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Permit K > CITY OF TIGARD MASTER PERMIT PERMIT #: MST2003 -00014 I�I� DEVELOPMENT SERVICES DATE ISSUED: 2/13/03 ��'�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14875 SW 103RD AVE PARCEL: 2S111CB -00300 SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: n all a- ct ium i A ittn o f BUILDING it n REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 12 FIRST: 447 sf BASEMENT: sf LEFT: 70 SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 70 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 19 VALUE: 43,494.00 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 447 sf REAR: 48 PLUMBING SINKS: 1 WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 2 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 3 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 5.00 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: $ 1,101.55 This permit is subject to the regulations contained in the ZINDA, TODD M OWNER Tigard Municipal Code, State of OR. Specialty Codes and 14875 SW 103RD AVE SIGNED RESPONSIBILITY all other applicable laws. All work will be done in TIGARD, OR 97224 FORM IN FILE accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone: Phone: Oregon Utility Notification Center. Those rules are set j,.�- g , , g �j f b 94 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You � 7 Reg #: may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Crawl Drain /Backwater Electrical Service Insulation Insp Final inspection Foundation Insp Footing /Foundation Dr Electrical Rough In Rain drain Insp Post/Beam Structural PLM /Underfloor Framing Insp Electrical Final Post/Beam Mechanical Mechanical Insp Shear Wall Insp Mechanical Final Underfloor insulation Plumb Top Out Exterior Sheathing Insr Plumb Final / Issued By : / .// ir/ Permittee Signature :, / Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next busin ay Permit #: H 2 o ?006- OOOI I Address: l �g75 A.0 � 10 i Issued by: f ig .. 4e,ft Date: — (3 —0 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: X 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR IT 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners ab : . truction Responsibilities on the reverse side of this form. ( ignatu t of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) information Notice to Property Owners About Construction Responsib'Y't'es No/c: I7118 iyi Propcity 01,n/az 6sp, NIA; /.x oo` 4evelopei /o'/6e('m/ nrrc/iw('"zir^c Board acu/o6n/ce with ORS 7V/,V55(5/ |/ you are acting vi.mr ow n contractor to construct a new 1)otne or make a substantr al improvement to an existing structure. on can pre prevent many problems by being aw are of the following responsibilities and Oleos of concern. EMPLOYER RESPONSIBILITIES: K}uu h//e ycoony not registered with the Construction Contractors Board to do labor in constructing or assist iog in the construction or improvement of a residential structure. you will. in most instances, be ruled to be an employer and the people you hire *J|hcemployees, /\s the employer, you must comply with the ["Uo"ing: Oregon's withholding tax law: ian cmplo\ Cr. on must withhold income taxes horn employee wages mlbxdmccmp|o}ccs are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information. call the Oregon Dept. ofKcvcouc at 945-8091 Unemployment insurance tax: /\suo employer, you are required to pas a tax or unemplus ment insiranec purposes on Oic \apes of all employees. For more information. call the Oregon Employment Department at 378-3524. Workcrs compensation insurance: As an einployer, you are subject to the Oregon Workers' Compensation Law , and must obtain oorkers compensation insurance for sour omplorees. lfvou fail to obtain workers compensation insurance, ron nay be subject to penalties and w ill he liable fora!? claim costs ifoneofyour employees is injured on the job. For more information. call the Workers' Compensation Division at the Department olConsunter and Business Services at 945-7888. US. Internal Revenue Service: As an employer. you must withhold federal income tax from employees' wages, You will he liable ft'rthe tax payment even i[vuu didn't actually withhold the tax. For more intom mation, call the Internal Revenue Service at |'800'R2V'|040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this p /cct,}»ounoyponsih|e/brroyo|vingnnyt/i|ure(omcc/codcoquircxynts that mar be brought to your attention throuirh inspections. LiabiIit and property damage insurance: ( ontact your insurance agent to see if you hay e adcquatc insurance coverage for occ ideu\yundomiuoions such as thiling tools, paint overspray, water damage from pipe punctures, fire, or vvork that must be re-done. Time to supervise employees: Make sure you have suFficicn1time k` supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coord Mate the work of rough-i n and finish trades. and to notify building officials at the appropriate times so they can perform the required inspections. Jfyou have additional questions, vvrite or call the Construction Contractors Board (P0 Box 14140, Salem, OR 97309'5052, 503/]78'4627). The Board is located at 700 Summer St. \L Suite 300.inSalem. pmp°v^pm4 ti t E USE Bt i1 in Per 1 ® n Received FOR OFFIC ONLY uilding Date /By: / — 1 S — O- Permit No.: {/lit9?-Ob33 C lt • Of Ti 1rd Planning Approval Other y g ^ oo� Date /By: Permit No.: 13125 SW Hall Blvd. JAN 1 ( Plan Review Other Tigard, Oregon 97223 GARD Date /By: Z' � } R r Permit No.: F ///��dl + � Land Use Phone: 503- 639 -4171 Eabc� S ��N G Y �P�E�k��� `N � Date /By: Pos[- Review Case No. . Internet: www.ci.tigard JU.D �" Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information (O S - l h / TYPE OF . . ;°WORKS ❑ New construction ❑ Demolition1 &;2FAMILY DWELLING 1T Addition/alteration/replacement ❑ Other _ �_ '- "� CATEGORYsOF��CONSTRUCTION ote: Permit fees* are based on the total value of the work performed. Indicate 1 & 2-Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi - Family /` $ ❑ Master Builder ❑ Other: Valuation 171 OQ / •a m� No. of bedrooms: 1 No. of baths: / / ,JOB SLTE�INFORMATION and LO TION�, ��, , � r s w /O_ � 7 - Total number of floors Job site address: � � : - ! I �� New dwelling area (sq. ft.) 7 C Suite #. Bldg. /Ajt. #. Garage /carport area (sq. ft.) Project Name: 1 4Lj r�s d8.7e » Covered porch area (sq. ft.) Cross streetlDirections to job site: Deck area (sq. ft.) / 3 . t- i/Iur. L T /03 Other structure area (sq ft ) REQUIlZEDDATA� , " } COMMERC USECHECKLIST: Subdivision:. .A_ Lot #: Tax map /parcel #: 9 5 I II C-e, Oo 11® Note: Permit fees* are based on the total value of the work performed. Indicate T , W � E P a . the value rounded to the nearest dollar of all e quipment , materials, labor, ;DESCRIP'riQN -QF �R - -_ ��� ��°= ( ) (" overhead and profit for the work indicated on this application. Valuation $ S uj r &' p, (��''� Z I �j r Existing building area (sq. ... .. New building areas t. Number of stories . Type e of construction r.,., a ;PRQP..ERT�l';;0,W,NER '��` ";r; ,�Q.TENANT' .: �.x���: �� �':'�� ame: 2: < Occupancy group(s): Existing: � nZ �� Address: I4' 5 ) �D3 — iii' New: City /State /Zip: 77 4,.I bi- ' 7-2z-y 5 3 q� � Fax: flz� - �'(� �zS3 NOTICE: All contractors and subcontractors are required to b Phone 5 -� 9 �c l licensed with the Oregon Construction Contractors e Board under tiJ Q APPLIGAN,T, " * R < ,x ® C.®NTACT =PERSON €; , provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing, the following reason applies: Address: City /State /Zip: Phone: Fax: a X74 - E- mail:E CONT�R .... . , >.._.�;'. . - �, �. 4 :��: X C'TOR aW .. �,� ::,�•� <,:�`� s „� � '- - Please�refer�to�fee,schedule�`� ��� , f � Business Name: Fees due upon application $ Address: City /State /Zip: Amount received $ Phone: Fax: Date received: CCB Lic. #: Authorized f Notice: This permit application expires if a permit is not obtained within Signature: = ! Date: �/ ' Q 180 days after it has been accepted as complete. 1 © ' I/1 dt *Fee methodology set by Tr-County Building Industry Service Board. (Please print name) �� ,5v1 I: \Dsts\Permit Forms\B1dgPermitApp.doc 01/03 One- and Two - Family Dwelling ' su- . f . , , � x , .rteo` . ! Building Permit Application Checklist Reference no.: Associated permits: City of Tigard City Of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 • • Fax: (503) 598 -1960 • THE. FOLLOWING ITEMS ARE :REQUIRED FOR PLAN REVIEW Yes 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 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, locatiomof 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 andfoundation, 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. 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 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not 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 & location per approved project street tree plan (if applicable), and COT Street Tree List. 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) Electrical Permit Application FOR OFFICE USE ONLY t Received Electrical I Date/By: Permit No.: Cit Cl of Ti and Planning Approval Sign y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503 -639 -4171 Fax: 503 -598 -1960 Post- Review Land Use //#IJ. i �r�� ('j A Date/By: Case No.: Internet: www.ci.tigard.or.us ���, _:' I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. TYPE OF WORK PLAN REVIEW (Please clie`ck all that apply) ❑ New construction Demolition ❑ Service over 225 amps- El Health-care facility commercial ❑ Hazardous location Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in RI 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: ' JOB SITE INFORMATION and LOCAON Submit sets of plans with any of the above The above are not a , . licable to tern i orar construction service. Job site address: J y ?).75--- c5� 1 a -D1 jts r � �t� _,�4 ; r Suite #: Bldg./Apt.#: ! ,� _ Number of inspections per permit allowed Project Name: /2€5; [?., , Description Qty Fee (ea.) Total i Cross street/Directions to job site: 0 0 dw New residential - single or multi- family per / l Ytiz dwelling unit. Includes attached garage. jimAide L I— ! 03 -- Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 I Limited energy, residential 75.00 2 Subdivision: Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: t S / /1 C-t Ott 3 fl 0 Each manufactured home or modular dwelling ESCRIPTLON OF WORK ^ _ service feeder 90.90 2 MA b1 r�1', /i_ L.O � �.. t " aerva i or and/or ree loc - installation �, / alter or relocation: , I '6 Y 21 1 200 amps or less 80.30 2 f 1 ` 1' 201 amps to 400 amps 106.85 2 5L�, 10 O 401 amps to 600 amps 160.60 2 [PRQP 3iW1 RIY . 0 TENANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 r Name: '' - s--, n d.Cc -- w A Reconnect only 66.85 2 Address: 1 q 07-s 4 Lam' 10 3 Temporary services or feeders - installation, � alte or relocation: City /State /Zip: j 6- t O _ 9, �ZZ 20 0 amps or less 66.85 1 Phone: 1) 'ri ' )616 Fax: , - �j 201 amps to 400 amps 100.30 2 ; p «' ; 401 to 600 amps 133.75 2 Branch circuits - new alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 ' E -mail: Misc.(Service or feeder not included): 3 Each pump or irrigation circle 53.40 2 CONTRACTOR ' Each sign or outline lighting 53.40 2 Job No: OW n Signal circuit(s) or a limited energy panel, Business Name: alteration, or extension Page 2 2 Description: Address: City/State/Zip: Each additional inspection over the allowable in any of the above: Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: Lic. #: Other: 4- .., an u a'it n w .,� , ` " V r� ' t °' . r , Sar `' r tia Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: ic. #: State Surcharge (8% of Permit Fee) $ A O TOTAL PERMIT FEE $ Authorized • Notice: This permit application expires if a permit is not obtained within Signature: ill Date: /_I t�,) 180 days after it has been accepted as complete. ii — 7-,h �, *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms\ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: n Audio and Stereo Systems Ej Burglar Alarm Garage Door Opener Fr Heating, Ventilation and Air Conditioning System 0 Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems El Boiler Controls Fl Clock Systems n Data Telecommunication Installation n Fire Alarm Installation HVAC n Instrumentation TI Intercom and Paging Systems n Landscape Irrigation Control F Medical n Nurse Calls El Outdoor Landscape Lighting E Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 Plumb Pe ing r' mit Application , ' ceived FOR OFFICE USE ONLY Plumbing Date/By: Permit No.: Planning Approval Sewer City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598- 1960 // a, di Post Review Land Use y � , Contact Case No.: Internet: www.ci.tigard.or.us �� •f I t': Contact Juris.: g See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information. )F:W :' FEE * o of alOi I st '' f,. '. , .a '-''''''°?'''' . TYPES QRK.. �1 1 Fe e ) New construction ❑ De molition D Q I F Addition/alteration/replacement ❑ Other: ea) Total ` on f . (inclines id0' _.'.� ifl . f(Ilty 4i!'e�Qn? . ': -w, ►TEGOR'Y OF',CONSTRUCTION SFR (1) bath. 249.20 L. 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 ['Accessory Building ❑ Multi- Family SFR (3) bath 399.00 p Master Builder ❑ Other: Each additional bath/kitchen 45.00 a ... C1<B E IF® . ea ' ' tiONand" CATI � n Fire �nkler . ft a e Job site address: 1,4-5 �` � � � r ; Suite #: Bldg. /Apt. #: Catch bas dra 16.60 Drywell/leach line/trench drain 16.60 Project Name: Z t "IAA A ge 5 O- Cr" t-e, Footing drain (no. linear ft.) Page 2 Cross street/Directions to job sit Manufactured home utilities 110.00 t071-40 4' i ' j D Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax ma / arcel #: C �� Water service (no ear ft P� 6.60 a .: 1) it s s s y i' a ' ` a � '� � � ° — r Absorption valve I' Q a ' *en/ C' /i ' XZl Backflow preventer Page 2 Backwater valve 16.60 S M ormi / 2-' v I � l Clothes washer 16.60 �` v Dishwasher 16.60 Drinking fountain 16.60 b , x .. ae i ' _ , ' • -. ; ` Ejectors/sump 16.60 Name: 0 /F - & Expansion tank 16.60 Address: ( t.� 4-5 � , 1) 3 ' Fixture/sewer cap 16.60 City/State/Zip: T S I Floor drain/floor sink/hub 16 60 / Z f Garbage disposal , Phone: . -VI � - • Fax: f ' S: Hose bib 16.60 _ 7 El ' �N ,. P 461 Ice maker 16.60 Name: Interceptor /grease trap 16.60 _ Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory 16.60 . E -mail: Tub /shower /shower pan 16.60 _ . x ' .r .. Urinal 16.60 ... ' n..�";'1'''.41'7747; 16.60 Business Name: Water closet �lvl'1G'/� Water heater 16.60 Address: Other: City /State /Zip: Other _ Phone: F . . r ' fni ;, ,,1n _ a= . i4. Subtotal $ CCB Lic. #: ' lumb. Lic. #: Minimum Permit Fee $72.50 $ / / - Authorized ° Residential Backflow Minimum Fee $36.25 Signature: /1. Date: / 4t 93 Plan Review (25% of Permit Fee) $ �6 , , % n AI State Surcharge (8% of Permit Fee) $ _ (Please print name) TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. - *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 —Plumbing-Permit-Application—City of Tigard Page 2 - Supplemental Information - . Fee Schedule: Residential Fire Suppression Systems: l( teal . Too Square Footage: Permit 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 Valuation: Permit Fee: 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 additional $100.00 or fraction thereof, to and Fixture or-item Qty. Fee :rota! 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 accurate! re • ort fixtures could result in increased sewer fees *. Comments regarding fixture work: t: a >, t 1k x -, � .. : ..10s, . 4 ...Capped 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" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage -Domestic Disposal -Commercial increase of sewer EDUs, a sewer permit will be issued and isposa - Industrial fees assessed for the sewer increase must be paid before the Ice MachiRefrig. Drains plumbing permit can be issued. Oil Separator LGas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory — -Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet ✓ Urinal Other Fixtures: is \Dsts\Permit Forms \P1mPermitAppPg2.doc 01/03 Mechanical Permit Application . .Received FOR OFFICE USE ONLY Mechanical Date/By: Permit No.: Planning Approval Building City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -1960 o 4 I ' Post - Review Land Use Post-Review Case No.: Internet: WWW.c .t]gard.or.us ilIl* •11 I Contact Juris.: El See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. ' ' ° COMMERCIAL FEE* SCHEDULE -'USE CHECKLIST ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ,® Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OP-CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. ® 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE* SCHEDULE Description I Qty I Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION 0 Furnace - add -on air conditioning ** 14.00 Job site address: 1 y (67-5- 5 L) / 0 3 3 ! Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: .� l /1 4 44 ge5 ideile Hydronic hot water system 14.00 T� �/ Residential boiler Cross street/Directions to job situ (for radiator or hydronic system) 14.00 . tv to (c IC_ j 0 3 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: Lot #: Repair units 12.15 Other Fuel Appliances Tax map /parcel #: 02 S i i ) CA 00, 0 v Water heater 10.00 '' 13 R ' C'I'IozKoF WOI .. Gas fireplace 10.00 1.10 Flue vent (water heater /gas fireplace) 10.00 /11 � � � C �� l � � _ Log lighter (gas) 10.00 �� �G X Z Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 (� h / yt j ( 1 ' I Chimney /liner /flue /vent 10.00 „ ' , RO OWNER -'. '❑ TENANT Other: 10.00 Name. -7 L a Environmental Exhaust & Ventilation Range hood/other kitchen equipment 10.00 �� w Address: � 5 10 Clothes dryer exhaust 10.00 City /State /Zip: ,6 , "( f' ZZ y Single duct exhaust Phone: r j b ) - S q $ 1 1 4 Fax 9)3j -5 - 1-C3 y (bathrooms, toilet compartments, ❑.APPLICANT . ❑ CONTACT PERSON utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Other: 10.00 Address: Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: Gas heat pump ** E -mail: Wall /suspended/unit heater ** WN'I ;C 'OR Water heater ** Business Name: OW 11Ge- Fireplace ** Address: Range ** City /State /Zip: Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lic. #: ./ Total: Authorized Mechanical Permit Fees* Signature: ,/ A:� Date: / -13-03 Subtotal: $ - Minimum Permit Fee $72.50 $ I D d", : 1 ,, g ',dab. Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $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 and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to I mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 . . , 0.3 I i . . s I .t/s L01 • . . 6 i - till Y 60 X ...$ bhl i. sb ,• IX 7.- I . . . . . . . . . •Ilk —• . . . . • o • . . ., . . . . . . . . . . - . .! . . . , S 1,4129 . . . . • .. . • , . . .. .,•:, ,i,,...,. • i illb•I;;' '. I. ":0• • , • •::. .. ! :. • f • S ' rsi . ' f'!WI • ' , '••. 0 • ' . • ., , .. • . • . . ,• . . , . , • . .; , . . EM . : • ; it r , 4 Nowt 11 0 X $ • X a X X Xi li XI X N . ...... . M. AA • IA I 0 A AN IM 111 1 . .1 .., . I, • • . -..... . .1 ..aaragi- ot ..... . . , . 4 VC ..'! • .: "...i. . : '6.4,' 'v5,!1. . . . ' :" ' .1 1 . • . ., .....'■• ." ' • i! ,..i. '..' ' ..: f :' - :' , •Hti,..." - :‘ ! . ., : • -... • ... ,. . . . . . ; . , . . . • k a 04 -9 2 Iii st ..P116=111.11111M1.41 awm......■ ■ . hvz tb 79 f ..........---- 1p ....".. tal r 5 ''' Vi3h 1 i l G‘l-e 94 L4'v Uri ri roj, ly" ei--- _ .140 • Llordwaliti. • . . ..■ A \ \ 1.4. . 10 -,1 172g2.86g2OST MaNIZ a�01 N311d3AAZ NUA Wci G:ita gz, —6Z —NUr P. 0 1 r.. • • h • C1eanWaier Services 33;N o ,ion Our commitment is clear. File Number I 6Z i Sensitive Ares Pre4creening Site As�sessmsnt Jurlsdictioa: ./ : > ' _ • 'Date . , .1 ; ;VT Map S Tax Lot ... 25/ f/ G:0.0,3_, o - Owner • . 1"�- , . - °> >' Site Address : W 10 6 - '• * L'1 Z Contact Proposed Activity . // ; ..j ' 1 Address 5 a;✓ 00 • /. a, or) i1/.'�.�1!t TZT Phone Official use only below this line Y N NA Y N NA ® ❑ 0 Sensitive e �Aree a Composite Map ❑ ❑ ® Stnrmwaater Infrastructure maps Map /1 OS# 1 151? Y N NA Y N ❑ ❑ ® Locally adopted studies or maps ❑ ❑ IN Other Specify Specify Based on a review of the above Information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 00.7:.. . . ❑ . Sensitive areas potentially sense on site or within 200' of the site. .THE - APPUCANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER ' LETTER OR STORMWATER CONNECTION PERMIT. if Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. t l Sensitive areas do not appear to exist on site or within 200' of the site. This pre - screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. 0 The proposed activity does not meet the definition of development. NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER iS REQUIRED. Comments: %, l of no ;4 Seer ;7;v.e 400.k ai s's TO 6e fi eQ Reviewed By: / J J1 4 _ Date: /f 7/43 Retamed to Applicant ll�ail,,� Fax Counter 155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Date /77o3 B)123" Phone: (503) 846 - 8621 • Fax: (503) 846 - 3525 www.cleanwataservices.org G2- CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 , *j 2 ooa �� INSPECTION DIVISION Business Line: (503) 639 -4171 �I BUP Received P 2/ /i /:/ 7' Requested l 2 1 D -3 AM PM BUP Location /6/67 7 . / v Suite MEC Contact Person 7 c,� d e2 Ph( 5 S ? 7 (4 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC 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 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 P ° ��N' PART FAIL • CHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final 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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date ') 3 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 a. 3_ 060/4 INSPECTION DIVISION Business Line:. (503) 639 -4171 / BUP Received Date Requested /0""t AM PM BUP Ver Location Suite MEC Contact Person l� Ph ( ) S '7" 6 L/ PLM Contractor Geet- Ph ( ) SWR BUILDING Tenant/Owner ELC 1-oo ing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing G -- f> 2t2 t °C / V6-3 K !4 /l z-na .4 tpr.i ere Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Final S PART FAIL BING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final • FAIL MECHANICAL.) Post & Beam Rough -In Gas Line S .i . ke Dampers P•S • • RT FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 10 - d 3 Inspector q1116 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 MST 3 - OOCAir l INSPECTION DIVISION Business Lines (508) 639 -4171 BUP Received Date Requested 7 AM PM BUP Location / g 7 .5 l d 3 �f_ Suite MEC Contact Person Ph ( ) 5l ' — " �e PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing �^ �� y� D = O raiiing 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 Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In D (� UG /Slab Low Voltage Fire Alarm P ASS T FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date/ ' _, i�. ' - Inspecto i q Ext - Other: Final DO NOT REMOVE this inspection record rom the Jo ' site. PASS PART FAIL