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UTY OF TIGARD _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT 0: MEC2001-00006
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 1/10/01
PARCEL: 2S102AA-02501
SITE ADDRESS: 12170 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: 1 VENT FANS:
OCCUPANCY GRP: VEN 7S W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_FUEL TYPES 0 3 HP: DOMES. INCIN:
LPG — 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15-30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP:
GAS PRESSURE: 50+ HP: COD RYERS:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: _ <= 10000 cfm: OTHER OR UNITS:
> 10006 cfm: GAS OUTLETS: 1
Remarks: Installation of gas wall heater and gas piping.
Owner: — FEES
FREY, HILDE C Type By Date Amount Receipt
21745 SW HEDGES DR PRMT DLH 1/10/01 $72.50 2720010000
TUALATIN, OR 97062 5PCT DLH 1/10/01 $5.80 2720010000
Phone: Total $78.30
—
Contrartor:
ANCTIL SHEET METAL CO.
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Gas Line Insp
Phone:503-281-0752 Mechanical Insp
Reg f!:LIC 8897 Final Inspection
QC
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wn his permit is issued subject to the re,ulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
-J and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if worts is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follt:v rales adopted in the Oregon Utility Notification Center. Those rules a re set forth in OAR
952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or dir�ni questions to OUNC by
calling (503)246-989. �--�"
Permittee Si ��ature:
Issue By: ti ��7//L�C �'�-_ 9 -
Call (503) 639-4175 by 7:00 P.M.for Inspections needed the next busln ss day
Mechanical il,'ermit Application
Date received: / /0 O/ Permit n�QO ,C Q
City of Tigard Project/appl.no.: Fnpiredate: —
('tryqfTigard Address: 13125 SW Hail Blvd,Tigard,OR 97223 --
Phone: (503) 639-4171 /� t Date issued: By Receipt no.:
Fax: (503) 59t;-1960 Gf/� _d O/�J Case file no.: Payment type:
Land use approval: Building permit no.:
U I R 2 family dwelling or accessory %Commcrcial/industrial U Multi-family U Tenant improvement
3 New construction Add ition/al teration/replace men I U Other:
Job address: ZI p ht1 m A l Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: Biock: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for reside,ttial permit fee.
City/county: _ ZIP: 16001 PgREIRIWaLLI
Description and location of work on premises: TT S i'>rlL t. b4 S
MALL fVlepi fife 1- iNQ.W GLASS Xcv— Fee(ea.) Total
Est.(late of completion/inspection: Description Qt . Rem.trnl Rea.only
Tenant improvement or change of use:
Is existing space heated or conditioned?U Yes '_t No Air handling unit
Air conditioning(site plan requ red, _
Is existing space insulated?U Yes U No Alteration o exisung system --
oi er compressors
State boi:er permit no.:
M
0usiness name. /�N CTl SiRvT t"`Q A t_
NP --Tons__B"fU/H
/'.Jdresa� W1 N r pryf Fir smo c a-M__peri7juct smoke detectorF _
City_ PTLD v?_ Slate:OCL_j ZIP: qui t-Lcat pump(sttc pian rcquire�j—
Phone:SuAta /rep acei'urnacerner 1 Tu/ri
Ltiri_pw t Fax: E-mail: ns
_ Including ductwork/vent liner U Yes IANo
CCB no.: ,oj l�4 7 nsta rep ac re ocate hemets-suspended,
City/metro lic.no.: //$ wall,or floor muunted
Name(please print): Vent for appliance other than furnace
Re"Bratwin
Absorption units BTU/H
Name: LDE FiL� Chillers_ _ HP
Address: I: 171 S,w q(;n — Com ressors HP
City: (,,p,�p State:V2 ZIP: 7 Z 2 �v ronmentitexhaust a ventilation:
l Appliance vent
lei,-ne: 2A Fax: E-mail: ere. aunt
Hoods,Type res. uc en azmat
hood fire suppression system
Name: 141 t_ t _FYLQy Exhaust fan with single duct(hath fans)
Mailing address: � 'Ts 5 A , i4Q �+ t_ ��us►s stem a,an rom heating orAC
L City: rU qL Tt:� State: ✓Z ZIP: piping■ distTon(up to out Pts)
Phone: Fax: E-mail: - Type: LPG _2 NG __ Oil —
f lFuel piping each a diin.t,a over "outlets _
nProceint Piping(schematic requ rr )
Number of outlets
Name: Other listed appliance or egta ptartN:
Address:
f] - Decorative fireplace
ace .
City: i State: ZIP: nsen-type
U Phone: Fax: E-mail:
-owe oo stov pc et stove -
r.
Appliean.'r signature: Date: I-/c>-.0k
Name(print): iaj ST tJ�
Not dl jurisdictions weep credit curia•olenfe call ittridictiot for morr information Permit fee.....................$
U Visa U Ma"PiCard
Notice:`Idris ptmtit application
expires fee................S
exprs rf a permit i:,not obteined
Credit card number Plan review(at _ %) $
Expires within ISO dsys After it has beer. Sl,
N�meof" d on�re�i .�v� accepted as�mTO $
plete. surcharge(896).... 5
S TOTAL .......................S
Cardholder elputure Ammar 411►�6t7(dIxK�DM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VAL_UATIO_W FEE: Des-Aptlra: A Price Total
$1.00 to$5,000.00 _ Minimum fee$72.50 Table ;A Mechanical Code -_ OtY (Es) Amt -
$5,001.00 to$10,000.00 $72.50 for the first$5,000.04 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or Including ducts&vents 14.00 -
fraction thereof,to and Including 2) Furnace 100,000 BTU+
$10,000.00. including ducts&vents 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Fumace
$1.54 for each addilioral$100.00 or includin vent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00. _ or floor mounted heater _ 14.00
$25,OU1.OU to 55Q 040.U0-� $379.50 for the first$25,000.00 and 5) Veof not included in appliance permit
$1.45 for each additional$100.00 or _ - 6.80
fraction thereof,to and inr,luding 6) Repair units
12.15
$50,001.00 and up $742.00 for the first$30,000.00 and Check all that apply: F.Ydier Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes below. _m
7)<3HP;absorb unit
o -
P-SSUMED VALUATIONS PERto 100K BTU 14.00_APPL!ANCE: 6)1-15 HP;absorb
�Value Total unit 100k to 500k BTU 25.60 _
Descrl`ptlon. t]t�I__ a) Amount 9)15-30 H�;absorb
Furnace So 100,000 BTU,Including 955 unit.5.1 mil BTU 35.00
ducts&vents 10)30-50 HP;absorb
Furnace> 100,000 BTU Including 1,170 unit 1-1.75 mil BTU _ 52.20
ducts&vents 11)>50HP:absorb
Floor furnace Including vent_ 955 _ unit>1.75 mil BTU_ 87.20
Suspended heater,wall heater or
floor mounted heater 955 12)Air handling unit l0 10,000 CFM _
- - 10.0
_ 0
_
Vent not included in applicance 445 13)Air handling unit 10,000('FM+
permit
1;.20
Re it units -- _�--�- 805 _-
<3 hp;absorb.unit, 955 14)Non-portable evaporate cooler
10.00
100k BTU _
to ----
15 hp;absorb.unit, a 700 - 15)Vent fan connected to a single duct
6.80
101k to 500k BTU
15-30 hp;absorb.unit,501k to 1 2,310 -�-- 16)Ventilation system not Incfuded in
mil.BTU a pliance permit 10.00
17)Hood served b
30-50 hp;absorb.unit, 3,400 -- y mechanical exhaust
_ 10.00
1-1.75 mil.BTU - 18)Domestic indnciators
>50 hp;absorb.unit,--- .5,725 17.40
>1.75 roil.BTU --- 19)Commercial or industrial type Incinerator
Air handlingunit to 10,000 cfm 656 _ _ 89.95_
Air handling unit>10,000 cfrin 1,170 2C)Other units,Including wood stoves
Non-portable ev�rala cooler 656 1000
Vent fan connected to a single duct 446 21)Gas piping one to four outlets
Vent system not Included in 656 _ 5.40
appliance permit - 22)More than 4-per outlet(each) -
Hood served by mechanical exhaust 656 -_ 100
Domestic Incinerator 1,170 Minimum Permit Fee$72.50 SURTOTAl
d Commercial or industrial incinerator 4,590
Other unit,including wood stoves, 656 8%state Surcharge
N inserts,etc.
N Gas i !n 1-4 outlets 360 - 25%Plan Review Fee(of subtotal
Each additional outlet 63 Required for ALL commercial pemtits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ _
VALUATION:
W
a Qthh r Insoectfons and Fen:
1 Inspections outside of normal business hours(minimum charge two hours)
$72 50 per hour
2 Inspedions for whlr.h no fee is specifically indirated (minirrKrm chsrge-hall hour)
$72.50 per hour
3 Additional plan review required by changes,additions no envisions to plans(minir„um
charweone-hall hour)$72.50 per hour
'State Contractor toiler Certification required for units>200x BTIt.
"Residential AIC requires slle plan showNnp plaa ment of unit.
i:ldstslforrnslmech-fecs.doc 10/11/00
. t CITE( OF TIGARD _EWER CONNECTION PERMIT
��
DEVELOPMENT SERVICES PERMIT#: SWR2000.00304
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 9/22/00
SITE ADDRESS; 12170 SW MAIN ST PARCEL: 2S102AA 02.501
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: GBD
BLOCK: LOT: JURISDICTION: TIG _
TENANT NAME:
USA NO: FIXTURE UNITS: 0
CLASS OF WORK: ADD DWELLING UNITS: 1
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Sewer charge for one EDU due to added plumbing fixtures.
Owner:
FEES
FREY, HILDE C
21745 SW HEDGES DR Type By Date Amount Receipt
—
TUALATIN, OR 97062 PRMT CTR 9/22/00 $2,300.00 27200000000
Phone: Total $2,300.00
Contractor:
Phone:
Reg M
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 directors from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install 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 952-001-0080.
You may obtain copies or these rules or direct questions to OUNC by calling(503) 246-1987.
Issued by: Permittee Slgnatf
Call( 03) 639-4175 by 7:00 P.M.for ars inspection needed the next business day
CITY OF TIGARD CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES PERMIT 0: BUP2000-00195
L� 4
13125 3W Hail Blvd.,Tigard,OR 97223 (503)639 171 DATE ISSUED: 00119/2000
PARCEL: 2S 102AA-02501
ZONING: CDD
JURISDICTION: TIG
SITE ADDRESS: 12170 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS
BLOCK: LOT:
CLASS OF WORK: ALT
TYPE OF USE: COM
TYPE OF CONSTR: 5N
OCCUPANCY GRP: M
OCCUPANCY LOAD: 16
TENANT NAME: U NDERWATER WORKS
REMARKS: Tenant in. -)vement: frame addition of 588 sq ft.
Owner:
FREY, HILDE C
21745 SW HEDGES DR
TUALATIN, OR 91062
Phone:
Contractor:
OWN ER
Phone:
Reg#:
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W This Certificate issued 03/07/2001 grants occupancy of the above referenced building or
portion thereof and confir a building has been inspected for compliance with the
State of Oregon Speci C es, r the group, occupa cy, and use under which the
re permit su
(D�t4
BUftDING INSPECTOR BUIL 1
POST IN CONSPICUOUS PLA E
August 8,2000
Hilde Frey
12170 SW Main Street MY C MD
Tigard,Oregon 97223 ^
RE: Underwater Works BtTPO!2 oo19QREGON
12170 SW Main Street
Dear Applicant:
Your plans for the proposed addition have been reviewed;the following items require your attention.
1. Under the provisions of OSSC,Section It 13.1;provide the following requirements on drawing 12170-4.
(a) Provide an accessible route to a public way.
(b) An accessible entry.
(c) One male and one female accessible toilet faciFy.
(d) Location of required accessible van accessible parking star and signage.
2. Provide a storm drainage:plan. '
3. Provide a utility plan.
4. Provide an erosion control plan.
Fire Lift S fety;
1. Drawing 12170-1 —With the addition,two exits are required OSSC,Table 10-A.The
placement of the exits sliall comply with OSSC,Section 1004.2.4.Provide details.
2. Drawing 12170-1 —Provide details on your floor plan on how you will comply with OSSC,
Section 1003.2.8.(Egress Illumination)Provide details.
3. The entire wall adjacent to the property line shall have a fire resistive rating of one hour.
OSSC,Table 5-A.Provide details.
9,regon Non-Residential Energy Code:
1. Provide completed ibrm:2a through 3e,and 5a through 5c to include related work sheets.
Structural:
1. The structural requin..nents provided by your Engineer shall be incorporated into the
L approved plans.Provide a drawing S•1 with these requirements to inclde an original seal by
r your Engineer.
IProvide(3)three sets of revised drawings.
a If you have questions,please call me at 639-4171 X 392
tl
S' a ely,
t e�Z. ..-�
Ro rt D.Poskin CBO
Senior Plans Examiner
13125 SW Hall Blvd., Tigard, OR 97223(503)639.4171 TDD(503)684-2772
G1A4X-;e WVEe
17-1 7.0
sub. /rta. Sf
SUBJECT: ACCESSIBILITY
BARRIER REMOVAL IMPROVEMENT PLAN
REQUIREMENT: OREGON REVISED STA.UTE (ORS)447.241.
(1) Every project for renovation,alteration or mc<56ualion to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per-cent(25%).
VALUATION of all renovation, alteration or modification being done
excluding painting, wallpapering.
multiglr. 25% Barrier removal requirement. -5
BUDGET FOR BARRIER REMOVAL j21'
In choosing which accessible elements to provide under this section, pr?ority shall be given to those
elements th2t will provide the greatest access. Elements shall be provided in the following order
(a) Parking $ _—
(b) An eccessibfe entrance:
(c) An accessible route to the altered area: $ �"
(d) At least one accessible restroom for $ Coe,
each sex or a single unisex restroorn:
(e) Accessible telephones $
(f) Accessible drinking fountains and $
i
(g) When possible additional accessible
I elements such as storage and alarms: $
I --
I
TOTAL: Shall equal line 2 of Value Computation $
iAdsrs\forms\acccss.doc
.lune 1, 2000
Crrf OF TIGARD
Hilde Frey OREGON
12170 S`'v Main Street
Tigard. Oregon 97223
7
RF: Underwater Works
12170 SW Main Street
Dear Applicant:
Your proposal for the addition cannot be reviewed for the following reasons:
Application Requirements
I. A site permit will be required, enclosed find the required application. -»moi" ke-
Your building permit application is incomplete, please provide the information hi-lighted
in yellow and return same to this writer.
Structural
The addition must comply with OSSC, Section 1630. Since the original construction does not
comply with seismic zone 3, the addition must be designed as a stand alone building, or up grade
the entire building to comply wi h the applicable code requirements. Provide details.
Accessibility
OSSC Section 1 1 13, requires 25%of the work valuation be expended in removing;,xisting
Architectural barriers. Provide the information required on the enclosed fonn, return it to this
writer.
Site
Referencing the requi-cments for permits above, your site plan must indicate the existing and
proposed construction in relation to all property lines. This plan shall indicate parking to include
accessible parking.
Fire Li a Sa et
Provide a floor plan showing existing and proposed construction. In addition I will require a roof
plan showing existing and proposed draft stops.
Euew� Code
Provide Oregon Non-Residential Code forms 2a through 5c, and related work sheets. These
forms can be download from the web at (www.energy.state.orp.).
13125 SW Hall Blvd., Tlgard, OR 97223(503)639-4171 TDD(503)684-2772
Page 2 continued
!Le ItgJA-al
Prov;de details on how you will heat the proposed addition, and comply with outside air
regi;irements from OSSC, Chapter 12.
Once I have received the requirements setout in this document, I will be able to proceed with a
plan rev,r�w.
If you have questions, please cdil me at 639-4171 X392.
Sincerely,
etber, Poskin, CBO
Senior Plans Examiner
i
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DATE: PLANS CHECK NO.:
-o a 5--
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PROJECT TITLE:
C/Np'felo/ywoe
COUNTYWIDE
TRAFFIC IMPACT FEE APPLICANT: ///z Lpf- Fag Y'
WORKSHEET I. 11LING ADDRESS, o sc
(FOIL NON-SINGLE FAWLY USES) CITY/ZIP/PHONE:
RATE PER TAX MAP NO.:
LAND USE CATEGORY TRIP SITUS NO.ADD SS:
SIDENTIAL $201.00
BUSINESS AND COMMERCIAL $51.00
OFFICE $184.00
INDUSTRIAL $193.06
INSTITUTIONAL $83.00
PAYMENT METHOD:
CAS WCHECK f
M
CREDIT TIO
STtRINAL ONLY'
BANCROFT(PROMISSOPY NOTE) LAND US/ICATE Y DESCRIPTION OF WEEKDAY VG. IP WEEKEND AVG.TRIP
DEFER TO OCCUPANCY 7 USE fPV,41L �91f- RAIE 7 ' `' IRATE
BASIS:
CALCULATIONS:
0. PROJECT TSP ENERATION:
FEE:
U)
FOR
7
FOR ACCOUNTING PURPOSES
� ONLY
ADDITIONAL NOTES:
? el ROAD AMT.: SS f
ETRANSIT AMT.Lae
.�
ARED BY
6/7.99 I.WunQ� ovopdam\soommNproo6dum nunuomoeoc~9900.doc
C WASMNGTON COUNTY TIF NOTEBOOK
COUNTYWIDE TRAFFIC IMPACT FEE
APPEAL INFORMATION COY OF T1 ARD
OREGON
Attached is a copy of the Director's decisior, cn this Traffic Impact Fee assessment or Traffic Impact Fee
CreditlOffset request.
This decision may be appealed and a public hearing held by filling a signed petition for review(appeal)
within fourteen (14) calendar days of the date written notice is provided (date mailed).
APPEAL PERIOD: Date mailed:__?_: -00 _to 5:C0 PM on - - ' -00
Appeal Due Date
A motior for reconsideration also may be filled within seven calendar days of the date written notice if
the decision is provided (see Section 2011 of the Washington County Community Development Cod(:). A
motion for reconsideration does not stop the appeal period(s) from running and is available only a! an
extraordinary remedy for when a mistake of law or fact has occurred. A. motion for reconsideraticn
requires a filling fee of$625.00.
This decision will be final if an appeal is not filed by the due dates(s), and a motion for reconsideration is
not granted by the Director.
The complete file is available at 13125 SW Nall Blvd , Tigard, OR 97223 for review.
,A petition for rev;ew (appeal) must contain the following
The name of the applicant and the relevant casefile/building permit/other development
permit number;
2. The name and signature of the petitioner fling the petition for review (appeal). If a
group consisting of more than one person is filing a single petition for review, one
individual shall be designated as the group's representative for all contacts with the
Department. All Department communications regarding the petition, including
correspondence, shall be with this representative;
3. A statement of the interest of the petitioner;
4. The date the notice of decision was sent as specified in the notice;
5. The petition "or review (appeal) shall state the relevant facts, applicable ordinance
provisions, and relief sought; and
j 6. The fee of$625.00 for Director's decisions being appealed to the Washington County
j Hearings Officer.
a
For further appeal information contact: &g?
13j2#s b"P@Ivd., Tigard, OR 97223(503)639-4171 TDD(,03)684-2772
July 7, 2000 C� OF 71GARD
Hilde Frey OREGON
12170 SW Main Street
Tigard, OR 97223
TRAFFIC IMPACT FEE FOR UNDERWA ER WORKS
Enclosed with this letter you will fins: a c;.ciculation sheet showing the computation that has
been performed to determine the amount o` the Traffic Impact Fee (TIF) to be paid for the
project noted above. The amount of the TIF is $1219.00.
You have two payment options available to you. The first is to pay the TIF at the time you
are issued a building permit. The second is to arrange for payment over time by signing a
promissory note (if you wish to exercise this second option please contact me for additional
details), Traffic impact fees are subject to an annual incret se of up to 6% if not paid or
financed prior to July 1 st of each year.
Please note that you may appeal the discretionary decisions made in determining the.-
appropriate
heappropriate category and the amount of the fee based on that category_ A notice of appeal
must be received by the City Recorder no !ater than 5:00 p.m. on July 21, 2000 and must be
accompanied by the $638.00 appeal fee required by Washington County. Although filed with
_ the City Recorder, an appeal would be heard by the Washington County Hearings Officer.
If you have any questions, or if I can be of further service, please contact me at 639-4171.
Geo Oberkamper
Development Services T-)chnician
c: TIF file
Building file
I0STS,znr ocr
13125 SW Hall Blvd., Tigard, OR 97223(503)639-4171 TDD(503)6f.4-2772 ---
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour irwection Line: 639-4175 Business Line: 638-4171
• BUP
Date Requested AM PM BLD
Location l�/���✓ Suite MEC
Contact Person Ph — PLM
Contractor �� �— - Ph SWR
BUILDINGTenant/Owner ELC
z�
Retaining Wall ELR
Footing Access: —
Foundation PPs
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab --- SIT
:)st& Beam —
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall _
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /7
Misc: _ CLCCr
Final
PASS PART FAIL --- -
PLUMBING
Post&Beam —"— — --`
Under Slab
Top Out - -- -
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post& Beam — —
IRough In
Gas Line -- — — -
Smoke Dampers
Final
PASS PART FAIL
LECT --�
. ervice
Ix Rough In
UG/Slab
} Low Voltage – --
k Fire—Alarm
J
m PA A^T FAiL — -_—
W _
Backfill/Grading `--- —
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$_ required before next inspection. Pay at laity Hall, 13125 SW Hall Rlvd
Catch Basin [ ]Please call for reinspection RE: nab;e to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2' le9l Inspector_ Ext
Other -
Final
PASS PART FAII DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MAT
24-Hour Inspection'Line: 639-4175 B slness Line: 639-4171
Date Requested AM PM BLD
Location Z/ 7 S w ?/ l,Lrl S w Suite MEC G�Gly
Contact Person Ph Z �" PLM
Cc„itractot Ph / SWR _
BUILDING Tenant'Owner CA.l1 -42f/n e, /` ELC
Retaining Wall ELR
Footing
Foundation Accu;s:
FPS
Ftg Drain
Crawl Drain InspHction Notes: SON
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Sheaf
Frarn Qg_
Ensu o
DryWa"TI NailingFirewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Poof
Misc: —
PASS PART FAIL
VINO
Post&Beam -- —
Under Slab
Top Out
Water Service
Sanitary Sewer —
Rain Drains
Final —"
PASS PART FAIL
(IMECHANI
ost&Beam
Rou
psURe` -- —.
SI&Ike Dampers
Fi
SS PART FAIL
WXEMICAL —
4. Ser lice
Rough In
CO) UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
O
W SITE
J Backfill/Grading —
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call fnr reinspection RE:_ _ ( I Unable to inspect-no access
ADA i
Approach/Sidewalk f
Date
Other _ --Inspector_ /�� Ext
Final
PASS FART FAIL DO NOT REMOVE this inspection record from the job site.
L CITY OF T I G A R D ELECTRICAL PERMIT
DEVELOPMENT SERVICES DATE SSUIED: 9/22/00 0-00562
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 PARCEL: 2S102AA-02501
SITE ADDRESS: 12170 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT : JURISDICTION: TIG
Prosect Description: Installation of service and 6 branch circuits for awfition to commercial.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: 6 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FUR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVL•I€DR>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
FREY, HILDE C HOMESTEAD ELECTRIC
2.1745 SW*WDGES DR PO BOX 13387
TUALATIN, OR 97062 PORTLAND,OR 97213
Phone: Phone: 257-4989
Reg#: SUP 2326S
LIC 42030
ELE 26-586C
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRNIT CTR 9/22/00 $120.20 2720000000( Elect'I Final
5PCT CTR 9/22/00 $9.62 2720000000(
Total $179,82
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;i,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
C rules are set forth in OAR 952-001-0010 through OAR 952.001-0080 You may obtain copies of these rules ordirect questions to OUNC at(.503)
246-1987. _ -
PERMITTEE'S SIGNATUAG�'xISSUED BY:
0 - ,
g _ OWNER INST LLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �___ ___ ____._ _ ___._ ___..�..__ DATE:_—_—_—.
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
CITY 0'8Z TIGARD Electrical Permit Application Plan Chad N
t3125 9W HALL BLVD. Recd By .a G/�' N'�2 /�
TIGARD OR 97223 Date Recd-=�r`-`Y��-
Date to P.E.
Phone(503)639-4171, x304 Date to DST
,(1
Inspection (503)639-4'175 Print of Type ` \�7 Permit 0 SGC2"y 'zVS6 A_
Fax (503)598-1960 Incomplete or Wegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inispecillone EM pwmit all
Name(or name of business) Sere:;.: Included: Items Cost Sum
Address 4s. Realdentlal•per unit
1000 sq fl,or less S 117.75 4
City/State/Zipr-�/ Each additional 500 aq fl.or
Commercial l!� portion thereof S 28.00 1
Residential ❑
Limited Energy $ 80.00
Each Manufd Home or Modular -
2a. Contractor installation only. Dwelling Service or Feeder - S 72.75 2
(Prior to permit issuance,applicants must provide contractor license 4b.Services or Feeders
Information for COT data bass). Installation,alteration,or relocation
Electrical 99ntractor4W&Leao �f fr!c. ait'iG� 200 amps or less _1_ $ O 2
AddreS$ I r ! - 201 amps to 400 amps $ 85.50 2
Cl --tel '�L 101 amps to 800 amps _ $ 128.50 2
y C .
ttate���C-2ip 801 amps to 1000 amps S 192.50 2
Phone No.-.5u 3--2 5 Z_ tJ T Over 1000 amps or volts S 363.75 2
Job No. _ Reconnect only _ $ 53.50 2
Elec. Cont. Lice. N0,21-- gLd_, Exp.Date4c.Temporary Services or Feeders
OR State CCB Reg. No._,Y t-4_3,0_Exp.Date(,ZIf� / j� Installation,alteration,or relocation
COT Business Tax or Metrq44o. Ex .Date 200 amps or less S 53.50 2
-- 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 _ 2
Over 5C0 amps to 1000 volts,
License No. Z Exp.Date N401 dl r:w"b^above.
4d.Branch Circuits
Phone NO. _ _ New,alteration or extension per panel
a)The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit _ S ,6 39 r 9a 2
Address b)The fee for branch circuits
without purchase of service
City _State_ -Zip --- or feeder lee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e.Miscellaneous
intended for sale, lease or rent. (Service or feeder not Included)
Each pump or Irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting _ $ 42.75
Signal circuits)or a limited energy
panel,alteration or extension $ 60.00
a 3. Plan Review section (if required)'* Minor Labels(10) - $ 197.99
� --
Please check appropriate item and enter fee in section 5B. 4f.Each additional Inspect on over /,000
4 or more residential units in one structure the allowable In any of the above
Cr
Service and feeder 225 amps or more Per inspection $ 50.00___ Par hour $ 50.00
J System over 600 volts nominal In Plant $ 50.00 _
m _Classified area or structure containing special occupancy as
O described in N E C Chapter 5 S. Fees:
„Wj 8a.Enter total of above fees $/,go • a Q
Submit 2 sets of plans with application where any of the above apply. 4%Surcharge(.06 X total fees) $ 1�
Not required for temporary construction services. Subtotal .dr' $
8b.Enter 25%of line Be for
NOTICE Plan Review M regulred(Sec.3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCT',ON AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Tiust Account 8
AT ANY TIME AFIFIR WORK IS COMMENCED. Total balance Due $
i
I 1dsts\forms\elcctric.d4)c
C,4TY OF TIGARD BUILDING INSPECTION DIVISION 11111118) .
..4 4-Hour Inspection Line: 639-4175 Rusinetss Line: 639-4171 --
BUIP
Date Requested --�� AM PM BLD
Location l 7� iJ //L��•� Suite _
MEC i
Contact Person Ph _ =�77'S PI-M —eV
Contractor _ Ph SINR
BUILDING Tenant/Owner U.0
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab _ 81T
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation --
Drywall Nailing _
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PT FAIL
C L
Post&Beam
Under Slab
Top Out
�Z—
Water Service
Sanitary Sewer
Rain Drains
A PART FAIL _
WEtRANICAL
Post&Bpam _
Rouyn In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
IL ELECTr?;CAL — --
Service
N Rough In
UG/Slab —
Low Voltage
J Fire Alarm
m Final
�j PASS PART FAIL
LU
SME
Backfill/Grading -- —
Sanitary Sewer
Storm Drain [ ]Rei ispection fee of$ required before next inspection. Pay at City Hal, 13125 SW Hell Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE:Y [ ]Unable to inspect-no access
ADA -�..
Approach/Sldp.walk
Other Dace �i Inspector_ _ _ Ext
Final
PASS PART FAIL j DO NOT REMOVE this Inspection record from the Job site.
f
CITY OF TIG/A►RD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT 0: PLM2000-00359
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 9/22/00
SITE ADDRESS: 12170 SW MAIN ST PARCEL: 2S102AA-02501
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SIF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing fixtures for addition to business.
FEES
Owner:
Type By Date Amount Receipt
FREY, HILDE C. PRMT CTR 9/22/00 $72.50 27200000000
21745 SW HEDGES DR 5PCT CTR 9/22/00 $5.00 27200000000
TUALATIN, OR 97062
Total $78.30
Phone 1:
Contractor:
CRESCENT PLUMBING
114 SE 45TH
PORTLAND,OR 97215 REQUIRED INSPECTIONS
Phone 1: Rough-in Insp
Reg#: LIC 39784 Underfloor/Underslab
PLM 26-299pb Top-out Insp
Final Inspection
C
n
M
J
This permit is issued sub ect 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 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: � L,.Q�� � Permlttoe Sfgnature:�
Call(50 639-4175 by 7:00 P.M.for an Inspection needs.:the next business day
chi Y OF TIGARD Plumbing Permit Application Plan Chea 0_
. 3125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 r Date Rac'd
(503) 639-4171 ,�', i Date to P.E.
Print or Type / Dale to DST
Incomplete or illegible applications will not be accepted Permite�i��,rp
Related SWR!-,Aw--x-30
Called_ _
Name of Development/Project FIXTURES ind:yIdual) y I 41Y,^ PRICE AMT
Job r I _ 11.50
Address Street Address Suite Lavatory 11.50
Tub or Tub/Shower Comb. 11.50
Bldg alt r ity/State Zip Shower Only 11.50
Name Water Closet 11.50
Urinal 11.50
_. ,
Owner Mailing Address Suite Dishwasher 11.50
s Garbage Disposal 11.50
C /late Zip Phone Laundry Tray 11.50
rf alo
Name Washing Machine/I.aundry Tray 11.50
Floor Drain/Floor Sink 2' 11.50
Occupant Mailing Address Suite 3" 11.50
City/State Zip Phone 4011 11.50
Water Heater O conversion O like klrxi 11.50
fyarne Gas piping requires a separate mechanical permit.
e C eK 1 MFG Home New Water Service 32.00
Contractor M>l�I�QA d ssr 41te MFG Home New San/Storm Sewer 32.00
G a Hose Bibs 11.50
�( Briar to permit y/St t� w J. J
011 0 Zip,21` Phone
1Drinking aFountain 11.50
issuance,a copy V .114,o.,
of all licenses are 9 re o nsC4oard 1-1c.9 Exp.Date
required if it`Q
Other Fixtures(Specify) 15.00
expired In COT PluJ`if1r�-Lic. D to
dal,ibase Ott" t�� So' I _
Name
55,
Architect Sewer+zt 100' e
Or Mailing Address Suite Sewer-each additional 100' 32.00
Engineer City/State Zip Phone Water Service-1st 100' 38.00
9 Water Service-each additional 200' 32.00
Describe work to be done: Storrs&Rain Drain-tat 100' 38.
New O Repair O Replace with like kind: Yes O No O Storm&Rain Drain-each additional 100' 2.00
Residential O Commercial g►---
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
O Catch Basin 11.50
CL Are you capping,movin or replacing any fixtures? Insp.of Existing Plumbing or Specially Requested 511.00
OC Yes No O Inspections irlhr
U) If yes,see back of form to Indicate work performed by Pain Drain,single family dwelling 4500
�. fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES.
-� I hereby acknowledge that I have read this application,that the Information (QUANTITY TOTAL
_m given is correct,that I am the owner or authorized agent of the owner,and Isometric:u riser diagram Is requked N Quantity Total Is >9
that plans submitted are fn compliance with Oregon State Laws. `SUBTOTAL �a S
W _
S1rMg Oa<ia�
-a
im ill LO 8%SURCHARGE
•-C c Pero Na e _ 5r
�, �t`�'� p� ""PLAN REVIEW 25X OF SUBTOTAL
`g
BA s 178 00 + Required on N fixture total a>9
r'�, TOTAL
*Minimum permit fee is$50+8%surcharge,except Residential Backflow Prevention
Device.which Is$25+8%surcharge
All New Commercial Buildings require plant with Isometric or riser diagram and
plan review. 7(�
I Wslskf r s\pbrcnapp doc 111181g9 '/d�jr :3 (D
•/
20t . /d.,
�6 41 �.
41 %
PLEASE COMPLETE: lll
Y vit
x �w, � + .do- p��, �� . u�:'-•
Sink
Lavato
Tub or Tub/Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray _
Washing Machine
Floor Drain/Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
a
_J
_m
r
I lMnvom,."SW dx 1I/M99
s .k* TY OF TIGARD BUILDING INSPECTION DIVISION MST K
24-Hour Inspection Line: 639-4175 Bysiness Line: 639-4171
?IC BUP
r Date Request;d AM PM BLD
Location I ZI 70 5ZzA) Suite ME Q
Con'iact Person Ph PLM
Contractor Ph &V— 3 SWR
BUILDING Tenant/Owner
Retaining Wall ELR _
Footing Access:
Foundation FPS
Ftg Drain _
Crawl Drain Inspection Notep: SON _
Slab �1_`TPLd2 Gv✓ �cs�l c� s, 81T
Post&Beam
Ext Sheath/Shear
c.
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
r2_101
r
4al
Cf�/CiC�'�
9PART FAIL
INO
Pas Beam
Under ab
Top out —
Wa�er Se
Sze iary ewer —
_7V
ins
ural
p S PART FAIL
MECHANICAL
Post&Beam
Rough In
Gas Line —
Smoke Dampers
Final —
PASS PART FAIL
ftfCTRICAL
CIL Servi
a Rough I —
tA UG/Slab
Low Vol ge
J Fi a rm
P SS PART FXL
W TE
Backfill/Grading
Sanitary Sewer
Storm Drain ( )Reinspection fen of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
match Basin
Fire Supply Line ( ]Please call for -inspection RE: _ ( ]Unable to Inspect-no access
ADA
,Approach!Sldewalk /
ether Date inspector i'l� Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CKY OF TIGARD BUILDING INSPECTION DIVISION 776"MI-ST
Z4-Hour Inspection Line: u39-4175 Business Line: 639-4171
BUP A."yy
`Date Requested AM PM
8L0 _
Locationj?_/ 21) A./ &>f h Suite — MEC %M &1744,
Contact Person Ph Za- PLM
Contractor Ph SWR
UI Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS _
Fig Drain SON
Slab Crawl Drain Inspection Notes: U
SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing 0q"-�
Insulation
DG — ��Z
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
SS PART FAI
PLUMBING
Post&Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS T FAIL
ANI
Post Beam
Rough In
Gas Line
Smoke Dampers
i -
ASS PART FAIL
RICAL —
Service
� Rough in
C UG/Slab
Low Vnitage
Fire Alarm
m Final
PASS PART FAIL
W
J SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RE: [ [Unable to insps v-no access
ADA
Otheoach/Sidewalk D Inspector L'�-- ��
Date
Final
PASS PART FAIL DO NOT REMOVE this Inlspoctlon record from the job tilt*.
I� 1 - BUILDING PERMIT
CITY OF TIGAR
PERMIT 0: BUP2000-00195
DEVELOPMENT SERVICES DATE ISSUED: 9/19/00
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 PARCEL: 2S102AA-02501
SITE ADDRESS: 12170 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: URISCICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 588 sf N: S: E: 1 HR W:
TYPE OF USE: COM SECOND: of PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 588.00 sf ROOF CONST: B FIRE RET?
OCCUPANCY LOAD: 16 BASEMENT: sof AREA SEP. RATED:
STOR: 1 HT: 12 ft GARAGE: sf OCCU SEP, RATED:
BSMT?: MEZZ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 60 psf LEFT: ft FIGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 21,767.00
Remarks: Tenant imrovement: frame addition of 588 sq ft.
Owner: Contractor:
FREY, HILDE C OWNER
21745 SW HEDGES DR
TUALATIN, OR 97062
Phone: 307-7117 Phone: 579-9125
Reg 0:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required Appr/sdwlk Insp
PLCK GEO 5/17/00 $122.69 0002242 Plumbing Permit Required Final Inspection
Foot/Found Insp
FIRE GEO 5/17/00 $75.50 0002242 Slab Insp
PRMT CTR 9/19/00 $235.00 27200000000 Framing Insp
5PCT CTR 9/19/00 $18.80 27200000000 Roof naiing insp
Insulation Insp
(additional fees not listed here) Shear Wall Insp
Total — Gyp Board Insp
X2,035.55 Sus Ceiln Ins
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
I Specialty Codes and all other applicable law. All work will be dorm in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987.
Pe nn itee
Signature:
Issued By:
Call 639.4175 by 7 p.m.for an Inspection the next iausiness day
4r IFT OF TIGARD Commercial Building Permit Application ��� s"C
13125 SW HALL BLVD. New Construction and Additions Date Redd �5'/�
TIGARD, OR 97223 Data to P E
(503) 639•X171 ate to DST -7O
Print or Tyre Permit• IF a-Da
Incomplete or Illegible applications will not be accepted Related SWR e
CalledI!�?ia /��
Name of Devslopment/Projec t
JobAIA--- ,g S Existing Building ew Building O
Address Street Address suite
Building
Bldg t KY/State &P1r7/_ Data
Name ]rzCaq_4P Q Existing Use of Building or Property:
Property 1_11-1"94r T S LES
Owner Mailing Address Suite Proposed Use of Building or Property:
C"I14/N.ST
state2v P�I Phone No. Of Stories: j
61..0-6993
Occupant Name Sq. Ft. Of Project:
Name Occupancy Class(es)
Contractor
Prior to permit Mailing Address suite
Issuance,a copy Type(s)of Construction
of all licenses
are required If City/State Zip Phone Will thin project have a Fire Suppression System?
expired In C.O.T. Yes No
o
database Americans with Disabilities Act ADA
Oregon Contr Cont.Hoard 1I Exp.Date Valuation X 25%=$ ( Participation
Name Complete Access llity Form
ANNOW 'tV'eUc. 1--40'Y .<-edcv1cC—
Pro
t t
Mailing Address Suite
1'/I!E Plansequired: ee M trix for number of sets to submit
CifyIstate ZIQ Prone on back
�e.rtA�+vO,a6 _
Engineer Name I hereby acknowledge that I have read this application,that the Informatbn
given is correct,that I em the owner or authorized agent of the owner,and
Mailing Address Suite that plans submitted aro hi compliance with Oregon State Laws.
Signature of Owner/Agent Date
R City/State Zip Phone
J _// '0 0
Il' (�
NContact Person Name Phone �l
Indicate type of work: New O Addition O'- Demolition O
J Accessory Structure O Foundation Only O Alteration O
Repair O Other o FOR OFFICE USE ONLY
Ma [Description of work:
(9 MapITL# Low Use.
W
J
Parks: Estimated R of Employees TIF.
If the above figure Is not supplied at the time of application,the city VIII r >
calculate the fee based upon the number of parking eWces. ^`
400
Note: Site Work Permit R.ppilcatlon must precede or accompany Building
Permit Application I rn
1 14; 7dff�I p
OdstsVo triftomnew.doc 5/10199
r i
•
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
40
AMP !i 01
Cfh
am:ift
i.
NOW �,11111
KEY:
S (Private) ,1" S = Site Work
B (New or Add) 1 B = Building
F (Nen or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) A. E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
„
Bar (A(t)
:........{Er
a & M &P(Aft) 3 >:
:}
:.
"F3&M & P&E(Al :
U
J
NOTES:
Ildsts\tormMmatacom doc 10/29/98
CITY OF T I G A R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT 0: MEC2000-00206
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394.71 DATE ISSUED: 9/19/00
PARCEL: 2S 102AA-02501
SITE ADDRESS: 12170 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15-30 HP: REPAIR UNIT'S:
FIRE DAMPERS?: 30 -50 HP: WOODSTOVES:
GAS PRESSURE: 50+ HP:
FURN <100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <: 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Mechanical for tenant improvements.
Owner: FEES _
FREY, HILDE C Type By Date Amount Receipt
21745 SW HEDGES DR PRMT CTR 9/19/00 $50.00 2720000000
TUALATIN, OR 97062 5PCT CTR 9/19/00 $4.00 2720000000
PLCK CTR 9/19/00 $12.50 2720000000
Phone: Total $66.50
Contractor:
HOMESTEAD ELECTRIC, INC.
PO BOX 13387
PORTLAND,OR 97213 REQUIRED INSPECTIONS
Phone:257-4989
Reg#:LIC 42030
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
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 in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copms of these rules or direct questions to OUNC b Iling E"-9189.
Issue By: Permittee Signature:
Call(503)6394175 by 7:00 P.M.for Inspections ne ded the next business day
• CITY OF TIGARD Mechanical Permit Application Plan -.h9ck«
Reed 13125 SW HAI_ Reed By
BLVD. Commercial and Residential ReIa y 7 -i
TIGARD, OR 97223 Dote ro I'.E. _
(503) 639-4171, x304 Date to DST
Print or Type Permittt►
Incomplete or illegible a plications will not be accepted called
Name of Deveapment/Prood Description -
e&! 1 Table 1A Mechanical Code price Amt
Job St�rsees _r
A Permit Fee 16.00
Address HJ T 1) Furnace to 100,000 BTU
Including duds 6 vents see footnote 1,2 9.65
Bldg# VceRIAVI
eylstate zip
Q 7ZL�? 2) Furnace 100,000 BTU+
OCL' Including ducts 6 vents ses footnote 1,2 12.00
Name(or name of buslnes 3) Floor Furnace
Owner Il1,.9Including vent ase footnote 1,2 9.65
all"Address - 4) Suspended heater,wall heater
or floor mountad hester a"footnote 1,2 9.65
/Z/TO ✓,i Y/ F9?Z49 5 Vent not Included Ina lionce rmN 4,75
city/State zip Phone Check all that appy: *Boller Hest Alr
2 97T �Go��z. For Items 6-10,ass or Pump Cond Qty Price Amt
Kerne(or niffm or business) footnotes 1,2 Comte ••
6)<cW;sbsorb unit to
- 100K BTU 1 9.65
Occupant aUkrg Address 7)3-15 HP,sbsoii�Link
s-r 100k to 500k BTU 17.65
ity/state Q7 Z, zip Phone 8)15-30 HP;absorb
_ unit.5-1 mill BTU 24.15
9)30-50 HP;absorb
Contractor N unit 1-1.75 mil BTU 38.00
-rz- Fcl M7_�' / 10)>50HP;absorb unit
Prior to permit Mailing Address >1.75 mil BTU 60.15
Issuance,a copy /"0 -i 3 6'7 11 Air handling unit to 10,000 CFM
of all licenses CMy/slate Zip Phone
7.00
are required If T y9 9 12)Air handling unit 10,000 CFM+
expired In COT Oregon Corset Cont Board Lic A Exp Date
database We 3 11.85
D � Z 13)Non-portable evaporate cooler
AilCt Name
7.00
'V AZ" - 14)Vent fan connected to a single dud
Or Mailing Address 4.75
15)Ventilation system not included in
appliance permit _ 7.00
Engineer cltytstete Zip Phone 16)Hood served by mechanical exhaust
L ZlI4-S2 oy
7.00
Describe work to be done: 17)Domestic Incinerators
12 00
New O Repair O Replace with like kind: Yes O NoPs/ 18)Cwmmerciat or Industrial type Incinerator
Residential U Commercial 9 48.25
_ 19)Repair Links
Additional Information or description of work' 8.40
20)Wood stove/gas Mother units/clothe dryer/etc.
7.00
NOTE: For Commercial projects only;Units over 400 lbs.require 21)Gas piping one to four outlets
structural gas calks. See footnote 1 3.75
l Type of fuel oil O natural gas O LPG O electric O 22 More then 4-per outlet(each) ,75
Minimum Permit Fee 60.00 SUBTOTAL
I hereby acknowledge that I have read this application,that the Information _ %SURCHARGE
I given is correct,that I am the owner or authorized agent of PLAN REVIEW 2596 OF SUBTOTAL
the owner,that plans submitted are in compliance with Oregon State laws. Required for ALL commercial Permits oni 'P
�� TQTAL
jSignature of Owner/Agent Date
\ Other Inspections and Fees:
1 1. Inspections outsids of normal business hours(mininum charge-two
Contact Person Name Phone hours) $50.00 par hour
2. :nopections for which no fee Is specifically Indicated (minimum
v7 3 charge-half how) $60.00 per hour
Foonotes for commerel-I projects only: 3. Additional plan review required by chmiges,additions or revisions to
1. Provide full scher, existing and proposed gas line and pressure. plans(minimum charge-one-half hour)$50.00 per hour
2. Provide drawings .ie showing existing and proposed mechanical
units. 'State Contractor Boller Certification tsquired
"Residential A/C requires site plan showkV placement of unit
1:lmechpenn.doc rev 7/19/99