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Permit t o ,, CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2003 -00130 e�4 DEVELOPMENT SERVICES DATE ISSUED: 5/7/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11400 SW LAUREL GLEN CT PARCEL: 2S110AC - 01800 SUBDIVISION: LAUREL GLEN ZONING: R -4.5 BLOCK: LOT: 001 JURISDICTION: TIG REMARKS: Const. new SF detached residence. BUILDING REISSUE: CUSTOM STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,288 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,391 sf GARAGE: 625 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 15 VALUE: 267,142.70 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,679 sf REAR: 15 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: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4 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 FD R: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF:. 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: 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: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,832.56 ALPENGLOW HOMES ALPENGLOW HOMES This permit is subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and 5620 SW KELLY AVE. 5620 SW KELLY AVE. all other applicable laws. All work will be done in PORTLAND, OR 97201 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: 503 793 - 3866 Phone: 503 245 - 7720 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 131932 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp 8' Post/Beam Mechanical Electrical Service Low Voltage Roof Nailing Electrical Final Sewer Inspection Underfloor insulation Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final Footing lnsp Crawl Drain /Backwater Framing Insp Gas Fireplace Water Line Insp Plumb Final Foundation Insp Mechanical Insp Shear Wall lnsp Insulation Insp Water Service Insp Building Final Post/Beam Structural Plumb Top Out Exterior Sheathing Insc Rain drain Insp Appr /Sdwlk Insp Issued By: (,1AI1 A . ('AA, Permittee Signature : 7 Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day 7 r . • Building Permit A s 1 ii 1 ! ® • FOR OFFICE USE ONLY Received i Ti ` Date /By: / `3 -O Building PermitNo.:7 r l3) n - Planning Approval Other //''. ,//�� City of Tigard Date /By: Permit No e.AO ,POP3 - 00/0 4 / 13125 SW Hall Blvd. APR 0 2 2A Plan Review Other Tigard, Oregon 97223 Date /By: r1 s -S -03 Permit No.: I `I\ Post - Review Land Use Phone: 503-639-4171 Fax: 503 5a $T0F TI aY lmi �1 mi�?II1 E ,� I � Date /By: Case No. Internet: www.ci.tigard.or.us BUILDING .,4 C on t ac t Juris.: ®See Page 2 for o 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information \3) Ke. i .,I E, i r,_ `, .T, tticif:#0,RK`' .. ��, n 24. .. = x N i f l u� - ' ,REQUI DATA ; ,� © New construction El Demolition 'a -. �� �1 e.-6. ❑ Addition/alteration/replacement ❑ Other: Note: Pe rmit fees* are based on the total value of the work performed. Indicate ��`_,� �� „���„ � �CAT�,EGORY�OF CONSTRiJCTI ®N':',,:.',� . , :�,_� * p [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 • $ JOB ySITE4NFORmATION an ditfooTIONi ,= No of bedrooms: 3 No C baths: 0 /y Job site address: / / 1 -10 O O �ju) Cst Ltd 6-1014 t 'i • Total number of floors New d we lli ng area (sq. ft .) a4° , Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) 5 Project Name: Covered porch area (sq. ft.) A 5"3 Cross stree Irections to job site: Deck area (sq. ft.) A A I A P � 1 � {/ + �( Other structure area (sq. ft.) R IAA +. R . _, ; 6 ,1 l I L e 1 D pi 1.°. G -1e ..� c �. � " � ;� � ` �,. " REQUIIT DA�TA� a�� 4' r ,w• f ' , : a COQ ERGIAL USE CHECKLIST till, Subdivision: Ca 64.1 G '54 Lot #: / Tax map /parcel #: ,,s i O 4 _ v l i(OC.) Note: Permit fees* are based on the total value of the work performed. Indicate . „,19 ran ` ESCRIPTION OFSWORK. r lii, M the value (rounded to the nearest dollar) of all equipment, materials, labor, 'overhead and profit for the work indicated on this application. Valuation $ . Existing building area (sq. ft.) New building area (sq. ft.) Number of stories 6 , PR®PERTY,,OWNER' "' I �;E'NANT' , ,. Type of construction Name: f} letri iihk) Hon.) e3 Occupancy group(s): Existing: Address: $6 Z4 5t..) V- i1 l4-4t City /State /Zip: (fik e/U- 1 7 Z3 I Phone 713-38,4 FaX Z 5 - 7 7 L 5 NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under ' 1 A f A PERSON , : �'� �� - PP � LIGAN T - :: „ 7 :.. P . � C � ONt � n CT provisions of ORS 701 and may be required to be licensed' in the Business Name: p r l i ovv 15 1ae,J 140,4-1-e S jurisdiction where work is being performed. If the applicant is exempt Contact Name: g 1 , 1 „, ,..c, „4_,7. licensing, the following reason applies: Address: / wtC City /State /Zip: Phone: 71.3— 3 84,6 ): Fax: Lys— 77.6 3 cx z y ;� �; t ' , BUII;DI a ak I E-mail: Pl ease e fe r t o fl s c h ed u l e *� £ � . z ., T, ,, Y i : r, . . off' . e ` - .. _ d ..�t f ... ` , ” K.:." �.....,. .� : a ;.� , �..�. k � �CONTRAGT(OR� _ ��. �.�� x y. '.. -. Business Name: 5O1, vVt-Q Fees due upon application $ ' Address: City /State /Zip: Amount received $ Phone: Fax: Date received: CCB Lic. #: I 3 i /3 L Authorized / 4 Notice: This permit application expires if a permit is not obtained within G - Signature: - - - Date: i f!? -. 0 3 180 days as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) is \ Dsts\Permit Forms\B1dgPermitApp.doc 01 /03 • A l k * Commercial Plan Submittal light Requirement Matrix City of Tigard g TYP OF SUBIIIIITTAL t� � - # ofxPlan (Includes1,Ne Additons or Alte Re at i ,, ,e _ F, Y , 3. . t.. `ff; .`_. Submttta Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities 2 Building 1* Fire Protection System 3 ** Mechanical 2 r • b ' 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. is \dsts \forms \COM- matrix.doc 9/24/01 Apr 02 03 06:37a Matt Weber 503 620 6019 p.1 Wednesday, April 02, 2003 6:33 AM Bob McCurdy (503)245 -7765 p.01 • ., . . _ � . [ QFFICT (5'1: -OL ° ., i Electrical Permit Application Rec Electrical Date/ y: Permmt No.: S/ Mertz 0 1 ° ... Si City of Tigard Planning A P al Da Permit No.: 13125 SW HaI1 Slvd. Plan Review Other N Hy: Permit No.: _. Tigard, Oregon 97223 Post-Review txtate Pend t Phone: 503-639-4171 Fax: 503-598-1960 ,, , t, t I , Iltt D Case No.: Internet wwW. ci.tigard.or us J 1 ` 1 Gantlet beret See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 NameFMettwd: Supplemental information. 4.1r.:-.1.,.:''':-70. . ...,.... ... IE.. ,(P _ :. PLAIn('�V c6ak'21Ftha tip}r } W � ,lease ly �:.. .. , .. :. Service over 225 amps- 0 Healthcare facility V! New construction _ � DeinOlftion commercial 0 Hazardous location $ Addition/alteration/ • lacerrtent 1 ❑ Other: Q Service over 320 amps- ruling of ❑ four or non r 10.000 square n t, t , ; ,, - ° ; ,::�:_ :;'��;GA�'EGUR?Y -QI! GsQ` 1YS�ilC'!['YOT : 1 & 2 family dwellings 0 System over 600 oohs nominal one strucwrc 1 & 2 -Famil dWtllin : �O[nIIlef CiaUlnduStrial 0 Building over three stories 0 Feeders. 400 amps or more • Aceesso Buildin _ • M ulti - Fared 0 Occupant load aver 99 persons 0 Manufactured structures or RV park • 0 Egress/lighting Plan 0 Other: Master Builder Other: I- ' © ' Q� Subaru sett of plats with any Onto above. ° - °'SFr•; 'JOB SI�E`II!iFOIZ ® Ad'Y u " The to temporary construction service. above ore not applicable icablee f y o0 W LA (,-1 .,. ; � ` Oppttt xF;> � :/),.. . k"'`T•,- i ,. Job site address: f i "` FiaF$C ttrxL+F v :: ,x`: :•. Bldg. ` : Number of inspections per permit allowe'. Suite #: Osseripttoa Qty Fee tea-) Twat Project Name: New residential - single or mnitt.ramlb per ' CIOSS street/Directions to job site: dwelling ntit, Laclede% attached garage. Service Inc luded 145.13 • 1000 sq. R m less - 35.13 � Each additional SOO se t. or portion thereof 35.40 I` 'a Limited eaapy.rcidentul Lot / I Limited errerrY, non residential Tax map/parcel 75.00 Subdivision: Ca �reel #: t vt( GdGh CTT �manufactured banner modular dwelrmg , : s an feeder ;'.-. r ?;,, %:::: 0rsSCiltil?TxOliti3O +,`l Eilt1C „T:r. .-..:.: q s ery ervice tceso rreeders-in alteration or relocation: 0030 2 amps m lass _ 106.85 201 amps to 400 alma feeders - l 100.60 401 amps to 600 amps 260.60 u: E'O s .Sr;t Wit' :Tilts ll7t1T:_:=: >�':' , Ir,'is`5:; Ov 000 am of s 454,65 �� 65.85 Name: 41 o t. J • 0 Reoa t only � I Temporary services or feeders Address: 7 6 Z 6 t� alteration, or raaocaNno: 58.85 2 00 amps m le ss City /State/Zip: b�",� Q ��Z3� 10030 .3 Fax: - 7 S 401 to 00 amps !00. 1 Phone: 7q 3 , ii i =. 7- .E , e /rvcr i {Elio ° :'1 ^ 9raa circuits - new. alteration, or C -' � � �`: eb Name:cslcxlv_,.. : e29. MC ,, ntensioa per paced: Name: 'M , A. Fee for branch circuits whir purchase Si 6 Address: • - " t service or feeder fee, each branch vtrouit B Fcc for branch circuity without purchase of 4685 City/State/Zip: service ar feeder fee, But branch circuit 6.65 Phone: I Fax: Each additional branch circuit Misc.(Service or feeder net included): 53RD E -mail Fach pump or irrigation circle . .E-mail: : ', `=7 :: •,: ,P; :`_ : .001iT SO. W :::: iiiiK: ` .. ;'`..., -;,x1 ::4!' ' Each sixes or outline tiolin6 53A0 - �o Signal circuits} or a limited energy panel. Job No: „" alteration, or extension Pale 2 Business Name: a L�r*G_ on. P r — ocuipli Address: Box 3 / t SA . A Q Each additional inspection over the allowable is aatof the � ere: Cit /State/Zi • : T. Qr.., i 972 S n t `F l s'► 4 Per asspertion per hour (min. 1 hour) Investigation fee: Phone ; � 0 . � .. Fax: - .. _ • ... .: other: s.. r� �yl:.: , r . CCB Lie. #: 4401_7 Lie. #: 34 —444 2L'. .., ', :, s�, elect"rleat'Peri�llt ;l N L sttbmtat J S signa ture electrician e requirctricia! - _ / Plan Review (25%ofPermit Fee) S __ S�atwe red: f State Surcharge (8% of Permit Fee) S ._ Print Name ;�6 Q� P�DE'l' ��c #:4021 TOTAL PERMIT FEE $ _ Notice: This pernsit app�t04a expires if a permit Is not obtained within Signature: ed Date: 180 days after It bas been accepted as complete. gtaiur attire: *Fee methodology set by Trt Building industry Service Board, — (Please print name) i :lDStsWermit FornutElcPermiIApp.doc 0)/03 Rpr 02 03 09:49a PLU.CON.INC. (5031658 - 5232 p.1 . ,Rpr 02 03 06:29a Bob McCurdy 15031245 -7765 p.1 • Building Fixtures . '. F(1R•O1' F1C'H t ?.SP: ONLY: , Plumbing_Permit Application Received Plumbins Datde Permit N c9.49-0 - ov) j . Planning Approval Sewer City Or 'Tigard Date/B Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 DatdB . - Permit No.: - -_ _ _ Phone: 503- 639 -4171 lax: 503 -598 -1960 1 Post - Review Land Use :3,�,', .,` + ?. Date /Dy: Case No -: .v iV Internet:ww.ei.Iigard.or.us a� � i Contact luris Sec Yale 2 for 4t " "'s •• : -W 24 -hour Inspection Request: 503 -639 -4175 NaName/Method: _ � rt Supplrntcntat Information. T WORK' S SCHEDULE (for special information else checklist) New construction O ! ❑ Demolition FEE - Description ]pry- [ n ea.) I Total ` Addition/alteration /replacement f ] Other: {{ N ew . & z :loo • CATEGORY OF CONSTRUCTION _ (iecbides 10 (t for =r each lly utility rdWc conne ction) 249.20 _ I & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 - Accessory Building (I) bath g 0 Multi kamily SFR (3) bath 799.00 [] Master Builder _ [3 Other: Each additional bath/kitchen 4500 . JOB SITE INFORMATION add LOCATION • - I Fire sprinkler - sq. ft_: Page 2 Job site address: 00 rj t...r LRuref 6-1e- C Ste. Utilities Staite4 -f- • / Bldg. /Apt. Catch basin/area drain 16.60 Drywell/leach linduench drain 16.60 Pro ect Name: q e / (71 at, g S Footing drain (no. linear ft.) Page 2 Cross street/Directions to job kite. wwAA Manufacnuod home utilities 110.00 .4 1... ., ..� � �i S k � r 7` 0. . /3,411 M4-. Manholes 16.60 /' Rain drain connector 16.60 (z r`51 - 6, `1 (4 6-- tem_ to . %A ir� �tn (. f Sanitary sewer (no. linear ft.} Page 2 4 [ Subdivision: 4 I Lot it Storm sewer (no. linear ft) Page 2 Water service (no, linear ft.) Page 2 M Tax map/parcel #: • DESCRIPTION'OF�WORK- izturr tiiateiii. ` Absorption valve 16.60 Backllow preventer Page 2 Backwater valve 16.60 -' Clothes washer 16.60 -- Dishwasher _ tfi -60 T Drinking fountain 16.60 Ilfi PROPERTY.OWNER D- T ENNAN'1• - .:: . : -.. Ejectors/sump 16.60 Name: A- 1p e Pi 9 /0.-.. FiOra ( GC s Expansion tank A~ 16.60 Address: 56Z0 St....) K ei t 14 t Fixture/sewer cap 16.60 ~ C1 : /Stale /Zi ®e ®2 ' q72 Floor drain /floor sink/hub 16.60 City/Stale/Zip: �l Garbage disposal 16.60 Phone: 7 -3/4s, Fax: U4 17 _ Hose bib 16.60 lg.-APPLICANT ®Z?- CONTACT PERSON Ice maker 16.60 Name: AL 44 ctc Interceptor / trap 16.60 Address: (5/05 St.d 7/ f 4.r{ Medical gas - value: $ Page 2 -- Primer 16.60 City /State /Zi : I- of (02 R Z -93o Roofdrain (commercial) 16.60 Phone: 79q-3844, Z Fax: iq 5..`�7 Sink/basirt/)avatory 16.60 E -mail: bob vt L. o 6 e e z. . C o __ Tub/showerlshowet pan 16 6 CON'T'RACTOR • . ' Urinal i Business flame: s Water closet I6.60 _ .� ., ! Water heater 1 6.60 Address: /�11 •130X /D/m' - Other: City /State /Zip: C'/ k, 0 70/5 ^ _ Other Phone:50,1-6,5.-5_ Fax: sane . -. ' ' - Plu m bin g P er mi.Fcc •:. " H . Subtotal CCB Lic. #: , 7 plumb_ Lic.!#: ,1 -,pue Minimum Permit Fee 572.50 s - ' Authorized y, Residential 1Jackflow Minimum Fee 536 25 3iv Signa : ' ""r---, Date: 9--.9 Plan Review (25% of Permit Fcc) S -. • 4'5a Zar19ur/'v State Surcharge (8% of Petmit Fee) S (Please print name) TOTAL PERMIT FEE S Notice: This permit application expires if a permit is not obtained within AU new commercial buildings require 2 sets of plans with Isometric or lino days after tt has beets accepted as complete. riser diagram for plan review. • Fee methodobty set by Tri-County Building Industry Service Board. i-\Dsts \Permit FormsWlmPermrtAppdoe 01/03 Mechanical Permit Application FOR OFFICE USE ONLY Received Mechanical Date/By: Permit No.: T2i 1 J7 � a) 1 3) • Planning Approval Building City of Tigard Date/By: 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 f1�i��� " ' + Date/By: No.: Internet: www.ci.tigard.or.us �. ' I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 - 4175 W Name /Method: Supplemental Information. _, 3 - ''� ` ,x-- 14C CIAL ESCHEDULE;= USEICHECK) IST ` .,n ' � � �� TYP.EI�OF�;WORK;..�r.. =art.. �.., .....�� °:� �� , ., QNIIVIER .. =E El 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 tr . , .__ _....��._._._....�_.,.,. . ___.... __,..__�.�n . _ mechanical materials equipment, labor, overhead and profit. ` fi, �.:` �' v��; ��_ CAT�EG® RYOF .,CONSTRiJC:TI®N4 =�:'sr:':'p a ro q P P [� 1 & 2- Family dwelling ❑ Commercial /Industrial ❑ Value $ See Page 2 for Fee Schedule ` RESIDENTIAIAQUIPMENT /S,YSTEMS,FEE* SCHED,ULE ' � Accessory Building El Multi- Family Description Qty I Fee(ea) I Total ❑ Master Builder ❑ Other: r Heating/Coolingi ;-,:•. _ i w JQB STTE= °INFQRIV 440( Nand LOCATION 4, ''. Furnace - add -on air conditioning ** 14.00 Job site address: / I tl 4)0 5 w CA u - 6.-1 - N.. 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: /...wr4l G.I -c.,, &54}.e Lot #: 1 Repair units 12.15 , :t'7;7 7 - ,- ::'' : luAppliaiieese -. "`" ., Tax map /parcel #: Water heater 10.00 WriiMe*S Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 . Chimney /liner /flue /vent 10.00 2:PROPERTY,OWNER .TENANT R ° Other 10.00 Name: p <i_ , ''. Envi►onii a idil'aExl a unt &Ventilation= �,, , ��� "� A s , = Range hood/other kitchen equipment 10.00 Address: S6 20 6,, petty Clothes dryer exhaust 10.00 ' City /State /Zip: '4• d k_ q 7 Z 3 g Single duct exhaust Phone: 7g 3- 386(, Fax: 2_14c-774 S (bathrooms, toilet compartments, ❑APPL'IC ;: . t. ,❑lCONTACT, PERS,ONi : utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Other . -. , ; :, „�F 10.00>^ ,',r Address: � r =� •� w �. , � uet`Pipia�_����° `� " - " �_ � � ��' City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: c�'� Gas heat pump . ** E- mail: c6 ` Wall /suspended/unit heater ** 1 .: .. x : t CONTRAC/ :TOR * _ . - s - i A Water heater ** Business Name:# 0 d- Hee+NA:3 rn Fireplace ** Address: 49.0. 03. l i 1 / Range ** BBQ ** City /State /Zip: Qorin 4/ 9 70 0 1 Clothes dryer (gas) ** Phone: 5 i _s- " Fax: ss' $- IZ ys Other: ** CCB Lic. #: I zit 7s-7 .. Total: 'Mechanical l Permiit'Fees *= ,; . ' Authorized y /,�� Subtotal: $ Signature_ _ 6 — 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: Total:- Valuation:;_ PermitFee: __. $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. Assumed ValuatioasPerAppliance 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; unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to I 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 w r 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 $ . VALUATION: • i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 4 111.1.11k k • .A43 r 3 - at) I 30 '` ' -4‘.A.AA-A414-AllAtkAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ' - V I it4 AI • Ilt• • , O• STREET TREE cERTIFicA , , , . .... ,, ,,,. :., -. - ps. . , . • • I, ER/ k 05 Fro 0 , 4 wner ' gent for 4Z-VC9i_ot-.} fiom,5-3 00. • E*- • (PLEASE PRIM) (PERMIT HOLDER) ri• I I . It*- • , ti• , ic•- A - 11•• • ;:r :, ,, , ' , i , 1 , , i : - I* If Do hereb thif c ;io.f `ec, ib g location 0,,, • ..' ' I> i meets ( . on ounty to- • .- , • land use and development standards for street tree installation. I . li• ' • 5 , y S • . It• • I 1*- • , , fr\-1 , • ADDRESS: ii V OU 5 L4lli2E 6 L E -- S ■ 1 04* A ' ' , ' ' ' - • 10' LOT: ' / SUBDIVISION: L4t4e6 Ge- -c ■ i 1 ill $ D• 1 • BY ,...."-,:;,.. „,...._ ... DATE: ■ 1 / , ' ---. I RECEIVED BY: 'iy,, A „ „ DATE: 5 1... . ....., ., 1 . • . .Aor VT,VVV-TVT,174, ,MX:VVVVYTTVI'VTVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVNIvirl, . .,., - , i: , = .-1.‘,:p i ,,,,,!,, ' I CITY OF TIGARD. 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST° 3 _ /3 INSPECTION DIVISION Business Line: (503) 639 -4171 i0:tit P4''1 BUP Received Date Reque ted 5 20 -O AM PM BUP • Location // e - Suite"` MEC Contact Person Ph ( ) 793 '3 A 'P PLM Contractor Ph ( ) SWR BUILDING 'a 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 '� " �7 %�� EL L'12i - L. ' ��.1/jL.. ; �ic= lv[7�' S15%�c�% Gt�� Firewall 6� Fire Sprinkler G = O— . /V • Fire Alarm Susp'd Ceiling Roof Other � a PART • BING — Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PA FAIL CH Post & Beam Rough -In Gas Line Smoke Dampers _ PART FAIL E C,TRICAL 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: 0 Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date Z C� — Inspector • Ext Other: Final DO NOT REMOVE this inspection record from the. job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING- ID Inspection Line: (503) 639 -4175 MST (4 3 — 66/36 INSPECTION DIVISION Business Line: (503) 639 -4171 4/ /U;Z3P // BUP Received Date Request-d 4` 30 = °c AM PM BUP Location nn ��_ - �_ / d Suite MEC Contact Person &/tA;C Ph ( —5793— 3 ."6 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: 9 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 larm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL S LI Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA 11 3 0 31 �Jt Approach /Sidewalk Date inspector ° " '`! Ext Other: Final DO NOT REMOVE this inspection record from the Job site. . PASS PART FAIL CITY OF TIGARD 1. 24 -Hour • BUILDING Inspection Line: (503) 639 -4175 MST 3 6o (3o INSPECTION DIVISION Business Line: (503) 639 - 4171 �j BUP Received D e Requested l �/ AM PM BUP Location 1 / '7 � *CP.u.Jl.2e L- &vi Suite MEC Contact Person z- Ph ( ) 7 3 -3 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain .7-> 7? Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear ' Int Sheath/Shear W% A 4( k-IQ a j i 1 • q'4 1L1) N�'P t'll 11 y1 13 Q Framing tll �i Insulation Drywall Nailing Fi rewal l Fire Sprinkler Fire Alarm Susp'd Ceiling Roof a t.,� C.`T (11�'r VI 0 4�® 1, 10 t'P tL klocsAN O LETS o e Other: Final PASS P RT FAIL M I KO& L (� RO23 P BI, l� v Po eam n - A , / Under Slab V �- Rough -In - Water Service tl I Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan / Shower iii AS 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS PART AIL SITE.'' s ' - ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA ,cS '� � Approach /Sidewalk Date `� ` � o Inspector v I 6% 1 Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL