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15265 SW 107TH TERRACE E 47'54" E 145.49' 3 L/17 r�_ NOTE: CENTERLINE CONCEPTS, +AOO' - SURVEYORS, WILL PUN ALL EXTERIOR 20 .0 FOUNDATION CORNERS AND PROVIDE �� y�, S- �1 : . U SUBSEQUENT MORTGAGE SURVEY. o M..-� "� j v LJ XO' L__--------- 33 Go t O s F-- �-- 1"-4� I aM N ) J ' F�'Fc 3y 2 S * .r en I A f Crd ! FL 3 7 5ir-' o O N NF1= 33 � o 3 3 1/ 20.0' i 4aoo' •-----'- '„✓L��•ir ��i EROSION CONTROL.,33s S 89'47'54" W _ SCALE i" = 20' 6L 7.3 -2. 1. PROVIDE 3 MAINTAIN 8" (min) THICK GRAVEL PAD & DRIVE UNTIL PEAN4,ANENT CONCRETE DRIVE IS IN PLACE. 2. PROVIDE& MAINTAIj,. SOIL SEDIMENT FENCE AS INDICATED. SCALE DRAWING LOT 52 ERICKSON. HEIGHTS S.E. 1/4 SEC. 10, T.2S., R.1 W., W.M. f, P f`=9C1 L �C S • CITY OF TIGARD Y: S�`lPs s WASHINGTON COUNTY, OREGON ---- A 2.5 LANDSCAPE EASEMENT SHALL EXIST 25 ALONG ALL STREET FRONTAGE AND A 7.5' �o;��' OCTOBER ' 2001 Centerline Concepts I n c �/ PUBLIC UT!L1TY EASEMENT SHALL EXIST BEHIND DRAWN BY: MSG CHECKED BY: WGDIII THE LANDSCAPE EASEMENT. � �� /' SCALE 1 "-20' ACCOUNT # 115 /,!� M: \MLI\L52ERICK 640503n650r, 0188 fax Gladstone,ve 503 650-0189027 ,...—,... .... +�r^�M!YMi� 'n•"M^'�Y;;1��...�,+tsP'A;liH1�K,9 v.a.�.:�,, p„Vl�i�i,. , OTICE: IFTHEPRINTORTYPEONANY tTITIIr I ( ! IIII 111II ( ! IIIIIIII IIIIIIIIII ► III- -CfTTr� -T.I.IfII 1Tfr ITT II ► If IIf � 1`f I`( 1 III III � I �L �1 � 1 IlL IIi III f�1 � 1 r � 1 III III I I I I I i 1 I 1 f ( � 1 f I 1 T Jill ( I ISI I I I IMAGE IS NOT AS CLEAR AS T I I I I 1 1 T I ! I THIS NOTICE, 1 2 13 4 I IT Is uv _ _ _ _ 8 9 10 I1. 12 i E TO THE QUALITY OF THE ---- ------ -----_ __ J No,36 �� °�.w. ORIGINAL DOCUMENT �- - �-- - - .- -- -_-- - .____ __-- -- --- -. I . E 6Z gZ LZ 9Z 5Z fi� Z EZ ZZ TZ OZ 6i 8T LT 9T 9i fiT ET ZI TT I 6 8 L 8 4 S Jill 1111 IIII IIII III! 111111111111111111111111 I ! il Tul 1a1 I1111Ili1111111111111llll. llllllllllilIll� 1111III� IIIIIlli11111111111 .1111I11i1111111! illililt11111111I111IIIl1 lllllLllllliillll1.111U tl ll Pi rn N 0 c� m 15265 SW 107"' Terrace FROM :CR=FTL,0Rk PLUMB i NC ?'A . I J0• :503644=%- 9 i^3r. 06 2002 0:: 5P". f _ TT _7_7 B Department of Transportation & Development TNCMAA 1 rAkotllUmDjH 01PICT011 TJPSTREALM NIAN14OLE RIM APPEARS TO BE ABOVE SOME OR A.LI, FIXTURE SPILT. RIMS IN THIS STRUCTURL. INFORMATION OF ELEVATION DIFFERENCE FROM S UD MANHOLE TO I.,OWI:ST FLOOR CONTAINING PLUMBING FIXTURES, IS NEEDED TO F-STA33LISH NEED FOR A BACKWATER VALVE AND TO DETERMINE WH1CIi FIXTURES NEED TO BE PROTECTED FROM BACKFLOW. OBTAIN AND SUBMIT WRITTEN DOCUMENTATION TO CLACKAA4S COUNTY PLUMBING DEPARTM1NTT THE FOLLOWING INFORMATION: a :z PERMIT 4 /_ �_ A TRANSIT SHOT ON (DATE) HAS ITRUI'ED TiiA",r TIT.-n_-ST UPSTREAM NIASHOLE SPILLR M IS -'o 91 IGHE1WR LOWER (CIRCI..E ONE) I'HE LOWEST FLOOR FM'Utf IO\. sr PWlr�v — __DATE -7_ In SUPE ruNrENDEN'1'` INSPECTION IS DENIED -APPROVAL P.[-NDING .RECEIPT OF INFORMATION "INSPECTOR" 2 4C? At@rn$IMy Road Oregon C,ly, DR 07041-1100 0 (60.7)655 0521 • PAXASO.7:151 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST T=e-Z 7Z, INSPECTION DIVISION Business Line: (503) 639-4171 BUP _ -____ _ Received __ Date Requested_ AM -- PM—_ BUP - — Location ,_._ Z U 7_-- Suite c — MEC Contact Person Ph( ) z PLM —_ Contractor -- __-- _.— Ph ( ) _ SWR _.._---------_-_ --- BUILDING Tenant/Owner __- - ELC Footing ELC Foundation Access: Ftg Drain ELR ----- ---- - - Crawl Drain — Slab Inspection Notes: SIT _- Post&Beam - - - Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - - - - - - - Insulation Drywall Nailing - - - - Firewall Fire Sprinkler - -- Fire Alarm Susp'd Ceiling Root Other: - Final PASS PART FAIL PLUMBING_ -- Post&Beam Under Slab - - -- -�- -- Nough-In Water Servico ---- -----' Sanitary Sewer Rain Drains —` -- Catch Basin/Manhole _ Storm Drain t Shower Pan Other: Final _PASS_ PART FAIL — MECHANICAL -- Post&Beam Rough-In — -- --- — ---- Gas Line Smoke Dampers -------- ------------- ---- - �._._. Final PASS RT FAIL — _ _ CTRIC L — Servim--- —— _— ---- - Rough•In ---_ —_ — --------- UG/Slab Low Voltage -----_-- - -_-- -------- — Frr_e Alarm ina PART FAIL F-] Reinspection fee of$_ —_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. g [] Please call for reinspection RE: —___. Unable to inspect-no access Fire Supply Line / ADA Date_1,0/-1 ( U Z llnspector7Kid Approach/Sidewalk - -- -- Other: Final DO NOT !REMOVE this lnspectlon record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST '' - c` INSPECTION DIVISION Business Line: (503) 639-4171 / BLIP ---------- Received .- Date Requested AM PMBLIP Location Suite MEC _ Contact Person ._ o, ��e Ph( ) �7-��L' --PLM - -_ Contractor - -- --- ---- Ph( ) SWR BUILDING Tenant/Owner - -- - -_ - ELC Footing Foundation El C Access: Ftg Drain ELF! Crawl Drain - Slab Inspection Notes: SIT Post&Beam Shear Anchors --- Ext Sheath/Shear Int Sheath/Shear Framing - Insulation Drywall Nailing -- - Firewall Fire Sprinkler - - - Fire Alarm Susp'd Ceiling Roof Other: -- - --- - - - - - Pro-W SSS PART FAIPLUML -- - - GING Post& Beam Under Slab — Rough-In Water Service -- --- - - -- -- -- --- -- Sanitary Sewer Rain Drains - --------- — --- --- Catch Basin/Manhole Storm Drain -- - -- - ---- -- Shower Pan Other:_ _ — Final PASS PART FAIL MEC_HANIC_AL _ Post&Beam -- Rough-In --- Gas Line _514oke Dampers ---- - --- !na S3 ART FAIL - - -- - -ELECTRICAL Service Service -- ------ - - ------- - ------- Rough-In ----------- -- - - -- UG/Slab Low Voltage -----------------�_--. -- - Fire Alarm Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _PASS PART FAIL SITE - R Please call for reinspection RE:-_ -- Unable to inspect-no access Fire Supply Line ADA ` Approach/Sidewalk Date_ _=L�1 Z Inspector _ __-Ext Other: Final - DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL �AAAAAAAAAA®AAAAAAAAAAAAAAAAAAAAAAAAAAAAA®AA/( ;z w r y ► n b 1 � ► \� ¢, oto ► ► ► ► CL CA- rD 'D ► rTl t' o' t p � ors ► i U b � �"'� ► �/♦TTTTTa'TTTTTTTT�/'TTTTTTTTTTTTTTTTTTTTTTTTTTT\� Street Tree Planting Requirements Community Development Code C oTi and 18.745.040 Street"frees C. Size and spacingy of street trees. 1. Landscaping in the front and exterior side yards shall include trees with a minimum caliper of two inches at four feet in height as specified in the requirements stated in Subsection 2 below; 2. The specific spacing of street trees by size of tree shall be as follows: a. Small or narrow-stature trees under 25 feet tall and less than 16 feet wide branching at maturity shall be spaced no greater than 20 feet apart; b. Medium-sized trees 25 feet to 40 feet tall, IG feet to 35 feet wide branching at maturity shall be spaced no greater than 30 feet apart; c. Large trees over 40 feet tall and more than 35 feet wide branching at maturity shall be spaced no greater than 40 feet apart; d. Except for signalized intersections as provided in Section 18.745.040 11, trees shall not be planted closer than 20 feet from a street intersection,nor closer than two feet from private driveways (measured at the back edge of the sidewalk),fire hydrants or utility poles to maintain visual clearance; e. No new utility pole location shall be established closer than five feet to any existing street tree; f. Tree pits shall be located so as not to include utilities(e.g.,water and gas meters)in the tree well; g. On-premises utilities(e.g.,water and gas meters)shall not be installed within existing tree well areas; h. Street trees shall not be planted closer than 20 feet to light standards; i. New light standards shall not be positioned closer than 20 feet to existing street trees except when public safety dictates, then they may be positioned no closer than 10 feet; j. Where there are overhead power lines,the street tree species selected shall he of a type which,at full maturity, will not interfere with the lines; k. 'frees shall not be planted within two feet from the face of the curb;and I. "frees shall not be planted within two feet of any permanent hard surface paving or walkway; (1) Space between the tree and the hard surface may be covered by a nonpenttanent hard surface such as grates,bricks on sand,paver blocks and cobblestones;and (2) Sidewalk cuts in concrete for tree planting shall be at least four by four feet to allow for air and water into the root area. iAdsts\rorma\Sttect'rreeCode.doc 08/30/01 Street Tree Planting List Land Use & Development Standards Cid,oLTignrd -- --- J Ash, Green;fraxinus pennsylvanica Ash, Raywood; fraxinus oxycarpa 'Raywood' Ash, White; fraxinus americana Beech, American; fagus grandifolia Beech, European; fagus sylvatica Birch, Whitespire, Japanese White; betula platyphylla, var.japonica Blackgum; nyssa sylvadca Cherry, Flowering;prunus sp. Coffeetree Kentucky; gymnocladus dioicus Dawn Redwood; metasequioia glyptostroboides Dogwood, Kousa; cornus kousa Elm,American; ulmus americana Elm, Lacebark or Chin( ulmus parvifolia Ginko, ginko biloba Goldenrain Tree; koelreuteria paniculata Hackberry, Common; celtis occidentalis Hawthorn; crataegus Honeylocust; gleditsia triancanthos, 'var.inermis' Hophornbeam, American; ostrya virgiana I lornbeam, American; carpinus caroliana Hornbeam, European; carpinus betulus Japanese Snowbell; styrax japonicus Katsura Tree; cercidiphyllum japonicum Lilac, Japanese Tree; syringa reticulata Li,,%:en, American; titin americana Magnolia. Cucumbertree; magnolia acuminata Magnolia, Star; magnolia stellata Maple, Black; acernigrum Maple, Hedge: acer campestre Maple, Paperbark; acer griseum Maple, Red, acer rubrum Maple, Sugar; acersaccharum Maple, Tatarian; acer tataricum Maple, Trident; acer buergeranurr Oak, English; quercus robur Oak, Northern Red; quercus rubra Oak, Oregon White; quercus garryana Oak, Pin, quercus palustris Oak, Sawtooth; quercus arutissima Cak, Shingle; quercus imbricaria Oak, Shumard; quercus shumardli Oak, Swamp White; quercus bicolor Oak, Willow; quercus phellos Pagodatree(a.k.a. Scholartree); sophora japonica Pear, Callery;pyrus clleryana Redbud; cercis Serviceberry; amelanchier Sweetgum, American; liquidambar styraciflua Zelkova; zelkiva serrata i.\dstslforms\Street7reeList.doc 08/30/01 o 0 0 H � O cr s � � a o (� H O Q R y Cq cl r) a �1 i � Q Im V o � r O � � 00 a �O R• o O a' 70 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GAGE ENTERPRISES INC PO BOX 1429 CLACKAMAS, OR 97015-1429 Electrical Signature Form Permit #: MST2001-00562 Date Issued: 12111101 Parcel: 2S110DA-09100 Site Address: 15265 SW 107TH TERR Subdivision: ERICKSON HEIGHTS Block: Lct: 052 Jurisdiction: TIG Zoning: R-3.5 Remarks: New .,F detached residence.Path 1 Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Pept. No electrical inspections will be authorized until this completed form is received OWNER. ELECTRICAL. c:'ONTRACTOR: RENAISSANCE CUSTOM HOMES GAGE ENTERPRISES INC 1672 SW WILLAMFTTE FALLS DR PO BOX 1.129 rr--PI u1,4iv, vr♦ J, Vuu I,LA%-txj-Iv.mS, UR 9-/01 i-14ZU Phone #: 557-8000 Phone #: 503-657-0142 Req #: su" 6185 LIG 34544 ELF: 3.1280 AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of Supero s ng Electrl crn If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 133125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE CRAFTWORK PLUMBING INC 7736 SW NIMBUS AVE BEAVERTON, OR 97008 Plumbing Signature Form Permit #: MST2001-00562 Date Issued: 12111101 Parcel: 2 S110DA-09100 Site Address: 15265 SW 107TH TERR Subdivision: ERICKSON HEIGHTS Block: Lot: 052 .Jurisdiction: TIG Zoning: R-3.5 Remarks: New SF detached residence.Path 1 Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: RENAISSANCE CUSTOM HOMES CRAFTWORK PLUMBING INC 1672 SW WILLAMETTE FALLS DR 7736 SW NIMBUS AVE WEST LINN, OR 97068 BEAVERTON, OR 97008 Phone #: 557-8000 Phone #: 644-8698 Rey # 1 IC: 79666 P1 M 20-148PB AN INK SIGNATURE IS REQUIRED ON THIS F=ORM x "/ Signature Signature of Authorized Plumber If you have any questions, please call (503) 639-4171 , ext. # 310 CITY OF TIGARD 24-Hour _ BUILDING Inspection Line: (503) 639-4175 MST •�f�� ''yU'� INSPECTION DIVISION Business Line: (503) 639-4171 BUP / - — BLIP — Received __ _ -___ Date Requested '-' � -- AM—.— PM Location �'�_ - Suite MEC -- ___—�� " � r e) ,7 Contact Person _.-- � i Ph( ) 'S y �(.�U PLM Contractor -- Ph ( - ) SWR BUILDINGT Tenanvowner - ELC T -- Footing ELC -- Foundation Access: ELF! Ftg Drain Crawl Drain -- --- Slab Inspection Notes: SI -- Post&Beam {— — Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - - Insulation ' Drywall Nailing T Firewall Fire Sprinkler Fire Alarm — _ -- Susp'd Ceiling Roof Other:. Final PASS PART FAIL Post&Beam Under Slab Rough-In Water Service // - Sanitary Sewer Rain Drains Catch Basin/Manhol _ Storm Drain Shower Pan Othe _ —-- __- PASS PART FAIL MECHANICAL Post&Beam Rough-In - Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL _ Service �.._, Roigh-In ---- -----.. -. ---T— UG)Slab Low Voltage -------- ----- - — Fire Alarm Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL Unable to inspect-no access SITE� Please call for reinsp��ctlon RE: --------- ----- Fire Supply Line ADA Date Inspector Ext Approach/Sidewalk Other: _- Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL MASTE ERMIT CITY OF TIGARD PERMIT lVIST2 PERMIT#: MS1'2001-00562 DEVELOPMENT SERVICES DATE ISSUED: 12/11/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 15265 SW 107TH TERR PARCEL: 2S110DA-09100 SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 052 JURISDICTION: TIG REMARKS: New SF detached residence.Path 1 BUILDING REISSUE. SI DRIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK, NEW HEIGHT: 28 FIRST: 1,705 at BASEMENT: 972.00 at LEFT, 5 SMOKE DETEC70RS. v TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.725 it GARAGE: 1,090 if FRONT: 20 PARKING SPACES: 2 TYPE OF CONST; 514 DWELLING UNITS 1 FINSSMENT: at RIGHT: 5 VALUE: $426.458.40 OCCUPANCY GRP: R3 BORM! 5 BATH: 4 TOTAL: 3,430.00 at REAR: 81 PLUMBING SINKS: I WATER CLOSETS. •I WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN. IDG TRAPS, LAVATORIES $ DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 .SF RAIN DRAINS 1 CATCH BASINS. TUBISHOWERS: 4 GARBAGE DISP. i WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FURN.100K. BOIL/CMP c 3HP: VENT FANS: CLOTHES DRYER: 1 GAS FURN>•100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT _SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FOR. 1 PUMPIIRRIGATION: PER INSPECTION! EA AUD'L 500SF: 9 201 400 amp: 201 400 amp: let W/O SVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR LIMITED ENERGY. 401 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT. MANU HMIEVCIFDR: 601 • 1000 amp: 601+ampr1000v: MINOR LABEL: 1000•amplvpit PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: SVCIFDR>•226 A.: >600 v NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL B.COMMERCIAL. AUDIO 8 STEREO: VACUUM SYSTEM AUDIO 6 STEREO: FIRE ALARM: lINTr:RCOM/PAGING OUTDOOR LNOSC L.T: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL OTHR: HVAC: DATAITELE COMM- NURSE CALLS TOTAL a SYSTEMS: Owner: Contractor: TOTAL FEES: $ 9,140.22 This permit is subject to the regulations contained In the RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES Tigard Municipal Code,State of OR. Specialty Codes and 1672.SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR all other applicable laws. All work will be done in WEST LINN,OR 97068 WEST LINN,OR 97068 accordance with approved plans. This permit will expire If work is not started within 180 days of issuance,or if the work Is suspended for more than 180 days. ATTENTION. Phone; Phone. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rep 0: LIC 049955 forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503)246-4987. REQUIRED INSPECTIONS Erosion Control Insp 8, Slab Insp Footing/Foundation Dr; Electrical Service Low Voltage Rain drain Insp Grading Inspection Post/Beam Structural Plmlundslab Insp Electrical Rough In Cas Line Insp Water Line Insp Sewer Inspection Post/Beam Mechanica PLM/Underfloor Framing Insp Vas Fireplace Appr/SdyAk Insp Footing Insp Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final Foundation Insp Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Inst Gyp Board Insp Mechanical Final Issued By : L _ Permittee Signature Call 503 39-4175 b 7:00 .m. for an inspection needed the next business da 1 1 y n P y CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: S 00313 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12//11 1/01 1/01 PARCEL: 2 S 110 DA-09100 SITE ADDRESS; 15265 SW 107TH TERR SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 052 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection permit for new SF residence. Owner: FEES RENAISSANCE CUSTOM FOMES Type By Date Amount Receipt 1672 SW WILLAMETTE FALLS DR ---- WEST LINN, OR 97068 PRMT CTR 12111101 $2,300.00 27200100000 INSP CTR 12/11/01 $35.00 27200100000 Phone: 557-8000 L Total $2,335.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer' Perm -�"y- , � Pcrrnittee Signature: Issued by: I l �-- Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day 1 Building Permit Application City of Tigard �- '�.r Date received: _Q 1 Permit no.: RojecUaate: ppl.no.: Expire dy CI Iry„/II aur! Address: 13125 SW Hall Blvd,Tigard,OR 97 3 Pl n me: (503) 639-4171 Date issued: y y• � Receiptno.: -� Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: I&2 family:Simple Complex: 1 &2 family dwelling or accessory U Commercial/indusuial U Multi-family New construction U Demolition U Addition/alteration/replacement LI Tenant improvement U Fire sprinkler/alarm U Other: G. .ion Situ:INFORMAT16N Job address: 152454� 111111111 1 2 �� _ Bldg. no.: Lot: 51 1 Block Subdivision: /s�,, ,., /rf _— ax map/tax IoUaccuunt net. Project name: Description and localinn of w Irl,nn premises/special condilions: 0 Ae. :i Name: Mailing address: /G /o-t F./�j " I & 2 family duelling: _ �r City: WJ State: ),Ae IZIP: r(,rxValuation of work................................. �G S�• - - Phone: E-mail: Na.of[led room s/baths........... S -- 15.,:-.Y. I...... .. .�,r Owner's representative: „,, , Total number of floors................................. Phone: s�, Fax: E-mail: New dwelling area(sq.ft,) .......................... VI 0 z _ Garage/carport area(sq, ft.) Name: r Covered porch area(sq. ft.) ......................... T Deck area(sq. ft. �►o _� Mailing address: ) ........................................ City: State: ZIP: (ether structure area(sq. ft.)......................... Phone: Far F-mail: ('ommercial/Industrial/multi-family: MMMValuation of work........................................ $ Existing bldg.arca(sq. ft.) ........X Business name: New bldg.area(sq,ft.)Address: .............. ...... City: State: 7.IP: Number of stories...................... ...... Type of construction.............................. Phone: Fax: is-mail: -- - CCB no.: -? group(s): Existing: _` 7 S j � New: Cilyhnetro lie.no. / Notice:All contractors and subcontractors are required to he licensed with the Oregon Construction Contractors Board under Name: 0 /�, - /'�„ provisions of ORS 701 and may he required to he licensed in the Address; - jurisdiction where work is being performed. If•the applicant is City: StaIE: ',' 71P: exempt from licensing,the following reason applies: Contact person: 1:,, --- Phone:f•e 6'1 a -'J,,s/ Fax -- Name: : Contact person: �t Fees due upon application ........................... $ _ Address: Dale received: City•_ State: [1,�' 7.I P: Amount received ......................................... Phone Fax: E-mail: Please refer to fee schedule. _ hereby certify 1 have read and examined th".application and the Not all)uriedictinns accept credit cards,please call ptrtstiction tut more Information attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard work will he complied with,whether specified herein or not. Credit card number: f I rphe, Authorized signature: / Date: r� `' o -- Narne of cu r�i ioldet as shown on credit card ►+ � — Pont Hanle:_ Tr -a► ui n ie'-S' C'tadholder signature -�--- Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. its(6MCOM) One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Ciryof figordC><t of Tigard Associated permits: City g U Electrical U Plumbing. J Mechanical Address: 13125 SW Ifall Blvd,Tivard,OR 97221 J r)thcr Phone: (503) 639-4171 - - Fax: (503) 598-1060 THE FOLLOWING 1 1 FOR PLAN REVIEW 1 Land use actions completed.Sce jurusdac11on criteria for concurrent a %iews. 2 Zoning. flood plain,solar balance points,seismic soils designation_,hi i0uric district,etc. 3 Verification of approved plattlot. 4 Fire district _approval required. 5 Septic system permit or authorization for remodel. Existing systern 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 C mplete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-sine sheet attached to the plans with crors references between plan location and details. Plan review cannot he completed if copyright violations exist. I I Site/plot plan drawn to scale.'i'hc plan must show lot and building setback dimensions;property comer elevations(if there is more than a 4-11.elevation differential,plan must show contour lint—sat 2-1t.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/selatx ,vstcnis;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 site 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 sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction. More than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof'slope,ceiling height,siding material,fo oling%and loundahon,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views, Provide elevations for new consinrction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four toot at building envelope. Full-size sheet addendunos showing foundation elevations with cross references are acceptable. _ 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must ind.*,:'rc details and locations;for _ nun-prescriptive path analvsis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for till floors/roof assemblies,indicating member siting,spacing,and hearing locations.Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of r1oar. For engineered systeans,sec item 22,.,Engineer's calculations.,' 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any hear/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required — for four or more.appliances. 22 Engineer's calculations.When required or provided,i i t, shear wall,roll truss)shall he stamped by an engineer or architect licensed in(hrgon and Shall he shotvtt Irl hr:114 ;all('to the luut('�u 111)(('1 review. 23 Five.(51 iii • plans aw w(Imir 1 lou 11('111 11 ahovc. Site p1anS must he 8-112"x I I"or I I" x 17". 24 Two(2)sets eac''are required lilt Items 16, 19,20&22 above. 25 Building plans shall not contain red Imes or tali. ams. 26 "Reversed"building plans must meet criteria outlined in the Permit& System Development Fees document. 27 No"mirrored"building plans will le accepted. 28 "Drawn to scale"indicates standard architect or engineer scale. _ Checklist must he completed before plan review start dtite. Minor changes or notes on submitted r'ans may he in blue or black ink. Red ink is reserved for department use only. ata u.u+mnMICoNl Plumbing Permit Application Date received: Permit to.: City of TigardDate no.: Building permit no.: pe Address: 13125 SW Hall 131v0,'l ward,OR 97223 Sewer — CitynfTigard Phone: (503) 639-4171 1'roject/appl.no.: Expire date: Fax: (503)598-1960 Date issued: By: Receipt no.: Land use approval: — case file no.: Payment type: TYPE OF PERM IT Rr:2 family dwelling;or accessory U Commercial/industrial J 811116 family U Tenant improvement ew construction U Addition/alteration/replacement J 1,()(x] s.cn tcc U Other: .1011 SITE INFORMATION. FEE St'HEDULE(for sileciall Information use checklist) SZCS 5! O% Description (qty. Fee(ea. Total Job address: ��, T P�r�..,, ) Bldg.no.: Suite no.: -- New 1-and 2-family dwelling;Y out}�: - — (Includes 100ft.for each utility connection) Tax map/tax lot/account no.: SFR(1)hath Lot: 2 Block: Subdivision: �„ /„ !; SFR(2)bath —--- - Pmject name: / fp;-/, „ SFR(3)bath City/county: T / � ZIP: Each additional bath/kitchen Description an location of work on premises: .rot... 11.nd.,,fro/ Siteutilities: Catch basin/area drain Est.date of complction/inspection. ---- hrywells/leach line/trench drain _ mmomil Footing drain(no.lin.ft.) Manufactured home utilities _ Business name: �rAf ./� r/ ,,,,,, Manholes — - Address: 77 S' �- Rain drain connector - City: &,,,. f.vr 1 State:O/Q ZIP: Sanitary sewer(no.lin. ft.) -_ - - --- - Phone:5r^.3 e g-7V Fax: E-mail: Storni sewer(no.lin.11.) CCB no.: 79C4Plumb.bus•reg,no: -ZV-11y1T1176 Water service(no.lin.ft.) City/metro lic.no.: F'ixUtre or item: Contractor's representative signature: Absorption valve Print name: T Back flow preventer Backwater vaFrc _ Basins/lavatory Clothes washer -- - Address: Dishwasher Drinking fountain(i) City: _ Statc: ZIP: — - Phonr I , E-mail: — Ejectors/sumpr Expansion tan'. Fixture/sewer cap Name(print): Floor drains/Iloor sinks/hub 1 : /lr'.ra ,s� r t_.�f. /��•. s Garbage disposal Mailing address: c t✓ n,�, FN c_ [lose Bibb City: wrc/- G,Ao state: o,P ZiP: - ----_ Ice maker - Phone: S'•:Z er7 goop I Fax: I E-mail: Interceptor/grease trap _ (honer installation/residential maintenance only: The actual installation Prinler(s) _ will be made by ale or the maintenance and repair made by my regular Roof drain(commercial) employee on die property I own as per URS Chapter 447. Sink(s),hasin(s),lays(s) Owner's signature: Datc: Sump Tubs/shower/shower pan _ Name: Urinal ---- ---- - Water closet Address_` Water looter ------ — City: _ _ State: ZIP: Other: Phone: —_ Fax_ E-mail: Total _ Not all jurisdiction.v accept credit canh,pleaw call iudulicdon fa more infomuaon. Minlmulll fee................$ Notice:"is permit application U Visa U Master('aid expires if a permit is not obtained Plan review(at _ 96) $ _. Credit card namher - ___ --/f--f/ within Igo days alter it has been State surcharge(8%) .•..$ Name of cardholr u shown on credit f :>tp rer accepted led as complete. TOTAL .......................$ etrd � S _ _(enlholdet signature —— Amount _ 44041616MWOM) PLUMBING PERMIT FEES: - PRICE TOTAL New 1 and 2-family dwellings only: PRICE TOTAL ESink ES (individual) C fY ea AMOUNT (Includes all plumbing fixtures in AMOUNT 16 60 - the dwelling and the Tirst100 ft. QTY (ea) for each utiltconnection 16.60 One(1)bath $249.20 $350.00 ub/Shower Comb. -----+ 16.60 Two 2 baht $399.00 16.60 Three(31 bath - Shower Only _ SUBTOTAL Water Closet 16.60 16.60 8%STATE SURCHARGE Urinal PLAN REVIEW 25%OF SUBTOTAL 16.60 - TOTAL Dishwasher - _ ---- Garbage Disposal 16.60 Laundry Tray - 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4. 16.60 _ -- --- yuan blit Work Performed - Water Heater O conversion O like kind 16.60 Fixture Type: New 0a Replaced Remov Medl Ca ed Gas piping requires a separate mechanical - p _ ermit. 46.40 -^�- Sink MFG Hunte New Water Service - Lavato - - MFG Home New San/Storm Sewer 46.40 _ Tub or Tub/Shower Hose Bibs 16.60 Combination - 16.60 Shower Only _ --- Roof Drains - Water Closet Drinking Fountain 16.60 - Urinal Other Fixtures(Specify) 16.60 Dishwasher Garba a Dis osal Laund Room Tr - - - Washin Machine Floor Drain/Sink: 2" _ - -- Sewer-1st 100' 55.00 3" 46.40 4" Sewer-each additional 100' Water Heater ter Sery Waice••1st 100' 55,00 Other Fixtures Water Servire-each additional 200' 46.40 - S eci - -&Rain Drabn-1st 1U0' 55.00 Storm Storm-&Rain Drain-each additional 100' 46.40 - - Contmercial Bark Flow Prevention Device 4640_ Residential Backflow Prevention Device' _ 27.55 - -- 16.60 - Catch Basin - Inspection of Existing Plumbing or Specially 7250 er/hr COMMENTS REGARDING ABOVE: Requested Inspections 65.25 - - -- ----- - Rain Drain,single family dwelling Grease Traps 16.60 -- - - QUANTITY TOTAL Isometric or riser diagram Is required It ------ -- �uantRY "----- 'SUBTOTAL - `8•/.STATE SURCHARGE •'PLAN REVIEW 25•/%OF SUBTOTAL F2eyulreC onit it I'ieturc qty total Ig �� - TOTT AL � "Minimum parmll lee is$12 50+B%stale surcharge,except Resvden1181 Backflow Prevention r)aeire,which is$30 25+a%state surcharge "Ali New Commercial Buildings require 2%els of plans with isometric or riser diagram for pian review. l:\dsts\forms\plm-fees.doc 08/29/01 i Electrical Permit Application - — - Ualc received Penna no.:j,(:J i z/; � city of 'Tigard Project/appl.n t, Expire date: Cit vu(Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Recciptno.: Phone: (503) 639-4171 Case file no.: Payment type: Fax: (503) 598-1960 Land use al)proval: TYPE'OF F &2 family dwelling or accessory U('0111111CILlal/industrial U Multi-family U Tenant improvement U Addition/alter itionheplacement U Other: U Partial EY construction �61 1112-1111 TV,1,111 it I I Job address: 0-7 y� ?� Bldg.no.: Suite no.: ITax map/tax lot/account no.: Wt: Block: Subdivision: — Project name: I Description and location of work on premises: Estimated date of completion/inspection: morlm 1111111111 MT1QLUW fcc Mat Job no: --- - - - Ikscription Qty. (ea.) futnl no.imp Business name: �ac �.a T�rSn S ___ -- Ver rnhkWial-single or multi-famliv p,1 !Phone: ddress: r; d„ellingu11h.lnclurkwattachedgarage . State: Zi P: hcnimincluderl: t ty: c s If"sq.h.or less _-- se j �5' O/ Z Fax: Email: Bach additional 5(x1 sq,ft.or portion thereof CB no.: 03 s y�� EICc.bus.Ilc.no: Limited energy,residential ` City/metro lie.no.: Limited energy,non•resideminl Each manufactured home or modular dwelling Service and/or feeder Signature of supervising a trician(required) Date V L ��. � Servicetorfrcdrrs-installation, Sup.elect.name(print) C,0 1 -,, o License no: alteration or relocation: FFTnlj I'll IQJ 111011[W 200 amps or less — 2 2111 amps to 4(x)amps _ 2 Name(print): P,A-,i r ' �� J�'r� 401 amps to 600 amps 2 Mailing address: -;7L !✓ lv, cam.f>"v _d, 1 601 amps to uxx)amps _ 2 State: ZIP: over - -- city: �,� a- C,�.,h -- , raj 5 s p,�_ I ax: Email: Reconnect Only Phone: ti Temporary wrvices or feeder- Owner installation:The installation is being made on property 1 own hntaltation,alteration,orreloctltioni which is not intended for sale,lease,rent,or exchange according to 201 amps or less `--- ORS 447,455,479,670,701. ?OI amps to 4(NI wnps Owner's signature: __—_ Date: iul tonLnlps Branch circuits-nen,alteration. or cstenslon per panel: Name: __ A. Fee lura branch circuits with purchase of Address. service of feeder fee,each branch circuit _ _ State: ZIP: B. Fee for branch circuits without purchase City: of service or feeder fee,first branch circuit: Phone: Fax: E-mail: Each add mal bnmch circuit Mlsc.(5errvIceorfeedernot Included►: Each um ur am au��n�ud Ic 2 U Service.over 225 amp%t,,runercial -JI I-10 w t"'1"` Each stgn ar outline hghuug - 2 U Service over 320 amps-rating of 1&2 J liataulous Irk auom Signal di cuitlsl or a limned energy panel, family dwellings U HuHding over MOM)square feet lour or Siginal L ctnt(glension• 2 U system over 600 volts nominal more residential units in one sinlclurc - U Building over three stories U Feeders.400 amps or more •l kscri ronn _ _—__ U Occupant load over 99 persons U Manufactured structures of HV park Each additlonat Inspection oyer the allowable In any of the above: U Egrcss/lighlingplan U t lihrr _--- — Per utspecliun _ Submit__sets of Mans with any of the above. Investigation fee -- The above are not applicable to temporary construction service, oder Permit fee.....................$ NM all Jurisdictions arc•ept crrdit cants,please call Jurisdiction Gx noir inforineann. Notice:'111is permit application Plan review(at ,-- %) $ ---- U Visa U MasictVard expires if a permit is not obtained within I go days after it has been State surcharge(896) ....$ — Credit card number ------ sphrs _ accepted as complete. IOTA — — Nrme of cu r as r wn on c It wS ---('rdhokkrdRnrture -- Amount "146016AXWOMr 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 permit allowed) (FOR ALL SYSTEMS) !'ervice included: Items Cost Total t Check Type of Work Involved Residential-per unit 1000 sq ft or less $145 15 4 ❑ Audio and Stereo Systems' Each additional 500 sq It or portion thereof �_- $33.40 I ❑ Burglar Alarm Limited Energy _ $75.00 Each Manufd Hume or Modular El Garage Door Opener' Dwelling Service or Feeder _ $90.90 2 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 2.00 amps or less $80.30 ?. r� 201 amps to 400 amps $106.85 2 I Vacuum System 401 amps to 600 amps $160.60 2 601 amps to 1000 amps _ $240.60 2 Other Over 1000 amps or volts $45465 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $75.00 200 amps or less $66.85 (SEE OAR 918-260-260) 201 amps to 400 amps _ $100.30 2 401 amps to 600 amps $133.75 Check Type of Work involved. Over 600 amps to 1000 volts, ❑ see"b"above. Audio and Stereo Systems Branch Circuits ❑ Boiler Controls Now,alteration or extension per panel a)The lee fnr branch circuits with purchase of service or ❑ Clock Systems feeder lee. trach branch circuit $6 65 2 ❑ Data Telecommunication Installation b))lie lee for branch circuits without purchase of service ❑ Fire Alarm installation or feeder fee. First branch circuit $46 85 ❑ Each additlunal branch circuit $665 HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s)or a limited energy panel,alteration or extension $75.00 Landscape Irrigation Control' Minor Labels(10) i $125.00 Each additional inspection over ❑ Medical the allowable In any of the above Nurse Calls Per inspec.ion $62.50 E.] Per hour S6250 In Plant $7315 ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ Other 8%State Surcharge, $ __ ____Numter of Systems 25%Plan Review Fee ' No licenses are required Licenses are required for all other Installations See"Plan Review"sera,un on $ front of application -Fees: Total Balance Due $ -_ --"�- Enter fetal of above fees El Trust Account N - I 8%State Surcharge $-- Total _Total Balance Due $- -. All New Commercial Buildings require 2 sets of plans. Wsts\furms\elc-fees,doc 09/30%01 MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code _ Qty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents 19.00 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 $5Q001.00 and up $742.00 for the firs($50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond -�_ fraction thereof. _ footnotes below. Comp* *' 7)<3HP;absorb unit Minimum Permit Fee$72.50 SUETOTAL: $ to 100K BTU 14.00 --- 8)3-15 HP;absorb 8%State Surcharge $ unit 100k to 500k BTU _ 25.60 9)15-30 HP;absorb 25%Pian Review Fee(of subtotal) $ unit.5-1 mil BTU _ 35.00 Required for ALL commercial permits only _ _ 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 _ 11)>50HP:absorb unit>1.75 mil BTU 87.20 - -- - -- -- ---- -- 12)Air handling unit to 10,000 CFM ASSUMED VALUATIONS PER APPLIANCE: _ 10.00 Value Total 13)Air handling unit 10,000 CFM+ Description: City EaL_ Amount_ 17.20 Furnace to 100,000 BTU,Including 955 141 Non-portable evaporate cooler ducts&vents 10.00 Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents 6.80 Floor furnace Including vent 955 _ 16)Ventilation system not Included In Suspended heater,wall healer or 955 appliance permit 1000 _ floor mounted heater _ 17)Hood served by mechanical exhaust Vent not Included In applicance 445 10.00 permit 18)Domestic Incinerators Repair units _ _ 805 17.40 <3 hp;absorb.unit, 955 19 Commercial or industrial to 100k BTU ) type incinerator _ 6995 3.15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU_ _ - 10.00 _ 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets mil.BTU _ ^^ 5.40 30-50 hp;absorb,unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU 1.00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $� >1.75 mil.BTU Air handling unit to 10,000 cfm 656 0 8%Sate Surcharge $ Air handling unit>10,000 cfm 1,170 _ Non-portable eve orate cooler 656 _ TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct y 446 Vent system not Included in 856 - a Ilanca__permi( Other Inspections end Fees: Hood served by mechanical exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours) Domestic Incinerator 1,170 $72 50 per hour Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee Is specifically indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 $72 50 per hour inserelc. 3 Additional plan review required by changes,additions or revisions to plans(minimun Gas piping 1-4 outlets 380 charge-one-half hour)$72 50 per hour - Each additional outlet 83 'State Contractor Boller Certification required for units>200k BTU '"Residential A/C requires site plan showing placement of unit. TOTAL COMMERCIAL $ VALUATION: t:ldstslforms\mech-fees.doc 08/06/01 Mechanical Permit Application Date received: pr r n)t t no.: City of �r;�;alyd __ ('i(vu/Ti�•urr/ Address: 13125 SW I]all Blvd,Tipard,OR 97223 Project/appl.no.: Expire date: Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503)598-1960 riBuilding asc file no.: Payment type: Land use approval: permitno.: -- & 2 family dwelling or accessory U Commercial/industrial New construction U Multi-family U Tenant improvement U Aclditiodt/alteratir)n/replacement U(hher: Job address: Qa�_ Indic:ne equipment quantities in boxes below. Indicate the dollar Bldg,no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax reap/tax lot/account no.: pi Value$ l.trt: Sl. Block: Subdivision: � ------ 1`�r/cs i+�p .� ' hecklist R)r important application information and _Project name: tion's fce schedule li,r residential permitCity/county: 7-r�, e / ,,, ZIP: -scription an location of work on premises: 1 t I 1 1 10 Est.date of completion/inspection: - Fm'(ea.) Total (11 Tenant improvement or change of use: I Desulplion i. Rm.onl.v Re-,.old AC:Is existing space heated or conditioned'?U Yes U No Airhandling unn CPM Is existing space insulated?U Yes U No ircon 'boning(site pan required) -- Iterationofexisting system MECHANICAL ' Boiler/compressors - Business name: C ,.• State boiler permit no.: Address: 2,7 7- SE 3`I"~ .o IIP Tons BTU/II Cit Fir campesmo r uct smorlcctors y' 0I/ Slate:t7", ZIP: cat pump(sire phrn required-- Phone:S'n�(,?y 2')t Fax; E-mail: nsla /rep accfurnace urncr " / CCB no,: ` 2 Including ductwork/vend liner U Yes U No -- o.: nsla I/rep ace re ocatehcaters-suspen c - - Cily/ntelmtic.n amc(please prwall,or flour mounted Nint): ,?-- Vent fin a lance other than furnace PERSON' e J;eral oat Absorption unils_ BTU/11Name: f: Chillers-- HP Address: - ('rnn ncssurs_ -- HPF4-- City: _ State: ZIP: — ny rontnenta ex ust an went at on; Appliance vent Phone: I ax: G snail: )rycrcx must - 17 0o s, ype / res. itc ten hazmat hood fire suppression system Name: �.� CKj >< '-,/ , 01 Exhaust fan with single duct(birth fans) Mailing address: /�y L n 71 A/o �;• .,,Fiat, s stem a inns from ncatin or At' — City: 1✓-, y. �, , Stale: r,.y ZIP: II,Ue p p ng mild distribution(up do 4 outlets) Phone: Fax: E-mail: type LPCJ NG rK I[)lot n I,eac I aO'llonal over 4 out cls - — roeess piping(sc,emalis required) Name: Number of outlets -- Address: _WWW"MIR app ance or equlpment: City: Decorative fireplace Stale: ZIP: nscrt-type 1'honc: ___TFax: E-mail: nor stove pe ctstovc Applicant's signature: h111e, ut ter: Name (print): other- Not f ertNor all Jurisdielloru accept credit cards,pdeasc call Jurisdiction rix more Inlormnwm. Notice:11iis permit application Permit fee.....................$ — U Vigil MasterCard Credit crud munhrr:--_ � � expires ifa permit is not obtained Minimum fee................$ �4tptrec within INO days after it has been Plan review(at _ %) $ Nene or c o r as r own rut credo car — accepted as complete. Stale surcharge(89F)....$ _ C holder shmaarre $ Amount TOTAL ..... .................$ _-- 4104617 I6MWOM) SEE 35M- M ROLL #21 FOR OVERSIZED DOCUMENT