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Permit II' , 9 . CITY OF TIGARD MASTER PERMIT PERMIT #: MST2002 -00398 ALA" 4. DEVELOPMENT SERVICES DATE ISSUED: 10/10/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14011 SW RIDGEFIELD LN PARCEL: 2S109AA - 06000 SUBDIVISION: ZONING: R -7 BLOCK: LOT: 038 JURISDICTION: TIG REMARKS: New SF detached, Path 1. BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: FIRST: / ■7 D sf BASEMENT: C'C 2. sf LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: SECOND: /8,9,0 sf GARAGE: 7 7 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: sf RIGHT: VALUE: 367,955.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 3o51 sf REAR: 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 > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 5 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: 7 201 - 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: 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: $ 8,639.51 ENTERPRISES INC This permit is subject to the regulations contained in the KOZAK ENTERPRISES INC KOZAK ENTERP KOZAK ENTERPRISES NOBLE ERPR ST KOZAK E NOBLE ST Tigard Municipal Code, State of OR. Specialty Codes and 22830 all other applicable laws. All work will be done in BEAVERTON, OR 97007 BEAVERTON, OR 97007 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 - 848 - 7014 Phone: 503 848 - 7014 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 077219 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 Grading Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insr Rain drain Insp Plumb Final Footing lnsp Crawl Drain /Backwater Electrical Service Low Voltage Water Line lnsp Final inspection Foundatio._Insp� Footing /Foundation Dr Electrical Rough In Gas Line Insp Appr /Sdwlk lnsp I `' i Issue c y : ' _' MO i mak . .1 _ 4J s_. Permittee Signature : , _ jjW�.. . �_ — Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day i-� S l ? -/G - O z -- 91 v Raooa -tea Building Permit Application A ,� Datereceived: F 6' 0 Permitno.:�,Poa -OD3p8 llifl City of Tigard o . - -.. Project/appl. no.: E date: C Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 V Phone: (503) 639 -4171 Date issued: '. jV Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: 1 &2 family: Simple Complex: ; i i ` g t r K' , $ i t „ i . R . 0 : , ,a a y f i r ` b T Y P E ' . OFF PERMIT . `4 ; ' ' ` , '. , ' ❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ New construction ❑ Demolition ❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: tip a °., ✓ r i e . r S+ '' b i ir d ; q � + A f t ,ac v r c �iS� a;�4.1�! �ey^5".."yv Wit. � '�:b t�.. k:f`�'*`.5 s"mi' r3 , "i - ° -.. ,r:.(e BfJ <,... - _ 7 , . ,t�' ) '�`� ., . , J O ITE oIN FO RMATION, �' Job address 1 Jqo // S4,--> i _, - g_ ' , J LA/ _ Bldg. no.: Suite no.: - Lot: -- ) '" cr Block: Siibdivis•on:/ ,//C or ,” • ,• t Tax map /tax lot/account no.: Project name: Description and location of work on premises /special conditions: � , i,' k`, � , iiferr ,, OWNER =r A he' 14 e, r s ° r ' ' , 't°' , FOR SPECIAL�IN,FORMATIONSE CHECKLIST ; ;U , to .' :. 7 3,t. v r . .N.F4 ,k::' ti . a k . . 4 0''' . ,: '' '; l °'''''''' ' '� " “ - � s A � ' �! H r '� i 't s l': +'� , �} S .. f4 ' ," ' , :' , . r , fi o " ,st u.6: } P k 4 u l'''.A [4 Z j Nam { (� `Z ' f i i S e s LNG r N,, N 1/42 ,.-7'4",-.„'l ( se , , , ,, 9 s k olar etc) r , 5 � 'Jtl n!).x .„. (Mailing- address:i ZZ ' 3 .S(,J 06./ a. - s 1 & 2 dwelling: SP - City: 1 / 3 2c, L e 't t :State:v R . ZIP: '~ 71707 - Valuation of work / $ ,�7 G ~Phone:- s 3 Y9S- 7 ax: g - 7 ° /r/ E -mail: (No bedrooms/baths z Owners: representative: K /,/.. IC . Total number of floors 3 c :Phone: 15 ( • Cab Z- E -mail: New dwelling..area (sq. ft.) �q ,?6.f L N t �, a �1° ; f b APPLICANT M;: b t: rsui ?: " ,,,, . , _: Garage /carport area (sq. ft.) 7 71 77 y Name: Covered porch area (sq. ft.) O Mailing address: Decck-area,(sq:. ft.) 7 7) City: State: ZIP: Other .structure - area :(s q.:ft.) - Phone: Fax: E -mail: Commeeciallindustriallmulti- family: 1, t6 = 'g � ,& .. �; -.... v , - ;r„ ,1, ;« � t a s 3 � �, � r,� au�'CONTRAC•TOR � 2 . ;: V aluation of work $ i (Business name. , �� t A 5. �� -k Existing bldg. area (sq. ft.) Address:: New bldg. area (sq. ft.) ji Number of stories City:--1 (State:. ZIP :i Type of construction - Phone: -, Fax: E -mail: Occupancy group(s): xisting: ( CCB no::, New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be } iF � ' cf-', t 4'1 ARCHITECT/DESIGNER y , V i0, t� 0; : licensed with the Oregon Construction Contractors Board under Name: `(q 5 C A 7 r'-' provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed. If the applicant is Cit State: ZIP: exempt from licensing, the following reason applies: Y :' '.t Contact person: Plan no.: Phone: Fax: E-mail: '.r ENGINEER. , ` • 1\ Name: Contact person: Fees due upon application $ Address: Date received: City: State: ZIP: Amount received ,, $ Ot Phone: Fax: 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 ❑ Visa ❑ MasterCard work will be complied with, wheth • - 9- - • et 'herein or not. Credit card number: Expires / Authorized - «- •Date:" 9' -/ a Z '7 Name of cardholder as shown on credit card Print - • ∎ / y 76 /r 41( 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 PP Application Checklist Reference no.: Ga i! • Associated permits: City of Tigard City of Tigard Y b ❑ Electrical ❑Plumbing ❑Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 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. • 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 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 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. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. 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 (6ro0/COM) Electrical Permit Application Date received: 9 // 0- Permit no.:)"/57» -ao 390 j , ,., , City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: .TYPE OF'PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial . ' . JOB SITE INFORMATION [Job address:) 0 / SG 0 ..'d . ; - e ( L,/v Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subd• ision: Project name: Description and location of work on premises: Estimated date of completion/inspection: x, a _'- CONTRACTOR APPLICATION .', '',. ,; FEE` SCHEDULE '• '-.4;': Job no: Fee Max Description Qty. (ea.) Total no. insp CBu Warne: C o ,. Q c �,, l tit c4 - New residential - single or multi - family per Address:,' _ • dwelling unit. Includes attached garage. City: - 1 t :State:. • ZIP: - i Service included: Phone: Fax: E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof __ CCB 1 (Elec. bus. lic: no:) Limited energy, residential ___ 2 City /metro lic. no.: Limited energy, non- residential ___ 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder ■■■ 2 "'!• Sup. elect. name (print): ( 'License no: _ / Services or feeders — installation, alteration or relocation: w `'` `' PROPERTY.OWNER 200 amps or less .. 2 Name (print): X o - i</4-JL Z� h.�,. ,—;s� s Z..,,/c 201 amps to 400 amps ___ 2 401 amps to 600 amps ___ 2 ; Mailing address: ZZ�3 ' �f,' ' a��� $ 601 amps to 1000 amps ___ 2 City: 6 2..‘ J .t 1'0-, Statei22 • ZIP: °1 700 7 Over 1000 amps or volts ___ 2 Phone: 5'/" - Ofoz- Fax: 1S' -74( E -mail: Reconnect only ___ 1 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 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..: '' h • ` ' "'' Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: State: ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: ■■ 2 Phone: Fax: E-mail: Each additional branch circuit: __ _— PLAN. REVIEW (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 11111 2 ❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting MI__ 2 family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal • more residential units in one structure alteration, or extension* ..1 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ 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 $ ❑ Visa ❑ 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 (6/00 /COM) • ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY 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 n Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 n Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular n Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n 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. n Audio and Stereo Systems Branch Circuits n Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or n Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit $46.85 ❑ Each additional branch circuit $6.65 HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 n Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 n Nurse Calls Per hour $62.50 In Plant $73.75 n Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ n Other 8% State Surcharge _ $ Number of Systems 25% Plan Review Fee 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 $ El Trust Account # 8% State Surcharge $ Total Balance Due $ All New Commercial Buildings require 2 sets of plans. i:\dsts \forms \elc- fees.doc 08/30/01 ' Building Fixtures Plumbing Permit Application OFFICE USE ONLY • Date received: 9 // mi Permit no.: )159 ,, _OQ398 City of Tigard t M��Jh City b 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: Receipt no.: Land use approval: Case file no.: Payment type: 'OW: l' °t,. :itl, . t ; - ,'? , ,, .:.: V `, , , L,': ' TYPE, OF PERMIT . . - , . . . . 01-r 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition /alteration/replacement ❑ Food service ❑ Other: V, `i'41 �^ _ w, # ' JOB: SITE :INFORMATION`:-1, Vi n ', >• "FEE SCHEDULE (for special information use checklist) Jf'ob_address ) i LI o/I ,S 1,,J .* Description Qty. Fee (ea.) Total Bldg. no.: New 1 -and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: Block: Subdivision: SFR (2) bath — Project name: SFR (3) bath _ City /county: . ZIP: Each additional bath/kitchen _ Description and location of work on premises: Site utilities: ■ - . Catch basin /area drain Est date of completion/inspection: Drywells /leach line /trench drain _ Footing drain lin. ft.) �� _ �, ,us.. �;, e„ � •, 'PLUIVIBING CONTRACTOR ": e� ,; ,.. ho Manufactured home utilities tBuusiness-name Al ti ED(i -(.r Manholes _ Address: ; Rain drain connector _ ( Gity: — States ZIP:• Sanitary sewer (no. lin. ft.) MI {Phone. Fax: E -mail: Storm sewer (no. lin. ft.) _ GCB= nor: Plumb. :bus._reg.. riot; Water service (no. lin. ft.) El City /metro lic. no.: Fixture or item: ■-. Contractor's representative signature: Absorption valve Back flow preventer _ -- Print name: Date Backwater valve _ 1 .� t' + .�° •, -� ., ".» CONTACT „ PERSON Basins /lavatory NM Clothes washer Mil ` Dishwasher _ Address: 7....2$'3 .5e„J op• 2 "1 , Drinking fountain(s) — City: 11, eG v e/' -4-o.n State: Q (c' ZIP: ' 7 0 0.7 Ejectors /sump _ Phone: S7/ p( Z Fax: - - 70/y E Expansion tank — 4 4 y ” °, `' t tt'' .� ` ': OWNER ': %," h ,,' r? Fixture /sewer cap I Name (print): Floor drains /floor sinks /hub _ Garbage disposal _ — _— Mailing address: Hose bibb ME City: State: ZIP: -Ice maker - Phone: Fax: E -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 Mil Address: Water heater — City: State: ZIP: Other: Phone: Fax: E -mail: Total Minimum fee $ Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application ❑ Visa CI MasterCard P lan review (at _ %) $ / / expires if a permit is not obtained State surcharge (8 %) .... $ Credit card number: within 180 days after it has been Expires Name of cardholder as shown on credit card accepted as complete. TOTAL $ U Cardholder signature Amount l�� 440 -4616 (6 /00 /COM) 1 o . . . PLUMBING PERMIT FEES: .:,.:-.-„,-;',V7i ,71;*T1.4 ;: ';'4 P ,.:•-: ,;,: .;,4 4 , FIX RES.(i iidiliiat.i iy :.-- 7-,' :t.' -.N eS:d76,2 r i46 f':48.141: i --; 4 .PRICE :'-179:7rAliV, Sink 16 ktiCO 'o •!'.,.. ,. „' •;aitY;: :7‘.-,4(004 ;=, ::: uti 1 itir76 iiiiiCS': ; . ;!:;'., : '`.:';',:.''! ..N4•':'.: V4.1 Lavatory 16.60 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 r.3,:t:,!..• :1;zrek,;,,,; Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL ',=--' : TOTAL Garbage Disposal 16.60 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 ••::,5'• 4(:) W611 Pei - i, ,- -, Gas piping requires a separate mechanical :•Fixture , ,z:06TWA: Moved .012eptad'ecttt : ;lerytcrVed/,. : permit. Ir'44::;!;L:i= . '4 . .• - •,•ia''.": 4 ,- ,i, ,TZ' ,•,,::•.;ii:?:.7m:4 1:•;;Capeci•-:: MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 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 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 . . i Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin • 16.60 Inspection of Existing Plumbing or Specially 62.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling . 65.25 Grease Traps 16.60 QUANTITY TOTAL CiNkti ' Isometric or riser diagram is required if 4,, VrA4 7 ,,,,,, •'• ,, ,:=' , ”?..4 4:'ir Quantity Total is > 9 *SUBTOTAL Mig: ' rl g.!tiell::Sk, . . 8% STATE SURCHARGE 1!" , ."', **PLAN REVIEW 25% OF SUBTOTAL 457-':;::,L Required only if fixture qty. total is >9 '''.1;1.'Y,IU ir:324,7ve TOTAL NS:1.:=e,,!:'t:al:773 $ . .. k If':'.:-.,•L?;;;;.7. • * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. . ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. hdsts\forms\plm-fees.doc 12/26/01 • • Mechanical Permit Application Date received: 7 # '- Permit no. //i;7 _a7 39f ma y, ..� � City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receiptno.: Phone: (503) 639 -4171 Fax: (503) 598 - 1960 Case file no.: Payment type: Land use approval: Building permit no.: , TYPE OF PERMIT , "" .., . ©'1'& 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family Cl Tenant improvement ❑ New construction ❑ Addition/alteration/replacement Cl Other: ' .JOB SITE INFORMATION °.`; ;: � `.: COMMERCIAL :VALUATION SCHEDULE" ,Yal..0 �J gy / f .411nINTIIMEREMIE Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: Su' e no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ . Lot: Block: Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: ZIP: ' I & . 2 FAMILY DWELLING PERMIT FEE SCHEDULE ` Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE' Fee(ea.) 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? CI Yes CI No Air handling unit CFM Air conditioning (site plan required) - Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system — MECHANICAL CONTRACTOR ' State t I ■■ Business name: / O • .1. . C State boiler permit no.: - 3 - 4 4 , .i n HP Tons BTU /H (Addres Fire /smoke dampers /duct smoke detectors - City . C State:) 1 ZIP: 1 Heat pump (site plan required) — '`Pho ie Fax: E -mail: InstalUreplacefurnace /burner BTU /H III Including ductwork/vent liner ❑ Yes ❑ No CCB no.J InstalUreplace/relocate heaters -suspended, ■-- City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace ' ' ,/V r ' CONTACT PERSON Refrigeration: srpti III 112 s� M : : Absorption units BTU /H • Chillers HP - Address: Z2.g'3o ,5 Ao L..l 0.- ST _ Compressors HP _ Environmental exhaust and ventilation: III - City: 6. Pte Stateb2. ZIP: 77 o O 7 Appliance vent Phone: S /9 o(Z9 Fax:g' , 7 E-mail: Dryer exhaust — }: .. 41 , • , OWNER . ' e -- , % Hoods, Type U IUres. kitchen/hazmat . _ ■__ hood fire suppression system Name: ' A C Can- . c., Y - Rt - "» Exhaust fan with single duct (bath fans) -__ Mailing address: Exhaust system apart from heating or AC _ City: State: ZIP: Fuel piping and distribution (up to 4 outlets) ■ -- Type: LPG NG Oil Phone: Fax: E -mail: Fuel piping each additional over 4 outlets I - ENGINEER • Process piping (schematic required) OM Name: Number of outlets Other listed appliance or equipment: El Address: Decorative fireplace City: State: ZIP: Insert - type ___ Phone: Fax: E-mail: Woodstove/pelletstove ME Other: MI Applicant's signature: Date: Other: . IM Name (P rint): 1 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ Notice: This permit application ❑ Visa ❑ MasterCard 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) 1 • MECHANICAL PERMIT FEES • COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: 'V� 4 P , ' _ _ ;f,,. ` =�, De n , >__ Pnce Total TOTAL 5,0 ON , � Table"1A, Iechanical'Code ., 4 r$ .�. : - "` i ( _ .. A • $1.00 to $5,000.00 Minimum fee $72.50 cTU B 0, to na 100,000 u F Frce $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) 14.00 2 $1.52 for each additional $100.00 or Furnace including in 1 o 10 000 B ducts BTU+ & vents fraction thereof, to and including 2) 17.40 $10,000.00. including ducts & vents $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 6.80 $1.45 for each additional $100.00 or 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' ell,that'apply ; •Bdiler Heat 't Air - - . : i i e or Pump Cond s $1.20 for each additional $100.00 or For�itenis 7 11 see -, � ; r . fraction thereof. footnotesbelow Comp r s,.Nr x °_:e'. . ' :e7fE".`Fs.,g '. .. `' ' :rL.,. Z .s".i .::.aR';y,`.,. AU Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit to 100K BTU 14.00 8% State Surcharge $ 8) 3 -15 HP; absorb 25.60 unit 100k to 500k BTU 25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00 Required for ALL commercial permits only unit .5 1 mil BTU TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20 unit 1 -1.75 mil BTU 11) >50HP; absorb unit >1.75 mil BTU 87.20 s . �-- � ,• 12) Air handling unit to 10 CFM ASSUMEDa VALUATIONS, PER APPLIAN,C:E 10.00 Value Total 13) Air handling unit 10,000 CFM+ Description: Qty (Ea) Amount 17.20 Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler ducts & vents 10.00 . Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct ducts & vents 6.80 Floor furnace including vent 955 16) Ventilation system not included in Suspended heater, wall heater or 955 appliance permit 10.00 floor mounted heater 17) Hood "served by mechanical exhaust Vent not included in appliance 445 10.00 permit 805 18) Domestic incinerators 17.40 Repair units < 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator to 100k BTU 69.95 3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves 101 k to 500k BTU 10.00 _ 15 -30 hp; absorb. unit, 501k to 1 2,310 • 21) Gas piping one to four outlets mil. BTU 5.40 30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) , 1 -1.75 mil. BTU 1.00 >50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL:` >1.75 mil. BTU *0,!c''' .,:, $ Air handling unit to 10,000 cfm 656 £ "* "" 9 8% State Surcharge $ ,. .-, ; ; $ Air handling unit >10,000 cfm p 1,170 , �s Non-portable eva orate cooler 656 ;$, ?" " Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: :; , $ Vent system not included in 656``'`` ` ' !`'='`' appliance permit Hood served by mechanical exhaust 656 Other Inspections and Fees: 1. Inspections outside of normal business hours (minimum charge - two hours) Domestic incinerator 1,170 $62.50 per hour. Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour) Other unit, including wood stoves, 656 $62.50 per hour inserts, etc. • 3. Additional plan review required by changes, additions or revisions to plans (minimum Gas piping 1 - 4 outlets 360 charge-one-half hour) $62.50 per hour Each additional outlet 63 "State Contractor Boiler Certification required for units >200k BTU. TOTAL COMMERCIAL n7.41, : •, , , , n , * ** Residential A/C requires site plan showing placement of unit. $ VALUATION: = - _.� ,� All New Commercial Buildings require 2 sets of plans. is \dsts \forms\mech- fees.doc 02/11 /02 CITY OF TIGARD ' 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MALMEDAL PLUMBING INC 111S18THAVE CORNELIUS, OR 97113 Plumbing Signature Form Permit #: MST2002 -00398 Date Issued: 10110;02 Parcel: 2S109AA -06000 Site Address: 14011 SW RIDGEFIELD LN Subdivision: Block: Lot: Jurisdiction: Zoning: Remarks: New SF detached, 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 Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: KOZAK ENTERPRISES INC MALMEDAL PLUMBING INC 22830 SW NOBLE ST 111 S 18TH AVE BEAVERTON, OR 97007 CORNELIUS, OR 97113 Phone #: 503 - 848 -7014 Phone #: 503 - 310 -9795 Reg #: MET 4232 LIC 102535 PLM 34 -276PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Sig a ure o Authorized Plumber If you have any questions, please call (503) 639 -4171, ext. # 310 CITY OF TIGARD ' S.W. HALL BLVD. TIGARD, OR 97223 • IMPORTANT PERMIT NOTICE COPPER LINE ELECTRIC INC 3500 NE 50TH ,CT #18 VANCOUVER, WA 98601 Electrical Signature Form Permit #: MST2002 -00398 Date Issued: 10/10/02 Parcel: 2S 109AA -06000 Site Address: 14011 SW RIDGEFIELD LN Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 038 Jurisdiction: TIG Zoning: R - Remarks: New SF detached, Path 1. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: KOZAK ENTERPRISES INC COPPER LINE ELECTRIC INC 22830 SW NOBLE ST 3500 NE 50TH CT #18 BEAVERTON, OR 97007 VANCOUVER, WA 98601 Phone #: 503 - 848 -7014 Phone #: 503 - 267 -3958 Reg #: LIC 150238 • ELE 37948C SUP 3514S AN INK SIGNATURE IS REQUIRED ON THIS FORM 4 /11( ' TO Si of S ervising trician If you have any questions, please call 503.718.2433. w, V STREET TREE .. 44 .. 0- 1 I, K,, / L. / <' - LAX*. ,Owner /Agent for ,e6. z alt V....-,..1.- ,--,0. � s es . e ,. ( PLEASE PRINT) (PERMITHOLDER) ® - • Do hereby hJat the foll location meets ,Ct :.of Ti ard/ on Count � r g _: ,_,fns. Y ® 41 land use and development standards for street tree installation. • ADDRESS: Q w ;‘,Q 4..-it) . 7' c7 • LOT: SUBDIVISION: e .--e / K -, Q '-. .,.,i ..c. - - - / BY: -�!'�i .�. DATE: z °� 414 44 TrO°F 0- • RECEIVED BY: - „i_/ 0 DATE: (p 7 „.. _ (., 4 AVVVVVVVVVVYTTVVVVVVVVYTYVVVVVVVVVVVVVVVVVVVVVVVVVVVVIVVVVVFVN CITY OF TIGARD 24 -Hour ,BUILDING * Inspection Line: (503) 639 -4175 4111 -7)3 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Receive/ q / / /2 - (2 D ate Requested � / 161 / 61 �" AM PM BUP Location l f/ G eoe Suie MEC Contact Person ' Ph ( ) 5,77 6 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: .w � p SIT Post & Beam Yt/` / e a J� Shear Anchors / Ext Sheath /Shear Int Sheath /Shear d KT C,/-1--e.." � 3 a • - (c) 15 c— (5 o f f 5 Insulation Drywall Nailing �L Fi rewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof • PART FAIL 1 BIND Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post" & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL... Service Rough -In UG /Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE El Please call for reinspection RE: � . El Unable to i -. -• pct - nn access Fire Supply Line ADA - � �' Approach/Sidewalk Dat / Inspector ��- Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639 -4175 ..dd 3 Ip4SPECTION Business, Line: (503) 639 -4171 BUP Received Date Re 4,2 — AM P BUP Location 6 I / !IBA Suite MEC Contact Person - n� Ph ( ) .5 I 7-06 PLM Contractor Ph ( ) SWR _BUILDING Tenant/Owner ELC Footing Foundation ELC AC Ftg Drain Access: ELR Crawl Drain t J V Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler 40 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: ev� PART FAIL HANICAL. Post& Beam E mers I S V L y V `J ` Final I PASS PART FAIL y� ELECTRICAL �0l9 � - IN 1\1\ii)) )1-k Service Rough -In UG /Slab Low Voltage Fire Alarm ma Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hail Blvd. PART FAIL SI : _ Please call for reinspection RE: El Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date / 3 Inspector / Ext Other: Final DO NOT REMOVE this inspection record from the, b site. PASS PART FAIL CITY OF TIGARD , - 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST ( e 37e INSPECTION 'DIVISION Business Line: (503) 639 -4171 BUP • Received / Date Requ ted � -" AM PM BUP Location / �D /1 J1 Suite MEC Contact Person i< o Ph ( ) �/ 9 — d Co° PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS M ECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Fina PART FAIL EL CTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL y4 SITE 1111 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Date 4- # 3 Inspector - Ext Approach /Sidewalk P Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL •