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A IRST RR.P LE. 3 30'/ LOT SIZE: 8,318 Sa FT.
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BUILDING COVERAGE: 3x33 Sa FT. ,()
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QUO I / ' 100 TABULATION:
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A*bLVED TOPOF CURB i' �� 5UILDING COVERAGE:
�f GARAGE G 3155 / % 1
/\ FOOTPRINT OF RESIDENCE
i AND GARAGE: 3,615 9a FT.
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COVERED PORG E9 FT.
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/ ,4-L-- --- -ar - -- ,''- - - r TOTAL: 3,933 SQFT.
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WALK LOT COVERAGE. Z
4' C DRIVE 3.933 50. FT. 8,318 SQ FT. 46.9A Q
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13369 SW 129'1' Avenue
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CITYOF TIGARD MASTER PERMIT
PERMIT#: MST2001-00490
DEVELOPMENT SERVICES DATE ISSUED: 10/24/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 13369 SW 129TH AVE PARCEL: 2S104DA-04200
SUBDIVISION: QUAIL HOLLOW - WEST ZONING.;: R-4.5
BLOCK: LOT: 028 JURISDICTION: TIG
REMARKS: New SF detached residence.Path 1
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS ncOUIRED _
CLASS OF WORK: NEW HEIGHT: 20 FIRST. 2.997 at BASEMENT: 45900 sf LEFT: 13 SMOKE DETECTORS:
TYPE OF USE: Sr FLOOR LOAD: 40 SECOND. sl GARAGE: 014 of FRONT: 20 PARKING SPACES. 2
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: 5
VALUE: 5 335,094 80
OCCUPANCY G^.P: R3 RDRM: 3 BATH. 3 TOTAL: .,997-u sf REAR IS
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS. i RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS. i FLOOR DRAINS: SLWER LINES. ''rj'rj SF RAR.;TRAINS: 1 CATCH BASINS.
TUBISHOWERS: 3 GARBAGE DISP: I WATER HEATERS: t WATER LINES. t]S BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FI',TURES'.
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VEP'', FANS: 5 CLOTHES DRYER I
GAS FURN>000K. I UNIT HEATERS: HOODS: I OTHER UNITS: I
MAXINP: blu FLOORFURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I
ELECTRICAL.
RESIDENTIAL IINIT SERVICE FEEDER TEMP SRVCFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS 1 0 200 amp: 0 2L3 amu: W/SVC OR FDR. 1 PUMP/IRR GATION: PER INSPECTION:
EA ADD'L 500SF 7 201 400 amp: 201 400 amp: tel W/O SVC!FDR, 00 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 000 amp: 401 000 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT
MANU HMISVCIFDR: 001 • 1000 amp: 601-amps-11000w MINOR LABEL.
1000♦amptvolt
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC/FDR-225 A.. >000 V NOMINAL CLS AREAISPC OCC
ELECTRICAL•RESTRICTED ENERGY
A.SF Rr JIDENTIAL B COMMERCIAL _
AUDIO 8 STEREO: VACUUM SYSTEM, AUDIO&STEREO: FIRE ALARM INTERCOMIPAGING. OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPF/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION. MEDICAL: 01HP:
HVAC DATA/TFLE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: P 5,677.56
This permit is subject to the egulations contained in the
GARY&SUET STUMP ECB CONSTRUCTION INC Tigard Municipal Code,Stata of OR. Specialty Codes and
125551 5W MORNING HILL UR PO 80X 204 all other applicable laws At work will be done in
TIGARD,OR 9713 SHERWOOD.OR 97140 accordance with approved clans. This permit will expire if
work is not started within 180 days of issuance,or If the
work Is suspended for mo•e than 180 days. ATTENTION:
Phone Phnne: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Repo a: 11.1", forth In OAR 952-001-0010 through 952-001-0020 You
may obtain copies of these roes or direct questions to
OUNO by calling(503)246-1.187.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Sewtr Inspection POst/Searn Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Footing Insp Underfloor Insulation Plumb Top Out Exterior Sheathing Ins► Rain drain Insp Plumb Final
Foundation Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Wtr Proofing Bsm't We Footing.IFoundalion Dr; Electrical Rough In Gas Line Insp ADpr/Sdwlk Insp
Issu 1 By L( L. �Ct Ot-41 Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF TIGARD SEWERCONNECTION PERMIT
DE ✓ELOPMENT SERVICES PERMIT#: SWR2001-00256
13125 SW Hall Blvd., Tigard, OR 9722.3 (503) 639-4171 DATE ISSUED: 10/24/01
SITE ADDRESS; 13369 SW 129TH AVE PARCEL: 2S104DA-04200
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT:_ 028 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:
GARY &JULI STUINIP -- FEES
125551 SW MOPNING HILL DR. Type By Date Amount Receipt
TIGARD, OR 97223 PRNT CTR 10!24/01 $2,300.00 27200100000
INSP CTR 10/24/01 $35.00 27200100000
Phone: 503-579-3046 = — _
Total $2,335.00
Contractor: -�
Phone:
Reg#
uired 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
Issed by: _ Permittee Signature: ._
Call (503) 639-4175 by 7:00 P.M for an inspection needed the next business day
/
6, �-
Building Permit application
i rProject/appl.
ed:f, " ( Permit no.: N � )�/
City of Tigard I , �
I L''1 no.: Expire date:
Address: 13125 SW Ball Blvd,Tigard. R 97223 Date issued: By: 1� Receipt no.:
C'iry u(Ti�urd Phone: (503) 639-4171 .`_/ �
Fax: (503) 598-1960 Case file no.: I Payment type.-
Land
ype:Land use approva.'i: — ------- ___
I&2 family:Simple Complex:
J I &2 family dwelling or accessory U Commercial/industrial U lvlulti-lanuly *New construction U Demolition
U Addition/alteration/replacement U Tenart improvement U Fire ;prinklerhilarnn U Other: _ -
t , ,
Bldg.no.: __ Suite no.: _ S
Job address: _
n:
Tax map/tax lot/acculot/accountno.:
131rx k: Suhdivisto
o
Project name: ,
Description and location of work on premises/special co ditiops:
Name: 6o .-K f'7'< ---
?ti� i '��A I &2(anally d"eilin �� +\
Mailing address: /.� sr� "'�
State• IP: x,11 Valuation of work..... ...S,..Q./•.7•r......... . $"�
City: �r _- .�•
Phone: _ y Fax: E moil: No.of bedrooms/baths.................................
Owner's representative:
t, m_ Total number of floors........................... ..
- (I ill New dwelling area(sq.ft.) ••..
Phuttc: I ;
Garage/carport area(sq.fL).....�/q...........APPLICANT
KOther
porch area(sq.ft.) ......................... -
Name: ea(sq.ft.) -�- —
Mailing address: structure arra(sq. ft.l......................... _ -A -
City: State: 7-1p.
Email: 'ommercfal/indtwtriallmulti-mail:
-1--ax:
Vul
Phone: uutiun of work................................ ....... $
iuligs Existing bldg.area(sq, ft.) ............... ... ..........
Business ntunc: New bldg.area(sq. ft.) ............. . ..............
Address: 10 O Number of stories.................... ... ............. --
City: H 1Statc' ZIP: J•ype of construction............ .......... .....
C. Fax�f E-mail: Occupancy group(s):(9): Existi.n..g..:Phon .
-
CCB no.:�l�75_s" New:
City/metro l' alt,.: Notice:All contractors and subcontractors are required to he
11 W9 Viol UIIIIIIIIIIIII licensed with the Oregon Construction Contractors Board under
` provisions of ORS 701 and may he required to he licensed in the
Name: flv� l�/ :'`�.' s- - ` jurisdiction where work is being performed. It the applicant is
Address: 7 ' r exempt from licensing,the following reason applies:
City: �.; _ Stat. . LIP: _-- -
Contact person: !f�.---- Plan no.: �-
Phone: -j ' .� ax marl:
/
C'untuct Ixru,n: Kers due ulx,n application ........................... $
Name: -
Address: ! J /_ Date received: _.�--
' State' ZIP: , Amount received ......................................... $ __
City: ,!'f - Please refer to fee schedule.
Phone: "�" Fa • E-mail: —
I hereby certify I have read artd examined this application and the Not dl Junxlictione accept credit codaplena call iuntdicti m for more mhwMation
Uvisa UMastercant
attached checklist. All provi+ions of laws and ordinances governing this c relit card nutntvt -__- -- - --L-�-
work will he complied with,whether specified herein or nowt. /� __ r tpir°'
Dale: L._
=_g, -e, Name nr rardhnldet u shown nn credit card `
Authorized signatun --�T _
Print name:
sf��l[� �f -_— —._.r, der Uuuw
pe _Amoum
--------------
Notice:'pais permit application expires if a permit is not obtained within Igo days after it has been accepted as complete.
41111613 rM10fC'OMI
JLOne- and Two-family Dwelling
Building Permit Application Checklist Reference no.:
Ciryv of Tigard City of Tigard Assoeiatedpermits:
Address: 13125 SW I call Itivd,Tigard.()R 97221U Elect, J I'lumbing U MechanicalU l)Ihcr:
Phone: (503) 639-4171 _ -
I-ax: (503) 598-1960
e � rMWIT"M WWI
I Land use actions completed.Sec jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,ctL
3 Verification of approved plat/lot.
4 Hire district _approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit. _
7 Water district approval.
8 Soils report.Must carry original��pplicable slampand signature on file or with application.
9 Erosion eonirnl 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 be 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-size
sheet attached to the plans with cross references between plan location and details. flan review cannot he completed
it'copyright violations exist.
1 I Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if'
there is more than a 4-11.elevation differential,plan must show contour Imes at 2-11.intervals);location of easements and
driveway;footprint of structure(including decks);location of wellstseptic systems;utility locations;direction indicator;lol
arra:building coverage area;percentage of coverage:impervious arca;existing structures on site;and surface drainage. _
I2 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details, vent
"Im and location.
1.1 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater.
furnace,ventilation Ems,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 Ilan 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,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 is greater than four Ingot at building envelope.
Full-sine sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standar Is, _
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered
systems,see item 22 "Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all heanrs and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform loud.
20 Manufactured Boor/roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required I
for four or more aplIhMices.
22 Engineer's calculations. When required or provided,(i.e..shear wall,i,I i1iia)shall he stamped by an engineer or
:uchilrcl licensed in Oregon and shall he shown to be Ilpplicahle to the pieta,i ui.(ler re%ie�k
23 Five(5)site plans are required for Item I I above Site plans mint he 1 t" , I I I I I
24 Two(2)sets each arc required for Items 16, 19,20& 22 aho%r
25 Building plans shall not contain red lines or tape-ons
26 No rolled,reversed or mirrored building plans will he accepted.
27 --- - -
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Iced ink is reserved fior department use only. au,4614(rurUCOM)
Plumbing Permit Application
City of Tigard Datcreceived: Permitno.: P57 ,qV/_a
Address: 13125 SW Hall Blvd.Tigard,OR 97223 Sewerpermit no.: Building permit no.:
City of Tigard phone: (503) 639-4171 Pro'ecda rl.no.:
J Pf Expire date:
Fax: (503) 598-1960 Date issued:
BY: Receipt no.:
Land use dpproVal: _ Case file no.: Payment type:
I
J I & 2 family(Iwellinp or acccstinry U Conuncrcial/industrial
�9 Ncw c( stnrcti,m UMulti-family
mU Tenant improvement
U Addition/alteration/replacement U Food service U Other:
1 1 1
f ( �
Job address: -�� ;►�/ ���_ _ Description Qty. I ec(ca.) Total
Bldg.no.: _ Suitt:no.:- ___ Ne" I-and 2-family d"elling.v onl,:
Tax map/tax lot/account no.: (includes 100 ft.foreach utilityconnec•tion)
Lot: Block: Subdivision: �l/,/ % SFR(1)h.,(i, -
Project name,: SFR(2)bath --- --
�- SFR(3)bath -
City/county; _ ZIP: <W Each a idd-it-ion-a-lb-a—flAtthen -
Description and I cation of w rk nn premises: _- Sifeutilities:
--- L5C Catch hasin/area drain
Est.date of completion/inspection: - - - Drywells/leach line/Irench drain
1 1 , Footing drain(no.lin. ft.) -
Business name: aa-n clurrd lhome utilities
Address: Ae - Manholes
City: €� Rain drain connector - -
r _ State ZIP ) Sanitary sewer(no,lin. ft.) _ --
Phone: E-mail: Storm sewer(no,lin.ft.) ---
CCB no.: _ Plumb,bus.reg.no: Water service(no,lin.ft.)
City/metro lic.no.: _ -- - Fixture or Item:
Contractor's representative,signature: -- Absorption valve
Print name: Back flow preventer
Backwater valve
1ISM Basinsavator -
Name: _ Clothes washer__
Address: -_ - Dishwasher -- —
City: Slate-: j1P. Drinkingi fountains)
Phone:: I - -"�� EjectoRAtimp
I: mail Expansion tank -'
ixtun/scwcrcap - -
Namr(print)_�4��,,, _/ U� Moor drairVfloorsinks/hub
Mailing address
a Garba a disposal
: _29�^ ,./!tJ J1i q
city: - --- stat . Zip.: >2� Huse bibb
Phone: - Ice maker
ax: E-mail: Interce)tor/grease trap -
Owner instal anon/residential maintenance only: The actual insta.lation Primers)
will he made by pre or the maintenance and repair made by my regular Roof drain(commercial)_
employee on the property I own as per ORS Chapter 447.
Sin (s),hasin(s), I vs(s)
Owner's signature: - -- Date,: Sump
T'ubs/shower/shower pan - -
_Name: Urinal --
Address: Water closet
-
City: - - Water heater
PState: ZIP: --
_ _ _
Phone: Other: --�
Fax: Total
Nut dI Jurltlicaonn accept crrdh card,, "eax call Jurisdich,m fix mmr inr,xtwien
U Vise ❑MasterCard Notice:This permit application Minimum fee................ .
expires if a permit is not obtained Plan review(�t , %) $ _
rtrdn card numbere
rixptrrc within 180 days after it has been State surcharge(8%) ...•$
p p TOTAL $
Nems of ca�inldet u shown on ctedi(c((td accepted as complete, ........................
440-4616(6(%roM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (indivldual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection) _
One 1 bath $249.20
Tub or Tub/Shower Comb_ __ 16.60 Two 2 bath _ $350.00
Shower Only 16.60 Three 3 bat 1 $399.00
Water oset 16.60 SUBTOTAL
Urinal 16.60 _ 8%STATE SURCHARGE
Dishwasher -� 16.60PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
-Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE!:
3" 16.60
4~ -- 16.60
Quay,,/
" b Work Performed _
Water Heater O conversion O like kind 16.60 .
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. - _Ca ed
MFG Home New Water Service 46.40 Sink
MF=G Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 1660 Combination
Roof Drains 16.60 i Shower Only -_
Drinking Fountai, 16.60 Water Closet
Other Fixtures(Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
--
Laundry Room Tray
Washing Machine
_ Floor Drain/Sink: 2"
Sewer-1 st 100' 55.00 3^ --
Sewer-each additional 100' 46.40 4"
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 48,40 011ier Fixtures
Specify)
Storm&Rain Drain-1st 100' 55.00
Storm&Rain Drain-each additional 100' 46.40 - ------
Commercial Back Flow Prevention Device 46.40 -
Residenital Backflow Prevention Device' 27.55
Catch Basin 18.80
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections _ per/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 -- -- -- -
QUANTITY TOTAL
Isometric or rlser diagram Is required if -
_ _ Quantity Total Is >9 _- - -
'SUBTOTAL - - --
8%STATE SURCHARGE ---- - --
"PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty.total is-9 _
TOTAL
Minimum permit tee is$12 50+6%stale surcharge,except Residential Backflow
Prevention Device,which Is$36 25+8%stale surcharge
**All New Commercial Buildings require plans with Isomelrlc or nisei diagram and
plan review
l:\dsts\forms\plm-fees.doc 10/10100
Mechanical Permit Application
Date received: Permit no.:
City of Tigard Project/appl.no.. Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 11 '.'{
bate issued: By:
Phone: (503) 639-4171 Receipt nu -
Fax: (503) 598-1960 Case file no. _ Payment type: -- —
Land use approval: _ Building permit no.:
❑ 1 &2 family dwelling or accessory U Commercial/industnai J Multi-family J'I cnant 1111pn3vetr3cnt
VNew construction J Addition/aheration/replacemcnt U Other: -
1 1 1 I I
Joh address,: ' �'rY �.� Indicate equipment quantities in boxes below.Indicate the dollar
—-1�.�>! � Jc[. ----
Bldg.no.: _�uite no.: _- value ofall mechanical materials,equipment,IaMx,overhead.
Tax map/tax IoUaclxrunt no.: _ profit. Value$ '
I.ax ma t Block: Subdivision: ��% 'See checklist for important application information and
Project name: ,t - jurisdiction's fee schedule tiro residential permit tcc.
ULE
City/county: / j„�a/ Ci ZIP: 4>1 e? 1 l
Description and location of work on premises:
I'cc(e3L) 11113:{
Est.date of completion/inspection: IIV- Desert on 01 Res.only Res.only
Tenant improvement or change of use: ha-'
Air handling unit CFM
!s existing space heated or conditioned'!U Ycs J No Air conditioning(site plan required)
Is existing space iUsulaied?U Yes U No Alteration of existing HVAC system _
oiler/compressors
1,1111H 11153011 rMMMM Slate boiler permit no.:
Business nanic: fj���► i rf HI' Tons BTU/H
Address: Fir smo edampers/duct smo a electors
City: �Slulc: �7.IP: cat pump(site plan required)
_ UAl
Phone:14 �,1/7 E-mail: Insta l fep accfurnac-t6urncr__._ t'
— Including ductwork/vent liner U Yes J No
CCB no.: Install/replace/re ocatcTicaters-suspends ,
City/metro lic.no.: wall,or floor mounted
Name(please print): Ven;for appliance other t an t urnace
' c gerat on:
Absorption units BTU/14
Name: Chillers
- - ('umrressors
Address: _ ;nr mnmenla ex must ane ventilation:
Illy' Slate: ZIP: Aphlia ice vent
Phone: I E-mail: )ryercx aunt
OWNER loo s, ypc res. its en/ atmat
hood fire suppression system —
Name: 16�erell I/Ja%,� s ��.N!� Exhaust fan with single duct(hath fans)
Mailing addre s: � ,S,V/ /J"1A//rte/tet=/7�T/��' ?x roust s and d t turn heating t) AC
ue piping and clr ration(up to 4 uut cls)
City: T/ s0e'&P0 Slutcg,)+r I'LIP: -I'yI1e I h NG oil
Phone Io-. f7a E-mail: Ticl ,i nng caclt additions over out Cts
'rocecspiping(schematicrequire.I
Number of outlets _
Name: - ter listed appliance or equipment:
Address: _
Dccorative fireplace T7- State: ZIP: _ Insert-ty e -_ --
('I one: — hax: I m;fil: rxr stov pC etstme
()they
Applicant's signature- - I>atr: Other:
Name (print):
Na all jurisdictions acceta credit cordo,plena call Jurisdiction fa mar intrxrnnthu3 Permit lee.....................$
Notice:•Phis permit application Minimum fee................$
J Viaa U MasteWard expires if a permit is not obtained
Credit card number:_ —_111-- Plan review(al — %) $
gxpiRa within 180 days oiler it has been State surcharge(891) ....$ _
Name o car r o a own u card - accepted as complete.
s TOTAL .......................$ _
Won r
cardholder riiinaiure Amount f 4404617(M)WOM3
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 Met;hanical Code Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,030 BTU
$1.52 for each additional$100.00 or including ducts&vents 1400
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts&vents 1740
$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 1400
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00. or floor mounted heater _ 14.0.0
$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 avd 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: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. _ footnotes below. comp* "
Minimum Permit Fee$72.50 SUBTOTAL: 7) abU unit
$ to 1 100K 00K BTU _ 14.00
°/.State Surcharge 8)3-15 HP;absorb
8
0 $ `V unit 100k to 500k BTU 25.60 _
25%Plan Review Fee(of subtotal) 9)15-30 ll absorb
---
Required for ALL commercial ermits only
$ unit.5 1 mil BTU 35.00
o
- 9 ---- -- P - 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU
11)>50HP:absorb
--� �- unit>1.75 frill BTI l I I87.20
12)Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: 10.00
Value Total 13)Air handling unit 10,000 CFM+
Description: at Ea Amount 17.20
Furnace to 100,000 BTU,Including 955 14)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 heater or 955 appliance permit 10.00
floor mounted heater 17)Hood served by mechanical exhaust
Vent not Included In applicance 445 _ 10.00
permit - 1 d)Domestic incinerators
Repair units _ 805 17.40
<3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator
to 100k BTU _ ` 69.95
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 frill.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 856 _ 8%State Surcharge $
Air handling unit>10,000 cfm 1,170
Non-portable evaporate cooler 656 _ TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not Included In 656 --- _
appliance permit Oar ns ec Ions snd Fees:
Hood served by mechanical exhaust 656 1 inspections outside of normal business hours(minimum charge-two hours)
Domestic inclnorstor 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
Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(mmin,un
Gag pliplin 11-4 outlets 360 __ charge-one-half hour)E72 50 per hoer
Each ado tional outlet 63 'State Contractor Boller Certification required for units>200k BTU.
TOTAL COMMERCIAL --j
"Residential A/C requires site plan showing placement of unit.
s-
VALUATION:
I:\dsts\fonns\rnech-fees.doc 08/06/01
Electrical Permit Application
Dale received: Permit no.:
City of Tigard Project/appl.no.: Expire date:
City(of Tigard Address: 13125 SW Ilall Blvd,Tigard,OR 97223 Date issued: - By: lteceiptno.:
Phone: (503) 639-4171 --Fax (503) 598-1960 Casc file no.: Payment type:
Land use approval:
all I
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-gamily U Tenant improvement
fi(New construction U Addition/.Jtcratic)n/replacement U Ocher: _ _ U Pirtial
JOB SITE kFORNIATION
Job address: Suite ax map/tax lot/account no.:
Lot: ,ZY Block: Subdivision:
Project name: s';044o,,*-r,4 77777TTescriplion and location of work on premises:
Estimated date of completion/inspection:
ON I It ACI Olt A 1SCHEDULE
Job no: Pee oras
Description Ql'i (Va.)
total nu.insp
Business name: �irC I e'O i�/1Ci[�ifje+ l iYlr�� Nrl+rnirkrdial-single ormulti-family iter
Address:
dsseaint;unit.Inclmrlsv alulcls•d knrlRe.
City: Stale: ZIP: Serviceincluded
Phone:'7pt1-,fZZ4/ Faxiryy-a'srE-mail: 1000 sq.ft.of l 4
CCB no.: Bloc.bus.lic.no: J,jC - Each additional Sot)s .ft.or portion thereof
Limited energy,residential 2
City/metro lic.no.: Limited energy,non-residential _
Bach mimufactuied home or modular dwelling
Signalure of supervising elecly-iia,(required) hale Service and/or feeder 2
---- - - -- --
Sup.elect.name(print i „,n.elto.'J Sersicesorfeeders-inslallalion.
alteration or relocation:
PROPERI1 200 amps or less 2
Name(print): 1Ae 1. 201 snips to 400 amps 2
Mailing address: a �. 401 amps to 6(10 amps 2
601 snips ti,I(0)amps 2
Gly: Stale' ZIP: 7�1 Over 1000 unq,s ar volts -- 2
Phone: I E-mail: Reconnectnnly I
Owner installation:The installation is being made on property I own Terni-ran serstees or fefeeden-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrelocation:
ORS 447,455,479,670,701. 200 amps or less ^, 2
201 amps to 400 an s 2
Owner's signature: Date: 401 to Wl am l5 2
ENGINEER Hrmo:hclrcuits ness,alleralioo.
or extension per panel:
Name: Or
Fee for hronch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: Stale: ZIP: H. Fee for branch circuits without purchase
Phone: E-mail:.i of service or feeder fre,first branch circuit: 2
C —
F.nch additional branch cmcuil'
Mime.(Service or feeder not Included):
U Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle 2
U Service over 320 amps-rating of 18:2 U Hazardous locndon Each sign or outline lighting 2
familydwcllings U Huilding over 10,000 square.feel four or Signal circuit(s)or a limited energy panel.
U System over 600 volts nominal Haire residential units in one structure alteration,or extension' 2
U Building over three stories U Feeders,401 amps or more •I kscn tion,
U(kcupant load over oy persons U Manufactured structures or Rv park tach additional Impection over the allowable In any of the above:
U Egretollighlingplan U(idler' Ver Inspection
Submit--.- sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not an Jurisdictions accept cmin cards,please call jurisdiction6x rrwrr information Notice:'nis permit application Permit fee.....................$
U visa U MasterCard expires if a permit is not obtained Plan review(at %) $
credit card numherwithin ISO days after it has been State surcharge(9%)....$
— spire' accepted as complete. TOTAL ............ .........$
Name d c of r upona�dle 1 cart
_ S
Cardholder s'IFnalure -Amouf 410-4611(rJOWOMI
Electrical Permit Fees: Limited Energy Fees:
-'—�-- TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................�........................... $75.00
Numbe: of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total I Check Type of Work Involved:
Residential-per unit
1000 sq ft-or less $145 15 _ 4 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 $9090 2
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 --� $10685 2
401 amps to 600 amps $160.60 2 Other_--
601 amps to 1000 amps _ $240.60 2 --
Over 1000 amps or volts $454.65_ 2
Reconnect only $66.85 2
Temporary ServicesorFeeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Fee for each system.......................................................... $75.00
Installation,alteration,or relocation
200 amps or less _ $66.85_ 2 (SEE OAR 918-260-260)
201 amps to 400 amps $i00.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
ee"b"above. Audio and Stereo Systems
❑
s
Branch Circuits ❑ Boiler Controls
New,alteration or extension per pans)
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder lee.
Each branch circuit $6.65 -- 2 Data Telecommunication Installation
h) I he fee for branch circuits
wifhovf purchase of service r�j Fire Alarm Installation
or feedr•.r fee.
First branch circuil $46 85 HVAC
Lath additional branch circuit — $665 1
Miscellaneous In 3trumentation
(Service or feeder not included)
Fach pump or Irrigation circle $53.40 _.__- _ latercom and Paging Systems
Each sign or outline lighting $53.40 _
Sial circuits)or a limited ener gy
pnanel,alteration or extension _ $75.00 _ �; Landscape Irrigation Conlrol'
Minor Labels(10) — $125.00_ —__ _
Medical
Eac It additional inspection over
the allowable In any of the ab.rve L] Nurse Calls
Per inspection $62.50
Per hour _ $62.50 _
In Plant $73.75 _ ❑ Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ Other
8"i State Surcharge $ Number of Systems
25%Plan Review Fee
See"Plan Review"section oil $ No licens,s are required Licenses are required for all other Installation
front of applir:ation --{ ---- —
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account f1_ 8%State Surcharge S
Total Balance Due $
iAdsts\fonns\elc-fees doc 10/09/00
SEE 35m- m
ROLL #21
FOR
OVERSIZED
D
OCUMENT
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NORTH STAR PLUMBING
1445 SE OREGON STREET
SHERWOOD, OR 97140
Plumbing Signature Form
Permit #: MST2001-00490
Date Issued: 10/24/2001
Parcel. 2S104DA-0400
Site Address: 13369 SW 121j i,' AVE
Subdivision: QUAIL HOLLOW - WEST
Block: Lot: 028
Jurisdiction: TIG
Zoning: R-4.5
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 slart of the work to the address above, AT i N: Building
Dept.
No plumbing inspections will be authorized until this completed form !a received
OWNER: PLUMBING CONTRACTOR:
GARY BJULI STUMP NORTH STAR PLUMBING
125551 SW MORNING HILL DR. 1445 SE OREGON STREET
TIGARD, OR 97223 SHERWOOD, OR 97140,
Phone #. 503-579-3046 Phone #: 625-2679
Reg # LIC 00090697
PLM 34-255PB
AN INK SIGNATURE IS REQUIR�D ON THIS FORM
i
Sig 0 ui - of Ai tho�iz umber
1
If you nave any questions, please call (503) 639-4171, ext 316