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15100 SW 89TH PLACE co PO n IS100 SW Sy"' Placa CITY OF T I G A R D MASTER PERMIT PERMIT#: MST2000-00528 DEVELOPMENT SERVICES DATE ISSUED: 12/14/00 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 15100 SW 89TH PL PARCEL: 2S111AD-12100 SUBDIVISION: SCHECKLA PARK ESTATES ZONING: R-4.5 BLOCK: LOT:038 JURISDICTION: TIG REMARKS: adding 2nd floor above garage approx 528 sq ft Path I S/F BUILDING REISSUE: STORIES: 2 FLOCK AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: HEIGHT: 20 FIRST: of BASEMENT of LEFT: SMOKE DETECTORS: Y TYPE OF USE: Sr FLOOR LOAD: 40 SECOND: 528 of GARAGE: of FRONT: PARKING SPACES TYPE of CONST: 5N DWELLING UNITS: FIN13SMENT: of RIGHT: OCCUPANCY ORP: R:i RDRM: 1 BATH: 1 TOTAL: 578VALUE; $16,80000.00 al REAR: PLUMBING SINKS: WATER CLOSETS: i WASHING MACH: LAUNDRY TRAYS: RAIU DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: MECHANICAL OTHER FIXTURES: _ FUEL TYPES FURN<100K: BOIUCMP<AHP: VENT FANS: 1 CLOTHES DRYER: GAS FURN>000K: UNIT HEATERS: HOODS: OTHER UNITS! MAX INP: h:d FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS: ri-ECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFrEOERS _BRANCH CIRCUITS MISCELLANEOJS ADD'L INSPECTIONS 1000 SF OF Lt:SS: 0 200 amp: 0 200 arip: WISVC OR FOR: 1 PUMPIIRRIGATION: PER INSPECTION. EA ADD't 5u0SF: 201 400 amp: 201 400 amp: tat W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR: LIMITEr rNERGY: 401 600 amp: 401 600 amp: EA ADDL BR CIR SIGNALIPANEL IN PLANT: MANU',MISVC/FDR• 691 • 100011 601+4mpa•1000v: MINOR!ABF : 1000•amolvolt: Reconnect only: PLAN REVIEW SEC71011 >.4 RES UNITS. S\CIFDR>-225 A.: >600 V NOMINAL: CLS ARE NSPC OCC: ELECTRICAL-RE:TRICI'FD ENERGY A SF RESIDEt TIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO IL STEREO: FIRE ALARM INTERCOM/PAGING OUTDOOR LNDSC LT. BURGLAR ALARM: BOILER: HVAC LANDSCAPEARRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK INSTRUMENTATION MEDICAL: OTHR: HVAC: DATA/TELE COMM NURSE CALLS TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 632.59 This permit is subject to the regulations contained in the R SMAREK+BARBARA OWNER Tigard Municipal Code,State of OR Specialty Codes and 15110000 S', '89TH PL all other applicable laws. All work will be done in TIGARI,VR 97224 accordance with approved pans This permit will expire H work is not started within 160 days of issuance,or if the work is suspended for more then 190 days ATTENTION Phone: Phone- Oregon law requires you to f illow rules adopted by the Oregon Utility Notification Caner. Those rules are set Reg 0: forth in OAR 952-001-0010 through 952.001-0080 You may obtain copies of these rules or direct questions to OUNC by cbll-ng(.503)246-1987. REQUIRED INSPECTIONS Urderfloor InsUI&tIon Electrical Rough In Insulation Insp Final inspection PLM,Underfloor Framing Insp Rain drain Insp Mechanical Insp Shear Wall Insp Electrical Final Plumb Top Out Exterior Sheathing Ins{ Mechanical Final Electrical Service Low Voltage Plumb Final Issued By : 1 1 • ;. ` Permittee Signature :_d 'VD- Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day r� 1 Building Permit Application Date received:!r Permit no.: -X S City of Tig and �J ProjecUappl.no.: Expire date: � CitygjTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 Date issued: By; .� Receipt no.. Fax: (503) 598-1960 [.C:asc file no.: Payment type: 1&2 family:Simple Complex: Land use approval: ` TYPE OF X 1 &2 family dwelling or accessory U Commercial/industrial J Multi-.'.111111Y �l hr t ncIni a at U Demolition Aldition/alteratiorereplacement U Tenant improvement U Fire sprinkler/alarm _1()1iici _— ',JOWSITEINFORMATION y; Job address: (00 -77_ (( A(,� R �_ Bldg.no.: _ Suite no.: Lot: Block: Subdivisian: Tax map/tiix lottaccount no.: _ — Project name: 1Description and location of work on premises/special conditions: —.__ — --- - — Name: Mailing address: lao�W 89s. 1 do 2 fatuil} drrellinl: c City: lG State: ZIP: Valuation of work........................ Phone: ! f 1._114-rrax: E-mail: No.of bedrooms/baths................................. �•— Owner's representative: .................. number of floors.............................. .. .................. Ste Phone: rax: IL-mail: New dwelling area(sq.ft.) ........ , p ■ Garage/carport area(sq.ft.)I........................ Covered porch area(sq.ft.) ......................... -- Name: _ Mailing address: -- — — Deck area(sq.ft.)..... .................. . ............ _ State: ZIP: Other structure arca(sq.ft.)......................... City: Comn,erciallindustriaUmulti-family: Phone: Fax: I E-mail: Valuation of work........................................ 5 --- -_ Existing bldg.area(sq.ft.) .......................... -- Business name: ��yl New bldg.area(sq.ft.)................................ _ Address: —_ �- Phone: Number of stories.................. r..:,..............City: _ StatType of constructionOccupancy group(s): Existing:Fax: — CCB no.: — New: City/metro lir.no: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Nance: provisiot,x of ORS 701 and may be regaired to be licensed in the — - jurisdiction where work is being performed. If the applicant is Address: - exempt from licensing,the following reason applies: City: state: Z1P: lax Plan no.: contact m • -- _ - Name: Contact person: Fees due upon application ........................... $ -- Address: Date received: .. City: �, -- Amount received ......................................... S - Phone: Fax: _- Please refer to ice schedule. -- 1 hereby certify I have read and examined pllcati and the Nd alt mdictlon,mrce.0 credit cads,ptewe call jurisdiction for owte inf-TIAii.v, attached checklist. All p visions la oral ces governing this r,v�xa L]MesutCattt work will tx complied w .wheth fled he 'n or not. credo coal number- work umber a:epires Authorized si nature: 0" ---�1r cardholder u shown on t end Print name: _ Car-3fai i�Ai�nature Amount Notice:This permit application expires if a permit is not obtained within I Bo days after it has been accepted as complete. 4401613(fiWrOMi r- Orae-and Two-Family Dwelling Building Permit Application Checklist Reference no.: ` Cirygffigard " T:.•. Associated permits: City ef A ,gard U Electrical U Plumbing U Mechanical Address; 13125 SW;call Blvd,Tigard,OR 97223 UOther: Phone: (503) 639-417; --- Fax: (503) 598-1960 t , 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Toning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of approved plat/fall. - 4 Fire district--approval reyulred. - 5 Septic system permit or authorization for remodel. Existing system capacity b Sewer permit. 7 .Vater dfatrict 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 draineee-way protection,silt fence design and location of _ catch-basin protection,etc. 10 .' Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and st,:e / building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed if copyright viclalions exist. I I Site/plot plan drawn to scale.The Plan roust show lot and building setback dimensions;property comer elevations(if there is more than a 44 elevation di;ferendal,plan must show contour lines at 24 intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;imperyious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,ani hold-downs and reinforcing pads,connection details,vent sii,-,and location. 13 Floor plans.Shop'•all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross sections)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, s,all construction,roof construction.More than one cross section may be required to clearly portray construction.Show detMIs of all wall and roof sheathing,rcx)frng,roof slope,ceiling height,siding material, irotings an'foundation,stairs, fireplace construction, thermal insulation,etc. is 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 L.greater than four fart at building envelope. Dull-size sheet addendums showing foundation elevations with cross refereaces are acceptable. lo Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations-,for non-prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all Iloors/ra)f assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,see item 22,"Engineer'!calculations." 19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joins over 10 feet long and/or any beam/joist carrying a new-unifonn 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, fur four or more.appliances. 22 Engineer's calculations.When required or provided,(i.e..shear wall,Wolf truss)shall be stamped by an engineer or architect licensed in Oregon and shall he shown to be apps Alle to the project under revic�+ 1 Fisc(5)site lans are required for Item I I above. 24 25 26 27 28 —---- Checklist must he completed before plan review start date. Minor changes or notes on Submitted plans may he in blue or black Ink. Red ink is reserved for dcp.rrtment use only. 4404614(MOCOM) Electrical Permit Application Datereceived: %1,.o lo- Permit no.:11,5 7 2,17 oos City of Tigard Project/appl.no,: Expiredate. Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: ay: ReceipI.no.: City of Tigard Phone: (503) 639-4171a Pment type: e Case file no.: ) Fax: (503) 598-1960 Land use approval: -_ - - 1 &2 family dwelling or accessorykAtd'diti(in/alte l mercialiintl:astrial U Multi family U Tenant improvement 0 ew cnnstricfion at.,)ti/repliceiii�,lit U C)thcr. U Partial J �^� _ Bldg.no : Suilc no.: III=/tax map o.: Ta /tax lot/account no.:_- ob address: 1S lqO �� of: Block: Subdivision: _— Project name, Description and locatiort of wok on premises: Estimated date of completion/inspection: FEE SCIIEDULE 1 MIT, 11111111 - Fur M+n Job not IHwcriplion Qtv. (ca.) Business name: Iver - New resident -vhnRkormulti family per Address: __ ,!wr:IgrigtulN.l laticcatt-wiK41garaw State: ZIP: S:rvicelncluded: ('Ity. 10(x1 sq.It or less _ 4 F,,t; Email: Phone: _ Each additional 500 s ft.or tion thereof Elec.bus.lie.no: Limited energy,resident I 2 CCB uo.: - — 2 City/metro lic.no.: _ I.in itedenergy,non-resid tial Each manufactured home o nodular dwelling � Uste - Service and/or feeder Si nature of su rvising elce_trician(requircc',__ - -- Services or Feeders-Installatl SuP elect. ,;n.e(print): I'i`'t'rrsr n t alteration or relocation: 2 hat 200 maps or less 2 201 strips to 400 amps _ 2 Name(print): 4j� Z 401 maps to 6(1(1 smps _ - S-I� SW 3 - 601 amps to IOW 2 Mailing address: 2 City: Slate: 7UP: Over 1(x10 am s or volts I Fax: E-mail: Reconnect only Phone: Temporary aerrlca or feeders Owner installation:Th- a ati s teeing made on property 1 ctwn InstaosUml,altention,orre cation: 2 which is not intended ease,ret exchange according to 21111 am or less 2 ORS 447,455,479,({I . 1• .P I amps to 41x1 am s 2 owner's SI nUlUrl': rule: 11 3° 4 401 to 600 amps Branch circuits•ne dtcnllou, or extension perp el: Name: A Fee for brancl ircuits with purchase of 2 -- service or f der fee,each branch circuit Address: N. Fee fur hr ch circuits without purchase City: state: QIP of servic or feeder fee•first branch circuit: _ 2 Phone: I i (i-netil: Each add.' nal branch circuit. M"bc,(,.i vice or feeder not included): 2 act p o1,tm111811 circle 2 Uservice liver,2,1anytsctnnna.tt1,11 -Jliealth-cruefacility latch gnorcutlinelighling -- U Service over 320 amps-rating of 1&2 U Hazardouslocation Si al circuh(a)or a limited energy panel, famiiydwellings U Huildingover 10,ftisyua-e feetfouror 2 more residential units in ti estructure m ration•or extension* U System over 6fNl votes nominal — _ J Building over three sturirs U Feedets.4(x1 Limps or mtion.c,e I I _� J(kQ9 p cupant load over Uersons U Manufactured structure.nr RV park Each additional Inspection over the ollowable In any of the above: UEgres4liandngplan U0thec __ _ -- Ferinslxution ��- Submit—sets of plant with any of the shote. Investigation fee _ The above are not applicable to temporary construction service. Other --- Permit fee..................... Noticc:This peratit application Plan review(at — %) $ NeA sit ludsdicrions accept credit coats,plr;w call p liklitnon fa Irxwr laftwnmuou ex f ires if a pe.mit i.,trot obtained U visa U Mastercatu State surcharge(8%)....$ �, ___j__L--- within ISO d ys atter it hn� been g t'rrda card number__-- Expires 1 UTAL .......................f accepted as�wmplete. Nanette o rwa awnone a tcs 4W4h1SuMx Okii - Cardholttei vipratrne - Amount Electrical Permit Fecs: Limited Energy Fees: F_ TYPE Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY ---- Restricted Energy Fee..................... ............................... S75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq ft.or less $145 15 a ❑ Audio and Stereo Systems Each additional 500 sq.ft.or portion thereof __ $33.40_ 1 Limited Energy $75.00 _ ❑ Burglar Alarm Each Manufd Home or Modular Dwelling Service or Feeder $90.90 _ 2 ❑ Garage D)or Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 stems' S 201 amps to 400 amps _ $106.85 2 ❑ %racuunr Y 401 amps to 600 amps ;160.i0 2 601 amps to 1000 amps __ $240.60_ 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF W,)RK INVOLVED -COMMERCIAL. ONLY Installation,alleralinn nr relocation Fee for each system................................................... ...,.. $75.00 200 ar,.�a v,.ess —+ $66.85 _ 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 2 411 amps to 600 amps $133.75 2 Check Type of Work Involved: _)ver 600 amps to 1000 volts, see"b"above. ❑ Audio and Stereo Syrtems Branch Circuits Ir----11 Boiler Controls New,alteration or extensior,per panel lr a)The fee for branch clrcr.its with purchase of sarvi,�e or ❑ Clock 5ystems feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation b)The fee for branch circuits without purchase of service ^,r feeder foe. ❑ Fire Alarm Installation First branch circuit $46.85 Each additional branch circuit $6.65 ❑ HVAC Miscellaneous Instrumentation (Service or feeder not Included) ❑ Each pump or Irrigation circle ___ $53.40 Each sign or outline lighting $53.40 intercom and Paging❑ 9 9 S Ystems Signal circult(s)or a limited energy panel,alteration or extension ___ $75.00 ❑ Landscaoe Irrigation Control' Minor Labels(10) $125.00 Each additional Inspection over ❑ Medical the allowable In any of the above Per Inspection S62.50 ❑ Nurse Calls Per hour $82.50_� In Plant $73.75 _ ❑ Outdoor Landscape Lighting' Fees' ❑ Protective Signaling Enter total of above fees $ I ❑ Other _ 8%Stare 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 tees $ ❑ Trust Account p-.. --- — —' j 8%State Surcharge $ Total Balance Due $ I:4ists\rorn><klc-fces.doc 10/09/00 Mechanical Permit Application Date received: ' ��d ?b Permit no.:ILrs City of Tigard Project/appl.no.: Expire date: 01%,ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503)598-1960 Case file no.: Payment type: — Land use approval: Building permit no.: 1VPE'OF PERMIT 1 &2 family dwelling or accessory ommercial/mdutiinal U Multi-fatnily U'lenant improvement ❑ •w construction ddition/alteration/replacement U t ether. '00 SITE INFORMATION' 0MM ERCIAL VALUATIO I Job address: 'S�t00 t.x) /kGtf Indicate equipment quantities in boxes lxluw. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: _ *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/.:ounty: ZIP: Del:cription and location of work on premises: I 1 ' a 1vt-(ea.)j Iolal Est.date of completion/inspection: on lit . Res,only Res.only Tenant improvement or change of use: unit _ FM Is existing space heated or conditioned?U Yes U No Air con Air handling g ng(site p a _CC ) Is existing space insulated?U Yes U No Alteration of existing systemINII CI IAN _ / , of er compressors _Business name: State bailer permit no.: HI Tons BTU/H Address: ire/sn,o a damper Vduct smo atectors -- City: State: 7_IP: eat pump(site plan requires— Pilo ne: Fax: E-mail: nsta rep al cefuraace/burner NTLyli Including ductwork/vcnt liner U Yes 4NO _CCB no.: nstu rep ace re ocate eaters-susp- c , City/rnclm tic,no.: wall,or floor mounted Name(please print): %Icw Grr a hance of rt nn furne PERSON of geral on: CONTACT Absorption units Name: t hitters — �- NP --- - C'oni pressors HP Address: _ Environmental d ventilation: City: State' ZIP: Appliance vent Phone- Fax I E-mail )ryctextaust 0o s, vpe It II/res. itc c armat �y hood fire suppressiu system Name: Exhaust fan with s' gle duct(hath fans) Mailing address: (� OO �vVT ti ust system art from heatingor AC State: ZIP: •uc p p ng an o rot on(up to 4 out ets) type: __-- _` .t".l NG Uil Phone: Fax E-mail: _ _uT cf 1 m� ,ic`h aJdition�over aur etv rocesspng(schematicrequired) Number f outlets Name: _ ter qted applianceor equipment: Address: Deco live fireplace City: ZIP: Insc -type _ Phone; x: E-mail: o %Io% PC let stove cr: Applicant's signator �`"^y� Untc: 'JOS t cr: Name (Prim): — _ _-- Not all Jurisdictions accept creta cant,please call lutialicthm lot move inhttmationPermit fee................ .... U visa U MnrtetCard Notice:'this permit application Minimum fee................$ expir ..if a permit is not obtained Plan review(at _ %) $ — t•redit card nundxr w'iUtUt IRI)clays s eller it has been -` State surcharge(8%)....$ —-- -- accepted as complete.Name of cardho t as shown on ere it car p p $ TOTAL .......................$ Cwt1hoklet denature i An wnt — ")-4617(6MWoM) MECHANICAL !PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: Description: - 7(Ea) Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Qty Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU 1.C2 for each additional$100.00 or including ducts&vents i 14.00 fraction thereof,to and including 2) Furnace 1.00,000 BTU+ --- $10,00 .00. Including ducts&vents 17.40 $10.001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or Including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater _ $25000.00, or floor mounted heater 14.00 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 6.60 fraction thereof,to and including 6) Repair units _ __ $50,000.00. _ 12.15 $50,001.00 and up $742.00 for the first$50,000.Or and Check all that apply: Boiler Heat Air $1.20 for each additional$10).00 or For Items 7.11,see or Pump Cond fraction thereof. _ footnotes below. Com • •" 7)<3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00 Value Total 8)3-15 HP;absorb unit 100k to 500k BTU 25.60 Description: Qt Ea Amount 9)15-30 HP;absorb Furnace to 100,000 BTU,including 955 unit.5.1 mil BTU 35.00 ducts&vents 10)30-50 HP;absorb Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU 52.20 ducts&vents - Floor furnace Including vent 955 11)%SOHP:absorb unit>1 75 mil BTU 87.20 Suspended heater,wall heater or 955 floor mounted heWur 12)Air handling unit to 10,000 CFM Vent not Included In applicance 445 10.00 ermit13)Air handling unit 10,000 CFM+ Repair units � 805 17.20 <3 hp;absorb.unit, 955 14)tJon-portable evaporate cooler to 100k BTU 1000 3.15 hp;absorb,unit, 1,700 �- 15)Vent fan connected to a single duct 101k to 500k BTU 6.80 15-30 hp;absorb.unit,501k to 1 2,310 16)Ventilation system not included in mit.BTU applianceepermit 10.00 30-50 hp;absorb.unit, 3,400 17)Hood served by mechanical exhaust 1-1.75 mil.BTU 10.00 >50 hp;absorb.unit, 5,725 18)Domest+;incir,eirators >1.75 mil.BTU 17.40 Air handling unit to 10,000 dm858 19)Commercial or Indus sial type Incineratnr Air handling unit>10,000 cfm _ 1,170 - 69.95 Non-portable evaporate cooler 656 _- 20)Oth3r units,Including wood stoves Vent fan connected to a single duct 446 10.00 _ Vent system not Included In 656 21)Gas piping one to four outlets appliance permit 5.40 Hood served by mechanical exhaust _658 22)More than 4-per outlet(each) ._. _ _. _ 1.00 Domestic incinerator _ _ 1,170 Commercial or Industrial Incinerator 4 Minimum Fee$72.50 SUBTOTAL:590 _ $ Other unit,Including wood stoves, 658 ----� g%State Surcharge Inserts,etc. fl $ Gas piping 14 outlets __ 360 Each additional outlet 83 Z$•/,plan Review Fee(of subtotal) $ _ Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: gibmer.lnlP.fs m tied Fee& 1 t, tpections outside of normal business hours(minimum charge-two hours) $r 2 50 per hour 2 Inspections for which no fee is specifically Indicated (minimum charge half hour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-one-half hour)$72 50 per hour *State Contractor Boller Certification requlred for units>200k BTU **Residential A/C requires site plan&flowing placement of unit. I\dsts\forms\mcch-fees.dor: 10111/OU �t r Plumbing Permit,Application "— Date received: Permit no.:/ic-r City of Tigard Sewer permit no.::� Building permit no.: AdJress-. 13125 SW Ball Blvd,Tigard,OR 97223 ProjecUappl.no.: Expire date: Ciryu(Tigard Phone: (503) 639-4171 Fax: (503) 599-1960 Date issued: By: Teceipt no.: Land use approval: _.� _-- _. Case file no.: Payment type: 0 ;CU &2 fad Lily dweiling or accessory O Commercial/industnal U Multi-familyC?Tenant improvement ewconstructi.tn Addition/alteration/replacement U Food servir,- U Other:� Iticriptinu QfV. F cc(ra.) 7'olal ddress: Ne-111-and 2-F:+ruily d;�+liin�c nnl�: Bld nuc o.: Bldg.no.: S_.._ _n _ (includes OOft.lorcachulililyt:enncrairtu) Tax map/tax lot/account no.: SFR(1)b th fit; Block: Subdivision: SFR(2)bato Project name: SFR(3)bat City/county: �LIP: - __ Each ..iaition I bath kitchen DIte escription and location of work on premises: Catch sics: babasin area ruin -- _ Drywells/Ieach lid trench drain Est.date of complctiorJins, . u. Footing drain(no. 5Q. ft.) t Manufactured home tktilities Z Business name: _ _ Manholes Address: Rain drain connector State: ZIP: Sanitarysewer(no,lin. R _ City: -- Stonn sewer(no.lin.ft.) Phone: Fax: E-mail: Plumb.bus.re no: Water service(no.lin.ft.) CCB no.: g' Fixture or item: City/metro lic.no.: _ — Abso tion valve Contractor's representative siynature: Back flow reventer Print name: - Date: Bcrkwater valve t Basins/lavatory Clothes washer Name: — Dishwasher __ Address: Drinking fountain(s) City: State: ZIP. E'ecJ tors/sum Phone: Fax: E-mail: Expansion tank _ Fixtum.lsewer cap Floor drains/floor sink, ub Name(print): F tQ(sJL._ _ — Garbage disposal Mailing address: s coo e" Hose bibb City: _ State: 7.IP_ Ice maker _ Phone: 2 Fax: E-mail. Interceptor/ rca trap Owner installation/residential mainte e : The actual installation Primer(:) _ will he made by me o the main) uuu .repair n c by my regular Roof drain( mmercial) employee on the pm I own per S C cr 447. tl ink(s),ha n(s),Invs(s) Owner's si nutui ate: .um Tubs/s wee/shower an YW Name: __ —_ oset _ Address:City: State: ZIP: - — - Phone: Fax: E-mail: Tote Minimum fee................$ Not all iorsdictiam accept credit cards,please can Jurisdiction for mrxe informntion Notice:This permit application Plan review(at _ %) $ --- — O Viaa U MasterCard expires if a permit is not obtained Credit card numtrr _ ---�—� within IRO days after it has been Slate surcharge(9'!h)....$ Esplre, acccplcd as complete, TOTAL .......................$ — Name of c Idet a snown on cre It card $ Cardholder siRttolttre Amount1 0-4616(6AM'nMl PLUMBING PERMIT FEES: v- PRICE TOTAL New 1 and 2-family dwellings only: QTY ' FIXTURES (individual ea AMOUNT (includes all plumLing fixtures in PRICE TOTAL Sink - 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility tonne(tion)_ - _ One 1 bath _ _$249.20 Tub or Tub/Shower Comb 16.60 Two(2)bath _ $350.00 Sht.NerOnly 16.60 Three 3 bath _ $3f'9.00 Water Closet 16.60 ----- SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Ga:uage Disposal 16.60 ___ _-_` -TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" - 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater O conversion O like kind 16.60 Quantity b Work Performed Gas piping requires a separate mechanical I Fixture Type: New Moved Replaced Removed/ permit. MFG Home New Water Service 46.40 Sink MFG Horne Now San/Storm Sewer 46.40 _Lvvatory ub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 1660 Shower Ong Drinking Fountain l 16.60 Water Closet Other Fixtures(Specify) 16.60 Urinal Dishwasher -T Garbage Disposal Laundry Room Tray _ Washing Machine _ Floor Drain/Sink: 2" Sewer-1st 100' 55.00 3" -- Sewer-each additional 100' 46.40 4" _ Water Service-1st 100' 55.00 Water Heater Water Service-each additional 200' 46.40 Other Fixtures Specify) Storm&Rain Drain-1st 100' 55.00 Storm 8 Ralri Crain-each additional 100' 46.40 _ Commercial Bock Flow Prevention Device 4640 Residential Backflow Prevention Device' 27.55 -� Catch Basin 16.60 -� Inspection of Existing Plumbing or Specially 72.50 Requested Inspections er/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 _ Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagr rn is required it -- Quantity Tot Is >B - *SUBTOTAL 8%STATE SURCHARGE - "PLAN REVIEW 25%OF SUBTOTAL Required only If fixture qty total ii>B TOTAL S "Minimum pe mit res is$7250+6%slate surcharge,except Residential Backflow Prevention Device,which Is$36 25+6%slate surcharge ~All New Commercial Buildings require plans with Isometric or riser diagram and plan review is\dsts\fomes\plm-fees.doc 10/10,00 Permit#: r�oo0-005g9 0� 01> r, -tL- PLI. ` Address: 15100 c'�LO b 9 Date: i©54 ----- — --- Statement: Information Notice to Property owners About Construction Responsibilities Note: Oregon Law, URS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued, This statement is requi. for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under DRS 701.010(7), need not submit this statement. This statement will fie filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313: 1. 1 own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. El3A. My general contractor is. (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must he registered with the Construction Contractors Board. OR 3B. I will he my own general contractor. If I hire subcontractors, 1 will hire only subcontractors registered with the Constniction Contractors Board. If I change my mind and hire a general contractor, l will contract with a contractc,.who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. 1 hereby certify that the above inf cation i, rrect and Ihi�t I have read and do understand the I nf��rnrat il�n Notice to I'm a IN Own about 'on ction Responsibilities on the reverse side of this form, lot L i tiignut pre of pe mit appli(ant) I ' Ilc (White cop to issuing agencY vermit file, pink copy to applicant) CITY OF TIGARD 24-hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BLIP _ Received __ _— Date Requested-- /0 /3! AM—_ PM -__ _ SUP Location _ _ LT 10 6 PL. Suite- MIEC —--- Contact Person — �-�-� _ Ph( ) h �O — �l ?>� PLM — --- Contr _ Ph (—) SWR -- UALD10 Tenant/Owner EL C - Foo ing ELC Foundation Across: 5-� t t r _ �} ELF! Drain I t e''-+_ GJ 1 EL - - - - Crawl Drain SIT Slab Inspection Notes: --- Post&Beam -- -------- Shear Anchors Ext SheathiShear �—• Int Sheath/Shear Frr ng -- Dryh.,.Nailing Firewall Fire Sprinkler Fire Alarm _ _ n, Susp'd Ceiling Roof S IPART FAIL me - PNitm Under Slab G - Rough-In _ Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain - - Shower Pan Other: PABT FAIL - tole - -- Post& Beam Rough-hi - Gas Line Smoke Dampers ------ -- — ABS PART F_AWM --�-"-- �- gt ICA _ _ — - ----_ Service Rough-In -- UG/Slab M Low Voltage Fire arm F' al Reinspection fee of$ _._required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ,tiiPASS PART FAIL --_-- n Please call for reinspection HE: Unabl to inspect-no access Fire Supply Line / ADA Deft ��3 L L. Inspector --- Ext Approach/Sidewalk Other:_ Final _ DO NOT REMOVE this Inspection record from t e job site. PASS PART FAIL