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11688 SW NACIRA PLACE-1 J w an Co Z n 1� 0 11688 SW Nacira Place CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 INSPECTION DIVISION Business Line: (503) 639-4171 MST - II BLIP -- --- Received —_. ._ Date Requested s 2ffAM— -- PM BLIP _- Location _— � � Suite__-__ _.. .___ MEC . �_ Contact Person __— _ Ph PLM Contractor .___ __ Ph 3WR ------------__.__ BUILDING - Tenant/Owner —_ _ _ _ _ ELC Footing Foundatioi - — ELC _— Ftg Drain Access: ELF! Crawl Drain Slab Inspection Notes: _ - SIT Post&Beam Shear Anchors -- - - -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - Firewall k e- Fire Sprinkler -- Fire Alarm Susp'd Ceiling - -- - — Roof Other: - Final - — PASS PART FAIL - - - -- PLUMBING Post&Beam Under Slab Rough-In Water Service —_- - Sanitary Sower Rain Drains - - Catch Basin/Manhole Storm Drain - - ------- --— Shower Pan Other: _.�---- Final —�— PASS PART FAIL --- —--- _MECHANICAL Post&Beam ------- -- _—._..-------- Rough-In --_----- _ _-_. —_-- ' Gas Line Smoke Dam rs —--------- ---- ---- - ---- &IdA—L PART FAIL Service — - -- --• --- ----- - Rough-In - - - --- - ---__ ----- — UG/Slab Low Voltage _-- Fire Alarm Final F] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RF:_ ____ -_-_--. _-_ Unable to inspect-no access Fire Supply Line ADA Datr1 J� - Inspector 4�1 _ _-_Ext._---- Approach/Sidewalk Other Final -- DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-How BUILDING Inspection Line: (503) 639-4175 MSr INSPECTION DIVISION Business Line: (503) 639-4171 0 / BUP Received _. _D to Requested—._ AM ---- -_ PM - BLIP Location ,. �' LZ-r�(�l.0 s�L _ -_Suite MEC Contact Person Ph(_ _) S! -S �w.Z PI-M Contractor — Ph( ) SWR BUILDING; Tenant/Owner _ — —_ ELC Footing -- Foundation .-. ELC - Access: Ftg Drain L �f ,/ !��( �; ELR Crawl Drain Slab Inspection Notes: SIT - - -- - Post&Beam —^ ----------------- Shear Anchors Ext Sheath/Shear .. In;Sheath/Shear Framing Insulation Drywall Nailing -- Firewall Fire Sprinkler ---- — Fire Alarm Susp'd Ceiling -- - - - Roof . 71 Other: Final , PASS PP RT FAIL--- -�'- PLUMBING _ -- ------------� - Post&Beam Under Slab - -------- ----- ---- Rough-In Water Service -- ------ ---- - Sanitary Sewer Rain Drains -- ---- --- Catch Basin/Manhole Storm Drain - -- - - - Shower Pen Other: --- -- Final - ----- PASS PART FAIL_ - - MECHANICAL Post&Beam Rough-In Gas Lino Smoke Dampers - Final ,110A_ __ T FAIL - - ELECTRICA Roug;rin -- - -- -- - --- UG/Slab Low Voltage -- -- - - - ------ ---- _. - - Fire Alarm In ❑ Reinspection fee of$ regw,Rd before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PARI FAIL bft/ _ 0 Please call for reinspection RE:_ _- _- ❑ Unable to inspect-no access Fire Supply Line ADA � I Approach/Sidewalk Date 1�`d Inspectot Elft -. Other: Final L)0 NOT REMOVE this Inspection rec,.rd `rpm the Job bite. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP —_--__ Received _ Date Requested__ _ AM PM BUP - Location _��–�-il� �_�_ Suite _ _ MEC Contact Person PLM Contractor _ __— Ph(_ _ SWR _ F UILDING — Tenanl/Owner ELC - oting Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT - Post&Beam - Shear Anchors - Ext Sheath/Shear Int Sheath/Shear �- Framing �'� -- ,•a. — --_— Insulation - t --- Drywall NailingFirewall ----- Fire Sprinkler -- Fire Alarm Susp'd Ceiling Roof 4L Other — Fine. rA58 -PART-FAIL ` ,�� • C�� Post&Beam -- Uncle! Slab " Rough-In ��.x -- � ` Water Service Sanitary Sewer __-_ 741 • ��' Rain Drains ---�L.i Catch Basin/Manhole - - Storm Drain ' ---- - ---- Shower Pan Other: ---- ---- ------ -_-___ _-- __.--- FAIL - - - - _- -_ - ---- - - --- --- - W&MI t`ilAl_ - ----_------ ---------- Post&Beam Rough-In - --- -- ----_-�-- Gas Line Srngie Dampers ina A PART FAIL -- - ---------- -------- - ---------- -- - --- _EttCYRICAL Service �---- ------ --- ------- -------- -- ----.__.._-.. Rough-In - --_----- ----------------- --- - - _--- - - UG/Slab Low Voltage FireAlarm --------------- ------------- -------..-_...._W-.---- Final L] Reinspection fee of$__--__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. t ASS PART FAIL SITE - �� Please calf for reinspection RE _. -_-- � Unable to inspect-no access Fire Supply Line ADA � Date _ � Ins actor " --- Approach/Sidewalk P -- ---------!_.-_Ext Other: Final v DO NOT REMOVE this inspection record from the job trite. PASS PART FAIL a n 0 U P 00 oil ~p�rvN ► ► ► CL a CD a o ► 1 � � CD J a ► a � � � ► \J ° omw ► a � ► a P i L___ rvvrevvvvvvvvvv-- ♦vivv vvvvvvvviv ►vvvvvvivvvvl a• q o z s �0 a ` � `� 0 e olo O a o � a � a� n 0 0 a• CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST ` bDoZ INSPECTION DIVISION Business Line: 1503) 639-4171 BUP _ _ - Received ___ Date Requested _._ 3 AM- _ PM BUP Location _ l g �� Suite -___ _ MEC Contact Person � �/Lr�]� Ph( ) _`D `1 5 �'�.�- PLM Contractor ----. Ph(_ ) SWR BUILDING Tenant/Owner _ - ______.______ - ELC Footing ELC FoundationAccess: Ftg Drain L rELR Crawl Drain SII Slab Inspection Notes: - Post&Beam -__-- - Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing -- - _ - ---- - Insulation Drvv.-all mailing - ---- irewall Fire Sprinkler -- F1,e Alarm Susp'd Ceiling -- Roof Other: -- - ina --- _-- - JPCSS_/l PART FAIL RQWNG ---- -- ------ - - Post&Beam Under Slab - -- ---- -_- _�- Rough-in Water Service --- -- ---- - - -------- Sanitary Sewer Rain Drains -- -- - --- -- Catch Basin/Manhole > Storm Drain - - -- - -- Shower Pan Other: --•----- -- --- - -- -- -- - Final PASS PART FAIL - - MECHANICAL --� _- -- --- ----- Post&Beam — Rough-In ----- — ----------- ------ Gas Line Smoke Dampers - -- --------- - Final PASS PART_ FAIL -'- - - --- -- --- ELECTRICAL Service Rough-In UG/Slab Low Voltage - Fire Alarm Final F� Reinspection fee of$--- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE _—_-_ Please call for reinspection RE: -_ - _ Unable to inspect-no access Fire Supply Line AD.A Approach/Sidewalk ��- Other Finai DO MOT REMOVE this Inspection record from tate job site. PASS PART FAIL CITY OF T I w A R D ___�_ MASTER PERMIT (�,+� PERMIT#: MS'r2002-00201 DEVELOPMENT SERVICES DATE ISSUED: 4/29/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4'171 SITE ADDRESS: 11688 SW NACIRA PL PARCEL: 1S135CD-NP008 SUBDIVISION: NACIRA PARK ZONING: R-4.5 BLOCK: LOT: 008 JURISDICTION: TIG REMARKS: New SF detached, Path 1. BUILDING REISSUE: STORIES. 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 29 FIRST: 097 of BASEMENT: of^ LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1 I Vi of GARAGE: 45D sf FRONT: 42 PARKING SPACES: TYPE OF CONST: 6N DWELLING UNITS: 1 FINSSMENT: of RIGHT: 15 VALUE: $196,707.6(1 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,040 00 of REAR: 44 PLUMBING SINKS: I WATER CLOSETS: 3 WASHING MACH. 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATnniE8: 4 DISHWASHERS. I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS. OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIUCMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS rURN>■t00K: 1 UNIT HEATERS: HOODS: I OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOOOSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT_ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'( INSPECTIONS 1000 9F OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: I PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 600SF: 3 201 400 amp: 201 400 amo: Tal W/O SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERG Y: 401 600 amp: 401 600 amp: EA ADDL SR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVC/FDR: 601 1000 amp: 601•amps•1000v: MINOR LABEL: 1000•amolvolt _ PLAN REVIEW SECTION _ Reconnect only: —— >.4 11 IINITI: SVCIFDR> 226 1. 600 V NOMINAL. CLS AREA/SPC OCC ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL _ B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYStEM: AUL ' K ATEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS. TOTAL M SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,823.69 INTERLOCKING ENTERPRISES INC INTERLOCKING ENTERPRISES INC This permit is al Codject , the regulations contained in the 10740 NW CORNELIUS PASS RD 10740 NW CORNELIUS PASS RD Tigard Municipal Code.State o OR Specialty Codes and PORTLAND,OR 97231 PORTLAND,OR 97231 all other applicable laws All work will be done it 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: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Repel: LIC 000902;; 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 Insp& Post/Beam Mechanica Mechanical Insp Exterior Sheathing Insl Rain drain Insp Plumb Final Sewer Inspection Underfloor Insulation Plumb Top Out Low Voltage Water Line Insp Final inspection Fooling Insp Crawl Drain/Backwater Electrical Service Gas Line Insp Appr/Sdwlk Insp Foundation Insp Footing/Foundation Dri Electrical Rough In Gas Fireplace Electrical Final Post/Beam Structural PLM/Underfloor Sheaf Wall Insp Insulation Insp Mechanical Final Issued By :'i "t I- >l E{ cl<. � :.f �_. Permittee Signature Call (503) 639-4175 by 7:00 p.m for an inspection needed the next business day CITYOF TIGAR® _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00142 -� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/29/02 SITE ADDRESS; 11688 SW NACIRA PL PARCEL: 1S135CD-NP008 SUBDIVISION: NACIRA PARK ZONING: R-4.5 BLOCK: LOT: 008 JURISDICTION: TIG TENANT NAME: USA NO' FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: � TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: L-fPSWR IMPERV SURFACE: Remarks, Sewer connection for new SF detached. Own3r: ----�__ FEES 10740 NW CORNELIUS PASS RD -�_�- — INTERLOCKING ENTERPRISES INC Type By Date Amount Receipt — PORTLAND,OR 97231 PRMT CTR 4129/02 $2,300.00 27200200000 INSP CTR 4/29/02 $35.00 27200200000 Phone: 503-531-3635 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 180 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 prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by calling(503) 246-1987. Issued by: T� : L; -c cc: Jr c Permittee Signature: Call (503) 639-4175 by 7.00 P.M. for an inspection needed the next business day TbdSr� Boding Permit Application City of 'Tigard Date received:' l' O;Z Permit no.:NS%arm W Address: 13125 SW Hall Blvd,Tigard,OR 972230)ecUappl.no.: Expire date: Phone: (503) 639-4171 Date issued: y Receipt no.: Fax: (503)598-1960 Case file no.: Payment type: Land use approval _ I&2 family Simple Complex: f �l 1 &2 family dwelling or accessory U Commercial/industrial U Multi lanuly Y+New construction U Demolition ff U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: J011SITE INOORMAI Joh address: jb S,Vj. NIU,i'raBldg.no.: Suite no.: LoR t: *- Block: _Subdivision: Tax map/tax lot/account no.: fS 13� Project name: , r -- — — Description and location of work on premiscs/special conditions: 0%%NFI? I OR SMA 1M. INFORMATION, USE' (1111 kIJSI Name:' 1solar, n — Mailing address: ,_ . 1 & 2 fandlt dNellilig: Cit � / / �u ' City: State ZIP: Valuation of work..........( �v 7t� r..7r...... $ f z..5.. Phon 3 mail: No.of bedrooms/baths......i ..... Owlter's%representative: �C f ' ,r\ --- Total number of floors........Z'............. . _—_dL- PI r - ax: ' - C mail: New dwelling area(sq. ft.) U p .. ... Garage/carport area(sq.ft.)... � Name: - Covered porch area(sq.ft.) .. _ --, c CCrnr,E, £N7l�ti�.t�c•S .Z/VG.. ....., Mailing address: r Deck area(sq. ft.) .. ............................. .. ... —.— --- City: State: ZIP: Other structure area i�ti,fl.)... ............ Phone: I Fax: 7-*551 E-mail: ('omniercial/industrial/multi-family: — Valuation of work ...................................... $ Existing bldg.area(sq.ft.) ................... ..... Business name:J.,,��((• � � ,r � � �- ,t Address: t ' New bldg.area(sq. ft.) ........... . ...... .......... ------------ Cit State ZIP: 3 fj Number o .............. .......f stories....................... ...................... Pax: Phut - _c r Type of construction ... .. _ :mail: CCB no.: -- 90ZM ----- Occupancy group(s): F,xis _ Ne ----- c'ity/metro lies nu" Notice:All contractors and sub Lontractors are required to be licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may he required to he licensed in the Address: jurisdiction where work is being performed. If the applicant is Cit �— State: exempt from licensing.the following reason applies: Contact person:-T?rp, J,acWl,nre t'lanno.: ;2C7 Q — -_ --- "b3 Phone:15"/q 74 f-- I t►x:07-9/t'5- E-mail: - Name: 5( PTW Contact person: Fees due upon application ........................... $ _ Address: I Dace received: City: _ State: I.IP: Amount received ......................................... $ _ Phone: Fax: E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Noi all Judsc halm accept rmdii cards,please can Jurisdktion ffx mvxe information attached checklist.All provisions of laws and ordinances governing this U Visa U MasterCard work will he complied wi ,whe to a in or not. opal card number------- `n O� Expires Authorized signature:"SX,( a!r Date: r4 arae al u shown on nrdit card Print name: J e Z ci - s C der dputttte _Amounr Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. gA1Pu14 MYWOM) Commercial flan Submittal Requirement Matrix Cit.r u/'7i and TYPE SOF SUBMITTAL # of Plans (Includes New, Additions or Alterations) Required at Submittal Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities 2 11 Building 1* Fire Protection System 3** Mechanical 2 Plumbing - Building Fixtures 2 Electrical 2 Plan review is dependent upon suhmittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over-the-counter commercial tenant improvements, submit 2 sets of plans **"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i kists\forms\COM-matrix.doc 9/24/01 a a. Plumbing Permit Application I)atereceived:�( 8 00- Permit n o.:Cit of Tigard g Sewer permit no.: Building Addresri: 13125 SW Hall Illvcl,'I iitard,(1R 97223 City of Tigard Phone: (503) 639-4171 l'roject/appl.no.: Expire d Fax: (503) 598-1960 Date issued: By: Land use approval: _ Case file no.: Payment type: III WOOL 10 X"Jim I &2 family dwelling or accessory 0 Commercial/industrial ❑Multi-family ._1 I enant improvement New construction 0 Addition/alteration/replacement U Food service J r hher: t Job address: r U)G fa. , Ilescription Q Fee(ea.) Total Bldg,no.: _J Suite no.: N,'ti I xnd Z family dwellings only: (includes 100 ft.fure�rchutilityconnection) Tax map/tax lot/account no.: SFR(1)bath Lot: # Block: I Subdivision: . r& SFR(2)bath --- - - Project name: NJ,1c.1r4 SFR(3)bath _ City/county: LIP: Each additional bath/kitchen Description and location of rk on premises:, /0CW — Siteutilities: _ Catch basin/area drain Est.date of completion/inspection v 11 z" Drywells/leach line/trench drainglim _ F'cxwting drain(no.lin. ft.) Manufactured home utilities Business name: �' �C_ __ Manholes Address: l, Rain drain connector City: State: ZIP: Sanitary sewer(no.lin. ft )_�— -_- -� ---_- ---- Fax: E-mail: Storm sewer(no. lin.ft.) CCB no.: Z Plumb.bus.reg.no:, Water service(no.lin. ft.) Cityhnetm lie.no,: Fixture or Item: Contractor's representative signature: Absorption valve —�-- --- Back flow prevcnter Print name: L2L r.Z 11):ute: 1p9 OZ� Backwater valve t Basins/lavatory Nary _: ' 'y I ^Iothes washer Dishwasher Address: O dfE) Drinking fountain(s) _ city: State- ZIP: 4r? i Ejectors/sump _ Ph 5 c I E-mail I Expansion lank Fixture/sewer cap _ Floor drains/floor sinks/hub _ Name(print Garbage disposal I� Mailing addmss: j ; , � Hose Bibb — r City:7 �y State: ZIP: Ice maker Ph e' C ' � x.�7- mail: Interceptor/grease trap Owner installation/residential maintenarr^c only: The actual installation Primers) _ will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _ employee on the pmpetty I own as per ORS Chapter 447. Sin (s),hasin(s),lays(s) Oiwfiiw�= Date: Sump — Tubs/shower/shower pan _ Urinal Water closet -- — Address: Water heater City: State: ZIP: Other: �- Rhone: Fax: E-mail: Total Not dl furisdicNono srcept credit can&,pleare call)urirdiction fca m dr inronrution. Notice:This permit application Minimum fee................$ __--- O�iss U MuterCard expires if a permit is not obtained Plan review(at _ %) $ Credit card number: — within 180 days after it has been State surcharge(8%)....$ _ apirer TOTAL.......................S New orardh colder to Swivn on ciedir crd — accepted as complete. _ S ('"older sipatute Mimi 440-4616(60WOCOM) OLUMBING PERMIT FEES: - PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (Individual) CITY (ea) AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 - the dwelling and the first100 ft. QTY (ea) AMOUNT 16.60 -- for each utility connection Lavatory One 1 bath $249.20 Tub or Tub/Shower Comb 16.60 Two(2)bath _ $350.00 Shower Only 16.60 Three(3)bath $399.00 _ via;er Closet 16.60 SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 q^ 16.60 -- -- ---- �Quantity b Work Performed Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed/ Gas piping requires a separate mechanical Capped permit. -- -- MFG Home New Water Service 4640 Sink _ MFG Home Now San/Storm Sewer 46.40 Lavato _ _ Tub or Tub/Shower Hose Bibs 1660 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet _ Urinal Other Fixtures(Specify) 16.60 Dishwasher Garbage Disposal _ Laundry Room Tray Washing Machine - _ Floor Drain/Sink: 2" _ sewer-1st 100' 55.00 3" Sewer-each additional 100' 46.40 4" Water Ser.. +sf 100' 55.00 Water Heater Other Fixtures Wate!3 ,vice ne h additional 200' 4640 S eci Y- Stom,X Rain Drain- 1 at 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 - Residential Backnow Prevention Device' 27.55 Catch Basin 16.60 - Inspection of F xisting Plumbing or Specially 62.50 Re nested Inspectionsper/hr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 ---- QUANTITY TOTAL Isometric or riser diagram Is required H OuantR Tolai Is >g _, - *SUBTOTAL -----�-- 8e/a STATE SURCHARGE ;'*-FLAN REVIEW 25°/s OF SUBTOTAL _ Re aired onl -A it fixture gt�total Is>N _ TOTAL S Minimum permit fee Is$72 50-a%state surcharge,except Residential Backflow Pre,on!inn Device,which Is$:16.25+8%state surcharge. "All New Cnmmercial&rildings require 2 sets of plans wHh Isometric or riser diagram for plan review. l:\flsts\forms\plm-fees.doc 12/26/01 `�Vj- ,g"t,:2-Ob10- Electrical Permit application �Iljatcreceived:o/ /o'► o?- Permit no.�'0%6000 City of Tigard Project/appl.no. Expuc date: ('urt(IY�un/ Address: 13125 SW Half !Ilvd,Tigard,OR 97223 Date issued: By: I Receipt no, Phone: (503) 639-4171 - Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: TYPE Of xl 1 ,t 2 family dwelling or accessory U Commercial/industrial J Multi-family U Tenant improvement K'. �k cul,struction U Addition/alteration/replacemt-i J Other: _ U Partial JOB SITE INFORMATION Joh address:I) S yJ. ( L, -rr Bldg. uu.:_ Suite no.: Tax map/tax lot/account nu.: 1 Block: Subdivision Protect namr'e; Description and location of work on premises;; /Jct -i Estimated date of cun)pletion/ins ection• UV62 SC,1I`EDULF Job no: 7771 Business name: S _ IAscription Qty. no.fns New residential-sirgk or multi lantily per Address: J .r — dnelllnRunit.Inchrdesattaclvvdtaragr. City: "( , Stale:00_ 7.11': Seniceinciuded: Phone: (,; $-S Fax:`IG` : ) E-mail: - IUlNlsy fl or less a Lach additional 5(x1 sq.ft.or portut thereof CCF no.: 10 1 a = Clec.bus.lic.no: A-/-y o'�r~ 2 � _ Limuedenergy,residenual Cilyhnetro lic•.Tno.: ��;� � `K lye Ltmnedener y,non-residential 2 FAch manufactured home or modular dwelling Signature of s ery 1 electrician(requiredl Dale _ Service and/or feeder 2 L 1 I.iccnsent, �r-� Services or feeder-hmallallon, SU, elect naine(print): alteration orrylocal ion: 21x1 amps or less 2 Name(print): 201 amps to 400 amps �� 2 — — 401 arnp:to 600 amps ___ _ 2 Mailing address: ��{�- 601 amps to 1(x)0 amps 2 Stallr1':CilY i l ��al Uver1000ampsorvolts --— r Al - Fax: H- ail: Reconnectonl y _ Ov�nt Istallatiun:The installation is being made on property I own Iemporaryservicesorfeeden- Installation,alteration,or relocation: sahlch Is not intended for sale, tense,rent,or exchange according to 2 201 amps less ORS 447,455,479,670,701 2 2111 amto strips to 400 amps (hvtler's Si suture: f)a1C; 401 to 600 ams -' f Branch cirruils-nesv,alteration. Ms- or extension per panel: Name �r .t — �— --- A Fee for branch circuits with purchase of Address: FL service or feeder fee,each branch circuli 2 City; Sale: ZIP: H Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: Fax' F.-mall' Fac:,ndditional branch circuit Misc.(Service or feeder not Included): 7,,lydw�l'l amps•commercial J Health careto i Each pump or tmgauun circle - amps-raungof 1&2 U Hazardouslo,,w,,,t Each signor outline lighting U Building over 10.(x)0 square feet four or Signal circuit(s)or a limited energy panel. volts nominal more residential units in one structure alleration,or CE tension, J Huddingover three stories U Feeders.400 amps armore *Desert ion J t kcupant load over 99 persons U Manufactured structures or RV park FAch additional Inspection over the allowable in any of the above: _ J I,gresv/hghungplan J 0111cr _ _--- Pci 111ye'non i Submit.__sets of plans with any of the above. Investugatun Ice The above are not applicable to temporary construction service` tither Nor all pusah.-tions rtccept credit cards,pteaw call tun.xiiction fa more Information. Notice 'I'his permit application Permit fee.....................$ ,]VISA U MasterCard expires if a pernti(is not obtained Plan review(al v 9E) $ credit cud number1— within 180 days after it has been State surcharge(8%) .... Apirea accepted as complete. TOTAL None of c—ar�r u s own on r it cud s Cardlickler signature Anaunt 440-41,IS nnlun'vivl Mechanical Permit Application "Datercceived: City of Tigard Projecvappl.no.: Expire date: C'ityof!'igard Address: 13125 SW Hall Blvd,Tigard,OR 97221 --- - - Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) .598-1960 Case file no.: Payment type: Land use approval: L Building permit no.. 1 1 &2 family dwelling or accessory U Commercial/indusliutl U Multi-family U1'enant improvenient bd New construction U Addition/alteration/replacement U Other: _ JOB SITE INFORMATiON COMMERCIAL VALUAT120INS1 Joh address: t ra UIndicate 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.: / 33-Q profit. Value$ Lett: CPA, JBIock: Subdivision: *See checklist for important application information and Project name: t ' _ 'P r jurisdiction's fee schedule for residential permit fee. City/county: 'LIP: c17 aSCHEDULE Description and kwnlion ork on premises:_11 CIIJ _ 1 i cr(ss.) !oral Est.date of completion/inspJaz Ikscripljou "y. Res.onlr Res.onh Tel ant improvement or change of use: Air handling unit NIf] Is existing space heated or conditioned''U Yes VNo it conditioning(site plan required) — -- 1 Is existing space intitdaled•t U Yc� Y No tern ion or fexisting HVAC system Boiler/compressors Business name: State boiler permit no.: __ HI Tons BTU/H Address: ? tare smo a camper. uct smo a detectors City; State LIP: �jQ eat pump(sate plan require ) Phone:.' G mail' i. tall/rep ace urnace/hurncr Pax: rJ Including ductwork/vent liner U Yes U No CCB no.: I a%taII replace/re locate heaters-suspended. City/metro lic.no.: IL-) wall,or floor mounted Name(please print): 1 Vent for a t— tan 'u ncc other t rnace Refrigeration: Absorption units _ BTU/H Name: t t'hillcrs- __ HP Cum ressors _ �_ HP _ Address: ` ( nr ron:nenta ex ausi and ventilation: Cit Slate 1 LIP:C Appliance vent _� Ph �• < Fax: E-mail: Dryc--rexhaust _ -Ilaro s, ype res. itches T/iazinat hood fire suppression system Name: 1 t Exhaust fan with single duct(bath fans) — Mailing address: 4 Exhaust System a% from tcatfn or AC (''t Stale ZIP: 'tic piping an sir tuilon(upto out eLs) Y: 2- Type: __LI'(; __ NO Oil ax: -mail: arc _!Eing each additional over 4 outlets ILION Process piping(sc sematic require ) Number of outlets Name: Other limed app once or equ--Fpmeot:-` - -- - Address: ' PM Decorative fireplace _ City: I State: ZIP: Insert- type oodstov pe etatove Phone: Fax: E-mail: O t er: Applicant's signature: t .r ter: Nmne (print): Not all jurisdictions accept credit cards pieaw call jtabdicti tate mire Iniorrttaaon. Ile-mit fee.....................$ _ U van U Mnstet(oval Notice:This permit application A lir',num fee................$ _ expires if a permit is not obtained F an review(at ._ %) $ Ordit cad numhet: �_—_ — ---1� widen ISO days alter it has been eariret y State surcharge(896)....$ ecce ted as complete. —� - —Name cardholder u shown on credit c t P P TOTAL .......................$ —_— Cardholder signature Amoaol 110-4617(6WCOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description: Pylae Total - � Table 1A Mechanical Code O (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$5,000.0-0-a n_dincluding ducts&vents 14.00 $1.52 for each additional$100.00 or 2 1 -- BTU+ fraction thereof,to and inClULing ) Furnace ducts&vents 17.40 $10,000.00. $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 includin vent 14.00 fraction thereof,to and Including 4) Suspended heater,wall heater $25,000.00, or floor mounted heater 1400 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included in appliance permit 6.80 $1.4.5 for each additional$100.00 or _ fraction thereof,to and Including 6) Repair units 12 15 $50,000.00. _ -- 150,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boder He:jt Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Gond Comp fraction thereof. footnotes below. _ 1A0 7)<3HP;absorb unit lnimum Permit Fee$72.5SUBTOTAL: $ Y to 100K BTU 14 00 8%State Surcharge $ 8)it 15 k t absorb unit 100k to 500k BTU 25.80 25%Plan Review Fee(of subtotal) $ 9) HP;absorb unit .5-1.5-1 mil BTU 35.00 Reyuiro for ALL commercial permits only - 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 11) ,50HP;absorb unit>1.75 mil BTU 87.20 12)Air handling unit to 10,000 CFM ASSUMED VALUATIONS PER APPLIANCE: 1000 Value Total 13)Air handling unit 10,000 CFM+ Description: _ QtyEa Amount 41 .So7.20 _ Fumaee to 100,000 BTU,Including 955 14)Non-portable evaporate cooler ducts&vents -7 0 00Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents Floor furnace Including vent 955 16)Ventilation system not Included in Suspended heater,wall heater or 955 appliance permit 10.00 floor mounted heater 17)Hood served by mechanical exhaust Vent not included In appliance 445 10.00 rmit 805 18)Domestic incinerators 17.40 Repair units <3 hp;absorb.unit, 955 19)Commer�.lal or industrial type Incinerator to 100k BTU 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,including wood stoves 101k to 500k BTU 1000 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets mil.BTU _ _ 5-T 40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU _ 1.00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mil.BTU ---- _ Alr handling unit to 10,000 aim 656 - 8%State Surcharge $ Air handling unit>10,000 cfm 1,170 Non ortable eve rate cooler 656 ----- NOTALRESIDINTIAL PERMIT FEE: $ Vent fan connected to a sin le duct 446 - Vent system not included In 656 - a Ilenoejermit - Other ns�jlons and Fees: Hood served by mechanical exhaust 858 1 Inspections outside of normal business hours(minimum charge-two hours) Domestic Incinerator 1.170 T_ $62 50 per hour Commerdal or industrial Indnerator _ 4,590 _ 2 Inspections for which no ler Is specifically Indicated (minimum charge half hour) Other unit,including wood stoves, 656 S1,2 5o per hour 0Sert3yetC. _ _ ___ 3 Additional plan review required by changes,additions or revisions to plans(minimum Gas plpinQ 1-4 outlets 360 charge-one-half hour)582.50 per hour Each h additional Outlet - 63 --- *State Contractor Boller certification required for units>200k BTU. - **Residential A/C requires site plan showing placement of unit. TOTAL COMMERCIAL- $ VALUATION: _ _____ All New Commercial Buildings require 2 sets of plans. I\dsts\forms\ tectl-fees.doC 12/26/01 i - n - N_ 1�— -•— — -- ------ — AIC _ I M 62' -1 (�%• t --1 HA s Sr�e�r ��t aU• M 91.5 6 �`¢Q • UJ NNW tit , _ '`' j �- 7871 SCJ. f o � Z2,lf.0 ' k R /� r N `rwn be. 97223 Nf}aO) 4oeK C1+tT1P/�ie13C-3 Iiv[. . /-OT 503- S�9 Z CCL ("rc&Y) A X Lot 50-6- 5 31. 3 6 35 oFfsze -1=z D ►At'1Vw"e� �S13SC,b a��rlrh