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12860 SW BLUE HERON PLACE N 00 O O ' C .c cfl '1 h �D 12860 CW Blue Heron Place CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST, r SUP Received �3_ _.3 '7'Date Requested 21 y�� AM PM BUP Location (.P Suite MEC Contact Person '�%r� Ate¢_ Ph(_ ) 1��D — �/ 7 S PLM _ Contractor__�_ _ Ph(_�) SWR ILC' Tenant/Owner _ ,_— ELC rng Foundation ELC Ft ACC@38: r-, g Drain ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam _ t Shear Anchors -~ --- ---- Ext Sheath/Shear int Sheath/Shear - Framing _--- - Insulation Drywall Nailing - -_ Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - -- ------ - _-_-- Roof Other: ---- -- -- -- - PART FAIL -- -` --- -- IN Under Slab -. - Rough-In Water Service - Sanitary Sewer Rain Drains - Catch Besin/Manholo Storm Drain --- - Shower Pan Other: -- - ,S ' PART FAIL E :HANK Rough-In Gas Line Smoke Dampers -- - �- - (Final MT FAIL -- -------- _. - �_ Service `--- -- -- Rough-In UG/Slab ~- arm Reinspection fee of$- required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. P 4&S PART FAIL F] Please call for reinspection RE: -_ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date. _/C - - - Inspoctoll' -_ ittxt Other: _ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE METZ_GER ELECTRIC INC 8780 SW LEHMAN ST TIGARD, OR 97223 Electrical Signature Form Permit l: MST2003-00030 Data Issued- 2/20/03 Parcel: 2S103BC-09100 Site Address: 12860 SW BLUE HERON PL Subdi iision' BLUE HERON PARK Block: Lot: 008 Jurisdiction: TIG Zoning: R-4.5 Remarks: C Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrics 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,he work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received O\/YNER ELEC1 RICAL CONTRACTOR: WINDWOOD CONSTRUCTION METZGER ELECTRIC INC 12655 SW NORTH DAKOTA 8780 SW LEHMAN ST TIGARD, OR 97223 TIGARD, OR 97223 Phone #: 503-625-6526 Phone #: 244-9025 Req #: \11 1 1034 1.11 4h805 slip 3130S ELE 34-167C AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 08/09/200:3 1.1:18 FAX 5035798056 2004 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD.. OR 97223 IMPORTANT PERMIT NOTICE GREENWAY ELECTRIC COMPANY 15145 SW GULL DR BEAVERTON. OR 97007 Electrical Signature Farm Fermit#: MST2003-00030 Date Issued 2/20/03 Parcel: 2S1038C-03100 Site Address- 12860 SW F;L.UE HERON PL Subdivision: BLUE HERON PARK Block: Lot: 008 Jurisdiction. TIG Zoning: R,.4.S Remarks: Con3truction of SFA Your company has been indicated as the elec ical contractor forthe permit indicated above. In order for the elect:ical 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 ele+ctneal Inspections will tae authorized until this completed form is received OWNER ELECTRICAL CONTRACTOR WINDWOOD CONSTRUCTION, INC. GREENWAY ELECTRIC COMPANY 12.655 SW NORTH DAKOTA 15145 SW GULL DR TIGARD, OR 97223 BEAVERTON, OR 97007 Phone#. 50.3-62S-6526 hone#' 5G3-579-8054 Reg #: Lic 163421 ELL-' :14-617C SUP s0z5s AN INK SIGNATURE IS REQUIRED ON THIS FORM Sin ure o upery s ng-ST W an It you have any questions, please call 503.718.2433. t•n o rpt WTI gCNQ 0,rs gp ayx, Tg9CrZ9C0r JVa CT�TT NOW M'80.'a0 .1 < L MASTED PERMIT CITY Y O F TIGARD PERMIT#: MST2003-00030 DEVELOPMENT SERVICES DATE ISSUED: 2/20/03 13125 SW Haii Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 12860 SW BLUE HERON PL PARCEL: 2S103BC-09100 SUBDIVISION: BLUE HERON PARK ZONING: R-4.5 BLOCK: LOT: 008 JURISDICTION: Ili i REMARKS: Construction of SFA BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 27 FIRST: k,i5i of BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 40 SECOND: 739 sf GARAGE: 400 sf FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 TNnD at RIGHT: 00876. OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1690 of VALUE: 165, REAR: is PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN c 100K: 1 BOILICMP c]HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN>•100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MiSCELLr NEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 -200 amp. 0 -200 imp: W/SVC OR FDR: PUMPIIRRIGAT1ON: PER INSPECTION: EA ADD'L 500SF• 3 201 - 4OU amp, 201 - 400 amp: tat W/O SVCIF DR SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HMISVCIFDR: 601 1000 amp: 601+amps-10D0V: MINOR LABEL: 1000+ampivolt: PLAN REVIEW SECTION Reconnect or IV: >-4 RES UNITS: SVCIFDR>=225 A.: >600 V NOMINAL: CLS AREA/SPC OCG: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO A STEREO: x VACUUM SYSTEM: x AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: x OTH: ALL ENCOMP BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: x CLOCK: WSTRUMENTATION: MEDICAL: OTHR: HVAC: x DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,239.87 WINDWOOD CONSTRUCTION,INC. WINDWOOD CONSTRUCTION, INC. This permit c s l Co to the reyul R,S contained in the 12655 SW NORTH DAKOTA 12655 S W NORTH DAKOTA Tigard Municipal Code,Slate o OR. Specialty Codes and TIGARD,OR 97223 TIGARD,OR 97223 all other applicable laws. All work will be done accordance withapproved 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: 503-625-652b phone 903-780-4175 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0080. You Rea a LIC 50196 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Foundation Insp Footing/Foundation Dr; Electrical Rough In Exterior Sheathing Ins; Gyp Board Insp Sewer Inspection Post/Beam Structural PLM/Underfloor Framing Insp Low Voltage Firewall Insp Footing Insp Post/Beam Mechanica Mechanical Insp Shear Wall Insp Gas Line Insp Rain drain Insp Footing Insp Underfloor insulation Plumb Top Out Shear Wall Insp Gas Fireplace Water Line Insp Foundation Insp Crawl Drain/Backwater Electrical Service Shear Wall!nsp Insulation Insp Appr/Sdwlk Insp J Issued By : 'i i rr l `1 Permittee Signature Call (503) 639-4 75 by 7:00 p.m. for an inspection needed the next business day I CITYOF TI GA.RD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-00027 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/20/03 SITE ADDRESS; 12860 SW BLUE HERON PL PARCEL: 2S10313C-09100 SUBDIVISION: BLUE 11FRON IIARK ZONING: R-4.5 BLOCK: LOT: OOH JURISDICTION: Illi 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: SI,,Jen? Ctoti1�1?�Tim� F°R" Owner: P -- FEES _ WINDWOOD CONSTRUCTION Description Date Amount 12655 SW NORTH DAKOTA TIGARD, OR 97223 1SWUSA] Swr Connect 2/20/03 $2,300.00 1 SWUSA] Swr Connect 2/20/03 $0.00 Phone: 503-625-6526 1SWINSP] Swr Inspect 2/20/03 $35.00 �SWINSP] Swr Inspect 2/20/03 $0.00 Contractor: Total $2,335.00 Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days frc.n 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 not locatod at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If riot so located,the installer shall purchase a "Tap and Side Sewer" Perm IssuedY� Permittee Signature: Call (503)6394175 by 7:00 P.M. for an Inspection needed the next business day I rZr 2,//_e) 3 h?r Building Permit Application City of Tigard __, Date received: / / City ujTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 ProjecUappl.no.: Expire Phone: (503) 639-4171 )A N !I "j /U U 3 Date issued: By: Receipt no.: Fax: (503) 598-1960 ,;ITY OF TIGARD Case file no.: Payment type: � - Land use approval: -iin niNG DIVISION 1&2 family:Simple Complex: him 1 ;LJ f'&2 Ihmily dweNing or accessory ❑Commercial/industrial OMulti-family 0 New construction 0 Demolition Add it"Walteration/replacement U Tenant improvement U Fire sprinkler/alarm 0 Other:address: /t�8�t? �W w ail t (P Bldg.no.: Suite no.: : Block: _ Suhdivisiun: ,8 ue �n r Tax map/tax lot account no.:7,S/ 74 3y Project name to I Description and location of work on premises/special conditions: OWNFR 1 ' 1 Name: LtJ-+�J,O6-lft7IO e61AJSr2)toA_ (Flood plain,septic capacit Y.War,etc.) Mailing address: _ cu Ala.-,4i) •. aft 1 &2 family dwelling: City: r 0 ?/ Valuation of work........................................ $ G — Phone: _65;a(:;, Fa G E-mail: No,of hedrooms/baths...........�.................... .3_ 2- Owner's Owner's representative: /'r 12( R Total number of floors...........a�. .... ............. 1 L i Phone:dCe jlY1 Fax: E-mail: New dwelling area(sq. ft.) ...../.,#O......... /G 0 Garage/carport area(sq. ft.)..... .......... Name: a! Covered porch area(sq. ft.) ......rl�4............ Mailing address: Deck area(sq. ft.) ......................- ........... City: State: ZIP: Other structure area(sq.ft.)..........=.......... Phone: Fax: I E-mail: Commercial/industrial/multi-family: LUIL'IN LU Valuation of work........................................ $ Existing bldg.arca(sq. ft.) ...........I............. Business name: �M New bldg.areas ft. ' Address: ( q. ) ............ ........... .... City: State: ZIP: Number of stories.......................... .......... _ Type of construction................ ............... Phone: Fax: E-mail: Occupancy group(s): Existing: CCB no.: / New: _ City/metro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: A14 provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed. If die applicant is Cit / Statet�' ZIP: Q y exempt from licensing,the following reason applies: y: L Conti Plan no.: Phone: t/(r Fax;P,25'!)' JE-mail: Name: t,t W I Contact person. Fees due upon application $ Address: D Date received: City: / State -c ZIP: a1 & Amount received ......................................... E Phone: tr ,J Fax: -/iT E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Na all paiwkuao wcro cmdit c".Plew call puisdictlon for mom tnformatton. attached checklist.All provisions of laws and ordinances governing this t7 Visa o MasterCard work will be complied with,whether specified herein or not. Credlf card comber: _ Expkm Authorized signature: �- —'�Date: Nww of cwtwl et as dbown on cmdtt caro Print name: S CudhoWu d ure Amount Notice:This permit application expires if a permit is not obtained within 190 days after it hes been accepted as complete. 4164613(6VOCOM) One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: City r;fTipardt C>I' y of Tigard Associated permits:Address: 13125 SW Hall Blvd,Tigard,OR 97223 ❑Electrical El Plumbing O Mechanical ❑Other. Phone: (503) 639-4171 Fax: (503) 598-1960 Kola] , 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 platllot. — 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 0 permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 _L 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. I I Site/plot plan drawn to scale.The plan must show lot and building setback dimensioc,a;property comer elevations(if there is more than a 4-R.elevation differential,plan must show contour lines at 24 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, lurnbin 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 vlews.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,i,.dicating 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,"Engine r'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-piling schematic is required for four or more appliances. 22 Engineer's calculi itions.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in 91egon and shall he shown to he applicable to the project under review. 23 Five(5)site plans are required for Item I I above. Site plans must be 8-1/2"x I I"or I I" 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(&MCoM) Building Fixtures Plumbing Permit Application Received Pl° ' N umbing Date/By: City of Tigard Planning Approval Sewer Date/By: Pernut No 13125 SW Hall Blvd. Plan Review tither - - -- -- Tigard,Oregon 97223 Date/By: _ .Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use - Date/By: Case No.: Internet: www.ci.tigard.or.us Contact loris.: see Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Su icmental Information. TYPE OF WORK FEE*SCHEDULE fors ecial information use checklist New construction I ❑ Demolition Description I Qty. I Fee(ca.) Total Addition/alteration/replacement Other: New I-&2-family dwellings CATEGORY OF CONSTRUCTION includes 100 ft.for each u llity connection 1 &2-Family dwelling Commercial/Industrial SIR I bath 249.20 SFR 2 bath 350.00 OAccessory Building Multi-Family SFR 3 bath ^_ _ 399.00 Master Builder Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATIONand LOCATION Fire sprinkler-sq.ft.: Pae 2 Job site address: / 5 ,,, Site U tildes Suite#: Bld ./A to Catch basin/arca drain 16.60 Project Name: D Nell/leach line/trench drain 16.60 Footing drain no.linear ft.) Pae 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 i Sanitary sewer no.linear ft. Pae 2 _ Subdivision: _ Lot#: Storm sewer no. linear ft. Pae 2 #: Water service no. linear ft. Pae 2 Tax map/parcel Fixture or Item DESCRIPTION OF WORK Absorption valve _ _ It>.GO Backflow prevcnter _ Page 2 _ Backwater valve 16.60 Clothes washer 16.60 -- - --------- - -- Dishwasher 16.60 Drinking fountain 16.60 PROP Y OWNER I,0 TENANT Ejectors/sum 16.60 _ Name: _ Ex ansion tank 16.60 _ Address: _ Fixture/sewer cap 16.60 City/State/Zip: v — Floor drain/floor sink/hub 16.60 -- - Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 APPLICANT _ _LLJ CONTACT PERSON Ice maker 16.60 Name: _ _ Interceptor/grease trap 16.60 Address: - J Medical gas-value: $ Pae 2 Primer 16.60 Cit /State/Zi - _-- -- Roof drain commercial 16.60 Phone: _____ _i ax _ Sinktbasin/lavato 16.60 E-mail: Tub/shower/shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: 'P ,, (n E,t Water closet 16.60 Water heater _16.60 Address: lq) (T Yy) S P A Other: City/State/Zip: CLO Other: Phone: Fax: Plumbing Permit Fees* CCB h' b. Lic.#: .S f�' Subtotal S` -- Minimum Permit Fee$72.!0 S AuthoNze / Residential Backflow Minimum Fee 53 .25 Signa ?! t Signature: Date: 7 L O 3 Plan Review 25%of Permit Fee $ J _ State Surcharge 8%of Permit Fee S (P ca riot name) _ _ TOTAL PERMIT FEE S Notice: Thi,permit appliestion explrq Ira permit is not obtained within All new commercial buildings require 2 sets of plans with Isometric or 180 days after it has l,cen accepted as complete. riser diagram for plan review. •Fee methodology set by Tri-County Building Industry Service Board. iADsts\Permit PormsU'mPermitApp.doc 01103 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(es) Total Square Footage: Permit Fee: Footing drain-I"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-I st 100' 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service-1 st 100' 55.00 Medical Gas S stems: 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&pain Drain•each additional 100' 46.40 $51001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional 5100.00 or fraction thereof,to and Fixture or Item Qty. Fee(es) Total including$10,000.00. Commercial Back Flow Prevention Device 46.40 510,001.00 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 ins etions-pet hour 1 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and S 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*. Comments regarding fixture work: uanitl b (Flit re)Work Performed g g ltlxtltrieTop: Replace _ New Moved E:ddn Capped HaptistryfFunt - Bath -Tub/Shower -JacuzzVWhirl I Car Wash -Each Stall - -Drive Thru Cuspidor/Water Aspirator Dishwasher -Commercial _ _-Domestic Drinkin Fountain Eye Wash Floor Dmin/sink .2" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage -Domestic increase of sewer EDUs,a sewer permit will be issued and Disposal -Commercial -industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refri .Drains plumbing permit can be Issued. Oil Se orator Gas Station Ree.Vehicle Dump-Station Shower -Oang -Stall Sink -Har/Lavatory -Bradley -Commercial -Service swimmina Pool Filler Washer-Clothes Water Extractor Water Closet-Toilet Urinal Other Fixtures: i:tDstsTerrnit Forms\PlmPerrnitAppPg1doc 01103 NLY Electrical Permit ApplicationReceived — Electrical , Date/By: Permit No.: 67a;)r r0�(/ !(}' O>t Tl and Planning Approval Sign g 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 Date/By: Case No.: Internet: www.ci.tigard.or.us Contact Juns.: 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) _ 12 ew construction Demolition Service over 225 amps- Health-care facility commercial ❑Hazardous locdtion Addition/alteration/re lacement ❑Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, _ CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in T&2-Family dwelling Commereial/Industrial ❑System over 600 volts nominal one structure ❑Building over three stories ❑Feeders,400 amps or more Accessory Building Multi-Family ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder Other: ❑Egresstlighting plan ❑Other: JOB SITE INFORMATION and LOCATION Submit—sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: U .A.64� FEE*SCHEDULE Suite#: Bldg./Apt.#: Number of Ins ectlons per permit allowed Project Name: Description Qty Fee(ea,) Total Cross street/Directions t0 job site: New residential-single unit.Includes 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 Limited energy,residential 75.00 2 JJ Subdivision: fin Lo #: Limited energy,non residential 75.00 2 1 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: — -'- '- - 200 amps or less _ 80.30 2 __.__--- __--._---------- --- ----- 201 amps to 400 ams 106.85 2 401 amps to 600 ams 160.60 2 PROPERTY OWNER 10TENANT 601 ams to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: CLQ _ Reconnect only 66.85 2 Address: ,;�N S S Temporary services or feeders-Installatlon, alteration,or relocation: Cit /State/Zl : a,-- 200 amps or less _ 66.85 1 Phone: „�S=6S�G Fax: l to 60 P-- /)$�H� 201 a,ampsto 400 am 100.30 z APPLICANT CONTACT PERSON 401 to 133.75 z �►' Branch circuits-new,alteration.or Name: �� extension per panel: A.Fee for branch circuits with purchase of Address: _ service or feeder fee each branch circuit 6.65 2 C1ty�State/Zlp: 13.Fee for branch circuits without purchase of service or feeder fee first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 E-mall: Misc.(Service or feeder not included): CONTRACTOR Pach Lump or irrigation circle 53.40 2 -�- Each sign or outline lightina 53.40 2 Job No: Signal circuit(s)or a limited energy panel, Business Name: rZ r.a /fL alteration or extension site 2 2 D cription! Address: _ Cit State/Zi Each additional inspection over the allowable In an of the above: Per inspection pet hour min.1 hour 62.50 Phone: FaX' Investi ation fee: CCB Lie. #: other' Lic. #: _ Electrical Permit Fees* Supervising electrician Subtotal 5 signature re uired: Plan Review 25%of Permit Fee $ Print Name: 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 daps after it has been accepted as complete. *Fee methodology set by Trl-County Building Industry Service Board. (Please print name) is\Dsts\Permit Forms\ElcPermitApp.doc 01/03 i Electrical Permit Application - City of Tigard Page 2-Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems............................................................ S75.00 Check Type of Work Involved: EJAudio and Stereo Systems* ❑ Burglar Alarm garage Door Opener* Heating,Ventilation and Air Conditioning System* Vacuum Systems* Other COMMERCIAL WORK ONLY: Fee for each system......................................................... $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: Audio and Stereo Systems Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation HVAC Instrumentation Intercom and Paging Systems Landscape Irrigation Contr)l* ❑ Medical Nurse Calls Outdoor Landscape Lighting* Protective Signaling F-1 0111cr �_..— ------- --- Nunrher of Systems * No licenses are required. Licenses are required for all other installations I:'J)stslPcmit Fomu\ElcPertnitAppPg2.dm 01/03 Mechanical Permit Application Date received: 7Recipt i r City of 'Tigard Project/appl.no.: : CiryojTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issue no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT U 18r.2 family dwelling or accer-ory U Commercial/industrial O Multi-family El Tenant improvement (l New construction LJ Addition/alteration/replacemcnt U Other: JOB SITE I NFORMATION Q COMMERCIAL1SCHEDULE Job address: /A U Indicate equipment quantities in boxes below. Indicate the dollar Bldg,no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: QLS/ q,6 Lj`L 3 yaC� profit. Value$ Lot. Block: Subdivision: 'See checklist for important application information and Project name: k� �rti, car jurisdiction's tee schedule for residential permit fee. City/County: t ( ems I ZIP: 472,�LWWI 111211111 IN1 Description and location6f work on premises: 1 r e 1 Fee(m) Total Est.date of completion/inspection: 41ADesai car Qty. Res.only Res.only Tenant improvement or change of use: ham Air handling writ —CFM--- Is FM—,_Is existing space heated or conditioned?U Yes O No it conditioning(site plan required) Is existing space insulated?0 Yes ❑No Alteration of existing HVAC system 1 Boiler/compressors State boiler permit no.: Business name: ��rH.�jC �>�� Hp __Tons BTU/H Address: Rd 7 �ire/smoke dampers/duct smoke detectors City: ,t A GM State: IP: !!PX30 Heat pump(site plan required) Phone:,/, i7ax: I E-mail: nsta rep ace furac urer Including ductwork/vent liner I7 Yes O No CCB no.: �/b ,�. nsta replac re locate eaters-suspEnde . City/metro lie.no.: $`� wall,or floor mounted Name(please print): A Sd,1 Vent for appimance other than furnace e gera n: Absorptionunits _ BTU/H Name: SCt t' Chillers_ HP -- Compressors HP Address: _ omenta exhaust a rent too: City; Slate: ZIP__ Appliancevent Phone: Fax: E-mail: rye.�exhaust Hoods,Type U I Ures.kitchenthazmat hood fire suppression system Name: Exhaust fa;.with single duct(bath fans) _ tExhaust s stem a artrom heat n or AMailingaddress: �� rr � �. /}q p g ac st cat ou(up to out Cts) City: A2/3 ,,y State: e: LPG __ NO Oil Phone:Ga -bSXk4 Fax: -h additional over 4 outlets 7rocesspiping(schematicregwre ) Number of outlets Name: t er app •e or eq pment: Address: Decorative fire lace City: State: ZIP: nserl-type Phone: Fax: E-mail: woo&stov pe et stove Other; Applicant's signature: Date: Name(print): Na all juriadktlom accep credit cards,pleue call juriadictlon for mare infotmation. Permit fee.....................$ Notice:This permit application Minimum fee................$ U Vise ❑MasterCard expires if a permit is not obtained card number: _ __-L1— Plan review(at _ 96) $ Credit Expires within Igo days after it has been State surcharge(8%) ....$ Named t rbn u owon credit card f accepted as complete. TOTAL .......................$ Cardholder dp alure Amami 41b460(6MOCOM) /CAL PERMIT FEES CIAL FEE SCHEDULE: 1 8 2 FAMILY DWELLING FEE SCHEDULE: /_$25001 _UATION: PERMIT FEE: Description: Face Total .00 Minimum fee$72.50 Table 1A Mechanical Code Qb (tel Amt 10,000.GO $72.50 for the first$5,000.00 and 1) Fumace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents I t.00 fraction thereof,to and including 2) Fumace 100,000 BTU+ $10,000.00. including ducts&vents 1740 S25,000 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater _ $25,000.00. or floor mounted heater 1400 550,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 6.80 I fraction thereof,to and including 6) Repair units $50,000.00. 12'15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond fraction thereof. footnotes below. Comp •• Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit to 100K BTU 14.00 �- -- -- 8'/.State Surcharge $ T 8)3-15 HP;absorb 25 60 unit 100k to 500k BTU 25°/.Plan Review Fee( of subtotal 9)1530 HP;absorb 35.00 Requir^d for-ALL.commercial ermits onl) $ W unit.5.1 mil BTU 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ 52.20 unit 1-1.75 mil BTU ----- - --- -- --- -- - --- -- 11)>50111P;absorb unit>1.75 mil BTU 8720 ASSUMED VALUATIONS PER APPLIANCE: 12)Air dandling unit to 10,000 CFM 10.00 _ Value Total 13)Air handling unit 10,000(,FM+ Descn htlon: Qt _(Ea A_mo_unt _ 17.20 Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts&vents _ _ 10.00 Furnace> 100,000 BTU including 1.170 15)Vent fan connected to a single duct ducts&vents _ ____ Floor furnace_including vent 955 16)Ventilation system not included in Suspended heater,wall heater or 955 a lianceere reit 10.00 floor mounted healer - 17)Hood served by mechanical exhaust Vent not included in applicance 445 1000 permit 18)Domestic incinerators Repair units 805 1740 <3 hp;absorb.unit, 955 19)Commercial or industrial type incinerator to 100k BTU_ _ 69.95 3-15 hp;absorb,unit, 1.700 201 Other units,including woad stoves 101k to 500k BTU _ 1000 15-30 hp:absorb.unit,591k to 1 2,310 21)Cas piping one to four outlets mil.BTU _ 5.40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 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 _ 656 -- B•G State Surcharge $ Air-handling unit X10,000 cfm y 1,170 Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: s Vent fan connected to a sin le dud 446 Vent system not included in 656 _ - -- appliance Dermil __ Hood served by mechanical exhaust _ 656 Other n pection o and Fees: 1 Inspections outside of normal business hours(minimum charge-two hours) Domestic incinerator _ 1,170 $62 50 per hour Commercial or industrial incinerator 4,590 2 Inspections for which no.ee is specifically indicated (minim m charge half fmur) Other unit,including wood stoves, 656 $62 50 per hour inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum Gag I in 1 4 OUtlel3 360 charge-one-half hour)$62 50 per hour Each additional outlet 63 __- 'State Contractor Boiler Certification required for units>200k BTU. TOTAL COMMERCIAL "Residential A/C requires site plan showing placement of unit. VALUATION:__ _.__ All New Commercial Buildings require 2 sets of plans. t:tdstsVormsVnech-fees.doc 12/26/01 OST X030 7-A 3a et I✓1�I c.u�j r� rl r. • L �' � � LerhnF v 2�, c- J r 00 a, �d O C � o v � o U r o flu W o g 72 �-J W •3 l 0 � w � N ,