The URL can be used to link to this page

11685 SW NICOLI PLACE J CD GO Ul S) G z F• O 01 n 11C385 SIN Nicoll Place / \ CITY OF TIGARD PLUMBING PERMIT / PERMIT#: PLM2003-00322 DEVELOPMENT SERVICES DATE ISSUED: 7/3/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110BD-08700 SITE ADDRESS: 11685 SW NICOLI PL ZONING: R-4.5 SUBDIVISION: EDWARDS PART/MLP2000-00010 JURISDICTION: TIG BLOGK: LOT: 003 _�—.-------- – —_ S: SPACE CLASS OF WORK: OTR GARBAGE DISPOSALS: BACKFLOW MOBILE HOME E SPACES: TYPE OF USE: SF WASHING MACH: FLOOR DRAINS, TRAPS: OCCUPANCY GRP: R3 WATER HE/.TERS: CATCH BASINS: STORIES: 5F RAIN DRAINS: FIXTURES LAUNDRY TRAYS: ------ URINALS: GREASE TRAPS: SINKS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: it WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: it Remarks: install irrigation backflow preventer. FEES Owner: _ Description Date Amount VASIL(. ` EPA �I'Ll �1BI Permit I-ce 7/3/03 $36.25 12425 NW BARNES RD.#99 1A N 1 x titatc fas 7/3/03 $2.90 PORTLAND, OR 97229 Total $39.15 Phone : 503-o44-4080 Contractor: OWNER REQUIRED INSPECTIONS RP'Backflow Preventer Phone : Firal Inspection Reg#: This permit is issued subject to the regulations contained in the Tigard Muni-ipal Code, State of OR. Specialty Codes and all other applicable laws. All 4 will hp clone in accordance with approved plans. This perp-tit wit! expire if work is not stp.,ted within re0 dou to follow rules adopted by the Or gran ays of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law req y Permittee Signature: Issued By: '[, lt. l*.r.t��c:a.- �t_ Call (503) 639-4175 by 7:00 P.M. for an inspectionneeded the next business day Hullaing t' ixtures Piumbinp, Permit Application 77— Plumbin - PermitNo!1hof - jCit Of rl ar(1 Sewer yg Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223Date�3y: ____ Permit No.: Phone: 503-639 4171 Fax: 503-59,811960 Date/1eview Land Use etc/Fl . Case No.: Internet: www.ci.tigard.onus contact -— -"- Juris.. see Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: '�G1 Supplemental Information._ f TYPE OF WORK _ FEE*SCHEDULE(for sprelal information use checklist New construction I ❑ f DemolitionDescriI tion Qr>• _F'ce(ca.) Total Addition/alteration/replacement ❑ Other: _ New I-&2-family dwellings Includes 100 ft.foreach utilityn conection CATEGORY OF CONSTRUCTION SFR j 1 & 2-Fadwelling I bath 249.20 _ mil LJ _ �—��in Commercial/Industrial— SFR 2 bath 350.00 Accesso Buildin Multi-Family SFR 3 bath 399.00 L] Master Builder _ Other: _ Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Firesprinkler- ft.: Pae 2 Job site address: / ` 5 JI I�0 L / I L Site Utilities Suite M Bid ./Apt.#: Catch basin/area drain 16.60 Pro'ect Name: q )1 / f•q Dr cll/leach:ine/trench drain 16.60 _ Footing drair.(no.linear ft.) Pae 2 _ Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes _16.60 Rein drain connector 16.50 -- Sanitary sewer(no.linear ft.) Pa c2 Lot#: _ Storm sewer io.linear fL _ Pa e 2 Tax map/parcel #: Water service no. linear R I Page 2 — _ Fixture or Item DESCRIPTION OF WORK Absurpdon valve 16.60 Backflow preventer Pae 2 Backwater valve �__---- 16.60 _ — __-- - ------_.._.-- Clothes washer -- _ 16.60 ------- Dishwasher _ W60 Drinking fountain 16.60 10 TENANT_ _ Ejectors/sump16.60 Name: 6A Expansion tank 16.60 _Address: VI . � /Yg, �� 1�Y Fixture/sewer ca 1`.60 Cit /state/Zl / , Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 PhoFax: Hose bib 16.60 _APPLICANT CIJ_NTACT_PERSON Ice maker 16.60 Name: Intcrcc tor/ reasc trap 16.60 Address: Medical gas-value: S Y Page 2 _ City/State/Zip: _ --- Primer _16.60 _— — _— Roof drain(co m' 16.60 Phone: Fax Sink/basin/lavatc — 16.60 E-mail: Tub/shower/shoµ _ 16.60 CONTRACTOR Urinal 16.60 Ftusiness Name: ( /l Water closet 16.60 i --- - - -- - Water heater 16.60 Address: other: __-- Cit��/State/Zip: - Other: Phone: Fa_x: PlumbingPermit Fees" Subtotal S _ Plumb. LiC.#: Minimum Pcnnit Fcc$72.50 S v� Authorized Residential Backflow Minimum Fee$36.25 A- Signature: S Dater_2_0 Plan Review(25%of Permit Fee) / State Surcharge(8%of Permit Fee) S (Please print nan,c) TOTAL PERMIT FEE S _ Notice: This permit application expires If a permlt Is not obtained within All new commercial buildings require 2 sets of plans with isometric or Igo clay%after It has been accepted as complete. riser diagram for plan review. "Fee methodology set by Tri-County Building Industry Service floard. i'.Osts\Petmn FormsV'ImI'ermuApp.doc 01103 Plumbing Permit Application -City of Tigard Page 2 - Supplemental Information Fee Schedule: _ Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total _S u� are Fuole: Permit Fee__—� Footing drain- I" I(N)__- — 55.00 — 0 to 70(10_ _ $11500 — Forting drain-each additional 100' 46.40 2,001 to 3 600 $160.00 _ 3,601 to 7,200 $220.00 _ Sewer-tat 100' 550) 7,201 and renter — — $309.00 Sewer-each additional 100' 46.40 Water Service" tat 100' _ 55.00 Medical Gas S stems' Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain• Ist 100' 55(N) S1 00 to SS,o00.00 Minimum fee$72.50 Storm&Rain Drain-each additional KV 4040 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each Fixture or Item Qty. Fee(ea) Total additional 5100.00 or fraction thereof,to and including 510,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to 525,000.00 $149.50 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,O0000. Rain Drain,single family dwelling 65.25 $250)1.00 to$50,000.00 5379.50 for the first$25,000.00 and 51.45 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.St] $50,(NI I '10 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 re port fixtures could result in increased sewer fees*. Quantity b Fixture Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved F.:Iclln (.'a ped_ --- — Ra list /Pont — Bath -Tub/S ower -Jacuzzi Whirlpool Car Wash -Each Stall •Drive Thru Cuspidor/Water Aspirator Dishwasher -Commercial -Domestic — -- - —" Drinking Fountain ---- 1'. c Wash — -- — — --- -- Floor Dram/sink •21, 3.. — -- ------ Car Wash Drain -- *Note: If the fixture work under this permit results in ao Garbage -Domestic __— Disposal -('ommcrr.iei increase of sewer EbUs,a sewer permit will be issued and Industrial _ fees assessed for the sewer increase must be paid before the Ice Mach./Rem .Drains _ plumbing permit can be issued. Oil Separator Gas Station Rec.Vehicle Dump Station Shower -Gang -Stall Sink -13or/Lavatory -Bradley -Commercial -Service _ Swimming Pool Filter _ Washer-Clothes Water Extractor Water Closet-Toilet Urinal _ Other Fixtures: i:\DatsWermit Fomu\PlmPermitAppPg2.doc 01/03 ELECTRICAL CITYOF TIGARD RESTRICTED ENERGY RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2002-002763 fma 13125 SW Hall Blvd., Tiqard. OR 97223 (503) 639-4171 DATE ISSUED: 12/3/02 PARCEL: 2S110BD-08700 SITE. ADDRESS. 11685 SW NICOLI PL SUBDIVISION: EDWARDS PART/MLP2000-00010 ZONING: IG BLOCK: LOT: 003 JURISDICTION: TIG TIG Proiect Description: Low voltage: All encompassing. A.RESIDENTIAL _—` B.COMMERCIAL__ — AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: X BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: X CLOCK: MEDICAL: HVAC: X DATA/TELE COMM: NURSE CALLS VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNA'... INS rRUMENTATION: OTHER: TOTAL#OF SYSTEMS: ____.___ Owner: Contractor: VASIL GHEPA OWNER 12425 NW BARNES RD.!4()9 PORTLAND, OR 97229 Phone: 503-644-4080 Phone: Reg#: —� FEES Required Inspections Description Date Amount Low Voltage Inspection Elect'I Final �I I PRNl'1 I I,I'R Permit 12/3/02 $75.00 I A X 19""state"Tux 12/3/02 $6.00 Total $81.00 This Permit is issuers subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and al!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 work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throuc Issued by _iz Permittee Signature. atif'� Ic OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: fit CONTRACTOR INSTALLATION ONLY SIGNATURE OP SUPR. ELEC'N — __ DATE:_ LICENSE NO: — ---- _ Call 639-4175 by 7:00 P.M. for it, 'nspection needed the next business day Electrical Fernnit Application -- Datereceived: 0A,7,_0.1- Permit no.: 0-00 (, City Of Tigard � v Pro)ect/appl.no.: Expire date: Address: 13125 S• I tall Blvgi4AP 97�P Date issued: By:� Receipt no.: CitynjTigard Phone: (503) 639-4171 Case file no.: Payment type: Fax: (503) 598.1960 DEC o 1002 Land use approval: _—ejTV r.&RD - 1 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacenicnl 'J(Wwr ❑Partial 1 1 r ' bldg.❑o.: Suite no.: ITax map/tax lot/accoun:no.: Joh address: _ LAW Block: Subdivision: Q 10 7 - Project name: Description and location ot work on premises: Estimated date of completion/inspection t 1 it i 1 ' 1 it' 111Ax Job no: 11 Iy Lit_ W-scriplion Qty. 0.0 Total no.ins —,---- Business name: New resldenllAl-slnl;k or malil-fantils per Address: dwelling unit.include-,nu ached garage. City: Slate: ZIP: Service included: — 1000 sq.ft.or less 4 Hone; Fax: E-mail: Each additional 500 s .ft.or union r roof CCB no,: Elec.bus.lic.no: Limited energy,residential 2 City/metro lie.no,: Limited energy,non-residential 2 Each manufactured home or modular dwelling 2 Service and/or feeder Date Signature ol'su rvisln electrician(re uirrd) Ierrlcesorfecders-itrsdllatlon, Sup.elect.name(print): License no: ■Betatron or relocation: W till 200 amps or less 2 2 201 amps to 400 amps Name(print): /1 401 amps to 600 amps 2 Mailing address: t J I/f 601 amps to 1000 amps 2 City: 11 ( 1/1 State: VP ZIP: Over 1000 amps or volts 1 Phone: j P, 4 IJ V 11, / Fax: E-mail: Reconnect onl 7'emponry services or feeders- Owner installation:The installation is being made on property I own inopliallon,dterallon,orrelocation: which is not intended for sale,lease,rent.or exchange according to 2t10 all,ps or less 2 ORS 447,455,479,670,701. 201 amps to 4(0 amps 2 ., • 2 Owner's si nutui cbate: L� l'C L 401 to 600 amps ftranch circuits-new,alleralion. ar extension per panel: Nat11e: A. Fce for branch circuits with purchase of 2 service or feeder fee,each branch circuit Address: R. Fee for branch circuits without purchase IIP' of service or feeder fee,first brunch circuit: 2^ Phone: Fax: tiulil F ch additional branch.ircuit: Misc.(Service or feeder not Included): 2 Each ump or irrigation circle O Serviaover 225amps-txnnn,crciul U HcaI11,•carefaclhly tiachsignoroutlinelightin� 2 O Service over 320 amps-rating of 1&2 U Hazardous location Signal circuit(s)or o limned energy panel, family dwellings U Building over I0,(MN)square feet four or Bna2 U System over600volts nominal more residential units in one structure alteration,atex•en-'an• U Building over three stories U Feeders,400 amps or more slkscri tion. - U()Lcupant load over 99 persons U Mnnufactured structures or RV park Each Militlonal inspection over the allowable In any of the above: _ U Egressflightingplan O(liber _ — Per inspection — —�—� Submit_sets of plans with any of the above. Investigeuon fee - The above are not applicable to temporary construction service. other Permit fee.....................$ Nal all jurisdictions srcept credit cards.please call jurisdiction for more informction expires T ii pprr1mitit 3 noticatppltioned Plan review(at _ %) $ U visa U MasterCard _1 days atter it has State surcharge(8%)....$ Credit(aid numberwithin I80 da been 6 -- --- Expire. TOTAL _ accepted as complete. .......................$ Nene of cardholde,u shown on c it cod S Crdholdei sisnatare Amount 44n16i316AM'oM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED -RESIDENTiAL ONLY_ Complete Fee Schedule Below: - - Kr-- 5. Rest—ricted—Energy Fee...................................................... $7 .00 Number of Inspections per permit allowed) (FOR Al.l_SYSTEMS) Service included_ Items Cost Total Check Type of Work Involved: Residential-per unit �� 1ft 000 sq. .or less $145.15 t Audio and Stereo Systems' Each additional 500 sq ft or portion thereof �. $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular Garage Door Opener' Dwelling Servico or Feeder $90.90 2 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 — $106.65 2 401 amps to 600 amps $160.60 2 x- 601 amps to 1000 amps $240.60 2 Otherl,r_ / N O vN Over 1000 amps or volts $454.65 2 Reconnect only $66.85 � 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system.......................................................... $75,00 200 amps or loss $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, ❑ see"b"above. Audio and Stereo Systems Branch Circuits ❑ Boiler Controls Now,alteration or extension per panel a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder foe. Each branch circuit $6.65 __ - ❑ Data Telecommunication Installation b)The fee for hranch circuits without purchase of service ❑ Fire Alarm Installation or feeder fre. First branch circuit _ $46.65 HVAC Each additional branch circuit $6.65 ❑ Miscellaneous ❑ Instrumentation (Service or feeder not Included) Each pump or Irrigation circle _ $53.40_ _ ❑ Intercom and Paging Systems Each sign or outline lighting _ $53.40 _.. Signal circuits)or a limited energy panel,alteration or extension $75.00 _ Landscape Irrigation Control' Minor Labels(10) $125.00 --� ❑ Medical Each additional inspection over the allowable in any of the aboveNurse Calls Per inspection $62.50 ❑ Per hour $62.50 In Plant $73.75 _ ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $_ ❑ Other 8%State Surcharge $ Number of Systems 25%Plan Review Fee ' No licensee are required Llcsnses are required for all other installations See'Plan Review"section on $ front of application. Fees: Total Balance Due $ _. Enter total of above fees $ Trust Account# 0'..1U State Surcharge Total Balance Due g All New Commercial Buildings require,2 sets of plans. i:\rlsts\femuklc-fees.doc OR/30/01 MASTER PERMIT CITYOF T'IGARD PERMIT#. MST2002-00315 DEVELOPMENT SERVICES DATE ISSUED: 7/25/02 13125 SW Hall Blvd., 1 igard, Ok 97223 (503) 639-4171 PARCEL: 2S11013D-08700 SITE ADDRESS: 11685 SW NICOLI PL ZONING: R-4.5 SUBDIVISION: EDWARDS PART/MLP2000-00010 JURISDICTION: TIG BLOCK: LOT:003 REMARKS: Construction of new SF detached residenee.Path 1 BUILDING 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED REISSUE: STORIES: LEFT: S SMOKE DETECTORS: Y CLASS OF WORK: NEW HEIGHT: 29 FIRST: 1.76v st BASEMENT: 40000 e1 TYPE OF USE: SF FLOOR L%-.0D. 40 SECOND: 920 al GARAGE: 607 At FRONT: 30 PARKING SPACES: 2 RIGHT: 20 TYPE OF CONST: 5N DWELLING UNITE: ' FINSSMENT: al VALUE: $396.66500 REAR: 3S OCCUPANCY ORP: R3 BDRM: 4 BATH: 4 TOTAL: 2.70900 al PLUMBING RAIN DRAIN: 100 TRAPS: SINKS: I WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: I SEWER LINES. IOU SF RAIN DRAINS' 1 CATCH BASINS: LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: GREASE TRAPS: TUBISHOWERS: 4 GARBAGE.DISP: 1 WATER HEATERS: 1 WATER LINES: IOU BCKFLW PREVNTR: 1 OTHER FIXTURES: MECHANICAL BOIUCMP<3HP: VENT FANS: 6 CLOTHES DRYER: I FUEL TYPES FURN<100K: UNIT HEATERS: HOODS: I OTHER UNITE: I GAS FURN�-100K: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: I ELECTRICAL RESIDENTIAL UNIT SERVICC FEEDER TEMP ERVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 0 200 amp WISVC OR FDR: t PUMPIIRRIGATION: PER INSPECTION: 1000 SF OR LESS: 1 0 200 amp: PER HOUR: 101 400 amp: ill WIO SVCIFDR: 00 SIGNIOUT LIN LT: EA ADD'L SOOSF B 201 •400 amp: 401 600 amp 401 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT: LIMITED ENERGY: MINOR LABEL. MANU HMISVCIFDR: 601 • 1000 amp: 60148mpa•1000v: 1000+amp/volt: PLAN REVIEW SECTION - Reconnect only: >600 V NOMINAL: CLS AREA)SPC OCC: >•4 RES UNITS: SVCIFDR>•225 A.: ELECTRICAL•RESTRICTED ENERGY — B.COMMERCIAL A.SF RESIDENTIAL -- AUDIO&STEREO: VACUUM SYSTEM: AUDIO 6 STEREO' FIRE ALARM' INTERCOWPAGING: OUTDOOR LNDSC LT: BOILER: HVAC. LANDSCAPE/I:41'' PROTECTIVE SIONL: BURGLAR ALARM: 0TH: GARAGE OPENER* CLOCK: INSTRUMENTATION: MEUI•, t� OTHR: DATAr1 ELE COMM NURSE CALLS: TOTAL N SYSTEMS: HVAC: TOTAL FEES: $ 9,152.12 Owner: Contractor: This permit is subject to the regulations contained in the VASIL CHEPA OWNER Tigard Municipal Code,State of OR. Specialty Codes and 12425 NW BARNES RD.#99 all other applicable laws. All work will be done in PORTLAND,OR 97229 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 Phone: Oregon Utility Notification Center. Those rules are set Rap a forth in OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS FSewer sion Control Insp& Wtr Proofing Bsm't Wa Footing/Foundation Dr; Electrical Rough In Gas Line Insp App Electrical k Insp ding Inspection Post/Seam Structural PLM/Underfloor Framing Insp Gas Insulation lace Mechanical Final Inspection post/Beam Mechanics Mechanical Insp Shear Wall Insp ting Insp Underfloor Insulation Pluma Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final Foundation Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final Inspection r 7 Permittee Signature Issued By : �/ r i �,< L '� --- Call (503) 639-4175 by 7.00 p.m. for an inspection needed the next business day CITYOF TIGAR® SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00218 13125 SW Hall Blvd., Tigard, OR 9'1223 (503) 639-4171 DATE ISSUED: 7/25/02 SITE ADDRESS; 11685 SW NICOLI PL PARCEL: 2S1 IOBD-08700 SUBDIVISION: EDWARDS PART/MLP2000-00010 ZONING: R-4.5 BLOCK: LOT: 003 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: DWELLING UNITS: TYPE OF USE: NO. OF BUILDINGS: INSTALL TYPE: IMPERV SURFACE: Remarks: Sewer connection permit for new SF residence. Owner: — - - --- - FEES _ VASIL GHEPA Type By Date Amount Receipt 12425 NW BARNES RD.#99 PORTLAND, OR 97229 PRMT CTR 7/25/02 $2,300.00 27200200000 INSP CTR 7/25/02 $35.00 27200200000 Phone: 503-644-4086 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 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 not located at the measurement given, the Installer shall prospect 3 feet In all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm Issued by: Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day AC10A To Building Permit Application City of Tigard Dojcct/ ppl ') -(l Expire Permit t� �5 Address: 13125 SW Ilall Blvd.] ON r 7223 ProjecUappl.no.: Expire date: City of Tigard ' pate issued: Ftecei Phone: (503) 639-4171 �''� �� Fax: (503) 59b3 19b0 ^I t I`�� Case file no.: Payment type: Land use approval: ;Jj�j `� '+ 71?�) _ 1&2 family:Simple Complex: c� U I &2 family dwr,-lling or accessory U Commercial/industrial U Multi family U New construction U Demolition <�? U Add ition/alteration/replacement U'renant improvement U Fire sprinkler/elann U Other: 1 1 1 Job address: //r� _ , ✓ Bldg.no.: Suite no.: Lot: I Block: Subdivision: — 7'ax map/tax loUaccount no.: Project name: ,� -- - r r� - 7.. .0 -- Description and location of work on premises/special conditions:___— <_ t T L� _ 1L en fit (Floodplain.se lit it,capacii.i.'�Inr.etc.) Mailing address: - filUC 'Z F U I do 2 family dwelling: City: J ,7 /it,,( Statc: 6 2 ZIP: .2 Valuation of work.......> - Phone t r Fax: E-mail: No,of bedrooms/haths................................. Owner's representative: Total number of floors................ Phone: Fax: E-mail: New dwelling area(sq.ft.) ........ — Garage/earport area(sq.ft.)......I.................. Name: Covered porch area(sq. ft.) ......................... Mailing address: Deck area(sq.ft.) ........................................ City: _ Slate: I ZIP: Other structure area(sq. ft.)... ..................... Phone: I ,)ti E-mail: fommerciaUindustrialhnutti-farnily: Valuation of work............................ . ......... $ Business name: J i Existing bldg.area(sq.ft.) ........... .... ......... 4� "a.._ 1 V f c -- New bldg.area(sq.ft.) .....� . ................ Address: /? . cA ,i rpt /C ' City: ' ' j �, /t r State: /.IP: u• Number of stories.. ............... ...... ........... Phone: S�" t (5� mail: Type of construction............ ......... ....... f Occupancy group(s): Existing: — CCB no.: New: City/metro tic.no.: Notice:All contractors and subcontractors are required to bac+ licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to he licensed in the Address: jurisdiction where work is being performed. If the applicant is City: Sutle ZIP: exempt from licensing,the following reason applies: ontact person: _ Plan no.: -- Phone: Fax: E-mail: --- — Name: Contact person: _ Fees due upon application ........................... $ Address: _ Date received: City: State:E-mail:ZIP: Amount received ......................................... $-- _ Phonc: Fax: Please refer to fee schedule. hereby certify I have read and examined this application and the Na all jurisdictions accept credit cards,please call jurisdiction rm mumxe informmion. attached checklist. All provisions of laws tion or,tiaances governing this U visa U Mastercard work will bac complied with,whether specnrcd herein or not. Ordii card number._- — -- —_ Expires Authorized signator;. � �' . J,�' Dote: n _ Nance of cardlwlski as shown an credit card Print name:, j l L �1< ,y — cardhohtet sigimure--- ' Amount Not c:This pernlit application expires if a permit is not obtained within 1 RO days after it has been accepted as complete. 410 4611(fiAXY N11) One-and Iwo-Family Dwelling Building Permit Application Checklist RefereAssoc aated petcdpe: rmits: City uf7'igard City of Tigard U Electrical U PIumbing U Mechanical Address: 13125 SW (fall Blvd,Tigard,OP 'r J-,; ❑Other: _ Phone: (503) 639-4171 Fax: (503) 598-1960 t ' I hand_use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verificadon of approved plat/lot, _ 4 Fire district _ approval required. 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. 7 Water district approval. — 8 Solis report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit rrquired.Include din inage-way protection,silt fence design and location of catch-basin rotection,etc._ 10 3 Complete sets of legible pians.Must he 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 cop right violations exist. _ - — I I Site/plot plan drawn to sale.The plan must show lot and building sethack dimensions;property comer elevations(if Utere is mors 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 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 toundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent re and location. _ 11 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 deta0s.Show nil framing-member sizes and:;pacing 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 clevations must reflect the actual grade if the change in grade is greater than four fox,t at building envelope. Full-size sheet addendtuns 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 floor:Jroof assemblies,indicating member sizing,spacing,and hearing locations.Show attic ventilation. 1 R Basement and retaining wells.Provide cross sections and details showing placement of rebar.For engineered _ systems,see item 21."Engineer's calculations." _ Ir► Beam calculations.Provide two sets of calculations using current axle design values for all beams and multiple joists over IO feet long and/or any•eam/ioist carrying a non-uniform load 20 Manufactured floor/roof trans 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,roan truss)shrill he stamped by an engineer or architect licensed in Uregen and shall be shown to be Villical1l i•�the project under review. JURISDIC'FlONALSPI( 11 HN 23 Five(5)site plans are required for Item I I above. Site plvr,1110,1 hr ti Ill" 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 Ices 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 he 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 ornYCOMr Plumbing Permit Application Date received: Permit no.:' City of Tigard - — � .x_ ' Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: City gfTigard Phone: (503) 6394171 Project/appl.no.: Expire date: Fax: (503)598-1960 Date issued: By: I Receipt no.: Land use approval: Case file no.: Payment type: U I &2 family dwelling oraccessory U Cununercial/indu tri:l U Multi-family IJ Tenant improvement 12 New construction U Addilion/altciatnnihl pl rre11111n0 ❑Food service LI Other: LE(f r � p' r r Job address: !�5 S. U/ /u l G _ ne riplion (jKy. Fue(ea.) Total Bldg.no.: Suite no.: _— _ Nen' I-and 2-family dwellings only: Tax map/tax lot/account no.: (Includes 100 ft.for each utility connection) SFR(1)bath Lot: 3 IBlock: I Subdivision: - - - -- - SFR(2)bath Project name: 1 f i SFR(3)hath City/county: Li eA D j 0 ZIP: 7 2 2 3 Each additional hath/kitchen . Description and I •ation of work on premises: Slteutilities: Catch basin/area d.-ain Est.date of completion/ins ction: Drywells/leach litre/trench drain Footing drain(no.lin. ft.) Manufactured home utilities Business name: - Manholes Address: Rain drain connector _ City: State:_ ZIP: _- Sanitary sewer(no.lin. ft.) Phone: Fax: I E-mail: Storm sewer(no.lin.ft.) - CCB no.: v Plumb.hus.reg.no: Witter service(no.lin.A.) City/metro lic.no.: Fixture or item: Contractor's representative signature: - Absorption valve — Back flow reventer _ Print name: n'ttr' Backwater valve _ Basins/lavatory Nance: Clothes washer - --- - - Address: Dishwasher _ -- Drinking fountains)~� City: - - - State: "LIP: - Ejectors/sump Phone: Fax: Email: Expansion tank Fixture/sewer cap Name(print): Floor drains/floor sinks/hub Mailing address: c e L? — Clarbage bis sal _ 1 Hose hihb City: 1-7COI, r( (X Statc: IZIP: l2 Ice maker Moneyjuy / Fax: I E-mail: Interceptor/grease trap Owner installation/residential maintenance only: The actual installation Primer(s) _ will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the pmp:rty I own as per ORS Chapter 447. Sink(s), lays(s) — — Owner's si nature: ' >w'' 1/ 04�0, Date: T_C f Sum -_ Tubs/shower/shower pan Urinal Namss:e: - - Water closet Addre _ Water heats City. State: I7,IP: _ Other: Phone:_ -- Fax:- - E-mail: Total ---- _ Not all jurisdictions accept credit card.,please call JuMinimum fee................$moreriadicri�n rot me information Notice:This permit application –` Oviaa O MasterCard expires if a permit is not obtained Plan review(at _ %) $ Credit cent numbrc within ISO days after it has beer, State surcharge(8%) ...$ Expires ------ -- accepted as complete. TOTAL .......................$ Name of cafdholder as shown an credit card _ $ Cardholder signature --- —Amoum 410J616(firOWOMl PLUMBING PERMIT FEES: PRICE TOTAL PNew'an d 2-famlly dwellings only: PRICE TOTAL FIXTURE�ndividual) QTY ea and t _ AM( :NT (includes all hfixtures In the dwelling and theeft first100 h. QTY (ea) AMOUNT Sink 16.60 16. 0 for each utilityconnection 6 Lavatory �_ __ One 1( )bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two 2)bath $350.00 -- 16,60 Three 3)bath $399.00 Shower Only Water Closet 16.60 _____ SUBTOTAL Urinal 1660 8Ye STATE SURCHARGE Dishwasher - 16.60 PLAN REVIEW_25%OF SUBTOTAL Garbage Disposal 16.60 TOTALEI _ Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" -- 16.60 _ PLEASE COMPLETE: 3^ 16.60 4^ 16.60 - -- - Quan�b _Work Performed_ Water Heater O conversion O like kine' 16.60 Fixture Type: New Move ; Replaced Removed/ Gas piping requires a separate mechanical - Capped permit. - - -- -� -- MFG Home New Water Service 46.40 Sink - - 46.40 Lavatory MFG Home New San/Storm Sewer Tub or Tub/Shower Hose Bibs - 16.60 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-1st 100' 55.00 - 3" Sewer-each additional 100' �� 46.40 4" Water Service-1st 100' 55.00 Water Heater Other Fixtures Water Service-each additional 200' 46.40 Sed Storm&Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Fiow Prevention Device 46.40 Residential Backflow Prevention De0ce* 27.55 Catch Basin - 16.50 Inspection of Existing Plumbing or Specially 62.50 Re nested Inspections arlhr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL ---- Isometric or riser diagram is required If QuantMY Total 19 >g - _-- *SUBTOTAL - 8%STATE SURCHARGE f- *"PLAN REVIEW 25%OF SUBTOTAL Required only If 8xlure t .total is>g 1 1--_ TOTAL I $ *Minimum permit fee is$72.50+8%state surcharge,except Residential Backf ow Prevention Device,which is$38.25+8%state surcharge. **All New Commercial Buildings require 2 sols of plans with Isometric or riser diagram for plan review. 1:\dsts\forms\plm-fees.doc 12/26/01 Mechanical Perniit Application Date received: City of Tigard Project/appl.no.: T Expiredate: Cifv(if Tigard Address: 13125 SW Ifall Blvd,Tigard,OR 97223 Phony. (503) 639-4171 Date issued: By: Receipt no,: Fax: (503) 598-1960 Case file no.: Pr yment type: Land use approval: Building permit no.: U I &2 fancily dwelling or accessory U Commercial/industrial U Multi-family J"i crani imprwcnu•nt U Nrw construction U Addition/alteration/replacement U Other: Job address: / t ( Indicate equipment quantities in boxes below.Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,e.)uipment,lalxir,overhead. Tax map/tax loYaccount no.: profit.Value$ — Lot: Block: Subdivision: _ 'See checklist for important application information and Project name: I ,jurisdiction's fee schedule for res idential permit fee. City/county: j ,t ZIP: _ Description and to ration of work on premises: -- Fre(rz.) 'Iota] Est.date of completion/inspection: - - — W-"Poon QI}. Res.onl Res,only Tenant improvement or change of use: Air handling unit -----CFM-- Is -__=CFM_Is existing space heated or conditioned'!U Yes U No it con inomng(snc p an r:yuirecfj— _, _ Is cxistinct space• in;111;1 •d°U Yes U No ierationo existing C system _ offer compressors tate boiler permit no.: Businessn:nnr _ - fiP ':ons_—B'fll/H Address: Fire/smokedemperstdict smo a etectors — ZIP: eat pum—p(-it p an require ) Phone: Fax: L mail: 'Install/replace furnac turner B" ITTT Including ductwork/vent liner U Yes U No CCB no.: _ ___ Insta rep ace relocate heaters-suspended, City/melro tic.no.: wall,or fluor mounted m Ilea i r farce ac Name(please print)- _ Veother than furne Ref gerat on: Ahsorption units _._ BTU/I I Chillers Name: -- ---- - Com ressors Address: __ — 'nv ronmental exhaust and vent lotion: City: tate ZIP' Appliance vent Phone: Fax: Email: cryerex taus( oo s,Type 11 111res. .itc a azmat hood fire suppression system - Name: V 3 Exhaust fan with single duct(hath fans) _ Mailing address: y h Z l Exhaust system a tart from eatin or AC ue p p ng and dlitribution hip to 4 out cts) City: / 2 E er 'P1,64 state: ZIP: 1 t Ty,e: t.l'G __ NG ()if Photce:I! , / Fax: I mail• Fuelpipint cat n uiona ovcr�otu cis rotes%piping(sc ernaticrequired) Number(it uutlets Name: er listed appHance or equ pment: Address: Decorative fireplace City: State: ZIP: nscrt--type _ oo stov pe et stove Phone: Fax: Email (h Fer: Applicant's signature: ' C'XC Date: G_ er: - Name (prinq: --- -- Perncit fee.....................$ NM au jurisdictkmfi accept t7mlil cards,ple:tw VIII jurisdicrim Im ninte inimn,111.1. Notice.Thisermit a licetiom p PP Minirnumfee................$ U Visa U MasterCard expires if a permit is not obtained Credit card numher:_ __1_-1 Plan review(at 96) $ ---- Upi1Cs A ithin I SO days aper it ha,been State surcharge(896)....$ Name of c,vtlhn r as ahnwn aI "at car S accepted as complete. TOTAL . ....................$ —. — Cerdhuhkr eiRnarure Amaror WA617(&OiWOM) MEICHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL V_A_LUATION: PERMIT FEES Description: - _ Price - Total $1.00 to$5,000.00 _Minimum fee a$72.50 Table 1A Mechanical Code _ Cry (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 $10,001.00 to$25,000.0() _ $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or I includirk vent 14 00 fraction thereof,to and including 4) Susp nded heater,wall heater $25,000.00. or 3 .,r 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 ar�.iance permit 680 $1.45 for each additional$100.00 or fraction thereof,to and including 6) Repair units $50,000.00. _ 1215 - $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 Purnp Gond traction thereof. footnotes below. Comp Mlnimm uPermit Fee$72.50 SUBTOTAL to$ - 7)I OHP;absorb unit 100K BTU 14.00 8•/.State Surcharge $ 8)3.15 HP;absorb 25.80 unit look to 500k BTU 25%Plan Review Fee of subtotal 9)15-30 HP;absorb p Required for ALL commercial permits onl) $ unit.5-1 mil BTU 35.00 ------�-- y-- 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 - -- - -- - - - 11)>50HP;absorb - unit>1.75 mil BTU 87.20 12)Air handling unit to 10,000 CFM ASSUMED VALUATIONS PER A_POL1ANCE: 10.00 Value Total 13)Air handling unit 10,000 CFM+ Desmon: at Ea Amount 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 _ _ 6.00 Floor furnace including vent 955 16)Ventilation system not included in Suspended heater,wall heater or 955 appliance permit 10.00 floor mounted heater 17)Hood served by mechanical exhaust Vent not included in appliance 445 10.00 ermit - 18)Domestic Incinerators -Repair units_____-- 805 17.40 <3 hp;absorb.unit, 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;absorb.unit,501k to 1 2.310 21)Gas 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 inil.BTU Air handling unit to 10,000 din _ 656 _--- - 8%State Surcharge $ Air handling unit>10,000 cfm 1.170 Non-portable evaporate cooler 658 TUTAL RESIQENTIAL PERMIT FEE: $ Vent fan connected to a single duct 448 Vent.ystem not Included In 656 -- -- -- ap I0ance emtit Other Inspections and Fees: Hood served by mechanical exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours) Domesllc incinerator 1,170 $62 50 per hour Commerclal or industrial indneralor 4 590 2 Inspections for which no fee is specifically Indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 0 per hour 3 Addi`ttiional plan review required by changes,additions or revisions to plans(minimum Inserts,etc. charge-one-half hour)$62 50 per hour Gas piping 1-4 outlets 380 -- Each additional ouUet- __ 63 -___ _-- 'State Contractor Boller Certification required for units>200k BTU. -- "Residential A/C requires site plan showing placement of unit. TOTAL COMMERCIAL $ VALUATION: �_.., - All New Commercial Buildings require 2 sets of plans. i:\dstsUonns\mech-fees.doc 02/11/02 j Electrical Permit Application Date received: Permunu.: (city of Tigard Project/appl.no.: Expire date: 01ygfTtgard Address: 13125 SW hall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.: Phone: (503) 6394171 Fax: (503) 598-1960 Case File no.: Payment type: Land use approval: U I &2 fanuly dwelling or accessory U Corn mercial/industrial U Multi-family U Tenant irnprovenlenl m New construction U Addition/alteration/replacement U Other: U Partial Job address: C 5 Bldg.no.: I Suite no.: ITax map/tax lot/account no.: Lot: 3 1 Block: Subdivision: Project name: ' f/ — Description and location of work on premises: Estimated date of cont (etion/ins ction -_---- ---- -- - Job no: K7. Fee Max Business name: __ Description Ory. (ea.) 'total no.Inc Nun residential-single or multi-family per Address: dssellrng unit.InchNks attached gas aRe. City: Slate: ZIP: 'we sh elacluded: Phone: Fax: E-mail: 1000 sq.ft.or less _ 4 F.ach additional 500 rq,ft.or portion thereof CCB no.: Elec,bus.lic.no: Limited energy,residt,.lial _ 2 City/metro lic,no.: Limited energy,non-residential _ 2 Each manufactured home or modular dwelling Signature of supervising electrician(requited) I t Service and/or feeder 2 tint, rlrri n;unr rl,rion I.iu:nsc no: Services or feeders-Installation, alteration or relocation: 200 amps or less 2 Name(print): Ar 201 amps to 400.mps 2 Mailing address: �/ /4 ) 401 amps to 600 amps 2 601 amps to 1(10(1 amps _ _ 2 City: j ( , 1 { Stale: (; 1 ZIP: c. Over I(xxl Amps or volts 2 Phone• G f' r,It `I Fax: 1i-mail: Reconnecionly �y _ — _ I Owner installation:The installation is being made on property I own Temporary services orfeeders- which is not intended for sale,lease,tent,or exchange according to Installation,alteration,or relocation: 2111 loops or less 2 ORS 447,455,479,6 7 ,701. b r 2111 nmps to 4(10 amps 2 Owner's si maturer = ! 10 Date: Z1 lot tr,600 amps 2 Branch circuits-new,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: State: ZIP: W Fee for branch circuits without purchase --- - _ -_ (if service or feeder fee,first branch circuit: 2. Phone: Fax: E-mail: Each additional branch circuit: ION 1111611 RIT M isc.(Service or feeder not included): U Service river 2.:5 sups,mmovi,ml U l lctdth-love tacihr} Each pump or irrigation circle 2 U Service over 320amps-rating ill ISL U IlazardouslocanUn Each sign m oulline lighting 2 family dwellings U Building over 10.1110 square feet four or Signal circuit(s)or a limited energy panel, U System over60U volt.,rouunal more residential units in one structure alteration,or extension* �^ 2 U Building over three stories U Feeders,4(1(1 amps or more •I kscri tion - U occupant load over 99 pentons U Manufactured structures or RV park FAch additional Inspection over the allowable In any of the above: U Egress/lighlingplan U Other — -- 1'rr impr,n n —�—�— Submil--sets of plank with any of the above. Ins ng,ru ,Icc The above are not applicable br temporary construction service. Other --_- ----- --� ,—_ --- — Permit fee.....................$ Not all Jurisdicllons accept credit earls,please call jurisdiction for atm InfomWhm Notice:Ellis pemlit application U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ Credit card number. _____.__ — vt iihio I R(1 days after it has been State surcharge(8%)....$ accepted as complete. TOTAL . $ _ Name of--cardholder r as shown rnu credit cu Cardholder signature Amount 40-461.5(MWOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Com tete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY /� Restricted Energy Fee............................................ ......... $75.00 Number of Ins ections er permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total I Cherk Type of Work involved: Residential-per unit f _Il 1000 sq.it.or less _ $145 15 -- 4 I Audio and Stereo Systems' Each additional 500 sq It or portion thereof _ $3340 _ 1 U Hurglar Alarm Limited Energy $1500 ^_ _ Each Manufd Home or Modular ❑ Dwelling Service or I eeder $9090 - - 2 Garage Door Opener Services or Feeders F-1 Heatino kr- ..dation and Air Conditioning System' Installation,alteration,or relucalion 200 amps or less _ _ `'80 30 2 201 amps to 400 amps $06.85 _-_ _ 2 Vacuum Systems' 401 amps to 600 amps _ _ $160,60 2 ❑ 601 amps to 1000 amps _v $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,alteration,or relocation Fee for each system............ ... ....... ........................._.... $75.00 200 amas or less _ $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 amps _ _ $10030 2 401 amps to 600 amps _ u- $133 75 _ 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. Ej Audio and Stereo Systems Branch Circuits F-1 New,alteration or extension per panel Boiler Controls a)The fee for branch circuits with purchase of service or Clock Systems feeder fee. Each branuh circuit _- $665__- 2 Data Telecommunication Installation b)The fee for branch circuits without purchase of service Fire Alarm Installation or feeder fee. First branch circuit $46.85 ❑ Each additional branch circuit $665 HVAC Miscellaneous Instrumentation (Service or feeder not included) Each pump or Irrigation circle $53.40 _- Each sign or outline fighting $5340 _ intercom and Paging Systems Signal circuit(s)or a limited energy panel,alteration or extension $150o __ Landscape Irrigation Control' Minor Labels(10) _ $125,00 __ _ Medical Each additional Inspection over C� the allowable In any of the above I'ei inspection $r,7 50 Nurse Calls 1',,hour $rig - - - -- In Plant $13 75 � outdoor Landscape Lighting' Fees: �_� Protective Signaling Enim total of above fees $ F-] Other _- 8%State Surcharge $ _ __ _Number of Systems 25%Plan Review Fee See"Plan Review"section on $ No licenses are required Licenses are required for all other installations front of application Fees: Total Balance Due $ Enter total of above fees $ Trust Account 0- 8%State Surcharge $ Total Balance Due $ All Now Commercial Buildings require 2 sets of plans. i:ldsts\fomn\elc-fees.doc 08/30/01 Address: issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Lair, URS 701.055(4), requires residential construction permit appli- cants trho etre not registered wilh the Construction Contractors /3nur•cl to sign the /irllo+r ing•+tcrtement hcrlore a building pc emit can he issued. 7his•snrtement i.s required for residential building, elearical, mechanical, and plumbing permits. Licensed urchilect unci rrrc,,ineer applicants, c xenrpl ftorn re,t;is•trunon undo►• ORS 701.(1/0(7), need n-�t •+•uh,rrit this.+•rute,ne,at. This.elulement trill he./fled trirh the perntit. Fill in the appropriate blanks and initial boxes 1 and 2.and either box 3A or 31:3: n 1. 1 own. reside in. or will reside in the completed structure. '. 1 understand that I must register as a construction contractor ifthe structure is sold or ufferrd for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. P will instruct my general cc►ntractc►r that all subcontractors who work on the structure must be registered \011 the Construction Contractors Board. OR [� 313. l will he my own general contractor. it•l hire subcontractors. I \%ill hire only subcontractors registered with the Construction Contractors Beard. If I change mN mind and hire a general contractor. I ++ill contract with a contractor ++ho is registered with the U(,11 and \%ill imr.1ediatel+ notik the office issuing this building permit of the name of the contractor hereby certif+ that the ahm c in I'll matioon is Correct and that I ha+v read and do under.t:mrd the Information Notice to i'roperIN Omivr% about Cuntitructio►n Responsibilities on the reverse side oof this form. e (Signature of permit applicatot)- ---� -- (Date) tff•hite c•oht•to issuing agent-►•permit file, pink cop},to applictint) Information Notice to Property Owners About Construction Responsibilities r`11j1' �Il!, �lrf�i)'/rl:rll,Irl \rill•, Ol,/1,'l.\ ith(tIJ(, 1Irll,ll'(11 !':•/ R, ,j'uN�ljllflH 11'.!t :�,•.•'1r��4 „ �'1 ,1'r_ ( nl;':ll'7n'1!r'1' i�,rulplr ! !I', js,,,ry,�l!I ,l. _ ,r•�.1' , , )!('� '/r' r. is lllaJll�j l'I� �11�'!ll- f)j i111 11;911 , EMPLOYER RESPONSIBILITIES: nl1,r(r\rnlr�ull,l ;llc . ! �'� ' ,i' ' •.'In1,II�\c','. 1.f11('Inli,la,\,.! : " 1111tl;I�f�llll�hltla++: laall�'n',hlr,\t'!' \ `1111`li'1t`,`.Illlhr'IIlII1,,111111'I,1tL'+itI'll,Cl11!d1:'.t ,N.;IL'C',alli ' IIr1!'II' 1t,1•Illi'1;;?, if Vr,ll },1111 aC111a11:, \11111I1(Ilt1 1111'IA\ jl('Ill AI'lif t'rn1,!" III ;!!L I,. ,, ,+n I}r11t (,I llc'\rnut'al`1:! �•.;{(I(;j rIn III inr111':I;Irc I.1[: \ II IIII,!I•.I-I• 1 , • it -I, i,•.:',II'iirii;I"1 ,iililli1),r, llal(.!ilai • I'-IL1!1-I• Iii i �' ��i l _ II.II,:,.�:. I '!'. i I�Ill i. ,l ili:� •1 , II, _lill,l- i , I �•! I I ! � :: ' 'I�.•'I-• (��,II!I,, Ii-�i11 ,I! 111, i :.•.i II !I:. I L• I•.-II!. :,r I�I n il!i': ! !,, ! iii! �Ii IIllff,1:11 R"IIv11`11'Iwo\IC1 , ! 'lig r:lA!�1air11iI11CA'• II li �',rUllll!11 i �.Ill�:i�` �.•. ill!!: 'i. I, 1 � :II.:I. I'1!�'ll'I',f!.11, +':11!IIIC 11111'1'll:'ll lf,r` I OTHER RESPONSIBILITIES ANn AREAS OF CONCERN: l,llli:lnrc: 1 ,IIx 1)LIImlhidII111'.'Ifill !I,I ',.I a 1�',1rrlu•IiIII- I, !'r,SII C.I I! II? \III I1 .111•:11111'It I I I I I II!'211 111'.14�'11i.•�1 ,1111 I1uoIIit-11+ I I a roll;I ge I11`,III':III v k- I 'll!,,i 1 \ Ittl III'.Ul,lr! I_;,'� Ill lI I ,Ix II \ 'U(L1\r. ;1,1.(111,IIC'IIINI ':.11! 'k,.I''. „i;!.,11111'rilll'inlUllb411t, :I'; faI1111(:LU\111.[1;1Ill 1011(:I`iplr1}. I\atcfdalllal ,.4 twill 1711E 1'1'11'.''`: s '.Irl, Ilr.l:lx'r'+i�cclnllln+l'1•.: \,I,IF.I.' :..,nr ,ln.. . . . I I \lIr 1llal': ��l;lh l'`,Il��'\IIU 11;IlCllh.'C\Ill'111'+C1i I:l�'I;1`:\11111 .1,111 L!l'lll'fall(`Ill f;l�l�`f.ll�(:t,,,t,l•., t1 .,I „(': , I-,. r, ,,- I !i� kilill im,rf`111 ial',;lt flit- I(,.,I lit"I(,,1 I 'file Klarll i. I(.uat\'ll a1 'till Summer SI M, ~rine 00. in Salem. I 02 Jun 25 11 "43 CATEMPIPARCEL3BBR-EC.awp TPW /j��7r�� - ao3cs BUFF BEND ROAD V.x7 5' UTILITY EASEMENT I 101 COVFNAGF N +01AF INVC((JDW(2 0Nl J919 So !1 �.� f; 7 - l l,l ARFA 9876 so I I _ - 1'l uCEN/AGF py X Dunt FFVIOUS 1 I •1100SI IINC(UOIN'G 0Nl Me 50 FI 1 I !> WAV------ 97J SO Fl WAI A(KWAr 9950 FI I IGlal AnfA 3940 50 FI 1 �INCI U01.S OOUNI E S IAplFD p(CK ARIA I IFGrND I _' Sul ft NCI I I� — 10' STORM I le SEWER I I EASEMENT ❑ ❑ 1 Df CK I 1 EL 1818' 'e I I I I. I ` I I I I I I I I 1 I I I I I I I I I I 1 . I 1AOiNT AGIN I — I 40 . APFA 1• 4 I +kl v, DRIVEWAY I3500 pSil I ....� PRN Al carr�lp � ,, r 'i'OCKoiIES � /!r{� L 0 DRIVE 1 EROSION CONTROL PLAN N A.;cAtfToN AC a.... 221Z2AA "I A"LYAC,at IRE TOPOPAPnr • Imo•' -..1 i\�1�j u:IKIN„ 9 t salF AEsooM96��n a rpt PARCEL 3 I L" .0%5 F¢wwpa . ti '.. AN0"o c"045 WE ' A vow • 'r YASCU40 DE5G4 ASSOCIAtES iNC BY LIDIYA CHEPA .91B?6 SO fT CITY OF TIGARD �t spection Line: (503)639-4175 our BUILDING MST INSPECTION DIVISION Business Line: (503)639-4171 P BUP _ Received / 1_/_r;_Date Requested_� o, I a AM P PM _- BU Location __ZIA� _.5__ L Suite MEC Contact Person __.___— __ Ph(. —) O — a PLM 3 ' �G 3 Contractor ________ Ph(--) _ _ SWR BUILDING Tenant/Owner _..._-- —. ELC __------- Foot,ig -- - ELr. --- -- - Foundation Access: Ftg Drain �_�J ELR — Crawl Drain Slab Inspectiolh tes: SIT Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - -- - -- ----_. _ - -- - -- - - - Insulation Drywall Nailing - - --- -- -- — ---�_- Firewall Fire Sprinkler -- --- ------- - -- Fire Alarm Susp'd Ceiling �_ --- -- --- -- - Roof 6 C Other.. - —T- -- - ---- --__. ---- - - - Final _ PASS PART FAIL PLUMBING --- - -- - --... ---- Post& Beam Under Slab -— - - - - - -------- — ----- Rough-In Water Service --- - _ -- - —— - Sanitary Sewer Rain Drains - - -- - — Catch Basin/Manhole - —_ Storm Drain __-- Shower Pan efAA PART FAIL _CHANICAL ----- Post&Beam Rough-In - - - _. ---- -- Gas Line Smoke Dampers - -- - — Final PASS PART FAIL ---- -- ELECTRICAL Service - - - Rough-In UG/Slab Low Voltage - - - - - Fire Alarm Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL_ SITE Please call for reinspection RE w Unable to inspect-no access Fire Supply Line ADA Date- —�- Inspector Approach/Sidewalk --- Ext Other:_ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL