Permit CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2004 -00385
1 DEVELOPMENT SERVICES DATE ISSUED: 1/21/2005
41' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14205 SW 89TH AVE PARCEL: 2S111AA -09000
SUBDIVISION: GREENSWARD PARK NO. 3 ZONING: R - 4.5
BLOCK: LOT: 074 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: SSN3267 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,325 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,942 sf GARAGE: 857 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 TURD: sf RIGHT: 5
VALUE: 323,625.50
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,267 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 2 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: / VENT FANS: 6 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 6
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVOFDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =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: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: ALL - ENCOMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 8,618.75
D CONSTRUCTION CO FOUR D CONSTRUCTION This permit is subject to the regulations contained in the
FOUR O R D ON FO FOUR
D CON Tigard Municipal Code, State of OR. Specialty Codes
F and all other applicable laws. All work will be done in
P AVER TON, OR 97075 P AVER TON, OR 97075
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.
Phone: 503 - 590 - 0805 Phone: 503 - 590 - 0805 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 71037 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.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain lnsp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain lnsp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Water Line lnsp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service lnsp Building Final
Post/Bea • tural Mechanical Insp Shear Wall lnsp Insulation Insp Appr /Sdwlk Insp if
Issu; d By : _ L. /! /! ILA / Permittee Signature :. /i�� /�
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next bu Hess day
RECEIVED
Buildine Permit ADDlicatio a „ FOR OFFICE USE ()NI 1
SE C 1 b 200
City of Tigard Received / �� I� 4') Permit No.:��� Cl�
13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TI es ` . w Plan Review /
Inspection Line: 503.639.4175 Other Permi ��r�r /�LC'�1 / � `
T Date
/By (API �- tl -OS -Ic�3.38;,
Phone: 503.639.4171 Fax: 503.598.1 V ILDI V - ' � I D ate Ready/By: / ® See Attached Checklist for
g G D = - /'42 I9S 1 (o • Internet: www.citigard.or.us Notified/Method Supplemental Information
1-C3--\r --R-,5 \ -e t A u-k---
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1 3 1- and 2 -family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family
Number of bedrooms: 4/
X Master builder ❑ Other: Number of bathrooms: 2 7 /�
JOB SITE INFORMATION AND LOCATION Total number of floors: 2.
Job site address: 192 b- S GO, ,-r,ey d New dwelling area: . S 2 4,7 square feet
City /State/ZIP: 7"/ j (,L 9? � 2 v. Garage /carport area: �S 7 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 3 0 square feet
Cross street /directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: 6 Dif -XIA1 , ?���/ ^7 Lot no.: 74‘ Permit fees* are based on the value of the work performed.
Tax map /parcel no.: •�r� Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
' _ j � f /-%;(1_1-J2..._.- Valuation: $
� Existing building area: square feet
New building area: square feet
1`r PROPERTY OWNER ❑ TENANT Number of stories:
Name: u / 7 (92 572 u y-7 ) (d— Type of construction:
Address: CP., L� 8 7 Occupancy groups:
City/State/ZIP: -3) 7
��i� OA_ ! / S Existing:
Phone: (.LT�3) sl^ _ W aS Fax: (3) S 'o 75/ New:
Vr APPLICANT ❑ CONTACT PERSON NOTICE
Business name: S /l 1 t* / 47.4 , ,,,,, n u-�� All contractors and subcontractors are required to be
Contact name:
licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State/ZIP: apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: --S //40 u--°--- BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City /State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
CCB lic.: 7/ 0 3 7 Amount received
Date received:
Authorized signature: ,,,,// d6f This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name ke....., `*)��7i -4 / a , e7 — Date: 72 — l j;o -vii • Fee methodology set by Tri -County Building Industry
Service Board.
i:\ Building \Permits\BUP- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
One- and Two - Family Dwelling
Buildin;r Permit Application Checklist 1.t11i 0111( l: t ' l: OO\l.\
City of Tigard Received
� Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960
24- Hour Inspection Line: 503.639.4175 � 1 I I i ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.ci.tigard.or.us ❑ Other:
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, 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 system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
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 ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements
and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction
indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and
surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑
floor, wall construction, roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings
and foundation, stairs, fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non - uniform 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.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore on and shall be shown to be licable to the o'ect under review.
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ El
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑
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 ❑ ❑ El
Street Tree List.
29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, El ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\ Building \Permits\BUP- RES- PermitApp.doc 2
Nt.tiVto
Electrical Permit Application_ I OR OFFICE.: I til.: O\I.A iDLC 15 2U
y�
City of Tigard v�
De/B Permit No.: DO3
13125 SW Flail Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OFT + ' , Date/B . Other Permit:
Inspection Line: 503.639.4175 t,l.y- 'l ! Date runs: See Page 2 for
Internet: www.ci.tigard.or.us BUILDING - Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition /alteration/replacement Please check all that apply:
❑ Demolition 0 Other: 0 Service over 225 amps, comm'I ❑Hazardous location
❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi - family Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
f / /Z �< �9 Q U � ❑ Health -care facility ❑Other:
Job no.: Job site address: / ' f /l Submit 2 sets of plans with any of the above.
City/ State/ZIP: — 7/y ///N`"% 0 R 9 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: r FEE* SCHEDULE
Description I Qty. I Fee. I T°tal I .
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 6 s 3 Lot no.: 7<' Ea. add'I 500 sq. ft. or portion 33.40 1
/ 9_4 0 1 � f�R.�
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
,l1
r W /-41(4-d--A-- dwelling, service and/or feeder 90.90 2
4 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
pi PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
� 401 amps to 600 amps 160.60 2
,. c
Name: 4 2) (<l. SJ— 601 amps to 1,000 amps 240.60 2
Address: c v 6R /,5 ? 7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: y , (.� ' A ` OA_ 27 75 Temporary services or feeders installation, alteration, and/or
Phone: g)3 ) , p _ Q t )p s' Fax: (, ,s-9 v - C 7. " relocation
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
r APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
(� service or feeder fee, each 6.65 2
Business name: J 4i o o - branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: "P �1 &72e- /e
Address: ? S - 7 S. t -&� v-� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: ( P,.> 4.7--Z4/ Ad i.),L. 7.22/ Investigation per hour (I hr min) 62.50
2)3) V_./.// . ( ) Industrial p lant per hour 73.75
Phone: � J " Fax: ELECTRICAL PERMIT FEES*
CCB Lie.: 9 3 de Electrical Lic.`:4G. -2 Suprv.Lic. C)C S Subtotal
/�?0y Suprv. Electrician signature, required: , „,l C � Plan review (25% of permit fee)
Print name: Kv Z - ( _, 1 j Date: 12__ /s v State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
��/ days after it has been accepted as complete
Print name: ) , a. ,Y!%i /e� �� Date: /2 - / = d * Fee methodology set by Tri- County Building Industry Service Board
/ • • Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PerrnitApp.doc 12/03 4404615T(l0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pennits\ELC- PermitApp.doc 04!03
Mechanical ,Permit ApREGE I V 2 FOR OFFICE USE ONLY
City of Tigard Date/By: Permit No.. /AO ,
,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i DEC 15 2M I i �p,, ,. _ Date/By: Other Permit:
ql \ �
Inspection Line: 503.639.4175 ■ 4 •f . L Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TI • 41, Notified/Method: Supplemental Information
%ill DIVISION
COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
New construction ❑ 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: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONatfa all r ° i r 1.`N Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
is 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family XMaster builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 7��/ Air conditioning or heat pump
AO S ( / , � , �� Z A , 0 ,
(requires site plan showing placement) 14.00
City/State /ZIP: 7/ � 9/2 4. - A 9 722 V Furnace 100,000 BTU (ducts/vents) 14.00
�J Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision i _.s�,i/W e 3 Lot no.: _ Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
;, , Gas fireplace 10.00
[��,L/� 64-464-4..e.- vent G�-.� Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
V( PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: v 6 e it 67 e d Environmental exhaust and ventilation
Range hood/other kitchen
Address: C P, CI as 7 equipment . 10.00
City/State /ZIP: ex 970,-73' Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ) jam' O - 0a>0 Fax: (. ) 53 a - / 7 7 toilet compartments, utility rooms) 6.80
A APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 10.00 .
� Other: 10.00
Business name: �q,'J4,1 /i 2 p t>,- -- - Fuel piping •
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: S / ��yyj./A: Other:
Address: / 4 c, / S /A. 1 a-cI- , MECHANICAL PERMIT FEES*
City/State /ZIP:
7 / 3 Subtotal
/ L_ L .S 2? p,Gd, d X, g 2
Phone: ( ) 6.2jj- 6 4.e2 Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 4, �
/ ,...5 State surcharge (8% of permit fee)
is TOTAL PERMIT FEE
Authorized signature: d'h --17C,:ie/e-ed.,.es This permit application expires if a permit is not obtained within 180
"0 days after it has been accepted as complete.
Print name: AU / /4. //Ai �.>244_ ,' Date: 12_-/S t5 ff * Fee methodology set by Tri -County Building Industry Service Board
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 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 $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$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
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\ Building \Permits \MEC- PermitApp.doc 12/03 2
RECEIVED
•
Plumbing Permit Applicaiitni. 5 2004 FOR OFFICE USE ONLY
City of Tigard gITy OF TIGA A DateB d Permit No. �� '" 38
13125 SW Hall Blvd., Tigard, OR 972 Plan Review Phone: 503.639.4171 Fax: 503.Bj1� DING DIV M '� , DateBy, Other Permit No.:
24- Hour Inspection Line: 503.639.4175 f 1 • 1 � Date Ready/By: Juris: 0 See Page 2 for ■ Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
�� . ..,
: 1 WO 'r FEE* SCHEDULE
New construction 1=1 Demolition
;ors pe i nformat i on use checklist
Description I Qty. I Ea. l Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
,. .. * Tl' ate s f40 :, , t t ,. H ., SFR (1) bath 249.20
X 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi - family SFR (3) bath 399.00
Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft) Page 2
� -& . .� _.., ,. Site utilit
Job site address: /4/,2 O.5 S. Gt) . 7 / 0-k-- Catch basin or area drain 16.60
City/State/ZIP: q iv ,J ! Ux _ 5 2 2 24,e- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Q ,e, 3 I Water service (no. linear ft.: ) Page 2
Subdivision: �i�NS w Lot no.: f
Fixture or item
Tax map /parcel no
mi ° ; '� * }
4.. � e .' ° , 6 � ' , "' h �,. a
Absorption valve 16.60
< . „, ", - a ,,. ;-,-,,,,, # " ,, . , . � y .. � Backflow preventer Page 2
- P� / Calle- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
� a � � A c °� Drinking fountain 16.60
.. • ' _ , . e ,/ E / sump 16.60
Name: �� `2), � S7� C/e c) L' Expansion tank 16.60
Address: (A. Z rY / �'`7 `7 Fixture /sewer cap 16.60
City/State/ZIP: I[ D � 7 5 Floor drain /floor sink/hub 16.60
Phone: (3t3) 3"20- 0,4 (�L
Fa a3) O C - j 7 Garbage disposal 16.60
W �; Hose bib 16.60
` Ice maker 16.60
Business name: S/972 •24 ,ZU 04 --' Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
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
E mail:
_� Urinal 16.60
' 974 Water closet 16.60
Business name: �- - / 2 64-76 !may W heater 16.60
Address: /672 S' E s/ , •io1�-�- Other:
Subtotal
City/State/ZIP: / ZJ a L .34 27/.2- 3 Minimum permit fee: $72.50
Phone: .(S22 ) 6 6 --9--3 // Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: / 5 ur ` Plumbing Lic. no3 �.4 1� Plan review (25% of permit fee) o l " C � State surcharge permit fee)
Authorized signature: : l/��` /_ i d , TOTAL AL PERMIT FEE
Print name: i;p kJ Lam/ Date /2/5�dy This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Serv Board.
iAlluilding \Permits\PLM- PermitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� ' �Tee
g t w �. • �,c>rxag. P Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems
Water Service - each additional 100' 46.40 111
Storm & Rain Drain - 1st 100' 55.00 ��
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
wee ' t i additional $100.00 or fraction thereof, to and
u`? ... x _ �_ including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
� Gant, b�FleW x l�eirn3ed
i . , si n a n e 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
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley Quantity Total
Comme iai Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
is\ Building \Pemilts\PLM- PcrnutApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004- 0030(3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/21/2006
Phone: (503) 639 -4171 'r ° hn��h'�oill��1i'l'''
Inspection Requests (24 Hrs.): (503) 639 -4175 _ . _ __..
INSPECTION WORKSHEET FOR DATE: 8/17/2005 TIME: 7:05AM PAGE: f;
SITE ADDRESS: 14205 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 074 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached. 8/15/05: Added NC unit.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503-590-0805
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503
Inspection Request Scheduled For: Date: 8/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message c,
299 Final inspection 013724 -01 503 - 720.7445 Y /
Corrections /Comments /Instructions:
?4/r (Olt
54- ( 44-- L./
'1.-bi-olvs t.
..-----
((5
!TI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 14---110 Date:? � fl � vs! Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION P ERMIT #: , r
' I MS i 20tki -00 i�3.,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/21/200
Phone: (503) 639 -4171 �n'NhPNNpillli'
Inspection Requests (24 Hrs.): (503) 639 -4175 .1A-
INSPECTION WORKSHEET FOR DATE: 8/17/2005 TIME: 7:05AM PAGE: 5
SITE ADDRESS: 14205 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 074 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached. 8/15/05: Added A/C unit.
OWNER: FOUR 0 CONSTRUCTION CO, PHONE #: 5
CONTRACTOR: FOUR D CONSTRUCTION PHONE #: 503-590-0805
Inspection Request Scheduled For: Date: 8/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message 1 6/ 699 Mechanical final 013724 -02 603- 720.7445 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I nspector:
q--- 1 r'0 S Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004- 003136
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 112//2006
Phone: (503) 639 -4171 °' ° 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: Bi1612005 TIME: 7 :0er PAGE: r
SITE ADDRESS: 14206 SW 89TH AVL CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 070 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: New SF detached. 8115/05: Added NC unit.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 60350805
CONTRACTOR: - ( - )(Jr? r '.`s~mNSTRUCTIUN PHONE #: 5033.69Q -Q806
Inspection Request Scheduled For: Date: it„ ; Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
Plumbing final '\..' �. 01 -01 503-720-7446
Corrections /Comments /Instructions: r-L
c I
/ ;'
/1 n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
" /
Inspector: l �� Date / u`" Phone #: (503) 718 -
I—
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004-00385
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/21/2005
Phone: (503) 639 -4171 "'u��� "'NI��V %`��I�'
Inspection Requests (24 Hrs.): (503) 639 -4175 J
INSPECTION WORKSHEET FOR DATE: 8/10/2005 TIME: 7:05AM PAGE: 11
SITE ADDRESS: 14205 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 074 TYPE OF USE:
PROJECT NAME: GREENSWARD PARK NO. 3
DESCRIPTION: Now SF detached.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503- 590 -0805
CONTRACTOR: FOUR U CONSTRUCTION PHONE #: 503.590 -0805
Inspection Request Scheduled For: Date: 8/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013271 -02 503.720 -7445 Y
Corrections/Comments/Instructions:
S k l
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �• 6 a L Date: %'' 1 o" 06 Phone #: (503) 718-
L- 3 3'S 4
STR T REE CERTIFICATION
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® I, D,6�v 1 S. _..3-, D E ✓v� rt r , Owner /Agent for PLO— L T) 66<) ST z C7 0 � 4-
® (PLEASE PRINT) (PERMIT HOLDER)
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® meets „ , t °'T Bard Wa on County ►
® l and use and development standards for street tree installation.
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ADDRESS: I H OS —S: Y� . e 9 T 0 -
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LOT: . 7 q SUBDIVISION C-( Sw / ;fz- 1 Tr-- 0-
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RECEIVED BY: �
DATE:
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