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10640 SW DEL MONTE DRIVE-1 . 5 a -- Property one I 22D I I i N I _ (AW crag) 100'-0" I . ..._..__._._�.._�.a _........_.....___,. ...._ . . . . - 11'-0^ ._ NOW , Property MOW OW ' lire C —MINK■~ .. Property line 1000 Gal. Silk fence AIN concrete to be septic tank Inst. here . 1 301-04 14 Q' (Existing house ) l 62'-0" 210 Simon Pham 10640 SW Derry Dell ct -�- - Tigard OR 97223 - _ H: 503-69M591 Mobil: 503-999«8991 N1. Propline Sheet 5 of $ 1. ertInst, erosion control, silk Site Plan fence, before mavation. scale: /16" w1 f fl ,..�w�.y,yt.WM�l4rp...N.1.H.w.M.... ay. „ :... .,.n... . . ..M.JnW..._.....-......r......... _ � . NOTICE: IF THE PRINT OR TYPE ON ANY rl-ritl � iii iii il � � � l � Ali tl � Ali � ( � SII I r ► II � I � � 1r- I r1-� Ilr Ilt Ilt ill Ill III Ilt Ilt Ilt tit t I ill III IIS _t.rt rTr �.� , !._ 1W-1 f 1 f 1 I 1 I I I I I r I Ili i i I i 1 I I I I ( I I n T I IJillll !IMAGE IS NOT AS CLEAR A T + i S HIS NOTICE, ---_ _--- ------ x ------_ _Z _—�---_- ------4 --_ -- 5 6 __ --- -- � - �U � 1 �� /1�7� IT IS DUE TO THE QUALITY OF THE ORIGINAL DOCUMENT . Jo.36 F 6Z SZ LZ 97, � Z fiZ EZ Z TZ OZ 6 [ 8T LT 9T 5T -- I ZI TT [ - 6 � L I y Ilii lllillll 111111!III!IIIIIIIIIIIIII!Illllllllll!'►�ll�lll 11111Llliillll. � I I I � � I � I 1 ,111111, ill11111111111111111II11�1111IIII .1111111. III� IIIlliiilll� IIII1111 (III1111 !1-�l �l Il1i1111 ...III�I 1.111►lllllll�Illlll ll�l �� 1.11.�1II_I I►I iII�►Il P ° 1 3 r �I ' 1 a � ' l a I f i j I i 10640 SW CITY OF 'TIGARD BUILDING INSPECTION DIVISION MST 24-11our Inspection Line: 639-4175 Business Line: 639-4171 � BUP _ Date Requested ' _AM�j&PM BLD Location_ _ �I U r? 1 Suite CM C-) C00 - cyxy 2- Contact Person 1��C�lC��- Ph _!^�� ' - PLM — Contrsctor_ Pri _ SWR _ B I J 1Y4 G__ Tenant/Owner ELC _ Retaining Wall ELR Footing Access: i Foundation �� -SIX-T roc, LA,r FPS _— Ftn Drain SGN grew!Drain Inspection Notes: Slab --_ --- --- —�_..----------- SIT Post K Beam — -- Ext Sheath/Shear Int Sheath/Shear Framing -- ---- — --- - -- Insulation Drywall Nailing F firewall Fire Sprinkler Fire Alarm Suso'd Ceiling --- ----- _ __ --� Root Mise --- -- ----- Final - - PASS PART FAIL ----- - --- — — PLUMBING Post KBeam -- ------ ---- — __ -- Under Slab ----- -- ------ ---- -- --- Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL Post& Hes+ni - - ------ - -- - - --------- ------- ---— Rough In Gas Line ---- — - --- -- -------- Smoke Dampers it -- ---------------..-- -- ------------ ----- - F7A-S,'P PART FAIL Service, Rough In UG/Slab Low Voltage Fire Alarm _- Final PASS PART FAIL ------ --_...------ -- --- - -- --SITE Backfill/Gradino -------- ---______._._.--- - -------------_ Sanitary Sewer Storm Drain [ ] Reinspection fee of$ required before next inspection. Pay at City Hall, 1317.5 SW Hall Elv.i Catch Basin Fire Supply Line I ] Please call for reinspection RE ( ]Unable to inspect no access ADA IIll Approach/Sidewalk — Date /A V Inspector lam^ _ Ext f Other - -- - - -- ------ - f mal PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF I I G A R D MECHANICAL PERMIT DEVEI OPMENT SERVICES PERMIT#: MEC2000 00012 13125 SW Hall Blvd., Tigcrd, OR 97223 (503) 639-41171 DATE ISSUED: 01/11/2000 PARCEL: 2S 103DA-03000 SITE ADDRESS: 10640 SW DERRY DELL CT SUBDIVISION: DERRY DELL PLAT 2 ZONING: R-3.5 BLOCK: LOT: 032 JURISDICTION. TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF- UNIT HEATERS: VENT FANS: OCCUPANCY GRP: 113 VENTS W/C,APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: _ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE_: 50 + HP: CLO DRYERS: FURN = 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 c1m: Remarks: REPLACE EXISTING GAS FURNACE WITH LIKE KIND. Owner: _ -— FEES — OLIVER, MILTON Type By Date Amount Receipt 10640 SW DERRY DELL CT PRMT GEO 01/11/20( $50.00 00-321074 TIGARD, OR 97223 5PCT GEO 01/11/20( $4 00 00-321074 :'hone: v Total $54.00 Contractor: ACME HEALING SERVICE RANDAL.L OLE STEWART PO BOX 375 REQUIRED INSPECTIONS OREGON CITY, OR 97045 Heating Unt Insp Phone:657-7036 Final Inspection Reg #:LIC 39357 0RIGINAL This permit is ;ssued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0017 through OAR 952-001-0080 You may obtain copies of-thes"les or direct questions to OUNC by calling (503)246-9189. Issue By: Permittee Signature: Call (503) 9-4175 by 7:00 P.M. for inspections needed the next business day Plan Check 0 _ CITY OF TIGARD Mechanical Permit Application Rec'dBy 13125 SW HALL BLVD. Comr iercial and Residential Date Rec'd TIGARD, OR 97223 Date to P E (503) 639-4171, x304 ^— Date to DST Print or Type y ��v PermitltAlfeAW0-LW1jF _ Incomplete or ill_eg;ble applications will not be accepted Called Name of Deveiopmenl,'Pro)ed w Oescrlption Table 1A Mechanical Code Cit Price Amt +i' Job Street Address L t- Swte# _A) Permit Fee �''taq4'1*. 16.00 1) Furnace to 100,000 BTU Address i `) I �' ' ,'E'Q including ducts&vents _ see f^_ot_note 1,2 9.65 Bldg# P\!LI nylStatd Zip 2) Furnace 100,000 BTU+ 2 2Z including ducts&vents see footnote 1,2 12.00 Name for name of business) 3) Floor Furnace Owner �1 t I_ { �� ,\ o rr l including vent see footnote 1,2 9 65 Melling Address r 4) Suspended heater,wall heater or floor mounted heater see footnote 1,2 965 l ``((� r�i`C 5) Vent not included in appliance permit _ _ 4 7.5 city/State Zip Phone r3heck all that apply, 'Boiler Heat Air 1nQC >>7 3 l C For Items 6-10,see or Pump Cond City Price Amt Name lor name or business) footnotes 1,2 _ Comp _ 6)<3HP,absorb unit to 100K BTU _ _ 965 Occupant Mailing Address 7)3-15 HP.absorb unit 100k to 500k BTU _ 1765 _ City/Stale Zip Phone 8)15-30 HP,absorb unit.5-1 mil BTU 24.15 Name — -- 9)30-50 HP,absorb Contractor r� unit 1-1 75 mil BTU 36 Ou f�` L, l cJIC 10)>50HP,absorb unit Prior to permit lMailingAddresa >1.75 mil BTU _ 60 15 issuance,a copy `0 11 Air handling unit to 10 000 CFM of all licenses Cny/Stale 21p Phone 7,00 are required K 0'� C (aJ t:,1. �7 S 7 7C)?, ' 12)Air handling unit 10,000 CFM+ expired in COT Oregon Cdnst.Cont Board IJc# Exp Date _ _ _ 11,85 _database J C 1 ci _ 'o 6 13)Non-portable evaporate cooler Architect Name7,00 14)Vent tan connected to a single duct Mailing Address _ 4 75 Or 15)Ventilation system not included in appliance pen•ut _ 700 Encgineer Coy/State zip Phone 16)Hood server;by mechanical exhaust 700 Describe work to be done: c 17)Domestic incinerators R�(� (Pc t- ck A. :1' ti 'c t _ 1200 New O Repair O Replace with like kind. Yes 6<0 O 18)Commercial or industrial type incinerator Residential O Commercial U 48.25 19)Repair units Additional information or description of work __ 8.40 20)Wood stove/gas FP/other units/clothe dryer/etc 7.00 _ NOTE: For Commercial projects only,Units over 400 lbs.require 2.1)Gas piping one to four outlets structural gas talcs_��_�� See footnote 1 _ 3,75 Type of fuel oil O natural pas; LPG O electric O 22)More than 4-per outlet(each) _ 75 Minimum Permit Fee.50.00 SUBTOTAL is a I hereby acknowledge that I have read this application,that the information 8%SURCHARGE _ given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTO FALi 4: the owner,that plans submiPe'are in compliance with Oregon State laws __ Required for ALL commercial permits only3 r TOTAL .; r .Sig tura of OwnerlAge t _ Date � Other Inspections and Fees: l I 17 rw 1. Inspections outside of normal business flours(mininum charge-two Contact Person Nalrine Phone hours) $50.00 per hour r 2 Inspections for which no fee is specifically Int icated (minimum charge-halt hour) $50.00 per hour Foonotes for commercial projects only: 3. Additional plan review required by changes,additions or revisions to 1 Provide full schematic of existing and proposed gas line and pressure plans(minimum charge-one-half hour)$50.00 per hour 2 Provide drawings to scale showing existing and proposed mechanical units 'State Contractor Boiler Certification required -- — -- -- -- "Residential A/C requires site plan showing placement of unit I\mechperm doc rev 7/19199 CITY OF TIGARD _ MASTER PERMIT PERMIT#: MST2003-00043 DEVELOPMENT SERVICES DATE ISSUED: 2/24/03 13125 SW Hall Blvd.,Tigard,OR 97223 (503) 639-4171 SITE ADDRESS: 10640 SW DERRY DELL CT PARCEL: 2S103DA-03000 SUBDIVISION: DERRY DELL PLAT 2 ZONING: BLOCK: LOT, n;' JURISDICTION: I I( REMARKS: Addition of 1050'family roorn. BUILDING REISSUE: STORIES. FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT n FIRST: I OSI at BASEMENT: at LEFT: 44 SMOKE DETECTORS: Y TYPE OF USE: SF rLOOR LOAD 0 SECOND at GARAGE. 0 of FRONT: 0 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS I 1RM at RIGHT: 11 000 00 OCCUPANCY GRP: R3 BORM: (, BATH �� TOTAL: t 05 at VALUE: 42, REAR: 0 PLUMBING SINKS: 0 WATER CLOSETS WASHING MACH: a LAUNDRY TRAYS: RAIN DRAIN: 0 TRAPS: LAVATORIES! n DISHWASHERS t FLOOR DRAINS: SEWER LINES 0 SF RAIN DRAINS: 0 CATCH BASINS: TUBISHOWERS: a GARBAGE DISP: r) WATER HEATERS: 0 WATER LINES: 0 BCKFLW PREVNTR: 0 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIL/CMP<9HP: VENT FANS: 0 CLOTHES DRYER: 0 GAS FURN—100K UNIT HEATERS: HOODS: 0 OTHER UNITS: 1 I MAX INP: btu FLOOR FURNANCES. VENTS: 0 WOODSTOVES: GAS OUTLETS• ' ELECTRICAL RFSIDENTIAL UNIT SERVICE FEEDER _TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 0 200 a . 0 200 amp: WISVC OR FDR: IMT PUAIPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: a 201 - 400 amp 201 400 amp: tat W/O SVCIF DR: SIGNIOUT LIN LT: PER POUR: LIMITED ENERGY: 401 - 600 amp. 401 - 600 amp: FAADDL BR CIR: SIGNAL/PANEL: IN PLANT MANU HMISVCIFDR: 601 - 1000 amp. 601-amps•1000v. MINOR LABEL: 1000.amplvoll 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 rr,STEREO: VACUUM SYSTEM: AUDIO R STEREO: FIRE ALARM INT ERCOMIPAGING. OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK INSTRUMENTATION: MEDICAL OTHR. HVAC: DATAITELE COMM: NURSE CALLS TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 980.15 SIMON PRAM OWNER This permit is subject to the regulations contained in the 10640 SW DERRY DELL CT Tigard Municipal Code,State of OR. Specialty Codes and 10640 S, D RY all other applicable laws. All work will be done In accordance with approved plans. This permit will expire If work is not started within 180 days of issuance,or if the work Is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Phone 503-998-8991 Phone: Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through 952-001-0080. You Reg 0: may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. r� �nj•-�� $ REQUIRED INSPECTIONS Erosion Control Insp 8, Crawl Drain/Backwater Shear Wall Insp Rain drain Insp Footing Insp Mechrinical Insp Exterior Sheathing Insf Electrical Final Foundation Insp Electrical Service Gas Line Insp Mechanical Filial Post/Beam Structural Electrlc-4l Rough In Gas Fireplace Building Final Post/BepjwMechenica FraminC Insp Insulation Insp r / ISSII d By : o _ Pf>rmittee Signature : ->✓'� c C.�- i —� Call (503) 639.4175 by 7:00 p.m. for an inspection needed the next business day FOR OFFICE tlSE ONLY Building e'er ' aRon teceiced � Ituit,bng t �� V r_ - Date/B l - a, -O I'erm:t No. Cit Of rrl and Planning Approval Other y g Date/By: Permit No.: 13125 SW Hall Blvd. JAN 2 8 2003 Plan Review — Other O Tigard,Oregon 97223Date/B : Permit No.: U Phone: 503-639-4171 M?M'9R1Vl D Post-Review Land Use fi0 Date/By: _ Case No. Internet: WWW.CI.tlgard. Contact v Juris. lice Page 2 for- 24-hour Inspection Request: 503-639-4175 Name/Method: Sri�It emental Infunnrtlon TYPE OF WORK — T REQUIRED DATA: New construction ___ Demolition I &2 FAMILY DWELLING p -Addition/alteration/re Im aceent 0 Other: — CATEGORY OF CONSTRUCTION Note: Permit fees'are based on the total value of the work performed. Indicate i & 2-Familydwellin Commercial/Industrial the value(rounded to the nearest dot'ar)of all equipment,materials.labor, overhead and profit for the work indicated on this application. FAccessory Building Multi-Family OR GirR�, Master Builder Other: Valuation..................................... y ................ S I JOB SiTE INFORMATION and LOCATION No.of Arooms: •— No.of baths: Job site address: 1� �• y�:��-3 Total number of floors........... ................I........ New dwelling area(sq.ft.).............................. Suite#: Bldg./Apt.#: "C ♦ Garage/carport area(sq. ft.).............I..........,... Project Name: !-) �-SJ Covered porch area(sq. ft.)............................. Deck area(sq.ft.)..................i.......,............... Cross street/Directions to joie site: - �T ( ' Other structure arca(sq. 12, ,� REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: ai<Q.-' l` sit Lot#: 2-- Tax --Tax map/parcel #: V 4 7 Note: Permit fees"are based 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 profit for the work indicated on this application. z�'T,�<►S.� '� _ Valuation.................................................. ..... $ Existing building area(sq.ft.).................. ...... - - n'"-�� -- i`�+� v e_ l New building area(sq.ft.)............................... Number of stories........................................... PROPERTY OWNER I Q TENANT _ Type of construction..... ................................ Name: , r �A - Occupancy group(s): Existing: New: Address: kiL,L& •• hemkk c Cit /State/Zi ). :t, cl:?,�f7?L NOTICE: All contactors and subcontractors are required to be Phone: St✓11, cict ifs.._ Fax' S.U; - "STLL, licensed with the Oregon Construction Contractors Board under APPLICANT I El CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: _`i _ - jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: Address: — --- - — --- -- ----- City/State/Zip:— --~--�� - --- -- -- Phone: Fax:^ --- E-mail: -- BUILDING PERMIT FEES* Please refer to fee schedule. CONTRACTOR - ---- ---- - Business Name: /iN ci Fees clue upon application................... .......... $ Address: Cit /State/Zi Amount received............................................. $ Phone: _ Fax: Date received:-__ CCB Lic. - Authorized J--- L Si nature: -y _•�_ Date: \16(V 7 Notice: This permit application expires It's permit Is not obtained within B � C�+ — —�T- Q IRO days after It has been accepted as complete. *Fee methodology set by Tri-County Building Industry Senlce Board. (Please print name) i:\Dsts\PcrmitFomis\tlldgPertnitApp.doc 01103 ,J One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: Ciryn('I'igurd CityOlrTI�rl:lCu Associated permits: b U Electrical U Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other: Phone: (503) 639-4171 Fax: (503) 599-1900 THE' FOLLOWING ITEMS ARE REQUIRED F1 ' 1 Land use actions completed.lice jurisdiction criteria lion concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/lot. _ 4 Hire district--approval required. 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. 7 Water district approval, _ 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of c tch-basin protection,etc. 10 :1 4'omplete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state kIFAIng codes. Lateral design details and connections must he incorporated into the plans or on it separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot he completed if copyright violations exist. I I Site/plot plan drawn to scale,The plan must show lot and building setback dimensions;property comer elevations(if there is more than a 441,elevation differential,plan must show contour lines at 2-11.intervals):location of easements and driveway;footprint of structure(including decks);location of wells/sepuc systems;utility locations,direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. I Floor plans.Show all dimensions,room identification,window size,location of smoke defectors,water heater, furnace,ventilation funs,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor Ixams,headers,joists,sub-floor, wall construction,roof constnuction. More than one cross section may he 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 Wgll bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations:for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing locations.Show attic ventilation. _ 18 Basement and retaining walls. Provide cross sections and details showing placement of rehar. For engineered systems,see item 22,"Engineer's calculations." _ 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When required or provided,(i.e..shear wall,roof miss)shall he stamped by an engineer or architect licensed in l hegon and shall be shown to he applicable to the proiect under review. JURISDICTIONAL 'i Five(5)s' a plans are required for Item I I above. Site plans must be 8-1/2"x I I"or I I"x 17". 24 Two(2)sets each art-required for Items 16, 19,20&22 above. 25 Buildi,tg plans shall not contain red lines or tape-ons. "Mirrored"building plans will he 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. 7H 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 star 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((v%r0M) Mechanical Permit Apniication ' Received Mechanical Date/By: _ Permit No.: N GlA�)O_'coy- Planning City of Tigard Appmval Building `-- — Date/By: _ Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review L. rd Use Date/By: Case No.: Internet: www.ci.tigard.or.us Contact loris.: See Page 2 for 24-hour inspection Request: 503-639-4175 Name/Method:.— J Supplemental Information. TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST TEAddition/alteration/rep w construction [:],Demolition Mechanical 1 rmit fees*are based on the total value of the work lacement ❑0-her: ��rformcd, Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit. 1 &2-Family dwelling Commercial/Industrial value: s See Page 2 for Fee Schedule Accessory Buildin Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE'SCHEDULE —�'- — Description 1 Fee ea. Total Master Builder Other: neatin /Loolin JOB SITE INFORMATION and LOCATION Furnace-add-on air conditionin " 14.00 Job site address: S Gas heat pump 1 14.00 Suite#: Bld ./A t.#: Duct work _ 14.00 -- — H dronic hot waters stem 14.00 Project Name: �� - Residential boiler Cross street/Directions to job site: ` F 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: "��. l.ot i/: Repair units 12.15 -- '�� ------ Other Fuel App4ances _ Tax map/parcel #: Water heater 10.00 _ DESCRIPTION F Gas fireplace 10.00 — 1 i A ya,� �� _ Flue vent(eater heater/ as fireplace) 10.00 _ Log lighter(gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 _ Chimne /liner/flue/vent 10.00 ROPERTY OWNER 'i ENANT Other: _ 10.00 NamEnvironmental Exhaust&Ventilation Address: L k ,.,� �a�i� �^ Range hood/other kitchen equipment 10.00 Address: ��k, y S c y �Z^yZ i Clothes dryer exhaust 10.00 City/State/Z.ip: ! -,{-2 L Single duct exhaust Phone: S -_� Fax: 3 _ rJ (bathrooms,toilet compartments, APPLiCAN_T _ CONTACT PERSON utility rooms) 6.80 Name: Attic/crawl space fans _ 10.00 Address---- ------ -- --_ Other: _ Fuel Piping City/Stat%) __ `_ "•($5.40 for first 4 $1.00 each additional Furnace,etc. a Phone: �ax: - ". - - -- --- --- Gas heat pump _ E-mail: __ _ Wall/suspended/unit heater CONTRACTOR? Water heater Business Nanle: L`'j��j/��.�. -Fireplace - ----- Range Address: r3s •• Clty/State/Zip: _ Clothes dryer as _ Phone: -- —Lax: Other: -- _ •• CCB Lic. #: Total: _ �Mechanical Permit tui: Authorized Subtotw: _ Signature: N� �N Date: •� -- S 1 r Minimum Permit Fee$72.50 S 12 CP ill-) 'K io 1. 9qK._ ck Plan Review Fee(25%of Permit_Fee S (Please print name) _ State Surcharge 8*o of Permit Fee) S — TOTAL PERMIT FEE S _ Notice: This permit application expires if a permit is not obtained ssithin *Fee methodology set by Tri-County Building Industry Servlet Rnard. 190 days after It hal;been accepted as complete. **Site plan required for exterior A/C units i AUsts\Permit Fomu\MecPermitApp dt)c 01103 Mechanical Permit A piication - City of'Tigard Page 2 - Supplemental Information Commercial Fee Schedule: _ 'Total Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 for the first$500.00 and$1.52 for each additional$100.00 or fraction thereof,to and including$10,000.0(1. S10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$I(M).00 or fraction thereof,to and inc.ludit g _625,000.(10. $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and $1.45 for each additional$100.00 or !Taction thereof,to and including $50,000.00. $50,001.00 and up 5742.00 for the first$50,(1(10.00 and $1.20 for each additional$100.00 or fraction thereof. Assumed Valuations Perms 11 nce: _ — Value Total Description: Qty Amount Furnace to 100,000 BTU,including 955 ducts&vents Furnace>100,000 BTU including ducts 1,170 &vents Floor furnace including vent 955 Suspended heater,wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 _ 3 hp;absorb.unit, 955 to look BTU 3-15 hp;absorb.unit, 1,700 101 k to 500k BTU _ 15-30 hp;absorb.unit,501 k to I mil. 2,310 GTU 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU >50 hp;absorb.unit, 5,725 >1.75 mil.BTU - Air handlinst unit to 10,000 cfm 656 Air handling unit>10,000 cfm 1,170 Non-portable eva rate coo!er _ 656 _ Vent fan connected to a single duct 446 Vent system not included in applinnee 656 permit Hood served hv_mechanical exhaust 656 Domestic incinerator 1170 Commercial or industrial incinerator _ 4,590 Other unit,including wood stoves, 656 inserts,etc. _ Das piping 14 outlets 360 Inch additional outlet 63 TOTAL.COMMERCIAL $ VALUATION: 0lhtsTermit Fotms\MccPcrmitAppPg2.doc 01/03 Electrical Permit Application Received Electrical dd Date/By: Permit No.: 61 I aC/(/">-0 J Planning Approval Sign City of Tigard Date/q� Permit No.: 13125 SW Hall Blvd. Plur.Review Other Tigard,Oregon 97223 Date/By: _ Permit No. Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use Date/By: Case No.: Internet: www.ci.tigard.or.us Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-6394175 Name/Method: _ Su r derncntal Information. TYPE OF WORK PLAN REVIEW(Please check all that apply) —^ New construction Demolition Service over 225 amps- El Health-care facility -- commercial ❑Hazardous location Addition/alteration/replacement Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, CATEGO-Y OF CONSTRUCTION_ _ I &2 family dwellings Lour or more residential units in I & Z-Family dwelling Commercial/Industrial ❑System over 600 volts nominal one structure ACCL'SSO Buildin r Multi-Famil ❑Building over three stories ❑Feeders,400 amps or more __rte— �— Y_— ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder El Other: ❑ligress/lighting plan ❑other:_._ JOB SiTE INFORMATION and LOCATION Submi sets of pluns with any of the above. The above arc nut a)pIlcable to temporary,construction service. Job site address: \Q(Q !ty�L•�'t"�� --_FEE*SCHEDULE__ Suite#: I Bldg./Apt.#: Number of ins ections per ermit allowed Pro'ect Name: Descrl tion— Qty Fee(Co.) 1,0111 New resldential-single or nmlll-fannih per Cross street/Directions to job site: 1 dwelling unit.Includes attached garage. Service Inrludrd: rJ '��-• ►'V� �� T�� 1000 sq.11.of less _ 145.15 4 Each additional 500 sq.0.or portion thereof 33.40 1 't,,- Limited energy,residential 75.00 2 ]� SUbd1VlSlOn: D c � __ 1 Ot# 3 Limited energy,non residential 75.00 2 Tax map/parcel #: 9- 4 -- Fach manutactured home or modular dwelling DESCRIPTION K service and/orfeeders feeder 90.90 2 Sees Ices or feeders-Installation, ration or rciiit'aN{in: 200 tan ","— am 80.30 2 'T _�� lU""�c� c_r_ — _1_ s to 40)amps 106.85 2 �_�_ ��_ J M 401 amps to 6W amps __ 160.60 1 P1lH1 RE TY OWNER TENANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: �' �J �� tA�.y Reconnect only _ 66.85 2 Address: k QU [} t.cG' F" Temporary services or feeders-installation, alteration,or relocation: Cit /State/Zip: (a► _C Z 200 am or less __ _ 66.85 - l Phone: 3 ` 201 amps to 400 amps _ _ 100.30 2 S�;,y SZCI; Fax - 401 to 6W amps _ 133.75 2 APPLICANT CONTACT PERSON Branch circuits-new,alteration,or Name: extension per panel: -- —""-- - A.Fee for branch circuits with purchase of Address: _ service or feeder fee,each branch circuit 6.65 2 Cit,,/State/Zip: B.Fee for branch circ,iits without purchase of service or feeder fee,first branch circuit 46.85 2 Phone: Fax: Fach additional branch circuit 6.65 2 E-mail: _ Misc.(Scrvice or feeder not included): CONTRACTOR _ Each um or irri anon circle 53.40 2 Fach sign or outline lighting 53.40 1 2 Job No: Q_-Q f'J k Signal circuit(s)or a limited energy panel, Business Name: alteration,or extension �._ Description: Address: __ City/State/Zip: - Each additional Inspection over th �e allowable In an of the above: _ C_ Per mspeFinazr hour(min. 1 hour) _ 62 50 Phone: I'ax: Investi tion fee: CCB Lic. #: — Lic.#:-- — other: —.- -- — Electrical Permit Fees" Supervising electrician _ Subtotal $ signature re uiq red: ^� Plan Review(25%of Permit Fee $ Print Name: Lic. #: State Surcharge 8%of Permit Fee $ -- TOTAL PERMIT FEE $ Authorized -, Notice: This permit application expires if a permit tc not obtained within Signature. �Mw xt.. Date: 180 days after it has been accepted as cmnmplete. ft *tee methodology set by Trl-County Building Indush) Scrvtrr Board. (Please print name) i:\Dsts\Permit Fortns\E1cPermitApp.doc 01/03 Electrical Permit Application -City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ S75.00 Check T)pe of Work involved: Audio and Stereo Systems* Burglar Alarm Garage Door Opener* EJ i leating,Ventilation and Air Conditioning System* Vacuum Systr• s* Other COMMERCIAL YORK ONLY: Fee for each system.......................................................... S75.00 (SEE OAR 918-260-260) Check Type of Work Involved: El Audio and Stereo Systems n Boiler Controls Clock Systems ❑ I)ata Telecommunication Installation nFire Alarm Installation IIVAC instrumentation ElIntercom and Paging Systems Landscape Irrigation Control* Medical Nurse Calls Outdoor Landscape Lighting* Protective Signaling F] Other--- -- — -- -- Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Fomu\ElcPermitApyPg2.dor 01103 19- RECEIVEE; AN 2 8 200? C]eanWate� Services sari o - o f 8 -200 , „ITY F00 Member Our commitment is c1r .. ,1111.n1 71 F) .Z 6 G Sensitive Area Pre-Screening Site Asssessment Jurisdiction __ pate mb2 Map & Tax h_uc _-�2,S/ o_,jD/i�03000 ownerSite Address `=-Cz�21j ;>��_ Z3�3 Contact Proposed Activity Address f -2- � (r Phone official use only below this line Y N NA Y N NA L Sensitive Area Composite Map ® Stormwater Infrastructure maps Map m– - ��--- �. QS# Y N NA Y N NA ❑ FI ['� Locally adopted studies or maps Other Specify __-- --__ Specifyo.:►o Based on a review of the above information and the requirements of Clean Water Services Desiy!>t and Construction Standards Resolution and Ordor No. 00-7: F] Sensitive areas potentially exist on site or if.%.hin 200' of the site. THE APPLICANT MUST PERFORM A SrTF CERTIFICATION PRIOR '7(.,ISSUANCE OF A SERVICE_ PROVIDER LETTER OR STORMWATER CONNECTION PERMIT. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas If they are subsequently discovered on your property. NO FURTHER SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. THIS FORM WILL SERVE AS AUTHORIZATION TO ISSUE A STORMWATER CONNECTION PERMIT. U The proposed activity does not meet the definition of development. NO SITE ASSESS-MENT OR SERVICE PROVIDER. LETTER IS REQUIRED. Comments: — —=+L•�Z"/ - o, — Y --'-� zUOG' a erl ___7e k.rz�� acv o� c% w r r'�,.Y !T� �-xi!t �H..:rl;4 __1.00 � '` -�..L�t'7 C• -- Reviewed By: i C�s�_•V+��)i` hate: --— ---- - Returned to Applicant Ka it X Fax_ Counter_ _ 155 N First Avonue, Suite 270•Hillsboro,Oregon 97124 Dare Phone (503) 846.8621 •Fax: (503)846-3525 www.c eanwntetxrvioes o g ! ' d 1690 h36y EOS WHHd NOW I S clap :90 EO 90 vet- RjE „IV E'D Permit #: MSI-001— O00,el--_ ,IAN 2 8 M3 ess:10;�- �' OF TIGARD CITY BUILDING DIVISIONtisued h� :{�. , Date: v BUILD — Statement: Information Notice to Property owners About Construction Responsibilities Note: Oregon Lase. ORS 7(11.(155(4), requires residential construction permit api7li- rants who are not registered with flit, Construction C,,ntractors Board to sign the /olloti+,itlg statement hc)Jirre a huildiiig per•nrit cam he is.seted 711is•s►crtenrt,rrt i.s reyuired Jbr residential building. electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt hunt, registration under ORS 701.010(7), need not swhmit this•ctult,nrent. ni.s siuteinent ivill he filed►rith the permit. Fill in the appropriate blanks and initial boxes i and 2. and either box 3A or 313: 1. f own,reside in,or will reside in the completed structure. I understand that i must register as a construction contractor if the structure is sold or offered for sale before or upon completion. l—� 3A. My general contractor is E] (Name) Contractor regis. # i will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. if i hire subcontractors. I skill hire only subcontractors registered wiGi the Construction Contractors Board. if i change mN mind and hire a general contractor, I will contract ssith a contractor ssho is registered with the CCB and will immediately notify the off ice issuing this building permit of the name of the contractor. herehs eertif� that the ahol a infornwtion is correct and that I hay e read and do understand the Information Notice to Profu-rfy 0%%ners about Construction Responsi 'Wits on file re%erse side of this form. (Signature of permit applicant) (White cope,to issuing agenc'v permit file, pink c•op�v to applicant) Information Notice to Property Owners About Construction Responsibilities 1 , . ! „. /!i';., . ;!r It��+ '\ •ll. f.' l(' !'/ i'� + ! I!I !I. �/,.'+'.•r�,,,, ! ' '/{!!' (�;i7r c(r,v;'!l;,rt ( !)(lith r/-1,u, %a. r!Y�Uf .l, - i�1, ;, .'t � - - . IllIlt:IIlk`,A littlllt't,l Ill;! L'J dIh'italIIlilt IIul-1k1\t'lll00It All C\]',lilt:_'".`,It tlllilt l'. 10,111 t'I .' 141 I l+ I rllt,, lift ul tic ti)tlu%618WspuIBRI'llit ics arld arc�►»,'t curlccnt , EMPLOYER RFSPONSIBILITIES: I � � , � �;� ' �,._1�1�1.:�1 ` IiI' illt I ,.Il;,llil�ll -II t �.rllll�lltt�{1 I,tUi!!(I lit lIv) Iahlvl III �I)II'+(f11L1111� nt :1'.``IStIIIt! !t1 Ill] I;,' 0-111111 11 ,ltl!t l!Ilt', 1 111 \!III. Ill Illt,`I 111'<i;I11Ce';,he 1`11I1'd W hl'nm C;Ilplo) of 'Ilid til'pt.l'ltit ll!Uti1,.,1111ilk Al;Iltti�fltlllt\\II1L' t1rc�,,Ilt'�:\\;tl►hnldint►ta\la\+: A;>utrmh111\'er.�;\nnnl�t\\'itIIh�'hlinrrrr,rtt�cc�,I�rt)In eml,lfl\�'et\IthccattIIetintt'rnll,ltl\t',:�. arc p,l1d. Ym \\III be h-1111c 11'r ilre t;r; pa\'nlrrtti e\en it vl,u tlor.'t tte tnr111\' \\ithhold the Irl\ iit'rc.rn vt,u►ctnpll�\t t, ! It t 101-mat the( ►rl' on 1)rl)t 'lt lir\cnueat'►1 '-Rut>I l ltiettlplo)'111ent iiistit•ance lax: r\� 111 Ci11111 ,1:'r, '. 'I' 1!, It,11.11 'tl l '1!,!'• I ( :'. 1 'i !111 c.!Iljllt r,lett'))) 11„;11 Iltce Plll l,� a'• t'II III \\rbcs ill till empluvees I.or more Informalt.iun.Call IIIc urvg(m hiipl,nnmcni I)cpmlIII :nl ;It 'ti-.i'i; I. 1�'urkrrs'complrnxsltil►n invur:uice: ,��all etlt('11tr\CC �tJll�lJt Nll�?l�t:l 1,'II';'Ulil'.tll `�url,l! • l �•tlljtt n`,Ill;,n I .1+\. ;tl,.l Hill<r - ` J� !:+1'•ti11111\tlfltl'r+'l'ltltll)Cn',�ltiurlinsurance larki(xuell tpllt\ccs. Il \till (rill fl)l'blillll\\1 Il,t'f' '!1111t'll',ill'IIlIll atfallt't' 1'011111I1\' be slab,lecttopcllalU.'sanO\killbeliable l0rrtllrl:l,111co"I it'tuct,Injulr,l It)thcl'I11, 1 11m11I Hil,'rin;lllt;u. t.rtlf tIu` C�',tr'kert"('ontpcliSMir'+lt t�ti��fi�i5tl Ill Il,e rjcllartnlrnr t t n,unit r,lllii ttll cilic� tilt\ It t'; t .y. lurernal 12c\enuc Sen ice: ?kikall C111111okcr.�1,u Hoist ithhold tederaI income t:.l+,f-olli cmplo. ces'\lat4cs. You\\'III III ii.lhlclurtile la:\paNnlc,It0ell II\ot,didn't actuallk \cithholdIII'. I I or more lit l'orntmon.rillliht ImerttalReVenuet"cl, Il, at I-800,92Q-1040 OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Collecompli711cv: ',titill'Ot'I'll!11Ilk:Ideriol1111,pwjt'QA,\(ill are icq)(,11"Ihil, loit -k (,IIIIIrPtUIl':'t'lt„tit'i'.,I II!clr!t Ji. that 111;1\ be hrt'lli'ltl ti,vom iltletll::ul Illrol'::fl 1ti;lll'Ctlt)", I.lalllllt\and propt-itl Il,miat"v insuritilil'v: + lrtllltt I \11111 Ill"t1l.ill"tv.112Clll It,tic"'It \,'tl1.1\t'.0k:(JII.Ilc Ir,olta!ltt'. ,,lt'I.iUi for tt',idellt,�Jn;l t)1)uYsiult :.all;.t, balling tl ck.paint o'.crspia.j.\\;Iter damage Goal (.'(IIIc I)ulh IIJres, III-C. t,r\\t'lk 01;11 1u011 t)c 1'c dt,nc '11 ime io%Iiper\isc t mVI#l\t'r,; \1:11,; ,mc\.oll ha\C .1111iL icnt little Ill supct\ki, it ul 01111 tT IG,\hl`rtltl': titill,c,,111 '\ lilifl\t:111ec\lwriI,C',I;ttlit` k,oitt ,\\11111'n:'r•IIu1lttll it.itlLl lilll';I it ll�frle�. end ft\hrttif\ hniddincr ctflirinls 5t IIIc appri,l)rit�te times sl)the\ r,th Itel`fnlrrn !Fn ',•tlu!r�.l ir.••I,�rtl.�n; " II \uu iit\e ad,',iUlnwl yucstiltns. \\rile ur 1;111 the CcnstrllctiIll('mill-actt,r, Bi1rard Wu leo.\ 111 tU. tialrnl.(►�,'1 ;ntl.;tl;: 503 178-4021), 1 lie Bolsi iS I''Mated at 700 tiumincr ht . `Ilite ;ltn. in tialem 1 94 SEE 35MM ROLL# 22 AOR LARGE DOCUME N '�' CITY OF TICARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST 3_ eio4 INSPECTION DIVISION Business Line: (503) 639-4171 — BLIP _ Rec3ived __ _ _-_ Date quested-_.-/ a---.a___L-- AM—_ PM BUP Location � � _ Suite_ MEC ---_ — Contact Parson _ — ----- Ph PLM -- Contrac r ---- _ Ph ( --) — SWR BUILDING Tenant/Owner _--- ELC Footing —�..--- - - Foundation Access: ELC Ftg Drain ELR -------- __ -- Crawl Drain Slab !nspection Notes: SIT _ Post& Beam - Shear Anchors Ext Sheath/Shear IntSheath/Shear --- -- - -- Framing --- - Insulation --- - Drywall Nailing - --- -- ---- —. Firewall Fire Sprinkler _ - _ --- -- Fire Alarm Susp'd Ceiling - _ ----- ----- ------ - Roof - _ -- Other: -- - -- ---— Final PASS PARI_ FAIL —_ ---- -- - - -- PLUMBING Post& Beam Under Slab - - --,--_---- --_— -- _ Rough-In -- - Water Service Sanitary Sewer Rain Drains - ------- -----.------- -- Catch Basin/Manhole - Sturm Drain ---- ---.-- -- — -- -- —. -- ShoNer Pan Other: ------- ----- - Final PASS_PART rAIL HA `---- — --- --------- MECCAL Post 8 Beam-- ----- — -- --- _ — —.-------- Rough-In -- __-- _- Gas Line ---------.--• ------ Smoke Dampers Final _PASS PART FAIL ---------- -- ---- -- --._-- -- ELECTRICAL Service - —_ — ------- -- -- Rough-!n _ UG Slab — -- -- - ---I.ow Voltage Fire Alarm - ------ ---- -- ----- -- na �] PART FAIL Reinspection fee of$__._ required before next inspection. Pay at Cit, Hall, 13125 SW Hall Blvd, C S_TE" _ — [] Please call for rsinspection RE: Un able to inspect-ro access Fire Supply Line ADA , Approach/-jewalk Date '� Inspector _-- Other: Final DO NOT REMOVE this Inspection record Froin the job 0/te. PASS PART FAIL CITY OF TIGARD 24-Flour BUILDI",dG Inspection Line: (503)639-4175 MST� INSPECTION DIVISION Business Line: 1503)639-4171 BLIP Received ,— Date Requested_ r z 7 02 `A_ PM __ BUP Location /��/_-1 k_ �4- __-Suite _ MEC Contact Person ;}:��- �, - - Ph( _..---f f1 ' q c1 l PLM - --- - Contractor Ph SWR BUILDING Tenant/Owner ELC Footle; ! LC uundation Access: — -- - - - Ftg Drain ELP Crawl Drain ---- -- Slab Inspection Notes SIT _ Post 5 Beam Shear Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - ---- _...-- ---- -- ---- - . Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -- --- Roof 4/ �PASS ` PART FAIL PZ -MBING Post�Beam — Under Slab Rough-In - - - Water Service - - _ Sanitary Sewer Rain Drains - -- -- Catch Basin/Manhole Storm Drain Shower Pan Other: - - - - Final rASS PART FAIL_ MECHANICAL Post& Bearn Rough-rn Gas Line ---- -----_._ �— Smoke Dampers - Final PASS PART FAIL - -- - --- - --- -- - ELECTRICAL Service - - -- - -- - -- Rough-In UG/Sl+tb Low Voltage -_ Fire Alarm Final [� Reinspection fee of$ required before next inapectiun. Pay at City Hall, 13125 SW Nall Blvd. PASS PART FAIL SITE ,—___ `�] Please call for reinspection RE:_- - Unable ro inspect-no access Fire Supply Line __ j ADA Approach/Sidewalk Gate i �__ �' Inspoeter , . .. - - tE" Other:_ Final DO NOT REMOVE thls Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD MECHANICAL DEVELOPMENT SERVICES PERMIT 13125 SW Hall Blvd., Tigard,OR 97223 (593)639.4171 PERMIT #. . . . . . . : MECyi-0340DATE ISSUED: 09/11/97 PARCEL.: 2SI03DA-01300 SITE: ADDRESS. . . : 10665 SW DERRY DELL CT SUBDIVISION. . . . : DERRY DELL PLAT 2 ZONING: R-3. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 13 JURISDICTION: TIG T-ASS OF WORK. . :ALT FLOOR TURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FI")NS. . . : 0 OCCUPANCY GRP. . :R3 VENTS W/O APDL: 0 VENT SY3TEMS: 1 STORIES. . . . . . . . s 0 BOILERS/COMPRESSORS HOODS. . . . . . . : m FUEL_ TYFE`5---------- -- 0-3 HP. . . . : 0 DOMES. INCIN: 0 :GAS 3-15 HP. . . . ,. 0 COMML. I NC I N: 0 MAX INPUT: 0 'TU 15-30 HP. . . . : 0 REPAIR UNITS: 0 F I RE DAMPERS?. . : 30•--50 HP. . . . : 0 WOODSTCIVES. . : 0 GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0 IVO. OF UNITS----------- AIR HANDLING U14 I T S OTHER UNITS. : 0 FURN ( 100K BTU: 0 (= 10000 cfm : 0 GAS GUT!_ETS. : 1 FURN ) =100K ETU: 0 > 10000 cfm: 0 Remarks : Installing ga: line and vent Owner: --- -------------- -----------------__ _-- --- ------- FEES ALLEN MILLER type amol-int by date recpt 106670 SW DERRY DELL PRMT $ 25. 00 B 09/JI/97 97--299137 IGARD OR 97223 SPCT $ 1. 237 B 09/ 11/97 97-299137 'hone #: Cont ract or r -------•-----------------------•-- f 26-. 25 TOTAL � 'hane #: REQUIRED INSPECTIONS This permit is issued subject to the regulations cmitained in the Gas Line Insp _ Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp applicable laws. All work will ;,e t:,,ne in accordrnce with Final Insper_t ion approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for sore than 188 days. ATTENTION: Oregon law requires you to follow rules )dopted by the Oregon Utility Notification Center. Those rules are _ set forth in OAR 952-Nl- BIO through OAR 95P-9O1-*N. You may obtain conies ff these rules or direct questions to OUNC by calling t 503 l 2Af,-9187. I ; lie By : N '�s!"V/t--� Permittee S i g n a t t_t r e :_ +++++•+++++++++++++++ ++++++++++•++.++++++++++++++++++++f•{ ++++++++++++++++++++f•++ Call 639-4175 by 6:00 p. m. for, inspections needed the next bmsiness day ++-+-+•++V+++++•Y++++++++•f+++++++++++-F +++++i-i++++++++++++++++++++++++++++++ +- +++++ Plan CheCK 0 CITY OF TIGARD Mechanical Permit Application Recd By 13125 SW HALL BLVD. Commercial and Residential Date Recd _ TIGARD, OR 97223 Date to P E. (9303) 639-4171, x304 Date to DST Print or Type Permit is Incomplete or illegible applications will not be accepted Called Name of Deve)opmenuProiect Description Table 1A Mechanical Code Cry PRICE AMT .lob Street Address Sudety A) Permit Fee 0 0• 1000 Address _ E3idgx Cny state Zip B) Supplemental Permit ��? 300 Name for name of business), 1 ) Furnace to 100.000 BTU 600 Owner '? `i incl ducts&vents Meiling Address / 2) Furnace 100,000 BTU+ —50- 77 -- �c�J /-)i'�. • /I�' / incl ducts 8 vents 7 50 Gryrsute / Zip Phone 3) Floor Furnace 600 _ incl vent Nerve for rame of business) 4.) Suspended heater,wall heater 600 or floor mounted heater Occupant Madinq Address 5) Vent not incl. in 3.00 1 appliance permit cny smte Zip Phots 6) Boder or comp,heat pump,air cond 6 0 to 3 HP;absorp unit to 100K BTU —Contractor Name 7.) Boder or comp,heat pump,air cond. 11 00 (Prior to 3-15 HP;absorp unit to 500K BTU issuance Msding Addrsss 8) Boder or comp,heat pump,air cond. applican' ;r^� �j 15 0015-30 HP,absorp unit 5-1 and BTU must provide all Cdylstatis Zip Phone 9) Boder or comp,heat pump,air cond 22.50 contractor / 30-50 FIN;absorp unit 1-1 75 and BTU license Oregon Const Cont.Bond t is aExp Date 10) Boder or comp,heat pump,air cond 37 50 information >50 HP,absorp unit 1 75 mil BTU for COT COT Busnesa 1'at or Meld o _ Exp Date 11 ) Air handling unit to 4 50 database) _ __ 10.000 CFM Architect Narne �� — 12) Air handling unit— 7 50 10.000 CTM+ Or Madmg Addlese --- 13.1 Non portable — _--- �— 4 50 evapo_-ata�enler En ineer C tv�Staie—'- `-- p Phone � — —� g — 14) Vent fan conrec+ed 3 00 _ to a single duct Descnbe work New 0 Addition O Alteration O Repair O 15) Ventdatton 9ysternnot 4 50 to be done Residential O Non-residential O included in appliance permit Additional Description of work 16) Hood served by mechanical exhaust 4 50 __—__ 17) Domestic ncinerators _ _ 750 _ F<sting use of 18 1 Commercial or industnaltype 3000 hudd,ng or property.------ incinerator _ _ 19) Repair units A 4 50 Procosed use of 20) Woodstove 4 50 budding or property _ 21) Clothes dryer etc _ 4 50 Type of fuel-oil O natural gas 0 LPG v electric O 22) Other units 4 50 1 hereby acknowledge that I have read this application.that the 23) Gas piping one to four outlets 2 10 information givens correct that I am the owner or authorized agent of the owner.that plans submitted are in compliance with Oregon State 24) More than 4-per outlet (each) 50 laws Signature of Owner/Agent Date QTY.SUBTOTAL SUBTOTAL Contact Person Name Phone 5"'o SURCHARGE PLAN REVIEW 25%OF SUBTOTAL --� TOTAL L_ J dstvnechpmt doe (rev 796) 'Mlnimum permit fees S25 a 5%surcharge