat/lot.
4 hire 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-hast!protection,etc. _
10 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state
building codes.Lateral design details and connections must be incorporated into thr plans or on a separate full-size
sheet attached to the plans with cross references between plan location and detr' lan review cannot be completed
if copyright violations exist.
11 Sifelplof plan drawn to seale.'rhe plan must show lot and building setback dimer.. is:property comer elevations(if
there is more than a 4-11.elevation dif ferentfal,plan must show contour lines at 2-ft.intervals);location of easements and
driveway;foxaprint of structure(including decks);location of wells/septic systems;utility locations:direction indicator:lot
area;building coverage area;percentage of coverage;impervious arca;existing structures on site;and surface drainage. _
12 Foundation plan.Show dimensions,anchor holts,any hold-downs and reinforcing pads,connection details,vent
sire 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 flair 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 roof sheathing,roofing,roof slope,ceiling height,siding material,fa)tings and foundation,stairs,
fireplace construction, U)ermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels,
Exterior elevations nuust reflect the actual grade if the change in grade is greater than four foot at building envelope.
Pull-size sheet addendunus showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis pians.Must indicate details and locations,for
ri m-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemhlier,,indicating member sizing,spacing,and hearing
_ locations.Show attic ventilation. _
18 Basement and retaining walls.Provide cross sections and details showing placement of rehar. Por engineered
systems,sce itch 22,"Lit ineer's calculations,"
19 Beam calculations.Provide two sets of calculations using current cafe design values for all beams and rnultiple.ioists
over 10 feet long and/or any beam/joist carrying;it 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,(i.e.,shear wall,roof truss)shall he stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
23 Five(5)site plans are required for Item I 1 above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets ea.h 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. au0-4614(60WOM)
Electrical Permit Application
IDatereceived: - rift-,0j Permit .q�p
City of Tigard ProjecVappl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: ReceiptiI
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: . _
Ilk]I
U I &2 family dwelling or accc sory U Commercial/industrial U Multi-family U Tenant improvement
U New construction *(Idition/alteration/replacement U c ober —_ U P^.:,ial
.1011 SITE INFORIIIIIATION
Job address. c 131dg.no,: Suite no.: Tax map/tax lot/account no./,5PL1 /I
Lot: Block: _ Subdivision:
Project name: Description and location of wr rk on premises:
Estimated date of comploion/inspectiow.
Job no: F'ce Max
Businessname: ( i2 �l [)(4cription Qly. (ea.) Total no.Itsp
New residential-%Ingle or multi-family per
Address: ,, < < FII dwellingunit.Includes attached garage.
('fly: AA Sl te: .IP: Senicelntlu(NYI:
Phone: Fax: E-mail: I(xxl sy.it.or less
CCB no.: Elec.bus.IIC.Ito: Fach additional 500 s .ft.or portion thereof
Limited energy,residential
City/metro lik.no.: Limited energy,non-residential 2�
Fach manufactured home or modular dwelling
Sigrmture of siI ising electrician(required) Date - -p Service and/or feeder — 2
n;unc riot): Act.( License nn: Z Services or feeders-Installation,
Sup elect.
alteration or relocation:
200 strips or less - 2
Name(print):I �n r 201 amps to AIM amps 2
401 amps to 600 amps
Mailing address. 601 amps to IW)amps _ 2
City: W State ZIP:172.Z, Over 1000 amps or volts 2
Phone:C �. Fax: E-mail: Rcconnectonly I
Owner installation:The installation is being made on property I own Temporary services urfeeden-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
201 amps or less
ORS S 447,455,479,670,701.
201 amps to 4(10 amps 2_ _ ___ 2
l)WtlCr'ti til nature; __ half: 4111 it)0(xlamps 2
Branch circuits-new,alteration,
or extension per panel:
Name: _ A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit -
-- - -
('jly; Slaw 771P: P. Fee for branch circuits without purchase
- -- - of service or feeder fee,first branch circuit: 2
I'hone: Fax I. nratl Each additional hranchcircuit: __-
Misc.(Service or feeder not Included):
79�emicv r 225 amps-commercicl U health-carclaciliuy Each pumporIrrigationcircle 2
ervice over 320 amps-rati-g of I&2 U llavnnlouslocation Each sign or outline ligating 2
amilyctwellings U Building over 10,000 square feet four or Signal circuil(s)or a limited energy panel.
U System over 600 volts nominal none residential units in one structure alteration,or extension* 2
U Building over three stories U Feeders,4(10 amps or mote *Description: —
LI Occupant load over 99 persons U Manufactured structures or RV park Fach additional Inspection over the allowable in any of the above:
U Fgres%nightingpion U Other Perinspection
Submit__-sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
_-- �—s' — Permit fee.....................$
NM all jut;i_'1 nas m_cept credit[aids,pleacall junrcllco,a,fon nurse infonrution Notice'.This pemltl application
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit cats nundwf _—— —L-- within 180 days alter it has been Stale surch—no(8%)....$
Expires accented as complete. TOTAL V $
--- Nnn,e of cardholder ea rhtrwn on credit cerci
-- Cardholder dstuture Amami II11J615(funarCOM)
Electrical Permit Fees: Limited Energy Fees:
—1 TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00
Number of Ins L±ctlons per permit allowed (FOR ALL SYS FEMS)
Service included: Items Cost Total Check Tvpe of Work Involved:
Residential-per unit
1000 sq.h.or less _ $145 15 —_ 4 ❑ Audio and Stereo Systems
Each additional 500 sq.ft,or 1 ❑
portion thereof
$33.40 _ Burglar Alarm
Limited Energy $7500
tach Manufd Horne or Modular 2 Garage Door Opener'
Dwellinc,Service or Feeder $90.90 T
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less �— $80.30 $a,SA 2 Vacuum Systems'
201 amps to 400 amps $10685 2
401 amps to 600 amps $160 60 — 2 Other _
601 amps to 1000 amps $240.60 2
Over 1000 amps or volts _ $454.65 2
Reconnect only $6685 2
TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders
Fee for each system.......................................................... $75.00
Installation,alteration,or relocation
(SEE OAR 918-260-260)
200 amps or less _ $66.85 2 I
201 amps to 400 amps v $100.30 2
401 amps to 600 arnps $133 75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, Li Audio and Stereo Systems
see"b"above.
Branch Circuit! ❑ Boiler Controls
New,alteration nr extension per panel
a)The fee for branch circuits Clock Systems
with purchase of service or
feeder toe.
Fach branch circuit _—1 U $665 a" 2 Lr-,J Data Telecommunication Installation
b)1 he fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
IF irst branch circuit _ _ $4685 (�] HVAC
Fach additional branch circuit $665
Miscellaneous Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53,40 ❑ Intercom and Paging Systems
Each sign or outline lighting $5340
Signal circuit(,)or a limited energy Landscape Irrigation Control'
panel,alteration or extension $75.00
Minor Labels(10) $12500 ^ _ r�
LJ Medical
Fach additional Inspection over
the allowable In any o'the above $62 50 ❑ Nurse Calls
Per inspe-tion _._—__ -----
Per hour _—^ $62..50 _
In Plant —__ $73 75 El
Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ �I� D n Other
8%State Surcharge. $ �I +7� -------Number of Systems
25%Plan Review Fee ' No licenses are required Licenses are required for all other installations
See'Plan Review-section on $
front of application Fees:
Total Balance Due $ � --.
Enter total of above fees $
❑ Trust Account p 8%State Surcharge $—-
-- --_--- - -- - Total Balance Due $ --
AktOinms\clr-Icc d", lu 01 00
Plumbing Permit Application
7Project/appl.
d: ���-Q Permitno.: �S
City of Tigard Sewer n0.' Building permit nu.:
Address: 13125 CAN Hall Blvd,Tigard,OR 97223
Citygffigard Phone: (503) 639-4171 no.: Expiredate:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land USC approval: _ Case file no.: Payment type:
$1 &2 family dwelling or accessory U Commercial/industrial 1]Multi-family U Tenant improvement
U New construction J* dditior./alteratiorr/replacement U Food service U Other: _
Job address: r Description I Qty-II`Cv(ea.) I Total
Bldg.no.; Sui co.: New I-and 2-family dwellings only:
IL' 25Tax mu /tax lodaccounl no.: (Includes 100 R.for each ulliflyconnection)
P a O SFR(1)bath
Lot: Block: Subdivision - --- --_ -
Sh'ft(2)bath _
Project name: _ SFR(3)bath
City/county: ZIP: Each additional hath/kitchen
Des ' lion nd to ion u r on premises: Siteutilities:
_2 Ur(,) (,C l�T U� Catch basin/area drain —�
Est.date of completion/inspection: - i Drywells/leach line/trench drain -
Footin drain(no.lin.ft.) _
kRain
tured home utilities _
Business names s _
Address: C_) in connectorCity; State: ' sewer(no. lin. ft.)
Phone: �- Fax: I -mail: wer(no. lin. ft.)CCB no.: S-r; Q� Plumb.bus.reg.no: - ervice(no. lin.ft.)
City/metro tic.no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow pecventcr
Print name: j N,C F Backwater valve --
Basins/lavatory
Name: Clothes washer Y_ _
Address: ------ Dishwasher _ -
--,--- - - Drinkingfountain(s)
City. - - State: ZIP: —'
_ _ _ Ejectors/sump _
Phone: Fax: E'-mail: Expansion tank
Fixture/sewer cap _
Name(print): 14 Floor drains/floor sinks/hub- -
Garbage disposal
Mailing address: (.t> }lose bibb
City: -
State ZIP: Ice maker _
�( ? Phone: . Fax: E-mail: Interceptor/grease trap
Owner installation/resider ,i1 maintenance only: 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 properly I own as per ORS Chapter 447. Sink(s),basin(s),Is Js(s)
Owner's signature: Date: Sump — ---
Tubs/shower/shower pan
Urinal _
Name: - -___.-- Water closet
Address: -- -- — _ Water�— Water heater ----- -Y
City: - State: ZI
_ P: —_ Other:
Phone: Fax: — E-mail: Total
Not all jurisdictions accept credit cards,please call jurisdiction rot mor:information, Notice:'llri
Minimum fee................
s permit application _
U Visa U MasterCard expires if a permit is not obtained plan review(at _ 96) $
credit card number _ —_ __��.— syj(hjn f tt0 days atl^r it has been State surcharge(8%) ....$ _
lExpires
Nae of cardholder as shown mrr credit card
accepted as complete. T'OTA1. .......................$
Name
Cardholder iiineuue Amount 440-4616(60WOM)
PLUMBING PERMIT FEES:
—— PRICE TOTAL NewTand 2-family dwellings only:
FIXTURES (individual)._.- QTY _ ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
16.60 the dwellinta and the first100 ft. QTY (ea) AMOUNT
Sink for each ut'!ity connection)
16 603249.20
Lavatory One(11ba,h --. —
16.60 Two(Z j oath $350.00 _—
Tub or Tub/Shower Comb. -- $399.00
16.60 Three(3)bath --_ -- ---
Shower Only
Water Closet 16,60 — SUBTOTAL
irinal 16.60 8%STATE S'JRCHARG_E
Dishwasher 16 60 PLAN REVIEW 25•/.OF SUBTOTAL
_ _ TOTAL
Garbage Disposal 1660 ----- - _
0
Laundry Tray 16 6
Washing Machine — 16 60 —
FloorDrain/Floorsink 2" �- 1660 � PLEASE COMPLETE:
3" -- 16.60
4" 16 60 _—_-- —
1;60 uantf�r b Work Performed
erHeater O like kindFixture Type: New Moved Replaced Removed!
Gas piping requires a separate mechanical Aped
permit. SinkMFG Home New Water Service 4 _ LavatoryFG Home New San/Storm Sewer Tub or Tub/Shower
Hose gibs 16.60 Combination
Root Drains 16,60 _Shower Only
16.60 Water Closet -- —
Drinking Fountain Urinal --
Other Fixtures(Specify) 1660 Dishwasher -
-- Garbage Disposal --
Laundry Room Trp — -
-- Washin Machine _ --
Floor Drain/Sink: 2"
Sewer-1st 100'— 55 00 — 3" _—
46.40 4„
Sewer-each adit
dional 100' Water Heater - —
Wailer Service-1st 100' 55.00 —
__ Other Fixtures
Water Service each additional 200' 46.40 S eci —
Storm&Rain Drain-1st 100' 55.0-0__46 4-0
046.40
—
Slor8 Rain Drain-each additional ln0'
m ----- -- _
Commercial Back Flow Prevention Device _ 46 40 `
Residential Backflow Prevention Device' 27 55 —� — ---
Catch Basin 1660 _—
Inspection of Existing Plumbing or Specially 7erthr COMMENTS REGARDING ABOVE:
Requested In50
s�Oclions -- �79 ------_.-----
Rain Drain,single family dwelling — -------- — _ _
Grease Traps — 1660 _ _ —
QUANTITY TOTAL _ __.-------— --------�—
Isometric or riser diagram is required if
Ouanlit Ty otal i9>9 —
*SUBTOTAL --� —.—
8%STATE SURCHARGE ---
"PLAN REVIEW 25%OF SUBTOTAL
rte ulred only if fixture qty total is-fl — e —
TOTAL i
"Minimum permit fee is$7250+B%state surcharge,except Residential Backflow
prevenuo, Device,which is$36 25.8%stale surcharge
"All Now Commercial Buildings require plans with isometric or riser diagram and
P1.111 review
l:\dsts\forms\plm-fees.doc 10110/00
Mechanical Permit Application
a Date ceceived:�'�_� permit no
City of Tigard Project/appl.no.: Expire dale:
Ciq n/l'i�unl Address: 13125 SW Ilall Blvd,Tigard,OR 97223 Dateissucd: By: T Receiptno.:
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no
U 1 &21'amily dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction ;NAddition/alteration/replact:mcnt U Other: __—
Joh address: Indicate equipment quantities in boxes below. Indicate the dollar
Bldg,no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: 1-5 profit.Value$
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule ti,r residential permit fee.
City/county: Zile
t
Description and location of work on pt
Fee(ca.) total
Est.date of completion/inspection: liewription OlTenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned?0-yes U No Airconditioning(stlep
Is existing space insulated? es U No I Iteration of ex HVAC system
of cr/compressors AMW
State boder permit no.:
BusWnaunne: . 1• e f _ 111' TonsBTU/HAdd •ir.smoke ampetectorsCityState ZIP: 1._ Icat pump(site p an require )Phox: F.-mail: Instarepacefurnac urner- Including ductwork/vent liner U Yes U NoCC __ caster /rep ace relocate healers-suspen ed.
City/metro lie.no.: wall,or floor mounted
Name I please print): l .r �r;• F, Vent fora fiance other Char.furnace
Refrigeration:
COWACTIPERSON
\bsurpuon units_____—_ B'f UlI1
Name: Chillers
- Cornttcssors III'
Address: ;nr ronmenta ex u4t and rent pt on:
City: — Slate: ZIP: Appliancevent
Phone: Fax: I mail I)ryerexhaust
I loo s, Type I res. htc a haznun
hood fire suppression system --
Name: �,,� Exhaust fan with single duct(hath fans)
Mailing address: :x haust s stem apart from hcatin or AC
'`� ) c.'
State ZIP:: tie p p ng and st ut on(up to out et-0 1
City: �-` Type: LPG ' NG Od I
r Phone: Fax: [ mail: ue i in sere additional over 4 outlets
piping(schernatic required)
Number of oullets
Ol _
Name: erst app ancr or equp—I ment:—
\ddress: V Decorative fireplace _
City: S 'the: ZIP: Insert-type
Fa E tnaiL oo slove/pc et stove —
Phone: Ot er:
Applicant's signature: Date: n/ t�r' ter: _
Name (print): '
,
Permit fee.....................$
Nor all jurisdictions accept credit cords,plena call jurisdiction for more infor mwi Notice: 11115rlhhll application Pe PP Minimum fee................$
U Visa U MasterCard expires if a permit is not obtained
Credit card number:. ---- — -- Plan review(at ` 96)
r�- within 180 days ager it has been State surcharge(8%)....$
---
accepted as complete.
None of I r as shown on credit car-fd- $ p TOTAL .......................$
Crdholder signature Amount W4617(ISMCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 i& 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: F"EE: Description: Price Total
$1,00 to$5,000.00_ _ _Minimun�fee$72.50 �_- T Table 1A Mechanical Code (�tY (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
_inclu ling ducts&vents 1x 00
$1.52 for each additional$100.00 or _
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts d 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
fractio-i thereof,to and including 4) Suspended heater,wall heater
$25,000.00. or floor mounted heater 14 00
$25,001 00 to-$50,000 06 $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: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. _ footnotes below. Comp*
7)<3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 8)3-15 3-15 HPP;;absorb
_ 14 00
Value Total unit 100k to 500k BTU 2560
Descriptfon �_ Qt Ea Amount 9)15-30 HP;absorb
Furnace to 100,000 BTU,Including 955 anit .5-1 mil BTU 3500
dLICtS&vents__ 1))30-50 HP;absorb
Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU 52 20
ducts 6 vents 11)>50HP:absorb
Floor furnace Including vent _ 955 unit>1.75 mil BTU 87 20 Yv
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater 1000 _
Vent riot included in applicance 445 13)Air handling unit 10,000 CFM+ _
e2"---- _ _1720 --
Repair units 805 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 10 00 _
to 100k BTU 15)Vent fan connected to a single duct _
3-15 hp;absorb.unit, 1,700 6 80 _
101k to 500k BTU 16)Ventilation system riot included in
1.5-315 tip;absorb.unit,501k to f_ 2,310 appliance permit 10 0U
mil.BTU 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit, 3,400 1000
1-1.75 mil.BTU ----- 18)Domestic incinerators
>50 hp;absorb.unit, 5,725 1740 .
>1.75 mil.BTU 19)Commercial or indusfrial type Incinerator
Air handlingunit to 10,000 cfm 656 __ _ 6995 _
Air handling unit>10,000 cfm 1,170 `-- 20)Other units,including wood stoves
Non-portable evaporate cooler 856 10.00
Vent fan connected to a single duct 446 _ 21)Gas piping one to four outlets
Vont system not included in 656 5.40
applianceyermit_ —�--- 22)More than 4-per outlet(each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 _ Minimum Permit Fee$72.50 SUBTOTAL: $
Commercial or industrial Incinerator 4,590
Uther unit,Inclurihlr,wood stoves, __ 656 8%State Surcharge $
Inserts,etc.
Gas piping 1-4 outlets 360 25%Plan Review Fee(of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION: __ —�
Other I�r sp4ctlons 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-half hour)
$72 50 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
charge-one-half hour)$72 50 per hour
`State Contractor Boller Certification required for units>200k BTU.
"Residential A/C requires site plan showing placement of unit.
is\dsts\forrnsUnech-fees doc 10/11100
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
R.E E7V�E IMPORTANT PERM
IT NOTICE FEB 1WINNER ELECTRIC INC5950 SW PROSPERITY PK
TUALATIN, OR 97062
Electrical Signature Form
Permit #: MST2001-00040
Date Issued: 02/09/2001
Parcel: 15134AB-01500
Site Address: 11335 SW IRONWOOD LP
Subdivision: ENGLEWOOD
Block: Lot: 072
Jurisdiction: TIG
Zoning: R-4.5
Remarks: 14' by 12' kitchen addition onto SE corner of house. Path 1
Your company has been indicated as the electrical contractor for the perm;t indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this E,ectrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
HENLEY, GEORGE A + SHARON L WINNER ELECTRIC INC
11335 SW IRONWOOD LOOP 5950 SW PROSPERITY PK
TIGARD, OR 97223 TUALATIN, OR 97062
Phone #: Phone #: 638-5028
Req #: LIC 14794
SUP 2825-5
ELE 34-1500
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X "t 'tv(
Slig6ature of Supervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MP PLUMBING CO
MILWAUKIE PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015
Plumbing Signature Form
Permit #: MST2001-00040
Date Issued: 02/09/2001
Parcel- 1c1?4.4g-n1ri0�
Site Address: 11335 SW IRONWOOD LP
Subdivision: ENGLEWOOD
Block: Lot: 072
Jurisdiction: TIG
Zoning: R4.5
Remarks: 14' by 12' kitchen addition onto SE corner of house. Path 1
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN. Building Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER. PLUMBING CONTRA `' TOR:
HENLEY, GEORGE A + SHARON L MP PLUMBING CO
11335 SW IRONWOOD LOOP MILWAUKIE PLUMBING CO
TIGARD, OR 97223 PO BOX 393
CLAUKAMAS, UR 97U16
Phone #: Phone #: 655-9161
Reg #. I Ir 5002
PI M 3-17PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber
If you ha /e any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: K 4175 Business Line: 639-4171
r rBUP
Date Requested l�-� 5 r �' AM PM BLD _
Location Suite MEC _
Contact Person ���� Ph PLM
Contracior Ph SWR
ILDIN Tenant!Owner ELC —
Retaining Wall —' ELR
Footing Access: ~
Foundation FPS
Fog Drain SGN
Crawl Drain Inspection Notes: ----------
Slab _— —_ -_� SIT
Post& Beam -�-
Ext Sheath/Shear
Int Sheath/Shear
Framing _-- _-- --
Insulation
Drywall Nailiig -
Firewall
Fire Sprinkler ____.--.___.___-. -, -
Fire Alarm
Susp'd Ceiling -- -- -- ----__ ------- t� -- ---
Roof
T FAIL -- - --. _.---- -------
P UMBING
Po.t& Beam
Under Slab
Top Out - -- - --- - ___ - ---- —
Water Service
Sanitary Sewer
rains
PARS'- FAIL _
MECHA A _
Rough In
Gas Line ---- - --- ---- - -"
Smoke Dampers
Final -- --- - ---- — - ---- _ _ - -
P T FAIL
Service
Rough In
UG/Slab
Low Voltage --------_ _------- -
Fir larm --- -- --- - - - -
PART FAIL ------- -----.---_--- -- - -- - -
SITE
Backfill/Grading -` J--_-"-- -- �-
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ _—required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( 1 Please call for reinspection RE. ( ,Unable to inspect-no access
ADA -c-"
Approach/Sidewalk Date L �a , — Inspector_ 6 Ext
Other — --- -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.