9660 SW NACIRA LANE NI "IOVN AiS 0996
z
a
a _
U
io N
13
W
J �
G'7
96f;rj SW NACIRA LN
.5 I
V !
Y
I
O
F�
�i
U �
F
v
o, r
LO
ca z w c
to
N
tel .
CITY OF TIGARD �- MAS'TERPERMIT
I
DEVELOPMENT SERVICES DATE ISSUED: 10/8/03
0 -OU446
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171
SITE ADDRESS: 09660 SW NACIRA LN PARCEL: 1S135CD-GP009
SUBDIVISION: GRFE14BURG PINES ZONING: R-4.5
BLOCK: LOT: 001) JURISDICTION: TIG
REMARKS: Const. of new SF detached residence.
BUILDING
REISSUE: MAS2164 S10RIES: 1 FLOOR AREAS �- REQUIRED SETBACKS REWRED
CLASS OF WORK: Nr'uV HEIGHT: 22 :.P%T: 1"76 of BASEMEN 1 of LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SP FLOOR LOA 3: 40 1,205 of GARAGE: SOF of FRONT: PARKING':PACES:
'7YPE OF CONST: 5N DWELLING UNITS: 1 THRID of RIGIfT: 5
44 2
OCCUPANCY GRP: R3 BORM: 7 BATH: 3 TOTAL: 2,481 of VALUF: 241,60REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: PAIN DRAIN: 100 TRAPS:
'AVATCRIES: 4 DISHWASHERS. 1 FLOnR DRAINS. SEWER LINES: 100 SF 4AIN DRIUNS: 1 CATCH BASINS:
rUB13HOWERS: 3 GARBAGE DISP: i WATER HEATERS: 1 WATER LINES: 100 BCKF.W PRFvNTR: GREASE TRAPS:
OTHER FIXTURES:
'MECHANICAL
FUEL TYPES FURN<100K BOIL ICMP,3HP: VENT FANS- 4 CLOT14ES DRYER: 1
GAS FURN>•100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
REoiDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS _BRANCH CIRCUITS _MISCELLANEOUS ADD'L INSPECTIONS _
10017SF OR LESS: 1 0 - 200 amp: 0 -200 amp. WISVC OR FOR: PUMP6RRIGATION: PER INSPECTION.
EA ADD'L SODSF: 4 201 400 amp 201 - 400 amp: 1st WID SVCIFDR: SIGNICUT LIN LT: PER'40UR:
LIMITED ENERGY: 401 600 amp: 401 - 660 amp: EAADDL.BR CIR: SIGNAUPANEL• IN PLANT:
MANU HIWSVCIFDR: 601 - 1000 amp601+anpa-1000x. MINOR LABEL:
1000-amplyoH
PLAN REVIEW SECTION
Reconrxct only:
1R4 RES UNITS: SVC/FDR>=225 A.: >600 V NOMINAL CLS AREAIf;oC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL. B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM- AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING: OUTrgOR LNDSC I.T:
BURGLAR ALARM: OTH: BOIL ER: HVAC: LANDSCAPEARRIG: P90TECTIVE SIONL:
GARAGE OPENEP: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA(TELE COMM: NURSE CALLS: TOTAL.p SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,537.63
This permit is subject to the regulations contained in the
VISTA NW VISTA NORTHWEST INC Tigard Municipal Code,State,of OR. Specialty Codes and
PO BOX 91459 PO BOX 91459 all other applicable la, York will be done In
PORTLAND,OR 97291 PORTLAND„OR 97291 accordance with ap ns. This permit will expire If
work is not started% !ays of Issuance,or if the
a work is suspended It an 180 days. ATTENTION:
Oregon law requires y�. 3 follow rules adopted by the
Phone: 503-531-051 5PAO-: 503-531-0505 Oregon UtlityNotiflcatlun Center. Those rules are set
forth in OAR 952-001.0010 through 952-001-0090. You
/wv
Roo"' LIC 75507 may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
1110 *' REQUIRED INSPECTIONS
LUErosion Control Insp 8, Post/Beam Mechanica' Plumb Top Out Exterior Sheathing Inst Storm drain Insp Mechanical Final
Sewer Inspection 0nderfloor insulation Electrical Service ,as I-ine Insp Water Line Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Rough In Gas FII-eplace Water Service Insp BL,ilding Final
Foundation Insp PI-M/Underfloor Framing Insp Insulation Insp Appr/Sdwlk Insp
Post/Beam Structural Mechanical Insp Sheor Wall Insp Rain drain Insp Ela^Mca Final ,
r
Issued By : "cw _ Permittee Signature : �4.6
Call (503) 639-4175 by 7:00 p.m.for an Inspection needed the next business day
CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#.-, SWR2003-00332
13125 SW Nall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 10/8103
PARCEL: 1 S 135CD-GP009
SITE ADDRESS; 09660 SW NACIRA LN
SUBDIVISION: GREENBURG PINI{S TONING: R-4.5
BLOCK: LOT: 001) JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO.OF BUILDINGS:
INSTALL_TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF dwelling.
Owner: _ _----� _ FEES
VISTA NW
PO BOX 91459 Description — Date Amount
--
PORTLAND,OR 97291 [SWUSA]Swr Connect 10/8/03 $2,400.00
[SWUSA]Swr Connect 10/8/03 $0.00
Phone: 303-531-0505 [SWINSP]Swr Inspect 10/8/03 : 35.00
[SWINSP]Swt Inspect 10/8/03 $0.00
Contractor:
— — Total $2,435.00
Phone:
Reg#:
Required Inspections T �_
a
to
m This Applicant agrees to comply with all the,ules, and regulations of the Clean Water Services. The permit expires 180
Wdays from the date issued. The total amount paid will be forfeited if the permit expires. The A(jency does not guarantee
the accuracy of the side sewer laterals. tf 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' Perm
Permittee Signature:
—
Issued by �� —���G 9
Call (503)635-4175 by 7:00 P.M.for nn In•.poction needed the next business day
o.
tpal
?-a�-'VX I�
Building Permit Application ReceiveBuilding .,,, �
R f ; 1 Date/B Permit 1 l c 0
�� \ 1 Planning Other
City of Tigard �te/tiy: _ PermitNo. ��e?C?�fOO .
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 /1� vete/e r permit No:
Phone: 503-639-4171 Fax: 503-596-1Lfq,f t PosaRev:ew Land Use -
Date/B�___� Jr p Case No.
lnterneInternet: wp w.ci.tigarl d.or.us Y�I-pContact - See Page 2 for
24-hour Inspection Reguest: 503-639 Narne/Methed: — Supplemental Information
TYPE OF WORK REQUIRED DATA: !Y
Ll New construction I F1 Demolition I&2 FAMILY DWELLING
Ad-lition/alteration/replacement Other:
�U
CATEGORY OFCONSTRUCTION Nate: Permit few are based on the total value of the work performed. Indicate
1 &2-Family dwelling Commercial/Industrial the value(rut-nded to the nearest dollar)of all equipment,materials,Isibor,
overhead and profit for the work indicated on this application.
Accesses Building Multi-Family
Valuation...................................................... .. S Z�l�.�
Master Builder Other: C
- No.of bedrooms: No.of baths: _
JOB_StTE INFORMATION and
Job site address:� >�' Total number of floors........................:..::..:..... Z
New dwelling area(sq.ft.)................ Z�
Suite#: 131dg./Apt.#:—-- —_ Garage/carport area(sq.ft.)............................
Project Name: Covered porch area(sq.ft.)............................. .� X Q —
--
— Deck area(sq.R.)...........................................
Cross street/Dlrections to fob site:
Other structure area(sq.ft.)......................... r _
-.__----^— REQUIRED DATA:
COMMERCIAL-USE CHECKLIST
Subdivision:
rim me / arcel#: , /5/:�r - Note: Permit fees•are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials.labor,
overhead and profit for the work indicated on this application.
Valuation................................................... .... S
_ - -
-- Existing building area(sq.ft.)....... .... ........ __-
-- _ New building gree(sq. ft.).............. _
Number of stories....................... ........ .......
ff
OWNER • T Type of construction............. .....
Name: Occupancy group(s): Existing: _
New: --
Address: '
Cit /State/7.i : ' �J�'�-�`•- —
���/��� Fax: NorICE: All contactors and subcontractors are required to be
Phone: , licensed with the Cregon Construction Contractors Board under
APPLICANT _-_ , CONTACT'•, 'ON— provi,ions of 011701 and may be required to be li insed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: _-- from licensing,the following reason applies:
Address: --
LL ('it /State/Zip:
c -- ---- J_ --
Phone: Fax: _-
-- --- BUILDING PERMIT F,, ,
�- E-mail:
Ple.:;.�rs;r t0 fee ached �•�
CONTRACTOR
--
m Business Name: p�f} j�Q _ — Fees due upon application...... S�
la Address:
lu — -- —. -- Amount received............................................. S`_,
-J Cit /StateiZl : _
Phone: Fax: Date received:
CCB Lic. ---
Authorized3 Notice: This permit application cI:plres If a p�rmlt Is not obtained within
Signature: ail: ' Igo days after it has Been accepted as complete.
_ •Fee methodology set by-rrl--ouniv Building Industry Strvice Board.
(Please print name)
is\Dsts\Permit Forms\BldgPermitApp.doc 01103
One-and Two-Family Dwelling
Building Permit Application Checklist Referorcene_
Associated permits:
CJrynj'/Ygard i
City of Tigard L]Electrical U Plumbing U Mechanical
Address: 13125 SW Itall l lvd,Tipi d OR 97213 UOthcr.
Phone: (503) 639 4171 — —�
Fax: (503) 598-1960
'1111i to LOWIN111- VIV 'AF,(Jn'1PED 1:011.01 AN ill-A'11 1111'
I IAnd use eetions completed.See jurisdiction criteria f r crnicunent reviews.
2 Loning.Flood plain.solar balance points,seismic soil designation,historic district,etc.
3 Verlficatlol�of approved platflot.
4 Fire district, ^approval required.
5 Septic system lkrmit or at uit,ivation for remodel •xisting system capacity
6 Sower permit.
7 Water district app vai.
3 Soils report.Must ca§original applicable stank and signature on file or with application. _
9 Erosion cantrol.0 planO permit required.Inc de drainage-way protection,alit fence design and location of
catch-basin protection,etc.
10 —L Compete sets of legii4e plans.Must be rawn to scale,showing conformance to applicable local and state
building codes. Lateral design etails and con ections must be its-orporated into the plans or on a separate full-size
sheet atta.hed to the plans with ss referen s between plan location and details.Plan review cannot be completed �=
if copyright violations exist.
I I Sitelplot plan drawn to Rrale.The p n must how lot and building setback dimensions;property comer elevations(if
there is more dean a 4-It.elevation diffe .ntia plan must show contour line.,at 2-ft.intervals);location of easements and
driveway;footprint of structure(includia ks);location of wells/septic systems;utility locations;direction indicator;lot
area;building covfrage area;percentage of verage;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimension%,and its,any hold-downs and reinforcing pads,connection details,vent
size and location.
I3 Floor plans.Show all ucnsions,room.aentifi tion,window size,location of smoke detectors,water heaver,
furnace,ventilation fans,plumbing fixtu s,balcoplks and decks 30 inches aboverag de,etc.
14 Crom section(s)and Jetalls.Show all f ming-mem sizes and spacing such as floor trams,headers,joists,sub-floor,
wall construction,roof construction.Mu than one cross effort may be required to clearly portray construction.Show
details of all wall and roof sheathing, rng,roof slope,ce 'ng height,siding material,footings and foundation,stairs, /
fireplace construction, thermal insulati ,etc. _
15 Elevation views.Provide elevations fc#new construction;minhRumof two elevations for additions and reruxiels.
Exterior elevations must reflect the ac al grade if the change in gTkade is greater than four foot at building-nvelope.
Full-size sheet addendums showing f ndation elevations with crosVIeferences are acceptable.
16 Wcrll bracing(prescriptive path)an /or latera!analysis plans.Mu. indicate details and locations;for
non-prescriptive path analysis provid specifications and calculations to gineering standards.
17 Floorlroof framing.Provide plans 11
r all floors/roof assemblies,indicatin member sizing,spacing,and bearing
locations.Show attic ventilation.
18 Basement and retaining walls.Pro 'de cross sections and details showing ala meet of retar.For engineered /
systems,see item 21,"Engineer's c culations."
19 Beam calculations.Provide two setf of calculations using current code design val s for all beams and multiple joists f
a over 10 feet long and/or any beam/j ist carrying a non-uniform load.
OC
20 Manufactured Iloorlroof truss d n details.
21 Energy Code compliance.Identify he prescriptive path or provide calculations.A gas-p ung schematic is requited /
for four or more appliances.
1.2 Engineer's calculations.When
re
fired or provided,(i.e.,shear wall,r...truss)shall be a by an engineer or
architect licensed in Oregon and sh ll be shown to be appli able to the project under revigv.
m
W23 Five(5)site plans are required for i m I I above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are rejji ,-d for ltckns 16, 19,20&22 above.
25 Building plans shall not contain red I es or tape-ons. "Mirrored"building plans will be not accepted.
26 "Reversed"building plans must meet c 'feria outlined in the Permit&System Development Fees document.
27 "Drawn to scale"indicates standard archite engineer scale.
28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or now on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614(6""M)
Wchanical Permit Application Received Mechanicyl
.�
Dau/By: Permit No.:V11_��oL -ap
City of Tigard Plan ling Approval Building -
I>.to Ry: _ Permit No.:
13125 SW Hall Blvd. i Plan ileview Other
Tigard,Oregon 97223 1 Date)%, Permit No.: _J_
Phone: 503-639-4171 Fax: .503-SQ-9�i Post Kcv;cw Land Use
Gate/B_.___— Case No.:
Internet: www.ci.tigard.or.us Contact June.: See Page 2 for
24-hour Inspection Request: 503-639-414 I�� Name/Method:_ — SuRplemen(sI Information.
rITY()F-TIGARQN �— - — — —
TYPE OF WO MERCIAL FEF. IEDUL'E-1)SE CHECKLIST
New construction _ Demolition' Mechanical permit fees•are based on the total value of the work
rl-
AdditiorlialteratlOn/fe 18celnen' Other: performed. indicate the value(rounded to the nears,t dollar)of all
CATEGORY OF CON Q� mechanical materials,equipment,labor,ovcrbead and profit.
1 &2-Family dwelling Commercial/Industrial Value: $ M—, See Page 2 for Fee Schedule
Accesso Buildin Mutt Famil RESIDROAiJ U/PN[yFN Y6 _-,18-M- E-
__ Ueaerlptlon F ea. I Total
Master Buildvr Other: -- - [teatln CooIla
JOB WYE INFORMATI N A- lli _LOCA Furnace-add••on air conditioni_n •• 14.00
Job site address: �c=� �la✓r� Gas heetpump 14.00
-_'��" - Dact work 14.00
Suite#: Bld ./AptA _ — - - --
-Hvdrunic hot water system _ 14.00
Project Name: --- Residential boiler
Cross street/'L)irections to job site: (for radiator or h)±tunica em 14.00
Unit heaters(fuel,not electric)
in wall in-duct suspended,etc. 14.00 _
Flue/vent for any of above _ 10.00 —
R it units 12.15 _
Subdivision- /°' s of#: tither itael_A ltaaea _
Tax map/parcel#: Water heater -- _ - 10.00
DESCRIPTION OF WORK � ''-4 J" Gas fireplace _ 10.00
Flue vent(water hesier/gas fireplace) 10_.00
Lo Ig ighttr es 10.00
- -- _--- --___- __- -_-- Wood/Pelletstove 10.00
Wood fireplace/insert _ 10.00
-- - --
Chimney/!iner/}lue/vent 10.00
' r ROPE �'OWN':et NT .,.�,+t• Other. .�- _- 10.00
_Environmental Eshaust R M —
Name: r " /'i� Range hood/other kitchen equipment - I(.M1
Address: Clothes dryer exhaust 10
Cit /$tate/Zi ��J r _` __--_ Single duct exhaust
Phone: ;3,/-Sa? Fax: (bathrcoms,toilet compartments, I
LICANT
utility rooms_ 6.E0 --
Name: �- --- Attic/crawl ace fans _ 10.00 __
-- Other: 10.00
Address: --
Clty/��atC/Zlt� _ -_ _ .— •0(55.40 for tint 4,$1.00 each addlttoaaI
-
Furnace,etc. —_ " --._
Phone:
L _ -----
Gas heat pump ••
E-mail: WalUsuspended/unit heater
Water heater ••
5 Business Name: ���r �% Fireplace --- -
Address: BB _ '• —__
Cit /S we/Zi — I r Clothes dryer ash_
Phone• _ Fax: ___.__ other: __— '•
Total:
CCB Lic. #_ Mecfiaaleal Parmlt r4m" - —
Authorized _ _ Subtotal: S _
Signature: _ ___ Date:--` Minimum Permit Fee$72.50 S
Plan Review Fee2( 5%of Permit Fee S^ _____--_
--- - --- State Surcharge(11%of Permit Fee
— (Please print name) E
----- TOTAL PERMIT"M S -__.--
Notice: ThH permit application expires If a permit is not obtained within *Fe"Site eth dekV d rad or a Tri
-CG mty B��ng Iednstry servlee Board.
100 days after It has beer.accepted as complete. p r
i:\Dsts\Permit Foma\MecPcrmitApp.doc 01/03
Mechanical Perr-it Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Pee_mit Fee:
51.00 to SS 000.00 Minimum fee$72.50
$5,001.00 to 510,0000) $72.50 for the first$5,000.00 and$1.52
for each additional$100.00 or fraction
__ lhereof0
,to and including$10,000.0
£10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and
$1.54 for tach additional$100.00or
fraction thereof,to and including
_ _52500).00.
S25,001.00 to$50,000.00 S379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
550.0_ $50 000.00.
01.00 end up 5742.00 for the first$50,000.00 a
$1.20 for each additional$100.00 r
fraction thereof'.
Assumed Valuadon_s Per Apyliance:
`
Value Total
Description Ea Amount
Furnace to 100,00 including 955 —
ducts&vents _
Furnace>100,M0 BTU include cts 1,170
&vents
Floor furnace ir,cludin vent 95
Suspended heater,wall beater or floor 95
mounted heater
Vent not included inapplience _rmi►
Repair units 5
<3 hp;absorb.unit, T 55
to 1 BTU — \\
'-IS hh p;absorb.unit. .700
IOlk to 500k BTIJ _ \
15-30 hp;ab sorb.unit,501 k to I mil 7.,310
BTU
30-50 hp;absorb.unit, 3,400
1-1.75 mil.BTU _-- _
>50 hp;absorb.unit, 5,725
>1.75 mil.BTU
Air handling unit to 10,000 elm 656
Air handling unit>iMW cfm _ 1,170
Non-portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
unit
Hood served by mechanicai xhaust _ 656
lbrnestic incirentor _ 1,170
a Commercial or industrial incinentar 4,590
Other unit,including wood stoves, 656
inserts,etc. __—
N blas piping I A outlets 360 _
Fach additional outlet 63
TOTAL COMMERCIAL S
VALUATION:
W
i\bats\Permil Forms\MecPermitAppPg2.doc 01103
�tttttttttttttt�ttttttttt�t■
Electrical Permit Application
�- Rcce;veal Electrical
t $I•d C V j'^ , p D Dale/F3y Permit No.:h i`� J(� ()D` `r
City(�It Or 1,11 Planning Approval+ Sign
g Nie/BL_ Permit No.:
13125 SW Hall Blvd. Plan Rev.ew Other
Tigard,Oregon 97223 AUG 1 i QQ3 DatciPy PermitNo.:_
Post-Review Land Use
Phone: 503-639-4171 Fax: 503-5
Lt 1-Y U[ T Date/By: ___ Can No.:
Internet: www.ci.tigard.or.us gg Contact 1mis. See Pose 2 fnr
24-hour lnspec!ion Request: 503-639 1NC Narme/Metbwd' Supplemental Infonnition.
TYPE OF WORK _ – PI;t►N REVIEWiPletll�1 ' kY>�,that#Filly)_
New construction Dem_olition 0 Service over 225 amps- ❑Health-care facility
LJfH comr ercial ❑Hazardous location
Addition/alteration/rMlaccment Others p Service over 120 amps-rating of ❑Building over 10,000 square feel.
CATEGORY OF CONSTRUCTIONI&2 family dwellings four cit more residential units in
1 &2-Family dwelling Commerci-il/Industrial - ❑System over 600 volts nominal one structure
[I Building river three stories (7 Feeders,400 amps or more
ACCCSSO Building Multi-I'am11� _ Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Other: ❑F..gress/lighdng plan []Other:
JOB SITEINFORMATION tend LOCATION Submit--sets of plans with any of the drove.
The above are 1,
0:applicable to tem Morar construction service
Job site address:
Suite#: I B_ldg./A. til #: _ _ Number of Ins ecectlona per permit allowed
Project Name: Descref•::on Qty Fee(ca.) Telal
-w rr sidenllal-Onit'r or ma111-family per
Cross street/Direelions to job site: dwenmt,nnit.Includes-ttached sarase.
Servk••.disded:
1000 sj_L or less 145.15 4
Each additional 500 ig ft.or portion thereof 33.40 I
Subdivision: Ot#: Limited enerly,mkk_ntW _ 75.00 2
Limited encu,,non residential _ 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
� DESCRI.PTION OF WORK service and/or feeder 90.90 2
-- - Services rr feeders-Installation,
alteration or relocation:
- -i 200 amps or less _ 80.10 2
201 am !!1400 ams _ 106.85 _ 2
401 amps to 600 amIM — --- 160.60 2
'NER TENANT 240.60 2—
ANT 601 am ro 1000-myna
I'EMOPW - `_ --
---- - --�— Over 1000 am or vo:ta 454.65 2
Name: / Over 1000 only --—-- 66.65 2
Address. 4? Temporary services or feeders-Installation.
=I �`-`- ---- alteration,or relocation:
City/State./Zip: tV200 amps or less __ 66.851
Phone: - Fax: 201 am ate
to 400 am - _ 100.30 - 2
401 to 600 amps 133.75 2
APPLICA T '" MMIA I d
_ -- Branch clrcnita-new,alteration,or
Maine: extension per panel:
-- - A.Fee for branch circuits with purchase of
Address: service or feeder fee each branch circuit 6.65 -
Cit /Sty ate/ZI B.Fee for branch circuits without purchase of
service or feeder fee,first branch circuit 46.95 2
Phone: FAX: _y Fach additional bench circuit 6.63 2
IJL. E-mail: Misc.(Semice or feeder not included):
R , r, Fae or r irrigation circle 53.40 2
ACTOR
per,. Each signor outhM:I�1•+ing - -53.40 _ 2
N Job No' ' Signal circuit(s)or a limi•ed energy,,panel,
�j -- alteration,or exten!tion _ Page 2 2
Business Name:/t S' .`-4 Description:
-1 Address: 3%Fe z> , 577 Jb9k- F Z4,!� -
`- Each additional lInspection over the allownble In any of the above: �A
City/State/Zip: Per ins ion r hour(min.I hour) _ _62.50
LU Fax: Investigation tee: �^ -
'J CCB Lic.M Li °t cm
Z. '.
Supervising a inn Subtotal S _
signature requi. _ Plan Review25%of permit Fee S _
Print Nam ' c Lic. #: —�,2 :5 __State Surcharge 3%of Permit Fee S
_ _TOTAL PERMIT FEE S___
Authorized N-)ticec This permit application expires If a permit Is not obtr,.lned within
Signature: 180 days after It has been accepted as complete.
Z "Fee methodAis"act by Tri-County Br.iiding Indmitry Service Board.
(Please print name)
i:lDstslPermit Forms0cPermitApp.doc 01103
Electrical Permit Application -City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems........................................................... $75.00
Check 7 ype of Work Involved:
l� Audio anaStereo Systems*
EjBurglar Alarm
C1tiaugeDoor Open
C7Ileating,Ventilatiolanit Conditioning System*
F] Vacuum Systems*
Ej Other
COMMERCUL WORK ONLY:
Fee for each system............................................. $7 .
00
(Sri'.OAR 918-260-260)
Cheek Type of Work Involved: \
Audio and Stereo Systems
Boiler Controls
II Clock Systems
nData Telecommunication Installation
F] Fire Alrrrn Installation
Ej HVAC
DInstrumentation
Fj intercom and Paging Systema
Landscape Irrigation Control*
L J Medical
u Nurse Calls
F] Outdoor Landscape ightinp*
[—] Protective Signal g \
Other — - -- ---- ---- ---
Number o!Systems
* No licenses are required. Licenses are required for all
other Installations
i!\D$ts\Permit Foams\F.IcPcrmitAppPg2.dor 0IA73
Isunaing r fixtures
Plumbinp. Permit Application Reccivod Plumbing r1 /
Dahl@ Permit No.:
City of Tigard RECEI Dste/ngApprovai Sewer —
ate/B : Pemrit No.:
13125 SW Hall Blvd. Plan Rcview Other
Tigard,Orcgon 97223G Dat�F3y: Permit No.: _
Phone: 503-639-4171 Fax: 503-598-I ate/By: land Use
1�(Y t.)) Date/By: Calc No.:
.0
Internet: www.ci.tigard.ors " Contact — Juris.: Set Page 2 for
24-hour Inspection Request: 503-639INJAMDI Name/Metho l:__—_ Sup iemental Information.
FEF SCHEDULL YL 1 Irk or tib 1
New construction Demolition nescri,"tio^ n Qty. Fee(«•) Total
Addition/alteration/re laremcni Other: !, New I-dk,24aro11ydwellitl� ' " a
cATGo 0 5I'Ru -' .(laelodea ltro:llF,�or eieh ntlli
I SFR I bath 249.20
& 2-Family dwelling Commercial/Industrial SFR 2 batt. 350.00
Accessor�Budding Multi-Family SFU 3 bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
JUB SITE 1N _)Z Fires rinkler- .111.7 P e 2
Job site address: t11R a
Suite#: Bld ./A t.//' Catch basin/area drain _ 16.60
---- Dt 01/leach line/trench drain 16.60
Project Name: _ _ _ _— Footing drain(no.linear ft.) Pae 2
Cross street/Directions to job site: Manufactured home utilities _ _ 110.00 _
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer;no.linear ft.) _Pgge 2
SubdivisiotpLot#: Storm sewer no.linear ft.) Page 2
Tax ma / atrel#: Water service Jno.linear ft. Page 2
DESCRIM01 - -- -- Absorption valve 16.60
Backflow prevcr.ter Pae 2
Backwater valve 16.60
Clothes washer _ 16.60
— -- Dishwasher 16.60
ry.
Dr;nking fountain 1 16.60
E'ectors/sum _ 16.60
Name: Expansion tank '6.60
:'lddress: ,e,/� Fixture�sewer cap 16.60
—"�—',`�',_� —` - Floor drain/floor sink/hub _ 16.60
City/State/Zip: —L1�
Garbage disposal
16.60
Phone:, Fax: Hose bib 16.60_
�PLICANT, �_.i Ice maker 16.60
Nvm_e: _ Interceptor/gtrRsc trap 16.60
Address: f Medical gas-value: S Page 2
-- -- - - Primer 16.60
Cit 'State/Zip: - _ Roof drain commercial _ 16.60
a. Phono: -
_-- Fax k/b
_ _ --- Sinasimlavato _ IF.60
R Tub/shower/shower pan _ 16.60
>'EJ-rnai l: -
Urinal
' Water closet 16.60
Business Name: s��T��-` �� _ Water heater 16.60
Address: ��,�t7`/ Other:
City/State/ ia Other__
IN Phone:��13N 9 Fes;. _ ,
WWI
_
CCB Llc. #' Subtotal S
Plumb. Llc.#' Minimum Pe-mit Fee$72.50 S
Authorized Resid-ntial Backflow Minin.um Fee$36.25 _
Signature: _ _ Datc: 'Ap16_-1 Plan Review 25%of Permit Fee $ _
State Surcharge 8%of Permit Fee` S _
(Please print name) __ _TOTAL PERMIT FEE S
Notice: This permit application expires If a permit Is not obtalned within All neerjmmercial buildings require 2 sets of plans with Isometric or
IRO days after It has been accepted as complete. riser dlagrnm for plan review.
•Fee methodology set by Tri-County Wilding Industry Service hoard.
is\Dsts\Permit Forms\PlmPermitApp.doc 01103
Plumbing-Permit Application -City of Tigard
Page 2 -Supplements; Information
Fee Schedule: Residential Firs Su ression Systems:
dw" Fanta s: YetTuitc��
i a,, bs: M L�Footing ----- ------
drain-I"100' 55.00 0 toSI 15.00 ---�
Fooling drain-each additional 100' 46.40 2001 to i,ryOG -_ Sl6o.no --
',6111 to 7,200 $220.00
Sewer- Ist 100' 55.00 /2, 01 and-at r_r 5309.00
Sewer-each additional 100' 46.40
Water Service-Ist I(V 55.00 Medical Gas Systems:
Water Service-each additional 100' _ 46.40 Valuation, Permit Fee:
Storm&Rain Drain-Iat 100' 5500 $t_00 to SS .00 Mir•_imum fee$72.5-6-
LT-
-_ _
Storni&Rain Drain-each additional 1 46.40 $5,001.1)0 to$I0,00o.00 $72.50 for the fiat$5,000.00 and 51.52 for each
additional 1100.00 or fraction thereof,to and
jtistare Vr ltt�tzl
____ includt�S10,000.04).
Cemmercial Back Flow Prevention Device 46.40 SI0.00LOO to 525,000.00 5148.50 fi; the first 'M0.00 and SL54 for
Pesittential Backflow Prevention Device each rdditional SI .00 or fraction thereof,to
minimum pemut fee S3 i.25)_ 27.55 _ and including$2 r;00. _
Rain Drain,singly family dwelling 65.25 $25,001 Of)to 550,000.00 5379.50 fort tett 525,000.00 and S1.45 for
each odd ti Is ifNi.00 or fraction thereof,to
Inspection of cxiatieg plumbing ur and inclu n $50 00_0 00.
a .cis!! requested inspections- S hour _ 72.50 $50,001.00 and up S'142. or the first$50,000.00 and 51.20 far
Subtotal: _ I eac dditional$100.00 or Ration thereof. _
Fixture Work:
Are you capping,moving or replacing existin fixtures? If
"yes",please indlcat,�work performed by flit e. Failure to
accurately report fixtures could result in increa d sewer fees"'.
_ _ r Co meats regarding 5xture work:
Ft:ture Type:, i' 'r
13a�rnisUy/1�ont --- ----_ --�-._ .�
Bath =Tub/Shower
-Jactuai/Whirl�l -_ -
Car Wash-Each Stall
Asps Toru -- -
CuSidor/Wattr Aspirator _
Dishwasher -Commercial
-Dorestic --
Drinking Fountain -
_ye Wuh �_ - _
Floor Drain/sink 2" t
A" -�
Car wash Drain -- -�
Garbage -Domestic `No : If the fixture work under this r armit results In as
d Disposal -Commercial - mire .IncreaXt 9f sewer EM Is,a sewer permit will be issaed and
Ir -industrial fees w-,Ned ed for the sewer incrca.. must br paid before the
Ice Mach./Refrig Drains phtmhingkermit can be Issued.
oil Separator(Gas Million -_ �`
tC� Rec.Vehicle Dump Su�tion _
Sh^Wer -Clang
-Stall - _ -
Sink -Bar/Lavatory \
W -13radley
Commercial \
_-Service
Smnuning Pool Filter
Washer-Clothes
Water Extractor -�
Water Closet-Toilet
Urinal __
Other Fixhtrea
iADabV'ermft Forrrn\PlmPemritAppPg2.doe 01/03
961 a ,sem ,chol— 4A/
IFO
1-77
or
• .._.._. ' •• (ISI<.�11'►'�!/ / 1 � �►
�._ _. ___,_ .. r .._,.�__..,.,,...,..!►.�!+t N Iii r�r }�j.11lfl►
f
—�
yes PXwdr-
a
w
c TV OF TIGARD-SITE PLAN ItEV1EW
HUILI)INt; pERIWt INO.: '�''—
PLANNING DIVISION: Approved C] Not Approved
Rcquired Setbacks: re DD Side: s
_�
tiidr: sirret
Garage: .�7 Rvar:J..
Frow. .'SSL— Not App
roved
Vista►! cl��malice: ($' A _pr"�edt C3 Not
Mtixintun► Bi6lilinµ Might.
t,WS ':ervicc Provider Letter Required: Q YesCOO
cie. V No
f'.t;tNLLttI (; DF.pP.R r t Approved
Actual Sto{x: 01" TOPpfovcdVDproved IJ of APPS'oved
Site flan: 03
B :
� -, a' f-(/ Date: F 1
Nut.r.
RECEIVED
AUG 21 2003
CITY OF TIGARD
BUILDING DIVISION
IL
u�
CITY OF TIGARD► 24-Hour 0
BUILDING . . Inspection Line: (503)636-4175
INSPECTION DIVISION Business Line: (503)636-4171 MST
ksUP
Received —Date Requested_ L 7- AM _PM _ OUP
Location r - suite MEC
Contact P9rson _ _— — Ph(--) 39 PLM
Contractor Ph(_ ) _- — SWR
i BUILDING TenanVOwner ELC —
Footing ELC
I-oundation Access: --
Ftg [^ G] ELR
'crawl
Dr Drain — --—
Slab Inspection Notes: SIT
Post&Beam
Sheat Anchors - ----
Ext Shgath/Shear
Irrt SheatlJShear
Framing �_-
Insulation
Drywall Wiling
Firewall
' Fire Sprinkler - ---- - ---
Pire Alarm
Suap'd Ceiling — -----
Roof
of -- -- -- ------ —
PAS PART FAIL —`-'
PLUMBING
Post&Beam
Under Slab
Rough-In
Weter Service — -- -
Sanitary Sewer
Rain Drains ----- - -_
Catch Basin/Manhale
Storm Drain —
Shower Pan
Other: —
Final
PASS PART FAIL — -
MECHANICAL
Post&Beam
Rough-In
tl Gas Line
Smoke Dampers
F-
U) JPAW PART FAIL -
ELECTRICAL
J Service
SD Rough-In
W Ur /Stab —
_j Low Voltage _-
Fire Alarm
Final Reins on fee of$ q aired before next ins
PASS PART FAIL LJ -----__ a pection. Pay at City Hell, 13125 SW Hall Blvd.
SITE _ Please call for reinspection RE_-____� n Unable to inspect-no access
Fire Supply Line _
ADA
Approach/Sidewalk - -- �__-f.��__,.. 111!'ealOf -_ _ ---Ext.------
Other:
Final �- DO NOT REMOVE thlb IMPS UM reeord!'M' n 00 JO stip.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUDDING• , Inspection LIr> 031639=4175 t MST 3._00�({b
INSPECTION DIVISION Business Line: (63)639-4171
BUP
Received _Date Reauested-_ AM PM BUP _
Locationfnn _Suite._ MEC
Contact Person Ph(, ) A 0 PLM
Contractor _—_ _ _ Ph(_. ) SWR _.
BUILDING Tenant/Owner _ ELC
Tooting
Foundation ACC988: FLC
Ftg Drain L = w ,\ ELR _
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors — -- --
Ext Sheattv'Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ---- —
Fire Alarm
Susp%t Ceiling
Root
Other: - -- - — -
FinLl
_PASS PART FAIL --`
PLUMBING
Post 8.Beam
Under Slab
Rough-In _
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
FiRAI
PASS PART FAIL —
MECHANICAL
Post& Beam
Rough-in _
IL GAS Line
W Smoks Dampers —
~ Final --
N
PASS PART FAIL - -
ELECTRICAL
Service
j Rorrgh-In --
WW UG/Slab —
Lnw Voltage Ci
Fire Alarm
Reinspection fee of$________.__-___required before next In�pectIon. Pay at City Hall, 13125 SW Hail Blvd.
AS PART FAIL
31T _—_ n Please call for,-einsr;e tion F1F __ Unable o inspect no access
Fire Supply Line
ADA Dab -1 _ (1y'�'
Approach/Sidewalk '"
Other:
Final DO NOT REMOVI lhib 1 IIIIIIIIIIIN111111111,1111000ord 11VOW the I"ON&
PASS PART FAIL
CITY OF TIGA,RD 74-Hour
BUILDING so Inspection Line: (503)631-4175 0' e-3 ele:�v
INSPECTION DIVISION Business Line: (503)639-4171 SUP
Received Date RAMMIARtea &T- —U qAM_—_ PM _— BUP
Location Suite_ MEC —
Co2
Contact Person _ — Ph( ) _ESS.— PLM
Contractor, --._ _-- Ph( ) SWR —
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain D ELR
Crawl Drain 9
Slab Inspection Notes: SIT
Post x Beam — _ ---.
Shear Anchors --- �—
Ext Sheath/Shear
Int Sheath/Shear —
Framing — --- — -------
Insulation
Drywall Nailing — -�
Firewall
Fire Sprinkler
Fire Alarm `�
Susp'd Ceiling +-� L - ---
Roof
Other: --- —-- — --
Final _
PASS PART FAIL
PLUMBING
Post&Beam -
Under Slab / --- — — —
Rough-In
Water Service -- -- - --
Sanitary Sewer
Rain Drains —
Catch Basin/ nhole
Storm Drain
Shower P
Fin
PART FAIL
MIWIANICAL
Post&Beam
Rough-In
a Gas line
ix Smoke Dampers - - --Ii-
Final
r PASS PART FAIL - — -
C_j ELECTRICAL
m Service
(� Rough-In
W UG/Slab
Low Voltage
Fire Alarm
Final L__I Reinspection fess of$__.._ --_required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE l J Please call for reir+epoction Rl= L Unable to inspe + no access
Fire Supply Line I�
APD roach/Sidewalk Drte '�" Inepeet4w` ��" — Ext_
P
Other:_
Final DO NOT REMOVt flips IMM"UM Mead Weill M0 J"11hL
PASS PART FAIL
e Pool
�I o ►
x
4 ... ►
A 011.
r ONO atn ►
.4 o Op ►
A ►
' ►
� � A ►
j
Poo.
t w ►
b
►
FLI. ►
m
1 A ►
t
0 U ►