7000 SW OAK STREET-2 48045 )Igo ms OOOL
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7000 SW OAK ST
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT*: ELC2003-00012
DEVELOPMENT SERVICES DATE ISSUED: 1/13/03
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1S136AD-02000
SITE ADDRESS: 07000 SW OAK ST
SUBDIVISION: VILLA RIDGE 2UMING; R 4.5
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Ins!allation of(1)hranch circuit for new sn' it domestic hot water pro-heat system.
RESIDENTIAL UNIT _ AP SRVC/FEEDERS - MISCELLANEOUS
1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT ONE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1af W/O ERVC OR FDR: PER HOUR:
401 - 600 amp: EA A0D'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC;FDR>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JOSEPH LEITCH OWNER
7000 SW OAK ST
TIGARD,OR 97223
Phone: 503-293 6034 Phone:
Reg 0:
FEES _
Description Date Amount
Required Inspections
[ELPRMT]ELC Permit 1/13/03 $46.05
[TAX]8%State Tax 1/13/03 $3,75 Rough-in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Cede,State of OR.Specialty Codes and all other applicable laws. AN
work wil be done in acL ordance with approved plans This permit will expire if work is not started within 180 days of issuance,or if work Is suspended
for mora than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are:ret
forth In OAR 952-001-0710 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246-6699 or
1- 332-2344.
lea ed By: iYl Permit Signature:
ca — OWNER INSTALLATION ONLY
The installation is being made on pro erty I own which is not intended for sale, lease, or rent.
m OWNER'S SIGNATURE: _ DATE: /0 �5
W
_J CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ DATE:
LICENSE NO:
Call 639-4175 by 7:00pm for an Inspection the next businsss day
Electrical Permit Applicationall
_. Receiveal MINUS Electric
t)ate/Hy: I /; Off' �- Permit No.:
Ci �f Tigard Planning Approval Sips
`J g Date/By: Permit No.: _
13125 SW Hall Blvd. Plan Review tither
Tigard,Oregon 97223 Dote/By: PermitNo. —
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us c'oatact Juris.: 1 0 See Page 2 for
24-hour inspection Request: 503-6394175 NametMethod: I Sum lementol Information.
TYPE OF WORK PLAN-REVIEWPI se ehe�k all that aPpl&
New construction_i _Demolition Service over 225 amps- Hralth-care facility
commercial Hazardous location
Addition/alteration/re lacemcnt 10 Other: p Service over 320 omr•-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1&2 family dwellirSs four of more residential units in
1 &2-Family dwellingCommercial/Industrial
C]Sy-"'m over 600 volts nominal one stmctum
1 P.uilding,-:er three stories []Feeders,400 amps or trace
Accessory Building Multi-Family Occupant to td over 99 persons ❑IvJynufactmxd stn turfs or v park
Master Builder OthCr: EgressAighting plan thea `-^Jr • ,a f w r'c S t-
k0IFTEINFO ON Abd LOCATION Submit_._.a its of pans with any of the slave. tL 4on)0 a
The above are not applicable to tem ora construction service.
Job site address: paC> _ FEE*SIGHED -
Suite/f: Bld ./A rt.#: Number of Inspect ua per permlt allowed
Project Name: Description -- Qty Fee(sa) Total
Cross street/Directions to job site: New rng unit.Includes
or inched gara per
dwelling unit.Ineludee attached garage.
Service Included:
1000 sq.iLw less 145.13 4
Each additional 500 sq.it or portion thereof 33.40 1
Subdivision: Lot#: Limited energy,recidentisl 75.00 2
Limited energy,ran residential 75.00 2
Tax ma /Parcel#: Each manufactured home or modular dwelling
_
DESCRIPTION OF WORK , service and/or feeder 90.90 2
L Servkes or feeders-Insiallatkn,
/V ej7`or S p d-A IL h p i V• >4 1 G S yJ/ew alteration or relocation:
r r 200 amps or legs mm� 80.30 2
.p/rp tt Lr a{ �.t,v.rttcr 1' to400amps 1 106.85 2
401 amps to 600 amps_ 160.60 2
601 amps to 1000 am 240.60 1 2
Over 1000 amp or volts454.65 2
-Name: J-Ole'OH e Cl 7C N Reconnect only — 66.85 2
Address: WPO a" Q,4K <4-. Temporary services or feeders-Installation,
alteration,or relocation:
CI /$tate/Zl : H341
c� 200:m or 66.85 I
Pbone:Sa a-2 r.�. .oFax: — 201 amps to 400 amps 100.30 2
0 401 to 600 am 133.75 2
- Branch circuits-new,alteration.or _
Name: extension per panel:
—' A.Fee for!ranch circuits with purchase of
Address: service or feeder fee,each branch circuit 6.65 2
City/State/Zip: B.Fee for branch circuits without purchase of
service at,feeder feefirst branch circuit 46.85 ____2
Phone: _ i _�aX: _ Each additional branch circuit 6.0 2
F-mall: Misc.(Servire or feeder not included):
.CONTRACT(-) Each or irrigation circle 53.40 _ 2
26 ------------'` Each sign or outline lighting 53.40 2
Job No: -� Signal cimuit(s)or a limited energy panel, —
ahem ° extension 2
Business Name: 2
� W -_ --- Description:
[#Dce+ we! o '
Address: are- _Jto✓ ,renrhj
Each additional l:ispeedot over the allowable In any of the above:
City/State/Zip: Per inspection per hour(min.i hertrrrr� 62.50 _
Phone: Fax: Invatigati°n fee: _
CCB Lic.#: Lic. #: other
Supervising electrician _ 3ubbal S
signature required: _ Plan Review(25%of Permit Fee S
Print Name: Lic.#: State Surcharge 8%of Permit FeeS _.
TOTAL PERMITFEF, $ o
Authorized / Notice: "Is permit application expires if a permit Is not obtained within
Signature: ��--- __ Date: 3�`6 c 180 days after it has been accepted as complete.
— 77-7/ *Fee methodology set by Tri-County Building Industry service Board.
s/
(Pletse print name)
is\I)sts\Permit Forms\F.IcPermitApp.doc OUO3
Electrical hermit Ajp ication -City of Tigard
Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feeor pll systems............................................................ $75.00
Check Type of Work Involved:
F] Audio and Stereo Systems*
❑ Bur�ar Alarm
FJGar - r Opener*
Hcating,Ven anon and Air Conditioning System*
ElVacuum Systems*
Other�----.---- ------
COMMERCIALWORK ONLY:
.... $7S.00Fee for rgh system.......
(SEE OAR 919-260-260)
Cheek Type of Work Involved-
0 Audio and Stereo Systems
Boiler(-ontrols
E] Clock Systems \
Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
ElLandscape Irrigation 1'ontrnl*
Medical
Nurse Calls
Fp,
Outdoor Landscape Lighting*
tA)
ElProt-cti�• Signaling
•� Other
------.____Number of Systems
lU
No licenses are required. Licenses are required for all
other installations
is\Dsts\Permit F6mes\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24-Flour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 _
BUP
Received .__—---Date Roquested AM---.PM -- BUP --
Location �/�OC] 1�3�-- '°._Suhe_-- _ MEC
Contact Person Ph�— _—) �� 3 �!e:) PLM _ —
Contractor ��` Ph SWR
BUILDING TenanVOatnof ELC ")49 Z_
Footing ', -
Foundation ELC -
Fig Drain �' ELR �—
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear
Framing _--
Insulation
Drywall Mailing -- ------- -- _^-_— __ __
Flrewall
Fire Sprinkler ------- --- -- - ----- -_
Fire Alarm
Susp'd Ceilirg ---------- ___T _ -
Roof
Other: _ -------- ---- ��
Final -�—
PASS PART FAIL -
PLUMBING
Post&Beam - -----_ --_— ---
Under Slab -
Amigh-In
Water Service - - - --- -
Sanitary Sewer
Rain Drains - - ----- — - --
Catch Basin/Manhole
Storm Drain
Shower Pan - v -- l--- - -- — ----
/I Other:
Final
PASS PART FAIL ---
MECHANICAL
we
L Smoke Dampers --- -- --.--
C Final
PASS PART FAIL
ELECTRICAL
3 Service
e_06_033)
lab
ULow Voltage _-"- - -- -- _--- --- ---
a Fire Alarm
I Ela Reinspection fee I S_-_- �required before next inspection.
PART FAIL � specti spectl Pay a!City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: —_d -_ _ Unable to Inspect-no access
Fire Supply Line
ADA
Appronch/Sidewalk Daft-L -1_ - - _ - 11lfa Ctor-_--�� _ --- E[4-
Other:
Final --- DO NOT REMOVE this Inspoe Ireeanl fralllt th i Job fitc
rASS PART FAIL
CITY OF TIGARD► PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT#- 3-QU076
3/6/03
13125 SW Hall Blvd., Tigard, OR 9722:, (503)639-4171 DATE ISSUED: 3/6/03
SITE ADDRESS: 07000 SW OAK ST PARCEL. 1S135AD-02000
SUBDIVISION: VILLA RIDGE ZONING: R-4.5
BLOCK LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
'TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: 1
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of deinking fountain in front yard. Also, requires a backflow prevention device. _
Owner: FEES — v
-- Description Date Amount
,JOE LEI'fCH �
7900 SW OAK [TAX]8%State Tax 3/6/03 $5.80
TIGARD, OR 97223 [PLUMB] Permit Fee 3/6/03 $72.50
Total $78.30
Phone : 503-293-6034
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Top-out Insp
RP/Backflow Preventer
Reg#: Final Inspection
IL
ac
as
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
c7
Specialty Codes and all other applicable laws. All work will be none in accordaice with approved
plans. This permit will expire if work is not started within 180 days of issuance, c.r if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Iss d By: Permittee Signature:
Call (503)630-4175 by 7:00 rI.M.for an Inspection needed 1:01next business day
ww��■
Building Fixtures
PlumbiuLy Permit Applicationl
Received Plumbing
Date/B : l0 OCA Permit No. 117-12V7
City of Tigard gv-
Planning Apr;oval Sewer -
yDate/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: I Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Iwnd Use
Date/By: Can No:
Internei: www.ci.tigard.or.us Contact Juris.: E9 See Page 2 for
24-hour Inspection Request: 503-6394175 Nsme.Nethod: Supplemental Information.
TYPE' F WORK 'r FEE"'lSCHEtOYJT,E tb dal Info
New constructlonBescrt floraAddition/alteration/re lacementJ::e_:1mo1ition
Other: err • -t! dwellings
a :.. aetud�il dr Rill atxtlotl _-
SFR I bath _ 249.20
1 &2-Family dwellin El Commercial/Industrial SFR 2 bath 350.0
Accesso Building Multi-Famil SFR(3)bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
LQ
B SITE INFORMATIO an TION Fire a rinkler ft.: Pr c 2
Job site address: 106C)) cc) G" K
Suite M Bld ./Apt.#: Catch basin/me drain _ 16.60
Project Name: D ell/leach lineArent h drain _ 16.60 _
- -
Footing drain no.linear ft. Pae 2
Cross street/Directiom to job site: Manufactured home utilities 110.00
0.00
Manholes 16.60
Rain drain connector 4Page2
Sanit sewer no.linear ft.Subdivision: Lot#: Storm sewer no.linear ft.Tax ma / arcel#: Water service no.linear ft.ON OF WO Absorption valve Backflow reventer 4
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
Ejectors/sump 16.60 _
Named !-e-/ r!/t-E Ex cion tank V 16.60
Address: -7 0(gy p 5 w a,4 k S % Fixturelsewer cap 16.60
City/State/Zip: 1-(q e, 5? 72.2 3 Floor drain/floor sink/hub 16.60
Garbage disposal _ 16.60
Phone: 2- --(c Fax: Hose bib '6.60
I C014 Ice maker 16.60
Name: -Interce%oriffease trap 16.60
Address: Medical gas-value: $ i Page t
Primer 16.60
Cit /StateJZi ___. Roof drain commercial 16.60
a_ Phone: Fax. Sink/basin/lavato 16.60 1
-
ft E-mail: - Tub/shower/shower pan 16.60
1F_Cn CO ACTO -__ Urinal _ _ 16.60
Business Name: Geer - Water closet ! 16.60
Water heater 16.60
-� Address: _ T Other:
City/State/Zip: Other:
WPhone: Fax: ---
- CCB Lic. M Plumb. Lic.#: total s
irMinimum Permit F� 2.50 S <7
AuthoriResidential 8 A4inin ttm-ree 536.25
Signature: Date: i Plan Review 25%of Permit Fee S
_ - State Surcharge 8%of Permit Fee S
(Please print name) _ TOTAL PERMIT FEE I
Notice- This permit application expires If a permit Is not obtained within All new commercial bulldinp require 2 seta of plans with Isometric or
180 days after It has been accepted as complete. riser diagram for plan review.
'Fee methodology set by Tri-County Building Industry Service Board.
i:\Dats\Permit Forns\PlmPernitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Infos mation
Fee Schedule: Residential Fire Suppsession Stems:
61tc Ut1llNes _` Wr. q4,6.4OO
tow Square F_oota>¢es P milt Fee:
Footing drain-1"100' 0 to 2 000 5115.00
Footing drain-each additinoal 100' 2 001 to 3 600 5160.00
3,601 to 7,200J $220.00Sewer-I at 100' 7 201 and greater $309.00
Sew(- ach additional 100' 46.40
Wo ter service-Ist 100' _ 55.00 Medical Gas Systems:
Watet Service-each ad'qional 100' 46.40 Valuation: _ Permit Fees
Storm&Rain in-Ist 100' 55.00 St.00 to 55,000.00_— Minimum fee$72.50
Storm&Rain Drain-each additional 10(P J6 40 55,001.00 to SIQ,000.00 S72.50 tett the feral$5,000.00 and 51 51 for tach
add:.::mal$100.00 or fraction thereof,to and
_ FitOre or Item Rh- Fee(a? . Tal inclusting slo,000.00. __
Commercial Back Flow Prevention Device 46 ,001.00 t
.40 S o 525,000.00 S14g.'0 for the first 510,000.00 and 51.54 for
Residential Backflow Prevention Device each additional 5100.00 or fraction thereof.to
minimum permit fee$36.25) _ 55 and including$25,000.00,
Rain[rain,single family dwelling65. T$25, 10)to$50,000.00 5379.50 for the first$25,000.00 and$1.45 for
g yeach additional:100.00 or fraction thereof,to
Inspection of existing plumbing or and including 550,000.00.s ciall re uested inspections- r hour 71 SO and up 5742.00 for the Brst$50,000.00 and 51.20 for
Subtoulr each additional$160.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurate,llyre tort fixtures could result in Increased sewer fe *.
nand V ix W rte Com en regarding fixture work,
BantiatrY/Fatt -_-_ — -----
Bath -Tub/Shower
-Jacum!MirI 1
Car Wash •Each Stall _
-Drive 71try
Cuspidor/Water Aspirator
Dishwasher Commercial --
-Domestic _
[rinkin'
Eye Wash
Floor Drain/sink 2"
3"
4"
Car Wash Drain —___— *Note: If the fixture work un r this permit remults In an
Garbage -Domestic _ increase of sewer EDUs,a sewerermlt will br Issued and
Disposal -Com-Industrial
—
tL -tndustrial fees assessed for the sewer increas must be paid before the
0. Ice Mach./Refri .Drains _ _r_ plumbing permit can be Issued.
Oil Separator Gas Statism
Rec.Vehicle Dump Station —
Shower -Clang
J_ -Stall _
!� Sink -Bar/Lavatory
(� -Bradley
W -Commercial _
j -Service
SwimmiM Pool Filter
Washer-Clothes
Water Extractor
Wr.ter Closet-Toilet _
Urinal
Locr Fixtures:
is\rMs\Permit Fsxms\PImPermitAppPg2.doc 01103
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639,4175
INSPECTION DIVISION Bushiess Line: (503)639-4171 MST
_
t7'/ OUP
Received Date R __: �
ed � '�_ HM ___PFA OUP
Location _ O _-Sufte_____ MEC
Contact Person Ph(_ � � 3^ p✓,_ PLM !
Contractor Ph(__ j _ 'SWR
BUILDINGS _ Tenant/Owner ELC
Fnoting ELC
Foundation Access: ---- -- -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT _-
Post&Beem
Shear Anchors - --- - -
Ext Sheath/Shear
Int Sheath/Shes - -_-
Framing
insulation
i;rvwnl!Nailing --
Fii ewall
Fire Sprinkler ----- - - ---- -----
Fire Alarm _
Susp'd Coiling -------- -
Roof
Other: ----
Finai
PASS PART FAIL -
PLUMBING
Post A Beam
Under Slab
Rough-In
Water Service ----- ----------- __
Sanitary Sewer
Rain Drains - - -- ---
Catch Basin/Manhole
Storm Drain - -- -
Shower Pan
PAS PART FAIL `-
__ HANICAL
Post A Beam
Rough-in
Gas Line
IL Smoke Dampers
p� Final
PASS PART FAIL
ELECTRICAL ---- ^---
Service
Hough-In
UG/Slab
UJ Low Voltage
--� Fire Alarm
Final Reinspection fee of a_ required bofore next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable In inspect-no awes
Fire Supply no
APIA
Appi oach/Sidewalk Daft- Inssreter -
Other:
Final DO 40T REMOVE this Inspeedon rd from the job elite.
PASS PART FAIL
CITY 01 T16ARD — PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00013
13125 SW Hall Blvd.,Tigard, OR 972.23 (503)639-4171 DATE ISSUED: 1113!03
SITE ADDRESS: 071,00 SW OAK ST
PARCEL: 1 S 136AD-02000
SUBDIVISION: VILLA RIDGE ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES-
TUB/SHOWERS: SEWER LINE: tt
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of solar domestic hot water pre-heats stem.
FEES
Owner:
" - Description Date Amount
JOSEPH LEITCH
7000 SW OAK ST (PLUMB]Permit Fee 1/13/03 872..50
TIGARD, OR 97223 [TAX]9%State Tax 1/13/03 85.80
Total $78.30
Phone : 503-293-6034
Contractor:
OWNER
RE(QUI'2ED INSPECTIONS
Prone
Fina! Inspection
Reg#:
A. I
a
ti
U)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
V P y PPI PP
W plans. This permit will expire if woi k is not started within 180 days of issuance, or if worts is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow pules adopted by the Oregon
Issue By: Permittee Signature:
Call(503 39-4175 by 7:00 P.M.for an Inspsction needed thA next business day
PlumbirigPermit Anliea�tio_n Received Plumbing
Datdl3y�� Crib Permit No.: 14t';b(J!r 13
Planning Approval Sewer
City of Tigan Datr/By: _ Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 4A Datr�y_ Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.oi'.us Contact Anis.: N Set Page 2 fur
24-hour inspection Request: 503-639A 175 Name/Nltthod. supplemeutal Information.
OF WORK FE!&•SCHEDULF,(for special tafermadon use i:hecklist
New construction Demolition Description tit,. Ptr{ca.) Tota
Addition/alteration/replacement Other: New l-&2-family dwellings
a
CATEGORY OF CONSTRUCTION (Iadud100 R.for each allllt caeaecttoo
SFR 1 bath 249.20
JAccessory
&.2-Familydwellin CommcrciaUindustrial SFR 2 bath 150.00
Building Multi-Famiy_ SFR 3 bath _ 399.00
aster Builder Other: Each add"ional bath/kitchen 45.00
JOB SiTE INFORMATION and LOCATION Fire sprinkler- it.: Page 2
Job site address: 77vyo S �-✓ � _ �
Suite#: _ �Hld /A t.#: Catch basiniarea drain _ 16.60
g' - cll/leach;ine/trench drain 16.60
Project Name: _^ Footing drain no.linear fl. Pae 2 _
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes _ 16.60
Rain drain connector 16.60
Sanitn sewer no.linear R.) Pae 2 _
Subdivision: Lot M Storm sewer(no.linear R.) Pie 2 __-
Water service(no.linear ft.) Pae 2
Tax map/parcel M
DESCRIPTION OF V�OR1C -_ Abso tion-valve 16.60
�IN-�S--Toll ,S o%r •(0-1rsfi e, d _ Backflow preventei Pt <
&/� --tT -Ar--- Bole 5115 e&%- • �k��f�" Backwater valve v 16-o
wT�r s xfr^- Clothes washer 16.60
Dishwasher ��- 16.60
DrinkinK fountain 16.60
JYMOPERTY T
Y)iCR Ejectors/sump 16.60
Name: .J o;E Qf/ L E(f�"f� _ - Expansion tank _ _ 16.60
Address: Fixture/sewer cap 16.60
City/State/Zip: 7-1JqVA n J 9'" 2 2 3 Floor drain/floor sink/hub 16.60
Garbage disposal 15.60
Phone:.S-O 3 -Z a 3 Fax: Hose bib 16.60
APPLICANT CONTACT P __ ice^raker 1b.60
Name:- _ Interc cod reasc trap 16.60
Address: -� -� -- _ Medical as-value: S e-_- Pe2
_ Primer 16.60
Cit /State/Zi _ -
- _ . - Roof drain commercial) 16.60
4 Phone: Fax: Sink/basin/lavatory 16.60
�- E mail: Tub/shower/shower pan 16.50
W CO RACTOR Urinal _ 16.60
Business Name: Q/,J .- W� _ Water closet 16.60
Water heater 16.60
Address: Other:
Cit /State/Zl - Other: `tJ
_Fax: �{ r t.
Phone: subtotal S
CCB Lic. #: F�'lumb. Lie.#: "- �Minimum Permit Fee 572.50 S
Authorized Resit.ontial Backflow Minimum Fee$36.25 -7 0.
Signature: _____ Date: 3/a _Plan Review 25%of Permit Fee S
State Surcharge 8%of Permit Fee S
(Please print name) _TOTAL PERMIT FEE S
Notice: This permit application explres If a permit Is not obtained within All new commercial buildings require 2 rets of plans wlth Isometric or
180 d-jys after It has been accepted as complete. rber diagram for plan review.
*Fee methodology so by Tri-County Building Industry Service Board.
is\Dsts\Permit Forms\P1mPermitApp.doc 01/03
Piumti_q __Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Uthdtes Qty ' Fee(to) Total Square Foam e; Permit Fee:
Footing drain-I'100' 55.00 0 to $115.00
$160.W
Footing drain-each additional 100' 46.40 2001 io 3,.690 $
_
3,601 to 7,200 $220.00
Sewer-I at 100' 55.00 7 201 and grereater _ $309.00
Sewer-each additional I(kl' 46.40
Water Service-Ist 100' 55.00 Medical Gas stems:
Water Service-each additionat 100' 46.40 Valuation; Permit Fee:
Storm&Rain Drain-I si 10(:' 55.00 $1.00 to$5,000.00 Minimum fer$72.50
Storm&Rain Drain-each additional 100' 46.41) $5,001.00 to$I u.000-00 $72..50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qt Fee(ea) Total _ including$10,000.00.
Commercial Back Flow Prevention Device 46A0 $t0,001.ttu to$25,000.00 $144.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
(minimum permit fee$36.25) 7.55 i and including 525,000.00. _
Rain train,single family dwelling
65q5 $25,001.00 to$50,000 W $379.50 for the first$25,000.00 and$1.45 for
_ each additional$100.00 or fraction thereof,to
Inspection of-existing plumbing or and including$50,0W.00.
---
specially requested inspections-.per hour 72.50 $50,001.00 and up 5742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uantl! bLiFixture Work Performed o menta regarding fixture work:
Fixture Type: Replm e
Now Moved Mx4tle Ca peel -
Baptistry/Font -
Bath -7'ub/Shower _
-Jacuzzi/Whirl i —
Car Wash -Each Stall
-Drive Thru _
Cuspidor/Water Aspirator
Dishwasher Commercial -Domestic
Drinking
Drinkin Fountai t e ��
Eye Wash —
Floor[rain/sink 2"
3'•
4„ --
Car Wash Drain *Note: If the fixture work der this permlt results in an
Garbage Irmrestter — increase of sewer EDLJs,a ser permit will be Issued and
0. Disposal -Commercial
-industrial
fees assessed for the sewer incre f must be paid before the
Ice Mach✓Berri .Drains — plumbing permit can be issued.
f� Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -Gang
,., -Stall
m Sink -Bar/[avatory
-Bradley
W -Commerci.l
-Service —
Swimming Fool Filter
Washer-Clothes
Water Extractor
Water Closet_-Toilet
Urinal
Other Fixtures: _
i:'D>sts\PermitForms\PlmPetmitAppPg2.doc 01/03
CITY OF TIGARD 24-Hour-
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 "
BUP
Received _ ____Date R udsted AM _PM___ _.__ BUR
Location 72�=LQ_ ,.,e _ Suite_- _ MEG
Contact Person - — Ph( ) .2=2 PLM ,3-d O d �3
Contractor_ __ _ Ph(._ ) _ SWR
BUILDING _ Tenant/Owner -- ELC _
Footing ELC —
Foundation Access: -
Fig Drain ELR
Crawl Drain
Slab inspection Notes: SIT
Post&Beam
Shear Anchors —
Ext Sheath/Shear _
Int Sheath/Shear
Framing
Insulation
Drywall Nailing — - —
Firewall
Fire Sprinkler -----
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
FAIL _
LAIMWNG-
Post&Beam
Under Slab —
Rough-In
Water SerAce -
Sanitary Sewer
Rain Drains -- --
Catch Basin/Manhole
Storm DrainShow -- — —
Other: Ppa,r/Or—
PA
r-
Other.y�''��L-
Fi
PA PART FAIL
H%NICAL
Post&Beam
Rough-In —
Gas Line
Smoke Dampers — -- -
Final
PASS PART FAIL — -
ELECTRICAL
Service
Rough-in
UG/Slab
UG/Slab
Low Voltage
Fire Alarm
Final pains rtion fee of$_—__ ___ .required before next ins
PASS PART FAIL l - Pte• Pay at City Hall, 1312E$W Hall Blvd.
SITE r] Please call for reinspection RE: - _-_._. _—_ Unable to inspect- no access
Fire Supply Line
ADA j j�
A roar_h/Sidewalk Dab -- Ilnptrr+�tre�P Eut_
PP —
Other-
Final
therFinal DO NOT REMOVE this inspettlon rmmrd ftm the Job site.
PASS PART FAIL