11345 SW 97TH COURT 11345 SW 97"' Court
CITY OF TIGAR�` MASTER PERMIT
;)ERMIT # MST2001-00574
DEVELOPMENT SERVICES DATE ISSUED: 12/26/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11345 SW 97TH CT PARCEL: IS135CA-08400
SUBDIVISION: MLP97-0018 SLIMICK ZONING: R-12
BLOCK: LOT:002 JURISDICTION: TIC
REMARKS: Construction of new single family residence. Path 1
BUILDING
REISSUE: STORIES: 1 FLOOR AREASREQUIRED SETBACKS REOUIREJ
CLASS OF WORK: NEW HEIGHT: 15 FIRST: 1.550 of BASEMENT: if LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: at GARAGE: 844 sf FRONT: 24 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNIrS: 1 FINBSMENT: of RIGHT: :9
VALUE: S 171,190 90
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 1.65000 of REAR: 45
_ PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS.
LAVATORIES: 3 DISHWASHERS: t FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS,
TUB/SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES. 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<10OK: I BOILICMP<3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN>-100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: I WOOOSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 3 201 400 amp: 201 400 amp: tat W/O SVC/FDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 800 amp: 401 600 amp: EA ADDL OR CIR: SIGNALIPANEL. IN PLANT.
MANU HMISVCIFDR: 801 • 10008111p: 5014ampr1000v: MINOR LABEL:
1000♦amp/Volt:
PLAN REVIEW SECTION
Reconnect oniv:
>-4 RES UNITS: SVCIFDR>-225 A.: >1100 V NOMINAL, CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO A STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTW BOILER: HVAC: LANDSCAPEARRIU: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
MVAC: DATA/TELE COMM- NURSE CALLS: TOTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,044.74
This permit is subject to the regulations contained in the
DANIEL SLIMICK OWNER Tigard Municipal Code,State of OR. Specialty Codes and
11344 SW 97TH CT all other applicable laws. All work will be done In
TIGARD,OR 977.23 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:
Phone: Phone Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Rogel forth in OAR 952-001-0010 through 952-001.0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246 1987.
REQUIRED INSPECTIONi
Erosion Control Insp 8, Post/Beam Mechanica Mechanical hrvp Exterior Sheathing Insl Water Line Insp Final Inspection
Sewer Inspection Underfloor Insulation Plumb Top Out Low Voltage Appr/Sdwlk Insp
Footing Insp Crawl Drain/Backwater Electrl;al Scrvicr Gas Line In',p Electrical Final
Foundation Insp Footing/Foundation Dn Electrical Rough In Insulation In,,p Mechanical Final
Post/Beam Structural PLM/Underfloor Framl% Insp Rain drain Insp Plumb Final
Is:t.Ied By : yJL rL lli_ J�c 1.< < Permittee Signature', f _
Call (503) 639-4175 by 7:00 p m, for an inspection needed the next business day
CITYOF TIGARD SEWE R CONNECTION PERMIT
DEVELOPMENT SERVICES EISSPERMIT#: S /26/01 00325
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
DATE ISSUED: 12/26/01
PARCEL: 15135CA-08400
SITE ADDRESS; 11345 SW 97TH CT
SUBDIVISION: MLP97-0018 SLIMICK ZONING: R-12
BLOCK: LOT: 002 _ JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NI-W DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: ',-TPSWR IMPERV SURFACE-
Remarks: Sewer connection for new single fancily residence
Owner: FEES
DANIEL SLIMICK Type By Date Amount Receipt
11344 SW 97TH CT
TIGARD, OR 97223 PRM"l C R 12/26/01 $2,300.00 27200100000
iNSP CTR 12/26/01 $35.00 27200100000
Phone: 503-684-6496 Total $2,335.00
Contractor:
Phone:
Reg#:
,—_Required Inspections
This Applicant agrees to comply with all the rules and regula'ions of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Issued b ( — Permittee Signature:v
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
,. Permit no.:Ml,�*el -�371
City of T:bard
Address: 13125 SW Hall Blvd,'figdrd,OR 97223 Prolect/appl.no.: Expire date:
City of Tigard
Phone: (503) 1139-4171 j 1�i' hate issued: By: Receipt no.:
Fax: (503) 598-1960 /1 Case file no.: Payment type:
Land use approval: rc�G/f 7'Gr'YJ,� I&z family:Simple Complex:
TYPE OF
U 1 &2 family dwelling or accessory U Commercial/industria! U Multi-family ?Jew construction U Demolition
U Addition/alteration/replacement U'fvimni improvement U firs sprinkler/alarm U Other:
r. 1711110 11 a IQ 1
Job address: 't 64- Bldg.no.: Suite no.:
Lot: Block: Su ivision_,__'- !i .- _ Tax rnap/tax lot/account no.: /5 .J
Project name:
Description-ind location of work on premises/special condition, _
� In I'S 1131111TA 0 FIT
Namc:
Maig s:
'S4� r( 'K Ct- I &2 family d"elling:
City: Slate:d ZIP: }D._ Valuation of work........................................ $
Phonc ' ' t(_C,q I
Fax: Email; No.of hedrooms'baths................................. 3 :L
Owner's representative: S111_�,,`•p,,,_ Total number of floors...................... _
Phone: Fax: L-mail: New dwelling area(sq. ft.) .......................... �'YJ
()arage/carpon area(sq.ft.).........................
Namc: t t•C\L Covered porch area(sq. 11.) ......................... --
Mailing add-ess:/ of ct'7 C _. Deck area(sq. ft.) ............. .
. .........................
City: '-7-1 G-^ D- rO State:ex- ZI1et71 1-
Other titniclule arra Csq. fl.)I............I...........
Phone: kt^(oC(4( Fax:!'. ,.., F.-nulil: ('otnmercial/industriallmulti-family:
Valuation of work....................................... $
t , n Fxisting bldg.area(sq. It.) ....... ........... .....
Business name: Y�*��e � K_ S (t tn..�c.IF--
New bldg. area(sq. ft.) ............... ... ..........
Address: /l �i�r Sw K/ Cf--
city:
¢-- —-
Numher of stories....................... ..... .......
city: T-(G-�-� Statt::�tc__ ZIP:-0 .� .3 _
-- I'ype of construction....................................
Phone: i -b c(Q Fax: `� 'F-mail: (k:cupancy group(s): Fxisting: _
CCB no. `f > Ca-
City/metro lie.no.: New:
Notice:All contractors and subcontractors are required to he
licensed with the Orel on Construction Contractors:Board under
provisions of ORS 701 and may Ix required to he licensed in the
Address: C', 5 Lc l p . `- jurisdiction where work is being performed. If the applicant is
( uy: T 1 o- ia-0 '.hate: e ZIP: e 1 L 3 exempt from licensing,the following reason applies:
l'untact pelstm: -
1'hunc:
Name: — lContact person: Dees clue upon application ............... ........... $ ---
Address: - _ - Dale received: _
-City: _ S(ate: 7.I P: Amount received ...... .................................
Plume: Fax: E-mail' Please refer to lee schedule.
1 hereby certil'y I have rend and examined this application and the Nal all jurisdictions accept credti card.,plea+e call Jurisdiction roe nKm fnrnrnwinn.
attached checklist. All provisions of s and ordinances governing this U visa U Mastercard
work will be compllt I.wl- ,r .•c'iNgd herein or not. uredo card number
C `,` _ Expires
Authorized sip" w ,(•,ts,,,t/ c Date. �`3 Q Name or cardholder as shown on c ii cud
Print name:__�!�1 ' �� t'w,� c �e C'udholder dRnnure —-- _ �m,wnt
Notice:This permit application expires if permit is not obtained with:n 190 do 7 9 after it has been ac:epted as complete. �ao�ada ttSlU0KY1Ml
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City q(Tigard City of Tigan: U Electrical U Plumbing U Mechanical
Address. t 3125 SN%' hall Blvd.'rigard,OR 9722 U Other:
Phone: (503) 639-4171
Fax: (503) 99l )(10
7on1 1 1 U I U 117
ctions completed.See jut i.� iction criteria for concurrent reviews. 7-7-77
ood plain,solar balance Points,seisnu-soils designation,historic district,etc.
n of approved plat/lot._ —
ct approval required.
5 Septic system permit or authorization for remodel.Existing system rapacity
6 Sewer permit.
7 Water district approval.
S Solis 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
catch-basin protection,etc.
10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes.Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references bete cen plan location and details. Plan review cannot be completed
if co yright violations exist.
11 Site/plot plan drawn to scale.'rhe plan must show lot and building setback dlinu nsinns:property comer elevations(if
there is more than a 4-11.elevation differential,plan must show contour line~at 21t.intervals):location of easements and
driveway;footprint of structure(including decks);location of wellS/septic systenn:utility fixations:direction indicator;lot
_area;building coverage area;percentage of coverage;impervious area:existing structures on site:and surface drainare.
12 Foundallon plan.Show dimensions,anchor hulls,any hold-downs and reinforcing Pads,connection detitils,s ant
sire and location. _
13 Floor plans.Show all dimensions,room idcntitict+tion,window sire,location of snn+k detectors,water healer,
furna;e,ventilation fan.,,plunthing tir,tures,balconies and decks 30 inches above grade,etc.
14 Cron+seelion(s)and details.Show all frnrning-ntcmler sires and spacing such as floor beams,headers.joists,sub-floor,
wtrll construction,crept construction.More than one cross section may he required to clearly portray construction.Show
details of all wall and root'sheatl;inst,rdwfing,r�xtt sl �pc,ceiling height,siding material,footings and foundation,stairs,
fMace construction, thermal insulation,etc.
I Elevation views.Provide eleva tons for new construction;mininnun of two elcvutions for additions and remodels.
Exterior elevations must ref".--.t the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet uddendutns showing fuunduliun elevations with cross references arc acceptable. _
16 Wall bracing(prescriptive path)and/or lateral analy9ls plans.Must indicate details and locations;for
nun-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floorlroof framing.Provide plans for all tluors/rool'assemblies,indicating member si/ing,spacing,and hearing
locations.Show attic ventilation. _
Ig Basement a.td retaining walls, Provide cross sections and details showing placement of rehar. For engineered
systems,see item)2,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all heams and inultiplc joists
over I(i feet long and/or tiny bean+/joist carrying it non-uniform load. _
20 Mamdacture^ floor/roof truss design details.
21 F,nergy Cade compliance.Identify the Presrriptivc path or provide calculations. A gas-piping schematic is required
for four or more a fiances. —
22 Engineer's calculations.When required or provided,i i c.,shear wall,roof tats 1~hall he stamped by an rnrinrer or
architect hcensed in(hegout and shall be"ho"t)to he applicable to the proiert under reg teas.
23 Five(5)site plans tore required for item I I above, Site plans nntst tic 4-112" s I I"tit I I" s 17"
24 Two(2)sets Tach are required torr Items 16. 19,20&22 above. —
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be:nut accepted.
26 "Reversed"building plans must meet criteria outlined in the Permit&System Uevelupmenl Fces ddxwnent.
27 "Drawn to Seale"indicates standard architect or engineer scale. —
2p; Site plan must includr street tree size,type& location per Cily of Tigard Street Tree List booklet.
Checklist must be completed before plan review start date. Miner changes or notes on submitted plans may be in blue or bluck ink.
Iced ink is resen ed for department use only. )4614 t NWOM1
Plumbing Permit Application i permit no.:/�jt�aD/KGs
Date received:/ff/ilt D/
city of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,l'igard,ON 97223 Project/appl.no.: Expiredate:
Cit'uJ Tigard Phone: (503) 639-4171 g Receipt no.:
Fax: (503) 598-196() Date issued: Payment
Case fle no.: yment type:
Land use approval:
U Multi-family ❑'1'rnant improvement
U 18c 2 family dwelline or accessory U Commercial/industrial J i:()od service
New conslnlcuun U Addition/alteration/replacement
t iM QTT7111
1110Q5M 111 --- Ucscri Aton �
t�. fee(ca-) 1 Tolai
Job address: 3 S 3 ) `47 i_'1 'c "v r i New t-and z-family dwellings onh:
Bldg.no.: Suite no.: — (includes 100 ft.for each utittlyconuection) - -
Tax map/tax lot/account no.: SFR(1)bath
Block: Subdivision: SFR(2)bath -
Lot: SFR(3)bath --
Project name: Each additional bath/kitchen --
City/county: � f)1IL ZIP: d(7�� .� Site utilities:
Description and I aeon of work nn premises: Catch basin/area drain
Drywells/leach line/trench drain _
Est,date of completion/inspectwo Footin drain(no.lin.ft.)
t 1 ' Manufactured home utilities
�� !,'���.
Business name: %'P ManholesRain drain connector -
Address: V 4 `-SW a��� Sanitary sewer(no.lin.ft.)
state:OR- ZIP:CO:L!1-3
City: t Cr4�IL Storm sewer(no.lin.ft.)
Phone: Fax: plumb E-mail: Water service no.lin.ft.)
CCB no.: Plumb.has,rev.no: Fixture or Item:
City/metro lic.no.: _ Absorption valve
Contractor's representative Fignature: Back flow reventer
I+,II Backwater valve -
Print name: g tsins/lavatory
Clothes washer
Name: _ is was cr -
Address: Drinking fountains) -
City: State: ZIP: Ejectors/sum
Phone: Fax: Email: Expansion tank -
Fixture/sewer cap
Floor drammiloor sinks/hub
N.une(print): ' S 11 i a Garba c disposal
cT-7 f4 Cf Hose bibb
Mailing address: 1 "5 `/`I � ZIP:2»--� 3 cc maker --
City: I &-h R Stater
Phonc: . 4 L( a Fax: E-mail:
nterce tort mase tra
Owner installatiou/resid,ntial maintenance only: The actual installation Primer(s)
will be made by lite or the mailite nanc and al rtm made
by MY regulnr ISticxkf(dmin Commerciays(al -
employee on th '„Y�" w P Uatc: /1 f 0 Sum -
owner's si nature: -_- ----- I Tubs/s owerlshower Pull
Urinal —
Name• Water c )set
- - - - alcr ie.ater ---
Address: State: ZIP: Other:
City: ot0
E-mail:
Fax:
Phone: Minimum fee................$Mformntlrnr —
Notice.'Ihis permit application Plan review(at ` ) $
Nd all iudadicrloru accept credit card.,please cmote all iuriadVcann fat expires if a permit is not obtained
❑VisitU MnatetC'anl
••••'
__ within IRO days atter it has been State surcharge(11%)
TOTAL ....•.................. � ---
Ctedii card number. ___ — aplrca
accepted as complete.
Name of c n r as shown on crc a c S
"14616 1MMtlr'r+Ml
Cardh r alltna�__ Amuunr
PLUMBING PERMIT FEES:
- PRICE TOTAL New 1 and 2-family dwellings only: T
TOTAL
QTY ea AMOUNT (includes all plumbing fixtures In PRICE AMOUNT
FIXTURES individual - 16.00 the dwelling and the first100 ft. QTY (ea) AMOUNT
Sink for each utility connection) _
Lavatory 2 16.60 One 1 bath $249.20
- 16.60 Two 2 bath - $350.00 _
Tub or TublShower Comb. Three 3 bath $399.00
Shower Only _J 16.60
Water Closet 16.60 SUBTOTAL
- 16.60 _ 8%STATE SURCHARGE
Urinal PLAN REVIEW 25%OF SUBTOTAL -
Dishwasher 16.60 TOTAL
Garbage Disposal j 16.60
Laundry Tray
16.80
Washing Mane 16.60
Floor Drain/Floor Sink z° 1660 PLEASE COMPLETE:
3" 16.60
4" 16.60 - Quantit b Work Performed
Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed/
Gas piping require,,a separate mechanical r Ca ed
erM 46.40 Sink -
MFG Home Nary Water Service 46.40 Lavarto
M --�
FG Home New San/Storm Sewer Tub or Tub/Shower IJ
Hose Bibs Z 16.60 Combination - - --
16.60 Shower Onl
Roof Draina Water Closet X --
Drinking Fountain 16'80 Urinal -
Other Fixtures(Specify) 16.60 Dishwasher
Garba a Dis oral K -
Laund Room Tra
Washin Machine
Floor Drain/Sink: 2" --
Sewer- st 100' I 55.00 3"
1
46.40 4" -
Sewer-each additional 100' Water Heater -
Water Service-1st 100' 55.00 Other Fixtures
Water Service-each additional 200' 46.40
(Specify)
Storm b Raln Drain•1st 100' 55.00 -
Storm 8 Rain 0raln Bach additional 100' 46.40
Commercial Back Flow PreventionDevl;e 46 40
Residential Backflow Prevention Devlae' 27.55
Catch 9asin 16.60
Inspection of Existing Plumbing or!9peclally 12.50 COMMENTS REGARDING ABOVE:
Re uesled Ins actions erRv -
Rain Drain,Bingle family dwelling 65.25 - - -
Grease Traps 16.60 -
q ANUANU TI TY TOTAL -
Isomewc or riser disgrar i Is required if �_--
ousnitty Total Is >9 --'----
•SUBTOTAL
Bs/s STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
FmLirod only If fixture qty total is?
MeOlianical Permit Application
"Datereme"ived: / 7 p/ Permit no.:f�sr �, �� %..
City of TigardProject/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 --
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
t
❑ 1St:2 family dwelling or accessory ❑Commercial/industrial U Multi-family U'Tenant improvement
❑New construction U Addition/al wration/re pIactme lit U Olhcr.
1 1RULZIMI I 1111011KIN
Job address: — 7 Indicate equipment quantities nl boxes hcloA. Indicate the d, ;lar
Bldg,no.' Suite no.: value of all mechanical materials,equipment,labor,o) .-rhead,
Tax map/tax lot/account no.: profit.Value$ _
Lot: Block: Sub.livisiofl• *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit flee.
City/county: IZIP:
Description and location of work on premises: I mjt, I
llj
Fee(ea.) lolal
Est.date of completion/inspection: Ik�cription _ ply. Res,only Re,.onlr
Tenant improvement or change of use: C:
Is existing space heated or conditioned?U Yes ❑No Air handling unit Ci;M
Is existing space insulated'?U Yes U No it conditioning(site plan required) -
Alinrationof existing IIVAC system _-
utier compressors
Business name: State boiler permit no.:
Address: HP Tons BTU/H
Ire smo a amper. uct smoke defectors
City: State: ZIP: Hcnt pump(site pan require )
Phone: Fax: E-mail: Instal I/rep lace urnac urner— B
CCB no.: Including ductwork/vent liner U Yes U No
Instal rep ac re locateheaters-suspen(c ,
City/metro lic.no.: wall,or floor mounted
Name(please print): eat fit(a 1 lance of er t ann furnace
1 b3 KTO MkCblije gerat on:
Absorption units__ BTU/14Ntuno Chillers _ _ Hp
Address: Com ressors 111)
City: ronments ex ust an ventilation:
Y _ State: ZIP: Appliance vent
Phone: hax: E-mail: Drycrexhaust —
oc s,` ype res. tc en hazmal
hood fire suppression system
Name: `� > LI t4 _ Exhaust fan with single duct(bath fans)
Mailing address: Exhaust s sterna art from catror AC
City: State: ZIP: Fuel Piping a st ut on(up to 4 out eta)
Type: _�LI'Ci NO __ Oil
Oki n 10111 Phone: Fax: E-mail• NO pipin cilch additional over 4 outlets —
rocess piping(scsematic re-617777—
Name: Number of outlets
Other listedappliance or equipment., --
Address: - Decorative fire lace
City: State: ZIP: nsert-t
Phone: r-a x I E-mail: WoodsloVe/pcllcl stove
Applicant's signature: Date: t er:
Name (print):
NM all jurisdictims accept cirdit cants,pleasr call jmisdicllun fat narr Infotmaaan Permit fee.................... $
U Visa U MasterCard Notice:flus penttft application Minimum fee........... ....$
Credit card numlwt —LL expires If a permit Is nut obtained Plan review(at __— %) $ �—
t a res within 180 days after it has been State surchar a(8%)....$
amt of c do a.down on c u c accepted as complete, g
Cardholder sipslu e —- Atrtount
11fY4617 0011a000M
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
Total
TOTAL VALUATION: PERMIT FEE: Description: � Price Arnt
$1.00 to$5,000.00 Minimum fee$72.50 Table na a to 10 Mechanical Code Qty (Ea) Amt
$5,0U1.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to cls& 0 BTU
includingducts 8 vents 14.00
$1.52 for each additional$100.00 or Furnacincludie 100,000 3TU+
fraction thereof,to and including 2) ducts 0 vents 17.40
$10,000.00. -
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional 5100.00 or includingvent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater 14,00
$25,000,00. or floor mounted heater
$25,001.00 to$50,000,00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit 6.80
$1.45 for each additional$100.00 or -
fraction thereof,to and Including 6) Repair units
12'15
$50,000-00.
�5-0
,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
__ fraction thereof. footnotes below. Comp
_ 7)<3HP;absorb unit
Minimum Permit Fee$72.50 SUBTOTAL: $ to 100K BTU 14.00
8)3-15 HP;absorb
8'/.State Surcharge $ unit 100k to 500k BTU 25.60
9)15-30 HP;absorb 35.00
25%Plan Review Fee(of subtotal) $ unit.5-1 mil BTU
Required for ALL commercial_Permits only 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
11)>50HP:absorb
- - _ - unit>1.75 mil BTU 87.20
12)Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: 10.00
Value Total 13)Air handling unit 10,000 CFM+
Description: O (�?a Amount 17.20
Furnace to 100,000 BTU,Including 055 14)Non-portable evaporate cooler 10.00
ducts 8 vents --
Furnace> 100,000 BTU including _ 1,170 15)Vent fan connected to a single duct
6.80
ducts&vents
Floor furnace including vent 955 _ 16)Ventilation system not Included in
Suspended healer,v.all heater or 955 a (lance ermit 10.00
floor mounted heater 17)Hood served by mechanical exhaust
Vent not Included in applicance 445 10.00
rmlt 18)Domestic Incinerators
Repair units _ 805 17.40
<3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator
69.95
to 100k BTU
3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves
101k to 500k BTU 10 00
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
5.40
mil.b.'U
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
L00
1-1.75 mil.BTU __
>50 hp;absorb.unit, 5.725 Minimum Permit Fee$72.80 SUBTOTAL: $
>1.75 mil.BTU -
Air handling unit to 10,000 cfm__ 656 _ 8%State Surcharge $
Air handling unit>10.000 dr" 1,170 _ _
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan oonnected to a single duct 448 _
Vent system not Included in 656
appliance permit Other Inspili and Fees:
Hood served b machanical oxheust _ 656 _ 1 Inspections outside or normal business hours(minimum charge-two hours)
Domestic Incinerator 1 170 $72 50 per hour
Commercial or industrial Incinerator 4 590 2 Inspections for which no fee is specific ay indicated (minimum charg.tfiaI hour)
c
$72 50 per hour
Other unit,including wood stoves, 650 3 Additional plan review required by the igen,adollions or revisions to plans(minimum
Inserts etc. charge-one-half hour)$72 50 per hour
Gas piping 1.4 outlets 380 _
Each additional Outlet 63 "State Contractor Boiler Certification required for units>200k BTU.
" Residential A/C requires site plan showing piacnment of unit
TOTAL COMMERCIAL s
VALUATION: _
I:\dslsUorms\mech-fees.doc 08/06101
Electrical Permit Application
Dalereceived: i:,r Permit no.:t12;W1.sW57
City of Tigard Project/appl.no.: _ Expire date:
Cltyu/'ligard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
TYPF 1
mmmlwm
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
ew construction U Addition/alteration/replacement U Other: U Fartial 7
1 . SITF INFORMATION
lob address' 3 cj'f`� e `1 t u-y4K Bldg•if(,.: Suite no.: Tax map/tax IoUaccount no.:
Lot: Block: Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACI Olt 1
Job no: Fee Mac
Business Rattle: _- - IAycriplion pty. (ea.) Total no.insp
— -- Newreskleniial %inpkormalti-famih 1wi
Address: dwellino,unit.Include%allaclrvl gar age.
City: State: %IP Serviceiucluded:
Phone: Fax: f mail: 1600 sq.ft.or less ( 4
-- Each additional SOU sq.ftor portion thereof
CCB no.: Elec.r lic. net. Limited energy,residential 2
City/metro lic.no.: Limitedenergy,non-residential 2
Each manufactured home od modular dwelling
Signature of supervising electrician(required) Service and/or feeder -- 2
Sup.elect,name(prow l License no: Se►rationien r r rebsedem ti installation,
alteration or relocation:
211(1 amrr,lir less 2
Name(print): f:C' t�iA1tr G 201 amps m 400 amps _ 2
401 amps to 61x)amps 2
Maurng address: 't, 601 amps to 10(x)arnpc
City: n 0-{! VL - Stated Y ZIP: q-?9-4- 3 over I(Kill amps or volts 2
PI ane: $cl- 11n Y I Fax: ,�,,..� I E-mail: Reconnect only I
Owner installation:The installation is being made on properly I own Temporary services or feeders-
which is not in •d for stile a• 'tit,o xchargge accordinti to inniallallon,alteration,orrelocation:
ORS 447,455,4 I. 2uu amp..or less _—_ 2
21)I amps l0 4(x1 amps 2
Owner's si'nature: { "'`' Date:/� /v C -ant ur6(xlamps
2
Branch circuits-new,alteration,
or exlenslon per pare(:
Name: A hce for brunch circuits with purchase of
Address: service or feeder f•e,each branch circuit 2
City: Slate: ZIP: H. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Fax:
Phone: I n i a l Each additional branch circuit
imayintiff I LIE=— 'In Misc.(Service or feeder not Included):
O Service ov.r 225 amps-commercial J neallh Laie laclllly Fach puitl or ori ation circle ____._ 2
U Service over 920 amps-rating of I alt 2 J Hazardous location trach signor outline lighting _ 2
familydwellings U Huilding over lo,oil l square feet four or Signal circuit(x)of a limited energy panel.
U system over 61x1 volts nominal nacre residential unlit.in one structure alleinuon,or extension* 2
U Huili ingoverlhreestones U Feeiler%,4(x)ampstit morr •Ikscri lion:
O(kcupant load river 91 persons U Manufactured structures or RV park Farh additional inspection over the allowable In any of the above:
U FlItess/lightingplan U()theee _ _ _- I'cr dnspccnon _
5lubmit_sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction flet vice. Other
Not all junsxctions facepi credit cards.please call jurisdiction hit muse Inco manor Notice:'this permit application Plan
rPermit lee.....................
U visa U MasterCard expires if a permit is not obtained review(at 71) _
Credit cord number within 1811 days alter it has leen State surcharge(8%) ....S _
spite% accepted as complete. TOlrAL
--�lirr�� sus wit exi e ar red
S _
------Crrdolder!ignsture - Amount 11(HMIs(N 'Olvl)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee............. $75.00
Numbe, of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total L Check Type of Work Involved:
Residential per unit
1000 sq it of less _ $145.15 4 ❑ Audio and Stereo Sys;ms'
Each additional 500 sq.ft.or
portion thereof 3 $33 40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modula Garage Door Opener'
Dwelling Service or Feeder $90.90 7
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or i,)ss 1_ $80.30 2
201 amps tc 400 amps $106.85 2 Vacuum Systems"
'01 amps to 600 amps _ $160.60 2
drill amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 _ 2
Reconnect wily i_ $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL 1NLY
Installation,alteration,or relocation Fee for each system................................................. ........ $75.00
200 amps of loss $66,85_ 2 (SEE OAR 918.260-260)
201 amps to 400 amps _ $100 30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved!
Over 600 amps to 1000 volts,
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits ❑
New,alteration or extension per panel Boller Controls
a)The fee for branch circuits
with purchase of service or ❑ Clock systems
feeder leo.
Each branch circuit _ $6.65 2 ❑ Data Telecommunication Installation
b)The fee for branch sirups
without purchase of service ❑ Fire Alarm.nstallation
or feeder fee.
First branch circuit _ $4665 ❑
Each additional branch circuit $665 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 Systems
Signal clicuit(s)or a limited energy
panel,alteration or extension $75.00 _ _ ❑ Landscape Irrigation Control'
Minor Labels(10) _ $125.00
Medical
Each additional Inspection over ❑
the allowable in any of the above
Per Inspectinn $82.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8%State Surcharge $ Number of Systems
25%Plan Review Fee
See"Plan Review"section on $ No licenses ate required Licenser are required for all o1hP•installations
front of application - -
Fees:
Total Balance Due $
- —� Enter total of above fees 1111
LJ Trust Account M _. 8%State Surcharge = _
Total Balance Due =
All Now Commercial Buildings require 2 sets of plans.
1:ldsts\fumts\eIc-fees doc 08/30/01
� ,- Permit#: T��/ _ Op,S7y
Address: lr3 yS -5, �-7 C T
peg' Issued by: Date:
Statement: Information Notice: to Property Owners
About Construction Rv ,ponsibilities
Note: Oregon Law, ORS 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 required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt front registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the Permit.
Fill in the appropriate blanks andinitial and 2, and either box 3A or 38:
® 1. I 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.
❑ 3A. My general contractor is
I will instruct my general contractor that all subcontractors who work o Contractor regis. #
registered with the Construction Contractors Board. n the stnrchrre must be
OR
L1=1 3B. I wil! be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of,he
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Iniirrmation
Notice to Property Owners a out Cc struction Responsibilities on the reverse side of this form.
(Signature of permit applicant)
( ate)
(White c•opv to issuing agency permit file,
pink cop►,to appli(-ant)
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST ' 7
INSPECTION DIVISION Business Line: (503)639-4171 BLIP
Received Date Requested � AM ----- PM BUP
Location ------- Li1 _Suite MEC
Contact Per3on —. Ph( ) SU 7 PLM
Contractor _ Ph( ) SWR
BUILDING Tenant/Owner - ELC -
Footing ELC - - -
Foundation Access:
EL
FI Drain R -- .-- -__-_ ---___--_—
Crawl Drain
Slab Inspection Not(-,,5.
Post&Beam -
Shear A.ichors
Ext Sheath/Shear --
Int Sheath/Shear _—
Framing
Insulation --
Drywall Nailing ---- - -
Firewall —
Fire Sprinkler
Fire Alarm -.
Susp'd Ceiling
Roof
other:.-- -.
ASS_PART FAIL
BING _ - - —
Post& Beam-
Under Slab --- ---.. -- --- __--
Rough-in
Water Service -
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain
Shower Pan -
Other:
Final —
PASS PART FAIL
MECHANICAL __._-----.---- — -----
Post& Bea
Rough-In til. -- --—..�. --------- — - -
Gas Line
Smoke DaPps
in
ASS PART FAIL -- - -- - — _.
ELECTRICAL
Service � ---�--- --_----
Rough-In
UG/Slab
Low Voltage _ �._— ---------- ------- --------
Fire Alarm
Final iJ Reinspection tee of$_-- required before next inspection. Pay at City Hall, 13125 SW He Blvd.
PASS PART FAIL
SITE F-1Please call for reinspection RE:—_________— _ Unable to inspect-no access
Fire Supply Line 11
ADA —�� i � OZ-
Data ._ ✓l '7)-D--_O Inspector _ _ EXt
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TICARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST
INSPECTION DIVISION Business Line: (503)639.4;171 — ---- --
BLIP - 4444--
Received __- cc// Date Requestea J6 AM-----_ PM _ _. _-__ BUP
Location _ �� �7_� 2 zC6 Suite _- MEC
Contact Person -._-- -___ - Ph(�—) - PLM
Contractor-- _- —__-- Ph( -_) ---_ SWR _-- ----
BUILCING Tenant/Owner - _
-- - -- - LC --
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab I bction Notes: SIT
Post& Beam
Shear Ai ichors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing ---
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Coiling - - -
Roof
Other:
Final
_PASS PART FAIL
PLUMBING _
Post 8 Beani
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain 4444 4444-- --
Shower Pan
Other: _ _-- --
PASS PART FAIL -
MECHANICAL —
Post b Beam
Rough-In
Gas Line -- --- —^
Smoke Dampers --
Final
PASS PART FAIL ---- — -- --
ELECTRICAL
Service - - -
Rough-In
UG/Siab
Low Voltage --------_-___-
Fire Alarm
Final I� Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE:_ Unable to inspect-nor -,ess
Fire Supply Line
ADA
Approach/Sidewalk Date 7e+e 4 Inspector
Other:
Final _-_ DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
GIT`1( OF TIGARD 24-Hour
BUILDING Inspection Line. (503)639-4175 MST _ -7y
INSPECTION DIVISION Business Line: (503) 6Z'9.4171 �-- ---
_ BUP
Received ._-- Date Requested 'S' `� AM_.__-___ PM —._- BUP _
Location --- v Suite MEC
Contact Person _ - Ph ( ) `� 7 5;4:2-7 PLM
Contractor Ph ( ) SWR _
BUILDING Tenant/Owner ELC
-- -
Footing -- - ------ -- ---- -
Foundation Access: ELC
F!g Drain ,�- ¢ �1t0\ h A3 ,C-vLO Im''IL ELR
Crawl Drain --- ---__--
Slab Inspection Notes: — SIT
Post& Beam - - - -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear - - -- ------ -
Framing
Insulation /
Drywall Nailing
Firewall
Fire Sprinkler ---
Fire Alarrrn
Susp'd Ce,ling -
Roof - - -
Other:
Final
PASS PART FAIL --
PLUMBING
Post& Beam
Under
—
Under Slab
Rough-In --
Water Serviue
Sanitary Sewer
- - - -
Rain Drains --.--- - ----- ---- --- -- ___ _
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final - - - - - -
PAS_S_ PART _FAIL --
MECHANICAL
Post&Beam ---- -----�.._
Hough-In
Gas Line - —'-
Smoke Dampers - _ -
Final -----
PASS PART FAIL _
ELECTRICAL
Service
Rough-In
UG/Slab —'-- - --- -- -
Low Voltage
Fire Alarm —
r
PART FAIL Reinspection fee of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE _ _ [� Please call for reinspection RE: _ Unable to inspect--no access
Fire Supply Line --- --- -
ADA
Other:
Approach/Sidewalk Inspector
-? - Ext
-... _.
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the Job site.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 r c-
INSPECTION DIVISION Business Line: (503)639-4171
MST
BUP
Received Date Requested— AMPM BUP
Location ' f`�' � Suite_ __—_ MEC —
Contact Person _ _ Ph( ) — PLM _
Centractor___ __ --w_ JPh'( ) SWR _
BUILDING Tenant/Owner - - �" yy�{- ELC
Footing t - � ,J
Foundation ELC —_
Ftg Chain Access: ELF!
C•iwl Drain
Slab Inspection Note— - SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Sheard _ ,rte �/
Framing --
Insulation
Drywall Nailing
Firewall vv-\ �
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Root —/?-7
F ` — - --
nb �—-
_�- �/ 5 -d-.e �J
PASS PART
eLUMMG
os 7
eam � 9 � � �-
Under Slab
Rough-In
Water Service
Sanitary Sewer C� •!" �
Rain Drains — ---`---
Catch Basin/Manhole e
Storm Drain - ----- --- ---
Shower Pan �- ` 'r.(
Other: {r��--
----- S
PASS PARTFAIL ) p
MECHANICAL _ cam, �,, �� S r�,it•�-��--./ "�—I Z- 2 07 _
Post&Beam �-
Rough-In r
Gas Line // � � �'�
Koke Dampers
I - � � �•� '
AS PART FAIL -- �-EtVC-TRIC _ t '
Service n
Rough-In ---��a�.�C
lt
Low Vo
Low Voltage —
Fire Alarm �15 �5 L4
Final Re ion fe of$ re fired before e t in11E:!
p act' n. P at Ci Ha , 13125 Fq H$11 BI
PASS PART FAIL JLt `�' _ �� 7 , _t_R L,.�C
SITE K- Please call for reinspection RE: _ _Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Data _� ` — _ Inspector___ ____ Ext ___.--
Other:
rival DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL