10690 SW KABLE STREET AVIA 1Ssa✓r of �us ��n f�- -r►P�
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CITY OF TI GARD
--A 2.5 FOOT PUBLIC LANDSCAPE EASEMENT i WASHINGTON COUNTY, OREGON a
SHALL EXIST ALONG ALL STREET FRCNTAGE. SEPTEMBER 7, 2001
--A 7.5 FOOT PUBLIC UT�L iTY EASEMENT ���,/ j S' ' Centerline Concepts Inc .
SHALL EXIST ALONG THE LANDSCAPE; EASEMENT. DRAWN BY: UPlr LrIECKED BY: WGDIII
SCALE 1 "=20' ACCOUNT 115 EMAIL www. CCIEMAIL(OAOL. COM
I� N 640 82nd Drive Gladstone, Oregon 97027
Ld-ireM: \MLI\L'IERICK 503 650-0188 fax 503 650-0189
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10690 SW Kable Street
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST � �-
INSPECTION DIVISION Business Line: (503)639-4171 BUP
Received Date Requested S Z -- AM PVI__ BLIP
I.ocation L �'`-�O _— Suite - MEC --
Contact Person ''�-e-_ _ Ph(__�—) __i c� Z.-PLM —
Ph(_ ) .r SWR _ - ------
Contracto[ - ----- - ELC _
UILDING T.nantrOwner
_ —_ -- ELC -----
Foundation Access: ELR --
Fog Drain
Crawl Drain
Slab — Inspection Notes: SI _------- -- -
�post& Beam)
-- ---- ----
91i r Ors
Ext Sheath/Shear -
Int Sheath/Shear
Framing - -- --- - - _
Insulation
Drywall Nailing
Firewall --
Fire Sprinkler - -— -
Fire Alarm - - -
Susp'd Ceiling
Roof -
Other:
- - - -
SS PART FAIL_
�Pr4;;t&Beam
Rough-In
Water Service -- — -- -
Sanitary Sewer --- ----
Rain Drains --
Catch Basin/Manhole — -
--
Storm Drain
Shower Pan
Other: -
Final --- —
A T FAIL
- ----
r3a,s Line
Smoke Dampers -- - - —
S PART FAIL
TRIS
Service
Rough-In -_ ---- - -
UG/Slab
Low Voltage - - -
Fire Alarm
Final �1 Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL Please call for reinspection RF Unable to inspect-no access
SITE ._.—__ -_ -
Fire Supply Line
AIA Date Inspector U ` Ext
Apl�nir.h/�;idr+wtaik -
Other
Lwal DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST 'G�G.� c
8UP
Received Dateeque
RPM
' BLIP
Location ' Z'�_�� ,� �.�L ---
- ---___- --- _.Suite
�� � MEC _
Contact Person ._._ Ph( ) -�1- 2 PLM
Contractor _ ph( ) SWR
BUILDING Tenant/Owner --_ _
ELC
-
Foundation ELG
Ftg Drain Access:
Crawl Drain _ ELR
Slab Inspection Notes. SIT
Post& Beam -- - - _.--•—
Shear Anchors - --- - ---- - -
---
_xt heath/shear - - --
Int Sheath/Shear
Framing -_-._-
Insulation - -- - -
Drywall Nailing
Firewall - --- -- .-
Fire Sprinkler -- - __--
Fire Alarm _ — -- --- ---
Susp'd Ceiling -- ---- ---
Roof --- -
Other: -- --- ---. -
---
Final _-- -
PASS PART FAh. - -- - - -
PLUMBING
Under Slab
Rough-In _
Water Service --
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain - -
Shower Pan
Other-
Final
therFinal - _ —
PASS _PART FAIL -- --
MECHANICAL
Post&Beam -
Rough-In
Gas Line
Smoke Dampers
Final
FAIL
FU
LEGTRI - . -_
G/Slab
Low Voltage -- -
----------
ire Alarm —- - --------
in r �
A35 PART FAIL L_1 Reinspection fee of _required before next ii'spection. Pay at City Hall, 13125 SW Hall Blvd
Please call for reinsp ction RE_ F-] Unable to inspect-no access
Fire Supply Line ` — -
ADA
Other:
Approach/Sidewalk Date —� Inspector - Ext -
_
Final _ DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIG,ARD 24-Hour
BUILDING Insrcc!lon Line: (503)639-4175
INSPECTION DIVISION Business LIne (503)639-4171 MST
ReceivedBLIP
� Date Reque ted.---Y� AM — PM---____ BUP --
Location / �/ G --- ------ -- — —
Suite
Contact Person � ,�;; MEC
Contractor PLM -_---__---- _---- --
Ph
[Int
ILDING SWR --_--
Tenant/Owner - --- -- --
ting - _ ELC
-- -- -
ndation - - - -
Drain Access: ELC
wl Drain .Ity�,, `j !,j L�; ELR
- -
Inspection Noles:
& Beam SIT
- -- -
ar Anchors ---
Sheath/Shear -- -_
heath/Shear
Framing .� Gt�/ rC
n -- - -
Insulation Drywall
Nailing
Firewall _-
Fire Sprinkler
Fire Alarm -----
Susp'd Ceiling - -- -
Roof —
Other: -
- _.-
Final
PASS PART FAIL -
PLUMBING_ -
Post& Bearn --
Under Slab -- --
Rough-In - --
Water Service -'
Sanitary Sewer
Rain Drains
Catch Basin/Manhole —
Storm Drain _
Shower Pan --
Other: -
7naPART FAILANICALeamnEDampers PART FAILRICA _--
UG/Slab - - -
- -- -
Ow cltage
Fire Alarm
Alarm -
- -
Final
- --
PASS PART FAIL Reinspection fee of$____- required before next inspection. pay at City Hall, 13125 SW Hall Blvd.
_ _ - -
SITE _ C� Please call for reinspection RE:
Fire Supply Line _ Unable to inspect-no access
ADA
Approach/Sidewalk ®ate 7 Z Inspector _
Other. ---` Ext- -
Final
SASS PART FAIL DO NOT REMOVE this Inspectlon record from the Job site.
MASTER PERMIT
CITYOF TIGARD PER.tAIT#: MST2001-00492
DEVELOPMENT SERVICES DATE ISSUED: 10/15/01
13195 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 10690 SW KABLE ST PARCEL: 2S11ODA-04600
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: New SF detached residence Path 1
BUILDING _
STORIES FLOOR AREAS _ _REQUIRED SETBACKS __REQUIRED
REISSUE: --
CLASS OF WORK: NEW HEIGHT: 5 FIRST 1.905 sf BASEMENT. LEFT 10 SMOKE DETECTORS r
TYPE OF USE: SF FLUOR LOAD: 41) SECOND of GARAGE 64 sf FRONT: 20 PARKING SPACES
sf :
TYPE OF CONST: 5N DWELLING UNITS 1 FINBSMF.NT: RIGHT10 VALUE: 4 3']��1'i`.q'�
OCCUPANCY GRP: R3 BDRM: 3 BATH:
3 TOTAL 1911500 At RFAR 53
PLUMBING _
UNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
SINKS: 2 WATER CLOSETS: 3 WASHING MACH: 1 LA1
LAVATORIES: 5 DISHWASHERS.
1 FLOOR DRAINS: SEWER LINES: '.'i0 5F RAIN DRAINS t CATCH BASINS:
TUB/SHOWERS, 3 GARBAGE DISP: 1 WATER HEATERS.
1 WATERLINES I"'.' RCKfLW NREVNTR� � GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K BOIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYER I
FURN—100K: I UNIT HEATERS: HOODS I OTHER UNI'T'S: 1
GAS
MAX INP: nw FLOOR FURNANCES.
VENTS WOODSTOVES: GAS OUTLETS. I
ELECTRICAL_
RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS _BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS__
0 200 amp: WISVC OR FDR, PUMPIIRRIGATI^N: PER INSPECTION.
1000 SF OR LESS•. 1 0 200 amp:
EA ADD'L 500SF: 6 201 400 amp: 201 400 amp:
1st WIU 5VCIFDR: ��'� SIGNIOUT LIN LT: PER HOUR.
p.
401 600 amp: EA ADDL BR CTR: SIGNAUPANEL: IN PLANT
IMITED ENERGY: 401 600 am :
MAI,U HMISVCIFOR:
601 - 1000 amp 601-amps•1000v: MINOR LABEL.
1000-amplvult PLAN REVIEW SECTION
Reconnect only: —4 RES UNITS: SVC/FDR-225 A. >600 V NOMINAL CLS AREA/EPC DCC,
ELECTRICAL•RESTRICTED ENERGY
B.COMMERCIAL
A.SF RESIDENTIAL _
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 6 STERE
F:RE ALARM INTERCOM WAGING. OUTDOOR LNOSC LT.
O.
BURGLAR ALARM: OT H: BOILER: HVAC. LANDSCAPE/IRRIG PROTECTIVE SIGNL.
GARAGE OPENER•.
CLOCK INSTRUMENTATION: MEDICAL: OTHR:
HVAC:
PATA/rELE COMM: NURSE CALLS TOTAL 0 SYSTEMS:
TOTAL FEES: $ 7,984.34
Owner: Contractor: This permit is subject to the regulations contained in the
RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES Tigard Municipal Code,Stale of OR. Specialty Codes and
1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR all other applicable laws. All work will be done In
WEST LINN,OR 97068 WEST LINN,OR 97068 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION'.
Phone: Oregon law requires you to followrules adopted by the
Phone: Oregon Utility Notification Center. Those rules are set
Rep C Ile: 0.14958 forth in OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control msp 8 Slab Insp Footing/Fo' ndation Dr; Electrical Service Low Voltage Water Line Insp
Grading Inspection -lost/Beam Structural Plm/undslab Insp Electrical Rough In Gas Line Insp Appr/Sdwlk Insp
Sewer Inspection F'ost/Beam Mechanica PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Footing Insp Underfloor insulation
Mechanical Insp Shear Wall Insp Insulat.-n Insp Mechanical Final
FoundatiopansP Crawl Drain/Eackwaler Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final
J
1
Issued y-: _ F�, - J� M' Permittee Signature
Call (503) 639-4175 by 7:00 p.rr. for an inspection needed the next business day
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-0026,1
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/15/01
SITE,ADDRESS; 10690 SW KABLE ST PARCEL: 2S110DA-04600
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT: 007 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK. NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new SF detached residence.
Owner: _
RENAISSANCE CUSTOM HOMES — __ FEES
1672 SW WILLAMETTE FALLS DR Type By Date Amount Receipt
WEST LINN, OR 97068 RRMT CTR 10/15/01 $2,300.00 27200100000
Phone: 557-8000 INSP CTR 10/15/01 $35.00 27200100000
Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
this Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 1=c
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospe--t
3 feet in all directions from tha distance given. If not so located, the installer shat' purchase a "Tap and Side Sewer' Pel-m
Issu by: 'c'��1 o1Wd y Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
or
Building Permit Application
City of Tigard ' Datereceived: fs p 1 Permit no.: .
Cir)ofTigard Address: 13125 SW EalI Blvd,Ti ard,O 423
F'roject/appl.no.: Expire date:
Phone: (503) 639-4171 Date issued: Hy: Receipino.:
Fax: (503) 598-1900
Case file no.: Payment type: -C
Land use approval: _ 1&2 family:Simple Complex: —�
1 A.2 family dwelling or accessory U Commercial/industrial U Multi-family 'New construction J Demolition
U Addition/alter ition/replacement U Tenant improvement U Dire sprinkler/alarm U Other:
Job address: 7 Y Lr, r S Bldg.no,: Suite no.:
L.ot: 7 Blc>Ck: Subdivision: /_' �r or/e, /i fax map/tax lot/account no.:
Project name: �-- � -----
J x/s, , lJ�� , II a'sIIc)DA-9g6ey _
Description and location 01 work on premises/special conditions: 3U - 21 '1' —
Name: 1.2�L
Mailing address: 1&7 i• c2✓ /� / n,M�,a - I &, family dwelling:
City: his, C r,+�r State: (?sir ZIP: 7f`►6� Valuation of work...................................BMW
Phone: ti' 7 yin nZ' Fax: s(, / Em
ail: No.of bedrooms/baths............................Owner's representative: Total number of floorsPhone: lax: L-mail: New dwellin area(s ft.>g q.Garage/carport area(sq.tt.).....................
Name: Covered porch arra(sq, ft.) .........................
Mailing address: -- Deck area(sq. ft.) ........................................ 3Z 7�-
City: State: _ ZIP: Other structure area(sq. ft.).........................
Phone: Fax: E-mail: ('ommercial/industrial/multi-family:
Valuation of work........................................ $
BUSInI'FC Hanle: ��.rNP
Existing bldg.area(sq, ft.) ..........................
Address:
New bldg,area(sq. ft.; ................................ ��----
-- State: ZIP: Number of stories........................................
City: _
— Type of construction..... .............................
Phone: Fax: � E-mail: ----- -
CCB no.: 7s 2) _ - Occupancy group(s): Existing:
New:
City/metro lir. no.: / ®` Notice:All contractors and subcontractor:;are required to Ix,
licensed with the Oregon Construction Contractors Board under
Name: l �!J. provisions of ORS 701 and may he required to he licensed in the.
Address: /3 o, ir( /g +z,` A, jurisdiction where work is being performed. If the applicant is
City: r^w AIIIIII d Istatc: c7R ZIP: exempt from licensing,the following reason applies:
Contact person: I Plan no.:
Phone: x: 'I-ES-0 -mail: ------
Name: a�r Contact person: Fees due upon application ........................... S
Address: lot 0"I Date received: -
City: •. ;* ,r 1, _ !State: --K 'LIP: _ Amount received ......................................... $
Phone: G 9 2 I Fax: _ E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Nor all:udidicamru accept credal cards,please tail jurisdiction for more inrrxtrurttrm.
attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard
work will be compiled withebether�"herein or not. credit card number
i' _ Gxpirec
Authorized signature: Fame m(cerdtwlder a shown on credit card
S
Print name:,!e ._c' 14 .` >,�3 - Cardholder signature — Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4104613(6WIC04)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.: -
Associated permits:
City"f hgard City of Tigard U Electrical U Plumbing U Mechanical
Address: 13125 SW I lalI Blvd,Tigard,OR ')'1223 U r aiher __—_-- --
Phone: (503) 639-4171
Fax: (503) 598-1960
111 NOW
1 Land use actions completed.See jurisdiction criteria for concurrent reviews,
2 Zoning.Flood plain,solar halance points,seismic soils designation,historic district,etc. _
3 Verillcation 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-basin protection,etc.
to3 Complete sets of legible plans. Must he drawn to scab!,showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-sine
sheet attached to the plans with cross references between plan location and details.Plan review cannot he completed
if'Copyright Violations exist.
1 1 SUMw
plot plan drawn to scale.The Plan must show lot and building setback dimensions property comer elevations(if
there is more than a 4-11.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway:f-ootprint 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. _ -
I3 Hoot 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 beams,headers,joists,sub-floor,
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,
fire lace construction, thermal insulation,etc.
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floorlroof framing.Provide plan.,for all floors/roof as.,emhlies,indicating member siring,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaing wa
inlls,Provide cross sections and details showing placement ol'rebar. For engineered
systems,see iienn 22,"F,a gineer's calculations."
19 cam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over Io feet long and/or any hcam/joist carrying a nun-uniform load,
20 Manufactured floor/roof truss design details,
21 Energy Code compliance.Identil�y 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)>:hall he stamped by an engineer or
architect licensed in Oregon and shall he shown to hr applicaole to the project under review.
23 Five(5)site plans are required for Item I I above. Site plans must he 8-I/2"x I I"or 11"x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons. _-
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document.
27 No"mirrored"building plans will be,accepted.
28 "Drawn to scale"indicates standard architect or engineer scale.
Checklist must he completed before pip . review start date. Minor changes or note:-' on submitted plans may be in blue or black ink.
Red ink is reserved torr department use only. 4"14 a"KWOMa
Electrical Permit Application
LtDate
eived: Pernut not.
City of 'Tigard appl.no.: Expire date:
City n/7igard Address: 13125 SW Hall Blvd,Tigard,OR 97223 ued: By Receiptno.:
Phone: (503) 639-4171 -
Fax: (503) 5Q8-1960 e no.: Payment type:
Land use approval:
2 family dwelling or accessory U Commercial/industrial J Multi-family J Tenant improvement
ew construction U Addlliun/alteration/re{tlacemcnt J Other: U Partial
Joh address: 106 q(P l-e-le S�. Fldg. net.: tiurlc• nn. Tax map/tax IoVaccount no.:
Lot: Block: Subdivision:
Pro.lect name: /� /s /�r �'� Uescrilttion and local.ion o work on premises
Estimated date of corn Iclion/ins ection:
Job no: _ rm Mat
Business name: F / Description_ Qty. (ea► tidal no.in%p
-- New residential-singe or nndtl-family per
Address: /"� dwelling unit.Includes attached garage
City: -e7- 4 i►,c�s SIatC:h� LIP; Servire itciuckrl:
Phone: f 7 01(17 1 Fax: I E-mail: 1114l11 sq It om lcss t
CCB no.: 07-C Elec.hus.lic.no: Each additional 500 sq It.or portion thereof _
I.intttedenergy,residential
Clly/tttelro IIC,no.: I.imitedenergy,non-residential
hach manufactured home or modular dwelling
Signature off'supervising electrician(tc uircd) Date Service and/or feeder
Sup.elect.narne(print): C4 S I License nn: Servlcesorfeeders-installation,
aherallon or relocation:
2(x)amps or less 2
Name(print): r t S ra.�, ��P1 201 amps to4lx)amps 2
Mai address: -� / r 401 amps to 6(1()amps 2
8 <[v (v,/ a>,-e�I'C 60l ma;+s to lo0o amps
2
City: 4/t-, State:Slate: 0� ZIP: ?oE"ff over I(Nx)turps or oohs 2
Phone: i C ' D pO I Fax: S /&, E-mail: Reconneclo.dy -- I
O%%tiei installation:The installation is being made on property I own Temporary servicesorfeeders-
which is not intended for sale,lease,rent,or exchange according to Ini!dallation,alteration,orrelocation:
ORS 447,455,479,670,701. 2(x)amps or less 2
201 amps to 40()amps 2
Owner's si nature: fate: 401 to 6110nnt s - 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 _ _ 2
City: State: ZIP: It Fee for branch circuits without purchase
-- -- of service or feeder fee,first branch circuit 2
Phone: Fax: I nutil —
I:uch additional branch circuit.
M(u.(Service or feeder not Included):
U Service over 225 amps-commercial J I h.11111 facility Irach pump or irrigation circle 2
U Service over 320 amps-rating of I&2 U Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,00(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' 2 _
U Building over three stories U Feeders,41x)amps or more *Dewri%tion
U occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In any of the alcove:
U Fgress/lightingplan U Other __-_---_. Per inspection
Sublrtlt sell of plans with any of the above. Investigation fee
Me above are not applicable to lemporar}con%tructlon service. Other
Not or
all Jurisdictions accept credit earth,please call jurisdiction tot me infrtnat art Notice: Mis permit application Permit fee.....................$
U Visa U Mastercard expire If a permit is not obtained Plan review(at _ %) $
Credit card n u mer -_ %%ithin 180 days after it has been State surcharge(8%)....$ —^
Expires accepted as complete. TOTAL. $ _
Name of cardholder>u shown on c it card
_ S
Cardholder signalure Amount 40-4615!{iAn/r OM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY _
Number of Inspections r permit allowed Restricted Energy Fee...................................................... $75.00
I (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved.
Residential-per unit
1000 sq ft.or less $145 15 _ 4 C] Audio and Stereo Systems`
Each additional 500 sq ft or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $7500
Each Manufd Home or Modular ^LL ---
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener'
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $8030 2
201 amps to 400 amps $10685 2 ❑ Vacuum Systems'
------ ----
401 amps to 600 amps $16060 2
601 amps to 1000 amps �_- $24060 2 ❑ Other
Over 1000 amps or volts _ $45465 2
Reconnect only _ $66.85 2
Temporary Services or Feeders _ TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps or less _ $6685 2 (SEE OAR 918-260-260)
201 amps to 400 amps _ $10030 _ 2
401 amps to 600 amps $133 75 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 ❑ Boiler Controls
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder fee.
Each branch cirruit $6 65 1
Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service
or feeder fee. ❑ Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $665 ❑ HVAC
Miscellaneous ❑
(Service or Raeder not included) Instrumentation
Fach puri,p or irrigation circle $5340 _
Each sign or outline lighting $5340 ❑ Intercom and Paging Systems
Signal circuit(s)or a limited energy
panel,alteration or extension $7500 Landscape Irrigation Control'
Mirn; Labels IT0) _ $12500
Each additional Inspection over - ❑ Medical
the allowable In any of the above
Per inspection $6250 ❑ Nurse Calls
Per hour ---- $6250In Plant $73 75 ❑ Outdoor Landscape Lighting`
Fees:
❑ Prolective Signaling
Enter total of above fees $ -_--_-. ❑ ----- --� -- -__.---` _--.
Other
8%State Surcharge $
- ----�----- Number of Systems
25%Plan Review Fee
See"Plan Review' se,icon oo $ ' No licenses are required Licenses are required for all other installations
front of application
- Fees:
Total Balance Due 5
Enter fatal of above fees $—
❑ Trust Account#
8%State Surcharge $
$
All New Commercial Buildings r,aglaire 2 sets of plans. Total Balance Due -
i 41sLs\forms\etc-fees doc 08/30/01
I
i
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Recd
_
Phone (503)639-4171, x304 Date to P EDate to DST
Inspection (503) 639-4175 Print of Type Perm!i
Fax (5031598-1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development_L,.,f-/L s,,1Number of Inspections per permit allowed
Name(or name of business) ��Z_—
Service included: Items Cost Sum
,Address 9® Sr,� ��r } itt Y- 4a. Residential-per unit
City/State/Zip
1000 sq ft or less $ 11775 4
��o.x �/'
Each additional 500 sq.ft.or
portion thereof $ 26/5 -- 1
Commercial ❑ Residential Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance,applicants must prov de contractor license 4b.Services or Feeders
information for COT data base). Installalion,alteration,or relocation
Electrical Contractor _ _ �- it E";re-7tak- 200 amps or less $ 6425 2
Address Po I_'o x Ili z 9 201 amps to 400 amps $ 85.50 2
-- 401 amps to 600 amps $ 128.50 2
City_ /&,/ca.H<� _State __Zip_-97m/s 601 amps to 1000 amps $ 192.50
Phone No.— S03 65 7- rD/ '/Z Over 1000 amps or volts $ 363.75
Job No. Reconnect only $ 53.50 2
Elec Cont lice. No. 3–/2 S Exp.Date_/�' / 0 4c.Temporary Services or Feeders
OR State CCB Reg No 03 SC VV _Exp.Date_9�Q2 Installation,alteration,or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less _ $ 53.50 _ z
201 amps to 400 amps $ 8025 2
Signature of Supr. Elec'n—t l� t? 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No 6/,f s Ex Date i ,�, see°b°above.
p - 4d.Branch Circuits
Phone NO _ _. -- New,alteration or extension per panel
a)The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5 35 2
Address b)The fee for branch circuits
--- -- ------ --- without purchase of service
City__ State -- --Zip— -- or feeder fee.
Phone N0 rirst branch circuit $ 37.50
T - - Each additional branch circuit $ 5.35 _
The Installation Is being made on property I own which is not 4e.Miscellaneous
Intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42 75
Owner's Signature E ich span or outline lighting $ 4275
— - - - - - -- Signal circoit(s)or a limited energy
pane!,alteration or extension $ 60.00
3, Plan Review section ,if required):* Minor labels(,0) _ $ 44M
Please check appropriate item and enter fee in section 5B. 4f.Each additional inspection over /Gd.00
4 or more residential units in one structure the allowable In any of the above
_
Service and feeder 225 amps or more Per inspection $ 50 00Per hour $ 50.00
System over 600 volts nominal In Plant $ 5900
__—Classified area or structure containing special occupancy as _
described in N E C Chapter 5 5. Fees:
Sa.Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 5 Surcharge(-r36X total fees) $
Not required fnr temporary construction services. Subtotal C $
Sb.Enter 25%of line 6a for
NOTICE Plan Review it required(Sec 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account#_
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due $
P dsts\firms\clectricdoc
Plumbing Permit Application
City of Tigard Date received: Permit no.:
Sewer permit no.: Huilding permit no.:
Address: Ia125SWHall lilvd,'I'igard,OR 97223
CirvofTigard Phonc: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
&2 family dwelling or accessory U Commercial/industrial U Mulli•family U Tenant improvement
ew construction U Add iIion/al teralion/replacement U Food service U Other: .... —
.10B SITEINFORMATION
11-111', SCI I EDULF(for special information*nse checklist)
Job address: �/ Description (p Fee(ea.) 'Total
/OG L,/ G 4 4/ s
!ew1-and 2-family dwellings only:
Bldg.no.: Suite no,-,
Tax map/tax lot/account no.: (Includes 100 It.for each utility connection)
— S I;R(1)bath
Lot: 7 1 Block: Subdivision:
_ SFR(2)bath -_ ---- -__
Pro:,ct name: art [So 7 7-, It ! SPR(3)hath --
City county: 'J r I ZIP: 70Each additional bath/kitchen ---
Description and location of work on premises: Siteulillties:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain ---
aniannon Footing drain(no. lin. ft.)
u�� / �- Manufactured home utilities -"
Business name: � �.�� Manholes — -
Address: 7 73t. Rain drain connector
City: 'V1 Stnte: O ZIP: Sanitary sewer(no. lin, ft.)
Phone: 9'6 Fax: E-mail: Storm sewer(no.lin. ft.) —
CCB no.: 7766 Plumb.bus.reg.no: -20 -1 Waler service(no. lin.ft.)
City/metro lic.no.: Fixture or Item:
Absorption valve
Contractor's representative signature: ---
Bach flow preventer _
Print name: �' L „/ r,, Date: J Backwater valve _
Basins/lavatory
Name: ✓r�4 //,,,, Clothes washer
Dishwasher — —
Address:
City: Drinking fountain(s)
Ititaic: Illy - -_ - F.jectors/sump — --
Phone: I ax t; meet: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/huh_
Name(print): �r'.�ta,, sa,rr ��,"�"�.^, '�^' Garbage disposal _ - --
Mailing address: 7 Cl✓ ., etr•1r1 r" �i Hose hihh
City: r. StalC: ZIP: 2706:f Ice maker _ --
Phone: s S J sr Fax: E-mail: Interceptor/grease trap
owner installation/residential maintenance only: The actual installation Primer(s)
will he made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property t•)wn as per URS Chapter 447. Sink(s),hasin(s), lays(s) —
U'vner's signature: Date: Surnp
Tubs/shower/shower pan —
Name: Urinal
--------- ---------- -------- ate—closet
Address: Water healer
City: Stsrtt ZIP: Other: —
Phone: _-- ^� Fax: �E mail: Total
Na nil Jurisdictions vccepi cmift cards, lemc can jurisdiiva,fa ninm Informntfnn. Minimum fee................$
Notice:This permit application _-
U visa a M� ^�^•{ Plan revi�,w(at —. °%) $ --
expires if a permit is not obtained
Crt+i card numbs_- -- — ��.- within 180 days after it has bem State surcharge(8%) ....$
l:xpite
3 Name of c older u shown on ctrdN card accepted as complete. TOTAL .......................$
C opiates � Amount 4404616(6RWOM1
PLUMZING PERMIT FEES:
PRICE TOTAL. New 1 and 2-family dwellings only:
FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16 60 for each utility connection) -- __
One(1)bath 4 ___ _ _ $249.20_
1 ub or Tub/Shower Comb 16.60 — —
Two 2 bath _ $350.00 _
Shower Only 16.60 Three 3 bath _ $399.00 4
Water Closet 1660 — SUBTOTAL
Urinal 1660 --_ _
_ 8_/.STATE SURCHARGE
Dishwasher � 16,60 _PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 _ N TOTAL
Laundry Tray 16.60
Washing Machine — — 16.60
Floor Drain/Floor Sink 2" 1660
3' - 1660 PLEASE COMPLETE:
4 �� -- lb 60
Water Heater O conversion O like kind 1660 Quantity b ir Work Performed_
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit _ _ Capped
MFG Home New Water Service 4640 Sink
MFG Home New San/Storm Sewer 46,40 Lavatory _
-- --- Tub or Tub/Shower
Hose Bibs 1660 Combination _
Roof Drains 16.60 Shower Only
Drinking Fountain — 16.60 Water Closet _
Other Fixtures(Specify) 1660 — Urinal
Dishwasher _
Garbage Disposal
— Laundry Room Tray
—
—Washing Machine _
�� --- Floor Drain/Si,ik: 2"
Sewer-1 st 100'— — 55 )0 3" —
Sewer-each additional 100' 4F,40 4" _
Water Service-1 s 100' _ ')500 Water Heater
Water Service-each additional 200' 46.40 — Other Fixtures
S eci
Storm 8 Rain Drain-1st 100' 7;5.00
Storm 8 Rain Drain-each additional 100' 46.40 —
Commercial Back Flow Prevention Device 1640 ——
Residential Backflow Prevention Device' 27 55 — —
Catch Basin 1660
Inspection of Existing Plumbing or Specially _ 72 50
Requested Inspections _ — per/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 —
QUANTITY TOTAL —�— --- ���--- —
Isometric or riser diagram is required if --------- --_—�_T_ _v.
Quantity Total Is >9 --
'SUBTOTAL
8%STATE SURCHARGE -- - -- —
"PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty total Is>9
TOTAL $
*Minimum permit fee is$72 50•8%slate surcharge,except Residential Backflow
Prevention pevlce,which is$36 25-8%state surcharge
"All New Co nmerclal Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
is\dsts\forms\plm-fees.doc 08/29/01
Mechanical Permit Application
fate received. Permit no.:
ai
City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 1.3125 SW Ilall lilvd,Tigard,OR 97223 Date issued: liy: Rccetptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: L Payment type;
Land use approval: -- - - Budding permit no.:
J,��/'1 &2 family dwelling or accessory U Commercial/industrial U Multi-family LI Tenant improvement
JO New construction U Addition/alteration/replacement U Other:
308 S111,INFORMATION COMMERCIAL VALUM ION SCIII-IDULF
Joh address: tlr ' ;.�. S: Indicate equipment quantities in boxes below. Indicate the dollar
_�_-_.
Bldg.no,; Suite no.: �^ value of all mechanical materials,equipment,labor,overhead,
Tax ntap/tax lot/account no.: profit. Value$
Lot: 7 ['lock: Suhdivision: r7t ,,,� hc�, •ice checklist for important application information and
Project name le�"e C_.n -4v' / ;urisdictinn's Ice schedule for residential permit ice.
City/county "LIP:
Mscription and location of work on premises: Y _ _ t
ixil
Pee(ea.) 'total
Ai Tik
Est.dale of completion/inspection: Dm-ri tion Qty. Res.oniy Rm.onit
Tenant intprovcntcnt or change of use: Air handling unit _ CFM
Is existing space heated or conditioned'!U Yes U No it conditioning(site plan require ) _
Is existing space insulated'?U Yes U No I Alteration of existing VACsystem
Sot er compressors
momimm State boiler permit no.:
Business name: CGre , •�� /�Rxtvz _ _ HP Tons_ BTU/11
Address: 2:3� 5 3' �` t:s•y _ __ I irc/sma a amper. ucl smo c electors
Cip ty: ��r r State: ZIP_ --wealpum (sne p an required) _
Photic: 2 o2')Z Fax: h:-mail: nsta! replace furnac turner N' /'
-— -- Including ductwork/vent liner U Yes U No
CCB no.: '?v`d N _ nsta I/replace rc Dealt caters-suspende
City/metro tic.no.: wall,or floor mounted
---- _ - --
Name(please print): Vent fc r ajriance other ilia n furnace
e g Tallon:
Ab sorption units ____ BTU/N
Name: `r, -I o, Ilers - HP
--- - Com ressors ___ HP
Address: AV ronmenta exhaust and ventilation:
City; _ State: Z1P: Appliance vent
Phone: 1 ar I nr,ril )rycrcx taunt
floods, ype 1 I ltres.kite ten/hazinat
hood fire suppression system —
Natne: /iCr ,t.r,c', L IAs,�tz^^ ry•a^,p, Exhaust fan with single.duct(bath fans)
Mailing address: Ex taus)s stem a tart from hcatin g or AC'
Fuel piping andistribution(up to outlets)
City: L/�5 --- stale: " 7.IP: Ivp, LIU NG Oil
Phone Sj % g 0:--.' fax, f'-mail: Duel piping cat ad tttona over4outicts
rocess piping(schematic required)
Number of outlets
Name T)1Tier st app an`ce ur rqufpment:
Address: Decorative f ireplace
City: stale: ZIP: _ Insert-lypc _—
i,oc stov pe et stove
Phonc: _ Fax: E-mail: t)theti —4EE
Applicant's signature: ^� [)ate: t er:_
Name (print): _ —
Not all turisd dines accept credit cants,please rail)urm
rixlictlon for more hdoetion. Permitfee ................$
Notice:This permit application Minimum fee
................$
U Visa U MasterCard
expires if a permit is not obtained Plan review tat '36) $ _
e'redu card number ___..____ - — - / /expire. sillit IRO days after it has been
State�-jrcharge(8%)....$
complete.d as— com
rt.me c Ider ax shown on credit cud accepted s P P TOTAL .......................$
Cardholder signature Amouat 4404617(&%ICOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
Description: Price Total
TOTAL VALUATION:
PERMITFEE: Table 1A Mechanical Code _ aty (Ea) Amt
$1.00 to$5,000.00 - Minimum fee$72.50 1) Furnace to 100,000 BTU
$5,001.00 to$10,000.00 72.50 for the first 55,000.00 and including ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU
fraction thereof,to and including includingducts R vents 17 40 -
$10,000.00. 3) Floor Furnace
910,001.00 to$25,000 00 $148.50 for the first$10,000.00 and including vent +1400 OU
$1.54 for each additional$100.00 or 4) Suspended heater,wall heaterfraction thereof,to and including or floor mounted heater
$25,000.00__,001.00 to$50,000.00 $379.50for the first$25,000.00 and 5) Vent col included in appliance permit80
$1.45 for each additional$100.00 or
fraction thereof,to and including 6) Rep^ir units 12 15
_ $50000.00.
Boiler Heat Air
S50,001.00 and up $742.00 tar the first$50,000.00 and 0. ck all that apply:
$1.20 for 3ach additional$100.00 or For Items 7.11,see or Pump Cond
fraction thereof. footnotes below. Comp` -_
`�`-- 7)<3t1P;absorb unit � 14.00
Minimum Permit Fee$72.50 J SUBTOTAL: S to 100K BTU --
_ _ 8)3-15 HP;absorb 25.60
State Surcharge S unit I 00 to 500k BTU
------------
9)15-30 HP;absorb 35.00
--
25%.Plan Review Fee(of subtotal) S unit.5 1 mil BTU
-_- -Required for ALL commerciallpermits only0;'+0-50_-_- 1HP;absorb 52.20
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU _
11)>50HP.absorb 87.20
_ __-_.-_-------- unit>1.75 mil BTU
12)Air handling unit to 10,000 CFM 10.00
ASSUMED VALUATIONS PER APPLIANCE: -
Value Total 13)Air handling unit 10,000 CFM+ 17.20
DescripQt Ea Amo int
tion:
Furnace to 100,000 BTU,including 955 t16)Ventilation
portable evaporate cooler
10.00
ducts&vents --
Furnace>100,000 BTU including 1,170 fan connected to a single duct 6.70
ducts&vents _ _
Floor furnace includin vent 955 system not included in 10.00
Suspended heater,wall heater or- 955 iance ermit
Floor mounted heater 17)Hood served by mechanical exhp:jst 10.00
Vent not Included in appilcanee 445
18)Domestic incinerators 17.40
permit
Repair units 805
<3 hp;absorb.unit, 955 19)Commercial or industrial t;�e Incinerator 69.95
to 100k BTU ---
3-1 5hp;absorb.unit, 1,700 20)Other units,including wood stoves 10.00
101k to 500k BTU
15-30 hp;absorb.unit,501k TO 1 2,310 21)Gas piping one to four outlets .5,40
mil.B'U_ 3,400 �22)More than 4-per outlet(each)
30-50 hp;absorb.unit, 1.00
1-1.75 mil.BTU _ $
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL:
>1.75 mil.BTU_ _ ---- -- -� 86/,State Surcharge $
Air handlingunit to 10,000 cfm 656 _.
Alr handlin unit>10,000 cfm 1,170
Non- ortable eve orate Cooler 658 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not Included In 656
appliance ermit _- Other Inspections and Fees:
Mood served by mechanical exhaust 656 1 Inspections outside of normal business hours(minimum herge-two hours)
1
Domestic incinerator 1,170 $72 50 per hour4,590 2. Inspections for which no fee is specifically indicated (minimum charge half hour'
Commercial or industrial Irclnerator 656 _ $72 50 per hour
Other Unit,including wood stoves, :, Additional plan review required by changes,additions or revisions to plans(minimun
Inserts,etc. charge-one-half hour)$72 50 per hour
Gas piping 1-4 ouNets 360
Each additional outi3t 83 Slate Contractor Boller Certification required for units>2130k B?i).
**Residential AIC requires site plan showing placement of unit.
TOTAL COMMERCIAL
VALUATION: -- --�
I:\dsts\forms\nlech-fees.doc 08/06/01
SEE 35MM
ROLL #20
FOR
OVERSIZED
DOCUMENT