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16350 SW PALERMO LANE U350 sW PALERMO :.ANE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST �7Z*) — INSPECTION DIVISION Business Line: (503) 639-4171 /� BUP -- - Received ( —_ Dat equested- _'( r?--Z -- AM _-. PM___ BUP Location ` \ �✓ V� _ Suite-_ _--__—-- MEC - Contact Person Ph(_ ) _ -__— PLM Contractor _ Ph(__. ) SWR Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain I EL.R Crawl Drain J SIT Slab Inspection Notes: - -- Post&Beam -- - - Shear Anchors Ext Sheath/Shear ----- - Int Sheath/Shear Framing - -- ---- - - Insulation L G(/h e^_ Drywall NailingFirewall - Fire Sprinkler r"" _O /'✓'cam C T7� 'V U✓►^,�J f-� _! Fire Alarm Susp'd Ceiling -' _� - --_ - - - ----- - Roof Other: � m ' PA _ PAR FAIL\ 1. MHI�1 Q -------- -- - Post& Beam Under Slab ------- - ------ -- - - -- - ---- ---- Rough-In Water Service ---- - -- _ ---- Sanitary Sewer Rein Drains - ------- -- -_ - Catch Basin/Manhole Qf-im Drain -- ---- --- - Shower Pan -- PAP AR f -FAIL -- — HA0�1._._. ----.------ - Rosh Beam Rough-In Gas Line Sm a Dampers -- -- -- PAS ---�� RT/_',FAIL ----�-'---- -- Servic© Rough-In - — ----- — - — UG/Slab Low Voltage Fire Alarm Reinspection fee of$_. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS OART FAIL SM _-_ u Please call for reinspection RE:----_-_..._--_- -_— Unable to inspect io access Fire Supply Line "Z-j� ADA Dafte.. q12 210 IR1sperct.os '_' 1-- Approach/Sidewalk Other:_ -__ L, inal DSO N07 REMOVE 'this Inspection :eCord from tl�q job site. PASS PART FAIL rTl I ► 4 ~` _ � � ► . ► � `J a b � ► ® -4 � . J ► 4 CL ► p, lot ► d �� h u ► . r '. o '`� / _ ► *41 -• O ► O '"'"' ► . ► CL y iV) . d ..� ► , � O p ► �-1 n ',A 05 o No. A ua J t . ► 4 O O J4 oil, / ► r ►/ r ► . O ► . `� ► 4 � �iivvvvvvvivsv♦ V TTTVVVVVVVVVVVI, 'VVVVVVVVVVe°� ...moo... n W CD O ti n nC I 7 1 c w� o o s c LJ r � D S � S n e I CITY 4F TIGARD 24-Hour BUILDING Inspection Line ;,03)639-4175 00 1710 INSPECTION DIVISION Business Line: (503)639-4171 MS BUP — Received Dat Requested- AM PM BUP _ Location Suite __ MEC Contact Person __— Ph(-5�) SD PLM Contractor- Ph( ; - — SWR -- _ BUILDING Tenant/Owner __- - ELC Footing ELC -_ Foundation Access: Ftg Drain ELR ____._✓.___.--- Crawl Drain Slab Inspection Notes: SIT Post&Beam _- Shear Anchors -"-- - Ext Sheath/Ghear Int Sheath/Shear Framing - C-ftL_��'JT/� L/'Z .� 11Ct C1��1 i�a I Insulation -s Drywall Nailing — Firewall - /�_��-�,'fri•.�w.'�'1 r 8 � �5 c �t.'�" Fire Sprinkler Fire Alarm Susp'd Ceiling - Roof S PART FAIL -- ING Post&Beam Under Slab ---- ---- - - ---- - Rot,Ch-In Water Service --- --- - Sanitary Sewer Rain Drains -- - - - -- Catch Basin/Manhole Storm Drain _ -- ---- - Shower Pan Other: - -- `---- - -- Final --_^--- - PASS PART FAIL _ ---- ---_--- --- - MECHANICAL -- Post&Beam--- Rough-In -- Gas Line SmokeDarpq _-.. __- --- ---- -- - ...-._--------- - ------ - --- ASS PART FAILELECTRICAL ServiService - ce � ------- - ------- - -----___-_._._- -------------- Rough-In UG/Slab Low Voltage -- ____-- ---- --- -----------..- -- --_ Fire Alarm Final ❑ Reinspection fee of$-_ ___- _required before next inspection. Pay at City Halt, 13125 SW Hall Blvd. PASS PA AT FAIL SITE ❑ Please call for reinspection RE:- _ _- ❑ Unable to inspect-no access Fire Supply Line ADA QApproach/Sideweik DOW ~ Z3 - In�Aortor�� ^ ` _Ext __-- Other: Final — DO NOT REMOVE. this In-"action record from the Job site. PASS PART FAIL CITY OF TIGAR® _ _MASTER PERMIT [v" PERMIT #: MST2003-00170 DEVELOPMENT SERVICES DATE ISSUED: 5/27/03 13125 SW Hall Bled., Tigard, OR 97223 (503) 639.4171 SITE ADDRESS 16350 SW PALERMO LN PARCEL: 2S105CC-T0026 SUBDIVISION: TUSCANY ZONING: R-7 BLOCK: LOT: 01.0 jURISGICTION: I'R1.3 REMARKS. Construction of new SF detached residence. BUILDING RLISSUE CEN2540 STOPIES FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NFN HEIGHT: 23 FIRST: 114o st BASEMENT: at LEFT: 5 SMOKE DETECTORS: TYPE OF USE* SF FLOOR LOAD: 40 SECOND: 1.40f, sf GARAGE: 440 of FRONT: 15 PARKING SPACES: TYPE OF CONST: 5N DWELLING UNITS: I TWO sf RIGHT: 5 OCCUPANCY GRP: F3 BVALUE: 147,100 00DRM: 5 BATH: 3 TOTAL ,..S�uI sl REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: I.AVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS• TUBISHOWEns: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES. MECHANICAL _ FUEL TYPES FURN<100K: BOILICMP<IIHP: VENT FANS: s CLOTHES DRYER: I GA5 FURN>•100K: I UNIT HEATERS: HOODS: t OTHER I,NIT&. I MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS',UTLETS: 4 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC,FEEDFRS BRANCH CIRCUITS `111CLLLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 -200 amp: 0 -200 amp. WISVC OR FOR PUMPIIRRIGATION: PER INSPECTION. EA ADD'L 500SF: 4 201 400 amp: 201 400 amp, tat WAD SVCIF DR: SIGNIOUT LIN LT'. PER HOUR'. LIMITED ENERGY: 401 600 amp: 401 600 trip: EAADDL AR CIR: SIGNAVPANEL: IN PLANT: MANU HM/SVC/FDR: 001 1000 amp: 601.anP.-100nv MINOR LABEL. 1000+amplvolt. PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: SVCIFDR>•225 A.: >BDO V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL _ B.COMMERCIAL AUDIO d STEREO: VACUUM SYSTEM: AUDIO IL STEREO: FIRE ALARM. INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER, HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL. GARAGE OPENER CLOCK: INSTRUMENTA11ON MEDICAL: OTHR: HVAC: DATA/TELF.COMM: NURSE CALLS TOTAL a SYSTEMS: Owner: Contractor' TOTAL FEES: $ 5,588.25 CENTER HOMES CENTER HOMES This permit is subject to the regulations contained in the 16520 SW UPPER BOONES FERRY 16520 SW UPPER BOONES FERRY Tigard Municipal Code,State OR. Specialty Codes and alll other applicable laws. All work will be done in PORTLAND,OR 97224 #200 accordance with approved plan.. This permit will expire N PORTLAND,OR 97224 work is not started within 180 c!ays of issuance,or if the work is suspended for more than 180 days. ATTENTION. Oregon law requires you to follov:'r11!as adopted by the Phone: 503-608-3060 Phone: 503-608-3060 Oregon Utility Notification Center. Thuse rules are set forth in nAR 952-0010010 through 952-001-0080. You Rog a I I(• 124490 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPEr.TIONS Erosion Control Insp 8, Post/Beam Mechanica Plumb Top Out Exterior Sheathing Insl Rain drain Insp Electrical Final Sower Inspection Underfloor Insulation Electrical Service Low Voltage Roof Nailing Mechanical Final Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line Insp Water Line Imo Plumb Final Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final Post/Beam Structural Mechanical Insp Shear Well Insp Insulation Insp Appr/Sdwlk Insp Issued By : � r.� l{� __. Permittee Signature : -- Call (5'0)', 639-4175 by 7:00 p m. for an inspection needed the next usiness day SANITARY• Q •r Services 9„z4 SURFACE WATER CleanWatc 1 I I' "UE DATE 050903 EXPIRATION DATE 110503 EC ZXP DA'T'E 050805 PERMIT 1.24065 RUCTURE ADDRESS 163 5 01 PROJECT 8610 %UCTURE STREET SW PALERMO LANE. LCAT 26 BLOCK I'YPE CONNECTION- NEW OF TUSCANY SUBDIVISION YPE INSTALLATION- ( 19 ) BLD `.iWR/ERR CON/SDC PYPC OCCUPANCY- ( 1 ) SINGLE: FAMILY PARCEL 251 5CC 11700 QTR SEC: 4413 MH 2405'; tWNER CENTEX HOMES DDRE;SS 16520 SW UPPER POONES FER TREATMENT PLANT DUPHAM PORTLAND OR 97224 !iC>NE; 503-305-.3060 WATER DISTRICT TIGARD i ' '4TURE -_H EQUIVALENT DW:ELLTNG RESIDENTIAL 71 TS SER.VIC}; UNITS 0 .(D UNITS 1 SERVICE UNIT'S 1 CONNECTION FEES SURFACE WATER DEVELOPMEEN'T FEES SEWER CC'NNEC ' V.1 C-�rJiEQ, WATER QUALITY 22 5 .00 LES CREDIT 425 . 00> WATER QUANTITY 17'5a. 00 Y LE 0 CREDIT ., 0 , 00> 01Y t7F TIGAk� INC;DIVISION EROSION CONTPOL I aun.n INSPECTION 64 .0, PLAN CHECK 41 , 5tr SUBTOTAL 2300- 00 :SUBTOTAL 38121 . 60 TOTAL 2680. 60 kkPPI, NAME MIKE, PHONE AFF'IL:LIATION REP VEMARKS LOT 26, TU3CANY, 08610 . « • ” « Num)a r to c 1 t`cj INSFECTION•-- 546-8444 « SIGNATURI' .� -_. . _, TS'S_IED BY W11,^,`)TR1 1 Permit Conclitions the applicant agrms to romply with all mles and regulations of the Unified 0rwerage Agen!v When calling for an inspection, please refer to'he Permit Nuiber The Permit expires ere hundred eighty (180) days Irom the date of lssllanort. The Agency does not guarantee the aoarracy of the iocation of side sewer laterals 7/93 WHITE - USA, BLUE - Accounting, GREEN -Inspection, YELLOW - CUstom@r `i I j (;ONIRACIOR/I NSI ALL1.R I YPE OF PI PE i Inspector, Please iikctch b!!i(✓w (1r atLaC,t1 1-�,��� i(� iL,swlisa llCtritl•a� ls: s� , i I Street & nearest Cross, strtlt't. i.out ion oi:I,urI, o-''ISI I Pol1tF? of rF.vi fi r, 1 flGs t Y4)Iti C) r connects to til't's s,,rVl'.;�' of �ery ice I ino ale !t V; 3t I.IU dimensions r,to✓;nC inq 1 ink' and/or rornt:�t ;., ,_,tc , 4 North arrow t i i 1 i i I i a 1 i Building Permit Application -- -- Date received:/ o�, Permit no.yl(',,J_6, GYJ/ City of Tigard Address: 13125 SW Hah Blvd,Tigard,OR 97223 ProjecVeppl.no.: Expire date: Ci of Tigard Phone: (503) 639-4171 Date issued: By: Receipt no.: - Fax: (503) 598-1960 Case file no.: Payment type: Ladd use approval:—_ 1&2 family: Simple Complex: ;Job &2 family dwelling or accessory 0 Commercial/industrial 0 Multi-family )(New construction O Demolition ddition/alteration/replacement 0 Tenant improvement �Fire sprinkler/alarm 0 Other: address: p �(/� Bldg. no.: Suite no.:Block: Subdivision: Tax map/tax lot account no.: Project name: �eSC.4fV -- Description and location of work on premises/special conditions: Name:CENTEX HCH Mailing address: g (L I &2 family dwelling: City: F2964NDState K Z.IP: 7FValuation of work ......................................... 5 _ Phone: J -3()(c C) Fax:(pOH- E-mail: No.of bedrooms/baths.................................. _ Owner's representative: M IKE EN iU( _ Total number of floors .................................. Z_ Phone: -DCjr Fax: E-mail: New dwelling area(sq. fl.)............................ _ 2sV IE ��AIUUNFWjl Garage/carport area(sq.ft.) .......................... I Name: Covered porch area(sq. fl.) ......................... Mailingaddress: Deck area(sq. .)................... ...................... City: _ State: 21P: Other structure area(sq,fl.)......................... _ Phone: Fax: E-mail: CommerciaIII adustriallmulti-famlly: Valuatiun of work ......................................... S Business name: Existing bldg.area(sq.ft.)........................... Address: New bldg.area(sq.ft.).................................. ---__-- Numberof stories.......................................... City: S�C. Zl P: Phone: l Fax: E-mail: Type of construction ..................................... Occupancy group(s): Lxisting: CCB no.: 2, _ _ New: City/metro lic.no.: Notice:All contractors and subcontractors are required to be EcribbiiidNiER licensed with the Oregon Constrw:tion Contractors Board under Name: provisiogs of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed If the applicant is City:- Statc: z1P: exempt from licensing,the following reason applies: Contact person: Plan no.: -- Phone: Fax: E-mail — Name: Contact person- Fees ftue upon application.............................S Address: Date received: --- City: State: zIP: Amount received..........................................S _ Phone: Fax_ E-mail Y Please refer to fee schedule. — I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards,pleas call jurisdiction for more Information attached checklist. All provisions of laws and ordinrnces govern),rig this U Via U MasterCard work will be comvlied wish-whethernne tr•ci herein or not. Credit card number: _ _ / / Expires � Authorized sr --— O Cl Date. 0 3Name o car o der a shown on credit card Print name: S Y -� _ Cardfulder signature Amount Notice:This permit application expires if a permit is not obtained within 180 days atter it has been accepted as complete. 410-4613(6N00rCOMI Electrical Permit Application Date received: Permit no.: City,of Tigard Pro;act/aopl. no.: Expire date: Ciof Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: E Phone: (503) 639-4171 y Receipt no Fax: (503) 598-1960 Cese file no.: Payment type: Land use approval: I &2 family dwelling or accessory OCommercial/industrial 0 Multi-family 0 Tenant improvement New construction 0Addition/alteration/replacement 0 Other: 0 Partial JOB SITEINIFORMATION Job address: ( Q Bldg, no.: Suite no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: Project name: _ Description and location of work on premises: I.E E AMI VMLDENTIAL Estimated date of completion/inspection: CONTRACTOR O' -SCHEDULE Job no: Fer Mee Business name: Description Qty, fes.) Total no.lnsp Address: � Newresidenthrl-singleormultl-family per dwelling unit.Include s attached garssge. City: State: ZIP: — Serrimincluded: Phone: 9 _L Fax: E-tnail: 1000 6!L-t.or leas 4 CCB no.: Elec,bus.lic,no: si 5 t G Each additional 500 sq, f.or portion thereof _ City/metro lie.no.: Limited enctgy, residential 2 _ Limited encs 2 gy, nen-rcaidcntial �''`'�1� �"-- _y•Ct Each manufactured home or modular dwelling Signature or supervising electrician (rc uirad) Date Service andior feeder 2 Sup.elect. name(print): Zl l �. q L.iccnse no: 463_7-S Sorvlcesorfeeders—Installation, t , IrY OWNER alteration or relocation: 200 amps or less 2 Name(print): 201 amps to 400 amps 2 Mail' address: Q 401 amps to 600 emus Z 601 empa to 1000 amps 2 City: I State: ZIP: Ovct 1000 amps or vola 2� Phone: Fax: Ip E-mail: Reconnect only Owner installation: The installation is being made on property 1 own Temporary services or feeders which is not intended for sale, lease,rent,or exchange accordin to Installation,alteration,or relocation: ORS 447,455,4790 631:701. 200 ams or leas _ 2 _ X71 /1 a i / 201 amps to 400 em 2 O Vner3 SIre' batC: e�f 401 to 6t10 ampa 2 Branch circuits-new,alteration, Name: or extension per panels A. Fee for branch circuits with purchase of hddreSS: +— _ service or feeder ftt,each branch circuit 2 �Ph :_ _ State: ZIP: B. Fee for branch circuits without purchasc ne: Fax: E-mail: of service or feeder fee, first branch circuit: 2 PLAN REVIEW(Illellea%e clieck sill Mail app y) Each additional branch circuit: Mise.(Service or feeder not Included): J Service over 725 amps-commercial U Nealth-arc facility Each Pump or irrigation circle 2 U Service over 320 amps-raving of Ide2 U Hazardous location Each sign or outline lighting 2 family dwellings O Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel, — a System over 600 volts nomiml more residential units in one structure alteration, or extension* 2 O Building over duce stories O Feeders,400 amps or snore Cl Occupant lad over 99 persons 0 Manufactured struehires or RV nark 'Desch tion: Q EgressAigluing plan t7 Other. Each additional inspection over the allowable In any of the above: Peri ccuon r Submit—sets of plain with any of the above. Investigation fee 77he above are not applicable to temporary construction service. Other _ -- Not all Jurisdictienr accept credit cards,please all Jurisdiction for mon Infmvtion. Notice- This permit application Permit fee ......................S ❑Visa U IdaaterCard expires if a permit is not obtained Plan review(at_ %) S Credit card number. /a within )80 days after it has been State surcharge(8%).....S Name of cardholder a shown on credit rard Expires accepted as complete. TOTAL. ....S S Cardholder signature Amount _ 4404615(tS/0(1/CONI ELECTRICAL PERMIT FEES: LIMITED ENERGY PER1,A1 i FEES: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY lete Fee Schedule Below: Tom- p — -^� Restricted Energy Fee..................................................... $75.00 Number or inspections per permit allowed (FOR ALL SYSTEMS) Service included: — Itpnis Cost Total l✓ Check Type of Work,Involved. Residential•per unit 1000 sq.R or less $145.15 4 ❑ Audic and Stereo Systems' Each additional 500 sq.ft or podlon therect _ $33.40 1 Burglar Alarm Llmlted Energy _ $75.00 Each Manurd Home or Modular Uwalling Service or Feeder $90.90 _ 2 ❑ Garage Door Opener' Services or Feeders Heating,Ventilation and Air Conditioning System' Installation,alta stlon,or relocation 200 amps or less _ $80.30_ _ 2 ❑ 201 amps to 400 amps _ $106.0.5 2 Vacuum Systems' 401 amps to 60C amps $160.60 2 t� 601 amps to 1000 amps $240.60 2 I J Other Over 1000 amps or volts $454.65 2 Reconnect only _— $66.85 2 Temporary Services or Feeders TYPE OF WORK INVC LVED-COMMERCIAL ONLY Installation,alteration,or relocatlon Fee fur each system.......................................................... 575. 0 200 amps or less $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 arnps $100.30 2 401 amps ro 600 amps $133.75 2 Check Type of Work bwolvod: Over 600 strips to 1000 volts, tee"b"above. ❑ Audio and Stereo Systems Branch Clrcults New,alteration or exlnnslon per panel Boiler Controls o)The fee for branch circuits with ourchese of service or ❑ Clock System! leader fee. Each branch circuit $6.65 _ 2 ❑ Data Telecommunication Installation h)The foe for branch circuits without purchase of service ❑ Fir. Alarm Installation or feedor fee. First branch circuit __ $46.85 Each addltional branch circuit u $665 y�A ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder riot Incluued) Each pump or Irrigation circle _ _ $53.40 _ Each sign or outline lighting $53.40 _ ❑ Intercom and Paging Systems Signal clrcuil(s)or a Ilmlled energ!r panel,alleration or extension ___ $15.00 n Landscape Irrigation Control' Minor Labels(10) $125.00 r---I Med;csl Each additional inspection over I—� the allowable in any of the above ❑ Per Inspection — $62 50 Nurse Calls rler hour _ 562.50 V _ In Plant — _ $73.75 _ ❑ Outdoor Landscape Lighting' Fees: i Protective Signaling Enter total of above fees $ ❑ Other 0%State Surcharge $ Number of Systems 25%Plan Review Fee Fee'Plan Review.,"section on $ ' No licenses are egwren Llcensos are required for all other Installations front of applicallon —•— -- --- Fees: Total Balance Due $ Enter total of above foes $__ LJ Trust Account N— _-_—_. _ I 8%State Surcharge $_ _ Totel Balance Due ss_-- All New Commercial Buildings require 2 sets of plans. J --_ i:,dsts\forms\elc•fees,doc 02/03102 Plumbing Permit ApplicationOFFICE,USK ONLY Dste re:eived: Permit no.: City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: City of Tigard Phone: (503) 639-4171 Project/appl. no.: Expire date: Fax: (503)598-1960 Date issued: 81: Recet it no.: Land use approval: Case file no.: Payment type: t D 1 &2 family dwelling or accessory ❑Commercial/industrial 0 Multi-family ❑T:mant improvement 0 New construction ❑Addition/alterationlreplacement ❑Fofjd service ❑Other: ti t t t Job address: , ''� � ILfj� /�/ _ Description _ Qty. Fee(ea.) I Total Bldg. no.: TSuite no.: New 1-and 2-family dwellings only: (includes 100 ft.for each utility eoruiection) Tax map/tax lot/account no.: SFR(1)bath _ [ot: Block: Subdivisi �J 5FR(2)bath Project name: __ SFR 3)bath City/county: LiP: Each additional bath/kitchen Description and location of work on premises: _ Site utilities: _ Catch basin/area drain _ Est.date of completion/inspection: Drywells/leach line/trench drainPILUIVIRING — •_ Footing drain(no.lin.ft.) >r C) S E S T Manufactured home utilities _ Business nameGO M - J4,1 Rain �_�_- Manholes Address: Q yr/sRain drain connector City: TA�`/� State:DIZI ZIP: a,2, Sanitary sewer(no.lin. ft.) Storm sewer(no.lin.f. )Phone: Fax6 CCB no.: f 5 ] 3(p Plumb. ri.reg, no:34-35 6 PH Water service no.lin.R.) City/metro lic.no.: (D a s t� Fixture or item: Contractor's representative signature: Absorption valve Print name: IL, STD Date: Har'flow reventer Backwater valve CONTACT PERSON Basins/lavatory Name: A Y' A n 6 2,YS e,Y) Clothes washer _ Address: t, 1,Soo S (AAs 2 Dishwasher _ Drinking fountain(s) City; State: R ZIP: a � Ejectors/sump Phone: $D;• 9�.LJJJF( Fax:5o3_Is39o4 -mail: Expansion tank -- Fixture/sewer ca _ Name(print): QM Floor drains/floor sinks/hub' — -- Garbage disposal Mailingaddress: VHose bib _ _ City; 1. _ State ZIP: 7 Ice maker _ Phone _ D W I Fax: E-mail: Interceptor/grease trap Owner installation/residcntial maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain commercial _ employee on the property I own as per ORS Chapter 447. Sink(s),basir.(s),lays(s) Owner's signature: _ Date: r,u_ mom_ _ ENGINEER Tubs/shower/shower pan Urinal _ Name: Water closet Address: — Water heater City: State: ZIP: Other: _ Phone:- Fax: I E-mail: Total NW all Jurisdictions accept credit canis,please call jurisdiction for more information. p pp Minimum fee...............$ Notice: This permit a lication O Via 0 MasterCard expires if a permit is nut obtained Plan review(at .o) S _ Credit cord number. ---- Expires— within 180 doss after it has been State surcharge(4 ).... S _ TOTAL........................S Nam or prdhol r u own ono It-card accepted as complete. _ f C of er sl4nattns Amount 4404616(6i0a'CON,) PLUMBING PERMIT FEES: -' - PRICE TOTAL New 1 and 2•family dwollings only: -� FIXTURES (individual) _ QTY _(ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (na) AfdOUNT Lavatory 16.60 for each utlll n conection _ One 1 bath - $249.20 Tub or Tub/Shuwer Comb. 16.60 Two 2 bath _ $350.00 Shower Only 16.60 Three 3 bath _ $399.00 Water Closet 16.60 SUBTOTAL Unnal 16.60 _ 8•/.STATE SURCHARGE - Dlshwasher _ 16.60 i LAN REVIEW 25%OF SUBTOTAL 16.60 L TOTAL Garbage Dleposal --- Laundry Trey 16.60 Washing Machine 16.60 FloorDralrdFloorSink- 2' 16'60 - PLEASE COMPLETE: 3• 16.60 q 16.60 Wlder Heater O converslor. O like kind 16.60 Quantic b Work Performed Gds p ping raqulres a separate mechanical Fixture Type: New Moved Replaced Removed/ ermlt. ___--__ _ __,_ - - GaP�ed MFG Home New Water Service 46.40 Sink MFG Horne New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 18.60 Combination Roof Drains __F6 60 Shower Only Drinking Fountain 18.60 Water Closet Urinal Other Fixtures(Specify) - 16.60 _ Dishwasher Garbage Disposal Laundry Room Troy. = Washing Machine F!oor Draia/Sink: 2" _ Sewer-1 at 100' 55.00 3- Sewer-each additional 100' 46.40 4" _ Water Service-1st 100 55.00 Watrir Healer _ - Other Fixtures Water Service-each additional 200' 46.40 - (Specify) _ Storm&Rain Drain-1st 100' 55.00 _ r - Storm&Rain Drain•each additional 100' 46.40 -- -- Commercial Back Flow Prevention Device 46.40 --- _ -- Residential Bdckno,.v Prevention Device' 27.55 Catch Basin 16.60 Inspec6on of Exlsting Piumbing or Specially 62.50 Requested Inspections _ _ er/hr _ COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 - Grease Traps 16 60 ---- - QUANTITY TOTAL: Isometric at Haw diagram is required if __-_- _ Ouantlly Total is >_9 'SUBTOTAL: - ---� 8%STATE SURCHARGE: - -- "FLAN REVIEW?5%OF SUBTOTAL: R!gulredonly If nxrurt ty total Is-9 TOTAL PERMIT FEE: $ *minimum permit fee is 1'2'^ 5%plats surcharge,except Re110e01141 Bar LLnaw Prevention Device,which Is 5301 25 f 8%+1910 surcharge. r -Nil Now Commeutul Buildings require 1 acts of plane with leomstric or rta0r diagram for plan,review l:1,dstslformslpim-fees.dac 02/05/02 D Mechanical Permit Application , ' Date recct�ed.' _r Permit no.; /, r C Ili Of Tigard Pt.ect/appl,nr.: Expire date: C n uJ Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97123 Date issurd: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-I^60 Case file no.: Payment type; Land use approval: Building permit no.: 1 1 &2 i'amily dwelling or accessory ❑Commercial/industrial ❑Multi-family ❑Tenant improvement } „New construction U Addition/alteration/replacement 'J Other: INFORMATION1 ' Job address: Indic me equipment quantities in boxes below.Indicate the dollar Bldg. no,: Suits no.: value of all mechanical materials,equipment,labor,overhoad, Tax map/tax I.t/account no.: profit.Value$ L.ut: Alock: Subdivision: 'See checklist for important application information and Project name: o�,f jurisdiction's fee schedule for residential permit fee. City/county: ZIP: 1 & 2 FAMILY 1SCHEDULE Description and location of work on premises: d 1 t u Fee(ea.) Total Est,date of completion/inspection: Description Qty. Res.only Res_only Tenant improvement or change of use: Air handling unit CGI i Is existing space heated or conditioned° Ps ❑No -T — — Air conditioning sne plan rcquirr ) Is existing space insulated?J Yes Q No Alteration of existmg HVAC system MECHANICAL 1 1 Boiler/compressors Business name: State boiler permit no.: Ise N T� HFA" 1��_��— HP Tons BTU/H Address; _Z ZLNUT DR. - smoke ompers/ uct smoke detectors City: COV?7 ( State: ZIP: D eat pump(sne�an regwreg) Phonc: A Fax _�a$ E-mail: �fns17a TcTacelirnact umer CCB r Inc ludiig ducts ort'-ant liner ❑Yes❑No CCB no.: (p�(p _ _ __ Tns►eTlhep ace trate heaters-suspended, City/metro lic,no.: _ wall,or floor mronted Name(please print): e Vent for appliance other than furnace 1 NTAC1 PERSONi _ r gerat on: � Absorption units BTU/H _Name: Chillers _ HP Address: ,----� _—--- Compressors _ HP _ Environmental exhaust and rent cat nn: l ty: _ -- State, ZIP Appliance vent _ - Phone: F'ax: E-mail: Dryer ex taus► OWNERI Hoods.Type U 11/res.kitcheVhazinat hood fire suppression system Name: �T�C, �5 _ Exhaust fan with single duce(bath fans) Mailing addressKr�7'_ xhausts stema art from heatin or AC Ci 5tatc: 7.IP. el p p ng and stribul on(up to 4 outlets) ty 1pglpe LPGNG Oil Phone: }ax: E mail eT�i in sac i-adduto�naTove-bout ets Process piping(schematic require ) _ Name: Number of outlets ter ste app once or equ Amen Address: _ _ Decorative fireplace City: �__ State: ZIP: nsert-type, _ Phone: Fax: E-mail: oo stove pe et stave Other: _ Applicant's signature: _ Date: _t her: — Name(priut)• Not all Jurisdictions accept credit cards,please call Jurisdiction to more mrtumaton. Permit ice ..................... S Notice: This permit application Minimum fee................S O visa L1 MuherCani expires if a permit is not obtained o Credit card number __ _,L_[_ Plan review(at_ /°) S Expires within 180 days slier it has been State surcharge(8°h).... S " accepted P.s complete,T Name of cardholder n shown nn credit card P P s TOTAL.........................S Cesar holder signature ---- Amount 41M611(M01'.1 MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE:_ _ -1 Description, - Price Total $1.00 to$5,0_00.00 _ Minimum fee$72.50 Table 1A Mechanical Code City (Ea) Amt -$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,OCu BTU $1.52 for each additional$100.00 or including ducts 8 vents _- 14.00 fraction thereof,to and Including 2) Furnace 100,000 BTU+ _ $10,00000. Including ducts&vents 17.40 $10,f 01.00 to$25,000.00 $148.50 for the nisi$10,000.00 and 3) Floor Furnace $1.54 for each addilionel$100.00 or includin vent 00 fraulion thereof,to and including 4) Suspended heater,wall heater $25,000.07. or floor mounted heater 14 UU $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included in appliance permit $1.45 for each additional$100.00 or 6.80 fraction thereof,to and including 6) Repair units _ _ $50,00000. 12.15 _,00 $501.00 and up $742.00 for the first$50,000.00 and Check 01 tha:apply. Boiler Hral Air $1.20 for each additional$1100.00 or For Ite..1s 7-11,see or Pump Con d fraction thereof. footnotes below. Comp Minimum Permit Fee$72.50 - SUBTOTAL: 7)<3HP,absorb unit $ l0 100K BTU 14.00 ^� 6'/e Stas Surcharge $ 8)3-15 HP;absorb unit took to 500k BTU 25.60 25%Plan Review Fee of subtotal) $ 9)15-30 HP,absorb Required unit 5-1 mil BT35.00 for ALL commercial ermitsns o _ . 0 TOTAL COMMERCIAL PERMIT FEE: $ unit 301.7 mi BTUabso52.20 _ unit 1.1.75 mil BTU _ 11)>50HP;absorb unit>1.75 mil BTU 87._20 [ASSUMED VALUATIONS PER APPLIANCE_: 121 Air handling unit l0 10,000 CFM _ 10.00 VBlue - Total 13)Air handling unit 10,000 CFM+ Description: ___ __ Ol _�E�_ Amount 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler - ducts 8 vents Moo Furnace>100,000 BTU Including 1.170 15)Vent fan connected to a single duct ducts&vents A 6.60 Floor furnace Includin vent------ 955 - - --- - - -fl- - 16)Ventilation system not included In Suspended heater,wall heater or 955 _a Ilance ermlt 10.00 floor mounted heater_ �-- - --- - -- Vent not included in applicanca 445 - 17)Hood served by mechanical exhaust 10.00 P-enit_ _____ 18)Domestic Incinerators Repair units _ 805 _ _ 17.40 <3 hp,absoro.unit, 955 - - to look BTU 19)Commercial or Industrial type Incinerator 69.95 3-15 hp;absorb unit, 1,700 - - - 101k to 500k BTU20)Other units,Including wood stoves 10.00 _ 15-30 hp;absorb.unit,5011k to 1 2,310 21)Gas piping one to lour outlets mil.BTU _ 5.4_0 30-50 hp;absorb.unit, 3,400 22)More Than 4-per outlet(each)- 1-1.75 mil.BTU _ 1.00 >50 np;absorb unit,^ 5,725 Minimum Permit Fee 572.50 SUBTOTAL: s -- >1,75 mil.BTU Air handling unit to 10,000 cfm 856 ----- --- - Air handling-unit>11 0 000 cfm 1,170 8%State Surcharge $ Non-portable evaparele cooler s56 -- TOTAL RESIDENTIAL PERMIT FEE: $ Vant fan connected to a single duct _ 448 _ Vent system not Included In 158 applance permit_ _ _Ho_cd served by mechanical exhaust ___65C __ oth )O' `ll�s-��' I Inspections outside of normal business hours(minimum charge-two hours) Dameatic incinerator 1,170 $62 50 per hour Commercial or Industrial Incinerator 4,59C 2 Inspechone for which no lee is specifically indicated (minimum charge-hall hour) Other unit,Including wood stoves, 656 562.50 per hour Inserts etc. 3 Additional Alan review(squired by changes,addilions or revisions to plana(minimum Gas piping 14 outlets 380 charge one-half hour)$62 50 per hour Each additional outlet __ 63 'Slats Contractor Boller Certification requlrsd for units>200k BTU. 'Residential A/C requires alts plan showing placement of snit. TO FAL COMMERCIAL $ VALUATION: _____j All New Commercial Bulsdings require 2 sets of plans. i;\dsts\forms\mach-fees.doc 02/05/02