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14350 SW 128TH PLACE 14350 SIN 128"' Place CITY OF TIGARD 24-Hour BUILDING !nspection Line: (503)639-4.175 MSTy �. INSPECTION DIVISION Business Line: (503) 639-4171 BUP Received Date Requestu l "ivi____ PM--__.__ BUP Location Suite__ MEC - --- - Contact Person G Ph PLM (— ) 1 =-- Contractor— -- _ _ Ph ( _ SWR _ BUILDING Tenant/Owner _— -- _ ELC _ — Footing �w ELC Foundation Access, Ftg Drain ELR Crawl Drain SIT Clnb Insp ction Notes- Post otesPost&Beam - - ---- — - Shear Anchors Ext Sheath/Shear - --- — Int Sheath/Sherr Framing — - -- Insulation Drywall Nailing ---- - Firewall _ - �- Fire Sprinkler - - --- Fire Alarm Susp'd Ceiling Roof Other. Final _PASS PART FAIL i 1 PLUMBING LL _ —_ Post& Beam Under Slabt) -- Rough-In Water Service Sanitary Sewer Sewer Rain Drains Catch Basin/Manhole Storm Drain - _ _ - _------------ — Shower Pan Other: Final _ — PASS Pkv PT FAIL MECHANICAL — — — Post&Beam - Rough-In Gas Line Smoke Dampers --- Final PASS PART FAIL -- ELECTRICAL - Service - -- _-- — Rough-In Ug/Slab �+----------- Fire Alarm ART FAIL F-1u Reinspection tee of$_ . required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. ft�!t u Please call for inspection RE:_- - _ — Ej Unable to inspect-no access Fare Supply Line /7 ADA Date �1*�_d Inspector j Approach/Sidewalk -- Ext Other: -- - - Final DO NOT REMUVE this inspection record from th ob situ. PASS PART FAIL AAAAAAAAAAAAAAAAAAAAAAAAAAAA a d n ► -,, ► w i � ro ► � � r_ a � `—I z ► � Gni.. � ° �� ► ® -' ► 4 ,e � cis o n � i► i w CD o r ► O 15 O ► - 0 ► 44 � C ► t i _ CD444 ► 4 Poo. 4 Poo. 44 u ► � P r CIN C7 p b i ISI ► 414 Q ► � ► .4 ► 4 ► 4 a �► CD n o CL N � o � r+. o c Q r. t Y < a .., co `D A S � G �n 0 o z CITY OF TIGARD 24-Hr;ur _ BUILDING Inspaction Line: (503)639-4',75 MST INSPECTION DIVISION Business Line: (503)639-410 BLIP Raceived - _-_Date Requested— 7 -3— AM PM BLIP Location __ f )- g' 41-- 19L- Suite MF' - Contact Person _._— Contractor _ __ Ph (_____—) SWR BUILDING Tenant/Owner _ __ _—_— ELC — Footing ELC Foundation Access: ELR — Ftg Drain Crawl Drain SIT Slao Inspection Notes: —�— - Post&Beam - -- — -- Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing insulation Drywall Nailing Firewall _ Fire Sprinkler -- Fire Alarm _ Susp'd Ceiling -- -- Roof Other: - - — . ' _ PASS a--PART FAIL ----- ` - - GING Post&Beam Under Slab -- — Rough-In Water Service Sanitary Sewer _ Rain Drains Catch Basin/Manhole _ — Storm Drain Shower Pan -Other:.---- Final ther:__ __Final - - PASS PART FAIL MECHANICAL _ -- Post&Beam Hough-In --- Gas line _- Smoke Dampers Final PASS PART FAIL — - - -- ELECTRICAL � _ _______ — --------- - --- — Service Rough-In __ ---- - UG/Slab Low Voltage ---_ -- - -- —"-- Fire Alarm Final Reinspection fee of$— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE — Please call for reinspection RE Unable to Inspect-no access Fire Supply Line ADA Data 7 7i--T Inspector --1xt Approach/Sidewalk O!her. Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 13125 S.W. HALL BLVD. y ' TIGARD, OR 97223 IMPORTANT PERMIT NOTICE FRANKLIN ELECTRIC INC 1031 SE 23RD COURT GRF.SHAM, OR 97080 Electrical Signature Form Permit #: IViST2002-00353 Date Issued: "0/14102 Parcel: 2S109AA-05500 Site Address: 14350 SW 128TH PL Subdivision: ELK HORN RIDGE. ESTATES Block: I.ot. 021 ,Jurisdiction: TIG Zoning: R-7 Remarks: New SF detached, 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 Division. No electrical inspections will be authorized until this completed form is received MNNFR ELECTRICAL CONTRACTOR: PAUL R CARNEY INC: FRANKLIN ELECTRIC INC 1480 NW 102ND AVE 1031 SE 23RD COURT PORTLAND, OR 97229 GRESHAM, OR 97080 Phone #- 503-297-9406 Phone #: 492-4651 Req #; t W 1411170 1;1, 26-1041c stT 2260~ AN INK SIGNATURE IS REQUIRED ON THIS FORM < u Si natre of Su Servisin Electrician Signature I 9 If you have any questions, please call (503) 639-4171, ext. # 310 CITO F TI CARD ELECTRICAL PERMIT- YY RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2003-00172 1?125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 6/17/03 PARCEL: 2S109AA-05500 SITE ADDRESS: 14350 SW 128TH PL. SUBDIVISION: E'_K HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 021 JURISDICTION: TIG FA. Description: Love \,oltage for Audio/Stereo only II A.RESIDENTIAL. B.COMMERCIAL AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEPi%,.AL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER TOTAL #OF SYSTEMS- Owner: YSTEMSOwner: -------- --- �._� Contractor: - -- — -- PAUL R CARNEY INC ELECTRONIC DESIGN GROUP 1480 NW 102ND AVE 10120 SW NIMBUS PORTLAND, OR 97229 SUITE C1 PORTLAND, OR 97223 Phone: 503-297-9406 Phone: 598-7380 Reg #: LIC 00090213 ELE 34-623CEA _ FEES 1 Required Inspections Description Date Amount Low Voltage Inspection I TAXI 8%State Tax 6/17/03 $12.00 Elect'/ Final IE'LPRMTI ELR Permit 6117/03 $150.00 Total $162.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952.-001-0100. You may obtain copies of these rules or direct questions to OUNC at (501) 246-6699. Issued by _ -Cr' fJ rl?:L� � C�Li��ir1� Permittee Signature .�— OWNER INSTALLATION UNLY fhe installation is being rnade on property I own which is not Intended fur sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRAC FOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N _ y -- DATE: LICENSE NO: Call 639-4175 by 7:00 P.M. for an inspection needed the ni-xt business day +ria. Electrical Permit Ak kation FOR ' ' —_— Received/� Electrical " L`ete/By:(�'2 6� Permit No.:[_K;z16&:2 L-X) V, Plauning Approval Sign City of Tigard Date/By: Permit No.: _ 13125 SW Hall Blvd. Plan Review other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fay 503-598-1960 Post-Review Canal Use Date/B Case No.: Internet: _`— www.ci.tigard.or.us Contac', Juris.; See Page 2 for 2;-hour Inspection Request: 503-639-4175 NameiMethod: — I Supplemental Information. TYPE OF WORK PLAN REVIEW SP!case check all that app! New construction —j Demolition Service over 225 amps- I lealth-cart facility commercial ❑1I.ardous location Addition/alteration/replacement . J er: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in �_ 1 &2-Family dwelling I_Commercial/hidustrial ❑System over 600 volts nominal one structure _�Accessory Building Multi-Famil _ ❑Building over force stories ❑Feeders,400 amps to more g y ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder Other: ❑Egress/lighting plan ❑Other: _ _JOB SITE INFORMATION and LOCATION Submil—_sets of plans with any of the above. The above are notaIp�r(cable to temporary construction service. Job site address: 44Ke_ FEES SCIiEDULE Suite#��_ Bldg./Apt.#: _ _ _ _ Number of Ins ections per permit allowed Project Name: Description Qty Fee(ea.) Total New residential-singly or nmld-lamily per Cross street/Directions to Job Site: dwelling unit.Includes attached garage. Service Included: 1000 sq.11.or less 14515 d Each additional 500 sq.ft.or portion thereof _ 33.40 I - Umited energy,residential 75.00 _ 2 Subdivision: Lot#: Limited energy,non residential 75.M.- Tax tnap/parcel#: Each manufactured home or modular dwelling DESC PTION OF WORK service and/or feeder 90.90 2 Services or feeders-Installation, alteration or relocation: -_-— �— 200 amps or less 80.30 2 _ --- - 201 amps to 4W ams 106.85 2 401 amps to 600 amps 160.60 2 P,dOPERTY OWNER TENAN601 am to 1000 am _� _ _240.60 _ 2 --- �—T over 1000 amps or volts 454.65 _ _ 2 Nrnle: Reconnect only 66.95 2 Address: Temporary services or fet•ders-installation, -- --- - - -- - — alteration,or relocation: City/State/Zip: —_ _ 2M aaaps or less 66.85 - 1 Phone: Fax: 201�s it,42q ampa 100.30 2 APPLICANT CONTACT PERSON 401 to i s 133.75 2 _ _ Branch circuits•new,alteration,or Name extension per panel: -- ----- ---- A.Fee for branch circuits with purchase of Address: servite or feeder fee,each branch circuit _ 6.65 1 City/State/Zip:— —__ B.Fee for branch circuits without purchase of --- service or feeder fee first branch circuit 46.85 2 Phone: —Fax: Each additional branch circuit 6.65 2 E-mail: Misc.(Service or ieeder not included): Each pump or irrigation circle _ 53.40 2 CONTRACTOR _T Each signor outline lighting 53.40 2 Job No: 3 L' Signal circuits)or a limited energy panel, ��"�,�,, alteration, teration or extension Page 2 s"N-�- 2 Business Name: (=VtItJQ V10-�"' Description: Address: o f 7 v fA.J IJ It E_A R C 1 Each additional Irtepectlon oyer the allowable in any of the above: r Cit ///Statc/ZI : _ 'b a- � _iVIL I� Per inspection per hour(min. I hour 62.50 Phone:527% S=i$�3 — Fax: t;Z L�S Investigation fee: Other CCB Lic. #: Z Lic #: - _ — Electrical Permit FeW Supervising electrici /'' Subtotal 1 $ si nature required. _ �—_ Plan Review(25%of Permit Fee) $__ _ Print Name: #: LC State Surcharge 8%of Permit Fee 5 6 < <' -- TOTAL PERMIT FEE I S Ii Authorized Notice: This permit application expires If a permit Is not obtained within Signature: _-. _�--— Date: 180 days atter It has been accepted as complete. / `Fee methodology set by Tri-Vount) Building Industry Service Board. �t (Please print name)! i")sts\Permit I'orms\ElcPermitApp.doc 01/03 t� Electrical Permit Application - City of'Tigard Page 2 . Supplemental Information LIMITED ENERGY PERMIT FEES: USIDENTIAL WORK ONLY: Fee for all systems............................................................ $75.00 Check Typt of Work Involved: 12/ Audio and Stereo Systs* UBurglar Alar: L J Garage Door Opener* I icuting,Ventilation and Air Conditioning System* VE.Uum Systems* Other _COMMERCIAL WORK ONLY: Fee for encl.system.......................................................... $75.00 (SEI:OAR 918-260-260) Check Type of Work Involved: Audio and Stereo Syi tans Boller Controls Clock Systems Data Telecommunicotion Installation Fire r%lann Installation IIVAC Instrumentation �] Intercom and Paging Systems Landscape Irrigation Control* Medical Nurse Calls FJ Outdoor Landscape Lighting* LJ Protective Signaling ---------_—_------------- Number of System, * No licenses are required. Licenses are required for all other Installations t\Dsts\Permit Formr\ElcPetmitAppPg2.doc 01103 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MALMEDAL PLUMBING INC 111 S 18TH AVE CORNELIUS, OR 97113 i Plumbing Signature Form Permit #: MST2002-00353 Date Issued' 10114102 Parcel: 2S109AA-05500 Site Address: 14350 SW 128TH PL Subdivision: Block: Lot. Jurisdiction: Zoning: Remarks: New SF detached, Path 1 Your company has been indicated as the plumbing contracdiv dual frompermit our cindicated ompany bign beloworder andfor retuhn plumbing permit to be valid, please have the appropriate in Y this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed torm is received PLUMBING CONTRACTOR OWNFR PAUL R C:ARNEY INC MAL.MF_DAL PLUMBING INC 111 S 18TH AVE 1480 NW 102ND AVE CORNELIUS, OR 9711 PORTLAND, OR 97229 :3 Phone #: 503-297-9406 Phone #: 503-310-9795 Reg #: MET 4232 LIC 102535 PLM 34-2.76PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Authorized P'umber It you have any qus-stions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (502)639-4175 MST — -- INSPECTION DIVISION Business Line: (503) 639-4171 BLIP - Received _ _Date Requested -- AM PM - BLIP --- Location -- 3 __�1 �_— _ _Suite _— MEC -_� -- Contact PersorPh( _ PLM - ) — G Y Ph( _) �' L7 U SWR _.._—___-------- BUILDING Tenant/Owner _-__— ELC - Footing ELC _-----.-_--- Foundation Access: FLR `_-2 -7, _ Ftg Drain --` -- Crawl Drain SIT Slab Inspection Notes: Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - --_... — ------- ----- Insulation Drywall Nailing Firewall __--- Fire Sprinkler Fire Alarm -- Susp'd Ceiling Roof _—_- Other: — Finst PASS PART FAIL _PLU41iWf3 - - - 0, st&Beam — Under Slab - — Rough-In Water Service --- Sanitary Sewer - Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other: Final - - - PASS_PART FAIL MECHANICAL -_ _- Post&Beam Rough-In Gas Line Smoke Dampers Final — PASS PART FAIL —- ELECTRICAL _ -- --- ---- Service Rough-In -- u-- UG/Slab Low Voltage Fire Alarm u Reinspection fee of$� •equired before next inspection. Pay at City Hall, 13125 SW Hall Blvd, PART FAIL — — Ij Please call for reinspection RE:— _ L_.r1J Unable to w%pect-no access Fire Supply Line /^ ADA Onto V � � G � Mspe _ [ �L�l ' -Ext---- --- Approach/Sidewnik J �' Other:.._ Final DO NOT REMOVE this Inspection record frons the Job site. PASS PART FAIL tY �� ARD MASTER PERMIT PERMIT #: MST2002-00353 DEVELOPMENT SERVICES DATE ISSUED: 10/14/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 SITE ADDRESS: 14350 SW 128TH PL PARCEL: 2S109AA-05500 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: It BLOCK: LOT: 021 JURISDICTION: I It REMARKS: New SF detached, Path 1. BUILDING REISSUE. STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 34 FIRST: 1,590 at BASEMENT: 1973 el LEFT: 4 SMOKE DETECTORD: Y TYPE OF USE: SF FLOOR LOAD: Oil SECOND: 1.404 at GARAGE 690 at FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNi rs: I 1WRD at RIGHT: 9 VALUE: 479 367.00 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 rOTAL' 2.999 St REAR: 54 PLUMBING_ SINKS. 2 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN D.3AIN. 106 TRAPS: LAVATORIES: 6 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS 1 CATCH bASINS: TUBISHOWEns: 4 GARBAGE DISP: 1 WATER HEATERS: 2 WATER LINES: 100 BCKFL W PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOILICMP<3HP: VENT FANS: 6 CLOTHES DRYER: 1 GAS FURN—100K: 2 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: bui FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 6 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDEr. TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 -200 amp: 0 200 ampWISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION: EA ADD'L SDOSF. 6 201 400 amp: 201 - 400 anip tet WIO SVCIF DR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 - 600 amp EAADDL OR CIR: SIGNALIPANEL: IN PLANT: MANU IJWSVCIFDR: $01 1000 amp: 601+anps•1000v. MINOR LABEL: 1000+amp/volt PLAN REVIEW SECTION Recognect only: »4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL S.COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOWPAGING. OUTDOOR LNOSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,659.54 This permit Is subject to tt ?gulatiorr3 contained in the PAUL R CARNEY INC PAUL R CARNEY INC Tigard Municipal Code,State of OR. Specialty Codus and 1480 NW 102ND AVE 1480 NW 102ND AVF1.IJE all other applicable laws. All work will be done In PORTLAND,OR 97229 PORTLAND,OR 97,!29 accordance with approved plans. This permit will expire 4 work Is not started within 180 days of Issuance,or if the work Is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted ty the Phone' 5O�_2O7_1),�O6 Phone 503.297-9406 Oregon Utility Notification Center Those rules are set for!h in OAR 952-001-0010 through X52--001-0080 You Reg It: LIC 56852 may obtain copies of these rules or direct questions to GI/NC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Slab Insp Crawl Drain/Backwater Mechanical Insp Electrical Rough In Shear Wall Insp Grading Inspection Slab Insp Footing/Foundslion Dr; Mechanical Insp Framing Insp Exterior Sheathing Ins( Sewer Inspection Post/Beam Structural PLM/Underfloor Plumb Top Out Framing Insp Low Voltage Footing Insp Pc sVBeam Mechanica Mechanical Insp Electrical Service Framing Insp Gas Line Insp Found atio Insp .._ Undarfloor insulation Mechanical Insp Electrical Rough In Framing Insp Gas Line Insp Issu ey : r�, Permittee Signature �-- Call (503) 63 -4175 by 7:00 p.m for an inspection needed the next business day I CITY OF TIGARD _SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00234 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/14/02 PARCEL: 28109AA-05500 SITE ADDRESS; 14350 SW 128TH Pl- SUBDIVISION: ZONING: BLOCK: LOT: !4/ JURISDICTION: TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: ;NSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF Owner: FEES _ PAUL R CARNY INC Description _ Date Amount 1480 NW 102ND AVE ---- — PORTLAND, OR 97229 [SWUSA] Swr Connect 10/14/02 $2,300.00 [SWINSP] Swr Inspect 10/14/02 $35.00 Phone: 503-297-9406 Total $2,325.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the ruips and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total arriount paid will be forfeited if the permit expires. The Ag 3ncy does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measuremp;it given,the installer shall prospect 3 feet in all directions from the distance given If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will iostall a lateral. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-004-el 00. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-Mg. Issued b t_'`1 _ _ Permittee Sin iature: Call (503) 639-4175 by 7:00 P.M for an inspection needed the next business day � • 'Application ' Building Permit pn- Datereceivcd: i CJ j Permit no.: I•/�l pU _!✓�S� City of Tigard Project/appl.no.: Expire date: � Addre ss: 1?125 SW {tall Blvd.Tigard,OR 9.7223 Date issued: y• _ �; Receiptno.: CityoJ7igard Phone: (503) 6i9-4171 / t1J Case file no.: Payment type: I,ax: (503) 598-1960 -- I�2 family:Simple Complex: Land use approval: r- D 1 &2 family dwelling or accessory U Conunercial/industrial U Multi-family U New construction - U Demolition ❑Addition/alteration/n;placcment U Tenant improvement U Fire sprinkler/alarm LI Other: / 2 Bldg.no.: Suite no.: `! Job address: �/ _ .,7=i ax map/tax lodaccount no.: _ Lot / Block Subdivision: Project name: —Y �� r' �/'r -_ 4 Description and locatioii of work on premises/special conditions: Name: Cf 7t 1 &l faniNy dwelling:_ 3 Mailing address: % • State: ZIP Valuation of work...... l•••••••• ......•••• -- - City: 'lam �- No.of bedrooms/baths................................. z- Phor,c: �' o(, FaX:ZyG-`/6 E-mail: Total number of floors..................... r Owner's representative: .f ". ^//. New dwelling arca(sq.fl.) ....... 1• Phone':�. Cii./� — -- f3ar•agc/carport arca(sq.ft.).......... .�..... ' Covered porch area(sq.ft.l ....... .••••• -- Name: _ � t Deck area(sq.ft.) ............... ..�•�2...r Mailing address: itatc: ZIP: Other structure arca(sq.ft•)• Ix !_�City; Comnicrciallindustrialhuulti-fancily: E-mail: Phone. I a.r, Valuation.of work........................................ -- �' Existing;bldg.area(sq.ft.) .................... ..... __---- Business na!re —� �.✓4 New bldg.arca(sq.ft.) .................. ... ........ - - Number of stories •••• •••• -- - Address: -�—_ ZIP: ................... . Cih: — State: '('ypc of construction.............................. .... _ _-- Pim Pax: E-mail_______. Occupanry group(s): Existing: _ — �- New: _-----.� (,Cp-nn.: _�_G 8S'z- — Cit!/metro lie.no. •otiee:All contractors and subcontractors are required to he X licensed with the Oregon Construction Contractors Board under provisiocs of ORS 701 and may be required to be licensed in the ,Jame: } 41 / urisdiction where work is being perfot ed.If the applicant is —� Address: exempt from licensing,the following reason applies: City 7/,Y State:p ZIP: Contact persol_ i`_ Plan no.: — Phonc: Z S- g/t;/ Fax:Z z5-''9 3 E-mail: O ZIP: Name: 2.3w s f �cc Contact person: Fees dile.upon application ............... . ......... Date received: Address: r t oZ � Statc• � Amount received ......................................... --- - City: ,'(1�!� Please refer to fee sched de. Phone: Z Y-6 t 1A, Fax: E-mail: _ Nd dl jutixrictl�xte rapt credit cards•pleo+e call jurisdiction(ur m�xr Information I hereby certify 1 have read and examired this application and the vtse u Mastere'atil 603t attached checklist. All provisions of IaH s and ordinances governing this Credit cud num r..plrcs work will be complied with,wl ther s cified herein or not. Y �r.v Date: 3/ N nrdhr r v rhown�n credl S Authorized signature: Amount 64 vr Print name: 4/04613(WWOM) Notice-This[emit applicritioc expires if a permit is not ohtained within 180 days after it has been acc ted&S co Electrical Permit Application -- lFatereceived: y( r? pennitno.: , rr -� City of Tigard P-, .vt/appl.no.: Expire date: City(if ngard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: Phone: (503) 639-4171 Y::-:✓1 Reccitn no.:_— Fax: (503) 598-1960 Case file no.: _ payinent type: Land use approval: a I &2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant in)provenrrnt 'New construction U Addition/alleralioii/renlaccmenl U Other: _ U Partial ]INFORMATIONJOB SITE Joh address: / ?,.;U �� /Z g t M Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: //� f,/.�,„ - , � J --- Project name: _ Description and location of work on premises: _ Estimated date of completion/inspection: ' 1APPLICATION Job no: Fee Max Business name: `A s,�� r �i i C Description Qty. (un.) Total no.Insp Address: New residential-single or nadti-fandly per _ dwelling unll.Includes allached garage. City: StIIte: ZIP: Seniceitcluded: Phone: Fax: E-mail: 1000'sq 11 or less_ 4 Each additional 500 sq.A.or portion thereof CCB no.: Elec.bus.lie.no: Limited energy,residential 2 City/metro hc.no.: _ Limited energy,non•residential 2 _ Each manufactured home or modular dwelling Signature of supervising electrician(required) i t,,i, Service and/or feeder 2 Sup.elect.name(print): l c,,isc a„ Services or feeders–lnstallation, WNER alteration or relocation: 1 200 um s or less 2 Name(print): y'r 201 amps )400 ams 2 Mailing address: U rl/�, /� 2 401 amps to 600 amps — 2 SIC, 601 amps to 1000 amps 2 city. , dw state:,-, l ZIP: 7.2.;, 7 Over 1000 amps or volts 2 Phone: '. ctbL I Fax: 7 74 76 111 F.-mail; Reconnect only �--^ I Owner installation:The installation is being made on property I own I emporary servlcdw or Gxdlerx- which is not intended for sale,lease,fent,or exchange according to installation,alteration,orrelocnlion: ORS 447,455,479,670,701. 1 r) •'•tit amps or less 2 i -7 201 anips to 41x)amps 2 Owner's signature: __ Date: 2- ' 401 toNX)am,s — Branch circuits-new,alterallon, or extension per panel: Name: a A. Fee for branch circuits with purchase of Address: ' service or feeder lee,each branch circuit _ 2 City: %�.q , '41 State:q, LIP: B. Fee rot branch circuits without purchase --- -- ax: 1'.-mail: of service or feeder f^x fit.-,branch circuit: 2 F:v:h additional branch circuit: Misc.(Service or feeder not Included): U Service over 225 amps-commercial U I Ie,dth care facility Each pump or irrigation circle 2 U Servide over 320 amps-rating of 1&2 U Hazardous Io-•atiou Facia sign or outline lighting 2 family dwellings U Building over IOAK)square feet four or Signal circuit(&)or a limited energy panel. U System over 61X)volts nominal more residential units in one structure alteration,-texlension• 2 U Building over three stories U Feeders,401)amps or more •I ksri tion:__ _______ U Occupant load over 99 persons U Manufactured structures or RV park Lach additional Inspe __ction over t he allowable In any of the above: U Egress/lighlingplan U Other Per inspection Submtl_ sets of plans with any of the above Investi ation fee -----`� The above are not applicable to temporary construction service. Other — —" Not all Jurisdictions accept credit cmds•please call Junuticuon lot nurre indannatiwa Notice:'This permit application Permit fee.....................$ _ U Visa U MasterCard expires il'a permit is not obtained Plan review(al _ %) $ Credit card number_- within 180 days eller it has been State surcharge(8%) ....$ Name of cardhol r a s own on credit card •xpifet accepted avcomplete. TOTAL $ S l'arwNa�i�er�iRur:!re Adnount 440-4615 IMWOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: — TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00 _ Number of Ins ctions r ertnit allowed (FOR ALL SYSTEMS) �— Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 4 ❑ 1000 sq.It or less — $145.1, Audio and Stereo Systems Each additional 500 sqft.or 1 ❑ portion thereof _— $33.40 Burglar P,larm Limitod Energy $75.00 Each Manufd Home or Modular 2 Garage Door Opener' Dwelling Service or Feeder $90.90 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation _ 200 amps or less $80.30 2 Vacuum Systems" 201 amps to 400 amps _ $106.85 2 401 amps to 600 amps — $160.60 2 _ $240.60 2 Other—�----------- ------------ 601 amps to 1000 amps -- 2 Ovcr 1000 amps or volts $454,65 Reconnect only $66.85 2 --- 'TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders Fee for each system.......................................................... $75.00 Installation,alteration,or relocation (SEE OAR 918-260 2E0) 200 amps or less $66.85 201 amps to 400 amps _ $100.30 , 2 401 amps to 600 amps $133,75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, ❑ Audio,and S'ereo Systems see"b"abovb. Branch Circuits Boiler Controls New,alteration or extension per panel a)The fee for branch circuits Cloc' Systems with purchase of service or feeder fee. Each branch circuit _ $665 2 Data Telecommunication Installation b)The fee for branch circuits without purchase of service Fire Alarm Installation or feeder fee. F irst branch circuit _ $46.85 ❑ HVA(' Each additional branch Urcult $6.65 Miscellaneous ❑ Instrumentation (Service or feeder not included) $53.40 �— Each pump or Irrigation circle ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuits;or a limited energy $75 00 �J Landscape Irrigation Control' panel,alteration or extension _ - Minor Labels(10) _ $12500 !�- Medical Each additional inspection over t;1e allowable in any of the above $62 50 lJ Nurse Calls Per inspection _ -- —Per hour $62 50 _ Outdoor Landscape Lighting' In Plant $73 75 Fees: Protective signaling Enter total of above fees $ ___-_--- Other__— _ ------�— e%state Surcharge $ ._—_ Number of Systems 25%Plan Review Fee $ Nu licenses are required Licenses are required for ell other Installations See 'Plan Review"section on _ — -- front of application Fees: Total Balance Due $ Enter total of above fee:. ❑ Trust Acccunt q o%stata Surcharge s- -- --- Total Balance Due --All New Commercial Buildings require 2 sets of plans. i:dsts\Furu1s,cic4ces.doc 08130I01 Building Fixtures OFFICE USE ONLY ' Plumbing Permit Application Date received:jI3i 0 - Permit no.: City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date: City of Tigard Phone: (503) 639-4171 Fax: (503) 598-1960 Date issued: By: Receipt no.: Case file no.: Payment type: Land use approval: _ _- --- YPE OF PERMIT &2 family dwelling or accessory U Commercial/industrial ❑Multi family U"1'rn nit improvement 7NCw construction ❑Addition/alteration/replacement U Food service U Other: �3.f �� Description Qty. Fee(ea.) "Total ddress: S �' /'` g �� c New 1-and 2-Gamily dwellings only: Bldg. no.: Suite no.: (includes 100 ft.fur each utility connection) _Tax map/tax lot/account no.: SFR(1)bath Lot: .�[, / Block: Subdivision: `t Ile oqn-, P,01 SFR(2)bath _ Project name: SFR(3)bath city/county-7A, ZIP: 7,t2 Each additional bath/kitchen Description an locati of work on premises: /V t .. - S_. 1,r Site utilities: 1-114 Catch basin/area drain Drywells/leach line/trench drain Gat.date of completion/inspection: Footing drain(no.lin. fl.) PLUMBING CONTRA"'011 Manufactured home utilities Business name: 77-77 �'��^__M Manholes — Address: J _ Rain drain connector — City: State: ZIP: Sanitary sewer(no. lin.ft.) Phone: Fax: E-mail: Storm sewer(no.lin. R.) — CCB no.: Plumb.bus.reg.no: _ Water service nlin.n. Fixture or item:: City/meat lic.no.: _ Absoilitiou valve _ Contractor's represet�ntive signature: flack tlow preventer Print name: fin.. Date:= J� Backwater valve Basins/lavatory C C othes washer Name: <'•�,�� '' '� Dishwashers Address: ' v ��'--/• /� `'Llij Drinking fountains) City: :Gr,'7 �+ rr State: e. LIP: i E'ectors/sump _ Phone: s Fax: ar Y&W E-mail: Expansion tank Fixture/sewer ca Floor drains/floor sinks/hub- Name(print): <� % _-- Oarba a is osa Mailing address: lose i City: State: ZIP: Ice maker Phone: I E-mail: Interceptor/grease trap Owner installation/residcntial maintenance only: The actual installation Primer(s) —will be made by me or the main3phance and repair made by my regular Roof rain commer! c a)_ employee on the property I owil aA per ORS C'ha icr 447• Sink(s),basin(s),lays(s) _ ! p Owner's si natur -- Uate: Vi"v� ,>! Sump -- — Tu s/shower/shower pan Urinal _Name: ff n., P q,. l =� Water closet _ Address: �.�Z Water heater City: -77o. State:moi+ ZIP: q 7 Other: Phone: ✓ r y ;. Fax:, S t� ,y E-malt: Tota Minimum fee................S Not aiI jurisdictions neap credit cord+,plow call jurisdiction rot mare lar°rmwk"• Notice: This permit application e $ Plan review(at —_ /°) SOW U Ifn1 ,� ��., expires if a permit is not obtained g t,MasterCard. State surcharge(8°/a).... S t'rcdu cud nam �'� —_L_ ' spires within 180 days after it has been _. accepted as complete — Name ofunn o b e q+fiit csM -$ — L Amaunt 440-4616 16MCOMt —del polo PLUMBING PERMIT FEES: =PR TOTAL Now 1 and 2-family dwellings only: FIXTURES (individual) :;TY AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink I 16.60 the dwellinq and the first100 ft. QTY (ea) AMOUNT ?6.60 for each utility connection Lavatory One 1( )bath _ _ $249.20 Tub or Tub/Shower Comb. 16 60 T_wo 2 bath $350.00 ahower Only - 16.60 Three 3 bath _— $399.00 4 Water Closet 16.60 -� SUBTOTAL Urinal 16.60 8%STATE SURCHARGE _ Dishwasher i 1G.60 PLAN REVIEW 25°/s OF SUBTOTALr - 16.60 --- _TOTAL. _�_--L- ---� Garbage Disposal — Laundry rray _ 16.60 Washing Machine 16.60 — Floor Drain/Floor Sink 2" 16.60 3.- 1660 PLEASE COMPLETE: 4^ 16.60 -- — Quantity b Work certormed Water Neater O conversion O like kind 1660 Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ Capped permit - - --- — MFG Home New Water Service 46.40 SinkLav _ MFG Home Now San/Storm Sewer 46�40TW,orfV Tr ur'TublShower Hose Bibs 16 Combination —_ Roof Drains 16.60 Shower Only Drinking Fountain 1660 _Water Closet Urinal Other Fixtures(Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" —_ Sewer-1st 100' 55.00 3' Sewer-each additional 100' 46.40 4" - -- Water Service-1st 100' 55.00 Water Heater Olher Fixtures Water Service-each addi lonal 200' 46.40 (Specify) -- Storm 6 Rain Drain•1st'00' 55.00 Storm 8 Waln Drain-each additional 100' 46.40 - --- Commercial Back Flow Prevention Device 46.40 -- - Residential Backflow Prevention Device' 27.55 _ Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 Re nested Ins ocllonsper/hr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 -------- Grease Traps 1660 ---- QUANTITY TOTAL --- --------------" - -- - Isometric or riser diagram is required It Quantity Total Is >B "SUBTOTAL --- ----- -------- 8%STATE SURCHARGE -—-- -- `— "--— "PLAN REVIEW 25%OF SUBTOTAL — Requhed only If fixture 1 tale)Is>9 — F-- TOTAL--- S — "Minimum permit lee Is$12 50•B%state surcharge,except Residential Backflow Prevention Device,which is$36 25+6%stale surcharge "All Now Commercial Buildings require 2 sets of plans with Ifometrlc o'riser diagram for plan review, 1-\dsLa\forms\plm-fees.doc 12/26/01 Mechanical Permit Application / Date received: 'J(3llo}- Permit no.: ro i City of Tigard Project/appl.no.: Expire date: Address: 13125 SW Hall Blvd,Tigard,OR 97223 Recei rt no.: City of Tigard Date issued: 9Y' Phone: (503) 639-4171 _I Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: [B.ilding permit no.: TYPE OF PERMIT 12 1&2 family dwelling or accessory U Commercial/industrial 0 Multi-family U Tenant improvement New construction U Addition/alteration/replacement U Other: 1li lot bill111111011 tub address: r �/ 3 r, r'.`�, /�`+S r /.r< Indicate equipment quanuues in b(lxcs below. Indicate the dollar Bldg.no.: ;tile no.: value of all mechanical materials,equipment,labor,overhead, _ profit. Value$ Tax map/lax lot/account no.: urck: X � r See checklist for important application information and Lot- J - RSubdivision: 17/� 41 Project name: jurisdiction's fee schedule for residential permit fee. 1 1 City/county: s., �.. G, ZIP: 7,Z Description and location o1'work on premises:T Fee(ea.) 'Total Est.date of completion/inspection: Description! _ Ot.. Kc�.only Kr�.only Tenant improvement or change of use: ti Air handling unit _—CFM is CXISllllg Space heated or conditioned'?U Yes U No it conditioning(site p an re(4..uir-�) Is existing space insulated?U Yes tU No A teration of existing fi A system Boiler/compressors State boiler permit no.: Business name: Cit y' " 7 HP Tons_ BTU/14 -ire smokedampers/ductsmo c erectors etp/'t _ Stale:e, P; aump(site plan requ re ) � -__ o,511hep ace urnacc urner H _ Phone: /,�N- Z I`ax: ?is' 0684 E-mail: Including ductwork/vent liner U Yes U No _ CCB no.; eta rep acc�ocatceaten--suspen ed, City/metro lie.no.: — , _ wall,or floor mounted Name(please print): Vent fora lance of Icr 1 run furnace Krfr ration: 1 Absorption units Chillers _ FII' Name: v "� ' Com ressors_---- - Ad(Iress: / y v ^� o -' rEn v ronmenta ex ausi an rent at on: City: 7 of 'o-Oc:61e ZIP: 7,.� ,: ' Appliance vent --- Phone: 'l Fax: 7f E-mail: I)ryerex oust _ oo fie res itc c azmat hood fin suppression system —•- Name: �i*7� a rxhaust fan with single duct(With fans) — x must s stem a part from to d o or C Mailing address: State: _ ZIP: uc p p ng an str ut ,,n(rip to out ets) City: Type: ^-LPC. --- Nei ()it Phone: Fax: I E-mail; -Fuel tin each add itional over out els rocrsspiping(schematic required) _— Number of outlets _ Name: �- • /' a ~' '� rt +► /''`I—_ ter sir-te app once or rqu pm:M: r Decorative fireplace / /c.v' t Address: ---- City: ?s State:��f,. ?..'P: ,7 Ins City: ty c oo stov pe et stove---- Phone: tove _Phone: Fax; E-mail: ter: Applicant's signature< __ --1 Date: 2,;'� a ter: Name (print): PIV e �^ �_ -- Permit fee.....................$ --r_ of all}udadicllons accept credit earth,please call}urisdlcticat ra mare information. Notice:Tliisermit application p pP Minimum fee................$ iw U MasterCard „ expires if a permit is not obtained Crrd11 crud own r y � � ��'+7 �°Vo. (r/�_ ,.,,, p P Plan review(at — 96) � T xpirel within 180 days eller it has been State sur..harge(896)....$ ca r a:.rlH+wn on c e s accepted m complete. hwm ofTUTAI. ....................... _--- ` r Ngneture— Amount 440.1(,17(6100/CDM) Jh MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: DeScrip'on: Price Total TO___L VA_LUAT_Iqo $72 RMIT FEE: Table 1A Mechanical Code _ Qty (Ea) Amt $1.00 to$5,000.00mum fee$i2.50- 1) Furnace to 100,000 BTU $5,001.00 to$10,000. .50 for the first$5,000.00 and includin ducts&vents - ta.00 2 for each additional$100.00 or 2) Furnace 100,000 BTU+ tion thereof,to and including includingducts&vents 11.40 ,000.00. 3) Floor Furnace $10,001.00 to$25,008.50 far the first$10,000.00 and Including vest - 14.00 - 54 for each additional$100.00 or 4) Suspended heater,wall heater tion thereof,to and including or Floor mounted heater 14_00 000.00. 5) Vent not included in appliance permit $25,001.00 to$50,009.50 for the first$25,000.00 and 6.80 $1.45 for a-3ch additional$100.00 or 6) Repair units fraction thea eof,to and including 12 15 _ $50,000.00. Boiler Heat Air $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: or Pump Cond ,01.20 for each additional$100.00 or footnotes Ile es below ms 7-1 ee Comp fraction thereof. _ 7)<3HP;absorb unit 14.00 SUBTOTAL: Minimum Permit Fee 572.50 $ to t00K BTU 8)3-15 HP;absorb 25.60 State Surcharge $ unit look to 500k BTU -- __ _ _ -- 9)15-30 HP;absorb 35.00 --- 25%Plan Review Fee(of subtotal) $ unit.5 1 rail BTU - - Re9uired for ALL_commercial permlts onl 10)30-50 HP;absorb 82.20 TOTAL COMMERCIAL PERMIT FEE: $- unit 1-1.75 mil BTU _ _- 11)>50HP;absorb 87.20 ---- - unit>1.75 mill BTU - _ 12)Air handling unit to 10,000 CFM 10.00 ASSUMED VALUATION TIONS PERLAPP ANC E Total 13)Air handling unit 10,000 CFM+ Descrl tion: Qt Ea Amount 17'20 Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler 10.00 ducts&vents Furnace>100,000 B 1,170 TU Including 15)Vent fan connected to a single duct 6.80 ducts&vents Floor furnace includin vent 955 ---- 16)Ventilation system not Included In 10.00 Suspended heater,wall healer or 955 - a (lance ermit floor,mounted healer 17)Hood served by mechanical exhaust 10.00 Vent not included in appilance 445 ermit 805 18)Domestic Incinerators 17.40 Repair units <3 hp;absorb.unit, 955 19)Commercial of Industrial type Incinerator 69.95 to look BTU 3.15 hp;absorh 1700 unit, 20)Other units,Including wood stoves 1000 101k to 500k BTU 2 310 15-30 hp;absorb.unit,501k to 1 21)Gas piping one to four outlets 5.40 _ mil.BTU 3,400 30-5-- 0 hp.absorb,unit----- 22)More-than 4-per nutlet(each) 1.00 1-11.75 mil.BTU 5,725 >50 hp;absorb.unit, Minimum Permit Fee$72.50 SUBTOTAL: $ - >1.75 mil.BTU 856 Air handling unit to 10,000 cfm 8%State Surcharge $ Air handlij unit>10,000 cfm 1 170.656 evaporate cooler 858 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent system not Included in 656 _M Ilance permit other inept ctl9-rts and Fees: Hood served bYmechsnical exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours) 50 Domestic Incinerator 1 170 $ee ec per Hour 4 590 2 Insp50 per ions for which no foo is specilically Indicated (minimum charge-hall hour) Commercial or industrial Indnerstor 856 182 50 par hour Other unit,InCluding wood stoves, 3 Additional plan review required by changes,additions or revisions lu plans(minimun i Inserts etc. - 360 charge-one-half hour)$e2 50 per hour Gas I in 1-4 outlets63 Each additional outlet _ 'Slate Contractor Boiler Certific:..fon required for units>200k BTU. * Residential AIC requires site plan showing placement of unit. TOTAL COMMERCIAL $ All New Commercial Buildings require 2 sets of plans. VALUATION: I:\dsts\forms\mech-fees doc 02/11102 + 0 0 19 + 00 lop S?:3 o v c 00,J.5 4 6 D 10T,22-- 82- -s- F-;::; 65 . Sf TRNTATIO DIM 'E N F ---NCLL- - _' �_ -,�_ -- ._ ---2--5 -D-0 WN _8LOPE AFT VR _ �-Go,y_p__IETE