15193 SW 107TH TERRACE NNW
1 r, EROSION PONTROL.
_ � _ •�
1 PRGv'u�7
NOTE: CENTERLINE CnlICEPTS,
_ GRAVEL f'AD 8 DRI'L'L U. . :Vci iT
SURVEYORS, WILL. PIN ALL EX s ERIOR S���; _ G S ti /� �� �,� CONCRETE DRIVE IS IN PLACE.
FOUNDATION CORNS RSAND PROVIDE
SUBSEQUENT MOR C-1AGE SURVEY. 2. PROVIDE& MAINTAIN SOIL SEDIMENT
FENCE AS INDICATED,
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?t/ SCALE 1" = 20'
.3 y•� 3V7
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oar
SCALE DRAWING LOT 50 ERICKSON. HEIGHTS
S.E. 1L4 SEC. 10, T.2S., R.1 W., W.M.
CITY OF TIGARD �
r�
--NEW HOUSE PER CLIENT, 10/1/01 MSG
n �ur/� --MADE HOUSE INTO STAKEOUT, MPW, 2/28/01 WASHINGTON COUNTY, OREGON
-- A 2.5' LANDSCAPE EASEMENT SHALL EXIST -- ADD HOUSE FROM LOT 2, ERIC:KSON. BUT JANUARY 16, 2001 C e n t e o -I i n e Concepts Inc .
MAKE GARA
ALONG ALL STREET FRONTAGE AND A 7.5' PER CLIENT,2/ 01HMSG HOUSE, GARAGE RIGHTB DRAWN BY: MSG CHECKED BY: WGDIII
PUBLIC UTILITY EASEMENT SHALL EXIST BEHIND --MADE H()USE INTO STAKEOUT, MPW, 1/25/01 SCALE 1 "=20' ACCOUNT 115
THE LANDSCAPE EASEMENT. --MOVED HOUSE TO 42' FRONT SETBACK 640 82nd Drive Gladstone, Oregon 97027
PER TRAVIS, 1/18/01, MPW M: \MLI\L50ERICK 503 650-0188 fax 503 650- 0189
t,
NOTICE: IF THE PRINT OR TYPE ON ANY rl.�-` 11i ( I1 � I ( � 1111111 IIIIIII 1111111 11111-3 -r-fTl 4
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IMAGE S NOT AS CLEAR AS THIS NOTICE, _ _ _ O _ 11 1211 �
IT IS DUE TO THE QUALITY OF THE _ i No.36 �,� ; �«�.,.
---- --- - I... Y"
ORIGINAL DOCUMENT E 63
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15193 SW 1071" Terrace
CITY OF TIGARD _ MASTER PERMIT
PERMIT#: MST2001-00554
DEVELOPMENT SERVICES DATE ISSUED: 12/18/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 15193 SW 107TH TERR PARCEL: 2S110DA-08900
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT: 050 JURISDICTION: TIG
REMARKS: Construction of new single family detached residence.Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS _ REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,450 at BASEMENT: 99500 sf LEFT: SMOKE DETECTORS v
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,427 at GARAGE: 641 sf FRONT: PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: I FINSSMENT: sf RIGHT: 5
OCCUPANCY ORP: R3 BORM: 4 BATH: 4 TOTAL: 2,87700 of VALUE: S 373.264.00 REAR: ..
PLUMBING
SINKS: 1 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 6 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: CATCH BASINS:
TUBISHOWERS: + GARBAGE DISP: 1 WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
MECHANICAL
OTHER FIXTURES:
FUEL TYPES FURN g 100K: BOILICMP c 3HP: VENT FANS: 6 CLOTHES DRYER: 1
GAS FURN>•100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: 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 0 200 amp: WISVC OR FDR: 1 PUMPARRIGATION: PER INSPECTION:
EA ADD'L 500SF: 0 201 •400 amp: 201 400 amo: let WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNAUPANEL. IN PLANT:
MANU HMISVCIFDR: 601 • 1000 amp: 601+amps•100ov: MINOR LABEL:
1000+amp/volt:
Reconnect only: PLAN REVIEW SECTION
—4 RES UNITS: SVCIFDR>•225 A.: a 600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO A STEREO: VACUUM SYSTEM: AUDIO B STEREO: FIRE ALARM. INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDrAI.: OTHR:
HVAC: DATAITELE COMM NURSE CALLS TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 8,716.14
RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES This permit is subject to the regulations contained In the
1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR Tigard r applicable
Code,State o OR. Specialty Codes and
WEST LINN,OR 97088 WEST LINN,OR 97068 all other applyable laws. All work will be done in
accordance wlth 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. Thosa rules are set
Reg N: LIC 049955 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 INSPECTIONS
Erosion Control Insp 8& Post/Beam Mechanica Mechanical Insp Shear Wall Insp Gyp Board Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final Inspection
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas Fireplace Appr/Sdwlk Insp
Post/Beam Structural PLM/Underfloor Framing Insp Insulation Insp Electrical Final
r
Issued By �. _ _. Permittee Signature
:���-�--• "��z.a� �
Call (503) 639-4175 by 7:00 p.m. for an Inspection needed the next business day
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S
DATE ISSUED: 12/18/01/18/01 -00304
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110DA-08900
SITE ADDRESS; 15193 SW 107TH TERR ZONING: R-3.5
SUBDIVISION: ERICKSON HEIGHTS JURISDICTION: TIG
BLOCK: LOT: 050
TENANT NAME:
FIXTURE UNITS:
USA NO:
CLASS OF WORK: NEW DWELLING UNITS: 1
NO. OF BUILDINGS:
TYPE OF USE: SF 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new single family residence.
Owner: _FEES
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR
WEST L_INN, OR 97068PRMT CTR 12I18I01 $2,300.00 27200 100000
INSP CTR 12/18/01 $35.00 27200100000
Phone: 503-557-8000 Total $2,335.00
Contractor:
Phone:
Reg#:
Required Inspections _
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will he 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 by: K--,)( , ` , c` Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
Date received: // /` p Permit no.:
City of 'Tigard
City ajTigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date: 1.l
Phone: (503) 639-4171 � Date issued: By: Receipt no.: `
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: I&2 family:Simple Complex:
TVPE OF IPFRMIT
)(I &2 family dwelling or accessory U Commercial/industrial U Multi-family XNew construction U Demolition
U Addition/alteration/replacement U Tenant improvement ❑Fire sprinkler/alarm U Other:
JOB SITE INFORMA'l ION
Job address: =-5- 93 Slt/ / m 7—,=' e Bldg. no.: Mite no.: _
Lot: rm I Block: Subdivision: ,-Ic Csav, ei Tax map/tax lot/account no.:
Project name: Ent kso ye oAuf r ------__
Description and location of work on premises/special conditions: jl.ylp 4 jz
011 NI It
/ LL 1INFORMATION,
Name: �t?ut A/�s n 4c a S��f Ta✓�r Narr4 ew (Floodplain, solar,
Mailing address: 1672 Sl✓ ti///tee • F� /4s AO 1&2 family dwelling:
City: (/fir/ I W*1 State: ZIP: Valuation of work................... .................... $323 26Y
Phone:Sal. 7 8o>s0 Fax:SoU-WiC E-mail: No.of bedrooms/baths.................................
Owner's representative: ;0'1's O.-C,o AS Total number of floors.................................
Phone: sa,'+e Fax: E-mail: New dwelling area(sq.ft.) .......................... 3$7 ZS 7 Z
Garage/earport area(sq. ft.)......I..................
Covered porch area(sq.ft.) _
Name: X-01^ .........................
Mailing address: Deck area(sq. ft.) ........................................ L� –
City: State: ZIP: Other structure area(s . ft.)......................
Phone: Fax: E-mail: Commercial/industrialhnulti-family:
1 Valuation of work........................................ -- —
Existing bldg.area(sq. ft.) ...X
..
Business name: ja�"t New bldg•area(sq.ft.)
Address: — _ ........ .. --
State: Z1P: Number of stories................. ..
City: —
Phone: Fax: E-mail: Type of construction..........�. .. _
1. Occupancy group(s): Existing:
CCB no.:
9759 e x z New:
City/metro Iia no.: e• -" /206 Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed.If the applicant is
City: I State: ZIP: exempt from licensing,the following reason applies:
Contact person: I Plan no.:
Phone: I Fax: E-mail –
Ila 1011111111111111111
Name: Contact person: Fees due upon application ........................... $
Address: Date received: —
City: State: ZIP: Amount received ......................................... $
Phone: I E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all Jurisdictions accept credit cards,please call jurisdiction for more information
attached checklist. All provisions of laws and ordinances governing this U vita l]MasterCard
work will be complied with,whether specified herein or not Credit card number: _
Expires
Authorized signature: 0--
ate: — Name of cardholder as shown on credit card
Print name: Ti�Dt/lf Cardholder signature $ Amount
Notice:'this permit application expires if a permit is not obtained within 190 days oiler it has been accepted as complete. 44a1613 tt OWOM)
One- andTwo-Family Dwelling
Building Perrnit Application Chec kliSt Reference no.:
CiryofTigard City of Tigard d Associated O Electrical O Plumbing O Mechanical permits:
Address: 13125 SW I loll Blvd,Tieard,OR 97223 OOther:
Phone: (503) 639-4171
Fax: (503) 598-1960
I Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 'Zoning.flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot.
4 Fire district —approval required. --�
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit. — —
7 Water district approval. --
8 Soils report.Must carry original applicable stamp and signature on file or with application.
9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 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 between plan location and details. Plan review cannot be completed
if copyright violations exist.
I 1 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft. -itervals);location of easements and
driveway,footprint of structure(including decks);location of wells/sepdc systems;utility locations;direction indicator,lot
area;building coverage area;percentage of coverage;impervious arra;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
sire and location.
13 Floor plans.Show 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 section(s)and detalls.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace constriction, thermal insulation,etc.
1.5 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for Y
non-prescriptive path analysis providespecifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof 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's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all heams and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details.
21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall he shown to he applicable to the project under review.
23 Five(5)site plans are required for Item I I above. Site plans must he Y-1/2"x I I"or I I"x 17".
24 Two(2)sets each are required fuer Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons.
26 "Reversed"building plans must meet criteria outlined in die Permit&System Development Fees document.
27 No"mirrored"building plans will be accepted.
28 "Drawn to scale"indicates standard architect or engineer scale.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 4404614(&MCOM)
Plumbing Permit Application
Date received:// �(o d� Permit :1/4/��106'55`�
Cit of Tigard City
' Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.:
Cm,n/liKard Phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: - - _- Case file no.: Payment type:
TVPE OF,PERMIT
I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
New constriction 'J A(Idition/alteration/replacement U Food Service J Ocher:
JOB SITE INFORMATIONSCHEDULE
lob address: Description Oty. Fee(ea.) Total
/5/ J 5✓ �L.��� - - -
Bldg.no.: Suite no.: Nc'++ I-:wd 2-family d++ellings or►Ir:
- — (include~100 ft.foreachulifitycnnnecliun)
Tax map/tax lot/account no.: _ M-R (1) bath
Lot: Sm Block: Subdivision: /c on ! SFR(2)bath
Project name: F-,,, / •,, , /�,., A Yjr SFR(3)bath
City/county: u� Each additional bath/kitchen
Description and location of work on premises: H e _ Site utilities:
Catch basin/area drain _ — —
Est.(late of completion/inspection: Drywells/leach line/trench drain
PLUMBING Footing drain(no. lin. ft.)
CONTRACTOR Manufactured home utilities
Business name: G., 1 s /� /a�wti 4N� Manholes
Address: 7 7 1-(� y ( , Rain drain connector
City: /j�,,,r,t.,, _ State: t^ ZIP:9 7 taZI.T Sanitary sewer(no. lin. ft.)
Phone:},rj-(, _Q' 7 Fax: I E-mail: Storm sewer(no. lin. ti.)
CCB no.: 79 CC I Plumb.bus.reg. no: Water service(no.lin. ft.)
City/metro lie.no.: 75,f/ Fixture or Item:
Absorption valve
Contractor's representative signature: ' Back flow preventer
Print name: e -e u Date: Backwater valve
Basins/lavatory
Name: e Clothes washer
Address: — Dishwasher
Drinking fountain(s)
City: State: ZIP: Ejectors/su n
Phone: Fax: F-mail: Expansion tank _
Fixture/sewer cap
Floor drains/floor sinks/hub
Name( ring: lfevar1romcC —
Garbage disposal
Mailing address: 16 st,. ✓ a s w -,t//s Hose bibb _
City:_6/f,�f ,�,N State: rye ZIP: r 7 Ice maker _
Phone: s n> '77 if Fax: E-mail: Interceptor/grease trap _
Owner installation/residential maintenance only: Ilse actual installation Primer(s)
will he made by me or the maintenance and repair trade by my regular Roof drain(commercial)
employee on the property I own as per URS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si nature: Date: Sum
'rubs/shower/shower pan _
Urinal
Name: -- ------ -_ Water closet _
Address: _ Water heater
City: — =ate: LIP: - -- Other: -- - -
Phone: Fax: E-mail: Total
Not all jurisdictions accept credit cardr,please call jurisdiction for more informationNotice:This permit
Minimum fee................$ _
application
U visa U MasterCard expires if a permit is not obtained plan review(at __ 96) S
Credit card number -- L within ISO days after it has been State surcharge(8%)....$
Expirer
--- accepted as complete. TOTAL .......................$ _
Name of cardholder ra shown on credit card
_ S _
Cardholder signature Amount 4104616(MDX'OMI
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual) CITY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16 60 the dwelling and the first100 ft. QTY (ea) AMOUNT
-
for each utility connection'
Lavatory 16.60 —
__ On bath _--_ $249.20
Tub nr Tub/Shower Comb 16.60 Two 2 bath _ $350.00
Shower On;y 1660 Three(3)bath $399.00
Water Closet 16.60 -- -- —=�
SUBTOTAL
Urinal 16.60 _ _ 8%STATE SURCHARGE
Dishwasher 1660 PLAN REVIEW 25%OF SUBTOTAL --�
Garbage Disposal -- _ 16.60 — _._—__._TOTAL —
t.aundry Tray --__—— 161 60
Washing Machine 1660
Floor Drain/Floor Sink 2" 16,60
3'• -- 116.60 -- PLEASE COMPLETE:
4" — 16.60
Water Heater O conversion O like kind 16 60 -- Quantity b I Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit_ Capped
MFG Home New Water Service — 46,40 Sink —
MFG Home New San/Storrs Sewer 46.40 Lavatory
— -- Tub or Tub/Shower
Hose Bibs 1660 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures(Specify) -- 1660 Dishwasher .
_
Garbage Disposal—
Laundry Room Tray
-- -- WashingMattune
---� Floor Drain/Sink. 2"
Sewer-1st 100' 55 00 3" —
Sewer-each additional 100' 46.40 — s 4"
Water Service-1st 100' 5500 Water Heater
Water Service-each additional 200' 4640 Other Fixtures
(specify)
Storm 8 Rain Drain- 1st 100' 55.00 —
Storm R Rain Drain-each additional 100' 4640
Commerclai Back Flow Prevention Device 4640
Residential Backflow Prevention Device' 27.55 —
Catch Basin 16.60 —
Inspection of Existing Plumbing or Specially 7250
Requested Inspections _ erRv _ COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 1660 -- ------------- ---
QUANTITY TOTAL —�—
Isometric or riser diagram is required if
Quantity Total Is ,9 '"—
*SUBTOTAL -- -- --
-`—8%STATE SURCHARGE — --
"PLAN REVIEW 25%OF SUBTOTAL
Regwred onl it f fixture qty total is,q
TOTAL $
'Minimum permit fes Is$72 5e+8%state surcharge,except Residential Backflow
Prevention Device,which is$36 25•8%state surcharge
"All New Commercial Buildings require plans with Isometric or deer diagram and
plan review
i\dsts\forms\plm-fees.doL 10/10/00
Mechanical Permit Application
Datereceived: // I& V1 Permit no.:
� j7gj/-GESS
City Of Tigard Projecdappl.no.: Expire date:
ttr f ,, i Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
1
7
I &2 family dwelling or accessory U Conimercial/industrial U Multi-family J Tenant improvement
New construction U Add ition/alteratlon/replacement U Other:
JOB SITE INFORMATION 1 1SCHEDULE
Job address: 15/9; /p I *"' r, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead.
Tax map/tax lot/account no.: profit.Value$
Lot: Subdivision: , 'See checklist for important application information and
Project name: / fSjurisdiction's fee schedule for residential permit fee.
City/county:-r,-,j,,,/ f✓a,h, ,, ZIP: SCHEDULE
Description and location of work on premises:
rrrir4,I J�ct/ Frr(ra.) lulu(
Est.date of completion/inspection: Ik•scription Res.only Re%.only
Tenant improvement or change of use:
Air handling unit __ _�CFM
Is existing space heated or conditioned?U Yes U No
Is existingspace insulated?O Yes U No irconditioning(site plan require )
p'ce Alteration of existing HVAC system _
MECHANICAL CONTRACTOR of er compressors
Business name: j, , , /fie., State boiler permit no.:
HP --Tons BTU/H
Address: 2 71 1 s F 3' '� •,• •ire/smo camper uct smokee detectors
City: // //S State: crl� I ZIP: 9 7/7-; Heat pump(site plan required) —
Phone: .! .,v9nZ JZ I Fax: E-mail: —� nsta replace urnac urner BU/H
Including ductwork/vent liner O Yes U No
CCB no.: / `,7 5jsj r p U�t'J/!r�/ _- ns-T tall/rep ac rl�c elocateheaters-suspen ed,
City/metro lir. no.. _11 fr jc wall,or floor mounted _
"Aiiiii
;//,, � � Vent for a t (lance of ter than t-urnace
in ms 6 2 OIL-is log Ke gent on:
Absorption units _ BTUIH
Name: Chillers _ HP _
Address:
Compressors HP
-
Environmental exhaust rn vent at on:
City: State: ZIP: _ Appliance vent
Phone: Fax: E-mail: Dryercx oust
I oo s,Type res. itc en�azmat
hood fire suppression system
Name: /1111.r&t ISO.it C («JJ...i es Exhaust fan with single duct(bath fans)
Mallin address: / ^ ixhaust system a art from heating.or C
Mailing / 2 !,�• e F• vim. _
City: •,J,,s t �,•,,,, Statc: .';+Q 7.IP: sue piping ondistribution(up to outlets)
---- ly _1_11(j _ NU __ (.)il _
Phone:s;1?fS I o cc Fax: ;v.;0Sd iG f-mail: •uc r-1�T lin e;ic a iuona over Ci6t7t
is-
rocess piping(sc ematic regmred)
Name: Number of outlets
—. 1 er�IGted a nce or equipment:
Address: Decorative fireplace
City: State: ZIP:
oodsstovc pe et stove
Phone: Fax: E-mail: —_
Ili cr
Applicant's signature: Date.: Ot er:
Name (print):
Nnt all Jurisdictions accept credit rinds,please call jurisdiction for more inlonnnuon. Permit fee.... ..�.•...•..$-
U Visa U MasterCard Notice:This permit application
Minimum fee......... ......S
Credit card number � / expires if a permit is not obtained plan review(at __ %) $
t tpira within 180 days after it has been State surcharge(8%) ....$
Name of cardholder as shown on credit c accepted as complete.
— cardholder dptature Amount
440-4617(MIa/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
Description: _ Price Total
TOTAL VALUATION: PERMIT FEE: Table 1A Mechanical Code _� Oty (Ea) Amt
$1.00 to$5,000.00 Minimum fee$72.50 1) Furnace to 100,000 BTU
$5,001.00 to$10,000.00 $72,50 for the first$5,000.00 and inciudin ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and Including inciudin ducts&vents 17.40
$10 000.00. 3 FlFurnace
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and ) oor 14.00
$1.54 for each additional$100.00 or Invent
fraction thereof,to and including 4) Suspended
ded 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.(j0 or --
fraction thereof,to and including 6) Repair units 12.15
$50,000.00. Boiler Heat Air
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: or Pump Co:d
$1.20 for each additional$100.00 or footnotes its es below see
Comp
fraction thereof.
7)<3HP;absorb unit 1400
Minimum Permit Fee$72.50 SUBTOTAL: $ to 10oK BTU
8)3-15 HP;absorb 25.60
8'/.State Surcharge $ unit look to 500k BTU
9)15.30 HP;absorb 35.00
25%Flan Review Fee(of subtotal) $ unit,5-1 mil BTU
_Royuired for ALL commercial�ermits only_ 10)30.50 HP;absorb 52.20
TOTAL CO,iMERCIAL PERMIT FEE: =$ -1I-)
unit 1-1.75 mil BTU
>50HP;absorb 87.20
--�-`"--- _ unit>1.75 mil BTU
12)Air handling unit to 10,000 CFM 10.00
ASSUMED VALUATIONS PER APPLIANCE:
Value Total 13)Alr handling unit 10,000 CFM+ 17.20
Descrl tion: Ot (Ea)... Amount
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler 10.00
ducts&vents
Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct 6.80
ducts&vents -955
Floor furnace Including vent _` 16)Ventilation system not included In 10.00
Suspended heater,wall hoater or 955 a /lance ermit
floor mounted healer 17)Hood served by mechanical exhaust 10.00
Vent not Included in applicance 445
ermit 18)Domestic Incinerators 17.40
Re air units 805
<3 hp;absorb.unit, 955 19)Commercial or industrial type incinerator 6995
to look BTU 1,700
3-15 hp;absorb.unit, 20)Other units,including wood stoves 1000
101k to 500k BTU 2,310
15-30 hp;absorb.unit,501k to 1 21)Gas piping one to four outlets 5.40
mil.BTU 400
30-50 hp;absorb.unit, 3, 22)More than 4-per outlet(each) 1.00
1-1.75 mil.BTU 5,725
>50 hp;absorb,unit, Minimum Permit Fes$72.50 SUBTOTAL: $
>1.75 mil.BTU
Air handiln unit to 10 000 ofm 656 8%State Surcharge
Air handlin unit>19,000cfm 1,170
Non- ortable eva orate cooler 856 TOTAL RESIDENTIAL PERMIT FEE: S
Vent fan connected to a single duct 446
Vent system not Included in 656
appliance permit - 656 Other Ins eecll9.trlan Feel:
Hood served b mechanlCal exhaust 1 inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator 1 170 $72 50 per hour
Commercial or industrial inclnerator 4 590 2 inspections for which no fee is specifically Indicated (minimum charge half hour)
656 $72 50 per hour
Other unit,Including wood stoves, Additional plan review required by changes,additions or revision&to plans(minimum
inserts,etc. 360 charge-one-half hour)$72 50 per hour
Gas i In 1-4 outlets 63 required for units
Each edditlonal outlet ----- *State Contractor Boiler Certification re 200k BTU
q '
- "Residential AJC requires site olan showing placement of unit.
TOTAL COMMERCIAL $ All New Commercial Buildings require 2 sets of plans.
EVALUATION:
I:\dsts\forms\mech-fees.doc 08/29/01
Electrical Permit Application
-- Date rec�1/ /(p 0/ Permit no.:/��jj U�-006�'5
City of Tigard Prolecdappl.no.: — Expire date:
C'iryo,('/igurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 ('ria file no.: Payment type:
Land use approval:
I &2 family dwelling or accessory U Commercial/industrial U Multi-family O Tenant improvement
New construction U Add ition/al teration/i idace men t J t alwr J Partial
.108 SITE INFORMATION
Job address: 0S /93 ft„, /07 � rpm. 1114- 11tr.: Swte no.: jTax map/tax lot/account no.:
Lot: S,7 1 Block: Subdivision: lf,e./c v,, ,, l�
Project name: ,,, 1Pr Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION !
Job not for7nsp
Max
Dmcriplion Olv. Ice.)
Business name: ,i •V. 1:51e, T..
Ne"residential single ormuni-famihper
Address: -z 9 dwellingunh.Includesattachedgarege.
City: Semiceincluded:
u
Phone: r^ a()sq.It.or less t
y c �S 1 p i`/Z rax: E-mail:E-mall: Each additional 500 s ft.or onion thereof
CCB no.: d13 ���/t/ Elec.bus.tic.no: j- /Z C I.nmtied energy,residential
City/metro lic.no.: Zt/3 Luoff red cnergy,non.residential
Each manufactured home or modular dwelling
Service and/or feeder
Signature of supervising electrician(rcyuucr) _ Date
Services or feeders-Installation,
Sup.elect.name(print): `.,/, (,-e, e License no: 41 1 alteration or relocation:
16111111.1111114 0=_ = 200 amps or less
201 amps to 400 umps 2
Name(print): c,.,�,�, C.,, J�ai..o' 401 amps to 600 amps - - 2
Mailing address: 16 7 601 amps to 1000 amps 2
City: , -.L L'r,r Stale:,?}Q ZIP: 170CY Over 1000 amps or volts _ 2
Phone: f., s &?rnr I Fax:Scl: 1 0 E-mail: Reconnectonk I
Owner installation:The installation is being made on property 1 own Temporary servicev or feeder-
which is not intended for sale, lease,rent Installatlon•alteration,or reio(arion:err exchange according to 200 um s or less _
ORS 447,455,479,670,701. 201 amps to 400 amps +
Owner's si nature: I .0 401 it)600amps
Branch circuits-nen,alteration,
11Hor extension per panel:
Name: _ A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuli =
City: State: 'LIP B Fee for branch circuNs without purchase
of service or feeder fee,first branch circuit: =
Phone: Fax: Email: Each additional branch circuit:
III %N RFYIIEW(Please check all that apply) Mlsc.(Settle*or feeder not Included):
0Service over 225amps-conuncrctat UHealth-care facility Eadtpump(it urrgaooncircle _
U Service over 320 amps-rating of 1&2 U Hitzmdous location I;achsilinotoutluit fighting
family dwellings U Building over 10.000 s4unrc feet four or Signal circuit(s)or a limited energy panel.
.-1 System over 600 volts nominal more residential units in one structure alteration,or extension* 2
J Building over three stories U Feeders,400 amps of more •Descn tion --
J Itccupant load over 49 persons U Manufactured structures or RV pnrk rAch additional Inspection over theallowable la any of the above:
J Egress/lightingplan U Other Per inspection �—
Submit___sea of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. tether
Not all Jurisdictions accept credit cards,plense tail jurisdiction for more information Notice:11tis permit application Permit fee.....................
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card numberName of cardhol within ISO days alter it has been State surcharge(8%) ....$
Expires accepted as complete. TOTAL .......................$
_ r ass own on credit carry
�� Cardholder st�nuure `� Amount ")-4615 r6Il10ICOAtr
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Number of Inspections per permit allowed Restricted Energy Fee..............................
$75.00
(FOR ALL SYSTEMS)
Service included: items Cost Total
Residential•per unit Check Type of Work Involved:
1000 sq ft or less $145 15 4
Each additional 500 sq.ft.or - - ❑ Audio and Stereo Systems'
portion thereof _ $33.40 1
Limited Energy $75.00 - ❑ Burglar Alarm
Each Manufd Home or Modular —
Dwelling Service or Feeder $90,90 2 ❑ Garage Door Opener"
Services or Feeders
Installation,alteration,or relocation ❑ Heating,Ventilation and Air Conditioning System'
7.00 amps or less $80.30 _ 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems'
401 amps to 600 amps $160,60 2
601 amps to 1000 amps $24060 _ 2 ❑ Other
Over 1000 amps or volts $454,65 2
Reconnect only _ $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation
200 amps or less $66.85 2
Fee for each system................................ .... . b75.G0
201 amps to 400 amps $100.30 7 (SEE OAR 918-260-260)
401 amps to 650 amps
Over 600 amps to 1000 volts, _ $133 75 2 Check Type of Work Involved:
`—
see"b"above. ❑
Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel ❑� Boiler Controls
a)The fee for branch circuits
with purchase of service or
feeder fee. ❑ Clock Systems
Each branch circuit $665 ❑
b)The lee for branch circuits -- --- Data Telecomrnunlcatic,i Installation
h'ifhout purchase of service
or feeder lee. ❑ Fire Alarm Installation
First branch circuit $46 85
Each additional branch circuit $6 65 _ - _ ❑ HVAC
Miscellaneous
(Service or feeder not Included) ❑ Instrumentation
Each pump or irrigation circle $5340
Each sign or outline lighting $5340 ❑ Intercom and Paging Systems
Signal circuits)ora limited energy
panel,alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels(10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per Inspection $r,;'hp ❑
Per hour Nurse Calls
- -- ---_
In Plant ----- $62 50 --- -
- - $73 i' -- ---- ❑
Fees: Outdoor Landscape Lighting'
❑ Protective Signaling
Enter total of above lees $
—_ — ❑
8%State Surcharge $ Other — —
25%Plan Review Fee Number of Systems
See"Plan Rnvhew"sac6nn an $ No licenses are required Licenses are required for all other installations
front of application
Total Balance DueFees:
ti
El
Trust Account
Enter total of above fees :
#
8!:State Surcharge =
Tobi Balance Due :
i hdstatfb msklc-fees.doc 06/07/01
SEE- 35MM
ROLL # 21
FOR
OVERSIZED
DOCUMENT
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171
MST _ Z ._
BLIP —
Received —__ -_- Date Requested__-_ a' 7 ,AM_ _ _ PM _ - BLIP
LocationMEC _-.------- —
Contact Person __. Ph(— ) �� �l 3/6 Z- PLM
Contractor -- - - -- Ph( - ..) SWR
BUILDING Tenant/Owner —_ - ELC
Footing ELC --
Foundation Access: — - --
Ftg Drain ELF!
Crawl Drain -- - --
Slab Inspection Notes: SIT
Post& Beam _ _ -
Shear Anchors — - -
Ext Sheath/Shear
Int S eath/Shear , All
Framing._ 7 A)O:e !,L
Insulation
Drywall Nailing -Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -- -
Roof
Other: -
ASS PART FAIL
Post&Beam - -
Under Slab
Rough-In ------_.------------
Water Service ------------- --- - - - -----
Sanitary Sewer
Rain Drains - -- -- ----.._.__ _-- --- _
Catch Basin/Manhole
Storm Drain - -- -- -- -- —
Shower Pan
Other-
Final
therFinal
PASS PART FAIL._ — -- —
MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers - — -------.-_.__ —
Ina
SS >ART FAIL --- -- ----- ---- -- ---
EL ICAL
Service __—_------ --------...-----------
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$ required before next inspection. Pay at Cily Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE C] Please call for reinspection RF -__ _ Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewaix Date Inspector ut
Other. --
Final DO NOT REMOVE this inspection record from the job sN.►-e.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
_ BUP
Received -__ _-_--. Date Requested_ AM---- PM -- -- _- BUP
Location Suite, / - -, MEC
Contact Person 1-1 A _ Ph( ) Yq Cl'-- PLM -- --
Contractor
-----__ ----- _� Ph(—) SWR
BUILDING Tenant/Owner -_- -_ ELC
Footing - -
Foundation ,Access: ELC -- -
Ftg Drain
Crawl Drain ELR --- -- -,_-__-- -----_ -
Slab Inspection Notes: FIT
ost&Beam
Shear Anchors
Ext Sheath/Shear -
Int Sheath/Shear --- -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: _
Final .—
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drain,
Catch Basin/Manhole
Storm Drain
Shower Pan
Otho --
PART FAIL ---
ECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers ---
Final
PASS PART FAIL -
ELECTRICAL _
Service -
Rough-In
UG/Slab ---- ----
Low Voltage
Fire Alarm — ---
Final
PASS PART FAIL Reinspection fee of$ —required before next inspection. Pay at City Hall, 13125 SW Ha!I Blvd.
_
SITE _ [� Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Do"
5 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
ELEVATION CERTIFICATION
PER SECTION 710.1 of the OSPSC (OREGON
TIGARD
3510.1 of the OTFDSC
THE UPSTREAM MANHOLE RIM APPEARS TO BE ABOVE SOME OR ALL
OF THE FIXTURE SPILL RIMS IN THIS STRUCTURE. INFORMATION IS
NEEDED ON THE ELEVATION DIFFERENCE FROM THE MANHOLE TO
THE LOWEST FLOOR CONTAINING PLUMBING FIXTURES TO
ESTABLISH THE NEED FOR A BACKWATER VALVE(S) AND TO
DETERMINE WHICH FIXTURES NEED TO BE PROTECTED FROM
BACKFLOW. OBTAIN AND SUBMIT WRITTEN DOCUMENTATION TO THE
CITY OF TIGARD BUILDING DEPARTMENT WITH THE FOLLOWING
INFORMATION:
LOT NUMBER Z�
SUBDIVISION_ e7rr,CK,,r ,,Ik i 1
2
'T4A 5 ir.11�A
ADDRESS
PERMIT#`_
A TRANSIT'SIIOT ON(DA'T'E) ? -Z I-Q Z HAS VERIFIED THAT THE FIRST
UPSTREAM MANHOLE SPILLRIM IS^35 �r'; Olt LOVER(CIRCLE
ONE)THAN THE LOWEST FINISH FLOOR ELEVATION.
`) �L� DATE 21 7?--
PLUMBER PLUMBER
DATE
JOB SlIPERINTENDANT
ABOVE INFORMATION ACCEPTED AND APPROVED BY:
INSPECToR__
13125 SW Hail Blvd„ Tigard, OR 97223(503)639-4171 TDD (503)684-2772
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
_
---------------
Received —_— Date Requested_ AM BUP
PM BP
Location _. 1 I e 3 /G 7 � ��l-? _ Suite _
-- -- ._ MEC
Contact Person -_-- -�l�-�C- -- Ph(----) - `� Cj /Cly PLM --
Contractor Ph (---) -_ SWR
BUILDING Tenant/Owner ELC
Footing - ---
Foundation ELC
Fig Drain Access:
Crawl Drain ELR
Slab Inspection Notes: SIT
- ---- -
Post& Beam _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear - -
Framing
Insulation
Drywall Nailing - -
Firewall
Fire Sprinkler - -
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final --
- � /
PASS PART FAIL
_
PLUMBING
Post& Beam - - - —-
Under Slab
Rough-In
-- -- -
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain —-- —
Shower Pan
Other: --
Final ----
PASS_PART FAIL
MECHANICAL
Post 8 Beam ----- - -- -
Rough-In
Gas Line
Smoke Dampers
Final ---
PASS PART FAIL ------- --
�LECTRICAL --- -_ ----�----- —~—
Service
Rough-In +
UG/Slab --_
Low Voltage
Fire Alarm -- - --- —___
n PART FAIL Reinspection fee of$- __ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Fire Supply Line Please call for reinspection RE:--_______ 0 Unable to inspect-no access
ADA �� / ✓
Approach/Sidewalk pate ;� Inspector.— _
Other: FM --- -
r
PASS PART FAIL DO NOT REMOVE this Inspectioll record from the fob site.
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