Permit T CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00108
lt DEVELOPMENT SERVICES DATE ISSUED: 4/22/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 13055 SW ST. JAMES LN PARCEL: 2S109AB -07500
SUBDIVISION: RAVEN RIDGE ZONING: R -
BLOCK: LOT: 004 JURISDICTION: TIG
REMARKS: Construction new SF detached residence.
BUILDING
REISSUE: MAS1201H STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1.099 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: . 40 SECOND: 1,677 sf GARAGE: 428 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 TroRD: sf RIGHT: 5
VALUE: 275
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 2,776 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 0 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 1 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5
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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 - 400 amp: 201 • 400 amp: 1st W/O SVC/FOR: ' SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: 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: $ 7,680.06
JAMES ARNETT AVALON CUSTOM HOMES This permit is subject to the regulations contained in the
15445 SW MIDDLETON CT. 15445 SW MIDDLETON CT.
Tigard other r applicable Code, State work k w Specialty Codes and
done a
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:
Oregon law requires you to follow rules adopted by the
Phone: 503 - 574 - 4418 Phone: 503 - 574 - 4418 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 102498 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Post/Beam Mechanical Electrical Service Low Voltage Rain drain Insp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Rough In Gas Line lnsp Water Line Insp Plumb Final
Footing Insp Crawl Drain /Backwater Framing Insp Gas Fireplace Water Service lnsp Building Final
Founds' nsp I echanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Post/ eam Structural Plu • Top Out Exterior Sheathing Insr Rain drain Insp Electrical Final
/ ■ ' / / / Permittee Si nature : . gym, I II Issu By _ .l1 �i 9
C
ir
all (503) . 9 -4175 by 7:00 p.m. for an inspection needed the nt business day
&w 1R )-ao - 000
Building Permit Application Received FOR OFFICE USE ONLY
Building
Date/By: 3 - 15 ") 1 Permit No. fr C 3 - 0) ' Og
CI of Ti and Planning Approval Other
ty g G O Date/By: Permit No.:
13125 SW Hall Blvd. ill4, Plan Review Other
Tigard, Oregon 97223 E Date/By: / `V 3 - 0 3 Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1 0 /�"u, �� !'u��l \03 Post Land
No 1
iii
Internet: www.ci.tigard.or.us ` e.: Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 `� � F -c \GA ,., d •lame /Method: Supplemental Information
GO
Qt11∎0� 4
TYPE OF WORK REQUIRED DATA:
0( New construction ❑ Demolition • 1 & 2 FAMILY DWELLING
Addition/alteration/replacement 111 Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
1 & 2- Family dwelling ❑ Commercial/Industrial Miam the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
C f
JOB SITE INFORMATION and OCATION No. of bedrooms: No. of baths:
Job site address: t `. 0$S Si c j,�ro1 Total number of floors
�I New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
/.3&_ A` / COMMERCIAL - USE CHECKLIST
Subdivision: ot,/4/1ic Adg,e I Lot #.
Tax map /parcel #: 5z. S / 09h It J 7 c",),!),:;) Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
/ v ew C s J JJJJ ► ► ► ►► a . 0 Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
'YPROPE TY.OWNER I ❑ TENANT Type of construction
Name: jam! g Act c+ r∎,(/ 7 Occupancy group(s): Existing:
New:
Address: I <q -/c/(S 01 t } o g r A, n „
City /State /Zip: ,g , 'TY 07?667
P s 4 A NOTICE: All contractors and subcontractors are required to be
'Ilen licensed with the Oregon Construction Contractors Board under
e: Fax S P
PPLICANT (CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: \ jurisdiction where work is being performed. If the applicant is exempt
Contact Name: < Aryje /}f /g Ve from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: I Fax:
BUILDING PERMIT FEES*
E -mail: Please refer to fee schedule.
CONTRACTOR
Business Name: / 41/A, In L1 CA Fees due upon application $
Address: �, .q�40v>
City /State /Zip: Amount received $
Phone: I Fax: Date received:
CCB Lic. #: 102 7 Lq%
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: � 4, .e) Date: 31 [ / 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPerrnitApp.doc 01/03
•
A ith One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard ty g ❑Electrical O Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TIIE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property 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 (6/00/COM)
Mechanical Permit Application Received FOR OFFICE USE ONLY
Mechanical
Date/By: Permit No.: j7 t 93 -O(Jm
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 4 Post - Review Land Use
emu li jd
Internet: www.ci.tigard.or.us .1.1. Date/By: Case No.:
Contact Juris.: ® See Page 2 for
- -
24 -hour Inspection Request: 503- 639 -4175 - Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST .
New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
] Addition/alteration/replacement El Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
E 1 & 2- Family dwelling El Commercial/Industrial Value: $ See Page 2 for Fee Schedule
Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
El Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: i ` (mot 32wyr j L-/l1 . Gas heat pump _ 14.00
Suite #: I Bldg. /Apt. #: Duct work _ 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Qc 'eviS PI d9 ? I Lot #: V Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
N eio Co v. Si """ t-111 "`��"" f 47 Flue vent (water heater /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
6ROPE OWNER I ❑ TEN T Other: 10.00
l Name: d/ Environmental Exhaust & Ventilation
1 V��Sr I ^� Range h000ther kitchen equipment 10.00
Address: t < (.( S W1 (. u^ �T' Clothes dryer exhaust 10.00
City/State/Zip: / 512 q---2047 Single duct exhaust
I
Phone: $ 4 14 (f� F : N/�_ (bathrooms, toilet compartments,
Z A n P I PLICANT CONTACT PERSON utility rooms) 6.80
e: S AA-v� Ot yawl space fans 10.00
�`'� Ot 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
F etc. **
Phone: Fax:
Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTOR /� Water heater **
Business Name: 9y54 -ewtA — �r‘✓\Q Fireplace **
Address: 1 --�' Range Qe **
City /State /Zip: 11 l/ a ( Clothes dryer (gas) *4. Phone: 5 24- 542.-7 Fax: Other: _ **
CCB Lic. #: Total:
Mechanical Permit Fees*
Authorized Subtotal: $
Signature: Date: Minimum Permit Fee $72.50 $
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information .. • ,
Commercial Fee Schedule:
Total Valuation: Permit Fee: •
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and •
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$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 and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance: , •
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units • 805
< 3 hp; absorb. unit, 955 •
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446 •
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet - 63 •
TOTAL COMMERCIAL $
VALUATION:
iADsts\Permit Forms\MecPerrnitAppPg2.doc 01/03
• Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical 7 o3 �eiag
Date/By: Permit No.
Planning Approval Sign
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone; 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
/�ennOA(�:� @i 0 Date/By: Case No.:
Internet: www.ci.tigard.or.us ^ ■ � eel I I Contact kris.: (81 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction ❑ Demolition ID Service over 225 amps- 0 Health care facility
,M commercial ❑ Hazardous location
Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
8 CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2 Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
/❑ ❑ Building over three stories ❑ Feeders, 400 amps or morc
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
1 ? c'S5 The above are not applicable to temporary construction service.
Job site address: jpvviAar FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: gaAr -0,.... gj aolt Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential - single or multi- family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot 4 Limited energy, residential 75.00 2
C Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
Al 4 n, NC 200 amps or less 80.30 2
�/ I.tJV� 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
f� Over 1000 amps or volts 454.65 2
Name: j- ,�w,,� i ,'1-, t, .�j ' ^ Reconnect only 66.85 2
Address: / ,1 S i,J d G Cif Temporary services or feeders - installation,
� alteration, or relocation:
A M
City /State /Zip: _2olAI _ b1 (frtZr? 200 amps or less 66.85 1
M
S . 2 / , i ` I g Fax: 201 amps to 400 amps 100.30 2
' A amps
APPLICANT
/ CONTACT Branc circuits - new, alteration, or 133.75 2
Naive: extension per panel:
/�
//��^, /�Q A. Fee for branch circuits with purchase of
Address: a /� C�V �' ` service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Q // �_ , L, Each sign or outline lighting 53.40 2
Job No: }-2 G LC rl QA (j - t � - Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
Description:
Address: t W v
City/State/Zip: uyYil Each additional inspection over the allowable in an of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone: 4552. Fax: Investigation fee:
Other:
CCB Lic. #: Lic. #: Electrical Permit Fees*
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: I Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ..
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
II Audio and Stereo Systems
0 Burglar Alarm
ID Garage Door Opener
Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls •
E Clock Systems
Data Telecommunication Installation
D Fire Alarm Installation
HVAC
Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control
0 Medical
0 Nurse Calls
Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
Building Fixtures •
Plumbing Permit Application Received FOR OFFICE USE ONLY
Plumbing
Permit No.� / 'O� / a( '
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 Post - Review Land Use
A'''') Date/By: Case No.:
Internet: www.ci.tigard.or.us e l I I Contact Juris.: ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 Name/Method: _ Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement El Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
1 & 2-Family dwelling ommercial/Inustrial SFR (1) bath 249.20
❑ Y g ❑ Cd SFR (2) bath 350.00
❑Accessory Building El Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE IN RMATION and LIVATION Fire sprinkler - sq. ft.: Page 2
Job site address: ) $- .s.a Si-, , CAA/ , Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
1 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) Page 2
Subdivision: PQ 4/€✓i5 Nix Lot #:1 Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
/ eAA i l ' Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPIWTY OWNER TENANT Ejectors/sump 16.60
ame: yy\p S •01-r ' '� I Expansion tank 16.60
Address: / cga Sri An, ?l of it lin, Ct. Fixture/sewer cap 16.60
City /State /Zip: B-e A,J4t 6 l a 91367 Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
hone: c $ 7'- 4 Fax: 901 Hose bib 16.60
APPLICANT 71,CONTACT PERSON Ice maker 16.60
ame: 5frt AnD1) Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan 16.60
CONTRACTOR Urinal 16.60
Business Name: C ork pkn/vt+� �v1� Water closet 16.60
`J Water heater 16.60
Address: '77 $'W u>~, b vs A - ti Other:
City/State/Zip: _aeok P- 6`3 p az grew' Other: Phone: td-fi k� Fax: f CJ Subtotal $
Plumbing Permit Fees*
CCB Lic. #: Plumb. Lic.#: Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
•
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
CRAFTWORK PLUMBING INC
7736 SW NIMBUS AVE
BEAVERTON, OR 97008
Plumbing Signature Form
Permit #: MST2003 -00108
Date Issued: 4/22/03
Parcel: 2S109AB -07500
Site Address: 13055 SW ST. JAMES LN
Subdivision: RAVEN RIDGE
Block: Lot: 004
Jurisdiction: TIG
•
Zoning: R -7
Remarks: Construction new SF detached residence.
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:
JAMES ARNETT CRAFTWORK PLUMBING INC
15445 SW MIDDLETON CT. 7736 SW NIMBUS AVE
BEAVERTON, OR 97007 BEAVERTON, OR 97008
Phone #: 503 - 574 -4418 Phone #: 644 -8698
Reg #: LIC 79666
PLM 20 -148PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber -
•
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
2920 SW 247TH AVE #A
HILLSBORO, OR 97123
Electrical Signature Form
Permit #: MST2003 -00108
Date Issued: 4/22/03
Parcel: 2 S 109AB -07500
Site Address: 13055 SW ST. JAMES LN
Subdivision: RAVEN RIDGE
Block: Lot: 004
Jurisdiction: TIG
Zoning: R -7
Remarks: Construction new SF detached residence.
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:
JAMES ARNETT GARNER ELECTRIC
15445 SW MIDDLETON CT. 2920 SW 247TH AVE #A
BEAVERTON, OR 97007 HILLSBORO, OR 97123
Phone #: 503 - 574 -4418 Phone #: 503 - 648 -4552
Reg #: MET 00004410
LIC 121159
SUP 3707S
ELE 34 -305C
AN INK SIGNATURE IS REQUIRED ON - TH,IS FORM
if
Signature of Supervising Electrician •
If you have any questions, please call 503.718.2433.
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1 RECEIVED BY: DATE: 07\ 3 /O •
AV7VVVVVVVVVVVVVVVVVVVVVVVVVVVVV VVVVVVVVVVVVVVVVVVVVVVVVVVVV®
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 00 rb
INSPECTION DIVISION — Business Line: (503) 639 -4171
BUP
Received Date Requested 2 AM PM BUP
Location f j w�5 Suite MEC
Contact Person Ph ( ) 93 "s % 5 PLM
Contractor • Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
ain �^
Crawl Drain 13O
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:
— ASS PART FAIL
M - ANICAL
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: El Unable to inspect – no access
Fire Supply Line
ADA D /AI" Inspector I / Ext
Approach/Sidewalk - P
Other:
Final D • NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 1 3 _ ` D
INSPECTION DIVISION Business Line: (503) 639 -4171
2 BUP
Vii
Received / G/ Date Reques ed. 27J/O AM PM BUP
Location /32 s Suite 2 -7 / 7 MEC
•!
Contact Person � �/ % 2-J� � A� ' Ph ( ?2 9 6 -- MPS LM
Contractor 1. //! _ � Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain /- ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam f1Z�'L
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation P p �) ,,�` ll � � �n �f I D r \ l �� 1 \ �'1 p.wiNG
Drywall Nailing I" r1 M \ lJ Ni ) 1 V
Firewall 1 R�� `' l� \ 1 \ . O t W `ti S ' V R '
Fire Sprinkler
Fire Alarm
Susp'd Ceiling l I I /�
Roof � = � Y U A S �\ 1� { ---�1Q l..l�
Other: � J�PIM 1 s ( `- IIV & HA
PASS PART FAIL
PLUMBING I -411 _
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
c roir , .m
SS PART FAIL Reinspection fee of $ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE D Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2 -3 -c7.5 Inspector T Ext
Other:
Final DO NOT REMOVE this Inspection record from the site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING dip Inspection Line: (503) 175A MST 3-6 0/0E 7
IIiSPECTION DIVISION Business Line: (50 - 417
BUP
Received Date Requested o2 — 43 AM PM BUP
Location (30S, S Jf i L Q.a cf'l Suite MEC
Contact Person Ph ( ) 534 - S" 8_S 44 15 9-006'63
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
g Access;
_ ELR
Ft Drai 13 0 X 1 ,312-0 Crawl Drain
Slab Inspetes i ' SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear 40 .0 �' ' ,
Int Sheath/Shear Framing��` Le- G?�fNl 3�
Insulation c...0"7 Drywall Nailing V / C./ - , 4/V
Firewall
Fire Sprinkler AI A .1A, " ' ` — _ l ` A
F
ill
ire Alarm 1/ S V� �� -
Susp'd C 'li / 6 . O
Roof ! • ,
Other:
111111 PART FAIL
\14--- Le"----re--- -..."
:ava:TP1-: ... C.--L-e— — c-,"..ie
Post r Slab A•�
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P n /
Oth = -. ( A,vt- -F
gilir _ °op
� � T FAIL
ANI L _
Pos cam
Rough -In
Gas Line
Smoke D mok rs
;1 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 ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA 3/6 lE '" (� ( -
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the jobs .
PASS PART FAIL