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9680 SW NACIRA LANE NI "IDVN MS 0896• z a U d z N o m w 9680 SW NACIRA LN eo I .e V � C v V � � U tu C 'b L7 cc ~ t ed 0 0 C1 V CITY �� �����® _ _ MASTER PERMIT - DEVELOPMENT SERVICES DATE ISSUED: 10/8/03 PERMIT#: 3-00447 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 SITE ADDRESS: 09680 SW NACIRA LN PARCEL: 1S135CD-GP008 SUBDIVISION: GREENBURG PINES ZONING: R4.5 BLOCK: LOT: 008 JURISDICTION. TIG REMARKS: Construction of new SF detached residence. BUILDING REISSUE: MAS2187 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REOUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST* 955 at BASEMENT: 5511 of LEFT: 5 SMOKE DETECTnRe: Yy TYPE OF USE: SF FLOOR LOAD: 40 SECOND: _. GARAGE: of FRONT. 15 PAR-4111 SPACES TYPE OF CONST: 5N DWELLING UNITS: 1 THMID at nIGHT* 5 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,390 of VALUE 235,104 111) REAR: 15 —PLUMBING - _-__,.•-_ __� - SINKS: I WATER CLOSETS: 3 WASHING IJACH: I LAUNDRY TRAYS: RAIN DRAIN 1011 TRAPS: LAVATORIES: 4 DIStfWA.9HERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS- TUR/SHOWERS: 7 GARBAGE DISP: I WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL. FUEL TYPES FURN<100K: SOILtCMp<3HP: V^•NT FANS: 4 �^LOTHUS DRYER. 1 ,AS FURN>*t00K: I UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCE9: VENTS: i WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WIS VC OR ED R: PUMPAnRIGATION: PER INSPECTION. EA ADD'L 5008F: 4 201 - 400■np: 201 - 400 amp: 101 w7O SVC T OR: SIGNIOIIT LIN LT: PER HOUR: LIMP Eb ENERGY: 401 600 amp: 401 WO amp. EAADDL BR CIR: SIGNAL IPANFL: IN PLANT: MANU H'71SVCIFDR but - 1000 amp: 001+amps-10(10, MINOR LABEL: 1000•amplvolt PLAN REVIEW SECTION Reconnect nnly: >•4 RES UNITS: SVCIFDR-225 A.: >EOO V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO S F.TERFO: VACUUM SYSTEM: AUDIO S STEREO: FIRE ALARM: INTERCOM'PAGING OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CAI LS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,303.89 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 laws. All worl�v,' )ne in PORTLAND,OR 97291 PORTLAND„OR 97291 accordance with approved plar.z. 1H Will expire N I work is not started within 180 day oe,or if the work Is suspended for more than ATTENTION: IL Oregon law requires you to follow 11., Idupted by the R "n"o S03.531-0505Phone: 503-531-0505 Oregon Utility Notification Center. Those rules are set ,a forth in OAR 9.52-001-0010 through 952-001-0080. Yov Rep 0: LIC 75507 may obtain copies of these rules or dirert questions to OUNC by calling(503)246-1987. m ���� REQUIRED INSPECTIONS UJI Erosion Control Insp 8r Post/Beam Mechanlca Plumb Top Out Gas Line Insp Water Lin:Insp Plumb Final —� Sewer Inspection Underfloor insulation Electrical Service Gas Fireplace Water Srnlice Insp Building Final Footing Insp Crawl Drain/Backwater Shear Wall Insp Insulation Insp Appr/Shcvik Insp Foundation Insp PLM/Underfloor Exterior Sheathing Insf Rain drain Insp Electrical Final Post/Beam Structural Mechanical Insp Low Voltage Storm drain Insp Mechanical Final Issued By . '� c�t�`"<-'_ Permittee Signature Call(503)639-4175 by 7:00 p.m.for an inspection needed the next business day CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-00333 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 10/8/03 SITE ADDRESS; 09680 SW NACIRA LN PARCEL: 1S135CD-,GP008 SUBDIVISION: GREENBURG PINES ZONING: R-4.5 FLOCK: LOT: 008 _ JURISDICTION: TIG _ TENAN'i NAME: USA NO: FIXTURE UNITS: CLASS 01=WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO.OF BUILDINGS: INSTAiJ_TYPE: LTPSWR IMPERV SURFACE: R4marks: Sewer connection for new SF detached residence. Owner: _ _ FEES VISTA NW Description Date Amount PO BOX 91459 PORTLAND,OR 97291 [SWUSAI Swr Connect 10/8/03 $2,400.00 [SWUSA]Swr Connect 10/8/03 $0.00 Phone: 503-531-0505 [SWINSP]Swr Inspect 10/8/03 $35.00 [SWINSP]Swr Inspect 10/8/03 $0.00 Contractor: � '— Total $2,435.00 Phone: Reg#: Required Inspections IL J_ m This Applicant agrees to comply with all the rules 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 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" Perm Issued by:.-,�� Permittee Signature: Call (503) 639-4175 by 7:00 P.M.for an inspection needed the next business day '7 fFT 9'7'1-i n Building Permit AplicationReceived Building Date/[3 � A� � Permit No.: y7 Planning Approval Other City of Tigard Date/By: — Perrnit No'310k pav3 3 13125 SW Hall Blvd. NQISIAIG JNIG'h i l4 Plan Revie Other Tigard,Oregon 97223 'aNtl�I I an Date/By: 9- -O 3 Permit No.: — Post-Review land Use Phone: 503-639-4171 Fax:, 98-1960 �IJJ ` Date/D : Case No. Internet: www.ci.tigard.or.us I ' Contact — Juris: See Page 2 for 24-hour Inspection Request: 503-6394175 Name/Method: _ _ _1 C 5n p n eutxl Information _ TYPE OF WORK REQUIRED DATA: New construction _ Demolitions 1&2 FAMILY DWELLING-- j Addition/alteration/replacement Other: _CATEGORY OF CONSTRUCTION Note: Pennit fees*are based on the total value of the work performed. Indicate 1 &2-Family dwelling CUmmeiClal/1ndUStrlal the value(rounded to the nearest dollar)of all equipment,mwtcnals,labor, overhead and profit for the work indicated on th;s application. Access ry Quilding Ll Multi-Family _ Master Builder Other: valuation................ ..................................... ,JOB SITEINFO ON and DATION No.of bcdrooms:I/_ No.of bsths:_..�_ Job site address: Total number of floors..................................... _-�-- /�` •-- New dwelling area(sq.ft.).............................. �— Suite#: 131d /A t.#: Gar'ge/carpott area ft. S Project Name: Covered porch area(sq.ft.)............................. Cross street/Directions to job site: Deck area(sq. ft.)............................................ Other structure area(sq.ft.)............................ CODITIERCIAL-USE CHECKLIST Subdivision Tax map/parcel#: Note: Permit fees"are based on the total value of the work performed. Indicate tj 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.............................. .....<i� ... S Existing building area(sq.ft).. -...New building area(sq.ft.)............ ....Number of stories...................... . ...JD_PROPERI OWNER TENANT Type of construction.............. .....Name: ��,—� Occupancy group(s): g: ----- New: Address: City/State/Zip: Phone:, / ax: NOTICE: All contractors and subcontractors are required to be APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant it exempt Contact Name: from licensing,tht following reason applies: Address: __ -- ---- -- a City/State/Zip: � ---- — -- oc vs Phone: Fax: BUILDING PERM E-mail: Please rehr to ree ..p. a — _CONTRACTOR -Business Name: ` m _ r �''T/� � Fees due upon application.... ..................... . a Address: WAmount received.......... ....................... ..... Cit /St:tte/Zl : _ Phone: Fax: Date received:--- CCB Lic. #: Authorized Notice: This permit application expires If a permit Is not obtained within Signature: Date: —__ IRO days after It hai been accepted as complete. _ _.. *Fee methodology set by Tri-County 81dlding Industry Service Board. (Please print name) i:\Dsts\PermitFortyWBldgPermitApp.doc 01103 One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: 01Vo.fTigard Cly Ol flgpard Associated permits: b U Electrical U Plumbing U Mechanical Address: 13125 SW Ball Blvd,Tigard,OR 97223 U Other: Phone: (503) 639-4171 Fax: (503) 599.1960 '1414 F011,01VING IIE'N!S ARE R-EQVIR.1-11) 1:011 PI \N 1UNII'll I v% No NIA 1 land use actions completed.Sev juMdictio7 criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic ,oils designation,historic distric!,etc. 3 Verification of approved platllot. 4 Fire 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 WXn U permit required.Include drainage-way protection,silt fence design and location of catch-basin prott:ction,etc. 10 3 Complete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a sep,-rate full-size sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed / if copyright violations exist. I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if there is more than a 4-ft.elevation differential,plan must show contour lines at 24 intervals);location of casements and driveway;footprint 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. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater,�� furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member siu;.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, firti 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 acre table_ 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 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing / locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered It/� systems,see item 22,"Engineer's calculations." 19 Ream calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beamljoist carrying a non-uniform load. IL 20 Manufactured floor/roof truss design details. it 21 Energy Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required Wfor four or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under revi m 23 Five(5)site plans are required for Item I 1 above. Site plans must be 8-1/2"x I V or 1 I"x 17". W24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not act epted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or 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 notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-*14(NWOM) 1su>< Ging r fixtures Plumbing Permit Application Received Plumbing D.te/By. Permit No.: Cit of Ti dI'(� Planning Approval Sewer 3' g Date/By: Pennit No.: 13125 SW liall Blvd. Plan Review Other Tigard,Oregon 97223 Da PemnI No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Revicw Land Use Date/By:: _ Case No.: Internet: www.ci.tigard.or.us I J J Contact luris.: 0 See Page 2 for 24-honr Inspection Request: -WMAWD Name/Method: ` Supplemental Information. TYPE OFWU12K )I'''EEE SCHEDULE(for Z- cial laity . bl I.i.i�becW ''•.�. ew construction Demolition= Description Qty. Fee(ea.) Total Addition/alterationhe r�lacement Other: New 1 & famF yd et ' a' 190 ub ad CATEGORY OF Cl) �idat tt+for each pull a s _ SFR 1 bath 249.20 &2-Famil dwelling Commercial/Industrial SFR(2)bath 350.00 Accesso BuildinMulti-Famil SFR(3)bath _ 399.00 Master Builder M Other: Fach additional bath/kitchen 45.00 JOB SITE INFORMATI and N '' Fires rinkla- .ft.: _ _ Page 2 Job site address_-� B t° Suite#: L `~' Bld ./A t.#: Catch basin/area dein _ 16.60 Project Name: D cll/leach line/trerch train 16.60 Footing drain Ino.Iii,ear ftZ Pae 2 Cross street/Directions to job site: Manufacture.•i hom,utilities 110.00 Manholes _ _ 16.60 _ Rain drain connector 16.60 Sanitary sewer(no.linear ft.) Page 2 Subdivisio Lot#: Storm sewer no.linear ft. Pae 2 Tax map/parcel#: Water service no. linear ft. Pae 2 F. i, JOINoAbsorption valve 16.60 Backflow preventer _ Pae 2 Backwater valve _ 16.60 _ Clothes washer 16.60 - Dishwasher 16.60 Drinking fountain 16.60 Q R Ejectors/sump 16.60 tame: Expansion tank _16.60 Address: Fixture/sewer cap 16.60 _ City/State/Zip: - Floor drain/floor sink/hub 16.60 _ Garbage disposal 16.60 Phone• _ems Fax: Hose bib 16.60 Wtr ' �"•` Ice maker 16.60 Nwne: Interceptor/gmase try 16.60 Address: Medical gas-value: $ _Pae 2 Cit /State/Zi : J Primer 16.60 �_ p Roof drain commercial _ 16.60 p, Phone: I-Fax: Sink/baslnAavato 16.60 E-mail: Tub/shower/showery _ 16.60 ~ CONTRACTORUrinal 16.60 U) Business Name: 1. Water closet - 16.60 f Water heater 16.60 .,� Address: Other: _ m City/State/Zi Other: WPhone Fax: _ ,c CCB Lic. #: 'a j Plttmb. Lir-_ - subtotal s Minimum Permit Fee$72.50 S Authorized 'ft Residential Backflow Minimum Fee$36.25 _ Signature: :ate Plen Review_L25°/s of Permit Fee $ State Surharge.,Q%of Permit Fee $ (Please print name) TOTAk "ERMIT FEE S __ _ Notice: This permit application expiry If a permit Is not obtained within All new commercial hulldlny:.,.3nlre 2 sets 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 Servlce Board. i:\Dsts\Permit Forms\PlmPcrmitApp.doc 01103 Plumbing Permit Application -City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential FireSu resSion stems: $_guAre Foota�: Pertuft Fees Footing drain-1'100' 55.00 010 _ $115.00 Y - Footing drain-each additional 100' 46.40 2,001 to 3,600 5160.00 V 3L601 to 71200 $ 220.00 Sewer-Ist 100' 55.0 7,201 and greater Y- $309.0 V-� Scwer-each additional 10' 46.407--:- -'- Water Service- Ist 100' 55•0 Medical Gas S stems: __ Water se-or rch additional 1O0' 46.0 Valusilon. Permit "i- ii- Storm&R n-I st 10' 55.0 $1.0 to SS rN1f1.hl Minimum fe 572.50 .. _ Storm&Rai; !',ain-each add ional 100' 46.40 $3,01.0 to$10,000.0 $72.59 for q1w first$5,00.0 and S1.52 for each additiona 10.0 or fractir n thereof,to and P11ttf.t!Ot Y. " ` inclut S10 00.0. _ Comtnercia!Back Flow Prevent n Device 46.40 410,01.0 to 525,00.0 S 148. .for the first 510,00.0 and 51.54 for Residential Backflo.v Preventiovice eac additional$10.0 or fraction thereof,to minimum permit fee$36.25 27.55 _ MA including S23,00.00. Rain Drain,single family dwelling 65.25 $25,01.0 to$50,000.0 es,79 50 for the first$25,00 0 and S 1.45 for Inspection of existing plumbing or each additional$10.0 or fraction thereof,to and includin $50 00.0. _ specially requested ins ctions- r ur 72.;1 $50,01.0 and up $742.0 for the first 550,00.0 and$1.20 for - Sub tal: each additional$10.0 or fraction thereof. Fixture Work: Are you capping,moving or replacing a ting(Nfures? If "yes",please indicate work performed by ture. Failure to accurate) report fixtures could result in fine ased sewer fees*, cant Ixture k Petit Comments regarding[fixture work: i?Irtture Type: pl _ �._�+I'�.d- -- - lis on_ _ Bath -Tub/Shower -� - -- -Jacuzzi/Whirl I - -- Car Wash -Each Stall -Drive Thru - -- - Cus idor/Water Aspirator -- Dishwasher -Commercial -Domestic _ - - Drinkinj Fountain - E,,,e Wash Floor Drain/sink .2" - ^� 3" 4" Car wash Chain *Note: If fixture work-.oder this permit results in an Garbage -Domestic (L Disposal -Comnxrciat increase of se EDtis,a sewer permit will be Issued and p� -Industrial fees assessed for sewer Increase must be paid before the Ice Mach./Refri .Drains plumbing permit ca a issraed. Oil Separator(Gas Station Rec.Vehicle Dump Station Shower -Gang m -Stall - ;ink -Bar/t,avatory - W -Bradley - _- ..J -Cmm�re ' 1 -Servic Swimming Pool Fil r Washer-Clothe Water Extract Water Closey-Toilet Urinal Other Fixtures: is\DJsts\Permit Forms\P1mPermitAppPg2.doc 01103 Electrical Permit A Wication Received Electrical C I V Dale/By: Permit No.:n K/,900" City Of -y�) try Planning Approval Sign �,Igal' Dale/B : Permit No.: 13125 SW flail Blvd. Plan Review Other Tigard,Oregon 97223 AUG 21 2003 Date/By: Permit No.: Phone: 503-639-4171 (81WYIffl�-V&-AND Post-Review Land Use Case No.: _ Internet: www.ci.tiga*! ���/�$j Contact Juris. See Page 2 for 24-hour Inspection)glgQCst !lr�ill7Ao(V Name/Method: Su bmenbl information. IIIIIILLUIIy �DI � r181oN 1------ ----- TYPE OF WORK5 W"7 YtEVIE_W Please check all tW��►!i'IY) ew construction Demolition IaN 5Servtee over 225 amps- healthcare facility -H commercial []tlazirdous location Addition/alteration/replacement Other: (]Service over 320 amps-rating of ❑Building over 10,000 square,feet, CATEGORY OF CONSTRUCTION_ 1&2 family dwellings four or more residential units in &2-Family dwell ing- Commercial/Industrial ❑System over 600 volts nominal one structure ❑Building over three stories ❑Feeders,400 amps or more Accessory Building__ Multi-Fam�L Q Occupant load over 99 persons ❑Manufscturcd sbucturcs or RV park Master Builder Other: []Egmss/lighting plan ❑Other:_ _-___ JOB SITE INFORMATION and LOCATION Submil---sets of plans with any of the above. The above are not applicable to tern rarx constractlon service. Job site address: j��p�iAV Suite#: O Bld ./A t.#: _ Number of ins ectiona ptr ermit allowed Project Name: Description —� - 94• Fee(ea.) TOW Cross street/Directions toob site: New residential-single or multi-family per J dwelling unit.Includes attacl ed garage. Service Included: 1000 sq.ft.or less _ _ 145.13 _ 4 Each additional 500 sq.R.or portion thereof _ 33.40 -_ 1 SubdlVlSlon: Lot#: Limited energy,residential 75.00 2 /�/4,jE - Limited energy,non residential.____ 73.00 2 Tax map/parcel M Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 40.90 -- Servkes or feeders-installation, alit-ration or relocation: `- -- LOQ-8-MO-ICE less -----_— -- 80,30 2 �__�--_- -__---_--- 201 amps to 400 amps --__--- 106.85 2 401 am sato 600 unps 1611_60 2 -'OWN NANT 601 amps 1000 amp+ 240.60 2 ER TE - ---. Over 1000 amps or volt 454.65 2 Name: j& _ Reconnect only 1 66.85 ~� 2 Address: Temporary services or feeders-Inatalletinn, alteration,or relocation: City/State/Zip: 200 amps or less 66.85 4 I Phone: SSC Fax: zol am to4400amps 100.30 2 APDL ANT CO ACT P O 401 600 am 133.73 z Branch elreulb-ntw,alteration,or Name: extension per panel: -- - --"- A.Fee for branch circuits with purchase of Address: _ service or feeder fee,each brunch circuit 6.65 2 City/State/Zip: T B.Fee for branch circuits without purehafe of service or feeder fee,fust branch circuit 46.85 2 Phone: Fax: - Each additional branch.;irruit 6AS 2 E-mail: Misc.(Service or feeder not included): 4. NTRA O Eacl- )ump of irri tion circle 53.40 2 Eachl. or outliq li hting 53.40 2 Job No: 6,V _ Signal circuit(s)or a limited energy panel. N 2 Business Name: alteration to extension _ _Pa e�2 _ Description: Address: ,cif/ Each additional InapecNon over the allowable lo any of The above: Cit /State/Zl : -7 � _— Peri tion hour(min. I hour) 62.50 (; Phone: Z erv- Fax.: Invesfi Non fee: W CCB Lic. M L' — other: supervising electrici Subtata) S signature required: Plan Review(25%of Permit Fee) $ Print Nam Lic.#: State Surcharge 8%of Permit Fee, S _ _TOTAL PERMIT FEE S Authorized "� / ' Netice: This permit application expires if a permit Is not obtained within Signature: Date:_7C--rte ✓� 180 days after It has been accepted as complete. `Fee methodology set by TrWounty Building Industry Service Board. (Please print name) i.\Dsts\Permit Forms\flcPermilApp.doc 01/03 Electrical Permit Application -City of Tigard Page 2 -Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ $75.00 heck l'ype of Work Involved: Audio and Sterco Systems* El rglar Alami Gar. D(. Opener* I Icating. `lilatinn and Air Conditioning System* Vacuum Sys\terr E] Other___\ -- — ------- COMMERCIAL WORD QNL Feefor re system............................... ........ ............... 375.00 (SEF OAR 919-260-260) Ch!ek Type of Work Involved: ❑ Audio and Stereo Systems 0 Boiler Controls Clock Systems Data Telecommunication nstallation Fire Alarm Installation HVAC EJ Instrumentation Intercom and P ging Systems landscape I igation Control* \ Medical Nurse Its a EJOut r landscape Lighting* C7 tective Signaling Other —_._— ----—---- —- _m of Systems w - * No licenses are required. Licenses are required for all other installations i:\Dsts\peffnitFomu\ElcPermitAppPg2.doc 01/03 Mechanical PermitApplication Received Mecfunical ing ♦� a� DaIern : _ Permit No.: I 7`a�yy City Ol Tl� Planning Approval Permit Crte/B Permit No.: 13125 SW Hall Blvd. 21 4003 Plan Review Other Tigard,Oregon 9722AUG at By: Permit No.: Phone: 503-639-41771 (*30960 Post-Review Land Use VI � � bate/Hy: case No.: _ Internet www.ci ISlO� r olV Contact Cast: See Prxe Z for 24-hour Inspectto : 03-639-4175 NanxlMethod: _^ Su lementai Information. 'TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CRECKLISr New construction I Demolition Mechanical permit fees'are based on the total value of the work Addition/alteration/replacement I El Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit. &2- amily dwelling Commercial/Industrial Value: S _ See Page 2 for Hee Schedule AccesseiT Building Multi-Family RFSIDENTiAL A1I!PME_NT/SYSTEMS F, is UULE Master Builder Other: Description Rafln ling licmc Fee ea. Total JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning•• _ 14.00 Job site address: >_ Gas heat pump 14.00 _ Suite M Bldg./, t. Duct work 14.00 Project Name: N dronic hot water s em 14.00 — Residential boiler Cross street/Directions to job site: for radiator or hydronic system _ 14.00 _ Unit heaters(fuel,not electric) in wall in-duct,suspended,etc. 14.0_0 _ Flue/vent for any of above) _ 10.00 Subdivision: #: Repair units 12.15 Other Fuel Appliances Tax map/parcef M Water heater 10.00 RSCRIPT ONO '` 7,71"T " Gas fir lace 10.00 Flue vent water heater/gas fireplace 10.00 - -- - -----�-- Log lighter(gas) 10.00 --- - — Wood/Pellet stove_ _ 10.00 Wood fireplace/insert 10.00 Chimney/liner/flue/vent 10.00 +__ Other: _ 10.00 Name: e'�� �� Environmental IExhaust k Ventilatbn — Range hood/other kitchen equipment 10.00 Address: -- Clothes dryer exhaust 10.00 City/State/Zip: Single duct exhaust Phone: "j Fax: (bathrooms,toilet compartments, _AIPPLICANT — _._ ; A . 'RMS '� ` ''_, utili!y rooms) -- 6.80 Name: Attic/crawl space fans _ 10.00 Address: �----�- — --._� ��----- ocher: _ — 10.001 --- -------- ------- Fuel Piping City/State/Zip *($5.40 for not 4 $1.110 each additional dFurnace,etc. Phone: �J _ Fax: — '— ®---— ---- Gas heat pump *• H E-mail: -Well/suspended/unit heater '* CONMM C TO _ Water heater M •• _ Business Name: '-;yam,% _ _ Fireplace 00 oJ—o Address: - Ra a -- .� -- City/State/Zip: !_ _ Clothes dryer(Baas) ,* �— _J Phone: r` -a Fax: other. _ •• _ CCB Lic. #: TQC' Mechanical Authoriz^d belt • +� _ Subtotal: S Signature: Dater/ Minimum Permit Fee$72.50 S Plan Review Fee 25%of Permit Fee) S - - (Please print narne) A—� - - State Surchar a 8%of Permit Fee $ N TOTAL,PERMIT FEE $ Notice: T"hls permit application expires If a permit Is not obtained within *Fee methodology set by Tri-County Building Industry Service Bt►ard. 180 days after It has been accepted as complete. "Site plan required for exterior A/C units. i:\Dsts\Permit FotTm\ tecPerrnitApp doc 01103 Mechanical Permit Appffcatiun - City of Tigard Page 2-Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction _ thereof,to and including$10,000.00. $10,001. $25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$100.00 or fraction thereof,to and including $25000,00. 525,001.00 to S50, .00 $379.50 for the first$25,000.00and $1.45 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,001.00 and up $742.00 for the first S50,000 and $1.20 for each additional S .00 or fraction thereof. Assumed Valuations Per A fiance: slue Total Description: Ea _Amount Fums,a to 100,000 BTU,including 955 ducts&vents Furnace>100,000 BTU including ducts 1,170 &vents Floor furnace including vent 955 Suspended heater,wall heater or floor 5 mounted heater — Vent not included in appliance pe 445 Repair units 805 _ <3 hp;absorb.unit, 955 to 100k BTU_ 3-15 hp;absorb.unit, 1,700 101k to 500k BTU _ 15-30 hp;absorb.unit,50 to I mil 2,310 BTU 30-50 hp;absorb unit, 3,400 1-1.75 mil.BTU \ >50 hp;absorb.uni 5,725 >1.75 mil.BTU Air handlin uni 10000 cfm 656 Air handlin u t>10,000 cfm 1,170 Non- rtable va rate cooler 656 Vent fan c ccted to a single duct 446 Vent syste not included in appliance 656 Hood se ed by mechanical exhaust _ 656 _ Domestic incinerator '.,170 Commercial or industrial incinerator _ 4,590 IL Other unit,including wood stoves, 656 inserts etc. t— Gas piping 1-4 outlets _ 360 N Each additional outlet 63 TOTAL COMMERCIAL S m VALUATION: W a is\1)qts\Permit Forma\MecPerrnitAppPg2.doc 01/03 4*AF4')f96$D S l!J iC1�",rL��4,; ri( fllht.rl,r✓� t.tl./ 'til i :a or �1cSa�l► M Nor �.r.� � C1ot�7 � �..E✓.ar�vn/ S 4 I �°`�� C•�� I a e W J RECEIVED AUG 21 ?.003 ,A VY OF FIGARD It1ILDING DIVISfQN CLAan- siT�rt�viFw Rao�jjl CITY OF TIGBUILDING PERMITNO.:�,r-�»� � r PLANf��lt 1(i DIVISl N- 5 Rcyuired Sctlmcks: Approved Q Not Approved Side: `2_._ Slr�et Side: - LL C.i Rear: (9 Frani. Vistf", �'le trance: ,ro:� d rJ Not Appro�,cd •1n�in am Rioildiny I�Ia' t ►•� fret ''N'S :>:r,i. ��ider f.ettrt I: .iuired: L1 No E3' . tNEE I N G 1)I;I'AR1 cItial Slope:.,._."•o pIjroved [2 Not Approved Site Plnn Approved [] pot Approved B ,: ry. � � Date.• Notes: CITY OF TIGARD 24-Hour BUILDING Inspection Lin (503)631"176 MST aZOD.3�Od � INSPECTION DIVISION Business L (503)634.4171 SUP _— Received __ _nate R nested AM PM OUP _ — I ovation �� 8U _ �= Suite _ MEG Contact Person Ph PLM — Contractor Ph( ) _ —_ SWR BUILDING TenanVOwner __ _ ELC _ footing Foundation ELC Ftg Drain ACCeSB:/ ELR _. Crawi Drain 6� �v Slab Inspection Notes: SIT Post&Beam -- Shear Anchors ^— Ext Sheath/Shear _ Int Sheath/Shear Framing Insulation U� Drywrll Nailing Firewall Fire Sprinkler — — ------- -- Fire Alarm iusp d Ceiling -- — —' Roof Other: _ — -- Final PASS PART FAIL PLUMBING Pos:&Beam f 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 — 0. Gas Line Smoke Dampers — — -- H U ASS PART FAIL - — J Service Rough-In UG/Slab W Low Voltage Fire Alarm Final F1 Reinspection fee of$ __. required before next Inspemion. Pay at City H 125 SW[fall 81vd. PASS PART FAIL gR� Please call fcr reinspection RE: ______ _._ J Unabl Inspect-no ams Fire Supply Line ADA 1 spells Approach/Sidewalk Other: Final DO NOT RtM OVI thb lispeoI' m "W j"'11111. PASS PART FAIL CITY OF TIGARD 24-Hour aa>3 � BUILDING Inspection Line: (503)6394175 MST5&A!n9 gil7 INSPECTION DIVISION Business Line: (503)6394171 BUP 139ceived __ Date Requesteds a�_ AM PM_ SUP Location A Sufte — MEC Contact Person Ph PLM Contractor Ph( ) _ SWR BUILDING Tenant/Owner _ ELC Footing ELC Foundation Access: Ftg Drain ELR _ Crawl Drain ` Stab Inspection Notes: SIT Post&Beam Shear Anchors _ -- Ext Sheath/Shear Int Sheath/Shear Framing M Insulation Drywall Nailing (`l V kti C 1-1 Lz_( <.. 130 4��d Firewall Fire Sprinkler — Fire Alarm Susli d Ceiling --- Root Other: Fine' PASS PART FAIL — PLUMBING 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 _ R. Gns Line Smoke Dampers —_ Final _PASS PARI FAIL - J ELECTRICAL Service - Rough-In W UG/Slab -j Low VoltageLI-W term i a Reins ton fee of$q required before next ins SS PART FAIL � �' - � pection. Pay at City Hall, 13125 SW Hall Blvd. SITE _ n Please call for reinspe-ti"n RE:_-.-._ -- -- �nablo to Inspect-no access Fire Supply Line ADA1 h© Approech/Sidewalk �� --- IAspsetAtf-(G� — _._t7(t Other: Final — DO NOT RRMOW thins IMpttll4t10111+tOON he111 tM J"M& PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING inspection Lino: (503)630-4175 MST . - ,1-i141 INSPECTION DIVISION Business Line: (503)630-4171 SUP — Received Data Requested _ AM ._PM SUP Location Suite_ MEC Contact Person _— Ph( —) _� �o PLM Contractor —_ Ph( ) SWR BUILDING Tenant/Owner _ ELC Footing Foundation ELC Fig Drain tx:e8a: Crawl Drain �� �," / � ELR Slab Inspection Nous: SIT Post 8 Beam Shear Anchors Ext Sheath/Shear IntSheath/Shear A •► ►t_ mil �;�� �� Z Framing Insulation — Drywall Nailing Firewall Fire Sprinkler --- — Fire Alarm Ss up'd Ceiling --- "•� ` Roof C( "Z . v 1^ Other: _ Final PASS PART FAIL - — PLUMBING Post 8 Beam Under Slab Rough-In Water Service -- - Sanitary Sewer Rain Drains --- Catch Basin/Manhole Storm Drain -- Shower Pan Other: — ---- AS PART _FAIL ANICAL Post fig Beam Rough-In — —_ Gas Line IL Smoke Dampers - 0. Final V~1 PASS PART FAIL — ELECTRICAL Service m Rough-In UG/Slab W Low Voltage Fire Alarm Final Reinspection fee of$.�__ required before next in PASS PART FAIL f' inspection. Pay at City Hell, 13125 SW Hall Blvd. SITE —, L' Please rail for reinspection RE: _.__ [] Un"to inspect no access Fire Supply Line ADA ApproactdSidewalk Ext--- Other: Final DO NOT REMOVE this Im**eftn mord from Un"tdho. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639.4176 MSToZO_4�— � IN9PIECTION DIVISION Business Line: (503)639-4171 00 OUP — Received — Date Requested __ ASU—PM OUP _ Locationuite _—_ MEC — Contact Person Ph( ) 7a! — (0 a- PLM Contractor Ph( ) - SWR — BUILDING Tenant/Owner _ ELC Footing ELC Foundation Access: Ftg Drain �- ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors Ext Sheath/Shear — Int Sheath/Shear Framing V 1 t-[� , v L -'i-►�L I-Y Insulation J i Kf`iCi Drywall Nailing -- - FirewRII Fire Sprinkler Fire Alarm {��P(:!) C Cv S Susp'd Ceiling Roof _ Other: PAY PART FAIL UMBING -_ — _ -- Post&Beam Under Slab Rough-In Water Service Sanitary Sewer Rein Drains - Catch Basin/Manhole Storm Drain — Shower Pan Other: Final _ PASS PART FAIL MECHANICAL --- Post&Beam Rough-In --- - a Gas Line Smoke Dampers Final N PASS PART FAIL ELECTRICAL J Service m Rough-In _ 0 UG/Slab JLow Voltage _-- _-_-_-- - --- — Fire Alarm Final Reinspection fee of grequired before next inspwilon. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE — Please call for rPinsrAction RE:_ .. Unable to inspect-no access Fire Supply Line / ,!� ADA , �N C) Approach/Sidewalk Dab — -y Ext Other: Final DO NOT REMOVE thle l -epodam ftl o"W j"111th. PASS PART FAIL .A'AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA/, � POO. ► co ► � o r ► i ISI 0 0 ► ► a + ` Or3i ► 0 bn A A ► ► / a � R Q t a z �► t W o O R cr, R W � o ► xi (u b oil. a 1 w ► 44 P. ro w A � � N j ►