Permit t I
'0 t l•
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00544
;_ DEVE P EN T OR RV 3CES 639 - 4171 DATE ISSUED: 1/9/04
SITE ADDRESS: 13745 SW JENNA CT PARCEL: 2S104CA -10000
SUBDIVISION: HILLSHIRE ZONING: R -7
BLOCK: LOT: 100 JURISDICTION: TIG
REMARKS: Basement and lower level remodel.
BUILDING
REISSUE: CUSTOM STORIES: - FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 800 sf BASEMENT: 800 sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT:
VALUE: g0,000.00
OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 800 sf REAR:
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: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER:
FURN 5=100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: 2
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: EAADDL BR CIR: 6.00 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: $ 1,011.15
CONSTRUCTION INC This permit is subject to the regulations contained in the
TAYLOR, GERALD P + BETH RJ PLATT
TAYLOR, R, JENNA GERALD CT RJ PL PLATT 11TH DR Tigard Municipal Code, State of OR. Specialty Codes and
TIGARD, OR 97223 PORTLAND, OR 97219 all other applicable laws. All work will be done i
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: 503 293 - 1700 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 98524 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Mechanical Insp Insulation Insp
Foundation Insp Plumb Top Out Electrical Final
Slab Insp Electrical Rough In Mechanical Final
Wtr Proofing Bsm't Wa Framing. Insp Plumb Final
PLM /Underfloor Shear Wall Insp Final inspection .
1 �
Issued By : � ls Permittee Signature : K \ ', ' .� .
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
IIP Building Permit a kgti FOR OFFICE-USE ONLY
Received Building
Date /By: /_ /p'Z /03 Permit No.: /. —405*
City of Tigard DEC 12 2003 Planning Approval Other
y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGAR Date /By: A/\ i 7 °C3 Permit No.:
5-1 U 1
Phone: 503- 639 -4171 Fax: O j'VISI 41.04441# Post - Review Land Use
I Date/By: Case No.
Internet: www.ci.tigard.or.us �2r
Contact --J7173:: Z See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method:
Supplemental Information
x , ,_ TYPEOF WORI{ , ` #k : , _, , .. a . ,` g , rn , , ; : T A I ,I. .,.
it. �-.. , . ; . : - ,
_ � k� = :� .��:� "' � P t ,� REQUIItED ti t r � �+? � ��'
�O
❑ New construction ❑ Demolition
r A 12 FAMIL DWELLING- °, : " . :`
JJ ,Addrtlon/alteration/replacement 111 Other:
'CATEGORY4OF'CONSTRUCTION ,', v''•': „ "j::: Y'a', Note: Permit fees* are based on the total value of the work performed. Indicate
Z1,1 & 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 $ r!1 000
:,- ''- ?: ''JOB SITE INFORIYIA LO•CAT3ON . ".. ° : °;y.'" No of bedrooms: ( No of baths:/ '
Job site address: / 3 7 5 kJ 3e?/✓/✓19 L7 , Total number of floors
a_
New dwelling area (sq. ft.) e• D P
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: Covered porch area (sq. ft.)
Cross street/Direction to job site: Deck area (sq. ft.)
Other structure area (.sq. ft.).
BTA'C.. o r l� . gbh' - 3Zoo A
1 r :,.,,::is'%-,� . y " ,, .,.. ,,.G.:"a'+a'Z.'F6 °.w.Y :'.": ' , :2t , R ,r° " ^ • " 4 .z .i'",i ,`i, tIT:': ' • :!
IA ( , Q U I R DAT,, , - . f':v ,`,._. A "R' -rt,..
GOMMERCIA I:,..iJSE
.
Sr4'µ' °' , : , �?,
'IS'
,;: �"..,;: -..,. .v€:��cs;? xr.;> w;;-,+: s:.,..,;.;, s=., p� .p;. "a,,..:.. ^.z•:., .,..s, wss' >:s •::•�., ;.:::,a.a;
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
. "' W4iICI' 4 w .40,ESCRIPTTION OF;tWORIC ; ?I'z "," " ",'>'�-?= `-? ` \ the value (rounded to the nearest dollar) of all equipment, materials, labor,
( , � �- /��� �� _ ' overhead and profit for the work indicated on this application.
6y/L'k.y (/ �( Valuation $
Existing building area (sq. ft.) 2
New building area (sq. ft.)
Number of stories
PRORERT CiWNEICM, ,n „ ° -- �� iTENAPI'T<;�";'i ° gi;i~ °;� ;:A :.,_ Type of construction
Name: 6- /' : 04 Occupancy group(s): Existing:
New:
Address: ( 2 q (is 5 (f.) - �ivAn)- ' t . '--
City /State /Zip: i'o't� �- O/L g9- 2Z3 J
Phone:6 - 03' 5614 - 5 -4 /54 Fax: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
4P,PLiCAI €T .” w: ! ;` ` ~.. LL ` � '°;� . ONT-ACT PER ON } P:r =,i:, i
provisions of ORS 701 and may be required to be licensed in the
Business Name: Ia. T, t jurisdiction where work is being performed. If the applicant is exempt
Contact Name: '- 2jf from licensing, the following reason applies:
Address: 767 -j 5c4.) / ,e.
City /State /Zip: P ,q z qua- y
Phone: 56 3 -Z93-/ 9 Fax: 2-9? 6 r 3 a
� � t" " �t � � . � �a .� �:�� �" � �` ,, �
/�� � / � �,; � , � s�; t g' BUIL'DING�P�ERMIT FEES *'' ��',, � �� ;�,;��� s
E - mail: �e f q_ ca MIt / C�� t 1 x so y . fie"•°" ' �.�s ?, r '#" 'x p,t4 Q r is� ,e�' ve,.
�k, �:.: r a., ,�r.:. - ...F:�� �.4 ,, •s...,,r._.,.. � , �,,,,,.,. �'. � � � �. kPlease refer fee�sche ���, ;��a��,� r � �
't`- "° * r , .. ;, CONTTRACTOR: .,. -. �_• . 'in, " :• . :. i-s : _ = s. ::'(.1_.." , .,F <-; �t r:. '`
' Business Name: Fees due upon application $
Address:
City /State /Zip: Amount received S
Phone: / Fax:, Date received:
CCB Lic. #: �' 3 S �1 �� 1► /
Authorized �j/� Notice: This permit application expires if a permit is not obtained within
Signature: � Q�f �/( D � ate: ' �g v '- 180 days after it has been accepted as complete.
/��"` �"''v *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms\B1dgPermitApp.doc 01/03
, v
Plan Submittal Requirement Matrix
41l Commercial & Multi - Family
City of Tigard New, Additions or Alterations
<Y:z,''�- "'�e�.�� °?. Kra°=".: i� ,;4�A.'°:sis.y,,,�i,�',`"J;`�`u ; sa�''". s ,�� �•tiF,.a�x ��;;;e ,- ;= rr�'�`,"�� ,`f�#si€':4�,x�:tf;,
�<: E TYP SUBMITTAL 1.1 # of Plans a
.,u �#s. x .7,s � � r � 3 �#x,'� ;,1� '�+�� �� '�, y m, � �` d:. 4is%;a'a`
Include N ;evv Additions �,or Alterations`> :R'equiredrat
Submit
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1*
•
Fire Protection System 3 **
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
* For over - the- counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:\ Building \Forms \PlanSubMatrix.doc 04/03
Mechanical Permit Application FOR OFFICE USE ONLY
Receive �-^_ Mechanical � /1�� ' /'/
Date/By: /.2.- / AB `3k Permit No.: I / I j3 - s97"
City of Tigard , A 1 Planning Approval Building
i i! 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= 1196bl Post- Review Land Use
t .1. !i� 7;11 ,Y I Date/By: .:
Case No
Internet: www.ci.tigard.or.us r - ' '°' � I Contact See Page 2 for
24 -hour Inspection Request: 503- 639 F 41 7(5ABV��� } W N ame/Method: / a Supplementa Info rmation.
BUILDI D IVIS 10
...., ''.- : TYPE OF,WORIC • '=''': COMMERCI'ALFEE* SCHEDULE "- USE`CHECKLIST!= :';>::•
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY
OFCU)`1ST�tUC:TION -' - `.`` :: 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 /SYSTEMSYEE* - -
Description Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Coolin.
' _ ' JOB SI` 'E. INFORMATIO1s-and:t0CATION ,.: .>' - 1 Furnace - add - air conditioning ** 14.00
Job site address: / 3 ?- eir Scv J it/rrvQ- G4- Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
., ''- DESCRIPTION_-OF WORK ``:r , _::' . Gas fireplace 10.00
�/t re rids-61 . s AA ^ Flue vent (water heater /gas fireplace) 10.00
�cJ t Log lighter (gas) 10.00
P6ILL 41))(_ . tfkiik-fi--- Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
'.1 J P.ROPERT OWNEIk:a :. % ] TENANT:: -'; ' y ": l':--'Y.:,'1'.': `i Other: 10.00
Name: • • . Environmental' Exhaust & Ventilation .
'dTeSS�' Range hood/other kitchen equipment 10.00
' .� Clothes dryer exhaust 10.00
Cc1ty/S p:51
Phone's r"' Single duct exhaust
Fax: (bathrooms, toilet compartments,
'`' ❑rAPPLICANT : : " _ . -, ; >[ EONTACT:PERSUN= '7 -: utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address:
Other: 10.00
Fuel Piping •
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. **
• Gas heat pump **
E-mail: Wall/suspended/unit heater **
;.=::::::' ::'',C0 ., '') CTO1C, ,-.` 1' = : :.:. =-, Water heater **
Business Name: '= P 0 7,477/0174 , ,i," / rlletc I, # Fireplace **
Range *
Address: z 73 z0 iii, 1,��,r��S BsQ **
City /State /Zi : ro'( -- 4vtJD On_ ` ! ' 7 7 (3/ ?- Clothes dryer (gas) . **
Phone:(R) / - 0-5 Fax: ft ` Other: **
CCB Lic. #: ' is11 Total:
Authorized Mechanical Permit Fees*
Signature: Date: Subtotal: $
�� 1 c�� Plan Review F e (255% o f Fee Permit Fee $
.ce ���� < % %!�S'iil�Y ° / U �� , ' , ' � iew Fe% of it e $
'' lease print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
TOTAL VALUATION: PERMIT FEE:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each
additional $100.00 or fraction thereof, to and
including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for
each additional $100.00 or fraction thereof, to
and including $10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for
each additional $100.00 or fraction thereof, to
and including $50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for
each additional $100.00 or fraction thereof, to
and including $100,000.00.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
•
•
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
Building Fixtures
FOR OFFICE USE ONLY : ,' -' . • -
Plumbing Permit App_ iCat ; ��� Received Plumbing 2
M C� Date/By: 7 /2 d:' �+ Permit No.: � 1i a -A 5 ! /4` //
City of Tigard Planning Approval Sewer
13125 SW Hall Blvd. VCL 1003 Date/By: Plan Review Permit No.:
Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598- 196a1TY T -IGq) Post - Review Land Use
Internet: www.ci.tigard.or.us I
BU ILD 1 i N Date /By: Case No.:
Contact
• "" .g ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 �' " W Name /Method:
� / /�j� Supplemental Information.
:4. ," . .e . K' "- ;;i A:.. NTYPE'.OF3WORK `''h . ���;.��` �;... �; " ��' *-SHEDiJL (f -�
°• E, orLLs` pecial tnfor`` matibn�use�elieciclist }' W:
❑ New construction ❑ Demolition Description 1 Qty. I Fee(ea.) Total
Addition/alteration/replacement k). :. 4 - & 2= famil'�fdwelltn s .,; ° -i`° ti }
p acement ❑Other: :' ° � ii -as . 4' V,W ' , Y g _ " = = °Ya "'. .:..
- ';'` €'. CATEGORY OF` CONSTRUCTION;,;" :': i .: r..t r�'�,� 71 (mcludesx1001ft:>for eac utility` connection) •-W , A . ` '.`
1 & 2-Family dwelling SFR (1) bath 249.20
❑ y g ❑ Commercial/Industrial SFR (2) bath 350.00
Accessor Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 •
,,' ., n° Fi J.OB;SITE N ORMAI1I LO
- ON`Fand� Fire sprinkler sq. ft • Page 2
Job site address: / &J 1 . < F�, x -.wf r ::. s , - =r ,g ..s: 4 <,
7 3 � 4 ,� '$ ✓i� � � �i,;��, „_ w��.= :����.�, u. t.,p..:a , �r,�. �'Sfe'Utilties< ,.� *�: `or�_•
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell /leach line /trench drain 16.60
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: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
. .. ... • ,DES.CRIPTION:OF`•WORte,', st Fixtiire,or Item o :, f...3..:a >> ::,, w ;, ,rye' ,
Absorption valve 16.60
/ J Backflow preventer Page 2
iv r /) /.` Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
III ;PROPERTY OVYNER: ,' . ° - .;.; x:;;.r Drinking fountain 16.60
J 'TENANTS; =. .t- ',• ro '„,."Y> is Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib
.APPLICANT,',,` ,„" r 16.60
IS `APPLICAN
W . ... �; " I� ■ > .,,, , :: P_ : Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory j ' 16.60
E -mail: Tub /shower /shower. pan / 16.60
�•'' s .��m ,��, ", ' -:: , _� CUN.TRA � :.- :, �r, _ - ,.
- t-` ,._ , Urinal
CTQR ° " "�;;.;;rr;;�t � ":';�< "t>: : 16.60
Business Name: Pe . � -e NO sd) Cj45 Water closet C 16.60
Water heater 16.60
Address: c)-(o 'S t,j / ( f 3 Other:
City /State /Zip: (/o list 942 Z 7 Other:
-- .w;• " r ;,.
Phon 5 * :,�. �.., w 3. my
/_ f 3 O / � Fax: Co Cn� 3 �- 7 jj �`�'':: 3,��,:��u.�':�� Plu�'° 46- Per:,mit;'Feesu - �.''r`s >';..;.. : ,�?`�� "�Y,�4 ��;,.
CCB tic. #: /367442. Plumb. Lic. #:3 357P,�j Subtotal $ kr
'! Minimum Permit Fee $72.50 $
Authorized
Signature: 8b. Igo 7 _ Date: y / 3o /a7 Residential Backflow Minimum Fee $36.25
//�� (� Plan Review (25% of Permit Fee) S
c a ( .{'GI - 0(05'6 ,7 ' 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.
is \Dsts \Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
:Fee' ea
t Pt:S r ` (. )`t 1Tota�; •Square Footage: • PerMit Fee: -
Footing drain - Ia 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 3,601 to 7,200 $220.00
55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation:., ': Permit Fee'
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
y Fee" ea T ofal "; additional $100.00 or fraction thereof, to and
' wIR: ` i ft. °) including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal:
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
-' nw$ m "z` =F ' ': ' �bQuanfity;by,(Fixtu`�e);Work Pertortrieit" Comments regarding fixture work:
Fixture Type z , `' P� t 4 , 41' ,t,'"$ = it , ;Repaee
> aNeww Moved` i 4.V1i0in `i „Capp dR
Baptistry /Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage Domestic *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:
is \Dsts \Permit Forms\P1mPermitAppPg2.doc 01/03
:. , .,
- FOR OFFICE USE ONLY
Electrical Permit Applitatioa D Received Electrical i j
lil Cc C I V 1— Date/By: /- rack Permit No.: r7 5raeo,3--oa.5
City of Tigard Planning Approval Sign
13125 SW Hall Blvd. bc i; 1 t V3 Date/By:
Plan Review Permit No.:
Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax 503-598-19(601Y OF Post-Review Land Use
Internet: www.ci.tigard.or.us BU I LD I ['Le ;XVt II i l' Date/By: Case No.:
1 J' Contact
_... pig 1,0 See Page 2 for
24-hour Inspection Request: 503-639-4175 ''''' -- " Name/Method: / KA' Supplemental Information.
TYRFAY:51-etigi5,.;,--gill,,V13C,C1F,IWORriC1-V4%,VKV,M;;'L:',, AlaP.%MttPLANFI,EMW,4111iiih76„61141tifillifillkP,51•3rWA.:6
EI New construction El Demolition 0 Service over 225 amps- 0 Health-care facility
commercial Hazardous location
0 Addition/alterati El on/replacement El Other: 0 Service over 320 amps-rating of 0 Building over 10,000 square feet,
CAT:EGORY1f0K '' .,:-,1:-: I & 2 family dwellings four or more residential units in
II] 1 & 2-Family dwelling El Commercial/Industrial 0 System over 600 volts nominal one structure
0 Building over three stories 0 Feeders, 400 amps or more
III Accessory Building El Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
0 Master Builder 0 Other: 0 Egress/lighting plan 0 Other:
-rtnoZi4:00sITE:INFOkNfATItKiiiditOCATION-1.'6':,':-:'1?: Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address : ,;:viViez,Vto,Al2kNtnE''',i$GHERUKESC:'ibg0.rgalMfgaai
Suite #: I Bldg./Apt.#: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
New residential-single or multi-family per
Cross street/Directions to job site:
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
' Limited energy, residential 75.00 2
Subdivision: Lot #:
Limited energy, non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
service and/or feeder 90.90 2
Services or feeders - installation,
A)ft. (4) C f 12_ c.z44/ /t) ,c-t---- alteration or relocation:
200 amps or less ,
i 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
laeROOMTV2 EiTTNOT.:01MtttaWNIM 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name:
Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip: 200 amps or less 66.85 I
Phone: Fax 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
TAI!, eLICANTZ'z 4.. i MI `I'CONUCVPERSON.Kr::.W Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address:
service or feeder fee, each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
NUtAnatWZ,Z EEaacchh sign ng e a t l i i o g n h c I e 53.40 2
,
53.40 2
P or o o r u iff tli
Job No:
.,, ,, Signal circuit(s) or a limited energy panel,
Business Name: AC I 5 R "-a- Ozi-e-r-rtg- alteration, or extension Page 2 2
Description:
Address: 1 F6 y 0 5 ti Al-e4l1 0 1.4
Each additional inspection over the allowable in any of the above:
City/State/Zia: , H.( LC, /$t3 1(4) . 401(.,.
Phone: 6- -z, 09 Fax: 2-s - 3 6 "-G
.52 Lic. #: 3d 46 G
)'
I P n e v r e i s n t s tg p: t c in ti n on t r e: r hour (min. 1 hour) 62.50
Other:
CCB Lic. #: l 3q -
Supervising electrician M-fl4Mkg*MttetEriiiiiiittaiiiifYieittiMAWAAVIV-
Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: ( :) -- -e--"/ 4- 1 /k/91 Lic. #: Jp5 9 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)
i:\Dsts\Permit Forms\ ElePermitApp.doe 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
❑ Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
F Other •
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
•
ri Audio and Stereo Systems
ri Boiler Controls
Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
F - 7 Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
n Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
HEBERLE ELECTRIC ff
7456 SW BASELINE RD 1 // ` 4
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2003 -00544
Date issued: 119704
Parcel: 2S104CA -10000
Site Address: 13745 SW JENNA CT
Subdivision: HILLSHIRE
Block: Lot: 100
Jurisdiction: TIG
Zoning: R -
Remarks: Basement and lower level 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:
TAYLOR, GERALD P + BETH HEBERLE ELECTRIC r's? `
13745 SW JENNA CT 7456 SW BASELINE RD: '`
TIGARD, OR 97223 HILLSBORO. OR 97123 qt
9
#: Phone #: 503 - 628 - 2095
Reg #: SUP 3o53S_ )-- --
LIC T52342
ELE( 4 -160 C u�-
AN INK SIGNATURE IS REQUIRED ON THIS -'RM
X I�
Signa re of .up=' g lectrician
If you have any questions, please call 503.718.2433.
je_411*-
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 4;? - - D 6 5 L {
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / 7 AM /16 PM _ BUP
Location �_:∎Aw.t� ' Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain . ELR
Crawl Drain
Slab Inspection Notes: S V \ SIT
Post & Beam
Shear Anchors \IZAAAll G
Ext Sheath/Shear
Int Sheath/Shear
Framing /�
Insulation K ' !/ /6 V 6yG . ) /lc - / i p
Drywall Nailing
Firewall J 2 o
Fire Sprinkler / / (t!
Fire Alarm 6 -4" - Q--..,2 1 •
Susp'd Ceiling
Roof
Other:
1 M !BING "t +21 OLI-
Post & Beam •
Under Slab
Rough -In
Water Service
Sanitary Sewer •
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other;
ink.
PART FAIL
ANICAL;Yy -
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE. ❑ Please call for reinspection RE: Unable to inspect- no access
Fire Supply Line
ADA } `
Approach/Sidewalk Date 1 Inspector Ext
Other:
. Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL 7 /F_ 2`1 Z-
CITY OF TIGARD 24 -Hour
BUILDING': Inspection Line: (50 • 75 ® .. Q .S
INSP DIVISION - 0 - •- 1
ECTIC$N DI I Business Line: ( 3 1 4 7
BUP
Received Date Re Rested AM 6)e -a BUP
. Location Suite MEC
Contact Person '� Ph ( ) PLM
Conte Ph ( ) SWR
UILD Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
‘ 1/4
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 11
Other:
in
ASS PART FAIL •
P 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 Y ' .
Post& Beam
. Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /
ADA Approach /Sidewalk Date / � 70 Inspector \ Ext
Other:
Final • DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST��3
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested I 7 AM PM BUP
Location / 37 Qs Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ wr r 6
,.1 ELC
Footing
•
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
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
PAS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ` Please call for reinspection RE: Un le inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection re rd from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503);675
// u. // /� MST 3 �d0
INSPECTION DIVISION . Business Line: (50 3) 639-4171 BUP
Received Date Requested '" c " AM pm PM BUP
Location / 3 7 4. 45 ge/n/1/6 c6 Suite MEC
Contact Person Ph ( ) , c - 4- �7 PLM
Contractor 0 Ph ( ) SWR
BUILDING, Tenant/Owner ELC
Footing
ELC
Foundation Access: -
Ftg Drain a ELR
Crawl Drain
Slab Inspection Notes: M / SIT
Post & Beam l
Shear Anchors / ,
Ext Sheath/Shear CJ�
Int Sheath/Shear - / / i / ?
Framing �/iy ii ' ��f: lee
Insulation /� (�'
Drywall Nailing ^-' � -�— ] �` > ') r�-c
Firewall . J ( ( 6 �# ,..-
Fire Sprinkler f '
Fire Alarm ( v 7) c; - 0 (4 ) F4.- (; J 2t - !- 9/' ,
Susp'd Ceiling /04(-- _n
"`/0 / `� L
Roof ? / o F 4 - 4 U a(5 3 ) 6 2 -Y- 36 3 6
Other: / '
— PA S S PART _
P ' . r4 . &i e �-- / Z-® ° 4- Vr a
f i J. At 4 , � / /2-6
Post & Beam ' 1,4 C _ 414—_.
Under Slab
Rough -In it r / / r/
Water Service !' ∎
Sanitary Sewer ` - "-#
Rain Drains "
Catch Basin / Manhole 4'",7- C "— �_
Storm Drain
Shower Pan ..2-t L► -
• i f - _
- - ASS PART
`MECHANICAL.
Post & Beam
Rough -In
Gas Line
make Dampers
/I►�
PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE "_ : , `; 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA Vf 29 " (I Ins ector 4::;(—X______.
Ext
Approach /Sidewalk Date p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL