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14105 SW MITCHELL COURT 12if103 ll3H311W MS 50M i 0 U J J W U H co a 14105 SW MS TCHELL COURT CITY OF Td-GARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE CRAFTWORK PLUMBING INC 7742 SW NIMBUS AVE BEAVERTON, OR 97008 Plumbing Signature Form Permit#: MST2004-00135 Date Issued: 6/15/2004 Parcel: 2S104BC-08600 Site Address: 14105 SW MITCHELL CT Subdivision: HILLSHIRE CREST Block: Lot: 008 Jurisdiction: TIG Zoning: R-7 Remarks: New SF detached Your company has baen indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: RIDGECREST CONSTRUCTION CRAFTWORK PLUMBING INC 6600 SW 92ND STE. 210 7742 SW NIMBUS AVE PORTLAND, OR 97223 BEAVERTON, OR 97008 Phone #: 503-246-8808 Phone #: 644-8698 a Reg #: LIC 79666 R PLM 20-148PB AN INK SIGNATURE IS REQUIRED ON THIS FORM m J X _ Signature of Authorized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 24-Hour BUILDING S Inspection Line: (503)6394175 MST Ef _60 � — INSPECTION DIVISION Business Line: (503)6394171 BUP Received __— _Date Requested_4!�_-� g AM PM BUP Location l ..d2Q Q Q Suite_ MEC — Contact Person Ph( ) ��' _ PLM — Contractor Ph(—) —— _ SWR _— BUILDING Tenant/Owner - — _ ELC I noting Foundation Access: �— ELC Ftg Drain ELR _— Grawl 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: - ---- -- —-------- Final — PASS PART FAIL - - — — PLUMBING Post&6 --;m - - -- -..-- Under Slab - Rough-Ir, Water Service Sanitary Sewer Rain Drains -- — Catch Basin/Manhole Storm Drain - - Shower Pan Other: -- ---- - PART FAIL - - -------- - -� -- MECHANICAL Post& Beam --�-------�- --- — Rough-In Gas Line a Smoke Dampers - ---- ---- -- —. Final N PASS PART FAIL — - -- -- -- ELECTRICAL - -----T ' �e-- - — Service mRough-In - _-- ---_ — ---- -- (g UG/Slab W Low Voltage Fire Alarm Final Heinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd. PASS PART FAIL SITE — �� Please call for reinspection RE: _ _ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date- -- -�_ Inspeotor Other: _ Final DO NOI REMOVE this Inspection record from the fob oft. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING 0 Inspection; Line: (503)63114175 r MSTdo�`o0 INSPECTION DIVISION Business Line: (503)639-4171 BUP Received _ _Date Requested -- - AM PM _ BUP Location d Suite MEC Contact Person Ph( ) Za_1.�-n-s�� PLM Contractor. — __— Ph( ) SWR _ BUILDING Tenant/Owner _ ELC Footing ELC _ Foundation Access: Fig Drain ELR Crawl Drain �--- Slab Inspection Notes: SR Post&Beam �.._._. - Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - — Insulation Drywall Nailing --�►'-�--"'M-)-� Firewall Fire Sprinkler -- — Fire Alarm , Susp'd Ceiling Roof - Other: — Final PASS PART FAIL PLUMBING Post&Beam Under Slab -- - Rough-In Water Service — — Sanitary Sewer Rain Drains - - Catch Basin/Manhole Storm Drain - Shower Pan Other: Final PASS PART FAIL MECHANICAL — Post&Beam -- Rough-In — - Gas Line IL Smoke Dampers — a Final PASS PART FAIL — — ELECTRICAL Service _ Rough-In W ---- in Reinspection fee of$ _required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL g --_— F Please call for reinspection RE: Unable to Inspect--no access Fire Supply Line ADAApproach/Sidewalk 0_._� Other: __-__—_-- Final DO NOT REMOVE this Inspoctlon record m the je, sIte. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 � MST INSPECTION DIVISION Business Lane: (503)639-4171 _ y BUP / — Rcceived __. Date Requested--,2_ AM PM BUP — Location — G' -�` p Suite MEC —_ Contact Person —�c� Ph(— ) L PLM Contractor—� _ _ _ Ph SWR BUILDING Tenant/Owner _ -�__- ELC Footing ELC Foundation Access: Ftg Drain ELR _. Crawl Drain Slab Inspection Notes: SIT Post&Beam - Shear Anchors !- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler -- — — - --- Fire Alarm Susp'd railing — Roof Other: — -i Ina ) - SS ART FAIL - PLUMBING Post&Beam Under Slab Rough-In Water Service -- -- Sanitary Sewer Ra!n Drains — - Catch Basin/Manhole Storm Drain - — Shower Pan Other: - Final PASS PART FAIL - MECHANICAL Post&Beam _ Rough-In Gas Line a Smoke Dampers -- - - ~ FAIL r LECTRICAL CJ Service m Rough-In --- -_��.�----- `W UG/Slab WLow Voltage Fire Alarm Final Rainspection fee of$____ required ion.ired before next Ins PASS PART FAIL - f Pay at City Hell, 73125 SW Hall Blvd. SITE Please call for reinspection RE: 4 Unable to inspect-rro access Fire Supply Line ADAKA '7 jr—d�-- 1 Approach/Sidewalk Dal%Z c_-<_ eweetpr 6Ext�— Other: Final DO NOT REMOVE this Inspection record from the job iib. PASS PART FAIL i � I � 1 0 V � w n +r L u V 7 O�J o h > a � A A 1 ♦AAAsAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA i ► A ► l ► pol0pop- i i Lo ► t o ► � a � o ► Cd N Poo. $—I N PI. ao.,V pop. lZ—j Poo. Ij H H ► 140. -� ► ► o ► y. v 'J CL4 Poo. o ► ► ► t � V 1 Iv1 'n t — ► �I Q O V ► •~ CITY OF TIGARD MASTER PERMIT DEVELOPMENT SERVICES DATE ISSUED: 001 35 ED: 6/15/2004 Ai� 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 SITE ADDRESS: 14105 SW MITCHELL C'r PARCEL: 2S104BC-08600 SUBDIVISION: HILLSHIRE CREST ZONING: R-7 BLOCK: LOT: 008 JURISDICTION: TIG REMARKS: New SF detached. 12/9/04: Added A/C. BUILDING R9P;3UF' ' "1212GO STORIES: 3 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED GLA` RK: NEW HHOIfT: 27 FIRST: 774 of BASEMENT: of LEFT: 5 SMOKE DETECTORS: Y T. USE: SF FLOOR LOAD: 40 SECOND: 1,338 of GARAGE: of FRONT: 15 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THR&, 1,332 of RIGHT: 5 980.70 OCCUF<kNCYGRP: R3 BORM. 4 BATH: 4 TOTAL: 3,142 a1 VALUE: 341 REAR: 15 PLUMBING SINKS: 1 1/ATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS- SEWER LINES: LOO SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS OTHER FIXTURES: _ MECHANICAL FUEL TYPES FURN-c 100K: BOIL/CMP c 3HP: 1 VENT FANS: 8 CLOTHES DRYER: I GAS FURN>-100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLEIS: 4 ELECTRICAL _^ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 emp: 0 - 200 amp: WISVC OR FOR: PUMPIIRRIGATION: PER INSPECTION: FA ADD'L 500SF: 7 201 400 amp: 201 -400 amp: tel WOSVCIFOR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - !00 amp. 401 -400 amp: FA ADDL HR CIR: SIGNAIJPANF.L: IN PLANT: MANII HMISVCIFDR: $01 . 1000 amp: W I+amlk-1000y.. MINOR LABEL: 1000•amplvoll PLAN REVIEW SECTION Reconnect only: >4 RES UNITS: SVCIFDR>=223 A.: >800 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL ^_ B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC t T: BURGLAR ALARM: OTH: ALL ENCOMP BOILER: HVA(:: tANDSCAPFARRIG: PROTECTIVE SIGN[: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATArTELE COMM: NURSE CALLS: TOTAL N SYSTEMS, TOTAL FEES: $ 8,623.26 Owner: Contractor: This permit is subject to the regulations contained in the RIDGECREST CONSTRUCTION RIDGECREST CONSTRUCTION CO Tigard Municipal Code, State of OR.Specialty Codes 6600,13,%A1 92ND STE.210 6600 SW 92ND AVE SUITE 100 and all other applicable laws. All work will be done in PORTLAND, OR 97223 PORTLAND, OR 97223 accordance with approved plans. This permit will expire IL if work is not started within 180 days of issuance,or N the work Is suspended for more than 180 days. 1— F 'on° X03-246-8808 Phone: 503-246-8808 ATTENTION: Oregon law requires you to follow rules CO) adopted by the Oregon Utility Notification Center. Those Rego: LIC 59228 rules are set forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. m REQUIRED INSPECTIONS WErsn Cntd '81-4444 Slab Insp Crawl Draln/Backwater Mechanical Insp Framing Insp Exterior Sheathirg Irsl Grading Insp,ction Slab Insp FootingiFoundation Dr; Plumb Top Out Framing Insp Low Voltage Sewer Inspec,on Wtr Proofing Bsm't Wa Plm/undslab Insp Electrical Service Shear Wall Insp Gas Line Insp Footing Insp Post/Beam Structural PLM/Underftoor Electrical Rough In Shear Wall Insp Gas Line Insp Foundation Insp Post/Beam Mechanical Mechan cal Insp Electrical Rough In Exterior Sheathing Insl Gas Fireplace Issued By : � I.L� Permittee Signature1 14 : c, Call (503) 639-4175 by 7:00 p.m.for an Inspection needed the next business day CITY OF T I C A R D SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2004-00134 13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 6115/2004 SITE ADDRESS; 14105 SW MITCHELL CT PARCEL: 2S10413C-08600 SUBDIVISION: IIILLSHIRE CREST ZONING: R-7 BLOCK: LOT: 008 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO.OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: sewer connection new SF Owner: FEES RIDGECRE-ST CONSTRUCTION Description Date Amount 6600 FJV 92ND STE. 210 PORTLAND, OR 97223 [SWUSAI Swr Connectif 6/15/2004 $2,400.00 [SWUSAI Swr Connectit 6/15/2004 $0.00 Phone: 503-246-8808 [SWINSPI Sewer Inspeci 6/15/2004 $35.00 [SWINSPI Sewer Inspect 6/15/2004 $0.00 Contractor: Total $2,435.00 Phone: Reg#: Required Inspections a ac J_ m This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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 J 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" 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 952-001-0100. You may rdby: copse these rules or direct questions to OUNC by calling(503) 246-6699. 1 Issu Permittee Signature: Call(503)6394175 by 7:00 P.M.for an Inspection needed the next business day Building P City of Tigarp Received permit No 13125 SW Hall Blvd.,Ti ar 9 Plan R : D � B (�(� I Plan Review _ Other PolTtu. p Phone: 503 639.4171 Fax NbO3:59 1 60 Date/D ryq of CW K AU+/ UO/� Inspection Line: 503.639.417 ASU y y to See Attached Checklist for {� OF TIGAK) Revd� I � !tar Internet: www.ei.tigard.of,llk1 D1V1S10N Notified/Method Supplemental ` New construction ❑Demolition Permit fees*are based on the value of the work performed. -- ln'icate the value(rounled to the nearest dollar)of all ❑Addition/altetation/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. S I-and 2-family dwelling ❑ Valuation: []Accessory building _ C]Multi-family _ Number of bedrooms ❑Master builder ❑Other: Number of bathrooms: Total number of floors: ^�---V lob site address: J New dwelling area: —square feet City/State/ZIP_J7 Garage/carport area: square feet Suite/bldg./apt.nn.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: squaw feet Other structure area: square feet > ti�A r�Cl ,R[!hrlk;�U3>E CHECKLIST Subdivision: / J�`" Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all �.�. — equipment,materials,labor,overhead,and the profit for the �F A work indicated on this application. Valuation: S Existing building area: square feet ^~ New building area: _ square feet Number of stories: — Name: / S Type of construction: Address: uYyZ 4' c Occupancy groups: C'ty/State/ZIP: i _ Existing: Ph>ur _ Fax:( New: — t Business name: I All contractors and subcontractors are required to be Contact name: j —_4 �— licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the r Address: jurisdiction in which work is being perfcrmed. If the City/State/ZIP: applicant is exempt from licensing,the following reasons apply Phone:( ) Fax: 0 E-mail: J Business name: 1* ` r Address: City/State/ZIP: Please refer ro fee schedule. Phone:( ) Fax: Pees due upon application —_ [, 1 Amount received CCB lir.: T ate received: Authorized.signature: This permit application expires If a permit Is not obtained within 180 drays after It has heen accepted as complete. Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board. i\Buildine\Prrmiu\SUP-PenneAppdnc 12/03 410-4611T(IIMCOMWBB) One- and Two-Family Dwelling Building Permit Application Checklist City of Tigard Received DttWB Pt:mdt No 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits Phone 503.639.4171 Fax: 503.598.1960 [4- .Flour Inspection Line: 503.639.4175 ❑ Electnctl ❑ Plumbing Cl Mechanical Internet: www.ci.tigard.or.us ❑ Other 1 Land use actions completed. Sce jurisdiction criteria for concurrent reviews. 2 Zoning. Floodplain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. _ ❑ 4 Fire district approval required. Name of district: _ �] 5 Septic sstem permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district a rove/. LJ El 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 9 Erosion control plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- basin protection,etc` 10 3 Complete sets o iFgible plans. Must be drawn to scale,showing conformance to applicable local and stateEl El 1:1 building codes. Lateral esign details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plan ith cross references between plan location and details. Plan review cannot be completed if copyright violations exist. _ I I Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property comer elevations(if there is more than a 4-ft.elevatio differential,plan must show contour lines at 2-ft.intervals);location of easements and dr,reway; footprint of structure ncluding decks);location ofwells/septic systems;utility locations;direction indicator;lot area;building coverage a;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan. Show dimensions,anch bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans. Show all dimensions,room identi tion,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balcon and decks 30 inches above grade,etc. _ 14 Cross section(s)and details. Show all framing-mem sizes and spacing such as floor beams,headers,joists,floor,wit:wi!1 construction,roof construction. More than o cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,r ing,roof slope,ceiling height,siding material,footings _ and foundation,stairs,fireplace construction,thermal insulati etc. _ 15 Elevation views. Provide elevations for new construction;mini of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in gra s greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross reNEences are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must in ate details and locations;for non- prescriptive path analysis provide specifications and calculations to en in-cri standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating meer sizing,spacing,and bearing [r locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement 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 s and multiple joists over 10 feet long and/or any beam/joist carrying a non-uniform load. a 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schema is required for four or more appliances. _ _ N 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engi or El El architect licensed in Oregon and shall be shown to be licable to the project tinder review. J ❑ m 23 Five 5 site plans are required for[tem 1 I above. Site plans must be 8-1/2"x 11"or I l"x 17". 0 24 Two 2 sets each are required for items 16, 19,20 and 22 above. _ T _D] _ W 25 Building plan: shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. —t 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. 30 A Clczn Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, [] int.luding decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a!ot of record approved prior to Sc tp ember 9, 1995, i is\Building\Permits\Cne-Two-FamilyChecklist.doc 12/03 Electrical Permit Application I City of Tigard `,C Hccn eJ Permit I.12- S11 [fallBlvd,agarDate 111� f 21 kPlali Rt,le" — --- Phone. 503.639.417! Fax )JJ1C It,. I'Mitt permit j Inspection Line: 503.631)4175 [),lie Ready it, Jwis ® See Page Z for �J IntemCl www.ci.ngard.or.us ,rip ! 02004 `Sonlied%tcthud L Sup dememut Inblrinati,m f�j'fI((Vr K PLAN REVIEW New construction ipp replacement Please check all that apply Demolition B'LJ- ibex:u jq ❑SCrttce user 225 amps,canon l ❑11azarJuw luclocation❑ - ❑Service mer 320 amps rating ❑0ulldng uvrr 10,(NN)sy ft. CATEGORY OF CONSTRUCTION of I-and 2-family dwellings 4 or more new residential I-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi-family ❑ Master builder ❑Other: ❑wilding over three stortes ❑Feeders,4014)amps or more ❑Occupant load over 99 person. ❑Manufactured structures or �— JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park ( � ( �/� ) ❑llcalth-care facility ❑Other Job no.: !oh site address: T `l (�(J Submit_.sets u1-plans with any of the above --J-_— City/State/ZIP: T/b I��L [tic above are mil applicable n)temporary cansirucuon.ery Icc Suite/bldg./apt.no.: Project name: FEE* SCHEDULE Dtecripnon Vty. f«.�_futal Cross street/directions to job site f New residential single-or multi-family dwelling unit. — Includes 21)ached garage, 1.00)sq Itor less 145 15 4 Subdivision: �a �,^ Lot no.: X ha add'(S(N)sq fL or portion 33 40 I JL Limited energy,residential 75(Hl 2 Tax map/parcel no.: - a Limited energy,non-residential 75(N) 2 DESCRIPTION OF WORK Mach manul-actured or modular dvtellin ,service and/or feeder 90 1N) _ 2 _ Services or feeders installation,alteration,and/or relocation 2(H)amps or less 80 30 2 PROPERTY OWNER ❑ T NANT J2U 1 amps lu 400 amps 106 85 2 401 amps to 000 amps 160(10 2 Name: L)K 601 amps to 1,000 amps _ 240 60 2 Address: Over 1,0(m)amps or volts 45465 2 Reconnect only 66 85 2 City/Stale/ZIP: �7� !�,owd- 3 Temporary services or feeders Installation,alteration,and/or q relocation Phone:( )j)� - P Fax:�3) •, d� 200 amps or less 66.85 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps I(H)30 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701 401 amps to 60(1 amps 133 75 2 Owner signature: Date:_ _ Branch circuits-new,alteration,or extension,per panel APPLICANT ❑ CONTACT PERSON A Fee I'nr branch circuits with service or feeder fee,each 2 60 Business name: branch circuit 11 Fee for branch circuits Contact name: /��r nithour service or(ceder lec, 4085 2 Address: each branch circuit _�n�- Each add'1 branch circuit 665 _2 0. City/StatcIZIP: Z- Miscellaneous(service or feeder not Included) Phone:( ) Far: :( ) Pump or Irrigation circle .5340 2 H Sign or outline lighting 5140 2 NE-mail. Signal circuitlS)or limited- CONTRACTOR energy panel,alteration,or �� extension Describe Pagc 2 Business name: �1--ae Address: S� jt,Q Y-77 A Each additional Inspection over allewable in ans of the above W — / L11 Per inspection 62 50 .J City/State'ZIP: � 7 ��✓ _ Imestigation per hour o hr mut) (52 50 Phone: 3) I)V - �ij Fax (.5 31 r�`O�- 7 � Industrial plant per hour 73 75 T----- ELECTRICAL PERMIT FEES, CCB Lice' I Electrical Lic. - �- C Suprv. Lic.: Subtotal -I Supra. Electrician signature,required. Plan review(25", ol'pernnt fee) { Print nameDate: State surcharge IR"„of permit fee) -- - �/ - — —( TOTAL PERMIT FEE Authorised stgnatute: This permit application expire%Its permit is not obtained ssithin ISO IF Jays after It has been accepted as cumpirie Print name: Date: Fee nwthndoingy<et hs Tn('nuns}Building 6tdustrn �.crs t"Bnerd •Number o(impcowns pet pennit allowed nuildmgPrrmasELC-PermoApph,c Crit 440AWTi100!Co%IwEn Elec rical Permit ALIDlication - City of'Tigard Page - Supplemental Information LIMI ED ENERGY PERMIT FEES: RESIDE TIAL WORK ONLY: Fee for all esidentlal systems combined........ $75.00 Check Tvpe f Work Involved: ❑ Audio d Stereo Systems* ❑ Burglar A rm ❑ C-srage Doo Opener* ❑ Heating, Venti ion and Air Conditioning System* Vacuum Systems* ❑ Other- COMMERCIAL therCOMMERCIAL WORK ONLY: Fee for each commercial system......... ........... $75.00 (SEE OAR 91$-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling F] Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations OwlJinp Pemnn F:L( Pnma A�+p Jnc M n� Mechanical Permit: pMIMLU � City of Tigard DDa Received Permit No I j r 00 y_ 00�J 13125 SW Hall Blvd.,Tigard,OR 97� J 0 204 Plan Review a By Other Permit Phone: 503.639 4171 Fax: 503.5opw Dat Inspection Line: 503.639.4175 Date Ready/By: lure ® See Page 2 for Internet www.ci.tigard.or.us CITY OF TIGARLI Notified/Method supplemental Inforrantion BUILDING DIVISION r = PL+E"•scHEbULE - yslF:iCHECICLfST New construction El Addition/alteration/replacement Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all Demolition ❑Other: mecha!,ical materials,equipMent,labor,overhead,and profit. FW pS1p$ EQUIPMENT/SYSTEMS FEES- and and 2-family dwelling 0 Cot nmerciaUindustrial E]Accessory building For special information use checklist ❑Multi-family ❑Mister builder ❑Other: Description rQty. Ea. Total ,, .•. i ' , ,,. Heatin coolln ( Air conditioning or heat pump Job site address / Jr �^ (requires site plan showing placemen0 14.00 City/Slate/ZIP: Furnace 100,000 BTU(ducts/vents) 14.00 Furnace 100,000+BTU(J_ _ants) 17.90 Suite(bldg./apt.no.: Project name: Gas heat pump 14.00_ Cross street/directions to job site: Duct work _ 14.00 H dy tonic hot water system 1400 Residential boiler(radiator or h dromic) 14.00 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc 10,00 Flue/vent for any of above 10,00 Subdivision: S �� Lot no.:-- Other: 1000 Tax map/parcel no 5 D Other fuel appliances yY� Water heater 10 00 Gas fir e1p ace_ 10.00 _ Flue vent for water heater or gas fireplace 10.00 _ Log lighter(gas) 10.00 Wood/ eller stove 10.00 Wood fir IAce/insert 10.00 Chimney/liner/flue/vent 10.00 "' L � y' „4 r y, ,ir.•^ �ti af;: Other �- -Name: c (6 �/ Environmental exhaust and ventilation Range hood/other kitchen Address: e�_ 5 �� ui ment 1000 _— CitylStale/ZIP: oti✓ 3 Clothes dryer exhaust 10.00 Single-duct exhaust(bathrooms, Phone (c��) _ Fax ccn3) — toilet compartments,utility rooms 6.80 Attic/crawlspace fans 10.00 Other: 10.00 Business name: _ _ _ Fuel I Ing Contact name: �' � C - -- $5.40 for first four;$1.00 for each additional -- Furnace,etc. Address: Gas heat pump N City-/Slale/ZIP: Wall/suspended/unit heater Phone:( ) Fax: :( ) Water heater r Fireplace _- m F-mai': Barbecue — J Clothes d tt Aa __ Business name: SOther: Address: - --- _ i; $1 1Lf4•. City/Stale/ZiP: j Subtotal 6 � `— — Minimum permit fee($72.50) Phone:�'�3) Fax:( )� T ,_ Plan review(25%of permit fee) CCB tic.: State surcharge(8%of permit fee) 4 TOTAL PERMIT FEE This permit application expires if a permit Is not obtained within 180 Authorized signature: days after It has been accepted a complete. Print name: r Date: Fee methodology set by Tri-Cou. y Building Industry Service Board \Building\permns�MFC-PemutApp doc 12103 440 4617T(I 11021 44rwEB) Mechanic 1 Permit Application - City of Tigard Page 2 -Suplemental Information Commercial ee Sch'itdule: Al $1.00 to$2,000. Minimum fee$72.50 $2,001.00 to$5,00 .00 $7 .50 for the first$2,000.00 and$2.30 for each additional$100.00 or fraction thereof,to and including$5,000.00. $5,001.00 to$10,000. 0 $141.50 for the first$5,000.00 and $1.80 for each additional$100.00 or fraction thereof,to and including $10000.00. $10,001.00 to$50,000.00 $231.50 for the first$10,000,00 and $1.35 for each additional$100.00 or fraction thereof,to and including $50,000.00. _ $50,001.00 to$100,000.00 771.50 for the first$50,000.00 and $ 25 for each additional$100.00 or fra ion thereof,to and including _ $10 .00. $100,000.01 and up $1,390 for the first$100,000.00 and $1.10 f each additional$100.00 or fraction reof. Note: All new commercial buildings equire 2 sets of plans. IL oc N 3 a W J i:\3uilding\Permits\NEC-PermitApp.doc 12/03 2 Building Fixtures Plumbine Permit Application City of Tigard [�F i V E D DReceived Permit No. �� -tv 13125 SW Hail Blvd.,TiElt Q Plan Review Phone: 503.639.4171 Fax: 503.,^R.1960 Other Permit No.: 24-Hour Inspection Line: 50IMP1 T� 6 �QQ� Date/D tun Internet: www.ci.ti rd.or.us Dau led/MethReady/Bo S See Panel for � Noti4ed/Method: Supplemental Infarmatlan F' New construction - 0 Demolition For s tial Information use chechUSL Description I Qty. I Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 R.for each utility connection) SFR(I)bath 249.20 I-and 2-family dwelling ❑Conunercial/industrial SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 399.00 Each additional bath/kitchen 45.00 ❑Master builder ❑Other: Fire sprinkler(_sq.fl.) Page 2 }, Site utillties Job site address: Catch basin or area drain 16.60 City/State/ZIP: 1 � i4e D, Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Projec name: Footing drain(no.linear fl.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 S C.cooft) ¢ .S Rain drain connector 16.60 Sanitary sewer(no linear fl.: ) Page 2 Storm sewer(no.linear ft.:___J Page 2 Subdivision: Lot no.: Water service(no.linear fl.:�� Page 2 Fixture or Item Tax map/parcel no.: Absorption valve 16.60 14 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16 60 Drinking fountain 16.60 Ejectors/surnp 16.60 Name: 7 Expansion tank 16.60 Address: /y Fixture/sewer cap 16.60 City/State/ZIP: Floor dmin/floor sinkthub 16.60 Phone: Fax: Garbage disposal 16.60 Hose bib 16.60 Ice maker 16.60 Business name: Interceptor/grcas:trap 16.60 Contact name: Medical gas(value:S ) Page 2 a � Address: Primer 16.60 City/State/ZIP: Roof drain(commercial) 16.60 Phone:( ) Fax: :( ) Sink/basin/lavatory 16.60 Tub/shower/shower pan 16.60 J_ E-mail: Urinal 16.60 ✓, �. ,,.:: ,.. �, Water closet 16.60 W Business name: Water heater 16.60 JI — Address:72S ! S Other City/State/ZIP: Subtotal /�/ Minimum permit fee: $72.50 Phone:(�0 3) _ Fax:W3)+JY - Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic.no. ' - Plan review (751,16 of permit fee) State surcharge(8%of permit fee) ".uthorized signature: _ TOTAL PERMIT FEE Print name: _ Date: J This permit application expires If a permit Is not obtained within 180 days after It has been accepted as complete.AL "Fee methodology set by Tri-County Building Industry Service Board. i\Building\Pmnits\PLMF-Prn OApp doc 11/07 440-4616T(10MVC0M/WEB) Plumbine Permit Application - City of Tigard Page 2 -Supplemental Information Fee Sched e: Residential Fire Suppression Systems: etk Footing drain-1 11), 55.00 0 to 2000 =113.00 Footing drain-each ditional 100' 46.40 2,001 to 3,600 S 160.00 3,601 to 7,200 5220,00 _ Sewer-Ist 100' 55.00 7 201 and greater 5309.00 Sewer-each additional 46.40 Water Service-Ist 100' 55.x1 Medical Gas S steno: Water Service-each additi al 11X1' 46.40 Storm&Rain!pain-1st 100 55.00 51.00 to SS 000.00 Minimum fee$72.50 Storm alk Rain Dein-each add)' al 100' 46.40 55,001.00 to 510,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100 00 or fraction thereof,to and including$10000.00. Commercial Back Flow Preventionvice 46.40 $10,001.00 to$25,000 00 $148.50 for the first$10,000.00 and SI 54 for Residential backflow Prevention Devi each additional SI00,00 or fraction thereof,to minimum permit fee$36.25 27.55 and including$25,000.00. Rain Drain,single family dwelling 65.25 525,001.00 to$50,000 00 $379.50 for the first 525,000.00 and$1 45 for Inspection of existing plumbing or each additional$100.00 or fraction thereof,to s iallrequested inspections-pet hour 72.50 and including 550,000.00. $50,001.00 and up 5742.00 for the first 550,000.00 and$1.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fix res? If "yes",please indicate w-rk performed by fixture. (lure to accurate) re ort fixtures could result in increased se er fees*. A ' Comments regarding fixture work: Baptistry/Font Bath -Tub/Shower -Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru -Cuspidor/Water Aspirator _ Dishwasher -Commercial -Domestic Drinking Fountain N IN _ -Eye Wash _ Floor Thain/sink 2" 3" 4" IL Car Wash Drain Garbage -Domestic F Disposal -Commercial CO) -Industrial *Note: If the fixt\sewer this permit resuits In an Ice Mach,/Refri .Drains increase of sewer permit will be issued and .J oil Separator Gas station fees assessed for tse must be paid before the m Rec.Vehicle Du station plumbing permit 0 Shower -Gang Ila -Stall J Sink -Bar/lAvatory Quantity Total -Bradley -Commercial Isometric or riser diagram is required if fixture quantity -Service total is>9. Swirrunitilt Pool Filter Washer-Clothes Water Fxtractor Plan Review Water closet-lbilet _ _ Plan review Is required If fixture quantity total is>9. Urinal Other Fixtures: i\BuildinaiPerm TI-M,Pe itApp doc J'oi Al W N Lu > u• ui C7 LIJ LU w 61 CL Lii *� t _ I I LL1 �� ,•� r •;r�i '' .l :� .a e° � of � I� �, � � `7 fr !29 tee rt_ ----------- Y M .p/t V I Ct : v r I 1 AD �� 04 , uj LL LL 41, w J W t I > T+ I 3 w / OD ko 10Z ap; CP ('�i1 .01 S �+---- ------------- ------ I �I -- 1 -'cep — — — — — — — _ .LC 8►t � `$ [� �� 4 r 3 .LO.gt.t0 N N �W � � � � V � � •off � � life La - _ - _ . _. ft-gs 0 w , � 4�i M o 0z c� Iju ti o LL U oz LLJ U� m _ v cti n ah � ^ 0 � � 1 c 2 D � Op 1 ' ' $ 4C of b� � a4 `�� ti cr' 4I,► �a (� 2 2 ti r •r 2� ;' to °° y 4c >, U z L+ a�