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Permit Alsb CITY O� TIGARD MASTER PERMIT PERMIT #: MST2003 -00205 I j I' , DEVELOPMENT SERVICES DATE ISSUED: 6/11/2003 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 08080 SW CHURCHILL CT PARCEL: 2S112CC - 03100 SUBDIVISION: BOND PARK NO. 3 ZONING: R -12 BLOCK: LOT: 059 JURISDICTION: TIG REMARKS: Addition of 66 square feet + kitchen /powder room remodel. 10/28/04 reinstated for 30 days for final inspections BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: FIRST: 66 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 15 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: TwRD: sf RIGHT: 5 VALUE: 40,000.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 66 sf REAR: 15 PLUMBING SINKS: 1 . WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: 1 WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: 1 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 FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 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: 9.00 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 9 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 996.29 BICKFORD, GARY J AND MERRIMAC CONSTRUCTION This permit is subject to the regulations contained in the B B ICKFO M MERRIMAC SW [ELAND RD S Tigard Muniapal Code, State of OR. Specialty Codes 8080 SW CHURCHILL CT OREGON CITY, OR 97045 and all cer applicable laws. All work will done in TIGARD, OR 97224 accordance anrace with approved plans. This p . This permimi t will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: Phone: 956 - ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: L IC 00050264 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 Footing Insp Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insf Building Final Footing Insp Underfloor insulation Electrical Rough In Insulation lnsp Foundation Insp Crawl Drain /Backwater Framing Insp Rain drain Insp Foundation Insp PLM /Underfloor Framing lnsp Mechanical Final Post/Beam Structural Mechanical lnsp Shear Wall Insp Plumb Final Issued By : Permittee Signature : Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day Building Per td.,-i �+% i 1 n FOR OFFICE USE. QNLY �� t. , Received Building Date /By: S alb 6 5 Of Permit No.:, .2 'COPUJ -- C of Tigard Planning Approval Other Y g MAY 2 0 2003 Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other W Tigard, Oregon 97223 CITY OF TIGARD Date /By: Permit No.: Phone: 503- 639 -4171 R1 1,0041# Post- Review t . (D- O ° j Land Use � �-�rv�� I� a a I , Date/By: ,L Case No. r Internet: www.ci.tigard.or.us c � --a Contact � `p Z See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: / /(p , Supplemental Information 4 ,, , " e' �1. = ;v;, , TYPE;OF-WORK x,: ...: Z:....'_ p z.,a �� � �k�z ^� REQUIRED.DAT�A � � , � ❑ New construction ❑ Demolition 'i . j ' 2 1 AIVIlLY DWELLING ` = ix Addition/alteration /replacement III Other ,, � 1 � % ���� ; �� m „.. ,X� 4'..,,,:t ,: '* „J. ` ;; CATEGORY ;OF,CONSTRUCTION: . Note: Permit fees* are based on the total value of the work performed. Indicate I• 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 $ 4 , f9D© iairAZ OBr SITE INEO LOGATTON = °. �; No of bedrooms: No. of baths: 2 Job site address: 80 go S�III` . �siUlpzid f t � Total number of floors �r- New dwelling area (sq. ft.) 41.0 6g Suite #: •--- _ El . /Apt. #: Garage /carport area (sq. ft.) Project Name: fj1CKAd,e tp” Covered porch area (sq. ft.) Cross street/Directions to job site: - Deck area (sq. ft.) Other structure area (sq. ft.) N REQUIRED DATA : , , �, ' , - _ COMMERCIALS „USE CHECILIST. ` ' - ° ; - Subdivision: I Lot #: Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate iff i s F ADESCRIETION'5OF W i RK , 3 „; ,, ,, „, the value (rounded to the nearest dollar) of all equipment, materials, labor, .A { ,�J r. . overhead and profit for the work indicated on this application. Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories LE PROPERt1 OWNER, ', a > p"TF,NAN:T MEF c' ,r; „Y : :: Type of construction , . Name: /yag�l� g lot }eo,e� Occupancy group(s): Existing: . _ Address: 6Q S'.∎41 C., l-kw -1 L New: City /State /Zip:T/64RD, . ©, 64/ - Phone:, - GZD - 51814 Fax: NOTICE: All contractors and subcontractors are required to be AP•PliICANT ., _; CONTACTwfPERSON _.: licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name : /rit612fzf /4/-16 $raz.nojj jurisdiction where work is being performed. If the applicant is exempt Contact Name: ja /VI <C4A/A/ from licensing, the following reason applies: Address: /J ,� L J WD RD City /State /Zip: Cir/AA 974 Phone :53 7$9'-.907 Fax50 66 1226 ., , - ., r . :Ni ,., E-mail: ` r it 3 B UILDING PT FEES* y 3 :.. A to fe es d g i - Please refer the e �� � �. , :� � �. ��,,.�:: t�.��..wCQNTRACTOR��,.,;. *, ,.. n Business Name: Mgeb /k 6 ikAii Fees due upon application $ Address:,'/ / '7 5'.456,34L0 2 D, City /State /Zip: 6, 44 /7 - 97041-6.-- Amount received $ Phone5e 7g9- . 7 Faxs43- -- /22,5'' Date received: . CCB Lic. • 5'02 Authorize. I (� Notice: This permit application expires if a permit is not obtained within Signature: i ' _ _ k!+` tajr ” - E Date: S , 0 7 180 days after it has been accepted as complete. i•ajla0 ! / � � i / t/ *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 • One- and Two - Family Dwelling • • ' • ° ' � ,� Buildin Permit A Checklist Reference no.: '`II - Associated permits: City of Tigard City of Tigard ❑ Electrical ❑ Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE.REQUIRED FOR PLAN REVIEW Yes • No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water,district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- in 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 •ght violations exist. �j 11 ploY plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if "� themore 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 -iize 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 • 3 Fi (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 1.1" x 17 ". 4 Tw• sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 -4614 (6 /00 /COM) Electrical Permit Application FOR OFFICE USE ONLY R ece i ve d Electrical , i Date/By: A 5 ' Permit No.: /71 O(J 2 <' Cit of Ti and Planning Approval Sign Y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review / Other Tigard, Oregon 97223 Date/By: NOV 6. /, v3 Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use //yerpd<b + Date/By: Case No.: Internet: www.ci.tigard.or.us , ol ® See Page 2 for g ■ �,�,, a C on t act Juris.: 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. _- ' ' 41 'REVIEWr Please afal` atrifti i 1 1 _ g aj ,.. -, ... _`� � Tl'PE;�OF WORK, r , , �..� � � .., .LAN ,�:.z��'n.�•�,���.;�_ �,.�: g ,�:� �, g.�,.�.: ,; ,.;_ �� ..�� ��_ �3.w_ � .,_ as ( -- - -- PP Y)d..�w��. � '���. ❑ New construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, V-ti ' CATEGORY OF CONSTRUCTIQN ' : `''r.. = I & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial El 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: `., RJ . JQB INiFORMATION.and J.t °" Submit sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: SDa'j �51i Wow/ L a t %�..�.� �;�+.�.: ter_ ,,:�:: FEESCHEDULE� a��r �.��ileari:�: t °..st €::: Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: HickFeR 17 Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential- single or multi - family per 1 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 Subdivision: I Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling om m - ?ii „gym`'; }. _. DESCRIPTIONtOF WORK .}i ....; • .,;, : serv and/or feeder 90.90 2 Ser vices 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 y , 4i /PROPERTYOWNER t 3; :I r .._� Ni n, N'd,'` 601 amps to 1000 amps 240.60 2 �TEANT / /�' � �e o O ver nett amps or volts 4 2 ' Name: Reconnect only 66.85 2 . Address: g,986 5, s (7 Of l- /LL. Temporary services or feeders - installation, alteration, or relocation: Cit /State /Zi • : - " ■ ! ♦ 4. - t 200 amps or less 66.85 1 Phone:503 .4,20-4 ,5, Fax: 201 amps to 400 amps 100.30 2 . , �„ , 401 to 600 amps 133.75 2 AP AN PLICT ;s` <� ,�,. , it ' ;C®NTACT PERSON ; °i Branch circuits - new, alteration, or • Name: /42e /h')� /S'j, o t.,I * j AI c",u1a extension per panel: Address: /t8 � A. Fee for branch circuits with purchase of 7' V l service or feeder fee, each branch circuit 6.65 2 City /State /Zip: Coy B. Fee for branch circuits without purchase of / service or feeder fee, first branch circuit f 46.85 2 Phone: I Fax: ' Each additional branch circuit P. 6.65 2 E -mail: Misc.(Service or feeder not included): ' ,, a �, „., r 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 F Business Name: ,1 et5 _ Cry ..1 r Description: Address: Each additional inspection over the allowable in any of the above: Cit /State /Zi.: i).. 4 1, i 4 Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: - Investigation fee: CCB Lic. #: Lic. #: Other :�� _ „.. 0 if.. cElectrlcaOermit:Fees t..4SaZ ,._ .a..... _ Supervising electrician 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: n Audio and Stereo Systems n Burglar Alarm n Garage Door Opener n Heating, Ventilation and Air Conditioning System n 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 F Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems ti n Landscape Irrigation Control n Medical I T Nurse Calls 0 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 liuilcttng fixtures Plumbing Permit Application FOR OFFICE USE ONLY N� Received o 5 Plumbing V 5 �� o3^ , Date/By: ? Permit No.: I r t76.2,65j Cit of Ti and Planning Approval Sewer y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 DataBy,: • Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post = Review land Use �H�u � �'�" i` Date/By: Case No.: Internet: www.ci.tigard.or.us • ar .611 � ® See Page 2 for g • e Contact Case : 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. t2 , ms re atOl Ci O ti y '311-, . .: F E SCHED T tr o taiotal >infort at su a chre atio ❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total A ddition/alteration/re lacement Other: Newi &2famtly dwelhngsWZ III F . R(1)b �°, Addition/alteration/replacement � (inetudesi100 ft�orieacL;y °tih �� �;�,� '•` , CATCOOTIV OF CONSTRUCTION :'' ,` pi . ,; El & 2- Family dwelling ❑ Commercial/Industrial bath 249.20 SFR (2) bath 350.00 ❑Accessory Building ❑ Multi Family SFR (3) bath 399,00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 U ILMAISI E INFOitii40ION.arid'LOCATIIONN M' Fire sprinkler - sq. ft.: Page 2 Job site address e0 5 .1,il e CNU,PCJ/JL L : at m_ t t Utilities .4: waif ' ; . Suite #: -'s) Bldg. /Apt. #: Catch basin/area drain 16.60 Drywell/leach line /trench drain 16.60 Project Name: 9/2 iFp, L 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 Tax map /parcel #: r (no. linear io 2 Water (n Fixture.FdrIte Page ate service t isanit : ,DESCRIPTION ®F ottiomm ,t.,;. Absorption valve 16.60 // &l(� 4 2 tiiY1i Backflow preventer Page 2 Pr E'Cr' Backwater valve 16.60 Clothes washer . 16.60 . Dishwasher 16.60 i PROP R =MIONNER = T :PsI ttOr it i fountain Drinkin fountai 16 0 l �� ` � � �'° �'�� � "' Ejectors /sump 16.60 Name: ,9&' S,(/i ,631C'FE L Expansion tank 16.60 Address: p 61t1 C/ JP'/.?t(L1 Fixture /sewer cap 16.60 City /State /Zip: 77 ,Q f 4 J .) Floor drain /floor sink/hub 16.60 Garbage disposal 16.60 Phone: .603 -,zo _ Idgi Fax: Hose bib 16.60 2 .. WPLICAN'T ~; ( , §;, . k GONTXC,T PE RSON ,. Ice maker 16.60 id. Name: En / 0 .0B!/ 4f4( (,.57 Interceptor /grease trap 16.60 Address: lig 7 /' '.4/1/0.,80 Medical gas - value: $ Page 2 • ( �,,�� a/7 y ( . Primer 16.60 City /State /Zip Roof drain (commercial) 16.60 Phone:c5 S 7 9 O7 Fax: 5o3- 6s6„-).25 Sink/basin/lavatory 16.60 E-mail: Tub /shower /shower. pan 16.60 getl , i mom: . CONTRACTORI.. `f. w= MitrA.T6, Urinal 16.60 Water closet 16.60 Business Name: C93'4,/ey // e / ,Y7gir /e. Water heater 16.60 Address: Other: City /State /Zip: Other: Phone: Fax: i U iii. IftaliiiiIiKiiiittlnalitiMMIKVAM r Z Plumb Lic. #: 3 7 3 subtotal $ CCB Lic. #: 3 7 Minimum Permit Fee $72.50 $ Authorized _ 2 - t.t G -3 0 loci/ Residential Backflow Minimum Fee $36.25 Signature: Date: 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: $1eilVjgifeivrz.40 1#:xe7,0 rlog e Footing drain - l 100' 55.00 0 to $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 , - 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 Iim additional $100.00 or fraction thereof, to and 500 including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Comments regarding fixture work: Fixturype t4g4:14ii itegrZir,PVgti4Z NeW7 iiA46C7e2 Existing Capped _ Baptistry/Font Bath -Tub/Shower -Jacuzzi/Whirlpool Car Wash -Each Stall • • -Drive Thru Cuspidor/Water Aspirator • Dishwasher -Commercial -Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" Car Wash Drain Garbage -Domestic *Note: If the fixture work under this permit results in an 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./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) • Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory -Bradley -Commercial -Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Forms \P1mPermitAppPg2.doc 01/03 Application FOR O FFIC E USE ONLY Mechanical Y Permit ` � plic tion Rece Mechanical Date/By: ,I) Permit No.: t ? —oo,09,6,5 _ C1 of Ti and Planning Approval Building `J b Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503 - 639 -4171 Fax: 503-598-1960 Post - Review Land Use //H�ru,,m 0 I Date/By: Case No.: Internet: www.ci.tigard.or.us a . ' I I Contact Juris.: Z See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information. .fir" ,,, wog_. ' 4 .Arad ;e10, OF W®RKc .. =' ;° . . COMMERCIAL; .FEE *'SCHEDULEi, USE,CiiFerm T Ne construction El Demolition Mechanical permit fees* are based �n the total value of the work Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all ntiaZaVt 04-10:00011000ONSTogUaTIONMAri ', ,: 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 III Master Builder El Other: °n gC Fee(ea) T Description � Qty Total __, JOBMTEtRORMATIO )`TandN0 „GATION.YiaM6 Furnace - add - on air conditioning** 14.00 Job site address: Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: 1j6aj,p,n Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: � (for radiator r 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 Tax map/parcel #: ' ��:_-:,a _ . -'� 1 O:flrir;Faei Appliances ' i ,':•, Water heater 10.00 `,I a 5.. DESCRIPTIO ON F WORK i t'� i � � � � �� �� ��� +j � v Gas fireplace 10.00 •- WA I4 k K i rC De r f�G.--- 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 PROI'E / � WNER / TENA ,;, :. ,. R hood/other er itc en equipment 10.00 Address: t. - _ _ ... W 1� ,,� 5 ter: Name: e C ��,Q,® '� c`_: , . < ' �` Envii• o` nmental�Ezha `tisf�` &;�'enfilation ;. „ , , ._.._ � _ ; � go $' 1 �1 'ho l � / l j Range } h k' h equipm A�, (' EtV�CC.l G L. Clothes dryer exhaust 10.00 City /State /Zip: ?i6442, 6,8E Single duct exhaust Phone:...523- 62.z3 -rig i4 Fax: (bathrooms, toilet compartments, -- FM APP<LICriNT:i ; °. tE .' YCOIYT.AOTYIERSON > M utility rooms) 6.80 Name: PD McC i/ ogAmep/!yI ele; .r Attic /crawl space fans 10.00 Address :a/187 /I s L, , cwo . r Other: 10.00 7 t a; , Tt �.°_ ,.� ''U'� F,uelrPii►i �'� . �. �� ° z ,; ,� . �A � ... °.`� a � City /State /Zip: , 3e C eW �� * *($5.40 for first 4, $1.00 each additional) Phone 3 _ 789.-9g07 1 Fax: 3 _06-122.5” Furnace, etc. ** Gas heat pump Email: Wall /suspended/unit heater ** s' 4 ,: r s S t E CONTRACTOR- > ".:,msµ „ ..'.��`'W Water heater ** Business Name: Fireplace ** Address: - Range ** BBQ ** City /State /Zip: Clothes dryer (gas) ** Phone: Fax: Other: ** CCB Lic. #: Total: Authorized • . - - :- eehinicarPefoil .Fees * - ."'. ' Subtotal: $ Signature: Date: 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: $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. Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 • Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 <3 hp; absorb. unit, 955 to 100k BTU 3-15 hp; absorb. unit, 1,700 101k to 500k BTU 15-30 hp; absorb. unit, 501k to 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 $ 4 ti VALUATION: \Dsts \Permit Forms NecPermitAppPg2.doc 01/03 CITY OF TIGARD . 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ROSE CITY ELECTRIC CO INC 4012 NE CULLY BLVD PORTLAND, OR 97213 Electrical Signature Form Permit #: MST2003 -00205 Date Issued: 6/11/03 Parcel: 2S112CC -03100 Site Address: 08080 SW CHURCHILL CT Subdivision: BOND PARK NO. 3 Block: Lot: 059 Jurisdiction: TIG Zoning: R - 12 Remarks: Addition of 66 square feet and kitchen remodel. 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: BICKFORD, GARY J AND ROSE CITY ELECTRIC CO INC HELENE M 4012 NE CULLY BLVD 8080 SW CHURCHILL CT PORTLAND, OR 97213 TIGARD, OR 97224 Phone #: Phone #: 287 - 6164 Reg #: MET 00001029 SUP 2127S LIC 3567 ELE 26 -113C AN INK SIGNATURE IS REQUIRED ON THIS FORM X 1 _A� AC f Signature of Supe 'sing Electrician If you have any questions, please call 503.718.2433. CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 • IMPORTANT PERMIT NOTICE CANBY PLUMBING 805 NE 4TH AVE CANBY, OR 97013 Plumbing Signature Form Permit #: MST2003 -00205 Date Issued: 6/11/03 Parcel: 2S112CC -03100 Site Address: 08080 SW CHURCHILL CT Subdivision: BOND PARK NO. 3 Block: Lot: 059 Jurisdiction: TIG Zoning: R - 12 Remarks: Addition of 66 square feet and kitchen remodel. 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: BICKFORD, GARY J AND CANBY PLUMBING HELENE M 805 NE 4TH AVE 8080 SW CHURCHILL CT CANBY, OR 97013 TIGARD, OR 97224 Phone #: Phone #: 266 - 2091 Reg #: MET 00003096 LIC 33572 PLM 3 -7PB AN INK SIGNATURE IS REQUIRED ON THIS FORM 11:? t -.� C.4.) .eC.rrL4 Q Signature of Authorized Plumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST °� 3 — A C INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested /v_ a? AM PM BUP Location 30 ga ./.0 . ej Suite MEC Contact Person Ph ( ) ' PLM Contractor Ph ( ) SWR (BUIL Tenant/Owner _ r t. /4_i. �}I ELC Footing (p o� D — L lb / ` f Foundation ELC Ftg Drain A ccess: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear , Int Sheath/Shear \ 6 - - -� , 6 ( L\ \� 0 1 N- � � ) 1,1\ Framing N� j `�F V� I iV Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling V Roof C- Ot et• in l C FAIL 4: _ , Post & Beam Under Slab Rough -In / Water Service ll Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan 4 Ot th her � : • - ART FAIL ECHAN ? . AL Post & Beam Rough -In , Gas Line �/ Smoke Dampers a T FAIL C T L Service Rough -In J- UG /Slab Low Voltage (/ 1E- g'3 0 3 / R/ � gr6 /a 3 .„.. z rm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL - El Please call for reinspection RE: 111 Unable to inspect —no access Fire Supply Line J / Approach /Sidewalk Date / /27 � Inspector % i — . Ext Other: Final DO NOT REMOVE this inspection record rom th =. job site. PASS PART FAIL