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10632 SW TUALATIN DRIVE S .),- S. W. TUALATIN DRIVE WA TF A vA F of . r rp .. Edtt M PAVLMtk1t Each or mvt<FAErIr too Or CURS d El. 101.11 �J !W)rWAt_K IOr OF Ct)np SIOEWALP, rJ - 101.59 EN MEtt 1525,00 A. I.7 5' N 73@47P5300 E r� smut t.lc,llt EL. 107. 8 I l` 02. 7�1 1 `J \ 11� 1 .11Y RISEP ^` ...-, \ \ l I1\ \ a� �. N It , , �T `a IFL o-le "00, 100117 1-10 i 9a I-0 T AL 1'..._ ""Now" CA vv W , �, ``--� C4 9A _T_ 1146 l_O .1 8 i i i i , NOTICE: IF THE PRINT OR TYPE ON ANY _rl._r� ll � � I � lili il � l � l � ililili 1111111 illi ililili ilili ( i ililili ► lillli Ililili tltllli ili � i � i � ililtll ililili illltll tltltll tl � lill II � IIII Il � Ill � lil � III 1111111 il � ill 1111111 /1 IMAGE IS NOT AS CLEAR AS THIS NOTICE, 1 3 4 _ -- -- -- -5 - - - -- - � - - - - 7 10 11 IZ `7 IT IS DUE TO THE QUALITY OF THE ti,, 36 ORIGINAL DOCUMENT --�� E 6Z �3Z LZ 9Z � Z fiZ EZ ZZ TZ UZ 6t SI LI 9t � I � t EI �It ti UI IEi 8 L 9 Z I �la�3w I I�Il �llilllllllliillll�lilllllllllllillil�illl �lllllllllllIII IIII�ILIIIII II illi IIII �Illllliiliiiillll 1111111 ! III illllll�llli ��llll�llll, 1111111 illillllllllllllllll �lll lllllll_LlJllllZLI_ III ill r CD rn W N N C d r_+ v m 1063;_ SW Tualatin Drive CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 f MST - .-1.... _ d_ `l• .. .. INSPECTION DIVISION Business Line: (503)639-4171 JUP Received _ Date Requested-_— a3 AM _ . --- - PM BLIP Location --__ __ � LO �� -- r �e..�+.. _ Suite _ o - - ( MEC -- - -- - - Contact Person - -- _ Ph(-------) - 7Q - I a- PLM _ Contractor_ ---- - - Ph(--- ) --- SWR - E'JILDING Tenant/Owner - - ELC Footing --J- - ELC Foundation Access' / y Fig Drain L_/� 0' K ELF! - Crawl Drain ",� Slab Inspection Notes: SIT Post&Beam - Shear Anchors Ext Sheath/Sheor -a -------------- Int Sheath/Shear Framing —- - Insulation J'/�/ Drywall Nailing - s Firewall Fire Sprinkler ze C & eT ISD S Fire Alarm G lrftJc/�Lc Susp'd Ceiling Root Other: na P PAR — uM_eI q I 6�0, S'/?g/ /2 Under Slab Rough-In Water Service - — --�-- Sanitary Sewer Rain Drains - Catch Basin/Manhole _ Storm Drain ---- -- — Shower Pan Other. ---- - _-- S PART FAIL _ NICAL — Post&Beam Rough-In - - - -- Gas Line Smoke Dampers A PARTFAIL - - - - - —_ --- AL — Service Rough-In UG/Slab Low Voltage - - — -- Fire larm S PART FAIL ❑ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. (TK _1 Please call for reinspection RE: —_ __ F_� Unable to inspect-nc,access Fire Supply Line - / Approach/Sidewalk PP Aoach/Sidewalk Date t -fnap4mtor -___. Ext 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 INTERSTATE ELECTRIC INC PO BOX 7342 SALEM, OR 97303-0068 Electrical Signature Form Permit #: MST2001-00472 Date issued: Parcel: 2S115AD-02700 Site Address: 10632 SW TUALATIN DR $30 Subdivision: DOVER LANDING Block: Lot: 008 Jurisdiction: TIG Zoning: R-4.5 Remarks: Construction of new single family detached residence.Path 1 advance framing. STREET OPENING PERMIT REQUIRED FOR ANY WORK IN RIGHT OF WAY Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical 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 Dept. No electrical inspections will be authorized until this completed form is received OWNER' ELECTRICAL CONTRACTOR: JAY MILLER BUILDER INC INTERSTATE ELECTRIC INC PO BOX 230459 PO BOX 7342 TIGARD, OR 97223 „",LEhi, :. 017303-00G� Phone #. Phone #: MBL 393-2223 Req #: LIC 117121 SUP 14795 ELE 24.354C AN INK SIGNATURE IS REQUIRED O 'THIS FO" Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE NORTHV';EST PREMIER PLUMBING P.O. BOX 23338 TIGARD, OR 97281 Plumbing Signature Form Permit #: MST2001-00472. Date Issued: Parcel: 2S115AD-02700 Site Address: 10632 SW TUALATIN DR $30 Subdivision: DOVER LANDING Block: Lot: 008 Jurisdiction: TIG Zoning: R-4.5 Remarks: Construction of new single family detached residence.Path 1 advance framing. STREET OPENING PERMIT REQUIRED FOR ANY WORK IN RIGHT OF WAY Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRAC—OR: JAY MILLER BUILDER INC NORTHWEST PREMIER PLUMBING PO BOX 230459 P.O. BOX 23338 TIGARD, OR 97223 TIGARD, OR 97281 Phone #: Prone #: 503-624-0582 Reg #: I Ir 135022 PI M 34-348PB AN INK SIGNATURE IS REQUIRED ON TRIS FORM Signature of Au orized Plumber If you have any questions, please call (503) 639-4171, ext. # 310 a � � c � a � o Glit, N N � N C o s y � y � � 0 3 O CITY OF TICARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST " O� q -7-2 INSPECTION DIVISION Business Line: (503)639-4171 BLIP -- _ ---- Received __Date Requested AM_. _ PM BUP - 1 Suite. _ MEC Location D�3 d-- — Contact Person - --- Ph( ) �� `�y1 PLM -- ___ I� _�_ ( ) SWR _. Contractor ' Ph *GILDING Tenant/Owner _. ELC - - — ELC Foundation Access: /� _ ELR Ftg Drain l_. V Crawl DrainSIT Slab Inspection Nates: Post&Beam - - - - Shear Anchors Ext Sheath/Shear "— Int Sheath/Shear __- Framing Insulation - Drywall Nailing Firewall Fire Sprinkler - Fire Alarm -- Susp'd Ceiling J -- Roof - Other:_--- -- -- - SS PART FAIL PLUMBING Post&Beam _ _-- Under Slab ----—�-- -- Rough-In — Water Service -- ---_ Sanitary Sewer Rain Drains --�--- ' Catch Basin/Manhole Storm Drain — —` Shower Pan Other: Final PASS PART FAIL MECHANICAL - -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 Unable to inspect-no access SITE Please call for reinspection RE: --- Fire Supply Line ADA I�Q AO Z Inspector Approach/Sidewalk Dste __�.. -- - Other: DO NOT REMOVE this Inspertlon record from the job site. Final PASS PART FAIL. MASTER PERMIT CITYOF TIGARD PERMIT#: MST2001-('0472 DEVELOPMENT SERVICES DATE ISSUED: 9/6101 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S115AD--02700 SITE ADDRESS: 10632 SW TUALATIN DR ZONING: R-4.5 SUBDIVISION: DOVER LANDING JURISDICTION: TIG BLOCK: LOT: 008 REMARKS: Construction FOR ANY WORK IN RIGHT-OF-WAY iadvance framing. STREET OPENING ERMI BUILDING 7 FLOUR AREAS SETBACKS REQUIRED REISSUE: STORIES: CLASS OF WORK: NEW HEIGHT: 27 FIRST: 926 sl BASEMENT: 48000 d LEFT. SMOKE DETECTORS TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,686 of GARAGE: 660 sl FRONT: 7U PARKING SPACES 1 RIGHT. TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: 573 sr VALUE: $351 147 4r REAR. OCCUPANCY GRP: R3 ISDRM: 5 BATH: 3 T01 AL: 3,185.00 sl PLUMBING 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS; SINKS: 1 WATER CLOSETS: 3 WASHING MACH CATCH BASINS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES. 100 SF RAIN DRAINS: 1 TUB'SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: t WATER LINES: 100 BCKFLW PREbTITR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL. FUEL TYPES FURN<100K: BOILJCMP<3HP. VENT FANS: 5 CLOTHES DRYER: I - HOODS: 1 OTHER UNITS: 1 (,AS FURN>•t00K: t UNIT HEATERS: VENTS: t WOODSTOVES: GAS OUTLETS: i MAX INP: btu FLOOR FURNANCES: ELECTRICAL — BRANCH MISCELLANEOUS ADD'L INSPECTIONS RESIDENTIAL UNIT SERVICE FEEDER .'EMP 5 200 sniEDER9 PER INSPECTION: 0 200 mpt WISVC OR FDR: i PUS.'"IRRIGATION: 1000 SF OR LESS: 1 0 200 snip: 201 400 amp:� 400 amp: PER HOUR 201 let W/O SVC/FDR: 00 SIGNfUUT LIN LT: EA ADD'L 500SF. SIGNALIPANEL: IN PLANT. 401 - 600 amp: 471 -600 amp: EA ADDL OR CTR: LIMITED ENERGY: MINOR LABEL. MANU HMISVCIFDR: 801 1000 amp. 801+3mos•1000v: 10004 amolvoll: PLAN REVIEW SECTION Rec—,led only: >•4 RES UNITS: 9VCIFDR>-225 A.: >600 V NOMINAL: CLS AREAJSPC OCC. ELEI.TRICAL-RESTRICTED ENERGY B.COMMERCIAL A.BE RESIDENTIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM INT ERCOMIPAGING: OUTDOOR LNDSC LT'. BOILER: HVAC LANOSCAPEIIRRIG: PROTECTIVE SIGNL: BURGLAR ALARM: OTH: CLOCK INSTRI 'J MEDICAL: OTHR: GARAGE.OPENER: DATA/1ELF.COMM NURSE CALLS TOTAL N SYSTEMS: HVAC: TOTAL FEES: $ 8,545.14 Owner: Contractor: This permit is subject to the regulations contained in the JAY MILLER DUILDER INC NEWCASTLE HOMES Tigard Municipal Code,State of OR. Specialty Codes and PO BOX 230459 PO BOX 230459 all other applicable laws. All work will be done in TIGARD,OR 97223 TIGARD,OR 97281 accordance with approved plans. This permit will expire H work Is not started within 180 days of Issuance,or if the work is suspended for more than 180 days. ATTENTION: Phone: Oregon law requires you to follow rules adopted by the Phone: Oregon Utility Notification Center. Those rules are set Rep N: lir 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)248-1987. REQUIRED INSPECTIONS Gas Fireplace Misc.Inspection Erosion Control Insp 8, Wtr Proofing Bsm't Wa Footing/Foundation On Framing Insp Insulation Insp Electrical Final Grading Inspection POat/Beam Structural PLM/Underfloor Shear Wall Insp Mechanical Final Sewer Inspection Post/Beam Mechanics Plumb Top Out Exterior Sheathing Inst Rain drain Insp plumb Final Electrical Service Low Voltage Water Line Insp Footing Insp Underfloor insulation r/SdWk Insp Final Inspection Foundation Insp Crawl Drain/Backwater Electrical Rough In Special Insp.required App Issued By A�,�'i,= J Permittee Signature : �� Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day CITYOF TIGARD SEWERCONNEC'-, PERM!T PERMIT#: 9/6/01 11 00245 DEVELOPMENT SERVICES DATE ISSUED: 9/6101 13125 SW ;:all Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S115AD 02700 SITE PDDRESS; 10632 SW TUALA IN DR$$0 SUBDIVISION: DOVER LANDING 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: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new single family residence. Owner: FEES _ JAY MILLER BUILDER INC Type By Date Amount Receipt PO BOX 230459 TIGARD, OR 97223 PRMT CTR 916/01 $2,300.00 27200100000 INSOP CTR 9/6/01 $35.00 27200100000 Phone: 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 t a 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 b 7 l �'J _ Permittee Signature: Y: _ Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day 8-23-2001 1O:39AM FROM JAY MILLER BLDR INC 503 684 0671 .2yS Buil(linLy Permit 1 ppUcaflon City of Tigard Datemceiveil: a) larmitno.: A'I'cvy7;�- t 1tyofYlgairf Addms&, 13125 SW IUB Blvd.Tigud,OR 97223 E'rolerderypLoa- �- BTtsdate: Phone: (303) 639.1171 Date icwcd: BY �lltsmpt nu.: Fax' (303) 598-1967 C sse flee no.: Paymesu type Land t1Se approval: t&2 family:Simple C miRbt: ---- ,A t do 2 funily dwelling or wmsv" L7 Cuano mialAncinstrial LIMulti-fatally ,110 Now conamcdcm U Derooliuou 0 Additiodaltcrahon/repla�cenirst U'Tenant improvement ❑Fite sptinkledalarm O Other. 3� Job addle&&:8) 2, S 14/:LU - a ___ Hld no: Suite no.: Lot Black: 3obdivuion_ (s/1 Telotlaccounr no Pmjeet tamea rn` - -- -- Deactipdon amd locabon of work cm rtcsmi wdspoci J ortexlltion9:. ------- MIKEMN Name: __..- Mailing address j r 1 d�2 fanft dweiHY1� City: - SratoU 7�' 71 S 1 _ Valuation of wont.... _.............»».......... $ _ Fax: $ ' y ( 7 E-mai. No.of bedroom&Ruche .... .. ..._...................» _ 1 Omvnces re tsave:J-" _rUi�S.�l Totxl number of floors............ ..a ne: to Ii ural: New dwelling area(sq-ft) .......��...... (iaragelearpm area(&q.ft.).........Sf.AQ... -Ys t} Covered porch arra(sq.ft.) .............. .. ... 1 Mailing&dtfteatr: Dock area(sq.fL) .._...._............................. (hirer stmctum area( ) Stsae: TdP ft ................. ..... City: r- ---- CommerdLlMr=trbRVmvA l-&mily: Valuation of wm t....................... .... ..._.__. r1Ci Fxistingbldg-&tea(aq.ft.) ................... . .. Badoess name: &I j Lc��)�_�fnm New bldg.area(sq.tt.) ......_.._. .. .....»... Addnms.: Number of ttnrfes..........._._.._.............. C-Ity: _ State: ZIP - Typo ofc4n&rsaction......._....... _......____..... Phone: Fax: I&tai. (k:cupancy gmap(&): Existing: OCB ? is _ _- Now: city/metro lic.no: Node&:All conuactos and eubam tacUn am requited to be boea&ed with the()egrm(intst uctlon Cun"11113 t Board tmckr Name ptoviaioos of ORS 701 and nay be requited hi be!textured in the Adams: - jutisdicum whereAt vmis being performed-If tilt applicant is State ZIP e.xwnpt from Bing the fbllawLag mason applies. (31y: - - Contact n: Pletm no.: --`-- Phone: Ftt _ &muL NAMC«acti tgn m: Fees due upw apokfidow.._... .-. _ ._.S Addtesa: [7aa trxeivexf Ammmtterrt.�t._. __._...._.__.-_._..S Phone:.. _ ; — lg. .i Plow rata to foe sdtafitlm 1 hereby caraft 1 have rrad end cXAmltred this rtppllL 26=ad f N«.n f ++e e.de dm v -A*bad.Ib o on r+er.ro. stwhed dgect-list- All prwiaforts Of lacus and omni=trots gaveUdng dill O An U NUKK " VPU&Will be arnrtplied hothar Wei a or wL Leaf ma,••�__ _ AndKirined &1jrmUtx� L 1W IJ. t oan1ToT-:. a.a.m s Prliv.trams i" hi :a J r1L&&L _ _ LL Natice:'flus permit egyliartfon atrpiure ifs peanut Is nut'rbte$med wfthln I l0(imp alltr it tar beat woeptr.J a armpleec. •+err MWtTJf 1� Electrical Permit Application -- Date received G Permit no.:)ti/xwel-ee;V7 City of Tigard Project/appl.no.: Expiredate: (.'thy„jTigard Address: 13125 SW Hall Blvd,Ti),ard,OR 97223 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598-1960 r .le no.: Payment type: Land use approval: TYPE OF PERMIT I & ' Family dwelling or accessory 0 Commercial/industrial 0 Mult'-fancily 0 Tenant improvement ONcw construction U Addition/alteration/replac-ement ❑Other. U Partial JOB SITE INFORMATION, Joh_address: / , 2 5 w 7L' y Bldg,no.: Suite no.: Tax map/tax lot/account no,; Lot Block; Subdivision: Project name: Description and location of ork on premises: Estimated(late of completion/inspection: Job no: Fee Max Business name: A Description I Qty. (es.) Total no.insp Audress: New residrntial-single or mule-famdv per dwelling unit.Incbttim attached garage. City: c State lC. ZIP: SeMccincmrierl: Phone: Pax: E-mail 10(x)sq.ft is 4 CCB no.: / Elec.bus. lic.no: Each additional 500 sq.It.nr porton thereof I.rnited energy,residential 2 City/metro IIc, no.: limited Fnergy,non-residential 2 Bach manufactured home or modular dwelling Signature of supervising electrician(required) pate Service and/or feeder , Sup.elect.name(print): I License no: Services or feeders-installation, PROOFRTY OWNEFJ alteration or relocation: 200 amps or less 2 Name(print): 201 amps to 400 amps 2 Plailing address: --- — 401 amps to 600 imps 2 te01 amps mW IO -cps 2 City: Stale: ZIP: Over 1000 em s or, Its 2 Phone: Fax: E-mail: Reconnect onl I Owner installation:The installation is being made on property I own Temporary services or freden- which is not intended for sale,lease,rent,or exchan,pe according to installation,alteratlon,orrelocation: ORS 447.455,479,670, 701. 2W amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 ams 2 Branch circuity-news alteration, Name: or extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: State: ZIP: B. Fee for branch circuits without purchase Phone: Fax: E-mail: of service or feeder fee,first branch circuit: 2 Each additional branch circuit: Misc.(Service or feeder not included): 11 Service over 225 amps-comra.rcial U Health-care tactiny Each pump or irrigation circle 2 0 Service over 320 amps-rating of 1&2 0 Hazardous locauon Each signor outline lighting 2 family dwellings 0 Building over A000 square feet four or Signal circuit(s)or a limited energy pnnel, 0 System over 600 volts nominal more residential units in one structure alteration,or extension* 2 0Building over three stories 0 Feeders,400 amps or more •Description: -7 0 Occuptuu load over 99 persons 0 Manufactured structures or RV park Fin.h additional Inspection over the nllowable in any of the above: 0 Egresallighting plan U Other —— Pennspecuon Submit— sets of lata with an of the above. T Plans Y Investigation The above are not applicable to temporary construction service. Other Not Al jurisdtctirwu accept credit cards,please call mnsd,ctiom trw rm"information. Notice:This permit application Permit fee..................... ❑visa U M^sterCard expires if a permit is not obtained Plan review(at — %) S Credit card numtwr within IRO days after it has been State surcharge(8%) ....$ Name of unlholder is shmvn on,tedn card c`p11es accepted as complete. TOTAL S —s. rdholda uanuhar �—N--�— -- Amount 440.4613(60"M) I ANN Electrical Pr -mit Fees: Limited Energy Fees: i — TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00 Number of;ns ections per permit allots ed (FOR ALL SYSTEMS) Service included: Items Cost Total y Check Type of Work Involved: Residential-per unit 1000 sq M.or less $145.15 _ 4 ❑ Audio and Stereo Systems Each additional 500 sq.ft or portion thereof $3340 1 ❑ Burglar Alarm Limited Energy _ $75.00 Each Manurd Home or Modular � Dwelling Service or Feeder $90.9u , 2 C I l— Garage Door Opener' Services or Feeders C Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 _ 2 201 amps to 400 amps $106.85 2 j Vacuum Systems' 401 amps to 600 amps $160 b0 _ 2 601 amps to 1000 amps $24060 2 Other Over 1000 amps Or volts $454.6`; _�r 2 Reconnect only _ $66 e5 _ 2. Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL. ONLY Installation,alteration,or relocation Fee for each system.............................................,.... ... .. $75.00 200 amps or less $66.85 2 (SEE OAR.918-260-260) 201 amps to 400 amps __ $10030 _ 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volis, see"b"above. ❑ Audio and Stereo Systems Branch Circuits ❑ New,alteration or extension per panel Boiler Controls a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder foo. Each branch circuit _ $6.65 2 ❑ Data Telecommunication Installation b)The fee for branch,circuits without purchase of service ❑ Fire Al,rn Installation or feeder fee. First branch circuit $ori 85 Each additional branch circuit $6.65 ! ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation r"ircle _ _ $53.40 Intercom and Paging Systems —_ —1 Each sign or outline lighting $53.40 L—J ,ignal circuil(s)or a limited energy (� panel,alteration or extension $75.00 LJ Landscape Irrigation Control' Mirk,Labels(10) $125.00 _ 1 F ;h additional inspection over M ❑ Medical F-,-.h the allowable in any of the above C7 Per inspection $62.50 L Nurse Calls Per hour _ $62,50 _ In Plant — $7375 ❑ Outdoor Landscape Lighting' Fees: El Protective Signaling Enter total of above fees $ ❑ Other 8%Stata 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 S _ Trust Account# 8%State Surcharge S --- - — --- --_ Total Batonce flue S, d�l• I�„rnc�,•Ir 1i•,• �i, 101100,00 Plumbing Permit Application ,� d Dtue rnceived-t � Perrrdt no.:Nr' City Of Tigard gewerpermit no.: Building permit no.: Address: 13125 SW hall Blvd,"Tigard,OR 97223 Ci.y of Tigard Phone: (503) 639-4171 Projut/appl•no.: Expire date: Fac: (503) 598-1960 Date issued: By: Rsceiptnr..: Larid use approval: Case file no.: Payment type: _ OF PERM IT 1 dt 2 family dwelling or accessory U Commercial/industnal U Multi-family U Tenant improvement New construction LJ AcldiUurt/:.dteraticrr�/repla.rment Cl I •,1 service ❑Other: _ 1t 1 r r specWlnformal Job address: 5 LL) 7 L)6 / t/; Dtwcri tion ()t . Fec(ea.) Total Bldg.no.: Suite no.: New 1-and 2-family dwellings only: Tax map/tax lot/account no.: - (includes 100 ft.for each r.tilityconnection) SFR(1)bath Lot: Block: Subdivision: 6 V U 1_ CI i SFR(2)bath ---�-- - - Project name: SFR(3)bath City/county: ,h I 71P: ('1-) 2_- additional bath/kitchen Description and location of work on premises: Siteududes: Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drainPLUMBING _ -'- CONTRUTOR Footing drain(no.lin.ft.) Manufactured home utilities Business name: d/ Manholes AddM.-_L j Z36 y Z 3-3 :,4 Rain drain connector City: State - -1 ZIP: "]G5 f Sanitarysewer(no. lin. ft.) -- — Phone: C Fax: E-mail: Storm sewer(no. lin. ft.) CCB no.: Plumb.bus.reg. no: Water service(no. lin.ft.) City/metro lic.no.: Fixture or Hem: Contractor's representative signature: Abso tion valve Back flow reventer UONTA(7 PERSON Print name: Date: Backwater valve Basins/lavato - Name: Clothes washer Address: — Dishwasher Drinking fountain(s) City- State: _ ZIP: Ej:-ctors/sum — Phonc: Fax: E-mail: Expansion tank -- Fixture/srwer cap - Name(print): Floor dratns/lloor sinksthub Mailing address: Garbage disposal V a bibh City: State: IP: Ice maker - Phone: Fax: H-mail: Interce tor/ rease trap Owner insW[adon/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 property I own as per ORS Chapter 447. Sink(s),basin(s),lacs(s) Owner's signature _ Date: Sump Tubs/showedshower pan _Name: Unnal - ---- Water closc-t _ Address: W iter heater - city _ State: ZIP: Other: - Phoue: Fax: E-mail: Totsi Not dt*bdk-fiom wcM Ln&t cad..vtean citl iurW"oo Tor n idarmaianMinitnum fee......_........S Notice: Iltis nermtt application - _ vvisa U MtsterCrutt expires if a ixrmit isnot obtained Plan review(at _ %) S — ceatt card armbcr _�_. _._�_-- within 180 days after it has been State surcharge(896) ....S Fapirn accepted as complete. TOTAL.......... ...........S — N.me d catdtolder..dwre oa credit and P P _ L Cahot dder rip sum Amount 440.4616(fr(XW0h11 PLUMBING PERMIT FEES. 'i+ �� 1^ IIN' -• ' `� – ,RICE.; •TOTAL Never pond 2-farhilly dwellings only: �. :A};:� FIXTURES ndlviiilie1) �� "'�' <(lTY ea?.a AMOUNT "IfInclido641111 plum6in4;flxtureain if pRIC Sink 16.60 the Q and:theflrstf0o R. r(eaj M UNr `foraach utili -t?onnectCon^• '- ''''� a+„ let . y,,,•. Lavatory 16.60 _ One 1 bath $249.20 Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 Shower Onty 16.60 Three(3)bath $399.00 Water Closet - 16.60 - SUBTOTAL _ Urinal — '6.60 8%STATE SURCHARGE Dishwasher 16.60 _PLAN REVIEW 25%OF SUBTOTAL TOTAL Garbage Disposal __-- -- 16.60 Laundry'fray - 16.60 Washing Machine 1660 FloorDrair,/FloorSink 2- ---- - 16.60 PLEASE COMPLETE: 3" 1660 4- 1660 -- "_Water Heater O jjnvarslon _O like kind 1660 - Quantitlr b Work Performed Gas piping requires a separate mechanlrm1 Fixture Type: Now Moved Replac,)d Removed/ ermit. _ _- ___ ._ _..._ -• -- -__-- Capped MFG Nome New Water Service 46.40 MFG Home New San/St onn Sewer _ 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 _ _ Combination _ Roof Drains - 16 60_ - Shower Only Drinking Fountain _ 16.60 Water Closet - 16,60 Omer Fixtures(Specify) _ - -- Dishwasher -Garbage Disposal - -- — Laundry Ro Tray _ — - -- - -- Washing V.chine ___ __. - _._. -- Floor DrainlSink 2" Sewer-1st 100' 5500 3" -- Sewer.each additional 100' - 4640 4" _- Wrier Service-1st 100' 55.00 Water Heater - -- --_ Water Service-each additional 200' 45.40 -- Other Fixtures Storm&Rain Drain• 1st t00_' 55.00 _ _Storm-&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 - - - -- - Residential Backflow Prevention Devine• -7 27.55 --�- Catce.Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Roquested Inspections - per/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 ___ _____-_"__ _-__-�-•- Grease Traps - - 16.60 -- ---------- -_ QUANTITY TOTAL — Iscmetric or riser diagram is requimr!11 — 'SUBTOTAI ---� 8%STATE SURCHARGE VI-AN REVIEW 25%OF SUBTOTAL R wrTJ only d fixture r Intal is TOTAL .Minimum permit fit is$72.50�8%state surcharge,errnpt Residential Backf(w Pfmv"Wn DC-Ace,which is f.'ie 25•a%state fsurchar?e. 'All New Commercial Buildings requires plans with Ilninetoc or mer r lagram arM plan revfev, I hdsl3lforni3lplm-fees.doc 1N10/00 Mechanical Permit Application Date received:7y ) Permit no.:rl!rel City of Tigard Prolect/appl.no.: Expire date: Bar Ory xl Ti d Address: 13125 SW Hall Blvd,Tigard,OR 972'23 b Phone: (503) 639-4171 Date issued: By: Receiptno.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _ _�_—__--- Building permit no.: 1 I &2 famil) dwelling ora.cessory U Commercial/industrial U Multi-family 11 Tenant improvement New construction U Add ition/aIterauon/re placement U Other. - 1SCHEDULE Job address: 5 v✓ Z C1 Zia- Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: — profit. Value$ ____—__ Lot: & JSubdivision:_ ,vey L(oCLt'/1� 'See checklist for important application information and Project name: jurisdiction's tee schedule for residential permit tee. City/county: ?Ca"d wq ZIP: 7-Z2 Description and location of work on premises: I k lilt LKINWIPINliqI Pee(ea.) ftNal Est.date of completion inspection: 7oierkr D�vcription try HM-itnlY RGvo�Y Tenant improvement or change of ure: Is existit+.g space heated or condil.ic•u,:.1?U Yes []No ngunit -CFM 'oning(Rite�Tanrcgwrcd) Is existing space insulated?U Yes CI No •.,�existi—ng HVA system _ mpressors Business name: F wn-S C State I oiler permit no.: HP Tons_ R'I'U/H Address: al,,X it smu a dampers/duct smoke detectors City: a �State: ? ZIP: ZC eat pump(site an re uire ) C Fax: E-mail: nsta rep ace furnac umer / Phones`7 7 Including ductwork/vent liner O Yes O No CCB no.: 132 _ _ Instal Vrep ac re ocateheaters-suspen e , City/metro lic.no.: _ J —� wall,or floor mounted Name(please print): K113 KIM 103ITIIIZ� Rint fora �lance other than furnace e rigerat on: v— Absorption units __. BTUiH Name: Chillers. Address' Compressors-- Environmental om ressors _onmenta exhaust and ventilation: City: a^� State: ZIP: _ LL Appliance vent Phone: Fax: E-mail: )ryerex aust _ IT-KOs,Type res.kitchenihazmat _ hood fire suppression system Naim: _ _ Exhaust fan with single durt(bath fans) Mailing address: iExhaust systema art rorn eenting or A City: -- —� — ---�„�_'e: Z1P— — Fuel piping andistribution(up to outlets I _ — _�� type: LPG NU Phone: Fax: E-mail: f ueia in each additional over 4 outlets Process;piping(sc ematic require ) Number of outlets _Name: _ _ t appliance orequipment: Address: _ _ Decorative fireplace City: __ State: ZIP: _ n_�-�Y�_ -- - Phone: Fax: - E-mail: — std Dov pellet stove t er: Applic,uit's signature: — Date: Name ,print) Na all jtuizdjctHnt swept Ln%it cards,please cau paiseicrim far moteInttxnwion. Permit fee............ ........ rl Visa p MasterCard Notice:'ibis permit application Minimum fee............... $ expirrs if a permit is not obtained Plan,-view(at ___ %) $ Credit said mmt+er. __--------_._.�--- .---�1.-_._ within 180 days after it Inas been ---- State surcharge(896) ....$ "rrte of mritmider u tiwnm m cmdn cmd accepted as complete. ---'— _Cardholdertiputwo _� — Amoam— 440-4617(WWOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TO'iALVALUATION: FEE: Description: - - Price Total $1.00 to S5,000.00 :ainirnum fee$72.50 ic Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 9TU - $1.52 for each additional$100.00 or including ducts&vents 1400 fraction thereof,to and including 2) Fumace 100,000 BTU+ ___ $10,1000 00. includingducts&vents 1740 $10,001.00 to$25,00_.'10 $148.50 for the first$10,000.00 and 3) Floor Fumace $1.54 for each additional$100.00 or including vent 1400 fraction thereof,to and including 4) Suspended heater,wall heater --- $25,000.00 _ or floor mounted heater 1400 $25,001.00 to$50,000AO $379.50 for the first$25.000.00 and 5) Vent not included in appliance permit --- $1.45 for each additional$100.00 or 6.60 fi- ;tion thereof,to and including 6) Repair units __ 50,000.00. _ $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply. :Boiler Heat Air 12 1, $1.20 for each additional$100.00 or For Items 7-11,.zee or Pump Cond fraction thereof T footnotes below. C.om ' �• <3HP;absorb unit -- ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00 Value Total 8)3-15 HP;absorb tkiscription: _ O _� Amount unit 100k to 500k BTU _ 25.60 Fumace to 100,000 RTU,including 955 9! 15-30 HP;absorb - -- oucts&vents /nit.5-1 mi!BTU 35.00 Furnace> 100,000 BTU including 1,170 10)30-50 HP;absorb ducts_&vents unit 1-1.75 mil BTU 52.20 Floor fumace including vent 955 11)>50HP:absorb Suspended heater,wall heater or 955 unit>1.75 mil BTU 67 20 floor mounted heater 12)Air handling unit to -- Vent not included in applicance 445 10.00 __Eermi: 13)Air handling unit 10,000 CFM+ Re air snits _ 805 1720 <3 ho;absorb.unit, 955 14)Non-portable evaporate ci oler tq 100k BTU _ 10,00 3-15 hp;absorb.unit, i 1,700 - 15)Vent fan connected to a single duct _- 101k to 500k BTU _ 680 15-30 hp;absorb.unit,501k to 1 2,310 16)Ventilation system not included in mil.BTU appliance permit 1000 30-50 hp;absorb.unit, 3,400 -- 17)Hood served by mechanical exhaust - 1-1.75 mil.BTU _ 1000 >50 hp;absorb.unit, 5,725 -- 18)Domestic incinerators _ >1.75 mil.BTU 1740 Air handling unit to 10,000 cfrrl 656 �- 19)Comme.,;ial or Industrial h;Ne in, ator Air handling unit>10,000 cfm 1,170 `--- 6995 Non-portable evaporate cooler 656 20)Other units,including-wood - Vent fan connected to a single duct 446 1000 Vent system not induded in B56� 21)Gas piping one to four outlets - appfiance permit 5.40 Hood served ty mechanical exhaust 656 22)More than 4-per outlet(each] Domestic incl lerator 1,170 1.00 Commerclal ur indusMal I dnerator 4,590 Minimum Permit Fee 572.50 -SUBTOTAL: - Other unit,inc'uding wood stoves, 656 inserts,etc. 8%State Surcharge E Gas I in 1-4 ououl ats _ 360 E?rh add;donal_outlet 83 25•/.Plan Revlew Fee(of subtotal) $ T" Required for ALL commercial permits only TOTAL COMMERCIAL f, - VALUATION: TOTAL RESIDENTIAL(PERMIT FEE: $ mer Inspection and Fses: �y 1 Inspections oulsido of normal business hours(minimum charge-"hours) $72.50 per hour 2 Inspections for which no fee is specifically indicated (minimum charp"alf hour) $72.50 per hour Additional plan review required by changes,additions or revision-to pians(m.:-mm charge-one-half tour)$72.50 per hour *State Contractor Boller Certification required for units>2e0k BTU. "Residential A/C requires sits plan showing placement of unit. i.wstsvrr-mslmectl-fees,dw, 10/11/00 SEE 35MM ROLL # 20 FOR OVERSIZED DOCUMENT