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Permit A . CITY OF TIGARD MASTER PERMIT PERMIT #: MST2001 -00503 ��, %. DEVELOPMENT SERVICES L DATE ISSUED: 10/3/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13499 SW 129TH AVE PARCEL: 2S104DA -03800 SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5 BLOCK: LOT: 024 JURISDICTION: TIG REMARKS: Construction of new single family detached residence.Path 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1.410 sf BASEMENT: sf LEFT: 13 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 2,197 sf GARAGE: 747 sf FRONT: 21 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 9 VALUE: S 346,887.40 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,607.00 sf REAR: 13 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 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: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 7 201 • 400 amp: 201 • 400 amp: 1st W/O SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: . BURGLAR ALARM: 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: $ 5,751.84 This permit is subject to the regulations contained in the STEVEN PRINCE HOMES INC STEVEN PRINCE Tigard Municipal Code, State of OR. Specialty Codes and 13410 SW 129TH AVE 13410 SW 129TH AVE all other applicable laws. All work will be done in TIGARD, OR 97223 TIGARD, OR 97223 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: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: LIC 56046 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 Erosion Control Insp 8i Post/Beam Structural PLM /Underfloor Electrical Rough In Gas Line Insp Plumb Final Grading Inspection Post/Beam Mechanical Ftng Drain Bsm't Walls Framing Insp Gas Fireplace Final inspection Sewer Inspection Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Footing lnsp Crawl Drain /Backwater Plumb Top Out Exterior Sheathing Insr Appr /Sdwlk Insp Foundation Insp Footing /Foundation Dr< Electrical Service Low Voltage Mecha ical Final Issued By : • 1_, ,, .. /Pr, . P ermittee Signature / X/" Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day rd - cis 1- 6 -°( c5 t Paii —00 ,-., 7 Building Permit Application A � Date received: 9 P Permit no.: t :1 City of Tigard 11y / - aoSD s Project/appl. no.: Expire date: City gfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Phone: (503) 639 -4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: I &2 family: Simple Complex: v t•-. TYPE OF PERMIT X I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family New New construction ❑ Demolition 0 Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION Job address: i i S'ix✓ gji A •-1/ 6 - • ,.,01,,x/) 9 7-- 7-3 Bldg. no.: Suite no.: . Lot: A N Block: Subdivision:(} It, I.d I,LD GU 'PS ( Tax map /tax lot/account no.: ZS / ott DR- oar Project name: Aii/57 Description and location of work on premises/special conditions: 4/l?i) 4 t/f�� 141 OWNER FOR SPECIAL INFORMATION, USE CHECKLIST EMEMENZEIMMINMENIIINNI (Flood plain, septic capacity, solar, etc.) Mailing address: /3 Lj f 0 5tx l ;7_9 fat !} tr t � 1 & 2 family dwellin • / l 35 f S 376 City: " • 64 �? p State: OR ZIP: ./P Valuation of work 5 Phone: 57'.- 7'- 3 p,s Fax: " is E -mail: No. of bedrooms /baths a /. Owner's representative: Si v , inf t'� Total number of floors Phone: -/ . I E -mail: New dwelling area (sq. ft.) ..3.6 0 7 APPLICANT Garage /carport area (sq. ft.) 7 lr sD Ele �/! ` s I Covered porch area (sq. ft.) ...1. .Z -/ ��� Mailing address: 2,0 ' Deck area (sq. ft.) City: State: ZIP: Other structure area (sq. ft.) Phone: Fax: E - mail: Commercial/industrial /multi - family: CONTRACTOR Valuation of work Business name: 5 '�V' -7/M Existing bldg. area (sq. ft.) Address: New bldg. area (sq. ft.) gn = rk r` Number of stories Phone: Fax: E -mail: Type of construction CCB no.: •3 d " ,, Occupancy group(s): Existing: New: City /metro lie. no.: Notice: All contractors and subcontractors are required to be ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under Name: T7,Z j p j provisions of ORS 701 and may be required to be licensed in the Address: / 6 jurisdiction where work is being performed. If the applicant is ROW (r1, �✓ State: ZIP: exempt from licensing, the following reason applies: Contact person: C it_ Plan no.: %Q o wl a Phone: ;,2._4/ b Fax: E -mail: ENGINEER Name: Contact person: Fees due upon application $ Address: Date received: City: State: ZIP: Amount received $ Phone: Fax: E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws ordinances governing this ❑ visa ❑ MasterCard work will be complied wi w ether s e i etJ herein or not J Credit c number: I / �y Q / �ry Expires Authorized signature: p . Date: r / /U ff / v/ Name of cardholder as shown on credit card Print name: (fE Pk. /id C ✓ $ Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6 /00 /COM) One- and Two - Family Dwelling � � Permit Application Checklist Building Permit Application Chkli Reference no.: Associated permits: CitygfTigard City of Tigard y b ❑ Electrical ❑Plumbing CI Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 • THE_FOLLQWING 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. 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 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. 26 No rolled, reversed or mirrored building plans will be accepted. 27 28- Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6 /00 /COM) ... ,, Electrical Permit Application Date received: Permit no.: .i City of Tigard Project/appl.no.: Expire date: CityafTigard Address: 13125 SW Hall Blvd, Tigard, OR 9 7223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT Cl 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: Cl Partial JOB SITE INFORMATION Job address: Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision: • Project name: I Description and location of work on premises: Estimated date of completion/inspection: • CONTRACTOR APPLICATION FEE SCHEDULE Job no: • Fee Max Business name: Ross C (e&-r. Description Qty. (ea.) Total no. insp Address: 7 j p �� 0 5 1 ArA L� Newresidential- singleormulti- familyper �/ 3 dwelingtmit. Includes attached garage. City: /'t /c —.carp I State:D /ZIP: 9 7/2j Service included: Phone: 64 2_2_ oOV I Fax: I E -mail: 1000 sq. ft. or less 4 CCB no.: /igi Z / I Elec. bus lic. no: �/ 2_3-2_s— Each additional 500 sq. ft. or portion thereof U Limited energy, residential 2 City /metro lic. no.: •• 1 4 69, Limited ener gy, non - residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: PROPERTY OWNER • 200 amps or less 2 Name (print): STE V / e . T A tiv ce 201 amps to 400 amps 2 Mailing address: 131110 5 ficiA 401 amps to 600 amps 2 601 amps to 1000 snips 2 City: I I r o., 11 f State: O g I ZIP:' • 2_24 Over 1000 amps or volts 2 Phone: X79 ? 0 5'/ 1 Fax: I E -mail: Reconnect only l Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 . Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: . service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase ' of service or feeder fee, first branch circuit: 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): ❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps - rating of 1 &2 O Hazardous location Each signor outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, O System over 600 volts nominal more residential units in one structure alteration, or extension* 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ Other: Per inspection Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires Name of cardholder as shown on credit card accepted as complete. TOTAL $ $ ' Cardholder signature Amount 440 -4615 (6 /00 /COM) • ! Electrical Permit Fees: Limited Energy Fees: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 Ti Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular n Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders n Heating, Ventilation and Air Conditioning System* installation, aiieraiiun, ui relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 n Vacuum Systems , 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation - Fee for each system $75.00 200 amps or less $66.85 ' 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. n Audio and Stereo Systems Branch Circuits n • New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or Ti Clock Systems feeder fee. • Each branch circuit $6.65 2 Ti Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit $46.85 Ti Each additional branch circuit $6.65 HVAC Miscellaneous I I Instrumentation .(Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 n Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) • $125.00 Each additional inspection over n Medical the allowable in any of the above Ti Per inspection $62.50 Nurse Calls Per hour $62.50 In Plant $73.75 n Outdoor Landscape Lighting Fees: Ti Protective Signaling Enter total of above fees $ I I Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations front of application. Fees: .Total Balance Due $ • Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ is \dsts \ forms \cic- fces.doc 10/09/00 • FROM : ROSS ELECTRIC PHONE NO. : 5036422800 Sep. 24 2001 09:37RM P1 sr, ► CITY OF TIGARD plan Check 13125 SW HALL BLVD. Etectricaf Permit Ap Recd By TIGARD OR 97223 Date Recd _ Phone (503) 639 -4171, x304 Date to P E. Inspection (503) 639-4175 Date to DST Print of Type Permit # Fax (503) 598 - 1960 Incomplete or illegible wilt not be accepted Called 1. Job Address: /J �_ 1/ 4. Complete Fee Schedule Below: • Name of Development Q / L • L - O(,/ G"VtUS% NutoLorof Inspections permit alloyed Name (or name of business) - '7 �" . j , Ps• ' -p Service included: Items Cost Sum 4- Address /37� S7jt,r /Z% ' /1V .4a. Residential - per unit City/State /Zip Ti ( ,' d ff,_ ? 72-2-3 1 . 1000 sq. ft. or.Iess 5 11 75 4 E_achadrlitinnai scams ft. or portion thereof $ 2875 1 Commercial El Residential 0 Limited Energy $ 80.00 • Each Manufd Home or Modular 2a. Contractor installation only; Dwelling Service or Feeder $ 72.75 2 - • ( Priocto- petmitissuance r -apptiearnsmustpravtde-co1 ,- kcettse - • infonnation for COT data ft). Installation, aferation, or relocation Electrical Contractor Ket S S e y . 200 amps or less 5- 64.25 2 Address A i1: — 201 amps to 400 amps $ 85.50 2 City 4/ l , I /r State Cr Zip 401 amps to 800 amps $ 128.50 2 Got amps to 1000_amps $ 59250 - 2 - Phone No. , t f 22*6 Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 'Elec. Cont. Lice. No. 3 itie( Exp. Date to Q Z . 4c. Temporary Services or Feeders OR State CCB Reg. No. 1110(4) . Exp.Date t/ oZ,(o Installation, alteration, or relocation COT BUSiness or No: yfpfc9 Exp.Date / 2j-t - 200- or less - - S - 53.50 2 ` 201 amps to 400 amps S 80.25 2 Signature Of Suer. Elec'n . r 401 amps to 600 amps S 107.00 2. Over 600 amps-to 1000 volts, O.2 2 �! see "b" above. License No. ! 3 p(.,,,� E xp.Date %O~ (-03 Phone No. 0 412- e) 4d: Branch Circuits New, alteration or extension per panel a)_The.fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name - Each branch circuit S - 5.35 2 - - Address b) The fee for branch circuits without purchase of service City State Zi(i orfccderfee - Phone No. First branch circuit $ 37.50 Each additional branch circuit $ 5.35- . - The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) Each pump or Irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting ' $ 42.75 Signal circuit(s) or a limited energy panel, alteration or extension $ 60.00 3. Plan Review section (if required):* Minor Labels (10) $ Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4.10. 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per inspection $ 5 00 Per Hour $ 50 00 System over 600 volts nominal In Plant $ 59.00 Classified area containing special occupancy as described in N.E.C. Chapter 5 5. Fees: Se_ ter total of above-tees_ - $ # Submit 2 sets of plans with application where any of the above apply. 0 , h Surcharge (.86 X total fees) S Not required for temporary construction services_ + ubtotal 'd $ 5b. Enter Z5%u of line 5a for NOTICE Plan Review if required (Sec 3) S PERMITS- BECOMEILOID IF WORK OR CONSTRUCTION-AUTHORIZED- Subtotal IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account ft AT ANY AFTER WORK ISCOMMENCEO Total balance Due $ is \rlstsAform_Mckaric,doc A. Plumbing Permit Application A l' Date received: Permit no.: '' Cit of Tigard ^ : _. . Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/app l. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ l & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: / ' f f Sit/ / Z� /1 Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: 2..1f Block: I Subdivision: Qugu` /4/ (2) bath . Project name: 6,„ fie /kw i✓ ery- SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and location of work on premises: Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells / leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft Manufactured home utilities Business name: C q r LA) ° A K .0 L, ix , i 61 Ai G Manholes Address: t ie, `7 73.4, S /(/ /p./ I 3LLs ve- Rain drain connector City: (pd,,ifgyirry I State: ZIP: q'07) k Sanitary sewer (no. lin. ft.) 513 Phone: , 4L% q I Fax: c f 9,0'0 E -mail: . Storm sewer (no. lin. ft.) CCB no.: 74 0 I Plumb. bus. reg. no: o —/ qg Po Water service (no. lin. ft.) City /metro lic. no.: ASV I Fixture or item: Contractor's representative signature: U� j. Absorption valve +� Back flow preventer Print name: fc i -a 11 Date: Z • 0 1 Backwater valve CONTACT PERSON Basins/lavatory Name: S7 v e , ni eci- Clothes washer 3 5 r � Dishwasher Address: p 2-/I21- Drinking fountain(s) City:? (jet go State: 01 ZIP: q 712,3 Ejectors /sump 9) Phone:' 7y o S Fax:57f l'5b E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): Mailing address: Floor drains /floor sinks hub 54---44 e a Garbage disposal ((f Hose bibb . Phone: I Fa:0� 1'!m�tP _ Ice maker Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs /shower /shower pan Name: Urinal Water closet Address: Water heater City: I State: ZIP: Other: Phone: Fax: E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ rm Notice: This permit application ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: Ez i r/ within 180 days after it has be State surcharge (8 %) .... $ p TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6 /00 /COM) PLUMBING PERMIT FEES: • ,PRICE TOTAL .New .1 and 2-fainily dwellings;only: • FIXTURES (individual) QTY - (ea) AMOUNT (includes all plumbing °fixtures in P ; RICE y .. " TOTAL Sink 16.60 the dwelling°and` the "first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Lauriciri Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE: 3" " 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 = - Quantlty-by,Work °P.erformed Gas piping requires a separate mechanical `Fixture;Type - .AMoved Replaced : Reittoved/. • permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Hose Bibs 16.60 Tub or Tub /Shower Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures (Specify) 16.60 Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3 ., Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow'Prevention Device` 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE "PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty total is > 9 TOTAL $ "Minimum permit fee is $72.50 + 8 state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. is \dsts \forms \plm- fees.doc 10/10/00 1. Mechanical Permit Application •.� Date received: Permit no.: ,r� i City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9 722 3 Phone: (503) 639 -4171 Date issued: By: Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT O 1 & 2 family dwelling or accessory U Commercial /industrial U Multi- family U Tenant improvement U New construction U Addition/alteration /replacement U Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: /3 q 99 emu/ 1 Zq i t-0( 6 Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ - Lot: 2..q. IBlock: I Subdivision:awl, j / ('OTt/ Wes' * See checklist for important application information and Project name: CR,( a f ` / 40 L` t?/it/ rimes j jurisdiction's fee schedule for residential permit fee. City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE • Description and location of work on premises: /l/'e it) //cm" e AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE Fee(ea.) Total Est. date of completion /inspection: Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? U Yes U No Air handling unit CFM Is existing space insulated'? U Yes U No Air conditioning (site plan required) Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors • Wall Business name: Ire" Ay Ai co State boiler permit no.: HP Tons BTU /H Address: P 0- 80).- / ? S' Fire /smoke dampers/duct smoke detectors City: H' L I- S /goe p State: OR I ZIP: q -7j y 3 Heat pump (site plan required) Phone: -69 3 3 / b/ I Fax: I E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner O Yes O No CCB no.: 07 Install/replace/relocate heaters - suspended, City /metro lic. no.: / 7 r . wall, or floor mounted Name (please print): ► b $ /A/ VA Vent for appliance other than'furnace CONTACT PERSON Refrigeration: Absorption units BTU /H Name: S E Jt/ /9 /A /CC:- Chillers HP Compressors HP Address: %3 y D SttJ /Z Environmental exhaust and ventilation: City: 776 ak/ I Statq..I ZIP: 972.2-3 Appliance vent Phone: , - 79 - 305/ Fax: 4'7k/ E -mail: Dryer exhaust OWNER Hoods, Type I/ lUres. kitchen/hazmat hood fire suppression system Name: Exhaust fan with single duct (bath fans) Mailing address: £T44e a s n P Exhaust system apart from heating or AC ' i City: r: fir' Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: Fax: E -mail: Fuel piping each additional over 4 outlets ENGINEER • Process piping (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: State: I ZIP: Insert - type Phone: I Fax: n I E -mail: Woodstove/pellet stove Other: Applicant's signatur /k „,i Date: . " / Other: Name (print): ,576 v -/J / /� ,af CE:- j 2— / Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ CI Visa O MasterCard Notice: This permit application Minimum fee $ if a pennit is not obtained Credit card number: / / expires p Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ • Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ Cardholder signature Amount 440 -4617 (6 /00 /COM) I MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00'or including ducts & vents 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14.00 $25.001.00 to $50.000.00 $379.50 for the first $25.000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and .,Chedkfall :that apply :J' , Boiler , : Heat_, ., -Air : h. - _ •,- ,; -. $1.20 for each additional $100.00 or For items.7 -1,1i see.• "' ' . 'nor` _;', ,Puriip`• 'fond = 4i, ", , _ fraction thereof. ,.f ootriotesJbelow,..• : ,,7" - -, a_ Comp � '** - � p': _ _ � ,r2: ; . °a 7) <3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: to - 15 BTU 14.00 3 Value Total 8) 3 -15 HP; absorb Description: unit 100k to 500k BTU 25.60 ' escription: Qty (Ea) Amount 9) 15 -30 HP; absorb Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00 ducts & vents 10) 30 -50 HP; absorb Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20 ducts & vents 11) >50HP: absorb Floor furnace including vent 955 unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM ' floor mounted heater 10.00 Vent not included in applicance 445 13) Air handling unit 10,000 CFM+ permit 17.20 Repair units 805 < 3 hp; absorb. unit, 955 14) Non - portable evaporate cooler 10.00 to 100k BTU 3-15 hp; absorb. unit, 1,700 15) Vent fan connected to a single duct 6.80 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in mil. BTU appliance permit 10.00 30 -50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust 10.00 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40 Air >1.75 ha mil. BTU ndling unit to 10,000 cfm 656 19 Commercial or industrial Air ha ) type incinerator 69.95 Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves Non - portable evaporate porate cooler 656 10.00 Vent fan connected to a single duct 446 21) Gas piping one to four outlets Vent system not included in 656 5.40 appliance permit 22) More than 4 -per outlet (each) Hood served by mechanical exhaust 656 1.00 Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge inserts, etc. $ Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ Each additional outlet 63 Required for ALL commercial permits only • TOTAL COMMERCIAL . $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION': • Other Inspections and Fees: 1. Inspections outside of normal business hours (minimum charge -two hours) $72.50 per hour. 2. Inspections for which no fee is specifically indicated (minimum charge- half'hour) $72.50 per hour 3. Additional plan review required by changes, additions or revisions to plans (minimum charge -one -half hour) $72.50 per hour • * State Contractor Boiler Certification required for units >200k BTU. *' Residential A/C requires site plan showing placement of unit. i:\dsts\forms\mech-fees.doc 10/11/00 E TIFICATION T R N IF STREET C 0. ,.., a PR M/G6 O wner /A gent for $ - t /^f 6� 11 e�--� e 1 I, (PLEASE PRINT) (PERMIT HOLDER) y e _ . ., Do hereby ee'rt 4y that the fo11dwing location meets ? City , of #T /XTashin on County l and use and development standards for street tree installation. s1J /2 /9 ADDRESS: / Y9? / , 0.-- : LOT: 7 S UBDIVISION: c. .� G(G�i L 6Lc�l(,cf Vt/ 'Y .. BY: G'/ . 4 ---- - t - -r DATE: A� 0 2_, ot- 41 RECEIVED BY: DATE: 4/ Th'�- • CITY OF TIGARD 24 -Hour BUILDING' 11 Inspection Line: (503) 639 -4175 / —' 3 -- INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM BUP Location / 3 (49 ci /a-9 Suite MEC Contact Person Ph ( ) 7 30S/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Aces: CT-)11 0 — EL f ` /?i�' ELR Crawl Drain K Slab Inspection Notes: , SIT Post & Beam 1L f r!� '2/ Shear Anchors Ext Sheath/Shear 1 j - --.. ` ' ),J1 Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: r . PART FAIL ?' BING 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 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 0 Please call for reinspection RE: ❑ Unable to inspect – no access Fire ADASupply Line C/e5 a� J \ Approach/Sidewalk Date Inspector U` Ext3 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 . 200 / 605 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 9 AM PM BUP Location / 1 1 G / /c? 9 Suite MEC Contact Person Ph ( ) `j 7 . 305"1 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation c ELC . Ftg Drain L L._ \,� 9� ©�/ i L ELR Crawl Drain /� -- Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear J Framing r5 4 Rp -49-k Insulation � ` Drywall Nailing 71-e- `"� 'e r ct /L` V�, 'o` 4 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: OOP ft* PART FAIL HANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG /Slab Low Voltage -Q 1 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 0 L Approach /Sidewalk Date Inspector Ext • Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL L CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST 0 ( 6 d 03 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 3 AM PM BUP Location / LI em "1 ` 'e-- Suite MEC Contact Person Ph ( ) G ) D--&' Q PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation / 1� / l� ELC Ftg Drain Ce - � ( Ill Crawl Drain L6 � Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear • Framing Insulation Drywall Nailing Fire wall Lav �U Fire Sprinkler 7-70,4<g. Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In J Water Service Sanitary Sewer O' 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 UG /Slab Low Voltage Alarm Fire Arm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line & ADA Approach /Sidewalk Date / Z V (dam Inspector Ext • Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL