12225 SW MARION STREET Cttr OF TIGAf�t
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For om►the woft as dewnt*d in:
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See Letter to: FOlbw.................. .. ( ):
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job Address ���
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— LIABILITY
The City of Tig�(rd and its
{ r employees shall not be
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12226 SW Marion Street
CITY OF T'GARD MASTER PERMIT
PERMIT#: MST2002-00326
DEVELOPMENT SERVICES DATE ISSUED: 8/6/02
13115 StIV Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12225 SW MARION ST PARCEL: 2S103CB-02800
SUBDIVISION: WILLAMETTE NO.2 ZONING: R-4.5
BLOCK: LOT: 032 JURISDICTION: TIG
REMARKS: Add two dorrTlers to second story. Space is to contain 2 bedrooms and 1 bathroom.
BUILDING
REISSUE: S1 DRIES: FLOOR AREAS REQUIRED SET BACKS REQUIRED
CLASS OF WORK: ADD HEIGHT FIRST. sf BASEMENT. 3f LEFT. SMOKE DETECTORS
TYPE OF USE: sr FLOOR LOAD •i l' SECOND: l3f, al GARAGE: sf FRONT: PARKING SPACES:
TYPE OF CONST: 5N DWFLLING UNITS: FINHSMENT: of ALUERIGHT,
. S-;��u45 a,�
OCCUPANCY GRP: R3 HDRM: I BATH TOTAL: llf,oIl of REAR:
_ PLUMBING
SINKS WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES 2 DISHWASHERS, FLOOR DVAINS. SEWER LINES SF RAIN DRAINS I CATCH BASINS:
TUBISHOWERS GARBAO'-OISP- WATER HEATERS WATER LINES: BCKFL'N PREVNTR- GREASE TRAPS.
01 HER FIXTURES.
MECHANICAL
FUEL TYPES FURN r.100K, BOILICMP c 3HP VENT FANS I CLOTHES DRYER.
FURN>-TOOK: UNIT HPATERS. HOODS: OTHER UNITS .f
MAX INP: Mu FLOOR FURNANCES: VENTS WOODSTOVFS. GAS OUTLETS:
ELECTRICAL
RESIDL.11r.L UNIT _ SERVICE F'_SER _TEMP SRVCIFEEDERS BRANCH CIRCUITSMISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS, 0 200 amp: 0 - 200 amu: W/SVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION
EA ADD'L 500SF: 201 400 amp: 201 100 amp: Tat WIO SVCIFDR, SIGNIOUT LIN LT. PER HOUR.
LIMITED ENERGY: 401 600 amp 401 600 amp. EA ADDI BR CIR: SIGNALWANEL. IN PLANT
MANU HMISVCIFDR: 601 1000 amp. 601-amps-1000v: MINOR L ABEL
1000.arlmlvoll
PLAN REVIEW SECTION
Reconnect oniv: _—
>=4 RES UNITS: SVCIFDR>=225 A.: >600 V NOMINAL. CLS AREA/SPC OCC.
_ ELECTRICAL•RESTRICTED ENERGY .. _
A.SF RESIDENTIAL B COMMERCIAL
AUDIO&STEREO VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING OUTDOOR LNDSC LT.
BURGLAR ALARM. OTH: BOILER: HVAC: LANDSCAPFARRIG. PROTECTIVE SIGNL:
GARAGE OPENER CLOCK: INSTRUMENTATION MEDICAL OTHR.
HVAC DATAfTELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Conti-ilrtor:
OTAL FEES: $ 924.30
This permit is subject to the regulations contained in the
BILL KAUSLER OWNEk Tigard Municipal Code,State of OR Specialty Codes arid
12.225 SW MARION ST all other applicable laws. All wo•k will be done in
TIGARD,OR 97223 accordance with approved plans. This permit will expire If
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone. Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg 0 forth in OAR 952-001-0010 thfough 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Underfloor insulation Electrical Rough In Electrical Final
PLM/Underfloor Framing Insp Mechanical Final
Mechanical Insp Low Voltage Plumb Final
I Plumb Top Out t,;sulation Insp Final inspection -��—
Elegtricat Service Rain drain Insp
1
Isiged By: �,� , f - �'1 ` ^ �_ Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Applicator
City of Tigard Date received: '� % 02 Permit no.;
date:
Address: 13125 SW Hall Blvd,T ,OR 97223 NrojecUappl.no.: ire
Cuyn�77gurd slued: fi :, Keccitno.:
Phone: (503) 639-4171 ��,; ; P
Fax: (503) 598-1960 ► ��' Case file no.: Payment type: -
Land use approval I&2 family:simple ('ampler:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/alteration/replacement U Tcnant improvenirnt `-1 Fire sprinkler/alarm U Other: �•.
INFORMATIONJOB SITE
Job address: ems} Ar t� j - Bldg.no.: Suite no.:
Lot: I Block_- Subdivision - 1'ax mapliar lot/account no.:
Project name: _ _-
Description and location of work on premises/special conditions: _.sly! _L41 U rM�r I H >r i w �_ ��lJ- -Tr'
OWNER
FOR SPECIAL INFORMATION, USE CIIECKLIS`117
(noodplain,septiccapillsolar,
Mailing address: 1-21 Z 5 S r i C^ 1 & 2 fill dttellill
City: I r� State: (;{� ZIP: G Z c Valuation of work.........'3.� � ...'........
_ �.....
Phone: Fax: Email: No.of bedrooms/bathe.................................
Owner's representative: Total i.umber of floors................................. -- -
!'hone: Fax: F-mail: i New dwelling arca(sq.ft.)
APPLICANT Garage/carport area(sq.ft.).........................
MEN
Name: Covered porch area(sq.ft.) ........................
Mailing address: Deck area(sq. t.) ........................... ... ...
- Other structure,area(s ft.
City: State: 'LII':----�-- --1: -famllv:
Phone: Fax: 1:-mail:
1 1 Valuation of work........................................ $
/, Existing bldg.area(sq.ft.) .V.................-
Business name: - + ` C_ /
New bldg.area(sq.fl.) .. .. _
Address: --�
City: --- State: ZIP: - Number of stories....................
Phone: E-mail:I Type of construction,,::.. .......................
_..- _ Occupancy group(s): Existing:
CCB n t.: _ - New: --
City/metro he.no.: INotice:All contractors and subcontractors are required to he
licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may he required to be licensed in the
--
Address: jurisdiction where work is being performed. If the applicant is
_ _
exempt from licensing,the following reason applies:
City: - State: - 7,11:
Contact person: Ilan no.. ---- ---- - —
Phone.
Name: Contact person: Fees due upon application ........................... $
Address: - -- --_- Date received:
T171—y— State:_- - Slntc: 77-_Ip: Amount received ......................................... $---
Phone: IFax: E-mail: _ - Please refer to fee schedule.
hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards.plena call jurisdiction for more information
ill checklist. All provisions of laws and ordinances governing this U visa u MasterCard
work will he complied w' et ter specified herein or not. credit rand nnmher _—_`-_-`
7 t � fixpircs
Authorfred signature: uo9- _ Date: } C Nnnw of cardholder as shown on cr•dii card
_ S
Print name: � U ' --.-- — Cardholder signature _Amount
Notice:This permit application expires if a pennit is not obtained within 180 days alter it has been accepted as complete. aat .l a(6KW'0s7)
r•-
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
Cirygf•I'igard City of Tigard U Electrical U Plumbing 'J Mechanical
Address; 13125 SW Holl Blvd,Tigard.OR 97223 U Other: _
Phone: (503) 639-4171
fax: (503) 598-1960
FOLLOWING1 1 ' PLAN REVIEW Yes No N/A
I band Ilse actions conglleled.See jurisdiction cl m-ria for concurrent reviews.
2 'Zoning.Flood 1,1,11 11 J.0 h,ll,ln e points,scisn r soils designation,historic district,etc.
--
3 Verification of approved platllot.
4 fire district approval required.
5 Septic system permit or authorisation for remodel. Existing system capacity_ P -
6 Sewer permit. --
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of
catch-hasin protection,etc.
10 3 Complete sets of legible plans. Must he drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections trust he incorporated into the plans or on it separate full-size
sheet attached to the plans with cross references between plan location and details. flan review cannot he completed
_ if'cr right violations exist.
1 I site/pl�, "t
.]hr 111,111 must show lot and huddint setback dimensions;property confer elevations Of
thele istion(111Wrentiaal,plan must show Comoro line:,at 2-n intervals);lx'atllm of casements and
drivewe(including decks);loCatiOfl of I,WI1',ACII1ic ,ystrms,utility I(x:atifnls,directilnl Indicator;lot
It uilding coverage aril► percenlarr of coverage:infix-r\imus arca;existing slnlctmes on site:alnd surGlce drlinaue.
12 Foundation plan..Show dinicww l., ,anchor bolts,silly Indd-downs and reinforcing pads,connection details,vent
_ size and location.
13 Floor plans.Show t.11 dimensions,toom identification,window size,location of smoke detectors,water heater,
furnace, ventilation Isms,plumbing Fixtures,!►alconies and decks 30 inches above grade,etc.
14 Cross section(.`.)and details.Show all framing-member sizes and spacing such as floor learns,headers, joists,soh-floor,
wall constnrctil nl,not construction.More than one cross section may be required to clearly portray construction.Show
details of all',\all and root,sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
FII 'pl;ue e Il'IIIlCllnll, thenllal insulation,etc.
I5 Iaevation steps. I'Ilovide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior clevau�„r,it silica the acul,ll grade if the change fn grade is greater than four foot al huiIdln)'en%elope.
Full-size sheet addoildums showing foundation elevations with cross references are acceptable. _
I r, Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for
non pIL'scriplive path analysis provide spec Iricarions and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating inembei sizing,spacing,and hearing
locations.Show attic.ventilation.
I H Basement and retaining walls.Profile cross sections and details showing placement of rebar. For engineered
_ systems,see. item 22,"Engineer's calculations."
19 Beaun ca lenlations,Provide two sets of cath Illations IItiI1111 elll1011 Colne detilgll values for all heams and multiple joists
over 10 feet long and/or any beans/,joist carrying a fou-unifimn load. _!
20 Manufactured floor/roof truss design details.
21 Energy Code compliance.identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or provided,(I shear wall,rool'Innss)shall he stamped by an engineer or
architect licensed in Oraon and shall hr shown In hr.11 1111• ,III I ,III Im11,".t under review.
JURISDICTIONAL
_23 Five(5)site plans are required for(tem 1 I above, tills plans must he h-1/2" x 11'Ill 1 1"x 17".
24 Two(2)sets each are required for Items 16, 19.20& 22 above.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will he not accepted.
26 "Reversed"building plans trust meet criteria outlined in the Pemmit&System Development Fees document.
27 "Drawn to scale" indicates standard architect or engineer scale.
28 Site plan to include tree size,type& location per approved project street tree plan(if applicable).and CUT Street Tree Liss
Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black ink.
Red ink is reserved torr department use only. 440-4614(idrx)/coM)
Electrical Perinit Application
Date received: Permitno.:
City of Tigard Projecl/appl.no.: E 'redate:
Address: 13125 SW Hall Blvd•Tipard,OR 97221 Date issued: B Receipt no.:
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Cas.file no.: Payment type:
Land use approval:
1
U I &2 family dwelling or accessory U Commercial/industrial U Mulli-family U Tenant iniprovetile nt
U New construction U Addition/alleration/replacrnit,III U()fill,[: _ U Partial
INFORMATION.1011 SITEI
Job address: 5 ' t r •J �1 131dg. no.: Suite no.: Tax map/tux lot/account no.:
Lot: I Block: Subdivision:
P-Wel name: _ _ Description and location of work on premises: ' ii r r'�, r' Z e
Estimated date of completion/inspection:
APPLICATIONCONTRAU11 Oil
Job no: lee Max
Business(lame: _ c (4- _ - De%criplion (p). (ca.) 'total no.Ins
---- --- ewresid.•nnal single-ormulli-family per
Address: — dwelling unit.lnrlodesattached garage.
City: �— St It(, ZIP: Service Included:
Phone: Fax: I E-mail: 1000 sq.ft.or less _ a
Each additional 500 sq.ft.or portion thereof _
CCB no.: Elec.bus.tic.no: Limited energy,residential 2
City/metro lie.no.: Limited energy,non-residential _ 2
Each manufactured home or modular dwelling
Signature of supervising electrician(required) Date Service and/or feeder 2
Sup.elect.name(print): 1-ic•enseno] Services orfeedem-installation,
allerstion or relocation:
2W amps or less 2
Name(print): �j hI i (' 201 amps to 400 amps w -- 2 -
-j -- --- 401 amps to 6W uu+ps 2
Mailing address: Z r' t _ - 601 amps l0 1001)mnps -- —
2
City: J�/'/�( _ SlalC:n - ZIP: r Over 10Wtripsorvolts 2
Phone: *h=T u� 'j"7} I ax: I E-mail: kecrnu+cctunl v I
Owner installation:The installation is being made on property I own Iemporaryservices orfeeders-
which is not intended for sale,lease rent,or exchange according to Inshllstlon,alteration,orrelocation:
URS 447,455,479,670,701. 200 anq,s or less
201 amps to Of map%
Owner', sigralurc: y'- tit Date: j i 4rl1n,600nm s - _ --- --
Aranch circuits-new,alteration,
or extension per panel:
Name' _ A. Fee for branch circuits with purchase of
Address: service or feeder fee,each hrnnch circuit _
City: Slate: !I I': _ E. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit:
I'hunc: — I ax: - --- -- —
Each additional branch circuit:
Mlsc.(Service or feeder not Included):
U Service over 225 amps-conut+ercial U He;till--tv facility Each rump or irrigation circle _ 2 -
U Service over 120 amps-rating of 1&2 U nazardous.ocauon F:achsign oroutline lighting _ 2
familydwellings U nuilding ov!r 10,01x1 square feat four or Signal circuit(%)or a limited energy panel.
U System over 600 volts not:+inal more tesiden0al units in one structure alteration,or extension* 1 _ 2
U Building over three stories U Fecders,4111)amt,.. more •lkscn,non _ _
U Occupant load over 99 persons U Manufactured structures or RV park FAch additional Inspection over the allowable In any of the above:
U EgteWlightingplan U Other. - 1'cnnspecuon
Submit—sets of plans with ony of the above. Investigation
The above are not applicable to temporary construction service. other T
Permit fee.....................
Nor all judMirlions accept credit cards,please call jurisdiction for+mxe infommtlea+ Notice:This permit application v`
U Visa L3 MasterCard expires if a permit is not obtained Plan review(at
Credit curd number: ____ _-L-1 ,within 180 days after it has been State surt:harge(8%) ....$
Esprrrs
accepted as complete. TOTAL .......... ............$
Name of cudhnlder u shown on credit card
_ S
Cardholder ai`naiure Amount 4404615;t MWOM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
— --��— TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed) (FOR ALL SYSTEMS)
Service Included: Items Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq `: or less $145 15 M 4 Audio and Stereo Systems'
Each additional 500 sq It,or
portion thereof $3340 1 Burglar Alarm
Limited Energy $7500
Each Manufd Home or Modular Garage Doo. Opener'
Dwelling Service or Feeder $30.40 1 u
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $8030 _ 2
201 amps to 400 amps _ $106.85 2 Vacuum Systems
401 amps to 600 amps $16060 _ 2 ❑
Other
601 amps to 1000 amps $24060 _ 7 Over 1000 amps or volts $45465 _ 2
Reconnect only $6685 _ 2
Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Sealteration,or relocationderFee for each system.......................................................... $75.00
Installation,
200 amps or less _ $66.85 2 (SEE GAR 918.260 260)
201 amps to 400 amps $100.30 _ 2
401 amps to 600 amps A—� $133 75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, r–,
see"b"above. Audio and Stereo Systems
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits ❑
with purchase of service or Clock Systems
feeder fee.
Each branch circuit $6 65 2 Data Telecommunication Installation
b)The fee for branch circuits
wltl, ut pu,•chase of service LJ Fire Alarm Installation
or feeder fee.
First branch circuit _ $46 85 HVAC
Each additional branch circuit l- _ $6.65 u
Miscellaneous Instru mentation
(Service or feeder riot included)
Each pump or irrigation circle $5340 Intercom and Paging Systems
Each sign or outline lighting _ $5340
Signal circuit(s)or a limited energy �T a
panel,alteration or extension _ $7500 Landscape Irrigation Control'_ ❑ p g
Minor Labels(10) $125.00
Medical
Each additional Inspection over
the allowable in any of the above Nurse Calls
Per inspection $62 50 _
Per hour _ $62.50
In Plant $73.75 Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ Other
8%State Surcharge /
$ y,�" Number of Systems
25%Plan Review Fee No licenses are required Licenses are required for all other installations
See"Plan Review"section on $
front of application
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account tY_-_- __- 8%State Surcharge $ -
- _ Total Balance Due =-------
All Now Commercial Buildings require 2 sets of plans.
i Adsts\fonms\cic-fccs doc 08/30/01
Building Fixtures
Plumbing Permit Application
Date received: Permit no.:N�;
City of Tigard _
b Sewer permit no.: Building permit no.
Address: 13125 SW Ifall Blvd,Tigard,OR 97223 — --
City o(Tigard Phone: (503) 639-4171 Project/appl, no.: c date: -
Fax: (503) 598-1960 Date issued: By Receipt no.: —
Ladd use approval: _ n __. _ ----_ Case file no.: Payment type:
7uuI & 2 family dwelling or accessory UCornmercial/industrial U Multi-familyU Tenant improvement
New construction U Addition/alteration/replacement U Food service U Other:..___- -_
111XI I 1 1011 1 t , +15 , t
w Ururi riion Qt). hcc(ca.) 7olal
Job address: �ZG �� �w' V f ( -1 1
esv 1-an 2-family dsiellitigs 411111:Bldg, no,; Suite no. _ (includes 100 ft.for each tit it it)connection)
Tax map/lax lot/account no.: SFR(I)bath _
Lot: Block: Subdivision: _ SFR(2)bath
Project name: SFR(3)bath
City/county: T.IP: Each additional bath/kitchen
Description and location of work on premises: 5iteutilitfes:
Catch basin/area drain
Drywells/leach line/trench drain
Est.date ofcompletion/inspection:
Footing drain(no.lin. R.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: Manholes
Address: Rain drain connector
City: State: ZIP: Sanitary sewer(no,lin. R.)
Phone: Fax: —LE--ma".. Storm sewer(no.lin, R.) _
CCB no.: Plumb.bus.reg.no: Water 7service no.lin. ft.
City/metro lic.no.: )Fixture or item:
valve
Contractor's representative signature: Absorption Back flow pvalvalve r
Print name: bate Backwater valve
COBasins/lavatory
Name: Clothes washer _.
--- 7Dishwasher
Address: Drinking fountain(a)
City — _� State: ZIP: _ Ejectors/sump
Phone: T Fax: TE-mail: Expansion tank
1 Fixture/sewer cap
Name(print): i Floor drains/fluor sinks/hub
Garbage disposal
Meiling address: 12 2 Z 5 ' ` �5 _ {Pose bibb _
City: r state: ZIP: Z Ice maker
Phone: 3 Fax: I E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the propert 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _
Owner's si nature: ' 1 Sump
ENGINEERTubs/shower/shower pan
Urinaly
Name: Water closet
Address_ ______ Water heater
City: State: ZIP: _ Other:
Phone: _,---�Fax: E-mail: Total
Minimum fee................ S
Not all jurisdictions accept credit cards,please call jurisdiction for more information Notice: This permit application
U visa O a MmteWard expires if permit is not obtained Plan review(at _ "/o) S
P State surcharge(8°'0).... S
Credit card numberr:apires
----- --1xpites -- within 180 days after it has been
TOTAL........................ _
Name of cardholder cr
shown on edit card
-- accepted as complete.
s Amount 110.1616 W00 cn�l i
Cardholder signature
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 24amlly dwellings only: -
FIXTURES (individual). QTY ea AMOUNT (Includes all plumbing fixtures lit PRICE TOTAL
sink - 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
-V- -- 16.60 3
for each ullilt connection)
Lavatory
One 1 bath _ $249.2_0-
Tub or Tub/Shower:omb, / 1660 5 o Two(2)bath __— $35_0.00
Shower Only —" 1660 Three(3)bath _- $399.00
Water Closet 1660 - - - SUBTOTAL
Urinal 1660 - 8%STATE SURCHARGE _
Dishwasher if-,-6O— PLAN REVIEW 25%OF SUBTOTAL _
Garbage Disposal --�-— 16 60 - — ^- - _TOTAL �- -
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 1660
3" -- - - - -- PLEASE COMPLETE:
4" -1660
Water Heater O conversion O like kind 16 60 � _ Quantic by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit Capped
MFG Home New Water Service 46.40 Sink _ _ __
MFG Horne New San/Storm Sewer 46.40 Lavatory —_ _ _ _ _ _-
Tub or Tub/Shower
Hose Bibs 16.60 Combination _
Roof Drains 16.60 Shower Only - ^
Drinking Fountain 16.60 Water Closet _
Other Fixtures(Specify) 16.60 Urinal
,., Dishwashgr
Garbage Disposal_ _
Laund Roem 1 y
Washing Machine -
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3„ _--
Sewer-each additional 100' 4640 - Y 4"
Water Service-1 st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
S�ecif
Storm&Rain Drain-1st 100' 5500
Storm 8 Rain 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 Sperlally 62.50
Re uested inspections er/hr COMMENTS REGARDING ABOVE.
Rain Drain,single family dwelling / 6525
Grease Traps 16.60
QUANTITY TOTAL -_-
Isometric or riser dl�, .n Is required I1 - — — -
Quantity Total is >9_ -
*SUBTOTAL -
8%STATE SURCHARGE ------ ------------
`PLAN REVIEW 25%OF SUBTOTAL
^_ RC�ui -_�Cnl If rixturC t total is>9
TOTAL 5
Minimum permit fee is$72 50+8%state surcharge,except Residential Backflow
Prevention Dewe,which is$36 25+8%slate surcharge
**Ali New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
is\dsts\forms\plm-fees.doc 12/26/01
MechanicalPermit Application
Date received: _. _ Permit no.:/1'1`,/"?v"2 -v "
City of Tigard Project/uppl.no.: Expire date:
c in ulTi� rrd Address: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: By: Itcccipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no,: Payment type:
Lana use approval: _ Building permit no.:
W I k 2 Gamily dwelling or accessory U Commercial/i 'al U Multi-family J'cram improvement
U New constntction U Additiottfa1tralion/teplacement U Other: _— --
Job address: �, _ U �� r Indicate equipment quantities in boxes below. Indicate the dollar
lildg.no. 1 Sujf'no.: value of all mechanical materials,equipment,labs r,overhead,
Tax map/tax lot/account no., profit.Value$
Lot: — Block: Subdivision: *See checklist for important applicdtion information and
jurisdiction's fee schedule for residential permit fee.
Protect name:
City/county: ZIP: DWELLING
n 1 1 ' 1
Desc�intir.n and location of work on premises;- r� F
4�_ 1U I ec(ea.) focal
Est.dateol'compleuut�/inspection: 11MA-ri ion (hy. Res.only Res.cndv
AC-
Tenant improvement or change of use:
Air handling unit CFM
Is existing space heated or conditioned?U Yes U No Air conditioning(sift p an require ) __
Is existing space insulated?U Yes U No Iteration of existing AC system ____
OPT I er COmpres%ors
now� State boiler permit no.:
Business name: L iAt IBJL HP --Tons—BTU/11
Address: _ Fire smo c ampetaduT� ctsntc a detectors
City: I State:_ ZI1': --- -Heatpwn-p(site plan required)ed) __—
Phone: Fax: E-mail: Instal/rep ace urnac urns 111
-- _____-- -- Including ductwork/vcnt!mer U Yes U No
CCB no.: Instal Ureplace/relocate licaters-suspended,—
City/metro
uspen eCity/metro K.no.: wall,or floor mounted
Name(please print): Vent fora lance other t t vt furnace
1 1Refrigeration:
Ahsorytuun units_-_ �_ R'fU/H — —
Nsutic: Chillcrs�,__ _ lir
CO
Address nvironmenta ex least an ventilation
-- --
C'Ity. State: 'l.11' _ Appliancevent —_
I'honc J I i•; F mail hyercx taunt _
1 I loo 'ype res. tic tetl/hazmat
s,
hood fire suppression system --- --
Name: tixhaust fan with single duct(bath fans)
Exhausts stem a part from licating or AC
Mailing address: str ul on(ti to outlets)
-- •ue p p ng an p
City: State: LIP: Type _LPfl, —_ NG —_ Oil
I'. mail — -- Oct��ipinf titch additional over outlets --
Process piping(whentaticrequired)
Number of outlets _
Name: _ _ ter ste applia o'rcryo pment:
Address:-- - - _--- Decorttl%cflieplacc-- —City: State: 'LIP: _ Insert--type - -
--' oo stove/pe ct stove _ —
1'hone: - I ax: E-mail: Other:
Applicant's signature: Date: _ ter: _
Name (print):
urisdiction for more inronmtuon Permit fee.....................$
Not all jwiubctions accept crnlit cards,plens call I Notice:This permit application
Minimum fee................$
U Visa U MasterCard expires if n permit is not obtained
credit cord number. — _--/ / Plan review(at
ire+
Fx within IRU days atler it ties been
r State surcharge(89h)... $
-_- - -
Name
of cardholckr as shown on credit accepted as complete.card S
TOTAL ................. .....
– Cardholder dgnatttre -- — Amount 440-4617(ty�Orc'rr.t
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL_VALUATIO_ N: PERMIT FEE: _ Description: - Price Total
$1.0_0 to$5,000.00_ Minimum fee$72.50 Table 1A Mechanical Code City (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and11 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. includin ducts&vents 17.40
$10 001.00_to_$25,000 00_ $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or iricluding vent _ 14 00
fraction thereof,to and Including 4) Suspended heater,wall Treater
_ _ $25,000.00. _ or floor mounted heater 14.00
$25,001.00 to$5_0,000.00 $379.50 fur the first$25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional$100.00 or _h 60
fraction thereof,to and including 6) Repair units
_
$50,000.00. 12 15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all lh.,it apply- Boiler Heat Air
$1.20 for r:ach additional$100.00 or For Items 7-':1,see or Pump Cord
fraction thereof. footnotes below. Comp
Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit
to 100K BTU _ 14.00
8°!e State Surcharge $ 8)3-15 HP;absorb 25.60
unit 100k to 500k BTU _
25i/,-P-Ian Review Fie of subtotal 9)15-30 HP;absorb
Required for ALL commercial permits ons10)unit.5-1 and BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ unit
30.t 1-175mil BTU absorb
. 52.20
uni
11)>50HP;absorb
unit>1.75 mil BTU 87.20
ASSUMED PER APPLIANCE: 121 Air handling unit to 10,000 CFM
VALUATIONS
_ 10.00
Vilue Total 13)Air handling unit 10,000 CFM+
Description: Q (Ea) Amount 1720
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 includinpvent _ 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 appliance 445 10.00
permit__ 18)Domestic Incinerators
Repair unlLs 805 _ 17.40
Z 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, i 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU _ 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU
Air handling unit to 10 000 ctm _ 656 - ---
Air handling unit>10,000 cfm 1,170 8/.State Surcharge $
Non- ortable ovaporate cooler 656 _ TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a ingle duct 446
s
Vent system not Included in 656 -
appliance permit Other Ins ect�ns and Feea:
Hood served by mechanical exhaust 658
-- 1 170 t Inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator $62 50 per hour
Comrnercial or Industrial incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
Othei Unit,including wood stoves, 656 $62 50 per hour
Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum
charge one-half hour)$62 50 per hour
Gas piping 14 outlets 360
Each additional outlet 83 'State Con!ractor Boiler Ceriificalion required for units 400k BTU.
TOTAL COMMERCIAL "Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
i.\dsts\formslmech-fees.doc 02/11102
G"'
Permit 0: �,�'�� [Z`ja - (pREIVED
�aL�p
)�.Jl I
Address:
f„l A 1 Uk ai rl Issued h\: �.�F;CI�P,r11Xl�R� n�,tc:
BUIL DI NCT M NI�J-
Statement: Information Notice to Property owners
About Construction Responsibilities
Note: Oregon Laiv, URS 701.055(4), requires residential construction permit appli-
cants who erre not registered with the Construction Contractors Board to sign the
Jollott'ing.statentent helitre a httilclingpertrrit ran bei is.stteal. T lois svatemeni i.s reyuit-e(I
litr residential building, electrical, mechanical, and phtmhing permits. Licensed
architect and engineer applicants, exempt from registration under URS 701.010(7).
need not strhmit this statement. This slatentent will he filed tris/t the permit,
Fill in the appropriate blanks and initial boxes i and 2.and either box 3A or 313:
Y-4 1. i own, reside in, or will reside in the completed structure.
'. 1 understand that i must register as a construction contractor il'the structure is sold or offered for sale
before or upon completion.
U 3A. My general contractor is --
(Name) Contractor r.gis. #
will instruct my general contractor that all subcontractors who work on the: structure must he
registered with the Construction Contractors Board
OR
Ef313. i will he my o\cn general contractor.
If i hire subconlu actors. I will hire only subcontractors registered \\ith the Construction Contractors
Board. i t'I change my mind and hire it general contractor. 1 will contract \\ith it contractor who is
registered \\ith the CCB and \\ill unmediatel\ notif\ the office Issuing this bUilding permit ofthe
name of the contractor.
I herehs certify that the aho\,e information is correct and that i have read and do understand the Information
Notice to Properh 0%%ners about Construrtion Responsibilities on the reverse side of this form.
71 L
(Signature of permit applicant) (Date)
(if hire copy to issuing agency permit,file.
pink copy,to applicant)
Information Notice to Property Owners
About Construction Responsibilities
A(Jte. bo, b/i,l ,I,ul+'In AIIfwe 1,1 J'/) '.%I+711'I'.A'f/!�(�lf/I ,�ilg!YII11irlll �lt'.,J'INr;:hP/IJtlry
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Emr3LOYER RE:SPONSIBILInEs:
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CITY OF TIGARD 24-Hour
BUILDING Inspection Lina: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 —
Received ___ Date Requested LCL Li -- AM _ PM —--- BLIP
Location, --f__ '_L Z S S W L"0_99) _._rx -- Suite_ -- --- MEC
Contact Person --_—_ —. , Ph( __) __ ______-- --_ PLM —_—
Contractor_ ._��_ _—__ - Ph( _) —..______ SWR
PI
ILDIN Tenant/Owner _ —___-_____�_.� _—___._ —_ ELCting ELC
Foundation Access:
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - - - - - - --- - --- -...
Insulation
Drywall Nailing --
Firewall
Fire Sprinkler - --- - -- - ---- - - ---- -
Fire Alarm
Susp'd Ceiling -
Roof
Other: ----.._ --- - - --_-
_ SS PART FAIL
Po eam
Under Slab -- --- - --- - —.
Rough-In
Water Service -
Sanitary Sewer
Rain Drains --- -- - -- - -
Catch Basin/Manhole
Storm Drain -------- - - - --_._----._.—'-
Shower Pan
Other. _.-.-
�rna
<SS RT FAIL
C --�
Rough-In - --- - - -- --
Gas Line
�Smoke Dampers
S _ _ T FAIL _ - ------ - ----- --..-__---- - -
CTRICAL
Service
Rough-In
UG/Slab
I_ow Voltage -- ----- _ --- - ---- -- -- -- - _----
Fire Alarm
Fir PART FAIL Reinspection fee of$___ _ _._-__ required before rnxt inspection Pay at City Hall, 1312G SW Hall Blvd.
_ _
SITE Please call for reinspection RE: Unable to inspect- no access
Fire Supply Line
ACA Date_� / _Ll Ext
-3 -_- Inspector
Approach/Sidewalk tr -----__---- -_-_- - -- --
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
SEE 35MM
ROLL # 20
FOR-
OVERSIZED
DOCUMENT
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