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Permit • y ` * • Alli CITY OF TIGARb MASTER PERMIT PERMIT #: MST2004 -00355 -411 13125 SERVICES DAT ISSUED: 12/17/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14825 SW 104TH AVE PARCEL: 25111 CB -01310 SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R - 3.5 BLOCK: LOT: 019 JURISDICTION: TIG REMARKS: kITCHEN REMODEL BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: VALUE: 2 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVGFDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: 3.00 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEWSECTION 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: $ 353.49 This permit is subject to the regulations contained in the BAKER, JOHN G + KEN HOSTETLER CONSTRUCTION BRADSHAW - BAKER, LEANNE 861 S REDWOOD ST Tigard Municipal Code, State of OR. Specialty Codes 14825 SW 104TH AVE CANBY, OR 97013 and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire TIGARD, OR 97224 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 - 598 - 4867 Phone: 503 266 - 5754 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 159836 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 PLM /Underfloor Gas Line Insp Mechanical Insp Electrical Final Plumb Top Out Mechanical Final Electrical Rough In Plumb Final Framing Insp Final inspection Issued By : ✓ l ti-e_-, Permittee Signature : A4.7" / fit Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Permit Application IOR (II l I( I 1 S1. ()'l.l City of Tigard tea . / / ' . P a Permit No.: , „ !/- Ql ,3j 5� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 - '.. - Date/B . Other Permit: Inspection Line: 503.639.4175 ..,-.8. '... Date ReadyBy: IL SI See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: . Supplemental Information ' TYPE OF WORK • REQUIRED DATA: 3- AND S- FAMILYDWELLING ❑ 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- and 2-family dwelling ❑ Comercial /industrial Valuation: $ m El Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /4/02_5 5 i dei'i'Ct A C New dwelling area: square feet City /State /ZIP: - r1 & t ) <J l Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: rellicall Covered porch area: square feet Cross street /directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL-USE CUECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map/parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ 1<itcN�/ 61 Dlit/M.t� � ePc2 Existing building area: square feet New building area: square feet PROPERTY OWNER 1 ❑ TENANT Number of stories: Name: Jail-iv e LE , Type of construction: Address: ( 9)zs SK/ /64 t e Occupancy groups: City /State/ZIP: - G Ua. Existing: Phone: (X13) 5 9 CJ 4-967 Fax: ( ) New: %APPLICANT jill CONTACT PERSON NO IiC Business name: KEN 1..f4..5 CC 7 //VC, All contractors and subcontractors are required to be Contact name: r..54E S?tr6X licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: Cr1 6 ( 5 tti f) ST jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City /State/ZIP: C y o 1: 701 3 apply: Phone: (563) 2 _ ,6 575 ¢ I Fax :: ( 3) 24,6 5-'75 E-mail: CONTRACTOR Business name: /f e ,Q A7 CRATT ` . " "WILDING P UT FEES* Address: Please refer to fee schedule. City /State/ZIP: Fees due upon application Phone:( ) Fax:( ) CCB lic.: f 563 � 3 �! qlo(t) Am ount received Date received: Authorized signature: ' .. /1 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: &O { -1z et S • 5-Tf(7 Date: // 4j1 * Fee methodology set by Tri -County Building Industry r Service Board. i:\ Building \Pennits\BUP- PermitApp.doc 12/03 44046131111/02/COM/WEB) One- and Two - Family Dwelling ' Building Permit Application Checklist i oiz 0 1 : 1 : 1 ( E 5t: O\l.l City of Tigard Received ty g 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 J ,t ❑ 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. ❑ ❑ ❑ 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. ❑ ❑ 0 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ 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 NOV _22 2004 11: 38RM HP LFISERJET 3200 p, 2 r • El a Electrical Permit A I1 EIVE I r FOR OFF'10E USE ONLY City of Tigard Received Permit r 13125 SW H Plan Re all Blvd., Tigard, OR 97223 t Da Re r � + rb�"655-5 view Phone: 503.639.4171 Fax: 503.598-1960 V 2 2 1U 1 �'' ! " Dates y: C�thcr Permit Inspection Line: 503.639.4175 Li,,..'' L . Date Ready/By: Juris. H See page 2 for Internet: www.citigard.or.us CITY Noti iediM Suppleme Information OF TIG , � `* i + + , 7 - 1 , i t 3 A 1 � rt ` - `'i r i 7 ;' a� S" '- " r ` y !, %! s fin' xX y m ' aNSh �1 t S+F �' ',w n r u " � � ',� � M,, _ r, 1.. ; (� ze. - �S_ + �� _ , � t��.mt , b , k �` �,� � . � �� ��ili.t ' � i�6^ , - , -4 4 ' , '-".--; , . - : ti a r � ❑ New construction ;1! Addition/alteration /replacement Please check all that apply: El Demolition 0 Other Service over 225 amps, comm'l ❑Hazardous location r 1 , „ ,, �„� �A ❑Service over 320 amps - rating ❑Buildngover10,000s . ft., `i l : I - P 1,i M q s- s 1 1 ,. r t y ,� .' -. tl C +r �4 a + y" { - $ "yt� i'lt , ;` ?:, 1 i 'lam''" r , ;._ , _A.,� i , � , of l and 2 dwellings 4 or more new residential t ...+. #t,k., a + � �..+ .�.. ,Uu.�.'f1�,.. 1 u;vJ, � ...� -.. .�,�,,... ` IF�r.)� Y 8 I,1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Minh famil ['Building over three stories :Weeders, 400 amps or more y ❑ Master builder ❑ Other. k s � r �, +r , d , t t , .,, it v.:; Ti P ., - ❑Occupant load over 99 persons ❑Manufactured structures or �,, . : t + - (q,: t .lH 4 l 0.1; 9 P y 4 4, - •,1 l y �'l'i l'i ills t t { lf' 't rt }r, It.�1" ._ V b�,i, R -u i i . . a , LI, no.ir._?or iniik.. hta� ::.4F, !rB -�P, if_a , 4x n !i11itito.lei i u .4ril.i:a. ['Egress/lighting plan RV park Job no.: 7S ' Job site address: /4 ZS rc /0 se el ❑Health -care facility ['Other: 77 Submit /sets of plans with any of the above. City /State /ZIP: - a J O4 9 7 Z ' ' V The above are not applicable to temporary construction service. SUitelbldgJapt. no.: Project name: „� ,," e ..li{ tt ! : : ':Ih` h`iil'_ V y 1 rli aJ %s+ ( CI i iE7 1 , 6`#i,tie + - ,. Descrtptloa Qty. Fee I Total I Cross street/directions to job site: / '11 . 0. ciw JN t New residential single -or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft or less 145.15 4 Subdivision: Lot no.: Ea add'l 500 sq. ft. or portion 33,40 1 Tax map/parcel no.: limited energy, residential 75.00 2 -i Limited energy, non-residential 75.00 2 'Fir'± wirer � t 'r � _3 V 1 r ii : - �. g, r 9 pall S T - v iiimA.. �BY I_]1i:1?. , ' .If:.: f ,.. i 1 d,i , l k e �A .� (t ' € 41 . .1.i.a.: tu ''-1' v ri et -, _. . m.r n _., iii �. 3:. Each manufactured or modular e, :.� t I. teF4 a e 4 j e../ . dwelling, service and/or feeder _ 90.90 2 l Services or feeders installation, alteration, and/or relocation ^ 200 amps or less 80.30 2 h .l eta , + 1 r ' ' i r �t111s 1 i..-1„,-,1--,, , , i1 m {Fl€' .,. 1: erg, ' ' 'n , r,1; ' a 201 amps to 400 a ar i1_ _...t.l !..I!- lt f5 i 1 tx i. ''.S. �i�i 14 ',a�.e $. _ cl3hi . " . I`� , C ,� o.d.I . 'C 7' I amps 106.85 2 t J f � r _ .� -t5il � .. kln,f =` �: S: +li' L 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 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 Pr 7;:-� - TIPT `, r rt hi =, o 6 T' lg r n a :� 1 r, �. _ "N 9 1N't fire dt l. -V Y ! r r .t i i rt +a e � ,a, a�TM { i ++ , �, b A�" a+ r rt i � , +t �(� �c� A. Fee for branch circuits with L .X;; w ,..:...:.x.i..,.. ::.±,L I.:, 1 14. ,,,T lr. i ,...ial 1).. g..�."t. + .. . . i r. }. ,.f;n.. 5<.r_ ,: 4.7 . ,., .;., ',. t "' service or feeder fee, each 6.65 2 Business name: branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, Address: each branch circuit / 46.85 y( ,g' 2 Each add'l branch circuit 6 6.65 3').9Q 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- energy panel, alteration, or Business name: extension. Describe: Page 2 2 0- - 7t t Address: Each additional inspection over allowable In any of the above JO Per inspection 62.50_ Investigation per hour (t hr grin) 62.50 Industrial plant per hour 73.75 Phone: ( jrjj ) 62 y - 3 ' t Fax: (S'63 ) 6 2: - Z Cl 3 S - 1 , ,ii,l i n ,,,. ifs u 5 p. ;��+ ,I;q, - , .. ,r, 1 i ut,, p lk 1 h �.. a ,�,,. '';,...1?; i ", Electrical Lic.: 74 24-7c. Suprv. Lic.: • 4 Ss - S" Subtotal 96 , 7S Suprv. Electrician signature, required: , / Plan review (25% of permit fee) �' - State surcharge (8% of permit fee) 6, 9 t " 1 _ii Print name: i ^� g ustiinzgi. c. TOTAL PERMIT FEE /T c73 + b7 Authorized signature: ' 8u This permit application expires if a permit Is not obtained within 180 days after ft kas been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board " Number of inspections per permit allowed. is lnaildinePermitsl ELC- PernitApp.doc 12/03 440- 4615T(10/021COM/WEB Mechanical. Permit Application FOR OFFICE USE ONLY Received 11,5r,9004/ r S City of Tigard Date/By: [i $a Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 gllr \ Date/By: Other Permit: Ux Inspection Line: 503.639.4175 a �i N4 "'�� Y ., Date ReadyBy: kris. H See Page 2 for Internet: www.ci.tigard.or.us Notifie Supplemental Information � ;�:: Con�., r��. " ; H .. d �t .' ,E� �� } �'�. , . : ' , . ": �.'�.�'Et� =�� ; �FIt* . * rSOHF:DT3I,E — USE: "CHECKLIST ❑ New struction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work pe rformed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: K 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Ii ESISTEMS FEES* For special information use checklist. Description Qty. Ea. Total I# . 3 3 0 di ,ii �p 7 t Job site address: t 4 2s 5 f04 '1 Ayr Air conditioning or heat pump (requires site plan showing placement) 14.00 City/State /ZIP: 11 G / `,� Furnace 100,000 BTU (ducts/vents) 14.00 Suite/bldg. /apt. no.: , 1 Project name: r � Gas heat 100,000+ BTU (ducts /vents) 17.90 • � 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 Lot no.: Flue /vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances Dt 9 t p ,' y r ` - ,t Water heater r 10.00 t.Q C "" ._.. * - , -. Gas fireplace 10.00 O('J(JJAI p rT rA7jZU . (v-r g Flue vent for water heater or gas f' , fireplace 10.00 CAS t\i 1 M (i � 1( 1 (; Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 _ Chimney/liner/flue/vent 10.00 Other: 10.00 Name: Environmental exhaust and ventilation Address: Range hood /other kitchen �/ equipment X 10.00 JO City/State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 r t I Attic/crawlspace fans 10.00 r a 6 s v I tf s '» . P y �,_ . ,.� Other: 10.00 Business name: k-Cry H C t r.-r i pt PVC ° Fuel piping Contact name: es I ( ' 7C �� \ $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: Wall/suspended/unit heater I Phone: (5i3) 3) 9 (3 20 33 I Fax: : ( ) Water heater Fireplace E -mail: Range = s a;F ;x- Barbecue - � y- � �,�,,�- Clothes dryer (gas) Business name: K . (ter WNS - rie criaiv /Arc Other: Address: 06 ( 5. I •Eb ivcoD ST :gym C A �' .X, Rvirr= EE* City/State /Z1P: y ©C g7 © Subtotal Phone: (50 3) Zk6 575 Fax: ( 7) 2 c, a 576* Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: 15 0 63 6 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: lam' 16k t S — ` Date: * Fee methodology set by Tri- County Building Industry Service Board 440.4617T(II/02/COM/WEB) i:\ Building \Permits\MEC- l'ermitApp.doc 12/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Tc'tal alii a on .3 j it (eL. , $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 ' $uilding Fixtures , r, Plumbing Permit Application FOR OFFICE USE ONLY City Of Tigard Dar ed ( / 7 / > y Permit No.: /4 7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 // / /;Nlli1 Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 -• Date Ready/By: J El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information t r r a . t a v : L � ..> y f s . '� C.....ti`. � �.w� �rt _s��Pa.t' __- ...,. �? _�'.5� �x� .. .P. ..,..�:, ., .., . ,,- _.._ El New Construction 1:1 Demolition For special informat use checklist. Description I Qty. I Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) '!;y n., v i ate > r r ..44 . t3'- 'T.';'. .,r .« Est i,, 1 '. ' .� t t t ..� -' - ,1, - 3,:::,,,,': SFR(1)bath 249.20 ., . _ `; t om . _ # ... _ :: . S .ry L ❑ 1- and 2 family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: � � Fire sprinkler (_ sq. ft.) Page 2 •" 4.�t _�� t � �_. Site utilities Job site address: 49 ZS 5 W I,- , AA/E Catch basin or area drain 16.60 City/State /ZIP: .--77 t G/L Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: 1, e i Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no, linear ft.: _) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no � m Absorption valve 16.60 , ,. _ e x1 _ _ w ,.� Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 p 1 r Drinking fountain 16.60 Ejectors /sump 16.60 Name: 1 f I 014.-K l Expansion tank 16.60 Address: G�ir}M € 4,5 X L) € Fixture /sewer cap 16.60 City/State/ZIP: � Floor drain/floor sink/hub 16.60 Phone: ( j 5 ) 7 - �� 7 Fax: ( ) Garbage disposal 16.60 a Hose bib 16.60 / 16.60 Business name: 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: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 „ .. c , + r 7 f a 7 b � ..•, cam( .. 3 't � x y A ^.. s ' Water closet 16.60 Business name: OLe.) Water heater / 16.60 Address: Other:ba U3Tlta JU//1 City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plum g Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: n het O fi e r Date: 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 Service Board. is\ Building \Permits\PLMF- 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: quare.Footage. Fermit.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 w: 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 jiff, additional $100.00 or fraction thereof, to and � 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 * . Ilk g " red 4n 9:01 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 Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and 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 Quantity Total - Bradley Commercial 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 \Permits\PLM- PennitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING 4 Inspection Line: (503) 639 -4175 MST 003_575 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested —4 ( AM ✓ PM BUP Location / ` 7 �t % Suite MEC Contact Person Ph ( ) 9/ 2 1_33 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain A ccess: �7 r 40, 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 Pan Other: PART FAIL M HANICAL 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 El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 2 1 4/05 -- Inspector CT t 9 ;we_ 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 0 O Y • INSPECTION DIVISION Business Line: 1 639 -4171 BUP Received Date Requested AM PM G BUP Location / D a / JIg Suite MEC Contact Person Ph ( ) 9 / .3 ' 33 PLM Contractor Ph ( ) SWR BUILDING - Tenant/Owner ELC Footing Foundation ELC g Access: Ft Drain 0 ill 0 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 mmiiii • ` • � ART FAIL _ PLUMBING _. Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fine T FAIL (rifEMM L Gas Line ,%i1• - Dampers I PART FAIL - ICAL - Se ' e Rough -In UG /Slab Low Voltage F' - ;arm _i__'" r FART FAIL Reinspection fee of $ required before next ' � pection. Pay at City Hall, 13125 SW Hall Blvd. El Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Z / ` Inspector Ext Other: Final DO NOT REMOVE this Inspection record fro t Job site. PASS PART FAIL