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Permit CITY OF TIGARD MECHANICAL PERMIT 1111 s ' COMMUNITY DEVELOPM Permit #: MEC2013 00732 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2013 Parcel: 2S104ACO3100 Jurisdiction: Tigard Site address: 12445 SW 134TH AVE Project: Neet Subdivision: MORNING HILL NO.8 Lot: 175 Project Description: Installation of gas fireplace insert. Contractor: HOLMES INSTALLATION SERVICE Owner: NEET, BRIANA M & 33535 NW VADIS RD HINESLY, PAULINE M CORNELIUS, OR 97005 12445 SW 134TH AVE TIGARD, OR 97223 PHONE: 503 - 647 -9320 PHONE: 503 - 329 -2889 FAX: FEES Specifics: Description Date Amount Gas Fireplace 12/05/2013 $33.39 Type of Use: SF 12% State Surcharge - Mechanical 12/05/2013 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/05/2013 $56.61 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct . = • OUNC by calling 503.232.1987 or 1.800.332.2344. Issue • By: ,/ Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application ryry 'oR OFFICE ICE USE ONLY of Tigard r d Received � 1 • • 1 Date /B /� _� Permit No.: D ^ �LL�3 ��7 ° 13125 SW Hall Blvd., Tigard, O 1223 U K b ,4 d Plan Review ` . Phone: 503.718.2439 Fax: 50359K19 - — Other Permit: Inspection Line: 503.639.4175 ae Ready/By: I G A K D Ins , p DEC 5 2 � 13 Date Ready/By: luri s 63 See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information CITY OF TIGARD TYPE OFiiW 111‘11SIOP COMMERCIAL ,FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 0 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total L1 JOB SITE INFORMATION AND LOCATION Heating/cooling: �/ Air conditioning 46.75 Job site address: r 2J/ c S W 1 S 44-x, / 1 " Furnace 100,000 BTU (ducts /vents) 46.75 City /State /ZIP: T�ati0 v� � 77 z 3 Furnace 100,000+ BTU (ducts /vents) 54.91 I 1 Heat pump 61.06 Suite/bldg. /apt. no.: Project name: Duct work 23.32 Cross street/directions to job site: • Hydronic hot water system 23.32 • Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map /parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert / 33.39 _ _� Flue vent for water heater or gas j am\ ti n S + 1__. F i "r G C ...7 fireplace 23.32 1 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 Other: 23.32 PROPERTY OWNER ❑ TENANT _ Environmental exhaust and ventilation: Name: 'V ` to N IV A .) 'Q (1 Range hood/other kitchen Z Liv W 3 (..+ P #4 ✓ Clothes dryer 33.39 Address: 1 1 1� J � J � -I Clothes dryer e:rhaust 33.39 City /State /ZIP: — l ) d vP 9 7 Z Z Single -duct exhaust (bathrooms, ��� toilet compartments, utility rooms) 23.32 Phone: ( G V ' Z Fax: ( ) Attic /crawlspace fans 23.32 ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: 514.15 for first four; $4.03 for each additional Contact name: Furnace, etc. Address: Gas heat pump Wall /suspended/unit heater City/State /ZIP: Water heater Phone: ( ) Fax: : ( ) Fireplace Range E -mail: Barbecue CONTRACTOR Clothes dryer (gas) It,, e G 1( ( 4 Other: FEES* Address: 33 7s cv Business name: v� MECHANICAL PERMI �, j J i S p `/ Subtotal City /State /ZIP: C I ,Q vi ( I ,9 b ) 97 ( 1 / Minimum permit fee ($90.00) Phone: ) tai- b ? 7 S State surcharge 7 . Fax: ( ) / Plan ha (25% (112 /o of permit fee) of permit fee) CCB Iic.: )02 1! 73 iot 1 TOTAL PERMIT FEE /e),/)• &t� f This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: / . * Fee methodology set by Tri- County Building Industry Service Board Print name: f v "' --L Date: 5/Z iJ I 1\ Buil ding \Permits�C_PerittApp_040113.doc 440 -461 Tr (1 OM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi - Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\ Building\ Permits \MEC_PermitApp_040113.doc 2 - . . LAS ; 4 • A • . • r • 1 • • . ' 5 . . •i"! aHDIgligSVI • . . . _ • . . CITY OF TIGARD ELECTRICAL PERMIT �. = COMMUNITY DEVELOPMENT Permit #: ELC2013 -00719 T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2013 Parcel: 2S112DD00200 Jurisdiction: Tigard Site address: 15500 SW 72ND AVE 200 Project: Trinity Flooring Subdivision: 1994 -006 PARTITION PLAT Lot: 2 Project Description: (1) branch circuit for monument sign. Contractor: D & B SPECIALTIES LLC Owner: PACIFIC REALTY ASSOCIATES LP 4475 SE POWELL VALLEY RD ATTN: N PIVEN GRESHAM, OR 97080 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 320 -3888 PHONE: FAX: 503 -912 -1363 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 12/05/2013 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/05/2013 $6.74 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuanc-, or if work is - spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C ter, .. -e les are set forth in 0 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the t questions to OUNC by calling 503.23 .1 or 1. • I c 2344. Issued By: ' 6 n- er ignature: mo A OWNER INSTALLATION ONLY , The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application Folz of licE usi ()NIA City of Tigard Date/B: Id- ;;, Permit No.: 4 ; ∎a 3 _ I -7 - 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.19 C .— Date/BV: Other Permit: ( 10c) J3 . 0��1 I' I C i r\ 1: U Inspection Line: 503.639.4175 n, ,,.,.,. Ni " �� - A Date Ready/By: lugs: I See Page 2 for Internet: www.tigard- or.gov Notified/Method: ( Supplemental Information TYPE .OF 'WORKUt ' J PLAN •REVIEW ,-dew construction ❑ Addition /alteratiotceplacetrien A lJ Please check all that apply (submit 2 sets of plans w /items checked below): 8 I V t , ,,,,, ,1 ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition El Other: %AI r11P.la ntkI lb( I where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder Mother: S (G9,1 ['Fire pump. ❑ Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job site address: //�� , . I A `( 10OHP or more. occupancy. Job no.: 3 g g� 2woQ 1' ACV ❑Six or more residential units. ❑ Recreational vehicle parks. � ❑ Health -care facilities. ❑ Supply voltage for more than ( ( L 2.,-z1. City/State/ZIP: ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: / o D I Project name: `"t � ( F La (4 S6 ❑ Service or feeder 600 amps or more. I Qf� FEE SCHEDULE Cross street/directions to job site: U f 9 9.20 PI e$ eE 4 0 . Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4 Ea. add' l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 ^ A' Limited energy, multi- family 14 Lt-A--0 M (f4 IV Mo MJM i T t� residential (with above sq. ft.) 75.00 2 Renewable Energy I ❑ See Page 2 Services or feeders installation, alteration, and/or relocation PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 � 201 amps to 400 amps 133.56 2 Name: e � � L ` , ` PP�� 401 amps to 600 amps 200.34 2 Address: 1 C 3 5. O SV4 ;& QC) V ( p c 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State /ZIP: PO f T C) t q- 0 (L.- °t 1 2 Temporary services or feeders installation, alteration, and/or Z Phone: ( �? j ) '( J ©� F relocation ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel aAPPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with above service or feeder fee, 7.42 2 Business name: O (ST (N C - T c (bA `e. `- e each branch circuit B. Fee for branch circuits without Contact name: % 4 . service or feeder fee, that y 2 `� Q . ! branch circuit / 5, .1 u Address: I 3 b ( '2- of P e A t „ 600 / `1 6J 4 f Each add'I branch circuit I 7.42 12 (, p,� p �/ Miscellaneous (service or feeder not included) City/State /ZIP: ► �-'C 0 s W �i�`() ( 0 -t f 0 3' Each manufactured or modular (5) dwelling, service and/or feeder 67.84 2 Phone: ?� 6,5c? _ S6 Fax: ( 113) (p ? t -- 8 7� — IA � p R econnect only 67.84 2 E - mail: IA t d( AfWc , C 123 Pump or irrigation circle 67.84 2 , 'CONTRACTOW Sign or outline lighting 67.84 2 Business name: ..e 4. ; '� S. �G Signal circuit(s) or limited-energy See 4 et panel, 'alteration, or extension. Page 2 2 Address: ach additional inspection over allowable in any of the above 0 Additional inspection (I hr min) 66.25/ hr City/State /ZIP: 1 - ` � Investigation (1 hr min) 66.25/ hr Phone: ( ) I Fax: ( 0 e % ,'�, 1�7 1 //II ; Industrial plant (1 hr min) 78.18/ hr .,, /� 17 Inspections for which no fee is CCB Lic.: I Electrical Lic.: L \” I Suprv. Lic.: specifically listed (%z hr min) 90.00/ hr w _ rj l f 'ELECTRICAL 'PERMIT FEES Suprv. Electrician signature, required: c �1 1V Q1(`r Subtotal: S6 ' I ' - Print name: 0° Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): 6i - iii Authorized signature: TOTAL PERMIT FEE: 6. _G This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\Building\Permits\ELC _PermitApp_ELR_ERE.doc Rev 05 /21/2013 440- 4615T(11/05 /COM/WEB Electrical Permit Application — City of Tigard Page 2 — Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined ... $75.00 Description I Qty. I Fie I Total I • Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 El Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva (fee in accordance with 552.26 2 El Heating, Ventilation and Air Conditioning OAR 918- 309 -0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva— no additional charge 0.0 3 El Other: additional inspection over allowable in any of the above: • Other: Each additional inspection is charged at an hourly (1 hr min) 66.25/ hr Inspections for which no fee is 90.00 / hr specifically listed (% hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee): State surcharge (12% of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 El Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. El Boiler Controls El Clock Systems El Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC E l Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: \ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 Electrical Permit Application p t .� l oR oHi lc L i o' ~ J >, ` City of TigarC11 ' .,`.,►ei fit ! -- Permit No.: ELC- aQ 13-0x) -7 13125 SW Han Blvd. r; rd, OR 97223 L ga "' Plan Review 111 :: , - Phone: 503.718.2439 Fax: 503.598.1960 ) 01 � Date/By: : Other Permit: 'Trtcy iw Inspection Line: 503.63 5 9.4175 DEC L DateReadyIBv: runs: RI See Page 2rire I,F;�:,c` : .,. Internet: www.tigurd- or.(eov ' titiediMethod: `T 6 Supplemental Information TYPE OF WORK G O r (.4. fi e if nr% tn�l PLAN 'REVIEW' . . ❑ New construction ❑ Addition /alterationrriitleM0 IJI V t, tV ° Please check all that apply (submit 2 sets of plans w /items checked below). ❑ Service or feeder 400 amps or more ❑ Building over three stones. ❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION . • exceeds 10.000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial•usc agricultural ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or ❑ Emergency system. larger separately derived system. JOB SITE 'INFORMATION AND LOCATION ❑ Addition of new motor load of ❑'A "E ". "I- 2 ". '1.3". I o01IP or more. occupancy. Job no Job site address: ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: ❑ Ile.althtnre facilities. ❑ Supply voltage for more than ❑ hazardous locations. 600 volts nominal. Suite/bldg. /apt, no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: neseripuon 1 try. I Fee. I Tom I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. h. or less 168.54 4 Fat. add'I 500 sq. IL or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 residential (with above sq. 0,) Renewable Energy ❑ Sec Page 2 Services or feeders installation, alteration, and/or relocation ❑ PROPERTY OWNER J ❑ TENANT 200 maps or less 100.70 201 amps to 4110 amps 133.56 2 Name: 401 amps to 608) amps 200.34 2 Address: 601 amps to 1,000 mops 301.04 2 Over 1,000 amps or volts 552.26 2 City /State/ZIP: Temporary services or feeders installation, alteration, and/or Phone: ( ) Fax: ( ) relocation 200 wnps o1 less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps I68.54 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ❑ .APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with above service or feeder tee, 7.42 2 Business name: each branch circuit B. Fee for branch circuits without Contact name: service or feeder fee, first 56.18 2 branch circuit Address: Each add'l branch circuit 7.42 2 Miscellaneous (service or feeder not included) City /Stale /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67 -84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: ' ✓ ik r ' ' h Signal circuit(s) or limited - energy' See � .. � ie �C 1 t-. panel, alteration, or extension. Page 2 2 Address: I� --k,. 0\. ,,.,_\ \) tx\ei\_ itz.: Each additional inspection over allowable in any of the above ((),, � ( Additional inspection (1 hr min) 66.25/ ltr City/State/ZIP: `� , � 4I ("� 0 x ' 3 �" y `' Investigation (1 hr min) I 66.25/ hr Phone: (' 5 O'c�- (''I (1_ 1 /7, ml.Y' _ Fax: 1F (5 Q 2 `-I b. Industrial plant (I hr rain) 78.18! hr � , htspections for which no tee is 90.00/ hr CCB Lie.: 11% 6550 Electrical Lic.:CZ 02 Suprv. Lic.: 79 6, 5/ specifically' listed (%, hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature. required: L iiiw Subtotal: Print name: R ,'j A ' C t_-_Date: 1, t i,, Plan review (25% of permit fee): / S tate surcharge (12% of permit fee): Authorized signature: 1 'TOTAL PERMIT FEE: r -- — This perm application expires If a permit is not obtained within 180 Print name: 12 >(7t1 -- /�n��No ', ate: i:', 2 6 /� days after it has been accepted as complete. ey ' Number of inspections allowed per permit trnuncling 'Yttmun1CLC_PennluApp_Fi.R CRE.doe Rev O 5212013 4404613T(I 1.05 COM'WEn