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Permit
A ° CITY OF TIGARD MASTER PERMIT • PERMIT #: MST2001 -00190 sl�I�� DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 4/18/01 SITE ADDRESS: 06993 SW LOCUST ST PARCEL: 1 S136AA -09100 SUBDIVISION: VENTURA ESTATES ZONING: R -4.5 . BLOCK: LOT: 013 JURISDICTION: TIG REMARKS: Construction of new single family detached residence. Path 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1,322 sf BASEMENT: sf LEFT: 13 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,306 sf GARAGE: 668 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 9 VALUE: $ 245,727.00 OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,628.00 sf REAR: 36 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =10OK: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 • 200 amp: 0 • 200 amp: W /SVC OR FDR: 1 PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 5 201 - 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: 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: X VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,098.84 INGATE CORP This permit is subject to the regulations contained in the W ING Tigard Municipal Code, State of OR. Specialty Codes and 15840 S S POPE OPE LANE 97045 all other applicable laws. All work will be done in OREGON accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg #: forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final Sewer Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Footing Insp Underfloor insulation Plumb Top Out Exterior Sheathing Ins[ Rain drain Insp Plumb Final Foundation Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection Wtr Proofing Bsm't Wa Footing /Foundation On Electrical Rough In Gas Line Insp Appr /Sdwlk Insp Building Final Issued By : rl �� Permittee Signature :�. ��. . Call (503) 639 -4175 by 7:00 p.m. for an inspection needen,e business day • Building Permit A ,/ - Permit no.: r/STAW —Q)j f, 3-i ,21:z::,1, . City of Tigard / 9 City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 - Expire date: Phone: (503) 639 - 4171 Date issued: By: I Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: 1 &2 family: Simple Complex: TYPE OF PERMIT 1II' 0 1 & 2 family dwelling or accessory 0 Commercial/industrial O Multi- family 1;iQ New construction 0 Demolition ❑ Addition/alteration/replacement 0 Tenant improvement 0 Fine sprinkler /alarm 0 Other: JOB SITE INFORilATlON Job _address: Gl, cj3 3 4.. ,„ s S1 _ Bldg. no.: Suite no.: ' Leot 13 I Block: (Subdivision: \IE.Nirigipt - S ; E,S I Tax map /tax lot/account no.: 15131 - Ci i OD Project name: ` ,– i PD Description and location of work on premises/special conditions: S t= R 1.1 E-y�) \ OWNER FOR SPECIAL lNFOlt19ATION, USE CHECKLIST Name: 1 a Ea Art. Cog" . (Floodplain, septic capacity, solar, etc.) Mailing address: 1 (A y p S, pmee. L ,,,► E. 1& 2 family dwelling: City: C) c,. otU vii Y? State: OI (ZIP: d..45 Valuation of work $ 24", 7Z 7 Phone:6s -33oo IFax: 51- -11 4d E-mail: No. of bedrooms/baths —3— Owner's representative:, .c ,. p : t er4S Total number of floors Z– Phone: I-'I 3-$$ • 5 Fax: E- mail:sc°tT,i , , c� - New dwelling area (sq. ft.) 26 Z-% _ APPLICANT Garage/carport area (sq. ft.) (p$ _,*dame: posA e. Covered porch area (sq. ft.) • ..1. (/ 3 `J M address : Deck area (sq. ft.) City: I State: I ZIP: Other structure area (sq. ft.) Phone: Fax: E- mail: Commercial industriaUmulti- family: CONTRACTOR OR Valuation of work $ • Business name: S(t'1 E Existing bldg. area (sq. ft.) . Address: New bldg. area (sq. ft.) City: I State: (ZIP: Number of stories Phone: I Fax: I E -mail: Type of construction CCB no.: 146%0 Occupancy group(s): Existing: New: City /metro lie. no.: Notice: All contractors and subcontractors are required to be ARCI IFl I:Ci IDFSIGNER licensed with the Oregon Construction Contractors Board under Name:1140c -5 , 2:J 1 51 ynis provisions of ORS 701 and may be required to be licensed in the Address: qQ9g Ss t L5 l 9 5-re Zpg jurisdiction where work is being performed. If the applicant is City: ' P -.rr .AyJ p I State: p e_4 ZIP: 9 Z2 S Contact person: iS exempt from licensing, the following reason applies: i__ Plan no.: y35 Z Phone: VI- -( 3 Fax: E -mail: ENGINEER Name: (,.i_e(L Erie( /1 nl Contact person: g g Fees due upon application $ Address: )1- too n1 µ) Lt.) e t ,s FF 6a_ Date received: City: Qom - 7_,i - rip IState:p (L (ZIP: C r 22C Amount received $ Phone: 5 ,3 -51-15 ( Fax: I E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this o Visa 0 MasterCard work will be complied with whether specified herein or not Credit card number: / / ) Expires Authorized signatu �s r Date: 3/2(0 6 D f Name of cardholder as shown on credit card Print name: S (.o • yr , R. i 6n6 S $ Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00/COM) One- and Two - Family Dwelling ;=, Building Permit Application Checklist Reference no.: 1 . CayofTigard City Ti and Associated permits: "J Tigard Electrical O Plumbing ❑ Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 TIIE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A I 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 -basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer 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. r 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". 24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. 25 Building plans shall not contain red lines or tape -ons. 26 No rolled, reversed or mirrored building plans will be accepted. 27 28 Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-4614 (6ro0icoM) • Mechanical Permit Application Date received: 3 D/ Permit no.: /15 j - gee Cr) /9D j''1 City of Tigard Project/appl.no.: Expire date: City flfTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 Date issued: By: I Receipt no.: Fax: (503) 598 -1960 Case tile no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family 0 Tenant improvement jiir New construction 0 Addition/alteration /replacement 0 Other: JOB SITE INFORMATION COi'IIIERCIAL VALUATION SCHEDULE Job address: foC*g3 S„.1 lL.a,w %.•r S T Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: i S 1; b ►'apt -- p (pp profit. Value $ • Lot: IS (Block: 'Subdivision: � - A E -rikT E,S *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county:1j(vItb . A T - ®>4ZIP: C 7 2, I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: S Fly. t•! EAAJ AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE • Fee (e .) Total Est. date of completion /inspection: Description Qty. Res.only Res.only Tenant improvement or change of use: — HVAC: Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system I%1 [CI IAN ICAL CONTRACTOR Boiler /compressors Business name: _-I -E i.� - G-'n nl - C:to c. , n ya State boiler permit no.: C l HP Tons BTU /H Address: I (000 0 SE. ■E,.I ? - 1 Fire /smoke dampers/duct smoke detec tors City: Ct, • ih q State:0 ' ZIP: Heat pump (site plan required) Phone: C,,gv —Sc.' Li Fax: E -mail: Install/replace furnace/burner BTU /H ' CCB no.: } 1 Including ductwork/vent liner ❑ Yes O No Install/replace/relocate heaters — suspended, City /metro lic. no.: wall, or floor mounted Name (please print): r/ t . S' . 7:7r 1 eD Vent for al p liance other than furnace CONTACT PERSON Refrigeration: Absorption units BTU/H Name: SPcpAE Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone: Fax: E -mail: Dryer exhaust OWNER Hoods, Type 1/ I1/res. kitchen/hazmat hood fire suppression system Name: Exhaust fan with single duct (bath fans) Mailing address: Exhaust system apart from heating or AC City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: Fax: E -mail: Fuel piping each additional over 4 outlets ess piping (schematic required) Name: Number of outlets Address: Other listed appliance or equipment: Decorative fireplace City: I State: I ZIP: Insert — type Phone: I Fax: I E -mail: Woodstove/pelletstove Othe Applicant's signature: I Date: 5/2 10 f Other Name (print):15c,..r- - 1 Cr.1 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ Notice: This 0 Visa 0 MasterCard permit applicatio Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ Cardholder signature Amount 440-4617 (6/00/COM) MECHANICAL PERMIT FEES • • COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Furnace 100,000 BTU+ $10,000.00. including ducts & vents 17.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace $1.54 for each additional $100.00 or including vent 14.00 fraction thereof, to and including 4) Suspended heater, wall heater $25,000.00. or floor mounted heater 14.00 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional $100.00 or 6.80 fraction thereof, to and including 6) Repair units $50,000.00. 12.15 $50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond fraction thereof. footnotes below. Comp* ** 7) <3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: to 3-15 BTU 14.00 8) 3 -15 HP; absorb Value Total unit 100k to 500k BTU 25.60 Description: Qty (Ea) Amount 9) 15 -30 HP; absorb Furnace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00 ducts & vents Furnace > 100,000 BTU including 1,170 10) 30 -50 HP; absorb unit 1 -1.75 mil BTU 52.20 ducts & vents 11) >50HP: absorb Floor furnace including vent 955 unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 floor mounted heater 12) Air handling unit to 10,000 CFM 10.00 Vent not included in applicance 445 permit 13) Air handling unit 10,000 CFM+ Repair units 805 17.20 < 3 hp; absorb. unit, 955 14) Non - portable evaporate cooler 10.00 to 100k BTU 3-15 hp; absorb. unit, 1,700 15) Vent fan connected to a single duct 101k to 500k BTU 6.80 15-30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in mil. BTU appliance permit 10.00 30 -50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust 1 -1.75 mil. BTU 10.00 >50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40 75 mil. BTU Air handling unit to 10,000 cfm 656 19) Commercial or industrial type incinerator Air Air handling unit >10,000 cfm 1,170 69.95 Non - portable evaporate cooler 656 20) Other units, including wood stoves Vent fan connected to a single duct 446 10.00 Vent system not included in 656 21) Gas piping one to four outlets 5.40 appliance permit 22) More than 4 -per outlet (each) Hood served by mechanical exhaust 656 1.00 Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge $ inserts, etc. Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ Each additional outlet 63 Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: Other Inspections and Fees: 1. Inspections outside of normal business hours (minimum charge -two hours) $72.50 per hour. 2. Inspections for which no fee is specifically indicated (minimum charge-half hour) $72.50 per hour 3. Additional plan review required by changes, additions or revisions to plans (minimum charge-one-half hour) $72.50 per hour State Contractor Boiler Certification required for units >200k BTU. "`Residential NC requires site plan showing placement of unit. is \dsts \forms\mech - fees.doc 10/11/00 • Plumbing Permit Application Date received: p j Permit no.:lAr /- >'./ :;• City of Tigard ' { Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date: Fax: (503) 598 -1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement New construction 0 Addition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: co 60-1 L_c,w ,— Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: Tax map /tax lot/account no.: {S 13 (a Vim- © 100 (includes 100 ft. for each utility connection) SFR (1) bath Lot: 1'3 I Block: I Subdivision: T OA ' 'r*1 SFR (2) bath Project name: SFR (3) bath City /county: T 04. I ZIP: C 1 - 1 - 1-1.5 Each additional bath/kitchen Description and location of work on premises: L S 7 14E1A-) Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: y, f . Pw v\> I,J� ` Manholes ' Address: L. k 00 fM f;`( Rain drain connector City: \/4-rJ c . J ■i E(?. I State:Ll)(} I ZIP: 9QG_(, I Sanitary sewer (no. lin. ft.) Phone: 360 1E-mail: Storm sewer (no. lin. ft.) CCB no.: j k52joz 'Plumb. bus. reg. no31- 'z ..f El. Water service (no. lin. ft.) City /metro lie. no.: Fixture or item: Contractor's representative signature: t ,0 ! Absorption valve t` ' Back flow preventer Print name: Sc.*. a i 11 ., . : , Date: ' /24, e, Backwater valve CONTACT PERSON Basins/lavatory Name: '=, M , 12 rye,& t ,,y6 Clothes washer Address: ,Spri Dishwasher m, Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: (3-- 4 3"} — i- Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): • Floor drains/floor sinks/hub Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: 1E-mail: - Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: 'Fax: 1E-mail: Total Not all jurisdictions accept credit cards, please call jurisdiction foi more information. Minimum fee $ Notice: This permit application O Visa O MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number. / / State surcharge (8 %) .... $ Expires within 180 days after it has been TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/ )0/COM) PLUMBING PERMIT FEES: • • • PRICE TOTAL New 1 and 2- family dwellings only: - • FIXTURES (individual) - • QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE .. .TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) , AMOUNT Lavatory 16.60 for each utility connection) One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 • Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3° 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 ' . • Quantity by Work Performed • • = : -. Gas piping requires a separate mechanical Fixture Ty New • Moved : . Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Hose Bibs 16.60 Tub or Tub /Shower Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2° Sewer - 1st 100' 55.00 3 " Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if • Quantity Total is > 9 *SUBTOTAL ' 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ • * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backfiow Prevention Device, which is $36.25 + 8% state surcharge. ** Ail New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts\forms\plm-fees.doc 10/10/00 • Electrical Permit Application Date received: Siff/MI Permit no.: PAVdt9 /�/9� .i `�I City Tigard . y o gar Project/appl. no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERi1IlT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement lgi New construction ❑ Addition/alteration/replacement ❑ Other: CI Partial JOB SITE INFORMATION Job address: G,9,612 , SuJ Lo W ST CI-- Bldg. no.: Suite no.: Tax map /tax lot/account no.: j St Sb{} O — d`(/A( Lot: l 2 I Block: (Subdivision: \iel..k TJQ mss. T E S Project name: I Description and location of work on premises: 3 r NS Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: Fee Max Business name: Descri . tion Qty. (ea.) Total no. insp New residential - single or multi - family per Address: 10639 SE Pa -►i,z "..) f� b dwelling mill. Includes attached garage. City: �ne-1-1—hrA . I Statex9(L I ZIP: q - I - 7...,27_, Servicelncluded: Phone: 6'4%1.6 I Fax: I E-mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: 3q 2.r-, I Elec. bus. lic. no: X32,1 �, Limited energy, residential X�e 2 City /metro lic. no.: Limited energy, non - residential ! 2 Each manufactured home or modular dwelling Signature of su ervising electrician (required) Date 3/7( 1 Service and/or feeder 2 Su elect name (print): License no: Services or feeders — Installation, Sup. Pea Je. Dey.h a t n" en.,_ Zl �-' alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E- mail:. Reconnect only I Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 . • Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, Name: or extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: I State: I ZIP: B. Fee for branch circuits without purchase Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2 Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps-commercial 0 Health-care facility • Each pump or irrigation circle • 2 ❑ Service over 320 amps- rating of l&.2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, O System over 600 volts nominal more residential units in one structure alteration, or extensions 2 O Building over three stories 0 Feeders, 400 amps or more *Description: O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress/lighting plan O Other: Per inspection Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other . Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6100 /COM) Electrical Permit Fees: Limited Energy Fees: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total 4, Check Type of Work Involved: Residential - per unit . 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems . Each additional 500 sq. ft. or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 El 201 amps to 400 amps $106.85 2 Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only • $66.85 2 • Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 -260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: • Over 600 amps to 1000 volts, see "b" above. ❑ Audio and Stereo Systems Branch Circuits ❑ New, alteration or extension per panel Boiler Controls a) The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 • Each additional branch circuit $6.65 ❑ HVAC Miscellaneous ❑ Instrumentation (Service Or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s) or a limited energy . panel, alteration or extension $75.00 ❑ Landscape lmgation Control Minor Labels (10) $125.00 • Each additional inspection over ❑ Medical the allowable in any of the above Per inspection $62.50 ❑ Nurse Calls Per hour $62.50 In Plant . $73.75 ❑ Outdoor Landscape Lighting • Fees: ❑ Protective Signaling Enter total of above fees $ ❑ Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee Revi See "Plan Review' section on $ * No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ • Total Balance Due $ i:\dsts \forms \elc- fees.doc 10/09/00 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE I M PLUMBING 411 HARNEY WAY • . VANCOUVER, WA 98661 Plumbing Signature Form Permit #: MST2001 -00190 Date Issued: 4/18/01 Parcel: 1 S136AA -09100 Site Address: 06993 SW LOCUST ST Subdivision: VENTURA ESTATES Block: Lot: 013 Jurisdiction: TIG Zoning: R-4.5 Remarks: Construction of new single family detached residence. Path 1 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 Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: WINGATE CORP I M PLUMBING 15840 S POPE LANE 411 HARNEY WAY OREGON CITY, OR 97045 VANCOUVER, WA 98661 Phone #: 503 - 793 -8895 Phone #: 310 -2083 Reg #: LIC 115262 PLM 37 -357nb AN INK SIGNATURE IS REQUIRED ON THIS F M Sign re of Authorized Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD BUILDING INSPECTION DIVISION Msr 3- 60/ 5 p 24 -Hour Inspection Line: 63: 75 Business Line: 639 -4', • BUP Date Requested /0 -.3 AM PM BLD Location r!o9g3 ._ Suite MEC Contact Person Ph 3 .F895 PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation 1� f k FPS Ftg Drain ` SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Fire • - 11 " �_,- R FAIL SITE BackfilUGrading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for r 'nspecti n RE: [ ] Unable to inspect - no access • ADA /�) " Other p Approach /Sidewalk D l Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 41w ITY OF TIGARD B' - "_DING INSPECTION DIVISIC _ -",- p / DO ( 0 24zHour Inspection Line: 644 -4175 Business Line: 639 -417 I! BUP Date Requested 10 — /O AM PM - BLD Location _.3 ., i S - - - C Contact Person _-_....i _;_....&ilf Ph 9 cl :- Ere?7,c P Contractor SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Aces ; FPS Foundation Ftg Drain C ri-bia ------- "\ Crawl Drain InSp io •: \ SGN Slab 4 . / / !� .�� - SIT Post & Beam I Ext Sheath /Shear G 1 Ina mingth /Shear 24 Oros- � ` Framing /' C. - - Insulation Drywall Nailing L Fire wall l Z4r/jez S -Q S 7 r-e-e e 6 `J 7 /L I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof 00.4 lie./ /�� O Misc: Ci ACP ! d/'3/o 1 C - SS PART Allet PLUMBING ' `10') e ,......_12 ` ,......_12 _ Post & Beam / ` Under Slab A L , Aid 6 C O d f I'd rT Top Out r Water Service ,� ^ , /2 , n �- / G'� -rrriv o._X Sanitary Sewer 02X Q Rain Drains W/ �A �°—�C . AS ` G--f-- � ' PASS PART FAIL _ MECHANICAL / Post & Beam / Rough In /.�� %� d 4 '' C: -G d I c s r . Line Smoke Dampers AIIIIIP2 ( 4 cam �/_ . PART dal 6.) t f j � / . RICAL '_'' — Service G „ 1� l �) P 'YxY Rough In � �. y 6 4 UG /Slab (6-;(--A L-:/ ' - c.i4 �` 7 . Low Voltage /� L.A. Fire Alarm ^ 6•) .-C _19._...4- C��✓ S ( S. Final `) �' v, -2—+- Z�*.✓ / ___) ��, PASS PART FAIL �> !/p� SITE Ci. " 61 r ! f Sanita ry Sewer Storm Drain n 1 [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin � Fire Supply Lin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA a A••roach /Sidealk O, � Date / /� Vo / Inspector Extt I w ff PASS PART FAIL DO NOT REMOVE this inspection record from the job site. I CITY OF TIGARD BUILDING INSPECTION DIVISION MST 20O [ o ©t c� 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 � � ` SUP Date Requested / 0 -" / Z AM PM BLD 2 Location I q 3 5-E- Suite MEC Contact Person Ph 3 5eZL (. 0D ( —O O - Contractor Ph SWR BUILDING Tenant/Owner ELC airing Wall ELR Foote Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes:C�.w Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing �j y Firewall '7 v 2 -r - �- C€_ r ( ,- Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: • - FAIL • • - ING Under Slab rOV Top Out Water Service Sanitary Sewer °� Ra' • i rains i PART FAIL ANICAL • Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to ins pect - no access ADA ey—C/74. Approach /Sidewalk Date ' /t Z /d ( I Ext Other Final PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.