Permit • CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2001 -00434
- , �i, DEVELOPMENT SERVICES DATE ISSUED: 9/4/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13088 SW ST. JAMES LN PARCEL: 2S109AB -10900
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 038 JURISDICTION: TIG
REMARKS: New SF detached. Path 1
BUILDING
REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,302 sf BASEMENT: sf LEFT: 7 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 960 sf GARAGE: 1,242 sf FRONT: 21 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: sf RIGHT: 8
VALUE: $ 236,061.60
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,262.00 sf REAR: 38
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: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOILJCMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN >=100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 • 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HWSVC /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: $ 7,158.96
This permit is subject to the regulations contained in the
CHARLES KIM ROYAL CONST.
CHARLES ES IVY GLENN ST. ROYAL CONST.
IVY GLENN ST. Tigard Municipal Code, State of OR. Specialty Codes and
BEAVERTON, OR 97007 BEAVERTON, OR 97007 all other applicable laws. All work will be done i
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg #: forth in OAR 952 - 001 -0010 through 952- 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8d Wtr Proofing Bsm't Wa Footing /Foundation Dn Electrical Rough In Special insp. required Water Line Insp
Grading Inspection Post/Beam Structural PLM /Underfloor Framing Insp Gas Line Insp Sprinkler Rough -In
Sewer Inspection Post/Beam Mechanical Mechanical Insp Shear Wall Insp Gas Fireplace Sprinkler Final
Footing Insp Underfloor insulation Plumb Top Out Exterior Sheathing Insr Insulation In • Appr /Sdwl. Insp
Foundation Insp Crawl Drain /Backwater Electrical Service Low Voltage Rain dr- -ctri : Final
c
Issued By : C' i ..i.,... dry / _ Permittee Signature - L%
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
TDd3T 6 -17 -a1 )2 - 7 —
D - O y\„
•
Building Permit Application ..,1
*
Datereceived / P no./21-5pai l Permit no. /1- pa / .�yy '
ri,i City of Tigard /6 / "` ,..,.
Project/appl. no.: Expire date:
Ciryn(/igard Address: 13125 SW Hall Blvd, Tigard. 9722 -
Phone: (503) 639 -4171 — Date issued: By`0 Receipt no.:
Fax: (503) 593 - 1960 ++++++"''''
Case file no.: Payment type:
Land use approval: I &2 family: Simple Complex:
TYPE OF PERMIT 'r.
^
U I & 2 family dwelling or accessory U Commercial /industrial U Multi - family r New construction U Demolition I
U Addition /alteration /replacement U Tenant improvement U Fire sprinkler /alarm U Other: C
JOB SITE INFORMATION
Job address: 1308: SW 51 e ( -v) • Bldg. no.: Suite no.: 1
Lot: 5 8 I Block: 'Subdivision: I Tax map /tax lot/account no.: C
Project name: avek. `1G1C` '- 38 AS /0°/'46 --/0 r< -7
7
Description al • Is anon of work on premise / 5 J pedal conditions: / 3' , — /O, 1 3
t
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
121111E2 1: 'ITI J MI (Floodplain, septic capacity, solar, etc.)
_ _ � .1e715_ � �( I & 2 family dwelling: ��
City: -...T...-.410 4 11 � piiiLIMI ZIP: a'Aei, J Valuation of work $ 234 OG 1,
Phone: _) i:IlYfri :JU�L�f► i /M PAT' . _ {z „ C,O'}ld ooms/baths 3 3
Owner's representative: Total number of floors 2
Phone: Fax: E -mail: New dwelling area (sq. ft.) 2261
APPLICANT Garage /carport area (sq. ft.) / a lj z.
Name: `t .A> �' Covered porch area (sq. ft.) 5(,
Mailing address: Deck area (sq. ft.)
—
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E Commercial/industrial /multi family:
CONTRACTOR Valuation of work $
+ � Existing bldg. area (sq. ft.)
Business name: UYIfJ • I �
I Address: ',0414t? G � New bldg. area (sq. ft.) i
City: l State: I ZIP:
Number of stories
Phone: Fax: E -mail:
Type of construction
CCB no.: Occupancy group(s): Ext. ting:
City /metro tic. no.:
New:
Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: AIL AA provisions of ORS 701 and may be required to be licensed in the
Address: N + Aug jurisdiction where work is being performed. If the applicant is
City: StateOyIZ1P9V.0ei exempt from licensing, the following reason applies:
Contact person: f'llkb pO 16 Plan no.: 7_240 9
Phone: 1 / Fax: r 3 E -mail:
ENGINEER
I Name: 'QM � Contact person Fees due upon application $
r Address: , 0 2– I]IMrt . _. Date received:
annir � 1 ���� r � ram ` �.' Amount received $
:'S7.izG7 4 E - mail: Please icier to lire schedule.
I hereby certify I have read and examined this application and the 'Not all jurisdictions accept credit cards. plea.e call jot isdiction loi mote info'ination.
attached checklist. All provi. 1 /lf la an lydina lees governing this U Visa U Nlastei(ard
work will he complied w 1. Ad) ice led h'. 'i11 or (lot ) ('icdn ca inflow: J 1
/" 4 e / liwites
Authorized signature: �.�, /� el ,. Date: I Name of r as shown on nedn tail
Print name: ..ktt.11 L.) • I■/- l S
('aul1101(1 a u
�nauc Autoum
Nnticc: This permit application expires ila permit is not obtained within 180 da> s after it has been accepted as complete. 4 13 (9A00/coxa)
. .
4111,, One- and Two - Family Dwelling -
,l,� Building Permit Application Checklist Reference no.:
Associated permits:
City ofTigard City f Ti and
y g ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TILE 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 A : • r . is approval.
$ Soils report. ■ ust carry original applicable stamp and signature on fi or with aprlic. .
9 Erosion co ; of ❑ plan ❑ permit required. Include drainage -way prole :41 fence design and location of
ca - ? rn protection, etc.
10 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 copyrigh violations exist.
11 Site/plot Ian drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there i . o 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
are • lding coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundati plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and ocation.
rt
13 Floor' Show all dimensions, room identification, window size, location of smoke detectors, water heater,
fu 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 I and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace nstruction, thermal insulation, etc.
15 Elevation view a Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior ele ions must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -si eet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing ( criptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescript' a path analysis provide specifications and calculations to engineering standards.
17 Floor /ro rami g. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Sho attic ventilation.
18 Basemen etaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see ' m 22, "Engineer's calculations."
19 Beam calc ations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 ffet I and/o any beam/joist carrying a non - uniform load.
20 Manufact ed floo oof t oss design details.
21 Energy Code co lianc . Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or mor applia es. _
22 Engineer's calculatj a ns. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed iftiOregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 44o -4614 (6 /00 /COM)
• Plumbing Permit Application
AI Date received: Permit no.(��1) i v� t,.:, , Cit of Tigard v
•? 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:
TYPE: OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial 0 Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: 1 3003 cr. 5 S r - Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: A Block: Subdivision: ��I; �� 4�a SFR (2) bath
ofr Project name: it 5 = SFR (3) bath
City/county: ZIP: 6 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 (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: ■i M illi A Manholes
Address: 1. 0 12, )C. Pj i Rain drain connector
City: it r • 'lav < State: _ :41_ ZIP: �,.� Sanitary sewer (no. lin. ft.)
Phone. # —,', —i :7,, Fax: E -mail: Storm sewer (no. lin. ft.)
CCB no.:( b •7 Plumb. bus. reg. no: 37- II I re Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Absorption valve
Contractor's representative signature: Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: - Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: 1 State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): (. A ^ . ,_ �� ,� 1 f ] Floor drains/floor sinks/hub
t • • _ - Garbage disposal
~�' :J - ,. Hose bibb
��.. - .�Pt I A I I I I NM My ZIP: 4j� Ice maker
Phone: Li • •M n Z D ER, E • / - ,_ ' Interceptor /grease trap
Owner installation/residential maintenance only: The actu• installation Primer(s)
will be made by me or the maintenance . • repair made by my regular Roof drain (commercial)
employee on the propert • as , , : ' S C •ter 447 Sink(s), basin(s), lays(s) j.
Owner's signature: Date: / o Sump
ENGINEER Tubs/shower /shower pan
i Urinal
/� 1 �'-' � 'E Water closet
Address: v
'AORW� Water heater
/�. - -- . _ -��� ZIP: ��li' Other:
Pho -- ��� ax�-- E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application
CI Visa 0 MasterCard Plan rev (at _ %) $
expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been
accepted as complete. TOTAL $
acce
Name of cardholder as shown on credit card p p
$
Cardholder signature Amount
440-4616 (6/00 /COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE . TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL _
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New • Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub /Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3 "
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
'"PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72.50 • 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dsts\forms\plm-fees.doc 10/10/00
• Electrical Permit Application
Date received: Permit no.: (craw / -DD (/34
�,L .� I _ City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: IIV / ST $ Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: `3F5 Block: (Subdivision:
Project name: ! ptA R d 'Description and location of work on premises:
Estimated date of completion/ins ion: ...075D-
CONTRACTOR
APPLICATION FEE SCIIEDU,E
Job no: Fee Max
Business name: $� .y- — i - ,c.. C , Description Qty. (ea) Total no. insp
„ 1 New residential - single or multi- family per dwellingunit. Includes attached garage.
City: 't) 9 Icg ,. f State:eThLIP: 9'90 0 Serviceincluded:
Phone: Are— i5 I Fax:/ --f !O E -mail: 1000 sq. ft. or less 4
CCB no.: 2oQj 9 Elec. bus. lic. no: � — 101'C loch ed energy, 500 si s ia or portion thereof
. 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:
PROPERTY OWNER 200 amps or less 2
�� w / 201 amps to 400 amps 2
Name (print): te‹ ... I / " rrl � , ��'tsf ; / 401 amps to 600 amps 2
Mailing address: P „ I T
������ 601 amps to 1000 amps 2
City: , i EMFM ZIP: 0 , ♦ - Over 1000 amps or volts 2
Phone: ' >> - �u2 E -mail: t. A &j ae Reconnect only 1
Owner installation: The installation is being made on pre pe Temporary services or feeders -
which is not intended for sale, lease re , or exchange acco n installation ,alteration,orrelocation:
ORS 447, 455, 479, 67‘1 0 . , / • 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: , ., _ / Date: ° 6 401 to 600 amps • 2
��� ENGINEER Branch circuits - new, alteration,
Name: Q)^ , "i eel or extension per panel:
A. Fee for branch circuits with purchase of
Address: , ( r1 service or feeder fee, each branch circuit 2
City: a .. I State I ZIP: 972.1 6 B. Fee for branch circuits without purchase
Phone: • — 01 , 4 Fax: 1 6 E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility • Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* _ 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other: Per inspection r
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 $
• 0 Visa 0 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 Fees: .
•
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
•
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential - per unit f �
1000 sq. ft. or less $145.15 4 l l Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders
•
❑ H eating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 El ,
201 amps to 400 amps $106.85 2 V acuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ . Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
' 200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ A udio and Stereo Systems
Branch Circuits ❑
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
•
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control*
Minor Labels (10) $125.00
Each additional inspection over ❑ 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: ❑ Protective Signaling
Enter total of above fees $ ❑ 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 $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
•
i:\dsts \forms \elc- fees.doc I 0 /09/00
Mechanical Permit Application
w Date received: Permit no.:/067;90D / -,N31 -,N31 I+L „•� l t l , City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
I
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PER111T
0, 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCIIEDULE
Job address: ; .S() sT . T a (/Q4 L . Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'a'a 'Block: ISubdivision: *See checklist for important application information and
Project name: 2ratkAfl R jurisdiction's fee schedule for residential permit fee.
City /county: l.t)A . I ZI I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
• Fee(ea.) Total
Est. date of completion/inspection: Z, Description Qty. Res.only Res. only
Tenant improvement or change of use: VAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECIIANICAL CONTRACTOR Boiler /compressors
B mess name: 1--h141-C.- ) Tyr State boiler permit no.: Mil OP
HP Tons BTU /H
Address: di • 1111. -- A / Fire/smoke dampers/duct smoke detectors
En.Th1 M • Q =RC ZIP: / a/MI Heat pump (site plan required)
Phone . I.. 1 - 7; t:' tVrad E -mail: Install/replace BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.:
54C7/7
InstalUreplace/relocateheaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address : ( pi-r... 5`t' Compressors HP
Environmental exhaust and ventilation:
City: H ii ■ I State: 6).-I ZIP: CM/ 2 3 Appliance vent
Phone:, 4 i . 5, Fax: i' ; ' *4 E -mail: Dryer exhaust
OWNER Hoods, Type 1/ Hires. kitchen/hazmat
hood fire suppression system
Name: C ��t/t j d ) Exhaust fan with single duct (bath fans)
Mailing address: ��• Z _ `, i . Exhaust system apart from heating or AC
� r r- Fuel piping and distribution (up to 4 outlets)
ri �)•. l I ZIP: 2 A Type: LPG NG Oil
Phone: i . g MM J !*� /� i I, 'n Fuel piping each additional over 4 outlets
ENGINEER Process p ping (schematic required) ,
� Number of outlets
Name: � Other 'sled appliance or equipment:
+
Address: A Decorative fireplace
irl �� ZIP: rg� Insert - type
Phone: _j: ] 4 E -mail: woodstovelpelletstove
Other:
Applicant's signature: f'���i/r/� Date: 0 Other:
Name (print): AreVr � 15
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Notice: This permit ap Minimum fee $
expires if a permit is not obtained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been
Name of cardholder as shown on credit card accepted as complete. State surcharge (8 %) .... $
$ TOTAL $
Cardholder signature Amount
440 -4617 (6/00 /COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00•or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* **
7) <3HP;absorb unit
to 100K BTU 14
ASSUMED VALUATIONS PER APPLIANCE: 14.00
8) 3 -15 HP; absorb
Value Total
unit 100k to 500k BTU 25.60 •
Description: Qty (Ea) Amount
9 ) 15-30 HP; absorb
Furnace to 100,000 BTU, including • 955
unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents
Floor furnace including vent 955 11) >50HP: absorb
Suspended heater, wall heater or 955 unit >1.75 mil BTU 87.20
floor mounted heater 12) Air handling unit to 10,000 CFM
Vent not included in applicance 445 10.00
permit 13) Air handling unit 10,000 CFM+
Repair units 805 - , 17.20
< 3 hp; absorb. unit, 955 14) Non - portable evaporate cooler
10.00
to 100k BTU
3-15 hp; absorb. unit, 1,700 15) Vent fan connected to a single duct
6.80
101k to 500k BTU
15-30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in
mil. BTU appliance permit 10.00
30 -50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust
1 -1.75 mil. BTU 10.00
>50 hp; absorb. unit, 5,725 18) Domestic incinerators
17.40
mil. BTU
Air handling 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656
•
5.40
appliance permit
Hood served by mechanical exhaust 656 22) More than 4 -per outlet (each)
1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator _ 4,590
Other unit, including wood stoves, 656 -
inserts, etc. 8% State Surcharge $
/o
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
. 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one-half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
i:\dsts\forms\mech-fees.doc 10/11/00
SEP 04 '00 01 :34PM P.1
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE RECEIVED
BEAR ELECTRIC SEP ®5 2001
P 0 BOX 389 COMMUNITY DEVELOPMENT
•
DONALD, OR 97020
Electrical Signature Form
• Permit #: MST2001 -00434
•
• Date Issued: - -- °� _.__ ... ..._ ..... __ • _- _-
Parcel: 2S109A,B -10900
Site Address: 13088 SW ST. JAMES LN
Subdivision: RAVEN RIDGE
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 Dept.
No electrical inspections will be authorized until this completed form Is received
OWNER: ELECTRICAL CONTRACTOR:
CHARLES KIM BEAR ELECTRIC
16655 SW IVY GLENN ST. P 0 BOX 389
- BEAVERTON,- R- -97-0'07-- _- . - . _ - DONALD,- OR-- 97020_
Phone #: 503 -515 -6011 Phone #: 503 -678 -1355
Reg #: Lac 2 20919
ELE 4.107C
SUP 31824
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X �
Signature of Supervising Electrician
If you have any questions, please call (503) 639 -4171, ext. # 310
•
•
• CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NELSON PLUMBING
PO BOX 818
BATTLE GROUND, WA 98604
Plumbing Signature Form
Permit #: MST2001 -00434
Date Issued: 9/4/01
Parcel: 2S109AB -10900
Site Address: 13088 SW ST. JAMES LN
Subdivision: RAVEN RIDGE
Block: Lot: 038
Jurisdiction: TIG
Zoning: R -7
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 Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
CHARLES KIM NELSON PLUMBING
16655 SW IVY GLENN ST. PO BOX 818
BEAVERTCN, OR 97007 BATTLE GROUND, WA 98604
Phone #: 503 - 515 - 6011 Phone #:
Reg #: LIC 125759
PI_M 37 -171 PB
AN INK SIGNATURE IS REQUIRED ON T IS FO -
-1 81I / / //�
x 4
Signat re of Authorized Plumber
If you have any questions, please call (503) 639 - 4171, ext. # 310
/457 gdZ (- coif 3
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• •
• •
• T CERTIFICATION
STREET
• .
• .
• , g . ►
• • I aug VV • e , Ow /Agent for y • •
• (PLEASE PRINT) (PERMIT HOLDER)
•
• ►
• ►
•
• ►
• Do hereby certify that the following location ■
• meets City of Tigard /Washington County ■
• ■
A land use and development standards for street tree installation. ■
• ■ ■
• ■ ■
• • • ADDRESS: / 88' Fo S 7 / 0 •
• •
. •
• LOT: SUBDIVISION: t✓") ( (
• � C� •
•
• •
• ►
DAT E: • • BY: LL 3/../.2_ •
• •
A . � • •
1 RECEIVED BY: 1 DATE: 3 // b `z., •
CITY OF TIGARD 24 -Hour '/3
BUILDING Inspection Line: (503) 639 -4175 O 66
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST �
BUP
Received Date Requested / '-S AM PM BUP
o a ion :t: Suite MEC
Contact Person Ph ( ) 6 6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
- Foundation ELC
Ftg Drain Access: I 60 , ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
_
Susp'd Ceiling
Roof
Other:
in
T FAIL
earn
Under Slab
"\\
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
dia
PART FAIL
NICAL
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 / ` 2 �i�'v pector Ext
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 MST boa / Ca f_V
INSPECTION DIVISION / Business Line: (503) 639 -4171 `
BUP
Received Date Requ ted 3-13 AM PM BUP
Q
Location / 30 0 Suite MEC
Contact Person C n Ph ( ) .. Lam c Ol ( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation � n - Ev l 1.2 ■ Sl ��
Drywall Nailing
Firewall 'at' 4' 1-k T
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
PASS PART
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
ECINICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
O
SS 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 D Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
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: (503) 639 -4175 T o 1 06 - q3`(
INSPECTION DIVISION Business Line: (503) 639-4171
I 7
J �' BUP
Received Date Requested /— AM PM BUP
Location —1 ; � Suite MEC
Contact Person ' Ph ( ) 57,,c 6 0 l / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: ��.eiv � r c1 I `{' qs I
Ft Drain 1
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: P,
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
T FAIL
41 11 . 514. CTRI
S pi'j
Fi : Al .. rm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• �
Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7A L.— Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
A
N�j2r �4
CITY OF TIC,ARD BUILDeINSPECTION DIVISIO �
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST - Gd?�
BUP
Date Requested 3 - 4 AM PM BLD , .
Location (.3t b 5-1 Suite ) MEC
Contact Person S� •Jw,� /s o P Ph 5 // PLM
Contractor Ph SWR
UILD Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: Age.,
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing ' P�,?o.��ra �`-►� )A.-So� G3 ,2� -crio J ,(emir
Insulation
Drywall Nailing r- 3 - l 3 – a —
Firewall
Fire Sprinkler _ .._./ . -s /4" z.a 1411 / sl _
Fire Alarm
Susp'd Ceiling Cr-27
T b C�r7
Roof
Misc:
Fin /lv
ASS) PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Dat 1-14C---e Inspect Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.