Permit A ' C ITY MASTER PERMIT
OF TIGARD
PERMIT #: MST2003 - 00022
I-
Viii DEVELOPMENT SERVICES DATE ISSUED: 2/25/03
'
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
• SITE ADDRESS: 12027 SW WILTON AVE PARCEL: 1S133CD-08900
SUBDIVISION: COTSWALD MEADOWS NO.3 ZONING: R - 25
BLOCK: LOT: 112 JURISDICTION: TIG
REMARKS: 473 sq. ft. upper level addition.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 23 FIRST: sf BASEMENT: sf LEFT: 16 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 473 sf GARAGE: sf FRONT: 24 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 23
VALUE: 45
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 473 sf REAR: 17
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 2 CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: 1
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: 00 PUMP/IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 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: 200 SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. MINOR LABEL:
1000+ amp/volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & 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: $ 950.26
VANCLEAVE, PHILIP A + SHARIL A RENOVATE INC This permit is subject to the regulations contained in the
12027 SW WILTON AVE 8425 SW CHARLOTTE DR
Tigard other r applicable cal a w
la , State work k w Specialty Codes and
all other applicable l rov All work will be done i
PORTLAND, OR 97223 BEAVERTON, OR 97007 t
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: 503 685 - 2972 Phone: 503 - 502 - 0323 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You .
Rae #: LIC 120000 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Footing Insp Crawl Drain /Backwater Framing Insp Electrical Final
Foundation Insp Footing /Foundation Dr; Shear Wall Insp Mechanical Final
Post/Beam Structural Mechanical Insp Exterior Sheathing Insr Plumb Final
Post/Beam Mechanical Plumb Top Out Insulation Insp Final inspection
Underfloor insulation Electrical Rough In Rain drain Insp •
I ued By : 1 . 'hi, gh ` 4, 1l1_ Permittee Signature : _%. ',' 1 1 " / dy%'
Call (50. 639 -4175 by 7:00 p.m. for an inspection needed the next business day
FOR OFFICE USE ONLY
Building Permit Application
Received q — I PeBuilding
Permit No. ps 3 -��
Date/By: 1 lo - 0 ` � Permt
Planning Approval Other
City of Tigard Date/By: Permit No :
13125 SW Hall Blvd. R c C E A. Plan Review Other
Tigard, Oregon 97223 L.•�/ Date/By. Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 / �; ' j�'h l' i Post R Lan Noe
I www.ci.tigard.or.us JAN ^� • • Contact Juris. ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 N� me/ eth Su pleme tal nformation
CITY OF TIGARD /Ora F . d t ,0- w „J,� Hd o- r J, ,1 erti:Q/ '
BUILDING DIVISION , 1.44.1.,.cd -o
.. TYPE OF WORK
REQUIRED DATA:
❑ Ne w construction III Demolition 1 & 2 FAMILY DWELLING
J J' Addition/alteration /replacement ❑ Other:
CATEGORY OF CONSTRUCTION . Note: Permit fees* are based on the total value of the work performed. Indicate
1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this apphcatio s a ��
' 111 Accessory Building III ' Multi- Family /
❑ Master Builder - ❑ Other: Valuation $ A,%/Car
JOB,SITE INFORMATION and LOCATION No. of bedrooms: No. of baths
Job site address: f 2627" 30,1 w .. f J T/ 4,6-12.)2 Total number of floors
t New dwelling area.(sq. ft.) D )t7 3
Suite #: I Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: Covered porch area (sq. ft.) 40
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL- USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: . f 536in t 2f� O (� 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, matenals, labor,
• OP 0 t if ` , / overhead and profit for the work indicated on this application, -
�� u Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
4
.❑ - PROPERTY OWNER I ❑ TENANT Type of construction
Name: 0 4} ) 14 p }.66 N r G� ,A U Occupancy group(s): Existing:
'-
Address: ( 7 4 4 1 L-To N • New:
City/State/Zip:"( / 4 F_P1 a.. q �Z�
Phone: 4 5 Z Fax: NOTICE All contra ctors and subcontractors are required to be
]� licensed with the Oregon Construction Contractors Board under
'B ❑' APPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
siness Name: 5,6--M• jurisdiction where work is being performed. If the applicant is exempt
Contact Name: V „ - 1 2. , —,,,w from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: Fax: " - •
BUILDING PERMIT FEES* , , • .
E -mail: Please refer to fee schedule.
.• - — ' . " , - CONTRACTOR .- -
Business Name: JJD VA 1 / V V t Fees due upon application $
Address: f L 2 SVJ C - 1 - 1 / 6 - r e - 4 6 . (3 6, V i --rz N I , 5 p •17e07. Amount received $
yd
Phone: e : 0 3 z, I Fax: 3 b t 233 ( Date received:
CCB Lic. #: 1 2 v D ri b ,AW1eS
Authorized / ? Notice: This permit application expires if a permit is not obtained within
Signature: ��/ / „/ /� Date: !d d / 180 days after it has been accepted as complete.
M / 6 / 6 L S- rl- -- *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name) ep'Y
%
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 91°
0 . ‘ksk
One- and Two - Family Dwelling
,;„ Building Permit Application Checklist Referenceno.:
Associated permits:
City of Tigard City of Tigard ❑ 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
Spwerpgrmit.
7 *ater district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan O permit required. Include drainage -way protection, silt fence design and location of
cat li bisin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
b�dfng 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)
At 5TaOZ73 --- z-.
Mechanical Permit Application FOR OFFICE USE ONLY
FOR
Mechanical
Date/By: Permit No.:
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 1' F� Date/By. Case No.:
Post Land Use
�4,
Internet: www.ci.tigard.or.us • Con tact Juris.: ® See Page 2 for
-
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information.
. - ' - - TYPE OF WORK - COMMERCIAL FEE* SCHEDULE - USE CHECKLIST r :
El New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
2-1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
El Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE • _
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATI N and LOCATION Furnace - add -on air conditioning" / 14.00
Job site address:/22
07 14J1,L"p )J , 7afrgb Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: r3 Aj 1f f 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
- Repair units 12.15
y , Subdivision: Lot #: Other Fuel Appliances
Tax map /parcel #: 1 5( 33‘..-17e f q 40 0 Water heater 10.00
•
DESCRIPTION OF WORK Gas fireplace 10.00
D I V U - D 04 Flue vent (water heater /gas fireplace) 10.00
" _ p C A 0--171 d Log lighter (gas) 10.00
It , t (/ ir Wood/Pellet ep ce /in 10.00
(J 1 `-'�V Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
. ❑ PROPERTY OWNER ❑ TENANT Other: 10.00
1 i j /A P / - Environmental Exhaust & Ventilation
%l
Name' r � V Range hood/other kitchen equipment 10.00
Address: / 24 .2_7- 5 /i 1
S Y Clothes dryer exhaust I 10.00
`
City /State /Zip: — ) 6 /7� / � ` g
G. 7 ?j� �7 Single duct exhaust
Phone: 6i y' 7Z Fax: (bathrooms, toilet compartments,
❑ APPLICANT' ❑ CONTACT PERSON utility rooms) 6.80
Name: ( c6.. (IJ Y %2-- Other: awl space fans 10.00
Othher: r: 1 0.00
Address: Fuel Piping -
City /State /Zip: "($5.40 for first 4, $1.00 each additional)
F etc. **
Phone . 2 D 3 3 Fax: *•
Gas heat pump
E -mail: Wall/suspended/unit heater
. • CONTRACTOR , 4 Water heater **
Business Name: 5�,11a' se t7r1 k `� /Y 4 Range Fireplace 4.* *
•s
Address: 0 v x , ` / � ? BBQ **
City /State/ ip: l j 1N, Di 6 r .1 31 �J Clothes dryer (gas) ••
Phone: 35 6-z. 9 7 Fax: Other: **
CCB Lic. #: ..--0 7-- - 5/ #0/0 Total:
Authorized / Q M echanical Permit Fees*
Signature: 7 Subtotal: $
St
gn /� i ���/ • ��, /„ Date: Minimum Permit Fee $72.50 $ 7D SO
I /�/ Plan Review Fee (25% of Permit Fee) $
" I , �r i State Surcharge (8% of Permit Fee) $ S
(Please print name) TOTAL PERMIT FEE $ g
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\Petmit 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
Descnption: Qty (Ea) Amount
Fumace to 100,000 BTU, including 955
ducts & vents
•
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor fumace 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:
i:\Dsts\Permit Forms MecPermitAppPg2.doc 01/03 —
•
.44 1'a0a3 o z
Plu bing Perm Applic FOR OFFICE USE ONLY
n�i Received Plumbing
Date/By Permit No.:
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
x/ +� Date/gy Case No.:
� �
Internet: www.ci.tigard.or.us eT 1 I Contact Juris.: El 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 ❑ Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
Erl & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
• ['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION mid LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: 12.-of.--7 Z)'Sf/� W )Ce1 1 or- . Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell/leach line/trench drain 16.60
Project Name: D {� l)1 G�� 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: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: ( 5) 3 3 `Q 48 9 D O Water service (no. linear ft.) Page 2
'DESCRIPTION OF WORK Fixture or Item
1� r) EV v f r -p A Absorption valve
P a6. e 62
J 1`� 1/ v" Backflow preventer g
aot k Backwater valve 16.60
Clothes washer I 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑.PROPERTX OWNER r j I El TENANT Ejectors/sump 16.60
Name: r'/- .- I P V A' 1 `I Ci rV I Expansion tank 16.60
Address: I Zes ? / I LTd N S 7 - i Fixture/sewer cap 16.60
City/State/Zip: 71 ,, n d q----2_2-3
Floor drain/floor sink/hub 16.60
y p' �t �" Garbage disposal 16.60
Phone: & g y r 2A - Z ax: Hose bib 16.60
❑ APPLICANT _ ❑ CONTACT PERSON Ice maker 16.60
Name: M (MA /B'_ (/ ]`-'/S. � 1� Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City/State /Zip: Roof drain (commercial) 16.60
Phone: Z a a 3 23 I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
'' • - CONTRACTOR Urinal 16.60
M C pi--01901 w' / t Water closet 16.60
Business Name: l N x `7 Water heater 16.60
Address: f/ d . 0D,4 3 ° 1,. Other:
City/State /Z1 � Q j i /} , 9 / Other:
Phone: 9 i N 2. Fax: I Plumbing Permit Fees*
Subtotal $
CCB Lic. #: I Li I $ I Plumb. Lic.#: Minimum Permit Fee $72.50 $
Authorized .
Date: il / /�
' Residential Backflow Minimum Fee $36.25
Signature: �� // �// r Ale/ Ale/ I/ Plan Review (25% of Permit Fee) $
1d ',14.MgraM %• 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 C
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' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000 00 $72 50 for the first $5,000.00 and $1.52 for each
additional $100.00 or fraction thereof, to and
'Flxtul'e 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:
J
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
- Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDU5, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice MachiRefrig. 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
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
JAN -15- 2003 - 09:26 PM BENTLEY ELECTRIC. INC. 503 905 9595 P.01
Electrical Permit A U Os It a:
Armor ertldtlb:
City of Turd 1i ,, o er
13123 SW Hall Blvd wt9rr P =40
Ti O egos 97223 ProeftevtP+ use
Mae: 303-639.4171 Pox 503 -598 -1960 peyp�r Can Nu:
']�.: � Sr MO 1 for
1
1�:. impaction Request 639 -4175 �.l I i - _ - s t tlaa. 2e-hour r teapentio Request - -- �`
--'..—PLAN REVIEtla• rase ellelk all that spp 1 •
TYPE OF WORK ' r fteat>neae feeihty
I Senate ova +23 mItPS-
1 � New construction -_ — Demolition Haze dow losetion
�' Builder8orct Io)oplagauefeat,
Addition/alteration = !eminent , P Other: 0 wee over= t'�n four m mac t 10,00 s mans are
1 & 2- Fa e
f CATEGORY OF CONSTRUCTION 16 21en�9y raffia; fO o r mac
mi�dwellt _ �� Commercial/Industrial El spa rboo storks rks WPM Mare
El er tau hterute mrcd tevctwm or Rv park
IN 1oss aver 99 Pen°m
V AO .: Buildin :: • Multi -Farm Bowmen, I�ti!so� Olher:_�—
Master Builder ■ Other: Sueadt _ prof rhos with s•y of tee erne,
JOE SITE INFORMATION LUCA S!1 • The �
address: • • a A. :i, ,- ._ ,.1 • n eoutrsdlea ear .
J s ite a: 1202 AlrErnr/ r 1rati .- . . . • , Fr: -y.l. , 'r• : .
am , - .emit scores
Susie B , •: L# — Numbei oft ( - 7r Tv Ie - two II
�,
Project Name: r� .. —_ — — — new fesleeadaFttsDe o, rsr0o I�r.
Cross SileewDirccatms to job site: etteeked rage.
1000 se B. ar, Ins MIS t4
Each addmatal sot • R. or loo •mar .
Limbed erprar. • , .. NUr r 75 tl •
Stilbdivisian: � Lot 4: ;bp ,tae.,+e'sr, 6 hones de c leb
"E' %alk , ∎ "eminency':
} -D � m
' � r. • IpTlON OF WORX - �T S ar;ec s o " en - lesmhan
t i y_� J ,. dtef t ai tltD . � e. `�
- ` y 701 a. ' ae` 16060 II
� 1jtIIcu L ;" •w.: M = 1 II
l; PROPF.RT1lOWNER :. Ae TENANT • . 1000 r. _ Mill 66ai
KI
Na ► �� b — — r � a..ua. ar reeds. tes�ll.noa.
Address: - '- D 5fWT/hIi iaera er ret PM
' tatelL' • • V� w eo w 1" — — t7
• 1 t , : NTA T l ... circuits . ea.. eltersdaa.or
uteri an*an*Pte•
II' t t A. Fee for brseeh Mott Om emirs or 61b
' - . i orate or feeder lea. rev kitsch musk
AeSS_ / a Fee *AMU elwea+'rC P
Ci ' /StaterLip: 13 ✓. D . ' arat r► eerrt� atbae dlud ry e *�° ` , g °"
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Phone D5Jo Z • • DSL 3t F ax: 1 � ol+m>r�e�
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e
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we 111 l:- :tsaa: NM 31.a0
gip ladx� ■
J � No: � •� • Sigma dewlap) a s Ended rem M�-
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Business Name: 6
i 1C a ee r Mil
SY: ` �q a7 r It Each Waldo lorcebaa Over • Wowed' as of else abate -
Ci /$tateIZ1' : 's 7 Per mrGe 1 haal, �_
Phone: •• - 7O - t ' Fax: 1 '1645.— Orb= . . (me . slimmINNOI El
CCB Lie. ti: ' Lk. a: Z - Z - sae -- Pao.
Supervising eleatriey�l+) - _ • � �' „ Review 25% of Peer rice
P
si - attire -toted: � . � � Starve Somber* ( • of Pamir Fee
Print Name: - I.ic { 3 ZS TOTAL. PERMIT FEE S
Nedee I permit spinlioe rpm Ke 0 b Oct obtained within S Signature: e : �f�� / � �3 ISO Are Aka it has be® emoted e. ,� .. giae V f�Y Dale: / free asethedrue set M TriCsoat3' xotldiaa i doauy Sala Third.
_. csarA' print sere) YAP —
LiDstistarehlForrrakFermitAoodeas CUM ■
1 i d acca-sse IEOS) Jarm.$ -S toeyotwl d40:SO co St u•C
■
Monday, March 17, 2003 1:46 PM Michael S. Sawyer (503) 356 -2338 p.02
•
AC 2oo.3 -Don
„, � RECEIVED MAR 1 8 2003
MAR 0 5 2003 ����'
CleanWate Services
n ur commitment is clear. B v _ Flle Number I 2
Sensitive Area Pre - Screening Site Assessment
Jurisdiction T /6-4/ Date 3
Map & Tax Lot 33CO 0: 'oo Owner P
Site Address
■ �trr� / - Contact u /Pr3.: • I li
Proposed Activity Address
/ t '4
; Phone
!«f\
Y N NA Official use only below this line
rr�� Y N NA
L� ❑ n Sensitive Area Composite Map ❑ ® Stormwater Infrastructure maps
Map# /5 /14.) QS# /S
Y N NA Y N NA
n ❑ l 4 Locally adopted studies or maps ® ❑ ❑ Other
Specify
Specify
Based on a review of the above information and the requirements of Clean Water Services
Design and Construction Standards Resolution and Order No. 00 -7:
n Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST
PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER
LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or
within 200 feet on adjacent properties, a Natural Resources Assessment Report may also
be required.
•
Sensitive areas do not appear to exist on site or within 200' of the site. This pre-
screening site assessment does NOT eliminate the need to evaluate and protect water
quality sensitive areas If they are subsequently discovered on your property. NO
FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS
-- FORM WILL -SERVE AS - ISSUE ST RM WATER CONNECTION
PERMIT.
❑ The proposed activity does not meet the definition of development. NO SITE
ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Comments:
6 , . _ cv - _ .. • • i _ . go a1.41 •
p r,odfee rp., P 97 .
L /'/ ',tor 4igHlt �►s i/
� J! rr / aer Tx s Axdt0-:..9 i'PMsi /'; y
a,vly . K vP rr r. r X"'
Reviewed By: �� Date: .7////0 3
Returned to Applicant
155 N First Avenue, Suite 270 • Hillsboro, Oregon 97124 Mall Fax Counter
Date
Phone: (503) 846 -8621 • Fax: (503) 846 -3525 3 / /�i B
www
•
pod 8££Z - 99£ (co) S JeAmeS 'S iaegoiii NW £V£ EOM 'SO 4aeyy 'AepsaupaM
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST OR
v Z-Z
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested / / — /9 AM PM BUP
Location / ) s D a-- 1 (--(J Suite MEC
Contact Person Ph ( ) 52 — o.3a3 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 eL
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall •
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
SS ART FAIL
P L N G
Post & Beam
Under Slab
Rough -In
Water Service 9, ( C)
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
A3S PART FAIL
MECHANICAL
Post & Beam 1
Rough -In
Gas Line I c-,,O
Smoke Dampers �•,.v*. ) PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA 1/4-1
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL