12840 SW BLUE HERON PLACE i
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12840 SW BWE HERON PL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503}639-4171
_ BUP
Received Date ReqUested_ _ AM _ PM — BUP
Location _____ A& -0 suite—_— MEC —_
Contact Person AS o Ph( ) �7�U- PLM _
Conti,%tor _ --_ Ph SWR _
Dl�w Tenan'JOt-rner _ ELC _—
Footing
Foundation Access: ELC
Ftg Drain ELR _
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors - -
Ext Sherth/Shear
Int Sheath/Shear -- ---
Framing - ---�-_-- _
Insulation
Drywall Nailing ---- -
Firewall ___-L/l/�1-
Fire Sprinkler �L ,L/�� _
Fire Alarrm l� (� U Shf
Susp'd Ceiiing
Roof
Other: -
ASS PART FAIL --
1 --
Post Beam -- - -- -- -
Under Slab
Rough-In
Water Service ------- _
Sanitary Sewer
Rain Drains ---- ------------
Catch Basin/Manhole
Storm Drain —--- - -- -
Shower Pan
Fin
A T FAIL -_ ----- - -
Post& Beam Y
Rough-In —
Gas Line
Smoke; ,inpers - —.---_-
na
J�FPIART FAIL ------- -- - --
L
Service - -- - -- —
Rough-In
UG/Slab -- -- --` - - -
Fire rm -
i ❑ Reirt;jeution fee of$-______required before next Ins
F PART FAIL 4 pection. Pay at City Hall, 13125 SW Hall Blvd.
_WE— --- [-I Please call for reinspection RE: E] Unable to inspect-no access
Fire Supply Line /
ADA Daft. ( �0 _ Inspector 1 Ext
_.
Approach/Sidewalk ----{-- _
Other:
Final DO NOT REMOVE this Inspection record from the fob eke.
PASS PART FAIL
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MASTER PERMIT
CITY OF TIGARD �
QEVELOPMENI SERVICES PERMIT#: 9/ -00355
DATE ISSUED: 9/118/038/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
SITE ADDRESS: 12840 SW BLUE HERON PL PARCEL: 28103BC-08900
SUBDIVISION: BLUE HERON PARK ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: T16
REMARKS: Construction of new SFA residence.
BUILDING
REISSUE: MAS4026 STORIES: 2 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED _
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,256 at BASEMENT: 01 I EFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SFA FLOOR LOAD: 40 SECOND: 554 at GARAGE: 319 of FRONT: 20 PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: 1 TRIM of RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 EDRM: 3 BAfH: 3 TOTAL: 1,812 of 175,180.50 REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATOR'rl 3 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS:
TUBISHOWERJ. 3 GARBAGE DISP 1 WA1 ER HEATERS: 1 WATER LINES: 100 BCKrLW PREVNTR: GREASE TRAPS:
MECHANICAL OTHER FIXTURES:
�- FUEL T I PES FURN<100K. BOILICMP c AHP: VENT FANS: 3 - CLOTHES DRYER: 1
GAS FURN>.100K: I UNIT HEATERS: HOODS: I OTHER UNITS: I
MAX INP: btu FLOOR. JRNANCES: VENTS: I WOODSTOVES: 0 GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR U--SS: 1 0 200 amp: u -2C0 amp: W/SVC OR FDR. PUMP/IRRIGATION: PER INSPECTION:
FA ADD'L SOOSF: .1 201 400 amp: 201 - 400 amp: 1 at WIO SVCIFDR: SIGNIOUT LIN LT: PER HOUR
LIMITED ENERGY: 401 600 amp: 401 bAU amp: EAADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM/SVCIFDR: 601 - 1000 amp: 801 aampo•1000v MINOR LABEL:
1000♦amplvoll:
Reconnect only: PLAN REVIEW SECTION
—4 RES UNrrs: SVCIFDR>•225 A: >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO III STEREO: FIRE ALARM INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: ALL•ENCOMP BOILER- HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,440.32
WINDWOOD CONF i RUCTION,INC. WINDWOOD CONSTRUCTION,INC. his permit is subject to the regulations contained in the
12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA Tigard Municipal Code,State o OR. Specialty Codes and
TIGARD,OR 97 223 TIGARb,OR 97223 all other applicable laws. 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 the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 401-625-6526 Phone: 503-625-6516 Oregon Utility Notification Center. Those rules are set
forth In OAR 952-001-0010 through 952-001-0080. You
Rog 0: LIC SO 196 may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Structural Mechanical Insp Sheaf Wall Insp Insulation Insp Water Service Insp
Grading Inspection Post/Beam Mechanica Plumb Top Out Exteri-, Sheathing In�r Firewall Insp Appr/Sdwlk Insp
Sewer Inspection Underfloor Insulation Electrical Service Low Voltage Rein drain Insp Flectrical Final
Footing Insp Crawl Drain/Backwater Electrical Reugh In Gas Line Insp Stnrm drain Insp Mechanical Final
Foundatl 4FtTiSj! PLM/Underfloor Framing Insp Gas Fireplace �r Line Insp Plumb Final
Issu 13y: lc. � `.��f?� Permittee Signature- —�
Call(503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
i
i
CITYo f TI GARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR21'03-00283
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/18/03
SITE ADDRFSS; 12840 SW BLUE HERON PL PARCEL: 2S103BC-08900
SUBDIVISION: BLUF Ill IMN 1),,\kK ZONING: R-4.5
B'_OCK: LOT: 006 JURISDICTION: T'IG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SFA dwelling.
Owner: — ----- -
___
WINDWOOD CONSTRUCTION, INC. FEES
DescriF�tion Date Amount
12655 SW NORTH DAKOTA _
TIGARD, OR 97223 [SWLISAJ Swi Connect 9/18/03 $2,400.00
1 SWUSA I Swr Connect 9/18/03 $0.00
Phone: 503-625-6526 JSWV,SPI S%%r Inspect 9/18/03 $35.00
.;WINSI'l Swr Inspect 9/18/03 $0.00
Contractor: L Total $2,435.00
Phone:
Reg#:
Required Inspections
This Applicant agrees to comply with all the rules .and regulations of file Clean Water Services. The permit expires X80
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is nel located at the measurement given, the installer shall prospect
3 feet in all directions from the distnnoe given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
r.
Issued by:,� r A +
(1 _ Permittee Signator
Call (503) 6331-4175 by 7:00 P.M. for an inspection needed the next business day
t
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Building Permit Application
Date received: - r� Permit no.p,c,!.7
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Prolect/appl.no.: Expire date:
Cityn/Tigard Phone: (503)639-4171Y Receipt Date issued: B �-
Fax: (503) 598-1960 Case file no.: Paymenttype:
I&2 family:Simple Complex:
U
' Land use approval: ._ -__ - p ICS p
Jd'f-&2 family dwelling or accessory U t'onunercial/industrial U Multi-landly U New construction U Demr lition
U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other:
job address: w If e-'O/k 77;
r (F Bldg.no.: _ Suite no.:
Lot: I Block: Subdivision: u� roe ., %� I:ix map/tax lot/account notes/Gt`JJL 3 y�
Project name:
Description and location of work on premises/special conditions:
Name: C G•• Q 1.US lin-- (Flood
Mailing address: r— cel /Vora -� e%c I &2 family d"elling:
City: r e('z Stat ZIP: Valuation of work........................................ $
Phone: . � JFa G E-mail: No.of bedrooms/baths...........;�.................... 3
Ow:der's representative: 0C.'Ar /1 A-t Total number of floors..........A.................. Z
Plume: 1Fax: E-mail: New dwelling area(sq. ft.) 2–
Gamge/carport area(sq. ft.)..... ..........
Name: �Q/h( Covered porch area(sq.ft.) ......!.fit!............
Mailing address: Deck area(sq.R.) ........... ............................
--_
City; State: IZIP: Oth;r structure area(sq. it.)......................... _ ---
Phone:
_Phone: I 1'. mail: Commercial/industrinUmulti-famit,
tNTIRAff OR Valuation of work.................................. �. $
Business name: Existing bldg.area(sq,ft.) ............... ........
New bldg.area(sq.ft.) .......
Address: -- ......
----------
City: State: (ZIP: Number of stories................... .............
Type of construction.........
_Phone: Fax: E-mail:
CCB no.: o/ Occupancy group(s): Existing:
New•
rily/metro tic. no.!
Notice:All contractors and subcontractors are required to he
t licensed with the Oregon Construction Contactors Board under
Name: a provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed. If the Address: �" w y}a j g� applicant is
Cit : < Stater! ZIP: Q .�ti exempt from licensing,the following reason applies:
Contact rson: �{/� Plan no.:
Phone:�� S �/ Fax Email:
Name: , Contact person: Pecs due upon application ........................... $
Address: – �7 Date received:
City: / State c ''p ),i/L Amount received ......................................... $
Phone: ,1V2 Fax: , E roan. Please refer to fee schedule. —
1 hereby certify i have read and examined this application and the Not all jurisdictions wcvN credit suds,plow call Jurisdiction for mote InfortnNion
attached checklist.All provisions of laws and ordinances governing this o visa U Mastercard
work will he complied with,whether specified herein or not. Credit card number:— Espl
res
Authorized signature- Date: _ Name or canWobkr as shown on ctrdit cud
Print mrne:_ _ .1 6
Cmdholder signature nmnun! -t
Notice:This permit application expires if a permit is not obtainad within 180 days after it has been accepted as complete. a fnJt.l i u,noR oM,
■
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
CitY nI 178 and Cit of Tigard Associated permits:
Y gi U Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
THE F011.11,01�11NG.1111.'MS ARE REQUIRED '
Land use actions completed.See.jurisdiction criteria for concurrent n•V icws.
Zoning. Mood plain,solar balance points,seismic soils designal ion,historic district.rt..
3 Verif ,alion of approved plat/lot.
4 hire 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 app'ication.
9 Erosion control U plan U 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 he completed
if copyright violations exist.
I I She/plot plan drawn to scale.The plan must;how lot and building setback dimensions;property corner elevations(if
there is more than a 4-11.elevation differential,plan must show contour lines at 2-11.intervals);location of easements and
driveway;footprint of structure(including decks);location of wv11,,septic systems;utility locations;direction indicator;lot
area;building coverage area;percentage of coverage;impervious atra;existing structures on site;and surface drtinage.
12 Fwtndation 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 hcater,
_ furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and deta0s.Show all framing-member sizes and spacing such as floor fivams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show
details of alt wall and roof sheathing,roofing,rool'slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thennal insulation,etc.
15 Eleva.lon 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-sine sheet addendums showing foundation elevations with cross references are acceptable. _
16 Wall bracing(prescriptive path)a-d/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysts provide speciti:...,ions and calculations to engineering standards. _
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
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 rode design values for all heams and multiple joists
over 10 feet long and/or any hearn/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 he stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review,
23 Five(5)site plans are required for Item 1 I above. Site plans must be 8-1/2"x 11"or 11"x 17".
24 Two(2)sets each are required for Iit ins 16, 19,20&22 above,
25 Building plans shall not contain red lines or tape-ons. "Mirrom-d' building plans will K, 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 applicaole),and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans m:.y be in blue or black ink.
Red ink is reserved for department use only. .40.4614(WEICOM)
Electrical Permit Application
Date received: Pennit no.:
City of Tigard Projecl/appl.no.: Expire date:
t tit„/Tib ,td Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued. By: Receipt no.:
Fax: (503) 598-1960 Case rile no.: Paymenttype:
Land use approval:
Mallunfiountiol
;adudress:
amily dwelling or accessory U Commercial/industriai U Multi-family U'Tenant improvement
onstruction U Additi,)n/alteration/replacement U Other:_ U Partial
I►( 4 K Bldg.no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision: --
Project name: OILq, ,,vjQN0_ I Description and location of work on premises:
Estimated date of completion/inspection
CONTRA(IOR.APPLICATION FIEV80WDULE
Job no: Fee toes
BUSLICSa name: t _ Ikscription _ (lr,. (ea.) load no_insp
L -- New rvshdential-single or multi fnmily pct
Address: �t1 - dwelling unit.Includcsattachedgarage.
City: 723 et CjSlate• r— jZlP4,i4t?-7 Servidrincludel:
Phone: a t/ Fax: E-mail: Irniu sq.It.or less 4
` U — Each additional 500 sq,ft.or portion thereof
CCB no.: S ;Z Elec.bus. lic.no: � Limited energy,residential 2
City/metrolic.no.: - _ Llmitedcnergy,non-residential 2
Each manufactured home or modular dwelling
Si natur f supervising electrician(rc uired) pate Service and/or feeder 2
Sup.elect,name(print): License no: _ Services or reeders-Installation,
alteration or relocatlon:
200 amps m less 2
Name(print): �'li ,�r/sGt/�0. � Al" 201 amps to 400 amps 2
Mailing address; 401:amps to 600 amps 7
601 amps to 1000 amps
City: t -Z State:G^I ZI I,' J Over 1000 amps or volts 2
Phone: o f6-V Fax: Gnlall; Reconnect nnly 1
Owner installation:The installation is being made on prolx:ny I own Temporary services or feeders- -
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrelocation:
ORS 447,455,479,670,701. 200 amps or less
201 amps to 400 amps
iiiaban
— — Date: 401 to 600 amps ---- -
Stanch circuits-new,alteration,
or extension per panel:
NamC: A. Fee for branch circuits with purchase of
Address: service or feeder fee,each brm;ch circuit
— -- -- — --
City: Stale: ZI B. Fee for branch circuits without purchase
-`— — of service or feeder fee,first branch circuit
Phone: I F. maul: F nth additional branch circuit
Mtsc.(Service or feeder not included):
UServiceover225amps-comu;,,;;inl Jlfeulthcnrefacility Each pump orirrigation cucle - _ 2
UService over 320amps-ratlagof1&2 U Hazardous location Each sign or outline lighting 2
familydwriting$ U Building over 10,000 square feet four or Sigralcircuit(s)nralimited energy panel.
U System over 600 volts nominal more residential units in one structure alteration,or extension* _ 2
U Building over three.stories U Feeders,400 amps or more 'Description:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional InspWlon over the allowable In any of the above:
U hgress/lightingplatt U Other: __— per inspection
Subndt_sets of plans tth any of the above. I Imestiation fec
The above are not applicable to temporary construction service. other
Not all jurisdictloru accept credit cards,pleae cs 11 judutiction for olote information. Notice:This permit application Permit fee......... .........$
U visa U MasterCard expires if a permit is not,)btained Plan review(at _ %) S
Credit card number _� [� within I RO days after it has been State surcharge(8%)....$
spires
cardhot—ushown on t c accepted as complete. TOTAL .......................$
—Flame of -
_ S
Cardholdef signature Amount
440-4615 1610aTbMI
9;
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee � chedule Below: Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Res!dential-per unit
1000 sq ft.or less $145.15 _ 4 ❑ Audio and Stereo Systems'
Each additional 500 sq.ft.or
portion thereof $33.40 _ ❑ Burglar Alarm
Limited Energy — $75.00
Each Manufd Home or Modular ❑ Garage Door Opener'
Dwelling Service or Feeder $90.90_
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 _ 2 Vacuum:systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $180.60 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,afteration,or relocation Fee for each system.......................................................... $75.00
200 amps or less $66.85 (SEE OAR 918-260-260)
201 amps to 400 amps $100.30
401 amps to 600 amps $133.75 ) Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
sae"b"above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
Now,alteration or extension per panel
d)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder!ae.
Each branch circuit _ $6.65_ _ 2 ❑ Data Telecommunication Installation
b)The fee for hrdnch circuits
without purchase of service ❑ Fire Alarm Installation
or!eater fee.
First Branch circuit $46.85 ❑
Each additional bunch circuit $6.65_ HVAC
Mlsenilaneous ❑ Instrumentation
(Service or feeder no'include:)
Each pump or irrigall In circle _ $53.40 Intercom and Paging Systems
Each sign or oullinb,ighting _ $53.40
Signal circuit(",)or a limited energy
panel,alteration or extension $7500 ❑ Landscape Irrigation Control'
Minor Labels(10) _ $125.00 _
Each additional Inspection over F-1 Medical
the allowable in any of the above
Per inspection _ $62.50 ❑ Nurse Calls
Per hour _ $62.50
In Plant $73.75 ❑ Outdoor Landscape Llghtlno'
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8%State Surcharge $ _._ _ � Number of Systems
25%.Plan Review Fee
No licenses are required Licenses are required for all other installations
See"Plan Review"section on $
front of application
Fees:
Total Balance Due $
Enter total of above fees $ _
El Trust Account#__. 8`/.State Surcharge $
Total Balance Due =
All New Commercial Buildings require 2 sets of plans.
0dsts\formsklc-fees.doc 08130/01
Mechanical Permit Application
Date received: Permit no. _oma?tFj
City Of 'Tigard Project/appl.no.: Expire dole:
cirynfngard Address: 13125 SW Hull Blvd,]igard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
U 1 &2 family dwelling or accessory U Commercirl/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacemcni U Other:
JOB SITE INFORMATION1
Job address: ke lkryn AN,t Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: I Suitc no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: t- 3 yo profit.Value$
Lot: Block: Subdivision: Blke Ilea,,v 'See checklist for important application information and
Project name: 161tte, kms, ct.4 jurisdiction's fee schedule for residential permit tee.
City/county: bVciS, ZIP: 6, ),a.
Description and location,6f work on premises: _ r1010 10 1 N A ULI FA I i 111111.3110111gli
Fee(ea.) Total
Est.date of completion/inspection: Description Qty. Res.only Res.onl
Tenant improvement or change of use: Air handling unit . CFM
Is existing space heated or conditioned?U Yes U No r conditioning(etre plan require ) _
Is existing space insulated?U Yes U No I Alteration of existing HVAC system _
1 o er compressors
Business name: /C State boiler permit no.:
HP Tons BTU/H
AddFire/smoke dampers/duct smoke detectors
City: ,,.-Yf l GM State.• .?IP: Gf�'/J eat pump(s to p an requ'-c ) _ _
Phone:Gy,-3rFax: E-mail: nsta rep ace urnoce�iutner
Including•:uctwork/vent liner U Yes U No _
CCB no.: //b y1 / — nsta rep ace re locate heaters-suspen e , —
Cit /metro lic.no.: .5-0,sk"{f — wall,or floor mounted _
Name(please print): Vent for ap lance other than furnace
Refrigeration:
Absorption units BTUIH
Name: -.5o Ir <- Chillers— HP
Address: Com ressots HP
nv onmenta ex ust
and—ventilation:
City: Slate: ZII'' Appliance vent _
r-- — —
Phone: _ Fax. l n,. ; )ryerex gust
o s, ype / res. tc a azmat
hood fire suppression system
;Ne W tum S Exhaust fan with single duct(bath fans)
g address: � 7 cJ , A A/ec,jW .x aust s stem a art rom eaten orCi CC
/12/) state:a,/` ZIP: ,)a3Fue p p ngen st ut on(upto out ets)
Type: LPO NO Oil
�� 6 G Fax: �,� - E-mail: uc l to eac a itiona over out etsrocess p p ng(sc emat c requ re )Number of outlets
ter st_ appliance or e�qu pment:
ss: _ Decorative fireplace
City: State: ZIP__ nsert-type_ -- _
Phone: Fax: E-mail; oo stov pe etstovc
Other:
Applicant's signature: Date: t n;
Name(print):
Not v1 juriadkaon.occept credit code,pleu�call)tniseiction r«more Irtformuion. Permit fee fee
................$
❑Vice CI MasterCard Notice:This permit application Minimum fee................$
expires if a permit is not obtained plan review(at _ %) $
Credit card number: ------ x Re within ISO days after it has been --
— accepted as complete. State surcharge(896)....$
- i-_
Nuns of c r u shown on credit cud S P P
TOTAL .......................$
-- Cudhdder el`pion — -- Ae►ouot 440-4617(61WICOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1 00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Cade Oty (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
$10,001.0( to$25,000.06 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or Including vent 1400
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$100A0 or 6.60
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: Boner Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
_ fraction thereof. footnotes below. Comp ••
Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit
to 100K BTU 14.90
8%State Surcharge $ 8) 15 absorb
unit 100kk to 500k BTU 25.60
t t
25%Plan Review Fee(of subtotel) 9)15-30 HP;absorb
35.00
Required for ALL commercial permits onlys unit,5-1 mil BTU _
TOTAL COMMERCIAL PERMIT FEE: S unit 3-1.7 mi absorb 52.20
unit 1-1.75 mil BTU
11)>50HP;absorb
unit>1.75 mil BTU 67.20 _
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00
Value Total 13)Air handling unit 10,000 CFM+
sc
Deription: Ot Ea Amount _ 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
duds&vents 10.00
Furnace>100,000 BTU Including 1,170 15)Ven'fan connected to a single duct
duds&vents 6.60
Floor furnace Indudinp vent _ 955 16)Ventilation system not Included In
Suspended heater,wall heater or 955 a ilance permit 10.00
floor mounted heater --- 17)Hood served by mechanical exhaust
Vent not Included In applicance 445 10.00
permit 18)Domestic Incinerators
Re air units 805 17.40
<3 hp;absorb.ultit, 955 19)Commercial or Industrial type incinerator
to 100k BTU 69.95
3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves
101k to 500k BTU 10.00
15-30 hp;absurb.unit,501k to 1 2,310 21)Gas piping one to four outlets
mll.BTU 5A(1
30.50 hp;absorb.unit, 3,400 22)More than 4-per outlet(rich)
1-1.75 mil.BTU _ 1.00
>50 hp;absorb,unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU _
Air handling unit to 10,000 cfm 858 _ 8%State Surcharge $
Air handlin unit>10,000 cfm 1,170
Non-portable evaporate cooler 656 - TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single dud 446
Vent system not included In 658 1 _
a Imp lance permit
Hood served b mechanical exhaust 858 Other n paectiona and Fees:
1 Inspections outside of normal business hours(minimum charge-Iwo hoLra)
Domestic Incinerator 1 170 $62 50 per hour
Commercial or Industrial Incinerator 4.590 2 Inspections for which no fee is specifically Indicated (minimum charge-half hour)
Other unit,indur"^g wood stoves, 856 er hour
3 Additions rplan review required by changes,additions or revisions to pians(minimum
Inserts etc. charge-one-half hour)$82.50 per hour
Gas piping 14 outlets 360
Each additional outlet 63 --. *State Contractor Boller Certlflcation required for units 3-200k BTU.
TOTAL COMMERCIAL S "Residential A/C requires site plan showing placement of unit.
VALUATION: _ All New Commercial Buildings require 7 sets of plans.
IAdsLa\forms4nech-fees.doc 12/26/01
Plumbing Permit Application
Datereceiveu: Permit no.:M,�-Fragv3–xp
City of Tigardl
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.:
—
CityojTigavJ phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: 1503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Casc file no.: Payment type: 4
U 1 ": fmily dvielling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U idew construction U Addition/alteration/replacemeni U Food service U Other:
Job address: �.�f L.t1�' j t cJ ii ; ^ / 1 Description Qty. Fee(ca.) Total
Bldg.no.. Suite no,: New 1-and 2-family dwellings only:
(Includes 100 B.for each utility connection)
Tax map/tax lot/account no,: SFR(1)bath
Lot: IBlock: I Subdivision: SFR(2)bath
Project name: t�c e,t4pj 7►– SFR(3)bath
City/county: ZIP: ;l 3 Each additional bath/kitchen
Description and I ation of work on premises: Site utilities:
Catch basin/area drain
Est.d tie of completion/inspection: Drywells/leach line/trench drain
t Footing drain(no. iin.ft.)
Manufactured home utilities _
Busintss name: A Manholes _
Address: 6 /�, Rain drain connector
�)
City: ,^e r eA Stateiiii',r, ZIP: 2 Sanitary sewer(no.lin.ft.)—_T
Phone: '� „Z– , Fax: I E-mail: Storm sewer(no.lin.ft.)
CCB no.: _ Plumb.bus.reg.no: Z
Water service(no.lin.ft.)
City/metro lie.no.: Fixture or Item:
_Contractor's representative si ,nature: Absorption valve
Back flow reventer _
Print name: t _, �- f�atr Backwater valve
Basit)s/lavalory
Nome: Clothes washer
Add--ss: Dishwasher 1
Drinkingfountain(s) 1
City: _ State: Z111 Ejectors/sum
Phone: '3 qj - p Fax: E-mail: Expansion tank _
Fixture/sewer cap
Name(print):
LU-}h/rOG.drJA Floor drains/floor sinks/hub
Garbe a disposal _
Mailing address: �J_�ll� ^a��t r Hose bibb _
City: n tiWrl I State: ZIP: Ice maker
Phone: VFax: I E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primera►
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on the property I own as per ORS Chapter 447. Sinks s), asin(s),lays(s)
Owner's si nature: Date: Sum
Tubs/shower/shower pan
Name: Urinal
—_.— _— Water closet _
Address: _ Water heater
City: _ State: ZIP:_ Other:
Phone: Fax: E-mail Totld
Not sit Juriedkdom.wept credit cede.please cdl Jurbdiction row mere IMarmaaon. Notice:This permit application Minimum fee................$
U Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $
Credit erd number:. —.-/ 1.— within 190 days after it has been State surcharge(8%)....$
F:xpitce
Name of cerdholdn u dawn on nedll cwd
accepted&%complete. TOTAL .......................$
S
CardMAder ssiigmium AawW 440-4616(60WOM)
1
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-ramlly dwellings only:
FIXTURES (individual) QTY ea _AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink — 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 — for each utilityn
conection _
____ _ One 1( )bath _ $249.20
., —�
Tub or Tub/Showeromb. 16.60 Two(2)bath _ $350.00
Shower Only 16.60 Three r3 b) ath $399.00
Water Closet 16 1.0 ——_ SUBTOTAL _
Urinal 16.60 _ 8%STATE SURCHARGE
Dishwasher 16.60 PLAN^EVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 __ -- TOTAL
Laundry Tray 1660
Washing Machine 16.60 —
Floor Drain/Floor Sink 2' 16.60 —
16.60 - PLEASE COMPLETE:
4" 16.60 �--
Water Heater O conversion O like kind 16.60 Quantic b Work Performed_
Gas piping requires a separate mechanical Fixtur,,Type: New Moved Replaced Removed/
ermit _ — _ _— Capped
MFG Horne New Water Service4 46.40 Sink -- -- —_
MFG Home New San/Storm Sewer 46.40 Lavato _-
-- Tub or Tub/Shower—
Hose Bibs 1660 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16,60 Water Closet
-- Urinal _
Other Fixtures(Specify) 16.60 Dishwasher —
Garbage Disposal
-
Laundry Room Tray
--- -- --
Washing Machine
Floor Drain/Sink: 2"
Sewer—,st 100' 55.00 -- 3.,
Sewer-each additional 100' 46.40 4" —
Water Sorvice-ls1 100' 55.00 Water Heater _
Water 6,Service-each additior al 200' 4 40 — Other Fixtures
-- (Specify —
Storm&Rain Drain-1 st 100' .55.00
Storm&Rain Drain-each add".ional 100' 46.40
Commercial Back Flow Preverdi,3n Device 46,40 — — --
_Residential Backflow Prevention Device' 27.55
Catch Basin ;F65
t_
Inspection of Existing Plumbing or Specially
Requested Inspectluns -- — COMMENTS REGARDING ABOVE
Rain Drain,single family dwelling Grease Traps -- --- ---- —
QUANTITY TOTAL
Isometric or riser diagram Is required if _
uo—fity Total Is >9 --� _--_-- —
_.— — *SUBTOTAL --------- — —
8%STATE SURCHARGE --- — ---
"PLAN REVIEW 25%,OF SUBTUTAL -
Required only If fixture qty total Is>9
'Minimum permit fee Is$72.50.8%state surcharge,except Residential Backflow
Vreven'lon Device.which Is 636 25-8%state surrharge
..All New Commercial 8, lines require 2 sets of plans with Isometric or riser
diagram for plan review.
I:1Jsts\formS\plm-fees.doc 12/26/01
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73 ,30/47
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4TVI
CITTGARD.SITE PLANItFN'IFW
T NO.: _ (W
ION: y 5 p D
V3Approved [1 Nut ApprovedSt eet Side: �_;crape: -A? Rear: J;j _
Visual llearance: Ali roved ❑ Not Approved
N4iirirntill, Building Fleight. feet
CWS Service Provider Letter Requi,ed: ❑ Yes No
fiv: ' U Received
A��� Craw - o I,�itc; 3
LN(,INCL-I NC; t)EPAItTN1EN"1 :
Actual Slopc:d % 05Approved ❑ Not Approved
Site Plan:
13 p Approved okf Approved
1+�6-- Date: L=� es
Notes: