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9680 SW NACIRA LANE-1 N, VUIDVN Mq 08969 z a h 1 1�1 V z IL 3 o 00 �o m W J 9680 SW NACIRA LN i .S u La VI .(n i O ^ C � O O i � I C o S C� N 2 � U •N 4 Z: 5 z � § 8 j+ V OC ^ter e � ° 0In � b 0 0 r W �F- � C tU _ 0 0A ��R D _ MASTER PERMIT CITY OF T I G I3-00447 DEVELOPMENT SERVICES DATES ISSUED: 0/8/03 13125 SW Hall Btvd.,Tigard,OR 972.23 1503)639-4171 SITE ADDRESS: 09680 SW NACIRA LN PARCEL: 1S135CD-GP008 SUBDIVISION: GREENDURG PINES ZONING: R-4.5 BLOCK: LOT: 008 JURISDICTION: 'ri(i REMARKS: Construction of new SF detached residence. BUILDING REISSUE: MAS21W STORIES: 2 FLOOR AREAS _ REQUIRED SETBACKS REQUIRED CLASS OF WORK HEIGHT: 24 FIRST: 955 d BASEMENT: 560 of LEFT: 5 SMOKE DETEC CORS: Y TVP2 OF USE: EF FLOOR LOAD. 40 SECOND: 1,435 a1 ( AAOE: of FRONT: 15 PARKING SPACES: TYPE OF CONS 5N DWELLING UNI'S: 1 H4111) a1 :WIGHT: 5 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: J, VALUE 2:16, 390 a! 1 n4.00 REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS: TUB/SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNT"L GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 4 CLOIHES DRYER: 1 GAS FURN>-100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: blu FLOOR FURNANCES: VFNTS: I WOODSTOVF.S: GAS OUTLETS: 4 ELECTRICAL - RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/rEEDERS BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTIONS 1000 SF OR LESS: 1 0 -200 anp: 0 -200 amp: WISVC OR FD 3: PUMPW�.IGATION: PER INSPECTION: EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 snip: 1 at WK)SVCIF OR: ;IGNIOUT LIN LT: PER HOER: LIMITED ENERGY: 401 600 amp: 41H - 600 amp: EAAODL.BR CIR: SIGNALIPANF.L: IN PLANT: MANU HWSVC/FDR: 601 - 1000 am": 601•ampa•1000v: MINOR LABFL: 100pi,amplvolt: PLAN REVIEW SECTION Reconnect only: -- - >-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNOSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAITFLE COMM: NURSE CALLS: TOTAL A SYSTEMS: Owner: Contractor: TOTAL FEES: $ 7,503.89 This permit is subject to the regulations contained in the VISTA NW VISTA NORTHWEST INC Tigard Municipal Code,State of OR. Specialty Codes and PO BOX 91459 PO BOX 91459 all other applicable laws. All work will be done In PORTLAND,OR 97291 PORTLAND„OR 9729. accordance with approved pl-3ns. 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. AT FEN TION: tZ, Oregon law requires yo',io folbwrules adopted by the Phone: 50;-531-0505 -531-0505 Phone: 503Oregon Utility Notification Center. These rules are set .�T forth in OAR 952-001-0010 through 952-001-0080. You Rao" LIQ' 75507 OUNC by calling(03)2obtain copies of these 6r1987Gr direct questions to OD REQUIRED INSPECTIONS WErosion Control Insp Post/Beam Mechanica Plumb Top Out Gas Line Insp Water Line Insp Plumb Final —J Sewer Inspection Underfloor Insulation Electrical Service Gas Fireplace Water Service Insp Building Final Footing Insp Crawl Drain/Backwater Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Foundation lisp PLM/Underfloor Exterior Sheathing Inst Rain drain Insp Electrical Final Post/Beam Structural Mechanical Insp Low Voltage Storm drain Insp Mechanical Final Issued Bye'-' t `L' Permittee Signature Call (503) 639-4175 by 7:00 p.m.for an Inspection needed the next business day CITY OF TIGARD SEWER CONNECTION PER DEVELOPMENT SERVICES PERMIT#: S -00333 2k 13125 SW Hall Blvd.,Tigard, OR 97223 (503)6394171 DATE ISSUED: 10//8/038/03 PARCEL: 1 S 135CD-GP008 SITE ADDRESS; 09680 SW NACIRA LN SUBDIVISION: GREENBURG PINES ZONING: R-4.5 BLOCK: LOT_ 008 __ JURISDICTION: TIG _ TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF detached residence. Owner: FEES VISTA NW Description Data Amount PO BOX 91459 PORTLAND,OR 97291 [SWUSA]Swr Connect 10/8/03 $2,400.00 1 S W USA]Swr Connect 10/8/03 $0.00 Phone: 503-531-0505 (SWINSP]Swr Inspect 10/8/03 $35.00 [SWINSP]Swr Inspect 10/8/03 $0.00 Contractor: - Total $2.,435.00 Phone: Reg#: Required Inspections CL ac w m This Applicant ag-ees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance coven. If not so located,the installer shall purchase a"Tap and Side Sewer' Perm Issued by: Permittee Signature: Call (503)639-4115 by 7:00 P.M.for an Inspection needed the next business day '70 Building Permit Application Received Q Building Date/By�1 D-0, 66 Permit No. 67 oveI3 –,9ou1Y7 Planning Approval Other C v .��33 j City of Tigard Date/By: Permit No,. 13125 SW flail Blvd. W0181Ala JNI0*111) Plan Revc Other Tigard,Oregon 97223 ClJvc I an A I t Date/B .iew / -0 3 Permit No.:Pos --- Phone: 503-639-4171 Fax: Q�398-1960 t-Rerand Cue No. o. ��JJ `` Internet: www.ci.tigard.or.us L Date/By:Contact Jure.: N See Page 2 for 24-hour Inspection Request: 503-639-417$ (_Nara;/Method: t Supplemental Information TYPE OF WORN. __ REQUIRED DATA: New construction__ Demolition _ I&2 FAMILY DWELLING_ �.- Addition/alteration/replacement Other: CATEGORY OF CONSTRUCTION Note Pemut fees*are based on the total value of the work performed. Indicate he nearest dollar)of all equipment materials,labor, 1 & 2-Familydwell� Cthe value(rounded to the Dy overhead and profit for the work indicated on tha application. Accessory Building_ Multi-Family -- - Master Builder Other: Valuation................................................... ..... —� JOB SLT]g INFO ION and OC LATIt�: No.of bedrooms:q No.of baths: Total number of floors..................................... Job site address: yc4 _/, --- New dwelling area(aq.ft.)............................. - Suite#: l`7t Bld ./A .#: Garage/carport arca( _p- -- sq.ft.)............................ -- — Project Narne: �— -- --- --- Covered porch arc: q.ft.)............................. ---- -- ------------ Cross street/Directions to.job site: Deck area(sq. t.)............................................ c Other structure area(sq.ft.)............................ COMMERCIAL-USE CHECKLIST Subdivision .r: Y of#: Tax map/parcel#: Note: Permit fees*are hosed on the total value of the work performed. Indicate DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and prufit for the work indicated on this application. Valuation...............................�.... s ------ Existing building area(sq.ft.).l ...... ............ __,y!_--- —_-- ------ New building area(sq.ft.)............. ............... Number of stories...................... ........ ......... a _ PR0PPM.0V Iit_ TENANT— _ Type of construction............. ................. . Name: /�'r" Occupancy group(s): Existing: New: Address: City/State/Zip: _ J Phone: / _ gx; NOTICE: All contractors and subcontractors are required to be APDL CANT ' CONTACT PERSON licensed with the Oregon Construction Contractors Board under I FI provisions of ORS 701 and may be required to be licensed in the Business Name:,5�� jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: Address: — -- IL City/State/Zip: R N Phone: Fax: t11[h11f+� I, r E-mail: C CONTRACTOR WILL- m Business Name: —__ _ Fees due upon application.............................. S Address: —J Cl /Slate/Zi — Amount received............................................. s Phone: Fax: - Date received:_-__- __T__ CCB Lic. #: - Authorized Notice: This permit application explt-es If a permit is not obtained with'" Signature: — _ Date:___ _- IAO days after It has been accepted as complete. _ •Fn methodology set by Trl-Coontt-Building Industry Service!bard. (Please print name) is\Dsts\Pernit F-'omis\Bldgt1ermitAppAoc 01103 One- and Two-Family Dwelling Building Permit Application Checklist rRefereu�ceno.: d permits: City��jTigprd Cit of Tigaard City b O Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard.OR 97223 U Other: Phone: (503)639-4171 —" Fax: (503) 598-1960 I HL FOLLOWING ITEMS ARE-REQUIRED 1:011 111 %N 11�6?lf Ves.. Ni*) N/ I band use nctions completed.See jurisdiction criteria lot concurrent reviews. 2 4�ning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plotllot. 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 fAplan U permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 3 Complete sats of legible plans.Must toe 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 slice(attached to the plans with cross references between plan location and details. Plan review cannot he completed if copyright violations exist. 1 I Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;properly corner elevations(if there is mon:than a 4-ft,elevation differential,plan must show contour lines at 24 intervals);location of casements and driveway;footprint of structure(including decks),location of wells/septic systems;utility locations;direction indicator;lot i arca;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. _ 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. _ 14 Cross sections)and details.Show all framing-member sizes and spacing such ar floor beams,heaters,joists,sub-flour, wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide specifications and calculations to engineering,standards. 17 Floor/roof framing.Provide plans for all floorstroof 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." iYO _ 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. (L 20 Manufactured floor/roof truss design dettdls. 21 Energy Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under revipw. _J M U 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". W 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 rpproved 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 he in blue or black ink. Red ink is reserved for department use only. 440-4614(601000M) nunaing it ixtures Plumbing Permit Application Received Plumbing Date/By: Permit No.: '11ri7.2W2i .66 e1q Planning Approval sswerCitJof Tigard Parmit No.: 13125 SW Hall Blvd, ' Plan Review Other Tigard,Oregon 97223 Datroy: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Pont-Rcview Lind Use Date/By: Case No.: Internet: www.ci.tigard.or.us +' Contact ,i Juris.: N See Page 2 for 24-hour Inspection Request; 503-('t��7��i Name/Method: Suppiementa!Information. ��aP�►fs�ol� TYPE OF WORK" FEEWSCHEDULE for aZclsl 14f9raW1b ch!CI( t) , _ew construction DemolitionDescriiption sty. Fee(es.) Total Addition/altera�tlon/rept_aucment Other: _ New 1-&2-fandly dwell lh CATEGORY OF ONSTRU p111 Qnflatlee 100 tit.for ach utiii wnq &2-Family dwelling Commercial/Industrial SFR l bath _ _ 350.20 SFR(2)bath 350.00_ Accessory I3uildiU__ Multi-Family SFR(3)bath _ — 399.00 _ Master Builder Other: Each additional bath/kitchen _��^ 45.00 ATI Aq IN Firesprinkler- .ft.: Pae 2 Job site address: te. BILI Suite#: Bld ./A t.#: Catch basinfam thin _ 16.60 Project Name: —� D ell/leach line/trenchdrain 16.60 _ ---- Footing drain(no.linear fl.) Pee 2 Cross street/Directions to job site: Manufactured home utilities _ 110.00 Manholes �!_ 16.60 Rain drain connector 16.60 _ Sanitary sewer(no.linear fl.) Pae 2 1 _ Subdivisio Lot#: Storm sewer no.linear fl. Pae 2 Tax ma / arc;el#: Water service no.linear R. Pae 2 _ �.. re 0 '7 Absorption Vl1Ve � Y 16.611 ' � Barkflowpreventer Page 2 " Backwattr valve 16.60 Clothes washer 16d166.60 60 - - Dishwasher Drinkin fountain E'ectors/sum time: Ex ansion tank Address: .,��'" Fixture/sewer ca City/State/Zip Floor drain/Poor sink/hub 16.60 Garbage disposal 16.60 Phone- /--ems Fax: Hose bib _ 16.60 I¢ i:. ,,. SRO!_ Ice maker 16.60 Name: lnterce tor/ ease"2 16.60 Address: Medical gas-value: $ Pae 2 Cit /State/Zl Primer 1b.60 City/State/Zip:_�, _ Roof drain commercial 16.60 n, Phone: Pax: Sink/basin/lavatot 16.60 OC E-mail: Tub/shower/shower pan _ 16.60 CONS RACTO J Urinal 16.60 � Business Name: Water closet 16.60- Water heater 16.60 J_ Address: Other: City/State/ Other: L I Phone• Fax: CCB Lic. M '� Plumb. Lic.#�S-y subtotal s �� _ — - Y� Minimum Permit Fee$72.50 S Authorized ` Residential Backflow Minimum Fee$36.25 Signature: Plan Review 25%of Permit Fee $ —� State Surch^_. 8%of P-rmit Fee S _ (Please print name) IOTA L PERMIT FEE I S Notice. This permit application expires If a permit Is not obtained within All new commercial buildings -.quire 2 sets of plans with Isometric or 180 days after It has been steepled ss complete. riser diagram for plan revb;w. 'Fee methodology set by 7 ri-County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01103 Plumbing Permit Application •. City of Tigard Page 2-Supplemental Informailk it Fee Schedule: Residential Fire Suppression Systems: ' Square r'oota e: I+ It iFcet Footing drain-1 100' 55.00 _2_to 2mo $115.00 _ ��-- Footing digin'-each additional 100' 46.40 2,001 to 3,600 _Sluo.00 3,601 to 7,200 $220.00 Sewer-Dat 100' 55.00 7,201 and greater $309.00 _ Sewer-cacti additional 100' 46.40 _ Water Service-Ist 100' —^ 55.00 Medical Gas S Stems' Water Service-each additional 100' 46.40 Valuation: Permit lace: Storm&Rain(rain-1 st 100' 55.00 $L(>U to$5,0()().00 Minimum fee$72.50 _ Storm&Rain Drain-each add ional 100' 46.40 $5,001.00 to$10,000 00 $72.50 for a first$5,000.00 and$1.52 for each additions 100.00 or fraction thereof,to and l±ixttire Or i'+ r t includi $IU,000.0U. __ Commer-ial Back Flow Prevent n Device 46.40 $10,001.00 to$25,000.00 f 148 for the first$10,000.00 and$1.54 for Residential Back!low Pre ventio evice eac additional 5100.00 or fraction thereof,to minimum permit fee$36.25 27.55 a including$25,00U.00. Rain Drain,single family dwelling 65.25 $25,001.00 to SS0,000.00379.50 for the first 525,000.00 and 51.45 for each additional 5100.00 or fraction thereof,to Inspec,�on of existing plumbing or _ and including$50 000.00. specially rc quested inspections-perVr 72.50 550,001.00 and up _ 5742.00 for the first$50,000.00 and$1.20 for uo Stal: _ each additional$100.00 or fraction thereof. Fixture Wo;-k: Are yon espping, moving or replacing a ting fixtures? If "yes",please indicate work performed by ture. Failure to accurate) repor t fixtures could result in ins ased sewer fees*. uintit tune k Pe o e Comments regarding fixture work: FIxture Type: - Ba tistr /Font _ Bath -Tub/Shower --_ - -` -Jacuzzi/Whirl sol --- - Car Wash -Each Stall -Drive Tttru - -- -- Cus idor/Water As iratrrr - ----- - —-- Dishwasher -Commercial -Domestic -- Drinking Fountain -- ---Eye Wash 4 �— Floor Drain/sink -2" 4„ --- Car Wash Drain Garbage -Domestic *Note: If fixture wor', under this permit results in an 4. Disposal -Commercial increase of se ED11s,a 7ewer permit will be issued and p� -Industrial fees assessed for the sewer Increase must be paid before the Ice Mach./Refri .Drains plumbing permit ca a issued. Oil Separator Gas Station Rec.Vehicle Dump Station Shower -Gang -Stall 0 Sink .J -Bar/Lav ato UJ -Bradley -COMmry -Servic Swimming Pool Fil r Washer-Clothe Water Extract Water Closet'-Toilet Urinal _ Other Fixtures: ONIaTcrmit Forms\PlmPermitAppPg2.doc 01/03 _ElectricalPermit AWieation Received Elad;eal —,y RECEIVED Date/By Permit Nol)I lr��l '00 qq CI Of Ti iil"li Planning Approval Sign City g Date/By: Permit No, 13125 SVV Hall Blvd. . A Plan Review Other Tigard,Oregon 97223 AUG 21 2003 DateB : _- Permit No.: �— - Phone: 503-639-4171 QJ$Xy"t"CS•AHU Post-Review Land Use Dste(By: Case No.: __ Internet: www.ci.tigera�} Contact Juris.: See Page 2 for 24-hc rr Inspection CIIII: bS1r~i1 ON Name/Method: Supplemental Informatlon. "�.uI UMMON TYPE;OF WORK �N REVIEW Please c6,�'It•fill M0 april�) eW Construction _ Demolition Service over 225 amps- Health-care facility commercial []Hazardous location _Addition/alteration/replacement _Other: ❑Service over 321)amps-rating of ❑Building over IO,000 square feet. " CATEGORY OF CONSTRUL'TI_ON I &2 family dwellings four or more rcsioential units in &2-Family dwelling Commercial/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 Otl e ❑ Egress/lighting plan Other: JOB SITE INFORMATION and LOCATION Submit__sets of plans with uny of the above. The above are not applicable totem raconstruction service Job site address: i — Suite#: Bldg./Apt.#: _ Number of Ins ectlons per permit allowed Project Name: Description Qty Fee(ca.) Taw New resktentlal mirk or multi-family per Cross street/Directions to job site: dwelling unit.Includes attached garage. Service Included: 1000 .A.or less _ 145.15 4 Each additional 500 sq.It.or portion thereof 33.40_ _ 1 Subdivision: �Cz-.P1 Lot#: Limited mer , el 75.00 2 Limited energ;�,non non residential 75.00 � 2 Tax map/parcel #: Each manufactured home or modular dwelling DESCWPTION..OIN.WORK y,., service and/or feeder 90.90 2 -- Services or feeders-Installation, _ alteration or relocation• --- _ 2o0 amps or lees 80.30 2 201 amps to 400 am _ 106.85 2 401 amps to 600 amps 160.60 2 601 amps to 1000 amps 240.60 2 --- Over 1000 amps or volts 454.65 — 2 Name: _ Reconnect only 66.85 2 Address: y� 'temporary services or feeder-Installation, — alteration,or relocation: City/State/Zip: 7z g/ 200 amp-or legs __ 65.P_5 1 ?01 amps to 400 amps 100.30 2 Phone: / >S� Fax401 to 600 am --�� _ 133.75 2 ADPL ANT CONT ACT P ON Branch clrcults-new,aiteratlon,or Name: extension per panel: -- — A Fee for Ixench circuits with purchase of Address: _ _ service or feeder roe,each branch circuit_ 6.65 2 CitylState/Zi : P Fee for branch circuits without purchase of -- service or feeder fee furst branch circuit 46.85 2 Phone: _- ax: Each additional bunch circuit 6.63 2 E-mall: � Misc.(Service or feeder not inchxled): Q l.V�IItA A,, Each or irrigation circle 53.40 2 Each sign or outline lighting S3_40 _ 2 I— Job No: r —� Signal circuit(s)or a limited energy panel. N alteration or extension _ P 2 2 Business Name: _ Description: Address: Each additional Inspection over the allowable'le any of the above: City/State/Zip: 3 Per ins S5ion per hour min.t hrnv 62.50 t; Phone: Z [x? Fax Investigation fee: — wCCB Lic. #: L 7 other. Supervising electrics Subtotal S signature required: Plan Review 25%of Permit Fee) $ Print Nam Lic. #: state Surcharge i(8%of Pemut Fee $ TOTAL PERMIT Authorized , Notice: This permit application expires 11's permit Is not obtained within Signatime: — Date:-�C=f 180 days ager It has ee bn accepted as complete. 'Fee methodology nN by Tri-County Building Industry Service Board. (Please print tome) i\i)sts\Permit Forms\FlcPermitApp.doc 01/03 Electrical Permit Application -City of Tigard - Page 2 -Supplemental Information A LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ $75.00 heck Typc of Work In%olved: Audio and Stereo Systems* FIrglar Alarm bare El Door Opener* Heating,ventilation and Air Conditioning System* ElVacuum Syste * Other, ----- COMMERCIAL WORK ONL Feefor gjr. system............................... ........ ............... $75.00 (SEF OAR 918-260-260) Check Type of Work Involved: ED Audio and Stereo Systema Boiler Controls Clock Systems Data Telecommunication nstallation nFire Alarm Installation \ FIVAC \ MInstrumentation \\ Intercom and P ging Systems 0 Landscape I 'gation Control* j Medical Nurse IIs n. Out r Lanescapt Lighting* L fR1 tective Signaling Other — _m (� ____Number of Systems W -'1 * No licenses are required. Licenses are required for all other Installations i:\Dsts\Permit Forms\ElcPetmitAppPg2.doc 01/03 Mechanical Per it plication Received Mechanical }.. Dote/By: J Permit:4o.: 1 �'I� 00 CI Of Ti jrL. Planning Approval Building City g Date/By_ Permit No.: 13125 SW Hall Blvd. Z 2003 Plan Review Other Tigard,Oregon 9722AUG Date/By: Permit No.. Phone: 503-639-41?1 0f 30 960 Post•keview tAnd Use ill Data'B : Case No.: Internet: www.ei. pIVIS10N Contact — Juris.: I See Frge Z for–�-- 24-hour Inspection est: 503-6394175 Name/Method: ,J SuLr&Teatal Informatic,. TYPE OF WOR _ COMMERCIAL FEV SCHEDULE-USE CHECKLIST, New construction Detriolltion Mechanical permit fees,r re based on the total value of the work Addition/alteration/re laeement Other: performed. Indicate the vr:iuc(rounded to the nearest dollar)of all CATEGORY C1F CONSi'RUCTIO mechanical materials,equipr.ient,labor,overhead,:nd profit. ITT &2-FamilydwellingCommercial/Industria) Value: S_ See Page 2 for Fee Schedule Accessory Buildin Multi-Family MIDER AL UI:PMENT/SYSTEMS�'EE" ULE Description ��ty_ Fee ea. Total Master Builder Other: ^Heatia Conlin _ SITE INFORMATION and LOCATION Furnace-add-on air conditioning•• _ 14.00 Job site address: % Gas heat pump__ _14.00 Suite#: Bld ./Apt. . Duct work 14.00 Project Name: N 14.00 tunic hot water system _ Residential boiler Cross street/Directions to job site: for radiator or hydronic system 14.00 Unit heaters(fuel,not electric) in wall,in duct,suspended etc. 14.00 Flue/vent for any of above) 10.00 Subdivision: #; Repair units _ 12.15 Other D!q Apj Women _ Tax ma / a ef#: Water heater _ 10.00 _ DESCMMON OF WItlRIC 7711 Gas fireplace 10.00 Flue vent water heater/gas fireplace)_ 10.00 -- — -- Log lighter ash10.00 ------- -- Wood/Pellet stove 10.00 Wood fire lace/insert 10.00 ChirnneyAiner/flue/vent 10.00 P.ROPERTYOWNER y T Other: 10.00 Name_ __ _Environmental_Exhaust&Ventilation Range hood/other kitchen equipment 10.00 Address: Z- Clothes dryer exhaust 10.00 Cit /y State/Zip:zg- �t �" Single duct exhaust Phone: / FaX: (hathroomr,toilet compartments, El _APPLICAWT '��` 'pU utility rooms) _ 6.80 _ Name: Attic/crawl space fans _ _ _ 10.00 Address: -- Other: 10.00 OtL+/State/Zip: i _` **($5.40 for Ont 4,51.00 each additional 4. Furnace etc. Phone: •• Fax: � --- --- Gas hest putM '• _ f- E-mail: Wall/suspended/unit heater •• . ` CC1MfiC'COIt____ -- Water heater Business Name: Fireplace •• roo Address: �_ BBQe .. �j City/State/Zip: _ Clothes dryer •• _ 9 Phone: Fax: Other: _ _ '• _ CCB Lic. #: __ Totu;: Authorized MechanicalPera dt PW Signature: ,Dater- s� Subtotal $ Minimum Permit Fee$7:.50 S Plan Review Fee 25%of Permit Fee S (Please print narne) State Surcharge(8%of Permit Fee) S _ TOTAL PERMIT FEE S _ Notice: This permit application expires If a permit Is not obtained within *Fee methodohW set by Tri-Canty Building Industry Service Board. 180 days after It has been accepted as complete. •^Site plan required for exterior A/C units. i:\Dsts\Permit Fora s\MecPenn4tApp.doc 01103 Mechanical Permit Application -City of Tigard Page 2 -Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fft: 51.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 51.52 for each additional$100.00 or fraction thereof,to and including$10,000.00. $101001. 525,000.00 5148.50 for the first 510,000.00 and S1.54 for each additional S100.00 or fraction thereof,to and including $25,000.00. _ 323,001.00 to 550, 00 $379 50 for the first S25,".00 and $1.45 for each additional$100.00 or fraction thereof,to and including $30,000.00. $50,001.00 and up 5742.00 for the first S50,000 and $1.20 for each additional$ .00 or fraction thereof. Assumed Valuations Per A lance: alue Total Description: Qty (EA) Amount Fumat,e to 100,000 BTU,including 955 ducts&vents Furnace>100,000 BTU including d--^.e 1,170 &vents Floor furnace includin vent 955 Suspended heater,wall heater or floor 5 mounted heatet Vent not included in ap liance 445 it units 805 <3 hp;absorb.unit, 955 to 100k BTU _ -- 3-15 hp;absorb.unit, 1,700 10:k to 500k BTU I5-30 hp;absorb.unit,50 to 1 mil. 2,310 BTU 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU __ \ >50 hp;absorb.uni >1.75 mil.BTU Air handlin uni 10 000 cfm 656 _ \ Air handlin u t>10 000 cfm 1,170 -Non-portable v 656 Vent fan c ected to a single duct 446 Vent syste not included in appliance 656 _pennit — Hood set ed b mechanical exhaust 65G Domestic incinerator _ _ 1,170 Com,nercial or industrial incinerator 4,590 IL Od-r unit,including wood stoves, 656 inserts,etc. Gas piping 14 outlets __. _ 360 N Each additional outlet 63 TOTAL COMMERCIAL S m VALUATION: W J is\Nts\Permit Firms\MecPerrnitAppP92.doc 01/03 N ..- tv Ile C 24) c/47) - io-1 , r� w -m �S� �/if•�c�se ft ,c�,�,r� w RECEIVED 4UG 2 ! 2003 � I rY OF fl(GARD 31 IILDING DIVIS(ON CITY OF TICARD SITE •ANREVIE W BUILDING PERMIT NO.: ....� -- NL.ANNIiJG DIVISION: Rryuired Seth"lrks: Approved' Gl Not Approved Side: 5— Sirvet Side: Lf — Not —29—. �:;,rttge: �0 Renr: Vigt,�� t:lenrance; A ,r•, ,1 �.1 Not Approved �1o�in,am ttititdim, Ne' ! t'� We .ider I,ettet I%`"Cluired:'2 L Yes No t� All,-QAllLlw.0-3 (lute: �� I:NG NEE R I N 6 Dr;PAR t;N I Actual Slope:—;L_% pproved [] Nut Approved Site 1'Inn: ..// E Approved [l jNot Approved Date; 4&Z Notes: C=ITY OF TIGARD 24-Hou/Lin BUILDING ® Inspect503)639-4175 MST C;'"KINSPECTION DIVISION Busine503)639.4171 BUPReceived _ Date R uested—__ AM —PM BUP Location &�1L_ — j-o� —Suite _ MEC - -- Cotact Person Ph(A ) d PLM _ Contractor �—_ Ph( —) SWR — BUILDING Tenant/Owner — ELC _ Footing Foundation L/ ELC Ftg Drain A�eR8D �j^ ELR _ Crawl Drain L_ Slab Inspection Notes: SIT ---- Post&Beam ---- _--�. Shear Anchors Ext Sheath/Shear Int Sheath/Sheb: _ Framing Insulation Drywall Nailing Firewall Fire Sprinkler — --- - Fire Alarm cusp d Ceiling -- --- - - Roof Other: -- --- -- - -- Final PASS PAR F FAIL -- - PLUMBING -- Post A Beam Under Slab - - - ----- Pough-In Water Service — -- Sanitary Sewer Rain Drains - - — - -- Catch Basin/Manhole Storm!Drain --- - Shower Pan Other- Final therFinal — PASS PART FAIL MECHANICAL Post&Beam Hough-In — -- — Gas Line Smoke Dampers — — -- -- - F- Z SS PART FAIL Ee" — ICAL —_— Service m Rough-In UG/Slab Uj Low Voltage Fire Alarm Final lJ Iieinspection fee of$___--_ PASS PART FAIL _required before next Inspection. Pey at City 125 8W Hell Blvd. _ _ SITE r1 Please call 1o, reinspection HE _______ - - Unabl Inspect-no acorn Fire Supply Line ADA G Approach/Sidewalk Dots /12 __ _-_ Inspector. Other: Final --- DO NOT N111101R this Il etlOe �elll tM . PASS PART FAIL CITY OF TIGARD 24-Hour 3 aIC� BUILDING Inspection Line: (503)e30.4175 INSPECTION DIVISION Business Line: 503 630.4171 Msz � SUP Received Date Requested_ LF_L____AM PM SUP Location ,� l� �0 � Shite MEC _ Contact Person — -�,,.Q-r�� Ph( ) o PLM _- w Contractor _ Ph( ) SWR BUILDING Terant/Owner ELC Footing ELC Foundation Access: —� Fig Drain ELR Crawl Drain Slab Inspection Notes: SIT Past&Beam Shear Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing — Insulation Drywall Nailing — Firrwall Fire Sprinkler — -- Fire Alarm Susp'd Ceiling -- Roof - Other: - - Final PASS PART FAIL 1103t&Beam Under Slab Rough-In Water Service Sani:sry Sewer Rain Drains Catch Basin/Manhole Storm Drain — Shower Pan Other:_ Final PASS PART FAIL MECHANICAL Post&Beam — Rough-In D. Gas Line Smoke Dampers N Final PASS PART S=AIL — -- -- J __ELECTRICAL ` Service Rough-In _— __-- W UG/Slab -j Low Voltage I.EimAlarm —� - _Tbp_ SReins required before next ins f S PART FAIL � �"tion fee of req inspection. Pay At City Hall, !`.125 5W Hall Blvd, SITE _ n Please call for reinspection RE:.— —. _-__--_ ��nable to In4o.,-no access Fire Supply Line ADAI Approach/Sidewalk �� 2 1 —-----— �ns'ealoe- � �✓" —�--- --- Other: Final DO NOT RIMM%iso In>sprd ftM!M job OR& PASS PART FAIL CITY OF TIGARD 24-Hour BUILDINGS � Inspection Line: (503)630-4175 � MST �b INSPECTION DIVISION Business Line: (503)630-4171 SUP Received _ Date Requested- a AM--PM— SUP _ location �-if:w/! .. Suite__ MEC Contact Person __`_ — — Ph(—) Ph( ) PLM _ Contractor Ph( ) SWR BUILDING TenanUOwner __ ELC Footing Foundation Arxess: ELC Ftg Drain / ELR Crawl Drain '7 Slab Inspection Notes: SIT _ Post&Beam Shear Anchors — Ext Sheath/Shear Int Sheath/Shear Framing Inf,ulatiorr Dr�,wall Nailing -- Firewall Fire Sprinkler — Fire Alarm n �y(L _ W�(Lm VJ cv— 6 Susp'o Ceiling ` -- Roof Ci Other: Final PASS PARI FAIL — — — PLUMBING Post&Beam Under Slab — Rough-In Water Service -- — — Se.nitary Sewer Rain Drains — — --- Catch Basin/Manhole Storm Drain -- Shower Pan Other: —' AS PART FAIL METIVANICAL Post&Beam Rnugh-M Gas Line Smoke Dampers - — Final PASS PART FAIL — — — ELECTRICAL Service —` Rough-In _ — UG/Slab Low Voltage Fire Alarm Final Reins ion fee of$_ required before next in PASS PART FAIL LJ P inspection. Pay et City Hall, 191 c5 SW Hall Blvd. SITE _ Please call for reinspection RE: --- _ Fj Unable to inspect--no access Fire Supply Line ADAa f Approach/Sidewalk DEW-10_ �"b __ _ In"toaN.K <—� ? • — Other: Final DO NOT REMOVE We 111111ARN0&M n NNd ftM"M job ON& PARS PART FAIL CITY OF TIGARD 24-Hour tL BUILDING Inspection Line: (503)639.4175 M3Tv7Q�.� _Od�T 1 INSPECTION DIVISION Business Line: (503)639.4171 BUP - Received — Date Requested-- — AM - PM . BUP Location _77- We MEC Contact Person — Ph PLM Contractor —__ _— Ph SWR - -- BUILDING Tenant/Owner ELC -. Footing ELC _ Foundation Access: Fig Drain = `�' ELR Crawl Drain Slab Inspection Notes: SIT —-- Post&Beam _ Shear Anchors `— — Ext Sheath/Shear — Int Sheath/Shear Framing Insulation Drywall Drywall Nailing --- Firewall Fire Sprinkler of - -- Fire Alarm Susp'd Ceiling Roof Other: PAS PART FAIL -PLUMBING - Post&Beam Under Slab — -- Rough-In 409 Water Service - — --- Sanitary Sewer Rain flrains Catch Basin/Manhole Storm Drain — Shower Pan Other: Final PASS PART FAIL MECHANICAL _ — - Post R Beam Rough-In -- - --- a. Gas Line Smoke Dampers Final PASS PART FAIL - ELECTRICAL — J_ Ser�lice _m Rouyh-In — C7 UG!�',iab W Low Voltage --- Fire Alarm Final neinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Rtvd. PASS PART FAIL SITE ❑ Please call for reinspection Unable to inspect--no access Fire Supply Line ADA Approach/sidewalk Other:_--_ Final DO NOT REMOVE thb IWIP" oe frem the job oft. 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