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Permit .- • , 4 � MASTER PERMIT R CITY O F T I GA D PERMIT #: MST2004 -00073 1411 SERVICES DATE ISSUED: 3i22iO4 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 08729 SW REILING ST PARCEL: 2S111AD -17500 SUBDIVISION: MLP2000 -00009 (WINTER'S) ZONING: R - 4.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: 1750 sf addition. No CWS letter required. Extra plumbing fixtures are 2 hose bibs and extra mechanical is gas fireplace. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 15 FIRST: 1.750 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 172 051.00 OCCUPANCY GRP: R3 BDRM: 6 BATH: 6 TOTAL: 1,750 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 7 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 9 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: ' OTHER FIXTURES: 2 MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: 1 VENT FANS: 8 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 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: 8.00 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: $ 2,609.24 RU, EUGEN OWNER This permit is subject to the regulations contained in the PAT PAT U, EUGEN ST. Tigard Municipal Code, State of OR. Specialty Codes and 8729 SW REILING all other applicable laws. All work will be done in S 97224 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 - 789 - 8469 Phone: Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #, may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Underfloor insulation Electrical Rough In Gas Fireplace Mechanical Final Footing lnsp Crawl Drain /Backwater Framing Insp Insulation lnsp Plumb Final Foundation Insp PLM /Underfloor Shear Wall Insp Rain drain lnsp Final inspection Post/Beam Structural Mechanical Insp Exterior Sheathing InsF Roof Nailing Post/Bea•. ' • - _ - - -I Plumb Top Out Gas Line Insp Electrical Final I. sued By : • `I _ I ,161 g& , II ,.;■ Permittee Signature : —�-_� !: T.�'i�l_i — Call (50 639 -4175 by 7:00 p.m. for an inspection needed the ne • usiness day Building Permit App FOR OFFICE USE ONLY 5 City of Tigard MAR 3 2004 Da / dy �_ PemutNo. — O�� / 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.19 / � ' '/ ' ' Date/By: )04 ( 1— 1 $ - G f Other Permit: Inspection Line: �iITY OF TIGAR � :'ll� Date Ready/By: 65 See Attached Checklist for 5 BUILDING DIVIS Internet: www.ci.tigard.or.us gard.or.us ' d/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: 1 - AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all IN Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 166. o00 I:4 1- and 2- family dwelling ❑ Commercial /industrial Number of bedrooms: 6 ❑ Accessory building ❑ Multi- family ❑ Master builder ❑ Other: Number of bathrooms: 3 /uffoid 4r40/ JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 3 Vzg 5 tift Redti-iq e5t New dwelling area: / S0 square feet City/State/ZIP: 75;91,15/ r ele f9' ' 2 4j Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: 00 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: as/ 1 4D• 1 500 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. V A--.PD /T /oA) Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT _ Number of stories: Name: E em P.9 roes/ Type of construction: Address: 8 xZ9 5 uv. & i 5, . Occupancy groups: City/ State/ZIP: T" o of 9, 2/ _ Existing: Phone: (543) —8469 Fax: ( ) New: ❑ APPLICANT P4 7- ❑ CONTACT PERSON NOTICE Business name: kl14E4/ Pi/ / RL� All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and maybe required to be licensed in the Address: 8 2s yy 5w. Re! � ' 1 ?Z jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/ State/ZIP: l ' vsr, / OR / Z5 - apply: Phone: (cpa) 149 -84. Fax:: ( ) E -mail: 6r/- I L b t CONTRACTOR . Business name: OW 04&1. BUILDING PERMIT FEES* Address: Please refer to fee schedule. City/State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lic.: Date received: Authorized signature: This permit application expires if a permit is not obtained / _ within 180 days after it has been accepted as complete. Print name: 5ij6g � Date: 0,3 03.00. * Fee methodology set by Tri- County Building Industry Service Board. , / g Q�'l/ i:\ Building \Pemtits\BUP- PennitApp.doc 12/03 440- 46I3T(I1 /02/COM/WEB) 9a � e4 Vt 9 tZt/a" ' " j� • _ f One- and Two - Family Dwelling - ., Building Permit Application Checklist FOR OFFICE USE ONLY City of Tigard . Received Permit No.: „ Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 • - ^ ��� 3 � w11 ' " t yP' i ❑ Electrical ❑ Plumbing ❑ Mechanical _ 24- Hour Inspection Line: 503.639.4175 4' Internet: www.ci.tigard.or.us '� ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ . 4 Fire district approval required. Name of district: ❑ ❑ ❑ 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.' -1 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. ' 1 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner 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. 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 Ore:on and shall be shown to be applicable to the .ro'ect under review. • - - JURISDICTIONAL SI'ECIFICS 23 Five (5) site plans are required for Item I 1 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 and 22 above. , ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn lo scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings • on a lot of record approved prior to September 9, 1995. . i:\Building\Permits \One- Two- FamilyChecklist.doc 12/03 Building Fixtures , Plumbing Permit IlitttE. E D FOR O USE ONLI' City of Tigard Date/By: Permit No.:MSTat1Ut '/ O -Dd 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.19AR 2004 � /� Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 , 4 4.4, M 7 ,,, , , , , ,.1../ Date ReadyBy: Jars: See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGAR D Notified/Method: l ® Supplemental Information t DkN 'V b JISION FEE* SCHEDULE Description For special information use checklist. ❑ New construction ❑ Demolition - p Qty. I Ea. I Total I Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 Ff I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 SFR (3) bath 399.00 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 45.00 . ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCCATION Site utilities Job site address: 8 . , Iiet Re, r tr..' Catch basin or area drain 16.60 City/State/ZIP: // rr� ow 9> y Drywell, leach line, or trench drain 16.60 / r Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Lot no.: Water service (no. linear ft.: ) Page 2 Subdivision: .4 6r Fixture or item • Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 IT I 074 Backwater valve 16.60 Clothes washer 16.60 Dishwasher - / 16.60 Drinking fountain 16.60 PROPERTY OWNER I ❑TENANT Ejectors /sump 16.60 Name: 606 EA/ p9T 'C' Expansion tank 16.60 Address: fJ '29 514/. ) '/ 6,4 Fixture/sewer cap 16.60 City/State/ZIP: k .9 aie 2z� Floordtain/floorsink/hub 16.60 � O3) / Garbage disposal r 16.60 Phone: 8¢ 6 F ax: ( ) Hose bib 2 ._.: 16.60 ❑ APPLICANT , ❑ CONTACT PERSON Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 Roof drain (commercial) 16.60 City/State/ZIP: Si aas'�vatory I L.A.4 9 16.60 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 • CONTRACTOR Water closet 16.60 Business name: Bezel; f Z� /X/c Water heater r_iI r:- -= . J!t. %; r / %' 16.60 / /: 3 L , a f / n emu• ) ) Other: 0 (Y�a C I Address: Tl�c' t/ Subtotal City/State/ZIP: tt/9-111 G Minimum permit fee: $72.50 Phone: (. )(''/ 7 - � `9 / Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: ,.3 0 6 /5" _ Plumbing Lic. no.: 3y -,360 f',G�, Plan review (25% of permit fee) v- - .St --oil State surcharge (8% of permit fee) Authorized signature: •.r TOTAL PERMIT FEE - Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. is\ Building \Perrnits\PLMF- PemtitApp.doc 12/03 440.4616T(10/02/COM/WEB) 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 2,000 $115.00 2,001 to 3,600 $160.00 Footing drain - each additional 100' 46.40 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 Qty, Fee (ea) Total additional $100.00 or fraction thereof, to and Fixture or Item - 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 Fixture Type: Replace New Moved Existing Capped Comments regarding fixture work: 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" • -4„ Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach./Refrig. Drains fees assessed for the sewer increase must be paid before the Oil Separator (Gas Station) Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink -Bar/Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\Buildineem its\PLM-PermitApp.dnc 3/03 Electrical Permit A t , t o FOR OFFICE USE ONLY • City of Tigard R 3 2004 Received 13125 SW Hall Blvd., Tigard, OR 97223 �� Date/By: Permit No.: VI 4 o 4 - 73 Phone: 503.639.4171 Fax: 503.598.19 TI( D ate / n y: Review CITY • :: c. : •�' ,� , ale Other Permit: pF b � , ���� Inspection Line: 503.639.4175 DIVl " e_ __, Date Ready/By: lam: EI See Page 2 for Internet: www.ci.tigard.or.us BUILD IN Notified/Method: Supplemental Information TYPE OF WORK _. PLAN REVIEW ❑ New construction K1 Addition/alteration /replacement Please check all that apply: ❑ Demolition ❑ Other. ['Service over 225 amps, comm'l ❑Hardous location ['Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft., - ..CATEGORY.' OF 'CONSTRUCTION . . - - " of 1- and 2- family dwellings 4 or more new residential 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure Multi - family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more persons Ma ufac ,. �.. . .. load over 99 e n to red structures or Occupant to _ , JOB_ . SITE. INFORMATION.•A LOCATION' -' ,� f Job no.: Job site address: g72 ( S R EILfAk S � DEgress/lighting plan RV park ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City/State/ZIP: <7-16 OA • 17214 The above are not a to temporary construction service. Suite/bldg. /apt no.: I Project name: [ c t FEE *.SCHEDULE Description I Qty. 1 Fee. I Total I •' Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. R. or less 145.15 4 Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I Tax map/parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF, WORK ';_ . Each manufactured or modular dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 III PROPERTY ;.', z ` ;OWNER _ ��' 201 amps to 400 amps 106.85 2 ❑ TENANT. 2 . ' ' . 401 amps to 600 amps 160.60 Name: E(JG ,d ( pirrQc/ 601 amps to 1,000 amps 240.60 2 Address: g - 7 2..? S W A ESL(,- S'� Over 1,000 amps or volts 454.65 2 �; Reconnect only 66.85 2 �- City /State/ZIP: I ( C 4 4 bg. 97 224 . Temporary services or feeders installation, alteration, and/or Phone: (�3 7 Sp _ g � 6 r /g . I Fax: ( ) relocation 7 7 1 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 1 33.75 Owner signature: Date: Branch circuits– new, alteration, or extension, per panel '._ -❑ APPLICANT -. - ,, ' . ' - ❑ CONTACT' PERSON ` A. Fee for branch circuits with service or feeder fee, each Business name: f u6 , 6 - A , P T • / /�J v branch circuit B. for branch circuits 6.65 2 Contact name: Ec)6'�iY' without wout service or feeder fee, 1 • 46.85 2 %72" S kE /. rti& ST ` each add'l branch Address: Each add'1 branch circuit a 6.65 2 City/State/ZIP: 1 d 0.4 1722* Miscellaneous (service or feeder not included) `` ® Pump or irrigation circle 53.40 2 Phone: (�/j� `j q �7 6 f Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- - . CONTRACTOR energy panel, - _ e alterati on, or L , //4 EZEC ` se) extension. Describe: Page 2 2 Business name: � I/ Address: 1 S. tog - Each additional inspection over allowable in any of the above n Per inspection 62.50 _ City/State/ZIP: /� 74/e/Y Ott 5 Investigation per hour (I hr min) 62.50 P h o n e : ( ) ) 16g _7 y$ I Fax: (9:01) 77 ( _5 OS Industrial plant per hour 73.75 CC1l /� - ELECTRICAI:•_PERMFF, FEES' ' CCB Lie.: /(6)4e Op I Electrical Lic.L6 Qgp I Suprv. Lic.: 4' 19 S' Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: S'fZ. ° /� ()/y �'/3 Date: 0Z 27 ,�� State surcharge (8 %oCpe fee) �-� TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per pemut allowed. is\ Building \Perrnits\ELC- PennitApp.doc 17/03 440.4615f(10/07/COM/WEB • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: '11ESIDENTIAL _WOitI ONLY; Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: ;CONIIYII;RCI L WORK >ONLY• ., Fee for each commercial 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 ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i: Building \PermitAELC- PmmitAPP.doe 04/03 Mechanical Permit Application ' ; c FOR OFFICE USE ONLY City of Tigard Received DaDate/By: Permit No. /1, C r � o 3 13125 SW Hall Blvd., Tigard, E I V E D , R Y Phone: 503.639.4171 Fax: 5 � Plan Plan Review e : Other Permit: Inspection Line: 503.639.4175 '` F41 Date Ready/By: Jura: La See Page 2 for Internet: www.ci.tigard.or.us MAR 3 2o0T J Notified/Method: Supplemental Information CIT ' NW alteefeadi c COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction B n tf� itYiil'�lvre placement 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. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 'a1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 8 7 Q 5 leP L ( . � • Air conditioning res ste plan ng or heat pump / 2 `/ (requires site plan showing placement) ) 14.00 • City/State/ZIP: Tiplarei ©s r l TLZ 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), in -wall, in -duct, suspended, etc. 10.00 Flue/vent for any of above 10.00 Subdivision: Lot no.: (/4•5 Ma. Other ' r c T 10 .00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK • Water heater / 10.00 Gas fireplace /r/5gr I 10.00 7 0720 - 0 6 LL 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 Chimney/liner /flue/vent 10.00 ❑ PROPERTY OWNER I ❑ TENANT Other: 10.00 Name: 1 U66--,,,/ .239747 Environmental exhaust and ventilation Address: 8.p'29 5 p Z/42" 6 . equipment hood /other kitchen e ui meat 10.00 City/ State/ZIP: 7 D� 9 ` 22, Clothes dryer exhaust 10.00 / Single -duct exhaust (bathrooms, Phone: (5x3) 9 01.69 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 Furnace, etc. Address: Gas heat pump City/ State/ZIP: Wall/suspended/unit heater • Phone: ( ) Fax :: ( ) Water heater Fireplace E -mail: Range CONTRACTOR /� Barbecue Business name: S Mdl>e7 1- T/E4'rl $ C0O� %N LL Clothes dryer (gas) F? C Other:OPS Tirs6�Lf / Address: •F�-J I G E , v E Q rr Ste' MECHANICAL PERMIT FEES* City/State/ZIP: �poR 7 LE}N1� O 9 2 I 'Z Subtotal 1 J Minimum permit fee ($72.50) Phone: (3S)3) 2o9 0 s4 7 G F ax: (SO 3) 2 s4 5-094. Plan review (25% of permit fee) CCB lic.: 4 54 4 3 3 State surcharge (8% of permit fee) //) TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit Is not obtained within 180 gn d "` days after It has been accepted as complete. Print name: t //6 6- 'A 7 Date: D3 -O Z - �� • Fee methodology set by Tri County Building Industry Service Board i:t BuildingtPerntiis \MEC- PemtitApp.doc 12/03 4404617T (I I /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 CITY OF TIGARD • 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE BELLA PLUMBING 17934 NW PARKVIEW BLVD PORTLAND, OR 97229 Plumbing Signature Form Permit #: MST2004 -00073 Date Issued: 3/22/04 Parcel: 2S111 AD -17500 Site Address: 08729 SW REILING ST Subdivision: MLP2000 -00009 (WINTER'S) Block: Lot: 002 Jurisdiction: TIG Zoning: R-4.5 Remarks: 1750 sf addition. No CWS letter required. Extra plumbing fixtures are 2 hose bibs and extra mechanical is gas fireplace. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: PATRU, EUGEN BELLA PLUMBING 8729 SW REILING ST. 17934 NW PARKVIEW BLVD TIGARD, OR 97224 PORTLAND, OR 97229 Phone #: 503 - 789 -8469 Phone #: 503 - 617 -4991 Reg #: LIC 138626 PLM 34 -360PB AN INK SIGNATURE IS REQUIRED ON THIS FORM x &Ia 4 - e/ Signature of Authoriz&IPlumber If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour x© 0/7 3 BUILDING Inspection Line: • 03) 639 -4175 MST °�' °C) INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested AM PM BUP Location A - / !� Suite MEC Contact Person •}-� Q� ' P ( ) 78 - P1 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: 88 Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear \ Int Sheath/Shear Framing / J 1 F ov / �� A-64 Insulation l �jA/ Drywall Nailing �' / JAI �� / Z.v O r Firewall v/ LL" 'X Fire Sprinkler Fire Alarm 4_-)NA t/l/ TA-1N 6 Fd • l" c`c S usp'd Ceiling Other: <,rz_Fee- - i .—Vvl as T p-L 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: 4 v Final / � r Q ECHA L FAIL A /C-- eam Rough -In fr\ i/4 � � q l fr � n Gas Line Sm • ke Dampers T t SGb n/t`lc�'Z 6 i114'S I O / P FZS (i in- •Rr FAIL L Service Rough -In UG/Slab Low Voltage "farm PAS PART elp Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 111 Please call for reinspection RE: / Unable to inspect - no access Fire Supply Line ADA ir7. / 1 O Approach/Sidewalk Date 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: •(,1 3) 639 -4175 00073 INSPECTION DIVISION Business Line: 03) 639 -4171 MST v �� BUP Received Date Requested - Z Z AM PM BUP Location B' a- C ' - i Suite MEC Contact Person e .' ' � � � Ph I ) 7 k `? — g�' q PLM Contractor P ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear ('' Int Sheath/Shear 6 n © ��► r 1 I , / / 7 �[,.,/ can sL Framing I� L. 1- L / C' / Insulation ( LZN 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 • age Fi _= = " E] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL ,, . SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line /7 r r App Date Inspector Ext pproachlSidewalk , Other: Final DO NOT REMOVE this Inspection record ' r . m the job site. PASS PART FAIL CITY C� TIGARD 24 -Hour BUILDING Inspection Liar (503) 639 -4175 MST 2 66 V - DOD INSPECTION DIVISION Business Line: (503) 639 -4171 BUP 73 Received Date Requested I -a ! AM PM BUP Location O c)-- /Q.L ,1 Suite MEC Contact Person E-L[ .o y vst._ Yoh ( ) - 7 - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain j tT_E k . a ELR Crawl Drain Slab Inspection Notes: , i (---t) -7/ ` SIT Post & Beam .):.A Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall 111) Fire Sprinkler Fire Alarm Susp'd Ceiling '` Roof At e• A #iter f -- ( --°-k-17\-- ASS' PART FAIL ING Post & Beam Afilia$ Under Slab Rough -In Water Service ��� �/ / Sanitary Sewer , ` Rain Drains i I Catch Basin / Manhole � � , Storm Drain Shower Pan Other: Final PAS FAIL CHAN CAL Pos eam Rough -In Gas Line .. ,:. Dampers , l' I,Y1— PAS PART FAIL LEC - ICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required b= ore next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL c SITE 0 Please for reins ction RE: ;.; 0 Unable to inspect - no access Fire Supply Line ADA -411 Approach/Sidewalk Da _ .J Inspecto Ext Other: Final DO OT REMOVE this Inspection record from the job site. PASS PART FAIL '