Permit A ��' MASTER PERMIT
Ty , PERMIT #: MST2004 -00250
,,r ;�� � i J DEVELOPMENT SERVICES DATE ISSUED: 9/27/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 09575 SW PIHAS ST PARCEL: 1 S135CD -13000
SUBDIVISION: GREENBURG PINES ZONING: R
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: MAS2239NG STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,199 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,326 sf GARAGE: 460 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE: 247,476.00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,525 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 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: 5 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 FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st IMO SVCIFD2: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HWSVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. 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 8 STEREO: VACUUM SYSTEM: AUDIO 8 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: $ 7,852.45
This permit is subject to the regulations contained in the
VISTA NORTHWEST INC VISTA NORTHWEST INC Tigard Municipal Code, State of OR. Specialty Codes
PO BOX 91459 PO BOX 91459 and all other applicable laws. All work will be done in
PORTLAND, OR 97291 PORTLAND„ OR 97291 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.
Phone: 503 - 531 - 0505 Phone: 503 - 531 - 0505 ATTENTION: Oregon law requires you to follow rules .
adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 75507 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins F Rain drain lnsp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Roof Nailing Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall lnsp Insulation lnsp Water Service Insp Building Final
Issued • , , " ' _ = i _ Permittee Signature : - -ir / , • , .
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
PI Buildin Permit A • I!i!E® FOR OFFICE USE ONLY
Ci of Ti and Permit No.:
h' g DateB : Rece ived g � ,,'0 �� Ns�i�x 04 SD
in
13125 SW Hall Blvd., Tigard, OR 97223 q��� I'( P R ev i ew
Phone: 503.639.4171 Fax: 503.598.19f17 / /aieA /O O '
2004 �j J � `W + +� Date/13 : p Other Permit: 'dam d1
Inspection Line: 503.639.4175 sag. F I Date Ready/By: p El See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: / a W /, Supplemental Information
BUILDING nivISION
TYPE OF WORK . . . ` REQUIRED DATA: 1- AND 2 - FAMILY DWELLING
ew construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
- . CATEGORY OF CONSTRUCTION ` work indicated on this application.
.. 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: Z r 5
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9i57 5— ,_"." 1 7 j 1 14 : 5, „ New dwelling area: s-- square feet
City/State/ZIP: ' /....."-% Garage/carport area: 3/1 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 2 square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CBECKLIST .b
Subdivision: ��0 N J /j S Lot no.: , Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
' DRIPTION OF WORK work indicated on this application.
K Valuation: $
Existing building "area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT ' Number of stories:
Name: , `l� J Type of construction:
Address: Z ,./V Occupancy groups:
City/ State/ZIP: /✓ ®4''22 �� Existing:
Phone:J':31/ Calr Fax: ( )
New:
❑ API5LICANT - • . .0 CONTACT PERSON .
NOTICE , _ .
Business name: <>I-44e— All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) Fax::( )
E -mail:
' - CONTRACTOR"
Business name: �i� BUILDING PERMIT `FEES * ...,
Address: .
Please refer to fee schedule.
City/State/ZIP:
Phone: ( ) Fax: Fees due upon application
( )
Amount received
CCB lic.: 7 � ` � �
"� f Date received:
Authorized signature ■ �j This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , ' , _:5.) ��r Date: - 7 * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building Wermits \BUP- PemtitApp.doc 12/03 440- 4613T(1I /02/COM/WEB)
•
Building Division
�' °��� ° "'61 ,\ Plan Submittal Requirement Matrix
�- Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type of Submittal . # of Plans
(includes new, additions and alterations.) Required at
Submittal. r .:
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(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 \COM- PlanSubReq.doc 12/24/03
liull ing r ixt>R EIVED
Plumbing Permit A plication FOR OFFICE USE ONLY
Received Plumbing
AUb LUO't Date/By: Permit No.: q5 - bt5:3'
City of Tigard Planning Approval Sewer
g CITY OF TIGARD Daffy: PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 BUILDING DIVISION Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post = Review Land Use
lollit !�° '�A Date/By: Case No.:
Internet: www.ci.tigard.or.us _ i1 I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist) • .
.'lTew construction ❑ Demolition Description . . I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2 -family dwellings
CATEGORY OF CONSTRUCTION (includes 100 tt for each utility connection)
dwelling Commercial/Industrial SFR (1) bath 249.20
2-Family It calic g ❑ SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: _ Page 2
Job site address: _Sr Site Utilities
Suite #: ,5' ,5' 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
Subdiv Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft Page 2
Fixture or Item
DESCRIPTIONN OF WORK Absorption valve 16.60
/(fe--/-0 r/ Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: / .4/ Expansion tank 16.60
Address: ,' /f :- Fixture/sewer cap 16.60
City /State /Zip .' in Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 5 jr g' Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City/State/Zip:
Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan 16.60
CONTRACTOR Urinal 16.60
Business Name: , _ ,z72,,f Water closet 16.60
Water heater 16.60
c
Address: ,� 5 j ,5: /� "/:__�� Other:
City /State /Zip: _...-4. _ Other:
Phone / ,3 ca Fax: Plumbing Permit Fees*
CCB Lic. #: - _ Plumb. Lic >�� Subtotal $
��/ Minimum Permit Fee $72.50 $
Authorized
D ater`- Residential Backflow Minimum Fee $36.25
Signature: /fi ---• Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fce methodology set by Tri- County Building Industry Service Board.
iADsts\Permit Forrns\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . Qty. Fee (ea) Total . Square Footage:.` Permit Fee:
Footing drain - 1" 100' 55.00 0 to T;000- $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
•
Water Service - each additional 100' 46.40
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
•
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture'work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
4 „
•
•
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
•
Shower -Gang
-Stall
Sink - Bar/Lavatory
•
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i :\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Electrical Permit A FOR OFFICE USE ONLY
a tlon Received Electrical
C r Date/By: Permit No.:�" � 5o
Cl Tigard Ti and R `V Planning Approval Sign
:
Plan Review Permit No.:
13125 SW Hall Blvd. AUG 25 2004 Plan Re Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 FaaXX,,,� S5Q(���-�� ]1 Post- Review Land Use
l�l l YCJt A V,1 ► , / / Hi aa: Al i�
I,t��{ ' l Date/By: Case No.:
Internet: www.ci.tigard.
DIVISION eel I Contact Juris.: ® See Page 2 for
24 -hour Inspection RequesT: 3 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply) ., • ,
„a ew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement ❑ Other:
commercial
Service ❑ Hazardous location
❑ over 320 amps- rating of ❑Building Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
_ f& 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 95757 /J j /.tt,¢5',g; FEE* SCHEDULE
Suite #: Bld • . /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total i
Cross street/Directions to job site: New residential-single gi. Includes attached tached garage. per
.l dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
11&�9 f, /% / Limited energy, non 75.00 2
Subdivis10
. ✓S � Lot #' Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
- DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation, .
alteration or relocation:
200 amps or less 80.30 2_
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
_ _. • J� PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
f , Over 1000 amps or volts 454.65 2
..
Name: $Z. ty J / Reconnect only 66.85 2
_ , Address: /31x)%?/fr/S-Y Temporary services or feeders - installation,
7 alteration, or relocation:
City /State /Zi : ,eY 2 ,'72 9/ 200 amps or less 66.85 1
Phone T /Fax: 201 amps to 400 amps 100.30 2
❑ AP IC ❑ CONTACT PERSON r n h c amps 133.75 2
� 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): •
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: �� / � j �-s /�� „� Signal circuit(s) or a limited energy panel,
alteration, , or or extension Page 2 2
Business ame:
Description:
Address: ;230fe Each pl .e - A, , f/
C1 City/State/Zip: Each additional inspection over the allowable in any of the above:
ty p: , /iIi 'a te far �7/7 Per inspection per hour (min. 1 hour) 62.50
Phone( 3).4412-714=2› 4/2 Z Fax: Investigation fee:
CCB Lic. #: : 1C. #: /L� Other:
Electrical Permit Fees*
Supervising electrician / , Subtotal $
sit ature re • uired: � / / ,,/! �± Plan Review (25% of Permit Fee) $
Print Name' .,A” .k � _ - Lic. #: SJ 3Z� 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\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - 'Supplemental Information
LIMITED ENERGY PERMIT FEES: -
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Burglar Alarm
0 Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
• Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
▪ Instrumentation
Intercom and Paging Systems
El Landscape Irrigation Control
El Medical
El Nurse Calls
0 Outdoor Landscape Lighting
El Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
Mechanical Per • ® FOR OFFICE USE ONLY
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 H4fo' � aSZ�
Phone: 503.639.4171 Fax: 503.59A�� 2 5 2004 i u . Plan Review Other Permit:
yh ..:y �,A\ Date/By:
Inspection Line: 503.639.4175 ■ j r -�I Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us C OF TIGAR® Notified/Method: Supplemental Information
DIJILDI NG.niVISION .
TYPE OF..WORK ; : a ,: COMMERCIAL, FEE *.'.'SCHEDULE= 'USECHECKLIST'
ew construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
' - • .- . t - CATEGORY OF CONSTRUCTION , ;v , --- Value: $
— • RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
Multi -famil
❑ Multi-family ❑ Master builder ❑ Other:
Description I Qty. I Ea. Total
JOB SITE INFORMATION .AND LOCATION • Heating/cooling
5-75— C, P/� ∎��
Air conditioning
fires s to plan ho or i gt place
Job site address: 9
(requires site Ian showin placement) 14.00
City/State/ZIP: 7 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
/- �G�/ / Other: in -wall, in -duct, suspended, etc. 10.00
Subdivision: 1q� ► /
Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF . WORK . Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER ' ,❑" TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: .// 5›..-- ���� Environmental exhaust and ventilation
Range hood/other kitchen
Address:
�, /f� ,9 equipment 10.00
City/State/ZIP: /„.,erl�/ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone• (� 5 -0/ ;v5 Fax: ( ) toilet compartments, utility rooms) 6.80
. - - ❑ APPLICANT ' ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: -
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR . • Barbecue
- Business name: �i�,�� . y(4.4i...7.-/.. Clothes dryer (gas)
�/ /� Other:
Address: MECHANICAL PERMIT FEES' .
City/ State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This per application expires If a permit Is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building 'Pennits'MBC- PemdtApp.doc 12/03 440 -461ST (11 /02/COM/WEB)
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.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\ Building \Permits'MEC- PermitApp.doc 12/03 2
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• Do hereby. certify h4. to following location V ■
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• meets ;C�i �yy'of; -igard /Washington County ■
land use and development standards for street tree installation. ■
• ►
• ■
• ADDRESS: ; r7.� -'G69 / x //75 SO j
• ■
j O• • LOT: d r SUBDIVISION: ,Z4 -C ■
• ■
• • BY: � � DATE: ��y��cx/ •
• • •
A RECEIVE BY: o DATE: 9.a7A •
• •
AIVVVVVVVVVVVVVVVVVVVVVVVYYVVVVYVVVVVVVVVVVVVVVYVVVYYVYVYVVV1
CITY OF TIGARD 24 -Hour r�11
BUILDING ` Inspection Line: (503) 639 -4175 MST c 4-63,5z
INSPECTION DIVISION Business Line: 03) 639 -4171
BUP
Received Date Requested , // — 1 ( AM PM BUP
Location 9 S 7 �� .,fit' ��� Suite MEC
Contact Person Ph ( )�� f) `����� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: 4 96 ELR
Crawl Drain " j ��
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear Li 1' L�
Framing
Insulation t
Drywall Nailing � A., (5 L7Z if2. t =}
Firewall i f
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final 7n.(7 I C�7�
PASS PART FAIL
PLUMBING d'- /4- (74-c_ S yS 7 V-1 q-z)
Post r Slab i 4 - � S � _ �L- � - f v PCB p
Under Slab j /�
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS P T FAIL
L
Po eam
Rough -In
Gas Line
S� Dampers
PASS PART 12,
ervice
Rough -In
UG/Slab
Low Voltage
Fire Alarm
t h i Sr
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA _
Approach/Sidewalk Date P 7 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record f t e Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 639 -4175 MST ° "-
INSPECTION DIVISION • Business Line: (51k ) 639 -4171
BUP
Received Date Requested — / M PM BUP
Location / Suite MEC
Contact Person i Ph ( ) 7� — 9 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ft Drain Access:
Crawl Drain �j 0)< ELR
S�
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear j� --^� ®--- 44/ Z _ j o � G 5�� S�s Framing 1 \ C" U� ( 6 vv
Insulation _e/`x't
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
AS 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: ` 0 Unable to inspect — no access
Fire Supply Line
ADA 2 /( -0
Approach/Sidewalk Date s Inspector
Ext
Other:
Final DO NOT REMOVE this inspection record fro • = job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175 MST .gO — ed )"383
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re guested ° l AM PM BUP
Location s Suite MEC
Contact Person Ph ( ) 7 Z.6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
l Ftg Drain
Drain
/ 2 (�" ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing '7c t b a S k �/ orb �, 17.e + .c ,�"wt (, 01/4) �cgrec.- O�
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:
i
PAS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ 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 _ -) I 1 J o< Inspector �'►"^'� 1 �� - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING 0 Inspection Line: (503) 639 -4175
I 02OD4_ OW- 5'D
INSPECTION DIVISION Business Line: 7 /394171 BUP
Received Date Ree uested PM BUP
Location 95 7 f A LIAS C1 / Suite MEC
Contact Person ces Ph 7 PLM
C Ph ( SWR
BUILDING Tenant/Owner ELC
oomg
Foundation ELC
Access:
Ftg Drain 4690 ELR
Crawl Drain •
Slab Inspection Notes: r SIT
Post & Beam r hed cc yavvi lh 5p-
Shear Anchors
lnt Sheath/Shear Sheath/Shear
Ina r , D _ s / Q �� P/ iV
Framing c���
Insulation rte
Drywall Nailing i
Firewall 1 N S �T w G l
Fire Sprinkler -'' �•�' ll
Fire Alarm
Susp'd Ceiling
Other • "A, OC• ' SQ
•ART FAIL
• ' ' BING
Post & Beam • I d, ' M 1 /
Under Slab !�
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next ins ection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE fl Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record fro e Job site.
PASS PART FAIL