Permit CITY F T I G A R D MASTER PERMIT
��11i.
DEVELOPMENT SERVICES DATE SSU 8/28/0303 00287
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16056 SW 93RD AVE PARCEL: 2S114AB -15300
SUBDIVISION: WILLIAMS PART /MLP2002 -00011 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Construction of new SF detached, Path 1.
BUILDING
REISSUE: SUN82499B STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,118 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,042 sf GARAGE: 746 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 218,707.80
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,160 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS • FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL /PANEL: 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: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,735.10
This permit is subject to the regulations contained in the
JEFF BETTINELLI BLACK DIAMOND HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
14780 SW OSPREY DR 14780 SW OSPREY DR all other applicable laws. All work will be done in
SUITE 240 STE 240 accordance with approved plans. This permit will expire if
BEAVERTON, OR 97007 BEAVERTON, OR 97007 work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 201 - 6304 Phone: 201 - 6304 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 109542 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Rain drain Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical, Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Pos am Stu_ al Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
Iss d By : 4 1 ' , . _i/JA - Permittee Signature `.1/i� ! .L
f
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next busin - ss day
r 'l. SN To 'Pr 7-2 3- C' 3
Building Pe»ii on
Datereceived:6) o3 Permitno.: j� j 3� ag 7
�� � i City of Tigard JUN 3 0 2003
Address: 13125 SW Hall Blvd, Ti and • ' '.7. Projecvappl. no.: ire date:
City of Tigard
> 1
1 Phone: (503) 639 -417 %.+iT ` Q ; ; ,1 s . Date issued: I Receipt no.:
)0 Fax: (503) 598 -19� #�
6 10 ase file no.: Payment type:
Land use approval: , 1 4 1&2 family: Simple Complex:
I TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family t o New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: (p 45G 5L4 9 ?'! -- Bldg. no.: Suite no.:
Lot: Block: Subdivision: uf C • it,. ' , I 1 hA Tax map /tax lot/account no.:
' Project name:
Description and location of work on premises/special conditions: /J JJsJ SW_
c f OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: jeFF- 1 ('tct (( ; (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 LL - 2 er, $.j sp O & 5 -0 i 2,q0 1 & 2 family dwelling:
City: [3pru,t4 7i1 IStat (ZIP: "2 Oa 7 Valuation of work $
Phone:'' , - ( v a " Fax: g%• -5 - • y E -mail: No. of bedrooms/baths i f /,.
A Owner's representative: Total number of floors
A Phone: Fax: E -mail: New dwelling area (sq. ft.) 2 /GO
1/
APPLICANT '
Garage/carport area (sq. ft.) `7 t i(n
r2 Name: UEFF ae n�( - 1. - .( — Bata- 003"06 ‘40,44.6 At , Covered porch area (sq. ft.) f 0
r Mailing address: ( LiAo J o °o -. r st t ie 240 Deck area (sq. ft.)
-3 City: 3eNji ,- J I State: CA I ZIP: 9700 -2 Other structure area (sq. ft.)
, ` 1 Phone: t - -630 Fax: ;3-5 ,' E -mail: Commerciallindustriallmulti- family:
CONTRACTOR Valuation of work $
` ! Business name: S3(, ItA'IMv ) (.j eS !A Existing bldg. area (sq. ft.)
Address: (� - 78o SW 05 -r{6y DR S 1 rE 2.140 New bldg. area (sq. ft.)
City: Number of stories
Y Z AL a' /J State: 0(L ZIP: • ti i
Phone: 5j0• _x,01 -1, Fax: i' _ 7' *E -mail: Type of construction
~,9 CCB no.: /0 95112_ Occupancy group(s): Existing:
_ New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
\) ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
T Name: S�/ -,,/ provisions of ORS 701 and may be required to be licensed in the
2 Address: 7 /( SW kg_ Coop SJ c7� la 4f jurisdiction where work is being performed. If the applicant is
,J City: �y(( -(t Q I State: 0(L I ZIP: 9 , Z Z3 exempt from licensing, the following reason applies:
Q Contact person: VecfLt (, Plan no.: 2. it Q R
t Phone: Z Z ,, - . -05 Fax. o E - .1,4-oi55
ENGINEER
it s Name: R81'l f 4 Contact person: Fees due upon application $
Address: t 7 - /Vw (40.50 6 fZ Date received:
ki j City: PD ?c (State: OR_ (ZIP: 97 z Amount received $
"` . Phone: 523- 533 -57751 Fax: I E -mail: Please refer to fee schedule.
4 I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this Li Visa ❑MasterCard
work will be complied with hethe s t i ed r rein or not.
Credit card number: / /
f 11 � Expires
Authorized signature: p l �'�� �� Date: 3 Name of cardholder as shown on credit card
Print. name: � -�:�( /Ti /i�1C -lit-( $
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6OOICOtrt)
One- and Two - Family Dwelling
' ' Permit Application Checklist Building Permit Application Chkli Reference no.:
Associated permits:
Gay of Tigard city f Tigard y g ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171 +•
Fax: (503) 598 -1960 a,
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW \'es No N/A
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.
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 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 Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above.
24
25
26
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6/00/COM)
Mechanical Permit Application
Date received: 6 5,4 Permit no.:11,9,ce3 -o, g]
Ail- �� City of Tigard Project/appl. no.: Expire date:
CitygfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171 .
' Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
I•∎i New construction 0 Addition/alteration /replacement 0 Other:
I • JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /6) 09", sq Q 3 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: I Subdivision: UkA.0/i+tN15 r tMe yy. See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 776,440 W '/, I ZIP: 7 7 zZ 4 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Ale 1, S FR /6 0 6J(eQ Pip / N U �CC/ Fee (ea.) Total
Est. date of completion/inspection: /2,-3/ .., Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
•
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
space insulated? CI ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: / . 0� IM A )Lf + Ai , State boiler permit no.:
� i� , / HP Tons BTU /H
Address: Po. 1 3O ..x (2. ( Fire/smoke dampers /duct smoke detectors
City: CAN) Qt{ I State: c /7 I ZIP: 013 Heat pump (site plan required)
Phone:503 -).. -12.4q I Fax:93 a4do3K7g E -mail: Install/replace furnace/burner BTU /H •
Including ductwork/vent liner ❑ Yes 0 No
CCB no.: I Li e70 ? InstalUreplace /relocate heaters- suspended,
City /metro lic. no.: 1 13 wall, or floor mounted
Name (please print): h 4 ■ V 1 C. r 0 Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
. Absorption units BTU /H
Name: 3f 1�E mhJL1.-[. ( Chillers HP
Address: , -Sc_ J O S'j( b2 . S il t ( Z4v Compressors HP
1 8th 1 Environmental exhaust and ventilation:
City: f b" N I St te: GA, I ZIP: Q 7 0) 0.7 Appliance vent
Phone: i, -LO (-(030 Fax: , 0?- -1. = 0 , E-mail: Dryer exhaust
OWNER Hoods, Type 1/11/res. kitchen/hazmat
hood fire suppression system
Name: .. o- : Exhaust fan with single duct (bath fans)
Mailing address: (1.1� , j 0 si ^ ofzivt S lF Z`L0 Exhaust system apart from heating or AC
City: jp a t.o.g - t -vt State: ZIP: '4 2 007 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone. 0 - got-44 p Fax: 13 . i d E - mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace .
City: I State: I ZIP: Insert - type
Phone: Fax: E -mail: Woodstove /pellet stove
i Other:
Applicant's signature: ' 4//Unit. Date:6-1,7 - Other:
Name (print): _a • E, A u(
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
El Visa O MasterCard Notice: This permit application Minimum fee $
Credit card number: / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $
Cardholder signature Amount 440 - 4617 (6/00 /COM)
•
MECHANICAL PERMIT FEES ti„
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
•
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
•
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
•
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
•
fraction thereof, to and including 4) Suspended heater, wall heater .
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50;000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to 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 that - apply: r. Boiler, - Heat '::Air = T _. -
$1.20 for each additional $100.00 or For :itemsT7 -1t see: ;'' ' t;:op: :..Pump .Cond:
fraction thereof. footnotes'belovv °:... :Comp - • • -' *` "`;
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k-to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15- 30 -hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU .
17) Hood served by mechanical exhaust .
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 • 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: .- r ? $
Commercial or industrial incinerator 4,590 ,. ;,- _, , - ; :,.
Other unit, including wood stoves, 656 8% State Surcharge 'x $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) %> ,A; ; ° ° w $
Each additional outlet 63 Required for ALL commercial permits only f',G ,,y< ',:', -' i; :
TOTAL COMMERCIAL $ ' TOTAL RESIDENTIAL PERMIT FEE: `':'. '' $
•
VALUATION:
Other Inspections and Fees:
1 Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2! Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour.
* State Contractor Boller Certification required for units >200k BTU.
* '`Residential A/C requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
•
<,
. A
Electrical Permit Applicat
1
Date received: 4/&) G S . Permit no.: M5 , • 3 . ej ,26 .
YS i A '
l Pro ect/a 1 no: Expire ,..� I City of Tig ard j p , . re date: p�
CirygfTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type: •
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION i
Job address: / C ago 4i n c/3--- i ,e / Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: ISubdivision: iNcC(c4,,, f AIM 4 rni\A-
Project name: I Description and location of work on premises: N 5,e
Estimated date of completion/inspection: _ _ Q
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: Ha l ( 6-taxa l (f tyr Description Qty. (ea.) Total no. insp
� New residential - single or multi - family per
Address: Lo an Nt� 4i. G t )(2 St,'LTE- (7-0 dwelling unit. Includes attached garage. '
City: Hr (Non ro I State: Q 2. I ZIP: en t vi Service included:
. Phone: 503 -533 - 5 L (5v I Fax: Sp - ' -5115-4E-mail: 1000 sq. ft. or less 4
I 4 1 r Each additional 500 sq. ft. or portion thereof
-L
CCB no.: I ( 6 Elec. bus. lic. no: 3L1-5-(49‹,, Limited energy, residential 2
City /metro lic. no.: (0 (O Z• Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) . Date Service and/or feeder 2
Su elect. name (print): �� t l i _ Services or feeders - installation,
Sup. (P ) Des r - V U-6 License no: alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): w - . ? ,tt i ►e�t� _ ... _... . _ 201 amps to 400 amps 2
Mailing address: ith eo SW ()Spay be.t2t 5t/i71" 0 1
2" 601 amps to 00 amps 2
601 amps to 1000 amps 2
City: ele St te: qQ ZIP: 9'70 0 7 Over 1000 amps or volts - 2
Phone: 543 I Fax:M C. E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
•
ENGINEER • Branch circuits - new, alteration,
or extension per panel:
Name:
A. Fee for branch circuits with'purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
• ' of service or feeder fee, first branch circuit: 2
Phone: FaX: E-mail: Each additional branch circuit:
PLAN, REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / • I within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
•
Residential - per unit
1000 sq. ft. or less $145.15 • ' 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n • Burglar Alarm
•
Limited Energy $75.00
Each Manuf'd Home or Modular I I Garage Door Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less • $80.30 2
201 amps to 400 amps $106.85 • 2 I Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 • 2
•
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
•
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n 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 n Clock Systems
feeder fee.
•
Each branch circuit $6.65 2 n
Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation •
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC •
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 f�
Each sign or outline lighting $53.40 I I Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 In Landscape Irrigation Control*
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: n Protective Signaling
•
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review' section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due .$
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
•
Total Balance Due $
•
i:\dsts \forms \elc- fees.doc 10/09/00
Plumbing Permit Application
Datereceived: 03 Permit no.: j re j3- G27p28')
* dY 3 � ; City of Tigard
a_ Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
A New construction O Addition/alteration /replacement ❑ Food service ❑ Other:
•
JOB SITE. INFORMATION FEE SCHEDULE (for special'nfortnation use checklist)
Qb.
Job address: 1 I9 n5 0 5 . A , 3� Pate, Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
Tax map/tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath.
Lot: / 'Block: I Subdivision: (/ /4411 c Aim tram SFR (2) bath
Project name: SFR (3) bath _
City /county: 7'f(,.4) di vet, ZIP 7 z-Zij Each additional bath/kitchen
Description and location of work on premises: - Site utilities:
Jp c n (2. - 3(.e j Catch basin/area drain
Est. date of completion/inspection: (Z- . 4 Drywells / leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
� � ) Manufactured home utilities
Business name: N W ' rep\ ter (U1Mk1 t n% . (KQ_, Manholes
Address: '( ,( &.t) (B )1 - C, e 1 Rain drain connector
City: Ti (440.O I State: Q(i, I ZIP: cf 7 •Z,Z■i Sanitary sewer (no. lin. ft.)
Phone: 5 (RA -Q5l,i Fax: (021{ -O5124-E-mail: Storm sewer (no. lin. ft.)
(35"02:1._ ' Water service (no. lin. ft.)
CCB no.: Plumb. bus. reg. no: 34- 3 ,
City /metro lic. no.: 1'0'8 1 — 0 i - Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: WMT Date: Backwater valve
CONTACT PERSON Basins /lavatory
A) ut Clothes washer •
Name: +i 1- Dishwasher
Address: I L ) Q SW OS /( • SO 7f.. 2.40 Drinking fountain(s)
City: & t .. - h r 1. ' State:Q(Z IZIP:g7 00-7 Ejectors /sump
Phone: 1, -2O(- (030`{ Fax: 7 -3710.1E-mail: Expansion tank
OWNE' Fixture /sewer cap
Name (print): ,,je _. Q 6! 7 Floor drains /floor sinks hub
address: r' Garbage disposal
Mailing (c{� aj sc,j 0 ,se y b t2 r 5v /rc 2 Hose bibb
City: L . 4 : _ _ I A I State:Q(. I ZIP: Q 70Q7 Ice maker
Phone: „ • Fax: • - .y?aJ 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 property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
Tubs /shower /shower pan
Urinal
Name:
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: Fax: E -mail: Total
N jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at %) $
O Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as Complete. $
Cardholder signature Amount 440 -4616. (6/00 /COM)
PLUMBING PERMIT FEES:
• • mow,IT0
FIXTURES QTY:: 4 AMOU den buridtikfu00ow; ;:gvi.fpg: PRICE TOTAL
Sink 16.60 Ottikilinellirig4pcItttrfirsylOCYltc ,;f,cery1 (ea) AMOUNT
Lavatory 16.60
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath . $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL
Urinal 16.60 • 8% STATE SURCHARGE ,*;
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
;LJ:
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60
Gas piping requires a separate mechanical Fture Type New Moved Replaced Removed!
- -
permit. .
MFG Home New Water Service 46.40 Sink
MEG Home 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
, Urinal
Other Fixtures (Specify) 16.60
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' • 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & 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 Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL " f'•
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
•
8% STATE SURCHARGE ''';'=.-'
**PLAN REVIEW 25% OF SUBTOTAL 1:- *q. ; • •
Required only if fixture qty. total is > 9
TOTAL " - $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
iAdsts\forms\plm-fees.doc 10/10/00
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
HOTWIRE ELECTRIC INC.
2020 NW ALOCLEK, #120
HILLSBORO, OR 97124
Electrical Signature Form
Permit #: MST2003 -00287
Date-Issued:--8128103--- -- _ _ _ _ _ _ _ _
Parcel: 2S114AB -15300
Site Address: 16056 SW 93RD AVE
Subdivision: WILLIAMS PART /MLP2002 -00011
Block: Lot: 001
Jurisdiction: TIG
Zoning: R - 4.5
Remarks: Construction of new SF detached, Path 1.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
JEFF BETTINELLI HOTWIRE ELECTRIC INC.
14780 SW OSPREY DR 2020 NW ALOCLEK, #120
SUITE 240 HILLSBORO, OR 97124
BEAVERTON, OR 97007
Phone #: 503 - 201 -6304 Phone #: 503 - 533 -5452
R #: LIC 146276
ELE 34 -549C
SUP 4487S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X /1/'
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NORTHWEST PREMIER PLUMBING
P.O. BOX 23338
TIGARD, OR 97281
Plumbing Signature Form
Permit #: MST2003 -00287
Date Issued: 8/28/03
- Parcel: 2S11 - 4AB- 153300
Site Address: 16056 SW 93RD AVE
Subdivision: WILLIAMS PART /MLP2002 -00011
- - - Block: -Lot: 00i- - - -- - - - -- - -- - - -
Jurisdiction: TIG
Zoning: R
Remarks: Construction of new SF detached, Path 1.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the 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:
JEFF BETTINELLI NORTHWEST PREMIER PLUMBING
14780 SW OSPREY DR P.O. BOX 23338
SUITE 240 TIGARD, OR 97281
BEAVER T OON, OR 97 007
Phone #: 503 - 201 -6304 Phone #: 503 - 624 -0582
Reg #: LIC 135022
PLM 34 -348PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
11:1 //
A e
Signature of Authorized Plumber
•
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING' Inspection Line: (503)639 =4175 MST 3' —00 Z‹? 7
INSPECTION DIVISION Business Line: (503) 639 - 4171
''// = BUP
7
Received OW Date Requested 2 ,i6/ AM PM BUP
Location ! )O b Suite / MEC
Contact Person Ph (_ 01: ad 1 '� 36>'" PLM
Contractor cc12_ -Jl , 4'l'LMc, Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access: 3 Co
Ftg Drain (�' ELR
Crawl Drain
Slab Inspection Notes:. L SIT
Post & Beam e / �'L2(;/I�. `14/Le. —
Shear Anchors GIAMA Z F y i t q, C f(11
/ G
Ext Sheath/Shear ,
(tom
Int Sheath/Shear
Framing /
Insulation
/
Drywall Nailing /110-r" /'15 -7-7q � - s -71
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
inal3
A_S ) 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
Smoke Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA _ d
Approach /Sidewalk Date 4" Inspector , Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 do 2 s 7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received � l� e 1 Date Requested 2 - 2, 77 AM PM BUP
Location / 6 0 5 Suite l MEC
Contact Person
6/666 Ph ( 50 — ` — �O3c 4LM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: 15 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:
Final
PASS_ T FAIL
ost & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
0 ..
Final
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL . .
Service
Rough -In
UG /Slab
Low Voltage
m
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
1'ART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
•
Fire Supply Line
ADA
Approach /Sidewalk Date 2 ^ ®L Inspector Est
Other:
Final DO NOT REMOVE this inspection record from the Job. site.
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Business Line: (503) 639 -4171 - MST
BUP
Received 1- Date Requested�iv / 4 --16 AM PM BUP
Location 93/ ,W /i 1 / //,- D1--* Suite MEC
Contact Person L 4 l�?Lr� l' % Ph (_ 5 5 I 5Z' l PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: c SIT
Post & Beam Oala
Shear Anchors
Ext Sheath /Shear
•
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ' t ' -
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: 57,
Final
PASS PART FAIL
Post & Be I L
Rough -In
Gas Line
Smoke Dampers
ina
PASS PART FAIL
ELECTRICAL •
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE`. Unable to inspect — no access
Fire Supply Line
re
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL