15950 SW 76TH AVENUE Cn
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15950 SW 76`x' Avenoje
CITY O F T'G A R® MASTER PERMIT!
PERMIT#: NlST2001-00389
DEVELOPMENT SERVICES DATE ISSUED: 7/9/01
13'125 SW Hail Blvd., Tigard, OR 97??3 (503) 639-4171
SITE ADDRESS: 15950 SW 76TH AVE PARCEL.: 2.S112CD-00701
SUBDIVISION: DURHAM ACRES ZONING: R-12
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Addition of 483 sq. ft. first floor and 592 second floor
BUILDING
REISSUE. STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 403 sf BASEMENT sf LEFT: � SMOKE DETECTORS.
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 59; of GARAGE: sf FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT. of RIGHT:
VALUE: $92.172.50
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 1.011,oo sf REAR:
PLUMBING _
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATJRIES: DISHWASHERS: FLOOR DRAINS SEWER LINES: SF RAIN DRAINS: I CATCH BASINS:
TUBIS',OWERS: GARBAGE DISP. WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
^A FUEL TYPES FURN<10OK: BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER:
FURN>-100K: UNIT HEATERS: HOODS: OTHER UNITS: I
MAX INP: Wtj FLOOR FURNANCES: VENTS: _ WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL _
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIrEEOERS BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTIONS
1000 SF OR LESS 0 - 200 amp: 0 - 200 amp W/SVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION:
FA ADD'L 500SF: 201 400 amp: 201 - 400 amp: tat WIO SVC/FDR, SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY. 401 - 600 amp: 401 600 amp: EA ADDL as CIR. I SIGNALIPANE.L: IN PLANT:
MANU HM/SVC/FUR 601 - 1000 amp: 601 amps-1000V: MINOR LABEL:
1000+amplvolt:
PLAN REVIEW SECTION
Reconnect only: ----
-4 RES UNITS: SVCIFUR>+225 A. >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL S.COMMERCIAL _
AUDIO 6 STEREO VACUUM SY:TEM. AUDIO d STEREO: FIRE ALARM- INTERCOM/PAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM. OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNI.
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: JATArTELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 1,500.24
This permit is subject to the regulations contained in the.
BLACKVVELL,JAY M+TRACT N PHIL ROSE CONSTRUCTION Tigard Municipal Code,State of OR Specialty Codes and
15950 SW i'eTH 17430 SW VIKING ST all other applicable laws. All work will be done in
TIGARD,OR 97224 ALOHA, OR 97007
accordance with approved plans. This permit will expire H
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
Rep N: LIC 911039 forth in OAR 952-001-0010 through 952-n01-0080 You
may obtain copies of these rules or dim 'estions to
gy 4 y REQUIRED INSPECTIONS OUNC by calling(503)246-1987.
Erosion Control Insp 0, Under'door insulatiun Electrical Rough In Insulation Insp Final inspection
Footing Insp Crawl Drain/Backwater Framing Insp Rain draln Insp
Foundation Insp Footing/Foundation Dn Shear Wall Insp Electrical Final
Post/Beam Structural Mechanical Insp Exterior Sheathing Insl Mechanical Final
Post/Beam Mechanics Electrical Service Low Voltage Plumb Final
Issued By : `" LGJ`Z ",' Permittee Slgn iture
Call (503) 639-4175 by 7:00 p.m. for an Inspection needed the next business day
lBuilding Peri
�� ))
Permit no.:
City of Tigard �. t Expirednie:
City u(Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503)639-4171 bale issued B Receipt no.:
� n
Fax: (503) 598-1960 �j / ' Case file no.: _ Payment type:
�' r
Land use approval: M2 family:Simple Complex:
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
A Addition/alteration/replacement U Tenant improvement U Firc sprinkler/alarm U Other:
Joh address: / 9 S o $ fi✓ w LAA(1(e _ Bldg.no.: Suite lo._,
'►'" Tax ma /tax lot/account no.:
Lot: BI-)ck__�°�tbdivision: — P _--
Project name:
Description and location of work oon`premises/special conditions: :t-b_6tUU
/J 7�
Name:
Mailing address: / S 9112 1 do 2 fandly dwelling: ((�� --77
State:O2, ZIP: Valuation of work.............:.[.. .�.l..7. '' $
Phone: Fux E-mail: No.of bedrooms/haths................................. •
Owner's representative: Total number of floors....... j —
Phone: Fax: Email: New dwelling area(sq.ft.)
Garage/carport area(sq.ft.)...... a
WNW Covered porch area(sq.ft.) ......................... -
Name: Deck area(sq. ft.)........................I............... G?
Mailing address: _
State: ZIP: Other structure area(sq.ft.).........................
City: — Commercial/Industriallmultl-family:
Phone: Fax: E-mail:
Valuation of work........................................ $
C.
F�I E SS M D b h Existing bldg.area(sq.ft.) .......................... _
Business Warne: New bldg.area(sq.ft.)...
Address: -)y 1 e' S W_ ytk 114(a, Number of stories........................................ _—
vii State:U4, ZIP: Type of construction.
Phone: Fax:(o - 3 E-mail:
Occupancy group(s): Existing:
CCB no.: 8 _ New:
City/ etro .no.: 0000 Notice:All contract n and subcontractors are required to be
JIMINE licensed with the Oregon Construction Contractors Board under
Name. p AVE h.Q Q.-'ib Vl provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed.If the applicant is
Address: I 13 2- exempt from licensing,the following reason applies:
Cit U TL.A�-�— State:01- 1 ZIP: Z.1 _
Contact person: Plan no.: _
Phone: t4 q_ r 2 Fax: E-mail: -�—
Name: Contact person: Fees due upon application ...........................
Address: — —- Date received: _
City: State: ZIP: Amount received ........................................ $_-- _-
Phone: Fax: E-mail: _Please refer to fee schedule_
I hereby certify I have read and examined this application and the Not all lurdkUrnr acoert cftdt cards,r*sor call)addiction fm nxne inf..Hl"'
attached checklist.All provi ions of laws and ordinances governing this U Viae U MuterCard
work will he complied wi kether specified herein or not. credit cad""toner:—
a rer
Authorized signatum: ` Date: Nnnw of cardholder u stwown on c"I cam- $
Print nam,.: PHI(-
Notice:
(-
Notice:'This permit application expireir ifill permit is not obt&inW witllin I go days atter it has been accepted as complete. "),413 0AGCOM)
One—and"I-wQ-Fainily Dwelling
Building Pernnit Application �.�13eckl1Sf— Referenceno.:
Associated permits:
u1,_r I'd City of Tigard ❑Electrical ❑Plumbing ❑Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 972231 1 LJ Other: _
Phone: (503) 639-4171
Fax: (503).598-1960
RM"
I band Ilse actions complet'.d.See jurisdiction criteria for concurrent reviews. —
loning.Hood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot. __._--
4 Fire district _approval required.
5 Septic system permlt or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. _
8 Soils report. Must carry original applicable stamp and signature on file or with application. _
9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc. —
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 roust he incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references netween plan location and details.Plan review cannot tc 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-R.elevation differential,plan must show contour lines at 2-11.intervals);location of easements and
driveway;footprint of structure(inducting 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 ('rose Rection(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace 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+,•greater than four foot at building envelope,
hull-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(preserlpllve path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescrihive nth analysis provide specifications and calculations to engineering standards.
17 Floor/root framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
loca(ions.Show attic ventilation.
18 Hasement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered
systems gee item 22 "Engineer's calculations." --
11) Ream calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 1 o feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/root truss design details.
I M;nergy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances. _
1.2 Engineer's calculations.When required or provided,(i.e.,shear wall,goof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be.shown to he applicable to the project under review.
23 I.*ivc(?)site plans are required for Item I 1 above. Site plans must he 8.1/2"x 11"or 11" x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above. _.
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or mirrored building plans will be accepted.
28 —
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Red ink is reserved for department use only. ")-K+14(aaur'oM)
I'lu><niaing Permit Application
rDatereceived: Permitno.:City of Tigalydrmit no.: Building pcnnil no.:
Address: 13125 SW I fall Blvd,Tigard,OR 97223 —
City ofTigard Phone: (503) 639-4171 Project/appl.no.: Fxpiredate:
Fax: (503)598-1960 Date issued: Hy: Receipt no.:
Land use approval: case file no.: Payment type:
1
U I &.2 family dwelling or accessory U Cominercial/industrial U Multi-family U Tenant itnpmvetnem
0 New construction 4 Addition/alteration/replacement O Food service U Other:
.1011 SUIT.INFORMATION 1`111' S( IILDII 11,(Ior specia I t
Job address: /S 7GO $L� �+V Descri tion Qty. Tee(ea.) Total
Bldg.no.: I Suite no.: v New 1-and 2-family dwellings only:
Tax map/tax lot/account no.: (includes 1000.foreachwilityconnection)
SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath -- --- -----
Project name: __ _ SFR(3)bath --- __
City/county: I(, fTR ZIP: Each additional badVkitchen J
Description and lavation of work n premises: LkO Q I T1 oti �t SiteutWtles:
Catch basin/area drain
Est.date of com�spection: Drywells/leach line/trench drain
Footing drain(no.lin.ft.) _
Manufactured home utilities _
Business name01.1M,VIF4- Manholes _
Address: Rain drain connector
City: .4'1,o titer- Statc:04t ZIP: DO Sanitary sewer(no.fin.ft.)
Phone: 3/ -1 8 (e Fax: Email: Storm sewer(no.lin.ft.) _
CCB no.: Plumb.bus.reg.no: Water service(no.lin.ft.
City/metro lie.no.: Fixture or Rem:
Contractor's representative signature: Absorption valve _ —
Print name: I Date: Back flow preventcr
Backwater valve
Basins/lavatory
Name: Clothes washer
Address: — Dishwasher
Dnnking fountain(s) _
City: _ _ State: IIP: Ejectors/sum —
Phone: --Tf'ar__ Email: Expansion tank
Fixture/sewer cap
Name(print): floor drains/floor sinks/hub
Mailing address: "--- Garbage disposal —
Hose hibb
City: State: Z1P: �_ Ice maker
Phone: Fax: I E-mail• Interce tor/ reasc trap
Owner instal lation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: Date: Sump _
Tubs/shower/shower pan
Urinal _
Name: _ -- ---- Water closet
-- - -- -
Address--.v_ �-- - _ _ Water heater
City: _ State: ZIP: _ Othci: y
Phone: — Fax 1:E-mail: Total
Not all iurlatactiotu accept credit rarde,pleaa cell lutisdiction fa mote Notice:111is permit application
intomtation. Minimum fee................$
❑MISS ❑MasterCard expires if a permit is not obtained Plan review(at __ %) $
Credit cant numbs _ _ � within 180 days after it has been State surcharge(8%)....$ _
E>tpiree
Name of canaroldrr ai ehrnm an c�t cry----
accepted as complete. TOTAL .......................$
_ _ s
Ctudholdet itp oume Amount 110-616(6AO MM)
PLUMBING PERMIT FEES:
-- -- PRICE TOTAL New t and 24amily dwellings only: � !^
FIXTURES individual] aTY
(ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. OTY (ea) AMOUNT
16 60 for each utility connection
Lavatory -- _ O_ne 1 bath $249.20
-- -- ---
Tub Tub/Shower Comb 16.60 Two bath -� _ $350.00
Tr p
_"-- 16.60 Three(3)bath $399.00
Shower Only - -J- ---' - -�
Water Closet 16.60 - _ _ SUBTOTAL
Urinal 16.60 8°/.STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25°/.OF SUBTOTAL
TOTAL
_
Garbaye Disposal 16.60 ---
Laundry Tray - --- - 16.60
Washing Machine -^ 16.60 -
FloorDrain/Floor Sink 2" - -- 1660 PLEASE COMPLETE:
3^ ---- 16.60
4• 16.60
Water Heater -6-r O like kind 16.60 � _ Quantit b Work Performed
Ga piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
Capped
-
MFG Home New Water Service - 46.40
MFG Home New San/Storm Sewer 46.40 Lav2lo - -
Tub or Tub/Shower
Hose Bibs _ 16.60 i/. Combination
Roof Drains 16.60 Shower Only --- -
Drinking Fountain 16.60 Water Closet
-16 60 Urinal
Other Fixtures(Specify) Dishwasher
` Garbage Disposal
laundry Room Tray
-_` - ---- Washing Machine
Floor Drain/Sink: 2" _-_-
Sewer-
St 100' 55.00 - 3" - -
Sewer-each additional 100' 46.40 4"
Water Service-1st 100' - 55.00 Water Heater
Other Fixtures
Water Service-each additional 200' 46.40 S eclf�___ -
Storm&Rain Drain-1st 100' 55.00 -
Storm&Rain Drain•each additional 100' 46.40 --
Commercial Back Flow Prevention Device 46.40 -- -- `--
Rosidentlal Backflow Prevention Device' 27.55
Catch Basin--Ji- - 16.60 -
inspection of Existing Plumbing or Specially 72.50
Requested Inspections _ er/hr COMMENTS REGARDING ABOVE.
Rain Drain,single family dwelling 65.25 --
Grease Traps ---- 1660 --u -- -
QUANTITY TOTAL
Isometric,or riser diagram Is required If -
_ r_ Ouantlty Total is >9 -- -
*SUBTOTAL
8./T.-ST-ATE SURCHARGE - `-
"PLAN REVIEW 25°/a OF SUBTOTAL -�
Required_only tl fixture qty.total Is>9 .
TOTAL a
*Minimum permit fee is$72 50•8%state surcharge,except Residential Backflow
Prevention Device,which Is$39 25•8%-,%late surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan rnview
I klsts\forms\phn-fees.doc 10/10/00
03b�
Mechanical Permit Application
,1 Datereceived: Permit no.
City of
f i►T 1guld Projectlappl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: __ Building permit no.:
1
U 1 &2 family dwelling or accessory U Commercial/industnal U Multi-family U Tenant improvement
U New construction 21 Addition/alteration/replacement U Other:2M it I a 101 me]140 IN
1 1
Job address: / S-o u/ -U' ��t�� _ Inairalc xiutpmcnt yuanuties in boxes below. Indicate the dollar
ue of all mechanical materials,equipment,labor,overhead,
Bldg.no.: Suite no.: val
profit.Value$
Tax map/tax lodaccount no.:
ti
Lot: Block: Subdivision: 'See checklist for important application information an
Project name: jurisdiction's fee schedule for residential permit fee.
ZIP: t
City/county: I �fi�•1(� 1
Description and location of Lw,.,k on premises:
am-
Jfl�"bFee(ea.) Total
Est.date of comp etion/inspection: of y r ,t' Desetipflon 2tj. Res.only Res.onl
Tenant improvement or change of use: Air handling unit _ CFM
Is existing space heated or conditioned?IN Yes U No Air conditioning(site plan req r rt 13� —
Is existing space insulated?)d Yes U No Alteration o existing # system
of er compressors
State boiler permit no.:
Business name: 4(✓►a/�fiDrn tikH'C"^<. �`Q _ HP
Address: 45-YO° $v✓ I ?��� Fire/smoke amper. ucl smoke detectors _
City: Sta
bftit~ te 0/1. I ZIP_ �o o'j heat pump(site )Ian require ) _
Pax: E-mail: nsta rep iceturnac urner �
Phone: 7 including ductwork/vent liner U Yes U No
CCB no.: iii -� nstarep ac re°cite eaters-suspen e
City/metro lic.no.: wal:,or floor mounted
Name(please print): Vent for a ranee Cher than furnace
e erat on:
Absorption units______ BTU/H
Chillers` _ —_ HP
Name: I Ip
Com ressors_
Address: Fovironmental ex a rent at on:
City: State: IP: —� Appliance vent _
Phone: Fax: Email: Drycrexhaust
'ype res. tc a azmat
hood fire suppression system —
Name: Exhaust fan with single duct(bath fans)
Exhaust System dart tom Iieating or 71
Mailing address_ ue piping distribution(tip to 4 outlets)
City: Stale: "LIP: Ty : LPG NO -- oil
Phone. 1171tx: E-mail: Fuel pi��injtcachadditionaTava 4 outlets
rocesspiping(sc emaucrequired)
Numbef of outlets
Name: Ter fixte4l app ince or equ pment:
Addmss• Decorative fireplace
late: ZIP: Insert-type
City: _--._ — — o stov pe et stove
Pltonc: Fax: Email:
er.
Applicant's signature: _ Date: _ y_
Name(print):
Permit fee.....................
Not dl jud"cliom accept credit card+,pkm cdt jurlwiction for wtv informatir n
$ _
Notice:'i•his hermit application Minimum Ice................$ _
U Viso U MasterCsrd expires if a permit is not obtained plan review(at _ %) $
Cmdu cord number: fig within 180 days after it has been
State surcharge(8%)....$ _
��cWho r u on c t c _
accepted sa complete.
s TOTAL .......................$ _-
-�_ c`r idTr ure— Amount 440.4617 OWC OND
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUA_T_ION:_ FEE: Description: Price Total
$1.00 to$,5,000.00 Minimum fee$72.50 Table na Mechanical Code Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to ducts
& 0 BTU
$1.52 for each additional$100.00 or including ducts&vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts&vents 17.40
$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 including vent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00 or floor mounted heater 14.00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional$100.00 or 6.80_
fraction thereof,to and including 6) Repair units -
$50,000-00,
12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. _ footnotes below. Comp*
7)<311P;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00_ 8)3-15 HP;absorb _
Value Total unit 100k to 500k BTU 25.60
^9scrl tion: C Ea Amount 9)15-30 HP;absorb
Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTU 35.00
ducts&vents 10)30-50 HP;absorb
Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU 52.20
ducts&vents - 11)>50HP:absorb
Floor furnace Including vent 955 _ _ unit>1.75 mil BTU -- 87.20
Suspended heater,wall heater or 955 12)Air handling unit to 10,000 CFM
fioor mounted heater - 10.00
Vent not Included In applicance 445 13)Air handling unit 10,000 CFM+
_PRrMLt 17.20
Repah units 805 - 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 10.00 `
to 100k BTU 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 6.80 y
101k to 500k BTU - 16)Ventilation system not Included in
15-30 hp;absorb.unit,501k to 1 2,310 ap (lance permit 10.00
mil.BTU 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit, 3,400 10.00 _
1-1.75 frill.BTU 18)Domestic Incinerators
>50 hp;absorb.unit 5,725 1740
>1.75 mll.BTU -- 19)Commercial or industrial type Incinerator _
Air handling unit to 10 000 cfm _ 658 69.95
Air handling unit: 10000 cfm 1,17q -_-_ 20)Other units,Including wood stoves
Non-portable evaporate cooler __ .. 656 10.00
Vent fan connected to a sin le duct 446 21)Gas piping one to four outlets
Vent system not Included in 656 5.40
appliance m It -- 22)More than 4-per outlet(each)
Hood served by mechanical exhaust _656 _ 1.00----
Domestic
.00 __Domestic Incinerator _ -1,170 _ Minimum Permit Fee$72.50 :SUBTOTAL: $
Commercial or Industrial Incinerator 4,590 ^
Other unit,Including wood stoves, 656 8%Stele Surcharge $
Inserts,etc.
G-B 1 I�1 4 outlets �� _ 360 _ _ - 25%Plan Review Fee(of subtotal) $�
Each additional outlet - 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION: _ __ __ _ --
Qtlh r it ctiontt atnd Falls:
1 Inspections outside of normal business hours(minimum charge-two hours)
$72%per hour.
Inspections for which no fee is specifically Indicated (minimum charge-hall hour)
$12 50 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
charge-ono-half hour)$72,50 per hour
'State Contractor Boller Certification required for units�200k BTU.
"Residential A/C requires site plan showing placement of unit.
11clsts\formsvnech-fees.doc 10/11/00
Electrical Permit Application
Date received Permit no.:
City of Tigard Project/appl.no.: Expimdate:
CitynjTigord Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receiprno.:
Phone: (503) 639-4171
Fax: (503) 598-1930 Case file no.: Payment type:
Land use approval:
T 'OF PERMIT
U I &2 family dwelling or accessory U C-'ummercialiindustrial U Multi-family U Tenant improvement
U New construction IN Addition/alteration/replacement U Other: U Partial
Job address: / SV 3io W16. &-7Bldg.no.: Suite no.: 1Tax map/tax lot/account no.:
Lot: Block: �Suhdivision: _
Project name: Description and location of work on premises: Ho
Estimated date of completion/inspection:
CONT�AF`tOR APPLICATION
Job no: Fee Max
Business name: fl�S p P,1 G?_TYL�L T 4 C. Ik-scripliun Qty. (ea.) 'total no.rasp
New residential-singleor multi-family per
Address: '20 S W t t , dwellingunit.Inclullmattaclxtiignrnge.
City: zeb'4'VLn-Tr✓1 StatcWt ZtP: 7)0-7 5wrvfainchtded:
Phone: G`iq - L S Pax: - mail: 1000 sq.it.or leas
Elec.bus.Ile.no: Each addirional 500 sq.ft.or portion thereof
CCB no.: (� l�sl.imitedenergy,residential 2
City/metro lic.no.: Limiledenergy,non•rcsidrntial 2
Each manufactured home or modular dwelling
Signature of supervising electrician(rc uhed) Date Service and/or Lader 2
Sup.elect.name(prinq; Licrns n° Servicesorfeeden-Installatlon,
alteralion or relocation:
200 antps or less 2
Name(print): 201 snips to 400 amps 2
401 amps to 600 amps- _ 2
Mailing address: 601 amps to 1000 ams 2
City: Slate: ZIP: Over 1000 amps or volts 2
Phone: Fax: E-mail: Reconnectonly I
Owner installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to installation,alterallon,orrelocnilon:
21x1 amps or less 2
ORS 447,455,479,670,701. _
201 amps to 400 amps __ 2
Owner's si nature: Date: 401 to 600 ams 2
Branch circults-new,alteratlon,
or extension per panel:
71c A. Fee for branch circuits with purchase of
service or feeder lex,each branch circuit
Slate: 7.11B. Fee for branch circuits without purchase
--- - — -- of service or fader fee,first branch circuit: 2_
Phone: Fax: E-mail. Fschadditional branch circuit:
!V1111 ''Fill III rm.,imM= Ike.(9ervice or reeder not Included)-
_r
over 223 amps-commercial U I lealth care facility Each um or imgauon circle 2
iceoer320amps-ratingof1 ttc2 U Hazardouslocation Each si n or outline lighting 2
ydwellings U Building over 10,M)square feet four rat Signal circuits)or a limited energy panel,
U System over 6W volts nominal more residential units in one slmclute alteration,or extension* —
U Building over three stories U Feeders,401)amps or mine. •tkscti tion.
U Occupant load over 99 persons U Manufactured sin.ctures or RV park Each eddltionsl liviWilion over the rdlowable M any of the above:
U Egress/lightingplan U Other -
Submit sets or plans with any of the above. Inveed atlon Fre
The above ane not applicable to temporary constsvction service, Other
Hot ail)urtadktioru accept crrx9t cards,please call jurisdiction for mnm Infor nsuon. Notice:This permit application Permit fce.....................$
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
credit card number: ., _ within ISO days after it has been State surcharge(8%)....$ -_
s `r'
TOTAL .......................
accepted as complete.
_.
-tT&id�- as shown on ered t cTTar -�
_ s
C odi er slptNure Amount 440-4615 It DICOM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee..._........... ..................................... $75.00
Number of Inspections per Liermit allowed) (FOR ALL SYSTEMS)
Service iflclud-ld: Items Cost Total l Check Type of Work involved:
Residential-per unit I�
1000 sq ft.or less _ $145.15 _ _ 4 LJ Audio and Stereo Systems'
Each additional 500 sq,ft.or
portion thereof $33.40 1 Burglar Alarm
Limited Energy $75.00 _
Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder _ $90.90 _— 2
Services or Feeders Healing,Ventilation and Air Conditioning System'
Installaton,alteration,or relocation
200 amps or less _ $80.30 2 Vacuum Systems'
201 amps to 400 amps $106.85 2
El
401 amps to 600 amps $160.60 2
601 amps to 1000 amps �— $240.60 2 Other
Over 1000 amps or volts _—� $454.65 2
Reconnect only _—_ $66.85 2
s or FrJeders TYPE. OF WORK INVOLVED -COMMERCIAL ONLY
Temporary tonly
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps or less $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133 75—� 2 Check Type of Work Involved:
Over 600 amps to t 00n volts,
see"b"above. Audio and Stet oystems
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder fee.
Each branch circuit — $665 2 ❑ Data Telecommunication Installation
h)The fee for branch circuits
without purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit _ $46.85 HVAC
Each additional branch circuit _ _ Sc 65
Miscellaneous LJ Instrumentation
(Service or feeder riot included)
Each pump or irrigation circle _ _ $5340 _ Intercom and Paging Systems
Each sign,o outline lighting $5340
Signal circult(s)or a limited energy
panel,al'Aralion or extension $7500 Landscape Irrigation Control'
Minor Labels(10) $125.00
Medical
Each additional Inspection over ❑
the allowable in any of the above Nurse Calls
Per Inspection — $62.50
Per hour $62.50 r,
In Plant $73,75 _ u Outdoor Landscape lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ -- -- E1 Other
8%State Surcharge $ ----_ Number of Systems
25%Plan Review roe No licenses are required Licenses are required for all orher Installations
See"Plan Review"sedum t $
front of application --
Fees.
Total Balance Due $
Enter total of above foes $ �_
iJ Trust Account M _ 8%State Surcharge
Total Balance Due $— —
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST ,+ZG�
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — f
_ SUP
—Date Requested —
--vtRq — �.� ANI— PM BLD
Location / ,5 l� L- � � U- �. -�-,,•
/t Suite MEC
Contact Person — f Ph 2-Z -- 2c10 PLM
Contractor _ _ Ph SWR
ILDI Tenant/Owner I.-�I[2 C1 - ( e.��._�LL,xe ELC
Re ming Wall - - / ELR _
Footing Access: - ---
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
&Beam ---- - ---_---.____
Ext Sheath/Shear
Int Sheath/Shear - - --
Framing
Insulation
Drywall Nailing TD 0 cc / TZ�4_ U c-u A.1
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof --------
in
PART FAIL __--- ---
P BING&B
ING
Post 8 Beam -_.____ --- ----- --
Under Slab
Top Out - - -----
Water Service
Sanitary Sewer -
Rain Drains
Final — - --_-- _ --------
PASS PART FAIL
MECHANICAL -^
Post& Beam
Rough In
Gas Line
Smoke Dampers -- -
Final —
PASS PART FAIT_
ELECTRICAL -
SprVICR -
Rough In — ---
UG/Slab
Low Voltage �-
Fire Alarm
Final ----------- ------•--
PASS PART FAIL
SITE
Backfill/Grading --__--_-- - -----
Sanitary Sewer
Storm Drain I )Reinspection fee of$_ required before next inspection Pay at City Hall, 13125 SW Hell Blid
Catch Basin
Fire Supply Line I i Please call for reinspection RE: J J Unable to inspect-no access
ADA
Approach/Sidewalk
Other Date U Insipfttor `-f�,t"-`vj--_ - Ext
Final
PASS PART FAIL- DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGA.RD DL"' MNG INSPECTION DIVISION
24-Hour Inspection Line: 6,,- 4175 Business Line: 639-4 t
BUP
_—_-- Date Requested__ -----.AM---PM ---- BLD ---Location Suite
— j -_ �� Suite
-- MEC
Contact Person4 Ph „��- O?) C7 —
—�-. —a— PLM
Contractor _ _ --_ Ph — —_ SWR
BUILDING_ -Tenant;Owner ELC
Detaining Wall —T— --___ -- -_--- ELR -------`
Footing Access: —
Foundation FPS
Fig Drain — -------.
Crawl Drain Inspection Notes: "- SGN
Slab --_-_----v
Post& Beam — — — - ------ SIT _
Ext Sheath/Shear —
Int Sheath/Shear -- — ------
Framing
Insulation - ----------------._
Drywall Nailing
Firewall ------ -- -------
Fire Sprinkler
Fire Alarm — ---- -
Susp'd Ceiling
Roof
Misc:
Final - -- —
PASS PART FAIL
PLUMBING
Post&Beam - --- -
Under Slab
Top Out ------
Water Service
Sanitary Sewer _.------_-----.---w__-__--
Rain Drains
Final -- _ -- ..__---- --- ---- --- ---
PASS _eARZ, FAIL
C !C ! —
Po. eam -
Rough In _
Gas Line --- - --------- �_- ___
SmokV Dampers
f Vin-al
RECTIRICAL
% PART FAIL
--- ___—_-_ ----
- -- -- -- --v _
Service
— --
Roligh In --- - --
UG/Slab
Low Voltage --- -- — _--_
Fire Alarm
Final -- --PASS PART PART FAIL — --`— — _
SITE -----
Backfill/Grading --- -- ----- —__— �____
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch basin
Fire Supply Line ( 1 Please call for reinspection RE: — [ )Unable to inspect-no access
ADA
Approach/Sidewalk
Other Date _1/— — 0/ Inspector __ Ext
Final — — �—
i-ASS PART FAIL DO NOT RFMOVE this inspection record from the job site.
CITY OF TIGAPD BU" O;NG INSPECTION DIVISION MST
24-Hour Inspection Line: 63b-4175 Business Line: 639-4,,. BUP
Date Req.,ested J ��J��� —AM--PM BLD _
Location _i`5-27,- �% !f�!'"�- Suite MEC
Contact Person ���-�- Ph / PLM
Contractor Ph SWR
BU?LDING Tenant/Owner ELC
Retaining Wall ELR — - -_
Footing Access: 0/-2,-
FPS
Foundation -�
IFtg Drain SGN
Crawl Drain Inspect lf Not
Slab SIT
Post&Beam
Ext Sheath/.Shear
Int Sheath/Shear
Framing ------ -- -------- - ---- -
Insulation
Drywall Nailing — ------ --- -- -- J—---
Firewall
Fire Sprinkler __- _--_- -- -- _----
Fire Alarm
Susp'd Ceiling --- -----
Roof
Misc: - --___-__—__----
Final
PASS PART FAIL --------- -_---- -
PLUMBING -----
Post& Beam
Under Slab ------�
ITC-1p 1✓
ater Service — --
Sanitary Sewer --- ---
Drains -
in
PART FAIL -- —"-_---
MECHANICAL
Post& Beam - - -- - .- ----
_--- -- -------....._---
Rough In
Gas Line
Smoke Dampers --
Final
PASS PART FAIT_
ELECTRIC;
Rough In
I ow Voltage _
F re Alarm
I inal
PASS PART FAIL_ _ -----------_..------ --
SITE --
hacktilVGrading -_--�--- ------ -^- -��-_
Sanitary Sewer
Storm Drain ( ] Reinspr,chor,lees of 3 _ - -__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
r;atch Basin I I pleasa call for rein-,pertinn RE: [ j Unable to inspect no access
I ire Supply Ling
ADA t
Approach/SiaeWUK Date ff/ Inspector / _ `�" Ext -__--
(')the..r
I inal
PASS PART FAIL. DO NOT REMOVE this inspection record from the Job site.
CITY OF TIGARD BUIL DING INSPECTION DIVISION MST ;2 ei
24-Hour Inspection Line: 63 175 Business Line: 639-4
BUP —
Date Requested _ /(—/1-7 AM —PM _ BLD
Location —� `�, 7L. Suite --_ MEC
Contact Person Ph ? PLM
Contractor j —_ Ph SWR
BUILDING —� Tenant/Owner did ELC --_
Retaining Wall N ELR _--
Footing Access: FPS
Foundation _—
Ftg Drain SIGN
Crawl Drain Inspection Notes:
Slab —_ _ SIT _
Post& Beam
Ext Sheath/Shear I —_
Int Sheath/Shear
Framing ---- --_--
Insulation
Drywall Nailing _—
Firewall
Fire Sprinkler i� -------- --
Fire Alarm
Susp'd Ceiling _--
Roof
Final
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab
Top Out --------- - -._- .----.�.--
Water Service
Sanitary Sewer -------_ -- --------- --- _-_� -._-�_.-_
Rain Drains - _ ----_-.---- - ------_-- ---- --
Final
PASS PART FAIL -----.-- ---- ----_.- --- - - ------MECHANICAL
Post
Post& Deam ---------- ----- — ---------�__�. - -- --- - - --- -
Rough In
GasLine ___-_..----- - ------- _ --- --- - - -
Smoke Dampers
Final ----------—---- ---- -- _._- _
PASS PART FAIL
ELECTRICAL --- __T^— _-_____-___-----.--_-_--- -- --- -----,------
Sei w ice - ------ _ - -------- - ------- - -- ---
Rough In
UG/Slab
Low Voltage
Fire Alarm ---------- —�_ _-- - - ---------- _.-_.-
A PART FAIL ------- --- --- - --- --- ---- --.-
Backfill/Grading ---- ---- -- -- ---- —
Sanitary Sewer
Storm Drain I ] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
F ire Supply Line ( ] Please call for reinspection RE: - [ ] Unable to inspect•no access
ADA _
Approach/Sidewalk Date / , ) Inspector 1 ~, Ext
Other Ll_=C e1 {) I "�i r 1 rT _
Final � L
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUII.DING INSPECTION DIVISION
MST
24-Hour Inspection Line: 63. :175 Business Line: 639-4 I
BUP —
_Date Requested `L��/ _ AM PM _— BLD
Location /,S� l5~6 (� Th , ✓� — Suite MEC — —
Contact Person _ _ _ Ph PLM _
Contractor— Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
F ooting Access.
I oundation FPS
Ftg Drain
Crawl Drain Inspection Notes SGN —
Slab — _. SIT
Post& Beam — --- -.
Ext Sheath/Shear
Int Sheath'Shear -- ---
Framing
Insulation -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm --
Susp'd Ceiling
Root __.------- --.---_
Misc:
Final —
PASS PART FAIL
PLUMBING
Post& 3eam ---- --- ----- ---- ----- -- -
Under Slab
Top Out - -_- -------- ---- -----
Water Service
Sanitary Sewer ------ —-- -- - -- --=T- -__, __.�-- -----
Rain Drains zo�
Final -- ---- - / -_ _ -- ------ --
PASS PART FAIL
MECHANICAL ---------_---
Post& Bearn -- -------- --- - --- -
Rough In
i
Gas Line
Smoke Dampers
Final -
T FAIL
ELECTRI --- ------ -- _--- -- ---- ---
Service
UG/Slab
Low Voltage
Fire Alarm
PASS 'PART FAIL
Backfill/Grading - ------ --- -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$-- required before next inspection Pay at Ci!y Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE:-_^ _ - _J ( J Unable to inspect-no access
ADA - -
Approach/Sidewalk
Other Date 9- inspector ins/'��~ / _- --
P ��G�- �. F'Xt -
Final
PASS PART _ FAIL DO NOT REMOVE this inspection record from the job site.