Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003-00500
liik DEVEL EN d Tigard, OR 3CES 639 171 DATE ISSUED: 10/30/03
13125 SW
SITE ADDRESS: 16790 SW 108TH AVE PARCEL: 2S115AD - 00900
SUBDIVISION: WILLOWBROOK FARM ZONING: R -4.5
BLOCK: LOT: 031 JURISDICTION: URB
REMARKS: 40 SFexisting space converting to habitable space.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: 20 FIRST: 40 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 12,996.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 40 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES: 1
MECHANICAL
FUEL TYPES FURN <100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
GAS 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 FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: oo SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 5.00 SIGNALJPANEL: 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: $ 533.93
TRITT, ROBIN L + MARK WEST LAURIE MILLS This permit is subject to the regulations contained in the
HOCHTRITT, TRIT MRK WEST Tigard Municipal Code, State of OR. Specialty Codes and
KIRK, MONICA CA M AVE CO BOX CONSTRUCTION 5 all other applicable laws. All work will be done in
16790 SW 108TH TIGARD, OR 97224 PORTLAND, OR 97298 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: 503 307 - 7133 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 62402 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Shear Wall Insp Plumb Final
Mechanical Insp Exterior Sheathing Insf Final inspection
Plumb Top Out Insulation Insp
Electrical Rough In Electrical Final
FC sP- - - Mechanical Final
\ \ Am 4 � "A ,!1 %,
Iss : k b , _ ! I, /„4._ P e r m it t ee Sign. ure • A / _ f
Call (503) •39 -4175 by 7:00 p.m. for an inspection n- -ded the ext business day
Building . Pe , k p��lOn FOR OFFICE USE ONLY
�v CC Received Building !1
Date/By: 11 / `f /o) Permit No.:l ► ^{ J
City f Tigard Planning Approval Other
Y g OCT 14 2003 Date/By: No.:
13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223
Date/By: Permit No.:
y�
// ''. mr A i \
Phone: 503 - 639 -4171 ���� ( M3 1 30/04 1 60 w�l'�t�! Ili '1 Post - Review Land Use
B
Internet: www.ci.tigar ING DIVISION Date/By: Case No.
Curie.: ® See Page 2 for
'
24 -hour Inspection Request: 503- 639 -4175 Name/Method: t4 K9 Supplemental Information
-a " fir.° _ $ ':.± , �xz*
� New construction ❑ Demolition -. - t : =
❑ Addition/alteration/re.lacement ❑ Other: `o
: ` `.: I w' ' €' . ! ,'' Note: 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.
1=1 Accessory Building El Multi-Family p lc
❑ Master Builder ID Other: Valuation $ 1 , C
i; r m r , t y
No of bedrooms: No of baths:
Job site address: I ( '1Q 51,0 (Q$ u ii 4/ Total number of floors r
N ew dwelling area (sq. ft.) '41 5 - is,,
Suite #: 1 BldgJApt. #: Garage /carport area (sq. ft.)
Project Name: Htc-t -j ft Ye Q, f Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.) N.
. 5 . .,: of Akue 1 ..1; % W
Subdivision: Lot #: �.._ .�., ..�. �._ _ .....�... u
Tax ma./ • arc el #: Note: Permit fees* are based on the total value of the work performed. Indicate
` ,; ° °i - L ' the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
MMl L_. 7a�i '/ iii A /.I 4, Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
; PROPERT% O. 9 _ 'jrl Type of construction
Name: ' ig i on/ g
Occupancy group(s): Existing:
Address: 1 1p O 5W r-Q g a
— New:
Ci /State/Zit: 1 ,„, Q dl[ • y
Phone LI, -l p m- 1 - Fax: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under r'r x ° ' ° °:` ° � ° r . ` . - -' ' ° 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:
E-mail:
v� 1d Laud& M (IC h
Business Name: Ma - - • ees due upon application $ I t)Q , 01
Address:1 )C 25'
City /State /Zip'py -f OR q rzq$ Amount received $
Phone: 503- 30'x= - 1 (3 3 I Fax: Date received: /j ) 0 0 1 , a - 7
CCB Lic. #: 1,Zik)z , -rx i 3, Y5 �� —
Authorized
Signs Air. _ 1f f , Date: Notice: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
n43-03
-03 *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
A lh One- and Two - Family Dwelling
e =iy Building Permit Application Checklist Reference no.:
City of Tigard City f Tigard Associated permits:
Y g ❑ 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 CI plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible pans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral desig etails and connections must be incorporated into the plans or on a separate full -size
attached n the- atis with cross references between plan location and details. Plan review cannot be completed
i d if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer elevations (if
/4 fl 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 /f ----
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. 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)
• 6 J7 ,/6 -) t -b3 MAV
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
RECEIVED Date/By: Permit No.: j,', - 00 6 )
City of Tigard RE Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 OCT 14 2003 Date /By: /'i A ' JU - 2 t / - a 3 Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 Post-Review Land Use
Internet: www.ci.tigard.pA OF TIGARD ��"""NCI
�` C Case No.:
I i� `I �� Contact Juris.: ® See Page 2 for
24 -hour Inspection Rec j3x6
tQ3193I $I Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement { 111 Other: commercial ❑ Hazardous
❑ Service over 320 amps- rating of ❑ Building Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 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 L ll CATION - Submit sets of plans with any of the above.
� �� 1 '. , I L � — The above are not a • s livable to tern I orar construction service.
Job site address: ,t V l/ FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross street/Directions to job site: " New residential - single or multi- family per I dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
PROPE ' OWNER A TENANT 601 amps to 1000 amps 240.60 2
Name: � � 11UNI g
Over amps or volts 454.65 2
Reconnect nnect nett only 66.85 2
Address: Temporary services or feeders - installation,
City/State/Zip: alteration, or relocation:
y p 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
El APPLICANT ❑ CONTACT PERSON r n h ch circuits amps 133.75 2
� / Branch - new, alteration, or
'
Name: MR k ((5 �u V e, M (�` C lt ' rm extension per panel:
Address:
i� I L. A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Z� k-r(a,t aR v l 1 ici g B. Fee for branch circuits without purchase of
�t 2 first branch circuit / 46.85 2
Phone-56,3 - 337 -7 i 5 Fax: Each additional branch circuit .5 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name :6a WI Hg -i.►) G - Description: —
Address:
C ity/State/Zip: Each additional inspection over the allowable in any of the above:
y p� Per inspection per hour (min. I hour) 62.50
Phone:56 - i-filz-36cn Fax: Investigation fee:
CCB Lic. #: O OHS Lic. # : dip l. C Other:
Su Supervising electrician Electrical Permit Fees*
P g Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*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:
❑ Audio and Stereo Systems
Burglar Alarm
Garage Door Opener
El Heating, Ventilation and Air Conditioning System
I 1 Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
Fl Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
El Fire Alarm Installation
D HVAC
O Instrumentation
D Intercom and Paging Systems
El Landscape Irrigation Control
• Medical
O Nurse Calls
I I Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \Dsts \Permit Forms \ElcPermitAppPg2.doc 01/03
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received Plumbing
Date/By: Permit No.:lYrire99D 3 - 25w
Cit of Tigard Planning Approval Sewer
Y g RECEIVED Date/By: Permit No.:
13125 SW Hall Blvd. . Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 FaET03t5a8 -1U63 Post - Review Land Use
g L ri�tl �i �jl� l + Date/By: Case No.: ■ ®
Internet: www.ci.ti ard.or.us ! Contact Juris.: See Page 2 for
24 -hour Inspection Requeti.I0- 6T39 -G4175 RD "'" W Name /Method: Supplemental Information.
F IA
BUILDING DIVISION
. 71 s, " TYPE OF WOR' . ° , ,¢, i` i : , FEE* SCHEDULE (for special information use checklist)
['New construction ❑ Demolition Description I Qty. I Fee(ea) . Total
C. < New 1- & 2- family dwelimgs r ,
❑ Addltlon/alteration/re . lacement ■Other P ". (includes 100 ft. for each utility conned} _ .
'''' iP„ e- s ° ► ;�'. . F`: SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
DAccessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LO� ., ,; Fire sprinkler ft.: Page 2
Job site address: ( (9`1 6 t&J {'Q g (� 1 1144/6‘, . i x Utilitte th _ ° '.1:',Ittat
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
7 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax ma. /. arcel #: More tir Ite
; t< .,11, LE I > e = n Fn r 16.60
Absorption valve
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 16.60
Drinking fountain 16.60
. t i . ;_ Ejectors/sump 16.60
Name: v Q O it j[jwn k Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: _Floor drain/floor sink/hub 16.60
Garbage disposal ( 16.60
Phone: Fax: Hose bib 16.60
► PLIC ° -° ,i,.. 6 r ‘ Ice maker 1 16.60
Name: N n g,,_(, 21' _/ V I ��lnyu/ [ iut,& _Interceptor /grease trap 16.60
Address: 0 . �
�- Medical gas - value: $ Page 2
�� Primer (commercial) 16.60
City/State/Zip: !� Roof drain commercial 16.60
Phone 3- 307 -103 I Fax: Sink/basin/lavatory r 16.60
E -mail: Tub /shower /shower pan 16.60
. . , ` t'� 7 :: " g Urinal 16.6
Business Name: :gjt�° a / �� s , Water closet
� t� Water heater 16.60
Address: 3 �/
�1�11J► tIM -
Other:
-- Cit /State /Zi.. , tRI / ZEI NI: _ CT / Other:
Phone:. - 771- bd3 1 jo �. < _-,h
S ubtotal $
CCB Lie. #: 3 do 92(p Plumb. Lic. #:21p 237 'f5j Minimum Permit Fee $72.50 $
Siy * 1 /� �y -1 /� , 1..../ 3 , J Residential Backflow Minimum Fee $36.25
Si a / //� ? Date: / V 1 Plan Review (25% of Permit Fee) $
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:
Site Utilities Qty. F 'otal, Square Footage: Permit Fee:
Footing drain - l' 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
F (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item Qty ( 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 $0,000.00 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
accuratel resort fixtures could result in increased sewer fees *.
„ , , , ; o Comments regarding fixture work:
{
Ba.tis• /Font
Bath - Tub /Shower - -_-
- Jacuzzi/Whirl.00l - - --
Car Wash -Each Stall - - --
-Drive Thru - - --
Cus.idor/Water As.irator - - --
Dishwasher - Commercial - - --
- Domestic - - --
Drinkin: Fountain - - --
E e Wash - - --
Floor Drain/sink - 2" - - --
- 3" - - --
- 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
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refri:. Drains plumbing permit can be issued.
Oil Se.arator Gas Station - - --
Rec. Vehicle Dum. Station _ - --
Shower -Gang -_ --
-Stall - - --
Sink - Bar /Lavatory - - -_
- Bradley -_ --
- Commercial - - --
- Service - - -_
i r - :Pool Filter
Washer = = =-
Washeher - Clothes
Water - Extractor - - --
Water Closet - Toilet - - --
Urinal - - --
Other Fixtures: - - -_
i:\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03
e
�
Mechanical Permit Application FOR OFFICE USE ONLY
N Received Mechanical ,,,f
Date/By: Permit No.: n( ' 0 _ O9 O
City of Tigard RECEIVED Planning Approval
Date Build Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 T j QQ Date /By: Permit No.:
Phone: 503- 639 -4171 Fax. �03- 598 4 -1960 n Post- Review Land Use
/4„ArX w ' N
Internet: www.ci.tigard.or.us '� '`\ Date/By: Case No.:
p q �F (; p � W Contact Juris.: Supplemental Information.
TYPE OF WORK 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 OF 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 L ATION • Furnace - add -on air conditioning ** 14.00
Job site address: ( 7 3 IS 4 - it i f got, f Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work f 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
• PROPE . . OWNER ■ TENANT Other: 1 10.00
Name: m / '�%^ Environmental Exhaust & Ventilation
���'�'� Range hood/other kitchen equipment / 10.00
Address:
City/State/Zip: Clothes dryer exhaust 10.00
Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
APPLICANT CI CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: l Fax: Furnace, etc. **
Gas heat pump **
E -mail. . Wall/suspended/unit heater **
CONT' ' C ■R Water heater **
Business Name: ' / ire .lace **
Address: Q I4 5 Range 1 **
City /State /Zip: - 42(Dr-F Qti Q q� �c(� CBees dryer (gas) **
Phone:S -33 37.7 FJx: Other: **
CCB Lic. #: J . Li + Total:
Aut �� Mechanical Permit Fees*
Si lt " ',�, Date: /6 —/3 -o3 Subtotal: $
Minimum Permit Fee $72.50 $
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 $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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
SAM HARDING INC
23833 NE GLISAN
WOOD VILLAGE, OR 97060 -2942
Electrical Signature Form
Permit #: MST2003 -00500
Date Issued: 10/30/03
Parcel: 2S115AD -00900
Site Address: 16790 SW 108TH AVE
Subdivision: WILLOWBROOK FARM
Block: Lot: 031
Jurisdiction: URB
Zoning: R - 4.5
Remarks: 40 SFexisting space converting to habitable space.
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:
HOCHTRITT, ROBIN L + SAM HARDING INC
KIRK, MONICA M 23833 NE GLISAN
16790 SW 108TH AVE WOOD VILLAGE, OR 97060 -2942
TIGARD, OR 97224
Phone #: Phone #: 780 - 3159
Reg #: LIC 00087048
SUP 3376S
ELE 26 -549C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x p
Signature of Supervising Electric':
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ABC PLUMBING
4326 SE WOODSTOCK BLVD
PORTLAND, OR 97206
Plumbing Signature Form
Permit #: MST2003 -00500
Date Issued: 10/30/03
Parcel: 2S115AD -00900
Site Address: 16790 SW 108TH AVE
Subdivision: WILLOWBROOK FARM
Block: Lot: 031
Jurisdiction: URB
Zoning: R - 4.5
Remarks: 40 SFexisting space converting to habitable space.
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:
HOCHTRITT, ROBIN L + ABC PLUMBING
KIRK, MONICA M 4326 SE WOODSTOCK BLVD
16790 SW 108TH AVE PORTLAND, OR 97206
TIGARD, OR 97224
Phone #: Phone #: 503 - 771 - 4603
Reg #: LIC 30926
LM 26 -237PB
AN INK SIGNATURE IS REQUIRED i H IS FO'
/.
X ,
ti/ .
S': , atu - •_ uthOrile c PI m t*
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24 -Hour
Inspection Line: 503
BUILDING p ( ) 639 -4175 MST 3 - 4 7 a5 - 6'd
INSPECTION DIVISION Business Line: (503) 639 -4171
3 BUP
3
Received J Date Requested /: & AM PM BUP
Location / 6 ' 7 l d /d F Suite MEC
Contact Person Ph ( ) D 7 - 7/ 33 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain AcceSS: ELR
Crawl Drain
Slab Inspection Notes: r ( 7 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm cYWZ\N.l IY, S °a g
Susp'd Ceiling I p v
Roof
Othe :
PAS PART FAIL
PL ' =NG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O • •
I
r42111 PART FAIL
ME ' NICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
qi PART FAIL
RI L
ervice
Rough -In
UG/Slab
Low Voltage
Firm
PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Si Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line f
ADA Date ns 1 � I ectnK L°'`- Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job s e.
PASS PART FAIL