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Permit MASTER PERMIT CITY OF TIGARD PERMIT #: MST2003 -00470 1 A DEVELOPMENT SERVICES DATE ISSUED: 10/6/03 . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12594 SW 131ST AVE PARCEL: 2S104AC -08300 SUBDIVISION: MORNING HILL NO. 9 ZONING: R -25 BLOCK: LOT: 226 JURISDICTION: TIG REMARKS: Addition to (2) existing bedrooms, bumping out over existing garage. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 20 FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 190 sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: 18,250.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 190 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: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FD R: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 1 00 SIGNAL /PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 526.55 This permit is subject to the regulations contained in the BOWEN, GREGORY S + DEBORAH M DENNIS WANLESS CONST Tigard Municipal Code, State of OR. Specialty Codes and 12594 SW 131ST AVE PO BOX 23453 all other applicable laws. All work will be done in TIGARD, OR 97223 TIGARD, OR 97281 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: 503 - 529 - 2228 Phone: 503 780 - 7658 Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through 952 - 001 -0080. You Reg #: LIC 93348 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Mechanical Insp Insulation Insp Electrical Rough In Electrical Final Framing Insp Mechanical Final Shear Wall Insp Final inspection Exterior Sheathing Insj I / Issued By :... s.., . _ Permittee Signature : _ / Call (503) 639 -4175 by 7:00 p.m. for an inspection needed th next business day ti Permit �. 1� . j n `' ' FOR OFFICE USE ONLY Building �e REs N C Rece ' �� ; � Building / Date/By: • < f- J Permit No.: M�� -OU`T 7d Cit Of Tiand �+ Planning Approval Other 3' g Date/By: Permit No.: '''''---..i. 13125 SW Hall Blvd. SEP 1 7 2003 Plan Review q Other Tigard, Oregon 97223 Date /By: (A v - l ` f y " 01, Permit No.: Phone: 503- 639 -4171 Fax: 1}�R , P ost - Review Land Use Internet: www.ci.tigard.or.0 (]3, t Ca No (,f`( DateB nCry NG DIVISI � =' °" Contact ( #3 ,4 \ u .. (2g See Page 2 for 24 -hour Inspection Request: `SB3 -639 -4175 Name/Method: /1 Supplemental Information & j. _ " a"�^ ' Y > z '�i-'�,; � &." ...,!: � �;; § � HrsR `'�,:'' :°��ia '.��5�'y`�k: �d.'i„, , #.... ,.: 4 , ;.;`�:.„' , «..aa. xu�,a.:�i h`Y4 � � �'.. §,.e._ � �� �'� � �.., e ��` " �i z �r��I�jlA;L1� jD�e�/� a a's "s { c . ,, 1 � h � �� -„, ❑ New construction ❑ Demolition �° - 13 . ga Y D�LLIN�� +° -t ? © ' Addition/alteration /replacement ❑ z,< _ '" GA)AEGOR OF Q 1 R aci mi Note: Permit fees* are based on the total value of the work performed. Indicate • E 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi - Family ❑ Master Builder ❑ Other: Valuation $ 1, 2 S OD �_�: r No. of bedrooms: No of baths: 2. /Z. I ; a� r®B,` 5 t amo vi l an l odeat N;` a: Job site address: / z. Sqt/ ..1,---) /3/ -s'` ,4ve 7-I /s7,e Total number of floors New dwelling area (sq. ft.) i Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) Project Name: / O- L,00s.ti Covered porch area (sq. ft.) - Cross street/Directions to job site: S r� //✓4L. Li Ti— Deck area (sq. ft.) Other structure area (sq. ft.) �/ n//,5/ .k.- oG lrf'U QO4/5 ,"" 1-'m C a � �� :�'�Q � 1 � I , � � 5 ., ; * C 0 it-W AEG US C tWel<LIST $ " ... r i _ Subdivision: Lot #: U , 4' ` 1.t : �, ` ,, i .1.3 Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate '/',tvla.,,DESCRIPION ®R }:� " the value (rounded to the nearest dollar) of all equipment, materials, labor, � ,`''E; / l overhead and profit for the work indicated on this application. K E - -'Vi1 L);U /�- I Lt7 -vtS A 2 6V `r E- /7-A-4 ( 67: 4/ a - 31 Valuation $ J Existing building area (sq. ft.) New building area (sq. ft.) Number of stories L' F;; '� : T 6 l ��PRQI '.L'+`�,R'1±xY�:O�TE'R..�g =�� • t.� 'GE NA�,1�� , �,�� :�� =�� Type of construction 1 &_ 40l�e_.tJ O ccupancy group(s Existing: Name: CS-,r U �- New: Address: l Z.Sci t/ S1-tJ / 31 -5 °- .4-/IL City /State /Zip: 7 G-4-r- d- .,1) , 4, ' r Z� . Phone: s31.9 - �a.a 4) Fax: NOTICE: All contractors and subcontractors are required to be y � licensed with the Oregon Construction Contractors Board under « . � s provisions of ORS 701 and maybe required to be licensed in the Business Name: .T ..i s 'i .s ) '' "" bf s 5 f!,4 ,v i , jurisdiction where work is being performed. If the applicant is exempt Contact Name: //) ,v.4 s 6�V � R .v 55 from licensing, the following reason applies: Address: PU i e' X_ 2 3' 5` 3 City /State /Zip: -r- /&4RJ , 42, 1 7 � l - Phone: 75(0 -7 /off Fax: / S/- 710 % „4��� ;� �:� 1 E -mail: , to B S� -- G P�ERMI EE i 4 g i 1? . ! p e� e aSe refers 0 Peer`s ited e . ;+ f r f k Business Name: ti /v / S 1/V.A. �-I ' e -s- r _4&37. Fees due upon application $ Address: gyp- .s e , x y S.3 City /State /Zip: - - l - A-,-ycl- , - /L , 7 Z5( / Amount received $ Phone: 7 <60 -7t S Fax: 9L p i �z7 - Date received: CCBLic. #: x/33 4 s, 3-2 q Authorized Notice: This permit application expires if a permit is not obtained within Signature: , ' il ` -'1 I -+�_': '171:;1 7 180 days after it has been accepted as complete. D p,414)� i 5 e 4 ^ ` /A✓IJ / s S *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 . • ' 4, M ' ' One- and Two - Family Dwelling ,. VP 1 Building Permit Application Checklist Referenceno.: Associated permits: City of Tigard City f Ti and 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. S Co' s report. Must carry original applicable stamp and signature on file or with application. 9 Erosion ontrol ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of cat`ch rotection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building des. Lateral design details and connections must be incorporated into the plans or on a separate full -size tached 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. "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) f Il • 1 , FOR OFFICE USE° ONLY n Electrical Permit Al 1 • • Received c / � Electrical ° ! . Date/By: / 7 0 3 Q-6 Permit No.: M/ O5- cv 5/70 Planning Approval Sign City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. SEP 1 7 2003 A Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 F ax: Post- Review Land Use F�iARD //nm i i ddjl y ��v , A Date/By: Case No.: Internet: www.ci.tigard.or.usp DIVISI • .1 it contact Juris.: ®See Page 2 for 24 -hour Inspection Request: 3- 639 -4175 - N ontact thod: Supplemental Information. • o- El New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ® Addition/alteration/re a lacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, 411 ..t . ,C .;E�( ° ®t,ONS'bZ.L'7; :017", ZF � �. , � ,. „ ,„�� a�1 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 stones ❑ 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: ra { , °q : G ° °,.. i " °`` axik ~` °` Submit sets of plans with any of the above. ; � f ��� SI�TL�iN ® x12MA��CINantl ;OC�;T1:QNp`;«���� P y Job site address. �� The above are not applicable to temporary construction service. Suite #: I Bldg. /Apt. #: .: ,. _ ,:,:.�3 „� fi � � Number of inspections per permit allowed Tt��T�,,X, "� . ��:� � a Project Name: Description Qty Fee (ea.) Total 1 New residential- single or multi - family per Cross street/Directions to job site: 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: I Lot #: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling =`a,f ':"”? "r A . `_ service and/or feeder 90.90 2 ;,T : ITSGRIRTTON �+;0_.:. _ ..z; x �� ��� ° Services or feeders - installation, alteration or relocation: 200 &nips or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 �iY�R� r o- E Al ,Ft sr � r 601 amps to 1000 amps 240.60 2 ` " °' `� `� ` '�� Over 1000 amps or volts 454.65 2 Name: Reconnect 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 ` ' . + r,° 401 to 600 amps 133.75 2 �� � � Branch circuits - new, alteration, or Name: I extension per panel: . A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 2 City /State /Zip: `B. Fee for branch circuits without purchase of i service or feeder fee, first branch circuit 46.85 2 Phone: I Fax: Each additional branch circuit 1 6.65 2 E -mail: Misc.(Service or feeder not included): ,{ W " x Each pum r p or irrigation circle 53.40 _ 2 ,� Each sign or outline lighting 53.40 2 Job No: 1 9 -- f) - j . /Z Signal circuit(s) or a limited energy panel, alteration, or extension Page 2 2 Business Name: Description: Address: City/State/Zip: Each additional inspection over the allowable in any of the above: y p Per inspection per hour (min. 1 hour) 62.50 Phone: • • Fax: Investigation fee: CCB Lic. #: Lic. #: other . , . AIecirica t" in t�`ees *' ? ....... _C NC . it Supervising electrician Subtotal $ signature required: Plan Review (25% of Permit Fee) $ Print Name: Li.. #: State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Authorized / Notice: This permit application expires if a permit is not obtained within Sign. e: - , J —��. J, /. . o-: , /7 - 180 days after it has been accepted as complete. *Fee methodology set.by Tri -County Building Industry Service Board. / -s J ' , _S S (Please print name) i:\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 El Burglar Alarm Ti Garage Door Opener 7 Heating, Ventilation and Air Conditioning System Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation E Fire Alarm Installation • HVAC PI Instrumentation O Intercom and Paging Systems Landscape Irrigation Control E Medical n Nurse Calls ri Outdoor Landscape Lighting n Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 . . ,..1. . .., . • - Mechanic , ' t... : 01. 7 ■ , . ,..tri plication . Received FOR OFFICE USE Mechanical , • ONLY ' - Date c /By: / 776 (nab Permit No.: ri5goe5- 064- • • -- City • of Tigard ,, E V. 2(/C113 Planning Approval Building Date/By: Permit No.: 13125 SW Hall Blvd. ___P Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: D Phone: 503-639-4171GIVWF5 A60 . Post-Review Land Use ni r-. n l I 4 L' ' " herappool,A Date/By: Case No.: Internet: www.ci.tig8tIVILlir - - -1 4 v. :4 1 1 I Contact Jut-is.: El See Page 2 for 24-hour Inspection Request: 503-639-4175 -"'" ' Name/Method: Supplemental Information. Wf. 4 tsemo . 7 0 New construction D Demolition Mechanical permit fees* are based on the total value of the work El Addition/alteration/replacement El Other: performed. Indicate the value (rounded to the nearest dollar) of all i0 -*STAY,MitraillIVIMONSTRIiIMI_O,Ntaill mechanical materials, equipment, labor, overhead and profit. El 1 & 2-Family dwelling ri Commercial/Industrial Value: $ See Page 2 for Fee Schedule 0 Accessory Building 111 Multi-Family ZW.WII)MrAREOWTSVIHT ISVSOWSIMMEEMVOI Description I Qty I Fee(ea.) I Total 0 Master Builder 0 Other: T.-4.1-PI4110,11:idiEE-FJRaftiigi.eallii413:0-4.\:.V-A*,,,,;;,7::,-: Mari 910VridEti:ant*M'M Furnace - add air conditioning** 14.00 Job site address: / t �11, 2_, • ,,,9 tg, v. , 7 4/ ( 4,j__ Gas heat pump 14.00 Suite #: '. Bldg./Apt.#: Duct work 2_ 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: '/,,„i / )4)14 7 (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: Lot #: Repair units 12.15 ekt:,EllgialtIti*TiO.iliCO:6W41301 iiiOfi%VieMl!*I'a Tax map/parcel #: Water heater 10.00 - ffrafft:::: . afgaYSOMORROWNSI....: Gas fireplace 10.00 iE)< (7--) ' H ka C.7.11:S-.' 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 9 Ela OaWWIWCI:YC'Wrg,.'WialiEikWtYA:Nir4NO*:;:Ntg:.C42 Other: 10.00 .':-:-WaValtiriraiiilaiifillitiiii;i4001111144ROMVIM-41*:iit Name: 6 A. a. (..,-- 5- A es_A .A / ,. 607,,.ief-A Range hood/other kitchen equipment 10.00 Address: / 2._.q L/ £ ki / 3 / Clothes dryer exhaust 10.00 City/State/Zip: - 7 -- /z.,-4- , .--J--- , -iz , 4 7 z 2 -.. Single duct exhaust Phone: s-03 S -79- 2z_2_8' Fax: (bathrooms, toilet compartments, rEnt 0 rt KOWAVOMO.Mitill utility rooms) 6.80 Name: Org_4,4ii's k,A A.,16SS Z.0-4/177 Attic/crawl space fans 10.00 moo Address: p ,s •.3 9 .s--3 6.7,-M Other: MV.W-11, City/State/Zip: 7 I L , 7 z y / **($5.40 for first 4, $1.00 each additional) Phone: 5' 3 71(0-7k_s7( Fax: s--,03 qhc/- y7z, 7 Furnace, etc. ** Gas heat pump - ** E-mail: , Wall/suspended/unit heater ** Eitfz:W;A*MSIit:S'KONMM.)*SMP":ntzraaV, Water heater ** Business Name: ,49 WA 5 S Z.e--4 77 Fireplace ** Address: to 29 &;. 2( 7 3 9. ss Range ** . . BBQ ** City/State/Zip: -- , , 472 5r 1 Clothes dryer (gas) ' ** Phone: 7y)-7z,9s Fax: 96 - y 76.7 Other: ** CCB Lic. # q s S 1.1 / ,_ r Total: Authorized it .1ik. eelialifei 1 aYeiiiiitio. i walatialopgiu ; 74 . , , : .:.:;.--;•:. . . i re: Subtotal: $ t Signa __:;„,_......r , _../..„( ,,,...„d , . II . e: - - -2 2 -ti..3 ,...0 e-,4A-6-y 5 ,e, /4/4-Ar ,.--°--5"..C. 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 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: • Wf, $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. galiateittOUatt0115 Appliance 4 ,zes Value Total Description: Qty (Ea) Amount Fumace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 <3 hp; absorb. unit, 955 to 100k BTU 3-15 hp; absorb. unit, 1,700 101k to 500k BTU 15-30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30-50 hp; absorb. unit, 3,400 1-1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non-portable evaporate cooler 656 Vent fan connected to a single duct . 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL KOMI $ VALUATION: wm':24 i:\Dsts\Permit Forms \MecPermitAppPg2.doc 01/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE OWNER Electrical Signature Form Permit #: MST2003 -00470 Date Issued: Parcel: 2S104AC -08300 Site Address: 12594 SW 131ST AVE Subdivision: MORNING HILL NO. 9 Block: ^ Lot: 226 Jurisdiction: TIG Zoning: R - 25 Remarks: Addition to (2) existing bedrooms, bumping out over existing garage. 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: BOWEN, GREGORY S + DEBORAH M OWNER 12594 SW 131ST AVE TIGARD, OR 97223 Phone #: 579 - ZzZ8 Phone #: Reg #: AN INK SIGNATURE IS REQUIRED ON THIS FORM X , Signat of Supervising Electrician If you have any questions, please call 503.718.2433. CITY OFTIGA 24 -Hour BUILDING Inspection Line: ,(503) 639 -4175 • MST `� 7 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received / Date Requested AM PM BUP , t' Location l - � ` / :3/ = Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner 5 7- z z 2- ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: / _ SIT Post & Beam 3 Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing • Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: ,fig ,T_ 'ART FAIL PO 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 ii Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE_ Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL